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Role of nutritional factors in pathogenesis of cancer

Role of nutritional factors in pathogenesis of cancer Diet and nutrition are crucial factors throughout the complete life course in the promotion and upholding of good health. It has always been accepted that our defencelessness to infection and disease was influenced by diet and environmental as well as genetic factors. Nutrition is coming to the front position as a principle modifiable determinant of chronic disease, with scientific confirmation with time more supporting the view that alterations in diet have strong effects, equally positive as well as negative, on health throughout life. For the most part notably, nutritional adjustments may not only influence present health but also determine whether or not an individual will develop chronic non-communicable diseases like cancer. Diet is a blend of protective, mutagenic, and carcinogenic agents; the majority of them are metabolized by the enzymes of biotransformation process. Genetic polymorphisms that alter protein expression or else the function of these enzymes can change the risk of developing cancer. The scientific community has identified numerous naturally occurring materials in plant food with the power to resolve possible carcinogens. A  few of these nutrients and natural phytochemicals look for toxins and usher them from the body before they can cause cell damage that may lead to cancer. Others give the impression to make it easier for the body to make repairs at the cellular level. At a standstill, others may help bring to an end cancer cells from reproducing. Even after a cell begins to experience damage that can lead to cancer, what you eat and drink, and how you live can still help short-circuit the cancer process. It is thought that a diet containing defensive micronutrients as well as carcinogens and mutagens may adapt the risk of cancer development, particularly in genetically susceptible individuals. Key words: Nutritional factor; Dietary practices; Susceptibility; Cancer. 1940s where sequential confinement of nutritional factors markedly Introduction reduced the incidence of cancer in mice (Tannenbaum, 1940). After Nutritional factors have been thought responsible for about 30 per 2 decades other advancement like development of cancer registries cent of cancers in more developed countries, making nutrient sec- and research focused on effect of environmental factors on human ondary only to tobacco as a mendable cause of cancer (Doll, 1981). health depicts larger picture about the geographical variations in The share of diet-to-cancer risk in low-income countries has been cancer incidence which might be due to the differences in lifestyle considered to be lower, perhaps around 20 per cent (Miller, 2001). and dietary habits (Doll, 1966; Doll, 1970; Armstrong, 1975). It The relationship between nutritional factors and pathogenesis is followed by prominent number of case-control studies in 1970s of cancer first established by an experimental study conducted in © The Author(s) 2018. Published by Oxford University Press on behalf of Zhejiang University Press. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact jour- nals.permissions@oup.com Downloaded from https://academic.oup.com/fqs/article-abstract/2/1/27/4912382 by Ed 'DeepDyve' Gillespie user on 16 March 2018 28 A. Patel et al., 2018, Vol. 2, No. 1 and 1980s to identify nutritional risk factors with greater specific- cancer, liver cancer, and breast cancer. In 2008, approximately 12.7 ity. Food patterns and specific food components, macro- and micro- million cancers were diagnosed and 7.6 million people died of can- nutrients may all play etiological roles and their effects may also cer worldwide. This makes cancer the leading cause of death in be modified by other lifestyle factors such as physical activity or the developed world, and the second leading cause of death in the childbearing patterns. It has been hypothesized that 30%–40% of developing world (Jemal, 2011). According to National Institute of different subtypes of cancer may preclude with a healthy lifestyle Cancer, a wing of National Institute of Health in 2016, a rough and and dietary habits. In some studies, probable associations have sug- ready 1,685,210 new cases of cancer will be identified in the USA gested with a few nutritional factors, but have focused mostly on the and about 595,690 individuals will pass away from the disease. In potential increased risks linked with the consumption of eggs, meat, 2016, the most common cancers are proposed to be bladder cancer, and dairy products and the promising drop in risk connected with breast cancer, bronchus cancer, colon and rectum cancer, lung cancer, high intake of fruit and vegetables (Wolk, 1996; Lindblad, 1997; prostate cancer, melanoma of the skin, leukaemia, thyroid cancer, Handa, 2002; Nicodemus, 2004). Obesity is substantially correlated kidney and renal pelvis cancer, pancreatic cancer, and endometrial with carbohydrate and an established risk factor for cancers of the cancer. oesophagus (adenocarcinoma) colorectum, breast, endometrium and The probability of developing cancer may either increase or de- kidney (International Agency for Research on Cancer, 2002; Key, crease depending on what individuals eat and how often they exer- 2004). Contribution to obesity by dietary carbohydrates after that cise. Nutritional factors are estimated to account for approximately they nearly without doubt also add to rising the risk for these metic- 30 per cent of cancers in industrialized countries, making diet sec- ulous cancer sites (van Dam, 2007). ondary only to tobacco as a hypothetically avoidable cause of cancer. Hormonal and reproductive factors are the established risk fac- Research to date has revealed few explicit relationships between tors for breast cancer, and it is obvious that higher intake of sucrose or exact nutritional factors and cancer risk. Studies have investigated else higher glycemic load may increase risk leading to obesity which the definite role of diet in the progress of major cancers. In develop- will in turn increase the endogenous oestrogen levels (Key, 2003). ing countries, 60 per cent of these cancers are attributed to a diet Some evidence has led to the suggestion that a high intake of dietary low in fruit, vegetables, and animal products. All the way through fibre might reduce the risk of breast cancer, colorectal cancer, and the world, consumption of thermally very hot drinks and food raises stomach cancer (Burkitt, 1969; De Stefani, 1999). Carbohydrates are the risk of these cancers. not considered to be directly pertinent to the aetiology of few types Alteration in diet possibly will play a significant role in the ris- of cancer like liver cancer, lung cancer, ovarian cancer, prostate can- ing frequency of specific cancers. Conventional and industrial food cer, and bladder cancer (Jain, 2000; Pandey, 2003; Zeegers, 2004; processing methods as well as microbiological and chemical food Chan, 2005). Experimental studies and epidemiological data both contaminants are the factors that may add to the carcinogenicity of indicate that high-fat diets increase the risk of cancer at sites such diets (Table 1) (Key, 2004). as breast, colon, prostate and pancreas (Armstrong, 1975; Carroll, Table  2 summarizes the association between food or nutrients 1983; Prentice, 1990). However, these associations are due to cor- and cancers, which are frequent or increasing and which have been relations with intake of animal fat, not vegetable fat (Rose, 1986). suggested to be related to dietary habits in the earlier epidemio- Based on these epidemiological investigations and animal studies, logical studies (Tominaga, 1987). dietary fat increasing has been hypothesized to act by excretion of bile acids, which can be converted to carcinogens or promoters. Demographic details Dietary polyunsaturated vegetable oils promote tumorigenesis in animals whereas saturated fats and polyunsaturated fish oils either Earlier it was believed that cancer is more of a developed world have little effect or are inhibitory. Omega-3 fat acids that are present issue; however, ratio is changing with time, and at present, 57 per in fish oils and in some vegetables may reduce the incidence of breast cent of all cancers (excluding non-melanoma skin cancer) occur in and colon cancer (Carroll, 1991). It seems that monounsaturated less developed countries and 43 per cent in more developed coun- oils such as olive oil, behave in a neutral manner. There is much con- tries. The list for cancer occurrence and mortality is topped by lung vincing evidence that a high consumption of protein sources such as cancer in the global population, and it has been the most common red and processed meat is associated with increased colorectal can- cancer since 1985, with 1.35 million cases found in 2002, repre- cer risk (World Cancer Research Fund and American Investigation sentative of 12.4 per cent of all new cancers. It is right now one of Cancer Research, 2007). Furthermore, in a controlled trial, a low of the most fatal widespread cancers—average 5  year survivals in protein–high protein weight-loss diet has been observed to reduce Europe is approximately 10 per cent, hardly better than (8%–9%) fecal cancer-protective metabolites and increase hazardous metabo- in developing countries and the most avoidable. Globally, in preva- lites, which could increase the risk of colon cancer (Russell, 2007). lence, stomach cancer ranks fourth; however, owing to its lethality, A  possible increased risk of respiratory cancer was observed with second among the causes of cancer death. China has the uppermost a tendency of an increased general cancer risk over a shorter time. rates as well as 42 per cent of universal cases. Almost 23 per cent of So cancer is one of the most important diseases that affect people all cancers among women are breast cancers, the most common can- worldwide. Cancer usually is an environmental disease and strongly cer among women, with approximately 1.15 million cancer cases in associated with nutritional factors and precipitated by genetic fac- 2002. Prevalence is greatly high in developed countries; more than tors. In this review, we have discussed the role of dietary factors half of all cases are diagnosed. The most lethal cancer is liver cancer, which could have a significant role as a promoter or inhibitor in which is sixth in