Zhang Q L, Zheng W, Li H L, Gao J, Fang J, Gao L F, Liu D K, Shu X O, Xiang Y B
School of Public Health, Fudan University, Shanghai 200032, China.
Zhonghua Yu Fang Yi Xue Za Zhi. 2017 May 6;51(5):386-392. doi: 10.3760/cma.j.issn.0253-9624.2017.05.004.
To investigate the combined impact of lifestyle factors on stomach cancer risk. We analyzed the data from the Shanghai Men's Health Study (SMHS) (2002-2013). The SMHS was conducted in eight neighborhood communities of urban Shanghai. From 2002 through June 2006, 61 480 residents aged 40 to 74 years old with no history of cancer were recruited. Failure time was the date of stomach cancer incidence, death or date of the last follow-up (December 31, 2013). The first two in-person follow-up surveys were conducted in 2004-2008, and 2008-2011, respectively. Using data on lifestyle, the healthy lifestyle index (HLI) was developed. The following lifestyle factors were included: smoking, alcohol consumption, diet habit, overweighted and physical activity. Cox proportional hazard models were used to evaluate the association of stomach cancer risk with lifestyle factors and HLI. Over 9.28 years' follow-up, 477 incident cases of stomach cancer were identified from 59 503 study participants. Participants with zero, one, two, three, four, and five favorable lifestyle behaviors accounted for 3.44% (2 045), 18.14% (10 793), 33.68% (20 041), 29.43% (17 511), 12.82% (7 627), and 2.50% (1 486), respectively. Among all the five lifestyle factors, smoking and alcohol use were significantly related to stomach cancer risk. The relative risk of stomach cancer was 0.71 (95: 0.57-0.87) for those who never smoked or quitted smoking for no less than 10 years and 0.70 (95: 0.55-0.90) for those who consumed alcohol no more than 14 drinks per week. For each increment of healthy lifestyle index, the relative risk of stomach cancer was 0.86 (95: 0.79-0.95). Compared to men with none or one healthy lifestyle factor, the relative risk for those with four or five was 0.62 (95: 0.46-0.83). When we rebuilt HLI using more categories of each lifestyle factors, the HLI ranged from 0 to 11. For each point increase, the relative risk of stomach cancer was 0.93 (95: 0.89-0.97). Compared those with 0 to 3 points, the relative risk of those with 8 to 11 points was 0.64 (95: 0.47-0.87). In the SMHS, only a small proportion of men adhered to all the five healthy lifestyle factors. Compared to those with none or one healthy lifestyle behaviors, those with five may prevent about 1/3 stomach cancer incidence and the HLI was inversely associated with stomach cancer risk.
为研究生活方式因素对胃癌风险的综合影响。我们分析了上海男性健康研究（SMHS）（2002 - 2013年）的数据。SMHS在上海市中心的八个社区进行。2002年至2006年6月，招募了61480名年龄在40至74岁之间且无癌症病史的居民。失效时间为胃癌发病日期、死亡日期或最后一次随访日期（2013年12月31日）。前两次面对面随访调查分别在2004 - 2008年和2008 - 2011年进行。利用生活方式数据，制定了健康生活方式指数（HLI）。纳入的生活方式因素如下：吸烟、饮酒、饮食习惯、超重和身体活动。采用Cox比例风险模型评估胃癌风险与生活方式因素及HLI的关联。在9.28年的随访中，从59503名研究参与者中确定了477例胃癌发病病例。具有零种、一种、两种、三种、四种和五种良好生活方式行为的参与者分别占3.44%（2045人）、18.14%（10793人）、33.68%（20041人）、29.43%（17511人）、12.82%（7627人）和2.50%（1486人）。在所有五个生活方式因素中，吸烟和饮酒与胃癌风险显著相关。对于从不吸烟或戒烟不少于10年的人，胃癌的相对风险为0.71（95%可信区间：0.57 - 0.87），对于每周饮酒不超过14杯的人，相对风险为0.70（95%可信区间：0.55 - 0.90）。健康生活方式指数每增加一个单位，胃癌的相对风险为0.86（95%可信区间：0.79 - 0.95）。与没有或只有一种健康生活方式因素的男性相比，具有四种或五种健康生活方式因素的男性的相对风险为0.62（95%可信区间：0.46 - 0.83）。当我们使用每个生活方式因素的更多类别重新构建HLI时（HLI范围为0至11），HLI每增加一分，胃癌的相对风险为0.93（95%可信区间：0.89 - 0.97）。与HLI为0至3分的人相比，HLI为8至11分的人的相对风险为0.64（95%可信区间：0.47 - 0.87）。在SMHS中，只有一小部分男性坚持所有五个健康生活方式因素。与没有或只有一种健康生活方式行为的人相比，具有五种健康生活方式行为的人可能预防约1/3的胃癌发病，且HLI与胃癌风险呈负相关。
