Substantial experimental evidence indicates the potential importance of dietary and nutritional factors in cancer prevention, but identifying relationships between diet and cancer in observational epidemiological studies and intervention trials has proved challenging
Study design issues, imprecise dietary assessments, and a lack of consideration of tumour heterogeneity generally attenuate relative-risk estimates in observational studies; dietary biomarkers and characterization of aetiological subtypes can help to better identify diet–cancer associations
Interventional findings are constrained by the timing and brevity of intervention, nonlinear diet–cancer relationships, issues relating to baseline nutritional status, and magnitudes of change in diet that are generally insufficient to affect cancer outcomes
Foods and eating patterns are complex, and assessment of dietary patterns, rather than the traditional reductionist approach focused on specific dietary factors, is a new and more-promising strategy for investigating relationships with cancer
New technologies and advances in genetics, epigenetics and metabolomics, and consideration of the influence of the microbiome, will expand our understanding of the role of dietary factors in cancer risk and disease progression
Effectively communicating the status of the evolving science, and evidence-based dietary recommendations for cancer prevention that are based on rigorous review processes should be emphasized in guidance for the public and individual patients
Despite the potentially important roles of diet and nutrition in cancer prevention, the evidence to support these roles is widely perceived by the public and health professionals as being inconsistent. In this Review, we present the issues and challenges in conducting and interpreting diet–cancer research, including those relating to the design of epidemiological studies, dietary data collection methods, and factors that affect the outcome of intervention trials. Approaches to improve effect estimates, such as the use of biomarkers to improve the accuracy of characterizing dietary exposures, are also discussed. Nutritional and dietary patterns are complex; therefore, the use of a reductionist approach to investigations, by focusing on specific nutrients, can produce misleading information. The effects of tumour heterogeneity and the failure to appreciate the nonlinear, U-shaped relationship between micronutrients and cancer in both observational studies and clinical trials are discussed. New technologies and investigational approaches are enabling the exploration of complex interactions between genetic, epigenetic, metabolic, and gut-microbial processes that will inform our knowledge of the diet–cancer relationship. Communicating the status of the evolving science in the context of the overall scientific evidence base, and evidence-based dietary recommendations for cancer prevention, should be emphasized in guidance for the public and for individual patients.
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The opinions and conclusions expressed in this article are solely the views of the authors and do not necessarily reflect those of the US Food and Drug Administration.
The authors declare no competing financial interests.
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Mayne, S., Playdon, M. & Rock, C. Diet, nutrition, and cancer: past, present and future. Nat Rev Clin Oncol 13, 504–515 (2016). https://doi.org/10.1038/nrclinonc.2016.24
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