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Role of diet in the risks of esophageal adenocarcinoma and squamous cell carcinoma: an updated umbrella review

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Abstract

Purpose

This updated umbrella review aimed to evaluate the evidence regarding the associations between dietary factors and the risks of esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EAC).

Methods

The PubMed, Embase, Cochrane Library, and Web of Science databases were searched to identify relevant studies. The quality of the included meta-analyses was evaluated using A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR 2). For each association, the number of cases, random effects pooled effect size, 95% confidence intervals (CIs), heterogeneity, 95% prediction interval (PrI), small-study effect, and excess significance bias were recalculated to determine the evidence level.

Results

We identified 33 meta-analyses describing 58 dietary factors associated with ESCC and 29 meta-analyses describing 38 dietary factors associated with EAC. There was convincing evidence regarding the association of 2 dietary factors (areca nut and high alcohol) with the risk of ESCC. There was highly suggestive evidence regarding the association of only 1 dietary factor (healthy pattern) with the risk of ESCC. There was suggestive evidence regarding the association of 11 dietary factors with the risk of ESCC, including fruit, citrus fruit, vegetables, pickled vegetables, maté tea, moderate alcohol, hot beverages and foods, hot tea, salt, folate, and vitamin B6. There was convincing evidence regarding the association of one dietary factor (vitamin B6) with the risk of EAC. There was suggestive evidence regarding the association of 4 dietary factors with the risk of EAC, including processed meat, dietary fibre, carbohydrate, and vitamin B12. The convincing evidence regarding the associations between dietary factors and the risks of ESCC and EAC remained robust in sensitivity analyses.

Conclusions

This umbrella review highlighted convincing evidence regarding the associations of areca nut and high alcohol with a higher risk of ESCC. Additionally, an association between vitamin B6 and a decreased risk of EAC was observed. Further research is needed to examine the dietary factors with weak evidence regarding their associations with ESCC and EAC.

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Data availability

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Code availability

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Abbreviations

EC:

Esophageal cancer

ESCC:

Esophageal squamous cell carcinoma

EAC:

Esophageal adenocarcinoma

AMSTAR 2:

A MeaSurement Tool to Assess systematic Reviews 2

CIs:

Confidence intervals

PrIs:

Prediction intervals

WCRF:

World Cancer Research Fund

PROSPERO:

Prospective Register of Systematic Reviews

MA:

Meta-analyses

OR:

Odds ratios

RR:

Risk ratio

O:

Observed number

E:

Expected number

SFA:

Saturated fat

MUFA:

Monounsaturated fat

CaCo:

Case–control and cohort

NA:

Not available

NOS:

Newcastle–Ottawa quality assessment scale

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Funding

This work was supported by grants from the National Natural Science Foundation of China (Grant No: 81874277).

Author information

Authors and Affiliations

  1. Beijing Municipal Key Laboratory of Clinical Epidemiology, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmenwai Street, Beijing, 100069, China

    Xiaorui Zhang, Xite Zheng, Ran Gao, Yijie Wang, Tong Wei, Zhaoping Zang, Lingyan Zhu, Quanmei Li, Yijun Zhang & Fen Liu

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  1. Xiaorui Zhang
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  2. Xite Zheng
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  3. Ran Gao
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  10. Fen Liu
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Contributions

The authors’ responsibilities were as follows—LF and ZXR: contributed to the umbrella review design; ZXR, ZXT, and GR: conducted the literature search, extracted the data, and conducted the analyses; ZXR and WYJ: wrote the first draft of the manuscript; WT and ZZP: review and editing; ZLY, LQM and ZYJ: visualization; LF is the guarantor of the paper. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Fen Liu.

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Zhang, X., Zheng, X., Gao, R. et al. Role of diet in the risks of esophageal adenocarcinoma and squamous cell carcinoma: an updated umbrella review. Eur J Nutr (2024). https://doi.org/10.1007/s00394-024-03393-z

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