Dietary intake and breast cancer risk in black South African women: the South African Breast Cancer study

Nut consumption and urogenital and genital, gastrointestinal and women-related cancers: Assessment and review

The prevalence of cancer, especially in industrial countries, is a major problem for health and treatment systems. Cancer can affect the quality of life of all family members and has many negative effects on the community. Despite many advances in cancer treatment, this disease is still a major worldwide problem. There is strong evidence that dietary habits are effective in protecting against cancer and even helping in the disease treatment progress. Nuts with various biologically-active compounds, such as vitamins, phytosterols, isoflavones, flavonoids, and polyphenols have been reported to possess anticarcinogenic properties. Accordingly, this review provides an insight into the association between nut consumption and the prevention of some cancers. We considered the cancers related to the urogenital and genital tract, gastrointestinal tract, as well as women-related cancers. Both cell culture examinations and experimental animal studies alongside observational epidemiological studies demonstrated that regular consumption of a nut-enriched diet is able to reduce the risk of these cancers.

Risk factors for breast cancer among women in Ekurhuleni Metropolitan Municipality, Gauteng province of South Africa, 2017‒2020: a case-control study

Introduction

Breast cancer (BC) is the most common cancer among women in South Africa (SA), with an age-standardised incidence rate of 52.6 and an age-standardised mortality rate of 16.0 per 100,000 population. There is a paucity of evidence on the risk factors for BC among women of all races in SA. Given the rising prevalence of BC in SA, literature-based evidence is critical for the appropriate dissemination of preventative measures. This study aimed to identify the risk factors associated with the development of BC among women in Ekhuruleni Metropolitan Municipality.

Methods

An unmatched case-control study was conducted from 1 January 2017 to 31 December 2020 using secondary data extracted from the Ekurhuleni Population-Based Cancer Registry. Unconditional multivariable logistic regression analysis was carried out using the adjusted odds ratio (aOR). The variables race, employment, human immunodeficiency virus (HIV), smoking and alcohol status were included in the multivariable logistic regression model while the model was adjusted for age.

Results

A total of 2,217 cases and 851 controls were enrolled in the study. The mean age (±SD) in years was 55.7 (±15.2). The White population group, being self-employed and being HIV positive was significantly associated with reduced odds of BC development. HIV-positive women were 61% less likely to have BC than women who were HIV-negative (aOR 0.39; 95% confidence interval (CI): 0.27‒0.57). White women were 65% less likely to have BC than women of other races (aOR 0.35; 95% CI: 0.29‒0.43). Self-employed women were 59% less likely to have BC than women who were formally employed (aOR 0.41; 95% CI: 0.18‒0.97). No evidence of association was observed between tobacco smoking and BC as well as alcohol consumption and BC.

Conclusion

There was a 65% reduction in BC risk among White women compared to other races. HIV-positive women demonstrated a 61% lower likelihood of BC while self-employed women showed a 59% reduced risk of developing BC. These findings suggest that being White, self-employed or HIV-positive may provide some protection against BC. However, additional research is needed to validate these results and establish the underlying reasons behind these associations.

Ultra-processed food consumption and cancer risk: A systematic review and meta-analysis

BACKGROUND

Ultra-processed foods (UPF) have become a staple of the diet in many countries, concomitant with increases in non-communicable diseases including cancer.

AIM

The aim of this systematic literature review was to evaluate associations between the consumption of UPF and cancer risk.

METHODS

A systematic literature search for observational studies investigating the association between cancer risk and UPF consumption, determined by the NOVA classification system, was performed. Random-effects meta-analyses were conducted. Independent review and risk of bias assessment was performed independently by the authors using the National Institutes of Health's Study Quality Assessment Tools.

