饮食中叶酸摄入量与结直肠癌发病风险的关联：队列研究的系统评价和剂量反应荟萃分析

The association between dietary folate intake and risk of colorectal cancer incidence: A systematic review and dose‒response meta-analysis of cohort studies.

作者信息

Khalighi Sikaroudi Masoumeh, Soltani Sepideh, Kolahdouz-Mohammadi Roya, Imanifard Roya, Abdollahi Shima, Shahinfar Hossein, Mohammadi Farsani Gholamreza

机构信息

Department of Clinical Nutrition, Tehran University of Medical Sciences, Tehran, Iran.

Yazd Cardiovascular Research Center, Noncommunicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

出版信息

Heliyon. 2024 Jun 26;10(13):e33564. doi: 10.1016/j.heliyon.2024.e33564. eCollection 2024 Jul 15.

DOI:10.1016/j.heliyon.2024.e33564

PMID:39071590

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11279277/

Abstract

BACKGROUND

Dietary components can influence the incidence of colorectal cancer (CRC). Folate is one of the compounds that plays an essential role in the formation of DNA structures, which can lead to or prevent tumorigenesis. The present study is the first systematic review and dose-response meta-analysis of cohort studies evaluating the association between dietary folate intake and the risk of CRC.

METHODS

The PubMed/Medline, Scopus, and ISI Web of Science databases were systematically searched for cohort studies that assessed the association between folate intake and CRC up to January 2024. Summary relative risks (RRs) and 95 % confidence intervals (CIs) were calculated using a random effects model. Also, linear and nonlinear dose-response analyses were conducted for the dose-response associations between folate intake and risk of CRC.

RESULTS

Eighteen prospective cohort studies with 931,469 participants, 14,860 CRC patients, 3536 colon cancer (CC) patients, and 1075 rectal cancer (RC) patients were included in the analysis. The summary RR of CRC for each 100-μg increase in dietary folate intake was 0.97 (95 % CI: 0.95-0.99, I: 0.0 %, P-heterogeneity: 0.616), which can be related to BMI (0.97 (95 % CI: 0.95-0.99)); a more protective effect was also observed in subjects who drank alcohol (0.97 (95 % CI: 0.95-0.99)) and those who smoked (0.97 (95 % CI: 0.95-0.99)). Additionally, it was positively related to a 7 % lower risk of CC (0.93 (95 % CI: 0.87-0.99, I: 33.7 %, P-heterogeneity: 0.159)), and the null relation for RC was 0.98 (95 % CI: 0.90-1.08), I: 16.6 %, P-heterogeneity: 0.309). There was evidence of nonlinearity in which up to 500 μg/day dietary folate intake was inversely associated with CC (P nonlinearity = 0.04).

CONCLUSION

The findings showed an inverse association between dietary folate intake and the risk of CRC, especially in high-risk persons, those who have a higher BMI, alcohol drinkers, and smokers.

摘要

背景

饮食成分可影响结直肠癌（CRC）的发病率。叶酸是在DNA结构形成中起关键作用的化合物之一，其既可能导致肿瘤发生，也可能预防肿瘤发生。本研究是第一项对评估饮食叶酸摄入量与CRC风险之间关联的队列研究进行的系统评价和剂量反应荟萃分析。

方法

系统检索PubMed/Medline、Scopus和ISI Web of Science数据库，查找截至2024年1月评估叶酸摄入量与CRC之间关联的队列研究。使用随机效应模型计算汇总相对风险（RR）和95%置信区间（CI）。此外，对叶酸摄入量与CRC风险之间的剂量反应关联进行线性和非线性剂量反应分析。

结果

分析纳入了18项前瞻性队列研究，共931,469名参与者，其中CRC患者14,860例，结肠癌（CC）患者3536例，直肠癌（RC）患者1075例。饮食叶酸摄入量每增加100μg，CRC的汇总RR为0.97（95%CI：0.95 - 0.99，I²：0.****%，P异质性：0.616），这可能与体重指数有关（0.97（95%CI：0.95 - 0.99））；在饮酒者（0.97（95%CI：0.95 - 0.99））和吸烟者（0.97（95%CI：0.95 - 0.99））中也观察到了更强的保护作用。此外，其与CC风险降低7%呈正相关（0.93（95%CI：0.87 - 0.99，I²：33.7%，P异质性：0.159）），而RC的无效关联为0.98（95%CI：0.90 - 1.08），I²：16.6%，P异质性：0.309）。有证据表明存在非线性关系，即饮食叶酸摄入量高达500μg/天时与CC呈负相关（P非线性 = 0.04）。