prevalence worldwide, and ranks third in death, pathogenesis of different subtypes of cancer worldwide. which comes after lung and stomach cancers. The major risk factor for liver cancer is chronic infection with hepatitis B virus (HBV), and hepatitis C virus is as well a factor. Cervical cancer comes after Prevalence of cancer breast cancer, the next most common cancer among women globally, and accounts for 15 per cent of cancer among women. Another Cancer accounts for approximately 13 per cent of all deaths each more common cancer in developing countries is oesophagus cancer. year with the most common lung cancer, stomach cancer, colorectal Downloaded from https://academic.oup.com/fqs/article-abstract/2/1/27/4912382 by Ed 'DeepDyve' Gillespie user on 16 March 2018 Role of Nutritional Factors, 2018, Vol. 2, No. 1 29 Table 1. Diet, nutrition, and cancer: levels of evidence. Evidence Decreased risk Increased risk Convincing Physical activity (colon) Overweight and obesity (oesophagus, colorectum, breast in post- menopausal women, endometrium, kidney) Atatoxin (liver) Chinese-style salted fish (nasopharynx) Probable Fruit and vegetables (oral cavity, oesophagus, Preserved meat (colorectum) colorectum) Salt-preserved food and salt (stomach) Very hot drinks and food (oral cavity, pharynx, oesophagus) Possible/insufficient Fibre, soya, fish, carotenoids Animal fat Vitamin B2, B6, folate, C, D, E Heterocyclic amines Calcium, zinc, and selenium Polycyclic aromatic hydrocarbons Non-nutrient plant constituents like flavonoids, Nitrosamines isoflavones, lignans Table 2. Nutritional risk factors for selected cancers. study conducted in Northern Italy (La Vecchia et al., 1991), a link- age was found with retinol, an indicator of meat intake. Direct asso- Site for cancer High risk factors Low risk factors ciations were found with eggs, pork, and sausages, which may again imitate a hostile effect of cholesterol and animal fats (Franceschi Stomach Salty food Milk and dairy products et al., 1991; Marshall and Boyle, 1996) and probably of carcinogens Salted or dried fish Raw vegetables Large amount of rice Fruit in broiled meat (de Meester and Gerber, 1995) but also will possibly Hot drinks and food be a common sign of a poorer diet. As in earlier studies (Marshall Irregular meals et al., 1992; Marshall and Boyle, 1996), a small indication emerged Colorectum High-fat diet Fibre-rich diet (grains and for a link among bread and cereals and oral cancer. The nutritional Low-fibre diet pulses) epidemiology of oral cancer is also marked by two risk factors that Beer (rectal cancer) Good protein–rich diet (cheese, appear far more powerful than nutrition: tobacco use and alcohol Cholesterol beaf) consumption (Marshall et al., 1992). Overall, a high intake of fruit Oesophagus Alcoholic beverages Vegetables and fruit and vegetables probably reduces the risk of oral cancer, and con- Hot drinks and food Diet rich in good protein, vita- sumption of very hot drinks and food, typically consumed in some Diet poor in protein, mins, and minerals cultures, probably increases the risk of cancers of the oral cavity and vitamins, and minerals Breast High fat/calorie diet – pharynx. Lung Cholesterol Green–yellow vegetables Carotene, vitamin A Gastrointestinal cancer Gastrointestinal (GI) cancer refers to malignant conditions of the GI Prevalence of colon as well as rectal cancers varies about 25-fold tract and accessory organs of digestion, including the oesophagus, from the high-income plus high-incidence developed countries to stomach, pancreas, small intestine, rectum, and anus. Oesophageal Africa and Asia, where occurrence is smallest. Even though detailed cancer is among upper digestive tract cancers and mainly prevalent explanations are indefinable, the difference is believed to be eco- in developing and underdeveloped countries. There is much suffi- logical, with the leading factors related to most important dietary cient evidence which supports that the use of uncooked fruit and components. Prostate cancer is comparatively common, more so in vegetables, mainly citrus fruit, might lessen the danger of oesopha- industrialized countries than in developing countries, 19 versus 5.3 geal cancer (Ziegler et al., 1981; Cheng et al., 1992; Hu et al., 1994). per cent. Three-quarters of all prostate cancer cases are in men aged Nevertheless, lack of a considerable link between oesophageal 65 and older (Institute of Medicine, 2007). cancer and cooked vegetables proposes that the defensive factors in vegetables cannot resist the heat involved in cooking. Furthermore, the stronger contrary relationship of oesophageal cancer risk with Role of nutritional factors in pathogenesis citrus, more willingly than other fruit, provides support to the theory of cancer that vitamin C might be playing a fundamental advantageous role as Cancer of oral cavity and pharynx it slows down the formation of carcinogens and protects DNA from Several studies confirmed dietary patterns particularly; food-intake mutagenic attack (Ziegler et  al.,1981; Tuyns et  al.,1987, Hercberg patterns have a pertinent role in the possibility of oral as well as et  al., 1998). Many studies support the fact that cereals may in- pharyngeal cancer. The oral cancer risk appeared to be reduced by crease the risk of oesophageal cancer (Yu et al., 1988; Tzonou et al., about 50 per cent by the addition of one serving of fruit and veg- 1996). Soup and very hot beverages are positively associated with etables per day, protection by fruit and vegetables mainly because of oesophageal cancer risk because their high temperature could be re- selected micronutrients, counting β-carotene, and other carotenoids sponsible for precancerous lesions of the oesophagus and precipitate (La Vecchia et al., 1991; Zheng et al., 1993). However, pre-cancer- in the form of cancer (De Stefani et  al., 1990; Cheng et  al., 1992; ous lesions of the oral cavity induce alterations in food practices Hu et  al., 1994). Several other studies showing an increased risk (e.g. lessened citrus as well as fruit consumption), which will so be are mainly related to barbecued and fried meat (Yu et  al., 1988; the consequence, more willingly than the cause, of the disease. In US De Stefani et  al.,1999), suggesting that the cooking method could study, moreover, we found some direct linkage among meat, satu- be involved in oesophageal carcinogenesis. Several studies suggested rated fats, cholesterol intake, and risk of oral cancer, and from the that vitamin A  can play a vital role in defensive injured epithelial Downloaded from https://academic.oup.com/fqs/article-abstract/2/1/27/4912382 by Ed 'DeepDyve' Gillespie user on 16 March 2018 30 A. Patel et al., 2018, Vol. 2, No. 1 cells in opposition to attack by carcinogens, and oesophageal epithe- concentration, or vitamin C that reduce DNA damage or mutations lial cells are more susceptible to the deficiency in vitamin A (Poulain by reducing oxidative stress and inflammation have inversely been et  al., 2009). Some studies have provided sturdy confirmation that associated with risk of pancreatic cancer (Lin et  al., 2005., Chan polyphenol derived from tea may possibly possess the bioactivity to et al., 2005., Stolzenberg-Solomon et al., 2009). The defensive effect have an effect on the development of different cancers (Khan and of nutrients linked with fruit and vegetables is also found, as the Mukhtar, 2007). Also the relationship between drinking different tea ingestion of most nutrients points out a dose-dependent risk reduc- and their associated danger has been reported in some studies from tion of pancreatic cancer growth. Antioxidants levels in serum diverse parts of the world (Castellsague et al., 2000; Ganesh et al., have positively been associated with intake of fruit and vegetables, 2009; Ibiebele et al., 2010; Li et al., 2002). Among minerals, the anti- (Dauchet et al., 2008), and these food items have been contrariwise cancer role of selenium and zinc was the research focus, and some related to pancreatic cancer risk (Inoue et  al., 2003; Nkondjock researchers reported that selenium and zinc were preventive factors et  al., 2008). Non-enzymatic nutritional antioxidants (e.g. vita- for occurrence of oesophageal cancer (Cai et  al., 2006; Lu et  al., min C and selenium) work jointly with enzymatic mechanisms to 2006; Wei et al., 2004). provide protection against oxidative stress (Maritim et  al., 2003). Evidence supports that gastric cancer has an environmental eti- Various other nutritional factors like meat, dairy products, and eggs ology, of which diet appears to be the most important component. have also been investigated and encountered with elevated disease Furthermore, a human model of gastric carcinogenesis has been risks in some studies, although some studies reported null results developed and studied extensively based on a multistage process in (Mills et al., 1988; Coughlin et al., 2000; Stolzenberg-Solomon et al., which dietary constituents act on the mucosa at various stages, lead- 2002; Michaud et al., 2003). Increased risk has generally been attrib- ing from superficial gastritis to carcinoma, and the role of N-nitroso uted to the fat, saturated fat, or cholesterol content of meats and compounds has been emphasized (Correa et al., 1988). other animal products (Ghadirian et  al., 2003; Risch et  al., 2003; A case–control study conducted in Spain suggests that higher in- Vimalachandrac et  al., 2004; Food, nutrition and the prevention take of salt and smoked as well as pickled food may perhaps be of cancer, 1997). Alternatively, meat preparation methods, such as linked with a higher danger of gastric cancer, and this relationship grilling and frying, have been proposed as a source of carcinogens will possibly result in the intragastric formation of nitrosamines (World Cancer Research Fund 1997; Ghadirian et al., 2003; Li et al., (Ramón et  al., 1993). Salt is not a directly acting carcinogen, al- 2004). Small intestine cancer is reasonably uncommon. Tobacco and though it is thought to raise the risk of gastric cancer all the way alcohol consumption was unrelated to small intestine cancer risk; through direct damage to gastric mucosa, resulting in gastritis, however, weekly or repeated consumption of red meat and monthly increased deoxyribonucleic acid (DNA) synthesis, along with cell or more recurrent intake of salted or smoked food were related to 2- proliferation (World Cancer Research Fund 1997). Superficial gas- to 