Adherence to Prudent and Mediterranean Dietary Patterns Is Inversely Associated with Lung Cancer in Moderate But Not Heavy Male Polish Smokers: A Case-Control Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Ethical Considerations
2.2. Study Design and Sample Characteristics
2.3. Dietary Data Collection and Dietary Pattern Identification
2.4. Smoking
- A man reported smoking 30 cigarettes a day for 10 years.
- The calculated number of pack-years is: 10 × 30/20 = 15 pack-years
- 10—years of smoking
- 30—number of cigarettes per day
- 20—number of cigarettes in one pack
2.5. Confounders
2.6. Statistical Analysis
3. Results
3.1. Food Consumption Frequency and Dietary Patterns
3.2. Dietary Patterns and Lung Cancer
4. Discussion
Strength and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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Variable | Cancer Control Sample | Cancer Sample | Control Sample | p-Value | |||
---|---|---|---|---|---|---|---|
n | % | n | % | n | % | ||
Sample size | 439 | 100.0 | 187 | 100.0 | 252 | 100.0 | |
Age (years *) | 62.6 (7.2) | 63.0 (7.1) | 62.3 (7.3) | 0.2586 | |||
45.0–49.9 | 12 | 2.8 | 3 | 1.6 | 9 | 3.6 | <0.0001 |
50.0–54.9 | 41 | 9.3 | 12 | 6.4 | 29 | 11.5 | |
55.0–59.9 | 76 | 17.3 | 24 | 12.8 | 52 | 20.6 | |
60.0–64.9 | 133 | 30.3 | 51 | 27.3 | 82 | 32.5 | |
65.0–69.9 | 97 | 22.1 | 42 | 22.5 | 55 | 21.8 | |
70.0–74.9 | 47 | 10.7 | 29 | 15.5 | 18 | 7.1 | |
75.0–80.0 | 33 | 7.5 | 26 | 13.9 | 7 | 2.8 | |
BMI (kg/m2 *) | 27.7 (4.8) | 27.3 (4.9) | 28.0 (4.7) | 0.1354 | |||
<18.5 | 10 | 2.3 | 10 | 5.4 | 0 | 0.0 | <0.0001 |
18.5–24.9 | 125 | 28.5 | 86 | 46.0 | 39 | 15.5 | |
25.0–29.9 | 160 | 36.4 | 55 | 29.4 | 105 | 41.7 | |
≥30 | 144 | 32.8 | 36 | 19.2 | 108 | 42.8 | |
Place of residence | |||||||
rural | 152 | 34.6 | 67 | 35.8 | 85 | 33.7 | 0.5981 |
sub-urban | 202 | 46.0 | 81 | 43.3 | 121 | 48.0 | |
urban | 85 | 19.4 | 39 | 20.9 | 46 | 18.3 | |
Education level | |||||||
primary | 104 | 23.7 | 72 | 38.5 | 32 | 12.7 | <0.0001 |
secondary | 258 | 58.8 | 104 | 55.6 | 154 | 61.1 | |
higher | 77 | 17.5 | 11 | 5.9 | 66 | 26.2 | |
Economic situation | |||||||
below average | 91 | 20.7 | 53 | 28.3 | 38 | 15.1 | <0.0001 |
average | 278 | 63.3 | 118 | 63.1 | 160 | 63.5 | |
above average | 70 | 16.0 | 16 | 8.6 | 54 | 21.4 | |
Socioeconomic status (SES index) a | |||||||
low | 235 | 53.5 | 121 | 64.7 | 114 | 45.2 | 0.0002 |
average | 87 | 19.,8 | 25 | 13.4 | 62 | 24.6 | |
high | 117 | 26.6 | 41 | 21.9 | 76 | 30.2 | |
Physical activity at work b | |||||||
low | 223 | 50.8 | 115 | 61.5 | 108 | 42.9 | 0.0003 |
moderate | 154 | 35.1 | 48 | 25.7 | 106 | 42.0 | |
high | 62 | 14.1 | 24 | 12.8 | 38 | 15.1 | |
Physical activity in leisure time c | |||||||
low | 148 | 33.7 | 71 | 38.0 | 77 | 30.6 | 0.2570 |
