O'Connell Caitlin P, Hong Hyokyoung G, Abar Leila, Khandpur Neha, Steele Eurídice Martínez, Liao Linda M, Sinha Rashmi, Trabert Britton, Loftfield Erikka
Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, United States.
Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, United States.
Am J Clin Nutr. 2025 Aug;122(2):513-522. doi: 10.1016/j.ajcnut.2025.05.024. Epub 2025 May 24.
Ultraprocessed food (UPF) accounts for more than half of caloric intake by the United States population. UPF intake has been linked to weight gain and obesity, a known risk factor for cancer, including endometrial cancer.
The objectives of this study were to evaluate the prospective association of UPF intake with ovarian and endometrial cancer risk.
Participants in the NIH-AARP Diet and Health Study reported baseline diet using a food frequency questionnaire (FFQ). We disaggregated FFQ items to assign Nova classification and created quintiles of energy-adjusted UPF intake (grams/day). We used Cox proportional hazards models, adjusted for potential confounding factors, to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for epithelial ovarian and endometrial cancer incidence, overall and by histotype.
Among 129,870 female participants, without a history of oophorectomy or cancer, 1234 epithelial ovarian cancer cases were diagnosed during >20 y of follow-up. UPF intake was not associated with ovarian cancer risk (quintile 5 compared with quintile 1: HR: 0.92; 95% CI: 0.77, 1.11), overall or by histotype. Among 107,592 female participants, without a history of hysterectomy or cancer, 2249 endometrial cancer cases were diagnosed. Participants in the highest quintile of UPF intake tended to have higher BMI (in kg/m) [median (IQR) BMI, 27.4 (23.9-31.7)] than those in the lowest quintile [24.4 (22.0-28.0)]. Higher UPF intake was associated with increased endometrial cancer risk (HR: 1.25; 1.09, 1.43). The association was no longer observed after adjusting for BMI (HR: 0.96; 0.83, 1.10). HR estimates were similar for type I endometrial cancer, the subtype most strongly associated with BMI.
In this cohort of United States females who were at risk of developing endometrial or ovarian cancer, we found evidence of a positive association between UPF intake and endometrial, but not ovarian cancer. The positive association with endometrial cancer was not independent of BMI.
超加工食品（UPF）在美国人群的热量摄入中占比超过一半。UPF的摄入与体重增加和肥胖有关，而肥胖是包括子宫内膜癌在内的癌症的已知风险因素。
本研究的目的是评估UPF摄入与卵巢癌和子宫内膜癌风险之间的前瞻性关联。
美国国立卫生研究院-美国退休人员协会饮食与健康研究的参与者使用食物频率问卷（FFQ）报告基线饮食。我们对FFQ项目进行分类以确定诺瓦分类，并创建了能量调整后的UPF摄入量（克/天）的五分位数。我们使用Cox比例风险模型，对潜在的混杂因素进行调整，以估计上皮性卵巢癌和子宫内膜癌发病率的风险比（HRs）和95%置信区间（CI），总体及按组织学类型分别进行估计。
在129,870名无卵巢切除术或癌症病史的女性参与者中，在超过20年的随访期间诊断出1234例上皮性卵巢癌病例。UPF摄入与卵巢癌风险无关（五分位数5与五分位数1相比：HR：0.92；95%CI：0.77，1.11），总体或按组织学类型均如此。在107,592名无子宫切除术或癌症病史的女性参与者中，诊断出2249例子宫内膜癌病例。UPF摄入量最高五分位数组的参与者的体重指数（kg/m）[中位数（四分位间距）BMI，27.4（23.9 - 31.7）]往往高于最低五分位数组[24.4（22.0 - 28.0）]。较高的UPF摄入量与子宫内膜癌风险增加相关（HR：1.25；1.09，1.43）。在调整BMI后，这种关联不再显著（HR：0.96；0.83，1.10）。对于I型子宫内膜癌（与BMI关联最强的亚型），HR估计值相似。
在这一有患子宫内膜癌或卵巢癌风险的美国女性队列中，我们发现有证据表明UPF摄入与子宫内膜癌之间存在正相关，但与卵巢癌无关。与子宫内膜癌的正相关并非独立于BMI。
