1
|
Yasin HK, Taylor AH, Ayakannu T. A Narrative Review of the Role of Diet and Lifestyle Factors in the Development and Prevention of Endometrial Cancer. Cancers (Basel) 2021; 13:cancers13092149. [PMID: 33946913 PMCID: PMC8125712 DOI: 10.3390/cancers13092149] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/12/2021] [Accepted: 04/16/2021] [Indexed: 12/19/2022] Open
Abstract
Simple Summary The incidence and prevalence of endometrial cancer is increasing globally. The main factors involved in this increase have been the way women live today and what they eat and drink. In fact, the obesity pandemic that is sweeping across the planet is considered to be the main contributory feature. This review aims to introduce to a new audience, those that are not experts in the field, what is known about the different types of endometrial cancer and the mechanisms for their induction and protection. We also seek to summarise the existing knowledge on dietary and lifestyle factors that prevent endometrial development in susceptible populations and identify the main problem in this arena; the paucity of research studies and clinical trials that investigate the interaction(s) between diet, lifestyle and endometrial cancer risk whilst highlighting those areas of promise that should be further investigated. Abstract Endometrial cancer is the most common cancer affecting the reproductive organs of women living in higher-income countries. Apart from hormonal influences and genetic predisposition, obesity and metabolic syndrome are increasingly recognised as major factors in endometrial cancer risk, due to changes in lifestyle and diet, whereby high glycaemic index and lipid deposition are prevalent. This is especially true in countries where micronutrients, such as vitamins and minerals are exchanged for high calorific diets and a sedentary lifestyle. In this review, we will survey the currently known lifestyle factors, dietary requirements and hormonal changes that increase an individual’s risk for endometrial cancer and discuss their relevance for clinical management. We also examine the evidence that everyday factors and clinical interventions have on reducing that risk, such that informed healthy choices can be made. In this narrative review, we thus summarise the dietary and lifestyle factors that promote and prevent the incidence of endometrial cancer.
Collapse
Affiliation(s)
- Hajar Ku Yasin
- Department of Obstetrics & Gynaecology, Cumberland Infirmary, Carlisle CA2 7HY, UK;
| | - Anthony H. Taylor
- Department of Molecular and Cell Biology, University of Leicester, Leicester LE1 7RH, UK;
| | - Thangesweran Ayakannu
- Gynaecology Oncology Cancer Centre, Liverpool Women’s NHS Foundation Trust, Liverpool Women’s Hospital, Liverpool L8 7SS, UK
- Correspondence: ; Tel.: +44-(0)-151-708-9988 (ext. 4531)
| |
Collapse
|
2
|
Penuelas J, Krisztin T, Obersteiner M, Huber F, Winner H, Janssens IA, Ciais P, Sardans J. Country-Level Relationships of the Human Intake of N and P, Animal and Vegetable Food, and Alcoholic Beverages with Cancer and Life Expectancy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7240. [PMID: 33022999 PMCID: PMC7579602 DOI: 10.3390/ijerph17197240] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 09/27/2020] [Accepted: 09/28/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND The quantity, quality, and type (e.g., animal and vegetable) of human food have been correlated with human health, although with some contradictory or neutral results. We aimed to shed light on this association by using the integrated data at country level. METHODS We correlated elemental (nitrogen (N) and phosphorus (P)) compositions and stoichiometries (N:P ratios), molecular (proteins) and energetic traits (kilocalories) of food of animal (terrestrial or aquatic) and vegetable origin, and alcoholic beverages with cancer prevalence and mortality and life expectancy (LE) at birth at the country level. We used the official databases of United Nations (UN), Food and Agriculture Organization of the United Nations (FAO), Organization for Economic Co-operation and Development (OECD), World Bank, World Health Organization (WHO), U.S. Department of Agriculture, U.S. Department of Health, and Eurobarometer, while also considering other possibly involved variables such as income, mean age, or human development index of each country. RESULTS The per capita intakes of N, P, protein, and total intake from terrestrial animals, and especially alcohol were significantly and positively associated with prevalence and mortality from total, colon, lung, breast, and prostate cancers. In contrast, high per capita intakes of vegetable N, P, N:P, protein, and total plant intake exhibited negative relationships with cancer prevalence and mortality. However, a high LE at birth, especially in underdeveloped countries was more strongly correlated with a higher intake of food, independent of its animal or vegetable origin, than with other variables, such as higher income or the human development index. CONCLUSIONS Our analyses, thus, yielded four generally consistent conclusions. First, the excessive intake of terrestrial animal food, especially the levels of protein, N, and P, is associated with higher prevalence of cancer, whereas equivalent intake from vegetables is associated with lower prevalence. Second, no consistent relationship was found for food N:P ratio and cancer prevalence. Third, the consumption of alcoholic beverages correlates with prevalence and mortality by malignant neoplasms. Fourth, in underdeveloped countries, reducing famine has a greater positive impact on health and LE than a healthier diet.
Collapse
Affiliation(s)
- Josep Penuelas
- CSIC, Global Ecology Unit CREAF-CSIC-UAB, 08193 Cerdanyola del Vallès, Spain;
- CREAF, 08193 Cerdanyola del Vallès, Spain
| | - Tamás Krisztin
- International Institute for Applied Systems Analysis (IIASA), Ecosystems Services and Management, Schlossplatz 1, A-2361 Laxenburg, Austria; (T.K.); (M.O.)
| | - Michael Obersteiner
- International Institute for Applied Systems Analysis (IIASA), Ecosystems Services and Management, Schlossplatz 1, A-2361 Laxenburg, Austria; (T.K.); (M.O.)
| | - Florian Huber
- Paris Lodron University of Salzburg, Mönchsberg 2a, A-5020 Salzburg, Austria; (F.H.); (H.W.)
| | - Hannes Winner
- Paris Lodron University of Salzburg, Mönchsberg 2a, A-5020 Salzburg, Austria; (F.H.); (H.W.)
- Austrian Institute of Economic Research (WIFO), Arsenal Objekt 20, A-1030 Vienna, Austria
| | - Ivan A. Janssens
- Research Group Plants and Ecosystems (PLECO), Department of Biology, University of Antwerp, B-2610 Wilrijk, Belgium;
| | - Philippe Ciais
- Laboratoire des Sciences du Climat et de l’Environnement, IPSL, 91191 Gif-sur-Yvette, France;
| | - Jordi Sardans
- CSIC, Global Ecology Unit CREAF-CSIC-UAB, 08193 Cerdanyola del Vallès, Spain;
- CREAF, 08193 Cerdanyola del Vallès, Spain
| |
Collapse
|
3
|
Li P, Shan B, Jia K, Hu F, Xiao Y, Zheng J, Gao YT, Wang H, Gao Y. Plasma omega-3 polyunsaturated fatty acids and recurrence of endometrial cancer. BMC Cancer 2020; 20:576. [PMID: 32563240 PMCID: PMC7305622 DOI: 10.1186/s12885-020-07035-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 06/03/2020] [Indexed: 11/16/2022] Open
Abstract
Background Omega-3 polyunsaturated fatty acids (PUFAs) were proposed to have potential effects against inflammation and cancer. However, results from epidemiology studies remain inconsistent. We aimed to explore the associations of plasma PUFAs with EC recurrence and all-cause mortality. Method Women diagnosed with endometrial cancer (EC) between 2008 and 2013 and underwent surgery at Fudan University Shanghai Cancer Center of China were recruited. Survival status was followed up through September 2017. EC recurrence and total cause deaths were identified through medical record and telephone interview. In total, 202 patients with enough plasma samples at time of surgery were included. There were 195 patients who provided baseline plasma and survival information included in the current study. Plasma omega-3 PUFAs were measured by GC-FID. Cox Proportional Hazard model adjusted for potential cofounders was used to estimate HRs and 95% CIs. Results Median follow-up time for patients was 58 months after surgery. A total of 13 recurrences and 11 all-cause deaths, of which, 2 deaths from EC, were identified. Level of plasma EPA was higher in recurrent patients than total patients (0.78% vs 0.51%, P = 0.015). Higher plasma eicosapentaenoic acid (EPA) level trended to have positive association with EC recurrence (P-trend = 0.04), although comparing to the lowest tertile, the highest tertile of EPA level was not significantly associated with increased risk of EC recurrence (HRT3vsT1 = 6.02; 95%CI = 0.7–52.06). The association between total omega-3 PUFA and EC recurrence tended to be stronger among patients with deeper myometrial invasion (OR = 3.41; 95%CI = 1.06–10.95; P-interaction = 0.04). Conclusions Higher plasma EPA level was significantly associated with EC recurrence. Further studies are warranted to confirm these findings. Trial registration ChiCTR1900025418; Retrospectively registered (26 August 2019); Chinses Clinical Trial Registry.
Collapse
Affiliation(s)
- Peiqin Li
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, People's Republic of China
| | - Boer Shan
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Keyu Jia
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, People's Republic of China
| | - Fan Hu
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, People's Republic of China
| | - Ying Xiao
- Macau Institute for Applied Research in Medicine and Health, Macau University of Science and Technology, Macau, China
| | - Jusheng Zheng
- School of Life Sciences, Westlake University, Hangzhou, China
| | - Yu-Tang Gao
- Department of Epidemiology, Shanghai Cancer Institute, Shanghai, China
| | - Huaying Wang
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Ying Gao
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, People's Republic of China.
| |
Collapse
|
4
|
Rosato V, Negri E, Parazzini F, Serraino D, Montella M, Ferraroni M, Decarli A, La Vecchia C. Processed meat and selected hormone-related cancers. Nutrition 2018; 49:17-23. [DOI: 10.1016/j.nut.2017.10.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 09/18/2017] [Accepted: 10/29/2017] [Indexed: 11/29/2022]
|
5
|
|
6
|
Brasky TM, Sponholtz TR, Palmer JR, Rosenberg L, Ruiz-Narváez EA, Wise LA. Associations of Dietary Long-Chain ω-3 Polyunsaturated Fatty Acids and Fish Consumption With Endometrial Cancer Risk in the Black Women's Health Study. Am J Epidemiol 2016; 183:199-209. [PMID: 26755676 DOI: 10.1093/aje/kwv231] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 08/24/2015] [Indexed: 12/11/2022] Open
Abstract
Dietary long-chain (LC) ω-3 polyunsaturated fatty acids (PUFAs), which derive primarily from intakes of fatty fish, are thought to inhibit inflammation and de novo estrogen synthesis. This study prospectively examined the associations of dietary LC ω-3 PUFAs and fish with endometrial cancer risk in 47,602 African-American women living in the United States, aged 21-69 years at baseline in 1995, and followed them until 2013 (n = 282 cases). Multivariable-adjusted Cox regression models estimated hazard ratios and 95% confidence intervals for associations of LC ω-3 PUFA (quintiled) and fish (quartiled) intake with endometrial cancer risk, overall and by body mass index (BMI; weight (kg)/height (m)(2)). The hazard ratio for quintile 5 of total dietary LC ω-3 PUFAs versus quintile 1 was 0.79 (95% confidence interval (CI): 0.51, 1.24); there was no linear trend. Hazard ratios for the association were smaller among normal-weight women (BMI <25: hazard ratio (HR) = 0.53, 95% CI: 0.18, 1.58) than among overweight/obese women (BMI ≥ 25: HR = 0.88, 95% CI: 0.54, 1.43), but these differences were not statistically significant. Fish intake was also not associated with risk (quartile 4 vs. quartile 1: HR = 0.86, 95% CI: 0.56, 1.31). Again hazard ratios were smaller among normal-weight women (HR = 0.65) than among overweight/obese women (HR = 0.94). While compatible with no association, the hazard ratios observed among leaner African-American women are similar to those from recent prospective studies conducted in predominantly white populations.
