Download - Nasopharynx SLR
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REPORT UPDATE:
The Associations between Food, Nutrition, and Physical Activity and the Risk of Cancer of the Nasopharynx and Underlying Mechanisms
Anthony J. Alberg Kristina Boyd
Xuguang (Grant) Tao Genevieve Matanoski
Lyssa Balick Laura Caulfield
LiWei Chen Lisa Gallichio Eliseo Guallar
James G. Herman Donna Hesson Tram Kim Lam
Stephanie Mickelson Karen Robinson
Johns Hopkins University Baltimore, Maryland, USA
Completion Date June 30, 2006
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Table of Contents 1. Introduction ................................................................................................................................................ 8 2. Changes to the agreed protocol .................................................................................................................. 8 3. Results of the search ................................................................................................................................... 9 4. Description of studies................................................................................................................................ 11
4.1 Amount of data and study types.......................................................................................................... 11 4.2 Populations studied.............................................................................................................................. 11 4.3 Exposures identified / timing of exposures within the lifespan .......................................................... 11 4.4 Outcomes identified ............................................................................................................................. 12 4.5 Length of follow-up.............................................................................................................................. 12 4.6 Site-specific issues for interpretation .................................................................................................. 12
5. Results by exposures .............................................................................................................................. 13 1 Patterns of diet ................................................................................................................................... 13
1.1 Regionally defined diets ............................................................................................................. 13 1.2 Socio-economically defined diets ............................................................................................... 13 1.3 Culturally defined diets.............................................................................................................. 13 1.4 Individual level dietary patterns................................................................................................ 13 1.5 Other dietary patterns ............................................................................................................... 13 1.6 Breast .......................................................................................................................................... 14 1.6.1 Mother ........................................................................................................................................ 14 1.6.2 Child ........................................................................................................................................... 14 1.7 Other issues ................................................................................................................................ 14
2 Foods .................................................................................................................................................. 15 2.1 Starchy foods .............................................................................................................................. 15 2.1.1 Cereals (grains) .......................................................................................................................... 15 2.1.1.1 Wholegrain cereals and cereal products ................................................................................... 15 2.1.1.2 Refined cereals and cereal products .......................................................................................... 15 2.1.2 Starchy roots, tubers and plantains........................................................................................... 16 2.1.3 Other starchy foods .................................................................................................................... 17 2.2 Fruit and (non-starchy) vegetables............................................................................................ 17 2.2.1 Non-starchy vegetables .............................................................................................................. 17 2.2.1.1 Non-starchy root vegetables and tubers .................................................................................... 20 2.2.1.2 Cruciferous vegetables ............................................................................................................... 21 2.2.1.3 Allium vegetables ....................................................................................................................... 23 2.2.1.4 Green leafy vegetables (not including cruciferous vegetables) ................................................. 23 2.2.1.5 Other non-starchy vegetables .................................................................................................... 25 2.2.1.6 Raw vegetables ........................................................................................................................... 28 2.2.2 Fruits........................................................................................................................................... 28 2.2.2.1 Citrus fruit.................................................................................................................................. 29 2.2.2.2 Other Fruits................................................................................................................................ 30 2.3 Pulses (legumes).......................................................................................................................... 31 2.4 Nuts and Seeds............................................................................................................................ 33 2.5 Meat, poultry, fish and eggs....................................................................................................... 33 2.5.1 Meat ............................................................................................................................................ 33 2.5.1.1 Fresh Meat.................................................................................................................................. 35 2.5.1.2 Processed meat ........................................................................................................................... 35 2.5.1.3 Red meat ..................................................................................................................................... 36 2.5.1.3.1 Beef.......................................................................................................................................... 36
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2.5.1.3.2 Pork......................................................................................................................................... 37 2.5.1.3.4 Organ Meats ........................................................................................................................... 37 2.5.1.4 Poultry ........................................................................................................................................ 38 2.5.2 Fish (excluding salted fish)......................................................................................................... 38 2.5.2.1 Salted Fish .................................................................................................................................. 38 2.5.2.2 Other preserved fish (excluding salted fish).............................................................................. 54 2.5.3 Shellfish and other seafood ........................................................................................................ 54 2.5.4. Eggs............................................................................................................................................. 56 2.6 Fats, oils and sugars ................................................................................................................... 57 2.6.1 Animal fats ................................................................................................................................. 57 2.6.2 Plant oils ..................................................................................................................................... 58 2.6.3 Hydrogenated fats and oils ........................................................................................................ 58 2.6.4 Sugars ......................................................................................................................................... 58 2.7 Milk and dairy products ............................................................................................................ 58 2.8 Herbs, spices, condiments .......................................................................................................... 59 2.9 Composite Foods ........................................................................................................................ 61
3 Beverages............................................................................................................................................ 62 3.1 Total fluid intake ........................................................................................................................ 62 3.2 Water .......................................................................................................................................... 63 3.3 Milk............................................................................................................................................. 63 3.5 Fruit juices.................................................................................................................................. 64 3.6 Hot drinks................................................................................................................................... 64 3.6.1 Coffee .......................................................................................................................................... 64 3.6.2 Tea .............................................................................................................................................. 64 3.6.2.1 Black tea ..................................................................................................................................... 65 3.6.2.2 Green tea .................................................................................................................................... 65 3.6.3 Maté ............................................................................................................................................ 66 3.6.4 Other hot drinks......................................................................................................................... 66 3.7 Alcoholic drinks.......................................................................................................................... 66 3.7.1 Total ............................................................................................................................................ 66 3.7.1.1 Beers ........................................................................................................................................... 71 3.7.1.2 Wines .......................................................................................................................................... 72 3.7.1.3 Spirits.......................................................................................................................................... 72 3.7.1.4 Other alcoholic drinks................................................................................................................ 72
4 Food production, preservation, processing and preparation ........................................................... 72 4.1 Production .................................................................................................................................. 72 4.1.1 Traditional methods (to include ‘organic’) ................................................................................ 72 4.1.2 Chemical contaminants.............................................................................................................. 72 4.1.2.1 Pesticides..................................................................................................................................... 73 4.1.2.2 DDT ............................................................................................................................................ 73 4.1.2.3 Herbicides................................................................................................................................... 73 4.1.2.4 Fertilisers .................................................................................................................................... 73 4.1.2.5 Veterinary drugs ........................................................................................................................ 73 4.1.2.6 Other chemicals.......................................................................................................................... 73 4.1.2.6.1 Polychlorinated dibenzofurans (PCDFs) ........................................................................... 73 4.1.2.6.2 Polychlorinated dibenzodioxins (PCDDs).......................................................................... 73 4.1.2.6.3 Polychlorinated biphenyls (PCBs) ..................................................................................... 73 4.1.2.7 Heavy metals............................................................................................................................... 73 4.1.2.7.1 Cadmium ............................................................................................................................ 74
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4.1.2.7.2 Arsenic ................................................................................................................................ 74 4.1.2.7.3 Other heavy metals............................................................................................................. 74 4.1.2.8 Waterborne residues .................................................................................................................. 75 4.1.2.8.1 Chlorinated hydrocarbons ................................................................................................. 75 4.1.2.9 Other contaminants.................................................................................................................... 75 4.2 Preservation................................................................................................................................ 76 4.2.1 Drying ......................................................................................................................................... 81 4.2.2 Storage ........................................................................................................................................ 83 4.2.2.1 Mycotoxins .......................................................................................................................... 83 4.2.2.1.1 Aflatoxins ............................................................................................................................ 84 4.2.2.1.2 Others.................................................................................................................................. 84 4.2.3 Bottling, canning, vacuum packing ........................................................................................... 84 4.2.4 Refrigeration .............................................................................................................................. 84 4.2.5 Salt, salting ................................................................................................................................. 84 4.2.5.1 Salt .............................................................................................................................................. 84 4.2.5.2 Salting ......................................................................................................................................... 84 4.2.5.3 Salted foods................................................................................................................................. 84 4.2.5.3.1 Salted animal food (excluding salted fish) ......................................................................... 84 4.2.5.3.1.1 Salted fish ........................................................................................................................ 86 4.2.5.3.2 Salted plant food ................................................................................................................102 2.2.1.1 Non-starchy root vegetables and tubers ...................................................................................102 4.2.6 Pickling ......................................................................................................................................105 4.2.7 Curing and smoking..................................................................................................................106 4.2.7.1 Cured foods ...............................................................................................................................106 4.2.7.1.1 Cured meats.......................................................................................................................107 4.2.7.1.2 Smoked foods .....................................................................................................................107 4.3 Processing ..................................................................................................................................108 4.3.1 Refining......................................................................................................................................109 4.3.2 Hydrogenation...........................................................................................................................110 4.3.3 Fermenting ................................................................................................................................110 4.3.4 Compositional manipulation.....................................................................................................112 4.3.4.1 Fortification ...............................................................................................................................112 4.3.4.2 Genetic modification .................................................................................................................112 4.3.4.3 Other methods ...........................................................................................................................112 4.3.5 Food additives............................................................................................................................112 4.3.5.1 Flavours .....................................................................................................................................112 4.3.5.2 Sweeteners (non-caloric) ...........................................................................................................113 4.3.5.3 Colours.......................................................................................................................................113 4.3.5.4 Preservatives..............................................................................................................................113 4.3.5.4.1 Nitrites and nitrates...........................................................................................................113 4.3.5.5 Solvents ......................................................................................................................................113 4.3.5.6 Fat substitutes............................................................................................................................113 4.3.5.7 Other food additives..................................................................................................................113 4.3.6 Packaging...................................................................................................................................113 4.3.6.1 Vinyl chloride ............................................................................................................................114 4.3.6.2 Phthalates ..................................................................................................................................114 4.4 Preparation................................................................................................................................114 4.4.1 Fresh food ..................................................................................................................................114 4.4.1.1 Raw ............................................................................................................................................118
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4.4.1.2 Juiced .........................................................................................................................................118 4.4.2 Cooked food...............................................................................................................................118 4.4.2.1 Steaming, boiling, poaching ......................................................................................................118 4.4.2.2 Stewing, casseroling...................................................................................................................119 4.4.2.3 Baking, roasting ........................................................................................................................119 4.4.2.4 Microwaving ..............................................................................................................................119 4.4.2.5 Frying.........................................................................................................................................119 4.4.2.6 Grilling (broiling) and barbecuing ...........................................................................................119 4.4.2.7 Heating, re-heating....................................................................................................................119
5 Dietary constituents ..........................................................................................................................119 5.1 Carbohydrate ............................................................................................................................119 5.1.1 Total carbohydrate....................................................................................................................119 5.1.2 Non-starch polysaccharides/dietary fibre.................................................................................119 5.1.2.1 Cereal fibre ................................................................................................................................120 5.1.2.2 Vegetable fibre...........................................................................................................................120 5.1.2.3 Fruit fibre ..................................................................................................................................120 5.1.3 Starch.........................................................................................................................................120 5.1.3.1 Resistant starch .........................................................................................................................120 5.1.4 Sugars ........................................................................................................................................120 5.2 Lipids .........................................................................................................................................120 5.2.1 Total fat .....................................................................................................................................120 5.2.2 Saturated fatty acids .................................................................................................................120 5.2.3 Monounsaturated fatty acids ....................................................................................................120 5.2.4 Polyunsaturated fatty acids.......................................................................................................120 5.2.4.1 n-3 fatty acids ............................................................................................................................120 5.2.4.2 n-6 fatty acids ............................................................................................................................121 5.2.4.3 Conjugated linoleic acid............................................................................................................121 5.2.5 Trans fatty acids........................................................................................................................121 5.2.6 Other dietary lipids, cholesterol, plant sterols and stanols. .....................................................121 5.3 Protein .......................................................................................................................................121 5.3.1 Total protein ..............................................................................................................................121 5.3.2 Plant protein ..............................................................................................................................121 5.3.3 Animal protein...........................................................................................................................121 5.4 Alcohol .......................................................................................................................................121 5.5 Vitamins.....................................................................................................................................121 5.5.1 Vitamin A ..................................................................................................................................122 5.5.1.1 Retinol........................................................................................................................................122 5.5.1.2 Provitamin A carotenoids .........................................................................................................122 5.5.2 Non-provitamin A carotenoids .................................................................................................122 5.5.3 Folates and associated compounds ...........................................................................................122 5.5.4 Riboflavin ..................................................................................................................................122 5.5.5 Thiamin (vitamin B1) ................................................................................................................122 5.5.6 Niacin .........................................................................................................................................122 5.5.7 Pyridoxine (vitamin B6) ............................................................................................................123 5.5.8 Cobalamin (vitamin B12) ..........................................................................................................123 5.5.9 Vitamin C ..................................................................................................................................123 5.5.10 Vitamin D (and calcium) ...........................................................................................................123 5.5.11 Vitamin E...................................................................................................................................123 5.5.12 Vitamin K ..................................................................................................................................123
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5.5.13 Other..........................................................................................................................................124 5.6 Minerals .....................................................................................................................................124 5.6.1 Sodium .......................................................................................................................................124 5.6.2 Iron ............................................................................................................................................124 5.6.3 Calcium (and Vitamin D)..........................................................................................................124 5.6.4 Selenium ....................................................................................................................................124 5.6.5 Iodine .........................................................................................................................................125 5.6.6 Other..........................................................................................................................................125 5.7 Phytochemicals ..........................................................................................................................127 5.7.1 Allium compounds.....................................................................................................................127 5.7.2 Isothiocyanates ..........................................................................................................................127 5.7.3 Glucosinolates and indoles ........................................................................................................127 5.7.4 Polyphenols................................................................................................................................127 5.7.5 Phytoestrogens eg genistein.......................................................................................................127 5.7.6 Caffeine......................................................................................................................................127 5.7.7 Other..........................................................................................................................................127 5.8 Other bioactive compounds ......................................................................................................127
6 Physical activity ................................................................................................................................128 6.1 Total physical activity (overall summary measures)................................................................128 6.1.1 Type of activity ..........................................................................................................................128 6.1.1.1 Occupational..............................................................................................................................128 6.1.1.2 Recreational...............................................................................................................................128 6.1.1.3 Household ..................................................................................................................................128 6.1.1.4 Transportation ..........................................................................................................................128 6.1.2 Frequency of physical activity ..................................................................................................128 6.1.3 Intensity of physical activity .....................................................................................................128 6.1.4 Duration of physical activity .....................................................................................................128 6.2 Physical inactivity......................................................................................................................128 6.3 Surrogate markers for physical activity e.g. occupation .........................................................128
7 Energy balance..................................................................................................................................129 7.1 Energy intake ............................................................................................................................129 7.1.1 Energy density of diet................................................................................................................129 7.2 Energy expenditure ...................................................................................................................129
8 Anthropometry .................................................................................................................................129 8.1 Markers of body composition ...................................................................................................129 8.1.1 BMI ............................................................................................................................................129 8.1.2 Other weight adjusted for height measures .............................................................................129 8.1.3 Weight........................................................................................................................................129 8.1.4 Skinfold measurements .............................................................................................................129 8.1.5 Other (e.g. DEXA, bio- impedance, etc) ...................................................................................129 8.1.6 Change in body composition .....................................................................................................129 8.2 Markers of distribution of fat ...................................................................................................129 8.2.1 Waist circumference..................................................................................................................130 8.2.2 Hips circumference ...................................................................................................................130 8.2.3 Waist to hip ratio.......................................................................................................................130 8.2.4 Skinfolds ratio ...........................................................................................................................130 8.2.5 Other e.g. CT, ultrasound .........................................................................................................130 8.3 Skeletal size................................................................................................................................130 8.3.1 Height (and proxy measures) ....................................................................................................130
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8.3.2 Other (e.g. leg length)................................................................................................................130 8.4 Growth in fetal life, infancy or childhood ................................................................................130 8.4.1 Birthweight ................................................................................................................................130 8.4.2 Weight at one year.....................................................................................................................130
F. Narrative review on mechanistic studies ................................................................................................131 6. Discussion.................................................................................................................................................134 7. References ................................................................................................................................................137Summary table......................................................................................................................................................145Results table..........................................................................................................................................................155
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1. Introduction Any evaluation of the role of diet, nutrition, and physical activity in relation to the risk of nasopharyngeal carcinoma (NPC) must account for the fact that it occurs at very high rates in a few specific regions of the world. NPC is a rare malignancy in most parts of the world, with age-adjusted incidence rates (per 100,000) of 1.7 among men and 0.6 among women, and mortality rates (per 100,000) in men and women of 1.0 and 0.4, respectively (Ferlay J., 2001). In contrast, specific high-risk areas include Hong Kong, Singapore, and southern China, especially the Cantonese living in the central region of Guangdong Province. The rates of NPC are intermediate (2 to 6 per 100,000) in other areas of Southeast Asia, such as Malaysia, Vietnam, Micronesia, and Guam. Dietary factors could contribute to the striking variation in NPC rates. A prominent hypothesis is that salted/preserved foods contribute to the burden of NPC in the high risk regions. A preponderance of the evidence concerning the potential role of diet in the etiology of NPC has focused on this hypothesis. Cantonese-style salted fish has been the primary focus, but other salted and preserved foods have also been investigated. Epstein-Barr virus (EBV) is a necessary cause of NPC. If diet does contribute to NPC risk, it is thus likely to do so by acting in concert with EBV infection. Any dietary factor that alters the risk of developing NPC, either increasing or decreasing risk, is thus likely to act by altering susceptibility to EBV-induced carcinogenesis. Driven by this focus in the evidence, this SLR emphasizes the risk associated with salted/preserved foods (e.g., Cantonese-prepared salted fish). Evaluation of the potential interrelationship of this dietary exposure with the major known cause of NPC, EBV infection, could not be assessed with epidemiologic data due to a lack of data evaluating these two exposures jointly in the same study. The mechanistic review thus forms the basis for evaluating the plausibility of the observed associations. 2. Changes to the agreed protocol Four changes were made to the approved protocol. First, the bibliographic databases searched (protocol p. 13, Table 1) were modified as follows. The Biosis database was included in the Biological Abstracts Silverplatter search. The SciSearch database was included in the ISI Web of Knowledge search. The PreCinahl database was included in the Cinahl search. As recommended by WCRF, the National Research Register (NRR) was replaced by searching metaRegister. Second, the term “head and neck” was excluded from the search strategy for outcomes (protocol p. 18) because in PubMed, including the term “head and neck”: 1) led to a 2.5-fold increase in the number of records and 2) did not add value to the search, as a check on a random sample of 200 records that included the items “head and neck” showed that none would have been judged relevant for full text retrieval. Third, ancillary searches of potential confounders or effect modifiers (protocol p. 19) were not performed. Instead, confounders and effect modifiers were incorporated into each phase of the overall search strategy as suggested by WCRF. Fourth, data extraction took place using serial rather than duplicate review for the majority of papers. Following the revised guidelines from WCRF (see: Section 3. Further instruction/clarifications to SLR centres 21/05/04), duplicate reviews were carried out the first twenty reviews and all studies with prospective dietary
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assessment, sorted out the coding differences, and then proceeded to serial extraction of the data for the remainder of the papers. Fifth, we did attempt to adhere to the revised guidelines concerning forest plots and meta-analyses. 3. Results of the search The following three steps were taken in the search strategy: 1) electronic searches of non-Chinese bibliographic databases; 2) electronic searches of the Chinese Biomedical Literature Database System (in Chinese); and 3) hand searching. These steps resulted in the identification of 5,224 potentially relevant unique (non-duplicate) articles, as summarized in Table 1. Of this total, 97.6% were identified in step #1, 0.8% in step #2, and 1.6% in step #3. The 5,098 articles identified in step #1 were ascertained via the following databases: PubMed, 57.9% (n=2,951); Embase, 6.7% (n=1,360); Pascal, 6.8% (n=349); Biological Abstracts, 3.9% (n=198); ISI, 3.4% (n=172); EbscoHost, 0.4% (n=20); NIAA, 0.3% (n=17); Cochrane, 0.2% (n=11); LILACS, 0.2% (n=10); IMSEAR, <0.1% (n=5); Agricola, <0.1% (n=3); and IMEMR, <0.1% (n=2). The 84 unique articles identified by hand searching (step #3) were found by checking references in: the data extraction articles (49%), reviews and meta-analyses ascertained via a PubMed search (45%), and the 1997 WCRF report (6%).
Table 1. Summary of the literature search
Database Date Searched Records Found Duplicates Detected Unique Records Imported
PubMed 01/24/2006 2961 10 2951 Embase 03/13/2006 3234 1874 1360 ISI Web of Science 04/11/2006 749 577 172 Biological Abstracts – Silverplatter 04/20/2006 405 207 198 Pascal – Silverplatter 04/20/2006 1417 1068 349 NIAAA Alcohol and Alcohol Problems Science Database
04/20/2006 28 11 17
Agricola 04/20/2006 22 19 3 Cochrane Library - Cochrane Collaboration (Central)
04/20/2006 13 2 11
CINAHL – EBSCOhost 04/20/2006 28 8 20 LILACS – Latin American and Caribbean Center on Health Sciences Information
04/20/2006 12 2 10
IMEMR – Index Medicus for WHO Eastern Mediterranean Region
04/20/2006 2 0 2
IMSEAR – Index Medicus for South East Asian Region
04/20/2006 6 1 5
Chinese Biomedical Literature Database System 4/04-6/04 202 160 42 Hand Searching 10/2005 84 N/A 84 Totals (as of 06/30/06) 9163 3939 5224 Upon duplicate abstract review, 624 (11.9%) of the 5,224 unique articles identified were not excluded and proceeded to full text review (Figure 1); 537 (86.1%) from step #1, 42 (6.7%) from step #2, and 45 (7.2%) from step #3. Reasons for exclusion of articles based on the abstract reviews are summarized in Table 2.
Figure 1. Flowchart for review results.
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Table 2. Reasons for exclusion of abstracts (n=4,600) from abstract reviews.
Reason for exclusion N Percent No evidence on the association between exposures and NPC. 3,192 69.4 Research at the cellular level only. 311 6.8 Research in animal models. 95 2.1 Mentions EBV, Tobacco, or other confounders only. 110 2.4 Not peer reviewed. 24 0.5 Meta analysis. 8 0.2 No original data. 156 3.4 Cancer survivors only. 199 4.3 Other 505 11.0
Upon duplicate full text review, 80 (12.8%) of the 624 unique articles not excluded from the abstract review were not excluded from the full text review; 58 (72.5%) from step #1, 17 (21.2%) from step #2, and 5 (6.3%) from step #3. There were 2 were potentially relevant articles that could not be obtained. The reasons for exclusion of full text articles for are summarized in Table 3.
Table 3. Reasons for exclusion of full text articles (n=542).
Reason for exclusion N Percent No evidence on the association between exposures and NPC. 160 29.5 Research at the cellular level only. 8 1.5 Research in animal models. 1 0.2 Mentions EBV, Tobacco, or other confounders only. 18 3.3 Meta-analysis 1 0.2 No original data. 86 15.9 Cancer survivors only. 14 2.6 Non-specific anatomy (mentions nasal, pharynx, etc. but no NPC) 213 39.3 Other 41 7.6
Of the 80 articles not excluded after full text review, a total of 74 articles met the eligibility criteria for data extraction for the SLR, 54 from step #1, 17 from step #2, and 3 from step #3. Six articles were case only studies with no genotype reported and therefore were not extracted.
5,224
Unique articles identified from
literature search
624
Articles not excluded after
duplicate abstract review
4,600
Articles excluded after
duplicate abstract review
542
Articles excluded after
duplicate full text review
80
Articles not excluded after
duplicate full text review
2
Articles could not be
obtained
5,224
Unique articles identified from
literature search
624
Articles not excluded after
duplicate abstract review
4,600
Articles excluded after
duplicate abstract review
542
Articles excluded after
duplicate full text review
80
Articles not excluded after
duplicate full text review
2
Articles could not be
obtained
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4. Description of studies 4.1 Amount of data and study types There were 75 studies from the 74 articles extracted; one article reported an ecological study and a cross-sectional study (Li, 1996). Of the 75 studies, the distribution of study designs was: 56 (75%) case-control, 15 (20%) ecological, 2 (3%) historical cohort, 1 (1%) prospective cohort, and 1 (1%) cross-sectional. 4.2 Populations studied The studies were concentrated in Asia (79%), particularly China (63% of studies, 57% of case-control studies). Ten studies (8 case-control and 2 ecologic) were conducted in the U.S.A.; no other non-Asian countries had more than one study. 4.3 Exposures identified / timing of exposures within the lifespan As can be seen from the summary of evidence for key exposures in Appendix 2 (Summary Tables), this systematic review identified evidence only relevant to the association between diet and nutrition and NPC. No results for physical activity, energy balance, or anthropometry were observed. The exposures identified were predominantly related to preserved foods, particularly salting. The most commonly studied exposure was salted fish. The intake of salted fish during different age windows (e.g., weaning/early childhood (0-3 years), later childhood (3 to 10 years), and adulthood has been studied; dose-response meta-analyses were performed for these exposure windows. One other key exposure in which a dose-response analysis was possible was total alcohol (1 cohort study, 18 case-control studies). Only adulthood consumption for this exposure was available for dose-response meta-analysis. Key exposures in which highest-versus-lowest category analysis was possible were non-starchy vegetables during adulthood (5 case-control studies, 2 ecological studies), carrots during childhood (6 case-control studies), tomatoes during adulthood (5 case-control studies), preserved vegetables during adulthood (5 case-control studies), citrus fruits during adulthood (5 case-control studies), processed meat during adulthood (5 case-control studies), herbal intake (6 case-control studies), and tea during adulthood (7 case-control studies). Other exposure categories with 5 or more case-control/cohort studies, but not eligible for meta-analysis include: total preserved vegetables during adulthood (7 case-control studies), non-preserved cruciferous vegetables during adulthood (5 case-control studies) and childhood (6 case-control studies), preserved cruciferous vegetables during adulthood (5 case-control studies), other preserved vegetables during adulthood (5 case-control studies), total fruits during adulthood (6 case-control studies), other non-preserved fruits during childhood (5 case-control studies), preserved plums during childhood (5 case-control studies), preserved soy/tofu during adulthood (8 case-control studies) and childhood (6 case-control studies), processed meat during adulthood (5 case-control studies), preserved fish-excluding salted fish (1 cohort, 5 case-control studies), preserved seafood during adulthood (5 case-control studies) and childhood (5 case-control studies), salted eggs during adulthood (5 case-control studies), other preserved eggs (5 case-control studies), preservation/preserved animal foods (1 cohort study, 5 case-control studies) and plant foods (12 case-control studies), drying/dried animal foods (5 case-control studies) and plant foods (5 case-control studies), salted animal food-excluding fish
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(10 case-control studies), salted plant food (9 case-control studies), pickled foods (11 case-control studies), processed foods (6 case-control studies), refined foods (6 case-control studies), fermented foods (1 cohort study, 10 case-control studies), and fresh animal foods (6 case-control studies) and plant foods (9 case-control studies). WCRF exposure categories with relatively sparse evidence included regionally and culturally defined diets, starchy foods and cereals, and micronutrients and macronutrients. 4.4 Outcomes identified This SLR focuses exclusively on nasopharyngeal carcinoma. 4.5 Length of follow-up Length of follow-up is relevant for only a few studies since the preponderance of the evidence stems from case-control (and ecologic) studies. The average length of follow-up for the 3 cohort studies was 9.2 ± 1.3 years. 4.6 Site-specific issues for interpretation When considering the possible role of diet to the etiology of nasopharyngeal carcinoma, the major methodological consideration is that NPC is a disease for which viral oncogenesis plays a central role. Specifically, Epstein-Barr virus (EBV) is considered a necessary cause of NPC. However, EBV is far from a sufficient cause, based on the following lines of evidence: 1) EBV infects the majority of the adult population not only in areas with high rates of NPC, but also in areas where NPC is uncommon (Cohen, 2000, Griffin, 2000); 2) after a primary infection with EBV, individuals remain lifelong EBV carriers, but even in regions with high NPC rates there is a small absolute risk of going on to develop NPC (Griffin, 2000). Thus, although exposure to EBV and even chronic EBV infection may be considered a necessary step in the causal pathway, these steps are far from sufficient to result in progression to clinical disease. This set of circumstances support the notion that in addition to EBV, nasopharyngeal carcinogenesis requires the presence of a “trigger” for disease progression to occur. Additional factors must modulate the risk of the development of nasopharyngeal carcinoma following EBV infection. These additional risk factors that act as “triggers” could be genetic and/or environmental exposures. Hence, if dietary factors contribute to NPC risk, they are likely to do so by acting in concert with EBV infection. Any dietary factor that alters the risk of developing NPC, either increasing or decreasing risk, is thus likely to act by altering susceptibility to EBV-induced carcinogenesis. A potentially critical element in study methodology would therefore be incorporating measures of EBV infection, such as antibody titres, into dietary studies of NPC. The literature on cervical cancer provides a useful example, as research on cervical cancer that has included measurement of infection with oncogenic strains of HPV has been important in elucidating the role of environmental factors in cervical carcinogenesis. Despite the importance of accounting for EBV infection status in studies of diet and NPC to advance our understanding of the etiology of nasopharyngeal carcinoma, very few studies have actually done so. In assessing this evidence, it is important to consider that very few studies that contributed to this systematic review accounted at all for EBV infection status. To summarize, NPC is caused by EBV, but EBV has not been accounted for in most of the evidence summarized in this report. Future research that addresses this gap would have potential to clarify the role of diet, and other environmental exposures, in relation to risk of NPC. Further refinements in approach could be envisioned, whereby timing of EBV infection in relation to exposure to dietary factors was considered, as any
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potential influence of dietary factors on EBV related carcinogenesis involving the reactivation of EBV must therefore occur temporally after primary Epstein-Barr virus infection. While epidemiologic studies with measurement of EBV infection status will be of great value, also of great importance would be studies in NPC cell lines to investigate empirical link between dietary agents and EBV reactivation, an important transforming event in NPC progression. 5. Results by exposures 1 Patterns of diet
1.1 Regionally defined diets No results found. 1.2 Socio-economically defined diets A3 Case-control studies (1) In a case-control study in Malaysia of histopathologically confirmed NPC patients ascertained from the main radiotherapy clinic in Kuala Lumpur each matched to one neighborhood control, in Chinese (OR 4.3; p-value 0.01) and Indian Malaysian (OR 9.0; p-value 0.05) cases were more likely than controls to have consumed poorer, simpler diet consisting mostly of rice with only little portions of meat, fish, vegetables, or fruit (Armstrong et al., 1983a). These data were adjusted for salted fish intake during childhood in addition to the matched factors of age, gender, residence and ethnicity. 1.3 Culturally defined diets A3 Case-control studies (1) In a preliminary report from the same case-control study of Armstrong and Armstrong in Malaysia which later formed the basis for the information reported in Section 1.2, being in a family that consumed a “multiethnic cuisine” was protective for NPC compared to being a family that adhered more strictly to the cuisine of a single ethnic group (OR = 0.2; p=<.01) (Armstrong, 1978). This association was not adjusted for any covariates. The authors interpreted this exposure to be a marker of adherence to traditional lifestyles. 1.4 Individual level dietary patterns No results found. 1.5 Other dietary patterns A3 Case-control studies (3) Three case-control studies looked at aspects of weaning and diet, including age stopped bottle-feeding, being weaned straight to an adult diet, and age at which first solid food was given. In a study of Chinese in Singapore, the risks related to age of cessation of bottle-feeding was non-significantly higher (OR 1.5; 95% CI 0.6 – 5.5) for those stopping past 24 months of age compared to those who were never bottle-fed as infants (Lee et al., 1994). Although this association was not statistically significant for the highest-versus-lowest category comparison, the authors reported that the trend was statistically significant (p=0.01). The results were adjusted for age, gender, education, and ethnicity. The maximum age of subjects in this study was 44 years.
14
The second study, conducted in Tunisia, used a food-frequency questionnaire (FFQ) to determine whether or not as children study participants were shifted to an adult diet during weaning (Jeannel et al., 1990a). The results indicated that individuals fed an adult diet at time of weaning had a statistically significant 5.1-fold (No CI, p=0.03) higher risk of NPC than those receiving a different diet, after adjusting for age, gender, residence and life style. In the third study, comprised of Chinese in China, the age of initiation of eating solid foods was investigated and the results showed that both cases and controls were fed solid foods at an average age of approximately 6 months. The results were adjusted for age, gender, and residence (Yu et al., 1989). In summary, studies of the association between weaning age in relation to risk of NPC do not lend themselves to a clear-cut conclusion. One study observed no association with age of eating solid foods (Yu et al., 1989), and the results of another suggested that later age of stopping weaning may be weakly associated with NPC risk (Lee et al., 1994). Perhaps the most intriguing findings in this regard were those of Jeannel et al (Jeannel et al., 1990a), which suggested that shifting from weaning straight to an adult diet, which may include potentially harmful constituents such as salted fish, was strongly associated with increased NPC risk. Thus, age at weaning per se may not be the key characteristic, but rather what foods are consumed around the time of weaning. 1.6 Breastfeeding No results found. 1.6.1 Mother No results found. 1.6.2 Breastfeeding--Child A3 Case-control studies (2) Two case-control studies examined the duration of being breastfed as a child. In the study in Algeria of Laouamri and colleagues, shorter durations of being breastfed as an infant were associated with NPC in the protective direction, except at the longest durations. In fact, significantly increased risk of NPC was present among those who were breast-fed for 24 months or more compared to those who were never breast-fed (OR=4.0 CI, 1.2 – 12.8) (Laouamri et al., 2001), but this result was based on an exposed group of only 12 cases and 4 controls. These data were adjusted for age, gender and residence. In a Chinese population in Singapore, duration of being breastfed was inversely associated with NPC risk. Compared to those who never breastfed, the odds ratio for NPC was 0.3 (95% CL 0.1, 0.8) among those who breastfed 1-6 months, and 0.6 (95% CL 0.2 – 1.4) among those who breast-fed for seven or more months (Lee et al., 1994). The markedly different cutpoints used to assess duration of breastfeeding in the two studies (>24 versus >7 months) makes it difficult to directly compare the results between the two studies. 1.7 Other issues A3 Case-control studies (1) One case control study examined the influence of patterns of eating meals and snacks on the risk of NPC in Chinese in Malaysia based on interview data (Armstrong, 1978). The authors noted that the unadjusted OR showed no significant association but details were not provided.
15
2 Foods 2.1 Starchy foods No results found. 2.1.1 Cereals (grains) Total Cereals: Adulthood consumption A3 Case-control studies (1) Adult consumption of corn and wheat, measured as a dichotomous “yes versus no” consumption was associated with increased risk of NPC (OR 1.53; 95% CL 1.02, 2.28) in a population-based case-control study (n=104 cases, n=104 controls) in China (Huang, 1997). This association was based on exposure three years prior to the cancer diagnosis and was adjusted for age, sex, neighborhood, and other factors. In this same study, an even stronger association was observed for the comparison of those who consumed cereals every day to those who consumed a few (OR 16; 95% CI 3.1-82.4), but this result was unadjusted. Total Cereals: Childhood consumption A3 Case-control studies (2) Two studies reported on the association between cereal consumption during childhood and NPC risk. Both of these studies were implemented in northern Africa. In Tunisia, the consumption of mhammas (cracked wheat) during childhood was associated with reduced risk of NPC (OR 0.3) for the highest-versus-lowest category comparison in a study that compared 80 NPC cases with 160 controls, but the interpretation of this association is hindered by the lack of reporting of further details (Jeannel et al., 1990a). In an Algerian study comprised of 72 cases and 72 controls, an imprecise odds ratio of 4.0 (95% CI 0.18-4.4) was observed for ever-versus-never use of cherchem during teething. Cherchem are wheat or barley pieces softened through contact with the floor and walls when stored underground (Laouamri et al., 2001). 2.1.1.1 Wholegrain cereals and cereal products A3 Case-control studies (1) A case-control study of 122 cases and 122 controls was carried out in China to investigate the association of wholegrain cereals and the risk of NPC. The results of this study were in the protective direction, with an odds ratio of 0.19 (p-value 0.02) for frequent versus infrequent consumption of wholegrain cereals after adjusting for age, sex, environmental factors and a number of dietary factors (Wang, 1993). 2.1.1.2 Refined cereals and cereal products Bread: Adulthood consumption A3 Case-control studies (3) Three case-control studies reported on the potential association between eating bread as an adult and risk of NPC. Two of these studies were carried out in China. In the first of the studies in China, Yu and colleagues observed that bread consumption during adulthood (Yu et al., 1989) was not significantly associated with NPC risk. These results were only reported in the text of the paper. In the second of the studies carried out in China,
16
the households of NPC cases were significantly less likely to often eat bread compared to the households of the controls (OR 0.43; 95% CL 0.27, 0.70) (Geser et al., 1978). The third study investigated Chinese living in Malaysia. In this study, cases were significantly more likely than controls to consume bread for breakfast, but further details were not reported (Armstrong, 1978). Interpreting the results of these three studies, which were very inconsistent, is hindered by the lack of detailed information. The inconsistent overall results could be a consequence of the heterogeneity in the exposures and study design features, or to fluctuation around an overall null result. Bread: Childhood consumption A3 Case-control studies (3) Three case-control studies reported on childhood bread consumption in relation to NPC risk. Two of these studies were carried out by Yu and colleagues in China. For these, the exposure measured was bread consumption at ten years of age. In results that were adjusted for at least age and sex, Yu and colleagues observed that bread consumption at age 10 years (Yu et al., 1989, Yu et al., 1988) was not significantly associated with NPC risk, as reported in the text of these papers. In contrast to these studies, the other study on this topic was conducted in Algeria and the exposure investigated was chewing bread crust during teething. In this study, the odds of chewing the crust of bread when teething were identical in NPC cases and controls (Laouamri et al., 2001). Overall, this evidence is consistent in suggesting that bread consumption during childhood is not associated with NPC. Noodles A3 Case-control studies (1) A study of Chinese in Malaysia compared 60 NPC cases to 150 controls with respect to the extent that the families of study participants ate noodles during meals. In matched analyses, the overall matched odds ratio of 1.2 indicates that families of cases were slightly more likely than the families of controls to eat noodles with their meals (Armstrong, 1978). In analyses by ethnic group, a stronger, statistically significant association was observed in the combined Hokkien plus Teochiu group. Rice A3 Case-control studies (2) Two studies reported on the association between eating rice and risk of NPC. A study of Chinese in Malaysia reported on the following associations: family eats rice for breakfast, family eats plain rice during evening meals, and family eats rice porridge during evening meal (Armstrong, 1978). Patterns of familial rice consumption were described in the text with very little detail. This study compared 60 NPC cases to 150 controls. A study carried out in China compared 104 NPC cases with 104 controls. In results that were unadjusted, eating rice at age 10 was inversely associated with risk of NPC (OR 0.71; 95% CI 0.51-0.92) (Huang, 1997). A5 Ecological studies (1) One study examined the per capita consumption of rice as determined in a food survey in both sexes of Chinese living in Hong Kong. The age-adjusted rates of NPC were significantly positively correlated with consumption of rice in both males and females (Koo et al., 1997). 2.1.2 Starchy roots, tubers and plantains A3 Case-control studies (2)
17
Two case-control studies examined the risk of NPC in association with consumption of starchy root vegetables. In one study, conducted in Algeria, the specific dietary exposure investigated was consumption of mashed potatoes during childhood. The results of this study showed a non-significantly elevated odds ratio of 2.0 (CI 0.06 – 59.7) for eating mashed potatoes >7 times versus <3 times per week, after adjustment for age, gender and residence area (Laouamri et al., 2001). The second case-control study was conducted by a team of investigators in China using a questionnaire to measure taro and sweet potato consumption in 101 cases and 199 controls. The investigators reported a lower risk of NPC with high versus no consumption of taro (OR 0.76; 95% CI 0.46 – 1.26) and sweet potatoes (OR 0.67; 95% CI 0.33 – 1.36) unadjusted for other factors (Zou, 1999). No trend was reported. 2.1.3 Other starchy foods No results found. 2.2 Fruit and (non-starchy) vegetables A3 Case-control studies (1) One case control study conducted in Tunisia examined the association of NPC with combined fruits and vegetables. Two controls were matched by age, sex, and area of residence to each case resulting in 80 included cases and 160 controls. They reported only that the data indicated no significant association between NPC risk and fruits and vegetables (Jeannel et al., 1990a). 2.2.1 Non-starchy vegetables Total non-preserved vegetables: Adulthood consumption A3 Case-control studies (5) A total of 5 case-control studies reported results for total non-preserved vegetables and NPC; however, only 2 provided enough information for a dose-response meta-analysis. All five studies were conducted in China and matched cases and controls. Four studies were included in a highest-versus-lowest forest plot and reported associations in the protective direction. The first study by Ward et al observed a highest-versus-lowest odds ratio of 0.6 (95% CI: 0.4-1.0) for vegetable intake after adjusting for age, sex, ethnicity/race, subjects with mother’s questionnaire, and total caloric intake (Ward et al., 2000). Yuan et al reported a maximally adjusted odds ratio of 0.85 (95% CI: 0.65-1.10) when comparing intake more than 2.4 times a day to intake less than 1.5 times per day (Yuan et al., 2000b). A study of 135 cases and 135 controls observed a significant association between non-starchy vegetables and NPC (OR=0.51, 95% CI: 0.29-0.88) when comparing intake more than 15.75 times per month to intake less than 15.75 times per month (Ye, 1995). The fourth study by Wang et al reported a maximally adjusted highest-versus-lowest OR of 0.256 (p=0.0051) (Wang, 1993). The fifth study, which was not included in the highest-versus-lowest forest plot, only reported a non-significant association between consumption of fresh vegetables 3 years prior to diagnosis and NPC (Ning et al., 1990).
Forest Plot for Highest vs. Lowest Analysis: Total non-starchy vegetables, Case-control studies
18
Odds Ratio: Highest vs. Lowest intake
.025 1 1.5
Study
Effect size
(95% CI)
NAS00531 (Ward, 2000) 0.60 ( 0.38, 0.95)
NAS00577 (Yuan, 2000) 0.85 ( 0.65, 1.11)
NAS06003 (Ye, 1995) 0.51 ( 0.29, 0.89)
NAS06022 (Wang, 1993) 0.26 ( 0.10, 0.67)
A5 Ecological studies (2) Two ecological studies examined the risk of NPC related to consumption of vegetables in Chinese residents in Hong Kong and China. The study in Hong Kong used per capita consumption to identify exposures and indicated significant correlations between the consumption of fresh vegetables and NPC after adjusting for age (r2=-0.77, p=0.009 among men and r2=-0.75, p=0.013 among women) (Koo et al., 1997). The second study determined local area consumption by interviews with residents and showed an increasing risk of NPC with increases in local consumption of non-starchy vegetables (r2=2.36) (Guo, 2001). This study did not report any adjustments for potential confounding variables or any report on whether the finding was significant. Total non-preserved vegetables: Childhood/Infancy consumption A3 Case-control studies (2) Two studies reported on consumption of non-preserved vegetables early in life. In a case-control study in China, evidence of a protective association (OR 0.3 to 0.6) was observed for eating fresh non-preserved vegetables at age 10, at age 3, and during weaning, and for mother’s consumption during breastfeeding (Ward et al., 2000). The results of another Chinese study of intake at age 10 observed no significant association between fresh vegetable consumption and NPC (Ning et al., 1990). Green vegetables: Adulthood consumption A3 Case-control studies (4) The four case-control studies reporting on green vegetable consumption were included in a highest-versus-lowest forest plot. The first study was conducted in the United States and included 129 cases and 206 controls (Farrow et al., 1998). They reported a highest-versus-lowest odds ratio of 0.99 (95% CI: 0.51-1.94) for the intake of labeled dark green vegetables. The second study of Chinese in Malaysia reported an odds ratio of 0.50 (95% CI: 0.23-1.07) for more than weekly consumption of green vegetables 5 years prior to diagnosis compared to monthly consumption (Armstrong et al., 1998b). In the third study, which matched 104 cases and 104 controls from China, a logistic regression OR of 0.63 (95% CI: 0.44-0.91) was observed for consumption of green peppers, chives, and celery (Chen et al., 1997). The fourth study, also from China, reported a highest-versus-lowest OR of 0.63 (95% CI 0.44-0.91) for green peppers, chives, and celery when consumed 3 years prior to diagnosis (Huang, 1997).
19
Forest Plot for Highest vs. Lowest Analysis: Green vegetables, Case-control studies
Odds Ratio: Highest vs. Lowest intake
.075 1 2
Study
Effect size
(95% CI)
NAS00700 (Farrow, 1998) 0.99 ( 0.51, 1.93)
NAS00749 (Armstrong, 1998) 0.50 ( 0.23, 1.08)
NAS00825 (Chen, 1997) 0.63 ( 0.44, 0.91)
NAS06024 (Huang, 1997) 0.63 ( 0.44, 0.91)
Green vegetables: Childhood consumption A3 Case-control studies (3) Three case-control studies investigated the association between childhood consumption of green vegetables and NPC. A study of Chinese in Malaysia reported an odds ratio of 0.59 (95% CI: 0.33-1.06) for more than weekly consumption of green vegetables at age 10 compared to monthly consumption (Armstrong et al., 1998b). In the second study, which matched 104 cases and 104 controls from China, a logistic regression OR of 0.54 (95% CI: 0.38-0.78) was observed for consumption of green peppers, chives, and celery at age 10 (Chen et al., 1997). The third study, also from China, reported results for fresh green vegetable consumption during multiple childhood stages (Yu et al., 1989). A protective, yet non-significant, association was observed for consumption during weaning (OR=0.6, 95% CI: 0.3-1.1). Non-significant results in the direction of risk were reported for intake during ages 1-2 (OR=1.7, 95% CI: 0.6-4.9) and at age 10 (OR=1.3, 95% CI: 0.3-5.1). Other non-preserved vegetables A3 Case-control studies (2) A study of Chinese in Malaysia evaluated intakes of vegetables at different meals and the risk of NPC (Armstrong, 1978). A significant odds ratio of less than one was reported for vegetables eaten at breakfast and for fresh vegetables eaten at evening meals among families of participants. Among cases and controls, an odds ratio of 0.9 was reported for vegetables eaten at three main daily meals when adjusted for age, sex, census district, household type, race and ethnicity, and socioeconomic status. In a study of Chinese in China, frequent consumption of coloured vegetables was significantly associated with NPC risk when compared to less frequent consumption after adjustment for various cofounders (OR=0.111, p=0.0108) (Wang, 1993). Total preserved vegetables: Adulthood consumption A3 Case-control studies (7) A total of 7 case-control studies reported results for total preserved vegetables and NPC; however, only 2 provided enough information for a dose-response or highest-versus-lowest meta-analysis. Ever-versus-never
20
consumption of preserved vegetables was not significant in a Chinese study of 375 cases and 327 controls (Ward et al., 2000). A large Chinese study of 935 cases and 1032 controls by Yuan et al observed a significant association between preserved vegetable intake and NPC (OR=1.43, 95% CI: 1.11-1.86) (Yuan et al., 2000b). Lee et al also reported a significant association between canned, salted, or pickled vegetables and NPC (OR=4.9, CI: 1.8-12.9) (Lee et al., 1994). Two studies by Zheng et al, one published in 1993 and one in 1994, reported different results for preserved vegetables (Zheng et al., 1993, Zheng et al., 1994b). The first reported a significant risk association for salted vegetables and the second reported no significant association for salted, dried, or tinned vegetables in brine. In a study of 100 cases and 300 matched controls conducted in China, no significant associations were reported for dried, salted, or pickled vegetables (Ning et al., 1990). The final study included 100 cases and 100 controls in China and observed a significant regression slope of 0.015 for the intake of pickled vegetables after adjusting for environmental factors, gas range, pungent foods, and socio-economic status (Duan, 2000). Total preserved vegetables: Childhood/Infancy consumption A3 Case-control studies (4) Four case-control studies investigated preserved vegetables during childhood and risk of NPC. The first study by Ward et al matched cases and controls in China (Ward et al., 2000). Non-significant associations were reported for intake of preserved vegetables at age 10 (OR=0.9, 95% CI: 0.3-2.6), at age 3 (OR=0.9, 95% CI: 0.3-2.4), and during weaning (OR=1.3, 95% CI: 0.6-2.5). Consumption of canned, salted or pickled vegetables at age 10 was not observed to be associated with NPC (OR=0.5, 95% CI: 0.1-1.4) in a study of Chinese in Singapore (Lee et al., 1994). A study by Jeannel et al reported an adjusted odds ratio of 2.2 for consumption of pickled vegetables during weaning, but no other details were offered (Jeannel et al., 1990a). Ning et al observed no significant associations for dried, salted, or pickled vegetables at age 10 (Ning et al., 1990). 2.2.1.1 Non-starchy root vegetables and tubers Total Root Vegetables A3 Case-control studies (1) One case-control study evaluated the association between total non-starchy root vegetables and tubers. The study conducted in Algeria included 72 cases and 72 controls (Laouamri et al., 2001). With adjustment for age, sex, and area of residence, a non-significant odds ratio of 1.0 was reported for use of non-starchy root vegetables and tubers when teething and NPC risk. Carrots: Adulthood consumption A3 Case-control studies (2) Two case-control studies evaluated the association between carrot consumption during adulthood and NPC. Adult consumption of carrots (within the past three to five years) was reported in the text as being not statistically significant in one study (Chen et al., 1997) and in another an odds ratio of 0.8 (95% CL 0.3, 1.9) was reported (Ning et al., 1990). Both studies were conducted in China and adjusted for age, sex, and area of residence. Carrots: Childhood consumption A3 Case-control studies (6) Four of the six case-control studies investigating consumption of carrots during childhood were included in a highest-versus-lowest analysis. A formal meta-analysis of these studies was not deemed tenable because two of
21
the six studies only reported findings in the text as being “not statistically significant”, and of the remaining studies there was heterogeneity in the exposure window studied, varying from baby food (Laouamri et al., 2001) to age 10 years (Chen et al., 1997, Huang, 1997, Yu et al., 1989). In a study in Algeria, consumption of carrots as a baby food was inversely associated with NPC (OR=0.3, 95% CI: 0.1-0.87) (Laouamri et al., 2001). At age 10 years, odds ratios in the protective direction were observed in three Chinese studies (Huang, 1997, Ning et al., 1990, Yu et al., 1989). Yu et al and Huang et al reported significant odds ratios of 0.2 (95% CI: 0.1-0.3) and 0.6 (95% CI: 0.41-0.99), respectively. Ning et al observed a non-significant odds ratio of 0.4 (p=0.09) when adjusting for age, sex, area of residence, salted fish and salted shrimp paste consumption at age 10. The two remaining studies not included in the highest-versus-lowest plot reported non-significant results for carrot consumption at age 10 (Chen et al., 1997, Yu et al., 1989).
Forest Plot for Highest vs. Lowest Analysis: Carrots, Case-control studies
Odds Ratio: Highest vs. Lowest intake
.025 1 1.5
Study
Effect size
(95% CI)
NAS00424 (Laouamri, 2001) 0.30 ( 0.10, 0.89)
NAS01459 (Yu, 1989) 0.20 ( 0.12, 0.35)
NAS01922 (Ning, 1990) 0.40 ( 0.14, 1.15)
NAS06024 (Huang, 1997) 0.60 ( 0.39, 0.93)
Preserved Root Vegetables A3 Case-control studies (2) The association between preserved root vegetables and NPC was evaluated in two case-control studies. Salted root vegetables were reported to be significantly associated with NPC among 97 cases and 192 controls in China (unadjusted OR=2.2; 95% CL: 1.3-2.2) (Zou, 1999). In another Chinese study, pickled root vegetables consumed at age 10 were inversely associated with NPC (OR=0.75, 95% CI: 0.57-0.99), preserved root vegetables consumed at age 10 were positively associated with NPC (OR=1.81, 95% CI: 1.01-3.33), and other preserved root vegetables consumed during adulthood were positively associated with NPC (OR=2.42, 95% CI: 0.99-5.92) (Huang, 1997). 2.2.1.2 Cruciferous vegetables Cabbage: Adulthood consumption A3 Case-control studies (3)
22
Three studies, all conducted in China, evaluated the relationship between cabbage consumption and NPC in China. In a large study of 935 cases and 1032 controls, no association was reported for daily intake and NPC when compared to less than weekly intake (OR=0.97, 95% CI: 0.81-1.17) of fresh bok choi (Chinese white cabbage) (Yuan et al., 2000b). Using a maximally adjusted model, Armstrong et al observed a significant protective association for more than monthly consumption of Chinese flowering cabbage (OR=0.5, p=0.0004) in a study of 282 cases and 282 matched controls (Armstrong et al., 1998b). Huang et al also reported a significant protective association for cabbage intake 3 years prior to diagnosis (OR=0.628, 95% CI: 0.44, 0.90) among 104 cases and 104 controls (Huang, 1997). Non-Preserved Cruciferous Vegetables: Adulthood consumption A3 Case-control studies (5) Five case-control studies assessed the relationships between various cruciferous vegetables and NPC, only one observed a significant association. Chinese kale was reported as protective, but not significant, when consumed more than weekly among matched cases and controls from China (OR=0.63, 95% CI: 0.39-1.01) (Armstrong et al., 1998b). Chen et al reported a significant logistic regression odds ratio of 0.63 (95% CI: 0.44-0.90) for intake of Chinese cabbage and rutabaga (Chen et al., 1997). In a study of Chinese in Singapore, turnip root was not observed to be associated with NPC when consumed more than 3 times per month (OR=1.0, 95% CI: 0.1-5.6) (Lee et al., 1994). No association was reported between mustard consumption and NPC by Ning et al in a study 100 cases and 300 controls matched for age, sex, and area of residence (Ning et al., 1990). Huang et al examined the association between cauliflower intake and NPC, but observed no significance (OR=1.048, 95% CI: 0.36-3.05) (Huang, 1997). Non-Preserved Cruciferous Vegetables: Childhood consumption A3 Case-control studies (6) Six case-control studies assessed the relationships between various cruciferous vegetables consumed during childhood and NPC. Chinese flowering vegetable consumed at age 10 was reported to be significantly protective (OR=0.47, 0.29-0.77) in a study by Armstrong et al, but Chinese kale consumed at the same age was not (OR=0.71, 0.40-1.27) (Armstrong et al., 1998b). Chen et al reported no association between Chinese cabbage and rutabaga consumption at age 10 and NPC in a matched case-control study conducted in China (Chen et al., 1997). Consumption of turnip root was not observed to be related to NPC in a study of Chinese in Singapore (OR=1.2, 95% CI: 0.4-3.4) (Lee et al., 1994). Mustard, consumed at age 10, was not associated with NPC in a matched case-control study in China (Ning et al., 1990); however, significant results were observed for leaf mustard consumed around 1978 (OR=1.92, 95% CI: 1.46-2.53) and 1968 (OR=1.44, 95% CI: 1.56-1.80) in another Chinese study (Cai, 1996). In the sixth study, cauliflower consumption at age 10 was reported to be protective with an odds ratio of 0.70 (95% CI: 00.52-0.94) among matched cases and controls in China (Huang, 1997). Preserved Cruciferous Vegetables: Adulthood consumption A3 Case-control studies (5) Of the five studies that reported results for preserved cruciferous vegetables consumed during adulthood, only 2 presented odds ratios. All 5 studies included Chinese men and women from Singapore or China. The first study by Chen et al observed no significant association between pickled Chinese cabbage and NPC (Chen et al., 1997). In the second study by Lee et al, results for 3 types of preserved cruciferous vegetables were in the risk direction, but only 2 were significant (Lee et al., 1994). The 2 significant results were for preserved Chinese radish (OR=2.8, 95% CI: 1.2-6.0) and salted mustard greens (OR=3.1, 95% CI: 1.4-6.5). No significance was observed for preserved cabbage (OR=1.5, 95% CI: 0.6-3.4). Yu et al and Ning et al both reported no significant
23
association for salted mustard greens and sour cabbage, respectively (Ning et al., 1990, Yu et al., 1986). In the fifth study, both pickled leaf mustard (OR=6.11, p<0.01) and pickled radish (OR=1.75, 95% CI: 1.10-2.79) were observed to be significantly related to NPC (Ye, 1995). Preserved Cruciferous Vegetables: Childhood consumption A3 Case-control studies (4) Four studies focused on various preserved cruciferous vegetables and any age group below age 10 years, with 3 reporting estimates for odds ratios. All four studies assessed the association between types of preserved cabbage at age 10 and NPC. Chen et al reported a protective odds ratio of 0.75 (95% CI: 0.57-0.99) for pickled cabbage consumption at age 10, whereas Yu et al (1988) observed no significant association (Chen et al., 1997, Yu et al., 1988). No significance was observed for preserved cabbage consumption at age 10 by Lee et al (OR=0.8, 95% CI: 0.2-2.6); for salted cabbage at age 10 by Yu et al (1988); or for sour cabbage at age 10 by Ning et al (Ning et al., 1990). Preserved radish was examined in two of the studies. In the first study of Chinese in Singapore (Lee et al., 1994), an odds ratio of unity (95% CI: 0.4-2.1) was reported for consumption of preserved Chinese radish at age 10. The second study from China (Yu et al., 1988) observed no significant association between the consumption of salted radish at age 10 and NPC. Two studies (Lee et al., 1994, Yu et al., 1988) examining the risk of salted mustard greens at age 10 showed no association. Yu et al (1988) also assessed consumption at ages 1-2 and weaning. No association was observed at ages 1-2, but salted mustard greens consumed during weaning were reported to be in the risk direction (OR=5.4, 95% CI: 1.2-23.8) in an ever-versus-never analysis. 2.2.1.3 Allium vegetables A3 Case-control studies (1) In a case-control study of Chinese in China, the association between NPC and consumption of garlic at age 10 or in adulthood was investigated using a food frequency questionnaire. There were 100 NPC cases and 300 controls. The authors reported no significant associations after adjustments were made for age, gender and area of residence (Ning et al., 1990). 2.2.1.4 Green leafy vegetables (not including cruciferous vegetables) Total Green Leafy Vegetables: Adulthood consumption A3 Case-control studies (4) Four studies, all from China, examined the association between adulthood consumption of green leafy vegetables and NPC. Two of the studies observed significant protective associations, whereas the other two studies observed risk associations, one significant and one not significant. Yuan et al reported a non-significant maximally adjusted odds ratio of 1.25 (95% CI: 0.73-2.14) for fresh dark green leafy vegetables (Yuan et al., 2000b). Zheng et al and Ye et al both used matched cases and controls and observed significant protective associations for leafy vegetables (OR=0.1, p=0.008 and OR=0.29, p<0.01, respectively) (Ye, 1995, Zheng et al., 1994b). In a study by Huang et al, a significant risk association was observed for green leafy vegetables consumed 3 years prior to diagnosis (OR=1.733, 95% CI: 1.19-2.53) (Huang, 1997).
Forest Plot for Highest vs. Lowest Analysis: Green leafy vegetables, Case-control studies
24
Odds Ratio: Highest vs. Lowest intake
.005 1 3
Study
Effect size
(95% CI)
NAS00577 (Yuan, 2000) 1.25 ( 0.73, 2.14)
NAS01113 (Zheng, 1994) 0.10 ( 0.02, 0.55)
NAS06003 (Ye, 1995) 0.29 ( 0.11, 0.74)
NAS06024 (Huang, 1997) 1.73 ( 1.19, 2.52)
Total Green Leafy Vegetables: Childhood consumption A3 Case-control studies (2) Two case-control studies from China studied the association between green leafy vegetables and NPC. The first study of 128 cases and 174 controls reported non-significant associations for fresh green leafy vegetables when consumed during weaning (p-for-trend 0.86), between ages 1-2 (p-for-trend 0.92), and at age 10 (Yu et al., 1988). In the second study, 115 cases and 115 controls were recruited from area hospitals during the 1991 calendar year (Cai, 1996). An adjusted odds ratio of 0.514 (95% CI: 0.34-0.78) was reported for green leafy vegetables consumed around 1968 and 0.444 (95% CI: 0.29-0.67) for consumption around 1978. Water spinach A3 Case-control studies (1) A study of Chinese in Malaysia including 282 cases and 282 controls investigated the association between consumption of water spinach at age 10 and 5 years prior to diagnosis and risk of NPC (Armstrong et al., 1998b). An unadjusted odds ratio of 0.72 (95% CI 0.45-1.17) was reported for those who consumed water spinach more than weekly 5 years prior to diagnosis compared to those with monthly consumption. More than weekly consumption at age 10 was reported as being significantly associated with NPC when compared to monthly consumption (unadjusted OR=0.51, 95% CI 0.28-0.93). Preserved Green Leafy Vegetables: Adulthood consumption A3 Case-control studies (3) Three case-control studies evaluated the association between preserved green leafy vegetables and NPC. The first study of Chinese in Malaysia reported an unadjusted odds ratio of 3.33 (95% CI: 1.84-6.01) when comparing more than weekly intake of salted green leafy vegetables to monthly consumption (Armstrong et al., 1998b). A second study of Chinese in Singapore reported a non-significant association between mei chye (preserved greens and leafy vegetables) and NPC after adjusted for various confounders (Lee et al., 1994). The third study of Chinese in China reported non-significant associations between dried kelp and dried seaweed and NPC after adjusting for age, sex, and area of residence (Ning et al., 1990).
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Preserved Green Leafy Vegetables: Childhood consumption A3 Case-control studies (2) Two case-control studies evaluated the association between preserved green leafy vegetables consumed during childhood and NPC. The first study of Chinese in Malaysia reported an unadjusted odds ratio of 0.84 (95% CI: 0.45-1.58) when comparing more than weekly intake of salted green leafy vegetables at age 10 to monthly consumption (Armstrong et al., 1998b). The second study of Chinese in China reported non-significant associations between consumption of dried kelp at age 10 and consumption of dried seaweed at age 10 and NPC after adjusting for age, sex, and area of residence (Ning et al., 1990). 2.2.1.5 Other non-starchy vegetables Tomatoes: Adulthood consumption A3 Case-control studies (5) Five studies evaluated the relationship between tomato consumption during adulthood and NPC, with four providing enough information for a highest-versus-lowest analysis. Of the four studies, 2 showed significant protective associations, and 2 reported non-significant results. No association was assessed for daily intake in a large Chinese study of 935 cases and 1032 controls when maximally adjusted (OR=0.92, p-for-trend=0.10) (Yuan et al., 2000b). In a study of Chinese in Malaysia, more than weekly intake 5 years prior to diagnosis was significantly associated with NPC risk (OR=0.5, 95% CI: 0.28-0.87) (Armstrong et al., 1998b). Zou et al reported an odds ratio in the direction of risk for intake nine times or more a month, but the confidence interval was wide and therefore not significant (OR=2.59, 95% CI: 0.69-9.72) (Zou, 1999). The study by Huang et al was the second study to report a significant protective association for tomato consumption (Huang, 2002). They observed an odds ratio of 0.57 (95% CI: 0.39-0.83) for frequent consumption compared to less frequent consumption among matched cases and controls. The fifth study, which was not eligible for highest-versus-lowest analysis, reported a significant association for tomatoes, but failed to provide any other details (Yu et al., 1989).
Forest Plot for Highest vs. Lowest Analysis: Tomatoes, Case-control studies
Odds Ratio: Highest vs. Lowest intake
.05 1 10
Study
Effect size
(95% CI)
NAS00577 (Yuan, 2000) 0.92 ( 0.83, 1.01)
NAS00749 (Armstrong, 1998) 0.50 ( 0.28, 0.88)
NAS06023 (Zou, 1999) 2.59 ( 0.69, 9.72)
NAS06030 (Huang, 2002) 0.57 ( 0.39, 0.83)
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Tomatoes: Childhood consumption A3 Case-control studies (3) The association between childhood tomato consumption and NPC was assessed in three case-control studies. In the first study of Chinese in Malaysia, an odds ratio of 0.80 (95% CI: 0.48-1.32) was reported for more than weekly intake compared to monthly intake of tomatoes (Armstrong et al., 1998b). In a Chinese study including matched cases and controls, strong protective trends were observed for tomato consumption at age 10 (OR=0.3, p-for-trend<0.05), at ages 1-2 (OR=0.3, p-for-trend<0.05), and during weaning (OR=0.0, 95% CI: 0.0-0.9) (Yu et al., 1989). In the third study, which matched cases and controls from China, no significant associations were reported for consumption at age 10 or at ages 1-2 (Yu et al., 1988). Other Non-Preserved Vegetables: Adulthood consumption A3 Case-control studies (3) Three studies examined various non-preserved vegetables consumed during adulthood and NPC. The first study included 935 cases and 1032 controls from China and used a food frequency questionnaire to assess intake (Yuan et al., 2000b). Daily intakes of fresh light green/orange leafy vegetables (OR=0.98, 95% CI: 0.63-1.50), fresh gourds (OR=0.89, 95% CI: 0.73-1.09), and fresh green peppers (OR=0.67, p=0.43) were not shown to be associated with NPC when compared to less than weekly intake and adjusted for various confounders. Significant protective trends were observed for the consumption of sliced raw chilli at evening meals and at 3 main daily meals in a study of Chinese in Malaysia (Armstrong, 1978). In a Chinese study of 135 cases and 135 controls matched by age, sex, and area of residence (Ye, 1995), white coloured vegetables were observed to be protective when consumed more than 3.3 times a month (OR=0.30, 95% CI: 0.18-0.51). Other Non-Preserved Vegetables: Childhood consumption A3 Case-control studies (2) Two studies reporting results for other non-preserved vegetables consumed during childhood showed significant protective associations. Both studies were conducted in China and matched cases and controls by age, sex, and area of residence. Cai et al observed significant relationships for yellow coloured vegetables consumed around 1968 (OR=0.64, 95% CI: 0.45-0.91) and 1978 (OR=0.83, 95% CI: 0.44-0.91) (Cai, 1996). An ever-versus-never odds ratio of 0.55 (95% CI: 0.33-0.92) was reported for green bean and eggplant consumption at age 10 in a study by Huang et al (Huang, 1997). Total Preserved Vegetables: Adulthood consumption A3 Case-control studies (5) Of the 5 studies reporting results for total preserved vegetables consumed during adulthood, 4 provided adequate details to be included in a highest-versus-lowest analysis. In an Algerian study, 72 cases and 72 controls were matched by age, sex, and area of residence (Laouamri et al., 2001). This study observed vegetables in brine used as seasonings to be significantly related to NPC (OR=2.77, 95% CI: 1.34-5.71). A Chinese study by Yuan et al examined various types of preserved vegetables in a population of 935 cases and 1032 controls (Yuan et al., 2000b). They reported a significant risk for the consumption of preserved stem vegetables (OR=1.88, 95% CI: 1.24-2.84) and non-significant associations in the direction of risk for the consumption of preserved leafy vegetables (OR=1.37, 95% CI: 0.65-2.9) and preserved root vegetables (OR=1.04, 95% CI: 0.7-1.53). Mei chye, a dish of preserved greens and leafy vegetables, was shown to be in the direction of risk, but not significant (OR=2.8, 95% CI: 0.9-8.2) in a study of Chinese in Singapore (Lee et al., 1994). Zou et al observed a significant risk association for salted non-starchy vegetables when consumed more than 9 times a month (OR=2.28, 95% CI: 1.40-3.73) in a study of 100 cases and 202 controls in China
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(Zou, 1999). The fifth study, which was not eligible for inclusion in the meta-analysis, reported no significant association between salted vegetables and NPC (Chen et al., 1997).
Forest Plot for Highest vs. Lowest Analysis: Total preserved vegetables, Case-control studies
Odds Ratio: Highest vs. Lowest intake
.25 1 9
Study
Effect size
(95% CI)
NAS00424 (Laouamri, 2001) 2.77 ( 1.34, 5.72)
NAS00577 (Yuan, 2000) 1.37 ( 0.65, 2.90)
NAS01056 (Lee, 1994) 2.80 ( 0.93, 8.46)
NAS06023 (Zou, 1999) 2.28 ( 1.40, 3.72)
Total Preserved Vegetables: Childhood consumption A3 Case-control studies (3) Three studies reported on preserved vegetables consumed during childhood; 2 reported significant protective associations for intake of salted vegetables at age 10. In the first study to examine salted vegetables, 104 cases and 104 controls were matched by age, sex, and area of residence and a logistic regression odds ratio of 0.76 (95% CI: 0.58-0.99) was observed (Chen et al., 1997). The second study reported similar results (OR=0.755, 95% CI: 0.58-1.0) for salted vegetables (Huang, 1997). In a study of Chinese in Singapore (Lee et al., 1994), including 150 cases and 341 controls, intake of preserved greens and leafy vegetables was not significantly associated with NPC (OR=1.3, 95% CI: 0.6-2.6) when adjusting for age, sex, education level, and dialect group. Other Preserved Vegetables: Adulthood consumption A3 Case-control studies (5) A heterogeneous mix of preserved vegetables consumed during adulthood was investigated in 5 case-control studies, all reported significant risk associations with NPC. An odds ratio of 7.5 (95% CI: 3.09-18.2) was reported for salted and dried tomatoes in an Algerian study which matched 72 cases and 72 controls by age, sex, and area of residence (Laouamri et al., 2001). Armstrong et al observed more than weekly consumption of salted root to be a risk factor for NPC (OR=2.19, 95% CI: 1.33-3.62) in study of Chinese in Malaysia (Armstrong et al., 1998b). Plum vegetable was shown as significantly associated with NPC (OR=2.53, 95% CI: 1.04-6.19) when maximally adjusted for in a Chinese study (Chen et al., 1997). After adjusting for age, sex, education level, and dialect group, salted Chinese tuber consumption was significantly associated with NPC (OR=2.4, 95% CI: 1.1-5.2) in a study of Chinese in Singapore (Lee et al., 1994). An ever-versus-never odds ratio of 3.3 (p=0.03) was observed for pickled vegetables with fungus after adjusting for age, sex, area of residence, and living condition score in a Tunisian study of 80 cases and 160 controls (Jeannel et al., 1990a).
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Other Preserved Vegetables: Childhood consumption A3 Case-control studies (4) In several studies, associations in the direction of increased risk were observed relating salted/preserved vegetable intake during childhood and NPC (Armstrong et al., 1998b, Jeannel et al., 1990a, Lee et al., 1994). Salted root intake at age 10 was in the risk direction, but not significant in 2 studies. The first study of Chinese in Malaysia included 282 cases and 282 controls (Armstrong, 1998) and observed an odds ratio f 1.75 (95% CI: 0.98-3.10) for more than weekly consumption compared to monthly consumption. The second study to examine salted root included 128 cases and 174 controls from China (Yu et al., 1988) and reported an age and sex adjusted odds ratio of 3.2 (95% CI: 0.6-17.6) for daily consumption compared to rare intake. In the same study by Yu et al, a significant association was observed for chung choi consumption during weaning using a maximally adjusted model (OR=0.518, p=0.042). Sze chuan chye, a salted Chinese tuber, was not found to be associated with NPC (OR=1.4, 95% CI: 0.4-4.5) in a study of Chinese in Singapore which included 145 cases and 340 controls (Lee et al., 1994). Jeannel et al (1990) reported a significant risk association for pickled vegetables with fungus consumed during weaning (OR=3.8, p=0.03) in a study of Tunisian cases and controls. 2.2.1.6 Raw vegetables A3 Case-control studies (2) Two case-control studies conducted by Armstrong and colleagues among Chinese in Malaysia reported on the associations between consumption of raw foods and NPC. Statistically significant trends in the protective direction were observed with greater consumption of raw green vegetables (p-for-trend 0.026) (Armstrong et al., 1998b) and sliced raw chilli (cases ate less at evening meals) (Armstrong, 1978). 2.2.2 Fruits Total non-preserved fruits: Adulthood consumption A3 Case-control studies (6) The evidence for non-preserved fruits consumed during adulthood was not amenable to meta-analysis since only 3 case-control studies provided sufficient information to be included. Of the six studies, 4 specified the intake of fresh fruits (Armstrong, 1978, Huang, 2002, Ning et al., 1990, Zheng et al., 1994a). A protective odds ratio was reported in 4 studies, although only 2 were statistically significant. Zheng et al and Ning et al reported non-significant results for the consumption of fresh fruit using a matched case-control design. Total non-preserved fruits: Childhood consumption A3 Case-control studies (4) In four studies, associations were examined relating non-preserved fruit intake during childhood and NPC. All studies included Chinese cases and controls, one from Taiwan and three from China. The study from Taiwan reported adjusted odds ratios of 0.9 (95% CI-0.3-2.6) for intake at age 3, 2.1 (95% CI: 0.6-7.4) for intake during weaning, and 0.5 (95% CI: 0.2-1.5) for mother’s diet during breastfeeding (Ward et al., 2000). Zheng et al and Ning et al reported non-significant results for fresh fruit consumption at age 10 or at ages 0-3 (Ning et al., 1990, Zheng et al., 1994a). The fourth study examined fresh fruit consumed around 2 different decades and observed significant protective associations for both (OR=0.67, 95% CI: 0.49-0.90 around 1968 and OR=0.68, 95% CI: 0.52-0.89) (Cai, 1996). Preserved fruits
29
A3 Case-control studies (1) A study of Chinese in Malaysia including 282 cases and 282 controls investigated the association between consumption of preserved fruits at age 10 and 5 years prior to diagnosis and risk of NPC (Armstrong et al., 1998b). An unadjusted odds ratio of 1.42 (95% CI 0.71-2.85) was reported for those who consumed preserved fruit more than weekly 5 years prior to diagnosis compared to those with less than monthly consumption. More than weekly consumption at age 10 was not significantly associated with NPC when compared to less than monthly consumption (unadjusted OR=1.50, 95% CI 0.82-2.75). 2.2.2.1 Citrus fruit Total citrus fruit: Adulthood consumption A3 Case-control studies (5) The evidence for citrus fruits was not compatible with the preferred dose-response approach, but analyses using the approach of highest-versus-lowest categories could be implemented with all five case-control studies contributing data. A statistically significant protective association was observed for 4 of the 5 studies, with the fifth study in the protective direction. Yuan et al compared daily intakes of fresh oranges and tangerines to less than weekly intakes and reported a maximally adjusted odds ratio of 0.06 (p-for-trend 0.0005) (Yuan et al., 2000b). In a US study, the only study outside of China, an adjusted odds ratio of 0.68 (95% CI: 0.33-1.41) was observed for consumption of oranges, grapefruits, and orange juice (Farrow et al., 1998). Armstrong et al and Chen et al implemented maximal adjustment models and observed significant protective associations for oranges and tangerines (OR=0.48, p=0.025 and OR=0.66, 95% CI: 0.50-0.89, respectively) (Armstrong et al., 1998b, Chen et al., 1997). An ever-versus-never odds ratio of 0.63 (95% CI: 0.41-0.95) was reported by Huang et al for consumption of citrus fruits 3 years prior to diagnosis among matched cases and controls from Heilongjiang province, China (Huang, 1997).
