title: Occupational, dietary, and other risk factors for myelodysplastic syndromes in Western Greece.
abstract: OBJECTIVE
  We have observed an increasing incidence of myelodysplastic syndromes (MDS) in the geographic area of Western Greece during the past two decades. The objective of this study was to investigate potential risk factors for the manifestation of MDS in this area of Greece.
  
  
  METHODS
  A hospital-based case-control study was conducted in the public hospitals of the region. Participants were interviewed based on a questionnaire regarding demographics, occupational exposures, smoking, alcohol consumption, dietary, and domestic factors.
  
  
  RESULTS
  A total of 228 individuals (126 cases, 102 controls) were recruited in this study. Univariate analysis showed that risk of MDS was associated with a family history of hematologic malignancy or solid tumor, exposure to pesticides, insecticides, herbicides, increased weekly intake of meat and eggs, and increased alcohol intake, whereas fruit intake had a protective effect. Analysis by pesticide ingredient showed a weak association of exposure to paraquat and glyphosate with the occurrence of MDS. Multivariate analysis showed that independent risk factors for the manifestation of MDS were family history of solid tumor (OR 2.47, 95% CI 1.32-4.65), meat intake for ≥5 days/week (OR 2.67, 95% CI 1.05-6.80) and exposure to pesticides (OR 3.25, 95% CI 1.73-6.11).
  
  
  CONCLUSIONS
  Exposure to pesticides is a major risk factor of MDS in Western Greece. Family history of solid tumor and increased meat intake also appear to play a role in the pathogenesis of MDS. Public health authorities should implement policies to advise and protect farmers from the harmful effects of agrochemicals. Emphasis should also be given to health promotion advice including healthy eating.
authors.affiliation: a Hematology Division, Department of Internal Medicine , Medical School, University of Patras , Greece.|b Laboratory of Public Health , Medical School, University of Patras , Greece.
authors.forename: Christina
authors.identifier: http://orcid.org/0000-0002-1445-1676
authors.initials: C
authors.lastname: Avgerinou
authors.affiliation: a Hematology Division, Department of Internal Medicine , Medical School, University of Patras , Greece.
authors.forename: Ioanna
authors.identifier: http://orcid.org/0000-0002-0270-9836
authors.initials: I
authors.lastname: Giannezi
authors.affiliation: a Hematology Division, Department of Internal Medicine , Medical School, University of Patras , Greece.
authors.forename: Stela
authors.identifier: http://orcid.org/0000-0001-7534-4164
authors.initials: S
authors.lastname: Theodoropoulou
authors.affiliation: a Hematology Division, Department of Internal Medicine , Medical School, University of Patras , Greece.
authors.forename: Vasileios
authors.identifier: http://orcid.org/0000-0003-4886-5700
authors.initials: V
authors.lastname: Lazaris
authors.affiliation: a Hematology Division, Department of Internal Medicine , Medical School, University of Patras , Greece.
authors.forename: Georgia
authors.identifier: http://orcid.org/0000-0002-5821-1308
authors.initials: G
authors.lastname: Kolliopoulou
authors.affiliation: c Department of Hematology , 'St Andrew' General Hospital , Patras , Greece.
authors.forename: Panagiotis
authors.identifier: http://orcid.org/0000-0001-5463-1105
authors.initials: P
authors.lastname: Zikos
authors.affiliation: b Laboratory of Public Health , Medical School, University of Patras , Greece.
authors.forename: Yannis
authors.identifier: http://orcid.org/0000-0001-5822-5702
authors.initials: Y
authors.lastname: Alamanos
authors.affiliation: b Laboratory of Public Health , Medical School, University of Patras , Greece.
authors.forename: Michalis
authors.identifier: http://orcid.org/0000-0002-0345-9410
authors.initials: M
authors.lastname: Leotsinidis
authors.affiliation: a Hematology Division, Department of Internal Medicine , Medical School, University of Patras , Greece.
authors.forename: Argiris
authors.identifier: http://orcid.org/0000-0002-3685-3473
authors.initials: A
authors.lastname: Symeonidis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking; D016022:Case-Control Studies; D015897:Comorbidity; D004032:Diet; D004781:Environmental Exposure / Q000009:adverse effects; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000453:epidemiology* / Q000209:etiology*; D016273:Occupational Exposure / Q000009:adverse effects; D009790:Occupations; D016017:Odds Ratio; D010575:Pesticides / Q000009:adverse effects; D012307:Risk Factors; D012907:Smoking
chemical_list: D010575:Pesticides
keywords: Myelodysplastic syndromes; comorbidities; dietary factors; glyphosate; paraquat; pesticides; risk factors; stressful life event