Women with lower adherence to healthy dietary patterns may have a higher risk of developing oral cavity cancer, according to a prospective cohort study. The association could be strongest among women who were nonsmokers or light smokers and nondrinkers or light drinkers, while no statistically significant associations may have been observed among men.
Investigators analyzed data from three prospective US cohorts: the Nurses’ Health Study, Nurses’ Health Study II, and the Health Professionals Follow-up Study. The analysis involved more than 210,000 patients without cancer at baseline who were followed-up for a period of 30 years. Dietary intake was assessed every 4 years using validated food frequency questionnaires, and the investigators evaluated the participants' adherence to the Western, Prudent, and Alternative Healthy Eating Index–2010 dietary patterns. Oral cavity cancer incidence was assessed using multivariable-adjusted Cox proportional hazards models.
During follow-up, the investigators identified 226 incident oral cavity cancer cases, including 124 among women and 102 among men. Among women, those in the lowest quartiles of adherence to the Prudent and Alternative Healthy Eating Index–2010 dietary patterns had 1.86 and 2.17 times the likelihood of experiencing oral cavity cancer, respectively, compared with those in the highest quartiles. The investigators reported that the incidence of oral cavity cancer increased by approximately two cases per 100,000 person-years in the lowest adherence categories compared with the highest adherence categories.
The association was more pronounced among women without substantial tobacco or alcohol exposure. For instance, women who were nonsmokers or light smokers and nondrinkers or light drinkers who showed low adherence to the Prudent dietary pattern had nearly three times the likelihood of developing oral cavity cancer compared with those in the high adherence group.
After evaluating oral cavity cancer subsites, the investigators noted that lower adherence to the Alternative Healthy Eating Index–2010 dietary pattern was associated with increased risk of nontongue oral cavity cancers among women. However, no statistically significant associations were observed for tongue cancers. Additionally, no statistically significant associations between dietary patterns and oral cavity cancer risk were observed among men in either the primary or subgroup analyses.
The investigators noted several limitations, including the relatively small number of oral cavity cancer cases despite the large cohort size and extended follow-up period. They also acknowledged the possibility of residual confounding related to oral hygiene, periodontal disease, dental care utilization, and unmeasured tobacco or alcohol exposure. Because dietary intake was self-reported and the cohorts were predominantly non-Hispanic White health professionals, the findings may have limited generalizability. The investigators cautioned that the findings were hypothesis generating and should be confirmed in larger pooled studies.
“This is the largest prospective study to date analyzing the relationship between dietary patterns and incident [oral cavity cancers] across three US cohorts spanning more than three decades,” wrote lead study author Mateo Useche, of the Department of Otolaryngology–Head and Neck Surgery at the University of Washington, and colleagues. They added that the findings underscored “the need for larger collaborative studies to confirm these findings and further elucidate the biological and behavioral mechanisms linking dietary quality to oral carcinogenesis.”
The study authors reported no conflicts of interest.
Source: Head & Neck
