ie Nutrition and Health

There is some suggestive but not conclusive evidence that correlates
consumption of salt-pickled, salt-cured, and smoked foods with stomach
and esophageal cancers, indicating that the public should continue to limit
its intake of these foods to the current low levels of consumption.

Special Populations

Persons at high risk for diet-related cancers because of family history,
obesity, or excessive alcohol intake should receive counseling from
qualified health professionals to design approaches that could reduce their
elevated risk for cancer.

Patients with cancer should receive appropriate nutritional support and
dietary advice to maintain optimal nutritional status throughout medical,
surgical, or radiological therapy. There is no credible evidence that nutri-
tional changes specifically help in the cure of cancer patients.

Children and older persons are not currently targeted by the dietary guide-
lines relative to cancer risk due to limited data for these groups.

Nutrition Programs and Services

Food Labels

Evidence related to the role of dietary factors in cancer suggests that food
manufacturers should include on package labels information about nutri-
tional content of the food, especially for fat and carbohydrate components
(and including fiber components to the extent permitted by analytical
methods). :

Food Services

Evidence related to the possible role of dietary factors in cancer suggests
that the public might benefit from increased availability of foods low in fat
and high in fiber.

Food Products

Evidence related to the role of dietary factors in cancer suggests that foods
low or reduced in calories and fat and high in fiber should be made
increasingly available by food manufacturers.

Special Populations

Persons with cancer should be provided with counseling and assistance in
the development of diets appropriate to their condition.

226
Cancer @|

Research and Surveillance

Research and surveillance issues of special priority related to the role of
diet in cancer should include investigations into:

e Molecular mechanisms of carcinogenesis and the ways in which ini-
tiating or promoting events may be affected by specific components of
dietary fat, fiber, protein, alcohol, vitamin A, carotenoids, and other
vitamins or minerals.

© Quantitative relationships between food and nutrient intake and can-
cer incidence through chemoprevention and dietary clinical trials.

© The effect of specific components of dietary fat, fiber, vitamin A, and
carotenoids on cancer etiology.

Interactions between dietary factors such as fat, fiber, calories, pro-
tein, and specific vitamins and minerals in cancer prevention and
causation.

@ Development of biochemical markers of dietary intake to better
monitor effects of dietary intervention on cancer risk.

e Patterns of food intake best associated with cancer prevention.

@ Development of national population data on food and nutrient con-
sumption patterns and specific cancer rates, including more accurate
assessment of intake of specific dietary factors within relatively homo-
geneous population groups.

@ Levels of carcinogenic and mutagenic substances in the food supply.

e Dietary guidance methods that are most effective in helping people
improve patterns of food intake.

@ The causes of wasting and malnutrition in cancer patients and the
effects of nutritional support on response to therapy and survival in
these patients.

227
ie Nutrition and Health

Literature Cited

Ackerman, L.V.; Weinstein, I.B.; and Kaplan, H.S. 1978. Cancer of the esophagus. In Cancer
in China, ed. H.S. Kaplan and PJ. Tsuchitaui, pp. 111-36. New York: Liss.

ACS. See American Cancer Society.

Adami, H.O.; Rimsten, A.; Stenkvist, B.; and Vegelius, J. 1977. Influence of height, weight
and obesity on risk of breast cancer in an unselected Swedish population. British Journal of
Cancer 36:787-92.

Albanes, D. 1987. Caloric intake, body weight, and cancer: a review. Nutrition and Cancer
9:199-217.

Alftlan, O.; Tarkkanen, T.; Grohn, P.; Heinonen, E.; Pyrhonen, S.; and Tigason, S.K. 1983.
Etretinate in prevention of recurrence of superficial bladder tumors. European Urology 9:6-9.

American Cancer Society. 1984. Unproven methods of cancer management: macrobiotic
diets. CA—A Cancer Journal for Clinicians 34( 1):60-63.

Ames, B. 1983. Dietary carcinogens and anticarcinogens, oxygen radicals and degenerative
diseases. Science 221:1256-64.

Anonymous. 1984. Cancer cachexia. Lancet i:833-34.

Aoki, K.; Okada, H.; Takeda, S.; Segi, M.; Ohno, Y.; Sasaki, R.; and Tominaga, S. 1982. Case
control study on esophageal cancer in Japan. Proceedings of the 13th International Cancer
Congress, abstract no. 986, p. 175.

Armstrong, B., and Doll, R. 1975. Environmental factors and cancer incidence and mortality
in different countries, with special reference to dietary practices. International Journal of
Cancer 15:617-31.

Armstrong, B.K., and Mann, J.[. 1985. Diet. In Cancer risks and prevention, ed. M.P. Vessey
and M. Gray, pp. 68-98. New York: Oxford Univ. Press.

Asal, N.; Geyer, J.; Risser, D.; Lee, E.; and Kadamani, S. 1985. Population-based case-
control study of risk factors in renal cell carcinoma [Abstract]. American Journal of Epidemi-
ology 122:541.

Bansal, B.R.; Rhoads, J.E.; and Bansal, S.C. 1978. Effects of diet on colon carcinogenesis and
the immune system in rats treated with 1,2-dimethylhydrazine. Cancer Research
38:3293-3303.

Barbolt, T.A., and Abraham, R. 1978. The effect of bran on dimethylhydrazine-induced colon
carcinogenesis in the rat. Proceedings of the Society for Experimental Biology and Medicine
157:656-59.

Bauer, H.G.; Asp, N.G.; Oste, R.; Dahlqvist, A.; and Fredlund, PE. 1979. Effect of dietary
fiber on the induction of colorectal tumors and fecal-glucuronidase activity in the rat. Cancer
Research 39:3742-56.

Beecher, G.R., and Khachik, F. 1984. Evaluation of vitamin A and carotenoid data in food
composition tables. Journal of the National Cancer Institute 73:1397-1404.

Beisel, W.R. 1984. Nutrition, infection, specific immune responses, and nonspecific host
defenses: a complex interaction. In Nutrition, disease resistance, and immune function, vol.
1, ed. R.R. Watson, pp. 3-34. New York: Marcel Dekker.

Bellur, S.N.; Chandra, V.; and Anderson, R.J. 1983. Association of meningiomas with obesity.
Annals of Neurology 13:346-47.

228
Cancer O -

Bertram, J.S.; Kolonel, L.N.; and Meyskens, F.L. 1987. Rationale and strategies for che-
moprevention of cancer in humans. Cancer Research 47:3012-31.* .

Bingham, S.A.; Williams, D.R.R.; and Cummings, JH. 1985. Dietary fibre consumption in
Britain: new estimates and their relation to large bowel cancer mortality. British Journal of
Cancer 52:399-402.

Bingham, S.; Williams, D.R.R.; Cole, T.J.; and James, W.P.T. 1979. Dietary fibre and regional
large-bowel cancer mortality in Britain. British Journal of Cancer 40:456-63.

Bingham, S.; Wiggins, H.S.; Englyst,-H.; Seppanen, R.: Helms, P.; Strand, R.; Burton, R.;
Jorgensen, I.M.; Poulsen, L.; Paerregaard, A.; Bjerrum, L.; and James, W.P. 1982. Methods
and validity of dietary assessments in four Scandinavian populations. Nutrition and Cancer
4:23. .

Birt, D.F., and Roebuck, B.D. 1986. Enhancement of pancreatic carcinogenesis by dietary fat
in the hamster and rat models. In Dietary fat and cancer, ed. C. Ip., D.F. Birt, A.E. Rogers,
and C.-Mettlin, pp. 331-56. New York: Liss. , - ,

Bishop, J.M. 1984. Genes gone awry. In Cancer today, chap. 2., ed. L. Roberts. Washington,
DC: National Academy Press. .

. 1987. The molecular genetics of cancer. Science 235:305-11.

 

Bjelke, E. 1974a. Case-control study in Minnesota. Scandinavian Journal of Gastroen-
terology Xsuppl. 31):49.

 

_ 1974b; Case-contro! study in Norway. Scandinavian Journal of Gastroenterology
suppl. 31):42. : : : :

_ 1975. Dietary vitamin A and human lung cancer. International Journal of Cancer
15:561-65. :

: . 1978. Dietary factors and the epidemiology of cancer of the stomach and large bowel.
Aktuel Ernaehrungsmed Klin Prax 2(supp!): 10-17. : -

 

 

Block, G., and Menkes, M. 1988. Ascorbic acid in cancer prevention. In Nutrition and cancer
prevention: the role of micronutrients, ed. T. Moon and M. Micozzi. New York: Marcel
Dekker.

Boissonneault, G.A.; Elson, C.E.; and Pariza, M.W. 1986. Net energy effects of dietary fat on
chemically-induced mammary carcinogenesis in F344 rats. Journal of the National Cancer
Institute 76:335-38.

Bonmasser, E.; Dallavalle, R.; and Guiliani, G. 1968. Influence of vitamin E with propylgallate
on carcinogenesis with benzopyrene in mice. Archivio Italiano di Patologia e Clinica dei
Tumori 11:245-50.

Braden, L.M., and Carroll, K. 1984. Dietary polyunsaturated fat in relation to mammary
carcinogenesis in rats. Lipids 21(4):285-88.

Brechot, C.; Nalpas, B.; Courouce A-M.; Duhamel, G.; Callard, P.; Carnot, E;; Tiolais, P.; and
Berthelot, P. 1982. Evidence that hepatitis B virus has a role in liver-cell carcinoma in alcoholic
liver disease. New England Journal of Medicine 306:1384-87.

Brennan, M.F. 1981. Total parenteral nutrition in the cancer patient. New England Journal of
Medicine 305:375-82.

Brennan, M.F., and Copeland, E.M. 1981, Panel report on nutritional support of patients with
cancer. American Journal of Clinical Nutrition 34:1199-1205.

229
@} Nutrition and Health

Brisson, J.; Morrison, A.S.; Kopans, D.B.; Sadowsky, N.L.; Kalisher, L.; Twaddle, J.A.;
Meyer, J.E.; Henschke, C.1.,and Cole, P. 1984. Height and weight, mammographic features of
breast tissue, and breast cancer risk. American Journal of Epidemiology 119:371-81.

