Alcohol, smoking, and dietary status and susceptibility to malignant lymphoma in Japan: results of a hospital-based case-control study at Aichi Cancer Center

Fish consumption and risk of non-Hodgkin lymphoma: A meta-analysis of observational studies

Objectives: Whether a relationship between fish consumption and non-Hodgkin lymphoma (NHL) risk exists is an open issue. We carried out a meta-analysis to explore this association according to the published observational studies.Methods: We performed a search of databases in MEDLINE and EMBASE to identify relevant studies. We derived meta-analytic estimates using random-effects models, and assessed between-study heterogeneity using the Cochran's Q and I² statistics.Results: We identified a total of seven case-control and two prospective cohort studies, including 7696 subjects with NHL. The summary relative risks (SRRs) estimated for NHL were 0.80 (95% confidence intervals (CIs): 0.68-0.94) for those in the highest fish consumption category compared with those in the lowest consumption category. There was evidence of significant heterogeneity across studies (Q = 26.72, P_{heterogeneity} = 0.002, I² = 66.3%). Stratified analysis by study design indicated that a significant risk association between fish consumption and NHL was observed in case-control studies, but not in cohort studies. Based on the dose-response meta-analysis, the SRRs of NHL were 0.85 (95% CIs: 0.71-1.01) for three servings increased per week of fish consumed with evidence of significant heterogeneity (P_{heterogeneity} = 0.007, I² = 63.9%).Conclusions: Findings from our meta-analysis indicate that consumption of fish may be not related to NHL risk.

Intake of fish and long-chain n-3 polyunsaturated fatty acids and risk of diseases in a Japanese population: a narrative review

Since the 1970s, the potential benefit of fish intake in terms of noncommunicable diseases has been one of the most important themes in disease prevention. Epidemiological studies have revealed the extent to which fish consumption affects the incidence of and mortality from diseases. Meta-analyses summarized the effect of fish and long-chain n-3 polyunsaturated fatty acid intake on noncommunicable diseases, especially cardiovascular diseases in Western countries. However, few reviews have spotlighted the effect of fish intake in East-Asian countries that have high population levels of fish intake such as Japan. We narratively reviewed the epidemiological studies concerned with the associations of fish and long-chain n-3 polyunsaturated fatty acid intake with risk of noncommunicable diseases, mainly of cardiovascular disease, among Japanese, whose fish intake has been twice or more than that of most Westerners. Overall, fish or long-chain n-3 polyunsaturated fatty acid intake may be beneficial for prevention of noncommunicable diseases, especially coronary heart disease and heart failure in Japanese as well as in Westerners. However, the beneficial effects of their intakes seemed to be nonlinear and varied according to disease severity and culture. Studies on other noncommunicable disease were also narratively reviewed.

Low expression of vascular endothelial growth factor and high serum level of cyclic guanine monophosphate as the risk factors of femoral head osteonecrosis in alcohol-exposed Wistar rat

PURPOSE

Severe damage to the femoral head in patients with osteonecrosis has a high impact on morbidity. Despite early diagnosis, the treatment outcome is still unsatisfactory. This study aimed to explore the expression of vascular endothelial growth factor (VEGF) and cyclic guanine monophosphate (cGMP) serum level as the risk factors of femoral head osteonecrosis in alcohol-exposed Wistar rats.

METHODS

This was an experimental study using randomized post-test only control group design, with samples using 10-14 weeks Wistar male rats. Rats were then divided into 6 groups: 3 groups without intervention, and 3 groups with intervention using 40% alcohol given perorally. Each one group from intervention and control group was euthanized by the end of the week for 3 consecutive weeks. Proximal femurs were examined under microscope for osteonecrosis, immunohistochemically for VEGF, and blood serum for cGMP levels.

RESULTS

VEGF expression in the femoral head of alcohol-exposed Wistar rats was lower than those not exposed to alcohol (p < 0.005). Blood serum cGMP levels of alcohol-exposed Wistar rats were higher than those not exposed to alcohol (p < 0.005). The number of necrotic osteocytes in the femoral head of Wistar rats exposed to alcohol was greater than those not exposed to alcohol (p < 0.005). There are significant differences between VEGF, cGMP levels, and number of necrotic osteocytes in the control group and treatment at 1st, 2nd^, and 3rd week (p < 0.005).

CONCLUSIONS

Based on the result of this study, VEGF and cGMP may be considered as diagnostic biomarkers for alcohol-induced femoral head osteonecrosis.

The Relation of Lymphomaand Hepatitis B Virus/Hepatitis C Virus Infections in the Region of East Black Sea, Turkey

Aim and background

Hepatitis B virus (HBV) and hepatitis C virus (HCV) are not only hepatotropic, but also lymphotropic viruses. Infections with these viruses induce chronic antigenicity and may stimulate clonal expansion of malignant B-cell neoplasms. Moreover, these viruses can proliferate in lymphatic structures and bone marrow. However, the relationship between lymphomas and HBV/HCV infections is not clear. In our region of the East Black Sea, Turkey (the city of Trabzon), we intended to demonstrate a relation of lymphoma and HBV/HCV infections with a case-controlled study.

Methods

A total of 109 patients diagnosed with lymphoma between 2002–2005 in the Black Sea Technical University Hospital was investigated. Seventy-one patients had a high-grade and 38 patients a low-grade lymphoma. Hepatitis B surface antigen (HBsAg) and anti-HCV antibodies (anti-HCV Ab) were screened. The control group consisted of patients (n = 551) from other departments with diagnoses other than lymphoma.

Results

HBsAg was 3.7% and anti-HCV Ab positivity was 2.8% in lymphoma patients, compared with control of 5.3%, 5.1%, respectively. There was no statistically significant difference between two groups ( P = 0.7, OR = 0.69, 95% CI, 0.20–2.10; P = 0.4, OR = 0.53, 95% CI, 0.13–1.86, respectively).

Conclusion

Our findings suggest that the incidence of HBV and HCV infections in lymphoma patients is no different than that of nonlymphoma patients. Therefore, no direct correlation can be deduced between lymphoma and HBV-HCV infections in our East Black Sea region of Turkey.

Cigarette smoking, dietary habits and genetic polymorphisms in GSTT1, GSTM1 and CYP1A1 metabolic genes: A case-control study in oncohematological diseases

AIM

To analyze the association between oncohematological diseases and GSTT1/GSTM1/CYP1A1 polymorphisms, dietary habits and smoking, in an argentine hospital-based case-control study.

METHODS

This hospital-based case-control study involved 125 patients with oncohematological diseases and 310 control subjects. A questionnaire was used to obtain sociodemographic data and information about habits. Blood samples were collected, and DNA was extracted using salting out methods. Deletions in GSTT1 and GSTM1 (null genotypes) were addressed by PCR. CYP1A1 MspI polymorphism was detected by PCR-RFLP. Odds ratio (OR) and 95%CI were calculated to estimate the association between each variable studied and oncohematological disease.

