从全球疾病负担看中国DRIs:挑战、证据与思考

Chinese DRIs in Perspective of Global Disease Burden:Challenges, Evidence and Thinking

目的系统分析目前我国膳食营养素参考摄入量(dietary reference intakes,DRIs)制定的现况及我国与全球DRIs制定的异同,为规范我国DRIs的制定提供合理的参考建议。方法计算机检索PubMed、ISI Web of Knowledge、he Cochrane Library、CBM、WanFang Data、CNKI、VIP等数据库,检索时限均为建库至2013年5月31日。按照纳入与排除标准选择文献和提取数据,采用描述性分析方法系统评价文献的基本信息、不同营养素DRIs的制定及不同年龄段的分布情况。结果初检获得文献588篇,最终纳入42篇,包括14篇指南、12篇系统评价及16篇原始研究文献。结果显示,WHO指南及全球系统评价研究主要关注的营养素是铁及脂溶性维生素(维生素A、D);我国除关注铁及维生素A外,还关注蛋白质、钙、锌、硒。纳入指南关注的人群主要是3～18岁及孕妇,而系统评价除关注此两类人群外,还关注>18岁的成年人。我国对各类人群均有研究,但主要关注18～45岁成年人和6～12岁学龄儿童。纳入的16个原始研究中,4个关注男性,2个关注女性。结论我国DRIs的制定及研究目前尚处于急需更新补充的状态。作为最大的发展中国家,我国的疾病负担、消费水平、膳食模式、膳食营养素的提供内容及保障水平均有别于发达国家和其他发展中国家。制定我国DRIs时宜在循证评价全球现有DRIs的基础上,借鉴当前可得的最佳DRIs标准、方法和证据,并结合我国实际国情、疾病负担及专家意见,循证制定既能满足我国人民健康需要又适合我国国情的DRIs。

Objective To systematically review current status of Chinese DRIs, and compare the similarities and differences between Chinese and global DRIs, so as to provide references for regulating Chinese DRIs. Methods Such database as PubMed, ISI Web of knowledge, The Cochrane Library, CBM, WanFang Data, CNKI and VIP were electronically searched from inception to May 31st, 2013. The reviewers independently screened studies according to inclusion and exclusion criteria, extracted data. Then, descriptive analysis was performed for basic information of literature, formulation of different DRIs, and DRIs distribution by different ages. Results Initially, a total of 588 articles were retrieved, 42 of which were finally included, involving 14 guidelines, 12 systematic reviews （SRs）, and 16 original studies. The results showed that, WHO guidelines and global systematic reviews focused on iron and fat-soluble vitamins （A and D）; the original studies in China focused not only on iron and vitamin A but also on protein, calcium, zinc, and selenium. The included guidelines focused mainly on population aged 3-18 years old and pregnant women; and except for those two kinds of population, SRs also paid attention to adults aged more than 18 years. The original studies of Chinese DRIs were concerned about all kinds of population, mainly focused adults aged 18-45 years and school children aged 6-12 years. Among 16 included original studies, 4 were concerned about men and 2 about women. Conclusion Chinese DRIs need urgent updates and supplement. As the largest developing country, China has different disease burdens, consumption levels, dietary patterns, nutrients’ content, and security levels, compared with developed countries and other developing countries. To develop evidence-based Chinese DRIs that are suitable for native health and Chinese local conditions, we should drawing lessons from the currently available best DRIs standards, methods and evidence based on Chinese actual conditions, disease burden, and expert opinion.