Aune Dagfinn, Keum NaNa, Giovannucci Edward, Fadnes Lars T, Boffetta Paolo, Greenwood Darren C, Tonstad Serena, Vatten Lars J, Riboli Elio, Norat Teresa
Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
Department of Nutrition, Harvard T H Chan School of Public Health, Boston, MA, USA.
BMJ. 2016 Jun 14;353:i2716. doi: 10.1136/bmj.i2716.
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.
PubMed and Embase searched up to 3 April 2016.
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.
Summary relative risks and 95% confidence intervals calculated with a random effects model.
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; I(2)=9%, n=7 studies) for coronary heart disease, 0.88 (0.75 to 1.03; I(2)=56%, n=6) for stroke, and 0.78 (0.73 to 0.85; I(2)=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; I(2)=37%, n=6) for total cancer, 0.83 (0.77 to 0.90; I(2)=83%, n=11) for all causes, 0.78 (0.70 to 0.87; I(2)=0%, n=4) for respiratory disease, 0.49 (0.23 to 1.05; I(2)=85%, n=4) for diabetes, 0.74 (0.56 to 0.96; I(2)=0%, n=3) for infectious diseases, 1.15 (0.66 to 2.02; I(2)=79%, n=2) for diseases of the nervous system disease, and 0.78 (0.75 to 0.82; I(2)=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.
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.
量化全谷物及特定谷物类型的摄入量与心血管疾病、总体癌症、全因死亡率及特定病因死亡率风险之间的剂量反应关系。
检索截至2016年4月3日的PubMed和Embase数据库。
报告全谷物或特定谷物类型摄入量与心血管疾病、总体癌症、全因或特定病因死亡率之间关联的调整相对风险估计值的前瞻性研究。
采用随机效应模型计算汇总相对风险及95%置信区间。
纳入45项研究（64篇出版物）。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物或一片半全麦皮塔饼），冠心病的汇总相对风险为0.81（95%置信区间0.75至0.87；I² = 9%，n = 7项研究），中风为0.88（0.75至1.03；I² = 56%，n = 6），心血管疾病为0.78（0.73至0.85；I² = 40%，n = 10），按结局是发病率还是死亡率进行分层时结果相似。全因死亡率的相对风险为0.85（0.80至0.91；I² = 37%，n = 6），总体癌症为0.83（0.77至0.90；I² = 83%，n = 11），呼吸系统疾病为0.78（0.70至0.87；I² = 0%，n = 4），糖尿病为0.49（0.23至1.05；I² = 85%，n = 4），传染病为0.74（0.56至0.96；I² = 0%，n = 3），神经系统疾病为1.15（0.66至2.02；I² = 79%，n = 2），所有非心血管、非癌症病因的死亡率为0.78（0.75至0.82；I² = 0%，n = 5）。大多数结局在摄入量达到210 - 225克/天（每天七至七份半）时风险降低有所观察到。特定类型的全谷物摄入量，包括全麦面包、全麦早餐谷物、添加的麸皮，以及总面包和总早餐谷物，也与心血管疾病和/或全因死亡率风险降低相关，但几乎没有证据表明与精制谷物、白米、总大米或总谷物存在关联。
这项荟萃分析进一步证明，摄入全谷物与冠心病、心血管疾病、总体癌症风险降低以及全因、呼吸系统疾病、传染病、糖尿病和所有非心血管、非癌症病因的死亡率降低相关。这些发现支持饮食指南中建议增加全谷物摄入量以降低慢性病风险和过早死亡风险的建议。
