维生素B族摄入量和结直肠癌风险的相关性
The Correlation between Vitamin B Intake and Colorectal Cancer Risk
DOI: 10.12677/acm.2025.153614, PDF,   
作者: 陈 果*, 唐云昊#：重庆医科大学第二附属医院胃肠外科，重庆
关键词: B族Vit；CRC；癌症预防；流行病学；炎症；B-Vitamin； CRC； Cancer Prevention； Epidemiology； Inflammation
摘要: 目的：本研究基于前列腺癌、肺癌、CRC和卵巢癌筛查试验(PLCO)的数据，探讨了维生素(Vit) B族亚型(VitB2、B3、B6、B9和B12)摄入量与结直肠癌(CRC)及其不同亚部位发病风险之间的关系。方法：研究纳入98,400名年龄在55至74岁之间的男性和女性，使用Cox回归模型评估了Vit摄入量与CRC发病率之间的关联。结果：研究发现，维生素B族亚型摄入量与CRC发病率显著负相关，且作用在不同亚部位表现出差异性。例如，VitB2和VitB6对直肠癌的保护作用显著，VitB9和VitB12则显著降低近端结肠癌的风险。此外，研究还揭示了BMI对Vit保护作用的调节效应，VitB6对BMI较低人群具有更强的保护作用，而VitB9在BMI较高人群中的保护作用更加显著。不吸烟人群中VitB9的保护作用也得到了进一步确认。补充剂来源的VitB9和VitB12与CRC风险显著负相关，而饮食来源的VitB2、B3和B6未表现出显著影响。结论：研究发现支持了VitB族在CRC预防中的潜在作用，并强调了个性化营养干预的重要性，并为CRC的预防策略和健康政策提供了重要依据。
Abstract: Objective: This study, based on data from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO), explored the relationship between the intake of B-vitamin subtypes (VitB2, B3, B6, B9, and B12) and the risk of colorectal cancer (CRC) and its various subsite incidences. Methods: The study included 98,400 men and women aged 55 to 74. Cox regression models were used to assess the association between vitamin intake and CRC incidence. Results: The study found a significant negative correlation between B-vitamin intake and CRC incidence, with varying effects across different subsites. For instance, VitB2 and VitB6 were significantly protective against rectal cancer, while VitB9 and VitB12 were significantly associated with reduced risk of proximal colon cancer. Additionally, the study revealed a moderating effect of BMI on the protective role of vitamins. VitB6 showed stronger protective effects in individuals with lower BMI, while VitB9 exhibited a more pronounced protective effect in those with higher BMI. The protective effect of VitB9 in non-smokers has also been further confirmed. Supplement-derived VitB9 and VitB12 were significantly negatively associated with CRC risk, while dietary VitB2, B3, and B6 showed no significant effects. Conclusion: The study supports the potential role of B-vitamins in CRC prevention, emphasizing the importance of personalized nutritional interventions. It provides crucial evidence for CRC prevention strategies and health policies.
文章引用：陈果, 唐云昊. 维生素B族摄入量和结直肠癌风险的相关性[J]. 临床医学进展, 2025, 15(3): 276-293. https://doi.org/10.12677/acm.2025.153614

参考文献

[1] Siegel, R.L., Giaquinto, A.N. and Jemal, A. (2024) Cancer Statistics, 2024. CA: A Cancer Journal for Clinicians, 74, 12-49. [Google Scholar] [CrossRef] [PubMed]
[2] Vernia, F., Longo, S., Stefanelli, G., Viscido, A. and Latella, G. (2021) Dietary Factors Modulating Colorectal Carcinogenesis. Nutrients, 13, Article 143. [Google Scholar] [CrossRef] [PubMed]
[3] Chan, A.T. and Giovannucci, E.L. (2010) Primary Prevention of Colorectal Cancer. Gastroenterology, 138, 2029-2043.e10. [Google Scholar] [CrossRef] [PubMed]
[4] Murphy, M.M. and Guéant, J.L. (2020) B Vitamins and One Carbon Metabolism Micronutrients in Health and Disease. Biochimie, 173, 1-2. [Google Scholar] [CrossRef] [PubMed]
[5] Lyon, P., Strippoli, V., Fang, B. and Cimmino, L. (2020) B Vitamins and One-Carbon Metabolism: Implications in Human Health and Disease. Nutrients, 12, Article 2867. [Google Scholar] [CrossRef] [PubMed]
[6] Martínez, M.E., Giovannucci, E., Jiang, R., Henning, S.M., Jacobs, E.T. (2000) Thompson, P., Smith-Warner, S.A. and Alberts, D.S. (2006) Folate Fortification, Plasma Folate, Homocysteine and Colorectal Adenoma Recurrence. International Journal of Cancer, 119, 1440-1446. [Google Scholar] [CrossRef] [PubMed]
