2型糖尿病患者氧化平衡评分与心血管疾病发病的关联：英国生物银行研究结果
Association of oxidative balance score with incident cardiovascular disease in patients with type 2 diabetes: findings of the UK Biobank study.
作者信息
Cheng Licheng, Wang Xuanyang, Dang Keke, Hu Jinxia, Zhang Jia, Xu Xiaoqing, Pan Sijia, Qi Xiang, Li Ying
机构信息
Department of Nutrition and Food Hygiene, The National Key Discipline, School of Public Health, Harbin Medical University, 157 Baojian Road, Harbin, 150081, P. R. China.
出版信息
Eur J Nutr. 2025 Mar 6;64(3):110. doi: 10.1007/s00394-024-03552-2.
BACKGROUND & AIMS: To clarify how dietary and lifestyle factors work on diabetes-related cardiovascular disease (CVD), we investigated whether the increased risk of CVD in patients with type 2 diabetes mellitus (T2DM) could be offset by an increase in diet and/or lifestyle with antioxidant potential.
RESEARCH DESIGN AND METHODS
A total of 7,658 individuals from UK Biobank (UKB) with T2DM but no diagnosed CVD were included in this study. We screened combinations of 16 nutrients and/or 4 lifestyles to calculate the Oxidative Balance Score (OBS), dietary OBS (DOBS), and lifestyle OBS (LOBS). Cox proportional hazards (CPH) regression models and mediation statistical models were performed.
RESULTS
After adjusting for covariates, CPH regression models showed inverse associations between both OBS and LOBS and CVD. The highest tertile of LOBS was significantly associated with a lower risk of CVD compared to the lowest tertile, with hazard ratios and 95% CIs as follows: Atherosclerotic Cardiovascular Disease (ASCVD) 0.81 (0.68-0.97), Coronary Artery Disease (CAD) 0.79 (0.67-0.93), Atrial Fibrillation (AF) 0.56 (0.45-0.70) and CVD mortality 0.67(0.51-0.88). Correspondingly, the results of associations between the highest tertile of OBS and risks of CVDs above were ASCVD 0.80 (0.64-0.99), CAD 0.83(0.68-1.01), AF 0.73 (0.57-0.92) and CVD mortality 0.68 (0.50-0.92). No associations between DOBS and CVDs were observed [ASCVD 0.83 (0.66-1.05), CAD 0.86 (0.70-1.05), AF 0.77 (0.60-1.00), and CVD mortality 0.79 (0.57-1.10)]. These results were consistent in stratified analyses. Additionally, we identified a mediating role for C-reactive protein (CRP) and white blood cell count (WBC) in the observed relations, with indirect effect and mediation estimates as follows: CRP - 0.003 6.0% (OBS and CAD), -0.008 17.2%, -0.003 11.7%, and - 0.010 14.5% (OBS/DOBS/LOBS and CVD mortality); WBC - 0.006 14.3%, -0.006 12.6%, -0.006 13.4%, -0.005 23.3% (OBS and CVDs), -0.008 11.8%, -0.008 11.9%, -0.008 11.8%, and - 0.005 5.3% (LOBS and CVDs).
CONCLUSION
Sustained adherence to diets and lifestyles with high antioxidant potential may significantly reduce the risk of CVD in individuals with T2DM.
背景与目的
为阐明饮食和生活方式因素如何作用于糖尿病相关心血管疾病（CVD），我们研究了2型糖尿病（T2DM）患者中，具有抗氧化潜力的饮食和/或生活方式的改善是否能够抵消CVD风险的增加。
研究设计与方法
本研究纳入了英国生物银行（UKB）中7658例患有T2DM但未诊断出CVD的个体。我们筛选了16种营养素和/或4种生活方式的组合，以计算氧化平衡评分（OBS）、饮食OBS（DOBS）和生活方式OBS（LOBS）。进行了Cox比例风险（CPH）回归模型和中介统计模型分析。
结果
在调整协变量后，CPH回归模型显示OBS和LOBS与CVD之间均呈负相关。与最低三分位数相比，LOBS的最高三分位数与较低的CVD风险显著相关,风险比和95%置信区间如下：动脉粥样硬化性心血管疾病（ASCVD）为0.81（0.68 - 0.97），冠状动脉疾病（CAD）为0.79（0.67 - 0.93），心房颤动（AF）为0.56（0.45 - 0.70），CVD死亡率为0.67（0.51 - 0.88）。相应地，OBS最高三分位数与上述CVD风险之间的关联结果为：ASCVD为0.80（0.64 - 0.99），CAD为0.83（0.68 - 1.01），AF为0.73（0.57 - 0.92），CVD死亡率为0.68（0.50 - 0.92）。未观察到DOBS与CVD之间的关联[ASCVD为0.83（0.66 - 1.05），CAD为0.86（0.70 - 1.05），AF为0.77（0.60 - 1.00），CVD死亡率为0.79（0.57 - 1.10）]。这些结果在分层分析中是一致的。此外，我们确定了C反应蛋白（CRP）和白细胞计数（WBC）在观察到的关系中的中介作用，间接效应和中介估计如下：CRP - 0.003 6.0%（OBS与CAD）， - 0.008 17.2%， - 0.003 11.7%，以及 - 0.010 14.5%（OBS/DOBS/LOBS与CVD死亡率）；WBC - 0.006 14.3%， - 0.006 12.6%， - 0.006 13.4%， - 0.005 23.3%（OBS与CVD）， - 0.008 11.8%， - 0.008 11.9%， - 0.008 11.8%，以及 - 0.005 5.3%（LOBS与CVD）。
结论
持续坚持具有高抗氧化潜力的饮食和生活方式可能会显著降低T2DM患者发生CVD的风险。
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