3-fold increases in risk. Nutritional factors are possibly concerned tritis can lead to chronic atrophic gastritis, which is considered to be about the risk of small intestine cancer, although further research a precursor lesion in the progress of gastric cancer (Nomura et al., in other settings is requisite to make clear the determinants of these 1996). Frequent consumption of beans and vegetables is recipro- uncommon cancers (Chow et al., 1993). cally associated with risk of gastric cancer, and fresh meats, dairy Colorectal cancer is a leading cause of death in the Western world. products, and fresh fish are positively associated with risk of gastric It is multifactorial in origin, combining genetic and environmental cancer, whereas frequent consumption of sweets was associated with causes. Certain lifestyle factors, including nutrition, have been associ- 70 per cent increased risk of gastric cancer (Ward et al., 1999). A diet ated with a higher cancer risk. Newmark et  al. (1984) studied the rich in meat-derived food has been suggested to play a role in gas- effect of dietary fat, phosphate, and calcium in colon cancer and sug- tric carcinogenesis by several studies in Western populations (Buiatti gested that increased dietary fat will endorse colon cancer by raising et al., 1989; Wu-Williams et al., 1990; De Stefani et al., 1998). The the free ionized fatty acid levels and bile acids in the colon contents. underlying mechanism for this association is unclear but may in- The annoying and toxic effects of the free acids in the presence of cal- volve increased tolerance to DNA damage associated with reduced cium ions on colon epithelial cells can be reduced by being converted mismatch repair (MMR) genes activity (Buermeyer et al., 1999). to insoluble calcium soaps. Supplementary dietary calcium level to Cancer of the exocrine pancreas ranks fourth for cancer mortality provide sufficient calcium and therefore to decrease the possible tox- in US men and women and is among the most rapidly fatal cancers icity of dietary fat was considered (Newmark et al., 1984). High con- worldwide (Surveillance, Epidemiology, and End Results Program, sumption of vegetables and fruit and the avoidance of highly refined 1997). Thirty to fifty per cent of pancreatic cancers may be attributed sugar containing food are likely to reduce the risk of colon cancer, to dietary factors (World Cancer Research Fund in association with although the responsible constituents remain unclear (Giovannucci the American Institute of Cancer Research, 1997). Dietary factors et  al., 1994). An alternative hypothesis proposed by Giovannucci influence pancreatic cancer progression, which involves nutritional (1995) is that hyperinsulinemia promotes colon carcinogenesis. For components affecting insulin insensitivity or else insulin-resistance colonic epithelial cells, insulin is an essential growth factor and is pathways. Pancreatic exocrine cells are exposed to very high insulin a mitogen of in vitro tumour cell development. The insulin/colon concentrations, and facts indicate that insulin acts as a growth pro- cancer theory is basically indirect and depends on the resemblance moter and mutagen in the pancreas resulting in pancreatic tumour of factors which generate high insulin levels with those related to promotion. In response to high blood glucose concentrations, insu- colon cancer risk supported by epidemiological study. The major lin is secreted into the blood, and the pancreas is exposed to a great determinants of insulin resistance and hyperinsulinemia are obesity, deal of higher insulin concentrations; comparable to blood cancer physical inactivity, and maybe a low dietary polyunsaturated fat-to- risk, pancreatic cancer risk might increase as a result of nutritional saturated fat ratio and come into view related to colon cancer risk. factors that generate insulin spikes (Fisher et  al., 1996; Kazakoff In the distal colon, elevated consumption of red meat raises the risk et al., 1996; Zagorsky et al., 2005). A second main hypothesis link- of colon cancer. Beef, pork, or lamb as a main dish is the particular ing dietary intake with pancreatic cancer suggests that dietary nutri- food item most sturdily correlated with higher risk of colon cancer or ents like β-carotene and total carotenoids, high serum α-tocopherol adenoma. In the small intestine, fat from red meat may well be less Downloaded from https://academic.oup.com/fqs/article-abstract/2/1/27/4912382 by Ed 'DeepDyve' Gillespie user on 16 March 2018 Role of Nutritional Factors, 2018, Vol. 2, No. 1 31 willingly digested or absorbed, possibly as a result of its high stearic types of cancers combined, including basal cell carcinoma (BCC), acid content or because of its physical obstruction in muscle tissue, squamous cell carcinoma (SCC), along with cancer of melanocytes and consequently, more of it might reach the large bowel, persuade (Siegel et al., 2012; Actinic keratosis, 2014; Skin cancer facts, 2014). mitogenesis of adenoma and a few carcinoma cells, and accelerate For skin cancer, there are numerous entrenched risk factors and a growth. The hypothesis that fibre decreases the risk of colon cancer dietary factor is one of them. Evidence also supported that nutri- arose primarily from observations made by Burkitt in Africa (Burkitt tional interventions may well benefit people who are at high risk et al., 1974). Fibres are thought to lower the risk of colorectal cancer, of skin carcinoma. Researchers prove that people who consumed either by altering the site of resistant starch fermentation from the higher levels of fruit and vegetables had a 54 per cent reduced risk proximal to the distal colon or by changing the absorption and me- of SCC (Ibiebele et al., 2007). Reduction in the risk was related to tabolism of carcinogens in food (Govers et  al., 1999, Kestell et  al., consumption of green leafy vegetables. Reduced risk of melanoma 1999). has been observed with high intake of vitamins A, C, D, α- and β-carotene, cryptoxanthin, lutein, and lycopene compared with low intake (Millen et  al., 2004). Regular eating (more than three Cancer of respiratory organs servings per week) of celeriac and pomegranates was linked with a There are few observational studies of diet and lung cancer which considerably reduced risk of BCC and SCC (de Vries et al., 2012). suggest that increased intake of vegetables and fruit is associated Abundant nutrients like vitamins C and E are present in plants act- with reduced risk in men and women; in various countries; in smok- ing as antioxidants and so may possibly help us to guard against ers, ex-smokers, and never-smokers; and for all histological types of skin cancer. Vitamin C acts by scavenging free radicals to restore lung cancer. the activity of other antioxidants, resulting in enhancement of the Slight protective effects were suggested for cruciferous vegetables immune system, and hydroxylates lysine as well as proline in the and tomatoes, in addition to the strong protection afforded by car- synthesis of connective tissues proteins, which may modify tumour rot consumption. Prospective studies of blood β-carotene levels, de- development. An intracellular antioxidant vitamin E prevents lipid batably the best obtainable biomarker of vegetable and fruit intake, peroxidation (McNaughton et al., 2005). The variant of vitamin A, point out that low β-carotene level is prognostic of increased lung retinoic acid, is important in skin cell proliferation, differentiation, cancer prevalence. Although, in a randomized and placebo-controlled and maintenance and will possibly lessen the quantity of ultraviolet clinical trial in male smokers, lung cancer occurrence and total mor- (UV) light reaching the underlying layers of the skin by raising epi- tality were raised considerably among the men receiving β-carotene dermal thickness with the intention that taking carotenoid through supplements owing to the exposure of heat and it turns into pro- food has been shown to reduce the danger of skin cancer (Siegel carcinogen. If β-carotene can prevent lung carcinogenesis, which the et  al., 2012). Researchers established that UV light–induced ery- trial cannot rule out, then the dosage, duration of use, method of thema was appreciably decreased by photoprotective effect observed administration, and/or subpopulation are critical. Several epidemio- in the combination of carotenoids and α-tocopherol (Stahl et  al., logical studies have studied the relationship between dairy consump- 2000). In a similar study, β-carotene supplementation or mixture tion and lung cancer risk, and produced inconsistent results. Few of carotenoids daily for 12 weeks was shown together to have pho- studies have been reported that intake of diary product may increase toprotective effects by reducing erythema induced by UV in human the risk of lung cancer (Axelsson et al., 1996; Nyberg et al., 1998). skin and gives defence against exposure to UV radiation (Heinrich However, some studies are in contradicted farmer studies and found et al., 2003). Carotenoids may slow down skin carcinogenesis due that dairy products were not significantly associated with lung cancer to their antioxidant abilities; β-carotene improves immune system risk (Rachtan et al., 2002; Van der Pols et al., 2007). One study con- functioning, whereas provitamin A  carotenoids could stop skin ducted in Missouri focused on non-smoking women with lung cancer, cancer through its conversion to retinoids (McNaughton et  al., including a large number with adenocarcinoma, showed a strongly 2005). Conversely, there are a few concerns in relation to the safety increasing trend in lung cancer risk with increased saturated fat con- of enormously high doses of carotenoid supplementation, owing sumption that may have been masked in earlier studies of lung cancer to higher lung cancer occurrence and mortality among smokers involving a high percentage of smokers (Michael et al., 1993). Several taking supplemental β-carotene (Omenn et  al., 1996). Numerous observational epidemiological studies have indicated that diets high in epidemiological studies have suggested that extreme use of red meat fat, saturated fat, and cholesterol may increase the risk of lung cancer. such as beef, pork, and lamb, and processed meats including bacon, The results showed a significant positive association between dietary sausage, and hot dogs is connected with higher rate of cancer and cholesterol and the risk of lung cancer