Bird C L, Frankl H D, Lee E R, Haile R W
Department of Preventive Medicine, School of Medicine, University of Southern California, Los Angeles 90033, USA.
Am J Epidemiol. 1998 Apr 1;147(7):670-80. doi: 10.1093/oxfordjournals.aje.a009508.
Epidemiologic studies of colorectal neoplasia have usually examined body mass index as a risk factor, but not other aspects of obesity. During 1991-1993, the authors obtained weight histories and comprehensive covariate data from men and women aged 50-75 years who underwent sigmoidoscopy at a health maintenance organization in southern California. Using 483 cases with adenomas and 483 controls, measures of obesity (body mass index), positive energy balance (net weight gain in the past 10 years), and weight variability (large weight changes) were each independently related to adenoma prevalence. Compared with subjects in the lowest quartile of body mass index, multivariate-adjusted odds ratios for subjects in increasingly higher quartiles were 2.1 (95% confidence interval (CI) 1.4-2.3), 1.8 (1.1-2.9), and 1.7 (1.0-2.8), respectively. Compared with subjects who reported a net weight loss during the 10 years before sigmoidoscopy, subjects with net weight gains of 1.5-4.5 kg or > or = 4.5 kg had adjusted odds ratios (95% CI) of 2.5 (1.2-5.6) and 1.8 (0.7-4.4), respectively. Compared with subjects who had no large weight changes during adulthood, subjects with 1-2, 3, or > or = 4 changes had adjusted odds ratios (95% CI) of 2.0 (1.0-3.9), 2.5 (1.2-5.5), and 1.5 (0.6-3.6), respectively. Obesity, weight gain, and unstable adult weight may be independently associated with colorectal carcinogenesis.
结直肠肿瘤的流行病学研究通常将体重指数作为一个风险因素进行考察，但未涉及肥胖的其他方面。在1991年至1993年期间，作者从南加州一家健康维护组织中接受乙状结肠镜检查的50至75岁男性和女性那里获取了体重史及全面的协变量数据。利用483例腺瘤患者和483例对照，肥胖指标（体重指数）、正能量平衡（过去10年的净体重增加）和体重变异性（大幅度体重变化）均各自独立地与腺瘤患病率相关。与体重指数处于最低四分位数的受试者相比，体重指数四分位数越来越高的受试者经多变量调整后的优势比分别为2.1（95%置信区间[CI] 1.4 - 2.3）、1.8（1.1 - 2.9）和1.7（1.0 - 2.8）。与在乙状结肠镜检查前10年报告有净体重减轻的受试者相比，净体重增加1.5至4.5千克或≥4.5千克的受试者经调整后的优势比（95% CI）分别为2.5（1.2 - 5.6）和1.8（0.7 - 4.4）。与成年期无大幅度体重变化的受试者相比，有1至2次、3次或≥4次体重变化的受试者经调整后的优势比（95% CI）分别为2.0（1.0 - 3.9）、2.5（1.2 - 5.5）和1.5（0.6 - 3.6）。肥胖、体重增加和成年期体重不稳定可能各自独立地与结直肠癌发生相关。
