Dietary Intake of Flavonoids, Barrett's Esophagus Development, and Esophageal and Gastric Cancer Incidence and Survival Public Deposited

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  • March 19, 2019
  • Petrick, Jessica Leigh
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
  • Flavonoids, polyphenolic compounds concentrated in fruits and vegetables, have experimentally demonstrated chemopreventive effects against esophageal and gastric cancer and Barrett's esophagus, a precursor lesion for esophageal adenocarcinoma. Few epidemiologic studies have examined flavonoids and incidence of esophageal and gastric cancers, and none have considered flavonoids with survival. Additionally, only one epidemiologic investigation has reported an inverse association between isoflavone intake and Barrett's esophagus risk, yet no study has considered other flavonoid classes, which are more commonly consumed in the U.S. This ancillary study built upon the U.S. Multi-Center Study (esophageal adenocarcinoma cases n=274, gastric cardia adenocarcinoma cases n=248, esophageal squamous cell carcinoma cases n=191, other gastric adenocarcinoma cases n=341, and frequency-matched controls n=662) and the Study of Reflux Disease (Barrett's esophagus cases n=170 and matched controls n=183). Participants completed a food frequency questionnaire, and responses were linked with USDA Flavonoid Databases and available literature for six flavonoid classes and lignans. Esophageal and gastric cancer cases were followed until 2000 for vital status. Multivariable-adjusted odds ratios (ORs) and hazard ratios (HRs) [95% confidence intervals (CI)] were estimated, comparing highest versus lowest intake quartiles, using logistic and proportional hazards regressions, respectively. Little or no association was found for total flavonoid intake (main sources in this population: black tea, orange/grapefruit juice, and wine) and development or survival for any tumor type. Intake of anthocyanidins, common in wine and fruit juice, was associated with a reduction in the risk of 57% for developing esophageal adenocarcinoma (OR=0.43, 95% CI: 0.29-0.66), 57% for developing squamous cell carcinoma (OR=0.43, 95% CI: 0.26-0.70), and 41% for developing Barrett's esophagus. ORs for isoflavones, for which coffee was the main source, were increased for all cancer types, except esophageal squamous cell carcinoma. A modest increased risk of Barrett's esophagus development was observed for flavones, for which the main dietary source in this population was pizza. Anthocyanidins were associated with decreased risk of mortality for gastric cardia (HR=0.63, 95% CI: 0.42-0.95) and more modestly for esophageal adenocarcinoma (HR=0.87, 95% CI: 0.60-1.26). Our findings, if confirmed, suggest that increased dietary anthocyanidin intake may reduce risk of developing these tumors and improve survival.
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  • Gammon, Marilie D.
  • Doctor of Philosophy
Graduation year
  • 2014

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