A multisite case-control study on factor analysis and several cancer sites (mouth and pharynx, esophagus, stomach, colon, rectum, larynx, lung, breast, prostate, bladder, kidney) was conducted in Uruguay. The study included 3,528 cases and 2,532 controls. Factor analysis (principal components) was modeled among controls. This patterning method retained 4 factors per sex, labeled as prudent, drinker, traditional and Western. Odds ratios for these cancer sites, stratified by sex, were estimated using polytomous regression. Whereas the prudent pattern was mainly negatively associated with cancers of the upper aerodigestive tract, the Western pattern showed a strong increase in breast, lung and colon cancers. The study allowed for the reproducibility of the prudent, drinker and Western patterns, whereas the traditional pattern appears to be country specific. ' 2008 Wiley-Liss, Inc.Key words: dietary patterns; factor analysis; principal components; polytomous regression Uruguay is a developing country with high rates of cancer, showing age-adjusted incidence rates of 386.0 per 100,000 men and 303.2 per 100,000 women for all sites. 1 The most frequent sites are female breast (age standardized rate 114.9 per 100,000 women) and lung (Age standardized rate 76.5 per 100,000 men). Smoking and alcohol drinking are the major risk factors for frequent cancers like lung cancer and cancers of the upper aerodigestive tract in the Uruguayan population. Also, a diet low in vegetables and fruits and high in beef consumption are risk factors for digestive tract cancers. 2 Since foods are consumed together it could be suggested that the true effect of the diet may only be observed when all components are analyzed simultaneously. In fact, foods could act in synergism or be metabolized jointly. [3][4][5] Patterning methodologies, including factor analysis, may turn the analytical difficulties into an advantage. Factor analysis is used to reduce a large number of foods or nutrients to smaller number of factors for modeling purposes. 6 This analytic method was originated in the pioneer paper of Spearman in 1904. 7 Since then it has grown explosively mainly in psychology and social sciences. In 1992, Randall et al. 8 firstly applied this method in the study of food patterns and colon cancer. Since then, numerous studies on dietary patterns and diverse cancers have been published all over the World.On the basis of a large dataset of cases and controls, we decided to conduct a multisite study using factor analysis in a high-risk country such as Uruguay. The main objective was to estimate odds ratios (ORs) of several cancer sites by means of the application of the principal components method and multinomial regression.
Material and methodsA large scale study was designed jointly by the