RESULTS

Women showed lower risk of disease compared to men (OR 0.52, 95%CI: 0.34-0.82, P = 0.003). Higher levels of education (> 12 years) were significantly associated with an increased risk, compared to complete primary school or less (OR 3.68, 95%CI: 1.82-7.40, P < 0.001 adjusted for age and sex). With respect to tobacco, none of the smoking categories showed association with oncohematological diseases. Regarding dietary habits, consumption of grilled/barbecued meat 3 or more times per month showed significant association with an increased risk of disease (OR 1.72, 95%CI: 1.08-2.75, P = 0.02). Daily consumption of coffee also was associated with an increased risk (OR 1.77, 95%CI: 1.03-3.03, P = 0.03). Results for GSTT1, GSTM1 and CYP1A1 polymorphisms showed no significant association with oncohematological diseases. When analyzing the interaction between polymorphisms and tobacco smoking or dietary habits, no statistically significant associations that modify disease risk were found.

CONCLUSION

We reported an increased risk of oncohematological diseases associated with meat and coffee intake. We did not find significant associations between genetic polymorphisms and blood cancer.

Coffee and the Risk of Lymphoma: A Meta-analysis Article

BACKGROUND

Coffee is implicated in the susceptibility to several cancers. However, the association between coffee and lymphoma remains unclear. This meta-analysis aimed to assess quantitatively the association between coffee and the incidence of lymphoma.

METHODS

A literature search was performed for cohort and case-control studies published using PubMed, Cochrane, and EMBASE databases. Studies were included if they reported relative ratios (RR) and corresponding 95% confidence intervals (CIs) of lymphoma with respect to coffee consumption. Pooled relative risk (RR) and its 95% confidence interval (CI) were calculated. All P values are two tailed.

RESULTS

Seven studies met the inclusion criteria, which included three cohort and four case-control studies. Compared with did not or seldom drink coffee per day, being no significantly association between coffee and risk of lymphoma (pooled RR: 1.05, 95%CI: 0.89-1.23). In the subgroup analysis, no significant association between coffee and lymphoma risk was detected not only in different study types (cohort studies RR: 1.29; 95% CI, 0.92-1.80; case control studies RR: 0.99; 95% CI, 0.82-1.99) but also in different regions (Europe RR: 1.21; 95% CI: 0.99-1.47; USA RR: 0.85; 95% CI, 0.62-1.15; Asia RR: 1.08, 95% CI: 0.84-1.40) and coffee consumption status (≥4cups/d 1.03, 95% CI: 0.69-1.56; < 4cups/d RR: 1.06, 95% CI: 0.89-1.26). The funnel plot revealed no evidence for publication bias.

CONCLUSION

There was no sufficient evidence to support coffee consumption association with the risk of lymphoma. Further well-designed large-scaled cohort studies are needed to provide conclusions that are more definitive.

Meat intake and non-Hodgkin lymphoma: a meta-analysis of observational studies

PURPOSE

High intake of meat has been inconsistently associated with increased risk of non-Hodgkin lymphoma (NHL). We carried out a meta-analysis to summarize the evidence of published observational studies reporting association between red meat and processed meat intake and NHL risk.

METHODS

Analytical studies reporting relative risks with 95 % confidence intervals (95 % CI) for the association between intake of red and/or processed meat and NHL or major histological subtypes were eligible. We conducted random-effects meta-analysis comparing lowest and highest intake categories and dose-response meta-analysis when risk estimates and intake levels were available for more than three exposure classes.

RESULTS

Fourteen studies (four cohort and ten case-control) were included in the meta-analysis, involving a total of 10,121 NHL cases. The overall relative risks of NHL for the highest versus the lowest category of consumption were 1.14 (95 % CI 1.03, 1.26) for red meat and 1.06 (95 % CI 0.98, 1.15) for processed meat. Significant associations were present when the analysis was restricted to case-control studies but not when restricted to cohort studies. No significant associations were found for major NHL etiological subtypes. Dose-response meta-analysis could be based only on eight studies that provided sufficient data, and compared to no meat consumption, the overall NHL relative risk increased nonlinearly with increased daily intake of red meat.

CONCLUSION

The observed positive association between red meat consumption and NHL is mainly supported by the effect estimates coming from case-control studies and is affected by multiple sources of heterogeneity. This meta-analysis provided mixed and inconclusive evidences on the supposed relationship between red and processed meat consumption and NHL.

Red and Processed Meat Consumption Increases Risk for Non-Hodgkin Lymphoma: A PRISMA-Compliant Meta-Analysis of Observational Studies

The association between consumption of red and processed meat and non-Hodgkin lymphoma (NHL) remains unclear. We performed a meta-analysis of the published observational studies to explore this relationship.We searched databases in MEDLINE and EMBASE to identify observational studies which evaluated the association between consumption of red and processed meat and risk of NHL. Quality of included studies was evaluated using Newcastle-Ottawa Quality Assessment Scale (NOS). Random-effects models were used to calculate summary relative risk (SRR) and the corresponding 95% confidence interval (CI).We identified a total of 16 case-control and 4 prospective cohort studies, including 15,189 subjects with NHL. The SRR of NHL comparing the highest and lowest categories were 1.32 (95% CI: 1.12-1.55) for red meat and 1.17 (95% CI: 1.07-1.29) for processed meat intake. Stratified analysis indicated that a statistically significant risk association between consumption of red and processed meat and NHL risk was observed in case-control studies, but not in cohort studies. The SRR was 1.11 (95% CI: 1.04-1.18) for per 100 g/day increment in red meat intake and 1.28 (95% CI: 1.08-1.53) for per 50 g/day increment in processed meat intake. There was evidence of a nonlinear association for intake of processed meat, but not for intake of red meat.Findings from our meta-analysis indicate that consumption of red and processed meat may be related to NHL risk. More prospective epidemiological studies that control for important confounders and focus on the NHL risk related with different levels of meat consumption are required to clarify this association.

Alcohol intake and the incidence of non-hodgkin lymphoid neoplasms in the cancer prevention study II nutrition cohort

Although several studies have shown a lower risk of non-Hodgkin lymphoma (NHL) in alcohol drinkers compared with nondrinkers, the dose-response relation and potential differences between former and current drinking and across beverage types and subtypes are unclear. The authors examined associations of alcohol intake with risk of NHL and NHL subtypes in the Cancer Prevention Study II Nutrition Cohort, a prospective study of US men and women aged 50-74 years. Between 1992 and 2007, there were 1,991 incident NHL cases among 143,124 participants. Multivariable-adjusted relative risks and 95% confidence intervals were computed using Cox proportional hazards regression. Compared with nondrinkers, the relative risk of NHL associated with former drinking was 0.90 (95% confidence interval (CI): 0.75, 1.10); the relative risks associated with current intakes of <1, 1-2, and >2 drinks/day were 0.93 (95% CI: 0.83, 1.03), 0.91 (95% CI: 0.78, 1.06), and 0.78 (95% CI: 0.65, 0.93), respectively. Associations did not differ by sex (P-interaction = 0.45) or beverage type (P-difference = 0.22). Alcohol intake was more strongly associated with B-cell lymphoma (P-trend = 0.005) than with T-cell lymphoma (P-trend = 0.76), and associations were similar among B-cell lymphoma subtypes. In this prospective study, current heavy alcohol intake was associated with a reduced risk of NHL. Associations did not differ by beverage type and were slightly stronger for B-cell tumors than for T-cell tumors.

