Slattery M L, Potter J, Caan B, Edwards S, Coates A, Ma K N, Berry T D
Department on Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City 84108, USA.
Cancer Res. 1997 Jan 1;57(1):75-80.
Low levels of physical activity and high levels of energy intake and body mass have all been directly associated with colon cancer. The purpose of this study was to determine how physical inactivity interacts with other components of energy balance (energy intake and body mass) in determining colon cancer risk. Data were obtained from 2073 first primary cases of colon cancer and 2466 age- and sex-matched controls identified from 8 counties in Utah, the Northern California Kaiser Permanente Medical Care Program, and the Twin Cities metropolitan area in Minnesota. Recent and lifetime physical activity was assessed by intensity of activities performed at home, leisure, and at work; energy intake was estimated from an extensive diet history questionnaire; and body mass index (BMI) was calculated from measured height at the time of interview and reported weight for the referent year. For both men and women, lack of lifetime vigorous leisure-time activity was associated with increased risk of colon cancer [odds ratio (OR), 1.63 and 95% confidence interval (CI), 1.26-2.12 for men and OR, 1.59 and 95% CI, 1.21-2.10 for women, comparing the lowest to highest level of activity]. There were no differences in risk associated with physical activity by tumor site within the colon or by age at diagnosis. High levels of energy intake were also associated with increased risk of colon cancer in men and women (OR, 1.74 and 95% CI, 1.14-2.67 for men and OR, 1.70 and 95% CI, 1.07-2.70 for women). A large BMI was more associated with increased risk in men (OR, 1.94 and 95% CI, 1.49-2.54) than in women (OR, 1.45 and 95% CI, 1.08-1.94). Those at greatest risk of colon cancer were those who had the most unfavorable energy balance in that they were physically inactive, had high energy intakes, and had a large BMI (OR, 3.35 and 95% CI, 2.09-5.35). However, when physical activity was high, having a high energy intake and large BMI resulted in a nonsignificant increased colon cancer risk (OR, 1.28 and 95% CI, 0.81-2.03). This pattern was consistent between the sexes, but there was some evidence that men may be at higher risk than women, especially older women, as a result of unfavorable energy balance. These results support previous findings that physical inactivity, high energy intake, and large body mass are associated with increased risk of developing colon cancer. However, energy balance as a whole seems to be associated with risk of colon cancer. These findings suggest systemic metabolic influences on carcinogenesis and have important implications for prevention.
低水平的体力活动、高水平的能量摄入和体重均与结肠癌直接相关。本研究的目的是确定在结肠癌风险的决定因素中，缺乏体力活动如何与能量平衡的其他组成部分（能量摄入和体重）相互作用。数据来自犹他州8个县、北加利福尼亚凯撒永久医疗保健项目以及明尼苏达州双子城大都市地区确定的2073例原发性结肠癌首例病例和2466例年龄及性别匹配的对照。通过在家、休闲和工作时进行的活动强度来评估近期和一生的体力活动；通过一份详尽的饮食史问卷估计能量摄入；根据访谈时测量的身高和报告的参考年份体重计算体重指数（BMI）。对于男性和女性，一生缺乏剧烈休闲活动均与结肠癌风险增加相关[男性的优势比（OR）为1.63，95%置信区间（CI）为1.26 - 2.12；女性的OR为1.59，95%CI为1.21 - 2.10，比较活动水平最低至最高者]。结肠癌风险与结肠内肿瘤部位或诊断时年龄的体力活动无差异。高水平的能量摄入也与男性和女性结肠癌风险增加相关（男性的OR为1.74，95%CI为1.14 - 2.67；女性的OR为1.70，95%CI为1.07 - 2.70）。大BMI与男性风险增加的关联度（OR为1.94，95%CI为1.49 - 2.54）高于女性（OR为1.45，95%CI为1.08 - 1.94）。结肠癌风险最高的是那些能量平衡最不利的人，即缺乏体力活动、能量摄入高且BMI大（OR为3.35，95%CI为2.09 - 5.35）。然而，当体力活动水平高时，高能量摄入和大BMI导致结肠癌风险增加不显著（OR为1.28，95%CI为0.81 - 2.03）。这种模式在男女之间是一致的，但有一些证据表明，由于能量平衡不利，男性可能比女性风险更高，尤其是老年女性。这些结果支持了先前的研究发现，即缺乏体力活动、高能量摄入和大体重与患结肠癌风险增加相关。然而，整体能量平衡似乎与结肠癌风险相关。这些发现提示了对致癌作用的系统性代谢影响，并对预防具有重要意义。