Broitman, S.A.; Vitale, J.J; and Gottlieb, L.S. 1983. Ethanolic beverage consumption,
cigarette smoking, nutritional status, and digestive tract cancers. Seminars in Oncology
10(3):322-29.

Buell, P. 1973. Changing incidence of breast cancer in Japanese-American women. Journal of
the National Cancer Institute §1:1479-83.

Bull, A.W.; Soullier, B.R.; Wilson, D.S.; Hayden, M.T.; and Nigro, N.D. 1979. Promotion of
azoxymethane-induced intestinal cancer by high-fat diet in rats. Cancer Research 39:4956-59.

Burkitt, D.P. 1980. Fiber in the etiology of colorectal cancer. In Progress in cancer research
and therapy, vol. 13, ed. S.J. Winawer, D. Schottenfeld, and P. Sherlock, pp. 13-18. New York:
Raven.

Bussey, H.J.R.; DeCosse, J.J.; Deschner, E.E.; Eyers. A.A.; Lesser, M.L.; Morson, B.C.;
Ritchie, S.M.; Thomson, J.PS.; and Wadsworth, J. 1982. A randomized trial of ascorbic acid
in polyposis coli. Cancer 50: 1434-39.

Butrum, R.R.; Clifford, C.K.; and Lanza, E. 1988. NCI dietary guidelines: rationale. Ameri-
can Journal of Clinical Nutrition 48(suppl.).

Byers, T., and Funch, D. 1984. Towards the dietary prevention of cancer: contributions of
epidemiology. Cancer Detection and Prevention 7:135—46.

Byers, T., and Graham, S. 1984. The epidemiology of diet and cancer. In Advances in cancer
research, vol. 41, ed. G. Klein and S. Weinhouse, pp. 1-69. Orlando, FL: Academic.

Byers, T.E.; Graham, S.; Haughey, B.P.; Marshall, J.R.; and Swanson, M.K. 1987. Diet and
lung cancer risk: findings from the Western New York Diet Study. American Journal of
Epidemiology 125:351-63.

Cameron, E., and Pauling, L. 1978. Supplemental ascorbate in three supportive treatments of
cancer: reevaluation of prolongation of survival times in terminal human cancer. Proceedings
of the National Academy of Sciences, USA 75:4538-42.

Carroll, K.K. 1980. Lipids and carcinogenesis. Journal of Environmental Pathology and
Toxicology 3:253-71.

___.. 1986. Experimental studies on dietary fat and cancer in relation to epidemiological
data. In Dietary fat and cancer. eds. C. Ip, D-F. Birt, A.E. Rogers. and C. Mettlin, pp. 231-48.
New York: Liss.

Carroll, K.K., and Khor, H.T. 1975. Dietary fat in relation to tumorigenesis. Progress in
Biochemical Pharmacology 10:308-53.

Carroll, K.K.; Gammal, E.B.: and Plunkett, E.R. 1968. Dietary fat and mammary cancer.
Canadian Medical Association Journal 98:590-91.

Centers for Disease Control. 1984. Selenium intoxication—New York. Morbidity and Mor-
tality Weekly Report 33(12): 157-58.

Chan, P.C.: Ferguson, K.A.; and Dao, T.L. 1983. Effects of different dietary fats on mammary
carcinogenesis. Cancer Research 43:1079-83.

Choi, N.W.; Howe, G.R.; Miller, A.B.; Matthews, V.: Morgan, R.W.; Munan, L.; Burch, J.D.:
Feather, J.; Jain, M.; and Kelly, A. 1978. An epidemiologic study of breast cancer. American
Journal of Epidemiology 107:510-21.

230
Cancer OQ

Chu, E.W., and Malmgren, R.A. 1965. An inhibitory effect of vitamin A on the induction of
tumors of forestomach and cervix in the Syrian hamster by carcinogenic polycyclic hydrocar-
bons. Cancer Research 25:884-95.

Cohen, L.A. 1986. Dietary fat and mammary cancer. In Diet, nutrition, and cancer: a critical
evaluation. Macronutrients and cancer, vol. 1, ed. B.S. Reddy and L.A. Cohen, pp. 77-100.
Boca Raton, FL: CRC.

. 1987. Diet and cancer. Scientific American 257(5):42-50.

Colditz, G.A.; Branch, L.G.; Lipnick, R.J.; Willett, W.C.; Rosner, B.; Posner, B.M.; and
Hennekens, C.H. 1985. Increased green and yellow vegetable intake and lowered cancer
deaths in an elderly population. ‘American Journal of Clinical Nutrition 41:32-36.

 

Cook, M.G., and McNamara, D. 1980. Effect of dietary vitamin E on dimethylhydrazine-
induced colonic tumors in mice. Cancer Research 40: 1329-31.

Cordle, F. 1986. The use of epidemiology, scientific data, and regulatory authority to deter-
mine risk factors in cancers of some organs of the digestive system. Regulatory Toxicology and
Pharmacology 6:171-80.

Correa, P. 1981. Epidemiological correlations between diet and cancer frequency. Cancer
Research 41:3685-90.

Creagan, E.T.; Moertel, C.G.; O'Fallon, J.R.; Schutt, A.J.; O’Connell, M.J.; Rubin, J.; and
Frytak, S. 1979. Failure of high-dose vitamin C (ascorbic acid) therapy to benefit patients with
advanced cancer. New England Journal of Medicine 301:687-90.

Cummings, J.H., and Branch, W.J. 1982. Postulated mechanisms whereby fiber may protect
against large bowel cancer. In A report of the Surgeon General. Rockville, MD: U.S. Public
Health Service.

Dales, L.G.; Friedman, G.D.; Ury, H.K.; Grossman, S.; and Willliams, S.R. 1978. A case
control study of relationships of diet and other traits to colorectal cancer in American blacks.
American Journal of Epidemiology 109: 132.

Dao, T.L., and Chan, P.C. 1983. Effect of duration of high fat intake on enhancement of
mammary carcinogenesis in rats. Journal of the National Cancer Institute 71:201-5.

Daoud, A.H., and Griffin, A.C. 1978. Effect of selenium and retinoic acid on the metabolism
of N-acetylaminofluorene and N-hydroxyacetylaminofluorene. Cancer Letters 5:231-37.

Darby, W. 1982. Nutrition, diet and cancer: concepts and policy. In Molecular interrelations of
nutrition and cancer, ed. M. Arnott, J. van Eys, and Y. Wang, pp. 27-33. New York: Raven.

DeCosse, J.J.; Adams, M.B.; Kuzma, J.E.; and Codon, R.E. 1975. Effect of ascorbic acid on
rectal polyps of patients with familial polyposis. Surgery 78:608-12.

de Waard, F., and Baanders-van Halewijn, E.A. 1974. A prospective study in general practice
on breast cancer risk in postmenopausal women. International Journal of Cancer 14:153-60.

de Waard, F.; Baanders-van Halewijn, E.A.; and Huizinga, J. 1964. The bimodal age distribu-
tion of patients with mammary carcinoma. Cancer 17:141-51.

DHHS. See U.S. Department of Health and Human Services.

Dion, P.W.; Bright-See, E.B.; Smith, C.C.; and Bruce, W.R. 1982. The effect of dietary
ascorbic acid and alpha-tocopherol on fecal mutagenicity. Mutation Research 102:27-31.

Diplock, A.T. 1987. Trace elements in human health with special reference to selenium.
American Journal of Clinical Nutrition 45: 1313-22.

231
CO Nutrition and Health

Doll, R., and Peto, R. 1981. The causes of cancer: quantitative estimates of avoidable risks of
cancer in the United States today. Journal of the National Cancer Institute 66:1191-308.

Donaldson, S.S. 1984. Nutritional support as an adjunct to radiation therapy. Journal of
Parenteral and Enteral Nutrition 8:302-10.

Drasar, B.S., and Irving, D. 1973. Environmental factors and cancer of the colon and breasi.
British Journal of Cancer 27:167-72.

Dungal, N. 1961. The special problem of stomach cancer in Ireland. With particular reference
to dietary factors. Journal of the American Medical Association 178:789-98.

Eastwood, M.A.; McKay, L.F.; and Brydon, W.G. 1986. Methane production and excretion: a
marker of cecal fermentation. In Dietary fiber: basic and clinical aspects, ed. G.V. Vahouny
and D. Kritchevsky, pp. 151-66. New York: Plenum.

Englyst, H.N.; Bingham, S.A.; Wiggins, H.S.; Southgate, D.A.T.; Seppanen, R.; Helms, P.;
Anderson, V.; Day, K.C.; Choolun, R.; Collinson, E.; and Cummings, J.H. 1982. Nonstarch
polysaccharide consumption in four Scandinavian populations. Nutrition and Cancer 4:50.

Enig, M.G.; Munn, R.J.; and Kenney, M. 1978. Dietary fats and cancer trends—a critique.
Federal Proceedings 37:2215-20.

Enstrom, JE. 1980. Health and dietary practices and cancer mortality among California
Mormons. In Banbury Report 4. Cancer incidence in defined populations, ed. J. Cairns, J.L.
Lyon, and M. Skolnick, pp. 69-92. Cold Spring Harbor, NY: Cold Spring Harbor Laboratory.

EOCCPS. See European Organization for Cooperation on Cancer Prevention Studies.

Epstein, S.S.; Joshi, S.; Audrea, J.; Forsyth, J.; and Mantel, N. 1967. The null effect of
antioxidants on the carcinogenicity of 3,4,9-10-dibenzopyrene in mice. Life Science 6:225-33.

European Organization for Cooperation on Cancer Prevention Studies. 1986. Consensus
statement on provisional dietary guidelines. Nutrition and Cancer 8(1):39-40.

Feinstein, A.R. 1987. Scientific standards and epidemiologic methods. American Journal of
Clinical Nutrition 45:1080-88.

Foote, C.S. 1976. In Free radicals in biology, vol. 2, ed. W. Pryor, pp. 85-133. New York:
Academic.

Freedman, B. 1987. Equipoise and the ethics of clinical research. New England Journal of
Medicine 317:141-45.