Intake of vitamins D and A and calcium and risk of non-Hodgkin lymphoma: San Francisco Bay Area population-based case-control study

Several nutrients identified as potentially cancer protective have been inconsistently associated with non-Hodgkin lymphoma (NHL) risk. Dietary history data, including use of vitamin supplements, were collected using a semiquantitative food frequency questionnaire administered during in-person interviews with 4,133 participants (2,052 cases, 2,081 controls) in a San Francisco Bay Area population-based case-control study. Data were used to determine the association of intake levels of vitamins D and A and calcium with risk of NHL and NHL subtypes. Odds ratios (OR) and 95% confidence intervals (CI) were computed as estimates of relative risk using adjusted unconditional logistic regression. Increasing vitamin D intake from food and supplements was positively associated with NHL risk in men (5th quintile: OR = 1.6, 95% CI = 1.0-2.4, P(trend) = 0.07) and with diffuse large B-cell lymphoma (DLBCL) in women and men (5th quintile: OR = 1.6, 95% CI = 1.0-2.5, P(trend) = 0.02); that was largely due to the effect in men (P(trend) = 0.03). These results do not support a strong role for vitamin D intake with NHL risk, with the exception of a potential association for DLBCL risk in men. Our results should be interpreted conservatively until further investigation in larger pooled studies can be conducted to better assess the role of vitamin D intake in lymphomagenesis.

Prediagnostic circulating carotenoid levels and the risk of non-Hodgkin lymphoma: the Multiethnic Cohort

This analysis examined the association of non-Hodgkin lymphoma (NHL) with prediagnostic carotenoid levels, a marker for a diet rich in fruits and vegetables. We conducted a nested case-control study within the Multiethnic Cohort with 271 NHL cases and 538 controls matched on sex, ethnicity, location (Hawaii or Los Angeles), birth year, date and time of blood draw, and hours fasting before blood draw. Serum carotenoid levels were obtained by high-pressure liquid chromatography with photodiode array detection. Conditional logistic regression was used to calculate odds ratios (ORs) according to tertiles of serum carotenoids and trend tests using continuous variables. Higher total serum carotenoids (OR(T3 vs T1) = 0.66 [0.46-0.96]; P(trend) = .02), lycopene (OR = 0.54 [0.38-0.78]; P(trend) = .003), and α-cryptoxanthin (OR = 0.53 [0.36-0.78]; P(trend) = .003) were associated with a lower risk of NHL. For retinol (OR = 0.90 [0.61-1.33]; P(trend) = .04), a statistically significant inverse linear trend was detected. Risk estimates remained unchanged with adjustment for NHL risk factors and were similar in analyses stratified by sex and ethnicity; heterogeneity with NHL subtype was detected only for β-carotene. Other carotenoids, including α-carotene, β-carotene, lutein, β-cryptoxanthin, and zeaxanthin, showed no association with risk. These data provide support for a protective role of carotenoid-rich fruits and vegetables in the etiology of NHL.

Food-frequency questionnaire-based estimates of total antioxidant capacity and risk of non-Hodgkin lymphoma

Antioxidants, primarily from fruits and vegetables, have been hypothesized to protect against non-Hodgkin lymphoma (NHL). The oxygen radical absorbance capacity (ORAC) assay, which measures total antioxidant capacity of individual foods and accounts for synergism, can be estimated using a food-frequency questionnaire (FFQ). We tested the hypothesis that higher intake of antioxidant nutrients from foods, supplements and FFQ-based ORAC values are associated with a lower risk of NHL in a clinic-based study of 603 incident cases and 1,007 frequency-matched controls. Diet was assessed with a 128-item FFQ. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals adjusted for age, sex, residence and total energy. Dietary intake of α-tocopherol (OR=0.50; p-trend=0.0002), β-carotene (OR=0.58; p-trend=0.0005), lutein/zeaxanthin (OR=0.62; p-trend=0.005), zinc (OR=0.54; p-trend=0.003) and chromium (OR=0.68; p-trend=0.032) was inversely associated with NHL risk. Inclusion of supplement use had little impact on these associations. Total vegetables (OR=0.52; p-trend<0.0001), particularly green leafy (OR=0.52; p-trend<0.0001) and cruciferous (OR=0.68; p-trend=0.045) vegetables, were inversely associated with NHL risk. NHL risk was inversely associated with both hydrophilic ORAC (OR=0.61, p-trend=0.003) and lipophilic ORAC (OR=0.48, p-trend=0.0002), although after simultaneous adjustment for other antioxidants or total vegetables, only the association for lipophilic ORAC remained significant. There was no striking heterogeneity in results across the common NHL subtypes. Higher antioxidant intake as estimated by the FFQ-ORAC, particularly the lipophilic component, was associated with a lower NHL risk after accounting for other antioxidant nutrients and vegetable intake, supporting this as potentially useful summary measure of total antioxidant intake.

Cigarette smoking, passive smoking, and non-Hodgkin lymphoma risk: evidence from the California Teachers Study

Epidemiologic studies conducted to date have shown evidence of a causal relation between smoking and non-Hodgkin lymphoma (NHL) risk. However, previous studies did not account for passive smoking exposure in the never-smoking reference group. The California Teachers Study collected information about lifetime smoking and household passive smoking exposure in 1995 and about lifetime exposure to passive smoking in 3 settings (household, workplace, and social settings) in 1997-1998. Multivariable-adjusted relative risks and 95% confidence intervals were estimated by fitting Cox proportional hazards models with follow-up through 2007. Compared with never smokers, ever smokers had a 1.11-fold (95% confidence interval (CI): 0.94, 1.30) higher NHL risk that increased to a 1.22-fold (95% CI: 0.95, 1.57) higher risk when women with household passive smoking were excluded from the reference category. Statistically significant dose responses were observed for lifetime cumulative smoking exposure (intensity and pack-years; both P 's for trend = 0.02) when women with household passive smoking were excluded from the reference category. Among never smokers, NHL risk increased with increasing lifetime exposure to passive smoking (relative risk = 1.51 (95% CI: 1.03, 2.22) for >40 years vs. ≤5 years of passive smoking; P for trend = 0.03), particularly for follicular lymphoma (relative risk = 2.89 (95% CI: 1.23, 6.80); P for trend = 0.01). The present study provides evidence that smoking and passive smoking may influence NHL etiology, particularly for follicular lymphoma.

Inverse association between soy intake and non-Hodgkin lymphoma risk among women: a case-control study in Japan

BACKGROUND

Non-Hodgkin lymphoma (NHL) is one of the common malignant tumors worldwide. Environmental factors, such as diet have an important association with the risk of cancer. Although soy intake has been associated with a reduced risk of several cancers, its association with NHL is not known.

PATIENTS AND METHODS

We evaluated the association between soy consumption and risk of NHL by conducting a hospital-based case-control study in 302 patients with NHL and 1510 age- and sex-matched control subjects. Odds ratio (OR) and 95% confidence intervals (CIs) for groups with moderate (27-51 g/day) to high (>51 g/day) relative to low (<27 g/day) intake were calculated using multivariate conditional logistic regression model.

