膳食炎症指数与超重和肥胖及腹型肥胖关系的Meta分析

The Correlation of Dietary Inflammatory Index with Overweight,Obesity and Abdominal Obesity:a Meta-analysis

背景膳食炎症指数(DII)作为定量评价膳食炎症潜力的新指标,已广泛应用于各种慢性病研究中,但DII与不同类型肥胖之间的相关性尚无统一定论。目的系统评价DII与超重、肥胖及腹型肥胖的相关性,为不同类型肥胖的预防提供参考。方法计算机检索中国知网、万方数据知识服务平台、维普网、中国生物医学文献数据库、PubMed、Embase、Cochrane Library、Web of Science数据库中DII与超重、肥胖及腹型肥胖相关性的横断面研究,检索时限均从建库至2023-01-10;运用美国卫生保健质量及研究机构(AHRQ)的偏倚风险评价表对纳入研究进行评价;运用RevMan 5.4.1进行Meta分析,计算汇总数据的OR值及其95%CI评估DII与超重、肥胖及腹型肥胖的相关性;根据性别、研究地域、调查方式、DII成分数量、样本人群是否健康、诊断标准、DII分组类型的差异进行亚组分析。结果本研究共纳入9个国家的20项研究,共214808例研究对象。Meta分析结果显示,高水平的DII可能是超重[OR=1.12,95%CI(1.03,1.22),P=0.005]、肥胖[OR=1.56,95%CI(1.34,1.82),P<0.00001]及腹型肥胖[OR=1.42,95%CI(1.14,1.78),P=0.002]的危险因素。针对原始研究的性别、研究地域、调查方式、DII成分数量、样本人群是否健康、诊断标准、DII分组类型的差异进行亚组分析,DII与超重相关性的各亚组内未发现组间异质性存在(P>0.05);DII与肥胖相关性的各亚组中,男性人群[OR=1.79,95%CI(1.13,2.85)]相较于其他性别人群肥胖所占比例更高;北美洲人群[OR=1.57,95%CI(1.27,1.83)]相较于其他地域的人群肥胖所占比例更高,24 h回忆的结果[OR=1.83,95%CI(1.39,2.42)]相较于其他调查方式的研究结果中肥胖所占比例更高;DII与腹型肥胖相关性的各亚组中,北美洲人群[OR=1.87,95%CI(1.44,2.44)]相较于其他地域的人群腹型肥胖所占比例更高,其他组间未发现明显异质性存在。本研究漏斗图分布具有良好的对称性,提示无明显发表偏倚。结论高DII膳食可能为超重、肥胖及腹型肥胖的危险因素,该影响在北美洲人群中更为显著;高DII膳食与肥胖的相关性在男性中更为显著;增加抗炎膳食成分摄入对于超重、肥胖及腹型肥胖的防治具有重要意义。

Background Dietary inflammatory index(DII),as a new index for quantitative evaluation of dietary inflammatory potential,has been widely used in various chronic disease studies,but the correlation between DII and different types of obesity has not been uniformly established.Objective To systematically evaluate the correlation of DII with overweight,obesity and abdominal obesity to provide reference for the prevention of different types of obesity.Methods CNKI,Wanfang Data,VIP,CBM,PubMed,Embase,Cochrane Library and Web of Science were searched by computer for cross-sectional studies of the association of DII with overweight,obesity and abdominal obesity from inception to January 10,2023.Risk of Bias Rating Scale of AHRQ was used to evaluate the included studies.Meta-analysis was performed using RevMan 5.4.1 to calculate OR and 95%CI of the pooled data to assess the association of DII with overweight,obesity and abdominal obesity.Subgroup analyses were performed based on differences in gender,study geography,survey method,number of DII components,whether the sample population was healthy,diagnostic criteria,and type of DII grouping.Results A total of 20 studies from 9 countries with 214808 subjects were included.Meta-analysis results showed that high levels of DII may be a possible risk factor for overweight〔OR=1.12,95%CI(1.03,1.22),P=0.005〕,obesity〔OR=1.56,95%CI(1.34,1.82),P<0.00001〕,abdominal obesity〔OR=1.42,95%CI(1.14,1.78),P=0.002〕.Subgroup analysis for differences in gender,study geography,survey method,number of DII components,whether the sample population was healthy,diagnostic criteria,and type of DII grouping in the original studies showed no significant between-group heterogeneity within each subgroup for the correlation between DII and overweight(P>0.05).Among the subgroups for the correlation between DII and obesity,the male population〔OR=1.79,95%CI(1.13,2.85)〕had a higher proportion of obesity than the other gender groups,the North American population〔OR=1.57,95%CI(1.27,1.83)〕had a higher proportion of obesity compared to populations from other geographic regions,and the results of the 24-h recall〔OR=1.83,95%CI(1.39,2.42)〕had a higher proportion of obesity compared to studies with other survey methods.Among the subgroups for the correlation between DII and abdominal obesity,the North American population〔OR=1.87,95%CI(1.44,2.44)〕had a higher proportion of abdominal obesity compared to populations from other geographic regions,and no significant heterogeneity was found among other groups.The funnel plot distribution in this study had good symmetry,suggesting no significant publication bias.Conclusion DII diets may be a risk factor for overweight,obesity and abdominal obesity,and the association is more obvious in North American populations.The association between a high DII diet and obesity was more significant in men.Increasing the intake of anti-inflammatory dietary components is important for the prevention and treatment of overweight,obesity and abdominal obesity.