Despite the established role of obesity in the etiology of endometrial cancer, limited data are available from analytical epidemiologic studies on the association of risk with dietary factors. A case-control study of 399 cases and 296 controls conducted in five areas of the United States from 1 June 1987 to 15 May 1990, enabled evaluation of risk related to dietary intakes adjusted for potential confounders. Caloric intake was associated modestly with increased risk (odds ratio [OR]=1.5,95 percent confidence interval [CI]=0.9–2.5 for highest cf lowest quartiles of intake), with the principal contributors being fat and protein calories. After adjustment for other risk factors, including body mass, increased risk was associated with higher intakes of fat. Several components of fat investigated were associated with increased risk, although associations were slightly stronger for saturated fat (OR=2.1, CI=1.2–3.7) and oleic acid (OR=2.2, CI=1.2–4.0) than for linoleic acid (OR=1.6, CI=0.9–2.8). Food-group analyses showed intake of complex carbohydrates—and specifically of breads and cereals—associated with reduced risks (OR=0.6, CI=0.4–1.1), whereas animal fat and fried foods were associated with elevated risks (OR=1.5 and 1.7, respectively). The relations of endometrial cancer with animal fat and complex carbohydrates were independent. No consistent associations were noted for intakes of cholesterol, fiber, vitamins A and C, individual carotenoids, or folate-rich foods. These data imply an etiologic role for a diet rich in total fat and/or animal fat and low in complex carbohydrates with endometrial cancer. These associations are consistent with a hormonal mechanism and were independent of the associations of obesity and other risk factors.
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References
Parazinni F, La Vecchia C, Bocciolone L, Franceschi S. Review: The epidemiology of endometrial cancer. Gynecol Oncol 1991; 41: 1–16.
Siiteri PK. Extraglandular oestrogen formation and serum binding of oestradiol: relationship to cancer. J Endocrinol 1981; 89: 119–29.
Siiteri PK. Adipose tissue as a source of hormones. Am J Clin Nutr 1987; 45: 277–82.
Enriori CL, Reforzo-Membrives J. Peripheral aromatization as a risk factor for breast and endometrial cancer in postmenopausal women: A review. Gynecol Oncol 1984; 17: 1–21.
Hill P, Garbaczewski L, Helman P, Huskisson J, Sporangisa E, Wynder EL. Diet, lifestyle, and menstrual activity. Am J Clin Nutr 1980; 33: 1192–8.
Rose DP, Boyar AP, Cohen C, Strong LE. Effect of lowfat diet on hormone levels in women with cystic breast disease. I. Serum steroids and gonadotropins. JNCI 1987; 78: 623–6.
Boyar AP, Rose DP, Loughridge A, et al. Response to a diet low in total fat in women with postmenopausal breast cancer: a pilot study. Nutr Cancer 1988; 11: 93–9.
Bennett FC, Ingram DM. Diet and female sex hormone concentrations: an intervention study for the type of fat consumed. Am J Clin Nutr 1990; 52: 808–12.
Prentice R, Thompson D, Clifford C, Gorbach S, Goldin B, Byar D. Dietary fat reduction and plasma estradiol concentration in healthy postmenopausal women. JNCI 1990; 82: 129–34.
Rose DP, Goldman M, Connolly JM, Strong LE. High-fiber diet reduces serum estrogen concentrations in premenopausal women. Am J Clin Nutr 1991; 54: 520–5.
Armstrong B, Doll R. Environmental factors and cancer incidence and mortality in different countries, with special reference to dietary practice. Int J Cancer 1975; 15: 617–31.
Prentice RL, Sheppard L. Dietary fat and cancer: consistency of the epidemiologic data, and disease prevention that may follow from a practical reduction in fat consumption. Cancer Causes Control 1990; 1: 81–9.
Kolonel LN, Hankin JH, Lee J, Chu SY, Nomura AMY, Hinds MW. Nutrient intakes in relation to cancer incidence in Hawaii. Br J Cancer 1981; 44: 332–9.
Shu XO, Zheng W, Potischman N, et al. A population based case-control study of dietary factors and endometrial cancer in shanghai, People's Republic of China. Am J Epidemiol 1993; 137: 155–65.
La Vecchia C, Decarli A, Fasoli M, Gentile A. Nutrition and diet in the etiology of endometrial cancer. Cancer 1986; 57: 1248–53.
Heinonen PK, Kuoppala T, Koskinen T, Punnonen R. Serum vitamins A and E and carotene in patients with gynecologic cancer. Arch Gynecol Obstet 1987; 241: 151–6.
Orr JW, Wilson K, Bodiford C, et al. Corpus and cervix cancer: A nutritional comparison. Am J Obstet Gynecol 1985; 153: 775–9.
Brinton LA, Berman ML, Mortel R, et al. Reproductive, menstrual and medical risk factors for endometrial cancer: Results from a case-control study. Am J Obstet Gynecol 1992a; 167: 1317–25.
