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Diet quality and lung cancer incidence in a low-income population in the United States

British Journal of Cancer volume 129, pages 626–635 (2023)Cite this article

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Abstract

Background

Although tobacco smoking is the leading cause of lung cancer, interest in the relationship of diet quality on risk has been growing.

Methods

We examined the association between Healthy Eating Index-2010 (HEI-10) at enrollment and lung cancer incidence among 70,802 participants in a predominantly African American and low-income prospective cohort in the southern United States. Outcomes were ascertained through linkages with state cancer registries and the National Death Index (NDI). Hazard ratios by HEI-10 quartiles were assessed using Cox proportional hazard models adjusted for potential confounders.

Results

During ≤16 years of follow-up, 1454 incident lung cancers were identified. The lowest HEI-10 quartile compared to the highest was adversely associated with lung cancer risk (HR: 1.89, 95% CI 1.16–3.07) among male former smokers and female never smokers (HR: 2.58, 95% CI 1.06–6.28).

Conclusions

Low-quality diet was associated with increased lung cancer risk among male former smokers and female never smokers but cautious interpretation of the findings should be taken due to the small number of lung cancers among never smokers and the possibility of residual confounding by smoking in ever smokers.

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Data availability

Requests for data are to be made at www.southerncommunitystudy.org.

References

  1. Centers for Disease Control and Prevention. An Update on Cancer Deaths in the United States. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, Division of Cancer Prevention and Control; 2021 [cited 2021 Oct 29]. Available from: https://www.cdc.gov/cancer/dcpc/research/update-on-cancer-deaths/index.htm.

  2. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2021. CA Cancer J Clin. 2021;71:7–33.

    Article  PubMed  Google Scholar 

  3. Kushi LH, Doyle C, McCullough M, Rock CL, Demark-Wahnefried W, Bandera EV, et al. American Cancer Society guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin. 2012;62:30–67.

    Article  PubMed  Google Scholar 

  4. World Cancer Research Fund/American Institute for Cancer Research. Continuous Update Project: Diet, Nutrition, Physical Activity and the Prevention of Cancer. Summary of Strong Evidence [cited 2021 Oct 29]. Available from: https://www.wcrf.org/cupmatrix.

  5. Wang C, Yang T, Guo X-F, Li D. The associations of fruit and vegetable intake with lung cancer risk in participants with different smoking status: a meta-analysis of prospective cohort studies. Nutrients. 2019;11:1791.

    Article  PubMed  PubMed Central  Google Scholar 

  6. World Cancer Research Fund/American Institute for Cancer Research. Diet, Nutrition, Physical Activity and Cancer: a Global Perspective. Continuous Update Project Expert Report 2018. Available at https://www.dietandcancerreport.org.

  7. Wirt A, Collins CE. Diet quality—what is it and does it matter? Public Health Nutr. 2009;12:2473–92.

    Article  PubMed  Google Scholar 

  8. Kant AK. Dietary patterns and health outcomes. J Am Diet Assoc. 2004;104:615–35.

    Article  PubMed  Google Scholar 

  9. Kennedy ET, Ohls J, Carlson S, Fleming K. The healthy eating index: design and applications. J Am Diet Assoc. 1995;95:1103–8.

    Article  CAS  PubMed  Google Scholar 

  10. Guenther PM, Reedy J, Krebs-Smith SM. Development of the healthy eating index-2005. J Am Diet Assoc. 2005;108:1896–901.

    Article  Google Scholar 

  11. Guenther PM, Casavale KO, Reedy J, Kirkpatrick SI, Hiza HAB, Kuczynski KJ, et al. Update of the healthy eating index: HEI-2010. J Acad Nutr Diet. 2013;113:569–80.

    Article  PubMed  Google Scholar 

  12. Cancer of the lung and Bronchus - Cancer stat facts [Internet]. Cancer.gov. [cited 2021 Oct 29]. Available from: https://seer.cancer.gov/statfacts/html/lungb.html.

