膳食炎症指数与老年2型糖尿病肌少症的关联-东南大学学报医学版

膳食炎症指数与老年2型糖尿病肌少症的关联

单位：1. 盐城市第三人民医院内分泌科, 江苏盐城 224001;
2. 盐城市第三人民医院呼吸内科, 江苏盐城 224001

分类号：R587.1;R592

出版年·卷·期（页码）：2025·44·第六期（966-973）

摘要：

目的: 基于美国国家健康与营养调查(NHANES)数据库分析膳食炎症指数(DII)与老年2型糖尿病(T2DM)肌少症的关联,以期为老年T2DM肌少症的临床防治提供参考。方法: 本研究提取美国NHANES数据库1999—2020年的数据进行分析。收集参与者的一般资料、血液学指标、DII、肌少症等数据。按DII四分位数将老年T2DM患者分为DII Q1组(DII＜0.448,n=251)、DII Q2组(0.448≤DII＜1.891,n=249)、DII Q3组(1.891≤DII＜2.879,n=250)、DII Q4组(DII≥2.879,n=251)。比较不同DII分组的种族、肌少症患病率等的差异。采用Logistic回归分析DII与老年T2DM肌少症的关系,并行趋势分析和亚组分析。采用限制性立方样条图(RCS)分析DII与老年T2DM肌少症的非线性关系。结果: 共纳入1 001例老年T2DM患者,肌少症患病率为34.07%(341/1 001)。不同DII分组老年T2DM患者的种族构成、性别构成、教育水平、饮酒比例、贫困指数、C反应蛋白水平,差异有统计学意义(P＜0.05)。Logistic分析显示,校正后DII每增高1,肌少症风险增高0.671倍(OR=1.671,95%CI:1.179~2.368,P＜0.05);相较DII Q1组,DII Q3组(OR=2.049,95%CI:1.362~3.101)、DII Q4组(OR=3.082,95%CI:2.042~4.651)老年T2DM患者患肌少症的风险增高1.049倍和2.082倍(P＜0.05)。且在2个模型中,DII Q1、Q2、Q3、Q4组老年T2DM患者患肌少症的风险OR均呈增加趋势(P_趋势＜0.05)。亚组分析显示,在不同种族、年龄、性别和饮酒情况的老年T2DM患者中,DII与肌少症风险关系基本一致,且DII与种族、年龄、性别和饮酒情况均不存在交互作用(P_交互＞0.05)。RCS分析显示,在老年T2DM患者中,DII与肌少症风险呈负对数型曲线(P_非线性=0.041)。结论: 在老年T2DM患者中,DII与肌少症风险呈负对数型曲线,随DII增加,老年T2DM肌少症的风险呈非线性增高趋势。

Objective: To analyze the association between dietary inflammatory index(DII) and sarcopenia in elderly patients with type 2 diabetes mellitus(T2DM) based on the U.S. National Health and Nutrition Examination Survey(NHANES) database, with the aim of providing a reference for the clinical prevention and treatment of sarcopenia in elderly patients with T2DM. Methods: Data from the US NHANES database from 1999 to 2020 were extracted and analyzed for this study. Data on participants' general information, hematologic indices, DII, and sarcopenia were collected. Elderly T2DM patients were categorized into DII Q1 group(DII<0.448, n=251), DII Q2 group(0.448≤DII<1.891, n=249), DII Q3 group(1.891≤DII<2.879, n=250), and DII Q4 group(DII≥2.879, n=251) according to the DII quartiles. Differences in race and prevalence of sarcopenia were compared among DII subgroups. Logistic regression was used to analyze the relationship between DII and sarcopenia in elderly T2DM patients with trend analysis and subgroup analysis. Restricted cubic spline plots(RCS) were used to analyze the nonlinear relationship between DII and sarcopenia in elderly T2DM patients. Results: A total of 1 001 elderly T2DM patients were included, and the prevalence of sarcopenia was 34.07%(341/1 001). Racial composition, gender composition, education level, percentage of alcohol consumption, poverty index, and C-reactive protein level of elderly T2DM patients in different DII subgroups showed statistically significant differences(P<0.05). Logistic analysis showed that the risk of sarcopenia increased by 0.671-fold for every 1 increase in DII after correcting(OR=1.671, 95% CI: 1.179-2.368, P<0.05). Compared to the DII Q1 group, elderly T2DM patients in the DII Q3 group(OR=2.049, 95% CI: 1.362-3.101) and DII Q4 group(OR=3.082, 95% CI: 2.042-4.651) had 1.049-fold and 2.082-fold increased risk(P<0.05). And in the 2 models, the OR of the risk of developing sarcopenia in elderly T2DM patients in the DII Q1, Q2, Q3, and Q4 groups showed an increasing trend(P_trend<0.05). Subgroup analysis showed that the relationship between DII and the risk of sarcopenia was basically the same in elderly T2DM patients with different races, ages, genders, and drinking status, and there was no interaction between DII and race, age, gender, and drinking status(P_interaction>0.05). RCS analysis showed a negative logarithmic curve between DII and the risk of sarcopenia in elderly T2DM patients(P_nonlinear=0.041). Conclusion: A negative logarithmic curve was observed between DII and the risk of sarcopenia in elderly patients with T2DM. And the risk of sarcopenia in elderly T2DM patients increased nonlinearly with increasing DII.

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