Overweight, obesity, and mortality from cancer in a prospectively studied cohort of US adults
Overweight, obesity, and mortality from cancer in a prospectively studied cohort of US adults
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DOI：
10.1056/nejmoa021423
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发表时间：
2003-04-24
影响因子：
158.5
通讯作者：
Thun, MJ
中科院分区：
文献类型：
--
作者：
Calle, EE;Rodriguez, C;Thun, MJ
背景：超重对癌症死亡风险的影响尚未完全明确。
方法：对1982年登记时无癌症的90多万美国成年人（404576名男性和495477名女性）进行前瞻性研究，在16年的随访期间，有57145人死于癌症。我们在多变量比例风险模型中控制其他风险因素的同时，研究了1982年男性和女性的体重指数与所有癌症以及各部位癌症死亡风险之间的关系。我们根据本研究的风险估计以及美国成年人群中超重和肥胖患病率的全国估计值，计算了美国人群中可归因于超重和肥胖的所有癌症死亡的比例。
结果：该队列中体重最重的成员（体重指数[体重（千克）除以身高（米）的平方]至少为40），其所有癌症合并死亡率比正常体重的男性高52%，比正常体重的女性高62%。男性的死亡相对风险为1.52（95%置信区间，1.13 - 2.05）；女性的死亡相对风险为1.62（95%置信区间，1.40 - 1.87）。在男性和女性中，体重指数还与食管癌、结肠癌和直肠癌、肝癌、胆囊癌、胰腺癌和肾癌的较高死亡率显著相关；非霍奇金淋巴瘤和多发性骨髓瘤的死亡情况也是如此。在男性中，观察到随着体重指数值升高，胃癌和前列腺癌死亡风险呈显著上升趋势；在女性中，观察到随着体重指数值升高，乳腺癌、子宫癌、宫颈癌和卵巢癌死亡风险呈显著上升趋势。根据本研究中观察到的关联，我们估计美国目前的超重和肥胖模式可能导致男性14%的癌症死亡和女性20%的癌症死亡。
结论：体重增加与所有癌症合并以及多个特定部位癌症的死亡率增加有关。
Background: The influence of excess body weight on the risk of death from cancer has not been fully characterized.Methods: In a prospectively studied population of more than 900,000 U.S. adults (404,576 men and 495,477 women) who were free of cancer at enrollment in 1982, there were 57,145 deaths from cancer during 16 years of follow-up. We examined the relation in men and women between the body-mass index in 1982 and the risk of death from all cancers and from cancers at individual sites, while controlling for other risk factors in multivariate proportional-hazards models. We calculated the proportion of all deaths from cancer that was attributable to overweight and obesity in the U.S. population on the basis of risk estimates from the current study and national estimates of the prevalence of overweight and obesity in the U.S. adult population.Results: The heaviest members of this cohort (those with a body-mass index [the weight in kilograms divided by the square of the height in meters] of at least 40) had death rates from all cancers combined that were 52 percent higher (for men) and 62 percent higher (for women) than the rates in men and women of normal weight. For men, the relative risk of death was 1.52 (95 percent confidence interval, 1.13 to 2.05); for women, the relative risk was 1.62 (95 percent confidence interval, 1.40 to 1.87). In both men and women, body-mass index was also significantly associated with higher rates of death due to cancer of the esophagus, colon and rectum, liver, gallbladder, pancreas, and kidney; the same was true for death due to non-Hodgkin's lymphoma and multiple myeloma. Significant trends of increasing risk with higher body-mass-index values were observed for death from cancers of the stomach and prostate in men and for death from cancers of the breast, uterus, cervix, and ovary in women. On the basis of associations observed in this study, we estimate that current patterns of overweight and obesity in the United States could account for 14 percent of all deaths from cancer in men and 20 percent of those in women.Conclusions: Increased body weight was associated with increased death rates for all cancers combined and for cancers at multiple specific sites.