Dose–Response Relation between Tea Consumption and Risk of Cardiovascular Disease and All-Cause Mortality: A Systematic Review and Meta-Analysis of Population-Based Studies

ABSTRACT Tea flavonoids have been suggested to offer potential benefits to cardiovascular health. This review synthesized the evidence on the relation between tea consumption and risks of cardiovascular disease (CVD) and all-cause mortality among generally healthy adults. PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, Food Science and Technology Abstracts, and Ovid CAB Abstract databases were searched to identify English-language publications through 1 November 2019, including randomized trials, prospective cohort studies, and nested case-control (or case-cohort) studies with data on tea consumption and risk of incident cardiovascular events (cardiac or peripheral vascular events), stroke events (including mortality), CVD-specific mortality, or all-cause mortality. Data from 39 prospective cohort publications were synthesized. Linear meta-regression showed that each cup (236.6 mL) increase in daily tea consumption (estimated 280 mg and 338 mg total flavonoids/d for black and green tea, respectively) was associated with an average 4% lower risk of CVD mortality, a 2% lower risk of CVD events, a 4% lower risk of stroke, and a 1.5% lower risk of all-cause mortality. Subgroup meta-analysis results showed that the magnitude of association was larger in elderly individuals for both CVD mortality (n = 4; pooled adjusted RR: 0.89; 95% CI: 0.83, 0.96; P = 0.001), with large heterogeneity (I2 = 72.4%), and all-cause mortality (n = 3; pooled adjusted RR: 0.92; 95% CI: 0.90, 0.94; P < 0.0001; I2 = 0.3%). Generally, studies with higher risk of bias appeared to show larger magnitudes of associations than studies with lower risk of bias. Strength of evidence was rated as low and moderate (depending on study population age group) for CVD-specific mortality outcome and was rated as low for CVD events, stroke, and all-cause mortality outcomes. Daily tea intake as part of a healthy habitual dietary pattern may be associated with lower risks of CVD and all-cause mortality among adults.

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Tea consumption and mortality of all cancers, CVD and all causes: a meta-analysis of eighteen prospective cohort studies

British Journal Of Nutrition ◽

10.1017/s0007114515002329 ◽

2015 ◽

Vol 114 (5) ◽

pp. 673-683 ◽

Cited By ~ 58

Author(s):

Jun Tang ◽

Ju-Sheng Zheng ◽

Ling Fang ◽

Yongxin Jin ◽

Wenwen Cai ◽

...

Keyword(s):

Cohort Studies ◽

Green Tea ◽

Prospective Cohort ◽

Lower Risk ◽

Meta Analysis ◽

Black Tea ◽

Tea Consumption ◽

Prospective Cohort Studies ◽

All Cause Mortality ◽

Cvd Mortality

AbstractEpidemiological studies have demonstrated inconsistent associations between tea consumption and mortality of all cancers, CVD and all causes. To obtain quantitative overall estimates, we conducted a dose–response meta-analysis of prospective cohort studies. A literature search in PubMed and Embase up to April 2015 was conducted for all relevant papers published. Random-effects models were used to calculate pooled relative risks (RR) with 95 % CI. In eighteen prospective studies, there were 12 221, 11 306 and 55 528 deaths from all cancers, CVD and all causes, respectively. For all cancer mortality, the summary RR for the highest v. lowest category of green tea and black tea consumption were 1·06 (95 % CI 0·98, 1·15) and 0·79 (95 % CI 0·65, 0·97), respectively. For CVD mortality, the summary RR for the highest v. lowest category of green tea and black tea consumption were 0·67 (95 % CI 0·46, 0·96) and 0·88 (95 % CI 0·77, 1·01), respectively. For all-cause mortality, the summary RR for the highest v. lowest category of green tea and black tea consumption were 0·80 (95 % CI 0·68, 0·93) and 0·90 (95 % CI 0·83, 0·98), respectively. The dose–response analysis indicated that one cup per d increment of green tea consumption was associated with 5 % lower risk of CVD mortality and with 4 % lower risk of all-cause mortality. Green tea consumption was significantly inversely associated with CVD and all-cause mortality, whereas black tea consumption was significantly inversely associated with all cancer and all-cause mortality.

