Dietary fats and mortality among patients with type 2 diabetes: analysis in two population based cohort studies
Dietary fats and mortality among patients with type 2 diabetes: analysis in two population based cohort studies
复制标题
DOI：
10.1136/bmj.l4009
复制
发表时间：
2019-07-02
影响因子：
105.7
通讯作者：
Sun, Qi
中科院分区：
文献类型：
--
作者：
Jiao, Jingjing;Liu, Gang;Sun, Qi
目的评估膳食脂肪酸与2型糖尿病患者心血管疾病死亡率和总死亡率的关系。前瞻性、纵向队列研究。美国的卫生专业人员。研究对象：护士健康研究（1980-2014）和卫生专业人员随访研究（1986-2014）中264名2型糖尿病患者。使用有效的食物频率问卷评估膳食脂肪摄入量，每2 - 4年更新一次。主要观察指标随访期间的总死亡率和心血管疾病死亡率。结果随访期间，2502例死亡，其中646例死于心血管疾病。多因素调整后，与总碳水化合物相比，摄入多不饱和脂肪酸（PUFAs）与较低的心血管疾病死亡率相关：总PUFAs的风险比为0.76(95%可信区间0.58至0.99；P为趋势=0.03)，海洋n-3 PUFAs的风险比为0.69(0.52至0.90；P=0.007)， a-亚麻酸的风险比为1.13(0.85至1.51)，亚油酸的风险比为0.75（0.56至1.01）。总PUFAs、n-3 PUFAs和亚油酸的摄入量也与总死亡率呈负相关，而动物来源的单不饱和脂肪酸与较高的总死亡率相关，而植物来源的单不饱和脂肪酸与较高的总死亡率无关。在检验用PUFAs替代其他脂肪的理论影响的模型中，用总PUFAs或亚油酸等热量替代饱和脂肪酸中2%的能量，分别与心血管疾病死亡率降低13%（风险比0.87,0.77至0.99）或15%（风险比0.85,0.73至0.99）相关。用总PUFAs替代2%的饱和脂肪酸能量与总死亡率降低12%（风险比0.88,0.83至0.94）相关。结论在2型糖尿病患者中，与碳水化合物或饱和脂肪酸相比，摄入较多的PUFAs与较低的总死亡率和心血管疾病死亡率相关。这些发现强调了膳食脂肪质量在预防心血管疾病和2型糖尿病成人总死亡率中的重要作用。
OBJECTIVETo assess the association of dietary fatty acids with cardiovascular disease mortality and total mortality among patients with type 2 diabetes.DESIGNProspective, longitudinal cohort study.SETTINGHealth professionals in the United States.PARTICIPANTS11 264 participants with type 2 diabetes in the Nurses' Health Study (1980-2014) and Health Professionals Follow-Up Study (1986-2014).EXPOSUREDietary fat intake assessed using validated food frequency questionnaires and updated every two to four years.MAIN OUTCOME MEASURETotal and cardiovascular disease mortality during follow-up.RESULTSDuring follow-up, 2502 deaths including 646 deaths due to cardiovascular disease were documented. After multivariate adjustment, intake of polyunsaturated fatty acids (PUFAs) was associated with a lower cardiovascular disease mortality, compared with total carbohydrates: hazard ratios comparing the highest with the lowest quarter were 0.76 (95% confidence interval 0.58 to 0.99; P for trend=0.03) for total PUFAs, 0.69 (0.52 to 0.90; P=0.007) for marine n-3 PUFAs, 1.13 (0.85 to 1.51) for a-linolenic acid, and 0.75 (0.56 to 1.01) for linoleic acid. Inverse associations with total mortality were also observed for intakes of total PUFAs, n-3 PUFAs, and linoleic acid, whereas monounsaturated fatty acids of animal, but not plant, origin were associated with a higher total mortality. In models that examined the theoretical effects of substituting PUFAs for other fats, isocalorically replacing 2% of energy from saturated fatty acids with total PUFAs or linoleic acid was associated with 13% (hazard ratio 0.87, 0.77 to 0.99) or 15% (0.85, 0.73 to 0.99) lower cardiovascular disease mortality, respectively. A 2% replacement of energy from saturated fatty acids with total PUFAs was associated with 12% (hazard ratio 0.88, 0.83 to 0.94) lower total mortality.CONCLUSIONSIn patients with type 2 diabetes, higher intake of PUFAs, in comparison with carbohydrates or saturated fatty acids, is associated with lower total mortality and cardiovascular disease mortality. These findings highlight the important role of quality of dietary fat in the prevention of cardiovascular disease and total mortality among adults with type 2 diabetes.