The Associations of Fruit and Vegetable Intake with Lung Cancer Risk in Participants with Different Smoking Status: A Meta-Analysis of Prospective Cohort Studies

Adherence to lifelines diet is associated with lower lung cancer risk in 98,459 participants aged 55 years and above: a large prospective cohort study

Background

Lifelines Diet Score (LLDS) was developed based on the 2015 Dutch Dietary Guidelines and current international scientific evidence. As a dietary quality assessment tool, the LLDS aims to evaluate the association between the Lifeline diet and the risk of chronic diseases. However, the evidence linking LLDS to lung cancer risk is currently limited.

Objective

Our objective was to explore whether adherence to the LLDS is associated with reduced incidence and mortality of lung cancer, including its major histological subtypes: small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC).

Methods

Data for this research were sourced from the Prostate, Lung, Colorectal, and Ovarian (PLCO) Trial. The LLDS for each participant was calculated based on responses to the dietary history questionnaire (DHQ), and subsequently analyzed after being categorized into quintiles. The Cox proportional hazards regression model was utilized to compute the hazard ratios (HRs) and 95% confidence intervals (CIs) for both the incidence and mortality of lung cancer, SCLC and NSCLC. Additionally, stratified analyses were conducted to ascertain possible effect modifiers, and several sensitivity analyses were performed to evaluate the robustness of the findings.

Results

During the mean follow-up periods of 8.8 years for incidence and 15.1 years for mortality, we identified 1,642 new cases and 1,172 related deaths from lung cancer. Participants in the highest quartiles of LLDS compared to those in the lowest exhibited a reduced incidence (HRQ4:Q1 = 0.80, 95% CI = 0.68-0.94, P for trend = 0.003) and mortality (HRQ4:Q1 = 0.81, 95%CI = 0.67-0.98, P for trend = 0.009) of lung cancer. Furthermore, this negative association remained for SCLC incidence (HRQ4:Q1 = 0.55, 95% CI = 0.35-0.87, P for trend = 0.002) and mortality (HRQ4:Q1 = 0.42, 95% CI = 0.25-0.70, P for trend <0.001). The association between LLDS and the incidence and mortality of lung cancer is not influenced by pre-defined potential effect modifiers (all P interaction > 0.05). The sensitivity analyses substantiated the robustness of the results.

Conclusion

In conclusion, our research indicates that among 98,459 U.S. adults aged 55 and older, adherence to the LLDS is linked to a diminished incidence and mortality of lung cancer.

Effect of Fruit and Vegetable Consumption on Human Health: An Update of the Literature

Several meta-analyses have consistently demonstrated that the consumption of an adequate level of fruit and vegetables (F&V), along with other food groups, is associated with a low risk of all-cause mortality, and, as such, represents one of the major modifiable risk factors related to the growing burden of Non-Communicable Diseases (NCDs). The aim of the present narrative review was to provide an up-to-date analysis of systematic reviews and meta-analyses published in the past five years, dealing with the effects of F&V consumption on human health, focusing on specific pathologies, such as total mortality, cancer, cardiovascular diseases (CVDs), type 2 diabetes, intestinal inflammation, and bone and respiratory illnesses. The results of our evaluation confirmed and consolidated the protective role of F&V consumption against the development of NCDs, especially CVDs. However, the need to corroborate existing evidence and clarify the role of confounding factors by performing additional randomized control trials and adopting more standardized approaches and study designs also emerged. Moreover, evaluating the protective role of fruit and vegetables as separate food categories appeared to be one of the most interesting areas to investigate in the near future. Overall, these outcomes could help in addressing future research to better establish a causal relationship between F&V consumption and human health.

Associations of sugary beverage consumption with chronic obstructive pulmonary disease, asthma, and asthma-chronic obstructive pulmonary disease overlap syndrome: a prospective cohort study

BACKGROUND

The associations between specific types of sugary beverages and major chronic respiratory diseases remain relatively unexplored.

OBJECTIVES

This study aimed to investigate the associations of sugar-sweetened beverages (SSBs), artificially sweetened beverages (ASBs), and natural juices (NJs) with chronic obstructive pulmonary disease (COPD), asthma, and asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS).

METHODS

This prospective cohort study included 210,339 participants from the UK Biobank. Sugary beverage intake was measured in units (glasses/cans/cartons/250 mL) through 24-h dietary questionnaires. Logistic regression and Cox proportional hazards models were used to analyze the prevalence and incidence, respectively. Quantile G-computation was used to estimate the joint associations and relative contributions of the 3 types of sugary beverages.