Forest Plot for Highest vs. Lowest Analysis: Citrus Fruits, Case-control studies
Odds Ratio: Highest vs. Lowest intake
.0025 1 1.5
Study
Effect size
(95% CI)
NAS00577 (Yuan, 2000) 0.06 ( 0.01, 0.29)
NAS00700 (Farrow, 1998) 0.68 ( 0.33, 1.40)
NAS00749 (Armstrong, 1998) 0.48 ( 0.25, 0.92)
NAS00825 (Chen, 1997) 0.66 ( 0.49, 0.88)
NAS06024 (Huang, 1997) 0.63 ( 0.41, 0.96)
Total citrus fruit: Childhood consumption A3 Case-control studies (4)
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Four studies from China examined the association between childhood consumption of citrus fruits and NPC, only 1 observed significant results (Armstrong et al., 1998b, Chen et al., 1997, Yu et al., 1989, Yu et al., 1988). All four studies reported non-significant results for consumption at age 10. Yu et al (1989) observed a significant protective association for consumption at ages 1-2 (OR=0.3, 95% CI: 0.1-0.9); however, a previous study by Yu et al (1988) did not show a significant association (p=0.86). Preserved citrus fruits A3 Case-control studies (1) One study of 104 cases and 104 controls in China evaluated the association between preserved citrus fruits and NPC (Huang, 1997). Consumption of preserved citrus fruits at age 10 was reported as a risk factor for NPC when compared to no consumption (unadjusted OR=2.17, 95% CI 1.12-4.21). After adjustment for age, sex, no separate kitchen, intake of dried vegetables and grapes, and family history of cancer, an odds ratio of 2.95 (95% CI 1.04-8.41) was reported for consumption of preserved oranges when compared to no consumption. 2.2.2.2 Other Fruits Non-preserved fruits: Adulthood consumption A3 Case-control studies (2) Two studies conducted in China investigated the association between non-preserved fruits consumed during adulthood and NPC. The first study of 104 cases and 104 controls matched for age, sex, and area of residence reported logistic regression results for consumption of apples (OR=0.64, 95% CI: 0.46-0.90), bananas (OR=0.59, 95% CI: 0.42-0.82), grapes (OR=0.42, 95% CI: 0.28-0.64), peaches (OR=0.65, 95% CI: 0.46-0.91), and watermelons (OR=1.56, 95% CI: 1.07-2.27) (Chen et al., 1997). The second study reported similar results for apples (OR=0.641, 95% CI=0.46-0.90), bananas (OR=0.587, 95% CI: 0.42-0.82), peaches (OR=0.651, 95% CI: 0.46-0.91), and watermelons (OR=1.559, 95% CI: 1.07-2.27) (Huang, 1997). When using a subset of the study participants based on provincial region, an odds ratio of 0.567 (95% CI: 0.38-0.85) was reported for banana consumption and 0.312 (95% CI: 0.17-0.58) for grape consumption. Preserved plums: Adulthood consumption A3 Case-control studies (4) Various types of preserved plums consumed during adulthood were examined in four case-control studies. All were in Chinese populations from China or Hong Kong. Yuan et al reported no significance for intakes of dried plums or preserved plums in a study of 935 cases and 1032 controls (Yuan et al., 2000b). Using maximally adjusted models, Chen et al reported significant risk results for the consumption of preserved prunes (OR=2.59, 95% CI: 1.04-8.41) and preserved plums (p-for-trend<0.05) in a matched case-control study (Chen et al., 1997). Limiting dietary intake to 3 years prior to diagnosis, Yu et al did not observe significant associations for 2 types of salted plums; however, when lifetime dietary data was used they observed significant associations for both types of salted plums (risk estimates not provided) (Yu et al., 1989). A second study by Yu et al reported non-significant results for preserved plums after adjusting for age, sex, and salted fish intake (Yu et al., 1986). Preserved plums: Childhood consumption A3 Case-control studies (5) Five studies investigated the relationship between consumption of preserved plums at age 10 and NPC risk; however, only 2 provided enough information for a meta-analysis. All five studies were in Chinese populations from China or Hong Kong. Chen et al reported significant risk associations for preserved prunes (OR=2.17,
31
95% CI: 1.12-4.21) and preserved plums (OR=2.10, 95% CI: 1.12-3.91) using logistic regression analyses and matched cases and controls (Chen et al., 1997). Significant risk trends were observed by Yu et al for 2 types of salted plums (p-for-trends 0.01 and 0.03) after adjusting for age, sex, area of residence, and consumption of salted fish during weaning (Yu et al., 1989). Two previous studies by Yu et al did not observe associations for various preserved plums (Yu et al., 1986, Yu et al., 1988). The fifth study included 104 cases and 104 matched controls and reported a significant risk association for ever-versus-never intake of preserved plums at age 10 (OR=2.10, 95% CI: 1.12-3.91) (Huang, 1997). Preserved olives: Adulthood consumption A3 Case-control studies (3) Three case-control studies evaluated the relationship between preserved olives consumed during adulthood and NPC. A study of 72 cases and 72 matched controls in Algeria reported significant associations between consumption of olives in brine (OR=2.0, 95% CI: 1.36-3.72) and dried olives (OR=4.66, 95% CI: 1.51-14.33) and risk of NPC (Laouamri et al., 2001). An adjusted odds ratio of 1.6 (95% CI: 0.3-7.5) was reported for intake of salted black olives more than once a month compared to no intake among 200 cases and 406 controls of Chinese in Singapore (Lee et al., 1994). The third study of 80 cases and 160 controls in Tunisia reported a maximally adjusted odds ratio of 8.7 for consumption of pickled olives in the year preceding diagnosis (Jeannel et al., 1990a). Preserved olives: Childhood consumption A3 Case-control studies (2) Two studies investigated the relationship between consumption of salted olives at age 10 and NPC risk. The first study of Chinese in Singapore reported a significant inverse association between salted black olives eaten more than once a month and NPC (OR=0.3, 95% CI: 0.1-0.9) (Lee et al., 1994). The second study of 128 cases and 174 controls conducted in China reported a non-significant association between salted olive intake at age 10 and NPC when adjusting for age and sex (Yu et al., 1988). Other preserved fruits: Adulthood consumption A3 Case-control studies (3) Three case control studies measured the association between dried fruits consumed during adulthood and NPC. One study of 72 cases and 72 matched controls in Algeria reported an odds ratio of 0.2 (95% CI: 0.08-0.17) for consumption of raisins (Laouamri et al., 2001). Two studies, one conducted in China and the other in Hong Kong, reported non-significant associations between dried red dates and NPC (Yu et al., 1986, Yuan et al., 2000b). Other preserved fruits: Childhood consumption A3 Case-control studies (2) Two case control studies measured the association between dried red dates consumed at age 10 and NPC. One study was conducted in China and included 128 cases and 174 controls (Yu et al., 1988). The other study took place in Hong Kong and included 250 cases and 250 controls (Yu et al., 1986). Both reported non-significant associations between dried red dates and NPC and provided no other details. 2.3 Pulses (legumes) Non-preserved pulses/legumes
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A2 Cohort studies (1) One cohort study reported the association between non-fermented pulses and NPC (Lin, 1997). A significant association (RR=7.2, 95% CI: 1.4-37.5) was observed for intake 6 or more times a week compared to intake less than twice a week when adjusting for age, EBV status, family history of NPC, and nasopharyngitis in the cohort of 9775 Chinese men in Taiwan. Non-preserved pulses/legumes A3 Case-control studies (2) In an Algerian study of 72 cases and 72 controls matched by age, sex, and area of residence, lentils consumed as baby food 3-7 times week was reported as a significant risk factor for NPC (OR=2.25, 95% CI: 1.0-5.0) when compared to consumption less than three times a week (Laouamri et al., 2001). In a second study by Ward et al, the associations between fresh soybean products consumed at various ages and NPC were evaluated among Chinese men and women in Taiwan (Ward et al., 2000). No significant association was reported for consumption during adulthood. At ages 10 and 3, fresh soybean consumption was reported as protective, but was only significant for age 10 (OR=0.4, 95% CI: 0.-1.0 and OR=0.7, 95% CI: .3-1.7, respectively). Neither consumption during weaning (OR=1.1, 95% CI: 0.5-1.2) or mother’s consumption during breastfeeding (OR=0.7, 95% CI: 0.3-1.6) was observed to be associated with NPC. Preserved soy/tofu: Adulthood consumption A3 Case-control studies (8) Eight case-control studies examined risks of NPC associated with exposure to preserved soy/tofu consumption during adulthood; however, only 3 provided enough detail for meta-analysis. The exposures included in this section were homogeneous in that all consisted of tofu/soy products that were not fresh. Most were fermented, but some others were salted, smelly, and moldy tofu/soy products. The studies were comparable in quality and only differed by the useable detailed information provided. None of the studies adequately controlled for other food intake that would allow evaluation of fermentation versus non-preservation of the same foods. Of the 8 studies in adults, 2 showed significant positive associations (Lee et al., 1994, Yuan et al., 2000b) and 1 showed non-significant positive associations (Zou, 1999), when the highest exposure was compared to the lowest. The remaining studies only indicated significant (Yu et al., 1989, Zheng et al., 1993) or non-significant (Ning et al., 1990, Ward et al., 2000, Yu et al., 1986, Yu et al., 1989) associations with NPC in the text without providing details. Preserved soy/tofu: Childhood consumption A3 Case-control studies (6) Six case-control studies examined risks of NPC associated with exposure to preserved soy/tofu consumption during childhood; however, only 3 provided enough detail for meta-analysis. Studies of childhood intake of fermented tofu/soy products in relation to NPC risk (Lee et al., 1994, Ning et al., 1990, Ward et al., 2000, Yu et al., 1988) indicated no significant increased risk for fermented soy/tofu products. In fact, analyses by (Ward et al., 2000) and (Ning et al., 1990) suggested odds ratios below one, but (Yu et al., 1988) suggested significantly increased risks from consumption of fermented soy bean products. Other preserved pulses/legumes A2 Cohort studies (1)
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One cohort study reported the association between fermented pulses and NPC (Lin, 1997). A significant association (RR=12.7, 95% CI: 2.2-72.3) was observed for intake 6 or more times a week compared to intake less than twice a week when adjusting for age, EBV status, family history of NPC, and nasopharyngitis in the cohort of 9775 Chinese men in Taiwan. A3 Case-control studies (3) This exposure consisted of salted black beans, fermented black bean paste, and fermented beans. Salted black beans were not associated with NPC when consumed during adulthood (OR=2.1, 95% CI: 0.8-5.4) or at age 10 (OR=1.0, 95% CI: 0.4-2.3) in a study of Chinese in Singapore (Lee et al., 1994). Yu et al reported a high risk for fermented black bean paste when consumed at ages 1-2 (OR=4.6, 95% CI: 1.8-11.4), but not when consumed at age 10 (OR=1.4, 95% CI: 0.6-3.1) in a study from China (Yu et al., 1988). When consumed more than 9 times a month, fermented beans were reported as a risk factor for NPC (OR=2.1, 95% CI: 1.3-3.4) in another study from China (Zou, 1999). 2.4 Nuts and Seeds Nuts and seeds: Adulthood consumption A3 Case-control studies (3) Three case-control studies reported on the association between adulthood consumption of nuts and seeds and the risk of NPC. One of these only mentioned in the text that the consumption of dried ginko seeds was not statistically significantly associated with NPC (Yuan et al., 2000b). Interpreting and rating this evidence is challenging without further detail. In a study that took place in Hong Kong (Geser et al., 1978), a strong protective association was noted with fennel seed consumption (OR 0.17; 95% CI 0.05-0.59) after adjusting for age and sex. In the same study, xantho-zylon seeds were not associated with NPC risk. In a study carried out in Algeria (Laouamri et al., 2001), a strong protective association was observed for the broad category of nuts and seeds (OR 0.33; p-value <0.05), and was adjusted for age, sex, and neighbourhood. Nuts and seeds: Childhood consumption A3 Case-control studies (2) Two case-control studies reported on the association between childhood consumption of nuts and seeds and the risk of NPC. Both of these studies were conducted in China. In one of these, the evidence presented was limited to mentioning in the text that the consumption of dried ginko seeds at age 10 years was not statistically significantly associated with NPC (Yu et al., 1988). In the other study, conducted in China, melon seed consumption between the ages of two and ten years was associated with increased NPC risk, with an OR of 2.8 (p-value 0.02), after adjusting for age, sex, area of residence, and sociodemographic score (Zheng et al., 1994b). 2.5 Meat, poultry, fish and eggs No results found. 2.5.1 Meat Preserved meat: Adulthood consumption A3 Case-control studies (7) Seven case control studies addressed the question of whether consumption of preserved meats in adults was associated with an increased risk of NPC; only 3 studies included enough information to be included in a meta-
34
analysis. One study was carried out in Algeria (Laouamri et al., 2001) and one in India (Chelleng et al., 2000) but the remaining five studies were conducted on Chinese populations in China (3), Singapore (Lee et al., 1994) or Taiwan (Ward et al., 2000). Two studies included children and teens in the age range of the subjects but others did not specify and none analyzed the data separately for children. With the exception of the studies of Zheng et al and Ning et al in China, all authors at least adjusted for age and sex in the analysis. All studies included only two categories or did not specify the categories with the exception of the study of Yuan et al in China that had three categories. Therefore, only that study was able to conduct a trend analysis to assess the presence of a possible dose response. All studies used a food frequency questionnaire that was study specific except for the Ward et al study in Taiwanese that used a dietary history questionnaire and the Chelleng et al study in India that did not specify the type of instrument used to assess food intake. The cases included in each of the studies ranged from 47 to 935. The types of exposures to specific preserved meats and the exposure periods varied for each study. Three of the studies found no significant association between consumption of any of the preserved meat products and occurrence of NPC. Ward et al found no significant risk associated with consumption of either cured or smoked meats adjusted for age, sex, and ethnicity when comparing Taiwanese subjects on a never/ever intake basis. The study of Zheng et al found no significant association between salted, dried and tinned meats as a group and NPC but this study did not specify any details on the exposure range used to test significance, the odds ratio or whether any of the data were adjusted for any potential confounding variables (Zheng et al., 1994b). Ning et al examined consumption of cured, smoked and salted meats separately and found no significant association with these foods and NPC (Ning et al., 1990). However, as in the previous study, the exposure range tested was not specified and there was no information regarding whether any of the analyses were adjusted for possible confounders. Four studies reported significant associations between exposure to preserved meats and NPC. Laouamri et al found a significant odds ratio of 4.75 associating consumption of dried or salted meat currently to 29 years ago after adjusting for age sex and area of residence. The Chelleng et al study of consumption of smoked meats in Indians reported an odds ratio of 10.8 based on a never/ever exposed classification and adjusted for multiple household environmental variables as well as tobacco and alcohol use. Yuan et al evaluated the risk associated with consumption of any preserved meat based on a frequency of consumption divided into 3 categories (Yuan et al., 2000b). The odds ratio was significant but low (1.77) as was the trend based on 935 cases and the data were adjusted for the usual variables as well as environmental factors and history of ear infection. The study of Lee et al evaluated the intake of rou gan and dried meat and found a significant association with NPC although the authors failed to provide any details such as the odds ratio. This is the only study that adjusted for other foods and vitamins as well as age, sex, ethnicity and education. The other foods for which the authors have adjusted may not actually be confounding factors or may be correlated with the dried meat intake. Preserved meat: Childhood consumption A3 Case-control studies (4) Four case control studies addressed risks of NPC from consumption of preserved meat in childhood. All studies included only Chinese subjects except for the study by Jeannel et al which was done in Tunisia (Jeannel et al., 1990a). All studies used food frequency questionnaires to determine exposures except for the Taiwan study that used a dietary history. All studies indicated no significant associations between consumption of preserved meats at various ages in childhood and the risk of NPC adjusted for age and sex and, for the Tunisian study only, area and lifestyle factors as well. The Ward et al study in Taiwanese examined the risks for children exposed according to cured or smoked meats at age 10 years, 3 years and at weaning (Ward et al., 2000). The odds ratios were all between 0.8 and 2.2 using an ever/never exposure range. The study of Lee et al in Singapore indicated no association between exposure to rou gan at age 10 and NPC with an odds ratio of 0.8 and a
35
borderline significant negative trend (p=0.08) using exposures at various frequencies per week and never consumed (Lee et al., 1994). The study by Ning et al examined exposures to cured, smoked or salted meats at age 10 and salted meats three years before cancer diagnosis and indicated non-significant associations for all measures without any further details (Ning et al., 1990). 2.5.1.1 Fresh Meat Fresh meat: Adulthood consumption A3 Case-control studies (4) Four case-control studies examined this exposure in China using study-specific food frequency questionnaires except for the study of Armstrong et al which evaluated exposure with a dietary history questionnaire. The three studies that examined consumption of fresh organ meats at any time prior to diagnosis and consumption of fresh meat and or fresh liver three years prior to diagnosis indicated no significant associations with these foods and NPC but provided no details regarding the conduct of the analysis (Ning et al., 1990, Yu et al., 1989, Yuan et al., 2000b). The study of Armstrong et al showed increased significant associations between NPC and both consumption of fresh liver at age 10 and 5 years prior to diagnosis as well as consumption of other pork/beef organs 5 years prior to diagnosis (Armstrong et al., 1998b). Exposures compared weekly consumption versus less than monthly and trend analysis for the liver consumption was also positive. None of the analyses were adjusted for any confounding variables. Fresh meat: Childhood consumption A3 Case-control studies (4) Four case-control studies examined the risks of NPC associated with childhood consumption of fresh meats. All studies but Armstrong et al used study-specific food frequency questionnaires and all showed no significant associations. The exposures included fresh meat at ages 10 and 1-2 and during weaning and one study specified consumption of fresh liver intake at age 10. None of the studies provided details of the analysis and all adjusted only for age and sex and sometimes area of residence (Ning et al., 1990, Yu et al., 1989, Yu et al., 1988). Only the Armstrong et al study reported a significant positive association with consumption of fresh liver at age 10 or 5 years before diagnosis but not with consumption of other organ meat at age 10 based on a dietary questionnaire (Armstrong et al., 1998b). The comparison of frequency of intake compared to less than monthly yielded a highly significant positive trend but the odds ratio of 2 was not adjusted for any potential confounding variables. 2.5.1.2 Processed meat Processed meat: Adulthood consumption A3 Case-control studies (5) Five case-control studies have examined the relationship of processed meats to the risk of NPC Three studies were done in Chinese in China or in Singapore, one in the Philippines (West et al., 1993) and one in the USA with unknown ethnicity of the subjects (Farrow et al., 1998). All of the studies had between 100 and 250 cases. Four of the studies reported no significant association of consumption of processed meat and the risk of NPC. The Farrow study in the USA found no association with all processed meats based on the NCI food frequency questionnaire and no trend after adjustment for age sex energy intake and alcohol and smoking. The Lee et al study using a study-specific food frequency questionnaire to identify exposure to Chinese sausage found no association or trend after adjustment for age and sex (Lee et al., 1994). The Yu et al study examined liver sausage intake for subjects at age 10 and three years before diagnosis using a food frequency questionnaire and
36
found no association after adjustment for age, sex and salted fish intake but with no details regarding the analysis (Yu et al., 1986). The West et al study of processed meats in general determined from an unspecified assessment instrument found a very low odds ratio of 0.46 based on tertiles of exposure that was of borderline significance when adjusted for the usual variables plus environmental factors, fish intake and herbal medicines. Only the study of Zou et al reported an association (odds ratio 1.8) between smoked processed meats and NPC without any adjustments for potential confounding variables (Zou, 1999).
Forest Plot for Highest vs. Lowest Analysis: Processed Meat, Case-control studies
Odds Ratio: Highest vs. Lowest intake
.05 1 3
Study
Effect size
(95% CI)
NAS00700 (Farrow, 1998) 1.54 ( 0.71, 3.33)
NAS01056 (Lee, 1994) 1.00 ( 0.33, 3.06)
NAS01153 (West, 1993) 0.46 ( 0.21, 1.03)
NAS06023 (Zou, 1999) 1.80 ( 1.09, 2.97)
Processed meat: Childhood consumption A3 Case-control studies (3) Three studies reporting results for processed meat during childhood examined types of sausage and observed no significant associations. The three studies were all done in China and used study-specific food frequency questionnaires to identify exposures. The number of cases in the studies ranged from 128 to 250. All studies adjusted at least for age and sex. All reported that the odds ratios were non-significant for any association but only the Lee et al study reported the actual odds ratio as 0.8 (Lee et al., 1994). Both the Lee et al and the Yu et al study reported the association between Chinese sausage and liver sausage respectively based on exposure at age 10 (Lee et al., 1994, Yu et al., 1988). The Yu et al study reported the association between liver sausage exposure at age 10 years and 3 years before diagnosis as reported under the adult consumption (Yu et al., 1986). 2.5.1.3 Red meat No results found. 2.5.1.3.1 Beef A3 Case-control studies (2) Two case-control studies reported on beef intake in relation to NPC. In a study in Malaysia in which 60 NPC cases were compared to 150 controls, the families of cases were less likely than the families of controls to eat beef with their meals (OR 0.4; p-value <0.05) (Armstrong, 1978, Zheng et al., 1994b).
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A5 Ecological studies (1) An ecologic study in China and Hong Kong also observed an inverse relationship between per capita beef consumption and the occurrence of NPC (Koo et al., 1997). 2.5.1.3.2 Pork Non-processed pork A5 Ecological studies (1) In an ecological study, per capita pork consumption was inversely correlated with NPC rates (Koo et al., 1997). Processed pork A3 Case-control studies (3) Three case-control studies, all implemented in China, reported on the association between processed pork consumption and NPC. The studies ranged in size from 128 cases/174 controls to 250 cases/250 controls, and all used study-specific food frequency questionnaires to measure the dietary exposure. None of the studies reported measures of association, but rather only whether the results were “statistically significant” or not. The one study to report a significant increased NPC risk was for the exposure of “salted pork” (Zheng et al., 1993). Consumption of salted pork or pork sausage at age 10 years or as an adult was reported to be not significantly associated with NPC risk in two other studies (Yu et al., 1986, Yu et al., 1988). 2.5.1.3.4 Organ Meats Non-processed organ meats: Adulthood consumption A3 Case-control studies (4) Of the four case-control studies to report on the association between adult consumption of organ meats and NPC, most have simply reported the findings as being not statistically significant without reporting detailed results (Ning et al., 1990, Yu et al., 1989, Yuan et al., 2000b). The lone exception was the study of Armstrong et al, in which NPC cases were significantly more likely than controls to have more frequently consumed pork/beef liver and other organs during adulthood (Armstrong et al., 1998b). Non-processed organ meats: Childhood consumption A3 Case-control studies (4) Four case-control studies reported on the association between childhood consumption of organ meats and NPC. Liver was specifically measured in all of these studies, and one study additionally measured “other fresh pork/beef organ.” For most of the studies, the results were simply reported as being not statistically significant without reporting detailed results (Ning et al., 1990, Yu et al., 1989, Yu et al., 1988)). The lone exception was the study of Armstrong et al, in which NPC cases were more likely than controls (highest-versus-lowest OR 1.98; 95% CI 0.97-4.05) to have more frequently consumed pork/beef liver and other organs at ten years of age (Armstrong et al., 1998b). Processed organ meats A3 Case-control studies (2)
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Two case-control studies reported on the consumption of processed organ meats during childhood in relation to NPC risk. Both of these studies were carried out by Yu and colleagues in China, and the exposure measured was liver sausage at ten years of age. The results for both studies were reported as being not statistically significant, but without further detail (Yu et al., 1986, Yu et al., 1988). 2.5.1.4 Poultry A3 Case-control studies (2) Two studies, both carried out in northern Africa, reported on the consumption chicken during childhood and NPC risk. After adjusting for age, sex, and area of residence, chicken intake as a baby food was inversely associated with NPC (OR 0.2; 95% CI 0.06-0.60) in a study in Algeria (Laouamri et al., 2001). In contrast to the findings in Algeria, findings from Tunisia indicated that chicken consumption during childhood was strongly associated with increased risk of NPC (OR 4.7) (Jeannel et al., 1990a). A5 Ecological studies (1) An ecologic study in China and Hong Kong observed per capita poultry consumption was inversely related to rates of NPC occurrence (Koo et al., 1997). 2.5.2 Fish (excluding salted fish) Non-preserved fish A3 Case-control studies (3) Three studies from China evaluated intake of fresh fish at varying ages in relation to NPC risk. None of the studies observed significant associations for any of the age groups analyzed. In the first study (Yu et al., 1989), no significant associations were observed among matched cases and controls for intake of fresh fish sauce during adulthood, at age 10, or at ages 1-2. A second study by Yu et al reported similar non-significant associations for fresh fish consumption at age 10, at ages 1-2 (p=0.23), and during weaning (p=0.09) (Yu et al., 1988). Likewise, the third study by Ning et al reported non-significant results for boiled fish consumption during adulthood and at age 10 (Ning et al., 1990). A5 Ecological studies (1) An ecological study of Chinese men and women in Hong Kong examined the association between per capita fish consumption and age-adjusted rates of NPC (Koo et al., 1997). Significant associations were observed for saltwater fish (r2= -0.83, p=0.039 for men and r2= -0.84, p=0.038 for women), but not for freshwater fish (r2= -0.70, p=0.124 for men and r2= -0.77, p=0.070 for women). 2.5.2.1 Salted Fish A2 Cohort studies (1) One cohort study reported on the association between salted fish intake and NPC (Zou, 1994). This study was carried out in Sihui County, Guangdong Province, China. The cohort for the analyses of adulthood consumption of salted fish was based on 505 individuals between the ages of 35-64 years who were followed-up for nine years. During follow-up, 17 cohort members were diagnosed with NPC. The investigators queried about salted fish intake during the decades of the 1960s, 1970s, and 1980s. The results were all unadjusted; no measures of association were presented, with only p-values reported in the text. The p-values comparing salted fish intake at least once per week compared to less frequent consumption were <0.001, 0.014, and 0.21 for consumption in the 1960s, 1970s, and 1980s, respectively. It is difficult to make strong inferences based on small number of NPC cases and the limited information presented, but the results of this cohort study document
39
the temporal association between salted fish intake and NPC risk and suggest that accounting for a longer latency period may strengthen the association between salted fish intake and NPC risk. Salted fish: Adulthood consumption A3 Case-control studies (21) A total of 21 case-control studies reported on the association between salted fish intake during adulthood and NPC. Nine of these studies reported data in sufficient detail to perform a dose-response meta-analysis. The results of the dose-response meta-analysis based on the number of times salted fish was consumed per week during adulthood showed evidence of a strong trend of increasing NPC risk as salted fish intake increased (summary random effects RR 1.28; 95% CI 1.13-1.44 per time/week). B2 Size of effect The magnitude of the summary RR (summary random effects RR 1.28; 95% CI 1.13-1.44 per time/week) observed in the dose-response meta-analyses indicates a strong dose-response association between salted fish intake and NPC. B3 Biological Gradient The dose-response analyses are compatible with a strong dose-response trend between salted fish consumption and NPC, with a summary random effect RRs of 1.28 (95% CI 1.13-1.44 per time/week). The results from all nine of the studies that contributed evidence to the meta-analysis were consistently in the direction of increased risk, with dose-response ORs ranging from 1.06 to 2.50 per time/week. There were three studies each with OR point estimates of 1.06 to 1.20, 1.21-1.50, and >1.50.
Dose-Response Graph: Salted fish intake during adulthood, Case-control studies
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B4 Internal Consistency/heterogeneity by dietary methodology In these studies, salted fish intake was measured using study specific FFQs or dietary history questionnaires, and was most often referred to as salted fish. All of the studies were hospital-based for case ascertainment. B5 Summary Illustrations of effects (e.g., forest plots)
Forest Plot for Dose-Response Analysis: Salted fish intake during adulthood, Case-control studies
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Odds Ratio, times/week .1 1 5
Study
Effect size
(95% CI) % Weight
NAS00577 (Shanghai China, Yuan, 2000) 1.73 ( 0.66, 4.52) 1.5
NAS01056 (Singapore, Lee, 1994) 1.17 ( 0.85, 1.61) 8.4
NAS01141 (Guangzhou China, Zheng, 1994) 2.50 ( 1.63, 3.85) 5.7
NAS01248 (Thailand, Sriamporn, 1992) 1.35 ( 1.06, 1.72) 11.1
NAS01459 (Guangzhou China, Yu, 1989) 1.10 ( 1.00, 1.21) 18.0
NAS01608 (Hong Kong, Yu, 1986) 1.31 ( 1.13, 1.51) 15.7
NAS06003 (S. Fujian China, Ye, 1995) 1.71 ( 1.08, 2.70) 5.2
NAS06010 (Fujian China, Cai, 1996) 1.06 ( 1.00, 1.12) 19.3
NAS06023 (Yangjiang China, Zou, 1999) 1.32 ( 1.13, 1.54) 15.2
Overall 1.28 ( 1.13, 1.44) 100.0
Forest Plot for Highest vs. Lowest Analysis: Salted fish intake during adulthood, Case-control studies
Odds Ratio: Highest vs. Lowest intake
.01 1 100
Study Effect size (95% CI)
NAS00531 (Taipei Taiwan, Ward, 2000) 0.80 ( 0.52, 1.24)
NAS00577 (Shanghai China, Yuan, 2000) 1.82 ( 0.86, 3.86)
NAS00749 (Selangor Malaysia, Armstrong, 1998) 4.22 ( 2.23, 7.99)
NAS01056 (Singapore, Lee, 1994) 4.40 ( 0.72, 26.76)
NAS01113 (Wuzhou China, Zheng, 1994) 4.07 ( 0.36, 45.80)
NAS01141 (Guangzhou China, Zheng, 1994) 17.20 ( 2.82, 104.79)
NAS01153 (Rizal Phillipines, West, 1993) 1.30 ( 0.67, 2.52)
NAS01248 (Northeast Thailand, Sriamporn, 1992) 2.50 ( 1.20, 5.20)
NAS01459 (Guangzhou China, Yu, 1989) 1.80 ( 0.90, 3.60)
NAS01608 (Hong Kong, Yu, 1986) 7.50 ( 0.88, 63.89)
NAS01922 (Tianjin City China, Ning, 1990) 2.20 ( 1.30, 3.71)
NAS06003 (South Fujian China, Ye, 1995) 5.00 ( 1.27, 19.72)
NAS06009 (Minan Fujian China, Ye, 1995) 2.00 ( 0.88, 4.56)
NAS06010 (Fujian China, Cai, 1996) 1.32 ( 0.98, 1.77)
NAS06021 (Guangxi China, Chen, 1994) 5.51 ( 1.74, 17.44)
NAS06022 (Heilongjiang China, Wang, 1993) 8.99 ( 1.60, 50.44)
NAS06023 (Yangjiang China, Zou, 1999) 3.07 ( 1.66, 5.69)
B6 Gene-nutrient interactions Does not apply.
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C Assessment of heterogeneity within and between study types Within the case-control dose-response meta-analysis, statistically significant heterogeneity was detected, with an I2 statistics of 75%. Inspection of the data reveals that the heterogeneity present relates to the magnitude of the dose-response gradient, not heterogeneity with respect to the presence of a dose-response trend. The results for all nine studies supported the presence of a positive dose-response trend. The source of the heterogeneity may relate to the fact that the two studies with the largest weights also observed the weakest dose-response trends, whereas studies with the smallest weights in the meta-analysis tended to observe strong dose-response trends. D. Factors influencing heterogeneity and meta-regression A factor that could contribute to the variability in the observed magnitude of associations is between-region differences in specific methods of salted fish preparation, and possibly with the type of fish consumed. This could potentially lead to differences in the risk associated with salted fish consumption but this is difficult to rigorously assess with so few studies, leaving an insufficient number of studies per region to analyze separately. E. Important quality issues for interpretation of the evidence The dose-response meta-analyses for case-control evidence for the association between salted fish intake and NPC yielded results compatible with a strong increased risk associated with salted fish intake. An important consideration is the potential confounding factors that have been accounted for in these studies. All nine of these studies included adjustments for at least age and sex, and the majority also controlled for neighborhood of residence. Other factors considered included cigarette smoking (3 studies), alcohol drinking (2 studies), and exposure to other environmental exposures (2 studies). Importantly, other dietary factors were rarely taken into consideration (1 study adjusted for consumption of fermented soy). The absence of information on EBV infection status is particularly notable. The limited extent to which potential confounding variables have been controlled for is thus an important issue affecting the quality of the overall evidence. Seventeen of the case-control studies could be included in highest-versus-lowest categories comparison. The results of this data summary strongly reinforce the evidence suggesting salted fish intake increases the risk of NPC. Of the 17 studies, only one reported an odds ratio of less than unity, whereas four studies reported odds ratios between 1.33 and 1.99, four studies reported odds ratios between 2.0 and 4.0, and in 8 studies odds ratios of greater than 4.0 were observed. Four of the 21 case-control studies that reported information concerning the association between adulthood consumption of salted fish and NPC did not present sufficient data to be included in any of the quantitative data summaries. In a case-control study of 205 NPC cases and 205 controls carried out in China, Zheng et al reported in the text that cases were “significantly” more likely to have the highest salted fish consumption, without reporting a p-value or measure of association (Zheng et al.). In a study in Malaysia comprised of 100 NPC cases and 100 controls, the case-control difference in current salted fish consumption in adults was reported to be not statistically significantly different (Armstrong et al., 1983a). No measure of association or p-value was reported, but the comparison was adjusted for age, sex, area of residence, and ethnicity. Similar results to this were reported in a case-control study conducted in the U.S. (n=156 cases, n=267 controls) (Henderson, 1976). In a much larger study carried out in Taiwan, a comparison of the consumption of moldy and firm salted fish was reported to be not statistically significantly different between 502 NPC cases and 1942 controls (Yang, 2005). Because only minimal information about the results were presented, it is difficult to compare these four studies to those that presented more thorough descriptions of the results. With this caveat, the results of these four studies appear to be less supportive of an association than studies included in the quantitative synthesis of the evidence.
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In summary, the case-control evidence is clear and consistent in suggesting that salted fish intake is associated with increased NPC risk. The evidence to specifically pinpoint the observed risks to salted fish would be more convincing if potential confounding factors had been more completely accounted for.
Funnel Plot for Dose-Response Analysis: Salted fish intake during adulthood, Case-control studies
Begg's funnel plot with pseudo 95% confidence limits
logR
s.e. of: logR0 .2 .4 .6
-1
-.5
0
.5
1
Funnel Plot for Highest vs. Lowest Analysis: Salted fish intake during adulthood, Case-control studies
Begg's funnel plot with pseudo 95% confidence limits
logR
s.e. of: logR0 .5 1 1.5
-2
0
2
4
F. Mechanisms and animal experimental data More studies have examined the role of nitrosamines and nitrites in salted fish as essential agents for transformation of NPC precursor tissues. Evidence suggests that high intake of nitrate and nitrosamine from salted fish account for some of this increased risk of NPC development. Nitrosamines are known mutagens and animal carcinogens that induce gene mutation through the formation of DNA adducts which if not repaired may lead to point mutations. The N-nitrosamines are a large group of compounds with a common carcinogenic mechanism (Goldman et al., 2003). Salted fish has been shown to contain N-dimethylnitrosamine, N-diethylnitrosamine, N-nitrosopyrrolidene and N-nitrosopiperidine (Zou et al., 1992, Zou et al., 1994). Levels of these compounds were highest in salted fish from areas with the highest NPC mortality, while lower in areas
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with lower NPC mortality (Zou et al., 1992, Zou et al., 1994). Exposure of the nasopharynx to these agents may be particularly damaging in that the carcinogenic properties of nitrosamines are greatest following oral administration. In addition, the variation in nitrosamine content of salted fish may contribute to heterogeneity in assigning risk to salted fish consumption in different geographic locations.
Alkylating agents including nitrosamines produce DNA adducts, specifically 7-methylguanine and O6-methylguanine. The O6-methylguanine is mostly responsible for the mutagenicity and carcinogenicity of these alkylating agents (Goldman et al., 2003). Unfortunately, the genes targeted for mutational alteration in NPC have to a large degree not been identified, which does not allow a definitive association of nitrosamine exposure to tumor suppressor or oncogene mutation. Among the commonly mutated genes in other types of tumors, no reports describe mutation of k-ras and studies of mutation of the retinoblastoma gene(Lin et al., 1992, Sun et al., 1993) and p16/ CDKN2a (Lo et al., 1995, Sun et al., 1995)have all been negative. The most extensively studied gene in NPC for mutational alterations is p53, also the most commonly mutated gene in other malignancies. Ten published studies in the last 12 years have reported mutation of p53 ranging from 0-27% of NPC tumors studied (Burgos, 2003, Chakrani et al., 1995, Effert et al., 1992, Lo et al., 1992, Lung et al., 1998, Nasrin et al., 1994, Spruck et al., 1992, Sun et al., 1992, Van Tornout et al., 1997, Xie et al., 1997), with the 27% result in a study of only 11 tumors(Lung et al., 1998). Overall, 18 of 282 tumors have been found to contain p53 mutations (overall percentage 6%), suggesting that mutations in p53 are not common and do not provide a connection between nitrosamines and the progression of NPC. However, in at least one study (Van Tornout et al., 1997), all 4 of the mutations detected were GC>AT, of particular mechanistic importance for alkylating agents.
The O6-methylguanine leads to GC->AT transitions in cell-culture and animal models if not repaired by O6-methylguanine methyltransferase (MGMT), and as described above, this lesion is produced by alkylating agents. MGMT has been shown to be altered in NPC, although through epigenetic changes, rather than mutational inactivation. Hypermethyaltion of the promoter region of MGMT silences expression of this gene in many cancers (Esteller et al., 1999) which has been reported in 20-28% of nasopharyngeal cancer (Kwong et al., 2002, Wong et al., 2003). Inactivation of MGMT has been shown to be associated with the type of p53 mutations described above in lung and colon cancer(Esteller et al., 2001, Wolf et al., 2001), but due to the infrequent mutations in NPC has not been studied . As noted above, LMP-1 produced by EBV reactivation may also reduce DNA repair capacity, compounding the mutagenic effects of nitrosamine compounds.
Additional support for the importance of nitrosamines in the carcinogenic process of NPC is provided by studies examining the cytochrome p450 enzyme CYP2E1. N-nitrosodimethylamine undergoes enzymatic hydroxylation catalyzed mainly by CYP2E1, a step in the activation of carcinogenic adducts (Goldman et al., 2003). CYP2E1 is expressed in the nasopharynx and in NPC tumors(He et al., 2002). Increased activity of this enzyme would then result in increased activation of pro-carcinogens. A genetic polymorphism in the 5'-flanking region of the human CYP2E1, the C2 allele, affects binding of trans-acting factor to the promoter(Hayashi et al., 1991), This sequence change affects transcriptional regulation, resulting in up to 10-fold differences in promoter activity of the CYP2E1 gene(Hayashi et al., 1991). Studies have demonstrated an increased risk of developing NPC in patients with this variant form(Hildesheim et al., 1997a, Hildesheim et al., 1995, Kongruttanachok et al., 2001), (relative risks of 2-2.5, higher in non-smokers), consistent with the increased formation of carcinogenic nitrosamines from salted fish for those individuals. These studies suggest genetic modifiers of environmental exposure contribute to the risks inherent in consumption of salted fish. Such genetic variation may contribute to the heterogeneity in studies examining risk of NPC following salted fish consumption. Salted fish: Childhood consumption (Age 10) A3 Case-control studies (16)
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A total of 16 case-control studies reported on the association between salted fish intake at approximately 10 years of age and NPC. Nine of these studies reported data in sufficient detail to be included in a dose-response meta-analysis. The results of the dose-response meta-analysis based on the number of times salted fish was consumed per week when 10 years-old showed evidence of a strong trend of increasing NPC risk as salted fish intake increased (summary random effects RR 1.35; 95% CI 1.14-1.60 per time/week). B2 Size of effect The magnitude of the summary RR (summary random effects RR 1.35; 95% CI 1.14-1.60 per time/week) observed in the dose-response meta-analyses indicates a strong dose-response association between salted fish intake at age 10 years and NPC. B3 Biological Gradient The dose-response analyses are compatible with a strong dose-response trend between salted fish consumption and NPC, with a summary random effect RR of 1.35 (95% CI 1.14-1.60 per time/week). The results from eight of the nine studies that contributed evidence to the meta-analysis were in the direction of increased risk, with dose-response ORs ranging from 0.97 to 1.75 per time/week. There were three studies with OR point estimates of 1.10 to 1.20, one study with an OR between 1.21-1.50, and four studies with ORs between 1.51 and 1.75.
Dose-Response Graph: Salted fish intake at age 10, Case-control studies
46
B4 Internal Consistency/heterogeneity by dietary methodology In these studies, salted fish intake was measured using study specific FFQs or dietary history questionnaires. All of the studies were hospital-based for case ascertainment. B5 Summary Illustrations of effects (e.g., forest plots)
Forest Plot for Dose-Response Analysis: Salted fish intake at age 10, Case-control studies
47
Odds Ratio, times/week .1 1 3
Study
Effect size
(95% CI) % Weight
NAS01056 (Singapore, Lee, 1994) 0.97 ( 0.77, 1.22) 11.9
NAS01113 (Wuzhou China, Zheng, 1994) 1.19 ( 0.86, 1.64) 9.9
NAS01141 (Guangzhou China, Zheng, 1994) 1.75 ( 1.47, 2.08) 13.2
NAS01459 (Guangzhou China, Yu, 1989) 1.10 ( 1.03, 1.18) 14.9
NAS01520 (Yulin Guangxi China, Yu, 1988) 1.43 ( 0.71, 2.89) 4.2
NAS01608 (Hong Kong, Yu, 1986) 1.74 ( 1.40, 2.16) 12.2
NAS01712 (Selangor Malaysia, Armstrong, 1983) 1.51 ( 1.17, 1.96) 11.3
NAS01922 (Tianjin City China, Ning, 1990) 1.55 ( 1.18, 2.04) 11.0
NAS05679 (Taiwan, Yang, 2005) 1.18 ( 0.91, 1.53) 11.3
Overall 1.35 ( 1.14, 1.60) 100.0
Forest Plot for Highest vs. Lowest Analysis: Salted fish intake at age 10, Case-control studies
Odds Ratio: Highest vs. Lowest intake
.01 1 100
Study
Effect size
(95% CI)
NAS00531 (Taipei Taiwan, Ward, 2000) 1.50 ( 0.80, 2.81)
NAS00749 (Selangor Malaysia, Armstrong, 1998) 2.74 ( 1.59, 4.73)
NAS00821 (Taiwan, Hildesheim, 1997) 1.40 ( 0.45, 4.33)
NAS01056 (Singapore, Lee, 1994) 0.80 ( 0.21, 3.05)
NAS01113 (Wuzhou China, Zheng, 1994) 1.30 ( 0.80, 2.12)
NAS01141 (Guangzhou China, Zheng, 1994) 10.10 ( 5.07, 20.13)
NAS01459 (Guangzhou China, Yu, 1989) 2.10 ( 1.21, 3.64)
NAS01520 (Yulin Guangxi China, Yu, 1988) 1.50 ( 0.51, 4.40)
NAS01608 (Hong Kong, Yu, 1986) 37.70 ( 14.12, 100.65)
NAS01712 (Selangor Malaysia, Armstrong, 1983) 17.40 ( 2.71, 111.55)
NAS01766 (Alaska US, Lanier, 1980) 4.00 ( 0.57, 28.06)
NAS01922 (Tianjin City China, Ning, 1990) 6.70 ( 2.18, 20.56)
NAS05679 (Taiwan, Yang, 2005) 1.78 ( 0.82, 3.88)
NAS06020 (Heilongjiang China, Na, 1988) 5.50 ( 0.99, 30.62)
B6 Gene-nutrient interactions Does not apply. C Assessment of heterogeneity within and between study types
48
Within the case-control dose-response meta-analysis, statistically significant heterogeneity was detected, with an I2 statistics of 83%. The presence of a dose-response trend was observed so consistently that the heterogeneity present relates primarily to the magnitude of the dose-response gradient, not with respect to the presence or absence of a dose-response trend. The results for eight of nine studies supported the presence of a positive dose-response trend. The relative weights that the studied contributed to the meta-analyses were mostly evenly distributed across many studies. A key source of the heterogeneity may be due to the study in Singapore of Lee et al (Lee et al., 1994), the one study in which a dose-response trend was completely absent. The fact that this was one of the few studies not conducted in China may also be relevant. D. Factors influencing heterogeneity and meta-regression A factor that could contribute to the variability in the observed magnitude of associations is between-region differences in specific methods of salted fish preparation, and possibly with the type of fish consumed. This could potentially lead to differences in the risk associated with salted fish consumption but this is difficult to rigorously assess with so few studies, leaving an insufficient number of studies per region to analyze separately. The one study in which a positive dose-response relationship was absent was a study conducted in Singapore (Lee et al., 1994), one of only two studies included in the dose-response meta-analysis that took place outside of China. E. Important quality issues for interpretation of the evidence The dose-response meta-analyses of case-control studies to assess the association between salted fish intake at age 10 years and NPC yielded results indicating that NPC risk increases markedly with greater intake of salted fish. Clearly, the potential role that confounding factors may be contributing to this statistical association is a key consideration in interpreting this body of evidence. All nine of these studies included adjustments for at least age and sex, and five also further controlled for neighborhood of residence. Other factors considered included indicators of socioeconomic status (2 studies). Importantly, cigarette smoking, alcohol drinking, and dietary factors were not taken into consideration in any of these studies. The absence of information on EBV infection status is particularly notable. The limited extent to which potential confounding variables have been controlled for is thus an important issue affecting the quality of the overall evidence. Another important issue related to quality of the evidence is the remote recall of diet, usually by the mother of the study participant. While the accuracy of reporting may be questionable, the main issue is the degree to which accuracy of reporting may differ by case-control status to introduce a bias. The consistency of the findings across studies conducted by different investigators in different locations suggests either this is unlikely to explain the findings or that the information bias is ubiquitous across studies. The former explanation seems more likely. Fourteen of the case-control studies could be included in highest-versus-lowest categories comparison. The results of this data summary strongly reinforce the evidence suggesting that salted fish intake at 10 years of age increases the risk of NPC. Of the 14 studies, only one reported an odds ratio of less than unity, whereas five studies reported odds ratios between 1.40 and 1.99, three studies reported odds ratios between 2.0 and 4.0, and in 5 studies odds ratios of greater than 4.0 were observed. Two of the 16 case-control studies that reported information concerning the association between childhood consumption of salted fish and NPC did not present sufficient data to be included in any of the quantitative data summaries. In a case-control study of 205 NPC cases and 205 controls carried out in China, Zheng et al reported in the text that cases were “significantly” more likely to have the highest salted fish consumption at age 10 years, without reporting a p-value or measure of association (Zheng et al., 1993). In a study in Malaysia comprised of 100 NPC cases and 100 controls, the case-control difference in current salted fish consumption in
49
children was reported to be statistically significantly different (Armstrong et al., 1983a). This comparison was adjusted for age, sex, area of residence, and ethnicity. In summary, the case-control evidence is clear and consistent in suggesting that salted fish intake in 10-year-old children is associated with increased NPC risk. The evidence to specifically pinpoint the observed risks to salted fish would be more convincing if potential confounding factors had been more completely accounted for.
Funnel Plot for Dose-Response Analysis: Salted fish intake at age 10, Case-control studies
Begg's funnel plot with pseudo 95% confidence limits
logR
s.e. of: logR0 .2 .4
-.5
0
.5
1
Funnel Plot for Highest vs. Lowest Analysis: Salted fish intake at age 10, Case-control studies
Begg's funnel plot with pseudo 95% confidence limits
logR
s.e. of: logR0 .5 1
-2
0
2
4
Salted fish: Childhood consumption (Ages 0-3) A3 Case-control studies (10) A total of 10 case-control studies reported on the association between salted fish intake at during 0-3 years of age and NPC. Five of these studies reported data in sufficient detail to be included in a dose-response meta-
50
analysis. The results of the dose-response meta-analysis based on the number of times salted fish was consumed per week when 0-3 years old showed evidence of a strong trend of increasing NPC risk as salted fish intake increased (summary random effects RR 1.42; 95% CI 1.11-1.81 per time/week). B2 Size of effect The magnitude of the summary RR (summary random effects RR 1.42; 95% CI 1.11-1.81 per time/week) observed in the dose-response meta-analyses indicates a strong dose-response association between salted fish intake at ages 0-3 years and NPC. B3 Biological Gradient The dose-response analyses are compatible with a strong dose-response trend between salted fish consumption and NPC, with a summary random effect RR of 1.42(95% CI 1.11-1.81 per time/week). The results from all five of the studies that contributed evidence to the meta-analysis were in the direction of increased risk, with dose-response ORs ranging from 1.21 to 1.84 per time/week. Four studies had OR point estimates of 1.21 to 1.21, with one study of relatively high influence reporting an OR of 1.84.
Dose-Response Graph: Salted fish intake at ages 0-3, Case-control studies
B4 Internal Consistency/heterogeneity by dietary methodology
51
In these studies, salted fish intake was measured using study specific FFQs or dietary history questionnaires. All of the studies were hospital-based for case ascertainment. B5 Summary Illustrations of effects (e.g., forest plots)
Forest Plot for Dose-Response Analysis: Salted fish intake at ages 0-3, Case-control studies
Odds Ratio, times/week
.05 1 4
Study
Effect size
(95% CI) % Weight
NAS01056 (Singapore, Lee, 1994) 1.21 ( 0.36, 4.08) 3.7
NAS01113 (Wuzhou China, Zheng, 1994) 1.30 ( 0.80, 2.10) 15.2
NAS01141 (Guangzhou China, Zheng, 1994) 1.84 ( 1.56, 2.17) 31.6
NAS01459 (Guangzhou China, Yu, 1989) 1.21 ( 1.01, 1.46) 30.5
NAS01520 (Yulin Guangxi China, Yu, 1988) 1.31 ( 0.88, 1.93) 19.0
Overall 1.42 ( 1.11, 1.81) 100.0
Forest Plot for Highest vs. Lowest Analysis: Salted fish intake at ages 0-3, Case-control studies
Odds Ratio: Highest vs. Lowest intake
.01 1 60
Study
Effect size
(95% CI)
NAS00531 (Taipei Taiwan, Ward, 2000) 1.00 ( 0.49, 2.05)
NAS01056 (Singapore, Lee, 1994) 1.20 ( 0.36, 4.04)
NAS01113 (Wuzhou China, Zheng, 1994) 1.30 ( 0.80, 2.12)
NAS01141 (Guangzhou China, Zheng, 1994) 12.90 ( 6.48, 25.67)
NAS01459 (Guangzhou China, Yu, 1989) 2.00 ( 1.11, 3.61)
NAS01520 (Yulin Guangxi China, Yu, 1988) 2.20 ( 0.67, 7.24)
NAS01608 (Hong Kong, Yu, 1986) 20.20 ( 6.79, 60.06)
NAS01812 (Hong Kong, Geser, 1978) 2.60 ( 1.26, 5.37)
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B6 Gene-nutrient interactions Does not apply. C Assessment of heterogeneity within and between study types Within the case-control dose-response meta-analysis, statistically significant heterogeneity was detected, with an I2 statistics of 66%. The presence of a dose-response trend was observed so consistently in all five studies that the heterogeneity present relates primarily to the magnitude of the dose-response gradient, not with respect to the presence or absence of a dose-response trend. D. Factors influencing heterogeneity and meta-regression The only study that exhibited any variation from the narrow range of dose-response associations observed was the steeper dose-response gradient observed in a study conducted in Guangzhou, China (Zheng et al., 1994a). However, another study from this same region also reported findings that were more in keeping with the findings of others (Yu et al., 1989), suggesting that the heterogeneity is not due to regional variation in preservation techniques. E. Important quality issues for interpretation of the evidence The dose-response meta-analyses of case-control studies to assess the association between salted fish intake at ages 0-3 years and NPC yielded results indicating that NPC risk increases markedly with greater intake of salted fish. Clearly, the potential role that confounding factors may be contributing to this statistical association is a key consideration in interpreting this body of evidence. All five of these studies included adjustments for at least age and sex, and three also further controlled for neighborhood of residence. Other factors considered included indicators of socioeconomic status (2 studies). Importantly, cigarette smoking, alcohol drinking, and dietary factors were not taken into consideration in any of these studies. The absence of information on EBV infection status is particularly notable. The limited extent to which potential confounding variables have been controlled for is thus an important issue affecting the quality of the overall evidence. Another important issue related to quality of the evidence is the remote recall of diet, usually by the mother of the study participant. While the accuracy of reporting may be questionable, the main issue is the degree to which accuracy of reporting may differ by case-control status to introduce a bias. The consistency of the findings across studies conducted by different investigators in different locations suggests either this is unlikely to explain the findings or that the information bias is ubiquitous across studies. The former explanation seems more likely. Eight of the case-control studies could be included in highest-versus-lowest categories comparison. The results of this data summary strongly reinforce the evidence suggesting that salted fish intake at 0-3 years of age increases the risk of NPC. Of the eight studies, only one reported an odds ratio of unity, one study reported an odds ratio of 1.20, another 1.30, with the remaining five studies reporting odds ratios of 2.0 or greater. Two of the ten case-control studies that reported information concerning the association between early childhood consumption (0-3 years of age) of salted fish and NPC did not present sufficient data to be included in any of the quantitative data summaries. In a case-control study of 205 NPC cases and 205 controls carried out in China, Zheng et al reported in the text that cases were “significantly” more likely to have the highest salted fish consumption at ages 0-3 years, without reporting a p-value or measure of association (Zheng et al., 1993). Jeannel and colleagues specifically examined consumption of salted anchovies during weaning in a case-control study of 80 NPC cases and 160 controls in Tunisia (Jeannel et al., 1990a). The reported odds ratio was 1.5 with a p-value of 0.5. The results were adjusted for age, sex, area of residence, and living condition score. Thus, the studies not included in the quantitative syntheses of the evidence also tend support the findings observed in the meta-analyses.
53
In summary, the case-control evidence is clear and consistent in suggesting that salted fish intake in children ages 0 to 3 years is associated with increased NPC risk. The evidence to specifically pinpoint the observed risks to salted fish would be more convincing if potential confounding factors had been more completely accounted for.
Funnel Plot for Dose-Response Analysis: Salted fish intake at ages 0-3, Case-control studies
Begg's funnel plot with pseudo 95% confidence limits
logR
s.e. of: logR0 .2 .4 .6
-1
0
1
2
Funnel Plot for Highest vs. Lowest Analysis: Salted fish intake at ages 0-3, Case-control studies
Begg's funnel plot with pseudo 95% confidence limits
logR
s.e. of: logR0 .2 .4 .6
-1
0
1
2
3
Salted fish: Mother’s consumption during pregnancy or breastfeeding A3 Case-control studies (3) Three case-control studies reported on the relationship between NPC and mother’s consumption of salted fish during pregnancy or while breastfeeding. Two of these studies were carried out in China, and the other took place in Singapore among individuals of Chinese ethnicity. Both of the studies conducted in China were carried out by Yu and colleagues. In the first of these studies, comparing 128 NPC cases with 174 controls, Yu and
54
colleagues observed that both consumption of salted fish during pregnancy and during nursing were associated with increased subsequent risk of NPC in the offspring (Yu et al., 1988). The odds ratios for these associations were consistent with a greater than three-fold increased risk with 95% confidence intervals that did not overlap unity after adjusting for age and sex. These results were corroborated in the second of the studies carried out in China, also by Yu and colleagues (Yu et al., 1989), in which the odds ratios for these associations were consistent with a greater than two-fold increased risk with 95% confidence intervals that did not overlap unity after adjusting for age, sex, and neighborhood. These results were based on a comparison of 306 NPC cases with 306 controls. In the study conducted in Singapore by Lee and colleagues, 49 NPC cases were compared to 96 controls, and the results were adjusted for age, sex, ethnicity, and education (Lee et al., 1994). Due to the smaller sample size, among other factors, the 95% confidence intervals were quite wide, but the point estimates of the odds ratios for maternal salted fish consumption during pregnancy (1.3) and during breastfeeding (2.0) were again in the direction of increased risk, although the associations were weaker than in the studies conducted in China.
The results of these three studies thus provide evidence that maternal salted fish consumption during pregnancy and breastfeeding is statistically associated with subsequent risk of NPC in offspring. Prominent among the many factors that have not been accounted for in these studies is whether this observed association is due this measured exposure simply because it is a marker of subsequent salted fish consumption by the index youth. 2.5.2.2 Other preserved fish (excluding salted fish) A2 Cohort studies (1) A cohort study of 505 men and women from China reported unadjusted associations for salted and dried fish consumption during different decades and NPC (Zou, 1994). Any consumption during the 1960’s, 1970’s, or 1980’s was reported as significantly associated when compared to no consumption (p<0.001 for all decades). A3 Case-control studies (5) Five case-control studies contributed evidence concerning intake of non-salted fish and NPC. A meta-analysis was not feasible, however, because several of these studies only reported non-significant associations in the text without details (Ning et al., 1990, Yu et al., 1989, Yu et al., 1988). In a study by Lee et al, risks for various types of preserved fish were examined for different age groupings (Lee et al., 1994). Their only significant finding was for dried, unsalted fish consumed at age 10 (OR=0.1, 95% CI: 0.01-1.0). Other exposures they investigated included dried, tiny fish; dried, tiny fish soup; preserved cuttlefish; preserved fish tidbits; and fish gravy, but none were observed to be significantly associated with NPC at any age group. Intake of fermented fish sauce at different ages was evaluated in a Chinese study by Yu et al (1989). Although no estimates of risk were provided, no significance was reported for highest-versus-lowest analyses or over trends at any age of intake. Likewise, Yu et al (1988) reported no significant association for the consumption of fermented fish paste at age 10. In the same Chinese study by Yu et al (1988), dried fish was observed to be a significant risk factor when consumed at age 10 (OR=6.4, 95% CI: 1.6-26.8), but not at ages 1-2 (OR=2.2, 95% CI: 0.9-5.3). Dried anchovies, consumed during adulthood or at age 10, were not associated with NPC in another Chinese study by Ning et al. The fifth study by Armstrong et al examined the relationship between dried fish consumed during meals and NPC among Chinese in Malaysia (Armstrong, 1978). A significant association was reported when dried fish was consumed at breakfast, but no direction or estimate of risk was offered. When consumed in 3 daily meals, no association between dried fish and NPC was observed. 2.5.3 Shellfish and other seafood Non-preserved seafood
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A3 Case-control studies (4) Four case-control studies examined the association between shellfish and the risk of NPC. All studies included only persons of Chinese background. Two studies were done in China and used study-specific food frequency questionnaires. These studies included 100 cases (Ning et al., 1990) and 935 cases (Yuan et al., 2000b). Both of these studies reported no significant association of the cancer with exposures to fresh seafood generally (Yuan et al., 2000b) and crab or fresh jellyfish consumed at age 10 and in the three years prior to diagnoses in separate analyses. No details were given regarding the analyses. Both studies of Armstrong et al were done in Malaysia and used a dietary history questionnaire or recall. The early study found a protective effect associated with the family eating prawns at the evening meal or any meal with a significant odds ratio of 0.7 with adjustment for age, sex, race, SES, residence and lifestyle factors (Armstrong, 1978). The later study examined the risks associated with consumption of shrimp at age 10 as well as five years prior to diagnosis and a lifetime exposure (Armstrong et al., 1998b). Only the unadjusted odds ratio for consumption of shrimp at age 10 showed a significantly low association although the lifetime exposure adjusted for SES as well as other food intakes had a borderline significant negative association with an odds ratio of 0.83 (p=.082). Preserved seafood: Adulthood consumption A3 Case-control studies (5) Five case-control studies examined the association between NPC and consumption of different forms of preserved seafood; however only 3 provided sufficient information to be included in a meta-analysis. All studies evaluated exposures through the use of study-specific food frequency questionnaires. All studies included Chinese cases and controls. None of the studies showed significant odds ratios or trends with the different foods although all that reported odds ratios were in the positive direction. Yuan et al examined the association of intake of salted food pastes using 935 controls and found a non-significant association (odds ratio 1.44 p=0.07) after adjustment for age, sex, education and other lifestyle and environmental factors (Yuan et al., 2000b). Lee et al studied the association between dried oysters and dried prawns and found no significant association after adjustment for basic variables (Lee et al., 1994). Yu et al studied the association of consumption of salted fish paste at 3 years prior to diagnosis and at an unknown time and found no association after adjustment for basic variables as well as other suspect foods (Yu et al., 1989). The earlier study of Yu et al examined the risks of eating dried shrimp both in childhood and 3 years prior to diagnosis and found no association after adjustment for possible confounding variables (Yu et al., 1986). Ning et al studied the intake of salted shrimp paste as well as dried shrimp and found no significant associations in the adjusted odds ratios (Ning et al., 1990). Preserved seafood: Childhood consumption A3 Case-control studies (5) Four of the studies investigating adult consumption and one additional study by Yu et al examined the risks of NPC associated with eating of preserved foods in childhood. Only 2 studies provided sufficient data for a meta-analysis. All studies examined exposure through the use of a study-specific food frequency questionnaire. All of the studies adjusted for at least age and sex in some of the analyses. With the exception of salted shrimp paste, all other exposures examined showed no association with NPC and exposure in childhood. Lee et al examined consumption of dried prawns and dried oysters and found no association with exposure at age 10 to either food (Lee et al., 1994). Yu 1988 and 1986 and Ning et al examined the risks associated with consumption fermented crab or shrimp pastes at age 10 as well as dried shrimp at age 10 and combined with adult exposure and found no association even after adjustment for basic variables (Ning et al., 1990, Yu et al., 1986, Yu et al., 1988). However, when Yu 1989 and Ning et al examined the risks of NPC associated with the consumption of salted shrimp paste at age 10 both authors reported a significant association either as a trend (Yu et al., 1989) or
56
as an odds ratio (OR = 3.2 p=0.007) with adjustments for not only the basic variables but for others such as salted fish consumption. Yu 1989 also reported a borderline significant trend (0.07) for this exposure at the ages of 1-2 years in children. 2.5.4. Eggs Non-preserved eggs A3 Case-control studies (4) Four studies examined the risks of NPC associated with consumption of fresh eggs at different ages in Chinese from China (three studies) and Malaysia (Armstrong, 1978). All studies used a study-specific food frequency questionnaire except for Armstrong et al who measured exposures through recall. All studies adjusted for the basic variables of age and sex for at least some of the analyses with the exception of Yuan et al. None of the studies showed an association with exposure to fresh eggs at any age (Yuan et al., 2000b) or three years before diagnosis (Yu et al., 1989), at age 10 years, at 1-2 years (Yu et al., 1989, Yu et al., 1988), or at weaning (Yu et al., 1988) with the exception of the Armstrong et al study that indicated a significant negative association for consumption of eggs by the family at evening meals. However, the same study showed no association with family consumption of eggs at other meals. A5 Ecological studies (1) In a study by Koo et al, per capita consumption of eggs in Hong Kong was analyzed in relation to NPC (Koo et al., 1997). No significant associations were reported for men (r2= -0.42, p=0.405) or women (r2= -0.14, p=0.796). Salted eggs: Adulthood consumption A3 Case-control studies (5) Five case–control studies examined the risk of NPC associated with the consumption of salted eggs with conflicting results; however, only 3 provided the necessary data for a meta-analysis. All studies were conducted in Chinese but the Armstrong studies were done in Malaysia and the others in China. Lee et al and Ning et al used a food frequency questionnaire and examined either the intake of unspecified salted eggs in adulthood or intake of specific chicken or duck eggs three years before diagnosis and found no significant association (Lee et al., 1994, Ning et al., 1990). Armstrong et al examined the risk of family consumption of salted eggs at meals and reported no association (Armstrong, 1978). However, a later study by Armstrong showed a significant association and trend from consumption of salted eggs with exposure derived from a dietary history and adjustment for several other food variables (Armstrong et al., 1998b). The crude odds ratio of 2.55 and the trend were significant and the odds ratio remained significant but lower after adjustment for various foods. The adjusted ratio from the Ward et al study was similar using exposure data from a dietary questionnaire (OR= 2.00) (Ward et al., 2000). Salted eggs: Childhood consumption A3 Case-control studies (4) Four case-control studies examined the risks of NPC associated with the consumption of salted eggs in childhood. All studies were done in Chinese but the study of Armstrong et al and Lee et al were done in Malaysia and Singapore respectively (Armstrong et al., 1998b, Lee et al., 1994). All studies determined the exposure based on a study-specific food frequency questionnaire except for the study of Armstrong et al that used a dietary history questionnaire. The Armstrong study of 282 cases examined the risks at age 10 and found a significant odds ratio without adjustment as well as an association between NPC and lifetime exposures to
57
salted eggs at both age 10 and 5 years prior to diagnosis after adjustment for basic variables and other foods (OR = 1.24). Yu et al studied the risks of exposure to salted eggs at weaning in 128 cases and found a borderline significant association (OR= 5.0 CI 1.2-21) following adjustment with very wide confidence intervals (Yu et al., 1988). The studies of Lee et al and Ning et al with 149 and 100 cases respectively found no association from exposure to salted eggs at age 10 (Lee et al., 1994, Ning et al., 1990). Preserved eggs A3 Case-control studies (5) Five case-control studies examined the risk of NPC associated with the consumption of preserved eggs; however, only 2 provided sufficient data to be included in a meta-analysis. All studies included Chinese from either Singapore (Lee et al., 1994) or China All used study-specific food frequency questionnaires to identify exposures. None of the five studies indicated significant associations between the cancer and preserved eggs of any kind. The studies of Yuan et al and Lee et al adjusted the odds ratios for several demographic variables (Lee et al., 1994, Yuan et al., 2000b). These studies examined the risks from exposure to either unspecified types of preserved eggs or century eggs from exposures at age 10 and in adulthood. The odds ratios and the trends were not significant. The other three studies did not specify the odds ratios but simply reported no significant associations between the cancers and salted dried and tinned eggs and fermented duck eggs at 10 years of age or 3 years prior to diagnosis (Ning et al., 1990, Yu et al., 1988, Zheng et al., 1994b). 2.6 Fats, oils and sugars A3 Case-control studies (3) A total of three case-control studies reported on associations between consumption of fats and oils and risk of NPC. In a case-control study of Chinese in Malaysia, the authors noted in the text that use of cooking oils and fats were not significantly associated with NPC, but the actual quantitative results were not presented (Armstrong, 1978). A study carried out in Algeria reported on the exposures of “dried, salted fat” in addition to a general measure of fat intake. A strong increased risk of NPC (OR 9.2; 95% CI 3.9-21.5) was noted with current consumption of dried, salted fat, after adjusting for age, sex, and neighborhood (Laouamri et al., 2001). In this same study population, the measure of fat intake also exhibited an association in the direction of increased risk that was less robust (OR 2.4; 95% CI 0.9-6.6). One study focused specifically on cod liver oil in early life, measured in infancy and at age 10 years. This study was of people of Chinese ethnicity who resided in Singapore. The results were adjusted for age, sex, ethnicity, and education. The association for consumption at age 10 was null, but during infancy the association was imprecise but in the protective direction (OR 0.5; 95% CI 0.1-2.0) (Lee et al., 1994). 2.6.1 Animal fats A3 Case-control studies (3) Three case-control studies reported on the association between consumption of animal fat and NPC. Two of these studies were carried out in northern Africa, and the other took place in China. The exposure categories considered were heterogeneous, comprised of butter and rancid butter in one study, sheep’s tail fat consumption during childhood in another study, and pork fat in the third study. On these grounds alone, the comparability of results across studies is questionable. In the study in Algeria, as a cooking medium, butter was not clearly associated with increased NPC risk but consumption of rancid butter was strongly associated with increased risk of NPC (OR 7.6; 95% CI 3.5-16.4), after adjusting for age, sex, and area of residence (Laouamri et al., 2001). In the study that took place in Tunisia, comprised of 80 NPC cases and 160 controls, the association between NPC and consumption of sheep’s tail fat during childhood was in the risk direction (OR 3.4; p-value 0.09) after adjusting for age, sex, neighbourhood, and lifestyle factors (Jeannel et al., 1990a). The study in
58
China compared pork fat consumption in 122 NPC cases and 122 controls. After adjusting for age, sex, income, environmental exposures, and numerous dietary factors including salted fish consumption, the investigators reported pork fat consumption was associated with decreased risk of NPC (OR 0.25; p-value 0.025) (Wang, 1993). 2.6.2 Plant oils A3 Case-control studies (4) A total of four case-control studies reported on the relationship between dietary intake of plant oils and the occurrence of NPC. One of these studies took place in Algeria, another in Singapore, and two in China. These studies have yielded mixed results. In the study in Algeria, plant oils such as sunflower oil and olive oil used as a cooking medium were associated with decreased risk of NPC but with wide confidence limits that overlapped unity (Laouamri et al., 2001). In this same study, intake of olive oil in seasonings was more clearly inversely associated with lower risk of NPC (OR 0.35; 95% CI 0.15-0.79) (Laouamri et al., 2001). In the study of Chinese in Singapore, more frequent margarine consumption at age 10 was inversely associated with NPC risk (OR 0.6; 95% CI 0.3-1.1), after adjusting for age, sex, ethnicity, and education (Lee et al., 1994). In one of the studies in China, fennel oil consumption at age 10 was reported as being not statistically significantly associated with NPC risk without details (Yu et al., 1988). In the other study in China, Wang and colleagues observed that plant oils were associated with NPC in the direction of increased risk (OR 4.3; p-value 0.001), after adjusting for factors that included age, sex, and environmental and dietary factors (Wang, 1993). 2.6.3 Hydrogenated fats and oils No results found. 2.6.4 Sugars A3 Case-control studies (1) In Algeria, Laouamri et al investigated the practice of giving a piece of sugar during teething, and observed that this was associated with increased risk of NPC (OR 2.2; 95% CI 1.1, 4.5). The results were adjusted for age, sex, area of residence (Laouamri et al., 2001). 2.7 Milk and dairy products A3 Case-control studies (4) Four case-controls studies have reported findings on consumption of milk and dairy products in relation to NPC, one in Algeria, one in Malaysia, and two in China. The specific dietary factors investigated have included powdered milk, animal milk, fresh milk, cow’s milk, milk, milo (fortified and flavored powdered milk drink), and horlicks (fortified and flavored powdered milk drink). It readily becomes apparent that within the exposure category of “milk” a wide array of specific exposures are represented. Not surprisingly under these circumstances, the results relating milk drinking to NPC have not yielded consistent findings. The results for fresh milk or cow’s milk were not indicative of being strongly associated with NPC risk. Among Chinese in Malaysia (Armstrong, 1978), drinking fresh milk was not associated with NPC risk overall, but was significantly associated with lower risk in specific subgroups, such as Cantonese. Armstrong and
59
colleagues reported that drinking milk with daily meals, measured as a dichotomous yes/no variable, was observed to be protective (OR 0.6; p<0.01) (Armstrong, 1978). The two studies in China (Yu et al., 1989, Yuan et al., 2000b) reported that the findings between NPC and cow’s milk consumption at age 10 and as an adult and drinking fresh milk were not statistically significant in the text, without presenting measures of association. Other forms of milk consumption, such as powdered milk and fortified and flavored powdered milk drinks (milo, horlicks) also did not appear to be strongly associated with NPC risk. In the study in Algeria, powdered milk was not strongly associated with NPC risk (Laouamri et al., 2001) In the Malaysian study, the association between NPC and the fortified and flavored powdered milk drink milo was null and similar findings were observed for horlicks (Armstrong, 1978). 2.8 Herbs, spices, condiments Herbal, spices, and condiments: Childhood consumption A3 Case-control studies (3) Three case-control studies, all from China, evaluated herbs, spices, and condiments consumed during childhood and NPC. In a study by Ward et al, a significant odds ratio of 2.3 (95% CI: 1.1-4.7) was reported for intake of herbs, spices, and condiments at age 10 when maximally adjusted for age, sex, ethnicity/race, subjects with mothers’ questionnaire and total caloric intake (Ward et al., 2000). Zheng et al observed no significant association for herbal mixtures consumed during weaning or childhood (OR=1.8, p=0.07) (Zheng et al., 1994b). Yu et al reported non-significant associations for various condiments, including hot pepper paste, soy sauce, fish sauce, and oyster sauce, consumed at age 10 (Yu et al., 1988). Herbal intake A3 Case-control studies (6) The evidence for herbal intake did not conform to the requirements for the preferred dose-response approach, but a sufficient number of studies to perform meta-analyses were available for the approach of analyzing highest-versus-lowest categories. A total of four case-control studies contributed data to these analyses. The odds ratios were significantly greater than unity in three of the studies, but a protective association was observed in one study (Armstrong, 1978, Geser et al., 1978, Henderson, 1976). All of the studies adjusted for several variables in the analysis including not only the basic demographic variables but salted fish, personal tobacco consumption, other environmental exposures, and even EBV in one study. Consumption of herbs has primarily been studied in relation to herbal medicines. Studies of herbal medicines in Asia have tended to observe strong risk associations. In India, use of herbal nasal drops were strongly associated with NPC risk (Chelleng et al., 2000), but the study included only 47 cases and the confidence intervals were very wide. In the Philippines, users of herbal medicines were observed to be at significantly higher risk of NPC compared to nonusers (Hildesheim et al., 1992, West et al., 1993). Odds ratios well in excess of unity have also been associated with used of herbal medicines in studies in China (Lin, 1973, Lin et al., 1986), but these studies were not included in the meta-analyses because details were lacking. A case-control study in the U.S. observed an association in the protective direction (OR 0.5; p=0.04) (Henderson, 1976). Most studies only used a never versus ever exposure categories.
Forest Plot for Highest vs. Lowest Analysis: Herbal intake, Case-control studies
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Odds Ratio: Highest vs. Lowest intake
.01 1 100
Study
Effect size
(95% CI)
NAS00544 (Chelleng, 2000) 58.40 ( 7.93, 430.32)
NAS01153 (West, 1993) 2.50 ( 1.14, 5.49)
NAS01251 (Hildesheim, 1992) 2.60 ( 1.44, 4.71)
NAS04928 (Henderson, 1976) 0.50 ( 0.26, 0.97)
Non-preserved spice intake A3 Case-control studies (3) Three case-control studies examined the association of .NPC and non-preserved spice intake. All the exposures differed. Two studies measured exposures in Chinese either in China (Geser et al., 1978) or in Malaysia (Armstrong, 1978) and both showed no significant association with consumption of vinegar or use of sauces by families of participants. The third study examined risks in Algerians using a food frequency questionnaire (Laouamri et al., 2001). The study showed a significant association with exposure to black pimento at least once a week (OR =10.6) and exposure to mint (OR = 3.2) both of which values are significant after adjustment for age, sex, and area of residence. Preserved spice intake A3 Case-control studies (4) Four case-control studies examined the risk of NPC and exposure to preserved spices. Laouamri (Laouamri et al., 2001) studied Algerians and the other studies included Chinese from China or in one case from Malaysia (Armstrong, 1978). Two studies used study-specific food frequency questionnaires and the others dietary recall (Armstrong, 1978, Ward et al., 2000). Two studies reported on the risks based on consumption in households of either mustard paste (Geser et al., 1978) or pickle chili and both found significant negative associations. Geser et al also found no association with direct consumption of cases. The study of Ward et al also reported no association of cancer with direct consumption of hot chili sauce (Ward et al., 2000). The only significant positive associations were from the Algerian study which evaluated harissa, dried peppers and pickled peppers, all of which spices showed significant associations with adjusted odds ratios ranging from 2.85 to 5.5 for the different exposures. The number of cases included in this study was 72 and the range of case size for all studies was 60 to 375. Soy sauce A3 Case-control studies (3) Three case-control studies have examined the association of NPC with consumption of soy sauce. The studies used food frequency questionnaires except for the study of Armstrong et al that used recall as an assessment
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tool (Armstrong, 1978, Shanmugaratnam et al., 1978, Yuan et al., 2000b). The Armstrong et al study also evaluated the characteristics of the family exposure rather than the individual. One study had two sets of controls (Shanmugaratnam et al., 1978). All studies were in Chinese and most reported several factors used in adjustment. All studies resulted in non-significant associations between soy sauce and NPC. Other fermented condiment intake A3 Case-control studies (2) Two case-control studies evaluated other fermented condiments in relation to NPC. Both studies included Chinese men and women, one in China (Yuan et al., 2000b)and the other in Hong Kong (Geser et al., 1978). No significant associations were reported for the consumption of fish sauce or oyster sauce in either study. 2.9 Composite Foods Mixed vegetables A3 Case-control studies (3) Mixed vegetables, including starchy and non-starchy vegetables, were evaluated in 3 case-control studies. All reported results in the protective direction, but not all reached significance. Green beans and peas were reported as significantly protective for NPC (OR=0.77, 95% CI: 0.62, 0.99) when maximally adjusted for in a Chinese study of 935 cases and 1032 controls (Yuan et al., 2000b). In a study of Chinese in Malaysia (Armstrong et al., 1998b), which included 282 cases and 282 controls, green beans and peas were significantly associated with NPC when consumed during adulthood (OR=0.60, 95% CI: 0.37-0.98), but not at age 10 (OR=0.88, 95% CI: 0.47-1.62). Armstrong et al also observed a significant protective association for carrots and sweet potatoes consumed during adulthood (OR=0.48, 95% CI: 0.28-0.83), but not at age 10 (OR=0.67, 95% CI: 0.33-1.27). In a US study of 140 cases and 208 controls (Farrow et al., 1998), a highest-versus-lowest odds ratio of 0.59 (0.29-1.22) was reported for yellow vegetables, including winter squash, carrots, and yams after adjusting for age, sex, alcohol consumption, smoking habits, and energy intake. Foods with sauces or pastes A3 Case-control studies (3) Three studies reported results for various foods consumed with sauces or pastes. In a study from Algeria (Laouamri et al., 2001), 72 cases and 72 controls were matched by age, sex, and area of residence. Various combinations of hot sauce and foods were shown to be in the direction of risk for NPC, with 5 of 7 exposures being significantly associated: (1) hot sauce with stews, OR=11.3 (95% CI: 4.2-28.5); (2) hot sauce with fried foods, OR=5.5 (95% CI: 2.2-14.0); (3) hot sauce with pulses, OR=4.5 (95% CI: 2.0-9.9); (4) hot sauce with couscous, OR=2.5 (95% CI: 4.1-37.9); (5) hot sauce with pasta, OR=8.0 (95% CI: 1.4-45.8); (6) hot sauce with bread and butter, OR=6.0 (95% CI: 0.6-60.5); and (7) hot sauce with salad, OR=7.0 (95% CI: 0.8-60.6). In a study of Chinese in Singapore (Lee et al., 1994), Chinese rojak, a salad containing prawn paste, was not observed to be associated with NPC when consumed at age 10 (OR=0.9, 95% CI: 0.3-2.2) or during adulthood (OR=1.6 (95% CI: 0.4-5.9) after adjusting for age, sex, education, and ethnicity/race. Belachan, prawn and chilli paste was reported to be significantly associated with NPC in the same study when consumed during adulthood, but no other details were provided. Consumption at age 10 was in the direction of risk, but was not significant (OR=1.8, 95% CI: 0.6-5.3). A study from Tunisia (Jeannel et al., 1990a), which included 80 cases and 160 controls, observed an adjusted odds ratio of 6.5 for consumption of harissa, olive oil, and bread during weaning, but provided no information about the significance of the finding. Foods with rice or noodles
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A3 Case-control studies (2) Two case-control studies evaluated the association between NPC and foods with rice and noodles. Both studies were done in Chinese, one in China and one in Malaysia. Zheng et al used a food frequency questionnaire to examine the risk associated with consumption of salted fish in rice porridge before age 2 and between ages of 2 and 10 and found significant associations with adjusted odds ratios of 3.8 and 3.2 for the two ages (Zheng et al., 1994b). The exposure categories were rarely, monthly and weekly. Armstrong et al studied the risks for family consumption at various meals of rice or noodles with meat, fish or eggs and found no association (Armstrong, 1978). ‘Cooling drink’ A3 Case-control studies (4) Four case-control studies examined the association between the consumption of various cooling drinks and NPC. Three studies by Yu reported the risks related to consumption of cooling soup, a medicinal drink, at age 10 (Yu et al., 1989, Yu et al., 1988) at 3 years prior to diagnosis (Yu et al., 1989) and at both age 10 and 3 years before diagnosis (Yu et al., 1986) and found no significant association of this exposure with NPC. The fourth study of specifies only a “cooling drink” and found no association using two sets of controls (Shanmugaratnam et al., 1978). All studies reported adjusting for the basic variables. Preserved composite foods A3 Case-control studies (4) Four case-control studies examined different types of composite foods in relation to the risk of NPC. Three studies were done in Chinese and one in the USA with mixed ethnicity. All used food frequency questionnaires except for Henderson et al which used an interview (Henderson, 1976). Results varied, possibly because of different exposures. The only significant positive association was reported by Yuan et al in which the interactive effects of preserved foods versus citrus was compared by high, medium and low exposures to each with the reference being high citrus and low preserved food intake (OR = 3.19) (Yuan et al., 2000b). Geser et al examined household consumption of tinned food with fish and Henderson et al examined salted snacks; both found significantly low associations (Geser et al., 1978, Henderson, 1976). Lee et al found no association with salted beef or malt extract. No studies examined the same exposures in this category (Lee et al., 1994). Other composite foods A3 Case-control studies (2) Two case-control studies examined varied foods in relation to the risk of NPC. Armstrong et al examined the consumption of dumplings and soup by the family at various meals and found case families had significantly lower consumption of soup at evening meals and significantly higher consumption of dumplings at breakfast compared to control families (Armstrong, 1978). However, these odds ratios are unadjusted and when consumption of dumplings is examined for all meals the ratios are not significant. Jeannel et al examined the risks associated with the intake of a stewing mixture of peppers and other spices at weaning and in the year prior to diagnosis (Jeannel et al., 1990a). Both adjusted odds ratios were significant and higher for exposure at weaning (OR = 8.4) than for the recent exposure (OR= 4.4). 3 Beverages 3.1 Total fluid intake
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A3 Case-control studies (1) In a case-control study in Malaysia, Armstrong et al (1978) observed that families of NPC cases had drinks at breakfast significantly less often than the families of controls, but this result was only presented in the text without any form of quantification (Armstrong, 1978). 3.2 Water A3 Case-control studies (2) In a case-control study in Algeria, compared to having spring water as a source of drinking water, the odds ratio for having well water as a source of drinking water was non-significantly elevated (OR 7.0); on the other hand, residential access to a piped water supply was associated with reduced risk of NPC(OR 0.2) (Laouamri et al., 2001). In a case-control study in Malaysia, being in a family that drank water with three meals per day was associated with increased risk of NPC compared to being in a family that did not drink water with three meals per day (adjusted OR 1.4, p-value <0.01) (Armstrong, 1978). 3.3 Milk A3 Case-control studies (4) Four case-control studies have reported findings on consumption of milk and dairy products in relation to NPC, one in Algeria, one in Malaysia, and two in China. The specific dietary factors investigated have included powdered milk, animal milk, fresh milk, cow’s milk, milk, milo (fortified and flavored powdered milk drink), and horlicks (fortified and flavored powdered milk drink). It is apparent that within the category of milk these represent a wide array of specific exposures. Not surprisingly under these circumstances, the results relating milk drinking to NPC have not yielded consistent findings. The results for fresh milk or cow’s milk were not indicative of being strongly associated with NPC risk. Among Chinese in Malaysia (Armstrong, 1978), drinking fresh milk was not associated with NPC risk overall, but was significantly associated with lower risk in specific subgroups, such as Cantonese. Armstrong and colleagues reported that drinking milk with daily meals, measured as a dichotomous yes/no variable, was observed to be protective (OR 0.6; p<0.01) (Armstrong, 1978). The two studies in China (Yu et al., 1989, Yuan et al., 2000b) reported that the findings between NPC and cow’s milk consumption at age 10 and as an adult and drinking fresh milk were not statistically significant in the text, without presenting measures of association. Other forms of milk consumption, such as powdered milk and fortified and flavored powdered milk drinks (milo, horlicks) also did not appear to be strongly associated with NPC risk. In the study in Algeria, powdered milk was not strongly associated with NPC risk (Laouamri et al., 2001) In the Malaysian study, the association between NPC and the fortified and flavored powdered milk drink milo was null and similar findings were observed for horlicks (Armstrong, 1978). 3.4 Soft drinks No results found. 3.4.1 Sugary No results found. 3.4.2 Carbonated
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No results found. 3.5 Fruit juices A3 Case-control studies (1) The sole study to examine fruit juice drinking in relation to NPC was a case-control study of 282 cases and 282 matched controls in Malaysia. Compared to those who drank fruit juice less than monthly 5 years prior to the index date of the case’s diagnosis, the odds ratio for those who drank orange juice less than weekly was 0.50 (95% CL 0.31, 0.82) and for those who drank more than weekly was 0.85 (95% CL 0.51, 1.42). For orange juice consumption at age 10 years the corresponding odds ratios were 0.14 (95% CL 0.03, 0.64) and 0.60 (95% CL 0.17, 2.15) for less than weekly and more than weekly consumption, respectively (Armstrong et al., 1998b). 3.6 Hot drinks A3 Case-control studies (1) In results that were presented without detail, it was noted that families of NPC cases were no more likely than the families of controls to drink coffee or tea for breakfast (Armstrong, 1978). 3.6.1 Coffee A3 Case-control studies (3) Of the three studies to assess the relationship between coffee drinking and NPC, two were conducted in the United States, and one study was conducted in Malaysia. All three of the studies used a simple dichotomization of coffee drinking, using either one cup per day versus less or any-versus-no coffee drinking. In the studies conducted in the United States, no associations were observed among drinkers of either regular or decaffeinated coffee (Henderson, 1976, Mabuchi et al., 1985). Among Chinese in Malaysia, those who drank coffee with three meals per day had significantly lower risk of NPC (OR 0.8; p<0.05) than those who did not (Armstrong, 1978). 3.6.2 Tea Tea: Adulthood consumption A3 Case-control studies (7) The evidence for drinking tea did not conform to the requirements for the preferred dose-response approach, but sufficient evidence was available to carry out a meta-analysis using the approach of highest-versus-lowest categories. A total of four case-control studies contributed data to these analyses. Two studies (Henderson, 1976, Mabuchi et al., 1985) included varied ethnic groups and were conducted in the USA. All other studies included Chinese and were located in China, Singapore, Taiwan and Malaysia. Two studies reported a negative association with any tea consumption (Henderson, 1976) or with consumption at three meals a day (Armstrong, 1978). All other studies but one (Zheng et al., 1994b) reported no significant association between tea drinking and risk of NPC. The Zheng et al study reported a significant association between consumption of herbal tea in the year before diagnosis (OR = 4.2) with the odds ratio being adjusted for the basic variables and environmental and food intakes. The latter study is the only one that specifically designated herbal tea consumption.
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One study conducted in the U.S. reported non-significant findings (Mabuchi et al., 1985), in comparison to the observation that any use of tea was associated with decreased NPC risk in the other U.S. study (Henderson, 1976). Shanmugaratnam et al reported non-significant odds ratios of 1.17 using ENT controls and 1.38 using non-ENT controls for Chinese tea (Shanmugaratnam et al., 1978). A case-control study conducted in China was not included in the meta-analysis because of lack of detailed results, but the text indicated an association that was not statistically significant (Lin, 1973).
Forest Plot for Highest vs. Lowest Analysis: Tea, Case-control studies
Odds Ratio: Highest vs. Lowest intake
.01 1 10
Study
Effect size
(95% CI)
NAS01113 (Zheng, 1994) 4.20 ( 1.33, 13.27)
NAS04928 (Henderson, 1976) 0.50 ( 0.27, 0.91)
NAS04944 (Armstrong, 1978) 0.50 ( 0.29, 0.85)
NAS06023 (Zou, 1999) 1.10 ( 0.57, 2.10)
Tea: Childhood consumption A3 Case-control studies (1) One study from Algeria investigated various tea intakes during childhood and NPC among 72 cases and 72 controls matched for age, sex, and area of residence (Laouamri et al., 2001). No significant associations were reported between infusions or herbal teas with cumin (OR=1.35, 95% CI: 0.71-2.63), olive oil (OR=0.84, 95% CI: 0.34-1.97), fenu-greek (OR=2.0, 95% CI: 0.51-7.78), or aniseed (OR=1.66, 95% CI: 0.09-28.3) and risk NPC. Bay leaf tea administered to newborns at least 3 times a week for at least 1 month was significantly associated with NPC when compared to no intake (OR=3.0, 95% CI: 2.93-5.23). 3.6.2.1 Black tea No results found. 3.6.2.2 Green tea A3 Case-control studies (1) In a study that observed no differences with respect to the temperature or frequency of tea drinking, green tea exhibited a protective association with NPC compared to non-drinkers after adjusting for age and sex in a case-control study in China and Hong Kong (Geser et al., 1978).
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3.6.3 Maté No results found. 3.6.4 Other hot drinks No results found. 3.7 Alcoholic drinks A3 Case-control studies (1) In a U.S. case-control study that used beer drinkers as the referent category, drinking wine (OR=1.6, 95% CI: 0.4-6.4) or liquor (OR=0.9, 95% CI: 0.4-2.1) were not significantly associated with NPC risk after adjustments for age, sex, and smoking (Vaughan et al., 1996). 3.7.1 Total Alcoholic Drinks A2 Cohort studies (1) One historical cohort study from Sweden reported results for NPC incidence among alcoholics and non-alcoholics (Boffetta et al., 2001). After adjustment for age, sex, and calendar year, a standard incidence ratio of 1.56 (95% CI: 0.97-2.39) was reported for alcoholics when compared to non-alcoholics. A3 Case-control studies (18) A total of 18 case-control studies reported on the association between alcohol drinking and NPC. Eight of these studies reported data in sufficient detail to perform a dose-response meta-analysis. The results of the dose-response meta-analysis based on the number of alcohol drinks per week showed evidence of a trend of increasing NPC risk as alcohol drinking increased (summary random effects OR 1.01; 95% CI 1.00-1.03 per drink/week). B2 Size of effect The magnitude of the summary OR (summary random effects OR 1.01; 95% CI 1.00-1.03 per drink/week) observed in the dose-response meta-analyses is compatible with a dose-response association between alcohol drinking and NPC. Although the point estimate of the odds ratio appears small, considering the units of drink per week along with the possible range of drinks per week, the risk differential between heavier alcohol drinkers and non-drinkers is potentially large. B3 Biological Gradient The results of the dose-response analyses were compatible with a dose-response trend between alcohol drinking and NPC, with a summary random effect OR of 1.01 (95% CI 1.00-1.03 per drink/week). Of the eight studies that contributed evidence to the meta-analysis, six had odds ratios consistent with a dose-response relationship in the direction of increased risk. Of the remaining two studies, in one study the odds ratio was less than 1.0, in the other study the odds ratio equaled 1.0. In the studies with odds ratios greater than unity, the dose-response odds ratios equaled 1.02 in four studies, and were 1.06 and 1.14 in the other two studies.
