Calcium Intake and the Risk of Stroke: An Up-dated Meta-analysis of Prospective Studies

钙的摄入与脑卒中风险：一项更新前瞻性研究的荟萃分析

Dan-Yang Tian ； Jie TianChang-He ShiBo SongJun WuYan JiRui-Hao Wang ； Cheng-Yuan Mao ； Shi-Lei Sun ； Yu-Ming Xu

《Asia Pacific Journal of Clinical Nutrition》 24卷2期 (2015/06) Pp. 245-252

https://doi.org/10.6133/apjcn.2015.24.2.22

摘要

背景与目的：尽管关于钙的摄入与脑卒中发生的关系已有meta分析研究，但新的研究结果与之前的分析结果并不一致。乳制品影响脑卒中发生可能与其中的钙摄入有关，因此，我们更新了现有的meta分析，以进一步研究摄入钙,尤其是含钙乳制品与脑卒中发生之间的关系。方法：利用计算机检索多个数据库中研究钙的摄入与脑卒中发生风险之间的关系的前瞻性队列研究，同时追索纳入文献的参考文献，检索文献自建库至2014年6月，按照纳入排除标准收集文献，根据the Newcastle-Ottawa Scale，对纳入文献进行严格的质量评价，应用STATA软件对符合标准的研究进行meta分析。结果：纳入10篇原始文献，共涉及371495例研究对象，其中10408例患者发生脑卒中。钙摄入的最高剂量范围与最低剂量范围相比，其脑卒中的发生并无显著性差异（RR=0.96; 95%CI: 0.89,1.04），脑卒中类型的亚组分析结果同样无显著性差异。然而，乳制品中高的钙摄入量与脑卒中的发生风险降低有关（RR=0.76; 95%CI: 0.66,0.86）。当随访时间大于14年时，钙的摄入与脑卒中呈显著负相关（RR=0.77; 95%CI: 0.63,0.95），在进行剂量相关的meta分析时，发现钙摄入与脑卒中的发生风险有着非线性的剂量关系。结论：乳制品中的钙摄入较高可降低脑卒中的发生风险。当随访时间足够长时，钙的摄入对于脑卒中的发生是保护性因素，钙的摄入与脑卒中发生风险呈非线性剂量关系。此结果仍需大型队列研究进一步确认。

關鍵字

卒中 ； 钙摄入 ； meta分析 ； 前瞻性队列研究 ； 剂量反应关系

並列摘要

Background and Purpose: Calcium intake has been associated with stroke risk in a prior meta-analysis, however, newly published results are inconsistent. Dairy food benefits on stroke incidence may involve a calciumrelated mechanism. We have therefore updated this meta-analysis with particular references to any possibility of a calcium-mediated dairy food risk reduction of stroke risk. Methods: We searched multiple databases and bibliographies for prospective cohort studies. Reports with multivariate-adjusted relative risk (RR) and corresponding 95% confidence intervals (CI) for the association of calcium intake with stroke incidence were considered. Results: Ten studies with 371,495 participants and 10,408 stroke events were analyzed. The pooled analysis showed no statistically significant association of the risk of total stroke (RR=0.96; 95% CI: 0.89-1.04) and stroke subtypes with the highest and lowest calcium intake quantiles. Nevertheless, high dairy calcium intake was significantly associated with an approximately 24% reduction of stroke risk. (RR=0.76; 95% CI: 0.66-0.86). Furthermore, a long-term follow-up (≥14 years) was helpful to reduce the risk of stroke (RR=0.67; 95% CI: 0.51-0.88). Additionally, a non-linear dose-response relationship was predicted between calcium intake and stroke risk. Conclusions: Dairy calcium intake is inversely associated with stroke incidence. There is a non-linear dose-response relationship between calcium intake and stroke risk. However, when the follow-up time is long enough, the inverse relationship is independent of dose. Additional large cohort studies are required to illustrate this relationship in detail.

並列關鍵字

stroke ； calcium intake ； meta-analysis ； prospective cohort studies ； dose-response