Jiao Li, Chen Liang, White Donna L, Tinker Lesley, Chlebowski Rowan T, Van Horn Linda V, Richardson Peter, Lane Dorothy, Sangi-Haghpeykar Haleh, El-Serag Hashem B
Department of Medicine, Department of Obstetrics and Gynecology, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX; Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Family, Population and Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, NY; Texas Medical Center Digestive Disease Center, Houston, TX; Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX; City of Hope National Medical Center, Duarte, CA.
J Natl Cancer Inst. 2018 Jan 1;110(1):49-56. doi: 10.1093/jnci/djx117.
Observational studies suggest that diet may influence pancreatic cancer risk. We investigated the effect of a low-fat dietary intervention on pancreatic cancer incidence.
The Women's Health Initiative Dietary Modification (WHI-DM) trial is a randomized controlled trial conducted in 48 835 postmenopausal women age 50 to 79 years in the United States between 1993 and 1998. Women were randomly assigned to the intervention group (n = 19 541), with the goal of reducing total fat intake and increasing intake of vegetables, fruits, and grains, or to the usual diet comparison group (n = 29 294). The intervention concluded in March 2005. We evaluated the effect of the intervention on pancreatic cancer incidence with the follow-up through 2014 using the log-rank test and multivariable Cox proportional hazards regression model. All statistical tests were two-sided.
In intention-to-treat analyses including 46 200 women, 92 vs 165 pancreatic cancer cases were ascertained in the intervention vs the comparison group (P = .23). The multivariable hazard ratio (HR) of pancreatic cancer was 0.86 (95% confidence interval [CI] = 0.67 to 1.11). Risk was statistically significantly reduced among women with baseline body mass indexes (BMIs) of 25 kg/m2 or higher (HR = 0.71, 95% CI = 0.53 to 0.96), but not among women with BMIs of less than 25 kg/m2 (HR = 1.62, 95% CI = 0.97 to 2.71, Pinteraction = .01).
A low-fat dietary intervention was associated with reduced pancreatic cancer incidence in women who were overweight or obese in the WHI-DM trial. Caution needs to be taken in interpreting the findings based on subgroup analyses.
观察性研究表明饮食可能影响胰腺癌风险。我们调查了低脂饮食干预对胰腺癌发病率的影响。
妇女健康倡议饮食调整（WHI-DM）试验是一项随机对照试验，于1993年至1998年在美国48835名50至79岁的绝经后妇女中进行。妇女被随机分配到干预组（n = 19541），目标是减少总脂肪摄入量并增加蔬菜、水果和谷物的摄入量，或分配到常规饮食比较组（n = 29294）。干预于2005年3月结束。我们使用对数秩检验和多变量Cox比例风险回归模型评估了干预对胰腺癌发病率的影响，并随访至2014年。所有统计检验均为双侧检验。
在意向性分析中纳入46200名妇女，干预组与比较组分别确诊92例和165例胰腺癌病例（P = 0.23）。胰腺癌的多变量风险比（HR）为0.86（95%置信区间[CI] = 0.67至1.11）。基线体重指数（BMI）为25 kg/m2或更高的女性中，风险有统计学意义的降低（HR = 0.71，95%CI = 0.53至0.96），但BMI小于25 kg/m2的女性中未降低（HR = 1.62，95%CI = 0.97至2.71，P交互作用 = 0.01）。
在WHI-DM试验中，低脂饮食干预与超重或肥胖女性胰腺癌发病率降低相关。基于亚组分析解释研究结果时需谨慎。