RESULTS

Soy intake was significantly associated with a reduced risk of NHL in women but not in men (OR [95% CI] for moderate and high intake: women, 0.64 [0.42-1.00] and 0.66 [0.42-1.02], respectively; men, 1.40 [0.87-2.24] and 1.33 [0.82-2.15], respectively; P-interaction = 0.02). This finding appeared consistent across NHL subtypes.

CONCLUSION

These results indicate the potential importance of certain ingredients in soy for lymphomagenesis. Further studies to evaluate the mechanism behind the association between soy intake and lymphomagenesis are warranted.

Consumption of meat and dairy and lymphoma risk in the European Prospective Investigation into Cancer and Nutrition

The consumption of meat and other foods of animal origin is a risk factor for several types of cancer, but the results for lymphomas are inconclusive. Therefore, we examined these associations among 411,097 participants of the European Prospective Investigation into Cancer and Nutrition. During a median follow-up of 8.5 years, 1,334 lymphomas (1,267 non-Hodgkin lymphoma (NHL) and 67 Hodgkin lymphomas) were identified. Consumption of red and processed meat, poultry, milk and dairy products was assessed by dietary questionnaires. Cox proportional hazard regression was used to evaluate the association of the consumption of these food groups with lymphoma risk. Overall, the consumption of foods of animal origin was not associated with an increased risk of NHLS or HL, but the associations with specific subgroups of NHL entities were noted. A high intake of processed meat was associated with an increased risk of B-cell chronic lymphocytic leukemia (BCLL) [relative risk (RR) per 50 g intake = 1.31, 95% confidence interval (CI) 1.06-1.63], but a decreased risk of follicular lymphomas (FL) (RR = 0.58; CI 0.38-0.89). A high intake of poultry was related to an increased risk of B-cell lymphomas (RR = 1.22; CI 1.05-1.42 per 10 g intake), FL (RR = 1.65; CI 1.18-2.32) and BCLL (RR = 1.54; CI 1.18-2.01) in the continuous models. In conclusion, no consistent associations between red and processed meat consumption and lymphoma risk were observed, but we found that the consumption of poultry was related to an increased risk of B-cell lymphomas. Chance is a plausible explanation of the observed associations, which need to be confirmed in further studies.

Hepatitis C: the complications of immune dysfunction

Hepatitis C virus (HCV) infection has been linked to numerous diseases of immune dysfunction, including, but not limited to, essential mixed cryoglobulinemia and non-Hodgkin's lymphoma. Clinical studies support these associations and treatment of the underlying HCV infection has been variably successful. Recent studies, focusing on the role of HCV gene products, have discovered evidence of dysregulated responses in multiple aspects of host immunity that may be contributing to the genesis of these diseases. Novel treatments that target these areas of dysregulation offer hope for improved therapy for the diseases associated with immunodysregulation by HCV.

Antioxidant intake from fruits, vegetables and other sources and risk of non-Hodgkin's lymphoma: the Iowa Women's Health Study

Antioxidant nutrients found in fruits, vegetables and other foods are thought to inhibit carcinogenesis and to influence immune status. We evaluated the association of these factors with risk of non-Hodgkin's lymphoma (NHL) overall and for diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma specifically in a prospective cohort of 35,159 Iowa women aged 55-69 years when enrolled at baseline in 1986. Diet was ascertained using a validated semiquantitative food frequency questionnaire. Through 2005, 415 cases of NHL (including 184 DLBCL and 90 follicular) were identified. Relative risks (RRs) and 95% confidence intervals (CIs) were estimated using Cox regression, adjusting for age and total energy. The strongest associations of antioxidants with risk of NHL (RR for highest versus lowest quartile; p for trend) were observed for dietary vitamin C (RR = 0.78; p = 0.044), alpha-carotene (RR = 0.71; p = 0.015), proanthocyanidins (RR = 0.70; p = 0.0024) and dietary manganese (RR = 0.62; p = 0.010). There were no associations with multivitamin use or supplemental intake of vitamins C, E, selenium, zinc, copper or manganese. From a food perspective, greater intake of total fruits and vegetables (RR = 0.69; p = 0.011), yellow/orange (RR = 0.72; p = 0.015) and cruciferous (RR = 0.82; p = 0.017) vegetables, broccoli (RR = 0.72; p = 0.018) and apple juice/cider (RR = 0.65; p = 0.026) were associated with lower NHL risk; there were no strong associations for other antioxidant-rich foods, including whole grains, chocolate, tea or nuts. Overall, these associations were mainly observed for follicular lymphoma and were weaker or not apparent for DLBCL. In conclusion, these results support a role for vegetables, and perhaps fruits and associated antioxidants from food sources, as protective factors against the development of NHL and follicular lymphoma in particular.

Association of alcohol intake and smoking with malignant lymphoma risk in Japanese: a hospital-based case-control study at Aichi Cancer Center

Given the lower incidence and differences in distribution of malignant lymphoma in Asian than western populations, the association of alcohol intake and smoking with malignant lymphoma risk in Asian populations merits investigation. Here, we conducted a sex- and age-matched case-control study of a Japanese population using two data sets, the first and second versions of the Hospital-based Epidemiological Research Program at Aichi Cancer Center Hospital (HERPACC-I and HERPACC-II, respectively), in 452 and 330 cases of histologically diagnosed malignant lymphoma and 2,260 and 1,650 noncancer controls, respectively. Odds ratios (OR) and 95% confidence intervals (95% CI) were estimated using a conditional logistic regression model that incorporated smoking exposure and alcohol intake. Compared with nondrinking, consumption of >or=50 g/d by frequent drinkers was associated with significantly decreased risk in both data sets [OR (95% CI), 0.70 (0.53-0.93) for HERPACC-I and 0.40 (0.23-0.68) for HERPACC-II]. Given similar findings among groups, we used pooled data sets in subsequent analyses. For any alcohol intake versus nondrinking, point estimates of OR were less than unity for all four malignant lymphoma subtypes. In contrast, pack-years of smoking were associated with increased malignant lymphoma risk: relative to the reference (0-4 pack-years), OR (95% CI) were 1.32 (1.02-1.71), 1.39 (1.07-1.80), and 1.48 (1.12-1.95) for 5 to 19, 20 to 39, and >or=40 pack-years, respectively. This association with smoking was less apparent for all subtypes, except Hodgkin's lymphoma. In conclusion, we found that alcohol had an inverse association with malignant lymphoma risk across all malignant lymphoma subtypes in our Japanese subjects. Smoking appeared to be positively associated with malignant lymphoma risk, but this finding may vary by subtype.

