| Objective:To analyze the prevalence and control of glucolipid metabolic disorder among middle-aged and olders of China,to evaluate and compare dietary intake and nutritional status among different glucolipid metabolic type by gender and age groups,to compare distribution of glucolipid metabolic disorder by anthropometric index,and to put forward lifestyle advice on glucolipid metabolic disorder prevention and control.Methods:Data was from National Nutrition and Health Surveillance(2010y to 2013y).Participants aged 45y and above were collected as our samples.Basic information,lifestyle condition,dietary intake were conducted by face to face interview,anthropometric indicators such as height,weight and waist circumference were measured by standard criteria,fasting and 2-hour postprandial blood glucose were tested by glucose oxidase,fasting serum lipids level such as total cholesterol,triglyceride and high-density lipoprotein cholesterol were tested accordingly by cholesterol oxidase method,glycerol phosphate oxidase method and direct method by automatic biochemical analyzer respectively.Glucolipid metabolic disorder was diagnosed by criteria of"Diagnosis and classification of diabetes mellitus of WHO on 1999" and "Chinese adult dyslipidemia prevention guideline(2007 revision)".Estimate of prevalence and control of glucolipid metabolic disorder were calculated by complex weighing adjustment procedure according to demographic data published by national bureau of statistics in 2009.Covariance analysis was applied to compare the difference between glucolipidmetabolic disorder type and dietary status by gender and age strata,complex sampling weighted adjustment of logistic regression was applied to analyze the relationship between glucolipid metabolic disorders with influencing factors.As for difference compare among anthropometric index(BMI,WC and WHtR)and glucolipid metabolic disorder we also selected covariance analysis.ROC curve was used to determine the cut-off of three anthropometric index to diagnose glucolipid metabolic disorders.Results:Part one:The adjusted total prevalence of pre-diabetes and diabetes among 71318 middle-aged and olders was 13.5%(95%CI:12.0%-15.0%)and 11.5%(95%CI:10.6%-12.5%)respectively.The sub-prevalence of pre-diabetes and diabetes by age groups were significantly different,which were 11.7%(95%CI:10.2%-13.1%)and 9.7%(95%CI:8.8%-10.5%)in 45y to 59y group,15.8%(95%CI:14.1%-17.4%)and 14.6%(95%CI:13.3%-15.9%)in 60y to 74y group,19.4%(95%CI:17.1%-21.7%)and 14.6%(95%CI:12.5%-16.7%)in 75y and above group.There pre-diabetes and diabetes prevalence distribution in urban or rural areas,gender,family income and educational level,smoking,drinking,exercise and family chronic diseases history were significantly different.The adjusted mean level of TC,TG,HDL-C and LDL-C were 4.80 mmol/L(95%CI:4.73-4.86 mmol/L),1.49 mmol/L(95%CI:1.45-1.52 mmol/L),1.21 mmol/L(95%CI:1.18-1.23 mmol/L)and 2.94 mmol/L(95%CI:2.88-3.00 mmol/L),the adjusted mean ratio of' TC and HDL-C was 4.28(95%CI:4.20-4.35)and the mean atherosclerosis index was 3.80(95%CI:3.73-3.86).Participants with pre-diabetes and diabetes had significantly higher levels of TC,TG and LDL-C,higher ratios of TC and HDL-C as well as higher AI but lower levels of HDL-C compared those with normal glucolipid level.The prevalence of dyslipidemia among different glucose status was significanlty different,the estimates were 39.7%(95%CI:37.4%-42.0%)in normal glucose group,47.8%(95%CI:44.3%-51.2%)in pre-diabetes group and 60.0%(95%CI:56.8%-63.2%)in diabetes group respectively.Alone with age increase,there was a trend of decline of dyslipidemia prevalence among different glucose status(P_trend<0.0001).Similarly,the dyslipidemia prevalence distribution among glucose status were significantly different in urban or rural areas,gender,family income and educational level,smoking,drinking,exercise,family chronic diseases history and body mass index groups.The adjusted proportion of awareness,treatment and control of diabetes was 51.7%,49.8%and 35.7%,respectively.Nevertheless,the awareness,treatment and control proportion of dyslipidemia among pre-diabetes and diabetes were just 14.3%vs 27.6%,11.9%vs 24.8%,4.9%vs 9.2%,respectively.Part two:As shown in dietary intake among different glucolipid metabolic type in 45-59y age group,food items such as rice and products,wheat and products,aquatic products,prok,fruits and alcohol intake,macronutrients such as proportion of energy from protein in glucolipid metabolic disorder groups were significantly different from that in normal glucose and lipid group,especially higher of aquatic products,pork and proportion of energy from protein in diabetes with dyslipidemia group than that in normal group(P<0.05);while in 60-74y age group,the major difference was shown in rice and products,other cereal products,other livestock meat,fruits,milk,aquatic products and edible oil intake,as well as carbohydrate intake and proportion of energy from protein between different glucolipid groups,lower rice and products and lower carbohydrate intake,higher egg and milk intake and higher energy from protein were significantly in diabetes with dyslipidemia group than that in normal group(P<0,05).Moerover,pre-diabetes with dyslipidemia in 75y and above group consumed higher pork,milk,protein and energy from protein than that in normal group aged 75y and above,the difference were statistically significant(P<0.05).Nevertheless,there was no significant difference in dietary fat intake and proportion of energy from fat among glucolipid metabolic types.Logistic regression analysis results demonstrated that glucolipid metabolic disorders positively associated with older age,smoking,higher BMI and centrol obesity,whereas negatively associated with female and drinking.Part three:with the increase of age,the mean BMI level decreased both in male and female,while the waist circumeference in female increased from 45-59y group to 60-74y group and then declined in 75y and above,and there was a trend of increase of WHtR with age in female(P<0.05).After calculated quintile of BMI,WC and WHtR,we found that TC,TG and LDL-C level increased with BMI but HDL-C level decreased with BMI(P_trend<0.05).Meanwhile,diabetes and dyslipidemia proportion increased with BMI,WC and WHtR.However,the proportion of diabetes and dyslipidemia reached the highest status at the 80th percentage of BMI(26.9 kg/m2)in the 45-59y group and 60-74y group,while highest at the 60th percentage of BMI(24.8 kg/m2)in the 75y and bove group and then declined at the 80th percentage.Different with BMI,when waist circumference and WHtR was in their 80th percentage(WC=91.1cm and WHtR=0.57),there was still a raising trends of prevalence of glucolipid metabolic disorder.BMI upper than 24.1 kg/m2 for male and 24.5 kg/m2 for female,waist circumference higher than 87.7cm for male and 86.2cm for female,and WHtR higher than 0.53 for male and 0.54 for female would increase the prevalence of glucolipid metabolic disorder among middle-aged and olders of China.Conclusion:This research demonstrated that glucolipid metabolic disorders might have reached a very high level of prevalence but much lower level of awareness,treatment and control proportion among Chinese middle-aged and older population.Epidemic of glucolipid metabolic disorders resulted from the interaction of social economic factors and lifestyle stations.Participants with glucolipid metabolic disorder should consume appropriately animal food items represented by pork but improve cereals,tuber and soybean products.The different association between glucolipid metabolic disorder with BMI,WC and WHtR suggested that control BMI and waist circumference mightbe benifitial for prevention and control of glucolipid metabolism disorder among middle-aged and olders of China. |
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