结肠癌和直肠癌危险因素的巢式病例对照研究

目的：探讨结肠癌和直肠癌的危险因素。方法：应用巢式病例对照研究方法,对一个6万余人队列随访10年队列中196例新发结、直肠癌病例作为病例组;从该队列中随机抽取980名正常人作为对照组,对有关暴露因素进行单因素分析和多因素非条件logistic回归分析,结果：年龄在病例组和对照之间差异有显著性,病例组年龄高于对照组,且结肠癌的发病年龄高于直肠癌。多因素分析表明,除年龄外,粘液血便中、肠息肉史与结肠癌关系密切,OR值分别为：2．961（95％CI：1．202－7．298）和8．941（95％CI：1．820－43．926）,饮用混合水与直肠癌的OR值为1．823（95％CI:1．024－3．247）。结论：结、直肠癌的危险因素不尽相同。除年龄是结、直肠癌发病的一个共同重要因素外,肠息肉史和粘液血便史与结肠癌有关联,而饮用混合水则与直肠癌关系密切。     

十种无机元素与结,直肠癌的关系

以一项基于全人群的病例对照研究数据（病例１３２８，对照１４００），探讨１０种无机元素（钾、钠、钙、镁、铁、锰、铜、磷、硒）与结、直肠癌发生的联系性以及与其他饮食因素的相关性。单因素（调整年龄、性别）结果显示：钾、钙、镁、铁、锌、铜、磷、硒的摄入量与结、直肠癌发病危险呈负相关。而８种无机元素（不包括钠、硒）８０％以上来源于植物性食品，并与“植物性“因素（如膳食纤维等）存在密切相关性。经多因素调整，上     

不同来源膳食纤维,钙与结直肠癌关系的研究

以一项基于全人群的营养流行病学病例对照研究数据，探讨不同食物来源的膳食纤维和钙与结、直肠癌联系性的可能差异。结果表明，蔬菜类膳食纤维与左、在半结肠癌和直肠癌，水果类膳食纤维与右半结肠癌均呈显著负相关；动物性膳食钙则具有降低左、右半结肠癌及直肠癌发病相对危险度的趋势。并经非条件Ｌｏｇｉｓｔｉｃ回归模型调整年龄、性别、总能量、维生索Ｃ、饱和脂肪酸等因素后上述联系仍然存在，提示为一类独立性变量。而谷类膳食纤维和植物性膳食钙的抗结直肠癌的保护性作用不显著。研究表明膳食纤维和钙对结直肠癌的保护性作用，不但与摄入量还与种类和来源密切相关。．．     

饮食、营养素与结肠癌——基于全人群的病例-对照研究

本文以大样本全人群病例一对照研究数据分析食物摄入频度、摄入量及营养素与结肠癌的关系。结果表明:大多数蔬菜、粗纤维、维生素C、维生素B_2、钙、铁等营养素降低结肠癌的发病危险性;动物性食品、脂肪、能量与结肠癌的发病危险性关系不甚密切;油炸、腌制、咸霉食品增高结肠癌发病的相对危险度;葱蒜类、海带紫菜与结肠癌发病危险呈负相关。还探讨了结肠癌高低发地区病因学的异同以及膳食调查的回忆误差,食物摄入频度与摄入量对反映饮食与肿瘤之间联系的差异。     

山西省结直肠癌P53蛋白异常表达危险因素的病例-病例研究

为探讨结直肠癌Ｐ５３蛋白异常表达的危险因素，对１２１例原发性结直肠癌病人手术切除癌组织进行Ｓ－Ｐ免疫组化检测，将病例划分为Ｐ５３异常表达阳性组和阴性组，应用病例－病例研究方法及ＳＡＳ软件进行因素分析。结果表明，Ｐ５３异常表达阳性组病人７２例，阳性率５９．５０％；单因素分析，有５个因素与Ｐ５３异常表达有联系，它们是吸烟（ＯＲ＝２．０９５）、接触毒物（ＯＲ＝２．１８０）、家人吸烟（ＯＲ＝３．０９６）、     

