Patrones dietarios y riesgo de cáncer de mama: un análisis factorial de alimentos y nutrientes / Dietary patterns and risk of breast cancer: a factor analysis of food and nutrient intakes

Objetivo: explorar los factores de riesgo dietarios en cáncer de mama (CM) mediante análisis factorial simultáneamente en alimentos y nutrientes. Introducción: la dieta es considerada un factor determinante en la carcinogénesis mamaria. Comparado con un análisis epidemiológico tradicional de alimentos y nutrientes aislados, el análisis factorial genera patrones de elementos asociados, útiles también para las comparaciones internacionales. Material y método: realizamos un estudio caso-control en donde 442 casos de CM y 442 controles fueron pareados por edad, residencia y estatus urbano/rural. Todas las pacientes presentaban un estatus socioeconómico bajo (bajo promedio de años de educación e ingresos). Los controles no presentaban afecciones relacionadas con tabaquismo o alcoholismo, ni habían modificado recientemente su dieta. Un análisis factorial (componentes principales) fue realizado entre controles para alimentos y nutrientes individuales sobre datos de un cuestionario alimentario de 64 ítems, ya utilizado en numerosos estudios caso-control previos. Resultados: el análisis factorial hecho con alimentos retuvo los factores occidental, tradicional, frutas totales, prudente y carnes procesadas. Este análisis usando nutrientes retuvo los factores base animal, almidón/lácteos, base frutal y carotenoides. Mientras que el patrón occidental mostró un riesgo significativo aumentado de CM (OR = 2,15), el patrón prudente se asoció inversa y significativamente (OR = 0,67). En patrones de nutrientes el factor base animal se asoció directamente con CM, mientras que el factor carotenoides se asoció inversamente. Hubo diferencias de asociación según estatus menopáusico. Conclusiones: el análisis factorial mostró el rol potencial de elementos dietarios a partir de alimentos y nutrientes, tanto de riesgo como protectores, en la etiología de CM.

Abstract Objective: to explore the dietary risk factors of breast cancer by means of a simultaneous factor analysis in food and nutrient intakes. Introduction: diet is considered a determining factor in breast carcinogenesis. If compared to a traditional epidemiological analysis of isolated food and nutrient intakes, the factor analysis creates patterns of associated elements, what is also useful for international comparisons. Method: we conducted a case control study where 442 cases of breast cancer and 442 controls were matched by age, residence and urban/rural status. All patients belonged to the lower socioeconomic status (low average of education and income). Controls did not evidence conditions associated to smoking or the consumption of alcohol, and they had not modified their diets either. A factor analysis (main components) was conducted among controls for individual food and nutrients on the basis of a food questionnaire of 64 items, which had already been used in several previous control case studies. Results: the factor analysis made with food kept the following factors: western, traditional, total fruits, cautious and processed meats. This analysis using nutrients kept the animal base, starch/dairy products, fruit base and carotenoids. While the western pattern showed an increased significant risk of breast cancer (OR= 2.15), the prudent pattern was inversely and significantly associated (OR= 0.67). In nutrient patterns the animal base factor was directly associated to breast cancer, whereas the carotenoid factor was inversely associated to it. There were association differences depending on the menopausal status. Conclusions: factor analysis showed the potential role of dietary elements in foods and nutrients, both as risk and protective factors, in the etiology of breast cancer.

Resumo Objetivo: explorar os fatores de risco dietético no câncer de mama (CM) utilizando análise fatorial simultânea em alimentos e nutrientes. Introdução: a dieta é considerada um fator determinante na carcinogénese mamaria. Comparada com uma análise epidemiológica tradicional de alimentos e nutrientes isolados, a análise fatorial gera padrões de elementos associados, úteis também para as comparações internacionais. Material e método: realizamos um estudo caso-controle com 442 casos deCMe 442 controles pareados por idade, residência e local de residência urbano/rural. Todas as pacientes apresentavam condições socioeconômicas baixas (baixas escolarização e renda). Os controles não apresentavam afecções relacionadas com tabaquismo ou alcoolismo, nem haviam modificado recentemente sua dieta. Uma análise fatorial (componentes principais) foi realizada entre controles para alimentos e nutrientes individuais utilizando os dados de um questionário alimentar de 64 itens, utilizado em vários estudos caso-controle anteriores. Resultados: a análise fatorial realizada com alimentos indicou os fatores ocidental, tradicional, frutas totais, prudente e carnes processadas. Esta análise usando nutrientes indicou os fatores base animal, amido/lácteos, frutas e carotenoides. O padrão ocidental mostrou um risco significativo aumentado de CM (OR = 2,15), enquanto o padrão prudente estava associado inversa e significativamente(OR = 0,67). Nos padrões de nutrientes o fator base animal estava associado diretamente com CM, enquanto o fator carotenoides estava inversamente associado. Foram observadas diferenças nas associações segundo condições menopausáticas. Conclusões: a análise fatorial mostrou o potencial de elementos dietéticos a partir de alimentos e nutrientes, tanto de risco como protetores, na etiologia do CM.

Meat consumption and risk of squamous cell carcinoma of the lung: a case-control study in Uruguayan men.

