Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queens University Belfast, Belfast, Northern Ireland.
Department of Pathology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, Northern Ireland.
Gastroenterology. 2017 Jan;152(1):92-104. doi: 10.1053/j.gastro.2016.09.003. Epub 2016 Sep 14.
BACKGROUND & AIMS: Certain subsets of colorectal serrated polyps (SP) have malignant potential. We performed a systematic review and meta-analysis to investigate the association between modifiable lifestyle factors and risk for SPs.
We conducted a systematic search of Medline, Embase, and Web of Science for observational or interventional studies that contained the terms risk or risk factor, and serrated or hyperplastic, and polyps or adenomas, and colorectal (or synonymous terms), published by March 2016. Titles and abstracts of identified articles were independently reviewed by at least 2 reviewers. Adjusted relative risk (RR) and 95% confidence interval (CI) were combined using random effects meta-analyses to assess the risk of SP, when possible.
We identified 43 studies of SP risk associated with 7 different lifestyle factors: smoking, alcohol, body fatness, diet, physical activity, medication, and hormone-replacement therapy. When we compared the highest and lowest categories of exposure, factors we found to significantly increase risk for SP included tobacco smoking (RR, 2.47; 95% CI, 2.12-2.87), alcohol intake (RR, 1.33; 95% CI, 1.17-1.52), body mass index (RR, 1.40; 95% CI, 1.22-1.61), and high intake of fat or meat. Direct associations for smoking and alcohol, but not body fat, tended to be stronger for sessile serrated adenomas/polyps than hyperplastic polyps. In contrast, factors we found to significantly decrease risks for SP included use of nonsteroidal anti-inflammatory drugs (RR, 0.77; 95% CI, 0.65-0.92) or aspirin (RR, 0.81; 95% CI, 0.67-0.99), as well as high intake of folate, calcium, or fiber. No significant associations were detected between SP risk and physical activity or hormone replacement therapy.
Several lifestyle factors, most notably smoking and alcohol, are associated with SP risk. These findings enhance our understanding of mechanisms of SP development and indicate that risk of serrated pathway colorectal neoplasms could be reduced with lifestyle changes.
某些结直肠锯齿状息肉（SP）亚群具有恶性潜能。我们进行了一项系统评价和荟萃分析，以调查可改变的生活方式因素与 SP 风险之间的关联。
我们对 Medline、Embase 和 Web of Science 进行了系统检索，以查找包含风险或风险因素、锯齿状或增生性、息肉或腺瘤以及结直肠（或同义词）术语的观察性或干预性研究，检索截至 2016 年 3 月。至少有 2 名评审员独立审查了确定的文章的标题和摘要。使用随机效应荟萃分析，当可能时，将调整后的相对风险（RR）和 95％置信区间（CI）合并，以评估 SP 的风险。
我们确定了 43 项与 7 种不同生活方式因素相关的 SP 风险研究：吸烟、饮酒、体脂、饮食、体力活动、药物和激素替代疗法。当我们比较暴露的最高和最低类别时，我们发现以下因素显著增加了 SP 的风险：吸烟（RR，2.47；95％CI，2.12-2.87）、饮酒（RR，1.33；95％CI，1.17-1.52）、体重指数（RR，1.40；95％CI，1.22-1.61）和高脂肪或肉类摄入量高。吸烟和饮酒的直接关联，但不是体脂，对无蒂锯齿状腺瘤/息肉的影响比增生性息肉更强。相比之下，我们发现以下因素显著降低了 SP 的风险：使用非甾体抗炎药（RR，0.77；95％CI，0.65-0.92）或阿司匹林（RR，0.81；95％CI，0.67-0.99），以及高叶酸、钙或纤维摄入量。未发现 SP 风险与体力活动或激素替代疗法之间存在显著关联。
几种生活方式因素，尤其是吸烟和饮酒，与 SP 风险相关。这些发现增强了我们对 SP 发展机制的理解，并表明通过生活方式改变可以降低锯齿状途径结直肠肿瘤的风险。
