老年人总体肥胖及体脂分布指标与癌症风险的比较：欧洲七项前瞻性队列研究个体参与者数据的荟萃分析
Comparison of general obesity and measures of body fat distribution in older adults in relation to cancer risk: meta-analysis of individual participant data of seven prospective cohorts in Europe.
作者信息
Freisling Heinz, Arnold Melina, Soerjomataram Isabelle, O'Doherty Mark George, Ordóñez-Mena José Manuel, Bamia Christina, Kampman Ellen, Leitzmann Michael, Romieu Isabelle, Kee Frank, Tsilidis Konstantinos, Tjønneland Anne, Trichopoulou Antonia, Boffetta Paolo, Benetou Vassiliki, Bueno-de-Mesquita H B As, Huerta José María, Brenner Hermann, Wilsgaard Tom, Jenab Mazda
机构信息
Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), 150 Cours Albert Thomas, 69008 Lyon, France.
Section of Cancer Surveillance, International Agency for Research on Cancer (IARC-WHO), 150 Cours Albert Thomas, 69008 Lyon, France.
出版信息
Br J Cancer. 2017 May 23;116(11):1486-1497. doi: 10.1038/bjc.2017.106. Epub 2017 Apr 25.
BACKGROUND
We evaluated the associations of anthropometric indicators of general obesity (body mass index, BMI), an established risk factor of various cancer, and body fat distribution (waist circumference, WC; hip circumference, HC; and waist-to-hip ratio, WHR), which may better reflect metabolic complications of obesity, with total obesity-related and site-specific (colorectal and postmenopausal breast) cancer incidence.
METHODS
This is a meta-analysis of seven prospective cohort studies participating in the CHANCES consortium including 18 668 men and 24 751 women with a mean age of 62 and 63 years, respectively. Harmonised individual participant data from all seven cohorts were analysed separately and alternatively for each anthropometric indicator using multivariable Cox proportional hazards models.
RESULTS
After a median follow-up period of 12 years, 1656 first-incident obesity-related cancers (defined as postmenopausal female breast, colorectum, lower oesophagus, cardia stomach, liver, gallbladder, pancreas, endometrium, ovary, and kidney) had occurred in men and women. In the meta-analysis of all studies, associations between indicators of adiposity, per s.d. increment, and risk for all obesity-related cancers combined yielded the following summary hazard ratios: 1.11 (95% CI 1.02-1.21) for BMI, 1.13 (95% CI 1.04-1.23) for WC, 1.09 (95% CI 0.98-1.21) for HC, and 1.15 (95% CI 1.00-1.32) for WHR. Increases in risk for colorectal cancer were 16%, 21%, 15%, and 20%, respectively per s.d. of BMI, WC, HC, and WHR. Effect modification by hormone therapy (HT) use was observed for postmenopausal breast cancer (P<0.001), where never HT users showed an ∼20% increased risk per s.d. of BMI, WC, and HC compared to ever users.
CONCLUSIONS
BMI, WC, HC, and WHR show comparable positive associations with obesity-related cancers combined and with colorectal cancer in older adults. For postmenopausal breast cancer we report evidence for effect modification by HT use.
背景
我们评估了一般肥胖的人体测量指标（体重指数，BMI）与各种癌症的既定危险因素，以及可能更好地反映肥胖代谢并发症的体脂分布指标（腰围，WC；臀围，HC；腰臀比，WHR）与肥胖相关癌症总发病率和特定部位（结肠直肠癌和绝经后乳腺癌）癌症发病率之间的关联。
方法
这是一项对参与CHANCES联盟的七项前瞻性队列研究的荟萃分析，包括18668名男性和24751名女性，平均年龄分别为62岁和63岁。使用多变量Cox比例风险模型对来自所有七个队列的统一个体参与者数据分别进行分析，并对每个人体测量指标进行交替分析。
结果
在中位随访期12年后，男性和女性中发生了1656例首次发生的肥胖相关癌症（定义为绝经后女性乳腺癌、结肠直肠癌、下食管、贲门胃、肝脏、胆囊、胰腺、子宫内膜、卵巢和肾脏）。在所有研究的荟萃分析中，肥胖指标每标准差增加与所有肥胖相关癌症综合风险之间的关联产生了以下汇总风险比：BMI为1.11（95%CI 1.02-1.21），WC为1.13（95%CI 1.04-1.23），HC为1.09（95%CI 0.98-1.21），WHR为1.15（95%CI 1.00-1.32）。结肠直肠癌风险每标准差增加分别为BMI的16%、WC的21%、HC的15%和WHR的20%。在绝经后乳腺癌中观察到激素治疗（HT）使用的效应修正（P<0.001），与曾经使用者相比，从未使用HT的使用者每标准差的BMI、WC和HC显示风险增加约20%。
结论
BMI、WC、HC和WHR在老年人中与肥胖相关癌症综合发病率和结肠直肠癌发病率显示出相当的正相关。对于绝经后乳腺癌，我们报告了HT使用效应修正的证据。
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