基于NHANES 2007-2018的一项关于体力活动与结肠癌风险之间关系的横断面研究-动脉网

A cross-sectional study on the association between physical activity and the risk of colon cancer based on NHANES 2007–2018

Nature 等信源发布 2025-01-26 22:40

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Abstract

摘要

Colon cancer poses a significant threat to global health, and studies have shown a correlation between physical activity (PA) and the incidence of colon cancer. However, existing research has not quantitatively analyzed PA to evaluate its impact on the risk of colon cancer comprehensively. Data related to the study were obtained from the NHANES database for participants aged 20 and above between 2007 and 2018.

结肠癌对全球健康构成重大威胁，研究表明身体活动（PA）与结肠癌发病率之间存在相关性。。与该研究相关的数据来自NHANES数据库，适用于2007年至2018年间20岁及以上的参与者。

Calculate the daily total metabolic equivalent (MET) based on the duration of different physical activities for each participant, use multivariate logistic regression analysis to evaluate the association between PA and colon cancer risk, perform subgroup analysis to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) between different subgroups, and use RCS regression analysis to evaluate the non-linear relationship between MET and colon cancer risk.

根据每个参与者不同体力活动的持续时间计算每日总代谢当量（MET），使用多变量逻辑回归分析评估PA与结肠癌风险之间的关联，进行亚组分析以计算调整后的优势比（OR）和不同亚组之间的95%置信区间（CI），并使用RCS回归分析评估MET与结肠癌风险之间的非线性关系。

After adjusting for potential confounding factors, multivariate logistic regression analysis showed that compared with the overall data of the participants in this study, the OR of the low PA group (PA ≤ 120MET/day) was 1.224 (95% CI 1.031–1.453, .

在调整了潜在的混杂因素后，多因素logistic回归分析显示，与本研究参与者的总体数据相比，低PA组（PA≤120MET/天）的OR为1.224（95%CI为1.031-1.453）。

= 0.023), the OR of the mild PA group (120 < PA ≤ 600MET/day) was 1.026 (95%CI 0.707–1.488,

===0.023），轻度PA组（120×PA≤600MET/天）的OR为1.026（95%CI 0.707-1.488，

= 0.894), the OR of the moderate intensity PA group (600 < PA ≤ 1200MET/day) was 0.798 (95% CI 0.506–1.258,

P=0.894），中等强度PA组（600<PA≤1200MET/天）的OR为0.798（95%CI 0.506-1.258，

= 0.334), and the OR of the high-intensity PA group (PA > 1200MET/day) was 0.470 (95% CI 0.249–0.885,

=0.334），高强度PA组（PA>1200MET/天）的OR为0.470（95%CI为0.249-0.885，

= 0.022), these results are consistent in subgroup analysis. The RCS regression analysis results showed a significant nonlinear relationship between MET and the risk of colon cancer(

=0.022），这些结果在亚组分析中是一致的。RCS回归分析结果显示MET与结肠癌风险之间存在显着的非线性关系(

< 0.001), with an inflection point observed at 1879 MET/day on the correlation curve. Low physical activity increases the risk of colon cancer, while moderate to high-intensity physical activity can reduce the risk of colon cancer. The results of this study emphasize the importance of maintaining appropriate physical activity as a healthy way to prevent colon cancer..

<0.001），在相关曲线上观察到1879 MET/天的拐点。低体力活动会增加结肠癌的风险，而中等强度至高强度的体力活动可以降低结肠癌的风险。这项研究的结果强调了保持适当的体育锻炼作为预防结肠癌的健康方式的重要性。。

Introduction

简介

Colorectal cancer (CRC) is the most common malignant tumor of the digestive tract worldwide

结直肠癌（CRC）是全世界最常见的消化道恶性肿瘤

. The latest epidemiological data shows that colorectal cancer ranks third in the incidence rate of cancer and second in the mortality rate in the United States

最新的流行病学数据显示，结直肠癌在美国的癌症发病率排名第三，死亡率排名第二

. Colon cancer is the most common pathological subtype of colorectal cancer, accounting for approximately 70% of all colorectal cancer pathologies

结肠癌是结直肠癌最常见的病理亚型，约占所有结直肠癌病理的70%

Serious threat to human life and health. Cancer is caused by complex etiologies, involving genetic, environmental, and lifestyle factors and their interactions. Therefore, preventing cancer through lifestyle changes is a feasible approach

严重威胁人类生命和健康。癌症是由复杂的病因引起的，涉及遗传，环境和生活方式因素及其相互作用。因此，通过改变生活方式来预防癌症是一种可行的方法

. Many epidemiological studies have shown that active physical activity (PA) is beneficial to physical health, and people with PA higher than the recommended level are associated with lower incidence rates and mortality

许多流行病学研究表明，积极的体育锻炼（PA）有益于身体健康，PA高于推荐水平的人与较低的发病率和死亡率相关

. In oncology, many studies have shown a strong association between PA and cancer risk

在肿瘤学方面，许多研究表明PA与癌症风险之间有很强的关联

. In the field of tumors, numerous studies have shown a strong correlation between PA and the risk of cancer, with research indicating that higher intensity PA is associated with a reduced risk of tumor onset in breast cancer

在肿瘤领域，许多研究表明PA与癌症风险之间存在很强的相关性，研究表明，较高强度的PA与乳腺癌发病风险降低有关

, endometrial cancer

，子宫内膜癌

, lung cancer

，肺癌

, and colon cancer

和结肠癌

. Studies have also explored the potential relationship between different types of physical activity and the risk of tumor onset, with findings suggesting that increasing occupational physical activity, recreational physical activity, and physical activity during walking may help prevent the occurrence of colorectal cancer.

