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      Fruit and vegetable consumption and risk of the metabolic syndrome: a meta-analysis

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          Abstract

          Objective

          Several epidemiological studies have been performed to evaluate the association of fruit and vegetable consumption with risk of the metabolic syndrome (MetS), but the results remain controversial. Thus, we conducted a systematic meta-analysis to assess the associations of fruit or/and vegetable consumption with risk of MetS, separately.

          Design

          We searched PubMed, EMBASE and Web of Science databases up to July 2017 for relevant available articles. Pooled OR with 95 % CI were calculated with the fixed- or random-effects model.

          Results

          A total of nine studies for fruit consumption, nine studies for vegetable consumption and seven studies for fruit and vegetable consumption were identified as eligible for the present meta-analysis. The pooled OR (95 % CI) of MetS for the highest v. lowest category were 0·87 (0·82, 0·92; I 2=46·7 %) for fruit consumption, 0·85 (0·80, 0·91; I 2=0·0 %) for vegetable consumption and 0·76 (0·62, 0·93; I 2=83·5 %) for fruit and vegetable consumption. In subgroup analyses stratified by continent where the study was conducted, the inverse association of fruit consumption (0·86 (0·77, 0·96)) and vegetable consumption (0·86 (0·80, 0·92)) with risk of MetS remained significant in Asia. There was no evidence of small-study effect.

          Conclusions

          Our meta-analysis indicates that fruit or/and vegetable consumption may be inversely associated with risk of MetS. It suggests that people should consume more fruits and vegetables to decrease the risk of MetS.

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          Most cited references29

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          The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men.

          The metabolic syndrome, a concurrence of disturbed glucose and insulin metabolism, overweight and abdominal fat distribution, mild dyslipidemia, and hypertension, is associated with subsequent development of type 2 diabetes mellitus and cardiovascular disease (CVD). Despite its high prevalence, little is known of the prospective association of the metabolic syndrome with cardiovascular and overall mortality. To assess the association of the metabolic syndrome with cardiovascular and overall mortality using recently proposed definitions and factor analysis. The Kuopio Ischaemic Heart Disease Risk Factor Study, a population-based, prospective cohort study of 1209 Finnish men aged 42 to 60 years at baseline (1984-1989) who were initially without CVD, cancer, or diabetes. Follow-up continued through December 1998. Death due to coronary heart disease (CHD), CVD, and any cause among men with vs without the metabolic syndrome, using 4 definitions based on the National Cholesterol Education Program (NCEP) and the World Health Organization (WHO). The prevalence of the metabolic syndrome ranged from 8.8% to 14.3%, depending on the definition. There were 109 deaths during the approximately 11.4-year follow-up, of which 46 and 27 were due to CVD and CHD, respectively. Men with the metabolic syndrome as defined by the NCEP were 2.9 (95% confidence interval [CI], 1.2-7.2) to 4.2 (95% CI, 1.6-10.8) times more likely and, as defined by the WHO, 2.9 (95% CI, 1.2-6.8) to 3.3 (95% CI, 1.4-7.7) times more likely to die of CHD after adjustment for conventional cardiovascular risk factors. The metabolic syndrome as defined by the WHO was associated with 2.6 (95% CI, 1.4-5.1) to 3.0 (95% CI, 1.5-5.7) times higher CVD mortality and 1.9 (95% CI, 1.2-3.0) to 2.1 (95% CI, 1.3-3.3) times higher all-cause mortality. The NCEP definition less consistently predicted CVD and all-cause mortality. Factor analysis using 13 variables associated with metabolic or cardiovascular risk yielded a metabolic syndrome factor that explained 18% of total variance. Men with loadings on the metabolic factor in the highest quarter were 3.6 (95% CI, 1.7-7.9), 3.2 (95% CI, 1.7-5.8), and 2.3 (95% CI, 1.5-3.4) times more likely to die of CHD, CVD, and any cause, respectively. Cardiovascular disease and all-cause mortality are increased in men with the metabolic syndrome, even in the absence of baseline CVD and diabetes. Early identification, treatment, and prevention of the metabolic syndrome present a major challenge for health care professionals facing an epidemic of overweight and sedentary lifestyle.
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            The metabolic syndrome and 11-year risk of incident cardiovascular disease in the atherosclerosis risk in communities study.

            To assess the magnitude of the association between the National Cholesterol Education Program's Third Adult Treatment Panel Report (ATP III) definition of the metabolic syndrome and cardiovascular disease (CVD). Cox regression was used to estimate the relative risk of incident coronary heart disease (CHD) and stroke among 12,089 black and white middle-aged individuals in the Atherosclerosis Risk in Communities (ARIC) study. The metabolic syndrome was present in approximately 23% of individuals without diabetes or prevalent CVD at baseline. Over an average of 11 years of follow-up, 879 incident CHD and 216 ischemic stroke events occurred. Among the components of the metabolic syndrome, elevated blood pressure and low levels of HDL cholesterol exhibited the strongest associations with CHD. Men and women with the metabolic syndrome were approximately 1.5 and 2 times more likely to develop CHD than control subjects after adjustment for age, smoking, LDL cholesterol, and race/ARIC center (sex interaction P < 0.03). Similar associations were found between the metabolic syndrome and incident ischemic stroke. Comparison of receiver operating characteristic curves indicated that the metabolic syndrome did not materially improve CHD risk prediction beyond the level achieved by the Framingham Risk Score (FRS). Individuals without diabetes or CVD, but with the metabolic syndrome, were at increased risk for long-term cardiovascular outcomes, although statistical models suggested that most of that risk was accounted for by the FRS. Nevertheless, identification of individuals with the metabolic syndrome may provide opportunities to intervene earlier in the development of shared disease pathways that predispose individuals to both CVD and diabetes.
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              Meta-analysis of genetic association studies.

              Meta-analysis, a statistical tool for combining results across studies, is becoming popular as a method for resolving discrepancies in genetic association studies. Persistent difficulties in obtaining robust, replicable results in genetic association studies are almost certainly because genetic effects are small, requiring studies with many thousands of subjects to be detected. In this article, we describe how meta-analysis works and consider whether it will solve the problem of underpowered studies or whether it is another affliction visited by statisticians on geneticists. We show that meta-analysis has been successful in revealing unexpected sources of heterogeneity, such as publication bias. If heterogeneity is adequately recognized and taken into account, meta-analysis can confirm the involvement of a genetic variant, but it is not a substitute for an adequately powered primary study.
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                Author and article information

                Journal
                applab
                Public Health Nutrition
                Public Health Nutr.
                Cambridge University Press (CUP)
                1368-9800
                1475-2727
                March 2018
                November 20 2017
                March 2018
                : 21
                : 04
                : 756-765
                Article
                10.1017/S136898001700310X
                29151369
                e5b08160-37c3-4c4c-b851-aeafc882e3a0
                © 2018
                History

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