Carotenoid intake, vegetables, and the risk of lung cancer among white men in New Jersey

Consumption of Vitamin K and Vitamin A Are Associated With Reduced Risk of Developing Emphysema: NHANES 2007-2016

Chronic obstructive pulmonary disease (COPD) comprising of emphysema and chronic bronchitis are the most common chronic respiratory diseases that impart a huge economic and clinical burden. Factors other than smoking and air pollutants can cause inflammation and emphysematous changes in the lung airspaces or alveoli have been understudied. Using a cross-sectional study design, we assessed the association of dark green vegetables, vitamin K and Vitamin A with emphysema status among adults at U.S. These nutrients have a role in lung biology. A complete case NHANES data (n = 17,681) was used. After adjusting for modifiable and non-modifiable confounders, consumption of recommended amounts of vitamin K was associated with 39% decrease in odds (Odds Ratio: 0.61; 95% CI: 0.40–0.92, P-val: 0.02) of emphysema. Similarly consumption of recommended amounts vitamin A dose was associated with 33% decrease in odds (Odds Ratio: 0.67; 95% CI: 0.44–1.00, P-val: 0.05) of emphysema. Vitamin K shows an inverse association suggesting that it may be important in slowing the emphysematous process. Vitamin A is important in maintaining the anti-inflammatory process. Together vitamin K and vitamin A are important in the lung health.

The suitability of chili pepper (Capsicum annuum L.) for alleviating human micronutrient dietary deficiencies: A review

Human micronutrient dietary deficiency remains an enormous global problem and probably accounts for the cause of many chronic health conditions and diseases. Above two (2) billion individuals on the planet today have been estimated to be deficient in major minerals and vitamins, predominantly zinc, iodine, vitamin A, and iron primarily due to inadequate dietary intake. The eradication of deficiencies in micronutrient on a sustainable basis will be conceivable only when diets of vulnerable populace provide all required nutrients in adequate amounts. Among the numerous approaches toward eradicating human dietary deficiency, feeding on a wide range of foods, especially vegetables that have an array of micronutrients, is still perceived as the best sustainable solution. The universal consumption of chili peppers (Capsicum annuum), known for their high nutritional content (which includes a good range of vitamins, minerals, phytochemicals, and dietary fiber), may play a role in decreasing human micronutrient deficiencies. Significant portions of recommended daily nutrients could be supplied by the incorporation of nutrient-rich chili pepper into human diets which could help in combating nutrient deficiencies. This present review, therefore, gives an overview of the universal occurrence of micronutrient deficiency. It also discusses approaches that have been used to tackle the situation while stressing the potentials of chili pepper as a promising vegetable which could be utilized in alleviating human micronutrient dietary deficiencies. For all available information provided, research databases (Science direct, Academic journals, PubMed, and Google Scholar) were searched independently using keyword search strategy. Titles and abstracts were examined initially, and full papers were retrieved if studies met the inclusion criteria.

Baseline serum β-carotene concentration and mortality among long-term asbestos-exposed insulators

BACKGROUND

Although interventional trials demonstrated that moderate-dose β-carotene supplementation increases lung cancer mortality in smokers and asbestos-exposed workers, differences in serum concentrations in absence of supplementation have not been studied in asbestos-exposed workers.

METHODS

A mortality analysis was performed to assess the relationship of nonsupplemented serum β-carotene to all-cause and cancer mortalities using 1981 to 1983 serum β-carotene concentration measurements from 2,646 U.S. white male insulators (mean age, 57.7 years). Multivariable-adjusted Cox proportional hazard models that included terms for age, duration of asbestos exposure, smoking, season, and region were fitted to estimate mortality HRs and 95% confidence intervals (CI) according to serum β-carotene concentrations.

RESULTS

Median follow-up was 12.8 years and 984 (33.8%) subjects died during the follow-up period, including 415 deaths from overall cancer and 219 deaths from lung cancer. The overall mortality HR for a serum β-carotene increase of 10 μg/dL was 0.97 (95% CI, 0.96-0.99). Compared with the lowest quartile, HRs were 0.90 (95% CI, 0.76-1.07) for the second (38-65 μg/dL), 0.80 (95% CI, 0.67-0.96) for the third (66-104 μg/dL), and 0.63 (95% CI, 0.51-0.77) for the highest serum β-carotene quartile (≥105 μg/dL). There was no association between serum β-carotene and overall cancer mortality (HR, 1.00; 95% CI, 0.97-1.02) or lung cancer mortality (HR, 0.99; 95% CI, 0.96-1.02).

CONCLUSIONS

Higher nonsupplemented serum β-carotene concentrations were negatively associated with all-cause mortality among asbestos-exposed individuals.

IMPACT

Serum β-carotene can be a marker of one or more determinants of reduced mortality in asbestos-exposed workers. Cancer Epidemiol Biomarkers Prev; 24(3); 555-60. ©2014 AACR.

Systematic review with meta-analysis of the epidemiological evidence in the 1900s relating smoking to lung cancer

BACKGROUND

Smoking is a known lung cancer cause, but no detailed quantitative systematic review exists. We summarize evidence for various indices.

METHODS

Papers published before 2000 describing epidemiological studies involving 100+ lung cancer cases were obtained from Medline and other sources. Studies were classified as principal, or subsidiary where cases overlapped with principal studies. Data were extracted on design, exposures, histological types and confounder adjustment. RRs/ORs and 95% CIs were extracted for ever, current and ex smoking of cigarettes, pipes and cigars and indices of cigarette type and dose-response. Meta-analyses and meta-regressions investigated how relationships varied by study and RR characteristics, mainly for outcomes exactly or closely equivalent to all lung cancer, squamous cell carcinoma ("squamous") and adenocarcinoma ("adeno").