in men and women (Goodman danger of all-cause mortality. Some carcinogens present in meat, et  al., 1988). A  positive dose–response relation has been observed which may increase the risk of cancer, comprise heterocyclic amines, between the consumption of processed meats, dairy foods, eggs, and polycyclic aromatic hydrocarbons, and nitrates as well as nitrites particular desserts, and the risk of lung cancer in men. Researchers (used as preservatives) (Kushi et  al., 2012). A diet rich in high fat also found a positive trend in the lung cancer risk in women with influences DNA damage, decreased cell apoptosis, increased in- higher intake of some processed meats like bacon, spam, and desserts flammatory cytokines in the skin, and oxidative stress, and it also such as cakes and custard or cream pies. The dose–response associ- enhances skin carcinogenesis influencing the composition of cell ation tended to be stronger among men who were intense smokers membrane lipids and intercellular communication. A  high-fat diet and also who were identified with squamous cell cancer of the lung and high intake of red meat as well as processed meats are con- (Goodman et al., 1992). However, some data were inconsistent and nected with skin cancer (McNaughton et al., 2005). concluded that there is no significant association between lung cancer and dietary cholesterol or saturated fat (Veierød et al., 1997). Breast cancer Skin cancer and diet Breast cancer is one of the most common cancers and the leading cause of cancer death among females, accounting for 23 per cent In USA, skin cancer is the most common form of cancer which of all cancer cases and 14 per cent of the cancer deaths all over affects nearly one in five Americans (Skin cancer facts, 2014). In the world (Ferlay et al., 2010). However, breast tumours may differ current years, skin cancer has been diagnosed greater than all other Downloaded from https://academic.oup.com/fqs/article-abstract/2/1/27/4912382 by Ed 'DeepDyve' Gillespie user on 16 March 2018 32 A. Patel et al., 2018, Vol. 2, No. 1 clinically and biologically by hormone receptor status and menopau- with either total consumption of vegetables and fruit or with veg- sal status. Dietary factors have long been thought to play a major etable subgroups (Van Gils et  al., 2005). In a population of fairly role in the development of breast cancer; it stands out among the young, pre-menopausal women, ingestion of red meat was linked modifiable risk factors and has thus been investigated in numerous with an elevated risk of hormone receptor–positive breast cancer but studies mostly with a focus on specific nutrients or components. not with hormone receptor–negative cancer risk (Cho et al., 2006). Vegetables and fruit intake has been hypothesized to decrease breast A meta-analysis of 31 case–control and cohort studies establishes a cancer risk. Studies have been inconsistent. A  case–control study 17 per cent increase in risk related to the highest category of meat which examined the relationship between diet, particularly veg- intake (Boyd et al., 2003). On the other hand, a pooled study of the etables and fruit, and breast cancer concluded that intake of veg- raw data from eight potential cohort studies conducted in North etables shows a reduced risk of premenopausal breast. Evaluated America, Canada, and Western Europe was not capable to reveal components found collectively in vegetables can have a synergis- such association (Missmer et  al., 2002). A case–control analysis of tic effect on the risk of breast cancer (Freudenheim et  al., 1996). Chinese women in Shanghai establishes that the optimistic associa- A meta-analysis was carried out, in order to summarize published tion with red meat ingestion was mainly limited to those who used data on the relationship between breast cancer, fruit and vegetable deep-frying cooking methods, predominantly between those who consumption and/or the intake of beta-carotene and vitamin C. deep-fried food to the “well done” stage, in pan drippings and in This analysis confirms the association between intake of vegetables meat surfaces that show a brown or black crust (Dai et  al., 2002), and, to a lesser extent, fruits and breast cancer risk from published suggestive of an effect of heterocyclic amines or other carcinogens sources. Increasing vegetable consumption might reduce the risk of produced at high temperatures. Nonetheless, the Nurses’ Health breast cancer (Gandini, 2000). In a case–control study of diet and nested case–control analysis showed no increase in risk with cooking breast cancer estimated by menopausal status, it was observed that method or meat eating even for the use of charred meat more than a significant reduction in breast cancer risk is associated with higher once in a week in rapid acetylators (Gertig et al., 1999). dietary intake of total lignan precursors, at least among premeno- Cervical cancer pausal women (McCann, 2004). Another case–control study carried out in Uruguay evaluated the protective effect associated with veg- Globally, in women, cervical cancer is the second most frequent etables and fruit on nutrients and bioactive substances present in cancer between the age of 15 and 44  years and most general in plant food in breast cancer cases. The results related to vegetable and developing countries (Parkin et  al., 2001). Human papillomavi- nutrient intake were consistent with antioxidant and antiestrogenic ruses (HPV) make up to 83 per cent of all cervical cancer cases and effects. This may be arbitrated, among other nutrients, by intake of recognized as an essential but not as an enough cause for cervical dietary fibre and lycopene (Ronco et al., 1999). An analytical study cancer. The risk of developing cervical cancer in combination with has been accomplished to assess and measure the effect of eating HPV may influence endogenous as well as exogenous co-factors of olive oil, margarine, and a variety of food groups on the breast (Bosch et al., 2002; Castellsague et al., 2003; Munoz et al., 2004). cancer risk. Majority of macronutrients are not showing noteworthy Some dietary factors could be involved as co-factors in cervical car- relations with breast cancer risk, although vegetables and fruit are cinogenesis, but evidence is inconclusive. Only a small number of contrariwise, considerably, and strongly associated with this risk. case–control and cohort studies looked at the role of diet intake as Evidence also supported that ingestion of olive oil decreases the risk a cofactor for cervical cancer or as a risk factor for HPV persist- of breast cancer, whereas margarine ingestion shows to be related to ence (Garcı´a-Closas et al., 2005; World Cancer Research Fund and high risk for the disease (Trichopoulou et al., 1995). A Chinese study American Investigation of Cancer Research, 2007). In a recent com- was conducted to examine the association between vegetables and prehensive review, an international expert committee concluded that fruit intake and breast cancer risk, which encountered an inverse there is limited evidence suggesting that carrot intake may protect association between the consumption of vegetable, fruit, and anti- against cervical cancer (World Cancer Research Fund and American oxidant nutrients and breast cancer risk and depicted a protective Investigation of Cancer Research, 2007). role of vegetables and fruit in breast cancer (Zhang et  al., 2009). Furthermore, few data are inconsistent and did not significantly cor - Prostate cancer relate nutritional factors with breast cancer. A  pooled analysis of Incidence and mortality rates vary widely across populations, with cohort studies suggested that consumption of fruit and vegetables the highest rates in North America and Northern Europe, inter- during adulthood or pre-menopausal state is not significantly associ- mediate rates in Southern Europe and Latin America, and the low- ated with breast cancer risk and did not identify any fruit and veg- est rates in Asia and Africa. Higher ingestion of animal protein may etable subgroup or specific fruit or vegetable that had stronger and increase the occurrence of prostate cancer by enhancing growth statistically significant associations with breast cancer risk compared hormone activity (Sato, 1963). Ecological studies suggested that with the associations observed for total consumption of fruit and milk drinking is strongly linked with both occurrence and mor- vegetables (Smith-Warner, 2001). In a randomized trial of 7.3 year tality from prostate cancer (Ganmaa et al., 2002; Colli and Colli, follow-up period of a nutritional intervention with which to attain 2006). Evidence also suggests that a higher intake of dairy protein a considerable change of diet that is rich in vegetables, fruit, and might increase the risk of prostate cancer by increasing the pro- fibre and low in fat, the risk of developing further breast cancer duction of insulin-like growth-factor-I (IGF-I), which can consecu- events and survival was not changed in women treated earlier for tively endorse the progress of prostate cancer (Allen et al., 2007). It early stage disease. In repetition, no major benefit was observed, in has been hypothesized that higher intake of calcium, mainly from general, among population subgroups characterized by demographic dairy products, may possibly increase the risk by suppressing the characteristics, baseline diet, or initial tumour types (Pierce et  al., synthesis of 1,25-dihydroxyvitamin D, which has an anti-tumour 2007). A  prospective multicentre study on dietary questionnaire effect on human prostatic cells in vitro (Giovannucci, 1998). Most carried out between the ages of 25 and 70  years including both mysteriously, many meats are cooked at elevated temperatures, pre- and post-menopausal women observed no association of risk for instance, by pan frying, grilling, or barbecuing resulting in the Downloaded from https://academic.oup.com/fqs/article-abstract/2/1/27/4912382 by Ed 'DeepDyve' Gillespie user on 16 March 2018 Role of Nutritional Factors, 2018, Vol. 2, No. 1 33 Carroll, M. D., Abraham, S., Dresser, C. M. 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Cancer Research, 53: 795–798. Research, 50: 2569–2576. Ziegler, R. G., Morris, L. E., Blot, W. J., Pottern, L. M., Hoover, R., Fraumeni, Yu, M. C., Garabrant, D. H., Peters, J. M., Mack, T. M. (1988). Tobacco, alco- J. F. Jr. (1981). Esophageal cancer among black men in Washington, hol, diet, occupation, and carcinoma of the esophagus. Cancer Research, D.C. II. Role of nutrition. Journal of the National Cancer Institute, 67: 48: 3843–3848. 1199–1206. Downloaded from https://academic.oup.com/fqs/article-abstract/2/1/27/4912382 by Ed 'DeepDyve' Gillespie user on 16 March 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Food Quality and Safety Oxford University Press

