從全球疾病負擔看中國DRIs：挑戰、證據與思考_《中國循證醫學雜志》

作者：

陳曉凡 ^1,2 ,  李幼平 ¹ , 喻佳潔 ¹

1. 四川大學華西醫院中國循證醫學中心（成都 610041）；2. 江西中醫藥大學（南昌 330004）;

關鍵詞：

膳食營養素參考攝入量推薦日攝入量平均需要量推薦需要量適宜攝入量可耐受最高攝入量

DOI：

10.7507/1672-2531.20130199

視頻：

導出 下載 收藏 掃碼 引用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的　系統分析目前我國膳食營養素參考攝入量（dietary reference intakes，DRIs）制定的現況及我國與全球DRIs制定的異同，為規范我國DRIs的制定提供合理的參考建議。
方法　計算機檢索PubMed、ISI Web of Knowledge、The Cochrane Library、CBM、WanFang Data、CNKI、VIP等數據庫，檢索時限均為建庫至2013年5月31日。按照納入與排除標準選擇文獻和提取數據，采用描述性分析方法系統評價文獻的基本信息、不同營養素DRIs的制定及不同年齡段的分布情況。
結果　初檢獲得文獻588篇，最終納入42篇，包括14篇指南、12篇系統評價及16篇原始研究文獻。結果顯示，WHO指南及全球系統評價研究主要關注的營養素是鐵及脂溶性維生素（維生素A、D）；我國除關注鐵及維生素A外，還關注蛋白質、鈣、鋅、硒。納入指南關注的人群主要是3～18歲及孕婦，而系統評價除關注此兩類人群外，還關注 gt;18歲的成年人。我國對各類人群均有研究，但主要關注18～45歲成年人和6～12歲學齡兒童。納入的16個原始研究中，4個關注男性，2個關注女性。
結論　我國DRIs的制定及研究目前尚處于急需更新補充的狀態。作為最大的發展中國家，我國的疾病負擔、消費水平、膳食模式、膳食營養素的提供內容及保障水平均有別于發達國家和其他發展中國家。制定我國DRIs時宜在循證評價全球現有DRIs的基礎上，借鑒當前可得的最佳DRIs標準、方法和證據，并結合我國實際國情、疾病負擔及專家意見，循證制定既能滿足我國人民健康需要又適合我國國情的DRIs。

引用本文： 陳曉凡,李幼平,喻佳潔. 從全球疾病負擔看中國DRIs：挑戰、證據與思考. 中國循證醫學雜志, 2013, 13(10): 1162-1171. doi: 10.7507/1672-2531.20130199 復制