[7] Sanjoaquin, M.A., Allen, N., Couto, E., Roddam, A.W. and Key, T.J. (2005) Folate Intake and Colorectal Cancer Risk: A Meta-Analytical Approach. International Journal of Cancer, 113, 825-828. [Google Scholar] [CrossRef] [PubMed]
[8] Van Guelpen, B., Hultdin, J., Johansson, I., Hallmans, G., Stenling, R., Riboli, E., Winkvist, A. and Palmqvist, R. (2006) Low Folate Levels May Protect Against Colorectal Cancer. Gut, 55, 1387-1389. [Google Scholar] [CrossRef] [PubMed]
[9] Gohagan, J.K., Prorok, P.C., Hayes, R.B., Kramer, B.-S. The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial of the National Cancer Institute: History, Organization, and Status. Controlled Clinical Trials, 21, 251S-272S. [Google Scholar] [CrossRef] 
[10] Prorok, P.C., Andriole, G.L., Bresalier, R.S., Buys, S.S., Chia, D., Crawford, E.D., Fogel, R., Gelmann, E.P., Gilbert, F., Hasson, M.A., Hayes, R.B., Johnson, C.C., Mandel, J.S., Oberman, A., O’Brien, B., Oken, M.M., Rafla, S., Reding, D., Rutt, W., Weissfeld, J.L., et al. (2000) Design of the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial. Controlled Clinical Trials, 21, 273S-309S. [Google Scholar] [CrossRef] 
[11] Zhu, C.S., Pinsky, P.F., Kramer, B.S., Prorok, P.C., Purdue, M.P., Berg, C.D. and Gohagan, J.K. (2013) The Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial and Its Associated Research Resource. Journal of the National Cancer Institute, 105, 1684-1693. [Google Scholar] [CrossRef] [PubMed]
[12] Click, B., Pinsky, P.F., Hickey, T., Doroudi, M. and Schoen, R.E. (2018) Association of Colonoscopy Adenoma Findings with Long-Term Colorectal Cancer Incidence. JAMA, 319, 2021-2031. [Google Scholar] [CrossRef] [PubMed]
[13] Laiyemo, A.O., Doubeni, C., Pinsky, P.F., Doria-Rose, V.P., Bresalier, R., Hickey, T., Riley, T., Church, T.R., Weissfeld, J., Schoen, R.E., Marcus, P.M. and Prorok, P.C. (2015) Occurrence of Distal Colorectal Neoplasia among Whites and Blacks Following Negative Flexible Sigmoidoscopy: An Analysis of PLCO Trial. Journal of General Internal Medicine, 30, 1447-1453. [Google Scholar] [CrossRef] [PubMed]
[14] Subar, A.F., Thompson, F.E., Kipnis, V., Midthune, D., Hurwitz, P., McNutt, S., McIntosh, A. and Rosenfeld, S. (2001) Comparative Validation of the Block, Willett, and National Cancer Institute Food Frequency Questionnaires: The Eating at America’s Table Study. American Journal of Epidemiology, 154, 1089-1099. [Google Scholar] [CrossRef] [PubMed]
[15] Willett, W.C., Sampson, L., Stampfer, M.J., Rosner, B., Bain, C., Witschi, J., Hennekens, C.H. and Speizer, F.E. (1985) Reproducibility and Validity of a Semiquantitative Food Frequency Questionnaire. American Journal of Epidemiology, 122, 51-65. [Google Scholar] [CrossRef] [PubMed]
[16] Sinharay, S., Stern, H.S. and Russell, D. (2001) The Use of Multiple Imputation for the Analysis of Missing Data. Psychological Methods, 6, 317-329. [Google Scholar] [CrossRef] 
[17] Donders, A.R., van der Heijden, G.J., Stijnen, T. and Moons, K.G. (2006) Review: A Gentle Introduction to Imputation of Missing Values. Journal of Clinical Epidemiology, 59, 1087-1091. [Google Scholar] [CrossRef] [PubMed]
[18] Dekker, E., Tanis, P.J., Vleugels, J.L.A., Kasi, P.M. and Wallace, M.B. (2019) Colorectal Cancer. The Lance, 394, 1467-1480. [Google Scholar] [CrossRef] 
[19] Kuipers, E.J., Grady, W.M., Lieberman, D., Seufferlein, T., Sung, J.J., Boelens, P.G., van de Velde, C.J. and Watanabe, T. (2015) Colorectal Cancer. Nature Reviews Disease Primers, 1, Article No. 15065. [Google Scholar] [CrossRef] [PubMed]
