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

Abstract

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. Electronic supplementary material The online version of this article (10.1007/s10120-019-00927-x) contains supplementary material, which is available to authorized users.

An updated systematic review and meta-analysis on adherence to mediterranean diet and risk of cancer

“…Although our results suggested a small reduction in overall cancer risk for alcohol intake within the range, compared to higher alcohol consumption, the benefit from light-to-moderate consumption of wine on cancer risk in observational studies is inconclusive [174][175][176]. Risk estimates for several cancers based on MedDiet scores including alcohol did not differ from those simply adjusted for total alcohol intake [122,[145][146][147][148][149]. Consumption of wine together with meals is a part of the cultural heritage in Mediterranean countries, but it is less common in other countries [177].…”

Adherence to the Mediterranean Diet and Risks of Prostate and Bladder Cancer in the Netherlands Cohort Study

“…34). Because of the equal or better performance of aMEDr compared with mMEDr in both the current and previous NLCS analyses (35)(36)(37), the Results section of this article mainly focuses on associations with aMEDr and subgroup analyses were only performed using this score. We preferred the aMED variant without alcohol (aMEDr), because alcohol consumption is a risk factor for several types of cancer (29).…”

Diet Quality and Upper Gastrointestinal Cancers Risk: A Meta-Analysis and Critical Assessment of Evidence Quality

“…However, findings from a prospective study demonstrated approximate reductions of 40% in the risk of gastric cancer [ 8 ] and 50% in the risk of esophageal cancer [ 9 ], when consuming a high-quality diet defined by the DII. Likewise, others have reported beneficial effects on the risk of UGI cancer when consuming high-quality diets, as measured by the MDS [ 10 , 11 ] and HEI [ 12 ].…”