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Dietary exposures and oral precancerous lesions in Srikakulam District, Andhra Pradesh, India

Published online by Cambridge University Press:  02 January 2007

James R Hebert ,
Prakash C Gupta ,
Ramesh B Bhonsle ,
Hemali Mehta ,
Wei Zheng ,
Maureen Sanderson  and
Jane Teas
James R Hebert*
Affiliation:
Department of Epidemiology and Biostatistics, University of South Carolina School of Public Health, Columbia, SC 29208, USA Nutrition Research Center, University of South Carolina School of Public Health, Columbia, SC 29208, USA Division of Population Studies, South Carolina Cancer Center, 15 Medical Park, Columbia, SC 29203, USA
Prakash C Gupta
Affiliation:
Epidemiology Research Unit, Tata Institute of Fundamental Research, Homi Bhabha Road, Bombay 400005, India
Ramesh B Bhonsle
Affiliation:
Epidemiology Research Unit, Tata Institute of Fundamental Research, Homi Bhabha Road, Bombay 400005, India
Hemali Mehta
Affiliation:
Epidemiology Research Unit, Tata Institute of Fundamental Research, Homi Bhabha Road, Bombay 400005, India
Wei Zheng
Affiliation:
Division of General Internal Medicine and Vanderbilt–Ingram Cancer Center, Vanderbilt University, Nashville, TN 37232, USA
Maureen Sanderson
Affiliation:
Department of Epidemiology and Biostatistics, University of South Carolina School of Public Health, Columbia, SC 29208, USA University of Texas School of Public Health at Brownsville, TX 78520, USA
Jane Teas
Affiliation:
Nutrition Research Center, University of South Carolina School of Public Health, Columbia, SC 29208, USA Division of Population Studies, South Carolina Cancer Center, 15 Medical Park, Columbia, SC 29203, USA Department of Health Promotion Research and Education, University of South Carolina School of Public Health, Columbia, SC 29208, USA
*
*Corresponding author: Email [email protected]
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Abstract

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Objective:

To test the effect of dietary nutrients on oral precancerous lesions in a reverse-smoking (i.e. smoking with the glowing end inside the mouth) population in South India.

Design:

Case–control. Cases with precancerous lesions were matched to an equal number of lesion-free controls matched on age (±5 years), sex and village. All subjects used tobacco in some form. Dietary data were obtained using an interviewer-administered food-frequency questionnaire, designed for use in this population. All interviews were conducted blinded to the disease status of the subject. Data were analysed using logistic regression.

Setting:

Nineteen rural villages in Srikakulam District, Andhra Pradesh.

Subjects:

From a survey of 6007 tobacco users, 485 (79% women) were found to have precancerous, mostly palatal, lesions (cases), and 487 lesion-free subjects were selected as controls.

Results:

All eligible subjects consented to participate and nearly all (>99%) had complete data for analyses. Reverse smoking was the most common form of tobacco use among cases (81.9%) and controls (73.5%), and reverse smokers were 5.19 times more likely than chewers to have these lesions (95% confidence interval = 1.35, 19.9). After controlling for relevant covariates, including the type of tobacco use, protective linear effects were observed for zinc (70% reduction across the interquartile range, P<<0.002 ), calcium (34% reduction, P<0.002 ), fibre (30% reduction, P<0.009 ), riboflavin (22% reduction, P<0.03 ) and iron (17% reduction, P<0.05 ).

Conclusions:

Several dietary nutrients appear to protect against oral precancerous lesions that are strongly associated with reverse smoking. The results of this study indicate scope for targeting dietary factors in preventing oral cancer, which should be coupled with aggressive anti-tobacco use efforts.

