Department of Health Sciences, College of Health Professions and Sciences, University of Central Florida, 4364 Scorpius Street, Orlando, FL 32816, USA.
Int J Environ Res Public Health. 2022 Jun 21;19(13):7579. doi: 10.3390/ijerph19137579.
This systematic review examined the effect of diet quality, defined as adherence to healthy dietary recommendations, on all-cause and breast cancer-specific mortality. Web of Science, Medline, CINAHL, and PsycINFO databases were searched to identify eligible studies published by May 2021. We used a random-effects model meta-analysis in two different approaches to estimate pooled hazard ratio (HR) and 95% confidence interval (CI) for highest and lowest categories of diet quality: (1) each dietary quality index as the unit of analysis and (2) cohort as the unit of analysis. Heterogeneity was examined using Cochran's Q test and inconsistency I statistics. The risk of bias was assessed by the Newcastle-Ottawa Scale for cohort studies, and the quality of evidence was investigated by the GRADE tool. The analysis included 11 publications from eight cohorts, including data from 27,346 survivors and seven dietary indices. Both approaches yielded a similar effect size, but cohort-based analysis had a wider CI. Pre-diagnosis diet quality was not associated with both outcomes. However, better post-diagnosis diet quality significantly reduced all-cause mortality by 21% (HR = 0.79, 95% CI = 0.70, 0.89, I = 16.83%, = 7) and marginally reduced breast cancer-specific mortality by 15% (HR = 0.85, 95% CI = 0.62, 1.18, I = 57.4%, = 7). Subgroup analysis showed that adhering to the Diet Approaches to Stop Hypertension and Chinese Food Pagoda guidelines could reduce breast cancer-specific mortality. Such reduction could be larger for older people, physically fit individuals, and women with estrogen receptor-positive, progesterone receptor-negative, or human epidermal growth factor receptor 2-positive tumors. The risk of bias in the selected studies was low, and the quality of evidence for the identified associations was low or very low due to imprecision of effect estimation, inconsistent results, and publication bias. More research is needed to precisely estimate the effect of diet quality on mortality. Healthcare providers can encourage breast cancer survivors to comply with healthy dietary recommendations to improve overall health. (Funding: University of Central Florida Office of Undergraduate Research, Registration: PROSPERO-CRD42021260135).
本系统评价研究了饮食质量（定义为遵循健康饮食建议的程度）对全因死亡率和乳腺癌特异性死亡率的影响。通过 Web of Science、Medline、CINAHL 和 PsycINFO 数据库检索了截至 2021 年 5 月发表的合格研究。我们使用随机效应模型荟萃分析了两种不同的方法来估计饮食质量最高和最低类别的汇总风险比（HR）和 95%置信区间（CI）：（1）每个饮食质量指数作为分析单位，（2）队列作为分析单位。使用 Cochran's Q 检验和不一致性 I 统计量来检查异质性。使用纽卡斯尔-渥太华量表评估队列研究的偏倚风险，并使用 GRADE 工具评估证据质量。该分析包括 11 项来自 8 项队列的研究，包括 27346 名幸存者和 7 项饮食指数的数据。这两种方法都得到了相似的效应大小，但基于队列的分析具有更宽的 CI。诊断前的饮食质量与这两个结局均无关。然而，更好的诊断后饮食质量可使全因死亡率降低 21%（HR = 0.79，95% CI = 0.70，0.89，I = 16.83%， = 7），使乳腺癌特异性死亡率降低 15%（HR = 0.85，95% CI = 0.62，1.18，I = 57.4%， = 7）。亚组分析表明，遵循停止高血压的饮食方法和中国佛塔饮食指南可以降低乳腺癌特异性死亡率。对于老年人、身体状况良好的个体以及雌激素受体阳性、孕激素受体阴性或人表皮生长因子受体 2 阳性肿瘤的女性，这种降低可能更大。所选研究的偏倚风险较低，由于效应估计的不精确性、结果不一致性和发表偏倚，确定关联的证据质量为低或极低。需要进一步的研究来准确估计饮食质量对死亡率的影响。医疗保健提供者可以鼓励乳腺癌幸存者遵循健康饮食建议，以改善整体健康状况。（资助：中佛罗里达大学本科生研究办公室，注册号：PROSPERO-CRD42021260135）。