Fujimaki, Y. 1926. Formation of cancer in albino rats fed on deficient diets. Journal of Cancer
Research 10:469-77.

Garfinkel, L. 1985. Presentation before the American Cancer Society 2nd National Confer-
ence on Diet, Nutrition and Cancer. Houston, TX.

Gaskill, S.P.; McGuire, W.L.; Osborne, C.K.; and Stern, M.P. 1979. Breast cancer mortality
and diet in the United States. Cancer Research 39:3628-37.

Geboers, J.; Joossens, J. V.; and Kesteloot, H. 1985. Epidemiology of stomach cancer. In Diet
and human carcinogenesis, ed. J.V. Joossens, M.J. Hill, and J. Geboers, pp. 81-95. New York:
Elsevier Science.

Gershwin M.E.; Beach R.S.; and Hurley L.S. 1985. Nutrition and immunity. Orlando, FL:
Academic.

Gey, K.F.; Brubacher, G.B.; and Stahelin, H.B. 1987. Plasma levels of antioxidant vitamins in
relation to ischemic heart disease and cancer. American Journal of Clinical Nutrition
45:1368-77.

232
Cancer e|

Goldin, B.R. 1986. The metabolism of the intestinal microflora and its relationship to dietary
fat, colon and breast cancer. In Dietary fat and cancer, ed. C. Ip, D.F. Birt, A.E. Rogers, and
C. Mettlin, pp. 655-85. New York: Liss.

Good, R.A. 1981. Nutrition and immunity. Journal of Clinical Immunology \(1):3-11.

Goodman, M.; Morgenstern, H.; and Wynder, E. 1986. A case-control study of factors
affecting the development of renal cell carcinoma. American Journal of Epidemiology
124:926-41.

Gori, G.B. 1979. Dietary and nutritional implications in the multifactorial etiology of certain
prevalent human cancers. Cancer 43(5 suppl.):2151-61.

Gouveia, J.; Hercend, T.; Lemaigre, G.; Mathe, G.; Gros, F.; Santelli, G.; Homasson, LP.;
Angebault, M.; Lededente, A.; Parrot, R.; Gaillard, J.P; Bonniot, J.P.,; Marsac, J.; and Pretet,
S. 1982. Degree of bronchial metaplasia in heavy smokers and its regression after treatment
with a retinoid. Lancet i:710-12.

Graham, S.; Schotz, W.; and Martino, P. 1972. Alimentary factors in the epidemiology of
gastric cancer. Cancer 30:927-38.

Graham, S.; Dayal, H.; Swanson, M.; Mittelman, A.; and Wilkinson, G. 1978. Diet in the
epidemiology of cancer of the colon and rectum. Journal of the National Cancer Institute
61:709-14.

Graham, S.; Marshall, J.; Mettlin, C.;Rzepka, T.; and Nemoto, T. 1982. Diet in the epidemiol-
ogy of breast cancer. American Journal of Epidemiology 116:68-75.

Graham, S.; Mettlin, C.; Marshall, J.; Priore, R.; Rzepka, T.; and Shedd, D. 1981. Dietary
factors in the epidemiology of cancer of the larynx. American Journal of Epidemiology
113:675-80.

Graham, S.; Haughey, B.; Marshall, J.; Priore, R.; Byers, T.; Rzepka, T.; Mettlin, C.; and
Pontes, J.E. 1983. Diet in the epidemiology of carcinoma of the prostate gland. Journal of the
National Cancer Institute 70:687-92.

Gray, G.E.; Pike, M.C.; and Henderson, B.E. 1979. Breast cancer incidence and mortality
rates in different countries in relation to known risk factors and dietary practices. British
Journal of Cancer 39:1-7.

Greenwald, P.; Damon, A.; Kirmss, V.; and Polan, A.K. 1974. Physical and demographic
features of men before developing cancer of the prostate. Journal of the National Cancer
Institute 53:341-46.

Greenwald, P.; Lanza, E.; and Eddy, G.A. 1987. Dietary fiber in the reduction of colon cancer
risk. Journal of the American Dietetic Association 87:1178-88.

Greenwald, P.; Sondik, E.; and Lynch, B.S. 1986. Diet and chemoprevention in NCI’s
research strategy to achieve national cancer control objectives. Annual Review of Public
Health 7:267-91.

Gregor, A.; Lee, P.N.; Roe, F.1.C.; Wilson, M.J.; and Melton, A. 1980. Comparison of dietary
histories in lung cancer cases and controls with special reference to vitamin A. Nutrition and
Cancer 2:93-97.

Haber, S.L., and Wissler, R.W. 1962. Effect of vitamin E on carcinogenicity of meth-
ylcholanthrene. Proceedings of the Society for Experimental Biology and Medicine
111:774-75.

Haenszel, W. 1982. Migrant studies. In Cancer epidemiology and prevention, ed. D. Schotten-
feld and J.F. Fraumeni, pp. 194-207. Philadelphia, PA: Saunders.

233
@} Nutrition and Health

Haenszel, W.; Locke, F.B.; and Segi, M. 1980. A case-control study of large bowel cancer in
Japan. Journal of the National Cancer Institute 64:17.

Haenszel, W.; Kurihara, M.; Segi, M.; and Lee, R-K. 1972. Stomach cancer among Japanese
in Hawaii. Journal of the National Cancer Institute 49:969-88.

Haenszel, W.; Berg, J.W.; Segi, M.; Kurihara, M.; and Locke, EB. 1973. Large-bowel cancer
in Hawaiian Japanese. Journal of the National Cancer Institute 51:1765-79.

Haenszel, W.; Kurihara, M.; Locke, F.B.; Schimuzu, K.; and Segi, M. 1976. Stomach cancer
in Japan. Journal of the National Cancer Institute 56:265-74.

Hebert, L.R., and Wynder, E.L. 1987. Letter to the editor. New England Journal of Medicine
317(3): 165-66.

Heinonen, P.K.; Koskinen, T.; and Tuimala, R. 1985. Serum levels of vitamins A and E in
women with ovarian cancer. Archives of Gynecology 237:37-40.

Helms, P.; Jorgensen, I.M.; Paerregaard, A.; Bjerrum, L.; Poulsen, L.; and Mosbech, J. 1982.
Dietary patterns in Them and Copenhagen, Denmark. Nutrition and Cancer 4:34—40.

Helzlsouer, K.J. 1983. Selenium and cancer prevention. Seminars in Oncology 10(3):305-10.

Hems, G. 1970. Epidemiological characteristics of breast cancer in middle and late age. British
Journal of Cancer 24:226-34.

_ 1978. The contributions of diet and childbearing to breast cancer rates. British Journal
of Cancer 37:974-82.

Henderson, B.E.; Casagrande, J.T.; Pike, M.C.; Mack, T.; Rosario, I.; and Duke, A. 1983.
The epidemiology of endometrial cancer in young women. British Journal of Cancer
47:749-56.

Herbert, V. 1986. Unproven (questionable) dietary and nutritional methods in cancer preven-
tion and treatment. Cancer 58:1930-41.

Heshmat, M.Y.; Kaul, L.; Kovi, J.; Jackson, M.A.; Jackson, A.G.; Jones G.W.; Edson M.;
Enterline, J.P.; Worrell R.G.; and Perry, S.L. 1985. Nutrition and prostate cancer: a case-
control study. The Prostate 6:7-17.

 

Higginson, J. 1967. Etiology of gastrointestinal cancer in man. NCI Monographs 25:191-98.
Hill, M.J. 1983. Bile, bacteria and bowel cancer. Gut 24:871-75.

Hill, M.J.; Crowther, J.S.; Drasar, B.S.; Hawksworth, G.; Aries, V.; and Williams, R.E.O.
1971. Bacteria and etiology of cancer of the large bowel. Lancet i:95-100.

Hinds, M.W.; Kolonel, L.N.; Hankin, J.H.; and Lee, J. 1984. Dietary vitamin A, carotene,
vitamin C and risk of lung cancer in Hawaii. American Journal of Epidemiology 119:227-37.

Hirayama, T. 1977. Changing patterns of cancer in Japan with special reference to the decrease
in stomach cancer mortality. In Origins of human cancer, ed. H.H. Hiatt, J.D. Watson, and
L.A. Winsten, pp. 55-75. Cold Spring Harbor, NY: Cold Spring Harbor Laboratory.

. 1978. Epidemiology of breast cancer with special reference to the role of diet.
Preventive Medicine 7:173-95.

 

_____, 1979, Diet and cancer. Nutrition and Cancer 1:67-81.

. 1981. A large-scale cohort study on the relationship between diet and selected cancers
of digestive organs. In Gastrointestinal cancer: endogenous factors. Banbury report no.7, ed.
WR. Bruce, P. Correa, M. Lipkin, S.R. Tannenbaum, and T.D. Wilkins, pp. 409-29. Cold
Spring Harbor, NY: Cold Spring Harbor Laboratory.

 

234
Cancer ie

Hirohata, T.; Nomura, A.M.; Hankin, J.H.; Kolonel, L.N.; and Lee, J. 1987. An epi-
demiologic study on the association between diet and breast cancer. Journal of the National
Cancer Institute 78(4):595-600.

Hislop, T.G.; Coldman, A.J.; Elwood, J.M.; Brauer, G.; and Kan, L. 1986. Childhood and
recent eating patterns and risk of breast cancer. Cancer Detection and Prevention
9(1-2):47-58.

Hodgson, T., and Meiners, M. 1982. Cost-of-illness methodology: a guide to current practices
and procedures. Milbank Memorial Fund Quarterly 60:429-62.

Howe, G.M., ed. 1986. Global geocancerology. New York: Longman Group, Ltd.

Howell, M.A. 1975. Diet as an etiological factor in the development of cancers of the colon and
rectum. Journal of Chronic Disease 28:67.

Hunter, K.; Linn, M.W.; and Harris, R. 1980. Dietary patterns and cancer of the digestive
tract in older patients. Journal of the American Geriatric Society 28:405.

Ibrahim, K.; Jafarey, N.A.; and Zuberi, S.J. 1977. Plasma vitamin A and carotene levels in
squamous cell carcinoma of oral cavity and coro-pharynx. Clinical Oncology 3:203-7.

