中国成年居民膳食模式变化及与肥胖关系的研究（1991-2009）
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摘要
研究背景
伴随着经济的快速发展,中国正处于营养变迁之中,成年居民超重和肥胖率呈现快速增长趋势。传统的膳食研究方法主要是探讨单一营养素或者食物与肥胖的关系,具有一定的局限性。膳食模式研究是对整体膳食进行分析,能够更全面实际地反映食物和营养素的综合效应,从而更有效地研究膳食与人体健康的关系。
研究目的
本研究旨在了解我国成年居民膳食模式特点及变化,分析膳食模式的影响因素,探讨不同膳食模式对成年居民超重和肥胖的影响。
研究内容与方法
本研究数据来源于中美合作课题“中国健康与营养调查”。根据研究目的,将研究对象分为两类。第一类包括1991-2009年至少参加一次调查的18～80岁成年居民。采用因子分析方法建立各年居民膳食模式,了解其营养特点及影响因素,并分析膳食模式在18年间的变化。第二类研究对象为参加1993年和2009年2次调查,并有完整数据的调查对象。采用多水平混合效应模型对纵向追踪人群进行分析,探讨不同膳食模式对我国成年居民超重和肥胖的影响。
研究结果
1、从1991年到2009年,中国成年居民的超重率和肥胖率显著增长。超重率从16.1%上升到28.0%,增长了73.9%。肥胖率从3.0%上升到7.7%,增长了156.7%。中心性肥胖率从1993年24.2%上升到2009年的44.9%,增长了85.5%。
2、谷类食物主要以大米和面粉消费为主。其中大米摄入量呈下降趋势,面粉摄入量保持平稳略有下降。肉类食物以猪肉和鱼虾类消费为主,摄入量呈上升趋势。薯类摄入量呈上升趋势。豆类摄入量略有下降。速食食品和小吃甜点摄入量从2004年开始呈现快速上升趋势。蔬菜摄入量总体保持稳定,男性摄入量约为350g/d,女性摄入量约为330g/d。水果摄入量呈显著上升趋势。蛋类摄入量呈上升趋势,奶类摄入量呈现波动趋势。
3、成年男性和女性居民有4种共同的膳食模式,分别是以大米、蔬菜和猪肉为主要食物的南方模式,以面粉、其他谷类和薯类为主要食物的北方模式,以奶类、水果和蛋类为主要食物的零食模式以及以速食食品、奶类和小吃甜点为主要食物的速食模式。
4、男性特有的膳食模式是以动物性食物、酒类和坚果为主要食物的酒类模式。女性特有的膳食模式,分别是以畜禽肉和鱼虾类为主要食物的肉类模式,以薯类和其他谷类为主要食物的粗粮模式。
5、1993年到2009年间,男性南方模式、肉类模式和零食模式的相关系数分别为0.62(p<0.01)、0.32(p<0.01)和0.24(p<0.01),女性分别为0.63(p<0.01)、0.32(p<0.01)和0.05(p>0.05)。
6、南方模式、肉类模式和零食模式变异中由社区因素解释的比例男性分别为66%、17%和18%,女性分别为65%、17%和19%。社区因素是南方模式变异的主要部分。年龄、教育程度、收入水平、身体活动水平和吸烟、饮酒是影响膳食模式的个体因素。
7、男性南方模式最高5分位发生超重/肥胖和中心性肥胖的危险分别是最低5分位的53%和60%。女性南方模式与腰围呈负相关(p<0.01)。
8、男性零食模式最高5分位发生超重/肥胖和中心性肥胖的危险分别是最低5分位的1.66倍和1.88倍。结论
1991-2009年,我国成年居民膳食模式呈现多样化,并且随着时间发生改变。各种膳食模式中,传统膳食模式的长期稳定性相对较高。膳食模式同时受社区、个体和时间等因素的影响。由于食物构成和营养成分的差异,膳食模式对成年居民肥胖的影响不同。以大米、蔬菜和猪肉为主要食物的南方模式,能降低男性发生超重/肥胖和中心性肥胖的危险性；并与女性腰围呈负相关,是女性腰围的保护因素。零食模式与男性超重/肥胖和中心性肥胖呈正相关,是男性超重/肥胖和中心性肥胖的危险因素。
Background
With the rapid development of the economy, China has experienced nutrition transition. At the same time, the overweight and obesity rates of Chinese adults were rising rapidly in the most recent decade. The traditional dietary analyses focused merely on the relationship between individual nutrient or food and obesity, which has certain limitations. However, dietary pattern analysis examines the effects of overall diet. Conceptually, dietary patterns represent combined effects of foods and nutrients and thus may be more effective to shed light on the impact of diet on health outcomes.
