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Title:Vegetable intake and head and neck cancer
Author(s):Goon, Shatabdi
Advisor(s):Chapman-Novakofski, Karen Marie
Contributor(s):Nickols-Richardson, Shelly; Arthur , Anna E.; Pepino, M. Yanina
Department / Program:Food Science & Human Nutrition
Discipline:Food Science & Human Nutrition
Degree Granting Institution:University of Illinois at Urbana-Champaign
Nutrition Impact Symptoms
Abstract:Introduction: Head and neck cancer (HNC), especially cancers of the oral cavity, oropharynx, hypopharynx, and larynx is the sixth most common cancer, affecting more than half a million patients worldwide and approximately 4% of patients in the United States, with a five-year survival rate of 60% and a high rate of recurrences. The majority of HNC patients undergo aggressive treatments with chemo-radiotherapy and surgical resection of the tumors leading to the development of severe side effects collectively known as Nutrition Impact Symptoms (NIS) that can impact the ability and desire to eat. Some prior epidemiological and intervention studies have suggested that increasing intake of vegetables before and following diagnosis with HNC may improve clinical outcomes such as disease recurrence and survival. Despite an increasing focus on the beneficial effects of fruits and vegetables on cancer survival, we still know very little about how the burden of these post-treatment symptoms may influence HNC patients’ vegetable intake. Oropharyngeal squamous cell carcinoma cancer (OPSCC), a subtype of HNC, has become the leading site for HPV-associated cancers in humans and causing ∼70% of all OPSCC in the United States. HPV infection alone may not be sufficient to cause OPSCC, requiring the presence of other factors such as smoking or chewing tobacco, high-risk sexual behavior, and alcohol abuse. Epidemiological studies have suggested that specific food groups may be protective against persistent cervical HPV infections and reduce the risk of progression of persistent HPV infection to cervical cancer, however, the association between nutritional status and the risk of oral HPV infections has not been adequately tested. Methods: We conducted a 30-item telephone administrated survey among twenty-two HNC survivors registered to the Carle Cancer Center, Champaign, Illinois to collect detailed information on vegetable intake and the use of seasonings. A scale with 11 HNC treatment-related side-effects such as fatigue, lack of appetite, and dry mouth was used to collect information on NIS that was adapted from M. D. Anderson Symptom Inventory HNC module where “0” represents “not present at all” and “10” represents “as bad as you can imagine”. We conducted Spearman correlations to examine the associations between NIS, vegetable intake, and seasonings. A mean composite score was created for all the symptoms listed on the survey where higher scores indicated greater symptom burden or problems with NIS. We conducted another study which was an analysis of secondary data from the US National Health and Nutrition Examination Survey (NHANES) 2009-2016 that investigated the association between vegetable intake and the risk of oral HPV infections (HPV 16 and 18, and combined risk of HPV 16 and 18). NHANES 2009-2016 survey and laboratory data for vegetable intake and HPV infections, respectively, were used for the analysis. The dataset included 30,612 participants (0-80 years) from 30 different survey locations. We extracted data for 11,553 adult participants (18-69 years old) who submitted oral samples for HPV testing, had complete 2-days 24-hour dietary recall data, and complete data on demographics and sexual behaviors. Of these samples, 1,427 were inadequate for HPV DNA typing and were excluded from the analysis. The final dataset had 10,126 participants with oral HPV test results. Logistic regression analysis was conducted using a survey logistic procedure in SAS 9.4. Odds Ratios (OR) with 95% CI were used to evaluate risks. Wald χ2 test was used to evaluate associations between the selected vegetable groups and HPV infection. Two-tailed P values less than 0.05 were considered statistically significant for all analyses in the study. Based on existing knowledge of confounders and results from the univariate analysis of socio-demographics, behavioral characteristics, and oral HPV, a final model was adjusted for age, sex, race, education, annual income, smoking status, alcohol consumption, and sexual behaviors. Results: The mean age of the survey study participants (n=22) was 61.4 ± 9.8, where 54.5% were female, 90% were White, and most (50%) had annual household incomes of $55,000 or more. Half (50%) of the participants reported that they had not changed their vegetable intake since diagnosis of cancer, and among those who reported eating more vegetables now, most (66.7%) ate vegetables to be healthier. Most participants ate ½ cup/week of each of the vegetable categories: green leafy vegetables, cruciferous, and carrots and tomatoes and 6.5 cups/week total vegetables. Most participants (86.4%) did not use or rarely used seasonings, and among those who used seasonings (n=3), all users reported that they used seasonings to make vegetables taste better. The mean score of NIS was 3.9 (SD = 1.6), indicating that on average, most participants had suffered from some forms of NIS and experienced symptoms burden. The NIS composite score had positive, moderate correlations with sweet potatoes and pumpkin intake, r (22) = .43. That is, participants ate more sweet potatoes and pumpkin if they had a higher score of NIS. Problem with teeth and gums had negative, moderate correlations with seasonings, r (22) = -.42, p=0.04. That is, participants used fewer seasonings in their vegetables if they had higher scores of problems with teeth and gums. Difficulties swallowing tended to have a negative influence on corn and peas intake, however, the relationship was not significant, r (22) =-.37, p=0.08. The overall prevalence of oral HPV 16 and HPV 18 in the U.S. population aged 18-69 years was 1.0% and 0.3% respectively. We did not find any significant relationship between oral HPV 16 and vegetable intake; however, models assessing the association between vegetable intake and HPV 18 indicated some associations. Results showed that people who consumed vegetables including cruciferous in the highest category (0.5 to 1.3 cup equivalence/day) compared to those who consumed in the lowest category (0.03 to 0.3 cup equivalence/day) had an odd ratio, OR of 0.1 (95% confidence interval, CI 0.04-0.4, p<0.01). The odds of having HPV 18 was higher among people who consumed dark green vegetables in the highest category (0.1 to 0.5 cup equivalence/day) compared to the lowest category (0 cup equivalence/day) (ORs, 3.6, CI 1.8-6.6, p<0.01). Higher consumption of dark green vegetables in the highest category than that of the lowest category significantly increased the odds ratio of the combined risk of HPV 16 and 18 (OR 1.72; 95% CI: 1.03-2.8, p=0.03). Selected effect modifications involving smoking status were tested and were not significant at p<0.05. Conclusion: The survey is the first study to collect information about HNC survivor’s vegetable intake and explore the relationship between NIS, vegetable intake, and seasonings. However, it is premature for any guidance or recommendations to be derived from the present study for health professionals because the findings provide only a few details on the relationship between NIS and vegetable intake and seasonings habit. A larger, observational study with a longer follow-up is needed to confirm the effects of NIS on HNC survivor’s vegetable intake and seasoning behaviors. Although some studies have found associations between fruit consumption and HNC risk modified by exposure to HPV16, we still know very little about whether vegetable has an independent association with oral HPV infections. To partially fill in the gap in the literature, this study examined the association between the consumption of vegetables and the risk of oral HPV. Although none of the vegetable groups were significantly associated with HPV 16, dark green vegetables and other vegetables including cruciferous showed some associations with HPV 18. Future observational studies are warranted to further explore this relationship.
Issue Date:2020-11-24
Rights Information:Copyright 2020 Shatabdi Goon
Date Available in IDEALS:2021-03-05
Date Deposited:2020-12

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