Seasonal variation in dietary intake and its association with obesity-related chronic diseases in northeast China

Cheng Wang; Zican Li; Dongwei Guan; Hongxin Fu; Rennan Feng

doi:10.1515/fzm-2024-0014

Seasonal variation in dietary intake and its association with obesity-related chronic diseases in northeast China

doi: 10.1515/fzm-2024-0014

Cheng Wang^{1, #},
Zican Li^{2, 3, #},
Dongwei Guan^{2, 3},
Hongxin Fu^{2, 3},
Rennan Feng^{2, 3
, ,}

1.
Department of Environmental Hygiene, School of Public Health, Harbin Medical University, Harbin 150081, China
2.
Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin 150081, China
3.
Key Laboratory of Precision Nutrition and Health of Ministry of Education, School of Public Health, Harbin Medical University, Harbin 150081, China

Funds:

the National Natural Science Foundation of China 82273612

the National Natural Science Foundation of China 81573133

More Information

Corresponding author: Rennan Feng, E-mail: fengrennan@yeah.net

摘要

Abstract: Objective The objective of this study was to assess seasonal changes in dietary and nutrient intake of residents (18-75 years old) in Northeast China during summer and winter, and to explore the associations between fatty acids, phytosterols, and the prevalence of obesity-related chronic diseases, particularly obesity, hyperlipidemia, and NAFLD. Methods A total of 4773 participants from the Internet-based Dietary Questionnaire for Chinese (IDQC) were included in this study. Dietary intake information was collected using a validated food frequency questionnaire. Student's t-test or Mann-Whitney U-test was used to analyze continuous variables, while Chi-squared tests were used to compare categorical variables. Multivariable logistic regression was employed to assess the relationship between fatty acids, phytosterols, and obesity-related chronic diseases. Results The mean consumption of legumes, vegetables, fruits, nuts, dairy products, fish, condiments, energy, protein, fat, and carbohydrate differed significantly between summer and winter (P < 0.05). Significant inverse associations were found between both fatty acids and phytosterols and obesity-related chronic diseases in multivariate adjusted models. Summer polyunsaturated fatty acid (PUFA) intake was negatively associated with the prevalence of hyperlipidemia (Q4, OR, 0.515; 95%CI, 0.283-0.921; P < 0.05) and non-alcoholic fatty liver disease (NAFLD) (Q4, OR, 0.331; 95%CI, 0.176-0.599; P < 0.001). Phytosterols intake was negatively associated with the prevalence of obesity (Q4, OR, 0.603; 95%CI, 0.414-0.873; P < 0.05), hyperlipidemia (Q4, OR, 0.420; 95%CI, 0.233-0.731; P < 0.001), and NAFLD (Q4, OR, 0.206; 95%CI, 0.111-0.360; P < 0.001) during the summer. Conclusions Higher PUFA intake was associated with a lower prevalence of obesity, hyperlipidemia, and NAFLD. Phytosterol intake was inversely associated with the prevalence of hyperlipidemia and NAFLD. These findings suggest that the associations between PUFA and phytosterols and the prevalence of obesity-related chronic diseases may be influenced by seasonal differences in food intake.
- obesity-related chronic diseases /
- polyunsaturated fatty acid /
- phytosterols
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Table 1. General characteristics of the participants

