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Article(id=1241102815578353782, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241102813938380911, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202403524, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1711555200000, receivedDateStr=2024-03-28, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773831569809, onlineDateStr=2026-03-18, pubDate=1724515200000, pubDateStr=2024-08-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773831569809, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773831569809, creator=13701087609, updateTime=1773831569809, updator=13701087609, issue=Issue{id=1241102813938380911, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='16', pageStart='2881', pageEnd='3072', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773831569418, creator=13701087609, updateTime=1773831807198, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241103811318706322, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241102813938380911, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241103811318706323, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241102813938380911, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=3022, endPage=3028, ext={EN=ArticleExt(id=1241102815926481020, articleId=1241102815578353782, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Analysis of the association between anthropometric indicators and gastric cancer and precancerouslesions in residents aged 40-69 years, Yangzhong City, columnId=1228016573156360233, journalTitle=Modern Preventive Medicine, columnName=Disease Control and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the association of 11 anthropometric indicators (AIs) with gastric cancer and precancerous lesions in people aged 40-69 years in Yangzhong City.

Methods

Using the cluster sampling method, 10 698 residents aged 40-69 years who participated in upper gastrointestinal cancer screening in Yangzhong City from November 2017 to December 2022 were selected for questionnaire survey, physical examination, endoscopy and pathological diagnosis. Multivariate logistic regression was used to analyze the association between AIs [body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), body fat percentage (BF%), conicity index (CI), body adiposity estimator (BAE), a body shape index (ABSI), body adiposity index (BAI), body roundness index (BRI) and abdominal volumetric index (AVI)] and gastric cancer and precancerous lesions.

Results

The prevalence of gastric cancer and precancerous lesions was 39.37% among 10 115 residents. The results of multivariate logistic regression showed that compared with those in quartile 1 (Q1), the Q3 and Q4 populations of BMI had an 11.1% (OR=0.889, 0.791-0.999) and 12.4% (OR=0.876, 0.779-0.984) lower risk of gastric cancer and precancerous lesions, respectively. The Q2, Q3 and Q4 populations of BF% had 14.2% (OR=0.858, 0.756-0.974), 17.4% (OR=0.826, 0.689-0.991) and 26.6% (OR=0.734, 0.603-0.893) lower risk of gastric cancer and precancerous lesions risk, respectively. The Q2 and Q4 populations of the BAE had reduced the risk of gastric cancer and precancerous lesions by 13.2% (OR=0.868, 0.766-0.983) and 21.3% (OR=0.787, 0.648-0.957). The risk of gastric cancer and precancerous lesions in BAI’s Q2 and Q3 populations was reduced by 13.7% (OR=0.863, 0.767-0.970) and 13.1% (OR=0.869, 0.769-0.983), respectively. Stratified analysis showed that BMI, BF%, BAE and BAI were associated with a reduced risk of non-cardia gastric cancer and precancerous lesions (all P<0.05). However, only the Q2 level of BAE was associated with a reduced risk of cardia gastric cancer and precancerous lesions compared to the Q1 (P<0.05).

Conclusion

Increased levels of BMI, BF%, BAE, and BAI among residents aged 40-69 years in Yangzhong City are associated with a reduced risk of gastric cancer and precancerous lesions. However, most of this association apply to non-cardia but not cardia.

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目的

分析扬中市40~69岁人群11种人体测量指标（AIs）与胃癌及癌前病变的关联。

方法

采用整群抽样方法，选取2017年11月至2022年12月，扬中市10698名参与上消化癌筛查的40~69岁居民进行问卷调查、体格检查、内镜检查及病理学诊断。采用多因素logistics回归分别分析体质量指数（BMI）、腰围（WC）、腰臀比（WHR）、腰高比（WHtR）、体脂百分比（BF%）、锥度指数（CI）、身体肥胖估计量（BAE）、身体形态指数（ABSI）、身体肥胖指数（BAI）、身体圆度指数（BRI）和腹部容积指数（AVI）与胃癌及癌前病变的关联。

结果

10115名调查对象胃癌及癌前病变的患病率为39.37%。多因素logistics回归结果显示，与第1分位数（Q1）相比，BMI的Q3和Q4人群患胃癌及癌前病变风险分别降低11.1%（OR=0.889，0.791~0.999）和12.4%（OR=0.876，0.779~0.984）。BF%的Q2，Q3和Q4人群患胃癌及癌前病变风险分别降低14.2%（OR=0.858，0.756~0.974）、17.4%（OR=0.826，0.689~0.991）和26.6%（OR=0.734，0.603~0.893）。BAE的Q2和Q4人群患胃癌及癌前病变风险分别降低13.2%（OR=0.868，0.766~0.983）和21.3%（OR=0.787，0.648~0.957）。BAI的Q2和Q3人群患胃癌及癌前病变风险分别降低13.7%（OR=0.863，0.767~0.970）和13.1%（OR=0.869，0.769~0.983）。分层分析显示，BMI、BF%、BAE和BAI与非贲门胃癌及癌前病变风险降低有关（均P<0.05）。但与Q1相比，仅BAE的Q2水平与贲门胃癌及癌前病变的风险降低有关（P<0.05）。

结论

扬中市40~69岁人群BMI、BF%、BAE和BAI水平的增加与胃癌及癌前病变患病风险降低相关。这种关联大多适用于非贲门而不是贲门。

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冯祥，E-mail：
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=10V2hOklucg47CucBb8HYw==, magXml=1W0pQ22DlQXphyikrmCJ1g==, pdfUrl=null, pdf=POQPLi2KXuIgyDUvdkec9w==, pdfFileSize=674247, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=wnDVPkQr0YvogQu751oWJA==, mapNumber=null, authorCompany=null, fund=null, authors=

印红军（1974—），男，硕士，副主任医师，研究方向：上消化道疾病防治研究

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印红军（1974—），男，硕士，副主任医师，研究方向：上消化道疾病防治研究

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印红军（1974—），男，硕士，副主任医师，研究方向：上消化道疾病防治研究