Keywords

IndiaOral neoplasmsPrecancerous conditionsDietary nutrients
Type
Research Article
Information
Public Health Nutrition , Volume 5 , Issue 2 , April 2002 , pp. 303 - 312
Copyright
Copyright © CABI Publishing 2002

References

1Parkin, DM, Pisani, P, Ferlay, J. Esimates of worldwide incidence of eighteen major cancers in 1985. Int. J. Cancer 1993; 54: 594–606.CrossRefGoogle Scholar
2World Health Organization(WHO). Control of oral cancer in developing countries: a WHO meeting. Bull. WHO 1984; 62: 817–30.Google Scholar
3Mehta, FS, Shroff, BC, Gupta, PC, Pindborg, JJ. A correlative histocytological study of carcinoma and epithelial atypia of the palate among Indian reverse smokers. Br. J. Cancer 1972; 26: 230–3.CrossRefGoogle ScholarPubMed
4Mehta, FS, Jalnawalla, PN, Daftary, DK, Gupta, PC,Pindborg, JJ. Reverse smoking in Andhra Pradesh, India: variability of clinical and histologic appearances of palatal changes. Int. J. Oral Surg. 1977; 6: 75–83.CrossRefGoogle Scholar
5Pindborg, J, Mehta, F, Gupta, P, Daftary, D, Smith, C. Reverse smoking in Andhra Pradesh, India: a study of palatal lesions among 10,169 villagers. Br. J. Cancer 1971; 25: 10–20.CrossRefGoogle Scholar
6Marshall, J, Graham, S, Mettlin, C, Shedd, D, Swanson, M. Diet in the epidemiology of oral cancer. Nutr. Cancer 1982; 3(3), 145–9.CrossRefGoogle ScholarPubMed
7Winn, D, Ziegler, R, Pickle, L, Gridley, G, Blot, W, Hoover, R. Diet in the etiology of oral and pharyngeal cancer among women from the Southern United States. Cancer.Res. 1984; 44: 1216–22.Google ScholarPubMed
8Franco, EL, Kowalski, LP, Oliveira, BV, Curado, MP, Pereira, RN, Silva, ME. Risk factors for oral cancer in Brazil: a case–control study. Int. J. Cancer 1989; 43: 992–1000.CrossRefGoogle ScholarPubMed
9Gupta, PC, Hebert, JR, Bhonsle, RB, Murti, PR, Mehta, H, Mehta, FS. Influence of dietary factors on oral precancerous lesions in a population-based case–control study in Kerala, India. Cancer 1999; 85: 1885–93.Google Scholar
10Gupta, PC, Hebert, JR, Bhonsle, RB, Sinor, PN, Mehta, H, Mehta, FS. Dietary factors in oral leukoplakia and submucous fibrosis in a population-based case–control study in Gujarat, India. Oral Dis 1998; 4: 200–6.CrossRefGoogle Scholar
11Marshall, JR, Boyle, P. Nutrition and oral cancer. Cancer Causes Control 1996; 7: 101–11.CrossRefGoogle ScholarPubMed
12Gupta, PC, Mehta, FS, Daftary, DK, Pindborg, JJ, Bhonsle, RB, Jalnawalla, PN, et al. Incidence of oral cancer and natural history of oral precancerous lesions in a 10-year follow-up study of Indian villagers. Community Dent. Oral Epidemiol. 1980; 8: 287–333.CrossRefGoogle Scholar
13Pindborg, JJ. Oral cancer and Precancer. Bristol: John Wright & Sons, Ltd, 1980; 177.Google Scholar
14Gupta, PC, Bhonsle, RB, Murti, PR, Daftary, DK, Mehta, FS, Pindborg, JJ. An epidemiologic assessment of cancer risk in oral precancerous lesions in India with special reference to nodular leukoplakia. Cancer 1989; 63: 2247–52.3.0.CO;2-D>CrossRefGoogle ScholarPubMed
15Murti, PR, Bhonsle, RB, Gupta, PC, Daftary, DK. Oral health consequences of tobacco use in Ernakulam District, Kerala, India. In: Gupta, PC, Hamner, JE, Murti, PR, eds. Proceedings of an International Symposium on Control of Tobacco-Related Cancers and Other Diseases, Bombay, India, 15–19 January 1990. Oxford: Oxford University Press, 1992; 85–105.Google Scholar
