成人体重增加与肥胖相关癌症：前瞻性观察研究的剂量反应荟萃分析。
Adult weight gain and adiposity-related cancers: a dose-response meta-analysis of prospective observational studies.
机构信息
Departments of Nutrition and Epidemiology (NK, DHL, FBH, ELG) and Department of Social and Behavioral Sciences (RK), Harvard School of Public Health, Boston, MA; Division of Biostatistics, University of Leeds, Leeds, UK (DCG); Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway (DA); Department of Epidemiology and Biostatistics, Imperial College London, London, UK (DA); Department of Obstetrics and Gynecology, Ewha Womans University, Seoul, Republic of Korea (WJ); Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (FBH, ELG).
出版信息
J Natl Cancer Inst. 2015 Mar 10;107(2). doi: 10.1093/jnci/djv088. Print 2015 Feb.
BACKGROUND
Adiposity, measured by body mass index, is implicated in carcinogenesis. While adult weight gain has diverse advantages over body mass index in measuring adiposity, systematic reviews on adult weight gain in relation to adiposity-related cancers are lacking.
METHODS
PubMed and Embase were searched through September 2014 for prospective observational studies investigating the relationship between adult weight gain and the risk of 10 adiposity-related cancers. Dose-response meta-analyses were performed using a random-effects model to estimate summary relative risk (RR) and 95% confidence interval (CI) for each cancer type. All statistical tests were two-sided.
RESULTS
A total of 50 studies were included. For each 5 kg increase in adult weight gain, the summary relative risk was 1.11 (95% CI = 1.08 to 1.13) for postmenopausal breast cancer among no- or low-hormone replacement therapy (HRT) users, 1.39 (95% CI = 1.29 to 1.49) and 1.09 (95% CI = 1.02 to 1.16) for postmenopausal endometrial cancer among HRT nonusers and users, respectively, 1.13 (95% CI = 1.03 to 1.23) for postmenopausal ovarian cancer among no or low HRT users, 1.09 (95% CI = 1.04 to 1.13) for colon cancer in men. The relative risk of kidney cancer comparing highest and lowest level of adult weight gain was 1.42 (95% CI = 1.11 to 1.81). Adult weight gain was unrelated to cancers of the breast (premenopausal women, postmenopausal HRT users), prostate, colon (women), pancreas, and thyroid. An increase in risk associated with adult weight gain for breast cancer was statistically significantly greater among postmenopausal women (P(heterogeneity) = .001) and HRT nonusers (P(heterogeneity) = .001); that for endometrial cancer was alike among HRT nonusers (P(heterogeneity) = .04).
CONCLUSIONS
Avoiding adult weight gain itself may confer protection against certain types of cancers, particularly among HRT nonusers.
背景
体质量指数（BMI）衡量的肥胖与致癌作用有关。虽然成年人的体重增加在衡量肥胖方面优于 BMI，但缺乏有关成人体重增加与肥胖相关癌症关系的系统综述。
方法
通过 2014 年 9 月对 PubMed 和 Embase 进行检索，寻找前瞻性观察性研究，调查成人体重增加与 10 种肥胖相关癌症风险之间的关系。使用随机效应模型进行剂量-反应荟萃分析，以估计每种癌症类型的汇总相对风险（RR）和 95%置信区间（CI）。所有统计检验均为双侧检验。
结果
共纳入 50 项研究。对于成人体重增加每增加 5kg，在未使用或低剂量激素替代疗法（HRT）的绝经后女性中，乳腺癌的汇总相对风险为 1.11（95%CI=1.08 至 1.13），在未使用和使用 HRT 的绝经后子宫内膜癌中，分别为 1.39（95%CI=1.29 至 1.49）和 1.09（95%CI=1.02 至 1.16），在未使用或低剂量 HRT 的绝经后女性中，卵巢癌的汇总相对风险为 1.13（95%CI=1.03 至 1.23），在男性中，结肠癌的汇总相对风险为 1.09（95%CI=1.04 至 1.13）。与最低和最高水平的成人体重增加相比，肾癌的相对风险为 1.42（95%CI=1.11 至 1.81）。成人体重增加与乳腺癌（绝经前妇女、绝经后 HRT 使用者）、前列腺癌、结肠癌（女性）、胰腺癌和甲状腺癌无关。在绝经后妇女（P（异质性）=.001）和 HRT 非使用者（P（异质性）=.001）中，与成人体重增加相关的乳腺癌风险增加具有统计学意义，在 HRT 非使用者中，子宫内膜癌的风险增加也具有统计学意义（P（异质性）=.04）。
结论
避免成人体重增加本身可能有助于预防某些类型的癌症，尤其是在 HRT 非使用者中。
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