School of Public Health, Tianjin Medical University, Qixiangtai Road 22, Heping District, Tianjin, 300070, China.
Department of Bioinformatics, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, China.
BMC Med. 2023 Jul 10;21(1):251. doi: 10.1186/s12916-023-02955-y.
A dietary pattern (DP) may impact on cancer incidence more strongly than individual foods, but this association remains uncertain. Here, we aimed to broadly explore the associations of an obesity-related DP with overall and 19 site-specific cancers.
This study included 114,289 cancer-free participants with at least two dietary assessments. A total of 210 food items were classified into 47 food groups, and the mean amount of each food group was used in reduced-rank regression to derive the obesity-related DP. Cox regressions were conducted to explore the associations of the obesity-related DP with overall and 19 site-specific cancers. The parallel mediation model was constructed to quantify the mediating roles of potential mediators.
During a median follow-up period of 9.4 years, 10,145 (8.9%) incident cancer cases were documented. The derived-DP was characterized by a higher intake of beer and cider, processed meat, high sugar beverages, red meat, and artificial sweetener, and a lower intake of fresh vegetables, olive oil, tea, and high fiber breakfast cereals. Observational analysis showed that a higher obesity-related DP Z-score was linearly associated with an increased risk of overall cancer (adjusted hazard ratio (HR) = 1.02, 95% CI: 1.01, 1.04 per 1-SD increase, corrected P < 0.001). For site-specific cancer, positive linear associations for six cancer sites (oral, colorectal, liver, lung, endometrium, and thyroid) and nonlinear associations for six cancer sites (esophagus, malignant melanoma, prostate, kidney, bladder, and multiple myeloma) were observed. The paralleled mediation analysis suggested that the association between the obesity-related DP and overall cancer is mediated by the body mass index (BMI), the waist-to-hip ratio (WHR), C-reactive protein, high-density lipoproteins (HDLs), and triglycerides.
The developed obesity-related DP is strongly associated with overall and multiple cancer sites. Our findings highlight the complicated and diverse associations between an obesity-related DP and cancers and provide clues for future research directions.
饮食模式（DP）可能比单个食物更能影响癌症的发病率，但这种关联尚不确定。在这里，我们旨在广泛探讨与肥胖相关的 DP 与整体和 19 个特定部位癌症的关联。
本研究纳入了 114289 名无癌症且至少进行了两次饮食评估的参与者。将 210 种食物分为 47 个食物组，使用简化秩回归法对每种食物组的平均摄入量进行分析，得出与肥胖相关的 DP。采用 Cox 回归模型探讨与肥胖相关的 DP 与整体和 19 个特定部位癌症的关系。构建平行中介模型来量化潜在中介因素的中介作用。
在中位随访 9.4 年期间，共记录到 10145 例（8.9%）癌症发病病例。所得到的 DP 特征为摄入更多的啤酒和苹果酒、加工肉类、高糖饮料、红肉和人工甜味剂，而摄入更少的新鲜蔬菜、橄榄油、茶和高纤维早餐谷物。观察性分析表明，与肥胖相关的 DP Z 分数越高，整体癌症的风险呈线性增加（校正后的危险比（HR）= 1.02，95%置信区间（CI）：每增加 1-SD 为 1.01，1.04，校正后 P < 0.001）。对于特定部位的癌症，六个部位（口腔、结直肠、肝脏、肺、子宫内膜和甲状腺）呈正线性关联，六个部位（食管、恶性黑色素瘤、前列腺、肾脏、膀胱和多发性骨髓瘤）呈非线性关联。平行中介分析表明，与肥胖相关的 DP 与整体癌症之间的关联部分是由体重指数（BMI）、腰臀比（WHR）、C 反应蛋白、高密度脂蛋白（HDLs）和甘油三酯介导的。
所开发的与肥胖相关的 DP 与整体和多个癌症部位密切相关。我们的研究结果强调了与肥胖相关的 DP 和癌症之间复杂多样的关联，并为未来的研究方向提供了线索。