Collapse
|
7
|
Dietary fat intake and endometrial cancer risk: dose-response meta-analysis of epidemiological studies. Sci Rep 2015; 5:16693. [PMID: 26568366 PMCID: PMC4645223 DOI: 10.1038/srep16693] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 10/19/2015] [Indexed: 12/11/2022] Open
Abstract
Epidemiological studies have provided controversial evidence of the association between dietary fat intake and endometrial cancer (EC) risk. To address this inconsistency, we conducted this dose-response meta-analysis by total dietary fat intake, based on epidemiological studies published up to the end of June 2015 identified from PubMed, EMBASE and Web of Science. Two authors (RH and Q-JW) independently performed the eligibility evaluation and data extraction. All differences were resolved by discussion with the third investigator (LJ). Random-effects models were used to estimate summary relative risks (RRs) and 95% confidence intervals (CIs). Overall, the search yielded 16 studies (6 cohort and 10 case-control studies) that involved a total of 7556 EC cases and 563,781 non-cases. The summary RR for EC for each 30g/day increment intake was 0.98 (95%CI = 0.95–1.001; I2 = 0%; n = 11) for total dietary fat. Non-significant results were observed in plant-based fat (summary RR = 1.05, 95%CI = 0.94–1.18; I2 = 0%; n = 5) and animal-based fat (summary RR = 1.17, 95%CI = 0.92–1.36; I2 = 85.0%; n = 6). Additionally, the null associations were observed in almost all the subgroup and sensitivity analyses. In conclusion, findings of the present meta-analysis suggested a lack of association between total dietary fat intake and EC risk. Further studies, especially prospective designed studies are warranted to confirm our findings.
Collapse
|
8
|
Brasky TM, Rodabough RJ, Liu J, Kurta ML, Wise LA, Orchard TS, Cohn DE, Belury MA, White E, Manson JE, Neuhouser ML. Long-chain ω-3 fatty acid intake and endometrial cancer risk in the Women's Health Initiative. Am J Clin Nutr 2015; 101:824-34. [PMID: 25739930 PMCID: PMC4381777 DOI: 10.3945/ajcn.114.098988] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 02/05/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Inflammation may be important in endometrial cancer development. Long-chain ω-3 (n-3) polyunsaturated fatty acids (LCω-3PUFAs) may reduce inflammation and, therefore, reduce cancer risk. Because body mass is associated with both inflammation and endometrial cancer risk, it may modify the association of fat intake on risk. OBJECTIVE We examined whether intakes of LCω-3PUFAs were associated with endometrial cancer risk overall and stratified by body size and histologic subtype. DESIGN Women were n = 87,360 participants of the Women's Health Initiative Observational Study and Clinical Trials who were aged 50-79 y, had an intact uterus, and completed a baseline food-frequency questionnaire. After 13 y of follow-up, n = 1253 incident invasive endometrial cancers were identified. Cox regression models were used to estimate HRs and 95% CIs for the association of intakes of individual ω-3 fatty acids and fish with endometrial cancer risk. RESULTS Intakes of individual LCω-3PUFAs were associated with 15-23% linear reductions in endometrial cancer risk. In women with body mass index (BMI; in kg/m(2)) <25, those in the upper compared with lowest quintiles of total LCω-3PUFA intake (sum of eicosapentaenoic, docosapentaenoic, and docosahexaenoic acids) had significantly reduced endometrial cancer risk (HR: 0.59; 95% CI: 0.40, 0.82; P-trend = 0.001), whereas there was little evidence of an association in overweight or obese women. The reduction in risk observed in normal-weight women was further specific to type I cancers. CONCLUSIONS Long-chain ω-3 intake was associated with reduced endometrial cancer risk only in normal-weight women. Additional studies that use biomarkers of ω-3 intake are needed to more accurately estimate their effects on endometrial cancer risk. This trial was registered at clinicaltrials.gov as NCT00000611.
Collapse
Affiliation(s)
- Theodore M Brasky
- From the Department of Internal Medicine, Division of Cancer Prevention and Control, College of Medicine (TMB), the Department of Human Sciences, College of Education and Human Ecology (TSO and MAB), and the Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, College of Medicine (DEC), The Ohio State University, Columbus, OH; the Women's Health Initiative Clinical Coordinating Center(RJR and JL) and the Cancer Prevention Program (EW and MLN), Fred Hutchinson Cancer Research Center, Seattle, WA; the Office of Epidemiology and Biostatistics, Allegheny County Health Department, Pittsburgh, PA (MLK); the Department of Epidemiology, Slone Epidemiology Center at Boston University, Boston University School of Public Health, Boston, MA (LAW); and the Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA (JEM)
| | - Rebecca J Rodabough
- From the Department of Internal Medicine, Division of Cancer Prevention and Control, College of Medicine (TMB), the Department of Human Sciences, College of Education and Human Ecology (TSO and MAB), and the Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, College of Medicine (DEC), The Ohio State University, Columbus, OH; the Women's Health Initiative Clinical Coordinating Center(RJR and JL) and the Cancer Prevention Program (EW and MLN), Fred Hutchinson Cancer Research Center, Seattle, WA; the Office of Epidemiology and Biostatistics, Allegheny County Health Department, Pittsburgh, PA (MLK); the Department of Epidemiology, Slone Epidemiology Center at Boston University, Boston University School of Public Health, Boston, MA (LAW); and the Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA (JEM)
| | - Jingmin Liu
- From the Department of Internal Medicine, Division of Cancer Prevention and Control, College of Medicine (TMB), the Department of Human Sciences, College of Education and Human Ecology (TSO and MAB), and the Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, College of Medicine (DEC), The Ohio State University, Columbus, OH; the Women's Health Initiative Clinical Coordinating Center(RJR and JL) and the Cancer Prevention Program (EW and MLN), Fred Hutchinson Cancer Research Center, Seattle, WA; the Office of Epidemiology and Biostatistics, Allegheny County Health Department, Pittsburgh, PA (MLK); the Department of Epidemiology, Slone Epidemiology Center at Boston University, Boston University School of Public Health, Boston, MA (LAW); and the Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA (JEM)
| | - Michelle L Kurta
- From the Department of Internal Medicine, Division of Cancer Prevention and Control, College of Medicine (TMB), the Department of Human Sciences, College of Education and Human Ecology (TSO and MAB), and the Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, College of Medicine (DEC), The Ohio State University, Columbus, OH; the Women's Health Initiative Clinical Coordinating Center(RJR and JL) and the Cancer Prevention Program (EW and MLN), Fred Hutchinson Cancer Research Center, Seattle, WA; the Office of Epidemiology and Biostatistics, Allegheny County Health Department, Pittsburgh, PA (MLK); the Department of Epidemiology, Slone Epidemiology Center at Boston University, Boston University School of Public Health, Boston, MA (LAW); and the Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA (JEM)
| | - Lauren A Wise
- From the Department of Internal Medicine, Division of Cancer Prevention and Control, College of Medicine (TMB), the Department of Human Sciences, College of Education and Human Ecology (TSO and MAB), and the Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, College of Medicine (DEC), The Ohio State University, Columbus, OH; the Women's Health Initiative Clinical Coordinating Center(RJR and JL) and the Cancer Prevention Program (EW and MLN), Fred Hutchinson Cancer Research Center, Seattle, WA; the Office of Epidemiology and Biostatistics, Allegheny County Health Department, Pittsburgh, PA (MLK); the Department of Epidemiology, Slone Epidemiology Center at Boston University, Boston University School of Public Health, Boston, MA (LAW); and the Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA (JEM)
| | - Tonya S Orchard
- From the Department of Internal Medicine, Division of Cancer Prevention and Control, College of Medicine (TMB), the Department of Human Sciences, College of Education and Human Ecology (TSO and MAB), and the Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, College of Medicine (DEC), The Ohio State University, Columbus, OH; the Women's Health Initiative Clinical Coordinating Center(RJR and JL) and the Cancer Prevention Program (EW and MLN), Fred Hutchinson Cancer Research Center, Seattle, WA; the Office of Epidemiology and Biostatistics, Allegheny County Health Department, Pittsburgh, PA (MLK); the Department of Epidemiology, Slone Epidemiology Center at Boston University, Boston University School of Public Health, Boston, MA (LAW); and the Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA (JEM)
| | - David E Cohn
- From the Department of Internal Medicine, Division of Cancer Prevention and Control, College of Medicine (TMB), the Department of Human Sciences, College of Education and Human Ecology (TSO and MAB), and the Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, College of Medicine (DEC), The Ohio State University, Columbus, OH; the Women's Health Initiative Clinical Coordinating Center(RJR and JL) and the Cancer Prevention Program (EW and MLN), Fred Hutchinson Cancer Research Center, Seattle, WA; the Office of Epidemiology and Biostatistics, Allegheny County Health Department, Pittsburgh, PA (MLK); the Department of Epidemiology, Slone Epidemiology Center at Boston University, Boston University School of Public Health, Boston, MA (LAW); and the Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA (JEM)
| | - Martha A Belury
- From the Department of Internal Medicine, Division of Cancer Prevention and Control, College of Medicine (TMB), the Department of Human Sciences, College of Education and Human Ecology (TSO and MAB), and the Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, College of Medicine (DEC), The Ohio State University, Columbus, OH; the Women's Health Initiative Clinical Coordinating Center(RJR and JL) and the Cancer Prevention Program (EW and MLN), Fred Hutchinson Cancer Research Center, Seattle, WA; the Office of Epidemiology and Biostatistics, Allegheny County Health Department, Pittsburgh, PA (MLK); the Department of Epidemiology, Slone Epidemiology Center at Boston University, Boston University School of Public Health, Boston, MA (LAW); and the Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA (JEM)
| | - Emily White
- From the Department of Internal Medicine, Division of Cancer Prevention and Control, College of Medicine (TMB), the Department of Human Sciences, College of Education and Human Ecology (TSO and MAB), and the Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, College of Medicine (DEC), The Ohio State University, Columbus, OH; the Women's Health Initiative Clinical Coordinating Center(RJR and JL) and the Cancer Prevention Program (EW and MLN), Fred Hutchinson Cancer Research Center, Seattle, WA; the Office of Epidemiology and Biostatistics, Allegheny County Health Department, Pittsburgh, PA (MLK); the Department of Epidemiology, Slone Epidemiology Center at Boston University, Boston University School of Public Health, Boston, MA (LAW); and the Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA (JEM)
| | - JoAnn E Manson
- From the Department of Internal Medicine, Division of Cancer Prevention and Control, College of Medicine (TMB), the Department of Human Sciences, College of Education and Human Ecology (TSO and MAB), and the Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, College of Medicine (DEC), The Ohio State University, Columbus, OH; the Women's Health Initiative Clinical Coordinating Center(RJR and JL) and the Cancer Prevention Program (EW and MLN), Fred Hutchinson Cancer Research Center, Seattle, WA; the Office of Epidemiology and Biostatistics, Allegheny County Health Department, Pittsburgh, PA (MLK); the Department of Epidemiology, Slone Epidemiology Center at Boston University, Boston University School of Public Health, Boston, MA (LAW); and the Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA (JEM)
| | - Marian L Neuhouser
- From the Department of Internal Medicine, Division of Cancer Prevention and Control, College of Medicine (TMB), the Department of Human Sciences, College of Education and Human Ecology (TSO and MAB), and the Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, College of Medicine (DEC), The Ohio State University, Columbus, OH; the Women's Health Initiative Clinical Coordinating Center(RJR and JL) and the Cancer Prevention Program (EW and MLN), Fred Hutchinson Cancer Research Center, Seattle, WA; the Office of Epidemiology and Biostatistics, Allegheny County Health Department, Pittsburgh, PA (MLK); the Department of Epidemiology, Slone Epidemiology Center at Boston University, Boston University School of Public Health, Boston, MA (LAW); and the Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA (JEM)
| |
Collapse
|
9
|
Merritt MA, Tzoulaki I, Tworoger SS, De Vivo I, Hankinson SE, Fernandes J, Tsilidis KK, Weiderpass E, Tjønneland A, Petersen KEN, Dahm CC, Overvad K, Dossus L, Boutron-Ruault MC, Fagherazzi G, Fortner RT, Kaaks R, Aleksandrova K, Boeing H, Trichopoulou A, Bamia C, Trichopoulos D, Palli D, Grioni S, Tumino R, Sacerdote C, Mattiello A, Bueno-de-Mesquita HB, Onland-Moret NC, Peeters PH, Gram IT, Skeie G, Quirós JR, Duell EJ, Sánchez MJ, Salmerón D, Barricarte A, Chamosa S, Ericson U, Sonestedt E, Nilsson LM, Idahl A, Khaw KT, Wareham N, Travis RC, Rinaldi S, Romieu I, Patel CJ, Riboli E, Gunter MJ. Investigation of dietary factors and endometrial cancer risk using a nutrient-wide association study approach in the EPIC and Nurses' Health Study (NHS) and NHSII. Cancer Epidemiol Biomarkers Prev 2015; 24:466-71. [PMID: 25662427 PMCID: PMC4324546 DOI: 10.1158/1055-9965.epi-14-0970] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Data on the role of dietary factors in endometrial cancer development are limited and inconsistent. We applied a "nutrient-wide association study" approach to systematically evaluate dietary risk associations for endometrial cancer while controlling for multiple hypothesis tests using the false discovery rate (FDR) and validating the results in an independent cohort. We evaluated endometrial cancer risk associations for dietary intake of 84 foods and nutrients based on dietary questionnaires in three prospective studies, the European Prospective Investigation into Cancer and Nutrition (EPIC; N = 1,303 cases) followed by validation of nine foods/nutrients (FDR ≤ 0.10) in the Nurses' Health Studies (NHS/NHSII; N = 1,531 cases). Cox regression models were used to estimate HRs and 95% confidence intervals (CI). In multivariate adjusted comparisons of the extreme categories of intake at baseline, coffee was inversely associated with endometrial cancer risk (EPIC, median intake 750 g/day vs. 8.6; HR, 0.81; 95% CI, 0.68-0.97, Ptrend = 0.09; NHS/NHSII, median intake 1067 g/day vs. none; HR, 0.82; 95% CI, 0.70-0.96, Ptrend = 0.04). Eight other dietary factors that were associated with endometrial cancer risk in the EPIC study (total fat, monounsaturated fat, carbohydrates, phosphorus, butter, yogurt, cheese, and potatoes) were not confirmed in the NHS/NHSII. Our findings suggest that coffee intake may be inversely associated with endometrial cancer risk. Further data are needed to confirm these findings and to examine the mechanisms linking coffee intake to endometrial cancer risk to develop improved prevention strategies.
