BMI and waist circumference as predictors of lifetime colon cancer risk in Framingham Study adults
BMI and waist circumference as predictors of lifetime colon cancer risk in Framingham Study adults
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DOI：
10.1038/sj.ijo.0802606
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发表时间：
2004-04-01
影响因子：
4.9
通讯作者：
Kreger, BE
中科院分区：
文献类型：
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作者：
Moore, LL;Bradlee, ML;Kreger, BE
背景：目前尚不清楚男性和女性与肥胖相关的结肠癌风险增加是否因体脂分布或肿瘤位置不同而不同。本研究的主要目的是解决这些问题。方法：Framingham研究队列中符合条件的受试者根据体重指数（BMI）和腰围大小在30 - 54岁（n = 3764）和55 - 79岁（n = 3802）两个年龄段进行分类。所有符合条件的男性和女性在基线时均无癌症，并具有以下潜在混杂因素的完整信息：年龄、性别、教育程度、身高、活动、吸烟和饮酒。在30 - 54岁开始随访的人群中有157例终生结肠癌病例，在55 - 79岁开始随访的人群中有149例终生结肠癌病例。研究对象根据性别、活动和肿瘤位置进一步分层。Cox比例风险模型用于校正上述因素可能造成的混淆。结果：BMI大于或等于30导致中年人（30 - 54岁）患结肠癌风险增加50% (95% CI: 0.92 - 2.5)，老年人（55 - 79岁）患结肠癌风险增加2.4倍（95% CI: 1.5 - 3.9）。BMI对男性的影响比女性更大，对发生在近端结肠的病例来说也是如此。当多变量模型中加入腰围时，这些不良反应通常会减弱。较大的腰围（女性和男性分别大于或等于99.1厘米（39英寸）和101.6厘米（40英寸））与结肠癌风险增加两倍有关；这种风险随着腰围的增加而线性增加，在近端和远端结肠癌中都是明显的。当BMI加入到多变量模型中时，这些效应没有衰减。在久坐不动的受试者中，腰粗的影响尤其不利(中年人的相对风险= 4.4；老年人RR = 3.0)。结论：这些发现表明，与BMI相比，腰围是结肠癌风险的一个更强的预测指标，中心肥胖是近端和远端结肠癌症风险增加的原因。
BACKGROUND: It is unclear whether the increased risk of colon cancer associated with obesity differs for men and women, by distribution of body fat, or by location of the tumor. The primary goal of this study was to address these questions.METHODS: Eligible subjects from the Framingham Study cohort were classified according to body mass index ( BMI) and waist size during two age periods: 30 - 54 y ( n = 3764) and 55 - 79 y ( n = 3802). All eligible men and women were cancer-free at baseline and had complete information on the following potential confounders: age, sex, education, height, activity, smoking, and alcohol. There were 157 incident lifetime cases of colon cancer among those followed beginning at 30 - 54 y of age and 149 lifetime cases among those whose follow up began at 55 - 79 y. Subjects were stratified further by gender, activity, and tumor location. The Cox Proportional Hazards Models were used to adjust for possible confounding by the above-described factors.RESULTS: A BMI greater than or equal to30 led to a 50% increased risk (95% CI: 0.92 - 2.5) of colon cancer among middle-aged ( 30 - 54 y) and a 2.4-fold increased risk ( 95% CI: 1.5 - 3.9) among older ( 55 - 79 y) adults. The BMI effect was stronger for men than for women and for cases occurring in the proximal colon. These adverse effects generally diminished when waist was added to the multivariable models. A larger waist size ( greater than or equal to99.1 cm ( 39 in) and 101.6 cm ( 40 in) for women and men, respectively) was associated with a twofold increased risk of colon cancer; this risk increased linearly with increasing waist size and was evident for both proximal and distal colon cancer. There was no attenuation of these effects when BMI was added to the multivariable models. A larger waist had a particularly adverse effect among sedentary subjects ( relative risk (RR) = 4.4 for middle-aged adults; RR = 3.0 for older adults).CONCLUSION: These findings suggest that waist circumference is a stronger predictor of colon cancer risk than is BMI, and that central obesity is responsible for an increased risk of cancer of both the proximal and distal colon.