Nutrient patterns and risk of lung cancer: A factor analysis in Uruguayan men

Adherence to Data-Driven Dietary Patterns and Lung Cancer Risk: A Systematic Review and Dose-Response Meta-Analysis

The effect of dietary patterns on lung cancer risk is currently debated. In this study, we evaluated the association between different "a posteriori" dietary patterns and lung cancer risk. The search was carried out (February 2023) through Scopus, Web of Science, and PubMed databases. Meta-analysis was performed by a random-effects model using risk values (RR and OR) extracted from the 12 selected studies. Two main dietary patterns were identified and named "Western/meat" and "Healthy/prudent". The highest adherence to the "Western/meat" dietary pattern significantly increased the lung cancer risk (OR = 1.39; 95% CI: 1.17-1.65; p = 0.0002) while the highest adherence to the "Healthy/prudent" pattern reduced it (OR = 0.65; 95% CI: 0.51-0.83; p = 0.001). A linear trend between both dietary patterns and lung cancer risk was observed. However, a statistically significant inverse dose-response trend was found only for the "Healthy/prudent" dietary pattern (regression coefficient = -0.0031, p = 0.003). Subgroup analyses showed that the "Western/meat" pattern significantly increased the lung cancer risk in former (n = 4) (OR = 1.93, 95% CI: 1.11-3.36) and current smokers (n = 7) (OR = 1.35, 95% CI: 1.06-1.71). Similarly, the "Healthy/prudent" pattern exerts a protective effect on former (n = 4) (OR = 0.61, 95% CI: 0.44-0.85) and current smokers (n = 8) (OR = 0.64, 95% CI: 0.46-0.88). For both dietary patterns, no significant effect was observed on never-smokers.

Dietary Patterns and Risk of Lung Cancer: A Systematic Review and Meta-Analyses of Observational Studies

PURPOSE OF REVIEW

Previous literature reviews summarized the associations between individual foods or food groups and lung cancer risk, but the relationship between dietary patterns and lung cancer risk has received less attention. We conducted a systematic review and meta-analyses of observational studies on the associations between dietary patterns and lung cancer risk.

RECENT FINDINGS

PubMed, Embase, and Web of Science were systematically searched from inception to February 2023. Random-effects models were used to pool relative risks (RR) on associations with at least two studies. Twelve studies reported on data-driven dietary patterns, and 17 studies reported on a priori dietary patterns. A prudent dietary pattern (high in vegetables, fruit, fish, and white meat) tended to be associated with a lower risk of lung cancer (RR = 0.81, 95% confidence interval [CI] = 0.66-1.01, n = 5). In contrast, Western dietary patterns, characterized by higher intakes of refined grains and red and processed meat, were significantly positively associated with lung cancer (RR = 1.32, 95% CI = 1.08-1.60, n = 6). Healthy dietary scores were consistently associated with a lower risk of lung cancer (Healthy Eating Index [HEI]: RR = 0.87, 95% CI = 0.80-0.95, n = 4; Alternate HEI: RR = 0.88, 95% CI = 0.81-0.95, n = 4; Dietary Approaches to Stop Hypertension: RR = 0.87, 95% CI = 0.77-0.98, n = 4; Mediterranean diet: RR = 0.87, 95% CI = 0.81-0.93, n = 10) while the dietary inflammatory index was associated with a higher risk of lung cancer (RR = 1.14, 95% CI = 1.07-1.22, n = 6). Our systematic review indicates dietary patterns characterized by a higher intake of vegetables and fruits, a lower intake of animal products, and anti-inflammation may be associated with a reduced risk of lung cancer.

Etiology of lung cancer: Evidence from epidemiologic studies

Lung cancer is one of the leading causes of cancer incidence and mortality worldwide. While smoking, radon, air pollution, as well as occupational exposure to asbestos, diesel fumes, arsenic, beryllium, cadmium, chromium, nickel, and silica are well-established risk factors, many lung cancer cases cannot be explained by these known risk factors. Over the last two decades the incidence of adenocarcinoma has risen, and it now surpasses squamous cell carcinoma as the most common histologic subtype. This increase warrants new efforts to identify additional risk factors for specific lung cancer subtypes as well as a comprehensive review of current evidence from epidemiologic studies to inform future studies. Given the myriad exposures individuals experience in real-world settings, it is essential to investigate mixture effects from complex exposures and gene-environment interactions in relation to lung cancer and its subtypes.

