Dietary patterns and risk of cervical cancer: A case-control study

Objective: Cervical cancer (CC) is the second most frequent malignancy. Infections with the human papillomavirus have a crucial role in the Pathology of CC. The association of nutrient and dietary pattern with CC have been reported in few studies. This study was conducted to evaluate the relationship between dietary patterns and CC situations in the Iranian population. Method: This is a case-control study in which totally 260 controls and 132 patients aged 30-79 were included as control, and case groups. Dietary data were evaluated by 147-items semi-quantitative food frequency questionnaire. Multivariate logistic regression was used to estimate the relationship between dietary patterns and risk of cervical cancer. Results: Statistical analysis investigated two dietary patterns (healthy and unhealthy). Two dietary patterns covered 17.76% of total variance of dietary intake. Higher adherence of the unhealthy dietary pattern was associated with increased risk of CC (OR = 2.23, 95% CI = 1.77-4.24); however, there was no association between healthy dietary pattern and CC (OR = 1.91, 95% CI = 0.90-3.20). Conclusion: Our results indicate that unhealthy dietary pattern is significantly associated with CC.

Dietary patterns; Cervical cancer; Case-control; Healthy dietary pattern; Unhealthy dietary pattern.

[1] Bendifallah S., de Foucher T., Bricou A., Ouldamer L., Lavoue V., Varinot J., et al.: “Cervical cancer recurrence: Proposal for a classification based on anatomical dissemination pathways and prognosis”. Surg. Oncol., 2019, 30, 40-46.

[2] Marth C., Landoni F., Mahner S., McCormack M., Gonzalez-Martin A., Colombo N., et al.: “Cervical cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up”. Ann. Oncol., 2017, 28, 72-83.

[3] Bosch F.X., de Sanjosé S.: “The epidemiology of human papillomavirus infection and cervical cancer”. Dis. Markers, 2007, 23, 213-227.

[4] Jiménez-Pérez M., Thomas D.B.: “Has the use of pap smears reduced the risk of invasive cervical cancer in Guadalajara, Mexico?” Int. J. Cancer, 1999, 82, 804-809.

[5] Brinton L.A., Reeves W.C., Brenes M.M., Herrero R., Gaitan E., Tenorio F., et al.: ”The ma le factor in the etiology of cervical cancer among sexually monogamous women”. Int. J. Cancer, 1989, 44, 199- 203.

[6] International Collaboration of Epidemiological Studies of Cervical Cancer.: “Cervical carcinoma and reproductive factors: collaborative reanalysis of individual data on 16,563 women with cervical carcinoma and 33,542 women without cervical carcinoma from 25 epidemiological studies”. Int. J. Cancer, 2006, 119, 1108-1124.

[7] Moreno V., Munoz N., Bosch F., De Sanjose S., Gonzalez L., Tafur L., et al.: “Risk factors for progression of cervical intraepithelial neoplasm grade III to invasive cervical cancer”. Cancer Epidemiol. Biomarkers Prev., 1995, 4, 459-467.

[8] Gonzalez C.A., Travier N., Lujan-Barroso L., Castellsague X., Bosch F.X., Roura E., et al.: “Dietary factors and in situ and invasive cervical cancer risk in the European prospective investigation into cancer and nutrition study”. Int. J. Cancer, 2011, 129, 449-459.

[9] Jia Y., Hu T., Hang C.Y., Yang R., Li X., Chen Z.L., et al.: ”Case-control study of diet in patients with cervical cancer or precancerosis in Wufeng, a high incidence region in China”. Asian Pac. J. Cancer Prev., 2012, 13, 5299-5302.

[10] Seo S.S., Oh H.Y., Lee J.K., Kong J.S., Lee D.O., Kim M.K.: “Combined effect of diet and cervical microbiome on the risk of cervical intraepithelial neoplasia”. Clin. Nutr., 2016, 35, 1434-1441.

