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Dietary Factors and the Risk of Pancreatic Cancer: a Case-Control Study in Shanghai, China1

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Dietary Factors and the Risk of Pancreatic Cancer: a Case-Control Study in Shanghai, China1 vol. 4. ‘85 893, De’ieniber 1995 Cancer EpidemioIo, Biomarkers & Prevention 885 Dietary Factors and the Risk of Pancreatic Cancer: A Case-Control Study in Shanghai, China1 Bu-Tian u,2 Wong-Ho Chow, Gloria Gridley, on consumptions well below the average intake in Western Joseph K. McLaughlin,3 Qi Dai, Sholom Wacholder, countries, where most previous studies on pancreatic cancer Maureen C. Hatch,4 Yu-Tang Gao, and were conducted. Our results suggest that dietary variations Joseph F. Fraumeni, Jr. have contributed little to the rising trends of pancreatic Division of Epidemiology. Columbia University, School of Public Health, cancer in Shanghai. However, given the improving food New York. New York 1(8)32 )B-T. J., M. C. H.): Department of availability and changing dietary patterns in China, further Epidemiology. Shanghai Cancer Institute, Shanghai. People’s Republic of study of dietary and nutritional risk factors for pancreatic China )B-T. I., Q. D.. Y-T. G.J: and Division of Cancer Epidemiology and cancer appears warranted. Genetics. National Cancer Institute, Bethesda, Maryland 20892 )W-H. C.. G. G.. J. K. M.. S. W.. I. F. F.) Introduction Abstract Diet is believed to play a role in pancreatic carcinogenesis ( I). although the specific components and mechanisms remain un- In Shanghai, China, age-adjusted incidence rates for clear. Several studies have reported inverse associations with pancreatic cancer have increased steadily, beginning in consumption of fruits and vegetables (2-8) and positive asso- the early 1970s. To examine the effects of diet on this ciations with intake of beef, pork, poultry. or fish (3-5, 9-1 I). cancer, a population-based case-control study was Elevated risks of pancreatic cancer have also been linked to conducted. Cases (n 451) were permanent residents of intake of eggs and dairy products (5, 12, 13), butter and mar- Shanghai, 30-74 years of age, newly diagnosed with game (2, 14), and rice and white bread (2, 6, 10, 14). Less pancreatic cancer between October 1, 1990 and June 30, consistent are the associations reported with specific dietary 1993. Deceased cases (19%) were excluded from the nutrients. Increased risks have been related to high intake of fat study. Controls (n 1552) were selected among Shanghai (15-17) and unsaturated fat (18) in some studies but not others residents, frequency matched to cases by gender and age. (2, 19 -2 1 ). An excess risk has been associated in some studies Information on usual adult dietary intake was obtained with high intake of carbohydrates (22-24). by trained interviewers in person, using a food frequency Age-adjusted incidence rates of pancreatic cancer in questionnaire. Dietary associations were measured by Shanghai, China, have increased steadily between 1972- odds ratios and 95% confidence intervals. Risks of 1974 and 1987-1989 (25). In 1987-1989, the average annual pancreatic cancer were inversely associated with rates were 6.1 and 4.2 per 100.000 and ranked eighth and consumption of vegetables (P for trend among men = ninth among cancer incidence in men and women, respec- 0.03; among women 0.15) and fruits (P among men tively. To identify the risk factors for pancreatic cancer in 0.02; among women = 0.08). Reductions in risk were Shanghai, we undertook a large population-based case-con- rebated also to intake of dietary fiber and micronutrients trol study. In an earlier report. we found elevated risks with abundant in plant sources, such as vitamins C and E and cigarette smoking but not alcohol consumption. suggesting carotene. There was also an inverse association with egg that the increasing prevalence of smoking has contributed to consumption (P for trend among men = 0.08; among the rising trend of pancreatic cancer (26). In addition, the women = 0.001). No consistent positive associations were living standard among Shanghai residents, including access observed with intake of other food groups, including to medical care and the availability of a variety of foods, has preserved animal foods, fresh red meat, organ meat, improved since the early l970s (27). In this report, we poultry, and staple foods. On the other hand, risks present the risks of pancreatic cancer associated with dietary increased with frequency of consumption of