从全球疾病负担看中国DRIs:挑战、证据与思考

来源 :中国循证医学杂志 | 被引量 : 0次 | 上传用户:tongjm2009
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目的系统分析目前我国膳食营养素参考摄入量(dietary reference intakes,DRIs)制定的现况及我国与全球DRIs制定的异同,为规范我国DRIs的制定提供合理的参考建议。方法计算机检索PubMed、ISI Web of Knowledge、he Cochrane Library、CBM、WanFang Data、CNKI、VIP等数据库,检索时限均为建库至2013年5月31日。按照纳入与排除标准选择文献和提取数据,采用描述性分析方法系统评价文献的基本信息、不同营养素DRIs的制定及不同年龄段的分布情况。结果初检获得文献588篇,最终纳入42篇,包括14篇指南、12篇系统评价及16篇原始研究文献。结果显示,WHO指南及全球系统评价研究主要关注的营养素是铁及脂溶性维生素(维生素A、D);我国除关注铁及维生素A外,还关注蛋白质、钙、锌、硒。纳入指南关注的人群主要是3~18岁及孕妇,而系统评价除关注此两类人群外,还关注>18岁的成年人。我国对各类人群均有研究,但主要关注18~45岁成年人和6~12岁学龄儿童。纳入的16个原始研究中,4个关注男性,2个关注女性。结论我国DRIs的制定及研究目前尚处于急需更新补充的状态。作为最大的发展中国家,我国的疾病负担、消费水平、膳食模式、膳食营养素的提供内容及保障水平均有别于发达国家和其他发展中国家。制定我国DRIs时宜在循证评价全球现有DRIs的基础上,借鉴当前可得的最佳DRIs标准、方法和证据,并结合我国实际国情、疾病负担及专家意见,循证制定既能满足我国人民健康需要又适合我国国情的DRIs。 Objective To systematically analyze the current status of the development of dietary reference intakes (DRIs) in China and the similarities and differences between DRIs in China and those in the world, and provide reasonable suggestions for regulating DRIs in China. Methods The databases of PubMed, ISI Web of Knowledge, HeCochrane Library, CBM, WanFang Data, CNKI and VIP were searched by computer. The search time was from the database to May 31, 2013. According to inclusion and exclusion criteria, selecting documents and extracting data, using descriptive analysis method to systematically evaluate the basic information of the literature, the formulation of different nutrients DRIs and the distribution of different age groups. Results A total of 588 articles were obtained during the initial examinations and 42 papers were finalized, including 14 guides, 12 systematic reviews and 16 original research articles. The results showed that the main nutrients of interest in the WHO guidelines and in the global systematic review were iron and fat-soluble vitamins (vitamins A and D). In addition to iron and vitamin A, our country also focused on protein, calcium, zinc and selenium. The main focus of the guideline is 3 to 18 years of age and pregnant women. In addition to these two categories of people, systematic reviews focus on adults> 18 years of age. There are studies on all kinds of people in our country, but we mainly focus on adults aged 18-45 years and school-age children aged 6-12 years. Of the 16 original studies included, four focused on men and two focused on women. Conclusion The formulation and research of DRIs in our country is still in an urgent need of renewal and supplement. As the largest developing country, China’s disease burden, consumption level, dietary patterns, the content of dietary nutrients and the level of protection are different from the developed countries and other developing countries. When formulating DRIs in our country, we should base on the evidence-based evaluation of the existing DRIs in the world and draw lessons from the best available DRIs standards, methods and evidences. Combining the actual conditions in our country, disease burden and expert opinion, DRIs that need health and are suitable for China’s national conditions.
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