Associations between Dietary Fiber and Colorectal Polyp Risk Differ by Polyp Type and Smoking Status
Associations between Dietary Fiber and Colorectal Polyp Risk Differ by Polyp Type and Smoking Status
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DOI：
10.3945/jn.113.183319
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发表时间：
2014-05-01
影响因子：
4.2
通讯作者：
Zheng, Wei
中科院分区：
文献类型：
--
作者：
Fu, Zhenming;Shrubsole, Martha J.;Zheng, Wei
膳食纤维摄入量与结直肠癌风险之间的关系已经确立。然而，吸烟者和不吸烟者之间的联系可能不同。我们在一项基于结肠镜检查的大型病例对照研究中评估了这一假设。膳食纤维的摄入量是通过自我管理的食物频率问卷来估计的。采用非条件logistic回归分析估计OR和95% CI，并对潜在混杂因素进行调整。分析还按吸烟和性别分层。高膳食纤维摄入量与结直肠息肉风险降低相关（P趋势= 0.003）。吸烟者（P趋势= 0.006）与非吸烟者（P趋势= 0.21）相比，这种关联更强，尽管乘法交互作用的检验没有统计学意义（P = 0.11）。这种关联模式在高危腺瘤性息肉（AD）中更为明显，定义为晚期或多发性AD（P-相互作用吸烟和膳食纤维摄入= 0.09）。在吸烟≥ 23年的吸烟者中，与最低四分位数纤维摄入组相比，高膳食纤维摄入量与高风险AD风险降低38%相关（P趋势= 0.004）。对于低风险AD（定义为单一非晚期AD），未观察到膳食纤维摄入与低风险AD呈负相关。吸烟可能会改变膳食纤维摄入量与结直肠息肉风险的关系，特别是高危AD，这是结直肠癌的一种公认的前兆。
The association of dietary fiber intake with colorectal cancer risk is established. However, the association may differ between cigarette smokers and nonsmokers. We evaluated this hypothesis in a large colonoscopy-based case-control study. Dietary fiber intakes were estimated by self-administered food frequency questionnaire. Unconditional logistic regression analysis was used to estimate ORs and 95% CIs with adjustment for potential confounders. Analysis also was stratified by cigarette smoking and sex. High dietary fiber intake was associated with reduced risk of colorectal polyps (P-trend = 0.003). This association was found to be stronger among cigarette smokers (P-trend = 0.006) than nonsmokers (P-trend = 0.21), although the test for multiplicative interaction was not statistically significant (P = 0.11). This pattern of association was more evident for high-risk adenomatous polyps (ADs), defined as advanced or multiple ADs (P-interaction smoking and dietary fiber intake = 0.09). Among cigarette smokers who smoked >= 23 y, a 38% reduced risk of high-risk ADs was found to be associated with high intake of dietary fiber compared with those in the lowest quartile fiber intake group (P-trend = 0.004). No inverse association with dietary fiber intake was observed for low-risk ADs, defined as single nonadvanced ADs. Cigarette smoking may modify the association of dietary fiber intake with the risk of colorectal polyps, especially high-risk ADs, a well-established precursor of colorectal cancer.