Dose-Response Graph: Total Alcohol, Case-control studies
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B4 Internal Consistency/heterogeneity by dietary methodology A disconcerting feature of the evidence on the association between alcohol drinking and NPC is the lack of information reported in the papers on precisely how alcohol drinking was measured. Of the studies included in the dose-response meta-analyses, reports from five studies provided no description of the measurement tool. The remainder of the studies indicated use of study-specific FFQs or dietary history questionnaires. B5 Summary Illustrations of effects (e.g., forest plots)
Forest Plot for Dose-Response Analysis: Total Alcohol, Case-control studies
68
Odds Ratio, drinks/week .35 1 1.5
Study
Effect size
(95% CI) % Weight
NAS00576 (Shanghai China, Yuan, 2000) 1.00 ( 0.99, 1.00) 30.4
NAS00612 (Taipei, Taiwan, Cheng, 1999) 1.06 ( 0.74, 1.53) 0.2
NAS00640 (US SEER, Nazar-Stewart, 1999) 1.02 ( 0.99, 1.06) 12.9
NAS00821 (Taiwan, Hildesheim, 1997) 0.99 ( 0.93, 1.05) 4.5
NAS00898 (US, Vaughan, 1996) 1.02 ( 1.00, 1.04) 18.6
NAS01254 (US Survey, Nam, 1992) 1.02 ( 1.00, 1.03) 23.9
NAS01495 (US-Washington, Vaughan, 1989) 1.02 ( 0.98, 1.07) 8.2
NAS01630 (Malaysia & Hong Kong, Yu, 1985) 1.14 ( 1.01, 1.29) 1.4
Overall 1.01 ( 1.00, 1.03) 100.0
Forest Plot for Highest vs. Lowest Analysis: Total Alcohol, Case-control studies
Odds Ratio: Highest vs. Lowest intake .05 1 9
Study
Effect size
(95% CI)
NAS00576 (Shanghai China, Yuan, 2000) 1.04 ( 0.74, 1.47)
NAS00612 (Taipei City Taiwan, Cheng, 1999) 1.20 ( 0.68, 2.13)
NAS00640 (US SEER, Nazar-Stewart, 1999) 1.60 ( 0.82, 3.12)
NAS00821 (Taiwan, Hildesheim, 1997) 0.92 ( 0.59, 1.43)
NAS00898 (US, Vaughan, 1996) 2.00 ( 1.00, 4.00)
NAS01248 (Thailand, Sriamporn, 1992) 1.50 ( 0.68, 3.30)
NAS01254 (US Survey, Nam, 1992) 1.80 ( 1.07, 3.02)
NAS01410 (Taiwan, Chen, 1990) 1.84 ( 0.97, 3.48)
NAS01495 (US-Washington, Vaughan, 1989) 2.43 ( 0.67, 8.84)
NAS01630 (Malaysia & Hong Kong, Yu, 1985) 2.80 ( 1.18, 6.62)
B6 Gene-nutrient interactions In the study of Hildesheim et al, the potential interaction between GSTM1 and alcohol intake was evaluated. No statistically significant interaction was observed overall, but among the heavier drinkers those with the GSTM1 null genotype had a higher risk of NPC, an association that was stronger than among lighter drinkers. In analyses limited to squamous cell carcinoma, the interaction was of borderline statistical significance (p=0.06). C Assessment of heterogeneity within and between study types
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Within the case-control dose-response meta-analysis, statistically significant heterogeneity was detected, with an I2 statistic of 50%. The sources of heterogeneity appear to stem from the studies that observed no dose-response trend, particularly the most heavily weighted study included by Yuan et al, which observed a dose-response odds ratio of 1.0 (Yuan et al., 2000a). Also adding to the heterogeneity was the much less heavily weighted study with a dose-response odds ratio of 0.99 conducted in Taiwan (Hildesheim et al., 1997b). A study that was an outlier in the risk direction took place in Malaysia and Hong Kong with a dose-response OR of 1.14; this study contributed little weight to the overall meta-analyses (Yu et al., 1985). D. Factors influencing heterogeneity and meta-regression Unlike many of the other exposures included in this systematic review, for which the evidence emanates almost exclusively from geographic regions with high rates of NPC, the dose-response evidence for alcohol drinking includes four of eight studies from the United States. Furthermore, the evidence includes only one study from China, with two from Taiwan and one from Malaysia and Hong Kong. This variability in geographic regions is a potentially important source of variability, as the distribution of exposure to risk factors such as salted fish consumption would vary widely between these populations. An additionally important source of variability, but about which little is known, is the degree to which the measurement of alcohol drinking may have contributed to the heterogeneity. E. Important quality issues for interpretation of the evidence The dose-response meta-analyses for the case-control evidence for the association between alcohol drinking and NPC yielded results compatible with an increased risk associated with alcohol drinking. An important consideration is the potential confounding factors that have been accounted for in these studies. Of the eight studies, one was not adjusted for any factors. Seven of the studies adjusted for sex, and six adjusted for age. An important potential confounder for alcohol drinking is cigarette smoking, and four of the studies included adjustments for cigarette smoking. Other factors adjusted for in at least two studies included education, family history of NPC, and ethnicity. The study that adjusted for the most factors, and was the only study to include adjustments for dietary factors, was a study in China that observed no evidence of a dose-response trend (Yuan et al., 2000a). Given the fact the quantitative evidence favoring the presence of a dose-response trend is equivocal, the strength of evidence is further weakened by the fact that other dietary factors were not taken into consideration in the studies that provided evidence favoring a dose-response association. The absence of information on EBV infection status is particularly notable. The limited extent to which potential confounding variables have been controlled for, and the genuine potential for confounding to contribute importantly to the association between alcohol drinking and NPC, makes this an important issue affecting the quality of the overall evidence. Ten of the case-control studies could be included in highest-versus-lowest categories comparison. The results of this data summary are in keeping with the results of the dose-response meta-analysis, in that the evidence tends to point more strongly than not in favor of an association between alcohol drinking and NPC, but the evidence is not entirely consistent. Of the ten studies, only one reported an odds ratio of less than unity, whereas two studies reported odds ratios between 1.01 and 1.20, four studies reported odds ratios between 1.50 and 1.85, and three studies reported odds ratios of 2.0 or greater. Seven of the 17 case-control studies that reported information concerning the association between alcohol drinking and NPC did not present sufficient data to be included in any of the quantitative data summaries. In two case-control studies in China, one a study of alcohol habits among 205 NPC cases and 205 controls (Zheng et al., 1994a), and the other comparing alcoholic drinks among 88 cases and 176 controls (Zheng et al., 1994b), it was mentioned in the text that the case-control differences in alcohol drinking were “not significant.” There was no indication the results of these studies were adjusted for any factors. In a study of 120 cases and 120 controls among Chinese in Singapore, Shanmugaratnam et al reported an OR of 1.5 (“not significant”) for daily-
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versus-never alcohol drinking, after adjusting for age and sex (Shanmugaratnam et al., 1978). In a study with very little detail presented at all among Chinese in Malaysia, Armstrong et al noted no significant differences between cases and controls with respect to their measure of alcohol drinking (Armstrong et al., 1983b). In the United States, Mabuchi noted a lack of statistically significant difference between cases and controls for drinking one or more drinks per day compared to less than one drink per day (Mabuchi et al., 1985). Two additional studies carried out in China observed comparable levels of alcohol drinking in NPC cases compared to controls after adjusting for age, sex, and other factors (Ning et al., 1990, Zou, 1999). Because only minimal information about the results were presented, it is difficult to compare the results of these seven studies to the results of the studies that presented more thorough descriptions of the results and were included in the quantitative synthesis of the evidence. With this caveat, the results of these seven studies clearly seem to be less supportive of an association than studies included in the quantitative synthesis of the evidence. Added to the somewhat inconsistent findings of the studies included in the quantitative summaries of the evidence, the results of the studies not included in the quantitative review tend to further detract from the strength of evidence. In summary, the case-control evidence is equivocal, but the quantitative summaries of the evidence tend to suggest that alcohol drinking is associated with increased NPC risk. In addition to the lack of consistency in the evidence, the evidence is weak with respect to measurement of alcohol drinking, and the lack of careful control for confounding factors that could potentially account for much of the observed association, such as cigarette smoking. Furthermore, consideration of the reports not included in the quantitative data summaries, despite being having important limitations, tends to further weaken the overall evidence.
Funnel Plot for Dose-Response Analysis: Total Alcohol Intake, Case-control studies
Begg's funnel plot with pseudo 95% confidence limits
logR
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Funnel Plot for Highest vs. Lowest Analysis: Total Alcohol Intake, Case-control studies
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Begg's funnel plot with pseudo 95% confidence limits
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s.e. of: logR0 .2 .4 .6 .8
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F. Mechanisms and animal experimental data Based on the present analyses, ethanol intake was associated with only a small increased risk of NPC, but an association of alcohol intake with increased risk for other upper aerodigestive tumors makes this association plausible. Interactions between alcohol drinking and EBV have not been directly explored. A recent review summarizes the increased risk associated with esophageal and head and neck cancer, as well as possible mechanisms behind this association (Yokoyama et al., 2003). This positive influence may be attributed to the formation of acetaldehyde, an oxidized product of ethanol. Acetaldehyde is carcinogenic and mutagenic, binding to DNA and protein (Poschl et al., 2004). Ethanol is eliminated from the body by its oxidation, first to acetaldehyde and then to acetate. These reactions are sequentially catalyzed by alcohol dehydrogenase and aldehyde dehydrogenase. Most of the acetaldehyde generated during alcohol metabolism in vivo is promptly eliminated by aldehyde dehydrogenase-2 (ALDH2), the low-Km mitochondrial ALDH. However, a mutant form of ALDH2, ALDH2*2 allele (Glu487Lys) encodes a catalytically inactive protein. The inactive form of ALDH2 with the mutant ALDH2*2 allele is common in people of Japanese descent. The distribution of the ALDH2*2 allele varies by race, being prevalent in East Asians, but not in Caucasians or Africans. When this enzyme is inactive, the body fails to metabolize acetaldehyde rapidly, leading to excessive accumulation of acetaldehyde. Thus, genetic predisposition may amplify the toxic and mutagenic effects of alcohol consumption. While this effect has been primarily attributed to esophageal and head and neck cancer, it is possible that similar effects may occur in other upper aerodigestive tumors including NPC, as exposure to these tissues would be similar.
Chronic alcohol consumption also induces cytochrome P450 enzyme (CP2E1) activity in mucosal cells (Poschl et al., 2004). As discussed above, the resulting increased activation of various dietary and environmental carcinogens would increase the mutagenic effects of dietary nitrosamines. In addition, alcohol intake has been shown to affect folate levels (Giovannucci, 2002) through inhibition of folate absorbance and through increased excretion of folate by the kidneys. Resulting folate deficiency may contribute to the accumulation of additional genetic and epigenetic alterations, as discussed above. All of these effects may contribute to the increased risk of NPC potentially seen in patients with consumption of alcohol. 3.7.1.1 Beers A3 Case-control studies (3) Beer drinking was not associated with NPC risk in two case-control studies conducted in the U.S. (Henderson, 1976, Mabuchi et al., 1985). Henderson et al observed an odds ratio of unity (p=0.48) for any use of beer among 156 cases and 267 when adjusted for age, sex, area of residence, ethnicity/race, and socio-economic
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status. In the second US study, Mabuchi et al reported no significant association for the consumption of at least one ale-beer per day when adjusted for age, sex, ethnicity/race, and marital status. In a study conducted among Chinese in Malaysia, a significantly increased risk was observed with beer drinking (OR 1.3; p=0.02) after adjustments for salted fish intake and socioeconomic status (Armstrong et al., 1998b). 3.7.1.2 Wines A3 Case-control studies (4) Of the four case-control studies have reported on wine drinking and NPC, two were conducted in the U.S. (Henderson, 1976, Mabuchi et al., 1985) and two were conducted in China (Geser et al., 1978, Lin, 1973). Only one study actually reported a measure of association; this study was conducted in the U.S. and a protective association of borderline statistical significance (OR 0.7; 95% CL 0.4, 1.1) was observed (Henderson, 1976). Others simply reported findings as significant (Geser et al., 1978) or non-significant (Lin, 1973, Mabuchi et al., 1985) without details. 3.7.1.3 Spirits A3 Case-control studies (3) In a study of Chinese in Malaysia, a strong, positive trend was observed between drinking alcoholic spirits and NPC risk (p-for-trend 0.008) among 282 cases and 282 controls (Armstrong et al., 1998b). A slight, but not statistically significant was observed in an early U.S. study (OR=1.2, p=0.31) (Henderson, 1976), and in a more recent U.S. study the findings were reported as statistically significant but without details given (Mabuchi et al., 1985). A5 Ecological studies (1) In an ecologic study in the U.S., per capita consumption of alcoholic spirits was significantly correlated with NPC among men (r2=0.21, p<0.001), but not among women (r2=0.01, p>0.05), after group-level adjustments were made for age and race/ethnicity (Longnecker-M-P et al., 1981). 3.7.1.4 Other alcoholic drinks A3 Case-control studies (1) In a small study of 18 cases and 16 controls conducted in the U.S., drinking at least one mixed drink a day was not significantly associated with NPC risk when adjusted for age, sex, ethnicity and race, and marital status (Mabuchi et al., 1985). 4 Food production, preservation, processing and preparation 4.1 Production No results found. 4.1.1 Traditional methods (to include ‘organic’) No results found. 4.1.2 Chemical contaminants
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A3 Case-control studies (2) In a Chinese case-control study reported twice (Zheng et al., 1993, Zheng et al., 1994a), drinking of polluted water was reported to be statistically significantly associated with NPC, reported only in the text without detail. The authors went on to note, that after drinking polluted water was added to a conditional logistic regression model that also included salted fish, drinking polluted water was no longer statistically significantly associated with NPC. It is difficult to draw strong inferences without more details, but this description of the results suggests that the observed association between drinking polluted water and NPC may be due to positive confounding by salted fish consumption. 4.1.2.1 Pesticides No results found. 4.1.2.2 DDT No results found. 4.1.2.3 Herbicides No results found. 4.1.2.4 Fertilisers No results found. 4.1.2.5 Veterinary drugs No results found. 4.1.2.6 Other chemicals No results found. 4.1.2.6.1 Polychlorinated dibenzofurans (PCDFs) No results found. 4.1.2.6.2 Polychlorinated dibenzodioxins (PCDDs) No results found. 4.1.2.6.3 Polychlorinated biphenyls (PCBs) No results found. 4.1.2.7 Heavy metals
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No results found. 4.1.2.7.1 Cadmium A3 Case-control studies (2) Two case-control studies, both conducted in China, have explored the possible relationship between markers of cadmium exposure and NPC. Ling-Wei and colleagues, in a comparison of 45 NPC cases with 30 controls, observed that the median cadmium exposure in NPC cases was 740% greater than controls (p-value 0.01) (Deng, 1995, Ling-Wei et al., 1988). Deng and colleagues assessed cadmium exposure by measuring concentrations in serum, as well as in rice and drinking water. In the comparison of 44 NPC cases with 42 controls, mean serum cadmium concentrations were 48% higher in cases than controls (p-value <0.01), mean cadmium concentrations in rice were 38% higher in cases than controls (p-value <0.05), and mean cadmium concentrations in drinking water that were 20% higher in cases than controls (p-value >0.05) (Deng, 1995). The reported results are thus consistently in the direction of increased risk, but the inferences are limited due to small sample sizes and the fact that in none of these comparison were potentially confounding variables adjusted for. 4.1.2.7.2 Arsenic A3 Case-control studies (1) In a case-control study in China, the mean arsenic concentrations in hair samples were 47% higher (p-value <0.05) in NPC cases (n=22) compared to controls (n=56) (Man et al., 1996). No adjustments were made in the analyses. A5 Ecological studies (3) Three ecologic studies in China and Taiwan have evaluated the relationship between arsenic concentrations in drinking water and the rates of NPC occurrence (Chen et al., 1990, Tsai et al., 1999, Wu et al., 1989). None of these studies found a statistically significant association between area measures of arsenic drinking water concentrations and area-level rates of NPC. 4.1.2.7.3 Other heavy metals Lead A3 Case-control studies (3) Three case-control studies reported on the association between lead exposure and NPC. Lead was measured differently in each study, as the specific exposures were “lead in maize leaf,” “lead in drinking water,” and “lead detected in hair sample.” The study of lead concentrations in maize leaf, conducted in Kenya, the mean exposure of NPC cases was actually 3% less than in controls, a difference that was not statistically significant (Robinson et al., 1968). In a study in China, the mean drinking water concentrations of lead were 300% higher in NPC cases than controls, a difference that was statistically significant (Ling-Wei et al., 1988). The study of Man et al in China used an actual biomarker of lead exposure. In this study, the mean lead concentrations in hair samples were actually 25% lower in NPC cases than controls, a difference that was not statistically significant (Man et al., 1996). The heterogeneous findings observed may at least be partly a function of the different exposures that were measured in each study. Mercury A3 Case-control studies (1)
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One case-control study conducted in China assessed the association between mercury concentrations in hair samples and NPC. Mercury concentrations in hair samples were 25% higher in cases than controls (“not significant”), in an unadjusted comparison of 29 NPC cases with 95 controls (Man et al., 1996). Molybdenum A3 Case-control studies (2) Two case-control studies reported on the association between molybdenum exposure and NPC. Different measures of molybdenum were used. In a study in Kenya, the specific exposure investigated was “molybdenum in maize leaf.” In a study in China, three different molybdenum were investigated, concentrations in serum, concentrations in rice, and concentrations in drinking water. In the study of molybdenum concentrations in maize leaf, conducted in Kenya, the mean exposure of NPC cases was 13% higher than in controls, a difference that was not statistically significant (Robinson et al., 1968). In the study in China (Deng, 1995), measures of molybdenum exposure were 25% or more lower in cases than controls in serum, rice, and drinking water, differences all with p-values less than 0.05. The heterogeneous findings observed may at least be partly a function of the different exposures that were measured in each study or the different exposure levels in the two regions. Nickel A3 Case-control studies (2) Two case-control studies reported on the association between nickel exposure and NPC. Different measures of nickel were used. In a study in Kenya, the specific exposure investigated was “nickel in maize leaf.” In a study in China, three different nickel exposures were investigated, concentrations in serum, concentrations in rice, and concentrations in drinking water. In the study of nickel concentrations in maize leaf, conducted in Kenya, the mean exposure of NPC cases was 3% higher than in controls, a difference that was not statistically significant (Robinson et al., 1968). In the study in China (Deng, 1995), all three measures of nickel exposure were markedly higher in cases than controls. The mean exposure to nickel was higher in cases than control by 61% in serum, 26% in rice, and 62% in drinking water, differences all with p-values less than 0.05. The findings for nickel thus differ from those observed for lead and molybdenum in providing somewhat consistent evidence of increased risk. The relatively scant evidence, and the use of different exposures that were measured in each study or the different exposure levels in the two regions, are worth consider in assessing whether or not this evidence reflects a genuine association. 4.1.2.8 Waterborne residues No results found. 4.1.2.8.1 Chlorinated hydrocarbons No results found. 4.1.2.9 Other contaminants A3 Case-control studies (1)
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In a case-control study in China, nitrosamines from soybean products were not associated with increased risk of NPC, but the evidence suggested nitrosamines from other smoked foods were associated with NPC risk particularly if consumed during childhood (Ward et al., 2000). A5 Ecological studies (1) In an ecologic study carried out in the U.S, water fluoridation was observed to be statistically significantly positively correlated with NPC rates among both men and women (Takahashi et al., 2001). 4.2 Preservation Preserved animal foods Preserved meat: Adulthood consumption A3 Case-control studies (4) Four case control studies addressed the question of whether consumption of generally preserved meats in adults was associated with an increased risk of NPC. One study was carried out in Algeria (Laouamri et al., 2001), but the remaining three studies were conducted on Chinese populations in China (Yuan et al., 2000b, Zheng et al., 1994b) or Singapore (Lee et al., 1994). With the exception of Zheng et al, all authors at least adjusted for age and sex in the analysis. All studies used a food frequency questionnaire that was study specific. The cases included in each of the studies ranged from 72 to 935. The specific preserved meats between studies varied. One of the studies found no significant association between consumption of any of the preserved meat products and occurrence of NPC. The study of Zheng et al found no significant association between salted, dried and tinned meats as a group and NPC, but this study did not specify any details on the exposure range used to test significance, the odds ratio or whether any of the data were adjusted for any potential confounding variables. Three studies reported significant associations between exposure to preserved meats and NPC. Laouamri et al found a significant odds ratio of 4.75 associating consumption of dried or salted meat currently to 29 years ago after adjusting for age sex and area of residence. Yuan et al evaluated the risk associated with consumption of any preserved meat based on a frequency of consumption divided into 3 categories. The odds ratio was significant but low (1.77) as was the trend based on 935 cases and the data were adjusted for the usual variables as well as environmental factors and history of ear infection. The study of Lee et al evaluated the intake of rou gan and dried meat and found a significant association with NPC although the authors failed to provide any details such as the odds ratio. This is the only study that adjusted for other foods and vitamins as well as age, sex, ethnicity and education. The other foods for which the authors have adjusted may not actually be confounding factors or may be correlated with the dried meat intake. Preserved meat: Childhood consumption A3 Case-control studies (2) Two case control studies addressed risks of NPC from consumption of generally preserved meat in childhood. One study included Chinese subjects from Singapore and the other was done in Tunisia. Both used food frequency questionnaires to determine exposures. Both studies indicated no significant associations between consumption of preserved meats at various ages in childhood and the risk of NPC adjusted for age and sex and, for the Tunisian study, area and lifestyle factors as well (Jeannel et al., 1990a). The study of Lee et al in Singapore indicated no association between exposure to rou gan at age 10 and NPC with an odds ratio of 0.8
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and a borderline significant negative trend (p=0.08) using exposures at various frequencies per week and never consumed (Lee et al., 1994). Preserved fish (excluding salted fish) A2 Cohort studies (1) A cohort study of 505 men and women from China reported unadjusted associations for salted and dried fish consumption during different decades and NPC (Zou, 1994). Any consumption during the 1960’s, 1970’s, or 1980’s was reported as significantly associated when compared to no consumption (p<0.001 for all decades). A3 Case-control studies (1) One case-control study contributed evidence concerning intake of generally preserved fish and NPC. In the study by Lee et al, risks for various types of preserved fish were examined for different age groupings (Lee et al., 1994). Their only significant finding was for dried, unsalted fish consumed at age 10 (OR=0.1, 95% CI: 0.01-1.0). Other exposures they investigated included dried, tiny fish; dried, tiny fish soup; preserved cuttlefish; preserved fish tidbits; and fish gravy, but none were observed to be significantly associated with NPC at any age group. Preserved eggs A3 Case-control studies (3) Three case-control studies examined the risk of NPC associated with the consumption of generally preserved eggs. All studies included Chinese from either Singapore (Lee et al., 1994) or China. All used study-specific food frequency questionnaires to identify exposures. None of the studies indicated significant associations between the cancer and preserved eggs of any kind. The studies of Yuan et al and Lee et al adjusted the odds ratios for several demographic variables (Lee et al., 1994, Yuan et al., 2000b). These studies examined the risks from exposure to either unspecified types of preserved eggs or century eggs from exposures at age 10 and in adulthood. The odds ratios and the trends were not significant. The other study (Zheng et al., 1994b) did not specify the odds ratios but simply reported no significant associations between NPC and salted, dried and tinned eggs. Preserved fats A3 Case-control studies (1) One case-control study reported on the association between consumption of preserved fats and the risk of NPC. The study, carried out in Algeria, reported on the exposures of “dried, salted fat” in addition to a general measure of fat intake. A strong increased risk of NPC (OR 9.2; 95% CI 3.9-21.5) was noted with current consumption of dried, salted fat, after adjusting for age, sex, and neighborhood (Laouamri et al., 2001). In this same study population, the measure of fat intake also exhibited an association in the direction of increased risk that was less robust (OR 2.4; 95% CI 0.9-6.6). Preserved plant foods Total preserved vegetables: Adulthood consumption A3 Case-control studies (4) A total of 4 case-control studies reported results for total preserved vegetables and NPC. Ever-versus-never consumption of preserved vegetables was not significant in a Chinese study of 375 cases and 327 controls (Ward et al., 2000). A large Chinese study of 935 cases and 1032 controls by Yuan et al observed a significant
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association between preserved vegetable intake and NPC (OR=1.43, 95% CI: 1.11-1.86) (Yuan et al., 2000b). Lee et al also reported a significant association between canned, salted, or pickled vegetables and NPC (OR=4.9, CI: 1.8-12.9) (Lee et al., 1994). A study by Zheng et al, reported no significant association for salted, dried, or tinned vegetables in brine (Zheng et al., 1994b). Total preserved vegetables: Childhood/Infancy consumption A3 Case-control studies (2) Two case-control studies investigated preserved vegetables during childhood and risk of NPC. The first study by Ward et al matched cases and controls in China (Ward et al., 2000). Non-significant associations were reported for intake of preserved vegetables at age 10 (OR=0.9, 95% CI: 0.3-2.6), at age 3 (OR=0.9, 95% CI: 0.3-2.4), and during weaning (OR=1.3, 95% CI: 0.6-2.5). Consumption of canned, salted or pickled vegetables at age 10 was not observed to be associated with NPC (OR=0.5, 95% CI: 0.1-1.4) in a study of Chinese in Singapore as reported by Lee et al (Lee et al., 1994). Preserved Root Vegetables A3 Case-control studies (1) The association between generally preserved root vegetables and NPC was evaluated in a single case-control study. In the Chinese study, preserved root vegetables consumed at age 10 were positively associated with NPC (OR=1.81, 95% CI: 1.01-3.33) and other preserved root vegetables consumed during adulthood were positively associated with NPC (OR=2.42, 95% CI: 0.99-5.92) (Huang, 1997). Preserved Cruciferous Vegetables: Adulthood consumption A3 Case-control studies (2) Two studies reported results for preserved cruciferous vegetables consumed during adulthood. Both studies included Chinese men and women from Singapore or China. In the study by Lee et al, results for 3 types of preserved cruciferous vegetables were in the risk direction, but only 2 were significant (Lee et al., 1994). The 2 significant results were for preserved Chinese radish (OR=2.8, 95% CI: 1.2-6.0) and salted mustard greens (OR=3.1, 95% CI: 1.4-6.5). No significance was observed for preserved cabbage (OR=1.5, 95% CI: 0.6-3.4). Ning et al reported no significant association for sour cabbage (Ning et al., 1990). Preserved Cruciferous Vegetables: Childhood consumption A3 Case-control studies (2) Two studies focused on various preserved cruciferous vegetables and any age group below age 10 years, with 1 reporting estimates for odds ratios. Both studies assessed the association between types of preserved cabbage at age 10 and NPC. No significance was observed for preserved cabbage consumption at age 10 by Lee et al (OR=0.8, 95% CI: 0.2-2.6) or for sour cabbage at age 10 by Ning et al (Lee et al., 1994, Ning et al., 1990). Preserved radish was examined by Lee et al; an odds ratio of unity (95% CI: 0.4-2.1) was reported for consumption of preserved Chinese radish at age 10. Preserved Green Leafy Vegetables: Adulthood consumption A3 Case-control studies (1) One case-control study evaluated the association between generally preserved green leafy vegetables and NPC. The study of Chinese in Singapore reported a non-significant association between mei chye (preserved greens and leafy vegetables) and NPC after adjustment for various confounders (Lee et al., 1994).
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Total Preserved Vegetables: Adulthood consumption A3 Case-control studies (3) Three studies reported results for total preserved vegetables consumed during adulthood and NPC. In an Algerian study, 72 cases and 72 controls were matched by age, sex, and area of residence (Laouamri et al., 2001). This study observed vegetables in brine used as seasonings to be significantly related to NPC (OR=2.77, 95% CI: 1.34-5.71). A Chinese study by Yuan et al examined various types of preserved vegetables in a population of 935 cases and 1032 controls (Yuan et al., 2000b). They reported a significant risk for the consumption of preserved stem vegetables (OR=1.88, 95% CI: 1.24-2.84) and non-significant associations in the direction of risk for the consumption of preserved leafy vegetables (OR=1.37, 95% CI: 0.65-2.9) and preserved root vegetables (OR=1.04, 95% CI: 0.7-1.53). Mei chye, a dish of preserved greens and leafy vegetables, was shown to be in the direction of risk, but was not significant (OR=2.8, 95% CI: 0.9-8.2) in a study of Chinese in Singapore (Lee et al., 1994). Total Preserved Vegetables: Childhood consumption A3 Case-control studies (1) One study reported on generally preserved vegetables consumed during childhood. In the study of Chinese in Singapore (Lee et al., 1994), including 150 cases and 341 controls, intake of preserved greens and leafy vegetables was not significantly associated with NPC (OR=1.3, 95% CI: 0.6-2.6) when adjusting for age, sex, education level, and dialect group. Other Preserved Vegetables: Adulthood consumption A3 Case-control studies (2) Generally preserved vegetables consumed during adulthood was investigated in 2 case-control studies, both reported significant risk associations with NPC. An odds ratio of 7.5 (95% CI: 3.09-18.2) was reported for salted and dried tomatoes in an Algerian study which matched 72 cases and 72 controls by age, sex, and area of residence (Laouamri et al., 2001). Plum vegetable was shown as significantly associated with NPC (OR=2.53, 95% CI: 1.04-6.19) when maximally adjusted for in a Chinese study (Chen et al., 1997). Preserved fruits A3 Case-control studies (1) A study of Chinese in Malaysia including 282 cases and 282 controls investigated the association between consumption of preserved fruits at age 10 and 5 years prior to diagnosis and risk of NPC (Armstrong et al., 1998b). An unadjusted odds ratio of 1.42 (95% CI 0.71-2.85) was reported for those who consumed preserved fruit more than weekly 5 years prior to diagnosis compared to those with less than monthly consumption. More than weekly consumption at age 10 was not significantly associated with NPC when compared to less than monthly consumption (unadjusted OR=1.50, 95% CI 0.82-2.75). Preserved citrus fruits A3 Case-control studies (1) One study of 104 cases and 104 controls in China evaluated the association between preserved citrus fruits and NPC (Huang, 1997). Consumption of preserved citrus fruits at age 10 was reported as a risk factor for NPC when compared to no consumption (unadjusted OR=2.17, 95% CI 1.12-4.21). After adjustment for age, sex, no
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separate kitchen, intake of dried vegetables and grapes, and family history of cancer, an odds ratio of 2.95 (95% CI 1.04-8.41) was reported for consumption of preserved oranges when compared to no consumption. Preserved plums: Adulthood consumption A3 Case-control studies (4) Various types of preserved plums consumed during adulthood were examined in four case-control studies. All were in Chinese populations from China or Hong Kong. Yuan et al reported no significance for intakes of dried plums or preserved plums in a study of 935 cases and 1032 controls (Yuan et al., 2000b). Using maximally adjusted models, Chen et al reported significant risk results for the consumption of preserved prunes (OR=2.59, 95% CI: 1.04-8.41) and preserved plums (p-for-trend<0.05) in a matched case-control study (Chen et al., 1997). Limiting dietary intake to 3 years prior to diagnosis, Yu et al did not observe significant associations for 2 types of preserved, salted plums; however, when lifetime dietary data was used they observed significant associations for both types of salted plums (risk estimates not provided) (Yu et al., 1989). A second study by Yu et al reported non-significant results for preserved plums after adjusting for age, sex, and salted fish intake (Yu et al., 1986). Preserved plums: Childhood consumption A3 Case-control studies (4) Four studies investigated the relationship between consumption of preserved plums at age 10 and NPC risk. All studies were in Chinese populations from China or Hong Kong. Chen et al reported significant risk associations for preserved prunes (OR=2.17, 95% CI: 1.12-4.21) and preserved plums (OR=2.10, 95% CI: 1.12-3.91) using logistic regression analyses and matched cases and controls (Chen et al., 1997). Significant risk trends were observed by Yu et al for 2 types of preserved, salted plums (p-for-trends 0.01 and 0.03) after adjusting for age, sex, area of residence, and consumption of salted fish during weaning (Yu et al., 1989). A previous study by Yu et al did not observe associations for various preserved plums (Yu et al., 1986). The fourth study included 104 cases and 104 matched controls and reported a significant risk association for ever-versus-never intake of preserved plums at age 10 (OR=2.10, 95% CI: 1.12-3.91) (Huang, 1997). Preserved olives: Adulthood consumption A3 Case-control studies (1) One case-control study evaluated the relationship between generally preserved olives consumed during adulthood and NPC. A study of 72 cases and 72 matched controls in Algeria reported significant associations between consumption of olives in brine (OR=2.0, 95% CI: 1.36-3.72) and risk of NPC (Laouamri et al., 2001). Preserved spice intake A3 Case-control studies (3) Three case-control studies examined the risk of NPC and exposure to preserved spices. Laouamri et al studied Algerians and the other studies included Chinese from China or Hong Kong. Two studies used study-specific food frequency questionnaires and the other used dietary recall (Ward et al., 2000). The only significant positive association was from the Algerian study which evaluated harissa and showed an adjusted odds ratio of 5.0 (p<0.001) (Laouamri et al., 2001). The number of cases included in this study was 72. The study of Ward et al also reported no association of cancer with direct consumption of hot chili sauce. Geser et al found protective associations for household consumption of mustard paste (OR=0.44, 95% CI: 0.26-0.74) and chili sauce (OR=0.41, 95% CI: 0.24-0.69) (Geser et al., 1978).
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4.2.1 Drying Dried animal food Dried fish (excluding salted fish) A3 Case-control studies (4) Four case-control studies contributed evidence concerning intake of non-salted fish and NPC. Several of these studies only reported non-significant associations in the text without details (Ning et al., 1990, Yu et al., 1988). In a study by Lee et al, risks for various types of preserved fish were examined for different age groupings (Lee et al., 1994). Their only significant finding was for dried, unsalted fish consumed at age 10 (OR=0.1, 95% CI: 0.01-1.0). Other exposures they investigated included dried, tiny fish and dried, tiny fish soup, but none were observed to be significantly associated with NPC at any age group. Yu et al reported that consumption of dried fish was observed to be a significant risk factor when consumed at age 10 (OR=6.4, 95% CI: 1.6-26.8), but not at ages 1-2 (OR=2.2, 95% CI: 0.9-5.3). Dried anchovies, consumed during adulthood or at age 10, were not associated with NPC in another Chinese study by Ning et al. The fourth study by Armstrong et al examined the relationship between dried fish consumed during meals and NPC among Chinese in Malaysia (Armstrong, 1978). A significant association was reported when dried fish was consumed at breakfast, but no direction or estimate of risk was offered. When consumed in 3 daily meals, no association between dried fish and NPC was observed. Dried seafood: Adulthood consumption A3 Case-control studies (3) Three case-control studies examined the association between NPC and consumption of dried seafood. All studies evaluated exposures through the use of study-specific food frequency questionnaires. All studies included Chinese cases and controls. None of the studies showed significant odds ratios or trends with the different foods although all that reported odds ratios were in the positive direction. Lee et al studied the association between dried oysters and dried prawns and found no significant association after adjustment for basic variables (Lee et al., 1994). An earlier study of Yu et al examined the risks of eating dried shrimp both in childhood and 3 years prior to diagnosis and found no association after adjustment for possible confounding variables (Yu et al., 1986). Ning et al studied the intake of dried shrimp and found no significant association in the adjusted odds ratios (Ning et al., 1990). Dried seafood: Childhood consumption A3 Case-control studies (4) Three of the studies investigating adult consumption and one additional study by Yu 1988 examined the risks of NPC associated with eating of dried seafood in childhood. All studies examined exposure through the use of a study-specific food frequency questionnaire. All of the studies adjusted for at least age and sex in some of the analyses. All exposures examined showed no association with NPC and exposure in childhood. Lee et al examined consumption of dried prawns and dried oysters and found no association with exposure at age 10 to either food (Lee et al., 1994). Yu 1988 and 1986 and Ning et al examined the risks associated with consumption of dried shrimp at age 10 and combined with adult exposure and found no association even after adjustment for basic variables (Ning et al., 1990, Yu et al., 1986, Yu et al., 1988). Dried plant foods Dried vegetables: Adulthood consumption
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A3 Case-control studies (1) A single case-control study reported results for dried vegetables and NPC. In a study of 100 cases and 300 matched controls conducted in China, no significant associations were reported for dried vegetables (Ning et al., 1990). Dried vegetables: Childhood/Infancy consumption A3 Case-control studies (1) A single case-control study investigated dried vegetables during childhood and risk of NPC. Ning et al observed no significant associations for dried vegetables at age 10 (Ning et al., 1990). Dried Green Leafy Vegetables: Adulthood consumption A3 Case-control studies (1) A single case-control study evaluated the association between dried green leafy vegetables and NPC. A study of Chinese in China reported non-significant associations between dried kelp and dried seaweed and NPC after adjusting for age, sex, and area of residence (Ning et al., 1990). Dried Green Leafy Vegetables: Childhood consumption A3 Case-control studies (1) A single case-control study evaluated the association between dried green leafy vegetables consumed during childhood and NPC. A study of Chinese in China reported non-significant associations between consumption of dried kelp at age 10 and consumption of dried seaweed at age 10 and NPC after adjusting for age, sex, and area of residence (Ning et al., 1990). Dried plums: Adulthood consumption A3 Case-control studies (1) Dried plums consumed during adulthood were examined in one case-control study. Yuan et al reported no significance for intakes of dried plums in a study of 935 cases and 1032 controls (Yuan et al., 2000b). Dried plums: Childhood consumption A3 Case-control studies (1) One study investigated the relationship between consumption of dried plums at age 10 and NPC risk. A study by Yu et al did not observe associations for various dried plums (Yu et al., 1988). Dried olives: Adulthood consumption A3 Case-control studies (1) One case-control study evaluated the relationship between dried olives consumed during adulthood and NPC. A study of 72 cases and 72 matched controls in Algeria reported significant associations between consumption of dried olives (OR=4.66, 95% CI: 1.51-14.33) and risk of NPC (Laouamri et al., 2001). Other dried fruits: Adulthood consumption A3 Case-control studies (3)
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Three case control studies measured the association between dried fruits consumed during adulthood and NPC. One study of 72 cases and 72 matched controls in Algeria reported an odds ratio of 0.2 (95% CI: 0.08-0.17) for consumption of raisins (Laouamri et al., 2001). Two studies, one conducted in China and the other in Hong Kong, reported non-significant associations between dried red dates and NPC (Yu et al., 1986, Yuan et al., 2000b). Other dried fruits: Childhood consumption A3 Case-control studies (2) Two case control studies measured the association between dried red dates consumed at age 10 and NPC. One study was conducted in China and included 128 cases and 174 controls (Yu et al., 1988). The other study took place in Hong Kong and included 250 cases and 250 controls (Yu et al., 1986). Both reported non-significant associations between dried red dates and NPC and provided no other details. Dried seeds: Adulthood consumption A3 Case-control studies (1) One case-control study reported on the association between adulthood consumption of dried seeds and the risk of NPC. This study only mentioned in the text that the consumption of dried ginko seeds was not statistically significantly associated with NPC (Yuan et al., 2000b). Dried seeds: Childhood consumption A3 Case-control studies (1) One case-control study reported on the association between childhood consumption of dried seeds and the risk of NPC. In the Chinese study, the evidence presented was limited to mentioning in the text that the consumption of dried ginko seeds at age 10 years was not statistically significantly associated with NPC (Yu et al., 1988). Dried spice intake A3 Case-control studies (1) One case-control study examined the risk of NPC and exposure to dried spices. Laouamri et al studied Algerians and used a study-specific food frequency questionnaire (Laouamri et al., 2001). A significant positive association was observed for the intake of dried peppers (OR=5.5, 95% CI: 2.55-11.8). The number of cases included in this study was 72 and the range of case size for all studies was 60 to 375. 4.2.2 Storage A3 Case-control studies (1) In a case-control study in Algeria, Laouamri and colleagues investigated whether NPC risk might be related to the practice of feeding infants who are teething cherchem, wheat and barley pieces that are softened in underground storage when they come into contact with moist floors and walls. The comparisons were limited by the fact that this storage variable was measured as ever-versus-never consumption and the problem of remote recall of an infant feeding practice. The odds ratio for NPC was in the direction of increased risk (OR 4.0; 95% CL 0.18, 4.4) (Laouamri et al., 2001) [Technical note: the results are accurate as presented, but some error in reporting occurred because the confidence limits are not consistent with the point estimate of the OR]. 4.2.2.1 Mycotoxins
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No results found. 4.2.2.1.1 Aflatoxins No results found. 4.2.2.1.2 Others No results found. 4.2.3 Bottling, canning, vacuum packing A3 Case-control studies (1) After adjusting for age and sex, the relative odds of living in a household that consumed tinned foods with fish was significantly lower in cases than controls (OR 0.5; 95% CI 0.2-0.9) in a case-control study in China and Hong Kong (Geser et al., 1978). 4.2.4 Refrigeration No results found. 4.2.5 Salt, salting No results found. 4.2.5.1 Salt A3 Case-control studies (2) Two case-control studies have investigated whether consumption of table salt is associated with NPC. Both studies were conducted in China, by Yu and colleagues, and included adjustments for at least age and sex. These findings are of particular interest to this SLR because of the associations noted with salted foods, as they provide the opportunity to assess the potential independent influence of salt per se. In these studies, the results were not presented in detail but it was noted that there were no significant case-control differences for table salt consumed three years prior to diagnosis or at age 10 years (Yu et al., 1989, Yu et al., 1988). 4.2.5.2 Salting No results found. 4.2.5.3 Salted foods A3 Case-control studies (1) In a study conducted in the U.S., cases were significantly less likely than controls (OR 0.4; p=0.03) to have consumed salted snacks, after adjusting for age, sex, area of residence, and race/ethnicity (Henderson, 1976). 4.2.5.3.1 Salted animal food (excluding salted fish)
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Salted meat: Adulthood consumption A3 Case-control studies (1) One case control study addressed the question of whether consumption of salted meats in adults was associated with an increased risk of NPC. Ning et al examined consumption of salted meats and found no significant association with these foods and NPC (Ning et al., 1990). However, the exposure range tested was not specified and there was no information regarding whether any of the analyses were adjusted for possible confounders. Salted meat: Childhood consumption A3 Case-control studies (1) One case control study addressed risks of NPC from consumption of salted meat in childhood. The study by Ning et al examined exposures to salted meats at age 10 and salted meats three years before cancer diagnosis and indicated non-significant associations for all measures without any further details (Ning et al., 1990). Salted pork A3 Case-control studies (3) Three case-control studies, all implemented in China, reported on the association between salted pork consumption and NPC. The studies ranged in size from 128 cases/174 controls to 250 cases/250 controls, and all used study-specific food frequency questionnaires to measure the dietary exposure. None of the studies reported measures of association, but rather only whether the results were “statistically significant” or not. The one study to report a significant increased NPC risk was for the exposure of “salted pork” (Zheng et al., 1993). Consumption of salted pork or pork sausage at age 10 years or as an adult was reported to be not significantly associated with NPC risk in two other studies (Yu et al., 1986, Yu et al., 1988). Salted seafood: Adulthood consumption A3 Case-control studies (3) Three case-control studies examined the association between NPC and consumption of salted seafood. All studies evaluated exposures through the use of study-specific food frequency questionnaires. All studies included Chinese cases and controls. None of the studies showed significant odds ratios or trends with the different foods although all that reported odds ratios were in the positive direction. Yuan et al examined the association of intake of salted food pastes using 935 controls and found a non-significant association (odds ratio 1.44 p=0.07) after adjustment for age, sex, education and other lifestyle and environmental factors (Yuan et al., 2000b). Yu et al studied the association of consumption of salted fish paste at 3 years prior to diagnosis and at an unknown time and found no association after adjustment for basic variables as well as other suspect foods (Yu et al., 1989). Ning et al studied the intake of salted shrimp paste and found no significant associations in the adjusted odds ratios (Ning et al., 1990). Salted seafood: Childhood consumption A3 Case-control studies (2) Two studies examined the risks of NPC associated with eating of salted seafood in childhood. Both studies examined exposure through the use of a study-specific food frequency questionnaire. When Yu et al and Ning et al examined the risks of NPC associated with the consumption of salted shrimp paste at age 10 both authors reported a significant association either as a trend (Yu et al) or as an odds ratio (OR = 3.2 p=0.007) with adjustments for not only the basic variables but for others such as salted fish consumption (Ning et al., 1990, Yu
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et al., 1989). Yu et al also reported a borderline significant trend (0.07) for this exposure at the ages of 1-2 years in children. Salted eggs: Adulthood consumption A3 Case-control studies (5) Five case–control studies examined the risk of NPC associated with the consumption of salted eggs with conflicting results; however, only 3 provided the necessary data for a meta-analysis. All studies were conducted in Chinese but the Armstrong et al studies were done in Malaysia and the others in China. Lee et al and Ning et al used a food frequency questionnaire and examined either the intake of unspecified salted eggs in adulthood or intake of specific chicken or duck eggs three years before diagnosis and found no significant association (Lee et al., 1994, Ning et al., 1990). Armstrong et al examined the risk of family consumption of salted eggs at meals and reported no association (Armstrong, 1978). However, a later study by Armstrong showed a significant association and trend from consumption of salted eggs with exposure derived from a dietary history and adjustment for several other food variables (Armstrong et al., 1998b). The crude odds ratio of 2.55 and the trend were significant and the odds ratio remained significant but lower after adjustment for various foods. The adjusted ratio from the Ward et al study was similar using exposure data from a dietary questionnaire (OR= 2.00) (Ward et al., 2000). Salted eggs: Childhood consumption A3 Case-control studies (4) Four case-control studies examined the risks of NPC associated with the consumption of salted eggs in childhood. All studies were done in Chinese but the studies of Armstrong et al and Lee et al were done in Malaysia and Singapore respectively (Armstrong et al., 1998b, Lee et al., 1994). All studies determined the exposure based on a study-specific food frequency questionnaire except for the study of Armstrong et al that used a dietary history questionnaire. The Armstrong study of 282 cases examined the risks at age 10 and found a significant odds ratio without adjustment as well as an association between NPC and lifetime exposures to salted eggs at both age 10 and 5 years prior to diagnosis after adjustment for basic variables and other foods (OR = 1.24). Yu et al studied the risks of exposure to salted eggs at weaning in 128 cases and found a borderline significant association (OR= 5.0 CI 1.2-21) following adjustment with very wide confidence intervals (Yu et al., 1988). The studies of Lee et al and Ning et al with 149 and 100 cases respectively found no association from exposure to salted eggs at age 10 (Lee et al., 1994, Ning et al., 1990). 4.2.5.3.1.1 Salted fish Salted fish: Adulthood consumption A2 Cohort studies (1) One cohort study reported on the association between salted fish intake and NPC (Zou, 1994). This study was carried out in Sihui County, Guangdong Province, China. The cohort for the analyses of adulthood consumption of salted fish was based on 505 individuals between the ages of 35-64 years who were followed-up for nine years. During follow-up, 17 cohort members were diagnosed with NPC. The investigators queried about salted fish intake during the decades of the 1960s, 1970s, and 1980s. The results were all unadjusted; no measures of association were presented, with only p-values reported in the text. The p-values comparing salted fish intake at least once per week compared to less frequent consumption were <0.001, 0.014, and 0.21 for consumption in the 1960s, 1970s, and 1980s, respectively. It is difficult to make strong inferences based on small number of NPC cases and the limited information presented, but the results of this cohort study document
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the temporal association between salted fish intake and NPC risk and suggest that accounting for a longer latency period may strengthen the association between salted fish intake and NPC risk. A3 Case-control studies (21) A total of 21 case-control studies reported on the association between salted fish intake during adulthood and NPC. Nine of these studies reported data in sufficient detail to perform a dose-response meta-analysis. The results of the dose-response meta-analysis based on the number of times salted fish was consumed per week during adulthood showed evidence of a strong trend of increasing NPC risk as salted fish intake increased (summary random effects RR 1.28; 95% CI 1.13-1.44 per time/week). B2 Size of effect The magnitude of the summary RR (summary random effects RR 1.28; 95% CI 1.13-1.44 per time/week) observed in the dose-response meta-analyses indicates a strong dose-response association between salted fish intake and NPC. B3 Biological Gradient The dose-response analyses are compatible with a strong dose-response trend between salted fish consumption and NPC, with a summary random effect RRs of 1.28 (95% CI 1.13-1.44 per time/week). The results from all nine of the studies that contributed evidence to the meta-analysis were consistently in the direction of increased risk, with dose-response ORs ranging from 1.06 to 2.50 per time/week. There were three studies each with OR point estimates of 1.06 to 1.20, 1.21-1.50, and >1.50.
Dose-Response Graph: Salted fish intake during adulthood, Case-control studies
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B4 Internal Consistency/heterogeneity by dietary methodology In these studies, salted fish intake was measured using study specific FFQs or dietary history questionnaires, and was most often referred to as salted fish. All of the studies were hospital-based for case ascertainment. B5 Summary Illustrations of effects (e.g., forest plots)
Forest Plot for Dose-Response Analysis: Salted fish intake during adulthood, Case-control studies
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Odds Ratio, times/week .1 1 5
Study
Effect size
(95% CI) % Weight
NAS00577 (Shanghai China, Yuan, 2000) 1.73 ( 0.66, 4.52) 1.5
NAS01056 (Singapore, Lee, 1994) 1.17 ( 0.85, 1.61) 8.4
NAS01141 (Guangzhou China, Zheng, 1994) 2.50 ( 1.63, 3.85) 5.7
NAS01248 (Thailand, Sriamporn, 1992) 1.35 ( 1.06, 1.72) 11.1
NAS01459 (Guangzhou China, Yu, 1989) 1.10 ( 1.00, 1.21) 18.0
NAS01608 (Hong Kong, Yu, 1986) 1.31 ( 1.13, 1.51) 15.7
NAS06003 (S. Fujian China, Ye, 1995) 1.71 ( 1.08, 2.70) 5.2
NAS06010 (Fujian China, Cai, 1996) 1.06 ( 1.00, 1.12) 19.3
NAS06023 (Yangjiang China, Zou, 1999) 1.32 ( 1.13, 1.54) 15.2
Overall 1.28 ( 1.13, 1.44) 100.0
Forest Plot for Highest vs. Lowest Analysis: Salted fish intake during adulthood, Case-control studies
Odds Ratio: Highest vs. Lowest intake
.01 1 100
Study Effect size (95% CI)
NAS00531 (Taipei Taiwan, Ward, 2000) 0.80 ( 0.52, 1.24)
NAS00577 (Shanghai China, Yuan, 2000) 1.82 ( 0.86, 3.86)
NAS00749 (Selangor Malaysia, Armstrong, 1998) 4.22 ( 2.23, 7.99)
NAS01056 (Singapore, Lee, 1994) 4.40 ( 0.72, 26.76)
NAS01113 (Wuzhou China, Zheng, 1994) 4.07 ( 0.36, 45.80)
NAS01141 (Guangzhou China, Zheng, 1994) 17.20 ( 2.82, 104.79)
NAS01153 (Rizal Phillipines, West, 1993) 1.30 ( 0.67, 2.52)
NAS01248 (Northeast Thailand, Sriamporn, 1992) 2.50 ( 1.20, 5.20)
NAS01459 (Guangzhou China, Yu, 1989) 1.80 ( 0.90, 3.60)
NAS01608 (Hong Kong, Yu, 1986) 7.50 ( 0.88, 63.89)
NAS01922 (Tianjin City China, Ning, 1990) 2.20 ( 1.30, 3.71)
NAS06003 (South Fujian China, Ye, 1995) 5.00 ( 1.27, 19.72)
NAS06009 (Minan Fujian China, Ye, 1995) 2.00 ( 0.88, 4.56)
NAS06010 (Fujian China, Cai, 1996) 1.32 ( 0.98, 1.77)
NAS06021 (Guangxi China, Chen, 1994) 5.51 ( 1.74, 17.44)
NAS06022 (Heilongjiang China, Wang, 1993) 8.99 ( 1.60, 50.44)
NAS06023 (Yangjiang China, Zou, 1999) 3.07 ( 1.66, 5.69)
B6 Gene-nutrient interactions Does not apply.
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C Assessment of heterogeneity within and between study types Within the case-control dose-response meta-analysis, statistically significant heterogeneity was detected, with an I2 statistics of 75%. Inspection of the data reveals that the heterogeneity present relates to the magnitude of the dose-response gradient, not heterogeneity with respect to the presence of a dose-response trend. The results for all nine studies supported the presence of a positive dose-response trend. The source of the heterogeneity may relate to the fact that the two studies with the largest weights also observed the weakest dose-response trends, whereas studies with the smallest weights in the meta-analysis tended to observe strong dose-response trends. D. Factors influencing heterogeneity and meta-regression A factor that could contribute to the variability in the observed magnitude of associations is between-region differences in specific methods of salted fish preparation, and possibly with the type of fish consumed. This could potentially lead to differences in the risk associated with salted fish consumption but this is difficult to rigorously assess with so few studies, leaving an insufficient number of studies per region to analyze separately. E. Important quality issues for interpretation of the evidence The dose-response meta-analyses for case-control evidence for the association between salted fish intake and NPC yielded results compatible with a strong increased risk associated with salted fish intake. An important consideration is the potential confounding factors that have been accounted for in these studies. All nine of these studies included adjustments for at least age and sex, and the majority also controlled for neighborhood of residence. Other factors considered included cigarette smoking (3 studies), alcohol drinking (2 studies), and exposure to other environmental exposures (2 studies). Importantly, other dietary factors were rarely taken into consideration (1 study adjusted for consumption of fermented soy). The absence of information on EBV infection status is particularly notable. The limited extent to which potential confounding variables have been controlled for is thus an important issue affecting the quality of the overall evidence. Seventeen of the case-control studies could be included in highest-versus-lowest categories comparison. The results of this data summary strongly reinforce the evidence suggesting salted fish intake increases the risk of NPC. Of the 17 studies, only one reported an odds ratio of less than unity, whereas four studies reported odds ratios between 1.33 and 1.99, four studies reported odds ratios between 2.0 and 4.0, and in 8 studies odds ratios of greater than 4.0 were observed. Four of the 21 case-control studies that reported information concerning the association between adulthood consumption of salted fish and NPC did not present sufficient data to be included in any of the quantitative data summaries. In a case-control study of 205 NPC cases and 205 controls carried out in China, Zheng et al reported in the text that cases were “significantly” more likely to have the highest salted fish consumption, without reporting a p-value or measure of association (Zheng et al., 1993). In a study in Malaysia comprised of 100 NPC cases and 100 controls, the case-control difference in current salted fish consumption in adults was reported to be not statistically significantly different (Armstrong et al., 1983a). No measure of association or p-value was reported, but the comparison was adjusted for age, sex, area of residence, and ethnicity. Similar results to this were reported in a case-control study conducted in the U.S. (n=156 cases, n=267 controls) (Henderson, 1976). In a much larger study carried out in Taiwan, a comparison of the consumption of moldy and firm salted fish was reported to be not statistically significantly different between 502 NPC cases and 1942 controls (Yang, 2005). Because only minimal information about the results were presented, it is difficult to compare these four studies to those that presented more thorough descriptions of the results. With this caveat, the results of these four studies appear to be less supportive of an association than studies included in the quantitative synthesis of the evidence.
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In summary, the case-control evidence is clear and consistent in suggesting that salted fish intake is associated with increased NPC risk. The evidence to specifically pinpoint the observed risks to salted fish would be more convincing if potential confounding factors had been more completely accounted for.
Funnel Plot for Dose-Response Analysis: Salted fish intake during adulthood, Case-control studies
Begg's funnel plot with pseudo 95% confidence limits
logR
s.e. of: logR0 .2 .4 .6
-1
-.5
0
.5
1
Funnel Plot for Highest vs. Lowest Analysis: Salted fish intake during adulthood, Case-control studies
Begg's funnel plot with pseudo 95% confidence limits
logR
s.e. of: logR0 .5 1 1.5
-2
0
2
4
F. Mechanisms and animal experimental data More studies have examined the role of nitrosamines and nitrites in salted fish as essential agents for transformation of NPC precursor tissues. Evidence suggests that high intake of nitrate and nitrosamine from salted fish account for some of this increased risk of NPC development. Nitrosamines are known mutagens and animal carcinogens that induce gene mutation through the formation of DNA adducts which if not repaired may lead to point mutations. The N-nitrosamines are a large group of compounds with a common carcinogenic mechanism (Goldman et al., 2003). Salted fish has been shown to contain N-dimethylnitrosamine, N-diethylnitrosamine, N-nitrosopyrrolidene and N-nitrosopiperidine (Zou et al., 1992, Zou et al., 1994). Levels of these compounds were highest in salted fish from areas with the highest NPC mortality, while lower in areas
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with lower NPC mortality (Zou et al., 1992, Zou et al., 1994). Exposure of the nasopharynx to these agents may be particularly damaging in that the carcinogenic properties of nitrosamines are greatest following oral administration. In addition, the variation in nitrosamine content of salted fish may contribute to heterogeneity in assigning risk to salted fish consumption in different geographic locations.
Alkylating agents including nitrosamines produce DNA adducts, specifically 7-methylguanine and O6-methylguanine. The O6-methylguanine is mostly responsible for the mutagenicity and carcinogenicity of these alkylating agents (Goldman et al., 2003). Unfortunately, the genes targeted for mutational alteration in NPC have to a large degree not been identified, which does not allow a definitive association of nitrosamine exposure to tumor suppressor or oncogene mutation. Among the commonly mutated genes in other types of tumors, no reports describe mutation of k-ras and studies of mutation of the retinoblastoma gene (Lin et al., 1992, Sun et al., 1993) and p16/ CDKN2a (Lo et al., 1995, Sun et al., 1995) have all been negative. The most extensively studied gene in NPC for mutational alterations is p53, also the most commonly mutated gene in other malignancies. Ten published studies in the last 12 years have reported mutation of p53 ranging from 0-27% of NPC tumors studied (Burgos, 2003, Chakrani et al., 1995, Effert et al., 1992, Lo et al., 1992, Lung et al., 1998, Nasrin et al., 1994, Spruck et al., 1992, Sun et al., 1992, Van Tornout et al., 1997, Xie et al., 1997), with the 27% result in a study of only 11 tumors (Lung et al., 1998). Overall, 18 of 282 tumors have been found to contain p53 mutations (overall percentage 6%), suggesting that mutations in p53 are not common and do not provide a connection between nitrosamines and the progression of NPC. However, in at least one study (Van Tornout et al., 1997), all 4 of the mutations detected were GC>AT, of particular mechanistic importance for alkylating agents.
The O6-methylguanine leads to GC->AT transitions in cell-culture and animal models if not repaired by O6-methylguanine methyltransferase (MGMT), and as described above, this lesion is produced by alkylating agents. MGMT has been shown to be altered in NPC, although through epigenetic changes, rather than mutational inactivation. Hypermethyaltion of the promoter region of MGMT silences expression of this gene in many cancers (Esteller et al., 1999) which has been reported in 20-28% of nasopharyngeal cancer (Kwong et al., 2002, Wong et al., 2003). Inactivation of MGMT has been shown to be associated with the type of p53 mutations described above in lung and colon cancer (Esteller et al., 2001, Wolf et al., 2001), but due to the infrequent mutations in NPC has not been studied . As noted above, LMP-1 produced by EBV reactivation may also reduce DNA repair capacity, compounding the mutagenic effects of nitrosamine compounds.
Additional support for the importance of nitrosamines in the carcinogenic process of NPC is provided by studies examining the cytochrome p450 enzyme CYP2E1. N-nitrosodimethylamine undergoes enzymatic hydroxylation catalyzed mainly by CYP2E1, a step in the activation of carcinogenic adducts (Goldman et al., 2003). CYP2E1 is expressed in the nasopharynx and in NPC tumors (He et al., 2002). Increased activity of this enzyme would then result in increased activation of pro-carcinogens. A genetic polymorphism in the 5'-flanking region of the human CYP2E1, the C2 allele, affects binding of trans-acting factor to the promoter (Hayashi et al., 1991), This sequence change affects transcriptional regulation, resulting in up to 10-fold differences in promoter activity of the CYP2E1 gene (Hayashi et al., 1991). Studies have demonstrated an increased risk of developing NPC in patients with this variant form(Hildesheim et al., 1997a, Hildesheim et al., 1995, Kongruttanachok et al., 2001), (relative risks of 2-2.5, higher in non-smokers), consistent with the increased formation of carcinogenic nitrosamines from salted fish for those individuals. These studies suggest genetic modifiers of environmental exposure contribute to the risks inherent in consumption of salted fish. Such genetic variation may contribute to the heterogeneity in studies examining risk of NPC following salted fish consumption. Salted fish: Childhood consumption (Age 10)
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A3 Case-control studies (16) A total of 16 case-control studies reported on the association between salted fish intake at approximately 10 years of age and NPC. Nine of these studies reported data in sufficient detail to be included in a dose-response meta-analysis. The results of the dose-response meta-analysis based on the number of times salted fish was consumed per week when 10 years-old showed evidence of a strong trend of increasing NPC risk as salted fish intake increased (summary random effects RR 1.35; 95% CI 1.14-1.60 per time/week). B2 Size of effect The magnitude of the summary RR (summary random effects RR 1.35; 95% CI 1.14-1.60 per time/week) observed in the dose-response meta-analyses indicates a strong dose-response association between salted fish intake at age 10 years and NPC. B3 Biological Gradient The dose-response analyses are compatible with a strong dose-response trend between salted fish consumption and NPC, with a summary random effect RR of 1.35 (95% CI 1.14-1.60 per time/week). The results from eight of the nine studies that contributed evidence to the meta-analysis were in the direction of increased risk, with dose-response ORs ranging from 0.97 to 1.75 per time/week. There were three studies with OR point estimates of 1.10 to 1.20, one study with an OR between 1.21-1.50, and four studies with ORs between 1.51 and 1.75.
Dose-Response Graph: Salted fish intake at age 10, Case-control studies
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B4 Internal Consistency/heterogeneity by dietary methodology In these studies, salted fish intake was measured using study specific FFQs or dietary history questionnaires. All of the studies were hospital-based for case ascertainment. B5 Summary Illustrations of effects (e.g., forest plots)
Forest Plot for Dose-Response Analysis: Salted fish intake at age 10, Case-control studies
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Odds Ratio, times/week .1 1 3
Study
Effect size
(95% CI) % Weight
NAS01056 (Singapore, Lee, 1994) 0.97 ( 0.77, 1.22) 11.9
NAS01113 (Wuzhou China, Zheng, 1994) 1.19 ( 0.86, 1.64) 9.9
NAS01141 (Guangzhou China, Zheng, 1994) 1.75 ( 1.47, 2.08) 13.2
NAS01459 (Guangzhou China, Yu, 1989) 1.10 ( 1.03, 1.18) 14.9
NAS01520 (Yulin Guangxi China, Yu, 1988) 1.43 ( 0.71, 2.89) 4.2
NAS01608 (Hong Kong, Yu, 1986) 1.74 ( 1.40, 2.16) 12.2
NAS01712 (Selangor Malaysia, Armstrong, 1983) 1.51 ( 1.17, 1.96) 11.3
NAS01922 (Tianjin City China, Ning, 1990) 1.55 ( 1.18, 2.04) 11.0
NAS05679 (Taiwan, Yang, 2005) 1.18 ( 0.91, 1.53) 11.3
Overall 1.35 ( 1.14, 1.60) 100.0
Forest Plot for Highest vs. Lowest Analysis: Salted fish intake at age 10, Case-control studies
Odds Ratio: Highest vs. Lowest intake
.01 1 100
Study
Effect size
(95% CI)
NAS00531 (Taipei Taiwan, Ward, 2000) 1.50 ( 0.80, 2.81)
NAS00749 (Selangor Malaysia, Armstrong, 1998) 2.74 ( 1.59, 4.73)
NAS00821 (Taiwan, Hildesheim, 1997) 1.40 ( 0.45, 4.33)
NAS01056 (Singapore, Lee, 1994) 0.80 ( 0.21, 3.05)
NAS01113 (Wuzhou China, Zheng, 1994) 1.30 ( 0.80, 2.12)
NAS01141 (Guangzhou China, Zheng, 1994) 10.10 ( 5.07, 20.13)
NAS01459 (Guangzhou China, Yu, 1989) 2.10 ( 1.21, 3.64)
NAS01520 (Yulin Guangxi China, Yu, 1988) 1.50 ( 0.51, 4.40)
NAS01608 (Hong Kong, Yu, 1986) 37.70 ( 14.12, 100.65)
NAS01712 (Selangor Malaysia, Armstrong, 1983) 17.40 ( 2.71, 111.55)
NAS01766 (Alaska US, Lanier, 1980) 4.00 ( 0.57, 28.06)
NAS01922 (Tianjin City China, Ning, 1990) 6.70 ( 2.18, 20.56)
NAS05679 (Taiwan, Yang, 2005) 1.78 ( 0.82, 3.88)
NAS06020 (Heilongjiang China, Na, 1988) 5.50 ( 0.99, 30.62)
B6 Gene-nutrient interactions Does not apply. C Assessment of heterogeneity within and between study types
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Within the case-control dose-response meta-analysis, statistically significant heterogeneity was detected, with an I2 statistics of 83%. The presence of a dose-response trend was observed so consistently that the heterogeneity present relates primarily to the magnitude of the dose-response gradient, not with respect to the presence or absence of a dose-response trend. The results for eight of nine studies supported the presence of a positive dose-response trend. The relative weights that the studied contributed to the meta-analyses were mostly evenly distributed across many studies. A key source of the heterogeneity may be due to the study in Singapore of Lee et al (Lee et al., 1994), the one study in which a dose-response trend was completely absent. The fact that this was one of the few studies not conducted in China may also be relevant. D. Factors influencing heterogeneity and meta-regression A factor that could contribute to the variability in the observed magnitude of associations is between-region differences in specific methods of salted fish preparation, and possibly with the type of fish consumed. This could potentially lead to differences in the risk associated with salted fish consumption but this is difficult to rigorously assess with so few studies, leaving an insufficient number of studies per region to analyze separately. The one study in which a positive dose-response relationship was absent was a study conducted in Singapore (Lee et al., 1994), one of only two studies included in the dose-response meta-analysis that took place outside of China. E. Important quality issues for interpretation of the evidence The dose-response meta-analyses of case-control studies to assess the association between salted fish intake at age 10 years and NPC yielded results indicating that NPC risk increases markedly with greater intake of salted fish. Clearly, the potential role that confounding factors may be contributing to this statistical association is a key consideration in interpreting this body of evidence. All nine of these studies included adjustments for at least age and sex, and five also further controlled for neighborhood of residence. Other factors considered included indicators of socioeconomic status (2 studies). Importantly, cigarette smoking, alcohol drinking, and dietary factors were not taken into consideration in any of these studies. The absence of information on EBV infection status is particularly notable. The limited extent to which potential confounding variables have been controlled for is thus an important issue affecting the quality of the overall evidence. Another important issue related to quality of the evidence is the remote recall of diet, usually by the mother of the study participant. While the accuracy of reporting may be questionable, the main issue is the degree to which accuracy of reporting may differ by case-control status to introduce a bias. The consistency of the findings across studies conducted by different investigators in different locations suggests either this is unlikely to explain the findings or that the information bias is ubiquitous across studies. The former explanation seems more likely. Fourteen of the case-control studies could be included in highest-versus-lowest categories comparison. The results of this data summary strongly reinforce the evidence suggesting that salted fish intake at 10 years of age increases the risk of NPC. Of the 14 studies, only one reported an odds ratio of less than unity, whereas five studies reported odds ratios between 1.40 and 1.99, three studies reported odds ratios between 2.0 and 4.0, and in 5 studies odds ratios of greater than 4.0 were observed. Two of the 16 case-control studies that reported information concerning the association between childhood consumption of salted fish and NPC did not present sufficient data to be included in any of the quantitative data summaries. In a case-control study of 205 NPC cases and 205 controls carried out in China, Zheng et al reported in the text that cases were “significantly” more likely to have the highest salted fish consumption at age 10 years, without reporting a p-value or measure of association (Zheng et al., 1993). In a study in Malaysia comprised of 100 NPC cases and 100 controls, the case-control difference in current salted fish consumption in
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children was reported to be statistically significantly different (Armstrong et al., 1983a). This comparison was adjusted for age, sex, area of residence, and ethnicity. In summary, the case-control evidence is clear and consistent in suggesting that salted fish intake in 10-year-old children is associated with increased NPC risk. The evidence to specifically pinpoint the observed risks to salted fish would be more convincing if potential confounding factors had been more completely accounted for.
Funnel Plot for Dose-Response Analysis: Salted fish intake at age 10, Case-control studies
Begg's funnel plot with pseudo 95% confidence limits
logR
s.e. of: logR0 .2 .4
-.5
0
.5
1
Funnel Plot for Highest vs. Lowest Analysis: Salted fish intake at age 10, Case-control studies
Begg's funnel plot with pseudo 95% confidence limits
logR
s.e. of: logR0 .5 1
-2
0
2
4
Salted fish: Childhood consumption (Ages 0-3) A3 Case-control studies (10) A total of 10 case-control studies reported on the association between salted fish intake at during 0-3 years of age and NPC. Five of these studies reported data in sufficient detail to be included in a dose-response meta-
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analysis. The results of the dose-response meta-analysis based on the number of times salted fish was consumed per week when 0-3 years old showed evidence of a strong trend of increasing NPC risk as salted fish intake increased (summary random effects RR 1.42; 95% CI 1.11-1.81 per time/week). B2 Size of effect The magnitude of the summary RR (summary random effects RR 1.42; 95% CI 1.11-1.81 per time/week) observed in the dose-response meta-analyses indicates a strong dose-response association between salted fish intake at ages 0-3 years and NPC. B3 Biological Gradient The dose-response analyses are compatible with a strong dose-response trend between salted fish consumption and NPC, with a summary random effect RR of 1.42(95% CI 1.11-1.81 per time/week). The results from all five of the studies that contributed evidence to the meta-analysis were in the direction of increased risk, with dose-response ORs ranging from 1.21 to 1.84 per time/week. Four studies had OR point estimates of 1.21 to 1.21, with one study of relatively high influence reporting an OR of 1.84.
Dose-Response Graph: Salted fish intake at ages 0-3, Case-control studies
B4 Internal Consistency/heterogeneity by dietary methodology
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In these studies, salted fish intake was measured using study specific FFQs or dietary history questionnaires. All of the studies were hospital-based for case ascertainment. B5 Summary Illustrations of effects (e.g., forest plots)
Forest Plot for Dose-Response Analysis: Salted fish intake at ages 0-3, Case-control studies
Odds Ratio, times/week
.05 1 4
Study
Effect size
(95% CI) % Weight
NAS01056 (Singapore, Lee, 1994) 1.21 ( 0.36, 4.08) 3.7
NAS01113 (Wuzhou China, Zheng, 1994) 1.30 ( 0.80, 2.10) 15.2
NAS01141 (Guangzhou China, Zheng, 1994) 1.84 ( 1.56, 2.17) 31.6
NAS01459 (Guangzhou China, Yu, 1989) 1.21 ( 1.01, 1.46) 30.5
NAS01520 (Yulin Guangxi China, Yu, 1988) 1.31 ( 0.88, 1.93) 19.0
Overall 1.42 ( 1.11, 1.81) 100.0
Forest Plot for Highest vs. Lowest Analysis: Salted fish intake at ages 0-3, Case-control studies
Odds Ratio: Highest vs. Lowest intake
.01 1 60
Study
Effect size
(95% CI)
NAS00531 (Taipei Taiwan, Ward, 2000) 1.00 ( 0.49, 2.05)
NAS01056 (Singapore, Lee, 1994) 1.20 ( 0.36, 4.04)
NAS01113 (Wuzhou China, Zheng, 1994) 1.30 ( 0.80, 2.12)
NAS01141 (Guangzhou China, Zheng, 1994) 12.90 ( 6.48, 25.67)
NAS01459 (Guangzhou China, Yu, 1989) 2.00 ( 1.11, 3.61)
NAS01520 (Yulin Guangxi China, Yu, 1988) 2.20 ( 0.67, 7.24)
NAS01608 (Hong Kong, Yu, 1986) 20.20 ( 6.79, 60.06)
NAS01812 (Hong Kong, Geser, 1978) 2.60 ( 1.26, 5.37)
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B6 Gene-nutrient interactions Does not apply. C Assessment of heterogeneity within and between study types Within the case-control dose-response meta-analysis, statistically significant heterogeneity was detected, with an I2 statistics of 66%. The presence of a dose-response trend was observed so consistently in all five studies that the heterogeneity present relates primarily to the magnitude of the dose-response gradient, not with respect to the presence or absence of a dose-response trend. D. Factors influencing heterogeneity and meta-regression The only study that exhibited any variation from the narrow range of dose-response associations observed was the steeper dose-response gradient observed in a study conducted in Guangzhou, China (Zheng et al., 1994a). However, another study from this same region also reported findings that were more in keeping with the findings of others (Yu et al., 1989), suggesting that the heterogeneity is not due to regional variation in preservation techniques. E. Important quality issues for interpretation of the evidence The dose-response meta-analyses of case-control studies to assess the association between salted fish intake at ages 0-3 years and NPC yielded results indicating that NPC risk increases markedly with greater intake of salted fish. Clearly, the potential role that confounding factors may be contributing to this statistical association is a key consideration in interpreting this body of evidence. All five of these studies included adjustments for at least age and sex, and three also further controlled for neighborhood of residence. Other factors considered included indicators of socioeconomic status (2 studies). Importantly, cigarette smoking, alcohol drinking, and dietary factors were not taken into consideration in any of these studies. The absence of information on EBV infection status is particularly notable. The limited extent to which potential confounding variables have been controlled for is thus an important issue affecting the quality of the overall evidence. Another important issue related to quality of the evidence is the remote recall of diet, usually by the mother of the study participant. While the accuracy of reporting may be questionable, the main issue is the degree to which accuracy of reporting may differ by case-control status to introduce a bias. The consistency of the findings across studies conducted by different investigators in different locations suggests either this is unlikely to explain the findings or that the information bias is ubiquitous across studies. The former explanation seems more likely. Eight of the case-control studies could be included in highest-versus-lowest categories comparison. The results of this data summary strongly reinforce the evidence suggesting that salted fish intake at 0-3 years of age increases the risk of NPC. Of the eight studies, only one reported an odds ratio of unity, one study reported an odds ratio of 1.20, another 1.30, with the remaining five studies reporting odds ratios of 2.0 or greater. Two of the ten case-control studies that reported information concerning the association between early childhood consumption (0-3 years of age) of salted fish and NPC did not present sufficient data to be included in any of the quantitative data summaries. In a case-control study of 205 NPC cases and 205 controls carried out in China, Zheng et al reported in the text that cases were “significantly” more likely to have the highest salted fish consumption at ages 0-3 years, without reporting a p-value or measure of association (Zheng et al., 1993). Jeannel and colleagues specifically examined consumption of salted anchovies during weaning in a case-control study of 80 NPC cases and 160 controls in Tunisia (Jeannel et al., 1990a). The reported odds ratio was 1.5 with a p-value of 0.5. The results were adjusted for age, sex, area of residence, and living condition score. Thus, the studies not included in the quantitative syntheses of the evidence also tend support the findings observed in the meta-analyses.
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In summary, the case-control evidence is clear and consistent in suggesting that salted fish intake in children ages 0 to 3 years is associated with increased NPC risk. The evidence to specifically pinpoint the observed risks to salted fish would be more convincing if potential confounding factors had been more completely accounted for.
Funnel Plot for Dose-Response Analysis: Salted fish intake at ages 0-3, Case-control studies
Begg's funnel plot with pseudo 95% confidence limits
logR
s.e. of: logR0 .2 .4 .6
-1
0
1
2
Funnel Plot for Highest vs. Lowest Analysis: Salted fish intake at ages 0-3, Case-control studies
Begg's funnel plot with pseudo 95% confidence limits
logR
s.e. of: logR0 .2 .4 .6
-1
0
1
2
3
Salted fish: Mother’s consumption during pregnancy or breastfeeding A3 Case-control studies (3) Three case-control studies reported on the relationship between NPC and mother’s consumption of salted fish during pregnancy or while breastfeeding. Two of these studies were carried out in China, and the other took place in Singapore among individuals of Chinese ethnicity. Both of the studies conducted in China were carried out by Yu and colleagues. In the first of these studies, comparing 128 NPC cases with 174 controls, Yu and
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colleagues observed that both consumption of salted fish during pregnancy and during nursing were associated with increased subsequent risk of NPC in the offspring (Yu et al., 1988). The odds ratios for these associations were consistent with a greater than three-fold increased risk with 95% confidence intervals that did not overlap unity after adjusting for age and sex. These results were corroborated in the second of the studies carried out in China, also by Yu and colleagues (Yu et al., 1989), in which the odds ratios for these associations were consistent with a greater than two-fold increased risk with 95% confidence intervals that did not overlap unity after adjusting for age, sex, and neighborhood. These results were based on a comparison of 306 NPC cases with 306 controls. In the study conducted in Singapore by Lee and colleagues, 49 NPC cases were compared to 96 controls, and the results were adjusted for age, sex, ethnicity, and education (Lee et al., 1994). Due to the smaller sample size, among other factors, the 95% confidence intervals were quite wide, but the point estimates of the odds ratios for maternal salted fish consumption during pregnancy (1.3) and during breastfeeding (2.0) were again in the direction of increased risk, although the associations were weaker than in the studies conducted in China.
The results of these three studies thus provide evidence that maternal salted fish consumption during pregnancy and breastfeeding is statistically associated with subsequent risk of NPC in offspring. Prominent among the many factors that have not been accounted for in these studies is whether this observed association is due this measured exposure simply because it is a marker of subsequent salted fish consumption by the index youth. 4.2.5.3.2 Salted plant food Total preserved vegetables: Adulthood consumption A3 Case-control studies (2) A total of 2 case-control studies reported results for salted vegetables and NPC. A study by Zheng et al reported a significant risk association for salted vegetables, but did not provide more details (Zheng et al., 1993). In a study of 100 cases and 300 matched controls conducted in China, no significant associations were reported for salted vegetables (Ning et al., 1990). Total preserved vegetables: Childhood/Infancy consumption A3 Case-control studies (1) One case-control study investigated salted vegetables during childhood and risk of NPC. Ning et al observed no significant associations for salted vegetables at age 10 (Ning et al., 1990). Salted Root Vegetables A3 Case-control studies (1) The association between preserved root vegetables and NPC was evaluated in a single case-control study. Salted root vegetables were reported to be significantly associated with NPC among 97 cases and 192 controls in China (unadjusted OR=2.2; 95% CL: 1.3-2.2) (Zou, 1999). Salted Cruciferous Vegetables: Adulthood consumption A3 Case-control studies (2) Both studies reporting results for salted cruciferous vegetables consumed during adulthood included Chinese men and women from Singapore or China. In the study by Lee et al, results for salted mustard greens (OR=3.1,
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95% CI: 1.4-6.5) were reported as significant (Lee et al., 1994). Yu et al reported no significant association for salted mustard greens (Yu et al., 1986). Salted Cruciferous Vegetables: Childhood consumption A3 Case-control studies (2) Two studies focused on salted cruciferous vegetables and any age group below age 10 years. Both studies (Lee et al., 1994, Yu et al., 1988) examining the risk of salted mustard greens at age 10 showed no association. Yu et al also assessed consumption at ages 1-2 and weaning. No association was observed at ages 1-2, but salted mustard greens consumed during weaning were reported to be in the risk direction (OR=5.4, 95% CI: 1.2-23.8) in an ever-versus-never analysis. Yu et al observed no significant associations for salted cabbage or salted radish at age 10 and NPC. Salted Green Leafy Vegetables: Adulthood consumption A3 Case-control studies (1) One case-control study evaluated the association between salted green leafy vegetables and NPC. The study of Chinese in Malaysia reported an unadjusted odds ratio of 3.33 (95% CI: 1.84-6.01) when comparing more than weekly intake of salted green leafy vegetables to monthly consumption (Armstrong et al., 1998b). Salted Green Leafy Vegetables: Childhood consumption A3 Case-control studies (1) One case-control study evaluated the association between salted green leafy vegetables consumed during childhood and NPC. The study of Chinese in Malaysia reported an unadjusted odds ratio of 0.84 (95% CI: 0.45-1.58) when comparing more than weekly intake of salted green leafy vegetables at age 10 to monthly consumption (Armstrong et al., 1998b). Salted Vegetables: Adulthood consumption A3 Case-control studies (2) Zou et al observed a significant risk association for salted non-starchy vegetables when consumed more than 9 times a month (OR=2.28, 95% CI: 1.40-3.73) in a study of 100 cases and 202 controls in China (Zou, 1999). The other study (Chen et al., 1997) reported no significant association between salted vegetables and NPC. Salted Vegetables: Childhood consumption A3 Case-control studies (2) Two studies reported on salted vegetables consumed during childhood; both reported significant protective associations for intake at age 10. In the first study to examine salted vegetables (Chen et al., 1997), 104 cases and 104 controls were matched by age, sex, and area of residence and a logistic regression odds ratio of 0.76 (95% CI: 0.58-0.99) was observed. The second study (Huang, 1997) reported similar results (OR=0.755, 95% CI: 0.58-1.0) for salted vegetables. Other Salted Vegetables: Adulthood consumption A3 Case-control studies (2) Salted vegetables consumed during adulthood was investigated in 2 case-control studies, both reported significant risk associations with NPC. Armstrong et al observed more than weekly consumption of salted root
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to be a risk factor for NPC (OR=2.19, 95% CI: 1.33-3.62) in study of Chinese in Malaysia (Armstrong et al., 1998b). After adjusting for age, sex, education level, and dialect group, salted Chinese tuber consumption was significantly associated with NPC (OR=2.4, 95% CI: 1.1-5.2) in a study of Chinese in Singapore (Lee et al., 1994). Other Salted Vegetables: Childhood consumption A3 Case-control studies (3) In three studies, associations in the direction of increased risk were observed relating salted vegetable intake during childhood and NPC (Armstrong et al., 1998b, Lee et al., 1994). Salted root intake at age 10 was in the risk direction, but not significant in 2 studies. The first study of Chinese in Malaysia included 282 cases and 282 controls (Armstrong, 1998) and observed an odds ratio f 1.75 (95% CI: 0.98-3.10) for more than weekly consumption compared to monthly consumption. The second study to examine salted root included 128 cases and 174 controls from China (Yu et al., 1988) and reported an age and sex adjusted odds ratio of 3.2 (95% CI: 0.6-17.6) for daily consumption compared to rare intake. In the same study by Yu et al, a significant association was observed for chung choi consumption during weaning using a maximally adjusted model (OR=0.518, p=0.042). Sze chuan chye, a salted Chinese tuber, was not found to be associated with NPC (OR=1.4, 95% CI: 0.4-4.5) in a study of Chinese in Singapore which included 145 cases and 340 controls (Lee et al., 1994). Salted olives: Adulthood consumption A3 Case-control studies (1) One case-control study evaluated the relationship between salted olives consumed during adulthood and NPC. An adjusted odds ratio of 1.6 (95% CI: 0.3-7.5) was reported for intake of salted black olives more than once a month compared to no intake among 200 cases and 406 controls of Chinese in Singapore (Lee et al., 1994). Salted olives: Childhood consumption A3 Case-control studies (2) Two studies investigated the relationship between consumption of salted olives at age 10 and NPC risk. The first study of Chinese in Singapore reported a significant inverse association between salted black olives eaten more than once a month and NPC (OR=0.3, 95% CI: 0.1-0.9) (Lee et al., 1994). The second study of 128 cases and 174 controls conducted in China reported a non-significant association between salted olive intake at age 10 and NPC when adjusting for age and sex (Yu et al., 1988). Salted soy: Adulthood consumption A3 Case-control studies (2) Two case-control studies examined risks of NPC associated with exposure to salted soy consumption during adulthood. Lee et al showed significant positive associations (OR=6.7, 95% CI: 1.2-36.6) when the highest exposure was compared to the lowest (Lee et al., 1994). The second study only indicated a significant association with NPC in the text without providing details (Zheng et al., 1993). Salted soy: Childhood consumption A3 Case-control studies (1)
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One case-control study examined risks of NPC associated with exposure to salted soy consumption during childhood. Lee et al showed no significant association (OR=1.1, 95% CI: 0.5-2.2) when the highest exposure was compared to the lowest (Lee et al., 1994). Other salted pulses/legumes A3 Case-control studies (1) Salted black beans were not associated with NPC when consumed during adulthood (OR=2.1, 95% CI: 0.8-5.4) or at age 10 (OR=1.0, 95% CI: 0.4-2.3) in a study of Chinese in Singapore (Lee et al., 1994). 4.2.6 Pickling Total pickled foods A3 Case-control studies (1) One study reported on consumption of pickled foods and NPC. In a matched case-control study in China, evidence of a risk association (OR=3.21, 95% CI: 1.71-5.71) was observed for frequent consumption of pickled foods (Huang, 2002). Pickled vegetables: Adulthood consumption A3 Case-control studies (2) A total of 2 case-control studies reported results for pickled vegetables and NPC. In a study of 100 cases and 300 matched controls conducted in China, no significant associations were reported for pickled vegetables (Ning et al., 1990). The second study included 100 cases and 100 controls in China and observed a significant regression slope of 0.015 for the intake of pickled vegetables after adjusting for environmental factors, gas range, pungent foods, and socio-economic status (Duan, 2000). Pickled vegetables: Childhood/Infancy consumption A3 Case-control studies (2) Two case-control studies investigated pickled vegetables during childhood and risk of NPC. A study by Jeannel et al reported an adjusted odds ratio of 2.2 for consumption of pickled vegetables during weaning, but no other details were offered (Jeannel et al., 1990a). Ning et al observed no significant associations for pickled vegetables at age 10 (Ning et al., 1990). Pickled Root Vegetables A3 Case-control studies (1) The association between pickled root vegetables and NPC was evaluated in a single case-control study. In a Chinese study, pickled root vegetables consumed at age 10 were inversely associated with NPC (OR=0.75, 95% CI: 0.57-0.99) (Huang, 1997). Pickled Cruciferous Vegetables: Adulthood consumption A3 Case-control studies (2) Both studies included Chinese men and women from Singapore or China. The first study by Chen et al observed no significant association between pickled Chinese cabbage and NPC (Chen et al., 1997). In the
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second study, both pickled leaf mustard (OR=6.11, p<0.01) and pickled radish (OR=1.75, 95% CI: 1.10-2.79) were observed to be significantly related to NPC (Ye, 1995). Pickled Cruciferous Vegetables: Childhood consumption A3 Case-control studies (2) Two studies focused on pickled cruciferous vegetables and NPC. Both studies assessed the association between pickled cabbages at age 10. Chen et al reported a protective odds ratio of 0.75 (95% CI: 0.57-0.99) for pickled cabbage consumption at age 10, whereas Yu et al observed no significant association (Chen et al., 1997, Yu et al., 1988). Other Pickled Vegetables: Adulthood consumption A3 Case-control studies (2) Pickled vegetables consumed during adulthood was investigated in 2 case-control studies, both reported significant risk associations with NPC. An ever-versus-never odds ratio of 3.3 (p=0.03) was observed for pickled vegetables with fungus after adjusting for age, sex, area of residence, and living condition score in a Tunisian study of 80 cases and 160 controls (Jeannel et al., 1990a). Zou et al reported a significant risk for pickles (OR=2.2, 95% CI: 1.3-3.6) when consumed 9 or more times month in a Chinese study (Zou, 1999). Other Pickled Vegetables: Childhood consumption A3 Case-control studies (1) In one study an association in the direction of increased risk was observed in relation to pickled vegetable intake during childhood and NPC. Jeannel et al reported a significant risk association for pickled vegetables with fungus consumed during weaning (OR=3.8, p=0.03) in a study of Tunisian cases and controls (Jeannel et al., 1990a). Pickled olives: Adulthood consumption A3 Case-control studies (1) One case-control study evaluated the relationship between pickled olives consumed during adulthood and NPC. The study of 80 cases and 160 controls in Tunisia reported a maximally adjusted odds ratio of 8.7 for consumption of pickled olives in the year preceding diagnosis (Jeannel et al., 1990a). Pickled spice intake A3 Case-control studies (2) Two case-control studies examined the risk of NPC and exposure to pickled spices. Laouamri et al observed significant positive associations from an Algerian study which evaluated pickled peppers (OR=2.85, 95% CI: 1.25-6.45) (Laouamri et al., 2001). The second study observed a protective association for pickled chili consumed during 3 meals (OR=0.3, p<0.01) in a study of Chinese in Malaysia (Armstrong, 1978). 4.2.7 Curing and smoking No results found. 4.2.7.1 Cured foods
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No results found. 4.2.7.1.1 Cured meats Cured meat: Adulthood consumption A3 Case-control studies (2) Two case control studies addressed the question of whether consumption of cured meats in adults was associated with an increased risk of NPC. Ward et al found no significant risk associated with consumption of cured meats adjusting for age, sex, and ethnicity when comparing Taiwanese subjects on a never/ever intake basis (Ward et al., 2000). Ning et al examined consumption of cured meats and found no significant association with these foods and NPC (Ning et al., 1990). Cured meat: Childhood consumption A3 Case-control studies (2) Two case control studies addressed risks of NPC from consumption of cured meat in childhood. The Ward et al study in Taiwanese examined the risks for children exposed according to cured meats at age 10 years and observed no significant association (Ward et al., 2000). The study by Ning et al examined exposures to cured meats at age 10 and indicated non-significant associations without any further details (Ning et al., 1990). 4.2.7.1.2 Smoked foods Smoked meat: Adulthood consumption A3 Case-control studies (4) Four case control studies addressed the question of whether consumption of smoked meats in adults was associated with an increased risk of NPC. Two of the studies found no significant association between consumption of smoked meat products and occurrence of NPC. Ward et al found no significant risk associated with consumption of either cured or smoked meats adjusted for age, sex, and ethnicity when comparing Taiwanese subjects on a never/ever intake basis (Ward et al., 2000). Ning et al examined consumption of smoked meats and found no significant association with these foods and NPC (Ning et al., 1990). Two studies reported significant associations between exposure to smoked meats and NPC. The Chelleng et al study of consumption of smoked meats in Indians reported an odds ratio of 10.8 based on a never/ever exposed classification and adjusted for multiple household environmental variables as well as tobacco and alcohol use (Chelleng et al., 2000). Zou et al reported an ever-versus-never odds ratio of 1.8 (95% CI: 1.09-2.97) for smoked processed meat in a Chinese study (Zou, 1999). Smoked meat: Childhood consumption A3 Case-control studies (2) Two case control studies addressed risks of NPC from consumption of smoked meat in childhood. Both studies included only Chinese and indicated no significant associations between consumption of smoked meats at various ages in childhood and the risk of NPC adjusting for age and sex. The Ward et al study in Taiwanese examined the risks for children exposed according to smoked meats at age 10 years, 3 years and at weaning (Ward et al., 2000). The odds ratios were all between 1.1 and 2.2 using an ever/never exposure range. The study by Ning et al examined exposures to smoked meats at age 10 and indicated non-significant associations for all measures without any further details (Ning et al., 1990).
