BMI越高 癌症风险大幅增加


  【24drs.com】根据在线登载于8月4日Lancet的研究,英国迄今最大型的BMI与癌症的研究认为,身体质量指数(BMI)越高则大部份癌症的风险大幅增加。
  
  英国伦敦卫生与热带医学院、国家健康研究院的Krishnan Bhaskaran博士表示,我们从一些小型研究得知,体重和发生某些癌症的风险有重要相关。
  
  他表示,我们这次研究的目的主要是厘清相关程度有多大,在各种癌症的个别关联程度,体重对整个人群的实际影响。我们发现,BMI和我们探讨的大部份癌症有关,对10种最常见的癌症而言,BMI与高风险有明确关联。
  
  他指出,BMI对不同癌症的影响有所差异,影响最大的是子宫癌,校正各种可能的共变项之后,BMI每增加5 kg/m2或体重增加15.5公斤与子宫癌风险增加62%有关(风险比[HR]为1.62)。
  
  Bhaskaran博士解释,对于一般身高的妇女,我们估计体重每增加12.7公斤,则子宫癌风险会增加约60%。
  
  他表示,估计这每年约影响英国共3,000例子宫癌。
  
  根据临床应用研究数据集的一般开业纪录资料,研究者检视了524万名16岁以上、没有癌症者;根据资料中的身高体重记录计算他们的BMI,获得研究对象的第一次BMI记录之后,平均追踪他们7.5年,平均BMI是25.5 kg/m2。
  
  这些研究对象中,于追踪期间内有166,955人发生评估的22种癌症中的其中1种,这22种癌症代表英国所有癌症诊断的90%。
  
  研究者发现,BMI和这22种癌症中的17种有关。
  
  体重增加与胆囊、肾脏、肝脏等癌症的风险大幅增加有关,结肠癌、子宫颈癌、甲状腺癌、卵巢癌和停经后乳癌以及白血病等癌症风险增加幅度则比较小。
  
  Bhaskaran博士指出,虽然BMI较高对于常见癌症如结肠癌和停经后乳癌的影响属于中等,但这些是常见的癌症,所以,在这情况下,因为体重过重的影响程度将会和子宫癌一样大。
  
  相对的,有一些迹象看来,高BMI和停经前乳癌及前列腺癌的风险略低有关。
  
  表. BMI每增加5 kg/m2与癌症风险增加百分比
癌症类型Percent Increase
子宫62
胆囊31
肾脏25
肝脏19
子宫颈10
结肠10
甲状腺9
白血病9
卵巢9
停经后乳癌5

  Bhaskaran博士表示,我们都知道要对付肥胖,因为它对心血管疾病和糖尿病有所影响,这次的研究确认肥胖对癌症的影响一样重要。
  
  因为肥胖问题的因素多面向,所以需要多元的解决方法。他指出,包括提高对有害食物的警觉,通常是便宜且容易取得的,也要改变环境以促使将运动纳为日常生活的一部分。
  
  美国癌症协会流行病研究计画Peter Campbell博士表示,这次的研究结果基本上是相当确认的。他表示,未发现此篇研究的缺点或潜在错误。
  
  Campbell博士表示,整体讯息是,确认肥胖是癌症的一个可避免的因素,这不是新闻,但是这篇研究增加了新证据确认这项关联,他也认同,就避免肥胖而言,还有诸多挑战。
  
  有一些证据认为美国的肥胖盛行率趋于稳定,他表示,这代表没有证据认为盛行率随时间下降,但至少在过去10年没有恶化,所以这也代表了还有一些改善希望。
  
  Campbell博士强调,不需要更多研究来证明或要求改变减少过重问题的政策,政府必须运用资源、采行减少热量摄取和增加运动的方法。
  
  资料来源:http://www.24drs.com/professional/list/content.asp?x_idno=7107&x_classno=0&x_chkdelpoint=Y
  

Substantially Increased Risk for Cancer With Higher BMI

By Pam Harrison
Medscape Medical News

A higher body mass index (BMI) substantially increases the risk for the majority of cancers diagnosed in the United Kingdom, the largest study of its kind on BMI and cancer suggests. The study was published online August 14 in the Lancet.

"We know from smaller studies that body weight is importantly related to the risk of developing some types of cancer," Krishnan Bhaskaran, PhD, from the National Institute for Health Research, London School of Hygiene & Tropical Medicine, in the United Kingdom.

"But what we really wanted to do with this study was find out how large these effects are, how they vary across a wide range of cancers, and what the real impact of body weight is at a population level. We found that BMI was associated with the majority of cancers that we looked at and, for 10 of the most common cancers, higher BMI was very clearly associated with higher risk," he told Medscape Medical News.

"There was a lot of variation in the effects of BMI on different cancers," he noted. However, the greatest effect was on cancer of the uterus. After adjustment for all potential confounders, each 5 kg/m2 increase in BMI (15.5 kg) was associated with a 62% increase in the risk for uterine cancer (hazard ratio [HR], 1.62), the researchers report.

"For a woman of average height, our estimates suggest that a 2-stone [12.7 kg] increase in weight would increase the risk of uterine cancer by over 60%," Dr. Bhaskaran explained.

"We estimate that this effect is responsible for over 3000 cases of uterine cancer a year in the United Kingdom," he said.

Study of More Than 5 Million People

Using data from general practitioner records in the Clinical Practice Research Datalink, the researchers identified 5.24 million people 16 years of age and older who were free of cancer at the time of assessment. BMI was calculated directly from weight and height records. Participants were followed for a mean of 7.5 years after the first eligible BMI measurement. Mean BMI was 25.5 kg/m2.

In the cohort, 166,955 people developed 1 of the 22 cancers evaluated during the follow-up period. The 22 cancers of interest represent 90% of all cancers diagnosed in the United Kingdom.

The researchers found that BMI was associated with 17 of the 22 cancers.

There were large weight-related increases in risk for cancers of the gallbladder, kidney, and liver, and smaller increases in the risk for colon, cervical, thyroid, ovarian, and postmenopausal breast cancer, and for leukemia.

Even though the effect of a higher BMI on common cancers, such as colon and postmenopausal breast cancer, were more modest, "these are very common cancers," Dr. Bhaskaran noted, "so the number of cases due to excess weight would be just as large [as for uterine cancer]."

In contrast, there was some indication that a high BMI was associated with a slightly lower risk for premenopausal breast cancer and prostate cancer.

Table. Increase in the Risk for Cancer With Every 5 kg/m2 Increase in BMI

    
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