Consumption of meat and fruit in relation to oral and esophageal cancer: a cross-national study.
Using data from 59 countries, we conducted an international comparison study to identify nutritional predictors of age-adjusted oral and esophageal cancer mortality rates. Statistical models accounted for per capita tobacco disappearance data, alcohol consumption, and various measures of socioeconomic status. For oral cancer, stepwise regression results showed protective effects for milk/dairy products (B = -0.030, p < 0.0001) and cabbage consumption (B = -0.391, p = 0.01) and increased risk from vegetable oil (B = 0.072, p = 0.04) and excess animal fat calories (B = 0.344, p < 0.0001) as well as marginally increased risk from cereals (B = 0.008, p = 0.08). Results were obtained after accounting for all background factors, including sex (model R2 = 0.52). For esophageal cancer, stepwise results indicated protective effects for fruit (B = -0.046, p = 0.0006) and total caloric intake (B = -0.013, p < 0.0001) and increased risk from vegetable oil (B = 0.061, p = 0.04) and meat (B = 0.031, p < 0.0001) consumption (model R2 = 0.55). When analyzed separately by sex, results were similar, indicating that the risk factors are probably the same in both sexes, even though women consistently have fewer deaths, on average, from these cancers. On the basis of results from stepwise regression models, we also fitted general linear models for mortality rates of each cancer site, and results were similar in terms of magnitude and direction of effects. Although the evidence provided by this type of analysis using data aggregated by country is limited in terms of control for potential confounding effects and modeling of possible effect modification, an effect of high meat, animal product, or vegetable oil and low fruit and cabbage consumption is consistent with the known biology of these tumors.
Department of Preventive and Behavioral Medicine, University of Massachusetts Medical Center, Worcester 01655.
J R
JR
Hebert
J
J
Landon
D R
DR
Miller
D000368:Aged; D004032:Diet; D004938:Esophageal Neoplasms / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008460:Meat; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000209:etiology*; D012044:Regression Analysis; D012307:Risk Factors; D014675:Vegetables