1991—2018年中国十五省(自治区、直辖市)成年居民宏量营养素供能比与肥胖关系

Relationship between the percentage of energy intake from macronutrients and obesity among adult residents in 15 provinces of China in 1991-2018

目的探讨中国成年居民宏量营养素供能比与肥胖的关系,分析预防肥胖发生的宏量营养素供能比切点值。方法利用1991—2018年“中国健康与营养调查”数据,选取至少参加两轮调查且基线未发生肥胖的18岁及以上成年人作为研究对象,以体质指数(body mass index,BMI)≥28.0 kg/m2判定为肥胖。采用广义估计方程分析宏量营养素供能比与BMI和肥胖的关系,利用受试者工作特征曲线(receiver operating characteristic curve,ROC)分析宏量营养素供能比预测肥胖的切点值。结果1991—2018年中国十五省(自治区、直辖市)成年居民蛋白质供能比和脂肪供能比呈上升趋势(P<0.01),碳水化合物供能比呈下降趋势(P<0.01)。调整协变量后,相较于脂肪供能比<20%组,脂肪供能比20%~30%组(β=0.05,95%CI 0.01~0.08)与脂肪供能比≥30%(β=0.15,95%CI 0.11~0.18)组与BMI呈正相关,20%~30%组和≥30%组发生肥胖的风险分别增加17%(OR=1.17,95%CI 1.04~1.31)和6%(OR=1.06,95%CI 1.24~1.56)。与<50%相比,碳水化合物供能比50%~65%组(β=-0.08,95%CI-0.11~-0.05)与≥65%(β=-0.17,95%CI-0.20~-0.13)组与BMI呈负相关,碳水化合物供能比在≥65%时能降低发生肥胖的风险(OR=0.71,95%CI 0.63~0.80)。预防肥胖发生的蛋白质供能比、脂肪供能比和碳水化合物供能比的切点值分别为11.78%、25.63%和68.53%。结论1991—2018年中国十五省成年居民碳水化合物摄入与肥胖发生风险呈负相关,过量摄入脂肪能增加肥胖发生风险。适宜的宏量营养素供能比摄入能够预防成年人肥胖。

OBJECTIVE To explore the relationship between the percentage ofenergy intake from macronutrients and obesity in Chinese adult residents,and analyze the cut-off values of macronutrients for predicting obesity.METHODS Data was collected inChina Health and Nutrition Survey(CHNS)in 1991-2018.Adults who participated in atleast two waves of the surveys and were not obese at baseline were selected as the studysubjects.Obesity was defined as body mass index(BMI)≥28.0 kg/m2.Generalizedestimating equation was used to analyze the relationship between the percentage of energyintake from macronutrients and BMI and obesity,and receiver operating characteristiccurve(ROC)was used to analyze the cut-off values of percentage of energy intake frommacronutrients to predict obesity.RESULTS The percentage of energy intake fromprotein and fat of adult residents in 15 provinces(autonomous regions and municipalities)in China showed an increasing trend(P<0.01),and the percentage of energy intake fromcarbohydrate showed a decreasing trend(P<0.01)between 1991 and 2018.Afteradjusting for covariates,the group of percentage of energy intake from fat in 20%~30%(β=0.05,95%CI 0.01-0.08)and≥30%(β=0.15,95%CI 0.11-0.18)were positivelycorrelated with BMI compared with the group of percentage of energy intake from fat<20%,and the risk of obesity in 20%-30%and≥30%was increased by 17%(OR=1.17,95%CI 1.04-1.31)and 6%(OR=1.06,95%CI 1.24-1.56),respectively.Compared with the group of the percentage of energy intake from carbohydrate<50%,thegroup of 50%to 65%(β=-0.08,95%CI-0.11--0.05)and≥65%(β=-0.17,95%CI-0.20--0.13)was negatively correlated with BMI,and the percentage of energyintake from carbohydrate≥65%reduced the risk of obesity(OR=0.71,95%CI 0.63-0.80).CONCLUSION Carbohydrate intake was inversely correlated with the risk ofobesity,and fat intake was positively correlated with the risk of obesity.Moderate intakeof carbohydrates and reduced fat intake can prevent obesity.