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

Published online by Cambridge University Press:  02 January 2007

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

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Objective:

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

Design:

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

Setting:

Nineteen rural villages in Srikakulam District, Andhra Pradesh.

Subjects:

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

Results:

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

Conclusions:

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

Type
Research Article
Copyright
Copyright © CABI Publishing 2002

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