AbstractThisstudyaimedtoexaminetheinteractionbetweendietqualityindices(DQIs)andsmokingontheincidenceofhypertension(HTN),stroke,cardiovasculardiseases,andall-causemortality.Weprospectivelyfollowed5720participantsandcollecteddietarydataviaavalidatedfoodfrequencyquestionnairetocalculateDQI-international(DQI-I)andDQI-revised(DQI-R).
摘要本研究旨在探讨饮食质量指数（DQIs）与吸烟对高血压（HTN），中风，心血管疾病和全因死亡率的相互作用。我们前瞻性地跟踪了5720名参与者，并通过经过验证的食物频率问卷收集了饮食数据，以计算DQI国际（DQI-I）和DQI修订版（DQI-R）。
Consideringaninteractionanalysis,weclassifiedparticipantsbasedondietquality(median:higher/lower)andsmokingstatus.Over9yearsoffollow-up,higherdietqualityscoreswereassociatedwithalowerriskofstrokeandmortality.WhilecurrentsmokershadahigherriskofstrokeandmortalitybuthadalowerriskofdevelopingHTN.
Comparedtothecurrentsmokerswithlowerdietquality,nonsmokerswithhigherdietqualityaccordingtotheDQI-I[HR0.24;95%CI(0.08,0.66)],andDQI-R[HR0.20;95%CI(0.07,0.57)]hadalowerriskofstroke.Moreover,thelowerriskofmortalitywasmoreevidentinnonsmokerswithhigherDQI-I[HR0.40;95%CI(0.22–0.75)]andDQI-Rscores[HR0.34;95%CI(0.18–0.63)]comparedtononsmokerswithlowerdietquality.
与目前饮食质量较低的吸烟者相比，根据DQI-I[HR0.24；95%CI（0.08，0.66）]和DQI-R[HR0.20；95%CI（0.07，0.57）]，饮食质量较高的非吸烟者中风风险较低。此外，与饮食质量较低的非吸烟者相比，DQI-I[HR0.40；95%CI（0.22-0.75）]和DQI-R评分[HR0.34；95%CI（0.18-0.63）]较高的非吸烟者死亡率较低。
WhilehigherDQI-IandDQI-Rscoreswereassociatedwithalowerriskofstrokeandmortality,thisbeneficialeffectmaybenegatedbysmoking..
IntroductionNon-communicablediseases(NCDs),particularlycardiovasculardiseases(CVDs),representthepredominantglobalcauseofmortality1.IranhasahighprevalencerateofCVD(>9000casesper100,000individuals),accountingforalmosthalfofthemortalitiesandcontributingto20–23%oftheoveralldiseaseburden2.
引言非传染性疾病（NCDs），特别是心血管疾病（CVDs），是全球死亡的主要原因1。伊朗的心血管疾病患病率很高（>每100000人中有9000例），几乎占死亡率的一半，占整体疾病负担的20-23%2。
Notably,hypertension(HTN)hasemergedastheleadingcontributortoCVDsincidence,affectingoneineveryfourIranians3,4.Whilesmokingandpoordietarerecognizedastheprimarycontributorstomortalityrisk5,ithasbeenshownthatCVDscanbemanagedthroughdietaryandlifestylebehaviors6,7.Smokingcontributestonearly25%ofannualstrokeincidentsandapproximately15%ofstroke-relatedmortality8,9.
Cigarettesmokinghasapronouncedeffectonmales,adultsrangingfrom18to44yearsold,individualswithlowersocioeconomicstatus,andresidentsofdevelopingnations10,11.EvidencesuggeststhatsmokerswithpoorernutritionalstatushaveatwofoldhigherriskofdevelopingCVDs12,13.Smokersoftenadoptunhealthydietaryhabits,likelowerintakeoffruitsandvegetablesandhigherconsumptionoffatsandalcohol14,15.