  13. Centers for Disease Control and Prevention. Racial/ethnic disparities and geographic differences in lung cancer incidence—38 states and the District of Columbia, 1998–2006. Morbid Mortal Weekly Rep. 2010;59:1434–8.

    Google Scholar 

  14. U.S. Cancer Statistics Working Group. U.S. Cancer Statistics Data Visualizations Tool, based on 2020 submission data (1999-2018): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute [released in June 2021, cited 2021 Oct 29]. www.cdc.gov/cancer/dataviz.

  15. O’Connor JM, Sedghi T, Dhodapkar M, Kane MJ, Gross CP. Factors associated with cancer disparities among low-, medium-, and high-income US counties. JAMA Netw Open. 2018;1:e183146.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Vadiveloo M, Perraud E, Parker HW, Juul F, Parekh N. Geographic differences in the dietary quality of food purchases among participants in the nationally representative Food Acquisition and Purchase Survey (FoodAPS). Nutrients. 2019;11:1233.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Yu D, Sonderman J, Buchowski MS, McLaughlin JK, Shu X-O, Steinwandel M, et al. Healthy eating and risks of total and cause-specific death among low-income populations of African-Americans and other adults in the southeastern United States: a prospective cohort study. PLoS Med. 2015;12:e1001830.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Signorello LB, Hargreaves MK, Steinwandel MD, Zheng W, Cai Q, Schlundt DG, et al. Southern community cohort study: establishing a cohort to investigate health disparities. J Natl Med Assoc. 2005;97:972–9.

    PubMed  PubMed Central  Google Scholar 

  19. Signorello LB, Hargreaves MK, Blot WJ. The Southern Community Cohort Study: investigating health disparities. J Health Care Poor Underserved. 2010;21:26–37.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Buchowski MS, Schlundt DG, Hargreaves MK, Hankin JH, Signorello LB, Blot WJ. Development of a culturally sensitive food frequency questionnaire for use in the Southern Community Cohort Study. Cell Mol Biol (Noisy-le-grand). 2003;49:1295–304.

    CAS  PubMed  Google Scholar 

  21. Signorello LB, Munro HM, Buchowski MS, Schlundt DG, Cohen SS, Hargreaves MK, et al. Estimating nutrient intake from a food frequency questionnaire: incorporating the elements of race and geographic region. Am J Epidemiol. 2009;170:104–11.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Schlundt DG, Buchowski MS, Hargreaves MK, Hankin JH, Signorello LB, Blot WJ. Separate estimates of portion size were not essential for energy and nutrient estimation: results from the Southern Community Cohort food-frequency questionnaire pilot study. Public Health Nutr. 2007;10:245–51.

    Article  PubMed  Google Scholar 

  23. Signorello LB, Buchowski MS, Cai Q, Munro HM, Hargreaves MK, Blot WJ. Biochemical validation of food frequency questionnaire-estimated carotenoid, alpha-tocopherol, and folate intakes among African Americans and non-Hispanic Whites in the Southern Community Cohort Study. Am J Epidemiol. 2010;171:488–97. https://doi.org/10.1093/aje/kwp402.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Bowman SA, Friday JE, Moshfegh AJ. MyPyramid Equivalents Database, 2.0 for USDA Survey Foods, 2003-2004 [Online]. Beltsville, MD: U.S. Department of Agriculture, ARS [2008, cited 2021 Oct 29]. www.ars.usda.gov/ba/bhnrc/fsrg.

  25. U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2010. 7th Edition, Washington, DC: U.S. Government Printing Office, December 2010 [cited 2021 Oct 29]. https://health.gov/our-work/nutrition-physical-activity/dietary-guidelines/previous-dietary-guidelines/2010.

  26. Overview & background of Healthy Eating Index (HEI) [Internet]. Cancer.gov. [cited 2021 Oct 29]. https://epi.grants.cancer.gov/hei/.

  27. Anic GM, Park Y, Subar AF, Schap TE, Reedy J. Index-based dietary patterns and risk of lung cancer in the NIH-AARP diet and health study. Eur J Clin Nutr. 2016;70:123–9.