Role of nutritional factors in pathogenesis of cancer

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Abstract

Diet and nutrition are crucial factors throughout the complete life course in the promotion and upholding of good health. It has always been accepted that our defencelessness to infection and disease was influenced by diet and environmental as well as genetic factors. Nutrition is coming to the front position as a principle modifiable determinant of chronic disease, with scientific confirmation with time more supporting the view that alterations in diet have strong effects, equally positive as well as negative, on health throughout life. For the most part notably, nutritional adjustments may not only influence present health but also determine whether or not an individual will develop chronic non-communicable diseases like cancer. Diet is a blend of protective, mutagenic, and carcinogenic agents; the majority of them are metabolized by the enzymes of biotransformation process. Genetic polymorphisms that alter protein expression or else the function of these enzymes can change the risk of developing cancer. The scientific community has identified numerous naturally occurring materials in plant food with the power to resolve possible carcinogens. A  few of these nutrients and natural phytochemicals look for toxins and usher them from the body before they can cause cell damage that may lead to cancer. Others give the impression to make it easier for the body to make repairs at the cellular level. At a standstill, others may help bring to an end cancer cells from reproducing. Even after a cell begins to experience damage that can lead to cancer, what you eat and drink, and how you live can still help short-circuit the cancer process. It is thought that a diet containing defensive micronutrients as well as carcinogens and mutagens may adapt the risk of cancer development, particularly in genetically susceptible individuals. Key words: Nutritional factor; Dietary practices; Susceptibility; Cancer. 1940s where sequential confinement of nutritional factors markedly Introduction reduced the incidence of cancer in mice (Tannenbaum, 1940). After Nutritional factors have been thought responsible for about 30 per 2 decades other advancement like development of cancer registries cent of cancers in more developed countries, making nutrient sec- and research focused on effect of environmental factors on human ondary only to tobacco as a mendable cause of cancer (Doll, 1981). health depicts larger picture about the geographical variations in The share of diet-to-cancer risk in low-income countries has been cancer incidence which might be due to the differences in lifestyle considered to be lower, perhaps around 20 per cent (Miller, 2001). and dietary habits (Doll, 1966; Doll, 1970; Armstrong, 1975). It The relationship between nutritional factors and pathogenesis is followed by prominent number of case-control studies in 1970s of cancer first established by an experimental study conducted in © The Author(s) 2018. Published by Oxford University Press on behalf of Zhejiang University Press. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact jour- nals.permissions@oup.com Downloaded from https://academic.oup.com/fqs/article-abstract/2/1/27/4912382 by Ed 'DeepDyve' Gillespie user on 16 March 2018 28 A. Patel et al., 2018, Vol. 2, No. 1 and 1980s to identify nutritional risk factors with greater specific- cancer, liver cancer, and breast cancer. In 2008, approximately 12.7 ity. Food patterns and specific food components, macro- and micro- million cancers were diagnosed and 7.6 million people died of can- nutrients may all play etiological roles and their effects may also cer worldwide. This makes cancer the leading cause of death in be modified by other lifestyle factors such as physical activity or the developed world, and the second leading cause of death in the childbearing patterns. It has been hypothesized that 30%–40% of developing world (Jemal, 2011). According to National Institute of different subtypes of cancer may preclude with a healthy lifestyle Cancer, a wing of National Institute of Health in 2016, a rough and and dietary habits. In some studies, probable associations have sug- ready 1,685,210 new cases of cancer will be identified in the USA gested with a few nutritional factors, but have focused mostly on the and about 595,690 individuals will pass away from the disease. In potential increased risks linked with the consumption of eggs, meat, 2016, the most common cancers are proposed to be bladder cancer, and dairy products and the promising drop in risk connected with breast cancer, bronchus cancer, colon and rectum cancer, lung cancer, high intake of fruit and vegetables (Wolk, 1996; Lindblad, 1997; prostate cancer, melanoma of the skin, leukaemia, thyroid cancer, Handa, 2002; Nicodemus, 2004). Obesity is substantially correlated kidney and renal pelvis cancer, pancreatic cancer, and endometrial with carbohydrate and an established risk factor for cancers of the cancer. oesophagus (adenocarcinoma) colorectum, breast, endometrium and The probability of developing cancer may either increase or de- kidney (International Agency for Research on Cancer, 2002; Key, crease depending on what individuals eat and how often they exer- 2004). Contribution to obesity by dietary carbohydrates after that cise. Nutritional factors are estimated to account for approximately they nearly without doubt also add to rising the risk for these metic- 30 per cent of cancers in industrialized countries, making diet sec- ulous cancer sites (van Dam, 2007). ondary only to tobacco as a hypothetically avoidable cause of cancer. Hormonal and reproductive factors are the established risk fac- Research to date has revealed few explicit relationships between tors for breast cancer, and it is obvious that higher intake of sucrose or exact nutritional factors and cancer risk. Studies have investigated else higher glycemic load may increase risk leading to obesity which the definite role of diet in the progress of major cancers. In develop- will in turn increase the endogenous oestrogen levels (Key, 2003). ing countries, 60 per cent of these cancers are attributed to a diet Some evidence has led to the suggestion that a high intake of dietary low in fruit, vegetables, and animal products. All the way through fibre might reduce the risk of breast cancer, colorectal cancer, and the world, consumption of thermally very hot drinks and food raises stomach cancer (Burkitt, 1969; De Stefani, 1999). Carbohydrates are the risk of these cancers. not considered to be directly pertinent to the aetiology of few types Alteration in diet possibly will play a significant role in the ris- of cancer like liver cancer, lung cancer, ovarian cancer, prostate can- ing frequency of specific cancers. Conventional and industrial food cer, and bladder cancer (Jain, 2000; Pandey, 2003; Zeegers, 2004; processing methods as well as microbiological and chemical food Chan, 2005). Experimental studies and epidemiological data both contaminants are the factors that may add to the carcinogenicity of indicate that high-fat diets increase the risk of cancer at sites such diets (Table 1) (Key, 2004). as breast, colon, prostate and pancreas (Armstrong, 1975; Carroll, Table  2 summarizes the association between food or nutrients 1983; Prentice, 1990). However, these associations are due to cor- and cancers, which are frequent or increasing and which have been relations with intake of animal fat, not vegetable fat (Rose, 1986). suggested to be related to dietary habits in the earlier epidemio- Based on these epidemiological investigations and animal studies, logical studies (Tominaga, 1987). dietary fat increasing has been hypothesized to act by excretion of bile acids, which can be converted to carcinogens or promoters. Demographic details Dietary polyunsaturated vegetable oils promote tumorigenesis in animals whereas saturated fats and polyunsaturated fish oils either Earlier it was believed that cancer is more of a developed world have little effect or are inhibitory. Omega-3 fat acids that are present issue; however, ratio is changing with time, and at present, 57 per in fish oils and in some vegetables may reduce the incidence of breast cent of all cancers (excluding non-melanoma skin cancer) occur in and colon cancer (Carroll, 1991). It seems that monounsaturated less developed countries and 43 per cent in more developed coun- oils such as olive oil, behave in a neutral manner. There is much con- tries. The list for cancer occurrence and mortality is topped by lung vincing evidence that a high consumption of protein sources such as cancer in the global population, and it has been the most common red and processed meat is associated with increased colorectal can- cancer since 1985, with 1.35 million cases found in 2002, repre- cer risk (World Cancer Research Fund and American Investigation sentative of 12.4 per cent of all new cancers. It is right now one of Cancer Research, 2007). Furthermore, in a controlled trial, a low of the most fatal widespread cancers—average 5  year survivals in protein–high protein weight-loss diet has been observed to reduce Europe is approximately 10 per cent, hardly better than (8%–9%) fecal cancer-protective metabolites and increase hazardous metabo- in developing countries and the most avoidable. Globally, in preva- lites, which could increase the risk of colon cancer (Russell, 2007). lence, stomach cancer ranks fourth; however, owing to its lethality, A  possible increased risk of respiratory cancer was observed with second among the causes of cancer death. China has the uppermost a tendency of an increased general cancer risk over a shorter time. rates as well as 42 per cent of universal cases. Almost 23 per cent of So cancer is one of the most important diseases that affect people all cancers among women are breast cancers, the most common can- worldwide. Cancer usually is an environmental disease and strongly cer among women, with approximately 1.15 million cancer cases in associated with nutritional factors and precipitated