吸烟对男性，18至44岁的成年人，社会经济地位较低的个体以及发展中国家的居民有显着影响10,11。有证据表明，营养状况较差的吸烟者患心血管疾病的风险高出两倍[12,13]。吸烟者经常采取不健康的饮食习惯，如水果和蔬菜的摄入量较低，脂肪和酒精的摄入量较高14,15。
Themutuallyinfluencingdisease-causingmechanismscommontobothsmokingandpoordietqualitycaninteractprogressively,indicatingthehigherpotentialriskofNCDsovertime16.Meanwhile,theoptimalmethodforconsideringassociationsandinteractionsamongdietarycomponentsistoassessoveralldietquality17.
Dietaryqualityindices(DQIs)offerathoroughapproachtoassessingdietarybehaviorswithanemphasisondietaryvariety,dietarymoderation,balancednutrientintake,anddiversefoodchoices18.Severalstudieshaveindividuallyexaminedtheimpactofdietaryfactorsorsmokingonhealthrisks.S.
饮食质量指数（DQIs）提供了一种全面的方法来评估饮食行为，重点是饮食多样性，饮食适度性，均衡的营养摄入和多样化的食物选择18。一些研究分别研究了饮食因素或吸烟对健康风险的影响。S。
Table1Baselinecharacteristicsofthestudyparticipantsforcardiovasculardiseaseincidentsandall-causemortalitybasedondietqualityandsmokingstatus(n=5048).FullsizetableSupplementaryTableS1displaysthebaselinecharacteristicsofthestudyparticipantsrecruitedforthestudyofHTN.
表1基于饮食质量和吸烟状况的研究参与者心血管疾病事件和全因死亡率的基线特征（n=5048）。全尺寸表补充表S1显示了为HTN研究招募的研究参与者的基线特征。
Themeanage±SDoftheparticipant'sagewas38.25years,and42.6%weremen.Thetotalpopulationhadthemean±SDofDQI-IandDQI-Rof62.43±8.03and70.00±12.81,respectively.ConsideringtheDQI-IandDQI-R,participantswithhigherdietquality,hadahigherpercentageofmen,highermeanageandBMI,higherphysicalactivityandeducationlevel,higherenergyintake,andexhibitedhigherlevelsofFBS,TC,TG,andSBP.
平均年龄±参与者年龄的SD为38.25岁，男性为42.6%。总人口的平均值±DQI-I和DQI-R的SD为62.43±8.03和70.00±分别为12.81。考虑到DQI-I和DQI-R，饮食质量较高的参与者男性比例较高，平均年龄和BMI较高，体育锻炼和教育水平较高，能量摄入较高，FBS，TC，TG和SBP水平较高。
AccordingtotheDQI-I,participantswithhigherdietqualityhadalowerHDL-Clevel.Comparedtonon-smokers,currentsmokersweremorelikelytobemale,hadahigherage,higherphysicalactivitylevel,higherlevelsofTC,TG,SBP,andhigherenergyintake,however,theyhadlowerHDL-C,lowerscoresofDQI-Ianditscomponentsincludingvarietyandmoderation,andalsolowerDQI-Rscoreanditsmoderationscore.Afterameanfollow-upof9.0years,357casesofCVDs(7.1%),54casesofstroke(1.1%),and131casesofmortality(2.6%)wereascertained.
根据DQI-I，饮食质量较高的参与者的HDL-C水平较低。与不吸烟者相比，目前吸烟者更可能是男性，年龄更高，体力活动水平更高，TC，TG，SBP水平更高，能量摄入更高，但HDL-C较低，DQI-I及其组成部分（包括多样性和适度性）得分较低，DQI-R得分及其适度得分也较低。平均随访9年后，确定了357例CVD（7.1%），54例中风（1.1%）和131例死亡率（2.6%）。
Also,consideringtheHTNoutcome,1032casesofHTN(18%)wererecordedafterameanfollow-upperiodof7.8years.Ourresultsindicatedtherobustaccuracyofthemultivariablemodelsinpredictingtheincidenceoftheinvestigatedoutcomes.TheHarrel’sCindexscoresfortheassociationsbetweensmokingandHTN(0.792),smokingandstroke(0.880),smokingandCVDs(0.823),smokingandmortality(0.847),DQI-IandHTN(0.791),DQI-Iandstroke(0.895),DQI-IandCVDs(0.823),DQI-Iand.
