1990—2019年中国居民归因于膳食因素的心血管疾病负担趋势分析

The trend of the cardiovascular disease burden attributable to dietary factors among Chinese residents from 1990 to 2019

目的了解1990—2019年中国居民归因于各膳食因素的心血管疾病负担变化趋势,为心血管疾病膳食预防策略的制定提供科学依据。方法采用全球疾病负担研究2019(GBD2019)中1990—2019年中国和全球各社会人口指数(SDI)地区的心血管疾病负担数据,采用Excel 2010描述心血管疾病整体和归因于各膳食因素的伤残调整寿命年(DALY)、疾病所致伤残引起的健康寿命损失年(YLD)、早死所致的寿命损失年(YLL)的粗率和标化率及人群归因分数(PAF)。采用Joinpoint Regression Program 4.7.0.0软件进行时间趋势分析,计算平均年度变化百分比(AAPC)。结果2019年中国心血管疾病DALY粗率、归因于膳食因素的DALY粗率和PAF分别为6463.47/10万、2745.21/10万和42.46%。1990—2019年中国归因于膳食因素的心血管疾病标化DALY率、标化YLL率和标化YLD率呈下降趋势(AAPC值分别为-1.45%、-1.57%和-0.02%,P<0.05),标化DALY和标化YLL率的下降速度居于中SDI地区和中高SDI地区之间,YLD标化率的下降速度低于各SDI地区。与1990年相比,2019年中国归因于高钠饮食的心血管疾病负担在各膳食因素中仍居于首位,归因于低全谷物摄入、高红肉摄入、低豆类摄入、高反式脂肪酸摄入和高加工肉摄入的心血管疾病负担排序上升。1990—2019年中国归因于高加工肉摄入的心血管疾病标化DALY率、标化YLL率和标化YLD率上升趋势显著(AAPC分别为1.46%、1.44%和1.72%,P<0.01)。结论中国心血管疾病健康膳食防控策略取得了一定效果,疾病负担和变化水平与全球中高SDI地区相近,但归因于膳食因素的心血管疾病伤残负担仍需加强防控。除减少膳食盐摄入外,还应强调增加全谷物和豆类摄入,减少红肉和加工肉类摄入。

Objective To understand the trend of the cardiovascular disease burden attributable to dietary factors of Chinese residents from 1990 to 2019,and provide the scientific basis for developing the prevention measures on diet prevention strategy for cardiovascular disease.Methods The data of the cardiovascular disease burden in China and other regions of different sociodemographic index(SDI)from 1990 to 2019 in the Clobal Burden of Disease Study 2019(CBD 2019)were used.Excel 2010 was used to describe the crude,age-standardized rates of disability-adjusted life years(DALY),years lived with disability(YLD)and years of life lost(YLL)of total cardiovascular disease and attributable to dietary factors and percentage of attribution fraction(PAF).The Joinpoint Regression Program 4.7.0.0 software was used for the time trend analysis.And the average annual percentage change(AAPC)was calculated.Results In 2019,the crude DALY rate of total cardiovascular disease,the crude DALY rate of cardiovascular disease attributable to dietary factors,and PAF in China were 6463.47/105,2745.21/105 and 42.46%,respectively.From 1990 to 2019,the standardized rates of DALY,YLL and YLD of cardiovascular diseases attributable to dietary factors in China showed the downward trend(AAPC values were-1.45%,-1.57%and-0.02%,respectively,P<0.05).The descent speed of the standardized rates of DALY and YLL was between the middle SDI and middle-high SDI regions,the descent speed of the YLD standardized rate was lower than that of all SDI regions.As compared with 1990,in 2019 the burden of cardiovascular disease attributable to diet with high sodium in China stillranked the first among all dietary factors,and the ranks of the cardiovascular disease burden attributable to diet with low whole grains,high red meat,low legumes,high trans fatty acids and high processed meat increased.From 1990 to 2019,the standardized rates of DALY,YLL and YLD of cardiovascular diseases attributable to diet with high processed meat in China significantly increased(AAPC values were 1.46%,1.44%and 1.72%,respectively,P<0.01).Conclusion The prevention and control strategy of healthy diets for cardiovascular diseases in China has achieved certain results,the disease burden and trend are similar to those in the middle-high SDI regions,but the prevention and control for disability burden of cardiovascular diseases attributable to dietary factors should be strengthened.In addition to reducing the high-sodium diet,the intake of whole grains and beans should be promoted and the intake of red meat and processed meat should be reduced.