Bunin G R, Kuijten R R, Buckley J D, Rorke L B, Meadows A T
Division of Oncology, Children's Hospital of Philadelphia.
N Engl J Med. 1993 Aug 19;329(8):536-41. doi: 10.1056/NEJM199308193290804.
It has been hypothesized that a high dietary intake of nitrosamines and their precursors, nitrites and nitrates, is a risk factor for brain tumors. Vitamins C and E inhibit the formation of nitrosamines and thus may be protective.
We conducted a case-control study of maternal diet and the risk of primitive neuroectodermal tumors of the brain in children. The case patients were under the age of six years at diagnosis in 1986 to 1989. The controls were selected by random-digit telephone dialing and were matched for age and race to 166 case patients. Telephone interviews with the mothers included questions on the frequency of consumption of alcohol, vitamin and mineral supplements, and 53 foods during pregnancy.
Significant protective trends were observed for vegetables (odds ratio for the highest quartile group for intake relative to the lowest, 0.37; P for trend = 0.005), fruits and fruit juices (odds ratio, 0.28; P = 0.003), vitamin A (odds ratio, 0.59; P = 0.03), vitamin C (odds ratio, 0.42; P = 0.009), nitrate (odds ratio, 0.44; P = 0.002), and folate (odds ratio, 0.38; P = 0.005). A nonsignificant trend of increasing risk was observed for nitrosamine (odds ratio, 1.65; P = 0.15). The use of iron (odds ratio, 0.43; P = 0.004), calcium (odds ratio, 0.42; P = 0.05), and vitamin C (odds ratio, 0.35; P = 0.04) supplements at any time during the pregnancy and the use of multivitamins during the first six weeks (odds ratio, 0.56; P = 0.02) were associated with decreased risk. In multivariate analyses, folate, early multivitamin use, and iron supplements generally remained protective.
These results do not support the hypothesis that nitrosamines have a role in the development of primitive neuroectodermal tumors in young children, but they do suggest that certain other aspects of maternal diet can influence the risk.
据推测，饮食中大量摄入亚硝胺及其前体亚硝酸盐和硝酸盐是脑肿瘤的一个风险因素。维生素C和E可抑制亚硝胺的形成，因此可能具有保护作用。
我们开展了一项关于母亲饮食与儿童原发性脑外胚层肿瘤风险的病例对照研究。病例患者在1986年至1989年确诊时年龄在6岁以下。通过随机数字拨号选择对照，并按照年龄和种族与166例病例患者进行匹配。对母亲进行电话访谈，内容包括孕期饮酒、维生素和矿物质补充剂以及53种食物的食用频率。
观察到蔬菜（摄入量最高四分位数组相对于最低四分位数组的比值比为0.37；趋势P值=0.005）、水果和果汁（比值比为0.28；P值=0.003）、维生素A（比值比为0.59；P值=0.03）、维生素C（比值比为0.42；P值=0.009）、硝酸盐（比值比为0.44；P值=0.002）和叶酸（比值比为0.38；P值=0.005）有显著的保护趋势。观察到亚硝胺有风险增加的不显著趋势（比值比为1.65；P值=0.15）。孕期任何时候使用铁补充剂（比值比为0.43；P值=0.004）、钙补充剂（比值比为0.42；P值=0.05）和维生素C补充剂（比值比为0.35；P值=0.04）以及孕早期六周内使用多种维生素（比值比为0.56；P值=0.02）与风险降低相关。在多变量分析中，叶酸、早期使用多种维生素和铁补充剂通常仍具有保护作用。
这些结果不支持亚硝胺在幼儿原发性脑外胚层肿瘤发生中起作用的假设，但确实表明母亲饮食的某些其他方面会影响风险。
