Whole grain consumption and risk of cardiovascular disease, cancer, and all cause and cause specific mortality: systematic review and dose-response meta-analysis of prospective studies.
Whole grain consumption and risk of cardiovascular disease, cancer, and all cause and cause specific mortality: systematic review and dose-response meta-analysis of prospective studies.
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DOI：
10.1136/bmj.i2716
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发表时间：
2016-06-14
期刊：
影响因子：
--
通讯作者：
Norat T
中科院分区：
文献类型：
--
作者：
Aune D;Keum N;Giovannucci E;Fadnes LT;Boffetta P;Greenwood DC;Tonstad S;Vatten LJ;Riboli E;Norat T
目的量化全谷物和特定类型谷物的摄入量与心血管疾病、总癌症和所有原因和原因特定死亡风险之间的剂量-反应关系。PubMed和Embase的数据来源搜索到2016年4月3日。研究选择：前瞻性研究报告了对摄入全谷物或特定类型谷物与心血管疾病、总癌症、所有原因或原因特定死亡率之间的关系的调整后的相对风险估计。数据综合：汇总相对风险和用随机效应模型计算的95%可信区间。结果共纳入45篇研究，均为类文献。全谷物摄入量每增加90克/天(90克相当于三份--例如，两片面包和一碗谷类食品或由全谷物制成的一块半皮塔面包)的汇总相对风险为：冠心病0.81(95%可信区间0.75~0.87；I2=9%，n=7研究)，中风0.88(0.75~1.03；I2=56%，n=6)，0.78(0.73~0.85；I2=40%，n=10)，当研究按结果是发病率还是死亡率分层时，结果相似。死亡的相对危险度：总癌症0.85(0.80~0.91；I2=37%，n=6)，各种原因0.83(0.77~0.90；I2=83%，n=11)，呼吸系统疾病0.78(0.70~0.87；I2=0%，n=4)，糖尿病0.49(0.23~1.05；I2=85%，n=4)，传染病0.74(0.56~0.96；I2=0%，n=3)，传染病1.15(0.66~2.02)；神经系统疾病的I2=79%(n=2)，所有非心血管、非癌症原因的I2=0.78(0.75~0.82；I2=0%，n=5)。在大多数结果中，可以观察到每天摄入210-225克(每天七到七份半)的风险降低。摄入特定类型的全谷物，包括全谷物面包、全谷物早餐麦片和添加的麦片，以及全麦面包和全麦早餐谷物，也与心血管疾病和/或所有原因死亡的风险降低相关，但几乎没有证据表明与精制谷物、白米、全米或全谷物有关。结论：这项荟萃分析提供了进一步的证据，表明全谷物摄入与降低冠心病、心血管疾病和总癌症的风险以及所有原因、呼吸系统疾病、传染病、糖尿病和所有非心血管、非癌症原因的死亡率有关。这些发现支持饮食指南，该指南建议增加全谷物的摄入量，以降低慢性病和过早死亡的风险。
Objective To quantify the dose-response relation between consumption of whole grain and specific types of grains and the risk of cardiovascular disease, total cancer, and all cause and cause specific mortality. Data sources PubMed and Embase searched up to 3 April 2016. Study selection Prospective studies reporting adjusted relative risk estimates for the association between intake of whole grains or specific types of grains and cardiovascular disease, total cancer, all cause or cause specific mortality. Data synthesis Summary relative risks and 95% confidence intervals calculated with a random effects model. Results 45 studies (64 publications) were included. The summary relative risks per 90 g/day increase in whole grain intake (90 g is equivalent to three servings—for example, two slices of bread and one bowl of cereal or one and a half pieces of pita bread made from whole grains) was 0.81 (95% confidence interval 0.75 to 0.87; I2=9%, n=7 studies) for coronary heart disease, 0.88 (0.75 to 1.03; I2=56%, n=6) for stroke, and 0.78 (0.73 to 0.85; I2=40%, n=10) for cardiovascular disease, with similar results when studies were stratified by whether the outcome was incidence or mortality. The relative risks for morality were 0.85 (0.80 to 0.91; I2=37%, n=6) for total cancer, 0.83 (0.77 to 0.90; I2=83%, n=11) for all causes, 0.78 (0.70 to 0.87; I2=0%, n=4) for respiratory disease, 0.49 (0.23 to 1.05; I2=85%, n=4) for diabetes, 0.74 (0.56 to 0.96; I2=0%, n=3) for infectious diseases, 1.15 (0.66 to 2.02; I2=79%, n=2) for diseases of the nervous system disease, and 0.78 (0.75 to 0.82; I2=0%, n=5) for all non-cardiovascular, non-cancer causes. Reductions in risk were observed up to an intake of 210-225 g/day (seven to seven and a half servings per day) for most of the outcomes. Intakes of specific types of whole grains including whole grain bread, whole grain breakfast cereals, and added bran, as well as total bread and total breakfast cereals were also associated with reduced risks of cardiovascular disease and/or all cause mortality, but there was little evidence of an association with refined grains, white rice, total rice, or total grains. Conclusions This meta-analysis provides further evidence that whole grain intake is associated with a reduced risk of coronary heart disease, cardiovascular disease, and total cancer, and mortality from all causes, respiratory diseases, infectious diseases, diabetes, and all non-cardiovascular, non-cancer causes. These findings support dietary guidelines that recommend increased intake of whole grain to reduce the risk of chronic diseases and premature mortality.