Skip to main content
SpringerLink
Log in

Dietary Patterns and Risk of Lung Cancer: A Systematic Review and Meta-Analyses of Observational Studies

  • REVIEW
  • Published:
Current Nutrition Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Previous literature reviews summarized the associations between individual foods or food groups and lung cancer risk, but the relationship between dietary patterns and lung cancer risk has received less attention. We conducted a systematic review and meta-analyses of observational studies on the associations between dietary patterns and lung cancer risk.

Recent Findings

PubMed, Embase, and Web of Science were systematically searched from inception to February 2023. Random-effects models were used to pool relative risks (RR) on associations with at least two studies. Twelve studies reported on data-driven dietary patterns, and 17 studies reported on a priori dietary patterns. A prudent dietary pattern (high in vegetables, fruit, fish, and white meat) tended to be associated with a lower risk of lung cancer (RR = 0.81, 95% confidence interval [CI] = 0.66–1.01, n = 5). In contrast, Western dietary patterns, characterized by higher intakes of refined grains and red and processed meat, were significantly positively associated with lung cancer (RR = 1.32, 95% CI = 1.08–1.60, n = 6). Healthy dietary scores were consistently associated with a lower risk of lung cancer (Healthy Eating Index [HEI]: RR = 0.87, 95% CI = 0.80–0.95, n = 4; Alternate HEI: RR = 0.88, 95% CI = 0.81–0.95, n = 4; Dietary Approaches to Stop Hypertension: RR = 0.87, 95% CI = 0.77–0.98, n = 4; Mediterranean diet: RR = 0.87, 95% CI = 0.81–0.93, n = 10) while the dietary inflammatory index was associated with a higher risk of lung cancer (RR = 1.14, 95% CI = 1.07–1.22, n = 6).

Summary

Our systematic review indicates dietary patterns characterized by a higher intake of vegetables and fruits, a lower intake of animal products, and anti-inflammation may be associated with a reduced risk of lung cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Abbreviations

AHEI:

Alternate Healthy Eating Index

CI:

Confidence intervals

DASH:

Dietary Approaches to Stop Hypertension

DII:

Dietary Inflammatory Index

EDIP:

Empirical Dietary Inflammation Pattern

HEI:

Healthy Eating Index

NOS:

Newcastle-Ottawa scale

RR:

Relative risk

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–49. https://doi.org/10.3322/caac.21660.

    Article  PubMed  Google Scholar 

  2. Howlader N NA, Krapcho M, Miller D, Brest A, Yu M, Ruhl J, Tatalovich Z,. SEER cancer statistics review, 1975–2018. site. Available at https://seer.cancer.gov/csr/1975_2018/.

  3. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70(1):7–30. https://doi.org/10.3322/caac.21590.

    Article  PubMed  Google Scholar 

  4. U.S. Department of Health and Human Services. The health consequences of smoking: a report of the surgeon general. In.; 2004.

  5. Parkin DM, Bray F, Ferlay J, et al. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55(2):74–108. https://doi.org/10.3322/canjclin.55.2.74.

    Article  PubMed  Google Scholar 

  6. World Cancer Research Fund International. Diet, nutrition, physical activity and cancer: a global perspective: a summary of the Third Expert Report. In.: World Cancer Research Fund International; 2018.

  7. •• Steck SE, Murphy EA. Dietary patterns and cancer risk. Nat Rev Cancer. 2020;20(2):125–38. https://doi.org/10.1038/s41568-019-0227-4. The review summarized the evidence on associations between dietary patterns and cancer risk and pointed out directions for future research.

  8. Krebs-Smith SM, Subar AF, Reedy J. Examining dietary patterns in relation to chronic disease: matching measures and methods to questions of interest. Circulation. 2015;132(9):790–3. https://doi.org/10.1161/CIRCULATIONAHA.115.018010.

    Article  PubMed  Google Scholar 

  9. Hu FB. Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol. 2002;13(1):3–9. https://doi.org/10.1097/00041433-200202000-00002.