RESULTS

287 studies (20 subsidiary) were identified. Although RR estimates were markedly heterogeneous, the meta-analyses demonstrated a relationship of smoking with lung cancer risk, clearly seen for ever smoking (random-effects RR 5.50, CI 5.07-5.96) current smoking (8.43, 7.63-9.31), ex smoking (4.30, 3.93-4.71) and pipe/cigar only smoking (2.92, 2.38-3.57). It was stronger for squamous (current smoking RR 16.91, 13.14-21.76) than adeno (4.21, 3.32-5.34), and evident in both sexes (RRs somewhat higher in males), all continents (RRs highest for North America and lowest for Asia, particularly China), and both study types (RRs higher for prospective studies). Relationships were somewhat stronger in later starting and larger studies. RR estimates were similar in cigarette only and mixed smokers, and similar in smokers of pipes/cigars only, pipes only and cigars only. Exceptionally no increase in adeno risk was seen for pipe/cigar only smokers (0.93, 0.62-1.40). RRs were unrelated to mentholation, and higher for non-filter and handrolled cigarettes. RRs increased with amount smoked, duration, earlier starting age, tar level and fraction smoked and decreased with time quit. Relationships were strongest for small and squamous cell, intermediate for large cell and weakest for adenocarcinoma. Covariate-adjustment little affected RR estimates.

CONCLUSIONS

The association of lung cancer with smoking is strong, evident for all lung cancer types, dose-related and insensitive to covariate-adjustment. This emphasises the causal nature of the relationship. Our results quantify the relationships more precisely than previously.

Association of the joint effect of menopause and hormone replacement therapy and cancer in African American women: the Jackson Heart Study

Cancer is the second leading cause of death in the US and in Mississippi. Breast cancer (BC) is the most common cancer among women, and the underlying pathophysiology remains unknown, especially among African American (AA) women. The study purpose was to examine the joint effect of menopause status (MS) and hormone replacement therapy (HRT) on the association with cancers, particularly BC using data from the Jackson Heart Study. The analytic sample consisted of 3202 women between 35 and 84 years of which 73.7% and 22.6% were postmenopausal and on HRT, respectively. There were a total of 190 prevalent cancer cases (5.9%) in the sample with 22.6% breast cancer cases. Menopause (p<0.0001), but not HRT (p=0.6402), was independently associated with cancer. Similar results were obtained for BC. BC, cancer, hypertension, type 2 diabetes, prevalent cardiovascular disease, physical activity and certain dietary practices were all significantly associated with the joint effect of menopause and HRT in the unadjusted analyses. The family history of cancer was the only covariate that was significantly associated with cancer in the age-adjusted models. In examining the association of cancer and the joint effect of menopause and HRT, AA women who were menopausal and were not on HRT had a 1.97 (95% CI: 1.15, 3.38) times odds of having cancer compared to pre-menopausal women after adjusting for age; which was attenuated after further adjusting for family history of cancer. Given that the cancer and BC cases were small and key significant associations were attenuated after adjusting for the above mentioned covariates, these findings warrant further investigation in studies with larger sample sizes of cancer (and BC) cases.

Tropical oils: Nutritional and scientific issues

Individually and in combination with other oils, the tropical oils impart into manufactured foods functional properties that appeal to consumers. The use of and/or labeling in the ingredient lists give the impression that these oils are used extensively in commercially processed foods. The estimated daily intake of tropical oils by adult males is slightly more than one fourth of a tablespoon (3.8 g), 75% of which consists of saturated fatty acids. Dietary fats containing saturated fatty acids at the beta-position tend to raise plasma total and LDL-cholesterol, which, of course, contribute to atherosclerosis and coronary heart disease. Health professionals express concern that consumers who choose foods containing tropical oils unknowingly increase their intake of saturated fatty acids. The saturated fatty acid-rich tropical oils, coconut oil, hydrogenated coconut oil, and palm kernel oil, raise cholesterol levels; studies demonstrating this effect are often confounded by a developing essential fatty acid deficiency. Palm oil, an essential fatty acid-sufficient tropical oil, raises plasma cholesterol only when an excess of cholesterol is presented in the diet. The failure of palm oil to elevate blood cholesterol as predicted by the regression equations developed by Keys et al. and Hegsted et al. might be due to the dominant alpha-position location of its constituent saturated fatty acids. If so, the substitution of interesterified artificial fats for palm oil in food formulations, a recommendation of some health professionals, has the potential of raising cholesterol levels. A second rationale addresses prospective roles minor constituents of palm oil might play in health maintenance. This rationale is founded on the following observations. Dietary palm oil does not raise plasma cholesterol. Single fat studies suggests that oils richer in polyunsaturated fatty acid content tend to decrease thrombus formation. Anomalously, palm oil differs from other of the more saturated fats in tending to decrease thrombus formation. Finally, in studies comparing palm oil with other fats and oils, experimental carcinogenesis is enhanced both by vegetable oils richer in linoleic acid content and by more highly saturated animal fats. The carotenoid constituents of red palm oil are potent dietary anticarcinogens. A second group of antioxidants, the tocotrienols, are present in both palm olein and red palm oil. These vitamin E-active constituents are potent suppressors of cholesterol biosynthesis; emerging data point to their anticarcinogenic and antithrombotic activities. This review does not support claims that foods containing palm oil have no place in a prudent diet.

Dietary isothiocyanates, glutathione S-transferase M1 (GSTM1), and lung cancer risk in African Americans and Caucasians from Los Angeles County, California

Isothiocyanates, found in cruciferous vegetables, are anticarcinogenic. Racial differences in smoking do not fully account for the African-American excess lung cancer incidence. African Americans consume more cruciferous vegetables than U.S. Whites. Impact on lung cancer risk is unknown. The glutathione S transferase M1 (GSTM1) gene promotes urinary isothiocyanate excretion. We evaluated dietary isothiocyanates and lung cancer using a population-based case-control study of 933 African Americans and Caucasians (non-Hispanic U.S. White) from Los Angeles County, California (311 cases; 622 controls). Broccoli, cauliflower, greens, and cabbage food-frequency variables represented isothiocyanates. Isothiocyanates were protective for lung cancer risk. Adjusted odds ratio (OR) for the uppermost quartile > 80 micro mol isothiocyanates/wk, compared to lowest, was 0.65 [95% confidence interval (CI) = 0.41-1.00, trend P = 0.02]. Association was stronger among subjects with homozygous deletion of GSTM1 (OR = 0.52, 95% CI = 0.31-0.86) than subjects with at least one GSTM1 copy (OR = 0.77, 95% CI = 0.49-1.21). The difference was not statistically significant (P = 0.16). Despite African Americans consuming more cruciferous vegetables, the isothiocyanate association did not vary by race (P = 0.52). Reduced lung cancer risk with higher isothiocyanate intake may be slightly stronger among subjects with deletion of GSTM1.

