Nutrient dietary patterns and the risk of colorectal cancer: a case–control study from Italy

Objective

The role of diet on colorectal cancer has been considered in terms of single foods and nutrients, but less frequently in terms of dietary patterns.

Methods

Data were derived from an Italian case–control study, including 1,225 subjects with cancer of the colon, 728 subjects with rectal cancer, and 4,154 hospital controls. We identified dietary patterns on a selected set of nutrients through principal component factor analysis. Odds ratios (OR) and 95% confidence intervals for both cancers were estimated using unconditional multiple logistic regression.

Results

We identified 5 major dietary patterns. Direct associations were observed between the Starch-rich pattern and both cancer of the colon (OR = 1.68) and of the rectum (OR = 1.74). Inverse relationships were found between the Vitamins and fiber pattern and rectal cancer (OR = 0.61), between the Unsaturated fats (animal source) and the Unsaturated fats (vegetable source) and cancer of the colon (OR = 0.80 and OR = 0.79, respectively). No other significant association was found.

Conclusions

The Starch-rich pattern is potentially an unfavorable indicator of risk for both colon and rectal cancer, whereas the Vitamins and fiber pattern is associated with a reduced risk of rectal cancer and the Unsaturated fats patterns with a reduced risk of colon cancer.     

Dietary fiber and stomach cancer risk: a case–control study from Italy

Objective  Fiber intake has been inversely related to stomach cancer risk, although this issue is still controversial. Methods  A case–control study was conducted in Italy between 1997 and 2007, including 230 cases with incident, histologically confirmed stomach cancer, and 547 controls with acute, non-neoplastic diseases. Dietary habits were investigated through a validated food frequency questionnaire. Results  Compared with the lowest quintile of intake, the multivariate odds ratios (ORs, including terms for major recognised confounding factors and total energy intake) for the highest quintile were 0.47 (95% confidence interval (CI): 0.28–0.79) for total fiber, 0.50 (95% CI: 0.30–0.85) for soluble non-cellulose polysaccharides (NCP), 0.39 (95% CI: 0.23–0.66) for total insoluble fiber, 0.54 (95% CI: 0.32–0.91) for insoluble NCP, 0.37 (95% CI: 0.22–0.64) for cellulose, and 0.59 (95% CI: 0.36–0.98) for lignin. With reference to the sources of fiber, an inverse association was found for fiber from vegetable (OR = 0.42, 95% CI: 0.24–0.72), and to a lesser extent from fruit (OR = 0.65, 95% CI: 0.38–1.10), but not for fiber from grain (OR = 1.25, 95% CI: 0.77–2.03). Conclusions  This study found an inverse relationship between stomach cancer risk and various types of fiber, derived, in particular, from vegetables and fruit.     

Male infertility and prostate cancer risk: a nested case–control study

The pathogenesis of prostate cancer is unclear, although experimental evidence implicates androgens as playing an important role. Infertile men frequently suffer from some degree of hypogonadism and may hence be hypothesized to be at lower risk of developing prostate cancer than fertile men. To test this hypothesis, we conducted a case–control study nested within “the Malmö Diet and Cancer Study” cohort in Sweden, inviting 661 prostate cancer cases and 661 age-matched controls to participate. Of the 975 (74%) respondents, we excluded 84 childless men with unknown fertility status. Thus, 891 men were included, providing 445 prostate cancer cases and 446 controls. Of these, 841 (94%) men were biological fathers and 50 (6%) men were infertile. Logistic regression showed that the infertile men were at significantly lower risk of being diagnosed with prostate cancer than the fertile men (odds ratio, 0.45; 95% confidence interval, 0.25–0.83). Conditional and unconditional multivariate models, adjusting for socioeconomic, anthropometric, and health-status-related factors, provided similar estimates. We conclude that enduring male infertility is associated with a reduced prostate cancer risk, thus corroborating the theory that normal testicular function, and hence most probably sufficient steroidogenesis, is an important contributing factor to the later development of this malignancy.     

