强化体重减轻干预和 2 型糖尿病成人的癌症风险：对 LOOK AHEAD 随机临床试验的分析。
Intensive Weight Loss Intervention and Cancer Risk in Adults with Type 2 Diabetes: Analysis of the Look AHEAD Randomized Clinical Trial.
机构信息
Departments of Medicine, Epidemiology, and Oncology, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA.
Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
出版信息
Obesity (Silver Spring). 2020 Sep;28(9):1678-1686. doi: 10.1002/oby.22936.
OBJECTIVE
This study was designed to determine whether intensive lifestyle intervention (ILI) aimed at weight loss lowers cancer incidence and mortality.
METHODS
Data from the Look AHEAD trial were examined to investigate whether participants randomized to ILI designed for weight loss would have reduced overall cancer incidence, obesity-related cancer incidence, and cancer mortality, as compared with the diabetes support and education (DSE) comparison group. This analysis included 4,859 participants without a cancer diagnosis at baseline except for nonmelanoma skin cancer.
RESULTS
After a median follow-up of 11 years, 684 participants (332 in ILI and 352 in DSE) were diagnosed with cancer. The incidence rates of obesity-related cancers were 6.1 and 7.3 per 1,000 person-years in ILI and DSE, respectively, with a hazard ratio (HR) of 0.84 (95% CI: 0.68-1.04). There was no significant difference between the two groups in total cancer incidence (HR, 0.93; 95% CI: 0.80-1.08), incidence of nonobesity-related cancers (HR, 1.02; 95% CI: 0.83-1.27), or total cancer mortality (HR, 0.92; 95% CI: 0.68-1.25).
CONCLUSIONS
An ILI aimed at weight loss lowered incidence of obesity-related cancers by 16% in adults with overweight or obesity and type 2 diabetes. The study sample size likely lacked power to determine effect sizes of this magnitude and smaller.
目的
本研究旨在确定旨在减肥的强化生活方式干预（ILI）是否降低癌症发病率和死亡率。
方法
对 LOOK AHEAD 试验的数据进行了检查，以调查随机分配至旨在减肥的 ILI 的参与者与糖尿病支持和教育（DSE）对照组相比，是否会降低总体癌症发病率、肥胖相关癌症发病率和癌症死亡率。该分析包括 4859 名基线时除非黑色素瘤皮肤癌外无癌症诊断的参与者。
结果
中位随访 11 年后，684 名参与者（ILI 组 332 名，DSE 组 352 名）被诊断患有癌症。ILI 和 DSE 组肥胖相关癌症的发病率分别为每 1000 人年 6.1 例和 7.3 例，风险比（HR）为 0.84（95%CI：0.68-1.04）。两组在总癌症发病率（HR，0.93；95%CI：0.80-1.08）、非肥胖相关癌症发病率（HR，1.02；95%CI：0.83-1.27）或总癌症死亡率（HR，0.92；95%CI：0.68-1.25）方面均无显著差异。
结论
针对超重或肥胖和 2 型糖尿病患者的减肥 ILI 可使肥胖相关癌症的发病率降低 16%。该研究样本量可能缺乏确定这种和更小效应大小的能力。
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