Collapse
Affiliation(s)
- Melissa A Merritt
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
| | - Ioanna Tzoulaki
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Shelley S Tworoger
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
| | - Immaculata De Vivo
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts. Program in Genetic Epidemiology and Statistical Genetics, Harvard School of Public Health, Boston, Massachusetts
| | - Susan E Hankinson
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts. Division of Biostatistics and Epidemiology, University of Massachusetts, Amherst, Massachusetts
| | - Judy Fernandes
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Konstantinos K Tsilidis
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece. Cancer Epidemiology Unit, University of Oxford, Oxford, United Kingdom
| | - Elisabete Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway. Department of Research, Cancer Registry of Norway, Oslo, Norway. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. Department of Genetic Epidemiology, Samfundet Folkhälsan, Helsinki, Finland
| | | | | | - Christina C Dahm
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Kim Overvad
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Laure Dossus
- Inserm, Centre for Research in Epidemiology and Population Health (CESP), Villejuif, France. University Paris Sud, Villejuif, France. IGR, Villejuif, France
| | - Marie-Christine Boutron-Ruault
- Inserm, Centre for Research in Epidemiology and Population Health (CESP), Villejuif, France. University Paris Sud, Villejuif, France. IGR, Villejuif, France
| | - Guy Fagherazzi
- Inserm, Centre for Research in Epidemiology and Population Health (CESP), Villejuif, France. University Paris Sud, Villejuif, France. IGR, Villejuif, France
| | - Renée T Fortner
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Krasimira Aleksandrova
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Antonia Trichopoulou
- Hellenic Health Foundation, Athens, Greece. Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece
| | - Christina Bamia
- Department of Hygiene, Epidemiology, and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - Dimitrios Trichopoulos
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts. Hellenic Health Foundation, Athens, Greece. Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece
| | - Domenico Palli
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute-ISPO, Florence, Italy
| | - Sara Grioni
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Rosario Tumino
- Cancer Registry and Histopathology Unit, "Civic-M.P. Arezzo" Hospital, ASP, Ragusa, Italy
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, AO Citta' della Salute e della Scienza-University of Turin and Center for Cancer Prevention (CPO-Piemonte), Turin, Italy. Human Genetics Foundation (HuGeF), Turin, Italy
| | - Amalia Mattiello
- Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy
| | - H Bas Bueno-de-Mesquita
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom. Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands. Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands. Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - N Charlotte Onland-Moret
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands
| | - Petra H Peeters
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom. Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands
| | - Inger T Gram
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Guri Skeie
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | | | - Eric J Duell
- Unit of Nutrition, Environment, and Cancer, Cancer Epidemiology Research Program, Bellvitge Biomedical Research Institute (IDIBELL), Catalan Institute of Oncology (ICO), Barcelona, Spain
| | - María-José Sánchez
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria de Granada (Granada.ibs), Granada, Spain. CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - D Salmerón
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain. Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain
| | - Aurelio Barricarte
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. Navarre Public Health Institute, Pamplona, Spain
| | - Saioa Chamosa
- Public Health Department of Gipuzkoa, Government of the Basque Country, San Sebastian, Spain. BioDonostia Research Institute, San Sebastian, Spain
| | - Ulrica Ericson
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Emily Sonestedt
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Lena Maria Nilsson
- Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden. Arcum, Arctic Research Centre at Umeå University, Umeå, Sweden
| | - Annika Idahl
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | - Kay-Tee Khaw
- University of Cambridge, School of Clinical Medicine, Cambridge, United Kingdom
| | - Nicholas Wareham
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Ruth C Travis
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Sabina Rinaldi
- International Agency for Research on Cancer, Lyon, France
| | | | - Chirag J Patel
- Center for Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Marc J Gunter
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| |
Collapse
|
10
|
Bravi F, Bertuccio P, Turati F, Serraino D, Edefonti V, Dal Maso L, Decarli A, Montella M, Zucchetto A, La Vecchia C, Bosetti C, Ferraroni M. Nutrient-based dietary patterns and endometrial cancer risk: an Italian case–control study. Cancer Epidemiol 2015; 39:66-72. [DOI: 10.1016/j.canep.2014.12.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 12/02/2014] [Accepted: 12/07/2014] [Indexed: 01/26/2023]
|
11
|
Chu KT, Song Y, Zhou JH. No Effect of Energy Intake Overall on Risk of Endometrial Cancers: a Meta-analysis. Asian Pac J Cancer Prev 2015; 15:10293-8. [DOI: 10.7314/apjcp.2014.15.23.10293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
12
|
Brasky TM, Neuhouser ML, Cohn DE, White E. Associations of long-chain ω-3 fatty acids and fish intake with endometrial cancer risk in the VITamins And Lifestyle cohort. Am J Clin Nutr 2014; 99:599-608. [PMID: 24500149 PMCID: PMC3927693 DOI: 10.3945/ajcn.113.070524] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Inflammation plays an important role in endometrial cancer etiology. Long-chain ω-3 (n-3) polyunsaturated fatty acids (PUFAs), derived from marine sources, are thought to be antiinflammatory; however, several studies of fish consumption suggest an increase in risk. OBJECTIVE This study examined whether intakes of long-chain ω-3 PUFAs, including eicosapentaenoic acid (EPA; 20:5ω-3) and docosahexaenoic acid (DHA; 22:6ω-3), from diet and supplements and intake of fish are associated with endometrial cancer risk. DESIGN Between 2000 and 2002, 22,494 women aged 50-76 y, living in western Washington State, were recruited to the VITamins And Lifestyle cohort study. Incident endometrial cancers (n = 263) were identified through the Surveillance, Epidemiology, and End Results cancer registry after 9 y of follow-up. Multivariable-adjusted HRs and 95% CIs for the association of intakes of individual long-chain ω-3 PUFAs and fish with endometrial cancer risk were estimated by using Cox proportional hazards. RESULTS Women in the highest compared with the lowest quintile of dietary EPA + DHA intake had a 79% increased risk of endometrial cancer (95% CI: 16%, 175%; P-trend = 0.026). Results were similar for EPA and DHA measured individually and for fish intake. When data were stratified by body mass index (in kg/m²; <25 or ≥ 25), increases in risk of long-chain ω-3 PUFAs were restricted to overweight and obese women, and statistically significant reductions in risk were observed for normal-weight women. CONCLUSIONS The overall increased risk reported here confirms the findings of several prior observational studies of fish intake, which observed similar increases in risk. Randomized trials are needed to confirm these findings.
Collapse
Affiliation(s)
- Theodore M Brasky
- Department of Internal Medicine, Division of Cancer Prevention and Control (TMB) and the Department of Obstetrics and Gynecology, Division of Gynecologic Oncology (DEC), The Ohio State University College of Medicine, Columbus, OH, and the Fred Hutchinson Cancer Research Center, Cancer Prevention Program, Seattle, WA (MLN and EW)
| | | | | | | |
Collapse
|
13
|
Arem H, Gunter MJ, Cross AJ, Hollenbeck AR, Sinha R. A prospective investigation of fish, meat and cooking-related carcinogens with endometrial cancer incidence. Br J Cancer 2013; 109:756-60. [PMID: 23695021 PMCID: PMC3738127 DOI: 10.1038/bjc.2013.252] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 04/24/2013] [Accepted: 04/27/2013] [Indexed: 12/11/2022] Open
Abstract
Background: There are limited prospective studies of fish and meat intakes with risk of endometrial cancer and findings are inconsistent. Methods: We studied associations between fish and meat intakes and endometrial cancer incidence in the large, prospective National Institutes of Health-AARP Diet and Health Study. Intakes of meat mutagens 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP), 2-amino-3,8-dimethylimidazo[4,5-f]quinoxaline (MeIQx), 2-amino-3,4,8-trimethylimidazo[4,5-f]quinoxaline (DiMeIQx) and benzo(a)pyrene (BaP) were also calculated. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results: We observed no associations with endometrial cancer risk comparing the highest to lowest intake quintiles of red (HR=0.91, 95% CI 0.77–1.08), white (0.98, 0.83–1.17), processed meats (1.02, 0.86–1.21) and fish (1.10, 95% CI 0.93–1.29). We also found no associations between meat mutagen intakes and endometrial cancer. Conclusion: Our findings do not support an association between meat or fish intakes or meat mutagens and endometrial cancer.
