目的:评估2型糖尿病患者补充鱼油和血浆omega3多不饱和脂肪酸(n-3PUFA)与大血管和微血管并发症风险的关系,并进一步探讨代谢相关生物标志物的潜在中介作用。
方法:本研究包括来自英国生物银行的20,338名2型糖尿病患者。通过医院住院记录确定糖尿病并发症。
结果:在13.2年的随访中,5396人出现了大血管并发症,4,868人出现了微血管并发症。经过多变量调整后,对于复合大血管并发症,鱼油患者的风险比(HR)和95%置信区间(CIs)为0.90(0.85,0.97),0.91(0.84,0.98)用于冠心病(CHD),外周动脉疾病为0.72(0.61,0.83);复合微血管并发症为0.89(0.83,0.95),0.87(0.79,0.95)用于糖尿病肾病,糖尿病性视网膜病变为0.88(0.80,0.97)。此外,较高的n-3PUFA水平,尤其是二十二碳六烯酸(DHA),与大血管和微血管并发症的风险较低相关。比较血浆DHA的极端四分位数,复合大血管并发症的HR(95%CI)为0.68(0.57,0.81),冠心病为0.63(0.51,0.77);糖尿病性神经病为0.59(0.38,0.91)。此外,包括血脂和炎症在内的生物标志物共同解释了54.4%和63.1%的血浆DHA与复合大血管并发症和CHD风险的关联。
结论:习惯性使用鱼油补充剂和较高的血浆n-3PUFA水平,尤其是DHA,与2型糖尿病患者的大血管和微血管并发症的风险较低相关,有利的关联部分是通过改善脂质分布和炎症的生物标志物介导的。
OBJECTIVE: To evaluate associations of fish oil supplementation and plasma omega 3 polyunsaturated fatty acids (n-3 PUFAs) with risks of macrovascular and microvascular complications among people with type 2 diabetes, and to further explore the potential mediating role of metabolism-related biomarkers.
METHODS: This study included 20,338 participants with type 2 diabetes from UK Biobank. Diabetic complications were identified through hospital inpatient records.
RESULTS: During 13.2 years of follow-up, 5,396 people developed macrovascular complications, and 4,868 people developed microvascular complications. After multivariable adjustment, hazard ratios (HRs) and 95% confidence intervals (CIs) for patients with fish oil were 0.90 (0.85, 0.97) for composite macrovascular complications, 0.91 (0.84, 0.98) for coronary heart disease (CHD), 0.72 (0.61, 0.83) for peripheral artery disease; and 0.89 (0.83, 0.95) for composite microvascular complications, 0.87 (0.79, 0.95) for diabetic kidney disease, and 0.88 (0.80, 0.97) for diabetic retinopathy. In addition, higher n-3 PUFA levels, especially docosahexaenoic acid (DHA), were associated with lower risks of macrovascular and microvascular complications. Comparing extreme quartiles of plasma DHA, the HRs (95% CIs) were 0.68 (0.57, 0.81) for composite macrovascular complications, 0.63 (0.51, 0.77) for CHD; and 0.59 (0.38, 0.91) for diabetic neuropathy. Moreover, biomarkers including lipid profile and inflammation collectively explained 54.4% and 63.1% of associations of plasma DHA with risks of composite macrovascular complications and CHD.
CONCLUSIONS: Habitual use of fish oil supplementation and higher plasma n-3 PUFA levels, especially DHA, were associated with lower risks of macrovascular and microvascular complications among individuals with type 2 diabetes, and the favorable associations were partially mediated through improving biomarkers of lipid profile and inflammation.