PO.PS01.06 · 人群科学

超加工食品与结直肠癌诊断后无病生存：来自ColoCare研究的发现

Ultra-processed foods and disease-free survival after colorectal cancer diagnosis: Findings from the Colocare Study

编号 5036 展板 9 时间 4/21 09:00–12:00 区域 Section 35 主讲 Patricia Erickson, PhD

分会场 Diet, Alcohol, and Tobacco, and Other Lifestyle Factors

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作者与单位 Authors & Affiliations

Patricia A. Erickson¹, Rachel Hoobler¹, Victoria Maria Bandera¹, Victoria Damerell², Ildiko Strehli¹, Megan Mclaws¹, Lyen Huang¹, Jessica N. Cohan¹, Erin Siegel³, Doratha Armenthus Byrd⁴, Adetunji T. Toriola⁵, David Shibata⁶, Christopher I. Li⁷, Jane C. Figueiredo⁸, Biljana Gigic⁹, Mary Playdon¹, Sheetal Hardikar¹, Cornelia M. Ulrich¹

¹University of Utah Huntsman Cancer Institute, Salt Lake City, UT,²Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany,³Colorectal Cancer Alliance, Washington, DC,⁴Moffitt Cancer Center, Tampa, FL,⁵Department of Surgery, Washington University School of Medicine, St. Louis, MO,⁶Assoc. Professor of Surgical Onc., Div. of Interdiscipl. Onc., University of Tennessee Health Science Center - Memphis, Memphis, TN,⁷Fred Hutch Cancer Center, Seattle, WA,⁸Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA,⁹Heidelberg University Hospital (UKHD), Heidelberg, Germany

摘要 Abstract

中文摘要

引言：超加工食品（ultra-processed foods, UPFs）是工业化配制、富含脂肪、糖和添加剂的产品，占美国每日热量摄入的约60%。UPF摄入已被认为与肥胖、糖尿病及某些癌症的风险相关，但其对结直肠癌（colorectal cancer, CRC）生存期的影响仍不明确。CRC生存者常面临与治疗相关的膳食挑战，可能因方便或为满足能量需求而依赖UPFs。方法：我们分析了ColoCare研究中来自美国四个中心的418例I-III期CRC患者。收集了基线的人口学、生活方式和临床数据。在诊断后6个月使用反映此前六个月情况的食物频率问卷（food frequency questionnaire, FFQ）评估膳食摄入。食物被归入四个NOVA分组之一：未加工、少加工、加工和超加工食品（UPFs）。我们聚焦于UPF摄入（NOVA第4组），使用两种指标将其分为四分位（第1四分位=最低；第4四分位=最高）：绝对摄入量（克/天）和相对摄入量（占每日总克数的百分比）。Cox比例风险模型估计无病生存（disease-free survival, DFS）的风险比（HR）及95%置信区间（CI），校正了研究中心、年龄、性别、肿瘤部位、辅助治疗、BMI和总热量摄入（kcal）。还进行了不校正BMI/kcal的敏感性分析。结果：参与者的平均年龄为58岁（标准差[SD]=13岁），平均BMI为29 kg/m²（SD=6.8）。50%的参与者为女性，49%被诊断为III期CRC，59%为结肠癌。中位随访期为4年（SD=2年）。UPFs按重量计约占每日总食物摄入的16%。平均健康饮食指数（Healthy Eating Index, HEI）评分为63（SD=10），但评分随UPF消费四分位升高而下降（p < 0.001）。按克/天评估时，BMI在UPF四分位间存在差异（p=0.04），使用占总克数百分比的四分位时也观察到相似模式（p=0.12）。无论以克/天还是占总摄入百分比衡量，UPF消费均与DFS无显著相关。对于克/天四分位，第2-4四分位相对于第1四分位的HR（95% CI）分别为0.92（0.52-1.65）、0.88（0.47-1.62）和0.88（0.45-1.74）。对于基于百分比的四分位，HR分别为1.12（0.61-2.09）、1.02（0.54-1.93）和1.27（0.70-2.30）。在未校正模型和不校正BMI/kcal的模型中结果一致。讨论：在这一大型多中心队列中，UPF摄入在CRC生存者中很常见，并与较低的膳食质量相关。然而，无论摄入以克/天还是占总摄入百分比衡量，UPF消费均与DFS无关。HR方向上的轻微差异可能反映了绝对摄入与相对摄入捕捉膳食模式的方式不同。这些发现为诊断后膳食与癌症结局提供了重要见解。

查看英文原文 English abstract

Introduction: Ultra-processed foods (UPFs), industrially formulated products high in fat, sugar, and additives, account for ~60% of daily calories in the United States. UPF intake has been linked to obesity, diabetes, and risk of some cancers, yet its impact on colorectal cancer (CRC) survivorship remains unclear. CRC survivors often face treatment-related dietary challenges and may rely on UPFs for convenience or to meet energy needs. Methods: We analyzed 418 stage I-III CRC patients in the ColoCare Study across four U.S. sites. Baseline demographic, lifestyle, and clinical data were collected. Dietary intake was assessed 6 months post-diagnosis using a food frequency questionnaire (FFQ) reflecting the prior six months. Foods were classified into one of four NOVA groups: unprocessed, minimally processed, processed, and ultra-processed foods (UPFs). We focused on UPF intake (NOVA Group 4), categorized into quartiles (Quartile 1 = lowest; Quartile 4 = highest) using two metrics: absolute intake (grams/day) and relative intake (percent of total grams/day). Cox proportional models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for disease-free-survival (DFS), adjusting for study site, age, sex, tumor site adjuvant treatment, BMI, and total caloric intake (kcal). Sensitivity analyses without BMI/kcal adjustment were also done. Results: Participants had a mean age of 58 years (standard deviation [SD]=13y) and a mean BMI of 29 kg/m² (SD=6.8). 50% of participants were female, 49% were diagnosed with stage III CRC, and 59% with colon cancer. The median follow-up was 4 years (SD=2y). UPFs comprised ~16% of the total daily food intake by weight. The mean Healthy Eating Index (HEI) score was 63 (SD=10), but scores decreased across quartiles of UPF consumption (p < 0.001). When evaluated by g/day, BMI differed by UPF quartiles (p=0.04), and a similar pattern was observed when quartiles of % g/day were used (p=0.12). UPF consumption, whether in g/day or percent of total intake, was not significantly associated with DFS. For g/day quartiles, HRs (95% CI) for quartiles 2-4 vs 1 were 0.92 (0.52-1.65), 0.88 (0.47-1.62), and 0.88 (0.45-1.74). For percentage-based quartiles, HRs were 1.12 (0.61- 2.09), 1.02 (0.54-1.93), and 1.27 (0.70-2.30). Results were consistent in both unadjusted models and those without BMI/kcal adjustment. Discussion: In this large, multi-center cohort, UPF intake was common among CRC survivors and associated with lower diet quality. However, UPF consumption was not associated with DFS, regardless of whether intake was measured in g/day or percentage of total intake. Modest differences in HR direction likely reflect how absolute versus relative intake captures dietary patterns. These findings offer important insights into post-diagnosis diet and cancer outcomes.

利益披露 Disclosure

P. A. Erickson, None.. R. Hoobler, None.. V. Damerell, None.. I. Strehli, None.. M. Mclaws, None.. L. Huang, None.. J. N. Cohan, None.. A. T. Toriola, None.. C. I. Li, None.

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