RESULTS

Eleven reports were identified, including eight retrospective case-control studies and three prospective cohorts. The outcome was risk of total cancer and/or one or more of the following cancers: colorectal, breast, prostate, pancreatic, chronic lymphocytic leukemia and central nervous system tumors. Nine studies reported a significant positive association between UPF intake and all the assessed cancers except prostate, after adjustment for confounding factors including obesity and total energy intake. A 10% increment in the diet's proportion of UPF was associated with increased risk of overall cancer (HR = 1.13, 95% CI 1.07 to 1.18) and breast cancer (HR = 1.11, 95% CI 1.01 to 1.21). In addition, a high intake of UPF was associated with increased risk of colorectal cancer (ORT3 vs. T1 = 1.30, 95% CI 1.11 to 1.51) and pancreatic cancer (HRQ4 vs. Q1 = 1.49, 95% CI 1.07 to 2.07). More modest associations were found for chronic lymphocytic leukemia and central nervous system tumors. Common limitations of several of the studies included no prior assessment of diet before known diagnosis (the case-control studies), higher participation rates among cases, and likely misclassification of several foods as UPF or non-UPF.

CONCLUSION

In conclusion, the available suggestive evidence shows a consistent significant association between intake of UPF and the risk of overall and several cancers, including colorectal-, breast- and pancreatic cancer. These data may inform updated dietary guidelines, policy makers and the public towards improving public health.

Dietary patterns and breast cancer risk, prognosis, and quality of life: A systematic review

Background

Statistics indicate that the morbidity of breast cancer is increasing globally, and its (overall figures) incidence has now surpassed that of lung cancer for the first time. The relation between a whole dietary pattern, rather than of a single food or nutrient, and breast cancer (BC) should be examined for findings to capture the complexities of diet and the potential for synergism between dietary components. Hence, the effects of dietary patterns on breast cancer have recently attracted increasing attention.

Objective

To systematically review the effects of dietary patterns on breast cancer risk, prognosis, and quality of life in survivors.

Methods

This systematic review was conducted following PRISMA guidelines and was registered in PROSPERO. Data from Ovid, China Biomedical Literature Database, Wanfang Data Knowledge Service Platform, CNKI, PubMed, Weipu, The Cochrane Library, Duxiu Data, ProQuest, Embase, Web of Science, and Scopus Database were retrieved and evaluated.

Results

A total of 47 studies that investigated the association between eating patterns and breast cancer were identified. Ten studies evaluated the effect of the model on treatment outcome and prognosis of breast cancer and two cross-sectional studies examined the influence of dietary patterns on quality of life. The resulting favorable dietary patterns were shown to regulate metabolic biomarkers, antioxidants, anti-inflammatory agents, and protective genes, and inhibit cell proliferation and invasion.

Conclusion

Numerous studies have examined the effects of healthy eating, plant-based, anti-inflammation, low-fat, and other favorable dietary patterns in relation to breast cancer. However, few studies reported significant associations and the studies had limitations, suggesting that the current findings should be interpreted with caution.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, CRD4202 2350171.

Degree of food processing and breast cancer risk in black urban women from Soweto, South African: the South African Breast Cancer study

This study aimed to investigate the association between consumption of ultra-processed foods, whole foods and breast cancer risk in black women from Soweto, South Africa. A population-based case (n 396)-control (n 396) study matched on age and residence, using data from the South African Breast Cancer study. Dietary intake was assessed using a validated quantified FFQ. Food items were categorised using the NOVA system ((1) unprocessed/minimally processed foods, (2) culinary ingredients, (3) processed foods and (4) ultra-processed foods). Conditional logistic regression models were used to estimate OR and 95 % CI of dietary contributions from each NOVA food group (as a percentage of total energy intake (EI)) and adjusting for potential confounders. Considering contributions to total EI per day, ultra-processed food consumption contributed to 44·8 % in cases and 47·9 % in controls, while unprocessed/minimally processed foods contributed to 38·8 % in cases and 35·2 % in controls. Unprocessed/minimally processed food consumption showed an inverse association with breast cancer risk overall (OR = 0·52, 95 % CI 0·35, 0·78), as well as in pre- and postmenopausal women separately (OR = 0·52, 95 % CI 0·27, 0·95 and OR = 0·55, 95 % CI 0·35, 0·89, respectively) and in women with progesterone positive breast cancer (OR = 0·23, 95 % CI 0·06, 0·86). There was no heterogeneity in association with breast cancer when analyses were stratified according to BMI. No significant associations were observed for the consumption of other NOVA food groups. Intake of unprocessed/minimally processed foods may reduce the risk of developing breast cancer in black women from Soweto, South Africa.

