观察剂量反应荟萃分析方法可能会使低消费水平的风险估计值出现偏差:肉类与结直肠癌的案例。

IF 8 1区 医学 Q1 NUTRITION & DIETETICS
Jane G Pouzou, Francisco J Zagmutt
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引用次数: 0

摘要

背景:众所周知,有关食物及其与健康关系的观察性研究容易产生偏倚,特别是由于饮食与其他生活方式因素之间的混杂。目的:使用剂量-反应荟萃分析(DRMA)模型评估儿童癌症与未加工红肉(RM)和加工肉类(PM)相关性的实证证据,以及在不同建模假设下,低消费人群和高消费人群之间这种相关性的一致性:我们以全球疾病负担项目的系统综述为起点,汇编了29个队列的加工肉类研究数据集,共计23,522,676人年;以及23个队列的红肉研究数据集,共计17,259,839人年。我们仅对低消费量人群( PM(21 克/天)或 RM(56 克/天)的消费量小于美国中位数)拟合了 DRMA 模型,并将其与使用全部消费量范围的 DRMA 模型进行了比较。为了研究模型选择的影响,我们将经典的 DRMA 模型与经验方法进行了比较,后者既适用于低消费人群,也适用于所有消费人群。最后,我们将参考消费者的类型(非消费者或混合消费者/非消费者)作为一个协变量纳入最低消费组的多元荟萃分析中:结果:根据任何 DRMA 模型类型,当仅使用较低消费者时,我们发现 RM(RR 为 50 克/天,1.04 (0.99-1.10) )或 PM(RR 为 20 克/天,1.01 (0.87-1.18))与 CRC 没有明显的正相关。只有全范围的消费量才与 CRC 相关,而经验 DR 显示出非线性、非单调关系。我们并没有发现明显的关系:这些结果表明,由于建模假设和较高消费量的影响,低消费量的风险可能被高估。此外,我们的结果表明,每天摄入 0 克 RM 和 PM 的无风险限制与证据不符:本文描述了剂量-反应模型经典方法中的关键问题,这些问题可能会引入和加剧偏差,导致高估低剂量摄入的风险。我们提出了可定量反映剂量-反应荟萃分析模型不确定性的替代方法,并表明低消费量时的风险高估可能源于建模假设和较高消费量的影响。以未加工和加工肉类与结直肠癌为例,展示了剂量反应的方法,这些方法可适用于其他剂量依赖风险的观察证据,并能以透明和系统的方式用于制定膳食指南。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Observational Dose-Response Meta-Analysis Methods May Bias Risk Estimates at Low Consumption Levels: The Case of Meat and Colorectal Cancer

Observational studies of foods and health are susceptible to bias, particularly from confounding between diet and other lifestyle factors. Common methods for deriving dose-response meta-analysis (DRMA) may contribute to biased or overly certain risk estimates. We used DRMA models to evaluate the empirical evidence for colorectal cancer (CRC) association with unprocessed red meat (RM) and processed meats (PM), and the consistency of this association for low and high consumers under different modeling assumptions. Using the Global Burden of Disease project’s systematic reviews as a start, we compiled a data set of studies of PM with 29 cohorts contributing 23,522,676 person-years and of 23 cohorts for RM totaling 17,259,839 person-years. We fitted DRMA models to lower consumers only [consumption < United States median of PM (21 g/d) or RM (56 g/d)] and compared them with DRMA models using all consumers. To investigate impacts of model selection, we compared classical DRMA models against an empirical model for both lower consumers only and for all consumers. Finally, we assessed if the type of reference consumer (nonconsumer or mixed consumer/nonconsumer) influenced a meta-analysis of the lowest consumption arm. We found no significant association with consumption of 50 g/d RM using an empirical fit with lower consumption (relative risk [RR] 0.93 (0.8–1.02) or all consumption levels (1.04 (0.99–1.10)), while classical models showed RRs as high as 1.09 (1.00–1.18) at 50g/day. PM consumption of 20 g/d was not associated with CRC (1.01 (0.87–1.18)) when using lower consumer data, regardless of model choice. Using all consumption data resulted in association with CRC at 20g/day of PM for the empirical models (1.07 (1.02–1.12)) and with as little as 1g/day for classical models. The empirical DRMA showed nonlinear, nonmonotonic relationships for PM and RM. Nonconsumer reference groups did not affect RM (P = 0.056) or PM (P = 0.937) association with CRC in lowest consumption arms. In conclusion, classical DRMA model assumptions and inclusion of higher consumption levels influence the association between CRC and low RM and PM consumption. Furthermore, a no-risk limit of 0 g/d consumption of RM and PM is inconsistent with the evidence.

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来源期刊
Advances in Nutrition
Advances in Nutrition 医学-营养学
CiteScore
17.40
自引率
2.20%
发文量
117
审稿时长
56 days
期刊介绍: Advances in Nutrition (AN/Adv Nutr) publishes focused reviews on pivotal findings and recent research across all domains relevant to nutritional scientists and biomedical researchers. This encompasses nutrition-related research spanning biochemical, molecular, and genetic studies using experimental animal models, domestic animals, and human subjects. The journal also emphasizes clinical nutrition, epidemiology and public health, and nutrition education. Review articles concentrate on recent progress rather than broad historical developments. In addition to review articles, AN includes Perspectives, Letters to the Editor, and supplements. Supplement proposals require pre-approval by the editor before submission. The journal features reports and position papers from the American Society for Nutrition, summaries of major government and foundation reports, and Nutrient Information briefs providing crucial details about dietary requirements, food sources, deficiencies, and other essential nutrient information. All submissions with scientific content undergo peer review by the Editors or their designees prior to acceptance for publication.
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