title: Natural vitamin C intake and the risk of head and neck cancer: A pooled analysis in the International Head and Neck Cancer Epidemiology Consortium.
abstract: Evidence of associations between single nutrients and head and neck cancer (HNC) is still more limited and less consistent than that for fruit and vegetables. However, clarification of the protective mechanisms of fruit and vegetables is important to our understanding of HNC etiology. We investigated the association between vitamin C intake from natural sources and cancer of the oral cavity/pharynx and larynx using individual-level pooled data from ten case-control studies (5,959 cases and 12,248 controls) participating in the International Head and Neck Cancer Epidemiology (INHANCE) consortium. After harmonization of study-specific exposure information via the residual method, adjusted odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were estimated using unconditional multiple logistic regression models on quintile categories of 'non-alcohol energy-adjusted' vitamin C intake. In the presence of heterogeneity of the estimated ORs among studies, we derived those estimates from generalized linear mixed models. Higher intakes of vitamin C were inversely related to oral and pharyngeal (OR = 0.54, 95% CI: 0.45-0.65, for the fifth quintile category versus the first one, p for trend<0.001) and laryngeal cancers (OR = 0.52, 95% CI: 0.40-0.68, p for trend = 0.006), although in the presence of heterogeneity among studies for both sites. Inverse associations were consistently observed for the anatomical subsites of oral and pharyngeal cancer, and across strata of age, sex, education, body mass index, tobacco, and alcohol, for both cancer sites. The inverse association of vitamin C intake from foods with HNC may reflect a protective effect on these cancers; however, we cannot rule out other explanations.
authors: Dipartimento di Scienze Cliche e di Comunità Sezione Di Statistica Medica E Biometria "Giulio A. Maccacaro,", Università degli Studi di Milano, Milan, Italy.
authors: Valeria
authors: V
authors: Edefonti
authors: Division of Public Health, Department of Family and Preventive Medicine and Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, USA.
authors: Mia
authors: M
authors: Hashibe
authors: Institute of Hygiene and Epidemiology, Department of Medical and Biological Sciences, University of Udine, Udine, Italy.
authors: Maria
authors: M
authors: Parpinel
authors: Department of Epidemiology, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri,", Milan, Italy.|S.C., Statistica Medica, Biometria e Bioinformatica, Fondazione IRCSS Istituto Nazionale Tumori di Milano, Milan, Italy.
authors: Federica
authors: F
authors: Turati
authors: Unit of Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, IRCCS, Aviano, Italy.
authors: Diego
authors: D
authors: Serraino
authors: Department of Preventive Medicine, Kyushu University Faculty of Medical Sciences, Kyushu, Japan.
authors: Keitaro
authors: K
authors: Matsuo
authors: Department of Epidemiology, Gillings School of Global Public Health, and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
authors: Andrew F
authors: AF
authors: Olshan
authors: Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors: Jose P
authors: JP
authors: Zevallos
authors: Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD.
authors: Deborah M
authors: DM
authors: Winn
authors: Department of Cancer Prevention and Control and Department of Immunology, Roswell Park Cancer Institute, Buffalo, NY.
authors: Kirsten
authors: K
authors: Moysich
authors: Department of Epidemiology, UCLA School of Public Health, Los Angeles, CA.
authors: Zuo-Feng
authors: ZF
authors: Zhang
authors: Department of Epidemiology and Environmental Health Sciences, School of Public Health and Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI, USA.
authors: Hal
authors: H
authors: Morgenstern
authors: Cancer Epidemiology Unit, Institute for Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland.
authors: Fabio
authors: F
authors: Levi
authors: Department of Pathology and Laboratory Medicine and Department of Epidemiology, Brown University, Providence, RI.
authors: Karl
authors: K
authors: Kelsey
authors: Department of Environmental Health, Boston University School of Public Health, Boston, MA.
authors: Michael
authors: M
authors: McClean
authors: Department of Epidemiology, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri,", Milan, Italy.
authors: Cristina
authors: C
authors: Bosetti
authors: Department of Epidemiology, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri,", Milan, Italy.
authors: Carlotta
authors: C
authors: Galeone
authors: Department of Otolaryngology, New York Eye and Ear Infirmary, New York, NY.
authors: Stimson
authors: S
authors: Schantz
authors: Medical Informatics Center, Peking University, Peking, China.
authors: Guo-Pei
authors: GP
authors: Yu
authors:  Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY.
authors: Paolo
authors: P
authors: Boffetta
authors: Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT.
authors: Yuan-Chin
authors: YC
authors: Amy Lee
authors: Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan.
authors: Shu-Chun
authors: SC
authors: Chuang
authors: Dipartimento di Scienze Cliche e di Comunità Sezione Di Statistica Medica E Biometria "Giulio A. Maccacaro,", Università degli Studi di Milano, Milan, Italy.
authors: Carlo
authors: C
authors: La Vecchia
authors: Dipartimento di Scienze Cliche e di Comunità Sezione Di Statistica Medica E Biometria "Giulio A. Maccacaro,", Università degli Studi di Milano, Milan, Italy.|S.C., Statistica Medica, Biometria e Bioinformatica, Fondazione IRCSS Istituto Nazionale Tumori di Milano, Milan, Italy.
authors: Adriano
authors: A
authors: Decarli
mesh_terms: D001205:Ascorbic Acid / Q000008:administration & dosage*; D016022:Case-Control Studies; D006258:Head and Neck Neoplasms / Q000453:epidemiology*; D006801:Humans; D007390:International Agencies / Q000706:statistics & numerical data*; D007558:Italy / Q000453:epidemiology; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013557:Switzerland / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014815:Vitamins / Q000008:administration & dosage
chemical_list: D014815:Vitamins; D001205:Ascorbic Acid
keywords: INHANCE; head and neck cancer; laryngeal cancer; oral and pharyngeal cancer; vitamin C
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