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Abstract P225: The Associations of Dietary and Biomarkers of Linoleic Acid Intake and All-cause and Cardiovascular Mortality: A Systematic Review and Meta-analysis

Circulation ◽

10.1161/circ.137.suppl_1.p225 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Jun Li ◽

Marta Guasch-Ferré ◽

Yanping Li ◽

Frank Hu

Keyword(s):

Systematic Review ◽

Linoleic Acid ◽

Cohort Studies ◽

Prospective Cohort ◽

Lower Risk ◽

Meta Analysis ◽

Dietary Survey ◽

Prospective Cohort Studies ◽

All Cause Mortality ◽

Cvd Mortality

Background: Previous studies on intake of linoleic acid (LA), a predominant n-6 fatty acid, and risk of mortality from all-cause and cardiovascular disease (CVD) have generated inconsistent results. We performed a systematic review and meta-analysis of prospective cohort studies to summarize the evidence regarding the relation of LA and all-cause and CVD mortality. Methods: We searched MEDLINE and EMBASE databases through June 2017 for prospective cohort studies reporting association of LA (assessed by dietary survey or biomarker in blood or adipose tissue) with all-cause and CVD mortality. In addition, unpublished data from pooling projects were included. We pooled the multivariate-adjusted Hazards ratios (HRs) using random-effect meta-analysis, which allowed for between-study heterogeneity. Results: 27 studies covering 37 prospective cohorts were identified; these included 274,565 individuals with dietary assessment (34,597 all-cause and 10,636 CVD deaths) and 54,794 individuals with biomarker measurements (6,767 all-cause and 5,311 CVD deaths). Comparing the highest category with the lowest, dietary LA intake was associated with a 14% lower risk of all-cause mortality (95% confidence interval [CI], 2%-25%, I 2 =71%) and a 20% lower risk of CVD mortality (95% CI, 13%-26%, I 2 =0). Baseline health status (i.e. general population, CVD/high risk for CVD, or cancer) might be a main source of heterogeneity for the association of dietary LA intake with all-cause mortality. As for biomarkers, 1 SD increment in LA was associated with a 9% lower risk of all-cause mortality (95% CI, 4%-14%, I 2 =61%) and a 10% lower risk of CVD mortality (95% CI, 5%-14%, I 2 =13%). Heterogeneity was presented across tissue types and between genders. Conclusions: In prospective cohort studies, LA intake, assessed by either dietary survey or biomarkers, was inversely associated with all-cause and CVD mortality in a dose-response manner. These data support the current recommendations on polyunsaturated fat intake for prevention of CVD and early death.

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Dietary intake of total, animal, and plant proteins and risk of all cause, cardiovascular, and cancer mortality: systematic review and dose-response meta-analysis of prospective cohort studies

BMJ ◽

10.1136/bmj.m2412 ◽

2020 ◽

pp. m2412 ◽

Cited By ~ 7

Author(s):

Sina Naghshi ◽

Omid Sadeghi ◽

Walter C Willett ◽

Ahmad Esmaillzadeh

Keyword(s):