A matched case-control study of bean intake and breast cancer risk in urbanized Nigerian women

PURPOSE

Bean intake has been associated with reduced risk of breast cancer, however; only a few studies considered molecular subtypes status and none in African women living in Sub-Saharan Africa (SSA). Therefore, the purpose of this study was to examine the associations between dietary intake of beans and breast cancer including its subtypes in Nigerian women.

METHODS

Overall, 472 newly diagnosed patients with primary invasive breast cancer were age-matched (± 5 years) with 472 controls from the Nigerian Integrative Epidemiology of Breast Cancer (NIBBLE) Study from 01/2014 to 07/2016. We collected the dietary intake of beans using a food frequency questionnaire (FFQ). Beans_alone intake was categorized into three levels never (never in the past year), low (≤ 1 portion/week), and high intake (> 1 portion/week). We used conditional and unconditional logistic regression models to estimate the Odds Ratio (OR) and 95% Confidence Intervals (CI) of beans_alone intake and the risk of breast cancer and by its molecular subtypes, respectively.

RESULTS

The mean (SD) age of cases was 44.4(10.0) and of controls was 43.5(9.5) years. In the case group, more than half (51.1%) have never consumed beans_alone in the past year compared to 39.0% in the control group. The multivariable models showed inverse associations between beans_alone (high vs. none) and breast cancer (OR = 0.55; 95%CI: 0.36-0.86, p-trend = 0.03), triple-negative (OR = 0.51 95%CI: 0.28-0.95, p-trend = 0.02) and marginally associated with hormone receptor-positive (OR = 0.53, 95%CI: 0.29-0.96, p-trend = 0.06).

CONCLUSION

Dietary intake of beans_alone may play a significant role in reducing the incidence of breast cancer, particularly of the more aggressive molecular subtype, triple-negative, in African women living in SSA.

Impacts of nutritive and bioactive compounds on cancer development and therapy

For persons who survive with progressive cancer, nutritional therapy and exercise may be significant factors to improve the health condition and life quality of cancer patients. Nutritional therapy and medications are essential to managing progressive cancer. Cancer survivors, as well as cancer patients, are mostly extremely encouraged to search for knowledge about the selection of diet, exercise, and dietary supplements to recover as well as maintain their treatment consequences, living quality, and survival of patients. A healthy diet plays an important role in cancer treatment. Different articles are studied to collect information and knowledge about the use of nutrients in cancer treatment as well as cancer prevention. The report deliberates nutrition and exercise strategies during the range of cancer care, emphasizing significant concerns during treatment of cancer and for patients of advanced cancer, but concentrating mostly on the requirements of the population of persons who are healthy or who have constant disease following their repossession from management. It also deliberates choice nutrition and exercise problems such as dietary supplements, food care, food selections, and weight; problems interrelated to designated cancer sites, and common questions about diet, and cancer survival. Decrease the side effects of medicines both during and after treatment.

