The Associations Between Dietary Intake And Metabolic Syndrome Prevalence

Objective:The aim of this study was to examine the metabolic syndrome prevalence and its associated factors among Chinese adults.And examine the association between dietary factors and metabolic syndrome prevalence.Methods:This study based on two national representative cross-sectional surveys:2010-2012 China National Nutrition and Health Survey(CNNHS)and 2015 China Choronic Diseases and Nutrition Survey.Metabolic syndrome was defined according to the updated NCEP ATP III criteria.This study selected participants aged 18 years and older.We explore the metabolic syndrome prevalence and its associated factors and the association between dietary intake and metabolic syndrome prevalence in four parts.The part one study aimed to explore the metabolic syndrome prevalence and its associated factors.Participants of cross-sectional study one:we excluded participants with missing data on waist circumference,triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),blood pressure,and fasting plasma glucose.Participants with incomplete information on education level,smoking status,drinking status,and physical activity were further excluded.A total of 98,042 participants were included for the analysis.Participants of cross-sectional study two:we excluded participants with missing data.A total of 169,593 participants were included for final analysis.Multivariable logistic regression model and decision tree model were performed to examine the associations between factors with metabolic syndrome prevalence.The part two study aimed to examine the association between metabolic syndrome prevalence and dietary patterns in two cross-sectional study.Participants of cross-sectional study one:we further excluded participants with diabetes,hypertension,dyslipidemia and incomplete dietary information based on participants of part one study.We included 27,514 participants in the final analysis.Participants of cross-sectional study two:A total of 53,241 participants were included for the final analysis.We used factor analysis to explore the main dietary patterns of participants.Multivariable logistic regression model and structural equation model were performed to examine the associations between dietary patterns with metabolic syndrome prevalence.The part three study aimed to examine the association between metabolic syndrome prevalence and dietary patterns in case-control study.Based on 2015 China Choronic Diseases and Nutrition Survey data,we excluded participants with missing data on waist circumference,triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),blood pressure,and fasting plasma glucose and with incomplete information on education level,smoking status,drinking status,and physical activity.Participants with diabetes,hypertension,dyslipidemia and incomplete dietary information were further excluded.According to the principle of the same gender and age,we matched one non-metabolic syndrome participant for each metabolic syndrome participant as the control.A total of 10,746 pairs(21,492 participants)were included for the final analysis.Cox regression model was used to calculate the OR(95%CI)of the metabolic syndrome prevalence.The part four study aimed to examine the association between foods intake and metabolic syndrome prevalence.The study participants were the same as the part two.Logistic regression model was performed to calculate the OR(95%CI)of the metabolic syndrome prevalence.Restricted cubic spline model was used to further analyze the dose-response relationship between foods intake and metabolic syndrome prevalence.Receiver-operating characteristic(ROC)curves analysis was used to evaluate the predictive accuracy discrimination of metabolic syndrome prevalence models incorporating traditional risk factors with and without dietary factors and body mass index(BMI).Results:Based on the NCEP ATP III criteria,the prevalence of abdominal obesity,elevated blood pressure,fasting plasma glucose and triglyceride,decreased high-density lipoprotein cholesterol(HDL-C),and metabolic syndrome was 26.8%,35.7%,25.3%,25.1%,48.1%and 24.2%in 2010-2012.The prevalence of abdominal obesity,elevated blood pressure,fasting plasma glucose and triglyceride,decreased HDL-C,and metabolic syndrome was 31.6%,40.4%,30.0%,28.7%,39.7%and 31.7%in 2015.Metabolic syndrome prevalence was associated with age,gender,educational level,smoking status,and physical activity level.The cross-sectional study on the association between dietary patterns and metabolic syndrome showed that the main dietary patterns of participants were not changed from 2010-2012 to 2015.We used factor analysis to explored main four dietary patterns:legume-vegetable dietary pattern,dairy-snacks dietary pattern,animal foods dietary pattern,and main-food dietary pattern.Logistic regression analysis showed that participants with higher animal foods dietary pattern scores had an increased metabolic syndrome prevalence.Structural equation model analysis showed that legume-vegetable and dairy-snacks dietary patterns were negatively associated with metabolic syndrome,animal foods and main-food dietary patterns were positively associated with metabolic syndrome.The case-control study on the association between dietary patterns and metabolic syndrome We used factor analysis to explored main four dietary patterns:seafood-vegetable dietary pattern,dairy-fruit dietary pattern,alcohol-meat dietary pattern,and main-food dietary pattern.Cox regression analysis showed that dairy-fruit dietary pattern was negatively associated with metabolic syndrome.Compared with the first percentile of the dietary score,the OR(95%CI)was 0.81(0.66-1.00),0.71(0.57-0.88),and 0.69(0.56-0.86)for the 3-5 percentiles of the dietary score.Sensitivity analysis showed that there existed interactional association between dairy-fruit dietary pattern and BMI on metabolic syndrome prevalence.Among normal participants,dairy-fruit dietary pattern was negatively associated with metabolic syndrome.Compared with the first percentile of the dietary score,the OR(95%CI)was 0.61(0.44-0.85)and 0.68(0.48-0.95)for the 4-5 percentiles of the dietary score.Among participants with low-body weight,overweight,and obesity,there was no association between dairy-fruit dietary pattern and metabolic syndrome(P-trend>0.05).Logistic regression analysis showed that the intake of rice,wheat,other livesock meat,and eggs may associate with metabolic syndrome prevalence.The results of restricted cubic spline model showed that there were nonlinear dose-response association between the intake of rice,wheat,other livesock meat,and eggs with metabolic syndrome prevalence.ROC curves analysis showed that addition of dietary factors and BMI to the metabolic syndrome prevalence prediction model can improve the discrimination of metabolic syndrome prevalence.Conclusion:From 2010-2012 to 2015,the metabolic syndrome prevalence shows an increasing trend among participants aged 18 years and older in China.The prevalence of metabolic syndrome is associated with age,gender,educational level,smoking status,and physical activity level.Different study design showed different associations between dietary patterns and metabolic syndrome.Metabolic syndrome prevalence was associated with the intake of rice,wheat,other livesock meat,and eggs.