Division of Pediatric Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota 55455, USA.
Pediatrics. 2012 Jun;129(6):1125-33. doi: 10.1542/peds.2011-3418. Epub 2012 May 21.
Epidemiologic evidence indicates that prenatal vitamin supplementation reduces risk for some childhood cancers; however, a systematic evaluation of population-based childhood cancer incidence trends after fortification of enriched grain products with folic acid in the United States in 1996-1998 has not been previously reported. Here we describe temporal trends in childhood cancer incidence in association with US folic acid fortification.
Using Surveillance, Epidemiology, and End Results program data (1986-2008), we calculated incidence rate ratios and 95% confidence intervals to compare pre- and postfortification cancer incidence rates in children aged 0 to 4 years. Incidence trends were also evaluated by using joinpoint and loess regression models.
From 1986 through 2008, 8829 children aged 0 to 4 years were diagnosed with malignancies, including 3790 and 3299 in utero during the pre- and postfortification periods, respectively. Pre- and postfortification incidence rates were similar for all cancers combined and for most specific cancer types. Rates of Wilms tumor (WT), primitive neuroectodermal tumors (PNETs), and ependymomas were significantly lower postfortification. Joinpoint regression models detected increasing WT incidence from 1986 through 1997 followed by a sizable decline from 1997 through 2008, and increasing PNET incidence from 1986 through 1993 followed by a sharp decrease from 1993 through 2008. Loess curves indicated similar patterns.
These results provide support for a decrease in WT and possibly PNET incidence, but not other childhood cancers, after US folic acid fortification.
流行病学证据表明，产前维生素补充可降低某些儿童癌症的风险；然而，在美国 1996-1998 年在强化谷物产品中添加叶酸之后，对人群为基础的儿童癌症发病率趋势进行的系统评估尚未见报道。在此，我们描述了与美国叶酸强化相关的儿童癌症发病率的时间趋势。
我们使用监测、流行病学和最终结果（Surveillance, Epidemiology, and End Results，SEER）计划的数据（1986-2008 年），计算发病率比和 95%置信区间，以比较儿童（0 至 4 岁）在强化前和强化后的癌症发病率。还使用 joinpoint 和 loess 回归模型评估了发病趋势。
1986 年至 2008 年间，诊断出 8829 名 0 至 4 岁的儿童患有恶性肿瘤，包括强化前和强化后分别有 3790 例和 3299 例在宫内发生的病例。所有癌症和大多数特定癌症类型的强化前和强化后的发病率相似。Wilms 肿瘤（WT）、原始神经外胚层肿瘤（PNETs）和室管膜瘤的发病率在强化后明显降低。Joinpoint 回归模型发现 WT 发病率从 1986 年至 1997 年呈上升趋势，随后从 1997 年至 2008 年大幅下降，PNET 发病率从 1986 年至 1993 年呈上升趋势，随后从 1993 年至 2008 年急剧下降。loess 曲线显示出相似的模式。
这些结果支持美国叶酸强化后 WT 发病率可能下降，可能还包括 PNET 发病率下降，但其他儿童癌症发病率没有下降。