研究还探讨了不同类型的体育活动与肿瘤发病风险之间的潜在关系，研究结果表明，增加职业体育活动，娱乐体育活动和步行期间的体育活动可能有助于预防结直肠癌的发生。

. However, systematic review and meta-analysis studies have shown that although physical activity is associated with a reduced risk of colon cancer, the difference does not reach statistical significance

然而，系统综述和荟萃分析研究表明，尽管体育锻炼可以降低结肠癌的风险，但差异没有统计学意义

Although many studies have shown that PA is related to the incidence rate of colon cancer, the existing studies still have some limitations. First, many studies are systematic meta-analysis, which has the problem of sample heterogeneity between different studies. Secondly, current research shows that PA can reduce the risk of colon cancer, but it is well known that low physical activity is not conducive to physical health.

尽管许多研究表明PA与结肠癌的发病率有关，但现有研究仍存在一些局限性。首先，许多研究都是系统的荟萃分析，这存在不同研究之间样本异质性的问题。其次，目前的研究表明，PA可以降低结肠癌的风险，但众所周知，低体力活动不利于身体健康。

. Low physical activity does not reduce the risk of colon cancer, but may increase the risk of colon cancer. Therefore, it is urgent to conduct a quantitative analysis of PA to comprehensively evaluate its impact on the risk of colon cancer. This study used the NHANES database to assess the association between PA levels and the risk of colon cancer in adults in the United States, to find the best level of physical activity to reduce the incidence rate of colon cancer, and to improve the understanding of the potential impact of lifestyle intervention on the incidence rate of colon cancer..

低体力活动不会降低结肠癌的风险，但可能会增加结肠癌的风险。因此，迫切需要对PA进行定量分析，以全面评估其对结肠癌风险的影响。这项研究使用NHANES数据库来评估PA水平与美国成年人结肠癌风险之间的关系，以找到降低结肠癌发病率的最佳体力活动水平，并提高对生活方式干预对结肠癌发病率的潜在影响的理解。。

Materials and methods

材料和方法

Database

数据库

In this study, we utilized data from the National Health and Nutrition Examination Survey (NHANES) in the United States, a cross-sectional analysis using stratified, multi-stage probability sampling in a non-institutionalized population. Detailed demographic and health information was collected through interviews, physical examinations, and laboratory tests in mobile examination centers to assess non-institutionalized Americans’ health and nutritional status.

在这项研究中，我们利用了美国国家健康与营养调查（NHANES）的数据，这是一项横断面分析，在非制度化人群中使用分层，多阶段概率抽样。通过在流动检查中心进行访谈、体格检查和实验室检查，收集了详细的人口和健康信息，以评估非制度化美国人的健康和营养状况。

The National Center for Health Statistics (NCHS) is responsible for conducting this survey. Participation in NHANES requires filling out an informed consent form authorized by the NCHS Ethics Review Committee. Using existing NHANES data for this analysis does not require additional approval from the Institutional Review Board.

国家卫生统计中心（NCHS）负责进行这项调查。参与NHANES需要填写NCHS道德审查委员会授权的知情同意书。使用现有NHANES数据进行此分析不需要机构审查委员会的额外批准。

In this study, we used the NHANES dataset from 2007 to 2018. The data for the NHANES project can be found on the NHANES website(.

在这项研究中，我们使用了2007年至2018年的NHANES数据集。NHANES项目的数据可以在NHANES网站上找到（。

https://www.cdc.gov/nchs/nhanes/index.htm

Study population

研究人群

This study recruited individuals who had completed interviews with NHANES data from 2007 to 2018, but excluded individuals with incomplete exposure variables, outcome variables, and covariates. To ensure the accuracy of cancer outcome variables, we used the questions in the medical condition questionnaire (Have you ever been told by a doctor or other health professional that you had cancer or a malignancy of any kind? ).

这项研究招募了2007年至2018年完成NHANES数据访谈的个人，但排除了暴露变量，结果变量和协变量不完整的个人。为了确保癌症结果变量的准确性，我们使用了医疗状况问卷中的问题（医生或其他卫生专业人员是否告诉过你患有癌症或任何类型的恶性肿瘤？）。

Participants who answered ‘yes’ further determined the tumor type based on the question’ What kind of cancer was it? ‘Participants who answered’ colon ‘were classified as colon cancer positive, while those who answered’ no ‘were classified as cancer negative. Participants who answered ‘refuse’ or ‘I don’t know’ were excluded from the analysis..

