Abebe Zegeye, Wassie Molla Mesele, Mekonnen Tefera Chane, Reynolds Amy C, Melaku Yohannes Adama
Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia.
Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia.
Nutr Rev. 2025 Mar 1;83(3):e991-e1013. doi: 10.1093/nutrit/nuae090.
Several studies have demonstrated that dietary patterns identified by a posteriori and hybrid methods are associated with gastrointestinal (GI) cancer risk and mortality. These studies applied different methods for analyzing dietary data and reported inconsistent findings.
This systematic review and meta-analysis were aimed to determine the association between dietary patterns, derived using principal component analysis (PCA) and reduced rank regression (RRR), and GI cancer risk and GI cancer-caused mortality.
Articles published up to June 2023 in English were eligible for inclusion. The Medline, SCOPUS, Cochrane Library, CINHAL, PsycINFO, ProQuest, and Web of Sciences databases were used to identify prospective studies. The Preferred Reporting Item for Systematic Review and Meta-analysis Protocol 2020 was used to report results.
A total of 28 studies were eligible for inclusion. Varied approaches to deriving dietary patterns were used, including PCA (n = 22), RRR (n = 2), combined PCA and RRR (n = 1), cluster analysis (CA; n = 2) and combined PCA and CA (n = 1).
Two dietary patterns, "healthy" and "unhealthy," were derived using PCA and RRR. The healthy dietary pattern was characterized by a higher intake of fruits, whole grains, legumes, vegetables, milk, and other dairy products, whereas the unhealthy dietary pattern was characterized by a higher intake of red and processed meat, alcohol, and both refined and sugar-sweetened beverages. The findings indicated that the PCA-derived healthy dietary pattern was associated with an 8% reduced risk (relative risk [RR], 0.92; 95% CI, 0.87-0.98), and the unhealthy dietary pattern was associated with a 14% increased risk (RR, 1.14; 95% CI, 1.07-1.22) of GI cancers. Similarly, the RRR-derived healthy dietary pattern (RR, 0.83; 95% CI, 0.61-1.12) may be associated with reduced risk of GI cancers. In contrast, the RRR-derived unhealthy dietary pattern (RR, 0.93; 95% CI, 0.57-1.52) had no association with a reduced risk of GI cancers. Similarly, evidence suggested that PCA-derived healthy dietary patterns may reduce the risk of death from GI cancers, whereas PCA-derived unhealthy dietary patterns may increase the risk.
Findings from prospective studies on the association of PCA-derived dietary patterns and the risk of GI cancers support the evidence of healthy and unhealthy dietary patterns as either protective or risk-increasing factors for GI cancers and for survivorship, respectively. The findings also suggest that the RRR-derived healthy dietary pattern reduces the risk of GI cancers (albeit with low precision), but no association was found for the RRR-derived unhealthy dietary pattern. Prospective studies are required to further clarify disparities in the association between PCA- and RRR-derived dietary patterns and the risk of GI cancers. Systematic review registration: PROSPERO registration no. CRD42022321644.
多项研究表明，通过后验法和混合法确定的饮食模式与胃肠道（GI）癌症风险及死亡率相关。这些研究采用了不同的方法分析饮食数据，报告的结果并不一致。
本系统评价和荟萃分析旨在确定使用主成分分析（PCA）和降秩回归（RRR）得出的饮食模式与GI癌症风险及GI癌症所致死亡率之间的关联。
截至2023年6月发表的英文文章符合纳入标准。使用Medline、SCOPUS、Cochrane图书馆、CINHAL、PsycINFO、ProQuest和Web of Sciences数据库来识别前瞻性研究。采用系统评价和荟萃分析方案2020的首选报告项目来报告结果。
共有28项研究符合纳入标准。采用了多种得出饮食模式的方法，包括PCA（n = 22）、RRR（n = 2）、PCA与RRR联合使用（n = 1）、聚类分析（CA；n = 2）以及PCA与CA联合使用（n = 1）。
使用PCA和RRR得出了两种饮食模式，即“健康”和“不健康”饮食模式。健康饮食模式的特点是水果、全谷物、豆类、蔬菜、牛奶及其他乳制品摄入量较高，而不健康饮食模式的特点是红肉、加工肉类、酒精以及精制和含糖饮料摄入量较高。研究结果表明，PCA得出的健康饮食模式与GI癌症风险降低8%相关（相对风险[RR]，0.92；95%置信区间[CI]，0.87 - 0.98），不健康饮食模式与GI癌症风险增加14%相关（RR，1.14；95% CI，1.07 - 1.22）。同样，RRR得出的健康饮食模式（RR，0.83；95% CI，0.61 - 1.12）可能与GI癌症风险降低相关。相比之下，RRR得出的不健康饮食模式（RR，0.93；95% CI，0.57 - 1.52）与GI癌症风险降低无关。同样，有证据表明，PCA得出的健康饮食模式可能降低GI癌症死亡风险，而PCA得出的不健康饮食模式可能增加风险。
关于PCA得出的饮食模式与GI癌症风险关联的前瞻性研究结果支持了健康和不健康饮食模式分别作为GI癌症的保护因素或风险增加因素以及与生存率相关的证据。研究结果还表明，RRR得出的健康饮食模式降低了GI癌症风险（尽管精度较低），但未发现RRR得出的不健康饮食模式与风险有关联。需要进行前瞻性研究以进一步阐明PCA和RRR得出的饮食模式与GI癌症风险关联中的差异。系统评价注册：PROSPERO注册号CRD42022321644。
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