Lung Cancer Risk in Men and Compliance with the 2018 WCRF/AICR Cancer Prevention Recommendations

Lung cancer is the most common and deadly form of cancer worldwide, especially in men. The 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) updated cancer prevention recommendations, and a standard scoring system (2018 WCRF/AICR Score) was published. The purpose of this study was to develop the adapted version of the 2018 WCRF/AICR Score with respect to lung cancer prevention recommendation (Ad-LC WCRF/AICR Score) and to examine the association between lung cancer risk in men and the Ad-LC WCRF/AICR Score as well as its single components. A case-control study was conducted among 439 men aged 45-80 years (187 controls, 252 primary lung cancer cases). Lifestyle and dietary data were collected with a questionnaire including the 62-item food frequency questionnaire (FFQ-6^®). The Ad-LC WCRF/AICR Score was used as a categorized and continuous variable. Odds ratios (ORs) and 95% confidence intervals (95% CIs) for lung cancer risk were calculated with the partly and fully adjusted model. One component of the score was independently associated with a lower risk of lung cancer in men, regardless of the set of confounders used. In the fully adjusted model following the recommendation "Limit smoking" was associated with a lower risk of lung cancer-in the never smokers by 87% (OR: 0.13; 95% CI: 0.04-0.37; p = 0.0002) and in the moderate smokers by 45% (OR: 0.55; 95% CI: 0.33-0.91; p = 0.0189) compared with the heavy smokers as a reference. By adding the single components making up the Ad-LC WCRF/AICR Score, the combination of three components or more, reducing the risk of lung cancer compared to lower compliance as a reference by 45% to 78% and by 39% to 66% for intermediate compliance (except two models out of seven) and higher compliance, respectively. In the fully adjusted model, the risk of lung cancer for the total Ad-LC WCRF/AICR Score was lower by 47% (OR: 0.53; 95% CI: 0.32-0.88; p = 0.0129) in higher compliance with the score compared to those with the lower compliance. Each one-point increase in the Ad-LC WCRF/AICR Score reduced lung cancer risk by 34% (OR: 0.66; 95% CI: 0.45-0.95; p = 0.0267). The results support previous evidence that limiting smoking reduces the risk of lung cancer in men. It also provides an insight into cancer research by showing that following the combined 2018 cancer prevention recommendations related to diet, lifestyle and body fatness was associated with a lower risk of lung cancer in men.

Indices of Diet Quality and Risk of Lung Cancer in the Women's Health Initiative Observational Study

BACKGROUND

Prospective evidence on associations between diet quality indices and lung cancer risk is limited, particularly among older women.

OBJECTIVES

We investigated associations between 4 diet quality indices [Healthy Eating Index-2015 (HEI-2015), Alternate Healthy Eating Index 2010 (AHEI-2010), alternate Mediterranean Diet (aMED), and Dietary Approaches to Stop Hypertension (DASH)] and lung cancer incidence and mortality in the Women's Health Initiative Observational Study.

METHODS

Postmenopausal women aged 50-79 y at baseline (1993-1998) self reported their diet intake and information on relevant covariates. We used Cox proportional hazards regression models to estimate HRs and 95% CIs after controlling for age, smoking, and other relevant covariates.

RESULTS

During ∼17 y of follow-up among 86,090 participants, 1491 lung cancer cases and 1393 lung cancer deaths were documented. Dietary indices were not associated with overall lung cancer incidence but were protective against squamous cell carcinoma (12.8% of total lung cancer) cases (HEI-2015: HR: 0.85; 95% CI: 0.76, 0.96; AHEI-2010: HR: 0.87; 95% CI: 0.78, 0.98; aMED: HR: 0.90; 95% CI: 0.81, 0.99; DASH: HR: 0.87; 95% CI: 0.77, 0.98). Among the indices, only HEI-2015 showed an inverse trend (P-trend = 0.02) with overall lung cancer mortality. Smoking status or participant age at baseline did not modify the association between dietary indices and lung cancer incidence or mortality.

CONCLUSIONS

After comprehensive control of smoking exposure, we found that diet quality was not associated with overall lung cancer among postmenopausal women. However, a high-quality diet was inversely related to incident lung cancer of the squamous cell subtype. Future studies in populations with diverse age, smoking history, and dietary intake may further elucidate the relation between diet quality indices and lung cancer, especially by histological subtype.

Association of Nutrient Patterns and Their Relation with Obesity in Iranian Adults: a Population Based Study

In the present research, we have evaluated the association between patterns of nutrient intake and obesity. The present cross-sectional study recruited 850 adults aged between 20–59 years old. Dietary intakes were assessed with three 24-hour recalls. As well, data on anthropometric measures were collected. General obesity was specified as body mass index ≥ 30 kg/m². Factor analysis was conducted, and followed by a varimax rotation, was performed to extract major nutrient patterns. Our analysis identified three major nutrient patterns: The first nutrient pattern was characterized by the high consumption of saturated fatty acids (SFAs), protein, vitamins B₁, B₂, B₆, B₅, B₃, B₁₂, Zinc, and iron. The second nutrient pattern was rich in total fat, polyunsaturated fatty acids, monounsaturated fatty acids, SFAs, oleic acid, linolenic acid, zinc, vitamin E, α-tocopherol, and β-carotene. The third one was greatly loaded with protein, carbohydrate, potassium, magnesium, phosphorus, calcium, vitamin C, and folate. Women in the third quintile of the first pattern were less likely to be generally obese in the fully adjusted model (odds ratio, 0.44; 95% confidence interval, 0.25–0.75). None of the other nutrient patterns had a significant association with obesity, even after adjusting for confounders. Adherence to a nutrient pattern rich in water-soluble vitamins was significantly associated with a greater chance of general obesity among women. Further studies in other populations, along with future prospective studies, are required to confirm these findings.

