Long-Term Consumption of 10 Food Groups and Cardiovascular Mortality: A Systematic Review and Dose Response Meta-Analysis of Prospective Cohort Studies

Buna Bhandari; Zhixin Liu; Sophia Lin; Rona Macniven; Blessing Akombi-Inyang; John Hall; Xiaoqi Feng; Aletta E Schutte; Xiaoyue Xu

doi:10.1016/j.advnut.2022.10.010

Long-Term Consumption of 10 Food Groups and Cardiovascular Mortality: A Systematic Review and Dose Response Meta-Analysis of Prospective Cohort Studies

Adv Nutr. 2023 Jan;14(1):55-63. doi: 10.1016/j.advnut.2022.10.010. Epub 2022 Dec 22.

Authors

Buna Bhandari¹, Zhixin Liu², Sophia Lin³, Rona Macniven³, Blessing Akombi-Inyang³, John Hall⁴, Xiaoqi Feng³, Aletta E Schutte⁵, Xiaoyue Xu⁶

Affiliations

¹ School of Population Health, University of New South Wales, Sydney, Australia; Central Department of Public Health, Tribhuvan University Institute of Medicine, Kathmandu, Nepal; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA.
² Stats Central, University of New South Wales, Sydney, Australia.
³ School of Population Health, University of New South Wales, Sydney, Australia.
⁴ School of Population Health, University of New South Wales, Sydney, Australia; Ministry of Health, New South Wales, Sydney, Australia.
⁵ School of Population Health, University of New South Wales, Sydney, Australia; The George Institute for Global Health, Sydney, Australia.
⁶ School of Population Health, University of New South Wales, Sydney, Australia; The George Institute for Global Health, Sydney, Australia. Electronic address: luna.xu@unsw.edu.au.

Abstract

A large body of evidence exists on diet and cardiovascular mortality, but limited studies have investigated the long-term intake of food groups, which may have cumulative effects on cardiovascular health in the long term. This review therefore evaluated the relationship between the long-term consumption of 10 food groups and cardiovascular mortality. We conducted a systematic search in Medline, Embase, Scopus, CINAHL, and Web of Science till January 2022. Of the 5318 studies initially identified, 22 studies with a total of 70,273 participants with cardiovascular mortality were included. Summary HRs and 95% CIs were estimated using a random effects model. We found that a long-term high intake of whole grains (HR: 0.87; 95% CI: 0.80, 0.95; P = 0.001), fruits and vegetables (HR: 0.72; 95% CI: 0.61, 0.85; P < 0.0001), and nuts (HR: 0.73; 95% CI: 0.66, 0.81; P < 0.00001) significantly reduced cardiovascular mortality. Each 10-gram increase in whole grain consumption per day was associated with a 4% reduction in the risk of cardiovascular mortality, whereas each 10-gram increase in red/processed meat consumption per day was associated with a 1.8% increase in the risk of cardiovascular mortality. Compared with the lowest intake category, red/processed meat consumption in the highest category was associated with an increased risk of cardiovascular mortality (HR: 1.23; 95% CI: 1.09, 1.39; P = 0.006). High intake of dairy products (HR: 1.11; 95% CI: 0.92, 1.34; P = 0.28), and legumes (HR: 0.86; 95% CI: 0.53, 1.38; P = 0.53) were not associated with cardiovascular mortality. However, in the dose-response analysis, each 10-gram increase in legume intake per week was associated with a 0.5% reduction in cardiovascular mortality. We conclude that the long-term high intake of whole grains, vegetables, fruits, nuts, and a low intake of red/processed meat are associated with reduced cardiovascular mortality. More data on the long-term effects of legumes on cardiovascular mortality are encouraged. This study was registered at PROSPERO as CRD42020214679.

Keywords: cardiovascular mortality; diet; fruits; grains; legumes; meat; nutrition; nuts; vegetables.

Publication types

Systematic Review
Meta-Analysis
Review
Research Support, Non-U.S. Gov't

MeSH terms

Cardiovascular Diseases*
Diet / adverse effects
Fabaceae*
Fruit
Humans
Prospective Studies
Risk Factors
Vegetables