Lu Yujia, Zhao Yu Chen, Liu Kuangyu, Bever Alaina, Zhou Ziyi, Wang Kai, Fang Zhe, Polychronidis Georgios, Liu Yuchen, Tao Liyuan, Dickerman Barbra A, Giovannucci Edward L, Song Mingyang
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
J Natl Cancer Inst. 2024 Dec 1;116(12):1942-1951. doi: 10.1093/jnci/djae193.
Despite the recognized role of visceral adipose tissue in carcinogenesis, its independent association with cancer risk beyond traditional obesity measures remains unknown because of limited availability of imaging data.
We developed an estimation equation for visceral adipose tissue volume using elastic net regression based on demographic and anthropometric data in a subcohort of participants in the UK Biobank (UKB; n = 23 148) with abdominal magnetic resonance imaging scans. This equation was externally validated in 2713 participants from the 2017-2018 National Health and Nutrition Examination Survey according to sex, age, and race groups. We then applied the equation to the overall UKB cohort of 461 665 participants to evaluate the prospective association between estimated visceral adipose tissue and cancer risk using Cox proportional hazards models. We also calculated the population attributable risk of cancer associated with estimated visceral adipose tissue and body mass index (BMI).
Estimated visceral adipose tissue showed a high correlation with measured visceral adipose tissue in internal and external validations (r = 0.81-0.86). During a median 12-year follow-up in the UKB, we documented 37 397 incident cancer cases; estimated visceral adipose tissue was statistically significantly associated with elevated risk of obesity-related and individual cancers, independent of BMI and waist circumference. Population attributable risk for total cancer associated with high (quartiles 2-4 vs 1) estimated visceral adipose tissue (9.0% for men, 11.6% for women) was higher than high BMI (quartiles 2-4 vs 1 = 5.0% for men, 8.2% for women).
Estimated visceral adipose tissue showed robust performance in UKB and National Health and Nutrition Examination Survey and was associated with cancer risk independent of BMI and waist circumference. This study provides a potential clinical tool for visceral adipose tissue estimation and underscores that visceral adipose tissue can be an important target for cancer prevention.
尽管内脏脂肪组织在致癌过程中的作用已得到认可，但由于影像数据有限，其独立于传统肥胖指标与癌症风险的关联仍不明确。
我们在英国生物银行（UKB；n = 23148）有腹部磁共振成像扫描的参与者亚队列中，基于人口统计学和人体测量数据，使用弹性网回归开发了一个内脏脂肪组织体积的估计方程。该方程在2017 - 2018年国家健康与营养检查调查的2713名参与者中，根据性别、年龄和种族组进行了外部验证。然后，我们将该方程应用于UKB的461665名参与者的总体队列，使用Cox比例风险模型评估估计的内脏脂肪组织与癌症风险之间的前瞻性关联。我们还计算了与估计的内脏脂肪组织和体重指数（BMI）相关的癌症的人群归因风险。
在内部和外部验证中，估计的内脏脂肪组织与测量的内脏脂肪组织显示出高度相关性（r = 0.81 - 0.86）。在UKB中位12年的随访期间，我们记录了37397例新发癌症病例；估计的内脏脂肪组织与肥胖相关癌症和个别癌症风险升高在统计学上显著相关，独立于BMI和腰围。与高（四分位数2 - 4与1）估计内脏脂肪组织相关的总癌症人群归因风险（男性为9.0%，女性为11.6%）高于高BMI（四分位数2 - 4与1 = 男性为5.0%，女性为8.2%）。
估计的内脏脂肪组织在UKB和国家健康与营养检查调查中表现出稳健性能，并且与独立于BMI和腰围的癌症风险相关。本研究为内脏脂肪组织估计提供了一种潜在的临床工具，并强调内脏脂肪组织可以成为癌症预防的重要靶点。