moderate | 236 | 53.8 | 95 | 50.8 | 141 | 55.9 | |
high | 55 | 12.5 | 21 | 11.2 | 34 | 13.5 | |
Overall physical activity d | |||||||
low | 227 | 51.7 | 113 | 60.4 | 114 | 45.2 | 0.0069 |
moderate | 165 | 37.6 | 57 | 30.5 | 108 | 42.9 | |
high | 47 | 10.7 | 17 | 9.1 | 30 | 11.9 | |
Current smoking status | |||||||
never smokers | 50 | 12.5 | 1 | 0.5 | 49 | 19.5 | <0.0001 |
current smokers | 157 | 34.6 | 69 | 36.9 | 88 | 45.6 | |
former smokers | 232 | 52.9 | 117 | 62.6 | 115 | 34.9 | |
Smoking period | |||||||
never smokers | 55 | 12.5 | 1 | 0.5 | 54 | 21.4 | <0.0001 |
<5 years | 27 | 6.1 | 5 | 2.7 | 22 | 8.7 | |
5–10 years | 13 | 3.0 | 2 | 1.1 | 11 | 4.4 | |
>10 years | 344 | 78.4 | 179 | 95.7 | 165 | 65.5 | |
Number of cigarettes smoked | |||||||
0 pcs | 55 | 12.5 | 1 | 0.5 | 54 | 21.4 | <0.0001 |
<10 pcs | 28 | 6.4 | 6 | 3.2 | 22 | 8.7 | |
11–20 pcs | 217 | 49.4 | 104 | 55.6 | 113 | 44.9 | |
21–40 pcs | 104 | 23.7 | 50 | 26.8 | 54 | 21.4 | |
>40 pcs | 35 | 8.0 | 26 | 13.9 | 9 | 3.6 | |
Smoking (pack-years) | |||||||
0 pack-years (never smoker) | 55 | 12.5 | 1 | 0.5 | 54 | 21.4 | <0.0001 |
2.5–11 pack-years (moderate smoker) | 252 | 57.4 | 112 | 59.9 | 140 | 55.6 | |
>11 pack-years (heavy smoker) | 132 | 30.1 | 74 | 39.6 | 58 | 23.0 | |
Family history of lung cancer among relatives | |||||||
yes | 91 | 20.7 | 39 | 20.9 | 52 | 20.6 | 0.9945 |
no | 324 | 73.8 | 138 | 73.8 | 186 | 73.8 | |
I do not know | 28 | 5.5 | 10 | 5.3 | 14 | 5.6 | |
Occupational exposure in the workplace | |||||||
yes | 137 | 31.2 | 64 | 34.2 | 73 | 28.9 | 0.2399 |
no | 302 | 68.8 | 123 | 65.8 | 179 | 71.1 |
Food Groups | PCA-Derived Dietary Patterns | Polish-aMED Score | ||
---|---|---|---|---|
Prudent | Westernized Traditional | Sweet Dairy | ||
Whole grain products | 0.65 | −0.04 | −0.03 | 0.49 * |
Fruits | 0.64 | 0.16 | 0.24 | 0.25 * |
Nuts and seeds | 0.57 | 0.05 | 0.12 | 0.54 * |
Vegetables | 0.49 | 0.43 | 0.20 | 0.50 * |
Fish | 0.48 | 0.23 | 0.08 | 0.41 |
Legumes | 0.47 | 0.04 | 0.26 | 0.41 * |
Fruit, vegetable, vegetable-fruit juices | 0.32 | 0.20 | 0.26 | 0.21 * |
Refined grains products | −0.54 | 0.39 | 0.35 | −0.21 * |
Sugar, honey, and sweets | −0.45 | 0.37 | 0.37 | −0.09 |
Red and processed meats | 0.08 | 0.63 | 0.07 | −0.00 |
White meat | 0.19 | 0.56 | −0.01 | 0.13 * |
Potatoes | −0.13 | 0.51 | 0.13 | −0.02 |
Other fats | −0.18 | 0.45 | −0.39 | −0.13 * |
Sweetened beverages and energy drinks | 0.10 | 0.38 | 0.23 | 0.14 * |
Animal fats | −0.11 | 0.01 | 0.66 | 0.06 |
Milk, fermented milk drinks, and curd cheese | 0.13 | 0.12 | 0.49 | 0.17 * |
Sweetened milk drinks and flavored homogenized cheese | −0.02 | 0.01 | 0.45 | 0.07 |
Eggs | 0.12 | 0.17 | 0.43 | 0.14 * |
Cheese | 0.12 | 0.15 | 0.38 | 0.19 * |