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4.3 Processing Processed meat: Adulthood consumption A3 Case-control studies (5) Five case-control studies have examined the relationship of processed meats to the risk of NPC Three studies were done in Chinese in China or in Singapore, one in the Philippines (West et al., 1993) and one in the USA with unknown ethnicity of the subjects (Farrow et al., 1998). All of the studies had between 100 and 250 cases. Four of the studies reported no significant association of consumption of processed meat and the risk of NPC. The Farrow study in the USA found no association with all processed meats based on the NCI food frequency questionnaire and no trend after adjustment for age sex energy intake and alcohol and smoking. The Lee et al study using a study-specific food frequency questionnaire to identify exposure to Chinese sausage found no association or trend after adjustment for age and sex (Lee et al., 1994). The Yu et al study examined liver sausage intake for subjects at age 10 and three years before diagnosis using a food frequency questionnaire and found no association after adjustment for age, sex and salted fish intake but with no details regarding the analysis (Yu et al., 1986). The West et al study of processed meats in general determined from an unspecified assessment instrument found a very low odds ratio of 0.46 based on tertiles of exposure that was of borderline significance when adjusted for the usual variables plus environmental factors, fish intake and herbal medicines. Only the study of Zou et al reported an association (odds ratio 1.8) between smoked processed meats and NPC without any adjustments for potential confounding variables (Zou, 1999).
Forest Plot for Highest vs. Lowest Analysis: Processed Meat, Case-control studies
Odds Ratio: Highest vs. Lowest intake
.05 1 3
Study
Effect size
(95% CI)
NAS00700 (Farrow, 1998) 1.54 ( 0.71, 3.33)
NAS01056 (Lee, 1994) 1.00 ( 0.33, 3.06)
NAS01153 (West, 1993) 0.46 ( 0.21, 1.03)
NAS06023 (Zou, 1999) 1.80 ( 1.09, 2.97)
Processed meat: Childhood consumption A3 Case-control studies (3) Three studies reporting results for processed meat during childhood examined types of sausage and observed no significant associations. The three studies were all done in China and used study-specific food frequency questionnaires to identify exposures. The number of cases in the studies ranged from 128 to 250. All studies adjusted at least for age and sex. All reported that the odds ratios were non-significant for any association but
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only the Lee et al study reported the actual odds ratio as 0.8 (Lee et al., 1994). Both the Lee et al and the Yu et al study reported the association between Chinese sausage and liver sausage respectively based on exposure at age 10 (Lee et al., 1994, Yu et al., 1988). The Yu et al study reported the association between liver sausage exposure at age 10 years and 3 years before diagnosis as reported under the adult consumption (Yu et al., 1986). Processed pork A3 Case-control studies (3) Three case-control studies, all implemented in China, reported on the association between processed pork consumption and NPC. The studies ranged in size from 128 cases/174 controls to 250 cases/250 controls, and all used study-specific food frequency questionnaires to measure the dietary exposure. None of the studies reported measures of association, but rather only whether the results were “statistically significant” or not. The one study to report a significant increased NPC risk was for the exposure of “salted pork” (Zheng et al., 1993). Consumption of salted pork or pork sausage at age 10 years or as an adult was reported to be not significantly associated with NPC risk in two other studies (Yu et al., 1986, Yu et al., 1988). 4.3.1 Refining Bread: Adulthood consumption A3 Case-control studies (3) Three case-control studies reported on the potential association between eating bread as an adult and risk of NPC. Two of these studies were carried out in China. In the first of the studies in China, Yu and colleagues observed that bread consumption during adulthood (Yu et al., 1989) was not significantly associated with NPC risk. These results were only reported in the text of the paper. In the second of the studies carried out in China, the households of NPC cases were significantly less likely to often eat bread compared to the households of the controls (OR 0.43; 95% CL 0.27, 0.70) (Geser et al., 1978). The third study investigated Chinese living in Malaysia. In this study, cases were significantly more likely than controls to consume bread for breakfast, but further details were not reported (Armstrong, 1978). Interpreting the results of these three studies, which were very inconsistent, is hindered by the lack of detailed information. The inconsistent overall results could be a consequence of the heterogeneity in the exposures and study design features, or to fluctuation around an overall null result. Bread: Childhood consumption A3 Case-control studies (3) Three case-control studies reported on childhood bread consumption in relation to NPC risk. Two of these studies were carried out by Yu and colleagues in China. For these, the exposure measured was bread consumption at ten years of age. In results that were adjusted for at least age and sex, Yu and colleagues observed that bread consumption at age 10 years (Yu et al., 1989, Yu et al., 1988) was not significantly associated with NPC risk, as reported in the text of these papers. In contrast to these studies, the other study on this topic was conducted in Algeria and the exposure investigated was chewing bread crust during teething. In this study, the odds of chewing the crust of bread when teething were identical in NPC cases and controls (Laouamri et al., 2001). Overall, this evidence is consistent in suggesting that bread consumption during childhood is not associated with NPC. Noodles A3 Case-control studies (1)
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A study of Chinese in Malaysia compared 60 NPC cases to 150 controls with respect to the extent that the families of study participants ate noodles during meals. In matched analyses, the overall matched odds ratio of 1.2 indicates that families of cases were slightly more likely than the families of controls to eat noodles with their meals (Armstrong, 1978). In analyses by ethnic group, a stronger, statistically significant association was observed in the combined Hokkien plus Teochiu group. Rice A3 Case-control studies (2) Two studies reported on the association between eating rice and risk of NPC. A study of Chinese in Malaysia reported on the following associations: family eats rice for breakfast, family eats plain rice during evening meals, and family eats rice porridge during evening meal (Armstrong, 1978). Patterns of familial rice consumption were described in the text with very little detail. This study compared 60 NPC cases to 150 controls. A study carried out in China compared 104 NPC cases with 104 controls. In results that were unadjusted, eating rice at age 10 was inversely associated with risk of NPC (OR 0.71; 95% CI 0.51-0.92) (Huang, 1997). A5 Ecological studies (1) One study examined the per capita consumption of rice as determined in a food survey in both sexes of Chinese living in Hong Kong. The age-adjusted rates of NPC were significantly positively correlated with consumption of rice in both males and females (Koo et al., 1997). 4.3.2 Hydrogenation A3 Case-control studies (1) One case-control study reported on the relationship between dietary intake of margarine and the occurrence of NPC. In the study of Chinese in Singapore, more frequent margarine consumption at age 10 was inversely associated with NPC risk (OR 0.6; 95% CI 0.3-1.1), after adjusting for age, sex, ethnicity, and education (Lee et al., 1994). 4.3.3 Fermenting Fermented soy/tofu: Adulthood consumption A3 Case-control studies (6) Six case-control studies examined risks of NPC associated with exposure to fermented soy/tofu consumption during adulthood; however, only 2 provided enough detail for meta-analysis. The exposures included in this section were homogeneous in that all consisted of tofu/soy products that were not fresh. The studies were comparable in quality and only differed by the useable detailed information provided. None of the studies adequately controlled for other food intake that would allow evaluation of fermentation versus non-preservation of the same foods. Of the 6 studies in adults, 1 showed significant positive associations (Yuan et al., 2000b) and 1 showed non-significant positive associations (Zou, 1999), when the highest exposure was compared to the lowest. The remaining studies only indicated significant (Yu et al., 1989) or non-significant (Ning et al., 1990, Ward et al., 2000, Yu et al., 1986, Yu et al., 1989) associations with NPC in the text without providing details. Fermented soy/tofu: Childhood consumption A3 Case-control studies (6)
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Six case-control studies examined risks of NPC associated with exposure to fermented soy/tofu consumption during childhood; however, only 3 provided enough detail for meta-analysis. Studies of childhood intake of fermented tofu/soy products in relation to NPC risk (Lee et al., 1994, Ning et al., 1990, Ward et al., 2000, Yu et al., 1988) indicated no significant increased risk for fermented soy/tofu products. In fact, analyses by (Ward et al., 2000) and (Ning et al., 1990) suggested odds ratios below one, but (Yu et al., 1988) suggested significantly increased risks from consumption of fermented soy bean products. Other fermented pulses/legumes A2 Cohort studies (1) One cohort study reported the association between fermented pulses and NPC (Lin, 1997). A significant association (RR=12.7, 95% CI: 2.2-72.3) was observed for intake 6 or more times a week compared to intake less than twice a week when adjusting for age, EBV status, family history of NPC, and nasopharyngitis in the cohort of 9775 Chinese men in Taiwan. A3 Case-control studies (2) This exposure consisted of fermented black bean paste and fermented beans. Yu et al reported a high risk for fermented black bean paste when consumed at ages 1-2 (OR=4.6, 95% CI: 1.8-11.4), but not when consumed at age 10 (OR=1.4, 95% CI: 0.6-3.1) in a study from China (Yu et al., 1988). When consumed more than 9 times a month, fermented beans were reported as a risk factor for NPC (OR=2.1, 95% CI: 1.3-3.4) in another study from China (Zou, 1999). Fermented fish A3 Case-control studies (2) Two case-control studies contributed evidence concerning intake of fermented fish and NPC. Intake of fermented fish sauce at different ages was evaluated in a Chinese study by Yu et al (Yu et al., 1989). Although no estimates of risk were provided, no significance was reported for highest-versus-lowest analyses or over trends at any age of intake. Likewise, Yu et al reported no significant association for the consumption of fermented fish paste at age 10 (Yu et al., 1988). Fermented seafood: Childhood consumption A3 Case-control studies (1) One study investigated the risks of NPC associated with eating of fermented seafood in childhood. Yu et al examined the risks associated with consumption fermented crab or shrimp pastes at age 10 and found no association even after adjustment for basic variables (Yu et al., 1988). Fermented eggs A3 Case-control studies (2) Two case-control studies examined the risk of NPC associated with the consumption of fermented eggs (Ning et al., 1990, Yu et al., 1988). Both studies included Chinese from China and used study-specific food frequency questionnaires to identify exposures. Neither study specified the odds ratios but simply reported no significant associations between the cancers and duck eggs at 10 years of age or 3 years prior to diagnosis. Soy sauce A3 Case-control studies (3)
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Three case-control studies have examined the association of NPC with consumption of soy sauce. The studies used food frequency questionnaires except for the study of Armstrong et al that used recall as an assessment tool. The Armstrong et al study also evaluated the characteristics of the family exposure rather than the individual (Armstrong, 1978). One study had two sets of controls (Shanmugaratnam et al., 1978). All studies were in Chinese and most reported several factors used in adjustment. All studies resulted in non-significant associations between soy sauce and NPC. Other fermented condiment intake: Adulthood consumption A3 Case-control studies (2) Two case-control studies evaluated other fermented condiments in relation to NPC. Both studies included Chinese men and women, one in China (Yuan et al., 2000b) and the other in Hong Kong (Geser et al., 1978). No significant associations were reported for the consumption of fish sauce or oyster sauce in either study. Other fermented condiment intake: Childhood consumption A3 Case-control studies (1) One case-control study from China evaluated fermented condiments consumed during childhood and NPC. Yu et al reported non-significant associations for various condiments, including soy sauce, fish sauce, and oyster sauce, consumed at age 10 (Yu et al., 1988). 4.3.4 Compositional manipulation No results found. 4.3.4.1 Fortification No results found. 4.3.4.2 Genetic modification No results found. 4.3.4.3 Other methods No results found. 4.3.5 Food additives No results found. 4.3.5.1 Flavours A3 Case-control studies (3) Three case-control studies were ascertained that investigated flavours in relation to NPC. All of these studies were conducted in China. In the study of Zheng and colleagues, NPC cases (n=88) were slightly and non-significantly less likely than controls (n=176) to have used monosodium glutamate during the past year (OR 0.7; p=0.3), after adjusting for age, sex, area of residence, and socioeconomic status (Zheng et al., 1994b). In a
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study of flavour essence, Geser and colleagues observed significant difference between those who did and did not use flavour essence (Geser et al., 1978). Duan and colleagues, in a study of 100 cases and 100 controls, reported that consumption of pungent foods was significantly and inversely associated with NPC risk (Duan, 2000). Despite the homogeneity of all the studies being conducted in China, the heterogeneity in the flavours investigated in these studies makes it difficult to draw strong inferences. 4.3.5.2 Sweeteners (non-caloric) No results found. 4.3.5.3 Colours No results found. 4.3.5.4 Preservatives No results found. 4.3.5.4.1 Nitrites and nitrates A3 Case-control studies (1) In a case-control study of 378 cases and 327 controls in China, Ward and colleagues assessed nitrate and nitrate intake using a dietary questionnaire (Ward et al., 2000). After adjusting for age, sex, ethnicity, and total calories, adult intake of nitrate from fresh and preserved vegetables was inversely associated with NPC risk (OR 0.5; 95% CL 0.3, 0.8). Intake of nitrite from soybean products during infancy or childhood was not significantly associated with NPC, after adjustments for age, sex, ethnicity, and vegetable intake. A5 Ecological studies (3) The ecologic evidence concerning the potential association between nitrites/nitrates in drinking water and NPC comes from a trio of reports from China and Taiwan. In an ecologic study conducted in Guangdong, pickles in the high-risk area of Sihui contained significantly higher concentrations of nitrites/nitrates than the low risk area of Wuhua (Huang, 1988). This association had not been observed in an earlier study by Huang and colleagues (Huang, 1982). However, Huang and colleagues published another report in which an association in the risk direction was present but the difference was not significant (Huang, 1983). 4.3.5.5 Solvents No results found. 4.3.5.6 Fat substitutes No results found. 4.3.5.7 Other food additives No results found. 4.3.6 Packaging
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No results found. 4.3.6.1 Vinyl chloride No results found. 4.3.6.2 Phthalates No results found. 4.4 Preparation No results found. 4.4.1 Fresh food Fresh animal foods Fresh meat: Adulthood consumption A3 Case-control studies (4) Four case-control studies examined this exposure in China using study-specific food frequency questionnaires except for the study of Armstrong et al which evaluated exposure with a dietary history questionnaire. The three studies that examined consumption of fresh organ meats at any time prior to diagnosis and consumption of fresh meat and or fresh liver three years prior to diagnosis indicated no significant associations with these foods and NPC but provided no details regarding the conduct of the analysis (Ning et al., 1990, Yu et al., 1989, Yuan et al., 2000b). The study of Armstrong et al showed increased significant associations between NPC and both consumption of fresh liver at age 10 and 5 years prior to diagnosis as well as consumption of other pork/beef organs 5 years prior to diagnosis (Armstrong et al., 1998b). Exposures compared weekly consumption versus less than monthly and trend analysis for the liver consumption was also positive. None of the analyses were adjusted for any confounding variables. Fresh meat: Childhood consumption A3 Case-control studies (4) Four case-control studies examined the risks of NPC associated with childhood consumption of fresh meats. All studies but Armstrong et al used study-specific food frequency questionnaires and all showed no significant associations. The exposures included fresh meat at ages 10 and 1-2 and during weaning and one study specified consumption of fresh liver intake at age 10. None of the studies provided details of the analysis and all adjusted only for age and sex and sometimes area of residence (Ning et al., 1990, Yu et al., 1989, Yu et al., 1988). Only the Armstrong et al study reported a significant positive association with consumption of fresh liver at age 10 or 5 years before diagnosis but not with consumption of other organ meat at age 10 based on a dietary questionnaire (Armstrong et al., 1998b). The comparison of frequency of intake compared to less than monthly yielded a highly significant positive trend but the odds ratio of 2 was not adjusted for any potential confounding variables. Fresh fish
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A3 Case-control studies (3) Three studies from China evaluated intake of fresh fish at varying ages in relation to NPC risk. None of the studies observed significant associations for any of the age groups analyzed. In the first study (Yu et al., 1989), no significant associations were observed among matched cases and controls for intake of fresh fish sauce during adulthood, at age 10, or at ages 1-2. A second study by Yu et al reported similar non-significant associations for fresh fish consumption at age 10, at ages 1-2 (p=0.23), and during weaning (p=0.09) (Yu et al., 1988). Likewise, the third study by Ning et al reported non-significant results for boiled fish consumption during adulthood and at age 10 (Ning et al., 1990). Fresh seafood A3 Case-control studies (3) Three case-control studies examined the association between fresh shellfish and the risk of NPC. All studies included only persons of Chinese background. Two studies were done in China and used study-specific food frequency questionnaires. These studies included 100 cases (Ning et al., 1990) and 935 cases (Yuan et al., 2000b). Both of these studies reported no significant association of the cancer with exposures to fresh seafood generally (Yuan et al., 2000b) and crab or fresh jellyfish consumed at age 10 and in the three years prior to diagnoses in separate analyses. No details were given regarding the analyses. A study by Armstrong et al was done in Malaysia and used a dietary history questionnaire or recall (Armstrong, 1978). The study found a protective effect associated with the family eating fresh prawns at the evening meal or any meal with a significant odds ratio of 0.7 with adjustment for age, sex, race, SES, residence and lifestyle factors. Fresh eggs A3 Case-control studies (3) Three studies examined the risks of NPC associated with consumption of fresh eggs at different ages in Chinese from China (two studies) and Malaysia (Armstrong, 1978). All studies used a study-specific food frequency questionnaire except for Armstrong 1978 who measured exposures through recall. All studies adjusted for the basic variables of age and sex for at least some of the analyses with the exception of Yuan et al. None of the studies showed an association with exposure to fresh eggs at any age (Yuan et al., 2000b) or at age 10 years, at 1-2 years (Yu et al., 1988), or at weaning (Yu et al) with the exception of the Armstrong et al study that indicated a significant negative association for consumption of eggs by the family at evening meals. However, the same study showed no association with family consumption of eggs at other meals. Fresh milk A3 Case-control studies (1) One case-control study in China reported findings on consumption of fresh milk in relation to NPC. The study in China (Yuan et al., 2000b) reported that the findings between NPC and drinking fresh milk were not statistically significant in the text, without presenting measures of association. Fresh plant food Fresh vegetables: Adulthood consumption A3 Case-control studies (2) A total of 2 case-control studies reported results for fresh vegetables and NPC. Both studies were conducted in China and matched cases and controls. Yuan et al reported a maximally adjusted odds ratio of 0.85 (95% CI:
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0.65-1.10) when comparing intake more than 2.4 times a day to intake less than 1.5 times per day (Yuan et al., 2000b). The second study only reported a non-significant association between consumption of fresh vegetables 3 years prior to diagnosis and NPC (Ning et al., 1990). A5 Ecological studies (1) One ecological study examined the risk of NPC related to consumption of fresh vegetables in Chinese residents in Hong Kong. The study used per capita consumption to identify exposures and indicated significant correlations between the consumption of fresh vegetables and NPC after adjusting for age (r2=-0.77, p=0.009 among men and r2=-0.75, p=0.013 among women) (Koo et al., 1997). Fresh vegetables: Childhood/Infancy consumption A3 Case-control studies (2) Two studies reported on consumption of fresh vegetables early in life. In a case-control study in China, evidence of a protective association (OR 0.3 to 0.6) was observed for eating fresh non-preserved vegetables at age 10, at age 3, and during weaning, and for mother’s consumption during breastfeeding (Ward et al., 2000). The results of another Chinese study of intake at age 10 observed no significant association between fresh vegetable consumption and NPC (Ning et al., 1990). Fresh green vegetables: Childhood consumption A3 Case-control studies (1) One case-control study investigated the association between childhood consumption of fresh green vegetables and NPC. The study from China reported results for fresh green vegetable consumption during multiple childhood stages (Yu et al., 1989). A protective, yet non-significant, association was observed for consumption during weaning (OR=0.6, 95% CI: 0.3-1.1). Non-significant results in the direction of risk were reported for intake during ages 1-2 (OR=1.7, 95% CI: 0.6-4.9) and at age 10 (OR=1.3, 95% CI: 0.3-5.1). Other fresh vegetables A3 Case-control studies (1) A study of Chinese in Malaysia evaluated intakes of vegetables at different meals and the risk of NPC (Armstrong, 1978). A significant odds ratio of less than one was reported for vegetables eaten at breakfast and for fresh vegetables eaten at evening meals among families of participants. Among cases and controls, an odds ratio of 0.9 was reported for vegetables eaten at three main daily meals when adjusted for age, sex, census district, household type, race and ethnicity, and socioeconomic status. Fresh Cabbage: Adulthood consumption A3 Case-control studies (1) One study conducted in China evaluated the relationship between fresh cabbage consumption and NPC. In a large study of 935 cases and 1032 controls, no association was reported for daily intake and NPC when compared to less than weekly intake (OR=0.97, 95% CI: 0.81-1.17) of fresh bok choi (Chinese white cabbage) (Yuan et al., 2000b). Fresh Green Leafy Vegetables: Adulthood consumption A3 Case-control studies (1)
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One study from China examined the association between adulthood consumption of fresh green leafy vegetables and NPC. Yuan et al reported a non-significant maximally adjusted odds ratio of 1.25 (95% CI: 0.73-2.14) for fresh dark green leafy vegetables (Yuan et al., 2000b). Fresh Green Leafy Vegetables: Childhood consumption A3 Case-control studies (1) One case-control study from China studied the association between fresh green leafy vegetables and NPC. The study of 128 cases and 174 controls reported non-significant associations for fresh green leafy vegetables when consumed during weaning (p-for-trend 0.86), between ages 1-2 (p-for-trend 0.92), and at age 10 (Yu et al., 1988). Fresh Tomatoes: Adulthood consumption A3 Case-control studies (1) One study evaluated the relationship between fresh tomato consumption during adulthood and NPC. No association was assessed for daily intake in a large Chinese study of 935 cases and 1032 controls when maximally adjusted (OR=0.92, p-for-trend=0.10) (Yuan et al., 2000b). Other Fresh Vegetables: Adulthood consumption A3 Case-control studies (1) One study examined fresh vegetables consumed during adulthood and NPC. The study included 935 cases and 1032 controls from China and used a food frequency questionnaire to assess intake (Yuan et al., 2000b). Daily intakes of fresh light green/orange leafy vegetables (OR=0.98, 95% CI: 0.63-1.50), fresh gourds (OR=0.89, 95% CI: 0.73-1.09), and fresh green peppers (OR=0.67, p=0.43) were not shown to be associated with NPC when compared to less than weekly intake and adjusted for various confounders. Total fresh fruits: Adulthood consumption A3 Case-control studies (4) The evidence for fresh fruits consumed during adulthood was not amenable to meta-analysis since only 3 case-control studies provided sufficient information to be included. A protective odds ratio was reported in 2 studies (Armstrong, 1978, Huang, 1997), although only 1 was statistically significant (Armstrong et al). Zheng et al and Ning et al reported non-significant results for the consumption of fresh fruit using a matched case-control design (Ning et al., 1990, Zheng et al., 1994a). Total fresh fruits: Childhood consumption A3 Case-control studies (3) In three studies, associations were examined relating fresh fruit intake during childhood and NPC. All studies included Chinese cases and controls from China. Zheng et al and Ning et al reported non-significant results for fresh fruit consumption at age 10 or at ages 0-3 (Ning et al., 1990, Zheng et al., 1994a). The third study examined fresh fruit consumed around 2 different decades and observed significant protective associations for both (OR=0.67, 95% CI: 0.49-0.90 around 1968 and OR=0.68, 95% CI: 0.52-0.89) (Cai, 1996). Fresh citrus fruit: Adulthood consumption A3 Case-control studies (1)
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Yuan et al compared daily intakes of fresh oranges and tangerines to less than weekly intakes and reported a maximally adjusted odds ratio of 0.06 (p-for-trend 0.0005) (Yuan et al., 2000b). Fresh pulses/legumes A3 Case-control studies (1) In a study by Ward et al, the associations between fresh soybean products consumed at various ages and NPC were evaluated among Chinese men and women in Taiwan (Ward et al., 2000). No significant association was reported for consumption during adulthood. At ages 10 and 3, fresh soybean consumption was reported as protective, but was only significant for age 10 (OR=0.4, 95% CI: 0.-1.0 and OR=0.7, 95% CI: .3-1.7, respectively). Neither consumption during weaning (OR=1.1, 95% CI: 0.5-1.2) or mother’s consumption during breastfeeding (OR=0.7, 95% CI: 0.3-1.6) was observed to be associated with NPC. Mixed vegetables A3 Case-control studies (1) Fresh green beans and peas were reported as significantly protective for NPC (OR=0.77, 95% CI: 0.62, 0.99) when maximally adjusted for in a Chinese study of 935 cases and 1032 controls (Yuan et al., 2000b). 4.4.1.1 Raw A3 Case-control studies (2) Two case-control studies conducted by Armstrong and colleagues among Chinese in Malaysia reported on the associations between consumption of raw foods and NPC. Statistically significant trends in the protective direction were observed with greater consumption of raw green vegetables (p-for-trend 0.026) (Armstrong et al., 1998b) and sliced raw chilli (cases ate less at evening meals) (Armstrong, 1978). 4.4.1.2 Juiced No results found. 4.4.2 Cooked food A3 Case-control studies (2) The two studies that provided evidence for cooked food were conducted in China and concerned cooking of salted fish (Ning et al., 1990, Zheng et al., 1994b). The first study assessed fried or steamed salted fish consumption from ages 2-10 and before age 2 and observed no significance (OR=1.4, p=0.2 and OR=1.4, p=0.3, respectively). The second study also reported no significant association between fried, grilled, or broiled salted fish at age 10 and NPC (OR=1.6, 95% CI: 0.8-3.2). 4.4.2.1 Steaming, boiling, poaching A3 Case-control studies (1) In a single case-control study in China, steamed salted fish consumed at age 10 was significantly associated an increased risk of NPC (OR 4.2; 95% CL 2.2, 8.3), whereas boiled fresh fish intake at age 10 years or adulthood was not significantly associated with NPC (Ning et al., 1990). The factors adjusted for in this study were age, sex, and area of residence.
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4.4.2.2 Stewing, casseroling A3 Case-control studies (1) A “stewing mixture” of peppers, spices, and other ingredients was evaluated in relation to NPC in a case-control study in Tunisia (Jeannel et al., 1990a). Intake of this stewing mixture was significantly associated with increased NPC risk both during weaning (OR 8.4; p<0.005) and adulthood (OR 4.4; p=0.04) when adjusted for age, sex, lifestyle factors, and area of residence. 4.4.2.3 Baking, roasting No results found. 4.4.2.4 Microwaving No results found. 4.4.2.5 Frying A3 Case-control studies (1) The association between consumption of fried food and NPC was reported to be not statistically significant for intake three years prior to diagnosis and at 10 years of age (Ning et al., 1990). These results were based on a study in China with 100 cases and 300 controls, and after adjustment for age, sex, and area of residence. 4.4.2.6 Grilling (broiling) and barbecuing A3 Case-control studies (1) The association between consumption of grilled food and NPC was reported to be not statistically significant for intake three years prior to diagnosis and at 10 years of age (Ning et al., 1990). These results were based on a study in China with 100 cases and 300 controls, and after adjustment for age, sex, and area of residence. 4.4.2.7 Heating, re-heating No results found. 5 Dietary constituents 5.1 Carbohydrate No results found. 5.1.1 Total carbohydrate No results found. 5.1.2 Non-starch polysaccharides/dietary fibre No results found.
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5.1.2.1 Cereal fibre No results found. 5.1.2.2 Vegetable fibre No results found. 5.1.2.3 Fruit fibre No results found. 5.1.3 Starch No results found. 5.1.3.1 Resistant starch No results found. 5.1.4 Sugars No results found. 5.2 Lipids No results found. 5.2.1 Total fat No results found. 5.2.2 Saturated fatty acids No results found. 5.2.3 Monounsaturated fatty acids No results found. 5.2.4 Polyunsaturated fatty acids No results found. 5.2.4.1 n-3 fatty acids
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No results found. 5.2.4.2 n-6 fatty acids No results found. 5.2.4.3 Conjugated linoleic acid No results found. 5.2.5 Trans fatty acids No results found. 5.2.6 Other dietary lipids, cholesterol, plant sterols and stanols. No results found. 5.3 Protein No results found. 5.3.1 Total protein A3 Case-control studies (1) The sole case-control study to examine the association between protein consumption and NPC took place in China, and was comprised of a comparison of 935 NPC cases with 1032 controls. The results showed that greater intake of “all protein containing preserved foods” was associated with increased risk and the presence of a statistically significant dose-response trend (p-value 0.001), after adjusting for an extensive list of variables that included age, sex, education, cigarette smoking, and history of chronic ear and nose conditions (Yuan et al., 2000b). 5.3.2 Plant protein No results found. 5.3.3 Animal protein No results found. 5.4 Alcohol No results found. 5.5 Vitamins No results found.
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5.5.1 Vitamin A A3 Case-control studies (1) The sole report of vitamin A in relation to NPC was a study of Chinese in Malaysia comprised of 87 NPC cases and 79 controls. In this study, the association between consumption of foods rich in vitamin A and NPC was reported to be “not statistically significant (Armstrong et al., 1983a). The analyses included adjustments for, among other factors, age, sex, and neighbourhood. 5.5.1.1 Retinol No results found. 5.5.1.2 Provitamin A carotenoids Beta-carotene A3 Case-control studies (2) Two case-control studies have assessed the association between β-carotene intake and NPC. One of these studies was carried out in the U.S. and the other in Singapore. In the U.S. study, which was made up of 129 NPC cases and 206 controls, compared to those with lowest intake, those with highest consumption of β-carotene were observed to have lower risk of NPC (OR 0.5; 95% CL 0.22, 1.02) (Farrow et al., 1998). Variables adjusted for in the data analyses included age, sex, energy intake, alcohol drinking and cigarette smoking. The study in Singapore was comprised of 64 cases and 102 controls, and a protective association was observed in the comparison of the highest-versus-lowest third of intake (OR 0.7, 95% CL 0.4, 1.2) (Lee et al., 1994). In this study, factors adjusted for were age, sex, ethnicity, and education. Considered in total, both studies observed associations in the protective direct and the magnitude of the comparisons of the highest-versus-lowest categories of consumption were similar in the two studies, but the test for trend was not statistically significant in either study. 5.5.2 Non-provitamin A carotenoids No results found. 5.5.3 Folates and associated compounds No results found. 5.5.4 Riboflavin No results found. 5.5.5 Thiamin (vitamin B1) No results found. 5.5.6 Niacin
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No results found. 5.5.7 Pyridoxine (vitamin B6) No results found. 5.5.8 Cobalamin (vitamin B12) No results found. 5.5.9 Vitamin C A3 Case-control studies (3) Three case-control studies have evaluated the potential link between vitamin C intake and NPC, one in the U.S., one among Chinese in Singapore, and another among Chinese in Malaysia. In the U.S. study, compared to those with lowest intake, those with highest consumption of vitamin C were observed to have non-significant lower risk of NPC (OR 0.5; 95% CL 0.2, 1.0) with a test-for-trend that was of borderline statistical significance (p=0.06) (Farrow et al., 1998). These results were adjusted for age, sex, smoking, alcohol drinking and energy intake. The results of the two studies that took place in Singapore and Malaysia were not presented in enough detail to permit meaningful comparisons, only noting in the text that the case-control differences were not statistically significant (Armstrong et al., 1983a, Lee et al., 1994). 5.5.10 Vitamin D (and calcium) A3 Case-control studies (1) In a study of 23 cases and 69 controls in China, hair concentrations of calcium were 21% lower in cases than controls, a difference that was not statistically significant (Li, 1996). The results were unadjusted. A4 Cross-sectional studies (1) Serum vitamin D concentrations were significantly lower in NPC cases compared to controls in a cross-sectional study of 380 persons in China, based on a percentage difference of 10% (Li, 1996). A5 Ecological studies (1) In an ecologic study in China, it was observed that drinking water concentrations of calcium were significantly associated with NPC (Farrow et al., 1998) when comparing high risk areas to low risk areas. Similarly, serum calcium levels were significantly associated with NPC. 5.5.11 Vitamin E A3 Case-control studies (1) The sole case-control study to evaluate the association between vitamin E intake and NPC took place in China. In a comparison of 64 NPC cases with 102 controls, vitamin E intake was inversely associated with NPC risk (p-for-trend 0.01) (Lee et al., 1994). These findings were adjusted for age, sex, education, and ethnic group. 5.5.12 Vitamin K No results found.
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5.5.13 Other minerals A3 Case-control studies (1) One study, carried out in the U.S., investigated the link between vitamin supplement use and NPC. In this study, there were 129 NPC cases and 206 controls. Compared to nonusers, multivitamin users and supplement users had approximately one-half the risk of NPC (OR 0.55-0.56; 95% CL 0.31, 1.01). The results were adjusted for age, sex, energy intake, alcohol drinking, and cigarette smoking (Deng, 1995). 5.6 Minerals No results found. 5.6.1 Sodium No results found. 5.6.2 Iron A3 Case-control studies (3) Three case-control studies, each using different measurement tools, have evaluated the potential association between measures of iron intake and NPC. Two of the studies took place in China, the other in Kenya. The results have been mixed. In China, Deng and colleagues assessed concentrations of iron in serum, drinking water, and rice (Robinson et al., 1968). The mean iron concentrations of all three measures were similar in cases and controls. Iron concentrations in maize leaf were studied in Kenya, with the case-control comparison showing the mean iron concentration was 8% higher in cases that controls, reported as not statistically significant (Man et al., 1996). Hair concentrations in iron were 64% higher in cases than controls (p-value <0.05) in a study in China (Man et al., 1996). 5.6.3 Calcium (and Vitamin D) A3 Case-control studies (1) In a study of 23 cases and 69 controls in China, hair concentrations of calcium were 21% lower in cases than controls, a difference that was not statistically significant (Li, 1996). The results were unadjusted. A4 Cross-sectional studies (1) Serum vitamin D concentrations were significantly lower in NPC cases compared to controls in a cross-sectional study of 380 persons in China, based on a percentage difference of 10% (Li, 1996). A5 Ecological studies (1) In an ecologic study in China, it was observed that drinking water concentrations of calcium were significantly associated with NPC (Lajtman et al., 1994) when comparing high risk areas to low risk areas. Similarly, serum calcium levels were significantly associated with NPC. 5.6.4 Selenium A3 Case-control studies (3) Three case-control studies have reported on the association between selenium and NPC. Two of these studies were implemented in China, and the other took place in Croatia. All of the studies relied on biomarkers to
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measure selenium, and all three compared the mean serum selenium concentrations in cases and controls, and the results were unadjusted. In a study of 37 cases and 47 controls in Croatia, NPC cases had serum selenium concentrations that were 11% lower than controls, a difference that was not statistically significant (Yang et al., 1990). In a study of 111 cases and 56 controls in China, serum selenium concentrations were 13% lower in cases than controls (p-value<0.05) (Deng, 1995). A 42% case-control difference (p-value<0.01) in serum selenium concentrations was observed in a smaller (44 cases, 42 controls) study in China (Deng, 1995). In this latter study, selenium concentration in drinking water and rice were also measured. These comparisons also showed notably large case-control differences, with the concentration of selenium in drinking water 45% lower in cases than controls (p-value <0.01) and in rice 31% lower in cases than controls (p-value <0.001) (Man et al., 1996). The evidence to date, albeit limited by the few small studies that have not accounted for potential confounding variables, is nevertheless consistent in suggesting a protective association between selenium exposure and NPC. 5.6.5 Iodine A3 Case-control studies (1) Mean hair concentrations of iodine were 85% higher in cases than controls in a study of 8 cases and 30 controls in China, a difference that was not statistically significant (Ling-Wei et al., 1988). The results were unadjusted. 5.6.6 Other minerals Chromium A3 Case-control studies (2) Two case-control studies, both carried out in China, examined the association between exposure to chromium and NPC risk. Both of these studies assess chromium concentrations in drinking water, and both reported unadjusted medians or means for NPC cases and controls. A case-control comparison of drinking water concentrations noted that the median drinking water concentration of chromium in cases (n=45) was identical to that of the controls (n=30) (Deng, 1995). Deng and colleagues studied 44 NPC cases and 42 controls. In their study, the chromium concentration in drinking water, and observed that the mean of cases was 50% higher than controls (p-value <0.01) (Robinson et al., 1968). Deng and colleagues also reported on two additional measures of chromium exposure, in rice and drinking water. Serum chromium concentrations were observed to be 68% higher in cases than controls (p-value <0.01), and an even larger case-control difference (95%, p-value <0.01) was noted in the chromium concentrations in rice. Thus, strong differences in the direction of increased risk were seen for every exposure metric in this latter study, but the drinking water result was not corroborated in the only other study identified to report on this topic. Copper A3 Case-control studies (4) A total of four case-control studies reported on the association between copper exposure and NPC. Three of these studies took place in China; the other was conducted in Kenya. Copper was measured differently in each study, as the specific exposures were copper measured in maize leaf, in drinking water, in hair, in serum, and in rice. In the study of copper concentrations in maize leaf, conducted in Kenya, the mean exposure of NPC cases was only 2% less than in controls, a difference that was not statistically significant (Ling-Wei et al., 1988). The following three studies were all performed in China. In the study of Ling-Wei et al, the mean drinking water concentrations of copper were 24% higher in NPC cases than controls (p-value 0.05) (Man et al., 1996). The
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study of Man et al in China the mean copper concentrations in hair samples were almost identical in NPC cases (mean 14.25) and controls (mean 14.29) (Deng, 1995). In the third study, three different measures of copper were investigated, concentrations in serum, rice, and drinking water. In this study (Robinson et al., 1968), the mean copper concentrations in drinking water were 37% higher in cases than controls (p-value <0.01) and 139% higher in rice (p-value <0.05). However, the mean copper concentrations in the serum of cases and controls were not consistent with the other exposure metrics, as NPC cases had 4% lower serum concentrations than controls. Large case-control differences were observed for selected exposures in selected studies, but overall the results did not display strong consistency across studies or internal consistency in studies that used multiple exposure metrics. Manganese A3 Case-control studies (3) A total of three case-control studies reported on the association between manganese exposure and NPC. Two of these studies were carried out in China, whereas the third occurred in Kenya. Manganese was measured differently in each study, as the specific exposures were manganese measured in maize leaf, in drinking water, and in hair. In the study of manganese concentrations in maize leaf, conducted in Kenya, the mean exposure of NPC cases was only 4% greater than in controls, a difference that was not statistically significant (Ling-Wei et al., 1988). The following two studies took place in China. In the study of Ling-Wei et al, the mean drinking water concentrations of manganese were 21% higher in NPC cases than controls (p-value 0.05) (Man et al., 1996). The study of Man et al in China the mean manganese concentrations in hair samples were 12% lower in NPC cases than controls (Robinson et al., 1968). In summary, the results for manganese are inconsistent, and it is difficult to discern the degree to which heterogeneity in exposure assessment, as well as differences in study characteristics, contributed to the inconsistencies. Zinc A3 Case-control studies (4) The association between zinc exposure and NPC was reported on in a total of four case-control studies. One of these studies was carried out in Kenya, with the other three taking place in China. Zinc was measured differently in each study, as the specific exposures were zinc measured in maize leaf, in drinking water, in hair, in serum, and in rice. In the study of zinc concentrations in maize leaf, conducted in Kenya, the mean exposure of NPC cases was identical to that in controls (Ling-Wei et al., 1988). The following three studies were all performed in China. In the study of Ling-Wei et al, the mean drinking water concentrations of zinc were 59% higher in NPC cases than controls (p-value 0.01) (Man et al., 1996). Man et al observed mean zinc concentrations in hair samples were 5% lower in NPC cases than in controls (Deng, 1995). These results were unadjusted. In the third Chinese study, three different measures of zinc were investigated, concentrations in serum, rice, and drinking water. In this study (Robinson et al., 1968), the mean zinc concentrations in drinking water were 23% lower in cases than controls (p-value <0.05), 20% lower in cases than controls in rice (p-value <0.01), and the mean zinc concentrations in the serum of cases was 10% lower than controls (p-value <0.05). These means were unadjusted. The study of Deng and colleagues thus displays internal consistency in study findings across exposure categories for zinc in the protective direction, but these findings are counterbalanced by the results of the other studies. Other minerals A3 Case-control studies (2)
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Other minerals that have been studied for possible associations with NPC include boron, aluminum, antimony, magnesium, potassium, strontium, sulfur, and vanadium. The study the reported the results for boron was conducted in Kenya and published over three decades ago. This was a study of boron concentrations in maize leaf from Kenyan farms, and the results showed the mean concentrations were nearly identical for NPC cases and controls (Man et al., 1996). All of the other exposures reported on in this category stem from the study of Man et al in China. In this study, hair samples were collected from 29 NPC patients seen at a single hospital in Hong Kong and “95 unselected healthy people.” All the results were unadjusted. Man et al case-control percentage differences in mean concentrations in hair samples that were -34% for strontium (p-value <0.05) and +208% for vanadium (p-value <0.05) (Cohen, 2000, Griffin, 2000, Young et al., 2003). The case-control comparisons for the other exposures were reported to be not statistically significant. 5.7 Phytochemicals No results found. 5.7.1 Allium compounds No results found. 5.7.2 Isothiocyanates No results found. 5.7.3 Glucosinolates and indoles No results found. 5.7.4 Polyphenols No results found. 5.7.5 Phytoestrogens eg genistein No results found. 5.7.6 Caffeine No results found. 5.7.7 Other No results found. 5.8 Other bioactive compounds No results found.
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6 Physical activity 6.1 Total physical activity (overall summary measures) No results found. 6.1.1 Type of activity No results found. 6.1.1.1 Occupational No results found. 6.1.1.2 Recreational No results found. 6.1.1.3 Household No results found. 6.1.1.4 Transportation No results found. 6.1.2 Frequency of physical activity No results found. 6.1.3 Intensity of physical activity No results found. 6.1.4 Duration of physical activity No results found. 6.2 Physical inactivity No results found. 6.3 Surrogate markers for physical activity e.g. occupation No results found.
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7 Energy balance 7.1 Energy intake No results found. 7.1.1 Energy density of diet No results found. 7.2 Energy expenditure No results found. 8 Anthropometry 8.1 Markers of body composition No results found. 8.1.1 BMI No results found. 8.1.2 Other weight adjusted for height measures No results found. 8.1.3 Weight No results found. 8.1.4 Skinfold measurements No results found. 8.1.5 Other (e.g. DEXA, bio- impedance, etc) No results found. 8.1.6 Change in body composition No results found.
8.2 Markers of distribution of fat
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No results found. 8.2.1 Waist circumference No results found. 8.2.2 Hips circumference No results found. 8.2.3 Waist to hip ratio No results found. 8.2.4 Skinfolds ratio No results found. 8.2.5 Other e.g. CT, ultrasound No results found.
8.3 Skeletal size No results found. 8.3.1 Height (and proxy measures) No results found. 8.3.2 Other (e.g. leg length) No results found. 8.4 Growth in fetal life, infancy or childhood No results found. 8.4.1 Birthweight, No results found. 8.4.2 Weight at one year No results found.
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F. Narrative review on mechanistic studies All considerations on mechanistic factors associated with the development of nasopharyngeal carcinoma (NPC) must take into account the role of the Epstein-Barr virus (EBV), which has long been associated with the development of NPC, reviewed in (Cohen, 2000, Griffin, 2000). The IARC has listed EBV as a group 1 carcinogen, which is an agent that is definitively carcinogenic to humans. This virus is present in the tumor cells of all undifferentiated NPC and the majority of the less common squamous NPC. Further support for the role of EBV infection in the etiology of NPC is the observation that infection is common in areas where NPC is endemic, suggesting that infection of nasopharyngeal cells with the EBV virus is a necessary factor in the development of NPC. However, EBV infects the majority of the adult population in both areas with high rates of NPC and those areas where NPC is uncommon (Griffin, 2000). In addition, following primary infection with EBV, individuals remain lifelong carrier of the virus, but few individuals even in endemic areas ultimately develop NPC(Cohen, 2000). Thus, exposure to EBV and even chronic EBV infection is not sufficient for transformation to malignancy. EBV infection is most highly associated with nasopharyngeal carcinoma and lymphoma (Griffin, 2000). In particular, the endemic nature of NPC, in contrast to the widespread distribution of EBV infection, suggests the influence of either genetic or environmental exposures as additional risk factors in the development of NPC. Interactions between environmental and genetic factors are also possible and have been shown, and will be discussed below in the context of dietary influences for the development of nasopharyngeal carcinoma. EBV does not usually replicate following infection, but instead forms a monoclonal episome after cellular infection (Young et al., 2003). This viral latency is characterized by the expression of a subset of virus latent genes, while most other viral genes are not expressed. Transformation is associated with activation of specific viral proteins and in many cases the lytic cycle of the virus. Any potential influence of dietary factors on EBV related carcinogenesis involving the reactivation of EBV must therefore occur temporally after primary Epstein-Barr virus infection. There is evidence that the age of infection with the Epstein-Barr virus occurs somewhat unevenly in different populations(Chan et al., 2003, Yadav et al., 1987). In underdeveloped regions, primary infection with EBV usually occurs during the first few years of life and is often asymptomatic. In many NPC endemic areas, such as Malaysia and Hong Kong, infection is nearly universal by early childhood(Young et al., 2003). In developed populations, primary infection is more frequently delayed until adolescence or adulthood, in many cases producing the characteristic clinical features of infectious mononucleosis (Chan et al., 2003). Even in symptomatic infection (infectious mononucleosis), an earlier age of infection is seen in China in comparison to Western countries(Young et al., 2003). However, this simple association of early infection with NPC is complicated by high rates of childhood infection in regions, such as Japan and Africa(Young et al., 2003), without coincident increases in NPC risk. In addition, regional differences in incidence of NPC, for example in regions of China, cannot be accounted for by differences in incidence or onset of EBV infection. Thus additional factors must modulate the risk of the development of nasopharyngeal carcinoma following EBV infection. In both lymphoma and nasopharyngeal carcinoma, transformation is associated with expression of specific oncogenic viral proteins(Yoshizaki, 2002). Latent membrane protein 1 (LMP-1) is the major transforming protein of EBV which has been shown to be essential for B-cell transformation in vitro. Transformation by LMP-1 involves multiple changes(Liu et al., 2004), including alteration in surface adhesion proteins, induction of anti-apoptotic proteins (including BCL-2), induce cytokine production and to inhibit DNA repair (Li et al., 2004). Each of these changes may contribute to the fully transformed phenotype, which is further supported by the inhibition of metastatic potential following siRNA inhibition of LMP-1 in a EBV + nasopharyngeal
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carcinoma cell line C666 (Bouvier et al., 1991, Shao et al., 1988). LMP-1 is expressed in the majority of NPC, but is not present in all tumors, suggesting that additional factors may accompany transformation to NPC in EBV infected cells. However, factors which induce the expression of latent virus and viral proteins may therefore contribute to the emergence of transformed cells. Of the dietary factors that might influence the development of NPC, consumption of Chinese-style salted fish has been shown to increase the risk of developing NPC in EBV exposed populations consistently in many studies. This was again confirmed as the strongest dietary risk factor for the development of NPC in the current report. In particular, the risk is highest when consumption occurs during early childhood. As mentioned above, even though exposure to salted fish may occur as early as the weaning period (< 2 years), this dietary exposure would likely follow the development of chronic EBV infection following initial infection, since infection is almost universal in young children in these areas.
The timing of these events (onset of exposure to salted fish and infection with EBV) has not been thoroughly examined in any of the studies included in this report, but the proximity of these two contributing factors is of interest. Although comprehensive studies have not explored the association between environmental factors and EBV infection, some published reports suggest that the development of NPC following EBV infection may potentially be influenced by dietary exposures in two ways: by directly influencing the expression of viral proteins and through inducing genetic and epigenetic changes associated with the progression to invasive NPC.
Evidence for the reactivation of EBV from latently infected cells by dietary agents is primarily derived from Burkitt’s lymphoma cell lines. Raji, an EBV positive Burkitt’s lymphoma, has been shown to induce latent viral promoters when treated with extracts of Cantonese salted dried fish in vitro (Bouvier et al., 1991). The components of these extracts have not been identified, nor the mechanism by which these foods activate viral promoters, but appear to be separate from the mutagen content (Goldman et al., 2003). While such studies provide an interesting empirical link between dietary agents and EBV reactivation, an important transforming event in NPC progression, the lack of such studies in NPC cell lines and the unknown components of processed foods contributing to this activation, suggest that the precise role dietary agents play in EBV reactivation remain unstudied.
More studies have examined the role of nitrosamines and nitrites in salted fish as essential agents for transformation of NPC precursor tissues. Evidence suggests that high intake of nitrate and nitrosamine from salted fish account for some of this increased risk of NPC development. Nitrosamines are known mutagens and animal carcinogens that induce gene mutation through the formation of DNA adducts which if not repaired may lead to point mutations. The N-nitrosamines are a large group of compounds with a common carcinogenic mechanism(Zou et al., 1992, Zou et al., 1994). Salted fish has been shown to contain N-dimethylnitrosamine, N-diethylnitrosamine, N-nitrosopyrrolidene and N-nitrosopiperidine(Zou et al., 1992, Zou et al., 1994). Levels of these compounds were highest in salted fish from areas with the highest NPC mortality, while lower in areas with lower NPC mortality (Goldman et al., 2003). Exposure of the nasopharynx to these agents may be particularly damaging in that the carcinogenic properties of nitrosamines are greatest following oral administration. In addition, the variation in nitrosamine content of salted fish may contribute to heterogeneity in assigning risk to salted fish consumption in different geographic locations.
Alkylating agents including nitrosamines produce DNA adducts, specifically 7-methylguanine and O6-methylguanine. The O6-methylguanine is mostly responsible for the mutagenicity and carcinogenicity of these alkylating agents (Lin et al., 1992, Sun et al., 1993). Unfortunately, the genes targeted for mutational alteration in NPC have to a large degree not been identified, which does not allow a definitive association of nitrosamine exposure to tumor suppressor or oncogene mutation. Among the commonly mutated genes in other types of tumors, no reports describe mutation of k-ras and studies of mutation of the retinoblastoma gene(Lo et al., 1995,
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Sun et al., 1995) and p16/ CDKN2a (Burgos, 2003, Chakrani et al., 1995, Effert et al., 1992, Lo et al., 1992, Lung et al., 1998, Nasrin et al., 1994, Spruck et al., 1992, Sun et al., 1992, Van Tornout et al., 1997, Xie et al., 1997)have all been negative. The most extensively studied gene in NPC for mutational alterations is p53, also the most commonly mutated gene in other malignancies. Ten published studies in the last 12 years have reported mutation of p53 ranging from 0-27% of NPC tumors studied (Lung et al., 1998), with the 27% result in a study of only 11 tumors(Van Tornout et al., 1997). Overall, 18 of 282 tumors have been found to contain p53 mutations (overall percentage 6%), suggesting that mutations in p53 are not common and do not provide a connection between nitrosamines and the progression of NPC. However, in at least one study (Esteller et al., 1999), all 4 of the mutations detected were GC>AT, of particular mechanistic importance for alkylating agents.
The O6-methylguanine leads to GC->AT transitions in cell-culture and animal models if not repaired by O6-methylguanine methyltransferase (MGMT), and as described above, this lesion is produced by alkylating agents. MGMT has been shown to be altered in NPC, although through epigenetic changes, rather than mutational inactivation. Hypermethyaltion of the promoter region of MGMT silences expression of this gene in many cancers (Kwong et al., 2002, Wong et al., 2003) which has been reported in 20-28% of nasopharyngeal cancer (Esteller et al., 2001, Wolf et al., 2001). Inactivation of MGMT has been shown to be associated with the type of p53 mutations described above in lung and colon cancer(Goldman et al., 2003), but due to the infrequent mutations in NPC has not been studied . As noted above, LMP-1 produced by EBV reactivation may also reduce DNA repair capacity, compounding the mutagenic effects of nitrosamine compounds.
Additional support for the importance of nitrosamines in the carcinogenic process of NPC is provided by studies examining the cytochrome p450 enzyme CYP2E1. N-nitrosodimethylamine undergoes enzymatic hydroxylation catalyzed mainly by CYP2E1, a step in the activation of carcinogenic adducts (He et al., 2002). CYP2E1 is expressed in the nasopharynx and in NPC tumors(Hayashi et al., 1991). Increased activity of this enzyme would then result in increased activation of pro-carcinogens. A genetic polymorphism in the 5'-flanking region of the human CYP2E1, the C2 allele, affects binding of trans-acting factor to the promoter(Hayashi et al., 1991), This sequence change affects transcriptional regulation, resulting in up to 10-fold differences in promoter activity of the CYP2E1 gene(Hildesheim et al., 1997a, Hildesheim et al., 1995, Kongruttanachok et al., 2001). Studies have demonstrated an increased risk of developing NPC in patients with this variant form(Armstrong et al., 1998a), (relative risks of 2-2.5, higher in non-smokers), consistent with the increased formation of carcinogenic nitrosamines from salted fish for those individuals. These studies suggest genetic modifiers of environmental exposure contribute to the risks inherent in consumption of salted fish. Such genetic variation may contribute to the heterogeneity in studies examining risk of NPC following salted fish consumption.
In other food categories, for example salted vegetables, fermented legumes, pickled foods and other preserved food ingredients, a consistent positive association of consumption with risk of NPC was observed. Most striking was the reversal of the otherwise protective effects for green leafy vegetables observed in most studies when salted green leafy vegetables were examined(Jeannel et al., 1990b). A similar effect was seen for pickled olives in comparison to other fruits(Armstrong et al., 1998a). Each of these analyses suggests that food preparation, rather than food substance, is important for this increased risk of consumption. Few, if any, studies have determined the components or substances that might account for this increased risk from food preservation itself, as this risk was not previously recognized. Future studies may determine whether nitrosamines are key components of the fermentation process in these foods as has been shown for salted fish.
Protective dietary effects include vegetables, which may mediate effects through multiple components, including beta-carotene, alpha-tocopherol, retinoids, sulphoraphane and folate. This report found the most clear protective effect from leafy vegetables which was not seen when salted green leafy vegetables were examined(Giovannucci, 2002). For leafy vegetables, some of the protective effect is often attributed to folate
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intake, which is also seen in many other fruits and vegetables. Folate deficiency may increase the risk of NPC by inducing an imbalance in DNA precursors, leading to altered DNA synthesis and repair which has been the most widely studied in colon cancer(Allday et al., 1990, Ernberg et al., 1989, Hu et al., 1991). This effect is mediated through interaction with methionine levels, ultimately changing levels of S-adenosylmethionine and methylene-tetrahydrofolate, leading to affects on DNA synthesis and the epigenetic modification of DNA methylation. Thus folate deficiency could lead to mutational events and affect DNA methylation patterns that have been observed in NPC. Mechanisms involving changes in methylation relevant for tumor genesis include reactivation of latent EBV virus associated with loss of methylation of viral promoters (Chow et al., 2004, Hui et al., 2003, Kao et al., 2002, Kwong et al., 2002, Lo et al., 1996, Lo et al., 2002a, Lo et al., 2002b, Qiu et al., 2004, Sze Wong et al., 2002, Wong et al., 2002) and increased methylation of important tumor suppressor genes(Yokoyama et al., 2003).
Based on the present analyses, ethanol intake was not associated with increased risk of NPC, but an association of alcohol intake with increased risk for other upper aerodigestive tumors makes this association plausible. Interactions between alcohol drinking and EBV have not been directly explored. A recent review summarizes the increased risk associated with esophageal and head and neck cancer, as well as possible mechanisms behind this association(Poschl et al., 2004). This positive influence may be attributed to the formation of acetaldehyde, an oxidized product of ethanol. Acetaldehyde is carcinogenic and mutagenic, binding to DNA and protein(Poschl et al., 2004). Ethanol is eliminated from the body by its oxidation, first to acetaldehyde and then to acetate. These reactions are sequentially catalyzed by alcohol dehydrogenase and aldehyde dehydrogenase. Most of the acetaldehyde generated during alcohol metabolism in vivo is promptly eliminated by aldehyde dehydrogenase-2 (ALDH2), the low-Km mitochondrial ALDH. However, a mutant form of ALDH2, ALDH2*2 allele (Glu487Lys) encodes a catalytically inactive protein. The inactive form of ALDH2 with the mutant ALDH2*2 allele is common in people of Japanese descent. The distribution of the ALDH2*2 allele varies by race, being prevalent in East Asians, but not in Caucasians or Africans. When this enzyme is inactive, the body fails to metabolize acetaldehyde rapidly, leading to excessive accumulation of acetaldehyde. Thus, genetic predisposition may amplify the toxic and mutagenic effects of alcohol consumption. While this effect has been primarily attributed to esophageal and head and neck cancer, it is possible that similar effects may occur in other upper aerodigestive tumors including NPC, as exposure to these tissues would be similar.
Chronic alcohol consumption also induces cytochrome P450 enzyme (CP2E1) activity in mucosal cells (Giovannucci, 2002). As discussed above, the resulting increased activation of various dietary and environmental carcinogens would increase the mutagenic effects of dietary nitrosamines. In addition, alcohol intake has been shown to affect folate levels through inhibition of folate absorbance and through increased excretion of folate by the kidneys. Resulting folate deficiency may contribute to the accumulation of additional genetic and epigenetic alterations, as discussed above. All of these effects may contribute to the increased risk of NPC potentially seen in patients with consumption of alcohol. 6. Discussion Even for the exposures for which a sufficient quantity of evidence was available to assess for the presence of a dose-response trend, the meta-analyses of dose-response data was entirely limited to frequency of consumption. Ideally, one would like additional information on serving size and duration of use to integrate a more complete dose metric into the assessment of the evidence. Unfortunately, this more comprehensive dose assessment approach that measured amounts consumed or the total duration of consumption was available for only a few studies. If one had to choose a single measure of dose for the exposures most relevant to this SLR, such as preserved foods, the frequency of consumption may in fact be the most relevant measure.
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Although some studies have looked at diet in periods three to five years prior to the onset of cancer, most have not reviewed intake to time of expected latency of cancer. In studies that measured frequency of food intake during childhood years, the implicit assumption in the interpretation of most investigators seems to be that early age at intake is a susceptibility factor. An alternative explanation is that this is a proxy measure of duration of consumption, as food habits cultivated in childhood may track into adulthood. For some exposures, there was an insufficient quantity of data to perform a meta-analysis based on dose-response data. To expand the number of exposures for meta-analysis, we performed a meta-analysis for the exposures that had enough (n=5 case-control) studies for a combined analysis using the highest exposure categories as recommended by WCRF. The entire body of evidence on diet, nutrition, and NPC would be strengthened if it were possible to generate additional evidence from prospective studies. For practical considerations relating to the relatively rare occurrence of this cancer there are many advantages to case-control studies, so it seems unlikely this situation will markedly change in the near term. A large proportion of the studies related to the risk of NPC related to foods took place in China where risks are high. Even so, the number of cases in many of studies was still relatively small. A unique aspect of this SLR is the search of the literature published in Chinese. Bias could potentially be introduced if the results of the peer-reviewed Chinese literature differed from the non-Chinese literature, and this was due to methodological differences that affected study quality. Our impression was that this was not a critical issue, but in general in this SLR it was not uncommon for the articles to omit details that would be expected in the highest quality epidemiologic studies. For example, few studies have discussed the problems of recall of dietary data for case-control studies especially when childhood consumption is a point of query. Most of the studies the contributed data to the meta-analyses adjusted for at least age, sex, and area of residence. Some of the studies also included OR estimates that were adjusted for additional factors such as personal history of nasal disease, family history of NPC, cigarette smoking, alcohol intake, and exposure to environmental factors. Few studies actually examined the data to determine whether these were actually confounding variables in, for example, Chinese populations. Infection or reactivation with EBV could be a key issue, yet none of the studies accounted for EBV. A relatively small proportion of studies accounted for other dietary factors when reporting the results for a specific dietary factor. We have not yet had the opportunity to assess the quantitative impact such adjustments may have had on the observed associations when they were performed, but our anecdotal impression is that the observed associations tended to be strengthened when other dietary factors were accounted for in the analyses. Food-specific results tended to be presented in these papers. For a relatively homogeneous exposure, such as salted fish, this was not a problem. The reliance on the food-specific approach was more problematic for foods that were classified into broader food classes, such as citrus fruits or cruciferous vegetables. Rarely did papers report results for the summed results across broader food classes such as these. For example, for exposures such as fruits and vegetables, results for preserved and non-preserved foods within a specific WCRF exposure category were reported separately and only one could contribute to the meta-analysis. In this situation, foods were separated within the broad exposure categories and only meta-analysed when sufficient data was available within the subgroups. This limited possibilities for some exposures to be included in meta-analyses by reducing the total number of studies within a given subgroup. Similar separation methods were implemented for adult versus childhood timing of exposures. In this SLR we took care to note the findings reported in the text even without detailed results. Particularly for the results for which meta-analyses were possible, the reader is encouraged to pay close attention to the results
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of these studies when assessing the entire body of evidence, as these results tended to be reported simply as “non-significant.” The results of the meta-analysis hinted that the association between salted fish and NPC may be stronger in 0-3 year olds than among older children and adults. Coupled with the fact that the age distribution of the NPC cases in the Chinese studies tended to be young, the possibility that early infection with EBV combined with early exposure to salted fish may accelerate NPC carcinogenesis is of interest. An examination of the specific studies, although limited, may provide some specific data that could determine time to tumor. Mechanistic studies that evaluate the interaction between dietary exposures and EBV in NPC cell lines would provide evidence to help guide interpretation concerning biologic plausibility of the epidemiologic evidence.
