Diet and cancers of the larynx and hypopharynx: the IARC multi-center study in southwestern Europe.

The main causes of cancer of the larynx and hypopharynx are smoking cigarettes and drinking alcohol. However, for these as well as for other cancers of the upper aerodigestive tract, some dietary components, mainly low consumption of fruit and vegetables, have been observed to be associated with increased cancer risk. We report results from a multicenter case-control study carried out in six regions of Europe located in northern Spain, northern Italy, Switzerland, and France. A total of 1,147 males with cancer (cases) and 3,057 population controls were interviewed on usual diet, lifelong drinking and smoking habits, and occupational history. Cancer cases had histologically verified epidermoid carcinomas. The cancers were classified in two anatomic sub-entities: the epilarynx (hypopharynx and upper part of the larynx), which enters into contact with the bolus and the air; and the endolarynx, through which air and tobacco smoke pass, but not the bolus. A previous report from this study found that alcohol drinking presents a greater risk factor for cancer of the epilarynx than for cancer of the endolarynx. The main results regarding diet indicate that high intake of fruit, vegetables, vegetable oil, fish, and low intake of butter and preserved meats were associated with reduced risk of both epilaryngeal and endolaryngeal cancers, after adjustment for alcohol, tobacco, socioeconomic status, and non-alcohol energy intake. Among nutrients, a reduced risk was found for high intake of vitamins C and E and for a high polyunsaturated/saturated fatty acids (P/S) ratio. While these variables are relevant in scoring nutritional behaviour, it remains unresolved whether the biologic properties of these nutrients play a role in the apparent protective effect.

Relationship between adiposity and food intake: an example of pseudo-contradictory results obtained in case-control versus between-populations studies.

Seemingly contradictory data support controversies concerning the relationships between food intake and illnesses. The present study of 1035 adults, aged 30-39 years, shows that (1) daily energy intake is not higher in obese than in non-obese people, (2) obesity is more prevalent in social groups where energy intake is higher. These pseudo-contradictory results can be reconciled on the basis of a constitution/environment interaction. A comparison of groups based on presence or absence of illness (obesity, hypertension, coronary heart disease (CHD), cancer, etc) shows that some people can develop risk factors, even though their feeding behaviour is normal. This result (no direct relationship) underlines differences in individual susceptibility. When comparisons are made between populations with different diets the results (direct relationship) express environmental factors. The hypotheses on behavioural contribution to the aetiology of certain diseases appears more clearly in between-population comparisons than in case-control studies. Results of comparisons between populations (if the hypotheses they suggest are confirmed by intervention studies) warrant prevention at the level of populations, while results of case-control studies justify particular prevention in subjects at risk.

A comparative study of smoking, drinking and dietary habits in population samples in France, Italy, Spain and Switzerland. I. Study design and dietary habits.

Diet, tobacco and alcohol consumption, and occupational histories have been investigated in stratified random samples of the adult population in 6 areas in France (departement of Calvados), Italy (province of Varese and city of Torino), Spain (provinces of Navarra and Zaragoza) and Switzerland (canton of Geneva), to be used as a reference group in a case-control study on cancer of the larynx and hypopharynx. Out of a total of 8,074 sampled subjects, 5,564 could be interviewed. Sampling procedures are described, and reasons for non-response are analysed. Everywhere the intake of the 4 energy providing nutrients (particularly alcohol) was much greater in men than in women. In both sexes, total caloric intake was higher in Calvados and in Italy than elsewhere. There were wide inter-area variations in the consumption of butter + milk products and oils, resulting in a polyunsaturated/saturated fatty acid ratio ranging from 0.27 in Calvados to 0.54-0.65 in Spain. Among nutrients suggested to be involved in cancer aetiology, inter-area differences in daily intake were up to 3-fold for carotene and smaller for vitamin C and fibre. The proportion of lipids, fibres, vitamin C and carotene provided by different foods varied widely between areas, thus suggesting that in etiological cancer studies consideration should be given not only to nutrients but also to foods providing them.

A comparative study of smoking, drinking and dietary habits in population samples in France, Italy, Spain and Switzerland. III. Consumption of alcohol.

Individual present and life time intake of aethanol has been studied in population samples of six areas of Italy (Torino, Varese), Spain (Navarra, Zaragoza), Switzerland (Geneva) and France (Calvados); 2,965 men and 2,369 women were interviewed. Abstinent men were no more than 4% except in Zaragoza (11.5%); 49 to 61% drank between 20 and 80 g. aethanol a day and 21 to 26% more than 80 g. (36% in Navarra). Women drank much less and were more often abstinent: 50 to 94% of them did not drink or drank less than 20 g. a day. Wine was the most commonly consumed beverage (over 60% of total alcohol intake), except in Calvados where cider was still largely consumed (over 30%). Such differences in drinking habits by sex and region are of major public health importance. They do not appear in national sales statistics which must be complemented by surveys on individuals.

