The Korean Journal of Gastroenterology (대한소화기학회지)

The Korean Society of Gastroenterology (대한소화기학회)
권호 표지

The Relationship between Intake of Vegetables and Fruits and Colorectal Adenoma-Carcinoma Sequence

대장 선종-암화 단계별 과정과 채소 및 과일 섭취와의 관련성

Lee, Se-Young;Choi, Kyu-Yong;Kim, Mi-Kyung;Kim, Kyoung-Mee;Lee, Jin-Hee;Meng, Kwang-Ho;Lee, Won-Chul
이세영;최규용;김미경;김경미;이진희;맹광호;이원철

  • Published : 20050100
⟨ Previous Next ⟩

Abstract

Background/Aims: Evidence for the effect of dietary factors on colorectal carcinogenesis is yet inconsistent. Few studies have been conducted to investigate whether dietary factors were associated with the developement of colorectal adenoma-carcinoma sequence in Korea. We evaluated the relationship between the intake of vegetables and fruits and the degree of dysplasia of the colorectal adenoma and cancer. Methods: For this study, 539 cases with histopathologically confirmed incidental colorectal adenoma, 162 cases with colorectal cancer and 2,576 controls were collected from Our Lady of Mercy Hospital, The Catholic University of Korea during 1994-1999. Informations on demographic characteristics, life style habits and dietary intake were obtained by interviewed questionnaire before the colonoscopy. Adjusted odds ratio (OR) and 95% confidence interval (CI) were estimated by using polytomous logistic regression model. Results: In female, the high intake of raw green and yellow vegetables were found to be negatively associated with the risk of colorectal cancer (adjusted OR: 0.54, 95% CI=0.32-0.93) and the high intake of persimmon, mandarin and strawberry among fruits were negatively associated with the risk of adenoma with mild dysplasia (adjusted OR: 0.43, 95% CI=0.20-0.94). In male, the high intake of banana, pear, apple and watermelon among fruits were negatively associated with the risk of colorectal cancer (adjusted OR: 0.36, 95% CI=0.16-0.84). Conclusions: These findings suggest that the intake of vegetables and fruits may act differently in developmental steps of colorectal adenoma-carcinoma sequence.

목적: 우리나라의 채소 및 과일 섭취와 이형성으로 분류한 대장선종 및 대장암과의 관련성을 살펴봄으로써 이들 섭취가 대장선종-암화 단계별 과정에 어떻게 영향을 미치는지를 규명하고자 하였다. 대상 및 방법: 연구 대상은 1994년 7월부터 1995년 6월까지와 1996년 5월부터 1999년 12월까지의 기간 동안 대장내시경을 시행하고 설문지에 응한 4,981명 중에서 대장선종으로 처음 진단받은 539명(남자 298명, 여자 241명)과 대장암으로 처음 진단받은 162명(남자 86명, 여자 76명)을 환자군으로 하고, 대장내시경에서 이상 소견을 보이지 않은 2,576명(남자 899명, 여자 1677명)을 대조군으로 선정하였다. 대장선종-암화 단계별 과정과 채소 및 과일 섭취와의 관련성은 polytomous 로짓모형을 이용하여 분석하였다. 이 모형에서 여러 교란 요인 중 유의한 교란 요인은 적합도 통계량에 근거하여 선택하였다. 결과: 여자에서 채소 및 과일 섭취와 대장선종 이형성 및 암과의 관련성을 살펴보면, 상치, 풋고추, 케일, 쑥갓, 당근 등의 녹황색 야채 섭취의 경우 1분위군에 비해 2분위군에서 대장암 발생 위험이 유의하게 감소하였으며(OR=0.54, 95% CI=0.32-0.93), 삶은 호박의 경우 2분위군에서 교차비가 0.61 (95% CI=0.07-0.38), 3분위군에서 교차비가 0.29 (95% CI=0.10-0.82)로 중증 이형성 선종의 발생 위험이 유의하게 감소하였다. 감, 귤, 딸기의 과일 섭취의 경우 3분위군에서 경도 이형성 선종의 발생 위험에 대한 교차비가 0.43 (95% CI=0.20-0.94)으로 유의하게 감소하였다. 한편, 남자에서 바나나, 배, 사과, 수박, 참외 섭취의 경우 2분위군에서 대장암 발생 위험이 경계역 유의성으로 감소하였으며(OR=0.60, 95% CI=0.35-1.03), 3분위군에서는 유의하게 감소하였다(OR=0.36, 95% CI=0.16-0.84). 결론: 각 채소 및 과일 섭취가 대장선종-암화 단계별 과정에 다양하게 영향을 미치는 것으로 생각한다. 또한 이로 인해 보다 적극적으로 대장암 발생을 예방할 수있는 지침을 제공할 수 있을 것이다.

