Cancer Causes & Control

, Volume 24, Issue 5, pp 1005–1014

Dietary intake of vegetables, folate, and antioxidants and the risk of Barrett’s esophagus

  • Li Jiao
  • Jennifer R. Kramer
  • Massimo Rugge
  • Paola Parente
  • Gordana Verstovsek
  • Abeer Alsarraj
  • Hashem B. El-Serag
Original paper

DOI: 10.1007/s10552-013-0175-3

Cite this article as:
Jiao, L., Kramer, J.R., Rugge, M. et al. Cancer Causes Control (2013) 24: 1005. doi:10.1007/s10552-013-0175-3



Diet is a potentially modifiable risk factor for Barrett’s esophagus (BE). We investigated the associations between intakes of fruits and vegetables and risk of BE.


We identified study subjects from 1,859 participants who underwent the endoscopy in a single VA Medical Center in the US between 2008 and 2011. Dietary intake in the previous year was elicited using a self-administered Block food frequency questionnaire (FFQ). Logistic regression model was used to estimate odds ratio (OR) and its 95 % confidence interval (CI) for BE.


A total of 151 cases with definite BE and 777 controls completed the FFQ. When highest tertile of intake was compared with the lowest, the OR (95 % CI) was 0.46 (0.26–0.81) for dark green vegetables, 0.52 (0.30–0.90) for legumes, 0.50 (0.28–0.90) for total fiber, 0.45 (0.25–0.81) for isoflavones, 0.52 (0.30–0.67) for total folate, and 0.45 (0.26–0.79) for lutein, adjusting for multiple confounding factors including use of aspirin or proton pump inhibitor, gastro-esophageal reflux symptoms, and physical activity. The association for dark green vegetables was attenuated after adjustment for lutein, total fiber, and total folate (OR = 0.82; 95 % CI 0.30–2.22).


Higher intake of dark green vegetables was associated with a decreased risk of BE in a veteran population. Such an inverse association may be partially mediated by lutein, fiber, and folate. The novel findings on the association between intake of lutein, total folate, or isoflavones and risk of BE need further confirmation.


Diet Barrett’s esophagus Risk Case–control 



Barrett’s esophagus


Body mass index


Confidence interval


Esophageal adenocarcinoma


Food frequency questionnaire


Gastro-esophageal reflux


Michael E. DeBakey Veterans Affairs Medical Center


Metabolic equivalent of task


MyPyramid equivalents database


Odds ratio


Proton pump inhibitors


Standard deviation


Waist-to-hip ratio

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Li Jiao
    • 1
    • 2
  • Jennifer R. Kramer
    • 1
    • 2
  • Massimo Rugge
    • 3
  • Paola Parente
    • 4
  • Gordana Verstovsek
    • 2
  • Abeer Alsarraj
    • 1
    • 2
  • Hashem B. El-Serag
    • 1
    • 2
  1. 1.Houston VA Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical CenterHoustonUSA
  2. 2.Department of MedicineBaylor College of MedicineHoustonUSA
  3. 3.Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMEDUniversity of PadovaPaduaItaly
  4. 4.Department of PathologyCasa Sollievo Della SofferenzaSan Giovanni RotondoItaly