title: Associations of dietary dark-green and deep-yellow vegetables and fruits with cervical intraepithelial neoplasia: modification by smoking.
abstract: Smoking has been positively and fruit and vegetable intake has been negatively associated with cervical cancer, the second most common cancer among women worldwide. However, a lower consumption of fruits and reduced serum carotenoids have been observed among smokers. It is not known whether the smoking effect on the risk of cervical neoplasia is modified by a low intake of fruits and vegetables. The present study examined the combined effects of tobacco smoking and diet using a validated FFQ and serum carotenoid and tocopherol levels on cervical intraepithelial neoplasia grade 3 (CIN3) risk in a hospital-based case-control study conducted in São Paulo, Brazil, between 2003 and 2005. The sample comprised 231 incident, histologically confirmed cases of CIN3 and 453 controls. A low intake ( ≤ 39 g) of dark-green and deep-yellow vegetables and fruits without tobacco smoking had a lesser effect on CIN3 (OR 1·14; 95 % CI 0·49, 2·65) than among smokers with higher intake ( ≥ 40 g; OR 1·83; 95 % CI 0·73, 4·62) after adjusting for confounders. The OR for the joint exposure of tobacco smoking and low intake of vegetables and fruits was greater (3·86; 95 % CI 1·74, 8·57; P for trend < 0·001) compared with non-smokers with higher intake after adjusting for confounding variables and human papillomavirus status. Similar results were observed for total fruit, serum total carotene (including β-, α- and γ-carotene) and tocopherols. These findings suggest that the effect of nutritional factors on CIN3 is modified by smoking.
authors.affiliation: Department of Nutrition, School of Public Health, University of São Paulo (USP), São Paulo, SP, Brazil.
authors.forename: Luciana Y
authors.initials: LY
authors.lastname: Tomita
authors.forename: Cecília M
authors.initials: CM
authors.lastname: Roteli-Martins
authors.forename: Luisa L
authors.initials: LL
authors.lastname: Villa
authors.forename: Eduardo L
authors.initials: EL
authors.lastname: Franco
authors.forename: Marly A
authors.initials: MA
authors.lastname: Cardoso
mesh_terms: D000328:Adult; D000368:Aged; D000975:Antioxidants / Q000494:pharmacology*; D001938:Brazil; D002338:Carotenoids / Q000097:blood / Q000494:pharmacology*; D016022:Case-Control Studies; D004032:Diet; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D016017:Odds Ratio; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D011795:Surveys and Questionnaires; D024505:Tocopherols / Q000097:blood / Q000494:pharmacology*; D002583:Uterine Cervical Neoplasms / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000097:blood / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000975:Antioxidants; D002338:Carotenoids; D024505:Tocopherols