PDF(Pubmed)
Abstract：
While advances in screening have resulted in declining rates of colorectal cancer (CRC) among adults ≥50 years of age since the mid-2000s, the incidence of early-onset CRC (EOCRC) has steadily increased over the last decade. This increase is not fully accounted for by hereditary factors, and the hypothesis that a sedentary lifestyle and obesity are the primary culprits is not fully supported by recent reports indicating that many affected individuals lead active lifestyles, maintain normal weight, and are otherwise healthy. Attention has shifted toward dietary patterns, notably the consumption of processed and ultra-processed foods found in Western diets, which are suspected of disrupting the gut microbiome balance that potentially leads to EOCRC. The impact of antibiotic use on the gut microbiome is also posited as a contributing factor, given its rising prevalence in medical and agricultural practices. We propose that a paradigm shift is necessary for EOCRC research, moving beyond metabolic factors to a broader exploration of dietary and microbial influences. Future research must prioritize understanding the relationship between dietary habits, particularly processed food intake, antibiotic exposure, and gut microbiome dynamics, to unravel the complex etiology of EOCRC. This will be crucial in developing comprehensive preventive strategies to address the increasing incidence of this malignancy in younger populations.
摘要：
虽然自2000年代中期以来，筛查的进步导致50岁以上成年人的结直肠癌（CRC）发病率下降，在过去10年中,早发型CRC(EOCRC)的发病率稳步上升.这一增长并没有完全由遗传因素引起，而久坐的生活方式和肥胖是主要罪魁祸首的假设并没有得到最近报告的完全支持，这些报告表明许多受影响的个体过着积极的生活方式，保持正常体重,否则是健康的。注意力已经转向了饮食习惯，特别是在西方饮食中发现的加工和超加工食品的消费，被怀疑破坏肠道微生物组平衡，可能导致EOCRC。抗生素使用对肠道微生物组的影响也被认为是一个促成因素，鉴于其在医疗和农业实践中的流行率不断上升。我们建议EOCRC研究需要进行范式转换，超越代谢因素，更广泛地探索饮食和微生物的影响。未来的研究必须优先理解饮食习惯之间的关系，特别是加工食品的摄入量，抗生素暴露,和肠道微生物组动态，解开EOCRC的复杂病因。这对于制定全面的预防策略以解决年轻人群中这种恶性肿瘤发病率的增加至关重要。