Ingram, D.M. 1981. Trends in diet and breast cancer mortality in England and Wales
1928-1977. Nutrition and Cancer 3:75-80.

Ip, C. 1981. Prophylaxis of mammary neoplasia by selenium supplementation in the initiation
and promotion phases of chemical carcinogenesis. Cancer Research 41:4386-90.

Ip, C.; Ip, M.M.; and Sylvester, P. 1986. Relevance of trans fatty acids and fish oil in animal
tumorigenesis studies. In Dietary fat and cancer, ed. C. Ip, D.F. Birt, A.E. Rogers, and C,
Mettlin, pp. 283-94. New York: Liss.

Irving, D., and Drasar, B.S. 1973. Fibre and cancer of the colon. British Journal of Cancer
28:462-63.

Jacobs, L.R. 1983. Enhancement of rat colon carcinogenesis by wheat bran consumption
during the stage of 1,2-dimethylhydrazine administration. Cancer Research 43:4057-61.

Jacobs, M.M.; Matney, T.S.; and Griffin, A.C. 1977. Inhibitory effects of selenium on the
mutagenicity of 2-acetylaminofluorine (AFF) and AAF derivatives. Cancer Letters 2:319-22.

Jain, M.; Cook, G.M.; Davis, F.G.; Grace, M.G.; Hove, G.R.; and Millerm, A.B. 1980. A
case-control study of diet and colo-rectal cancer. International Journal of Cancer 26:757-68.

Jensen, O.M. 1983. Cancer risk among Danish male Seventh-day Adventists and other
temperance society members. Journal of the National Cancer Institute 70(6):1011-14.

Jensen, O.M.; MacLennan, R.; and Wahrendorf, J. 1982. Diet, bowel function, fecal character-
istics, and large bowel cancer in Denmark and Finland. Nutrition and Cancer 4:5-19.

Jones, D.Y.; Schatzkin, A.; Green, S.B.; Block, G.; Brinton, L.A.; Ziegler, R.G.; Hoover, R.;
and Taylor, P.R. 1987. Dietary fat and breast cancer in the National Health and Nutrition
Examination Survey. I. Epidemiological follow-up study. Journal of the National Cancer
Institute 79(3):465-71.

Joossens, J.V., and Geboers, J. 1985. Diet, cancer and other diseases. In Diet and human
carcinogenesis, ed. J.V. Joossens, M.J. Hill, and J. Geboers, pp. 277-297. New York: Elsevier
Science.

Judd, J.T.; Kelsay, J.L.; and Mertz, W. 1983. Potential risks from low-fat diets. Seminars in
Oncology 10:273-80.

Kakar, F., and Henderson, M. 1985. Diet and breast cancer. Clinical Nutrition 4:119-30.

235
C Nutrition and Health

Kamm, J.J. 1982. Toxicology, carcinogenicity and teratogenicity of some orally administered
retinoids. Journal of American Academy of Dermatology 6:652-56.

Kark, J.D.; Smith, A.H.; Switzer, B.R.: and Hanes, C.G. 1981. Serum vitamin A (retinol) and
cancer incidence in Evans County, Georgia. Journal of the National Cancer Institute 66:7-16.

Karmali, R.A.; Marsh, J.; and Fuchs, C. 1984. Effect of omega-3 fatty acids on growth of a rat
mammary tumor. Journal of the National Cancer Institute 73(2):457-61.

Katsouyanni, K.; Trichopoulos, D.; Boyle, P.; Xirouchki, E.; Trichopoulou, A.; Lisseos B.;
Vasilaros, S.; and MacMahon, B. 1986. Diet and breast cancer: a case-control study in
Greece. International Journal of Cancer 38:815-20.

Kelsey, J.L.; Fischer, D.B.; Holford, T.R.; LiVolsi, V.A.; Mostow, E.D.; Goldenberg, I.S.;
and White, C. 1981. Exogenous estrogens and other factors in the epidemiology of breast
cancer. Journal of the National Cancer Institute 67:327-33.

Kelsey, J.L.; LiVolsi, V.A.; Holford, T.R.; Fischer, D.B.; Mostow, E.D.; Schwartz, P.E.;
O’Connor, T.; and White, C. 1982. ‘A case-control study of cancer of the endometrium.
American Journal of Epidemiology 116:333-42.

Kinlen, L.J. 1982. Meat and fat consumption and cancer mortality: a study of strict religious
orders in Britain. Lancet i:946-49.

Kleinbaum, D.G.; Kupper, L.L.; and Morgenstern, H. 1982. Epidemiologic research. New
York: Van Nostrand Reinhold.

Knox, E.G. 1977. Foods and diseases. British Journal of Preventive and Social Medicine
31:71-80.

Kok, F.J.; De Bruijn, A.M.; Hofman, A.; Vermeeren, R.; and Valkenburg, H.A. 1987. Is
serum selenium a risk factor for cancer in men only? American Journal of Epidemiology
125:12-16.

Kolonel. L.N. 1987. Fat and colon cancer: how firm is the evidence? American Journal of
Clinical Nutrition 45:336-41.

Kolonel, L.N., and Le Marchand, L. 1986. The epidemiology of colon cancer and dietary fat.
In Dietary fat and cancer, ed. C. Ip, D.F. Birt, A.E. Rogers, and C. Mettlin, pp. 69-91. New
York: Liss.

Kolonel, L.N.; Hankin, J.H.; and Nomura, A.M. 1986. Multiethnic studies of diet, nutrition,
and cancer in Hawaii. In Diet, nutrition, and cancer, ed. Y. Hayashi, pp. 29-40. Tokyo: Japan
Science Society Press.

Kolonel, L.N.; Nomura, A.M.Y.; Hirobata, T.; Hankin, J.H.; and Hinds, M.W. 1981. Asso-
ciation of diet and place of birth with stomach cancer incidence in Hawaii, Japanese and
Caucasians. American Journal of Clinical Nutrition 34:2478-85.

Kolonel, L.N.; Hankin, J.H.; Lee, J.; Chu, S.Y.; Nomura, A.M.Y.; and Hinds, M.W. 1981.
Nutrient intakes in relation to cancer incidence in Hawaii. British Journal of Cancer
44:332-39.

Kritchevsky, D. 1982. Lipids and cancer. In Molecular interrelations of nutrition and cancer,
ed. M.S. Arnott, J. van Eys, and Y.M. Wang, pp. 209-17. New York: Raven.

Kritchevsky, D., and Klurfeld, D.M. 1987, Caloric effects in experimental mammary tu-
morigenesis. American Journal of Clinical Nutrition 45:236-42.

Kritchevsky, D.; Weber, M.M.; and Klurfeld, D.M. 1984. Dietary fat versus caloric content in
initiation and promotion of 7,12-dimethylbenz(a)anthracene-induced mammary tu-
morigenesis in rats. Cancer Research 44:3174-77.

236
Cancer @)

Kummet, T.; Moon, T-E.; and Meyskens, F.L., Jr. 1983. Vitamin A: evidence for its preven-
tive role in human cancer. Nutrition and Cancer §(2):96-106.

Kune, S.; Kune, G.A.; and Watson, L.F. 1987. Case-control study of dietary etiological
factors: the Melbourne colorectal cancer study. Nutrition and Cancer \(1):21-42.

Kvale, G.; Bjelke, E.; and Gart, J.J. 1983. Dietary habits and lung cancer risk. International
Journal of Cancer 31:397-405.

Lasnitzki, I., and Goodman, D.S. 1974. Inhibition of the effects of methylcholanthrene on
mouse prostate in organ culture by vitamin A and its analogs. Cancer Research 34:1564-71.

Last, J.M, ed. 1983. A dictionary of epidemiology. New York: Oxford Univ. Press.
La Vecchia, C.; Franceshci, S.; Decarli, A.; Gentile, A.; Fasoli, M; Pampallona, S.: and

Tognoni G. 1984. Dietary vitamin A and the risk of invasive cervical cancer. International
Journal of Cancer 34:319-22.

Le, M.G.; Moulton, L.H.; Hill, C.; and Kramar, A. 1986. Consumption of dairy produce and
alcohol in a case-control study of breast cancer. Journal of the National Cancer Institute
77(3):633-36.

Lea, A.J. 1966. Dietary factors associated with death-rates from certain neoplasms in man.
Lancet ii:332-33.

Leuchtenberger, C., and Leuchtenberger, R. 1977. Protection of hamster lung cultures by L-
cysteine or vitamin C against carcinogenic effects of fresh smoke from tobacco or marihuana
cigarettes. British Journal of Experimental Pathology 58:625-34.

Lew, E.A., and Garfinkel, L. 1979. Variations in mortality by weight among 750,000 men and
women. Journal of Chronic Diseases 32:563-76.

Lijinsky, W., and Ross, A.E. 1967. Production of carcinogenic polynuclear hydrocarbons in
the cooking of food. Food and Cosmetics Toxicology 5:343-47.

Lijinsky, W., and Shubik, P. 1964. Benzo(a)pyrene and other polynuclear hydrocarbons in
charcoal-broiled meat. Science 145:53-55.

Lilienfeld, A.M., and Lilienfeld, D.E. 1980. Foundations of epidemiology. New York: Oxford
Univ. Press.

Lin, T.M.; Chen, K.P.; and MacMahon, B. 1971. Epidemiologic characteristics of cancer of
the breast in Taiwan. Cancer 27:1497-1504.

Linder, M.C. 1985. Nutrition and metabolism of vitamins. In Nutritional biochemistry and
metabolism, ed. M.C. Linder, pp. 69-131. New York: Elsevier Science.

Liv, K.; Stamler, J.; Moss, D.; Garside, D.; Persky, V.; and Soltero, I. 1979. Dietary
cholesterol, fat, and fiber and colon-cancer mortality. Lancet ii:782-85.

Lo, M.T., and Sandi, E.M. 1980. Selenium: occurrence in foods and its toxicological signifi-
cance: a review. Journal of Environmental Pathology and Toxicology 4:193-218.

