J Acad Nutr Diet. 2019 Mar;119(3):464-481. doi: 10.1016/j.jand.2018.11.007. Epub 2019 Jan 11.
Low fruit and vegetable intakes are recognized risk factors for noncommunicable diseases. This systematic review summarizes published meta-analyses of global burden of diseases attributable to low fruit and vegetable intakes, and the best relative risk estimates.
A published novel assessment process combining Cochrane Review measures, Assessing the Methodological Quality of Systematic Reviews checklist, and Newcastle-Ottawa Quality Assessment Scale was employed.
Sixty-four reports investigating 98 risk-disease pairs were included in the systematic review. Fifty-six pairs from 39 reports were assessed as statistically significant, involving 29 burden of diseases. Dose responses were identified for 31 negative and two positive associations. High against low intake relative risks were identified for 22 negative and one positive association. The highest identified linear dose response for each 100 g/day increase in fruit intakes was 0.56 (95% CI 0.42 to 0.74) for esophageal cancer, followed by 0.72 (95% CI 0.59 to 0.87) for mouth, pharynx, and larynx cancer; nonlinear dose response for the first 100 g/day of fruit intakes were 0.86 (95% CI 0.84 to 0.88) for stroke, followed by 0.89 (95% CI 0.88 to 0.90) for all-cause mortality. The highest identified linear dose response for each 100 g/day increase in vegetable intakes was 0.88 (95% CI 0.80 to 0.95) for renal cell cancer, followed by 0.89 (95% CI 0.84 to 0.95) for non-Hodgkin lymphoma; nonlinear dose responses for the first 100 g/day of vegetable intake were 0.86 (95% CI 0.84 to 0.89) for coronary heart disease, followed by 0.87 (95% CI 0.84 to 0.90) for all-cause mortality. For nonlinear associations, clear increases in protective associations were observed with the first 200 g/day of intakes, whereas little further increase or even decrease in protective associations were reported beyond 300 g/day intakes. Canned fruit intakes were positively associated with all-cause and cardiovascular disease mortality, and pickled vegetable intakes were positively associated with stomach cancer.
This systematic review supports existing recommendations for fruit and vegetable intakes. Current comparative risk assessments might significantly underestimate the protective associations of fruit and vegetable intakes.
低水果和蔬菜摄入量被认为是非传染性疾病的危险因素。本系统评价总结了全球归因于低水果和蔬菜摄入量的疾病负担的已发表荟萃分析，并提供了最佳相对风险估计。
采用了一种新的已发表评估过程，结合 Cochrane 综述措施、系统综述方法学质量评估清单和纽卡斯尔-渥太华质量评估量表。
该系统评价共纳入了 64 项研究报告中的 98 个风险疾病对，其中 39 项报告中的 56 对被评估为具有统计学意义，涉及 29 种疾病负担。确定了 31 个负相关和 2 个正相关的剂量反应。确定了 22 个负相关和 1 个正相关的高摄入量与低摄入量的相对风险。每增加 100 克/天水果摄入量，食管癌的最高线性剂量反应为 0.56（95%CI 0.42 至 0.74），随后是口腔、咽和喉癌的 0.72（95%CI 0.59 至 0.87）；对于水果摄入量的前 100 克/天，首次非线性剂量反应为 0.86（95%CI 0.84 至 0.88）为中风，随后是全因死亡率的 0.89（95%CI 0.88 至 0.90）。每增加 100 克/天蔬菜摄入量，肾细胞癌的最高线性剂量反应为 0.88（95%CI 0.80 至 0.95），随后是非霍奇金淋巴瘤的 0.89（95%CI 0.84 至 0.95）；对于蔬菜摄入量的前 100 克/天，首次非线性剂量反应为冠心病的 0.86（95%CI 0.84 至 0.89），随后是全因死亡率的 0.87（95%CI 0.84 至 0.90）。对于非线性关联，在摄入前 200 克/天内，观察到保护性关联明显增加，而在摄入超过 300 克/天之后，保护性关联几乎没有进一步增加甚至减少。罐装水果摄入量与全因和心血管疾病死亡率呈正相关，腌制蔬菜摄入量与胃癌呈正相关。
本系统评价支持现有的水果和蔬菜摄入量建议。目前的比较风险评估可能严重低估了水果和蔬菜摄入量的保护作用。
