(3.9)--原文医学信息检索与利用.pdf

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1、ORIGINAL ARTICLEDietary intake and risk of rheumatoid arthritisa cross sectionmulticenter studyJingHe1&YuWang2&MinFeng1&XiaZhang1&Yue-BoJin1&XueLi1&Lin-ChongSu3&Shuang Liu1&Ai-Xue Wang4&Xiao-Mei Chen4&Li-Jun Wu4&Xiao-Xia Yu5&Ning Xu6&Xiang-Yuan Liu6&Hui-Ming Yan7&Yong-Fu Wang7&Bin Jia8&Jun-Fang Li8&

2、Jie-Mei Tao9&Feng-Xiao Zhang9&Ping Yu10&Liu-Fu Cui10&Jing Yang11&Zhen-Bin Li11&Jian-Li Xie12&Ping Wei12&Wen-Wen Sun13&Lu Gong13&Yong-Jing Cheng14&Ci-Bo Huang14&Xiao-Yuan Wang15&Yi Wang15&Hui-Fang Guo16&Hong-Tao Jin16&Xia Liu17&Guo-Chun Wang17&Yan-Hua Wang18&Lan He18&Yi Zhao19&Xiao-Xia Li19&Yan Zhang

3、20&Jian-Ping Guo1&Zhan-Guo Li1Received:19 March 2016/Revised:8 July 2016/Accepted:12 August 2016#The Author(s)2016.This article is published with open access at SAbstract Environmental factors play an important role in thedevelopment of rheumatoid arthritis(RA).Among these fac-tors,smoking is genera

4、lly considered to be an established riskfactor for RA.Data regarding the impact of diet on risk of RAdevelopment is limited.This study assessed the impact ofdietary patterns on RA susceptibility in Chinese populations.This was a large scale,case-control study composed of 968patientswithRAand 1037mat

5、ched healthycontrols.SubjectsJing He,Yu Wang and Min Feng have equally contributed to this work.*Jian-Ping G*Zhan-Guo L1Department of Rheumatology and Immunology,PekingUniversity Peoples Hospital,11 Xizhimen South Street,Beijing 100044,China2School of Statistics and The Center for Applied Statistics

6、,RenminUniversity of China,Beijing 100872,China3Department of Rheumatology and Immunology,UniversityHospital of Hubei University for Nationalities,Enshi 445000,China4Departmentof RheumatologyandImmunology,PeoplesHospitalofXinjiang Uygur Autonomous Region,Urumqi 830001,China5Department of Rheumatolog

7、y and Immunology,Cangzhou Hospitalof Integrated Traditional Chinese and Western Medicine of HebeiProvince,Cangzhou 061001,China6Department of Rheumatology and Immunology,Peking UniversityThird Hospital,Beijing 100191,China7Department of Rheumatology and Immunology,The First AffiliatedHospital of Bao

8、tou Medical College,Baotou 014010,China8Department of Rheumatology and Immunology,Hebei ProvinceCentral Hospital of Handan City,Handan 056001,China9Department of Rheumatology and Immunology,Hebei GeneralHospital,Shijiazhuang 050051,China10Department of Rheumatology and Immunology,Kailuan GeneralHosp

9、ital,Tangshan 063000,China11Department of Rheumatology and Immunology,BethuneInternational Peace Hospital,Shijiazhuang 050082,China12DepartmentofRheumatologyandImmunology,TheThirdAffiliatedHospital of Hebei Medical University,Shijiazhuang 050052,China13Department of Rheumatology and Clinical Immunol

10、ogy,GeneralHospital of Tianjin Medical University,Tianjin 300052,China14Department of Rheumatology and Immunology,Beijing Hospital,Beijing 100005,China15Department ofRheumatology and Immunology,LanzhouUniversitySecond Hospital,Lanzhou 730030,China16Department of Rheumatology and Immunology,The Secon

11、dHospital of Hebei Medical University,Shijiazhuang 050000,China17Department of Rheumatology and Immunology,China-JapanFriendship Hospital,Beijing 100029,China18Department of Rheumatology and Immunology,The First AffiliatedHospital of Xian Jiaotong University,Xian 710061,China19Department of Rheumato