Keywords

References

  1. National Statistical Office. Annual Report on the Cause of Death Statistics. 2002
  2. Parkin DM, Whelan SL, Ferlay J, Raymond L, Young J. Cancer incidence in five continents. 8th ed. Lyon: IARC, 2003
  3. Potter JD. Nutrition and colorectal cancer. Cancer Causes Control 1996;7:127-146 https://doi.org/10.1007/BF00115644
  4. Willett WC, Stampfer MJ, Colditz GA, Rosner BA, Speizer FE. Relation of meat, fat and fiber intake to the risk of colon cancer in a prospective study among women. N Engl J Med 1990;323:1644-1672
  5. Kim MK, Lee WC, Choi KY, et al. Case-control study on dietary factors of colorectal adenomatous polyps by sites. Korean J Epidemiol 1998;20:154-166
  6. Spratt JS Jr, Ackerman LV. Small primary adenocarcinoma of the colon and rectum. JAMA 1962;179:337-346 https://doi.org/10.1001/jama.1962.03050050027005
  7. Shamsuddin AM, Kato Y, Kunishima N, Sugano H, Trump BF. Carcinoma in situ in nonpolypoid mucosa of the large intestine. Cancer 1985;56:2849-2854 https://doi.org/10.1002/1097-0142(19851215)56:12<2849::AID-CNCR2820561222>3.0.CO;2-5
  8. Hill MJ, Morson BC, Bussey HJ. Aetiology of adenoma-carcinoma sequence in large bowel. Lancet 1978;1:245-247
  9. Day DW. The adenoma-carcinoma sequence. Scand J Gastroenterol 1984;104(suppl):99S-107S
  10. Jackman RJ, Mayo CW. The adenoma-carcinoma seqeunce in cancer of the colon. Surg Gynecol Obstet 1951;93:327-330
  11. Vogelstein B, Fearon ER, Hamilton SR, et al. Genetic alterations during colorectal tumor development. N Engl J Med 1988;319:525-532 https://doi.org/10.1056/NEJM198809013190901
  12. Correa P, Strong JP, Reif A, Johnson WD. The epidemiology of colorectal polyps: prevalence in New Orleans and international comparison. Cancer 1977;39:2258-2264 https://doi.org/10.1002/1097-0142(197705)39:5<2258::AID-CNCR2820390545>3.0.CO;2-S
  13. Sandler RS, Lyles CM, Mcauliffe C, Woosley JT, Kupper LL. Cigarette smoking, alcohol, and the risk of colorectal adenomas. Gastroenterology 1993;104:1445-1451
  14. Breuer-Katschinski B, Nemes K, Marr A, et al. Colorectal adenoma study group. Alcohol and cigarette smoking and the risk of colorectal adenomas. Dig Dis Sci 2000;45:487-493 https://doi.org/10.1023/A:1005432804902
  15. Steinmetz KA, Potter JD. Vegetables, fruit, and cancer. II. Mechanisms. Cancer Causes Control 1991;2:427-442 https://doi.org/10.1007/BF00054304
  16. Hennekens CH, Mayrent SL, Willet W. Vitamin A, carotenoids and retionoids. Cancer 1986;58:1837-1841 https://doi.org/10.1002/1097-0142(19861015)58:8+<1837::AID-CNCR2820581409>3.0.CO;2-X
  17. Ziegler RG. A review of epidemiologic evidence that carotenoids reduce the risk of cancer. J Nutr 1989;119:116-122 https://doi.org/10.1093/jn/119.1.116
  18. Hoff G, Moen IE, Trygg K, et al. Epidomiology of polyps in the rectum and sigmoid colon. Evaluation of nutritional factors. Scand J Gastroenterol 1986;21:199-204
  19. Macquart-Moulin G, Riboli E, Cornee J, Kaaks R, Berthezene P. Colorectal polyps and diet: a case-control study in Marseilles. Int J Cancer 1987;40:179-188 https://doi.org/10.1002/ijc.2910400209
  20. Sandler RS, Lyles CM, Peipins LA, McAuliffe CA, Woosley JT, Kupper LL. Diet and risk of colorectal adenomas: macronutrients, cholesterol, and fiber. J Natl Cancer Inst 1993;85:884-891 https://doi.org/10.1093/jnci/85.11.884
  21. Kato I, Tominaga S, Matsuura A, Yoshii Y, Shirai M, Kobayashi S. A comparative case-control study of colorectal cancer and adenoma. Jpn J Cancer Res 1990;81:1101-1108 https://doi.org/10.1111/j.1349-7006.1990.tb02520.x
  22. Benito E, Cabeza E, Moreno V, Obrador A, Bosch FX. Diet and colorectal adenomas: a case-control study in Majorca. Int J Cancer 1993;55:213-219 https://doi.org/10.1002/ijc.2910550208
