A Case-control Study Of Insulin-related Dietary Indexes And Gastric Precancerous Lesions

ObjectiveGastric mucosal inflammation increases under high insulin levels.However,dietary inflammatory potential has an unclear impact on the occurrence and development of gastric precancerous lesions（GPL）.From the perspective of insulin-related dietary indexes,this study explored the relationships between diet,inflammation and the risk of GPL,so as to provide theoretical basis for guiding the rational diet of GPL patients.MethodsFrom September 2020 to December 2022,345 subjects were enrolled from the inpatient Department of North District,the First Affiliated Hospital of Anhui Medical University.A 1:2 matched case-control study with age difference±5 years was conducted.The basic data and dietary intake in the past year of the case group（N=115）and the control group（N=230）were collected.And the fasting blood glucose,blood lipid,white blood cell counts and C-reactive protein of the subjects were detected.Dietary data were standardized and converted according to the Table of Food Ingredients in China（6th Edition）.The dietary inflammatory index（DII）,the experience hyperinsulinemia dietary index（EDIH）,the empirical insulin resistance dietary index（EDIR）,glycemic index（GI）,glycemic load（GL）and other insulin related index scores were calculated.Because of the different dietary structure at domestic and abroad,the calculation of EDIH_abroad,EDIH_domestic,EDIR_abroad and EDIR_domestic are based on those constructed at domestic and abroad.The SPSS 25.0 software was used for data analysis.The bilateral significance levelαequals to 0.05.To compare the differences between the case group and the control group,theχ² test and Wilcoxon Signed Rank Test were used.Various dietary index scores were divided into three equal scores from low to high.Multi-model adjusted logistic regression analysis was used to investigate the relationships between insulin-related dietary indexes and the risk of GPL.Age,sex,Helicobacter Pylori（H.Pylori）and body mass index were grouped to analyze the correlations between insulin-related dietary indexes and GPL.Results1.The case group was consisted of 115 patients with GPL,including all stages of GPL（atrophic gastritis,intestinal metaplasia,intraepithelial neoplasia,and early gastric cancer）,while the control group was consisted of 230 patients with non-atrophic gastritis（clinically considered to be approximately normal）and normal gastric mucosa.Compared with the control group,the patients in the case group were more male,less educated,engaged in manual labor,and had a relatively lower level of annual household income.In the comparison between the case group and the control group,there were more patients with hypertension（P=0.014）and diabetes（P=0.004）,and higher fasting blood glucose（P=0.028）and H.pylori positive rate（P=0.006）in the case group.2.The comparison of food groups and dietary indexes between the case group and the control group showed that the intake of dairy products（P=0.038）,EDIR_domestic score（P=0.033）and GI score（P=0.016）in the case group were higher than those in the control group.There was no significant difference between the two groups in other food groups and dietary indexes DII,EDIH_abroad,EDIH_domestic,EDIR_abroad and GL（P>0.05）.3.A comparative study was conducted on the foods,food groups or nutrients contained in the insulin-related dietary indexes between the case group and the control group.Although there was no statistical difference in DII scores between the case group and the control group,compared with the control group,In DII scores,the intakes of fat,saturated fatty acids,monounsaturated fatty acids,polyunsaturated fatty acids,selenium,vitamin A and riboflavin were lower in case group（P<0.05）.Similarly,there was no statistical difference between case group and control group for EDIH_abroad and EDIH_domestic,but the intake of tomatoes in case group was lower than that in control group（P<0.05）.In addition,compared with the control group for EDIR_abroad,the intake of refined grains in the case group was higher,and the intake of tomatoes and nuts was lower（P<0.05）.In the EDIR_domestic,the intake of refined grains（P=0.033）was higher in the case group than in the control group.4.Logistic regression analysis of insulin-related dietary index and GPL showed that there was no statistical significance between DII,EDIH_abroad,EDIH_domestic,EDIR_abroad,GI,GL and GPL risk（P>0.05）.After adjusting for age,sex,education,history of hypertension,history of diabetes,body mass index,H.pylori,fasting blood glucose,triglycerides,total cholesterol,HDL cholesterol,LDL cholesterol,and C-reaction protein,the highest score in the EDIR_domestic was 1.02 times with GPL than the lowest score（OR=1.02,95%CI:0.54～1.92）.5.Further subgroup analysis of EDIR_domestic showed that the risk of GPL in the highest score in EDIR_domestic was 2.55 times that of the lowest score in the population younger than 45 years old after multivariate adjustment（P=0.045）.Among those older than 45years,the highest score in EDIR_domestic was 1.20 times more likely to develop GPL than the lowest score（P=0.019）.6.Multiple model conditional Logistic regression analysis was performed on refined grains,tomatoes,monounsaturated fatty acids,polyunsaturated fatty acids,selenium,vitamin A and riboflavin in the groups from low to high.The results showed that the risk of GPL was higher when the intake of refined grain was 318.33 to 513 g/d.Tomato intake was 12.93 to 31.18g/d,vitamin A intake was 517.55 to 952.32μg/d,riboflavin intake was0.93 to 1.89mg/d,and the risk of GPL was low.Conclusion1.In the insulin-related dietary index,the GI and EDIR_domestic score of case group were higher than that of control group,after adjusting for multiple factors,EDIR_domesticcan be used to assess the risk of GPL;2.Refined grain intake of 318.33～513 g/d increased the risk of GPL;Tomato intake of 12.93～31.18 g/d,vitamin A intake of 517.55～952.32μg/d,riboflavin intake of 0.93～1.89 mg/d,reduce the risk of GPL.