Dietary Supplements and Risk of Cause-Specific Death, Cardiovascular Disease, and Cancer: A Systematic Review and Meta-Analysis of Primary Prevention Trials.
Dietary Supplements and Risk of Cause-Specific Death, Cardiovascular Disease, and Cancer: A Systematic Review and Meta-Analysis of Primary Prevention Trials.
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DOI：
10.3945/an.116.013516
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发表时间：
2017-01
期刊：
影响因子：
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通讯作者：
Chaimani A
中科院分区：
文献类型：
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作者：
Schwingshackl L;Boeing H;Stelmach-Mardas M;Gottschald M;Dietrich S;Hoffmann G;Chaimani A
我们的目的是通过使用荟萃分析方法评估膳食补充剂在一级预防死因特异性死亡、心血管疾病（CVD）和癌症方面的疗效。电子和手动检索进行至2016年8月。入选标准如下：1）最短干预时间为12个月; 2）一级预防试验; 3）平均年龄≥18岁; 4）干预措施包括维生素、脂肪酸、矿物质、含有维生素和矿物质组合的补充剂、蛋白质、纤维、益生元和益生菌; 5）全因死亡率的主要结局和死亡率或CVD或癌症发病率的次要结局。通过使用随机效应荟萃分析来估计研究间的合并效应。总体而言，49项试验（69份报告），包括287，304名受试者符合纳入标准。32项试验被判定为低风险，15项试验被判定为中度风险，2项试验被判定为高偏倚风险研究。补充维生素E（RR：0.88; 95% CI：0.80，0.96）可显著降低心血管死亡风险，而补充叶酸可降低CVD风险（RR：0.81; 95% CI：0.70，0.94）。维生素D，C和K;硒;锌;镁;和二十碳五烯酸显示任何结果的风险没有显著降低。相反，维生素A与癌症风险增加有关（RR：1.16; 95% CI：1.00，1.35）。补充β-胡萝卜素没有显示出显著的效果;然而，在单独给予β-胡萝卜素的亚组中，观察到全因死亡率增加6%（RR：1.06; 95% CI：1.02，1.10）。总之，我们发现没有足够的证据支持使用膳食补充剂对死因特异性死亡、心血管疾病发病率和癌症发病率进行一级预防。一些补充剂的应用产生了小的有益效果;然而，不同类型和剂量的补充剂限制了对总人口的普遍性。
Our aim was to assess the efficacy of dietary supplements in the primary prevention of cause-specific death, cardiovascular disease (CVD), and cancer by using meta-analytical approaches. Electronic and hand searches were performed until August 2016. Inclusion criteria were as follows: 1) minimum intervention period of 12 mo; 2) primary prevention trials; 3) mean age ≥18 y; 4) interventions included vitamins, fatty acids, minerals, supplements containing combinations of vitamins and minerals, protein, fiber, prebiotics, and probiotics; and 5) primary outcome of all-cause mortality and secondary outcomes of mortality or incidence from CVD or cancer. Pooled effects across studies were estimated by using random-effects meta-analysis. Overall, 49 trials (69 reports) including 287,304 participants met the inclusion criteria. Thirty-two trials were judged as low risk–, 15 trials as moderate risk–, and 2 trials as high risk–of-bias studies. Supplements containing vitamin E (RR: 0.88; 95% CI: 0.80, 0.96) significantly reduced cardiovascular mortality risk, whereas supplements with folic acid reduced the risk of CVD (RR: 0.81; 95% CI: 0.70, 0.94). Vitamins D, C, and K; selenium; zinc; magnesium; and eicosapentaenoic acid showed no significant risk reduction for any of the outcomes. On the contrary, vitamin A was linked to an increased cancer risk (RR: 1.16; 95% CI: 1.00, 1.35). Supplements with β-carotene showed no significant effect; however, in the subgroup with β-carotene given singly, an increased risk of all-cause mortality by 6% (RR: 1.06; 95% CI: 1.02, 1.10) was observed. Taken together, we found insufficient evidence to support the use of dietary supplements in the primary prevention of cause-specific death, incidence of CVD, and incidence of cancer. The application of some supplements generated small beneficial effects; however, the heterogeneous types and doses of supplements limit the generalizability to the overall population.