Behavioral and Epidemiology Research Group, American Cancer Society, 250 Williams St, Atlanta, GA, 30303, USA.
Eur J Nutr. 2020 Jun;59(4):1739-1749. doi: 10.1007/s00394-019-02032-2. Epub 2019 Jun 25.
Evidence supports a role of whole grains in colorectal cancer (CRC) prevention, but the association between gluten intake and CRC risk in healthy populations is unclear. We examined the association of grain and gluten intake with risk of CRC overall and by subsite among Cancer Prevention Study-II Nutrition Cohort participants.
In 1999, 50,118 men and 62,031 women completed food frequency questionnaires assessing grain intake. Gluten intake was estimated using the protein content of grain products. Multivariable-adjusted hazards ratio (HR) and 95% confidence interval (CI) of CRC risk were estimated using Cox proportional hazards regression.
During follow-up through 2013, 1742 verified CRC cases occurred. For the highest vs. lowest quintiles of whole grain intake, HRs (95% CIs) of CRC risk were 0.77 (0.61-0.97; P trend = 0.03) among men and 1.10 (95% CI 0.88-1.36; P trend = 0.14) among women (P interaction by sex = 0.01). Men in the highest vs. lowest quintile of whole grain intake had a 43% lower risk of rectal cancer (HR = 0.57, 95% CI 0.35-0.93, P trend = 0.04). Gluten intake was not associated with CRC risk overall (HR = 1.10, 95% CI 0.93-1.32, P trend = 0.10), but was associated with risk of proximal colon cancer among men and women, combined (HR = 1.37, 95% CI 1.07-1.75, quintile 5 vs. 1, P trend = 0.001) and separately. Refined grains and grain-based sweets were not associated with CRC risk.
We found that higher whole grain intake was associated with lower CRC risk among older US men, but not women. The positive association of gluten intake with the risk of proximal colon cancer deserves further study.
有证据表明全谷物在结直肠癌（CRC）预防中发挥作用，但在健康人群中，谷蛋白摄入量与 CRC 风险之间的关系尚不清楚。我们研究了谷物和谷蛋白摄入量与癌症预防研究 II 营养队列参与者总体 CRC 风险以及亚部位风险的关系。
1999 年，50118 名男性和 62031 名女性完成了评估谷物摄入量的食物频率问卷。谷蛋白摄入量是通过谷物产品的蛋白质含量来估计的。使用 Cox 比例风险回归估计 CRC 风险的多变量调整风险比（HR）和 95%置信区间（CI）。
在 2013 年的随访期间，共发生 1742 例确诊 CRC 病例。与全谷物摄入量最高和最低五分位数相比，男性 CRC 风险的 HR（95%CI）分别为 0.77（0.61-0.97；P 趋势=0.03）和 1.10（95%CI 0.88-1.36；P 趋势=0.14）（性别交互作用 P=0.01）。与全谷物摄入量最低五分位数相比，最高五分位数的男性直肠癌风险降低 43%（HR=0.57，95%CI 0.35-0.93，P 趋势=0.04）。总体而言，谷蛋白摄入与 CRC 风险无关（HR=1.10，95%CI 0.93-1.32，P 趋势=0.10），但与男性和女性的近端结肠癌风险相关，合并（HR=1.37，95%CI 1.07-1.75，五分位数 5 与 1，P 趋势=0.001）和分别。精制谷物和谷物基甜食与 CRC 风险无关。
我们发现，较高的全谷物摄入量与美国老年男性较低的 CRC 风险相关，但在女性中并非如此。谷蛋白摄入与近端结肠癌风险的正相关值得进一步研究。
