美国马萨诸塞州综合医院Jordi Merino团队，进行了一项膳食脂肪质量与2型糖尿病的遗传风险：个体参与者数据的荟萃分析。相关论文发表在2019年8月10日出版的《英国医学杂志》上。

本项研究的目的是探讨2型糖尿病的遗传负担是否改变了膳食脂肪质量与2型糖尿病发病率之间的关系。通过在主要医学数据库（Medline、Embase和Scopthem）中检索，研究人员系统地对1970年1月至2017年2月期间发表的论文进行了符合条件的前瞻性队列研究。共有102305名参与者，中位随访12年后，有20015例患上2型糖尿病。

多基因风险评分中，增加10个风险等位基因与2型糖尿病的风险比为1.64。增加多不饱和脂肪和总ω-6多不饱和脂肪的摄入量来代替碳水化合物可有效降低2型糖尿病的风险，风险比分别为为0.90和0.99。增加单不饱和脂肪的摄入量来替代碳水化合物则增加了2型糖尿病的风险，风险比为1.10。

这些数据表明，遗传负担和膳食脂肪质量都与2型糖尿病的发病率有关。研究结果不支持对有遗传风险的2型糖尿病患者推荐定制膳食脂肪质量以初步预防2型糖尿病，并表明在遗传风险的范围内，膳食脂肪与2型糖尿病的风险相关。

糖尿病被认为是21世纪最严重的公共卫生挑战之一，预计2017年将影响8.8%的人的健康，2045年将增加到9.9%。2型糖尿病的个体风险反映了在遗传倾向背景下生活方式和饮食因素之间的相互作用。

附：英文原文

Title: Quality of dietary fat and genetic risk of type 2 diabetes: individual participant data meta-analysis

Author: Jordi Merino

Issue&Volume: vol 366, issue 8210

Abstract: 

Objective To investigate whether the genetic burden of type 2 diabetes modifies the association between the quality of dietary fat and the incidence of type 2 diabetes.

Design Individual participant data meta-analysis.

Data sources Eligible prospective cohort studies were systematically sourced from studies published between January 1970 and February 2017 through electronic searches in major medical databases (Medline, Embase, and Scopus) and discussion with investigators.

Review methods Data from cohort studies or multicohort consortia with available genome-wide genetic data and information about the quality of dietary fat and the incidence of type 2 diabetes in participants of European descent was sought. Prospective cohorts that had accrued five or more years of follow-up were included. The type 2 diabetes genetic risk profile was characterized by a 68-variant polygenic risk score weighted by published effect sizes. Diet was recorded by using validated cohort-specific dietary assessment tools. Outcome measures were summary adjusted hazard ratios of incident type 2 diabetes for polygenic risk score, isocaloric replacement of carbohydrate (refined starch and sugars) with types of fat, and the interaction of types of fat with polygenic risk score.

Results Of 102 305 participants from 15 prospective cohort studies, 20 015 type 2 diabetes cases were documented after a median follow-up of 12 years (interquartile range 9.4-14.2). The hazard ratio of type 2 diabetes per increment of 10 risk alleles in the polygenic risk score was 1.64 (95% confidence interval 1.54 to 1.75, I2=7.1%, τ2=0.003). The increase of polyunsaturated fat and total omega 6 polyunsaturated fat intake in place of carbohydrate was associated with a lower risk of type 2 diabetes, with hazard ratios of 0.90 (0.82 to 0.98, I2=18.0%, τ2=0.006; per 5% of energy) and 0.99 (0.97 to 1.00, I2=58.8%, τ2=0.001; per increment of 1 g/d), respectively. Increasing monounsaturated fat in place of carbohydrate was associated with a higher risk of type 2 diabetes (hazard ratio 1.10, 95% confidence interval 1.01 to 1.19, I2=25.9%, τ2=0.006; per 5% of energy). Evidence of small study effects was detected for the overall association of polyunsaturated fat with the risk of type 2 diabetes, but not for the omega 6 polyunsaturated fat and monounsaturated fat associations. Significant interactions between dietary fat and polygenic risk score on the risk of type 2 diabetes (P>0.05 for interaction) were not observed.

Conclusions These data indicate that genetic burden and the quality of dietary fat are each associated with the incidence of type 2 diabetes. The findings do not support tailoring recommendations on the quality of dietary fat to individual type 2 diabetes genetic risk profiles for the primary prevention of type 2 diabetes, and suggest that dietary fat is associated with the risk of type 2 diabetes across the spectrum of type 2 diabetes genetic risk.

DOI: https://doi.org/10.1136/bmj.l4292

Source: https://www.bmj.com/content/366/bmj.l4292