Jeong Seok-Hoo, Kim Pumsoo, Yi Sang-Wook, Kim Yu Jin, Baeg Myong Ki, Yi Jee-Jeon
Department of Internal Medicine, Catholic Kwandong University International St. Mary's Hospital, Incheon, Korea.
Department of Preventive Medicine and Public Health, Catholic Kwandong University College of Medicine, Gangneung, Korea.
J Gastroenterol Hepatol. 2018 Feb 6. doi: 10.1111/jgh.14115.
The association between body mass index (BMI) and mortality from gastrointestinal (GI) cancer remains unclear, especially in Asian populations.
A total of 510 148 Korean adults who participated in routine health examinations during the period 2002-2003 were followed up until 2013.
During a mean follow up of 10.5 years, 7831 individuals died of GI cancer. Various associations with BMI were found: U-curve (overall GI, colorectal, liver, and gallbladder cancer), L-curve (stomach cancer), linear (esophageal, extrahepatic bile duct [EBD], and small intestine cancer), and none (pancreatic cancer). Overall GI cancer mortality was lowest at approximately 23.5-26 kg/m . For cancers with linear associations, the multivariable adjusted hazard ratios per each 5 kg/m higher BMI were 0.53 (95% confidence interval = 0.43-0.65, esophagus), 1.19 (1.02-1.40, EBD), and 0.64 (0.41-0.999, small intestine). For cancers with U-curve or L-curve associations, the corresponding hazard ratios ≥25 kg/m were 1.19 (1.08-1.32, overall GI), 1.30 (1.04-1.64, colorectal), 1.28 (1.07-1.53, liver), and 1.30 (0.85-1.97, gallbladder), while in the range of <25 kg/m , they were 0.81 (0.76-0.87, overall GI), 0.43 (0.32-0.58, esophagus), 0.70 (0.62-0.79, stomach), and 0.77 (0.65-0.90, colorectal), and these inverse associations did not weaken after excluding the first 7 years of follow up and ever smokers.
Both low and high BMIs were associated with excess mortality from GI cancers in Korean adults. EBD cancer had a positive association, while esophageal and small intestine cancers had inverse associations. Above 25 kg/m , liver and colorectal cancers had positive associations with BMI, whereas below 25 kg/m , stomach and colorectal cancers had inverse associations.
体重指数（BMI）与胃肠道（GI）癌死亡率之间的关联仍不明确，尤其是在亚洲人群中。
对2002年至2003年期间参加常规健康检查的510148名韩国成年人进行随访，直至2013年。
在平均10.5年的随访期间，7831人死于胃肠道癌。发现了BMI与各种癌症之间的不同关联：U型曲线（总体胃肠道、结肠直肠、肝脏和胆囊癌）、L型曲线（胃癌）、线性（食管癌、肝外胆管[EBD]癌和小肠癌）以及无关联（胰腺癌）。总体胃肠道癌死亡率在约23.5至26kg/m²时最低。对于呈线性关联的癌症，BMI每升高5kg/m²，多变量调整后的风险比分别为：0.53（95%置信区间=0.43-0.65，食管癌）、1.19（1.02-1.40，EBD癌）和0.64（0.41-0.999，小肠癌）。对于呈U型曲线或L型曲线关联的癌症，BMI≥25kg/m²时相应的风险比分别为：1.19（1.08-1.32，总体胃肠道癌）、1.30（1.04-1.64，结肠直肠癌）、1.28（1.07-1.53，肝癌）和1.30（0.85-1.97，胆囊癌），而在<25kg/m²范围内，相应的风险比分别为：0.81（0.76-0.87，总体胃肠道癌）、0.43（0.32-0.58，食管癌）、0.70（0.62-0.79，胃癌）和0.77（0.65-0.90，结肠直肠癌），并且在排除随访的前7年和曾经吸烟者后，这些反向关联并未减弱。
低BMI和高BMI均与韩国成年人胃肠道癌的额外死亡率相关。EBD癌呈正相关，而食管癌和小肠癌呈负相关。BMI高于25kg/m²时，肝癌和结肠直肠癌与BMI呈正相关，而低于25kg/m²时，胃癌和结肠直肠癌呈负相关。
