BMJ|超加工食品会增加心血管疾病风险?

           

BMJ|超加工食品会增加心血管疾病风险?

心血管疾病(CVD)是全球死亡的主要原因,占全球死亡总数的三分之一。在CVD的发生和预防过程中,饮食的作用至关重要。除了戒烟,保持饮食的平衡多样化(经常食用水果、蔬菜、鱼、和全谷物食品,以及限制钠、饱和脂肪,和精制碳水化合物),避免过度饮酒,和进行有规律的体育锻炼是公认的预防心血管疾病的关键因素。

法国一项基于人群的营养与健康队列研究为评估食用超加工食品与心血管疾病风险之间的潜在关联,纳入了105159名年龄不小于18岁的参与者,通过重复的24小时饮食记录(平均每位参与者5.7次)收集膳食摄入量,记录参与者通常食用的3300种食物,并将这些食品根据加工程度采用NOVA分类。


  在5.2年的中位随访时间里,可以看出摄入超加工食品与总体心血管疾病风险较高相关。在1409例研究对象中,食物中超加工食物比例明显增加10%的风险比为1.12(95%置信区间为1.05至1.20);P<0.001, 518 208人年,高消费超加工食品(第四季度)277人/ 10万人年,低消费(第一季度)242人/ 10万人年。

  冠心病风险评估:共665例; 危险比1.13(1.02至1.24); P=0.02, 520 319人年,在高消费人群和低消费人群中发病率分别为124和109 每10万人年,脑血管疾病风险评估:共829例; 危险比1.11(1.01至1.21); P=0.02, 520 023人年,在高消费和低消费人群中发病率分别为163和144每10万人年。这些结果在调整了饮食营养质量的几个指标(饱和脂肪酸、钠和糖的摄入量、膳食纤维,或通过主成分分析得出的健康饮食模式)并进行了一系列敏感性分析之后,仍然具有统计学意义。


  在这一大型前瞻性观察研究中,食用更多的超加工食品与更高的心血管、冠心病和脑血管疾病风险相关。这些结果需要在其他人群和环境中得到证实,因果关系仍有待确定。加工过程中的各种因素,如最终产品的营养成分、添加剂、接触材料和新形成的污染物,都可能在这些关联中发挥作用,需要进一步的研究来更好地理解它们。与此同时,几个国家的公共卫生当局最近开始推广未经加工或最低限度加工的食品,并建议限制超加工食品的消费。

摘要原文

Objective 

To assess the prospective associations between consumption of ultra-processed foods and risk of cardiovascular diseases.


Design 

Population based cohort study.


Setting 

NutriNet-Santé cohort, France 2009-18.


Participants 

105 159 participants aged at least 18 years. Dietary intakes were collected using repeated 24 hour dietary records (5.7 for each participant on average), designed to register participants’ usual consumption of 3300 food items. These foods were categorised using the NOVA classification according to degree of processing.


Main outcome measures 

Associations between intake of ultra-processed food and overall risk of cardiovascular, coronary heart, and cerebrovascular diseases assessed by multivariable Cox proportional hazard models adjusted for known risk factors.


Results 

During a median follow-up of 5.2 years, intake of ultra-processed food was associated with a higher risk of overall cardiovascular disease (1409 cases; hazard ratio for an absolute increment of 10 in the percentage of ultra-processed foods in the diet 1.12 (95% confidence interval 1.05 to 1.20); P<0.001, 518 208 person years, incidence rates in high consumers of ultra-processed foods (fourth quarter) 277 per 100 000 person years, and in low consumers (first quarter) 242 per 100 000 person years), coronary heart disease risk (665 cases; hazard ratio 1.13 (1.02 to 1.24); P=0.02, 520 319 person years, incidence rates 124 and 109 per 100 000 person years, in the high and low consumers, respectively), and cerebrovascular disease risk (829 cases; hazard ratio 1.11 (1.01 to 1.21); P=0.02, 520 023 person years, incidence rates 163 and 144 per 100 000 person years, in high and low consumers, respectively). These results remained statistically significant after adjustment for several markers of the nutritional quality of the diet (saturated fatty acids, sodium and sugar intakes, dietary fibre, or a healthy dietary pattern derived by principal component analysis) and after a large range of sensitivity analyses.


Conclusions 

In this large observational prospective study, higher consumption of ultra-processed foods was associated with higher risks of cardiovascular, coronary heart, and cerebrovascular diseases. These results need to be confirmed in other populations and settings, and causality remains to be established. Various factors in processing, such as nutritional composition of the final product, additives, contact materials, and neoformed contaminants might play a role in these associations, and further studies are needed to understand better the relative contributions. Meanwhile, public health authorities in several countries have recently started to promote unprocessed or minimally processed foods and to recommend limiting the consumption of ultra-processed foods.

参考文献

SROUR B, FEZEU L K, KESSE-GUYOT E, et al. Ultra-processed food intake and risk of cardiovascular disease: prospective cohort study (NutriNet-Santé)[J]. BMJ, 2019:l1451.

文字:Janine

编辑:Terrell



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