Spanish Mediterranean diet and other dietary patterns and breast cancer risk: case–control EpiGEICAM study

Background:

Although there are solid findings regarding the detrimental effect of alcohol consumption, the existing evidence on the effect of other dietary factors on breast cancer (BC) risk is inconclusive. This study aimed to evaluate the association between dietary patterns and risk of BC in Spanish women, stratifying by menopausal status and tumour subtype, and to compare the results with those of Alternate Healthy Index (AHEI) and Alternate Mediterranean Diet Score (aMED).

Methods:

We recruited 1017 incident BC cases and 1017 matched healthy controls of similar age (±5 years) without a history of BC. The association between ‘a priori'' and ‘a posteriori'' developed dietary patterns and BC in general and according to menopausal status and intrinsic tumour subtypes (ER+/PR+ and HER2− HER2+ and ER−/PR− and HER2−) was evaluated using logistic and multinomial regression models.

Results:

Adherence to the Western dietary pattern was related to higher risk of BC (OR for the top vs the bottom quartile 1.46 (95% CI 1.06–2.01)), especially in premenopausal women (OR=1.75; 95% CI 1.14–2.67). In contrast, the Mediterranean pattern was related to a lower risk (OR for the top quartile vs the bottom quartile 0.56 (95% CI 0.40–0.79)). Although the deleterious effect of the Western pattern was similarly observed in all tumour subtypes, the protective effect of our Mediterranean pattern was stronger for triple-negative tumours (OR=0.32; 95% CI 0.15–0.66 and P_{heterogeneity}=0.04). No association was found between adherence to the Prudent pattern and BC risk. The associations between ‘a priori'' indices and BC risk were less marked (OR for the top vs the bottom quartile of AHEI=0.69; 95% CI 0.51–0.94 and aMED=0.74; 95% CI 0.46–1.18)).

Conclusions:

Our results confirm the harmful effect of a Western diet on BC risk, and add new evidence on the benefits of a diet rich in fruits, vegetables, legumes, oily fish and vegetable oils for preventing all BC subtypes, and particularly triple-negative tumours.     

Hypercholesterolemia and prostate cancer: a hospital-based case–control study

Objective  High levels of serum cholesterol have been proposed to increase the risk of prostate cancer but the epidemiologic evidence is limited. Methods  We conducted a hospital-based case–control study in Fargo, ND, USA, to examine the association between hypercholesterolemia and prostate cancer. Cases were men with incident, histologically confirmed prostate cancer. Controls were men without clinical cancer who were seen at the same hospital for an annual physical exam. Demographic and clinical data were abstracted from patients’ medical charts. Results  From a patient population aged 50 to 74 years old, we obtained data on 312 White cases and 319 White controls. Hypercholesterolemia was defined as total cholesterol greater than 5.17 (mmol/l). Univariate logistic regression showed a significant association between hypercholesterolemia and prostate cancer (odds ratio (OR) = 1.64, 95% confidence interval (CI): 1.19–2.27). This association changed only slightly after adjustment for age, family history of prostate cancer, body mass index, type 2 diabetes, smoking, and multivitamin use (OR = 1.58, 95% CI: 1.11–2.24). A significant association was found between low HDL and prostate cancer (OR = 1.57, 95% CI: 1.04–2.36). High LDL was associated with a 60% increased risk for prostate cancer (OR = 1.60, 95% CI: 1.09–2.34). Compared to never smokers, current smokers had an 84% increased risk for prostate cancer (OR = 1.84, 95% CI: 1.09–3.13). Conclusion  This study adds to recent evidence that hypercholesterolemia may increase the risk of prostate cancer in white men.     

Early-onset baldness and the risk of aggressive prostate cancer: findings from a case–control study

Purpose

We aimed to evaluate the associations between androgenetic alopecia at a young age and subsequent development of aggressive prostate cancer (PC).

Methods

Using a case–control design with self-administered questionnaire, we evaluated the association between aggressive PC and very early-onset balding at age 20, and early-onset balding at age 40 years in 1,941 men. Cases were men with high-grade and/or advanced stage cancer and controls were clinic based men who had undergone biopsy and were found to be histologically cancer negative. Additionally, for cases we assessed whether early-onset balding was associated with earlier onset of disease.

