title: Dietary and nutritional factors and pancreatic cancer: a case-control study based on direct interviews.
abstract: BACKGROUND
  The relationship between diet and pancreatic cancer remains unclear. In this study, we assessed the role of diet and nutrition as risk factors for pancreatic cancer, using data obtained from direct interviews only, rather than data from less reliable interviews with next of kin. We evaluated whether dietary factors could explain the higher incidence of pancreatic cancer experienced by black Americans compared with white Americans.
  
  
  METHODS
  We conducted a population-based case-control study of pancreatic cancer diagnosed in Atlanta (GA), Detroit (MI), and 10 New Jersey counties from August 1986 through April 1989. Reliable dietary histories were obtained for 436 patients and 2003 general-population control subjects aged 30-79 years.
  
  
  RESULTS
  Obesity was associated with a statistically significant 50%-60% increased risk of pancreatic cancer that was consistent by sex and race. Although the magnitude of risk associated with obesity was identical in blacks and whites, a higher percentage of blacks were obese than were whites (women: 38% versus 16%; men: 27% versus 22%). A statistically significant positive trend in risk was observed with increasing caloric intake, with subjects in the highest quartile of caloric intake experiencing a 70% higher risk than those in the lowest quartile. A statistically significant interaction between body mass index (weight in kg/height in m2 for men and weight in kg/height in m1.5 for women) and total caloric intake was observed that was consistent by sex and race. Subjects in the highest quartile of both body mass index and caloric intake had a statistically significant 180% higher risk than those in the lowest quartile.
  
  
  CONCLUSIONS
  Obesity is a risk factor for pancreatic cancer and appears to contribute to the higher risk of this disease among blacks than among whites in the United States, particularly among women. Furthermore, the interaction between body mass index and caloric intake suggests the importance of energy balance in pancreatic carcinogenesis.
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA. silvermd@EPNDCE.NCI.NIH.GOV
authors.forename: D T
authors.initials: DT
authors.lastname: Silverman
authors.forename: C A
authors.initials: CA
authors.lastname: Swanson
authors.forename: G
authors.initials: G
authors.lastname: Gridley
authors.forename: S
authors.initials: S
authors.lastname: Wacholder
authors.forename: R S
authors.initials: RS
authors.lastname: Greenberg
authors.forename: L M
authors.initials: LM
authors.lastname: Brown
authors.forename: R B
authors.initials: RB
authors.lastname: Hayes
authors.forename: G M
authors.initials: GM
authors.lastname: Swanson
authors.forename: J B
authors.initials: JB
authors.lastname: Schoenberg
authors.forename: L M
authors.initials: LM
authors.lastname: Pottern
authors.forename: A G
authors.initials: AG
authors.lastname: Schwartz
authors.forename: J F
authors.initials: JF
authors.lastname: Fraumeni
authors.forename: R N
authors.initials: RN
authors.lastname: Hoover
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D015992:Body Mass Index; D016022:Case-Control Studies; D003069:Coffee; D004032:Diet / Q000009:adverse effects*; D004041:Dietary Fats; D002149:Energy Intake; D005260:Female; D005502:Food / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009747:Nutritional Physiological Phenomena; D016017:Odds Ratio; D010190:Pancreatic Neoplasms / Q000208:ethnology* / Q000209:etiology*; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*
chemical_list: D003069:Coffee; D004041:Dietary Fats