Reliability and Validity of Simple Stroke Food Frequency Questionnaire (SS-FFQ) for Nutrition Monitoring in Patients with Acute Ischemic Stroke

Objectives  Standard dietary questionnaires may have some limitations in cases with stroke, particularly in those suffering from language and communication difficulties. The present study aimed to develop a dietary questionnaire appropriate for patients with acute ischemic stroke (AIS).

Materials and Methods  Major food groups ( n = 19) were first identified using the dietary questionnaire of the INTERHEART study. Using the Food Frequency Questionnaire (FFQ), an expert dietitian and a vascular neurologist then selected a total number of 68 corresponding food items from 168 available FFQ items. In the next phase, a panel of expert dietitians ( n = 10) assessed the face validity and the content validity of these 68 items and approved a total number of 62 items for the final questionnaire, namely, the Simple Stroke FFQ (SS-FFQ). Employing test-retest method, the intraclass correlation (ICC) of the SS-FFQ was subsequently calculated in 30 randomly selected cases affected with AIS. Ultimately, principal component analysis (PCA) was utilized for 153 cases with AIS to assess the construct validity of the questionnaire concerned. The SPSS Statistics software (version 18: SPSS Inc., Chicago, Illinois, United States) as well as descriptive tests including mean and percentage were additionally used to account for the baseline characteristics of the study participants.

Results  The results revealed that the reliability of the newly developed form of the SS-FFQ was perfect (ICC = 0.86). Dietary conditions were further assessed administering the SS-FFQ on 153 cases of AIS with the mean age of 63.76 ± 15.93 years. The PCA results also showed that 15 extracted items of the given questionnaire could explain 73.10% of total item variance.

Conclusions  It was concluded that the SS-FFQ was a valid and reliable questionnaire to assess nutrient intakes among patients with AIS.

Adherence to Prudent and Mediterranean Dietary Patterns Is Inversely Associated with Lung Cancer in Moderate But Not Heavy Male Polish Smokers: A Case-Control Study

Lung cancer is the most commonly diagnosed cancer in men worldwide. Studies regarding dietary patterns (DPs) and lung cancer are limited, with results remaining inconclusive, and the association of DPs with lung cancer in smokers is unclear. This study analyzed the associations between DPs, including the Polish-adapted Mediterranean diet (Polish-aMED) score, and lung cancer risk in Polish adult male smokers. This case-control study involved 439 men aged 45–80 years from northeastern Poland, including 187 newly diagnosed lung cancer cases. Dietary data was collected with a 62-item food frequency questionnaire (FFQ-6). Two approaches were applied to identify dietary patterns. The Polish-aMED score was calculated (hypothesis-driven approach) and a principal component analysis (PCA) was used to identify PCA-driven DPs (data-driven approach). A logistic regression analysis was performed to estimate the odds ratio (OR) and 95% confidence interval (95% CI) of the lung cancer risk associated with the adherence to DPs overall as well as for moderate (2.5–11 pack-years) and heavy (>11 pack-years) smokers. Among moderate smokers, the risk of lung cancer was lower by 41% (OR: 0.59; 95% CI: 0.39–0.90; p < 0.05; adjusted model) in the higher adherence to the prudent DP when compared to the lower adherence, and by 66% (OR: 0.34; 95% CI: 0.15–0.76; p < 0.05; adjusted model) in the high adherence (7–9 points) to the Polish-aMED score when compared to the low adherence (0–3 points). No significant association between the westernized traditional DP or the sweet dairy DP and lung cancer was revealed. In conclusion, the current study suggests that pro-healthy dietary patterns, including the Mediterranean pattern, may favour lower risk of lung cancer in moderate smokers, although it was not confirmed in heavy smokers.

Nutrient patterns and depressive symptoms among Australian adults

PURPOSE

Much of the current literature on the associations between diet and depression focus on single nutrients rather than nutrient patterns (NPs). We investigated the association between NPs and depressive symptoms (DepS) in an Australian adult population.

METHODS

DepS were examined at two different time points, in 2010 (Stage 3, n = 1743, 49.0% males) and 2015 [North West 2015 (NW15), n = 1,024, 46.6% males] of the North West Adelaide Health Study (NWAHS). Dietary habits were evaluated using a food frequency questionnaire (FFQ) at Stage 3. DepS were assessed using the Center for Epidemiological Studies Depression (CES-D) scale at Stage 3 and NW15. Principal component analysis was used to identify NPs as well as the factor structure of the CES-D. Log- and negative binomial regression analyses were used to assess the association between NPs and DepS scores. Ordinal logistic regression analysis was undertaken between the NPs and identified factors of the CES-D score.

RESULTS

Three NPs (from the FFQ) and two-factors (from the CES-D score) were obtained. After adjusting for known confounding variables, a 'plant-sourced' NP (β-carotene, fibre, vitamin C, potassium and α-carotene) was inversely associated with DepS at Stage 3 [prevalence ratio (PR)_Q4VsQ1, 0.78; 95% CI 0.66-0.92; p = 0.003], whereas an 'animal-sourced' (ω-3 fatty acid, monounsaturated fat, vitamin E and cholesterol) or 'mixed-source' (phosphorous, protein, vitamin B2, iodine and zinc) NP was not associated with DepS. There was an inverse relationship between the 'plant-sourced' NP and the '(absence of) positive-affect' factor from the CES-D in both stages.

