巧克力摄入量与心力衰竭发病风险的系统评价

Systematic review of chocolate intake and risk of heart failure

目的:探讨巧克力摄入量与心力衰竭(heart failure,HF)发病风险的关系,以确定巧克力摄入在预防HF方面的作用。方法:系统检索PubMed,Web of Science,Scopus,中国知网和万方数据库关于巧克力摄入量与心力衰竭发病风险关系的文献,检索截至2019年3月28日,纳入符合标准的文献研究。结果:最终纳入前瞻性试验研究5项,总样本量为106109例,结局心力衰竭事件4832例,Meta分析结果示:与未摄入巧克力组比较,低至中度摄入量巧克力(<7份/周)可以降低HF的发病风险(HR=0.86,95%CI:0.81~0.90);高摄入量组(≥7份/周)与HF的发病风险差异无统计学意义(HR=0.93,95%CI:0.81~1.06),研究结果稳定,不存在发表偏倚;对于剂量反应关系的Meta分析的结果提示:巧克力摄入量与HF发病风险存在非线性剂量反应关系(P for nonlinearity=0.004),与未摄入巧克力组比较,巧克力摄入量为1份/周与HF发病风险关系为HR=0.93,95%CI:0.88~0.97,3份/周与HF发病风险关系为HR=0.86,95%CI:0.78~0.95,7份/周与HF发病风险关系为HR=0.94,95%CI:0.85~1.03,10份/周与HF发病风险关系为HR=1.06,95%CI:0.93~1.24。结论:适量的巧克力的摄入可能与降低HF风险有关。

Objective:To explore the association between chocolate intake and risk of heart failure(HF)and determine the role of chocolate intake in the prevention of HF.Methods:A systematical search was conducted in PubMed,Web of Science,Scopus,CNKI and Wangfang database until March 28,2019,complemented with chocolate intake and risk of HF to identify clinical studies eligible for inclusion.Results:A total of 5 prospective studies with 106109 participants and 4832 HF cases were finally included.Meta-analysis showed that compared to no intake of chocolate,the pooled HRs(95%CIs)of HF were 0.86(0.81–0.90)for low-to-moderate intake(<7 servings/week)and 0.93(0.81–1.06)for high intake(≥7 servings/week).In dose-response Meta-analysis,we detected a curve linear relationship between chocolate intake and risk of HF(P for nonlinearity=0.004).Compared with non-consumption,the HRs(95%CIs)of HF across chocolate intake levels were 0.93(0.88–0.97),0.86(0.78–0.95),0.94(0.85–1.03),and 1.06(0.93–1.24)for 1,3,7,and 10 servings/week,respectively.Conclusion:Chocolate intake in moderation may be related with a reduced risk of HF.