Proportion of colon cancer attributable to lifestyle in a cohort of US women.
Proportion of colon cancer attributable to lifestyle in a cohort of US women.
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DOI：
10.1007/s10552-015-0619-z
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发表时间：
2015-09
期刊：
影响因子：
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通讯作者：
Willett W
中科院分区：
文献类型：
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作者：
Erdrich J;Zhang X;Giovannucci E;Willett W
许多可改变的生活方式因素与结肠癌风险相关，但综合考虑它们对疾病的影响却知之甚少。估计通过采用可改变的生活方式组合可以预防的结肠癌病例比例将为疾病预防提供重要的见解。在护士健康研究中，我们根据六个因素的组合定义了低风险组：体重指数<25kg/m2、每周体力活动≥21代谢当量、饮酒量≤30g/天、30岁之前吸烟<10包年、目前使用多种维生素≥15年、总钙摄入量≥700mg/天。创建了综合风险评分指数，并在考虑其他已知风险或保护因素后计算了人群归因风险（PAR%）。我们在 24 年的随访中记录了 81,092 例结肠癌病例中的 1,127 例。与最低风险类别的女性相比，所有其他暴露水平的女性患结肠癌的风险比为1.81（95%置信区间，1.15-2.85）。评分指数与结肠癌风险增加呈显着线性相关（趋势P值<0.0001）。综合考虑与结肠癌相关的六种危险因素的 PAR% 为 0.37（95%CI：0.09-0.60）。当定期服用阿司匹林（每周两片，持续 6 年或更长）与其他低风险行为一起使用时，PAR% 增加至 0.43（95%CI：0.14-0.65）。除了结肠镜检查/乙状结肠镜检查的已知益处之外，关键的行为改变和坚持健康的生活方式可以避免女性中约 37% 的结肠癌病例。
Many modifiable lifestyle factors have been associated with colon cancer risk, but less is known about their effect on disease when considered together. Estimating the proportion of colon cancer cases that could be prevented by the adoption of combined modifiable lifestyle behaviors will provide important insights into disease prevention. In the Nurses’ Health Study, we defined a low-risk group according to a combination of six factors: body-mass index < 25kg/m2, physical activity of ≥ 21 metabolic equivalent of task per week, alcohol consumption ≤ 30g/day, cigarette smoking <10 pack years before the age of 30, current use of multivitamins for ≥ 15 years, and total calcium intake ≥700mg/day. A composite risk score index was created and the population attributable risk(PAR%) was calculated after accounting for other known risk or protective factors. We documented 1,127 colon cancer cases among 81,092 over 24 years of follow-up. Compared to women in the lowest-risk category, the women at all other exposure levels had a hazard ratio of colon cancer of 1.81(95% confidence interval, 1.15-2.85). The score index was significantly and linearly related to an increasing risk of colon cancer (P-value for trend <0.0001). The PAR% of the six risk factors considered together in relation to colon cancer was 0.37(95%CI: 0.09-0.60). When regular aspirin use(two tablets/week for 6 or more years) was included with the other low-risk behaviors, the PAR% increased to 0.43(95%CI: 0.14-0.65). Beyond the known benefit from colonoscopy/sigmoidoscopy, key behavior modifications and adherence to a healthy lifestyle could avoid approximately 37% of colon cancer cases among women.