Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
Cancer Epidemiol Biomarkers Prev. 2024 Nov 1;33(11):1445-1455. doi: 10.1158/1055-9965.EPI-24-0048.
Diet-disease association studies increasingly use dietary patterns (DP) to account for the complexity of the exposure. We assessed if a DP associated with type 2 diabetes mellitus, cardiovascular disease, and all-cause mortality is also associated with colorectal cancer.
We used reduced rank regression on 24-hour recall data to identify DPs, explaining the maximum variation in four nutrient-response variables: energy density, saturated fatty acids, free sugars, and fiber density. Cox proportional hazards models examined prospective associations between DP adherence (coded in a continuous scale as z-scores as well as in quintiles) and incident colorectal cancer. Subgroup analyses were conducted for tumor site, age, and sex.
After exclusions, 1,089 colorectal cancer cases occurred in 114,443 participants over a median follow-up of 8.0 years. DP1 was characterized by increased intake of chocolate and confectionery; butter; low-fiber bread; red and processed meats; and alcohol, as well as low intake of fruits, vegetables, and high-fiber cereals. After accounting for confounders, including body mass, there were positive linear associations between DP1 and incident overall colorectal cancer (HR of quintile 5 vs. 1, 1.34; 95% confidence interval, 1.16-1.53, Ptrend = 0.005) and rectal cancer (HR of quintile 5 vs. 1, 1.58; 95% confidence interval, 1.27-1.96, Ptrend = 0.009) but not for proximal or distal colon cancers. No DP2-colorectal cancer association was observed.
A DP previously associated with cardiometabolic disease is also associated with incident colorectal cancer, especially rectal cancers.
These consistent associations of particular food groups with both cardiometabolic disease and this diet-related cancer strengthen the evidence base for holistic population dietary guidelines to prevent ill-health.
饮食与疾病关联研究越来越多地使用饮食模式（DP）来解释暴露的复杂性。我们评估了与 2 型糖尿病、心血管疾病和全因死亡率相关的 DP 是否也与结直肠癌相关。
我们使用 24 小时回忆数据的降秩回归来识别 DP，这些 DP 可以解释四个营养反应变量（能量密度、饱和脂肪酸、游离糖和纤维密度）的最大变化。Cox 比例风险模型检查了 DP 依从性（以 z 分数连续量表以及五分位数编码）与结直肠癌发病之间的前瞻性关联。进行了肿瘤部位、年龄和性别亚组分析。
排除后，在 114443 名参与者中位随访 8.0 年期间，共发生 1089 例结直肠癌病例。DP1 的特点是增加了巧克力和糖果；黄油；低纤维面包；红肉和加工肉；以及酒精的摄入量，同时减少了水果、蔬菜和高纤维谷物的摄入量。在考虑了包括体重在内的混杂因素后，DP1 与总体结直肠癌（五分位数 5 与 1 的 HR，1.34；95%置信区间，1.16-1.53，Ptrend = 0.005）和直肠癌（五分位数 5 与 1 的 HR，1.58；95%置信区间，1.27-1.96，Ptrend = 0.009）的发病呈正线性关联，但与近端或远端结肠癌无关。没有观察到 DP2-结直肠癌的关联。
先前与心血管代谢疾病相关的 DP 也与结直肠癌的发病相关，尤其是直肠癌。
这些特定食物组与心血管代谢疾病和这种与饮食相关的癌症之间的一致关联，为预防不良健康状况的整体人群饮食指南提供了更有力的证据。