Longnecker, M.P.; Taylor, P.R.; Levander, 0.A.; Howe, S.M.; Veillon, C.; McAdam, P.A.;
Patterson, K.Y.; Holden, J.M.; Stampfer, M.J.; Morris, S.J.; and Willett, W.C. 1987. Tissue
selenium (Se) levels and indices of Se exposure in a seleniferous area. Federation Proceedings
46: 1580.

Lubin, J.H.; Wax, Y.; and Modan B. 1986. Role of fat, animal protein, and dietary fiber in
breast cancer etiology: a case-control study. Journal of the National Cancer Institute
T7:605-11.

237
C Nutrition and Health

Lubin, }.H.; Burns, P.E.; Blot, W.J.; Ziegler, R.G.; Lees, A.W.; and Fraumeni J.F. 1981.
Dietary factors and breast cancer risk. International Journal of Cancer 28:685-89.

Lyon, J.L., and Sorenson, A.W. 1978. Colon cancer in a low-risk population. American
Journal of Clinical Nutrition 31:S227-30.

Lyon, J.L.; Gardner, J.W.; and West, D.W. 1980. Cancer incidence in Mormons and non-
Mormons in Utah during 1967-75. Journal of the National Cancer Institute 65:1055-61.

Lyon, J.L.; Mahoney, A.W.; West, D.W.; Gardner, J.W.; Smith, K.R.; Sorenson, A.W.; and
Stanish, W. 1987. Energy intake: its relationship to colon cancer risk. Journal of the National
Cancer Institute 78:853-61.

MacLennan, R.; Jensen, O.M.; Mosbech, J.; and Vuori, H. 1978. Diet, transit time, stool
weight, and colon cancer in two Scandinavian populations. American Journal of Clinical
Nutrition 31:8239.

Maclure, K.M., and MacMahon, B. 1985. A case-control study of renal adenocarcinoma
{Abstract]. American Journal of Epidemiology 122:520.

Macquart-Moulin, G.; Riboli, E.; Cornee, J.; Charnay, B.; Berthezene, P.; and Day, N. 1986.
Case-control study on colorectal cancer and diet in Marseilles. International Journal of
Cancer 38:183-91.

Mahboubi, E.; Eyler, N.; and Wynder, E.L. 1982. Epidemiology of cancer of the endo-
metrium. Clinical Obstetrics and Gynecology 25(1):5-17.

Maisto, O.E., and Gremner, C.G. 1981. Cancer of the colon and rectum in the coloured
population of Johannesburg. South African Medical Journal 60:571.

Malhorta, S.L. 1977. Dietary factors in a study of cancer colon from cancer registry, with
special reference to the role of saliva, milk and fermented milk products and vegetable fibre.
Medical Hypotheses 3:122-26.

Manousos, O.; Day, N.E.; Trichopoulos, D.; Gerovassilis, F.; Tzonou, A.; and Poly-
chronopoulou, A. 1983. Diet and colorectal cancer: a case-control study in Greece. Interna-
tional Journal of Cancer 32:1-S.

Martinez, I.; Torres, R.; Frias, Z.; Colon, J.R.; and Fernandez, M. 1981. Factors associated
with adenocarcinomas of the large bowel in Puerto Rico. Revista Latinoamericana de On-
cologia Clin 13:45.

McArdle, A.H.; Laplante, M.P.; and Freeman, C.R. 1986. Prophylaxis against radiation
injury: the use of elemental diet prior to and during radiotherapy for invasive bladder cancer
and in early postoperative feeding following radical cystectomy and ileal conduit. Archives of
Surgery 121:879-85.

McCay, P.B.; King, M.; Rikans, L.R.; and Pitha, J. V. 1980. Interactions between dietary fats
and antioxidants on DMBA-induced mammary carcinomas and on AAF-induced hyperplastic
nodules and hepatomas. Journal of Environmental Pathology and Toxicology 3(4):451-65.

McConnell, K.P.; Jayer, R.M.; Bland, K.I.; and Blotcky, A.J. 1980. The relationship of dietary
selenium and breast cancer. Journal of Surgical Oncology 15:67~70.

McKeown-Eyssen, G.E., and Bright-See, E. 1985. Dietary factors in colon cancer: interna-
tional relationships. An update. Nutrition and Cancer 7:251.

McKeown-Eyssen, G.E.; Holloway, C.; Jazmaiji, V.; et al. 1987. A randomized trial of vitamin
C and E supplementation in the prevention of recurrence of colorectal polyps [Abstract].
Presented at the eleventh annual meeting of the American Society of Preventive Oncology,
March 11-13, San Francisco.

238
Cancer e

McLaughlin, J.K.; Mandel, J.S.; Blot, W.J.; Schuman, L.M.; Mehl, E.S.; and Fraumeni, J.F.
1984. A population-based case-control study of renal cell carcinoma. Journal of the National
Cancer Institute 72:275-B4.

McMichael, A.J.; Potter, J.D.; and Hetzel, B.S. 1979. Time trends in colo-rectal cancer
mortality in relation to food and alcohol consumption: United States, United Kingdom,
Australia and New Zealand. International Journal of Epidemiology 8:295.

McMichael, A.J.; Jensen, O.M.; Parkin, D.M.; and Zaridze, D.G. 1984. Dietary and endoge-
nous cholesterol and human cancer. Epidemiologic Reviews 6:196-216.

McTiernan, A.; Weiss, N.; and Daling, J. 1985. Incidence of thyroid cancer in women in
relation to known or suspected risk factors for breast cancer [Abstract]. American Journal of
Epidemiology 122:528.

Medina, D. 1985. Mechanism of selenium inhibition of tumorigenesis. Journal of the American
College of Toxicology §:21-27.

Menkes, M., and Comstock, G. 1984. Vitamins A and E and lung cancer. American Journal of
Epidemiology 120(3):342-49.

Mettlin, C. Epidemiologic studies on vitamin A and cancer. Advances in Nutrition Research
6:47-65.

Mettlin, C.; Graham, S.; and Swanson, M. 1979. Vitamin A and lung cancer. Journal of the
National Cancer Institute 62(6): 1435-38.

Meyskens, F.L. 1982. Studies of retinoids in the prevention and treatment of cancer. Journal of
the American Academy of Dermatology 6:824-27.

Miettinen, O.S., and Cook, E.F. 1981. Confounding: essence and detection. American Jour-
nal of Epidemiology 114(4):593-603.

Miller, A.B. 1986. Dietary fat and the epidemiology of breast cancer. In Dietary fat and cancer,
ed. C. Ip, D.F. Birt, A-E. Rogers, and C. Mettlin, pp. 17-32. New York: Liss.

Miller, A.B.; Kelly, A.; Choi, N.W.; Matthews, V.; Morgan, L.W.; Munan, L.; Burch, J.D.;
Feather, J.; Howe, G.R.; and Jain, M. 1978. A study of diet and breast cancer. American
Journal of Epidemiology 107(6):499-509.

Miller, E.C., and Miller, J.A. 1976. The metabolism of chemical carcinogens to reactive
electrophiles and their possible mechanisms of action in carcinogenesis. American Chemical
Society Monograph No. 1 73, pp. 737-62. Washington, DC: American Chemical Society.

Mirra, A.P.; Cole, P.; and MacMahon, B. 1971. Breast cancer in an area of high parity. Sao
Paulo, Brazil. Cancer Research 31:77-83.

Mirvish, S.S.; Cardesa, A.; Wallcave, L.; and Shubik, P. 1975, Induction of lung adenomas by
amines or ureas plus nitrite and by N- itroso compounds: effect of ascorbate, gallic acid,
thiocyanate and caffeine. Journal of the National Cancer Institute 55:633-36.

Mirvish, S.S.; Pelfrene, A.F., Garcia, H.; and Shubik, P. 1976. Effect of sodium ascorbate on
tumor induction in rats treated with morpholine and sodium nitrate and with nitrosomorphine.
Cancer Letters 2:101-8.

Misslbeck, N., and Campbell, T.C. 1986. Alcohol, nutrition, and cancer. In Diet, nutrition,
and cancer: a critical evaluation. Micronutrients, nonnutritive dietary factors, and cancer,
vol. II, ed. B.S. Reddy and L.A. Cohen, pp. 101-34. Boca Raton, FL: CRC.

Modan, B. 1980. Role of migrant studies in understanding the etiology of cancer. American
Journal of Epidemiology 112(2):289-94.

239
le Nutrition and Health

Modan, B.; Barell, V.; Lubin, F., Modan, M.; Greenberg, R.A.; and Graham, S. 1975. Low-
fiber intake as an etiologic factor in cancer of the colon. Journal of the National Cancer
Institute 55:125.

Modan, B.:; Cuckle, H.; and Lubin, F. 1981. A note on the role of dietary retinol and carotene
in human gastrointestinal cancer. International Journal of Cancer 28:421-24.

Moertel, C.G.; Fleming, T.R.; Creagan, E.T.; Rubin, J.; O’Connell, M.J.; and Ames, M.M.
1985. High-dose vitamin C versus placebo in the treatment of patients with advanced cancer
who have had no prior chemotherapy. New England Journal of Medicine 312:137-41.

Moskowitz, M.; White, C.; Barnett, R.N.; Stevens, S.; Russell, E.; Vargo, D.; and Floch,
M.H. 1979. Diet fecal bile acids and neutral sterols in carcinoma of the colon. Digestive
Diseases and Sciences 24:746-51.

Nair, P-P.; Turjman, N.; Goodman, G.T.; Guidry, C.; and Calkins, B.M. 1984. Diet, nutrition
intake, and metabolism in populations at high and low risk for colon cancer: metabolism of
neutral sterols. American Journal of Clinical Nutrition 40:931.

National Research Council. 1980. Recommended dietary allowances. 9th ed. Committee on
Dietary Allowances, Food and Nutrition Board. Washington, DC: National Academy of
Sciences.

. 1982. Diet, nutrition, and cancer. Committee on Diet, Nutrition, and Cancer, Nation-
al Academy of Sciences. Washington, DC: National Academy Press.

 

Newberne, P.M., and Suphakarn, V. 1983. Nutrition and cancer: a review, with emphasis on
the role of vitamins C and E and selenium. Nutrition and Cancer 5(2):107-19.

