目的 利用大规模人群队列研究,探讨BMI与恶性肿瘤发病的关联性及其强度.方法 采用2006年开滦集团体检人群队列(收集基线调查时人口学、生活方式和身高、体重等测量指标信息),通过主动和被动随访相结合方式,收集肿瘤发病、死亡等结局信息.排除随访时间＜1年的新发病例后,采用多因素Cox比例风险回归模型分析低体重、超重和肥胖与肿瘤发病的风险比(HR)和95％CI,调整变量包括年龄、受教育程度、吸烟、饮酒和HBsAg(仅在肝癌中调整).对男性肺癌、肝癌和女性乳腺癌分别按吸烟、HBsAg和绝经状态分层后纳入模型重新分析.结果 至2011年12月31日,随访人群纳入队列133 273人,其中男性106 630人(80.01％)、女性26 643人(19.99％),共随访570 531.02人年,平均随访时间为4.28年.男性低体重(BMI＜18.5kg/m2)2 387人(2.24％),正常体重(BMI 18.5 ～23.9 kg/m2) 45 090人(42.29％),超重(BMI 24.0～27.9 kg/m2)43 774人(41.05％),肥胖(BMI≥28.0 kg/m2) 15 379人(14.42％)；女性低体重858人(3.22％),正常体重14 037人(52.69％),超重8 507人(31.93％),肥胖3 241人(12.16％).共收集肿瘤新发病例1 647例,其中男性1 348例,女性299例.多因素Cox比例风险回归模型分析表明,与正常体重者相比,男性低体重者胃癌(aHR=3.82,95％CI:1.97～7.38)和肝癌(aHR=3.00,95％CI:1.36 ～ 6.65)的发病风险增加；男性肥胖(aHR=2.75,95％CI:1.25y6.06)和超重(aHR=1.98,95％CI:1.03～ 3.82)者结肠癌发病风险增加；男性膀胱癌病例中,超重为保护性因素(aHR=0.44,95％CI:0.23～ 0.84);男性肺癌病例中,超重和肥胖均为保护性因素(超重:aHR=0.59,95％Ch0.46 ～ 0.76;肥胖:aHR=0.64,95％ CI:0.44～ 0.92).而较之体重正常女性,女性肥胖者乳腺癌(aHR=1.86,95％CI:1.05 ～ 3.31)的发病风险增加.分层分析显示:对于男性肺癌,超重对不吸烟者和吸烟者均起保护作用(不吸烟者:aHR=0.50,95％CI:0.35～0.72；吸烟者:aHR=0.70,95％CI:0.50～0.98),肥胖仅对男性不吸烟者起保护作用(aHR =0.57,95％CI:0.33 ～ 0.97),而男性吸烟者与肺癌发病风险不存在相关性(aHR=0.72,95％CI:0.43 ～ 1.21).按女性绝经状态分层后,肥胖增加了绝经后乳腺癌的发病风险(aHR=1.97,95％CI:1.01 ～ 3.82),而与绝经前乳腺癌的发病风险之间的关联无统计学意义.结论 BMI与恶性肿瘤发病风险的相关性因肿瘤不同而存在差异.低体重与男性胃癌和肝癌的发病风险存在相关性,肥胖与男性结肠癌、女性绝经后乳腺癌和卵巢癌的发病风险存在相关性,而超重可能对于男性肺癌和膀胱癌发病起到保护作用,肥胖可能对于非吸烟男性肺癌发病起到保护作用.
