| ObjectivesTo investigate the dining out status of adult residents in rural areas of Henan and the influencing factors of eating out behaviors,to study the dose-response relationship between the frequency of eating out and the risk of type 2 diabetes mellitus(T2DM)and the possible mediators' factor.Thus,providing valid scientific evidence for prevention of T2DM through dietary behavior.MethodsThe research participants were from the Henan Rural Cohort Study(Chi CTR-OOC-15006699).Using the cluster sampling method with village as the unit,39,259 adults aged 18-79 years old were selected from Yima,Xinxiang,Tongxu,Suiping,and Yuzhou as the research participants.A total of 29,910 subjects were included(17,733 femal es and 12,177 males),9349 people were excluded if they:(1)did not have information about T2DM and dining out;(2)were diagnosed with type 1 diabetes and malignant tumors.Information was collected through dietary questionnaires,biochemical examinations and physical measurements.Cross-sectional study was used to evaluate the current situation and influencing factors of eating out in rural population of Henan.The association between eating out frequency and type 2 diabetes was evaluated by using multivariate logistic regression and restricted cubic spline analysis,and using the software PROCESS in SPSS25.0 to analyze the mediating effect of body mass index(BMI)on the frequency of dining out and T2DM.Results1.Among the 29,910 subjects included,the mean age was 55.44 ± 12.36 years old,of which 12,177 were males,accounting for 40.71%;females were 17,733,accounting for 59.29%;the proportion of people in this study who had dining out was 12.37%,among men the odds ratio was 23.05%;there were 2,632 T2DM patients,and the crude prevalence was 8.80%.2.When eating out,meat,poultry,fish and shrimp,milk and related products,beans and related products,nuts and grains and their products had a higher intake than those who did not dine out,while staple food and vegetable intake were lower than in the dining at home behavior group(P<0.001).The mean daily intakes of energy,protein,fat,vitamin A,dietary fiber,vitamin E,calcium,magnesium,and iron were higher when eating outside,while the average daily intakes of carbohydrates and vitamin C was lower than those who did not eat out(P<0.05).3.Unmarried or divorced or widowed,education level was high school or above,and the mean monthly incomes was 500-1000 yuan,smoking,central obesity or whole body obesity and alcohol drinking were favorable factors for eating out,according to the results of multivariate logistic regression analysis;women,moderate physical activity,age?60 years,family members was 2,and the dietary pattern of vegetables and fruits(mode III)which was disadvantageous for dining out factor.4.Adjusting for potential confounding factors,compared with those who had not away from home meals,the ratio of the incidence of T2DM among subjects who ate out 11 or more times a week was 1.39(95%CI:1.08-1.80).There was a non-linear dose-response association between the frequency of away from home meals and T2DM(P<0.05 and Ptrend>0.05).For each additional frequency of eating out a week and a standard deviation(3.19),the risk of T2DM increased by 2%(95%CI:1%-3%)and 6%(95%CI:1%-10%).A subgroup analysis based on gender showed that there was an association between eating out frequency in men and total(P<0.05),but it was not observed in women(P>0.05).The OR of T2DM was 1.36(95%CI:1.01-1.84)in men who ate out meals more than 11 times per week,and also showed a non-linear dose-response relationship between meal frequency and T2DM in men(P<0.05 and(Ptrend>0.05),the risk of T2DM increased by 2%(95%CI:1%-4%)for each additional meal frequency per week.Similar results were not found in women.5.After controlling for potential confounding variables,the results of the intermediary analysis showed that the OR of the total effect of frequency of eating out on T2DM was 1.018(95%CI:1.004,1.033)(P=0.006).This total effect includes the direct effect of frequency of eating out on T2DM and indirect effects of BMI mediation,the proportion of mediation effects was 23.4%,and approximately 23.4%of the increase in T2DM prevalence due to the frequency of eating out was attributed to high BMI(Sobel test=5.22,P<0.001).Conclusions(1)People who dine out in rural areas of Henan consume more animal foods,beans,nuts and grain foods than those who eat at home,so their intakes of nutrients such as energy,fat,protein and dietary fiber are also higher.(2)People in rural areas of Henan who are male,relatively higher education level,higher-income,unmarried/divorced/widowed,smoking,light physical activity,obesity,alcohol drinking and dietary pattern of the "meat(poultry,fish,shrimp,and meat)" are more likely to choose to eat out.(3)Among rural people in Henan,the frequency of away-from home meals is positively correlated with T2DM,and there is a nonlinear dose reaction relationship.(4)In rural population of Henan province,the effect of BMI partial intermediary dining out on T2DM disease risk. |
PDF Full Text Request