RESULTS

Over a median follow-up of 11.6 y, 3491 participants developed COPD, 4645 asthma, and 523 ACOS. In prevalence analysis, certain categories of SSB and NJ consumption were associated with increased asthma prevalence, while high ASB consumption (>2 units/d) was linked to higher risks of all 3 outcomes. In incidence analysis, high SSB consumption (>2 units/d) was associated with incident COPD (hazard ratio [HR]: 1.53; 95% confidence interval [CI]: 1.19, 1.98) and asthma (HR: 1.22; 95% CI: 0.98, 1.52). Dose‒response relationships were observed for ASB consumption with all 3 outcomes (continuous HR: 1.98; 95% CI: 1.36, 2.87, for COPD; continuous HR: 1.65; 95% CI: 1.24, 2.20, for asthma; and continuous HR: 2.84; 95% CI: 1.20, 6.72, for ACOS). Moderate NJ consumption (>0-1 unit/d) was inversely associated with COPD (HR: 0.89; 95% CI: 0.82, 0.97), particularly grapefruit and orange juice. Joint exposure to these beverages (per unit increase) was associated with COPD (HR: 1.15; 95% CI: 1.02, 1.29) and asthma (HR: 1.16; 95% CI: 1.06, 1.27), with ASBs having greater positive weights than SSBs.

CONCLUSIONS

Consumption of SSBs and ASBs was associated with increased risks of COPD, asthma, and potentially ACOS, whereas moderate NJ consumption was associated with reduced risk of COPD, depending on the juice type.

Trends and projection of burden on lung cancer and risk factors in China from 1990 to 2060

BACKGROUND

Lung cancer (LC) is currently the number one malignancy death rate disease in China, and its disease burden is serious. The study aimed to analyze trends of LC and its risk factor attributable disease in China from 1990 to 2019 and predict the next 41 years.

METHODS

The average annual percentage change (AAPC) was used to analyze the trend of LC and its risk factor attributable incidence, deaths, and disability-adjusted life years (DALYs) rate in China from 1990 to 2019, collected in the Global Burden of Disease 2019. Cochran-Armitage trends examine trends in lung cancer disease burden by sex, age, and attributable risk factor groups in China from 1990 to 2019. In addition, based on data on death and DALYs rate due to LC and its risk factors between 1990 and 2019, an autoregressive integrated moving average (ARIMA) model was developed to predict the change in the trend of burden of disease due to LC and its risk factors over the next 41 years, and the model was evaluated using the model parameters root mean square error, mean absolute error, and mean absolute percentage error.

RESULTS

From 1990 to 2019, the incidence, mortality and DALYs of LC were all increased. Among the eight risk factors associated with lung cancer, the DALYs rate and mortality rate of lung cancer risk factors for Chinese residents increased from 1990 to 2019, except for household air pollution from solid fuels and diet low in fruit, which showed a decrease; among them, the DALYs rate and mortality rate due to ambient particulate matter pollution showed the greatest increase with AAPC values of 2.880 and 3.310, respectively, while DALYs and mortality rates due to household air pollution from solid fuels showed the largest decreases, with AAPC values of -4.755 and -4.348, respectively. The results of the ARIMA model predictions show that both the mortality rate and the rate of DALYs for lung cancer are increasing yearly, and it is predicted that the rate of DALYs for lung cancer by 2060 will reach 740.095/100 000 and the mortality rate will reach 35.151/100 000. It is expected that by 2060, the top four risk factors for lung cancer in China will be, in order of DALYs rate and mortality rate, smoking, ambient particulate matter pollution, high fasting plasma glucose (HFPG), and secondhand smoke, with HFPG showing the greatest increase.

CONCLUSIONS

The LC burden increased from 1990 to 2019 in China, the LC burden that could be attributed to HFPG will continue to increase in the next 40 years, and will be the third most factor by 2060. Targeted interventions are warranted to facilitate the prevention of LC and improvement of health-related quality of life patients with LC.