    Article  CAS  PubMed  Google Scholar 

  10. Guenther PM, Casavale KO, Reedy J, et al. Update of the Healthy Eating Index: HEI-2010. J Acad Nutr Diet. 2013;113(4):569–80. https://doi.org/10.1016/j.jand.2012.12.016.

    Article  PubMed  Google Scholar 

  11. Sacks FM, Svetkey LP, Vollmer WM, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med. 2001;344(1):3–10. https://doi.org/10.1056/NEJM200101043440101

  12. Trichopoulou A, Costacou T, Bamia C, et al. Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med. 2003;348(26):2599–608. https://doi.org/10.1056/NEJMoa025039.

    Article  PubMed  Google Scholar 

  13. Shivappa N, Steck SE, Hurley TG, et al. Designing and developing a literature-derived, population-based dietary inflammatory index. Public Health Nutr. 2014;17(8):1689–96. https://doi.org/10.1017/S1368980013002115.

    Article  PubMed  Google Scholar 

  14. Tabung FK, Smith-Warner SA, Chavarro JE, et al. Development and validation of an empirical dietary inflammatory index. J Nutr. 2016;146(8):1560–70. https://doi.org/10.3945/jn.115.228718.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Sun Y, Li Z, Li J, et al. A healthy dietary pattern reduces lung cancer risk: a systematic review and meta-analysis. Nutrients. 2016;8(3):134. https://doi.org/10.3390/nu8030134.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. • Bahrami A, Khalesi S, Makiabadi E, et al. Adherence to the Mediterranean diet and the risk of lung cancer: a systematic review and dose-response meta-analysis of observational studies. Nutr Rev. 2022;80(5):1118–28. https://doi.org/10.1093/nutrit/nuab117. The study reviewed the evidence on Mediterranean diet and risk of lung cancer, and results were consistent with our main findings.

  17. Schulpen M, van den Brandt PA. Adherence to the Mediterranean diet and risk of lung cancer in the Netherlands Cohort Study. Br J Nutr. 2018;119(6):674–84. https://doi.org/10.1017/S0007114517003737.

    Article  CAS  PubMed  Google Scholar 

  18. Boden S, Myte R, Wennberg M, et al. The inflammatory potential of diet in determining cancer risk; a prospective investigation of two dietary pattern scores. PLoS One. 2019;14(4):e0214551. https://doi.org/10.1371/journal.pone.0214551

  19. Shivappa N, Wang R, Hebert JR, et al. Association between inflammatory potential of diet and risk of lung cancer among smokers in a prospective study in Singapore. Eur J Nutr. 2019;58(7):2755–66. https://doi.org/10.1007/s00394-018-1825-8.

    Article  CAS  PubMed  Google Scholar 

  20. • Wang Q, Hashemian M, Sepanlou SG, et al. Dietary quality using four dietary indices and lung cancer risk: the Golestan Cohort Study (GCS). Cancer Causes Control. 2021;32(5):493–503. https://doi.org/10.1007/s10552-021-01400-w. This is the latest study examaining the association between different dietary quality indices and lung cancer risk using a prospective cohort design.

  21. Park SY, Boushey CJ, Shvetsov YB, et al. Diet quality and risk of lung cancer in the multiethnic cohort study. Nutrients. 2021;13(5):1614. https://doi.org/10.3390/nu13051614.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg. 2010;8(5):336–41. https://doi.org/10.1016/j.ijsu.2010.02.007.

    Article  PubMed  Google Scholar 

  23. Wells GA, Shea B, O’Connell Da, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. In.: Oxford; 2000.

  24. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177–88. https://doi.org/10.1016/0197-2456(86)90046-2.

    Article  CAS  PubMed  Google Scholar 

  25. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58. https://doi.org/10.1002/sim.1186.

    Article  PubMed  Google Scholar 

  26. Gnagnarella P, Maisonneuve P, Bellomi M, et al. Red meat, Mediterranean diet and lung cancer risk among heavy smokers in the COSMOS screening study. Ann Oncol. 2013;24(10):2606–11. https://doi.org/10.1093/annonc/mdt302.

