Ziller Shelby G, Blew Robert M, Roe Denise J, Odegaard Andrew, Chen Zhao, Caan Bette J, Luo Juhua, Manson JoAnn E, Neuhouser Marian L, Rohan Thomas E, Bea Jennifer W
University of Arizona, Tucson, AZ, United States.
University of Arizona, United States.
Cancer Epidemiol Biomarkers Prev. 2025 Aug 1. doi: 10.1158/1055-9965.EPI-25-0581.
Determine if dual-energy X-ray absorptiometry (DXA) derived adiposity was associated with colorectal cancer (CRC) incidence and mortality in postmenopausal women from the Women's Health Initiative (WHI) DXA Cohort.
Whole-body DXA scans estimated adiposity. Women with cancer history (except non-melanoma skin cancer) or missing baseline DXA were excluded. For 27 years of follow-up, outcomes and death were adjudicated. Descriptive statistics by CRC status were calculated. Fine and Gray's competing risks regression was used to estimate sub-hazard ratios (SHR) and 95% confidence intervals (CI). Observation time was from enrollment to first CRC event or competing risk (other cancer, other cause of death); women without cancer at last follow-up were censored. Covariates included sociodemographic, clinical, and study characteristics.
After exclusions, 9,950 women were included, with 191 first-incident CRC and 88 CRC-related deaths identified. At baseline, mean (±SD) age was 63.3 (±7.4) years, and body mass index was 28.2 (±5.7) kg/m2. In adjusted models, baseline continuous abdominal visceral adipose tissue (VAT) (per 100cm2) and android fat (per kg) were significantly associated with a higher risk of first-incident CRC: SHR (95% CI) 1.23 (1.04-1.45) and 1.15 (1.01-1.31), respectively. There were no significant associations between adiposity and CRC mortality.
Higher amounts of abdominal VAT and android fat were associated with a higher risk of CRC incidence in postmenopausal women.
Associations between VAT and CRC, independent of BMI, support clinical assessment of body composition across weight categories. A head-to-head comparison of VAT and BMI for CRC prediction is recommended in future research.
确定来自女性健康倡议（WHI）双能X线吸收测定（DXA）队列的绝经后女性中，DXA得出的肥胖指标是否与结直肠癌（CRC）的发病率和死亡率相关。
全身DXA扫描评估肥胖情况。排除有癌症病史（非黑色素瘤皮肤癌除外）或基线DXA缺失的女性。在27年的随访期间，对结局和死亡情况进行判定。计算按CRC状态的描述性统计量。使用Fine和Gray竞争风险回归来估计亚风险比（SHR）和95%置信区间（CI）。观察时间从入组至首次发生CRC事件或竞争风险（其他癌症、其他死亡原因）；最后随访时无癌症的女性被截尾。协变量包括社会人口统计学、临床和研究特征。
排除后，纳入9950名女性，其中191例首次发生CRC，88例CRC相关死亡。基线时，平均（±标准差）年龄为63.3（±7.4）岁，体重指数为28.2（±5.7）kg/m²。在调整模型中，基线时连续的腹部内脏脂肪组织（VAT）（每100cm²）和男性型脂肪（每千克）与首次发生CRC的较高风险显著相关：SHR（95%CI）分别为1.23（1.04 - 1.45）和1.15（1.01 - 1.31）。肥胖指标与CRC死亡率之间无显著关联。
绝经后女性腹部VAT和男性型脂肪含量较高与CRC发病率较高相关。
VAT与CRC之间的关联独立于BMI，支持对不同体重类别进行身体成分的临床评估。建议未来研究对VAT和BMI用于CRC预测进行直接比较。
