Lahmann Petra H, Lissner Lauren, Gullberg Bo, Olsson Håkan, Berglund Göran
Department of Medicine, Lund University, Malmö University Hospital, Malmö, Sweden.
Int J Cancer. 2003 Jan 10;103(2):246-52. doi: 10.1002/ijc.10799.
High BMI is a well-known risk factor for postmenopausal breast cancer. There have been some reports of excess risk in association with weight gain and WHR, but little is known about the influence of body fatness per se. Using data from the Malmö Diet and Cancer Study, a prospective cohort study, 12,159 postmenopausal women (59.9 +/- 7.7 years) were categorized by quintiles of baseline anthropometric and impedance measures and reported weight change since age 20. RRs from multivariate Cox regression models were calculated. All analyses were adjusted for age, height, smoking, alcohol consumption, occupation, marital status, parity, age at first pregnancy, age at menarche and current hormone use. During the 5.7 years of follow-up, there were 246 incident breast cancer cases. Weight, height, BMI and %BF were positively associated with risk of breast cancer (p(trend) <or= 0.02). %BF showed the strongest association, with an RR of 2.01 (95% CI 1.26-3.21) in the highest vs. lowest quintile. There was significant modification of this association by hormone use, suggesting a greater impact of body fatness among nonusers. Fat distribution was not independently associated with breast cancer risk. Women with weight gain >21 kg (top quintile) had an RR of 1.75 (95% CI 1.11-2.77) compared to women with low weight gain. Breast cancer risk in postmenopausal women is predicted by increased body fat and weight gain. %BF is a more discriminating risk factor for breast cancer incidence than the commonly used BMI.
高体重指数是绝经后乳腺癌的一个众所周知的风险因素。已有一些关于体重增加和腰臀比与额外风险相关的报道，但对于身体肥胖本身的影响却知之甚少。利用马尔默饮食与癌症研究（一项前瞻性队列研究）的数据，将12159名绝经后女性（59.9±7.7岁）按照基线人体测量和阻抗测量的五分位数进行分类，并报告自20岁以来的体重变化。计算多变量Cox回归模型的相对风险（RR）。所有分析均对年龄、身高、吸烟、饮酒、职业、婚姻状况、生育次数、首次怀孕年龄、初潮年龄和当前激素使用情况进行了调整。在5.7年的随访期间，有246例新发乳腺癌病例。体重、身高、体重指数和体脂百分比与乳腺癌风险呈正相关（趋势p≤0.02）。体脂百分比显示出最强的相关性，最高五分位数与最低五分位数相比，RR为2.01（95%可信区间1.26 - 3.21）。激素使用对这种相关性有显著的修正作用，表明在未使用者中身体肥胖的影响更大。脂肪分布与乳腺癌风险无独立相关性。体重增加>21 kg（最高五分位数）的女性与体重增加少的女性相比，RR为1.75（95%可信区间1.11 - 2.77）。绝经后女性的乳腺癌风险可通过体脂增加和体重增加来预测。与常用的体重指数相比，体脂百分比是乳腺癌发病率更具鉴别力的风险因素。