Exploring the contribution of lifestyle to the impact of education on the risk of cancer through Mendelian randomization analysis

Educational attainment (EA) has been linked to the risk of several types of cancer, despite having no expected direct biological connection. In this paper, we investigate the mediating role of alcohol consumption, smoking, vegetable consumption, fruit consumption and body mass index (BMI) in explaining the effect of EA on 7 cancer groupings. Large-scale genome wide association study (GWAS) results were used to construct the genetic instrument for EA and the lifestyle factors. We conducted GWAS in the UK Biobank sample in up to 335,024 individuals to obtain genetic association data for the cancer outcomes. Univariable and multivariable two-sample Mendelian randomization (MR) analyses and mediation analyses were then conducted to explore the causal effect and mediating proportions of these relations. MR mediation analysis revealed that reduced lifetime smoking index accounted for 81.7% (49.1% to 100%) of the protective effect of higher EA on lower respiratory cancer. Moreover, the effect of higher EA on lower respiratory cancer was mediated through vegetable consumption by 10.2% (4.4% to 15.9%). We found genetic evidence that the effect of EA on groups of cancer is due to behavioural changes in avoiding well established risk factors such as smoking and vegetable consuming.

Higher fresh fruit intake relates to larger grey matter volumes in areas involved in dementia and depression: A UK Biobank study

The benefits of consuming fruits and vegetables are widely accepted. While previous studies suggest a protective role of fruits and vegetables against a variety of diseases such as dementia and depression, the biological mechanisms/effects remain unclear. Here we investigated the effect of fruit and vegetable consumption on brain structure. Particularly on grey matter (GM) and white matter (WM) volumes, regional GM volumes and subcortical volumes. Cross-sectional imaging data from UK Biobank cohort was used. A total of 9925 participants (Mean age 62.4 ± 7.5 years, 51.1 % men) were included in the present analysis. Measures included fruit and vegetable intake, other dietary patterns and a number of selected lifestyle factors and clinical data. Brain volumes were derived from structural brain magnetic resonance imaging. General linear model was used to study the associations between brain volumes and fruit/vegetable intakes. After adjusting for selected confounding factors, salad/raw vegetable intake showed a positive association with total white matter volume, fresh fruit intake showed a negative association with total grey matter (GM) volume. Regional GM analyses showed that higher fresh fruit intake was associated with larger GM volume in the left hippocampus, right temporal occipital fusiform cortex, left postcentral gyrus, right precentral gyrus, and right juxtapositional lobule cortex. We conclude that fruit and vegetable consumption seems to specifically modulate brain volumes. In particular, fresh fruit intake may have a protective role in specific cortical areas such as the hippocampus, areas robustly involved in the pathophysiology of dementia and depression.

Diet quality and lung cancer incidence in a low-income population in the United States

BACKGROUND

Although tobacco smoking is the leading cause of lung cancer, interest in the relationship of diet quality on risk has been growing.

METHODS

We examined the association between Healthy Eating Index-2010 (HEI-10) at enrollment and lung cancer incidence among 70,802 participants in a predominantly African American and low-income prospective cohort in the southern United States. Outcomes were ascertained through linkages with state cancer registries and the National Death Index (NDI). Hazard ratios by HEI-10 quartiles were assessed using Cox proportional hazard models adjusted for potential confounders.

RESULTS

During ≤16 years of follow-up, 1454 incident lung cancers were identified. The lowest HEI-10 quartile compared to the highest was adversely associated with lung cancer risk (HR: 1.89, 95% CI 1.16-3.07) among male former smokers and female never smokers (HR: 2.58, 95% CI 1.06-6.28).

CONCLUSIONS

Low-quality diet was associated with increased lung cancer risk among male former smokers and female never smokers but cautious interpretation of the findings should be taken due to the small number of lung cancers among never smokers and the possibility of residual confounding by smoking in ever smokers.

A review of recent advances in the novel therapeutic targets and immunotherapy for lung cancer

Lung cancer is amongst the most pervasive malignancies having high mortality rates. It is broadly grouped into non-small-cell lung cancer (NSCLC) and small-cell lung cancer (SCLC). The concept of personalized medicine has overshadowed the conventional chemotherapy given to all patients with lung cancer. The targeted therapy is given to a particular population having specific mutations to help in the better management of lung cancer. The targeting pathways for NSCLC include the epidermal growth factor receptor, vascular endothelial growth factor receptor, MET (Mesenchymal epithelial transition factor) oncogene, Kirsten rat sarcoma viral oncogene (KRAS), and anaplastic lymphoma kinase (ALK). SCLC targeting pathway includes Poly (ADP-ribose) polymerases (PARP) inhibitors, checkpoint kinase 1 (CHK 1) pathway, WEE1 pathway, Ataxia Telangiectasia and Rad3-related (ATR)/Ataxia telangiectasia mutated (ATM), and Delta-like canonical Notch ligand 3 (DLL-Immune checkpoint inhibitors like programmed cell death protein 1 (PD-1)/ programmed death-ligand 1 (PD-L1) inhibitors and Cytotoxic T-lymphocyte-associated antigen-4 (CTLA4) blockade are also utilized in the management of lung cancer. Many of the targeted therapies are still under development and require clinical trials to establish their safety and efficacy. This review summarizes the mechanism of molecular targets and immune-mediated targets, recently approved drugs, and their clinical trials for lung cancer.