CONCLUSION

The 'plant-sourced' NP is consistently and inversely associated with DepS; however, longitudinal studies are recommended to confirm these results.

Dietary patterns, BCMO1 polymorphisms, and primary lung cancer risk in a Han Chinese population: a case-control study in Southeast China

BACKGROUND

We investigated whether BCMO1 variants and dietary patterns are associated with lung cancer risk.

METHODS

Case-control study including 1166 lung cancer cases and 1179 frequency matched controls was conducted for three BCMO1 variants (rs6564851, rs12934922, and rs7501331) and four dietary patterns were investigated. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs).

RESULTS

The rs6564851, rs12934922, and rs7501331 were not found to be associated with lung cancer risk (P > 0.05). In multivariable-adjusted models, compared to the lowest quartile of the score on the "fruits and vegetables" pattern, the highest quintile was associated with a 78.4% decreased risk (OR _{Q4 vs. Q1} = 0.216; 95% CI, 0.164-0.284; P for trend < 0.001). Other patterns were not found the association. The "fruits and vegetables" pattern was associated with a reduced risk of lung cancer with all 3 SNPs irrespective of genotypes (all P for trend< 0.001). The association for the "Frugal" pattern was associated with increased risk of lung cancer among smokers (P for interaction = 0.005). The protective effects of the "cereals/wheat and meat" pattern was more evident for squamous cell carcinoma and other histological type.

CONCLUSIONS

We did not observe associations of BCMO1 variants and lung cancer. Diets rich in fruits and vegetables may be protective against lung cancer.

Associations of Mediterranean Diet and a Posteriori Derived Dietary Patterns with Breast and Lung Cancer Risk: A Case-Control Study

Lung cancer in men and breast cancer in women are the most commonly diagnosed cancers in Poland and worldwide. Results of studies involving dietary patterns (DPs) and breast or lung cancer risk in European countries outside the Mediterranean Sea region are limited and inconclusive. This study aimed to develop a ‘Polish-adapted Mediterranean Diet’ (‘Polish-aMED’) score, and then study the associations between the ‘Polish-aMED’ score and a posteriori-derived dietary patterns with breast or lung cancer risk in adult Poles. This pooled analysis of two case-control studies involved 560 subjects (280 men, 280 women) aged 40–75 years from Northeastern Poland. Diagnoses of breast cancer in 140 women and lung cancer in 140 men were found. The food frequency consumption of 21 selected food groups was collected using a 62-item Food Frequency Questionnaire (FFQ)-6. The ‘Polish-adapted Mediterranean Diet’ score which included eight items—vegetables, fruit, whole grain, fish, legumes, nuts and seeds—as well as the ratio of vegetable oils to animal fat and red and processed meat was developed (range: 0–8 points). Three DPs were identified in a Principal Component Analysis: ‘Prudent’, ‘Non-healthy’, ‘Dressings and sweetened-low-fat dairy’. In a multiple logistic regression analysis, two models were created: crude, and adjusted for age, sex, type of cancer, Body Mass Index (BMI), socioeconomic status (SES) index, overall physical activity, smoking status and alcohol abuse. The risk of breast or lung cancer was lower in the average (3–5 points) and high (6–8 points) levels of the ‘Polish-aMED’ score compared to the low (0–2 points) level by 51% (odds ratio (OR): 0.49; 95% confidence interval (Cl): 0.30–0.80; p < 0.01; adjusted) and 63% (OR: 0.37; 95% Cl: 0.21–0.64; p < 0.001; adjusted), respectively. In the middle and upper tertiles compared to the bottom tertile of the ‘Prudent’ DP, the risk of cancer was lower by 38–43% (crude) but was not significant after adjustment for confounders. In the upper compared to the bottom tertile of the ‘Non-healthy’ DP, the risk of cancer was higher by 65% (OR: 1.65; 95% Cl: 1.05–2.59; p < 0.05; adjusted). In conclusion, the Polish adaptation of the Mediterranean diet could be considered for adults living in non-Mediterranean countries for the prevention of the breast or lung cancers. Future studies should explore the role of a traditional Mediterranean diet fitted to local dietary patterns of non-Mediterranean Europeans in cancer prevention.

