Submitted to: Nutrition and Cancer
Publication Type: Peer reviewed journal
Publication Acceptance Date: 11/29/2001
Publication Date: 11/1/2002
Citation: CHEN, H., TUCKER, K.L., GRAUBARD, B.I., HEINEMAN, E.F., MARKIN, R.S., POTISCHMAN, N.A., RUSSELL, R.M., WEISENBURGER, D.D., WARD, M.H. NUTRIENT INTAKES AND ADENOCARCINOMA OF THE ESOPHAGUS AND DISTAL STOMACH. NUTRITION AND CANCER. 2002;42:33-40 Interpretive Summary: The number of deaths from esophageal cancer has been increasing for more than 20 years in the United States, although experts do not fully understand why. Rates of stomach cancer, on the other hand, have been decreasing in Western countries over the past several decades, although stomach cancer is still the second most common type of cancer and cause of cancer death in the world. Diet plays an important role in the development of stomach cancer and may have contributed to the decline in incidence, but the effect of diet on esophageal cancer has been less studied. In this study, we looked at the relationship between nutrient intakes and cancer of the esophagus and stomach among 124 people with esophageal cancer, 124 with stomach cancer, and 449 with neither in eastern Nebraska. Higher intakes of vitamin A, cryptoxanthin, riboflavin, folate, zinc, fiber, protein or carbohydrate were associated with a lower risk of esophageal cancer. Only higher intakes of vitamin C, fiber or carbohydrate were associated with a lower risk of stomach cancer. Higher intake of saturated fat was associated with higher risk of both cancers among self-reporting respondents but not proxy respondents. These results suggest that greater intake of dietary fiber, certain carotenoids, and vitamins may decrease the risk of esophageal cancer, whereas greater intake of saturated fat may increase the risk of esophageal cancer and stomach cancer.
Technical Abstract: We studied the relationship between nutrient intakes and adenocarcinoma of the esophagus and distal stomach among 124 esophageal adenocarcinoma cases, 124 distal stomach cancer cases, and 449 controls in a population-based case-control study in eastern Nebraska. The residual method was used to adjust nutrient intake quartiles or tertiles for energy intake. We observed significant inverse associations with risk of esophageal adenocarcinoma for dietary intakes of total vitamin A [highest vs. lowest quartile, multivariate odds ratio (OR) = 0.5, P for trend = 0.05], -cryptoxanthin (OR = 0.5, P = 0.05), riboflavin (OR = 0.5, P = 0.01), folate (OR = 0.5, P = 0.03), zinc (OR = 0.5, P = 0.05), dietary fiber (OR = 0.5, P = 0.05), protein (OR = 0.5, P = 0.02), and carbohydrate (OR = 0.4, P = 0.02). For distal stomach cancer, only vitamin C (OR = 0.6, P = 0.04), dietary fiber (OR = 0.4, P = 0.007), and carbohydrate (OR = 0.4, P = 0.004) were inversely associated with risk. Our analyses showed significant interaction between dietary fat intake, but not intakes of other nutrients, and respondent type for both cancer sites. Subgroup analyses among self-respondents revealed positive associations between saturated fat intake and risk of esophageal adenocarcinoma (OR = 1.0, 4.1, and 4.6 for intake tertiles, P for trend = 0.02) and risk of distal stomach cancer (OR = 1.0, 1.2, and 3.6, P = 0.03). However, no such associations were found among proxy respondents. Our data suggest that greater intake of dietary fiber, certain carotenoids, and vitamins may decrease the risk of esophageal adenocarcinoma, whereas greater intake of saturated fat may increase the risk of esophageal adenocarcinoma and distal stomach cancer.