回答“是”的参与者进一步根据“它是哪种癌症”的问题确定了肿瘤类型回答“结肠癌”的参与者被归类为结肠癌阳性，而回答“否”的参与者被归类为癌症阴性。回答“拒绝”或“我不知道”的参与者被排除在分析之外。。

Exposure variables

暴露变量

The PA report uses the Global Physical Activity Questionnaire (GPAQ) to provide data on the physical activity level of respondents. PA is divided into five types: high-intensity work, moderate-intensity work, walking/cycling traffic, intense recreational activities, and moderate recreational activities.

PA报告使用全球体育活动问卷（GPAQ）提供受访者体育活动水平的数据。PA分为五种类型：高强度工作，中等强度工作，步行/自行车交通，剧烈娱乐活动和中度娱乐活动。

Determine through the following 5 questions: (1) How much time do you usually spend on high-intensity activities at work every day? (2). How much time do you usually spend on moderate-intensity activities at work every day? (3). How much time do you usually spend walking or cycling for travel every day? (4).

通过以下5个问题确定：（1）你每天在工作中通常花多少时间进行高强度活动？（2）。你每天在工作中通常花多少时间进行中等强度的活动？（3）。你每天通常花多少时间步行或骑自行车旅行？（4）。

How much time do you usually spend on high-intensity exercise, fitness, or recreational activities every day? (5). How much time do you usually spend on moderate-intensity exercise, fitness, or recreational activities every day? Referring to the metabolic equivalent (MET) score recommended by NHANES, the MET score for high-intensity work and intense recreational activities is 8.0; The MET score for moderate-intensity work, walking/cycling traffic, and moderate recreational activities is 4.0.

你每天通常花多少时间在高强度运动、健身或娱乐活动上？（5）。你每天通常花多少时间在中等强度的锻炼、健身或娱乐活动上？参考NHANES推荐的代谢当量（MET）评分，高强度工作和剧烈娱乐活动的MET评分为8.0；中等强度工作、步行/自行车交通和中等娱乐活动的MET得分为4.0。

The MET of each activity is determined by multiplying its duration by the corresponding score. The total MET is calculated by adding the MET of each activity within a day..

每个活动的MET是通过将其持续时间乘以相应的分数来确定的。总MET是通过将一天内每个活动的MET相加来计算的。。

Covariance

协方差

Based on previous literature, the potential impact of multiple covariates was evaluated. Covariates include age, race/ethnicity, education level, household income, smoking habits, alcohol consumption, and sedentary time. Race/ethnic categories include: non-Hispanic white, non-Hispanic black, Mexican American, and other races.

根据以前的文献，评估了多个协变量的潜在影响。协变量包括年龄，种族/民族，教育程度，家庭收入，吸烟习惯，饮酒和久坐时间。种族/民族类别包括：非西班牙裔白人、非西班牙裔黑人、墨西哥裔美国人和其他种族。

The education level is divided into 5 groups: less than 9th grade, 9th–11th grade (including 12th grade without diploma), high school graduation/GED or equivalent, and college degree or above. Household income is evaluated based on the ratio of family income to poverty (PIR). According to previous research.

。家庭收入是根据家庭收入与贫困的比率（PIR）进行评估的。根据之前的研究。

We divided the participants into three groups: low-income (PIR ≤ 1), middle-income (1 < PIR < 4), and high-income (PIR ≥ 4). Smoking status is determined through the question (Have you smoked at least 100 cigarettes in your entire life?), where respondents who answer “yes” are defined as having a smoking history, while those who answer “no” are defined as having no smoking history.

我们将参与者分为三组：低收入（PIR≤1），中等收入者（PIR 4），和高收入人群（PIR≥4）。吸烟状况是通过这个问题来确定的（你一生中至少吸过100支香烟吗？），回答“是”的受访者被定义为有吸烟史，而回答“否”的受访者被定义为没有吸烟史。

The drinking situation is determined by the question (Had at least 12 alcohol drinks/1 year?), where a respondent’s answer of “yes” is defined as having a history of drinking, and a respondent’s answer of “no” is defined as having no history of drinking. The duration of sedentary behavior was determined with the use of questions(How much time do you usually spend sitting on a typical day?).

饮酒情况由问题决定（每一年至少饮酒12次？），其中受访者的回答“是”被定义为有饮酒史，而受访者的回答“否”被定义为没有饮酒史。久坐行为的持续时间是通过使用问题来确定的（你通常每天花多少时间坐着？）。

Many studies report that sedentary behavior (SB) time is divided into SB < 8 h/day and SB ≥ 8 h/day, which is the critical value associated with an increased risk of adverse clinical health outcomes for SB time.

许多研究报道，久坐行为（SB）时间分为SB<8小时/天和SB≥8小时/天，这是与SB时间不良临床健康结果风险增加相关的临界值。

. Therefore, based on previous studies, we divided participants into SB ≤ 4 h, 4 h< SB<8 h, and SB ≥ 8 h according to their sedentary time.

