周北凡
中國醫學(xué)科學(xué)阜外心血管病醫院，北京 100037

文章編號：1000－8020（2002）S0－0023－02
中國分類(lèi)號：R151.4 R54 文獻標識碼：A

　　 本報告的目的是探討中國膳食模式與心血管病特點(diǎn)之間的關(guān)系。資料來(lái)源是世界衛生組織最新的死亡統計、我國多中心心血管病流行病學(xué)合作研究（即國家六五到八五科技攻關(guān)課題）結果，以及宏量營(yíng)養素與血壓關(guān)系的國際合作研究結果（INTERMAP Study, 由美國心肺血研究所資助，中國、日本、美國、英國17個(gè)研究中心的合作研究，中國有3個(gè)研究中心參加）。與西方人群相比，目前中國人群心血管病的特點(diǎn)是腦卒中高發(fā)，其中出血型卒中比例較西方人群為高，冠心病較低發(fā)，國內不同人群間發(fā)病率有很大差異。生態(tài)學(xué)對比研究結果顯示：人群冠心病發(fā)病率的預測因素是舒張壓、血清總膽固醇、高密度脂蛋白膽固醇和體質(zhì)指數的平均水平。和西方人群相比， 決定中國人群血清總膽固醇水平和冠心病發(fā)病率較低的膳食因素是較低的總脂肪、飽和脂肪、膳食膽固醇和Keys脂質(zhì)分值。人群的膳食脂質(zhì)分值每增高5，血清總膽固醇均值升高約7 mg/dl，冠心病年發(fā)病率約增高6.7/10萬(wàn)。人群腦卒中發(fā)病率的最強預測因素是舒張壓水平，與高血壓相關(guān)的膳食因素是高鈉、低鉀和低鈣。人群日均烹調用食鹽每相差3 g, 人群舒張壓均值約相差1.8mmHg, 腦卒中年發(fā)病率約相差17/10萬(wàn)。每天人均攝入魚(yú)類(lèi)和新鮮水果增加各50 g, 舒張壓均值分別降低3mmHg 和2mmHg，腦卒中年發(fā)病率約降低28/10萬(wàn)和19/10萬(wàn)。人群的腦卒中急性期死亡率（間接反映出血型卒中發(fā)病率）與日均膳食動(dòng)物蛋白質(zhì)攝入量呈顯著(zhù)負關(guān)聯(lián)，而與膳食鈉/鉀比值呈顯著(zhù)正關(guān)聯(lián)，此種關(guān)聯(lián)獨立于血壓和體質(zhì)指數。結論：在中國，預防心血管病的健康膳食應強調降低食鹽攝入量、增加魚(yú)類(lèi)和新鮮水果蔬菜、保持低脂肪、低飽和脂肪和膽固醇，以達到降低腦卒中發(fā)病率，抑制冠心病發(fā)病率的上升。 Chinese dietary pattern and features of cardiovascular diseases

Zhou Beifan

Fu Wai Hospital,Chinese Academy of Medical Sciences,Beijing 100037

The purpose of this presentation is to explore the possible relationship of Chinese dietary pattern to the characteristics of cardiovascular diseases in China. Main sources of data used for the analyses were WHO mortality statistics, China Multi－center Collaborative Study of Cardiovascular Epidemiology (China MUCA study) and International Study of Macro－nutrients on Blood Pressure (INTERMAP study, an international collaborative study of 17 centers of 4 countries, including 3 centers in China). In comparison with western countries, cardiovascular diseases in Chinese population was characterized by high incidence of stroke, higher proportion of hemorrhagic stroke, lower incidence of coronary heart disease, and big variation in incidence among populations within China. Results of ecological analysis showed that the predictive factors for incidence of CHD in a population were mean levels of DBP, serum total cholesterol (TC), HDL－C and BMI. Dietary factors related to lower incidence of CHD compared with western populations were lower total fat, saturated fat and lower Keys score. Among populations within China , each 5 increase in mean Keys score was associated with 7 mg/dl increase in mean level of TC and roughly 6.7 /100,000 increase in annual incidence of CHD. The strong predictive factors for stroke incidence was DBP. Dietary factors related to higher DBP was high salt, low potassium and calcium. Among populations within China, each 3 g difference in mean daily intake of cooking salt was associated with 1.8 mmHg difference in mean level of DBP and roughly 17 /100000 difference in incidence of stroke. Each 50 g increase in mean daily intake of fish or fruits was associated with 3 mmHg or 2 mmHg decrease in mean level of DBP, and then 28 /100000 or 19/100000 decrease in incidence of stroke respectively. The variation in acute phase mortality of stroke (indirectly reflect the mortality from hemorrhagic stroke) among populations was associated inversely with mean daily intake of animal protein and positively with Na/K ratio even after adjusting for mean blood pressure and BMI. Revealed that Chinese dietary factors might be related to high incidence of hemorrhagic stroke independent of blood pressure and BMI. Public health efforts for preventing CVD in China should be aimed at reducing salt intake, increasing intake of fish and fresh fruits, vegetables, maintaining low levels in intake of total fat, saturated fat and cholesterol.