三种健康膳食模式与认知障碍类疾病发生风险关联的Meta分析

Association between adherence to three healthy dietary patterns and risk of cognitive disorders:Meta-analysis

目的采用Meta分析的方法探讨地中海饮食(Mediterranean dietary pattern,MED)、高血压干预膳食模式(dietary approaches to stop hypertension,DASH)、地中海-DASH干预神经退行性病变的饮食(Mediterranean-DASH intervention for neurodegenerative delay,MIND)与认知障碍类疾病发生风险之间的关联。方法采取标题/摘要相结合的检索策略,从PubMed、万方、中国知网、维普数据库中检索中英文文献中有关MED、DASH、MIND膳食模式和认知障碍类疾病发生风险的前瞻性队列研究,检索时限从建库至2022年2月28日,纳入15项符合纳入排除标准的前瞻性队列研究,涵盖124977名研究对象。提取相对危险度和95%CI,计算合并效应值和剂量-反应关系,利用Q检验和I-2计算统计学异质性,通过漏斗图、Begg’s检验和Egger’s检验分析发表偏倚。结果与依从性最低组相比,MED、DASH和MIND依从性最高的人群罹患认知障碍类疾病的风险分别为0.84(95%CI 0.84-0.97)、0.79(95%CI 0.79-1.00)和0.48(95%CI 0.48-0.71)。根据认知障碍类疾病病程进行亚组分析发现,MED、DASH依从性最高的人群发生轻度认知障碍的风险分别为0.76(95%CI 0.65-0.90)、0.63(95%CI 0.48-0.82);未发现MED、DASH与痴呆的关联。按不同地区、MED膳食模式评分方法、膳食调查方法、研究样本量、随访时间对MED研究进行亚组分析,结果与合并结果存在不一致情况,且部分亚组异质性降低。结论依从MED、DASH、MIND模式与较低的认知障碍类疾病风险有关。其中,MED、DASH与轻度认知障碍风险降低有关,与痴呆风险无显著关联。

OBJECTIVE To investigate the association between adherence to healthy dietary patterns, such as Mediterranean dietary pattern(MED), dietary approaches to stop hypertension(DASH), Mediterranean-DASH intervention for neurodegenerative delay with cognitive disorders(MIND), and the incidence of cognitive disorders.METHODS Prospective studies on the association of MED, DASH and MIND with cognitive disorders in Chinese and English literatures were retrieved from PubMed, Wanfang, CNKI and VIP databases by title/abstract retrieval strategy from database establishment to February 28, 2022. Relative risk and its 95% confidence intervals were extracted to calculated the pooled effect and dose-response relationship. Heterogeneity was calculated by using Q test and I-2, and publication bias were analyzed by funnel plot, Begg’s test and Egger’s test.RESULTS Totally, 124 977 participants and 15 studies about the relationship between healthy dietary patterns and cognitive impairment diseases were included in this study. Compared with the lower adherence group, the relative risks of cognitive disorders were 0.84(95%CI 0.84-0.97) for participants with higher adherence to MED, 0.79(95%CI 0.79-1.00) for participants with higher adherence to DASH, 0.48(95%CI 0.32-0.71) for participants with higher adherence to MIND, respectively. Subgroup analysis showed that the risk of mild cognitive impairment was 0.76(95%CI 0.65-0.90) for participants with higher adherence to MED, and 0.63(95%CI 0.48-0.82) for DASH. No significant association were observed in the relationship of MED, DASH with dementia. Different scoring method for dietary patterns, dietary survey method, study area, follow-up time and sample size might be the main sources of heterogeneity.CONCLUSION Higher adherence to MED, DASH and MIND were associated with lower risk of cognitive disorders. MED and DASH were associated with a reduced risk of mild cognitive impairment rather than dementia.