Shoff S M, Newcomb P A
University of Wisconsin Comprehensive Cancer Center, Madison 53706, USA.
Am J Epidemiol. 1998 Aug 1;148(3):234-40. doi: 10.1093/oxfordjournals.aje.a009630.
Data from a population-based case-control study of Wisconsin women were used to evaluate the relation of diabetes to the risk of endometrial cancer on the basis of body mass index (BMI). Cases (n=723) were identified from a statewide tumor registry; controls (n=2,291) were selected randomly from population lists. Diabetes status, weight, height, and other factors were ascertained by telephone interview. Subjects were categorized as not overweight (BMI, <29.1), overweight (BMI, 29.1-31.9), or obese (BMI, >31.9) according to the BMI distribution of middle-aged white women in the Second National Health and Nutrition Examination Survey. Joint associations between diabetes status, BMI, and endometrial cancer were evaluated using unconditional logistic regression models that controlled for age, parity, use of hormone replacement therapy, education, and smoking. Compared with persons without diabetes, those with diabetes had an adjusted odds ratio of 1.86 (95% confidence interval (CI) 1.37-2.52) for endometrial cancer. This association was modified by BMI (p interaction=0.04). Compared with nonoverweight nondiabetic subjects, nonoverweight and overweight women who reported diabetes had nonsignificant elevated risks of endometrial cancer (nonoverweight, odds ratio (OR)=1.10, CI 0.66-1.86; overweight, OR=1.58, CI 0.81-3.05). In contrast, elevated risk estimates were observed for obese diabetic women (OR=2.95, CI 1.60-5.46). These data contradict earlier reports and suggest that diabetes confers no additional risk of endometrial cancer in women who are neither overweight nor obese.
一项基于威斯康星州女性人群的病例对照研究数据被用于评估糖尿病与基于体重指数（BMI）的子宫内膜癌风险之间的关系。病例（n = 723）来自全州范围的肿瘤登记处；对照（n = 2291）从人口名单中随机选取。通过电话访谈确定糖尿病状态、体重、身高和其他因素。根据第二次全国健康和营养检查调查中中年白人女性的BMI分布，将受试者分为非超重（BMI，<29.1）、超重（BMI，29.1 - 31.9）或肥胖（BMI，>31.9）。使用无条件逻辑回归模型评估糖尿病状态、BMI与子宫内膜癌之间的联合关联，该模型控制了年龄、产次、激素替代疗法的使用、教育程度和吸烟情况。与无糖尿病者相比，糖尿病患者患子宫内膜癌的调整优势比为1.86（95%置信区间（CI）1.37 - 2.52）。这种关联受BMI影响（p交互作用 = 0.04）。与非超重非糖尿病受试者相比，报告患有糖尿病的非超重和超重女性患子宫内膜癌的风险虽有升高但无统计学意义（非超重，优势比（OR）= 1.10，CI 0.66 - 1.86；超重，OR = 1.58，CI 0.81 - 3.05）。相比之下，肥胖糖尿病女性的风险估计值升高（OR = 2.95，CI 1.60 - 5.46）。这些数据与早期报告相矛盾，表明在既不超重也不肥胖的女性中，糖尿病不会增加子宫内膜癌的额外风险。
