Cho Eunyoung, Smith-Warner Stephanie A, Ritz John, van den Brandt Piet A, Colditz Graham A, Folsom Aaron R, Freudenheim Jo L, Giovannucci Edward, Goldbohm R Alexandra, Graham Saxon, Holmberg Lars, Kim Dong-Hyun, Malila Nea, Miller Anthony B, Pietinen Pirjo, Rohan Thomas E, Sellers Thomas A, Speizer Frank E, Willett Walter C, Wolk Alicja, Hunter David J
Channing Laboratory, Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health, and Harvard Center for Cancer Prevention, Boston, Massachusetts 02115, USA.
Ann Intern Med. 2004 Apr 20;140(8):603-13. doi: 10.7326/0003-4819-140-8-200404200-00007.
Epidemiologic studies have generally reported positive associations between alcohol consumption and risk for colorectal cancer. However, findings related to specific alcoholic beverages or different anatomic sites in the large bowel have been inconsistent.
To examine the relationship of total alcohol intake and intake from specific beverages to the incidence of colorectal cancer and to evaluate whether other potential risk factors modify the association.
Pooled analysis of primary data from 8 cohort studies in 5 countries.
North America and Europe.
489,979 women and men with no history of cancer other than nonmelanoma skin cancer at baseline.
Alcohol intake was assessed in each study at baseline by using a validated food-frequency questionnaire.
During a maximum of 6 to 16 years of follow-up across the studies, 4687 cases of colorectal cancer were documented. In categorical analyses, increased risk for colorectal cancer was limited to persons with an alcohol intake of 30 g/d or greater (approximately > or =2 drinks/d), a consumption level reported by 4% of women and 13% of men. Compared with nondrinkers, the pooled multivariate relative risks were 1.16 (95% CI, 0.99 to 1.36) for persons who consumed 30 to less than 45 g/d and 1.41 (CI, 1.16 to 1.72) for those who consumed 45 g/d or greater. No significant heterogeneity by study or sex was observed. The association was evident for cancer of the proximal colon, distal colon, and rectum. No clear difference in relative risks was found among specific alcoholic beverages.
The study included only one measure of alcohol consumption at baseline and could not investigate lifetime alcohol consumption, alcohol consumption at younger ages, or changes in alcohol consumption during follow-up. It also could not examine drinking patterns or duration of alcohol use.
A single determination of alcohol intake correlated with a modest relative elevation in colorectal cancer rate, mainly at the highest levels of alcohol intake.
流行病学研究普遍报告饮酒与结直肠癌风险之间存在正相关。然而，关于特定酒精饮料或大肠不同解剖部位的研究结果并不一致。
研究总酒精摄入量和特定饮料的摄入量与结直肠癌发病率之间的关系，并评估其他潜在风险因素是否会改变这种关联。
对来自5个国家的8项队列研究的原始数据进行汇总分析。
北美和欧洲。
489979名在基线时除非黑色素瘤皮肤癌外无其他癌症病史的男性和女性。
在每项研究中，通过使用经过验证的食物频率问卷在基线时评估酒精摄入量。
在各项研究最长6至16年的随访期间，记录了4687例结直肠癌病例。在分类分析中，结直肠癌风险增加仅限于酒精摄入量为30克/天或更高（约≥2杯/天）的人群，该消费水平在4%的女性和13%的男性中报告。与不饮酒者相比，每天摄入30至不足45克酒精的人群汇总多变量相对风险为1.16（95%CI，0.99至1.36），而每天摄入45克或更多酒精的人群相对风险为1.41（CI，1.16至1.72）。未观察到按研究或性别划分的显著异质性。该关联在近端结肠癌、远端结肠癌和直肠癌中均明显。在特定酒精饮料之间未发现相对风险的明显差异。
该研究仅在基线时测量了一次酒精摄入量，无法调查终生酒精摄入量、年轻时的酒精摄入量或随访期间酒精摄入量的变化。它也无法检查饮酒模式或饮酒持续时间。
单次酒精摄入量测定与结直肠癌发病率适度相对升高相关，主要在酒精摄入量最高水平时。
