Schatzkin A, Lanza E, Corle D, Lance P, Iber F, Caan B, Shike M, Weissfeld J, Burt R, Cooper M R, Kikendall J W, Cahill J
National Cancer Institute, Bethesda, MD, USA.
N Engl J Med. 2000 Apr 20;342(16):1149-55. doi: 10.1056/NEJM200004203421601.
We tested the hypothesis that dietary intervention can inhibit the development of recurrent colorectal adenomas, which are precursors of most large-bowel cancers.
We randomly assigned 2079 men and women who were 35 years of age or older and who had had one or more histologically confirmed colorectal adenomas removed within six months before randomization to one of two groups: an intervention group given intensive counseling and assigned to follow a diet that was low in fat (20 percent of total calories) and high in fiber (18 g of dietary fiber per 1000 kcal) and fruits and vegetables (3.5 servings per 1000 kcal), and a control group given a standard brochure on healthy eating and assigned to follow their usual diet. Subjects entered the study after undergoing complete colonoscopy and removal of adenomatous polyps; they remained in the study for approximately four years, undergoing colonoscopy one and four years after randomization.
A total of 1905 of the randomized subjects (91.6 percent) completed the study. Of the 958 subjects in the intervention group and the 947 in the control group who completed the study, 39.7 percent and 39.5 percent, respectively, had at least one recurrent adenoma; the unadjusted risk ratio was 1.00 (95 percent confidence interval, 0.90 to 1.12). Among subjects with recurrent adenomas, the mean (+/-SE) number of such lesions was 1.85+/-0.08 in the intervention group and 1.84+/-0.07 in the control group. The rate of recurrence of large adenomas (with a maximal diameter of at least 1 cm) and advanced adenomas (defined as lesions that had a maximal diameter of at least 1 cm or at least 25 percent villous elements or evidence of high-grade dysplasia, including carcinoma) did not differ significantly between the two groups.
Adopting a diet that is low in fat and high in fiber, fruits, and vegetables does not influence the risk of recurrence of colorectal adenomas.
我们检验了这样一种假设，即饮食干预可抑制复发性结直肠腺瘤的发展，而复发性结直肠腺瘤是大多数大肠癌的癌前病变。
我们将2079名年龄在35岁及以上、在随机分组前六个月内接受过一次或多次经组织学证实的结直肠腺瘤切除手术的男性和女性随机分为两组：干预组接受强化咨询，并被安排遵循低脂肪饮食（占总热量的20%）、高纤维饮食（每1000千卡含18克膳食纤维）以及水果和蔬菜丰富的饮食（每1000千卡3.5份）；对照组则收到一份关于健康饮食的标准手册，并被安排遵循其平常的饮食。受试者在接受完整的结肠镜检查并切除腺瘤性息肉后进入研究；他们在研究中停留约四年，在随机分组后1年和4年接受结肠镜检查。
共有1905名随机分组的受试者（91.6%）完成了研究。在完成研究的干预组958名受试者和对照组947名受试者中，分别有39.7%和39.5%的人至少有一个复发性腺瘤；未调整的风险比为1.00（95%置信区间，0.90至1.12）。在有复发性腺瘤的受试者中，干预组此类病变的平均（±标准误）数量为1.85±0.08，对照组为1.84±0.07。两组之间大腺瘤（最大直径至少为1厘米）和进展期腺瘤（定义为最大直径至少为1厘米或至少25%为绒毛成分或有高级别异型增生证据，包括癌）的复发率没有显著差异。
采用低脂肪、高纤维、水果和蔬菜丰富的饮食不会影响结直肠腺瘤的复发风险。