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3.扬中市人民医院慢病筛查科
5.东南大学附属中大医院消化科
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Socioeconomic status and obesity:a systematic review on their conception measurements,influencing effects and mechanism[J]. ChineseJournal of Social Medicine, 2022, 39(5): 601-606., articleTitle=Socioeconomic status and obesity:a systematic review on their conception measurements,influencing effects and mechanism, refAbstract=null), Reference(id=1241102829201453599, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102815578353782, doi=null, pmid=null, pmcid=null, year=2020, volume=15, issue=10, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[23], rfOrder=30, authorNames=Sanikini H, Muller DC, Chadeau-Hyam M, journalName=PLOS One, refType=null, unstructuredReference=Sanikini H, Muller DC, Chadeau-Hyam M, et al. Anthropometry, body fat composition and reproductive factors and risk of oesophageal and gastric cancer by subtype and subsite in the UK Biobank cohort[J].PLOS One, 2020, 15(10): e0240413., articleTitle=Anthropometry, body fat composition and reproductive factors and risk of oesophageal and gastric cancer by subtype and subsite in the UK Biobank cohort, refAbstract=null), Reference(id=1241102829297922604, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102815578353782, doi=null, pmid=null, pmcid=null, year=2018, volume=15, issue=11, pageStart=659, pageEnd=670, url=null, language=null, rfNumber=[24], rfOrder=31, authorNames=Murphy N, Jenab M, Gunter MJ, journalName=Nature Reviews. Gastroenterology & Hepatology, refType=null, unstructuredReference=Murphy N, Jenab M, Gunter MJ. Adiposity and gastrointestinal cancers: epidemiology, mechanisms and future directions[J]. Nature Reviews. Gastroenterology & Hepatology, 2018, 15(11): 659-670., articleTitle=Adiposity and gastrointestinal cancers: epidemiology, mechanisms and future directions, refAbstract=null)], funds=[Fund(id=1241102823677554968, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102815578353782, awardId=2016YFC0901400, language=CN, fundingSource=国家重点研发计划(2016YFC0901400), fundOrder=null, country=null), Fund(id=1241102823790801179, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102815578353782, awardId=2016YFC1302800, language=CN, fundingSource=国家重点研发计划(2016YFC1302800), fundOrder=null, country=null), Fund(id=1241102823866298656, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102815578353782, awardId=GTCZ-2021-JS-32-0001, language=CN, fundingSource=中国消化道早癌医师共同成长计划(GTCZ-2021-JS-32-0001), fundOrder=null, country=null), Fund(id=1241102824017293603, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102815578353782, awardId=SH2022051, language=CN, fundingSource=镇江市重点研发计划-社会发展(SH2022051), fundOrder=null, country=null), Fund(id=1241102824101179690, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102815578353782, awardId=Ym2023031, language=CN, fundingSource=2023年江苏省预防医学面上项目(Ym2023031), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241102816484323467, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102815578353782, xref=1., ext=[AuthorCompanyExt(id=1241102816492712076, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102815578353782, companyId=1241102816484323467, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Gastroenterology, Yangzhong People’s Hospital, Yangzhong, Jiangsu 212200, China), AuthorCompanyExt(id=1241102816501100685, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102815578353782, companyId=1241102816484323467, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.扬中市人民医院消化科，江苏 扬中 210009)]), AuthorCompany(id=1241102816584986768, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102815578353782, xref=2., ext=[AuthorCompanyExt(id=1241102816593375377, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102815578353782, companyId=1241102816584986768, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.扬中市人民医院肿瘤防治研究所)]), AuthorCompany(id=1241102816727593110, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102815578353782, xref=3., ext=[AuthorCompanyExt(id=1241102816735981719, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102815578353782, companyId=1241102816727593110, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.扬中市人民医院慢病筛查科)]), AuthorCompany(id=1241102816824062105, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102815578353782, xref=4., ext=[AuthorCompanyExt(id=1241102816828256410, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102815578353782, companyId=1241102816824062105, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=4.扬中市疾病预防控制中心慢性病防制科)]), AuthorCompany(id=1241102816916336798, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102815578353782, xref=5., ext=[AuthorCompanyExt(id=1241102816924725408, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102815578353782, companyId=1241102816916336798, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=5.东南大学附属中大医院消化科)]), AuthorCompany(id=1241102818438869156, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102815578353782, xref=6., ext=[AuthorCompanyExt(id=1241102818447257766, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102815578353782, companyId=1241102818438869156, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=6.东南大学医学院)])], figs=[ArticleFig(id=1241102821433602305, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102815578353782, language=EN, label=Table 1, caption=

Basic characteristics of the study subjects [n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
特征胃癌及癌前病变χ2或Z值P值
合计（n=10 115）否（n=6 133）是（n=3 982）
年龄, M(Q1, Q3)56.00(51.00, 62.00)55.00(50.00,61.00)57.00(52.00,63.00)-14.614<0.001
性别50.122<0.001
男4 411(43.61)2 502(40.80)1 909(47.94)
女5 704(56.39)3 631(59.20)2 073(52.06)
婚姻状况2.4770.116
单身/离异/分居/丧偶643(6.36)3 71(6.05)272(6.83)
已婚9 472(93.64)5 762(93.95)3 710(93.17)
文化程度22.570<0.001
未正规上学835(8.26)468(7.63)367(9.22)
小学2 644(26.14)1 536(25.04)1 108(27.83)
初中4 977(49.20)3 079(50.20)1 898(47.66)
高中及以上1 659(16.40)1 050(17.12)609(15.29)
家庭人口数(人)9.8770.007
1~36 110(60.41)3 647(59.47)2 463(61.85)
4~63 852(38.08)2 379(38.79)1 473(36.99)
≥7153(1.51)107(1.74)46(1.16)
家庭年收入(万元)31.626<0.001
<3874(8.64)466(7.60)408(10.25)
3~<72 792(27.60)1 678(27.36)1 114(27.98)
7~<112 683(26.52)1 606(26.19)1 077(27.05)
≥113 766(37.23)2 383(38.86)1 383(34.73)
吸烟77.417<0.001
从不吸烟7 053(69.73)4 472(72.92)2 581(64.82)
曾经吸烟535(5.29)306(4.99)229(5.75)
当前吸烟2 527(24.98)1 355(22.09)1 172(29.43)
饮酒22.701<0.001
否8 114(80.22)5 013(81.74)3 101(77.88)
是2 001(19.78)1 120(18.26)881(22.12)
饮茶17.539<0.001
否8 250(81.56)5 082(82.86)3 168(79.56)
是1 865(18.44)1 051(17.14)814(20.44)
蔬菜水果是否充分2.5960.107
否9 411(93.04)5 686(92.71)3 725(93.55)
是704(6.96)447(7.29)257(6.45)
腌制品4.4440.035
否4 375(43.25)2 704(44.09)1 671(41.96)
是5 740(56.75)3 429(55.91)2 311(58.04)
饮食不规律4.7030.030
否9 652(95.42)5 830(95.06)3 822(95.98)
是463(4.58)303(4.94)160(4.02)
烫热食物8.2740.004
否8 462(83.66)5 183(84.51)3 279(82.35)
是1 653(16.34)950(15.49)703(17.65)
深度油炸品0.5960.440
否9 846(97.34)5 976(97.44)3 870(97.19)
是269(2.66)157(2.56)112(2.81)
剩菜剩饭0.0460.831
否4 207(41.59)2 556(41.68)1 651(41.46)
是5 908(58.41)3 577(58.32)2 331(58.54)
霉变食物1.0440.307
否10 093(99.78)6 122(99.82)3 971(99.72)
是22(0.22)11(0.18)11(0.28)
进食速度过快1.0440.307
否7 381(72.97)4 453(72.61)2 928(73.53)
是2 734(27.03)1 680(27.39)1 054(26.47)
高盐饮食0.1440.704
否7 803(77.14)4 739(77.27)3 064(76.95)
是2 312(22.86)1 394(22.73)918(23.05)
辣食4.2640.039
否8 791(86.91)5 296(86.35)3 495(87.77)
是1 324(13.09)837(13.65)487(12.23)
体育锻炼0.7850.675
从不6 566(64.91)3 967(64.68)2 599(65.27)
偶尔1 015(10.03)628(10.24)387(9.72)
经常2 534(25.05)1 538(25.08)996(25.01)
癌症家族史3.2260.072
否3 664(36.22)2 264(36.92)1 400(35.16)
是6 451(63.78)3 869(63.08)2 582(64.84)
常见慢性病家族史0.8420.359
否3 641(36.00)2 186(35.64)1 455(36.54)
是6 474(64.00)3 947(64.36)2 527(63.46)
胃部疾病既往史4.2030.040
否9 464(93.56)5 763(93.97)3 701(92.94)
是651(6.44)370(6.03)281(7.06)
食管疾病9.2240.002
否9 459(93.51)5 772(94.11)3 687(92.59)
是656(6.49)361(5.89)295(7.41)
HP感染186.69<0.001
否5 839(57.73)3 872(63.13)1 967(49.40)
是4 276(42.27)2 261(36.87)2 015(50.60)
), ArticleFig(id=1241102822926774531, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102815578353782, language=CN, label=表1, caption=