	Summer (N = 2718)	Winter (N = 2055)	P Value
Age	40.23 ± 16.29	38.68 ± 14.87	< 0.01
Gender			0.854
Male	1215 (44.70)	925(45.01)
Female	1503 (55.30)	1130 (54.99)
Body mass index, kg/m²	23.37 ± 3.47	23.090 ± 3.18	< 0.01
Systolic blood pressure, mmHg	121.43 ± 14.71	120.143 ± 12.21	< 0.01
Diastolic blood pressure, mmHg	79.58 ± 9.93	78.665 ± 8.30	< 0.01
Drinking, N (% current)	425(15.64)	219(10.66)	< 0.01
Smoking, N (% current)	364(13.39)	269(13.09)	0.729
Educational status			< 0.01
Junior school and below	639(23.51)	543(26.42)
Senior high school or equivalent	579(21.30)	395(19.22)
College or equivalent	1448 (53.27)	964(46.91)
Postgraduate or above	52 (1.91)	153(7.45)
Work intensity, N (%)			< 0.01
Light	1762 (64.83)	1137 (55.33)
Moderate	765(28.15)	685(33.33)
Heavy	191(7.03)	233(11.34)
Income per month, yuan			< 0.01
< 1000	584(21.49)	540(26.28)
1000-2000	555(20.42)	302(14.70)
2000-3000	753(27.70)	565(27.49)
3000-4000	418(15.38)	315(15.33)
> 4000	408(15.01)	333(16.20)
P Values were determined using Chi-squared test for categorical variables, analysis of Student's t test for continuous variables and Mann-Whitney U test for non-normal continuous variables. Data are expressed as mean ± SD, frequencies and percentages as appropriate.

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Table 2. Dietary and nutrients intake of the participants in summer and winter

Groups	Summer (N = 2718)	Winter (N = 2055)	% difference	P Value
Refined grains, g/d	287.67 ± 167.89	296.03 ± 165.91	1.43%	0.087
Potatoes, g/d	55.68 ± 57.91	53.73 ± 52.64	-1.78%	0.232
Legumes, g/d	98.11 ± 100.67	87.18 ± 82.60	-5.89%	< 0.001
Vegetables, g/d	386.81 ± 282.88	333.23 ± 236.60	-7.44%	< 0.001
Fungi, g/d	44.00 ± 49.54	45.87 ± 55.96	2.07%	0.224
Fruits, g/d	281.04 ± 249.78	215.36 ± 182.38	-13.23%	< 0.001
Seed and nuts, g/d	41.83 ± 47.75	29.97 ± 33.27	-16.51%	< 0.001
Livestock, g/d	75.79 ± 61.16	72.44 ± 54.22	-2.26%	0.050
Poultry, g/d	26.37 ± 32.94	27.81 ± 33.15	2.67%	0.135
Dairy products, g/d	96.92 ± 110.78	107.48 ± 112.91	5.16%	0.001
Egg, g/d	27.56 ± 28.85	28.11 ± 26.41	0.98%	0.501
Fish, g/d	66.59 ± 70.85	37.69 ± 37.78	-27.72%	< 0.001
Fast food, g/d	52.36 ± 57.61	50.53 ± 55.29	-1.78%	0.270
Sweets, g/d	3.01 ± 6.80	3.27 ± 5.26	4.25%	0.140
Beverages, mL/d	38.48 ± 96.73	41.27 ± 95.70	3.49%	0.322
Condiments, g/d	10.25 ± 17.67	8.40 ± 19.67	-9.93%	< 0.001
Total energy, kcal/d	2362.22 ± 819.53	2094.75 ± 789.09	-6.00%	< 0.001
Protein, g/d	89.99 ± 36.51	84.34 ± 34.56	-3.24%	< 0.001
Total fat, g/d	76.13 ± 36.10	62.30 ± 30.62	-9.99%	< 0.001
Carbohydrate, g/d	345.62 ± 133.51	310.04 ± 128.95	-5.43%	< 0.001
Fiber, g/d	20.07 ± 10.81	15.51 ± 9.43	-12.83%	< 0.001
Cholesterol, g/d	501.51 ± 322.20	371.76 ± 232.62	-14.86%	< 0.001
Fatty acids, g/d	42.84 ± 24.03	44.20 ± 23.63	1.56%	0.052
Saturated fatty acids, g/d	10.09 ± 5.21	11.62 ± 5.70	7.03%	< 0.001
Monounsaturated fatty acids, g/d	13.93 ± 7.69	16.50 ± 9.50	8.44%	< 0.001
Polyunsaturated fatty acid, g/d	18.39 ± 12.34	15.51 ± 10.02	-8.48%	< 0.001
Phytosterols, mg/d	1326.10 ± 1000.12	503.32 ± 762.50	-44.97%	< 0.001
P Values were determined using Student's t test for continuous variables and Mann-Whitney U-test for non-normal continuous variables. Difference in percentage of average summer consumption as it relates to average winter consumption. Data are expressed as mean ± SD.