    Article  CAS  PubMed  Google Scholar 

  27. Tsai YY, McGlynn KA, Hu Y, et al. Genetic susceptibility and dietary patterns in lung cancer. Lung Cancer. 2003;41(3):269–81. https://doi.org/10.1016/s0169-5002(03)00238-1.

    Article  PubMed  Google Scholar 

  28. Balder HF, Goldbohm RA, van den Brandt PA. Dietary patterns associated with male lung cancer risk in the Netherlands Cohort Study. Cancer Epidemiol Biomarkers Prev. 2005;14(2):483–90. https://doi.org/10.1158/1055-9965.EPI-04-0353.

    Article  PubMed  Google Scholar 

  29. Mai V, Kant AK, Flood A, et al. Diet quality and subsequent cancer incidence and mortality in a prospective cohort of women. Int J Epidemiol. 2005;34(1):54–60. https://doi.org/10.1093/ije/dyh388.

    Article  PubMed  Google Scholar 

  30. De Stefani E, Boffetta P, Ronco AL, et al. Nutrient patterns and risk of lung cancer: a factor analysis in Uruguayan men. Lung Cancer. 2008;61(3):283–91. https://doi.org/10.1016/j.lungcan.2008.01.004.

    Article  PubMed  Google Scholar 

  31. De Stefani E, Deneo-Pellegrini H, Boffetta P, et al. Dietary patterns and risk of cancer: a factor analysis in Uruguay. Int J Cancer. 2009;124(6):1391–7. https://doi.org/10.1002/ijc.24035.

    Article  CAS  PubMed  Google Scholar 

  32. De Stefani E, Ronco AL, Deneo-Pellegrini H, et al. Dietary patterns and risk of adenocarcinoma of the lung in males: a factor analysis in Uruguay. Nutr Cancer. 2011;63(5):699–706. https://doi.org/10.1080/01635581.2011.563033.

    Article  PubMed  Google Scholar 

  33. Gorlova OY, Weng SF, Hernandez L, et al. Dietary patterns affect lung cancer risk in never smokers. Nutr Cancer. 2011;63(6):842–9. https://doi.org/10.1080/01635581.2011.589958.

    Article  CAS  PubMed  Google Scholar 

  34. Gnagnarella P, Maisonneuve P, Bellomi M, et al. Nutrient intake and nutrient patterns and risk of lung cancer among heavy smokers: results from the COSMOS screening study with annual low-dose CT. Eur J Epidemiol. 2013;28(6):503–11. https://doi.org/10.1007/s10654-013-9803-1.

    Article  CAS  PubMed  Google Scholar 

  35. Anic GM, Park Y, Subar AF, et al. Index-based dietary patterns and risk of lung cancer in the NIH-AARP diet and health study. Eur J Clin Nutr. 2016;70(1):123–9. https://doi.org/10.1038/ejcn.2015.122.

    Article  CAS  PubMed  Google Scholar 

  36. Hodge AM, Bassett JK, Shivappa N, et al. Dietary inflammatory index, Mediterranean diet score, and lung cancer: a prospective study. Cancer Causes Control. 2016;27(7):907–17. https://doi.org/10.1007/s10552-016-0770-1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Maisonneuve P, Shivappa N, Hebert JR, et al. Dietary inflammatory index and risk of lung cancer and other respiratory conditions among heavy smokers in the COSMOS screening study. Eur J Nutr. 2016;55(3):1069–79. https://doi.org/10.1007/s00394-015-0920-3.

    Article  CAS  PubMed  Google Scholar 

  38. Tu H, Heymach JV, Wen CP, et al. Different dietary patterns and reduction of lung cancer risk: a large case-control study in the U.S. Sci Rep. 2016;6:26760. https://doi.org/10.1038/srep26760

  39. He F, Xiao RD, Lin T, et al. Dietary patterns, BCMO1 polymorphisms, and primary lung cancer risk in a Han Chinese population: a case-control study in Southeast China. BMC Cancer. 2018;18(1):445. https://doi.org/10.1186/s12885-018-4361-2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Kane-Diallo A, Srour B, Sellem L, et al. Association between a pro plant-based dietary score and cancer risk in the prospective NutriNet-sante cohort. Int J Cancer. 2018;143(9):2168–76. https://doi.org/10.1002/ijc.31593.