Nigro, N.D.; Singh, D.V.; Campbell, R.L.; and Pak, M.S. 1975. Effect of dietary beef fat on
intestinal tumor formation by azoxymethane in rats. Journal of the National Cancer Institute
54:439-42.

Nomura, A.: Henderson, B.E.; and Lee, J. 1978. Breast cancer and diet among the Japanese in
Hawaii. American Journal of Clinical Nutrition 31(11):2020-25.

Nomura, A.M.Y.; Stemmermann, G.N.; Heilbrun, L.K.; Salkeld, R.M.; and Vuilleumier, J.P.
1985. Serum vitamin levels and the risk of cancer of specific sites in Hawaiian males of
Japanese ancestry. Cancer Research 45:2369-72.

O'Connor, T.P., and Campbell, T.C. 1986. Dietary guidelines. In Dietary fat and cancer, ed.C.
Ip, D.F. Birt, A.E. Rogers, and C. Mettlin, pp. 731-71. New York: Liss.

Olson, J.A. 1983. Adverse effects of large doses of vitamin A and retinoids. Seminars in
Oncology 10(3):290-93.

Paffenbarger, R.S., Jr.; Kampert, J.B.; and Chang, H.G. 1980. Characteristics that predict risk
of breast cancer before and after the menopause. American Journal of Epidemiology
112:258-68.

Palgi, A. 1984. Vitamin A and lung cancer: a perspective. Nutrition and Cancer 6(2):105-20.

Palmer, S. 1986. Diet, nutrition, and cancer. Progress in Food and Nutrition Science
9:283-341.

Palmer, S., and Bakshi, K. 1983. Diet, nutrition, and cancer: interim dietary guidelines.
Journal of the National Cancer Institute 70:1151-70.

Pardee, A.B.; Dubrow, R.; Hamlin, J.L.; and Kletzien, R.F. 1978. Animal cell cycle. Annual
Review of Biochemistry 47:715—50.

Pariza, M.W., and Boutwell, R.K. 1987. Historical perspective: calories and energy expendi-
ture in carcinogenesis. American Journal of Clinical Nutrition 45:151-56.

240
Cancer @|

Pariza, M.W., and Simopoulos, A.P., guest eds. 1987. Calories and energy expenditure in
carcinogenesis. Proceedings of a symposium held in Washington, DC, February 24-25, 1986.
American Journal of Clinical Nutrition 45(1, suppl.):149-372.

Perera, E.P. 1987. Molecular cancer epidemiology: a new tool in cancer prevention. Journal of
the National Cancer Institute 78:887-98.

Peto, R.; Doll, R.; Buckley, J.D.; and Sporn, M.B. 1981. Can dietary beta-carotene materially
reduce human cancer rates? Nature 290(5803):201-8.

Phillips, R.L. 1975. Role of life-style and dietary habits in risk of cancer among Seventh-day
Adventists. Cancer Research 35:3513-22.

Phillips, R.L., and Snowdon, D.A. 1983. Association of meat and coffee use with cancers of
the large bowel, breast, and prostate among Seventh-day Adventists: preliminary results.
Cancer Research 43(5, suppl.):2403s-08s.

Pickle, L.W.; Green, M.H.; Ziegler, R.G.; Toledo, A.; Hoover, R.; Lynch, H.T.; and
Fraumeni, J.F. 1984. Colorectal cancer in rural Nebraska. Cancer Research 44:363.

Pilch, S.M., ed. 1987. Physiological effects and health consequences of dietary fiber. Bethes-
da, MD: Federation of American Societies for Experimental Biology.

Pipkin, G.E.; Schlegel, J.U.; Nishimura, R.; and Shultz, G.N. 1969. Inhibitory effect of L-
ascorbate on tumor formation in urinary bladders implanted with 3-hydroxyanthranilic acid.
Proceedings of the Society for Experimental Biology and Medicine 131:522-24.

Pollack, E.S.; Nomura, A.M.Y.; Heilbrun, L.K.; Stemmermann, G.N.; and Green, S.B.
1984. Prospective study of alcohol consumption and cancer. New England Journal of Medi-
cine 10:617-21.

Potter, .D., and McMichael, A.J. 1986. Diet and cancer of the colon and rectum: a case-
control study. Journal of the National Cancer Institute 76:557.

Pourie, W.D.; Wu, C.H.; Rosin, M.P.; and Stich, H.F. 1981. Clastrogenic and mutagenic
activities of Maillard reaction model systems. Journal of Food Science and Agriculture
46:1433-38.

Powles, J.W., and Williams, D.R.R. 1984. Trends in bowel cancer in selected countries in
relation to wartime changes in flour milling. Nutrition and Cancer 6(1):40-48.

Reddy, B.S. 1982. Dietary fiber and colon carcinogenesis: a critical review. In Dietary fiber in
health and disease, ed. G.V. Vahouny and D. Kritchevsky, pp. 265-85. New York: Plenum.

. 1986. Diet and colon cancer: evidence from human and animal model studies. In Diet,
nutrition, and cancer: a critical review, vol. 1, ed. B.S. Reddy, and L.A. Cohen, pp. 27-45.

Boca Raton, FL: CRC.

Reddy, B.S.; Hedges, A.; Laakso, K.; and Wynder, E.L. 1978. Fecal constituents of a high-
risk North American and a low-risk Finnish population for the development of large bowel
cancer. Cancer Letters 4:217.

Reddy, B.S.; Ekelund, G.; Bohe, M.; Engee, A.; and Domellof, L. 1983. Metabolic epidemiol-
ogy of colon cancer: dietary pattern and fecal sterol concentration of three populations.
Nutrition and Cancer 5:34.

Reddy, B.S.; Sharma, C.; Darby, L.; Laakso, K.;and Wynder, E.L. 1980. Metabolic epidemi-
ology of large bowel cancer. Fecal mutagens in high- and low-risk populations for colon cancer.
Mutation Research 72:511-22.

Reddy, B.S.; Sharma, C.; Simi, B.; Engle, A.; Laakso, K.; Puska, P.; and Korpela, R. 1987.
Metabolic epidemiology of colon cancer: effect of dietary fiber on fecal mutagens and bile
acids in healthy subjects. Cancer Research 47:644-48.

 

241
le Nutrition and Health

Rose, D.P. 1986. The biochemical epidemiology of prostatic carcinoma. In Dietary fat and
cancer, ed. C. Ip, D.F. Birt, A.E. Rogers, and C. Mettlin, pp. 43-68. New York: Liss.

Rose, D.P.; Boyar, A.P.; and Wynder, E.L. 1986. International comparisons of mortality rates
for cancer of the breast, ovary, prostate, and colon, and per capita food consumption. Cancer
58:2363-71.

Ross, M.H., and Bras, G. 1973. Influence of protein under- and overnutrition on spontaneous
tumor prevalence in the rat. Journal of Nutrition 103:944-63.

Rozen, P.; Hellerstein, S.M.; and Horwitz, C. 1981. The low incidence of colorectal cancer in
a “high-risk” population: its correlation with dietary habits. Cancer 48(12):2692-95.

Russell-Briefel, R.; Caggiula, A.W.; and Kuller, L.H. 1985. A comparison of three dietary
methods for estimating vitamin A intake. American Journal of Epidemiology 122:628-36.

Sackett, D.L. 1979. Bias in analytic research. Journal of Chronic Disease 32:51-63.

Salonen, J.T.; Alfthan, G.; Huttunen, J.K.; and Puska, P. 1984. Association between serum
selenium and the risk of cancer. American Journal of Epidemiology 120(3):342-49.

Salonen, J.T.; Salonen, R.; Lappetelainen, R.; Maenpaa, P.H., Alfthan, G.; and Puska, P.
1985. Risk of cancer in relation to serum concentrations of selenium and vitamins A and E:
matched case-control analysis of prospective data. British Medical Journal 290:417-20.

Samet, J.M.; Skipper, B.J.; Humble, C.G.; and Pathak, D.R. 1985. Lung cancer risk and
vitamin A consumption in New Mexico. American Review of Respiratory Disorders
131;198-202.

Sasco, A.J.; Hubert, A.; and De The, G. 1985. Diet and nasopharyngeal carcinoma: epi-
demiologic approach to comparative dietary assessment in different populations. In Diet and
human carcinogenesis, ed. J.V. Joussens, M.J. Hills. and J. Geboers, pp. 63-69. New York:
Elsevier Science.

Schatzkin, A.; Jones, Y.; Hoover, R.N.; Taylor. P.R.: Brinton, L.A.; Ziegler. R.G.: Harvey,
E.B.; Carter, C.L.; Licitra, L.M.: Dufour, M.C.; and Larson, D.B. 1987. Alcohol consump-
tion and breast cancer in the epidemiologic follow-up study of the first National Health and
Nutrition Examination Survey. New England Journal of Medicine 316(19): 1169-73.

Schlesselman, J.J. 1982. C ase-control studies: design, conduct, analysis. New York: Oxford
Univ. Press.

Schrauzer, G.N.; White, D.A.; and Schneider. C.J. 1977. Cancer mortality correlation studies.

III. Statistical associates with dietary selenium intakes. Bioinorganic Chemistry 7:23-34.

Schuman, L.M.:; Mandell. J.S.; Radke. A.; Seal, U.: and Halberg. F. 1982. Some selected
features of the epidemiology of prostatic cancer: Minneapolis-St. Paul. Minnesota, case-
control study, 1976-79. In Trends in cancer incidence: causes and practical implications. ed.
K. Magnus. pp. 345-54. Washington, DC: Hemisphere Publ.

Scott. R.E.; Wille. J.J, Jr; and Wier, M.L. 1984. Mechanisms for the initiation and promotion
of carcinogenesis: a review and a new concept. Mayo Clinic Proceedings 59:107-17.

Seidman. H.: Mushinski. M.H.. Gelb, S.K.; and Silverberg, E. 1985. Probabilities of even-
tually developing or dying of cancer—United States. 1985. CA—A Cancer Journal for Clini-
cians 35:36-50.