Breakfast cereals | 0.10 | −0.25 | 0.37 | 0.10 * |
Vegetable oils | 0.11 | 0.24 | 0.33 | 0.11 * |
Dried fruit and preserves | 0.23 | 0.02 | 0.32 | 0.15 * |
Alcohol | 0.05 | 0.12 | 0.01 | 0.21 * |
Ratio of vegetable oils to animal fat | NA | NA | NA | 0.11 * |
Share in explaining the variance (%) | 15 | 10 | 6 | NA |
Adherence to the Dietary Pattern | Cancer Control Sample (n = 439) | Smoking Status | ||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Never Smoker (n = 55) | Moderate Smoker (n = 252) | Heavy Smoker (n = 132) | ||||||||||||||
Sample Size | Cancer Cases | p | Sample Size | Cancer Cases | p | Sample Size | Cancer Cases | p | Sample Size | Cancer Cases | p | |||||
n | % | n | % | n | % | n | % | |||||||||
Prudent | <0.0001 | 0.6742 | 0.0046 | 0.6541 | ||||||||||||
lower | 146 | 81 | 55.5 | 7 | 0 | 0.0 | 90 | 51 | 56.7 | 49 | 30 | 61.2 | ||||
moderate | 146 | 64 | 43.8 | 17 | 0 | 0.0 | 85 | 41 | 48.3 | 44 | 23 | 52.3 | ||||
higher | 147 | 42 | 28.6 | 30 | 1 | 3.3 | 77 | 20 | 25.9 | 40 | 21 | 52.5 | ||||
Westernized Traditional | 0.8912 | 0.4102 | 0.9861 | 0.1221 | ||||||||||||
lower | 147 | 63 | 42.9 | 20 | 1 | 5.0 | 84 | 37 | 44.0 | 43 | 25 | 58.1 | ||||
moderate | 146 | 64 | 43.8 | 19 | 0 | 0.0 | 82 | 37 | 45.1 | 45 | 27 | 60.0 | ||||
higher | 146 | 60 | 41.1 | 16 | 0 | 0.0 | 86 | 38 | 44.2 | 44 | 22 | 50.0 | ||||
Sweet Dairy | 0.4017 | 0.4101 | 0.9054 | 0.8343 | ||||||||||||
lower | 146 | 62 | 42.5 | 17 | 0 | 0.0 | 85 | 37 | 43.5 | 44 | 25 | 56.8 | ||||
moderate | 147 | 57 | 38.8 | 20 | 1 | 5.0 | 89 | 37 | 41.6 | 38 | 19 | 50.0 | ||||
higher | 146 | 68 | 46.6 | 18 | 0 | 0.0 | 78 | 38 | 48.7 | 50 | 30 | 60.0 | ||||
Polish–aMED score | <0.0001 | 0.4102 | 0.0003 | 0.8254 | ||||||||||||
low (0–3 points) | 177 | 97 | 51.9 | 15 | 0 | 0.0 | 106 | 63 | 59.4 | 56 | 34 | 60.7 | ||||
moderate (4–6 points) | 221 | 83 | 44.4 | 27 | 1 | 3.7 | 127 | 47 | 37.1 | 67 | 35 | 52.2 | ||||
high (7–9 points) | 41 | 7 | 3.7 | 13 | 0 | 0.0 | 19 | 2 | 10.5 | 9 | 5 | 55.6 |
Adherence to the Dietary Pattern | Cancer-Control Sample (n = 439) | |||
---|---|---|---|---|
Crude Model | p | Adjusted Model | p | |
Prudent | ||||
lower (ref.) | Ref. | Ref. | ||
moderate | 0.63 (0.39; 1.00) | 0.0472 | 0.63 (0.37; 1.08) | 0.1394 |
higher | 0.57 (0.44; 0.72) | <0.0001 | 0.72 (0.53; 0.96) | 0.0432 |
Westernized Traditional | ||||
lower (ref.) | Ref. | Ref. | ||
moderate | 1.04 (0.65; 1.66) | 0.8667 | 0.79 (0.45; 1.37) | 0.5123 |
higher | 0.96 (0.76;1.22) | 0.7601 | 0.81 (0.60; 1.08) | 0.1495 |
Sweet Dairy | ||||
lower (ref.) | Ref. | Ref. | ||
moderate | 0.86 (0.54; 1.37) | 0.5203 | 0.68 (0.39; 1.20) | 0.1495 |
higher | 1.09 (0.86; 1.37) | 0.4803 | 0.99 (0.75; 1.30) | 0.7999 |
Polish–aMED score | ||||
