Associations of dietary patterns with the risk of all-cause, CVD and stroke mortality: a meta-analysis of prospective cohort studies

Abstract

Considerable controversy exists regarding the associations of dietary patterns with the risk of all-cause, CVD and stroke mortality. Therefore, a meta-analysis was conducted to elucidate the potential associations between dietary patterns and the risk of all-cause, CVD and stroke mortality. The PubMed database was searched for prospective cohort studies on the associations between dietary patterns and the risk of all-cause, CVD and stroke mortality published until February 2014. Random-effects models were used to calculate the summary relative risk estimates (SRRE) based on the highest v. the lowest category of dietary pattern scores. Stratified analyses were conducted based on sex, geographical region, follow-up duration, and adjustment/non-adjustment for energy intake. A total of thirteen prospective cohort studies involving 338 787 participants were included in the meta-analysis. There was evidence of inverse associations between the prudent/healthy dietary pattern and the risk of all-cause (SRRE ¼ 0·76, 95 % CI 0·68, 0·86) and CVD (SRRE ¼ 0·81, 95 % CI 0·75, 0·87) mortality and an absence of association between this dietary pattern and stroke mortality (SRRE ¼ 0·89, 95 % CI 0·77, 1·02). However, no significant associations were observed between the Western/unhealthy dietary pattern and the risk of all-cause (SRRE ¼ 1·07, 95 % CI 0·96, 1·20), CVD (SRRE ¼ 0·99, 95 % CI 0·91, 1·08) and stroke (SRRE ¼ 0·94, 95 % CI 0·81, 1·10) mortality. In conclusion, the findings provide evidence that greater adherence to a prudent/healthy dietary pattern is associated with a lower risk of all-cause and CVD mortality and not significantly associated with stroke mortality and that the Western/unhealthy dietary pattern is not associated with all-cause, CVD and stroke mortality. Further studies are required to confirm these findings.Key words: Dietary patterns: Mortality: All-cause mortality: Meta-analysisThe proportion of elderly people as well as the incidence of chronic diseases, such as CVD, is increasing globally. CVD remains a major public health problem and represents the leading cause of mortality, affecting millions of people in both developed and developing countries. Furthermore, it is estimated that deaths due to CVD and cancer will account for more than 50 % of total mortality cases in 2030 (1) . The incidence of CVD is rising at an alarming rate, especially among people aged $60 years, which will lead to a heavy social and economic toll worldwide (2) . Therefore, strategies to promote health and prevent deaths due to major chronic diseases, such as CVD and stroke, are required to be implemented. Dietary habits play an important role as determinants of health status. Nutrients and foods can never be eaten in isolation and have complex interactions, resulting in the masking of true associations (3) . In recent decades, the dietary pattern analysis has emerged as an alternative and complementary approach to examine the effects of overall diet on all-cause, CVD and stroke mortality instead of the assessment † Co...

Association of dietary patterns and risk of cardiovascular disease events in the MASHAD cohort study

“…The prudent dietary pattern described by Atkins et al (42) was characterised by a high consumption of poultry, fish, vegetables, legumes, fruits, pasta and rice and wholemeal bread, which is relatively similar to the 'Balanced' dietary pattern in the present study. Although recent studies have shown that a Western dietary pattern is significantly associated with an increased risk of CVD (7,14,39,40) , several previous studies have found no significant association between Western dietary pattern and cardiovascular events (12,41,43) . Previous studies evaluating the associations between major dietary patterns and CVD risk in Iran found similar categories of dietary patterns.…”

“…Several studies have reported that adherence to prudent dietary pattern was associated with significant decrease in CVD incidence (7,39,40) . The results of a review and meta-analysis study have indicated that a prudent/healthy dietary pattern was inversely associated with CVD mortality (41) . Lack of an association between Balanced dietary pattern, as a healthy pattern, and CVD events in the present study might be a result of the high consumption of red meat.…”

Dietary patterns and all-cause, cancer, and cardiovascular disease mortality in Japanese men and women: The Japan public health center-based prospective study

“…Our findings of the inverse associations between the prudent dietary pattern and all-cause and CVD mortality is in line with those of a meta-analysis that included 7 studies (6 in Western countries and 1 in Asia) for all-cause mortality and 6 studies (2 in Western countries and 4 in Asia) for CVD mortality, which reported 24% and 19% lower risk of all-cause and CVD mortality, respectively, among those in the highest category of the “prudent/healthy” dietary pattern (high intake of vegetables, fruits, fish, poultry, whole grains, and low-fat dairy products) compared to the lowest category [4]. In addition, Kumagai et al [5] found an inverse association for a dietary pattern characterized by high intake of soybean products, vegetables, seaweeds, potatoes, and fruit, with all-cause mortality among Japanese elderly (>65 years old).…”

“…This finding is inconsistent with the findings of previous studies. In the meta-analysis (in which 6 of 7 studies were conducted in Western countries) [4], the “Western/unhealthy” dietary pattern (high intake of processed and/or red meat, refined grains, sweets, desserts, eggs, and high-fat dairy products) was not associated with all-cause or CVD mortality. Of two Japanese studies, one showed an increased risk of CVD mortality associated with an “animal food” pattern (high intake of beef, pork, ham, sausage, chicken, liver, butter, coffee, and alcohol) [7].…”

“…For a priori dietary patterns, our study group recently reported that higher adherence to the Japanese Food Guide Spinning Top (balanced consumption of energy, grains, vegetables, fruits, meat, fish, eggs, soy products, and dairy products and limited consumption of confectionaries and alcoholic beverages), which was jointly developed by the Ministry of Health, Labour and Welfare and the Ministry of Agriculture, Forestry and Fisheries of Japan, was associated with decreased risk of mortality [3]. For a posteriori dietary patterns, the “prudent/healthy” dietary pattern, which is characterized by high intake of vegetables, fruits, fish, poultry, whole grains, and low-fat dairy products, has been associated with a decreased risk of all-cause and cardiovascular disease (CVD) mortality in a meta-analysis including 7 studies (6 in Western countries and 1 in Asia) for all-cause mortality and 6 studies (2 in Western countries and 4 in Asia) for CVD mortality [4]. However, it is not clear whether the distinctive dietary patterns of Japanese population is associated with mortality because only a few Japanese studies have examined the association of a posteriori dietary patterns with mortality from all causes (among the elderly) [5], CVD [6,7], and stomach cancer [8].…”