Association of the Mediterranean Diet With Onset of Diabetes in the Women's Health Study.
Association of the Mediterranean Diet With Onset of Diabetes in the Women's Health Study.
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DOI：
10.1001/jamanetworkopen.2020.25466
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发表时间：
2020-11-02
影响因子：
13.8
通讯作者：
Mora S
中科院分区：
文献类型：
--
作者：
Ahmad S;Demler OV;Sun Q;Moorthy MV;Li C;Lee IM;Ridker PM;Manson JE;Hu FB;Fall T;Chasman DI;Cheng S;Pradhan A;Mora S
地中海(MED)饮食是否与降低美国人患糖尿病的风险有关？如果是，潜在的生物机制途径是什么？在一项前瞻性流行病学队列研究中，对25名 317名女性进行了长达20年的跟踪调查，其中2,307名女性患上了2型糖尿病。较高的基础MED摄入量与未来糖尿病风险降低30%相关；胰岛素抵抗、肥胖、高密度脂蛋白和炎症等生物标记物对这种反向关联的解释最多。这些发现表明，MED饮食可能通过改善胰岛素抵抗、脂蛋白代谢和炎症来预防糖尿病。这项队列研究表明，在美国人群中，地中海饮食相关的2型糖尿病风险降低与传统生物标记物和新型生物标记物的相对关联性。较高的地中海饮食(MED)摄入量与降低2型糖尿病的风险有关，但潜在的生物学机制尚不清楚。研究美国人群中传统和新型生物标记物在MED相关2型糖尿病风险降低中的相对作用。这项队列研究是在25名 317名看起来健康的女性中进行的。所有传统的和新的代谢生物标记物或有基线糖尿病的信息缺失的参与者被排除在外。参与者在1992年9月至1995年5月期间被邀请进行基线评估。数据收集时间为1992年11月至2017年12月，分析时间为2018年12月至2019年12月。MED摄入量评分(范围从0到9)是根据自我报告的饮食摄入量计算的，代表对地中海饮食摄入量的坚持。2型糖尿病发病病例，通过年度问卷确定；报告病例通过电话访谈或补充问卷确认。估计了临床危险因素和代表不同生理途径的40个生物标记物所解释的2型糖尿病风险降低的比例。25名 317名女性参与者的平均年龄(SD)为52.9(9.9)岁，并获得了平均19.8(5.8年)年的随访期。较高的基础≥摄入量(≤6分与BMI 3分)与2型糖尿病风险降低30%相关(年龄调整和能量调整的风险比为0.70；95%CI，0.62-0.79；当回归模型另外调整身体质量指数时：风险比，0.85；95%CI，0.76-0.96)。胰岛素抵抗的生物标志物对降低风险的贡献最大(占2型糖尿病相关性的65.5%)，其次是体重指数(55.5%)、高密度脂蛋白(53.0%)和炎症(52.5%)，支链氨基酸(34.5%)、极低密度脂蛋白(32.0%)、低密度脂蛋白(31.0%)、血压(29.0%)和载脂蛋白(23.5%)的贡献较小，血红蛋白A1c的贡献最小(≤2%)。在特别小组后的分析中，只有体重指数在基线时至少为25的女性才能看到MED饮食与2型糖尿病的反向关联，而那些体重指数小于25的女性没有(例如，体重指数为25的女性，年龄和能量调整后的心率，≥评分为6比≤3，1.01；95%CI，0.77-1.33；P为趋势 = .92；体重指数≥为25的女性：HR，0.76；95%CI，0.67-0.87；P为趋势 <； .001)。在这项队列研究中，在20年期间，较高的MED摄入量得分与2型糖尿病的相对风险降低30%相关，这在很大程度上可以由胰岛素抵抗、BMI、脂蛋白代谢和炎症的生物标记物解释。
Is the Mediterranean (MED) diet associated with reduced risk of diabetes in a US population, and if so, what are possible underlying biological mechanistic pathways? Among 25 317 women followed up for 20 years in a prospective epidemiological cohort study, 2307 developed type 2 diabetes. Higher baseline MED intake was associated with a 30% reduction in future risk of diabetes; biomarkers of insulin resistance, adiposity, high-density lipoprotein, and inflammation contributed most to explaining this inverse association. These findings suggest that the MED diet may be protective against diabetes by improving insulin resistance, lipoprotein metabolism, and inflammation. This cohort study characterizes the relative association of conventional and novel biomarkers in Mediterranean diet–related type 2 diabetes risk reduction in a US population. Higher Mediterranean diet (MED) intake has been associated with reduced risk of type 2 diabetes, but underlying biological mechanisms are unclear. To characterize the relative contribution of conventional and novel biomarkers in MED-associated type 2 diabetes risk reduction in a US population. This cohort study was conducted among 25 317 apparently healthy