研究对象的基本特征[n(%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
特征胃癌及癌前病变χ2或Z值P值
合计（n=10 115）否（n=6 133）是（n=3 982）
年龄, M(Q1, Q3)56.00(51.00, 62.00)55.00(50.00,61.00)57.00(52.00,63.00)-14.614<0.001
性别50.122<0.001
男4 411(43.61)2 502(40.80)1 909(47.94)
女5 704(56.39)3 631(59.20)2 073(52.06)
婚姻状况2.4770.116
单身/离异/分居/丧偶643(6.36)3 71(6.05)272(6.83)
已婚9 472(93.64)5 762(93.95)3 710(93.17)
文化程度22.570<0.001
未正规上学835(8.26)468(7.63)367(9.22)
小学2 644(26.14)1 536(25.04)1 108(27.83)
初中4 977(49.20)3 079(50.20)1 898(47.66)
高中及以上1 659(16.40)1 050(17.12)609(15.29)
家庭人口数(人)9.8770.007
1~36 110(60.41)3 647(59.47)2 463(61.85)
4~63 852(38.08)2 379(38.79)1 473(36.99)
≥7153(1.51)107(1.74)46(1.16)
家庭年收入(万元)31.626<0.001
<3874(8.64)466(7.60)408(10.25)
3~<72 792(27.60)1 678(27.36)1 114(27.98)
7~<112 683(26.52)1 606(26.19)1 077(27.05)
≥113 766(37.23)2 383(38.86)1 383(34.73)
吸烟77.417<0.001
从不吸烟7 053(69.73)4 472(72.92)2 581(64.82)
曾经吸烟535(5.29)306(4.99)229(5.75)
当前吸烟2 527(24.98)1 355(22.09)1 172(29.43)
饮酒22.701<0.001
否8 114(80.22)5 013(81.74)3 101(77.88)
是2 001(19.78)1 120(18.26)881(22.12)
饮茶17.539<0.001
否8 250(81.56)5 082(82.86)3 168(79.56)
是1 865(18.44)1 051(17.14)814(20.44)
蔬菜水果是否充分2.5960.107
否9 411(93.04)5 686(92.71)3 725(93.55)
是704(6.96)447(7.29)257(6.45)
腌制品4.4440.035
否4 375(43.25)2 704(44.09)1 671(41.96)
是5 740(56.75)3 429(55.91)2 311(58.04)
饮食不规律4.7030.030
否9 652(95.42)5 830(95.06)3 822(95.98)
是463(4.58)303(4.94)160(4.02)
烫热食物8.2740.004
否8 462(83.66)5 183(84.51)3 279(82.35)
是1 653(16.34)950(15.49)703(17.65)
深度油炸品0.5960.440
否9 846(97.34)5 976(97.44)3 870(97.19)
是269(2.66)157(2.56)112(2.81)
剩菜剩饭0.0460.831
否4 207(41.59)2 556(41.68)1 651(41.46)
是5 908(58.41)3 577(58.32)2 331(58.54)
霉变食物1.0440.307
否10 093(99.78)6 122(99.82)3 971(99.72)
是22(0.22)11(0.18)11(0.28)
进食速度过快1.0440.307
否7 381(72.97)4 453(72.61)2 928(73.53)
是2 734(27.03)1 680(27.39)1 054(26.47)
高盐饮食0.1440.704
否7 803(77.14)4 739(77.27)3 064(76.95)
是2 312(22.86)1 394(22.73)918(23.05)
辣食4.2640.039
否8 791(86.91)5 296(86.35)3 495(87.77)
是1 324(13.09)837(13.65)487(12.23)
体育锻炼0.7850.675
从不6 566(64.91)3 967(64.68)2 599(65.27)
偶尔1 015(10.03)628(10.24)387(9.72)
经常2 534(25.05)1 538(25.08)996(25.01)
癌症家族史3.2260.072
否3 664(36.22)2 264(36.92)1 400(35.16)
是6 451(63.78)3 869(63.08)2 582(64.84)
常见慢性病家族史0.8420.359
否3 641(36.00)2 186(35.64)1 455(36.54)
是6 474(64.00)3 947(64.36)2 527(63.46)
胃部疾病既往史4.2030.040
否9 464(93.56)5 763(93.97)3 701(92.94)
是651(6.44)370(6.03)281(7.06)
食管疾病9.2240.002
否9 459(93.51)5 772(94.11)3 687(92.59)
是656(6.49)361(5.89)295(7.41)
HP感染186.69<0.001
否5 839(57.73)3 872(63.13)1 967(49.40)
是4 276(42.27)2 261(36.87)2 015(50.60)
), ArticleFig(id=1241102823031632134, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102815578353782, language=EN, label=Table 2, caption=