1.	Wang H, Dwyer-Lindgren L, Lofgren KT, et al. Age-specific and sex-specific mortality in 187 countries, 1970–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012, 380(9859): 2071-2094.
2.	Lim SS, Vos T, Flaxman AD, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012, 380(9859): 2224-2260.
3.	中國營養學會. 中國居民膳食營養素參考攝入量. 中國輕工業出版社, 2000.
4.	WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Daily iron RN and folic acid supplementation in pregnant women. Geneva: World Health Organization, 2012.
5.	WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Intermittent iron and folic acid supplementation in non-anaemic pregnant women. Geneva: World Health Organization, 2012. http://www.who.int/nutrition/publications/micronutrients/guidelines/guideline_intermittent_ifa_non_anaemic_pregnancy/en/.
6.	WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Sodium Intake for Adults and Children. Geneva: World Health Organization, 2012.
7.	WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Potassium Intake for Adults and Children. Geneva: World Health Organization, 2012.
8.	WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Intermittent iron supplementation in preschool and school-age children. Geneva: World Health Organization, 2011. http://www.who.int/nutrition/publications/micronutrients/guidelines/guideline_iron_supplementation_children/en/.
9.	WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Intermittent iron and folic acid supplementation in menstruating women. Geneva: World Health Organization, 2011. http://www.who.int/nutrition/publications/micronutrients/guidelines/guideline_iron_folicacid_suppl_women/en/.
10.	WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Vitamin A supplementation during pregnancy for reducing the risk of mother-to-child transmission of HIV. Geneva: World Health Organization, 2011. http://www.who.int/nutrition/publications/micronutrients/guidelines/vas_mtct_hiv/en/.
11.	WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Neonatal vitamin A supplementation. Geneva: World Health Organization, 2011. http://www.who.int/nutrition/publications/micronutrients/guidelines/vas_neonatal/en/.
12.	WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Vitamin A supplementation for infants and children 6-59 months of age. Geneva: World Health Organization, 2011. http://www.who.int/nutrition/publications/micronutrients/guidelines/vas_6to59_months/en/.
13.	WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Vitamin A Supplementation in Infants 1–5 Months of Age. Geneva: World Health Organization, 2011.
14.	McGuire S. WHO Guideline: Vitamin A supplementation in pregnant women. Adv Nutr, 2012, 3(2): 215-216.
15.	McGuire S. WHO Guideline: Vitamin A supplementation in postpartum women. Adv Nutr, 2012, 3(2):215-216.
16.	WHO Guidelines Approved by the Guidelines Review Committee. FAO. Guidelines on food fortification with micronutrients. Geneva: WHO, 2006 [cited July 21, 2011]. Available from: http://www.who.int/nutrition/publications/ micronutrients/9241594012/en/index.html.
17.	Thiele DK, Senti JL, Anderson CM. Maternal vitamin D supplementation to meet the needs of the breastfed infant: a systematic review. J Hum Lact, 2013, 29(2): 1-8.
