大气PM_(2.5)长期暴露对人群糖尿病影响及饮食因素调节作用的研究

Effects of long-term exposure to ambient fine particulate matter on diabetes mellitus and the moderating effects of diet

[背景]大气细颗粒物(PM_(2.5))长期暴露会增加糖尿病患病风险,健康的饮食可以有效地控制空腹血糖值,然而,目前尚不清楚饮食因素对大气PM_(2.5)暴露相关的糖尿病风险是否具有调节作用。[目的]探讨大气PM_(2.5)长期暴露与宁夏农村地区人群糖尿病患病风险之间的关联,以及大气PM_(2.5)长期暴露和饮食情况对糖尿病影响的交互作用。[方法]研究对象来源于中国西北区域自然人群队列研究-宁夏队列的基线调查资料,排除缺失协变量信息者,共纳入研究对象13917人。本研究以2014—2018年大气PM_(2.5)年均浓度作为长期暴露水平,采用logistic回归模型和多重线性回归模型分析大气PM_(2.5)长期暴露与糖尿病和空腹血糖值之间的关联;按照研究对象的食用蔬菜频率、食用水果频率和咸口味进行分层,分析其对大气PM_(2.5)暴露相关的糖尿病风险的调节作用。[结果]13917名研究对象平均年龄为(56.8±10.0)岁,糖尿病患病率为9.8%。2014—2018年大气PM_(2.5)年均浓度为(38.10±4.67)μg·m^(-3)。大气PM_(2.5)浓度每升高1μg·m^(-3),糖尿病患病风险的OR为1.018(95%CI:1.005~1.032),空腹血糖值升高0.011(95%CI:0.004~0.017)mmol·L^(-1)。与食用蔬菜频率<1次·周^(-2)相比,食用蔬菜1~3次·周^(-1)和≥4次·周^(-1)的人群患糖尿病的风险分别降低27.1%(OR=0.729,95%CI:0.594~0.893)和16.8%(OR=0.832,95%CI:0.715~0.971);与食用水果频率<1次·周^(-1)相比,食用水果频率1~3次·周^(-1)和≥4次·周^(-1)的人群患糖尿病的风险分别降低16.4%(OR=0.836,95%CI:0.702~0.998)和18.2%(OR=0.818,95%CI:0.700~0.959)食用蔬菜频率1~3次·周^(-1)的人群空腹血糖值降低0.202(95%CI:-0.304~-0.101)mmol·L^(-1);尚未发现咸口味对糖尿病和空腹血糖值的影响。饮食因素及PM_(2.5)浓度的分层分析显示,与PM_(2.5)低浓度-高蔬菜摄入频率组相比,PM_(2.5)低浓度-低蔬菜摄入频率、PM_(2.5)高浓度-低蔬菜摄入频率组的糖尿病患病风险升高,OR值分别为3.987(95%CI:2.943~5.371)和1.433(95%CI:1.143~1.796)。与PM_(2.5)低浓度-高水果摄入频率人群相比,PM_(2.5)高浓度-低水果摄入频率人群的糖尿病患病风险升高50.1%(OR=1.501,95%CI:1.171~1.926)。尚未发现咸口味与PM_(2.5)对糖尿病影响的交互作用。[结论]大气PM_(2.5)长期暴露与宁夏农村地区人群糖尿病患病风险增加和空腹血糖值升高有关;增加每周食用蔬菜、水果的频率对糖尿病患病风险具有一定的保护作用,同时对大气PM_(2.5)长期暴露相关的糖尿病患病风险和空腹血糖值具有调节作用。

[Background]Long-term exposure to ambient fine particulate matter(PM_(2.5))may increase the risk of diabetes,and a healthy diet can effectively control fasting blood glucose levels.However,it is unclear whether dietary factors have a moderating effect on the risk of diabetes associated with atmospheric PM_(2.5)exposure.[Objective]To investigate the association between long-term exposure to PM_(2.5)and diabetes in rural areas of Ningxia,and potential interaction of long-term exposure to atmospheric PM_(2.5)and diet on diabetes.[Methods]The study subjects were selected from the baseline survey data of the China Northwest Cohort-Ningxia(CNC-NX),a natural population cohort.A total of 13917 subjects were included,excluding participants with missing covariate information.We utilized the annual average ambient PM_(2.5)concentration from 2014 to 2018 as the long-term exposure level.Logistic regression and multiple linear regression were employed to analyze the associations of long-term atmospheric PM_(2.5)exposure with diabetes and fasting blood glucose levels.Stratification by frequency of vegetable consumption,frequency of fruit consumption,and salty taste was used to examine moderating effects on the diabetes risk associated with atmospheric PM_(2.5)exposure.[Results]The mean age of the 13917 subjects was(56.8±10.0)years,and the prevalence of diabetes was 9.8%.Between 2014 and 2018,the average annual concentration of PM_(2.5)was(38.10±4.67)μg·m^(−3).The risk(OR)of diabetes was 1.018(95%CI:1.005,1.032)and the fasting blood glucose was increased by 0.011(95%CI:0.004,0.017)mmol·L^(−1) for each 1μg·m−3 increase in PM_(2.5)concentration.Compared to those who consumed vegetables<1 time per week,individuals who consume vegetables 1-3 times per week and≥4 times per week had a reduced risk of developing diabetes by 27.1%(OR=0.729,95%CI:0.594,0.893)and 16.8%(OR=0.832,95%CI:0.715,0.971)respectively.Similarly,when compared to those who consumed fruits<1 time per week,individuals who consumed fruits 1-3 times per week and≥4 times per week exhibited a reduced risk of diabetes by 16.4%(OR=0.836,95%CI:0.702,0.998)and 18.2%(OR=0.818,95%CI:0.700,0.959)respectively.Fasting blood glucose decreased by 0.202(95%CI:-0.304,-0.101)mmol·L^(−1) in participants who ate vegetables 1-3 times per week.The effect of salty taste on diabetes and fasting blood glucose was not significant.The results of stratified analysis by dietary factors and PM_(2.5)concentration showed that the risks of diabetes were increased in the low PM_(2.5)pollution-low vegetable intake frequency group and the high PM_(2.5)pollution-low vegetable intake frequency group compared with the low PM_(2.5)pollution-high vegetable intake frequency group,with OR values of 3.987(95%CI:2.943,5.371)and 1.433(95%CI:1.143,1.796)respectively.The risk of diabetes was 50.1%higher in participants with high PM_(2.5)pollution and low fruit intake frequency than in participants with low PM_(2.5)pollution and high fruit intake frequency(OR=1.501,95%CI:1.171,1.926).No interaction was found between salty taste and PM_(2.5)on diabetes.[Conclusion]Long-term exposure to ambient PM_(2.5)is associated with an increased fasting blood glucose and an elevated risk of diabetes in rural Ningxia population.Increasing the frequency of weekly consumption of vegetables or fruits may have a certain protective effect against diabetes occurrence,as well as a moderating effect on diabetes and fasting blood glucose levels associated with long-term exposure to atmospheric PM_(2.5).