中华预防医学杂志    2017年10期 中老年男性饮酒与2型糖尿病发病关系的前瞻性队列研究    PDF     文章点击量:225    
中华预防医学杂志2017年10期
中华医学会主办。
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文章信息

张一枝 余艳秋 袁瑜 何美安 邬堂春
ZhangYizhi,YuYanqiu,YuanYu,HeMei'an,WuTangchun
中老年男性饮酒与2型糖尿病发病关系的前瞻性队列研究
Association of alcohol use and incidence of type 2 diabetes mellitus in the middle-aged and elderly male population: a prospective cohort study
中华预防医学杂志, 2017,51(10)
http://dx.doi.org/10.3760/cma.j.issn.0253-9624.2017.10.010

文章历史

投稿日期: 2017-03-16
上一篇:1990—2015年中国缺血性心脏病疾病负担趋势分析
下一篇:基于东风-同济队列的离退休人群骨质疏松症患病率及相关因素分析
中老年男性饮酒与2型糖尿病发病关系的前瞻性队列研究
张一枝 余艳秋 袁瑜 何美安 邬堂春     
张一枝 430030 武汉,华中科技大学同济医学院公共卫生学院
余艳秋 430030 武汉,华中科技大学同济医学院公共卫生学院
袁瑜 430030 武汉,华中科技大学同济医学院公共卫生学院
何美安 430030 武汉,华中科技大学同济医学院公共卫生学院
邬堂春 430030 武汉,华中科技大学同济医学院公共卫生学院
摘要: 目的  探讨饮酒与中老年男性2型糖尿病(T2DM)发病风险的关联性。方法  研究人群来源于东风同济队列,该队列于2008年在湖北省招募了27 009名东风汽车公司离、退休职工,基线调查采用半结构化问卷收集饮酒信息和相关协变量,并进行了体格检查、血糖和血脂等测定。从队列中选取男性并排除基线调查时已患糖尿病、冠心病、卒中和恶性肿瘤者,最终纳入6 784名男性。2013年进行随访,通过研究对象的医疗保险号收集其疾病或死亡结局。应用COX比例风险模型分析不同饮酒特征和模式与T2DM的关联性。结果  6 784名研究对象中,3 541名从不饮酒者共随访15 852.2人年,新发T2DM 270例,发病密度为1 703.2/10万人年;3 243名饮酒者共随访14 509.8人年,新发T2DM 258例,发病密度为1 778.1/10万人年。多因素COX比例风险模型显示:与不饮酒人群相比,饮酒人群T2DM发生风险总体上未升高[HR(95%CI):1.09(0.91~1.30)],但平均乙醇摄入量>20 g/d和饮酒频率高于7次/周的饮酒者T2DM发生风险均升高[HR(95%CI)值分别为1.27(1.02~1.58)和1.35 (1.00~1.83)];饮酒频率>7次/周的人群中,单次乙醇摄入量为0.01~40和>40 g者发生T2DM的HR(95%CI)值分别为1.48(1.05~2.09)和1.27(0.80~2.01)。结论  总体上饮酒与T2DM发生风险无关,但平均乙醇摄入量>20 g/d或饮酒频率>7次/周会增加T2DM发生风险。
关键词 :饮酒;糖尿病,2型;队列研究;中老年男性
Association of alcohol use and incidence of type 2 diabetes mellitus in the middle-aged and elderly male population: a prospective cohort study
ZhangYizhi,YuYanqiu,YuanYu,HeMei'an,WuTangchun     
School of Public Health, TongJi Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
Corresponding author: Wu Tangchun, Email: wut@mails.tjmu.edu.cn
Abstract:Objective  To investigate the association between alcohol use and incidence of type 2 diabetes mellitus (T2DM) in the middle-aged and elderly male population.Methods  All participants were from Dongfeng-Tongji cohort, 27 009 retired employees from Dongfeng Motor Corporation in Hubei Province were enrolled in the Dongfeng-Tongji cohort baseline survey in 2008. In baseline study, information of alcohol use and other covariates were collected by semi-structured questionnaire and all participants completed physical examination including the test of fasting glucose and blood lipid levels. A total of 6 784 male participants from Dongfeng-Tongji cohort who were without diagnosis of diabetes, coronary heart disease, stroke, or cancer in baseline study were enrolled in this study. We completed the first follow-up in 2013 and the outcome of disease or death was retrieved based on health-care medical records according to the unique medical insurance ID. Cox proportional hazard regression model was used to estimate the association between alcohol use and incidence of type 2 diabetes mellitus (T2DM), by drinking features and patterns.Results  Out of the 6 784 participants, 3 541 participant were defined as non-alcohol drinkers and there were 15 852.2 person-years of follow-up; among which 270 new cases of T2DM were diagnosed withthe crude incidence density of non-alcohol drinkers at 1 703.2/100 000 person-years. The other 3 243 subjects were classified as alcohol drinkers and there were 14 509.8 person-years of follow-up; and among which 258 new cases of T2DM were diagnosed, with the crude incidence density of T2DM at 1 778.1/100 000 person-years. Multivariate COX proportional hazard regression model indicated that there was no significantly increased risk of T2DM incidence between alcohol drinkers and non-alcohol drinkers(HR(95% CI): 1.09 (0.91- 1.30)). However, participants who averagely consumed >20 g/d or>7 times/week had a significantly increased risk of T2DM compared with non-alcohol drinkers, and the value of HR(95%CI) was 1.27 (1.02- 1.58) and 1.35 (1.00- 1.83), respectively. Among men who consumed alcoholic beverages more than 7 times/week, HR (95%CI) for T2DM incidence in the subjects who consumed 0.01 to 40 g and > 40 g once a time were 1.48 (1.05- 2.09) and 1.27 (0.80- 2.10), respectively.Conclusion  Although we found no relationship between alcohol use and T2DM incidence overall, alcohol use more than 20 g/d or more than 7 times/week would increase the risk of T2DM.
Key words :Alcohol drinking;Diabetes mellitus, type 2;Cohort studies;Middle-aged and elderly men
全文