Cardiovascular Disease ◽

Cohort Studies ◽

Dose Response ◽

Cancer Mortality ◽

Prospective Cohort ◽

Lower Risk ◽

Meta Analysis ◽

Plant Protein ◽

Prospective Cohort Studies ◽

All Cause Mortality

AbstractObjectiveTo examine and quantify the potential dose-response relation between intake of total, animal, and plant protein and the risk of mortality from all causes, cardiovascular disease, and cancer.DesignSystematic review and meta-analysis of prospective cohort studies.Data sourcesPubMed, Scopus, and ISI Web of Science until December 2019, and references of retrieved relevant articles.Study selectionProspective cohort studies that reported the risk estimates for all cause, cardiovascular, and cancer mortality in adults aged 18 or older.Data synthesisRandom effects models were used to calculate pooled effect sizes and 95% confidence intervals for the highest versus lowest categories of protein intake and to incorporate variation between studies. Linear and non-linear dose-response analyses were done to evaluate the dose-response relations between protein intake and mortality.Results32 prospective cohort studies were included in the systematic review and 31 in the meta-analysis. During the follow-up period of 3.5 to 32 years, 113 039 deaths (16 429‬ from cardiovascular disease and 22 303‬ from cancer) occurred among 715 128 participants. Intake of total protein was associated with a lower risk of all cause mortality (pooled effect size 0.94, 95% confidence interval 0.89 to 0.99, I2=58.4%, P<0.001). Intake of plant protein was significantly associated with a lower risk of all cause mortality (pooled effect size 0.92, 95% confidence interval 0.87 to 0.97, I2=57.5%, P=0.003) and cardiovascular disease mortality (pooled hazard ratio 0.88, 95% confidence interval 0.80 to 0.96, I2=63.7%, P=0.001), but not with cancer mortality. Intake of total and animal protein was not significantly associated with risk of cardiovascular disease and cancer mortality. A dose-response analysis showed a significant inverse dose-response association between intake of plant protein and all cause mortality (P=0.05 for non-linearity). An additional 3% energy from plant proteins a day was associated with a 5% lower risk of death from all causes.ConclusionsHigher intake of total protein was associated with a lower risk of all cause mortality, and intake of plant protein was associated with a lower risk of all cause and cardiovascular disease mortality. Replacement of foods high in animal protein with plant protein sources could be associated with longevity.

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Intake of Fish and Marine n-3 Polyunsaturated Fatty Acids and Risk of Cardiovascular Disease Mortality: A Meta-Analysis of Prospective Cohort Studies

Nutrients ◽

10.3390/nu13072342 ◽

2021 ◽

Vol 13 (7) ◽

pp. 2342

Author(s):

Lan Jiang ◽

Jinyu Wang ◽

Ke Xiong ◽

Lei Xu ◽

Bo Zhang ◽

...

Keyword(s):

Cardiovascular Disease ◽

Fatty Acids ◽

Polyunsaturated Fatty Acids ◽

Cohort Studies ◽

Mortality Risk ◽

Prospective Cohort ◽

Meta Analysis ◽

Pufa Intake ◽

Prospective Cohort Studies ◽

Cvd Mortality

Previous epidemiological studies have investigated the association of fish and marine n-3 polyunsaturated fatty acids (n-3 PUFA) consumption with cardiovascular disease (CVD) mortality risk. However, the results were inconsistent. The purpose of this meta-analysis is to quantitatively evaluate the association between marine n-3 PUFA, fish and CVD mortality risk with prospective cohort studies. A systematic search was performed on PubMed, Web of Science, Embase and MEDLINE databases from the establishment of the database to May 2021. A total of 25 cohort studies were included with 2,027,512 participants and 103,734 CVD deaths. The results indicated that the fish consumption was inversely associated with the CVD mortality risk [relevant risk (RR) = 0.91; 95% confidence intervals (CI) 0.85−0.98]. The higher marine n-3 PUFA intake was associated with the reduced risk of CVD mortality (RR = 0.87; 95% CI: 0.85–0.89). Dose-response analysis suggested that the risk of CVD mortality was decreased by 4% with an increase of 20 g of fish intake (RR = 0.96; 95% CI: 0.94–0.99) or 80 milligrams of marine n-3 PUFA intake (RR = 0.96; 95% CI: 0.94–0.98) per day. The current work provides evidence that the intake of fish and marine n-3 PUFA are inversely associated with the risk of CVD mortality.

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Dietary magnesium intake and the risk of cardiovascular disease, type 2 diabetes, and all-cause mortality: a dose–response meta-analysis of prospective cohort studies

BMC Medicine ◽

10.1186/s12916-016-0742-z ◽

2016 ◽

Vol 14 (1) ◽

Cited By ~ 81

Author(s):

Xuexian Fang ◽

Kai Wang ◽

Dan Han ◽

Xuyan He ◽

Jiayu Wei ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Cohort Studies ◽

Prospective Cohort ◽

Meta Analysis ◽

Disease Type ◽

Prospective Cohort Studies ◽

Dietary Magnesium ◽

All Cause Mortality

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Tea Flavonoids and Risk of Cardiovascular and All-Cause Mortality: A Systematic Review and Meta-Analysis

Proceedings of The Nutrition Society ◽

10.1017/s0029665120001573 ◽

2020 ◽

Vol 79 (OCE2) ◽

Cited By ~ 1

Author(s):

Ding Ding Wang ◽

Aedin Cassidy ◽

Mario G. Ferruzzi ◽

Paul Jacques ◽

Elizabeth Johnson ◽

...

