ω-6/ω-3多不饱和脂肪酸比值对不同肿瘤发病风险的系统综述和Meta分析

doi:10.6040/j.issn.1671-7554.0.2024.0589

摘要/Abstract

摘要： 目的系统评价ω-6/ω-3多不饱和脂肪酸(omega-6/omega-3 polyunsaturated fatty acids)比值与不同肿瘤发病风险的关系。方法系统检索9个数据库(Pubmed、Embase、Web of Science、Cochrane Library、Medline、知网、维普、万方、生物医学文献数据库)截至2024年1月31日有关ω-6/ω-3 PUFAs比值与肿瘤发病风险关系的研究,利用纽卡斯尔-渥太华量表(Newcastle-Ottawa Scale,NOS)对最终纳入的文献进行质量评价,R4.3.3软件进行Meta分析。结果共纳入27篇ω-6/ω-3PUFAs比值对不同肿瘤发病率影响的研究,其中队列研究7项,病例对照研究20项。共纳入研究对象197 401例,病例组和暴露组81 950例,对照组和非暴露组115 451例。Meta分析结果显示: ω-6/ω-3PUFAs比值与不同肿瘤发病风险关联无统计学意义(OR=1.03,95%CI:0.98~1.09,P=0.18)。亚组分析显示,较高的ω-6/ω-3PUFAs比值会增加乳腺癌的发病风险(OR=1.05,95%CI:1.01~1.10,P=0.01),而与前列腺癌(OR=1.26,95%CI:0.67~2.38,P=0.47),结直肠癌(OR=0.99,95%CI:0.89~1.10,P=0.85)的发病风险关联无统计学意义。在非欧美地区,较高的ω-6/ω-3PUFAs比值会显著增加不同肿瘤发病的风险(OR=1.24,95%CI:1.01~1.51,P=0.04),而在欧美地区则没有统计学意义(OR=1.02,95%CI:0.97~1.07,P=0.46),在评估暴露指标与不同肿瘤发病风险的关系中,饮食摄入(OR=1.04, 95%CI: 0.98~1.09,P=0.17)和基于血液(红细胞、血清、血浆)测定的ω-6/ω-3PUFAs比值(OR=1.00, 95%CI:0.92~1.09,P=0.96),均无统计学意义的关联。针对乳腺癌的亚组分析显示,在欧美地区,较高的ω-6/ω-3PUFAs比值会增加乳腺癌的发病风险(OR=1.05,95%CI:1.01~1.11,P=0.03),但在非欧美地区则无统计学意义(OR=1.05,95%CI:0.97~1.14,P=0.22)。较高的饮食摄入ω-6/ω-3PUFAs比值会增加乳腺癌的发病风险(OR=1.05,95%CI:1.01~1.10,P=0.02),而血液中(红细胞、血清、血浆)ω-6/ω-3PUFAs比值对乳腺癌发病的风险关联却没有统计学意义(OR=1.07,95%CI:0.93~1.23,P=0.37)。结论 ω-6/ω-3PUFAs比值与不同肿瘤发病风险的影响尚无明确结论,但较高的ω-6/ω-3PUFAs比值会增加乳腺癌的发病风险,尤其是在欧美地区。而在非欧美地区,较高的ω-6/ω-3PUFAs比值会显著增加不同肿瘤发病的风险。此外,较高的饮食摄入ω-6/ω-3PUFAs比值也会增加乳腺癌的发病风险。上述观点有待通过更多前瞻性干预实验加以实证确认。