by genetic fac- 2002. Prevalence is greatly high in developed countries; more than tors. In this review, we have discussed the role of dietary factors half of all cases are diagnosed. The most lethal cancer is liver cancer, which could have a significant role as a promoter or inhibitor in which is sixth in prevalence worldwide, and ranks third in death, pathogenesis of different subtypes of cancer worldwide. which comes after lung and stomach cancers. The major risk factor for liver cancer is chronic infection with hepatitis B virus (HBV), and hepatitis C virus is as well a factor. Cervical cancer comes after Prevalence of cancer breast cancer, the next most common cancer among women globally, and accounts for 15 per cent of cancer among women. Another Cancer accounts for approximately 13 per cent of all deaths each more common cancer in developing countries is oesophagus cancer. year with the most common lung cancer, stomach cancer, colorectal Downloaded from https://academic.oup.com/fqs/article-abstract/2/1/27/4912382 by Ed 'DeepDyve' Gillespie user on 16 March 2018 Role of Nutritional Factors, 2018, Vol. 2, No. 1 29 Table 1. Diet, nutrition, and cancer: levels of evidence. Evidence Decreased risk Increased risk Convincing Physical activity (colon) Overweight and obesity (oesophagus, colorectum, breast in post- menopausal women, endometrium, kidney) Atatoxin (liver) Chinese-style salted fish (nasopharynx) Probable Fruit and vegetables (oral cavity, oesophagus, Preserved meat (colorectum) colorectum) Salt-preserved food and salt (stomach) Very hot drinks and food (oral cavity, pharynx, oesophagus) Possible/insufficient Fibre, soya, fish, carotenoids Animal fat Vitamin B2, B6, folate, C, D, E Heterocyclic amines Calcium, zinc, and selenium Polycyclic aromatic hydrocarbons Non-nutrient plant constituents like flavonoids, Nitrosamines isoflavones, lignans Table 2. Nutritional risk factors for selected cancers. study conducted in Northern Italy (La Vecchia et al., 1991), a link- age was found with retinol, an indicator of meat intake. Direct asso- Site for cancer High risk factors Low risk factors ciations were found with eggs, pork, and sausages, which may again imitate a hostile effect of cholesterol and animal fats (Franceschi Stomach Salty food Milk and dairy products et al., 1991; Marshall and Boyle, 1996) and probably of carcinogens Salted or dried fish Raw vegetables Large amount of rice Fruit in broiled meat (de Meester and Gerber, 1995) but also will possibly Hot drinks and food be a common sign of a poorer diet. As in earlier studies (Marshall Irregular meals et al., 1992; Marshall and Boyle, 1996), a small indication emerged Colorectum High-fat diet Fibre-rich diet (grains and for a link among bread and cereals and oral cancer. The nutritional Low-fibre diet pulses) epidemiology of oral cancer is also marked by two risk factors that Beer (rectal cancer) Good protein–rich diet (cheese, appear far more powerful than nutrition: tobacco use and alcohol Cholesterol beaf) consumption (Marshall et al., 1992). Overall, a high intake of fruit Oesophagus Alcoholic beverages Vegetables and fruit and vegetables probably reduces the risk of oral cancer, and con- Hot drinks and food Diet rich in good protein, vita- sumption of very hot drinks and food, typically consumed in some Diet poor in protein, mins, and minerals cultures, probably increases the risk of cancers of the oral cavity and vitamins, and minerals Breast High fat/calorie diet – pharynx. Lung Cholesterol Green–yellow vegetables Carotene, vitamin A Gastrointestinal cancer Gastrointestinal (GI) cancer refers to malignant conditions of the GI Prevalence of colon as well as rectal cancers varies about 25-fold tract and accessory organs of digestion, including the oesophagus, from the high-income plus high-incidence developed countries to stomach, pancreas, small intestine, rectum, and anus. Oesophageal Africa and Asia, where occurrence is smallest. Even though detailed cancer is among upper digestive tract cancers and mainly prevalent explanations are indefinable, the difference is believed to be eco- in developing and underdeveloped countries. There is much suffi- logical, with the leading factors related to most important dietary cient evidence which supports that the use of uncooked fruit and components. Prostate cancer is comparatively common, more so in vegetables, mainly citrus fruit, might lessen the danger of oesopha- industrialized countries than in developing countries, 19 versus 5.3 geal cancer (Ziegler et al., 1981; Cheng et al., 1992; Hu et al., 1994). per cent. Three-quarters of all prostate cancer cases are in men aged Nevertheless, lack of a considerable link between oesophageal 65 and older (Institute of Medicine, 2007). cancer and cooked vegetables proposes that the defensive factors in vegetables cannot resist the heat involved in cooking. Furthermore, the stronger contrary relationship of oesophageal cancer risk with Role of nutritional factors in pathogenesis citrus, more willingly than other fruit, provides support to the theory of cancer that vitamin C might be playing a fundamental advantageous role as Cancer of oral cavity and pharynx it slows down the formation of carcinogens and protects DNA from Several studies confirmed dietary patterns particularly; food-intake mutagenic attack (Ziegler et  al.,1981; Tuyns et  al.,1987, Hercberg patterns have a pertinent role in the possibility of oral as well as et  al., 1998). Many studies support the fact that cereals may in- pharyngeal cancer. The oral cancer risk appeared to be reduced by crease the risk of oesophageal cancer (Yu et al., 1988; Tzonou et al., about 50 per cent by the addition of one serving of fruit and veg- 1996). Soup and very hot beverages are positively associated with etables per day, protection by fruit and vegetables mainly because of oesophageal cancer risk because their high temperature could be re- selected micronutrients, counting β-carotene, and other carotenoids sponsible for precancerous lesions of the oesophagus and precipitate (La Vecchia et al., 1991; Zheng et al., 1993). However, pre-cancer- in the form of cancer (De Stefani et  al., 1990; Cheng et  al., 1992; ous lesions of the oral cavity induce alterations in food practices Hu et  al., 1994). Several other studies showing an increased risk (e.g. lessened citrus as well as fruit consumption), which will so be are mainly related to barbecued and fried meat (Yu et  al., 1988; the consequence, more willingly than the cause, of the disease. In US De Stefani et  al.,1999), suggesting that the cooking method could study, moreover, we found some direct linkage among meat, satu- be involved in oesophageal carcinogenesis. Several studies suggested rated fats, cholesterol intake, and risk of oral cancer, and from the that vitamin A  can play a vital role in defensive injured epithelial Downloaded from https://academic.oup.com/fqs/article-abstract/2/1/27/4912382 by Ed 'DeepDyve' Gillespie user on 16 March 2018 30 A. Patel et al., 2018, Vol. 2, No. 1 cells in opposition to attack by carcinogens, and oesophageal epithe- concentration, or vitamin C that reduce DNA damage or mutations lial cells are more susceptible to the deficiency in vitamin A (Poulain by reducing oxidative stress and inflammation have inversely been et  al., 2009). Some studies have provided sturdy confirmation that associated with risk of pancreatic cancer (Lin et  al., 2005., Chan polyphenol derived from tea may possibly possess the bioactivity to et al., 2005., Stolzenberg-Solomon et al., 2009). The defensive effect have an effect on the development of different cancers (Khan and of nutrients linked with fruit and vegetables is also found, as the Mukhtar, 2007). Also the relationship between drinking different tea ingestion of most nutrients points out a dose-dependent risk reduc- and their associated danger has been reported in some studies from tion of pancreatic cancer growth. Antioxidants levels in serum diverse parts of the world (Castellsague et al., 2000; Ganesh et al., have positively been associated with intake of fruit and vegetables, 2009; Ibiebele et al., 2010; Li et al., 2002). Among minerals, the anti- (Dauchet et al., 2008), and these food items have been contrariwise cancer role of selenium and zinc was the research focus, and some related to pancreatic cancer risk (Inoue et  al., 2003; Nkondjock researchers reported that selenium and zinc were preventive factors et  al., 2008). Non-enzymatic nutritional antioxidants (e.g. vita- for occurrence of oesophageal cancer (Cai et  al., 2006; Lu et  al., min C and selenium) work jointly with enzymatic mechanisms to 2006; Wei et al., 2004). provide protection against oxidative stress (Maritim et  al., 2003). Evidence supports that gastric cancer has an environmental eti- Various other nutritional factors like meat, dairy products, and eggs ology, of which diet appears to be the most important component. have also been investigated and encountered with elevated disease Furthermore, a human model of gastric carcinogenesis has been risks in some studies, although some studies reported null results developed and studied extensively based on a multistage process in (Mills et al., 1988; Coughlin et al., 2000; Stolzenberg-Solomon et al., which dietary constituents act on the mucosa at various stages, lead- 2002; Michaud et al., 2003). Increased risk has generally been attrib- ing from superficial gastritis to carcinoma, and the role of N-nitroso uted to the fat, saturated fat, or cholesterol content of meats and compounds has been emphasized (Correa et al., 1988). other animal products (Ghadirian et  al., 2003; Risch et  al., 2003; A case–control study conducted in Spain suggests that higher in- Vimalachandrac et  al., 2004; Food, nutrition and the prevention take of salt and smoked as well as pickled food may perhaps be of cancer, 1997). Alternatively, meat preparation methods, such as linked with a higher danger of gastric cancer, and this relationship grilling and frying, have been proposed as a source of carcinogens will possibly result in the intragastric formation of nitrosamines (World Cancer Research Fund 1997; Ghadirian et al., 2003; Li et al., (Ramón et  al., 1993). Salt is not a directly acting carcinogen, al- 2004). Small intestine cancer is reasonably uncommon. Tobacco and though it is thought to raise the risk of gastric cancer all the way alcohol consumption was unrelated to small intestine cancer risk; through direct