Dietary flavonoid intake and risk of esophageal squamous cell carcinoma: A population-based case-control study

Liping Sun; Wenjing Zhao; Jun Li; Lap Ah Tse; Xiangbin Xing; Sihao Lin; Jin Zhao; Zefang Ren; Cai-Xia Zhang; Xudong Liu

doi:10.1016/j.nut.2021.111235

Dietary flavonoid intake and risk of esophageal squamous cell carcinoma: A population-based case-control study

Nutrition. 2021 Sep:89:111235. doi: 10.1016/j.nut.2021.111235. Epub 2021 Mar 7.

Authors

Liping Sun¹, Wenjing Zhao², Jun Li³, Lap Ah Tse⁴, Xiangbin Xing⁵, Sihao Lin⁶, Jin Zhao⁷, Zefang Ren¹, Cai-Xia Zhang¹, Xudong Liu⁸

Affiliations

¹ Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.
² Department of Public Health, Faculty of Medicine, Hokkaido University, Sapporo, Japan.
³ Department of Cancer Prevention and Treatment, Yanting Cancer Hospital, Mianyang, China.
⁴ JC School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China.
⁵ Department of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
⁶ School of Management, Putian University, Putian, China.
⁷ Shenzhen Center for Disease Control and Prevention, Shenzhen, China.
⁸ Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China. Electronic address: liuxudong@mail.sysu.edu.cn.

PMID: 33878555
DOI: 10.1016/j.nut.2021.111235

Abstract

Objectives: The aim of this population-based case-control study was to investigate the association between dietary consumption of the total flavonoids, subclasses, and specific flavonoids and the risk of esophageal squamous cell carcinoma (ESCC) among adults in a high-risk area of China.

Methods: We recruited 820 ESCC participants and 863 control participants from Yanting County. Dietary flavonoids were assessed using a validated 76-item food frequency questionnaire. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using logistic regression after considering potential confounders.

Results: Comparing the highest and lowest intake quartiles, we observed a negative association of ESCC risk with consumption of isoflavones (OR = 0.34, 95% CI = 0.23-0.50, P for trend < 0.001), daidzein (OR = 0.31, 95% CI = 0.21-0.45, P for trend < 0.001), genistein (OR = 0.34, 95% CI = 0.23-0.50, P for trend < 0.001), and glycitein (OR = 0.32, 95% CI = 0.22-0.48, P for trend < 0.001) after adjustment for potential confounders. A more pronounced negative association was observed when comparing the third quartile, rather than the fourth, with the lowest quartile for consumption of anthocyanidins (OR = 0.58, 95% CI = 0.42-0.80, P for trend = 0.004), delphinidin (OR = 0.57, 95% CI = 0.41-0.78, P for trend = 0.004), and cyanidin (OR = 0.48, 95% CI = 0.35-0.66, P for trend = 0.003) after considering potential confounders. Consumption of total flavonoids, flavones, flavonols, and six other specific flavonoids (quercetin, myricetin, kaempferol, luteolin, apigenin, and peonidin) was not associated with ESCC risk.

Conclusions: The results suggest that increased dietary intake of isoflavones and moderate consumption of anthocyanidins were associated with a decreased risk of ESCC. Future nutritional guidelines may emphasize foods or supplements rich in specific isoflavones and anthocyanidins for ESCC chemoprevention.

Keywords: Anthocyanidins; Dietary flavonoid intake; Esophageal squamous cell carcinoma; Isoflavones.

MeSH terms

Case-Control Studies
Diet
Eating
Esophageal Neoplasms* / epidemiology
Esophageal Neoplasms* / etiology
Esophageal Neoplasms* / prevention & control
Esophageal Squamous Cell Carcinoma*
Flavonoids
Humans
Risk Factors

Substances

Flavonoids