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Modifiable risk factors for prostate cancer in low- and lower-middle-income countries: a systematic review and meta-analysis

Abstract

Background

Most of the epidemiological data on prostate cancer risk factors come from high-income countries (HIC). Reducing exposure to prostate cancer modifiable risk factors may significantly lower PCa morbidity and mortality in LIC and MIC. The objective of this study was to summarize the evidence on modifiable risk factors (RFs) for PCa in LIC and lower-middle-income countries (LMIC).

Methods

We conducted a systematic search on MEDLINE, EMBASE, and Global Health databases. We selected case-control and cohort studies from 2010 onwards that studied modifiable RFs for PCa in LIC and LMIC with a population of 30 million or more, as defined by the World Bank in January 2021. Risk of bias was assessed by the Ottawa-Newcastle tool. Individual study estimates were pooled when estimates were available for at least two studies.

Results

5740 studies were initially identified; 16 studies met inclusion criteria. All were case–control studies except one retrospective cohort study. Higher fat intake was associated with a higher risk of PCa incidence with an odds ratio (OR) of 3.13 (95% CI 1.33–7.33). Higher vegetable intake (OR 0.48, 95% CI 0.24–0.97) and tea consumption (OR 0.51, 95% CI 0.32–0.83) were associated with a lower risk for PCa. There was no association between fruits, fish, and chicken consumption and risk of PCa. Alcohol consumption, smoking, red meat intake, and a BMI ≥ 25–30 kg/m2 showed a trend towards an increased risk, although these were not statistically significant.

Conclusions

In LIC and LMIC, high fat intake was associated with higher risk of PCa while a diet rich in vegetables and tea intake was associated with a lower risk. Future prospective studies will be important to elucidate whether other modifiable risk factors for PCa specific to LIC and LMIC can be identified to inform impactful and cost-effective preventive strategies in these countries.

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Fig. 1: Prisma flow-chart.
Fig. 2: Forest plots for dietary factors.
Fig. 3: Forest plots for other lifestyle and body compostion factors.

Data availability

All the data used for this study are available online on journal sites where the included studies were retrieved from.

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FC helped design the search strategy, collected the data, performed the statistical analysis and contributed to the manuscript; CK collected the data and contributed to the manuscript; SZ collected the data and contributed to the manuscript; SDM helped design the search strategy and contributed to the manuscript; MD contributed to the manuscript; JP designed the search strategy; DPL helped design the search strategy, reviewed the statistical analysis and contributed to the manuscript.

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Correspondence to Filipe Cirne.

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Cirne, F., Kappel, C., Zhou, S. et al. Modifiable risk factors for prostate cancer in low- and lower-middle-income countries: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 25, 453–462 (2022). https://doi.org/10.1038/s41391-022-00570-1

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