title: Vitamin and carotenoid intake and risk of head-neck cancer subtypes in the Netherlands Cohort Study.
abstract: BACKGROUND
  Head and neck cancer (HNC) is the seventh most-common type of cancer worldwide. Evidence regarding the potential protective effect of vitamins and carotenoids on HNC is limited and mostly based on case-control studies.
  
  
  OBJECTIVE
  We evaluated the association of intake of dietary vitamins C and E (including supplementation) and the most-common carotenoids (α-carotene, β-carotene, lutein plus zeaxanthin, lycopene, and β-cryptoxanthin) and risk of HNC and HNC subtypes in a large prospective study.
  
  
  METHODS
  The Netherlands Cohort Study included 120,852 participants. For efficiency reasons, a case-cohort design was used. At baseline in 1986, participants completed a food-frequency questionnaire. A subcohort was randomly selected from the total cohort. After 20.3 y of follow-up, 3898 subcohort members and 415 HNC cases [131 oral cavity cancer (OCCs), 88 oro-/hypopharyngeal cancer (OHPs), and 193 laryngeal cancer cases] were available for analysis. Rate ratios and 95% CIs for highest (quartile 4) compared with lowest (quartile 1) quartiles of vitamin and carotenoid intake were estimated by using the Cox proportional hazards model.
  
  
  RESULTS
  A strong inverse association was shown between vitamin C and HNC overall (multivariable-adjusted rate ratio for quartile 4 compared with quartile 1: 0.39; 95% CI: 0.23, 0.66; P-trend < 0.001), OCC (multivariable-adjusted rate ratio for quartile 4 compared with quartile 1: 0.35; 95% CI: 0.16, 0.77; P-trend < 0.05), and OHPC (multivariable-adjusted rate ratio for quartile 4 compared with quartile 1: 0.29; 95% CI: 0.12, 0.67; P-trend < 0.01). No statistically significant results were shown for vitamin E, α-carotene, β-carotene, lycopene, and lutein plus zeaxanthin. The association of vitamin E and HNC was modified by alcohol status (P-interaction = 0.003) with lower risks in alcohol abstainers.
  
  
  CONCLUSIONS
  With this study, we show an inverse association between intake of vitamin C and the incidence of HNC and HNC-subtypes. Future research is recommended to investigate the underlying mechanisms and to confirm our results, which may be promising for the prevention of HNC.
authors.affiliation: Department of Epidemiology, GROW-School for Oncology & Developmental Biology, Maastricht University, Maastricht, Netherlands; and.
authors.forename: Leonie
authors.initials: L
authors.lastname: de Munter
authors.affiliation: Department of Epidemiology, GROW-School for Oncology & Developmental Biology, Maastricht University, Maastricht, Netherlands; and.
authors.forename: Denise H E
authors.initials: DH
authors.lastname: Maasland
authors.affiliation: Department of Epidemiology, GROW-School for Oncology & Developmental Biology, Maastricht University, Maastricht, Netherlands; and.
authors.forename: Piet A
authors.initials: PA
authors.lastname: van den Brandt
authors.affiliation: Department of Otorhinolaryngology, Head & Neck Surgery, GROW-School for Oncology & Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands.
authors.forename: Bernd
authors.initials: B
authors.lastname: Kremer
authors.affiliation: Department of Epidemiology, GROW-School for Oncology & Developmental Biology, Maastricht University, Maastricht, Netherlands; and lj.schouten@maastrichtuniversity.nl.
authors.forename: Leo J
authors.initials: LJ
authors.lastname: Schouten
mesh_terms: D000368:Aged; D000975:Antioxidants / Q000008:administration & dosage / Q000627:therapeutic use*; D001205:Ascorbic Acid / Q000008:administration & dosage / Q000627:therapeutic use*; D002338:Carotenoids / Q000008:administration & dosage / Q000627:therapeutic use; D016022:Case-Control Studies; D015331:Cohort Studies; D004032:Diet; D019587:Dietary Supplements; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000453:epidemiology / Q000517:prevention & control; D015994:Incidence; D007822:Laryngeal Neoplasms / Q000453:epidemiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000453:epidemiology / Q000517:prevention & control; D009426:Netherlands / Q000453:epidemiology; D009959:Oropharyngeal Neoplasms / Q000453:epidemiology / Q000517:prevention & control; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D014810:Vitamin E / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D000975:Antioxidants; D014810:Vitamin E; D002338:Carotenoids; D001205:Ascorbic Acid
keywords: carotenoid intake; head-neck cancer; prospective cohort study; risk factors; vitamins