Collapse
Affiliation(s)
- H Arem
- Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Rockville, MD 20852, USA.
| | | | | | | | | |
Collapse
|
14
|
Genkinger JM, Friberg E, Goldbohm RA, Wolk A. Long-term dietary heme iron and red meat intake in relation to endometrial cancer risk. Am J Clin Nutr 2012; 96:848-54. [PMID: 22952183 DOI: 10.3945/ajcn.112.039537] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Heme and total iron, present in meat, have been hypothesized to promote carcinogenesis. Few prospective studies have examined the associations between intakes of heme and total iron, types of meat, and endometrial cancer risk. OBJECTIVE We evaluated the associations between intakes of heme and total iron, types of meat, and risk of endometrial cancer in a large cohort of women. DESIGN Among 60,895 women in the Swedish Mammography Cohort, 720 endometrial cancer cases were confirmed during 21 y of follow-up. RRs and 95% CIs were calculated by Cox proportional hazards models. RESULTS A comparison of the highest with the lowest quartile showed a 20-30% higher risk of endometrial cancer for higher intakes of heme iron (RR: 1.24; 95% CI: 1.01, 1.53 for ≥1.63 compared with <0.69 mg/d), total iron (RR: 1.31; 95% CI: 1.07, 1.61 for ≥15.09 compared with <12.27 mg/d), and liver (RR: 1.29; 95% CI: 1.06, 1.56 for ≥100 compared with <100 g/wk). No statistically significant associations were observed between intakes of red and processed meats and endometrial cancer risk. RRs did not greatly differ when we stratified by BMI, parity, and intakes of alcohol, vitamin C, or zinc or when we excluded patients with diabetes. CONCLUSIONS Our study suggests a modest positive association between heme iron, total iron, and liver intakes and endometrial cancer risk; no statistically significant associations were observed for intakes of other red and processed meats and endometrial cancer risk.
Collapse
Affiliation(s)
- Jeanine M Genkinger
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
| | | | | | | |
Collapse
|
15
|
Arem H, Neuhouser ML, Irwin ML, Cartmel B, Lu L, Risch H, Mayne ST, Yu H. Omega-3 and omega-6 fatty acid intakes and endometrial cancer risk in a population-based case-control study. Eur J Nutr 2012; 52:1251-60. [PMID: 22915050 DOI: 10.1007/s00394-012-0436-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 08/06/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE Animal and laboratory studies suggest that long-chain omega-3 (n-3) fatty acids, a type of polyunsaturated fat found in fatty fish, may protect against carcinogenesis, but human studies on dietary intake of polyunsaturated fats and fish with endometrial cancer risk show mixed results. METHODS We evaluated the associations between endometrial cancer risk and intake of fatty acids and fish in a population-based sample of 556 incident cancer cases and 533 age-matched controls using multivariate unconditional logistic regression methods. RESULTS Although total n-3 fatty acid intake was not associated with endometrial cancer risk, higher intakes of eicosapentaenoic (EPA 20:5) and docosahexaenoic (DHA 22:6) fatty acids were significantly associated with lower risks (OR = 0.57, 95 % CI: 0.39-0.84; OR = 0.64, 95 % CI: 0.44-0.94; respectively) comparing extreme quartiles. The ratio of n-3:n-6 fatty acids was inversely associated with risk only on a continuous scale (OR = 0.84, 95 % CI: 0.71-0.99), while total fish intake was not associated with risk. Fish oil supplement use was significantly associated with reduced risk of endometrial cancer: OR = 0.63 (95 % CI: 0.45-0.88). CONCLUSIONS Our results suggest that dietary intake of the long-chain polyunsaturated fatty acids EPA and DHA in foods and supplements may have protective associations against the development of endometrial cancer.
Collapse
Affiliation(s)
- Hannah Arem
- Yale School of Public Health, 60 College Street, P.O. Box 208034, New Haven, CT 06520, USA.
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Ganmaa D, Cui X, Feskanich D, Hankinson SE, Willett WC. Milk, dairy intake and risk of endometrial cancer: a 26-year follow-up. Int J Cancer 2011; 130:2664-71. [PMID: 21717454 DOI: 10.1002/ijc.26265] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Accepted: 06/03/2011] [Indexed: 12/18/2022]
Abstract
Estrogens have a central role in the etiology of endometrial cancer. Milk and dairy products are a source of steroid hormones and growth factors that might have physiological effects in humans. We hypothesized that high intakes of milk and dairy products are associated with an increased risk of endometrial cancer, particularly among postmenopausal women not using hormone therapy. This was a prospective cohort study with 68,019 female participants in the Nurses' Health Study aged 34-59 in 1980. Milk and dairy consumption were assessed in 1980, 1984, 1986, 1990, 1994, 1998 and 2002 as servings per day and the follow-up continued through 2006. The multivariate relative risks (RRs) of adenocarcinoma of the endometrium across categories of cumulatively averaged total dairy consumption compared with < 1 svg/day were: 0.94 (95% CI = 0.71-1.25) for 1-1.4 svg/day, 1.14 (0.87-1.49) for 1.5-1.9 svg/day, 1.10 (0.84-1.44) for 2-2.9 svg/day, 1.26 (0.94-1.70) for ≥ 3 svg/day (p for trend = 0.06). The association between total dairy intake and endometrial cancer was significant only among the postmenopausal women (for ≥ 3 svg/day RR = 1.41, 95% CI = 1.01-1.98, p for trend = 0.02) and was evident only among those who were not currently using hormone therapy (RR = 1.58, 95% CI = 1.05-2.36, p for trend = 0.003). Total dairy intake was not significantly associated with risk of preinvasive endometrial cancer. In conclusion, we observed a marginally significant overall association between dairy intake and endometrial cancer and a stronger association among postmenopausal women who were not using estrogen-containing hormones.
Collapse
Affiliation(s)
- Davaasambuu Ganmaa
- Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA.
| | | | | | | | | |
Collapse
|
17
|
Biel RK, Friedenreich CM, Csizmadi I, Robson PJ, McLaren L, Faris P, Courneya KS, Magliocco AM, Cook LS. Case-control study of dietary patterns and endometrial cancer risk. Nutr Cancer 2011; 63:673-86. [PMID: 21614724 DOI: 10.1080/01635581.2011.563025] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Dietary patterns, rather than intakes of specific foods or nutrients, may influence risk of endometrial cancer (EC). This population-based case-control study in Canada (2002-2006) included incident EC cases (n = 506) from the Alberta Cancer Registry and controls frequency age-matched to cases (n = 981). Past-year dietary patterns were defined using factor analysis of food frequency questionnaire data. Logistic regression was used to estimate EC risk within quartiles of dietary patterns. Three patterns (sweets, meat, plants) explained 23% of the variance in the dietary data. In multivariable models, EC risk was significantly reduced by 30% for women in the highest quartile of the healthier plants pattern (OR = 0.70, 95% CI 0.50-0.98, P trend = 0.02). When stratified by body mass index (BMI; kg/m(2)), risk was further reduced among overweight or obese women with a BMI ≥25 (OR = 0.57, 95% CI 0.39-0.83; P trend = 0.004). EC was not associated with the less healthy sweets and meat patterns. However, risk was modestly, but not significantly, elevated for higher intakes of the meat pattern among overweight or obese women. A mostly plant-based dietary pattern may reduce EC risk. Recommendations for risk reduction should focus on maintaining a healthy weight and the role of diet should be studied further.
Collapse
Affiliation(s)
- Rita K Biel
- Department of Population Health Research, Division of Cancer Care, Alberta Health Services, Calgary, Canada.
| | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Cui X, Rosner B, Willett WC, Hankinson SE. Dietary fat, fiber, and carbohydrate intake in relation to risk of endometrial cancer. Cancer Epidemiol Biomarkers Prev 2011; 20:978-89. [PMID: 21393567 DOI: 10.1158/1055-9965.epi-10-1089] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Macronutrients such as fat and fiber have been hypothesized to play a role in the etiology of endometrial cancer. METHODS To investigate these associations, the authors analyzed data from the Nurses' Health Study. From 1980 to 2006, 669 invasive adenocarcinoma cases were identified over 1.3 million person-years of follow-up. Dietary intake was assessed in 1980 and updated every 2-4 years. Cox proportional hazard models were used to calculate relative risks (RRs), controlling for total energy and other risk factors. RESULTS Overall, the authors found no significant associations between most dietary factors and endometrial cancer risk. Total fat was associated with a borderline significant decreased risk (top vs. bottom quintile RR = 0.78; 95% CI = 0.60-0.99; P(trend) = 0.18). Findings for animal fat were similar. No inverse associations between dietary fibers and cancer risk were observed. Cereal fiber was modestly positively associated with risk (top vs. bottom quintile RR = 1.38, 95% CI = 1.07-1.79; P(trend) = 0.05). The inverse association with animal fat intake and a positive association with carbohydrate intake were observed among premenopausal but not among postmenopausal women. CONCLUSIONS In this large prospective study, no overall association was observed between dietary fat, fiber, and carbohydrates with endometrial cancer risk, although several of the relationships may vary by menopausal status. IMPACT Dietary fat and fiber intake do not seem to play a major role in endometrial cancer etiology overall. However, further evaluation of these associations, particularly in premenopausal women, is needed.
Collapse
Affiliation(s)
- Xiaohui Cui
- Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
| | | | | | | |
Collapse
|
19
|
Chandran U, Bandera EV, Williams-King MG, Sima C, Bayuga S, Pulick K, Wilcox H, Zauber AG, Olson SH. Adherence to the dietary guidelines for Americans and endometrial cancer risk. Cancer Causes Control 2010; 21:1895-904. [PMID: 20652737 PMCID: PMC3065196 DOI: 10.1007/s10552-010-9617-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Accepted: 07/09/2010] [Indexed: 11/26/2022]
Abstract
The Healthy Eating Index (HEI) was developed by the US Department of Agriculture with the goal of quantifying adherence to the Dietary Guidelines for Americans. The purpose of this study was to evaluate the impact of the HEI-2005 score and each of its components on endometrial cancer risk in a population-based case-control study in New Jersey. A total of 424 cases and 398 controls completed a Food Frequency Questionnaire, which was used to derive the HEI-2005 score. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using unconditional logistic regression while adjusting for potential covariates, which included all major endometrial cancer risk factors. The adjusted OR for women in the highest quartile when compared to the lowest quartile was 0.83 (95% CI: 0.52-1.34). For the meat and beans component comprising meat, eggs, poultry, fish, and beans, the OR was 0.70 (95% CI: 0.45-1.11; p for trend: 0.07), with little evidence of an association with any of the individual foods. There was no indication of an association for any of the other components of the HEI or of effect modification by body mass index. This study suggested limited value for the HEI-2005 in predicting endometrial cancer risk.
Collapse
Affiliation(s)
- Urmila Chandran
- The Cancer Institute of New Jersey, Robert Wood Johnson Medical School, 195 Little Albany St., New Brunswick, NJ 08903, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Kallianpur AR, Lee SA, Xu WH, Zheng W, Gao YT, Cai H, Ruan ZX, Xiang YB, Shu XO. Dietary iron intake and risk of endometrial cancer: a population-based case-control study in Shanghai, China. Nutr Cancer 2010; 62:40-50. [PMID: 20043258 DOI: 10.1080/01635580903191544] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Dietary red meat and animal fat have been linked to endometrial cancer (EC) risk, but the impact of bioavailable iron in animal-derived foods has been less well studied. Our objective was to investigate the effects of iron and fats on the risk of EC in a large, population-based, case-control study. The Shanghai Endometrial Cancer Study enrolled 1,204 EC cases and 1,212 controls who completed in-person interviews, including a food frequency questionnaire. Animal-derived iron and fat intakes were calculated from dietary intakes and food composition tables. Logistic regression models were used to evaluate independent and joint effects of iron and fat on EC risk. Animal-derived iron intake was positively associated with EC risk [adjusted OR = 1.9; 95% CI = 1.4-2.7, P(trend) < 0.01, highest vs. lowest quartile], predominantly after menopause (OR = 2.2; 95%CI = 1.4-3.4, P(trend) < 0.01) and in women with BMI >or= 25 kg/m(2)(OR = 3.2; 95% CI = 1.4-7.5 in postmenopausal obese women, P(trend) < 0.01). Animal-derived fat was also associated with postmenopausal EC risk (OR = 1.7; 95% CI = 1.2-2.5, P(trend) < 0.01). Multiplicative interactions between animal-derived iron and BMI or animal-derived fat intake were not observed. Animal-derived iron intake is associated with increased risk of EC after menopause and among obese women. Avoidance of animal-derived (heme) iron may reduce the risk of EC in these women.
