Effects of tree nuts on blood lipids, apolipoproteins, and blood pressure: systematic review, meta-analysis, and dose-response of 61 controlled intervention trials
Effects of tree nuts on blood lipids, apolipoproteins, and blood pressure: systematic review, meta-analysis, and dose-response of 61 controlled intervention trials
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DOI：
10.3945/ajcn.115.110965
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发表时间：
2015-12-01
影响因子：
7.1
通讯作者：
Mozaffarian, Dariush
中科院分区：
文献类型：
--
作者：
Del Gobbo, Liana C.;Falk, Michael C.;Mozaffarian, Dariush
背景：坚果对主要心血管疾病(CVD)危险因素的影响，包括坚果类型或植物甾醇含量的剂量反应和潜在的异质性，还没有很好的建立。目的：我们研究了树坚果(核桃、开心果、澳洲坚果、山核桃、腰果、杏仁、榛子和巴西坚果)对老年人血脂[总胆固醇、低密度脂蛋白(LDL)胆固醇、高密度脂蛋白和甘油三酯]、脂蛋白[载脂蛋白A1、载脂蛋白B(ApoB)和载脂蛋白B100]、血压和炎症(C-反应蛋白)的影响。=18年，没有流行的心血管疾病。设计：我们按照系统综述和荟萃分析指南的首选报告项目进行了系统性综述和荟萃分析。两名调查人员筛选了1301篇可能符合条件的PubMed文章，一式两份。我们通过逆方差固定效应荟萃分析计算了坚果干预组和对照组之间的平均差异，剂量标准化为1盎司(28.4克)/天。用线性回归和分数次多项式模型检验坚果摄入量的剂量效应。年龄、性别、背景饮食、基线危险因素、坚果类型、疾病状况、病程和质量评分的异质性通过Meta回归进行评估。采用漏斗图、Egger‘s和Begg’s检验评价发表偏倚。结果：有61项试验符合资格标准(n=2582)。干预时间从3周到26周不等。每天摄入坚果可降低总胆固醇(-4.7 mg/dL；95%可信区间：-5.3，-4.0 mg/dL)、低密度脂蛋白(-4.8 mg/dL；95%可信区间：-5.5，-4.2 mg/dL)、载脂蛋白B(-3.7 mg/dL；95%可信区间：-5.2，-2.3 mg/dL)和甘油三酯(-2.2 mg/dL)；95%可信区间：-3.8，-0.5 mg/dL)，对其他结果无统计学意义。坚果摄入量与总胆固醇和低密度脂蛋白之间的剂量-反应关系是非线性的(P-非线性<；0.001)；坚果摄入量与总胆固醇和低密度脂蛋白之间的剂量-反应关系在坚果类型或其他因素中没有观察到显著的异质性。对于载脂蛋白B，2型糖尿病患者的作用更强(-11.5 mg/dL；95%CI：-16.2，-6.8 mg/dL)，而健康人群(-2.5 mg/dL；95%CI：-4.7，-0.3 mg/dL)(P-异质性=0.015)。结论：食用坚果可降低总胆固醇、低密度脂蛋白胆固醇、载脂蛋白B和甘油三酯。降低胆固醇的主要决定因素似乎是坚果剂量，而不是坚果类型。我们的发现也强调了在高坚果剂量和糖尿病人群中研究可能更强的影响的必要性。
Background: The effects of nuts on major cardiovascular disease (CVD) risk factors, including dose-responses and potential heterogeneity by nut type or phytosterol content, are not well established.Objectives: We examined the effects of tree nuts (walnuts, pistachios, macadamia nuts, pecans, cashews, almonds, hazelnuts, and Brazil nuts) on blood lipids [total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein, and triglycerides], lipoproteins [apolipoprotein A1, apolipoprotein B (ApoB), and apolipoprotein B100], blood pressure, and inflammation (C-reactive protein) in adults aged >= 18 y without prevalent CVD.Design: We conducted a systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two investigators screened 1301 potentially eligible PubMed articles in duplicate. We calculated mean differences between nut intervention and control arms, dose-standardized to one 1-oz (28.4 g) serving/d, by using inverse-variance fixed-effects meta-analysis. Dose-response for nut intake was examined by using linear regression and fractional polynomial modeling. Heterogeneity by age, sex, background diet, baseline risk factors, nut type, disease condition, duration, and quality score was assessed with meta-regression. Publication bias was evaluated by using funnel plots and Egger's and Begg's tests.Results: Sixty-one trials met eligibility criteria (n = 2582). Interventions ranged from 3 to 26 wk. Nut intake (per serving/d) lowered total cholesterol (-4.7 mg/dL; 95% CI: -5.3, -4.0 mg/dL), LDL cholesterol (-4.8 mg/dL; 95% CI: -5.5, -4.2 mg/dL), ApoB (-3.7 mg/dL; 95% CI: -5.2, -2.3 mg/dL), and triglycerides (-2.2 mg/dL; 95% CI: -3.8, -0.5 mg/dL) with no statistically significant effects on other outcomes. The dose-response between nut intake and total cholesterol and LDL cholesterol was nonlinear (P-nonlinearity < 0.001 each); stronger effects were observed for >= 60 g nuts/d. Significant heterogeneity was not observed by nut type or other factors. For ApoB, stronger effects were observed in populations with type 2 diabetes (-11.5 mg/dL; 95% CI: -16.2, -6.8 mg/dL) than in healthy populations (-2.5 mg/dL; 95% CI: -4.7, -0.3 mg/dL) (P-heterogeneity = 0.015). Little evidence of publication bias was found.Conclusions: Tree nut intake lowers total cholesterol, LDL cholesterol, ApoB, and triglycerides. The major determinant of cholesterol lowering appears to be nut dose rather than nut type. Our findings also highlight the need for investigation of possible stronger effects at high nut doses and among diabetic populations.