Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Harvard University, Boston, Massachusetts.
Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden.
JAMA. 2024 Jan 23;331(4):318-328. doi: 10.1001/jama.2023.25869.
Weight loss is common in primary care. Among individuals with recent weight loss, the rates of cancer during the subsequent 12 months are unclear compared with those without recent weight loss.
To determine the rates of subsequent cancer diagnoses over 12 months among health professionals with weight loss during the prior 2 years compared with those without recent weight loss.
DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort analysis of females aged 40 years or older from the Nurses' Health Study who were followed up from June 1978 until June 30, 2016, and males aged 40 years or older from the Health Professionals Follow-Up Study who were followed up from January 1988 until January 31, 2016.
Recent weight change was calculated from the participant weights that were reported biennially. The intentionality of weight loss was categorized as high if both physical activity and diet quality increased, medium if only 1 increased, and low if neither increased.
Rates of cancer diagnosis during the 12 months after weight loss.
Among 157 474 participants (median age, 62 years [IQR, 54-70 years]; 111 912 were female [71.1%]; there were 2631 participants [1.7%] who self-identified as Asian, Native American, or Native Hawaiian; 2678 Black participants [1.7%]; and 149 903 White participants [95.2%]) and during 1.64 million person-years of follow-up, 15 809 incident cancer cases were identified (incident rate, 964 cases/100 000 person-years). During the 12 months after reported weight change, there were 1362 cancer cases/100 000 person-years among all participants with recent weight loss of greater than 10.0% of body weight compared with 869 cancer cases/100 000 person-years among those without recent weight loss (between-group difference, 493 cases/100 000 person-years [95% CI, 391-594 cases/100 000 person-years]; P < .001). Among participants categorized with low intentionality for weight loss, there were 2687 cancer cases/100 000 person-years for those with weight loss of greater than 10.0% of body weight compared with 1220 cancer cases/100 000 person-years for those without recent weight loss (between-group difference, 1467 cases/100 000 person-years [95% CI, 799-2135 cases/100 000 person-years]; P < .001). Cancer of the upper gastrointestinal tract (cancer of the esophagus, stomach, liver, biliary tract, or pancreas) was particularly common among participants with recent weight loss; there were 173 cancer cases/100 000 person-years for those with weight loss of greater than 10.0% of body weight compared with 36 cancer cases/100 000 person-years for those without recent weight loss (between-group difference, 137 cases/100 000 person-years [95% CI, 101-172 cases/100 000 person-years]; P < .001).
Health professionals with weight loss within the prior 2 years had a significantly higher risk of cancer during the subsequent 12 months compared with those without recent weight loss. Cancer of the upper gastrointestinal tract was particularly common among participants with recent weight loss compared with those without recent weight loss.
重要性：体重减轻在初级保健中很常见。在最近体重减轻的人群中，与最近没有体重减轻的人群相比，在随后的 12 个月内癌症的发生率尚不清楚。
目的：确定与最近没有体重减轻的人群相比，在过去 2 年内体重减轻的健康专业人员在随后的 12 个月内诊断出癌症的发生率。
设计、地点和参与者：前瞻性队列分析，纳入年龄在 40 岁及以上的女性，来自护士健康研究，随访时间从 1978 年 6 月至 2016 年 6 月 30 日；纳入年龄在 40 岁及以上的男性，来自健康专业人员随访研究，随访时间从 1988 年 1 月至 2016 年 1 月 31 日。
暴露：参与者的体重变化是根据每两年报告的体重计算得出的。体重减轻的意图被归类为高，如果体力活动和饮食质量都增加；中，如果只有 1 项增加；低，如果都没有增加。
主要结果和措施：体重减轻后 12 个月内癌症的诊断率。
结果：在 157474 名参与者（中位年龄，62 岁[IQR，54-70 岁]；111912 名女性[71.1%]；2631 名参与者[1.7%]自我认定为亚裔、美洲原住民或夏威夷原住民；2678 名黑人参与者[1.7%]；149903 名白人参与者[95.2%]）和 1640 万人年的随访中，共发现 15809 例新发癌症病例（发病率为 964 例/10 万人年）。在报告体重变化后的 12 个月内，与最近没有体重减轻的人群相比，体重减轻超过 10.0%的所有参与者中有 1362 例癌症病例/10 万人年（组间差异，493 例/10 万人年[95%CI，391-594 例/10 万人年]；P<0.001）。在体重减轻意图归类为低的参与者中，体重减轻超过 10.0%的人群中有 2687 例癌症病例/10 万人年，而最近没有体重减轻的人群中有 1220 例癌症病例/10 万人年（组间差异，1467 例/10 万人年[95%CI，799-2135 例/10 万人年]；P<0.001）。上消化道癌症（食管、胃、肝、胆道或胰腺癌症）在最近体重减轻的参与者中尤为常见；与最近没有体重减轻的人群相比，体重减轻超过 10.0%的人群中有 173 例癌症病例/10 万人年（组间差异，137 例/10 万人年[95%CI，101-172 例/10 万人年]；P<0.001）。
结论：与最近没有体重减轻的人群相比，在过去 2 年内体重减轻的健康专业人员在随后的 12 个月内癌症风险显著增加。与最近没有体重减轻的人群相比，上消化道癌症在最近体重减轻的参与者中尤为常见。
