诊断后的脂肪摄入量与致命性前列腺癌和全因死亡率的关系。
Fat intake after diagnosis and risk of lethal prostate cancer and all-cause mortality.
机构信息
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA 94158, USA.
出版信息
JAMA Intern Med. 2013 Jul 22;173(14):1318-26. doi: 10.1001/jamainternmed.2013.6536.
IMPORTANCE
Nearly 2.5 million men currently live with prostate cancer in the United States, yet little is known about the association between diet after diagnosis and prostate cancer progression and overall mortality.
OBJECTIVE
To examine postdiagnostic fat intake in relation to lethal prostate cancer and all-cause mortality.
DESIGN, SETTING, AND PARTICIPANTS: Prospective study of 4577 men with nonmetastatic prostate cancer in the Health Professionals Follow-up Study (1986-2010).
EXPOSURES
Postdiagnostic intake of saturated, monounsaturated, polyunsaturated, trans, animal, and vegetable fat.
MAIN OUTCOMES AND MEASURES
Lethal prostate cancer (distant metastases or prostate cancer-specific death) and all-cause mortality.
RESULTS
We observed 315 events of lethal prostate cancer and 1064 deaths (median follow-up, 8.4 years). Crude rates per 1000 person-years for lethal prostate cancer were as follows (highest vs lowest quintile of fat intake): 7.6 vs 7.3 for saturated, 6.4 vs 7.2 for monounsaturated, 5.8 vs 8.2 for polyunsaturated, 8.7 vs 6.1 for trans, 8.3 vs 5.7 for animal, and 4.7 vs 8.7 for vegetable fat. For all-cause mortality, the rates were 28.4 vs 21.4 for saturated, 20.0 vs 23.7 for monounsaturated, 17.1 vs 29.4 for polyunsaturated, 32.4 vs 17.1 for trans, 32.0 vs 17.2 for animal, and 15.4 vs 32.7 for vegetable fat. Replacing 10% of energy intake from carbohydrate with vegetable fat was associated with a lower risk of lethal prostate cancer (hazard ratio [HR], 0.71; 95% CI, 0.51-0.98; P = .04) and all-cause mortality (HR, 0.74; 95% CI, 0.61-0.88; P = .001). No other fats were associated with lethal prostate cancer. Saturated and trans fats after diagnosis (replacing 5% and 1% of energy from carbohydrate, respectively) were associated with higher all-cause mortality (HR, 1.30 [95% CI, 1.05-1.60; P = .02] and 1.25 [95% CI, 1.05-1.49; P = .01], respectively).
CONCLUSIONS AND RELEVANCE
Among men with nonmetastatic prostate cancer, replacing carbohydrates and animal fat with vegetable fat may reduce the risk of all-cause mortality. The potential benefit of vegetable fat for prostate cancer-specific outcomes merits further research.
重要性
目前，美国有近 250 万男性患有前列腺癌，但对于诊断后的饮食与前列腺癌进展和全因死亡率之间的关系知之甚少。
目的
研究诊断后脂肪摄入与致命性前列腺癌和全因死亡率的关系。
设计、地点和参与者：健康专业人员随访研究中的 4577 名非转移性前列腺癌患者的前瞻性研究（1986-2010 年）。
暴露因素
诊断后摄入的饱和脂肪、单不饱和脂肪、多不饱和脂肪、反式脂肪、动物脂肪和植物脂肪。
主要结局和测量指标
致命性前列腺癌（远处转移或前列腺癌特异性死亡）和全因死亡率。
结果
我们观察到 315 例致命性前列腺癌和 1064 例死亡（中位随访时间为 8.4 年）。每 1000 人年致命性前列腺癌的粗发生率如下（脂肪摄入量最高与最低五分位数相比）：饱和脂肪为 7.6 比 7.3，单不饱和脂肪为 6.4 比 7.2，多不饱和脂肪为 5.8 比 8.2，反式脂肪为 8.7 比 6.1，动物脂肪为 8.3 比 5.7，植物脂肪为 4.7 比 8.7。对于全因死亡率，饱和脂肪为 28.4 比 21.4，单不饱和脂肪为 20.0 比 23.7，多不饱和脂肪为 17.1 比 29.4，反式脂肪为 32.4 比 17.1，动物脂肪为 32.0 比 17.2，植物脂肪为 15.4 比 32.7。用植物脂肪替代 10%的碳水化合物能量摄入与致命性前列腺癌风险降低相关（风险比 [HR]，0.71；95%CI，0.51-0.98；P =.04）和全因死亡率（HR，0.74；95%CI，0.61-0.88；P =.001）。其他脂肪与致命性前列腺癌无关。诊断后摄入的饱和脂肪和反式脂肪（分别替代 5%和 1%的碳水化合物能量）与全因死亡率升高相关（HR，1.30[95%CI，1.05-1.60；P =.02]和 1.25[95%CI，1.05-1.49；P =.01]）。
结论和相关性
在非转移性前列腺癌患者中，用植物脂肪替代碳水化合物和动物脂肪可能会降低全因死亡率的风险。植物脂肪对前列腺癌特异性结局的潜在益处值得进一步研究。
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