肉和脂肪摄入量与 NIH-AARP 队列中肝脏疾病和肝细胞癌的关联。
Association of meat and fat intake with liver disease and hepatocellular carcinoma in the NIH-AARP cohort.
机构信息
Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, 6120 Executive Blvd., Rockville, MD 20852, USA.
出版信息
J Natl Cancer Inst. 2010 Sep 8;102(17):1354-65. doi: 10.1093/jnci/djq301. Epub 2010 Aug 20.
BACKGROUND
Several plausible mechanisms, including fat, iron, heterocyclic amines, and N-nitroso compounds, link meat intake with chronic liver disease (CLD) and hepatocellular carcinoma (HCC). Few studies have investigated these associations.
METHODS
We prospectively examined the relationship between meat and associated exposures with CLD mortality (n = 551; not including HCC) and HCC incidence (n = 338) in 495 006 men and women of the National Institutes of Health-AARP Diet and Health Study. Hazard ratios (HRs) and 95% confidence intervals (CIs) for the fifth (Q5) vs the first (Q1) quintile were estimated from multivariable adjusted Cox proportional hazards regression models. All tests of statistical significance were two-sided.
RESULTS
We found inverse associations between white meat and risk of CLD (HR = 0.52, 95% CI = 0.39 to 0.70, 7.5 vs 18.2 cases per 100 000 person-years) and HCC (HR = 0.52, 95% CI = 0.36 to 0.77, 5.8 vs 14.3 cases per 100 000 person-years). Red meat was associated with higher risk of CLD (HR = 2.59, 95% CI = 1.86 to 3.61, 22.3 vs 6.2 cases per 100 000 person-years) and HCC (HR = 1.74, 95% CI = 1.16 to 2.61, 14.9 vs 5.7 cases per 100 000 person-years). Among fat types, results were strongest for saturated fat (for CLD, HR = 3.50, 95% CI = 2.48 to 4.96, 23.0 vs 6.5 cases per 100 000 person-years; for HCC, HR = 1.87, 95% CI = 1.23 to 2.85, 14.5 vs 6.3 cases per 100 000 person-years). After mutual adjustment, risk estimates persisted for saturated fat, red meat, and white meat. Heme iron, processed meat, nitrate, and nitrite were positively associated with CLD but not with HCC. Individual heterocyclic amines, 2-amino-3,4,8-trimethylimidazo[4,5,-f]quinoxaline (DiMeIQx), 2-amino-3,8-dimethylimidazo[4,5-f] quinoxaline (MeIQx), and 2-amino-1-methyl-6-phenyl-imidazo[4,5-b]pyridine (PhIP), were not associated with either outcome.
CONCLUSION
Our results suggest that red meat and saturated fat may be associated with increased CLD and HCC risk, whereas white meat may be associated with reduced risk.
背景
有几种推测性机制，包括脂肪、铁、杂环胺和 N-亚硝基化合物，将肉类摄入与慢性肝病（CLD）和肝细胞癌（HCC）联系起来。很少有研究调查过这些关联。
方法
我们前瞻性地研究了 495006 名美国国家卫生研究院-美国退休人员协会饮食与健康研究中男性和女性的肉类摄入量及相关暴露与 CLD 死亡率（n=551；不包括 HCC）和 HCC 发病率（n=338）之间的关系。使用多变量调整的 Cox 比例风险回归模型，估计第五个五分位数（Q5）与第一个五分位数（Q1）之间的危险比（HR）和 95%置信区间（CI）。所有统计学检验均为双侧。
结果
我们发现白肉与 CLD（HR=0.52，95%CI=0.39 至 0.70，7.5 例/每 100000 人年与 18.2 例/每 100000 人年）和 HCC（HR=0.52，95%CI=0.36 至 0.77，5.8 例/每 100000 人年与 14.3 例/每 100000 人年）风险降低有关。红肉与 CLD（HR=2.59，95%CI=1.86 至 3.61，22.3 例/每 100000 人年与 6.2 例/每 100000 人年）和 HCC（HR=1.74，95%CI=1.16 至 2.61，14.9 例/每 100000 人年与 5.7 例/每 100000 人年）风险增加有关。在脂肪类型中，结果最强的是饱和脂肪（CLD：HR=3.50，95%CI=2.48 至 4.96，23.0 例/每 100000 人年与 6.5 例/每 100000 人年；HCC：HR=1.87，95%CI=1.23 至 2.85，14.5 例/每 100000 人年与 6.3 例/每 100000 人年）。在相互调整后，饱和脂肪、红肉和白肉的风险估计仍然存在。血红素铁、加工肉、硝酸盐和亚硝酸盐与 CLD 呈正相关，但与 HCC 无关。个别杂环胺、2-氨基-3,4,8-三甲基咪唑[4,5-f]喹喔啉（DiMeIQx）、2-氨基-3,8-二甲基咪唑[4,5-f]喹喔啉（MeIQx）和 2-氨基-1-甲基-6-苯基-咪唑[4,5-b]吡啶（PhIP）与这两种结局均无关。
结论
我们的研究结果表明，红肉和饱和脂肪可能与 CLD 和 HCC 风险增加有关，而白肉可能与风险降低有关。
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