Advertisement

Cancer Causes & Control

, Volume 18, Issue 7, pp 713–722 | Cite as

Fiber intake and risk of adenocarcinomas of the esophagus and stomach

  • Anna H. WuEmail author
  • Chiu-Chen Tseng
  • Jean Hankin
  • Leslie Bernstein
Original Paper

Abstract

Background

Since the 1970s, incidence rates for esophageal and gastric cardia adenocarcinomas have risen substantially for reasons that are not well understood. We sought to determine the role of dietary factors in these tumor types.

Methods

This analysis on dietary factors included 206 esophageal adenocarcinoma, 257 gastric cardia, 366 distal gastric adenocarcinoma patients and, 1,308 control subjects from a population-based, case-control study conducted in Los Angeles County. Polytomous logistic regression was used to calculate odds ratios (ORs), as an estimate of the relative risk, and corresponding 95% confidence intervals (CIs) for the three tumor types.

Results

Intake of fiber had a significant impact on risk of esophageal and gastric cardia adenocarcinoma after adjustment for age, gender, race, birthplace, education, cigarette smoking, body size, history of reflux, and vitamin use. Compared to subjects in the lowest quartile of fiber intake, subjects in the highest quartile of intake showed odd ratios of 0.44 (95% CI = 0.26–0.76) for esophageal adenocarcinoma (P trend = 0.004) and 0.58 (95% CI = 0.38–0.88) for gastric cardia adenocarcinoma (P trend = 0.016); these inverse associations remained after further adjustment for intake of fat. Positive associations between dietary fat and the three tumor types weakened after adjustment for fiber intake and were no longer statistically significant. For distal gastric cancer, a significant inverse association with fiber was observed only after adjustment for fat intake. The significant inverse associations with fiber remained after further adjustment for H. pylori infection for all three tumor types.

Conclusions

High intake of fiber was associated with significant reduced risks of esophageal and gastric cardia adenocarcinoma even after adjustment for dietary fat, H. pylori infection and other covariates.

Keywords

Fiber Fat Meat H. pylori Esophageal/gastric adenocarcinomas 

Notes

Acknowledgments

We thank all the study participants for their contributions and Annie Fung, Isaura Rivera, Timothy Stirton, and June Yashiki for their help with data collection. The authors have contributed to the conception and design (A Wu, L Bernstein), obtaining funding (A Wu, L Bernstein), data collection (A Wu), data management (C Tseng), statistical analysis (A Wu, C Tseng, L Bernstein), interpretation of study results (A Wu, J Hankin, L Bernstein), and preparation (A Wu, C Tseng) and reviewing of the manuscript (A Wu, C Tseng, J Hankin, L Bernstein). The authors have no conflicts of interest, i.e., involvements that might raise the question of bias in the work reported or in the conclusions, implications or opinions stated in this report. Supported by grant no. 3RT-0122 and 10RT-0251 from the California Tobacco Related Research Program, and grant no. CA59636 from the National Cancer Institute, and NIEHS Grant # 5P30 ES07048. Incident cancer cases for this study were collected by the USC Cancer Surveillance Program (CSP), which is supported under subcontract by the California Department of Health. The CSP is also part of the National Cancer Institute’s Division of Cancer Prevention and Control Surveillance, Epidemiology, and End Results Program, under contract number N01CN25403.

