中国成人血清尿酸在脂肪摄入水平对肾功能损伤影响间的中介效应

郑涵; 田璐; 李岩志; 贾崇奇

doi:10.16462/j.cnki.zhjbkz.2021.05.010

中国成人血清尿酸在脂肪摄入水平对肾功能损伤影响间的中介效应

doi: 10.16462/j.cnki.zhjbkz.2021.05.010

250012 济南，山东大学齐鲁医学院公共卫生学院流行病学系

详细信息

通讯作者:
贾崇奇，E-mail：jiachongqi@sdu.edu.cn

中图分类号: R181.3+8
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出版历程
- 收稿日期: 2020-09-18
- 修回日期: 2020-12-19
- 网络出版日期: 2021-06-16
- 刊出日期: 2021-05-10

The mediating effect of serum uric acid on the association of fat intake with renal dysfunction among Chinese adults

Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China

More Information

Corresponding author: JIA Chong-qi, E-mail: jiachongqi@sdu.edu.cn

摘要

摘要: 目的探究血清尿酸(serum uric acid, SUA)在脂肪摄入水平与肾功能损伤关系中的中介效应。方法对来自2009年中国健康与营养调查(China Health and Nutrition Survey, CHNS)的8 187名具有完整血液检测信息的成人进行分析。肾功能损伤定义为肾小球滤过率(estimated glomerular filtration rate, eGFR)＜60 ml/(min/1.73m²)。通过计算脂肪摄入量占总能量摄入量的百分比来评估脂肪摄入水平。使用基于二分类Logistic回归分析模型的限制性立方样条(restrictive cubic spline, RCS)探究脂肪摄入水平与肾功能损伤之间的剂量反应关系。采用Karlson-Holm-Breen分解方法中的Logistic回归进行中介分析。结果脂肪摄入水平与肾功能损伤呈线性正相关(β=0.015, 95% CI: 0.007~0.023, P < 0.001)。SUA的中介作用占脂肪摄入水平对肾功能损伤总效应的13.33%(P=0.014)。结论在中国成年人中，脂肪摄入水平增加可能会增加肾功能损伤的风险，其可能通过引起SUA水平升高而导致肾脏损害的发生。
- 中介效应 /
- 血清尿酸 /
- 脂肪摄入水平 /
- 肾功能损伤 /
- 中国成人
Abstract: Objective To evaluate the association of high-fat diet with renal dysfunction and the mediating effect of serum uric acid. Methods Total 8 187 adult participants from the China Health and Nutrition Survey (CHNS) in 2009 with blood specimens were included in this national cross-sectional study. Renal dysfunction was defined as the estimated glomerular filtration rate (eGFR) < 60 ml/(min/1.73 m²). The fat intake level was assessed by the percentage of fat intake in total energy intake. Restrictive cubic spline (RCS) regression based on binary logistic regression analyses was used to explore the dose-response relationship between fat intake and renal dysfunction. Mediation analysis was conducted based on the Karlson-Holm-Breen method using Logistic regression. Results There was a linear positive relationship between fat intake level and the risk of renal dysfunction (β=0.015, 95% CI: 0.007-0.023, P < 0.001). The mediating effect of serum uric acid accounted for 13.33% of total effect of fat intake level on risk of renal dysfunction (P=0.014). Conclusions Increased fat intake level may increase the risk of renal dysfunction among Chinese adults, and serum uric acid may play a statistically significant mediatory role in the relationship between high-fat diet and renal dysfunction.
- Mediating effect /
- Serum uric acid /
- Fat intake level /
- Renal dysfunction /
- Chinese adults

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图 1 中介效应分析

注：^a：P＜0.05。

Figure 1. Mediation analysis

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表 1 不同脂肪摄入水平人群的一般特征[n(%)]

Table 1. Characteristics of subjects with different levels of fat intake [n(%)]

