Grosso Giuseppe, Yang Justin, Marventano Stefano, Micek Agnieszka, Galvano Fabio, Kales Stefanos N
From the Department of Clinical and Molecular Biomedicine, Section of Pharmacology and Biochemistry (GG and FG) and the Department GF Ingrassia, Section of Hygiene and Public Health (SM), University of Catania, Catania, Italy (GG and FG); the Department of Environmental Health, Environmental and Occupational Medicine and Epidemiology, Harvard School of Public Health, Boston, MA (JY and SNK); the Steward St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA (JY); the Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Krakow, Poland (AM); and the Cambridge Health Alliance, Harvard Medical School, Cambridge, MA (SNK).
Am J Clin Nutr. 2015 Apr;101(4):783-93. doi: 10.3945/ajcn.114.099515. Epub 2015 Feb 4.
Recent pooled analyses supported a beneficial impact of nut consumption on health, but to our knowledge, whether nuts are associated with overall decreased mortality has not been previously reviewed.
We aimed to systematically review prospective studies that explored the effects of nut consumption on all-cause, cardiovascular disease (CVD), and cancer mortality and quantify the size effect through a meta-analysis. We also reviewed confounding factors associated with nut consumption to assess potential clustering with other covariates.
We searched PubMed and EMBASE for studies published up to June 2014. Study characteristics, HRs, and 95% CIs were generated on the basis of quantitative analyses. A dose-response analysis was performed when data were available.
Seven studies for all-cause mortality, 6 studies for CVD mortality, and 2 studies for cancer mortality were included in the meta-analysis with a total of 354,933 participants, 44,636 cumulative incident deaths, and 3,746,534 cumulative person-years. Nut consumption was associated with some baseline characteristics such as lower body mass index and smoking status as well as increased intakes of fruit, vegetables, and alcohol. One-serving of nuts per week and per day resulted in 4% (RR: 0.96; 95% CI: 0.93, 0.98) and 27% (RR: 0.73; 95% CI: 0.60, 0.88) decreased risk of all-cause mortality, respectively, and decreased risk of CVD mortality [RR: 0.93 (95% CI: 0.88, 0.99) and 0.61 (95% CI: 0.42, 0.91), respectively]. Effects were primarily driven by decreased coronary artery disease deaths rather than stroke deaths. Nut consumption was also associated with decreased risk of cancer deaths when highest compared with lowest categories of intake were compared (RR: 0.86; 95% CI: 0.75, 0.98), but no dose-effect was shown.
Nut consumption is associated with lower risk of all-cause, CVD, and cancer mortality, but the presence of confounding factors should be taken into account when considering such findings.
最近的汇总分析支持食用坚果对健康有益，但据我们所知，坚果是否与总体死亡率降低相关此前尚未得到综述。
我们旨在系统综述探索食用坚果对全因死亡率、心血管疾病（CVD）死亡率和癌症死亡率影响的前瞻性研究，并通过荟萃分析量化效应大小。我们还综述了与食用坚果相关的混杂因素，以评估与其他协变量的潜在聚集情况。
我们检索了截至2014年6月发表在PubMed和EMBASE上的研究。基于定量分析得出研究特征、风险比（HR）和95%置信区间（CI）。当有数据时进行剂量反应分析。
荟萃分析纳入了7项关于全因死亡率的研究、6项关于CVD死亡率的研究和2项关于癌症死亡率的研究，共有354,933名参与者、44,636例累积死亡事件和3,746,534人年。食用坚果与一些基线特征相关，如较低的体重指数和吸烟状况，以及水果、蔬菜和酒精摄入量增加。每周和每天食用一份坚果分别使全因死亡率风险降低4%（RR：0.96；95%CI：0.93，0.98）和27%（RR：0.73；95%CI：0.60，0.88），CVD死亡率风险也降低[分别为RR：0.93（95%CI：0.88，0.99）和0.61（95%CI：0.42，0.91）]。效应主要由冠状动脉疾病死亡减少而非中风死亡减少驱动。与摄入量最低类别相比，摄入量最高类别时食用坚果也与癌症死亡风险降低相关（RR：0.86；95%CI：0.75，0.98），但未显示剂量效应。
食用坚果与全因、CVD和癌症死亡率风险降低相关，但在考虑这些发现时应考虑混杂因素的存在。
