| Objective:The objective of this study was to investigate the burden of cancer and cardio-cerebrovascular disease in the Linxian dysplasia Nutrition Intervention Trial(NIT)cohort,as well as explore the association between multivitamins and minerals supplementation and the long-term risk of cancer and cardio-cerebrovascular disease by analyzing the 35-year follow-up data of the NIT cohort.Methods:The Linxian Dysplasia Nutrition Intervention Trial was a randomized,double-blind,placebo-controlled trial.3318 subjects aged 40-69 years with esophageal squamous dysplasia received nutrition intervention for 6 years and were followed up to collect cancer incidence and all-cause mortality data.Cancer incidence/mortality rates and cardio-cerebrovascular disease mortality rates were calculated separately based on sex and age-class.Hazard ratio(HR)and 95%confidence intervals(95%Cl)was estimated by Cox proportional hazard model.Results:(1)Analysis of cancer incidence/mortality and cardio-cerebrovascular disease mortality:During the follow-up period,a total of 1304 cancer cases were diagnosed,with the cumulative incidence rate of 2276.93 per 100,000.The 3 most common cancers are esophageal cancer(EC),gastric cardia carcinoma(GCC),and gastric non-cardia carcinoma(GNCC),accounting for 86.4%of all cancer cases.The 3 leading causes of death are cancers,cerebrovascular disease,and cardiovascular disease,with the cumulative mortality rates of 1782.64,1169.3,and 962.21 per 100,000,respectively,accounting for 88.3%of total deaths.The 3 leading causes of cancer death are EC,GCC,and GNCC,accounting for 85.1%of all cancer deaths.The cancer incidence and all-cause mortality rates were higher in male than that in female,and higher in younger subjects(less than 55 years old)than that in older subjects(55 years or older)(P<0.05).(2)Nutrition intervention and the risk of cancer and cardio-cerebrovascular disease:During the 35-year follow-up,multivitamin supplementation did not affect cancer incidence or total mortality in all participants.Nutrition intervention reduced upper gastrointestinal(UGI)cancer mortality by 24%among subjects less than 55 years old,and the difference was statistically significant(HR=0.81,95%CI:0.67-0.99).The protective effects were also found for cardiovascular disease and cerebrovascular disease mortality among men aged 55 years and older(HR cardiovascular disease=0.62,95%CI:0.45-0.84;HR cerebrovascular disease=0.74,95%CI:0.55-0.99).No effects were observed for the risk of cancer,cardiovascular disease,and cerebrovascular disease in women of different age groups.Conclusion:(1)UGI cancer(mainly EC)is the most common malignancy in the Linxian dysplasia population.Cerebrovascular disease and cardiovascular disease are also the leading causes of deaths apart from cancer.The mortality rates of cardio-cerebrovascular disease and cancer are increasing year-by-year,indicating that there are long-term risk factors for malignant tumors,cardiovascular and cerebrovascular diseases exist in this population.(2)Taking multivitamins and minerals could not reduce the risk of cancer incidence/mortality and cardio-cerebrovascular disease mortality among the esophageal squamous severe dysplasia population,but could reduce the risk of deaths from cardio-cerebrovascular disease among men aged 55 years and older,indicating that gender and age may be critical factors that influence the effects of nutrition intervention. |
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