因此，根据以前的研究，我们根据久坐时间将参与者分为SB≤4小时，4小时<SB＜8小时和SB≥8小时。

Statistical analysis

统计分析

The statistical analysis of the study considered sample weights and performed weighted calculations using the R language “survey” software package. According to the distribution characteristics, categorical variables are expressed as percentages (%), and continuous variables are expressed as means (SD).

该研究的统计分析考虑了样本权重，并使用R语言“调查”软件包进行了加权计算。根据分布特征，分类变量表示为百分比（%），连续变量表示为均值（SD）。

Use t-test and Wilcoxon rank sum test to analyze the differences in continuous variables between the colon cancer group and non-tumor group. Use the chi-square test to analyze the categorical variables between two groups. Use multivariate logistic regression to investigate the association between PA and the incidence of colon cancer.

使用t检验和Wilcoxon秩和检验分析结肠癌组和非肿瘤组之间连续变量的差异。使用卡方检验分析两组之间的分类变量。使用多因素logistic回归分析PA与结肠癌发病率之间的关系。

The nonlinear relationship between PA and the incidence rate of colon cancer was further evaluated by using the RCS (Restricted cubic spline) regression analysis. Finally, we also conducted a covariate stratified subgroup analysis to assess the relationship between PA and the incidence rate of colon cancer in different subgroups..

通过使用RCS（限制性三次样条）回归分析进一步评估PA与结肠癌发病率之间的非线性关系。最后，我们还进行了协变量分层亚组分析，以评估PA与不同亚组结肠癌发病率之间的关系。。

As this study utilized the NHANES dataset, the sample size was predetermined by the survey design. As a secondary data analysis, we did not conduct preliminary statistical efficiency calculations, but focused on analyzing available data. All statistical analyses were conducted using the R 4.3.1 version.

由于这项研究使用了NHANES数据集，样本量由调查设计预先确定。作为二次数据分析，我们没有进行初步的统计效率计算，而是专注于分析可用数据。所有统计分析均使用R 4.3.1版本进行。

A p-value less than 0.05 is considered statistically significant..

p值小于0.05被认为具有统计学意义。。

Results

结果

Inclusion and exclusion criteria for the study population

研究人群的纳入和排除标准

This study collected data from six survey cycles of NHANES from 2007 to 2018, with a total of 59,842 participants. Firstly, participants under the age of 20 were excluded, followed by those with missing covariates, exposure variables, and outcome variables. The detailed study population inclusion criteria are shown in Fig. .

这项研究收集了2007年至2018年NHANES六个调查周期的数据，共有59842名参与者。首先，20岁以下的参与者被排除在外，其次是那些缺少协变量，暴露变量和结果变量的参与者。。

, and ultimately 24,677 participants were included in the final analysis (Fig.

，最终有24677名参与者被纳入最终分析（图）。

Fig. 1

图1

Study population enrollment process.

研究人口登记过程。

Full size image

全尺寸图像

Baseline characteristics

基线特征

We calculated the MET of each participant based on the duration of different types of PA and their corresponding MET scores per day. Based on previous research, it is recommended to engage in moderate-intensity physical activity for at least 30 min or more per day

我们根据不同类型PA的持续时间及其每天相应的MET分数计算了每个参与者的MET。根据以前的研究，建议每天至少进行30分钟或更长时间的中等强度体育锻炼

. We divided participants’ PA levels into four groups based on MET: low PA (PA ≤ 120MET/day), mild PA (120 < PA ≤ 600MET/day), moderate intensity PA (600 < PA ≤ 1200MET/day), and high-intensity PA (PA > 1200MET/day).

我们根据MET将参与者的PA水平分为四组：低PA（PA≤120MET/天），轻度PA（120MET≤600MET/天），中等强度PA（600 <PA≤1200MET/天）和高强度PA（PA>1200MET/天）。

Table

表

presents the baseline characteristics of all participants in detail (Table

), with a gender ratio of 24,677 participants (male: female 12200:12477) and an average age of 48.20 ± 17.30 years. Among the participants, 180 were colon cancer patients, and 24,497 participants had no history of cancer. The average age of the 180 patients with colon cancer was 69.39 ± 11.93 years old.

)，性别比为24677（男性：女性12200:12477），平均年龄为48.20±17.30岁。在参与者中，180名是结肠癌患者，24497名参与者没有癌症病史。180例结肠癌患者的平均年龄为69.39±11.93岁。

The incidence rate of men was slightly higher than that of women: 94 (52.2%) vs. 86 (47.8%). Table .

男性的发病率略高于女性：94（52.2%）比86（47.8%）。表。

also shows the relationship between exposure variables and covariates and the incidence rate of colon cancer. The results show that the incidence rate of colon cancer is significantly related to age, race, physical activity, and smoking (all

还显示了暴露变量和协变量与结肠癌发病率之间的关系。结果表明，结肠癌的发病率与年龄、种族、体育锻炼和吸烟密切相关

< 0.001).

（0.001）

Table 1 Baseline characteristics of participants.

表1参与者的基线特征。

Full size table

全尺寸表

Association between PA and the risk of colon cancer incidence

PA与结肠癌发病风险的关系

We used multivariate logistic regression to investigate the association between PA and the incidence of colon cancer. To correct the possible impact of confounding factors on the results, we constructed three models and gradually adjusted the covariates involved. In Model 1, we did not add covariates for adjustment.