    Article  CAS  PubMed  Google Scholar 

  28. Park S-Y, Boushey CJ, Shvetsov YB, Wirth MD, Shivappa N, Hébert JR, et al. Diet quality and risk of lung cancer in the Multiethnic Cohort Study. Nutrients. 2021;13:1614.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Myneni AA, Giovino GA, Millen AE, LaMonte MJ, Wactawski-Wende J, Neuhouser ML, et al. Indices of diet quality and risk of lung cancer in the Women’s Health Initiative Observational Study. J Nutr. 2021;151:1618–27.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Wu J, Cai Q, Li H, Cai H, Gao J, Yang G, et al. Circulating C-reactive protein and colorectal cancer risk: a report from the Shanghai Men’s Health Study. Carcinogenesis. 2013;34:2799–803.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Zhang X, Shu X-O, Signorello LB, Hargreaves MK, Cai Q, Linton MF, et al. Correlates of high serum C-reactive protein levels in a socioeconomically disadvantaged population. Dis Markers. 2008;24:351–9.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Murphey LJ, Williams MK, Sanchez SC, Byrne LM, Csiki I, Oates JA, et al. Quantification of the major urinary metabolite of PGE2 by a liquid chromatographic/mass spectrometric assay: determination of cyclooxygenase-specific PGE2 synthesis in healthy humans and those with lung cancer. Anal Biochem. 2004;334:266–75.

    Article  CAS  PubMed  Google Scholar 

  33. Munro HM, Tarone RE, Wang TJ, Blot WJ. Menthol and nonmenthol cigarette smoking: all-cause deaths, cardiovascular disease deaths, and other causes of death among blacks and whites: all-cause deaths, cardiovascular disease deaths, and other causes of death among blacks and whites. Circulation. 2016;133:1861–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Blot WJ, McLaughlin JK. Are women more susceptible to lung cancer? J Natl Cancer Inst. 2004;96:812–3.

    Article  PubMed  Google Scholar 

  35. Rock CL, Thomson C, Gansler T, Gapstur SM, McCullough ML, Patel AV, et al. American Cancer Society guideline for diet and physical activity for cancer prevention. CA Cancer J Clin. 2020;70:245–71.

    Article  PubMed  Google Scholar 

  36. Sun Y, Li Z, Li J, Li Z, Han J. A healthy dietary pattern reduces lung cancer risk: a systematic review and meta-analysis. Nutrients. 2016;8:134.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Hodge AM, Bassett JK, Shivappa N, Hébert JR, English DR, Giles GG, et al. Dietary inflammatory index, Mediterranean diet score, and lung cancer: a prospective study. Cancer Causes Control. 2016;27:907–17.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Yang JJ, Yu D, Takata Y, Smith-Warner SA, Blot W, White E, et al. Dietary fat intake and lung cancer risk: a pooled analysis. J Clin Oncol. 2017;35:3055–64.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Yang JJ, Yu D, Xiang Y-B, Blot W, White E, Robien K, et al. Association of dietary fiber and yogurt consumption with lung cancer risk: a pooled analysis. JAMA Oncol. 2020;6:e194107.

    Article  PubMed  Google Scholar 

  40. Willemsen RF, McNeil J, Heer E, Johnson ST, Friedenreich CM, Brenner DR. Dietary patterns with combined and site-specific cancer incidence in Alberta’s Tomorrow Project cohort. Eur J Clin Nutr. 2021. https://doi.org/10.1038/s41430-021-00958-7.

    Article  PubMed  Google Scholar 

  41. Il’yasova D, Colbert LH, Harris TB, Newman AB, Bauer DC, Satterfield S, et al. Circulating levels of inflammatory markers and cancer risk in the health aging and body composition cohort. Cancer Epidemiol Biomarkers Prev. 2005;14:2413–8.