Polymorphisms ofp53Arg72Pro,p73G4C14-to-A4T14 at Exon 2 andp21Ser31Arg and the risk of non-Hodgkin's Lymphoma in Japanese

We hypothesized that the polymorphisms in the two p53 family genes (p53 Arg72Pro and p73 G4C14-to-A4T14 at exon 2 (G4A)) and p21 Ser31Arg polymorphism might modulate the risk of non-Hodgkin's lymphoma, and conducted a hospital-based prevalent case control study at Aichi Cancer Center Hospital to clarify the association. Risk estimation for each genotype by the unconditional logistic model demonstrated the possible association between the p53 Pro72 allele and the risk of non-Hodgkin's lymphoma in Japanese population (OR = 1.59; 95% CI, 0.99-2.57, P = 0.057), although no other significant association was observed. The analyses of statistical interactions between these three polymorphisms (p73 G4A, p53 Arg72Pro and p21 Ser31Arg polymorphisms) revealed the marginally significant OR for interaction between p53 Arg72Pro and p73 G4A polymorphisms (OR = 2.54; 95% CI, 0.97 6.62, P = 0.057). When those without p53 Pro72 and p73 A4T14 alleles were defined as a reference, those with p53 Pro72 and p73 A4T14 alleles demonstrated a significantly higher OR (2.08; 95% CI, 1.11-3.90, P = 0.023). Further examination with a sufficiently larger population and other ethnicities are required to confirm our findings.

Genetic polymorphisms in nitric oxide synthase genes modify the relationship between vegetable and fruit intake and risk of non-Hodgkin lymphoma

Oxidative damage caused by reactive oxygen species and other free radicals is involved in carcinogenesis. It has been suggested that high vegetable and fruit intake may reduce the risk of non-Hodgkin lymphoma (NHL) as vegetables and fruit are rich in antioxidants. The aim of this study is to evaluate the interaction of vegetable and fruit intake with genetic polymorphisms in oxidative stress pathway genes and NHL risk. This hypothesis was investigated in a population-based case-control study of NHL and NHL histologic subtypes in women from Connecticut, including 513 histologically confirmed incident cases and 591 randomly selected controls. Gene-vegetable/fruit joint effects were estimated using unconditional logistic regression model. The false discovery rate method was applied to adjust for multiple comparisons. Significant interactions with vegetable and fruit intake were mainly found for genetic polymorphisms on nitric oxide synthase (NOS) genes among those with diffuse large B-cell lymphoma and follicular lymphoma. Two single nucleotide polymorphisms in the NOS1 gene were found to significantly modify the association between total vegetable and fruit intake and risk of NHL overall, as well as the risk of follicular lymphoma. When vegetables, bean vegetables, cruciferous vegetables, green leafy vegetables, red vegetables, yellow/orange vegetables, fruit, and citrus fruits were examined separately, strong interaction effects were narrowed to vegetable intake among patients with diffuse large B-cell lymphoma. Our results suggest that genetic polymorphisms in oxidative stress pathway genes, especially in the NOS genes, modify the association between vegetable and fruit intake and risk of NHL.

The impact of tobacco smoking and alcohol drinking on survival of patients with non-Hodgkin lymphoma

Tobacco smoking and alcohol consumption have not been clearly related to the risk of non-Hodgkin lymphoma (NHL), and the impact of these two factors on survival of NHL patients has received little attention. Cases were 268 subjects with incident histologically-confirmed NHL, admitted as inpatients to the Division of Medical Oncology, between 1983 and 2002. These individuals were enrolled as cases in case-control studies conducted at the same institution over the same period. For all patients clinical (histological subtype, major prognostic factors and treatment) and epidemiological data (smoking and drinking habits) were available. Survival analysis was performed using Kaplan-Meier methods. Hazard ratio (HR) was estimated by Cox proportional hazard model. Compared to never smokers, patients who smoked >or=20 cigarettes/day had higher risks of death (HR = 1.70, 95% confidence interval (CI): 1.06-2.73) and lower survivals at 5 years (60 and 46%, respectively). Likewise, patients who drunk >or=4 drinks/day showed 1.69-fold higher probability of death (95% CI: 1.04-2.76) in comparison to drinkers of <2 drinks/day (5-year survival: 47 and 67%, respectively). When combining exposure to alcohol and tobacco, no excess of death emerged in light drinkers (<4 drinks/day), irrespective of their smoking habits, but higher risks of death emerged among heavy drinkers. In the present study, heavy tobacco smoking, and particularly, heavy alcohol drinking were associated with poor survival in NHL patients. Our findings strongly encourage physicians to advice NHL patients to stop smoking and diminish alcohol consumption to obtain improvements in the course of NHL.

The role of dietary factors in the epidemiology of non-Hodgkin's lymphoma

The incidence of non-Hodgkin's lymphoma (NHL) has risen dramatically over recent decades and, despite some known risk factors, such as compromised immunity, the etiology of NHL and the reasons for most of this increase are unknown. Dietary components may be a common and critical source of immunologic antigens and promoters, which needs to be incorporated more in the etiologic research of NHL. To date, epidemiologic evidence suggests that obesity and fat intake, in particular saturated or animal fat, may increase the risk of NHL; whereas whole-grains, vegetables and moderate consumption of alcohol may be inversely associated with NHL risk. Much of the current evidence is obtained from case-control studies, which are subject to dietary recall bias; therefore, this area of research requires further study within prospective cohorts with detailed dietary information and with a large number of cases to examine disease sub-type heterogeneity.

Dietary folate, alcohol consumption, and risk of non-Hodgkin lymphoma

Dietary deficiency of folate and other micronutrients involved in the one-carbon metabolism (i.e., vitamins B2, B6, B12, and methionine) have been related to several diseases, including cancers, but results on non-Hodgkin lymphoma (NHL) are controversial. A hospital-based case-control study was conducted in Italy, in 1999-2002. Cases were 190 incident, histologically confirmed NHL aged 18-84 years. Controls were 484 subjects admitted to hospitals for acute, non-neoplastic diseases supposed to be unrelated to alcohol consumption or to diet modification. Dietary habits, including alcohol drinking, were assessed by a validated food-frequency questionnaire. Nutrient intakes were computed using the Italian food composition database. Odds ratios (ORs) and corresponding 95% confidence intervals for tertiles of nutrients' intake were computed using the energy-adjusted residual models. No significant association emerged between NHL risk and intakes of folate (OR=0.9), vitamin B2 (OR=0.9), vitamin B6 (OR=0.8), and methionine (OR=0.7). However, a significant inverse association was observed for all the nutrients examined among abstainers and former drinkers, whereas no relations between one-carbon nutrients and NHL risk emerged among current alcohol drinkers. Our findings support the possibility of an antagonist effect of alcohol on the one-carbon metabolism in NHL etiology. However, the lack of an overall effect for one-carbon nutrients and the small sample size suggested caution in interpreting our results.

Case-control study of lymphoid neoplasm in three French areas: description, alcohol and tobacco consumption

A multi-centre hospital-based case-control study was conducted in three regions of France between 2000 and 2003 in order to establish the risk factors of lymphoid neoplasms. We report here results concerning alcohol and tobacco consumption. A total of 298 cases and 276 controls, case-matched by inclusion centre, age and sex were included. Cases were classified according to the World Health Organization classification and validated by an expert panel of eight pathologists. Overall alcohol intake did not incur any risk increase for non-Hodgkin's lymphoma. Wine consumption marginally increased the risk of follicular lymphoma [odds ratio=2.19 (0.83-5.80)], with a higher risk for drinkers who started before the age of 20 years [odds ratio=4.04 (1.19-13.76)] and for drinkers who consumed more than 19 g of alcohol per day [odds ratio=4.37 (1.04-18.45)]. Beer and spirit consumption was not linked to non-Hodgkin's lymphoma risk. Tobacco consumption did not show a risk increase. The risk increase of follicular lymphoma due to wine consumption was new. We discuss this risk based on the French context, France being the European country with the highest alcohol consumption, particularly of wine.