Diet and esophageal cancer in Calvados (France).

The role of nutrients and food factors in relation to esophageal cancer was observed in a large case-control study in a region having a high incidence of the disease. Several factors that increased or decreased the risk were identified. After adjusting for other covariates, we found that animal proteins and polyunsaturated fats had a significant protective effect. Separating the effects of specific nutrients was difficult because of the intercorrelation between individual intakes of most nutrients. Foods were not so highly intercorrelated. Fresh meat, citrus fruits, and oil were found to be protective. A dietary index combining these foods was used; between the lowest and the highest levels of intake, a nine-fold difference in risk was observed. This effect is added to that of alcohol, which remains the major risk factor. The adequacy of the concepts of nutrients and foods in epidemiological studies is discussed in addition to the theoretical and practical implications of the findings.

[Results of a dietary survey in the Calvados. Dietary intake, tobacco and alcohol consumption]. / Résultats d'une enquête alimentaire dans le Calvados. Ration alimentaire, consommation de tabac et d'alcool.

A survey on individual nutritional intake was conducted in a representative sample of 1,975 people in the French province of Calvados using a dietary history method. The energy ration (2,964 kcal/d in males, 2,148 kcal/d in females) was found to exceed the recommended allowances by 150 kcal/d in women and by 300 kcal/d in men, corresponding to alcohol consumption. The trends observed were similar to those seen elsewhere in France and other developed countries: a diet with a high proportion (41-43 p. 100) of lipids and saturated fatty acids (16-18 p. 100) mainly due to reduced consumption of vegetable foods; a high intake of cholesterol (513-422 mg) and a low ration of polyunsaturated fatty acids (3.9-4.5 p. 100) leading to a high risk of vascular diseases, particularly of the coronary arteries. The high intake of alcohol may be responsible for the high incidence of alcohol-related diseases, possibly in association with tobacco. The intake of vitamins and minerals was adequate, with the exception of iron, which was below the recommended allowance for females. In contrast with common belief, the dietary energy intake increased when alcohol consumption increased in both sexes. For tobacco, the energy ration decreased moderately in females only with increasing consumption; no relationship was observed in males.

[Diet and rectocolonic cancers. Results of a case-control study]. / Alimentation et cancers recto-coliques. Résultats d'une étude "cas-témoin".

In a case-control study performed in an hospital of the North-Eastern Paris area, nutritional intakes of 94 patients with colorectal carcinoma were compared with those of 94 control patients, matched for age and sex. Results were expressed as mean daily nutrients and energy intakes. This dietary survey covered the "present period" (i.e. prior to the hospitalisation) and the "past-period" in case of striking and prolonged changes in dietary habits. Whatever the site of carcinoma (the rectum and sigmoid or the remaining colon) there was no statistically significant difference between patients and controls (in both sexes) for the following parameters: a) total energy intake, b) proportions of lipids, proteins and fat expressed as percentages of total energy intake, c) minerals, d) vitamins and e) dietary fibers. In women with colorectal carcinoma, a decrease in alcohol and lipid consumptions was observed. In patients with rectal or sigmoid carcinoma past alcoholic intakes were higher in both sexes. These results do not allow any clear epidemiological conclusion. In spite of their cost and length prospective studies are probably the only way to answer the difficult question of which dietary factors may be found in colorectal carcinoma.

Alcohol consumption in healthy women: relationship to gamma-glutamyl transferase activity, mean corpuscular volume and hormonal status.

