替代健康饮食指数与儿童及青少年哮喘的关系：基于2005~2018年NHANES横断面研究

Association between Alternate Healthy Eating Index and Asthma in Children and Adolescents: A Cross-Sectional Study Based on NHANES 2005~2018

摘要: 目的：研究儿童及青少年哮喘与替代健康饮食指数(AHEI)之间的关系。方法：选取国家健康与营养调查(NHANES) 2005~2018年4~16岁儿童青少年数据。以AHEI作为膳食质量评价指标，以哮喘作为结局变量。采用复杂抽样加权方法进行描述性分析及组间比较，构建加权logistic回归模型评估AHEI与哮喘患病的关联，并逐步调整人口学特征、社会经济因素、生活方式及能量摄入等混杂因素。在此基础上，纳入身体质量指数z评分(BMI z-score)探讨其与AHEI、哮喘之间的关系，并采用中介分析评估BMI z评分在两者之间的中介作用。同时进行AHEI分位数敏感性分析及各组成成分分析。结果：AHEI评分与儿童哮喘患病呈显著负相关，在逐步调整混杂因素后该关联仍存在。纳入BMI z评分后，AHEI与哮喘之间的负相关关系略有减弱但仍具有统计学意义。中介分析结果显示BMI z评分在AHEI与哮喘之间存在显著但较小的中介效应。敏感性分析表明，随着AHEI水平升高，哮喘患病风险呈下降趋势。成分分析显示，水果摄入与哮喘风险降低相关，而含糖饮料摄入与哮喘风险升高相关。结论：较高AHEI评分与儿童青少年较低哮喘患病风险相关，BMI z-score可能部分参与二者之间的关联。研究结果提示，饮食模式可能通过体重状态等途径与儿童青少年哮喘患病风险相关，为进一步探索饮食、肥胖及炎症通路在儿童哮喘中的作用提供了研究思路。

Abstract: Objective: To investigate the relationship between the Alternate Healthy Eating Index (AHEI) and asthma in children and adolescents. Methods: Data were extracted from the National Health and Nutrition Examination Survey (NHANES) 2005~2018 for participants aged 4~16 years. AHEI was used as a measure of dietary quality, and asthma as the outcome variable. Complex sampling weighting was applied for descriptive analysis and between-group comparisons. Weighted logistic regression models were constructed to assess the association between AHEI and asthma prevalence, with stepwise adjustment for demographic characteristics, socioeconomic factors, lifestyle variables, and energy intake. Subsequently, body mass index z-score (BMI z-score) was introduced to explore its relationship with AHEI and asthma, and mediation analysis was performed to examine the mediating role of BMI z-score in the association between AHEI and asthma. Sensitivity analyses across AHEI quantiles and component analyses were also conducted. Results: AHEI score was significantly and inversely associated with asthma prevalence in children. This association remained stable after stepwise adjustment for confounders. After including BMI z-score, the inverse association between AHEI and asthma was slightly attenuated but remained statistically significant. Mediation analysis revealed a significant but modest mediating effect of BMI z-score on the AHEI-asthma relationship. Sensitivity analysis showed a decreasing trend in asthma risk with higher AHEI levels. Component analysis indicated that fruit intake was associated with a lower risk of asthma, whereas sugar-sweetened beverage intake was associated with a higher risk. Conclusions: Higher AHEI scores were associated with a lower prevalence of asthma among children and adolescents, and BMI z-score may partially contribute to this association. These findings suggest that dietary patterns may be linked to asthma prevalence in children and adolescents through pathways related to body weight status, providing a basis for future research on the roles of diet, obesity, and inflammatory pathways in childhood asthma.