The non-Hodgkin lymphomas: a review of the epidemiologic literature

The non-Hodgkin lymphomas (NHL) are a heterogeneous group of B-cell and T-cell neoplasms that arise primarily in the lymph nodes. NHL incidence rates in the US doubled between about 1970 and 1990, and stabilized during the 1990s. NHL accounts for approximately 3.4% of cancer deaths in the US. Although some of the observed patterns in NHL have been related to HIV/AIDS, these conditions cannot fully explain the magnitude of the changes; neither do changes in classification systems nor improved diagnostic capabilities. Studies of occupational and environmental exposures (e.g., pesticides, solvents) have produced no consistent pattern of significant positive associations. Inverse associations with ultraviolet radiation exposure and alcohol and fish intake, and positive associations with meat and saturated fat intake have been reported in several studies; additional studies are needed to confirm or refute these associations. Family history of NHL or other hematolympho-proliferative cancers and personal history of several autoimmune disorders are associated with increased risk of NHL, but are not likely to account for a large proportion of cases. HIV and other infectious agents, such as human herpesvirus 8 and Epstein-Barr, appear to be associated with differing types of NHL, such as some B-cell lymphomas. Future epidemiologic studies should evaluate associations by NHL type, enhance exposure information collected, and elucidate factors that may identify susceptible (or resistant) subpopulations because of genetic, immunologic or other characteristics. The extent to which the etiology of NHL types may differ is important to resolve in ongoing and future studies.

Obesity, diet and risk of non-Hodgkin lymphoma

Non-Hodgkin lymphoma (NHL) represents a group of heterogeneous diseases that significantly vary in their causes, molecular profiles, and natural progression. In 2007, there will be approximately 59,000 newly diagnosed NHL cases in the United States and over 300,000 cases worldwide. Although new therapeutic regimens are minimizing the number of deaths related to NHL, causes for the majority of lymphomas remain undetermined. Recent studies suggest that dietary factors may contribute to the rising rates of NHL. This review will summarize epidemiologic reports that have studied the relationship between obesity, physical activity, and diet and risk of NHL. Based on a number of case-control and prospective cohort studies, overweight/obesity probably increases the risk of NHL, whereas moderate physical activity may reduce risk. Several studies support an inverse association between intakes of vegetables and NHL risk, particularly for the consumption of cruciferous vegetables. This may relate to the induction of apoptosis and growth arrest in preneoplastic and neoplastic cells, two important actions of isothiocyanates found in cruciferous vegetables. Studies also suggest that fish intake may be inversely associated with risk of NHL, although findings have not been entirely consistent. This may relate to the high organochlorine content in some fish that could override a protective effect. High consumption of fats, meat, and dairy products also may increase lymphoma risk. The accumulated scientific evidence concerning the associations between obesity, diet, and NHL suggests several identified modifiable risk factors that might be recommended to decrease lymphoma risk.

Ultraviolet radiation, dietary vitamin D, and risk of non-Hodgkin lymphoma (United States)

OBJECTIVE

Because of conflicting findings about the relationship between ultraviolet (UV) radiation and the risk of non-Hodgkin lymphoma (NHL), we evaluated the risk of several indicators related to UV, including two not previously studied: dietary vitamin D, and ambient UV levels by residential location.

METHODS

As part of a case-control study conducted in four Surveillance, Epidemiology, and End Results (SEER) registries, we collected UV information from a self-administered questionnaire and computer-assisted personal interview with 551 NHL cases and 462 controls. We estimated the relative risk (RR) and 95% confidence intervals (CI) from unconditional logistic regression models.

RESULTS

Eye color, a marker of host susceptibility to UV, showed a decreasing risk gradient for lightest eyes (0.47) compared to darkest. Relative risks were in the range of 0.73-0.78 for participants reporting more hours in the mid-day summer sun. Use of sunlamps or tanning booths was associated with decreased risk (RR = 0.88), as was estimated overall ambient UV (RR = 0.76 per 50 RB-units) overall. Vitamin D intake from diet and supplements was not related to risk. Results were thus consistent for the various indicators, although some estimated risks were not statistically significant. Effects were generally similar for diffuse large B-cell (DLBCL) and follicular lymphomas.

CONCLUSION

These data suggest a slight protective effect of sunlight against NHL, and they agree with geographic patterns of NHL incidence observed in the US.

Effect of dietary antioxidants and risk of oral, pharyngeal and laryngeal squamous cell carcinoma according to smoking and drinking habits

Several intervention trials and prospective studies have reported that beta-carotene supplementation is not associated with a decreased risk of several cancers among smokers and drinkers, and that it may even have adverse effects in these groups. The relationship between dietary antioxidant intake and the risk of head and neck squamous cell carcinoma (HNSCC) has been examined intensively, but little is known about the effects of antioxidants on HNSCC with respect to smoking and drinking habits. Here, we conducted a case-control study of 385 histologically confirmed cases of HNSCC (193 oral, 132 pharyngeal and 60 laryngeal), excluding nasal and paranasal cancer, and 1925 age-matched and sex-matched cancer-free outpatient controls using data from the Hospital-based Epidemiologic Research Program at Aichi Cancer Center, Japan. The intake of nutrients and food groups was assessed with a food frequency questionnaire, and multivariate-adjusted odds ratios for cancer were estimated for smoking and drinking habits using logistic models. The results showed an overall inverse association between the intake of dietary antioxidants, including carotene, and vitamins C and E, and risk of HNSCC. The protective effect of these antioxidants was seen in both men and women. High consumption of antioxidants was associated with a decreased risk of HNSCC among smokers, drinkers and those with both smoking and drinking habits. These findings suggest that dietary antioxidant intake prevents HNSCC in smokers and drinkers.

Food groups and risk of non-Hodgkin lymphoma: a multicenter, case-control study in Italy

Incidence of non-Hodgkin lymphoma (NHL) has been rising worldwide, but the reasons are undefined. Dietary habits may play a role in the etiology of NHL by influencing the metabolic pathways of several cells of the immune system. This case-control study investigated the relation between food consumption and NHL risk. Between 1999 and 2002, we conducted a hospital-based case-control study on NHL in 2 areas of Italy. Cases were 190 patients (median age 58 years) with incident NHL admitted to specialized and general hospitals. Controls were 484 patients (median age 63 years) with acute non-neoplastic conditions admitted to the same hospitals network of cases. A validated food-frequency questionnaire was used to assess habitual diet 2 years before interview. Unconditional multiple logistic regression was used to estimate the odds ratios (OR) and the corresponding 95% confidence intervals (CI), with allowance for energy intake, according to the residual model. Consumption of highest versus lowest quartile of pasta/rice (OR = 1.87, 95% CI: 1.04-3.36) and cheese (OR = 1.66, 95% CI: 0.98-2.83) were associated with a significantly increased NHL risk. Inverse association was found for vegetables (OR = 0.49, 95% CI: 0.28-0.87), fruits (OR = 0.51, 95% CI: 0.30-0.85), and egg consumption (OR = 0.59, 95% CI: 0.36-0.97). The association of pasta/rice was also supported by an increased risk of high glycemic load levels (OR = 1.86, 95% CI: 1.04-3.32). In conclusion, our results suggested that diet could affect NHL risk.