Results

Men with very early-onset balding at age 20 years were at increased risk for subsequent aggressive PC [odds ratio (OR) 1.51, 95% confidence interval (CI) 1.07–2.12] after adjustment for age at baseline, family history of PC, smoking status, alcohol intake, body shape, timing of growth spurt and ejaculatory frequency. Additionally, these men were diagnosed with PC approximately 16 months earlier than cases without the exposure. The effect was present particularly for men with advanced stage pT3+ disease (OR 1.68, 95% CI 1.14–2.47) while men with organ-confined high-grade (8–10) PC did not exhibit the same relationship. No significant associations were observed for men who were balding at age 40 years, given no balding at age 20.

Conclusion

Men with androgenetic alopecia at age 20 years are at increased risk of advanced stage PC. This small subset of men are potentially candidates for earlier screening and urological follow-up.

     

Dietary fat intake and prostate cancer risk: a case–control study in Spain

Objectives: Epidemiological evidence suggests that dietary factors can play a role in the etiology of prostate cancer. Results from several case–control and cohort studies on nutrient intake and prostate cancer have been unclear. The authors examined the effect of lipid intake on the risk of prostate cancer. Methods: In order to assess associations between lipid intake and prostate cancer risk, a case–control study was conducted between May 1994 and March 1998 in the Barcelona metropolitan area, Spain. Two hundred seventeen incident cases with histologically confirmed diagnosis of prostate cancer were matched to 434 hospital and community controls by age and residence. Information about food intake was gathered by a semiquantitative food-frequency questionnaire. Unconditional logistic regression was used for the analysis. Results and conclusions: Animal fat intake was associated with prostate cancer with an estimated OR for highest quartile of 2.0 (95% CI 1.2–3.2). Vitamin C intake was inversely associated with prostate cancer (OR = 0.6; 95% CI 0.3–0.9). The prostate cancer risk increased in proportion to -linolenic acid intake. In the analysis adjusting for energy and major covariables the estimated OR for upper quartile of -linolenic acid was 3.1 (95% CI 1.1–3.8). In conclusion, the association between fat intake and prostate cancer may be correlated with -linolenic acid, although the specific mechanism has to be determined.     

Inflammatory potential of diet and risk of laryngeal cancer in a case–control study from Italy

Background

Besides tobacco and alcohol, diet and inflammation have been suggested to be important risk factors for laryngeal cancer. In this study, we examined the role of diet-associated inflammation, as estimated by dietary inflammatory index (DII) scores, in laryngeal cancer in a multicentre case–control study conducted between 1992 and 2000 in Italy.

Methods

This study included 460 cases with incident, histologically confirmed laryngeal cancer, and 1,088 controls hospitalized for acute non-neoplastic diseases unrelated to tobacco and alcohol consumption. DII scores were computed from a reproducible and valid 78-item food-frequency questionnaire. Logistic regression models controlling for age, sex, study center, education, body mass index, tobacco smoking, alcohol drinking, and non-alcohol energy intake were used to estimate odds ratios (ORs) and the corresponding 95 % confidence intervals (CIs).

Results

Subjects with higher DII scores (i.e., with a more pro-inflammatory diet) had a higher risk of laryngeal cancer. The OR was 3.30 (95 % CI 2.06, 5.28; p for trend <0.0001) for the highest versus the lowest DII quartile. When DII was considered as a continuous variable, the OR was 1.27 (95 % CI 1.15, 1.40) for a one-unit (9 % of the DII range) increase. Stratified analyses produced slightly stronger associations between DII and laryngeal cancer risk among Subjects <60 years old (OR_quartile4vs1 = 4.68), overweight subjects (OR_Quartile4vs1 = 3.62), and among those with higher education (OR_Quartile4vs1 = 3.92). We also observed a strong combined effect of higher DII and tobacco smoking or alcohol consumption on risk of laryngeal cancer. Compared with non-smokers having low DII scores, the OR was 6.64 for smokers with high DII scores. Likewise, compared with non/moderate drinkers with low DII, the OR was 5.82 for heavy drinkers with high DII.

Conclusion

These results indicate that a pro-inflammatory diet is associated with increased risk of laryngeal cancer.