    Article  PubMed  Google Scholar 

  42. Chaturvedi AK, Caporaso NE, Katki HA, Wong H-L, Chatterjee N, Pine SR, et al. C-reactive protein and risk of lung cancer. J Clin Oncol. 2010;28:2719–26.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Shiels MS, Pfeiffer RM, Hildesheim A, Engels EA, Kemp TJ, Park J-H, et al. Circulating inflammation markers and prospective risk for lung cancer. J Natl Cancer Inst. 2013;105:1871–80.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Shiels MS, Katki HA, Hildesheim A, Pfeiffer RM, Engels EA, Williams M, et al. Circulating inflammation markers, risk of lung cancer, and utility for risk stratification. J Natl Cancer Inst. 2015;107. https://doi.org/10.1093/jnci/djv199.

  45. Travier N, Jeffreys M, Brewer N, Wright CS, Cunningham CW, Hornell J, et al. Association between glycosylated hemoglobin and cancer risk: a New Zealand linkage study. Ann Oncol. 2007;18:1414–9.

    Article  CAS  PubMed  Google Scholar 

  46. Dibaba DT, Judd SE, Gilchrist SC, Cushman M, Pisu M, Safford M, et al. Association between obesity and biomarkers of inflammation and metabolism with cancer mortality in a prospective cohort study. Metabolism. 2019;94:69–76.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Goto A, Noda M, Sawada N, Kato M, Hidaka A, Mizoue T, et al. High hemoglobin A1c levels within the non-diabetic range are associated with the risk of all cancers: hemoglobin A1c and cancer risk. Int J Cancer. 2016;138:1741–53.

    Article  CAS  PubMed  Google Scholar 

  48. Rentsch CT, Farmer RE, Eastwood SV, Mathur R, Garfield V, Farmaki A-E, et al. Risk of 16 cancers across the full glycemic spectrum: a population-based cohort study using the UK Biobank. BMJ Open Diabetes Res Care. 2020;8:e001600.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Crowe-White KM, Ellis AC, Mehta T, Locher JL, Ard JD. Dietary quality assessed by the HEI-2010 and biomarkers of cardiometabolic disease: an exploratory analysis. J Am Coll Nutr. 2019;38:640–7.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Buchowski MS, Matthews CE, Cohen SS, Signorello LB, Fowke JH, Hargreaves MK, et al. Evaluation of a questionnaire to assess sedentary and active behaviors in the Southern Community Cohort Study. J Phys Act Health. 2012;9:765–75.

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors wish to thank the Southern Community Cohort Study (SCCS) team members who have contributed to the SCCS.

Funding

Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Numbers U01CA202979 and R01CA092447. Biomarker assays were partially supported by NIH grant P50CA090949. Biospecimens and data collection and use as well as cytokine assays were conducted by the Survey and Biospecimen Shared Resource, which is supported in part by the Vanderbilt-Ingram Cancer Center (P30 CA68485).

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Authors and Affiliations

  1. International Epidemiology Field Station, Vanderbilt University Medical Center, Nashville, TN, USA

    Heather M. Munro & Martha J. Shrubsole

  2. Department of Medicine, Division of Epidemiology, Vanderbilt Epidemiology Center, Vanderbilt University, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA

    Danxia Yu, Wei Zheng, William J. Blot, Qiuyin Cai & Martha J. Shrubsole

  3. International Epidemiology Institute, Rockville, MD, USA

    William J. Blot

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Contributions

HMM and MJS conceived the work that led to the submission. DY, WZ, WJ, and QC acquired data. All authors played an important role in interpreting the results, drafted or revised the manuscript, approved the final version and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Martha J. Shrubsole.

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Competing interests

WZ and MJS receive research support from Pfizer, Inc which is unrelated to the contents of this manuscript. HMM, DY, WJB, and QC declare no competing interests.

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All study participants provided written informed consent. The study was approved by the Institutional Review Board at Vanderbilt University and Meharry Medical College. The study was performed in accordance with the Declaration of Helsinki.

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Munro, H.M., Yu, D., Zheng, W. et al. Diet quality and lung cancer incidence in a low-income population in the United States. Br J Cancer 129, 626–635 (2023). https://doi.org/10.1038/s41416-023-02342-7

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