The African Female Breast Cancer Epidemiology Study Protocol

Breast cancer is now the commonest cancer in most sub-Saharan African countries. Few studies of the epidemiology and genomics of breast cancer and its molecular subtypes in these countries have been done. The African Female Breast Cancer Epidemiology (AFBRECANE) study, a part of the Human Heredity and Health in Africa (H3Africa) initiative, is designed to study the genomics and epidemiology of breast cancer and its molecular subtypes in Nigerian women. We link recruitment of breast cancer cases at study sites with population-based cancer registries activities to enable ascertainment of the incidence of breast cancer and its molecular subtypes. We use centralized laboratory processing to characterize the histopathological and molecular diagnosis of breast cancer and its subtypes using multiple technologies. By combining genome-wide association study (GWAS) data from this study with that generated from 12,000 women participating in our prospective cohort study of cervical cancer, we conduct GWAS of breast cancer in an entirely indigenous African population. We test associations between dietary intakes and breast cancer and focus on vitamin D which we measure using dietary intakes, serum vitamin D, and Mendelian randomization. This paper describes the AFBRECANE project, its design, objectives and anticipated contributions to knowledge and understanding of breast cancer.

Adherence to cancer prevention recommendations is associated with a lower breast cancer risk in black urban South African women

Breast cancer prevention is of great importance to reduce high incidence in South Africa. This study aimed to investigate adherence to the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Cancer Prevention Recommendations and the association with breast cancer risk in black urban women from Soweto, South Africa. A total of 396 breast cancer cases and 396 population-based controls from the South African Breast Cancer study (SABC) matched on age and demographic settings were included. Validated questionnaires were used to collect dietary and epidemiological data. To assess adherence to these recommendations, an eight-point adherence score was developed, using tertiles among controls for scoring each recommendation (0, 0·5 and 1) with zero indicating the lowest adherence to the recommendations. OR and 95 % CI were estimated using multivariate logistic regression models to analyse associations between the WCRF/AICR score and breast cancer risk. Greater adherence (>4·5 v. <3·25) to the 2018 WCRF/AICR Cancer Prevention Recommendations was associated with a significant inverse association with breast cancer risk overall (OR = 0·54, 95 % CI 0·35, 0·91) and specifically in postmenopausal women (OR = 0·55, 95 % CI 0·34, 0·95), in cases with oestrogen positive and progesterone positive breast cancer subtypes (OR = 0·54, 95 % CI 0·39, 0·89 and OR = 0·68, 95 % CI 0·43, 0·89, respectively) and in obese women (OR = 0·52, 95 % CI 0·35, 0·81). No significant association with breast cancer risk was observed in premenopausal women. Greater adherence to the 2018 WCRF/AICR Cancer Prevention Recommendations may reduce breast cancer risk in this black urban population of Soweto. Adherence thereof should be encouraged and form a part of cost-effective breast cancer prevention guidelines.

Dietary Intake and Cancer in Sub-Saharan Africa: A Critical Review of Epidemiological Studies

Cancer incidence is rising rapidly in Sub-Saharan Africa (SSA). Dietary intake is an established risk factor for certain cancers but only a few epidemiological studies have been conducted in SSA. This study systematically reviewed and summarized the published literature on this issue and identified gaps that can be addressed in future research. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and literature searched was conducted until 11/2/2021. Out of the 5,457 potential references, we reviewed 19 eligible studies: 17 case-controls, two cross-sectionals and no cohort study. South Africa and Kenya conducted the majorities of the studies. The commonest studied cancers were esophageal (9/19), colorectal (4/19) and breast (4/19). Only four studies utilized a validated Food Frequency Questionnaire (FFQ). Although most studies (16/19) reported associations between dietary intake and cancer risks, they were lacking important confounders including total energy intake, multivitamin intake, body fat measures, physical-activity, smoking, and alcohol. Despite rapidly expanding cases of cancer associated with diet, the existent evidence on diet-cancer relationship is too scarce to deduce solid conclusions. There is a need for large cohorts with comprehensive datasets, validated dietary instruments while using advanced statistical analyses that can provide further insights into the imperative links between African diet and cancer risk.Supplemental data for this article is available online at https://doi.org/10.1080/01635581.2022.2032217 .

