地中海饮食预防（PREDIMED）研究中的膳食纤维摄入量与全因死亡率
Fiber intake and all-cause mortality in the Prevención con Dieta Mediterránea (PREDIMED) study.
作者信息
Buil-Cosiales Pilar, Zazpe Itziar, Toledo Estefanía, Corella Dolores, Salas-Salvadó Jordi, Diez-Espino Javier, Ros Emilio, Fernandez-Creuet Navajas Joaquin, Santos-Lozano José Manuel, Arós Fernando, Fiol Miquel, Castañer Olga, Serra-Majem Lluis, Pintó Xavier, Lamuela-Raventós Rosa M, Marti Amelia, Basterra-Gortari F Javier, Sorlí José V, Verdú-Rotellar Jose M, Basora Josep, Ruiz-Gutierrez Valentina, Estruch Ramón, Martínez-González Miguel Á
机构信息
From the Prevención con Dieta Mediterránea Research Network (Red 06/0045) (PB-C, IZ, ET, JS-S, JD-E, FA, LS-M, XP, RML-R, AM, FJB-G, JB, VR-G, RE, and MÁM-G) and the Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (PB-C, IZ, ET, DC, JS-S, JD-E, ER, JF-CN, JMS-L, FA, MF, OC, LS-M, XP, RML-R, AM, FJB-G, JVS, JMV-R, JB, VR-G, RE, and MÁM-G), Instituto de Salud Carlos III, Madrid, Spain; the Servicio Navarro de Salud-Osasunbidea (PB-C, JD-E, and FJB-G), Pamplona, Spain; the Departments of Preventive Medicine and Public Health (IZ, ET, and MÁM-G) and Nutrition (AM), University of Navarra, Pamplona, Spain; the Department of Preventive Medicine, University of Valencia, Valencia, Spain (DC and JVS); the Human Nutrition Department, Hospital Universitari Sant Joan, Institut d'Investigació Sanitaria Pere Virgili, Universitat Rovira i Virgili, Reus, Spain (JS-S and JB); the Lipid Clinic, Department of Endocrinology and Nutrition (ER), the Department of Internal Medicine (RE), Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, and the Department of Nutrition and Food Science, School of Pharmacy, Xarxa de Referència en Tecnologia dels Aliments, Instituto de Investigación en Nutrición y Seguridad Alimentaria (RML-R), University of Barcelona, Barcelona, Spain (ER); the Department of Preventive Medicine, University of Malaga, Malaga, Spain (JF-CN); the Department of Family Medicine, Primary Care Division of Seville, San Pablo Health Center, Seville, Spain (JMS); the Department of Cardiology, University Hospital of Alava, Vitoria, Spain (FA); the Institute of Health Sciences, University of Balearic Islands, and Hospital Son Espases, Palma de Mallorca, Spain (MF); the Cardiovascular and Nutrition Research Group, Institut de Recerca Hospital del Mar, Barcelona, Spain (OC); the Department of Clinical Sciences, University of Las Palmas de Gran Canaria, Las Palmas, Spain (LS-M); the Lipids and Vascular Risk Unit, Int
出版信息
Am J Clin Nutr. 2014 Dec;100(6):1498-507. doi: 10.3945/ajcn.114.093757. Epub 2014 Sep 10.
BACKGROUND
Few observational studies have examined the effect of dietary fiber intake and fruit and vegetable consumption on total mortality and have reported inconsistent results. All of the studies have been conducted in the general population and typically used only a single assessment of diet.
OBJECTIVE
We investigated the association of fiber intake and whole-grain, fruit, and vegetable consumption with all-cause mortality in a Mediterranean cohort of elderly adults at high cardiovascular disease (CVD) risk by using repeated measurements of dietary information and taking into account the effect of a dietary intervention.
DESIGN
We followed up 7216 men (55-75 y old) and women (60-75 y old) at high CVD risk in the Prevención con Dieta Mediterránea (PREDIMED) trial for a mean of 5.9 y. Data were analyzed as an observational cohort. Participants were initially free of CVD. A 137-item validated food-frequency questionnaire administered by dietitians was repeated annually to assess dietary exposures (fiber, fruit, vegetable, and whole-grain intakes). Deaths were identified through the continuing medical care of participants and the National Death Index. An independent, blinded Event Adjudication Committee adjudicated causes of death. Cox regression models were used to estimate HRs of death during follow-up according to baseline dietary exposures and their yearly updated changes.
RESULTS
In up to 8.7 y of follow-up, 425 participants died. Baseline fiber intake and fruit consumption were significantly associated with lower risk of death [HRs for the fifth compared with the first quintile: 0.63 (95% CI: 0.46, 0.86; P = 0.015) and 0.59 (95% CI: 0.42, 0.82; P = 0.004), respectively]. When the updated dietary information was considered, participants with fruit consumption >210 g/d had 41% lower risk of all-cause mortality (HR: 0.59; 95% CI: 0.44, 0.78). Associations were strongest for CVD mortality than other causes of death.
CONCLUSION
Fiber and fruit intakes are associated with a reduction in total mortality. PREDIMED was registered at controlled-trials.com as ISRCTN35739639.
背景
很少有观察性研究探讨膳食纤维摄入量以及水果和蔬菜的食用量对总死亡率的影响，且报告的结果并不一致。所有这些研究都是在普通人群中进行的，并且通常只对饮食进行了一次评估。
目的
我们通过重复测量饮食信息并考虑饮食干预的影响，调查了心血管疾病（CVD）高风险的地中海老年人群队列中纤维摄入量、全谷物、水果和蔬菜的食用量与全因死亡率之间的关联。
设计
我们对预防地中海饮食（PREDIMED）试验中7216名心血管疾病高风险的男性（55 - 75岁）和女性（60 - 75岁）进行了平均5.9年的随访。数据作为观察性队列进行分析。参与者最初无心血管疾病。由营养师管理的一份经过验证的包含137个条目的食物频率问卷每年重复使用，以评估饮食暴露情况（纤维、水果、蔬菜和全谷物摄入量）。通过参与者的持续医疗护理和国家死亡指数确定死亡情况。一个独立的、盲法的事件判定委员会判定死亡原因。使用Cox回归模型根据基线饮食暴露情况及其每年更新的变化来估计随访期间的死亡风险比（HR）。
结果
在长达8.7年的随访中，425名参与者死亡。基线纤维摄入量和水果食用量与较低的死亡风险显著相关[与第一五分位数相比，第五五分位数的HR分别为：0.63（95%CI：0.46，0.86；P = 0.015）和0.59（95%CI：0.42，0.82；P = 0.004）]。当考虑更新后的饮食信息时，水果食用量>210 g/天的参与者全因死亡率风险降低41%（HR：0.59；95%CI：0.44，0.78）。与其他死亡原因相比，与心血管疾病死亡率的关联最为强烈。
结论
纤维和水果摄入量与总死亡率降低有关。PREDIMED在controlled-trials.com上注册，注册号为ISRCTN35739639。
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