Mediterranean diet adherence and risk of esophageal and gastric cancer subtypes in the Netherlands Cohort Study

Background Mediterranean diet (MD) adherence has been associated with reduced risks of esophageal and gastric cancer (subtypes) in a limited number of studies. We prospectively investigated associations between MD adherence and risks of esophageal squamous cell carcinoma (ESCC), esophageal adenocarc...

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Bibliographic Details
Published in:Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 2019-07, Vol.22 (4), p.663-674
Main Authors: Schulpen, Maya, Peeters, Petra H., van den Brandt, Piet A.
Format: Article
Language:English
Subjects:
Abdominal Surgery
Adenocarcinoma
Adenocarcinoma - diet therapy
Adenocarcinoma - pathology
Adenocarcinoma - prevention & control
Aged
Alcohol
Cancer Research
Carcinoma, Squamous Cell - diet therapy
Carcinoma, Squamous Cell - pathology
Carcinoma, Squamous Cell - prevention & control
Cohort analysis
Diet
Diet, Mediterranean
Esophageal cancer
Esophageal Neoplasms - diet therapy
Esophageal Neoplasms - pathology
Esophageal Neoplasms - prevention & control
Esophagus
Female
Follow-Up Studies
Gastric cancer
Gastroenterology
Humans
Male
Medicine
Medicine & Public Health
Middle Aged
Netherlands
Oncology
Original Article
Patient Compliance
Prognosis
Prospective Studies
Risk Factors
Squamous cell carcinoma
Stomach Neoplasms - diet therapy
Stomach Neoplasms - pathology
Stomach Neoplasms - prevention & control
Surgical Oncology
Surveys and Questionnaires
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Summary:Background Mediterranean diet (MD) adherence has been associated with reduced risks of esophageal and gastric cancer (subtypes) in a limited number of studies. We prospectively investigated associations between MD adherence and risks of esophageal squamous cell carcinoma (ESCC), esophageal adenocarcinoma (EAC), gastric cardia adenocarcinoma (GCA), and gastric non-cardia adenocarcinoma (GNCA) in a Dutch cohort. Methods Analyses were conducted using data from the 120852 participants of the Netherlands Cohort Study (NLCS), who were aged between 55 and 69 years at enrollment. Various MD scores, with and without alcohol, were calculated to estimate MD adherence. Using 20.3 years of follow-up, 133 ESCC, 200 EAC, 191 GCA, and 586 GNCA cases could be included in multivariable Cox regression analyses. Results Of the investigated scores, the alternate Mediterranean diet score without alcohol (aMEDr) performed best. aMEDr was inversely associated with risks of GCA and GNCA in men and women. However, statistical significance was only reached in men [ p trend : 0.019 (GCA), 0.016 (GNCA)]. Furthermore, higher aMEDr values were significantly associated with a reduced ESCC risk in men [HR per two−point increment (95% CI) = 0.57 (0.41–0.80), p trend  = 0.013], but not in women ( p heterogeneity  = 0.008). There was no evidence of an association between aMEDr and EAC risk. Educational level was a significant effect modifier for the association between aMEDr and GNCA risk ( p heterogeneity  = 0.0073). Conclusions Higher MD adherence was associated with reduced risks of ESCC, GCA, and GNCA in the NLCS. However, the decreased ESCC risk might be limited to men.
ISSN:1436-3291
1436-3305
DOI:10.1007/s10120-019-00927-x