Vitamin D, alcohol, and risk of lymphomas in a prospective cohort of women

描述（由申请人提供）：淋巴细胞恶性肿瘤，包括非霍奇金淋巴瘤（NHL）、霍奇金淋巴瘤（HL）和多发性骨髓瘤（MM），是美国第四大最常诊断的癌症。饮食和其他可改变的行为改变可以部分解释近几十年来NHL发病率显著增加的原因。以前的流行病学研究表明，摄入酒精、维生素D和植物性食物与降低几种淋巴瘤的风险有关。生物活性维生素D的抗淋巴细胞增殖作用以及膳食抗氧化剂和某些植物营养素的抗癌作用的生物学证据支持对淋巴瘤发展的保护作用，而酒精的化学保护作用则不太确定。迄今为止，很少有关于饮食和非HL风险的前瞻性研究，也没有关于HL或MM风险的研究；目前还没有关于阳光和这些癌症风险的前瞻性调查。因此，我们的目标是调查是否从饮食或阳光中暴露维生素D；饲料抗氧化剂摄入指标；食用植物雌激素或异硫氰酸酯；在加州教师研究的大型前瞻性队列研究中，110,215名女性在不同年龄饮酒与淋巴细胞恶性肿瘤风险降低相关。在1995-1996年至2006年12月31日完成基线问卷期间，515名队列成员被诊断为NHL， 32名被诊断为HL， 84名被诊断为MM，这是迄今为止最大的淋巴瘤前瞻性研究。我们将使用多变量Cox比例风险分析来估计NHL、NHL亚型、HL和MM与某些营养素、植物营养素和食物的基线饮食摄入量相关的相对风险；饲料抗氧化指标；不同年龄的饮酒量；严重晒伤的频率；第一次严重晒伤的年龄；皮肤对阳光敏感。此外，我们将使用一个基于全国范围内紫外线b辐射（UVB）测量的验证模型，根据居住地址计算年平均UVB暴露量。我们研究的前瞻性设计排除了回忆偏倚，而详细暴露信息的收集可以对广泛的潜在混杂因素和修饰因素进行调整。如果维生素D、膳食抗氧化剂和/或植物营养素确实能降低淋巴瘤的风险，那么饮食调整就能降低这些恶性肿瘤的发病率和死亡率，以及它们的长期不良治疗效果。

DESCRIPTION (provided by applicant): Lymphoid malignancies, including non-Hodgkin lymphoma (NHL), Hodgkin lymphoma (HL), and multiple myeloma (MM), comprise the fourth most commonly diagnosed cancer in the United States. Dietary and other modifiable behavioral changes may explain part of the striking increase in the incidence rate of NHL during recent decades. Previous epidemiological studies suggest that intake of alcohol, vitamin D, and plant foods are associated with lower risk of several types of lymphoma. Biological evidence of antilymphoproliferative effects of bioactive vitamin D, and anti-cancer effects of dietary antioxidants and certain phytonutrients, support a protective role against lymphoma development, whereas a chemoprotective effect of alcohol is less certain. To date, there have been few prospective studies of diet and NHL risk, and none of HL or MM risk; there has been no prospective investigation of sunlight and risk of these cancers. Therefore, we aim to investigate whether exposure to vitamin D from diet or sunlight; indices of dietary antioxidant intake; consumption of phytoestrogens or isothiocyanates; or consumption of alcohol at various ages is associated with reduced risk of lymphoid malignancies among 110,215 women in the large, prospective California Teachers Study cohort. Between completion of a baseline questionnaire in 1995-1996 and December 31, 2006, 515 cohort members were diagnosed with NHL, 32 with HL, and 84 with MM, making this the largest prospective study of lymphoma to date. We will use multivariate Cox proportional hazards analysis to estimate the relative risks of NHL, NHL subtypes, HL, and MM associated with baseline dietary intake of certain nutrients, phytonutrients, and foods; dietary antioxidant indices; alcohol consumption at various ages; frequency of severe sunburns; age at first severe sunburn; and skin sensitivity to sunlight. In addition, we will use a validated model based on nationwide ultraviolet-B radiation (UVB) measurements to compute average annual UVB exposure according to residential address. Our study's prospective design precludes recall bias, while collection of detailed exposure information enables adjustment for a wide range of potential confounders and modifiers. If vitamin D, dietary antioxidants, and/or phytonutrients indeed decrease the risk of lymphoma, then dietary modification could reduce the considerable morbidity and mortality due to these malignancies and their long-term adverse treatment effects.