Collapse
Affiliation(s)
- Asha R Kallianpur
- Institute for Medicine and Public Health, Vanderbilt Epidemiology Center and Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, Tennessee 37203-1738, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Yeh M, Moysich KB, Jayaprakash V, Rodabaugh KJ, Graham S, Brasure JR, McCann SE. Higher intakes of vegetables and vegetable-related nutrients are associated with lower endometrial cancer risks. J Nutr 2009; 139:317-22. [PMID: 19074206 DOI: 10.3945/jn.108.099960] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A limited number of studies have investigated diet in association with endometrial cancer (EC). We examined the association between intakes of selected food groups and nutrients with EC risk among 541 women with histologically confirmed EC and 541 women with an intact uterus and noncancer diagnoses seen at Roswell Park Cancer Institute between 1982 and 1998. Self-reported dietary and other epidemiologic data were collected by questionnaire. Unconditional logistic regression was used to estimate odds ratios (OR) and 95% CI, adjusting for age, BMI, hormone replacement therapy use, cigarette smoking, lifetime duration of menstruation, and total energy intake. We observed significant inverse associations for women in the highest vs. lowest quartiles of intake of total vegetables (OR, 0.51; 95% CI, 0.34-0.75), vitamin E (OR, 0.44; 95% CI, 0.27-0.70), dietary fiber (OR, 0.60; 95% CI, 0.39-0.94), beta-carotene (OR, 0.55; 95% CI, 0.37-0.82), lutein (OR, 0.52; 95% CI, 0.34-0.78), and folate (OR, 0.57; 95% CI, 0.36-0.91). Our results support that vegetables and related nutrients are associated with decreased risk of EC.
Collapse
Affiliation(s)
- Michael Yeh
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY 14263, USA
| | | | | | | | | | | | | |
Collapse
|
22
|
Endometrial hyperplasia, endometrial cancer and prevention: Gaps in existing research of modifiable risk factors. Eur J Cancer 2008; 44:1632-44. [DOI: 10.1016/j.ejca.2008.05.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2008] [Revised: 04/25/2008] [Accepted: 05/01/2008] [Indexed: 12/13/2022]
|
23
|
Pérez-López FR. Sunlight, the vitamin D endocrine system, and their relationships with gynaecologic cancer. Maturitas 2008; 59:101-13. [PMID: 18289805 DOI: 10.1016/j.maturitas.2007.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2007] [Revised: 12/03/2007] [Accepted: 12/11/2007] [Indexed: 10/22/2022]
Abstract
Vitamin D has classically been considered an important nutrient, but modern scientific evidence points out that it has a new and more critical role as ubiquitous hormone at the centre of a complex endocrine, paracrine, and autocrine system involved in maintaining general health. Vitamin D is found in small quantities in food; however, it is also produced by the skin when exposed to certain intensities of ultraviolet light. Substantial epidemiological and clinical data suggest a link between low levels of vitamin D and an increased risk of a number of female specific cancers. Different types of cancer cells present vitamin D receptors and the enzymatic system involved in both vitamin D synthesis and inhibition. Sustained low levels of its precursor are responsible for alterations in vitamin D tissue and cell production and metabolism. The active form of vitamin D, 1,25(OH)2D3, can induce differentiation, inhibit proliferation, and modulate immune responsiveness of breast and a wide variety of female genital cell types. Vitamin D effects have been observed on expression of cell cycle regulators, growth factors and their receptors, apoptotic machinery, metastatic potential, and angiogenesis; all of which have some effect on hyperproliferative conditions. However, vitamin D blood levels may not be representative of the local metabolic alterations during carcinogenesis. Clinical studies support the recommendation to increase vitamin D levels to a normal range in order to prevent the tissue disorders related to hypovitaminosis D which are thought to be involved in the initiation and progression of cancer.
Collapse
Affiliation(s)
- Faustino R Pérez-López
- Department of Obstetrics and Gynaecology, University of Zaragoza Faculty of Medicine, Domingo Miral s/n, Zaragoza 50009, Spain.
| |
Collapse
|
24
|
Kabat GC, Miller AB, Jain M, Rohan TE. Dietary iron and haem iron intake and risk of endometrial cancer: a prospective cohort study. Br J Cancer 2007; 98:194-8. [PMID: 18059399 PMCID: PMC2359694 DOI: 10.1038/sj.bjc.6604110] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
We used data from a large cohort study of Canadian women to assess the association of meat intake and dietary intake of iron and haem iron with risk of endometrial cancer. Among 34 148 women with an intact uterus at baseline and followed for a mean of 16.4 years, we identified 426 incident endometrial cancer cases. Data from a food frequency questionnaire administered at baseline were used to calculate intake of all meats, red meat, total dietary iron, iron from meat, haem iron, and non-haem iron. Analyses were carried out using Cox proportional hazards models with adjustment for known risk factors and covariates. We found no association of intake of meat or any of the dietary iron-related variables with risk of endometrial cancer.
Collapse
Affiliation(s)
- G C Kabat
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Room 1301, Bronx, NY 10461, USA.
| | | | | | | |
Collapse
|
25
|
Cust AE, Slimani N, Kaaks R, van Bakel M, Biessy C, Ferrari P, Laville M, Tjønneland A, Olsen A, Overvad K, Lajous M, Clavel-Chapelon F, Boutron-Ruault MC, Linseisen J, Rohrmann S, Nöthlings U, Boeing H, Palli D, Sieri S, Panico S, Tumino R, Sacerdote C, Skeie G, Engeset D, Gram IT, Quirós JR, Jakszyn P, Sánchez MJ, Larrañaga N, Navarro C, Ardanaz E, Wirfält E, Berglund G, Lundin E, Hallmans G, Bueno-de-Mesquita HB, Du H, Peeters PHM, Bingham S, Khaw KT, Allen NE, Key TJ, Jenab M, Riboli E. Dietary carbohydrates, glycemic index, glycemic load, and endometrial cancer risk within the European Prospective Investigation into Cancer and Nutrition cohort. Am J Epidemiol 2007; 166:912-23. [PMID: 17670911 DOI: 10.1093/aje/kwm161] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The associations of dietary total carbohydrates, overall glycemic index, total dietary glycemic load, total sugars, total starch, and total fiber with endometrial cancer risk were analyzed among 288,428 women in the European Prospective Investigation into Cancer and Nutrition cohort (1992-2004), including 710 incident cases diagnosed during a mean 6.4 years of follow-up. Cox proportional hazards models were used to estimate relative risks and 95% confidence intervals. There were no statistically significant associations with endometrial cancer risk for increasing quartile intakes of any of the exposure variables. However, in continuous models calibrated by using 24-hour recall values, the multivariable relative risks were 1.61 (95% confidence interval: 1.06, 2.45) per 100 g/day of total carbohydrates, 1.40 (95% confidence interval: 0.99, 1.99) per 50 units/day of total dietary glycemic load, and 1.36 (95% confidence interval: 1.05, 1.76) per 50 g/day of total sugars. These associations were stronger among women who had never used postmenopausal hormone therapy compared with ever users (total carbohydrates p(heterogeneity) = 0.04). Data suggest no association of overall glycemic index, total starch, and total fiber with risk, and a possible modest positive association of total carbohydrates, total dietary glycemic load, and total sugars with risk, particularly among never users of hormone replacement therapy.
Collapse
Affiliation(s)
- Anne E Cust
- Nutrition and Hormones Unit, International Agency for Research on Cancer, Lyon, France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Bandera EV, Kushi LH, Moore DF, Gifkins DM, McCullough ML. Dietary lipids and endometrial cancer: the current epidemiologic evidence. Cancer Causes Control 2007; 18:687-703. [PMID: 17572853 PMCID: PMC2601627 DOI: 10.1007/s10552-007-9021-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2007] [Accepted: 05/07/2007] [Indexed: 01/11/2023]
Abstract
BACKGROUND Because dietary fat has been postulated to affect obesity and estrogen levels, two important risk factors for endometrial cancer, its association with this disease has received some attention. We summarize here the current evidence for several dietary lipids. METHODS Searches were conducted to identify peer-reviewed manuscripts up to December 2006. Two cohort studies and nine case-control studies were included in meta-analyses. RESULTS Random-effects summary estimates for case-control studies were 1.24 (95% CI: 1.10, 1.41) per 10% kcal from total fat and 1.28 (95% CI: 1.12, 1.47) per 10 g/1,000 kcal of saturated fat. The only cohort study evaluating total fat and saturated fat did not find an association. We estimated a 35% increased risk (95% CI: 0.96, 1.90) per 150 mg/1,000 kcal of cholesterol intake, based on six case-control studies. For animal fat (per 10 g/1,000 kcal) the summary estimates were 0.78 (95% CI: 0.63, 0.96) and 1.34 (95% CI: 1.06, 1.69) for two cohort and four case-control studies, respectively. CONCLUSIONS Case-control data suggest an increased risk for total, saturated, and animal fat. However, the limited available cohort data do not support these associations. Additional data, particularly from prospective studies, are needed before conclusions can be drawn.
Collapse
Affiliation(s)
- Elisa V Bandera
- The Cancer Institute of New Jersey, Robert Wood Johnson Medical School, 195 Little Albany St, 5568, New Brunswick, NJ 08903, USA.
| | | | | | | | | |
Collapse
|
27
|
Friedenreich C, Cust A, Lahmann PH, Steindorf K, Boutron-Ruault MC, Clavel-Chapelon F, Mesrine S, Linseisen J, Rohrmann S, Pischon T, Schulz M, Tjønneland A, Johnsen NF, Overvad K, Mendez M, Arguelles MV, Garcia CM, Larrañaga N, Chirlaque MD, Ardanaz E, Bingham S, Khaw KT, Allen N, Key T, Trichopoulou A, Dilis V, Trichopoulos D, Pala V, Palli D, Tumino R, Panico S, Vineis P, Bueno-de-Mesquita HB, Peeters PHM, Monninkhof E, Berglund G, Manjer J, Slimani N, Ferrari P, Kaaks R, Riboli E. Physical activity and risk of endometrial cancer: the European prospective investigation into cancer and nutrition. Int J Cancer 2007; 121:347-55. [PMID: 17357139 DOI: 10.1002/ijc.22676] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The etiologic role of physical activity in endometrial cancer risk remains unclear given the few epidemiologic studies that have been conducted. To investigate this relation more fully, an analysis was undertaken in the European prospective investigation into cancer and nutrition (EPIC). During an average 6.6 years of follow-up, 689 incident endometrial cancer cases were identified from an analytic cohort within EPIC of 253,023 women. Cox proportional hazards models were used to estimate the associations between type of activity (total, occupational, household, recreational) and endometrial cancer risk. For total activity, women in the highest compared with the lowest quartile of activity had a risk of 0.88 (95% confidence interval (95% CI=0.61-1.27). No clear associations between each type of activity and endometrial cancer risk were found for the total study population combined. Associations were more evident in the stratified results, with premenopausal women who were active versus inactive experiencing a risk of 0.66 (95% CI=0.38-1.14) overall. Among premenopausal women, for household and recreational activities the risk estimates in the highest as compared with the lowest quartiles were, respectively, 0.48 (95% CI=0.23-0.99) and 0.78 (95% CI=0.44-1.39). No effect modification by body mass index, hormone replacement therapy, oral contraceptive use or energy intake was found. This study provides no evidence of a protective effect of increased physical activity in endometrial cancer risk in all women but some support for a benefit among premenopausal women. The relative risk reductions are most apparent for household activities.
