基于推荐的饮食指数与护士健康研究和健康专业人员随访研究中结直肠癌风险的关系。
Recommendation-based dietary indexes and risk of colorectal cancer in the Nurses' Health Study and Health Professionals Follow-up Study.
机构信息
Departments of Nutrition, Harvard TH Chan School of Public Health, Boston, MA.
Epidemiology, Harvard TH Chan School of Public Health, Boston, MA.
出版信息
Am J Clin Nutr. 2018 Nov 1;108(5):1092-1103. doi: 10.1093/ajcn/nqy171.
BACKGROUND
Many dietary indexes exist for chronic disease prevention, but the optimal dietary pattern for colorectal cancer prevention is unknown.
OBJECTIVE
We sought to determine associations between adherence to various dietary indexes and incident colorectal cancer in 2 prospective cohort studies.
DESIGN
We followed 78,012 women in the Nurses' Health Study and 46,695 men in the Health Professionals Follow-up Study from 1986 and 1988, respectively, until 2012. We created dietary index scores for the Dietary Approaches to Stop Hypertension (DASH) diet, Alternative Mediterranean Diet (AMED), and Alternative Healthy Eating Index-2010 (AHEI-2010) and used Cox regression to estimate HRs and 95% CIs for risk of colorectal cancer (CRC) and by anatomic subsite. We also conducted latency analyses to examine associations between diet and CRC risk during different windows of exposure. We conducted analyses in men and women separately, and subsequently pooled these results in a random-effects meta-analysis.
RESULTS
We documented 2690 colorectal cancer cases. Pooled multivariable HRs for colorectal cancer risk comparing the highest to lowest quintile of diet scores were 0.89 (95% CI: 0.74, 1.08; P-trend = 0.10) for DASH, 0.89 (95% CI: 0.73, 1.10; P-trend = 0.31) for AMED, and 0.95 (95% CI: 0.83, 1.09; P-trend = 0.56) for AHEI-2010 (P-heterogeneity ≥ 0.07 for all). In sex-specific analyses, we observed stronger associations in men for all dietary indexes (DASH: multivariable HR = 0.81, 95% CI: 0.66, 0.98; P-trend = 0.003; AMED: multivariable HR = 0.80, 95% CI: 0.65, 0.98; P-trend = 0.02; AHEI-2010: multivariable HR = 0.88, 95% CI: 0.72, 1.07; P-trend = 0.04) than in women (multivariable HRs range from 0.98 to 1.01).
CONCLUSIONS
Adherence to the DASH, AMED, and AHEI-2010 diets was inversely associated with colorectal cancer risk in men. These diets were not associated with colorectal cancer risk in women. This observational study was registered at http://www.clinicaltrials.gov as NCT03364582.
背景
有许多饮食指数可用于预防慢性病，但预防结直肠癌的最佳饮食模式尚不清楚。
目的
我们旨在通过两项前瞻性队列研究来确定不同饮食指数与结直肠癌发病风险之间的关联。
设计
我们分别从 1986 年和 1988 年开始随访了 78012 名女性护士健康研究（Nurses' Health Study）和 46695 名男性健康专业人员随访研究（Health Professionals Follow-up Study），随访至 2012 年。我们为饮食方式防治高血压（Dietary Approaches to Stop Hypertension，DASH）饮食、替代地中海饮食（Alternative Mediterranean Diet，AMED）和 2010 年替代健康饮食指数（Alternative Healthy Eating Index-2010，AHEI-2010）创建了饮食指数评分，并使用 Cox 回归估计了风险比（HR）和 95%置信区间（CI），用于结直肠癌（CRC）和解剖部位的风险。我们还进行了潜伏期分析，以检查在不同暴露窗口期饮食与 CRC 风险之间的关联。我们分别在男性和女性中进行了分析，然后在随机效应荟萃分析中合并了这些结果。
结果
我们共记录了 2690 例结直肠癌病例。与饮食评分最高五分位组相比，最低五分位组结直肠癌风险的多变量 HR 分别为 DASH 饮食为 0.89（95%CI：0.74，1.08；P 趋势=0.10）、AMED 饮食为 0.89（95%CI：0.73，1.10；P 趋势=0.31）和 AHEI-2010 饮食为 0.95（95%CI：0.83，1.09；P 趋势=0.56）（所有 P 异质性值均≥0.07）。在按性别进行的分析中，我们观察到所有饮食指数在男性中的关联更强（DASH：多变量 HR=0.81，95%CI：0.66，0.98；P 趋势=0.003；AMED：多变量 HR=0.80，95%CI：0.65，0.98；P 趋势=0.02；AHEI-2010：多变量 HR=0.88，95%CI：0.72，1.07；P 趋势=0.04），而在女性中则较弱（多变量 HR 范围为 0.98 至 1.01）。
结论
DASH、AMED 和 AHEI-2010 饮食的依从性与男性结直肠癌风险呈负相关。这些饮食与女性结直肠癌风险无关。这项观察性研究在 http://www.clinicaltrials.gov 上注册为 NCT03364582。
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