References

  1. 1.
    Chow WH, Blot WJ, Vaughan TL et al (1998) Body mass index and risk of adenocarcinomas of the esophagus and gastric cardia. J Natl Cancer Inst 90:150–155PubMedCrossRefGoogle Scholar
  2. 2.
    Wu AH, Wan P, Bernstein L (2001) A multiethnic population-based study of smoking, alcohol and body size and risk of adenocarcinomas of the stomach and esophagus (United States). Cancer Causes Control 12:721–732PubMedCrossRefGoogle Scholar
  3. 3.
    Wu AH, Tseng CC, Bernstein L (2003) Hiatal hernia, reflux symptoms, body size, and risk of esophageal and gastric adenocarcinoma. Cancer 98:940–948PubMedCrossRefGoogle Scholar
  4. 4.
    Lagergren J, Bergstrom R, Lindgren A et al (1999) Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med 340:825–831PubMedCrossRefGoogle Scholar
  5. 5.
    Gammon MD, Schoenberg JB, Ahsan H et al (1997) Tobacco, alcohol, and socioeconomic status and adenocarcinomas of the esophagus and gastric cardia. J Natl Cancer Inst 89:1277–1284PubMedCrossRefGoogle Scholar
  6. 6.
    Chainani-Wu N (2002) Diet and oral, pharyngeal, and esophageal cancer. Nutr Cancer 44:104–126PubMedCrossRefGoogle Scholar
  7. 7.
    Nomura AM, Hankin JH, Kolonel LN et al (2003) Case-control study of diet and other risk factors for gastric cancer in Hawaii (United States). Cancer Causes Control 14:547–558PubMedCrossRefGoogle Scholar
  8. 8.
    Larsson SC, Bergkvist L, Wolk A (2006) Processed meat consumption, dietary nitrosamines and stomach cancer risk in a cohort of Swedish women. Int J Cancer 119:915–919PubMedCrossRefGoogle Scholar
  9. 9.
    Kabat GC, Ng SK, Wynder EL (1993) Tobacco, alcohol intake, and diet in relation to adenocarcinoma of the esophagus and gastric cardia. Cancer Causes Control 4:123–132PubMedCrossRefGoogle Scholar
  10. 10.
    Brown LM, Swanson CA, Gridley G, et al (1995) Adenocarcinoma of the esophagus: role of obesity and diet. J Natl Cancer Inst 87:104–109PubMedCrossRefGoogle Scholar
  11. 11.
    Zhang ZF, Kurtz RC, Yu GP et al (1997) Adenocarcinomas of the esophagus and gastric cardia: the role of diet. Nutr Cancer 27:298–309PubMedCrossRefGoogle Scholar
  12. 12.
    Chen H, Ward MH, Graubard BI, et al (2002) Dietary patterns and adenocarcinoma of the esophagus and distal stomach. Am J Clin Nutr 75:137–144PubMedGoogle Scholar
  13. 13.
    Cheng KK, Sharp L, McKinney PA et al (2000) A case-control study of oesophageal adenocarcinoma in women: a preventable disease. Br J Cancer 83:127–32PubMedCrossRefGoogle Scholar
  14. 14.
    Ekstrom AM, Serafini M, Nyren O et al (2000) Dietary antioxidant intake and the risk of cardia cancer and noncardia cancer of the intestinal and diffuse types: a population-based case-control study in Sweden. Int J Cancer 87:133–140PubMedCrossRefGoogle Scholar
  15. 15.
    Mayne ST, Risch HA, Dubrow R et al (2001) Nutrient intake and risk of subtypes of esophageal and gastric cancer. Cancer Epidemiol Biomarkers Prev 10:1055–1062PubMedGoogle Scholar
  16. 16.
    Terry P, Lagergren J, Ye W et al (2001) Inverse association between intake of cereal fiber and risk of gastric cardia cancer. Gastroenterology 120:387–391PubMedCrossRefGoogle Scholar
  17. 17.
    Terry P, Lagergren J, Wolk A et al (2000) Reflux-inducing dietary factors and risk of adenocarcinoma of the esophagus and gastric cardia. Nutr Cancer 38:186–191PubMedCrossRefGoogle Scholar
  18. 18.
    Gonzalez CA, Jakszyn P, Pera G et al (2006) Meat intake and risk of stomach and esophageal adenocarcinoma within the European Prospective Investigation Into Cancer and Nutrition (EPIC). J Natl Cancer Inst 98:345–354PubMedCrossRefGoogle Scholar
  19. 19.
    Wu AH, Crabtree JE, Bernstein L et al (2003) Role of Helicobacter pylori CagA+ strains and risk of adenocarcinoma of the stomach and esophagus. Int J Cancer 103:815–821PubMedCrossRefGoogle Scholar
  20. 20.
    Kolonel LN, Hankin JH, Whittemore A et al (2000) Vegetables, fruits, legumes and prostate cancer: A multiethnic case-control study. Cancer Epidemiol Biomarkers Prev 9:795–804PubMedGoogle Scholar
  21. 21.
    Department of Agriculture (1992) Nutrient Database for Standard Reference, Release 10 tape, Human Nutrition Information Service. Bethesda, MD: United States Department of AgricultureGoogle Scholar
  22. 22.
    Holland B, Welch AA, Unwin ID, Buss DH, Paul AA, Southgate DAT (1991) McCance and Widdowson’s the composition of foods, ED. 5. Royal Society of Chemistry, Cambridge, EnglandGoogle Scholar
  23. 23.
    Lupton JR,Turner ND (1999) Potential protective mechanisms of wheat bran fiber. Am J Med 106:24S–27SPubMedCrossRefGoogle Scholar
  24. 24.
    Marlett JA, McBurney MI, Slavin JL (2002) Position of the American Dietetic Association: health implications of dietary fiber. J Am Diet Assoc 102:993–1000PubMedCrossRefGoogle Scholar
  25. 25.
    Chen H, Tucker KL, Graubard BI et al. (2002) Nutrient intakes and adenocarcinoma of the esophagus and distal stomach. Nutr Cancer 42:33–40PubMedCrossRefGoogle Scholar
  26. 26.
    Gortner WA (1975). Nutrition in the United Status, 1900 to 1974. Cancer Research 35:3246–3253PubMedGoogle Scholar
  27. 27.
    Lanza E, Jones DY, Block G et al. (1987) Dietary fiber intake in the US population. Am J Clin Nutr 46:790–797PubMedGoogle Scholar
  28. 28.
    Van Horn L (1997) Fiber, lipids, and coronary heart disease. A statement for healthcare professionals from the Nutrition Committee, American Heart Association. Circulation 95:2701–2704PubMedGoogle Scholar
  29. 29.
    Burkitt DP (1981) Hiatus hernia: is it preventable? Am J Clin Nutr 34:428–431PubMedGoogle Scholar
  30. 30.
    El-Serag HB, Satia JA, Rabeneck L (2005) Dietary intake and the risk of gastro-oesophageal reflux disease: a cross sectional study in volunteers. Gut 54:11–17PubMedCrossRefGoogle Scholar
  31. 31.
    Wu-Williams AH, Yu MC, Mack TM (1990) Life-style, workplace, and stomach cancer by subsite in young men of Los Angeles County. Cancer Res 50:2569–2576PubMedGoogle Scholar

Copyright information

© Springer Science + Business Media B.V. 2007

Authors and Affiliations

  • Anna H. Wu
    • 1
    Email author
  • Chiu-Chen Tseng
    • 1
  • Jean Hankin
    • 2
  • Leslie Bernstein
    • 1
  1. 1.Department of Preventive MedicineUniversity of Southern California, Keck School of MedicineLos AngelesUSA
  2. 2.Cancer Research Center of HawaiiUniversity of HawaiiHonoluluUSA

Personalised recommendations