J Acad Nutr Diet. 2020 Nov;120(11):1859-1883.e31. doi: 10.1016/j.jand.2020.06.021. Epub 2020 Sep 12.
Observational data have established a link between the consumption of whole grains and reduced risk of cardiovascular disease (CVD); however, there is a need to review interventional research.
Our aim was to determine whether interventions providing whole grain or whole pseudo-grain for dietary consumption improved CVD-related outcomes compared with refined grain or placebo in adults with or without chronic disease and/or associated risk factors.
A systematic review and meta-analysis of randomized controlled trials that compared whole-grain vs refined-grain or placebo consumption by human adults was conducted. PubMed, CINAHL, Embase, Web of Science, and Cochrane CENTRAL were searched for studies of 12 weeks (or 2 weeks for inflammatory outcomes) duration until 21 February 2020. Data were extracted for 14 types of CVD risk factors (40 outcomes in total). Risk of bias was assessed using the Cochrane Risk-of-Bias tool. Meta-analysis was performed using Comprehensive Meta-Analysis software. The Grading of Recommendations Assessment, Development and Evaluation method was used to determine confidence in the pooled effects and to inform a clinical recommendation.
Twenty-five randomized controlled trials were included and 22 were meta-analyzed. Interventions ranged from 2 to 16 weeks; most samples were healthy (n = 13 studies) and used mixed whole grains (n = 11 studies). Meta-analysis found that whole-grain oats improved total cholesterol (standardized mean difference [SMD] = -0.54, 95% CI -0.95 to -0.12) and low-density lipoprotein cholesterol (SMD = -0.57, 95% CI -0.84 to -0.31), whole-grain rice improved triglycerides (SMD = 0.22, 95% CI -0.44 to -0.01), and whole grains (all types) improved hemoglobin A1c (SMD = -0.33, 95% CI -0.61 to -0.04) and C-reactive protein (SMD = -0.22, 95% CI -0.44 to -0.00).
For adults with or without CVD risk factors, consuming whole grains as opposed to refined grains can improve total cholesterol, low-density lipoprotein cholesterol, hemoglobin A1c, and C-reactive protein. There is insufficient evidence to recommend the whole grains as opposed to refined grains for the prevention and treatment of CVD. Further interventional research is needed to better understand the preventive and treatment potential of whole-grain and whole pseudo-grain dietary intake for cardiovascular disease, particularly among those with existing CVD risk factors.
观察性数据已经证实，全谷物的摄入与心血管疾病（CVD）风险降低之间存在关联；然而，仍需要对干预性研究进行审查。
我们旨在确定在患有或不患有慢性疾病和/或相关危险因素的成年人中，摄入全谷物或全伪谷物与摄入精制谷物或安慰剂相比，是否能改善与 CVD 相关的结局。
系统检索了PubMed、CINAHL、Embase、Web of Science 和 Cochrane CENTRAL 数据库中截至 2020 年 2 月 21 日为期 12 周（或炎症结局为 2 周）的比较全谷物与精制谷物或安慰剂摄入的随机对照试验。共提取了 14 种 CVD 风险因素的数据（总计 40 个结局）。使用 Cochrane 偏倚风险工具评估偏倚风险。使用 Comprehensive Meta-Analysis 软件进行荟萃分析。采用 Grading of Recommendations Assessment, Development and Evaluation 方法确定汇总效应的可信度，并为临床推荐提供信息。
共纳入 25 项随机对照试验，其中 22 项进行了荟萃分析。干预措施的持续时间为 2 至 16 周；大多数样本为健康人群（n=13 项研究），并使用混合全谷物（n=11 项研究）。荟萃分析发现，全燕麦可改善总胆固醇（标准化均数差[SMD]=-0.54，95%置信区间-0.95 至-0.12）和低密度脂蛋白胆固醇（SMD=-0.57，95%置信区间-0.84 至-0.31），全谷物大米可改善甘油三酯（SMD=0.22，95%置信区间-0.44 至-0.01），全谷物（所有类型）可改善糖化血红蛋白（SMD=-0.33，95%置信区间-0.61 至-0.04）和 C 反应蛋白（SMD=-0.22，95%置信区间-0.44 至-0.00）。
对于患有或不患有 CVD 危险因素的成年人，摄入全谷物而非精制谷物可改善总胆固醇、低密度脂蛋白胆固醇、糖化血红蛋白和 C 反应蛋白。目前尚无足够证据推荐全谷物而非精制谷物用于 CVD 的预防和治疗。需要进一步的干预性研究，以更好地了解全谷物和全伪谷物饮食摄入对心血管疾病的预防和治疗潜力，尤其是在存在现有 CVD 危险因素的人群中。
