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Dietary quality using four dietary indices and lung cancer risk: the Golestan Cohort Study (GCS)

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Abstract

Purpose

The lung cancer incidence in Iran has increased almost ten times over the past three decades. In addition to the known causes such as smoking and certain occupational exposure, dietary quality has been suggested to play a role in lung cancer. We aim to explore the association between dietary pattern and lung cancer risk among a Middle East population.

Methods

Data came from Golestan Cohort Study which included 48,421 participants with 136 lung cancer cases diagnosed during a median follow-up of 12 years. Multivariable Cox proportional hazards regression models were used to calculate the HRs and 95% CI of lung cancer risk by tertile of the four dietary index scores—the Health Eating Index (HEI)-2015, the Alternative Health Eating Index (AHEI)-2010, the Alternative Mediterranean Diet (AMED), and the Dietary Approach to Stop Hypertension (DASH)-Fung.

Results

A higher DASH-Fung score was inversely associated with risk of lung cancer after adjusting for potential confounders (tertile three vs. tertile one: HR = 0.59 (0.38–0.93); p for trend = 0.07), and pinteraction with smoking was 0.46. Similar findings were observed among current smokers with the HEI-2015 score (tertile three vs. tertile one: HR = 0.22 (0.08–0.60): p for trend < 0.01), and pinteraction between smoking and the HEI-2015 score was 0.03.

Conclusion

In the GCS, consuming a diet more closely aligned with the DASH diet was associated with a reduced risk of lung cancer, which appeared to be independent of smoking status. There was also an inverse link between the HEI-2015 score and lung cancer risk among current smokers. Our finding is particularly important for the Middle East population, as diet may play an important role in cancer prevention and overall health.

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Data availability

Data described in the manuscript, code book, and analytic code will be made available upon request.

Abbreviations

AHEI-2010:

Alternative Healthy Eating Index-2010

AMED:

Alternate Mediterranean Diet

CI:

Confidence interval

CRP:

C-Reactive Protein

DASH:

Dietary Approach to Stop Hypertension

FFQ:

Food Frequency Questionnaire

GCS:

Golestan Cohort Study

HEI-2015:

Healthy Eating Index-2015

HR:

Hazard ratio

IL:

Interleukin

MUFAs:

Monounsaturated fatty acid

PUFAs:

Polyunsaturated fatty acids

SFA:

Saturated fatty acid

SSB:

Sugary-sweetened beverage

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Acknowledgments

We thank all participants of the Golestan Cohort study for agreeing to be enrolled in the study and providing biological samples and follow-up data over many years. We also thank all the professionals including medical doctors, nurses, epidemiologists, and nutritionists involved in the recruitment of participants and collection and storage of biospecimens for their precious expertise; the Golestan Cohort Study Center staff; the local health networks and health workers (Behvarzes) in the study area; the Golestan University of Medical Sciences (Gorgan, Iran); and the chiefs of the Maraveh-tappeh, Gonbad, Kalaleh, and Aq-qala health districts for their assistance and support.

Funding

Golestan cohort study was funded by the Cancer Research UK (Grant Number: C20/A5860), Tehran University of Medical Sciences (Grant Number: 81/15), the International Agency for Research on Cancer, and the Intramural Research Program of the U.S. National Cancer Institute. The funders had no role in study design, collection, analysis, and interpretation of data, in manuscript writing or in submission process for publication.

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Authors and Affiliations

  1. Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1079, New York, NY, 10029, USA

    Qian Wang

  2. Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran

    Maryam Hashemian, Sadaf G. Sepanlou, Maryam Sharafkhah, Hossein Poustchi, Masoud Khoshnia, Abdolsamad Gharavi, Akram Pourshams, Akbar Fazeltabar Malekshah & Reza Malekzadeh

  3. Biology Department, Utica College, Utica, NY, USA

    Maryam Hashemian

  4. Liver and Pancreatobiliary Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran

    Hossein Poustchi, Akram Pourshams & Reza Malekzadeh

  5. Digestive Disease Research Center, Digestive Research Institute, Tehran University of Medical Sciences, Tehran, Iran

    Sadaf G. Sepanlou & Reza Malekzadeh

  6. Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran

    Masoud Khoshnia & Abdolsamad Gharavi

  7. Morgan State University, Baltimore, MD, USA

    Farin Kamangar

  8. Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, USA

    Arash Etemadi, Christian C. Abnet & Sanford M. Dawsey

  9. Stony Brook Cancer Center, New York, NY, USA

    Paolo Boffetta

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  1. Qian Wang
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Contributions

QW: Contributed to the data analysis and interpretation, and wrote the initial draft of the manuscript. MH: Contributed to the data analysis, dietary score calculation, and reviewed provided feedback to the manuscript. HP: Contributed to the intellectual input for design of GCS, field officer of GCS for data acquisition, and provided review and confirmation of the final version of the manuscript. MS: Contributed to the data analysis, dietary score calculation, and reviewed provided feedback to the manuscript. AP: Contributed to the intellectual input for design of GCS, field officer of GCS for data acquisition, and provided review and confirmation of the final version of the manuscript. SS: Contributed to the intellectual input for design of GCS follow-up, data cleaning and follow-up data acquisition, and provided review and confirmation of the final version of the manuscript. MK: Contributed to outcome assessment by collecting and reviewing file to make the final diagnosis during GCS follow-up, and provided review and confirmation of the final version of the manuscript. AG: Contributed to outcome assessment by collecting and reviewing file to make the final diagnosis during GCS follow-up, and provided review and confirmation of the final version of the manuscript. AFM: Contributed by design and validation of food frequency questioner for GCS, and provided review and confirmation of the final version of the manuscript. AE: Contributed to the intellectual input into the design and follow-up of GCS, and provided review and confirmation of the final version of the manuscript. FK: Contributed to the intellectual input into the design and follow-up of GCS, and provided review and confirmation of the final version of the manuscript. RM: Contributed to the intellectual input for the design of the experiments as well as accomplishment of Golestan cohort study. He supervised all data and biospecimen collection, and provided review and confirmation of the final version of the manuscript. PB: Contributed to the intellectual input for the design of the experiments as well as accomplishment of Golestan cohort study, and provided review and confirmation of the final version of the manuscript.

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Correspondence to Qian Wang.

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Ethical approval

The GCS was approved by the institutional review boards (IRB) of the Digestive Disease Research Institute of the Tehran University of Medical Sciences (reference number: FWA00001331), the International Agency for Research on Cancer (reference number: CN/23/3), and the US National Cancer Institute.

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A written informed consent was obtained from all study participants.

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Wang, Q., Hashemian, M., Sepanlou, S.G. et al. Dietary quality using four dietary indices and lung cancer risk: the Golestan Cohort Study (GCS). Cancer Causes Control 32, 493–503 (2021). https://doi.org/10.1007/s10552-021-01400-w

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