Sieri Sabina, Agnoli Claudia, Pala Valeria, Grioni Sara, Palli Domenico, Bendinelli Benedetta, Macciotta Alessandra, Ricceri Fulvio, Panico Salvatore, De Magistris Maria Santucci, Tumino Rosario, Fontana Luigi, Krogh Vittorio
Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy.
Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50139 Florence, Italy.
Cancers (Basel). 2022 Jun 13;14(12):2917. doi: 10.3390/cancers14122917.
We prospectively investigated the associations of protein intake with colorectal cancer (CRC) risk in middle-aged Italian men and women. Food consumption was assessed by validated Epic semiquantitative food-frequency questionnaires. Multivariable Cox models stratified by center, age, and sex, adjusted for confounders, estimated the associations of animal and plant protein consumption with CRC risk by subsite. Among 44,824 men and women, we identified 539 incident CRCs after a median follow-up of 14 years. Replacing animal proteins with plant proteins was associated with a decreased risk of rectal (HR, 0.71; 95% CI, 0.55-0.92) but not colon cancer. By contrast, replacing animal proteins with plant proteins from high-glycemic-index (GI) foods was associated with an increased risk of proximal and distal (including sigma) colon cancer (HR, 1.23; 95% CI, 1.07-1.40) but not when animal proteins were replaced with plant proteins from low-GI foods (HR, 0.93; 95% CI, 0.79-1.11). Further evaluation revealed that the increased colon cancer risk was limited to the substitution of proteins from red and processed meat, as well as dairy and eggs, with vegetable proteins from high-GI foods. Participants in the highest quintile of animal protein intake had higher plasma glucose and cholesterol levels than those in the lowest quintile. By contrast, higher intake of plant proteins from low-GI foods was inversely associated with fasting insulin and HOMA-IR levels. In conclusion, replacing animal proteins with plant proteins from high-GI foods was associated with an increased risk of colon cancer.
我们前瞻性地研究了意大利中年男性和女性蛋白质摄入量与结直肠癌（CRC）风险之间的关联。通过经过验证的Epic半定量食物频率问卷评估食物摄入量。采用按中心、年龄和性别分层的多变量Cox模型，并对混杂因素进行调整，估计动物蛋白和植物蛋白摄入量与不同部位结直肠癌风险之间的关联。在44824名男性和女性中，经过14年的中位随访，我们共识别出539例新发结直肠癌病例。用植物蛋白替代动物蛋白与直肠癌风险降低相关（风险比[HR]，0.71；95%置信区间[CI]，0.55 - 0.92），但与结肠癌风险无关。相比之下，用高血糖指数（GI）食物中的植物蛋白替代动物蛋白与近端和远端（包括乙状结肠）结肠癌风险增加相关（HR，1.23；95% CI，1.07 - 1.40），而用低血糖指数食物中的植物蛋白替代动物蛋白时则无此关联（HR，0.93；95% CI，0.79 - 1.11）。进一步评估发现，结肠癌风险增加仅限于用高GI食物中的植物蛋白替代红肉、加工肉以及乳制品和蛋类中的蛋白质。动物蛋白摄入量处于最高五分位数的参与者比最低五分位数的参与者具有更高的血糖和胆固醇水平。相比之下，低血糖指数食物中植物蛋白摄入量较高与空腹胰岛素和胰岛素抵抗指数（HOMA - IR）水平呈负相关。总之，用高GI食物中的植物蛋白替代动物蛋白与结肠癌风险增加相关。