我们使用多变量逻辑回归来研究PA与结肠癌发病率之间的关系。为了纠正混杂因素对结果的可能影响，我们构建了三个模型，并逐渐调整了所涉及的协变量。在模型1中，我们没有添加协变量进行调整。

In Model 2, we added social demographic factors such as age, gender, race/ethnicity, education, and household income for adjustment. Model 3 includes a comprehensive set of adjustments: age, gender, race/ethnicity, education, household income, sedentary time, smoking history, and drinking history. These adjustments corrected the potential impact of confounding factors on the results, further enhancing the reliability of the findings in this study..

在模型2中，我们添加了年龄，性别，种族/民族，教育程度和家庭收入等社会人口因素进行调整。模型3包括一套全面的调整：年龄，性别，种族/民族，教育程度，家庭收入，久坐时间，吸烟史和饮酒史。这些调整纠正了混杂因素对结果的潜在影响，进一步提高了本研究结果的可靠性。。

After adjusting for potential confounding factors, the model demonstrated a negative correlation between PA levels and the risk of colon cancer. In the fully adjusted Model 3, compared with the overall data of the participants in this study, the OR of the low PA group was 1.224 (95% CI 1.031–1.453, .

在调整了潜在的混杂因素后，该模型显示PA水平与结肠癌风险之间呈负相关。在完全调整后的模型3中，与本研究参与者的总体数据相比，低PA组的OR为1.224（95%CI为1.031-1.453）。

= 0.023), the OR of the mild PA group was 1.026 (95% CI 0.707–1.488,

=0.023），轻度PA组的OR为1.026（95%CI为0.707-1.488，

= 0.894), the OR of the moderate intensity PA group was 0.798 (95% CI 0.506–1.258,

=0.894），中等强度PA组的OR为0.798（95%CI为0.506-1.258，

= 0.334), and the OR of the high-intensity PA group was 0.470 (95% CI 0.249–0.885,

=0.334），高强度PA组的OR为0.470（95%CI为0.249-0.885，

= 0.022) (Fig.

=0.022）（图。

). After adjusting for all covariates, we found that the risk of colon cancer in the low PA group significantly increased by 22.4%. As physical activity increases, the risk of colon cancer gradually decreases. There was no significant difference in the risk of colon cancer in the mild PA group compared to the overall sample.

)。在调整了所有协变量后，我们发现低PA组结肠癌的风险显着增加了22.4%。随着体力活动的增加，结肠癌的风险逐渐降低。与整体样本相比，轻度PA组的结肠癌风险没有显着差异。

The risk of colon cancer in the moderate-intensity PA group was significantly reduced by 20.2%, and in the high-intensity PA group, the risk of colon cancer was significantly reduced by 53.0%. To further evaluate the association between PA and the risk of colon cancer, we used RCS regression analysis to assess the relationship between MET and the risk of colon cancer.

中等强度PA组结肠癌风险显着降低20.2%，高强度PA组结肠癌风险显着降低53.0%。为了进一步评估PA与结肠癌风险之间的关联，我们使用RCS回归分析来评估MET与结肠癌风险之间的关系。

As shown in Fig. .

如图所示。

, there is a significant causal relationship (P-overall:<0.001) and a significant non-linear relationship (P-non-linear:<0.001) between MET and the risk of colon cancer. The result shows that as MET increases, the risk of colon cancer gradually decreases. However, at 1879 MET/day, the correlation curve shows a turning point, indicating that increasing physical activity within a certain range can reduce the risk of colon cancer (Fig. .

，MET与结肠癌风险之间存在显着的因果关系（P总体：<0.001）和显着的非线性关系（P非线性：<0.001）。结果表明，随着MET的增加，结肠癌的风险逐渐降低。然而，在1879 MET/天时，相关曲线显示出一个转折点，表明在一定范围内增加体力活动可以降低结肠癌的风险（图）。

Fig. 2

图2

Multivariable logistic regression analyses of physical activity and risk of colon cancer incidence. Model 1: Non-adjusted. Model 2: adjusted for age, gender, race/ethnicity, education, and household income. Model 3: adjusted for age, gender, race/ethnicity, education, household income, sedentary time, smoking history, and drinking history..

体力活动和结肠癌发病风险的多变量logistic回归分析。模型1：未调整。模型2：根据年龄、性别、种族/民族、教育程度和家庭收入进行调整。模型3：根据年龄，性别，种族/民族，教育程度，家庭收入，久坐时间，吸烟史和饮酒史进行调整。。

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Fig. 3

图3

RCS regression analysis the relationship between MET and the risk of colon cancer. Significant causal relationship (P-overall:<0.001) and a significant non-linear relationship (P-non-linear:<0.001) between MET and the risk of colon cancer. At 1879 MET/day, the correlation curve shows a turning point..