Carotenoid intakes, assessed by food-frequency questionnaires (FFQs), are associated with serum carotenoid concentrations in the Jackson Heart Study: validation of the Jackson Heart Study Delta NIRI Adult FFQs

OBJECTIVES

Intake and status of carotenoids have been associated with chronic disease. The objectives of this study were to examine the association between carotenoid intakes as measured by two regional food-frequency questionnaires (FFQs) and their corresponding measures in serum, and to report on dietary food sources of carotenoids in Jackson Heart Study (JHS) participants.

DESIGN

Cross-sectional analysis of data for 402 African American men and women participating in the Diet and Physical Activity Sub-Study (DPASS) of the JHS.

RESULTS

Mean serum carotenoid concentrations and intakes in this population were comparable to those reported for the general US population. After adjustment for covariates, correlations between serum and dietary measures of each carotenoid, for the average of the recalls (deattenuated), the short FFQ and the long FFQ, respectively, were: 035 and 0-carotene; 026 and 0-carotene; 017 and 0-carotene; 034 and 0-cryptoxanthin; 015 and 037, 014 for lycopene. Major dietary sources of -carotene and lutein plus zeaxanthin, mustard, turnip and collard greens; of beta-cryptoxanthin, orange juice; and of lycopene, tomato juice.

CONCLUSIONS

On average, carotenoid intakes and serum concentrations are not lower in this southern African American population than the general US population. The two regional FFQs developed for a southern US population and used as dietary assessment tools in the JHS appear to provide reasonably valid information for most of these carotenoids.

Beta-cryptoxanthin and lung cancer in Shanghai, China--an examination of potential confounding with cigarette smoking using urinary cotinine as a biomarker for true tobacco exposure

Diet may be a modifier of smoking-related cancer risk, with protective effects of intake of fruits and vegetables and associated antioxidants found in many observational studies. We previously reported serum beta-cryptoxanthin levels being inversely associated with smoking-related lung cancer incidence in a cohort of Chinese men. We noted, however, that serum beta-cryptoxanthin is negatively correlated with smoking. Since self-reports of smoking intensity undoubtedly contain errors, this negative correlation indicates a potential bias in assessing the effects of beta-cryptoxanthin, due to confounding with the unmeasured (residual) portion of cigarette exposure. We evaluated cotinine levels in pre-diagnostic spot urine samples to attempt to improve smoking assessment. We noted that urinary cotinine levels correlated significantly with cigarette consumption overall and that cotinine was strongly predictive of lung cancer risk. Urinary cotinine, however, was not as strong a predictor of lung cancer risk in current smokers as were self-reports of cigarette consumption and cotinine remained only a marginally significant predictor of lung cancer risk after adjustment for self-reports. An apparent benefit of beta-cryptoxanthin remained evident when including both urinary cotinine and self-reported cigarette consumption and cotinine in the statistical model. However, we conclude that cotinine measured from a single spot urine seems to have only limited value in augmenting self-reports of cigarette consumption so that, at present, the apparent protective effects of beta-cryptoxanthin, as seen in our own study, should continue to be regarded as unproven. We believe that future epidemiological evaluation of the association between beta-cryptoxanthin (and other antioxidants) and reduced lung cancer risk must utilize improved biomarkers to augment smokers' own self-reports of smoking amount.

Lung cancer in women: exploring sex differences in susceptibility, biology, and therapeutic response

Src tyrosine kinases regulate a large number of important mechanisms in normal and cancerous cells, are overexpressed in a broad range of tumors including lung cancer, and thus represent a potential target for cancer therapy. Preclinical experiments indicate that small-molecule inhibitors of Src block tumor growth, metastasis, and angiogenesis. Phase I data from healthy volunteers also suggest that inhibitors of Src prevent bone resorption. Several phase II trials with small-molecule inhibitors of Src are under way or have been initiated in lung cancer and in other malignancies, as discussed herein.

Fruits, vegetables and lung cancer: a pooled analysis of cohort studies

Inverse associations between fruit and vegetable consumption and lung cancer risk have been consistently reported. However, identifying the specific fruits and vegetables associated with lung cancer is difficult because the food groups and foods evaluated have varied across studies. We analyzed fruit and vegetable groups using standardized exposure and covariate definitions in 8 prospective studies. We combined study-specific relative risks (RRs) using a random effects model. In the pooled database, 3,206 incident lung cancer cases occurred among 430,281 women and men followed for up to 6-16 years across studies. Controlling for smoking habits and other lung cancer risk factors, a 16-23% reduction in lung cancer risk was observed for quintiles 2 through 5 vs. the lowest quintile of consumption for total fruits (RR = 0.77; 95% CI = 0.67-0.87 for quintile 5; p-value, test for trend < 0.001) and for total fruits and vegetables (RR = 0.79; 95% CI = 0.69-0.90; p-value, test for trend = 0.001). For the same comparison, the association was weaker for total vegetable consumption (RR = 0.88; 95% CI = 0.78-1.00; p-value, test for trend = 0.12). Associations were similar between never, past, and current smokers. These results suggest that elevated fruit and vegetable consumption is associated with a modest reduction in lung cancer risk, which is mostly attributable to fruit, not vegetable, intake. However, we cannot rule out the possibility that our results are due to residual confounding by smoking. The primary focus for reducing lung cancer incidence should continue to be smoking prevention and cessation.

Lung cancer and related risk factors: an update of the literature

At the present time, lung cancer is the leading cause of cancer-related death in males. Diagnostic difficulty makes detection complicated and this, in conjunction with the low survival rate, renders the disease a serious health problem. In-depth knowledge of associated risk factors is therefore called for, in order to prevent or at least reduce the appearance of lung cancer and to open new avenues of research. Although the disease has a multicausal aetiology, tobacco accounts for 85-90% of all cases. This paper reviews the current situation, dividing the risk factors, for study purposes, into two groups; intrinsic (non-modifiable) and extrinsic (modifiable).

