Ziegler R G
Adv Exp Med Biol. 1986;206:11-26. doi: 10.1007/978-1-4613-1835-4_3.
Epidemiologic studies of the relationships between vitamins and 3 types of cancer are reviewed. First, the widely reported association between vitamin A and beta-carotene and risk of lung cancer is considered. In a large population-based case-control study of lung cancer among white males in New Jersey, increased intake of vegetables, dark green vegetables, dark yellow-orange vegetables, and carotenoids were each associated with reduced risk, but intake of retinol or total vitamin A was not related. The protective effect of vegetables was limited to current and recent cigarette smokers, which suggests that vegetable intake prevents a late-stage event in carcinogenesis. Consumption of dark yellow-orange vegetables was consistently more predictive of reduced risk than either the total carotenoid index or consumption of any other food group, possible because of the high content of beta-carotene in this food group. The results and limitations of other epidemiologic studies of diet and lung cancer are reviewed. Second, the evolving relationship between multiple micronutrient deficiencies and esophageal cancer is discussed. In a death certificate-based case-control study of esophageal cancer in black males in Washington, D.C., several indicators of general nutritional status, including consumption of fresh or frozen meat and fish, dairy products and eggs, and fruit and vegetables, and the number of meals eaten per day, were inversely and independently correlated with the risk of esophageal cancer. Estimates of intake of micronutrients, such as carotenoids, vitamin C, thiamin, and riboflavin, were less strongly associated with reduced risk than were the broad food groups that provide most of each micronutrient. Thus no single micronutrient deficiency was identified. Other studies suggest that generally poor nutrition may partially explain the susceptibility of urban black men to esophageal cancer. Finally, the postulated association between low folacin levels and risk of cervical cancer is examined. Among women who use oral contraceptives, serum and red blood cell folacin levels were reported to be lower among those with cervical dysplasia. In a clinical trial involving oral contraceptive users, cervical dysplasia gradually decreased in the group supplemented with oral folate but remained unchanged in the group given the placebo. Other epidemiologic studies of diet and cervical cancer are discussed.
本文综述了维生素与三种癌症之间关系的流行病学研究。首先，探讨了维生素A、β-胡萝卜素与肺癌风险之间广泛报道的关联。在新泽西州针对白人男性肺癌开展的一项大型基于人群的病例对照研究中，蔬菜、深绿色蔬菜、深黄橙色蔬菜及类胡萝卜素摄入量增加均与风险降低相关，但视黄醇或总维生素A摄入量与之无关。蔬菜的保护作用仅限于当前及近期吸烟者，这表明蔬菜摄入可预防致癌过程中的晚期事件。深黄橙色蔬菜的食用对降低风险的预测作用始终高于总类胡萝卜素指数或其他任何食物组的食用，这可能是因为该食物组中β-胡萝卜素含量高。本文还综述了其他饮食与肺癌流行病学研究的结果及局限性。其次，讨论了多种微量营养素缺乏与食管癌之间不断演变的关系。在华盛顿特区针对黑人男性食管癌开展的一项基于死亡证明的病例对照研究中，包括新鲜或冷冻肉类及鱼类、乳制品和蛋类、水果和蔬菜的食用量以及每日用餐次数在内的多项一般营养状况指标，均与食管癌风险呈负相关且相互独立。类胡萝卜素、维生素C、硫胺素和核黄素等微量营养素摄入量的估计值与风险降低的关联程度，低于提供这些微量营养素的主要宽泛食物组。因此，未发现单一微量营养素缺乏的情况。其他研究表明，总体营养状况较差可能部分解释了城市黑人男性易患食管癌的原因。最后，研究了低叶酸水平与宫颈癌风险之间的假定关联。据报道，在使用口服避孕药的女性中，宫颈发育异常者的血清和红细胞叶酸水平较低。在一项涉及口服避孕药使用者的临床试验中，补充口服叶酸的组中宫颈发育异常逐渐减轻，而给予安慰剂的组中则无变化。本文还讨论了其他饮食与宫颈癌的流行病学研究。