Keyword(s):

Systematic Review ◽

Cohort Studies ◽

Green Tea ◽

Lower Risk ◽

Meta Analysis ◽

Black Tea ◽

Tea Consumption ◽

Prospective Cohort Studies ◽

All Cause Mortality ◽

Meta Regression

AbstractThere is increasing evidence that both black and green tea are beneficial for prevention of cardiovascular disease (CVD). We conducted a systematic review and meta-analysis evaluating the effects of tea flavonoids on cardiovascular (CVD) and all-cause mortality outcomes.Searches across five databases including PubMed and Embase were conducted through November 2018 to identify randomized controlled trials (RCTs) and prospective cohort studies reporting cardiovascular and all-cause mortality outcomes. Two investigators independently conducted abstract and full-text screenings, data extractions, and risk of bias (ROB) assessments using the Nutrition Evidence Library Bias Assessment Tool (NEL BAT). Mixed-effects dose-response meta-regression and standard random-effects meta-analyses for outcomes with ≥ 4 studies were performed. 0 RCTs and 38 prospective cohort studies were included in the systematic review. NEL BAT scores ranged from 0–15 (0 being the lowest risk). Our linear meta-regression model showed that each cup increase in daily tea consumption (about 280 mg and 338 mg of total flavonoids for black and green tea, respectively) was associated with 3–4% lower risk of CVD mortality (predicted adjusted RR = 0.96; CI 0.93–0.99 for green tea and RR = 0.97; CI 0.94–0.99 for black tea). Furthermore, eachcup increase in daily tea consumption was associated a 2% lower risk of all-cause mortality (predicted adjusted relative risk (RR) = 0.98; 95% CI 0.97–0.99 for black tea and RR = 0.98; CI 0.96–0.99 for green tea, respectively). Two studies reported multivariable Cox regression analysis results for the relationship between black tea intake and risks of all-cause mortality outcomes. The results from these two studies were combined with our linear meta-regression result in a random-effects model meta-analysis and showed that each cup increase in daily black tea consumption was associated with an average of 3% lower risk of all-cause mortality (pooled adjusted RR = 0.97; 95% CI 0.87- 1.00) with large heterogeneity (I2 = 81.4%; p = 0.005). Current evidence indicates that increased tea consumption may reduce cardiovascular and all-cause mortality in a dose-response manner. This systematic review was registered on PROSPERO.

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Legume Consumption and All-Cause and Cardiovascular Disease Mortality

BioMed Research International ◽

10.1155/2017/8450618 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Hua Li ◽

Jinmeng Li ◽

Yegen Shen ◽

Jie Wang ◽

Depu Zhou

Keyword(s):

Cardiovascular Disease ◽

Lower Risk ◽

Meta Analysis ◽

Random Effects Model ◽

Protective Effects ◽

Prospective Cohort Studies ◽

Relative Risks ◽

Disease Mortality ◽

All Cause Mortality ◽

Cvd Mortality

Background. Legume consumption is suggested to have protective effects against cardiovascular disease (CVD) mortality in the general population, but the results have been equivocal. We conducted a meta-analysis of prospective cohort studies to assess the association between legume consumption and risk of CVD mortality and all-cause mortality. Methods and Results. Medline (via Ovid) and EMBASE (via Ovid) databases were searched through April 2017 to identify eligible studies. The two authors independently extracted the data and the adjusted relative risks (RRs) and 95% confidence intervals (CIs) were pooled by using a random-effects model. A total of 6 studies were identified, including the sizes of participants ranging from 23,601 to 59,485 with a sum of 21,8997. Comparing the highest category with the lowest, the pooled RR (95% CI) was 0.96 (0.86–1.06) for CVD mortality and 0.93 (0.87–0.99) for all-cause mortality. Conclusions. Results from the current study show that high legume intakes are associated with lower risk of all-cause mortality. In consideration of the small number of studies, the evidence for assessing relationship between legumes intake and risk of all-cause mortality remains inclusive and warrants further study in the future. Further, consuming legumes does not increase the risk of CVD mortality.