Dietary factors and the risk of lung cancer in New Caledonia (South Pacific)

Our objective was to study the relations between the risk of lung cancer and dietary factors in New Caledonia, in the South Pacific. A population-based case-control study of respiratory cancers was conducted between 1993 and 1995 in New Caledonia; we analyzed data for 134 incident lung cancer cases (109 men and 25 women) and 295 controls (227 men and 68 women) who had completed a food frequency questionnaire. Odds ratios (ORs) associated with food and nutrient intakes were calculated with unconditional logistic regression, with adjustment for smoking, age, and ethnicity. Analyses were performed separately for men and women. Among men, no significant associations were observed with any foods, including vegetables and fruits. Nonetheless, high consumption of dark green leafy vegetables (highest vs. lowest tertile of intake) was associated with decreased risk (OR = 0.5, 95% confidence interval = 0.2-1.2, P for trend = 0.12), particularly among Melanesians (OR = 0.4, 95% confidence interval = 0.1-1.0, P for trend = 0.07). A similar protective effect was also suggested for high consumption of poultry (P for trend = 0.06) and fresh fish (P for trend = 0.08). No significant association was found with nutrients. Among women, the analyses concerned few subjects and were not informative. This study suggests that high consumption of dark green leafy vegetables may reduce the risk of lung cancer among men in this population.

Epidemiology of lung cancer

In the United States, lung cancer remains the leading cause of cancer death in both men and women even though an extensive list of risk factors has been well-characterized. Far and away the most important cause of lung cancer is exposure to tobacco smoke through active or passive smoking. The reductions in smoking prevalence in men that occurred in the late 1960s through the 1980s will continue to drive the lung cancer mortality rates downward in men during the first portion of this century. This favorable trend will not persist unless further reductions in smoking prevalence are achieved.

The evolving role of carotenoids in human biochemistry

The growth of our knowledge of carotenoid biochemistry has opened new and divergent paths for research. The earliest role established for beta-carotene in animals was as a vitamin A precursor, a role it shares with several other pro-vitamin A carotenoids. Additional studies have continued to refine our understanding of this function. Because carotenoids are excellent scavengers of singlet oxygen and respectable scavengers for other reactive oxygen species, substantial work was done concerning their potential role as antioxidants. In an unexpected twist, the ability of radicals in cigarette smoke to degrade carotenoids might be responsible for the finding that high-dose dietary beta-carotene increased the incidence of lung cancer in smokers. A new role for the polar carotenoids lutein and zeaxanthin was identified, when those carotenoids were found to constitute the macular pigment (the yellow spot at the center of the human retina). Many different carotenoids can be metabolized to products with retinoid activity, which might affect gene expression and cell differentiation. The formation of retinoids from diverse carotenoids might account for a portion of their activities as anticancer agents. Studies of lycopene in prostate cancer prevention have been very promising, and clinical studies of lycopene are underway. Carotenoids have emerged as the best single tissue marker for a diet rich in fruits and vegetables, and measurements of plasma and tissue carotenoids have an important role in defining the optimal diets for humans.

Cohort analysis of fruit and vegetable consumption and lung cancer mortality in European men

Our aim was to examine the relationship between fruit and vegetable consumption and lung cancer mortality in a cohort of European males. Around 1970, dietary intake of Finnish, Italian and Dutch middle-aged men was assessed using a cross-check dietary history. Complete baseline information was available for 3,108 men, of whom 1,578 were baseline smokers. We used Cox proportional hazard analyses to calculate risk estimates for the consumption in country-specific tertiles on lung cancer in smokers. During 25 years of follow-up, 149 lung cancer deaths occurred in the smokers. Fruit consumption was inversely associated with lung cancer mortality among smokers; compared with the lowest, adjusted RRs for the intermediate and highest tertiles were 0.56 (0.37-0.84) and 0.69 (0.46-1.02), p-trend 0.05. Only in the Dutch cohort was this association statistically significant [adjusted relative risks (RRs) 1.00, 0.33 (0.16-0.70) and 0.35 (0.16-0.74), p-trend 0.004]. In Finland lung cancer risk was lower with higher fruit intake but not significantly, whereas in Italy no association was observed. Stratifying on cigarette smoking intensity (non, light and heavy) revealed an inverse association in the heavy smokers only [adjusted RRs (95% confidence intervals [CI]) 1; 0.47 (0.26-0.84); 0.40 (0.20-0.78)). Vegetable consumption was not related to lung cancer risk in smokers. However, analyses stratified on cigarette smoking intensity gave some indication for a lower lung cancer risk with higher intake. In conclusion, in this prospective analysis among European smoking men, fruit intake was inversely related to lung cancer mortality. This association was confined to heavy cigarette smokers.

Diet and lung cancer: a new approach

Lung cancer is one of major public health problems facing the world today, owing to the high incidence of the disease and its poor prognosis. Although the principal cause of lung cancer is tobacco use, smokers find it extremely difficult to quit the habit. Hence, there is a need to take action targeted at other risk factors for this disease. One such factor is diet, which is known to be able to raise or lower the risk of lung cancer. This paper seeks to complement other reviews in the field and to shed more light both on the influence that dietary factors may have upon the occurrence of this neoplasm and on the causes of this possible effect.

Fish consumption is inversely associated with male lung cancer mortality in countries with high levels of cigarette smoking or animal fat consumption

BACKGROUND

A striking difference in fish consumption and lung cancer mortality (LCM) exists among populations worldwide. This study investigated the relation between fish consumption and LCM at the population level.

METHODS

Sex-specific LCM data, mostly around 1993 and fish consumption data for 10 periods 1961-1994 in 36 countries were obtained from WHO and FAO, respectively.

RESULTS

A significant inverse correlation exists between log fish consumption and LCM rate in 9 out of the 10 time periods (r = -0.34 to r = -0.46, P = 0.044 to P = 0.005). After adjusting for smoking and other confounders, log fish consumption (% of total energy [% E]) was inversely and significantly associated with LCM rate (per 100 000 per year) in all 10 time periods (beta = -26.3 to beta = -36.7; P = 0.0039 to P < 0.0001). The stratified analysis showed that this inverse relation was significant only in countries with above median level of smoking (>2437 cigarettes/adult/year) or animal fat minus fish fat consumption (22.4% E). An increase in fish consumption by 1% E was calculated to reduce mean male LCM rate of the populations examined in the age class of 45-74 years by 8.4%. In women, no significant relation between fish consumption and LCM could be established.

CONCLUSIONS

Fish consumption is associated with a reduced risk from LCM, but this possible protective effect is clear-cut only in men and in countries with high levels of cigarette smoking or animal fat consumption.

