青海省藏族牧民肥胖流行状况及其与饮食模式关系的队列研究

目的 探索青海省城镇化转型中藏族牧民成年人肥胖的流行状况及其与饮食模式的关系。方法 采用开放队列设计,2018年基线入组1 003人,2022年随访599人,新入组1 012人。共纳入 ≥ 18岁成年人1 913人,对其开展问卷调查和健康检查。使用因子分析法识别饮食模式,用混合效应模型分析饮食模式与肥胖关系。结果 2018-2022年超重、肥胖和中心性肥胖患病率分别为27.6%、33.8%和54.6%,肥胖和中心性肥胖年龄性别标化患病率均上升。共识别3种饮食模式:现代饮食模式(常食用猪肉、家禽肉类、加工肉类、新鲜水果、含糖饮料、咸味零食等)、城镇饮食模式(常食用精制碳水化合物、牛羊肉、蔬菜和鲜蛋类等)、牧区饮食模式(常食用糌粑、藏式奶酪、酥油茶/奶茶和乳制品等)。校正人口学特征、社会经济状况及生活行为方式后,相比城镇饮食模式得分T₁组,T₃组超重和超重/肥胖风险显著增加(超重:OR=2.09,95%CI:1.10~3.95;超重/肥胖:OR=1.23,95%CI:1.00~1.51),而牧区饮食模式得分T₃组超重、肥胖、超重/肥胖和中心性肥胖的风险降低(超重:OR=0.45,95%CI:0.24~0.84;肥胖:OR=0.81,95%CI:0.69~0.95;超重/肥胖:OR=0.75,95%CI:0.61~0.91;中心性肥胖:OR=0.58,95%CI:0.38~0.89)。结论 城镇化转型中藏族牧民肥胖和中心性肥胖高发。城镇饮食模式是超重、超重/肥胖的危险因素,牧区饮食模式是超重、肥胖、超重/肥胖和中心性肥胖的保护因素。需制定针对性干预措施,提升健康水平。

Prevalence of obesity and its association with dietary patterns:a cohort study among Tibetan pastoralists in Qinghai Province

Objectives To explore obesity prevalence and its association with dietary patterns among Tibetan pastoralists during the urbanization transition in Qinghai Province. Methods Using an open cohort study design, 1 003 subjects were enrolled at baseline in 2018, 599 were followed up, and 1 012 were newly recruited in 2022. A total of 1 913 adults over 18 years were included in the study, and a questionnaire survey and health examination were conducted. Factor analysis was used to identify dietary patterns, and a mixed-effects model was used to analyze the association between dietary patterns and obesity. Results From 2018 to 2022, the prevalence rates of overweight, obesity, and central obesity were 27.6%, 33.8%, and 54.6%, respectively. Age-sex-standardized prevalence of obesity and central obesity increased. Three dietary patterns were identified:the modern pattern was characterized by frequent consumption of pork, poultry, processed meat, fresh fruits, sugary drinks, salty snacks, etcetera; the urban pattern was characterized by frequent consumption of refined carbohydrates, beef and mutton, vegetables and eggs, etcetera; and pastoral pattern featured frequent consumption of tsamba, Tibetan cheese, buttered/milk tea, and whole-fat dairy products. After adjusting for demographic characteristics, socioeconomic status, and lifestyle factors, compared with the T₁, subjects in the T₃ of urban pattern scores were more likely to be overweight (OR=2.09, 95%CI:1.10-3.95) and overweight/obese (OR=1.23, 95%CI:1.00-1.51), whereas those in the T₃ of pastoral pattern scores had a lower risk of overweight (OR=0.45, 95%CI:0.24-0.84), obesity (OR=0.81, 95%CI:0.69-0.95), overweight/obesity (OR=0.75, 95%CI:0.61-0.91) and central obesity (OR=0.58, 95%CI:0.38-0.89). Conclusions Prevalence of obesity and central obesity was high among Tibetan pastoralists during the urbanization transition. Urban dietary pattern was a risk factor for overweight and overweight/obesity, whereas pastoral dietary pattern was a protective factor for overweight, obesity, overweight/obesity, and central obesity. Tailored interventions are needed to improve local people''s health.