Collapse
Affiliation(s)
- Christine Friedenreich
- Division of Population Health and Information, Alberta Cancer Board, Calgary, Alberta, Canada.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Dalvi TB, Canchola AJ, Horn-Ross PL. Dietary patterns, Mediterranean diet, and endometrial cancer risk. Cancer Causes Control 2007; 18:957-66. [PMID: 17638105 DOI: 10.1007/s10552-007-9037-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Accepted: 06/27/2007] [Indexed: 12/17/2022]
Abstract
This study examines the association between dietary patterns and endometrial cancer risk. A case-control study of endometrial cancer was conducted from 1996 to 1999 in the San Francisco Bay Area in white, African-American, and Latina women age 35-79. Dietary patterns were defined using a principal components analysis; scoring dietary intake based on correspondence to a Mediterranean-style diet; and by jointly categorizing intake of fruits/vegetables and dietary fat. Four dietary patterns were identified and labeled "plant-based," "western," "ethnic," and "phytoestrogen-rich." None of these dietary patterns nor adherence to a Mediterranean diet (to the extent consumed by this population) was associated with endometrial cancer risk. However, among non-users of supplements, greater consumption of the "western" dietary pattern was associated with a 60% increase in risk (95% CI: 0.95-2.7 per unit change; P-interaction = 0.10). A diet characterized by high fat consumption increased risk, regardless of fruit and vegetable consumption (OR = 1.4, 95% CI: 0.97-2.1 for high fat, low fruit/vegetable intake and OR = 1.4, 95% CI: 0.95-2.1 for high fat, high fruit/vegetable intake compared to low fat, high fruit/vegetable intake). Thus, while like others we found that dietary fat increases endometrial cancer risk, the evaluation of dietary patterns did not provide any additional information regarding risk.
Collapse
Affiliation(s)
- Tapashi B Dalvi
- Northern California Cancer Center, 2201 Walnut Avenue, Fremont, CA 94538, USA
| | | | | |
Collapse
|
29
|
Bandera EV, Kushi LH, Moore DF, Gifkins DM, McCullough ML. Consumption of animal foods and endometrial cancer risk: a systematic literature review and meta-analysis. Cancer Causes Control 2007; 18:967-88. [PMID: 17638104 PMCID: PMC2592095 DOI: 10.1007/s10552-007-9038-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Accepted: 06/27/2007] [Indexed: 12/11/2022]
Abstract
This article summarizes and quantifies the current evidence relating dietary intake of animal products and endometrial cancer. Literature searches were conducted to identify peer-reviewed manuscripts published up to December 2006. Twenty-two manuscripts from three cohort studies and 16 case-control studies were identified. One of these cohort studies evaluated only fried meat and another only milk consumption; they were not included in our meta-analyses. The third cohort study identified did not present exposure levels and could not be included in dose-response meta-analysis. This cohort study did not show an association with meat or red meat consumption. Random-effects dose-response summary estimates for case-control studies evaluating these foods were 1.26 (95% CI: 1.03-1.54) per 100 g/day of total meat, 1.51 (95% CI: 1.19-1.93) per 100 g/day of red meat, 1.03 (95% CI: 0.32-3.28) per 100 g/day of poultry, 1.04 (95% CI: 0.55-1.98) per 100 g/day of fish, and 0.97 (95% CI: 0.93-1.01) per serving of dairy. Our meta-analysis, based on case-control data, suggests that meat consumption, particularly red meat, increases endometrial cancer risk. The current literature does not support an association with dairy products, while the evidence is inconsistent for poultry, fish, and eggs. More studies, particularly prospective studies, are needed.
Collapse
Affiliation(s)
- Elisa V Bandera
- Robert Wood Johnson Medical School, The Cancer Institute of New Jersey, 195 Little Albany St, 5568, New Brunswick, NJ 08903, USA.
| | | | | | | | | |
Collapse
|
30
|
Xu WH, Dai Q, Xiang YB, Zhao GM, Ruan ZX, Cheng JR, Zheng W, Shu XO. Nutritional factors in relation to endometrial cancer: a report from a population-based case-control study in Shanghai, China. Int J Cancer 2007; 120:1776-81. [PMID: 17230528 PMCID: PMC2039904 DOI: 10.1002/ijc.22456] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We evaluated the role of dietary nutrients in the etiology of endometrial cancer in a population-based case-control study of 1,204 newly diagnosed endometrial cancer cases and 1,212 age frequency-matched controls. Information on usual dietary habits was collected during an in-person interview using a validated, quantitative food frequency questionnaire. Logistic regression analysis was conducted to evaluate the association of nutrients with endometrial cancer risk using an energy density method (e.g., nutrient intake/1,000 kilocalories of intake). Higher energy intake was associated with increased risk, which was attributable to animal source energy and a high proportion of energy from protein and fat. Odds ratios comparing highest versus lowest quintiles of intake were elevated for intake of animal protein (Odds ratio (OR) = 2.0, 95% confidential interval: 1.5-2.7) and fat (OR = 1.5, 1.2-2.0), but reduced for plant sources of these nutrients (OR = 0.7, 0.5-0.9 for protein and OR = 0.6, 0.5-0.8 for fat). Further analysis showed that saturated and monounsaturated fat intake was associated with elevated risk, while polyunsaturated fat intake was unrelated to risk. Dietary retinol, beta-carotene, vitamin C, vitamin E, fiber, and vitamin supplements were inversely associated with risk. No significant association was observed for dietary vitamin B1 or vitamin B2. Our findings suggest that associations of dietary macronutrients with endometrial cancer risk may depend on their sources, with intake of animal origin nutrients being related to higher risk and intake of plant origin nutrients related to lower risk. Dietary fiber, retinol, beta-carotene, vitamin C, vitamin E, and vitamin supplementation may decrease the risk of endometrial cancer.
Collapse
Affiliation(s)
- Wang-Hong Xu
- Department of Epidemiology, Fu Dan University School of Public Health, Shanghai, People's Republic of China
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Xu WH, Dai Q, Xiang YB, Zhao GM, Zheng W, Gao YT, Ruan ZX, Cheng JR, Shu XO. Animal food intake and cooking methods in relation to endometrial cancer risk in Shanghai. Br J Cancer 2006; 95:1586-92. [PMID: 17060930 PMCID: PMC2360744 DOI: 10.1038/sj.bjc.6603458] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
We evaluated animal food intake and cooking methods in relation to endometrial cancer risk in a population-based case–control study in Shanghai, China. A validated food frequency questionnaire was used to collect the usual dietary habits of 1204 cases and 1212 controls aged 30–69 years between 1997 and 2003. Statistical analyses were based on an unconditional logistic regression model adjusting for potential confounders. High intake of meat and fish was associated with an increased risk of endometrial cancer, with adjusted odds ratios for the highest vs the lowest quartile groups being 1.7 (95% confidence interval: 1.3–2.2) and 2.4 (1.8–3.1), respectively. The elevated risk was observed for all types of meat and fish intake. Intake of eggs and milk was not related to risk. Cooking methods and doneness levels for meat and fish were not associated with risk, nor did they modify the association with meat and fish consumption. Our study suggests that animal food consumption may play an important role in the aetiology of endometrial cancer, but cooking methods have minimal influence on risk among Chinese women.
Collapse
Affiliation(s)
- W-H Xu
- Department of Epidemiology, Shanghai Cancer Institute, 2200/25 Xie Tu Road, Shanghai 200032, China
| | - Q Dai
- Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt University, Nashville TN 37232-8300, USA
| | - Y-B Xiang
- Department of Epidemiology, Shanghai Cancer Institute, 2200/25 Xie Tu Road, Shanghai 200032, China
| | - G-M Zhao
- Department of Epidemiology, Fudan University School of Public Health, Shanghai 200032, China
| | - W Zheng
- Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt University, Nashville TN 37232-8300, USA
| | - Y-T Gao
- Department of Epidemiology, Shanghai Cancer Institute, 2200/25 Xie Tu Road, Shanghai 200032, China
| | - Z-X Ruan
- Department of Epidemiology, Shanghai Cancer Institute, 2200/25 Xie Tu Road, Shanghai 200032, China
| | - J-R Cheng
- Department of Epidemiology, Shanghai Cancer Institute, 2200/25 Xie Tu Road, Shanghai 200032, China
| | - X-O Shu
- Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt University, Nashville TN 37232-8300, USA
- E-mail:
| |
Collapse
|
32
|
Abstract
An optimal diet is one that not only prevents nutrient deficiencies by providing sufficient nutrients and energy for human growth and reproduction, but that also promotes health and longevity and reduces the risk of diet-related chronic diseases. The composition of the optimal diet for women with polycystic ovary syndrome (PCOS) is not yet known, but such a diet must not only assist short term with weight management, symptoms and fertility, but also specifically target the long-term risks of type 2 diabetes, CVD and certain cancers. With insulin resistance and compensatory hyperinsulinaemia now recognised as a key factor in the pathogenesis of PCOS, it has become clear that reducing insulin levels and improving insulin sensitivity are an essential part of management. Diet plays a significant role in the regulation of blood glucose and insulin levels, yet research into the dietary management of PCOS is lacking and most studies have focused on energy restriction rather than dietary composition per se. On the balance of evidence to date, a diet low in saturated fat and high in fibre from predominantly low-glycaemic-index-carbohydrate foods is recommended. Because PCOS carries significant metabolic risks, more research is clearly needed.
Collapse
Affiliation(s)
- Kate Marsh
- Human Nutrition Unit, School of Molecular and Microbial Biosciences, University of Sydney, NSW Australia 2006.
| | | |
Collapse
|
33
|
Salazar-Martinez E, Lazcano-Ponce E, Sanchez-Zamorano LM, Gonzalez-Lira G, Escudero-DE Los Rios P, Hernandez-Avila M. Dietary factors and endometrial cancer risk. Results of a case-control study in Mexico. Int J Gynecol Cancer 2005; 15:938-45. [PMID: 16174249 DOI: 10.1111/j.1525-1438.2005.00253.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Daily diet factors that could potentially be related to endometrial cancer (EC) in Mexico are still unknown. This study aims to evaluate the association between EC and Mexican dietary factors. A case-control study in Mexico City was conducted during 1995-1997 in a social security hospital, using 85 incident cases of EC and 629 controls. A validated questionnaire with 116 items about the frequency and type of food intake was used. The analysis of nutrients was performed using the residual method, adjusting by predictor variables through logistic regression methods. In addition, partitional models estimated total caloric intake for other sources. We found no association between EC risk and consumption of animal or vegetable proteins, saturated, monounsaturated, or polyunsaturated fat, although high intake of nutrients such as lactose (odds ratio [OR], 0.46; 95% confidence interval [CI], 0.21-1.01, P for trend = 0.004), vitamin D (OR, 0.38; 95% CI, 0.18-0.82, P= 0.003), and calcium (OR, 0.39; 95% CI, 0.17-0.89, P= 0.02) were inversely associated with EC. Our results suggest that dietary vitamin D and calcium play an important role in the development of EC, although the mechanisms postulated should be explained with additional studies with large populations.
Collapse
Affiliation(s)
- E Salazar-Martinez
- Center for Research in Population Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico.
| | | | | | | | | | | |
Collapse
|
34
|
Tao MH, Xu WH, Zheng W, Gao YT, Ruan ZX, Cheng JR, Xiang YB, Shu XO. A case-control study in Shanghai of fruit and vegetable intake and endometrial cancer. Br J Cancer 2005; 92:2059-64. [PMID: 15886701 PMCID: PMC2361791 DOI: 10.1038/sj.bjc.6602609] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
In a population-based case–control study of 832 incident endometrial cancer cases and 846 frequency-matched controls among Chinese women in Shanghai, using a validated food-frequency questionnaire, dietary habits were estimated by in-person interviews. Total vegetable consumption was inversely associated with endometrial cancer risk (highest quartile vs lowest: OR=0.69, 95% CI 0.50–0.96). The risk was reduced with increasing intake of dark green/dark yellow vegetables (trend test, P=0.02), fresh legumes (trend test, P<0.01), and allium vegetables (trend test, P=0.04). Fruit consumption was unrelated to risk. These results suggest that high consumption of certain vegetables may reduce the risk of endometrial cancer.
