Obesity, weight change, and risk of adenoma recurrence: a prospective trial.
Obesity, weight change, and risk of adenoma recurrence: a prospective trial.
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肥胖、体重变化和腺瘤复发的风险：一项前瞻性试验。
DOI：
10.1055/s-0032-1309837
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发表时间：
2012
期刊：
影响因子：
9.3
通讯作者：
Cross,AJ
中科院分区：
文献类型：
--
作者：
Laiyemo,AO;Doubeni,C;Badurdeen,DS;Murphy,G;Marcus,PM;Schoen,RE;Lanza,E;Smoot,DT;Cross,AJ
背景和研究目的：肥胖是结直肠肿瘤的危险因素。人们提倡改变生活方式，包括减肥，以降低风险。然而，还没有前瞻性研究评估体重减轻是否真的会影响腺瘤复发。本研究的目的是检查 4 年内体重变化（减轻或增加）是否与腺瘤复发相关。 患者和方法：息肉预防试验中共有 1826 名结直肠腺瘤患者在基线时测量了身高和体重。腺瘤复发是通过研究进入 4 年后试验结肠镜检查结束时重新测量患者体重来确定的。采用泊松回归模型评估体重指数（BMI）、4年内体重变化以及任何腺瘤和晚期腺瘤复发的风险。结果：723例患者（39.6%）观察到腺瘤复发，其中118例（6.5%）晚期腺瘤复发。基线BMI< 25 kg/m2 (n = 466)、BMI 25 – 29 kg/m2 (n = 868)和BMI ≥ 30 kg/m2 (n = 492)的患者中，复发率为分别为 34.5%、41.0% 和 41.9%。肥胖与腺瘤复发（RR = 1.19；95 %CI 1.01 – 1.39）和晚期腺瘤复发（RR = 1.62；95 %CI 1.01 – 2.57）风险增加相关。然而，与 4 年试验中体重相对稳定（体重变化< 5 磅）的患者相比，体重增加或减少与腺瘤复发无关。无论基线 BMI 如何，这一结果都是一致的。结论：4 年内体重减轻或增加不会影响腺瘤复发。这项研究并不支持单独减肥作为减少腺瘤复发的有效干预措施。
Background and study aims:Obesity is a risk factor for colorectal neoplasia. Lifestyle modifications, including weight loss, have been advocated to reduce the risk. However, no prospective study has evaluated whether weight loss actually affects adenoma recurrence. The aim of this study was to examine whether weight change (loss or gain) over 4 years is associated with adenoma recurrence.Patients and methods:A total of 1826 patients with colorectal adenoma in the Polyp Prevention Trial had their height and weight measured at baseline. Adenoma recurrence was determined by end of trial colonoscopy 4 years after study entry when patients’ weights were re-measured. Poisson regression models were used to evaluate body mass index (BMI), weight change over 4 years, and the risk of any adenoma and advanced adenoma recurrence.Results:Adenoma recurrence was observed in 723 patients (39.6 %), 118 (6.5 %) of whom had advanced adenoma recurrence. Among those with baseline BMI < 25 kg/m² (n = 466), BMI 25 – 29 kg/m² (n = 868), and BMI ≥ 30 kg/m² (n = 492), the recurrence rate was 34.5 %, 41.0 %, and 41.9 %, respectively. Obesity was associated with an increased risk of adenoma recurrence (RR = 1.19; 95 %CI 1.01 – 1.39) and advanced adenoma recurrence (RR = 1.62; 95 %CI 1.01 – 2.57). However, when compared with those with relatively stable weight (weight change < 5 lb) over the 4-year trial, weight gain or loss was not associated with adenoma recurrence. This was consistent, regardless of the baseline BMI.Conclusions:Weight loss or gain over 4 years does not affect adenoma recurrence. This study does not support weight loss alone as an effective intervention for reducing adenoma recurrence.