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NPC: Summary Tables: 22 May, 2006
Reasons for inclusion in summary 1) exposure convincing, probable or possible in 1997 report, 2) at least 2 cohort or at least 5 case-control studies, 3) robust and reproducible human or animal experimental studies 4) Other – please state reason
Table of numbers of studies found and included in meta-analyses by study design Exposure Cohort studies Case-control studies Total
n Number Included in meta-analysis
Summary OR and 95% CI (Random)
Total n
Number Included in meta-analysis
Summary OR and 95% CI (Random)
Additional issues/ or reasons meta-analysis not appropriate
Included in summary (indicate reason)
1.2 Socio-economically defined diets
0 0 N/A 1 0 N/A <5 case-controls
1.3 Culturally defined diets
0 0 N/A 1 0 N/A <5 case-controls
1.5 Other dietary patterns
0 0 N/A 3 0 N/A <5 case-controls
1.6.2 Breast-feeding, child
0 0 N/A 2 0 N/A <5 case-controls
1.7 Other dietary pattern issues
0 0 N/A 1 0 N/A <5 case-controls
2.1.1 Cereal (grains) Adulthood consumption 0 0 N/A 1 0 N/A <5 case-controls Childhood consumption 0 0 N/A 2 0 N/A <5 case-controls 2.1.1.1 Wholegrain cereals
0 0 N/A 1 0 N/A <5 case-controls
2.1.1.2 Refined cereals and cereal products Bread:
Adulthood consumption 0 0 N/A 3 0 N/A <5 case-controls Childhood consumption 0 0 N/A 3 0 N/A <5 case-controls
Noodles 0 0 N/A 1 0 N/A <5 case-controls Rice 0 0 N/A 2 0 N/A <5 case-controls;
1 ecological study
2.1.2 Starchy roots, tubers and plantains
0 0 N/A 2 0 N/A <5 case-controls
2.2 Fruit and (non-starchy vegetables)
0 0 N/A 1 0 N/A <5 case-controls
2.2.1 Non-starchy vegetables Total vegetables:
Adulthood consumption 0 0 N/A 5 0 N/A 2 ecological studies Case-control: 4 Highest vs. Lowest
Childhood consumption 0 0 N/A 3 0 N/A <5 case-controls Green vegetables:
Adulthood consumption 0 0 N/A 4 0 N/A <5 case-controls
NPC: Summary Tables: 22 May, 2006
Reasons for inclusion in summary 1) exposure convincing, probable or possible in 1997 report, 2) at least 2 cohort or at least 5 case-control studies, 3) robust and reproducible human or animal experimental studies 4) Other – please state reason
Exposure Cohort studies Case-control studies Total
n Number Included in meta-analysis
Summary OR and 95% CI (Random)
Total n
Number Included in meta-analysis
Summary OR and 95% CI (Random)
Additional issues/ or reasons meta-analysis not appropriate
Included in summary (indicate reason)
Childhood consumption 0 0 N/A 3 0 N/A <5 case-controls Preserved vegetables:
Adulthood consumption 0 0 N/A 7 0 N/A Only 2 studies could be included in meta-analysis
2
Childhood consumption 0 0 N/A 4 0 N/A <5 case-controls Other vegetables 0 0 N/A 2 0 N/A <5 case-controls
2.2.1.1 Non-starchy root vegetables and tubers Total root vegetables 0 0 N/A 1 0 N/A <5 case-controls
Carrots: Adulthood consumption 0 0 N/A 2 0 N/A <5 case-controls Childhood consumption 0 0 N/A 6 0 N/A Case-control:
4 Highest vs. Lowest Preserved root veg 0 0 N/A 2 0 N/A <5 case-controls
2.2.1.2 Cruciferous vegetables Cabbage 0 0 N/A 3 0 N/A <5 case-controls
Other non-preserved: Adulthood consumption 0 0 N/A 5 0 N/A Heterogeneous exposures
(kale, rutabagas, turnip root, mustard, cauliflower)
2
Childhood consumption 0 0 N/A 6 0 N/A Heterogeneous exposures (kale, rutabagas, turnip root, mustard, cauliflower)
2
Preserved vegetables: Adulthood consumption 0 0 N/A 5 0 N/A Heterogeneous exposures
(pickled radish, sour cabbage, salted mustard)
2
Childhood consumption 0 0 N/A 4 0 N/A <5 case-controls 2.2.1.3 Allium vegetables
0 0 N/A 1 0 N/A <5 case-controls
2.2.1.4 Green leafy vegetables Total green leafy:
Adulthood consumption 0 0 N/A 4 0 N/A <5 case-controls Childhood consumption 0 0 N/A 2 0 N/A <5 case-controls
Water spinach 0 0 N/A 1 0 N/A <5 case-controls Total green leafy:
NPC: Summary Tables: 22 May, 2006
Reasons for inclusion in summary 1) exposure convincing, probable or possible in 1997 report, 2) at least 2 cohort or at least 5 case-control studies, 3) robust and reproducible human or animal experimental studies 4) Other – please state reason
Exposure Cohort studies Case-control studies Total
n Number Included in meta-analysis
Summary OR and 95% CI (Random)
Total n
Number Included in meta-analysis
Summary OR and 95% CI (Random)
Additional issues/ or reasons meta-analysis not appropriate
Included in summary (indicate reason)
Adulthood consumption 0 0 N/A 3 0 N/A <5 case-controls Childhood consumption 0 0 N/A 2 0 N/A <5 case-controls 2.2.1.5 Other non-starchy vegetables
Tomatoes: Adulthood consumption 0 0 N/A 5 0 N/A Case-control:
4 Highest vs. Lowest Childhood consumption 0 0 N/A 3 0 N/A <5 case-controls
Other non-preserved: Adulthood consumption 0 0 N/A 3 0 N/A <5 case-controls Childhood consumption 0 0 N/A 2 0 N/A <5 case-controls
Total preserved: Adulthood consumption 0 0 N/A 5 0 N/A Case-control:
4 Highest vs. Lowest Childhood consumption 0 0 N/A 3 0 N/A <5 case-controls
Other preserved: Adulthood consumption 0 0 N/A 5 0 N/A Heterogeneous exposures
(dried tomato, salted root, plum vegetables)
2
Childhood consumption 0 0 N/A 4 0 N/A <5 case-controls 2.2.1.6 Raw vegetables 0 0 N/A 2 0 N/A <5 case-controls 2.2.2 Fruits (general)
Total non-preserved: Adulthood consumption 0 0 N/A 6 0 N/A Only 3 studies could be
included in meta-analysis 2
Childhood consumption 0 0 N/A 4 0 N/A <5 case-controls Preserved fruits 0 0 N/A 1 0 N/A <5 case-controls
2.2.2.1 Citrus fruits Total citrus fruits:
Adulthood consumption 0 0 N/A 5 0 N/A Case-control: 5 Highest vs. Lowest
Childhood consumption 0 0 N/A 4 0 N/A <5 case-controls Preserved citrus fruits 0 0 N/A 1 0 N/A <5 case-controls
2.2.2.2 Other fruits Non-preserved fruits:
Adulthood consumption 0 0 N/A 2 0 N/A <5 case-controls
NPC: Summary Tables: 22 May, 2006
Reasons for inclusion in summary 1) exposure convincing, probable or possible in 1997 report, 2) at least 2 cohort or at least 5 case-control studies, 3) robust and reproducible human or animal experimental studies 4) Other – please state reason
Exposure Cohort studies Case-control studies Total
n Number Included in meta-analysis
Summary OR and 95% CI (Random)
Total n
Number Included in meta-analysis
Summary OR and 95% CI (Random)
Additional issues/ or reasons meta-analysis not appropriate
Included in summary (indicate reason)
Childhood consumption 0 0 N/A 5 0 N/A Heterogeneous exposures (grapes, bananas, peaches, apples, watermelons)
2
Preserved plums: Adulthood consumption 0 0 N/A 4 0 N/A <5 case-controls Childhood consumption 0 0 N/A 5 0 N/A Only 2 studies could be
included in meta-analysis 2
Preserved olives: Adulthood consumption 0 0 N/A 3 0 N/A <5 case-controls Childhood consumption 0 0 N/A 2 0 N/A <5 case-controls Other preserved fruits:
Adulthood consumption 0 0 N/A 3 0 N/A <5 case-controls Childhood consumption 0 0 N/A 2 0 N/A <5 case-controls 2.3 Pulses(legumes)
Non-preserved pulses 1 0 N/A 2 0 N/A <2 cohort; <5 case-controls Preserved soy/tofu:
Adulthood consumption 0 0 N/A 8 0 N/A Only 3 studies could be included in meta-analysis
2
Childhood consumption 0 0 N/A 6 0 N/A Only 3 studies could be included in meta-analysis
2
Other preserved pulses 1 0 N/A 3 0 N/A <5 case-controls 2.4 Nuts and seeds Adulthood consumption 0 0 N/A 3 0 N/A <5 case-controls Childhood consumption 0 0 N/A 2 0 N/A <5 case-controls 2.5.1 Meat
Preserved meat: Adulthood consumption 0 0 N/A 7 0 N/A Only 3 studies could be
included in meta-analysis 2
Childhood consumption 0 0 N/A 4 0 N/A <5 case-controls 2.5.1.1 Fresh meat Adulthood consumption 0 0 N/A 4 0 N/A <5 case-controls Childhood consumption 0 0 N/A 4 0 N/A <5 case-controls 2.5.1.2 Processed meat Adulthood consumption 0 0 N/A 5 0 N/A Case-control:
4 Highest vs. Lowest
NPC: Summary Tables: 22 May, 2006
Reasons for inclusion in summary 1) exposure convincing, probable or possible in 1997 report, 2) at least 2 cohort or at least 5 case-control studies, 3) robust and reproducible human or animal experimental studies 4) Other – please state reason
Exposure Cohort studies Case-control studies Total
n Number Included in meta-analysis
Summary OR and 95% CI (Random)
Total n
Number Included in meta-analysis
Summary OR and 95% CI (Random)
Additional issues/ or reasons meta-analysis not appropriate
Included in summary (indicate reason)
Childhood consumption 0 0 N/A 3 0 N/A <5 case-controls 2.5.1.3.1 Beef 0 0 N/A 2 0 N/A <5 case-controls;
1 ecological study
2.5.1.3.2 Pork 0 0 N/A 3 0 N/A <5 case-controls; 1 ecological study
2.5.1.3.4 Organ meats Non-processed organs: Adulthood consumption 0 0 N/A 4 0 N/A <5 case-controls Childhood consumption 0 0 N/A 4 0 N/A <5 case-controls Processed organ meats 0 0 N/A 2 0 N/A <5 case-controls 2.5.1.4 Poultry 0 0 N/A 2 0 N/A <5 case-controls;
1 ecological study
2.5.2 Fish: non-preserved
0 0 N/A 3 0 N/A <5 case-controls; 1 ecological study
2.5.2.1 Salted fish Adulthood consumption 1 0 N/A 21 9 1.28
(1.13-1.44), times/week
Case-control: 9 Dose-Response; 17 Highest vs. Lowest
Consumption, age 10 1 0 N/A 16 9 1.35 (1.14-1.60), times/week
Case-control: 9 Dose-Response; 14 Highest vs. Lowest
Consumption, ages 0-3 0 0 N/A 10 5 1.42 (1.11-1.81), times/week
Case-control: 5 Dose-Response; 8 Highest vs. Lowest
Mother’s consumption 0 0 N/A 3 0 N/A <5 case-controls 2.5.2.2 Other preserved fish
1 0 N/A 5 0 N/A Heterogeneous exposures (dried, fermented, pastes)
2
2.5.3 Shellfish and other seafood Non-preserved seafood 0 0 N/A 4 0 N/A <5 case-controls
Preserved seafood: Adulthood consumption 0 0 N/A 5 0 N/A Only 3 studies could be
included in meta-analysis 2
Childhood consumption 0 0 N/A 5 0 N/A Only 2 studies could be included in meta-analysis
2
2.5.4 Eggs
NPC: Summary Tables: 22 May, 2006
Reasons for inclusion in summary 1) exposure convincing, probable or possible in 1997 report, 2) at least 2 cohort or at least 5 case-control studies, 3) robust and reproducible human or animal experimental studies 4) Other – please state reason
Exposure Cohort studies Case-control studies Total
n Number Included in meta-analysis
Summary OR and 95% CI (Random)
Total n
Number Included in meta-analysis
Summary OR and 95% CI (Random)
Additional issues/ or reasons meta-analysis not appropriate
Included in summary (indicate reason)
Non-preserved eggs 0 0 N/A 4 0 N/A <5 case-controls; 1 ecological study
Salted eggs: Adulthood consumption 0 0 N/A 5 0 N/A Only 3 studies could be
included in meta-analysis 2
Childhood consumption 0 0 N/A 4 0 N/A <5 case-controls Other preserved eggs 0 0 N/A 5 0 N/A Heterogeneous exposures
(dried, fermented, tinned) 2
2.6 Fats, oils and sugars
0 0 N/A 3 0 N/A <5 case-controls
2.6.1 Animal fats 0 0 N/A 3 0 N/A <5 case-controls 2.6.2 Plant oils 0 0 N/A 4 0 N/A <5 case-controls 2.6.4 Sugars 0 0 N/A 1 0 N/A <5 case-controls 2.7 Milk and dairy products
0 0 N/A 4 0 N/A <5 case-controls
2.8 Herbs, spices and condiments Childhood consumption 0 0 N/A 3 0 N/A <5 case-controls
Herbal intake 0 0 N/A 6 0 N/A Case-control: 4 Highest vs. Lowest
Non-preserved spices 0 0 N/A 3 0 N/A <5 case-controls Preserved spices 0 0 N/A 4 0 N/A <5 case-controls
Soy sauce 0 0 N/A 3 0 N/A <5 case-controls Other fermented sauce 0 0 N/A 2 0 N/A <5 case-controls
2.9 Composite foods 0 0 N/A 14 0 N/A Heterogeneous exposures (soups, stews, porridges)
3.1 Total fluid intake 0 0 N/A 1 0 N/A <5 case-controls 3.2 Water 0 0 N/A 2 0 N/A <5 case-controls 3.3 Milk (as beverage) 0 0 N/A 4 0 N/A <5 case-controls 3.5 Fruit juices 0 0 N/A 1 0 N/A <5 case-controls 3.6 Hot drinks 0 0 N/A 1 0 N/A <5 case-controls 3.6.1 Coffee 0 0 N/A 3 0 N/A <5 case-controls 3.6.2 Tea Adulthood consumption 0 0 N/A 7 0 N/A Case-control:
4 Highest vs. Lowest Childhood consumption 0 0 N/A 1 0 N/A <5 case-controls
NPC: Summary Tables: 22 May, 2006
Reasons for inclusion in summary 1) exposure convincing, probable or possible in 1997 report, 2) at least 2 cohort or at least 5 case-control studies, 3) robust and reproducible human or animal experimental studies 4) Other – please state reason
Exposure Cohort studies Case-control studies Total
n Number Included in meta-analysis
Summary OR and 95% CI (Random)
Total n
Number Included in meta-analysis
Summary OR and 95% CI (Random)
Additional issues/ or reasons meta-analysis not appropriate
Included in summary (indicate reason)
3.6.2.2 Green tea 0 0 N/A 1 0 N/A <5 case-controls 3.7 Alcoholic drinks 0 0 N/A 1 0 N/A <5 case-controls 3.7.1 Total alcohol 1 0 N/A 18 8 1.01
(1.00-1.03), drinks/wk
<2 cohorts Case-control: 8 Dose-Response; 10 Highest vs. Lowest
3.7.1.1 Beer 0 0 N/A 3 0 N/A <5 case-controls 3.7.1.2 Wines 0 0 N/A 4 0 N/A <5 case-controls 3.7.1.3 Spirits 0 0 N/A 3 0 N/A <5 case-controls;
1 ecological study
3.7.1.4 Other alcoholic drinks
0 0 N/A 1 0 N/A <5 case-controls
4.1.2 Chemical contaminants
0 0 N/A 2 0 N/A <5 case-controls
4.1.2.7.1 Cadmium 0 0 N/A 2 0 N/A <5 case-controls 4.1.2.7.2 Arsenic 0 0 N/A 1 0 N/A <5 case-controls;
3 ecological studies
4.1.2.7.3 Other heavy metals Lead 0 0 N/A 3 0 N/A <5 case-controls
Mercury 0 0 N/A 1 0 N/A <5 case-controls Molybdenum 0 0 N/A 2 0 N/A <5 case-controls
Nickel 0 0 N/A 2 0 N/A <5 case-controls 4.1.2.9 Other contaminants
0 0 N/A 1 0 N/A <5 case-controls; 1 ecological studies
4.2 Preservation Preserved animal food 1 0 N/A 5 0 N/A Heterogeneous exposures
(meat, fish, eggs, dairy) 2
Preserved plant food 0 0 N/A 12 0 N/A Heterogeneous exposures (tomatoes, plums, roots)
2
4.2.1 Drying Dried animal food 0 0 N/A 5 0 N/A Heterogeneous exposures
(fish, shrimp, oysters) 2
Dried plant food 0 0 N/A 5 0 N/A Heterogeneous exposures (dates, plums, seaweed)
2
4.2.2 Storage 0 0 N/A 1 0 N/A <5 case-controls
NPC: Summary Tables: 22 May, 2006
Reasons for inclusion in summary 1) exposure convincing, probable or possible in 1997 report, 2) at least 2 cohort or at least 5 case-control studies, 3) robust and reproducible human or animal experimental studies 4) Other – please state reason
Exposure Cohort studies Case-control studies Total
n Number Included in meta-analysis
Summary OR and 95% CI (Random)
Total n
Number Included in meta-analysis
Summary OR and 95% CI (Random)
Additional issues/ or reasons meta-analysis not appropriate
Included in summary (indicate reason)
4.2.3 Bottling, canning etc
0 0 N/A 1 0 N/A <5 case-controls
4.2.5.1 Salt 0 0 N/A 2 0 N/A <5 case-controls 4.2.5.3 Salted/salty foods
0 0 N/A 1 0 N/A <5 case-controls
4.2.5.3.1 Salted animal food Salted fish only:
Adulthood consumption 1 0 N/A 21 9 1.28 (1.13-1.44), times/week
Case-control: 9 Dose-Response; 17 Highest vs. Lowest
Consumption, age 10 1 0 N/A 16 9 1.35 (1.14-1.60), times/week
Case-control: 9 Dose-Response; 14 Highest vs. Lowest
Consumption, ages 0-3 0 0 N/A 10 5 1.42 (1.11-1.81), times/week
Case-control: 5 Dose-Response; 8 Highest vs. Lowest
Mother’s consumption 0 0 N/A 3 0 N/A <5 case-controls Other salted animal
foods 0 0 N/A 10 0 N/A Heterogeneous exposures
(meat, fish, seafood, eggs) 2
4.2.5.3.2 Salted plant food
0 0 N/A 9 0 N/A Heterogeneous exposures (dates, plums, pulses)
2
4.2.6 Pickling 0 0 N/A 11 0 N/A Heterogeneous exposures (vegetables, fruits, spices )
2
4.2.7.1.1 Cured meats 0 0 N/A 2 0 N/A <5 case-controls 4.2.7.1.2 Smoked foods 0 0 N/A 4 0 N/A <5 case-controls 4.3 Processing 0 0 N/A 6 0 N/A Heterogeneous exposures
(meats, pork ) 2
4.3.1 Refining 0 0 N/A 6 0 N/A 1 ecological study; Heterogeneous exposures (bread, rice, noodles )
2
4.3.2 Hydrogenation 0 0 N/A 1 0 N/A <5 case-controls 4.3.3 Fermenting 1 0 N/A 10 0 N/A Heterogeneous exposures
(soy, fish, seafood, eggs) 2
4.3.5.1 Flavours 0 0 N/A 3 0 N/A <5 case-controls 4.3.5.4.1 Nitrites and nitrates
0 0 N/A 1 0 N/A <5 case-controls; 3 ecological studies
NPC: Summary Tables: 22 May, 2006
Reasons for inclusion in summary 1) exposure convincing, probable or possible in 1997 report, 2) at least 2 cohort or at least 5 case-control studies, 3) robust and reproducible human or animal experimental studies 4) Other – please state reason
Exposure Cohort studies Case-control studies Total
n Number Included in meta-analysis
Summary OR and 95% CI (Random)
Total n
Number Included in meta-analysis
Summary OR and 95% CI (Random)
Additional issues/ or reasons meta-analysis not appropriate
Included in summary (indicate reason)
4.4.1 Fresh foods Fresh animal foods 0 0 N/A 6 0 N/A Heterogeneous exposures
(meat, fish, eggs, milk) 2
Fresh plant foods 0 0 N/A 9 0 N/A 1 ecological study; Heterogeneous exposures (vegetables, fruits, pulses)
2
4.4.1.1 Raw 0 0 N/A 2 0 N/A <5 case-controls 4.4.2 Cooked food 0 0 N/A 2 0 N/A <5 case-controls 4.4.2.1 Steaming, boiling, poaching
0 0 N/A 1 0 N/A <5 case-controls
4.4.2.2 Stewing, casseroling
0 0 N/A 1 0 N/A <5 case-controls
4.4.2.5 Frying 0 0 N/A 1 0 N/A <5 case-controls 4.4.2.6 Grilling and BBQ
0 0 N/A 1 0 N/A <5 case-controls
5.3 Protein 0 0 N/A 1 0 N/A <5 case-controls 5.5.1 Vitamin A 0 0 N/A 1 0 N/A <5 case-controls 5.5.2 Non-provitamin A carotenoids
0 0 N/A 2 0 N/A <5 case-controls
5.5.9 Vitamin C 0 0 N/A 3 0 N/A <5 case-controls 5.5.10 Vitamin D and calcium
0 0 N/A 1 0 N/A <5 case-controls; 1 ecological study; 1 cross-sectional study
5.5.11 Vitamin E 0 0 N/A 1 0 N/A <5 case-controls 5.5.13 Other vitamins 0 0 N/A 1 0 N/A <5 case-controls 5.6.2 Iron 0 0 N/A 3 0 N/A <5 case-controls 5.6.3 Calcium (and vitamin D)
0 0 N/A 1 0 N/A <5 case-controls; 1 ecological study; 1 cross-sectional study
5.6.4 Selenium 0 0 N/A 3 0 N/A <5 case-controls 5.6.5 Iodine 0 0 N/A 1 0 N/A <5 case-controls 5.6.6 Other minerals
Chromium 0 0 N/A 2 0 N/A <5 case-controls Copper 0 0 N/A 4 0 N/A <5 case-controls
Manganese 0 0 N/A 3 0 N/A <5 case-controls
NPC: Summary Tables: 22 May, 2006
Reasons for inclusion in summary 1) exposure convincing, probable or possible in 1997 report, 2) at least 2 cohort or at least 5 case-control studies, 3) robust and reproducible human or animal experimental studies 4) Other – please state reason
Exposure Cohort studies Case-control studies Total
n Number Included in meta-analysis
Summary OR and 95% CI (Random)
Total n
Number Included in meta-analysis
Summary OR and 95% CI (Random)
Additional issues/ or reasons meta-analysis not appropriate
Included in summary (indicate reason)
Zinc 0 0 N/A 4 0 N/A <5 case-controls Other minerals 0 0 N/A 2 0 N/A <5 case-controls
1 June, 2006
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Results Tables Table of contents
1.2 Socio-economically defined diets ........................................................................................................................................................................4 1.3 Culturally defined diets .......................................................................................................................................................................................4 1.5 Other dietary patterns .........................................................................................................................................................................................4 1.6.2 Child ..................................................................................................................................................................................................................5 1.7 Other issues...........................................................................................................................................................................................................5 2.1.1 Cereals (grains).................................................................................................................................................................................................6 2.1.1.1 Wholegrain cereals and cereal products ........................................................................................................................................................7 2.1.1.2 Refined cereals and cereal products ...............................................................................................................................................................7 2.1.1 Starchy roots, tubers and plantains..............................................................................................................................................................10 2.2 Fruit and vegetables...........................................................................................................................................................................................10 2.2.1 Non-starchy (and starchy) vegetables ..........................................................................................................................................................11 2.2.1.1 Non-starchy root vegetables and tubers.......................................................................................................................................................19 2.2.1.2 Cruciferous vegetables...................................................................................................................................................................................22 2.2.1.3 Allium vegetables ...........................................................................................................................................................................................28 2.2.1.4 Green leafy vegetables ...................................................................................................................................................................................28 2.2.1.5 Other non-starchy vegetables .......................................................................................................................................................................32 2.2.1.6 Raw vegetables ...............................................................................................................................................................................................39 2.2.2 Fruits (general) ...............................................................................................................................................................................................40 2.2.2.1 Citrus fruits ....................................................................................................................................................................................................42 2.2.2.2 Other fruits .....................................................................................................................................................................................................45 2.3 Pulses (legumes)..................................................................................................................................................................................................55 2.4 Nuts and seeds ....................................................................................................................................................................................................62 2.5.1 Meat .................................................................................................................................................................................................................63 2.5.1.1 Fresh Meat ......................................................................................................................................................................................................67 2.5.1.2 Processed meat ...............................................................................................................................................................................................69 2.5.1.3.1 Beef ..............................................................................................................................................................................................................71 2.5.1.3.2 Pork .............................................................................................................................................................................................................72 2.5.1.3.4 Organ meats................................................................................................................................................................................................74 2.5.1.4 Poultry.............................................................................................................................................................................................................77 2.5.2 Fish ..................................................................................................................................................................................................................78 2.5.2.1 Salted Fish.......................................................................................................................................................................................................79
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2
2.5.2.2 Other preserved fish (excluding salted fish) ................................................................................................................................................91 2.5.3 Shellfish and other seafood............................................................................................................................................................................95 2.5.4 Eggs .................................................................................................................................................................................................................99 2.6 Fats, oils and sugars as foods ..........................................................................................................................................................................104 2.6.1 Animal fats (as foods) ..................................................................................................................................................................................105 2.6.2 Plant oils (as foods) ......................................................................................................................................................................................106 2.6.4 Sugars ............................................................................................................................................................................................................108 2.7 Milk and dairy products..................................................................................................................................................................................108 2.8 Herbs, spices, condiments................................................................................................................................................................................109 2.9 Composite foods ...............................................................................................................................................................................................116 3.1 Total fluid intake ..............................................................................................................................................................................................122 3.2 Water .................................................................................................................................................................................................................122 3.3 Milk as beverage...............................................................................................................................................................................................123 3.5 Fruit juices ........................................................................................................................................................................................................124 3.6 Hot drinks .........................................................................................................................................................................................................125 3.6.1 Coffee.............................................................................................................................................................................................................125 3.6.2 Tea .................................................................................................................................................................................................................126 3.6.2.2 Green tea .......................................................................................................................................................................................................128 3.7 Alcoholic drinks................................................................................................................................................................................................128 3.7.1 Total alcoholic drinks ..................................................................................................................................................................................129 3.7.1.1 Beers ..............................................................................................................................................................................................................134 3.7.1.2 Wines .............................................................................................................................................................................................................135 3.7.1.3 Spirits ............................................................................................................................................................................................................135 3.7.1.4 Other alcoholic drinks .................................................................................................................................................................................136 4.1.2 Chemical contaminants ...............................................................................................................................................................................137 4.1.2.7.1 Cadmium...................................................................................................................................................................................................137 4.1.2.7.2 Arsenic.......................................................................................................................................................................................................138 4.1.2.7.3 Other heavy metals ..................................................................................................................................................................................139 4.1.2.9 Other contaminants .....................................................................................................................................................................................142 4.2 Preservation (preserved foods) .......................................................................................................................................................................143 4.2.1 Drying (dried foods) .....................................................................................................................................................................................158 4.2.2 Storage...........................................................................................................................................................................................................166 4.2.3 Bottling, canning, vacuum packing ............................................................................................................................................................167 4.2.5.1 Salt .................................................................................................................................................................................................................167 4.2.5.3 Salted foods ...................................................................................................................................................................................................167
1 June, 2006
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3
4.2.5.3.1 Salted animal food....................................................................................................................................................................................168 4.2.5.3.2 Salted plant food.......................................................................................................................................................................................185 4.2.6 Pickling (pickled foods) ...............................................................................................................................................................................192 4.2.7.1.1 Cured meats ..............................................................................................................................................................................................197 4.2.7.1.2 Smoked foods ............................................................................................................................................................................................198 4.3 Processing .........................................................................................................................................................................................................199 4.3.1 Refining .........................................................................................................................................................................................................202 4.3.2 Hydrogenation ..............................................................................................................................................................................................204 4.3.3 Fermenting....................................................................................................................................................................................................205 4.3.5.1 Flavours.........................................................................................................................................................................................................213 4.3.5.4.1 Nitrites and nitrates .................................................................................................................................................................................214 4.4.1 Fresh food .....................................................................................................................................................................................................216 4.4.1.1 Raw ................................................................................................................................................................................................................230 4.4.2 Cooked food ..................................................................................................................................................................................................231 4.4.2.1 Steaming, boiling, poaching ........................................................................................................................................................................231 4.4.2.2 Stewing, casseroling .....................................................................................................................................................................................232 4.4.2.5 Frying ............................................................................................................................................................................................................232 4.4.2.6 Grilling (broiling) and barbecuing .............................................................................................................................................................233 5.3.1 Total protein .................................................................................................................................................................................................233 5.5.1 Vitamin A......................................................................................................................................................................................................234 5.5.1.2 Provitamin A carotenoids..............................................................................................................................Error! Bookmark not defined. 5.5.1.2.1 Beta-carotene ............................................................................................................................................................................................234 5.5.9 Vitamin C......................................................................................................................................................................................................235 5.5.10 Vitamin D (and calcium) .............................................................................................................................................................................235 5.5.11 Vitamin E ......................................................................................................................................................................................................236 5.5.13 Other vitamins (including multivitamins) .................................................................................................................................................237 5.6.2 Iron ................................................................................................................................................................................................................237 5.6.3 Calcium (and vitamin D) .............................................................................................................................................................................238 5.6.4 Selenium ........................................................................................................................................................................................................239 5.6.5 Iodine .............................................................................................................................................................................................................240 5.6.6 Other minerals..............................................................................................................................................................................................240
1 June, 2006
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4
1.2 Socio-economically defined diets Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS02182
Armstrong
1983
Childhood history of poorer, simpler diet (mostly rice)
Yes or no Hospital records
Malaysia Chinese N/A Mixed 87 79 2 4.3 Popula-tion
N/A .01 N/A Sex, area of residence, ethnicity/ race, age, salted fish intake
1.3 Culturally defined diets Case-control (1) Studyy identiier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS04944
Armstrong
1978
Multi-ethnic cuisine
Single v. multi-ethnic
Recall: interview
Malaysia Chinese 210 25-81/ Mixed
N/A N/A 2 0.2 single N/A < .01 N/A Unadjusted
1.5 Other dietary patterns Case-control (3)
1 June, 2006
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5
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01056
Lee
1994
Age stopped bottlefeeding
Never to 24+ months
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
64 102 4 OR = 1.6 Never 0.6-5.5
N/A .01 Age, sex, education, ethnicity/ race
NAS01381
Jeannel
1990
Adult diet for weaning
Yes or no FFQ - Study-specific
Tunisia Tunisian 240 N/A/ Mixed
80 160 2 OR = 5.1 No N/A 0.03 N/A Sex, age, lifestyle factors, area of residence
NAS01459
Yu
1989
Age at which first solid food was given
N/A FFQ - Study-specific
China Chinese 612 Max 49/ Mixed
306 306 N/A Median = 6 months for both
N/A N/A Not signif-icant
N/A Area of residence, age, sex
1.6.2 Breastfeeding-Child Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00424
Laouamri
2001
Breast-feeding duration
Never to > 24 months
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
122 122 6 4.0 Never 1.24-12.8
0.02 N/A Area of residence, age, sex
NAS01056
Lee
1994
Breast-feeding duration
Never to 7+ months
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
64 103 3 0.6 Never 0.2-1.4
N/A .03 Age, sex, ethnicity/ race, education
1.7 Other diet pattern issues Case-control (1) Study Exposure Exposure Assess- Country Ethnicity No of Age/Sex of No. No. No. OR Ref CI P value p value Adjusted
1 June, 2006
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6
identifier
Author, Yr
range ment
Tool
of subjects
subjects analysed
subjects cases controls categories group for trend
for
NAS04944
Armstrong
1978
Patterns of meals and snacks
N/A Recall: interview
Malaysia Chinese 210 25-81/ Mixed
N/A N/A N/A N/A N/A N/A Not signif-icant
N/A Un-adjusted
2.1.1 Cereals (grains) Total Cereals: Adulthood consumption Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of sub jects
No.
cases
No.
Cont-rols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS06024
Huang
1997
Cereals (grains) Consume few to consume every day
Question-naire
China Chinese 416 N/A/ Mixed
208 208 4 16 Consume few
3.11- 82.42
N/A N/A Unadjusted
NAS06024
Huang
1997
Cereals: exposed 3 years before disease dx, include corn, wheat, cases and control were from Heilongjiang province
Yes vs No Question-naire
China Chinese 416 N/A/ Mixed
104 104 2 1.526 No 1.02-2.28
0.039 N/A Age, Sex, Chronic otolaryngological diseases, Area of residence, Consumption of vegetables, Use coal as fuel
Total Cereals: Childhood consumption Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of sub jects
No.
cases
No.
Cont-rols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
1 June, 2006
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7
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of sub jects
No.
cases
No.
Cont-rols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00424
Laouamri
2001
Foods for chewing when teething: cherchem (wheat or barley pieces that have softened through contact w/ the floor and walls when these cereals are stored underground)
Ever vs Never
FFQ - Study-specific
Algeria Un-known
144 9-70/ Mixed
72 72 2 4.0 Ever 0.18-4.4
N/A N/A Age, Sex, Area of residence
NAS01381
Jeannel
1990
Mhammas (cracked wheat), consumption during childhood
Less than once a month to 2+ times/ week
FFQ - Study-specific
Tunisia Tunisian 240 Mean 41/ Mixed
80 160 3 0.3 Less than once a month
N/A N/A N/A Age, Sex, Area of residence, Living condition score
2.1.1.1 Wholegrain cereals and cereal products Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS06022
Wang
1993
Whole-grain cereals
Not frequent or frequent
Question-naire
China Chinese 244 13-70/ Mixed
122 122 2 0.186 Not frequent
N/A .0235 N/A Sex, age, environmental factors, plant oil, pork fat, salted fish, non-nutrient chemicals, high-income, vegetable intake, coloured vegetables
2.1.1.2 Refined cereals and cereal products Bread: Adulthood consumption Case-control (3)
1 June, 2006
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8
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Cont-rols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01459
Yu
1989
Bread, consumption at age 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 612 Max 49/ Mixed
306 306 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of residence
NAS01812
Geser
1978
Bread eaten often, by household of cases and controls
Yes vs No FFQ - Study-specific
China Chinese 300 N/A/ Mixed
147 147 2 0.43 No 0.27-0.7
N/A N/A Age, Sex
NAS04944
Armstrong
1978
Bread, for breakfast among families of participants
N/A Recall Malaysia Chinese 210 25-81/ Mixed
60 150 N/A OR > 1
N/A N/A Signif-icant
N/A Unadjusted
Bread: Childhood consumption Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of sub jects
No.
cases
No.
Cont-rols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS00424
Laouamri
2001
Foods for chewing when teething: crust of bread
Ever vs Never
FFQ - Study-specific
Algeria Un-known
144 9-70/ Mixed
72 72 2 OR = 1
Ever N/A N/A N/A Age, Sex, Area of residence
NAS01459
Yu
1989
Bread, consumption at age 10
N/A FFQ - Study-specific
China Chinese 612 Max 49/ Mixed
306 306 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of residence
NAS01520
Yu
1988
Bread, consumed by subject at age 10
N/A FFQ - Study-specific
China Chinese 302 Mean 35/ Mixed
128 174 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex
Noodles Case-control (1)
1 June, 2006
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9
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Cont-rols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS04944
Armstrong
1978
Noodles in three main daily meals combined, among cases and controls
N/A Recall Malaysia Chinese 210 25-81/ Mixed
60 150 N/A 1.2 N/A N/A Not signif-icant
N/A Ethnicity/ Race, Census district, Household type, Socio-economic status, Sex, Age
Rice Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Cont-rols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS04944
Armstrong
1978
Rice, for breakfast; families of participants
N/A Recall Malaysia Chinese 210 25-81/ Mixed
60 150 N/A OR > 1
N/A N/A Signif-icant
N/A Unadjusted
NAS04944
Armstrong
1978
Plain rice, at evening meal; families of participants
N/A Recall Malaysia Chinese 210 25-81/ Mixed
60 150 N/A OR < 1
N/A N/A Signif-icant
N/A Unadjusted
NAS04944
Armstrong
1978
Rice porridge, at evening meal among families of participants
N/A Recall Malaysia Chinese 210 25-81/ Mixed
60 150 N/A OR > 1
N/A N/A Signif-icant
N/A Unadjusted
NAS06024
Huang
1997
Rice, exposed at age 10, specific on rice cases and control were from Heilongjiang province
Yes vs No Question-naire
China Chinese 416 N/A/ Mixed
104 104 2 0.707 No 0.505-0.92
0.044 N/A Unadjusted
Ecological (1) Study identifier
Author, Yr
Exposure Exposure range
Assessment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
categories
r2 Ref group
CI P value
p value for trend
Adjusted for
1 June, 2006
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10
NAS00817
Koo
1997
Rice Per capita consumption
Food survey
China, Hong Kong
Chinese N/A Male N/A N/A Continuous 0.86 N/A N/A .001 N/A age
NAS00817
Koo
1997
Rice Per capita consumption
Food survey
China, Hong Kong
Chinese N/A Female N/A N/A Continuous 0.85 N/A N/A .034 N/A age
2.1.2 Starchy roots, tubers and plantains Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS00424
Laouamri
2001
Baby foods: mashed potatoes
<3 times to >7 times a week
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
56 58 3 2.0 <3 times a week
0.06-59.7
Not signif-icant
N/A Sex, age, area of residence
NAS06023
Zou
1999
Taro None to high Question-naire
China Chinese 304 14-82/ Mixed
101 199 5 0.76 none 0.46-1.26
0.29 N/A Unadjusted
NAS06023
Zou
1999
Sweet potatoes
None to high Question-naire
China Chinese 304 14-82/ Mixed
100 199 5 0.67 none 0.33-1.36
0.25 N/A Unadjusted
2.2 Fruit and (non-starchy) vegetables
Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Asses-sment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
categories
OR Ref group
CI P value p value for trend
Adjusted for
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
11
Study identifier
Author, Yr
Exposure Exposure range
Asses-sment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
categories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01381
Jeannel
1990
Fruits and vegetables
N/A FFQ - Study-specific
Tunisia Tunisian 240 N/A/ Mixed
80 160 2 N/A N/A N/A Not signif-icant
N/A Age, sex, area of residence
2.2.1 Non-starchy vegetables Total non-preserved vegetables: Adulthood consumption Case-control (5) Meta-analysis Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group CI P value
p value for trend
Adjusted for
NAS00531
Ward
2000
Adult Dietary Intake: vegetable
Lowest to Highest
Dietary History question-naire
China Chinese 702 Max 74/ Mixed
375 327 4 0.6 Lowest 0.4-1.0
Not Signif-icant
N/A Age, Sex, Ethnicity/ Race, Subjects w/ mothers questionnaire, Total calories
NAS00577
Yuan
2000
All fresh vegetables
≤ 538 times per year to > 866 times per year
FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 4 0.85 ≤ 538 times per year
0.65-1.10
N/A 0.13 Sex, Age, Education, Smoking, Exposure to smoke from heated rapeseed oil and burning coal while cooking, occupational exposure to chemical fumes, History of chronic ear and nose condition
NAS01922
Ning
1990
Fresh vegetable, consumption 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of Residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
12
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group CI P value
p value for trend
Adjusted for
NAS06003
Ye
1995
Non-starchy vegetables
≤15.75 times per month to > 15.75 times per month
Dietary History question-naire
China Chinese 270 21-75/ Mixed
135 135 2 0.51 ≤15.75 times per month #
0.29-0.88
<0.05 N/A Age, Sex, Area of residence
NAS06022
Wang
1993
Non-starchy vegetables
less consumed vs frequently consumed
Question-naire
China Chinese 244 13-70/ Mixed
122 122 2 0.256 Less consumed
N/A 0.0051 N/A Age, Sex, high-income, Non nutrient chemicals, Consumption of salted fish, pork fat, whole grains, plant oil, and vegetables, smoking in living area
Ecological (2) Study identifier
Author, Yr
Exposure Exposure range
Assessment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
categories
Regression slope
Ref group
CI P value
p value for trend
Adjusted for
NAS00817
Koo
1997
Fresh vegetables
N/A Per capita consumption
China, Hong Kong
Chinese N/A Male N/A N/A Continuous r2 = -0.77 N/A N/A 0.009 N/A age
NAS00817
Koo
1997
Fresh vegetables
N/A Per capita consumption
China, Hong Kong
Chinese N/A Female N/A N/A Continuous r2 = -0.75 N/A N/A 0.013 N/A age
NAS06029
Guo
2001
Non-starchy vegetables
N/A Interview of local residents
China Chinese N/A Mixed N/A N/A Continuous Regression slope =2.36
N/A N/A N/A N/A N/A
Total non-preserved vegetables: Childhood/Infancy consumption Case-control (2)
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
13
Study identifier
Author, Yr
Exposure Exposure range
Assessment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00531
Ward
2000
Intake for Age 10: Non-specific vegetables
0-4 servings to >4 servings
Dietary History questionnaire
China Chinese 702 Max 74/ Mixed
91 114 2 0.4 0-4 servings
0.1-1.0
N/A N/A Age, Sex, Ethnicity/Race
NAS00531
Ward
2000
Intake for Age 3: Non-specific vegetables
0-4 servings to >4 servings
Dietary History questionnaire
China Chinese 702 Max 74/ Mixed
87 110 2 0.5 0-4 servings
0.3-1.1
N/A N/A Age, Sex, Ethnicity/ Race
NAS00531
Ward
2000
During Weaning: Non-specific vegetables
None to > 4 servings
Dietary History questionnaire
China Chinese 702 Max 74/ Mixed
84 111 3 0.6 None 0.3-1.3
N/A N/A Age, Sex, Ethnicity/ Race
NAS00531
Ward
2000
Mother's diet during breastfeeding: Fresh vegetables
Highest vs lowest
Dietary History questionnaire
China Chinese 702 Max 74/ Mixed
375 327 N/A 0.3 Lowest 0.1-1/5
N/A N/A N/A
NAS01922
Ning
1990
Fresh vegetable, consumption at 10 years of age
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of Residence
Green vegetables: Adulthood consumption Case-control (4) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00700
Farrow
1998
Labeled dark green vegetables (broccoli, cauliflower, spinach, mustard or turnip greens, coleslaw)
Lowest to highest
FFQ – Block
United States
Unknown 345 18-74/ Mixed
129 206 4 0.99 Lowest 0.51-1.94
N/A 0.60 Age, Sex, Energy Intake, Alcohol consumption, Smoking Habits
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
14
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00749
Armstrong
1998
Other green vegetables (green onions, broccoli, chives, watercress, Chinese lettuce), 5 years pre-diagnosis
Monthly to greater than weekly
Dietary History question-naire
Malaysia Chinese 564 Mean 45/ Mixed
282 282 3 0.5 Monthly 0.23-1.07
N/A 0.026 Unadjusted
NAS00825
Chen
1997
Green pepper, chives, celery, 3 years ago
N/A FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 Continuous 0.63 N/A 0.44-0.91
N/A N/A Age, Sex, Area of Residence
NAS06024
Huang
1997
Exposed 3 years before disease diagnosed (green pepper, celery, cases and control were from Guangdong province)
Yes vs no Question-naire
China Chinese 416 N/A/ Mixed
208 208 2 0.63 No 0.44-0.91
0.014 N/A Unadjusted
Green vegetables: Childhood consumption Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00749
Armstrong
1998
Other green vegetables (green onions, broccoli, chives, watercress, Chinese lettuce), consumption at age 10
Monthly to greater than weekly
Dietary History questionnaire
Malaysia Chinese 564 Mean 45/ Mixed
282 282 3 0.59 Monthly 0.33-1.06
N/A N/A Unadjusted
NAS00825
Chen
1997
Green peppers, chives, celery, 10 years old
N/A FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 Contin-uous
0.54 N/A 0.38-0.78
N/A N/A Age, Sex, Area of Residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
15
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01459
Yu
1989
Fresh green vegetables, consumption during weaning
Yes vs No FFQ - Study-specific
China Chinese 612 Max 49/ Mixed
306 306 2 0.6 No 0.3-1.1
N/A N/A Age, Sex, Area of Residence
NAS01459
Yu
1989
Fresh green vegetables, consumption during ages 1-2
Rarely to weekly
FFQ - Study-specific
China Chinese 612 Max 49/ Mixed
110 139 3 1.7 Weekly 0.6-4.9
N/A Not Signif icant
Age, Sex, Area of Residence
NAS01459
Yu
1989
Fresh green vegetables, consumption at age 10
Less than daily to daily
FFQ - Study-specific
China Chinese 612 Max 49/ Mixed
306 306 2 1.3 Daily 0.3-5.1
N/A N/A Age, Sex, Area of Residence
Other non-preserved vegetables Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group CI P value
p value for trend
Adjusted for
NAS04944
Armstrong
1978
Vegetables, for breakfast among families of participants
N/A Recall Malaysia Chinese 210 25-81/ Mixed
60 150 N/A OR < 1
N/A N/A Signif- icant
N/A Unadjusted
NAS04944
Armstrong
1978
Fresh vegetables, at evening meal among families of participants
N/A Recall Malaysia Chinese 210 25-81/ Mixed
60 150 N/A OR < 1
N/A N/A Signif- icant
N/A Unadjusted
NAS04944
Armstrong
1978
Vegetables in three main daily meals combined, among cases and controls
N/A Recall Malaysia Chinese 210 25-81/ Mixed
60 150 N/A 0.9 N/A N/A N/A N/A Age, Sex, Census district, Household type, Race/ ethnicity, SES
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
16
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group CI P value
p value for trend
Adjusted for
NAS06022
Wang
1993
Colored vegetables
less consumed vs frequently consumed
Question-naire
China Chinese 244 13-70/ Mixed
122 122 2 0.111 Less consumed
N/A 0.0108 N/A Age, Sex, high-income, Non nutrient chemicals, Consumption of salted fish, pork fat, whole grains, plant oil, and vegetables, Has smoking in living area
Total preserved vegetables: Adulthood consumption Case-control (7) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00531
Ward
2000
Adult Dietary Intake: Preserved vegetables
Ever vs Never
Dietary History question-naire
China Chinese 702 Max 74/ Mixed
375 327 2 N/A N/A N/A Not Signif-icant
N/A Age, Sex, Ethnicity/ Race, Subjects w/ mothers questionnaire, Total calories
NAS00577
Yuan
2000
All preserved vegetables (salted mustard green/ bok choi/ stem vegetables, pickled stem vegetable/ cucumber, salted root and preserved root)
≤40 times per year to > 200 times per year
FFQ - Study-specifi
China Chinese 1967 15-74/ Mixed
935 1032 4 1.43 ≤40 times per year
1.11-1.86
N/A 0.001 Sex, Age, Educational Level, Smoking, Exposure to smoke from heated rapeseed oil and burning coal while cooking, Occupational exposure to chemical fumes, History of chronic ear and nose condition
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
17
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01056
Lee
1994
Canned salted or pickled vegetables, consumption during adulthood
Never exposed to more than 3 times per month
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
199 405 4 4.9 Never 1.8-12.9
N/A 0.004 Age, Sex, Education level, Dialect Group
NAS01113
Zheng
1994
Salted, dried, or tinned vegetables in brine
N/A FFQ - Study-specific
China Chinese 264 Mean 42/ Mixed
88 176 N/A N/A N/A N/A Not signif- icant
N/A N/A
NAS01190
Zheng
1993
Salted vegetables
N/A FFQ - Study-specific
China Chinese 410 N/A/ Mixed
205 205 N/A >1.0 N/A N/A Signif- icant
N/A N/A
NAS01922
Ning
1990
Dried vegetable, consumption 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of Residence
NAS01922
Ning
1990
Salted vegetable, consumption 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of Residence
NAS01922
Ning
1990
Pickled vegetable, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of Residence
NAS06002
Duan
2000
Pickled vegetables
N/A Question-naire
China Chinese 200 N/A/ Mixed
100 100 Continuous r2 = 0.015
N/A N/A Signif- icant
N/A Environmental Factors, Gas Range, Pungent foods, SES
Total preserved vegetables: Childhood/Infancy consumption Case-control (4)
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
18
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00531
Ward
2000
Preserved vegetables Intake for Age 10
None to >59.2 grams
Dietary History question-naire
China Chinese 702 Max 74/ Mixed
89 113 4 0.9 None 0.3-2.6
N/A N/A Age, Sex, Ethnicity/ Race
NAS00531
Ward
2000
Intake for Age 3: Preserved vegetables
None to > 44.8 grams
Dietary History question-naire
China Chinese 702 Max 74/ Mixed
88 103 4 0.9 None 0.3-2.4
N/A N/A Age, Sex, Ethnicity/ Race
NAS00531
Ward
2000
During Weaning: Preserved vegetables
None to > 0 Dietary History question-naire
China Chinese 702 Max 74/ Mixed
87 112 2 1.3 None 0.6-2.5
N/A N/A Age, Sex, Ethnicity/ Race
NAS00531
Ward
2000
Mother's diet during breastfeeding: Preserved vegetables
Highest vs lowest
Dietary History question-naire
China Chinese 702 Max 74/ Mixed
375 327 N/A 0.6 Lowest 0.2-1/5
N/A N/A N/A
NAS01056
Lee
1994
Canned salted or pickled vegetables, at age 10
Never exposed to more than 3 times per month
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
149 344 4 0.5 Never 0.1-1.4
N/A 0.2 Age, Sex, Education level, Dialect Group
NAS01381
Jeannel
1990
Dietary Intake During Weaning: Consumption of Pickled Vegetables
Less than once a month to more than 2 a week
FFQ - Study-specific
Tunisia Tunisian 240 Mean 41/ Mixed
80 160 3 2.2 Less than once a month
N/A N/A N/A Age, Sex, Area of Residence, Living condition score
NAS01922
Ning
1990
Dried vegetable, consumption at 10 years of age
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of Residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
19
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01922
Ning
1990
Salted vegetable, consumption at 10 years of age
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of Residence
NAS01922
Ning
1990
Pickled vegetable, at age 10
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of Residence
2.2.1.1 Non-starchy root vegetables and tubers Total Root Vegetables Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS00424
Laouamri
2001
Non-starchy root vegetables/tubers, Foods for chewing when teething
Ever vs Never
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
72 72 2 1.0 N/A N/A Not Signif- icant
N/A Age, Sex, Area of Residence
Carrots: Adulthood consumption Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS00825
Chen
1997
Carrots, 3 years ago
N/A FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 N/A N/A N/A N/A Not Signif- icant
N/A Age, Sex, Area of Residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
20
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01922
Ning
1990
Carrots, consumption 3 years prior to diagnosis
Never to Weekly
FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 4 0.8 Never 0.3-1.9
N/A 0.3 Age, Sex, Area of Residence
Carrots: Childhood consumption Case-control (6) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00424
Laouamri
2001
Baby Foods: Carrots
< 3 times per week to > 7 times a week
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
72 72 3 0.3 N/A 0.1-0.87
0.05 N/A Age, Sex, Area of Residence
NAS00825
Chen
1997
Carrot, 10 years old
N/A FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 N/A N/A N/A N/A Not Signif- icant
N/A Age, Sex, Area of Residence
NAS01459
Yu
1989
Carrots, consumption at age 10
Rarely to weekly
FFQ - Study-specific
China Chinese 612 Max 49/ Mixed
306 306 2 0.2 Rarely 0.1-0.3
N/A N/A Age, Sex, Area of Residence
NAS01520
Yu
1988
Carrots, consumed by subject at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
NAS01922
Ning
1990
Carrots, consumption at 10 years
Never to Weekly
FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 4 0.4 Never N/A 0.09 N/A Age, Sex, Area of Residence, salted fish consumption and salted shrimp paste consumption at 10 years
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
21
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS06024
Huang
1997
Carrot, exposed at age of 10, cases and control were from Guangdong province
Yes vs no Question-naire
China Chinese 416 N/A/ Mixed
104 104 2 0.6 No 0.41-0.99
0.011 N/A Unadjusted
Preserved Root Vegetables Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group CI P value
p value for trend
Adjusted for
NAS06023
Zou
1999
Salted root vegetables
< 9 times a month to ≥ 9 times a month
Question-naire
China Chinese 289 Mean 53/ Mixed
97 192 2 2.2 < 9 times a month
1.3-3.6
0.003 N/A Unadjusted
NAS06024
Huang
1997
Pickled root vegetables, exposed at age of 10, cases /control were from Guangdong province
Yes vs no Question-naire
China Chinese 416 N/A/ Mixed
104 104 2 0.75 No 0.57-0.99
0.045 N/A Unadjusted
NAS06024
Huang
1997
Preserved root vegetables exposed at age of 10, cases and control were from Guangdong province
Yes vs no Question-naire
China Chinese 416 N/A/ Mixed
104 104 2 1.81 No 1.01– 3.33
0.045 N/A Age, Sex, No Separate Kitchen, Grapes, and dired orange, Family history of cancer
NAS06024
Huang
1997
Preserved other root vegetables
consume few to consume every week
Question-naire
China Chinese 416 N/A/ Mixed
104 104 3 2.42 Consume few
0.99-5.92
N/A N/A Unadjusted
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
22
2.2.1.2 Cruciferous vegetables Cabbage: Adulthood consumption Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Coun-try
Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00577
Yuan
2000
Fresh Bok Choi (chinese white cabbage)
Less than weekly to daily
FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 3 0.97 Weekly 0.81-1.17
N/A 0.85 Age, sex, area of residence, environmental factors, smoking, chemical fumes, history of ear/nose condition
NAS00749
Armstrong
1998
Chinese flowering cabbage, 5 years pre-diagnosis
Less than weekly to weekly
Dietary History question-naire
China Chinese 564 N/A/ Mixed
282 282 2 0.64 Less than weekly
0.4-1.04
0.016 N/A Unadjusted
NAS00749
Armstrong
1998
Chinese flowering cabbage, lifetime, trichotomous categories at age 10 and age 5 years prior to diagnosis
Less than monthly to monthly or more
Dietary History question-naire
China Chinese 564 N/A/ Mixed
282 282 2 0.5 Less than monthly
N/A 0.0004 N/A salted fish, recent consumption, salted egg/ oranges/ tangerines/ shrimp, lifetime consumption, pork/beef liver / beer consumption, SES
NAS06024
Huang
1997
Cabbage: exposed 3 years before disease: cases and control were from Guangdong province
Yes vs No Question-naire
China Chinese 416 N/A/ Mixed
104 104 2 0.628 No 0.44-0.9
0.011 N/A Unadjusted
Non-Preserved Cruciferous Vegetables: Adulthood consumption Case-control (5)
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
23
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Coun-try
Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00749
Armstrong
1998
Chinese kale, 5 years pre-diagnosis
Monthly to more than weekly
Dietary History question-naire
China Chinese 564 N/A/ Mixed
282 282 3 0.63 Monthly 0.39-1.01
N/A 0.068 Unadjusted
NAS00825
Chen
1997
Chinese cabbage and rutabaga, 3 years ago
N/A FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 Continuous 0.63 N/A 0.44-0.9
N/A N/A Age, Sex, Area of Residence
NAS01056
Lee
1994
turnip root, consumption during adulthood
Never exposed to more than 3 times per month
FFQ - Study-specific
Singa-pore
Chinese 606 Max 44/ Mixed
200 405 4 1.0 Never 0.1-5.6
N/A 0.4 Age, Sex, Education level, Dialect Group
NAS01922
Ning
1990
mustard, consumption 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of residence
NAS06024
Huang
1997
Cauliflower Less than once a month to every day
Question-naire
China Chinese 416 N/A/ Mixed
104 104 4 1.048 No 0.36-3.05
N/A N/A Unadjusted
Non-Preserved Cruciferous Vegetables: Childhood consumption Case-control (6) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Coun-try
Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00749
Armstrong
1998
Chinese flowering vegetable, consumption at age 10
Less than weekly to weekly
Dietary History question-naire
China Chinese 564 N/A/ Mixed
282 282 2 0.47 Less than weekly
0.29-0.77
N/A N/A Unadjusted
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
24
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Coun-try
Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00749
Armstrong
1998
Chinese kale, consumption at age 10
Monthly to more than weekly
Dietary History question-naire
China Chinese 564 N/A/ Mixed
282 282 3 0.71 Monthly 0.4-1.27
N/A N/A Unadjusted
NAS00825
Chen
1997
Chinese cabbage, rutabaga, 10 years old
N/A FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 N/A N/A N/A N/A Not Signif icant
N/A Age, Sex, Area of Residence
NAS01056
Lee
1994
turnip root, consumption at age 10 years
Never exposed to more than 3 times per month
FFQ - Study-specific
Singa-pore
Chinese 606 Max 44/ Mixed
145 344 4 1.2 Never 0.4-3.4
N/A 0.3 Age, Sex, Education level, Dialect Group
NAS01922
Ning
1990
mustard, consumption at 10 years of age
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of residence
NAS60010
Cai
1996
leaf mustard, consumed around 1978 and >=3 times/ week
< 12 times per month to ≥ 12 times per month
Dietary History question-naire
China Chinese 230 16-68/ Mixed
115 115 2 1.918 < 12 times per month
1.456-2.527
0.000 N/A Age, Sex, Area of Residence, family cooking fuel, fresh green vegetables, history of chronic nasopharyngeal diseases
NAS60010
Cai
1996
leaf mustard, consumed around 1968 and >=3 times/ week
< 12 times per month to ≥ 12 times per month
Dietary History question-naire
China Chinese 230 16-68/ Mixed
115 115 2 1.443 < 12 times per month
1.158-1.8
0.011 N/A Age, Sex, Area of Residence
NAS06024
Huang
1997
cauliflower, exposed at age of 10, cases / controls were from Heilongjiang province
Yes vs No Question-naire
China Chinese 416 N/A/ Mixed
104 104 2 0.697 No 0.52-0.94
0.019 N/A Age, Sex, Area of Residence, chronic otolaryngological diseases, use coal as fuel, rice, wheat, and corns
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
25
Preserved Cruciferous Vegetables: Adulthood consumption Case-control (5) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Coun-try
Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00825
Chen
1997
Pickled chinese cabbage, 3 years ago
N/A FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 N/A N/A N/A N/A Not Signif icant
N/A Age, Sex, Area of Residence
NAS01056
Lee
1994
tang chye, a type of preserved cabbage, consumption during adulthood
Never exposed to more than 3 times per month
FFQ - Study-specific
Singa-pore
Chinese 606 Max 44/ Mixed
199 406 5 1.5 Never 0.6-3.4
N/A N/A Age, Sex, Education level, Dialect Group
NAS01056
Lee
1994
chye poh, preserved Chinese radish, consumption during adulthood
Never exposed to more than 3 times per month
FFQ - Study-specific
Singa-pore
Chinese 606 Max 44/ Mixed
200 406 4 2.8 Never 1.2-6.0
N/A 0.1 Age, Sex, Education level, Dialect Group
NAS01056
Lee
1994
kiam chye, salted mustard greens, consumption during adulthood
Never exposed to 1-3 times per week
FFQ - Study-specific
Singa-pore
Chinese 606 Max 44/ Mixed
200 406 4 3.1 Never 1.4-6.5
N/A 0.007 Age, Sex, Education level, Dialect Group
NAS01608
Yu
1986
salted mustard green (mui choi), subject's consumption at 10 years of age or 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 500 Max 34/ Mixed
250 250 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, salted fish intake
NAS01922
Ning
1990
sour cabbage, consumption 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
26
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Coun-try
Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS06003
Ye
1995
Pickled leaf mustard Less than 4.2 times per month to greater than 75 times per month
Dietary history question-naire
China Chinese 270 21-75/ Mixed
135 135 3 6.11 ≤ 4 .2 times per month
N/A < 0.01 N/A Age, Sex, Area of residence
NAS06003
Ye
1995
pickled radish <75 times per month to ≥ 75 times per month
Dietary history question-naire
China Chinese 270 21-75/ Mixed
135 135 2 1.75 ≤ 75 times per month
1.1-2.79
< 0.05 N/A Age, Sex, Area of residence
Preserved Cruciferous Vegetables: Childhood consumption Case-control (4) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Coun-try
Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00825
Chen
1997
Pickled Chinese Cabbage, 10 years old
N/A FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 Continuous 0.75 N/A 0.57-0.99
N/A N/A Age, Sex, Area of Residence
NAS01056
Lee
1994
tang chye, a type of preserved cabbage, consumption at age 10 years
Never exposed to more than 3 times per week
FFQ - Study-specific
Singa-pore
Chinese 606 Max 44/ Mixed
147 342 5 0.8 Never 0.2-2.6
N/A N/A Age, Sex, Education level, Dialect Group
NAS01056
Lee
1994
chye poh, preserved Chinese radish, consumption at age 10 years
Never exposed to 1-3 times per week
FFQ - Study-specific
Singa-pore
Chinese 606 Max 44/ Mixed
150 342 4 1.0 Never 0.4-2.1
N/A 0.7 Age, Sex, Education level, Dialect Group
NAS01056
Lee
1994
kiam chye, salted mustard greens, consumption at 10 years old
Never exposed to more than 3 times per month
FFQ - Study-specific
Singa-pore
Chinese 606 Max 44/ Mixed
148 344 4 1.1 Never 0.4-2.6
N/A 0.9 Age, Sex, Education level, Dialect Group
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
27
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Coun-try
Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01520
Yu
1988
salted mustard greens, consumed by subject during weaning
Yes vs no FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 2 5.4 No 1.2-23.8
0.06 N/A Age, sex
NAS01520
Yu
1988
salted mustard green, consumed by subject between ages 1 to 2 years
Rarely to weekly
FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 3 1.6 Rarely 0.5-4.7
0.06 N/A Age, sex
NAS01520
Yu
1988
salted mustard green, consumed by subject at age 10
Rarely to weekly
FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 3 1.3 Rarely 0.3-6.7
Not signif-icant
Not signif-icant
Age, sex
NAS01520
Yu
1988
salted cabbage, consumed by subject at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
NAS01520
Yu
1988
salted radish, consumed by subject at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
NAS01520
Yu
1988
pickled cabbage, consumed by subject at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
NAS01520
Yu
1988
salted mustard green, consumed by subject during weaning
Rarely to monthly
FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
NAS01922
Ning
1990
sour cabbage, consumption at 10 years of age
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
28
2.2.1.3 Allium vegetables Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assessment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
categories
RR/OR Ref group
CI P value
p value for trend
Adjusted for
NAS01922
Ning
1990
Garlic, at age 10 or adult
N/A FFQ - Study-specific
China Chinese 400 Max 64/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, area of residence
2.2.1.4 Green leafy vegetables (excluding cruciferous vegetables) Total Green Leafy Vegetables: Adulthood consumption Case-control (4) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00577
Yuan
2000
Other dark green leafy vegetable (not bok choi) fresh
Less than weekly to daily
FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 3 1.25 Less than weekly
0.73-2.14
N/A 0.33 Age, sex, area of residence, environmental factors, smoking, chemical fumes, history of ear/nose condition
NAS01113
Zheng
1994
Leafy Vegetables, in the year before diagnosis
Monthly to Daily
FFQ - Study-specific
China Chinese 264 N/A/ Mixed
88 176 3 0.1 Monthly N/A 0.008 N/A Age, sex, SES, area of residence
NAS06003
Ye
1995
Green leafy vegetables (not cruciferous)
<12.5 times/ month to ≥75.8 times/month
Dietary history question-naire
China Chinese 270 21-75/ Mixed
135 135 3 0.29 <12.5 times/ month #
N/A <0.01 N/A Age, Sex, Area of residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
29
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS06024
Huang
1997
Green leafy vegetables, exposed 3 years before disease diagnosed, cases and control were from Guangdong province
Yes vs No Question-naire
China Chinese 416 N/A/ Mixed
104 104 2 1.733 No 1.19-2.53
.004 N/A Unadjusted
Total Green Leafy Vegetables: Childhood consumption Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01520
Yu
1988
fresh green leafy vegetables, during weaning
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
0.86 Age, sex
NAS01520
Yu
1988
fresh green leafy vegetables, between ages 1 to 2 years
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
0.92 Age, sex
NAS01520
Yu
1988
fresh leafy green vegetables, at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
NAS60010
Cai
1996
Green leafy vegetables, consumed around 1968 and < 3 time/week
<12 times per month to ≥12 times per month
Dietary History question-naire
China Chinese 230 16-68/ Mixed
115 115 2 0.514 <12 times per month #
0.34-0.78
0.0016 N/A Age, Sex, Area of residence, history of other nasopharyngeal diseases, family cooking fuel, pickled foods
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
30
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS60010
Cai
1996
Green leafy vegetables, consumed around 1978 and < 3 time/week
<12 times per month to ≥12 times per month
Dietary History question-naire
China Chinese 230 16-68/ Mixed
115 115 2 0.444 <12 times per month #
0.29-0.67
0.000 N/A Age, Sex, Area of residence
Water spinach Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00749
Armstrong
1998
water spinach, 5 years pre-diagnosis
Monthly to more than weekly
Dietary History question-naire
Malaysia Chinese 564 N/A/ Mixed
282 282 3 0.72 Monthly 0.45-1.17
N/A 0.063 Unadjusted
NAS00749
Armstrong
1998
water spinach, consumption at age 10
Monthly to more than weekly
Dietary History question-naire
Malaysia Chinese 564 N/A/ Mixed
282 282 3 0.51 Monthly 0.28-0.93
N/A N/A Unadjusted
Preserved Green Leafy Vegetables: Adulthood consumption Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00749
Armstrong
1998
Salted green leafy vegetables, 5 years pre-dx
Monthly to more than weekly
Dietary History question-naire
Malaysia Chinese 564 N/A/ Mixed
282 282 3 3.33 Monthly 1.84-6.01
N/A 0.001 Unadjusted
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
31
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01056
Lee
1994
Mei chye (preserved greens and leafy vegetables), consumption in adulthood
N/A FFQ - Study-specific
Singa-pore
Chinese 606 Max 44/ Mixed
200 406 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, ethnicity/ race, education, belachan, canned, salted, & pickled vegetables, vitamin C, salted soy beans, kiam chye, vitamin E
NAS01922
Ning
1990
dried kelp, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not Signif- icant
N/A Age, Sex, Area of residence
NAS01922
Ning
1990
dried seaweed, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not Signif- icant
N/A Age, Sex, Area of residence
Preserved Green Leafy Vegetables: Childhood consumption Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS00749
Armstrong
1998
Salted green leafy vegetables, at age 10
Monthly to more than weekly
Dietary History question-naire
Malaysia Chinese 564 N/A/ Mixed
282 282 3 0.84 Monthly 0.45-1.58
N/A N/A Unadjusted
NAS01922
Ning
1990
dried kelp, at 10 years of age
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not Signif- icant
N/A Age, Sex, Area of residence
NAS01922
Ning
1990
dried seaweed at 10 years of age
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not Signif- icant
N/A Age, Sex, Area of residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
32
2.2.1.5 Other non-starchy vegetables Tomatoes: Adulthood consumption Case-control (5) Meta-analysis Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group CI P value
p value for trend
Adjusted for
NAS00577
Yuan
2000
Tomatoes, fresh
Less than weekly to daily
FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 3 0.92 Less than weekly
N/A N/A 0.10 Age, sex, area of residence, environmental factors, smoking, chemical fumes, history of ear/nose condition, oranges/ tangerines
NAS00749
Armstrong
1998
tomatoes, 5 years pre-diagnosis
Monthly to more than weekly
Dietary History question-naire
Malaysia Chinese 564 N/A/ Mixed
282 282 3 0.5 Monthly 0.28-0.87
N/A 0.059 Unadjusted
NAS01459
Yu
1989
tomatoes, unsure time of consumption
N/A FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
306 306 N/A N/A N/A N/A Signif-icant
N/A Age, sex, area of residence, salted fish, fermented fish sauce, moldy bean curd, chan pai mui, salted shrimp paste, gar ink gee
NAS06023
Zou
1999
tomatoes None to ≥ 9 times a month
Question-naire
China Chinese 304 14-82/ Mixed
102 201 3 2.59 None 0.69-9.72
0.36 N/A Unadjusted
NAS06030
Huang
2002
Tomatoes Less to frequently consumed
Question-naire
China Chinese 525 10-78/ Mixed
175 359 2 0.571 Less consumed
0.39-0.83
0.003 N/A Age, Sex, Area of Residence
Tomatoes: Childhood consumption Case-control (3)
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
33
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS00749
Armstrong
1998
tomatoes, consumption at age 10
Monthly to more than weekly
Dietary History question-naire
Malaysia Chinese 564 N/A/ Mixed
282 282 3 0.8 Monthly 0.48-1.32
N/A N/A Unadjusted
NAS01459
Yu
1989
tomatoes, during weaning
Yes vs no FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
306 306 2 0.0 No 0.0-0.9
N/A N/A Age, sex, area of residence
NAS01459
Yu
1989
tomatoes, during ages 1-2
Rarely to weekly
FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
110 138 3 0.3 Rarely 0.1-0.7
N/A <.05 Age, sex, area of residence
NAS01459
Yu
1989
tomatoes, at age 10
Rarely to daily
FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
110 137 4 0.3 Rarely 0.1-1.3
N/A <.05 Age, sex, area of residence
NAS01520
Yu
1988
tomatoes, between ages 1 to 2 years
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A 0.38 (one sided)
N/A Age, sex
NAS01520
Yu
1988
tomatoes, at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif- icant
N/A Age, sex
Other Non-Preserved Vegetables: Adulthood consumption Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
34
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00577
Yuan
2000
Light green/ orange leafy vegetables, fresh
Less than weekly to daily
FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 3 0.98 Less than weekly
0.63-1.5
N/A 0.79 Age, sex, area of residence, environmental factors, smoking, chemical fumes, history of ear/nose condition
NAS00577
Yuan
2000
Gourds, fresh Less than weekly to daily
FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 3 0.89 Less than weekly
0.73-1.09
N/A 0.33 Age, sex, area of residence, environmental factors, smoking, chemical fumes, history of ear/nose condition
NAS00577
Yuan
2000
Green peppers, fresh
Less than weekly to daily
FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 3 0.67 Less than weekly
N/A N/A 0.43 Age, sex, area of residence, environmental factors, smoking, chemical fumes, history of ear/nose condition, oranges/tangerines
NAS04944
Armstrong
1978
sliced raw chili, at evening meal among families of participants
N/A Recall Malaysia Chinese 210 25-81/ Mixed
60 150 N/A <1.0 N/A N/A Signif- icant
N/A Unadjusted
NAS04944
Armstrong
1978
sliced raw chili, in three main daily meals combined, among families of participants
N/A Recall Malaysia Chinese 210 25-81/ Mixed
60 150 N/A 0.8 N/A N/A <.01 N/A Unadjusted
NAS06003
Ye
1995
white color vegetables
≤ 3.3 times per month to > 3.3 times per month
Dietary history question-naire
China Chinese 270 21-75/ Mixed
135 135 2 0.30 ≤ 3.3 times per month #
0.18-0.51
< 0.05 N/A Age, Sex, Area of residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
35
Other Non-Preserved Vegetables: Childhood consumption Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS60010
Cai
1996
Yellow color, consumed around 1968
< 12 times per month to ≥ 12 times per month
Dietary History question-naire
China Chinese 230 16-68/ Mixed
115 115 2 0.64 < 12 times per month #
0.45-0.91
0.0134 N/A Age, Sex, Area of Residence
NAS60010
Cai
1996
yellow color, consumed around 1978 and < 3 times /week
< 12 times per month to ≥ 12 times per month
Dietary History question-naire
China Chinese 230 16-68/ Mixed
115 115 2 0.83 < 12 times per month #
0.44-0.91
0.0408 N/A Age, Sex, Area of Residence
NAS06024
Huang
1997
Green bean and eggppant, at age of 10, cases /control were from heilongjiang province
Yes vs No Question-naire
China Chinese 416 N/A/ Mixed
104 104 2 0.551 No 0.33-0.92
0.021 N/A Age, Sex, Area of Residence
Total Preserved Vegetables: Adulthood consumption Case-control (5) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00424
Laouamri
2001
Seasonings: vegetables in brine
Currently- twenty years ago
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
72 72 2 2.77 N/A 1.34-5.71
N/A N/A Age, Sex, Area of Residence
NAS00577
Yuan
2000
Preserved leafy vegetables (salted mustard green, salted bok choi, etc)
Less than monthly to daily
FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 4 1.37 Less than monthly
0.65-2.9
N/A 0.85 Age, sex, area of residence, environmental factors, smoking, chemical fumes, history of ear/nose condition
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
36
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00577
Yuan
2000
Preserved Stem Vegetables (salted stem vegetables and pickled stem vegetable)
Less than monthly to daily
FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 4 1.88 Less than monthly
1.24-2.84
N/A <0.001 Age, sex, area of residence, environmental factors, smoking, chemical fumes, history of ear/nose condition
NAS00577
Yuan
2000
Preserved root vegetables (salted root and preserved root)
Less than monthly to daily
FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 4 1.04 Less than monthly
0.7-1.53
N/A 0.14 Age, sex, area of residence, environmental factors, smoking, chemical fumes, history of ear/nose condition
NAS00825
Chen
1997
Salted vegetables, 3 years ago
N/A FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 N/A N/A N/A N/A Not signfi- icant
N/A Age, Sex, Area of Residence
NAS01056
Lee
1994
Mei chye (preserved greens and leafy vegetables), consumption in adulthood
Never exposed to 1-3 times per month
FFQ - Study-specific
Singa-pore
Chinese 606 Max 44/ Mixed
200 406 4 2.8 Never 0.9-8.2
N/A 0.07 Age, Sex, Education level, Dialect Group
NAS06023
Zou
1999
Salted other non-starchy vegetables
None to ≥ 9 times a month
Question-naire
China Chinese 304 14-82/ Mixed
100 202 4 2.28 None 1.4-3.73
0.0007 N/A Unadjusted
Total Preserved Vegetables: Childhood consumption Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
37
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00825
Chen
1997
salted vegetables, 10 years old
N/A FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 Contin-uous
0.76 N/A 0.58-0.99
N/A N/A Age, Sex, Area of Residence
NAS01056
Lee
1994
Mei chye (preserved greens and leafy vegetables), at age 10 years
Never exposed to 1-3 times per month
FFQ - Study-specific
Singa-pore
Chinese 606 Max 44/ Mixed
150 341 4 1.3 Never 0.6-2.6
N/A 0.8 Age, Sex, Education level, Dialect Group
NAS06024
Huang
1997
Salted vegetables, exposed at age of 10, cases /control were from Guangdong province
Yes vs No Question-naire
China Chinese 416 N/A/ Mixed
104 104 2 0.755 No 0.58-1.0
0.041 N/A Unadjusted
Other Preserved Vegetables: Adulthood consumption Case-control (5) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00424
Laouamri
2001
Seasoning: salted dried tomatoes
Currently- twenty years ago
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
72 72 2 7.5 N/A 3.09-18.2
0.001 N/A Age, Sex, Area of Residence
NAS00749
Armstrong
1998
salted root, 5 years pre-diagnosis
Monthly to more than weekly
Dietary History question-naire
Malaysia Chinese 564 N/A/ Mixed
282 282 3 2.19 monthly 1.33-3.62
N/A 0.001 Unadjusted
NAS00825
Chen
1997
Plum vegetable (Chan Pai Mui), 3 years ago
N/A FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 Contin-uous
1.73 N/A 1.19-2.53
N/A N/A Age, Sex, Area of Residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
38
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00825
Chen
1997
Plum vegetable Less than once a month to greater than once a week
FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 3 2.53 Less than once a month
1.04-6.19
N/A <0.05 Age, Sex, Area of Residence, Grape and Preserved Plum, No separate kitchen, Kitchen range without chimney
NAS01056
Lee
1994
sze chuan chye, a salted Chinese tuber, consumption during adulthood
Never exposed to 1-3 times per month
FFQ - Study-specific
Singa-pore
Chinese 606 Max 44/ Mixed
197 404 4 2.4 Never 1.1-5.2
N/A 0.008 Age, Sex, Education level, Dialect Group
NAS01381
Jeannel
1990
Intake During Preceding Year to Diagnosis: Fungus on Pickled Vegetables
Yes or no FFQ - Study-specific
Tunisia Tunisian 240 Mean 41/ Mixed
80 160 2 3.3 No N/A 0.03 N/A Age, sex, area of residence, living condition score
Other Preserved Vegetables: Childhood consumption Case-control (4) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00749
Armstrong
1998
salted root, at age 10
Monthly to more than weekly
Dietary History question-naire
Malaysia Chinese 564 N/A/ Mixed
282 282 3 1.75 monthly 0.98-3.10
N/A N/A Unadjusted
NAS01056
Lee
1994
sze chuan chye, a salted Chinese tuber, consumption at age 10 years
Never exposed to 1-3 times per month
FFQ - Study-specific
Singa-pore
Chinese 606 Max 44/ Mixed
145 340 4 1.4 Never 0.4-4.5
N/A 0.6 Age, Sex, Education level, Dialect Group
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
39
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01381
Jeannel
1990
During Weaning: Fungus on pickled vegetables
Yes or no FFQ - Study-specific
Tunisia Tunisian 240 Mean 41/ Mixed
80 160 2 3.8 No N/A 0.03 N/A Age, sex, area of residence, living condition score
NAS01520
Yu
1988
salted root, at age 10
Rarely to daily
FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 4 3.2 Rarely 0.6-17.6
0.03 (one sided)
N/A Age, sex
NAS01520
Yu
1988
chung choi, consumed by subject during weaning
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 Contin-uous
0.518 N/A N/A 0.021 (one sided)
N/A Age, sex, other household member smoked at birth, salted fish during pregnancy, salted duck egg/ salted mustard green during weaning, dried fish/ fermented soy paste during ages 1 and 2 yr
2.2.1.6 Raw vegetables Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS00749
Armstrong
1998
Raw green vegetables
Monthly to more than weekly
Dietary History question-naire
Malaysia Chinese 564 N/A/ Mixed
282 282 3 0.5 Monthly 0.23-1.07
N/A .026 Unadjusted
NAS04944
Armstrong
1978
Sliced raw chili
At evening meals
Recall Malaysia Chinese 210 25-81/ Mixed
60 150 2 N/A N/A N/A Cases ate less at evening meals
N/A Unadjusted
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
40
2.2.2 Fruits (general) Total non-preserved fruits: Adulthood consumption Case-control (6) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group CI P value
p value for trend
Adjusted for
NAS00700
Farrow
1998
Fruits, (apples, bananas, peaches, cantaloupe, watermelon, strawberries, oranges, grapefruit, juice, etc)
Lowest to highest
FFQ – Block
United States
Unknown 345 18-74/ Mixed
129 206 4 0.87 Lowest 0.41-1.83
N/A 0.63 Age, Sex, Energy Intake, Alcohol consumption, Smoking Habits
NAS01141
Zheng
1994
Fresh fruit, in the past 7 years
N/A FFQ - Study-specific
China Chinese 410 Max 55/ Mixed
205 205 N/A N/A N/A N/A Not signif-icant
N/A N/A
NAS01922
Ning
1990
fresh fruit, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of residence
NAS04944
Armstrong
1978
Fresh fruit, at evening meal, families of participants
N/A Recall Malaysia Chinese 210 25-81/ Mixed
60 150 N/A <1.0 N/A N/A Signif- icant
N/A Unadjusted
NAS06003
Ye
1995
Green color fruits less to more frequently
Dietary history question-naire
China Chinese 270 21-75/ Mixed
135 135 2 0.40 Consumed less #
0.36-0.61
< 0.01 N/A Age, Sex, Area of residence
NAS06030
Huang
2002
Fresh fruits Less to frequently consumed
Question-naire
China Chinese 525 10-78/ Mixed
175 359 2 0.679 Less consumed
0.44-1.04
0.077 N/A Age, Sex, Area of Residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
41
Total non-preserved fruits: Childhood consumption Case-control (4) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS00531
Ward
2000
Fruits: Childhood Dietary Intake for Age 3
None to ≥ 4.4 per month
Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
375 327 4 0.9 None 0.3-2.6
N/A N/A Age, sex, ethnicity/ race
NAS00531
Ward
2000
Fruits: Childhood Dietary Intake During Weaning
Less than 0.36 to ≥ 8 per month
Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
375 327 4 2.1 Less than 0.36 per month
0.6-7.4
N/A N/A Age, sex, ethnicity/ race
NAS00531
Ward
2000
Fruits: Mother's diet during breastfeeding
N/A Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
375 327 3 0.5 None 0.2-1.5
N/A N/A N/A
NAS01141
Zheng
1994
Fresh fruit, ages 0-3
N/A FFQ - Study-specific
China Chinese 410 Max 55/ Mixed
205 205 N/A N/A N/A N/A Not signif-icant
N/A N/A
NAS01141
Zheng
1994
Fresh fruit, age of 10
N/A FFQ - Study-specific
China Chinese 410 Max 55/ Mixed
205 205 N/A N/A N/A N/A Not signif-icant
N/A N/A
NAS01922
Ning
1990
Fresh fruit, at age 10
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of residence
NAS60010
Cai
1996
fresh fruit, consumed around 1968 and <3 times/ week
< 12 times / month to ≥ 12 times / month
Dietary History question-naire
China Chinese 230 16-68/ Mixed
115 115 2 0.67 < 12 times /month #
0.49-0.90
0.0084 N/A Age, Sex, Area of Residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
42
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS60010
Cai
1996
fresh fruit, consumed around 1978, < 3 time/week
< 12 times / month to ≥ 12 times / month
Dietary History question-naire
China Chinese 230 16-68/ Mixed
115 115 2 0.68 < 12 times /month #
0.52-0.89
0.0061 N/A Age, Sex, Area of Residence
Preserved fruits Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00749
Armstrong
1998
Preserved fruits, 5 years pre-diagnosis
Less than monthly to more than weekly
Dietary History question-naire
China Chinese 564 N/A/ Mixed
282 282 3 1.42 Less than monthly
0.71-2.85
N/A 0.091 Unadjusted
NAS00749
Armstrong
1998
Preserved fruits, at age 10
Less than monthly to more than weekly
Dietary History question-naire
China Chinese 564 N/A/ Mixed
282 282 3 1.5 Less than monthly
0.82-2.75
N/A N/A Unadjusted
2.2.2.1 Citrus fruits Total citrus fruit: Adulthood consumption Case-control (5) Meta-analysis Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
43
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00577
Yuan
2000
Oranges and tangerines, fresh
Less than weekly to daily
FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 3 0.061 Less than weekly
N/A N/A 0.0005 Age, sex, area of residence, environmental factors, smoking, chemical fumes, history of ear/nose condition, green/red peppers, tomatoes, & green beans/peas
NAS00700
Farrow
1998
oranges, grapefruit, and orange juice
Lowest to highest
FFQ – Block
United States
Unknown 345 18-74/ Mixed
129 208 4 0.68 Lowest 0.33-1.41
N/A 0.08 Age, Sex, Energy Intake, Alcohol, Smoking Habits
NAS00749
Armstrong
1998
Orange/ tangerine, 5 years pre-diagnosis
Less than monthly to more than weekly
Dietary History question-naire
China Chinese 564 N/A/ Mixed
282 282 3 0.52 Less than monthly
0.31-0.85
N/A 0.072 Unadjusted
NAS00749
Armstrong
1998
oranges/ tangerines lifetime, dichotomous categories at age 10 and age 5 years prior to diagnosis
Less than monthly to monthly or more
Dietary History question-naire
China Chinese 564 N/A/ Mixed
282 282 2 0.48 Less than monthly
N/A 0.025 N/A SES, Salted fish, recent consumption, salted egg/ shrimp / Chinese flowering cabbage, lifetime consumption, pork/ beef liver/ beer consumption
NAS00825
Chen
1997
Tangerine/ orange, 3 years ago
Regression model
FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 Contin-uous
0.66 N/A 0.5-0.89
N/A N/A Age, Sex, Area of Residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
44
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS06024
Huang
1997
Citrus fruits, exposed 3 years before disease diagnosed, cases / control from Guangdong province
Yes vs No Question-naire
China Chinese 416 N/A/ Mixed
104 104 2 0.664 No 0.5-0.89
0.007 N/A Age, Sex, Area of Residence
NAS06024
Huang
1997
Citrus fruits, exposed 3 years before disease diagnosed cases / control were from Heilongjiang province
Yes vs No Question-naire
China Chinese 416 N/A/ Mixed
104 104 2 0.628 No 0.41-0.95
0.029 N/A Age, Sex, Area of Residence
Total citrus fruit: Childhood consumption Case-control (4) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00749
Armstrong
1998
orange/ tangerine, consumption at age 10
Less than monthly to more than weekly
Dietary History question-naire
China Chinese 564 N/A/ Mixed
282 282 3 0.98 Less than monthly
0.51-1.86
N/A N/A Unadjusted
NAS00825
Chen
1997
Tangerine/ orange, age 10
N/A FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of Residence
NAS01459
Yu
1989
oranges/ tangerines ages 1-2
Rarely to weekly
FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
110 139 3 0.3 Rarely 0.1-0.9
N/A <.05 Age, sex, area of residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
45
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01459
Yu
1989
oranges/ tangerines at age 10
Rarely to weekly
FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
110 139 3 1.2 Rarely 0.5-2.9
N/A Not signif- icant
Age, sex, area of residence
NAS01520
Yu
1988
oranges / tangerines ages 1-2
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A 0.86 N/A Age, sex
NAS01520
Yu
1988
oranges / tangerines at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif- icant
N/A Age, sex
Preserved citrus fruits Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS06024
Huang
1997
Preserved orange, cases and control were from Guangdong province
Yes vs No
Question-naire
China Chinese 416 N/A/ Mixed
104 104 2 2.95 No 1.04-8.41
0.043 N/A Age, Sex, No separate kitchen, dried vegetables and grapes, Family history of Cancer
NAS06024
Huang
1997
Citrus fruits, preserved, exposed at age of 10, cases / control were from Guangdong province
Yes vs No
Question-naire
China Chinese 416 N/A/ Mixed
104 104 2 2.169 No 1.12-4.21
0.022 N/A Age, Sex, Area of Residence
2.2.2.2 Other fruits Non-preserved fruits: Adulthood consumption
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
46
Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00825
Chen
1997
Apple, 3 years ago
N/A FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 Contin-uous
0.64 N/A 0.46-0.9
N/A N/A Age, Sex, Area of Residence
NAS00825
Chen
1997
Banana, 3 years ago
N/A FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 Contin-uous
0.59 N/A 0.42-0.82
N/A N/A Age, Sex, Area of Residence
NAS00825
Chen
1997
Grape, 3 years ago
N/A FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 Contin-uous
0.42 N/A 0.28-0.64
N/A N/A Age, Sex, Area of Residence
NAS00825
Chen
1997
Water melon, 3 years ago
N/A FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 Contin-uous
1.56 N/A 1.07-2.27
N/A N/A Age, Sex, Area of Residence
NAS00825
Chen
1997
Peach, 3 years ago
N/A FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 Contin-uous
0.65 N/A 0.46-0.91
N/A N/A Age, Sex, Area of Residence
NAS00825
Chen
1997
grape, unknown age at consumption
N/A FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 Contin-uous
0.31 N/A 0.17-0.58
N/A <0.001 Age, Sex, Area of Residence, Consumption of Plum Vegetable/ Preserved Prune, No separate kitchen, Kitchen Range wo chimney, Family Cancer History
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
47
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00825
Chen
1997
Grape Less than once / month to 1- 4 times / week
FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 3 0.13 Less than once a month
0.05-0.29
N/A <0.001 Age, Sex, Area of Residence, Plum Vegetable/ Preserved Plum, No separate kitchen, Kitchen Range wo Chimney
NAS06024
Huang
1997
Apple, exposed 3 years before disease diagnosed, cases and control were from Guangdong province
Yes vs No Question-naire
China Chinese 416 N/A/ Mixed
104 104 2 0.641 No 0.46-0.9
0.01 N/A Age, Sex, Area of Residence
NAS06024
Huang
1997
Peach, exposed 3 years before disease diagnosed, cases and control were from Guangdong province
Yes vs No Question-naire
China Chinese 416 N/A/ Mixed
104 104 2 0.651 No 0.46-0.91
0.013 N/A Age, Sex, Area of Residence
NAS06024
Huang
1997
Watemelon, exposed 3 years before disease diagnosed, cases and control were from Guangdong province
Yes vs No Question-naire
China Chinese 416 N/A/ Mixed
104 104 2 1.559 No 1.07-2.27
0.021 N/A Age, Sex, Area of Residence
NAS06024
Huang
1997
Banana, exposed 3 years before disease diagnosed, cases and control were from Guangdong province
Yes vs No Question-naire
China Chinese 416 N/A/ Mixed
104 104 2 0.587 No 0.42-0.82
0.002 N/A Age, Sex, Area of Residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
48
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS06024
Huang
1997
Banana, exposed 3 years before disease diagnosed, cases and control were from Heilongjiang province
Yes vs No Question-naire
China Chinese 416 N/A/ Mixed
104 104 2 0.567 No 0.38-0.85
0.006 N/A Age, Sex, Area of Residence
NAS06024
Huang
1997
Grape, cases and control were from Guangdong province
Yes vs No Question-naire
China Chinese 416 N/A/ Mixed
104 104 2 0.312 No 0.17-0.58
<0.001 N/A Age, Sex, Family history of Cancer, dried vegetables / oranges, No separate kitchen
Non-preserved fruits: Childhood consumption Case-control (5) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00424
Laouamri
2001
Baby Foods: Grapes
< 3 times / week to 3-7 times / week
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
72 72 2 0.66 N/A N/A Not signif- icant
N/A Age, Sex, Area of Residence
NAS00825
Chen
1997
Grape, 10 years old Logistic regression model
FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 Contin-uous
0.63 N/A 0.4-0.99
N/A N/A Age, Sex, Area of Residence
NAS00825
Chen
1997
apple, 10 years old N/A FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of Residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
49
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00825
Chen
1997
banana, 10 years old
N/A FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of Residence
NAS00825
Chen
1997
water melon, 10 years old
N/A FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of Residence
NAS00825
Chen
1997
peach, 10 years old N/A FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of Residence
NAS01459
Yu
1989
other fresh fruits (not oranges/ tangerines), ages 1-2
Rarely to weekly
FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
110 139 3 0.6 Rarely 0.3-1.2
N/A Not signif- icant
Age, sex, area of residence
NAS01459
Yu
1989
other fresh fruits (not oranges/ tangerines), at age 10
Rarely to daily
FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
110 139 4 0.3 Rarely 0.1-1.1
N/A Not signif- icant
Age, sex, area of residence
NAS01520
Yu
1988
other fresh fruits (not oranges / tangerines) ages 1 to 2
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif- icant
N/A Age, sex
NAS01520
Yu
1988
other fresh fruits (not oranges/ tangerines at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif- icant
N/A Age, sex
NAS06024
Huang
1997
Banana, exposed at age of 10, cases and control were from Heilongjiang province
Yes vs No Question-naire
China Chinese 416 N/A/ Mixed
104 104 2 0.472 No 0.29-0.77
0.003 N/A Age, Sex, Area of Residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
50
Preserved plums: Adulthood consumption Case-control (4) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00577
Yuan
2000
Dried plum (chan pai mui)
N/A FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 N/A N/A N/A N/A Not signif- icant
N/A N/A
NAS00577
Yuan
2000
preserved plum (gar ink gee)
N/A FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 N/A N/A N/A N/A Not signif- icant
N/A N/A
NAS00825
Chen
1997
preserved prune, 3 years ago
N/A FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of Residence
NAS00825
Chen
1997
preserved plum, 3 years ago
N/A FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of Residence
NAS00825
Chen
1997
Preserved prune N/A FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 Contin-uous
2.59 N/A 1.04-8.41
N/A 0.043 Age, Sex, Area of Residence, Consumption of Plum Veg/ grape, No separate kitchen, Kitchen Range wo chimney, Family Cancer History
NAS00825
Chen
1997
Preserved Plum Less than once per month to 1-4 times per month
FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 2 1.7 Less than once a month
0.72-3.9
N/A <0.05 Age, Sex, Area of Residence, Plum Vegetable/ Grape, No separate kitchen, Kitchen Range wo Chimney
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
51
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01459
Yu
1989
chan pai mui, preserved (salted) plum, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
110 139 N/A N/A N/A N/A N/A Not signif- icant
N/A
NAS01459
Yu
1989
gar ink gee preserved (salted plum),, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
110 139 N/A N/A N/A N/A N/A Not signif- icant
N/A
NAS01459
Yu
1989
chan pai mui, preserved (salted plum), unsure time of consumption
N/A FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
110 139 N/A N/A N/A N/A N/A Signif- icant
Age, sex, area of residence, salted fish, fermented fish sauce, moldy bean curd, salted shrimp paste, gar ink gee, tomatoes
NAS01459
Yu
1989
gar ink gee, preserved (salted plum), unsure time of consumption
N/A FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
110 139 N/A N/A N/A N/A N/A Signif- icant
Age, sex, area of residence, salted fish, fermented fish sauce, moldy bean curd, chan pai mui, salted shrimp paste, tomatoes
NAS01608
Yu
1986
dried fruits (chan pai mui, gar ink gee), at 10 years of age or 3 years prior to diagnosis
N/A FFQ - Study-specific
China, Hong Kong
Chinese 500 Max 34/ Mixed
250 250 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, salted fish intake
Preserved plums: Childhood consumption Case-control (5) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
52
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00825
Chen
1997
preserved prune, 10 years old
N/A FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 Contin-uous
2.17 N/A 1.12-4.21
N/A N/A Age, Sex, Area of Residence
NAS00825
Chen
1997
preserved plum, 10 years old
N/A FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 Contin-uous
2.10 N/A 1.12-3.91
N/A N/A Age, Sex, Area of Residence
NAS01459
Yu
1989
preserved (salted) plum, at age 10
Rarely to daily
FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
110 139 4 N/A Rarely N/A N/A 0.01 Age, sex, area of residence, consumption of salted fish during weaning
NAS01459
Yu
1989
gar ink gee, preserved (salted) plum, at age 10
Rarely to daily
FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
110 139 4 N/A Rarely N/A N/A 0.03 Age, sex, area of residence, consumption of salted fish during weaning
NAS01520
Yu
1988
various dried plums, at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif- icant
N/A Age, sex
NAS01608
Yu
1986
chan pai mui, gar ink gee, at 10 years of age or 3 years prior to diagnosis
N/A FFQ - Study-specific
China, Hong Kong
Chinese 500 Max 34/ Mixed
250 250 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, salted fish intake
NAS06024
Huang
1997
Preserved plums, exposed at age of 10, cases and control were from Guangdong province
Yes vs No
Question-naire
China Chinese 416 N/A/ Mixed
104 104 2 2.095 No 1.12-3.91
0.02 N/A Age, Sex, Area of Residence
Preserved olives: Adulthood consumption Case-control (3)
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
53
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00424
Laouamri
2001
Seasonings: Olives in Brine
Currently- twenty years ago
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
72 72 2 2.0 N/A 1.36-3.72
0.05 N/A Age, Sex, Area of Residence
NAS00424
Laouamri
2001
Seasonings: Dried Olives
Currently- twenty years ago
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
72 72 2 4.66 N/A 1.51-14.33
0.01 N/A Age, Sex, Area of Residence
NAS01056
Lee
1994
salted black olives, during adulthood
Never to more than once a month
FFQ - Study-specific
Singa-pore
Chinese 606 Max 44/ Mixed
200 406 3 1.6 Never 0.3-7.5
N/A 0.4 Age, Sex, Education level, Dialect Group
NAS01381
Jeannel
1990
During Preceding Year to Diagnosis: Pickled Olives
Less than once a month to > 8 times / month
FFQ - Study-specific
Tunisia Tunisian 240 Mean 41/ Mixed
80 160 3 8.7 Less than once a month
N/A N/A N/A Age, sex, area of residence, living condition score
NAS01381
Jeannel
1990
Preceding Year to Diagnosis: Pickled Olives
<once/ month to > 8 times / month
FFQ - Study-specific
Tunisia Tunisian 240 Mean 41/ Mixed
80 160 3 5.5 Less than once a month
N/A N/A N/A Age, sex, area of residence
Preserved olives: Childhood consumption Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01056
Lee
1994
salted black olives, at age 10
Never to more than once a month
FFQ - Study-specific
Singa-pore
Chinese 606 Max 44/ Mixed
151 344 3 0.3 Never 0.1-0.9
N/A 0.09 Age, Sex, Education level, Dialect Group
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
54
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01520
Yu
1988
salted olive, at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif- icant
N/A Age, sex
Other preserved fruits: Adulthood consumption Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00424
Laouamri
2001
Seasonings: Raisins
Currently- twenty years ago
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
72 72 2 0.2 N/A 0.08-0.17
0.001 N/A Age, Sex, Area of Residence
NAS00577
Yuan
2000
dried red date (gone hong zhao)
N/A FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 N/A N/A N/A N/A Not signif- icant
N/A N/A
NAS01608
Yu
1986
dried red date, at 10 years of age or 3 years prior to diagnosis
N/A FFQ - Study-specific
China, Hong Kong
Chinese 500 Max 34/ Mixed
250 250 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, salted fish intake
Other preserved fruits: Childhood consumption Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01520
Yu
1988
dried red date, at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif- icant
N/A Age, sex
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
55
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01608
Yu
1986
dried red date, at 10 years of age or 3 years prior to diagnosis
N/A FFQ - Study-specific
China, Hong Kong
Chinese 500 Max 34/ Mixed
250 250 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, salted fish intake
2.3 Pulses (legumes) Non-preserved pulses/legumes Cohort (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
RR Ref group
CI P value
p value for trend
Adjusted for
NAS06046
Lin
1997
Non-fermented pulses
<2 times a week 6+ times a week
Question-naire
China, Taiwan
Chinese 9775 Min 30/ Males
N/A N/A 3 7.2 <2 times a week
1.4-37.5
<.001 N/A Age, EBV status, family history of NPC, nasopharyngitis
Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00424
Laouamri
2001
Baby foods: Lentils
< 3 times a week to 3-7 times a week
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
72 72 2 2.25 N/A 1.0-5.0