2型糖尿病(type 2 diabetes mellitus, T2DM)是全球范围内主要的慢性非传染性疾病之一,给各国造成重大疾病负担[1,2,3,4,5]。2013年中国糖尿病患者达9 840万例(其中90%以上为T2DM),是糖尿病人数最多的国家[6,7,8,9,10]。生活方式影响糖尿病的发生与发展[11,12],饮酒是其中的重要因素之一[13,14,15,16,17,18,19,20,21]。中老年期是T2DM高发的年龄阶段[22,23],本研究探讨饮酒与中老年人T2DM发病风险的关联性。

对象与方法  

1.对象:  2008年于湖北省共招募了27 009名东风汽车公司离、退休职工,形成东风-同济队列[24,25],2013年进行了第1次随访,截至2013年10月共随访25 978名,随访率为96.2%。本研究纳入该队列的6 784名男性,纳入标准为:东风-同济队列中≥45岁的男性离、退休职工且完成了基线问卷调查和健康体检;排除标准为:基线调查时已患糖尿病、冠心病、卒中或恶性肿瘤者(9 804例),戒酒人群(664名),饮酒数据缺失(18名),以及关键变量数据缺失者(711名)。本研究通过了同济医学院伦理委员会的伦理审核(审批号:2012-10),所有研究对象均签署了知情同意书。

2.调查方法:  (1)问卷调查:包括社会人口学信息、饮酒和吸烟情况、疾病史等。(2)健康体检:包括体格指标(身高、体重、腰围)、血压、空腹血糖和血脂检测等[12]。所有研究对象晚饭后禁食10~12 h,次日早晨抽取静脉血,分别采用美国雅培公司的Architect CI8200和Aeroset自动分析仪检测空腹血糖和血脂。(3)随访:通过研究对象的医疗保险号收集其疾病或死亡结局。

3. T2DM诊断标准:  参考2013年美国糖尿病协会指南,满足以下任一标准且排除1型糖尿病即可诊断为新发T2DM:(1)空腹血糖≥7.0 mmol/L;(2)糖化血红蛋白检测值≥6.5%;(3)有口服降糖药或胰岛素使用史[26]

4.变量的定义:  (1)饮酒:饮用酒精性饮料≥ 1次/周且持续半年以上为饮酒,过去饮酒但饮酒< 1次/周且持续半年以上为戒酒。饮酒的特征分为:是否饮酒,饮酒的类型、频率,单次和平均乙醇摄入量等。饮酒模式目前尚无统一的定义,本研究饮酒模式定义为:饮酒者在一段时间内的饮酒方式,饮酒频次和单次饮用量是饮酒方式的重要因素[27]。(2)超重与肥胖:BMI≥24.0且<28 kg/m2为超重,≥ 28.0 kg/m2为肥胖,男性腰围≥85 cm为中心性肥胖[28]。(3)吸烟:每天吸烟≥1支且持续超过半年,过去吸烟但现在不吸烟持续半年以上为戒烟;(4)锻炼:规律性进行的每次超过20 min以锻炼身体为目的的各种活动。