Epidemiology of lung cancer

There are few relationships in the epidemiology of cancer between an exposure and disease that are as consistent as those observed between tobacco and lung cancer. The health consequences of tobacco use are not limited to lung cancer; the 1990 Surgeon General's Report described that the use of cigarettes was the leading cause of avoidable mortality in the United States, with about 434,000 preventable deaths per year. Although a majority of the adults in the United States are current or former smokers, smoking cessation and prevention efforts have been successful, although currently about one in four adults still smoke cigarettes. The decline in ever-smoking has reached a plateau in the past few years, however, and rates of teenage smoking have begun to increase. In 1997, smoking rates among high school students in the United States were 32% higher compared with 1991. As noted by Cinciripini et al, adult smokers who quit or die are being replaced by children who smoke. Until recently, lung cancer control efforts primarily have focused on smoking prevention in youth and cessation among adults, with little obvious potential for reducing deaths through early detection. With the recent publication of early results from the Early Lung Cancer Action Project showing remarkably more favorable screening performance compared with chest radiography, the potential to detect lung cancer early and save lives is being revisited. Ultimately, the preferred disease control strategy is the prevention of lung cancer through the elimination of tobacco use altogether, but for the foreseeable future a legacy of decades of tobacco use in a significant proportion of the US population means we are still challenged to develop public health strategies to reduce deaths and suffering from those destined to develop lung cancer.

Exploring spatial patterns of mortality: the new atlas of United States mortality

The National Center for Health Statistics, CDC, has produced an Atlas of United States Mortality which includes maps of rates for the leading causes of death in the United States for the period 1988-1992. As part of this project, many aspects of statistical mapping have been re-examined to maximize the atlas's effectiveness in conveying accurate mortality patterns to epidemiologists and public health practitioners. Because recent cognitive research demonstrated that no one map style is optimal for answering many different map questions, maps and graphs of several different mortality statistics are included for each cause of death. New mixed effects models were developed to provide predicted rates and improved variance estimates. Results from these models were smoothed using a weighted head-banging algorithm to produce maps of general spatial trends free of background noise. Maps of White female lung cancer rates from the new atlas are presented here to illustrate how this innovative combination of maps and graphs permits greater exploration of the underlying mortality data than is possible from previous single-map atlas designs. Published in 1999 by John Wiley & Sons, Ltd. This article is a U.S. Government work and is in the public domain in the United States.

Transplacental inhibitory effect of carrot juice on the clastogenicity of cyclophosphamide in mice

Genetic damage during the prenatal period can provoke important neoplastic alterations and other diseases in postnatal life. Beta-carotene (ßC) is considered to be one of the most important anticarcinogens in the diet and can protect mammalian cells against genotoxic events. As carrots are important dietary source of ßC, we decided to test the effect of fresh carrot juice (CaJ) on cyclophosphamide (CP)-induced genotoxicity in maternal and fetal erythropoietic tissues. The treatment with CaJ started on the 7th day of the pregnancy of BALB/c female mice. We observed, on the 16th gestational day, that this treatment did not modify the spontaneous frequency of micronucleated polychromatic erythrocytes (mPCE) in the bone marrow of the females nor in the livers of their fetuses. The mPCE frequency observed 24 h after an intraperitoneal injection of CP (40 mg/kg) on the 15th day was significantly lower in CaJ-pretreated pregnant female bone marrow and in the liver of their fetuses than those observed in the group treated with CP only. These results demonstrate the presence of natural anticlastogens in carrots.

Mentholated cigarette smoking and lung-cancer risk

PURPOSE

Menthol smoking may lead to a greater increase in lung-cancer risk than smoking of nonmentholated cigarettes. Mentholation of cigarettes adds additional carcinogenic components to cigarette smoke and increases retention times for cigarette smoke in the lungs. Only two epidemiologic studies have been conducted on menthol smoking and lung cancer, and their results are conflicting. Of note, African American males have much higher rates of lung cancer than Caucasian males despite smoking fewer cigarettes per day. Because the consumption of menthol cigarettes is much more frequent among African Americans, it is of interest to examine the possible association between menthol smoking and lung-cancer risk in this population.

METHODS

We examined the association between menthol cigarette smoking and lung-cancer risk among smokers by comparing 337 incident cases of lung cancer with 478 population controls enrolled in a case-control study of lung cancer. Information on smoking history and other known and potential risk factors for lung cancer, including dietary intake, was obtained by in-person interviews.

RESULTS

The adjusted odds ratios did not differ appreciably between smokers of mentholated cigarettes versus exclusive nonmentholated cigarette smokers in the overall study group of smokers. The odds ratio (OR) for 32 pack-years or more of mentholated vs. nonmentholated cigarettes was 0.90 (95% confidence interval (CI) = 0.38-2.12) in African Americans and 1.06 (95% CI = 0.47-2.36) in Caucasians, and did not differ for either ethnic group (p = 0.98).

CONCLUSIONS

Our results suggest that the lung-cancer risk from smoking mentholated cigarettes resembles the risk from smoking non-mentholated cigarettes. Our data do not support the hypothesis that the increased risk of lung cancer among African Americans is due to the increased prevalence of menthol smoking.

A cross-sectional study of vitamin intake in postoperative non-small cell lung cancer patients

BACKGROUND AND OBJECTIVES

This cross-sectional study of postoperative non-small cell lung cancer (NSCLC) patients examined possible effects of vitamin intake and folate status on disease-free survival.

METHODS

Supplemental vitamin usage, dietary vitamin intake (Willett Food Frequency Questionnaire), red blood cell (RBC) folate, and serum folate concentrations were assessed in patients with a history of NSCLC. Exclusion criteria included factors that alter folate status or that are associated with altered nutritional habits: (1) evidence of cancer on history, physical, or chest radiograph; (2) tobacco, alcohol ingestion (>2 drinks/ day), or cancer treatment within 3 months; (3) use of folate antagonists; and (4) age <60 years.

RESULTS

36 subjects were evaluated. The median disease-free censored survival was 24 months (range 4-41). Nineteen of 36 patients (53%) reported vitamin supplementation. Vitamin users had a longer median censored survival compared with nonusers (41 months versus 11 months; P = 0.002). With adjustment for cancer stage, the association between RBC folate and censored survival (r = 0.35; P = 0.055) and between serum folate and censored survival (r = 0.32; P = 0.083) approached statistical significance.

CONCLUSIONS

NSCLC patients who took vitamin supplements were more likely to be long-term survivors in the patients studied; a similar trend toward long-term survival was seen among patients with higher circulating folate concentrations.