Dietary Patterns and Breast Cancer Risk in Black Urban South African Women: The SABC Study

A total of 396 breast cancer cases and 396 population-based controls from the South African Breast Cancer study (SABC) matched on age and demographic settings was included. Validated questionnaires were used to collect dietary and epidemiological data. Dietary patterns were derived using principal component analysis with a covariance matrix from 33 food groups. Odds ratios and 95% confidence intervals were estimated using conditional logistic regression. A traditional, a cereal-dairy breakfast and a processed food dietary pattern were identified, which together explained 40.3% of the total variance in the diet. After adjusting for potential confounders, the traditional dietary pattern and cereal-dairy breakfast dietary pattern were inversely associated with breast cancer risk (highest tertile versus lowest tertile) (OR = 0.72, 95%CI: 0.57-0.89, p-trend = 0.004 and OR = 0.73, 95%CI: 0.59-0.90, p-trend = 0.004, respectively). The processed food dietary pattern was not significantly associated with breast cancer risk. The results of this study show that a traditional dietary pattern and a cereal-dairy breakfast dietary pattern may reduce the risk of developing breast cancer in this population.

Impact of home-based aerobic training combined with food orientation on food consumption, daily physical activity and cardiorespiratory fitness among breast cancer survivors: six-month clinical trial

BACKGROUND

Anticancer treatment gives rise to adverse effects such as increased pain and changes to body weight and menstrual cycles, with negative effects on activities of daily living.

OBJECTIVE

To analyze the effect of food orientation combined with supervised (face-to-face, FF) versus home-based (HB) aerobic training on lifestyle (food consumption and daily physical activity (PA) levels), body composition, metabolic profile and cardiorespiratory fitness, among breast cancer survivors.

DESIGN AND SETTING

Clinical trial study (six months) conducted at a public university in Presidente Prudente, Brazil.

METHODS

Twenty-three female breast cancer survivors (40-75 years old) were allocated to aerobic training groups, either FF or HB. Both groups were trained and received food orientation. They were evaluated through a dietary record, ergometric treadmill test and blood test and the Baecke questionnaire.

RESULTS

After six months, both groups had reduced their lipid levels, total energy consumption and polyunsaturated fat intake, and had increased their PA levels and treadmill test durations. However, only the HB showed reduced carbohydrate percentage and increased folic acid; and only the FF showed reduced lipid, saturated fat and sodium levels, along with increased carbohydrate and protein levels. No differences in body composition or metabolic profile were found.

CONCLUSIONS

These results demonstrated the feasibility of HB aerobic training. In isolation, HB showed greater regulation of carbohydrate percentage and increased folic acid levels. Moreover, these breast cancer survivors presented improvements in food consumption, PA levels and cardiorespiratory fitness, while also maintaining their body composition and metabolic profile after the intervention, independent of the group.

Preexisting morbidity profile of women newly diagnosed with breast cancer in sub-Saharan Africa: African Breast Cancer-Disparities in Outcomes study

The presence of preexisting morbidities poses a challenge to cancer patient care. There is little information on the profile and prevalence of multi-morbidities in breast cancer patients across middle income countries (MIC) to lower income countries (LIC) in sub-Saharan Africa (SSA). The African Breast Cancer-Disparities in Outcomes (ABC-DO) breast cancer cohort spans upper MICs South Africa and Namibia, lower MICs Zambia and Nigeria and LIC Uganda. At cancer diagnosis, seven morbidities were assessed: obesity, hypertension, diabetes, asthma/chronic obstructive pulmonary disease, heart disease, tuberculosis and HIV. Logistic regression models were used to assess determinants of morbidities and the influence of morbidities on advanced stage (stage III/IV) breast cancer diagnosis. Among 2189 women, morbidity prevalence was the highest for obesity (35%, country-specific range 15-57%), hypertension (32%, 15-51%) and HIV (16%, 2-26%) then for diabetes (7%, 4%-10%), asthma (4%, 2%-10%), tuberculosis (4%, 0%-8%) and heart disease (3%, 1%-7%). Obesity and hypertension were more common in upper MICs and in higher socioeconomic groups. Overall, 27% of women had at least two preexisting morbidities. Older women were more likely to have obesity (odds ratio: 1.09 per 10 years, 95% CI 1.01-1.18), hypertension (1.98, 1.81-2.17), diabetes (1.51, 1.32-1.74) and heart disease (1.69, 1.37-2.09) and were less likely to be HIV positive (0.64, 0.58-0.71). Multi-morbidity was not associated with stage at diagnosis, with the exception of earlier stage in obese and hypertensive women. Breast cancer patients in higher income countries and higher social groups in SSA face the additional burden of preexisting non-communicable diseases, particularly obesity and hypertension, exacerbated by HIV in Southern/Eastern Africa.