18.	Ngo J, Roman-Viñas B, Ribas-Barba L, et al. A systematic review on micronutrient intake adequacy in adult minority populations residing in Europe: the need for action. J Immigrant Minority Health, 2013, 3: 1-10.
19.	Rolland Y, de Souto Barreto P, Abellan Van Kan G, et al. Vitamin D supplementation in older adults: searching for specific guidelines in nursing homes. J Nutr Health Aging, 2013, 17(4): 402-412.
20.	Aranceta J, Pérez-Rodrigo C. Recommended dietary reference intakes, nutritional goals and dietary guidelines for fat and fatty acids: a systematic review. Br Nutr, 2012, 107: S8-s22.
21.	Steyn NP, Temple NJ. Evidence to support a food-based dietary guideline on sugar consumption in South Africa. BMC Public Health, 2012, 12: 502.
22.	Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab, 2011, 96(7): 1911-1930.
23.	Popkin BM, D’Anci KE, Rosenberg IH. Water, hydration, and health. Nutr Rev, 2010, 68(8): 439-458.
24.	Torheim LE, Ferguson EL, Penrose K, et al. Women in resource-poor settings are at risk of inadequate intakes of multiple micronutrients. J Nutr, 2010, 140(11): 2051S-2058S.
25.	Hanley DA, Cranney A, Jones G, et al. Vitamin D in adult health and disease: a review and guideline statement from Osteoporosis Canada. CMAJ, 2010, 182(12): E610-E618.
26.	Yetley EA, Brulé D, Cheney MC, et al. Dietary Reference Intakes for vitamin D: justification for a review of the 1997 values. Am J Clin Nutr, 2009, 89(3): 719-727.
27.	Tabacchi G, Wijnhoven TM, Branca F, et al. How is the adequacy of micronutrient intake assessed across Europe? A systematic literature review. Br J Nutr, 2009, 101: S29-S36.
28.	Cranney A, Horsley T, O’Donnell S, et al. Effectiveness and safety of vitamin D in relation to bone health. Evid Rep Technol Assess (Full Rep), 2007, (158): 1-235.
29.	詠梅, 舒暢, 寧鴻珍, 等. 學齡兒童鋅、硒、銅、鐵攝入水平對抗氧化能力的影響. 現代預防醫學, 2011, 38(13): 2471-2473.
30.	弈明, KE Hill, 李平, 等. 中國成人硒需要量研究. 營養學報, 201, 33(2): 109-113.
31.	馬冠生, 左嬌蕾. 水的適宜攝入量. 中華預防醫學雜志, 2011, 45(8): 675-678.
32.	唐詠梅, 朱驕峰, 周會, 等. 學齡兒童VA、VC、VE攝入水平對免疫功能影響. 中國公共衛生, 2010, 26(2): 208-210.
33.	郭長江, 韋京豫, 楊繼軍, 等. 我軍重度勞動部隊推薦的核黃素攝入量. 解放軍預防醫學雜志, 2010, 28(4): 238-241.
34.	周建烈, 毛絢霞, 顧景范. 維生素D膳食參考攝入量的再評估. 生理科學進展, 2009, 40(1): 36-40.
35.	何麗, 付萍, 張剛, 等. 不同鈣攝入量對青年男性骨密度的影響. 中國健康教育, 2007, 23(6): 413-418.
36.	何麗, 付萍, 張堅, 等. 補鈣對青年女性全身各部位骨密度的影響. 中國臨床營養雜志, 2007, 15(3): 185-190.
37.	樸建華, 姬一兵, 田園, 等. 中國青年男性膳食蛋白質參考攝入量研究. Danone Institute China, 2008, 28-29.
38.	田穎. 中國青年女性膳食蛋白質參考攝入量研究. 博士論文, 2008: 298-299.
39.	尹婧, 張倩, 劉愛玲, 等.利用鈣平衡法制定青春期少年鈣參考攝入量的研究. 中國營養學會營養基金項目論文匯編, 2008: 33-40.
40.	陳祖培, 閻玉芹. 碘的膳食參考攝入量. 中華內分泌代謝雜志, 2005, 21(2): 188-192.
41.	賈青, 黃承鈺, 周繼昌. 藏族成年男子膳食中鐵的吸收狀況研究. 現代預防醫學, 2005, 32(8): 872-874.
42.	賈青, 黃承鈺, 周繼昌. 藏族成年男子膳食中鋅的吸收狀況研究. 中國公共衛生, 2005, 21(8): 928-930.
43.	龐文貞, 許爾怡, 李守勤, 等. 學齡前兒童氮平衡測定及蛋白質適宜攝入量探討. 營養學報, 1990, 12(4): 44-348.
44.	龐文貞, 黃思齊, 沈麗華, 等. 城市孕婦營養狀況及孕婦熱能、營養素適宜攝入量探討. 營養學報, 1989, 11(3): 215-221.
45.	Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012, 380(9859): 2095-2128.
46.	Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012, 380(9859): 2163-2196.
47.	郭麗青. 飲食營養以及生活方式與慢性病控制. 第13屆全國臨床營養學術會議論文.
48.	羅衛平, 劉來新, 馬江平, 等. 2010 年新疆監測點居民慢性病及其行為危險因素調查分析. 疾病預防控制通報, 2013, 28(1): 20-23.
49.	趙佳, 王建華, 葉薇薇, 等. 上海市楊浦區常住居民慢性病危險因素調查分析. 中國慢性病預防與控制, 2012, 20(1): 23-25.
50.	王勁, 郭紅衛. 膳食營養素參考攝入量的制定原理和應用原則. 環境與職業醫學, 2008, 25(5): 476-479.

