Singh P N, Fraser G E
Center for Health Research, Loma Linda University, CA, USA.
Am J Epidemiol. 1998 Oct 15;148(8):761-74. doi: 10.1093/oxfordjournals.aje.a009697.
In a 6-year prospective study, the authors examined the relation between diet and incident colon cancer among 32,051 non-Hispanic white cohort members of the Adventist Health Study (California, 1976-1982) who, at baseline, had no documented or reported history of cancer. The risk of colon cancer was determined from proportional hazards regression with adjustment for age and other covariates. The authors found a positive association with total meat intake (risk ratio (RR) for > or =1 time/week vs. no meat intake = 1.85, 95% confidence interval (CI) 1.19-2.87; p for trend = 0.01) and, among subjects who favored specific types of meat, positive associations with red meat intake (RR for > or =1 time/week vs. no red meat intake = 1.90, 95% CI 1.16-3.11; p for trend = 0.02) and white meat intake (RR for > or =1 time/week vs. no white meat intake = 3.29, 95% CI 1.60-6.75; p for trend = 0.006). An inverse association with legume intake (RR for >2 times/week vs. <1 time/week = 0.53, 95% CI 0.33-0.86; p for trend = 0.03) was observed. Among men, a positive association with body mass index was observed (relative to the RR for tertile III (>25.6 kg/m2) vs. tertile I (<22.5 kg/m2) = 2.63, 95% CI 1.12-6.13; p for trend = 0.05). A complex relation was identified whereby subjects exhibiting a high red meat intake, a low legume intake, and a high body mass experienced a more than threefold elevation in risk relative to all other patterns based on these variables. This pattern of putative risk factors would likely contribute to increases in both insulin resistance (high body mass, high red meat intake) and glycemic load (low legume intake), a synergism that, if causal, implicates hyperinsulinemic exposure in colon carcinogenesis. The overall findings from this cohort identify both red meat intake and white meat intake as important dietary risk factors for colon cancer and raise the possibility that the risk due to red meat intake reflects a more complex etiology.
在一项为期6年的前瞻性研究中，作者调查了基督复临安息日会健康研究（加利福尼亚，1976 - 1982年）中32,051名非西班牙裔白人队列成员的饮食与结肠癌发病之间的关系，这些成员在基线时没有记录在案或报告过癌症病史。结肠癌风险通过比例风险回归确定，并对年龄和其他协变量进行了调整。作者发现，总肉类摄入量与之呈正相关（每周≥1次与不摄入肉类相比，风险比（RR）= 1.85，95%置信区间（CI）为1.19 - 2.87；趋势p值 = 0.01），在偏好特定类型肉类的受试者中，红肉摄入量（每周≥1次与不摄入红肉相比，RR = 1.90，95% CI为1.16 - 3.11；趋势p值 = 0.02）和白肉摄入量（每周≥1次与不摄入白肉相比，RR = 3.29，95% CI为1.60 - 6.75；趋势p值 = 0.006）也呈正相关。观察到豆类摄入量与之呈负相关（每周>2次与每周<1次相比，RR = 0.53，95% CI为0.33 - 0.86；趋势p值 = 0.03）。在男性中，观察到与体重指数呈正相关（相对于第三三分位数（>25.6 kg/m²）与第一三分位数（<22.5 kg/m²）相比，RR = 2.63，95% CI为1.12 - 6.13；趋势p值 = 0.05）。确定了一种复杂的关系，即相对于基于这些变量的所有其他模式，红肉摄入量高、豆类摄入量低且体重指数高的受试者风险升高了三倍多。这种假定的风险因素模式可能会导致胰岛素抵抗（高体重指数、高红肉摄入量）和血糖负荷（低豆类摄入量）都增加，这种协同作用如果是因果关系，则表明高胰岛素血症暴露与结肠癌发生有关。该队列的总体研究结果确定红肉摄入量和白肉摄入量都是结肠癌重要的饮食风险因素，并提出红肉摄入量导致的风险可能反映了更复杂病因的可能性。
