Principal component analysis of dietary and lifestyle patterns in relation to risk of subtypes of esophageal and gastric cancer.

PURPOSE To carry out pattern analyses of dietary and lifestyle factors in relation to risk of esophageal and gastric cancers. METHODS We evaluated risk factors for esophageal adenocarcinoma (EA), esophageal squamous cell carcinoma (ESCC), gastric cardia adenocarcinoma (GCA), and other gastric cancers (OGA) using data from a population-based case-control study conducted in Connecticut, New Jersey, and western Washington state. Dietary/lifestyle patterns were created using principal component analysis (PCA). Impact of the resultant scores on cancer risk was estimated through logistic regression. RESULTS PCA identified six patterns: meat/nitrite, fruit/vegetable, smoking/alcohol, legume/meat alternate, GERD/BMI, and fish/vitamin C. Risk of each cancer under study increased with rising meat/nitrite score. Risk of EA increased with increasing GERD/BMI score, and risk of ESCC rose with increasing smoking/alcohol score and decreasing gastroesophageal reflux disease (GERD)/body mass index (BMI) score. Fruit/vegetable scores were inversely associated with EA, ESCC, and GCA. CONCLUSIONS PCA may provide a useful approach for summarizing extensive dietary/lifestyle data into fewer interpretable combinations that discriminate between cancer cases and controls. The analyses suggest that meat/nitrite intake is associated with elevated risk of each cancer under study, whereas fruit/vegetable intake reduces risk of EA, ESCC, and GCA. GERD/obesity were confirmed as risk factors for EA and smoking/alcohol as risk factors for ESCC.

[1]  R. Holmes,et al.  Epidemiology and pathogenesis of esophageal cancer. , 2007, Seminars in radiation oncology.

[2]  M. Gammon,et al.  Body mass index and risk of adenocarcinomas of the esophagus and gastric cardia. , 1998, Journal of the National Cancer Institute.

[3]  Joseph Waksberg,et al.  Sampling Methods for Random Digit Dialing , 1978 .

[4]  R. Hayes,et al.  Adenocarcinoma of the esophagus: role of obesity and diet. , 1995, Journal of the National Cancer Institute.

[5]  R. Hayes,et al.  Dietary factors and the risk of squamous cell esophageal cancer among black and white men in the United States , 1998, Cancer Causes & Control.

[6]  M. Zwahlen,et al.  Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies , 2008, The Lancet.

[7]  R. Fitzgerald,et al.  Epidemiologic risk factors for Barrett's esophagus and associated adenocarcinoma. , 2005, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[8]  J. Fraumeni,et al.  Risk factors for esophageal cancer in Shanghai, China. II. Role of diet and nutrients , 1994, International journal of cancer.

[9]  L. Signorello,et al.  Diet and risk of esophageal cancer by histologic type in a low‐risk population , 1996, International journal of cancer.

[10]  J. Potter.  Vegetables, fruit, and cancer , 2005, The Lancet.

[11]  J. Fraumeni,et al.  Rising incidence of adenocarcinoma of the esophagus and gastric cardia. , 1991, JAMA.

[12]  D. Palli,et al.  Dietary patterns, nutrient intake and gastric cancer in a high-risk area of Italy , 2001, Cancer Causes & Control.

[13]  J. Potter,et al.  Eating patterns and risk of colon cancer. , 1998, American journal of epidemiology.

[14]  T. Bjørge,et al.  Height and Body Mass Index in Relation to Esophageal Cancer; 23-year Follow-up of Two Million Norwegian Men and Women , 2004, Cancer Causes & Control.

[15]  J. Fraumeni,et al.  The relation of gastroesophageal reflux disease and its treatment to adenocarcinomas of the esophagus and gastric cardia. , 1995, JAMA.

[16]  B. Rifkind,et al.  Some difficulties inherent in the interpretation of dietary data from free-living populations. , 1984, The American journal of clinical nutrition.

[17]  N. H. Timm.  Applied Multivariate Analysis , 2002 .

[18]  Peter D Siersema,et al.  Esophageal cancer. , 2008, Gastroenterology clinics of North America.

[19]  J. Potter,et al.  Vegetables, fruit, and cancer. II. Mechanisms , 1991, Cancer Causes & Control.

[20]  W. Willett,et al.  Adherence to the Dietary Guidelines for Americans and risk of major chronic disease in women. , 2000, The American journal of clinical nutrition.

[21]  C. Heckler.  A Step-by-Step Approach to Using the SAS™ System for Factor Analysis and Structural Equation Modeling , 1996 .

[22]  A. Kristal,et al.  Associations of race/ethnicity, education, and dietary intervention with the validity and reliability of a food frequency questionnaire: the Women's Health Trial Feasibility Study in Minority Populations. , 1997, American journal of epidemiology.

[23]  E. Rimm,et al.  Adherence to the Dietary Guidelines for Americans and risk of major chronic disease in men. , 2000, The American journal of clinical nutrition.