16National Institute of Nutrition (NIN). National Nutrition Monitoring Bureau Report of Repeat Surveys (1988–90). Hyderabad, India: NIN, Indian Council of Medical Research, 1991.Google Scholar
17Rao, B. Monitoring nutrient intakes in India. Indian J. Pediatr. 1987; 54: 495–501.Google ScholarPubMed
18Hebert, JR, Gupta, PC, Mehta, H, Ebbeling, CB, Bhonsle, RB, Varghese, F. Sources of variability in dietary intake in two distinct regions of rural India: implications for nutrition study design and interpretation. Eur. J. Clin. Nutr. 2000; 54: 479–86.CrossRefGoogle ScholarPubMed
19Hebert, JR, Miller, DR. Methodologic considerations for investigating the diet–cancer link. Am. J. Clin. Nutr. 1988; 47: 1068–77.CrossRefGoogle ScholarPubMed
20Kandarkar, SV, Sawant, SS. The effect of vitamin C on the hamster cheek pouch treated with the water soluble carcinogen 4-nitroquinoline-1-oxide (4NQO). Eur. J. Cancer 1996; 32B, 230–7.CrossRefGoogle ScholarPubMed
21Shklar, G, Schwartz, J (1993). Oral cancer inhibition by micronutrients. The experimental basis for clinical trials. Eur. J. Cancer 29B, 9–16.CrossRefGoogle ScholarPubMed
22Krishnaswamy, K, Prasad, MP, Krishna, TP, Annapurna, VV, Reddy, GA. A case study of nutrient intervention of oral precancerous lesions in India. Eur. J. Cancer 1995 21B, 41–8.CrossRefGoogle Scholar
23Garewal, HS, Schantz, S. Emerging role of beta-carotene and antioxidant nutrients in prevention of oral cancer. Arch. Otolaryngol. Head Neck Surg. 1995; 121: 141–4.CrossRefGoogle ScholarPubMed
24Maher, R, Aga, P, Johnson, NW, Sankaranarayanan, R, Warnakulasuriya, S. Evaluation of multiple micronutrient supplementation in the management of oral submucous fibrosis in Karachi, Pakistan. Nutr. Cancer 1997; 27: 41–7.CrossRefGoogle ScholarPubMed
25Prasad, MP, Mukundan, MA, Krishnaswamy, K. Micronuclei and carcinogen DNA adducts as intermediate end points in nutrient intervention trial of precancerous lesions in the oral cavity. Eur. J. Cancer 1995; 31B, 155–9.CrossRefGoogle ScholarPubMed
26Tanaka, T (1995) Chemoprevention of oral carcinogenesis. Eur. J. Cancer 31B, 3–15.CrossRefGoogle ScholarPubMed
27Zheng, W, Blot, WJ, Shu, XO, Diamond, EL, Gao, YT, Ji, BT. Risk factors for oral and pharyngeal cancer in Shanghai, with emphasis on diet. Cancer Epidemiol. Biomark. Prev. 1992; 1: 441–8.Google ScholarPubMed
28Zaridze, D, Blettner, M, Trapeznikou, N, Kuvshinou, J, Matiakin, E, Poljakov, B. Survey of a population with a high incidence of oral and oesophageal cancer. Int. J. Cancer 1985; 36: 153–8.CrossRefGoogle ScholarPubMed
29Marshall, JR, Graham, S, Haughey, BP, Shedd, D, O'Shea, R, Brasure, J. Smoking, alcohol, dentition and diet in the epidemiology of oral cancer. Eur. J. Cancer 1992; 28B, 9–15.CrossRefGoogle ScholarPubMed
30Franceschi, S, Bidoli, E, Baron, AE, La Vecchia, C. Maize and risk of cancers of the oral cavity, pharynx, and esophagus in northeastern Italy [see comments]. J. Natl. Cancer Inst. 1991; 83: 138–9.Google Scholar
31National Institute of Nutrition (NIN). Nutritive Value of Indian Foods. Hyderabad, India: NIN, 1993.Google Scholar
32Gupta, PC, Mehta, FS, Pindborg, JJ, Aghi, MB, Bhonsle, RB, Daftary, DK, et al. Intervention study for primary prevention of oral cancer among 36,000 Indian tobacco users. Lancet 1986; 1: 1235–9.CrossRefGoogle Scholar
33Hebert, JR, Gupta, PC, Bhonsle, RB, Murti, PR, Mehta, H, Verghese, F. Development and testing of a quantitative food frequency questionnaire for use in Kerala, India. Public Health Nutr. 1998; 1: 123–30.CrossRefGoogle ScholarPubMed
