超加工食品与心血管疾病:对美国三个大型前瞻性队列的分析以及对前瞻性队列研究的系统回顾和荟萃分析

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES
Kenny Mendoza , Stephanie A. Smith-Warner , Sinara Laurini Rossato , Neha Khandpur , JoAnn E. Manson , Lu Qi , Eric B. Rimm , Kenneth J. Mukamal , Walter C. Willett , Molin Wang , Frank B. Hu , Josiemer Mattei , Qi Sun
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引用次数: 0

摘要

背景超加工食品(UPF)总量和组别与心血管疾病(CVD)之间的前瞻性关联仍有待确定。我们的目的是在三个大型美国成年人前瞻性队列中评估超高加工食品的总摄入量和特定组别摄入量与心血管疾病、冠心病(CHD)和中风之间的关系。方法在护士健康研究(NHS;n = 75,735)、护士健康研究II(NHSII;n = 90,813)和卫生专业人员随访研究(HPFS;n = 40,409)中通过食物频率问卷评估UPF摄入量。Cox 回归估算了总摄入量和特定组群的 UPF 摄入量与心血管疾病(病例数 = 16800 例)、冠心病(病例数 = 10401 例)和中风(病例数 = 6758 例)风险的队列特异性关联,随后通过固定效应模型进行了汇总。随机效应荟萃分析汇集了截至2024年4月5日在Medline和Embase上发现的有关UPF与心血管疾病关系的现有前瞻性研究结果,没有语言限制。使用纽卡斯尔-渥太华量表、漏斗图和Egger检验评估偏倚风险,并使用NutriGrade评估荟萃证据。研究结果NHS的基线平均(标清)年龄为50.8岁(7.2),NHSII为36.7岁(4.6),HPFS为53.4岁(9.6)。在 NHS 中,白种人的比例为 97.7%,在 NHSII 中为 96.4%,在 HPFS 中为 94.9%。在三个队列中,UPF 总摄入量最高(与最低)五分位数的心血管疾病、冠心病和中风的多变量调整危险比[HRs (95% CIs)]分别为 1.11 (1.06-1.16)、1.16 (1.09-1.24) 和 1.04 (0.96-1.12)。UPF组显示出不同的关联性。加糖/人工甜味饮料和加工肉类与较高的心血管疾病风险相关,而面包/冷谷物、酸奶/乳制品甜点和咸味零食则呈反向关系。对22项前瞻性研究进行的元分析表明,UPF总摄入量最高类别(与最低类别相比)与心血管疾病、冠心病和中风风险分别增加17%(11%-24%)、23%(12%-34%)和9%(3%-15%)有关。解读UPF总摄入量与美国成年人的心血管疾病和冠心病风险呈负相关,多个国家的前瞻性研究也证实了这一点,同时还表明中风风险略有增加。针对心血管健康的营养建议应考虑到特定群体UPF的不同后果。需要在种族/民族多样化的人群中进行重复研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Ultra-processed foods and cardiovascular disease: analysis of three large US prospective cohorts and a systematic review and meta-analysis of prospective cohort studies

Background

Prospective associations between total and groups of ultra-processed foods (UPF) and cardiovascular disease (CVD) remained to be characterised. Our aim was to assess the association of total and group-specific UPF intakes with CVD, coronary heart disease (CHD), and stroke in three large prospective cohorts of US adults. Additionally, we conducted a systematic review and meta-analyses on the existing evidence on the associations of total UPF intake with these outcomes.

Methods

UPF intake was assessed through food frequency questionnaires in the Nurses’ Health Study (NHS; n = 75,735), Nurses’ Health Study II (NHSII; n = 90,813), and Health Professionals Follow-Up Study (HPFS; n = 40,409). Cox regression estimated cohort-specific associations of total and group-specific UPF intake with risk of CVD (cases = 16,800), CHD (cases = 10,401), and stroke (cases = 6758), subsequently pooled through fixed-effect models. Random-effects meta-analyses pooled existing prospective findings on the UPF-CVD association identified on Medline and Embase up to April 5, 2024, without language restrictions. Risk of bias was assessed with the Newcastle–Ottawa Scale, funnel plots, and Egger’s tests, and meta-evidence was evaluated using NutriGrade.

Findings

The baseline mean (SD) age was 50.8 years (7.2) for the NHS, 36.7 years (4.6) for the NHSII, and 53.4 years (9.6) for the HPFS. The proportion of participants of White race was 97.7% in the NHS, 96.4% in the NHSII, and 94.9% in the HPFS. Among the three cohorts, multivariable-adjusted hazard ratios [HRs (95% CIs)] for CVD, CHD, and stroke for the highest (vs. lowest) total UPF intake quintile were 1.11 (1.06–1.16), 1.16 (1.09–1.24), and 1.04 (0.96–1.12), respectively. UPF groups demonstrated divergent associations. Sugar-/artificially-sweetened drinks and processed meats were associated with higher CVD risk, whereas inverse associations were observed for bread/cold cereals, yoghurt/dairy desserts, and savoury snacks. Meta-analysing 22 prospective studies showed that total UPF intake at the highest category (vs. lowest) was associated with 17% (11%–24%), 23% (12%–34%), and 9% (3%–15%) higher CVD, CHD, and stroke risk. Meta-evidence quality was high for CHD, moderate for CVD, and low for stroke.

Interpretation

Total UPF intake was adversely associated with CVD and CHD risk in US adults, corroborated by prospective studies from multiple countries, also suggesting a small excess stroke risk. Nutritional advice for cardiovascular health should consider differential consequences of group-specific UPF. Replication is needed in racially/ethnically-diverse populations.

Funding

National Institutes of Health (NIH) grants supported the NHS, NHSII, and HPFS.

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期刊介绍: The Lancet Regional Health – Americas, an open-access journal, contributes to The Lancet's global initiative by focusing on health-care quality and access in the Americas. It aims to advance clinical practice and health policy in the region, promoting better health outcomes. The journal publishes high-quality original research advocating change or shedding light on clinical practice and health policy. It welcomes submissions on various regional health topics, including infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, emergency care, health policy, and health equity.
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