肠息肉与结直肠癌发病关系队列研究

目的研究肠息肉与结直肠癌发病之间的关系.方法以1989年5月～1990年4月,参加浙江省嘉善县大肠癌筛查的10个乡镇30岁及以上人口为研究队列,按是否具有肠息肉分为暴露组和非暴露组,从1990年5月～2000年1月进行随访,应用回顾性队列研究的方法,对结直肠癌发病率进行分析,并作相对危险度(RR)估计.结果暴露组和非暴露组的结直肠癌发病率具有显著性差异(P＜0.05),Logistic回归分析表明,控制年龄因素后,肠息肉史仅在男性结肠癌表现出有统计学意义,有肠息肉史者结肠癌的发病风险较无肠息肉史者高10余倍,RR为10.79,95%可信限为3.802～30.605.结论肠息肉史与结肠癌的发病有关,肠息肉史是结肠癌的重要危险因子.     

阑尾炎史与结直肠癌发病关系的研究

目的研究阑尾炎与结直肠癌发病之间的关系.方法以1989年5月至1990年4月期间,参加浙江省嘉善县大肠癌筛查的10个乡镇30岁及以上人口为研究队列,按是否具有阑尾炎史分为暴露组和非暴露组,随访从1990年5月至2001年1月,应用回顾性队列研究的方法,对结直肠癌发病率进行分析,并作相对危险度(RR)估计.结果 Poisson回归分析表明,经控制年龄因素后,阑尾炎史仅在女性结肠癌中表现出有统计学意义(P＜0.05),有阑尾炎史者结肠癌的发病风险较之无阑尾炎史者高达近2倍,RR为1.9335,95%可信限为1.0456～3.5754.结论阑尾炎史与结肠癌的发病有关,阑尾炎史是结肠癌的重要危险因子.     

1990—2005年杭州市萧山区人群肠癌发病部位和年龄特点及生存率影响因素

目的研究1990—2005年杭州市萧山区人群结、直肠癌的发病部位和年龄特点及生存率影响因素。方法以杭州市萧山区恶性肿瘤发病与死亡监测系统为基础,采用寿命表法计算结、直肠癌的生存率,分析结、直肠癌的发病年龄、部位、生存率的变化趋势及其影响因素。结果 1990—2005年结、直肠癌病例共2450例,中位发病年龄65.3岁,1990—1995年、1996—2000年、2001—2005年中位发病年龄分别为63.2岁、65.3岁、66.8岁,结、直肠癌病例的发病年龄呈增高趋势。结肠癌中位发病年龄64.5岁,低于直肠癌病人中位发病年龄(65.8岁),差别有统计学意义(Z=2.06,P=0.039)。发病部位以直肠癌为主,占60.2%,60岁以下发病的病人中结肠癌的比例高于60岁以上年龄组。近年来结肠癌的比例呈增高趋势,2001—2005年已占全部结、直肠癌患者的46.6%。本组结、直肠癌病人的1年、3年、5年生存率分别为51.5%,45.6%和43.4%。影响结、直肠癌预后的主要因素有肿瘤部位[直肠癌相对危险度是结肠癌的1.453倍(95%CI:1.293～1.633)]、发病年龄[45～59岁组和≥60岁组的相对危险度分别为45岁组的1.071倍(95%CI:0.867～1.325)和1.847倍(95%CI:1.535～2.222)]、诊断时期[1996—2000年和2001年以后的相对危险度分别为1996年以前的0.901倍(95%CI:0.788～1.030)和0.691倍(95%CI:0.600～0.795)]。结论结、直肠癌病人有发病年龄增高、发病部位趋向近端、预后改善的趋势,须针对发病特征及相关影响因素采取积极有效的预防措施。     

