Kampman E, Giovannucci E, van 't Veer P, Rimm E, Stampfer M J, Colditz G A, Kok F J, Willett W C
Department of Epidemiology, Harvard School of Public Health, Boston, MA.
Am J Epidemiol. 1994 Jan 1;139(1):16-29. doi: 10.1093/oxfordjournals.aje.a116931.
A high intake of calcium, vitamin D, or specific dairy products is thought to reduce the incidence of colorectal cancer. The association of these nutrients and foods with the occurrence of colorectal adenomas, precursors of cancer, was studied in two large US cohort studies. Cases were patients with a diagnosis of adenomatous polyps of the left colon or rectum (331 men, 1986-1990; 350 women, 1980-1988), and controls were persons with endoscopic findings negative for adenoma (9,159 men and 8,585 women). After adjustment for age, total energy, family history of colorectal cancer, body mass index, alcohol consumption, folate, intake of saturated fat and fiber, indications for endoscopy, and previous endoscopy, total calcium intake was not associated with the risk for adenoma (relative risk (RR), highest vs. lowest quintile of intake: men, 1.13, 95% confidence interval (CI) 0.76-1.66; women, 1.17, 95% CI 0.81-1.69). Total vitamin D intake was unrelated to the risk for adenoma in men (RR = 1.29, 95% CI 0.87-1.93). An inverse nonsignificant association was observed in women in the 1980-1988 analyses (RR = 0.68, 95% CI 0.41-1.13, trend p = 0.09), mainly attributable to the intake of multivitamin supplements, but an analysis of 4-year data (1984-1988) using a more detailed dietary assessment showed no association with vitamin D (RR = 1.04, 95% CI 0.65-1.67). Milk consumption and intake of total fermented dairy products were not related to adenoma risk. In conclusion, the occurrence of colorectal adenoma was neither related to calcium intake nor to milk consumption, whereas vitamin D from supplements but not diet was slightly, but not significantly, inversely associated with risk among women only.
高钙、维生素D或特定乳制品的摄入量被认为可降低结直肠癌的发病率。在美国的两项大型队列研究中，对这些营养素和食物与结直肠癌癌前病变——结直肠腺瘤发生之间的关联进行了研究。病例为诊断为左半结肠或直肠腺瘤性息肉的患者（331名男性，1986 - 1990年；350名女性，1980 - 1988年），对照为内镜检查腺瘤结果为阴性的人（9159名男性和8585名女性）。在对年龄、总能量、结直肠癌家族史、体重指数、饮酒量、叶酸、饱和脂肪和纤维摄入量、内镜检查指征以及既往内镜检查进行调整后，总钙摄入量与腺瘤风险无关（相对风险（RR），摄入量最高五分位数与最低五分位数相比：男性为1.13，95%置信区间（CI）为0.76 - 1.66；女性为1.17，95% CI为0.81 - 1.69）。男性的总维生素D摄入量与腺瘤风险无关（RR = 1.29，95% CI为0.87 - 1.93）。在1980 - 1988年的分析中，女性中观察到一种无统计学意义的负相关（RR = 0.68，95% CI为0.41 - 1.13，趋势p = 0.09），主要归因于多种维生素补充剂的摄入，但使用更详细饮食评估的4年数据（1984 - 1988年）分析显示与维生素D无关联（RR = 1.04，95% CI为0.65 - 1.67）。牛奶消费和总发酵乳制品摄入量与腺瘤风险无关。总之，结直肠腺瘤的发生既与钙摄入量无关，也与牛奶消费无关，而仅在女性中，补充剂而非饮食中的维生素D与风险呈轻微但无统计学意义的负相关。
