Recent european nutrition journal This study investigated the risk of esophageal adenocarcinoma (OAC) and head and neck cancer (HNC) caused by the consumption of ultra-processed foods (UPF). This analysis was conducted in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort.
background
The relationship between disease etiology and industrial food processing has recently received much attention. UPF is manufactured using ingredients such as hydrogenated oils, emulsifiers, and modified starches – products you won’t find in your kitchen. These products are ready to eat, inexpensive, and are often consumed in significant quantities. Examples of UPF include sweet or savory packaged snacks, soft drinks, and shelf-stable cooked or frozen dishes.
Studies have documented that consuming UPF may lead to an increased risk of cancer. In the EPIC cohort, positive associations are observed between HNC, OAC, and UPF consumption. UPF also leads to increased obesity, which is a risk factor for OAC. Studies in non-smokers have also demonstrated that BMI is positively correlated with their HNC risk.
About research
The purpose of this study was to further investigate the association between UPF consumption and the risk of HNC and OAC. In addition to studying the association between UPF and HNC, researchers also investigated the association with subtypes of HNC: hypopharyngeal, laryngeal, oral, oropharyngeal, and other cancers. The influence of additional factors such as smoking, alcohol intake, and physical activity were also analyzed. Additionally, the role of her BMI in the association between UPF, HNC, and OAC was studied using mediation analysis.
The study included 450,111 EPIC participants. Cox regression was used to investigate the correlation between UPF consumption and the risk of HNC and OAC. The role of BMI and waist-hip ratio (WHR) in these correlations was evaluated. Accidental death as a negative control outcome was investigated in a sensitivity analysis.
Main findings
UPF intake was associated with increased risk of OAC and HNC. There was no evidence of heterogeneity between HNC subtypes. Men showed a stronger positive correlation between UPF consumption and HNC compared to women. Additionally, mediation analysis concluded that residual confounding may have influenced the results.
The mediation results are consistent with those described in the existing literature. UPF consumption is associated with central obesity (WHR) and excess body weight (BMI). It has low nutritional value and is often consumed in large quantities. Some studies have put forward the idea that UPF intake may have a negative impact on the gut microbiome. Existing evidence suggests that obesity may increase his risk of OAC and HNC. In the present study, the mediation effects through BMI and WHR were observed to be small, suggesting that other mechanisms may be involved.
strengths and limitations
The large sample size and extended follow-up period of the EPIC cohort is one of the key strengths of this study. Another strength was the fact that BMI and WHR were measured rather than self-reported. EPIC’s multicenter design also resulted in a highly diverse sample. The use of different measurements of UPF intake increased comparability with previous studies and reduced measurement error as cancer cases were detected through registries.
One important limitation of this study was the assumption that the association between UPF intake and cancer was not subject to measurement error or residual confounding. These are very strong assumptions, and inaccurately measured confounders are almost certainly biasing the estimates. Analysis of negative control results also supports this point.
Additionally, follow-up data on BMI and WHR were available for only 5% and 27% of participants. Therefore, it was not possible to perform sensitivity analyzes on follow-up data. The assumption that the relationship between UPF consumption and OAC risk is influenced by BMI and WHR through separate pathways was a further limitation. This is inaccurate because BMI and WHR are correlated. A final issue is the potential for random misclassification bias and the potential weakening of documented association estimates.
conclusion
Taken together, this study showed that UPF intake was associated with increased risk of OAC and HNC. BMI and WHR did not significantly explain these associations. The results presented here may be affected by residual confounding and should be replicated in other settings.
Reference magazines:
- Morales-Berstein, F., Biecy, C., Vialon, V., Gonçalves-Soares, A., Casagrande, C., Emon, B., Kleeman, N., Kailert, M., Blanco-López, J. ., Al-Nahas, A., Chan, K., Vamos, E., Lauber, F., Bertazzi-Levy, R., Barbosa-Cunha, D., Jaksin, P., Ferrari, P., Vineis, P., Masala, G., Catalano, A., Sonnestedt, E., Borne, Y., Katzke, V., Bajracharya, R., Agnoli, C., Guevara, M., Heath, A., Radoi, L., Mancini, F., Weiderpas, E., Huerta, J.M., Sánchez, M.-J., Choneland, A., Kilo, C., Schulze, M.B., Ski, G., Lukic, M. , Braaten, T., Gunther, M., Millet, C., Agudo, A., Brennan, P., Borges, MC, Richmond, RC, Richardson, TG, Davey-Smith, G., Relton, CL, Heibrechts, I. (2023) european nutrition journal. Toi: 10.1007/s00394-023-03270-1. https://link.springer.com/article/10.1007/s00394-023-03270-1