Plant-based diets to reduce prostate cancer risk and improve prostate cancer outcomes-ready for prime time?
Plant-based diets to reduce prostate cancer risk and improve prostate cancer outcomes-ready for prime time?
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以植物为基础的饮食可降低前列腺癌风险并改善前列腺癌结果——准备好迎接黄金时期了吗？
DOI：
10.1038/s41391-022-00601-x
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发表时间：
2023
影响因子：
4.8
通讯作者：
Csizmadi,Ilona
中科院分区：
文献类型：
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作者：
Friedrich,NadineA;Freedland,StephenJ;Csizmadi,Ilona
密集的研究旨在确定可改变的饮食因素以降低前列腺癌（PC）风险并改善结果，但这些策略的证据仍然不确定[1]。然而，以植物为基础的饮食模式正在成为一种有吸引力的选择，其潜在的好处值得考虑。从历史上看，水果和蔬菜中的成分被研究，以阐明其摄入量与降低PC风险的机制。虽然观察性研究的结果令人鼓舞，但缺乏支持特定成分，植物性饮食模式和植物性食品益处的1级证据[2]。在最新一期的前列腺癌和前列腺疾病中，Gupta et al. [3]报告了植物性饮食模式与PC风险和进展之间关系的系统性综述。在32篇论文中发表的5项干预性研究和11项观察性研究符合纳入标准。在5项干预研究中，只有2项是随机对照试验（RCT），并且都是小型（< 100例受试者），短期干预（1年或更短）。干预措施不仅限于饮食，还包括减压和/或冥想和/或锻炼。报告的结果包括前列腺特异性抗原（PSA）、PSA倍增时间（PSADT）、循环激素和脂质水平以及参与者的营养充足性。虽然结果表明植物性饮食的益处，但考虑到样本量有限，短期干预，使用中间生物标志物和全面的生活方式干预措施，而不仅仅是植物性饮食，并且只有2项RCT和一项是试点试验，结论充其量可以被视为计划更大规模干预的支持性证据。事实上，这是本综述中两项RCT的结论[4，5]。在11项观察性研究中，7项是大型队列研究，研究PC风险与素食之间的关系。重要的是，7个队列中有5个报告了无效结果，即植物性饮食与PC风险降低之间没有关联。两个队列，英国生物银行队列和基督复临安息日会健康研究-2，在多变量调整模型中分别报告了素食者/素食者与肉食者、素食者与乳蛋素食者、鱼素食者和半素食者饮食相关的PC风险降低。几项病例对照研究报告了男性在不同疾病阶段的结果参差不齐。这篇综述的结论是什么？首先，缺乏设计严谨、性能良好的随机对照试验。男性饮食和健康生活（MEAL）试验是一项大型RCT，未纳入本综述，但在讨论中提到，仍然是迄今为止最大的设计良好的RCT，测试了增加水果和蔬菜消费与日常饮食的PC效应[6]。在男性中进行的为期2年的主动监测试验发现，PC进展没有益处
Intensive research has aimed to identify modifiable dietary factors to reduce prostate cancer (PC) risk and improve outcomes, but the evidence for these strategies remains inconclusive [1]. Plant-based dietary patterns, however, are emerging as appealing options with potential benefits that merit consideration. Historically, constituents in fruit and vegetables were studied to elucidate mechanisms linking their intake with reduced PC risk. While results from observational studies are encouraging, Level 1 evidence to support the benefits of specific constituents, plant-based dietary patterns, and plant-based foods is lacking [2]. In the current issue of Prostate Cancer and Prostatic Diseases, Gupta et al.[3] report a systematic review of the association between plant-based dietary patterns and PC risk and progression. Five intervention and 11 observational studies, published in 32 papers, were identified meeting the inclusion criteria. Of the 5 intervention studies, only two were randomized controlled trials (RCT), and all were small (< 100 subjects), with short-term interventions (1-year or less). Interventions were not limited to diet but included stress reduction and/or meditation and/or exercise. Outcomes reported included prostate specific antigen (PSA), PSA doubling time (PSADT), circulating hormonal and lipid levels and nutritional adequacy of participants. While results suggested benefits from plant-based diets, given the limited sample sizes, short-term intervention, use of intermediate biomarkers and comprehensive lifestyle interventions vs just a plant-based diet alone, and the fact that only 2 were RCTs and one was a pilot trial, at best the conclusions may be viewed as supportive evidence to plan a larger scale intervention. Indeed, this was the conclusion from the two RCTs [4, 5] in this review. Of the 11 observational studies, 7 were large cohort examining the associations between PC risk and vegetarian diets. Importantly, 5 of 7 cohorts reported null results, ie, no association between plant-based diet and reduced PC risk. Two cohorts, the UK Biobank cohort, and the Adventist Health Study-2, reported reduced PC risks associated with vegetarian/vegan vs meat-eaters, and vegan vs lacto-ovo-vegetarian, pesco-vegetarian and semivegetarian diets, respectively, in multivariable adjusted models. Several case-control studies reported mixed results in men at various disease stages.What are the take-home messages from this review? First, rigorously designed, well-powered RCTs are lacking. The Men’s Eating and Healthy Living (MEAL) trial, a large RCT not included in this review, but mentioned in the discussion, remains the largest well-designed RCT to date testing the PC effect of increasing fruit and vegetable consumption vs. usual diet [6]. The 2-year trial of men on active surveillance found no benefits for PC progression