damage to gastric mucosa, resulting in gastritis, however, weekly or repeated consumption of red meat and monthly increased deoxyribonucleic acid (DNA) synthesis, along with cell or more recurrent intake of salted or smoked food were related to 2- proliferation (World Cancer Research Fund 1997). Superficial gas- to 3-fold increases in risk. Nutritional factors are possibly concerned tritis can lead to chronic atrophic gastritis, which is considered to be about the risk of small intestine cancer, although further research a precursor lesion in the progress of gastric cancer (Nomura et al., in other settings is requisite to make clear the determinants of these 1996). Frequent consumption of beans and vegetables is recipro- uncommon cancers (Chow et al., 1993). cally associated with risk of gastric cancer, and fresh meats, dairy Colorectal cancer is a leading cause of death in the Western world. products, and fresh fish are positively associated with risk of gastric It is multifactorial in origin, combining genetic and environmental cancer, whereas frequent consumption of sweets was associated with causes. Certain lifestyle factors, including nutrition, have been associ- 70 per cent increased risk of gastric cancer (Ward et al., 1999). A diet ated with a higher cancer risk. Newmark et  al. (1984) studied the rich in meat-derived food has been suggested to play a role in gas- effect of dietary fat, phosphate, and calcium in colon cancer and sug- tric carcinogenesis by several studies in Western populations (Buiatti gested that increased dietary fat will endorse colon cancer by raising et al., 1989; Wu-Williams et al., 1990; De Stefani et al., 1998). The the free ionized fatty acid levels and bile acids in the colon contents. underlying mechanism for this association is unclear but may in- The annoying and toxic effects of the free acids in the presence of cal- volve increased tolerance to DNA damage associated with reduced cium ions on colon epithelial cells can be reduced by being converted mismatch repair (MMR) genes activity (Buermeyer et al., 1999). to insoluble calcium soaps. Supplementary dietary calcium level to Cancer of the exocrine pancreas ranks fourth for cancer mortality provide sufficient calcium and therefore to decrease the possible tox- in US men and women and is among the most rapidly fatal cancers icity of dietary fat was considered (Newmark et al., 1984). High con- worldwide (Surveillance, Epidemiology, and End Results Program, sumption of vegetables and fruit and the avoidance of highly refined 1997). Thirty to fifty per cent of pancreatic cancers may be attributed sugar containing food are likely to reduce the risk of colon cancer, to dietary factors (World Cancer Research Fund in association with although the responsible constituents remain unclear (Giovannucci the American Institute of Cancer Research, 1997). Dietary factors et  al., 1994). An alternative hypothesis proposed by Giovannucci influence pancreatic cancer progression, which involves nutritional (1995) is that hyperinsulinemia promotes colon carcinogenesis. For components affecting insulin insensitivity or else insulin-resistance colonic epithelial cells, insulin is an essential growth factor and is pathways. Pancreatic exocrine cells are exposed to very high insulin a mitogen of in vitro tumour cell development. The insulin/colon concentrations, and facts indicate that insulin acts as a growth pro- cancer theory is basically indirect and depends on the resemblance moter and mutagen in the pancreas resulting in pancreatic tumour of factors which generate high insulin levels with those related to promotion. In response to high blood glucose concentrations, insu- colon cancer risk supported by epidemiological study. The major lin is secreted into the blood, and the pancreas is exposed to a great determinants of insulin resistance and hyperinsulinemia are obesity, deal of higher insulin concentrations; comparable to blood cancer physical inactivity, and maybe a low dietary polyunsaturated fat-to- risk, pancreatic cancer risk might increase as a result of nutritional saturated fat ratio and come into view related to colon cancer risk. factors that generate insulin spikes (Fisher et  al., 1996; Kazakoff In the distal colon, elevated consumption of red meat raises the risk et al., 1996; Zagorsky et al., 2005). A second main hypothesis link- of colon cancer. Beef, pork, or lamb as a main dish is the particular ing dietary intake with pancreatic cancer suggests that dietary nutri- food item most sturdily correlated with higher risk of colon cancer or ents like β-carotene and total carotenoids, high serum α-tocopherol adenoma. In the small intestine, fat from red meat may well be less Downloaded from https://academic.oup.com/fqs/article-abstract/2/1/27/4912382 by Ed 'DeepDyve' Gillespie user on 16 March 2018 Role of Nutritional Factors, 2018, Vol. 2, No. 1 31 willingly digested or absorbed, possibly as a result of its high stearic types of cancers combined, including basal cell carcinoma (BCC), acid content or because of its physical obstruction in muscle tissue, squamous cell carcinoma (SCC), along with cancer of melanocytes and consequently, more of it might reach the large bowel, persuade (Siegel et al., 2012; Actinic keratosis, 2014; Skin cancer facts, 2014). mitogenesis of adenoma and a few carcinoma cells, and accelerate For skin cancer, there are numerous entrenched risk factors and a growth. The hypothesis that fibre decreases the risk of colon cancer dietary factor is one of them. Evidence also supported that nutri- arose primarily from observations made by Burkitt in Africa (Burkitt tional interventions may well benefit people who are at high risk et al., 1974). Fibres are thought to lower the risk of colorectal cancer, of skin carcinoma. Researchers prove that people who consumed either by altering the site of resistant starch fermentation from the higher levels of fruit and vegetables had a 54 per cent reduced risk proximal to the distal colon or by changing the absorption and me- of SCC (Ibiebele et al., 2007). Reduction in the risk was related to tabolism of carcinogens in food (Govers et  al., 1999, Kestell et  al., consumption of green leafy vegetables. Reduced risk of melanoma 1999). has been observed with high intake of vitamins A, C, D, α- and β-carotene, cryptoxanthin, lutein, and lycopene compared with low intake (Millen et  al., 2004). Regular eating (more than three Cancer of respiratory organs servings per week) of celeriac and pomegranates was linked with a There are few observational studies of diet and lung cancer which considerably reduced risk of BCC and SCC (de Vries et al., 2012). suggest that increased intake of vegetables and fruit is associated Abundant nutrients like vitamins C and E are present in plants act- with reduced risk in men and women; in various countries; in smok- ing as antioxidants and so may possibly help us to guard against ers, ex-smokers, and never-smokers; and for all histological types of skin cancer. Vitamin C acts by scavenging free radicals to restore lung cancer. the activity of other antioxidants, resulting in enhancement of the Slight protective effects were suggested for cruciferous vegetables immune system, and hydroxylates lysine as well as proline in the and tomatoes, in addition to the strong protection afforded by car- synthesis of connective tissues proteins, which may modify tumour rot consumption. Prospective studies of blood β-carotene levels, de- development. An intracellular antioxidant vitamin E prevents lipid batably the best obtainable biomarker of vegetable and fruit intake, peroxidation (McNaughton et al., 2005). The variant of vitamin A, point out that low β-carotene level is prognostic of increased lung retinoic acid, is important in skin cell proliferation, differentiation, cancer prevalence. Although, in a randomized and placebo-controlled and maintenance and will possibly lessen the quantity of ultraviolet clinical trial in male smokers, lung cancer occurrence and total mor- (UV) light reaching the underlying layers of the skin by raising epi- tality were raised considerably among the men receiving β-carotene dermal thickness with the intention that taking carotenoid through supplements owing to the exposure of heat and it turns into pro- food has been shown to reduce the danger of skin cancer (Siegel carcinogen. If β-carotene can prevent lung carcinogenesis, which the et  al., 2012). Researchers established that UV light–induced ery- trial cannot rule out, then the dosage, duration of use, method of thema was appreciably decreased by photoprotective effect observed administration, and/or subpopulation are critical. Several epidemio- in the combination of carotenoids and α-tocopherol (Stahl et  al., logical studies have studied the relationship between dairy consump- 2000). In a similar study, β-carotene supplementation or mixture tion and lung cancer risk, and produced inconsistent results. Few of carotenoids daily for 12 weeks was shown together to have pho- studies have been reported that intake of diary product may increase toprotective effects by reducing erythema induced by UV in human the risk of lung cancer (Axelsson et al., 1996; Nyberg et al., 1998). skin and gives defence against exposure to UV radiation (Heinrich However, some studies are in contradicted farmer studies and found et al., 2003). Carotenoids may slow down skin carcinogenesis due that dairy products were not significantly associated with lung cancer to their antioxidant abilities; β-carotene improves immune system risk (Rachtan et al., 2002; Van der Pols et al., 2007). One study con- functioning, whereas provitamin A  carotenoids could stop skin ducted in Missouri focused on non-smoking women with lung cancer, cancer through its conversion to retinoids (McNaughton et  al., including a large number with adenocarcinoma, showed a strongly 2005). Conversely, there are a few concerns in relation to the safety increasing trend in lung cancer risk with increased saturated fat con- of enormously high doses of carotenoid supplementation, owing sumption that may have been masked in earlier studies of lung cancer to higher lung cancer occurrence and mortality among smokers involving a high percentage of smokers (Michael et al., 1993). Several taking supplemental β-carotene (Omenn et  al., 1996). Numerous observational epidemiological studies have indicated that diets high in epidemiological studies have suggested that extreme use of red meat