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Dietary intake of flavonoids and oesophageal and gastric cancer: incidence and survival in the United States of America (USA)
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    Flavonoids, polyphenolic compounds concentrated in fruits and vegetables, have experimentally demonstrated chemopreventive effects against oesophageal and gastric cancer. Few epidemiologic studies have examined flavonoid intake and incidence of these cancers, and none have considered survival.


    In this USA multicentre population-based study, case participants (diagnosed during 1993–1995 with oesophageal adenocarcinoma (OEA, n=274), gastric cardia adenocarcinoma (GCA, n=248), oesophageal squamous cell carcinoma (OES, n=191), and other gastric adenocarcinoma (OGA, n=341)) and frequency-matched controls (n=662) were interviewed. Food frequency questionnaire responses were linked with USDA Flavonoid Databases and available literature for six flavonoid classes and lignans. Case participants were followed until 2000 for vital status. Multivariable-adjusted odds ratios (ORs) and hazard ratios (HRs) (95% confidence intervals (CIs)) were estimated, comparing highest with lowest intake quartiles, using polytomous logistic and proportional hazards regressions, respectively.


    Little or no consistent association was found for total flavonoid intake (main population sources: black tea, orange/grapefruit juice, and wine) and incidence or survival for any tumour type. Intake of anthocyanidins, common in wine and fruit juice, was associated with a 57% reduction in the risk of incident OEA (OR=0.43, 95% CI=0.29–0.66) and OES (OR=0.43, 95% CI=0.26–0.70). The ORs for isoflavones, for which coffee was the main source, were increased for all tumours, except OES. Anthocyanidins were associated with decreased risk of mortality for GCA (HR=0.63, 95% CI=0.42–0.95) and modestly for OEA (HR=0.87, 95% CI=0.60–1.26), but CIs were wide.


    Our findings, if confirmed, suggest that increased dietary anthocyanidin intake may reduce incidence and improve survival for these cancers.

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    P30 ES010126/ES/NIEHS NIH HHS/United States
    K05 CA124911/CA/NCI NIH HHS/United States
    U01 CA057949/CA/NCI NIH HHS/United States
    T32 ES007018/ES/NIEHS NIH HHS/United States
    T32 CA009330/CA/NCI NIH HHS/United States
    U01 CA057983/CA/NCI NIH HHS/United States
    U01-CA057983/CA/NCI NIH HHS/United States
    T32-CA009330/CA/NCI NIH HHS/United States
    U01 CA057923/CA/NCI NIH HHS/United States
    T32-ES007018/ES/NIEHS NIH HHS/United States
    R03 CA159409/CA/NCI NIH HHS/United States
    U01-CA057923/CA/NCI NIH HHS/United States
    R03-CA159409/CA/NCI NIH HHS/United States
    U01-CA057949/CA/NCI NIH HHS/United States
    P30-ES10126/ES/NIEHS NIH HHS/United States
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