此外，考虑到HTN的结果，平均随访7.8年后，记录了1032例HTN（18%）。我们的结果表明，多变量模型在预测调查结果发生率方面具有强大的准确性。吸烟与HTN（0.792），吸烟与中风（0.880），吸烟与心血管疾病（0.823），吸烟与死亡率（0.847），DQI-I与HTN（0.791），DQI-I与中风（0.895），DQI-I与心血管疾病（0.823），DQI-I与。
Table2Hazardratio(95%confidenceintervals)forcardiovascularevents,all-causemortality,andhypertensionbasedonthequartilesofdietaryqualityindices.FullsizetableFigure1indicatesthehazardratioforincidenceofCVDs,stroke,mortality,andHTNincurrentsmokerscomparedwithnon-smokers.
表2基于饮食质量指数的四分位数，心血管事件，全因死亡率和高血压的风险比（95%置信区间）。全尺寸表图1显示了当前吸烟者与非吸烟者相比，心血管疾病，中风，死亡率和HTN发病率的风险比。
Inthecrudemodel,theriskofall-causemortalitywassignificantlyhigherinthecurrentsmokersthannon-smokers[HR1.87,95%CI(1.19–2.93)];theassociationremainedsignificantinthefinaladjustedmodel[HR2.11;95%CI(1.30–3.45)].Asignificantlyincreasedriskofstrokewasalsoobservedinthecurrentsmokersthanthenon-smokersafteraccountingforallpotentialcovariates[HR2.32;95%CI(1.06–5.10)].
在粗略模型中，当前吸烟者的全因死亡风险显着高于非吸烟者[HR1.87，95%CI（1.19-2.93）]；在最终调整后的模型中，这种关联仍然很显着[HR2.11；95%CI（1.30-3.45）]。考虑到所有潜在的协变量，目前吸烟者的中风风险也比不吸烟者显着增加[HR2.32；95%CI（1.06-5.10）]。
TheriskofHTNwassignificantlylowerinthecurrentsmokerscomparedtonon-smokersinthefullyadjustedmodel[HR0.77;95%CI(0.62–0.96)].Figure1Thehazardratioand95%confidenceinterval(CI)fortheincidenceofhypertension,all-causemortality,strokeandcardiovasculardiseases(CVDs)amongcurrentsmokersvs.
在完全调整后的模型中，当前吸烟者的HTN风险显着低于非吸烟者[HR0.77；95%CI（0.62-0.96）]。图1当前吸烟者中高血压，全因死亡率，中风和心血管疾病（CVD）发病率的风险比和95%置信区间（CI）。
non-smokers(referencegroup):TehranLipidandGlucoseStudy.FullsizeimageTable3displaystheHR(95%CI)forcardiovascularevents,all-causemortality,andHTNbasedonthecombinedeffectsofdietqualityandsmokingstatus.Nosignificantinteraction(Pinteraction>0.05)wasnotedamongthestudiedgroupsconcerningcardiovascularevents,all-causemortality,andHTN.
非吸烟者（参考组）：德黑兰脂质和葡萄糖研究。全尺寸图像表3显示了基于饮食质量和吸烟状况的综合影响，心血管事件，全因死亡率和HTN的HR（95%CI）。没有明显的相互作用（P相互作用>在研究组中，关于心血管事件，全因死亡率和HTN，注意到0.05）。
Comparedtocurrentsmokerswithpoordietquality,thehazard(95%CI)ofstrokewas0.23(0.08,0.63)inadjustedmodel1and0.24(0.08,0.66)intheadjustedmodel2innon-smokerswithgooddietqualitybasedonDQI-I.Alowerriskofstrokewasalsoobservedinnon-smokerswithgooddietqualitybasedonDQI-Rcomparedtocurrentsmokerswithpoordi.