N/A N/A Age, Sex, Area of Residence
NAS00531
Ward
2000
Adult Dietary Intake: consumption of fresh soybean products
Never vs. ever
Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
375 327 2 N/A No N/A Not signif-icant
N/A Age, sex, ethnicity/ race, total calories, mothers questionnaire
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
56
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00531
Ward
2000
Age 10: Fresh soybean products
≤1.96
grams to ≥ 6.4 grams
Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
93 114 4 0.4 ≤1.96 grams
0.2-1.0
N/A N/A Age, sex, ethnicity/ race, total calories, mothers questionnaire
NAS00531
Ward
2000
Age 3: Fresh soybean products
≤1,6 grams to > 4 grams
Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
90 110 4 0.7 ≤1,6 grams
0.3-1.7
N/A N/A Age, sex, ethnicity/ race
NAS00531
Ward
2000
During Weaning: Fresh soybean products
None to > 0 grams
Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
84 104 2 1.1 None 0.5-1.2
N/A N/A Age, sex, ethnicity/ race
NAS00531
Ward
2000
Mother's diet during breastfeeding: fresh soy products
Lowest to highest
Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
375 327 3 0.7 Lowest 0.3-1.6
N/A N/A Age, sex, ethnicity/ race, Vegetable intake
NAS00531
Ward
2000
Mother's diet during breastfeeding: fresh soy products
Lowest to highest
Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
375 327 3 0.6 Lowest 0.2-1.5
N/A N/A N/A
Preserved soy/tofu: Adulthood consumption Case-control (8) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00531
Ward
2000
Adult Dietary Intake: fermented soybean products
Never vs. ever
Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
375 327 2 N/A No N/A Not signif-icant
N/A Age, sex, ethnicity/ race, total calories, mothers questionnaire
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
57
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00577
Yuan
2000
Fermented beans/ pastes (not specified, but measured fermented bean curd (fu yu), fermented bean paste (tau ban cheung)
Less than monthly to weekly or more
FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 3 1.76 Less than monthly
1.39-2.22
N/A <0.001 Sex, Age, Educational Level, Smoking, Exposure to smoke from heated rapeseed oil and burning coal while cooking, Occupational exposure to chemical fumes, History of chronic ear and nose condition
NAS01056
Lee
1994
salted soy beans, during adulthood
Never exposed to > 3 times per week
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
199 406 5 6.7 Never 1.2-36.6
N/A N/A Age, Sex, Education level, Dialect Group
NAS01190
Zheng
1993
Salted Soya Bean Pastes
N/A FFQ - Study-specific
China Chinese 410 N/A. Mixed
205 205 N/A N/A N/A N/A Signif-icant
N/A N/A
NAS01459
Yu
1989
moldy bean curd, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
306 306 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, area of residence
NAS01459
Yu
1989
moldy bean curd, unsure time of consumption
N/A FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
306 306 N/A N/A N/A N/A Signif-icant
N/A Age, sex, area of residence, salted fish, fermented fish sauce, salted shrimp paste, chan pai mui, gar ink gee, tomatoes
NAS01608
Yu
1986
moldy bean curd, at 10 years or 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 500 Max 34/ Mixed
250 250 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, salted fish intake
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
58
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01922
Ning
1990
moldy bean curd, preserved, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A Age, Sex, Area of residence
NAS01922
Ning
1990
smelly bean curd, consumption 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A Age, Sex, Area of residence
NAS01922
Ning
1990
fermented soy/flour paste, consumption 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A Age, Sex, Area of residence
NAS06023
Zou
1999
Fermented soy < 9 times a month to ≥ 9 times a month
Dietary History question-naire
China Chinese 304 14-82/ Mixed
100 202 2 1.45 < 9 times a month
0.78-2.83
N/A N/A Age, Sex, Live in area with high level of background radiation, Alcohol, Smoking habits, Salted fish
NAS06023
Zou
1999
tofu, soy products
Never to ≥ 9 times a month
Dietary History question-naire
China Chinese 304 14-82/ Mixed
102 201 2 2.36 Never 0.26-21.3
0.17 N/A Unadjusted
Preserved soy/tofu: Childhood consumption Case-control (6) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00531
Ward
2000
2.3 Fermented soybean products, at Age 10
< 16 grams to ≥ 118.8 grams
Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
98 115 4 0.5 < 16 grams
0.2-1.2
N/A N/A Age, sex, ethnicity/ race
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
59
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00531
Ward
2000
Fermented soybean products, at Age 3
None to ≥80.4 grams
Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
93 111 4 0.7 None 0.3-1.9
N/A N/A Age, sex, ethnicity/ race
NAS00531
Ward
2000
During Weaning Fermented soybean products
None to 12.04 grams
Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
90 113 4 0.6 None 0.3-1.3
N/A N/A Age, sex, ethnicity/ race
NAS01056
Lee
1994
salted soy beans, at age 10 year
Never exposed to 1-3 times a week
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
146 342 4 1.1 Never 0.5-2.2
N/A 0.6 Age, Sex, Education level, Dialect Group
NAS01056
Lee
1994
fermented bean curd, at age 10
Never exposed to 1-3 times per week
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
151 341 4 0.8 Never 0.4-1.8
N/A 0.3 Age, Sex, Education level, Dialect Group
NAS01459
Yu
1989
Moldy bean curd, ages 1-2
Rarely to weekly
FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
110 139 3 N/A Rarely N/A N/A 0.05 Age, sex, area of residence, salted fish consumption during weaning
NAS01459
Yu
1989
Moldy bean curd, at age 10
Rarely to daily
FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
110 138 4 N/A Rarely N/A N/A 0.98 Age, sex, area of residence, salted fish consumption during weaning
NAS01520
Yu
1988
fermented soy bean paste, ages 1 to 2
Rarely to weekly
FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 3 3.6 Rarely 1.6-8.1
N/A 0.007 Age, sex
NAS01520
Yu
1988
fermented soy bean paste, at age 10
Rarely to weekly
FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 3 1.5 Rarely 0.8-3.0
N/A Not signif-icant
Age, sex
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
60
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01520
Yu
1988
moldy bean curd, consumed at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N?A N/A Not signif-icant
N/A Age, sex
NAS01520
Yu
1988
fermented soy bean paste, consumed by subject at age 1-2
Rarely to monthly
FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 Contin-uous
r2 = -.23
Rarely N/A 0.240 N/A Age, sex, salted fish during pregnancy, salted duck egg / salted mustard green / chung choi during weaning, dried fish during ages 1 and 2 yr
NAS01520
Yu
1988
fermented soy bean paste, consumed by subject at age 1-2
Rarely to weekly
FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 Contin-uous
r2 = .988
Rarely N/A 0.018 N/A Age, sex, salted fish during pregnancy, salted duck egg / salted mustard green / chung choi during weaning, dried fish during ages 1 and 2 yr
NAS01608
Yu
1986
moldy bean curd, at 10 years or 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 500 Max 34/ Mixed
250 250 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, salted fish intake
NAS01922
Ning
1990
moldy bean curd, preserved, at age 10
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A Age, Sex, Area of residence
NAS01922
Ning
1990
smelly bean curd, consumption at 10 years of age
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A Age, Sex, Area of residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
61
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01922
Ning
1990
fermented soy/flour paste, consumption at 10 years of age
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A Age, Sex, Area of residence
Other preserved pulses/legumes Cohort (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
RR Ref group
CI P value
p value for trend
Adjusted for
NAS06046
Lin
1997
Fermented pulses
<2 times a week v. 6+ times a week
Question-naire
China, Taiwan
Chinese 9775 Min 30/ Males
N/A N/A 3 12.7 <2 times a week
2.2-72.3
<.05 N/A Age, EBV status, family history of NPC, nasopharyngitis
Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01056
Lee
1994
salted black beans, consumption during adulthood
Never exposed to > 3 times per month
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
200 406 4 2.1 Never 0.8-5.4
N/A 0.8 Age, Sex, Education level, Dialect Group
NAS01056
Lee
1994
salted black beans, consumption at age 10 years
Never exposed to more than three times per month
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
148 341 4 1.0 Never 0.4-2.3
N/A 0.5 Age, Sex, Education level, Dialect Group
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
62
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01520
Yu
1988
fermented black bean paste, consumed by subject between ages 1 to 2 years
Rarely to weekly
FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 3 4.6 Rarely 1.8-11.4
N/A 0.0009 Age, sex
NAS01520
Yu
1988
fermented black bean paste, consumed by subject at age 10
Rarely to weekly
FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 3 1.4 Rarely 0.6-3.1
N/A Not signif-icant
Age, sex
NAS06023
Zou
1999
Fermented beans <9 times/ month to ≥9 times/ month
Dietary History question-naire
China Chinese 304 14-82/ Mixed
97 192 2 2.1 <9 times per month
1.3-3.4
0.004 N/A Age, sex, year of death
2.4 Nuts and seeds Nuts and seeds: Adulthood consumption Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00424
Laouamri
2001
Nuts and Seeds
N/A FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
72 72 2 0.33 N/A N/A <0.05 N/A Age, sex, area of residence
NAS00577
Yuan
2000
dried ginko seed (bei guo)
N/A FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 N/A N/A N/A N/A Not signif- icant
N/A N/A
NAS01812
Geser
1978
Fennel in households of cases and controls
Yes or no FFQ - Study-specific
China, Hong Kong
Chinese 300 N/A/ Mixed
143 141 2 0.17 No 0.05-0.59
N/A N/A Age, Sex
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
63
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01812
Geser
1978
Xanthozylon Seeds
N/A FFQ - Study-specific
China, Hong Kong
Chinese 300 N/A/ Mixed
150 150 N/A N/A N/A N/A N/A N/A Sex, Age, Vinegar, Flavor Essence, Mustard Paste, Chinese Wine, Bread, Oyster soy, Use of ancestral alters and Buddhist alters
Nuts and seeds: Childhood consumption Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01113
Zheng
1994
Melon seeds, between the ages of 2 and 10
Yes vs No
FFQ - Study-specific
China Chinese 264 N/A/ Mixed
88 174 2 2.8 No N/A 0.02 N/A Age, sex, area of residence, Sociodemographic score (housing in childhood, presence of windows, monthly income the year before diagnosis)
NAS01520
Yu
1988
dried gingko seed, consumed by subject at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif- icant
N/A Age, sex
2.5.1 Meat Preserved meat: Adulthood consumption Case-control (7) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
64
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00424
Laouamri
2001
Seasonings: Dried, salted meat
Currently to twenty years ago
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
72 72 2 4.75 N/A 1.8-12.5
0.01 N/A Age, sex, area of residence
NAS00531
Ward
2000
Adult Dietary Intake: cured meats
Never vs. Ever
Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
375 327 2 N/A Never N/A Not signif-icant
N/A Age, sex, ethnicity/ race
NAS00531
Ward
2000
Adult Dietary Intake: smoked meats
Never vs. Ever
Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
375 327 2 N/A Never N/A Not signif-icant
N/A Age, sex, ethnicity/ race
NAS00544
Chelleng
2000
smoked meat Never & rarely to frequently
Unknown-NA
India Indian 141 Mean 44/ Mixed
47 94 2 10.8 Never & rarely
3.4-39
0.0002 N/A Age, sex, ethnicity/ race, Area of residence, Alcohol / Smoking / betel nut chewing habits, type of house, number of windows, kitchen inside/ outside, soot in living room, type of cooking fuel, smokeless tobacco use
NAS00577
Yuan
2000
Preserved Meats (not specified: ham, cured duck, salted pork)
Less than monthly to weekly or more
FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 3 1.77 Less than monthly
1.12-2.79
N/A 0.56 Age, sex, area of residence, environ-mental factors, smoking, chemical fumes, history of ear/nose condition
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
65
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01056
Lee
1994
rou gan, dried sweetened meat, during adulthood
N/A FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
200 406 N/A N/A N/A N/A Signif-icant
N/A Age, sex, ethnicity/ race, education, belachan, mei chye, canned, salted, & pickled vegetables, vitamin C, salted soy beans, sze chuan chye, kiam chye, vitamin E
NAS01113
Zheng
1994
Salted dried and tinned meat
N/A FFQ - Study-specific
China Chinese 264 N/A/ Mixed
88 175 N/A N/A N/A N/A Not signif- icant
N/A N/A
NAS01922
Ning
1990
cured meat, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A N/A
NAS01922
Ning
1990
smoked meat, consumption 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A N/A
NAS01922
Ning
1990
salted meat, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A N/A
Preserved meat: Childhood consumption Case-control (4) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
66
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00531
Ward
2000
Cured Meat, At Age 10
Yes vs. no Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
89 111 2 1.11 No 0.6-2
N/A N/A Age, sex, ethnicity/ race
NAS00531
Ward
2000
Cured Meat, At Age 10
Yes vs. no Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
92 109 2 0.8 No 0.4-1.8
N/A N/A Age, sex, ethnicity/ race
NAS00531
Ward
2000
Smoked meat, Age 10
Yes vs. no Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
92 114 2 1.1 No 0.5-2.4
N/A N/A Age, sex, ethnicity/ race
NAS00531
Ward
2000
Smoked meat, at Age 3
Yes vs. no Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
92 110 2 1.2 No 0.4-3.3
N/A N/A Age, sex, ethnicity/ race
NAS00531
Ward
2000
Smoked meat, During Weaning
Yes vs. no Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
89 112 2 2.2 No 0.2-27.6
N/A N/A Age, sex, ethnicity/ race
NAS01056
Lee
1994
rou gan, dried sweetened meat, usually pork, at 10 years old
Never to >1 times per week
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
149 342 3 0.8 Never 0.2-3.0
N/A 0.08 Age, sex, ethnicity/ race, education
NAS01381
Jeannel
1990
Intake Before Weaning: Quaddid (spiced dried meat stored in oil)
Yes vs. No FFQ - Study-specific
Tunisia Tunisian 240 N/A/ Mixed
80 160 2 3.2 No N/A 0.2 N/A Age, sex, area of residence, lifestyle factors
NAS01381
Jeannel
1990
Intake During Weaning: Quaddid (spiced dried meat stored in oil)
<1 time a month to 2+ times a week
FFQ - Study-specific
Tunisia Tunisian 240 N/A/ Mixed
80 160 3 2.8 <1 time a month
N/A N/A N/A Age, sex, area of residence, lifestyle factors
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
67
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01922
Ning
1990
cured meat, at age 10
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A N/A
NAS01922
Ning
1990
smoked meat, at age 10
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A N/A
NAS01922
Ning
1990
salted meat, at age 10
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A N/A
NAS01922
Ning
1990
salted meat, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A N/A
2.5.1.1 Fresh Meat Fresh meat: Adulthood consumption Case-control (4) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS00577
Yuan
2000
Organ meat, fresh
N/A FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 3 N/A N/A N/A Not signif-icant
N/A Unadusted
NAS00749
Armstrong
1998
Fresh pork/beef liver, at age 10 and age 5 years prior to diagnosis
Less than monthly to more than weekly
Dietary History question-naire
China Chinese 564 N/A/ Mixed
282 282 3 2.03 Less than monthly
NA 0.0001 N/A Unadjusted
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
68
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS00749
Armstrong
1998
other fresh pork/beef organs, 5 years prior to diagnosis
Less than monthly to more than weekly
Dietary History question-naire
China Chinese 564 N/A/ Mixed
282 282 3 4.63 Less than monthly
1.89-11.3
N/A .009 Unadjusted
NAS01459
Yu
1989
Fresh meat, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
306 306 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, area of residence
NAS01922
Ning
1990
fresh liver, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A Age, Sex, Area of residence
Fresh meat: Childhood consumption Case-control (4) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS00749
Armstrong
1998
fresh pork/beef liver, at age 10 and age 5 years prior to diagnosis
Less than monthly to more than weekly
Dietary History question-naire
China Chinese 564 N/A/ Mixed
282 282 3 2.03 Less than monthly
NA 0.0001 N/A Unadjusted
NAS00749
Armstrong
1998
other fresh pork/beef organs, at age 10
Less than monthly to more than weekly
Dietary History question-naire
China Chinese 564 N/A/ Mixed
282 282 3 1.12 Less than monthly
0.51-2.46
N/A N/A Unadjusted
NAS01459
Yu
1989
Fresh meat, at age 10
N/A FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
306 306 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, area of residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
69
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01459
Yu
1989
Fresh meat, at age 1-2
N/A FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
306 306 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, area of residence
NAS01520
Yu
1988
fresh meats, during weaning
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A 0.98 N/A Age, sex
NAS01520
Yu
1988
fresh meats, ages 1-2
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A 0.88 N/A Age, sex
NAS01520
Yu
1988
fresh meats, at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
NAS01922
Ning
1990
fresh liver, at 10 years of age
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A Age, Sex, Area of residence
2.5.1.2 Processed meat Processed meat: Adulthood consumption Case-control (5) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
70
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00700
Farrow
1998
Processed, preserved meat (ham, bacon, sausage, liverwurst, hot dogs)
Lowest to highest
FFQ – Block
United States
Unknown 345 18-74/ Mixed
129 204 4 1.54 Lowest 0.71-3.33
N/A 0.15 Age, Sex, Energy Intake, Alcohol, Smoking Habits
NAS01056
Lee
1994
lapcheong, Chinese sausage, during adulthood
Never to 3+ times a month
FFQ - Study-specific
Singa-pore
Chinese 606 Max 44/ Mixed
200 406 4 1.0 Never 0.3-2.8
N/A 0.9 Age, sex, ethnicity/ race, education
NAS01153
West
1993
Processed meat, including ham and longanisa
Low to high tertile
Unknown Philip-pines
Filipino 205 11-83/ Mixed
104 205 3 0.46 Low tertile
0.2-1.0
N/A N/A Age, sex, fresh fish, processed meat, hospital ward, Smoking, Burning anti-mosquito coils. Dust/ exhaust, Formaldehyde, Herbal medicines, Education
NAS01608
Yu
1986
liver sausage, at 10 years of age or 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 500 Max 34/ Mixed
250 250 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, salted fish intake
NAS06023
Zou
1999
Smoked, processed meat
Yes vs. no Question-naire
China Chinese 304 14-82/ Mixed
102 202 2 1.8 No 1.09-2.97
0.02 N/A Unadjusted
Processed meat: Childhood consumption Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
71
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01056
Lee
1994
lapcheong, Chinese sausage, at age 10
Never to 3+ times a month
FFQ - Study-specific
Singa-pore
Chinese 606 Max 44/ Mixed
149 344 4 0.8 Never 0.3-2.4
N/A 0.8 Age, sex, ethnicity/ race, education
NAS01520
Yu
1988
liver sausage, consumed by subject at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
NAS01608
Yu
1986
liver sausage, at 10 years of age or 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 500 Max 34/ Mixed
250 250 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, salted fish intake
Processed pork Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
categories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01520
Yu
1988
Ham, at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
NAS01520
Yu
1988
Pork sausage, at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
NAS01608
Yu
1986
Pork sausage, at age 10 or adult
N/A FFQ - Study-specific
China Chinese 500 Max 34/ Mixed
250 250 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, salted fish intake
2.5.1.3.1 Beef
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
72
Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01113
Zheng
1994
Beef <2 times per year to 1+ times per week
FFQ - Study-specific
China Chinese 264 N/A/ Mixed
88 175 3 0.6 <2 times per year
N/A 0.30 N/A Age, sex, SES, area of residence
NAS04944
Armstrong
1978
Beef Yes or no Recall Malaysia Chinese 210 25-81/ Mixed
60 150 2 0.4 no N/A <.05 N/A Age, sex, SES, ethnicity/ race, area of residence, lifestyle factors
Ecological (1) Study identifier
Author, Yr
Exposure Exposure range
Assessment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
categories
r2 Ref group
CI P value
p value for trend
Adjusted for
NAS00817
Koo
1997
Beef N/A Per capita consumption
China, Hong Kong
Chinese N/A N/A/ Male N/A N/A Correlation/ regression
r2 = -0.87
N/A N/A .026 N/A Age
NAS00817
Koo
1997
Beef N/A Per capita consumption
China, Hong Kong
Chinese N/A N/A/ Female
N/A N/A Correlation/ regression
r2 = -0.84
N/A N/A .034 N/A Age
2.5.1.3.2 Pork Non-processed pork Ecological (1) Study identifier
Author, Yr
Exposure Exposure range
Assessment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
categories
r2 Ref group
CI P value
p value for trend
Adjusted for
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
73
Study identifier
Author, Yr
Exposure Exposure range
Assessment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
categories
r2 Ref group
CI P value
p value for trend
Adjusted for
NAS00817
Koo
1997
Pork N/A Per capita consumption
China, Hong Kong
Chinese N/A N/A/ Male N/A N/A Correlation/ regression
r2 = -0.92
N/A N/A 0.01 N/A Age
NAS00817
Koo
1997
Pork N/A Per capita consumption
China, Hong Kong
Chinese N/A N/A/ Female
N/A N/A Correlation/ regression
r2 = -0.83
N/A N/A 0.039 N/A Age
Processed pork Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
categories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01190
Zheng
1993
Salted pork N/A FFQ - Study-specific
China Chinese 410 N/A./ Mixed
205 205 N/A N/A N/A N/A Signif-icant
N/A Un-adjusted
NAS01520
Yu
1988
Ham, at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
NAS01520
Yu
1988
Pork sausage, at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
NAS01520
Yu
1988
Salted pork, at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
74
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
categories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01608
Yu
1986
Salted pork, at age 10 or adult
N/A FFQ - Study-specific
China Chinese 500 Max 34/ Mixed
250 250 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, salted fish intake
NAS01608
Yu
1986
Pork sausage, at age 10 or adult
N/A FFQ - Study-specific
China Chinese 500 Max 34/ Mixed
250 250 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, salted fish intake
2.5.1.3.4 Organ meats Non-processed organ meats: Adulthood consumption Case-control (4) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00577
Yuan
2000
Organ meat, fresh
N/A FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 3 N/A N/A N/A Not signif-icant
N/A Unadusted
NAS00749
Armstrong
1998
Fresh pork/beef liver, 5 years pre-diagnosis
Less than monthly to more than weekly
Dietary History question-naire
China Chinese 564 N/A/ Mixed
282 282 3 3.53 Less than monthly
1.83-6.84
N/A .001 Unadjusted
NAS00749
Armstrong
1998
other fresh pork/beef organs, 5 years prior to diagnosis
Less than monthly to more than weekly
Dietary History question-naire
China Chinese 564 N/A/ Mixed
282 282 3 4.63 Less than monthly
1.89-11.3
N/A .009 Unadjusted
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
75
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00749
Armstrong
1998
fresh, pork/beef liver, trichotomous categories: includes dietary information at age 10 and age 5 years prior to diagnosis
Less than monthly to more than weekly
Dietary History question-naire
China Chinese 564 N/A/ Mixed
282 282 3 2.03 Less than monthly
N/A N/A .0001 SES, salted fish, recent consumption, salted egg/ shrimp / chinese flowering cabbage/ oranges/ tangerines, lifetime consumption, beer consumption
NAS01459
Yu
1989
liver, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
306 306 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, area of residence
NAS01922
Ning
1990
fresh liver, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A Age, Sex, Area of residence
Non-processed organ meats: Childhood consumption Case-control (4) Study identifier
Author,Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00749
Armstrong
1998
Fresh pork/beef liver, at age 10
Less than monthly to more than weekly
Dietary History question-naire
China Chinese 564 N/A/ Mixed
282 282 3 1.98 Less than monthly
0.97-4.05
N/A N/A Unadjusted
NAS00749
Armstrong
1998
other fresh pork/beef organs, at age 10
Less than monthly to more than weekly
Dietary History question-naire
China Chinese 564 N/A/ Mixed
282 282 3 1.12 Less than monthly
0.51-2.46
N/A N/A Unadjusted
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
76
Study identifier
Author,Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01459
Yu
1989
liver, at age 10
N/A FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
306 306 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, area of residence
NAS01459
Yu
1989
liver, at age 1-2
N/A FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
306 306 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, area of residence
NAS01520
Yu
1988
liver, consumed by subject at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
NAS01520
Yu
1988
liver, consumed by subject ages 1-2
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
NAS01922
Ning
1990
fresh liver, at 10 years of age
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A Age, Sex, Area of residence
Processed organ meats Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01520
Yu
1988
liver sausage, consumed by subject at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
77
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01608
Yu
1986
liver sausage, at 10 years of age or 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 500 Max 34/ Mixed
250 250 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, salted fish intake
2.5.1.4 Poultry Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00424
Laouamri
2001
Baby foods: chicken
<3 times a week to 3-7 times a week
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
35 47 2 0.2 <3 times a week
0.06-0.6
0.01 N/A Age, sex, area of residence
NAS01381
Jeannel
1990
Chicken, during childhood
<1 time a month to 2+ times a week
FFQ - Study-specific
Tunisia Tunisian 240 N/A/ Mixed
80 160 4 4.7 <1 time a month
N/A N/A N/A Age, sex, area of residence, lifestyle factors
Ecological (1) Study identifier
Author, Yr
Exposure Exposure range
Assessment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
categories
r2 Ref group
CI P value
p value for trend
Adjusted for
NAS00817
Koo
1997
Poultry N/A Per capita consumption
China, Hong Kong
Chinese N/A N/A/ Male N/A N/A Correlation/ regression
r2 = -0.83
N/A N/A 0.04 N/A Age
NAS00817
Koo
1997
Poultry N/A Per capita consumption
China, Hong Kong
Chinese N/A N/A/ Female
N/A N/A Correlation/ regression
r2 = -0.84
N/A N/A 0.038 N/A Age
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
78
2.5.2 Fish Non-preserved fish Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01459
Yu
1989
Fresh fish sauce, adult
N/A FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
306 306 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, area of residence
NAS01459
Yu
1989
Fresh fish sauce, age 10
N/A FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
306 306 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, area of residence
NAS01459
Yu
1989
Fresh fish sauce, age 1-2
N/A FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
306 306 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, area of residence
NAS01520
Yu
1988
Fresh fish, age 10
Yes or no FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
NAS01520
Yu
1988
Fresh fish, age 1-2
Yes or no FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A 0.23 N/A Age, sex
NAS01520
Yu
1988
Fresh fish, during weaning
Yes or no FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A 0.09 N/A Sex
NAS01922
Ning
1990
boiled fish, fresh, at age 10
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A Age, Sex, Area of residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
79
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01922
Ning
1990
boiled fish, fresh, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A Age, Sex, Area of residence
Ecological (1) Study identifier
Author, Yr
Exposure Expo-sure range
Assessment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
Regression Slope
Ref group
CI P value
p value for trend
Adjusted for
NAS00817
Koo
1997
Saltwater Fish
N/A Per capita consumption
China, Hong Kong
Chinese N/A N/A/ Male N/A N/A N/A r2 = -0.83 N/A N/A 0.039 N/A Age
NAS00817
Koo
1997
Saltwater Fish
N/A Per capita consumption
China, Hong Kong
Chinese N/A N/A/ Female
N/A N/A N/A r2 = -0.84 N/A N/A 0.038 N/A Age
NAS00817
Koo
1997
Freshwater fish
N/A Per capita consumption
China, Hong Kong
Chinese N/A N/A/ Male N/A N/A N/A r2 = -0.70 N/A N/A 0.124 N/A Age
NAS00817
Koo
1997
Freshwater fish
N/A Per capita consumption
China, Hong Kong
Chinese N/A N/A/ Female
N/A N/A N/A r2 = -0.77 N/A N/A 0.070 N/A Age
2.5.2.1 Salted Fish Salted fish: Adulthood consumption Cohort (1)
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
80
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
categories
Chi-square
Ref group
CI P value
p value for trend
Adjusted for
NAS06011
Zou
1994
Salted fish, 1960s
none to 1+ times a week
Dietary History question-naire
China Chinese 505 35-64/ Mixed
N/A N/A 2 Chi-square = 12.91
Not exposed
N/A <.001 N/A Unadjusted
NAS06011
Zou
1994
Salted fish, 1970s
none to 1+ times a week
Dietary History question-naire
China Chinese 505 35-64/ Mixed
N/A N/A 2 Chi-square = 6.07
Not exposed
N/A <.014 N/A Unadjusted
NAS06011
Zou
1994
Salted fish, 1980s
none to 1+ times a week
Dietary History question-naire
China Chinese 505 35-64/ Mixed
N/A N/A 2 Chi-square = 1.545
Not exposed
N/A .214 N/A Unadjusted
Case-control (21) Meta-analysis Study identifier
Author
Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group CI P value p value for trend
Adjusted for
NAS00531
Ward
2000
Salted fish, adult intake
5g/wk Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
375 327 2 0.8 No 0.5-1.2
Not signif-icant
N/A Age, sex, ethnicity/ race, total calories, mothers questionnaire
NAS00577
Yuan
2000
Salted fish Less than monthly to weekly or more
FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 3 1.82 Less than monthly
0.86-3.88
N/A 0.07 Age, sex, area of residence, env factors, smoking, chemical fumes, history of ear/nose condition
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
81
Study identifier
Author
Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group CI P value p value for trend
Adjusted for
NAS00749
Armstrong
1998
Salted fish, 5 years prior
Less than monthly to more than weekly
Dietary History question-naire
China Chinese 564 N/A/ Mixed
282 282 3 4.22 Less than monthly
2.23-7.99
Signif-icant
.001 Unadjusted
NAS01056
Lee
1994
Salted fish, adult
Never to 3+ times a week
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
200 406 4 4.4 Never 0.7-25.9
Not signif-icant
0.6 Age, sex, ethnicity/ race, education
NAS01113
Zheng
1994
Salted fish, year before dx
Yes or no FFQ - Study-specific
China Chinese 264 Mean 42/ Mixed
88 176 2 N/A No N/A Not signif-icant
N/A Age, sex, area of residence, SES
NAS01141
Zheng
1994
Salted fish, tough meat
Never and yearly to weekly and daily
FFQ - Study-specific
China Chinese 410 Max 55/ Mixed
205 205 3 11.2 Never and yearly
4.6-32.0
Signif-icant
N/A Age, sex, area of residence
NAS01141
Zheng
1994
Salted fish, soft meat
Never and yearly to weekly and daily
FFQ - Study-specific
China Chinese 410 Max 55/ Mixed
205 205 3 17.2 Never and yearly
4.1-152
Signif-icant
N/A Age, sex, area of residence
NAS01153
West
1993
Salted fish Low to high tertile
Unknown Philippines Filipino 205 11-83/ Mixed
104 101 3 1.3 Low tertile 0.69-2.6
Not signif-icant
N/A Age, sex, fresh fish, processed meat, hospital ward
NAS01190
Zheng
1993
Highest consumption of salted fish from 3 time periods: last 7 years, at age 10, and in the first 3 years
N/A FFQ - Study-specific
China Chinese 410 N/A/ Mixed
205 205 N/A N/A N/A N/A Signif-icant
N/A N/A
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
82
Study identifier
Author
Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group CI P value p value for trend
Adjusted for
NAS01248
Sriamporn
1992
Salted fish Freshwater only, sea salted +/- once a week
FFQ - Study-specific
Thailand Thai 240 Mean 47/ Mixed
120 120 3 2.5 Fresh-water only
1.2-5.2
Signif-icant
N/A Age, sex, area of residence, smoking, alcohol, occupation
NAS01459
Yu
1989
Salted fish, 3 years prior to dx
Rarely to daily
FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
306 306 4 1.8 Rarely 0.9-3.6
Not signif-icant
<.05 Age, sex, area of residence
NAS01608
Yu
1986
Salted fish, adult
Rarely to daily
FFQ - Study-specific
China, Hong Kong
Chinese 500 Max 34/ Mixed
250 250 4 7.5 Rarely 0.9-65.3
Not signif-icant
N/A Age, sex
NAS01608
Yu
1986
Salted fish head soup, adult
Rarely to more than once a month
FFQ - Study-specific
China, Hong Kong
Chinese 500 Max 34/ Mixed
250 250 2 4.2 Rarely 1.6-11.7
Signif-icant
N/A Age, sex
NAS01922
Ning
1990
salted fish, ever consumed
Ever vs. Never
FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 2 2.2 Never 1.3-3.7
0.003 N/A Age, Sex, Area of residence
NAS01922
Ning
1990
Salted fish age at first exposure
Never exposed to older than 21
FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 4 1.5 Never 0.7-3.3
N/A 0.0006 Age, Sex, Area of residence
NAS01922
Ning
1990
salted fish, duration of consumption (years)
Never exposed to more than 21 years
FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 4 2.8 Never 1.4-5.6
N/A 0.001 Age, Sex, Area of residence
NAS01922
Ning
1990
2.5.2 salted fish, 3 years prior to diagnosis
Never to weekly or daily
FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 4 N/A Never N/A Not signif-icant
0.41 Age, Sex, Area of residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
83
Study identifier
Author
Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group CI P value p value for trend
Adjusted for
NAS01922
Ning
1990
salted fish, age/ duration at first exposure
Never exposed to age 21+/ duration 11+ years
FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 7 2.5 N/A N/A N/A N/A Age, Sex, Area of residence
NAS01922
Ning
1990
salted fish, age/ duration at first exposure (those who consumed at least monthly during the earliest decade of exposure)
Never exposed to 11+ years at first exposure and 11+ years duration
FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 5 2.2 N/A N/A N/A N/A Age, Sex, Area of residence
NAS02182
Armstrong
1983
Salted fish, current consumption as adults
N/A N/A Malaysia Chinese 200 N/A/
Mixed
100 100 N/A N/A N/A N/A Not signif-icant
N/A Age, Sex, Area of residence, Ethnicity/ Race
NAS04928
Henderson
1976
Current use of salted fish
N/A N/A United States
Chinese 423 Mean 52/ Mixed
156 267 N/A N/A N/A N/A Not signif-icant
N/A Age, Sex, Area of residence, SES
NAS05679
Yang
2005
Salted fish, moldy and firm, after age 10
Yes vs. No FFQ - Study-specific
Taiwan Chinese 2444 Mean 47/ Mixed
502 1942 2 N/A N/A N/A Not signif-icant
N/A Age, Sex, Family history of NPC
NAS06003
Ye
1995
salted fish ≤ 4 time per month to > 4 times per month
Dietary history question-naire
China Chinese 270 21-75/ Mixed
135 135 2 5.0 ≤ 4 time per month
1.26- 19.6
< 0.05 N/A Age, Sex, Area of residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
84
Study identifier
Author
Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group CI P value p value for trend
Adjusted for
NAS60010
Cai
1996
Salted Fish <12 times per month to ≥12 times per month
Dietary History question-naire
China Chinese 230 16-68/ Mixed
115 115 2 1.318 < 12 times per month
0.995-1.793
0.0538 N/A Age, Sex, Area of residence
NAS06021
Chen
1994
Salted Fish frequently consumed
Question-naire
China Chinese 56 N/A/ Mixed
28 28 Contin-uous
r2= 0.8661
N/A N/A 0.008 N/A Sex, Age
NAS06021
Chen
1994
Salted Fish, frequently consumed
Yes or No Question-naire
China Chinese 56 N/A/ Mixed
28 28 2 5.51 No 1.74-17.46
<0.01 N/A Sex, Age
NAS06022
Wang
1993
Salted Fish, consumed frequently
less consumed to frequently consumed
Question-naire
China Chinese 244 13-70/ Mixed
122 122 2 8.99 less consumed
N/A 0.0127 N/A Consumption of pork fat, colored vegetables, whole grains, plant oils, and vegetables, Non-nutrient chemicals, smoking in living area, Sex, Age, SES
NAS06023
Zou
1999
Salted Fish < 9 times a month to ≥ 9 times a month
Question-naire
China Chinese 304 14-82/ Mixed
100 202 2 2.8 < 9 times a month
1.52-5.18
Significant N/A Age, Sex, Live in area with high level of background radiation, Alcohol, Smoking habits, Consumption of fermented soy
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
85
Salted fish: Childhood consumption (Age 10) Cohort (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
categories
Chi-square
Ref group
CI P value
p value for trend
Adjusted for
NAS06011
Zou
1994
Salted fish, childhood
none to 1+ times a week
Dietary History question-naire
China Chinese 505 35-64/ Mixed
N/A N/A 2 Chi-square = 41.3
Not exposed
N/A <.038 N/A Unadjusted
Case-control (16) Meta-analysis Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group CI P value
p value for trend
Adjusted for
NAS00531
Ward
2000
Salted fish, at age 10
Yes or no Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
82 110 2 1.5 No 0.8-2.8
Not signif-icant
N/A Age, sex, ethnicity/ race
NAS00749
Armstrong
1998
Salted fish, at age 10
Less than monthly to more than weekly
Dietary History question-naire
China Chinese 564 N/A/ Mixed
282 282 3 2.74 Less than monthly
1.59-4.75
Signif-icant
N/A Unadjusted
NAS00821
Hildesheim
1997
Salted fish during childhood
Yes or no Unknown China, Taiwan
Chinese 684 15-74/ Mixed
364 320 2 1.4 No 0.47-4.5
Not signif-icant
N/A Age, sex
NAS01056
Lee
1994
Salted fish, at age 10
Never to 3+ times a week
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
161 369 5 0.8 Never 0.2-2.9
Not signif-icant
0.3 Age, sex, ethnicity/ race, education
NAS01113
Zheng
1994
Salted fish, steamed or fried, age 2-10
Rarely v. monthly/ weekly
FFQ - Study-specific
China Chinese 264 Mean 42/ Mixed
88 176 2 1.4 Rarely N/A 0.2 N/A Age, sex, area of residence, SES
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
86
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group CI P value
p value for trend
Adjusted for
NAS01113
Zheng
1994
Salted fish soup, age 2-10
Rarely v. monthly/ weekly
FFQ - Study-specific
China Chinese 264 Mean 42/ Mixed
88 176 2 2.3 Rarely N/A 0.05 N/A Age, sex, area of residence, SES
NAS01141
Zheng
1994
Salted fish, tough meat, age 10
Never and yearly to weekly and daily
FFQ - Study-specific
China Chinese 410 Max 55/ Mixed
205 205 3 9.1 Never and yearly
5.1-16.4
Signif-icant
N/A Age, sex, area of residence
NAS01141
Zheng
1994
Salted fish, soft meat, age 10
Never and yearly to weekly and daily
FFQ - Study-specific
China Chinese 410 Max 55/ Mixed
205 205 3 10.1 Never and yearly
5.2-20.7
Signif-icant
N/A Age, sex, area of residence
NAS01190
Zheng
1993
Highest consumption of salted fish from 3 time periods: last 7 years, at age 10, and in the first 3 years
N/A FFQ - Study-specific
China Chinese 410 N/A/ Mixed
205 205 N/A N/A N/A N/A Signif-icant
N/A N/A
NAS01459
Yu
1989
Salted fish, at age 10
Rarely to daily
FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
306 306 4 2.1 Rarely 1.2-3.6
Signif-icant
<.05 Age, sex, area of residence
NAS01520
Yu
1988
Salted fish, age 10
Rarely to monthly
FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 3 1.5 Rarely 0.5-4.3
Not signif-icant
N/A Age, sex
NAS01520
Yu
1988
Salted fish head soup, age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
NAS01608
Yu
1986
Salted fish, age 10
Rarely to more than weekly
FFQ - Study-specific
China, Hong Kong
Chinese 500 Max 34/ Mixed
250 250 3 37.7 Rarely 14.1-100
Signif-icant
N/A Age, sex
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
87
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group CI P value
p value for trend
Adjusted for
NAS01608
Yu
1986
Salted fish head soup, age 10
Rarely to more than once a month
FFQ - Study-specific
China, Hong Kong
Chinese 500 Max 34/ Mixed
250 250 2 5.1 Rarely 2.6-10.4
Signif-icant
N/A Age, sex
NAS01712
Armstrong
1983
Salted fish, child Ever v. never
Unknown Malaysia Chinese 200 Mean 43/ Mixed
100 100 2 17.4 Never 2.7-111
Signif-icant
N/A Age, sex, area of residence
NAS01766
Lanier
1980
Salted fish, child Yes or no Question-naire
United States, Alaska
Alaskan native
26 32-80/ Mixed
13 13 2 4.0 No 0.4-19.7
Not signif-icant
N/A Age, sex, area of residence, ethnicity/ race
NAS01922
Ning
1990
salted fish, at age 10 years
Never to weekly or daily
FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 4 6.7 Never N/A N/A 0.003 Age, Sex, Area of residence, salted shrimp paste and carrot consumption at 10 years
NAS01922
Ning
1990
steamed salted fish, at age 10
Ever vs Never
FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 2 4.2 Never 2.2-8.3
N/A N/A Age, Sex, Area of residence
NAS01922
Ning
1990
fried, grilled, broiled salted fish, at age 10
Ever vs Never
FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 2 1.6 Never 0.8-3.2
N/A N/A Age, Sex, Area of residence
NAS02182
Armstrong
1983
NPC and Salted Fish, during childhood
Ever vs Never
N/A Malaysia Chinese 200 N/A/
Mixed
100 100 2 3.0 Never N/A 0.04 N/A Age, Sex, Area of residence, Ethnicity/ Race
NAS02182
Armstrong
1983
NPC and Salted Fish, during childhood
Never to daily
N/A Malaysia Chinese 200 N/A/
Mixed
100 100 3 17.4 Never 2.7-111.1
N/A N/A Age, Sex, Area of residence, Ethnicity/ Race
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
88
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group CI P value
p value for trend
Adjusted for
NAS02182
Armstrong
1983
NPC and Salted Fish, Consumption during adolescence
Less than weekly to daily
N/A Malaysia Chinese 200 N/A/
Mixed
100 100 2 3.5 Less than weekly
1.2- 10.7
N/A N/A Age, Sex, Area of residence, Ethnicity/ Race
NAS05679
Yang
2005
Salted fish, moldy and firm, during childhood
Never vs. 1+ times/wk
FFQ - Study-specific
Taiwan Chinese 2444 Mean 47/ Mixed
502 1942 3 1.78 Never 0.82-3.89
Not signif-icant
N/A Age, Sex, Family history of NPC
NAS06020
Na
1988
Salted Fish, during childhood
N/A Question-naire
China Chinese 344 N/A/ Mixed
127 217 Contin-uous
r2= 1.575
N/A N/A Signif-icant
N/A Area of residence, coal as family fuel, History of cancer/ naso-pharyngitis, Sex, Age
NAS06020
Na
1988
Salted Fish, during childhood
consume less to more
Question-naire
China Chinese 344 N/A/ Mixed
127 217 2 5.5 Consume less
1.16-35.89
<0.05 N/A Unadjusted
Salted fish: Childhood consumption (Ages 0-3) Case-control (10) Meta-analysis Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group CI P value
p value for trend
Adjusted for
NAS00531
Ward
2000
Salted fish, at age 3
Yes or no Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
86 102 2 1.0 No 0.5-2.1
Not signif-icant
N/A Age, sex, ethnicity/ race, total calories, mothers questionnaire
NAS01056
Lee
1994
Salted fish, during infancy
Never to more than once a month
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
200 406 3 1.2 Never 0.3-3.4
Not signif-icant
N/A Age, sex, ethnicity/ race, education
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
89
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group CI P value
p value for trend
Adjusted for
NAS01113
Zheng
1994
Salted fish, during weaning
Yes or no FFQ - Study-specific
China Chinese 264 Mean 42/ Mixed
87 171 2 2.4 No N/A 0.01 N/A Age, sex, area of residence, SES
NAS01113
Zheng
1994
Salted fish, steamed or fried, before 2
Rarely v. monthly/ weekly
FFQ - Study-specific
China Chinese 264 Mean 42/ Mixed
87 172 2 1.4 Rarely N/A 0.3 N/A Age, sex, area of residence, SES
NAS01113
Zheng
1994
Salted fish soup, before 2
Rarely v. monthly/ weekly
FFQ - Study-specific
China Chinese 264 Mean 42/ Mixed
87 162 2 1.8 Rarely N/A 0.2 N/A Age, sex, area of residence, SES
NAS01141
Zheng
1994
Salted fish, age 0-3
Never and yearly to weekly and daily
FFQ - Study-specific
China Chinese 410 Max 55/ Mixed
151 195 3 12.9 Never and yearly
5.2-20.6
Signif-icant
N/A Age, sex, area of residence
NAS01190
Zheng
1993
Highest consumption of salted fish from 3 time periods: last 7 years, at age 10, and in the first 3 years
N/A FFQ - Study-specific
China Chinese 410 N/A/ Mixed
205 205 N/A N/A N/A N/A Signif-icant
N/A N/A
NAS01381
Jeannel
1990
Salted anchovies, during weaning
Yes or no FFQ - Study-specific
Tunisia Tunisian 240 Mean 41/ Mixed
80 160 2 1.5 No N/A 0.5 N/A Age, sex, area of residence, living condition score
NAS01459
Yu
1989
Salted fish, age 1-2
Rarely to weekly
FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
306 306 3 2.0 Rarely 1.1-3.6
Signif-icant
<.05 Age, sex, area of residence
NAS01459
Yu
1989
Salted fish, during weaning
Yes or no FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
306 306 2 2.1 No 1.2-3.6
Signif-icant
N/A Age, sex, area of residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
90
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group CI P value
p value for trend
Adjusted for
NAS01520
Yu
1988
Salted fish, age 1-2
Rarely to monthly
FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 3 2.2 Rarely 0.7-7.6
Not signif-icant
.11 Age, sex
NAS01520
Yu
1988
Salted fish, during weaning
Yes or no FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 2 2.6 No 1.2-5.6
.01 N/A Age, sex
NAS01608
Yu
1986
Salted fish, age 1-2 by mother
Never to often
FFQ - Study-specific
China, Hong Kong
Chinese 500 Max 34/ Mixed
250 250 3 20.2 Never 6.8-60.2
Signif-icant
N/A Age, sex
NAS01608
Yu
1986
Salted fish, during weaning (mother)
Ever v. never
FFQ - Study-specific
China, Hong Kong
Chinese 500 Max 34/ Mixed
250 250 3 7.5 Never 3.9-14.8
Signif-icant
N/A Age, sex
NAS01608
Yu
1986
Salted fish head soup, age 1-2 (mother)
Ever v. never
FFQ - Study-specific
China, Hong Kong
Chinese 500 Max 34/ Mixed
250 250 2 8.3 Never 2.5-32.5
Signif-icant
N/A Age, sex
NAS01812
Geser
1978
Salted fish, after weaning
Yes or no FFQ - Study-specific
China, Hong Kong
Chinese 300 N/A/ Mixed
150 150 2 2.6 No N/A < 0.01 N/A Unadjusted
NAS01812
Geser
1978
Salted Fish During Weaning
No salted fish / low traditional life-style index to yes salted fish/ high traditional lifestyle index
FFQ - Study-specific
China, Hong Kong
Chinese 300 N/A/ Mixed
98 89 6 2.2 No salted fish and low traditional life-style index
N/A Not signif-icant
N/A traditional lifestyle: compilation of Chinese wine drinking, bread consumption, ancestral / Buddhist alters
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
91
Salted fish: Mother’s consumption during pregnancy or breastfeeding Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01056
Lee
1994
Salted fish, during breast-feeding
Never to more than once a month
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
49 96 3 2.0 never 0.3-10.6
Not signif-icant
0.3 Age, sex, ethnicity/ race, education
NAS01056
Lee
1994
Salted fish, during pregnancy
Never to more than once a month
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
46 94 3 1.3 never 0.4-3.7
Not signif-icant
0.6 Age, sex, ethnicity/ race, education
NAS01459
Yu
1989
Salted fish, during nursing
Rarely to daily
FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
306 306 4 2.3 Rarely 1.1-4.6
Signif-icant
<.05 Age, sex, area of residence
NAS01459
Yu
1989
Salted fish, during pregnancy
Rarely to daily
FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
306 306 4 2.2 Rarely 1.1-4.6
Signif-icant
<.05 Age, sex, area of residence
NAS01520
Yu
1988
Salted fish, while nursing
Rarely to monthly
FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 3 4.9 Rarely 1.5-15.9
Signif-icant
.01 Age, sex
NAS01520
Yu
1988
Salted fish, during pregnancy
Rarely to monthly
FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 3 3.1 Rarely 1.1-8.8
Signif-icant
.003 Age, sex
2.5.2.2 Other preserved fish (excluding salted fish) Cohort (1) Study identifier
Author, Yr
Exposure Exposure range
Assessment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
Chi-square
Ref group
CI P value
p value for trend
Adjusted for
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
92
Study identifier
Author, Yr
Exposure Exposure range
Assessment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
Chi-square
Ref group
CI P value
p value for trend
Adjusted for
NAS06011
Zou
1994
Salted and dried fish, 1960s
none to 1+ times a week
Dietary History questionnaire
China Chinese 505 35-64/ Mixed
N/A N/A 2 Chi-square = 40.4
Not exposed
N/A <.001 N/A Unadjusted
NAS06011
Zou
1994
Salted and dried fish, 1970s
none to 1+ times a week
Dietary History questionnaire
China Chinese 505 35-64/ Mixed
N/A N/A 2 Chi-square = 42.6
Not exposed
N/A <.001 N/A Unadjusted
NAS06011
Zou
1994
Salted and dried fish, 1980s
none to 1+ times a week
Dietary History questionnaire
China Chinese 505 35-64/ Mixed
N/A N/A 2 Chi-square = 21.1
Not exposed
N/A <.001 N/A Unadjusted
Case-control (5) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01056
Lee
1994
Dried, unsalted fish, adult
Never to more than once a month
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
195 405 3 2.2 Never 0.8-5.4
Not signif-icant
0.3 Age, sex, ethnicity/ race, education
NAS01056
Lee
1994
Dried, unsalted fish, at age 10
Never to more than once a month
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
141 337 3 0.1 Never 0.01-1.0
Signif-icant
0.03 Age, sex, ethnicity/ race, education
NAS01056
Lee
1994
Dried, tiny fish, at age 10
Never to 3+ times a week
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
148 345 5 0.6 never 0.02-2.1
Not signif-icant
0.06 Age, sex, ethnicity/ race, education
NAS01056
Lee
1994
Dried, tiny fish, adult
Never to 3+ times a week
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
190 306 5 1.1 never 0.3-3.8
Not signif-icant
0.8 Age, sex, ethnicity/ race, education
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
93
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01056
Lee
1994
Dried, tiny fish, infancy
Never to 3+ times a week
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
59 96 4 0.7 never 0.05-8.6
Not signif-icant
0.6 Age, sex, ethnicity/ race, education
NAS01056
Lee
1994
Dried, tiny fish soup, during infancy
Never to 3+ times a week
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
60 96 4 4.2 never 0.4-42.8
Not signif-icant
0.5 Age, sex, ethnicity/ race, education
NAS01056
Lee
1994
Preserved cuttlefish, adult
Never to 3+ times a week
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
198 305 4 1.3 Never 0.5-2.9
Not signif-icant
0.9 Age, sex, ethnicity/ race, education
NAS01056
Lee
1994
Preserved cuttlefish, at age 10
Never to 3+ times a week
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
146 341 4 0.6 Never 0.1-1.8
Not signif-icant
0.08 Age, sex, ethnicity/ race, education
NAS01056
Lee
1994
Preserved fish tidbits, adult
Never to 3+ times a week
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
198 406 4 2.6 Never 0.6-10.0
Not signif-icant
0.6 Age, sex, ethnicity/ race, education
NAS01056
Lee
1994
Preserved fish tidbits, at age 10
Never to 3+ times a week
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
144 343 4 0.4 Never 0.1-1.3
Not signif-icant
0.1 Age, sex, ethnicity/ race, education
NAS01056
Lee
1994
Fish gravy, adult Never to 3+ times a week
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
197 398 5 1.3 Never 0.6-2.7
Not signif-icant
0.1 Age, sex, ethnicity/ race, education
NAS01056
Lee
1994
Fish gravy, at age 10
Never to 3+ times a week
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
143 334 5 1.0 Never 0.4-2.4
Not signif-icant
0.9 Age, sex, ethnicity/ race, education
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
94
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01459
Yu
1989
Fermented fish sauce -adult
N/A FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
306 306 2 N/A N/A N/A Not signif-icant
N/A Age, sex, area of residence
NAS01459
Yu
1989
Fermented fish sauce -age 10
Rarely to daily
FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
306 306 4 N/A Rarely N/A N/A .93 Age, sex, area of residence, salted fish
NAS01459
Yu
1989
Fermented fish sauce -age 1-2
Rarely to weekly
FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
306 306 3 N/A Rarely N/A N/A .08 Age, sex, area of residence, salted fish
NAS01520
Yu
1988
Dried fish, age 10
Rarely to monthly
FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 3 6.4 Rarely 1.6-26.8
Signif-icant
.04 Age, sex
NAS01520
Yu
1988
Dried fish, age 1-2
Rarely to monthly
FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 3 2.2 Rarely 0.9-5.3
Not signif-icant
.002 Age, sex
NAS01520
Yu
1988
Fermented fish paste, age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
NAS01922
Ning
1990
dried anchovy, at age 10
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A Age, Sex, Area of residence
NAS01922
Ning
1990
dried anchovy, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A Age, Sex, Area of residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
95
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS04944
Armstrong
1978
dried fish, for breakfast among families of cases/ controls
N/A Recall Malaysia Chinese 210 25-81/ Mixed
60 150 N/A N/A N/A N/A Signig-icant
N/A Unadjusted
NAS04944
Armstrong
1978
dried fish in three main daily meals combined, among cases and controls
Unclear Recall Malaysia Chinese 210 25-81/ Mixed
60 150 N/A 0.8 N/A N/A Not signif-icant
N/A Age, Sex, Area of residence, Ethnicity/ Race, Socio-economic status, Lifestyle Factors
2.5.3 Shellfish and other seafood Non-preserved seafood Case-control (4) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00577
Yuan
2000
Seafood, fresh N/A FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 N/A N/A N/A N/A Not signif- icant
N/A N/A
NAS00749
Armstrong
1998
shrimp, 5 years pre-diagnosis
Monthly to more than weekly
Dietary History question-naire
Malaysia Chinese 564 N/A/ Mixed
282 282 3 0.87 Monthly 0.47-1.62
N/A 0.066 Unadjusted
NAS00749
Armstrong
1998
shrimp, at age 10 Monthly to more than weekly
Dietary History question-naire
Malaysia Chinese 564 N/A/ Mixed
282 282 3 0.57 Monthly 0.34-0.96
N/A N/A Unadjusted
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
96
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00749
Armstrong
1998
shrimp, lifetime consumption, analysis includes dietary information at age 10 and age 5 years prior to diagnosis
Less than monthly to monthly and more
Dietary History question-naire
Malaysia Chinese 564 N/A/ Mixed
282 282 3 0.83 Less than monthly
N/A 0.082 N/A SES, salted fish/pork/ beef liver, recent consumption, salted egg/ chinese flowering cabbage/ oranges/ tangerines/ beer lifetime consumption
NAS01922
Ning
1990
crab, fresh, at age 10
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A N/A
NAS01922
Ning
1990
crab, fresh, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A N/A
NAS01922
Ning
1990
jellyfish, fresh, at age 10
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A N/A
NAS01922
Ning
1990
jellyfish, fresh, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A N/A
NAS04944
Armstrong
1978
fresh prawns, at evening meal among families of cases / controls
N/A Recall Malaysia Chinese 210 25-81/ Mixed
60 150 N/A <1.0 N/A N/A Signif-icant
N/A N/A
NAS04944
Armstrong
1978
fresh prawn in 3 main daily meals combined, among cases / controls
N/A Recall Malaysia Chinese 210 25-81/ Mixed
60 150 N/A 0.7 N/A N/A <0.05 N/A Age, sex, SES, ethnicity/ race, area of residence, lifestyle factors
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
97
Preserved seafood: Adulthood consumption Case-control (5) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00577
Yuan
2000
Salted seafood pastes
Yes vs. no FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 2 1.44 No 0.97-2.15
0.07 N/A Age, sex, occupational exposure to fumes, education, smoking, environmental factors, other diseases
NAS01056
Lee
1994
dried oyster, during adulthood
Never to more than 3 times per month
FFQ - Study-specific
Singa-pore
Chinese 606 Max 44/ Mixed
200 405 4 2.2 Never 0.6-7.3
N/A 0.7 Age, sex, ethnicity/ race, education
NAS01056
Lee
1994
dried prawn, consumption during adulthood
Never to 3+ times per week
FFQ - Study-specific
Singa-pore
Chinese 606 Max 44/ Mixed
199 406 5 1.5 Never 0.5-3.6
N/A 0.4 Age, sex, ethnicity/ race, education
NAS01459
Yu
1989
salted shrimp paste, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 612 Max 49/ Mixed
306 306 N/A N/A N/A N/A Not signif-icant
N/A N/A
NAS01459
Yu
1989
salted shrimp paste, unsure time of consumption
N/A FFQ - Study-specific
China Chinese 612 Max 49/ Mixed
306 306 N/A N/A N/A N/A Not signif-icant
N/A Area of residence, age, sex, salted fish, fermented fish sauce, moldy bean curd, chan pai mui, gar ink gee, tomatoes
NAS01608
Yu
1986
dried shrimp, subject's at 10 years of age or 3 years prior to diagnosis
N/A FFQ - Study-specific
China, Hong Kong
Chinese 500 Max 34/ Mixed
250 250 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, salted fish intake
NAS01922
Ning
1990
salted shrimp paste, 3 years prior to diagnosis
Never to Weekly
FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 3 1.8 Never 0.9-3.8
N/A 0.12 Age, Sex, Area of Residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
98
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01922
Ning
1990
dried shrimp, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A N/A
Preserved seafood: Childhood consumption Case-control (5) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01056
Lee
1994
prawn, dried, at age 10
Never to 1-3 times per week
FFQ - Study-specific
Singa-pore
Chinese 606 Max 44/ Mixed
150 340 4 0.7 Never 0.3-1.4
N/A 0.5 Age, sex, ethnicity/ race, education
NAS01056
Lee
1994
oyster, dried, at age 10
Never to 1-3 times per week
FFQ - Study-specific
Singa-pore
Chinese 606 Max 44/ Mixed
151 342 4 1.1 Never 0.3-3.4
N/A 0.3 Age, sex, ethnicity/ race, education
NAS01459
Yu
1989
salted shrimp paste, during ages 1-2
Rarely to weekly
FFQ - Study-specific
China Chinese 612 Max 49/ Mixed
110 138 3 N/A Rarely N/A N/A 0.07 Area of residence, age, sex, salted fish consumption during weaning
NAS01459
Yu
1989
salted shrimp paste, at age 10
Rarely to daily
FFQ - Study-specific
China Chinese 612 Max 49/ Mixed
110 139 4 N/A Rarely N/A N/A 0.04 Area of residence, age, sex, salted fish consumption during weaning
NAS01520
Yu
1988
fermented crab paste, at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
99
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01520
Yu
1988
fermented shrimp paste, at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
NAS01520
Yu
1988
dried shrimp, at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
NAS01608
Yu
1986
dried shrimp, subject's at 10 years of age or 3 years prior to diagnosis
N/A FFQ - Study-specific
China, Hong Kong
Chinese 500 Max 34/ Mixed
250 250 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, salted fish intake
NAS01922
Ning
1990
dried shrimp, at age 10
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A N/A
NAS01922
Ning
1990
dried shrimp, at age 10
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A N/A
NAS01922
Ning
1990
salted shrimp paste, at 10 years
None to weekly/ daily
FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 4 3.2 None N/A 0.007 N/A Age, Sex, Area of residence, salted fish and carrot consumption at 10 years
2.5.4 Eggs Non-preserved eggs Case-control (4)
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
100
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS00577
Yuan
2000
Eggs, fresh N/A FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 N/A N/A N/A N/A Not signif-icant
N/A N/A
NAS01459
Yu
1989
Eggs, at age 1-2 N/A FFQ - Study-specific
China Chinese 612 Max 49/ Mixed
306 306 N/A N/A N/A N/A Not signif-icant
N/A Area of residence, age, sex
NAS01459
Yu
1989
Eggs, at age 10 N/A FFQ - Study-specific
China Chinese 612 Max 49/ Mixed
306 306 N/A N/A N/A N/A Not signif-icant
N/A Area of residence, age, sex
NAS01459
Yu
1989
Eggs, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 612 Max 49/ Mixed
306 306 N/A N/A N/A N/A Not signif-icant
N/A Area of residence, age, sex
NAS01520
Yu
1988
fresh eggs during weaning
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A 0.92 N/A Age, sex
NAS01520
Yu
1988
fresh eggs, ages 1 to 2 years
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A 0.36 N/A Age, sex
NAS01520
Yu
1988
fresh eggs, at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
NAS04944
Armstrong
1978
fresh eggs, at evening meal among families of cases and controls
N/A Recall Malaysia Chinese 210 25-81/ Mixed
60 150 N/A <1.0 N/A N/A Signif-icant
N/A N/A
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
101
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS04944
Armstrong
1978
fresh egg in three main daily meals, among cases/ controls
N/A Recall Malaysia Chinese 210 25-81/ Mixed
60 150 N/A 1.1 N/A N/A Not signif-icant
N/A Age, sex, SES, ethnicity/ race, area of residence, lifestyle factors
NAS04944
Armstrong
1978
Fresh egg, for breakfast among families of partici-pants
N/A Recall Malaysia Chinese 210 25-81/ Mixed
60 150 N/A N/A N/A N/A Not signif-icant
N/A N/A
Ecological (1) Study identifier
Author, Yr
Exposure Exposure range
Assessment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
categories
r2 Ref group
CI P value
p value for trend
Adjusted for
NAS00817
Koo
1997
Eggs N/A Per capita consumption
China, Hong Kong
Chinese N/A N/A/ Male N/A N/A Correlation/ regression
r2 = -.42
N/A N/A 0.405 N/A Age
NAS00817
Koo
1997
Eggs N/A Per capita consumption
China, Hong Kong
Chinese N/A N/A/ Female
N/A N/A Correlation/ regression
r2 = -.14
N/A N/A 0.796 N/A Age
Salted eggs: Adulthood consumption Case-control (5) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00531
Ward
2000
Adult Dietary Intake: salted eggs
Lowest to highest
Dietary History question-naire
China Chinese 702 Max 74/ Mixed
89 113 2 2.0 N/A 1.2-3.2
N/A N/A Age, Sex, Ethnicity/ Race, Total calories, Subjects w/ mothers questionnaire
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
102
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00749
Armstrong
1998
Salted eggs, 5 years pre-diagnosis
Monthly to more than weekly
Dietary History question-naire
Malaysia Chinese 564 N/A/ Mixed
282 282 3 2.55 Monthly 1.44-4.53
N/A 0.001 Unadjusted
NAS00749
Armstrong
1998
Salted eggs, lifetime consumption, includes dietary information at age 10 and age 5 years prior to diagnosis
Less than monthly to monthly or more
Dietary History question-naire
Malaysia Chinese 564 N/A/ Mixed
282 282 2 1.24 Less than monthly
N/A 0.039 N/A SES, salted fish/ pork/ beef liver, recent consumption, shrimp/ chinese flowering cabbage/ oranges/ tangerines, lifetime consumption, beer
NAS01056
Lee
1994
Salted egg, during adulthood
Never to 1-3 times per week
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
200 406 4 1.4 Never 0.6-3.2
N/A 0.2 Age, sex, ethnicity/ race, education
NAS01922
Ning
1990
salted chicken or duck egg, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A N/A
NAS04944
Armstrong
1978
salted egg in three main daily meals combined, among cases and controls
N/A Recall Malaysia Chinese 210 25-81/ Mixed
60 150 N/A 0.7 N/A N/A Not signif-icant
N/A Age, sex, SES, ethnicity/ race, area of residence, lifestyle factors
Salted eggs: Childhood consumption Case-control (4) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
103
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00749
Armstrong
1998
Salted eggs, consumption at age 10
Monthly to more than weekly
Dietary History question-naire
Malaysia Chinese 564 N/A/ Mixed
282 282 3 2.4 Monthly 1.4-4.11
N/A N/A Unadjusted
NAS00749
Armstrong
1998
Salted eggs, lifetime consumption, includes dietary information at age 10 and age 5 years prior to diagnosis
Less than monthly to monthly or more
Dietary History question-naire
Malaysia Chinese 564 N/A/ Mixed
282 282 2 1.24 Less than monthly
N/A 0.039 N/A SES, salted fish/ pork/ beef liver, recent consumption, shrimp/ chinese flowering cabbage/ oranges/ tangerines, lifetime consumption, beer
NAS01056
Lee
1994
salted egg, at age 10
Never to 3+ times per month
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
149 344 4 0.5 Never 0.2-1.5
N/A 0.4 Age, sex, ethnicity/ race, education
NAS01520
Yu
1988
salted duck eggs, during weaning
Yes vs. no FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 2 5.0 No 1.2-21
0.06 N/A Age, sex
NAS01922
Ning
1990
salted chicken or duck egg, at age 10
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A N/A
Preserved eggs Case-control (5) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
104
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00577
Yuan
2000
Preserved eggs- not specified, but measured salted egg, fermented black egg
Less than monthly to weekly or more
FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 3 1.17 Less than monthly
0.88-1.55
N/A 0.11 Age, sex, occupational exposure to fumes, education, smoking, environmental factors, other diseases
NAS01056
Lee
1994
Century egg, an unsalted preserved egg, at age 10
Never to 1-3 times per month
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
151 341 3 0.8 Never 0.4-1.6
N/A 0.8 Age, sex, ethnicity/ race, education
NAS01056
Lee
1994
Century egg, an unsalted preserved egg, at adulthood
Never to 3+ times per month
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
200 406 4 1.0 Never 0.3-3.8
N/A 0.9 Age, sex, ethnicity/ race, education
NAS01113
Zheng
1994
Salted, dried and tinned eggs
N/A FFQ - Study-specific
China Chinese 264 N/A/ Mixed
88 176 N/A N/A N/A N/A Not signif-icant
N/A N/A
NAS01520
Yu
1988
pay dann - a kind of fermented duck egg, at age 10
Rarely to weekly
FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
NAS01922
Ning
1990
fermented duck egg, at 10 years of age
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A N/A
NAS01922
Ning
1990
fermented duck egg, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A N/A
2.6 Fats, oils and sugars as foods
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
105
Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00424
Laouamri
2001
Unspecified fat
Currently to 20 years ago
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
53 currently, 63 20 years ago
9 currently, 56 20 years ago
2 2.4 Not clear
0.87-6.56
Not signif-icant
N/A Age, sex, area of residence
NAS00424
Laouamri
2001
Dried, salted fat
Currently to 20 years ago
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
39 currently, 65 20 years ago
3 currently, 27 20 years ago
2 9.25 Not clear
3.9-21.5
.001 N/A Age, sex, area of residence
NAS01056
Lee
1994
Cod-liver oil, during infancy
Never to 3+ times per week
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
62 97 4 0.5 Never 0.1-2.0
Not signif-icant
0.3 Age, sex, ethnicity/ race, education
NAS01056
Lee
1994
Cod-liver oil, at age 10
Never to 3+ times per week
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
150 341 5 1.0 Never 0.5-1.9
Not signif-icant
0.9 Age, sex, ethnicity/ race, education
NAS04944
Armstrong
1978
Use of cooking oils and fats
N/A Recall Malaysia Chinese 210 25-81/ Mixed
60 150 N/A N/A N/A N/A Not signif-icant
N/A Unadjusted
2.6.1 Animal fats (as foods) Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
106
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS00424
Laouamri
2001
Butter used as a cooking medium
Currently and 20 years ago
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
current: 37
20 years ago: 56
current: 34
20 years ago: 64
2 Current: OR = 1.16;
20 years ago: OR = 0.42
N/A Current: 0.63-2.12;
20 years ago: 0.16-1.09
Not signif-icant
N/A Age, sex, area of residence
NAS00424
Laouamri
2001
Rancid butter used as a cooking medium
Currently and 20 years ago
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
current: 44
20 years ago: 59
current: 11
20 years ago: 44
2 Current: OR = 7.6;
20 years ago: OR = 4.0
N/A Current: 3.51-16.4;
20 years ago: 1.62-9.84
Current: 0.001;
20 years ago: 0.01
N/A Age, sex, area of residence
NAS01381
Jeannel
1990
Sheep’s tail fat, childhood
Yes or no FFQ - Study-specific
Tunisia Tunisian 240 N/A/ Mixed
80 160 2 3.4 No N/A 0.09 N/A Age, sex, area of residence, lifestyle factors
NAS06022
Wang
1993
Pork fat Frequent of less frequent
Question-naire
China Chinese 244 13-10/ Mixed
122 122 2 0.256 Less frequent
N/A .0253 N/A Age, sex, salted fish, plant oil, less whole-grain consumption, vegetable intake, coloured vegetables non-nutrient chemicals, environmental factors, high income
2.6.2 Plant oils (as foods) Case-control (4)
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
107
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Coun-try Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00424
Laouamri
2001
Oils and fats used as a cooking medium: Sunflower oil
Currently to twenty years ago
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
135 138 2 0.5 N/A 0.15-1.62
N/A N/A Age, sex, area of residence
NAS00424
Laouamri
2001
Oils and fats used as a cooking medium: Olive oil
Currently to twenty years ago
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
54 57 2 0.66 N/A 0.31-1.38
N/A N/A Age, sex, area of residence
NAS00424
Laouamri
2001
Oils and fats used as a cooking medium: Vegetable fats
Currently to twenty years ago
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
25 31 2 3.0 N/A 0.04-223
N/A N/A Age, sex, area of residence
NAS00424
Laouamri
2001
Seasonings: vegetable fats
Currently to twenty years ago
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
27 46 2 1.0 N/A Not signif-icant
N/A N/A Age, sex, area of residence
NAS00424
Laouamri
2001
Seasonings: Olive oil
Currently to twenty years ago
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
93 119 2 0.35 N/A 0.15-0.79
0.02 N/A Age, sex, area of residence
NAS01056
Lee
1994
margarine, at age 10
Never to >3 times a week
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
113 340 5 0.6 Never 0.3-1.1
N/A 0.03 Age, sex, education, ethnicity/ race
NAS01520
Yu
1988
fennel oil, at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A N/A
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
108
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Coun-try Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS06022
Wang
1993
Plant oils Less frequently to frequently consumed
Question-naire
China Chinese 244 13-70/ Mixed
122 122 2 4.29 Less frequent
N/A 0.0019 N/A Sex, age, env factors, wholegrains, pork fat, salted fish, non-nutrient chemicals, high-income, vegetable intake, coloured vegetables
2.6.4 Sugars Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00424
Laouamri
2001
Piece of sugar, teething
Ever or never
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
36 24 2 2.2 Never 1.1-4.5
.05 N/A Age, sex, area of residence
2.7 Milk and dairy products Case-control (4) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00424
Laouamri
2001
Powdered milk, duration of nursing
Never to 18 months
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
18 14 4 1.4 Never 0.44-4.43
Not signif-icant
Not signif-icant
Age, sex, area of residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
109
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00424
Laouamri
2001
Animal milk, duration of nursing
Never to 12 months
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
18 10 3 2.33 Never 0.62-8.64
Not signif-icant
Not signif-icant
Age, sex, area of residence
NAS00577
Yuan
2000
Fresh milk N/A FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 N/A N/A N/A N/A Not signif-icant
N/A Unadjusted
NAS01459
Yu
1989
Cow’s milk, age 10 or adult
N/A FFQ - Study-specific
China Chinese 612 Max 49/ Mixed
306 306 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, area of residence
NAS04944
Armstrong
1978
Milk With daily meals: yes or no
Recall Malaysia Chinese 210 25-81/ Mixed
60 150 2 0.6 N/A N/A <0.01 N/A Age, sex, SES, ethnicity/ race, area of residence, lifestyle factors
NAS04944
Armstrong
1978
Milo, fortified and flavoured powdered milk drink
With daily meals: yes or no
Recall Malaysia Chinese 210 25-81/ Mixed
60 150 2 1.0 N/A N/A Not signif-icant
N/A Age, sex, SES, ethnicity/ race, area of residence, lifestyle factors
NAS04944
Armstrong
1978
Horlicks, fortified and flavoured powdered milk drink
With daily meals: yes or no
Recall Malaysia Chinese 210 25-81/ Mixed
60 150 2 1.5 N/A N/A Not signif-icant
N/A Age, sex, SES, ethnicity/ race, area of residence, lifestyle factors
2.8 Herbs, spices, condiments Herbal, spices, and condiments: Childhood consumption Case-control (3)
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
110
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00531
Ward
2000
Herbs, spices, condiments, Dietary intake during childhood (at age 10) reported by subjects
Lowest to Highest
Dietary History question-naire
China Chinese 702 Max 74/ Mixed
375 327 3 2.3 Lowest 1.1-4.7
N/A N/A Age, Sex, Ethnicity/ Race, Subjects w/ mothers questionnaire, Total calories
NAS01113
Zheng
1994
Herbal mixtures, weaning / childhood
N/A FFQ - Study-specific
China Chinese 264 N/A/ Mixed
88 176 N/A 1.8 N/A N/A 0.07 N/A N/A
NAS01520
Yu
1988
hot pepper paste, at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A N/A
NAS01520
Yu
1988
soy sauce, at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A N/A
NAS01520
Yu
1988
fish sauce, at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A N/A
NAS01520
Yu
1988
oyster sauce, at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A N/A
Herbal intake Case-control (6) Meta-analysis Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
111
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00544
Chelleng
2000
Herbal nasal drops
Yes vs. No
Unknown India Indian 141 Mean 44/ Mixed
47 94 2 58.4 No 7.9-430
0.0001 N/A Age, sex, ethnicity/ race, Area of residence, Alcohol habits, Smoking habits, type of house, number of windows, kitchen inside/outside, soot in living room, type of cooking fuel used, habit of chewing betel nut, smokeless tobacco use
NAS01153
West
1993
Herbal medicines consumption
Never vs. ever
Unknown Philippines Filipino 205 11-83/ Mixed
104 205 2 2.5 Never 1.1-5.3
N/A N/A Sex, Age Processed meats, Fresh fish, Smoking Habits, Educational Level, Formaldehyde, Public vs. private hospital ward, Dust/exhaust, Burning anti-mosquito coils
NAS01251
Hildesheim
1992
herbal medicines
Never vs. ever
FFQ - Study-specific
Philippines Filipino 309 N/A/ Mixed
104 205 2 2.6 Never 1.4-4.6
N/A N/A Age, Sex, Area of residence, Smoking, Educational Level, Chinese ancestry, Salted Fish
NAS01593
Lin
1986
Use of herb drug
Never to usual
Unknown China Chinese 1360 N/A/ Mixed
343 1017 3 11.7 N/A N/A N/A N/A Smoking Habits, Titer of antibodies to EB virus capsid antigen, Use of nasal baim or oil, Poor ventilation, Place of birth Mainland China or Taiwan
NAS04917
Lin
1973
Herb drugs Reference to frequently
Interview China, Taiwan
Chinese 1360 Mean 46/ Mixed
343 1017 3 3.51 N/A N/A N/A N/A Age, Sex, Nativity
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
112
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS04928
Henderson
1976
Use of medicinal soups (herbs concocted in teas or soups used in traditional Chinese medicine for curative purposes)
Yes vs no Interview United States
Various 423 Mean 52/ Mixed
156 267 2 0.5 No N/A 0.04 N/A Age, race, area of residence, ethnicity/ race, SES
Non-preserved spice intake Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS00424
Laouamri
2001
Black pimento, used at least once a week
>1 time a week: yes or no
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
72 72 2 10.6 N/A N/A <0.001 N/A Age, sex, area of residence
NAS00424
Laouamri
2001
Mint, at least once per week
>1 time a week: yes or no
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
72 72 2 3.2 N/A N/A <0.01 N/A Age, sex, area of residence
NAS01812
Geser
1978
vinegar N/A FFQ - Study-specific
China, Hong Kong
Chinese 300 N/A/ Mixed
150 150 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, Use of ancestral alters and Buddhist alters, Oyster soy, Xanthozylon Seeds, Flavor Essence, Mustard Paste, Chinese Wine, Bread
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
113
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS04944
Armstrong
1978
sauces, for dinner among families of participants
N/A Recall Malaysia Chinese 210 25-81/ Mixed
60 150 N/A N/A N/A N/A Not signif-icant
N/A N/A
Preserved spice intake Case-control (4) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00424
Laouamri
2001
Harissa (chili peppers, dried then pickled and preserved in olive oil with garlic), at least once per week
>1 time a week: yes or no
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
72 72 2 5.0 No N/A <.001 N/A Age, sex, area of residence
NAS00424
Laouamri
2001
Seasonings: Dried Peppers
Currently to twenty years ago
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
72 72 2 5.5 N/A 2.55-11.8
0.001 N/A Age, sex, area of residence
NAS00424
Laouamri
2001
Seasonings: Pickled Peppers
Currently to twenty years ago
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
72 72 2 2.85 N/A 1.25-6.45
N/A N/A Age, sex, area of residence
NAS00531
Ward
2000
Adult Dietary Intake: hot chili sauce
Lowest to Highest
Dietary History question-naire
China Chinese 702 Max 74/ Mixed
375 327 2 1.4 Lowest 0.9-2.1
N/A N/A Age, Sex, Ethnicity/ Race, Subjects w/ mothers question-naire, Total calories
NAS01812
Geser
1978
Households w/ NPC patients and of controls: mustard paste
Yes or no FFQ - Study-specific
China, Hong Kong
Chinese 300 N/A/ Mixed
144 143 2 0.44 No 0.26-0.74
N/A N/A Age, sex
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
114
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01812
Geser
1978
Households w/ NPC patients and of controls: chilli sauce
Yes or no FFQ - Study-specific
China, Hong Kong
Chinese 300 N/A/ Mixed
144 144 2 0.41 No 0.24-0.69
N/A N/A Age, sex
NAS01812
Geser
1978
Mustard paste N/A FFQ - Study-specific
China, Hong Kong
Chinese 300 N/A/ Mixed
150 150 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, Use of ancestral alters and Buddhist alters, Vinegar, Xanthozylon Seeds, Flavor Essence, Oyster Soy, Chinese Wine, Bread
NAS04944
Armstrong
1978
pickled chili, in three main daily meals combined, among cases and controls
Yes or no Recall Malaysia Chinese 210 25-81/ Mixed
60 150 2 0.3 N/A N/A <.01 N/A Age, sex, ethnicity/ race,SES, household type, area of residence
Soy sauce Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00577
Yuan
2000
Soy sauce (see yao)
N/A FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 N/A N/A N/A N/A Not signif-icant
N/A N/A
NAS01813
Shanmugaratnam
1978
Soya Sauce (Ear, Nose, and Throat Department controls)
Less than once daily to more than twice daily
FFQ - Study-specific
Singapore Chinese 2018 N/A/ Mixed
379 1639 5 0.973 N/A N/A Not signif-icant
N/A Age, Sex, interviewer
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
115
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01813
Shanmugaratnam
1978
Soya Sauce (Non-ENT hospital controls)
Less than once daily to more than twice daily
FFQ - Study-specific
Singapore Chinese 2018 N/A/ Mixed
379 1639 5 0.754 N/A N/A Not signif-icant
N/A Age, Sex, interviewer
NAS04944
Armstrong
1978
thin soya sauce, in three main daily meals combined, among cases and controls
N/A Recall Malaysia Chinese 210 25-81/ Mixed
60 150 N/A 0.9 N/A N/A Not signif-icant
N/A Age, sex, ethnicity/ race,SES, household type, area of residence
NAS04944
Armstrong
1978
thin soya sauce, for breakfast among families of participants
N/A Recall Malaysia Chinese 210 25-81/ Mixed
60 150 N/A N/A N/A N/A Not signif-icant
N/A N/A
Other fermented condiment intake Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00577
Yuan
2000
Fish sauce (yu lo)
N/A FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 N/A N/A N/A N/A Not signif-icant
N/A N/A
NAS00577
Yuan
2000
Oyster sauce (ho yao)
N/A FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 N/A N/A N/A N/A Not signif-icant
N/A N/A
NAS01812
Geser
1978
Oyster Soy
N/A FFQ - Study-specific
China, Hong Kong
Chinese 300 N/A/ Mixed
150 150 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, Use of ancestral alters and Buddhist alters, Vinegar, Xanthozylon Seeds, Flavor Essence, Mustard Paste, Chinese Wine, Bread
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
116
2.9 Composite foods Mixed vegetables Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00577
Yuan
2000
Fresh green beans and peas
Less than weekly to daily
FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 3 0.77 Less than weekly
0.62-0.99
N/A 0.02 Age, sex, occupational exposure to fumes, education, smoking, environmental factors, other diseases
NAS00700
Farrow
1998
labeled yellow vegetables and includes winter squash, carrots, yams
Lowest to highest
FFQ - Block
United States
American 345 18-74/ Mixed
140 208 4 0.59 lowest 0.29-1.22
N/A 0.21 Age, Sex, Alcohol consumption, Smoking Habits, Energy Intake
NAS00749
Armstrong
1998
carrots/ sweet potatoes; 5 years pre-diagnosis
Monthly to more than weekly
Dietary History question-naire
Malaysia Chinese 564 N/A/ Mixed
282 282 3 0.48 Monthly 0.28-0.83
N/A 0.02 Unadjusted
NAS00749
Armstrong
1998
carrots, sweet potatoes, at age 10
Monthly to more than weekly
Dietary History question-naire
Malaysia Chinese 564 N/A/ Mixed
282 282 3 0.67 Monthly 0.33-1.27
N/A N/A Unadjusted
NAS00749
Armstrong
1998
green beans/ peas, 5-years pre-diagnosis
Monthly to more than weekly
Dietary History question-naire
Malaysia Chinese 564 N/A/ Mixed
282 282 3 0.60 Monthly 0.37-0.98
N/A 0.067 Unadjusted
NAS00749
Armstrong
1998
green beans/ peas, consumption at age 10
Monthly to more than weekly
Dietary History question-naire
Malaysia Chinese 564 N/A/ Mixed
282 282 3 0.88 Monthly 0.47-1.62
N/A N/A Unadjusted
Foods with sauces or pastes
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
117
Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00424
Laouamri
2001
Hot sauce 3-4 times a week with stews
3-4 times a week: yes or no
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
72 72 2 11.3 No 4.2-28.5
Signif-icant
N/A Age, sex, area of residence
NAS00424
Laouamri
2001
Hot sauce 3-4 times a week with fried foods
3-4 times a week: yes or no
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
72 72 2 5.5 No 2.2-14.0
Signif-icant
N/A Age, sex, area of residence
NAS00424
Laouamri
2001
Hot sauce 3-4 times a week with pulses
3-4 times a week: yes or no
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
72 72 2 4.5 No 2.0-9.9
Signif-icant
N/A Age, sex, area of residence
NAS00424
Laouamri
2001
Hot sauce 3-4 times a week with couscous
3-4 times a week: yes or no
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
72 72 2 12.5 No 4.1-37.9
Signif-icant
N/A Age, sex, area of residence
NAS00424
Laouamri
2001
Hot sauce 3-4 times a week with pasta
3-4 times a week: yes or no
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
72 72 2 8.0 No 1.4-45.8
Signif-icant
N/A Age, sex, area of residence
NAS00424
Laouamri
2001
Hot sauce 3-4 times a week with bread and butter
3-4 times a week: yes or no
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
72 72 2 6.0 No 0.6-60.5
Not signif-icant
N/A Age, sex, area of residence
NAS00424
Laouamri
2001
Hot sauce 3-4 times a week with salad
3-4 times a week: yes or no
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
72 72 2 7.0 No 0.8-60.6
Not signif-icant
N/A Age, sex, area of residence
NAS01056
Lee
1994
chinese rojak, salad containing prawn paste, at age 10
Never to 1-3 times per month
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
64 102 4 0.9 Never 0.3-2.2
N/A 0.3 Age, sex, education, ethnicity/ race
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
118
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01056
Lee
1994
chinese rojak, a salad containing prawn paste, during adulthood
Never to > 3 times per month
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
64 102 4 1.6 Never 0.4-5.9
N/A N/A Age, sex, education, ethnicity/ race
NAS01056
Lee
1994
belachan, prawn and chilli paste, at age 10
Never to > 3 times per week
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
64 102 5 1.8 Never 0.6-5.3
N/A N/A Age, sex, education, ethnicity/ race
NAS01056
Lee
1994
belachan, prawn and chilli paste, during adulthood
N/A FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
64 102 N/A N/A N/A N/A Signif-icant
N/A N/A
NAS01381
Jeannel
1990
Dietary Intake During Weaning: Harissa, olive oil and bread
Less than once a month to more than twice a week
FFQ - Study-specific
Tunisia Tunisian 240 N/A/ Mixed
80 160 4 6.5 Less than once a a month
N/A N/A N/A Sex, age, lifestyle factors, area of residence
Foods with rice or noodles Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01113
Zheng
1994
Salted fish in rice porridge, before the age of 2
Rarely to monthly and weekly
FFQ - Study-specific
China Chinese 264 Mean 42/ Mixed
88 176 3 3.8 Rarely 1.5-9.8
.005 N/A Age, Sex, Area of residence, Socio-demographic score made up of housing in childhood and the presence of windows and monthly income the year before diagnosis, Use of wood fuel in the year before diagnosis, consumption of herbal tea in the year before diagnosis
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
119
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01113
Zheng
1994
Salted fish in rice porridge, between the ages of 2 and 10
Rarely to monthly and weekly
FFQ - Study-specific
China Chinese 264 Mean 42/ Mixed
88 176 3 3.2 Rarely N/A 0.003 N/A Age, Sex, Area of residence, Socio-demographic score made up of housing in childhood and the presence of windows and monthly income the year before diagnosis
NAS04944
Armstrong
1978
a dish of rice or noodles either with fish, prawns, pork, chicken or egg, with vegetables and sauces, sometimes in a soup, for lunch among families of participants
N/A Recall Malaysia Chinese 210 25-81/ Mixed
60 150 2 N/A N/A N/A Not significant
N/A Unadjusted
NAS04944
Armstrong
1978
rice with fish, pork, chicken or egg, for evening meal among families of participants
N/A Recall Malaysia Chinese 210 25-81/ Mixed
60 150 2 N/A N/A N/A Not significant
N/A Unadjusted
‘Cooling drink’ Case-control (4) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01459
Yu
1989
Cooling soup, a popular medicinal drink, at age 10
N/A FFQ - Study-specific
China Chinese 612 Max 49/ Mixed
306 306 N/A N/A N/A N/A Not signif-icant
N/A Area of residence, age, sex
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
120
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01459
Yu
1989
Cooling soup, a popular medicinal drink, at 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 612 Max 49/ Mixed
306 306 N/A N/A N/A N/A Not signif-icant
N/A Area of residence, age, sex
NAS01520
Yu
1988
cooling soup, at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif- icant
N/A Age, sex
NAS01608
Yu
1986
cooling soup, at 10 years of age or 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 500 Max 34/ Mixed
250 250 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, salted fish intake
NAS01813
Shanmugaratnam
1978
'Cooling' drink (ENT Hospital controls)
Never or unknown to weekly or more
FFQ - Study-specific
Singapore Chinese 2018 N/A/ Mixed
379 1639 3 1.282 Never or known
N/A Not signif-icant
N/A Age, Sex, interviewer
NAS01813
Shanmugaratnam
1978
‘Cooling' drink (non-ENT hospital controls)
Never or unknown to weekly or more
FFQ - Study-specific
Singapore Chinese 2018 N/A/ Mixed
379 1639 3 1.087 Never or known
N/A Not signif-icant
N/A Age, Sex, interviewer
Preserved composite foods Case-control (4) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group CI P value
p value for trend
Adjusted for
NAS00577
Yuan
2000
All preserved food and fresh oranges/ tangerines
High to low preserved by high to low citrus
FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 9 3.19 Low preserved, high citrus
2.08-4.91
Signif-icant
N/A Age, sex, occupational exposure to fumes, education, smoking, environmental factors, other diseases
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
121
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group CI P value
p value for trend
Adjusted for
NAS01056
Lee
1994
salted beef or malt extract, during infancy
Never to > 3 times per week
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
62 95 4 0.3 Never 0.05-1.6
N/A 0.3 Age, sex, education, ethnicity/ race
NAS01812
Geser
1978
Households of NPC patients / controls: Tinned food w/ fish
Yes or no FFQ - Study-specific
China, Hong Kong
Chinese 300 N/A/ Mixed
150 150 2 0.46 No 0.23-0.94
N/A N/A Age, sex
NAS04928
Henderson
1976
Salted snacks Yes vs. no Interview United States
Various 423 Mean 52/ Mixed
156 267 2 0.4 No N/A 0.03 N/A Age, race, area of residence, ethnicity/ race
Other composite foods Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01381
Jeannel
1990
Dietary Intake During Weaning: Stewing mixture (red pepper, black pepper, caraway, coriander, oil, salt and garlic)
Yes or no FFQ - Study-specific
Tunisia Tunisian 240 N/A/ Mixed
80 160 2 8.4 No N/A <0.005 N/A Sex, age, lifestyle factors, area of residence
NAS01381
Jeannel
1990
Dietary Intake During Preceding Year to Diagnosis: Stewing mixture (red pepper, black pepper, caraway, coriander, oil, salt and garlic)
Yes or no FFQ - Study-specific
Tunisia Tunisian 240 N/A/ Mixed
80 160 2 4.4 No N/A 0.04 N/A Sex, age, lifestyle factors, area of residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
122
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS04944
Armstrong
1978
dumpling, for breakfast among families of participants
N/A Recall Malaysia Chinese 210 25-81/ Mixed
60 150 N/A N/A N/A N/A Case families had dumplings significantly more often at breakfast
N/A Unadjusted
NAS04944
Armstrong
1978
soup, at evening meal among families of participants
N/A Recall Malaysia Chinese 210 25-81/ Mixed
60 150 2 N/A N/A N/A Case families ate soup significantly less often at evening meal
N/A Unadjusted
NAS04944
Armstrong
1978
Dumplings in three main daily meals combined, among families of participants
Yes or no Recall Malaysia Chinese 210 25-81/ Mixed
60 150 2 1.1 No N/A Not significant N/A Sex, Age, race, Household type, census district, Socio-economic status
3.1 Total fluid intake Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS04944
Armstrong
1978
Drinks for breakfast
Yes or no Recall Malaysia Chinese 210 25-81/ Mixed
60 150 2 N/A N/A N/A Case families had drinks significantly less often at breakfast
N/A Unadjusted
3.2 Water Case-control (2)
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
123
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00424
Laouamri
2001
Type of drinking: water supply
Spring, individual well, collective well, piped
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
72 85 4 Well: OR = 7.0
Piped: OR = 0.2
Spring Well: 0.8-60.7
Piped: 0.05-0.78
Not signif-icant
0.05
N/A Age, sex, area of residence
NAS04944
Armstrong
1978
Water with 3 daily meals combined
Yes or no Recall Malaysia Chinese 210 25-81/ Mixed
60 150 2 OR = 1.4
N/A N/A <.01 N/A Age, sex, ethnicity/ race,SES, household type, area of residence
3.3 Milk as beverage Case-control (4) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00424
Laouamri
2001
Powdered milk, duration of nursing
Never to 18 months
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
18 14 4 1.4 Never 0.44-4.43
Not signif-icant
Not signif-icant
Age, sex, area of residence
NAS00424
Laouamri
2001
Animal milk, duration of nursing
Never to 12 months
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
18 10 3 2.33 Never 0.62-8.64
Not signif-icant
Not signif-icant
Age, sex, area of residence
NAS00577
Yuan
2000
Fresh milk N/A FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 N/A N/A N/A N/A Not signif-icant
N/A Unadjusted
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
124
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01459
Yu
1989
Cow’s milk, age 10 or adult
N/A FFQ - Study-specific
China Chinese 612 Max 49/ Mixed
306 306 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, area of residence
NAS04944
Armstrong
1978
Milk With daily meals: yes or no
Recall Malaysia Chinese 210 25-81/ Mixed
60 150 2 0.6 N/A N/A <0.01 N/A Age, sex, SES, ethnicity/ race, area of residence, lifestyle factors
NAS04944
Armstrong
1978
Milo, fortified and flavoured powdered milk drink
With daily meals: yes or no
Recall Malaysia Chinese 210 25-81/ Mixed
60 150 2 1.0 N/A N/A Not signif-icant
N/A Age, sex, SES, ethnicity/ race, area of residence, lifestyle factors
NAS04944
Armstrong
1978
Horlicks, fortified and flavoured powdered milk drink
With daily meals: yes or no
Recall Malaysia Chinese 210 25-81/ Mixed
60 150 2 1.5 N/A N/A Not signif-icant
N/A Age, sex, SES, ethnicity/ race, area of residence, lifestyle factors
3.5 Fruit juices Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assessment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS00749
Armstrong
1998
Orange juice, at age 10
Monthly to more than weekly
Dietary History questionnaire
Malaysia Chinese 564 N/A/ Mixed
282 282 3 0.60 Monthly 0.17-2.15
Not significant
N/A Age, sex, area of residence
NAS00749
Armstrong
1998
Orange juice, 5 prior to diagnosis
Monthly to more than weekly
Dietary History questionnaire
Malaysia Chinese 564 N/A/ Mixed
282 282 3 0.85 Monthly 0.51-1.42
N/A .047 Age, sex, area of residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
125
3.6 Hot drinks Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS04944
Armstrong
1978
Coffee or tea for breakfast
Yes or no Recall Malaysia Chinese 210 25-81/ Mixed
60 150 2 N/A N/A N/A Not different between case families and controls
N/A Unadjusted
3.6.1 Coffee Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01639
Mabuchi
1985
Coffee At least 1 cup a day
Unknown United States
Various 78 16-79/ Mixed
29 32 2 N/A <1 cup a day
N/A Not signif-icant
N/A Age, sex, ethnicity/ race, marital status
NAS01639
Mabuchi
1985
Caffeine-free coffee
At least 1 cup a day
Unknown United States
Various 78 16-79/ Mixed
4 8 2 N/A <1 cup a day
N/A Not signif-icant
N/A Age, sex, ethnicity/ race, marital status
NAS04928
Henderson
1976
Any use of coffee
No use or any use
Interview United States
Various 423 Mean 52/ Mixed
156 267 2 1.1 No use
N/A 0.49 N/A Age, race, area of residence, ethnicity/ race, SES
NAS04944
Armstrong
1978
Coffee with 3 main daily meals
Yes or no Recall Malaysia Chinese 210 25-81/ Mixed
60 150 2 0.8 N/A N/A 0.05 N/A Age, sex, area of residence, household type, SES , ethnicity/ race
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
126
3.6.2 Tea Tea: Adulthood consumption Case-control (7) Meta-analysis Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01113
Zheng
1994
Herbal tea, in the year before diagnosis
Yes vs. no
FFQ - Study-specific
China Chinese 264 Mean 42/ Mixed
88 176 2 4.2 No 1.3-13
0.02 N/A Age, Sex, Area of residence, Socio-demographic (housing in childhood/ windows, monthly income the year before diagnosis) Use wood fuel in the year before diaganosis, Salted fish in rice porridge before the age of 2
NAS01639
Mabuchi
1985
Tea, at least one cup per day
< 1 cup per day to ≥ 1 cup per day
Interview United States
Various 78 16-74/ Mixed
39 39 2 N/A No N/A Not significant
N/A Age, sex, ethnicity/ race, marital status
NAS01813
Shanmugaratnam
1978
Chinese Tea (ENT hospital controls)
Less than once monthly to daily
FFQ - Study-specific
Singapore Chinese 2018 N/A/ Mixed
379 1639 3 1.166 N/A N/A Not signif-icant
N/A Age, Sex, interviewer
NAS01813
Shanmugaratnam
1978
Chinese Tea (Non-ENT hospital controls)
Less than once monthly to daily
FFQ - Study-specific
Singapore Chinese 2018 N/A/ Mixed
379 1639 3 1.279 N/A N/A Not signif-icant
N/A Age, Sex, interviewer
NAS04917
Lin
1973
Drinking of tea
N/A Interview China, Taiwan
Chinese 1360 Mean 46/ Mixed
343 1017 N/A N/A N/A N/A Not signif-icant
N/A N/A
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
127
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS04928
Henderson
1976
Any use of tea
Any use vs no use
Interview United States
Various 423 Mean 52/ Mixed
156 267 2 0.5 No use
0.3-1.0
0.02 N/A Age, sex, area of residence, ethnicity/ race, SES
NAS04944
Armstrong
1978
tea, with three main daily meals, among cases / controls
N/A Recall: interview
Malaysia Chinese 210 25-81/ Mixed
N/A N/A N/A 0.5 N/A N/A < .01 N/A Sex, Age, Household type, SES, Census district, Ethnicity/ Race
NAS06023
Zou
1999
Tea < 1 cup per day to ≥ 1 cup per day
Dietary History question-naire
China Chinese 289 28-82/ Mixed
96 192 2 1.1 < 1 cup per day
0.6-2.2
0.738 N/A Age, sex, year of death
Tea: Childhood consumption Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00424
Laouamri
2001
Cumin, (at least 3 times a week for at least 1 month) to newborn, in terms of infusions or herb teas
Yes vs. no FFQ - Study-specific
Algeria Unknown 144 9-70/ Mixed
72 72 2 1.35 No 0.71-2.63
N/A N/A Age, Sex, Area of residence
NAS00424
Laouamri
2001
Olive oil, (at least 3 times a week for at least 1 month) to newborn, in terms of infusions or herb teas
Yes vs. no FFQ - Study-specific
Algeria Unknown 144 9-70/ Mixed
72 72 2 0.84 No 0.34-1.97
N/A N/A Age, Sex, Area of residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
128
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00424
Laouamri
2001
Bay leaf, (at least 3 times a week for at least 1 month) to newborn: in text notes that this is bay leaf tea
Yes vs. no FFQ - Study-specific
Algeria Unknown 144 9-70/ Mixed
72 72 2 3.0 No 2.93-5.23
0.05 N/A Age, Sex, Area of residence
NAS00424
Laouamri
2001
Fenu-greek, (at least 3 times a week for at least 1 month) to newborn, in terms of infusions or herb teas
Yes vs. no FFQ - Study-specific
Algeria Unknown 144 9-70/ Mixed
72 72 2 2.0 No 0.51-7.78
N/A N/A Age, Sex, Area of residence
NAS00424
Laouamri
2001
Aniseed, (at least 3 times a week for at least 1 month) to newborn, in terms of infusions or herb teas
Yes vs. no FFQ - Study-specific
Algeria Unknown 144 9-70/ Mixed
72 72 2 1.66 No 0.09-28.3
N/A N/A Age, Sex, Area of residence
3.6.2.2 Green tea Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assessment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
categories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01812
Geser
1978
Green tea
Yes or no FFQ - Study-specific
China, Hong Kong
Chinese 300 N/A/ Mixed
150 150 2 0.57 No N/A 0.05 N/A Age, sex
3.7 Alcoholic drinks Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
129
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00898
Vaughan
1996
Comparison of wine and liquor consumption with beer consumption among ever drinkers
Beer, wine, or liquor
Dietary History question-naire
United States
Various 232 18-74/ Mixed
66 166 3 Wine: OR = 1.6
Liquor: OR = 0.9
Beer Wine: 0.4-6.4
Liquor: 0.4-2.1
Not signif-icant
Not signif-icant
N/A Age, sex, clinic site, education, smoking, alcohol consumption
3.7.1 Total alcoholic drinks Cohort (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
SIR Ref group CI P value p value for trend
Adjusted for
NAS00381
Boffetta
2001
Alcoholic Alcoholics v. non-alcoholics
Unknown Sweden Swedish 173665 N/A/ Mixed
21 N/A 2 1.56 Non-alcoholics
0.97-2.39
Not signif-icant
N/A Age, sex, calendar year
Case-control (18) Meta-analysis Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
130
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00576
Yuan
2000
Weekly alcohol drinking
Yes vs. No FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 2 0.8 No O,64-1.01
N/A N/A Sex, Age, Exposure to smoke from heated rapeseed oil/ burning coal while cooking, Preserved foods and oranges/ tangerines, Family history of Cancer, Occupational exposure to chemical fumes, Smoking, Edu Level, History of chronic ear/ nose condition
NAS00576
Yuan
2000
Total Alcoholic Drinks
None to ≥ 29 drinks per week
FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 4 1.04 None 0.73-1.46
N/A N/A Sex, Age, Exposure to smoke from heated rapeseed oil and burning coal while cooking, Preserved foods and oranges/ tangerines, Family history of Specific Cancer, Occupational exposure to chemical fumes, Smoking Habits, Educational Level, History of chronic ear and nose condition
NAS00612
Cheng
1999
Alcohol consumption; Drinking habit
Ever vs, Never
Unknown China Chinese 702 15-74/
Mixed 375 327 2 0.9 Never 0.6-
1.3 N/A N/A Age, Sex,
Ethnicity/ Race, Smoking Habits, family history of NPC, Educational Level
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
131
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00612
Cheng
1999
Drinking status
Never to current
Unknown China Chinese 702 15-74/
Mixed 375 327 3 0.8 Never 0.6-
1.2 N/A 0.3 Age, Sex,
Ethnicity/ Race, Smoking Habits, family history of NPC, Educational Level
NAS00612
Cheng
1999
Alcohol consumption: Age starting alcohol drinking
Never to ≥ 25 Unknown
China Chinese 702 15-74/ Mixed
375 327 3 0.8 Never 0.5-1.3
N/A 0.4 Age, Sex, Ethnicity/Race, Smoking Habits, family history of NPC, Educational Level
NAS00612
Cheng
1999
Alcohol consumption: duration of alcohol drinking
None to ≥ 15 gram*years
Unknown China Chinese 702 15-74/
Mixed 373 323 3 1.1 None 0.7-
1.6 N/A 0.9 Age, Sex,
Ethnicity/ Race, Smoking Habits, family history of NPC, Educational Level
NAS00612
Cheng
1999
Alcohol consumption: cumulative alcohol consumption (gram-year)
None to ≥ 2000 grams per month
Unknown China Chinese 702 15-74/
Mixed 373 322 4 1.2 None 0.7-
2.2 N/A 1.0 Age, Sex,
Ethnicity/ Race, Smoking Habits, family history of NPC, Educational Level
NAS00612
Cheng
1999
Alcohol consumption quantity
None to 60 grams per month
Unknown China Chinese 702 15-74/
Mixed 374 324 3 1.1 None 0.7-
1.7 N/A 0.9 Age, Sex,
Ethnicity/ Race, Smoking Habits, family history of NPC, Educational Level
NAS00640
Nazar-Stewart
1999
Alcohol use < 2 drinks per day to ≥ 2 drinks per day
Unknown United States
Multi-ethnic
225 18-74/ Mixed
80 139 2 1.6 < 2 drinks per day
0.82-3.12
N/A N/A Unadjusted
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
132
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00821
Hildesheim
1997
Consumption of alcohol
None to > 2 drinks per week
Unknown China, Taiwan
Chinese 684 15-74/ Mixed
364 318 3 0.92 None 0.58-1.4
N/A N/A Age, sex
NAS00898
Vaughan
1996
Alcohol Use ≤ 6 drinks per
week to ≥ 21 drinks per week
Dietary History question-naire
United States
Various 232 18-74/ Mixed
175 237 4 2.0 ≤ 6 drinks per week
1.0-4.0
N/A 0.15 Age, sex, clinic site, education, smoking
NAS01113
Zheng
1994
Alcoholic drinks
N/A FFQ - Study-specific
China Chinese 264 N/A/ Mixed
88 176 N/A N/A N/A N/A Not signif-icant
N/A N/A
NAS01141
Zheng
1994
Alcohol habits N/A FFQ - Study-specific
China Chinese 410 Max 55/ Mixed
205 205 N/A N/A N/A N/A Not signif-icant
N/A N/A
NAS01248
Sriamporn
1992
Alcohol Intake Yes vs. no FFQ - Study-specific
Thailand Thai 240 Mean 47/ Mixed
120 120 2 1.5 No 0.7-3.4
N/A N/A Age, sex, area of residence, smoking, alcohol, occupation, Educational Level
NAS01254
Nam
1992
Alcohol consumption
≤3 drinks per
week to ≥24 drinks per week
Question-naire
United States
White 612 Mean 54/ Mixed
204 408 3 1.8 ≤3 drinks per week
1.1-3.1
N/A N/A Sex, Smoking habits
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
133
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01254
Nam
1992
Alcohol and cigarette consumption
≤ 3 drinks/
week and ≤ 30 pack-years of smoking to ≥ 24+ drinks/ week and ≥ 60 pack-years of smoking
Question-naire
United States
White 612 Mean 54/ Mixed
204 408 9 5.2 ≤ 3 drinks per week and ≤ 30 pack-years of smoking
N/A < 0.01
N/A Sex
NAS01410
Chen
1990
Years of Alcohol Consumption, among men
None to > 30 years
Question-naire
China Chinese 694 N/A/ Mixed
238 238 4 1.84 None 0.97-3.47
N/A N/A Age, Sex
NAS01495
Vaughan
1989
Alcohol Use ≤ 6 drinks/
week to ≥ 21 drinks/ week
Unknown United States
N/A 573 20-74/ Mixed
21 552 3 2.43 ≤ 6 drinks per week
0.43-9.32
0.17 N/A Age, Sex
NAS01630
Yu
1985
Alcohol consumption
Rarely to Daily
Unknown Malaysia Chinese 200 Mean 43/ Mixed
100 100 4 2.8 Rarely N/A N/A N/A Age, Sex, Race and ethnicity, Area of residence
NAS01639
Mabuchi
1985
Alcohol consumption
≥ 1 drink/ day to < 1 drink/ day
Unknown United States
Various 78 16-74/ Mixed
25 26 2 N/A < 1 drink per day
N/A Not signif-icant
N/A Age, sex, ethnicity/ race, marital status
NAS01712
Armstrong
1983
Alcohol N/A Unknown Malaysia Chinese 200 Mean 43/ Mixed
100 100 N/A N/A N/A N/A Not signif-icant
N/A N/A
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
134
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01813
Shanmugar-atnam
1978
Alcohol (v. ENT hospital controls)
Never to daily FFQ - Study-specific
Singapore Chinese 2018 N/A/ Mixed
379 1639 5 1.497 N/A N/A Not signif-icant
N/A Age, Sex, interviewer
NAS01813
Shanmugar-atnam
1978
Alcohol (v. non-ENT hospital controls)
Never to daily FFQ - Study-specific
Singapore Chinese 2018 N/A/ Mixed
379 1639 5 1.345 N/A N/A Not signif-icant
N/A Age, Sex, interviewer
NAS01922
Ning
1990
Use of alcohol N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A 0.97 N/A Age, Sex, Area of Residence
NAS05679
Yang
2005
Alcohol Years of consumption prior to diagnosis
FFQ - Study-specific
Taiwan Chinese 2444 Mean 47/ Mixed
502 1942 N/A N/A N/A N/A Not signif-icant
N/A Age, Sex, Family history of NPC
NAS06023
Zou
1999
Total Alcoholic Drinks
Yes vs. No Dietary History question-naire
China Chinese 289 28-82/ Mixed
70 160 2 0.9 No 0.5-1.9
0.856 N/A Age, sex, year of death
3.7.1.1 Beers Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00749
Armstrong
1998
Beers Less than monthly to more than weekly
Dietary History question-naire
Malaysia Chinese 564 Mean 45/ Mixed
282 282 3 1.31 Less than monthly
N/A 0.023 N/A SES, salted fish consumption
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
135
NAS01639
Mabuchi
1985
Ale-beer At least one per day
Unknown United States
Various 78 16-74/ Mixed
25 26 2 N/A N/A N/A Not signif-icant
N/A Age, sex, ethnicity/ race, marital status
NAS04928
Henderson
1976
Beer Any use Interview United States
Various 423 Mean 52/ Mixed
156 267 2 1.0 No use N/A 0.48 N/A Age, sex, area of residence, ethnicity/ race, SES
3.7.1.2 Wines Case-control (4) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01639
Mabuchi
1985
Wine At least 1 glass a day
Interview United States
Various 78 16-74/ Mixed
13 18 2 N/A No N/A Not significant
N/A Age, sex, ethnicity/ race, marital status
NAS01812
Geser
1978
Chinese wine
Yes or no FFQ - Study-specific
China, Hong Kong
Chinese 300 N/A/ Mixed
150 150 2 N/A N/A N/A Stated in text as significant
N/A Age, sex, other foods, lifestyle factors
NAS04917
Lin
1973
Wine Drinking of wine
Interview China, Taiwan
Chinese 1360 Mean 46/ Mixed
343 1017 2 N/A N/A N/A Not significant
N/A N/A
NAS04928
Henderson
1976
Wine Any use Interview United States
Various 423 Mean 52/ Mixed
156 267 2 0.7 No use
0.4-1.1
0.05 N/A Age, sex, area of residence, ethnicity/ race, SES
3.7.1.3 Spirits Case-control (3)
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
136
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS00749
Armstrong
1998
Spirits Low, medium, high
Dietary History question-naire
Malaysia Chinese 564 Mean 45/ Mixes
282 282 3 Med: OR = 1.28
High: OR = 2.92
Low Med: 0.74-2.22
High: 1.05-8.14
Not signif-icant
Signif-icant
,008 Unadjusted
NAS01639
Mabuchi
1985
Whiskey At least 1 glass a day
Interview United States
Various 78 16-74/ Mixed
7 15 2 N/A No N/A <0.05 N/A Age, sex, ethnicity/ race, marital status
NAS04928
Henderson
1976
Any liquor
Any use Interview United States
Various 423 Mean 52/ Mixed
156 267 2 1.2 No use
N/A 0.31 N/A Age, sex, area of residence, ethnicity/ race, SES
Ecological (1) Study identifier
Author, Yr
Exposure Exposure range
Asses-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
Con-trols
No.
