Kabat Geoffrey C, Matthews Charles E, Kamensky Victor, Hollenbeck Albert R, Rohan Thomas E
From the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (GCK, VK, and TER); the Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD (CEM); and AARP, Washington, DC (ARH).
Am J Clin Nutr. 2015 Mar;101(3):558-69. doi: 10.3945/ajcn.114.094854. Epub 2015 Jan 7.
Several health agencies have issued guidelines promoting behaviors to reduce chronic disease risk; however, little is known about the impact of such guidelines, particularly on cancer incidence.
The objective was to determine whether greater adherence to the American Cancer Society (ACS) cancer prevention guidelines is associated with a reduction in cancer incidence, cancer mortality, and total mortality.
The NIH-AARP Diet and Health Study, a prospective cohort study of 566,401 adults aged 50-71 y at recruitment in 1995-1996, was followed for a median of 10.5 y for cancer incidence, 12.6 y for cancer mortality, and 13.6 y for total mortality. Participants who reported a history of cancer or who had missing data were excluded, yielding 476,396 subjects for analysis. We constructed a 5-level score measuring adherence to ACS guidelines, which included baseline body mass index, physical activity, alcohol intake, and several aspects of diet. Cox proportional hazards models were used to compute HRs and 95% CIs for the association of the adherence score with cancer incidence, cancer mortality, and total mortality. All analyses included fine adjustment for cigarette smoking.
Among 476,396 participants, 73,784 incident first cancers, 16,193 cancer deaths, and 81,433 deaths from all causes were identified in the cohort. Adherence to ACS guidelines was associated with reduced risk of all cancers combined: HRs (95% CIs) for the highest compared with the lowest level of adherence were 0.90 (0.87, 0.93) in men and 0.81 (0.77, 0.84) in women. Fourteen of 25 specific cancer sites showed a reduction in risk associated with increased adherence. Adherence was also associated with reduced cancer mortality [HRs (95% CIs) were 0.75 (0.70, 0.80) in men and 0.76 (0.70, 0.83) in women] and reduced all-cause mortality [HRs (95% CIs) were 0.74 (0.72, 0.76) in men and 0.67 (0.65, 0.70) in women].
In both men and women, adherence to the ACS guidelines was associated with reductions in all-cancer incidence and the incidence of cancer at specific sites, as well as with reductions in cancer mortality and total mortality. These data suggest that, after accounting for cigarette smoking, adherence to a set of healthy behaviors may have considerable health benefits.
几家卫生机构已发布指南，倡导有助于降低慢性病风险的行为；然而，对于此类指南的影响，尤其是对癌症发病率的影响，人们了解甚少。
确定对美国癌症协会（ACS）癌症预防指南的更高依从性是否与癌症发病率、癌症死亡率和总死亡率的降低相关。
NIH-AARP饮食与健康研究是一项前瞻性队列研究，于1995 - 1996年招募了566401名年龄在50 - 71岁的成年人，对癌症发病率随访了10.5年中位数时间，对癌症死亡率随访了12.6年中位数时间，对总死亡率随访了13.6年中位数时间。报告有癌症病史或有缺失数据的参与者被排除，最终有476396名受试者纳入分析。我们构建了一个衡量对ACS指南依从性的5级评分，其中包括基线体重指数、身体活动、酒精摄入量以及饮食的几个方面。采用Cox比例风险模型计算依从性评分与癌症发病率、癌症死亡率和总死亡率之间关联的风险比（HR）及95%可信区间（CI）。所有分析都对吸烟情况进行了精细校正。
在476396名参与者中，队列中确定了73784例首次发生的癌症、16193例癌症死亡以及81433例全因死亡。对ACS指南的依从性与所有癌症综合风险的降低相关：男性中依从性最高与最低水平相比的HR（95%CI）为0.90（0.87，0.93），女性为0.81（0.77，0.84）。25个特定癌症部位中有14个显示出随着依从性增加风险降低。依从性还与癌症死亡率降低相关[男性的HR（95%CI）为0.75（0.70，0.80），女性为0.76（0.70，0.83）]以及全因死亡率降低相关[男性的HR（95%CI）为0.74（0.72，0.76），女性为0.67（0.65，0.70）]。
在男性和女性中，对ACS指南的依从性都与所有癌症发病率和特定部位癌症发病率的降低相关，同时也与癌症死亡率和总死亡率的降低相关。这些数据表明，在考虑吸烟因素后，坚持一套健康行为可能会带来相当大的健康益处。
