A Systematic Review of the Evidence Supporting a Causal Link Between Dietary Factors and Coronary Heart Disease

摘要: Background: Although a wealth of literature links dietaryfactorsandcoronaryheartdisease(CHD),thestrength oftheevidencesupportingvalidassociationshasnotbeen evaluated systematically in single investigation. Methods: We conducted systematic search MEDLINE for prospective cohort studies or randomized trials investigating dietary exposures relation to CHD. used the Bradford Hill guidelines derive causation score based on 4 criteria (strength, consistency, temporality, and coherence) each exposure examined consistency with findings trials. Results:Strongevidencesupportsvalidassociations(4criteriasatisfied)ofprotectivefactors,includingintakeofvegetables,nuts,and“Mediterranean”andhigh-qualitydietary patternswithCHD,andassociationsofharmfulfactors,includingintakeoftrans–fattyacidsandfoodswithahighglycemicindexorload.Amongstudiesofhighermethodologic quality,therewasalsostrongevidenceformonounsaturated fatty acids “prudent” “western” patterns. Moderateevidence(3criteria)ofassociationsexistsforintakeoffish,marine-3fattyacids,folate,wholegrains,dietary vitamins E C, beta carotene, alcohol, fruit, fiber. Insufficient evidence (2 criteria) association is present intake supplementary vitamin ascorbic acid (vitamin C); saturated polyunsaturated acids;totalfat;-linolenicacid;meat;eggs;andmilk.Among thedietaryexposureswithstrongevidenceofcausationfrom cohortstudies,onlyaMediterraneandietarypatternisrelated CHD Conclusions: The supports valid limited number factors patterns Future evaluation patterns, including their nutrient food components, recommended.