Shi Yangpiaoyi, Xu Zhiquan, Tan Wanhao, Liu Hang, Wei Qi, Wang Yaxu, Xiang Ling, Peng Linglong, Gu Haitao
Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Front Immunol. 2025 Jun 26;16:1529011. doi: 10.3389/fimmu.2025.1529011. eCollection 2025.
Given the significantly increased risk of colorectal adenoma in middle-aged and elderly populations, identifying modifiable risk factors remains a priority. While dietary protein is an essential nutrient in human metabolism, its relationship with colorectal adenoma remains controversial. With advances in nutritional science, contemporary dietary guidelines advocate increasing plant-based protein intake to achieve a more balanced protein consumption pattern. To provide new insights, we sought to investigate the association between colorectal adenoma risk and the Protein Diet Score, which comprehensively evaluates both protein intake and sources.
This analysis was based on data from the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. The Cox proportional hazards regression model was utilized to compute the hazard ratios (HRs) and 95% confidence intervals (CIs). Restricted cubic spline was employed to illustrate the variation in colorectal adenoma risk across the entire spectrum of the Protein Diet Score. Additionally, subgroup analyses were conducted to ascertain possible effect modifiers, and several sensitivity analyses were performed to evaluate the robustness of the findings.
During the mean follow-up period of 11.0 years, 992 newly diagnosed colorectal adenomas were identified. In the fully adjustment for potential confounders, the inverse association between Protein Diet Score and colorectal adenoma risk remained statistically significant with an HR of 0.81 (95% CI: 0.67-0.99; P =0.005) comparing the highest versus lowest quartile. Restricted cubic spline analysis revealed a linear inverse relationship between Protein Diet Score and colorectal adenoma risk (P for nonlinearity =0.317). In the subgroup analyses, we observed a more pronounced inverse association between Protein Diet Score and colorectal adenoma among participants with a history of hypertension (HR : 0.60; 95% CI: 0.43-0.85; P =0.017). Finally, a series of sensitivity analyses strengthened the robustness of our findings.
Our findings indicate that higher Protein Diet Score is associated with reduced colorectal adenoma incidence among middle-aged and elderly Americans, with similar findings observed for the PAR. These results provide important evidence for optimizing protein intake and source composition to promote intestinal health.
鉴于中老年人群患结直肠腺瘤的风险显著增加，确定可改变的风险因素仍是当务之急。虽然膳食蛋白质是人体新陈代谢中的必需营养素，但其与结直肠腺瘤的关系仍存在争议。随着营养科学的发展，当代膳食指南提倡增加植物性蛋白质的摄入量，以实现更均衡的蛋白质消费模式。为了提供新的见解，我们试图研究结直肠腺瘤风险与蛋白质饮食评分之间的关联，该评分综合评估了蛋白质摄入量和来源。
本分析基于前列腺、肺、结直肠和卵巢（PLCO）癌症筛查试验的数据。采用Cox比例风险回归模型计算风险比（HRs）和95%置信区间（CIs）。使用受限立方样条来描述蛋白质饮食评分全范围内结直肠腺瘤风险的变化。此外，进行亚组分析以确定可能的效应修饰因素，并进行了多项敏感性分析以评估研究结果的稳健性。
在平均11.0年的随访期内，共确诊992例新发结直肠腺瘤。在对潜在混杂因素进行充分调整后，蛋白质饮食评分与结直肠腺瘤风险之间的负相关在统计学上仍然显著，最高四分位数与最低四分位数相比，HR为0.81（95%CI：0.67 - 0.99；P = 0.005）。受限立方样条分析显示蛋白质饮食评分与结直肠腺瘤风险之间存在线性负相关（非线性P值 = 0.317）。在亚组分析中，我们观察到在有高血压病史的参与者中，蛋白质饮食评分与结直肠腺瘤之间的负相关更为明显（HR：0.60；95%CI：0.43 - 0.85；P = 0.017）。最后，一系列敏感性分析增强了我们研究结果的稳健性。
我们的研究结果表明，较高的蛋白质饮食评分与美国中老年人群结直肠腺瘤发病率降低相关，PAR也有类似发现。这些结果为优化蛋白质摄入量和来源组成以促进肠道健康提供了重要证据。
