美国成人将近一半死于十种不良饮食习惯

　　2017年3月7日，《美国医学会杂志》发表波士顿塔夫茨大学弗里德曼营养科学政策学院、英国医学研究理事会、剑桥大学、纽约蒙特菲奥医学中心的研究报告，发现美国人将近一半死亡与不良饮食习惯有关。过多或过少摄入特定食物都可能引起心脏病、卒中、糖尿病患者死亡。

　　该研究对全国健康和营养体检调查（NHANES）的人口统计学（年龄、性别、种族、教育）、饮食习惯、特定疾病进行了分析。

　　2012年，美国成人共发生702308例心源性代谢性死亡，其中包括心脏病506100例（冠心病371266例、高血压性心脏病35019例、其他心血管疾病99815例）、卒中128294例（缺血16125例、出血32591例、其他79578例）、2型糖尿病67914例。

　　结果发现，45.4%的美国成人死亡与10种食物或营养素摄入过多或过少有相关性。其中：

  • 对人体有益但通常摄入过少的：坚果或种子、不饱和脂肪、海鲜ω-3脂肪、水果、蔬菜、全谷物。

  • 对人体无益但通常摄入过多的：钠、经过加工的肉类、未经加工的红肉、含糖饮料。

　　该研究对特定食物或营养素及其风险或益处提供了详细信息。挑选这10种食物和营养素是因为既往研究发现其与死亡原因相关。例如，某些研究表明，钠盐过量可以增加血压，给动脉和心脏带来风险；坚果含有可以提高高密度脂蛋白胆固醇水平的健康脂肪；培根和其他加工肉类含有饱和脂肪，增加不健康的低密度脂蛋白胆固醇水平。

　　在研究中，钠盐摄入量多是最大问题，与9.5%的心源性代谢性死亡有相关性。坚果或种子摄入量少、经过加工的肉类摄入量多、海鲜ω-3脂肪摄入量少、蔬菜摄入量少、水果摄入量少、含糖饮料摄入量多，分别与8.5%、8.2%、7.8%、7.6%、7.5%、7.4%的心源性代谢性死亡有相关性。

　　根据美国政府指南、营养专家建议、既往研究发现有益或有害食物和营养素的摄入量，该研究建议10种食物或营养素的摄入量如下：

有益食物或营养素

  • 水果：每天300克

  • 蔬菜：每天400克

  • 坚果或种子：每天20.2克

  • 全谷物：每天125克

  • 多不饱和脂肪：大多数植物油，取代碳水化合物或饱和脂肪每天摄入热量的11%

  • 海鲜ω-3脂肪：每天250毫克

有害的食物或营养素

  • 未经加工的红肉：每天14.3克

  • 经过加工的肉类：不推荐

  • 含糖饮料：不推荐

  • 盐：每天2克

　　对此，约翰霍普金斯大学的预防医学、流行病学、临床研究中心、公共卫生和内科学家发表同期评论：将死亡归因于饮食的精确计数！

　　如果增加摄入不同食物，增加有益营养素或减少有害营养素，可以避免很多死亡。美国人普遍吃了太少的好食物，包括坚果、种子、富含ω-3脂肪的海鲜（包括鲑鱼、沙丁鱼）、水果、蔬菜、全谷物。相反，美国人吃了太多的坏食物，包括钠盐和过咸的食物、加工肉类（包括培根）、意大利式腊肠、热狗、红肉（包括牛排、汉堡肉）、含糖饮料。如果增加坚果和种子的摄入量，如果减少加工食物里钠的摄入量（这占钠摄入量的80%），可以看到心脏代谢改善，包括减少心脏代谢疾病所致死亡。针对不健康饮食的公共卫生政策，可能有助于防止一些死亡。不过，该流行病学研究尚不能确定某些饮食是否直接致命。

JAMA. 2017 Mar 7;317(9):912-924.

Association Between Dietary Factors and Mortality From Heart Disease, Stroke, and Type 2 Diabetes in the United States.

Micha R, Penalvo JL, Cudhea F, Imamura F, Rehm CD, Mozaffarian D.

Tufts Friedman School of Nutrition Science and Policy, Boston, Massachusetts; MRC Epidemiology Unit, University of Cambridge, Cambridge, England; Office of Community and Population Health, Montefiore Medical Center, Bronx, New York.

This nutritional epidemiology study uses NHANES data to estimate associations between dietary components and mortality due to heart disease, stroke, and type 2 diabetes among US adults between 2002 and 2012.

IMPORTANCE: In the United States, national associations of individual dietary factors with specific cardiometabolic diseases are not well established.