     

Fiber intake and pancreatic cancer risk: a case–control study

BackgroundScanty and inconsistent studies are available on the relation between dietary fiber intake and pancreatic cancer. A case–control study was carried out in northern Italy to further investigate the role of various types of dietary fibers in the etiology of pancreatic cancer.Patients and methodsCases were 326 patients with incident pancreatic cancer, excluding neuroendocrine tumors, admitted to major teaching and general hospitals during 1991–2008. Controls were 652 patients admitted for acute, nonneoplastic conditions to the same hospital network of cases. Information was elicited using a validated food frequency questionnaire. Odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) were estimated for intake quintiles of different types of fiber after allowance for total energy intake and other potential confounding factors.ResultsTotal fiber intake was inversely related to risk of pancreatic cancer (OR = 0.4 for highest versus lowest quintile of intake; 95% CI 0.2–0.7). An inverse association emerged between pancreatic cancer and both soluble (OR = 0.4; 95% CI 0.2–0.7) and total insoluble fiber (OR = 0.5; 95% CI 0.3–0.8), particularly cellulose (OR = 0.4; 95% CI 0.3–0.7) and lignin (OR = 0.5; 95% CI 0.3–0.9). Fruit fiber intake was inversely associated with pancreatic cancer (OR = 0.5; 95% CI 0.3–0.8), whereas grain fiber was not (OR = 1.2; 95% CI 0.7–2.0).ConclusionsThis study suggests that selected types of fiber and total fiber are inversely related to pancreatic cancer.     

Statins and pancreatic cancer risk: a nested case–control study

Objective  

To investigate the relationship between statin use and pancreatic cancer risk.     

Occupation and keratinocyte cancer risk: a population-based case–control study

Objective The aim of our study was to identify occupations associated with increased risk of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Methods We conducted a population-based case–control study of BCC and SCC in New Hampshire. Cases (n = 599 BCC, n = 290 SCC) and controls (n = 524) completed a self-administered residence and work history questionnaire and personal interview regarding major risk factors for skin cancer. Reported jobs were coded using the Standardized Occupational Classification system (SOC). Odds ratios (ORs) and confidence intervals (CIs) for BCC and SCC were calculated for men and women separately using unconditional logistic regression models taking into account age, education, skin reaction to sun, history of painful sunburns, time spent outdoors, and for SCC, smoking. Results Among men, we observed elevated risks of both BCC and SCC among groundskeepers and gardeners, except farm (SOC 5622). We also found that garage and service station-related occupations (SOCs 873) and to some extent food/beverage preparation/service occupations (SOC 521) were associated with BCC risk among men. Women in health services occupations (SOC 523) had elevated risks for both tumors, especially for BCC. Additionally, administrative support (SOC 46/47) occupations were related to BCC risk among women. Other occupations were associated with excess risks, but without consistent trends by duration of employment. Conclusion We observed several occupations associated with elevated BCC and SCC risk. These results resemble reported findings for cutaneous melanoma and are generally consistent with the few available studies on keratinocyte cancers.     

Alcohol and endometrial cancer risk: a case–control study and a meta-analysis

To evaluate the association between alcohol consumption and endometrial cancer risk, we analyzed data from a hospital-based case–control study, conducted in Italy between 1992 and 2006, on 454 endometrial cancer cases and 908 controls, and performed a meta-analysis updated to October 2009. Compared to never alcohol drinkers, the odds ratio was 1.03 (95% confidence interval, CI, 0.76–1.41) for ≤7, 1.27 (95% CI 0.86–1.87) for 8–14, and 1.19 (95% CI 0.80–1.77) for ≥15 drinks/week, with no trend in risk. No association emerged for wine, beer, and spirit consumption analyzed separately. The meta-analysis included 20 case–control and seven cohort studies, for a total of 13,120 cases. Compared to non/low drinkers, the pooled relative risks for drinkers were 0.90 (95% CI 0.80–1.01) for case–control studies, 1.01 (95% CI 0.90–1.14) for cohort studies, and 0.95 (95% CI 0.88–1.03) overall, with no heterogeneity between study design (p = 0.156). The overall estimate for heavy versus non/low drinkers was 1.12 (95% CI 0.87–1.45). The results were consistent according to selected study characteristics, including geographic area, definition of alcohol drinkers, and type of controls in case–control studies. Our findings provide evidence that alcohol drinking is not associated with endometrial cancer risk, although a weak positive association for very high drinkers cannot be excluded.     