Prospective Study of Avocado Consumption and Cancer Risk in U.S. Men and Women

Avocados contain nutrients and phytochemicals that make it promising for cancer prevention, and chemopreventive properties have been demonstrated in prior studies. Prospective studies on avocado consumption and cancer risk have yet to be conducted. This study included data from 45,289 men in the Health Professionals Follow-Up Study (HPFS, 1986-2016) and 67,039 women in the Nurses' Health Study (NHS, 1986-2014). Avocado consumption was assessed using validated food frequency questionnaires every 4 years. Cox proportional hazards models calculated multivariable HRs and 95% confidence intervals (CI) for associations between avocado consumption and risk of total and site-specific cancers in each cohort. In HPFS, consumption of ≥1 weekly serving of avocados was associated with decreased risk of total (HR, 0.85; 95% CI, 0.80-0.91), colorectal (HR, 0.71; 95% CI, 0.59-0.85), lung (HR, 0.71; 95% CI, 0.57-0.90), and bladder cancer (HR, 0.72; 95% CI, 0.57-0.90). In NHS, avocado consumption was associated with increased risk of breast cancer (HR, 1.21; 95% CI, 1.07-1.37). No associations were observed between avocado consumption and risk of total cancer (HR, 1.06; 95% CI, 0.98-1.14) or other site-specific cancers in NHS. Considering the surprising breast cancer finding, analyses were repeated using data from 93,230 younger women in the parallel NHSII (1991-2017). In NHSII, avocado consumption was not associated with breast cancer risk (HR, 0.93; 95% CI, 0.76-1.13). Overall, avocado consumption may be associated with reduced risk of total and some site-specific cancers in men. The positive association with breast cancer risk in NHS was not seen in the younger NHSII.

PREVENTION RELEVANCE

The results of this prospective study suggest that avocado consumption may be associated with decreased risk of total and some site-specific cancers in men. See related Spotlight, p. 187.

Inappropriate dietary habits in tobacco smokers as a potential risk factor for lung cancer: Pomeranian cohort study

OBJECTIVE

Little is known whether diet quality modulates lung cancer risk in smokers. The aim of the study was to assess the dietary habits of a large group of volunteers participating in the lung cancer screening program.

METHODS

The 62-item food frequency questionaire was completed by 5997 participants, 127 of whom (2.1%) were later diagnosed with lung cancer. Two approaches were applied to identify dietary habits. The non-healthy diet index was calculated, and a direct analysis of the frequency of consumption was used. A logistic regression analysis was performed to estimate the association between food product intake and the risk of lung cancer.

RESULTS

The study population did not follow the Polish nutritional recommendations. They consumed fruits and vegetables too rarely and far too often ate non-recommended foods, such as processed meat, refined products, sugar, sweets, and salty snacks. Participants diagnosed with lung cancer more often consumed low-quality processed meat, red meat, fats, and refined bread and less often whole-grain products, tropical fruits, milk, fermented unsweetened milk drinks, nuts, honey, and wine. The non-healthy diet index score was significantly higher in those with cancer diagnosis compared with those without lung cancer (11.9 ± 5.2 versus 10.9 ± 5.3; P < 0.001).

CONCLUSIONS

The surveyed population of smokers did not follow dietary recommendations; there was a particularly high index of an unhealthy diet in by people diagnosed with lung cancer. Prevention programs should be based on encouraging smoking cessation, lifestyle modification, and methods of early detection of lung cancer. Lifestyle modification should include changing eating habits based on a healthy diet, which may be an additional factor in reducing the risk of developing cancer.

Isoflavone and soy food intake and risk of lung cancer in never smokers: report from prospective studies in Japan and China

PURPOSE

Evidence from several cohorts has suggested that a higher intake of isoflavone is associated with lower risk of lung cancer in never smokers, but the association has not been investigated by histologic type of lung cancer. Adenocarcinoma is a common histologic type found in never smokers. We hypothesized that a higher intake of isoflavone is associated with a lower risk of lung adenocarcinoma among never smokers. Here, we examined the associations of isoflavone and soy food intake with lung cancer and its histologic types in never smokers.

