title: Macronutrients, vitamins and minerals intake and risk of esophageal squamous cell carcinoma: a case-control study in Iran.
abstract: BACKGROUND
  Although Iran is a high-risk region for esophageal squamous cell carcinoma (ESCC), dietary factors that may contribute to this high incidence have not been thoroughly studied. The aim of this study was to evaluate the effect of macronutrients, vitamins and minerals on the risk of ESCC.
  
  
  METHODS
  In this hospital-based case-control study, 47 cases with incident ESCC and 96 controls were interviewed and usual dietary intakes were collected using a validated food frequency questionnaire. Data were modeled through unconditional multiple logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI), controlling for age, sex, gastrointestinal reflux, body mass index, smoking history (status, intensity and duration), physical activity, and education.
  
  
  RESULTS
  ESCC cases consumed significantly more hot foods and beverages and fried and barbecued meals, compared to the controls (p < 0.05). After adjusting for potential confounders, the risk of ESCC increased significantly in the highest tertiles of saturated fat [OR:2.88,95%CI:1.15-3.08], cholesterol [OR:1.53, 95%CI: 1.41-4.13], discretionary calorie [OR:1.51, 95%CI: 1.06-3.84], sodium [OR:1.49,95%CI:1.12-2.89] and total fat intakes [OR:1.48, 95%CI:1.09-3.04]. In contrast, being in the highest tertile of carbohydrate, dietary fiber and (n-3) fatty acid intake reduced the ESCC risk by 78%, 71% and 68%, respectively. The most cancer-protective effect was observed for the combination of high folate and vitamin E intakes (OR: 0.02, 95%CI: 0.00-0.87; p < 0.001). Controls consumed 623.5 times higher selenium, 5.48 times as much β-carotene and 1.98 times as much α-tocopherol as the amount ESCC cases consumed.
  
  
  CONCLUSIONS
  This study suggests that high intake of nutrients primarily found in plant-based foods is associated with a reduced esophageal cancer risk. Some nutrients such as folate, vitamin E and selenium might play major roles in the etiology of ESCC and their status may eventually be used as an epidemiological marker for esophageal cancer in Iran, and perhaps other high-risk regions.
authors.affiliation: Human Nutrition Division, Department of Agricultural, Food and Nutritional Sciences, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Canada.
authors.forename: Mahsa
authors.initials: M
authors.lastname: Jessri
authors.forename: Bahram
authors.initials: B
authors.lastname: Rashidkhani
authors.forename: Bahareh
authors.initials: B
authors.lastname: Hajizadeh
authors.forename: Maryam
authors.initials: M
authors.lastname: Jessri
authors.forename: Carolyn
authors.initials: C
authors.lastname: Gotay
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000473:pathology* / Q000517:prevention & control; D016022:Case-Control Studies; D016001:Confidence Intervals; D004032:Diet; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004041:Dietary Fats / Q000008:administration & dosage; D004043:Dietary Fiber / Q000008:administration & dosage; D002149:Energy Intake; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000517:prevention & control; D005247:Feeding Behavior; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007407:Interviews as Topic; D007492:Iran / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D018977:Micronutrients / Q000008:administration & dosage*; D008875:Middle Aged; D016017:Odds Ratio; D010865:Pilot Projects; D012307:Risk Factors; D012643:Selenium / Q000008:administration & dosage; D011795:Surveys and Questionnaires; D014810:Vitamin E / Q000008:administration & dosage; D014815:Vitamins / Q000008:administration & dosage*; D024502:alpha-Tocopherol / Q000008:administration & dosage; D019207:beta Carotene / Q000008:administration & dosage
chemical_list: D004040:Dietary Carbohydrates; D004041:Dietary Fats; D004043:Dietary Fiber; D018977:Micronutrients; D014815:Vitamins; D019207:beta Carotene; D014810:Vitamin E; D005492:Folic Acid; D024502:alpha-Tocopherol; D012643:Selenium