34Hebert, JR, Gupta, PC, Bhonsle, RB, Sinor, PN, Mehta, H, Mehta, FS. Development and testing of a quantitative food frequency questionnaire for use in Gujarat, India. Public Health Nutr. 1999; 2: 39–50.CrossRefGoogle ScholarPubMed
35Bhonsle, RN, Murti, PR, Gupta, PC. Tobacco habits in India. In: Gupta, PC, Hamner, JE, Murti, PR, eds. Proceedings of an International Symposium on Control of Tobacco-Related Cancers and Other Diseases, Bombay, India,15–19 January 1990. Oxford: Oxford University Press 1992; 25–46.Google Scholar
36Willett, WC. Nutritional Epidemiology. 2nd ed. Monographs in Epidemiology and Biostatistics, Vol. 30. New York: Oxford University Press, 1992.Google Scholar
37Bingham, SA, Nelson, M. Assessment of food consumption and nutrient intake. In: Margetts, BM, Nelson, M, eds. Design Concepts in Nutritional Epidemiology. New York: Oxford University Press, 1991; 153–67.Google Scholar
38Goodhart, RS, Shils, ME. Modern Nutrition in Health and Disease. Philadelphia, PA: Lea & Febiger, 1980; 1370.Google Scholar
39SAS. SAS User's Guide. Cary, NC: SAS Institute, Inc., 2001.Google Scholar
40SAS. SAS/STAT Software: Changes and Enhancements through Release 8.01 (Guide). Cary, NC: SAS Institute, Inc. 2001; 1167 pp.Google Scholar
41Hebert, JR & Miller, DR (1991) The inappropriateness of conventional use of the correlation coefficient in assessing validity and reliability of dietary assessment methods. Eur. J. Epidemiol. 1992; 7: 339–43.CrossRefGoogle ScholarPubMed
42Gupta, PC. Epidemiologic study of the association between alcohol habits and oral leukoplakia. Oral Epidemiol 1984; 12: 47–50.CrossRefGoogle ScholarPubMed
43Hebert, JR, Kabat, GC. Differences in dietary intake associated with smoking status. Eur. J. Clin. Nutr. 1990; 44: 185–93.Google ScholarPubMed
44Hebert, JR, Kabat, GC. Implications for cancer epidemiology of differences in dietary intake associated with alcohol consumption. Nutr. Cancer 1991; 15: 107–19.CrossRefGoogle ScholarPubMed
45Stryker, WS, Kaplan, LA, Stein, EA, Stampfer, MJ, Sober, A, Willett, WC. The relation of diet, cigarette smoking, and alcohol consumption to plasma beta-carotene and alpha-tocopherol levels. Am. J. Epidemiol. 1988; 127: 283–96.CrossRefGoogle ScholarPubMed
46Hebert, JR, Hurley, TG, Hsieh, J, Rogers, E, Stoddard, AM, Sorensen, G. Determinants of plasma vitamins and lipids: the Working Well Study. Am. J. Epidemiol. 1994; 140: 132–47.CrossRefGoogle ScholarPubMed
47Zheng, T, Boyle, P, Willett, WC, Hu, H, Dan, J, Evstifeeva, TV. A case–control study of oral cancer in Beijing, People's Republic of China: associations with nutrient intakes, foods and food groups. Eur. J. Cancer 1993; 29B, 45–55.CrossRefGoogle ScholarPubMed
48Hebert, JR, Ma, Y, Clemow, L, Ockene, IS, Saperia, G, Stanek, EJ, et al. Gender differences in social desirability and social approval bias in dietary self report. Am. J. Epidemiol. 1997; 146: 1046–55.CrossRefGoogle ScholarPubMed
49Messer, E. Intra-household allocation of food and health care: current findings and understandings – introduction. Soc. Sci. Med. 1997; 44: 1675–84.CrossRefGoogle ScholarPubMed
50Gupta, PC, Mehta, FS, Pindborg, JJ, Bhonsle, RB, Murti, PR, Daftary, DK, et al. Primary prevention trial on oral cancer in India: a 10-year follow-up study. J. Oral Pathol. Med. 1992; 21: 433–9.CrossRefGoogle ScholarPubMed
