Whole grain, bran, and germ intake and risk of type 2 diabetes: a prospective cohort study and systematic review.
Whole grain, bran, and germ intake and risk of type 2 diabetes: a prospective cohort study and systematic review.
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全谷物，麸皮和细菌摄入量以及2型糖尿病的风险：前瞻性队列研究和系统评价。
DOI：
10.1371/journal.pmed.0040261
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发表时间：
2007-08
期刊：
影响因子：
15.8
通讯作者：
van Dam, Rob M.
中科院分区：
文献类型：
--
作者：
de Munter, Jeroen S. L.;Hu, Frank B.;Spiegelman, Donna;Franz, Mary;van Dam, Rob M.
通过平衡能量摄入和能量消耗来控制体重对于预防2型糖尿病具有重要意义，但特定饮食因素在2型糖尿病病因学中的作用尚不明确。我们在前瞻性队列研究中评估了全谷物、麸皮和胚芽的摄入量与2型糖尿病风险的关系。我们随访了161737名参加护士健康研究（NHSs） I和II的美国女性，她们在基线时没有糖尿病、心血管疾病或癌症史。基线年龄NHSI为37 ~ 65岁，NHSII为26 ~ 46岁。饮食摄入量和潜在的混杂因素通过定期管理的问卷进行评估。在12-18年的随访中，我们记录了6486例2型糖尿病病例。截至2007年1月，在MEDLINE和EMBASE检索中发现了其他关于全谷物摄入与2型糖尿病风险的前瞻性队列研究，数据由两位审稿人独立提取。NHSI组最低和最高五分位数全谷物摄取量的中位数分别为3.7和31.2 g/d， NHSI组为6.2和39.9 g/d。在对潜在混杂因素进行调整后，与全谷物摄入量最低的五分位数相比，NHSI的最高五分位数的相对风险（rr）为0.63(95%可信区间[CI] 0.57-0.69)， NHSII的相对风险（rr）为0.68(95%可信区间[CI] 0.57-0.81)（两者均为p值，趋势检验<0.001）。在进一步调整体重指数（BMI）后，这些相对危险度分别为0.75 （95% CI 0.68-0.83； p值，趋势检验<0.001）和0.86 （95% CI 0.72-1.02； p值，趋势检验0.03）。麸皮摄取量与全谷物摄取量的相关性相似，而在调整麸皮摄取量后，未观察到与胚芽摄取量的显著相关性。根据6项队列研究的汇总数据，包括286125名参与者和10944例2型糖尿病患者，在调整潜在混杂因素和BMI后，每天增加两份全谷物摄入量与2型糖尿病风险降低21% （95% CI 13%-28%）相关。全谷物摄入与2型糖尿病的风险呈负相关，而麸皮的这种关联要强于胚芽。前瞻性队列研究的结果一致支持增加全谷物消费以预防2型糖尿病。Jeroen de Munter及其同事在美国护士健康研究中发现，全谷物摄入量与患2型糖尿病的风险呈负相关。麸皮的相关性强于胚芽。2型糖尿病（有时也称为成人发病或非胰岛素依赖型糖尿病）在世界范围内呈上升趋势，是最常见的糖尿病形式。它增加了人们患心脏病和中风的风险，以及失明、肾病和溃疡等一系列其他疾病的风险，从而使人们面临健康状况不佳和死亡的风险。人们早就认识到饮食和患2型糖尿病之间存在联系，因为超重的人（因为他们饮食中的能量大于他们消耗的能量）患2型糖尿病的风险更大。然而，目前还不清楚哪些特定的营养素或食物可能会增加风险或提供保护。谷物——如大米、小麦、玉米（玉米）等——构成了大多数人饮食的主要部分。在谷物的精炼过程中，谷物的大部分外部部分（谷粒）通常被去除。如果籽粒的所有成分（麸皮、胚芽和胚乳）仍然以其自然比例存在，那么食品就被称为“全谷物”。有充分的证据表明，食用全谷物可以降低患多种疾病的风险，包括各种癌症、心脏病和中风。一些证据还表明，吃富含全谷物的饮食可能有助于预防糖尿病，但这还没有得到确凿的证实。这项研究的作者想要找出一大批人在几年里吃了多少全谷物，并记录这些人中有多少人患上了2型糖尿病。如果这两件事密切相关，它将提供更多的证据来支持全谷物消费有助于预防2型糖尿病的观点。研究人员利用了美国一项非常大且持续的研究——护士健康研究——中记录的信息，该研究始于1976年，当时有超过10万名美国注册女性护士完成并邮寄了一份问卷，以评估她们的健康和生活方式。1989年增加了更多的护士。这是所谓的“队列研究”的一个例子。每两年，调查问卷被邮寄给护士。询问的问题包括护士的年龄，体重，饮食，是否吸烟，是否使用口服避孕药；以及他们的糖尿病、心血管疾病和癌症的个人病史。研究人员以克数计算了每个护士每天的全谷物摄入量。他们发现，到2004年，其中约有6500人患上了2型糖尿病。从数据分析来看，很明显，全谷物的摄入量越大，患2型糖尿病的风险就越低。研究的另一个部分是，研究人员搜索了医学文献，寻找其他研究全谷物摄入与2型糖尿病风险之间关系的队列研究。（这种类型的研究被称为“系统综述”，它要求研究人员事先明确定义他们要寻找的研究类型，以及他们将如何分析数据。）他们发现了五个这样的研究。他们把所有研究的结果加在一起，包括他们自己的。在大约28.6万人中，总共有近1.1万例2型糖尿病患者。根据他们的分析，他们计算出，每天增加两份全谷物的摄入量，患2型糖尿病的风险就会降低21%。科学家说，联系永远不能证明因果关系。（这需要另一种叫做“试验”的研究，在试验中，两组相似的人要么吃粗粮含量高的食物，要么吃粗粮含量低的食物。）尽管如此，这项研究确实强烈表明，降低患2型糖尿病风险的健康饮食应该包括每天食用几份全谷物。作者确实指出，选择吃大量粗粮的人在其他方面也往往有健康的生活方式，而且很难准确计算摄入量。然而，他们并不认为他们研究的这些局限性会对整体结果产生太严重的影响。请通过本摘要的在线版本http://dx.doi.org/10.1371/journal.pmed.0040261访问这些网站。关于糖尿病（1型和2型）的良好介绍性信息可以在美国国家糖尿病信息中心和英国糖尿病中心的网站上找到。更详细的信息可以在Medline Plus上找到。Medline Plus是一个汇集了几个美国政府机构和健康相关组织的权威信息的网站。维基百科上有一个关于全谷物的条目（维基百科是一个免费的在线百科全书，任何人都可以编辑）。护士健康研究有一个网站
Control of body weight by balancing energy intake and energy expenditure is of major importance for the prevention of type 2 diabetes, but the role of specific dietary factors in the etiology of type 2 diabetes is less well established. We evaluated intakes of whole grain, bran, and germ in relation to risk of type 2 diabetes in prospective cohort studies. We followed 161,737 US women of the Nurses' Health Studies (NHSs) I and II, without history of diabetes, cardiovascular disease, or cancer at baseline. The age at baseline was 37–65 y for NHSI and 26–46 y for NHSII. Dietary intakes and potential confounders were