Plant-based dietary patterns and risk of esophageal cancer: A prospective cohort study spanning 17 years

Xiaorui Zhang; Feifan He; Jiayue Li; Ru Chen; Xinqing Li; Li Li; Fen Liu; Shaoming Wang; Wenqiang Wei

doi:10.21147/j.issn.1000-9604.2024.01.04

Plant-based dietary patterns and risk of esophageal cancer: A prospective cohort study spanning 17 years

Chin J Cancer Res. 2024 Feb 29;36(1):36-45. doi: 10.21147/j.issn.1000-9604.2024.01.04.

Authors

Xiaorui Zhang¹, Feifan He², Jiayue Li², Ru Chen², Xinqing Li³, Li Li², Fen Liu¹, Shaoming Wang², Wenqiang Wei²

Affiliations

¹ Department of Epidemiology and Health Statistics, School of Public Health, Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing 100069, China.
² National Central Cancer Registry office, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
³ Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.

PMID: 38455370
PMCID: PMC10915634
DOI: 10.21147/j.issn.1000-9604.2024.01.04

Abstract

Objective: Plant-based diets have multiple health benefits for cancers; however, little is known about the association between plant-based dietary patterns and esophageal cancer (EC).This study presents an investigation of the prospective associations among three predefined indices of plant-based dietary patterns and the risk of EC.

Methods: We performed endoscopic screening for 15,709 participants aged 40-69 years from two high-risk areas of China from January 2005 to December 2009 and followed the cohort until December 31, 2022. The overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), and unhealthful plant-based diet index (uPDI), were calculated using survey responses to assess dietary patterns. We applied Cox proportional hazard regression to estimate the multivariable hazard ratios (HRs) and 95% confidence intervals (95% CIs) of EC across 3 plant-based diet indices and further stratified the analysis by subgroups.

Results: The final study sample included 15,184 participants in the cohort. During a follow-up of 219,365 person-years, 176 patients with EC were identified. When the highest quartile was compared with the lowest quartile, the pooled multivariable-adjusted HR of EC was 0.50 (95% CI, 0.32-0.77) for hPDI. In addition, the HR per 10-point increase in the hPDI score was 0.42 (95% CI, 0.27-0.66) for ECs. Conversely, uPDI was positively associated with the risk of EC, and the HR was 1.80 (95% CI, 1.16-2.82). The HR per 10-point increase in the uPDI score was 1.90 (95% CI, 1.26-2.88) for ECs. The associations between these scores and the risk of EC were consistent in most subgroups. These results remained robust in sensitivity analyses.

Conclusions: A healthy plant-based dietary pattern was associated with a reduced risk of EC. Emphasizing the healthiness and quality of plant-based diets may be important for preventing the development of EC.

Keywords: Esophageal cancer; diet; dietary pattern; epidemiology; nutrition; prospective cohort study.