51Fabris, N, Mocchegiani, E. Zinc, human diseases and aging. Aging 1995; 7: 77–93.Google ScholarPubMed
52Chen, TS, Chen, PS. Rise and fall of the Plummer–Vinson syndrome. J. Gastroenterol. Hepatol. 1994; 9: 654–8.CrossRefGoogle ScholarPubMed
53Paul, RR, Chatterjee, J, Das, AK, Dutta, SK, Roy, C. Zinc and iron as bioindicators of precancerous nature of oral submucous fibrosis. Biol. Trace Elem. Res. 1996; 54: 213–30.CrossRefGoogle ScholarPubMed
54Stevens, R, Jones, Y, Micozzi, M, Taylor, P. Body iron stores and the risk of cancer. N. Engl. J. Med. 1988; 319: 1047–52.CrossRefGoogle ScholarPubMed
55Wynder, E, Hultberg, S, Jacobson, F, Bross, I. Environmental factors in cancer of the upper alimentary tract. Cancer 1957; 10(3), 470–87.3.0.CO;2-7>CrossRefGoogle ScholarPubMed
56Bay, BH, Sit, KH, Liau, LS. Cytosolic calcium mobilization concomitant with cell retraction induced by sulphate in oral KB carcinoma cells. Anticancer Res. 1996; 16: 821–6.Google ScholarPubMed
57Rogers, MA, Thomas, DB, Davis, S, Vaughan, TL, Nevissi, AE. A case–control study of element levels and cancer of the upper aerodigestive tract. Cancer Epidemol. Biomark. Prev. 1993; 2: 305–12.Google ScholarPubMed
58Zaridze, DG, Huvshinov, JP, Matiakin, E, Polakov, BI, Boyle, P, Blettner, M. Chemoprevention of oral and esophageal cancer in Uzbekistan, Union of Soviet Socialist Republics. J. Natl. Cancer Inst. Monogr. 1985; 69: 259–62.Google ScholarPubMed
59Zheng, W, Blot, WJ, Diamond, EL, Norkus, EP, Spate, V, Morris, JS. Serum micronutrients and the subsequent risk of oral and pharyngeal cancer. Cancer Res. 1993; 53: 795–8.Google ScholarPubMed
60Kaugars, GE, Silverman, SJ, Lovas, JG, Thompson, JS, Brandt, RB, Singh, VN. Use of antioxidant supplements in the treatment of human oral leukoplakia. Oral Surg. Oral Med. Oral Pathol. 1996; 81: 5–14.CrossRefGoogle ScholarPubMed
61Zheng, W, Sellers, TA, Doyle, TJ, Kushi, LH, Potter, JD, Folsom, AR. Retinol, antioxidant vitamins, and cancers of the upper digestive tract in a prospective cohort study of postmenopausal women. Am. J. Epidemiol. 1995; 142: 955–60.CrossRefGoogle Scholar
62Garewal, J, Mayskens, FJ, Friedman, S, Alberts, D, Ramsey, L. Oral cancer prevention: the case for carotenoids and anti-oxidant nutrients. Prev. Med. 1993; 22: 701–11.CrossRefGoogle ScholarPubMed
63Garewal, JS. Beta-carotene and vitamin E in oral cancer prevention. J. Cell Biochem. 1993; 17F, 262–9.CrossRefGoogle ScholarPubMed
64Munoz, N, Hayashi, M, Bang, LJ, Wahrendorf, J, Crespi, M, Bosch, FX. Effect of riboflavin, retinol, and zinc on micronuclei of buccal mucosa and of esophagus: a randomized double-blind intervention study in China. J. Natl. Cancer Inst. 1987; 79: 687–91.Google ScholarPubMed
65Hebert, JR, Ma, Y, Ebbeling, CB, Matthews, CE, Ockene, IS. Self-Report Data. Compliance in Healthcare and Research. Armonk, NY: Futura; 2001; 163–79.Google Scholar
66US Departments of Agriculture and Health and Human Services. Nutrition and Your Health: Dietary Guidelines for Americans, 4th ed. Home and Garden Bulletin No. 232. Washington, DC: US Departments of Agriculture and Health and Human Services, 1995.Google Scholar
67American Institute for Cancer Research. Food, Nutrition and the Prevention of Cancer: A Global Perspective. Washington, DC: American Institute for Cancer Research, 1997; 670.Google Scholar
68Butrum, RR, Clifford, CK, Lanza, E. NCI dietary guidelines: rationale. Am. J. Clin. Nutr. 1988; 48: 888–95.CrossRefGoogle ScholarPubMed