School of Food Science and Nutrition, University of Leeds, Leeds, United Kingdom.
School of Medicine, University of Leeds, Leeds, United Kingdom.
PLoS One. 2021 Nov 10;16(11):e0259144. doi: 10.1371/journal.pone.0259144. eCollection 2021.
To summarise the totality of evidence regarding dietary risk factors for hip fracture in adults, evaluating the quality of evidence, to provide recommendations for practice and further research.
Systematic review of meta-analyses of prospective cohort studies.
Systematic reviews with meta-analyses reporting summary risk estimates for associations between hip fracture incidence and dietary exposures including oral intake of a food, food group, beverage, or nutrient, or adherence to dietary patterns.
Medline, Embase, Web of Science, and the Cochrane Library from inception until November 2020.
The methodological quality of systematic reviews and meta-analyses was assessed using AMSTAR-2, and the quality of evidence for each association was assessed using GRADE. Results were synthesised descriptively.
Sixteen systematic reviews were identified, covering thirty-four exposures, including dietary patterns (n = 2 meta-analyses), foods, food groups, or beverages (n = 16), macronutrients (n = 3), and micronutrients (n = 13). Identified meta-analyses included 6,282 to 3,730,424 participants with between 322 and 26,168 hip fractures. The methodological quality (AMSTAR-2) of all systematic reviews was low or critically low. The quality of evidence (GRADE) was low for an inverse association between hip fracture incidence and intake of fruits and vegetables combined (adjusted summary relative risk for higher vs lower intakes: 0.92 [95% confidence interval: 0.87 to 0.98]), and very low for the remaining thirty-three exposures.
Dietary factors may play a role in the primary prevention of hip fracture, but the methodological quality of systematic reviews and meta-analyses was below international standards, and there was a lack of high-quality evidence. More long-term cohort studies reporting absolute risks and robust, well-conducted meta-analyses with dose-response information are needed before policy guidelines can be formed.
PROSPERO CRD42020226190.
总结成人髋部骨折饮食危险因素的全部证据，评估证据质量，为实践和进一步研究提供建议。
对前瞻性队列研究荟萃分析的系统评价。
系统评价，对髋部骨折发生率与饮食暴露（包括食物、食物组、饮料或营养素的口服摄入，或饮食模式的依从性）之间的关联进行汇总风险估计的荟萃分析。
从建库到 2020 年 11 月，在 Medline、Embase、Web of Science 和 Cochrane Library 进行检索。
使用 AMSTAR-2 评估系统评价和荟萃分析的方法学质量，使用 GRADE 评估每个关联的证据质量。结果以描述性方式进行综合。
共确定了 16 项系统评价，涵盖了 34 项暴露因素，包括饮食模式（2 项荟萃分析）、食物、食物组或饮料（16 项）、宏量营养素（3 项）和微量营养素（13 项）。纳入的荟萃分析包括 6282 至 3730424 名参与者，髋部骨折人数为 322 至 26168 人。所有系统评价的方法学质量（AMSTAR-2）均较低或极低。髋部骨折发生率与水果和蔬菜摄入量之间呈反比关系的证据质量（GRADE）为低（调整后的汇总相对风险：较高 vs 较低摄入量：0.92[95%置信区间：0.87 至 0.98]），其余 33 项暴露的证据质量为极低。
饮食因素可能在髋部骨折的一级预防中发挥作用，但系统评价和荟萃分析的方法学质量低于国际标准，且缺乏高质量的证据。在制定政策指南之前，需要更多的长期队列研究报告绝对风险，并进行稳健、精心设计的荟萃分析，提供剂量-反应信息。
PROSPERO CRD42020226190。
