DIET AND RISK OF COLORECTAL ADENOMAS - MACRONUTRIENTS, CHOLESTEROL, AND FIBER
DIET AND RISK OF COLORECTAL ADENOMAS - MACRONUTRIENTS, CHOLESTEROL, AND FIBER
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DOI：
10.1093/jnci/85.11.884
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发表时间：
1993-06-02
影响因子：
10.3
通讯作者：
KUPPER, LL
中科院分区：
文献类型：
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作者：
SANDLER, RS;LYLES, CM;KUPPER, LL
背景：饮食被认为是结直肠癌的重要病因。研究表明，红肉和饱和脂肪含量高，膳食纤维和蔬菜含量低的饮食可能会增加癌症风险。饮食也可能是重要的结直肠腺瘤的发展，是大多数结直肠癌的前兆，但这一假设还没有得到很好的研究。目的：这项病例对照研究旨在检查胆固醇，纤维（蔬菜，水果，豆类和谷物）和常量营养素（蛋白质，碳水化合物和脂肪）的饮食消费对结直肠腺瘤风险的影响。研究方法：分析基于来自236名组织学证实的腺瘤受试者（105名男性和131名女性）和409名无腺瘤对照受试者（165名男性和244名女性）的数据，所有受试者都进行了结肠镜检查。病例组和对照组在性别、体重、种族、婚姻状况、教育程度和结肠镜检查适应症方面相似。使用有效的定量食物频率问卷，一位经验丰富的研究生营养学家通过电话采访了每个主题。进行了性别特异性分析，因为男性和女性的营养素摄入量范围有很大差异。根据营养素摄入量的五分位数计算比值比（OR）。结果：碳水化合物摄入量与女性腺瘤风险呈负相关（趋势P = 0.002）。与碳水化合物摄入量最低的五分之一女性相比，碳水化合物摄入量最高的五分之一女性患腺瘤的可能性降低了60%（OR = 0.39; 95%置信区间[CI] = 0.19-0.80）。水果的摄入量（趋势P = 0.028）和蔬菜和水果中纤维的摄入量（趋势P = 0.012）也与女性腺瘤呈负相关。总脂肪在女性中显示出正相关性（趋势P = 0.004），最高与最低五分位数的OR为2.69（95% CI = 1.31-5.50）。饱和脂肪的结果相当（趋势P = 0.027）。男性的风险在方向和程度上大致相似，但没有统计学意义。结论：这些数据支持这样的假设，即高脂肪和低碳水化合物，水果，水果和蔬菜纤维的饮食不仅会增加结直肠癌的风险，还会增加结直肠腺瘤的风险。含义：这些结果与其他研究人员的发现一致，表明影响结直肠癌风险的环境因素，如高风险饮食，可能导致前体腺瘤的发展。
Background: Diet is thought to be important in the etiology of colorectal cancer. Studies suggest that a diet high in red meat and saturated fat and low in dietary fiber and vegetables may increase cancer risk. Diet may also be important in the development of colorectal adenomas that are precursors of most colorectal cancers, but this hypothesis has not been well studied. Purpose: This case-control study was designed to examine the effects of dietary consumption of cholesterol, fiber (vegetables, fruits, beans, and grains), and macronutrients (protein, carbohydrate, and fat) on risk for colorectal adenomas. Methods: Analyses were based on data from 236 subjects (105 men and 131 women) with histologically confirmed adenomas (cases) and 409 adenoma-free control subjects (165 men and 244 women), all of whom had had colonoscopy. Case and control subjects were similar with respect to gender, body mass, race, marital status, education, and indications for colonoscopy. Using a validated quantitative food-frequency questionnaire, an experienced graduate nutritionist interviewed each subject by telephone. Sex-specific analyses were conducted because the ranges of nutrient intake were substantially different for men and women. Odds ratios (ORs) were calculated according to quintiles of nutrient intake. Results: Carbohydrate intake was inversely related to adenoma risk in women (P for trend = .002). Compared with women in the lowest quintile of carbohydrate consumption, those in the highest quintile were 60% less likely to develop adenomas (OR = 0.39; 95% confidence interval [CI] = 0.19-0.80). Intake of fruit (P for trend = .028) and intake of fiber derived from vegetables and fruits (P for trend = .012) were also inversely related to adenomas in women. Total fat showed a positive association in women (P for trend = .004), with an OR of 2.69 for the highest versus the lowest quintile (95% CI = 1.31-5.50). Results were comparable for saturated fat (P for trend = .027). The risks in men were generally similar in direction and magnitude but were not statistically significant. Conclusions: These data support the hypothesis that a diet high in fat and low in carbohydrates, fruits, and fruit and vegetable fiber increases risk not only for colorectal cancer but also for precursor colorectal adenomas. Implications: These results, which are consistent with findings of other investigators, suggest that environmental factors influencing risk for colorectal cancer, such as a high-risk diet, may lead to development of the precursor adenomas.