Distribution characteristics of anthropometric indicators of the study subjects [M (Q1, Q3)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量胃癌及癌前病变Z值P值
合计否是
BH162.00(156.00,168.00)161.50(156.00,168.00)162.00(156.00,168.93)-1.1450.252
BW63.20(56.60,70.60)63.40(56.70,71.00)63.00(56.40,70.20)-2.0410.041
HC90.00(86.00,95.00)90.00(86.00,95.00)90.00(85.00,94.00)-4.953<0.001
BMI24.17(22.16,26.16)24.28(22.22,26.26)23.99(22.04,26.03)-3.735<0.001
WC83.00(77.00,89.00)83.00(77.00,89.00)83.00(77.00,89.00)-0.3200.749
WHR0.92(0.87,0.98)0.92(0.87,0.97)0.92(0.88,0.98)-4.805<0.001
WHtR0.51(0.48,0.55)0.51(0.48,0.55)0.51(0.48,0.55)-0.0050.996
BF%32.43(26.81,36.85)32.76(27.16,36.96)31.81(26.32,36.67)-4.320<0.001
CI1.22(1.17,1.27)1.22(1.16,1.26)1.22(1.17,1.27)-3.527<0.001
BAE32.04(25.66,36.93)32.52(26.18,37.13)31.19(25.04,36.66)-5.916<0.001
ABSI0.08(0.07,0.08)0.08(0.07,0.08)0.08(0.08,0.08)-4.683<0.001
BAI25.56(23.05,28.34)25.72(23.29,28.45)25.32(22.63,28.12)-5.084<0.001
BRI3.60(2.97,4.28)3.60(2.97,4.29)3.59(2.98,4.28)-0.0050.996
AVI13.82(12.00,15.87)13.82(11.98,15.87)13.81(12.14,15.86)-0.1290.897
), ArticleFig(id=1241102823144878344, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102815578353782, language=CN, label=表2, caption=

研究对象人体测量指标分布特征[M (Q1, Q3)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量胃癌及癌前病变Z值P值
合计否是
BH162.00(156.00,168.00)161.50(156.00,168.00)162.00(156.00,168.93)-1.1450.252
BW63.20(56.60,70.60)63.40(56.70,71.00)63.00(56.40,70.20)-2.0410.041
HC90.00(86.00,95.00)90.00(86.00,95.00)90.00(85.00,94.00)-4.953<0.001
BMI24.17(22.16,26.16)24.28(22.22,26.26)23.99(22.04,26.03)-3.735<0.001
WC83.00(77.00,89.00)83.00(77.00,89.00)83.00(77.00,89.00)-0.3200.749
WHR0.92(0.87,0.98)0.92(0.87,0.97)0.92(0.88,0.98)-4.805<0.001
WHtR0.51(0.48,0.55)0.51(0.48,0.55)0.51(0.48,0.55)-0.0050.996
BF%32.43(26.81,36.85)32.76(27.16,36.96)31.81(26.32,36.67)-4.320<0.001
CI1.22(1.17,1.27)1.22(1.16,1.26)1.22(1.17,1.27)-3.527<0.001
BAE32.04(25.66,36.93)32.52(26.18,37.13)31.19(25.04,36.66)-5.916<0.001
ABSI0.08(0.07,0.08)0.08(0.07,0.08)0.08(0.08,0.08)-4.683<0.001
BAI25.56(23.05,28.34)25.72(23.29,28.45)25.32(22.63,28.12)-5.084<0.001
BRI3.60(2.97,4.28)3.60(2.97,4.29)3.59(2.98,4.28)-0.0050.996
AVI13.82(12.00,15.87)13.82(11.98,15.87)13.81(12.14,15.86)-0.1290.897
), ArticleFig(id=1241102823224570123, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102815578353782, language=EN, label=Table 3, caption=

Multivariate logistic regression analysis of the association of anthropometric indicators with gastric cancer and precancerous lesions

, figureFileSmall=null, figureFileBig=null, tableContent=
变量胃癌及癌前病变Wald χ2P值OR(95%CI)
否是
BMI
Q1(<22.16)1 4871 0411.000
Q2(22.16~<24.17)1 4881 0410.3050.5811.033(0.920~1.159)
Q3(24.17~<26.16)1 5649653.9240.0480.889(0.791~0.999)
Q4(≥26.16)1 5949354.9400.0260.876(0.779~0.984)
WC
Q1(<77.00)1 3898601.000
Q2(77.00~<83.00)1 5211 0370.5740.4491.047(0.929~1.180)
Q3(83.00~<89.00)1 5731 0141.1630.2810.936(0.829~1.056)
Q4(≥89.00)1 6501 0712.8190.0930.901(0.797~1.018)
WHR
Q1(<0.87)1 6318801.000
Q2(0.87~<0.92)1 5281 0121.1230.2891.066(0.947~1.201)
Q3(0.92~<0.98)1 4791 0560.7590.3841.056(0.935~1.192)
Q4(≥0.98)1 4951 0340.3050.5810.966(0.853~1.093)
WHtR
Q1(<0.48)1 5279781.000
Q2(0.48~<0.51)1 5281 0130.0040.9501.004(0.894~1.128)
Q3(0.51~<0.55)1 5321 0000.4650.4950.960(0.854~1.079)
Q4(≥0.55)1 5469912.3910.1220.911(0.810~1.025)
BF%
Q1(<26.81)1 4321 0971.000
Q2(26.81~<32.43)1 5281 0005.6000.0180.858(0.756~0.974)
Q3(32.43~<36.85)1 5939354.2540.0390.826(0.689~0.991)
Q4(≥36.85)1 5809509.5040.0020.734(0.603~0.893)
CI
Q1(<1.17)1 6029261.000
Q2(1.17~<1.22)1 5261 0030.8740.3501.057(0.941~1.189)
Q3(1.22~<1.27)1 5319980.1720.6780.975(0.866~1.098)
Q4(≥1.27)1 4741 0550.0010.9691.002(0.890~1.129)
BAE
Q1(<25.66)1 4081 1201.000
Q2(25.66~<32.04)1 5339964.9900.0250.868(0.766~0.983)
Q3(32.04~<36.93)1 5939362.2000.1380.869(0.722~1.046)
Q4(≥36.93)1 5999305.7570.0160.787(0.648~0.957)
ABSI
Q1(<0.075)1 6239051.000
Q2(0.075~<0.078)1 5309990.7390.3901.053(0.936~1.185)
Q3(0.078~<0.081)1 5191 0100.0040.9501.004(0.891~1.130)
Q4(≥0.081)1 4611 0680.2490.6181.031(0.915~1.162)
BAI
Q1(<23.05)1 4051 1181.000
Q2(23.05~<25.56)1 5549726.0810.0140.863(0.767~0.970)
Q3(25.56~<28.34)1 5839524.9670.0260.869(0.769~0.983)
Q4(≥28.34)1 5919403.1200.0770.888(0.779~1.013)
BRI
Q1(<2.97)1 5279781.000
Q2(2.97~<3.60)1 5281 0130.0040.9501.004(0.894~1.128)
Q3(3.60~<4.28)1 5321 0000.4650.4950.960(0.854~1.079)
Q4(≥4.28)1 5469912.3910.1220.911(0.810~1.025)
AVI
Q1(<12.00)1 5459671.000
Q2(12.00~<13.82)1 5111 0290.4380.5081.040(0.926~1.168)
Q3(13.82~<15.87)1 5389911.3810.2400.932(0.828~1.048)
Q4(≥15.87)1 5399953.0440.0810.898(0.796~1.013)
), ArticleFig(id=1241102823337816334, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102815578353782, language=CN, label=表3, caption=