[24]  P. Brennan,et al.  Vegetables, Fruits, Related Dietary Antioxidants, and Risk of Squamous Cell Carcinoma of the Esophagus: A Case-Control Study in Uruguay , 2000, Nutrition and cancer.

[25]  B. Graubard,et al.  A prospective study of diet quality and mortality in women. , 2000, JAMA.

[26]  N. Kreiger,et al.  Dietary patterns and risk of incident gastric adenocarcinoma. , 2007, American journal of epidemiology.

[27]  N. Muñoz,et al.  Influence of mate drinking, hot beverages and diet on esophageal cancer risk in south america , 2000, International journal of cancer.

[28]  L. Sobin,et al.  Risk of stomach cancer in relation to consumption of cigarettes, alcohol, tea and coffee in Warsaw, Poland , 1999 .

[29]  C. la Vecchia,et al.  Food groups and risk of squamous cell esophageal cancer in Northern Italy , 2000, International journal of cancer.

[30]  H. Vainio,et al.  IARC Handbooks of cancer prevention. Volume 8: fruit and vegetables. , 2003 .

[31]  M. Gammon,et al.  Tobacco, alcohol, and socioeconomic status and adenocarcinomas of the esophagus and gastric cardia. , 1997, Journal of the National Cancer Institute.

[32]  C. Gutschow,et al.  Demographic variations in the rising incidence of esophageal adenocarcinoma in white males , 2001, Cancer.

[33]  W. Chow,et al.  Incidence of adenocarcinoma of the esophagus among white Americans by sex, stage, and age. , 2008, Journal of the National Cancer Institute.

[34]  D. Weisenburger,et al.  Dietary patterns and adenocarcinoma of the esophagus and distal stomach. , 2002, The American journal of clinical nutrition.

[35]  R. Peto,et al.  Esophageal cancer and body mass index: Results from a prospective study of 220,000 men in China and a meta‐analysis of published studies , 2007, International journal of cancer.

[36]  P. Shubik,et al.  Ascorbate-Nitrite Reaction: Possible Means of Blocking the Formation of Carcinogenic N-Nitroso Compounds , 1972, Science.

[37]  J. Weisburger,et al.  REDUCTION OF GASTRTC CARCINOGENS WITH ASCORBIC ACID * , 1975, Annals of the New York Academy of Sciences.

[38]  C. la Vecchia,et al.  Diet diversity and gastric cancer , 1997, International journal of cancer.

[39]  A. Wolk,et al.  Inverse association between intake of cereal fiber and risk of gastric cardia cancer. , 2001, Gastroenterology.

[40]  P. Loehrer.  Opposing Risks of Gastric Cardia and Noncardia Gastric Adenocarcinomas Associated With Helicobacter pylori Seropositivity , 2008 .

[41]  J. Lagergren,et al.  Association between Body Mass and Adenocarcinoma of the Esophagus and Gastric Cardia , 1999, Annals of Internal Medicine.

[42]  A. Kristal,et al.  Obesity, alcohol, and tobacco as risk factors for cancers of the esophagus and gastric cardia: adenocarcinoma versus squamous cell carcinoma. , 1995, Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology.

[43]  A B West,et al.  An inverse relation between cagA+ strains of Helicobacter pylori infection and risk of esophageal and gastric cardia adenocarcinoma. , 1998, Cancer research.

[44]  J. Stanford,et al.  Food group intake and risk of subtypes of esophageal and gastric cancer , 2008, International journal of cancer.

[45]  W. Ye,et al.  Dietary Patterns and Risk of Squamous-Cell Carcinoma and Adenocarcinoma of the Esophagus and Adenocarcinoma of the Gastric Cardia: A Population-Based Case-Control Study in Sweden , 2006, Nutrition and cancer.

[46]  S. Feig.  IARC Handbooks of Cancer Prevention , 2003 .

[47]  S. Graham,et al.  High-risk health behaviors associated with various dietary patterns. , 1991, Nutrition and cancer.

[48]  R. Jeffery,et al.  Using cluster analysis to examine dietary patterns: nutrient intakes, gender, and weight status differ across food pattern clusters. , 1997, Journal of the American Dietetic Association.

[49]  J. Stanford,et al.  Gastroesophageal reflux disease, use of H2 receptor antagonists, and risk of esophageal and gastric cancer , 2000, Cancer Causes & Control.

[50]  A. Lindgren,et al.  Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. , 1999, The New England journal of medicine.

[51]  A. Lindgren,et al.  The role of tobacco, snuff and alcohol use in the aetiology of cancer of the oesophagus and gastric cardia , 2000, International journal of cancer.

[52]  H. Comber,et al.  Risk factors for Barrett's oesophagus and oesophageal adenocarcinoma: results from the FINBAR study. , 2007, World journal of gastroenterology.

[53]  A. Miller,et al.  Dietary factors and the incidence of cancer of the stomach. , 1985, American journal of epidemiology.

[54]  M. Gammon,et al.  Nutrient intake and risk of subtypes of esophageal and gastric cancer. , 2001, Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology.