Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands and.
School of Public Health, Imperial College London, London, UK.
Int J Epidemiol. 2017 Apr 1;46(2):612-621. doi: 10.1093/ije/dyw121.
Nutritional deprivation during growth and development may contribute to colorectal cancer (CRC) risk in later life.
We studied 7906 women who were aged 0-21 years during the 1944-45 Dutch famine, who enrolled in the Prospect-EPIC study between 1993 and 1997. We used Cox proportional hazard analyses to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for colorectal (proximal, distal and rectal) cancer risk across self-reported famine exposure and exposure-age categories, while adjusting for potential confounders.
During a median of 17.3 years of follow-up, 245 CRC cases occurred. Moderately and severely famine-exposed women showed a respective 24% and 44% higher CRC risk compared with women who reported no exposure [HR moderate 1.24 (95% CI: 0.93-1.64); HR severe 1.44 (1.03-2.03); P trend 0.027]. This relation attenuated when adjusted for potential confounders [adjusted HR moderate 1.15 (0.87-1.53); HR severe 1.35 (0.96-1.90); P trend 0.091]. Stratified results suggested that severe famine exposure between 10 and 17 years of age was particularly related to CRC risk[adjusted HR moderate 1.39 (0.91-2.11); HR severe 1.76 (1.10-2.83); P trend 0.019; P interaction(famine*10-17yrs) 0.096]. Overall, we found no differences in famine effects across CRC subsites, but age-at-exposure stratified results suggested an increased risk for proximal CRC in those aged 10-17 years during exposure to the famine [adjusted HR moderate 2.14 (1.06-4.32), HR severe 2.96 (1.35-6.46); P trend 0.005]. Overall and within age-at-exposure categories, tests for subsite specific heterogeneity in famine effects were not significant.
Our findings suggest that severe exposure to a short period of caloric restriction in pre-adult women may relate to CRC risk decades later.
生长发育过程中的营养剥夺可能导致中老年时期结直肠癌（CRC）的风险增加。
我们研究了 1944-1945 年荷兰饥荒期间年龄在 0-21 岁的 7906 名女性，她们于 1993 年至 1997 年期间参加了前瞻性 EPIC 研究。我们使用 Cox 比例风险分析来估计结直肠（近端、远端和直肠）癌症风险的危险比（HR）和 95%置信区间（CI），跨越自我报告的饥荒暴露和暴露年龄类别，同时调整潜在的混杂因素。
在中位 17.3 年的随访期间，发生了 245 例 CRC 病例。与报告无暴露的女性相比，中度和重度饥荒暴露的女性 CRC 风险分别升高 24%和 44%[中度暴露 HR 1.24（95%CI：0.93-1.64）；重度暴露 HR 1.44（1.03-2.03）；趋势 P 值 0.027]。当调整潜在混杂因素时，这种关系减弱[调整后的 HR 中度 1.15（0.87-1.53）；HR 重度 1.35（0.96-1.90）；趋势 P 值 0.091]。分层结果表明，10-17 岁时严重的饥荒暴露与 CRC 风险特别相关[调整后的 HR 中度 1.39（0.91-2.11）；HR 重度 1.76（1.10-2.83）；趋势 P 值 0.019；P 交互作用（饥荒*10-17 岁）0.096]。总体而言，我们没有发现 CRC 亚部位的饥荒效应存在差异，但根据暴露年龄的分层结果表明，在暴露于饥荒期间年龄为 10-17 岁的人群中，近端 CRC 的风险增加[调整后的 HR 中度 2.14（1.06-4.32），HR 重度 2.96（1.35-6.46）；趋势 P 值 0.005]。总体而言和在暴露年龄类别内，对饥荒效应在亚部位特异性方面的差异检验没有显著意义。
我们的研究结果表明，成年前女性严重暴露于短期热量限制可能与几十年后结直肠癌的风险有关。
