2005-2018年我国七大区域居民全谷物摄入不足对2型糖尿病死亡归因风险趋势研究

Risk for type 2 diabetes mellitus death attributed to insufficient whole grain intake in seven regions of China,2005-2018

目的估计我国七大区域2005-2018年全谷物摄入水平及摄入不足导致2型糖尿病(T2DM)死亡归因风险及变化趋势。方法利用中国居民营养与健康状况监测、中国成人慢性病与营养监测数据,采用普通克里金插值结合局部加权回归法,估计2005-2018年我国居民全谷物摄入水平;采用2017全球疾病负担研究结果以及中国死因监测数据,计算我国不同区域不同性别≥20岁人群全谷物摄入不足对T2DM死亡的人群归因分值(PAF)、归因死亡人数和归因死亡率,并利用2010年中国人口普查数据进行标化,比较我国七大区域归因于全谷物摄入不足的T2DM死亡变化。结果2002、2010和2015年我国≥20岁人群全谷物摄入水平依次为19.0、14.3和19.8 g/d。2018年估计的我国居民全谷物摄入水平为20.1 g/d,其中男性为19.4 g/d,女性为20.8 g/d,七大区域中,华北地区最高(47.4 g/d),西南地区最低(6.0 g/d)。2018年我国华北地区T2DM的PAF最低,西南地区最高,分别为12.8%和19.3%。2005-2018年七大区域PAF变化不同,东北地区PAF在18.5%左右波动;其他地区均呈现下降趋势,华北和西北地区呈现明显的下降趋势,分别下降26.4%和21.2%。14年间,七大区域T2DM归因死亡人数均呈现上升趋势,华南地区年平均增长率最高(6.7%),华北地区最低(2.4%)。2018年,我国居民全谷物摄入不足的T2DM标化归因死亡率为3.13/10万,其中,男性为3.21/10万,女性为3.05/10万;西南地区标化归因死亡率最高(3.97/10万),华北地区标化归因死亡率最低(1.78/10万)。2005-2018年我国男性T2DM标化归因死亡率上升了11.5%,女性下降了8.1%;西南、华南和华中地区依次上升23.7%、21.3%和4.2%,华北、西北、华东和东北地区依次下降20.9%、11.0%、4.5%和3.9%。结论我国居民全谷物摄入水平较低,七大区域均应提高居民全谷物的摄入,尤其是西南地区,男性较女性更应增加全谷物摄入,以减少T2DM患者死亡风险。

Objective To estimate the risk for type 2 diabetes mellitus(T2DM)death attributed to insufficient whole grain intake in seven regions of China from 2005 to 2018.Methods Based on China National Nutrition and Health Surveys and China Adult Chronic Disease and Nutrition Surveillance,ordinary Kriging method and locally weighted regression were used to estimate the level of whole grain intake of Chinese residents from 2005 to 2018.Based on the results of the Global Burden of Diseases,Injuries,and Risk Factors Study(GBD)2019 and Chronic Diseases Risk Factors Surveillance in China,we calculated the population attributable fraction(PAF),attributable death number and attributable mortality rate of T2DM due to insufficient whole grain intake in people aged≥20 years in different regions of China,and we used the 2010 Chinese census data to compare the changes in T2DM deaths attributed to insufficient intake of whole grains in seven regions of China.Results The whole grain intake levels of Chinese people over 20 years old in 2002,2010 and 2015 were 19.0 g/d,14.3 g/d and 19.8 g/d,respectively.The estimated overall whole grain intake level was 20.1 g/d in Chinese residents in 2018,and the intake level was 19.4 g/d in men and 20.8 g/d in women.Among the seven regions,the intake level was highest in northern China(47.4 g/d)and lowest in southwestern China(6.0 g/d).In 2018,the PAF was lowest in northern China(12.8%)and highest in southwestern China(19.3%).From 2005 to 2018,the PAF varied in the seven regions,and the PAF in northeastern China fluctuated around 18.5%.Other regions showed downward trends,especially in northern China and northwestern China,decreased by 26.4%and 21.2%,respectively.Over the past 14 years,the number of attributable deaths in the seven regions showed upward trends,with the highest annual average growth rate of 6.7%in southern China and the lowest annual average growth rate of 2.4%in northern China.In 2018,the standardized T2DM mortality rate attributed to insufficient whole grain intake in China was 3.13/100000,and the attributable mortality was 3.21/100000 in men and 3.05/100000 in women.The standardized attributable mortality rate was highest in southwestern China(3.97/100000)and lowest in northern China(1.78/100000).From 2005 to 2018,the standardized attributable mortality rate increased by 11.5%in men and decreased by 8.1%in women.The standardized attributable mortality rate in southwestern,southern and central China increased by 23.7%,21.3%and 4.2%,respectively.The standardized attributable mortality rate in northern,northwestern,eastern and northeastern China decreased by 20.9%,11.0%,4.5%and 3.9%,respectively.Conclusion The whole grain intake level of Chinese residents was low,and the whole grain intake of residents in all seven regions should be increased,especially in the southwest,and men should have more whole grain intake than women to reduce the death risk in patients with T2DM.