目的 利用大規模人群隊列研究,探討BMI與噁性腫瘤髮病的關聯性及其彊度.方法 採用2006年開灤集糰體檢人群隊列(收集基線調查時人口學、生活方式和身高、體重等測量指標信息),通過主動和被動隨訪相結閤方式,收集腫瘤髮病、死亡等結跼信息.排除隨訪時間＜1年的新髮病例後,採用多因素Cox比例風險迴歸模型分析低體重、超重和肥胖與腫瘤髮病的風險比(HR)和95％CI,調整變量包括年齡、受教育程度、吸煙、飲酒和HBsAg(僅在肝癌中調整).對男性肺癌、肝癌和女性乳腺癌分彆按吸煙、HBsAg和絕經狀態分層後納入模型重新分析.結果 至2011年12月31日,隨訪人群納入隊列133 273人,其中男性106 630人(80.01％)、女性26 643人(19.99％),共隨訪570 531.02人年,平均隨訪時間為4.28年.男性低體重(BMI＜18.5kg/m2)2 387人(2.24％),正常體重(BMI 18.5 ～23.9 kg/m2) 45 090人(42.29％),超重(BMI 24.0～27.9 kg/m2)43 774人(41.05％),肥胖(BMI≥28.0 kg/m2) 15 379人(14.42％)；女性低體重858人(3.22％),正常體重14 037人(52.69％),超重8 507人(31.93％),肥胖3 241人(12.16％).共收集腫瘤新髮病例1 647例,其中男性1 348例,女性299例.多因素Cox比例風險迴歸模型分析錶明,與正常體重者相比,男性低體重者胃癌(aHR=3.82,95％CI:1.97～7.38)和肝癌(aHR=3.00,95％CI:1.36 ～ 6.65)的髮病風險增加；男性肥胖(aHR=2.75,95％CI:1.25y6.06)和超重(aHR=1.98,95％CI:1.03～ 3.82)者結腸癌髮病風險增加；男性膀胱癌病例中,超重為保護性因素(aHR=0.44,95％CI:0.23～ 0.84);男性肺癌病例中,超重和肥胖均為保護性因素(超重:aHR=0.59,95％Ch0.46 ～ 0.76;肥胖:aHR=0.64,95％ CI:0.44～ 0.92).而較之體重正常女性,女性肥胖者乳腺癌(aHR=1.86,95％CI:1.05 ～ 3.31)的髮病風險增加.分層分析顯示:對于男性肺癌,超重對不吸煙者和吸煙者均起保護作用(不吸煙者:aHR=0.50,95％CI:0.35～0.72；吸煙者:aHR=0.70,95％CI:0.50～0.98),肥胖僅對男性不吸煙者起保護作用(aHR =0.57,95％CI:0.33 ～ 0.97),而男性吸煙者與肺癌髮病風險不存在相關性(aHR=0.72,95％CI:0.43 ～ 1.21).按女性絕經狀態分層後,肥胖增加瞭絕經後乳腺癌的髮病風險(aHR=1.97,95％CI:1.01 ～ 3.82),而與絕經前乳腺癌的髮病風險之間的關聯無統計學意義.結論 BMI與噁性腫瘤髮病風險的相關性因腫瘤不同而存在差異.低體重與男性胃癌和肝癌的髮病風險存在相關性,肥胖與男性結腸癌、女性絕經後乳腺癌和卵巢癌的髮病風險存在相關性,而超重可能對于男性肺癌和膀胱癌髮病起到保護作用,肥胖可能對于非吸煙男性肺癌髮病起到保護作用.
목적 이용대규모인군대렬연구,탐토BMI여악성종류발병적관련성급기강도.방법 채용2006년개란집단체검인군대렬(수집기선조사시인구학、생활방식화신고、체중등측량지표신식),통과주동화피동수방상결합방식,수집종류발병、사망등결국신식.배제수방시간＜1년적신발병례후,채용다인소Cox비례풍험회귀모형분석저체중、초중화비반여종류발병적풍험비(HR)화95％CI,조정변량포괄년령、수교육정도、흡연、음주화HBsAg(부재간암중조정).대남성폐암、간암화녀성유선암분별안흡연、HBsAg화절경상태분층후납입모형중신분석.결과 지2011년12월31일,수방인군납입대렬133 273인,기중남성106 630인(80.01％)、녀성26 643인(19.99％),공수방570 531.02인년,평균수방시간위4.28년.남성저체중(BMI＜18.5kg/m2)2 387인(2.24％),정상체중(BMI 18.5 ～23.9 kg/m2) 45 090인(42.29％),초중(BMI 24.0～27.9 kg/m2)43 774인(41.05％),비반(BMI≥28.0 kg/m2) 15 379인(14.42％)；녀성저체중858인(3.22％),정상체중14 037인(52.69％),초중8 507인(31.93％),비반3 241인(12.16％).공수집종류신발병례1 647례,기중남성1 348례,녀성299례.다인소Cox비례풍험회귀모형분석표명,여정상체중자상비,남성저체중자위암(aHR=3.82,95％CI:1.97～7.38)화간암(aHR=3.00,95％CI:1.36 ～ 6.65)적발병풍험증가；남성비반(aHR=2.75,95％CI:1.25y6.06)화초중(aHR=1.98,95％CI:1.03～ 3.82)자결장암발병풍험증가；남성방광암병례중,초중위보호성인소(aHR=0.44,95％CI:0.23～ 0.84);남성폐암병례중,초중화비반균위보호성인소(초중:aHR=0.59,95％Ch0.46 ～ 0.76;비반:aHR=0.64,95％ CI:0.44～ 0.92).이교지체중정상녀성,녀성비반자유선암(aHR=1.86,95％CI:1.05 ～ 3.31)적발병풍험증가.분층분석현시:대우남성폐암,초중대불흡연자화흡연자균기보호작용(불흡연자:aHR=0.50,95％CI:0.35～0.72；흡연자:aHR=0.70,95％CI:0.50～0.98),비반부대남성불흡연자기보호작용(aHR =0.57,95％CI:0.33 ～ 0.97),이남성흡연자여폐암발병풍험불존재상관성(aHR=0.72,95％CI:0.43 ～ 1.21).안녀성절경상태분층후,비반증가료절경후유선암적발병풍험(aHR=1.97,95％CI:1.01 ～ 3.82),이여절경전유선암적발병풍험지간적관련무통계학의의.결론 BMI여악성종류발병풍험적상관성인종류불동이존재차이.저체중여남성위암화간암적발병풍험존재상관성,비반여남성결장암、녀성절경후유선암화란소암적발병풍험존재상관성,이초중가능대우남성폐암화방광암발병기도보호작용,비반가능대우비흡연남성폐암발병기도보호작용.
