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JAMA:夜间禁食改善乳腺癌预后

 

导读:这是一项为前瞻性、多中心的队列研究,发现夜间禁食长(≥13小时)可减低36%的乳腺癌复发风险。以前的研究多集中关注吃什么可以预防癌症的复发,但啥时候吃也可能达到预防目的。这是第一篇有关夜间禁食和乳腺癌预后的研究,与肿瘤防控相关,但是这些数据还不成熟,不足以为临床和公共卫生提供充足证据。

 方法:

美国多中心的前瞻性研究,1995年3月1日至2007年5月3日入组2413例早期乳腺癌而无糖尿病患者,年龄介于27至70岁之间。平均随访时间7.3年,2015年5月18日至10月5日数据整理分析。通过回忆记录24小时膳食情况计算禁食时间,收集基线、1年和4年数据。采集血液样本检测血红蛋白A1c(HBA1c)、C反应蛋白(CRP)浓度。研究首要目标是复发和新发的乳腺癌。采用COX回归得出风险比。
 
结果:
1、平均年龄52.4岁,平均夜间禁食时间为12.5小时,平均每日进食4.4次,778例(32.7%)患者晚上八点以后食用超过25Kcal的食物。较短的夜间禁食时间(<13小时)与大学教育、低体重指数(BMI)、较短睡眠、更高的热量摄入、更多的进食次数和晚上8点以后进食相关。
2、 与夜间禁食<13个小时比较,≥13小时增加乳腺癌复发风险(HR1.36;95% CI, 1.05-1.76),未显著增加乳腺癌死亡风险(HR, 1.21; 95% CI, 0.91-1.60)及任何原因的死亡风险(HR, 1.22; 95% CI, 0.95-1.56)。
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3、夜间禁食每增加2小时,可显著减低血红蛋白A1c水平((β = –0.37; 95% CI, –0.72 to –0.01)和更长的夜间睡眠时间((β = 0.20; 95% CI, 0.14-0.26)。夜间禁食时间与BMI和CRP浓度无关,晚上八点以后进食与高的BMI和CRP浓度相关。
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结论:
延长夜间禁食时间是一种简单、没药物治疗就可以改善乳腺癌预后的方法。禁食可能通过改善糖代谢和睡眠提高乳腺癌的预后。
 
点评:
为前瞻性、多中心的队列研究,发现夜间禁食长(≥13小时)可减低36%的乳腺癌复发风险。以前的研究多集中关注吃什么可以预防癌症的复发,但啥时候吃也可能达到预防目的。这是第一篇有关夜间禁食和乳腺癌预后的研究,与肿瘤防控相关,但是这些数据还不成熟,不足以为临床和公共卫生提供充足证据。该研究来自美国“女性健康饮食和生活” 研究项目,目的是分析富含蔬菜水果纤维而且低脂饮食是否能减低乳腺癌复发和死亡风险。但该研究存在以下缺陷。第一,通过患者回忆记录吃了什么、何时进食、如何进食?收集数据可能不准确,既往研究显示如果不去称重,自我评估进食量要比实际少40%。第二,该研究未纳入饮酒和吸烟情况,食物中脂肪含量不得而知。第三,其他影响乳腺癌预后因素如分期、分级及治疗未纳入分析。第四,为什么有的患者禁食时间长而有的禁食时间会短呢?这个能和先天激素水平有关,也可能是治疗副反应。无论何种原因,夜间禁食时间长的女性乳腺癌复发风险下降。我们需要更多研究去分析禁食时间与乳腺癌预后的关系。
 
参阅文献
Catherine R. Marinac, et al: Prolonged Nightly Fasting and Breast Cancer Prognosis.
JAMA ONCOLOGY. March 31, 2016.
IMPORTANCE:Rodent studies demonstrate that prolonged fasting during the sleep phase positively influences carcinogenesis and metabolic processes that are putatively associated with risk and prognosis of breast cancer. To our knowledge, no studies in humans have examined nightly fasting duration and cancer outcomes.
OBJECTIVE:To investigate whether duration of nightly fasting predicted recurrence and mortality among women with early-stage breast cancer and, if so, whether it was associated with risk factors for poor outcomes, including glucoregulation (hemoglobin A1c), chronic inflammation (C-reactive protein), obesity, and sleep.
DESIGN, SETTING, AND PARTICIPANTS:Data were collected from 2413 women with breast cancer but without diabetes mellitus who were aged 27 to 70 years at diagnosis and participated in the prospective Women's Healthy Eating and Living study between March 1, 1995, and May 3, 2007. Data analysis was conducted from May 18 to October 5, 2015.
EXPOSURES:Nightly fasting duration was estimated from 24-hour dietary recalls collected at baseline, year 1, and year 4.
MAIN OUTCOMES AND MEASURES:Clinical outcomes were invasive breast cancer recurrence and new primary breast tumors during a mean of 7.3 years of study follow-up as well as death from breast cancer or any cause during a mean of 11.4 years of surveillance. Baseline sleep duration was self-reported, and archived blood samples were used to assess concentrations of hemoglobin A1c and C-reactive protein.
RESULTS:The cohort of 2413 women (mean [SD] age, 52.4 [8.9] years) reported a mean (SD) fasting duration of 12.5 (1.7) hours per night. In repeated-measures Cox proportional hazards regression models, fasting less than 13 hours per night (lower 2 tertiles of nightly fasting distribution) was associated with an increase in the risk of breast cancer recurrence compared with fasting 13 or more hours per night (hazard ratio, 1.36; 95% CI, 1.05-1.76). Nightly fasting less than 13 hours was not associated with a statistically significant higher risk of breast cancer mortality (hazard ratio, 1.21; 95% CI, 0.91-1.60) or a statistically significant higher risk of all-cause mortality (hazard ratio, 1.22; 95% CI, 0.95-1.56). In multivariable linear regression models, each 2-hour increase in the nightly fasting duration was associated with significantly lower hemoglobin A1c levels (??=?-0.37; 95% CI, -0.72 to -0.01) and a longer duration of nighttime sleep (??=?0.20; 95% CI, 0.14-0.26).
CONCLUSIONS AND RELEVANCE:Prolonging the length of the nightly fasting interval may be a simple, nonpharmacologic strategy for reducing the risk of breast cancer recurrence. Improvements in glucoregulation and sleep may be mechanisms linking nightly fasting with breast cancer prognosis.
 
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