1. Wang H, Dwyer-Lindgren L, Lofgren KT, et al. Age-specific and sex-specific mortality in 187 countries, 1970–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012, 380(9859): 2071-2094.
2. Lim SS, Vos T, Flaxman AD, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012, 380(9859): 2224-2260.
3. 中國營養學會. 中國居民膳食營養素參考攝入量. 中國輕工業出版社, 2000.
4. WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Daily iron RN and folic acid supplementation in pregnant women. Geneva: World Health Organization, 2012.
5. WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Intermittent iron and folic acid supplementation in non-anaemic pregnant women. Geneva: World Health Organization, 2012. http://www.who.int/nutrition/publications/micronutrients/guidelines/guideline_intermittent_ifa_non_anaemic_pregnancy/en/.
6. WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Sodium Intake for Adults and Children. Geneva: World Health Organization, 2012.
7. WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Potassium Intake for Adults and Children. Geneva: World Health Organization, 2012.
8. WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Intermittent iron supplementation in preschool and school-age children. Geneva: World Health Organization, 2011. http://www.who.int/nutrition/publications/micronutrients/guidelines/guideline_iron_supplementation_children/en/.
9. WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Intermittent iron and folic acid supplementation in menstruating women. Geneva: World Health Organization, 2011. http://www.who.int/nutrition/publications/micronutrients/guidelines/guideline_iron_folicacid_suppl_women/en/.
10. WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Vitamin A supplementation during pregnancy for reducing the risk of mother-to-child transmission of HIV. Geneva: World Health Organization, 2011. http://www.who.int/nutrition/publications/micronutrients/guidelines/vas_mtct_hiv/en/.
11. WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Neonatal vitamin A supplementation. Geneva: World Health Organization, 2011. http://www.who.int/nutrition/publications/micronutrients/guidelines/vas_neonatal/en/.
12. WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Vitamin A supplementation for infants and children 6-59 months of age. Geneva: World Health Organization, 2011. http://www.who.int/nutrition/publications/micronutrients/guidelines/vas_6to59_months/en/.
13. WHO Guidelines Approved by the Guidelines Review Committee. Guideline: Vitamin A Supplementation in Infants 1–5 Months of Age. Geneva: World Health Organization, 2011.
14. McGuire S. WHO Guideline: Vitamin A supplementation in pregnant women. Adv Nutr, 2012, 3(2): 215-216.
15. McGuire S. WHO Guideline: Vitamin A supplementation in postpartum women. Adv Nutr, 2012, 3(2):215-216.
16. WHO Guidelines Approved by the Guidelines Review Committee. FAO. Guidelines on food fortification with micronutrients. Geneva: WHO, 2006 [cited July 21, 2011]. Available from: http://www.who.int/nutrition/publications/ micronutrients/9241594012/en/index.html.
17. Thiele DK, Senti JL, Anderson CM. Maternal vitamin D supplementation to meet the needs of the breastfed infant: a systematic review. J Hum Lact, 2013, 29(2): 1-8.
18. Ngo J, Roman-Viñas B, Ribas-Barba L, et al. A systematic review on micronutrient intake adequacy in adult minority populations residing in Europe: the need for action. J Immigrant Minority Health, 2013, 3: 1-10.
