Cerhan James R, Bernstein Leslie, Severson Richard K, Davis Scott, Colt Joanne S, Blair Aaron, Hartge Patricia
Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Cancer Causes Control. 2005 Dec;16(10):1203-14. doi: 10.1007/s10552-005-0358-7.
Recent reports suggest that obesity, or conditions associated with obesity, might be risk factors for non-Hodgkin lymphoma (NHL), a cancer with dramatically increasing incidence in western countries over the last several decades. Physical inactivity increases the risk of obesity and of type 2 diabetes, but there are few data on the association of physical activity with risk of NHL.
We evaluated these factors in a population-based case-control study conducted in Detroit, Iowa, Los Angeles, and Seattle from 1998 to 2000. Incident HIV-negative NHL cases aged 20-74 years were rapidly reported in each area (n = 1321). Controls were identified through random digit dialing and Medicare files, and were frequency matched to cases on sex, age, race, and study site (n = 1057). Risk factor data were collected by in-person interviews and self-administered questionnaires. Unconditional logistic regression was used to estimate the odds ratio (OR) and 95% confidence intervals (CI), adjusted for age, sex, race and study center.
High body mass index (OR = 1.73 for 35+ versus <25 kg/m2; 95% CI 1.15-2.59) and history of gallstones (OR = 1.95, 95% CI 1.11-3.40) were positively associated with diffuse NHL, but were not associated with follicular or all NHL combined. Height was positively associated with risk of all NHL combined (OR = 1.38 for >70 versus <65 inches; 95% CI 0.98-1.94), and positive associations were apparent for both diffuse and follicular NHL. Non-occupational physical activity was inversely associated with risk of all NHL combined (ORs with increasing level: 1, 0.75, 0.71, 0.55, 0.68; p-trend = 0.04) and for diffuse and follicular NHL. We observed no association of total energy intake, type 2 diabetes, or hypertension with risk of NHL. In a multivariable model to predict risk of diffuse NHL, BMI (OR = 2.15 for 35+ versus <25 kg/m2; 95% CI 1.09-4.25) and height (OR = 1.63 for 71+ versus <65 inches; 95% CI 0.75-3.57) were positively associated with risk while physical activity was weakly and inversely associated risk (ORs with increasing level: 1, 0.76, 0.72, 0.78, 0.82; p-trend = 0.9).
BMI and history of gallstones were positively associated with risk of diffuse NHL, supporting a role for obesity in this NHL subtype. Height was positively associated with NHL risk across subtypes, and suggests a role for early life nutrition in NHL risk. Non-occupational physical activity was only weakly and inversely associated with NHL risk after adjustment for obesity, height and alcohol use.
近期报告表明，肥胖或与肥胖相关的状况可能是非霍奇金淋巴瘤（NHL）的危险因素，在过去几十年中，这种癌症在西方国家的发病率急剧上升。缺乏身体活动会增加肥胖和2型糖尿病的风险，但关于身体活动与NHL风险之间关联的数据较少。
我们在1998年至2000年于底特律、爱荷华州、洛杉矶和西雅图开展的一项基于人群的病例对照研究中评估了这些因素。在每个地区迅速报告了年龄在20 - 74岁的HIV阴性NHL新发病例（n = 1321）。通过随机数字拨号和医疗保险档案确定对照，对照在性别、年龄、种族和研究地点方面与病例进行频率匹配（n = 1057）。危险因素数据通过面对面访谈和自填问卷收集。使用无条件逻辑回归来估计比值比（OR）和95%置信区间（CI），并对年龄、性别、种族和研究中心进行了调整。
高体重指数（35+与<25 kg/m²相比，OR = 1.73；95% CI 1.15 - 2.59）和胆结石病史（OR = 1.95，95% CI 1.11 - 3.40）与弥漫性NHL呈正相关，但与滤泡性或所有NHL合并症无关。身高与所有NHL合并症的风险呈正相关（>70与<65英寸相比，OR = 1.38；95% CI 0.98 - 1.94），并且在弥漫性和滤泡性NHL中均有明显的正相关。非职业性身体活动与所有NHL合并症的风险呈负相关（随着活动水平增加的OR值：1、0.75、0.71、0.55、0.68；p趋势 = 0.04），在弥漫性和滤泡性NHL中也是如此。我们未观察到总能量摄入、2型糖尿病或高血压与NHL风险之间的关联。在一个预测弥漫性NHL风险的多变量模型中，BMI（35+与<25 kg/m²相比，OR = 2.15；95% CI 1.09 - 4.25）和身高（71+与<65英寸相比）与风险呈正相关，而身体活动与风险呈弱负相关（随着活动水平增加的OR值：1、0.76、0.72、0.78、0.82；p趋势 = 0.9）。
BMI和胆结石病史与弥漫性NHL风险呈正相关，支持肥胖在这种NHL亚型中的作用。身高与各亚型的NHL风险呈正相关，提示早期生活营养在NHL风险中的作用。在调整了肥胖、身高和饮酒因素后，非职业性身体活动与NHL风险仅呈微弱的负相关。