人体测量指标与胃癌及癌前病变关联的多因素logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量胃癌及癌前病变Wald χ2P值OR(95%CI)
否是
BMI
Q1(<22.16)1 4871 0411.000
Q2(22.16~<24.17)1 4881 0410.3050.5811.033(0.920~1.159)
Q3(24.17~<26.16)1 5649653.9240.0480.889(0.791~0.999)
Q4(≥26.16)1 5949354.9400.0260.876(0.779~0.984)
WC
Q1(<77.00)1 3898601.000
Q2(77.00~<83.00)1 5211 0370.5740.4491.047(0.929~1.180)
Q3(83.00~<89.00)1 5731 0141.1630.2810.936(0.829~1.056)
Q4(≥89.00)1 6501 0712.8190.0930.901(0.797~1.018)
WHR
Q1(<0.87)1 6318801.000
Q2(0.87~<0.92)1 5281 0121.1230.2891.066(0.947~1.201)
Q3(0.92~<0.98)1 4791 0560.7590.3841.056(0.935~1.192)
Q4(≥0.98)1 4951 0340.3050.5810.966(0.853~1.093)
WHtR
Q1(<0.48)1 5279781.000
Q2(0.48~<0.51)1 5281 0130.0040.9501.004(0.894~1.128)
Q3(0.51~<0.55)1 5321 0000.4650.4950.960(0.854~1.079)
Q4(≥0.55)1 5469912.3910.1220.911(0.810~1.025)
BF%
Q1(<26.81)1 4321 0971.000
Q2(26.81~<32.43)1 5281 0005.6000.0180.858(0.756~0.974)
Q3(32.43~<36.85)1 5939354.2540.0390.826(0.689~0.991)
Q4(≥36.85)1 5809509.5040.0020.734(0.603~0.893)
CI
Q1(<1.17)1 6029261.000
Q2(1.17~<1.22)1 5261 0030.8740.3501.057(0.941~1.189)
Q3(1.22~<1.27)1 5319980.1720.6780.975(0.866~1.098)
Q4(≥1.27)1 4741 0550.0010.9691.002(0.890~1.129)
BAE
Q1(<25.66)1 4081 1201.000
Q2(25.66~<32.04)1 5339964.9900.0250.868(0.766~0.983)
Q3(32.04~<36.93)1 5939362.2000.1380.869(0.722~1.046)
Q4(≥36.93)1 5999305.7570.0160.787(0.648~0.957)
ABSI
Q1(<0.075)1 6239051.000
Q2(0.075~<0.078)1 5309990.7390.3901.053(0.936~1.185)
Q3(0.078~<0.081)1 5191 0100.0040.9501.004(0.891~1.130)
Q4(≥0.081)1 4611 0680.2490.6181.031(0.915~1.162)
BAI
Q1(<23.05)1 4051 1181.000
Q2(23.05~<25.56)1 5549726.0810.0140.863(0.767~0.970)
Q3(25.56~<28.34)1 5839524.9670.0260.869(0.769~0.983)
Q4(≥28.34)1 5919403.1200.0770.888(0.779~1.013)
BRI
Q1(<2.97)1 5279781.000
Q2(2.97~<3.60)1 5281 0130.0040.9501.004(0.894~1.128)
Q3(3.60~<4.28)1 5321 0000.4650.4950.960(0.854~1.079)
Q4(≥4.28)1 5469912.3910.1220.911(0.810~1.025)
AVI
Q1(<12.00)1 5459671.000
Q2(12.00~<13.82)1 5111 0290.4380.5081.040(0.926~1.168)
Q3(13.82~<15.87)1 5389911.3810.2400.932(0.828~1.048)
Q4(≥15.87)1 5399953.0440.0810.898(0.796~1.013)
), ArticleFig(id=1241102823438479633, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102815578353782, language=EN, label=Table 4, caption=

Multivariate logistic regression analysis of the association of anthropometric indices withlesions at different diseased sites

, figureFileSmall=null, figureFileBig=null, tableContent=
变量非贲门胃癌及癌前病变贲门胃癌及癌前病变
OR (95%CI)P值OR (95%CI)P值
BMI
Q1(<22.16)1.0001.000
Q2(22.16~<24.17)1.031(0.914~1.163)0.6201.240(0.898~1.713)0.191
Q3(24.17~<26.16)0.879(0.778~0.994)0.0391.065(0.768~1.476)0.705
Q4(≥26.16)0.889(0.786~1.005)0.0610.913(0.648~1.287)0.605
BF%
Q1(<26.81)1.0001.000
Q2(26.81~<32.43)0.862(0.753~0.986)0.0300.779(0.569~1.067)0.120
Q3(32.43~<36.85)0.849(0.701~1.027)0.0920.856(0.515~1.423)0.548
Q4(≥36.85)0.741(0.602~0.912)0.0050.891(0.502~1.579)0.691
BAE
Q1(<25.66)1.0001.000
Q2(25.66~<32.04)0.882(0.773~1.006)0.0620.706(0.517~0.965)0.029
Q3(32.04~<36.93)0.881(0.725~1.070)0.2010.941(0.541~1.639)0.831
Q4(≥36.93)0.794(0.647~0.975)0.0280.870(0.475~1.592)0.651
BAI
Q1(<23.05)1.0001.000
Q2(23.05~<25.56)0.837(0.740~0.947)0.0050.846(0.617~1.161)0.301
Q3(25.56~<28.34)0.847(0.745~0.963)0.0111.000(0.723~1.384)1.000
Q4(≥28.34)0.861(0.751~0.988)0.0330.935(0.642~1.363)0.727
), ArticleFig(id=1241102823543337234, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102815578353782, language=CN, label=表4, caption=