categories
r2 Ref group
CI P value
p value for trend
Adjusted for
NAS03683
Longnecker
1981
Spirits Per-capita Per-capita consumption
United States
Various N/A N/A/ Male N/A N/A N/A r2 = 0.21
N/A N/A <.001 N/A Age, ethnicity/ race
NAS03683
Longnecker
1981
Spirits Per-capita Per-capita consumption
United States
Various N/A N/A/ Female
N/A N/A N/A r2 = 0.01
N/A N/A >.05 N/A Age, ethnicity/ race
3.7.1.4 Other alcoholic drinks Case-control (1) Study Exposure Exposure Assessment Country Ethnicity No of
subjects Age/Sex No. No. No. OR Ref CI P value p value
for Adjusted for
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
137
identifier
Author, Yr
range Tool of subjects
analysed of subjects cases controls categories group trend
NAS01639
Mabuchi
1985
Mixed drinks
At least 1 drink per day
Interview United States
Various 78 16-74/ Mixed
18 16 2 N/A None N/A Not signif-icant
N/A Age, sex, ethnicity/ race, marital status
4.1.2 Chemical contaminants Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Categories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01141
Zheng
1994
Drinking of polluted water
N/A FFQ - Study-specific
China Chinese 410 Max 55/ Mixed
205 205 N/A N/A N/A N/A Signif-icant
N/A N/A
NAS01190
Zheng
1993
Drinking of polluted water
N/A FFQ - Study-specific
China Chinese 410 N/A/ Mixed 205 205 N/A N/A N/A N/A < 0.001 N/A N/A
4.1.2.7.1 Cadmium Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assessment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
categories
Mean/ Median
Ref group
CI P value
p value for trend
Adjusted for
NAS02012
Ling-Wei
1988
Cadmium Median exposure cases vs. controls
Unknown-NA
China Chinese 75 N/A/ N/A 45 30 Median exposure cases vs. controls
Median cases: 0.42
Median controls: 0.05
N/A 0.01 N/A Unadjusted
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
138
NAS06012
Deng
1995
measured in serum Cd concentration
Mean exposure cases vs. controls
Serum level, measured by colorimeter
China Chinese 86 20-60/ Mixed
44 42 Mean exposure cases vs. controls
Mean cases: 5.29
Mean controls: 3.57
Cases: 4.6-5.98
Controls: 2.31-4.83
<0.01 N/A Unadjusted
NAS06012
Deng
1995
concentration in rice
Mean exposure cases vs. controls
N/A China Chinese 86 20-60/ Mixed
44 42 Mean exposure cases vs. controls
Mean cases: 34.46
Mean controls: 24.96
N/A <0.05 N/A Unadjusted
NAS06012
Deng
1995
Cd concentration in drinking water
Mean exposure cases vs. controls
N/A China Chinese 86 20-60/ Mixed
44 42 Mean exposure cases vs. controls
Mean cases: 0.3
Mean controls: 0.25
N/A >0.05 N/A Unadjusted
4.1.2.7.2 Arsenic Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
categories
Means Ref group CI P value
p value for trend
Adjusted for
NAS02696
Man
1996
Arsenic detected in hair sample
Mean exposure cases vs. controls
Hair Sample
China Unknown 124 30-69/ N/A
22 56 Mean exposure cases vs. controls
Mean cases: 0.195 ppm
Mean controls: 0.133 ppm
N/A <0.05 N/A Unadjusted
Ecological (3) Study identifier
Author, Yr
Exposure Exposure range
Assessment
Tool
Country Ethnicity
of subjects
No of popula-tions analysed
Age/Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
SMR Ref group
CI P value
p value for trend
Adjusted for
NAS00617
Tsai
1999
Arsenic in Artesian wells
N/A assessment of arsenic in artesian well water was done in previous studies
China, Taiwan
Chinese 4 N/A/ Male
60 N/A N/A 1.10 N/A 0.84-1.41
Not signif-icant
N/A Unadjusted
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
139
Study identifier
Author, Yr
Exposure Exposure range
Assessment
Tool
Country Ethnicity
of subjects
No of popula-tions analysed
Age/Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
SMR Ref group
CI P value
p value for trend
Adjusted for
NAS00617
Tsai
1999
Arsenic in Artesian wells
N/A assessment of arsenic in artesian well water was done in previous studies
China, Taiwan
Chinese 4 N/A/ Female
29 N/A N/A 1.30 N/A 0.87-1.86
Not signif-icant
N/A Unadjusted
NAS01383
Chen
1990
Arsenic in drinking water
N/A arsenic level in waters of 83,656 wells was determined by a special survey team; standard mercuric bromide stain method
China, Taiwan
Chinese 314 N/A/ Mixed
N/A N/A N/A N/A N/A N/A Not signif-icant
N/A Age
NAS01434
Wu
1989
Arsenic in well water
< 30 to 60+ mg/L?
arsenic concentration in drinking water
China, Taiwan
Chinese 3 N/A/ Male
11 N/A 3 Event rate = 8.58/ 100000/ year
N/A N/A Not signif-icant
N/A Age
NAS01434
Wu
1989
Arsenic in well water
< 30 to 60+ mg/L?
arsenic concentration in drinking water
China, Taiwan
Chinese 3 N/A/ Female
7 N/A 3 Event rate = 4.89/ 100000/ year
N/A N/A Not signif-icant
N/A Age
4.1.2.7.3 Other heavy metals Lead Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Controls
No.
Cate-gories
Means Ref group
CI P value
p value for trend
Adjusted for
NAS01865
Robinson
1968
Lead, in maize leaf
Mean exposure cases vs. controls
Unknown/NA Kenya Central Bantu and Nilo-Hamitic
100 N/A/ N/A 50 50 2 Mean cases: 2.08
Mean controls: 2.14
N/A Not signif-icant
N/A Area of residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
140
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Controls
No.
Cate-gories
Means Ref group
CI P value
p value for trend
Adjusted for
NAS02012
Ling-Wei
1988
Lead, in drinking water
Median exposure cases vs. controls
Unknown/NA China Chinese 75 N/A/ N/A 45 30 2 Median cases: 6.4
Median controls: 1.6
N/A 0.05 N/A Unadjusted
NAS02696
Man
1996
lead, detected in hair sample
Mean exposure cases vs. controls
Hair Sample China Unknown 124 30-69/ N/A
29 95 2 Mean cases: 5.58 ppm
Mean controls: 7.408
N/A Not signif-icant
N/A Unadjusted
Mercury Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Controls
No.
Cate-gories
Means Ref group CI P value
p value for trend
Adjusted for
NAS02696
Man
1996
mercury, detected in hair sample
Mean exposure cases vs. controls
Hair Sample
China Unknown 124 30-69/ N/A
29 95 2 Mean cases: 3.45 ppm
Mean controls: 2.75
N/A Not signif-icant
N/A Unadjusted
Molybdenum Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Asses-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Controls
No.
Cate-gories
Means Ref group
CI P value
p value for trend
Adjusted for
NAS01865
Robinson
1968
Molybdenum, in maize leaf
Mean exposure cases vs. controls
Unknown Kenya Central Bantu and Nilo-Hamitic
100 N/A/ N/A 50 50 2 Mean cases: 1.91
Mean controls: 1.69
N/A Not signif-icant
N/A Area of residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
141
Study identifier
Author, Yr
Exposure Exposure range
Asses-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Controls
No.
Cate-gories
Means Ref group
CI P value
p value for trend
Adjusted for
NAS06012
Deng
1995
serum Molybdenum concentration
Mean exposure cases vs. controls
Serum level, measured by colorimeter
China Chinese 86 20-60/ Mixed
44 42 2 Mean cases: 18.39
Mean controls: 26.7
Cases: 16.4-22.2
Controls: 20.8-32.6
<0.01 N/A Unadjusted
NAS06012
Deng
1995
Molybdenum concentration in rice
Mean exposure cases vs. controls
N/A China Chinese 86 20-60/ Mixed
44 42 2 Mean cases: 136.07
Mean controls: 180.56
N/A <0.05 N/A Unadjusted
NAS06012
Deng
1995
Molybdenum concentration in drinking water
Mean exposure cases vs. controls
N/A China Chinese 86 20-60/ Mixed
44 42 2 Mean cases: 0.41
Mean controls: 0.71
N/A <0.05 N/A Unadjusted
Nickel Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of sub-jects ana-lysed
Age/ Sex of sub-jects
No.
cases
No.
Controls
No.
Cate-gories
Means Ref group
CI P value p value for trend
Adjusted for
NAS01865
Robinson
1968
Nickel, in maize leaf
Mean exposure cases vs. controls
Unknown Kenya Central Bantu and Nilo-Hamitic
100 N/A/ N/A
50 50 2 Mean cases: 1.33
Mean controls: 1.29
N/A Not signif-icant
N/A Area of residence
NAS06012
Deng
1995
serum Nickel (Ni) concentration
Mean exposure cases vs. controls
Serum level, measured by colorimeter
China Chinese 86 20-60/ Mixed
44 42 2 Mean cases: 66.59
Mean controls: 41.39
Cases: 55-78.2
Controls: 32.3-50.5
<0.001 N/A Unadjusted
NAS06012
Deng
1995
Nickel (Ni) concentration in rice
Mean exposure cases vs. controls
N/A China Chinese 86 20-60/ Mixed
44 42 2 Mean cases: 170.82
Mean controls: 135.16
N/A <0.05 N/A Unadjusted
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
142
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of sub-jects ana-lysed
Age/ Sex of sub-jects
No.
cases
No.
Controls
No.
Cate-gories
Means Ref group
CI P value p value for trend
Adjusted for
NAS06012
Deng
1995
Nickel (Ni) concentration in drinking water
Mean exposure cases vs. controls
N/A China Chinese 86 20-60/ Mixed
44 42 2 Mean cases: 1.85
Mean controls: 1.14
N/A <0.0001 N/A Unadjusted
4.1.2.9 Other contaminants Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00531
Ward
2000
Childhood Dietary Intake Age 3: Nitrosamines from soybean products, smoked
Lowest to highest
Dietary History question-naire
China Chinese 702 Max 74/ Mixed
375 327 4 0.7 Lowest 0.3-1.8
N/A N/A Age, Sex, Ethnicity/ Race, Vegetable intake
NAS00531
Ward
2000
Dietary Intake During Weaning: Nitrosamines from soybean products, smoked
Lowest to highest
Dietary History question-naire
China Chinese 702 Max 74/ Mixed
375 327 4 0.8 Lowest 0.4-1.8
N/A N/A Age, Sex, Ethnicity/ Race, Vegetable intake
NAS00531
Ward
2000
Childhood Dietary Intake Age 10: Nitrosamines from other foods, smoked
Lowest to highest
Dietary History question-naire
China Chinese 702 Max 74/ Mixed
375 327 4 2.2 Lowest 0.8-5.6
N/A N/A Age, Sex, Ethnicity/ Race, Vegetable intake
NAS00531
Ward
2000
Childhood Dietary Intake Age 3: Nitrosamines from other foods, smoked
Lowest to highest
Dietary History question-naire
China Chinese 702 Max 74/ Mixed
375 327 4 2.6 Lowest 1.0-7.0
N/A N/A Age, Sex, Ethnicity/ Race, Vegetable intake
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
143
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00531
Ward
2000
Childhood Dietary Intake During Weaning: Nitrosamines from other foods, smoked
Lowest to highest
Dietary History question-naire
China Chinese 702 Max 74/ Mixed
375 327 4 3.9 Lowest 1.4-10.4
N/A N/A Age, Sex, Ethnicity/ Race, Vegetable intake
NAS00531
Ward
2000
Mother's intake of nitrosamines during breastfeeding: from soybean products, smoked
Lowest to highest
Dietary History question-naire
China Chinese 702 Max 74/ Mixed
375 327 4 0.6 Lowest 0.2-1.4
N/A N/A Age, Sex, Ethnicity/ Race, Vegetable intake
NAS00531
Ward
2000
Mother's intake of nitrosamines during breastfeeding: from other products, smoked
Lowest to highest
Dietary History question-naire
China Chinese 702 Max 74/ Mixed
375 327 4 1.4 Lowest 0.5-3.6
N/A N/A Age, Sex, Ethnicity/ Race, Vegetable intake
Ecological (1) Study identifier
Author, Yr
Exposure Exposure range
Assessment
Tool
Country Ethnicity
of subjects
No of popula-tions analysed
Age/Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
Regression Slope
Ref group
CI P value
p value for trend
Adjusted for
NAS00384
Takahashi
2001
Flouridation in drinking water
N/A water flouridation data were obtained from the Fluoridation Census 1985
United States
Various 9 N/A/ Male
Incidence rate = 1.51 over 15 years
N/A N/A 0.089 N/A N/A .049 N/A Age
NAS00384
Takahashi
2001
Flouridation in drinking water
N/A water flouridation data were obtained from the Fluoridation Census 1985
United States
Various 9 N/A/ Female
Incidence rate = 2.73 over 15 years
N/A N/A 0.217 N/A N/A .024 N/A Age
4.2 Preservation (preserved foods) Preserved animal foods
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
144
Preserved meat: Adulthood consumption Case-control (4) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00424
Laouamri
2001
Seasonings: Dried, salted meat
Currently to twenty years ago
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
72 72 2 4.75 N/A 1.8-12.5
0.01 N/A Age, sex, area of residence
NAS00577
Yuan
2000
Preserved Meats (not specified: ham, cured duck, salted pork)
Less than monthly to weekly or more
FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 3 1.77 Less than monthly
1.12-2.79
N/A 0.56 Age, sex, area of residence, environ-mental factors, smoking, chemical fumes, history of ear/nose condition
NAS01056
Lee
1994
rou gan, dried sweetened meat, during adulthood
N/A FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
200 406 N/A N/A N/A N/A Signif-icant
N/A Age, sex, ethnicity/ race, education, belachan, mei chye, canned, salted, & pickled vegetables, vitamin C, salted soy beans, sze chuan chye, kiam chye, vitamin E
NAS01113
Zheng
1994
Salted dried and tinned meat
N/A FFQ - Study-specific
China Chinese 264 N/A/ Mixed
88 175 N/A N/A N/A N/A Not signif- icant
N/A N/A
Preserved meat: Childhood consumption Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01056
Lee
1994
rou gan, dried sweetened meat, usually pork, at 10 years old
Never to >1 times per week
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
149 342 3 0.8 Never 0.2-3.0
N/A 0.08 Age, sex, ethnicity/ race, education
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
145
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01381
Jeannel
1990
Intake Before Weaning: Quaddid (spiced dried meat stored in oil)
Yes vs. No FFQ - Study-specific
Tunisia Tunisian 240 N/A/ Mixed
80 160 2 3.2 No N/A 0.2 N/A Age, sex, area of residence, lifestyle factors
NAS01381
Jeannel
1990
Intake During Weaning: Quaddid (spiced dried meat stored in oil)
<1 time a month to 2+ times a week
FFQ - Study-specific
Tunisia Tunisian 240 N/A/ Mixed
80 160 3 2.8 <1 time a month
N/A N/A N/A Age, sex, area of residence, lifestyle factors
Preserved fish (excluding salted fish) Cohort (1) Study identifier
Author, Yr
Exposure Exposure range
Assessment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
Chi-square
Ref group
CI P value
p value for trend
Adjusted for
NAS06011
Zou
1994
Salted and dried fish, 1960s
none to 1+ times a week
Dietary History questionnaire
China Chinese 505 35-64/ Mixed
N/A N/A 2 Chi-square = 40.4
Not exposed
N/A <.001 N/A Unadjusted
NAS06011
Zou
1994
Salted and dried fish, 1970s
none to 1+ times a week
Dietary History questionnaire
China Chinese 505 35-64/ Mixed
N/A N/A 2 Chi-square = 42.6
Not exposed
N/A <.001 N/A Unadjusted
NAS06011
Zou
1994
Salted and dried fish, 1980s
none to 1+ times a week
Dietary History questionnaire
China Chinese 505 35-64/ Mixed
N/A N/A 2 Chi-square = 21.1
Not exposed
N/A <.001 N/A Unadjusted
Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
146
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01056
Lee
1994
Preserved cuttlefish, adult
Never to 3+ times a week
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
198 305 4 1.3 Never 0.5-2.9
Not signif-icant
0.9 Age, sex, ethnicity/ race, education
NAS01056
Lee
1994
Preserved cuttlefish, at age 10
Never to 3+ times a week
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
146 341 4 0.6 Never 0.1-1.8
Not signif-icant
0.08 Age, sex, ethnicity/ race, education
NAS01056
Lee
1994
Preserved fish tidbits, adult
Never to 3+ times a week
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
198 406 4 2.6 Never 0.6-10.0
Not signif-icant
0.6 Age, sex, ethnicity/ race, education
NAS01056
Lee
1994
Preserved fish tidbits, at age 10
Never to 3+ times a week
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
144 343 4 0.4 Never 0.1-1.3
Not signif-icant
0.1 Age, sex, ethnicity/ race, education
Preserved eggs Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00577
Yuan
2000
Preserved eggs- not specified, but measured salted egg, fermented black egg
Less than monthly to weekly or more
FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 3 1.17 Less than monthly
0.88-1.55
N/A 0.11 Age, sex, occupational exposure to fumes, education, smoking, environmental factors, other diseases
NAS01056
Lee
1994
Century egg, an unsalted preserved egg, at age 10
Never to 1-3 times per month
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
151 341 3 0.8 Never 0.4-1.6
N/A 0.8 Age, sex, ethnicity/ race, education
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
147
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01056
Lee
1994
Century egg, an unsalted preserved egg, at adulthood
Never to 3+ times per month
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
200 406 4 1.0 Never 0.3-3.8
N/A 0.9 Age, sex, ethnicity/ race, education
NAS01113
Zheng
1994
Salted, dried and tinned eggs
N/A FFQ - Study-specific
China Chinese 264 N/A/ Mixed
88 176 N/A N/A N/A N/A Not signif-icant
N/A N/A
Preserved fats Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00424
Laouamri
2001
Dried, salted fat
Currently to 20 years ago
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
39 currently, 65 20 years ago
3 currently, 27 20 years ago
2 9.25 Not clear
3.9-21.5
.001 N/A Age, sex, area of residence
Preserved plant foods Total preserved vegetables: Adulthood consumption Case-control (4) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00531
Ward
2000
Adult Dietary Intake: Preserved vegetables
Ever vs Never
Dietary History question-naire
China Chinese 702 Max 74/ Mixed
375 327 2 N/A N/A N/A Not Signif-icant
N/A Age, Sex, Ethnicity/ Race, Subjects w/ mothers questionnaire, Total calories
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
148
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00577
Yuan
2000
All preserved vegetables (salted mustard green/ bok choi/ stem vegetables, pickled stem vegetable/ cucumber, salted root and preserved root)
≤40 times per year to > 200 times per year
FFQ - Study-specifi
China Chinese 1967 15-74/ Mixed
935 1032 4 1.43 ≤40 times per year
1.11-1.86
N/A 0.001 Sex, Age, Educational Level, Smoking, Exposure to smoke from heated rapeseed oil and burning coal while cooking, Occupational exposure to chemical fumes, History of chronic ear and nose condition
NAS01056
Lee
1994
Canned salted or pickled vegetables, consumption during adulthood
Never exposed to more than 3 times per month
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
199 405 4 4.9 Never 1.8-12.9
N/A 0.004 Age, Sex, Education level, Dialect Group
NAS01113
Zheng
1994
Salted, dried, or tinned vegetables in brine
N/A FFQ - Study-specific
China Chinese 264 Mean 42/ Mixed
88 176 N/A N/A N/A N/A Not signif- icant
N/A N/A
Total preserved vegetables: Childhood/Infancy consumption Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00531
Ward
2000
Preserved vegetables Intake for Age 10
None to >59.2 grams
Dietary History question-naire
China Chinese 702 Max 74/ Mixed
89 113 4 0.9 None 0.3-2.6
N/A N/A Age, Sex, Ethnicity/ Race
NAS00531
Ward
2000
Intake for Age 3: Preserved vegetables
None to > 44.8 grams
Dietary History question-naire
China Chinese 702 Max 74/ Mixed
88 103 4 0.9 None 0.3-2.4
N/A N/A Age, Sex, Ethnicity/ Race
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
149
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00531
Ward
2000
During Weaning: Preserved vegetables
None to > 0 Dietary History question-naire
China Chinese 702 Max 74/ Mixed
87 112 2 1.3 None 0.6-2.5
N/A N/A Age, Sex, Ethnicity/ Race
NAS00531
Ward
2000
Mother's diet during breastfeeding: Preserved vegetables
Highest vs lowest
Dietary History question-naire
China Chinese 702 Max 74/ Mixed
375 327 N/A 0.6 Low-est
0.2-1/5
N/A N/A N/A
NAS01056
Lee
1994
Canned salted or pickled vegetables, at age 10
Never exposed to more than 3 times per month
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
149 344 4 0.5 Never 0.1-1.4
N/A 0.2 Age, Sex, Education level, Dialect Group
Preserved Root Vegetables Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group CI P value
p value for trend
Adjusted for
NAS06024
Huang
1997
Preserved root vegetables exposed at age of 10, cases and control were from Guangdong province
Yes vs no Question-naire
China Chinese 416 N/A/ Mixed
104 104 2 1.81 No 1.01– 3.33
0.045 N/A Age, Sex, No Separate Kitchen, Grapes, and dired orange, Family history of cancer
NAS06024
Huang
1997
Preserved other root vegetables
consume few to consume every week
Question-naire
China Chinese 416 N/A/ Mixed
104 104 3 2.42 Consume few
0.99-5.92
N/A N/A Age, Sex, Area of Residence
Preserved Cruciferous Vegetables: Adulthood consumption Case-control (2)
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
150
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Coun-try
Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01056
Lee
1994
tang chye, a type of preserved cabbage, consumption during adulthood
Never exposed to more than 3 times per month
FFQ - Study-specific
Singa-pore
Chinese 606 Max 44/ Mixed
199 406 5 1.5 Never 0.6-3.4
N/A N/A Age, Sex, Education level, Dialect Group
NAS01056
Lee
1994
chye poh, preserved Chinese radish, consumption during adulthood
Never exposed to more than 3 times per month
FFQ - Study-specific
Singa-pore
Chinese 606 Max 44/ Mixed
200 406 4 2.8 Never 1.2-6.0
N/A 0.1 Age, Sex, Education level, Dialect Group
NAS01922
Ning
1990
sour cabbage, consumption 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of residence
Preserved Cruciferous Vegetables: Childhood consumption Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Coun-try
Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01056
Lee
1994
tang chye, a type of preserved cabbage, consumption at age 10 years
Never exposed to more than 3 times per week
FFQ - Study-specific
Singa-pore
Chinese 606 Max 44/ Mixed
147 342 5 0.8 Never 0.2-2.6
N/A N/A Age, Sex, Education level, Dialect Group
NAS01056
Lee
1994
chye poh, preserved Chinese radish, consumption at age 10 years
Never exposed to 1-3 times per week
FFQ - Study-specific
Singa-pore
Chinese 606 Max 44/ Mixed
150 342 4 1.0 Never 0.4-2.1
N/A 0.7 Age, Sex, Education level, Dialect Group
NAS01922
Ning
1990
sour cabbage, consumption at 10 years of age
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
151
Preserved Green Leafy Vegetables: Adulthood consumption Case-control (1) Study identifier
Author, Yr
Exposure Expo-sure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01056
Lee
1994
Mei chye (preserved greens and leafy vegetables), consumption in adulthood
N/A FFQ - Study-specific
Singa-pore
Chinese 606 Max 44/ Mixed
200 406 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, ethnicity/ race, education, belachan, canned, salted, & pickled vegetables, vitamin C, salted soy beans, kiam chye, vitamin E
Total Preserved Vegetables: Adulthood consumption Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00424
Laouamri
2001
Seasonings: vegetables in brine
Currently- twenty years ago
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
72 72 2 2.77 N/A 1.34-5.71
N/A N/A Age, Sex, Area of Residence
NAS00577
Yuan
2000
Preserved leafy vegetables (salted mustard green, salted bok choi, etc)
Less than monthly to daily
FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 4 1.37 Less than monthly
0.65-2.9
N/A 0.85 Age, sex, area of residence, environmental factors, smoking, chemical fumes, history of ear/nose condition
NAS00577
Yuan
2000
Preserved Stem Vegetables (salted stem vegetables and pickled stem vegetable)
Less than monthly to daily
FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 4 1.88 Less than monthly
1.24-2.84
N/A <0.001 Age, sex, area of residence, environmental factors, smoking, chemical fumes, history of ear/nose condition
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
152
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00577
Yuan
2000
Preserved root vegetables (salted root and preserved root)
Less than monthly to daily
FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 4 1.04 Less than monthly
0.7-1.53
N/A 0.14 Age, sex, area of residence, environmental factors, smoking, chemical fumes, history of ear/nose condition
NAS01056
Lee
1994
Mei chye (preserved greens and leafy vegetables), consumption in adulthood
Never exposed to 1-3 times per month
FFQ - Study-specific
Singa-pore
Chinese 606 Max 44/ Mixed
200 406 4 2.8 Never 0.9-8.2
N/A 0.07 Age, Sex, Education level, Dialect Group
Total Preserved Vegetables: Childhood consumption Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01056
Lee
1994
Mei chye (preserved greens and leafy vegetables), at age 10 years
Never exposed to 1-3 times per month
FFQ - Study-specific
Singa-pore
Chinese 606 Max 44/ Mixed
150 341 4 1.3 Never 0.6-2.6
N/A 0.8 Age, Sex, Education level, Dialect Group
Other Preserved Vegetables: Adulthood consumption Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00424
Laouamri
2001
Seasoning: salted dried tomatoes
Currently- twenty years ago
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
72 72 2 7.5 N/A 3.09-18.2
0.001 N/A Age, Sex, Area of Residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
153
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00825
Chen
1997
Plum vegetable (Chan Pai Mui), 3 years ago
N/A FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 Contin-uous
1.73 N/A 1.19-2.53
N/A N/A Age, Sex, Area of Residence
NAS00825
Chen
1997
Plum vegetable
Less than once a month to greater than once a week
FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 3 2.53 Less than once a month
1.04-6.19
N/A <0.05 Age, Sex, Area of Residence, Grape and Preserved Plum, No separate kitchen, Kitchen range without chimney
Preserved fruits Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00749
Armstrong
1998
Preserved fruits, 5 years pre-diagnosis
Less than monthly to more than weekly
Dietary History question-naire
China Chinese 564 N/A/ Mixed
282 282 3 1.42 Less than monthly
0.71-2.85
N/A 0.091 Unadjusted
NAS00749
Armstrong
1998
Preserved fruits, at age 10
Less than monthly to more than weekly
Dietary History question-naire
China Chinese 564 N/A/ Mixed
282 282 3 1.5 Less than monthly
0.82-2.75
N/A N/A Unadjusted
Preserved citrus fruits Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
154
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS06024
Huang
1997
Preserved orange, cases and control were from Guangdong province
Yes vs No
Question-naire
China Chinese 416 N/A/ Mixed
104 104 2 2.95 No 1.04-8.41
0.043 N/A Age, Sex, No separate kitchen, dried vegetables and grapes, Family history of Cancer
NAS06024
Huang
1997
Citrus fruits, preserved, exposed at age of 10, cases / control were from Guangdong province
Yes vs No
Question-naire
China Chinese 416 N/A/ Mixed
104 104 2 2.169 No 1.12-4.21
0.022 N/A Age, Sex, Area of Residence
Preserved plums: Adulthood consumption Case-control (4) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00577
Yuan
2000
preserved plum (gar ink gee)
N/A FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 N/A N/A N/A N/A Not signif- icant
N/A N/A
NAS00825
Chen
1997
preserved prune, 3 years ago
N/A FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of Residence
NAS00825
Chen
1997
preserved plum, 3 years ago
N/A FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of Residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
155
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00825
Chen
1997
Preserved prune N/A FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 Contin-uous
2.59 N/A 1.04-8.41
N/A 0.043 Age, Sex, Area of Residence, Consumption of Plum Veg/ grape, No separate kitchen, Kitchen Range wo chimney, Family Cancer History
NAS00825
Chen
1997
Preserved Plum Less than once per month to 1-4 times per month
FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 2 1.7 Less than once a month
0.72-3.9
N/A <0.05 Age, Sex, Area of Residence, Plum Vegetable/ Grape, No separate kitchen, Kitchen Range wo Chimney
NAS01459
Yu
1989
preserved (salted) plum, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
110 139 N/A N/A N/A N/A N/A Not signif- icant
N/A
NAS01459
Yu
1989
gar ink gee preserved (salted plum),, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
110 139 N/A N/A N/A N/A N/A Not signif- icant
N/A
NAS01459
Yu
1989
chan pai mui, preserved (salted plum), unsure time of consumption
N/A FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
110 139 N/A N/A N/A N/A N/A Signif- icant
Age, sex, area of residence, salted fish, fermented fish sauce, moldy bean curd, salted shrimp paste, gar ink gee, tomatoes
NAS01459
Yu
1989
gar ink gee, preserved (salted plum), unsure time of consumption
N/A FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
110 139 N/A N/A N/A N/A N/A Signif- icant
Age, sex, area of residence, salted fish, fermented fish sauce, moldy bean curd, chan pai mui, salted shrimp paste, tomatoes
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
156
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01608
Yu
1986
chan pai mui, gar ink gee, at 10 years of age or 3 years prior to diagnosis
N/A FFQ - Study-specific
China, Hong Kong
Chinese 500 Max 34/ Mixed
250 250 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, salted fish intake
Preserved plums: Childhood consumption Case-control (4) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00825
Chen
1997
preserved prune, 10 years old
N/A FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 Contin-uous
2.17 N/A 1.12-4.21
N/A N/A Age, Sex, Area of Residence
NAS00825
Chen
1997
preserved plum, 10 years old
N/A FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 Contin-uous
2.1 N/A 1.12-3.91
N/A N/A Age, Sex, Area of Residence
NAS01459
Yu
1989
preserved (salted) plum, at age 10
Rarely to daily
FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
110 139 4 N/A Rarely N/A N/A 0.01 Age, sex, area of residence, consumption of salted fish during weaning
NAS01459
Yu
1989
gar ink gee, preserved (salted) plum, at age 10
Rarely to daily
FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
110 139 4 N/A Rarely N/A N/A 0.03 Age, sex, area of residence, consumption of salted fish during weaning
NAS01608
Yu
1986
chan pai mui, gar ink gee, at 10 years of age or 3 years prior to diagnosis
N/A FFQ - Study-specific
China, Hong Kong
Chinese 500 Max 34/ Mixed
250 250 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, salted fish intake
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
157
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS06024
Huang
1997
Preserved plums, exposed at age of 10, cases and control were from Guangdong province
Yes vs No
Question-naire
China Chinese 416 N/A/ Mixed
104 104 2 2.095 No 1.12-3.91
0.02 N/A Age, Sex, Area of Residence
Preserved olives: Adulthood consumption Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00424
Laouamri
2001
Seasonings: Olives in Brine
Currently- twenty years ago
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
72 72 2 2.0 N/A 1.36-3.72
0.05 N/A Age, Sex, Area of Residence
Preserved spice intake Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00424
Laouamri
2001
Harissa (chili peppers, dried then pickled and preserved in olive oil with garlic), at least once per week
>1 time a week: yes or no
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
72 72 2 5.0 No N/A <.001 N/A Age, sex, area of residence
NAS00531
Ward
2000
Adult Dietary Intake: hot chili sauce
Lowest to Highest
Dietary History question-naire
China Chinese 702 Max 74/ Mixed
375 327 2 1.4 Lowest 0.9-2.1
N/A N/A Age, Sex, Ethnicity/ Race, Subjects w/ mothers question-naire, Total calories
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
158
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01812
Geser
1978
Households w/ NPC patients and of controls: mustard paste
Yes or no FFQ - Study-specific
China, Hong Kong
Chinese 300 N/A/ Mixed
144 143 2 0.44 No 0.26-0.74
N/A N/A Age, sex
NAS01812
Geser
1978
Households w/ NPC patients and of controls: chilli sauce
Yes or no FFQ - Study-specific
China, Hong Kong
Chinese 300 N/A/ Mixed
144 144 2 0.41 No 0.24-0.69
N/A N/A Age, sex
NAS01812
Geser
1978
Mustard paste N/A FFQ - Study-specific
China, Hong Kong
Chinese 300 N/A/ Mixed
150 150 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, Use of ancestral alters and Buddhist alters, Vinegar, Xanthozylon Seeds, Flavor Essence, Oyster Soy, Chinese Wine, Bread
4.2.1 Drying (dried foods) Dried animal foods Dried fish (excluding salted fish) Case-control (4) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01056
Lee
1994
Dried, unsalted fish, adult
Never to more than once a month
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
195 405 3 2.2 Never 0.8-5.4
Not signif-icant
0.3 Age, sex, ethnicity/ race, education
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
159
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01056
Lee
1994
Dried, unsalted fish, at age 10
Never to more than once a month
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
141 337 3 0.1 Never 0.01-1.0
Signif-icant
0.03 Age, sex, ethnicity/ race, education
NAS01056
Lee
1994
Dried, tiny fish, at age 10
Never to 3+ times a week
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
148 345 5 0.6 never 0.02-2.1
Not signif-icant
0.06 Age, sex, ethnicity/ race, education
NAS01056
Lee
1994
Dried, tiny fish, adult
Never to 3+ times a week
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
190 306 5 1.1 never 0.3-3.8
Not signif-icant
0.8 Age, sex, ethnicity/ race, education
NAS01056
Lee
1994
Dried, tiny fish, infancy
Never to 3+ times a week
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
59 96 4 0.7 never 0.05-8.6
Not signif-icant
0.6 Age, sex, ethnicity/ race, education
NAS01056
Lee
1994
Dried, tiny fish soup, during infancy
Never to 3+ times a week
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
60 96 4 4.2 never 0.4-42.8
Not signif-icant
0.5 Age, sex, ethnicity/ race, education
NAS01520
Yu
1988
Dried fish, age 10
Rarely to monthly
FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 3 6.4 Rarely 1.6-26.8
Signif-icant
.04 Age, sex
NAS01520
Yu
1988
Dried fish, age 1-2
Rarely to monthly
FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 3 2.2 Rarely 0.9-5.3
Not signif-icant
.002 Age, sex
NAS01922
Ning
1990
dried anchovy, at age 10
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A Age, Sex, Area of residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
160
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01922
Ning
1990
dried anchovy, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A Age, Sex, Area of residence
NAS04944
Armstrong
1978
dried fish, for breakfast among families of cases/ controls
N/A Recall Malaysia Chinese 210 25-81/ Mixed
60 150 N/A N/A N/A N/A Signig-icant
N/A Unadjusted
NAS04944
Armstrong
1978
dried fish in three main daily meals combined, among cases and controls
Unclear Recall Malaysia Chinese 210 25-81/ Mixed
60 150 N/A 0.8 N/A N/A Not signif-icant
N/A Age, Sex, Area of residence, Ethnicity/ Race, Socio-economic status, Lifestyle Factors
Dried seafood: Adulthood consumption Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01056
Lee
1994
dried oyster, during adulthood
Never to more than 3 times per month
FFQ - Study-specific
Singa-pore
Chinese 606 Max 44/ Mixed
200 405 4 2.2 Never 0.6-7.3
N/A 0.7 Age, sex, ethnicity/ race, education
NAS01056
Lee
1994
dried prawn, consumption during adulthood
Never to 3+ times per week
FFQ - Study-specific
Singa-pore
Chinese 606 Max 44/ Mixed
199 406 5 1.5 Never 0.5-3.6
N/A 0.4 Age, sex, ethnicity/ race, education
NAS01608
Yu
1986
dried shrimp, subject's at 10 years of age or 3 years prior to diagnosis
N/A FFQ - Study-specific
China, Hong Kong
Chinese 500 Max 34/ Mixed
250 250 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, salted fish intake
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
161
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01922
Ning
1990
dried shrimp, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A N/A
Dried seafood: Childhood consumption Case-control (4) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01056
Lee
1994
prawn, dried, at age 10
Never to 1-3 times per week
FFQ - Study-specific
Singa-pore
Chinese 606 Max 44/ Mixed
150 340 4 0.7 Never 0.3-1.4
N/A 0.5 Age, sex, ethnicity/ race, education
NAS01056
Lee
1994
oyster, dried, at age 10
Never to 1-3 times per week
FFQ - Study-specific
Singa-pore
Chinese 606 Max 44/ Mixed
151 342 4 1.1 Never 0.3-3.4
N/A 0.3 Age, sex, ethnicity/ race, education
NAS01520
Yu
1988
dried shrimp, at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
NAS01608
Yu
1986
dried shrimp, subject's at 10 years of age or 3 years prior to diagnosis
N/A FFQ - Study-specific
China, Hong Kong
Chinese 500 Max 34/ Mixed
250 250 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, salted fish intake
NAS01922
Ning
1990
dried shrimp, at age 10
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A N/A
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
162
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01922
Ning
1990
dried shrimp, at age 10
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A N/A
Dried plant foods Dried vegetables: Adulthood consumption Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01922
Ning
1990
Dried vegetable, consumption 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of Residence
Dried vegetables: Childhood/Infancy consumption Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01922
Ning
1990
Dried vegetable, consumption at 10 years of age
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of Residence
Dried Green Leafy Vegetables: Adulthood consumption Case-control (1)
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
163
Study identifier
Author, Yr
Exposure Expo-sure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01922
Ning
1990
dried kelp, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not Signif- icant
N/A Age, Sex, Area of residence
NAS01922
Ning
1990
dried seaweed, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not Signif- icant
N/A Age, Sex, Area of residence
Dried Green Leafy Vegetables: Childhood consumption Case-control (1) Study identifier
Author, Yr
Exposure Expo-sure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01922
Ning
1990
dried kelp, at 10 years of age
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not Signif- icant
N/A Age, Sex, Area of residence
NAS01922
Ning
1990
dried seaweed at 10 years of age
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not Signif- icant
N/A Age, Sex, Area of residence
Dried plums: Adulthood consumption Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS00577
Yuan
2000
Dried plum (chan pai mui)
N/A FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 N/A N/A N/A N/A Not signif- icant
N/A N/A
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
164
Dried plums: Childhood consumption Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01520
Yu
1988
various dried plums, at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif- icant
N/A Age, sex
Dried olives: Adulthood consumption Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00424
Laouamri
2001
Seasonings: Dried Olives
Currently- twenty years ago
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
72 72 2 4.66 N/A 1.51-14.33
0.01 N/A Age, Sex, Area of Residence
Other dried fruits: Adulthood consumption Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00424
Laouamri
2001
Seasonings: Raisins Currently- twenty years ago
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
72 72 2 0.2 N/A 0.08-0.17
0.001 N/A Age, Sex, Area of Residence
NAS00577
Yuan
2000
dried red date (gone hong zhao)
N/A FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 N/A N/A N/A N/A Not signif- icant
N/A N/A
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
165
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01608
Yu
1986
dried red date, at 10 years of age or 3 years prior to diagnosis
N/A FFQ - Study-specific
China, Hong Kong
Chinese 500 Max 34/ Mixed
250 250 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, salted fish intake
NAS01608
Yu
1986
dried fruits (chan pai mui, gar ink gee), at 10 years of age or 3 years prior to diagnosis
N/A FFQ - Study-specific
China, Hong Kong
Chinese 500 Max 34/ Mixed
250 250 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, salted fish intake
Other dried fruits: Childhood consumption Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01520
Yu
1988
dried red date, at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif- icant
N/A Age, sex
NAS01608
Yu
1986
dried red date, at 10 years of age or 3 years prior to diagnosis
N/A FFQ - Study-specific
China, Hong Kong
Chinese 500 Max 34/ Mixed
250 250 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, salted fish intake
Dried seeds: Adulthood consumption Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS00577
Yuan
2000
dried ginko seed (bei guo)
N/A FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 N/A N/A N/A N/A Not signif- icant
N/A N/A
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
166
Dried seeds: Childhood consumption Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01520
Yu
1988
dried gingko seed, consumed by subject at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif- icant
N/A Age, sex
Dried spice intake Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00424
Laouamri
2001
Seasonings: Dried Peppers
Currently to twenty years ago
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
72 72 2 5.5 N/A 2.55-11.8
0.001 N/A Age, sex, area of residence
4.2.2 Storage Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of sub jects
No.
cases
No.
