Departments of Environmental Medicine (C.C.L., R.B.H., J.A., Y.S., G.D.T.), New York University School of Medicine.
Population Health (R.B.H., J.A., Y.S., G.D.T.), New York University School of Medicine.
Circulation. 2019 Apr 9;139(15):1766-1775. doi: 10.1161/CIRCULATIONAHA.118.035742.
Recent experimental evidence suggests that nutritional supplementation can blunt adverse cardiopulmonary effects induced by acute air pollution exposure. However, whether usual individual dietary patterns can modify the association between long-term air pollution exposure and health outcomes has not been previously investigated. We assessed, in a large cohort with detailed diet information at the individual level, whether a Mediterranean diet modifies the association between long-term exposure to ambient air pollution and cardiovascular disease mortality risk.
The National Institutes of Health-American Association for Retired Persons Diet and Health Study, a prospective cohort (N=548 845) across 6 states and 2 cities in the United States and with a follow-up period of 17 years (1995-2011), was linked to estimates of annual average exposures to fine particulate matter and nitrogen dioxide at the residential census-tract level. The alternative Mediterranean Diet Index, which uses a 9-point scale to assess conformity with a Mediterranean-style diet, was constructed for each participant from information in cohort baseline dietary questionnaires. We evaluated mortality risks for cardiovascular disease, ischemic heart disease, cerebrovascular disease, or cardiac arrest associated with long-term air pollution exposure. Effect modification of the associations between exposure and the mortality outcomes by alternative Mediterranean Diet Index was examined via interaction terms.
For fine particulate matter, we observed elevated and significant associations with cardiovascular disease (hazard ratio [HR] per 10 μg/m, 1.13; 95% CI, 1.08-1.18), ischemic heart disease (HR, 1.16; 95% CI, 1.10-1.23), and cerebrovascular disease (HR, 1.15; 95% CI, 1.03-1.28). For nitrogen dioxide, we found significant associations with cardiovascular disease (HR per 10 ppb, 1.06; 95% CI, 1.04-1.08) and ischemic heart disease (HR, 1.08; 95% CI, 1.05-1.11). Analyses indicated that Mediterranean diet modified these relationships, as those with a higher alternative Mediterranean Diet Index score had significantly lower rates of cardiovascular disease mortality associated with long-term air pollution exposure ( P-interaction<0.05).
A Mediterranean diet reduced cardiovascular disease mortality risk related to long-term exposure to air pollutants in a large prospective US cohort. Increased consumption of foods rich in antioxidant compounds may aid in reducing the considerable disease burden associated with ambient air pollution.
最近的实验证据表明，营养补充可以减轻急性空气污染暴露引起的不良心肺影响。然而，通常的个体饮食模式是否可以改变长期空气污染暴露与健康结果之间的关联尚未被研究。我们在一个个体层面有详细饮食信息的大型队列中评估了，地中海饮食是否可以改变长期暴露于环境空气中的污染物和心血管疾病死亡率风险之间的关联。
美国国立卫生研究院-美国退休人员协会饮食与健康研究（National Institutes of Health-American Association for Retired Persons Diet and Health Study）是一项前瞻性队列研究（N=548845），在美国 6 个州和 2 个城市进行，随访时间为 17 年（1995-2011 年），该研究将每年的平均暴露水平与住宅普查区的细颗粒物和二氧化氮暴露水平相关联。替代地中海饮食指数（Alternative Mediterranean Diet Index）是根据队列基线饮食问卷中的信息，使用 9 分制来评估与地中海式饮食的一致性程度。我们评估了心血管疾病、缺血性心脏病、脑血管疾病或心源性猝死与长期空气污染暴露相关的死亡率风险。通过交互项检验了替代地中海饮食指数与暴露和死亡率结果之间的关联的效应修饰。
对于细颗粒物，我们观察到与心血管疾病（每增加 10 μg/m 的风险比 [HR]，1.13；95%置信区间 [CI]，1.08-1.18）、缺血性心脏病（HR，1.16；95%CI，1.10-1.23）和脑血管疾病（HR，1.15；95%CI，1.03-1.28）呈显著正相关。对于二氧化氮，我们发现与心血管疾病（每增加 10 ppb 的 HR，1.06；95%CI，1.04-1.08）和缺血性心脏病（HR，1.08；95%CI，1.05-1.11）呈显著正相关。分析表明，地中海饮食模式修饰了这些关系，因为替代地中海饮食指数得分较高的人，与长期空气污染暴露相关的心血管疾病死亡率明显较低（P-交互<0.05）。
在一个大型的美国前瞻性队列中，地中海饮食降低了与长期暴露于空气污染物相关的心血管疾病死亡率风险。增加富含抗氧化化合物的食物的摄入可能有助于减轻与环境空气污染相关的巨大疾病负担。
