Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany.
Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, 14558 Nuthetal, Germany.
Nutrients. 2017 Sep 26;9(10):1063. doi: 10.3390/nu9101063.
The aim of the present systematic review and meta-analysis was to gain further insight into the effects of adherence to Mediterranean Diet (MedD) on risk of overall cancer mortality, risk of different types of cancer, and cancer mortality and recurrence risk in cancer survivors. Literature search was performed using the electronic databases PubMed, and Scopus until 25 August 2017. We included randomized trials (RCTs), cohort (for specific tumors only incidence cases were used) studies, and case-control studies. Study-specific risk ratios, hazard ratios, and odds ratios (RR/HR/OR) were pooled using a random effects model. Observational studies (cohort and case-control studies), and intervention trials were meta-analyzed separately. The updated review process showed 27 studies that were not included in the previous meta-analysis (total number of studies evaluated: 83 studies). An overall population of 2,130,753 subjects was included in the present update. The highest adherence score to a MedD was inversely associated with a lower risk of cancer mortality (RR: 0.86, 95% CI 0.81 to 0.91, ² = 82%; = 14 studies), colorectal cancer (RR: 0.82, 95% CI 0.75 to 0.88, ² = 73%; = 11 studies), breast cancer (RR: 0.43, 95% CI 0.21 to 0.88, = 1 study) (RR: 0.92, 95% CI 0.87 to 0.96, ² = 22%, = 16 studies), gastric cancer (RR: 0.72, 95% CI 0.60 to 0.86, ² = 55%; = 4 studies), liver cancer (RR: 0.58, 95% CI 0.46 to 0.73, ² = 0%; = 2 studies), head and neck cancer (RR: 0.49, 95% CI 0.37 to 0.66, ² = 87%; = 7 studies), and prostate cancer (RR: 0.96, 95% CI 0.92 to 1.00, ² = 0%; = 6 studies). Among cancer survivors, the association between the adherence to the highest MedD category and risk of cancer mortality, and cancer recurrence was not statistically significant. Pooled analyses of individual components of the MedD revealed that the protective effects appear to be most attributable to fruits, vegetables, and whole grains. The updated meta-analysis confirms an important inverse association between adherence to a MedD and cancer mortality and risk of several cancer types, especially colorectal cancer. These observed beneficial effects are mainly driven by higher intakes of fruits, vegetables, and whole grains. Moreover, we were able to report for the first time a small decrease in breast cancer risk (6%) by pooling seven cohort studies.
本系统评价和荟萃分析的目的是进一步了解地中海饮食（MedD）依从性对总体癌症死亡率、不同类型癌症风险以及癌症幸存者癌症死亡率和复发风险的影响。使用电子数据库 PubMed 和 Scopus 进行文献检索，检索时间截至 2017 年 8 月 25 日。我们纳入了随机试验（RCT）、队列研究（仅针对特定肿瘤使用发病率病例）和病例对照研究。使用随机效应模型汇总研究特异性风险比、风险比和比值比（RR/HR/OR）。观察性研究（队列和病例对照研究）和干预试验分别进行荟萃分析。更新的审查过程显示，有 27 项研究未包含在前一次荟萃分析中（评估的研究总数：83 项研究）。目前的更新共纳入了 2130753 名受试者。最高的 MedD 依从性评分与较低的癌症死亡率风险呈负相关（RR：0.86，95%CI 0.81 至 0.91，² = 82%； = 14 项研究）、结直肠癌（RR：0.82，95%CI 0.75 至 0.88，² = 73%； = 11 项研究）、乳腺癌（RR：0.43，95%CI 0.21 至 0.88， = 1 项研究）（RR：0.92，95%CI 0.87 至 0.96，² = 22%； = 16 项研究）、胃癌（RR：0.72，95%CI 0.60 至 0.86，² = 55%； = 4 项研究）、肝癌（RR：0.58，95%CI 0.46 至 0.73，² = 0%； = 2 项研究）、头颈部癌症（RR：0.49，95%CI 0.37 至 0.66，² = 87%； = 7 项研究）和前列腺癌（RR：0.96，95%CI 0.92 至 1.00，² = 0%； = 6 项研究）。在癌症幸存者中，最高 MedD 类别的依从性与癌症死亡率和癌症复发风险之间的关联没有统计学意义。MedD 各个组成部分的汇总分析显示，保护作用似乎主要归因于水果、蔬菜和全谷物。更新的荟萃分析证实，地中海饮食的依从性与癌症死亡率和几种癌症类型的风险之间存在重要的反比关系，尤其是结直肠癌。这些观察到的有益效果主要归因于水果、蔬菜和全谷物的摄入量增加。此外，我们首次能够报告通过汇总 7 项队列研究，乳腺癌风险降低 6%（RR：0.94，95%CI 0.90 至 0.98）。