Chemopreventive potential of fumaric acid, N-acetylcysteine, N-(4-hydroxyphenyl) retinamide and beta-carotene for tobacco-nitrosamine-induced lung tumors in A/J mice

Four agents, fumaric acid (FA), N-acetylcysteine (NAC), N-(4-hydroxyphenyl) retinamide (4-HPR) and beta-carotene (beta-CT), were evaluated for potential chemopreventive activity using the tobacco-specific carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK)-induced lung tumor model in female A/J mice. The agents were evaluated in both 16-week and 52-week bioassays at two dose levels corresponding to 0.8 maximum tolerated dose (MTD) and 0.4 MTD administered throughout the bioassay either in the diet (FA, 160 and 80 mmol/kg diet; NAC, 160 and 80 mmol/kg diet; 4-HPR, 4 and 2 mmol/kg diet) or by subcutaneous injection twice a week (beta-CT, 32 and 16 mg/kg b.w.). Mice were treated with a single i.p. dose of 10 micromol NNK in saline 1 week after administration of test agent. Lung adenomas were evaluated in the 16-week bioassay, whereas both adenomas and adenocarcinomas of the lung were determined in the 52-week bioassay. Both bioassays showed that all four agents did not significantly inhibit the total tumor incidence and multiplicity of the lung. However, the incidence of adenocarcinomas was reduced (P < 0.01) at 52 weeks in NNK groups given either 0.8 MTD NAC or 0.8 MTD beta-CT compared with the NNK control group. The decreases in adenocarcinomas were accompanied by corresponding increases in adenomas in these treatment groups. Thus, this study showed that FA, NAC, 4-HPR and beta-CT did not inhibit the total tumor formation, however, at the higher doses both NAC and beta-CT significantly retarded the malignant progression in the lung of NNK-treated A/J mice.

Women and lung cancer: waiting to exhale

Lung cancer is now the leading cause of cancer deaths among women. In the United States, 64,300 women are expected to die of lung cancer in 1996. Smoking is responsible for about 80% of lung cancer cases. Unfortunately, the prevalence of smoking among women remains unacceptably high at about 22% and is expected to surpass the rate in men by the year 2000. Smoking rates are highest among young girls and the less educated. Whether lung cancer represents a different disease in women than in men is unclear. Data are conflicting regarding the magnitude of the relative risk of developing lung cancer due to smoking between the genders. There appears to be a difference in the relative distribution of lung cancer histologic features between men and women that is not explained entirely by differences in smoking patterns. Women who smoke appear to be at higher risk of developing small cell lung cancer than squamous cell lung cancer, whereas men who smoke have a similar risk for the two histologic conditions. Furthermore, women smokers are more likely to develop adenocarcinoma of the lung, and estrogens may play a causative role in this phenomenon. Data are unclear regarding whether the outcome of lung cancer treatment differs between genders. Solutions to the lung cancer epidemic among US women include (1) prevention of the disease by reducing smoking rates, (2) improving early detection methods, and (3) exploring new therapeutic strategies.

Vegetable and fruit intake and the risk of lung cancer in women in Barcelona, Spain

A case-control study on women was carried out in Barcelona, Spain, to investigate the relationship of lung cancer with the intake of vegetables, fruits and some foods of animal origin. The study included 103 cases and 206 controls matched by age and residence. Diet intake was assessed by means of a food frequency questionnaire. A reduction in risk, adjusted for smoking habit, was found for the intake of yellow/orange vegetables (mainly carrots) and tomatoes. The odds ratio (OR) and 95% confidence interval (CI) for the highest versus lowest tertile of intake were 0.37 (0.19-0.74) for yellow/orange vegetables and 0.45 (0.22-0.91) for tomatoes; both had a significant inverse trend. A tendency to a reduction in risk of lung cancer with increased intake was observed for all vegetables, leafy green vegetables, dark green vegetables and cruciferous, but these associations did not reach statistical significance. No association with lung cancer was found for the intake of fruits or foods of animal origin rich in retinol. Similar patterns were observed for women who never smoked and when the analysis was restricted to adenocarcinoma.

Vegetables, fruit, and cancer prevention: a review

In this review of the scientific literature on the relationship between vegetable and fruit consumption and risk of cancer, results from 206 human epidemiologic studies and 22 animal studies are summarized. The evidence for a protective effect of greater vegetable and fruit consumption is consistent for cancers of the stomach, esophagus, lung, oral cavity and pharynx, endometrium, pancreas, and colon. The types of vegetables or fruit that most often appear to be protective against cancer are raw vegetables, followed by allium vegetables, carrots, green vegetables, cruciferous vegetables, and tomatoes. Substances present in vegetables and fruit that may help protect against cancer, and their mechanisms, are also briefly reviewed; these include dithiolthiones, isothiocyanates, indole-3-carbinol, allium compounds, isoflavones, protease inhibitors, saponins, phytosterols, inositol hexaphosphate, vitamin C, D-limonene, lutein, folic acid, beta carotene, lycopene, selenium, vitamin E, flavonoids, and dietary fiber. Current US vegetable and fruit intake, which averages about 3.4 servings per day, is discussed, as are possible noncancer-related effects of increased vegetable and fruit consumption, including benefits against cardiovascular disease, diabetes, stroke, obesity, diverticulosis, and cataracts. Suggestions for dietitians to use in counseling persons toward increasing vegetable and fruit intake are presented.

Nutrition and lung cancer

Epidemiologic evidence on the relationship between nutrition and lung cancer is reviewed. Observational studies of diet and lung cancer, both prospective and retrospective, continue to suggest strongly that increased vegetable and fruit intake is associated with reduced risk in men and women; in various countries; in smokers, ex-smokers, and never-smokers; and for all histologic types of lung cancer. Prospective studies of blood beta-carotene levels, arguably the best available biomarker of vegetable and fruit intake, indicate that low levels are predictive of increased lung cancer incidence. However, in a randomized, placebo-controlled clinical trial in male smokers, lung cancer incidence and total mortality were increased significantly among the men receiving beta-carotene supplements. If beta-carotene can prevent lung carcinogenesis, which the trial cannot rule out, then the dosage, duration of use, method of administration, and/or subpopulation are critical. Ongoing clinical trials, some of which include women, will provide much-needed information. Other carotenoids, other phytochemicals, and associated dietary patterns may explain the beneficial effects of vegetables and fruits and have not been explored adequately in epidemiologic work. Several observational epidemiologic studies, both prospective and retrospective, have indicated that diets high in fat, saturated fat, and cholesterol may increase the risk of lung cancer and that the effect is not mediated through vegetable and fruit intake. The relationship, although not yet established, merits further investigation. Since beta-carotene can function as an antioxidant, other micronutrients with this potential, specifically vitamins E and C and selenium, also have been proposed to reduce lung cancer risk. However, the totality of the epidemiologic evidence is not, at present, persuasive for any one of these micronutrients.

