达能营养中心第五届学术研讨会论文集
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周北凡 |
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文章编号：1000－8020（2002）S0－0023－02 本报告的目的是探讨中国膳食模式与心血管病特点之间的关系。资料来源是世界卫生组织最新的死亡统计、我国多中心心血管病流行病学合作研究（即国家六五到八五科技攻关课题）结果，以及宏量营养素与血压关系的国际合作研究结果（INTERMAP Study, 由美国心肺血研究所资助，中国、日本、美国、英国17个研究中心的合作研究，中国有3个研究中心参加）。与西方人群相比，目前中国人群心血管病的特点是脑卒中高发，其中出血型卒中比例较西方人群为高，冠心病较低发，国内不同人群间发病率有很大差异。生态学对比研究结果显示：人群冠心病发病率的预测因素是舒张压、血清总胆固醇、高密度脂蛋白胆固醇和体质指数的平均水平。和西方人群相比， 决定中国人群血清总胆固醇水平和冠心病发病率较低的膳食因素是较低的总脂肪、饱和脂肪、膳食胆固醇和Keys脂质分值。人群的膳食脂质分值每增高5，血清总胆固醇均值升高约7 mg/dl，冠心病年发病率约增高6.7/10万。人群脑卒中发病率的最强预测因素是舒张压水平，与高血压相关的膳食因素是高钠、低钾和低钙。人群日均烹调用食盐每相差3 g, 人群舒张压均值约相差1.8mmHg, 脑卒中年发病率约相差17/10万。每天人均摄入鱼类和新鲜水果增加各50 g, 舒张压均值分别降低3mmHg 和2mmHg，脑卒中年发病率约降低28/10万和19/10万。人群的脑卒中急性期死亡率（间接反映出血型卒中发病率）与日均膳食动物蛋白质摄入量呈显著负关联，而与膳食钠/钾比值呈显著正关联，此种关联独立于血压和体质指数。结论：在中国，预防心血管病的健康膳食应强调降低食盐摄入量、增加鱼类和新鲜水果蔬菜、保持低脂肪、低饱和脂肪和胆固醇，以达到降低脑卒中发病率，抑制冠心病发病率的上升。 Chinese dietary pattern and features of cardiovascular diseases Zhou Beifan Fu Wai Hospital,Chinese Academy of Medical Sciences,Beijing 100037 The purpose of this presentation is to explore the possible relationship of Chinese dietary pattern to the characteristics of cardiovascular diseases in China. Main sources of data used for the analyses were WHO mortality statistics, China Multi－center Collaborative Study of Cardiovascular Epidemiology (China MUCA study) and International Study of Macro－nutrients on Blood Pressure (INTERMAP study, an international collaborative study of 17 centers of 4 countries, including 3 centers in China). In comparison with western countries, cardiovascular diseases in Chinese population was characterized by high incidence of stroke, higher proportion of hemorrhagic stroke, lower incidence of coronary heart disease, and big variation in incidence among populations within China. Results of ecological analysis showed that the predictive factors for incidence of CHD in a population were mean levels of DBP, serum total cholesterol (TC), HDL－C and BMI. Dietary factors related to lower incidence of CHD compared with western populations were lower total fat, saturated fat and lower Keys score. Among populations within China , each 5 increase in mean Keys score was associated with 7 mg/dl increase in mean level of TC and roughly 6.7 /100,000 increase in annual incidence of CHD. The strong predictive factors for stroke incidence was DBP. Dietary factors related to higher DBP was high salt, low potassium and calcium. Among populations within China, each 3 g difference in mean daily intake of cooking salt was associated with 1.8 mmHg difference in mean level of DBP and roughly 17 /100000 difference in incidence of stroke. Each 50 g increase in mean daily intake of fish or fruits was associated with 3 mmHg or 2 mmHg decrease in mean level of DBP, and then 28 /100000 or 19/100000 decrease in incidence of stroke respectively. The variation in acute phase mortality of stroke (indirectly reflect the mortality from hemorrhagic stroke) among populations was associated inversely with mean daily intake of animal protein and positively with Na/K ratio even after adjusting for mean blood pressure and BMI. Revealed that Chinese dietary factors might be related to high incidence of hemorrhagic stroke independent of blood pressure and BMI. Public health efforts for preventing CVD in China should be aimed at reducing salt intake, increasing intake of fish and fresh fruits, vegetables, maintaining low levels in intake of total fat, saturated fat and cholesterol. |