METHODS

We performed a pooled analysis using data from the Japan Public Health Center-based Prospective Study, Shanghai Women's Health Study and Shanghai Men's Study with 147,296 never smokers aged 40-74 years with no history of cancer. During 1,990,040 person-years of follow-up, 1247 lung cancer cases were documented. Dietary isoflavone and soy food intake were assessed using a food-frequency questionnaire. Multivariable Cox proportional hazards models assessed the associations between isoflavone and soy intake with incidence of lung cancer by histologic type.

RESULTS

A higher intake of dietary isoflavone and soy food were associated with reduced risk of lung adenocarcinoma. The multivariable hazard ratios (HRs) (95% CI) of risk of lung adenocarcinoma for the highest versus lowest intakes of isoflavone and soy food were 0.74 (0.60-0.92) and 0.78 (0.63-0.96), respectively. The multivariable HRs of risk of lung adenocarcinoma associated with each 10 mg/day increase in isoflavone and each 50 g/day increase in soy food intake were 0.81 (0.70-0.94) and 0.84 (0.73-0.96), respectively.

CONCLUSION

Higher intake of isoflavone and soy food was associated with lower risk of lung adenocarcinoma in never smokers.

Dietary Phytochemicals as Potential Chemopreventive Agents against Tobacco-Induced Lung Carcinogenesis

Lung cancer is the second most common cancer in the world. Cigarette smoking is strongly connected with lung cancer. Benzo[a]pyrene (BaP) and 4-(N-methyl-N-nitrosamine)-1-(3-pyridyl)-butanone (NNK) are the main carcinogens in cigarette smoking. Evidence has supported the correlation between these two carcinogens and lung cancer. Epidemiology analysis suggests that lung cancer can be effectively prevented through daily diet adjustments. This review aims to summarize the studies published in the past 20 years exploring dietary phytochemicals using Google Scholar, PubMed, and Web of Science databases. Dietary phytochemicals mainly include medicinal plants, beverages, fruits, vegetables, spices, etc. Moreover, the perspectives on the challenges and future directions of dietary phytochemicals for lung cancer chemoprevention will be provided. Taken together, treatment based on the consumption of dietary phytochemicals for lung cancer chemoprevention will produce more positive outcomes in the future and offer the possibility of reducing cancer risk in society.

Etiology of lung cancer: Evidence from epidemiologic studies

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

Levels of evidence for the association between different food groups/items consumption and the risk of various cancer sites: an umbrella review

This study aimed to determine the level of evidence on the association between food groups/items consumption and the risk of different cancer sites from the meta-analyses/pooled analyses of observational studies. A systematic search was executed in Scopus, PubMed/MEDLINE, and Web of Science. The criteria from the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Expert Report were adopted for evidence grading. In summary, there was convincing evidence for the association between fibre intake and decreased risk of colon and breast cancer. Also, consumption of dairy products, milk, fruits, and fibre was associated with a probable decreased risk of breast cancer. Consumption of whole grains, dairy products, milk, fruits, vegetables, and fibre had a probable inverse association with the incidence risk of gastrointestinal tract cancers. More qualified studies are needed to find reliable findings on the association between various food groups/items consumption and the risk of different cancer sites.

Associations of Dietary Intakes of Carotenoids and Vitamin A with Lung Cancer Risk in a Low-Income Population in the Southeastern United States

Observational studies found inverse associations of dietary carotenoids and vitamin A intakes with lung cancer risk. However, interventional trials among high-risk individuals showed that β-carotene supplements increased lung cancer risk. Most of the previous studies were conducted among European descendants or Asians. We prospectively examined the associations of lung cancer risk with dietary intakes of carotenoids and vitamin A in the Southern Community Cohort Study, including 65,550 participants with 1204 incident lung cancer cases. Multivariate Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Lung cancer cases had lower energy-adjusted dietary intakes of all carotenoids and vitamin A than non-cases. However, dietary intakes of carotenoids and vitamin A were not associated with overall lung cancer risk. A significant positive association of dietary vitamin A intake with lung cancer risk was observed among current smokers (HRQ4 vs. Q1 = 1.23; 95% CI: 1.02-1.49; Ptrend = 0.01). In addition, vitamin A intake was associated with an increased risk of adenocarcinoma among African Americans (HRQ4 vs. Q1 = 1.55; 95%CI: 1.08-2.21; Ptrend = 0.03). Dietary lycopene intake was associated with an increased risk of lung cancer among former smokers (HRQ4 vs. Q1 = 1.50; 95% CI: 1.04-2.17; Ptrend = 0.03). There are positive associations of dietary β-cryptoxanthin intake with squamous carcinoma risk (HRQ4 vs. Q1 = 1.49; 95% CI: 1.03-2.15; Ptrend = 0.03). Further studies are warranted to confirm our findings.

