Table 5_Global burden of disease analysis and projections of ischemic stroke linked to inadequate polyunsaturated fatty acid intake in older women (1990–2021).docx

BackgroundIschemic stroke (IS), a major global cause of death and disability, is significantly influenced by diet. While polyunsaturated fatty acid (PUFA) exhibits neuroprotective effects, the specific stroke burden attributable to inadequate PUFA intake among women ≥ 50 years remains unquantified. This study aimed to quantify the global IS burden linked to suboptimal PUFA intake in this population and analyze its temporal and sociodemographic trends.
MethodsWe estimated ischemic stroke deaths and disability-adjusted life years (DALYs) attributable to the global burden of disease (GBD) risk factor “diet low in PUFA” using the GBD 2021 comparative risk assessment, reporting age-standardized rates and counts with 95% uncertainty intervals. Key burden metrics were assessed using age-standardized rates, with temporal trends (estimated annual percentage change), regional/sociodemographic variations, and decomposition analyses performed. Future burden (to 2050) was projected.
ResultsFrom 1990 to 2021, global age-standardized rates (ASRs) for DALYs, deaths, years lived with disability (YLDs), and years of life lost (YLLs) attributable to PUFA-related ischemic stroke in women aged ≥ 50 years declined or remained stable, with EAPCs of −1.32% (DALYs), −1.47% (deaths), +0.07% (YLDs), and −1.61% (YLLs) per year. Absolute counts increased over the same period, a pattern explained by population growth and aging as shown by our decomposition analysis. Older age groups exhibited higher ASRs, and China and India contributed the largest share of the global absolute burden. Across SDI strata, declines were steepest in high-SDI settings, whereas changes were smaller—often flat to slightly decreasing—in low-SDI settings; the rise in absolute burden there reflects population growth and aging rather than higher per-capita risk. The GBD due to IS associated with PUFAs in women over 50 years is expected to continue increasing in the coming decades, with YLDs projected to experience the most rapid growth. External validation (Global Dietary Database 2018, women ≥ 50 years) confirmed a negative association consistent with the main analysis.
ConclusionSuboptimal PUFA intake accounted for a substantial share of ischemic stroke burden among women aged ≥ 50 years, while age-standardized rates declined, absolute numbers rose with population growth and aging.

研究背景：缺血性脑卒中（Ischemic stroke, IS）是全球范围内致死与致残的主要病因之一，其发生发展受膳食因素显著影响。尽管多不饱和脂肪酸（polyunsaturated fatty acid, PUFA）已被证实具有神经保护作用，但≥50岁女性群体中因PUFA摄入不足所导致的特异性脑卒中疾病负担仍未被量化。本研究旨在量化该群体中因PUFA摄入不佳所关联的全球缺血性脑卒中疾病负担，并分析其时间趋势与社会人口学特征变化。
研究方法：本研究借助2021年全球疾病负担（Global Burden of Disease, GBD）比较风险评估（comparative risk assessment）框架，针对"PUFA摄入不足"这一GBD危险因素，估算了与该因素相关的缺血性脑卒中死亡病例与伤残调整寿命年（disability-adjusted life years, DALYs），并报告了年龄标准化率与绝对数值，同时附带95%不确定区间。核心疾病负担指标采用年龄标准化率进行评估，并开展了时间趋势（年度估计百分比变化（estimated annual percentage change, EAPC））、区域/社会人口学差异分析与分解分析，同时对至2050年的未来疾病负担进行了预测。
研究结果：1990年至2021年间，≥50岁女性中因PUFA相关缺血性脑卒中导致的全球DALYs、死亡病例、伤残生存年（years lived with disability, YLDs）及早死寿命损失年（years of life lost, YLLs）的年龄标准化率均呈下降或平稳态势，年度估计百分比变化（EAPC）分别为-1.32%（DALYs）、-1.47%（死亡病例）、+0.07%（YLDs）与-1.61%（YLLs）。同期绝对发病/死亡数呈上升趋势，分解分析显示该现象可归因于人口增长与人口老龄化。高龄组的年龄标准化率更高，中国与印度贡献了全球最大的绝对疾病负担份额。在不同社会人口学指数（Socio-demographic Index, SDI）分层中，高SDI地区的年龄标准化率下降幅度最为显著，而低SDI地区的变化幅度较小——通常趋于平稳或仅小幅下降；该地区绝对疾病负担的上升则反映为人口增长与老龄化，而非人均风险升高。预计未来数十年内，≥50岁女性中与PUFA相关的缺血性脑卒中GBD负担将持续上升，其中YLDs的增长速度最快。通过2018年全球膳食数据库（针对≥50岁女性）开展的外部验证结果证实，其关联方向与主分析结果一致，呈负相关关系。
研究结论：PUFA摄入不佳在≥50岁女性的缺血性脑卒中疾病负担中占比可观；尽管年龄标准化率有所下降，但绝对病例数随人口增长与老龄化呈上升趋势。