天然营养丰富(NNR)评分与结直肠癌死亡风险的相关性
The Association of the Natural Nutrient Rich (NNR) Score with Colorectal Cancer Mortality Risk
摘要: 目的：结直肠癌(CRC)是全球主要癌症死因之一，饮食是可调控的风险因素。天然营养丰富(NNR)评分可量化整体饮食质量。本研究旨在探讨NNR评分与CRC死亡风险的关联。方法：纳入美国PLCO筛查试验中98,415名参与者，通过饮食史问卷收集饮食信息，采用NNR评分评估高营养密度饮食依从性。使用Cox回归和限制性立方样条分析关联及剂量反应关系。结果：平均随访15年，记录到497例CRC死亡。校正潜在混杂因素后，与最低四分位组相比，最高四分位组参与者的CRC死亡风险较低(HR = 0.75；95% CI：0.58~0.97；趋势P = 0.005)。限制性立方样条分析显示线性关联(非线性P = 0.027)。结论：坚持高NNR饮食模式与美国成年人群结直肠癌死亡风险较低存在关联。这一发现为NNR评分在公共卫生领域的推广提供了新的科学依据，同时也提示了饮食干预与结直肠癌结局的关联。
Abstract: Objective: Colorectal cancer (CRC) is one of the leading causes of cancer-related death worldwide, and diet is a modifiable risk factor. The Natural Nutrient Rich (NNR) score quantifies overall diet quality. This study aims to investigate the association between the NNR score and CRC mortality. Methods: A total of 98,415 participants from the US PLCO Screening Trial were included. Dietary information was collected using a Diet History Questionnaire, and adherence to a nutrient‑dense diet was assessed using the NNR score. Cox regression and restricted cubic splines were used to analyze the association and dose‑response relationship. Results: Over a mean follow‑up of 15 years, 497 CRC deaths were recorded. After adjusting for potential confounders, participants in the highest quartile of the NNR score had a significantly lower risk of CRC mortality compared with those in the lowest quartile (HR = 0.75; 95% CI: 0.58~0.97; P‑trend = 0.005). Restricted cubic spline analysis indicated a linear association (P‑nonlinearity = 0.027). Conclusion: Adherence to a high‑NNR dietary pattern is associated with a lower risk of colorectal cancer mortality among the adult population in the United States. This finding provides new scientific evidence for promoting the NNR score in the field of public health and also suggests an association between dietary interventions and colorectal cancer outcomes.
文章引用：黄学文, 王亚旭. 天然营养丰富(NNR)评分与结直肠癌死亡风险的相关性[J]. 临床医学进展, 2026, 16(5): 1430-1443. https://doi.org/10.12677/acm.2026.1651944

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