women. The participants with missing information regarding all traditional and novel metabolic biomarkers or those with baseline diabetes were excluded. Participants were invited for baseline assessment between September 1992 and May 1995. Data were collected from November 1992 to December 2017 and analyzed from December 2018 to December 2019. MED intake score (range, 0 to 9) was computed from self-reported dietary intake, representing adherence to Mediterranean diet intake. Incident cases of type 2 diabetes, identified through annual questionnaires; reported cases were confirmed by either telephone interview or supplemental questionnaire. Proportion of reduced risk of type 2 diabetes explained by clinical risk factors and a panel of 40 biomarkers that represent different physiological pathways was estimated. The mean (SD) age of the 25 317 female participants was 52.9 (9.9) years, and they were followed up for a mean (SD) of 19.8 (5.8) years. Higher baseline MED intake (score ≥6 vs ≤3) was associated with as much as a 30% lower type 2 diabetes risk (age-adjusted and energy-adjusted hazard ratio, 0.70; 95% CI, 0.62-0.79; when regression models were additionally adjusted with body mass index [BMI]: hazard ratio, 0.85; 95% CI, 0.76-0.96). Biomarkers of insulin resistance made the largest contribution to lower risk (accounting for 65.5% of the MED–type 2 diabetes association), followed by BMI (55.5%), high-density lipoprotein measures (53.0%), and inflammation (52.5%), with lesser contributions from branched-chain amino acids (34.5%), very low-density lipoprotein measures (32.0%), low-density lipoprotein measures (31.0%), blood pressure (29.0%), and apolipoproteins (23.5%), and minimal contribution (≤2%) from hemoglobin A1c. In post hoc subgroup analyses, the inverse association of MED diet with type 2 diabetes was seen only among women who had BMI of at least 25 at baseline but not those who had BMI of less than 25 (eg, women with BMI <25, age- and energy-adjusted HR for MED score ≥6 vs ≤3, 1.01; 95% CI, 0.77-1.33; P for trend = .92; women with BMI ≥25: HR, 0.76; 95% CI, 0.67-0.87; P for trend < .001). In this cohort study, higher MED intake scores were associated with a 30% relative risk reduction in type 2 diabetes during a 20-year period, which could be explained in large part by biomarkers of insulin resistance, BMI, lipoprotein metabolism, and inflammation.
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影响因子：
7.6
作者：
BARON, RM;KENNY, DA
通讯作者：
KENNY, DA
饮食质量分数和男性2型糖尿病的风险。
影响因子：
16.2
作者：
de Koning L;Chiuve SE;Fung TT;Willett WC;Rimm EB;Hu FB
通讯作者：
Hu FB
影响因子：
105.7
作者：
Martinez-Gonzalez, M. A.;de la Fuente-Arrillaga, C.;Bes-Rastrollo, M.
通讯作者：
Bes-Rastrollo, M.
影响因子：
13.8
作者：
Ahmad, Shafqat;Moorthy, M. Vinayaga;Mora, Samia
通讯作者：
Mora, Samia
影响因子：
7.7
作者：
Howe LD;Smith AD;Macdonald-Wallis C;Anderson EL;Galobardes B;Lawlor DA;Ben-Shlomo Y;Hardy R;Cooper R;Tilling K;Fraser A
通讯作者：
Fraser A