与目前饮食质量较差的吸烟者相比，基于DQI-I的饮食质量良好的非吸烟者，调整后模型1的卒中风险（95%CI）为0.23（0.08，0.63），调整后模型2中的卒中风险（95%CI）为0.24（0.08，0.66）。与目前di较差的吸烟者相比，基于DQI-R的饮食质量良好的非吸烟者的卒中风险也较低。
Table3Hazardratio(95%confidenceintervals)forcardiovascularevents,all-causemortality,andhypertensionbasedonthecombinedeffectsofdietqualityandsmokingstatus.FullsizetableDiscussionThecurrentstudyrevealedthatahigh-qualitydietwaslinearlyassociatedwithalowerriskofstrokeandmortality.
Comparedtonon-smokers,currentsmokershadanhigherriskofstroke,CVDs,andmortality,andalowerriskofHTN.Additionally,non-smokerswithhigherdietqualityhadalowerriskofstrokecomparedtocurrentsmokerswithlowerdietquality.Non-smokersexperiencealowerriskofmortalitythancurrentsmokerswithlowerdietquality.
与不吸烟者相比，目前吸烟者患中风，心血管疾病和死亡的风险更高，患HTN的风险更低。此外，与目前饮食质量较低的吸烟者相比，饮食质量较高的非吸烟者中风风险较低。与目前饮食质量较低的吸烟者相比，不吸烟者的死亡风险较低。
Notably,thelowerriskforstrokeandall-causemortalitywasmorepronouncedinnon-smokerswithhigherdietqualitythaninthosewithlowerdietquality.ThesimilaritiesintheassociationsbetweentheDQI-IandtheDQI-Rwiththestudiedoutcomesarelikelyattributabletosimilaritiesintheirfoodandnutrientcomponents.
值得注意的是，饮食质量较高的非吸烟者中风和全因死亡率较低的风险比饮食质量较低的非吸烟者更为明显。DQI-I和DQI-R与研究结果之间关联的相似性可能归因于其食物和营养成分的相似性。
Ingeneral,higherDQI-IandtheDQI-Rscoresindicateahealthierdiet,characterizedbyavarietyoffoodchoices,adequateintakeoffruits,vegetables,grains,andmicronutrients,andsuitablepercentagesoftotalenergyintakefortotalfat,saturatedfats,andhigh-caloriefoods.Additionally,theDQI-Rconsidersmoderationofalcoholconsumption,whichmakesitvaluableinpopulationswherealcoholuseiseitherexcessiveorcontraindicated.
一般来说，较高的DQI-I和DQI-R分数表示更健康的饮食，其特征在于多种食物选择，足够摄入水果，蔬菜，谷物和微量营养素，以及总脂肪，饱和脂肪和高热量食物的总能量摄入量的适当百分比。此外，DQI-R考虑了适度饮酒，这使得它在饮酒过量或禁忌的人群中很有价值。
Althoughbothindicesevaluateanapproximatelyequalnumberofdietarycomponents,theDQI-IencompassesabroaderspectrumofdietaryaspectscomparedtotheDQI-R.IncontrasttotheDQI-R,theDQI-Iassessestheadequacyoffiber,protein,andvitaminCintake,aswellasthebalanceinratiosbetweenmacronutrientsandfattyacids.Despitethel.
虽然这两个指数评估的饮食成分数量大致相等，但与DQI-R相比，DQI-I涵盖了更广泛的饮食方面。与DQI-R相比，DQI-I评估了纤维，蛋白质和维生素C摄入量的充足性，以及常量营养素和脂肪酸之间的比例平衡。尽管l。
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Thedatasetsusedand/oranalyzedduringthecurrentstudyareavailablefromthecorrespondingauthoruponreasonablerequest.
本研究中使用和/或分析的数据集可根据合理要求从通讯作者处获得。
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