Different dietary patterns and reduction of lung cancer risk: A large case-control study in the U.S

Reducing lung cancer risk by modifying diet is highly desirable. We investigated whether different U.S. dietary patterns were associated with lung cancer risk. Dietary patterns were derived using exploratory factor analysis for 2139 non-small cell lung cancer (NSCLC) cases and 2163 frequency-matched controls. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs). Highest adherence (highest vs. lowest quintile) to the “Tex-Mex”, “fruits and vegetables”, and “American/Western” patterns was associated with a 55% reduced (OR = 0.45; 95% CI = 0.37–0.56; P < 0.001), 32% reduced (OR = 0.68; 95% CI = 0.55–0.85; P = 0.001), and 45% increased (OR = 1.45; 95% CI = 1.18–1.78; P < 0.001) risk of lung cancer, respectively. The effects were stronger for squamous cell carcinoma and ever smokers for the “fruits and vegetables” pattern, and stronger for other non-small cell lung cancer and never smokers for the “American/Western” pattern. Among six genome-wide association (GWA) studies-identified lung cancer susceptibility loci assessed, a variant (rs2808630) of the C-reactive protein gene modified the associations for the “fruits and vegetables” (P for interaction = 0.03) and “American/Western” (P for interaction = 0.02) patterns. Our study first showed that the “Tex-Mex” dietary pattern was associated with a reduced lung cancer risk. Also, the “fruits and vegetables” and “American/Western” patterns affected lung cancer risk, and the effects were further modified by host genetic background.

A Healthy Dietary Pattern Reduces Lung Cancer Risk: A Systematic Review and Meta-Analysis

Background: Diet and nutrients play an important role in cancer development and progress; a healthy dietary pattern has been found to be associated with several types of cancer. However, the association between a healthy eating pattern and lung cancer risk is still unclear. Objective: Therefore, we conducted a systematic review with meta-analysis to evaluate whether a healthy eating pattern might reduce lung cancer risk. Methods: We identified relevant studies from the PubMed and Embase databases up to October 2015, and the relative risks were extracted and combined by the fixed-effects model when no substantial heterogeneity was observed; otherwise, the random-effects model was employed. Subgroup and publication bias analyses were also performed. Results: Finally, eight observational studies were included in the meta-analysis. The pooled relative risk of lung cancer for the highest vs. lowest category of healthy dietary pattern was 0.81 (95% confidence interval, CI: 0.75–0.86), and no significant heterogeneity was detected. The relative risks (RRs) for non-smokers, former smokers and current smokers were 0.89 (95% CI: 0.63–1.27), 0.74 (95% CI: 0.62–0.89) and 0.86 (95% CI: 0.79–0.93), respectively. The results remained stable in subgroup analyses by other confounders and sensitivity analysis. Conclusions: The results of our meta-analysis suggest that a healthy dietary pattern is associated with a lower lung cancer risk, and they provide more beneficial evidence for changing the diet pattern in the general population.

A treelet transform analysis to relate nutrient patterns to the risk of hormonal receptor-defined breast cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC)

OBJECTIVE

Pattern analysis has emerged as a tool to depict the role of multiple nutrients/foods in relation to health outcomes. The present study aimed at extracting nutrient patterns with respect to breast cancer (BC) aetiology.

DESIGN

Nutrient patterns were derived with treelet transform (TT) and related to BC risk. TT was applied to twenty-three log-transformed nutrient densities from dietary questionnaires. Hazard ratios (HR) and 95 % confidence intervals computed using Cox proportional hazards models quantified the association between quintiles of nutrient pattern scores and risk of overall BC, and by hormonal receptor and menopausal status. Principal component analysis was applied for comparison.

SETTING

The European Prospective Investigation into Cancer and Nutrition (EPIC).

SUBJECTS

Women (n 334 850) from the EPIC study.

RESULTS

The first TT component (TC1) highlighted a pattern rich in nutrients found in animal foods loading on cholesterol, protein, retinol, vitamins B12 and D, while the second TT component (TC2) reflected a diet rich in β-carotene, riboflavin, thiamin, vitamins C and B6, fibre, Fe, Ca, K, Mg, P and folate. While TC1 was not associated with BC risk, TC2 was inversely associated with BC risk overall (HRQ5 v. Q1=0·89, 95 % CI 0·83, 0·95, P trend<0·01) and showed a significantly lower risk in oestrogen receptor-positive (HRQ5 v. Q1=0·89, 95 % CI 0·81, 0·98, P trend=0·02) and progesterone receptor-positive tumours (HRQ5 v. Q1=0·87, 95 % CI 0·77, 0·98, P trend<0·01).

CONCLUSIONS

TT produces readily interpretable sparse components explaining similar amounts of variation as principal component analysis. Our results suggest that participants with a nutrient pattern high in micronutrients found in vegetables, fruits and cereals had a lower risk of BC.

Nutrient patterns and their association with socio-demographic, lifestyle factors and obesity risk in rural South African adolescents

The aim of this study was to identify and describe the diversity of nutrient patterns and how they associate with socio-demographic and lifestyle factors including body mass index in rural black South African adolescents. Nutrient patterns were identified from quantified food frequency questionnaires (QFFQ) in 388 rural South African adolescents between the ages of 11-15 years from the Agincourt Health and Socio-demographic Surveillance System (AHDSS). Principle Component Analysis (PCA) was applied to 25 nutrients derived from QFFQs. Multiple linear regression and partial R2 models were fitted and computed respectively for each of the retained principal component (PC) scores on socio-demographic and lifestyle characteristics including body mass index (BMI) for age Z scores. Four nutrient patterns explaining 79% of the total variance were identified: PCI (26%) was characterized by animal derived nutrients; PC2 (21%) by vitamins, fibre and vegetable oil nutrients; PC3 (19%) by both animal and plant derived nutrients (mixed diet driven nutrients); and PC4 (13%) by starch and folate. A positive and significant association was observed with BMI for age Z scores per 1 standard deviation (SD) increase in PC1 (0.13 (0.02; 0.24); p = 0.02) and PC4 (0.10 (-0.01; 0.21); p = 0.05) scores only. We confirmed variability in nutrient patterns that were significantly associated with various lifestyle factors including obesity.