Brinton LA, Barrett RJ, Berman ML, Mortel R, Twiggs LB, Wilbanks GD. Cigarette smoking and the risk of endometrial cancer. Am J Epidemiol 1993; 137: 281–91.
Waksberg J. Sampling methods for random digit dialing. J Am Stat Assoc 1978; 73: 40–6.
Swanson CA, Potischman N, Wilbanks GD, et al. Relation of endometrial cancer risk to past and contemporary body size and body fat distribution. Cancer Epidemiol Biomarkers Prev (in press).
Block G, Hartman AM, Naughton D. A reduced dietary questionnaire: development and validation. Epidemiology 1990; 1: 58–64.
Block G. Health habits and history questionnaire, diet history and other risk factors, personal computer packet. Bethesda: National Cancer Institute, Division of Prevention and Control, 1989.
Block G, Hartman AM, Dresser CM, Carroll MD, Gannon J, Gardner L. A data-based approach to diet questionnaire design and testing. Am J Epidemiol 1986; 124: 453–69.
SAS Institute, Inc. SAS Users Guide. Cary, NC: SAS Institute, Inc., 1990.
BMDP Statistical Software. Berkeley, CA: University of California Press, 1990.
Breslow NE, Day NE. Statistical Methods in Cancer Research: The Analysis of Case-Control Studies. Lyon, France: International Agency for Research on Cancer, 1980: IARC Sci. Pub. No. 32.
Voigt LF, Weiss NS. Epidemiology of endometrial cancer. In: Surwit E, Alberts D, eds. Cancer Treatment and Research, Vol. 29. Boston: Kluwer Academic Publishers, 1989.
Austin H, Austin JM Jr., Partridge EE, Hatch KD, Shingleton HM. Endometrial cancer, obesity, and body fat distribution. Cancer Res 1991; 51: 568–72.
Goldin BR, Aldercreutz H, Gorbach SL, et al. The relationship between estrogen levels and diets of Caucasian American and Oriental immigrant women. Am J Clin Nutr 1986; 44: 945–53.
Shimizu H, Ross RK, Bernstein L, Pike MC, Henderson BE. Serum oestrogen levels in postmenopausal women: comparison of American whites and Japanese in Japan. Br J Cancer 1990; 62: 451–3.
Gorbach SL, Goldin BR. Diet and the excretion and enterohepatic cycling of estrogens. Prev Med 1987; 16: 525–31.
Barbosa JC, Shultz TD, Filley SJ, Nieman DC. The relationship among adiposity, diet, and hormone concentrations in vegetarian and nonvegetarian postmenopausal women. Am J Clin Nutr 1990; 51: 798–803.
Bernstein L, Yuan J-M, Ross RK, et al. Serum hormone levels in pre-menopausal Chinese women in Shanghai and white women in Los Angeles: results from two breast cancer case-control studies. Cancer Causes Control 1990; 1: 51–8.
Armstrong BK, Brown JB, Clarke HT, Crooke DK, Hahnel R, Masarei JR, Ratajczak T. Diet and reproductive hormones: A study of vegetarian and non-vegetarian postmenopausal women. JNCI 1981; 67: 761–7.
Goldin BR, Adlercreutz H, Gorbach SL, et al. Estrogen excretion patterns and plasma levels in vegetarian and omnivorous women. N Engl J Med 1982; 307: 1542–7.
Adlercreutz H, Hockerstedt K, Bannwart C, et al. Effect of dietary components, including lignans and phytoestrogens, on enterohepatic circulation and liver metabolism of estrogens and on sex hormone binding globulin (SHBG). J Steroid Biochem Mol Biol 1987; 27: 1135–44.
Additional information
Drs Potischman, Swanson, Brinton, and Hoover are with the Environmental Epidemiology Branch, National Cancer Institute, Bethesda, MD, USA. Authors are also affiliated with Information Management Services, Inc., Silver Spring, MD (Ms McAdams), and the Departments of Obstetrics and Gynecology at Bowman Gray School of Medicine, Winston-Salem, NC (Dr Barrett); University of California at Irvine Medical Center, Irvine, CA (Dr Berman); Milton S. Hershey Medical Center, Hershey, PA (Dr Mortel); University of Minnesota Medical School, Minneapolis, MN (Dr Twiggs); Rush Medical College, Chicago, IL (Dr Wilbanks). Address correspondence to Dr Potischman, Nutritional Epidemiology Section, Division of Cancer Etiology, National Cancer Institute, Executive Plaza North, Suite 443, Bethesda, MD 20892, USA.
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Potischman, N., Swanson, C.A., Brinton, L.A. et al. Dietary associations in a case-control study of endometrial cancer. Cancer Causes Control 4, 239–250 (1993). https://doi.org/10.1007/BF00051319
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DOI: https://doi.org/10.1007/BF00051319