| 刘梦冉,王志宏,王惠君,苏畅,姜红如,王柳森,李惟怡,项春,丁钢强.食物摄入对血糖水平影响的中介效应和调节效应研究[J].中华流行病学杂志,2024,45(12):1726-1735 |
| 食物摄入对血糖水平影响的中介效应和调节效应研究 |
| Study on the mediating and moderating effects of food intake on blood glucose levels |
| 收稿日期:2024-07-23 出版日期:2024-12-16 |
| DOI：10.3760/cma.j.cn112338-20240723-00450 |
| 中文关键词: 食物 血糖 中介效应 调节效应 |
| 英文关键词: Food Blood glucose Mediation effect Moderating effect |
| 基金项目:国家重点研发计划(2020YFC2006300);国家财政项目(102393220020070000012) |
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| 中文摘要: |
| 目的 分析食物摄入对血糖水平影响中存在的中介效应和调节效应。方法 使用2018年中国健康与营养调查项目中年龄≥18岁，膳食数据、腰围、糖化血红蛋白、人口学特征及生活方式等关键变量信息完整者，最终纳入研究对象11 043人。采用连续3天24小时回顾法和家庭称重记账法实施膳食调查并计算平均每日食物摄入量。中介效应和调节效应分析采用简单中介模型、直接调节效应模型、有调节的中介模型，运用置信区间法进行检验分析。结果 共纳入男性4 951人，女性6 092人，按性别进行分层分析。男性中，腰围在米类、面类、畜肉与糖化血红蛋白关系中存在中介效应，中介效应标准化系数分别为-0.009（P<0.001）、0.013（P<0.001）、-0.005（P=0.008）；女性中，腰围在面类与糖化血红蛋白关系中存在中介效应，中介效应标准化系数为0.017（P<0.001）；畜肉摄入对糖化血红蛋白的影响受到深色蔬菜摄入的负向调节，存在直接调节效应，畜肉与深色蔬菜交互项标准化系数为-0.024（P=0.008）。男性中，深色蔬菜对米类→腰围→糖化血红蛋白路径存在有调节的中介作用（a3b1=-0.003，P=0.041）；腰围发挥的中介效应受到深色蔬菜摄入的负向调节（中介效应差异U1/-1=-0.006，P=0.048）。女性中，深色蔬菜对面类→腰围→糖化血红蛋白路径存在有调节的中介作用（a3b1=-0.004，P=0.045），腰围发挥的中介效应受到深色蔬菜摄入的负向调节（中介效应差异U1/-1=-0.009，P=0.049）。结论 米类、面类、畜肉摄入导致腰围指标的变化，并通过腰围作为中介变量对糖化血红蛋白水平产生影响。深色蔬菜通过与米类、面类、畜肉交互作用，直接或间接调节糖化血红蛋白水平。 |
| 英文摘要: |
| Objective Analyze the mediating and moderating effects of the relationship between food intake and blood glucose levels. Methods This study uses data from the China Health and Nutrition Survey project in the survey 2018, involving 11 043 adults aged 18 years or older, who have complete dietary data, waist circumference (WC), glycated hemoglobin A1c (HbA1c) indicators, and other key variables. Food consumption data was gathered via three consecutive 24-hour dietary recalls and weighing accounting method, which included two weekdays and one weekend day. The average daily intake of various foods and total energy intake were calculated. The mediation effect and moderation effect analysis were conducted using simple mediation models, direct moderation effect models, and moderated mediation analysis theoretical models. The confidence interval method (bootstrap method) was performed for testing and analysis. Results A total of 4 951 males and 6 092 females were included in the stratified analysis by gender. The mediating effects on the rice, wheat, and red meat→WC→HbA1c were all statistically significant in males. The standardized coefficients were -0.009 (P<0.001), 0.013 (P<0.001), and -0.005 (P=0.008), respectively. In females, the mediating effect on the wheat→WC→HbA1c was statistically significant, and the standardized coefficient was 0.017 (P<0.001); the impact of red meat intake on HbA1c is negatively regulated by the intake of dark vegetables, with a direct moderating effect; the standardized coefficient of the interaction term between red meat and dark vegetables was -0.024 (P=0.008). Dark vegetables have a moderated mediator on the pathway from rice to WC and HbA1c (a3b1=-0.003, P=0.041) in males. The mediating effect of WC is negatively regulated by the intake of dark vegetables (mediation effect difference U1/-1-0.006, P=0.048). Dark vegetables showed a moderated mediator on the pathway from wheat to WC and HbA1c (a3b1=-0.004, P=0.045) in females. The mediating effect of WC is negatively regulated by the intake of dark vegetables (mediation effect difference U1/-1=-0.009, P=0.049). Conclusions Changes in WC indicators caused by rice, wheat, and red meat intake. WC could mediate between rice, wheat, red meat, and HbA1c. Dark vegetables directly or indirectly regulate HbA1c levels by interacting with rice, wheat, and red meat. |
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