Dietary patterns and severity of symptom with the risk of esophageal squamous cell carcinoma and its histological precursor lesions in China: a multicenter cross-sectional latent class analysis
Zhaoping Zang,
Yong Liu,
Jialin Wang,
Yuqin Liu,
Shaokai Zhang,
Yongzhen Zhang,
Liwei Zhang,
Deli Zhao,
Fugang Liu,
Lina Chao,
Xinzheng Wang,
Chunli Zhang,
Guohui Song,
Zhiyi Zhang,
Youpeng Li,
Zheng Yan,
Yongxiu Wen,
Yinyin Ge,
Chen Niu,
Wei Feng,
Rena Nakyeyune,
Yi Shen,
Yi Shao,
Xiuhua Guo,
Aiming Yang,
Fen Liu,
Guiqi Wang
Affiliations
Zhaoping Zang
Department of Epidemiology and Health Statistics, School of Public Health, Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University
Yong Liu
Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
Jialin Wang
Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences
Yuqin Liu
Gansu Provincial Cancer Hospital
Shaokai Zhang
Department of Cancer Epidemiology and Prevention, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital
Yongzhen Zhang
Department of Epidemiology, Shanxi Cancer Hospital
Liwei Zhang
The Fourth Hospital of Hebei Medical University
Deli Zhao
Feicheng People’s Hospital
Fugang Liu
Dongping People’s Hospital
Lina Chao
Department of Epidemiology, Hebi People’s Hospital
Xinzheng Wang
Yangcheng Cancer Hospital
Chunli Zhang
The First People’s Hospital of Ningyang County
Guohui Song
Cixian Institute for Cancer Prevention and Control
Zhiyi Zhang
Gansu Wuwei Cancer Hospital
Youpeng Li
Minqin County People’s Hospital
Zheng Yan
Linze County People’s Hospital
Yongxiu Wen
Shandan County People’s Hospital
Yinyin Ge
Gaotai County People’s Hospital
Chen Niu
Department of Epidemiology and Health Statistics, School of Public Health, Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University
Wei Feng
Department of Epidemiology and Health Statistics, School of Public Health, Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University
Rena Nakyeyune
Department of Epidemiology and Health Statistics, School of Public Health, Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University
Yi Shen
Department of Epidemiology and Health Statistics, School of Public Health, Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University
Yi Shao
Department of Epidemiology and Health Statistics, School of Public Health, Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University
Xiuhua Guo
Department of Epidemiology and Health Statistics, School of Public Health, Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University
Aiming Yang
Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences
Fen Liu
Department of Epidemiology and Health Statistics, School of Public Health, Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University
Guiqi Wang
Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
Abstract Background Dietary patterns and symptoms research among Chinese with esophageal squamous cell carcinoma (ESCC) and its precursor lesions is limited, especially as it relates to multiple food consumption and multiple co-occurring symptoms. The aim of our study was to identify the dietary patterns and severity of symptom classes with the risk of esophageal squamous cell carcinoma and its histological precursor lesions, and develop a risk prediction model for different stages of esophageal disease. Methods We analyzed data from a multicenter cross-sectional study carried out in ESCC high incidence areas between 2017 and 2018, which included 34,707 individuals aged 40–69 years. Dietary patterns and severity of symptom classes were derived by applying a latent class analysis (LCA). A multiple logistic regression model was used to derive the odds ratio (ORs) and corresponding 95% confidence intervals (CIs) for ESCC and the different stages of esophageal disease according to the dietary patterns and severity of symptom classes identified. We built the risk prediction model by using a nomogram. Results We identified five dietary patterns and three severity of symptom classes. The dietary patterns were classified as follows: “Healthy”, “Western”, “Lower consumers-combination”, “Medium consumers-combination” and “Higher consumers-combination” patterns based on the intake of foods such as red meat, vegetables and fruits. The severity of symptoms was categorized into “Asymptomatic”, “Mild symptoms” and “Overt symptoms” classes based on health-related symptoms reported by the participants. Compared to the “Healthy” pattern, the other four patterns were all associated with an increased risk of esophageal disease. Similarly, the other two symptom classes present different degrees of increased risk of esophageal disease compared to the “Asymptomatic”. The nomograms reflect the good predictive ability of the model. Conclusion Among individuals aged 40–69 years in high incidence regions of upper gastrointestinal cancer, the results supplied that subjects with diets rich in livestock and poultry meat and low in fruits and vegetables and subjects with typical symptoms were at increased ESCC risk. The findings highlight the importance of considering food and symptom combinations in cancer risk evaluation.
