肥胖与结直肠癌风险：队列研究的荟萃分析
Obesity and colorectal cancer risk: a meta-analysis of cohort studies.
作者信息
Dai Zhe, Xu Yan-Cheng, Niu Li
机构信息
Department of Endocrinology, Zhongnan Hospital, Wuhan University, Wuhan 430071, Hubei Province, China.
出版信息
World J Gastroenterol. 2007 Aug 21;13(31):4199-206. doi: 10.3748/wjg.v13.i31.4199.
AIM
To evaluate the association between obesity and colorectal cancer risk.
METHODS
We searched PubMed, EMBASE, and the Cochrane Library up to January 1, 2007. Cohort studies permitting the assessment of causal association between obesity and colorectal cancer, with clear definition of obesity and well-defined outcome of colorectal cancer were eligible. Study design, sample size at baseline, mean follow-up time, co-activators and study results were extracted. Pooled standardized effect sizes were calculated.
RESULTS
The pooled relative risk (RR) of colorectal cancer was 1.37 (95% CI: 1.21-1.56) for overweight and obese men, 1.07 (95% CI: 0.97-1.18) for women measured by body mass index (BMI). The pooled RR for the highest vs the lowest quantiles of BMI was 1.59 (95% CI: 1.35-1.86) for men and 1.22 (95% CI: 1.08-1.39) for women at risk of colon cancer, 1.16 (95% CI: 0.93-1.46) for men and 1.23 (95% CI: 0.98-1.54) for women at risk of rectal cancer. The pooled RR for the highest vs the lowest quantiles of waist circumference was 1.68 (95% CI: 1.36-2.08) for men and 1.48 (95% CI: 1.19-1.84) for women at risk of colon cancer, 1.26 (95% CI: 0.90-1.77) for men and 1.23 (95% CI: 0.81-1.86) for women at risk of rectal cancer. The pooled RR for the highest quantiles vs the lowest quantiles of waist-to-hip ratio was 1.91 (95% CI: 1.46-2.49) for men and 1.49 (95% CI 1.23-1.81) for women at risk of colon cancer, 1.93 (95% CI: 1.19-3.13) for men and 1.20 (95% CI: 0.81-1.78) for women at risk of rectal cancer. Compared with 'normal range', the pooled RR for proximal colon cancer was 1.14 (95% CI: 0.88-1.47) for the overweight and 1.41 (95% CI: 0.66-3.01) for the obese. The pooled RR for the highest quantiles vs the lowest quantiles was 2.05 (95% CI: 1.23-3.41) with waist circumference, 1.66 (95% CI: 0.69-3.99) with waist-to-hip ratio. Compared with 'normal range', the pooled RR for distal colon cancer was 1.38 (95% CI: 1.02-1.87) for the overweight and 1.23 (95% CI: 0.80-1.90) for the obese. The pooled RR for the highest quantiles vs the lowest quantiles was 1.86 (95% CI: 1.05-3.30) with waist circumference, and 1.79 (95% CI: 0.82-3.90) with waist-to-hip ratio.
CONCLUSION
Obesity is a statistically significant risk factor for colorectal cancer and the relationship is more significant in men than in women among different cancer subsites. Indexes of abdominal obesity are more sensitive than those of overall obesity.
目的
评估肥胖与结直肠癌风险之间的关联。
方法
我们检索了截至2007年1月1日的PubMed、EMBASE和Cochrane图书馆。符合条件的队列研究需允许评估肥胖与结直肠癌之间的因果关联，对肥胖有明确的定义且结直肠癌的结局定义明确。提取研究设计、基线样本量、平均随访时间、协同因素及研究结果。计算合并标准化效应量。
结果
以体重指数（BMI）衡量，超重和肥胖男性患结直肠癌的合并相对风险（RR）为1.37（95%可信区间：1.21 - 1.56），女性为1.07（95%可信区间：0.97 - 1.18）。对于有患结肠癌风险的男性，BMI最高四分位数与最低四分位数相比，合并RR为1.59（95%可信区间：1.35 - 1.86），女性为1.22（95%可信区间：1.08 - 1.39）；对于有患直肠癌风险的男性，合并RR为1.16（95%可信区间：0.93 - 1.46），女性为1.23（95%可信区间：0.98 - 1.54）。对于有患结肠癌风险的男性，腰围最高四分位数与最低四分位数相比，合并RR为1.68（95%可信区间：1.36 - 2.08），女性为1.48（95%可信区间：1.19 - 1.84）；对于有患直肠癌风险的男性，合并RR为1.26（95%可信区间：0.90 - 1.77），女性为1.23（95%可信区间：0.81 - 1.86）。对于有患结肠癌风险的男性，腰臀比最高四分位数与最低四分位数相比，合并RR为1.91（95%可信区间：1.46 - 2.49），女性为1.49（95%可信区间1.23 - 1.81）；对于有患直肠癌风险的男性，合并RR为1.93（95%可信区间：1.19 - 3.13），女性为1.20（95%可信区间：0.81 - 1.78）。与“正常范围”相比，超重者患近端结肠癌的合并RR为1.14（95%可信区间：0.88 - 1.47），肥胖者为1.41（95%可信区间：0.66 - 3.01）。腰围最高四分位数与最低四分位数相比，合并RR为2.05（95%可信区间：1.23 - 3.41），腰臀比为1.66（95%可信区间：0.69 - 3.99）。与“正常范围”相比，超重者患远端结肠癌的合并RR为1.38（95%可信区间：1.02 - 1.87），肥胖者为1.23（95%可信区间：0.80 - 1.90）。腰围最高四分位数与最低四分位数相比，合并RR为1.86（95%可信区间：1.05 - 3.30），腰臀比为1.79（95%可信区间：0.82 - 3.90）。
结论
肥胖是结直肠癌的一个具有统计学意义的危险因素，在不同癌症亚部位中，男性的这种关系比女性更显著。腹部肥胖指标比总体肥胖指标更敏感。
Zotero 插件