Consumption of nuts and legumes and risk of incident ischemic heart disease, stroke, and diabetes: a systematic review and meta-analysis
Consumption of nuts and legumes and risk of incident ischemic heart disease, stroke, and diabetes: a systematic review and meta-analysis
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DOI：
10.3945/ajcn.113.076901
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发表时间：
2014-07-01
影响因子：
7.1
通讯作者：
Mozaffarian, Dariush
中科院分区：
文献类型：
--
作者：
Afshin, Ashkan;Micha, Renata;Mozaffarian, Dariush
背景资料：坚果和豆类的消费和缺血性心脏病（IHD），中风和diabetes.Objective的风险之间的关系还没有得到很好的建立：我们系统地调查和量化协会坚果和豆类消费与事件IHD，中风和diabetes.Design：我们系统地搜索多个数据库，以确定随机对照试验或观察性研究，检查的关系。如果研究仅报告了中等生理指标、软心血管结局或粗略的风险估计，则将其排除。独立提取数据，一式两份。我们使用广义最小二乘趋势估计评估了汇总的剂量-反应关系，并使用荟萃回归评估了预先指定的异质性来源。通过使用漏斗图、Begg和Egger检验以及Duval和Tweedie修剪和填充方法来探讨发表偏倚的可能性。在3851篇摘要中，25项观察性研究（23项前瞻性研究和2项回顾性研究）和2份试验报告符合入选标准，包括501，791例独特个体和11，869例IHD，8244例卒中和14例，449例糖尿病事件坚果的摄入量与致死性IHD呈负相关（6项研究; 6749起事件;每4周28.4克份量的RR：0.76; 95%CI：0.69，0.84; I-2 = 28%），非致命性IHD（4项研究; 2101起事件; RR：0.78; 0.67，0.92; I-2 = 0%）和糖尿病（6项研究; 13，308起事件; RR：0.87; 0.81，0.94; I-2 = 22%），但不包括卒中（4项研究; 5544起事件）。豆类摄入量与总IHD呈负相关（5项研究; 6514起事件;每4周100 g服务的RR：0.86; 0.78，0.94; I-2 = 0%），但与卒中（6项研究; 6690起事件）或糖尿病（2项研究; 2746起事件）无显著相关性。荟萃回归未发现年龄、随访持续时间、研究地点或研究质量的影响。混合的证据被视为出版偏见，但通过使用Duval和Tweedie修剪和填充方法的分析并没有明显改变results.Conclusion：本系统评价支持吃坚果和事件IHD和糖尿病和吃豆类和事件IHD之间的负相关。
Background: Relations between the consumption of nuts and legumes and risk of ischemic heart disease (IHD), stroke, and diabetes have not been well established.Objective: We systematically investigated and quantified associations of nut and legume consumption with incident IHD, stroke, and diabetes.Design: We systematically searched multiple databases to identify randomized controlled trials or observational studies that examined the relations. Studies were excluded if they reported only intermediate physiologic measures, soft cardiovascular outcomes, or crude risk estimates. Data were extracted independently and in duplicate. We assessed pooled dose-response relations by using a generalized least-squares trend estimation, and prespecified sources of heterogeneity were assessed by using metaregression. The potential for publication bias was explored by using funnel plots, Begg's and Egger's tests, and Duval and Tweedie trim-and-fill methods.Results: Of 3851 abstracts, 25 observational studies (23 prospective and 2 retrospective studies) and 2 trial reports met inclusion criteria and comprised 501,791 unique individuals and 11,869 IHD, 8244 stroke, and 14,449 diabetes events. The consumption of nuts was inversely associated with fatal IHD (6 studies; 6749 events; RR per 4 weekly 28.4-g servings: 0.76; 95% CI: 0.69, 0.84; I-2 = 28%), nonfatal IHD (4 studies; 2101 events; RR: 0.78; 0.67, 0.92; I-2 = 0%), and diabetes (6 studies; 13,308 events; RR: 0.87; 0.81,0.94; I-2 = 22%) but not stroke (4 studies; 5544 events). Legume consumption was inversely associated with total IHD (5 studies; 6514 events; RR per 4 weekly 100-g servings: 0.86; 0.78, 0.94; I-2 = 0%) but not significantly associated with stroke (6 studies; 6690 events) or diabetes (2 studies; 2746 events). A meta-regression did not identify the effect modification by age, duration of follow-up, study location, or study quality. Mixed evidence was seen for publication bias, but analyses by using the Duval and Tweedie trim-and-fill method did not appreciably alter results.Conclusion: This systematic review supports inverse associations between eating nuts and incident IHD and diabetes and eating legumes and incident IHD.