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

Cancer Causes & Control volume 24, pages 1005–1014 (2013)Cite this article

Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusion

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.

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Fig. 1

Abbreviations

BE:

Barrett’s esophagus

BMI:

Body mass index

CI:

Confidence interval

EAC:

Esophageal adenocarcinoma

FFQ:

Food frequency questionnaire

GER:

Gastro-esophageal reflux

MEDVAMC:

Michael E. DeBakey Veterans Affairs Medical Center

MET:

Metabolic equivalent of task

MPED:

MyPyramid equivalents database

OR:

Odds ratio

PPI:

Proton pump inhibitors

SD:

Standard deviation

WHR:

Waist-to-hip ratio

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Acknowledgments

Thanks to Liang Chen for her assistance in preparing the manuscript. This work was supported by grant R01-116845 (to El-Serag, HB) from the National Cancer Institute, National Institutes of Health. Hashem B. El-Serag is supported by grant K24-04-107 from National Institute of Diabetes and Digestive and Kidney Diseases. This work is supported in part by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, and the Houston VA Health Services Research and Development Center of Excellence (HFP90-020), and by the Texas Digestive Disease Center NIH DK58338. The funding agencies did not influence the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Houston VA Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA

    Li Jiao, Jennifer R. Kramer, Abeer Alsarraj & Hashem B. El-Serag

  2. Department of Medicine, Baylor College of Medicine, 2002 Holcombe Boulevard, MS152, Houston, TX, 77030, USA

    Li Jiao, Jennifer R. Kramer, Gordana Verstovsek, Abeer Alsarraj & Hashem B. El-Serag

  3. Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padova, Padua, Italy

    Massimo Rugge

  4. Department of Pathology, Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy

    Paola Parente

Authors
  1. Li Jiao
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  2. Jennifer R. Kramer
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  3. Massimo Rugge
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  4. Paola Parente
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  5. Gordana Verstovsek
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  6. Abeer Alsarraj
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  7. Hashem B. El-Serag
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Correspondence to Li Jiao.

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Jiao, L., Kramer, J.R., Rugge, M. et al. Dietary intake of vegetables, folate, and antioxidants and the risk of Barrett’s esophagus. Cancer Causes Control 24, 1005–1014 (2013). https://doi.org/10.1007/s10552-013-0175-3

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  • DOI: https://doi.org/10.1007/s10552-013-0175-3

Keywords

  • Diet
  • Barrett’s esophagus
  • Risk
  • Case–control