OBJECTIVE: To estimate associations of intake of 10 specific dietary factors with mortality due to heart disease, stroke, and type 2 diabetes (cardiometabolic mortality) among US adults.

DESIGN, SETTING, AND PARTICIPANTS: A comparative risk assessment model incorporated data and corresponding uncertainty on population demographics and dietary habits from National Health and Nutrition Examination Surveys (1999-2002: n=8104; 2009-2012: n=8516); estimated associations of diet and disease from meta-analyses of prospective studies and clinical trials with validity analyses to assess potential bias; and estimated disease-specific national mortality from the National Center for Health Statistics.

EXPOSURES: Consumption of 10 foods/nutrients associated with cardiometabolic diseases: fruits, vegetables, nuts/seeds, whole grains, unprocessed red meats, processed meats, sugar-sweetened beverages (SSBs), polyunsaturated fats, seafood omega-3 fats, and sodium.

MAIN OUTCOMES AND MEASURES: Estimated absolute and percentage mortality due to heart disease, stroke, and type 2 diabetes in 2012. Disease-specific and demographic-specific (age, sex, race, and education) mortality and trends between 2002 and 2012 were also evaluated.

RESULTS: In 2012, 702308 cardiometabolic deaths occurred in US adults, including 506100 from heart disease (371266 coronary heart disease, 35019 hypertensive heart disease, and 99815 other cardiovascular disease), 128294 from stroke (16125 ischemic, 32591 hemorrhagic, and 79578 other), and 67914 from type 2 diabetes. Of these, an estimated 318656 (95% uncertainty interval [UI], 306064-329755; 45.4%) cardiometabolic deaths per year were associated with suboptimal intakes-48.6% (95% UI, 46.2%-50.9%) of cardiometabolic deaths in men and 41.8% (95% UI, 39.3%-44.2%) in women; 64.2% (95% UI, 60.6%-67.9%) at younger ages (25-34 years) and 35.7% (95% UI, 33.1%-38.1%) at older ages (≥75 years); 53.1% (95% UI, 51.6%-54.8%) among blacks, 50.0% (95% UI, 48.2%-51.8%) among Hispanics, and 42.8% (95% UI, 40.9%-44.5%) among whites; and 46.8% (95% UI, 44.9%-48.7%) among lower-, 45.7% (95% UI, 44.2%-47.4%) among medium-, and 39.1% (95% UI, 37.2%-41.2%) among higher-educated individuals. The largest numbers of estimated diet-related cardiometabolic deaths were related to high sodium (66508 deaths in 2012; 9.5% of all cardiometabolic deaths), low nuts/seeds (59374; 8.5%), high processed meats (57766; 8.2%), low seafood omega-3 fats (54626; 7.8%), low vegetables (53410; 7.6%), low fruits (52547; 7.5%), and high SSBs (51694; 7.4%). Between 2002 and 2012, population-adjusted US cardiometabolic deaths per year decreased by 26.5%. The greatest decline was associated with insufficient polyunsaturated fats (-20.8% relative change [95% UI, -18.5% to -22.8%]), nuts/seeds (-18.0% [95% UI, -14.6% to -21.0%]), and excess SSBs (-14.5% [95% UI, -12.0% to -16.9%]). The greatest increase was associated with unprocessed red meats (+14.4% [95% UI, 9.1%-19.5%]).

CONCLUSIONS AND RELEVANCE: Dietary factors were estimated to be associated with a substantial proportion of deaths from heart disease, stroke, and type 2 diabetes. These results should help identify priorities, guide public health planning, and inform strategies to alter dietary habits and improve health.

PMID: 28267855

DOI: 10.1001/jama.2017.0947

JAMA. 2017 Mar 7;317(9):908-909.

Attributing Death to Diet: Precision Counts.

Mueller NT, Appel LJ.

Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland.

A substantial body of evidence has implicated several aspects of diet with the occurrence of cardiometabolic disease (CMD)—heart disease, stroke, and type 2 diabetes. Dietary factors studied have included individual nutrients (macronutrients, micronutrients, minerals, vitamins, electrolytes, and phytochemicals), foods, and overall dietary patterns. It is generally accepted that a suboptimal diet is causally related to CMD, but scientists debate which factors are responsible and the relative importance of each factor given the challenges of isolating and estimating the potential effects of individual nutrients and foods, especially in observational studies. Another topic that is receiving considerably more attention is estimating the fraction of preventable deaths due to suboptimal diet and other factors. Policy makers, in particular, are eager to understand the total burden of CMD that may be attributable to suboptimal diet, given that modification of diet is a cornerstone of prevention policy.

PMID: 28267836

DOI: 10.1001/jama.2017.0946

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