Fish intake, cooking practices, and risk of prostate cancer: results from a multi-ethnic case–control study

Purpose  

Studies conducted to assess the association between fish consumption and prostate cancer (PCA) risk are inconclusive. However, few studies have distinguished between fatty and lean fish, and no studies have considered the role of different cooking practices, which may lead to differential accumulation of chemical carcinogens. In this study, we investigated the association between fish intake and localized and advanced PCA taking into account fish types (lean vs. fatty) and cooking practices.     

Vitamin and mineral use and risk of prostate cancer: the case–control surveillance study

Background  Many studies have evaluated the association between vitamin and mineral supplement use and the risk of prostate cancer, with inconclusive results. Methods  The authors examined the relation of use of multivitamins as well as several single vitamin and mineral supplements to the risk of prostate cancer risk among 1,706 prostate cancer cases and 2,404 matched controls using data from the hospital-based case–control surveillance study conducted in the United States. Odds ratios (OR) and 95% confidence intervals (CI) for risk of prostate cancer were estimated using conditional logistic regression model. Results  For use of multivitamins that did not contain zinc, the multivariable odds ratios of prostate cancer were 0.6 for 1–4 years, 0.8 for 5–9 years, and 1.2 for 10 years or more, respectively (p for trend = 0.70). Men who used zinc for ten years or more, either in a multivitamin or as a supplement, had an approximately two-fold (OR = 1.9, 95% CI: 1.0, 3.6) increased risk of prostate cancer. Vitamin E, beta-carotene, folate, and selenium use were not significantly associated with increased risk of prostate cancer. Conclusion  The finding that long-term zinc intake from multivitamins or single supplements was associated with a doubling in risk of prostate cancer adds to the growing evidence for an unfavorable effect of zinc on prostate cancer carcinogenesis.     

Urinary tract diseases and bladder cancer risk: a case–control study

Objective The role of urinary tract diseases in bladder cancer (BC) etiology is not well established. To gain more insight on the role of urinary tract diseases in bladder cancer risk, we analyzed data from a large case–control study of bladder cancer. Methods Epidemiological data were collected via in-person interview. Logistic regression analyses were used to estimate BC risk in association with prior history of urinary tract diseases. Results A total of 659 BC patients and 689 age-, gender-, -ethnicity matched controls were included in the analyses. Increased bladder cancer risk was associated with history of cystitis (OR = 1.52, 95% CI: 1.12, 2.06), however, the risk was attenuated for infections diagnosed >1 year from the time of BC diagnosis or interview. In contrast, a history of four or more kidney infections was associated with a significant decreased risk of BC (OR=0.17, 95% CI: 0.04, 0.69), and there was a significant dose-response relationship between number of episode and BC risk (P for trend = 0.002). The joint effect of smoking with cystitis, kidney infection, bladder stone, kidney stone, and prostate infection was studied but revealed no significant interaction between smoking and these urinary tract diseases. Conclusion This study does not support the concept that urinary tract infections play a major role in the development of BC. Our study has the strength of collecting diagnosis time data of urinary tract diseases to allow analyzing the impact of timing of diagnosis between cancer and urinary tract diseases. This enables us to effectively address the issue of detection bias in case–controls studies of prior urinary diseases and BC.     

Blood fatty acid patterns are associated with prostate cancer risk in a prospective nested case–control study

Background

Circulating fatty acids are highly correlated with each other, and analyzing fatty acid patterns could better capture their interactions and their relation to prostate cancer. We aimed to assess the associations between data-derived blood fatty acid patterns and prostate cancer risk.

Methods

We conducted a nested case–control study in the Physicians’ Health Study. Fatty acids levels were measured in whole blood samples of 476 cases and their matched controls by age and smoking status. Fatty acid patterns were identified using principal component analysis. Conditional logistic regression was used to estimate odds ratio (OR) and 95 % confidence interval (CI).

