Dietary patterns and cancer risk

Abstract

Over the past decade, the search for dietary factors on which to base cancer prevention guidelines has led to the rapid expansion of the field of dietary patterns and cancer. Multiple systematic reviews and meta-analyses have reported epidemiological associations between specific cancer types and both data-driven dietary patterns determined by empirical analyses and investigator-defined dietary indexes based on a predetermined set of dietary components. New developments, such as the use of metabolomics to identify objective biomarkers of dietary patterns and novel statistical techniques, could provide further insights into the links between diet and cancer risk. Although animal models of dietary patterns are limited, progress in this area could identify the potential mechanisms underlying the disease-specific associations observed in epidemiological studies. In this Review, we summarize the current state of the field, provide a critical appraisal of new developments and identify priority areas for future research. An underlying theme that emerges is that the effectiveness of different dietary pattern recommendations in reducing risk could depend on the type of cancer or on other risk factors such as family history, sex, age and other lifestyle factors or comorbidities as well as on metabolomic signatures or gut microbiota profiles.

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Fig. 1: Radar plot illustrating principal component analyses.
Fig. 2: A posteriori dietary patterns and cancer risk.
Fig. 3: A priori dietary patterns and cancer risk.
Fig. 4: Associations between dietary patterns based on biological processes and cancer risk.
Fig. 5: Emerging statistical techniques for investigating cancer risk associations.
Fig. 6: Potential mechanisms underpinning associations between diet and cancer.

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Acknowledgements

S.E.S. and E.A.M. are co-principal investigators of a Susan G. Komen Graduate Training in Disparities Research grant (GTDR 17500160). This work was funded by grants from the National Institutes of Health (1R01CA218578) and the American Institute for Cancer Research (359566).

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Glossary

Healthy eating index

(HEI). An a priori diet quality score based on adherence to the US Dietary Guidelines.

Alternate HEI

(aHEI). An a priori diet quality score based on overall chronic disease prevention guidelines.

Dietary Approaches to Stop Hypertension

(DASH). An a priori dietary pattern based on the dietary recommendations employed in the DASH randomized controlled trial, which demonstrated a significant effect of the diet intervention on blood pressure.

Dietary inflammatory index

(DII). An a priori algorithm for scoring diet quality based on weighted inflammatory effect scores for up to 45 dietary components, as determined by previous literature related to diet, and six inflammatory biomarkers.

Food frequency questionnaire

(FFQ). A closed-ended questionnaire used to obtain information about the usual consumption of foods and beverages (frequency and sometimes portion sizes) over a specific period of time.

Mediterranean diet score

(MDS). An a priori diet quality score based on adherence to dietary components comprising the traditional Mediterranean diet.

Prospective dietary cohort studies

Epidemiological studies in which diet is assessed prior to cancer development and participants are followed prospectively over time to determine cancer endpoints.

Case–control studies

Epidemiological studies in which patients with cancer and healthy control individuals are enrolled and diet is assessed retrospectively.

Reduced rank regression

(RRR). A data-driven outcome-dependent statistical technique that typically employs an intermediate marker to first define a dietary pattern based on its ability to explain variation in the marker and then examine associations with cancer risk.

Metabolomics

A field of research related to measuring small-molecule metabolic products (metabolites) in body cells, fluids or tissues, often with an agnostic approach to discovering relationships between metabolites and disease.

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Steck, S.E., Murphy, E.A. Dietary patterns and cancer risk. Nat Rev Cancer 20, 125–138 (2020). https://doi.org/10.1038/s41568-019-0227-4

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