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Table 3. Association of different types of fatty acids and phytosterols with prevalence of obesity in participants during summer and winter

Quartiles	Summer (N = 2718)				Winter (N = 2055)
	Q1	Q2	Q3	Q4	Q1	Q2	Q3	Q4
Fatty acids
Crude	1	1.421 (0.991-2.048)	1.402 (0.977-2.023)	1.077 (0.736-1.578)	1	1.384 (0.858-2.254)	1.241 (0.761-2.040)	0.728 (0.414-1.262)
Model1	1	1.441 (1.001-2.088)	1.423 (0.987-2.063)	1.047 (0.711-1.543)	1	1.254 (0.767-2.068)	1.041 (0.624-1.747)	0.605 (0.336-1.072)
Model2	1	1.451 (1.006-2.103)^*	1.432 (0.992-2.078)	1.056 (0.716-1.560)	1	1.272 (0.776-2.104)	1.081 (0.646-1.819)	0.636 (0.353-1.131)
Model3	1	1.441 (0.996-2.097)	1.371 (0.945-2.000)	1.031 (0.695-1.530)	1	1.239 (0.747-2.069)	1.083 (0.639-1.843)	0.607 (0.333-1.092)
Saturated fatty acids
Crude	1	1.092 (0.753-1.585)	1.266 (0.883-1.821)	1.264 (0.882-1.818)	1	0.842 (0.502-1.404)	1.286 (0.808-2.064)	0.812 (0.482-1.358)
Model1	1	1.100 (0.756-1.602)	1.335 (0.928-1.928)	1.264 (0.878-1.827)	1	0.753 (0.441-1.275)	1.091 (0.666-1.795)	0.662 (0.382-1.139)
Model2	1	1.107 (0.760-1.614)	1.346 (0.935-1.947)	1.292 (0.896-1.870)	1	0.733 (0.428-1.246)	1.102 (0.670-1.822)	0.675 (0.388-1.164)
Model3	1	1.079 (0.737-1.582)	1.326 (0.915-1.930)	1.234 (0.848-1.802)	1	0.703 (0.405-1.210)	1.062 (0.635-1.782)	0.623 (0.353-1.089)
Monounsaturated fatty acids
Crude	1	1.229 (0.853-1.775)	1.192 (0.826-1.725)	1.288 (0.897-1.855)	1	1.703 (1.053-2.799)^*	1.112 (0.656-1.891)	1.036 (0.606-1.773)
Model1	1	1.332 (0.921-1.935)	1.269 (0.875-1.845)	1.331 (0.923-1.927)	1	1.566 (0.956-2.605)	0.950 (0.548-1.649)	0.862 (0.492-1.511)
Model2	1	1.326 (0.916-1.927)	1.271 (0.875-1.851)	1.333 (0.923-1.932)	1	1.563 (0.950-2.611)	0.968 (0.557-1.686)	0.891 (0.507-1.568)
Model3	1	1.335 (0.919-1.948)	1.236 (0.847-1.810)	1.302 (0.896-1.901)	1	1.557 (0.938-2.619)	0.946 (0.537-1.670)	0.859 (0.483-1.528)
Polyunsaturated fatty acid
Crude	1	1.209 (0.852-1.721)	1.158 (0.813-1.652)	0.862 (0.591-1.255)	1	1.247 (0.785-1.993)	0.787 (0.468-1.311)	0.787 (0.468-1.311)
Model1	1	1.164 (0.814-1.669)	1.081 (0.754-1.553)	0.796 (0.541-1.168)	1	1.085 (0.676-1.749)	0.650 (0.380-1.100)	0.661 (0.386-1.119)
Model2	1	1.161 (0.811-1.666)	1.088 (0.758-1.565)	0.795 (0.540-1.169)	1	1.116 (0.694-1.803)	0.680 (0.398-1.154)	0.693 (0.404-1.177)
Model3	1	1.163 (0.809-1.675)	1.067 (0.741-1.540)	0.790 (0.533-1.167)	1	1.155 (0.711-1.886)	0.693 (0.399-1.193)	0.688 (0.395-1.186)
Phytosterols
Crude	1	0.573 (0.404-0.807)^*	0.618 (0.438-0.865)^*	0.530 (0.371-0.751)^^	1	0.841 (0.524-1.343)	0.790 (0.488-1.269)	0.589 (0.348-0.976)^*
Model1	1	0.619 (0.434-0.876)^*	0.707 (0.498-0.998)	0.609 (0.423-0.871)^*	1	0.806 (0.501-1.289)	0.790 (0.487-1.270)	0.738 (0.421-1.274)
Model2	1	0.605 (0.424-0.857)^*	0.687 (0.483-0.972)^*	0.598 (0.414-0.858)^*	1	0.824 (0.511-1.322)	0.811 (0.499-1.308)	0.738 (0.420-1.279)
Model3	1	0.616 (0.429-0.878)^*	0.675 (0.471-0.963)^*	0.603 (0.414-0.873)^*	1	0.815 (0.503-1.315)	0.803 (0.489-1.307)	0.729 (0.408-1.286)
Crude not adjusted for any potential covariates; Model 1adjusted for age, gender; Model 2 adjusted for age, gender, drinking status, smoking status; Model 3 adjusted for age, gender, drinking status, smoking status, educational status, income, work intensity. ^*P < 0.001; ^P < 0.05; non letter or symbol, P > 0.05.

