糖尿病风险降低饮食与肝癌及慢性肝病死亡风险：一项前瞻性队列研究

Diabetes risk reduction diet and risk of liver cancer and chronic liver disease mortality: A prospective cohort study

JOURNAL OF INTERNAL MEDICINE

影响因子:9.2

分区:医学1区 Top / 医学：内科2区

发表日期:2024 Nov

作者: Yun Chen, Longgang Zhao, Su Yon Jung, Margaret S Pichardo, Melissa Lopez-Pentecost, Thomas E Rohan, Nazmus Saquib, Yangbo Sun, Fred K Tabung, Tongzhang Zheng, Jean Wactawski-Wende, JoAnn E Manson, Marian L Neuhouser, Xuehong Zhang

DOI: 10.1111/joim.20007

摘要

本研究旨在前瞻性评估糖尿病风险降低饮食（DRRD）评分与肝癌发生风险及慢性肝病特异性死亡之间的关联。我们纳入了来自妇女健康倡议-观察性研究及饮食调整试验常规饮食组的98,786名绝经后妇女。DRRD评分由八个因素构成：高摄入量的膳食纤维、咖啡、坚果、多不饱和脂肪酸，低摄入红肉和加工肉、血糖指数高的食物、含糖饮料（SSBs）以及反式脂肪，基于在基线（1993-1998年）使用的验证过的食品频率问卷计算得出。通过Cox比例风险模型估算肝癌发生率及慢性肝病死亡的多变量风险比（HR）及95%置信区间（CI）。随访中位数为22.0年，确认216例肝癌新发病例及153例慢性肝病死亡。较高的DRRD评分显著降低肝癌（第三组与第一组的HR=0.69；95% CI：0.49-0.97；趋势p=0.03）和慢性肝病死亡（HR=0.54；95% CI：0.35-0.82；趋势p=0.003）的风险。我们还发现膳食纤维和咖啡摄入与风险呈负相关，血糖指数、含糖饮料及反式脂肪摄入与风险呈正相关。总体而言，较高的DRRD评分与绝经后妇女肝癌及慢性肝病死亡风险的降低有关。

Abstract

We aimed to prospectively evaluate the association between a diabetes risk reduction diet (DRRD) score and the risk of liver cancer development and chronic liver disease-specific mortality.We included 98,786 postmenopausal women from the Women's Health Initiative-Observational Study and the usual diet arm of the Diet Modification trial. The DRRD score was derived from eight factors: high intakes of dietary fiber, coffee, nuts, polyunsaturated fatty acids, low intakes of red and processed meat, foods with high glycemic index, sugar-sweetened beverages (SSBs), and trans fat based on a validated Food-Frequency Questionnaire administered at baseline (1993-1998). Multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) for liver cancer incidence and chronic liver disease mortality were estimated using Cox proportional hazards regression models.After a median follow-up of 22.0 years, 216 incident liver cancer cases and 153 chronic liver disease deaths were confirmed. A higher DRRD score was significantly associated with a reduced risk of developing liver cancer (HRTertile 3 vs. Tertile 1 = 0.69; 95% CI: 0.49-0.97; Ptrend = 0.03) and chronic liver disease mortality (HRT3 vs. T1 = 0.54; 95% CI: 0.35-0.82; Ptrend = 0.003). We further found inverse associations with dietary fiber and coffee, and positive associations with dietary glycemic index, SSBs, and trans fat. A higher DRRD score was associated with reduced risk of developing liver cancer and chronic liver disease mortality among postmenopausal women.