RCS回归分析MET与结肠癌风险之间的关系。MET与结肠癌风险之间存在显着的因果关系（P总体：<0.001）和显着的非线性关系（P非线性：<0.001）。。。

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Subgroup analysis of the association between PA and the risk of colon cancer incidence

PA与结肠癌发病风险关系的亚组分析

We conducted subgroup analyses for four different PA levels to evaluate the impact of physical activity on the risk of colon cancer across subgroups (Figs.

我们对四种不同的PA水平进行了亚组分析，以评估身体活动对亚组结肠癌风险的影响（图）。

). Subsequently, interaction effect analysis was used to assess whether participant characteristics affected the association between physical activity (PA) and the risk of colon cancer. The results showed a significant interaction in the sedentary time subgroup (

)。随后，使用相互作用效应分析来评估参与者特征是否影响身体活动（PA）与结肠癌风险之间的关联。结果表明，久坐时间亚组之间存在显著的相互作用(

= 0.043) (Figs.

= 0.043）（图。

). Although there was an interactive effect in the sedentary time subgroup, the risk of colon cancer incidence increased in all subgroups in the low PA group (Fig.

)。虽然久坐时间亚组有交互作用，但低PA组所有亚组结肠癌发病率均增加（图）。

). It decreased in all subgroups in the high-intensity PA group (Fig.

)。它在高强度PA组的所有亚组中均下降（图）。

). This once again indicates a stable association between PA and the risk of colon cancer.

)。这再次表明PA与结肠癌风险之间存在稳定的关联。

Fig. 4

图4

Forest plots for subgroup analysis of the low PA group(PA ≤ 120MET/day).

用于低PA组亚组分析的森林图（PA≤120MET/天）。

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Fig. 5

图5

Forest plots for subgroup analysis of the mild PA group(120< PA ≤ 600MET/day).

轻度PA组亚组分析的森林图（120<PA≤600MET/天）。

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Fig. 6

图6

Forest plots for subgroup analysis of the moderate intensity PA group(600 < PA ≤ 1200MET/day).

用于中等强度PA组亚组分析的森林图（600 <PA≤ 1200MET/天）。

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Fig. 7

图7

Forest plots for subgroup analysis of the high-intensity PA group(PA>1200MET/day).

用于高强度PA组亚组分析的森林图（PA>1200MET/天）。

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Discussion

讨论

This cross-sectional study assessed the association between PA and the incidence rate of colon cancer in adults in the United States. The results showed that PA was significantly related to the incidence rate of colon cancer, and the risk of colon cancer decreased with the increase of PA intensity. Compared with all participants included in the study, the risk of colon cancer in the low PA group (.

这项横断面研究评估了PA与美国成年人结肠癌发病率之间的关系。结果表明，PA与结肠癌的发病率显着相关，结肠癌的风险随着PA强度的增加而降低。。

≤ 120MET/day) was significantly increased by 22.4% (95% CI 1.031–1.453,

≤120MET/天）显着增加了22.4%（95%CI 1.031-1.453，

= 0.023), the mild PA group (120< PA ≤ 600MET/day) had no significant impact on the incidence rate of colon cancer OR 1.026 (95% CI 0.707–1.488,

=0.023），轻度PA组（120<PA≤600MET/天）对结肠癌发病率OR 1.026（95%CI 0.707-1.488，

= 0.894), the risk of colon cancer in the moderate PA group (600< PA ≤ 1200MET/day) was reduced by 20.2% (95% CI 0.506–1.258,

=0.894），中度PA组（600 PA≤1200MET/天）结肠癌风险降低20.2%（95%CI 0.506-1.258，

= 0.334), and the risk of colon cancer in the high-intensity PA group (PA>1200MET/day) was reduced by 53.0% (95% CI 0.249–0.885,

=0.334），高强度PA组（PA>1200MET/天）结肠癌的风险降低了53.0%（95%CI 0.249-0.885，

= 0.022). The results showed that low physical activity increased the risk of colon cancer and was indeed an unhealthy lifestyle, which was consistent with previous studies

结果表明，低体力活动会增加结肠癌的风险，确实是一种不健康的生活方式，这与以前的研究一致

. Meanwhile, research has also shown that high-intensity physical activity can reduce the risk of colon cancer, consistent with previous studies

同时，研究还表明，高强度的体育锻炼可以降低结肠癌的风险，这与之前的研究一致

. This emphasizes that a reasonable and healthy lifestyle is particularly important for preventing the occurrence of colon cancer.

这强调了合理健康的生活方式对于预防结肠癌的发生尤为重要。

In the past, many studies have explored the relationship between the incidence rate of colorectal cancer and PA. One study assessed the relationship between PA and the risk of colorectal cancer in Asian people. This study recruited 63,257 adults in total. The results showed that compared with those without physical activity, any intense physical activity in men was significantly associated with a statistically significant reduction in the risk of colorectal cancer (HR = 0.84,95% CI 0.71–0.99), while there was no significant statistical significance in female participants.