人体测量指标与不同患病部位病变关联的多因素logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量非贲门胃癌及癌前病变贲门胃癌及癌前病变
OR (95%CI)P值OR (95%CI)P值
BMI
Q1(<22.16)1.0001.000
Q2(22.16~<24.17)1.031(0.914~1.163)0.6201.240(0.898~1.713)0.191
Q3(24.17~<26.16)0.879(0.778~0.994)0.0391.065(0.768~1.476)0.705
Q4(≥26.16)0.889(0.786~1.005)0.0610.913(0.648~1.287)0.605
BF%
Q1(<26.81)1.0001.000
Q2(26.81~<32.43)0.862(0.753~0.986)0.0300.779(0.569~1.067)0.120
Q3(32.43~<36.85)0.849(0.701~1.027)0.0920.856(0.515~1.423)0.548
Q4(≥36.85)0.741(0.602~0.912)0.0050.891(0.502~1.579)0.691
BAE
Q1(<25.66)1.0001.000
Q2(25.66~<32.04)0.882(0.773~1.006)0.0620.706(0.517~0.965)0.029
Q3(32.04~<36.93)0.881(0.725~1.070)0.2010.941(0.541~1.639)0.831
Q4(≥36.93)0.794(0.647~0.975)0.0280.870(0.475~1.592)0.651
BAI
Q1(<23.05)1.0001.000
Q2(23.05~<25.56)0.837(0.740~0.947)0.0050.846(0.617~1.161)0.301
Q3(25.56~<28.34)0.847(0.745~0.963)0.0111.000(0.723~1.384)1.000
Q4(≥28.34)0.861(0.751~0.988)0.0330.935(0.642~1.363)0.727
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扬中市40~69岁居民人体测量指标与胃癌及癌前病变的关联分析
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印红军 1 , 冯祥 2, 3 , 华召来 2, 3 , 陈梦星 2, 3 , 仝海员 4 , 朱进华 2, 3, 5, 6
现代预防医学 | 疾病预防控制 2024,51(16): 3022-3028
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现代预防医学 | 疾病预防控制 2024, 51(16): 3022-3028
扬中市40~69岁居民人体测量指标与胃癌及癌前病变的关联分析
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印红军1, 冯祥2, 3 , 华召来2, 3, 陈梦星2, 3, 仝海员4, 朱进华2, 3, 5, 6
作者信息
  • 1.扬中市人民医院消化科，江苏 扬中 210009
  • 2.扬中市人民医院肿瘤防治研究所
  • 3.扬中市人民医院慢病筛查科
  • 4.扬中市疾病预防控制中心慢性病防制科
  • 5.东南大学附属中大医院消化科
  • 6.东南大学医学院

    • 印红军（1974—），男，硕士，副主任医师，研究方向：上消化道疾病防治研究

通讯作者:

冯祥，E-mail：
Analysis of the association between anthropometric indicators and gastric cancer and precancerouslesions in residents aged 40-69 years, Yangzhong City
Hong-jun YIN1, Xiang FENG2, 3 , Zhao-lai HUA2, 3, Meng-xing CHEN2, 3, Hai-yuan TONG4, Jin-hua ZHU2, 3, 5, 6
Affiliations
  • Department of Gastroenterology, Yangzhong People’s Hospital, Yangzhong, Jiangsu 212200, China
出版时间: 2024-08-25 doi: 10.20043/j.cnki.MPM.202403524
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摘要
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目的

分析扬中市40~69岁人群11种人体测量指标（AIs）与胃癌及癌前病变的关联。

方法

采用整群抽样方法，选取2017年11月至2022年12月，扬中市10698名参与上消化癌筛查的40~69岁居民进行问卷调查、体格检查、内镜检查及病理学诊断。采用多因素logistics回归分别分析体质量指数（BMI）、腰围（WC）、腰臀比（WHR）、腰高比（WHtR）、体脂百分比（BF%）、锥度指数（CI）、身体肥胖估计量（BAE）、身体形态指数（ABSI）、身体肥胖指数（BAI）、身体圆度指数（BRI）和腹部容积指数（AVI）与胃癌及癌前病变的关联。

结果

10115名调查对象胃癌及癌前病变的患病率为39.37%。多因素logistics回归结果显示，与第1分位数（Q1）相比，BMI的Q3和Q4人群患胃癌及癌前病变风险分别降低11.1%（OR=0.889，0.791~0.999）和12.4%（OR=0.876，0.779~0.984）。BF%的Q2，Q3和Q4人群患胃癌及癌前病变风险分别降低14.2%（OR=0.858，0.756~0.974）、17.4%（OR=0.826，0.689~0.991）和26.6%（OR=0.734，0.603~0.893）。BAE的Q2和Q4人群患胃癌及癌前病变风险分别降低13.2%（OR=0.868，0.766~0.983）和21.3%（OR=0.787，0.648~0.957）。BAI的Q2和Q3人群患胃癌及癌前病变风险分别降低13.7%（OR=0.863，0.767~0.970）和13.1%（OR=0.869，0.769~0.983）。分层分析显示，BMI、BF%、BAE和BAI与非贲门胃癌及癌前病变风险降低有关（均P<0.05）。但与Q1相比，仅BAE的Q2水平与贲门胃癌及癌前病变的风险降低有关（P<0.05）。

结论

扬中市40~69岁人群BMI、BF%、BAE和BAI水平的增加与胃癌及癌前病变患病风险降低相关。这种关联大多适用于非贲门而不是贲门。

人体测量指标  /  胃癌  /  癌前病变  /  关联  /  筛查
Objective

To analyze the association of 11 anthropometric indicators (AIs) with gastric cancer and precancerous lesions in people aged 40-69 years in Yangzhong City.

Methods

Using the cluster sampling method, 10 698 residents aged 40-69 years who participated in upper gastrointestinal cancer screening in Yangzhong City from November 2017 to December 2022 were selected for questionnaire survey, physical examination, endoscopy and pathological diagnosis. Multivariate logistic regression was used to analyze the association between AIs [body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), body fat percentage (BF%), conicity index (CI), body adiposity estimator (BAE), a body shape index (ABSI), body adiposity index (BAI), body roundness index (BRI) and abdominal volumetric index (AVI)] and gastric cancer and precancerous lesions.

