Jeanine M. Genkinger, Anita Koushik*
发表日期2007年12月11日
发表于PLoS Med 4(12): e345 doi:10.1371/journal.pmed.0040345
网址：http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040345&ct=1
国际的癌症发病率不同和从移民的研究中，表明环境因素如饮食习惯与患癌症的风险相关。摄取的肉类如牛肉，世界各地存在三倍的差异，世界各地的消耗量最高的在发达国家（23公斤/人均），相比欠发达国家的消耗量（ 6公斤/人均）[1] 。基于Richard Doll and Richard Peto在1981年的研究，据估计，大约有35 ％ （范围10％ - 70％）的癌症可以归因于饮食，这和吸烟致癌的幅度类似达30％（范围25％-40％） [2] 。
已经有一百多篇流行病学研究报道肉类消耗和癌症的风险，这包括了世界各国的不同饮食习惯的研究。这些研究从不同方面对肉类摄入量和癌症的风险的联系进行了评估，既包括了总体肉类摄入量之间的比较，又有更精细的分类，尤其是摄取红肉，其中包括牛肉，羊肉，猪肉，小牛肉摄入量之间的比较，还有处理过肉类，包括肉类保存腌制，熏制，或压制之间的比较。
虽然癌症和肉类摄入量的联系可部分归罪于高能量或高脂肪（ "西化" ）的饮食，但我们更感兴趣是直接作用的潜在致癌化合物。肉类中含有包括N -亚硝基化合物，杂环胺，或多环芳烃。 动物实验中发现N -亚硝基化合物和亚硝胺是烈性致癌物质[3]。同样，杂环胺被列为诱变因素和动物致癌物[4-8] 。科学界公认存在于肉类这些化合物（盐，硝酸盐，亚硝酸盐，血红素铁，饱和脂肪，雌二醇）会增加DNA合成和细胞增殖，增加胰岛素样生长因子，影响激素代谢，促进自由基损伤，并产生致癌物质杂环胺[9-16] ，所有这些都可能促进癌症的产生。
肠癌
肉类摄入量和结肠癌的关系被研究得最广泛。地球人生态研究发现，人均肉类摄入量与结肠癌发病率（>0.85）和死亡率（>0.70）率联系非常高[17,18] 。同样在案例和人群研究中发现，大肠癌的风险直接与红肉和加工肉类摄入量相关。 1997年总结这些研究后，由世界癌症研究基金组织和美国癌症研究组织得出的结论是，摄入的红肉可能增加患结直肠癌的几率，而加工肉类可能增加大肠癌的危险[ 19 ] 。据报道，在世界卫生组织的共识会议结肠癌讨论小组[20]和关于饮食与癌症的委员会对医疗方面的食品和营养政策工作组[21] 得出类似的结论。在最近的汇总分析肠癌（其中包括公布到2005年研究）结论表示，红肉摄取量增加肠癌风险28 ％ -35 ％，加工肉类增加肠癌风险的20% - 49% [22-24]。
其他癌症
此外，还有大量的研究探讨了肉类摄入量与胃癌的风险。在最近一次的汇总分析得出结论：加工肉类摄入量增加胃癌的风险[25]。现在有一些研究报道，肉类摄入量与膀胱癌[26,27]、乳腺癌[28,29]、子宫内膜癌[30]、神经胶质瘤[31]、胰脏癌[32-34]、前列腺癌[35]，肾癌[36]风险有关，但需要更多的实验数据支持。同样，肉类摄入量和肺癌[37,38]、食道癌[39]、口腔癌[40,41] ，卵巢[42-44] ，子宫颈[45]，与肝癌[41]的风险有待于更多实验数据支持。这些研究需要进一步考虑能量摄入或身体质量指数两个指标。
最新的多种癌症研究
在这期plos医药杂志上，Amanda Cross和他的同事，分析了一个很有前瞻性的大型的关于红色和加工肉类摄入量与人体数种癌症风险联系的人群研究[46]。这个研究是美国国家卫生研究院（NIH）和美国退休者协会（前身为美国退休人员协会）的饮食习惯和健康研究，它包括了500000美国人，其中超过53000癌症案例。
对于肠癌，红肉摄入量62.5克/1000千卡增加24％的风险，红肉摄入量22.6克/1000千卡增加20%的风险。男性和女性没有区别。这个结论和以前汇总结论相同[22-24]。研究人员还发现，红肉摄入量增加食道癌、肝癌、肺癌风险20％ - 60％。加工肉制品摄入量增加肺癌16％。红肉和加工肉类摄入会增加男人胰腺癌的风险。
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