title: Association of maternal and index child's diet with subsequent leukemia risk: A systematic review and meta analysis.
abstract: Exploring the effect of maternal and/or childhood diet on offspring leukemogenesis is challenging, given differences in food group categories, their potentially variable impact depending on time window of exposure and the multiple leukemia subtypes. We opted to quantitatively synthesize published data on the association of maternal/child diet with leukemia risk.
  
  
  
  Medline was searched until June 30th, 2016 for eligible articles on the association of childhood leukemia with consumption of (i) food groups, excluding alcoholic and non-alcoholic beverages, and (ii) specific dietary supplements before/during index pregnancy and childhood.
  
  
  
  Eighteen studies of case-control design (N=11,720 cases/18,721 controls) were included, of which nine assessed maternal dietary components, five index child's and four both, mainly focusing on acute lymphoblastic leukemia (ALL). Statistically significant inverse estimates for ALL were found (2 studies, 413 cases, 490 controls) for fruit (OR: 0.81, 95% CI: 0.67, 0.99); vegetables (OR: 0.51, 95% CI: 0.28, 0.94); legumes (OR: 0.76, 95% CI: 0.62, 0.94); fish (OR: 0.27, 95% CI: 0.14, 0.53, among the 0-4year old; 2 studies 215 cases, 215 controls); preconception folic acid supplementation (OR: 0.69, 95%CI: 0.50-0.95; published meta analysis plus 2 studies, 3511 cases, 6816 controls); and use of vitamins during pregnancy (OR: 0.81, 95%CI: 0.74-0.88; published meta analysis plus one study, 5967 cases, 8876 controls). The associations (2 studies) of the remaining food groups and maternal dietary supplements consumption during pregnancy as well as of childhood diet and supplements intake (2-4 studies) were non significant.
  
  
  
  Maternal consumption of specific food groups comprising"healthy" items of the Mediterranean diet, preconception use of folic acid and intake of vitamins during pregnancy were associated with decreased ALL risk. Further research is needed, however preferably with homogeneous dietary information and data on immunophenotypic/cytogenetic subtypes to also explore the interaction of specific macro- and micronutrients intake with gene polymorphisms.
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Greece.
authors.forename: Nick
authors.initials: N
authors.lastname: Dessypris
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Greece.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Karalexi
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Greece.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Ntouvelis
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Greece; Neurologische Klinik, Klinikum Mittelbaden Rastatt, Rastatt, Germany.
authors.forename: Andreas-Antonios
authors.initials: AA
authors.lastname: Diamantaras
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Greece.
authors.forename: Vassilios
authors.initials: V
authors.lastname: Papadakis
authors.affiliation: Department of Pediatric Hematology-Oncology, "Pan.&Agl. Kyriakou" Children's Hospital, Athens, Greece.
authors.forename: Margarita
authors.initials: M
authors.lastname: Baka
authors.affiliation: 2nd Department of Pediatrics, Aristotelion University of Thessaloniki, AHEPA General Hospital, Thessaloniki, Greece.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Hatzipantelis
authors.affiliation: Department of Pediatric Hematology and Oncology, Hippokration Hospital, Thessaloniki, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Kourti
authors.affiliation: Haematology-Oncology Unit, First Department of Pediatrics, Athens University Medical School, "Aghia Sophia" Children's Hospital, Athens, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Moschovi
authors.affiliation: Department of Pediatric Haematology-Oncology, "Aghia Sophia" Children's Hospital, Athens, Greece.
authors.forename: Sophia
authors.initials: S
authors.lastname: Polychronopoulou
authors.affiliation: Department of Pediatric Hematology and Oncology, Hippokration Hospital, Thessaloniki, Greece.
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Sidi
authors.affiliation: Department of Pediatric Hematology-Oncology, University Hospital of Heraklion, Heraklion, Greece.
authors.forename: Eftichia
authors.initials: E
authors.lastname: Stiakaki
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Greece. Electronic address: epetrid@med.uoa.gr.
authors.forename: Eleni Th
authors.initials: ET
authors.lastname: Petridou
mesh_terms: D000328:Adult; D002648:Child; D004032:Diet; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000209:etiology* / Q000517:prevention & control*; D011247:Pregnancy; D012307:Risk Factors
keywords: Childhood diet; Folic acid; Food group; Iron; Leukemia; Maternal diet; Micronutrients; Preconception; Supplements; Vitamins