Epidemiologic studies of antioxidants and cancer in humans

To assess whether antioxidants may reduce the risk of cancer, we reviewed the epidemiologic literature from 1985 through 1993. We assessed the separate relationships of three antioxidants (carotenoids, vitamin C, and vitamin E) with six sites of cancer (lung, upper aerodigestive tract, uterine cervix, colon, breast, prostate). This review was limited to dietary intake or serum nutrient studies that met a predefined set of methodologic standards. We judged the evidence in support of causal relationships based upon consistency of results across studies, strength of association, and evidence of a dose-response relationship. The data concerning carotenoids and lung cancer risk were most consistent (protection found in 4 of 8 diet studies and 5 of 6 serum studies), with strong associations that tended to follow a dose-response pattern. For lung cancer, there was weaker evidence of protection from vitamin C (2 of 6 diet studies) and vitamin E (3 of 4 serum studies). For upper aerodigestive tract cancers (oral cavity, pharynx, or larynx), there was evidence of a protective effect of carotenoids (3 of 4 diet studies) and vitamin C (4 of 5 diet studies). For cancer of the uterine cervix, we found suggestive evidence of protection from vitamin C (4 of 5 diet studies) and perhaps carotenoids (2 of 5 diet studies). For cancers of the colon, breast, and prostate, the current data do not support a protective effect of antioxidants. More definite conclusions about the benefits of antioxidants in cancer prevention will be derived from on-going intervention trials.

Antioxidants and carcinogenesis

It is established beyond doubt that free radicals in tissues and cells can damage DNA, proteins, carbohydrates and lipids. These potentially deleterious reactions are at least partly controlled by antioxidants capable of scavenging free radicals. It is widely believed that a proper balance between free radicals and antioxidants is essential for the health of an organism. A vast body of observational epidemiological studies has suggested that high intake of dietary or supplemental antioxidants protects against ischaemic heart disease, various types of cancer and several other diseases. Final proof for the beneficial effects of antioxidants can, however, be obtained from controlled studies. Conflicting results of the first three major clinical trials force us to postpone conclusions of the usefulness of antioxidant supplements in disease prevention until the other on-going trials have been published.

Risk factors for lung cancer in Rio de Janeiro, Brazil: a case-control study

The association between the risk of lung cancer and tobacco smoking, dietary factors and occupational exposures was examined in a hospital-based case-control study. The study involved 123 consecutive cases and 123 controls, matched by age (+/- 3), sex, and race. In this first study of lung cancer risk in Brazil, we found that tobacco smoking is the strongest risk factor with an odds ratio (OR) for current and former smokers of 22 (CI, 6.5-76) and 7.7 (CI, 2.2-27), respectively. An OR of 2.8 (CI, 1.0-7.7) was found for users of black tobacco in the form of hand-rolled cigarettes) in combination with conventional cigarettes, after adjustment for life-time consumption of any kind of tobacco; users of conventional cigarettes only were considered as a reference group. Cessation of smoking had an important influence in reducing the lung cancer risk, whereas early initiation of smoking increased the risk. Among dietary factors, frequent consumption of meat (P < 0.01) and pasta (P = 0.02) were positively associated with lung cancer risk after adjusting for smoking and income. No association was found with green/yellow vegetables or fruits. We were unable to detect any significant association related to occupational exposures. This study confirmed the association of lung cancer with smoking as the most important predictor of risk. It also indicates the increase in risk associated with the use of black tobacco in combination with conventional cigarettes.

Amrita Bindu--a salt-spice-herbal health food supplement for the prevention of nitrosamine induced depletion of antioxidants

Ayurveda, practised in India, identified a large number of plant components to be used in the diet for the prevention or the delayed development of degenerative disorders. They include some of the commonly used spices, namely pepper and ginger. The Materia Medica includes both naturally occurring and artificially produced salts, as a partial substitute for common salt. Health promoting herbs and spices which are classified pharmacologically as rejuvenating, nourishing, invigorating, cleansing, wound-healing, etc., are used as food additives. Amrita Bindu is a salt-spice-herbal mixture based on these principles and was tested for its effect in maintaining antioxidant defense systems in blood and liver when exposed to a carcinogenic nitrosamine, N-methyl-N'-nitro-N-nitrosoguanidine (MNNG). Amrita Bindu supplementation prevented MNNG induced depletion of the antioxidant enzymes and the scavenger antioxidants glutathione and vitamins A, C and E. Amrita Bindu provides protection against free radical and reactive oxygen species induced tissue lipid peroxidation and the resultant tissue degeneration.

Vitamin A as a hormone: recent advances in understanding the actions of retinol, retinoic acid, and beta carotene

Within the past few years, much has been learned about the metabolism and actions of vitamin A and the carotenoids. This article reviews the biochemical and cellular events in retinoid metabolism that lead to production of retinoic acid, an active metabolite of vitamin A. Retinoic acid functions in a hormone-like manner to regulate the expression of a number of genes. Beta carotene is now under study as an anticancer agent and for its possible beneficial effects in a number of chronic diseases. Current recommendations for carotene intake exceed the usual daily intake nearly fourfold.

Diet as risk and therapy for cancer

This article provides a brief overview of the scientific rationale for dietary guidelines that may reduce the risk of some types of cancers--breast, colon, and prostate in particular. Dietary modification clinical trials currently sponsored by the National Cancer Institute are described. Other topics include the role of total parenteral nutrition in cancer therapy and low-fat dietary interventions as an adjunct to breast cancer treatment.

