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Dietary patterns and oesophageal cancer: a multi-country latent class analysis
  1. Michela Dalmartello1,
  2. Jeroen Vermunt2,
  3. Diego Serraino3,
  4. Werner Garavello4,
  5. Eva Negri5,
  6. Fabio Levi6,
  7. Carlo La Vecchia1
  1. 1 Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
  2. 2 Department of Methodology and Statistics, Tilburg University, Tilburg, Netherlands
  3. 3 Centro di Riferimento Oncologico, Aviano, Italy
  4. 4 Department of Otorhinolaryngology, School of Medicine and Surgery, University of Milan–Bicocca, Milan, Italy
  5. 5 Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
  6. 6 Institute of Social and Preventive Medicine (IUMSP), University of Lausanne, Lausanne, Switzerland
  1. Correspondence to Michela Dalmartello, Department of Clinical Sciences and Community Health, University of Milan, Via A. Vanzetti, 5, Milan 20133, Italy; michela.dalmartello{at}


Background The considerable differences in food consumption across countries pose major challenges to the research on diet and cancer, due to the difficulty to generalise and reproduce the dietary patterns identified in a specific population.

Methods We analysed data from a multicentric case-control study on oesophageal squamous cell carcinoma (ESCC) carried out between 1992 and 2009 in three Italian areas and in the Canton of Vaud, Switzerland, which included 505 cases and 1259 hospital controls. Dietary patterns were derived applying LCA on 24 food groups, controlling for country membership, and non-alcoholic energy intake. A multiple logistic regression model was used to derive odds ratio (ORs) and corresponding 95% CIs for ESCC according to the dietary patterns identified, correcting for classification error.

Results and Conclusion We identified three dietary patterns. The ‘Prudent’ pattern was distinguished by a diet rich in fruits and vegetables. The ‘Western’ pattern was characterised by low consumption of these food groups and higher intakes of sugar. The ‘Lower consumers-combination pattern’ exhibited a diet poor in most of the nutrients, preferences for fish, potatoes, meat and a few specific types of vegetables. Differences between Italy and Switzerland emerged for pattern sizes and for specific single food preferences. Compared to the ‘Prudent’ pattern, the ‘Western’ and the ‘Lower consumers-combination’ patterns were associated with an increased risk of ESCC (OR=3.04, 95% CI=2.12–4.38 and OR=2.81, 95% CI=1.65–4.76).

  • Cancer epidemiology
  • DIET

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  • Abbreviations BIC: Bayesian information criterion; BVR: bivariate residual statistic; CA: cluster analysis; CI: CI; ESCC: oesophageal squamous cell carcinoma; FA: factor analysis; LCA: latent class analysis; PCA: principal components analysis; OR: Odds ratio.

  • Contributors MD conducted data analysis and released the first draft. JV supervised data analysis and revised the manuscript. CLV designed the study and the data collection and revised the manuscript. EN revised data collection and managements and revised the manuscript. FL, WG and DS organized data collection and revised the manuscript. All authors approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publicationin most of nutrients Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.