过去，许多研究探讨了结直肠癌发病率与PA之间的关系。一项研究评估了PA与亚洲人结直肠癌风险之间的关系。这项研究共招募了63257名成年人。结果表明，与没有体育锻炼的人相比，男性任何剧烈的体育锻炼都会显着降低患结直肠癌的风险（HR = 0.84,95%可信区间为0.71-0.99），而女性参与者无统计学意义。

. A systematic meta-analysis of 17 cohort studies and 21 case-control studies involving approximately 3.5 million participants showed that different types of physical activity can reduce the risk of colon cancer to some extent

. However, previous studies have not quantitatively analyzed different physical activities. In this study, we systematically integrated different physical activities and converted each participant’s physical activity level into MET based on the recommended MET score by NHANES. Subsequently, participants were divided into four PA levels based on their MET scores.

然而，以前的研究没有定量分析不同的身体活动。在这项研究中，我们系统地整合了不同的体育活动，并根据NHANES推荐的MET评分将每个参与者的体育活动水平转换为MET。随后，参与者根据他们的MET分数分为四个PA水平。

The results indicate that the risk of colon cancer is significantly increased in the low PA group (PA ≤ 120MET/day), while the risk of colon cancer is significantly reduced in the high-intensity PA group (PA > 1200MET/day). Subsequent RCS regression analysis shows a significant nonlinear relationship between MET and the risk of colon cancer.

结果表明，低PA组结肠癌的风险显着增加（PA ≤ 120。随后的RCS回归分析显示MET与结肠癌风险之间存在显着的非线性关系。

As MET increases, the risk of colon cancer gradually decreases, and the curve reaches a turning point when MET is approximately 1879MET. The results of this study once again emphasize the association between PA and the risk of colon cancer, and also clarify the optimal amount of physical activity to reduce the risk of colon cancer.

随着MET的增加，结肠癌的风险逐渐降低，当MET约为1879MET时，曲线达到转折点。这项研究的结果再次强调了PA与结肠癌风险之间的关联，并阐明了减少结肠癌风险的最佳体力活动量。

Our study results suggest that for individuals engaged in non-manual work, increasing high-intensity recreational activities (such as running or playing basketball) by about one hour per day or moderate-intensity recreational activities (such as brisk walking or cycling) by about two hours can significantly reduce the risk of colon cancer..

我们的研究结果表明，对于从事非体力工作的人来说，每天增加大约一小时的高强度娱乐活动（如跑步或打篮球）或大约两小时的中等强度娱乐活动（如快走或骑自行车）可以显着降低结肠癌的风险。。

Many studies have shown that sedentary behavior can increase the risk of colon cancer

许多研究表明，久坐不动的行为会增加结肠癌的风险

. To further enhance the stability of the results, we added covariates such as sedentary behavior time, smoking, alcohol consumption, household income, education level, and race during the study. Although there is a significant interaction between sedentary behavior subgroups, this is consistent with previous studies.

为了进一步提高结果的稳定性，我们在研究期间添加了协变量，例如久坐行为时间，吸烟，饮酒，家庭收入，教育水平和种族。尽管久坐行为亚组之间存在显着的相互作用，但这与先前的研究一致。

However, subsequent subgroup analysis showed that the risk of colon cancer increased in all subgroups of the low PA group, while the risk of colon cancer decreased in all subgroups of the high-intensity PA group, once again highlighting the reliability of the results of this study. Previous studies have shown that sedentary behavior is associated with an increased risk of colon cancer.

然而，随后的亚组分析显示，低PA组所有亚组的结肠癌风险均增加，而高强度PA组所有亚组的结肠癌风险均降低，这再次突显了本研究结果的可靠性。先前的研究表明，久坐不动的行为与结肠癌风险增加有关。

Our study results also indicate that low physical activity (PA) is associated with an increased risk of colon cancer. The combined effect of these two factors leads to a significant increase in the risk of colon cancer, resulting in a significantly higher risk of colon cancer in the low PA group with high sedentary time compared to the group with low sedentary time.

我们的研究结果还表明，低体力活动（PA）与结肠癌风险增加有关。这两个因素的综合作用导致结肠癌风险显着增加，导致久坐时间高的低PA组结肠癌风险显着高于久坐时间低的组。

Conversely, in the high-intensity PA group, high levels of PA can mitigate the impact of sedentary behavior on the risk of colon cancer, thus the reduction in colon cancer risk in the high sedentary time group is significantly greater than that in the low sedentary time group. This result suggests that high-intensity physical activity is particularly important for adults who with more sedentary behavior..

相反，在高强度PA组中，高水平的PA可以减轻久坐行为对结肠癌风险的影响，因此高久坐时间组结肠癌风险的降低显着大于低久坐时间组。这一结果表明，高强度的体育锻炼对于久坐不动的成年人尤为重要。。

Many studies have explored the potential molecular mechanisms of exercise and tumor occurrence and development

许多研究探索了运动与肿瘤发生发展的潜在分子机制

. Basic research shows that exercise can alter the structure of colon crypt cells and inhibit their proliferation

基础研究表明，运动可以改变结肠隐窝细胞的结构并抑制其增殖

. Some studies have also found that exercise can increase markers of cell apoptosis in colorectal tissue

