Africa's Oesophageal Cancer Corridor: Geographic Variations in Incidence Correlate with Certain Micronutrient Deficiencies.
Africa's Oesophageal Cancer Corridor: Geographic Variations in Incidence Correlate with Certain Micronutrient Deficiencies.
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DOI：
10.1371/journal.pone.0140107
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
McCormack V
中科院分区：
文献类型：
--
作者：
Schaafsma T;Wakefield J;Hanisch R;Bray F;Schüz J;Joy EJ;Watts MJ;McCormack V
非洲东部食管鳞状细胞癌走廊的病因学知之甚少。在世界其他地区，营养素缺乏与这种癌症有关，但在非洲，营养素缺乏的作用尚不清楚。如果没有前瞻性队列，可以通过生态研究获得及时的见解。在整个非洲，我们评估了一个国家的食管癌发病率与食物平衡表得出的7种营养素平均国家膳食供应量估计值之间的关联：钙（Ca），铜（Cu），铁（Fe），碘（I），镁（Mg），硒（Se）和锌（Zn）。我们纳入了32个国家，这些国家对膳食营养供应和更高质量的GLOBCAN 2012癌症发病率进行了估计。使用贝叶斯分层泊松对数正态模型估计与每种营养素相关的食管癌发病率比，调整年龄，性别，能量摄入，植酸盐，吸烟和饮酒，以及其95%后验可信区间（CI）。成年人的饮食不足进行了量化使用估计平均需求（ESTA）的临界点的方法。与平均营养供应加倍相关的食管癌校正发病率比为：铁0.49（95%CI：0.29-0.82）;镁0.58（0.31-1.08）;硒0.40（0.18-0.90）;锌0.29（0.11-0.74）。与Ca、Cu、I无相关性。在大多数国家，镁和铁的平均全国营养供应量超过成人EAR。对于硒，在食管癌排名最高的10个国家中，有7个国家的平均供应量低于EAR（男女），而其余国家的这一比例为23%。对于锌，在这10个排名最高的国家中，有8个国家的平均供应量低于男性EAR，而其他国家为36%。生态协会是一致的硒和/或锌缺乏症在鳞状细胞食管癌在非洲的潜在作用。需要进行个人层面的分析研究，以阐明它们在这种情况下的因果作用。
The aetiology of Africa’s easterly-lying corridor of squamous cell oesophageal cancer is poorly understood. Micronutrient deficiencies have been implicated in this cancer in other areas of the world, but their role in Africa is unclear. Without prospective cohorts, timely insights can instead be gained through ecological studies. Across Africa we assessed associations between a country’s oesophageal cancer incidence rate and food balance sheet-derived estimates of mean national dietary supplies of 7 nutrients: calcium (Ca), copper (Cu), iron (Fe), iodine (I), magnesium (Mg), selenium (Se) and zinc (Zn). We included 32 countries which had estimates of dietary nutrient supplies and of better-quality GLOBCAN 2012 cancer incidence rates. Bayesian hierarchical Poisson lognormal models were used to estimate incidence rate ratios for oesophageal cancer associated with each nutrient, adjusted for age, gender, energy intake, phytate, smoking and alcohol consumption, as well as their 95% posterior credible intervals (CI). Adult dietary deficiencies were quantified using an estimated average requirements (EAR) cut-point approach. Adjusted incidence rate ratios for oesophageal cancer associated with a doubling of mean nutrient supply were: for Fe 0.49 (95% CI: 0.29–0.82); Mg 0.58 (0.31–1.08); Se 0.40 (0.18–0.90); and Zn 0.29 (0.11–0.74). There were no associations with Ca, Cu and I. Mean national nutrient supplies exceeded adult EARs for Mg and Fe in most countries. For Se, mean supplies were less than EARs (both sexes) in 7 of the 10 highest oesophageal cancer ranking countries, compared to 23% of remaining countries. For Zn, mean supplies were less than the male EARs in 8 of these 10 highest ranking countries compared to in 36% of other countries. Ecological associations are consistent with the potential role of Se and/or Zn deficiencies in squamous cell oesophageal cancer in Africa. Individual-level analytical studies are needed to elucidate their causal role in this setting.