2型糖尿病患者水果和蔬菜摄入量与全死因及心脑血管死亡关系

Association of fruit and vegetable intake with all-cause and cardiocerebrovascular mortality among type 2 diabetes mellitus patients in Huaian city–a 9-year retrospective follow-up study

目的了解2型糖尿病(T2DM)患者水果和蔬菜摄入量与全死因死亡及心脑血管死亡的关系,为延长糖尿病患者的生存寿命提供参考依据。方法于2013年1月采用多阶段随机整群抽样方法在江苏省淮安市抽取纳入基本公共卫生服务慢性病患者健康管理的10086例T2DM患者进行标准化半定量食物频度问卷(FFQ)调查,随后于2021年12月与死因监测平台进行匹配,追踪截至2021年12月31日的死亡结局,最终纳入水果和蔬菜摄入量数据完整的4977例T2DM患者进行水果和蔬菜摄入量与全死因死亡及心脑血管死亡关系的单因素和多因素Cox比例风险回归模型分析。结果截至2021年12月31日,4977例T2DM患者中死亡617例,其中心脑血管死亡238例;水果和蔬菜总摄入量<200、200~249、250~349和≥350 g/d时,全死因死亡比例分别为14.37%、11.57%、11.29%和11.55%,心脑血管死亡比例分别为5.79%、5.04%、3.71%和4.05%;在调整了性别、年龄、文化程度、婚姻状况、家庭年均收入、吸烟情况、饮酒情况、糖尿病病程、体质指数、是否高血压、是否血脂异常、是否冠心病和是否脑卒中等混杂因素后,多因素Cox比例风险回归模型分析结果显示,总水果和蔬菜摄入量为250~349 g/d T2DM患者的心脑血管死亡风险为总水果和蔬菜摄入量<200 g/d T2DM患者的0.67倍(HR=0.67,95%CI=0.47~0.95)。结论适当摄入水果和蔬菜可以降低T2DM患者心脑血管死亡风险,对降低T2DM患者死亡风险具有一定意义。

Objective To investigate the relationship between fruit and vegetable intake and all-cause and cardiocerebrovascular mortality in patients with type 2 diabetes mellitus(T2DM)for providing evidence to improve the survival of the patients.Methods The participants of the study were 10086 T2DM patients recruited with multistage random cluster sampling from community chronic disease sufferers under the management of basic public health services in Huaian city,Jiangsu province.A baseline survey including questionnaire interview,physical examination and laboratory tests were conducted and fruit and vegetable intake during previous one year were estimated using a standardized semiquantitative Food Frequency Questionnaire among the participants during January 2013.All-cause and cardiocerebrovascular mortality up to December 31,2021 among the participants were identified using municipal vital registration information system.Univariate analysis and multivariate Cox proportional risk regression model were adopted to analyze the association of fruit and vegetable intake with all-cause and cardio-cerebrovascular mortality for the 4977 T2DM patients with complete data.Results During the 9-year period among the 4977 T2DM patients,totally 617 all-cause and 238 cardio-cerebrovascular deaths were observed;for the patients reporting the average daily fruit and vegetable intake of<200,200–249,250–349,and≥350 grams,the cumulative mortality of all-cause were 14.37%,11.57%,11.29%,and 11.55%and the cumulative cardio-cerebrovascular mortality were 5.79%,5.04%,3.71%,and 4.05%,respectively.After adjusting for gender,age,education,marital status,annual household income,smoking,alcohol consumption,duration of diabetes,body mass index,hypertension,dyslipidemia,coronary heart disease and stroke,the results of multivariate Cox proportional risk regression model showed that the patients with the average daily fruit and vegetable intake of 250–349 grams were at a decreased risk of cardio-cerebrovascular mortality(hazard risk=0.67,95%confidence interval:0.47–0.95)compared to those with the intake of<200 grams.Conclusion Appropriate intake of fruit and vegetable could reduce the risk of cardio-cerebrovascular mortality in community T2DM patients.