Serum cholesterol and cancer.
Serum cholesterol and cancer.
复制标题
血清胆固醇与癌症。
作者：
M. Law
许多前瞻性流行病学研究已经探讨了血清胆固醇与缺血性心脏病之间的关系。在这些研究中发现低血清胆固醇与癌症之间的关联是出乎意料的（Rose et al., 1974），但许多研究已经证实了这一点。人们认识到临床前癌症会降低血清胆固醇（Rose & Shipley，1980；Cambien 等，1980），这可能是由于恶性细胞中低密度脂蛋白（LDL）受体活性增加所致（Vitols 等，1985）。然而，目前还不确定这种短期效应是否完全解释了低血清胆固醇与癌症的关联：存在相互矛盾的证据表明存在临床前癌症无法解释的额外长期关联。最近对所有已发表的前瞻性研究的分析（Law & Thompson，1991）表明存在长期影响。当每项已发表研究的数据以相同的方式表达（作为平均病例对照血清胆固醇差异）并通过省略早期癌症（发病率研究中前两年或死亡率研究中前5年出现的癌症）充分考虑临床前效应时，患癌症的人的平均血清胆固醇显着低于未患癌症的人（P<0.001）。然而，长期影响很小，相当于胆固醇最低五分位数组的癌症发病率平均增加约 15%（短期关联更大）。研究之间也存在明显的差异，一些研究中效果很大，但另一些研究中则没有，这一点通过同样具有统计显着性的异质性测量得到证实（P = 0.01）。在国际比较中并未发现低血清胆固醇与癌症之间的关联。日本、中国、希腊和西班牙等低胆固醇国家的心脏病发病率低于北欧和北美，但癌症发病率并不高。七国研究已证实低胆固醇与各国内所有部位的癌症和肺癌之间存在长期关联，但表明七国之间没有关联（Keys 等，1985）。国家之间血清胆固醇的差异几乎完全由饮食差异决定，而一个国家内个体之间的差异则具有重要的遗传因素。因此，国际上缺乏低胆固醇与癌症之间的关联，这表明低膳食脂肪不会诱发癌症，事实上，动物研究和流行病学证据都表明，如果情况相反，高膳食脂肪与癌症风险增加有关（Kinlen，1983；Carroll 等人，1986；Prentice 和 Sheppard，1990）。因此，低胆固醇与个体癌症的长期关联可能表明，与低胆固醇相关的基因和另一个易患癌症的基因之间存在遗传联系。然而，似乎更有可能的是
Many prospective epidemiological studies have examined the relationship between serum cholesterol and ischaemic heart disease. The discovery of an association of low serum cholesterol with cancer in these studies was unexpected (Rose et al., 1974), but many of the studies have confirmed it. An explanation emerged with the recognition that pre-clinical cancer lowers serum cholesterol (Rose & Shipley, 1980; Cambien et al.. 1980), probably due to increased low-densitylipoprotein (LDL) receptor activity in malignant cells (Vitols et al., 1985). It has been uncertain however whether this short term effect entirely accounts for the association of low serum cholesterol with cancer: there is conflicting evidence as to the presence of an additional long term association not explained by pre-clinical cancer. A recent analysis of all the published prospective studies (Law & Thompson, 1991) showed that there is a long-term effect. When the data from each published study were expressed in the same way (as the mean case-control serum cholesterol difference) and adequate allowance was made for the pre-clinical effect by omitting the early cancers (those presenting in the first two years in incidence studies or the first 5 years in mortality studies), the mean serum cholesterol was significantly lower in persons who developed cancer than in those who did not (P<0.001). The long term effect is small however, equivalent on average to about a 15% increased cancer incidence in the lowest cholesterol quintile group (the short term association is much greater). There is also pronounced variation between studies, the effect being large in some studies but absent in others, confirmed by a measure of heterogeneity that was also statistically significant (P = 0.01). This association of low serum cholesterol with cancer is not seen in international comparisons. Low cholesterol countries like Japan and China, Greece and Spain, have lower rates of heart disease than northern Europe and North America, but their rates of cancer are no higher. The Seven Countries Study has confirmed a long-term association of low cholesterol with both cancer of all sites and lung cancer within the countries, but has shown no association between the seven countries (Keys et al., 1985). Variation in serum cholesterol between countries is determined almost entirely by dietary differences, whereas variation between individuals within a country has an important genetic component. The absence of an international association of low cholesterol with cancer therefore suggests that low dietary fat does not predispose to cancer, and indeed both animal studies and epidemiological evidence indicate that if anything the opposite is the case, high dietary fat being associated with increased cancer risk (Kinlen, 1983; Carroll et al.. 1986; Prentice & Sheppard. 1990). The long term association of low cholesterol with cancer in individuals might therefore suggest a genetic linkage between a gene associated with low cholesterol and another that predisposes to cancer. It seems more likely however that the
膳食脂肪与肺癌的关联。
DOI：
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发表时间：
1987
期刊：
Journal of the National Cancer Institute
影响因子：
--
作者：
Wynder,EL;Hebert,JR;Kabat,GC
通讯作者：
Kabat,GC
成年早期吸烟开始以及血清脂质和脂蛋白的纵向变化：Bogalusa 心脏研究。
影响因子：
5
作者：
Freedman,DS;Srinivasan,SR;Shear,CL;Hunter,SM;Croft,JB;Webber,LS;Berenson,GS
通讯作者：
Berenson,GS