蔬菜摄入量与膀胱癌风险的关系：BLadder Cancer Epidemiology and Nutritional Determinants（BLEND）国际研究。
Vegetable intake and the risk of bladder cancer in the BLadder Cancer Epidemiology and Nutritional Determinants (BLEND) international study.
机构信息
Department of Complex Genetics and Epidemiology, School of Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 40 (Room C5.570), 6229 ER, Maastricht, the Netherlands.
CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
出版信息
BMC Med. 2021 Mar 9;19(1):56. doi: 10.1186/s12916-021-01931-8.
BACKGROUND
Although a potential inverse association between vegetable intake and bladder cancer risk has been reported, epidemiological evidence is inconsistent. This research aimed to elucidate the association between vegetable intake and bladder cancer risk by conducting a pooled analysis of data from prospective cohort studies.
METHODS
Vegetable intake in relation to bladder cancer risk was examined by pooling individual-level data from 13 cohort studies, comprising 3203 cases among a total of 555,685 participants. Pooled multivariate hazard ratios (HRs), with corresponding 95% confidence intervals (CIs), were estimated using Cox proportional hazards regression models stratified by cohort for intakes of total vegetable, vegetable subtypes (i.e. non-starchy, starchy, green leafy and cruciferous vegetables) and individual vegetable types. In addition, a diet diversity score was used to assess the association of the varied types of vegetable intake on bladder cancer risk.
RESULTS
The association between vegetable intake and bladder cancer risk differed by sex (P-interaction = 0.011) and smoking status (P-interaction = 0.038); therefore, analyses were stratified by sex and smoking status. With adjustment of age, sex, smoking, energy intake, ethnicity and other potential dietary factors, we found that higher intake of total and non-starchy vegetables were inversely associated with the risk of bladder cancer among women (comparing the highest with lowest intake tertile: HR = 0.79, 95% CI = 0.64-0.98, P = 0.037 for trend, HR per 1 SD increment = 0.89, 95% CI = 0.81-0.99; HR = 0.78, 95% CI = 0.63-0.97, P = 0.034 for trend, HR per 1 SD increment = 0.88, 95% CI = 0.79-0.98, respectively). However, no evidence of association was observed among men, and the intake of vegetable was not found to be associated with bladder cancer when stratified by smoking status. Moreover, we found no evidence of association for diet diversity with bladder cancer risk.
CONCLUSION
Higher intakes of total and non-starchy vegetable are associated with reduced risk of bladder cancer for women. Further studies are needed to clarify whether these results reflect causal processes and potential underlying mechanisms.
背景
尽管已有研究报道蔬菜摄入与膀胱癌风险之间存在潜在的反比关系，但流行病学证据并不一致。本研究旨在通过对来自前瞻性队列研究的数据进行汇总分析，阐明蔬菜摄入与膀胱癌风险之间的关联。
方法
通过汇总来自 13 项队列研究的个体水平数据，对蔬菜摄入与膀胱癌风险之间的关系进行了研究，这些研究共包含 555685 名参与者中的 3203 例病例。使用 Cox 比例风险回归模型，按队列对总蔬菜、蔬菜亚组（即非淀粉类、淀粉类、绿叶类和十字花科蔬菜）和个体蔬菜类型的摄入量进行分层，估计了多变量危险比（HRs）及其相应的 95%置信区间（CIs）。此外，还使用饮食多样性评分来评估不同类型的蔬菜摄入量与膀胱癌风险之间的关联。
结果
蔬菜摄入量与膀胱癌风险之间的关联因性别（P 交互作用=0.011）和吸烟状态（P 交互作用=0.038）而异；因此，按性别和吸烟状态对分析进行了分层。在调整年龄、性别、吸烟状况、能量摄入、种族和其他潜在的饮食因素后，我们发现，对于女性，较高的总蔬菜和非淀粉类蔬菜摄入量与膀胱癌风险呈负相关（与最低摄入量 tertile 相比：HR=0.79，95%CI=0.64-0.98，P=0.037 趋势，HR 每增加 1 SD=0.89，95%CI=0.81-0.99；HR=0.78，95%CI=0.63-0.97，P=0.034 趋势，HR 每增加 1 SD=0.88，95%CI=0.79-0.98）。然而，在男性中没有观察到这种关联，而且按吸烟状态分层时，蔬菜摄入量与膀胱癌之间也没有关联。此外，我们没有发现饮食多样性与膀胱癌风险之间存在关联。
结论
女性中较高的总蔬菜和非淀粉类蔬菜摄入量与膀胱癌风险降低有关。需要进一步的研究来阐明这些结果是否反映了因果关系和潜在的机制。
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