中小学生膳食模式与视力不良相关性研究

The Association Between Dietary Patterns and Poor Vision in Primary and Middle School Students

目的:调查膳食模式与中小学生视力不良的相关性,探索视力不良特异膳食模式及其关键膳食构成因子。方法:采用多阶段随机整群抽样方法,于2019年9—10月选取湖北省城乡不同地区23所中小学5541名学生进行身高、体重和视力检测。采用简化的食物频率调查问卷调查学生过去1年膳食摄入情况,共调查11类食物的摄入频率及消费量。采用主成分分析(PCA)和降秩回归(RRR)两种方法建立膳食模式,并运用多因素Logistic回归模型分析膳食模式与视力不良的相关性。结果:PCA方法得到5种膳食模式(PCA模式)—零食模式、杂粮模式、肉类模式、传统模式、素食模式,膳食摄入变异累积贡献率为40.0%;RRR方法提取1种膳食模式(RRR模式)—高摄入红薯、豆腐、胡萝卜、菠菜、虾/蟹、软体动物类等,膳食摄入变异累积贡献率为3.6%。在调整相关混杂因素后,肉类模式得分越高,视力不良的发生风险越高(OR值:1.32,95%CI:1.07~1.62);RRR模式得分越高,视力不良的发生风险越低(OR值:0.70,95%CI:0.57~0.87);零食模式、杂粮模式、传统模式和素食模式得分与视力不良的发生风险无显著性相关。结论:摄入较多的猪肉、牛肉、油炸食品及含糖饮料等,摄入较少的红薯、豆腐、胡萝卜、菠菜、虾/蟹、软体动物类等可能是中小学生罹患视力不良的危险因素。相比PCA方法,RRR方法提取的膳食模式更有行为意义,联合采用PCA和RRR方法有利于研究膳食模式与中小学生视力不良相关性。

Objective To analyze the association between dietary patterns and poor vision using principal component analysis(PCA)and reduced rank regression(RRR).Method According to the multistage stratified cluster sampling,5541 students from 23 primary and middle schools were selected from urban and rural areas of Hubei province.Weight,height and naked vision were measured by trained surveyors using standard measurement techniques.This study measured diet over the past year with a simplified food frequency questionnaire,and a total of 11 kinds of food intake frequency and consumption were investigated.Dietary patterns were derived by PCA and RRR method.Meanwhile,the association between dietary pattern scores and outcomes were calculated using multiple linear regression and logistic regression.Result Totally 5 types of dietary patterns including snack pattern,grains pattern,meat pattern,traditional pattern and vegetarian pattern were extracted by PCA(PCA pattern)and the cumulative contribution rate was 40.0%.Merely one type of dietary patterns were extracted by RRR(RRR pattern)and the cumulative contribution rate was 3.6%.The RRR pattern was characterized by higher consumption of sweet potatoes,tofu,carrots,spinach,shrimp/crab,molluscs,etc.After adjusting related confounders,a higher meat pattern score was associated with a higher risk of poor vision,while a higher RRR pattern score was associated with a lower risk of poor vision.Snack pattern,grains pattern,traditional pattern and vegetarian pattern were not related with poor vision.Conclusion A higher intake of pork,beef,fried foods and sugary drinks,lower intake of sweet potatoes,tofu,carrots,spinach,shrimp/crab and molluscs may be the risk factors of poor vision in elementary and middle school students.By comparing the dietary pattern structures of RRR and PCA,we found that the RRR pattern was also behaviorally meaningful.