Index-based dietary patterns and risk of head and neck cancer in a large prospective study

• Published in: The American journal of clinical nutrition 2014-03, Vol.99 (3), p.559-566
• Main Authors: Li, Wen-Qing, Park, Yikyung, Wu, Jennifer W, Goldstein, Alisa M, Taylor, Philip R, Hollenbeck, Albert R, Freedman, Neal D, Abnet, Christian C
• Format: Article
• Language: English
• Subjects: Aged; alcohol drinking; Alcohol use; clinical nutrition; Cohort Studies; Diet; Diet - adverse effects; Diet, Mediterranean; dietary recommendations; eating habits; Female; Follow-Up Studies; food frequency questionnaires; foods; head; Head & neck cancer; Head and Neck Neoplasms - epidemiology; Head and Neck Neoplasms - etiology; Head and Neck Neoplasms - prevention & control; health information; Health Promotion; healthy diet; Humans; Incidence; larynx; Male; Mediterranean diet; men; Middle Aged; mouth; neck; Nutrition Policy; Patient Compliance; Proportional Hazards Models; prospective studies; Public health; Regression analysis; risk; Risk assessment; Surveys and Questionnaires; United States - epidemiology; women
• ISSN: 0002-9165; 1938-3207
• DOI: 10.3945/ajcn.113.073163

Background: Head and neck cancer (HNC) is the seventh most common cancer worldwide. Although diet has been proposed to play an important role in HNC, few associations with diet have been convincing other than alcohol intake. Studies of dietary patterns that examine overall diets may provide broader insight than studies of individual foods. Little is known about the association between dietary patterns and risk of HNC.Objective: We prospectively evaluated the association between 2 index-based dietary patterns [ie, the Healthy Eating Index-2005 (HEI-2005) and alternate Mediterranean Diet Score (aMED)] and risk of head and neck squamous cell carcinoma.Design: We included 494,967 participants from the NIH-AARP Diet and Health study (1995-2006). HRs (95% CIs) were estimated by using Cox regression. Scores for the HEI-2005 and aMED were calculated on the basis of diet assessed by using a baseline food-frequency questionnaire. Higher scores reflected adherence to dietary recommendations for healthy eating. Our main outcome was the incidence of HNC, including cancer of the larynx, oral cavity, and orohypopharynx.Results: A total of 1868 HNC cases were identified during follow-up. Higher HEI-2005 scores were associated with reduced risk of HNC in men [HR: 0.74 (95% CI: 0.61, 0.89) for highest compared with lowest quintiles; P-trend = 0.0008] and women [HR: 0.48; 95% CI: 0.33, 0.70; P-trend < 0.0001]. High aMED scores were also associated with lower HNC risk in men (HR: 0.80; 95% CI: 0.64, 1.01; P-trend = 0.002) and women (HR: 0.42; 95% CI: 0.24, 0.74; P-trend < 0.0001). Associations were similar among subsites. We did not find significant interactions between smoking and alcohol intake and each index on HNC risk.Conclusions: HEI-2005 and aMED scores were associated inversely with risk of HNC. Large interventional studies are required to assess the causality before conveying definite public health messages. This trial was registered at clinicaltrials.gov as NCT00340015.