Chan Wing Ching, Millwood Iona, Kartsonaki Christiana, Du Huaidong, Schmidt Daniel, Stevens Rebecca, Chen Junshi, Pei Pei, Yu Canqing, Sun Dianjianyi, Lv Jun, Han Xianyong, Li Liming, Chen Zhengming, Yang Ling
Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Medical Research Council Population Health Research Unit (MRC PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Int J Cancer. 2025 Jun 1;156(11):2094-2106. doi: 10.1002/ijc.35303. Epub 2024 Dec 31.
Associations of adiposity with risks of oesophageal squamous cell carcinoma (ESCC) and non-cardia stomach cancer, both prevalent in China, are still inconclusive. While adiposity is an established risk factor for colorectal cancer, the relevance of fat-free mass and early-adulthood adiposity remains to be explored. The prospective China Kadoorie Biobank study included 0.5 million adults (aged 30-79 years) from 10 areas in China. Participants' body size and composition were measured at baseline and at resurveys (amongst a subset). After >10 years of follow-up, 2350, 3345 and 3059 incident cases of oesophageal (EC), stomach (SC) and colorectal (CRC) cancers were recorded, respectively. Cox regression was used to estimate hazard ratios (HRs) for these cancers in relation to different adiposity traits. General and central adiposity were inversely associated with EC (primarily ESCC) risk, with HRs of 0.81 (95% CI 0.77-0.85), 0.76 (0.72-0.81) and 0.87 (0.83-0.92) per SD increase in usual levels of BMI, body fat percentage (BF%) and waist circumference (WC), respectively. Adiposity was also inversely associated with SC risk [HR = 0.79 (0.75-0.83) and 0.88 (0.84-0.92) per SD increase in usual BF% and WC], with heterogeneity by cardia and non-cardia subsites, and positively associated with CRC [HR = 1.09 (1.03-1.15) and 1.17 (1.12-1.22) per SD higher usual BF% and WC]. Fat-free mass was inversely associated with EC [HR = 0.93 (0.89-0.98) per SD increase] but positively associated with CRC [1.09 (1.04-1.14)], while BMI at age 25 was positively associated with all three cancers. After mutual adjustment, general adiposity remained inversely associated with EC and SC, while central adiposity remained positively associated with CRC.
肥胖与在中国都很常见的食管鳞状细胞癌（ESCC）和非贲门胃癌风险之间的关联仍不明确。虽然肥胖是结直肠癌的既定风险因素，但无脂肪量和成年早期肥胖的相关性仍有待探索。前瞻性的中国嘉道理生物银行研究纳入了来自中国10个地区的50万成年人（年龄在30 - 79岁之间）。在基线和再次调查时（在一个子集中）测量了参与者的体型和身体组成。经过10多年的随访，分别记录了2350例、3345例和3059例食管癌（EC）、胃癌（SC）和结直肠癌（CRC）的发病病例。使用Cox回归来估计这些癌症与不同肥胖特征相关的风险比（HR）。总体肥胖和中心性肥胖与EC（主要是ESCC）风险呈负相关，通常BMI、体脂百分比（BF%）和腰围（WC）每增加1个标准差，HR分别为0.81（95%CI 0.77 - 0.85）、0.76（0.72 - 0.81）和0.87（0.83 - 0.92）。肥胖也与SC风险呈负相关[通常BF%和WC每增加1个标准差，HR分别为0.79（0.75 - 0.83）和0.88（0.84 - 0.92）]，贲门和非贲门亚部位存在异质性，且与CRC呈正相关[通常BF%和WC每增加1个标准差，HR分别为1.09（1.03 - 1.15）和1.17（1.12 - 1.22）]。无脂肪量与EC呈负相关[每增加1个标准差，HR = 0.93（0.89 - 0.98）]，但与CRC呈正相关[1.09（1.04 - 1.14）]，而25岁时的BMI与所有三种癌症均呈正相关。相互调整后，总体肥胖仍与EC和SC呈负相关，而中心性肥胖仍与CRC呈正相关。