PIP: 362 nonpregnant women aged 18-76 years participated in a study to determine the relationship between gamma-glutamyl-transferase (GGT), mean corpuscular volume (MCV), and alcohol consumption in women. The women provided information on their tobacco consumption over the past 5 years, their dietary habits, their mean daily intake of pure alcohol, and their hormonal status, including use of oral contrceptives (OCs). The women were classified into 3 groups: 176 nonusers of OCs (NOC), 85 users of OCs, mainly prepartions with 50 mcg estrogen (OC), and 101 postmenopausal women (PM). 29 additional women were excluded from the analysis because of missing data or because they used estrogens for medical reasons independent of contraception. Average age was 34.9 years for the NOC group, 31.4 for the OC, and 55.6 for the PM group. Tobacco consumption did not differ and alcohol consumption was quite similar in the 3 groups. MCV in cu mcm was 89.7 +or- 1.4 for NOC, 89.9 +or- 1.6 for OC, and 90.5 +or- 1.9 for PM. GGT in U/1 was 14.3 +or- 1.4 for NOC, 13.7 +or- 1.2 for OC, and 22.4 +or- 5.0 for PM. The results indicated that the effect of alcohol might be different in the 3 groups. In the NOC group, MCV was slightly different between teetotalers and drinkers (88.2 +or- 0.5 and 90.2 +or- 0.2 cu mcm respectively), while the GGT level was 9.3 +or- 0.4 in teetotalers and 15.7 +or- 2.2 in drinkers. In the OC group, the only significant difference was observed in GGT levels with a lower degree of significance than for the NOC group. OC teetotalers had GGT levels of 11.5 +or- 6.0 U/1 compared to 14.4 +or- 1.5 for drinkers. No difference was observed for any parameter in the PM group but there was a tendency toward higher MCV and GGT values among the teetolalers. A multiple regression analysis in each group indicated that in the NOC group, GGT and MCV are the 2 main relevant parameters in predication of alcohol consumption, with age a 3rd factor. The multiple regression coefficient is much higher in the NOC group than in the total female group and is quite similar to that of the male group. In the OC group, age is the 1st relevant factor in prediction of alcohol consumption, followed by GGT. No significant correlation with any variable was found in the PM group.^ieng

Greater risk of ascitic cirrhosis in females in relation to alcohol consumption.

The risk of ascitic cirrhosis increases with average daily consumption of alcoholic beverages, both in males and in females. For the latter, however, the curve is much steeper, indicating a greater risk for the female liver, with the disease occurring earlier in life. Health implications are discussed.

Alcohol consumption patterns in the department of Calvados (France).

The individual consumption of alcoholic beverages was determined by interviewing 1.976 people, a representative sample of the population. 92% of males and 74% of females drink alcohol but no more than 4% of females consume over 40 g per day, against 39% males. The average intake is greater in rural than in urban areas. Wine is the most popular beverage but the consumption of cider remains important in rural areas. Apple brandy is also consumed in sizeable quantities by rural males. There are few beer drinkers, except in the younger age groups. The implications of these results are discussed. They probably reflect changes in drinking patterns over time; the traditional locally produced cider and apple brandy are progressively abandoned by the young, who turn to beer and aperitifs. Consequent changes in alcohol related pathology are expected.

Maternal smoking and birth weight in relation to dietary habits.

A study on dietary and smoking behavior during pregnancy was performed between January, 1976, and September, 1979, at the St. Antoine Maternity Hospital in Paris. In addition to the routine clinical examinations at the third, sixth, eight, and ninth months of pregnancy, the women were systematically questioned about their dietary and tobacco habits. No dietary advice was given by the dietitians at any time, nor was there special counseling against smoking. Among 534 women who were followed up, 200 (37%) were smokers before pregnancy. At the sixth month, half of them had stopped smoking and the others had reduced their consumption. The analysis showed that the mean caloric intake and the gain in weight were the highest in the women who continued to smoke and the lowest in nonsmokers. Intermediate results were found in smokers who stopped. Birth weight was, on the average, 70 gm lower among smokers throughout pregnancy, compared with the other two groups, but this difference was not significant. These findings are consistent with the hypothesis that the negative effects of smoking on the fetus could be compensated for, to a great extent, by extra food.

Varicose veins: a risk factor for atherosclerotic disease in middle-aged men?

The prevalence of varicose veins was higher among lower social subjects and was positively associated with a body-mass index, cigarette consumption and diastolic blood pressure. A detailed dietary survey in a subsample of the population showed a significantly higher total calory intake in men with varicose veins but no difference in the distribution of the various nutrients. During follow up for subsequent atherosclerotic disease (average 6.6 yrs), men with varicose veins were at a significantly higher risk for intermittent claudication and, at least in the lower social class, for hard coronary heart disease. No association was found with angina pectoris incidence.

Alcohol consumption in a healthy population. Relationship to gamma-glutamyl transferase activity and mean corpuscular volume.

We analyzed the multivariate relationship between alcohol consumption and gamma-glutamyl-transferase (GGT), mean corpuscular volume (MCV), and tobacco consumption. A group of 995 healthy outpatients (604 men and 391 women, 18 to 76 years old) were systematically examined. Daily alcohol consumption was established after an interview regarding complete dietary habits. Significant correlations have been found between daily alcohol intake and corresponding GGT and MCV values, .35 and .34, respectively, in men and .24 and .21 in women. Multiple regression analyses confirm the superiority of GGt over MCV as a laboratory marker of alcohol intake and show the advantage of using them together. A rough estimation of alcohol consumption is proposed as a first step in mass screening of heavy drinkers.