5.质量控制:  本研究基线和随访调查均采用统一的调查方案,由经过统一培训合格后的调查员采用自制问卷进行面对面调查。调查中使用的器械和材料均统一购置,确保研究结果的稳定性、准确性和可比性。流行病调查数据采用双人双录入,并由专人进行复查。

6.统计学分析:  应用Epidata 3.1软件建立数据库,采用统计软件SPSS 20.0对数据进行整理和分析。连续性变量均符合正态分布,以±s表示,分类变量以n(%)表示。采用t检验比较连续性变量的饮酒与不饮酒组间差异,采用χ2检验比较分类变量的组间差异。采用多因素COX比例风险模型评估饮酒特征以及饮酒模式与T2DM发生的关联性。所有统计检验均为双侧检验,以P<0.05为差异具有统计学意义。

结果  

1.研究对象基线特征:  研究对象中饮酒者3 242名,从不饮酒者3 541名。饮酒者的年龄和受教育程度低于不饮酒者,而吸烟率、腰围、DBP、TC和HDL-C浓度高于不饮酒者。饮酒者与不饮酒者的BMI、SBP、LDL-C、TG、高血压、高血脂患病率及家族糖尿病史差异无统计学意义(表1)。

表12008—2013年东风同济队列中老年男性饮酒与不饮酒人群基线特征比较

2.饮酒与T2DM发生风险:  3 541名从不饮酒者共随访15 852.2人年,新发T2DM 270例,发病密度为1 703.2/10万人年;3 243名饮酒者共随访14 509.8人年,新发T2DM 258例,发病密度为1 778.1/10万人年。应用多因素COX比例风险模型,调整年龄、吸烟、教育水平、BMI、中心性肥胖、高血压病史以及糖尿病家族史等因素后,与从不饮酒者相比,未见饮酒者T2DM发生风险升高[HR(95%CI):1.09(0.91~1.30),β=0.052,P=0.560]。

3.饮酒特征与T2DM发生风险:  多因素COX比例风险模型分析显示:平均乙醇摄入量和饮酒频率与T2DM有关联,饮酒类型和单次饮酒量与T2DM无关联。与从不饮酒者相比,平均乙醇摄入量>20 g/d和饮酒频率高于7次/周者发生T2DM的风险升高[HR(95%CI)分别为:1.27(1.02~1.58)和1.35(1.00~ 1.83)](表2)。

表22008—2013年东风同济队列中老年男性饮酒特征与2型糖尿病的关系

4.饮酒模式与T2DM发病风险:  多因素COX比例风险模型分析显示,在饮酒频率>7次/周的人群中,单次乙醇摄入量为0.01~40和>40 g者发生T2DM的HR(95%CI)值分别为1.48(1.05~2.09)和1.27(0.80~2.01),提示饮酒频次和饮酒剂量的共同作用可能是T2DM发生风险的重要因素(表3)。

表32008—2013年东风同济队列中老年男性饮酒模式与2型糖尿病的关系

讨论  饮酒与T2DM的关系存在着争议,系统综述和Meta分析的结果显示适量饮酒可以降低T2DM的发生风险,高剂量饮酒与T2DM的关系有待进一步的验证[29]。以往的研究仅分析了饮酒量对T2DM发生风险的作用,忽视了饮酒特征和饮酒模式对T2DM发生风险的重要影响[30]。目前关于饮酒与T2DM发病关系的研究多来自西方人群且结论不一致[31,32],中国人群的研究证据较少[33,34]。本研究结果显示:饮酒人群T2DM发生风险总体上未升高,饮酒频次和饮酒剂量的共同作用均可增加T2DM发生风险。目前关于饮酒与T2DM发生的生物学机制尚不明确,有研究发现其可能与饮酒可以影响机体的胰岛素敏感性和抗性、改变血脂代谢和炎症状态等有关[35,36]
        本研究的优势在于:(1)详细地收集了饮酒数据,并将饮酒特征作为一个重要因素,综合分析饮酒模式与T2DM发病风险的关联性;(2)对照组人群是从不饮酒者,最大程度减少了戒酒人群对于研究结果的影响;(3)T2DM的诊断依据为医疗记录,诊断结局比较可靠。本研究的局限性在于:(1)饮酒数据是通过面对面问卷调查得到的,可能会低估研究对象的饮酒量;(2)研究人群为中老年男性,结论需要更长随访时间、更大样本量人群进一步验证。

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