In the period 1995-2004, a hospital-based case-control study on meat consumption and squamous cell carcinoma of the lung in men was conducted in Montevideo, Uruguay. The study included 300 cases and 600 controls, frequency matched on age and residence. The results showed that total meat [odds ratio (OR) = 1.72, 95% confidence interval (CI): 1.05-2.81, P value for trend = 0.03], red meat (OR = 1.82, 95% CI: 1.13-2.91, P value for trend = 0.01), beef consumption (OR = 2.22, 95% CI: 1.42-3.45, P value for trend = 0.0004), bacon (OR = 1.50, 95% CI: 1.00-2.24, P value for trend = 0.03), saucisson (OR = 1.69, 95% CI: 1.07-2.67, P value for trend = 0.01), and salted meat intake (OR = 2.70, 95% CI: 1.63-4.46, P value for trend = 0.0001) were positively associated with squamous cell lung cancer. These results are discussed and we suggest that meat consumption could be considered as a strong risk factor for squamous cell lung cancer.

Meat consumption, animal products, and the risk of bladder cancer: a case-control study in Uruguayan men.

In the time period 1996-2004, all incident cases of bladder cancer were included in a case-control study in order to study the role of meat consumption and product animals in the etiology of urothelial cancer. The study included 225 cases and 1,510 hospitalized controls with non-neoplastic conditions, not related to smoking and alcohol drinking. Relative risks, approximated by the odds ratios, were calculated in order to clarify the effect of meat consumption in the etiology of urothelial cancer. Total meat consumption (OR 1.47, 95% CI 1.02-2.11), total processed meat (OR 1.57, 95% CI 1.08-2.27), frankfurters (hot dogs) (OR 2.03, 95% CI 1.28-3.21), ham (OR 1.79, 95% CI 1.21-2.67) and salted meat (OR 2.73, 95% CI 1.78-4.18) were positively associated with risk of bladder cancer. Animal products, like cheese, whole milk, and total eggs were also associated with bladder cancer risk (OR for eggs 4.05, 95% CI 2.68-6.12). In conclusion, total meat, processed meat, and eggs could play an important role in the etiology of bladder cancer in Uruguay.

Processed meat consumption and squamous cell carcinoma of the oesophagus in a large case-control study in Uruguay.

BACKGROUND: The role of processed meat in the aetiology of squamous cell oesophageal cancer has been explored in detail. METHODS: In the time period 1990-2005, a case-control study was conducted in Montevideo, Uruguay including 2,368 participants (876 cases of oesophageal cancer and 1,492 controls). Relative risks, approximated by the odds ratios, were estimated by multiple unconditional logistic regression. RESULTS: Processed meat was positively associated with oesophageal cancer (upper quartile vs lower quartile OR 2.30, 95%CI 1.72-3.07), whereas salted meat intake was positively associated with squamous cell oesophageal cancer (OR 3.82, 95%CI 2.74-5.33). Finally other cured meats were positively associated with oesophageal cancer (OR 1.65, 95%CI 1.22- 2.22). CONCLUSIONS: It could be concluded that processed meat consumption could be an important risk factor for the aetiology of squamous cell oesophageal cancer in Uruguay.

Diet patterns and risk of squamous cell oesophageal carcinoma: a case-control study in Uruguay.

BACKGROUND: Oesophageal cancer presents high incidence rates in the so-called Brazilian-Uruguayan belt. MATERIALS AND METHODS: The present study included 1,170 participants (234 cases and 936 controls) which were analyzed by unconditional multiple logistic regression in order to examine risk of oesophageal squamous cell carcinoma (OESCC) associated with several food groups. RESULTS: Boiled red meat (OR 2.59, 95%CI 1.69-3.97), lamb meat (OR 1.64, 95%CI 1.07-2.51), processed meat (OR 1.49, 95%CI 1.01-2.21), whole milk (OR 1.78, 1.19-1.68), fresh vegetables and fruits (OR 0.42, 95%CI 0.27-0.63), mate consumption (OR 2.04, 95%CI 1.32- 3.16), and black tea (OR 0.10, 95%CI 0.04-0.28) were significantly associated with risk of OESCC. CONCLUSIONS: Hot beverages (mate) and hot foods (boiled meat) appear to be important determinants in the risk of OESCC, allowing the penetration of carcinogens in tobacco and alcohol into the oesophageal mucosa.

Maté drinking and esophageal squamous cell carcinoma in South America: pooled results from two large multicenter case-control studies.