青少年直肠癌发病危险因素分析与防治

目的：探讨青少年直肠癌发病危险因素及防治策略。方法：选择随访至今发生的直肠癌青少年存活病例45例,及45名与病例匹配的同年龄、同性别、同居住地的非直肠癌健康者,采用1∶1配对的病例对照研究方法,以条件Logistic回归法分析各因素与直肠癌的关系。结果：食用红色肉及肥肉（OR=3.634）、食用腌制品（OR=5.865）、情绪自我调节能力差（OR=2.057）、粘液血便史（OR=7.588）、肠息肉史（OR=7.857）、家族结直肠癌史（OR=10.936）与结直肠癌发病呈正相关,P〈0.01;而食用蔬菜水果（OR=0.597）与结直肠癌发病呈负相关,P〈0.01。结论：食用红色肉及肥肉、食用腌制食品、情绪自我调节能力差、粘液血便史、肠息肉史、家族结直肠癌史是直肠癌发病危险因素,而食用蔬菜水果是直肠癌发病的保护因素。因此,防治青少年直肠癌,除需特别重视个人病史及家族史外,可以从改变饮食习惯和加强精神心理辅导等方面着手。     

营养素摄入量与高脂血症的关系

目的探索各类营养素摄入量与高胆固醇血症、高甘油三酯血症之间的关系。方法用现况调查结合病例对照研究的方法，随机抽取271名调查对象，按血脂检测结果分为病例组和对照组。用食物模型和流行病学问卷调查表的方法，调查研究对象1年中各种食物摄人量，按食物成分表换算成17类营养素的摄入量，比较病例组和对照组间各类营养素摄入量的差异。结果单因素检验结果显示，病例组每天能量、蛋白质、碳水化合物及粗纤维的摄入量（分别为13193KJ，111．91g，606．31g，10．53g）大于对照组（分别为10904．77KJ，97．23g，427．80g，8．75g），单不饱和脂肪酸的摄入量低于对照组（分别为10．28g和13．97g）。因子分析结果显示，高胆固醇血症病例能量因子得分高于对照组；高甘油三酯血症病例能量因子得分高于对照组，脂肪因子得分低于对照组。结论能量摄入过多是高胆固醇血症和高甘油三酯血症发病的危险因素，不饱和脂肪酸摄入不足是高甘油三酯血症发病的危险因素。     

Vegetable and fruit consumption and risks of colon and rectal cancer in a prospective cohort study: The Netherlands Cohort Study on Diet and Cancer

The relation between vegetable and fruit consumption and colorectal cancer risk was comprehensively assessed in the Netherlands Cohort Study on Diet and Cancer using a validated 150-item food frequency questionnaire. After 6.3 years of follow-up (1986-1992), over 1,000 incident cases of colorectal cancer were registered. Using case-cohort analysis, the authors calculated rate ratios and 95% confidence intervals adjusted for age, alcohol intake, and family history of colorectal cancer. For colon cancer, no statistically significant associations with total vegetable intake or total fruit intake were found. However, among women, an inverse association was observed with vegetables and fruits combined (for the highest quintile vs. the lowest, the rate ratio was 0.66 (95% confidence interval: 0.44, 1.01)). Brassica vegetables and cooked leafy vegetables showed inverse associations for both men and women. Among women and, to a lesser extent, among men, inverse associations were stronger for distal colonic tumors than for proximal colonic tumors. For rectal cancer, no statistically significant associations were found for vegetable consumption or fruit consumption or for specific groups of vegetables and fruits; only Brassica vegetables showed a positive association in women. As in other cohort studies, the observed inverse relation between vegetable and fruit consumption and occurrence of colorectal cancer was less strong than relations reported in case-control studies.     

Colorectal cancer and the consumption of foods: A case‐control study in Belgium

A case‐control study on 453 cases with colon cancer, 365 with rectal cancer, and 2,851 population controls was carried out in two Belgian provinces known to differ in certain dietary habits, particularly with regard to the use of butter.

