Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany.
German Center for Diabetes Research (DZD), Partner Düsseldorf, Düsseldorf, Germany.
BMC Med. 2023 Nov 16;21(1):404. doi: 10.1186/s12916-023-03093-1.
There is growing evidence that substituting animal-based with plant-based foods is associated with a lower risk of cardiovascular diseases (CVD), type 2 diabetes (T2D), and all-cause mortality. Our aim was to summarize and evaluate the evidence for the substitution of any animal-based foods with plant-based foods on cardiometabolic health and all-cause mortality in a systematic review and meta-analysis.
We systematically searched MEDLINE, Embase, and Web of Science to March 2023 for prospective studies investigating the substitution of animal-based with plant-based foods on CVD, T2D, and all-cause mortality. We calculated summary hazard ratios (SHRs) and 95% confidence intervals (95% CI) using random-effects meta-analyses. We assessed the certainty of evidence (CoE) using the GRADE approach.
In total, 37 publications based on 24 cohorts were included. There was moderate CoE for a lower risk of CVD when substituting processed meat with nuts [SHR (95% CI): 0.73 (0.59, 0.91), n = 8 cohorts], legumes [0.77 (0.68, 0.87), n = 8], and whole grains [0.64 (0.54, 0.75), n = 7], as well as eggs with nuts [0.83 (0.78, 0.89), n = 8] and butter with olive oil [0.96 (0.95, 0.98), n = 3]. Furthermore, we found moderate CoE for an inverse association with T2D incidence when substituting red meat with whole grains/cereals [0.90 (0.84, 0.96), n = 6] and red meat or processed meat with nuts [0.92 (0.90, 0.94), n = 6 or 0.78 (0.69, 0.88), n = 6], as well as for replacing poultry with whole grains [0.87 (0.83, 0.90), n = 2] and eggs with nuts or whole grains [0.82 (0.79, 0.86), n = 2 or 0.79 (0.76, 0.83), n = 2]. Moreover, replacing red meat for nuts [0.93 (0.91, 0.95), n = 9] and whole grains [0.96 (0.95, 0.98), n = 3], processed meat with nuts [0.79 (0.71, 0.88), n = 9] and legumes [0.91 (0.85, 0.98), n = 9], dairy with nuts [0.94 (0.91, 0.97), n = 3], and eggs with nuts [0.85 (0.82, 0.89), n = 8] and legumes [0.90 (0.89, 0.91), n = 7] was associated with a reduced risk of all-cause mortality.
Our findings indicate that a shift from animal-based (e.g., red and processed meat, eggs, dairy, poultry, butter) to plant-based (e.g., nuts, legumes, whole grains, olive oil) foods is beneficially associated with cardiometabolic health and all-cause mortality.
越来越多的证据表明，用植物性食物替代动物性食物与降低心血管疾病 (CVD)、2 型糖尿病 (T2D) 和全因死亡率的风险相关。我们的目的是在系统评价和荟萃分析中总结和评估用植物性食物替代任何动物性食物对心脏代谢健康和全因死亡率的证据。
我们系统地检索了 MEDLINE、Embase 和 Web of Science 数据库，以获取截至 2023 年 3 月的前瞻性研究，这些研究调查了用植物性食物替代动物性食物对 CVD、T2D 和全因死亡率的影响。我们使用随机效应荟萃分析计算了汇总风险比 (SHR) 和 95%置信区间 (95%CI)。我们使用 GRADE 方法评估证据的确定性 (CoE)。
共纳入 37 篇基于 24 项队列研究的文献。用坚果替代加工肉类[SHR (95%CI): 0.73 (0.59, 0.91), n = 8 项队列]、豆类[0.77 (0.68, 0.87), n = 8 项]和全谷物[0.64 (0.54, 0.75), n = 7 项]，以及用坚果替代鸡蛋[0.83 (0.78, 0.89), n = 8 项]和用橄榄油替代黄油[0.96 (0.95, 0.98), n = 3 项]，与 CVD 风险降低的中等 CoE 相关。此外，我们发现用全谷物/谷物替代红肉[0.90 (0.84, 0.96), n = 6 项]和用坚果替代红肉或加工肉[0.92 (0.90, 0.94), n = 6 项或 0.78 (0.69, 0.88), n = 6 项]，以及用全谷物替代禽肉[0.87 (0.83, 0.90), n = 2 项]和用坚果或全谷物替代鸡蛋[0.82 (0.79, 0.86), n = 2 项或 0.79 (0.76, 0.83), n = 2 项]与 T2D 发病率呈负相关，且具有中等 CoE。此外，用坚果替代红肉[0.93 (0.91, 0.95), n = 9 项]和全谷物[0.96 (0.95, 0.98), n = 3 项]，用坚果替代加工肉[0.79 (0.71, 0.88), n = 9 项]和豆类[0.91 (0.85, 0.98), n = 9 项]，用坚果替代奶制品[0.94 (0.91, 0.97), n = 3 项]，以及用坚果替代鸡蛋[0.85 (0.82, 0.89), n = 8 项]和豆类[0.90 (0.89, 0.91), n = 7 项]与全因死亡率降低相关，具有中等 CoE。
我们的研究结果表明，从动物性食物(如红肉和加工肉、鸡蛋、奶制品、禽肉、黄油)向植物性食物(如坚果、豆类、全谷物、橄榄油)的转变与心脏代谢健康和全因死亡率的降低有关。
