每日膳食中反式脂肪酸摄入量与中年女性双相情感障碍的关系

The Relationship between Daily Trans Fatty Acid Intake and Bipolar Disorder in Middle-aged Women

目的:研究每日膳食中反式脂肪酸摄入量与中年女性双相情感障碍的关系。方法:2363例美国妇女健康研究(SWAN)中年女性资料,依据《精神疾病诊断与统计手册》第五版(DSM-5)标准,将纳入研究对象分为双相情感障碍组(n=393)和非双相情感障碍组(对照组,n=1970)。采用1995年版饮食频率调查问卷估算纳入人群每日膳食中反式脂肪酸摄入情况,比较两组年龄、家庭总收入、种族/国家、血压、血脂、反式脂肪酸摄入量等差异,Logistic回归分析膳食反式脂肪酸与双向情感障碍之间的关系,限制性三次样条分析两者的非线性关系。结果:与对照组比较,双相情感障碍组患者有更高的脉搏、体重指数(BMI)和更低的高密度脂蛋白胆固醇(HDL-C),差异均具有统计学意义(P<0.05或P<0.01)。此外,双相情感障碍组每日膳食反式脂肪酸摄入量高于对照组,差异具有统计学意义(P<0.01)。膳食中反式脂肪酸摄入量与双相情感障碍呈正相关关系,OR及其95%CI置信区间为1.063(1.041-1.084),以膳食中反式脂肪酸摄入量<3.14g/天为参照,反式脂肪酸摄入量为5.05-7.93g/天和≥7.93g/天者双相情感障碍风险显著增高,OR及其95%CI分别1.729(1.249-2.392)和2.412(1.763-3.301),且这种正相关关系在调整了年龄后仍然存在。在充分调整潜在混在因素年龄、种族/国家、家庭总收入、脉搏、BMI后,反式脂肪酸摄入量为5.05-7.93g/天和≥7.93g/天者双相情感障碍风险依然高于<3.14g/天者,OR及其95%CI分别1.561(1.122-2.170)和2.183(1.581-3.013)。随着膳食反式脂肪酸摄入量的增高,双相情感障碍风险先缓慢增长,在每日摄入量为4g左右时快速增长,摄入量超过10g后再次进入缓慢增长期,整体呈“S”形曲线。结论:膳食反式脂肪酸摄入量与双相情感障碍之间存在正相关关系,但本研究尚不能断定膳食反式脂肪酸摄入量与双相情感障碍的因果关系。

Objective:To study the relationship between dietary trans fatty acid intake and bipolar disorder in middle-aged women.Method:The 2363 datas were from study of women's health across the nation(SWAN).According to the standards of the diagnostic and statistical manual of mental disorders,fifth edition(DSM-5),they were divided into bipolar disorder group(n=393)and the non-bipolar disorder group(control group,n=1970).The 1995 version of the diet frequency questionnaire to estimate the daily dietary intake of trans fatty acids in the included population,and the two groups'age,total family income,race/country,and blood pressure,blood lipids,trans fatty acid intake were compared.Logistic regression was used to analysis the relationship between dietary trans fatty acids and bipolar affective disorder.The non-linear relationship between them was analyzed by restricted cubic spline.Results:Compared with the control group,patients with bipolar disorder had higher pulse,BMI and lower HDL-C(P<0.05 or P<0.01).The daily intake of trans fatty acids in bipolar disorder group was higher than that in control group,and the difference was statistically significant(P<0.01).Dietary trans fatty acid intake was positively correlated with bipolar disorder.OR and its 95%CI confidence interval were 1.063(1.041-1.084).With dietary trans fatty acid intake<3.14g/day,the risk of bipolar disorder was significantly increased in 5.05-7.93g/day and>7.93g/day OR and 95%CI were 1.729(1.249-2.392)and 2.412(1.763-3.301)respectively.This positive correlation still exised after adjusting for age.The risk of bipolar disorder in group which with dietary trans fatty acid intake 5.05-7.93g/day and>7.93g/day was still higher than that in<3.14g/day after adjusting the potential confounding factors such as age,race,total family income,pulse and BMI,OR and 95%CI were 1.561(1.122-2.170)and 2.183(1.581-3.013),respectively.With the increase of dietary trans fatty acid intake,the risk of bipolar disorder increased slowly at first,and increased rapidly at about 4g daily intake.After the intake exceeded 10g,it entered a slow growth period again,showing a"S"curve as a whole.Conclusion:There is a positive correlation between dietary trans fatty acid intake and bipolar affective disorder,however,the causal relationship between dietary trans fatty acid intake and bipolar affective disorder cannot be determined.