Carbohydrate quality and human health: a series of systematic reviews and meta-analyses

医学 荟萃分析 系统回顾 系列(地层学) 梅德林 内科学 生物 生物化学 古生物学
作者
Andrew Reynolds,Jim Mann,John Cummings,Nicola Winter,Evelyn Mete,Lisa Te Morenga
出处
期刊:The Lancet [Elsevier]
卷期号:393 (10170): 434-445 被引量:1181
标识
DOI:10.1016/s0140-6736(18)31809-9
摘要

Summary

Background

Previous systematic reviews and meta-analyses explaining the relationship between carbohydrate quality and health have usually examined a single marker and a limited number of clinical outcomes. We aimed to more precisely quantify the predictive potential of several markers, to determine which markers are most useful, and to establish an evidence base for quantitative recommendations for intakes of dietary fibre.

Methods

We did a series of systematic reviews and meta-analyses of prospective studies published from database inception to April 30, 2017, and randomised controlled trials published from database inception to Feb 28, 2018, which reported on indicators of carbohydrate quality and non-communicable disease incidence, mortality, and risk factors. Studies were identified by searches in PubMed, Ovid MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials, and by hand searching of previous publications. We excluded prospective studies and trials reporting on participants with a chronic disease, and weight loss trials or trials involving supplements. Searches, data extraction, and bias assessment were duplicated independently. Robustness of pooled estimates from random-effects models was considered with sensitivity analyses, meta-regression, dose-response testing, and subgroup analyses. The GRADE approach was used to assess quality of evidence.

Findings

Just under 135 million person-years of data from 185 prospective studies and 58 clinical trials with 4635 adult participants were included in the analyses. Observational data suggest a 15–30% decrease in all-cause and cardiovascular related mortality, and incidence of coronary heart disease, stroke incidence and mortality, type 2 diabetes, and colorectal cancer when comparing the highest dietary fibre consumers with the lowest consumers Clinical trials show significantly lower bodyweight, systolic blood pressure, and total cholesterol when comparing higher with lower intakes of dietary fibre. Risk reduction associated with a range of critical outcomes was greatest when daily intake of dietary fibre was between 25 g and 29 g. Dose-response curves suggested that higher intakes of dietary fibre could confer even greater benefit to protect against cardiovascular diseases, type 2 diabetes, and colorectal and breast cancer. Similar findings for whole grain intake were observed. Smaller or no risk reductions were found with the observational data when comparing the effects of diets characterised by low rather than higher glycaemic index or load. The certainty of evidence for relationships between carbohydrate quality and critical outcomes was graded as moderate for dietary fibre, low to moderate for whole grains, and low to very low for dietary glycaemic index and glycaemic load. Data relating to other dietary exposures are scarce.

Interpretation

Findings from prospective studies and clinical trials associated with relatively high intakes of dietary fibre and whole grains were complementary, and striking dose-response evidence indicates that the relationships to several non-communicable diseases could be causal. Implementation of recommendations to increase dietary fibre intake and to replace refined grains with whole grains is expected to benefit human health. A major strength of the study was the ability to examine key indicators of carbohydrate quality in relation to a range of non-communicable disease outcomes from cohort studies and randomised trials in a single study. Our findings are limited to risk reduction in the population at large rather than those with chronic disease.

Funding

Health Research Council of New Zealand, WHO, Riddet Centre of Research Excellence, Healthier Lives National Science Challenge, University of Otago, and the Otago Southland Diabetes Research Trust.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
大幅提高文件上传限制,最高150M (2024-4-1)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
诗剑逍遥完成签到,获得积分10
1秒前
cocolu应助无情黑米采纳,获得10
1秒前
手机应助矢思然采纳,获得10
1秒前
2秒前
小琥同学完成签到,获得积分10
2秒前
sukai发布了新的文献求助10
3秒前
猫南北完成签到,获得积分20
3秒前
dd完成签到,获得积分10
5秒前
6秒前
高山我梦发布了新的文献求助10
7秒前
善学以致用应助小琥同学采纳,获得10
7秒前
隐形曼青应助优秀笑寒采纳,获得10
7秒前
Orange应助张张采纳,获得10
10秒前
10秒前
wwc发布了新的文献求助10
11秒前
手机应助矢思然采纳,获得10
12秒前
zoeydonut发布了新的文献求助30
13秒前
14秒前
19秒前
Kitty发布了新的文献求助10
20秒前
21秒前
zoeydonut完成签到,获得积分20
21秒前
执念发布了新的文献求助10
23秒前
23秒前
科研通AI2S应助林夕君采纳,获得10
23秒前
张张发布了新的文献求助10
24秒前
研友_闾丘枫完成签到,获得积分10
28秒前
JJ完成签到,获得积分10
29秒前
32秒前
学阀小智发布了新的文献求助10
33秒前
BLYY完成签到,获得积分10
34秒前
wan发布了新的文献求助10
36秒前
猫南北发布了新的文献求助10
37秒前
37秒前
38秒前
林夕君完成签到,获得积分10
41秒前
42秒前
43秒前
哈哈完成签到,获得积分10
45秒前
陆陆发布了新的文献求助10
46秒前
高分求助中
Mantiden: Faszinierende Lauerjäger Faszinierende Lauerjäger Heßler, Claudia, Rud 1000
PraxisRatgeber: Mantiden: Faszinierende Lauerjäger 1000
Natural History of Mantodea 螳螂的自然史 1000
A Photographic Guide to Mantis of China 常见螳螂野外识别手册 800
Autoregulatory progressive resistance exercise: linear versus a velocity-based flexible model 500
Spatial Political Economy: Uneven Development and the Production of Nature in Chile 400
Research on managing groups and teams 300
热门求助领域 (近24小时)
化学 医学 生物 材料科学 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 基因 遗传学 物理化学 催化作用 细胞生物学 免疫学 冶金
热门帖子
关注 科研通微信公众号,转发送积分 3329591
求助须知:如何正确求助?哪些是违规求助? 2959170
关于积分的说明 8594608
捐赠科研通 2637675
什么是DOI,文献DOI怎么找? 1443672
科研通“疑难数据库(出版商)”最低求助积分说明 668807
邀请新用户注册赠送积分活动 656231