Reproductive factors and risk of breast cancer in black South African women

PURPOSE

Breast cancer (BC) is increasing in black South African women, but few studies have investigated its risk factors.

METHODS

We conducted an analysis of reproductive factors and BC risk in the South African Breast Cancer (SABC) study-a population-based case-control study of black South African women from Soweto that included 399 cases and 399 matched controls. Information on lifestyle and reproductive history was obtained by interviews. Conditional logistic regression was used to determine the association of reproductive factors with BC, adjusting for potential confounding factors.

RESULTS

Seventy-five percent of all BC cases were ER+, 66% PR+, 30% HER2+, and 16% TN. None of the reproductive variables were associated with BC overall or by subtype in the overall population, nor in pre- (n = 135 cases) or in post-menopausal women separately. In HIV-negative pre-menopausal women (n = 97 cases), later age at first pregnancy and longer time between menarche and first full-time pregnancy were inversely related to BC risk (OR 0.89 (95% CI 0.82-0.97; and 0.93 95% CI 0.86-1.01, respectively).

CONCLUSION

In this population of black South African women, reproductive factors were not associated with BC risk.

Hubungan Asupan dan Kadar Serum β-karoten, Aktivitas SOD, TNF-α dan 8-isoprostan serum dengan Ukuran Tumor Payudara

Latar Belakang: Kanker payudara dapat disebabkan oleh berkembangnya Reactive Oxygen Species (ROS) di dalam sel yang memicu stres oksidatif dan oksidasi pada DNA. DNA akan kehilangan kemampuannya untuk memperbaiki diri dan terjadi mutasi. Mutasi dapat menyebabkan pertumbuhan dan perkembangan sel tumor. Asupan antioksidan seperti β-karoten pada penderita tumor dimungkinkan dapat menurunkan stres oksidatif dan risiko berkembangnya kanker.Tujuan: Penelitian ini bertujuan untuk menganalisis hubungan asupan dan kadar serum β-karoten, aktivitas SOD, TNF-α dan 8-isoprostan serum dengan ukuran tumor payudara.Metode: Penelitian ini menggunakan desain cross-sectional. Data yang digunakan adalah data baseline dari penelitian utama yang diambil pada bulan November-Desember 2018. Sebanyak 15 orang wanita yang terindikasi tumor payudara dan memenuhi kriteria inklusi serta eksklusi diikutsertakan dalam penelitian ini. Data dianalisis menggunakan uji korelasi Pearson dan spearman.Hasil: Usia subjek berkisar antara 22-52 tahun dengan rata-rata usia 36 tahun. Hasil penelitian menunjukkan asupan β-karoten per hari masih kurang. Terdapat hubungan antara asupan β-karoten dengan aktivitas SOD (p=0,025; r=0,408) dan aktivitas SOD dengan ukuran tumor payudara (p=0,018; r=-0,430). Hal ini menunjukkan bahwa terdapat hubungan tidak langsung antara asupan β-karoten dengan ukuran tumor payudara. Kadar serum β-karoten, TNF-α dan 8-isoprostan serum tidak berhubungan signifikan dengan ukuran tumor payudara (p=0,107; r=-0,430 | p=0.061; r=0,347 | p= 0,217; r=0,232).Kesimpulan: Terdapat hubungan antara asupan β-karoten dengan aktivitas SOD dan aktivitas SOD dengan ukuran tumor payudara.