Protective effects of raw vegetables and fruit against lung cancer among smokers and ex-smokers: a case-control study in the Tokai area of Japan

In a hospital-based case control study, the protecting effects of fruit, raw and green vegetables against lung cancer risk among male smokers were studied in 282 cases and the same number of controls. The current smokers showed a 6.61-fold increased risk of lung cancer. The odds ratio (OR) declined markedly with starting age of smoking habit and increased markedly with number of cigarettes smoked per day. The ex-smokers showed a 3.56-fold increased risk of lung cancer. The ORs gradually decreased with years passed since cessation of smoking. In the single factor analysis, significant protective effects of fruit, raw vegetables, green vegetables, lettuce and cabbage against lung cancer were found. The risk for all lung cancer decreased to 0.45 (95% confidence intervals (CI) 0.30-0.67), 0.64 (95% CI 0.43-0.97) and 0.44 (95% CI 0.26-0.73) with increment of intake frequency of fruit, raw and green vegetables respectively. The OR for lung cancer decreased to 0.41 (95% CI 0.24-0.72) and 0.56 (95% CI 0.32-0.99) with increasing intake frequency of fruit and raw vegetables among current smoking males. Lettuce and cabbage showed protective effects against lung cancer, and the OR for risk of lung cancer decreased to one-half among the high intake frequency group. The risk of lung cancer among current smokers declined markedly with increasing intake of lettuce and cabbage. A similar effect was observed among ex-smokers and non-smokers, but there was no statistical significance. In the multivariate analysis, fruit and raw vegetables showed the strongest protective effects against lung cancer among current smokers (P = 0.01). Among ex-smokers, the protective effect of fruit is also statistically significant (P = 0.03). These results suggest that fruit and raw vegetables may play an important role in protecting smokers from lung cancer.

Race and sex differences in associations of vegetables, fruits, and carotenoids with lung cancer risk in New Jersey (United States)

We used data from a case-control study conducted in New Jersey between 1980 and 1983 to evaluate race and sex differences in associations of vegetable, fruit, and carotenoid consumption with lung cancer. Cases included 736 White males, 860 White females, 269 Black males, and 86 Black females with incident, histologically confirmed, primary cancer of the trachea, bronchus, or lung. Controls were identified through drivers' license and Health Care Financing Administration files and included 548 White males, 473 White females, 170 Black males, and 47 Black females. Usual intakes of vegetables (predominantly yellow/green) and fruit (predominantly yellow/orange) as well as other food sources of carotenoids were ascertained by a food frequency questionnaire. White females showed significant inverse associations of lung cancer with vegetables, fruit, and carotenoids. White males showed nonsignificant inverse associations with vegetables and carotenoids, and Black females just with vegetables. No inverse associations were found for Black males. Vegetable consumption was associated with risk of all histologic types of lung cancer, but the pattern of increasing risk with decreasing intake was limited to smokers. We infer that consumption of yellow/green vegetables and carotenoids may confer protection from lung cancer to White male and White female smokers. Further studies are needed to clarify the effect in Blacks.

Carotenoid content of fruits and vegetables: an evaluation of analytic data

The test of the association between dietary intake of specific carotenoids and disease incidence requires the availability of accurate and current food composition data for individual carotenoids. To generate a carotenoid database, an artificial intelligence system was developed to evaluate data for carotenoid content of food in five general categories, namely, number of samples, analytic method, sample handling, sampling plan, and analytic quality control. Within these categories, criteria have been created to rate analytic data for beta-carotene, alpha-carotene, lutein, lycopene, and beta-cryptoxanthin in fruits and vegetables. These carotenoids are also found in human blood. Following the evaluation of data, acceptable values for each carotenoid in the foods were combined to generate a database of 120 foods. The database includes the food description; median, minimum, and maximum values for the specific carotenoids in each food; the number of acceptable values and their references; and a confidence code, which is an indicator of the reliability of a specific carotenoid value for a food. The carotenoid database can be used to estimate the intake of specific carotenoids in order to examine the association between dietary carotenoids and disease incidence.

The development and application of a carotenoid database for fruits, vegetables, and selected multicomponent foods

A carotenoid database for individual and multicomponent foods has been compiled that contains values for the five most common carotenoids (alpha-carotene, beta-carotene, beta-cryptoxanthin, lycopene, lutein) in 2,458 fruits, vegetables, and multicomponent foods containing fruits and vegetables. The database was used to estimate intakes of specific carotenoids for 19- to 50-year-old women (n = 1,102), using food consumption data obtained from dietary recalls in the US Department of Agriculture Continuing Survey of Food Intake by Individuals, 1986. The major contributors of alpha-carotene were carrots consumed as a single food or as an ingredient in multicomponent foods. Carrots, cantaloupe, and broccoli were the main sources of beta-carotene. Orange juices and blends, oranges, and tangerines were important contributors of beta-cryptoxanthin. Tomatoes and tomato products consumed as single foods or as ingredients in multicomponent foods provided most of the dietary lycopene. Contributors of lutein + zeaxanthin included collard, mustard, or turnip greens; spinach; and broccoli. The per capita consumption of total carotenoids (the sum of the five specific carotenoids) among these women was approximately 6 mg/day.

A work-site nutrition intervention: its effects on the consumption of cancer-related nutrients

OBJECTIVES

In a work-site nutrition intervention targeting fat and fiber, we examined the intervention's effect on specific nutrients implicated in carcinogenesis, including trace metals, vitamins, and categories of fatty acids. The rationale was based on the association observed in a variety of epidemiologic studies between these nutrients and epithelial cancers.

METHODS

Data were taken from eight control companies and five intervention companies that fully implemented the Treatwell intervention. Analyses of variance were used preserving the study's nested design.

RESULTS

Significant intervention-related associations were observed for increased total vitamin A and carotene. Marginal intervention effects were observed for relative decreases in the percentage of calories from both saturated and monounsaturated fatty acids, a relatively smaller increase in the percentage of calories from polyunsaturated fatty acids, and an increase in the consumption of vitamin B6.

CONCLUSIONS

Results indicate a broader effect of the intervention than on fat and fiber only. Increased intake of carotene, the single most important of these other nutrients, is plausibly related to a variety of epithelial cancers.

The etiology of lung cancer

The association between tobacco smoking and lung cancer has been noted for more than 50 years and continues to dominate the etiologic milieu of this malignant disease. Other agents, many discovered in the occupational setting, have also been substantiated as lung carcinogens. Inherent predisposition to the disease has long been suspected, and recent investigations suggest several potential mechanisms and a possible mode of inheritance. Considerable progress has been made in deciphiring the molecular defects present in lung cancer cells. These recent findings have been incorporated into two well-known models of lung carcinogenesis. As the details of the carcinogenic process are unraveled, one goal is to identify intermediate (preneoplastic) markers of exposure and inherent predisposition that will help assess the risk of lung cancer for individuals as well as for groups.