19. Rolland Y, de Souto Barreto P, Abellan Van Kan G, et al. Vitamin D supplementation in older adults: searching for specific guidelines in nursing homes. J Nutr Health Aging, 2013, 17(4): 402-412.
20. Aranceta J, Pérez-Rodrigo C. Recommended dietary reference intakes, nutritional goals and dietary guidelines for fat and fatty acids: a systematic review. Br Nutr, 2012, 107: S8-s22.
21. Steyn NP, Temple NJ. Evidence to support a food-based dietary guideline on sugar consumption in South Africa. BMC Public Health, 2012, 12: 502.
22. Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab, 2011, 96(7): 1911-1930.
23. Popkin BM, D’Anci KE, Rosenberg IH. Water, hydration, and health. Nutr Rev, 2010, 68(8): 439-458.
24. Torheim LE, Ferguson EL, Penrose K, et al. Women in resource-poor settings are at risk of inadequate intakes of multiple micronutrients. J Nutr, 2010, 140(11): 2051S-2058S.
25. Hanley DA, Cranney A, Jones G, et al. Vitamin D in adult health and disease: a review and guideline statement from Osteoporosis Canada. CMAJ, 2010, 182(12): E610-E618.
26. Yetley EA, Brulé D, Cheney MC, et al. Dietary Reference Intakes for vitamin D: justification for a review of the 1997 values. Am J Clin Nutr, 2009, 89(3): 719-727.
27. Tabacchi G, Wijnhoven TM, Branca F, et al. How is the adequacy of micronutrient intake assessed across Europe? A systematic literature review. Br J Nutr, 2009, 101: S29-S36.
28. Cranney A, Horsley T, O’Donnell S, et al. Effectiveness and safety of vitamin D in relation to bone health. Evid Rep Technol Assess (Full Rep), 2007, (158): 1-235.
29. 詠梅, 舒暢, 寧鴻珍, 等. 學齡兒童鋅、硒、銅、鐵攝入水平對抗氧化能力的影響. 現代預防醫學, 2011, 38(13): 2471-2473.
30. 弈明, KE Hill, 李平, 等. 中國成人硒需要量研究. 營養學報, 201, 33(2): 109-113.
31. 馬冠生, 左嬌蕾. 水的適宜攝入量. 中華預防醫學雜志, 2011, 45(8): 675-678.
32. 唐詠梅, 朱驕峰, 周會, 等. 學齡兒童VA、VC、VE攝入水平對免疫功能影響. 中國公共衛生, 2010, 26(2): 208-210.
33. 郭長江, 韋京豫, 楊繼軍, 等. 我軍重度勞動部隊推薦的核黃素攝入量. 解放軍預防醫學雜志, 2010, 28(4): 238-241.
34. 周建烈, 毛絢霞, 顧景范. 維生素D膳食參考攝入量的再評估. 生理科學進展, 2009, 40(1): 36-40.
35. 何麗, 付萍, 張剛, 等. 不同鈣攝入量對青年男性骨密度的影響. 中國健康教育, 2007, 23(6): 413-418.
36. 何麗, 付萍, 張堅, 等. 補鈣對青年女性全身各部位骨密度的影響. 中國臨床營養雜志, 2007, 15(3): 185-190.
37. 樸建華, 姬一兵, 田園, 等. 中國青年男性膳食蛋白質參考攝入量研究. Danone Institute China, 2008, 28-29.
38. 田穎. 中國青年女性膳食蛋白質參考攝入量研究. 博士論文, 2008: 298-299.
39. 尹婧, 張倩, 劉愛玲, 等.利用鈣平衡法制定青春期少年鈣參考攝入量的研究. 中國營養學會營養基金項目論文匯編, 2008: 33-40.
40. 陳祖培, 閻玉芹. 碘的膳食參考攝入量. 中華內分泌代謝雜志, 2005, 21(2): 188-192.
41. 賈青, 黃承鈺, 周繼昌. 藏族成年男子膳食中鐵的吸收狀況研究. 現代預防醫學, 2005, 32(8): 872-874.
42. 賈青, 黃承鈺, 周繼昌. 藏族成年男子膳食中鋅的吸收狀況研究. 中國公共衛生, 2005, 21(8): 928-930.
43. 龐文貞, 許爾怡, 李守勤, 等. 學齡前兒童氮平衡測定及蛋白質適宜攝入量探討. 營養學報, 1990, 12(4): 44-348.
44. 龐文貞, 黃思齊, 沈麗華, 等. 城市孕婦營養狀況及孕婦熱能、營養素適宜攝入量探討. 營養學報, 1989, 11(3): 215-221.
45. Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012, 380(9859): 2095-2128.
46. Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012, 380(9859): 2163-2196.
47. 郭麗青. 飲食營養以及生活方式與慢性病控制. 第13屆全國臨床營養學術會議論文.
48. 羅衛平, 劉來新, 馬江平, 等. 2010 年新疆監測點居民慢性病及其行為危險因素調查分析. 疾病預防控制通報, 2013, 28(1): 20-23.
49. 趙佳, 王建華, 葉薇薇, 等. 上海市楊浦區常住居民慢性病危險因素調查分析. 中國慢性病預防與控制, 2012, 20(1): 23-25.
50. 王勁, 郭紅衛. 膳食營養素參考攝入量的制定原理和應用原則. 環境與職業醫學, 2008, 25(5): 476-479.

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《中國循證醫學雜志》

從全球疾病負擔看中國DRIs：挑戰、證據與思考

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摘要全文圖表視頻參考文獻施引文獻補充材料