背景:最近的证据表明整体饮食质量,根据饮食评分评估,可能在上消化道(UGI)癌症的发展中起作用。然而,现有的饮食评分来自高收入国家,其饮食习惯与UGI癌症负担最高的地区不同,可用数据有限的地方。这项研究旨在调查整体饮食质量与UGI癌症高危地区食管癌和胃癌风险之间的关系。
方法:我们在2004年至2008年期间从伊朗东北部招募了50045名年龄在40-75岁之间的个体,并每年随访至2020年7月。人口统计数据,饮食,并使用经过验证的问卷收集各种暴露。饮食质量通过计算健康饮食指数(HEI)来评估,替代健康饮食指数(AHEI),替代地中海饮食(AMED),停止高血压(DASH)的饮食方法和世界癌症研究基金-美国癌症研究所(WCRF-AICR)评分。
结果:在平均12年的随访中,359名参与者发展为食道癌,358人发展为胃癌。调整后,基线饮食评分的每个标准差增加与食管癌风险降低12%和胃癌风险降低17%相关.食管癌与AMED的依从性呈较强的负相关(HRQ4-vs-Q1=0.69(0.49-0.98),P-趋势=0.038)。胃癌与WCRF-AICR呈较强的负相关(HRQ4-vs-Q1=0.58(0.41-0.83),P-趋势=0.004),和DASH(HRC4-vs-C1=0.72(0.54-0.96),P-趋势=0.041)。这些关联在不同的人口亚组之间具有可比性。在该人群中,我们没有观察到HEI和AHEI评分与UGI癌症之间的显着关联。
结论:尽管个体食物组的消费量不同,在这一高危人群中,坚持现有饮食建议(来自高收入国家)与随后发生食管癌和胃癌的风险较低相关.教育公众拥有健康的饮食习惯可能是预防高危地区UGI癌症的有效策略。
BACKGROUND: Recent evidence suggests overall diet quality, as assessed by dietary scores, may play a role in the development of upper gastrointestinal (UGI) cancers. However, the existing dietary scores are derived from high-income countries with different dietary habits than regions with the highest burden of UGI cancers, where limited data is available. This
study aimed to investigate the association between overall diet quality and risk of esophageal and stomach cancers in a high-risk region for UGI cancers.
METHODS: We recruited 50045 individuals aged 40-75 between 2004-2008 from northeastern Iran and followed them annually through July 2020. Data on demographics, diet, and various exposures were collected using validated questionnaires. Diet quality was assessed by calculating the Healthy Eating Index (HEI), Alternative Healthy Eating Index (AHEI), Alternative Mediterranean Diet (AMED), Dietary Approaches to Stop Hypertension (DASH), and World Cancer Research Fund-American Institute for Cancer Research (WCRF-AICR) scores.
RESULTS: During an average 12 years of follow-up, 359 participants developed esophageal cancer and 358 developed stomach cancer. After adjustments, each standard deviation increase in baseline dietary scores was associated with up to 12% reduction in esophageal cancer risk and up to 17% reduction in stomach cancer risk. Esophageal cancer showed stronger inverse associations with adherence to AMED (HRQ4-vs-Q1=0.69 (0.49-0.98), P-trend=0.038). Stomach cancer showed stronger inverse correlation with WCRF-AICR (HRQ4-vs-Q1=0.58 (0.41-0.83), P-trend=0.004), and DASH (HRC4-vs-C1=0.72 (0.54-0.96), P-trend=0.041). These associations were comparable across different population subgroups. We did not observe significant associations between HEI and AHEI scores and UGI cancers in this population.
CONCLUSIONS: Despite the differences in consuming individual food groups, adherence to the available dietary recommendations (derived from high-income countries) was associated with lower risk for subsequent esophageal and gastric cancers in this high-risk population. Educating the public to have a healthy eating pattern might be an effective strategy towards prevention of UGI cancers in high-risk regions.