目的 分析6~18岁儿童青少年群体中膳食支链氨基酸(BCAAs)摄入与血脂异常的关系,为血脂异常防治提供新的思路。方法 选取“中国儿童与乳母营养健康监测”四省份11 019例6~18岁儿童青少年膳食调查与血生化数据。采用食物频率表法获得膳食调查数据,结合《中国食物成分表》计算儿童青少年人群膳食BCAAs 摄入量。比较不同BCAAs摄入水平组间各血脂异常亚组的患病差异,利用logistic回归模型评估BCAAs与血脂异常的关联并利用乘法模型来评估年龄、性别和体质量指数(BMI)分别与BCAAs的交互作用对血脂异常的影响。结果 正常对照组9 389例,血脂异常组1 630例,其中高胆固醇(TC)血症470例。总BCAAs、BCAAs密度高水平组的高TC血症患病率显著高于低水平组(χ2=9.554、18.109,P＜0.01)。分层分析表明,与低水平组比较,正常体重组BCAAs高水平组(OR=1.781,95%CI:1.326~2.391)和BCAAs密度高水平组(OR=2.011,95%CI:1.493~2.708)高TC血症发病风险均升高(P＜0.05),女性中BCAAs高水平组(OR=1.721,95%CI:1.243~2.384)、BCAAs密度高水平组(OR=1.899,95%CI:1.361~2.651)高TC血症发病风险升高(P＜0.05),6~12岁组BCAAs高水平组高TC血症发病风险升高(OR=1.447,95%CI:1.100~1.905),各年龄组BCAAs密度高水平组高TC血症发病风险升高(6~12岁OR=1.636,95%CI:1.242~2.155;OR=1.881,95%CI:1.170~3.024)(P<0.05)。BCAAs密度与BMI对高TC血症的影响存在显著交互效应(P=0.027)。中介效应分析显示BMI在总BCAAs摄入量、BCAAs密度与高TC血症之间表现出异质性中介效应。结论 BCAAs摄入增加是高TC血症的独立危险因素,通过调整膳食结构,减少红肉及其制品的摄入来限制饮食中BCAAs可降低高TC血症发病风险。
Abstract
Objective To analyze the relationship between dietary branched-chain amino acids (BCAAs) intake and the risk of dyslipidemia in children and adolescents aged 6 - 18 years, in order to provide new insights for the prevention and treatment of dyslipidemia. Methods Dietary survey and blood biochemical data of 11 019 children and adolescents aged 6 - 18 years in four provinces of the China Children and Lactating Women Nutrition and Health Surveillance (CCLWNHS) project were analyzed.Dietary BCAAs intake was calculated using food frequency questionnaires combined with the China Food Composition Table.Differences in the prevalence of dyslipidemia subtypes across different BCAAs intake levels were compared.Logistic regression models were used to assess the association between BCAAs and dyslipidemia, and multiplicative interaction models were employed to evaluate the effects of interactions between BCAAs and age, sex, or body mass index (BMI) on dyslipidemia. Results Among the participants, 9,389 were in the normal control group, while 1 630 had dyslipidemia, including 470 cases of hypercholesterolemia.The hypercholesterolemia prevalence was significantly higher in the high total BCAAs and high BCAAs density groups compared to the low-intake groups (χ2=9.554, 18.109, P<0.01).Stratified analysis showed that, compared to the low-intake group, the high BCAAs intake group (OR=1.781, 95% CI: 1.326 - 2.391) and high BCAAs density group (OR=2.011, 95% CI: 1.493 - 2.708) had increased hypercholesterolemia risk in the normal-weight subgroup (P<0.05).Compared to the low-intake group, females in the high BCAAs intake group (OR=1.721, 95% CI: 1.243 - 2.384) and high BCAAs density group (OR=1.899, 95% CI: 1.361 - 2.651) also exhibited elevated hypercholesterolemia risk (P<0.05).In the 6 - 12 age group, high BCAAs intake was associated with increased hypercholesterolemia risk (OR=1.447, 95% CI: 1.100 - 1.905) compared to the low-intake group, while high BCAAs density elevated hypercholesterolemia risk across all age groups (6 - 12 years old OR=1.636, 95% CI: 1.242 - 2.155; 13-18 years old OR=1.881, 95% CI: 1.170 - 3.024) (P<0.05).A significant interaction effect was observed between BCAAs density and BMI on hypercholesterolemia risk (P=0.027).Mediation analysis revealed heterogeneous mediating effects of BMI on the relationship among total BCAAs intake, BCAAs density, and hypercholesterolemia risk. Conclusions Increased BCAAs intake is an independent risk factor for hypercholesterolemia.Adjusting dietary patterns by reducing red meat and processed meat consumption to limit BCAAs intake may lower the risk of hypercholesterolemia.
关键词
支链氨基酸 /
血脂异常 /
胆固醇 /
高胆固醇血症 /
代谢性疾病 /
儿童青少年
Key words
branched-chain amino acids /
dyslipidemia /
cholesterol /
hypercholesterolemia /
metabolic diseases /
children and adolescents
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基金
齐鲁卫生与健康杰出青年人才项目(2021.01-2025.12);山东省医药卫生科技发展计划项目(2019WS436);山东省自然科学基金项目(ZR2023QH157);国家卫生健康委公共营养与健康重点实验室开放课题(WLKFZ202505);日照市自然科学基金(RZ2024ZR64)
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