low (0–3 points; ref.) | Ref. | Ref. | ||
moderate (4–6 points) | 0.50 (0.33; 0.74) | 0.0004 | 0.51 (0.31; 0.81) | 0.0048 |
high (7–9 points) | 0.41 (0.27; 0.64) | <0.0001 | 0.51 (0.32; 0.81) | 0.0046 |
Adherence to the Dietary Pattern | Moderate Smoker (n = 252) | Heavy Smoker (n = 132) | ||||||
---|---|---|---|---|---|---|---|---|
Crude Model | p | Adjusted Model | p | Crude Model | p | Adjusted Model | p | |
Prudent | ||||||||
lower (ref.) | Ref. | Ref. | Ref. | Ref. | ||||
moderate | 0.67 (0.37; 1.21) | 0.2579 | 0.68 (0.34; 1.34) | 0.2579 | 0.80 (0.34; 1.90) | 0.6226 | 0.82 (0.30; 2.26) | 0.6958 |
higher | 0.51 (0.37; 0.71) | < 0.0001 | 0.59 (0.39; 0.90) | 0.0154 | 0.88 (0.57; 1.37) | 0.5758 | 1.10 (0.64; 1.88) | 0.7187 |
Westernized Traditional | ||||||||
lower (ref.) | Ref. | Ref. | Ref. | Ref. | ||||
moderate | 1.09 (0.59; 2.00) | 0.8320 | 0.92 (0.43; 1.96) | 0.8320 | 0.95 (0.40; 2.33) | 0.9147 | 0.79 (0.28; 2.27) | 0.6574 |
higher | 1.03 (0.76; 1.40) | 0.8131 | 0.95 (0.65; 1.40) | 0.8131 | 0.77 (050; 1.21) | 0.2505 | 0.69 (0.40; 1.19) | 0.1495 |
Sweet Dairy | ||||||||
lower (ref.) | Ref. | Ref. | Ref. | Ref. | ||||
moderate | 0.96 (0.53; 1.76) | 0.5139 | 0.78 (0.38; 1.64) | 0.5139 | 0.68 (0.27; 1.69) | 0.3944 | 0.49 (0.16; 1.46) | 0.1496 |
higher | 1.14 (0.84;1.56) | 0.8109 | 1.05 (0.72; 1.51) | 0.8109 | 0.98 (0.64; 1.50) | 0.9244 | 0.92 (0.56; 1.50) | 0.7999 |
Polish–aMED score | ||||||||
low (0–3 points; ref.) | Ref. | Ref. | Ref. | Ref. | ||||
moderate (4–6 points) | 0.40 (0.23; 0.68) | 0.0007 | 0.35 (0.18; 0.65) | 0.0010 | 0.71 (0.34; 1.46) | 0.3462 | 0.64 (0.27; 1.55) | 0.2485 |
high (7–9 points) | 0.28 (0.13; 0.61) | 0.0010 | 0.34 (0.15; 0.76) | 0.0079 | 0.77 (0.90; 0.44) | 0.7692 | 1.17 (0.53; 2.61) | 0.3462 |
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Hawrysz, I.; Wadolowska, L.; Slowinska, M.A.; Czerwinska, A.; Golota, J.J. Adherence to Prudent and Mediterranean Dietary Patterns Is Inversely Associated with Lung Cancer in Moderate But Not Heavy Male Polish Smokers: A Case-Control Study. Nutrients 2020, 12, 3788. https://doi.org/10.3390/nu12123788
Hawrysz I, Wadolowska L, Slowinska MA, Czerwinska A, Golota JJ. Adherence to Prudent and Mediterranean Dietary Patterns Is Inversely Associated with Lung Cancer in Moderate But Not Heavy Male Polish Smokers: A Case-Control Study. Nutrients. 2020; 12(12):3788. https://doi.org/10.3390/nu12123788
Chicago/Turabian StyleHawrysz, Iwona, Lidia Wadolowska, Malgorzata Anna Slowinska, Anna Czerwinska, and Janusz Jacek Golota. 2020. "Adherence to Prudent and Mediterranean Dietary Patterns Is Inversely Associated with Lung Cancer in Moderate But Not Heavy Male Polish Smokers: A Case-Control Study" Nutrients 12, no. 12: 3788. https://doi.org/10.3390/nu12123788