Morze Jakub, Danielewicz Anna, Przybyłowicz Katarzyna, Zeng Hongmei, Hoffmann Georg, Schwingshackl Lukas
Department of Cardiology and Internal Diseases, University of Warmia and Mazury, al. Warszawska 30, 10-082, Olsztyn, Poland.
Department of Human Nutrition, University of Warmia and Mazury, ul. Sloneczna 45f, 10-718, Olsztyn, Poland.
Eur J Nutr. 2021 Apr;60(3):1561-1586. doi: 10.1007/s00394-020-02346-6. Epub 2020 Aug 8.
The aim of current systematic review was to update the body of evidence on associations between adherence to the Mediterranean diet (MedDiet) and risk of cancer mortality, site-specific cancer in the general population; all-cause, and cancer mortality as well as cancer reoccurrence among cancer survivors.
A literature search for randomized controlled trials (RCTs), case-control and cohort studies published up to April 2020 was performed using PubMed and Scopus. Study-specific risk estimates for the highest versus lowest adherence to the MedDiet category were pooled using random-effects meta-analyses. Certainty of evidence from cohort studies and RCTs was evaluated using the NutriGrade scoring system.
The updated search revealed 44 studies not identified in the previous review. Altogether, 117 studies including 3,202,496 participants were enclosed for meta-analysis. The highest adherence to MedDiet was inversely associated with cancer mortality (RR: 0.87, 95% CI 0.82, 0.92; N = 18 studies), all-cause mortality among cancer survivors (RR: 0.75, 95% CI 0.66, 0.86; N = 8), breast (RR: 0.94, 95% CI 0.90, 0.97; N = 23), colorectal (RR: 0.83, 95% CI 0.76, 0.90; N = 17), head and neck (RR: 0.56, 95% CI 0.44, 0.72; N = 9), respiratory (RR: 0.84, 95% CI 0.76, 0.94; N = 5), gastric (RR: 0.70, 95% CI 0.61, 0.80; N = 7), bladder (RR: 0.87, 95% CI 0.76, 0.98; N = 4), and liver cancer (RR: 0.64, 95% CI 0.54, 0.75; N = 4). Adhering to MedDiet did not modify risk of blood, esophageal, pancreatic and prostate cancer risk.
In conclusion, our results suggest that highest adherence to the MedDiet was related to lower risk of cancer mortality in the general population, and all-cause mortality among cancer survivors as well as colorectal, head and neck, respiratory, gastric, liver and bladder cancer risks. Moderate certainty of evidence from cohort studies suggest an inverse association for cancer mortality and colorectal cancer, but most of the comparisons were rated as low or very low certainty of evidence.
本次系统评价的目的是更新关于坚持地中海饮食（MedDiet）与一般人群癌症死亡率、特定部位癌症；癌症幸存者的全因死亡率、癌症死亡率以及癌症复发之间关联的证据。
使用PubMed和Scopus对截至2020年4月发表的随机对照试验（RCT）、病例对照研究和队列研究进行文献检索。使用随机效应荟萃分析汇总MedDiet类别中最高与最低依从性的特定研究风险估计值。使用NutriGrade评分系统评估队列研究和RCT证据的确定性。
更新后的检索发现了117项研究，包括3,202,496名参与者，纳入荟萃分析。最高程度坚持MedDiet与癌症死亡率（RR：0.87，95%CI 0.82，0.92；N = 18项研究）、癌症幸存者的全因死亡率（RR：0.75，95%CI 0.66，0.86；N = 8）、乳腺癌（RR：0.94，95%CI 0.90，0.97；N = 23）、结直肠癌（RR：0.83，95%CI 0.76，0.90；N = 17）、头颈癌（RR：0.56，95%CI 0.44，0.72；N = 9）、呼吸道癌（RR：0.84，95%CI 0.76，0.94；N = 5）、胃癌（RR：0.70，95%CI 0.61，0.80；N = 7）、膀胱癌（RR：0.87，95%CI 0.76，0.98；N = 4）和肝癌（RR：0.64，95%CI 0.54，0.75；N = 4）呈负相关。坚持MedDiet并未改变血液癌、食管癌、胰腺癌和前列腺癌的风险。
总之，我们的结果表明，最高程度坚持MedDiet与一般人群较低的癌症死亡率、癌症幸存者的全因死亡率以及结直肠癌、头颈癌、呼吸道癌、胃癌、肝癌和膀胱癌风险相关。队列研究证据的中等确定性表明癌症死亡率与结直肠癌呈负相关，但大多数比较被评为低或非常低的证据确定性。
