Elsevier

Seminars in Oncology

Volume 37, Issue 3, June 2010, Pages 282-296
Seminars in Oncology

Cancer prevention I
Epidemiological and Clinical Studies of Nutrition

https://doi.org/10.1053/j.seminoncol.2010.05.011Get rights and content

In this review, we briefly summarize some of the key developments in nutritional epidemiology and cancer over the past two decades with a focus on the strengths and limitations of study designs and dietary assessment methods. We present the evidence on dietary fat, meat, fiber, antioxidant nutrients, and calcium in relation to carcinogenesis from large cohort studies and randomized clinical trials (RCTs) and refer to the conclusions of the 2007 World Cancer Research Fund/American Institute for Cancer Research summary report. One prominent theme that emerged is the lack of concordance of results from RCTs and observational studies. There are multiple potential reasons for these discrepancies, including differences in study population, dose and timing of the exposure, adherence to an intervention, length of follow-up, and the primary endpoint. Therefore, null findings of RCTs do not necessarily indicate a lack of effect for the tested dietary factors on cancer risk, as some of these nutrients may have chemopreventive effects if given at the right time and in the right dose. It is likely that potential benefits from diet are due to a combination of food constituents rather than single components acting in isolation. Future efforts need to recognize the integrative nature of dietary exposures and attempt to study nutrients in the larger context of the foods and diets in which they are consumed.

Section snippets

Dietary Fat

The hypothesized link between dietary fat and risk of cancer is controversial and has been extensively studied, particularly in relation to breast cancer.18, 19, 20 Initial evidence for a dietary fat-breast cancer association came from animal studies,21 ecologic studies,1, 22 and migrant studies.23, 24 Early case–control studies largely supported a positive association,25 although two large studies found no association;26, 27 however, these results may include recall and selection biases.

Meat

Meat has been of interest in relation to carcinogenesis since early ecologic studies observed high correlations between per capita meat consumption and cancer incidence and mortality.1, 43, 44 Since consumption of meat already constitutes approximately 10% of total energy intake in high-income countries and is expected to increase globally,2, 45 epidemiologic investigations of meat and cancer have the potential for widespread impact on cancer prevention. Much of the epidemiologic research on

Dietary Fiber and Whole Grains

Dietary fiber is present naturally in plant foods, with high amounts in legumes, minimally processed cereals, fruits, and vegetables. Synthetic forms of fiber and fiber isolated from plant cell walls also are increasingly being added to other foods. The majority of epidemiologic investigations of dietary fiber and carcinogenesis have been in relation to colorectal cancer, and there are several potential mechanisms through which dietary fiber could reduce colorectal cancer risk. These include

Antioxidant Nutrients

The idea that increased consumption of fruits and vegetables can decrease cancer risk has been a major theme of research on diet and cancer, but initial enthusiasm was based largely on results from case–control studies.11 Findings from prospective cohort studies conducted since the mid-1990s have not supported such a strong role for fruit and vegetable intake,2 suggesting that methodological biases may have influenced the case–control study results, particularly selection bias.11 The 2007

Calcium

Dietary calcium has been extensively studied in relation to cancer risk, particularly for colorectal cancer. Experimental evidence supports an antineoplastic role for calcium in the colon,144, 145, 146 as intracellular calcium directly influences cell proliferation, differentiation, and apoptosis, and dietary calcium also may prevent damage to the intestinal epithelium by binding bile acids.2, 147 Epidemiologic studies of dietary calcium and dairy food consumption have generally supported a

Conclusions

The most prominent theme to emerge from our review of epidemiologic and clinical studies of nutrition and cancer over the past two decades is the lack of concordance of results from RCTs of individual nutrients and observational studies. As we have discussed, there are a number of possible reasons for these discrepancies, including differences in study population, dose, and timing of the exposure, adherence to an intervention in an RCT, length of follow-up, or the endpoint being studied. For

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    This research was supported in part by the Intramural Research Program of the National Institutes of Health and the National Cancer Institute and by grant no. TU2-CA-105666.

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