fat, saturated fat, and cholesterol may increase the risk of lung cancer. such as beef, pork, and lamb, and processed meats including bacon, The results showed a significant positive association between dietary sausage, and hot dogs is connected with higher rate of cancer and cholesterol and the risk of lung cancer in men and women (Goodman danger of all-cause mortality. Some carcinogens present in meat, et  al., 1988). A  positive dose–response relation has been observed which may increase the risk of cancer, comprise heterocyclic amines, between the consumption of processed meats, dairy foods, eggs, and polycyclic aromatic hydrocarbons, and nitrates as well as nitrites particular desserts, and the risk of lung cancer in men. Researchers (used as preservatives) (Kushi et  al., 2012). A diet rich in high fat also found a positive trend in the lung cancer risk in women with influences DNA damage, decreased cell apoptosis, increased in- higher intake of some processed meats like bacon, spam, and desserts flammatory cytokines in the skin, and oxidative stress, and it also such as cakes and custard or cream pies. The dose–response associ- enhances skin carcinogenesis influencing the composition of cell ation tended to be stronger among men who were intense smokers membrane lipids and intercellular communication. A  high-fat diet and also who were identified with squamous cell cancer of the lung and high intake of red meat as well as processed meats are con- (Goodman et al., 1992). However, some data were inconsistent and nected with skin cancer (McNaughton et al., 2005). concluded that there is no significant association between lung cancer and dietary cholesterol or saturated fat (Veierød et al., 1997). Breast cancer Skin cancer and diet Breast cancer is one of the most common cancers and the leading cause of cancer death among females, accounting for 23 per cent In USA, skin cancer is the most common form of cancer which of all cancer cases and 14 per cent of the cancer deaths all over affects nearly one in five Americans (Skin cancer facts, 2014). In the world (Ferlay et al., 2010). However, breast tumours may differ current years, skin cancer has been diagnosed greater than all other Downloaded from https://academic.oup.com/fqs/article-abstract/2/1/27/4912382 by Ed 'DeepDyve' Gillespie user on 16 March 2018 32 A. Patel et al., 2018, Vol. 2, No. 1 clinically and biologically by hormone receptor status and menopau- with either total consumption of vegetables and fruit or with veg- sal status. Dietary factors have long been thought to play a major etable subgroups (Van Gils et  al., 2005). In a population of fairly role in the development of breast cancer; it stands out among the young, pre-menopausal women, ingestion of red meat was linked modifiable risk factors and has thus been investigated in numerous with an elevated risk of hormone receptor–positive breast cancer but studies mostly with a focus on specific nutrients or components. not with hormone receptor–negative cancer risk (Cho et al., 2006). Vegetables and fruit intake has been hypothesized to decrease breast A meta-analysis of 31 case–control and cohort studies establishes a cancer risk. Studies have been inconsistent. A  case–control study 17 per cent increase in risk related to the highest category of meat which examined the relationship between diet, particularly veg- intake (Boyd et al., 2003). On the other hand, a pooled study of the etables and fruit, and breast cancer concluded that intake of veg- raw data from eight potential cohort studies conducted in North etables shows a reduced risk of premenopausal breast. Evaluated America, Canada, and Western Europe was not capable to reveal components found collectively in vegetables can have a synergis- such association (Missmer et  al., 2002). A case–control analysis of tic effect on the risk of breast cancer (Freudenheim et  al., 1996). Chinese women in Shanghai establishes that the optimistic associa- A meta-analysis was carried out, in order to summarize published tion with red meat ingestion was mainly limited to those who used data on the relationship between breast cancer, fruit and vegetable deep-frying cooking methods, predominantly between those who consumption and/or the intake of beta-carotene and vitamin C. deep-fried food to the “well done” stage, in pan drippings and in This analysis confirms the association between intake of vegetables meat surfaces that show a brown or black crust (Dai et  al., 2002), and, to a lesser extent, fruits and breast cancer risk from published suggestive of an effect of heterocyclic amines or other carcinogens sources. Increasing vegetable consumption might reduce the risk of produced at high temperatures. Nonetheless, the Nurses’ Health breast cancer (Gandini, 2000). In a case–control study of diet and nested case–control analysis showed no increase in risk with cooking breast cancer estimated by menopausal status, it was observed that method or meat eating even for the use of charred meat more than a significant reduction in breast cancer risk is associated with higher once in a week in rapid acetylators (Gertig et al., 1999). dietary intake of total lignan precursors, at least among premeno- Cervical cancer pausal women (McCann, 2004). Another case–control study carried out in Uruguay evaluated the protective effect associated with veg- Globally, in women, cervical cancer is the second most frequent etables and fruit on nutrients and bioactive substances present in cancer between the age of 15 and 44  years and most general in plant food in breast cancer cases. The results related to vegetable and developing countries (Parkin et  al., 2001). Human papillomavi- nutrient intake were consistent with antioxidant and antiestrogenic ruses (HPV) make up to 83 per cent of all cervical cancer cases and effects. This may be arbitrated, among other nutrients, by intake of recognized as an essential but not as an enough cause for cervical dietary fibre and lycopene (Ronco et al., 1999). An analytical study cancer. The risk of developing cervical cancer in combination with has been accomplished to assess and measure the effect of eating HPV may influence endogenous as well as exogenous co-factors of olive oil, margarine, and a variety of food groups on the breast (Bosch et al., 2002; Castellsague et al., 2003; Munoz et al., 2004). cancer risk. Majority of macronutrients are not showing noteworthy Some dietary factors could be involved as co-factors in cervical car- relations with breast cancer risk, although vegetables and fruit are cinogenesis, but evidence is inconclusive. Only a small number of contrariwise, considerably, and strongly associated with this risk. case–control and cohort studies looked at the role of diet intake as Evidence also supported that ingestion of olive oil decreases the risk a cofactor for cervical cancer or as a risk factor for HPV persist- of breast cancer, whereas margarine ingestion shows to be related to ence (Garcı´a-Closas et al., 2005; World Cancer Research Fund and high risk for the disease (Trichopoulou et al., 1995). A Chinese study American Investigation of Cancer Research, 2007). In a recent com- was conducted to examine the association between vegetables and prehensive review, an international expert committee concluded that fruit intake and breast cancer risk, which encountered an inverse there is limited evidence suggesting that carrot intake may protect association between the consumption of vegetable, fruit, and anti- against cervical cancer (World Cancer Research Fund and American oxidant nutrients and breast cancer risk and depicted a protective Investigation of Cancer Research, 2007). role of vegetables and fruit in breast cancer (Zhang et  al., 2009). Furthermore, few data are inconsistent and did not significantly cor - Prostate cancer relate nutritional factors with breast cancer. A  pooled analysis of Incidence and mortality rates vary widely across populations, with cohort studies suggested that consumption of fruit and vegetables the highest rates in North America and Northern Europe, inter- during adulthood or pre-menopausal state is not significantly associ- mediate rates in Southern Europe and Latin America, and the low- ated with breast cancer risk and did not identify any fruit and veg- est rates in Asia and Africa. Higher ingestion of animal protein may etable subgroup or specific fruit or vegetable that had stronger and increase the occurrence of prostate cancer by enhancing growth statistically significant associations with breast cancer risk compared hormone activity (Sato, 1963). Ecological studies suggested that with the associations observed for total consumption of fruit and milk drinking is strongly linked with both occurrence and mor- vegetables (Smith-Warner, 2001). In a randomized trial of 7.3 year tality from prostate cancer (Ganmaa et al., 2002; Colli and Colli, follow-up period of a nutritional intervention with which to attain 2006). Evidence also suggests that a higher intake of dairy protein a considerable change of diet that is rich in vegetables, fruit, and might increase the risk of prostate cancer by increasing the pro- fibre and low in fat, the risk of developing further breast cancer duction of insulin-like growth-factor-I (IGF-I), which can consecu- events and survival was not changed in women treated earlier for tively endorse the progress of prostate cancer (Allen et al., 2007). It early stage disease. In repetition, no major benefit was observed, in has been hypothesized that higher intake of calcium, mainly from general, among population subgroups characterized by demographic dairy products, may possibly increase the risk by suppressing the characteristics, baseline diet, or initial tumour types (Pierce et  al., synthesis of 1,25-dihydroxyvitamin D, which has an anti-tumour 2007). A  prospective multicentre study on dietary questionnaire effect on human prostatic cells in vitro (Giovannucci, 1998). Most carried out between the ages of 25 and 70  years including both mysteriously, many meats are cooked at elevated temperatures, pre- and post-menopausal women observed no association of risk for instance, by pan frying, grilling, or barbecuing resulting in the Downloaded from https://academic.oup.com/fqs/article-abstract/2/1/27/4912382 by Ed 'DeepDyve' Gillespie user on 16 March 2018 Role of Nutritional Factors, 2018, Vol. 2, No. 1 33 Carroll, M. D., Abraham, S., Dresser, C. M. 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