饮食中坚果摄入量与五大洲 16 个国家的危险因素、心血管疾病和死亡率的关系：来自前瞻性城乡流行病学（PURE）研究的分析。

Association of nut intake with risk factors, cardiovascular disease, and mortality in 16 countries from 5 continents: analysis from the Prospective Urban and Rural Epidemiology (PURE) study.

机构信息

Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.

Population Health Research Institute, Hamilton, ON, Canada.

出版信息

Am J Clin Nutr. 2020 Jul 1;112(1):208-219. doi: 10.1093/ajcn/nqaa108.

DOI:10.1093/ajcn/nqaa108

PMID:32433740

Abstract

BACKGROUND

The association of nuts with cardiovascular disease and deaths has been investigated mostly in Europe, the USA, and East Asia, with few data available from other regions of the world or from low- and middle-income countries.

OBJECTIVE

To assess the association of nuts with mortality and cardiovascular disease (CVD).

METHODS

The Prospective Urban Rural Epidemiology study is a large multinational prospective cohort study of adults aged 35-70 y from 16 low-, middle-, and high-income countries on 5 continents. Nut intake (tree nuts and ground nuts) was measured at the baseline visit, using country-specific validated FFQs. The primary outcome was a composite of mortality or major cardiovascular event [nonfatal myocardial infarction (MI), stroke, or heart failure].

RESULTS

We followed 124,329 participants (age = 50.7 y, SD = 10.2; 41.5% male) for a median of 9.5 y. We recorded 10,928 composite events [deaths (n = 8,662) or major cardiovascular events (n = 5,979)]. Higher nut intake (>120 g per wk compared with <30 g per mo) was associated with a lower risk of the primary composite outcome of mortality or major cardiovascular event [multivariate HR (mvHR): 0.88; 95% CI: 0.80, 0.96; P-trend = 0.0048]. Significant reductions in total (mvHR: 0.77; 95% CI: 0.69, 0.87; P-trend <0.0001), cardiovascular (mvHR: 0.72; 95% CI: 0.56, 0.92; P-trend = 0.048), and noncardiovascular mortality (mvHR: 0.82; 95% CI: 0.70, 0.96; P-trend = 0.0046) with a trend to reduced cancer mortality (mvHR: 0.81; 95% CI: 0.65, 1.00; P-trend = 0.081) were observed. No significant associations of nuts were seen with major CVD (mvHR: 0.91; 95% CI: 0.81, 1.02; P-trend = 0.14), stroke (mvHR: 0.98; 95% CI: 0.84, 1.14; P-trend = 0.76), or MI (mvHR: 0.86; 95% CI: 0.72, 1.04; P-trend = 0.29).

CONCLUSIONS

Higher nut intake was associated with lower mortality risk from both cardiovascular and noncardiovascular causes in low-, middle-, and high-income countries.

摘要

背景

坚果与心血管疾病和死亡的关联主要在欧洲、美国和东亚进行了研究，来自世界其他地区或中低收入国家的数据较少。

目的

评估坚果与死亡率和心血管疾病（CVD）的关系。

方法

前瞻性城市农村流行病学研究是一项大型的多国家前瞻性队列研究，涉及来自五大洲 16 个低、中、高收入国家的 35-70 岁成年人。在基线访问时使用特定国家/地区的经过验证的 FFQ 测量坚果摄入量（树坚果和花生）。主要结局是死亡率或主要心血管事件（非致命性心肌梗死（MI）、中风或心力衰竭）的复合结果。

结果

我们对 124329 名参与者（年龄=50.7 岁，标准差=10.2；41.5%为男性）进行了中位数为 9.5 年的随访。我们记录了 10928 例复合事件[死亡（n=8662）或主要心血管事件（n=5979）]。与<30g/月相比，较高的坚果摄入量（>120g/周）与死亡率或主要心血管事件的复合结局风险降低相关[多变量 HR（mvHR）：0.88；95%CI：0.80，0.96；P 趋势=0.0048]。总死亡率（mvHR：0.77；95%CI：0.69，0.87；P 趋势<0.0001）、心血管死亡率（mvHR：0.72；95%CI：0.56，0.92；P 趋势=0.048）和非心血管死亡率（mvHR：0.82；95%CI：0.70，0.96；P 趋势=0.0046）显著降低，癌症死亡率呈降低趋势（mvHR：0.81；95%CI：0.65，1.00；P 趋势=0.081）。坚果与主要 CVD（mvHR：0.91；95%CI：0.81，1.02；P 趋势=0.14）、中风（mvHR：0.98；95%CI：0.84，1.14；P 趋势=0.76）或 MI（mvHR：0.86；95%CI：0.72，1.04；P 趋势=0.29）无显著相关性。