Low-carbohydrate diets and cardiovascular and total mortality in Japanese: a 29-year follow-up of NIPPON DATA80

Long-term safety of consuming low-carbohydrate diets (LCD) in Asian populations, whose carbohydrate intake is relatively high, is not known. In the present study, the association of LCD with CVD and total mortality was assessed using data obtained in the NIPPON DATA80 (National Integrated Project for Prospective Observation of Non-communicable Disease and Its Trends in the Aged 1980) during 29 years of follow-up. At baseline in 1980, data were collected from study participants aged ≥ 30 years from randomly selected areas in Japan. LCD scores were calculated based on the percentage of energy as carbohydrate, fat and protein, estimated by 3 d weighed food records. A total of 9200 participants (56% women, mean age 51 years) were followed up. During the follow-up, 1171 CVD deaths (52% in women) and 3443 total deaths (48% in women) occurred. The multivariable-adjusted hazard ratio (HR) for CVD mortality using the Cox model comparing the highest v. lowest deciles of LCD score was 0·60 (95% CI 0·38, 0·94; P(trend) = 0·021) for women and 0·78 (95% CI 0·58, 1·05; P(trend) = 0·079) for women and men combined; the HR for total mortality was 0·74 (95% CI 0·57, 0·95; P(trend) = 0·029) for women and 0·87 (95% CI 0·74, 1·02; P(trend) = 0·090) for women and men combined. None of the associations was statistically significant in men. No differential effects of animal-based and plant-fish-based LCD were observed. In conclusions, moderate diets lower in carbohydrate and higher in protein and fat are significantly inversely associated with CVD and total mortality in women.

Nutrient patterns and their food sources in an International Study Setting: report from the EPIC study

BACKGROUND

Compared to food patterns, nutrient patterns have been rarely used particularly at international level. We studied, in the context of a multi-center study with heterogeneous data, the methodological challenges regarding pattern analyses.

METHODOLOGY/PRINCIPAL FINDINGS

We identified nutrient patterns from food frequency questionnaires (FFQ) in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study and used 24-hour dietary recall (24-HDR) data to validate and describe the nutrient patterns and their related food sources. Associations between lifestyle factors and the nutrient patterns were also examined. Principal component analysis (PCA) was applied on 23 nutrients derived from country-specific FFQ combining data from all EPIC centers (N = 477,312). Harmonized 24-HDRs available for a representative sample of the EPIC populations (N = 34,436) provided accurate mean group estimates of nutrients and foods by quintiles of pattern scores, presented graphically. An overall PCA combining all data captured a good proportion of the variance explained in each EPIC center. Four nutrient patterns were identified explaining 67% of the total variance: Principle component (PC) 1 was characterized by a high contribution of nutrients from plant food sources and a low contribution of nutrients from animal food sources; PC2 by a high contribution of micro-nutrients and proteins; PC3 was characterized by polyunsaturated fatty acids and vitamin D; PC4 was characterized by calcium, proteins, riboflavin, and phosphorus. The nutrients with high loadings on a particular pattern as derived from country-specific FFQ also showed high deviations in their mean EPIC intakes by quintiles of pattern scores when estimated from 24-HDR. Center and energy intake explained most of the variability in pattern scores.

CONCLUSION/SIGNIFICANCE

The use of 24-HDR enabled internal validation and facilitated the interpretation of the nutrient patterns derived from FFQs in term of food sources. These outcomes open research opportunities and perspectives of using nutrient patterns in future studies particularly at international level.

Dietary patterns and risk of cancers of the upper aerodigestive tract: a factor analysis in Uruguay

In the time period 1996-2004, we conducted a case-control study in Montevideo, Uruguay with the objective of exploring the role of foods and alcoholic beverages in the etiology of cancers of the upper aerodigestive tract (UADT). In brief, 563 male cases and 1099 male controls were frequency matched on age and residence using random sampling. All the participants were drawn from the 4 major public hospitals in Montevideo. We used exploratory factor analysis among controls. Through Scree plot test, the model retained 4 factors, which were labeled as prudent, starchy plants, Western, and drinker. These dietary patterns explained 34.8% of the total variance. Whereas the prudent pattern was inversely associated with UADT cancer [odds ratios (OR) for the upper tertile vs. the lowest one 0.52, 95% confidence intervals 0.32-0.76, P value for trend = 0.0005), the remaining patterns were significantly and positively associated with UADT cancers. We conclude that these patterns were similar among the oral and laryngeal cancers, both in the direction of the ORs and in the magnitude of the associations, suggesting that these cancer sites share the effect of dietary patterns in the etiology of cancer of the upper aerodigestive tract.