BACKGROUND: Maté tea is a nonalcoholic infusion widely consumed in southern South America, and may increase risk of esophageal squamous cell carcinoma (ESCC) and other cancers due to polycyclic aromatic hydrocarbons (PAH) and/or thermal injury. METHODS: We pooled two case-control studies: a 1988 to 2005 Uruguay study and a 1986 to 1992 multinational study in Argentina, Brazil, Paraguay, and Uruguay, including 1,400 cases and 3,229 controls. We computed ORs and fitted a linear excess OR (EOR) model for cumulative maté consumption in liters/day-year (LPDY). RESULTS: The adjusted OR for ESCC with 95% confidence interval (CI) by ever compared with never use of maté was 1.60 (1.2-2.2). ORs increased linearly with LPDY (test of nonlinearity; P = 0.69). The estimate of slope (EOR/LPDY) was 0.009 (0.005-0.014) and did not vary with daily intake, indicating maté intensity did not influence the strength of association. EOR/LPDY estimates for consumption at warm, hot, and very hot beverage temperatures were 0.004 (-0.002-0.013), 0.007 (0.003-0.013), and 0.016 (0.009-0.027), respectively, and differed significantly (P < 0.01). EOR/LPDY estimates were increased in younger (<65) individuals and never alcohol drinkers, but these evaluations were post hoc, and were homogeneous by sex. CONCLUSIONS: ORs for ESCC increased linearly with cumulative maté consumption and were unrelated to intensity, so greater daily consumption for shorter duration or lesser daily consumption for longer duration resulted in comparable ORs. The strength of association increased with higher maté temperatures. IMPACT: Increased understanding of cancer risks with maté consumption enhances the understanding of the public health consequences given its purported health benefits.

Nutrient-based dietary patterns of head and neck squamous cell cancer: a factor analysis in Uruguay.

OBJECTIVE: The aim of this study was to investigate the association between nutrient-based dietary patterns and squamous cell cancers of the head and neck. METHODS: We used a case-control study which included 548 cases and 548 controls. From these participants, we derived 23 nutrients and they were then submitted to a factorability analysis in order to conduct a principal component factor analysis. RESULTS: We were able to identify four nutrient-derived patterns. The first pattern (meat-based pattern) was positively associated with squamous cell cancer of the head and neck (OR 2.85, 95 % CI 1.81-4.15), whereas the third pattern (fruit-based) was strongly protective (OR 0.43, 95 % CI 0.27-0.63). The other nutrient patterns were also significantly associated with head and neck squamous cell carcinoma with minor ORs. CONCLUSION: Both patterns suggest that red meat and fruits are major factors in the etiology of head and neck squamous cell cancer, replicating previous studies in the field.

Meat, milk and risk of lymphoid malignancies: a case-control study in Uruguay.

In the time period 1996-2004, 697 cases with lymphoid neoplasms and 3606 controls with nonneoplastic conditions were included in a case-control study conducted in the Cancer Institute of Uruguay. They were administered a routine questionnaire that included 8 sections and a food frequency questionnaire focused on intakes of total meat, red meat, salted meat, barbecued meat, processed meat, milk, total vegetables and total fruits, and alcoholic beverages. Lymphoid cancers were analyzed by multiple polytomous regression. Red meat, salted meat, and milk were positively associated with risk of lymphoid cancers [odds ratios (OR) for the highest tertile vs. the lowest one of red meat = 1.68, 95% confidence interval (CI) 1.37-2.08, OR for whole milk = 2.92, 95% CI 2.63-3.63). On the other hand, plant foods, particularly total fruits, and alcoholic beverages (mainly red wine) were protective. We could conclude that these foods could play a significant role in the etiology of lymphoid malignancies.

Dietary patterns and risk of cancers of the upper aerodigestive tract: a factor analysis in Uruguay.

In the time period 1996-2004, we conducted a case-control study in Montevideo, Uruguay with the objective of exploring the role of foods and alcoholic beverages in the etiology of cancers of the upper aerodigestive tract (UADT). In brief, 563 male cases and 1099 male controls were frequency matched on age and residence using random sampling. All the participants were drawn from the 4 major public hospitals in Montevideo. We used exploratory factor analysis among controls. Through Scree plot test, the model retained 4 factors, which were labeled as prudent, starchy plants, Western, and drinker. These dietary patterns explained 34.8% of the total variance. Whereas the prudent pattern was inversely associated with UADT cancer [odds ratios (OR) for the upper tertile vs. the lowest one 0.52, 95% confidence intervals 0.32-0.76, P value for trend = 0.0005), the remaining patterns were significantly and positively associated with UADT cancers. We conclude that these patterns were similar among the oral and laryngeal cancers, both in the direction of the ORs and in the magnitude of the associations, suggesting that these cancer sites share the effect of dietary patterns in the etiology of cancer of the upper aerodigestive tract.

Maté consumption and risk of oral cancer: Case-control study in Uruguay.

BACKGROUND: In the period 1990 to 2001, a case-control study on oral cancer and maté consumption was conducted at the Cancer Institute of Uruguay. METHODS: The study included 696 newly diagnosed cases with squamous cell carcinoma and 696 controls afflicted with nonneoplastic conditions not related to tobacco smoking and alcohol drinking. The participants were matched on age and residence and the study was restricted to men. RESULTS: In order to control confounding for tobacco and alcohol, we fitted 2 models. According to model 1, the odds ratio (OR) for maté consumption was 1.15 (95% confidence interval [CI], 0.76-1.73), whereas the results for model 2 showed an OR of 3.47 (95% CI, 1.60-7.52). CONCLUSIONS: The inclusion of a term for the interaction between maté and smoking (or drinking) was rewarding and the ORs were even higher than those observed with the crude estimates.