12、logy and Immunology,Beijing XuanwuHospital,Beijing 100053,China20Department of Rheumatology and Immunology,The 309th Hospitalof Chinese Peoples Liberation Army,Beijing 100000,ChinaClin RheumatolDOI 10.1007/s10067-016-3383-xwererecruitedfrom18teachinghospitals.Socio-demographiccharacteristics and die

13、tary intakes 5 years prior to the onset ofRA were reported by a self-administered questionnaire.Differences in quantity of consumption between cases andcontrols were analyzed by Students t test.Multiple logisticregressionanalysis was appliedto identify independentdietaryrisk factor(s)responsible for

14、 RA susceptibility.Compared tohealthy individuals,RA patients had decreased consumptionof mushrooms(P=0.000),beans(P=0.006),citrus(P=0.000),poultry(P=0.000),fish(P=0.000),edibleviscera(P=0.018),and dairy products(P=0.005).Multivariate analyses revealed that several dietary items mayhave protective e

15、ffects on RA development,such as mush-rooms(aOR=0.669;95%CI=0.5180.864,P=0.002),citrusfruits(aOR=0.990;95%CI=0.9810.999,P=0.04),anddairyproducts(aOR=0.921;95%CI0.8670.977,P=0.006).Several dietary factors had independent effects on RA suscep-tibility.Dietary interventions may reduce the risk of RA.Ke

16、ywords Chinesepopulation.Dietaryfactors.Diseasesusceptibility.RheumatoidarthritisIntroductionRheumatoid arthritis(RA)is a chronic systemic inflammatorydisease that leads to progressive joint erosion and destructionand affects 0.51%of the population.RA is considered to be acomplex disease that is tri

17、ggered by both genetic and environ-mental factors,and the pathogenesis of RA has not yet beenfully elucidated.Recent advances in high-throughput genomescanning have enabled the identification of many genetic riskfactors that contribute to RA susceptibility.However,it hasbeen estimated that the genet

18、ic factors account for only 60%of the risk for RA susceptibility 1,while environmental andother non-genetic factors account for the remaining 40%.Among environmental factors,while only smoking is cur-rently considered to be an established risk factor for RA 2,3,other factors,such as diet,may contrib

19、ute to RA susceptibility.Diet is an environmental factor that affects inflammation,anti-gen presentation,antioxidant defense mechanisms,allergies,and gut microbiota,and the exact impact of diet on RA riskremains uncertain.Several case-control studies have suggestedthat omega-3 fatty acids,which are

20、present in fish,soybean,safflower,sunflower,and corn oils,may confer protectionagainstRA4,5.AlcoholmayreducetheriskofRAinwomen6.Whilereactiveoxygenspecies(ROS)areproducedinrheu-matoid joints 7,the roles of dietary factors such as antioxi-dants and vitamins in the pathogenesis of RA remain unclear.Vi

21、tamin C is both an intracellular and an extracellular scaven-ger of ROS,and in models of rat adjuvant arthritis supplemen-tation with vitamin C contributed to improved arthritis scores,evidenced by a reduction in paw volume 8,9.However,thereis little clinical evidence on the effects of antioxidants,

22、such asvitamins E and C,on individuals with RA 10,11.A 2-yearstudy on the effects of the Mediterranean diet on RA patientsrevealed that the consumption of cereals,vegetables,legumes,fruits,and olive oil decreased the risk of new onset of inflam-matory polyarthritis 12.While there is evidence on the

23、effects of diet on RA path-ogenesis in Western populations,there is little information todate concerning the impact of diet on the development of RAin Chinese populations.Here,we assess the impact of dietaryfactors on the development of RA in Chinese populations.Patients and methodsStudy populationA

24、 total of 968 RA patients and 1037 ethnic and geographicallymatched healthy controls were recruited from 18 hospitals(Fig.1).All RA patients fulfilled the American College ofRheumatology(ACR)criteria for RA 13.Healthy controlswere randomly selected from medical workers without any his-tory of chroni

25、c diseases.A self-administered food frequencyquestionnaire(FFQ)was designed to measure socio-demographic characteristics and dietary intakes.Patients wereaskedtocompleteadetailedweeklyretrospectiveFFQ(i.e.,overthelast5yearspriortoRAonset).Healthycontrolswererequiredto complete a similar weekly retro