Dietary pattern and oral cancer risk--a factor analysis study

OBJECTIVES

The role of diet in cancer risk has mainly been investigated based on intake of individual food items. However, food consumption is made up of a combination of various food items. This study aims to determine the association of dietary patterns with oral cancer risk.

METHODS

A total of 306 matched cases and controls were recruited in this study. Data on dietary intake were obtained using food frequency questionnaire (FFQ). Factor analysis (FA) was performed to identify dietary patterns based on the intake of nine major food groups, resulting in four factors/components being retained. The odds ratio (OR) was computed for each component using conditional logistic regression.

RESULTS

The first pattern labelled as 'modern' was loaded with processed foods and snacks, whereas the second pattern termed as 'prudent' was characterized by intake of fruits and vegetables. The third pattern labelled as 'traditional' consisted of beverages and starches, while the fourth pattern termed as 'combination' was loaded with intakes of dairy, fermented/salted and meat/by-products. A significant reduced risk was found for 'prudent' (OR 0.53, 95% CI = 0.28-0.98), whereas an increased risk was found for both 'combination' (OR 2.43, 95% CI = 1.33-4.45) and 'traditional' (OR 2.32, 95% CI = 1.23-4.25) patterns. However, after adjusting for risk habits of tobacco smoking, alcohol consumption and betel quid chewing, only 'combination' (aOR 2.99, 95% CI = 1.55-5.75) and 'traditional' (aOR 2.08, 95% CI = 1.09-3.97) patterns remained significant.

CONCLUSION

Consumption in the highest tertile of 'traditional' and 'combination' patterns may induce twice and thrice the risk of oral cancer, respectively.

Pattern Discovery from Biological Data

Extracting useful information from structured and unstructured biological data is crucial in the health industry. Some examples include medical practitioner’s need to identify breast cancer patient in the early stage, estimate survival time of a heart disease patient, or recognize uncommon disease characteristics which suddenly appear. Currently there is an explosion in biological data available in the data bases. But information extraction and true open access to data are require time to resolve issues such as ethical clearance. The emergence of novel IT technologies allows health practitioners to facilitate the comprehensive analyses of medical images, genomes, transcriptomes, and proteomes in health and disease. The information that is extracted from such technologies may soon exert a dramatic change in the pace of medical research and impact considerably on the care of patients. The current research will review the existing technologies being used in heart and cancer research. Finally this research will provide some possible solutions to overcome the limitations of existing technologies. In summary the primary objective of this research is to investigate how existing modern machine learning techniques (with their strength and limitations) are being used in the indent of heartbeat related disease and the early detection of cancer in patients. After an extensive literature review these are the objectives chosen: to develop a new approach to find the association between diseases such as high blood pressure, stroke and heartbeat, to propose an improved feature selection method to analyze huge images and microarray databases for machine learning algorithms in cancer research, to find an automatic distance function selection method for clustering tasks, to discover the most significant risk factors for specific cancers, and to determine the preventive factors for specific cancers that are aligned with the most significant risk factors. Therefore we propose a research plan to attain these objectives within this chapter. The possible solutions of the above objectives are: new heartbeat identification techniques show promising association with the heartbeat patterns and diseases, sensitivity based feature selection methods will be applied to early cancer patient classification, meta learning approaches will be adopted in clustering algorithms to select an automatic distance function, and Apriori algorithm will be applied to discover the significant risks and preventive factors for specific cancers. We expect this research will add significant contributions to the medical professional to enable more accurate diagnosis and better patient care. It will also contribute in other area such as biomedical modeling, medical image analysis and early diseases warning.

Dietary patterns and risk of adenocarcinoma of the lung in males: a factor analysis in Uruguay

In the period 1996-2004, a hospital-based case-control study on diet and adenocarcinoma of the lung in men was conducted in Montevideo, Uruguay. The study included 200 cases and 800 controls, frequency matched on age, residence, and interviewers. Factor analysis (principal components) was used to identify the major food patterns associated with adenocarcinoma. The analysis of food groups led to the identification of 4 patterns, arbitrarily labeled as Western, starchy vegetables, prudent, and milk/coffee. Whereas the Western pattern (OR 1.94, 95% CI 1.08-3.45) and the milk/coffee pattern (OR 2.30, 95% CI 1.35-3.90) were positively associated with risk of adenocarcinoma of the lung, the starchy vegetables (OR 0.49, 95% 0.28-0.86) and prudent patterns (OR 0.54, 95% CI 0.32-0.92) were significantly protective against this malignancy. The results suggests that adenocarcinoma of the lung could be considered a different nosologic entity, compared with the other histologies of lung cancer.