Depression, smoking, and lung cancer risk over 24 years among women

BACKGROUND

Studies evaluating depression's role in lung cancer risk revealed contradictory findings, partly because of the small number of cases, short follow-up periods, and failure to account for key covariates including smoking exposure. We investigated the association of depressive symptoms with lung cancer risk in a large prospective cohort over 24 years while considering the role of smoking.

METHODS

Women from the Nurses' Health Study completed measures of depressive symptoms, sociodemographics, and other factors including smoking in 1992 (N = 42 913). Depressive symptoms were also queried in 1996 and 2000, whereas regular antidepressant use and physician-diagnosed depression were collected starting in 1996. Multivariable Cox regression models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) of lung cancer risk until 2016.

RESULTS

We identified 1009 cases of lung cancer. Women with the highest v. lowest level of depressive symptoms had an increased lung cancer risk (HRsociodemographics-adjusted = 1.62, 95% CI 1.34-1.95; HRfully-adjusted = 1.25, 95% CI 1.04-1.51). In a test of mediation, lifetime pack-years of smoking accounted for 38% of the overall association between depressive symptoms and disease risk. When stratifying by smoking status, the elevated risk was evident among former smokers but not current or never smokers; however, the interaction term suggested no meaningful differences across groups (p = 0.29). Results were similar or stronger when considering time-updated depression status (using depressive symptoms, physician diagnosis, and regular antidepressant use) and chronicity of depressive symptoms.

CONCLUSIONS

These findings suggest that greater depressive symptoms may contribute to lung cancer incidence, directly and indirectly via smoking habits, which accounted for over a third of the association.

Burden of Lung Cancer Attributable to Occupational Carcinogens from 1990 to 2019 and Projections until 2044 in China

Simple Summary

The disease burden trend of lung cancer that is attributable to occupational carcinogens in China remains unclear. We used the data from the Global Burden of Disease (GBD) study in 2019 to investigate the related disease burden from 1990 to 2019 and to project the disease burden for the next 25 years. The results indicate that the disease burden of lung cancer that can be attributed to occupational carcinogens significantly increased from 1990 to 2019 in China, and the absolute burden will continue to increase in the next 25 years.

Abstract

Background: Little is known about trends in the lung cancer burden from the disease that can be attributed to occupational carcinogens in China. Methods: Data regarding the lung cancer burden that can be attributed to occupational carcinogens in China were extracted from the Global Burden of Disease (GBD) study in 2019. Joinpoint regression analysis and an age-period-cohort (APC) analysis were conducted to estimate the trend of lung cancer burden as a result of occupational carcinogens from 1990 to 2019. A Bayesian APC model was used to predict the disease burden until 2044. Results: The average annual percentage changes of age-standardized summary exposure values (SEVs) of occupational lung carcinogens, as well as the age-standardized population attributable fraction (PAF) of lung cancer due to occupational carcinogens, were 0.5% (95% confidence interval (CI): 0.4–0.5%) and 0.1% (95% CI: 0–0.2%), respectively. In addition, both the joinpoint regression analysis and APC analysis demonstrated significantly increased trends of age-standardized lung cancer mortality (ASMR) and age-standardized disability-adjusted life years (ASDR) as a result of occupational carcinogens. Asbestos and silica accounted for the two most important occupational lung carcinogens in China. The absolute burden is expected to increase, mainly due to population aging and the age-specific rate of illness. Conclusions: The lung cancer burden that could be attributed to occupational carcinogens significantly increased from 1990 to 2019 in China, and the absolute burden will continue to increase in the next 25 years.

Non-linear associations between healthy Nordic foods and all-cause mortality in the NOWAC study: a prospective study

Background

The shape of the associations between intake of foods basic in a healthy Nordic diet and long-term health is not well known. Therefore, we have examined all-cause mortality in a large, prospective cohort of women in Norway in relation to intake of: Nordic fruits and vegetables, fatty fish, lean fish, wholegrain products, and low-fat dairy products.

Methods

A total of 83 669 women who completed a food frequency questionnaire between 1996 and 2004 were followed up for mortality until the end of 2018. Cox proportional hazards regression models were used to examine the associations between consumption of the Nordic food groups and all-cause mortality. The Nordic food groups were examined as categorical exposures, and all but wholegrain products also as continuous exposures in restricted cubic spline models.