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Table 4. Association of different types of fatty acids and phytosterols with prevalence of hyperlipidemia in participants during summer and winter

Quartiles	Summer (N = 2623)				Winter (N = 1948)
	Q1	Q2	Q3	Q4	Q1	Q2	Q3	Q4
Fatty acids
Crude	1	1.412 (0.881-2.288)	1.342 (0.833-2.183)	1.100 (0.668-1.820)	1	0.927 (0.426-2.003)	1.222 (0.596-2.546)	0.927 (0.426-2.003)
Model1	1	1.381 (0.851-2.266)	1.310 (0.804-2.156)	0.966 (0.579-1.618)	1	0.735 (0.330-1.624)	0.830 (0.390-1.787)	0.619 (0.274-1.387)
Model2	1	1.490 (0.911-2.464)	1.474 (0.897-2.447)	1.124 (0.667-1.902)	1	0.725 (0.319-1.630)	0.894 (0.415-1.953)	0.712 (0.310-1.626)
Model3	1	1.421 (0.862-2.368)	1.336 (0.804-2.243)	0.996 (0.584-1.704)	1	0.924 (0.397-2.138)	1.174 (0.524-2.678)	0.901 (0.380-2.131)
Saturated fatty acids
Crude	1	0.885 (0.544-1.433)	0.885 (0.544-1.433)	1.260 (0.807-1.979)	1	1.375 (0.629-3.102)	1.187 (0.526-2.728)	1.661 (0.787-3.666)
Model1	1	0.846 (0.514-1.385)	0.942 (0.574-1.542)	1.180 (0.747-1.874)	1	1.079 (0.479-2.497)	0.812 (0.345-1.935)	1.118 (0.509-2.556)
Model2	1	0.870 (0.527-1.432)	1.025 (0.620-1.689)	1.340 (0.841-2.149)	1	0.942 (0.409-2.222)	0.810 (0.339-1.964)	1.154 (0.515-2.682)
Model3	1	0.814 (0.487-1.355)	0.911 (0.545-1.519)	1.138 (0.704-1.852)	1	1.241 (0.520-3.035)	0.878 (0.354-2.213)	1.232 (0.530-2.974)
Monounsaturated fatty acids
Crude	1	1.030 (0.629-1.689)	1.289 (0.808-2.074)	1.224 (0.763-1.977)	1	1.519 (0.731-3.271)	1.519 (0.731-3.271)	0.745 (0.302-1.777)
Model1	1	1.135 (0.685-1.884)	1.402 (0.869-2.281)	1.205 (0.742-1.967)	1	1.213 (0.567-2.675)	1.033 (0.477-2.304)	0.488 (0.191-1.204)
Model2	1	1.190 (0.714-1.988)	1.555 (0.955-2.555)	1.333 (0.815-2.197)	1	1.071 (0.488-2.413)	0.971 (0.439-2.207)	0.499 (0.192-1.256)
