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期刊来源：JAMA

原文链接：https://doi.org/10.1001/jama.2023.25869

摘要内容如下：

重要性

减肥在初级保健中很常见。在近期体重减轻的个体中，与近期体重未减轻的个体相比，随后12个月的癌症发病率尚不清楚。

目的

确定前2年体重减轻的卫生专业人员与近期体重未减轻的卫生专业人员在12个月内的后续癌症诊断率。

设计、设置和参与者

对1978年6月至2016年6月30日随访的护士健康研究中40岁及以上的女性和1988年1月至2016年1月31日随访的卫生专业人员随访研究中40岁及以上的男性进行前瞻性队列分析。

曝光

最近的体重变化是根据每两年报告一次的参与者体重计算的。如果身体活动和饮食质量都增加，则减肥的意向性分类为高，如果只增加1，则为中等，如果两者都不增加，则为低。

主要成果和措施

体重减轻后12个月内的癌症诊断率。

结果

在157474名参与者中（中位年龄，62岁[IQR，54-70岁]；女性111912人，占71.1%；有2631名参与者[1.7%]自认为是亚洲人、美洲土著人或夏威夷土著人；2678名黑人参与者[1.7%]；149903名白人参与者[95.2%]），在164万人年的随访期间，确定了15809例新发癌症病例（发病率为964例/10万人年）。在报告体重变化后的12个月内，在近期体重减轻超过体重10.0%的所有参与者中，有1362例癌症病例/100，000人-年，而在近期体重未减轻的参与者中，有869例癌症病例/100，000人-年（组间差异，493例/100，000人-年[95%CI，391-594例/100，000人-年]；P<.001）。在被归类为低意向性减肥的参与者中，体重减轻超过体重的10.0%的参与者中有2687例癌症病例/10万人-年，而近期无体重减轻的参与者中有1220例癌症病例/10万人-年（组间差异，1467例/10万人-年[95%CI，799-2135例/10万人-年]；P<.001）。上消化道癌症（食道癌、胃癌、肝癌、胆道癌或胰腺癌）在近期体重减轻的参与者中尤为常见；体重减轻超过体重的10.0%的患者中有173例癌症病例/100，000人年，而近期无体重减轻的患者中有36例癌症病例/100，000人年（组间差异，137例/100，000人年[95%CI，101-172例/100，000人年]；P<.001）。

结论和相关性

前2年内体重减轻的卫生专业人员在随后的12个月内患癌症的风险明显高于近期体重没有减轻的人。与近期体重没有下降的参与者相比，近期体重下降的参与者中上消化道癌症尤为常见。

英文原文如下：

Abstracts

Importance  Weight loss is common in primary care. Among individuals with recent weight loss, the rates of cancer during the subsequent 12 months are unclear compared with those without recent weight loss.

Objective  To determine the rates of subsequent cancer diagnoses over 12 months among health professionals with weight loss during the prior 2 years compared with those without recent weight loss.

Design, Setting, and Participants  Prospective cohort analysis of females aged 40 years or older from the Nurses' Health Study who were followed up from June 1978 until June 30, 2016, and males aged 40 years or older from the Health Professionals Follow-Up Study who were followed up from January 1988 until January 31, 2016.

Exposure  Recent weight change was calculated from the participant weights that were reported biennially. The intentionality of weight loss was categorized as high if both physical activity and diet quality increased, medium if only 1 increased, and low if neither increased.

Main Outcome and Measures  Rates of cancer diagnosis during the 12 months after weight loss.

Results  Among 157 474 participants (median age, 62 years [IQR, 54-70 years]; 111 912 were female [71.1%]; there were 2631 participants [1.7%] who self-identified as Asian, Native American, or Native Hawaiian; 2678 Black participants [1.7%]; and 149 903 White participants [95.2%]) and during 1.64 million person-years of follow-up, 15 809 incident cancer cases were identified (incident rate, 964 cases/100 000 person-years). During the 12 months after reported weight change, there were 1362 cancer cases/100 000 person-years among all participants with recent weight loss of greater than 10.0% of body weight compared with 869 cancer cases/100 000 person-years among those without recent weight loss (between-group difference, 493 cases/100 000 person-years [95% CI, 391-594 cases/100 000 person-years]; P < .001). Among participants categorized with low intentionality for weight loss, there were 2687 cancer cases/100 000 person-years for those with weight loss of greater than 10.0% of body weight compared with 1220 cancer cases/100 000 person-years for those without recent weight loss (between-group difference, 1467 cases/100 000 person-years [95% CI, 799-2135 cases/100 000 person-years]; P < .001). Cancer of the upper gastrointestinal tract (cancer of the esophagus, stomach, liver, biliary tract, or pancreas) was particularly common among participants with recent weight loss; there were 173 cancer cases/100 000 person-years for those with weight loss of greater than 10.0% of body weight compared with 36 cancer cases/100 000 person-years for those without recent weight loss (between-group difference, 137 cases/100 000 person-years [95% CI, 101-172 cases/100 000 person-years]; P < .001).

Conclusions and Relevance  Health professionals with weight loss within the prior 2 years had a significantly higher risk of cancer during the subsequent 12 months compared with those without recent weight loss. Cancer of the upper gastrointestinal tract was particularly common among participants with recent weight loss compared with those without recent weight loss.

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