Association of Total Nut, Tree Nut, Peanut, and Peanut Butter Consumption with Cancer Incidence and Mortality: A Comprehensive Systematic Review and Dose-Response Meta-Analysis of Observational Studies

Data on the association of nut intake with risk of cancer and its mortality are conflicting. Although previous meta-analyses summarized available findings in this regard, some limitations may distort their findings. Moreover, none of these meta-analyses examined the dose-response associations of total nut intake with the risk of specific cancers as well as associations between specific types of nuts and cancer mortality. Therefore, this study aimed to summarize available findings on the associations of total nut (tree nuts and peanuts), tree nut (walnuts, pistachios, macadamia nuts, pecans, cashews, almonds, hazelnuts, and Brazil nuts), peanut (whole peanuts without considering peanut butter), and peanut butter consumption with risk of cancer and its mortality by considering the above-mentioned points. We searched the online databases until March 2020 to identify eligible articles. In total, 43 articles on cancer risk and 9 articles on cancer mortality were included in the current systematic review and meta-analysis. The summary effect size (ES) for risk of cancer, comparing the highest with lowest intakes of total nuts, was 0.86 (95% CI: 0.81, 0.92, P < 0.001, I2 = 58.1%; P < 0.01), indicating a significant inverse association. Such a significant inverse association was also seen for tree nut intake (pooled ES: 0.87, 95% CI: 0.78-0.96, P < 0.01, I2 = 15.8%; P = 0.28). Based on the dose-response analysis, a 5-g/d increase in total nut intake was associated with 3%, 6%, and 25% lower risks of overall, pancreatic, and colon cancers, respectively. In terms of cancer mortality, we found 13%, 18%, and 8% risk reductions with higher intakes of total nuts, tree nuts, and peanuts, respectively. In addition, a 5-g/d increase in total nut intake was associated with a 4% lower risk of cancer mortality. In conclusion, our findings support the protective association between total nut and tree nut intake and the risk of cancer and its mortality.

Differences in Dietary Patterns Identified by the Gaussian Graphical Model in Korean Adults With and Without a Self-Reported Cancer Diagnosis

BACKGROUND

The synergistic effect of food groups on health outcomes is better captured by examining dietary patterns (DPs) than single food groups. Regarding this issue, a Gaussian graphical model (GGM) can identify pairwise correlations between food groups and adjust for the remaining items. However, the application of GGMs in the nutritional field has not been widely investigated, especially in Korean adults.

OBJECTIVE

The aim of this study was to identify the major DPs of Korean adults by using a GGM and to examine the associations between the DP scores and prevalence of self-reported cancer.

DESIGN

This cross-sectional study used baseline data from the 2007-2019 Cancer Screenee Cohort of the National Cancer Center, Korea.

PARTICIPANTS/SETTING

In total, 10,777 Korean adults who completed a questionnaire regarding their general medical history, including clinical test results, and a validated food frequency questionnaire were included.

MAIN OUTCOME MEASURES

The main outcome measure was the prevalence of self-reported cancer at baseline.

STATISTICAL ANALYSIS

DP networks were identified using a GGM. The GGM-identified networks were scored and categorized into tertiles, and their association with the prevalence of self-reported cancer was investigated using a multivariable logistic regression model.

