Kearney J, Giovannucci E, Rimm E B, Stampfer M J, Colditz G A, Ascherio A, Bleday R, Willett W C
Department of Nutrition, Harvard School of Public Health, Boston, MA, USA.
Cancer Causes Control. 1995 Jan;6(1):45-56. doi: 10.1007/BF00051680.
Hyperplastic polyps of the colon reveal a geographic distribution similar to that of colorectal cancer and adenomatous polyps. However, unlike adenomas--known precursors of colorectal cancer--little is known about the etiology or clinical significance of the hyperplastic polyp. In this prospective study, we set out to determine the main dietary and other lifestyle factors in the United States that might be associated with this lesion. Hyperplastic polyps of the distal colon and rectum were diagnosed in 219 of 12,922 men of the Health Professionals Follow-up Study having had an endoscopic procedure between 1986 and 1992, and 175 of 15,339 women of the Nurses' Health Study who had undergone an endoscopy for a variety of reasons between 1980 and 1990. After adjusting for age, family history of colon cancer, history of previous endoscopy, and total energy intake using multiple logistic regression, those consuming 30 g or more of alcohol per day were at increased risk relative to nondrinkers among men (relative risk [RR] = 1.69; 95 percent confidence interval [CI] = 1.01-2.80) and women (RR = 1.79, CI = 1.02-3.15). Current smoking also was found to be associated strongly positively with hyperplastic polyps in men (RR = 2.45, CI = 1.59-3.75) and women (RR = 1.96, CI = 1.16-2.86). High intake of folate was associated inversely with risk in both men (RR = 0.74, CI = 0.49-1.11, between high and low intakes of folate) and women (RR = 0.45, CI = 0.28-0.74, between high and low intakes of folate). Among macronutrients, a suggestive increase in risk existed with intake of animal fat, although this was attenuated in the full multivariate model (RR[men] = 1.48, CI = 0.94-2.41, and RR[women] = 1.22, CI = 0.77-1.94) between high and low quantities of animal fat intake. These prospective data provide evidence of associations between low folate intake, alcohol consumption, and current cigarette smoking, and risk of hyperplastic polyps of the distal colon and rectum. These same factors also have been found to be related to adenoma and cancer of the colon. The hyperplastic polyp is an indicator of populations at high risk for colorectal carcinoma, and it also may serve as a marker for factors that influence neoplastic evolution.
结肠增生性息肉的地理分布与结直肠癌及腺瘤性息肉相似。然而，与已知的结直肠癌前体腺瘤不同，人们对增生性息肉的病因或临床意义知之甚少。在这项前瞻性研究中，我们着手确定美国可能与这种病变相关的主要饮食及其他生活方式因素。在1986年至1992年间接受内镜检查的12922名男性健康专业人员随访研究中，有219人被诊断为远端结肠和直肠增生性息肉；在1980年至1990年间因各种原因接受内镜检查的15339名护士健康研究女性中，有175人被诊断为远端结肠和直肠增生性息肉。在使用多元逻辑回归对年龄、结肠癌家族史、既往内镜检查史和总能量摄入进行调整后，与不饮酒者相比，每天饮酒30克或更多的男性（相对风险[RR]=1.69；95%置信区间[CI]=1.01 - 2.80）和女性（RR = 1.79，CI = 1.02 - 3.15）患增生性息肉的风险增加。目前吸烟也被发现与男性（RR = 2.45，CI = 1.59 - 3.75）和女性（RR = 1.96，CI = 1.16 - 2.86）的增生性息肉呈强正相关。高叶酸摄入量与男性（RR = 0.74，CI = 0.49 - 1.11，高叶酸摄入量与低叶酸摄入量之间）和女性（RR = 0.45，CI = 0.28 - 0.74，高叶酸摄入量与低叶酸摄入量之间）的患病风险呈负相关。在常量营养素中，动物脂肪摄入量增加有提示性的风险增加，尽管在完整的多变量模型中这种关联有所减弱（高动物脂肪摄入量与低动物脂肪摄入量之间，男性RR = 1.48，CI = 0.94 - 2.41，女性RR = 1.22，CI = 0.77 - 1.94）。这些前瞻性数据提供了低叶酸摄入量、饮酒和当前吸烟与远端结肠和直肠增生性息肉风险之间存在关联的证据。同样这些因素也被发现与结肠腺瘤和癌症有关。增生性息肉是结直肠癌高危人群的一个指标，它也可能作为影响肿瘤演变因素的一个标志物。