Objective
To investigate characteristics and dynamics of dietary patterns among Chinese adults as well as the potential influencing factors of these dietary patterns; To examine the effects of different dietary patterns on overweight and obesity.
Methods
The study was based on the data from the China Health and Nutrition Survey (CHNS), an ongoing longitudinal cohort study. According to the aims of the present study, study subjects were divided into two groups. The first group included those adults aged18to80years who participated in at least one wave of surveys between1991and2009. Factor analysis was performed to establish dietary patterns of each survey year, and the nutrition composition and potential influencing factors for each dietary pattern were investigated further. Meanwhile, the18-year shifts in dietary patterns between1991and2009were also examined. The second group included those who were involved in both the1993and2009survey years and had completed dietary and anthropometric data. Multilevel mixed effect model was conducted to examine the effects of different dietary patterns on overweight and obesity risks of adults.
Results
1. The overweight and obesity rates of adults in China increased significantly between1991and2009:The rate of overweight increased by73.9%(16.1%vs.28.0%), the rate of general obesity increased by156.7%(3.0%vs.7.7%). Central obesity rate increased by85.5%(24.2%in1993vs.44.9%in2009).
2. Rice and flour were frequently consumed. The intake of rice was declining and the intake of flour decreased a little. The intakes of pork, fish and shrimp were very high and on the rise. Meanwhile, the intake of tubers was also growing. However, the intakes of soy products declined slightly. Since2004, the intakes of fast food, desserts and cakes had grown rapidly. Male vegetable intake was about350g/d, and female was about330g/d. Both vegetable intakes were remained stable. The intakes of fruits and eggs were increased. Dairy consumption was not stable.
3. Four dietary patterns were identified among men and women. A southern pattern was rich in rice, vegetables and pork. A northern pattern was rich in flour, other cereals and tubers. A snack pattern was rich in milk, fruits and eggs. A fast food pattern was rich in fast food, dairy and snacks.
4. An alcohol pattern was identified specially among men, that was rich in meat, alcohol and nuts. Two dietary patterns were identified specially among women. A meat pattern was rich in livestock, poultry, fish and shrimp. A coarse cereal pattern was rich in tubers and other cereals.
5. For men, the correlation coefficients for southern pattern, meat pattern and snack pattern between1993and2009were0.62,0.32and0.24, respectively(p<0.01). For women, the correlation coefficients for southern pattern, meat pattern and snack pattern between1993and2009were0.63(p<0.01),0.32(p<0.01) and0.05(p>0.05), respectively.
6. Multilevel mixed effect linear regression model of dietary patterns indicated that community-level variation accounts for66%,17%and18%of total score variation of southern, meat and snack dietary patterns among men respectively, whereas community-level variation explained65%,17%and19%of each dietary pattern among women, respectively. Therefore, community-level factor was the major part for score variation of the southern dietary pattern. Individual-level factors in relation to dietary patterns included age, education, income level, physical activity, smoking, and alcohol consumption.
7. Men in the top quintile of the southern dietary pattern had lower risk of overweight/general obesity and central obesity compared to men in the lowest quintile of the southern dietary pattern(OR,0.53and0.60). The southern dietary pattern in women was negatively associated with waist circumference (p<0.01).
8. Men in the top quintile of the snack dietary pattern had higher risk of overweight/general obesity and central obesity compared to men in the lowest quintile of the snack dietary pattern(OR,1.66and1.88).
Conclusions
From1991to2009, there were various dietary patterns among China adults. And those dietary patterns kept changing over time. The traditional dietary pattern remained relatively stable compared to other patterns. Dietary patterns were influenced by community-level factor, individual-level factor and time factor. Due to differences in food nutrients and components, the effects of dietary patterns on adult obesity were varied. The southern dietary pattern was associated with reduced general obesity and central obesity in men and was negatively associated with waist circumference in women, which may serve as a protective factor. The snack pattern in men was positively associated with both general and central obesity.