26、spective FFQ,to gather infor-mation on their dietary intakes for the previous 5 years.FFQswerecodedandanalyzed.The patientsandhealthycontrolswithincomplete data from FFQs were excluded from the study.The study was conducted in China between May 2012 andSeptember 2013.A survey was designed following

27、theFig.1 Patient flow chart.RA rheumatoid arthritis,HC healthy controls.A total of 968 RA patients and 1037healthy controls were recruited from18 hospitalsClin Rheumatolguidelines established by the Chinese RheumatologyAssociation(CRA).The study was approved by the MedicalEthics Committee of Peking

28、University Peoples Hospital.Informed written consent forms were obtained from all studyparticipants.Demographic dataDemographics and personal characteristics were gathered,in-cludinggender,age,maritalstatus,education,occupation,per-sonal income,height,and weight.Dietary assessmentDietary assessmento

29、ntheFFQincludesthefrequency and theamount of dietary intake.The frequency of red meat,poultry,fish,edible viscera,vegetables,potatoes,mushrooms,beans,nuts,milk or yogurt,eggs,citrus,and other fruit except forcitruswasmeasuredwitharesponserangefrom1to8(1=lessthan once per month,2=13 times per month,3

30、=12 timesper week,4=34 times per week,5=56 times per week,6=1timeperday,7=2timesperday,and8=3ormoretimesperday).Theintakeamountperservingofrice,flourmeal,redmeat,poultry,fish,edible viscera,vegetables,potatoes,mush-rooms,beans,and nuts was measured with a response rangefrom 1 to 4(1=50 g or less,2=5

31、0100 g,3=100150 g,4=150200 g ormore).The amountofeggs,citrus,and otherfruit except for citrus was measured with a response rangefrom 1 to 5(1=1/2 or less,2=1/22/3,3=2/31,4=12,5=23 or more).The intake amount per serving of milk oryogurt was measured with a response range from 1 to 5(1=50 ml or less,2

32、=5075 ml,3=75100 ml,4=100200 ml,5=200300 ml or more).The total amount of dietaryintake per month of a food item is equal to the intake amountper serving ofthatfood item the frequency ofdietary intake.Statistical analysesDifferences in quantity of consumption between cases andcontrols were assessed u

33、sing t test analyses.Multiple logisticregression analysis was applied to identify independent die-tary risk factor(s)responsible for RA susceptibility.Odds ra-tios(ORs)with 95%confidence intervals(CIs)were calcu-lated to estimate the relative risk.P values less than 0.05 wereconsidered significant.R

34、esultsDemographic profile of RA patientsThe study subjects were mainly recruited from two ethnicgroups:Han(n=913)and Hui(n=18).Additionally,therewere 37 subjects coming from other ethnic groups,includingMan(n=27),Mongol(n=7),Yi(n=1),and Zhuang(n=1).The demographic characteristics of patients and con

35、trols areshown in Table 1.Dietary intakes in RA patients and healthy controlsThe results of the dietary intakes of both groups are shown inFig.2 and Table 2.Compared with healthy controls,RA pa-tients consumed lower amounts of chicken(P=0.0001),fish(P=0.0001),mushrooms(P=0.0001),beans(P=0.006),dairy

36、 products(P=0.005),citrusfruits(P=0.000),and organmeats(P=0.018).There were no significant differences inconsumption of red meat between RA patients and healthycontrols.Comparison of dietary intake between Han and Huipopulations in both RA and HC groupsWe compared the dietary consumption between the

37、 Han andHui populations in the RA and HC cohorts,respectively.Asshown in Table 3,except for dairy products,there were nosignificant differences in dietary consumption between Hanand Hui groups.Comparison of dietary intakes between Han and non-Hanin both RA and HC groupsWe compared the dietary consum

38、ption between the Han andnon-Han populations in both RA and HC groups.Han peoplewith RA intake more fish and less dairy products than non-Table 1Characteristics of RA patients and healthy controlsRA(n=968)HC(n=1037)Gender(%)Male202(20.9)220(21.2)Female766(79.1)817(78.8)Age(years),(mean SD)52.1 13.44