Linoleic acid, vitamin D and other nutrient intakes in the risk of non-Hodgkin lymphoma: an Italian case-control study

BACKGROUND

Dietary habits have been suggested as a factor related to the increase of non-Hodgkin lymphoma (NHL) incidence in western populations, but the role of individual nutrients is still unclear.

PATIENTS AND METHODS

A hospital-based case-control study was conducted in Italy, 1999-2002.

CASES

190 incident, histologically-confirmed NHL cases aged 18-84 years.

CONTROLS

484 subjects admitted to hospital for acute, non-neoplastic diseases unrelated to diet. Dietary habits were assessed by a validated food-frequency questionnaire; nutrient intakes were computed using the Italian food composition database. Odds ratios (ORs) and corresponding 95% confidence intervals (CI) for tertiles of intake of nutrient were computed using the energy-adjusted residual models.

RESULTS

Inverse association emerged for polyunsaturated fatty acids (OR=0.6; 95% CI: 0.4-0.9), linoleic acid (OR=0.6; 95% CI: 0.4-0.9), and vitamin D (OR=0.6; 95% CI: 0.4-0.9). The protective effect for linoleic acid (OR=0.3; 95% CI: 0.2-0.7) and vitamin D (OR=0.4; 95% CI: 0.2-0.9) was stronger in women; no differences emerged according to age. Linoleic acid was inversely related to follicular and diffuse large B-cell lymphoma; the protective effect of vitamin D emerged most clearly for follicular subtypes.

CONCLUSIONS

Our study suggests that a diet rich in polyunsaturated fatty acids and vitamin D is associated with a reduced risk of NHL.

Use of hydroxy-methyl-glutaryl coenzyme A reductase inhibitors is associated with risk of lymphoid malignancies

It has been speculated that the use of hydroxy-methyl-glutaryl coenzyme A reductase inhibitors (statins) is associated with the risk of malignant diseases. Considering their immunosuppressive activities, malignant diseases that are associated with an immunosuppressive status seem feasible to examine the association. We therefore examined the association between statin use and development of lymphoid malignancies in a case-control study. Cases were 221 consecutive incident cases with histopathologically proven lymphoid malignancies (lymphoma and myeloma), hospitalized in the Department of Hematology of Toranomon Hospital (Tokyo, Japan) between 1995 and 2001. Two independent control groups, comprising 442 and 437 inpatients without malignancies from the Departments of Orthopedics and Otorhinolaryngology of the same hospital, were selected to test for consistency of association. Controls were matched individually with cases for age, sex and year of admission. Subject information, including statin use, was abstracted from medical records at the time of hospitalization. Strength of association was evaluated as an adjusted odds ratios (aOR) using a conditional logistic regression model. A higher frequency of statin use was found among patients with lymphoid malignancies in comparison with both orthopedic (aOR 2.11, 95% CI 1.20-3.69, P = 0.009) and otorhinolaryngology patients (aOR 2.59, 95% CI 1.45-4.65, P = 0.001), the significance being maintained when the two control groups were combined (aOR 2.24, 95% CI 1.37-3.66, P = 0.001). In conclusion, we observed an elevated risk of lymphoid malignancy with statin use among Japanese patients. Further evaluations in different populations are required to draw conclusions as to the carcinogenicity of lymphoid malignancies with statin use.

Tobacco and alcohol consumption and risk of lymphoma: Results of apopulation-based case-control study in Germany

Changing trends in lifestyle exposures are suggested to be contributing factors to the increasing incidence rates for lymphoma. We investigated the relationship between smoking and alcohol consumption and the risk of lymphoma among adult participants of a population-based case-control study recently conducted in Germany. In 710 case-control pairs, an increased risk of lymphoma was associated with a long duration of smoking (p for trend = 0.01 for men) and smoking of > 20 cigarettes per day(OR = 2.7; 95% CI = 1.4-5.2 for women). Elevated odds ratios were seen for most lymphoma subentities, albeit mostly without reaching statistical significance. A strong association was evident between smoking and multiple myeloma (OR = 2.4, 95% CI = 0.98-5.74 for men; OR = 2.9, 95% CI = 1.1-7.4 for women) and Hodgkin's lymphoma among men (OR = 3.6; 95% CI = 1.7-7.5). Alcohol consumption 10 years prior to the date of interview appeared to decrease the risk of lymphoma. Odds ratios for men who reported alcohol consumption were 53% lower (95% CI = 0.31-0.71) compared to men who drank very little or no alcohol. The same tendency was evident for women, although the association was less pronounced. The inverse relationship was also seen for low amounts of alcohol and did not appear to be restricted to specific types of beverages. Although biologic rationale for a protective effect of alcohol consumption may be given, a more in-depth analysis involving genetic markers is indicated to clarify if ethanol, other components in alcoholic beverages, or factors associated with moderate drinking reduce lymphoma risk among adults. In conclusion, this investigation suggests a positive association between tobacco smoking and lymphoma risk and finds decreased odds ratios among consumers of alcohol.

Tobacco smoking, alcohol drinking and non-Hodgkin's lymphoma: A European multicenter case-control study (Epilymph)

To study the role of tobacco smoking and alcohol drinking in the etiology of non-Hodgkin's lymphoma (NHL), we conducted a multicenter case-control study in Spain, France, Germany, Italy, Ireland and Czech Republic between 1998 and 2004, which included 1,742 cases of NHL and 2,465 controls matched on age, sex and recruitment area. Tobacco smoking was not associated with the risk of NHL overall or with risk of specific histological subtypes. Similarly, there was no association between alcohol drinking and the risk of NHL overall or across histological subtypes. However, a protective effect of alcohol drinking was observed among men (OR = 0.76, 95% CI = 0.62-0.93) and in non-Mediterranean countries (OR = 0.73, 95% CI = 0.61-0.86). There was no evidence of interaction between alcohol drinking and tobacco smoking in NHL etiology. The results of this large-scale European study did not support an association between tobacco and NHL and suggested a protective effect of alcohol on development of NHL for men and in non-Mediterranean countries.

