Predictive role of modifiable factors in stroke: an umbrella review
Background A growing number of meta-analyses reviewed the existing associations between modifiable factors and stroke. However, the methodological quality of them and quality of evidence remain to be assessed by validated tools. Thus, this umbrella review was conducted to consolidate evidence from s...
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BMJ Publishing Group
2022-06-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/6/e056680.full |
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| author | Yue Wang Lu Wen Xiaotong Wang Man Liang Fanxin Zeng Yuetian Yang Fangfang Nie Mengke Shang Na Ta Lanxin Ou Zhibin Yang Wanyang Liu |
| author_facet | Yue Wang Lu Wen Xiaotong Wang Man Liang Fanxin Zeng Yuetian Yang Fangfang Nie Mengke Shang Na Ta Lanxin Ou Zhibin Yang Wanyang Liu |
| author_sort | Yue Wang |
| collection | DOAJ |
| description | Background A growing number of meta-analyses reviewed the existing associations between modifiable factors and stroke. However, the methodological quality of them and quality of evidence remain to be assessed by validated tools. Thus, this umbrella review was conducted to consolidate evidence from systematic reviews and meta-analyses of cohort studies investigating the association between modifiable factors and incidence of stroke.Methods PubMed, Web of Science, Embase, Wanfang and China National Knowledge Infrastructure databases for systematic reviews and meta-analyses of cohort studies from inception until March 2021. Assess the methodological quality of systematic reviews 2 was used to evaluate the methodological quality of each included published meta-analysis. Excess significance test was used to investigate whether the observed number of studies (O) with nominally significant results (‘positive’ studies, p<0.05) was larger than the expected number of significant results (E). Statistically significant (p<0.05) associations were rated into five levels (strong, highly suggestive, suggestive, weak and no) using specific criteria. Sensitivity analyses were performed.Results 2478 records were identified through database searching. At last, 49 meta-analyses including 70 modifiable factors and approximately 856 801 stroke cases were included in the present review. The methodological quality of three meta-analyses was low, while others were critically low. Evidence of walking pace was strong. High suggestive evidence mainly included total meat, processes meat, chocolate, sodium, obesity, pulse pressure, systolic blood pressure, diastolic blood pressure, sleep duration and smoking. Suggestive evidence mainly included dietary approaches to stop hypertension (DASH) diet, vitamin C, magnesium, depression and particulate matter 2.5. After sensitivity analyses, evidence of DASH diet, magnesium and depression turned to weak. No publication bias existed, except only one study which could be explained by reporting bias.Discussion Diet with rich macronutrients and micronutrients, healthy dietary patterns and favourable physical, emotional health and environmental management should be promoted to decrease the burden of stroke.PROSPERO registration number CRD42021249921. |
| format | Article |
| id | doaj-art-65245199becf4acaaeeb52e8d5dc7ab8 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-65245199becf4acaaeeb52e8d5dc7ab82025-01-28T02:45:10ZengBMJ Publishing GroupBMJ Open2044-60552022-06-0112610.1136/bmjopen-2021-056680Predictive role of modifiable factors in stroke: an umbrella reviewYue Wang0Lu Wen1Xiaotong Wang2Man Liang3Fanxin Zeng4Yuetian Yang5Fangfang Nie6Mengke Shang7Na Ta8Lanxin Ou9Zhibin Yang10Wanyang Liu11Pritzker School of Molecular Engineering, The University of Chicago, Chicago, Illinois, USA1 Beijing Advanced Innovation Center for Genomics, Department of General Surgery, College of Life Sciences, Third Hospital, Peking University, Beijing, ChinaDepartment of Nutrition and Food Hygiene, School of Public Health, China Medical University, Shenyang, Liaoning, ChinaDepartment of Nutrition and Food Hygiene, School of Public Health, China Medical University, Shenyang, Liaoning, ChinaDepartment of Nutrition and Food Hygiene, School of Public Health, China Medical University, Shenyang, Liaoning, ChinaDepartment of Nutrition and Food Hygiene, School of Public Health, China Medical University, Shenyang, Liaoning, ChinaDepartment of Nutrition and Food Hygiene, School of Public Health, China Medical University, Shenyang, Liaoning, ChinaDepartment of Nutrition and Food Hygiene, School of Public Health, China Medical University, Shenyang, Liaoning, ChinaDepartment of Nutrition and Food Hygiene, School of Public Health, China Medical University, Shenyang, Liaoning, ChinaDepartment of Nutrition and Food Hygiene, School of Public Health, China Medical University, Shenyang, Liaoning, ChinaDepartment of Nutrition and Food Hygiene, School of Public Health, China Medical University, Shenyang, Liaoning, ChinaDepartment of Nutrition and Food Hygiene, School of Public Health, China Medical University, Shenyang, Liaoning, ChinaBackground A growing number of meta-analyses reviewed the existing associations between modifiable factors and stroke. However, the methodological quality of them and quality of evidence remain to be assessed by validated tools. Thus, this umbrella review was conducted to consolidate evidence from systematic reviews and meta-analyses of cohort studies investigating the association between modifiable factors and incidence of stroke.Methods PubMed, Web of Science, Embase, Wanfang and China National Knowledge Infrastructure databases for systematic reviews and meta-analyses of cohort studies from inception until March 2021. Assess the methodological quality of systematic reviews 2 was used to evaluate the methodological quality of each included published meta-analysis. Excess significance test was used to investigate whether the observed number of studies (O) with nominally significant results (‘positive’ studies, p<0.05) was larger than the expected number of significant results (E). Statistically significant (p<0.05) associations were rated into five levels (strong, highly suggestive, suggestive, weak and no) using specific criteria. Sensitivity analyses were performed.Results 2478 records were identified through database searching. At last, 49 meta-analyses including 70 modifiable factors and approximately 856 801 stroke cases were included in the present review. The methodological quality of three meta-analyses was low, while others were critically low. Evidence of walking pace was strong. High suggestive evidence mainly included total meat, processes meat, chocolate, sodium, obesity, pulse pressure, systolic blood pressure, diastolic blood pressure, sleep duration and smoking. Suggestive evidence mainly included dietary approaches to stop hypertension (DASH) diet, vitamin C, magnesium, depression and particulate matter 2.5. After sensitivity analyses, evidence of DASH diet, magnesium and depression turned to weak. No publication bias existed, except only one study which could be explained by reporting bias.Discussion Diet with rich macronutrients and micronutrients, healthy dietary patterns and favourable physical, emotional health and environmental management should be promoted to decrease the burden of stroke.PROSPERO registration number CRD42021249921.https://bmjopen.bmj.com/content/12/6/e056680.full |
| spellingShingle | Yue Wang Lu Wen Xiaotong Wang Man Liang Fanxin Zeng Yuetian Yang Fangfang Nie Mengke Shang Na Ta Lanxin Ou Zhibin Yang Wanyang Liu Predictive role of modifiable factors in stroke: an umbrella review BMJ Open |
| title | Predictive role of modifiable factors in stroke: an umbrella review |
| title_full | Predictive role of modifiable factors in stroke: an umbrella review |
| title_fullStr | Predictive role of modifiable factors in stroke: an umbrella review |
| title_full_unstemmed | Predictive role of modifiable factors in stroke: an umbrella review |
| title_short | Predictive role of modifiable factors in stroke: an umbrella review |
| title_sort | predictive role of modifiable factors in stroke an umbrella review |
| url | https://bmjopen.bmj.com/content/12/6/e056680.full |
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