Model3	1	1.147 (0.683-1.930)	1.436 (0.873-2.383)	1.165 (0.702-1.945)	1	1.286 (0.569-2.997)	1.190 (0.511-2.853)	0.559 (0.208-1.457)
Polyunsaturated fatty acid
Crude	1	1.540 (0.988-2.428)	1.279 (0.806-2.044)	0.605 (0.342-1.046)	1	0.939 (0.465-1.889)	0.698 (0.322-1.468)	0.698 (0.322-1.468)
Model1	1	1.304 (0.822-2.091)	1.039 (0.645-1.686)	0.465 (0.259-0.815)*	1	0.689 (0.334-1.412)	0.463 (0.209-0.998)	0.476 (0.213-1.030)
Model2	1	1.325 (0.831-2.135)	1.114 (0.688-1.817)	0.520 (0.288-0.920)*	1	0.705 (0.337-1.468)	0.535 (0.238-1.169)	0.526 (0.232-1.161)
Model3	1	1.336 (0.832-2.171)	1.107 (0.678-1.822)	0.515 (0.283-0.921)*	1	0.913 (0.426-1.953)	0.800 (0.344-1.819)	0.824 (0.349-1.906)
Phytosterols
Crude	1	0.769 (0.508-1.157)	0.513 (0.321-0.804)*	0.319 (0.183-0.533)**	1	0.490 (0.218-1.034)	0.845 (0.432-1.632)	0.490 (0.218-1.034)
Model1	1	0.859 (0.559-1.313)	0.601 (0.370-0.958)*	0.372 (0.210-0.633)**	1	0.444 (0.196-0.944)*	0.857 (0.435-1.671)	0.956 (0.401-2.173)
Model2	1	0.890 (0.577-1.367)	0.644 (0.394-1.037)	0.416 (0.233-0.714)**	1	0.486 (0.212-1.049)	1.029 (0.511-2.058)	1.065 (0.438-2.477)
Model3	1	0.955 (0.613-1.484)	0.674 (0.406-1.101)	0.420 (0.233-0.731)**	1	0.499 (0.214-1.096)	1.089 (0.531-2.221)	1.070 (0.430-2.550)
Crude not adjusted for any potential covariates; Model 1adjusted for age, gender; Model 2 adjusted for age, gender, drinking status, smoking status; Model 3 adjusted for age, gender, drinking status, smoking status, educational status, income, work intensity. ^*P < 0.001; ^P < 0.05; non letter or symbol, P > 0.05.

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Table 5. Association of different types of fatty acids and phytosterols with prevalence of NAFLD in participants during summer and winter