Results

A total of 8 507 women died during the 20-year follow-up period. Nordic fruits and vegetables, fatty fish and low-fat dairy products were observed to be non-linearly associated with all-cause mortality, while higher intake of lean fish and wholegrain products reduced all-cause mortality. Intake levels and hazard ratios (HR) and 95% confidence intervals (CI) associated with lowest mortality were approximately 200 g/day of Nordic fruits and vegetables (HR 0.83 (95% CI: 0.77–0.91)), 10–20 g/day of fatty fish (10 g/day: HR 0.98 (95% CI: 0.94–1.02)) and 200 g/day of low-fat dairy products (HR 0.96 (95% CI: 0.81–1.01)) compared to no consumption. Consumption of fatty fish ≥ 60 g/day compared to no intake statistically significantly increased the mortality (60 g/day: HR 1.08 (95% CI: 1.01–1.16)), as did consumption of low-fat dairy products ≥ 800 g/day compared to no intake (800 g/day: HR 1.10 (95% CI: 1.02–1.20)). After stratification by smoking status, the observed association between Nordic fruits and vegetables and all-cause mortality was stronger in ever smokers.

Conclusion

The associations between intake of foods basic in healthy Nordic diets and all-cause mortality may be non-linear. Therefore, assumptions of linear associations between traditional Nordic food groups and health outcomes could lead to wrong conclusions in analyses of healthy Nordic diets.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12572-8.

Dietary glycemic index, glycemic load and cancer risk: a meta-analysis of prospective cohort studies

PURPOSE

There is considerable inconsistency in results regarding the association of dietary glycemic index (GI) and glycemic load (GL) with cancer risk. We therefore conducted this systematic review and dose-response meta-analysis of prospective cohort studies to evaluate the relationship between dietary GI/GL and cancer risk.

METHODS

We searched PubMed and Web of Science for prospective cohort studies of dietary GI/GL in relation to risks of all types of cancer up to 31 March 2021. We used a random-effect model to calculate summary relative risks (RR) and 95% confidence intervals (CI). The certainty of evidence was assessed by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. This study was registered at PROSPERO (CRD42020215338).

RESULTS

Overall, 55 cohorts were included in the meta-analysis. We assessed the relationship between dietary GI or GL and risks of 23 cancer types, including hormone-related cancers, cancers from digestive system, respiratory system, urinary system and other cancer sites. High GI diet increased overall risk of cancer with low certainty of evidence (highest vs lowest categories, n = 3, RR 1.04, 95% CI 1.01-1.07). For site-specific cancers, high GI diet increased risks of lung cancer (highest vs lowest categories, n = 5, RR 1.08, 95% CI 1.01-1.18) and breast cancer (highest vs lowest categories, n = 14, RR 1.05, 95% CI 1.01-1.09), especially for postmenopausal breast cancer (highest vs lowest categories, n = 10, RR 1.06, 95% CI 1.00-1.13), all with low certainty of evidence. Additionally, dietary GI was positively related to risk of bladder cancer with low certainty of evidence (highest vs lowest categories, n = 3, RR 1.23, 95% CI 1.09-1.40), as well as negatively related to ovarian cancer risk with very low certainty of evidence (highest vs lowest categories, n = 4, RR 0.83, 95% CI 0.69-1.00) and lymphoma risk with low certainty of evidence (highest vs lowest categories, n = 2, RR 0.84, 95% CI 0.72-0.98). Besides, we found an inverse association of dietary GL with lung cancer risk with low certainty of evidence (highest vs lowest categories, n = 5, RR 0.87, 95% CI 0.80-0.94).

CONCLUSION

High dietary GI increased overall cancer risk with low certainty of evidence. For site-specific cancers, high GI diet increased the risks of breast cancer with low certainty of evidence and lung cancer with low certainty of evidence. Dietary GL was inversely associated with lung cancer risk with low certainty of evidence.

Diet and Risk of Incident Lung Cancer: A Large Prospective Cohort Study in UK Biobank

BACKGROUND

Epidemiological evidence remains conflicting regarding diet and risk of lung cancer.

OBJECTIVES

We sought to systematically investigate whether dietary factors are associated with the risk of incident lung cancer in the UK Biobank.

METHODS

A total of 416,588 participants (54% women) from the UK Biobank were included in the present study. Based on baseline data from FFQs, 3 main dietary patterns were identified by using principal component analysis. Cox proportional hazards models were used to investigate the association of individual food groups and dietary patterns with lung cancer risk.