  23. Witte JS, Longnecker MP, Bird CL. Relation of vegetable, fruit, and grain consumption to colorectal adenomatous polyps. Am J Epidemiol 1996;144:1015-1025 https://doi.org/10.1093/oxfordjournals.aje.a008872
  24. Michels KB, Giovannucci E, Joshipura KJ, et al. Prospective study of fruit and vegetable consumption and colon cancer risk in men and women. J Natl Cancer Inst 2000;92:1740-1752 https://doi.org/10.1093/jnci/92.21.1740
  25. Giovannucci E, Stampfer MJ, Colditz G, Rimm EB, Willett WC. Relationship of diet to risk of colorectal adenoma in men. J Natl Cancer Inst 1992;84:91-98 https://doi.org/10.1093/jnci/84.2.91
  26. Smith-Warner SA, Elmer PJ, Fosdick L, et al. Fruits, vegetables and adenomatous polyps: the Minnesota Cancer Prevention Research Unit case-control study. Am J Epidemiol 2002;155:1104-1113 https://doi.org/10.1093/aje/155.12.1104
  27. Franceschi S, Parpinel M, La Vecchia C, Favero A, Talamini R, Negri E. Role of different types of vegetables and fruit in the prevention of cancer of the colon, rectum, and breast. Epidemiology 1998;9:338-341 https://doi.org/10.1097/00001648-199805000-00020
  28. Voorrips LE, Goldbohm RA, Van Poppel G, Sturmans F, Hermus RJ, van den Brandt PA. Vegetable and fruit consumption and risks of colon and rectal cancer in a prospective cohort study: The Netherlands Cohort Study on Diet and Cancer. Am J Epidemiol 2000;152:1081-1092 https://doi.org/10.1093/aje/152.11.1081
  29. Trock BJ, Lanza E, Greenwald P. High fiber diet and colon cancer: a critical review. Prog Clin Biol Res 1990;346:145-157
  30. Thun MJ, Calle EE, Namboodiri MM, et al. Risk factors for fatal colon cancer in a large prospective study. J Natl Cancer Inst 1992;84:1491-1500 https://doi.org/10.1093/jnci/84.19.1491
  31. Shibata A, Paganini-Hill A, Ross RK, Henderson BE. Intake of vegetables, fruits, beta-carotene, vitamin C and vitamin supplements and cancer incidence among the elderly: a prospective study. Br J Cancer 1992;66:673-679 https://doi.org/10.1038/bjc.1992.336
  32. Steinmetz KA, Kushi LH, Bostick RM, Folsom AR, Potter JD. Vegetables, fruit and colon cancer in the lowa Women's Health Study. Am J Epidemiol 1994;139:1-15 https://doi.org/10.1093/oxfordjournals.aje.a116921
  33. Willett WC. Diet and cancer: one view at the start of the millennuim. Cancer Epidemiol Biomarkers Prev 2001;10:3-8
  34. Hill MH. Female sex hormones and colorectal cancer. Eur J Cacner Prev 1998;7:425-426 https://doi.org/10.1097/00008469-199812000-00001
  35. McMichael AJ, Potter JD. Reproduction, endogenous and exogenous sex hormones and colon cancer: a review and hypothesis. J Natl Cancer Inst 1980;65:1201-1207
  36. Lampe JW, Fredstrom SB, Slavin JL, et al. Sex differences in colonic function: a randomised trial. Gut 1993;34:531-536 https://doi.org/10.1136/gut.34.4.531
  37. McMichael AJ, Potter JD. Do intrinsic sex differences in lower alimentary tract physiology influence the sex-specific risks of bowel cancer and other biliary and intestinal diseases? Am J Epidemiol 1983;118:620-627
  38. Davies GJ, Crowder M, Reid B, et al. Bowel function measurements of individuals with different eating patterns. Gut 1986;27:164-169 https://doi.org/10.1136/gut.27.2.164
  39. Gordis L. Epidemiology. 2nd ed. Philadelphia: W.B. Saunders Company, 2000
  40. Giovannucci E, Rimm EB, Stampfer MJ, Colditz GA, Ascherio A, Willett WC. Intake of fat, meat, and fiber in relation to risk of colon cancer in men. Cancer Res 1994;54:2390-2397
  41. Todoroki I, Kono S, Shinchi K, et al. Relationship of cigarette smoking, alcohol use, and dietary habits with sigmoid colon adenomas. Ann Epidemiol 1995;5:478-483 https://doi.org/10.1016/1047-2797(95)00064-X
  42. The Korean society of pathology. Pathology. 4th ed. Seoul: Komoonsa, 2000
  43. Muto T, Nagawa H, Watanabe T, Masaki T, Sawada T. Colorectal carcinogenesis. Dis Colon Rectum 1997;40(suppl):80S-85S https://doi.org/10.1007/BF02062026