[11] Labani L., Andallu B., Meera M., Asthana S., Satyanarayana L.: “Food consumption pattern in cervical carcinoma patients and controls”. Indian J. Med. Paediatr. Oncol., 2009, 30, 71-75.

[12] Barchitta M., Maugeri A., La Mastra C., Rosa M.C., Favara G., Lio R.M.S., et al.: “Dietary antioxidant intake and human papillomavirus infection: evidence from a cross-sectional study in Italy”. Nutrients, 2020, 12, 1384.

[13] Esfahani F.H., Asghari G., Mirmiran P., Azizi F.: “Reproducibil-ity and relative validity of food group intake in a food frequency questionnaire developed for the Tehran Lipid and Glucose Study”. J. Epidemiol., 2010, 20, 150-158.

[14] Aadahl M., Jørgensen T.: “Validation of a new self-report instrument for measuring physical activity”. Med. Sci. Sports Exerc., 2003, 35, 1196-1202.

[15] Hu F.B., Rimm E., Smith-Warner S.A., Feskanich D., Stampfer M.J., Ascherio A., et al.: “Reproducibility and validity of dietary patterns assessed with a food-frequency questionnaire”. Am. J. Clin. Nutr., 1999, 69, 243-249.

[16] Barchitta M., Maugeri A., Quattrocchi A., Agrifoglio O., Scalisi A., Agodi A.: “The association of dietary patterns with high-risk human papillomavirus infection and cervical cancer: a cross-sectional study in Italy”. Nutrients, 2018, 10, 469.

[17] Weatherill A.R., Lee J.Y., Zhao L., Lemay D.G., Youn H.S., Hwang D. H.: “Saturated and polyunsaturated fatty acids reciprocally modulate dendritic cell functions mediated through TLR4”. J. Immunol., 2005, 174, 5390-5397.

[18] Calder P.C.: “Polyunsaturated fatty acids and inflammation”. Biochem. Soc. Trans., 2005, 33, 423-427.

[19] Galland L.: “Diet and inflammation”. Nutr. Clin. Pract., 2010, 25, 634- 640.

[20] Fernandes J.V., Fernandes T.A.A.d.M., De Azevedo J.C.V., Cobucci R.N.O., De Carvalho M.G.F., Andrade V.S., et al.: “Link between chronic inflammation and human papillomavirus-induced carcino-genesis”. Oncol Lett., 2015, 9, 1015-1026.

[21] Deivendran S., Marzook K.H., Pillai M.R.: “The role of inflammation in cervical cancer”. Adv. Exp. Med. Biol., 2014, 816, 377-399.

[22] Zhang H., Tsao R.: ”Dietary polyphenols, oxidative stress and an-tioxidant and anti-inflammatory effects”. Curr. Opin. Food Sci., 2016, 8, 33-42.

[23] Ebrahimi S., Soltani A., Hashemy S.I.: “Oxidative stress in cervical cancer pathogenesis and resistance to therapy”. J. Cell. Biochem., 2019, 120, 6868.

[24] Guo W., Kong E., Meydani M.: “Dietary polyphenols, inflammation, and cancer”. Nutr. Cancer, 2009, 61, 807-810.

[25] Rock C.L., Moskowitz A., Huizar B., Saenz C.C., Clark J.T., Daly T. L., et al.: “High vegetable and fruit diet intervention in pre-menopausal women with cervical intraepithelial neoplasia”. J. Am. Diet. Assoc., 2001, 101, 1167-1174.

[26] Herrero R., Potischman N., Brinton L.A., Reeves W.C., Brenes M. M., Tenorio F., et al.: “A case-control study of nutrient status and invasive cervical cancer: I. Dietary indicators”. Am. J. Epidemiol., 1991, 134, 1335-1146.

[27] Verreault R., Chu J., Mandelson M., Shy K.: “A case-control study of diet and invasive cervical cancer”. Int. J. Cancer, 1989, 43, 1050-1054.