编者按：根据世界公共卫生营养协会和巴西圣保罗大学和里约热内卢州立大学制定并且已被联合国粮农组织和世界卫生组织采纳的食品新（葡萄牙语：NOVA）分类法，精加工食品主要指面包、饼干、蛋糕、冰淇淋、果酱、蜜饯、罐装糖水水果、巧克力、糖果、谷物棒、加糖麦片、薯片、调味料、甜食、奶酪、含糖水果和乳制饮料、汽水、可乐、热狗、香肠、汉堡、方便面、腌肉、熏肉、罐装蔬菜、罐装肉类、婴儿配方奶粉等非常好看美味的食品，有的甚至过度加工。这些食品为了改善色香味，往往添加了很多添加剂。植物油、人造奶油、黄油、猪油、精制糖、精制盐、淀粉、精制面粉、精制大米、蛋白粉也可以视为精加工，已经不属于天然食品。
2018年2月14日，英国医学会《英国医学杂志》在线发表法国国家农业研究院、巴黎第十三大学（北巴黎大学）、阿维森纳医院、巴西圣保罗大学的前瞻研究报告，对过度加工食品摄入量与癌症风险之间的相关性进行了评定。
该法国人群队列研究（NutriNet-Santé）于2009～2017年通过互联网招募10万4980位年龄≥18岁（平均年龄42.8岁）无癌症参与者（2万2821位男性，占21.7%；8万2159位女性，占78.3%），通过24小时饮食记录问卷，收集饮食摄入量，该问卷被设计用于登记参与者3300项不同食品日常摄入量。根据NOVA分类法，对这些食品的加工程度进行分类。通过多因素比例风险模型，对已知风险因素的影响进行校正，对过度加工食物摄入量与所有癌、乳腺癌，前列腺癌、结直肠癌风险之间的相关性进行评定。
结果发现，中位5年随访后，出现原发癌2228例，其中乳腺癌739例（绝经前264例、绝经后475例）、前列腺癌281例、结直肠癌153例。过度加工食品摄入占饮食比例每增加10%，以下癌症风险显著提高：
所有癌风险增加12%（风险比：1.12，95%：1.06～1.18，趋势P<0.001）
乳腺癌风险增加11%（风险比：1.11，95%：1.02～1.22，趋势P=0.02）
对若干饮食营养质量指标（脂肪、钠、碳水化合物的摄入量，西方饮食模式）影响因素进行校正后，上述癌症风险仍然显著提高。
因此，根据该大样本前瞻研究结果，至少对于这10万多位愿意通过互联网填写24小时3300项饮食记录问卷的法国人，过度加工食品占饮食比例每增加10%，所有癌和乳腺癌的风险显著增加超过10%。有必要开进展进一步研究，深入了解食品加工各个相关因素（营养组合、食品添加剂、包装材料、新形成污染物）对上述风险的相对影响。
对此，墨西哥国家公共卫生研究所、美国哈佛大学陈曾熙公共卫生学院发表同期述评：过度加工食品与癌症风险的相关性值得进一步仔细探索。
BMJ. 2018 Feb 14;360:k322.
Consumption of ultra-processed foods and cancer risk: results from NutriNet-Santé prospective cohort.
Fiolet T, Srour B, Sellem L, Kesse-Guyot E, Allès B, Méjean C, Deschasaux M, Fassier P, Latino-Martel P, Beslay M, Hercberg S, Lavalette C, Monteiro CA, Julia C, Touvier M.
Paris 13 University, Bobigny, France; INRA, UMR 1110 MOISA, Montpellier, France; Avicenne Hospital, AP-HP, Bobigny, France; University of Sao Paulo, Sao Paulo, Brazil.
OBJECTIVE: To assess the prospective associations between consumption of ultra-processed food and risk of cancer.
DESIGN: Population based cohort study.
SETTING AND PARTICIPANTS: 104980 participants aged at least 18 years (median age 42.8 years) from the French NutriNet-Santé cohort (2009-17). Dietary intakes were collected using repeated 24 hour dietary records, designed to register participants' usual consumption for 3300 different food items. These were categorised according to their degree of processing by the NOVA classification.
MAIN OUTCOME MEASURES: Associations between ultra-processed food intake and risk of overall, breast, prostate, and colorectal cancer assessed by multivariable Cox proportional hazard models adjusted for known risk factors.
RESULTS: Ultra-processed food intake was associated with higher overall cancer risk (n=2228 cases; hazard ratio for a 10% increment in the proportion of ultra-processed food in the diet 1.12 (95% confidence interval 1.06 to 1.18); P for trend<0.001) and breast cancer risk (n=739 cases; hazard ratio 1.11 (1.02 to 1.22); P for trend=0.02). These results remained statistically significant after adjustment for several markers of the nutritional quality of the diet (lipid, sodium, and carbohydrate intakes and/or a Western pattern derived by principal component analysis).
CONCLUSIONS: In this large prospective study, a 10% increase in the proportion of ultra-processed foods in the diet was associated with a significant increase of greater than 10% in risks of overall and breast cancer. Further studies are needed to better understand the relative effect of the various dimensions of processing (nutritional composition, food additives, contact materials, and neoformed contaminants) in these associations.
STUDY REGISTRATION: Clinicaltrials.gov NCT03335644.
PMID: 29444771
DOI: 10.1136/bmj.k322
BMJ. 2018 Feb 14;360:k599.
Ultra-processed foods and cancer: The possibility of a link deserves further careful exploration.
Monge A, Lajous M.
National Institute of Public Health, Mexico City, Mexic; Harvard T.H. Chan School of Public Health, Boston, MA.
PMID: 29444772
DOI: 10.1136/bmj.k599
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