PO.PS01.06 · 人群科学
美国前瞻性队列中按体力活动分层的液态和固态果糖摄入与结直肠癌死亡率
Liquid and solid fructose intake and colorectal cancer mortality by physical activity in U.S. prospective cohorts
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
背景：我们近期发现，在临床前模型（包括人类癌细胞系和小鼠）中，液态果糖促进结直肠癌（CRC）转移（Feng等，2025）。在人类中，果糖以液态和固态两种形式摄入（Li等，2023），但这些来源是否与CRC死亡率存在不同关联尚不清楚。此外，体力活动可能改变果糖的代谢效应（Tappy & Rosset，2019）。
方法：我们在护士健康研究（Nurses' Health Study，1984-2018）和卫生专业人员随访研究（Health Professionals Follow-Up Study，1990-2018）中，使用每四年一次的食物频率问卷评估诊断前和诊断后的液态和固态果糖摄入量。营养素摄入量采用残差法进行能量校正。诊断后果糖摄入在诊断后至少六个月但不超过四年时评估。液态果糖来源于含糖饮料和果汁，固态果糖计算为总果糖减去液态果糖。采用Cox比例风险模型估计果糖摄入与CRC特异性死亡率的风险比（HR），按诊断前体力活动分层（<11.5 vs. ≥11.5 代谢当量任务[MET]-小时/周），并校正人口学特征、肿瘤特征、生活方式因素和膳食。
结果：在724例诊断前体力活动较低（<11.5 MET-小时/周）的CRC患者中，我们在7,412人年中观察到96例CRC特异性死亡。较高的诊断后（而非诊断前）液态和固态果糖摄入与较高的CRC特异性死亡率相关。诊断后液态果糖与CRC死亡率的关联最强（多变量[MV]校正 HR，每5 g/天，1.18；95% CI，1.04-1.34；P值，0.011），而诊断后固态果糖表现出更为温和的关联（MV校正 HR，每20 g/天，1.04；95% CI，1.01-1.06；P值，0.002）。在705例诊断前体力活动较高（≥11.5 MET-小时/周）的患者中（6,611人年；95例CRC特异性死亡），无论诊断前还是诊断后的液态或固态果糖摄入均与CRC特异性死亡率无关。这些发现表明，果糖摄入与CRC死亡率之间的正相关见于体力活动较低的个体，仅限于诊断后果糖摄入，且液态果糖比固态果糖的关联更强。
结论：较高的诊断后果糖摄入，尤其来自液态来源，与体力活动较低患者中CRC特异性死亡率升高相关。这些发现提示体力活动与果糖摄入在CRC死亡率背景下可能存在交互作用，并强调了食物选择在CRC生存期中的重要性。
查看英文原文 English abstract
Background : We recently found that liquid fructose promotes colorectal cancer (CRC) metastasis in preclinical models, including human cancer cell lines and mice (Feng et al., 2025). In humans, fructose is consumed in both liquid and solid forms (Li et al., 2023), but whether these sources relate differently to CRC mortality is unknown. Additionally, physical activity may modify the metabolic effects of fructose (Tappy & Rosset, 2019).
Methods : We assessed pre- and post-diagnostic liquid and solid fructose intakes using quadrennial food frequency questionnaires in the Nurses' Health Study (1984-2018) and Health Professionals Follow-Up Study (1990-2018). Nutrient intakes were energy-adjusted using the residual method. Post-diagnostic fructose intake was assessed at least six months but no more than four years after diagnosis. Liquid fructose was derived from sugar-sweetened beverages and juice, and solid fructose was calculated as total minus liquid fructose. Cox proportional hazards models were used to estimate hazard ratios (HRs) for fructose intake and CRC-specific mortality, stratified by pre-diagnostic physical activity (<11.5 vs. ≥11.5 metabolic equivalent of task [MET]-hrs/wk) and adjusted for demographics, tumor characteristics, lifestyle factors, and diet.
Results : Among 724 CRC patients with low pre-diagnostic physical activity (<11.5 MET-hrs/wk), we observed 96 CRC-specific deaths over 7,412 person-years. Higher post-diagnostic, but not pre-diagnostic, liquid and solid fructose intakes were associated with higher CRC-specific mortality. Post-diagnostic liquid fructose showed the strongest association with CRC mortality (Multivariable [MV]-adjusted HR per 5 g/day, 1.18; 95% CI, 1.04-1.34; P-value, 0.011), whereas post-diagnostic solid fructose showed a more modest association (MV-adjusted HR per 20 g/day, 1.04; 95% CI, 1.01-1.06; P-value, 0.002). Among 705 patients (6,611 person-years; 95 CRC-specific deaths) with high pre-diagnostic physical activity (≥11.5 MET-hrs/wk), neither liquid nor solid fructose intake, pre- or post-diagnostic, was associated with CRC-specific mortality. These findings showed that the positive associations between fructose intake and CRC mortality were observed for individuals with low physical activity, confined to post-diagnostic fructose intake, and stronger for liquid than for solid fructose.
Conclusions : Higher post-diagnostic fructose intake, especially from liquid sources, was associated with increased CRC-specific mortality among patients with low physical activity. These findings suggest a potential interaction between physical activity and fructose intake in the context of CRC mortality and highlight the importance of food choices in CRC survivorship.
利益披露 Disclosure
H. Kim, None..
J. Yun, None..
C. R. Daniel-MacDougall, None..
L. H. Nguyen, None..
E. L. Giovannucci, None.