2015—2017年南平市体检人群膳食脂肪酸摄入与非酒精性脂肪肝关系的病例-对照研究

Case-control study of the relationship between dietary fatty acids intake and non-alcoholic fatty liver disease in Nanping City,2015-2017

目的探讨不同种类膳食脂肪酸摄入水平与非酒精性脂肪肝(NAFLD)发病风险的关系。方法对2015-2017年南平市第一医院体检人群中全部546名NAFLD新发病例和随机抽取的性别相同、年龄±5岁的546名对照人群进行频数匹配病例-对照研究。采用自制的结构式调查问卷及半定量食物频数问卷面对面调查研究对象的一般行为特征及膳食摄入情况。利用残差法对营养素摄入量进行能量校正,采用多因素非条件Logistic回归方法计算OR值及其95%CI。结果病例组的总脂肪酸(FAs)、总饱和脂肪酸(SFAs)、总单不饱和脂肪酸(MUFAs)、总多不饱和脂肪酸(PUFAs)、总n-3多不饱和脂肪酸(n-3 PUFAs)、总n-6多不饱和脂肪酸(n-6 PUFAs)、棕榈酸(C16∶0)、硬脂酸(C18∶0)、棕榈油酸(C16∶1)、油酸(C18∶1)、α-亚麻酸(C18∶3)、亚油酸(C18∶2)日均摄入量均高于对照组(P<0.05或P<0.01)。多因素Logistic回归分析日均摄入量显示,FAs≥98.96 g、MUFAs≥38.83 g、n-6 PUFAs≥26.23 g、C18∶1≥33.55 g、C18∶2≥24.91 g是NAFLD的危险因素,调整OR(95%CI)分别为2.26(1.49~3.44)、1.93(1.29~2.88)、5.13(3.40~7.76)、1.82(1.22~2.79)、5.24(3.40~7.76)。而花生四烯酸(C20∶4)、二十二碳六烯酸(C22∶6)日均摄入量在0.07~0.09 g和0.01~0.02 g可降低NAFLD的发病风险,调整的OR(95%CI)分别为0.58(0.39~0.85)和0.64(0.43~0.94)。结论 FAs、MUFAs、n-6 PUFAs、C18∶1、C18∶2日均摄入量≥98.96 g、≥38.83 g、≥26.23 g、≥33.55 g、≥24.91 g是NAFLD的危险因素,而C20∶4、C22∶6日均摄入量0.07~0.09 g、0.01~0.02 g可降低NAFLD的发病风险。

OBJECTIVE To explore the relationship between different kinds of dietary fatty acids intake and non-alcoholic fatty liver disease(NAFLD). METHODS A 1∶1 frequency matched case-control study was conducted among 546 NAFLD patients diagnosed by ultrasound as case group, 546 people without NAFLD randomly selected and matched by sex and age(±5) as control group from April 2015 to August 2017 in Nanping first hospital. The data was obtained from participants using structured questionnaires during face-to-face interviews.Information on dietary intake was collected using semi-quantitative food frequency questionnaires. Residual method was used to derive energy-adjusted variable, unconditional Logistic regression was used to estimate odds ratios(OR) and their 95% CI. RESULTS The NAFLD group consumed a significantly higher amount of fatty acid(FAs),saturated fatty acid(SFAs),mono-unsaturatedfattyacids(MUFAs),poly-unsaturated fatty acids(PUFAs),n-3 PUFAs,n-6 PUFAs, C16∶0,C18∶0,C16∶1,C18∶1,C18∶3 and C18∶2. Multivariate unconditional Logistic regression analysis indicated that daily intake of total fatty acids, MUFAs, n-6 PUFAs, C18∶1, C18∶2 more than 98.96 g/d, 38.83 g/d, 26.23 g/d, 33.55 g/d and 24.91 g/d respectively, were the risk factors for NAFLD. The adjusted ORs and 95% CI were 2.26(1.49-3.44),1.93(1.29-2.88),5.13(3.40-7.76),1.82(1.22-2.79) and 5.24(3.40-7.76). Daily intake of C20∶4, C22∶6 in 0.07-0.09 g/d, 0.01-0.02 g/d were the protective factors for NAFLD. The adjusted ORs and 95% CI were 0.58(0.39-0.85) and 0.64(0.43-0.94). CONCLUSION Daily intake of total fatty acids, MUFAs, n-6 PUFAs, C18∶1, C18∶2 more than 98.96, 38.83, 26.23, 33.55 and 24.91 g/d respectively, were the risk factors for NAFLD. Daily intake of C20∶4, C22∶6 in 0.07-0.09 g/d, 0.01-0.02 g/d respectively, were the protective factors for NAFLD.