肥胖与子宫内膜癌关系的病例对照研究

目的　研究不同时期的肥胖与子宫内膜癌发生之间的关系。方法　采用全人群病例对照研究 ,调查 1997年 1月至 2 0 0 0年 6月确诊的上海市区 4 97例 30～ 6 9岁子宫内膜癌病例和 4 97名对照的发育史 ,并进行身体测量。结果　青少年时期的身高和体重与子宫内膜癌未见显著性关联 ;除2 0岁左右外 ,成年各阶段的体重指数 (BMI)均与子宫内膜癌的发生有关 ,体重增加 >7.5kg显著增加子宫内膜癌的危险 ,但体重增加比例为 15 %以上只在 4 0～ 5 0岁年龄段有显著意义。 2 0～ 30岁的体重减轻对子宫内膜癌有保护作用。体重、BMI、腰围臀围比 (WHR)的测量值大均是子宫内膜癌发生的独立危险因素 ,而身高、坐高身高比与子宫内膜癌的发生无关。结论　青少年时期肥胖与子宫内膜癌的发生无显著联系 ,而成年时期的肥胖程度和体脂的分布均是独立危险因素。 30岁前后体重变化对子宫内膜癌的发生具有不同的影响。

Obesity at different ages and endometrial cancer risk factors in urban Shanghai, China

Objective To study the relationship between obesity at different ages and the risk of endometrial cancer in urban Shanghai, China.Methods In a population based case control study conducted in urban Shanghai, in person interviews and anthropometric measurements were completed for 497 women at age 30 to 69 and an equal number of controls frequency matched to cases on age distribution. All cases were newly diagnosed with endometrial cancer from January 1,1997 to June 30, 2000. Unconditional logistic regression model was employed to estimate the adjusted odds ratios ( OR s) and 95% confidence intervals ( CI s) of the obesity at different ages. Results After adjustment for some potential confounding variables, neither adolescent height nor weight was significantly related to endometrial cancer. Obesity in adulthood, except around 20 years old, was associated with elevated risks, with odds ratios for the highest versus lowest quartile of body mass index (BMI) being 1.5 (95% CI : 1.0 2.1 ), 1.7 (95% CI : 1.2 2.4 ), 1.9 (95% CI : 1.3 2.8 ) and 1.7 (95% CI : 1.0 2.7 ) at ages 30,40,50 and 60, respectively. Weight gain of more than 7.5 kg at different 10 year intervals in adulthood were associated with increased risk of endometrial cancer, whereas only weight gain more than 15% of initial weight from 40 to 50 years old significantly related to the risk. Only weight loss from ages 20 to 30 was inversely associated with endometrial cancer risk ( OR = 0.4 ,95% CI : 0.2 0.8 ). Current body weight, BMI and waist to hip ratio (WHR) were independent risk factors to endometrial cancer while standing height and sitting to standing height ratio were unrelated to the risk of endometrial cancer. Conclusion Results indicated that adolescent obesity was unrelated to endometrial cancer. General obesity in adulthood, as well as body fat distribution, were associated with the risk of endometrial cancer independently. Weight changes before and after age 30 had different effects on the risk of endometrial cancer.