RESULTS

The GGM identified the following 4 DP networks: principal, oil-sweet, meat, and fruit. After adjusting for covariates, the odds of moderate and high consumption of foods in the oil-sweet DP for participants who self-reported cancer were 25% and 34% lower than those for participants who did not report a cancer diagnosis (odds ratio [OR] = 0.75, 95% confidence interval [CI] = 0.62-0.90 and OR = 0.66, 95% CI = 0.53-0.81, respectively). Additionally, the odds of meat DP consumption in the self-reported cancer group was 29% lower than in participants who did not report a cancer diagnosis (OR = 0.71 and 95% CI = 0.57-0.88). In contrast, an increase in the odds of fruit DP consumption was observed for self-reported cancer participants (OR = 1.34 and 95% CI = 1.09-1.65). Similar results were observed among the female but not the male subjects.

CONCLUSIONS

GGM is a novel method that can distinguish the direct pairwise correlation of food groups and control for the indirect effect of other foods. Future large-scale longitudinal population-based studies are needed to build on these findings in general populations.

The evolving epidemic of breast cancer in sub-Saharan Africa: Results from the African Cancer Registry Network

Breast cancer (BC) is the leading cause of cancer in sub-Saharan Africa (SSA) with rapidly increasing incidence rates reported in Uganda and Zimbabwe. However, the magnitude of these rising trends in premenopausal and postmenopausal women is unknown in most African countries. We used data from the African Cancer Registry Network on incident breast cancers in women from 11 population-based cancer registries in 10 countries representing each of the four SSA regions. We explored incidence changes among women before and after age 50 by calendar period and, where possible, generational effects in this unique sub-Saharan African cohort. Temporal trends revealed increasing incidence rates in all registries during the study period, except in Nairobi where rates stabilised during 2010 to 2014 after rapidly increasing from 2003 to 2010 (APC = 8.5 95%, CI: 3.0-14.2). The cumulative risk varied between and within regions, with the highest risks observed in Nairobi-Kenya, Mauritius and the Seychelles. There were similar or more rapidly increasing incidence rates in women aged 50+ compared to women <50 years in all registries except The Gambia. Birth cohort analyses revealed increases in the incidence rates in successive generations of women aged 45 and over in Harare-Zimbabwe and Kampala-Uganda. In conclusion, the incidence of BC is increasing rapidly in many parts of Africa; however, the magnitude of these changes differs. These results highlight the need for urgent actions across the cancer continuum from in-depth risk factor studies to provision of adequate therapy as well as the necessity of supporting the maintenance of good quality population-based cancer registration in Africa.

Temporal trends in food group availability and cancer incidence in Africa: an ecological analysis

OBJECTIVE

We evaluated the relationship between food availability, as the only dietary exposure data available across Africa, and age-standardised cancer incidence rates (ASR) in eighteen countries.

DESIGN

Ecological study.

SETTING

Availability of food groups and dietary energy was considered for five hypothetical time points: years of collection of ASR (T0) and 5, 10, 15 and 20 preceding years (T-5, T-10, T-15, T-20). Ecological correlations adjusted for human development index, smoking and obesity rates were calculated to evaluate the relationship between food availability and ASR of breast, prostate, colorectal, oesophageal, pancreatic, stomach and thyroid cancer.

RESULTS

Red meat was positively correlated with pancreatic cancer in men (T-20: r-20 = 0·61, P < 0·05), stomach cancer in women (T0: r0 = 0·58, P < 0·05), and colorectal cancer in men (T0: r0 = 0·53, P < 0·05) and women (T-20: r-20 = 0·58, P < 0·05). Animal products including meat, animal fats and higher animal-sourced energy supply tended to be positively correlated with breast, colorectal, pancreatic, stomach and thyroid cancer. Alcoholic beverages were positively correlated to oesophageal cancer in men (r0 = 0·69, P < 0·001) and women (r-20 = 0·72, P < 0·001).

CONCLUSIONS

The present analysis provides initial insights into the impact of alcoholic beverages, and increasing use of animal over plant products, on the incidence of specific cancers in Africa. The findings support the need for epidemiological studies to investigate the role of diet in cancer development in Africa.