BMI越高 癌症風險大幅增加


  【24drs.com】根據線上登載於8月4日Lancet的研究,英國迄今最大型的BMI與癌症的研究認為,身體質量指數(BMI)越高則大部份癌症的風險大幅增加。
  
  英國倫敦衛生與熱帶醫學院、國家健康研究院的Krishnan Bhaskaran博士表示,我們從一些小型研究得知,體重和發生某些癌症的風險有重要相關。
  
  他表示,我們這次研究的目的主要是釐清相關程度有多大,在各種癌症的個別關聯程度,體重對整個人群的實際影響。我們發現,BMI和我們探討的大部份癌症有關,對10種最常見的癌症而言,BMI與高風險有明確關聯。
  
  他指出,BMI對不同癌症的影響有所差異,影響最大的是子宮癌,校正各種可能的共變項之後,BMI每增加5 kg/m2或體重增加15.5公斤與子宮癌風險增加62%有關(風險比[HR]為1.62)。
  
  Bhaskaran博士解釋,對於一般身高的婦女,我們估計體重每增加12.7公斤,則子宮癌風險會增加約60%。
  
  他表示,估計這每年約影響英國共3,000例子宮癌。
  
  根據臨床應用研究數據集的一般開業紀錄資料,研究者檢視了524萬名16歲以上、沒有癌症者;根據資料中的身高體重記錄計算他們的BMI,獲得研究對象的第一次BMI記錄之後,平均追蹤他們7.5年,平均BMI是25.5 kg/m2。
  
  這些研究對象中,於追蹤期間內有166,955人發生評估的22種癌症中的其中1種,這22種癌症代表英國所有癌症診斷的90%。
  
  研究者發現,BMI和這22種癌症中的17種有關。
  
  體重增加與膽囊、腎臟、肝臟等癌症的風險大幅增加有關,結腸癌、子宮頸癌、甲狀腺癌、卵巢癌和停經後乳癌以及白血病等癌症風險增加幅度則比較小。
  
  Bhaskaran博士指出,雖然BMI較高對於常見癌症如結腸癌和停經後乳癌的影響屬於中等,但這些是常見的癌症,所以,在這情況下,因為體重過重的影響程度將會和子宮癌一樣大。
  
  相對的,有一些跡象看來,高BMI和停經前乳癌及前列腺癌的風險略低有關。
  
  表. BMI每增加5 kg/m2與癌症風險增加百分比
癌症類型Percent Increase
子宮62
膽囊31
腎臟25
肝臟19
子宮頸10
結腸10
甲狀腺9
白血病9
卵巢9
停經後乳癌5

  Bhaskaran博士表示,我們都知道要對付肥胖,因為它對心血管疾病和糖尿病有所影響,這次的研究確認肥胖對癌症的影響一樣重要。
  
  因為肥胖問題的因素多面向,所以需要多元的解決方法。他指出,包括提高對有害食物的警覺,通常是便宜且容易取得的,也要改變環境以促使將運動納為日常生活的一部分。
  
  美國癌症協會流行病研究計畫Peter Campbell博士表示,這次的研究結果基本上是相當確認的。他表示,未發現此篇研究的缺點或潛在錯誤。
  
  Campbell博士表示,整體訊息是,確認肥胖是癌症的一個可避免的因素,這不是新聞,但是這篇研究增加了新證據確認這項關聯,他也認同,就避免肥胖而言,還有諸多挑戰。
  
  有一些證據認為美國的肥胖盛行率趨於穩定,他表示,這代表沒有證據認為盛行率隨時間下降,但至少在過去10年沒有惡化,所以這也代表了還有一些改善希望。
  
  Campbell博士強調,不需要更多研究來證明或要求改變減少過重問題的政策,政府必須運用資源、採行減少熱量攝取和增加運動的方法。
  
  資料來源: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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