Quartiles	Summer (N = 2367)				Winter (N = 1959)
	Q1	Q2	Q3	Q4	Q1	Q2	Q3	Q4
Fatty acids
Crude	1	1.874 (1.154-3.108)*	1.449 (0.869-2.448)	1.324 (0.786-2.254)	1	0.998 (0.563-1.769)	0.749 (0.402-1.373)	0.708 (0.376-1.308)
Model1	1	1.914 (1.170-3.194)*	1.463 (0.873-2.486)	1.284 (0.758-2.200)	1	0.706 (0.386-1.289)	0.444 (0.230-0.844)*	0.409 (0.209-0.785)*
Model2	1	2.063 (1.252-3.470)*	1.641 (0.972-2.812)	1.468 (0.858-2.542)	1	0.714 (0.384-1.322)	0.470 (0.241-0.903)*	0.447 (0.225-0.871)*
Model3	1	1.871 (1.118-3.195)*	1.383 (0.802-2.416)	1.159 (0.663-2.045)	1	0.954 (0.501-1.818)	0.630 (0.310-1.267)	0.569 (0.278-1.146)
Saturated fatty acids
Crude	1	1.170 (0.714-1.927)	0.930 (0.551-1.566)	1.594 (1.005-2.564)	1	0.773 (0.407-1.447)	1.043 (0.579-1.884)	0.952 (0.521-1.737)
Model1	1	1.164 (0.706-1.928)	0.991 (0.584-1.677)	1.620 (1.015-2.622)*	1	0.532 (0.270-1.028)	0.627 (0.333-1.178)	0.545 (0.286-1.034)
Model2	1	1.229 (0.741-2.048)	1.092 (0.639-1.862)	1.880 (1.166-3.075)*	1	0.466 (0.232-0.918)*	0.623 (0.325-1.191)	0.536 (0.276-1.034)
Model3	1	1.122 (0.665-1.904)	0.893 (0.513-1.549)	1.405 (0.850-2.350)	1	0.598 (0.287-1.223)	0.698 (0.350-1.391)	0.571 (0.283-1.146)
Monounsaturated fatty acids
Crude	1	1.292 (0.785-2.145)	1.329 (0.811-2.201)	1.404 (0.862-2.316)	1	1.249 (0.694-2.272)	1.198 (0.662-2.189)	0.704 (0.352-1.374)
Model1	1	1.442 (0.871-2.411)	1.430 (0.867-2.382)	1.449 (0.884-2.404)	1	0.928 (0.500-1.735)	0.732 (0.389-1.385)	0.409 (0.197-0.827)*
Model2	1	1.504 (0.902-2.532)	1.595 (0.959-2.682)	1.591 (0.962-2.663)	1	0.860 (0.454-1.639)	0.691 (0.360-1.332)	0.412 (0.195-0.847)*
Model3	1	1.379 (0.816-2.352)	1.308 (0.771-2.241)	1.213 (0.716-2.076)	1	1.126 (0.576-2.220)	0.906 (0.447-1.850)	0.475 (0.218-1.016)
Polyunsaturated fatty acid
Crude	1	1.024 (0.658-1.595)	0.998 (0.640-1.558)	0.386 (0.212-0.675)**	1	0.781 (0.441-1.367)	0.535 (0.281-0.986)*	0.640 (0.348-1.149)
Model1	1	0.908 (0.576-1.431)	0.894 (0.567-1.409)	0.329 (0.179-0.580)**	1	0.532 (0.294-0.954)*	0.319 (0.163-0.605)*	0.393 (0.207-0.729)*
Model2	1	0.921 (0.582-1.458)	0.954 (0.603-1.511)	0.360 (0.195-0.640)**	1	0.547 (0.297-0.992)*	0.354 (0.179-0.678)*	0.417 (0.217-0.784)*
Model3	1	0.923 (0.573-1.487)	0.948 (0.588-1.530)	0.331 (0.176-0.599)**	1	0.722 (0.382-1.350)	0.539 (0.264-1.071)	0.658 (0.329-1.293)
Phytosterols
Crude	1	0.400 (0.258-0.607)**	0.225 (0.130-0.369)**	0.188 (0.105-0.318)**	1	0.679 (0.362-1.248)	1.038 (0.596-1.814)	0.601 (0.312-1.124)
Model1	1	0.440 (0.282-0.673)**	0.259 (0.150-0.429)**	0.216 (0.119-0.369)**	1	0.609 (0.321-1.129)	1.089 (0.618-1.923)	1.340 (0.656-2.688)
Model2	1	0.434 (0.277-0.666)**	0.267 (0.153-0.445)**	0.233 (0.128-0.401)**	1	0.667 (0.348-1.256)	1.265 (0.706-2.279)	1.443 (0.695-2.950)
Model3	1	0.418 (0.262-0.656)**	0.247 (0.139-0.420)**	0.206 (0.111-0.360)**	1	0.700 (0.356-1.353)	1.343 (0.731-2.478)	1.271 (0.595-2.670)
Crude not adjusted for any potential covariates; Model 1adjusted for age, gender; Model 2 adjusted for age, gender, drinking status, smoking status; Model 3 adjusted for age, gender, drinking status, smoking status, educational status, income, work intensity. ^*P < 0.001; ^P < 0.05; non letter or symbol, P > 0.05.

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