Chen G-C, Chen S-J, Zhang R, Hidayat K, Qin J-B, Zhang Y-S, Qin L-Q
Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, Suzhou, China.
Department of Oncology, the Second Affiliated Hospital of Soochow University, Suzhou, China.
Obes Rev. 2016 Nov;17(11):1167-1177. doi: 10.1111/obr.12443. Epub 2016 Jul 19.
Epidemiologic evidence has shown inconsistent findings regarding the relationships between abdominal fatness, as measured by waist circumferences (WC) or waist-to-hip ratio (WHR), and risks of pre- and postmenopausal breast cancer (BC). A dose-response meta-analysis of prospective studies was conducted to address these issues. Potentially eligible studies were identified by searching PubMed and EMBASE databases, and by carefully reviewing the bibliographies of retrieved publications and related reviews. The summary relative risks (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. When the most fully adjusted RRs were combined, both WC (14 studies, RR = 1.06, 95% CI: 1.04-1.09, I = 29.9%) and WHR (15 studies, RR = 1.07, 95% CI: 1.01-1.14, I = 52.9%) were significantly positively associated with postmenopausal BC, but neither WC (eight studies, RR = 1.05, 95% CI: 0.99-1.10, I = 0%) nor WHR (11 studies, RR = 1.07, 95% CI: 0.95-1.21, I = 59.7%) were associated with premenopausal BC. The WHR-postmenopausal BC association lost statistical significance after correcting publication bias (RR = 1.06, 95% CI: 0.99-1.13). When considering BMI-adjusted RRs, WC was associated with both pre- (five studies, RR = 1.09, 95% CI: 1.02-1.16, I = 0%) and postmenopausal BC (seven studies, RR = 1.05, 95% CI: 1.02-1.08, I = 6.3%), whereas WHR was not associated with either pre- (seven studies, RR = 1.12, 95% CI: 0.94-1.34, I = 70.9%) or postmenopausal BC (eight studies, RR = 1.05, 95% CI: 0.98-1.13, I = 57.3%). Among non-current (former or never) users of hormone replacement therapy, the summary RR of postmenopausal BC associated with WC was 1.08 (95% CI: 1.03-1.05, I = 69.2%, seven studies; BMI-adjusted RR = 1.05, 95% CI: 1.02-1.09, I = 22.8%, four studies). This meta-analysis indicates that central obesity measured by WC, but not by WHR, is associated with modestly increased risks of both pre- and postmenopausal BC independent of general obesity.
流行病学证据表明，以腰围（WC）或腰臀比（WHR）衡量的腹部肥胖与绝经前和绝经后乳腺癌（BC）风险之间的关系存在不一致的研究结果。进行了一项前瞻性研究的剂量反应荟萃分析以解决这些问题。通过检索PubMed和EMBASE数据库，并仔细查阅检索到的出版物和相关综述的参考文献，确定了潜在符合条件的研究。使用随机效应模型计算了95%置信区间（CI）的汇总相对风险（RR）。当合并调整最充分的RR时，WC（14项研究，RR = 1.06，95% CI：1.04 - 1.09，I² = 29.9%）和WHR（15项研究，RR = 1.07，95% CI：1.01 - 1.14，I² = 52.9%）均与绝经后BC显著正相关，但WC（8项研究，RR = 1.05，95% CI：0.99 - 1.10，I² = 0%）和WHR（11项研究，RR = 1.07，95% CI：0.95 - 1.21，I² = 59.7%）均与绝经前BC无关。校正发表偏倚后，WHR与绝经后BC的关联失去统计学意义（RR = 1.06，95% CI：0.99 - 1.13）。当考虑BMI调整后的RR时，WC与绝经前（5项研究，RR = 1.09，95% CI：1.02 - 1.16，I² = 0%）和绝经后BC（7项研究，RR = 1.05，95% CI：1.02 - 1.08，I² = 6.3%）均相关，而WHR与绝经前（7项研究，RR = 1.12，95% CI：0.94 - 1.34，I² = 70.9%）或绝经后BC（8项研究，RR = 1.05，95% CI：0.98 - 1.13，I² = 57.3%）均无关。在非当前（既往或从未）使用激素替代疗法的人群中，与WC相关的绝经后BC的汇总RR为1.08（95% CI：1.03 - 1.05，I² = 69.2%，7项研究；BMI调整后的RR = 1.05，95% CI：1.02 - 1.09，I² = 22.8%，4项研究）。这项荟萃分析表明，以WC而非WHR衡量的中心性肥胖与绝经前和绝经后BC风险适度增加相关，且独立于一般肥胖。
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