高脂饮食与儿童哮喘或反复喘息关联性的系统评价和Meta分析

The association between high fat diet and asthma or recurrent wheezing in children:a systematic review and meta-analysis

目的探讨高脂饮食与儿童哮喘或反复喘息的关联性。方法纳入研究对象为基于社区、学校和医疗机构的儿童,暴露因素为高脂饮食,观察与哮喘和反复喘息结局相关性的横断面研究和队列研究。计算机检索PubMed、Embase、Clinical trials、Central、Web of Science数据库、维普数据库、万方数据库和中国知网,检索截止日期为2018年4月1日。对纳入的文献行文献筛选、资料提取及方法学质量评价,横断面研究采用AHRQ评价工具,队列研究采用NOS评价工具。应用stata软件行Meta分析。结果 12篇观察性研究(n=17 622)进入本文分析,年龄3～17岁。9篇为横断面研究(AHRQ评分5篇8分,3篇7分,1篇6分),3篇为队列研究(NOS评分2篇8分,1篇7分)。(1)儿童哮喘风险高脂较非高脂饮食人群高78%[敏感性分析后OR=1.78 (95%CI:1.44～2.21),P<0.001],儿童哮喘与西方化的饮食习惯(OR=1.79,95%CI:1.28～2.51)、单一高脂食物(OR=1.86,95%:1.26～2.68)密切相关。(2)儿童反复喘息风险高脂饮食较非高脂饮食人群高33%[敏感性分析后OR=1.33 (95%CI:1.16～1.51),P<0.001]。Egger回归提示纳入文献不存在发表偏倚。结论高脂饮食与儿童哮喘和反复喘息密切联系。

Objective To systematically review the association between high fat diet(HFD)and asthma or recurrent wheezing in children.Methods The inclusion participants were from communities,schools or medical institutions with the exposure factor of the high fat diet(HFD).Observational studies(cross-sectional and cohort studies)assessing the outcome of asthma or recurrent wheezing were included.The databases of PubMed,Embase,Clinical trials,Central,Web of Science,VIP,Wanfang Data and CNKI up to April 1,2018 were searched for the relevant studies.Two authors performed the literature screening,data extraction and methodological quality evaluation.Using the Newcastle-Ottawa Scale(NOS)for cohort study and Agency for Healthcare Research and Quality(AHRQ)for cross-sectional study.The meta-analysis was conducted by the Stata 12.0 software.Results The final 12 observational studies with 17 622 participants,ranging from 3 to 17 years old,were included.The included studies contained 9 cross-sectional studies(5 articles in 8 points,3 articles in 7 points and 1 article in 6 points with AHRQ)and 3 cohort studies(2 articles in 8 points and 1 article in 7 points with NOS).①The risk of pediatric asthma with HFD was significantly 78%higher than non-HFD(OR=1.78,95%CI:1.44-2.21,P<0.001,adjusted by sensitivity analysis).Pediatric asthma had a significant association with the dietary pattern of western diet(OR=1.79,95%CI:1.28-2.51),and with the individual high-fat foods(OR=1.86,95%CI:1.26-2.68).②The risk of recurrent wheezing with HFD in children was significantly 33%higher than non-HFD(OR=1.33,95%CI:1.16~1.51,P<0.001,adjusted by sensitivity analysis).The test of publication bias using Egger's regression method showed the absence of publication bias in included studies.Conclusion The HFD was significantly associated with asthma and recurrent wheezing in children.