NUTRITION INTERVENTION TRIALS IN LINXIAN, CHINA - SUPPLEMENTATION WITH SPECIFIC VITAMIN MINERAL COMBINATIONS, CANCER INCIDENCE, AND DISEASE-SPECIFIC MORTALITY IN THE GENERAL-POPULATION
NUTRITION INTERVENTION TRIALS IN LINXIAN, CHINA - SUPPLEMENTATION WITH SPECIFIC VITAMIN MINERAL COMBINATIONS, CANCER INCIDENCE, AND DISEASE-SPECIFIC MORTALITY IN THE GENERAL-POPULATION
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DOI：
10.1093/jnci/85.18.1483
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发表时间：
1993-09-15
影响因子：
10.3
通讯作者：
LI, B
中科院分区：
文献类型：
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作者：
BLOT, WJ;LI, JY;LI, B
工作背景：流行病学证据表明，水果和蔬菜含量高的饮食与几种癌症的风险降低有关，包括食道癌和胃癌。这些食物中的维生素和矿物质可能有助于降低癌症风险。中国林县是世界上食管癌/贲门癌发病率最高的地区之一，几种微量营养素的摄入量持续偏低。目的：我们试图确定在林县膳食中补充特定的维生素和矿物质是否可以降低癌症的死亡率或发病率以及其他疾病的死亡率。方法：1985年从林县四个公社招募了40-69岁的个体。死亡率和癌症发病率在1986年3月至1991年5月期间，确定了29584名成年人在此期间每天补充维生素和矿物质。受试者被随机分配到干预组，根据24析因实验设计的一半重复。这种设计使得能够测试四种营养素组合的效果：（A）视黄醇和锌;（B）核黄素和烟酸;（C）维生素C和钼;以及（D）β胡萝卜素、维生素E和硒。剂量范围为美国推荐每日允许量的一到两倍。结果：在干预期间，共有2127名试验参与者死亡。癌症是死亡的主要原因，食管癌或胃癌占所有死亡人数的32%，其次是脑血管疾病（25%）。在接受β-胡萝卜素、维生素E和硒补充的人群中，总死亡率显著降低（P = 0.03）（相对风险[RR] = 0.91; 95%置信区间[CI] = 0.84-0.99）。这主要是由于癌症发病率较低（RR = 0.87; 95% CI = 0.75-1.00），尤其是胃癌（RR = 0.79; 95% CI = 0.64-0.99），在开始补充这些维生素和矿物质后约1-2年，风险开始降低。补充视黄醇和锌、核黄素和烟酸或维生素C和钼对所有原因引起的死亡率没有显著影响。根据1298例病例，癌症发病率的模式与癌症死亡率的模式大致相似。结论：研究结果表明，林县成年人饮食中补充维生素和矿物质，特别是β-胡萝卜素、维生素E和硒的组合，可能会降低这一人群的癌症风险。含义：这些结果本身并不是决定性的，但这些有希望的发现应该会刺激进一步的研究，以澄清微量营养素补充剂的潜在益处。
Background: Epidemiologic evidence indicates that diets high in fruits and vegetables are associated with a reduced risk of several cancers, including cancers of the esophagus and stomach. Vitamins and minerals in these foods may contribute to the reduced cancer risk. The people of Linxian County, China, have one of the world's highest rates of esophageal/gastric cardia cancer and a persistently low intake of several micronutrients. Purpose: We sought to determine if dietary supplementation with specific vitamins and minerals can lower mortality from or incidence of cancer as well as mortality from other diseases in Linxian. Methods: Individuals of ages 40-69 were recruited in 1985 from four Linxian communes. Mortality and cancer incidence during March 1986-May 1991 were ascertained for 29584 adults who received daily vitamin and mineral supplementation throughout this period. The subjects were randomly assigned to intervention groups according to a one-half replicate of a 24 factorial experimental design. This design enabled testing for the effects of four combinations of nutrients: (A) retinol and zinc; (B) riboflavin and niacin; (C) vitamin C and molybdenum; and (D) beta carotene, vitamin E, and selenium. Doses ranged from one to two times U.S. Recommended Daily Allowances. Results: A total of 2127 deaths occurred among trial participants during the intervention period. Cancer was the leading cause of death, with 32% of all deaths due to esophageal or stomach cancer, followed by cerebrovascular disease (25%). Significantly (P = .03) lower total mortality (relative risk [RR] = 0.91; 95% confidence interval [CI] = 0.84-0.99) occurred among those receiving supplementation with beta carotene, vitamin E, and selenium. The reduction was mainly due to lower cancer rates (RR = 0.87; 95% CI = 0.75-1.00), especially stomach cancer (RR = 0.79; 95% CI = 0.64-0.99), with the reduced risk beginning to arise about 1-2 years after the start of supplementation with these vitamins and minerals. No significant effects on mortality rates from all causes were found for supplementation with retinol and zinc, riboflavin and niacin, or vitamin C and molybdenum. Patterns of cancer incidence, on the basis of 1298 cases, generally resembled those for cancer mortality. Conclusions: The findings indicate that vitamin and mineral supplementation of the diet of Linxian adults, particularly with the combination of beta carotene, vitamin E, and selenium, may effect a reduction in cancer risk in this population. Implications: The results on their own are not definitive, but the promising findings should stimulate further research to clarify the potential benefits of micronutrient supplements.