Associations of dietary dark-green and deep-yellow vegetables and fruits with cervical intraepithelial neoplasia: modification by smoking

Smoking has been positively and fruit and vegetable intake has been negatively associated with cervical cancer, the second most common cancer among women worldwide. However, a lower consumption of fruits and reduced serum carotenoids have been observed among smokers. It is not known whether the smoking effect on the risk of cervical neoplasia is modified by a low intake of fruits and vegetables. The present study examined the combined effects of tobacco smoking and diet using a validated FFQ and serum carotenoid and tocopherol levels on cervical intraepithelial neoplasia grade 3 (CIN3) risk in a hospital-based case-control study conducted in Sao Paulo, Brazil, between 2003 and 2005. The sample comprised 231 incident, histologically confirmed cases of CIN3 and 453 controls. A low intake (<= 39 g) of dark-green and deep-yellow vegetables and fruits without tobacco smoking had a lesser effect on CIN3 (OR 1.14; 95% CI 0.49, 2.65) than among smokers with higher intake (>= 40 g; OR 1.83; 95% CI 0.73, 4.62) after adjusting for confounders. The OR for the joint exposure of tobacco smoking and low intake of vegetables and fruits was greater (3.86; 95% CI 1.74, 8.57; P for trend < 0.001) compared with non-smokers with higher intake after adjusting for confounding variables and human papillomavirus status. Similar results were observed for total fruit, serum total carotene (including beta-, alpha-and gamma-carotene) and tocopherols. These findings suggest that the effect of nutritional factors on CIN3 is modified by smoking.

Amparo a Pesquisa do Estado de Sao Paulo, Brazil[FAPESP/03/03013-4]

Conselho Nacional de Desenvolvimento Cientifico e Tecnologico, Brazil[CNPq/473043/03-3]

CNPq Conselho Nacional de Desenvolvimento Cientifico e Tecnologico, Brazil[300167/97-0]

FAPESP[02/11184-0]

Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior[CAPES/BEX3775/05-4]