妇女健康倡议饮食调整随机对照试验中的低脂饮食模式与癌症发病率
Low-fat dietary pattern and cancer incidence in the Women's Health Initiative Dietary Modification Randomized Controlled Trial.
作者信息
Prentice Ross L, Thomson Cynthia A, Caan Bette, Hubbell F Allan, Anderson Garnet L, Beresford Shirley A A, Pettinger Mary, Lane Dorothy S, Lessin Lawrence, Yasmeen Shagufta, Singh Baljinder, Khandekar Janardan, Shikany James M, Satterfield Suzanne, Chlebowski Rowan T
机构信息
Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, PO Box 19024, Seattle, WA 98109-1024, USA.
出版信息
J Natl Cancer Inst. 2007 Oct 17;99(20):1534-43. doi: 10.1093/jnci/djm159. Epub 2007 Oct 9.
BACKGROUND
The Women's Health Initiative Dietary Modification (DM) Randomized Controlled Trial evaluated the effects of a low-fat dietary pattern on chronic disease incidence, with breast cancer and colorectal cancer as primary outcomes. The trial protocol also listed ovarian cancer and endometrial cancer as outcomes that may be favorably affected by the intervention.
METHODS
A total of 48,835 postmenopausal women were randomly assigned during 1993-1998 to a DM intervention (n = 19,541) or comparison (usual diet; n = 29,294) group and followed up for an average of 8.1 years. The intervention goal was to reduce total fat intake to 20% of energy and to increase consumption of vegetables, fruits, and grains. Cancer outcomes were verified by pathology report review. We used weighted log-rank tests to compare incidence of invasive cancers of the ovary and endometrium, total invasive cancer, and invasive cancers at other sites between the groups. All statistical tests were two-sided.
RESULTS
Ovarian cancer risk was lower in the intervention than in the comparison group (P = .03). Although the overall ovarian cancer hazard ratio (HR) was not statistically significantly less than 1.0, the hazard ratio decreased with increasing intervention duration (P(trend) = .01). For the first 4 years, the risk for ovarian cancer was similar in the intervention and control groups (0.52 cases per 1000 person-years in the intervention group versus 0.45 per 1000 person-years in the comparison group; HR = 1.16, 95% confidence interval [CI] = 0.73 to 1.84); over the next 4.1 years, the risk was lower in the intervention group (0.38 cases per 1000 person-years in the intervention group versus 0.64 per 1000 person-years in the comparison group; HR = 0.60, 95% CI = 0.38 to 0.96). Risk of cancer of the endometrium did not differ between the groups (P = .18). The estimated risk of total invasive cancer was slightly lower in the intervention group than in the control group (HR = 0.95, 95% CI = 0.89 to 1.01; P = .10).
CONCLUSIONS
A low-fat dietary pattern may reduce the incidence of ovarian cancer among postmenopausal women.
背景
女性健康倡议饮食调整（DM）随机对照试验评估了低脂饮食模式对慢性病发病率的影响，以乳腺癌和结直肠癌作为主要结局。试验方案还将卵巢癌和子宫内膜癌列为可能受该干预措施产生有利影响的结局。
方法
1993年至1998年期间，共48835名绝经后女性被随机分配至DM干预组（n = 19541）或对照组（常规饮食；n = 29294），并平均随访8.1年。干预目标是将总脂肪摄入量降至能量的20%，并增加蔬菜、水果和谷物的摄入量。癌症结局通过病理报告审查进行核实。我们使用加权对数秩检验比较两组之间卵巢和子宫内膜浸润性癌、总浸润性癌以及其他部位浸润性癌的发病率。所有统计检验均为双侧检验。
结果
干预组的卵巢癌风险低于对照组（P = .03）。尽管总体卵巢癌风险比（HR）在统计学上无显著低于1.0，但风险比随干预持续时间增加而降低（P趋势 = .01）。在最初4年中，干预组和对照组的卵巢癌风险相似（干预组每1000人年0.52例，对照组每1000人年0.45例；HR = 1.16，95%置信区间[CI] = 0.73至1.84）；在接下来的4.1年中，干预组风险较低（干预组每1000人年0.38例，对照组每1000人年0.64例；HR = 0.60，95%CI = 0.38至0.96）。两组之间子宫内膜癌风险无差异（P = .18）。干预组总浸润性癌的估计风险略低于对照组（HR = 0.95，95%CI = 0.89至1.01；P = .10）。
结论
低脂饮食模式可能降低绝经后女性卵巢癌的发病率。
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