| Objective: To understand dietary diversity and the prevalence of type 2 diabetes mellitus(T2DM)in rural population of Yili,Xinjiang,to analyze the association between dietary diversity and T2 DM,and to explore the etiology of T2 DM from the perspective of amino acid metabolites,in order to provide a research basis for the precise prevention and control and targeted intervention of T2 DM in the future.Methods:(1)In the first part,the cross-sectional survey method was adopted to study the population aged 35-74 years recruited in Yili for "Research on the Construction and Follow-up of Multi-ethnic Natural Population cohort in Xinjiang".Questionnaire survey,physical measurement,dietary survey and blood sample collection were conducted.Dietary diversity score(DDS)and food diversity score(FVS)were calculated,and logistic regression analysis was used to screen the risk factors related to behavior and dietary diversity of T2DM;(2)Based on the first part of the baseline study population,combined with the national physical examination data from 2017 to 2019,new T2 DM patients from 2017 to 2019 were screened out according to the diabetes disease history registered with chronic disease and blood glucose level.According to the results of single factor analysis of new diabetes,using the method of radius of propensity score matching and propensity score matching method in the recent to select the new diabetes patients of control group,and analyzed the association between DDS and FVS with risk of new type 2 diabetes;(3)Based on the previous study,110 T2 DM patients and 220 non-T2 DM patients were selected as baseline subjects.A case-control design was used to detect amino acid metabolomics based on ULTRA-performance liquid chromatography-tandem mass spectrometry(UPLC-MC),and logistic regression and ridge regression analysis were used to screen characteristic amino acids of T2 DM.The mediating role of BMI in the association between characteristic amino acids and risk of T2 DM was investigated by using mediation analysis.Results:First: 1)A total of 8011 subjects were investigated in this study,and the average age of the subjects was(51.12±9.99)years old.Among them,4245 were females,accounting for53.00%,and 3766 were males,accounting for 47.00%.The Hui accounted for the highest proportion of 33.30%,followed by Uygur,Kazak,Han and other ethnic groups,accounting for 28.30%,22.90%,13.70% and 1.80%.2)DDS of the subjects were mainly3-4 points,and the scores of the young and the female were higher.FVS was mainly 7-10,and the score of food diversity was higher in younger age and female.The dietary intake of the subjects was mainly pasta and meat.Eggs,beans and their products were infrequent,edible oil was mainly sunflower seed oil,carbonated drinks and various snacks were infrequent.3)A total of 668 cases of T2 DM were screened out in this baseline survey,with a prevalence rate of 8.34%.Multivariate analysis showed that DDS was associated with the risk of T2 DM,but FVS was not.Further analysis of food categories showed that there were statistical differences in the intake of staple food,red meat,fresh fruit,eggs and beans between T2 DM and non-T2 DM groups.Second: 1)A total of 136 cases of newly diagnosed T2 DM were screened from 2017 to 2019,with an incidence of 1.82%.Analysis of different ethnic groups showed that Uyghur accounted for the highest proportion of new T2 DM patients,followed by Hui and Kazak.BMI analysis showed that the incidence of T2 DM in overweight and obese group was significantly higher than that in normal weight group,and the difference was statistically significant.2)The propensity score radius matching method was used to analyze the association between DDS and FVS and the incidence of new T2 DM.The results showed that the distribution of DDS in different groups was statistically different,and the DDS score in the case group was lower than that in the control group.The FVS score of newly diagnosed T2 DM was lower than that of non-T2 DM,but the difference was not statistically significant.3)The association between DDS and FVS and newly diagnosed T2 DM was analyzed by using the tendency score nearest matching method.The results showed that the distribution of DDS in different groups was statistically different,and the DDS score in the case group was lower than that in the control group.The FVS score of newly diagnosed T2 DM was lower than that of non-T2 DM,but the difference was not statistically significant.4)Further analysis of food groups showed that there were statistical differences in the intake of red meat,fresh fruit and beans between T2 DM and non-T2 DM groups.Third: 1)Amino acid metabolomics detection,a total of five characteristic amino acids were screened out and correlated with dietary diversity score,namely,serine,leucine,isoleucine,aspartic acid and lysine.2)The specific amino acids leucine,isoleucine,phenylalanine,valine and threonine were screened out by multi-factor analysis based on ridge regression analysis.3)The mediating analysis showed that BMI partially mediated the effect of leucine and valine on the risk of T2 DM.Conclusions:(1)The overall dietary diversity level of the study population was low,and dietary intake was mainly pasta and red meat,with low intake of eggs and beans.Dietary diversity score was associated with the risk of T2 DM,and the higher the score was,the lower the risk of T2 DM,providing the latest evidence for precise dietary intervention strategies for T2 DM.(2)Two characteristic metabolic markers of amino acids,leucine and isoleucine,were found to be associated with dietary diversity score and T2 DM,which could be used for early prediction and recognition of high-risk population and provide important clues for further exploration of etiological mechanism.(3)BMI played an important role in the metabolic markers of leucine and isoleucine and the risk of T2 DM,which preliminarily verifies the etiological role of characteristic amino acids in T2 DM and provides an important basis for targeted intervention. |
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