Self, S.; Prentice, R.; Iverson, D.: Henderson, M.; Thompson. D.; Byar, D.: Insull, W.:
Gorbach, S.L.: Clifford, C.: Goldman, S.; Urban. N.: Sheppard, L.: and Greenwald, P. 1988.
Statistical design of the Women’s Health Trial. Controlled Clinical Trials 9: 1-18.

Sestili, M.A. 1983. Possible adverse health effects of vitamin C and ascorbic acid. Seminars in
Oncology 10(3):299-304.

242
Cancer Q

Shamberger, RJ. 1970. Relation of selenium to cancer. I. Inhibitory effects of selenium on
carcinogenesis. Journal of the National Cancer Institute 44:931-36.

Shamberger, R.J., and Rudolph, G. 1966. Protection against cocarcinogens by antioxidants.
Experientia 22:116.

Shamberger, R.J., and Willis, C.E. 1971. Selenium distribution and human cancer mortality.
CRC Clinical Reviews in Clinical Laboratory Sciences 2:2\\-21.

Shamberger, R.J.; Rukovena, E.; Longfield, A.K.; Tytko, S.A.; Deodhar, S.: and Willis. C.E.
1973. Antioxidants and cancer. I. Selenium in the blood of normals and cancer patients.
Journal of the National Cancer Institute 50:863-70.

Shekelle, R.B.; Liu, S.; Raynor, W.J., Jr.; Lepper, M.: Maliza.C.: Rossof, A.H.: Oglesby. P.;
Shyrock, A.M.; and Stamler, J. 1981. Dietary vitamin A and the risk of cancer in the Western
Electric study. Lancet i:1185-90.

Siiteri, P.K. 1987. Adipose tissue as a source of hormones. American Journal of C linical
Nutrition 45:277-82.

Silverberg, E., and Lubera, J. 1987. Cancer statistics. 1987. CA—A Cancer Journal for
Clinicians 37:2-19.

Silverstone, H., and Tannenbaum, A. 1950. The effect of proportion of dietary fat on the rate of
formation of mammary carcinoma in mice. Cancer Research 10:448-53.

Snowdon, D.A.; Phillips, R.L.; and Choi, W. 1984. Diet, obesity, and risk of fatal prostate
cancer. American Journal of Epidemiology 120:244-50.

Soini, I. 1977. Risk factors of breast cancer in Finland. International Journal of Epidemiology
6:365-73.

Soloway, M.S.; Cohen, S.M.; Dekernion, J.B.; and Persky, L. 1975. Failure of ascorbic acid to
inhibit FANFT-induced bladder cancer. Journal of Urology 113:483-86.

Sondik, E.J.; Young, J.L.; Horn, J.W.; and Ries, L.A. 1987. 1986 annual cancer Statistics
review. NJH publication no. 87-2789. Bethesda, MD: National Cancer Institute.

Sorenson, A.W. 1982. Assessment of nutrition in epidemiologic studies. In Cancer epidemiol-
ogy and prevention, ed. D. Schottenfeld and J.F. Fraumeni, pp. 434-74. Philadeiphia, PA:
Saunders.

Sporn, M.B. 1980. Retinoids and cancer prevention. In C arcinogenesis—a comprehensive
survey. Modification of chemical carcinogenesis, ed. T.J. Slaga. pp. 99-109. New York:
Raven.

Sporn, M.B., and Roberts, A.B. 1984. Role of retinoids in differentiation and carcinogenesis.
Journal of the National Cancer Institute 73:1381-87.

Stahelin, H.B.; Rosel, F.; Buess, E.; and Brubacher, G. 1984. Cancer, vitamins, and plasma
lipids: prospective Basel study. Journal of the National Cancer Institute 73(6): 1463-68.

Stehr, P.A.; Gloninger, M.F.; Kuller, L.H.; Marsh, G.M.; Radford, E.P.; and Weinberg. G.B.
1985. Dietary vitamin A deficiencies and stomach cancer. American Journal of Epidemiology
121(1):65—-70. °

Steiner, PE. 1954. Cancer: race and geography. Baltimore, MD: Williams & Wilkins. Quoted
in Haenszel, W. 1982. Migrant studies. In Cancer epidemiology and prevention, ed. D.
Schottenfeld, and J.F. Fraumeni, pp. 194-207. Philadelphia, PA: Saunders.

Stich, H.E.; Stich, W.; Rosin, M.P.; and Vallejera, M.O. 1984. Use of the micronucleus test to
monitor the effect of vitamin A, beta-carotene and canthaxanthin on the buccal mucosa of
betel nut/tobacco chewers. International Journal of Cancer 34:745—50.

243
e| Nutrition and Health

Studer, U.E.; Biedermann, C.; Chollet, D.; Karrer, P.; Kraft, R.; Toggenburg, H.; and
Vonbank, F. 1984. Prevention of recurrent superficial bladder tumors by oral etretinate:
preliminary results of a randomized, double-blind multicenter trial in Switzerland. Journal of
Urology 131:47-49.

Stunkard, A.J. 1983. Nutrition, aging and obesity: a critical review of a complex relationship.
International Journal of Obesity 7.201-20.

Sugimura, T. 1982. Mutagens, carcinogens, and tumor promoters in our daily food. Cancer
49: 1970-84.

Talamini, R.; La Vecchia, C.; DeCarli, A.; Franceschi, S.; Gratton, E.; Grigoletto, E.;
Liberati, A.; and Tognon, G. 1984. Social factors, diet and breast cancer in a northern Italian
population. British Journal of Cancer 49:723-29.

Tannenbaum, A. 1940a. The initiation and growth of tumors: introduction. I. Effects of
underfeeding. American Journal of Cancer 38:335-50.

. 1940b. Relationship of body weight to cancer incidence. Archives of Pathology
30:509-17.

. 1942. The genesis and growth of tumors. III. Effects of a high fat diet. Cancer
Research 2:468-75.

 

 

Tannenbaum, A., and Silverstone, H. 1949. The genesis and growth of tumors. IV. Effects of
varying the proportion of protein (casein) in the diet. Cancer Research 9:162-73.

_ 1957, Nutrition and genesis of tumors. In Cancer, vol. 1, ed. R.W. Raven, pp. 306-34.
London: Butterworth.

 

Tuyns, A.J. 1982. Alcohol. In Cancer epidemiology and prevention, ed. D. Schottenfeld and
J.E. Fraumeni, Jr., pp. 293-303. Philadelphia, PA: Saunders.

_ 1986. A case-control study on colorectal cancer in Belgium. Sozial-Preventivmedizin

 

31:81.

Tuyns, A.J.; Riboli, E.;and Doornbos, G. 1985. Nutrition and cancer of the esophagus. In Diet
and human carcinogenesis, ed. J.V. Joossens, M.J. Hill, and J. Geboers, pp. 71-79. New York:
Elsevier Science.

Upton, A.C. 1979. Statement before the Subcommittee on Nutrition, Senate Committee on
Agriculture, Nutrition and Forestry, 2 October.

U.S. Department of Health and Human Services. 1982. The health consequences of smoking:
cancer. A report of the Surgeon General. DHHS publication no. (PHS) 82-50179. Rockville,
MD: U.S. Public Health Service.

. 1985. Report of the Secretary's Task Force on Black and Minority Health, executive
summary, vol. 1. Washington, DC: U.S. Government Printing Office.

 

Valaoras, V.G.; MacMahon, B.; Trichopoulos, D.; and Polychronopoulou, A. 1969. Lactation
and reproductive histories of breast cancer patients in greater Athens, 1965-67. International
Journal of Cancer 4:350-63.

Van Alstyne, E.V., and Beebe, S.P. 1913. Diet studies in transplantable tumors. I. The effect
of noncarbohydrate diet upon the growth of transplantable sarcoma in rats. Journal of Medical
Research 29:217-32.

Vitale, J.J.; Broitman, S.A.; and Gottlieb, L.S. 1981. Alcohol and carcinogenesis. In Nutrition
and cancer: etiology and treatment, ed. G.R. Newell and N.M. Ellison, pp. 291-301. New
York: Raven. .

244
Cancer O

Wald, N.; Idle, M.; and Boreham J. 1980. Low serum vitamin A and subsequent risk of cancer.
Preliminary results of a prospective study. Lancet ii:813-15.

Wald, N.J.; Boreham, J., Hayward, J.L.; and Bulbrook, R.D. 1984. Plasma retinol, B-carotene
and vitamin E levels in relation to the future risk of breast cancer. British Journal of Cancer
49:321-24.

Walker, A.R.P.; Walker, B.F.; and Walker, A.J. 1986. Faecal pH, dietary fiber intake and
proneness to colon cancer in four South African populations. British Journal of Cancer
53:489.

Wassertheil-Smoller, S.; Romney, S.L.; Wylie-Rosett, J.; Slagle, S.; Miller, G.; Lucido, D.;
Duttagupta, C.; and Palan, P.R. 1981. Dietary vitamin C and uterine cervical dysplasia.
American Journal of Epidemiology 114:714-24.

Watson, R.R. 1984. Alcohol and cellular immune response. In Nutrition, disease resistance,
and immune function, vol. 1, ed. R.R. Watson, pp. 313-24. New York: Marcel! Dekker.

Watson, A.R., and Mellanby, E. 1930. Tar cancer in mice. Condition of skin when modified by
external treatment or diet, as factors in influencing cancerous reaction. British Journal of
Experimental Pathology 11:311-22.

Wattenberg, L.W., and Loub, W.D. 1978. Inhibition of polycyclic aromatic hydrocarbon-
induced neoplasia by naturally occurring indoles. Cancer Research 38:1410-13.

Weindruch, R., and Walford, R.L. 1982. Dietary restriction in mice beginning at one year of
age: effect on life span and spontaneous cancer incidence. Science 215:1415-18.

Weisburger, J.H.; Barnes, W.S.; and Czerniak, R. 1986. Mutagens and carcinogens in food.
In Diet, nutrition, and cancer: a critical review, vol. 2, ed. B.S. Reddy and L.A. Cohen, pp.
115-34. Boca Raton, FL: CRC.

Weisburger, J.H.; Horn, C.L.; and Barnes, W.S. 1983. Possible genotoxic carcinogens in
foods in relation to cancer causation. Seminars in Oncology 10(3):330-41.

