【作者】 李光琳；

【导师】 马爱国；

【作者基本信息】 青岛大学 ， 营养与食品卫生学， 2010， 博士

【摘要】 研究背景和目的：我国恶性肿瘤死亡率高于全球平均水平,消化系统恶性肿瘤已成为威胁我国城乡居民健康的主要死因。国外大量的研究报道消化道恶性肿瘤与膳食营养和生活方式密切相关,但我国尚缺乏膳食营养摄入情况与消化系统肿瘤相关性的大样本人群流行病学研究分析报道。本论文利用“全国第三次以恶性肿瘤为重点的全死因回顾抽样调查”和2002年“中国居民营养与健康状况调查”(以下分别简称肿瘤死亡调查和营养调查)两项大规模的调查数据资料,了解和分析我国居民食物及营养摄入情况与消化系统肿瘤死亡之间的相关性,为我国政府及相关部门制定措施,有效地预防和控制与膳食营养相关的消化系统恶性肿瘤提供科学依据。研究方法：利用肿瘤死亡调查数据资料,考虑地理位置相邻或相近、经济水平相当、生活习惯相似、人口构成相近等因素,在肿瘤死亡全国调查点中选取与营养调查点相匹配的32个县/区调查点,采用单因素和多元回归方法统计分析食物及营养素摄入量与消化系统肿瘤死亡情况的相关性。营养调查内容和方法包括：2002年居民食物摄入种类及数量,各种营养素摄入水平,采用食物频率法、24小时3天回忆法和称量记账法收集相关资料,食物和营养素摄入量以标准人日作为单位,不同年龄、性别、生理状况以及劳动强度均按一定比例换算为轻体力劳动成年男子,便于统计分析和比较。肿瘤死亡调查内容和方法包括：调查地区2004-2005年户籍人口中全部死者的死亡原因及相关信息,如死亡原因、死亡日期、地点、疾病诊断依据和疾病最高诊断单位等内容以及人口资料及社会经济等信息,确定死亡名单后,调查死亡原因,对已有《死亡医学证明书》的开展质量验证调查。结果：32个肿瘤死亡调查点居民每标准人日谷类、畜禽肉类、油脂摄入量均达到中国居民平衡膳食宝塔的推荐摄入量,盐的摄入量超过推荐量的88%；蔬菜类、水果类、鱼虾类、奶及奶制品、大豆及坚果的摄入量低于宝塔推荐量,奶类摄入量仅为推荐量的25.6%。调查点居民每标准人日膳食纤维摄入量每天为12g,仅为推荐量(每天30g)的39.3%，摄入严重不足；矿物质钙、镁、锌以及维生素A、核黄素摄入量较低；而铁、钠、维生素E的摄入量偏高,分别达到162.7%、285.9%和370%，营养素的摄入量也分别达到推荐摄入量或适宜摄入量。消化系统肿瘤死亡率分析结果显示肝癌、胃癌、食管癌、结直肠癌、胰腺癌在恶性肿瘤中占55.10%，其中我国肝癌、胃癌和食管癌前三种肿瘤的死亡率高于发达国家和发展中国家平均水平。肿瘤死亡与食物营养素摄入相关性分析结果显示食管癌的死亡率与硒、维生素A、奶、植物油的摄入量呈负相关,与动物油脂、酱类的摄入量呈正相关；胃癌死亡率与维生素A的摄入量呈负相关；结直肠癌的死亡率则与糕点类、猪肉、禽肉等的摄入量呈正相关；胆囊癌女性死亡率与糕点类、禽肉等的摄入量呈正相关；肝癌的死亡率与膳食纤维等的摄入量呈负相关,与腌菜的摄入量呈正相关；胰腺癌的死亡率与维生素C摄入量呈负相关。结论：本文32个调查点居民膳食结构可能存在不合理和某些营养素的摄入量不平衡,主要消化系统肿瘤死亡率较高,成为构成肿瘤死亡的主要死因。部分消化系统肿瘤死亡率与膳食纤维、硒、维生素A的摄入量呈负相关,具有一定的保护作用。本文分析的主要消化系统肿瘤死亡与各种食物或营养素间所表现出的正相关和负相关关系,可能与以往的研究报道不尽相同,有待深入研究。更多还原

【Abstract】 Background and objectives:Cancer was the second leading cause of death in China, and the mortality has been higher than the level of in the world. Cancers from upper digestive organ, such as oesophagus cancer, gastric carcinoma, liver cancer were very common in China and becoming a major public health problem. However, there are few of studies about the relationship between causes of cancer death and intakes of foods and nutrients in China. The objective of our study is to understand the correlation using the data from both National Death Survey in 2004-2005 and National Nutrition Survey in 2002 in China.Methods:The death database from the third national death survey in 2004-2005 were retrieved,32 areas of which were selected and matched with 32 sites from national nutrition survey in 2002 in geographical distribution, socio-economic levels, etc. The nutrition survey was done by combining weighing and recording methods to collect household foods consumption data for three days, and food intake data of individual members of the household was collected using "24 hour recall" method for consecutive days. The cancer cases identified as cancer deaths in the respective areas from all hospitals, community health centers, death registries and the Civil Administration Bureau, which holds cremation records. Population information was obtained from official registration records and the average intakes of nutrients were expressed as daily intake of an male adult with light physical activity. Linear regression and multiple regression models were applied to examine the association between mortality rates and the average intakes of foods and nutrients. Analyses were performed using the multiple linear regression model with SAS version 9.1(SAS institute,Cary,NC,USA)Result:The analysis of daily average food consumption in 32 sites showed that intakes of cereals, meats and oil reached recommedation daily amount (RDA), and salt intake was 88% over its RDA; while vegitables, fruit, fish or shrump, milk, soybean or its products were less, and milk intake was 25.6% of its RDA. Nutrient intakes were evaluated. Average intake of dietary fiber was 12g/day,39.3% of its adequate intake (AI), and intakes of retinol, zinc, riboflavin, and calsium and magnesium were less than those of their recommendation nutrient intake (RNI) and AI. The intakes of iron and tochopherol were 162.7% and 370% of their RNI and AI. Correlative analysis showed that the intakes of selenium, vitamin A and milk had a negetive correlation with the mortality of esophageal carcinoma (p<0.05); the intakes of vitamin A had a negetive correlation with the mortality of gastric cancer (p<0.05). However, there was a strong positive correlation between the intakes of pork, chicken and dessert and cancer of colon (p<0.05), and a positive correlation was also found between gallbladder cancer and the intakes of dessert and chicken. Liver cancer had a negetive correlation with the intake of dietary fiber (p=0.018) and a positive one with the amount of pickles one took in (p=0.01). When it came to pancreatic cancer, with which vitamin C had a negetive correlation (p=0.047).Conclusion:A significant negative correlation between the mortality of digestive cancer and the intakes of dietary fiber, selenium and vitamin A was found, which means these nutrients may protect human from cancer; while the intake of foods as pork, dessert, etc. might probably increase the risk of developing digestive tumors. However, some of the results in our study inconsistent with other reports were expected to be examined by more researches in the future.更多还原