| Autor: |
Zurbau A; Department of Nutritional Sciences Faculty of Medicine University of Toronto Ontario Canada.; Clinical Nutrition and Risk Factor Modification Center St. Michael's Hospital Toronto Ontario Canada.; Toronto 3D Knowledge Synthesis and Clinical Trial Unit Toronto Ontario Canada., Au-Yeung F; Department of Nutritional Sciences Faculty of Medicine University of Toronto Ontario Canada.; Clinical Nutrition and Risk Factor Modification Center St. Michael's Hospital Toronto Ontario Canada.; Toronto 3D Knowledge Synthesis and Clinical Trial Unit Toronto Ontario Canada., Blanco Mejia S; Department of Nutritional Sciences Faculty of Medicine University of Toronto Ontario Canada.; Clinical Nutrition and Risk Factor Modification Center St. Michael's Hospital Toronto Ontario Canada.; Toronto 3D Knowledge Synthesis and Clinical Trial Unit Toronto Ontario Canada., Khan TA; Department of Nutritional Sciences Faculty of Medicine University of Toronto Ontario Canada.; Toronto 3D Knowledge Synthesis and Clinical Trial Unit Toronto Ontario Canada., Vuksan V; Department of Nutritional Sciences Faculty of Medicine University of Toronto Ontario Canada.; Clinical Nutrition and Risk Factor Modification Center St. Michael's Hospital Toronto Ontario Canada.; Li Ka Shing Knowledge Institute St. Michael's Hospital Toronto Ontario Canada.; Division of Endocrinology and Metabolism St. Michael's Hospital Toronto Ontario Canada., Jovanovski E; Department of Nutritional Sciences Faculty of Medicine University of Toronto Ontario Canada.; Clinical Nutrition and Risk Factor Modification Center St. Michael's Hospital Toronto Ontario Canada., Leiter LA; Department of Nutritional Sciences Faculty of Medicine University of Toronto Ontario Canada.; Clinical Nutrition and Risk Factor Modification Center St. Michael's Hospital Toronto Ontario Canada.; Toronto 3D Knowledge Synthesis and Clinical Trial Unit Toronto Ontario Canada.; Li Ka Shing Knowledge Institute St. Michael's Hospital Toronto Ontario Canada.; Division of Endocrinology and Metabolism St. Michael's Hospital Toronto Ontario Canada.; Department of Medicine, Faculty of Medicine University of Toronto Ontario Canada., Kendall CWC; Department of Nutritional Sciences Faculty of Medicine University of Toronto Ontario Canada.; Clinical Nutrition and Risk Factor Modification Center St. Michael's Hospital Toronto Ontario Canada.; Toronto 3D Knowledge Synthesis and Clinical Trial Unit Toronto Ontario Canada.; College of Pharmacy and Nutrition University of Saskatchewan Saskatoon Saskatchewan Canada., Jenkins DJA; Department of Nutritional Sciences Faculty of Medicine University of Toronto Ontario Canada.; Clinical Nutrition and Risk Factor Modification Center St. Michael's Hospital Toronto Ontario Canada.; Toronto 3D Knowledge Synthesis and Clinical Trial Unit Toronto Ontario Canada.; Li Ka Shing Knowledge Institute St. Michael's Hospital Toronto Ontario Canada.; Division of Endocrinology and Metabolism St. Michael's Hospital Toronto Ontario Canada., Sievenpiper JL; Department of Nutritional Sciences Faculty of Medicine University of Toronto Ontario Canada.; Clinical Nutrition and Risk Factor Modification Center St. Michael's Hospital Toronto Ontario Canada.; Toronto 3D Knowledge Synthesis and Clinical Trial Unit Toronto Ontario Canada.; Li Ka Shing Knowledge Institute St. Michael's Hospital Toronto Ontario Canada.; Division of Endocrinology and Metabolism St. Michael's Hospital Toronto Ontario Canada. |
| Abstrakt: |
Background Public health policies reflect concerns that certain fruit sources may not have the intended benefits and that vegetables should be preferred to fruit. We assessed the relation of fruit and vegetable sources with cardiovascular outcomes using a systematic review and meta-analysis of prospective cohort studies. Methods and Results MEDLINE, EMBASE, and Cochrane were searched through June 3, 2019. Two independent reviewers extracted data and assessed study quality (Newcastle-Ottawa Scale). Data were pooled (fixed effects), and heterogeneity (Cochrane-Q and I 2 ) and certainty of the evidence (Grading of Recommendations Assessment, Development, and Evaluation) were assessed. Eighty-one cohorts involving 4 031 896 individuals and 125 112 cardiovascular events were included. Total fruit and vegetables, fruit, and vegetables were associated with decreased cardiovascular disease (risk ratio, 0.93 [95% CI, 0.89-0.96]; 0.91 [0.88-0.95]; and 0.94 [0.90-0.97], respectively), coronary heart disease (0.88 [0.83-0.92]; 0.88 [0.84-0.92]; and 0.92 [0.87-0.96], respectively), and stroke (0.82 [0.77-0.88], 0.82 [0.79-0.85]; and 0.88 [0.83-0.93], respectively) incidence. Total fruit and vegetables, fruit, and vegetables were associated with decreased cardiovascular disease (0.89 [0.85-0.93]; 0.88 [0.86-0.91]; and 0.87 [0.85-0.90], respectively), coronary heart disease (0.81 [0.72-0.92]; 0.86 [0.82-0.90]; and 0.86 [0.83-0.89], respectively), and stroke (0.73 [0.65-0.81]; 0.87 [0.84-0.91]; and 0.94 [0.90-0.99], respectively) mortality. There were greater benefits for citrus, 100% fruit juice, and pommes among fruit sources and allium, carrots, cruciferous, and green leafy among vegetable sources. No sources showed an adverse association. The certainty of the evidence was "very low" to "moderate," with the highest for total fruit and/or vegetables, pommes fruit, and green leafy vegetables. Conclusions Fruits and vegetables are associated with cardiovascular benefit, with some sources associated with greater benefit and none showing an adverse association. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03394339. |
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