Results

Two patterns explaining 40.9 % of total variation in blood fatty acid levels were identified. Pattern 1, which mainly reflects polyunsaturated fatty acid metabolism, was suggestively positively related to prostate cancer risk (OR_{quintile 5 vs. quintile 1} = 1.37, 95 % CI = 0.91–2.05, P _trend = 0.07). Pattern 2, which largely reflects de novo lipogenesis, was significantly associated with higher prostate cancer risk (OR_{quintile5 vs. quintile1} = 1.63, 95 % CI = 1.04–2.55, P _trend = 0.02). This association was similar across tumor stage, grade, clinical aggressiveness categories and follow-up time.

Conclusion

The two patterns of fatty acids we identified were consistent with known interactions between fatty acid intake and metabolism. A pattern suggestive of higher activity in the de novo lipogenesis pathway was related to higher risk of prostate cancer.

     

Dietary patterns and the risk of postmenopausal breast cancer in a German case–control study

Objective  

Dietary patterns have been inconsistently associated with breast cancer risk. We assessed dietary patterns in association with postmenopausal breast cancer risk using an exploratory approach.     

Lifetime body size and prostate cancer risk in a population-based case–control study in Sweden

Purpose

The role of body size in prostate cancer etiology is unclear and potentially varies by age and disease subtype. We investigated whether body size in childhood and adulthood, including adult weight change, is related to total, low–intermediate-risk, high-risk, and fatal prostate cancer.

Methods

We used data on 1,499 incident prostate cancer cases and 1,118 population controls in Sweden. Body figure at age 10 was assessed by silhouette drawings. Adult body mass index (BMI) and weight change were based on self-reported height and weight between ages 20 and 70. We estimated odds ratios (ORs) with 95 % confidence intervals (CIs) by unconditional logistic regression.

Results

Height was positively associated with prostate cancer. Overweight/obesity in childhood was associated with a 54 % increased risk of dying from prostate cancer compared to normal weight, whereas a 27 % lower risk was seen in men who were moderately thin (drawing 2) in childhood (P _trend = 0.01). Using BMI <22.5 as a reference, we observed inverse associations between BMI 22.5 to <25 at age 20 and all prostate cancer subtypes (ORs in the range 0.72–0.82), and between mean adult BMI 25 to <27.5 and low–intermediate-risk disease (OR 0.75, 95 % CI 0.55–1.02). Moderate adult weight gain increased the risk of disease in men with low BMI at start and in short men.

Conclusions

Our comprehensive life-course approach revealed no convincing associations between anthropometric measures and prostate cancer risk. However, we found some leads that deserve further investigation, particularly for early-life body size. Our study highlights the importance of the time window of exposure in prostate cancer development.     

Proanthocyanidins and other flavonoids in relation to endometrial cancer risk: a case–control study in Italy

Background:

Because of their antioxidant and antimutagenic properties, flavonoids may reduce cancer risk. Some flavonoids have antiestrogenic effects that can inhibit the growth and proliferation of endometrial cancer cells.

Methods:

In order to examine the relation between dietary flavonoids and endometrial cancer, we analysed data from an Italian case–control study including 454 incident, histologically confirmed endometrial cancers and 908 hospital-based controls. Information was collected through a validated food-frequency questionnaire. We applied data on food and beverage composition to estimate the intake of flavanols, flavanones, flavonols, anthocyanidins, flavones, isoflavones, and proanthocyanidins. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated from multiple logistic regression models conditioned on age and study centre and adjusted for major confounding factors.

Results:

Women in the highest quartile category of proanthocyanidins with ⩾3 mers vs the first three quartile categories had an OR for endometrial cancer of 0.66 (95% CI=0.48–0.89). For no other class of flavonoids, a significant overall association was found. There was a suggestion of an inverse association for flavanones and isoflavones among women with body mass index <25 kg m⁻², and, for flavanones, among parous or non-users of hormone-replacement therapy women.

Conclusion:

High consumption of selected proanthocyanidins may reduce endometrial cancer risk.