Liu Ya-Shu, Wu Qi-Jun, Lv Jia-Le, Jiang Yu-Ting, Sun Hui, Xia Yang, Chang Qing, Zhao Yu-Hong
Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China.
Clinical Research Center, Shengjing Hospital of China Medical University, Shenyang, China.
Front Nutr. 2021 Apr 29;8:670411. doi: 10.3389/fnut.2021.670411. eCollection 2021.
The associations between dietary carbohydrate and diverse health outcomes remain controversial and confusing. To summarize the existing evidence of the association between dietary carbohydrate intake and diverse health outcomes and to evaluate the credibility of these sources of evidence. We performed this umbrella review of evidence from meta-analyses of observational studies. PubMed, Embase, Web of Science databases, and manual screening of references up to July 2020 were searched. Systematic reviews with meta-analyses of observational studies in humans investigating the association between dietary carbohydrate intake and multiple health outcomes were identified. We assessed the evidence levels by using summary effect sizes, 95% prediction intervals, between-study heterogeneity, evidence of small-study effects, and evidence of excess significance bias for each meta-analysis. We included 43 meta-analyses of observational research studies with 23 health outcomes, including cancer ( = 26), mortality ( = 4), metabolic diseases ( = 4), digestive system outcomes ( = 3), and other outcomes [coronary heart disease ( = 2), stroke ( = 1), Parkinson's disease ( = 1), and bone fracture ( = 2)]. This umbrella review summarized 281 individual studies with 13,164,365 participants. Highly suggestive evidence of an association between dietary carbohydrate intake and metabolic syndrome was observed with adjusted summary odds ratio of 1.25 [95% confidence interval (CI) 1.15-1.37]. The suggestive evidences were observed in associations of carbohydrate consumption with esophageal adenocarcinoma (0.57, 95% CI = 0.42-0.78) and all-cause mortality (adjusted summary hazard ratio 1.19, 95% CI = 1.09-1.30). Despite the fact that numerous systematic reviews and meta-analyses have explored the relationship between carbohydrate intake and diverse health outcomes, there is no convincing evidence of a clear role of carbohydrate intake. However, there is highly suggestive evidence suggested carbohydrate intake is associated with high risk of metabolic syndrome, suggestive evidence found its association with increased risk of all-cause mortality and decreased risk of esophageal adenocarcinoma. CRD42020197424.
膳食碳水化合物与多种健康结局之间的关联仍存在争议且令人困惑。为总结膳食碳水化合物摄入量与多种健康结局之间关联的现有证据，并评估这些证据来源的可信度。我们对观察性研究的荟萃分析证据进行了这项伞状综述。检索了截至2020年7月的PubMed、Embase、Web of Science数据库，并手动筛选参考文献。确定了对人类进行的观察性研究的荟萃分析的系统综述，这些研究调查了膳食碳水化合物摄入量与多种健康结局之间的关联。我们通过使用汇总效应量、95%预测区间、研究间异质性、小研究效应的证据以及每项荟萃分析的过度显著性偏差证据来评估证据水平。我们纳入了43项对观察性研究的荟萃分析，涉及23种健康结局，包括癌症（n = 26）、死亡率（n = 4）、代谢性疾病（n = 4）、消化系统结局（n = 3）以及其他结局[冠心病（n = 2）、中风（n = 1）、帕金森病（n = 1）和骨折（n = 2）]。这项伞状综述总结了281项个体研究，涉及13164365名参与者。观察到膳食碳水化合物摄入量与代谢综合征之间存在高度提示性关联，调整后的汇总比值比为1.25[95%置信区间（CI）1.15 - 1.37]。在碳水化合物消费与食管腺癌（0.57，95%CI = 0.42 - 0.78）和全因死亡率（调整后的汇总风险比1.19，95%CI = 1.09 - 1.30）的关联中观察到提示性证据。尽管众多系统综述和荟萃分析探讨了碳水化合物摄入量与多种健康结局之间的关系，但没有令人信服的证据表明碳水化合物摄入量有明确作用。然而，有高度提示性证据表明碳水化合物摄入量与代谢综合征的高风险相关，提示性证据发现其与全因死亡率风险增加和食管腺癌风险降低相关。CRD42020197424