All raw vegetables had a clear protective effect for both colon and rectal cancer; bread was also protective for colon cancer. Starchy foods and foods rich in oligosaccharides (sugar) caused an increased risk for both colon and rectal cancer. No other foods were found to have a systematic effect in both sexes and in both provinces, either in one direction or in the other, except for maize, soybean, and sunflower oils, which were clearly protective in all cases. Among the foods contributing to the intake of fats, there was no effect either for butter, margarine, or fatty meats; the only clear‐cut protective effect was that of the oils having a high polyunsaturated‐to‐saturated ratio. These findings are consistent with our previous findings on the role nutrients play in the relationship with colon and rectal cancers.     

Vegetables,but Not Pickled Vegetables,Are Negatively Associated With the Risk of Breast Cancer

This study investigated the association between pickled vegetable consumption and the risk of breast cancer using a validated food frequency questionnaire. A total of 358 patients with breast cancer who were matched to 360 healthy controls by age (using a 5-yr age distribution) were recruited from the National Cancer Center in South Korea. After adjusting for nondietary risk factors, total vegetable intake was inversely associated with risk of breast cancer. However, unlike nonpickled vegetables, pickled vegetable intake and its proportion relative to total vegetables were positively associated with the risk of breast cancer, and this association was more profound and consistent when pickled vegetable intake was considered as a proportion relative to total vegetables (odds ratio [OR] = 6.24, 95% confidence interval [CI] = 3.55–10.97; P for trend <0.001 for highest vs. lowest quartiles of intake) than as the absolute consumed amount (OR = 2.47, 95% CI = 1.45–4.21; P for trend = 0.015 for highest vs. lowest quartiles of intake). These results suggest that not only the amount of total vegetable intake but also the amounts of different types of vegetable (i.e., pickled or nonpickled) and their proportions relative to total vegetables are significantly associated with the risk of breast cancer.     

Colorectal cancer and the consumption of foods: a case-control study in Belgium

A case-control study on 453 cases with colon cancer, 365 with rectal cancer, and 2,851 population controls was carried out in two Belgian provinces known to differ in certain dietary habits, particularly with regard to the use of butter. All raw vegetables had a clear protective effect for both colon and rectal cancer; bread was also protective for colon cancer. Starchy foods and foods rich in oligosaccharides (sugar) caused an increased risk for both colon and rectal cancer. No other foods were found to have a systematic effect in both sexes and in both provinces, either in one direction or in the other, except for maize, soybean, and sunflower oils, which were clearly protective in all cases. Among the foods contributing to the intake of fats, there was no effect either for butter, margarine, or fatty meats; the only clear-cut protective effect was that of the oils having a high polyunsaturated-to-saturated ratio. These findings are consistent with our previous findings on the role nutrients play in the relationship with colon and rectal cancers.     

Dietary Intake of B Vitamins and Methionine and Colorectal Cancer Risk

B vitamins are involved in 1-carbon metabolism, which is necessary for DNA replication, DNA repair, and regulation of gene expression. Recent studies suggest inverse associations between folate and vitamin B6 intakes and colorectal cancer risk but associations with other B vitamins and methionine have not been widely studied. After following 14,645 men and 22,467 women for 15 yr on average, we ascertained 910 incident colorectal cancers. Dietary intakes were estimated using a 121-item food frequency questionnaire. Hazard ratios (HRs) and 95% confidence intervals were estimated using Cox regression. We found some evidence of a U-shaped relationship between colon cancer risk and vitamin B6 and an inverse U-shaped relationship between rectal cancer risk and B12 (test for the quadratic trend, P = 0.005 and P = 0.0005 respectively). For colon cancer, we observed a reduced risk associated with low methionine/high folate, HR = 0.63 (0.49, 0.80) and an increased risk associated with high methionine/high folate, HR = 1.36 (1.06, 1.74) (P interaction < 0.0001). Our study suggests a U-shaped association between colon cancer risk and vitamin B6 intake and an inverse U-shaped association between rectal cancer risk and vitamin B12. Adequate folate intake might protect against colon cancer risk in those with low methionine intake.     

