Händel M N, Rohde J F, Jacobsen R, Nielsen S M, Christensen R, Alexander D D, Frederiksen P, Heitmann B L
The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark.
Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark.
Eur J Clin Nutr. 2020 Aug;74(8):1132-1148. doi: 10.1038/s41430-020-0576-9. Epub 2020 Feb 6.
The objective was to use accumulated evidence to explore the association between processed meat intake and risk of colorectal cancer (CRC) and to investigate the reliability of associations by evaluating patterns of risk by study population characteristics and research quality parameters. We included 29 observational prospective cohort studies with relative risk estimates and 95% confidence intervals for CRC according to various levels of processed meat consumption. Risk of bias was assessed using Risk Of Bias In Non-randomized Studies-of Interventions (ROBINS-I) tool. Data sources were PubMed and Embase up to January 2017. The summary relative risks for high versus low processed meat consumption and risk of CRC, colon, and rectal cancer were 1.13 (95% CI: 1.01, 1.26), 1.19 (95% CI: 1.09, 1.31), and 1.21 (95% CI: 0.98, 1.49), respectively. Similar estimates were observed for the dose-response analyses. Heterogeneity across studies was detected in most analytical models. The overall judgment showed that two out of 29 studies had a moderate risk of bias, 25 had a serious risk of bias, and 2 had a critical risk of bias. The bias domains most often rated critical were bias due to risk of confounding, bias due to missing data, and selective outcome reporting bias. Although this meta-analysis indicates a modest association between processed meat intake and an increased risk of CRC, our assessment of internal validity warrants a cautious interpretation of these results, as most of the included studies were judged to have serious or critical risks of bias.
目的是利用积累的证据探讨加工肉类摄入量与结直肠癌（CRC）风险之间的关联，并通过根据研究人群特征和研究质量参数评估风险模式来调查关联的可靠性。我们纳入了29项观察性前瞻性队列研究，这些研究根据不同水平的加工肉类消费给出了CRC的相对风险估计值和95%置信区间。使用干预性非随机研究中的偏倚风险（ROBINS-I）工具评估偏倚风险。数据来源为截至2017年1月的PubMed和Embase。高加工肉类摄入量与低加工肉类摄入量相比，CRC、结肠癌和直肠癌风险的汇总相对风险分别为1.13（95%CI：1.01，1.26）、1.19（95%CI：1.09，1.31）和1.21（95%CI：0.98，1.49）。剂量反应分析也观察到了类似的估计值。在大多数分析模型中检测到研究间存在异质性。总体判断显示，29项研究中有2项存在中度偏倚风险，25项存在严重偏倚风险，2项存在关键偏倚风险。最常被评为关键的偏倚领域是混杂风险导致的偏倚、数据缺失导致的偏倚和选择性结果报告偏倚。尽管这项荟萃分析表明加工肉类摄入量与CRC风险增加之间存在适度关联，但我们对内部有效性的评估要求谨慎解释这些结果，因为纳入的大多数研究被判定存在严重或关键的偏倚风险。
