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

Association of the ratio ofω-6/ω-3 polyunsaturated fatty acids with various tumor types risk:a systematic review and Meta-analysis

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197401例,病例组和暴露组81950例,对照组和非暴露组115451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。

Objective The purpose of this study was to systematically evaluate the relationship between the ratio ofω-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 ofω-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 ofω-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 ofω-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 ofω-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 higherω-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 ofω-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 higherω-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 ofω-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 ofω-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 ofω-6/ω-3PUFAs on the risk of different tumors remains inconclusive.However,a higherω-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 ofω-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.