Objective To evaluate the association and its strength between body mass index (BMI,kg/m2) and cancer incidence in a large-scale population-based cohort study.Methods A dynamic cohort was established on May 1,2006.Baseline information on demography,lifestyle,anthropometry such as body height and weight,were collected during the first interview,and cancer incidence,mortality and other related outcome information were obtained through active follow-up every two years and passive follow-up every year.Cancer cases diagnosed within 1 year follow-up period were excluded.Multivariable Cox proportional-hazards regression model was used to calculate the hazard ratios (HRs)and 95％ confidence interval (CI) between BMI and cancer incidence after adjusted for age group,education level,tobacco smoking (smokers and non-smokers),alcohol consumption (drinkers or non-drinkers) and HBsAg status (positive or negative,for liver cancer only) when appropriate.Repeated analysis was carried out on male lung cancer,male liver cancer and female breast cancer,stratified by tobacco smoking,HBsAg status and menopausal status respectively.Results By December 31,2011,a total of 133 273 subjects,including 106 630 (80.01％) males and 26 643 (19.99％) females were enrolled in the cohort.There were 570 531.02 person-years of followup and 4.28-year of average follow-up period.According to the Guidelines for Prevention and Control of Overweight and Obesity in Chinese Adults,study subjects were divided into groups as:underweight (BMI＜18.5 kg/m2),normal weight (BMI 18.5 kg/m2-23.9 kg/m2),overweight (BMI 24.0 kg/m2-27.9 kg/m2) and obese (BMI ≥ 28.0 kg/m2).In males,2 387 (2.24％) were underweight,45 090 (42.29％) were normal weight,43 774 (41.05％) were overweight and 15 379 (14.42％) were obese.Meanwhile,in females,858 (3.22％) were underweight,14 037 (52.69％) were normal weight,8 507 (31.93％) were overweight and 3 241 (12.16％) were obese.A total of 1 647 incident cancer cases among different cancers were collected during the follow-up,including 1 348 in men and 299 in women.Results from Multivariate Cox proportional-hazards regression model showed that ‘underweight' increased the risk on both gastric cancer incidence (adjusted HR=3.82,95％ CI:1.97-7.38) and liver cancer incidence (adjusted HR=3.00,95％ CI:1.36-6.65) in males,while both ‘overweight' (adjusted HR=1.98,95％ CI:1.03-3.82) and ‘obesity' (adjusted HR=2.75,95％ CI:1.25-6.06) increased the risk of colon cancer incidence in males.But for bladder cancer incidence in males,overweight seemed being protective (adjusted HR =0.44,95％ CI:0.23-0.84).And for lung cancer incidence in males,both overweight and obesity were protective as well (adjusted overweight vs.normal weight,HR=0.59,95％CI:0.46-0.76; adjusted obese vs.normal weight,HR=0.64,95％CI:0.44-0.92).In females,obesity increased the risk of breast cancer incidence (adjusted HR=1.86,95％CI:1.05-3.31).Further analysis for lung cancer cases stratified by tobacco smoking,data showed that overweight decreased the risk of lung cancer in both male non-smokers (adjusted HR=0.50,95％ CI:0.35-0.72) and male smokers (adjusted HR =0.70,95％CI:0.50-0.98) while obesity decreased the risk of lung cancer in male non-smokers (adjusted HR=0.57,95％ CI:0.33-0.97),but not in smokers (adjusted HR=0.72,95％CI:0.43-1.21).Stratified analysis in females by menopausal status,data showed that obesity increased the incidence of breast cancer in postmenopausal subjects (adjusted HR=1.97,95％ CI:1.01-3.82),but not in premenopausal subjects.Conclusion The association between BMI and cancer incidence varied by cancer site.Underweight increased the risk of gastric cancer and liver cancer in males,and obesity increased the risk of colon cancer in males,breast cancer and ovarian cancer in females.However,overweight might played a protective role in lung cancer incidence and bladder cancer incidence in males and obesity might play a protective role in lung cancer incidence in male non-smokers.