Region-specific nutrient intake patterns exhibit a geographical gradient within and between European countries

Until recently, the study of nutrient patterns was hampered at an international level by a lack of standardization of both dietary methods and nutrient databases. We aimed to describe the diversity of nutrient patterns in the European Prospective Investigation into Cancer and Nutrition (EPIC) study at population level as a starting point for future nutrient pattern analyses and their associations with chronic diseases in multi-center studies. In this cross-sectional study, 36,034 persons aged 35-74 y were administered a single, standardized 24-h dietary recall. Intake of 25 nutrients (excluding intake from dietary supplements) was estimated using a standardized nutrient database. We used a graphic presentation of mean nutrient intakes by region and sex relative to the overall EPIC means to contrast patterns within and between 10 European countries. In Mediterranean regions, including Greece, Italy, and the southern centers of Spain, the nutrient pattern was dominated by relatively high intakes of vitamin E and monounsaturated fatty acids (MUFA), whereas intakes of retinol and vitamin D were relatively low. In contrast, in Nordic countries, including Norway, Sweden, and Denmark, reported intake of these same nutrients resulted in almost the opposite pattern. Population groups in Germany, The Netherlands, and the UK shared a fatty acid pattern of relatively high intakes of PUFA and SFA and relatively low intakes of MUFA, in combination with a relatively high intake of sugar. We confirmed large variability in nutrient intakes across the EPIC study populations and identified 3 main region-specific patterns with a geographical gradient within and between European countries.

No effect of meat, meat cooking preferences, meat mutagens or heme iron on lung cancer risk in the prostate, lung, colorectal and ovarian cancer screening trial

Recent epidemiological studies have suggested that red and processed meat may increase the risk of lung cancer. Possible underlying mechanisms include mutagens produced during high-temperature cooking or preservation, or formed endogenously from heme iron in meat. We used data from 99,579 participants of both screened and nonscreened arms of the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial, aged 55-74 years, to investigate whether meat type, cooking method, doneness level, intake of specific meat mutagens 2-amino-3,8-dimethylimidazo[4,5-f]quinoxaline (MeIQx), 2-amino-3,4,8-trimethylimidazo[4,5-f]quinoxaline] (DiMeIQx), 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP) and benzo(a)pyrene (B(a)P)] and heme iron are associated with lung cancer. Participants' diet was assessed prospectively using a 124-item food frequency questionnaire and an additional meat-cooking module. Dietary data were used in conjunction with a database to estimate intake of MeIQx, DiMeIQx, PhIP, B(a)P and heme iron. After up to 8 years of follow-up, 782 incident lung cancer cases were ascertained. Lung cancer risk was not associated with the consumption of either red (men: HR(Q₅ vs. Q₁) = 1.11, 95% CI = 0.79-1.56, P(trend) = 0.42; women: HR(Q₅ vs. Q₁) = 1.30, 95% CI = 0.87-1.95, P(trend) = 0.65) or processed meat (men: HR(Q₅ vs. Q₁1) = 1.12, 95% CI = 0.83-1.53, P(trend) = 0.22; women: HR(Q₅ vs. Q₁) = 0.98, 95% CI = 0.68-1.41, P(trend) = 0.32) in multivariable models. High-temperature cooking methods, level of meat doneness, meat mutagens and heme iron had no effect on lung cancer risk. In this population, we found no association between meat type, cooking method, doneness level or intake of specific meat mutagens or heme iron and lung cancer risk.

A prospective study of meat, cooking methods, meat mutagens, heme iron, and lung cancer risks

BACKGROUND

Red and processed meat consumption may play a role in lung cancer pathogenesis because of these meats' fat and carcinogen content.

OBJECTIVE

We prospectively investigated whether meat type, cooking method, doneness level, and intake of specific meat mutagens and heme iron are associated with lung carcinoma.

DESIGN

Men (n = 278,380) and women (n = 189,596) from the National Institutes of Health-AARP Diet and Health Study with no history of cancer at baseline were monitored for 8 y. Diet was assessed with a 124-item food-frequency questionnaire. A meat-cooking module was used to estimate the intake of individual heterocyclic amines, benzo(a)pyrene, and heme iron. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% CIs.

RESULTS

In a comparison of quintiles 5 with 1 (Q5vsQ1), a high intake of red meat was associated with an increased risk of lung carcinoma in both men (HR(Q5vsQ1): 1.22; 95% CI: 1.09, 1.38; P for trend = 0.005) and women (HR(Q5vsQ1): 1.13; 95% CI: 0.97, 1.32; P for trend = 0.05). A high intake of processed meat increased the risk only in men (HR(Q5vsQ1): 1.23; 95% CI: 1.10, 1.37; P for trend = 0.003). In an analysis stratified by smoking status, we observed a tendency for an increased risk with red meat intake in never smoking men and women; however, the risks were not statistically significant. In a comparison of tertiles 3 and 1 (T3vsT1), the risk of lung carcinoma was associated with intake of well-/very-well-done meat (HR(T3vsT1): 1.20; 95% CI: 1.07, 1.35; P for trend = 0.002) and the intake of 2-amino-3,8-dimethylimidazo[4,5-f]quinoxaline (HR(Q5vsQ1): 1.20; 95% CI: 1.04, 1.38; P for trend = 0.04) in men. Heme iron intake increased the risk of lung carcinoma in both men (HR(Q5vsQ1): 1.25; 95% CI: 1.07, 1.45; P for trend = 0.02) and women (HR(Q5vsQ1): 1.18; 95% CI: 0.99, 1.42; P for trend = 0.002).

CONCLUSION

We observed a moderate association between meat consumption and lung carcinoma, which might be explained by heme iron intake, high-temperature cooking, and associated mutagens.