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Dietary Intake and Biomarkers of α-Linolenic Acid and Mortality: A Meta-Analysis of Prospective Cohort Studies

Frontiers in Nutrition ◽

10.3389/fnut.2021.743852 ◽

2021 ◽

Vol 8 ◽

Author(s):

Li-Hua Chen ◽

Qingjing Hu ◽

Guijie Li ◽

Li Zhang ◽

Li-Qiang Qin ◽

...

Keyword(s):

Cohort Studies ◽

Linolenic Acid ◽

Prospective Cohort ◽

Fixed Effects ◽

Meta Analysis ◽

Response Analysis ◽

Prospective Cohort Studies ◽

Body Tissues ◽

All Cause Mortality ◽

Cvd Mortality

Background: The association between α-linolenic acid (ALA) and mortality is inconsistent and has not been summarized systematically.Objective: The purpose was to conduct a meta-analysis that synthesized the results of prospective cohort studies to investigate associations between ALA intake and mortality.Methods: We conducted a comprehensive search on PubMed, Embase, and Web of Science databases on May 1, 2021, for relevant prospective cohort studies which reported associations of ALA (assessed by dietary surveys and/or ALA concentrations in body tissues) with mortality from all-cause, cardiovascular disease (CVD), and other diseases. Multivariable-adjusted relative risks (RRs) were pooled by a random or fixed-effects model.Results: A total of 34 prospective cohort studies, of which 17 reported dietary ALA intake, 14 for ALA biomarkers, and the remaining 3 reported both of intake and biomarkers. The studies included 6,58,634 participants, and deaths were classified into all-cause mortality (56,898), CVD mortality (19,123), and other diseases mortality (19,061). Pooled RRs of ALA intake were 0.93 (95% CI: 0.86, 1.01, I2 = 71.2%) for all-cause mortality, 0.90 (95% CI: 0.83, 0.98, I2 = 22.1%) for CVD mortality, and 0.94 (95% CI: 0.83, 1.06, I2 = 73.3%) for other diseases mortality. The two-stage random-effects dose-response analysis showed a linear relationship between dietary ALA intake and CVD-mortality and each 0.5% energy increment of ALA intake was associated with a 5% lower risk of CVD-mortality (RR: 0.95; 95% CI: 0.90, 1.00). Pooled RRs per SD increment of ALA biomarkers were 0.99 (95% CI: 0.96, 1.01, I2 = 27%) for all-cause mortality, 1.00 (95% CI: 0.98, 1.03, I2 = 0%) for CVD mortality and 0.98 (95% CI: 0.95, 1.01, I2 = 0%) for other diseases mortality.Conclusions: This meta-analysis summarizing the available prospective cohort studies indicated that ALA intake was associated with reduced risk of mortality, especially CVD mortality. Our findings suggest that ALA consumption may be beneficial for death prevention. Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO; identifier: CRD42021264532.

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Abstract MP48: Whole Grain Intake is Inversely Associated with Mortality From All Causes, Cardiovascular Disease, and Cancer in a Dose-response Manner, a Meta-analysis of Prospective Cohort Studies

Circulation ◽

10.1161/circ.133.suppl_1.mp48 ◽

2016 ◽

Vol 133 (suppl_1) ◽

Author(s):

Geng Zong ◽

Alisa Gao ◽

Frank Hu ◽

Qi Sun

Keyword(s):

