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Dietary Factors and Risk of Non-Hodgkin Lymphoma in Men and Women

Departments of ¹ Medical Epidemiology and Biostatistics and ² Oncology and Pathology; ³ Division of Nutritional Epidemiology, National Institute of Environmental Medicine, Karolinska Institutet; ⁴ Department of Pathology and Cytology, Medilab, Stockholm, Sweden; ⁵ Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, and Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts; ⁶ Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark; ⁷ Department of Oncology, Radiology and Clinical Immunology, University of Uppsala, Uppsala, Sweden

Requests for reprints: Ellen Chang, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, SE-171 77 Stockholm, Sweden. Phone: 46-8-524-86154; Fax: 46-8-31-49-57. E-mail: ellen.chang{at}meb.ki.se

Background: The incidence of non-Hodgkin lymphoma (NHL) has increased worldwide in recent decades. Diet could influence NHL risk by modulating the immune system, although evidence is limited. We did a population-based case-control study to determine whether differences in diet were associated with NHL risk.

Methods: A total of 597 NHL cases and 467 population controls in Sweden completed a semiquantitative food frequency questionnaire evaluating their dietary habits 2 years before the interview. Unconditional logistic regression was used to estimate the odds ratios (OR) and corresponding 95% confidence intervals (95% CI) for associations between food intake and risk of NHL.

Results: High consumption of dairy products and fried red meat was associated with increased risk of NHL. The OR of NHL for individuals in the highest quartile compared with the lowest quartile of dairy intake was 1.5 (95% CI, 1.1-2.2; P_trend = 0.003). The OR for the highest versus lowest quartile of fried red meat intake was 1.5 (95% CI, 1.0-2.1; P_trend = 0.02). In contrast, high consumption of fruits and vegetables was associated with reduced risk of NHL, particularly follicular lymphoma, among women but not men. Compared with the lowest quartile of vegetable intake, the OR of follicular lymphoma among women in the highest quartile of vegetable intake was 0.3 (95% CI, 0.1-0.7; P_trend = 0.002).

Conclusions: The positive associations of NHL risk with dairy products and fried red meat and the inverse association with fruits and vegetables suggest that diet affects NHL risk and could explain the increase of some histopathogic subtypes.

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