Etiologic effects and optimal intakes of foods and nutrients for risk of cardiovascular diseases and diabetes: Systematic reviews and meta-analyses from the Nutrition and Chronic Diseases Expert Group (NutriCoDE).
Etiologic effects and optimal intakes of foods and nutrients for risk of cardiovascular diseases and diabetes: Systematic reviews and meta-analyses from the Nutrition and Chronic Diseases Expert Group (NutriCoDE).
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DOI：
10.1371/journal.pone.0175149
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Mozaffarian D
中科院分区：
文献类型：
--
作者：
Micha R;Shulkin ML;Peñalvo JL;Khatibzadeh S;Singh GM;Rao M;Fahimi S;Powles J;Mozaffarian D
饮食习惯是导致冠心病、中风和糖尿病的主要因素。然而，综合评价的病因学影响的饮食因素对心脏代谢的结果，其定量的影响，并相应的最佳摄入量还没有得到很好的建立。系统回顾饮食因素对心脏代谢疾病影响的证据，包括全面评估因果关系的证据;估计病因学影响的程度;评估这些病因学影响的异质性和偏倚的可能性;并确定最佳人群摄入水平。我们使用Bradford-Hill标准来评估多种饮食-心脏代谢疾病关系的因果效应的可能或令人信服的证据。病因学效应通过前瞻性研究或随机临床试验的已发表或从头荟萃分析进行量化，纳入标准化单位、剂量反应估计值以及年龄和其他特征的异质性。在有效性分析中评估了偏倚的可能性。最佳摄入量由与最低疾病风险相关的水平确定。我们确定了10种食物和7种营养素具有因果心脏代谢影响的证据，包括水果，蔬菜，豆类/豆类，坚果/种子，全谷物，鱼，酸奶，纤维，海鲜omega-3，多不饱和脂肪和钾的保护作用;以及未加工红肉，加工肉类，含糖饮料，血糖负荷，反式脂肪和钠的危害。比例病因学效应随年龄增长而下降，但一般不因性别而异。确定的最佳人群摄入量与观察到的国家摄入量和主要膳食指南基本一致。在有效性分析中，确定的个别饮食成分的影响与饮食模式对心血管危险因素和硬终点的量化影响相似。这些新的发现提供了因果证据，定量病因学影响，异质性和心脏代谢疾病的主要饮食因素的最佳摄入量的全面总结，为疾病影响估计和政策规划和优先事项提供信息。
Dietary habits are major contributors to coronary heart disease, stroke, and diabetes. However, comprehensive evaluation of etiologic effects of dietary factors on cardiometabolic outcomes, their quantitative effects, and corresponding optimal intakes are not well-established. To systematically review the evidence for effects of dietary factors on cardiometabolic diseases, including comprehensively assess evidence for causality; estimate magnitudes of etiologic effects; evaluate heterogeneity and potential for bias in these etiologic effects; and determine optimal population intake levels. We utilized Bradford-Hill criteria to assess probable or convincing evidence for causal effects of multiple diet-cardiometabolic disease relationships. Etiologic effects were quantified from published or de novo meta-analyses of prospective studies or randomized clinical trials, incorporating standardized units, dose-response estimates, and heterogeneity by age and other characteristics. Potential for bias was assessed in validity analyses. Optimal intakes were determined by levels associated with lowest disease risk. We identified 10 foods and 7 nutrients with evidence for causal cardiometabolic effects, including protective effects of fruits, vegetables, beans/legumes, nuts/seeds, whole grains, fish, yogurt, fiber, seafood omega-3s, polyunsaturated fats, and potassium; and harms of unprocessed red meats, processed meats, sugar-sweetened beverages, glycemic load, trans-fats, and sodium. Proportional etiologic effects declined with age, but did not generally vary by sex. Established optimal population intakes were generally consistent with observed national intakes and major dietary guidelines. In validity analyses, the identified effects of individual dietary components were similar to quantified effects of dietary patterns on cardiovascular risk factors and hard endpoints. These novel findings provide a comprehensive summary of causal evidence, quantitative etiologic effects, heterogeneity, and optimal intakes of major dietary factors for cardiometabolic diseases, informing disease impact estimation and policy planning and priorities.