伴随着经济的快速发展,中国正处于营养变迁之中,成年居民超重和肥胖率呈现快速增长趋势。传统的膳食研究方法主要是探讨单一营养素或者食物与肥胖的关系,具有一定的局限性。膳食模式研究是对整体膳食进行分析,能够更全面实际地反映食物和营养素的综合效应,从而更有效地研究膳食与人体健康的关系。
研究目的
本研究旨在了解我国成年居民膳食模式特点及变化,分析膳食模式的影响因素,探讨不同膳食模式对成年居民超重和肥胖的影响。
研究内容与方法
本研究数据来源于中美合作课题“中国健康与营养调查”。根据研究目的,将研究对象分为两类。第一类包括1991-2009年至少参加一次调查的18～80岁成年居民。采用因子分析方法建立各年居民膳食模式,了解其营养特点及影响因素,并分析膳食模式在18年间的变化。第二类研究对象为参加1993年和2009年2次调查,并有完整数据的调查对象。采用多水平混合效应模型对纵向追踪人群进行分析,探讨不同膳食模式对我国成年居民超重和肥胖的影响。
研究结果
1、从1991年到2009年,中国成年居民的超重率和肥胖率显著增长。超重率从16.1%上升到28.0%,增长了73.9%。肥胖率从3.0%上升到7.7%,增长了156.7%。中心性肥胖率从1993年24.2%上升到2009年的44.9%,增长了85.5%。
2、谷类食物主要以大米和面粉消费为主。其中大米摄入量呈下降趋势,面粉摄入量保持平稳略有下降。肉类食物以猪肉和鱼虾类消费为主,摄入量呈上升趋势。薯类摄入量呈上升趋势。豆类摄入量略有下降。速食食品和小吃甜点摄入量从2004年开始呈现快速上升趋势。蔬菜摄入量总体保持稳定,男性摄入量约为350g/d,女性摄入量约为330g/d。水果摄入量呈显著上升趋势。蛋类摄入量呈上升趋势,奶类摄入量呈现波动趋势。
3、成年男性和女性居民有4种共同的膳食模式,分别是以大米、蔬菜和猪肉为主要食物的南方模式,以面粉、其他谷类和薯类为主要食物的北方模式,以奶类、水果和蛋类为主要食物的零食模式以及以速食食品、奶类和小吃甜点为主要食物的速食模式。
4、男性特有的膳食模式是以动物性食物、酒类和坚果为主要食物的酒类模式。女性特有的膳食模式,分别是以畜禽肉和鱼虾类为主要食物的肉类模式,以薯类和其他谷类为主要食物的粗粮模式。
5、1993年到2009年间,男性南方模式、肉类模式和零食模式的相关系数分别为0.62(p<0.01)、0.32(p<0.01)和0.24(p<0.01),女性分别为0.63(p<0.01)、0.32(p<0.01)和0.05(p>0.05)。
6、南方模式、肉类模式和零食模式变异中由社区因素解释的比例男性分别为66%、17%和18%,女性分别为65%、17%和19%。社区因素是南方模式变异的主要部分。年龄、教育程度、收入水平、身体活动水平和吸烟、饮酒是影响膳食模式的个体因素。
7、男性南方模式最高5分位发生超重/肥胖和中心性肥胖的危险分别是最低5分位的53%和60%。女性南方模式与腰围呈负相关(p<0.01)。
8、男性零食模式最高5分位发生超重/肥胖和中心性肥胖的危险分别是最低5分位的1.66倍和1.88倍。结论
1991-2009年,我国成年居民膳食模式呈现多样化,并且随着时间发生改变。各种膳食模式中,传统膳食模式的长期稳定性相对较高。膳食模式同时受社区、个体和时间等因素的影响。由于食物构成和营养成分的差异,膳食模式对成年居民肥胖的影响不同。以大米、蔬菜和猪肉为主要食物的南方模式,能降低男性发生超重/肥胖和中心性肥胖的危险性；并与女性腰围呈负相关,是女性腰围的保护因素。零食模式与男性超重/肥胖和中心性肥胖呈正相关,是男性超重/肥胖和中心性肥胖的危险因素。
Background
With the rapid development of the economy, China has experienced nutrition transition. At the same time, the overweight and obesity rates of Chinese adults were rising rapidly in the most recent decade. The traditional dietary analyses focused merely on the relationship between individual nutrient or food and obesity, which has certain limitations. However, dietary pattern analysis examines the effects of overall diet. Conceptually, dietary patterns represent combined effects of foods and nutrients and thus may be more effective to shed light on the impact of diet on health outcomes.
