Furberg Anne-Sofie, Thune Inger
Institute of Community Medicine, Faculty of Medicine, University of Tromsø, Tromsø, Norway.
Int J Cancer. 2003 May 10;104(6):669-76. doi: 10.1002/ijc.10974.
Since high energy intake, inactivity, hypertension and diabetes are linked to obesity and an unfavorable hormonal profile, we wanted to test whether energy intake, physical activity, blood pressure and serum glucose are related to the risk of endometrial cancer independent of the body mass index (BMI). A cohort of 24,460 women, aged 20-49 years, attended a Norwegian health screening twice during 1974-1981; they answered questions about diet, physical activity and chronic diseases, and their height, weight, blood pressure and non-fasting serum glucose were measured. By the end of 1996, during 15.7 years of follow-up, 130 cases of endometrial carcinomas were identified. The relative risks (RRs) for endometrial cancer were estimated in proportional hazards models including potentially confounding factors. Obese women (BMI > or = 30 kg/m(2)) were at 2.6 times increased risk of endometrial cancer compared to normal weight women (BMI < 25 kg/m(2)) (RR = 2.57, 95%CI = 1.61-4.10). Among overweight women (BMI > or = 25 kg/m(2)), non-fasting serum glucose in the upper quartile vs. in the lower quartile was associated with a 2.4 times increase in risk (RR = 2.41, 95%CI = 1.08-5.37), whereas among obese women, blood pressure above 140/90 mmHg vs. below 140/90 mmHg in both surveys was associated with a 3.5 times increase in risk (RR = 3.47, 95%CI = 1.24-9.70). Especially in women younger than 50 years, high energy intake (5,044-6,401 kJ/day) conferred higher risk compared to low energy intake (< 4266 kJ/day) (RR = 3.40, 95%CI = 1.52-7.60). Increasing recreational activity tended to be protective. Among obese women with non-sedentary jobs at both screenings, RR declined to 0.18 (95%CI = 0.05-0.62) as the level of sustained occupational activity increased (p(trend) = 0.03). Our results suggest that inactivity and high energy intake are major risk factors for endometrial cancer independent of BMI, and that hypertension and relative hyperglycemia are significant markers of risk, especially among the heaviest women.
由于高能量摄入、缺乏运动、高血压和糖尿病与肥胖及不良激素状况相关，我们想测试能量摄入、身体活动、血压和血糖水平是否独立于体重指数（BMI）与子宫内膜癌风险相关。1974年至1981年间，一组24460名年龄在20至49岁的女性参加了挪威的健康筛查；她们回答了有关饮食、身体活动和慢性病的问题，并测量了身高、体重、血压和非空腹血糖。到1996年底，在15.7年的随访期间，共确诊了130例子宫内膜癌病例。在包含潜在混杂因素的比例风险模型中估计了子宫内膜癌的相对风险（RR）。与正常体重女性（BMI<25kg/m²）相比，肥胖女性（BMI≥30kg/m²）患子宫内膜癌的风险增加了2.6倍（RR=2.57，95%CI=1.61-4.10）。在超重女性（BMI≥25kg/m²）中，非空腹血糖处于上四分位数与下四分位数相比，风险增加了2.4倍（RR=2.41，95%CI=1.08-5.37），而在肥胖女性中，两次调查中血压高于140/90mmHg与低于140/90mmHg相比，风险增加了3.5倍（RR=3.47，95%CI=1.24-9.70）。特别是在50岁以下的女性中，高能量摄入（5044-6401kJ/天）与低能量摄入（<4266kJ/天）相比，风险更高（RR=3.40，95%CI=1.52-7.60）。增加休闲活动往往具有保护作用。在两次筛查时从事非久坐工作的肥胖女性中，随着持续职业活动水平的增加，RR降至0.18（95%CI=0.05-0.62）（趋势p=0.03）。我们的研究结果表明，缺乏运动和高能量摄入是独立于BMI的子宫内膜癌主要危险因素，高血压和相对高血糖是风险的重要标志物，尤其是在最重的女性中。