Collapse
Affiliation(s)
- M H Tao
- Center for Health Services Research, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, 6009 Medical Center East, 1215 21st Avenue South, Nashville, TN 37232-8300, USA
- Currently a doctoral student at the Department of Epidemiology, School of Public Health, University of California at Los Angeles, Box 951772, Los Angeles, CA 90095-1772, USA
| | - W H Xu
- Department of Epidemiology, Shanghai Cancer Institute, #25 2200 Xie Tu Road, Shanghai 200032, People's Republic of China
| | - W Zheng
- Center for Health Services Research, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, 6009 Medical Center East, 1215 21st Avenue South, Nashville, TN 37232-8300, USA
| | - Y T Gao
- Department of Epidemiology, Shanghai Cancer Institute, #25 2200 Xie Tu Road, Shanghai 200032, People's Republic of China
| | - Z X Ruan
- Department of Epidemiology, Shanghai Cancer Institute, #25 2200 Xie Tu Road, Shanghai 200032, People's Republic of China
| | - J R Cheng
- Department of Epidemiology, Shanghai Cancer Institute, #25 2200 Xie Tu Road, Shanghai 200032, People's Republic of China
| | - Y B Xiang
- Department of Epidemiology, Shanghai Cancer Institute, #25 2200 Xie Tu Road, Shanghai 200032, People's Republic of China
| | - X O Shu
- Center for Health Services Research, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, 6009 Medical Center East, 1215 21st Avenue South, Nashville, TN 37232-8300, USA
- Center for Health Services Research, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, 6009 Medical Center East, 1215 21st Avenue South, Nashville, TN 37232-8300, USA. E-mail:
| |
Collapse
|
35
|
Moyad MA. An introduction to dietary/supplemental omega-3 fatty acids for general health and prevention: Part II. Urol Oncol 2005; 23:36-48. [PMID: 15885582 DOI: 10.1016/j.urolonc.2005.03.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The correction of a subtle nutritional deficiency that may reduce the risk of a future chronic disease is indeed a challenge. However, some specific examples in the past, such as the addition of folic acid to prevent neural tube defects and calcium and vitamin D to prevent osteoporosis, should provide some encouragement that some conditions can be prevented with the appropriate addition of a deficient compound. One of the most intriguing current and future impacts on public health may come from a higher intake of omega-3 fatty acids, such as alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). The omega-3 fatty acids continue to accumulate research that suggests that they may prevent a variety of diverse chronic diseases and potentially some acute clinical scenarios. In the first part of this article, the potential for these compounds to prevent certain cardiovascular conditions are discussed. In the second part, the potential for an impact in arthritis, numerous areas of cancer research, depression, maternal and child health, neurologic diseases, osteoporosis, and other medical disciplines are also briefly covered. The future appears bright for these agents, but specifically which conditions, who qualifies, testing, frequency, adequate sources, future trials, and numerous other questions need to be addressed and answered before the potential impact can catch up to the recent hype.
Collapse
Affiliation(s)
- Mark A Moyad
- Phil F. Jenkins Director of Complementary & Alternative Medicine, Department of Urology, University of Michigan Medical Center, Ann Arbor, 48109-0330, USA.
| |
Collapse
|
36
|
Folsom AR, Demissie Z, Harnack L. Glycemic index, glycemic load, and incidence of endometrial cancer: the Iowa women's health study. Nutr Cancer 2004; 46:119-24. [PMID: 14690786 DOI: 10.1207/s15327914nc4602_03] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Although specific foods or nutrients have not been linked consistently with risk of endometrial cancer, obesity and diabetes are associated with increased risk. These conditions may be influenced by the glycemic index or load of the usual diet. We therefore examined the association of glycemic index and load measured at baseline using a food frequency questionnaire in a cohort of 23335 postmenopausal women. Over 15 yr of follow-up, we identified 415 incident endometrial cancers. The average glycemic index was not associated with endometrial cancer occurrence. After adjustment for other risk factors, the average glycemic load was positively but weakly associated, with a relative risk of 1.24 (95% CI = 0.90-1.72) for the highest versus lowest quintile of glycemic load (P for trend = 0.08). This relative risk was 1.46 (95% CI = 1.02-2.08; P for trend = 0.02) among nondiabetic women, but the trend was in the opposite direction among diabetic women. Our study indicates that a higher dietary glycemic load may be a risk factor for endometrial cancer incidence in nondiabetic women.
Collapse
Affiliation(s)
- Aaron R Folsom
- Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, MN 55454, USA.
| | | | | |
Collapse
|
37
|
Petridou E, Kedikoglou S, Koukoulomatis P, Dessypris N, Trichopoulos D. Diet in relation to endometrial cancer risk: a case-control study in Greece. Nutr Cancer 2003; 44:16-22. [PMID: 12672637 DOI: 10.1207/s15327914nc441_3] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The risk of endometrial cancer is positively associated with obesity, but the role of specific nutrients remains unclear. Given the distinct characteristics of the Greek diet and the low incidence of this form of cancer among Greek women, we undertook a case-control study to investigate the association of endometrial cancer with food groups and micronutrients. Cases were 84 women with histologically confirmed endometrial cancer and controls were 84 women with intact uterus admitted to the same teaching hospital in Athens, Greece. Consumption of pulses, nuts, and seeds was significantly inversely related to the risk for endometrial cancer. No other significant association with food groups was detected, although a protective effect of added lipids, which in the Greek diet are primarily represented by olive oil, was highly suggestive. Retinol, nicotinic acid, vitamin B- 6, and riboflavin were inversely associated with the disease. These findings need to be replicated, because this was a relatively small study with the statistical power to detect only strong associations between cases and controls; they appear, however, to support a role of diet in the etiology of endometrial cancer.
Collapse
Affiliation(s)
- Eleni Petridou
- Department of Hygiene and Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA.
| | | | | | | | | |
Collapse
|
38
|
Furberg AS, Thune I. Metabolic abnormalities (hypertension, hyperglycemia and overweight), lifestyle (high energy intake and physical inactivity) and endometrial cancer risk in a Norwegian cohort. Int J Cancer 2003; 104:669-76. [PMID: 12640672 DOI: 10.1002/ijc.10974] [Citation(s) in RCA: 169] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Since high energy intake, inactivity, hypertension and diabetes are linked to obesity and an unfavorable hormonal profile, we wanted to test whether energy intake, physical activity, blood pressure and serum glucose are related to the risk of endometrial cancer independent of the body mass index (BMI). A cohort of 24,460 women, aged 20-49 years, attended a Norwegian health screening twice during 1974-1981; they answered questions about diet, physical activity and chronic diseases, and their height, weight, blood pressure and non-fasting serum glucose were measured. By the end of 1996, during 15.7 years of follow-up, 130 cases of endometrial carcinomas were identified. The relative risks (RRs) for endometrial cancer were estimated in proportional hazards models including potentially confounding factors. Obese women (BMI > or = 30 kg/m(2)) were at 2.6 times increased risk of endometrial cancer compared to normal weight women (BMI < 25 kg/m(2)) (RR = 2.57, 95%CI = 1.61-4.10). Among overweight women (BMI > or = 25 kg/m(2)), non-fasting serum glucose in the upper quartile vs. in the lower quartile was associated with a 2.4 times increase in risk (RR = 2.41, 95%CI = 1.08-5.37), whereas among obese women, blood pressure above 140/90 mmHg vs. below 140/90 mmHg in both surveys was associated with a 3.5 times increase in risk (RR = 3.47, 95%CI = 1.24-9.70). Especially in women younger than 50 years, high energy intake (5,044-6,401 kJ/day) conferred higher risk compared to low energy intake (< 4266 kJ/day) (RR = 3.40, 95%CI = 1.52-7.60). Increasing recreational activity tended to be protective. Among obese women with non-sedentary jobs at both screenings, RR declined to 0.18 (95%CI = 0.05-0.62) as the level of sustained occupational activity increased (p(trend) = 0.03). Our results suggest that inactivity and high energy intake are major risk factors for endometrial cancer independent of BMI, and that hypertension and relative hyperglycemia are significant markers of risk, especially among the heaviest women.
Collapse
Affiliation(s)
- Anne-Sofie Furberg
- Institute of Community Medicine, Faculty of Medicine, University of Tromsø, Tromsø, Norway.
| | | |
Collapse
|
39
|
Terry PD, Rohan TE, Wolk A. Intakes of fish and marine fatty acids and the risks of cancers of the breast and prostate and of other hormone-related cancers: a review of the epidemiologic evidence. Am J Clin Nutr 2003; 77:532-43. [PMID: 12600840 DOI: 10.1093/ajcn/77.3.532] [Citation(s) in RCA: 176] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Marine fatty acids, particularly the long-chain eicosapentaenoic and docosahexaenoic acids, have been consistently shown to inhibit the proliferation of breast and prostate cancer cell lines in vitro and to reduce the risk and progression of these tumors in animal experiments. However, whether a high consumption of marine fatty acids can reduce the risk of these cancers or other hormone-dependent cancers in human populations is unclear. Focusing primarily on the results of cohort and case-control studies, we reviewed the current epidemiologic literature on the intake of fish and marine fatty acids in relation to the major hormone-dependent cancers. Despite the many epidemiologic studies that have been published, the evidence from those studies remains unclear. Most of the studies did not show an association between fish consumption or marine fatty acid intake and the risk of hormone-related cancers. Future epidemiologic studies will probably benefit from the assessment of specific fatty acids in the diet, including eicosapentaenoic and docosahexaenoic acids, and of the ratio of these to n-6 fatty acids, dietary constituents that have not been examined individually very often.
Collapse
Affiliation(s)
- Paul D Terry
- Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.
| | | | | |
Collapse
|
40
|
Terry P, Vainio H, Wolk A, Weiderpass E. Dietary factors in relation to endometrial cancer: a nationwide case-control study in Sweden. Nutr Cancer 2003; 42:25-32. [PMID: 12235647 DOI: 10.1207/s15327914nc421_4] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The incidence of endometrial cancer varies up to 10-fold between high- and low-incidence regions, suggesting the importance of environmental factors, including diet, in the etiology of this disease. However, few studies have examined the role of diet in the etiology of endometrial cancer. Using unconditional logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI), we analyzed data from a large, case-control study of Swedish-born postmenopausal women aged 50-74 yr (709 cases and 2,887 controls) residing in Sweden between 1994 and 1995. We found no clear association between foods or food groups and endometrial cancer risk, although high consumption of certain foods, such as Brassica vegetables, coffee, and legumes, might be associated with small-to-moderate reduced risks of endometrial cancer, while red meat consumption might be associated with a small-to-moderate increased risk. Daily use of calcium supplements appeared to lower endometrial cancer risk (OR = 0.5, 95% CI = 0.3-0.9, P for trend = 0.04), especially among women with low calcium intake from dairy products. On the other hand, the use of iron supplements appeared to increase the risk (OR = 1.7, 95% CI = 0.9-3.3, P for trend = 0.03). The findings are discussed with respect to previous studies and the possible underlying mechanisms.