Results

The prevalence of gastric cancer and precancerous lesions was 39.37% among 10 115 residents. The results of multivariate logistic regression showed that compared with those in quartile 1 (Q1), the Q3 and Q4 populations of BMI had an 11.1% (OR=0.889, 0.791-0.999) and 12.4% (OR=0.876, 0.779-0.984) lower risk of gastric cancer and precancerous lesions, respectively. The Q2, Q3 and Q4 populations of BF% had 14.2% (OR=0.858, 0.756-0.974), 17.4% (OR=0.826, 0.689-0.991) and 26.6% (OR=0.734, 0.603-0.893) lower risk of gastric cancer and precancerous lesions risk, respectively. The Q2 and Q4 populations of the BAE had reduced the risk of gastric cancer and precancerous lesions by 13.2% (OR=0.868, 0.766-0.983) and 21.3% (OR=0.787, 0.648-0.957). The risk of gastric cancer and precancerous lesions in BAI’s Q2 and Q3 populations was reduced by 13.7% (OR=0.863, 0.767-0.970) and 13.1% (OR=0.869, 0.769-0.983), respectively. Stratified analysis showed that BMI, BF%, BAE and BAI were associated with a reduced risk of non-cardia gastric cancer and precancerous lesions (all P<0.05). However, only the Q2 level of BAE was associated with a reduced risk of cardia gastric cancer and precancerous lesions compared to the Q1 (P<0.05).

Conclusion

Increased levels of BMI, BF%, BAE, and BAI among residents aged 40-69 years in Yangzhong City are associated with a reduced risk of gastric cancer and precancerous lesions. However, most of this association apply to non-cardia but not cardia.

