Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
Nutrients. 2024 Jan 2;16(1):152. doi: 10.3390/nu16010152.
Many epidemiological studies have evaluated the intake of macronutrients and the risk of mortality and cardiovascular disease (CVD). However, current evidence is conflicting and warrants further investigation. Therefore, we carried out an umbrella review to examine and quantify the potential dose-response association of dietary macronutrient intake with CVD morbidity and mortality. Prospective cohort studies from PubMed, Embase, and CENTRAL were reviewed, which reported associations of macronutrients (protein, fat, and carbohydrate) with all-cause, CVD, cancer mortality, or CVD events. Multivariable relative risks (RR) were pooled, and heterogeneity was assessed. The results of 124 prospective cohort studies were included in the systematic review and 101 in the meta-analysis. During the follow-up period from 2.2 to 30 years, 506,086 deaths and 79,585 CVD events occurred among 5,107,821 participants. High total protein intake was associated with low CVD morbidity (RR 0.88, 95% confidence interval 0.82-0.94), while high total carbohydrate intake was associated with high CVD morbidity (1.08, 1.02-1.13). For fats, a high intake of total fat was associated with a decreased all-cause mortality risk (0.92, 0.85-0.99). Saturated fatty acid intake was only associated with cancer mortality (1.10, 1.06-1.14); Both monounsaturated fatty acid (MUFA) and polyunsaturated fatty acids (PUFA) intake was associated with all-cause mortality (MUFA: 0.92, 0.86-0.98; PUFA: 0.91, 0.86-0.96). This meta-analysis supports that protein intake is associated with a decreased risk of CVD morbidity, while carbohydrate intake is associated with an increased risk of CVD morbidity. High total fat intake is associated with a low risk of all-cause mortality, and this effect was different in an analysis stratified by the type of fat.
许多流行病学研究评估了宏量营养素的摄入量与死亡率和心血管疾病（CVD）的风险。然而，目前的证据相互矛盾，需要进一步研究。因此，我们进行了一项伞式综述，以检查和量化饮食中宏量营养素摄入与 CVD 发病率和死亡率的潜在剂量反应关联。从 PubMed、Embase 和 CENTRAL 中审查了前瞻性队列研究，这些研究报告了宏量营养素（蛋白质、脂肪和碳水化合物）与全因、CVD、癌症死亡率或 CVD 事件的相关性。汇总了多变量相对风险（RR），并评估了异质性。124 项前瞻性队列研究的结果被纳入系统评价，101 项被纳入荟萃分析。在 2.2 至 30 年的随访期间，在 5107821 名参与者中，有 506086 人死亡，79585 人发生 CVD 事件。高总蛋白摄入量与低 CVD 发病率相关（RR 0.88，95%置信区间 0.82-0.94），而高总碳水化合物摄入量与高 CVD 发病率相关（1.08，1.02-1.13）。对于脂肪，总脂肪摄入量高与全因死亡率降低相关（0.92，0.85-0.99）。饱和脂肪酸摄入量仅与癌症死亡率相关（1.10，1.06-1.14）；单不饱和脂肪酸（MUFA）和多不饱和脂肪酸（PUFA）的摄入量均与全因死亡率相关（MUFA：0.92，0.86-0.98；PUFA：0.91，0.86-0.96）。这项荟萃分析支持蛋白质摄入量与 CVD 发病率降低相关，而碳水化合物摄入量与 CVD 发病率增加相关。总脂肪摄入量高与全因死亡率降低相关，这种影响在按脂肪类型分层的分析中有所不同。
