Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK.
BMJ. 2020 Mar 18;368:m688. doi: 10.1136/bmj.m688.
To investigate the association of macronutrient intake with all cause mortality and cardiovascular disease (CVD), and the implications for dietary advice.
Prospective population based study.
UK Biobank.
195 658 of the 502 536 participants in UK Biobank completed at least one dietary questionnaire and were included in the analyses. Diet was assessed using Oxford WebQ, a web based 24 hour recall questionnaire, and nutrient intakes were estimated using standard methodology. Cox proportional models with penalised cubic splines were used to study non-linear associations.
All cause mortality and incidence of CVD.
4780 (2.4%) participants died over a mean 10.6 (range 9.4-13.9) years of follow-up, and 948 (0.5%) and 9776 (5.0%) experienced fatal and non-fatal CVD events, respectively, over a mean 9.7 (range 8.5-13.0) years of follow-up. Non-linear associations were found for many macronutrients. Carbohydrate intake showed a non-linear association with mortality; no association at 20-50% of total energy intake but a positive association at 50-70% of energy intake (3.14 2.75 per 1000 person years, average hazard ratio 1.14, 95% confidence interval 1.03 to 1.28 (60-70% 50% of energy)). A similar pattern was observed for sugar but not for starch or fibre. A higher intake of monounsaturated fat (2.94 3.50 per 1000 person years, average hazard ratio 0.58, 0.51 to 0.66 (20-25% 5% of energy)) and lower intake of polyunsaturated fat (2.66 3.04 per 1000 person years, 0.78, 0.75 to 0.81 (5-7% 12% of energy)) and saturated fat (2.66 3.59 per 1000 person years, 0.67, 0.62 to 0.73 (5-10% 20% of energy)) were associated with a lower risk of mortality. A dietary risk matrix was developed to illustrate how dietary advice can be given based on current intake.
Many associations between macronutrient intake and health outcomes are non-linear. Thus dietary advice could be tailored to current intake. Dietary guidelines on macronutrients (eg, carbohydrate) should also take account of differential associations of its components (eg, sugar and starch).
研究宏量营养素摄入与全因死亡率和心血管疾病（CVD）的关系，并探讨其对饮食建议的意义。
前瞻性人群研究。
英国生物银行。
英国生物银行 502536 名参与者中，有 195658 名至少完成了一次饮食问卷，并纳入了分析。通过牛津网络问卷（Oxford WebQ）评估饮食，这是一种基于网络的 24 小时回顾性问卷，使用标准方法估计营养素摄入量。使用带惩罚三次样条的 Cox 比例模型研究非线性关联。
全因死亡率和 CVD 发生率。
在平均 10.6 年（范围为 9.4-13.9 年）的随访中，4780 名（2.4%）参与者死亡，948 名（0.5%）和 9776 名（5.0%）参与者分别经历了致命和非致命 CVD 事件，平均随访 9.7 年（范围为 8.5-13.0 年）。许多宏量营养素的摄入与死亡率呈非线性关联。碳水化合物摄入量与死亡率呈非线性关联；在总能量摄入的 20-50%之间没有关联，但在 50-70%之间呈正相关（每 1000 人年增加 3.14 2.75，平均危险比 1.14，95%置信区间 1.03 至 1.28（60-70% 50%的能量））。这种模式在糖中也观察到了，但在淀粉或纤维中没有观察到。较高的单不饱和脂肪摄入量（每 1000 人年增加 2.94 3.50，平均危险比 0.58，0.51 至 0.66（20-25% 5%的能量））和较低的多不饱和脂肪摄入量（每 1000 人年增加 2.66 3.04，0.78，0.75 至 0.81（5-7% 12%的能量））和饱和脂肪摄入量（每 1000 人年增加 2.66 3.59，0.67，0.62 至 0.73（5-10% 20%的能量））与较低的死亡率风险相关。制定了一个饮食风险矩阵，以说明如何根据当前摄入量提供饮食建议。
宏量营养素摄入与健康结果之间的许多关联是非线性的。因此，饮食建议可以根据当前摄入量进行定制。关于宏量营养素（如碳水化合物）的饮食指南还应考虑其成分（如糖和淀粉）的差异关联。