一般特征	脂肪摄入水平				χ²/F值	P值
一般特征	低(n=2 047)	中(n=2 047)	中高(n=2 047)	高(n=2 046)	χ²/F值	P值
年龄(x±s，岁)	49.65±14.86	50.01±14.85	50.31±14.80	51.91±15.15	9.090^a	< 0.001
性别					15.349^b	0.002
男	1 007(49.19)	999(48.80)	942(46.02)	898(43.89)
女	1 040(50.81)	1 048(51.20)	1 105(53.98)	1 148(56.11)
婚姻状况					16.617^b	0.001
其他	305(14.90)	290(14.17)	310(15.14)	377(18.43)
已婚	1 742(85.10)	1 757(85.83)	1 737(84.86)	1 669(81.57)
受教育水平					135.933^b	< 0.001
小学及以下	1 022(49.93)	929(45.38)	798(38.98)	812(39.69)
中学	701(34.24)	671(32.78)	676(33.03)	643(31.43)
高中及以上	324(15.83)	447(21.84)	573(27.99)	591(28.88)
体育锻炼
MET(小时/周)	91.60 (22.17, 176.63)	83.17 (21.00, 169.00)	80.47 (21.00, 170.55)	55.79 (19.00, 147.00)	50.027^c	< 0.001
吸烟
从不吸烟	1 373(67.07)	1 359(66.39)	1 442(70.44)	1 455(71.11)	18.052^b	0.006
过去吸烟	66(3.23)	73(3.57)	73(3.57)	59(2.88)
现在吸烟	608(29.70)	615(30.04)	532(25.99)	532(26.00)
饮酒	687(33.56)	690(33.71)	669(32.68)	642(31.38)	3.187^b	0.364
每日总能量摄入(kcal)	2 051.40±650.19	2 143.12±626.84	2 136.90±626.97	2 194.94±647.47	17.780^a	< 0.001
每日蔬菜和水果摄入(g)	286.42±151.94	295.75±155.11	287.41±151.37	284.14±136.91	2.370^a	0.069
每日嘌呤摄入量(mg/100 g)	346.29(233.74, 506.15)	428.66(290.85, 635.60)	488.59(322.42, 684.20)	526.16(370.10, 738.42)	518.440^c	< 0.001
BMI(kg/m²)	23.29±3.42	23.24±3.52	23.45±3.44	23.54±3.50	3.150^a	0.024
高血压	595(29.07)	651(31.80)	633(30.92)	655(32.01)	5.177^b	0.159
糖尿病	175(8.55)	190(9.28)	206(10.06)	242(11.83)	13.607^b	0.003
高血脂	932(45.53)	1 004(49.05)	1 032(50.42)	1 108(54.15)	31.220^b	< 0.001
心脑血管疾病	33(1.61)	57(2.78)	52(2.54)	47(2.30)	6.948^b	0.074
肾功能损伤	175(8.55)	244(11.92)	232(11.33)	321(15.69)	50.666^b	< 0.001
SUA(mg/dl)	5.10±1.85	5.21±1.79	5.14±1.67	5.30±1.80	4.900^a	0.002
农村	1 588(77.58)	1 488(72.69)	1 354(66.15)	1 072(52.39)	332.528^b	< 0.001
城市化指数	54.72(42.81, 73.00)	61.02(50.40, 84.69)	68.94(54.95, 86.67)	81.93(57.13, 90.27)	638.368^c	< 0.001
注：^a：单因素方差分析；^b：Pearson χ²检验；^c：Kruskal-Wallis检验。

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表 2 SUA水平在脂肪摄入水平和肾功能损伤之间的中介效应

Table 2. The mediating effect of serum uric acid levels between fat intake and renal dysfunction

效应	β值	s_x	(95% CI)值	Z值	P值	中介作用 (%)
总效应	0.015	0.004	(0.007~0.023)	3.60	< 0.001
直接效应	0.013	0.004	(0.005~0.021)	3.20	0.001	13.33
间接效应	0.002	0.001	(0.0003~0.003)	2.46	0.014

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