RESULTS

During a median follow-up of 7.13 y, 1782 incident lung cancer cases were documented. The association analysis showed high intake of red meat and processed meat was associated with an increased risk of lung cancer (HRper 50 g/d: 1.36; 95% CI: 1.13, 1.65 for red meat; HRper 25 g/d: 1.30; 95% CI: 1.10, 1.53 for processed meat). However, the consumption of fruits (HRper 100 g/d: 0.90; 95% CI: 0.84, 0.95), vegetables (HRper 100 g/d: 0.89; 95% CI: 0.81, 0.99), breakfast cereals (HRper 50 g/d: 0.81; 95% CI: 0.74, 0.89), and dietary fiber (HRper 5 g/d: 0.76; 95% CI: 0.69, 0.84) was inversely associated with the risk of lung cancer. For the dietary pattern analysis [quartile (Q) comparison], high adherence to the Prudent pattern (HRQ4 compared with Q1: 0.84; 95% CI: 0.73, 0.96) was associated with a lower risk of lung cancer, whereas the Western pattern (HRQ4 compared with Q1: 1.27; 95% CI: 1.11, 1.46) was associated with a higher risk of lung cancer.

CONCLUSIONS

Our study indicated that a diet characterized by high intake of fruits, vegetables, breakfast cereals, and dietary fiber, as well as low intake of red meat and processed meat, was associated with a lower risk of lung cancer.

Combined effects of cigarette smoking, DNA methyltransferase 3B genetic polymorphism, and DNA damage on lung cancer

BACKGROUND

Smoking increases DNA methylation and DNA damage, and DNA damage acts as a vital cause of tumor development. The DNA methyltransferase 3B (DNMT3B) enhances promoter activity and methylation of tumor suppressor genes. Tea polyphenols may inhibit DNMT activity. We designed a case-control study to evaluate the combined effects of smoking, green tea consumption, DNMT3B - 149 polymorphism, and DNA damage on lung cancer occurrence.

METHODS

Questionnaires were administered to obtain demographic characteristics, life styles, and family histories of lung cancer from 190 primary lung cancer cases and 380 healthy controls. Genotypes and cellular DNA damage were determined by polymerase chain reaction and comet assay, respectively.

RESULTS

The mean DNA tail moment for lung cancer cases was significantly higher than that for healthy controls. Compared to nonsmokers carrying the DNMT3B - 149 CT genotype, smokers carrying the TT genotype had a greater lung cancer risk (odds ratio [OR]: 2.83, 95% confidence interval [CI]: 1.62-4.93). DNA damage levels were divided by the tertile of the healthy controls' values. Compared to nonsmokers with low DNA damage, smokers with moderate DNA damage (OR: 2.37, 95% CI: 1.54-3.63) and smokers with high DNA damage (OR: 3.97, 95% CI: 2.63-5.98) had elevated lung cancer risks. Interaction between smoking and DNA damage significantly affected lung cancer risk.

CONCLUSIONS

Our study suggested that the DNMT3B - 149 TT genotype, which has higher promoter activity, can increase the lung cancer risk elicited by smoking, and DNA damage may further promote smoking related lung cancer development.

The Role of Nutritional Support in Malnourished Patients With Lung Cancer

This review aimed to aggregate and describe the available data about clinical nutrition in lung cancer and the role of the dietitian in multidisciplinary patient care. Scientific literature was searched in order to summarize key aspects related to clinical nutrition in lung cancer. This information can be used to arrange a proper nutritional therapy that can enhance patient treatment responses, prevent side-effects, shorten recovery time, improve prognosis and increase quality of life. An anti-inflammatory diet rich in antioxidants, immunomodulatory compounds, dietary fibre and an appropriate intake of protein can reduce the risk of initiation and progression of lung cancer, support the regeneration of tissues (also after surgery) and improve the nutritional status during the disease and after remission. A correct intake of nutrients is significant prior to disease occurrence and at every stage of treatment and recovery.

The Mediterranean Diet and Cancer: What Do Human and Molecular Studies Have to Say about It?

Mediterranean diet (MD) is a well-known healthy dietary pattern, linked to: (1) high intakes of olive oil as main the culinary fat, plant-based foods (fruits, vegetables, legumes, whole grains, tree nuts, and seeds), and fish; and (2) a moderate consumption of white meat, eggs, dairy products such as yogurt and cheese, and wine always with meals [...].