Association between substituting macronutrients and all-cause mortality: a network meta-analysis of prospective observational studies

作者：Sabina Wallerer, Theodoros Papakonstantinou, Jakub Morze, Julia Stadelmaier, Eva Kiesswetter, Lea Gorenflo, Janett Barbaresko, Edyta Szczerba, Manuela Neuenschwander, William R. Bell, Tilman Kühn, Szimonetta Lohner, Marta Guasch‐Ferré, Georg F. Hoffmann, Joerg J Meerpohl, Sabrina Schlesinger, Adriani Nikolakopoulou, Lukas Schwingshackl · 发表于：EClinicalMedicine · 年份：2024 · DOI：10.1016/j.eclinm.2024.102807 · 被引用次数：14 · 研究领域：Nutritional Studies and Diet、Agriculture Sustainability and Environmental Impact、Diet and metabolism studies

Background Suboptimal diet quality is a key risk factor for premature death. Assuming relatively stable energy intake among individuals, changes in nutrient intakes occur by exchanging different nutrients. Therefore we aimed to examine the association of isocaloric substitution of dietary (macro)nutrients with all-cause mortality using network meta-analysis (NMA). Methods For this systematic review and NMA of prospective observational studies MEDLINE, Embase, and Scopus were searched from inception to February 13th, 2024. Eligible studies reported substitution analyses for quantity and/or quality of macronutrients, including carbohydrates, proteins, and fatty acids on all-cause mortality. Random-effects NMA were used in order to evaluate the pooled hazard ratios (HR) and 95% confidence intervals (CI) of substituting each included nutrient with another. We assessed risk of bias with the ROBINS-E tool, and the certainty of evidence (CoE) using the Grading of Recommendations Assessment, Development and Evaluations (GRADE) approach. This study is registered with PROSPERO (CRD42023450706). Findings Thirty-nine studies with 1,737,644 participants, 395,491 deaths, 297 direct comparisons, and seven nutrient-specific networks were included. Moderate CoE was found for an association with lower mortality risk when replacing 5% of energy intake from carbohydrates with polyunsaturated fatty acids (PUFA; HR: 0.90; 95%CI: 0.84, 0.95), n-6 PUFA (0.85; 0.77, 0.94), n-3 PUFA (0.72; 0.59, 0.86)...