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[JAMA发表论文]:饮食中胆固醇或鸡蛋消耗量与心血管病发病率及死亡率的相关性
2019年04月09日 时讯速递, 进展交流 暂无评论

Original Investigation|March 19, 2019

Associations of Dietary Cholesterol or Egg Consumption With Incident Cardiovascular Disease and Mortality

Victor W. Zhong, Linda Van Horn, Marilyn C. Cornelis, et al

JAMA. 2019;321(11):1081-1095. doi:10.1001/jama.2019.1572

Importance  背景

Cholesterol is a common nutrient in the human diet and eggs are a major source of dietary cholesterol. Whether dietary cholesterol or egg consumption is associated with cardiovascular disease (CVD) and mortality remains controversial.

胆固醇是人类饮食中常见的营养成分,鸡蛋是饮食中胆固醇的主要来源。饮食中胆固醇或鸡蛋消耗是否与心血管病(CVD)发生及死亡率相关尚不清楚。

Objective  目的

To determine the associations of dietary cholesterol or egg consumption with incident CVD and all-cause mortality.

确定饮食中胆固醇或鸡蛋消耗与CVD发病及全因死亡率的相关性。

Design, Setting, and Participants  设计、场景及研究对象

Individual participant data were pooled from 6 prospective US cohorts using data collected between March 25, 1985, and August 31, 2016. Self-reported diet data were harmonized using a standardized protocol.

从美国6项前瞻队列研究中收集1985年3月25日至2016年8月31日之间每位患者的数据。采用标准化方案总结自诉饮食数据。

Exposures  暴露因素

Dietary cholesterol (mg/day) or egg consumption (number/day).

饮食中胆固醇(mg/d)或鸡蛋消耗(每日数量)

Main Outcomes and Measures  主要研究结局指标

Hazard ratio (HR) and absolute risk difference (ARD) over the entire follow-up for incident CVD (composite of fatal and nonfatal coronary heart disease, stroke, heart failure, and other CVD deaths) and all-cause mortality, adjusting for demographic, socioeconomic, and behavioral factors.

在整个随访期间,根据人口统计学、社会经济及行为因素进行校正的CVD发病(致命性及非致命性冠心病、卒中、心功能衰竭及其他CVD死亡)及全因死亡率的风险比(HR)及绝对风险差异(ARD)。

Results  结果

This analysis included 29 615 participants (mean [SD] age, 51.6 [13.5] years at baseline) of whom 13 299 (44.9%) were men and 9204 (31.1%) were black. During a median follow-up of 17.5 years (interquartile range, 13.0-21.7; maximum, 31.3), there were 5400 incident CVD events and 6132 all-cause deaths. The associations of dietary cholesterol or egg consumption with incident CVD and all-cause mortality were monotonic (all P values for nonlinear terms, .19-.83). Each additional 300 mg of dietary cholesterol consumed per day was significantly associated with higher risk of incident CVD (adjusted HR, 1.17 [95% CI, 1.09-1.26]; adjusted ARD, 3.24% [95% CI, 1.39%-5.08%]) and all-cause mortality (adjusted HR, 1.18 [95% CI, 1.10-1.26]; adjusted ARD, 4.43% [95% CI, 2.51%-6.36%]). Each additional half an egg consumed per day was significantly associated with higher risk of incident CVD (adjusted HR, 1.06 [95% CI, 1.03-1.10]; adjusted ARD, 1.11% [95% CI, 0.32%-1.89%]) and all-cause mortality (adjusted HR, 1.08 [95% CI, 1.04-1.11]; adjusted ARD, 1.93% [95% CI, 1.10%-2.76%]). The associations between egg consumption and incident CVD (adjusted HR, 0.99 [95% CI, 0.93-1.05]; adjusted ARD, −0.47% [95% CI, −1.83% to 0.88%]) and all-cause mortality (adjusted HR, 1.03 [95% CI, 0.97-1.09]; adjusted ARD, 0.71% [95% CI, −0.85% to 2.28%]) were no longer significant after adjusting for dietary cholesterol consumption.

分析供纳入29 615名研究对象(平均 [SD]基线年龄, 51.6 [13.5]岁),其中13 299名 (44.9%) 为男性,9204名 (31.1%) 为黑人。中位随访时间17.5年(四分位区间13.0-21.7;最长随访时间,31.3)。随访期间,共有5400例CVD事件,6132例全因死亡。饮食中胆固醇或鸡蛋消耗与CVD发病及全因死亡率呈单调型相关(非线性相关所有P值,.19-.83)。每天饮食中每消耗300 mg胆固醇伴随CVD发病风险(校正HR, 1.17 [95% CI, 1.09-1.26]; 校正ARD, 3.24% [95% CI, 1.39%-5.08%])及全因死亡率(校正HR, 1.18 [95% CI, 1.10-1.26]; 校正ARD, 4.43% [95% CI, 2.51%-6.36%])显著增加。每天每消耗半个鸡蛋伴随CVD发病风险(校正HR, 1.06 [95% CI, 1.03-1.10]; 校正ARD, 1.11% [95% CI, 0.32%-1.89%])及全因死亡率(校正HR, 1.08 [95% CI, 1.04-1.11]; 校正ARD, 1.93% [95% CI, 1.10%-2.76%])显著增加。对饮食中胆固醇消耗进行校正后,鸡蛋消耗与CVD发病(校正HR, 0.99 [95% CI, 0.93-1.05]; 校正ARD, −0.47% [95% CI, −1.83% to 0.88%])及全因死亡率(校正HR, 1.03 [95% CI, 0.97-1.09]; 校正ARD, 0.71% [95% CI, −0.85% to 2.28%])不再具有显著相关性。

Conclusions and Relevance 结论与意义

Among US adults, higher consumption of dietary cholesterol or eggs was significantly associated with higher risk of incident CVD and all-cause mortality in a dose-response manner. These results should be considered in the development of dietary guidelines and updates.

在美国成年人中,饮食中胆固醇或鸡蛋消耗越高,伴随CVD发病及全因死亡风险越高,且呈剂量反应性。在制定及更新饮食指南时,应当考虑这些结果。

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