Association of vegetable, fruit, and grain intakes with colorectal cancer: the Multiethnic Cohort Study

BACKGROUND: It is uncertain whether or not vegetables, fruit, or grains protect against colorectal cancer. OBJECTIVE: In a large prospective study, we investigated the association of vegetable, fruit, and grain intakes with colorectal cancer risk. DESIGN: Between 1993 and 1996, 85 903 men and 105 108 women completed a quantitative food-frequency questionnaire that included approximately 180 foods and beverages in the Multiethnic Cohort Study. A diagnosis of colorectal cancer was made in 1138 men and 972 women after an average follow-up of 7.3 y. Cox proportional hazards models were used to calculate multivariate-adjusted relative risks and 95% CIs for colorectal cancer. RESULTS: In men, multivariate adjustment for energy intake, dietary, and nondietary variables resulted in relative risks in the highest quintile group of 0.74 (95% CI: 0.59, 0.93; P for trend = 0.02) for vegetables and fruit combined, 0.80 (95% CI: 0.64, 0.99; P for trend = 0.09) for fruit alone, and 0.85 (95% CI: 0.69, 1.05; P for trend = 0.05) for vegetables alone. When colon and rectal cases were separated among men, the inverse associations were stronger for colon than for rectal cancer. In women, none of the associations with vegetables, fruit, or vegetables and fruit combined were significant. Grain intake was not associated with colorectal cancer for either men or women. CONCLUSION: The intake of vegetables and fruit was inversely related to colorectal cancer risk among men but not among women. The association appears stronger for colon than for rectal cancer.     

Fruit,Vegetable, and Animal Food Intake and Breast Cancer Risk by Hormone Receptor Status

The effects of diet on breast cancer are controversial and whether the effects vary with hormone receptor status has not been well investigated. This study evaluated the associations of dietary factors with risk for breast cancer overall and by the hormone receptor status of tumors among Chinese women. The Shanghai Breast Cancer Study, a large, population-based, case-control study, enrolled 3,443 cases and 3,474 controls in 1996–1998 (phase I) and 2002–2005 (phase II); 2676 cases had estrogen receptor (ER) and progesterone receptor (PR) data. Dietary intake was assessed using a validated, quantitative, food frequency questionnaire. Odds ratios (OR) and 95% confidence intervals (95% CI) were derived from multivariate, polychotomous, unconditional logistic regression models. Total vegetable intake was inversely related to breast cancer risk, with an adjusted OR for the highest quintile of 0.80 (95% CI = 0.67–0.95; P trend = 0.02). Reduced risk was also related to high intake of allium vegetables (P trend = 0.01) and fresh legumes (P trend = 0.0008). High intake of citrus fruits and rosaceae fruits were inversely associated with breast cancer risk (P trend = 0.003 and 0.004, respectively), although no consistent association was seen for total fruit intake. Elevated risk was observed for all types of meat and fish intake (all P trend < 0.05), whereas intakes of eggs and milk were associated with a decreased risk of breast cancer (both P trend <0.05). There was little evidence that associations with dietary intakes varied across the 4 tumor subtypes or between ER+/PR+ and ER-/PR- tumors (P for heterogeneity >0.05). Our results suggest that high intake of total vegetables, certain fruits, milk, and eggs may reduce the risk of breast cancer, whereas high consumption of animal-source foods may increase risk. The dietary associations did not appear to vary by ER/PR status.     