Anthropometric indicator  /  Gastric cancer  /  Precancerous lesion  /  Association  /  Screening
印红军, 冯祥, 华召来, 陈梦星, 仝海员, 朱进华. 扬中市40~69岁居民人体测量指标与胃癌及癌前病变的关联分析. 现代预防医学, 2024 , 51 (16) : 3022 -3028 . DOI: 10.20043/j.cnki.MPM.202403524
Hong-jun YIN, Xiang FENG, Zhao-lai HUA, Meng-xing CHEN, Hai-yuan TONG, Jin-hua ZHU. Analysis of the association between anthropometric indicators and gastric cancer and precancerouslesions in residents aged 40-69 years, Yangzhong City[J]. Modern Preventive Medicine, 2024 , 51 (16) : 3022 -3028 . DOI: 10.20043/j.cnki.MPM.202403524
正文
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胃癌是全球的高发癌种之一。全球癌症统计报告显示，2020年，胃癌发病和死亡人数占比分别排在总人群的第5位和第4位[1]，其中中国胃癌的发病人数几乎占全球的一半，造成了巨大的癌症负担[1-2]。2016年，中国胃癌新发病例39.65万例，死亡28.85万例，粗发病率和粗死亡率分别为28.68/10万和20.87/10万，均位于癌谱的第3位[3]。一项meta分析结果显示，超重/肥胖是胃癌的保护因素[4]。来自林县的一项队列研究未发现BMI与胃癌存在关联[5]。既往研究表明，肥胖在近端胃癌的发生发展中起到重要作用[6]。然而，有关肥胖与胃癌关联的流行病学证据是矛盾的[4-7]。为了克服体质量指数（body mass index，BMI）和腰围（waist circumference，WC）在描述肥胖时的局限性，一些新型人体测量指标（anthropometric indicators, AIs）被开发[8-12]。但关于不同AIs与胃部疾病关联的研究较少。本研究旨在探讨新旧AIs与胃癌及癌前病变的关联，我们还探索了关联在不同患病部位中效应的异质性，以期为胃癌及癌前病变的科学预防提供参考。
1　对象与方法
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1.1　研究对象
本研究数据来源于“上消化道癌筛查及早诊早治和食管癌专病队列研究项目”[13-15]的基线数据。采用整群抽样的方法，邀请扬中市当地40~69岁居民自愿参与上消化道癌筛查。2017年11月至2022年12月共完成了10 698例参与者的基线调查。纳入标准：（1）40~69岁户籍居民；（2）无内镜检查禁忌证。（3）无严重认知障碍。排除标准：（1）不愿意参与或签署知情同意书者；（2）无完整的流行病学调查和体格检查资料；（3）有恶性肿瘤及上消化道手术史。最终10 115人被纳入分析。本研究经过扬中市人民医院伦理委员会批准（No.202402），所有调查对象均已签署知情同意书。
1.2　调查方法与内容
1.2.1　问卷调查
采用结构化问卷进行面访调查，问卷涉及一般人口学特征（年龄、性别、婚姻状况等）、健康相关特征（吸烟、饮酒、饮茶、蔬菜水果摄入频率和摄入量等）、癌症家族史、常见慢性病家族史和胃部疾病既往史。
1.2.2　体格测量
参照标准方案测量筛查对象的身高（body height, BH）、体重（body weight, BW）、WC、和臀围（hip circumference，HC），分别精确到0.1cm和0.1kg。参照既往文献分别计算BMI[12-13]、WC、腰臀比（waist-hip ratio，WHR）[12]、腰高比（waist-to-height ratio，WHtR）[12]、体脂百分比（body fat percentage，BF%）[8]、锥度指数（c-index，CI）[9]、身体肥胖估计量（body adiposity estimator，BAE）[10]、身体形态指数（a body shape index，ABSI）[11]、身体肥胖指数（body adiposity index，BAI）[11]、身体圆度指数（body roundness index，BRI）[12]和腹部容积指数（abdominal volume index，AVI）[12]。
1.2.3　内镜筛查和病理学诊断
参照早诊早治技术方案进行规范化的内镜检查，行可疑病灶及高发位点活检后送检病理[14]。在内镜检查期间，行快速尿素酶实验确定幽门螺杆菌（helicobacter pylori，HP）感染情况，具体请见参考文献[15]。
1.3　指标定义
吸烟、饮酒、蔬菜水果摄入充分、腌制品、饮食不规律、深度油炸品、剩菜剩饭、辣食和体育锻炼等指标定义与既往文献一致[13,15]。饮茶、霉变和烫热饮食（烫热食物或烫热茶）：每周频率≥1次。食管疾病包括食管癌、高级别、低级别上皮内瘤变和反流性食管炎。胃癌及癌前病变包括胃癌、高级别、低级别上皮内瘤变、肠上皮化生和萎缩性胃炎。
1.4　统计学分析
采用SPSS 27.0进行数据的整理和分析。定量资料用M（Q1, Q3）描述。计数资料用n（%）表示。Mann-Whitney U或χ2检验被用于组间比较。将单因素分析有意义的变量（P<0.05）纳入多因素logistic回归模型探索各AIs四分位数与胃癌及癌前病变的关联。AIs与不同部位疾病关联通过构建无序多分类logistic回归进行（0=非胃癌及癌前病变，1=单纯非贲门胃癌及癌前病变，2=单纯贲门胃癌及癌前病变，3=合并非贲门和贲门胃癌及癌前病变）。检验水准α=0.05，双侧。
2　结果
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2.1　基本特征
本研究共对10 115名筛查对象进行统计学分析，其中胃癌及癌前病变3 982名，非胃癌及癌前病变6 133名。两组的中位年龄分别为57岁和55岁，男性分别占47.94%和40.80%。两组在年龄、性别、文化程度、家庭人口数、家庭年收入、吸烟、饮酒、饮茶、腌制品、饮食不规律、烫热食物、辣食、胃部疾病既往史、食管疾病和HP感染方面的差异有统计学意义（均P<0.05）。见表1。
2.2　人体测量指标的分布特征
两组的BW、HC、BMI、WHR、BF%、CI、BAE、ABSI和BAI水平差异有统计学意义（均P<0.05）。见表2。
2.3　人体测量指标与胃癌及癌前病变的多因素logistic回归分析
调整所有单因素有意义（P<0.05）的变量后，多因素logistic回归模型结果显示，处于BMI第3和4分位数的研究对象发生胃癌及癌前病变风险是处于第1分位数的0.889倍（OR=0.889，0.791~0.999）和0.876倍（OR=0.876，0.779~0.984）。处于BF%第2、3和4分位数的研究对象发生胃癌及癌前病变风险是处于第1分位数的0.858倍（OR=0.858，0.756~0.974）、0.826倍（OR=0.826，0.689~0.991）和0.734倍（OR=0.734，0.603~0.893）。处于BAE第2和第4分位数的研究对象发生胃癌及癌前病变风险是处于第1分位数的0.868倍（OR=0.868，0.766~0.983）和0.787倍（OR=0.787，0.648~0.957）。处于BAI第2和3分位数的研究对象发生胃癌及癌前病变风险是处于第1分位数的0.863倍（OR=0.863，0.767~0.970）和0.869倍（OR=0.869，0.769~0.983）。见表3。此外，将P<0.1和P<0.2的变量分别纳入多因素模型进行敏感性分析，结果未有实质性变化。
2.4　人体测量指标与贲门及非贲门胃癌及癌前病变的多因素logistic回归分析
调整所有混杂变量（不存在共线性）后，BMI的第3分位数、BF%的第2和4分位数、BAE的第4分位数和BAI第2、3和4分位数人群患非贲门胃癌及癌前病变的风险分别是第1分位数人群的0.879、0.862、0.741、0.794、0.837、0.847和0.861倍。然而，BMI、BF%和BAI四分位数与贲门胃癌及癌前病变无统计学关联（均P>0.05）。与第1分位数人群相比，仅BAE的第2分位数对贲门胃癌及癌前病变具有显著的保护作用（OR=0.706，0.517~0.965）。见表4。
3　讨论
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本研究结果显示，胃癌及癌前病变的患病风险随着BMI、BF%、BAE和BAI水平的增加而降低，与Poorolajal 和Bae等的研究结果一致[4,16]。然而，一项基于开滦前瞻性队列的研究发现，与正常体重人群相比，低体重可能会增加男性胃癌的发病风险（HR=2.11，95%CI：1.23~3.62），但超重/肥胖与胃癌发病风险无统计学关联[17]。Jang等[18]发现BMI与胃癌风险存在“U”型关联，体重不足和肥胖组的胃癌风险均高于参考组（HR=1.15，95% CI：1.05~1.25；HR=1.12，95% CI：1.03~1.22）。日本的一项队列研究发现，BMI与贲门胃癌存在正向关联，但与非贲门胃癌风险不存在显著关联[19]。Azizi等[20]和Choi等[21]的研究发现，BMI和WC与胃癌均存在正向关联。人体脂肪含量较多意味着机体长期处于营养过剩状态，高热量饮食往往伴随各种微量元素/矿物质的摄入，微量元素和抗氧化剂的作用会降低胃癌的发病风险[17]。此外，在农村地区脂肪含量较高的人群通常社会经济地位相对较好[22]，可以促进就医可及性和就医频率提高，从而改善健康水平。最后，研究调查对象主要来源高危地区自愿参与筛查的人群，健康素养存在一定优势。肥胖人群的胃部早期病变可能已经在日常体检或诊疗中予以了干预。
本研究结果显示，BMI、BF%、BAE和BAI水平的增加对非贲门胃癌及癌前病变有保护作用，与既往研究结果不一致[6]。与第1分位数人群相比，仅有BAE第2分位数与贲门胃癌及癌前病变的患病风险降低有关，提示肥胖对贲门胃癌及癌前病变的作用并不明显，与Jang等[18]研究结论一致。通常，肥胖者被认为更容易罹患胃食管反流病，从而增加贲门胃癌及癌前病变的风险[23]。肥胖还会导致促炎细胞因子、胰岛素、瘦素和性类固醇水平升高，从而增加个体患癌风险[24]。这种差异一方面可能归因于分层分析中仅纳入了全身型肥胖指标且病例大多为癌前病变患者；另一方面，可能与本研究中贲门胃癌及癌前病变例数较少有关。此外，还可能是反向因果关系所致[17]。
本研究存在一定局限性，首先，数据仅来自扬中市，研究结果外推受限；其次，纳入的混杂因素有限，例如缺少就医行为变量，可能对分析产生一定影响；最后，本研究是典型的横断面研究，无法论证AIs和结局的因果关系。
综上所述，BMI、BF%、BAE和BAI水平增加与胃癌及癌前病变患病风险降低相关，但更适用于非贲门，而不是贲门。
基金
收起
  • 国家重点研发计划(2016YFC0901400)
  • 国家重点研发计划(2016YFC1302800)
  • 中国消化道早癌医师共同成长计划(GTCZ-2021-JS-32-0001)
  • 镇江市重点研发计划-社会发展(SH2022051)
  • 2023年江苏省预防医学面上项目(Ym2023031)
文献
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2024年第51卷第16期
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doi: 10.20043/j.cnki.MPM.202403524
  • 接收时间：2024-03-28
  • 首发时间：2026-03-18
  • 出版时间：2024-08-25
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  • 收稿日期：2024-03-28
基金
国家重点研发计划(2016YFC0901400)
国家重点研发计划(2016YFC1302800)
中国消化道早癌医师共同成长计划(GTCZ-2021-JS-32-0001)
镇江市重点研发计划-社会发展(SH2022051)
2023年江苏省预防医学面上项目(Ym2023031)
作者信息
    1.扬中市人民医院消化科，江苏 扬中 210009
    2.扬中市人民医院肿瘤防治研究所
    3.扬中市人民医院慢病筛查科
    4.扬中市疾病预防控制中心慢性病防制科
    5.东南大学附属中大医院消化科
    6.东南大学医学院

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