在结直肠癌幸存者中，诊断后摄入更多促炎饮食与复发风险和全因死亡率升高相关。

Postdiagnostic intake of a more proinflammatory diet is associated with a higher risk of recurrence and all-cause mortality in colorectal cancer survivors.

机构信息

Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands.

出版信息

Am J Clin Nutr. 2023 Feb;117(2):243-251. doi: 10.1016/j.ajcnut.2022.11.018. Epub 2022 Dec 22.

DOI:10.1016/j.ajcnut.2022.11.018

PMID:36811565

Abstract

BACKGROUND

The inflammatory potential of the diet has been associated with colorectal cancer (CRC) risk, but its association with CRC prognosis is unclear.

OBJECTIVE

To investigate the inflammatory potential of the diet in relation to recurrence and all-cause mortality among persons diagnosed with stage I to III CRC.

METHODS

Data of the COLON study, a prospective cohort among CRC survivors were used. Dietary intake, 6 mo after diagnosis, was assessed by using a food frequency questionnaire and was available for 1631 individuals. The empirical dietary inflammatory pattern (EDIP) score was used as a proxy for the inflammatory potential of the diet. The EDIP score was created by using reduced rank regression and stepwise linear regression to identify food groups that explained most of the variations in plasma inflammatory markers (IL6, IL8, C-reactive protein, and tumor necrosis factor-α) measured in a subgroup of survivors (n = 421). Multivariable Cox proportional hazard models with restricted cubic splines were used to investigate the relation between the EDIP score and CRC recurrence and all-cause mortality. Models were adjusted for age, sex, BMI, PAL, smoking status, stage of disease, and tumor location.

RESULTS

The median follow-up time was 2.6 y (IQR: 2.1) for recurrence and 5.6 y (IQR: 3.0) for all-cause mortality, during which 154 and 239 events occurred, respectively. A nonlinear positive association between the EDIP score and recurrence and all-cause mortality was observed. For example, a more proinflammatory diet (EDIP score +0.75) compared with the median (EDIP score 0) was associated with a higher risk of CRC recurrence (HR: 1.15; 95% CI: 1.03, 1.29) and all-cause mortality (HR: 1.23; 95% CI: 1.12, 1.35).

CONCLUSIONS

A more proinflammatory diet was associated with a higher risk of recurrence and all-cause mortality in CRC survivors. Further intervention studies should investigate whether a switch to a more anti-inflammatory diet improves CRC prognosis.

摘要

背景

饮食的炎症潜能与结直肠癌（CRC）风险相关，但与 CRC 预后的关系尚不清楚。

目的

研究饮食的炎症潜能与诊断为 I 期至 III 期 CRC 的患者的复发和全因死亡率之间的关系。

方法

使用 COLON 研究的数据，这是一项 CRC 幸存者的前瞻性队列研究。在诊断后 6 个月，通过食物频率问卷评估饮食摄入情况，共有 1631 名个体的数据可用。经验性饮食炎症模式（EDIP）评分被用作饮食炎症潜能的替代指标。EDIP 评分通过使用降秩回归和逐步线性回归来创建，以确定解释在幸存者亚组（n = 421）中测量的血浆炎症标志物（IL6、IL8、C 反应蛋白和肿瘤坏死因子-α）变化的大部分食物组。使用受限立方样条的多变量 Cox 比例风险模型来研究 EDIP 评分与 CRC 复发和全因死亡率之间的关系。模型调整了年龄、性别、BMI、PAL、吸烟状况、疾病分期和肿瘤位置。

结果

复发的中位随访时间为 2.6 年（IQR：2.1），全因死亡率的中位随访时间为 5.6 年（IQR：3.0），在此期间分别发生了 154 例和 239 例事件。EDIP 评分与复发和全因死亡率之间观察到非线性正相关。例如，与中位数（EDIP 评分 0）相比，饮食更具促炎作用（EDIP 评分+0.75）与 CRC 复发的风险增加相关（HR：1.15；95%CI：1.03，1.29）和全因死亡率（HR：1.23；95%CI：1.12，1.35）。