Dietary determinants of one-carbon metabolism and the risk of non-Hodgkin's lymphoma: NCI-SEER case-control study, 1998-2000

The role of dietary one-carbon determinants remains largely unexplored for non-Hodgkin's lymphoma (NHL). In a population-based case-control study of non-African-American adult (aged 20-74 years) women and men from four US Surveillance, Epidemiology, and End Results study centers (Detroit, Michigan; Iowa; Los Angeles, California; and Seattle, Washington; 1998-2000), the authors examined folate; vitamins B2, B6, and B12; methionine; and a one-carbon antagonist, alcohol, in 425 incident NHL cases and 359 controls who completed a detailed food frequency questionnaire. Adjusted odds ratios and 95% confidence intervals were estimated by using unconditional logistic regression. Higher intake of one-carbon determinants from food was associated with a lower risk of NHL, but that for only vitamin B6 (highest vs. lowest quartile: odds ratio = 0.57, 95% confidence interval: 0.34, 0.95; p trend = 0.01) and methionine (odds ratio = 0.49, 95% confidence interval: 0.31, 0.76; p trend = 0.002) reached statistical significance. Folate from food was inversely associated with diffuse subtype (odds ratio = 0.47, 95% confidence interval: 0.23, 0.94; p trend = 0.03). The authors found no association between total (food plus supplement) vitamins and NHL. Nonusers of alcohol had an elevated NHL risk compared with users, and alcohol did not modify other nutrient-NHL associations. Findings suggest that one-carbon nutrients, particularly vitamin B6 and methionine, may be protective against NHL.

Tobacco use and non-Hodgkin lymphoma: results from a population-based case-control study in the San Francisco Bay Area, California

OBJECTIVE

Investigate the association between tobacco use and non-Hodgkin lymphoma (NHL).

METHODS

Tobacco-use data were collected during in-person interviews in a population-based case-control study of NHL (N=1593 patients, N=2515 controls) conducted in the San Francisco Bay Area between 1988 and 1995. Odds ratios (ORs) for HIV-negative participants were obtained from adjusted unconditional logistic regression models stratified by sex.

RESULTS

NHL was not associated with overall tobacco use, intensity or duration of cigarette smoking in women or men. However, ORs were increased for NHL among men who used any non-cigarette tobacco alone (OR=1.7), non-cigarette tobacco and cigarettes (OR=1.4), multiple types of non-cigarette tobacco alone (OR=2.1) and smokeless tobacco alone (OR=4.0). In analyses stratified by sex and age, ORs for NHL associated with cigarette smoking in general were above unity among those aged > or =60 years. ORs for follicular lymphoma were increased in men who used cigarettes and other tobacco, cigars alone and smokeless tobacco alone. Diffuse large-cell lymphoma in men was associated with use of cigarettes and other tobacco, and multiple types of non-cigarette tobacco.

CONCLUSION

Our data do not support an association between overall tobacco use and all NHL in women or men. Further analyses are warranted in larger studies to evaluate non-cigarette tobacco use, tobacco-related biologic markers and genetic factors in the development of NHL.

Smoking and non‐Hodgkin lymphoma: Case‐control study in Italy

Tobacco smoking is a well-documented risk factor for several cancers, but the role of cigarette smoking in the etiology of non-Hodgkin lymphoma (NHL) is inadequately understood. Hepatitis C virus (HCV) has been associated with NHL, but the interaction between HCV and smoking habits has not yet been studied. Between 1999 and 2002, we conducted a case-control study on the association of HCV, smoking habits and NHL in 2 areas of northern and southern Italy. Cases were 225 consecutive patients (median age, 59 years) with a new diagnosis of NHL that were admitted to reference and general hospitals. Controls were 504 patients (median age, 63 years) admitted to the same hospitals as cases, for a wide spectrum of acute, nonneoplastic, nonimmune-, nor tobacco-related conditions. Current, heavy smokers (> or = 20 cigarettes/day) had an odds ratio (OR) of NHL of 2.10 (95% confidence interval, CI: 1.07-4.12) compared to never smokers. The association between smoking and NHL was consistent across strata of sex and age. Compared to never smokers, current smokers of > or = 20 cigarettes/day had ORs of 1.14 (95% CI: 0.37-3.56) for B-cell-low-grade, 2.10 (95% CI: 0.94-4.67) for B-cell-intermediate and high-grade, and 25.84 (95% CI: 1.95-342.17) for T-cell NHL. The effect of tobacco smoking and HCV were independent on the relative risk, leading a 4-fold elevated risk in current smokers HCV positive subjects. Tobacco smoking and hepatitis C virus (HCV) have been associated to non-Hodgkin lymphoma (NHL), but the interaction between HCV and smoking habits has not yet been studied. Our study confirms that tobacco is related to NHL, and reports on the combined effect of tobacco smoking and HCV. Infection acted together according to a multiplicative model, leading to a 4-fold elevated risk in current smokers HCV positive subjects.

Effect of hepatitis C virus infection on the risk of non-Hodgkin's lymphoma: a meta-analysis of epidemiological studies

Although a high prevalence of hepatitis C virus (HCV) infection among non-Hodgkin's lymphoma (NHL) patients had been reported, subsequent epidemiological studies conducted to examine a causal association between HCV and NHL have provided inconsistent results across studies. A strikingly positive association has been reported primarily from Italy and Japan, while no association was found in other regions of the world. To clarify the association between HCV and NHL, we conducted a systematic literature review. Eligible study designs were nested case-control studies, population-based case-control studies, and hospital-based case-control studies using non-cancer subjects as controls. The studies published through January 1991 to August 2003 were searched through Medline. Ultimately, 23 studies with 4049 NHL patients and 1,813,480 controls were identified. Summary statistics were crude odds ratios (ORs) comparing the anti-HCV seropositive and seronegative subjects. As we identified heterogeneity between studies, summary statistics were calculated based on a random-effect model. We did not find any evidence of publication bias. The major sources of variation were the use of blood donor controls and year of publication. The summary OR for NHL was 5.70 (95% confidence interval (CI), 4.09-7.96, P < 0.001). The subgroup analysis by phenotype showed a similar trend for B-cell (5.04, 95% CI: 3.59-7.06) and T-NHL (2.51, 95% CI: 1.39-4.56). In conclusion, we found a strongly positive association between anti-HCV seropositive test subjects and risk of NHL. Further biological studies examining this association are warranted.

Dietary Fish Intake and Risk of Leukaemia, Multiple Myeloma, and Non-Hodgkin Lymphoma

This study aimed to determine whether fish intake was protective against leukemia, multiple myeloma, and non-Hodgkin lymphoma (NHL), and if our previous finding of a protective effect of fish-related occupations on the risk of these diseases was due to dietary intake of fish. We used data from a population-based case-control study undertaken in Canada in 1994–1998. Dietary information was available for 919 leukemia cases, 287 myeloma cases, 1418 NHL cases, and 4202 controls. The risk of each of the three cancers was determined using multiple logistic regression analysis according to quartiles of weekly fresh fish intake, percentage of total energy intake from fresh fish, and percentage of total fat intake from fresh fish. After adjusting for age, sex, smoking, BMI, and proxy status, people who consumed greater proportions of their total energy intake from fresh fish had a significantly lower risk of each of the three types of cancer, and there was a significant dose-response for risk of leukemia and NHL. Those in the highest quartile for percentage of fat intake from fish were at lowest risk: leukemia odds ratio (OR) 0.72, 95% confidence interval (CI) 0.58–0.89; multiple myeloma OR 0.64, 95% CI 0.45–0.90; NHL OR 0.71, 95% CI 0.60–0.85; and all LH cancers combined OR 0.70, 95% CI 0.61–0.81. The protective effect previously observed for working with fish on the risk of leukemia and lymphoma was independent of fish intake. These findings suggest that a diet high in fish may be protective against lymphohematopoietic cancers and confirm the reduced risk among fish workers.