Cohort Studies ◽

Dose Response ◽

Cancer Mortality ◽

Prospective Cohort ◽

Meta Analysis ◽

Multiple Chronic Conditions ◽

Whole Grain ◽

Prospective Cohort Studies ◽

All Cause Mortality ◽

Cvd Mortality

Introduction: Whole grain intake has been associated with lower risks of multiple chronic conditions, but its association with mortality warrants further evaluation. Hypothesis: We performed a meta-analysis of prospective cohort studies on the association of whole grain intake with all-cause and cause-specific mortality, and tested the hypothesis that they followed inverse dose-response pattern. Methods: Published studies reporting relative risks (RRs) between whole grain consumption and mortality from Medline and Embase through August, 2015. Original results from National Health and Nutrition Examination Survey (NHANES) III and NHANES 1999-2004 were included. Whole grain ingredients (gram/day) were estimated among studies reporting RRs for ≥3 categories of whole grain intake. Results: Fourteen unique analyses were included, which consisted of 786,076 participants, 97,867 all-cause deaths, 23,957 CVD deaths, and 37,492 cancer deaths. Pooled RRs (95% confidence intervals) comparing high with low whole grain categories were 0.84 (0.80, 0.88; P <0.001, I2=74%, P heterogeneity<0.001) for all-cause mortality, 0.82 (0.79, 0.85; P <0.001, I2=0%, P heterogeneity=0.53) for CVD mortality, and 0.88(0.83, 0.94; P <0.001, I2=54%, P heterogeneity=0.02) for cancer mortality. Whole grain consumption was <50 grams/day among most studies. Dose-response meta-analysis showed strong monotonic associations between whole grain and mortality (All P nonlinearity > 0.05): RRs (95%CIs) for each 16 grams/day increase (approximately 1 serving/day) in whole grain were 0.93(0.92, 0.94) for all-cause mortality, 0.91(0.90, 0.93) for CVD mortality, and 0.95(0.94, 0.96) for cancer mortality. These findings were robust in several stratified analyses and/or sensitivity analyses. Egger’s test did not suggest significant publication bias. Conclusions: Our findings supported health benefit of increasing current whole grain intake of <1 serving/day to ≥3 servings/day as recommended by current Dietary Guidelines for Americans.

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Dietary glycemic index, glycemic load, and risk of mortality from all causes and cardiovascular diseases: a systematic review and dose-response meta-analysis of prospective cohort studies

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqz061 ◽

2019 ◽

Vol 110 (4) ◽

pp. 921-937 ◽

Cited By ~ 4

Author(s):

Farnaz Shahdadian ◽

Parvane Saneei ◽

Alireza Milajerdi ◽

Ahmad Esmaillzadeh

Keyword(s):

Cohort Studies ◽

Glycemic Index ◽

Prospective Cohort ◽

Meta Analysis ◽

Glycemic Load ◽

Positive Association ◽

Prospective Cohort Studies ◽

All Cause Mortality ◽

Dietary Glycemic Index ◽

Cvd Mortality

ABSTRACT Background Previous findings on the association of dietary glycemic index (GI) and glycemic load (GL) with mortality are conflicting. Objectives The aim of this study was to summarize earlier findings on the association between dietary GI and GL and the risk of cardiovascular disease (CVD) and all-cause mortality. Methods A comprehensive literature search was performed of electronic databases, including MEDLINE (PubMed), Scopus, ISI Web of Science, EMBASE, and Google scholar, up to September 2018. Prospective cohort studies that reported GI and GL as the exposure and all-cause or CVD mortality as the outcome were included in the analysis. The random-effects model was used to estimate pooled RR and 95% CIs of all-cause and CVD mortality. Results Eighteen cohort studies with a total of 251,497 participants, reporting 14,774 cases of all-cause mortality and 3658 cases of CVD mortality, were included in the present analysis. No significant association was found between dietary GI and all-cause mortality (RR: 1.07; 95% CI: 0.96, 1.19) and CVD mortality (RR: 1.02; 95% CI: 0.87, 1.20). In addition, dietary GL was not associated with all-cause mortality (RR: 1.08; 95% CI: 0.93, 1.27) or CVD mortality (RR: 1.07; 95% CI: 0.92, 1.25). However, the highest dietary GI, in comparison to the lowest one, significantly increased the risk of all-cause mortality in women (RR: 1.17; 95% CI: 1.02, 1.35). No evidence for a nonlinear association between dietary GI or GL and all-cause and CVD mortality was found (P > 0.05). Conclusions This meta-analysis of prospective cohort studies showed no significant association between either dietary GI or GL and all-cause and CVD mortality in men, but a positive association of GI with all-cause mortality in women.

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