中青年原发性高血压患者饮食结构与代谢综合征相关性研究

Relation between dietary pattern and metabolic syndrome in young and middle-aged essential hypertension patients

目的探讨饮食结构对中青年原发性高血压患者代谢综合征(MS)患病率的影响。方法连续入选2017年1月至2019年3月首都医科大学宣武医院收治的未经治疗的中青年原发性高血压患者304例,应用调查问卷形式了解患者的饮食结构,测量患者的身高、体质量、腰围,并收集临床和实验室检查资料。根据饮食结构将入选患者分为3组,素食组植物性食物(蔬菜、水果和碳水化合物)占饮食结构的70%及以上,共62例;肉食组动物性食物占饮食结构的70%及以上,共98例;平衡组植物性食物(蔬菜、水果和碳水化合物)及动物性食物在饮食结构中各占50%,共144例。比较3组的临床和生化指标,分析饮食结构与MS患病率及其各组分的相关性。结果素食组、平衡组、肉食组患者的男性比例、体重指数、腰围、血清肌酐、MS患病率均呈逐渐升高趋势,而HDL-C水平呈逐渐降低趋势(均P <0. 05)。与素食组比较,肉食组患者的年龄明显降低[(47±8)岁比(50±8)岁],收缩压、脉压、丙氨酸转氨酶、血清尿酸和三酰甘油水平均明显增高[(156±20) mm Hg(1 mm Hg=0. 133 k Pa)比(146±20) mm Hg、(57±15) mm Hg比(50±15) mm Hg、(36±22) IU/L比(24±16) IU/L、(338±89)μmol/L比(269±81)μmol/L、(3. 2±2. 7) mmol/L比(2. 3±2. 0) mmol/L](均P <0. 05);而素食组和平衡组上述指标差异均无统计学意义(均P> 0. 05)。Spearman相关性分析显示,饮食结构中动物性食物比例的升高与收缩压、腰围、体重指数、三酰甘油、MS患病率呈正相关(r=0. 263、0. 460、0. 406、0. 213、0. 328,P=0. 001、<0. 001、<0. 001、0. 007、<0. 001),与HDL-C呈负相关(r=-0. 421,P <0. 001)。结论饮食结构与中青年原发性高血压患者MS的患病率及各组分显著相关。随着饮食结构中动物性食物比例升高,患者的血压水平和超重与腹型肥胖、血脂异常比例均显著增加。

Objective To investigate the impact of dietary pattern on metabolic syndrome( MS) in young and middle-aged essential hypertension patients. Methods Totally 304 untreated young and middle-aged patients with essential hypertension admitted to Xuanwu Hospital,Capital Medical University from January 2017 to March2019 were enrolled. Dietary patterns of patients were collected by questionnaire and they were divided into3 groups: vegetarian group( 62 cases),with vegetables,fruits and carbohydrates accounting for 70% or more of daily diet;meat group( 98 cases),with meat and animal food accounting for 70% or more of daily dietary;balance group( 144 cases),with vegetable food and meat accounting for 50% respectively. Height,weight and waist circumference were measured. Clinical data and laboratory biochemical indicators were recorded. The correlation between dietary pattern and MS components was analyzed. Results Male ratio,body mass index,waist circumference,serum creatinine level,MS prevalence increased and high density lipoprotein cholesterol decreased among the vegetarian group,balance group and meat group( all P < 0. 05). Compared with the vegetarian group,age in the meat group was significantly younger [( 47 ± 8) years vs( 50 ± 8) years],systolic blood pressure,pulse pressure,alanine aminotransferase,serum uric acid and triglyceride levels were significantly higher [( 156 ±20) mm Hg vs( 146 ± 20) mm Hg,( 57 ± 15) mm Hg vs( 50 ± 15) mm Hg,( 36 ± 22) IU/L vs( 24 ± 16) IU/L,( 338 ± 89) μmol/L vs( 269 ± 81) μmol/L,( 3. 2 ± 2. 7) mmol/L vs( 2. 3 ± 2. 0) mmol/L]( all P < 0. 05),but there were no statistical differences between the vegetarian group and balance group( all P > 0. 05). Spearman analysis showed that the proportion of animal food in diet was positively correlated with systolic blood pressure,waist circumference,body mass index,serum triacylglycerol level and the prevalence rate of MS( r = 0. 263,0. 460,0. 406,0. 213,0. 328;P = 0. 001, < 0. 001, < 0. 001,0. 007, < 0. 001);it was negatively correlated with HDL-C( r =-0. 421,P < 0. 001). Conclusions MS in young and middle-aged essential hypertension patients is associated with dietary pattern. Blood pressure,overweight,abdominal obesity and dyslipidemia significantly increase with animal food proportion in daily diet.