    Article  CAS  PubMed  Google Scholar 

  41. Hawrysz I, Wadolowska L, Slowinska MA, et al. Adherence to prudent and mediterranean dietary patterns is inversely associated with lung cancer in moderate but not heavy male polish smokers: a case-control study. Nutrients. 2020;12(12). https://doi.org/10.3390/nu12123788

  42. Cai H, Sobue T, Kitamura T, et al. Low-carbohydrate diet and risk of cancer incidence: the Japan Public Health Center-based prospective study. Cancer Sci. 2022;113(2):744–55. https://doi.org/10.1111/cas.15215.

    Article  CAS  PubMed  Google Scholar 

  43. Zhang Y, Zhong G, Zhu M, et al. Association between diabetes risk reduction diet and lung cancer risk in 98,159 participants: results from a prospective study. Front Oncol. 2022;12:855101. https://doi.org/10.3389/fonc.2022.855101

  44. Deschasaux M, Huybrechts I, Murphy N, et al. Nutritional quality of food as represented by the FSAm-NPS nutrient profiling system underlying the Nutri-Score label and cancer risk in Europe: Results from the EPIC prospective cohort study. PLoS Med. 2018;15(9):e1002651. https://doi.org/10.1371/journal.pmed.1002651

  45. Myneni AA, Giovino GA, Millen AE, et al. Indices of diet quality and risk of lung cancer in the women’s health initiative observational study. J Nutr. 2021;151(6):1618–27. https://doi.org/10.1093/jn/nxab033.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Sadeghi A, Parastouei K, Seifi S, et al. Inflammatory potential of diet and odds of lung cancer: a case-control study. Nutr Cancer. 2022;74(8):2859–67. https://doi.org/10.1080/01635581.2022.2036770.

    Article  CAS  PubMed  Google Scholar 

  47. Wei X, Zhu C, Ji M, et al. Diet and risk of incident lung cancer: a large prospective cohort study in UK biobank. Am J Clin Nutr. 2021;114(6):2043–51. https://doi.org/10.1093/ajcn/nqab298.

    Article  PubMed  Google Scholar 

  48. Willemsen RF, McNeil J, Heer E, et al. Dietary patterns with combined and site-specific cancer incidence in Alberta’s Tomorrow Project cohort. Eur J Clin Nutr. 2022;76(3):360–72. https://doi.org/10.1038/s41430-021-00958-7.

    Article  CAS  PubMed  Google Scholar 

  49. Vieira AR, Abar L, Vingeliene S, et al. Fruits, vegetables and lung cancer risk: a systematic review and meta-analysis. Ann Oncol. 2016;27(1):81–96. https://doi.org/10.1093/annonc/mdv381.

    Article  CAS  PubMed  Google Scholar 

  50. Angelino D, Godos J, Ghelfi F, et al. Fruit and vegetable consumption and health outcomes: an umbrella review of observational studies. Int J Food Sci Nutr. 2019;70(6):652–67. https://doi.org/10.1080/09637486.2019.1571021.

    Article  PubMed  Google Scholar 

  51. Huang Y, Cao D, Chen Z, et al. Red and processed meat consumption and cancer outcomes: umbrella review. Food Chem. 2021;356:129697. https://doi.org/10.1016/j.foodchem.2021.129697