Weisburger, J.H.; Marquardt, H.; Mower, H.F.; Hirota, N.; Mori, H.;and Williams, G. 1980.
Inhibition of carcinogenesis: vitamin C and the prevention of gastric cancer. Preventive
Medicine 9:352-61.

Welsch, C.W. 1987. Enhancement of mammary tumorigenesis by dietary fat: review of
potential mechanisms. American Journal of Clinical Nutrition 45:192-202.

Welsch, C.W.; Zile, M.H.; and Cullum, M.E. 1986. Retinoids and mammary gland tu-
morigenesis: a critique. In Diet, nutrition, and cancer: a critical review, vol. 2, ed. B.S.
Reddy, and L.A. Cohen, pp. 1-21. Boca Raton, FL: CRC.

Whelan, P.; Walker, B.E.; and Kelleher, J. 1983. Zinc, vitamin A and prostatic cancer. British
Journal of Urology 55:525-28.

WHO. See World Health Organization.

Wilkins, T.D., and Van Tassell, R.L. 1983. Production of intestinal mutagens. In Human
intestinal microflora in health and disease, ed. D.J. Hentges, pp. 265-88. New York: Aca-
demic.

Wilkins, T.; Lederman, M.; and Van Tassell, R.L. 1981. Isolation of a mutagen produced in
the human colon by bacterial action. In Banbury report no.7, pp. 205-26. Cold Spring Harbor,
NY: Cold Spring Harbor Laboratory.

Willett, W.C. 1987. Implications of total energy intake for epidemiologic studies of breast and
large-bowel cancer. American Journal of Clinical Nutrition 45:354-60.

245
O Nutrition and Health

Willett, W.C., and MacMahon, B. 1984a. Diet and cancer: an overview (first of two parts).
New England Journal of Medicine 310(10):633-38.

____, 1984b. Diet and cancer: an overview (second of two parts). New England Journal of
Medicine 310(11):697-703.

Willett, W.C.; Stampfer, M.J.; Colditz, G.A.; Rosner, B.A.; Hennekens, C.H.; and Speizer,
F.E. 1987. Dietary fat and the risk of breast cancer. New England Journal of Medicine
316:22-28.

Willett, W.C.; Morris, J.S.; Pressel, S.; Taylor, J.O.; Polk, B.F.; Stampfer, M.J.; Rosner, B.;
Schneider, K.; and Hames, C.G. 1983. Prediagnostic serum selenium and risk of cancer.
Lancet ii(8342): 130-34.

Willett, W.C.; Polk, B.F.; Underwood, B.A.; Stampfer, M.J.; Pressel, S.; Rosner, B.;
Taylor, J.O.; Schneider, K.; and Hames, C.G. 1984. Relation of serum vitamins A and E and
carotenoids to the risk of cancer. New England Journal of Medicine 310:430-34.

Williams, R.R., and Horm, JW. 1977. Association of cancer sites with tobacco and alcohol
consumption and socioeconomic status of patients: interview study from the third National
Cancer Survey. Journal of the National Cancer Institute 58:525-47.

Wilpart, M.; Mainguet, P.; Maskens, A.; and Roberfroid, M. 1983. Structure-activity relation-
ship amongst biliary acids showing comutagenic activity towards 1,2-dimethylhydrazine.
Carcinogenesis 4: 1239-41.

Wood, C., and Watson, R.R. 1984. Interrelationships among nutritional status, cellular
immunity, and cancer. In Nutrition, disease resistance, and immune function, vol. 1, ed. R.R.
Watson, pp. 53-69. New York: Marcel Dekker.

World Health Organization. 1964. Prevention of cancer. Technical report series 276. Geneva:
World Health Organization.

Wu, A.H.; Henderson, B.E.; Pike, M.C.;and Yu, M.C. 1985, Smoking and other risk factors
for lung cancer in women. Journal of the National Cancer Institute 74:747-S1.

Wynder, E.L., and Gori. G.B. 1977. Contribution of the environment to cancer incidence: an
epidemiologic exercise (guest editorial). Journal of the National Cancer Institute 58:825-32.

Wynder, E.L.. and Reddy, B.S. 1983. Dietary fat and fiber and colon cancer. Seminars in
Oncology 103):264-72.

Wynder, E.L.: Mabuchi, K.. and Whitmore, W.F. 1971. Epidemiology of cancer of the
prostate. Cancer 28:344-60.

___. 1974. Epidemiology of adenocarcinoma of the kidney. Journal of the National Cancer
Institute 53:1619-34.

Wynder, E.L.: Kajitani, T.; Ishikawa. §.; Dodo, H.; and Takano, A. 1969. Environmental
factors of cancer of the colon and rectum. II. Japanese epidemiologic data. Cancer
23:1210-20.

Wynder, E.L.; McCoy, G.D.; Reddy, B.S.,; Cohen, L.; Hill, P.; Spingarn, N.E.; and
Weisburger, J.H. 1981. Nutrition and metabolic epidemiology of cancers of the oral cavity,
esophagus, colon, breast. prostate and stomach. In Nutrition and cancer: etiology and
treatment, eds. G.R. Newell and N.M. Ellison, pp. 11-48. New York: Raven.

Yang, C.S. 1980. Research on esophageal cancer in China: a review. Cancer Research
40:2633-44.

Yu, M.C., Mack, T.M.; Hanisch, R.; Cicioni, C.; and Henderson, B.E. 1986. Cigarette
smoking, obesity, diuretic use, and coffee consumption as risk factors for renal cell car-
cinoma. Journal of the National Cancer Institute 7735156.

246
Cancer e

Ziegler, R.G.; Morris, L.E.; Blot, W.J.; Pottern, L.M.; Hoover, R.; and Fraumeni, J.F., Jr.
1981. Esophageal cancer among black men in Washington, D.C. II. Role of nutrition. Journal
of the National Cancer Institute 67:1199-1206.

Ziegler, R.G.; Mason, T.J.; Stemhagen, A.; Hoover, R.; Schoenberg, J.B.; Gridley, G.; Virgo.
P.W.; and Fraumeni, J.F. 1986. Carotenoid intake, vegetables, and the risk of lung cancer
among white men in New Jersey. American Journal of Epidemiology 123:1080-93.

247
G
Chapter 5
Diabetes

_. , urine wonderfully sweet, as if imbued
with honey or sugar.
Thomas Willis, physician to
Charles II of England, 1670

Introduction

Diabetes mellitus (commonly called diabetes) is the name given to a spec-
trum of conditions found in 11 million Americans. Diabetes is charac-
terized by metabolic abnormalities (of which the most evident is hyper-
glycemia, an elevated concentration of glucose in blood) and by long-term
complications involving multiple organs, especially the eyes, kidneys,
nerves, and blood vessels. These complications result from a deficiency of
the hormone insulin, a reduction in the effectiveness of insulin, or other
less well understood metabolic disorders. There are two major forms of
diabetes mellitus: Type I, or insulin-dependent, and Type II, or noninsulin-
dependent. These types are distinguished by the need in Type I diabetes for
exogenous replacement of insulin, which is necessary for the metabolism
of glucose. The treatment goal for both types of diabetes is to prevent or
reduce the risk and severity of complications; generally this goal is best
achieved by maintaining normal or near-normal blood glucose and blood
lipid levels. In longstanding diabetes, certain other aims of treatment
assume great importance, including blood pressure control and reducing

protein load on the kidney (see the following section and the chapter on
kidney diseases).

Type I diabetes, or insulin-dependent diabetes mellitus (IDDM), formerly
known as juvenile-onset diabetes, accounts for about 10 percent of di-
abetes in the United States. It is characterized by an absolute deficiency of
insulin, caused by beta-cell destruction of the islets of Langerhans in the
pancreas. Genetic factors, including an autoimmune response (Eisenbarth
1986), affect the risk of beta-cell destruction as well as environmental
factors such as viral agents or cytotoxic chemicals (Arky 1983).

249

 
ie Nutrition and Health

Type I diabetes usually appears before age 40 and begins abruptly. Typical
symptoms are thirst, excessive urination, increased appetite, rapid weight
loss, breath that smells of acetone, and urine that is sweet because of its
high sugar concentration. Affected persons are usually of normal body
weight. Because their insulin levels are low, persons with Type I diabetes
require insulin for survival. Treatment usually includes administration of
insulin, diet coordinated with the insulin dosage schedule, and regular
physical exercise. At present, no method to prevent development of this
form of the disease has been identified (Browner 1986).

Type II diabetes, or noninsulin-dependent diabetes mellitus (NIDDM),
also known as adult- or maturity-onset diabetes, accounts for approximate-
ly 90 percent of all cases and affects at least 10 million Americans. It usually
appears in mid-life, most commonly among people who are overweight or
obese. Its onset is gradual, and many persons have a long history of mild
symptoms or display no symptoms at all. Often, the condition is first
diagnosed among individuals with no overt symptoms who display ele-
vated fasting blood glucose levels during a routine physical examination.
Genetic predisposition appears to play an important role in Type II as well
as in Type I diabetes.

Persons with Type II diabetes may display normal pancreatic histology,
secrete insulin in response to glucose ingestion, and have normal levels of
insulin in their blood. But because the body is less able to use this insulin,
or perhaps for some other as yet unknown reason (Feldberg, Pyke, and
Stubbs 1985), blood sugar levels are inappropriately high, and insulin levels
are insufficient. The three principal approaches to diabetes management
are diet, exercise, and treatment with oral antidiabetic agents or insulin.
Overweight persons able to lose weight can be managed by diet and
exercise alone. Some individuals unable to lose weight may respond to
treatment with sulfonylurea and other antidiabetic, hypoglycemic drugs
(agents that reduce blood sugar levels), but others will need insulin treat-
ment to control their diabetes.

Although it is generally believed that maintenance of normal blood glucose
levels will prevent or reduce the complications and premature mortality
associated with diabetes, this supposition has yet to be proved.
Historical Perspective

Since ancient times, diet has been recognized as a cornerstone of diabetes

management, yet ideas about the most effective dietary treatment have
varied widely throughout history (Bierman 1979). The uncertainty has

250