preserved and nutritional factors. vegetables and foods that were deep fried, grilled, cured, or smoked, providing clues to the possible role of nitrosamines, polycyclic aromatic hydrocarbons, and Materials and Methods heterocyclic aromatic amines. The inverse associations Methods for this population-based case-control study of gas- observed with intake of dietary fat and protein in our trointestinal cancers (pancreas, esophagus, colon, and rectum) study were unexpected, although these findings were based have been described in detail elsewhere (26, 28). Briefly, pan- creatic cancer cases newly diagnosed between October 1 , 1990, and June 30, 1993, were identified through a rapid reporting Received 4/19/95: revised 7/6/95: accepted 7/7/95. system. Cases were 30-74 years of age and permanent resi- I This study was supported by National Cancer Institute Contract N0I-CP-05626. dents in urban Shanghai. Of the 577 eligible patients, 41 2 To whom requests for reprints should be addressed. at National Cancer Institute. (78.2%) were interviewed. Study cases were confirmed by 613)) Executive Boulevard, EPN 431. Rockville. MD 2t)852. histopathology (37%), surgery with gross but not microscopic ; Present address: International Epidemiology Institute. Rockville. MD 20850. 4 Present address: Department of Community Medicine, Mount Sinai Medical pathology (20%), or computed tomography scan/ultrasound Center. New York. NY 10029. (43%). Excluded from the study were 109 cases who died Downloaded from cebp.aacrjournals.org on October 2, 2021. © 1995 American Association for Cancer Research. 886 Diet and Risk of Pancreatic Cancer Table I ORs” a nd 95C/ CIs o f pancreatic c ancer in relation to quartiles of food grou p consumpti on by sex. Shanghai. China. 1990-1993 Men P for Women P for Q15 (low) Q2 Q3 Q4 (high) trend QI (low) Q2 Q3 Q4 (high) trend Preserved OR 1.0)) 1.16 1.65 1.37 0.07 1.00 1.54 2.17 3.07 <0.001 vegetables 95% Cl )t).74-l.82) (1.07-2.53) (0.89-2.11) (0.85-2.80) (1.22-3.84) (1.77-5.33) Preserved OR I(S) 0.82 1.05 0.82 0.63 1.00 1.38 0.87 0.88 0.31 animal foods 95 CI )t).53-I.28) (t).7t)-l.59) (0.53-1.26) (0.85-2.26) (0.51-1.48) (0.52-1.51) Fresh red meats OR ItS) 0.64 0.76 0.73 0.24 1.00 1.34 0.83 1.24 0.86 95% Cl )t).42-().99) )t).50-I .15) (0.47-1 . 12) (0.81-2.2 I ) (0.47-I .43) (0.73-2.13) Organ meats OR 1(10 lIt) l.3t) 0.82 0.63 1.00 0.64 1.51 1.21 0.27 95C/( CI )t).7t)-l .8 I ) (0.90-I .91 ) (0.67- 1.3 I ) (0.38-I .41 ) (0.91-2.34) (0.72-1.80) Poultry OR 1.01) 1.23 0.97 0.93 0.46 1.00 0.85 0.66 1.06 0.96 951%. Cl )t).8I-l.87) (t).63-l.51 ) (0.60-1.44) (0.51-1.42) (0.39-1.13) (0.63-1.78) Fish OR 1.00 1.19 1.32 1.29 0.23 1.00 0.61 1.19 0.94 0.59 95i:/ CI 0.75-I .87) (0.85-2(34) (0.83-2.01 ) (0.35-I .06) (0.73-1 .96) (0.56-1.58) Eggs OR ItS) 0.77 t).77 0.67 0.08 1.00 0.79 0.56 0.46 0.001 95% CI )t).51-I.18) (0.50-1.17) (0.44-1.03) (0.49-1.28) (0.34-0.93) (0.27-0.79) Staple foods OR 1.00 1.00 1.10 1.41 0.10 1.00 0.91 0.70 1.10 0.86 95% CI (OW)- I .54) (0.70- I .70) (0.90-2. I I ) (0.50- 1.4 I ) (0.4 1 - I .3 1 ) (0.72-1.80) “ Adjusted for age. income, smoking. green tea drinking (females only). and response status. I. QI. quartile I: Q2. quartile 2: Q3. quartile 3: Q4. quartile 4. before participation, 1 1 who moved away, and 6 who refused Total dietary intake ofeach nutrient was calculated by summing interview. the amount of intake from all food items, which were individ- Controls were randomly selected from the general Shang- ually estimated by multiplying the nutrient content of the re- hai population, frequency matched to the expected age (S-year ported frequency by the amount of intake for each food item. category) and sex distribution of the 4 gastrointestinal cancers Use of vitamin supplements was uncommon and, therefore, not combined in the overall study. Personal identification cards ascertained in this study. from the Shanghai Resident Registry were used to select con- For analysis, consumption of foods and nutrients was trols. The cards contain information on name, address, date of divided into quartiles based on the distribution among con- birth, gender, and other demographic factors. Two random trols, separately for men and women, with approximately numbers (a 4-digit number for locating a drawer and a 3-digit equal numbers of controls in each intake stratum (see Ap- number for locating a personal identification card within the pendix 2 for cutpoints for food items and food groups and drawer) were generated to select each control.
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