能量摄入对消化道癌症风险影响的荟萃分析。
A meta-analysis of the effects of energy intake on risk of digestive cancers.
机构信息
Department of Gastroenterology, Huadong Hospital, Fudan University, Shanghai 200040, China.
出版信息
World J Gastroenterol. 2012 Dec 28;18(48):7362-70. doi: 10.3748/wjg.v18.i48.7362.
AIM
To quantitatively assess the relationship between energy intake and the incidence of digestive cancers in a meta-analysis of cohort studies.
METHODS
We searched MEDLINE, EMBASE, Science Citation Index Expanded, and the bibliographies of retrieved articles. Studies were included if they reported relative risks (RRs) and corresponding 95% CIs of digestive cancers with respect to total energy intake. When RRs were not available in the published article, they were computed from the exposure distributions. Data were extracted independently by two investigators and discrepancies were resolved by discussion with a third investigator. We performed fixed-effects meta-analyses and meta-regressions to compute the summary RR for highest versus lowest category of energy intake and for per unit energy intake and digestive cancer incidence by giving each study-specific RR a weight that was proportional to its precision.
RESULTS
Nineteen studies consisting of 13 independent cohorts met the inclusion criteria. The studies included 995,577 participants and 5620 incident cases of digestive cancer with an average follow-up of 11.1 years. A significant inverse association was observed between energy intake and the incidence of digestive cancers. The RR of digestive cancers for the highest compared to the lowest caloric intake category was 0.90 (95% CI 0.81-0.98, P < 0.05). The RR for an increment of 239 kcal/d energy intake was 0.97 (95% CI 0.95-0.99, P < 0.05) in the fixed model. In subgroup analyses, we noted that energy intake was associated with a reduced risk of colorectal cancer (RR 0.90, 95% CI 0.81-0.99, P < 0.05) and an increased risk of gastric cancer (RR 1.19, 95% CI 1.08-1.31, P < 0.01). There appeared to be no association with esophageal (RR 0.96, 95% CI 0.86-1.07, P > 0.05) or pancreatic (RR 0.79, 95% CI 0.49-1.09, P > 0.05) cancer. Associations were also similar in studies from North America and Europe. The RR was 1.02 (95% CI 0.79-1.25, P > 0.05) when considering the six studies conducted in North America and 0.87 (95% CI 0.77-0.98, P < 0.05) for the five studies from Europe.
CONCLUSION
Our findings suggest that high energy intake may reduce the total digestive cancer incidence and has a preventive effect on colorectal cancer.
目的
通过荟萃分析队列研究，定量评估能量摄入与消化系统癌症发病之间的关系。
方法
我们检索了 MEDLINE、EMBASE、科学引文索引扩展版和检索文章的参考文献。如果研究报告了总能量摄入与消化系统癌症的相对风险（RR）和相应的 95%置信区间（CI），则将其纳入研究。如果在已发表的文章中没有 RR，则从暴露分布中计算出来。数据由两位研究者独立提取，如果有分歧，由第三位研究者进行讨论。我们进行了固定效应荟萃分析和荟萃回归，以计算最高与最低能量摄入类别以及单位能量摄入与消化系统癌症发病率之间的汇总 RR，为每个研究特有的 RR 赋予与其精度成比例的权重。
结果
共有 19 项研究符合纳入标准，包含 13 个独立队列。这些研究包括 995577 名参与者和 5620 例消化系统癌症发病，平均随访时间为 11.1 年。观察到能量摄入与消化系统癌症的发病呈负相关。与最低热量摄入组相比，最高热量摄入组的消化系统癌症 RR 为 0.90（95%CI 0.81-0.98，P < 0.05）。在固定模型中，每天增加 239 千卡能量摄入的 RR 为 0.97（95%CI 0.95-0.99，P < 0.05）。在亚组分析中，我们注意到能量摄入与结直肠癌（RR 0.90，95%CI 0.81-0.99，P < 0.05）风险降低和胃癌（RR 1.19，95%CI 1.08-1.31，P < 0.01）风险增加相关。与食管癌（RR 0.96，95%CI 0.86-1.07，P > 0.05）或胰腺癌（RR 0.79，95%CI 0.49-1.09，P > 0.05）之间似乎没有关联。北美和欧洲的研究也得出了相似的结果。考虑到来自北美 6 项研究的 RR 为 1.02（95%CI 0.79-1.25，P > 0.05），来自欧洲的 5 项研究的 RR 为 0.87（95%CI 0.77-0.98，P < 0.05）。
结论
我们的研究结果表明，高能量摄入可能降低总体消化系统癌症的发病率，并对结直肠癌具有预防作用。
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