39、9.7 15.2Age group(years),(%)2022(1.3)27(2.6)213050(5.2)76(7.3)314083(8.7)88(8.5)4150183(19.1)237(22.9)5160324(33.8)370(35.7)6170212(22.1)160(15.4)7194(9.8)79(7.6)Ethnicity(%)Han913(94.3)967(93.2)Hui18(1.9)20(1.9)Others37(3.8)50(4.8)RA rheumatoid arthritis,HC healthy controlsClin RheumatolHan people

40、with RA.There were no other significant differ-ences in dietary consumption between the Han and non-Hangroups(Table 4).Dietary intake as independent risk factor for RAdevelopmentThe multivariate analyses revealed that females and individ-uals older than 50 years of age were more susceptible to RA(Ta

41、ble5).Consumptionofseveraldietaryitemswereindepen-dent factors for higher risk of RA development,includingpotatoes(OR=1.160;95%CI=1.0351.300,P=0.011)and fruits except for citrus fruits(OR=1.013;95%CI=1.0031.023,P=0.013).In contrast,some dietary itemswere found to have protective effects on RA,includ

42、ing mush-rooms(OR=0.669;95%CI=0.5180.864,P=0.002),dairyproducts(OR=0.921;95%CI=0.8670.977,P=0.006),and citrus fruits(OR=0.990;95%CI=0.9810.999,P=0.040).Consumption of red meats,fruits,and vegetableswas not found to have any effect on RA risk.The analysesrevealed that higher intakes of carbohydrates

43、and lower in-takes of dairy products,mushrooms,and citrus fruits mayassociate with RA development.There was a trend for highintakes of fish(OR=0.864;95%CI=0.6471.156,P=0.325)and beans(OR=0.938;95%CI=0.8111.086,P=0.391)to have protective effects against RA,though thesedid not reach statistical signif

44、icance.Additionally,no signifi-cant associations were observed between the consumption ofred meat and RA risk.DiscussionThe etiology of RA remains an area of considerable interest.RA is triggered by genetic factors;however,environmentalfactors may also play a role in the pathogenesis of RA.Dietary a

45、nd lifestyle factors(e.g.,smoking)2,3 contributeto RA.Smoking is so far the most well-established environ-mental risk factor for development of RA 2,3.Additionally,infectiousagentssuchasviruses,bacteria,andfungihavelongbeen suspected risk factors for RA,but there is no conclusiveevidence to support

46、the hypothesis 14.Influences of otherenvironmental factors on RA,such as hormones,have alsobeensuggested.HormonesarebelievedtoinfluenceRAbasedonthefactthatfemalesaremorepronetodevelopRAthanaremen,with a peak onset at 5060 years of age 1,15.Salminen et al.15 reported that 3375%patients believethat fo

47、od plays an important role in their symptom severityand approximately 50%will have tried dietary manipulationin an attempt to improve their symptoms.Diets rich in fiber,omega-3 fatty acids,and antioxidants,and low in red meathave been reported associated with decreased RA risks051015Red meatPoultryF

48、ishVisceraVegetablesPotatoMushroomBeanNutsDairy productsEggsCitrusOther fruitsRAHCKg or unit per monthFig.2 Dietary intakes of RA patients and healthy controls(HC).Compared with healthy controls,RA patients had higher amount ofconsumption in potatoes and lower amount of consumption in chicken,fish,m

49、ushrooms,beans,dairy products,citrus fruits,and organ meats.There were no significant differences in consumption of red meatbetween RA patients and healthy controlsTable 2 Differences in monthlydietary consumption between RApatients and healthy controlsRA(n=968)aHC(n=1037)aPRed meat(kg/month),mean S

50、D1.688 1.6211.911 1.6200.363Poultry(kg/month),mean SD0.339 0.4980.521 0.8900.000Fish(kg/month),mean SD0.361 0.5460.526 1.0290.000Edible viscera(kg/month),mean SD0.139 0.2240.195 0.6350.018Potatoes(kg/month),mean SD1.275 1.8841.015 1.0950.001Vegetables(kg/month),mean SD5.465 4.3684.997 3.9120.020Mush