我国成年人红肉摄入过多与脑卒中发病关系的前瞻性研究

目的 探讨我国成年人红肉摄入水平与脑卒中发病的关联。方法 选取2010年中国慢性病及其危险因素监测11个省60个监测点的数据作为基线数据，2016-2017年进行随访调查，完成随访且调查资料完整者共27 762人。采用多元营养素密度Cox比例风险回归模型分析红肉摄入水平与脑卒中发病的关联。并按照基线特征进行亚组分析，应用标准多元模型、能量分解模型和营养素残差模型进行敏感性分析。结果 研究对象共26 187人，平均随访6.0年，共发生脑卒中1 259人，其中缺血性脑卒中1 074人；脑卒中和缺血性脑卒中发病密度分别为815.0/10万人年和692.0/10万人年。调整相关混杂因素后，以红肉摄入水平Q₁组为参照，Q₂组脑卒中发病风险未增加［风险比（HR）=1.07，95%CI：0.87~1.32］，Q₃~Q₅组脑卒中发病风险分别增加23%（HR=1.23，95%CI：1.00~1.51）、27%（HR=1.27，95%CI：1.03~1.58）和32%（HR=1.32，95%CI：1.06~1.64）；Q₂组缺血性脑卒中发病风险未增加（HR=1.03，95%CI：0.80~1.32），Q₃~Q₅组缺血性脑卒中发病风险分别增加32%（HR=1.32，95%CI：1.04~1.68）、35%（HR=1.35，95%CI：1.05~1.73）和38%（HR=1.38，95%CI：1.07~1.79）。亚组分析发现，血压对红肉摄入水平与脑卒中发病风险存在效应修饰作用（交互P=0.037）。敏感性分析结果未发生明显变化。结论 红肉摄入水平过高，脑卒中及缺血性脑卒中发病风险增加，控制红肉摄入水平可能对我国的脑卒中防控具有重要意义。

Association between higher intake of red meat and incidence of stroke in adults in China: a prospective study

Objective To explore the relationship between red meat intake level and the incidence of stroke in Chinese adults. Methods The baseline data were from China Chronic Disease Surveillance Project conducted in 60 surveillance sites in 11 provinces in China in 2010. A total of 27 762 subjects with complete data in baseline survey were included in the cohort follow-up from 2016 to 2017. Multivariate nutrient-density cox proportional hazards regression model was used to analyze the association between red meat intake level and the incidence of stroke. Subgroup analysis were performed based on baseline characteristics. Sensitivity analysis was performed by using standard multivariate model, energy partition model and nutrient residual model. Results In the 26 187 subjects, 1 259 stroke cases, including 1 074 ischemic stroke cases, occurred during an average of 6.0 years of follow-up, the incidence density was 815.0/100 000 person-years for stroke and 692.0/100 000 person-years for ischemic stroke. In models using the multivariate nutrient-density model of energy adjustment, compared with quintile group, red meat intake in quintile 2 group showed no significant association with stroke hazard ratio (HR)=1.07, 95%CI:0.87-1.32] and ischemic stroke (HR=1.03, 95%CI:0.80-1.32) and in group of quintile 3-5, the red meat intake related risk for stroke increased by 23% (HR=1.23, 95%CI:1.00-1.51), 27% (HR=1.27, 95%CI:1.03-1.58) and 32% (HR=1.32, 95%CI:1.06-1.64), respectively, while the risk for ischemic stroke increased by 32% (HR=1.32, 95%CI:1.04-1.68), 35% (HR=1.35, 95%CI:1.05-1.73) and 38% (HR=1.38, 95%CI:1.07-1.79), respectively. Subgroup analysis revealed that blood pressure had modification effect on the association between red meat intake and incidence of stroke (interaction P=0.037). The sensitivity analysis showed no changes. Conclusions These findings suggest that higher intake of red meat is significantly associated with an increased risk for stroke and ischemic stroke. It is necessary to take red meat intake level as one of the important indicators of stroke prevention and control.