Kantor Elizabeth D, Udumyan Ruzan, Signorello Lisa B, Giovannucci Edward L, Montgomery Scott, Fall Katja
Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA.
Clinical Epidemiology and Biostatistics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Gut. 2016 Aug;65(8):1289-95. doi: 10.1136/gutjnl-2014-309007. Epub 2015 May 18.
Adult obesity and inflammation have been associated with risk of colorectal cancer (CRC); however, less is known about how adolescent body mass index (BMI) and inflammation, as measured by erythrocyte sedimentation rate (ESR), relate to CRC risk. We sought to evaluate these associations in a cohort of 239 658 Swedish men who underwent compulsory military enlistment examinations in late adolescence (ages 16-20 years).
At the time of the conscription assessment (1969-1976), height and weight were measured and ESR was assayed. By linkage to the national cancer registry, these conscripts were followed for CRC through 1 January 2010. Over an average of 35 years of follow-up, 885 cases of CRC occurred, including 501 colon cancers and 384 rectal cancers. Cox regression was used to estimate adjusted HRs and corresponding 95% CIs.
Compared with normal weight (BMI 18.5 to <25 kg/m(2)) in late adolescence, upper overweight (BMI 27.5 to <30 kg/m(2)) was associated with a 2.08-fold higher risk of CRC (95% CI 1.40 to 3.07) and obesity (BMI 30+ kg/m(2)) was associated with a 2.38-fold higher risk of CRC (95% CI 1.51 to 3.76) (p-trend: <0.001). Male adolescents with ESR (15+ mm/h) had a 63% higher risk of CRC (HR 1.63; 95% CI 1.08 to 2.45) than those with low ESR (<10 mm/h) (p-trend: 0.006). Associations did not significantly differ by anatomic site.
Late-adolescent BMI and inflammation, as measured by ESR, may be independently associated with future CRC risk. Further research is needed to better understand how early-life exposures relate to CRC.
成人肥胖和炎症与结直肠癌（CRC）风险相关；然而，对于青少年体重指数（BMI）和以红细胞沉降率（ESR）衡量的炎症与CRC风险之间的关系，人们了解较少。我们试图在一组239658名瑞典男性队列中评估这些关联，这些男性在青春期后期（16 - 20岁）接受了义务兵役体检。
在征兵评估时（1969 - 1976年），测量身高和体重并检测ESR。通过与国家癌症登记处的关联，对这些应征入伍者随访至2010年1月1日。在平均35年的随访期间，发生了885例CRC，包括501例结肠癌和384例直肠癌。采用Cox回归估计调整后的风险比（HR）及相应的95%可信区间（CI）。
与青春期后期正常体重（BMI 18.5至<25 kg/m²）相比，超重（BMI 27.5至<30 kg/m²）与CRC风险高2.08倍相关（95% CI 1.40至3.07），肥胖（BMI 30+ kg/m²）与CRC风险高2.38倍相关（95% CI 1.51至3.76）（P趋势：<0.001）。ESR（15+ mm/h）的男性青少年患CRC的风险比ESR低（<10 mm/h）的青少年高63%（HR 1.63；95% CI 1.08至2.45）（P趋势：0.006）。不同解剖部位的关联无显著差异。
青春期后期的BMI和以ESR衡量的炎症可能独立于未来CRC风险相关。需要进一步研究以更好地理解早期生活暴露与CRC的关系。
