尽管水果和蔬菜的消费已被证明与较低的死亡风险有关,癌症,和心血管疾病(CVD),中国关于该协会形式的数据有限。这项研究旨在量化水果水平之间的关系,蔬菜,和豆类消费有严重心血管疾病的风险,CVD死亡率,癌症发病率,癌症死亡率,和全因死亡率。
在基线调查中,参与者参加了来自12个省的115个(45个城市和70个农村)社区中的1个,以完成标准化问卷,并在2005年至2009年期间接受体检,随访至2017年(用于当前分析)。通过使用经过验证的食物频率问卷进行面对面访谈来评估饮食。临床结果由训练有素的医生使用标准化定义集中裁定。Cox脆弱模型用于探索水果之间的关联,蔬菜,和豆类消费的风险,CVD,和癌症死亡率。
共有41.243名参与者有资格纳入分析。水果的平均综合平均每日摄入量,蔬菜,豆类每天为2.97[标准偏差(SD)1.22]份。在8.9年的中位随访期间[四分位距(IQR)6.7-9.9年],我们记录了1893年的主要CVD,794个癌症事件,1324人死亡,411例CVD死亡和429例癌症死亡。在根据年龄调整的模型中,性别,和中心(随机效应),水果的总摄入量较高,蔬菜,豆类与CVD死亡率呈负相关,癌症发病率,癌症死亡率,和全因死亡率。在调整额外的协变量后,相关性明显减弱,只有与全因死亡率的相关性(风险比[HR]趋势0.92,95%CI0.86-0.98,p趋势=0.021)仍然显着。主要CVD趋势不显著(HR趋势1.02,95%CI0.97-1.08,p趋势=0.449),CVD死亡率(HR趋势0.94,95%CI0.84-1.06,p趋势=0.301),癌症发病率(HR趋势0.97,95%CI0.89-1.06,p趋势=0.540),或癌症死亡率(HR趋势0.92,95%CI0.82-1.04,p趋势=0.174)。与参照组相比,全因死亡的风险在每天摄入4至5份水果的情况下是最低的,蔬菜,和豆类(HR0.73,95%CI0.55-0.97),并且对于较高摄入量组没有显示进一步减少。分别,在完全校正模型中,水果摄入与较低的全因死亡率风险相关(HR趋势0.92,95%CI0.86~0.99,p趋势=0.020),豆类摄入与较低的主要CVD风险相关(HR趋势0.95,95%CI0.90~0.99,p趋势=0.028)和全因死亡率相关(HR趋势0.94,95%CI0.89~0.99,p趋势=0.020).
这项前瞻性研究表明,每天食用4至5份(相当于500-625克/天)水果的中国人,蔬菜,豆类死亡率最低,向公众传达了一个令人鼓舞的信息,那就是改变生活方式以增加水果,蔬菜,豆类摄入量可能对降低全因死亡率有更大的有益效果。
Although fruits and vegetable consumption has been shown to be associated with lower risks of mortality, cancers, and cardiovascular disease (CVD), there are limited data from China on the shape of the association. This
study aimed to quantify the relationship between levels of fruit, vegetable, and
legume consumption with the risk of major CVD, CVD mortality, cancer incidence, cancer mortality, and all-cause mortality.
In the baseline survey, participants attended 1 of 115 (45 urban and 70 rural) communities from 12 provinces to complete a standardized questionnaire, and undergo a physical examination between 2005 and 2009, and were followed up till 2017 (for the current analysis). Diet was assessed through in-person interviews by using validated food-frequency questionnaires. The clinical outcomes were adjudicated centrally by trained physicians using standardized definitions. Cox frailty models were used to explore the associations between fruit, vegetable, and
legume consumption with the risk of all-cause, CVD, and cancer mortality.
A total of 41 243 participants were eligible for inclusion in the analyses. The average combined average daily intake of fruit, vegetable, and
legume was 2.97 [standard deviation (SD) 1.22] servings per day. During a median follow-up of 8.9 years [interquartile range (IQR) 6.7-9.9 years], we recorded 1893 major CVDs, 794 cancer events, and 1324 deaths, with 411 CVD deaths and 429 cancer deaths. In the models adjusted for age, sex, and center (random effect), a higher total intake of fruit, vegetable, and legume was inversely associated with CVD mortality, cancer incidence, cancer mortality, and all-cause mortality. After adjusting for additional covariates, the associations were evidently attenuated and only the association with all-cause mortality (hazard ratio [HR] trend 0.92, 95% CI 0.86-0.98, p trend = 0.021) remained significant, with a non-significant trend for major CVD (HR trend 1.02, 95% CI 0.97-1.08, p trend = 0.449), CVD mortality (HR trend 0.94, 95% CI 0.84-1.06, p trend = 0.301), cancer incidence (HR trend 0.97, 95% CI 0.89-1.06, p trend = 0.540), or cancer mortality (HR trend 0.92, 95% CI 0.82-1.04, p trend = 0.174). Compared with the reference group, the risk of all-cause mortality was the lowest for four to five servings of total daily intake of fruit, vegetable, and legume (HR 0.73, 95% CI 0.55-0.97), and did not show a further decrease for the higher intake group. Separately, fruit intake was associated with a lower risk of all-cause mortality (HR trend 0.92, 95% CI 0.86-0.99, p trend = 0.020) and legume intake was associated with a lower risk of major CVD (HR trend 0.95, 95% CI 0.90-0.99, p trend = 0.028) and all-cause mortality (HR trend 0.94, 95% CI 0.89-0.99, p trend = 0.020) in the fully adjusted models.
This prospective
study suggests that Chinese people with daily consumption of four to five servings (equivalent to 500-625 g/day) of fruit, vegetable, and
legume demonstrated the lowest mortality, which conveys an encouraging message to the public that lifestyle modification to increase fruit, vegetable, and legume intakes may have greater beneficial effects on reducing all-cause mortality.