assessed with regularly administered questionnaires. We documented 6,486 cases of type 2 diabetes during 12–18 y of follow-up. Other prospective cohort studies on whole grain intake and risk of type 2 diabetes were identified in searches of MEDLINE and EMBASE up to January 2007, and data were independently extracted by two reviewers. The median whole grain intake in the lowest and highest quintile of intake was, respectively, 3.7 and 31.2 g/d for NHSI and 6.2 and 39.9 g/d for NHSII. After adjustment for potential confounders, the relative risks (RRs) for the highest as compared with the lowest quintile of whole grain intake was 0.63 (95% confidence interval [CI] 0.57–0.69) for NHSI and 0.68 (95% CI 0.57–0.81) for NHSII (both: p-value, test for trend <0.001). After further adjustment for body mass index (BMI), these RRs were 0.75 (95% CI 0.68–0.83; p-value, test for trend <0.001) and 0.86 (95% CI 0.72–1.02; p-value, test for trend 0.03) respectively. Associations for bran intake were similar to those for total whole grain intake, whereas no significant association was observed for germ intake after adjustment for bran. Based on pooled data for six cohort studies including 286,125 participants and 10,944 cases of type 2 diabetes, a two-serving-per-day increment in whole grain consumption was associated with a 21% (95% CI 13%–28%) decrease in risk of type 2 diabetes after adjustment for potential confounders and BMI. Whole grain intake is inversely associated with risk of type 2 diabetes, and this association is stronger for bran than for germ. Findings from prospective cohort studies consistently support increasing whole grain consumption for the prevention of type 2 diabetes. Jeroen de Munter and colleagues found that, in women in the US Nurses' Health Studies, whole grain intake was inversely associated with risk of type 2 diabetes. The association was stronger for bran than for germ. Type 2 diabetes mellitus (also sometimes called adult-onset or noninsulin-dependent diabetes) is increasing worldwide and is the most common form of diabetes. It puts people at risk of poor health and death by increasing their risk of heart disease and stroke, and a range of other conditions including blindness, kidney disease, and ulcers. It has long been recognized that there is a link between diet and developing type 2 diabetes, because people who are overweight (because the amount of energy in their diet is greater than the energy they use up) run a greater risk of getting type 2 diabetes. However, it has not been clear which particular nutrients or foods might increase the risk or might give protection. Cereals—such as rice, wheat, corn (maize), etc.—make up a major part of most people's diets. During the refining of cereal grains, much of the outer part of the grain (kernel) are usually removed. Foods are described as “whole grain” if all components of the kernel (the bran, germ, and endosperm) are still present in their natural proportions. There is good evidence that consumption of whole grains may reduce the risk of several diseases, including various types of cancer, heart attacks, and strokes. Some evidence also suggests that eating a diet rich in whole grains might help protect against diabetes, but this has not been firmly established. The authors of this study wanted to find out how much whole grain was eaten by a large number of people over several years and to record how many of these people developed type 2 diabetes. If these two things