Dietary sodium and potassium intake and colorectal cancer risk

Abstract

In a large, comprehensive, population‐based case‐control study of colorectal cancer (The Melbourne Colorectal Cancer Study), a high intake of sodium was shown to be a statistically significant risk factor for rectal cancer in males (RR = 1.72, p = 0.07; and was close to statistical significance in females (RR = 7.55, p = 0.06). This was independent of previously described dietary risk factors and also independent of the previously described beer risk. A high intake of potassium was protective for both males and females, but this effect disappeared after adjustment was made for the previously described dietary risk factors. A high ratio of dietary potassium to sodium was a statistically significant protective factor in females for both colon and rectal cancer, and the significance of this effect was reduced after adjustment was made for the previously described dietary risk factor (RR for colon cancer = 0.70, p = 0.08; RR for rectal cancer = 0.67, p = 0.08). So far, no biological explanations are available for these associations, and while they are of obvious etiologic interest, they should be interpreted with caution.     

Fluid Intake and Colorectal Cancer Risk in the Netherlands Cohort Study

Total fluid intake, specifically water intake, has been suggested to protect against colorectal cancer. We examined the association of total fluid intake with colorectal cancer endpoints and possible effect modification by fiber intake within the Netherlands Cohort Study (N = 120,852). We also investigated intake of specific beverages. After 13.3 yr, 1,443 male and 1,040 female colorectal cancer cases with complete baseline questionnaires were available for case-cohort analyses. Multivariate analyses showed no dose-response relationship of total fluid intake and intake of specific beverages with the risk of overall colorectal, proximal, and distal colon cancer. For rectal cancer risk in men, there was a nonsignificant positive trend for total fluid intake [> 1,500 vs. ≤ 1,000 ml/day: HR = 1.50, 95% CI = 0.95–2.37, P trend = 0.08) and a significant positive trend for coffee intake (> 6 vs. ≤ 2 cups/day: HR = 1.60, 95% CI = 0.96–2.66, P trend = 0.05). However, a nonsignificant positive trend for total fluid intake was no longer observed when additionally adjusting for coffee intake. Tests for interaction were not significant. In conclusion, total fluid intake was not associated with colorectal cancer risk in either men or women. There was no evidence that fiber intake modified associations. Of the specific beverages, coffee intake was positively associated with rectal cancer risk in men.     

Fruit and vegetable intake and prevalence of colorectal adenoma in a cancer screening trial

BACKGROUND: Research on the association between fruit and vegetable intake and risk of colorectal adenoma is inconclusive. OBJECTIVE: We studied whether intake of fruit, vegetables, or their subgroups is associated with a lower risk of prevalent colorectal adenoma. DESIGN: In men and women (aged 55-74 y) who were screened for colorectal cancer in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) (1993-2001), we compared 3,057 cases with at least one prevalent histologically verified adenoma of the distal large bowel with 29,413 control subjects. Using a food-frequency questionnaire, we quantified intake of fruit and vegetables in the 12 mo before screening as energy-adjusted pyramid servings/d (ps/d). Adjusted odds ratios (ORs) and 95% CIs were estimated by logistic regression. RESULTS: Risk of distal adenoma was significantly lower among subjects in high (approximately 5.7 ps/d) versus low (approximately 1.2 ps/d) quintiles of total fruit intake (OR: 0.75; 95% CI: 0.66, 0.86, P for trend <0.001), which was not completely explained by dietary folate or fiber intake. Inverse associations between adenoma and total fruit intake were observed regardless of adenoma histopathology and multiplicity. However, the protective effect was seen only for colon and not rectal adenoma. Total vegetable intake was not significantly associated with reduced risk of adenoma. ORs for colorectal adenoma among persons with high versus low intakes of deep-yellow vegetables, dark-green vegetables, and onions and garlic were significantly related to lower risk of adenoma, although the P for trend for dark-green vegetables was not significant. CONCLUSION: Diets rich in fruit and deep-yellow vegetables, dark-green vegetables, and onions and garlic are modestly associated with reduced risk of colorectal adenoma, a precursor of colorectal cancer.