Cont-rols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00424
Laouamri
2001
Foods for chewing when teething: cherchem (wheat or barley pieces that have softened through contact w/ the floor and walls when these cereals are stored underground)
Ever vs Never
FFQ - Study-specific
Algeria Un-known
144 9-70/ Mixed
72 72 2 4.0 Ever 0.18-4.4
N/A N/A Age, Sex, Area of residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
167
4.2.3 Bottling, canning, vacuum packing Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assessment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
categories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01812
Geser
1978
Households of NPC patients / controls: Tinned food w/ fish
Yes or no FFQ - Study-specific
China, Hong Kong
Chinese 300 N/A/ Mixed
150 150 2 0.46 No 0.23-0.94
N/A N/A Age, sex
4.2.5.1 Salt Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assessment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
categories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01459
Yu
1989
Table salt use, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 612 Max 49/ Mixed
110 138 3 N/A N/A N/A Not signif-icant
N/A Area of residence, age, sex
NAS01459
Yu
1989
Table salt use, at age 10
N/A FFQ - Study-specific
China Chinese 612 Max 49/ Mixed
110 138 3 N/A N/A N/A Not signif-icant
N/A Area of residence, age, sex
NAS01520
Yu
1988
Table salt use, at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
4.2.5.3 Salted foods Salted composite foods Case-control (1)
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
168
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS04928
Henderson
1976
Salted snacks
Yes vs. no Interview United States
Various 423 Mean 52/ Mixed
156 267 2 0.4 No N/A 0.03 N/A Age, race, area of residence, ethnicity/ race
4.2.5.3.1 Salted animal food Salted meat: Adulthood consumption Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01922
Ning
1990
salted meat, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A N/A
Salted meat: Childhood consumption Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01922
Ning
1990
salted meat, at age 10
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A N/A
Salted pork Case-control (3)
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
169
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
categories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01190
Zheng
1993
Salted pork N/A FFQ - Study-specific
China Chinese 410 N/A./ Mixed
205 205 N/A N/A N/A N/A Signif-icant
N/A Un-adjusted
NAS01520
Yu
1988
Salted pork, at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
NAS01608
Yu
1986
Salted pork, at age 10 or adult
N/A FFQ - Study-specific
China Chinese 500 Max 34/ Mixed
250 250 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, salted fish intake
Salted fish: Adulthood consumption Cohort (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
categories
Chi-square
Ref group
CI P value
p value for trend
Adjusted for
NAS06011
Zou
1994
Salted fish, 1960s
none to 1+ times a week
Dietary History question-naire
China Chinese 505 35-64/ Mixed
N/A N/A 2 Chi-square = 12.91
Not exposed
N/A <.001 N/A Unadjusted
NAS06011
Zou
1994
Salted fish, 1970s
none to 1+ times a week
Dietary History question-naire
China Chinese 505 35-64/ Mixed
N/A N/A 2 Chi-square = 6.07
Not exposed
N/A <.014 N/A Unadjusted
NAS06011
Zou
1994
Salted fish, 1980s
none to 1+ times a week
Dietary History question-naire
China Chinese 505 35-64/ Mixed
N/A N/A 2 Chi-square = 1.545
Not exposed
N/A .214 N/A Unadjusted
Case-control (21) Meta-analysis
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
170
Study identifier
Author
Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group CI P value p value for trend
Adjusted for
NAS00531
Ward
2000
Salted fish, adult intake
5g/wk Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
375 327 2 0.8 No 0.5-1.2
Not signif-icant
N/A Age, sex, ethnicity/ race, total calories, mothers questionnaire
NAS00577
Yuan
2000
Salted fish Less than monthly to weekly or more
FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 3 1.82 Less than monthly
0.86-3.88
N/A 0.07 Age, sex, area of residence, env factors, smoking, chemical fumes, history of ear/nose condition
NAS00749
Armstrong
1998
Salted fish, 5 years prior
Less than monthly to more than weekly
Dietary History question-naire
China Chinese 564 N/A/ Mixed
282 282 3 4.22 Less than monthly
2.23-7.99
Signif-icant
.001 Unadjusted
NAS01056
Lee
1994
Salted fish, adult
Never to 3+ times a week
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
200 406 4 4.4 Never 0.7-25.9
Not signif-icant
0.6 Age, sex, ethnicity/ race, education
NAS01113
Zheng
1994
Salted fish, year before dx
Yes or no FFQ - Study-specific
China Chinese 264 Mean 42/ Mixed
88 176 2 N/A No N/A Not signif-icant
N/A Age, sex, area of residence, SES
NAS01141
Zheng
1994
Salted fish, tough meat
Never and yearly to weekly and daily
FFQ - Study-specific
China Chinese 410 Max 55/ Mixed
205 205 3 11.2 Never and yearly
4.6-32.0
Signif-icant
N/A Age, sex, area of residence
NAS01141
Zheng
1994
Salted fish, soft meat
Never and yearly to weekly and daily
FFQ - Study-specific
China Chinese 410 Max 55/ Mixed
205 205 3 17.2 Never and yearly
4.1-152
Signif-icant
N/A Age, sex, area of residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
171
Study identifier
Author
Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group CI P value p value for trend
Adjusted for
NAS01153
West
1993
Salted fish Low to high tertile
Unknown Philippines Filipino 205 11-83/ Mixed
104 101 3 1.3 Low tertile 0.69-2.6
Not signif-icant
N/A Age, sex, fresh fish, processed meat, hospital ward
NAS01190
Zheng
1993
Highest consumption of salted fish from 3 time periods: last 7 years, at age 10, and in the first 3 years
N/A FFQ - Study-specific
China Chinese 410 N/A/ Mixed
205 205 N/A N/A N/A N/A Signif-icant
N/A N/A
NAS01248
Sriamporn
1992
Salted fish Freshwater only, sea salted +/- once a week
FFQ - Study-specific
Thailand Thai 240 Mean 47/ Mixed
120 120 3 2.5 Fresh-water only
1.2-5.2
Signif-icant
N/A Age, sex, area of residence, smoking, alcohol, occupation
NAS01459
Yu
1989
Salted fish, 3 years prior to dx
Rarely to daily
FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
306 306 4 1.8 Rarely 0.9-3.6
Not signif-icant
<.05 Age, sex, area of residence
NAS01608
Yu
1986
Salted fish, adult
Rarely to daily
FFQ - Study-specific
China, Hong Kong
Chinese 500 Max 34/ Mixed
250 250 4 7.5 Rarely 0.9-65.3
Not signif-icant
N/A Age, sex
NAS01608
Yu
1986
Salted fish head soup, adult
Rarely to more than once a month
FFQ - Study-specific
China, Hong Kong
Chinese 500 Max 34/ Mixed
250 250 2 4.2 Rarely 1.6-11.7
Signif-icant
N/A Age, sex
NAS01922
Ning
1990
salted fish, ever consumed
Ever vs. Never
FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 2 2.2 Never 1.3-3.7
0.003 N/A Age, Sex, Area of residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
172
Study identifier
Author
Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group CI P value p value for trend
Adjusted for
NAS01922
Ning
1990
Salted fish age at first exposure
Never exposed to older than 21
FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 4 1.5 Never 0.7-3.3
N/A 0.0006 Age, Sex, Area of residence
NAS01922
Ning
1990
salted fish, duration of consumption (years)
Never exposed to more than 21 years
FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 4 2.8 Never 1.4-5.6
N/A 0.001 Age, Sex, Area of residence
NAS01922
Ning
1990
2.5.2 salted fish, 3 years prior to diagnosis
Never to weekly or daily
FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 4 N/A Never N/A Not signif-icant
0.41 Age, Sex, Area of residence
NAS01922
Ning
1990
salted fish, age/ duration at first exposure
Never exposed to age 21+/ duration 11+ years
FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 7 2.5 N/A N/A N/A N/A Age, Sex, Area of residence
NAS01922
Ning
1990
salted fish, age/ duration at first exposure (those who consumed at least monthly during the earliest decade of exposure)
Never exposed to 11+ years at first exposure and 11+ years duration
FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 5 2.2 N/A N/A N/A N/A Age, Sex, Area of residence
NAS02182
Armstrong
1983
Salted fish, current consumption as adults
N/A N/A Malaysia Chinese 200 N/A/
Mixed
100 100 N/A N/A N/A N/A Not signif-icant
N/A Age, Sex, Area of residence, Ethnicity/ Race
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
173
Study identifier
Author
Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group CI P value p value for trend
Adjusted for
NAS04928
Henderson
1976
Current use of salted fish
N/A N/A United States
Chinese 423 Mean 52/ Mixed
156 267 N/A N/A N/A N/A Not signif-icant
N/A Age, Sex, Area of residence, SES
NAS05679
Yang
2005
Salted fish, moldy and firm, after age 10
Yes vs. No FFQ - Study-specific
Taiwan Chinese 2444 Mean 47/ Mixed
502 1942 2 N/A N/A N/A Not signif-icant
N/A Age, Sex, Family history of NPC
NAS06003
Ye
1995
salted fish ≤ 4 time per month to > 4 times per month
Dietary history question-naire
China Chinese 270 21-75/ Mixed
135 135 2 5.0 ≤ 4 time per month
1.26- 19.6
< 0.05 N/A Age, Sex, Area of residence
NAS60010
Cai
1996
Salted Fish <12 times per month to ≥12 times per month
Dietary History question-naire
China Chinese 230 16-68/ Mixed
115 115 2 1.318 < 12 times per month
0.995-1.793
0.0538 N/A Age, Sex, Area of residence
NAS06021
Chen
1994
Salted Fish frequently consumed
Question-naire
China Chinese 56 N/A/ Mixed
28 28 Contin-uous
r2= 0.8661
N/A N/A 0.008 N/A Sex, Age
NAS06021
Chen
1994
Salted Fish, frequently consumed
Yes or No Question-naire
China Chinese 56 N/A/ Mixed
28 28 2 5.51 No 1.74-17.46
<0.01 N/A Sex, Age
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
174
Study identifier
Author
Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group CI P value p value for trend
Adjusted for
NAS06022
Wang
1993
Salted Fish, consumed frequently
less consumed to frequently consumed
Question-naire
China Chinese 244 13-70/ Mixed
122 122 2 8.99 less consumed
N/A 0.0127 N/A Consumption of pork fat, colored vegetables, whole grains, plant oils, and vegetables, Non-nutrient chemicals, smoking in living area, Sex, Age, SES
NAS06023
Zou
1999
Salted Fish < 9 times a month to ≥ 9 times a month
Question-naire
China Chinese 304 14-82/ Mixed
100 202 2 2.8 < 9 times a month
1.52-5.18
Significant N/A Age, Sex, Live in area with high level of background radiation, Alcohol, Smoking habits, Consumption of fermented soy
Ecological (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Categories
RR/OR Ref group
CI P value p value for trend
Ad-justed for
NAS01222
Zou
1992
Nitrosamines from salted fish
36.96-183.85 ug/kg
Food testing
China Chinese N/A N/A/ Mixed
21 N/A Mean exposure: cases v. controls
N/A N/A N/A No tests of signif-icance
N/A N/A
Salted fish: Childhood consumption (Age 10) Cohort (1)
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
175
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
categories
Chi-square
Ref group
CI P value
p value for trend
Adjusted for
NAS06011
Zou
1994
Salted fish, childhood
none to 1+ times a week
Dietary History question-naire
China Chinese 505 35-64/ Mixed
N/A N/A 2 Chi-square = 41.3
Not exposed
N/A <.038 N/A Unadjusted
Case-control (16) Meta-analysis Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group CI P value
p value for trend
Adjusted for
NAS00531
Ward
2000
Salted fish, at age 10
Yes or no Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
82 110 2 1.5 No 0.8-2.8
Not signif-icant
N/A Age, sex, ethnicity/ race
NAS00749
Armstrong
1998
Salted fish, at age 10
Less than monthly to more than weekly
Dietary History question-naire
China Chinese 564 N/A/ Mixed
282 282 3 2.74 Less than monthly
1.59-4.75
Signif-icant
N/A Unadjusted
NAS00821
Hildesheim
1997
Salted fish during childhood
Yes or no Unknown China, Taiwan
Chinese 684 15-74/ Mixed
364 320 2 1.4 No 0.47-4.5
Not signif-icant
N/A Age, sex
NAS01056
Lee
1994
Salted fish, at age 10
Never to 3+ times a week
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
161 369 5 0.8 Never 0.2-2.9
Not signif-icant
0.3 Age, sex, ethnicity/ race, education
NAS01113
Zheng
1994
Salted fish, steamed or fried, age 2-10
Rarely v. monthly/ weekly
FFQ - Study-specific
China Chinese 264 Mean 42/ Mixed
88 176 2 1.4 Rarely N/A 0.2 N/A Age, sex, area of residence, SES
NAS01113
Zheng
1994
Salted fish soup, age 2-10
Rarely v. monthly/ weekly
FFQ - Study-specific
China Chinese 264 Mean 42/ Mixed
88 176 2 2.3 Rarely N/A 0.05 N/A Age, sex, area of residence, SES
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
176
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group CI P value
p value for trend
Adjusted for
NAS01141
Zheng
1994
Salted fish, tough meat, age 10
Never and yearly to weekly and daily
FFQ - Study-specific
China Chinese 410 Max 55/ Mixed
205 205 3 9.1 Never and yearly
5.1-16.4
Signif-icant
N/A Age, sex, area of residence
NAS01141
Zheng
1994
Salted fish, soft meat, age 10
Never and yearly to weekly and daily
FFQ - Study-specific
China Chinese 410 Max 55/ Mixed
205 205 3 10.1 Never and yearly
5.2-20.7
Signif-icant
N/A Age, sex, area of residence
NAS01190
Zheng
1993
Highest consumption of salted fish from 3 time periods: last 7 years, at age 10, and in the first 3 years
N/A FFQ - Study-specific
China Chinese 410 N/A/ Mixed
205 205 N/A N/A N/A N/A Signif-icant
N/A N/A
NAS01459
Yu
1989
Salted fish, at age 10
Rarely to daily
FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
306 306 4 2.1 Rarely 1.2-3.6
Signif-icant
<.05 Age, sex, area of residence
NAS01520
Yu
1988
Salted fish, age 10
Rarely to monthly
FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 3 1.5 Rarely 0.5-4.3
Not signif-icant
N/A Age, sex
NAS01520
Yu
1988
Salted fish head soup, age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
NAS01608
Yu
1986
Salted fish, age 10
Rarely to more than weekly
FFQ - Study-specific
China, Hong Kong
Chinese 500 Max 34/ Mixed
250 250 3 37.7 Rarely 14.1-100
Signif-icant
N/A Age, sex
NAS01608
Yu
1986
Salted fish head soup, age 10
Rarely to more than once a month
FFQ - Study-specific
China, Hong Kong
Chinese 500 Max 34/ Mixed
250 250 2 5.1 Rarely 2.6-10.4
Signif-icant
N/A Age, sex
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
177
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group CI P value
p value for trend
Adjusted for
NAS01712
Armstrong
1983
Salted fish, child Ever v. never
Unknown Malaysia Chinese 200 Mean 43/ Mixed
100 100 2 17.4 Never 2.7-111
Signif-icant
N/A Age, sex, area of residence
NAS01766
Lanier
1980
Salted fish, child Yes or no Question-naire
United States, Alaska
Alaskan native
26 32-80/ Mixed
13 13 2 4.0 No 0.4-19.7
Not signif-icant
N/A Age, sex, area of residence, ethnicity/ race
NAS01922
Ning
1990
salted fish, at age 10 years
Never to weekly or daily
FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 4 6.7 Never N/A N/A 0.003 Age, Sex, Area of residence, salted shrimp paste and carrot consumption at 10 years
NAS01922
Ning
1990
steamed salted fish, at age 10
Ever vs Never
FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 2 4.2 Never 2.2-8.3
N/A N/A Age, Sex, Area of residence
NAS01922
Ning
1990
fried, grilled, broiled salted fish, at age 10
Ever vs Never
FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 2 1.6 Never 0.8-3.2
N/A N/A Age, Sex, Area of residence
NAS02182
Armstrong
1983
NPC and Salted Fish, during childhood
Ever vs Never
N/A Malaysia Chinese 200 N/A/
Mixed
100 100 2 3.0 Never N/A 0.04 N/A Age, Sex, Area of residence, Ethnicity/ Race
NAS02182
Armstrong
1983
NPC and Salted Fish, during childhood
Never to daily
N/A Malaysia Chinese 200 N/A/
Mixed
100 100 3 17.4 Never 2.7-111.1
N/A N/A Age, Sex, Area of residence, Ethnicity/ Race
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
178
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group CI P value
p value for trend
Adjusted for
NAS02182
Armstrong
1983
NPC and Salted Fish, Consumption during adolescence
Less than weekly to daily
N/A Malaysia Chinese 200 N/A/
Mixed
100 100 2 3.5 Less than weekly
1.2- 10.7
N/A N/A Age, Sex, Area of residence, Ethnicity/ Race
NAS05679
Yang
2005
Salted fish, moldy and firm, during childhood
Never vs. 1+ times/wk
FFQ - Study-specific
Taiwan Chinese 2444 Mean 47/ Mixed
502 1942 3 1.78 Never 0.82-3.89
Not signif-icant
N/A Age, Sex, Family history of NPC
NAS06020
Na
1988
Salted Fish, during childhood
N/A Question-naire
China Chinese 344 N/A/ Mixed
127 217 Contin-uous
r2= 1.575
N/A N/A Signif-icant
N/A Area of residence, coal as family fuel, History of cancer/ naso-pharyngitis, Sex, Age
NAS06020
Na
1988
Salted Fish, during childhood
consume less to more
Question-naire
China Chinese 344 N/A/ Mixed
127 217 2 5.5 Consume less
1.16-35.89
<0.05 N/A Unadjusted
Salted fish: Childhood consumption (Ages 0-3) Case-control (10) Meta-analysis Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group CI P value
p value for trend
Adjusted for
NAS00531
Ward
2000
Salted fish, at age 3
Yes or no Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
86 102 2 1.0 No 0.5-2.1
Not signif-icant
N/A Age, sex, ethnicity/ race, total calories, mothers questionnaire
NAS01056
Lee
1994
Salted fish, during infancy
Never to more than once a month
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
200 406 3 1.2 Never 0.3-3.4
Not signif-icant
N/A Age, sex, ethnicity/ race, education
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
179
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group CI P value
p value for trend
Adjusted for
NAS01113
Zheng
1994
Salted fish, during weaning
Yes or no FFQ - Study-specific
China Chinese 264 Mean 42/ Mixed
87 171 2 2.4 No N/A 0.01 N/A Age, sex, area of residence, SES
NAS01113
Zheng
1994
Salted fish, steamed or fried, before 2
Rarely v. monthly/ weekly
FFQ - Study-specific
China Chinese 264 Mean 42/ Mixed
87 172 2 1.4 Rarely N/A 0.3 N/A Age, sex, area of residence, SES
NAS01113
Zheng
1994
Salted fish soup, before 2
Rarely v. monthly/ weekly
FFQ - Study-specific
China Chinese 264 Mean 42/ Mixed
87 162 2 1.8 Rarely N/A 0.2 N/A Age, sex, area of residence, SES
NAS01141
Zheng
1994
Salted fish, age 0-3
Never and yearly to weekly and daily
FFQ - Study-specific
China Chinese 410 Max 55/ Mixed
151 195 3 12.9 Never and yearly
5.2-20.6
Signif-icant
N/A Age, sex, area of residence
NAS01190
Zheng
1993
Highest consumption of salted fish from 3 time periods: last 7 years, at age 10, and in the first 3 years
N/A FFQ - Study-specific
China Chinese 410 N/A/ Mixed
205 205 N/A N/A N/A N/A Signif-icant
N/A N/A
NAS01381
Jeannel
1990
Salted anchovies, during weaning
Yes or no FFQ - Study-specific
Tunisia Tunisian 240 Mean 41/ Mixed
80 160 2 1.5 No N/A 0.5 N/A Age, sex, area of residence, living condition score
NAS01459
Yu
1989
Salted fish, age 1-2
Rarely to weekly
FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
306 306 3 2.0 Rarely 1.1-3.6
Signif-icant
<.05 Age, sex, area of residence
NAS01459
Yu
1989
Salted fish, during weaning
Yes or no FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
306 306 2 2.1 No 1.2-3.6
Signif-icant
N/A Age, sex, area of residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
180
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group CI P value
p value for trend
Adjusted for
NAS01520
Yu
1988
Salted fish, age 1-2
Rarely to monthly
FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 3 2.2 Rarely 0.7-7.6
Not signif-icant
.11 Age, sex
NAS01520
Yu
1988
Salted fish, during weaning
Yes or no FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 2 2.6 No 1.2-5.6
.01 N/A Age, sex
NAS01608
Yu
1986
Salted fish, age 1-2 by mother
Never to often
FFQ - Study-specific
China, Hong Kong
Chinese 500 Max 34/ Mixed
250 250 3 20.2 Never 6.8-60.2
Signif-icant
N/A Age, sex
NAS01608
Yu
1986
Salted fish, during weaning (mother)
Ever v. never
FFQ - Study-specific
China, Hong Kong
Chinese 500 Max 34/ Mixed
250 250 3 7.5 Never 3.9-14.8
Signif-icant
N/A Age, sex
NAS01608
Yu
1986
Salted fish head soup, age 1-2 (mother)
Ever v. never
FFQ - Study-specific
China, Hong Kong
Chinese 500 Max 34/ Mixed
250 250 2 8.3 Never 2.5-32.5
Signif-icant
N/A Age, sex
NAS01812
Geser
1978
Salted fish, after weaning
Yes or no FFQ - Study-specific
China, Hong Kong
Chinese 300 N/A/ Mixed
150 150 2 2.6 No N/A < 0.01 N/A Unadjusted
NAS01812
Geser
1978
Salted Fish During Weaning
No salted fish / low traditional life-style index to yes salted fish/ high traditional lifestyle index
FFQ - Study-specific
China, Hong Kong
Chinese 300 N/A/ Mixed
98 89 6 2.2 No salted fish and low traditional life-style index
N/A Not signif-icant
N/A traditional lifestyle: compilation of Chinese wine drinking, bread consumption, ancestral / Buddhist alters
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
181
Salted fish: Mother’s consumption during pregnancy or breastfeeding Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01056
Lee
1994
Salted fish, during breast-feeding
Never to more than once a month
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
49 96 3 2.0 never 0.3-10.6
Not signif-icant
0.3 Age, sex, ethnicity/ race, education
NAS01056
Lee
1994
Salted fish, during pregnancy
Never to more than once a month
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
46 94 3 1.3 never 0.4-3.7
Not signif-icant
0.6 Age, sex, ethnicity/ race, education
NAS01459
Yu
1989
Salted fish, during nursing
Rarely to daily
FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
306 306 4 2.3 Rarely 1.1-4.6
Signif-icant
<.05 Age, sex, area of residence
NAS01459
Yu
1989
Salted fish, during pregnancy
Rarely to daily
FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
306 306 4 2.2 Rarely 1.1-4.6
Signif-icant
<.05 Age, sex, area of residence
NAS01520
Yu
1988
Salted fish, while nursing
Rarely to monthly
FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 3 4.9 Rarely 1.5-15.9
Signif-icant
.01 Age, sex
NAS01520
Yu
1988
Salted fish, during pregnancy
Rarely to monthly
FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 3 3.1 Rarely 1.1-8.8
Signif-icant
.003 Age, sex
Salted seafood: Adulthood consumption Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
182
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00577
Yuan
2000
Salted seafood pastes
Yes vs. no
FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 2 1.44 No 0.97-2.15
0.07 N/A Age, sex, occupational exposure to fumes, education, smoking, environmental factors, other diseases
NAS01459
Yu
1989
salted shrimp paste, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 612 Max 49/ Mixed
306 306 N/A N/A N/A N/A Not signif-icant
N/A N/A
NAS01459
Yu
1989
salted shrimp paste, unsure time of consumption
N/A FFQ - Study-specific
China Chinese 612 Max 49/ Mixed
306 306 N/A N/A N/A N/A Not signif-icant
N/A Area of residence, age, sex, salted fish, fermented fish sauce, moldy bean curd, chan pai mui, gar ink gee, tomatoes
NAS01922
Ning
1990
salted shrimp paste, 3 years prior to diagnosis
Never to Weekly
FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 3 1.8 Never 0.9-3.8
N/A 0.12 Age, Sex, Area of Residence
Salted seafood: Childhood consumption Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01459
Yu
1989
salted shrimp paste, during ages 1-2
Rarely to weekly
FFQ - Study-specific
China Chinese 612 Max 49/ Mixed
110 138 3 N/A Rarely N/A N/A 0.07 Area of residence, age, sex, salted fish consumption during weaning
NAS01459
Yu
1989
salted shrimp paste, at age 10
Rarely to daily
FFQ - Study-specific
China Chinese 612 Max 49/ Mixed
110 139 4 N/A Rarely N/A N/A 0.04 Area of residence, age, sex, salted fish consumption during weaning
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
183
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01922
Ning
1990
salted shrimp paste, at 10 years
None to weekly/ daily
FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 4 3.2 None N/A 0.007 N/A Age, Sex, Area of residence, salted fish and carrot consumption at 10 years
Salted eggs: Adulthood consumption Case-control (5) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00531
Ward
2000
Adult Dietary Intake: salted eggs
Lowest to highest
Dietary History question-naire
China Chinese 702 Max 74/ Mixed
89 113 2 2.0 N/A 1.2-3.2
N/A N/A Age, Sex, Ethnicity/ Race, Total calories, Subjects w/ mothers questionnaire
NAS00749
Armstrong
1998
Salted eggs, 5 years pre-diagnosis
Monthly to more than weekly
Dietary History question-naire
Malaysia Chinese 564 N/A/ Mixed
282 282 3 2.55 Monthly 1.44-4.53
N/A 0.001 Unadjusted
NAS00749
Armstrong
1998
Salted eggs, lifetime consumption, includes dietary information at age 10 and age 5 years prior to diagnosis
Less than monthly to monthly or more
Dietary History question-naire
Malaysia Chinese 564 N/A/ Mixed
282 282 2 1.24 Less than monthly
N/A 0.039 N/A SES, salted fish/ pork/ beef liver, recent consumption, shrimp/ chinese flowering cabbage/ oranges/ tangerines, lifetime consumption, beer
NAS01056
Lee
1994
Salted egg, during adulthood
Never to 1-3 times per week
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
200 406 4 1.4 Never 0.6-3.2
N/A 0.2 Age, sex, ethnicity/ race, education
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
184
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01922
Ning
1990
salted chicken or duck egg, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A N/A
NAS04944
Armstrong
1978
salted egg in three main daily meals combined, among cases and controls
N/A Recall Malaysia Chinese 210 25-81/ Mixed
60 150 N/A 0.7 N/A N/A Not signif-icant
N/A Age, sex, SES, ethnicity/ race, area of residence, lifestyle factors
Salted eggs: Childhood consumption Case-control (4) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00749
Armstrong
1998
Salted eggs, consumption at age 10
Monthly to more than weekly
Dietary History question-naire
Malaysia Chinese 564 N/A/ Mixed
282 282 3 2.4 Monthly 1.4-4.11
N/A N/A Unadjusted
NAS00749
Armstrong
1998
Salted eggs, lifetime consumption, includes dietary information at age 10 and age 5 years prior to diagnosis
Less than monthly to monthly or more
Dietary History question-naire
Malaysia Chinese 564 N/A/ Mixed
282 282 2 1.24 Less than monthly
N/A 0.039 N/A SES, salted fish/ pork/ beef liver, recent consumption, shrimp/ chinese flowering cabbage/ oranges/ tangerines, lifetime consumption, beer
NAS01056
Lee
1994
salted egg, at age 10
Never to 3+ times per month
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
149 344 4 0.5 Never 0.2-1.5
N/A 0.4 Age, sex, ethnicity/ race, education
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
185
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01520
Yu
1988
salted duck eggs, during weaning
Yes vs. no FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 2 5.0 No 1.2-21
0.06 N/A Age, sex
NAS01922
Ning
1990
salted chicken or duck egg, at age 10
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A N/A
4.2.5.3.2 Salted plant food Salted vegetables: Adulthood consumption Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01190
Zheng
1993
Salted vegetables N/A FFQ - Study-specific
China Chinese 410 N/A/ Mixed
205 205 N/A N/A N/A N/A Signif- icant
N/A N/A
NAS01922
Ning
1990
Salted vegetable, consumption 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of Residence
Salted vegetables: Childhood/Infancy consumption Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
186
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01922
Ning
1990
Salted vegetable, consumption at 10 years of age
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of Residence
Salted Root Vegetables Case-control (1) Study identifier
Author, Yr
Exposure Exposure range Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS06023
Zou
1999
Salted root vegetables
< 9 times a month to ≥ 9 times a month
Question-naire
China Chinese 289 Mean 53/ Mixed
97 192 2 2.2 < 9 times a month
1.3-3.6
0.003 N/A Unadjusted
Salted Cruciferous Vegetables: Adulthood consumption Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Coun-try
Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01056
Lee
1994
kiam chye, salted mustard greens, consumption during adulthood
Never exposed to 1-3 times per week
FFQ - Study-specific
Singa-pore
Chinese 606 Max 44/ Mixed
200 406 4 3.1 Never 1.4-6.5
N/A 0.007 Age, Sex, Education level, Dialect Group
NAS01608
Yu
1986
salted mustard green (mui choi), subject's consumption at 10 years of age or 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 500 Max 34/ Mixed
250 250 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, salted fish intake
Salted Cruciferous Vegetables: Childhood consumption Case-control (2)
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
187
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Coun-try
Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01056
Lee
1994
kiam chye, salted mustard greens, consumption at 10 years old
Never exposed to more than 3 times per month
FFQ - Study-specific
Singa-pore
Chinese 606 Max 44/ Mixed
148 344 4 1.1 Never 0.4-2.6
N/A 0.9 Age, Sex, Education level, Dialect Group
NAS01520
Yu
1988
salted mustard greens, consumed by subject during weaning
Yes vs no FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 2 5.4 No 1.2-23.8
0.06 N/A Age, sex
NAS01520
Yu
1988
salted mustard green, consumed by subject between ages 1 to 2 years
Rarely to weekly
FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 3 1.6 Rarely 0.5-4.7
0.06 N/A Age, sex
NAS01520
Yu
1988
salted mustard green, consumed by subject at age 10
Rarely to weekly
FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 3 1.3 Rarely 0.3-6.7
Not signif-icant
Not signif-icant
Age, sex
NAS01520
Yu
1988
salted cabbage, consumed by subject at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
NAS01520
Yu
1988
salted radish, consumed by subject at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
NAS01520
Yu
1988
salted mustard green, consumed by subject during weaning
Rarely to monthly
FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
Salted Green Leafy Vegetables: Adulthood consumption Case-control (1)
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
188
Study identifier
Author, Yr
Exposure Expo-sure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00749
Armstrong
1998
Salted green leafy vegetables, 5 years pre-dx
Monthly to more than weekly
Dietary History question-naire
Malaysia Chinese 564 N/A/ Mixed
282 282 3 3.33 Monthly 1.84-6.01
N/A 0.001 Unadjusted
Salted Green Leafy Vegetables: Childhood consumption Case-control (1) Study identifier
Author, Yr
Exposure Expo-sure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00749
Armstrong
1998
Salted green leafy vegetables, at age 10
Monthly to more than weekly
Dietary History question-naire
Malaysia Chinese 564 N/A/ Mixed
282 282 3 0.84 Monthly 0.45-1.58
N/A N/A Unadjusted
Salted Vegetables: Adulthood consumption Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS00825
Chen
1997
Salted vegetables, 3 years ago
N/A FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 N/A N/A N/A N/A Not signfi- icant
N/A Age, Sex, Area of Residence
NAS06023
Zou
1999
Salted other non-starchy vegetables
None to ≥ 9 times a month
Question-naire
China Chinese 304 14-82/ Mixed
100 202 4 2.28 None 1.4-3.73
0.0007 N/A Unadjusted
Salted Vegetables: Childhood consumption Case-control (2)
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
189
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00825
Chen
1997
salted vegetables, 10 years old
N/A FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 Contin-uous
0.76 N/A 0.58-0.99
N/A N/A Age, Sex, Area of Residence
NAS06024
Huang
1997
Salted vegetables, exposed at age of 10, cases /control were from Guangdong province
Yes vs No Question-naire
China Chinese 416 N/A/ Mixed
104 104 2 0.755 No 0.58-1.0
0.041 N/A Age, Sex, Area of Residence
Other Salted Vegetables: Adulthood consumption Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00749
Armstrong
1998
salted root, 5 years pre-diagnosis
Monthly to more than weekly
Dietary History question-naire
Malaysia Chinese 564 N/A/ Mixed
282 282 3 2.19 monthly 1.33-3.62
N/A 0.001 Unadjusted
NAS01056
Lee
1994
sze chuan chye, a salted Chinese tuber, consumption during adulthood
Never exposed to 1-3 times per month
FFQ - Study-specific
Singa-pore
Chinese 606 Max 44/ Mixed
197 404 4 2.4 Never 1.1-5.2
N/A 0.008 Age, Sex, Education level, Dialect Group
Other Salted Vegetables: Childhood consumption Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
190
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00749
Armstrong
1998
salted root, at age 10
Monthly to more than weekly
Dietary History question-naire
Malaysia Chinese 564 N/A/ Mixed
282 282 3 1.75 monthly 0.98-3.10
N/A N/A Unadjusted
NAS01056
Lee
1994
sze chuan chye, a salted Chinese tuber, consumption at age 10 years
Never exposed to 1-3 times per month
FFQ - Study-specific
Singa-pore
Chinese 606 Max 44/ Mixed
145 340 4 1.4 Never 0.4-4.5
N/A 0.6 Age, Sex, Education level, Dialect Group
NAS01520
Yu
1988
salted root, at age 10
Rarely to daily
FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 4 3.2 Rarely 0.6-17.6
0.03 (one sided)
N/A Age, sex
NAS01520
Yu
1988
chung choi, consumed by subject during weaning
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 Contin-uous
0.518 N/A N/A 0.021 (one sided)
N/A Age, sex, other household member smoked at birth, salted fish during pregnancy, salted duck egg/ salted mustard green during weaning, dried fish/ fermented soy paste during ages 1 and 2 yr
Salted olives: Adulthood consumption Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01056
Lee
1994
salted black olives, during adulthood
Never to more than once a month
FFQ - Study-specific
Singa-pore
Chinese 606 Max 44/ Mixed
200 406 3 1.6 Never 0.3-7.5
N/A 0.4 Age, Sex, Education level, Dialect Group
Salted olives: Childhood consumption
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
191
Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01056
Lee
1994
salted black olives, at age 10
Never to more than once a month
FFQ - Study-specific
Singa-pore
Chinese 606 Max 44/ Mixed
151 344 3 0.3 Never 0.1-0.9
N/A 0.09 Age, Sex, Education level, Dialect Group
NAS01520
Yu
1988
salted olive, at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif- icant
N/A Age, sex
Salted soy: Adulthood consumption Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01056
Lee
1994
salted soy beans, during adulthood
Never exposed to > 3 times per week
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
199 406 5 6.7 Never 1.2-36.6
N/A N/A Age, Sex, Education level, Dialect Group
NAS01190
Zheng
1993
Salted Soya Bean Pastes
N/A FFQ - Study-specific
China Chinese 410 N/A. Mixed
205 205 N/A N/A N/A N/A Signif-icant
N/A N/A
Salted soy: Childhood consumption Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
192
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01056
Lee
1994
salted soy beans, at age 10 year
Never exposed to 1-3 times a week
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
146 342 4 1.1 Never 0.5-2.2
N/A 0.6 Age, Sex, Education level, Dialect Group
Other salted pulses/legumes Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01056
Lee
1994
salted black beans, consumption during adulthood
Never exposed to > 3 times per month
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
200 406 4 2.1 Never 0.8-5.4
N/A 0.8 Age, Sex, Education level, Dialect Group
NAS01056
Lee
1994
salted black beans, consumption at age 10 years
Never exposed to more than three times per month
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
148 341 4 1.0 Never 0.4-2.,3
N/A 0.5 Age, Sex, Education level, Dialect Group
4.2.6 Pickling (pickled foods) Total pickled foods Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assessment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
categories
OR Ref group CI P value
p value for trend
Adjusted for
NAS06030
Huang
2002
Pickled foods
Less to frequently consumed
Questionnaire China Chinese 525 10-78/ Mixed
175 359 2 3.21 Less consumed
1.706-5.707
N/A N/A Age, Sex, Area of Residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
193
Pickled vegetables: Adulthood consumption Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01922
Ning
1990
Pickled vegetable, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of Residence
NAS06002
Duan
2000
Pickled vegetables
N/A Question-naire
China Chinese 200 N/A/ Mixed
100 100 Continuous r2 = 0.015
N/A N/A Signif- icant
N/A Environmental Factors, Gas Range, Pungent foods, SES
Pickled vegetables: Childhood/Infancy consumption Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01381
Jeannel
1990
Dietary Intake During Weaning: Consumption of Pickled Vegetables
Less than once a month to more than 2 a week
FFQ - Study-specific
Tunisia Tunisian 240 Mean 41/ Mixed
80 160 3 2.2 Less than once a month
N/A N/A N/A Age, Sex, Area of Residence, Living condition score
NAS01922
Ning
1990
Pickled vegetable, at age 10
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of Residence
Pickled Root Vegetables Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
194
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS06024
Huang
1997
Pickled root vegetables, exposed at age of 10, cases /control were from Guangdong province
Yes vs no Question-naire
China Chinese 416 N/A/ Mixed
104 104 2 0.75 No 0.57-0.99
0.045 N/A Unadjusted
Pickled Cruciferous Vegetables: Adulthood consumption Case-control (2) Study identifier
Author, Yr
Exposure Exposure range Assess-ment
Tool
Coun-try
Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00825
Chen
1997
Pickled chinese cabbage, 3 years ago
N/A FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 N/A N/A N/A N/A Not Signif icant
N/A Age, Sex, Area of Residence
NAS06003
Ye
1995
Pickled leaf mustard
Less than 4.2 times per month to greater than 75 times per month
Dietary history question-naire
China Chinese 270 21-75/ Mixed
135 135 3 6.11 ≤ 4 .2 times per month
N/A < 0.01 N/A Age, Sex, Area of residence
NAS06003
Ye
1995
pickled radish <75 times per month to ≥ 75 times per month
Dietary history question-naire
China Chinese 270 21-75/ Mixed
135 135 2 1.75 ≤ 75 times per month
1.1-2.79
< 0.05 N/A Age, Sex, Area of residence
Pickled Cruciferous Vegetables: Childhood consumption Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Coun-try
Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
195
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Coun-try
Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS00825
Chen
1997
Pickled Chinese Cabbage, 10 years old
N/A FFQ - Study-specific
China Chinese 208 25-54/ Mixed
104 104 Continuous 0.75 N/A 0.57-0.99
N/A N/A Age, Sex, Area of Residence
NAS01520
Yu
1988
pickled cabbage, consumed by subject at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
Other Pickled Vegetables: Adulthood consumption Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01381
Jeannel
1990
Intake During Preceding Year to Diagnosis: Fungus on Pickled Vegetables
Yes or no FFQ - Study-specific
Tunisia Tunisian 240 Mean 41/ Mixed
80 160 2 3.3 No N/A 0.03 N/A Age, sex, area of residence, living condition score
NAS06023
Zou
1999
pickles <9 times/ month to ≥ 9 times/ month
Dietary History question-naire
China Chinese 289 28-82/ Mixed
97 191 2 2.2 <9 times per month
1.3-3.6
0.003 N/A Age, sex, year of death
Other Pickled Vegetables: Childhood consumption Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
196
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01381
Jeannel
1990
During Weaning: Fungus on pickled vegetables
Yes or no FFQ - Study-specific
Tunisia Tunisian 240 Mean 41/ Mixed
80 160 2 3.8 No N/A 0.03 N/A Age, sex, area of residence, living condition score
Pickled olives: Adulthood consumption Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01381
Jeannel
1990
During Preceding Year to Diagnosis: Pickled Olives
Less than once a month to > 8 times / month
FFQ - Study-specific
Tunisia Tunisian 240 Mean 41/ Mixed
80 160 3 8.7 Less than once a month
N/A N/A N/A Age, sex, area of residence, living condition score
NAS01381
Jeannel
1990
Preceding Year to Diagnosis: Pickled Olives
<once/ month to > 8 times / month
FFQ - Study-specific
Tunisia Tunisian 240 Mean 41/ Mixed
80 160 3 5.5 Less than once a month
N/A N/A N/A Age, sex, area of residence
Pickled spice intake Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00424
Laouamri
2001
Seasonings: Pickled Peppers
Currently to twenty years ago
FFQ - Study-specific
Algeria N/A 144 9-70/ Mixed
72 72 2 2.85 N/A 1.25-6.45
N/A N/A Age, sex, area of residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
197
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS04944
Armstrong
1978
pickled chili, in three main daily meals combined, among cases and controls
Yes or no Recall Malaysia Chinese 210 25-81/ Mixed
60 150 2 0.3 N/A N/A <.01 N/A Age, sex, ethnicity/ race,SES, household type, area of residence
4.2.7.1.1 Cured meats Cured meat: Adulthood consumption Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS00531
Ward
2000
Adult Dietary Intake: cured meats
Never vs. Ever
Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
375 327 2 N/A Never N/A Not signif-icant
N/A Age, sex, ethnicity/ race
NAS01922
Ning
1990
cured meat, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A N/A
Cured meat: Childhood consumption Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS00531
Ward
2000
Cured Meat, At Age 10
Yes vs. no Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
89 111 2 1.11 No 0.6-2
N/A N/A Age, sex, ethnicity/ race
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
198
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS00531
Ward
2000
Cured Meat, At Age 10
Yes vs. no Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
92 109 2 0.8 No 0.4-1.8
N/A N/A Age, sex, ethnicity/ race
NAS01922
Ning
1990
cured meat, at age 10
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A N/A
4.2.7.1.2 Smoked foods Smoked meat: Adulthood consumption Case-control (4) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00531
Ward
2000
Adult Dietary Intake: smoked meats
Never vs. Ever
Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
375 327 2 N/A Never N/A Not signif-icant
N/A Age, sex, ethnicity/ race
NAS00544
Chelleng
2000
smoked meat Never & rarely to frequently
Unknown-NA
India Indian 141 Mean 44/ Mixed
47 94 2 10.8 Never & rarely
3.4-39
0.0002 N/A Age, sex, ethnicity/ race, Area of residence, Alcohol / Smoking / betel nut chewing habits, type of house, number of windows, kitchen inside/ outside, soot in living room, type of cooking fuel, smokeless tobacco use
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
199
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01922
Ning
1990
smoked meat, consumption 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A N/A
NAS06023
Zou
1999
Smoked, processed meat
Yes vs. no Question-naire
China Chinese 304 14-82/ Mixed
102 202 2 1.8 No 1.09-2.97
0.02 N/A Unadjusted
Smoked meat: Childhood consumption Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS00531
Ward
2000
Smoked meat, Age 10
Yes vs. no Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
92 114 2 1.1 No 0.5-2.4
N/A N/A Age, sex, ethnicity/ race
NAS00531
Ward
2000
Smoked meat, at Age 3
Yes vs. no Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
92 110 2 1.2 No 0.4-3.3
N/A N/A Age, sex, ethnicity/ race
NAS00531
Ward
2000
Smoked meat, During Weaning
Yes vs. no Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
89 112 2 2.2 No 0.2-27.6
N/A N/A Age, sex, ethnicity/ race
NAS01922
Ning
1990
smoked meat, at age 10
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A N/A
4.3 Processing
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
200
Processed meat: Adulthood consumption Case-control (5) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00700
Farrow
1998
Processed, preserved meat (ham, bacon, sausage, liverwurst, hot dogs)
Lowest to highest
FFQ – Block
United States
Unknown 345 18-74/ Mixed
129 204 4 1.54 Lowest 0.71-3.33
N/A 0.15 Age, Sex, Energy Intake, Alcohol, Smoking Habits
NAS01056
Lee
1994
lapcheong, Chinese sausage, during adulthood
Never to 3+ times a month
FFQ - Study-specific
Singa-pore
Chinese 606 Max 44/ Mixed
200 406 4 1.0 Never 0.3-2.8
N/A 0.9 Age, sex, ethnicity/ race, education
NAS01153
West
1993
Processed meat, including ham and longanisa
Low to high tertile
Unknown Philip-pines
Filipino 205 11-83/ Mixed
104 205 3 0.46 Low tertile
0.2-1.0
N/A N/A Age, sex, fresh fish, processed meat, hospital ward, Smoking, Burning anti-mosquito coils. Dust/ exhaust, Formaldehyde, Herbal medicines, Education
NAS01608
Yu
1986
liver sausage, at 10 years of age or 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 500 Max 34/ Mixed
250 250 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, salted fish intake
NAS06023
Zou
1999
Smoked, processed meat
Yes vs. no Question-naire
China Chinese 304 14-82/ Mixed
102 202 2 1.8 No 1.09-2.97
0.02 N/A Unadjusted
Processed meat: Childhood consumption Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
201
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01056
Lee
1994
lapcheong, Chinese sausage, at age 10
Never to 3+ times a month
FFQ - Study-specific
Singa-pore
Chinese 606 Max 44/ Mixed
149 344 4 0.8 Never 0.3-2.4
N/A 0.8 Age, sex, ethnicity/ race, education
NAS01520
Yu
1988
liver sausage, consumed by subject at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
NAS01608
Yu
1986
liver sausage, at 10 years of age or 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 500 Max 34/ Mixed
250 250 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, salted fish intake
Processed pork Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
categories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01520
Yu
1988
Ham, at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
NAS01520
Yu
1988
Pork sausage, at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
NAS01608
Yu
1986
Pork sausage, at age 10 or adult
N/A FFQ - Study-specific
China Chinese 500 Max 34/ Mixed
250 250 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, salted fish intake
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
202
4.3.1 Refining Bread: Adulthood consumption Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Cont-rols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01459
Yu
1989
Bread, consumption at age 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 612 Max 49/ Mixed
306 306 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of residence
NAS01812
Geser
1978
Bread eaten often, by household of cases and controls
Yes vs No FFQ - Study-specific
China Chinese 300 N/A/ Mixed
147 147 2 0.43 No 0.27-0.7
N/A N/A Age, Sex
NAS04944
Armstrong
1978
Bread, for breakfast among families of participants
N/A Recall Malaysia Chinese 210 25-81/ Mixed
60 150 N/A OR > 1
N/A N/A Signif-icant
N/A Unadjusted
Bread: Childhood consumption Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of sub jects
No.
cases
No.
Cont-rols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS00424
Laouamri
2001
Foods for chewing when teething: crust of bread
Ever vs Never
FFQ - Study-specific
Algeria Un-known
144 9-70/ Mixed
72 72 2 OR = 1
Ever N/A N/A N/A Age, Sex, Area of residence
NAS01459
Yu
1989
Bread, consumption at age 10
N/A FFQ - Study-specific
China Chinese 612 Max 49/ Mixed
306 306 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
203
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of sub jects
No.
cases
No.
Cont-rols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01520
Yu
1988
Bread, consumed by subject at age 10
N/A FFQ - Study-specific
China Chinese 302 Mean 35/ Mixed
128 174 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex
Noodles Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Cont-rols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS04944
Armstrong
1978
Noodles in three main daily meals combined, among cases and controls
N/A Recall Malaysia Chinese 210 25-81/ Mixed
60 150 N/A 1.2 N/A N/A Not signif-icant
N/A Ethnicity/ Race, Census district, Household type, Socio-economic status, Sex, Age
Rice Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Cont-rols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS04944
Armstrong
1978
Rice, for breakfast; families of participants
N/A Recall Malaysia Chinese 210 25-81/ Mixed
60 150 N/A OR > 1
N/A N/A Signif-icant
N/A Unadjusted
NAS04944
Armstrong
1978
Plain rice, at evening meal; families of participants
N/A Recall Malaysia Chinese 210 25-81/ Mixed
60 150 N/A OR < 1
N/A N/A Signif-icant
N/A Unadjusted
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
204
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Cont-rols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS04944
Armstrong
1978
Rice porridge, at evening meal among families of participants
N/A Recall Malaysia Chinese 210 25-81/ Mixed
60 150 N/A OR > 1
N/A N/A Signif-icant
N/A Unadjusted
NAS06024
Huang
1997
Rice, exposed at age 10, specific on rice cases and control were from Heilongjiang province
Yes vs No Question-naire
China Chinese 416 N/A/ Mixed
104 104 2 0.707 No 0.505-0.92
0.044 N/A Unadjusted
Ecological (1) Study identifier
Author, Yr
Exposure Exposure range
Assessment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
categories
r2 Ref group
CI P value
p value for trend
Adjusted for
NAS00817
Koo
1997
Rice Per capita consumption
Food survey
China, Hong Kong
Chinese N/A Male N/A N/A Continuous 0.86 N/A N/A .001 N/A age
NAS00817
Koo
1997
Rice Per capita consumption
Food survey
China, Hong Kong
Chinese N/A Female N/A N/A Continuous 0.85 N/A N/A .034 N/A age
4.3.2 Hydrogenation Margarine Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Coun-try Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
205
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Coun-try Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01056
Lee
1994
margarine, at age 10
Never to >3 times a week
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
113 340 5 0.6 Never 0.3-1.1
N/A 0.03 Age, sex, education, ethnicity/ race
4.3.3 Fermenting Fermented soy/tofu: Adulthood consumption Case-control (6) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00531
Ward
2000
Adult Dietary Intake: fermented soybean products
Never vs. ever
Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
375 327 2 N/A No N/A Not signif-icant
N/A Age, sex, ethnicity/ race, total calories, mothers questionnaire
NAS00577
Yuan
2000
Fermented beans/ pastes (not specified, but measured fermented bean curd (fu yu), fermented bean paste (tau ban cheung)
Less than monthly to weekly or more
FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 3 1.76 Less than monthly
1.39-2.22
N/A <0.001 Sex, Age, Educational Level, Smoking, Exposure to smoke from heated rapeseed oil and burning coal while cooking, Occupational exposure to chemical fumes, History of chronic ear and nose condition
NAS01459
Yu
1989
moldy bean curd, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
306 306 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, area of residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
206
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01459
Yu
1989
moldy bean curd, unsure time of consumption
N/A FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
306 306 N/A N/A N/A N/A Signif-icant
N/A Age, sex, area of residence, salted fish, fermented fish sauce, salted shrimp paste, chan pai mui, gar ink gee, tomatoes
NAS01608
Yu
1986
moldy bean curd, at 10 years or 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 500 Max 34/ Mixed
250 250 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, salted fish intake
NAS01922
Ning
1990
moldy bean curd, preserved, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A Age, Sex, Area of residence
NAS01922
Ning
1990
smelly bean curd, consumption 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A Age, Sex, Area of residence
NAS01922
Ning
1990
fermented soy/flour paste, consumption 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A Age, Sex, Area of residence
NAS06023
Zou
1999
Fermented soy < 9 times a month to ≥ 9 times a month
Dietary History question-naire
China Chinese 304 14-82/ Mixed
100 202 2 1.45 < 9 times a month
0.78-2.83
N/A N/A Age, Sex, Live in area with high level of background radiation, Alcohol, Smoking habits, Salted fish
NAS06023
Zou
1999
tofu, soy products
Never to ≥ 9 times a month
Dietary History question-naire
China Chinese 304 14-82/ Mixed
102 201 2 2.36 Never 0.26-21.3
0.17 N/A Unadjusted
Fermented soy/tofu: Childhood consumption
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
207
Case-control (6) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00531
Ward
2000
2.3 Fermented soybean products, at Age 10
< 16 grams to ≥ 118.8 grams
Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
98 115 4 0.5 < 16 grams
0.2-1.2
N/A N/A Age, sex, ethnicity/ race
NAS00531
Ward
2000
Fermented soybean products, at Age 3
None to ≥80.4 grams
Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
93 111 4 0.7 None 0.3-1.9
N/A N/A Age, sex, ethnicity/ race
NAS00531
Ward
2000
During Weaning Fermented soybean products
None to 12.04 grams
Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
90 113 4 0.6 None 0.3-1.3
N/A N/A Age, sex, ethnicity/ race
NAS01056
Lee
1994
fermented bean curd, at age 10
Never exposed to 1-3 times per week
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
151 341 4 0.8 Never 0.4-1.8
N/A 0.3 Age, Sex, Education level, Dialect Group
NAS01459
Yu
1989
Moldy bean curd, ages 1-2
Rarely to weekly
FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
110 139 3 N/A Rarely N/A N/A 0.05 Age, sex, area of residence, salted fish consumption during weaning
NAS01459
Yu
1989
Moldy bean curd, at age 10
Rarely to daily
FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
110 138 4 N/A Rarely N/A N/A 0.98 Age, sex, area of residence, salted fish consumption during weaning
NAS01520
Yu
1988
fermented soy bean paste, ages 1 to 2
Rarely to weekly
FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 3 3.6 Rarely 1.6-8.1
N/A 0.007 Age, sex
NAS01520
Yu
1988
fermented soy bean paste, at age 10
Rarely to weekly
FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 3 1.5 Rarely 0.8-3.0
N/A Not signif-icant
Age, sex
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
208
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01520
Yu
1988
moldy bean curd, consumed at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
NAS01520
Yu
1988
fermented soy bean paste, consumed by subject at age 1-2
Rarely to monthly
FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 Contin-uous
r2 = -.23
Rarely N/A 0.240 N/A Age, sex, salted fish during pregnancy, salted duck egg / salted mustard green / chung choi during weaning, dried fish during ages 1 and 2 yr
NAS01520
Yu
1988
fermented soy bean paste, consumed by subject at age 1-2
Rarely to weekly
FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 Contin-uous
r2 = .988
Rarely N/A 0.018 N/A Age, sex, salted fish during pregnancy, salted duck egg / salted mustard green / chung choi during weaning, dried fish during ages 1 and 2 yr
NAS01608
Yu
1986
moldy bean curd, at 10 years or 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 500 Max 34/ Mixed
250 250 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, salted fish intake
NAS01922
Ning
1990
moldy bean curd, preserved, at age 10
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A Age, Sex, Area of residence
NAS01922
Ning
1990
smelly bean curd, consumption at 10 years of age
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A Age, Sex, Area of residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
209
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01922
Ning
1990
fermented soy/flour paste, consumption at 10 years of age
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A Age, Sex, Area of residence
Other fermented pulses/legumes Cohort (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
RR Ref group
CI P value
p value for trend
Adjusted for
NAS06046
Lin
1997
Fermented pulses
<2 times a week- 6+ times a week
Question-naire
China, Taiwan
Chinese 9775 Min 30/ Males
N/A N/A 3 12.7 <2 times a week
2.2-72.3
<.05 N/A Age, EBV status, family history of NPC, nasopharyngitis
Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01520
Yu
1988
fermented black bean paste, consumed by subject between ages 1 to 2 years
Rarely to weekly
FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 3 4.6 Rarely 1.8-11.4
N/A 0.0009 Age, sex
NAS01520
Yu
1988
fermented black bean paste, consumed by subject at age 10
Rarely to weekly
FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 3 1.4 Rarely 0.6-3.1
N/A Not signif-icant
Age, sex
NAS06023
Zou
1999
Fermented beans <9 times/ month to ≥9 times/ month
Dietary History question-naire
China Chinese 304 14-82/ Mixed
97 192 2 2.1 <9 times per month
1.3-3.4
0.004 N/A Age, sex, year of death
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
210
Fermented fish Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01459
Yu
1989
Fermented fish sauce -adult
N/A FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
306 306 2 N/A N/A N/A Not signif-icant
N/A Age, sex, area of residence
NAS01459
Yu
1989
Fermented fish sauce -age 10
Rarely to daily
FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
306 306 4 N/A Rarely N/A N/A .93 Age, sex, area of residence, salted fish
NAS01459
Yu
1989
Fermented fish sauce -age 1-2
Rarely to weekly
FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
306 306 3 N/A Rarely N/A N/A .08 Age, sex, area of residence, salted fish
NAS01520
Yu
1988
Fermented fish paste, age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
Fermented seafood: Childhood consumption Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01520
Yu
1988
fermented crab paste, at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
NAS01520
Yu
1988
fermented shrimp paste, at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
211
Fermented eggs Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01520
Yu
1988
pay dann - a kind of fermented duck egg, at age 10
Rarely to weekly
FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
NAS01922
Ning
1990
fermented duck egg, at 10 years of age
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A N/A
NAS01922
Ning
1990
fermented duck egg, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A N/A
Soy sauce: Adulthood consumption Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00577
Yuan
2000
Soy sauce (see yao)
N/A FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 N/A N/A N/A N/A Not signif-icant
N/A N/A
NAS01813
Shanmugaratnam
1978
Soya Sauce (Ear, Nose, and Throat Department controls)
Less than once daily to more than twice daily
FFQ - Study-specific
Singapore Chinese 2018 N/A/ Mixed
379 1639 5 0.973 N/A N/A Not signif-icant
N/A Age, Sex, interviewer
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
212
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01813
Shanmugaratnam
1978
Soya Sauce (Non-ENT hospital controls)
Less than once daily to more than twice daily
FFQ - Study-specific
Singapore Chinese 2018 N/A/ Mixed
379 1639 5 0.754 N/A N/A Not signif-icant
N/A Age, Sex, interviewer
NAS04944
Armstrong
1978
thin soya sauce, in three main daily meals combined, among cases and controls
N/A Recall Malaysia Chinese 210 25-81/ Mixed
60 150 N/A 0.9 N/A N/A Not signif-icant
N/A Age, sex, ethnicity/ race,SES, household type, area of residence
NAS04944
Armstrong
1978
thin soya sauce, for breakfast among families of participants
N/A Recall Malaysia Chinese 210 25-81/ Mixed
60 150 N/A N/A N/A N/A Not signif-icant
N/A N/A
Other fermented condiment intake: Adulthood consumption Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00577
Yuan
2000
Fish sauce (yu lo)
N/A FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 N/A N/A N/A N/A Not signif-icant
N/A N/A
NAS00577
Yuan
2000
Oyster sauce (ho yao)
N/A FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 N/A N/A N/A N/A Not signif-icant
N/A N/A
NAS01812
Geser
1978
Oyster Soy
N/A FFQ - Study-specific
China, Hong Kong
Chinese 300 N/A/ Mixed
150 150 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, Use of ancestral alters and Buddhist alters, Vinegar, Xanthozylon Seeds, Flavor Essence, Mustard Paste, Chinese Wine, Bread
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
213
Other fermented condiment intake: Childhood consumption Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
categories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01520
Yu
1988
soy sauce, at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A N/A
NAS01520
Yu
1988
fish sauce, at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A N/A
NAS01520
Yu
1988
oyster sauce, at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A N/A
4.3.5.1 Flavours Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
categories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01113
Zheng
1994
Monosodium glutamate, in the year before diagnosis
Yes or No
FFQ - Study-specific
China Chinese 264 Mean 42/ Mixed
88 176 2 0.7 No N/A 0.3 N/A Age, sex, area of residence, SES
NAS01812
Geser
1978
Flavour Essence
Yes vs No
FFQ - Study-specific
China Chinese 300 N/A/ Mixed
147 147 2 N/A No N/A Not Signif-icant
N/A Age, Sex, lifestyle factors, Vinegar, Xanthozylon Seeds, Oyster Soy, Mustard Paste, Chinese Wine, Bread
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
214
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
categories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS06002
Duan
2000
pungent foods N/A Question-naire
China Chinese 200 N/A/ Mixed
100 100 Continuous r2 = -1.695
N/A N/A Signif- icant
N/A Environmental Factors, Pickled foods, SES
4.3.5.4.1 Nitrites and nitrates (as food additives) Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00531
Ward
2000
Adult Intake: nitrate intake from fresh and preserved vegetables
Highest vs lowest
Dietary History question-naire
China Chinese 702 Max 74/ Mixed
375 327 2 0.5 Low-est
0.3-08
Signif-icant
N/A Age, sex, total calories, ethnicity/ race, Subjects w/ mothers questionnaire
NAS00531
Ward
2000
Childhood Intake for Age 10: Nitrite from soybean products
Highest vs lowest quartile
Dietary History question-naire
China Chinese 702 Max 74/ Mixed
375 327 4 0.6 Low-est
0.3-1.4
Not signif-icant
N/A Age, sex, ethnicity/ race, vegetable intake
NAS00531
Ward
2000
Childhood Intake for Age 3: Nitrite from soybean products
Highest vs lowest quartile
Dietary History question-naire
China Chinese 702 Max 74/ Mixed
375 327 4 1.2 Low-est
0.4-3.0
Not signif-icant
N/A Age, sex, ethnicity/ race, vegetable intake
NAS00531
Ward
2000
Intake During Weaning: Nitrite from soybean products
Highest vs lowest quartile
Dietary History question-naire
China Chinese 702 Max 74/ Mixed
375 327 4 0.7 Low-est
0.3-1.4
Not signif-icant
N/A Age, sex, ethnicity/ race, vegetable intake
NAS00531
Ward
2000
Mother's intake of nitrite during breast-feeding: from soybean products
Highest vs lowest tertile
Dietary History question-naire
China Chinese 702 Max 74/ Mixed
375 327 3 0.7 Low-est
0.3-1.7
Not signif-icant
N/A N/A
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
215
Ecological (3) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Source
Country Ethnicity
of subjects
No of Populations analysed
Age/ Sex of sub-jects
No.
cases
No.
controls
No.
categories
Mean Ref group
CI P value Adjusted for
NAS06019
Huang
1982
Nitrites .007 - .029 g/L
pickles China Chinese 86 N/A/ Mixed
Wuhua: 61, Sihui: 86, Zhong-shang: 61
N/A 3 Sihui = .007
Zhong-shang = .029
Wuhua = .019g/L
N/A Sihui = <0.01
Zhong-shang = <0.05
Unadjusted
NAS06019
Huang
1982
Nitrates 9.76 – 13.78 g/L
pickles China Chinese 86 N/A/ Mixed
Wuhua: 61, Sihui: 86, Zhong-shang: 61
N/A 3 Sihui = 9.76
Zhong-shang = 12.02
Wuhua = 13.78 g/L
N/A Sihui = >0.05
Zhong-shang = >0.05
Unadjusted
NAS06019
Huang
1982
Secondary amines
9.67 – 15.82 g/L
pickles China Chinese 86 N/A/ Mixed
Wuhua: 61, Sihui: 86, Zhong-shang: 61
N/A 3 Sihui = 15.82
Zhong-shang = 14.36
Wuhua = 9.67 g/L
N/A Sihui = >0.05
Zhong-shang = >0.05
Unadjusted
NAS06041
Huang
1983
Nitrites 0-0.53 mg/L
rice China Chinese N/A N/A/ Mixed
Wuhua: 60, Sihui: 109, Zhong-shang: 60
N/A 3 Sihui = 0.13
Zhong-shang = 0.23
Wuhua = 0.23 mg/L
N/A Sihui = <0.01
Zhong-shang = >0.05
Unadjusted
NAS06041
Huang
1983
Nitrites 0-0.40 mg/L
drinking water
China Chinese N/A N/A/ Mixed
Wuhua: 61, Sihui: 86, Zhong-shang: 61
N/A 3 Sihui = .0018
Zhong-shang = .017
Wuhua = 0.01 mg/L
N/A Sihui = >0.05
Zhong-shang = <0.01
Unadjusted
NAS06041
Huang
1983
nitrates 0.13-17.44 mg/L
rice China Chinese N/A N/A/ Mixed
Wuhua: 60, Sihui: 109, Zhong-shang: 60
N/A 3 Sihui = 6.44
Zhong-shang = 1.14
Wuhua = 1.05 mg/L
N/A Sihui = <0.01
Zhong-shang = >0.05
Unadjusted
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
216
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Source
Country Ethnicity
of subjects
No of Populations analysed
Age/ Sex of sub-jects
No.
cases
No.
controls
No.
categories
Mean Ref group
CI P value Adjusted for
NAS06041
Huang
1983
nitrates 0-43.28 mg/L
drinking water
China Chinese N/A N/A/ Mixed
Wuhua: 61, Sihui: 86, Zhong-shang: 61
N/A 3 Sihui = 2.26
Zhong-shang = 13.21
Wuhua = 2.33 mg/L
N/A Sihui = >0.05
Zhong-shang = <0.01
Unadjusted
NAS06041
Huang
1983
Secondary amines
0.34-99.46 mg/L
Pickled foods
China Chinese N/A N/A/ Mixed
Wuhua: 61, Sihui: 45, Zhong-shang: 61
N/A 3 Sihui = 15.52
Zhong-shang = 14.36
Wuhua = 9.67 mg/L
N/A Sihui = >0.05
Zhong-shang = >0.05
Unadjusted
NAS06043
Huang
1988
Nitrites and nitrates
3.9-13 ppb
pickles consumed by local residents
China, Taiwan
Chinese Case present the high risk area of NPC-Sihui county, Control present the low risk area of NPC-Wuhua County
N/A/ Mixed
45 36 2 Sihui = 13 ppb
Wuhua = 3.9 ppb
N/A <0.01 Unadjusted
4.4.1 Fresh food Fresh animal foods Fresh meat: Adulthood consumption Case-control (4) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS00577
Yuan
2000
Organ meat, fresh
N/A FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 3 N/A N/A N/A Not signif-icant
N/A Unadusted
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
217
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS00749
Armstrong
1998
Fresh pork/beef liver, at age 10 and age 5 years prior to diagnosis
Less than monthly to more than weekly
Dietary History question-naire
China Chinese 564 N/A/ Mixed
282 282 3 2.03 Less than monthly
NA 0.0001 N/A Unadjusted
NAS00749
Armstrong
1998
other fresh pork/beef organs, 5 years prior to diagnosis
Less than monthly to more than weekly
Dietary History question-naire
China Chinese 564 N/A/ Mixed
282 282 3 4.63 Less than monthly
1.89-11.3
N/A .009 Unadjusted
NAS01459
Yu
1989
Fresh meat, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
306 306 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, area of residence
NAS01922
Ning
1990
fresh liver, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A Age, Sex, Area of residence
Fresh meat: Childhood consumption Case-control (4) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS00749
Armstrong
1998
fresh pork/beef liver, at age 10 and age 5 years prior to diagnosis
Less than monthly to more than weekly
Dietary History question-naire
China Chinese 564 N/A/ Mixed
282 282 3 2.03 Less than monthly
NA 0.0001 N/A Unadjusted
NAS00749
Armstrong
1998
other fresh pork/beef organs, at age 10
Less than monthly to more than weekly
Dietary History question-naire
China Chinese 564 N/A/ Mixed
282 282 3 1.12 Less than monthly
0.51-2.46
N/A N/A Unadjusted
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
218
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01459
Yu
1989
Fresh meat, at age 10
N/A FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
306 306 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, area of residence
NAS01459
Yu
1989
Fresh meat, at age 1-2
N/A FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
306 306 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, area of residence
NAS01520
Yu
1988
fresh meats, during weaning
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A 0.98 N/A Age, sex
NAS01520
Yu
1988
fresh meats, ages 1-2
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A 0.88 N/A Age, sex
NAS01520
Yu
1988
fresh meats, at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
NAS01922
Ning
1990
fresh liver, at 10 years of age
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A Age, Sex, Area of residence
Fresh fish Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
219
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01459
Yu
1989
Fresh fish sauce, adult
N/A FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
306 306 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, area of residence
NAS01459
Yu
1989
Fresh fish sauce, age 10
N/A FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
306 306 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, area of residence
NAS01459
Yu
1989
Fresh fish sauce, age 1-2
N/A FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
306 306 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, area of residence
NAS01520
Yu
1988
Fresh fish, age 10
Yes or no FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
NAS01520
Yu
1988
Fresh fish, age 1-2
Yes or no FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A 0.23 N/A Age, sex
NAS01520
Yu
1988
Fresh fish, during weaning
Yes or no FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A 0.09 N/A Sex
NAS01922
Ning
1990
boiled fish, fresh, at age 10
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A Age, Sex, Area of residence
NAS01922
Ning
1990
boiled fish, fresh, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A Age, Sex, Area of residence
Fresh seafood
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
220
Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS00577
Yuan
2000
Seafood, fresh N/A FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 N/A N/A N/A N/A Not signif- icant
N/A N/A
NAS01922
Ning
1990
crab, fresh, at age 10
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A N/A
NAS01922
Ning
1990
crab, fresh, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A N/A
NAS01922
Ning
1990
jellyfish, fresh, at age 10
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A N/A
NAS01922
Ning
1990
jellyfish, fresh, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A N/A
NAS04944
Armstrong
1978
fresh prawns, at evening meal among families of cases / controls
N/A Recall Malaysia Chinese 210 25-81/ Mixed
60 150 N/A <1.0 N/A N/A Signif-icant
N/A N/A
NAS04944
Armstrong
1978
fresh prawn in 3 main daily meals combined, among cases / controls
N/A Recall Malaysia Chinese 210 25-81/ Mixed
60 150 N/A 0.7 N/A N/A <0.05 N/A Age, sex, SES, ethnicity/ race, area of residence, lifestyle factors
Fresh eggs Case-control (3)
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
221
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS00577
Yuan
2000
Eggs, fresh N/A FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 N/A N/A N/A N/A Not signif-icant
N/A N/A
NAS01520
Yu
1988
fresh eggs during weaning
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A 0.92 N/A Age, sex
NAS01520
Yu
1988
fresh eggs, ages 1 to 2 years
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A 0.36 N/A Age, sex
NAS01520
Yu
1988
fresh eggs, at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
NAS04944
Armstrong
1978
fresh eggs, at evening meal among families of cases and controls
N/A Recall Malaysia Chinese 210 25-81/ Mixed
60 150 N/A <1.0 N/A N/A Signif-icant
N/A N/A
NAS04944
Armstrong
1978
fresh egg in three main daily meals, among cases/ controls
N/A Recall Malaysia Chinese 210 25-81/ Mixed
60 150 N/A 1.1 N/A N/A Not signif-icant
N/A Age, sex, SES, ethnicity/ race, area of residence, lifestyle factors
NAS04944
Armstrong
1978
Fresh egg, for breakfast among families of partici-pants
N/A Recall Malaysia Chinese 210 25-81/ Mixed
60 150 N/A N/A N/A N/A Not signif-icant
N/A N/A
Fresh milk Case-control (1)
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
222
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS00577
Yuan
2000
Fresh milk
N/A FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 N/A N/A N/A N/A Not signif-icant
N/A Unadjusted
Fresh plant foods Fresh vegetables: Adulthood consumption Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00577
Yuan
2000
All fresh vegetables
≤ 538 times per year to > 866 times per year
FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 4 0.85 ≤ 538 times per year
0.65-1.10
N/A 0.13 Sex, Age, Education, Smoking, Exposure to smoke from heated rapeseed oil and burning coal while cooking, occupational exposure to chemical fumes, History of chronic ear and nose condition
NAS01922
Ning
1990
Fresh vegetable, consumption 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of Residence
Ecological (1) Study identifier
Author, Yr
Exposure Exposure range
Assessment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
categories
Regression slope
Ref group
CI P value
p value for trend
Adjusted for
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
223
NAS00817
Koo
1997
Fresh vegetables
N/A Per capita consumption
China, Hong Kong
Chinese N/A Male N/A N/A Continuous r2 = -0.77 N/A N/A 0.009 N/A age
NAS00817
Koo
1997
Fresh vegetables
N/A Per capita consumption
China, Hong Kong
Chinese N/A Female N/A N/A Continuous r2 = -0.75 N/A N/A 0.013 N/A age
Fresh vegetables: Childhood/Infancy consumption Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assessment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00531
Ward
2000
Mother's diet during breastfeeding: Fresh vegetables
Highest vs lowest
Dietary History questionnaire
China Chinese 702 Max 74/ Mixed
375 327 N/A 0.3 Lowest 0.1-1/5
N/A N/A N/A
NAS01922
Ning
1990
Fresh vegetable, consumption at 10 years of age
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of Residence
Fresh green vegetables: Childhood consumption Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01459
Yu
1989
Fresh green vegetables, consumption during weaning
Yes vs No FFQ - Study-specific
China Chinese 612 Max 49/ Mixed
306 306 2 0.6 No 0.3-1.1
N/A N/A Age, Sex, Area of Residence
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
224
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01459
Yu
1989
Fresh green vegetables, consumption during ages 1-2
Rarely to weekly
FFQ - Study-specific
China Chinese 612 Max 49/ Mixed
110 139 3 1.7 Weekly 0.6-4.9
N/A Not Signif icant
Age, Sex, Area of Residence
NAS01459
Yu
1989
Fresh green vegetables, consumption at age 10
Less than daily to daily
FFQ - Study-specific
China Chinese 612 Max 49/ Mixed
306 306 2 1.3 Daily 0.3-5.1
N/A N/A Age, Sex, Area of Residence
Other fresh vegetables Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS04944
Armstrong
1978
Fresh vegetables, at evening meal among families of participants
N/A Recall Malaysia Chinese 210 25-81/ Mixed
60 150 N/A OR < 1
N/A N/A Signif- icant
N/A Unadjusted
Fresh cabbage: Adulthood consumption Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Coun-try
Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00577
Yuan
2000
Fresh Bok Choi (chinese white cabbage)
Less than weekly to daily
FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 3 0.97 Weekly 0.81-1.17
N/A 0.85 Age, sex, area of residence, environmental factors, smoking, chemical fumes, history of ear/nose condition
Fresh Green Leafy Vegetables: Adulthood consumption Case-control (1)
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
225
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00577
Yuan
2000
Other dark green leafy vegetable (not bok choi) fresh
Less than weekly to daily
FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 3 1.25 Less than weekly
0.73-2.14
N/A 0.33 Age, sex, area of residence, environmental factors, smoking, chemical fumes, history of ear/nose condition
Fresh Green Leafy Vegetables: Childhood consumption Case-control (1) Study identifier
Author, Yr
Exposure Expo-sure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01520
Yu
1988
fresh green leafy vegetables, during weaning
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
0.86 Age, sex
NAS01520
Yu
1988
fresh green leafy vegetables, between ages 1 to 2 years
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
0.92 Age, sex
NAS01520
Yu
1988
fresh leafy green vegetables, at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif-icant
N/A Age, sex
Fresh Tomatoes: Adulthood consumption Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
226
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00577
Yuan
2000
Tomatoes, fresh
Less than weekly to daily
FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 3 0.92 Less than weekly
N/A N/A 0.10 Age, sex, area of residence, environmental factors, smoking, chemical fumes, history of ear/nose condition, oranges/ tangerines
Other Fresh Vegetables: Adulthood consumption Case-control (1) Study identifier
Author, Yr
Exposure Expo-sure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00577
Yuan
2000
Light green/ orange leafy vegetables, fresh
Less than weekly to daily
FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 3 0.98 Less than weekly
0.63-1.5
N/A 0.79 Age, sex, area of residence, environmental factors, smoking, chemical fumes, history of ear/nose condition
NAS00577
Yuan
2000
Gourds, fresh Less than weekly to daily
FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 3 0.89 Less than weekly
0.73-1.09
N/A 0.33 Age, sex, area of residence, environmental factors, smoking, chemical fumes, history of ear/nose condition
NAS00577
Yuan
2000
Green peppers, fresh
Less than weekly to daily
FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 3 0.67 Less than weekly
N/A N/A 0.43 Age, sex, area of residence, environmental factors, smoking, chemical fumes, history of ear/nose condition, oranges/tangerines
Fresh fruits: Adulthood consumption Case-control (4) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group CI P value
p value for trend
Adjusted for
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
227
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group CI P value
p value for trend
Adjusted for
NAS01141
Zheng
1994
Fresh fruit, in the past 7 years
N/A FFQ - Study-specific
China Chinese 410 Max 55/ Mixed
205 205 N/A N/A N/A N/A Not signif-icant
N/A N/A
NAS01922
Ning
1990
fresh fruit, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of residence
NAS04944
Armstrong
1978
Fresh fruit, at evening meal, families of participants
N/A Recall Malaysia Chinese 210 25-81/ Mixed
60 150 N/A <1.0 N/A N/A Signif- icant
N/A Unadjusted
NAS06030
Huang
2002
Fresh fruits Less to frequently consumed
Question-naire
China Chinese 525 10-78/ Mixed
175 359 2 0.679 Less consumed
0.44-1.04
0.077 N/A Age, Sex, Area of Residence
Fresh fruits: Childhood consumption Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01141
Zheng
1994
Fresh fruit, ages 0-3
N/A FFQ - Study-specific
China Chinese 410 Max 55/ Mixed
205 205 N/A N/A N/A N/A Not signif-icant
N/A N/A
NAS01141
Zheng
1994
Fresh fruit, age of 10
N/A FFQ - Study-specific
China Chinese 410 Max 55/ Mixed
205 205 N/A N/A N/A N/A Not signif-icant
N/A N/A
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
228
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01922
Ning
1990
Fresh fruit, at age 10
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of residence
NAS60010
Cai
1996
fresh fruit, consumed around 1968 and <3 times/ week
< 12 times / month to ≥ 12 times / month
Dietary History question-naire
China Chinese 230 16-68/ Mixed
115 115 2 1.502 ≥ 12 times per month
1.11-2.03
0.0084 N/A Age, Sex, Area of Residence
NAS60010
Cai
1996
fresh fruit, consumed around 1978, < 3 time/week
< 12 times / month to ≥ 12 times / month
Dietary History question-naire
China Chinese 230 16-68/ Mixed
115 115 2 1.471 ≥ 12 times per month
1.12-1.94
0.0061 N/A Age, Sex, Area of Residence
Fresh citrus fruit: Adulthood consumption Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00577
Yuan
2000
Oranges and tangerines, fresh
Less than weekly to daily
FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 3 0.061 Less than weekly
N/A N/A 0.0005 Age, sex, area of residence, environmental factors, smoking, chemical fumes, history of ear/nose condition, green/red peppers, tomatoes, & green beans/peas
Other fresh fruits: Childhood consumption Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
229
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01459
Yu
1989
other fresh fruits (not oranges/ tangerines), ages 1-2
Rarely to weekly
FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
110 139 3 0.6 Rarely 0.3-1.2
N/A Not signif- icant
Age, sex, area of residence
NAS01459
Yu
1989
other fresh fruits (not oranges/ tangerines), at age 10
Rarely to daily
FFQ - Study-specific
China Chinese 612 Mean 49/ Mixed
110 139 4 0.3 Rarely 0.1-1.1
N/A Not signif- icant
Age, sex, area of residence
NAS01520
Yu
1988
other fresh fruits (not oranges / tangerines) ages 1 to 2
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif- icant
N/A Age, sex
NAS01520
Yu
1988
other fresh fruits (not oranges/ tangerines at age 10
N/A FFQ - Study-specific
China Chinese 302 Max 44/ Mixed
128 174 N/A N/A N/A N/A Not signif- icant
N/A Age, sex
Fresh pulses/legumes Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00531
Ward
2000
Adult Dietary Intake: consumption of fresh soybean products
Never vs. ever
Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
375 327 2 N/A No N/A Not signif-icant
N/A Age, sex, ethnicity/ race, total calories, mothers questionnaire
NAS00531
Ward
2000
Age 10: Fresh soybean products
≤1.96
grams to ≥ 6.4 grams
Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
93 114 4 0.4 ≤1.96 grams
0.2-1.0
N/A N/A Age, sex, ethnicity/ race, total calories, mothers questionnaire
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
230
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00531
Ward
2000
Age 3: Fresh soybean products
≤1,6 grams to > 4 grams
Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
90 110 4 0.7 ≤1,6 grams
0.3-1.7
N/A N/A Age, sex, ethnicity/ race
NAS00531
Ward
2000
During Weaning: Fresh soybean products
None to > 0 grams
Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
84 104 2 1.1 None 0.5-1.2
N/A N/A Age, sex, ethnicity/ race
NAS00531
Ward
2000
Mother's diet during breastfeeding: fresh soy products
Lowest to highest
Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
375 327 3 0.7 Lowest 0.3-1.6
N/A N/A Age, sex, ethnicity/ race, Vegetable intake
NAS00531
Ward
2000
Mother's diet during breastfeeding: fresh soy products
Lowest to highest
Dietary History question-naire
China, Taiwan
Chinese 702 < 75/ Mixed
375 327 3 0.6 Lowest 0.2-1.5
N/A N/A N/A
Mixed vegetables Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00577
Yuan
2000
Fresh green beans and peas
Less than weekly to daily
FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 3 0.77 Less than weekly
0.62-0.99
N/A 0.02 Age, sex, occupational exposure to fumes, education, smoking, environmental factors, other diseases
4.4.1.1 Raw Case-control (2)
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
231
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS00749
Armstrong
1998
Raw green vegetables
Monthly to more than weekly
Dietary History question-naire
Malaysia Chinese 564 N/A/ Mixed
282 282 3 0.5 Monthly 0.23-1.07
N/A .026 Unadjusted
NAS04944
Armstrong
1978
Sliced raw chili
At evening meals
Recall Malaysia Chinese 210 25-81/ Mixed
60 150 2 N/A N/A N/A Cases ate less at evening meals
N/A Unadjusted
4.4.2 Cooked food Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01113
Zheng
1994
Salted fish, steamed or fried, age 2-10
Rarely v. monthly/ weekly
FFQ - Study-specific
China Chinese 264 Mean 42/ Mixed
88 176 2 1.4 Rarely N/A 0.2 N/A Age, sex, area of residence, SES
NAS01113
Zheng
1994
Salted fish, steamed or fried, before 2
Rarely v. monthly/ weekly
FFQ - Study-specific
China Chinese 264 Mean 42/ Mixed
87 172 2 1.4 Rarely N/A 0.3 N/A Age, sex, area of residence, SES
NAS01922
Ning
1990
fried, grilled, broiled salted fish, at age 10
Ever vs Never
FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 2 1.6 Never 0.8-3.2
N/A N/A Age, Sex, Area of residence
4.4.2.1 Steaming, boiling, poaching Case-control (1)
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
232
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01922
Ning
1990
boiled fish, fresh, at age 10
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A Age, Sex, Area of residence
NAS01922
Ning
1990
boiled fish, fresh, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif-icant
N/A Age, Sex, Area of residence
NAS01922
Ning
1990
steamed salted fish, at age 10
Ever vs Never
FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 2 4.2 Never 2.2-8.3
N/A N/A Age, Sex, Area of residence
4.4.2.2 Stewing, casseroling Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01381
Jeannel
1990
Dietary Intake During Weaning: Stewing mixture (red pepper, black pepper, caraway, coriander, oil, salt and garlic)
Yes or no FFQ - Study-specific
Tunisia Tunisian 240 N/A/ Mixed
80 160 2 8.4 No N/A <0.005 N/A Sex, age, lifestyle factors, area of residence
NAS01381
Jeannel
1990
Dietary Intake During Preceding Year to Diagnosis: Stewing mixture (red pepper, black pepper, caraway, coriander, oil, salt and garlic)
Yes or no FFQ - Study-specific
Tunisia Tunisian 240 N/A/ Mixed
80 160 2 4.4 No N/A 0.04 N/A Sex, age, lifestyle factors, area of residence
4.4.2.5 Frying
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
233
Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
categories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01922
Ning
1990
Fried food, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of Residence
NAS01922
Ning
1990
Fried food, at 10 years of age
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of Residence
4.4.2.6 Grilling (broiling) and barbecuing Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS01922
Ning
1990
grilled food, 3 years prior to diagnosis
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of Residence
NAS01922
Ning
1990
grilled food, at 10 years of age
N/A FFQ - Study-specific
China Chinese 400 Mean 45/ Mixed
100 300 N/A N/A N/A N/A Not signif- icant
N/A Age, Sex, Area of Residence
5.3.1 Total protein Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group CI P value
p value for trend
Adjusted for
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
234
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group CI P value
p value for trend
Adjusted for
NAS00577
Yuan
2000
All protein-containing preserved foods
Quantiles: 0 to 97+ times per year
FFQ - Study-specific
China Chinese 1967 15-74/ Mixed
935 1032 4 1.78 Lowest quantile: 13 times per year
1.37-2.31
Signif-icant
0.001 Sex, Age, Educational Level, Smoking, Exposure to smoke from heated rapeseed oil and burning coal while cooking, Occupational exposure to chemical fumes, History of chronic ear and nose condition
5.5.1 Vitamin A Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assessment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value p value for trend
Adjusted for
NAS02182
Armstrong
1983
Foods rich in vitamin A
N/A Hospital records
Malaysia Chinese N/A Mixed 87 79 2 N/A N/A N/A Not signif-icant
N/A Sex, area of residence, ethnicity/ race, age
5.5.1.2.1 Beta-carotene Beta-carotene Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00700
Farrow
1998
beta carotene
Lowest to highest
FFQ – Block
United States
Unknown 345 18-74/ Mixed
129 206 4 0.47 Lowest 0.22-1.02
N/A 0.10 Age, Sex, Energy Intake, Alcohol consumption, Smoking Habits
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
235
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS01056
Lee
1994
beta-carotene, during adulthood
Highest v. lowest tertile
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
64 102 3 0.7 lowest 0.4-1.2
N/A 0.10 Age, sex, education, ethnicity/ race
5.5.9 Vitamin C Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00700
Farrow
1998
Vitamin C Lowest to highest
FFQ – Block
United States
Unknown 345 18-74/ Mixed
129 206 4 0.50 Lowest 0.24-1.04
N/A 0.06 Age, Sex, Energy Intake, Alcohol consumption, Smoking Habits
NAS01056
Lee
1994
Vitamin C, during adulthood
N/A FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
64 102 N/A N/A N/A N/A Not signif-icant
N/A Age, sex, education, ethnicity/ race, other nutrients
NAS02182
Armstrong
1983
Foods rich in vitamin C
N/A Hospital records
Malaysia Chinese N/A Mixed 87 79 2 N/A N/A N/A Not signif-icant
N/A Sex, area of residence, ethnicity/ race, age
5.5.10 Vitamin D (and calcium) Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Source
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
Mean for cases
Mean for controls
CI P value
p value for trend
Adjusted for
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
236
NAS02696
Man
1996
Calcium (and Vitamin D), detected in hair sample
Mean exposure cases vs. controls
Hair Sample
China Unknown 124 30-69/ N/A
23 69 2 cases: 1022
controls: 1302
N/A Not signif-icant
N/A Unadjusted
Cross-sectional (1) Study identifier
Author, Yr
Exposure Exposure range
Assessment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
categories
Mean for cases
Mean for controls
t P value
Adjusted for
NAS06005
Li
1996
Calcium (and Vitamin D)
2.0678-2.3006
Serum China Chinese 380 20-60/ Mixed
66 314 2 Cases = 2.0678
Controls = 2.3006
3.3381 <0.05 Unadjusted
Ecological (1) Study identifier
Author, Yr
Exposure Exposure range
Assessment
Source
Country Ethnicity
of subjects
No of populations analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
Mean for cases
Mean for controls
t P value
Adjusted for
NAS06005
Li
1996
Calcium (and Vitamin D)
24.545-76.28
Ca concentration in drinking water
China Chinese Case represent Sihui, Control represent Meizhou
N/A 190 53 2 Cases = 24.545
Controls = 76.28
8.377 <.001 Unadjusted
NAS06005
Li
1996
Calcium (and Vitamin D)
2.238-2.358
Ca concentration in serum
China Chinese Case represent Sihui, Control represent Meizhou
N/A 190 53 2 Cases = 2.238
Controls = 2.358
2.2099 <.05 Unadjusted
5.5.11 Vitamin E Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assessment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
237
NAS01056
Lee
1994
Vitamin E, during adulthood
Lowest v. highest
FFQ - Study-specific
Singapore Chinese 606 Max 44/ Mixed
64 102 3 0.5 Lowest 0.3-0.8
Signif-icant
.001 Age, sex, education, ethnicity/ race
5.5.13 Other vitamins (including multivitamins) Multi-Vitamins, supplements only Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
OR Ref group
CI P value
p value for trend
Adjusted for
NAS00700
Farrow
1998
Other vitamins, Multivitamin use
Yes or no FFQ – Block
United States
Unknown 345 18-74/ Mixed
129 206 2 0.56 No 0.31-1.01
N/A N/A Age, Sex, Energy Intake, Alcohol consumption, Smoking Habits
NAS00700
Farrow
1998
Other vitamins, supplements
Yes or no FFQ – Block
United States
Unknown 345 18-74/ Mixed
129 206 2 0.55 No 0.31-1.01
N/A N/A Age, Sex, Energy Intake, Alcohol consumption, Smoking Habits
5.6.2 Iron Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assessment
Source
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
Controls
No.
Cate-gories
Mean for cases
Mean for controls
CI P value
p value for trend
Adjusted for
NAS06012
Deng
1995
serum Fe concentration
Mean exposure cases vs. controls
Serum level, measured by colorimeter
China Chinese 86 20-60/ Mixed
44 42 2 Mean cases: 388.19
Mean controls: 390.39
Cases: 267-509
Controls: 315-466
>0.05 N/A Unadjusted
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
238
Study identifier
Author, Yr
Exposure Exposure range
Assessment
Source
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
Controls
No.
Cate-gories
Mean for cases
Mean for controls
CI P value
p value for trend
Adjusted for
NAS06012
Deng
1995
Fe concentration in drinking water
Mean exposure cases vs. controls
in drinking water
China Chinese 86 20-60/ Mixed
44 42 2 Mean cases: 14.70
Mean controls: 14.78
N/A >0.05 N/A Unadjusted
NAS06012
Deng
1995
Fe concentration in rice
Mean exposure cases vs. controls
in rice China Chinese 86 20-60/ Mixed
44 42 2 Mean cases: 13.53
Mean controls: 13.60
N/A >0.05 N/A Unadjusted
NAS01865
Robinson
1968
Iron on maize leaf
Mean exposure cases vs. controls
maize leaf Kenya Central Bantu and Nilo-Hamitic
100 N/A/ N/A 50 50 2 Mean cases: 695
Mean controls: 644
N/A Not signif-icant
N/A Area of residence
NAS02696
Man
1996
Iron, detected in hair sample
Mean exposure cases vs. controls
Hair Sample China Unknown 124 30-69/ N/A
12 38 2 cases: 58.8
controls: 35.8
N/A <0.05 N/A Unadjusted
5.6.3 Calcium (and vitamin D) Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Source
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
Mean for cases
Mean for controls
CI P value
p value for trend
Adjusted for
NAS02696
Man
1996
Calcium (and Vitamin D), detected in hair sample
Mean exposure cases vs. controls
Hair Sample
China Unknown 124 30-69/ N/A
23 69 2 cases: 1022
controls: 1302
N/A Not signif-icant
N/A Unadjusted
Cross-sectional (1) Study identifier
Author, Yr
Exposure Exposure range
Assessment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
categories
Mean for cases
Mean for controls
t P value
Adjusted for
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
239
NAS06005
Li
1996
Calcium (and Vitamin D)
2.0678-2.3006
Serum China Chinese 380 20-60/ Mixed
66 314 2 Cases = 2.0678
Controls = 2.3006
3.3381 <0.05 Unadjusted
Ecological (1) Study identifier
Author, Yr
Exposure Exposure range
Assessment
Source
Country Ethnicity
of subjects
No of populations analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
Cate-gories
Mean for cases
Mean for controls
t P value
Adjusted for
NAS06005
Li
1996
Calcium (and Vitamin D)
24.545-76.28
Ca concentration in drinking water
China Chinese Case represent Sihui, Control represent Meizhou
N/A 190 53 2 Cases = 24.545
Controls = 76.28
8.377 <.001 Unadjusted
NAS06005
Li
1996
Calcium (and Vitamin D)
2.238-2.358
Ca concentration in serum
China Chinese Case represent Sihui, Control represent Meizhou
N/A 190 53 2 Cases = 2.238
Controls = 2.358
2.2099 <.05 Unadjusted
5.6.4 Selenium Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assessment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
Mean for cases
Mean for controls
CI P value
p value for trend
Adjusted for
NAS01145
Lajtman
1994
Selenium Mean exposure cases vs. controls
Serum, atomic absorption methods
Zagreb Croatia
Croatian 81 37-78/ Mixed
34 47 2 Mean cases: 59.27
Mean controls: 66.62
N/A >0.05 N/A Unadjusted
NAS01402
Yang
1990
Selenium Mean exposure cases vs. controls
Serum, fluorometric method
China Chinese 167 20-65/ Mixed
111 56 2 Mean cases: 0.109
Mean controls: 0.125
N/A <0.05 N/A Unadjusted
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
240
Study identifier
Author, Yr
Exposure Exposure range
Assessment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
Mean for cases
Mean for controls
CI P value
p value for trend
Adjusted for
NAS06012
Deng
1995
serum Se concentration
Mean exposure cases vs. controls
Serum level, measured by colorimeter
China Chinese 86 20-60/ Mixed
44 42 2 Mean cases: 49.17
Mean controls: 84.54
Cases: 40.8-57.6
Controls: 73.4-95.7
<0.01 N/A Unadjusted
NAS06012
Deng
1995
Se concentration in drinking water
Mean exposure cases vs. controls
in drinking water
China Chinese 86 20-60/ Mixed
44 42 2 Mean cases: 0.06
Mean controls: 0.11
N/A <0.01 N/A Unadjusted
NAS06012
Deng
1995
Se concentration in rice
Mean exposure cases vs. controls
in rice China Chinese 86 20-60/ Mixed
44 42 2 Mean cases: 20.13
Mean controls: 29.15
N/A <0.001 N/A Unadjusted
5.6.5 Iodine Case-control (1) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/Sex of subjects
No.
cases
No.
controls
No.
categories
Mean for cases
Mean for controls
CI P value
p value for trend
Adjusted for
NAS02696
Man
1996
Iodine, detected in hair sample
Mean exposure cases vs. controls
Hair Sample
China Unknown 124 30-69/ N/A
8 30 2 cases: 1.038
controls: 0.56
N/A Not signif-icant
N/A Unadjusted
5.6.6 Other minerals Chromium Case-control (2)
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
241
Study identifier
Author, Yr
Exposure Exposure range
Assessment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of sub-jects
No.
cases
No.
Con-trols
No.
Cate-gories
Mean for cases
Mean for controls
CI P value
p value for trend
Adjusted for
NAS02012
Ling-Wei
1988
Chromium, in drinking water
Median exposure cases vs. controls
Unknown-NA China Chinese 75 N/A/ N/A
45 30 2 Median cases: 4.0
Median controls: 4.0
N/A >0.05 N/A Unadjusted
NAS06012
Deng
1995
serum Chromium (Cr) concentration
Mean exposure cases vs. controls
Serum level, measured by colorimeter
China Chinese 86 20-60/ Mixed
44 42 2 Mean cases: 65.56
Mean controls: 39.12
Cases: 53.3-77.8
Controls: 33.0-45.2
<0.01 N/A Unadjusted
NAS06012
Deng
1995
Chromium (Cr) concentration in drinking water
Mean exposure cases vs. controls
in drinking water
China Chinese 86 20-60/ Mixed
44 42 2 Mean cases: 0.42
Mean controls: 0.28
N/A <0.01 N/A Unadjusted
NAS06012
Deng
1995
Chromium (Cr) concentration in rice
Mean exposure cases vs. controls
in rice China Chinese 86 20-60/ Mixed
44 42 2 Mean cases: 140.75
Mean controls: 72.03
N/A <0.01 N/A Unadjusted
Copper Case-control (4) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of sub-jects
No.
cases
No.
Con-trols
No.
Cate-gories
Mean for cases
Mean for controls
CI P value
p value for trend
Adjusted for
NAS01865
Robinson
1968
Copper, in maize leaf
Mean exposure cases vs. controls
Unknown-NA
Kenya Central Bantu and Nilo-Hamitic
100 N/A/ N/A
49 49 2 Mean cases: 15.5
Mean controls: 15.8
N/A Not signif-icant
N/A Area of residence
NAS02012
Ling-Wei
1988
Copper, in drinking water
Median exposure cases vs. controls
Unknown-NA
China Chinese 75 N/A/ N/A
45 30 2 Median cases: 2.6
Median controls: 2.1
N/A 0.05 N/A Unadjusted
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
242
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of sub-jects
No.
cases
No.
Con-trols
No.
Cate-gories
Mean for cases
Mean for controls
CI P value
p value for trend
Adjusted for
NAS02696
Man
1996
copper, detected in hair sample
Mean exposure cases vs. controls
Hair Sample China Unknown 124 30-69/ N/A
24 78 2 cases: 14.25
controls: 14.29
N/A Not signif-icant
N/A Unadjusted
NAS06012
Deng
1995
serum Copper concentration
Mean exposure cases vs. controls
Serum level, measured by colorimeter
China Chinese 86 20-60/ Mixed
44 42 2 Mean cases: 0.50
Mean controls: 0.52
Cases: 0.25-0.75
Controls: 0.35-0.69
>0.05 N/A Unadjusted
NAS06012
Deng
1995
Copper concentration in drinking water
Mean exposure cases vs. controls
in drinking water
China Chinese 86 20-60/ Mixed
44 42 2 Mean cases: 1.82
Mean controls: 1.33
N/A <0.01 N/A Unadjusted
NAS06012
Deng
1995
Copper concentration in rice
Mean exposure cases vs. controls
in rice China Chinese 86 20-60/ Mixed
44 42 2 Mean cases: 30.32
Mean controls: 12.87
N/A <0.05 N/A Unadjusted
Manganese Case-control (3) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
Mean for cases
Mean for controls
CI P value
p value for trend
Adjusted for
NAS01865
Robinson
1968
Manganese, in maize leaf
Mean exposure cases vs. controls
Unknown-NA
Kenya Central Bantu and Nilo-Hamitic
100 N/A/ N/A 49 49 2 Mean cases: 128
Mean controls: 123
N/A Not signif-icant
N/A Area of residence
NAS02012
Ling-Wei
1988
Manganese, in drinking water
Median exposure cases vs. controls
Unknown-NA
China Chinese 75 N/A/ N/A 45 30 2 Median cases: 7.6
Median controls: 6.3
N/A 0.05 N/A Unadjusted
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
243
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
Mean for cases
Mean for controls
CI P value
p value for trend
Adjusted for
NAS02696
Man
1996
Manganese, detected in hair sample
Mean exposure cases vs. controls
Hair Sample
China Unknown 124 30-69/ N/A
26 75 2 cases: 2.12
controls: 2.41
N/A Not signif-icant
N/A Unadjusted
Zinc Case-control (4) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
Mean for cases
Mean for controls
CI P value
p value for trend
Adjusted for
NAS01865
Robinson
1968
Zinc, in maize leaf
Mean exposure cases vs. controls
Unknown-NA
Kenya Central Bantu and Nilo-Hamitic
100 N/A/ N/A 50 50 2 Mean cases: 30.2
Mean controls: 30.2
N/A Not signif-icant
N/A Area of residence
NAS02012
Ling-Wei
1988
Zinc, in drinking water
Median exposure cases vs. controls
Unknown-NA
China Chinese 75 N/A/ N/A 45 30 2 Median cases: 12.0
Median controls: 7.6
N/A 0.01 N/A Unadjusted
NAS02696
Man
1996
zinc, detected in hair sample
Mean exposure cases vs. controls
Hair Sample China Unknown 124 30-69/ N/A
25 74 2 cases: 199.92
controls: 210.16
N/A Not signif-icant
N/A Unadjusted
NAS06012
Deng
1995
serum zinc concentration
Mean exposure cases vs. controls
Serum level, measured by colorimeter
China Chinese 86 20-60/ Mixed
44 42 2 Mean cases: 4.24
Mean controls: 4.72
Cases: 3.11-5.37
Controls: 3.72-5.72
<0.05 N/A Unadjusted
NAS06012
Deng
1995
zinc concentration in drinking water
Mean exposure cases vs. controls
in drinking water
China Chinese 86 20-60/ Mixed
44 42 2 Mean cases: 3.65
Mean controls: 4.71
N/A <0.05 N/A Unadjusted
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
244
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
Mean for cases
Mean for controls
CI P value
p value for trend
Adjusted for
NAS06012
Deng
1995
zinc concentration in rice
Mean exposure cases vs. controls
in rice China Chinese 86 20-60/ Mixed
44 42 2 Mean cases: 8.41
Mean controls: 10.46
N/A <0.01 N/A Unadjusted
Other minerals Case-control (2) Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
Mean for cases
Mean for controls
CI P value
p value for trend
Adjusted for
NAS01865
Robinson
1968
Boron, in maize leaf
Mean exposure cases vs. controls
Unknown-NA
Kenya Central Bantu and Nilo-Hamitic
100 N/A/ N/A 41 41 2 cases: 14.8
controls: 14.9
N/A Not signif-icant
N/A Area of residence
NAS02696
Man
1996
aluminum, detected in hair sample
Mean exposure cases vs. controls
Hair Sample
China Unknown 124 30-69/ N/A
26 76 2 cases: 15.62
controls: 15.26
N/A Not signif-icant
N/A Unadjusted
NAS02696
Man
1996
antimony, detected in hair sample
Mean exposure cases vs. controls
Hair Sample
China Unknown 124 30-69/ N/A
25 61 2 cases: 0.221
controls: 0.173
N/A Not signif-icant
N/A Unadjusted
NAS02696
Man
1996
magnesium, detected in hair sample
Mean exposure cases vs. controls
Hair Sample
China Unknown 124 30-69/ N/A
29 72 2 cases: 134.1
controls: 137.5
N/A Not signif-icant
N/A Unadjusted
NAS02696
Man
1996
potassium, detected in hair sample
Mean exposure cases vs. controls
Hair Sample
China Unknown 124 30-69/ N/A
24 64 2 cases: 22.46
controls: 18.72
N/A Not signif-icant
N/A Unadjusted
1 June, 2006
# Changed referent group to lowest intake measured ‡ Derived RR using STATA 8.0
245
Study identifier
Author, Yr
Exposure Exposure range
Assess-ment
Tool
Country Ethnicity
of subjects
No of subjects analysed
Age/ Sex of subjects
No.
cases
No.
Con-trols
No.
Cate-gories
Mean for cases
Mean for controls
CI P value
p value for trend
Adjusted for
NAS02696
Man
1996
strontium, detected in hair sample
Mean exposure cases vs. controls
Hair Sample
China Unknown 124 30-69/ N/A
19 59 2 cases: 4.332
controls: 6.532
N/A <0.05 N/A Unadjusted
NAS02696
Man
1996
sulfur, detected in hair sample
Mean exposure cases vs. controls
Hair Sample
China Unknown 124 30-69/ N/A
29 95 2 cases: 6.21
controls: 5.89
N/A Not signif-icant
N/A Unadjusted
NAS02696
Man
1996
vanadium, detected in hair sample
Mean exposure cases vs. controls
Hair Sample
China Unknown 124 30-69/ N/A
20 85 2 cases: 263.1
controls: 85.5
N/A <0.05 N/A Unadjusted