PO.PS01.10 · 人群科学
预防前列腺癌男性衰弱的最佳诊断后膳食模式
Optimal post-diagnostic dietary patterns for prevention of frailty among men with prostate cancer
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
背景：衰弱与前列腺癌患者的不良预后相关。以植物性食物为重点的膳食与较低的衰弱风险相关，但很少有研究考察这些膳食对前列腺癌幸存者衰弱的影响。因此，我们在一个大型美国前瞻性队列中，前瞻性评估了前列腺癌诊断后的各种膳食模式与衰弱风险的关系。
方法：我们纳入了来自健康专业人员随访研究（Health Professional Follow-up Study）的5,191名男性，他们在1986年至2018年间前列腺癌诊断之前均无衰弱，并基于一般膳食建议评估了诊断后的膳食模式。截至2020年，事件性衰弱定义为在FRAIL量表五项标准中满足≥3项（疲劳、抵抗力下降、有氧能力下降、患有多种疾病，以及前一年内显著体重减轻）。我们使用左截断Cox比例风险回归模型，估计各膳食评分四分位数间衰弱的风险比和95%置信区间，并校正潜在混杂因素。
结果：在中位随访12年期间，我们在5,191名前列腺癌男性中观察到1,433例衰弱事件。诊断后膳食依从性较好的参与者更可能有较低的BMI、更活跃的身体活动、使用多种维生素，且更不可能吸烟。在校正年龄、生活方式因素、临床特征、治疗和其他健康状况的模型中，比较极端四分位数，糖尿病风险降低膳食（DRRD，HR = 0.81，95% CI = 0.76, 0.86）、终止高血压膳食方法评分（DASH，HR = 0.84，0.79, 0.90）、替代健康饮食指数-2010（HR = 0.85，0.79, 0.91）和替代地中海膳食（HR=0.92，0.87, 0.98）的依从性与较低的衰弱风险相关（所有趋势P < 0.01），而世界癌症研究基金会/美国癌症研究所膳食、健康植物性膳食、高胰岛素血症经验性膳食指数（EDIH）和经验性膳食炎症模式则未发现关联。膳食模式与衰弱之间的负向关联在各亚组中持续存在，并且在较年轻、超重或肥胖、从事剧烈身体活动、从不吸烟、饮酒量较低、Gleason评分较高以及曾接受雄激素剥夺治疗的男性中通常更强。膳食模式与衰弱之间的关联在4年滞后分析中相似。当排除2008年之前诊断的前列腺癌病例时，DRRD（HR=0.62，0.42, 0.91）和反向EDIH（HR=0.51，0.34, 0.78）观察到更明显的趋势。
结论：前列腺癌诊断后对健康膳食模式的依从性与较低的衰弱风险相关，这可能为前列腺癌幸存者未来的膳食指南提供参考。
查看英文原文 English abstract
Background. Frailty has been associated with poor prognosis in prostate cancer patients. Diets with a focus on plant-based foods associated with a lower risk of frailty, but few studies have examined these diets on frailty among prostate cancer survivors. We thus prospectively assessed various dietary patterns after prostate cancer diagnosis in relation to risk of frailty in a large U.S. prospective cohort.
Methods. We included 5,191 males who were not frail prior to their prostate cancer diagnosis between 1986 and 2018 from the Health Professional Follow-up Study and assessed post-diagnostic dietary patterns based on general dietary recommendations. Incident frailty was defined as having ≥3 out of five criteria (fatigue, reduced resistance, reduced aerobic capacity, having several illnesses, and a significant weight loss during the previous year) in the FRAIL scale through 2020. We used left-truncated Cox proportional hazards regression models to estimate hazard ratios and 95% confidence intervals for frailty across quartiles of dietary scores adjusting for potential confounders.
Results. During a median follow-up of 12 years, we observed 1,433 events of frailty among 5,191 men with prostate cancer. Participants with better adherence to the post-diagnostic diets were more likely to have a lower BMI, be more physically active, to use multivitamins, and less likely to smoke. In models adjusting for age, lifestyle factors, clinical characteristics, treatments, and other health conditions, comparing extreme quartiles, adherence to the Diabetes Risk Reduction Diet (DRRD, HR = 0.81, 95% CI = 0.76, 0.86), Dietary Approaches to Stop Hypertension score (HR = 0.84, 0.79, 0.90), Alternative Healthy Eating Index-2010 (HR = 0.85, 0.79, 0.91), and Alternate Mediterranean Diet (HR=0.92, 0.87, 0.98) were associated with a lower risk of frailty (P for trend < 0.01 for all), while no association was found for the World Cancer Research Fund/American Institute for Cancer Research diet, healthful plant-based diet, empirical dietary index for hyperinsulinemia (EDIH), and empirical dietary inflammation pattern. The inverse associations between dietary patterns and frailty persisted in subgroups, and were generally stronger in men who were younger, overweight or obese, engaged in vigorous physical activity, never smoked, with lower alcohol consumption, with higher Gleason score, and ever received androgen deprivation therapy. The associations between dietary patterns and frailty were similar in the 4-year lagged analysis. When excluding prostate cancer cases diagnosed before 2008, a more pronounced trend was observed for the DRRD (HR=0.62, 0.42, 0.91) and reversed EDIH (HR=0.51, 0.34, 0.78).
Conclusions. Adherence to healthy dietary patterns after prostate cancer diagnosis were associated with lower risk of frailty, which may inform on future dietary guidelines for prostate cancer survivors.
利益披露 Disclosure
C. Ma, None..
Y. Deng, None..
L. Wu, None..
C. Himbert, None.