Association of fruit and vegetable intake with all-cause and cardio-cerebrovascular mortality among type 2 diabetes mellitus patients in Huaian city – a 9-year retrospective follow-up study
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摘要:
目的 了解2型糖尿病（T2DM）患者水果和蔬菜摄入量与全死因死亡及心脑血管死亡的关系，为延长糖尿病患者的生存寿命提供参考依据。 方法 于2013年1月采用多阶段随机整群抽样方法在江苏省淮安市抽取纳入基本公共卫生服务慢性病患者健康管理的10086例T2DM患者进行标准化半定量食物频度问卷（FFQ）调查，随后于2021年12月与死因监测平台进行匹配，追踪截至2021年12月31日的死亡结局，最终纳入水果和蔬菜摄入量数据完整的4977例T2DM患者进行水果和蔬菜摄入量与全死因死亡及心脑血管死亡关系的单因素和多因素Cox比例风险回归模型分析。 结果 截至2021年12月31日，4977例T2DM患者中死亡617例，其中心脑血管死亡238例；水果和蔬菜总摄入量 < 200、200～249、250～349和 ≥ 350 g/d时，全死因死亡比例分别为14.37%、11.57%、11.29%和11.55%，心脑血管死亡比例分别为5.79%、5.04%、3.71%和4.05%；在调整了性别、年龄、文化程度、婚姻状况、家庭年均收入、吸烟情况、饮酒情况、糖尿病病程、体质指数、是否高血压、是否血脂异常、是否冠心病和是否脑卒中等混杂因素后，多因素Cox比例风险回归模型分析结果显示，总水果和蔬菜摄入量为250～349 g/d T2DM患者的心脑血管死亡风险为总水果和蔬菜摄入量 < 200 g/d T2DM患者的0.67倍（HR = 0.67，95%CI = 0.47～0.95）。 结论 适当摄入水果和蔬菜可以降低T2DM患者心脑血管死亡风险，对降低T2DM患者死亡风险具有一定意义。 Abstract:Objective To investigate the relationship between fruit and vegetable intake and all-cause and cardio-cerebrovascular mortality in patients with type 2 diabetes mellitus (T2DM) for providing evidence to improve the survival of the patients. Methods The participants of the study were 10 086 T2DM patients recruited with multistage random cluster sampling from community chronic disease sufferers under the management of basic public health services in Huaian city, Jiangsu province. A baseline survey including questionnaire interview, physical examination and laboratory tests were conducted and fruit and vegetable intake during previous one year were estimated using a standardized semiquantitative Food Frequency Questionnaire among the participants during January 2013. All-cause and cardio-cerebrovascular mortality up to December 31, 2021 among the participants were identified using municipal vital registration information system. Univariate analysis and multivariate Cox proportional risk regression model were adopted to analyze the association of fruit and vegetable intake with all-cause and cardio-cerebrovascular mortality for the 4 977 T2DM patients with complete data. Results During the 9-year period among the 4 977 T2DM patients, totally 617 all-cause and 238 cardio-cerebrovascular deaths were observed; for the patients reporting the average daily fruit and vegetable intake of < 200, 200 – 249, 250 – 349, and ≥ 350 grams, the cumulative mortality of all-cause were 14.37%, 11.57%, 11.29%, and 11.55% and the cumulative cardio-cerebrovascular mortality were 5.79%, 5.04%, 3.71%, and 4.05%, respectively. After adjusting for gender, age, education, marital status, annual household income, smoking, alcohol consumption, duration of diabetes, body mass index, hypertension, dyslipidemia, coronary heart disease and stroke, the results of multivariate Cox proportional risk regression model showed that the patients with the average daily fruit and vegetable intake of 250 – 349 grams were at a decreased risk of cardio-cerebrovascular mortality (hazard risk = 0.67, 95% confidence interval: 0.47 – 0.95) compared to those with the intake of < 200 grams. Conclusion Appropriate intake of fruit and vegetable could reduce the risk of cardio-cerebrovascular mortality in community T2DM patients. -
Key words:
- all-cause mortality /
- cardio-cerebrovascular mortality /
- fruit /
- vegetable /
- intake /
- type 2 diabetes mellitus patients
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表 1 不同特征T2DM患者水果和蔬菜总摄入量分布情况比较
Table 1. Daily consumption of fruit and vegetable by demographic and lifestyle factors and disease conditions among 4 977 community type 2 diabetes mellitus patients at base line survey of a 9-year retrospective follow-up study in a city of Jiangsu province, 2013 – 2021
特征 水果和蔬菜总摄入量 χ2 值 P 值 ≤ 200 g/d 200～249 g/d 250～349 g/d ≥ 350 g/d n % n % n % n % 性别 男性 565 30.1 416 22.1 490 26.1 408 21.7 13.34 0.00 女性 1042 33.6 595 19.2 856 27.6 605 19.5 年龄（岁） < 60 639 30.4 407 19.3 583 27.7 475 22.6 12.28 0.00 ≥ 60 968 33.7 604 21.0 763 26.6 538 18.7 文化程度 文盲/半文盲 590 33.1 340 19.1 505 28.3 347 19.5 4.20 0.24 小学 415 30.8 275 20.4 347 25.8 310 23.0 初中 326 30.4 223 20.8 309 28.8 215 20.0 高中及以上 276 35.6 173 22.3 185 23.9 141 18.2 婚姻状况 非在婚 219 35.3 129 20.8 171 27.5 102 16.4 10.19 0.01 在婚 1388 31.9 882 20.2 1175 27.0 911 20.9 家庭年均收入（万元） < 1 321 32.4 174 17.5 269 27.1 228 23.0 6.92 0.07 1～3 579 32.0 375 20.7 511 28.2 344 19.0 4～10 589 31.3 400 21.3 503 26.8 388 20.6 > 10 118 39.9 62 20.9 63 21.3 53 17.9 吸烟情况 不吸烟 1203 33.2 728 20.1 987 27.2 709 19.5 7.99 0.04 吸烟 404 29.9 283 21.0 359 26.6 304 22.5 饮酒 不饮酒 1377 33.4 839 20.3 1100 26.7 811 19.7 16.00 0.00 饮酒 230 27.1 172 20.2 246 28.9 202 23.8 糖尿病病程（年） < 2 402 28.3 288 20.3 390 27.5 339 23.9 42.10 0.00 2～4 461 31.0 287 19.3 414 27.9 324 21.8 5～9 391 34.6 230 20.4 305 27.0 203 18.0 ≥ 10 353 37.4 206 21.8 237 25.2 147 15.6 BMI 低体重 18 40.0 8 17.8 9 20.0 10 19.2 1.12 0.77 正常体重 455 33.4 265 19.4 381 28.0 262 19.2 超重 708 31.2 481 21.2 608 26.8 474 20.9 肥胖 426 32.8 257 19.8 348 26.8 267 20.6 是否高血压 否 468 30.3 330 21.4 426 27.6 319 20.7 4.44 0.22 是 1139 33.2 681 19.8 920 26.8 694 20.2 是否血脂异常 否 781 33.6 474 20.4 640 27.6 427 18.4 11.07 0.01 是 826 31.1 537 20.2 706 26.6 586 22.1 是否冠心病 a 否 1341 32.0 844 20.2 1139 27.2 862 20.6 1.33 0.72 是 185 33.6 120 21.8 140 25.4 106 19.2 是否脑卒中 a 否 1355 31.9 867 20.4 1162 27.4 860 20.3 1.40 0.71 是 204 34.0 124 20.7 150 25.0 122 20.3 注：a 数据有缺失。 
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