成都地区人群中维生素D水平与代谢综合征发病关系的前瞻性队列研究

Relationship between vitamin D level and the incidence of metabolic syndrome in adults in Chengdu city: a prospective cohort study

目的了解成都地区人群中25羟维生素D(25-hydroxyvitamin D,25OHD)与代谢综合征(metabolic syndrome,MS)发病风险的关系。方法采用随机整群抽样的方法,随机抽取四川省成都市龙泉驿区一个社区和两个乡镇共474名调查对象。采用问卷调查的方式收集其人口学、个人史和家族史等相关资料。采用Logistic回归分析25OHD基线水平与MS发病风险的关系,并通过多元线性回归分析基线25OHD水平与胰岛素抵抗的变化关系。结果共纳入474名研究对象,新发MS 39例,发病密度为20.8/1 000人年。采用多种回归模型,逐步调整年龄、个人史、心脑血管疾病和代谢性疾病家族史、代谢综合征各组分基线水平后,与上四分位数组相比,女性受试者下四分位数组的25OHD水平与代谢综合征发病有相关性[OR=4.29,95%CI(1.05,29.50),P=0.044]。多元线性回归分析显示:女性或男性受试者基线25OHD水平均与随访期间HOMA-IR的增加呈负相关(P<0.05);而女性受试者基线25OHD水平与随访期间ISIcomp的降低呈正相关(P<0.05)。结论成都地区人群中低维生素D水平可能增加胰岛素抵抗,而女性的低维生素D水平可能增加代谢综合征的发病风险。

Objective To explore the association between level of 25-hydroxyvitamin D （25OHD） and risk of the onset of metabolic syndrome （MS） in people in Chengdu. Methods In total, 474 participants were selected randomly by cluster sampling from one urban district and two rural villages in Longquanyi district of Chengdu. The data of sociodemographic information, lifestyle and family history were collected by questionnaires. Binary logistic regression was performed to assess the relationship between baseline 25OHD level and incident of MS, while multiple linear regression was conducted to analyze the relationship between baseline 25OHD level and insulin resistance. Results Four hundred seventy-four people were enrolled in the cohort study, 39 of them developed MS, with the incidences of 20.8 events per 1 000 person years. Among women, low 25OHD status was significantly associated with the risk of developing MS （OR=4.29, 95%CI 1,05 to 29.50, P=0.044） after adjustment for multiple potential confounders. In a multiple linear regression analysis, low 25OHD level of baseline was independently associated with the increased HOMA-IR over a 4-year period among Chengdu individuals （P〈0.05） and was independently related to the decreased ISIcomp over a 4-year period in female （P〈0.05）. Conclusion The current prospective study suggests that low 25OHD level may contribute to increase insulin resistance in Chengdu population. Furthermore, low 25OHD level may increase the risk of MS among women in Chengdu.