老年人膳食多样化与高同型半胱氨酸血症的关系

Relationship between dietary diversity and hyperhomocysteinemia in the elderly

目的探讨膳食多样化对高同型半胱氨酸血症(HHcy)病人的影响,为指导老年人防治HHcy提供膳食干预依据。方法以"北京市老龄化多维纵向研究"2009年的调查人群为研究对象,进行膳食调查,并检测总同型半胱氨酸(t Hcy)。根据食物对t Hcy代谢的不同影响,将日常膳食分为富含维生素(Vit)B12/叶酸/甜菜碱饮食、Vit饮食B6、抗氧化剂饮食三类,分别计算三类膳食的膳食多样化评分(DDS),将t Hcy>15μmol/L定义为HHcy,采用Logistic回归分析三类膳食DDS分值与患HHcy的关系。结果 1458人中有902人血清t Hcy升高,HHcy的患病率为61.9%。HHcy的患病风险与富含Vit B12/叶酸/甜菜碱类膳食DDS分值呈剂量-反应关系,与≤1分组相比,2分组、3分组、4分组老年人HHcy患病风险分别降低了44%(OR=0.56,95%CI:0.37~0.86,P=0.008)、51%(OR=0.49,95%CI:0.33~0.74,P=0.001)和67%(OR=0.33,95%CI:0.22~0.50,P<0.001),控制各项混杂因素后,依然保持这一趋势。同时发现增加富含Vit B6膳食的摄入,是HHcy的保护因素,控制各项混杂因素后,2分组、3分组老年人患病风险比0分组分别降低了37%和53%(OR=0.63,95%CI:0.44~0.89,P=0.009;OR=0.47,95%CI:0.30~0.73,P=0.001)。未发现多样化摄入富含抗氧化剂食物与患HHcy相关。结论老年人多样化摄入富含Vit B12/叶酸/甜菜碱膳食及Vit B6膳食均可明显降低HHcy患病风险。

Objective To explore the relationship between dietary diversity and hyperhomocysteinemia（ HHcy） in the elderly,and to provide evidence for dietary intervention for the prevention and treatment of HHcy. Methods Participants came from the cohort of Beijing Longitudinal Study of Aging in 2009,who completed a survey about the intake of the foodhabits. Meanwhile the blood sample was collected for the detection of total homocysteine（ t Hcy）. The commonly foods intake were divided into three categories based on the mechanism of Hcy,rich in vitamin（ Vit） B12/folic acid/betaine,rich in Vit B6,or rich in antioxidant. The dietary diversity score（ DDS） was calculated. HHcy was defined as Hcy〉15 μmol/L.Logistic regression analyze was used to analyze the relationship between DDS and HHcy. Results Among 1458 subjects,902 elderly people showed high level of t Hcy,and the prevalence of HHcy was 61. 9%.The risk of HHcy was significantly increased with the decrease of DDS of food rich in Vit B12/folic acid/betaine. The risk of HHcy decreased by 44%（ OR = 0. 56,95% CI： 0. 37-0. 86,P = 0. 008） in group with a DDS = 2,by 51%（ OR = 0. 49,95% CI： 0. 33-0. 74,P = 0. 001） in group with a DDS = 3 and by 67%（ OR = 0. 33,95% CI： 0. 22-0. 50,P〈0. 001） in group with a DDS = 4 compared with that in group with a DDS≤1. After adjusting for potential confounders,the risk was still significantly decreased. And with the increase of DDS of food rich in Vit B6,the risk of HHcy was significantly decreased. Compared with group with a DDS = 0,the risk of HHcy decreased by 37%（ OR =0. 63,95%CI： 0. 44-0. 89,P = 0. 009） in group with a DDS = 2,and by 53%（ OR = 0. 47,95% CI： 0. 30-0. 73,P = 0. 001） in group with a DDS = 3. There was no significant relationship between the risk of HHcy and DDS and food rich in antioxidant. Conclusions The dietary diversity of elderly people can affect the incidence of HHcy,and diversification of VitB12/betaine/folic acid and VitB6 diet can significantly reduce the risk of HHcy.