Merry Audrey H H, Schouten Leo J, Goldbohm R Alexandra, van den Brandt Piet A
Department of Epidemiology, NUTRIM, Maastricht University, PO Box 616, 6200 MD, Maastricht, Netherlands.
Gut. 2007 Nov;56(11):1503-11. doi: 10.1136/gut.2006.116665. Epub 2007 Mar 2.
In the last decades, the incidence of oesophageal and gastric cardia adenocarcinoma has increased rapidly in the Western world. We investigated the association between body mass index (BMI), height and risk of oesophageal and gastric cardia adenocarcinoma.
The Netherlands Cohort Study was initiated in 1986. All participants (n = 120,852), aged 55-69 years, completed a self administered questionnaire. Cases were identified through annual record linkage with the Netherlands Cancer Registry. After 13.3 years of follow-up, excluding the first follow-up year, complete data from 4552 subcohort members, 133 oesophageal and 163 gastric cardia adenocarcinomas were available for case-cohort analyses. Incidence rate ratios (RRs) and corresponding 95% confidence intervals were estimated using Cox proportional hazard models.
The RRs (95% CI) of oesophageal adenocarcinoma were 1.40 (0.95 to 2.04) and 3.96 (2.27 to 6.88) for overweight (BMI 25.0-29.9 kg/m(2)) and obese subjects (BMI >or=30.0 kg/m(2)), respectively, compared to subjects with normal weight (BMI 20.0-24.9 kg/m(2)). For gastric cardia adenocarcinoma, these RRs were 1.32 (0.94 to 1.85) and 2.73 (1.56 to 4.79). Also change in BMI during adulthood was positively associated with the risk of oesophageal and gastric cardia adenocarcinoma (p trend 0.001 and 0.02, respectively), while no association was found with BMI in early adulthood (p trend 0.17 and 0.17, respectively). None of the tumour types investigated was significantly associated with height.
These results confirm higher risks of oesophageal and gastric cardia adenocarcinoma with increasing BMI. This implies that the increasing prevalence of obesity may be one of the explanations for the rising incidence of oesophageal and gastric cardia adenocarcinoma in the Western world.
在过去几十年中，西方国家食管和贲门腺癌的发病率迅速上升。我们调查了体重指数（BMI）、身高与食管和贲门腺癌风险之间的关联。
荷兰队列研究始于1986年。所有年龄在55 - 69岁的参与者（n = 120,852）完成了一份自我管理的问卷。通过与荷兰癌症登记处的年度记录链接来识别病例。经过13.3年的随访（不包括第一个随访年），4552名亚队列成员的完整数据、133例食管癌和163例贲门腺癌可用于病例 - 队列分析。使用Cox比例风险模型估计发病率比（RRs）及相应的95%置信区间。
与体重正常（BMI 20.0 - 24.9 kg/m²）的受试者相比，超重（BMI 25.0 - 29.9 kg/m²）和肥胖受试者（BMI≥30.0 kg/m²）患食管腺癌的RRs（95% CI）分别为1.40（0.95至2.04）和3.96（2.27至6.88）。对于贲门腺癌，这些RRs分别为1.32（0.94至1.85）和2.73（1.56至4.79）。成年期BMI的变化也与食管和贲门腺癌的风险呈正相关（p趋势分别为0.001和0.02），而在成年早期未发现与BMI有关联（p趋势分别为0.17和0.17）。所研究的肿瘤类型均与身高无显著关联。
这些结果证实随着BMI升高，食管和贲门腺癌的风险更高。这意味着肥胖患病率的上升可能是西方国家食管和贲门腺癌发病率上升的原因之一。