  52. Miller V, Webb P, Micha R, et al. Defining diet quality: a synthesis of dietary quality metrics and their validity for the double burden of malnutrition. Lancet Planet Health. 2020;4(8):e352–70. https://doi.org/10.1016/s2542-5196(20)30162-5.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Greten FR, Grivennikov SI. Inflammation and cancer: triggers, mechanisms, and consequences. Immunity. 2019;51(1):27–41. https://doi.org/10.1016/j.immuni.2019.06.025.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Marx W, Veronese N, Kelly JT, et al. The dietary inflammatory index and human health: an umbrella review of meta-analyses of observational studies. Adv Nutr. 2021;12(5):1681–90. https://doi.org/10.1093/advances/nmab037.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Fowler ME, Akinyemiju TF. Meta-analysis of the association between dietary inflammatory index (DII) and cancer outcomes. Int J Cancer. 2017;141(11):2215–27. https://doi.org/10.1002/ijc.30922.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Subramaniam S, Selvaduray KR, Radhakrishnan AK. Bioactive compounds: natural defense against cancer? Biomolecules. 2019;9(12):758. https://doi.org/10.3390/biom9120758.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Yang JJ, Yu D, Xiang YB, et al. Association of dietary fiber and yogurt consumption with lung cancer risk: a pooled analysis. JAMA Oncol. 2020;6(2):e194107. https://doi.org/10.1001/jamaoncol.2019.4107

  58. Gomes M, Teixeira AL, Coelho A, et al. The role of inflammation in lung cancer. Adv Exp Med Biol. 2014;816:1–23. https://doi.org/10.1007/978-3-0348-0837-8_1.

    Article  CAS  PubMed  Google Scholar 

  59. Abid Z, Cross AJ, Sinha R. Meat, dairy, and cancer. Am J Clin Nutr. 2014;100(Suppl 1):386S-393S. https://doi.org/10.3945/ajcn.113.071597.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Ward HA, Whitman J, Muller DC, et al. Haem iron intake and risk of lung cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Eur J Clin Nutr. 2019;73(8):1122–32. https://doi.org/10.1038/s41430-018-0271-2.

    Article  CAS  PubMed  Google Scholar 

  61. Heydari G, Heidari F, Yousefifard M, et al. Smoking and diet in healthy adults: a cross-sectional study in tehran, iran, 2010. Iran J Public Health. 2014;43(4):485–91.

    PubMed  PubMed Central  Google Scholar 

  62. Alkerwi A, Baydarlioglu B, Sauvageot N, et al. Smoking status is inversely associated with overall diet quality: Findings from the ORISCAV-LUX study. Clin Nutr. 2017;36(5):1275–82. https://doi.org/10.1016/j.clnu.2016.08.013.

    Article  PubMed  Google Scholar 

  63. MacLean RR, Cowan A, Vernarelli JA. More to gain: dietary energy density is related to smoking status in US adults. BMC Public Health. 2018;18(1):365. https://doi.org/10.1186/s12889-018-5248-5.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Polanski J, Chabowski M, Jankowska-Polanska B, et al. Histological subtype of lung cancer affects acceptance of illness, severity of pain, and quality of life. J Pain Res. 2018;11:727–33. https://doi.org/10.2147/JPR.S155121.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We acknowledge authors of the original studies that included in our systematic review and meta-analyses.

Author information

Authors and Affiliations

  1. Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA

    Longgang Zhao, Bezawit Kase & Susan E. Steck

  2. School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Jiali Zheng

Authors
  1. Longgang Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bezawit Kase
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jiali Zheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Susan E. Steck
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study conception and design: LZ and SS; study protocol: LZ and SS; literature research and data extraction: LZ and BK; data analyses: LZ and BK; results interpretation: LZ, BK, JZ, and SS; draft: LZ; review and critical revision: LZ, BK, JZ, and SS; read and approved the version of the manuscript being submitted: LZ, BK, JZ, and SS.

Corresponding author

Correspondence to Susan E. Steck.

Ethics declarations

Conflict of Interest

All authors have no conflict of interest to declare.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 84 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhao, L., Kase, B., Zheng, J. et al. Dietary Patterns and Risk of Lung Cancer: A Systematic Review and Meta-Analyses of Observational Studies. Curr Nutr Rep 12, 338–357 (2023). https://doi.org/10.1007/s13668-023-00469-w

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13668-023-00469-w

Keywords

Search

Navigation