title: Dietary intake of flavonoids and oesophageal and gastric cancer: incidence and survival in the United States of America (USA).
abstract: BACKGROUND
  Flavonoids, polyphenolic compounds concentrated in fruits and vegetables, have experimentally demonstrated chemopreventive effects against oesophageal and gastric cancer. Few epidemiologic studies have examined flavonoid intake and incidence of these cancers, and none have considered survival.
  
  
  METHODS
  In this USA multicentre population-based study, case participants (diagnosed during 1993-1995 with oesophageal adenocarcinoma (OEA, n=274), gastric cardia adenocarcinoma (GCA, n=248), oesophageal squamous cell carcinoma (OES, n=191), and other gastric adenocarcinoma (OGA, n=341)) and frequency-matched controls (n=662) were interviewed. Food frequency questionnaire responses were linked with USDA Flavonoid Databases and available literature for six flavonoid classes and lignans. Case participants were followed until 2000 for vital status. Multivariable-adjusted odds ratios (ORs) and hazard ratios (HRs) (95% confidence intervals (CIs)) were estimated, comparing highest with lowest intake quartiles, using polytomous logistic and proportional hazards regressions, respectively.
  
  
  RESULTS
  Little or no consistent association was found for total flavonoid intake (main population sources: black tea, orange/grapefruit juice, and wine) and incidence or survival for any tumour type. Intake of anthocyanidins, common in wine and fruit juice, was associated with a 57% reduction in the risk of incident OEA (OR=0.43, 95% CI=0.29-0.66) and OES (OR=0.43, 95% CI=0.26-0.70). The ORs for isoflavones, for which coffee was the main source, were increased for all tumours, except OES. Anthocyanidins were associated with decreased risk of mortality for GCA (HR=0.63, 95% CI=0.42-0.95) and modestly for OEA (HR=0.87, 95% CI=0.60-1.26), but CIs were wide.
  
  
  CONCLUSIONS
  Our findings, if confirmed, suggest that increased dietary anthocyanidin intake may reduce incidence and improve survival for these cancers.
authors: Department of Epidemiology, CB 7435, University of North Carolina, Chapel Hill, NC 27599-7435, USA.
authors: J L
authors: JL
authors: Petrick
authors: Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA.
authors: S E
authors: SE
authors: Steck
authors: Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA.
authors: P T
authors: PT
authors: Bradshaw
authors: Division of Cancer Prevention and Control, Centers for Disease Control, Atlanta, GA, USA.
authors: K F
authors: KF
authors: Trivers
authors: Salmon Bay Consulting, Inc., Seattle, WA, USA.
authors: P E
authors: PE
authors: Abrahamson
authors: Department of Epidemiology, CB 7435, University of North Carolina, Chapel Hill, NC 27599-7435, USA.
authors: L S
authors: LS
authors: Engel
authors: Department of Epidemiology and Biostatistics, Indiana University, Bloomington, IN, USA.
authors: K
authors: K
authors: He
authors: Department of Epidemiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: W-H
authors: WH
authors: Chow
authors: Department of Chronic Disease Epidemiology, Yale School of Public Health and Yale Cancer Center, New Haven, CT, USA.
authors: S T
authors: ST
authors: Mayne
authors: Department of Chronic Disease Epidemiology, Yale School of Public Health and Yale Cancer Center, New Haven, CT, USA.
authors: H A
authors: HA
authors: Risch
authors: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors: T L
authors: TL
authors: Vaughan
authors: Department of Epidemiology, CB 7435, University of North Carolina, Chapel Hill, NC 27599-7435, USA.
authors: M D
authors: MD
authors: Gammon
mesh_terms: D016022:Case-Control Studies; D004032:Diet / Q000706:statistics & numerical data*; D004938:Esophageal Neoplasms / Q000453:epidemiology*; D005260:Female; D005419:Flavonoids / Q000008:administration & dosage*; D005638:Fruit; D006801:Humans; D015994:Incidence; D008297:Male; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000453:epidemiology*; D016019:Survival Analysis; D014481:United States; D014675:Vegetables
chemical_list: D005419:Flavonoids