一些研究还发现，运动可以增加结直肠组织中细胞凋亡的标志物

. This may be a potential molecular mechanism by which PA reduces the risk of colon cancer. In a mouse model of colon cancer, compared with sedentary animals, exercising 6 days a week for 12 weeks on a treadmill for 1 h significantly reduced the number of large polyps (

。在结肠癌小鼠模型中，与久坐不动的动物相比，每周6天在跑步机上锻炼12周1小时可显着减少大息肉的数量(

< 0.05), tumor-associated macrophages related to colon tumor progression were reduced in the exercise group compared to the sedentary group (

<0.05），(

< 0.05)

（0.05）

. The correlation between gut microbiota and the risk of colon cancer has been confirmed by many studies

许多研究证实了肠道微生物群与结肠癌风险之间的相关性

. Exercise can promote gastrointestinal tract peristalsis, thus reducing the stimulation of harmful substances in feces on the colon, which may also be one of the possible reasons that exercise can reduce the incidence rate of colon cancer.

运动可以促进胃肠道蠕动，从而减少粪便中有害物质对结肠的刺激，这也可能是运动可以降低结肠癌发病率的可能原因之一。

However, there are also some limitations to this study. Firstly, the data in this study was sourced from the NHANES database, although the National Center for Health Statistics (NCHS) in the United States has strict quality control and professional personnel responsible for conducting questionnaire surveys.

然而，这项研究也有一些局限性。首先，本研究中的数据来自NHANES数据库，尽管美国国家卫生统计中心（NCHS）有严格的质量控制和专业人员负责进行问卷调查。

The survey results rely on self-reporting, which may lead to participant recall bias. Secondly, after collecting participants from NHANES from 2007 to 2018, some participants had incomplete data, so these incomplete participants were deleted, which may lead to potential data deletion bias. Finally, as this study utilized public datasets, the sample size was predetermined by the survey design, resulting in fewer colon cancer patients among the participants, which may lead to a decrease in statistical power..

调查结果依赖于自我报告，这可能导致参与者回忆偏差。其次，在2007年至2018年从NHANES收集参与者后，一些参与者的数据不完整，因此这些不完整的参与者被删除，这可能导致潜在的数据删除偏见。。。

Conclusion

结论

In summary, our research suggests that low physical activity is an unhealthy lifestyle that significantly increases the risk of colon cancer. In contrast, sufficient intensity of physical activity can significantly reduce the risk of colon cancer. This indicates that daily adherence to reasonable physical activity is particularly important for preventing colon cancer.

总之，我们的研究表明，低体力活动是一种不健康的生活方式，会显着增加结肠癌的风险。相反，足够强度的体育锻炼可以显着降低结肠癌的风险。这表明每天坚持合理的体育锻炼对于预防结肠癌特别重要。

At the same time, our study also highlights the association between sedentary behavior and the risk of colon cancer, and for individuals with prolonged sedentary behavior, special attention should be given to increasing physical activity..

同时，我们的研究还强调了久坐行为与结肠癌风险之间的关联，对于久坐行为持续的个体，应特别注意增加体力活动。。

Data availability

数据可用性

The data that support the findings of this study are openly available in the NHANES database: https://www.cdc.gov/nchs/nhanes/index.htm.

支持本研究结果的数据可在NHANES数据库中公开获得：https://www.cdc.gov/nchs/nhanes/index.htm.

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Acknowledgements

致谢

We are grateful to NHANES for providing the data set used in this study.

我们感谢NHANES提供本研究中使用的数据集。

Funding

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This study was supported by the Special funds for tutor of a ph.d. student in the Second Affiliated Hospital of Fujian Medical University, No.2024BD0501; the Bureau of Science and Technology of Ganzhou Municipality, No. GZ2021ZSF341.

这项研究得到了福建医科大学第二附属医院博士生导师专项资金的支持，编号为2024BD0501；赣州市科学技术局，编号：GZ2021ZSF341。

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The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China

福建医科大学第二附属医院，泉州

Daoyang Zou, Yunxian Xu, Huangzhen Xu & Tianwen Xu

邹道阳、徐云贤、徐黄珍、徐天文

Ganzhou People’s Hospital, Ganzhou, China

赣州市人民医院，赣州

Xi Xin

希欣

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Daoyang Zou

佐大阳

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Xi Xin

希欣

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Yunxian Xu

徐云徐

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Huangzhen Xu

黄振旭（音）

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Tianwen Xu

徐天文

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Contributions

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Daoyang Zou was responsible for the data analysis, data reduction, and manuscript writing of this study; Xi Xin was responsible for software support and reviewing the manuscript; Yunxian Xu was responsible for investigating and reviewing the manuscript; Huangzhen Xu was responsible for investigating and reviewing the manuscript; Tianwen Xu was responsible for obtaining funding support, designing the project idea, and reviewing the final article..

邹道阳负责本研究的数据分析，数据缩减和手稿撰写；Xi Xin负责软件支持和审阅手稿；徐云贤负责调查和审查稿件；黄振旭负责调查和审查稿件；徐天文负责获得资金支持，设计项目构想，并审查最终文章。。

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Tianwen Xu

徐天文

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Zou, D., Xin, X., Xu, Y.

佐，D，欣，X，徐，Y。