Collapse
Affiliation(s)
- Paul Terry
- Department of Medical Epidemiology, Karolinska Institute, Stockholm, Sweden.
| | | | | | | |
Collapse
|
41
|
Kasum CM, Nicodemus K, Harnack LJ, Jacobs DR, Folsom AR. Whole grain intake and incident endometrial cancer: the Iowa Women's Health Study. Nutr Cancer 2002; 39:180-6. [PMID: 11759278 DOI: 10.1207/s15327914nc392_4] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
We examined whether there is an association between whole grain intake and incident endometrial cancer and whether the association varied by use of hormone replacement therapy. The study included 23,014 Iowa women, aged 55-69 years in 1986. A mailed food frequency questionnaire was used to estimate grain intake, hormone replacement therapy use, and other cancer risk factors. Cancer incidence from 1986 to 1998 was also collected. In analyses stratified by hormone replacement therapy use, an inverse association between whole grain intake and endometrial cancer was observed among never-users of hormone replacement therapy (p for trend = 0.05). Never-users in the highest quintile of whole grain intake were 0.63 times as likely to develop endometrial cancer as those in the lowest quintile of whole grain intake (95% confidence interval = 0.39-1.01). Among hormone replacement therapy users, no association between whole grain intake and endometrial cancer was evident. There was no statistically significant association between whole grain intake and incident endometrial cancer when users of hormone replacement therapy and nonusers were analyzed together. There also was no association between refined grain intake and endometrial cancer. Whole grain intake may protect against endometrial cancer among never-users of hormone replacement therapy.
Collapse
Affiliation(s)
- C M Kasum
- Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
| | | | | | | | | |
Collapse
|
42
|
Jain MG, Rohan TE, Howe GR, Miller AB. A cohort study of nutritional factors and endometrial cancer. Eur J Epidemiol 2001; 16:899-905. [PMID: 11338120 DOI: 10.1023/a:1011012621990] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
To evaluate the role of nutritional factors in the etiology of endometrial cancer, we performed a case-cohort analysis using data from women enrolled in the National Breast Screening Study in Canada from 1980 to 1985. For this analysis, a subcohort was constructed by selecting a 10% random sample from the 56,837 women in the dietary cohort. Cases were the 221 women diagnosed with incident adenocarcinoma of the endometrium during follow-up to December 31, 1993 and ascertained by record linkage to the Canadian Cancer Database. Information on usual diet at enrollment and other epidemiological variables was collected by means of self-administered questionnaires. Hazard ratios were obtained from proportional hazards regression models, with estimation of robust standard errors. We found a strong association of endometrial cancer with body mass index > 25 kg/m2 (hazard ratio 2.72, 95% CI: 2.06-3.50). Endometrial cancer risk was not associated significantly with intakes of total energy, carbohydrates, proteins, total fat and major fatty acids, total dietary fiber and various types of fibers, vitamin C, E and A, folic acid, beta-carotene, lutein, or cryptoxanthin. Some decrease in risk was noted with relatively high intakes of saturated fat, animal fat or lycopene. The associations observed in the study were independent of total energy intake and most non-dietary risk factors. The study suggests that dietary intakes of energy and most major nutrients are not related to the risk of endometrial cancer among Canadian women.
Collapse
Affiliation(s)
- M G Jain
- Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada.
| | | | | | | |
Collapse
|
43
|
Weyer PJ, Cerhan JR, Kross BC, Hallberg GR, Kantamneni J, Breuer G, Jones MP, Zheng W, Lynch CF. Municipal drinking water nitrate level and cancer risk in older women: the Iowa Women's Health Study. Epidemiology 2001; 12:327-38. [PMID: 11338313 DOI: 10.1097/00001648-200105000-00013] [Citation(s) in RCA: 192] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Nitrate contamination of drinking water may increase cancer risk, because nitrate is endogenously reduced to nitrite and subsequent nitrosation reactions give rise to N-nitroso compounds; these compounds are highly carcinogenic and can act systemically. We analyzed cancer incidence in a cohort of 21,977 Iowa women who were 55-69 years of age at baseline in 1986 and had used the same water supply more than 10 years (87% > 20 years); 16,541 of these women were on a municipal supply, and the remainder used a private well. We assessed nitrate exposure from 1955 through 1988 using public databases for municipal water supplies in Iowa (quartile cutpoints: 0.36, 1.01, and 2.46 mg per liter nitrate-nitrogen). As no individual water consumption data were available, we assigned each woman an average level of exposure calculated on a community basis; no nitrate data were available for women using private wells. Cancer incidence (N = 3,150 cases) from 1986 through 1998 was determined by linkage to the Iowa Cancer Registry. For all cancers, there was no association with increasing nitrate in drinking water, nor were there clear and consistent associations for non-Hodgkin lymphoma; leukemia; melanoma; or cancers of the colon, breast, lung, pancreas, or kidney. There were positive associations for bladder cancer [relative risks (RRs) across nitrate quartiles = 1, 1.69, 1.10, and 2.83] and ovarian cancer (RR = 1, 1.52, 1.81, and 1.84), and inverse associations for uterine cancer (RR = 1, 0.86, 0.86, and 0.55) and rectal cancer (RR = 1, 0.72, 0.95, and 0.47) after adjustment for a variety of cancer risk/protective factors, agents that affect nitrosation (smoking, vitamin C, and vitamin E intake), dietary nitrate, and water source. Similar results were obtained when analyses were restricted to nitrate level in drinking water from 1955 through 1964. The positive association for bladder cancer is consistent with some previous data; the associations for ovarian, uterine, and rectal cancer were unexpected.
Collapse
Affiliation(s)
- P J Weyer
- Center for Health Effects of Environmental Contamination, University of Iowa, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Abstract
Although there is evidence that phytochemicals decrease the incidence of breast and endometrial cancer, many observations are only phenomenologic, and much work needs to be done to explore basic mechanisms and the strategic exploitation of their interactions. The multiplicity of phytochemical actions at different sites in the process of tumorigenesis may eventually lead to the development of a multiagent strategy designed to maximize the complementary effects of different agents. A number of effects with possible relevance to cancer chemoprevention have been excluded from this review, including effects of phytochemicals on the immune response; the question of dietary restriction, which has a profound effect on tumorigenesis; the relatively low methionine levels in some phytochemicals such as soy, which may limit the synthesis of polyamines necessary for tumor growth [151]; and the fact that diets higher in plant products are usually lower in fat and result in leaner individuals with less potential for the synthesis of estradiol in adipose tissue. Also, many studies dealing solely with in vitro mutagenesis were excluded.
Collapse
Affiliation(s)
- J M Cline
- Bowman Gray School of Medicine, Department of Comparative Medicine, Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC 27157, USA
| | | |
Collapse
|
45
|
Abstract
The large differences in cancer rates among countries, striking changes in these rates among migrating populations, and rapid changes over time within countries indicate that some aspect of lifestyle or environment is largely responsible for the common cancers in Western countries. Dietary fat has been hypothesized to be the key factor because national consumption is correlated with the international differences. However, detailed analyses in large prospective studies have not supported an important role of dietary fat. Instead, positive energy balance, reflected in early age at menarche and weight gain as an adult, is an important determinant of breast and colon cancers, consistent with numerous studies in animals. As a contributor to positive energy balance, and possibly by other mechanisms, physical inactivity has also been shown to be a risk factor for these diseases and in part accounts for the international differences. Although the percentage of calories from fat in the diet does not appear related to risk of colon cancer, greater risks have been seen with higher consumption of red meat, suggesting that factors other than fat per se are important. In many case-control studies, a high consumption of fruits and vegetables has been associated with reduced risks of numerous cancers, but recent prospective studies suggest these associations may have been overstated. Among the factors in fruits and vegetables that have been examined in relation to cancer risk, present data most strongly support a benefit of higher folic acid consumption in reducing risks of colon and breast cancers. These findings have been bolstered by an association between incidence of colon cancer and a polymorphism in the gene for methylenetetrahydrofolate reductase, an enzyme involved in folic acid metabolism. The benefits of folic acid appear strongest among persons who regularly consume alcohol, which itself is associated with risk of these cancers. Numerous other aspects of diet are hypothesized to influence the risks of cancers in Western countries, but for the moment the evidence is unclear.
Collapse
Affiliation(s)
- W C Willett
- Departments of Epidemiology and Nutrition, Harvard School of Public Health, Boston, Massachusetts 02115, USA
| |
Collapse
|
46
|
Jain MG, Howe GR, Rohan TE. Nutritional factors and endometrial cancer in Ontario, Canada. Cancer Control 2000; 7:288-96. [PMID: 10832115 DOI: 10.1177/107327480000700312] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- M G Jain
- Department of Public Health Sciences, University of Toronto, Ontario, Canada
| | | | | |
Collapse
|
47
|
Stoll BA. New metabolic-endocrine risk markers in endometrial cancer. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1999; 106:402-6. [PMID: 10430187 DOI: 10.1111/j.1471-0528.1999.tb08290.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- B A Stoll
- Oncology Department, St. Thomas' Hospital, London
| |
Collapse
|
48
|
|
49
|
Doyle TJ, Zheng W, Cerhan JR, Hong CP, Sellers TA, Kushi LH, Folsom AR. The association of drinking water source and chlorination by-products with cancer incidence among postmenopausal women in Iowa: a prospective cohort study. Am J Public Health 1997; 87:1168-76. [PMID: 9240108 PMCID: PMC1380892 DOI: 10.2105/ajph.87.7.1168] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES This study assessed the association of drinking water source and chlorination by-product exposure with cancer incidence. METHODS A cohort of 28,237 Iowa women reported their drinking water source. Exposure to chlorination by-products was determined from statewide water quality data. RESULTS In comparison with women who used municipal ground-water sources, women with municipal surface water sources were at an increased risk of colon cancer and all cancers combined. A clear dose-response relation was observed between four categories of increasing chloroform levels in finished drinking water and the risk of colon cancer and all cancers combined. The relative risks were 1.00, 1.06, 1.39, and 1.68 for colon cancer and 1.00, 1.04, 1.24, and 1.25 for total cancers. No consistent association with either water source or chloroform concentration was observed for other cancer sites. CONCLUSIONS These results suggest that exposure to chlorination by-products in drinking water is associated with increased risk of colon cancer.
Collapse
Affiliation(s)
- T J Doyle
- Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis 55454-1015, USA
| | | | | | | | | | | | | |
Collapse
|
50
|
Tzonou A, Lipworth L, Kalandidi A, Trichopoulou A, Gamatsi I, Hsieh CC, Notara V, Trichopoulos D. Dietary factors and the risk of endometrial cancer: a case--control study in Greece. Br J Cancer 1996; 73:1284-90. [PMID: 8630294 PMCID: PMC2074517 DOI: 10.1038/bjc.1996.246] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
In a hospital-based case-control study of endometrial cancer undertaken in Athens (1992-94), 145 women residents of Greater Athens with confirmed cancer of the endometrium were compared with 298 control patients with orthopaedic diseases. Personal interviews were conducted in the hospital setting, and diet was assessed using a validated semiquantitative food frequency questionnaire. Nutrient intakes for individuals were calculated by multiplying the nutrient intake of a typical portion size for each specified food item by the frequency at which the food was consumed per month and summing these estimates for all food items. Data were modelled through logistic regression, controlling for demographic, reproductive and somatometric risk factors for endometrial cancer as well as for total energy intake. No macronutrient was significantly associated with endometrial cancer risk, but increasing intake of monounsaturated fat, mostly olive oil, by about one standard deviation was associated with a 26% risk reduction (odds ratio = 0.74; 95% confidence interval 0.54-1.3). Among micronutrients, only calcium intake was significantly inversely associated with endometrial cancer risk, whereas there was evidence against retinol and zinc imparting protection against the disease. With respect to food groups, there was weak and non-significant evidence that vegetables are protective, whereas consumption of pulses was positively associated with disease possibly because they contribute substantially in Greece to energy intake in excess of physical activity-dependent requirements.
Collapse
Affiliation(s)
- A Tzonou
- Department of Hygiene and Epidemiology, University of Athens Medical School, Goudi, Greece
| | | | | | | | | | | | | | | |
Collapse
|