Vitamin and carotenoid intake and risk of head-neck cancer subtypes in the Netherlands Cohort Study

Am J Clin Nutr. 2015 Aug;102(2):420-32. doi: 10.3945/ajcn.114.106096. Epub 2015 Jul 8.

Abstract

Background: Head and neck cancer (HNC) is the seventh most-common type of cancer worldwide. Evidence regarding the potential protective effect of vitamins and carotenoids on HNC is limited and mostly based on case-control studies.

Objective: We evaluated the association of intake of dietary vitamins C and E (including supplementation) and the most-common carotenoids (α-carotene, β-carotene, lutein plus zeaxanthin, lycopene, and β-cryptoxanthin) and risk of HNC and HNC subtypes in a large prospective study.

Design: The Netherlands Cohort Study included 120,852 participants. For efficiency reasons, a case-cohort design was used. At baseline in 1986, participants completed a food-frequency questionnaire. A subcohort was randomly selected from the total cohort. After 20.3 y of follow-up, 3898 subcohort members and 415 HNC cases [131 oral cavity cancer (OCCs), 88 oro-/hypopharyngeal cancer (OHPs), and 193 laryngeal cancer cases] were available for analysis. Rate ratios and 95% CIs for highest (quartile 4) compared with lowest (quartile 1) quartiles of vitamin and carotenoid intake were estimated by using the Cox proportional hazards model.

Results: A strong inverse association was shown between vitamin C and HNC overall (multivariable-adjusted rate ratio for quartile 4 compared with quartile 1: 0.39; 95% CI: 0.23, 0.66; P-trend < 0.001), OCC (multivariable-adjusted rate ratio for quartile 4 compared with quartile 1: 0.35; 95% CI: 0.16, 0.77; P-trend < 0.05), and OHPC (multivariable-adjusted rate ratio for quartile 4 compared with quartile 1: 0.29; 95% CI: 0.12, 0.67; P-trend < 0.01). No statistically significant results were shown for vitamin E, α-carotene, β-carotene, lycopene, and lutein plus zeaxanthin. The association of vitamin E and HNC was modified by alcohol status (P-interaction = 0.003) with lower risks in alcohol abstainers.

Conclusions: With this study, we show an inverse association between intake of vitamin C and the incidence of HNC and HNC-subtypes. Future research is recommended to investigate the underlying mechanisms and to confirm our results, which may be promising for the prevention of HNC.

Keywords: carotenoid intake; head-neck cancer; prospective cohort study; risk factors; vitamins.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Antioxidants / administration & dosage
  • Antioxidants / therapeutic use*
  • Ascorbic Acid / administration & dosage
  • Ascorbic Acid / therapeutic use*
  • Carotenoids / administration & dosage
  • Carotenoids / therapeutic use
  • Case-Control Studies
  • Cohort Studies
  • Diet*
  • Dietary Supplements*
  • Female
  • Follow-Up Studies
  • Head and Neck Neoplasms / epidemiology
  • Head and Neck Neoplasms / prevention & control*
  • Humans
  • Hypopharyngeal Neoplasms / epidemiology
  • Hypopharyngeal Neoplasms / prevention & control
  • Incidence
  • Laryngeal Neoplasms / epidemiology
  • Laryngeal Neoplasms / prevention & control
  • Male
  • Middle Aged
  • Mouth Neoplasms / epidemiology
  • Mouth Neoplasms / prevention & control
  • Netherlands / epidemiology
  • Oropharyngeal Neoplasms / epidemiology
  • Oropharyngeal Neoplasms / prevention & control
  • Prospective Studies
  • Registries
  • Risk Factors
  • Vitamin E / administration & dosage
  • Vitamin E / therapeutic use

Substances

  • Antioxidants
  • Vitamin E
  • Carotenoids
  • Ascorbic Acid