关键词: ω-3多不饱和脂肪酸, ω-6/ω-3多不饱和脂肪酸比值, 肿瘤发病风险, 乳腺癌, Meta分析

Abstract: Objective The purpose of this study was to systematically evaluate the relationship between the ratio of ω-6/ω-3 polyunsaturated fatty acids(omega-6/omega-3 polyunsaturated fatty acids)and the risk of various types of tumors. Methods A systematic search was carried out in 9 databases(Pubmed, Embase, Web of Science, Cochrane Library, Medline, CNKI, VIP, Wanfang, CBM)up to January 31, 2024, for studies related to the association between the ratio of ω-6/ω-3PUFAs and tumor incidence risk. The quality of the finally included literature was assessed using the Newcastle-Ottawa Scale(NOS). Meta-analysis was performed using the R version 4.3.3 software. Results A total of 27 studies investigating the effect of the ratio of ω-6/ω-3PUFAs on different tumor incidence rates were included, comprising 7 cohort studies and 20 case-control studies. A total of 197,401 subjects were involved, with 81,950 cases and exposed participants and 115,451 controls and unexposed participants.Meta-analysis results showed that there was no statistically significant association between the ratio of ω-6/ω-3 PUFAs and the incidence risk of different tumors(OR=1.03, 95%CI:0.98-1.09, P=0.18). Subgroup analysis revealed that a higher ratio of ω-6/ω-3 PUFAs was associated with an increased risk of breast cancer incidence(OR=1.05, 95%CI:1.01-1.10,P=0.01), but not with prostate cancer(OR=1.26, 95%CI:0.67-2.38, P=0.47)or colorectal cancer(OR=0.99, 95%CI:0.89-1.10,P=0.85). In non-European and American regions, a higher ω-6/ω-3PUFAs ratio significantly increased the risk of various tumor incidences(OR=1.24, 95%CI:1.01-1.51, P=0.04), while in European and American regions, this association was not statistically significant(OR=1.02, 95%CI:0.97-1.07, P=0.46). When evaluating the relationship between exposure indicators and the incidence risk of various cancers, neither dietary intake(OR=1.04, 95%CI:0.98-1.09, P=0.17)nor the ratio of ω-6/ω-3PUFAs measured in blood components(red blood cells, serum, plasma)(OR=1.00, 95%CI:0.92-1.09, P=0.96)showed statistically significant associations with cancer risk. Subgroup analysis focusing on breast cancer revealed that in European and American regions, a higher ω-6/ω-3PUFAs ratio was associated with an increased risk of breast cancer incidence(OR=1.05, 95%CI:1.011.11, P=0.03), but this link was not statistically significant in non-European and American regions(OR=1.05, 95%CI:0.97-1.14, P=0.22). A higher dietary intake ratio of ω-6/ω-3PUFAs was correlated with an elevated risk of breast cancer incidence(OR=1.05, 95%CI:1.01-1.10, P=0.02), whereas the ratio of ω-6/ω-3PUFAs in blood(red blood cells, serum, plasma)did not show a statistically significant association with breast cancer risk(OR=1.07, 95%CI:0.93-1.23, P=0.37). Conclusion The influence of the ratio of ω-6/ω-3PUFAs on the risk of different tumors remains inconclusive. However, a higher ω-6/ω-3PUFAs ratio is associated with an increased risk of breast cancer, particularly in the European and American regions. In non-European and American regions, a higher ratio was found to significantly increase the risk of various types of tumor. Furthermore, a higher dietary ratio of ω-6/ω-3PUFAs intake is also associated with an increased risk of breast cancer development. These findings warrant further confirmation through additional prospective interventional studies.

Key words: ω-3 polyunsaturated fatty acids, ω-6/ω-3 polyunsaturated fatty acids ratio, Risk of carcinogenesis, Breast cancer, Meta-analysis

中图分类号:

刘向荣,张新胜,杨荩冉,杨雪艳,刘钊,刘英华. ω-6/ω-3多不饱和脂肪酸比值对不同肿瘤发病风险的系统综述和Meta分析[J]. 山东大学学报 (医学版), 2024, 62(8): 34-48.

LIU Xiangrong, ZHANG Xinsheng, YANG Jinran, YANG Xueyan, LIU Zhao, LIU Yinghua. Association of the ratio of ω-6/ω-3 polyunsaturated fatty acids with various tumor types risk: a systematic review and Meta-analysis[J]. Journal of Shandong University (Health Sciences), 2024, 62(8): 34-48.

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