[20] Moazzen, S., Dastgiri, S., Dolatkhah, R., Abdolahi, H.M., Alizadeh, B.Z. and de Bock, G.H. (2020) Folic Acid Supplement Intake and Risk of Colorectal Cancer in Women; A Case Control Study. Annals of Global Health, 86, 23. [Google Scholar] [CrossRef] [PubMed]
[21] Kennedy, D.A., Stern, S.J., Moretti, M., Matok, I., Sarkar, M., Nickel, C. and Koren, G. (2011) Folate Intake and the Risk of Colorectal Cancer: A Systematic Review and Meta-Analysis. Cancer Epidemiology, 35, 2-10. [Google Scholar] [CrossRef] [PubMed]
[22] Kim, Y.I. (2004) Folate, Colorectal Carcinogenesis, and DNA Methylation: Lessons from Animal Studies. Environmental and Molecular Mutagenesis, 44, 10-25. [Google Scholar] [CrossRef] [PubMed]
[23] Choi, S.W. and Mason, J.B. (2000) Folate and Carcinogenesis: An Integrated Scheme. The Journal of Nutrition, 130, 129-132. [Google Scholar] [CrossRef] [PubMed]
[24] Zhang, X.H., Ma, J., Smith-Warner, S.A., Lee, J.E. and Giovannucci, E. (2013) Vitamin B6 and Colorectal Cancer: Current Evidence and Future Directions. World Journal of Gastroenterology, 19, 1005-1010. [Google Scholar] [CrossRef] [PubMed]
[25] Larsson, S.C., Orsini, N. and Wolk, A. (2010) Vitamin B6 and Risk of Colorectal Cancer: A Meta-Analysis of Prospective Studies. JAMA, 303, 1077-1083. [Google Scholar] [CrossRef] [PubMed]
[26] Komatsu, S., Yanaka, N., Matsubara, K. and Kato, N. (2003) Antitumor Effect of Vitamin B6 and Its Mechanisms. Biochimica et Biophysica Acta (BBA)-Proteins and Proteomics, 1647, 127-130. [Google Scholar] [CrossRef] 
[27] Yoon, Y.S., Jung, S., Zhang, X., Ogino, S., Giovannucci, E.L. and Cho, E. (2016) Vitamin B2 Intake and Colorectal Cancer Risk; Results from the Nurses’Health Study and the Health Professionals Follow-Up Study Cohort. International Journal of Cancer, 139, 996-1008. [Google Scholar] [CrossRef] [PubMed]
[28] Shrubsole, M.J., Yang, G., Gao, Y.T., Chow, W.H., Shu, X.O., Cai, Q., Rothman, N., Gao, J., Wagner, C. and Zheng, W. (2009) Dietary B Vitamin and Methionine Intakes and Plasma Folate Are Not Associated with Colorectal Cancer Risk in Chinese Women. Cancer Epidemiology, Biomarkers & Prevention, 18, 1003-1006. [Google Scholar] [CrossRef] 
[29] Fu, Y., Zhu, Z., Huang, Z., He, R., Zhang, Y., Li, Y., Tan, W. and Rong, S. (2023) Association between Vitamin B and Obesity in Middle-Aged and Older Chinese Adults. Nutrients, 15, Article 483. [Google Scholar] [CrossRef] [PubMed]
[30] Ueland, P.M., McCann, A., Midttun, Ø. and Ulvik, A. (2017) Inflammation, Vitamin B6 and Related Pathways. Molecular Aspects of Medicine, 53, 10-27. [Google Scholar] [CrossRef] [PubMed]
[31] Ulloque-Badaracco, J.R., Hernandez-Bustamante, E.A., Alarcon-Braga, E.A., Al-Kassab-Córdova, A., Cabrera-Guzmán, J.C., Herrera-Añazco, P., et al. (2023) Vitamin B12, Folate, and Homocysteine in Metabolic Syndrome: A Systematic Review and Meta-Analysis. Frontiers in Endocrinology, 14, 1221259. [Google Scholar] [CrossRef] [PubMed]
[32] Temova Rakuša, Ž., Roškar, R., Hickey, N. and Geremia, S. (2022) Vitamin B12 in Foods, Food Supplements, and Medicines—A Review of Its Role and Properties with a Focus on Its Stability. Molecules, 28, Article 240. [Google Scholar] [CrossRef] [PubMed]
[33] McNulty, H. and Pentieva, K. (2004) Folate Bioavailability. The Proceedings of the Nutrition Society, 63, 529-536. [Google Scholar] [CrossRef] 

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