Wahl David, Loftfield Erikka, Zouiouich Sémi, Liao Linda M, Hong Hyokyoung G, McGlynn Katherine A, Sinha Rashmi
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, United States.
JNCI Cancer Spectr. 2025 Jul 1;9(4). doi: 10.1093/jncics/pkaf068.
We investigated the relationship between intakes of red, white, and processed meats with liver cancer-including hepatocellular carcinoma and intrahepatic cholangiocarcinoma, gallbladder cancer, and other biliary tract cancers.
The analytic cohort consisted of 480 347 US adults in the prospective National Institutes of Health-AARP Diet and Health Study who were cancer-free at baseline at ages 50-71 years. With a median follow-up of 19.68 years, we identified 1150 participants with incident liver cancer (219 intrahepatic cholangiocarcinomas and 931 hepatocellular carcinomas), 231 with incident gallbladder cancer, and 472 with other incident biliary tract cancers (272 extrahepatic cholangiocarcinomas). At baseline, a self-administered food frequency questionnaire assessed usual dietary intake. We used multivariable Cox proportional hazards models to estimate the associations of meat type with hepatobiliary cancers. We used substitution models with the "leave-one-out" approach as our primary analysis and addition models as a supplemental analysis.
Replacing red meat with white meat was inversely associated with liver cancer (hazard ratio [HR]50 g/1000 kcal = 0.62, 95% CI = 0.51 to 0.77), hepatocellular carcinoma (HR50 g/1000 kcal = 0.63, 95% CI = 0.50 to 0.80), and intrahepatic cholangiocarcinoma (HR50 g/1000 kcal = 0.56, 95% CI = 0.35 to 0.90). Because of the symmetry of substitution models, replacing white meat with red meat yielded hazard ratios equal to the reciprocal of these values, indicating increased risk for the same cancer sites. No associations were observed for meat intake and gallbladder or other biliary tract cancers.
Our study indicates replacing intake of red meat with white meat could lower risk of liver cancer by nearly 40%, whereas replacing white meat with red meat could increase the risk by more than 60%.
我们研究了红肉、白肉和加工肉类的摄入量与肝癌（包括肝细胞癌和肝内胆管癌）、胆囊癌及其他胆道癌之间的关系。
分析队列包括美国国立卫生研究院 - 美国退休人员协会饮食与健康前瞻性研究中的480347名成年人，他们在50 - 71岁基线时无癌症。中位随访19.68年，我们确定了1150例新发肝癌患者（219例肝内胆管癌和931例肝细胞癌）、231例新发胆囊癌患者以及472例其他新发胆道癌患者（272例肝外胆管癌）。在基线时，通过一份自行填写的食物频率问卷评估日常饮食摄入量。我们使用多变量Cox比例风险模型来估计肉类类型与肝胆癌之间的关联。我们将“留一法”替代模型作为主要分析方法，并将加法模型作为补充分析方法。
用白肉替代红肉与肝癌（风险比[HR]50 g/1000 kcal = 0.62，95%置信区间[CI] = 0.51至0.77）、肝细胞癌（HR50 g/1000 kcal = 0.63，95% CI = 0.50至0.80）和肝内胆管癌（HR50 g/1000 kcal = 0.56，95% CI = 0.35至0.90）呈负相关。由于替代模型的对称性，用红肉替代白肉得出的风险比等于这些值的倒数，表明相同癌症部位的风险增加。未观察到肉类摄入量与胆囊癌或其他胆道癌之间存在关联。
我们的研究表明，用白肉替代红肉的摄入可使肝癌风险降低近40%，而用红肉替代白肉则可使风险增加60%以上。
