Nut consumption and the risk of oesophageal squamous cell carcinoma in the Golestan Cohort Study

Br J Cancer. 2018 Jul;119(2):176-181. doi: 10.1038/s41416-018-0148-0. Epub 2018 Jun 28.


Background: Nut consumption has been inversely associated with gastric cancer incidence in US-based studies, but not with oesophageal cancer. However, there is aetiologic heterogeneity, among oesophageal squamous cell carcinoma (ESCC) cases in low-risk vs. high-risk populations. The objective of this study was to evaluate the association between nut consumption and risk of ESCC in a high-risk population.

Methods: The Golestan Cohort Study enroled 50,045 participants in Northeastern Iran, between 2004 and 2008. Intake of peanuts, walnuts and mixed nuts (including seeds) were assessed using a validated food frequency questionnaire at baseline. Cox proportional hazard models were used to estimate hazard ratios (HR) and 95% confidence intervals for subsequent ESCC adjusted for potential confounders. Non-consumers of nuts were used as the reference category and the consumers were categorised into tertiles.

Results: We accrued 280 incident ESCC cases during 337,983 person-years of follow up. Individuals in the highest tertiles of total nut consumption, and mixed nut consumption were significantly associated with lower risk of developing ESCC compared to non-consumers (HR = 0.60, 95% CI = 0.39-0.93, p-trend = 0.02, and HR = 0.52, 95% CI = 0.32-0.84, p trend = 0.002, respectively).

Conclusions: We found a statistically significant inverse association between total nut consumption and the risk of ESCC in this high-risk population.

Publication types

  • Research Support, N.I.H., Intramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cohort Studies
  • Diet*
  • Esophageal Squamous Cell Carcinoma / diet therapy*
  • Esophageal Squamous Cell Carcinoma / epidemiology
  • Esophageal Squamous Cell Carcinoma / pathology
  • Feeding Behavior*
  • Female
  • Humans
  • Iran / epidemiology
  • Male
  • Middle Aged
  • Nuts*
  • Proportional Hazards Models
  • Risk Factors