were closely associated it would provide more evidence to support the idea that whole grain consumption helps protect against type 2 diabetes. The researchers drew on information recorded in a very large and continuing study in the US, the Nurses' Health Study, which began in 1976, when over 100,000 female registered US nurses completed and returned a mailed questionnaire to assess their health and lifestyle. More nurses were added in 1989. It is an example of what is known as a “cohort study.” Every two years, questionnaires have been mailed to the nurses. Questions asked include the nurses' age, weight, their diet, whether they smoke, their use of oral contraception; and their personal history of diabetes, cardiovascular disease, and cancer. The researchers calculated each nurse's whole grain intake in grams per day. They found that by 2004 about 6,500 of them had developed type 2 diabetes. From an analysis of the data it was clear that the greater the consumption of whole grains the lower the risk of getting type 2 diabetes. An additional part of the study was that the researchers searched the medical literature for other cohort studies that examined whole grain intake in relation to risk of type 2 diabetes. (This type of research is called a “systematic review,” and it requires that researchers define clearly in advance the kind of studies they are looking for and how they will analyze the data.) They found five such studies. They added together the results of all the studies, including their own. This gave a total of nearly 11,000 cases of type 2 diabetes, out of around 286,000 people. From their analysis they calculated that a two-serving-per-day increment in whole grain consumption was associated with a 21% decrease in risk of type 2 diabetes. Scientists say that association can never prove causation. (That would require a different sort of study called a trial, where two similar groups of people would be given either a diet high in whole grains or one that was low.) Nevertheless, the research does strongly suggest that a healthy diet that reduces the risk of developing type 2 diabetes should include the consumption of several servings of whole grains daily. The authors do point out that people who choose to eat a lot of whole grains also tend to have a healthy lifestyle in other respects, and that it was hard to calculate intake accurately. However, they do not consider that these limitations to their study would have affected the overall result too seriously. Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.0040261. Good introductory information about diabetes (type 1 and type 2) may be found on the Web sites of the National Diabetes Clearing House (US) and Diabetes UK More detailed information is available on Medline Plus, a Web site that brings together authoritative information from several US government agencies and health-related organizations Wikipedia has an entry on whole grain (Wikipedia is a free online encyclopedia that anyone can edit) The Nurses' Health Study has a Web site
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影响因子：
4.7
作者：
Esmaillzadeh, A;Mirmiran, P;Azizi, F
通讯作者：
Azizi, F
影响因子：
5
作者：
GREENLAND, S;LONGNECKER, MP
通讯作者：
LONGNECKER, MP
影响因子：
16.2
作者：
Jenkins, DJA;Kendall, CWC;Josse, RG
通讯作者：
Josse, RG
DOI：
10.1016/0197-2456(86)90046-2
发表时间：
1986-09-01
期刊：
CONTROLLED CLINICAL TRIALS
影响因子：
--
作者：
DERSIMONIAN, R;LAIRD, N
通讯作者：
LAIRD, N
影响因子：
2
作者：
Higgins, JPT;Thompson, SG
通讯作者：
Thompson, SG