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ARS Home » Northeast Area » Boston, Massachusetts » Jean Mayer Human Nutrition Research Center On Aging » Research » Publications at this Location » Publication #307347
Title: Adherence to Mediterranean-style dietary pattern and risk of esophageal squamous cell carcinoma: a case-control study in Iran

Author
item JESSRI, MAHSA - University Of Alberta
item RASHIDKHANI, BAHRAM - Shahid Beheshti University Of Medical Sciences
item HAJIZADEH, BAHAREH - Kurdistan University Of Medical Sciences
item JACQUES, PAUL - Jean Mayer Human Nutrition Research Center On Aging At Tufts University

Submitted to: Journal of the American College of Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 5/7/2012
Publication Date: 10/1/2012
Citation: Jessri, M., Rashidkhani, B., Hajizadeh, B., Jacques, P.F. 2012. Adherence to Mediterranean-style dietary pattern and risk of esophageal squamous cell carcinoma: a case-control study in Iran. Journal of the American College of Nutrition. 31(5):338-351. DOI: 10.1080/07315724.2012.10720437.

Interpretive Summary: Esophageal squamous cell carcinoma (ESCC) is a lethal malignancy with a 5-year survival rate of less than 10%. Although it is the sixth most common cancer in the world, it ranks fourth in developing countries. ESCC occurs more frequently in certain regions of the world that are on the ‘‘esophageal cancer belt,’’ such as Iran, China, and northern France. The latest epidemiological study has reported the highest incidence rate of ESCC to be in Iran. Research has shown that cancer malignancy in Iran is unrelated to smoking and alcohol consumption, and epidemiological evidence supports the role of dietary habits influencing the development of ESCC in this region. Although several studies have examined the role of diet in ESCC, traditionally these studies have followed the approach of assessing individual food items or nutrients, and limited attention has focused on analyzing defined dietary patterns. Research has already well-established that one dietary pattern, the Mediterranean diet, yields beneficial health effects including reductions in overall mortality, cancer mortality, cardiovascular disease, hypertension, and obesity. This dietary pattern is rich in fruits, vegetables, legumes, nuts, and whole-grain cereals. It incorporates moderate red wine consumption and utilizes olive oil as the only source of added fat. Interestingly, incidence and mortality rates of upper aerodigestive tract (UADT) cancers in Mediterranean countries are substantially lower than in Western countries, even despite high tobacco smoking rates in the Mediterranean region. Thus, we hypothesize that the traditional Mediterranean diet is responsible for conveying protection against UADT cancers. The aim of the present study was, therefore, to evaluate the Mediterranean dietary pattern and the risk of ESCC in the context of a high-risk population in Iran. We examined 47 ESCC cases and 96 hospital controls with no history of ESCC. Both cases and controls reported on their typical dietary intake, and a score was created to measure how well each individual’s reported diet adhered to the Mediterranean dietary pattern. Having the highest adherence to the Mediterranean-style dietary pattern was associated with a 37% reduction in risk of ESCC, compared to having the lowest adherence. Higher intakes of olive oil, fish, other seafood, whole grains, and fruits were associated with reduced ESCC risk, as well. In contrast, higher intakes of sweets and meats were associated with higher ESCC risk. Our results indicate that consuming a Mediterranean-style diet may protect against ESCC. Preventive strategies to reduce ESCC in high-risk countries should focus on changing overall dietary patterns and dietary habits.

Technical Abstract: The benefit of adherence to a Mediterranean-style dietary pattern in relation to the risk of esophageal squamous cell carcinoma (ESCC) has not been investigated among non-Mediterranean high-risk populations. The objective of the present study was to examine the association of compliance with the Mediterranean dietary pattern as measured by Mediterranean-Style Dietary Pattern Score (MSDPS) and the risk of ESCC in Iranian population. This case-control study was conducted on 47 ESCC cases and 96 hospital controls aged 40–75 years. Participants were interviewed using validated questionnaires, and dietary patterns were characterized using the MSDPS. Generally, the mean MSDPS in this population was low (30.84 6 8.58). MSDPS showed content validity through having expected positive associations with several lifestyle characteristics and dietary intakes. Being in the highest quartile category of MSDPS, compared to the lowest, was independently associated with 37% reduction in risk of ESCC. Two-unit and 3-unit increases in the MSDPS resulted in 41% and 47% reduction in risk of ESCC, respectively. Higher intakes of olive oil (odds ratio [OR] 1/4 0.15, 95% CI: 0.01–0.49), fish and other seafood (OR ¼ 0.48, 95% CI: 0.23–0.98), whole grain (OR 1/4 0.57, 95% CI: 0.28–0.76), and fruits (OR 1/4 0.77, 95% CI: 0.38–0.86) were significantly associated with reduced ESCC risk. In contrast, higher sweet (OR 1/4 1.86, 95% CI: 1.04–2.12) and meat intakes (OR 1/4 1.61, 95% CI: 1.25–2.49) were associated with higher ESCC risk. Consuming a diet in concordance with the principles of the Mediterranean dietary pattern may protect against ESCC. Preventive strategies to reduce ESCC risk in high-risk countries should focus on overall dietary pattern and dietary habits to be effective.