Objective
To investigate characteristics and dynamics of dietary patterns among Chinese adults as well as the potential influencing factors of these dietary patterns; To examine the effects of different dietary patterns on overweight and obesity.
Methods
The study was based on the data from the China Health and Nutrition Survey (CHNS), an ongoing longitudinal cohort study. According to the aims of the present study, study subjects were divided into two groups. The first group included those adults aged18to80years who participated in at least one wave of surveys between1991and2009. Factor analysis was performed to establish dietary patterns of each survey year, and the nutrition composition and potential influencing factors for each dietary pattern were investigated further. Meanwhile, the18-year shifts in dietary patterns between1991and2009were also examined. The second group included those who were involved in both the1993and2009survey years and had completed dietary and anthropometric data. Multilevel mixed effect model was conducted to examine the effects of different dietary patterns on overweight and obesity risks of adults.
Results
1. The overweight and obesity rates of adults in China increased significantly between1991and2009:The rate of overweight increased by73.9%(16.1%vs.28.0%), the rate of general obesity increased by156.7%(3.0%vs.7.7%). Central obesity rate increased by85.5%(24.2%in1993vs.44.9%in2009).
2. Rice and flour were frequently consumed. The intake of rice was declining and the intake of flour decreased a little. The intakes of pork, fish and shrimp were very high and on the rise. Meanwhile, the intake of tubers was also growing. However, the intakes of soy products declined slightly. Since2004, the intakes of fast food, desserts and cakes had grown rapidly. Male vegetable intake was about350g/d, and female was about330g/d. Both vegetable intakes were remained stable. The intakes of fruits and eggs were increased. Dairy consumption was not stable.
3. Four dietary patterns were identified among men and women. A southern pattern was rich in rice, vegetables and pork. A northern pattern was rich in flour, other cereals and tubers. A snack pattern was rich in milk, fruits and eggs. A fast food pattern was rich in fast food, dairy and snacks.
4. An alcohol pattern was identified specially among men, that was rich in meat, alcohol and nuts. Two dietary patterns were identified specially among women. A meat pattern was rich in livestock, poultry, fish and shrimp. A coarse cereal pattern was rich in tubers and other cereals.
5. For men, the correlation coefficients for southern pattern, meat pattern and snack pattern between1993and2009were0.62,0.32and0.24, respectively(p<0.01). For women, the correlation coefficients for southern pattern, meat pattern and snack pattern between1993and2009were0.63(p<0.01),0.32(p<0.01) and0.05(p>0.05), respectively.
6. Multilevel mixed effect linear regression model of dietary patterns indicated that community-level variation accounts for66%,17%and18%of total score variation of southern, meat and snack dietary patterns among men respectively, whereas community-level variation explained65%,17%and19%of each dietary pattern among women, respectively. Therefore, community-level factor was the major part for score variation of the southern dietary pattern. Individual-level factors in relation to dietary patterns included age, education, income level, physical activity, smoking, and alcohol consumption.
7. Men in the top quintile of the southern dietary pattern had lower risk of overweight/general obesity and central obesity compared to men in the lowest quintile of the southern dietary pattern(OR,0.53and0.60). The southern dietary pattern in women was negatively associated with waist circumference (p<0.01).
8. Men in the top quintile of the snack dietary pattern had higher risk of overweight/general obesity and central obesity compared to men in the lowest quintile of the snack dietary pattern(OR,1.66and1.88).
Conclusions
From1991to2009, there were various dietary patterns among China adults. And those dietary patterns kept changing over time. The traditional dietary pattern remained relatively stable compared to other patterns. Dietary patterns were influenced by community-level factor, individual-level factor and time factor. Due to differences in food nutrients and components, the effects of dietary patterns on adult obesity were varied. The southern dietary pattern was associated with reduced general obesity and central obesity in men and was negatively associated with waist circumference in women, which may serve as a protective factor. The snack pattern in men was positively associated with both general and central obesity.
引文
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