Dietary patterns and severity of symptom with the risk of esophageal squamous cell carcinoma and its histological precursor lesions in China: a multicenter cross-sectional latent class analysis

Abstract

Background: Dietary patterns and symptoms research among Chinese with esophageal squamous cell carcinoma (ESCC) and its precursor lesions is limited, especially as it relates to multiple food consumption and multiple co-occurring symptoms. The aim of our study was to identify the dietary patterns and severity of symptom classes with the risk of esophageal squamous cell carcinoma and its histological precursor lesions, and develop a risk prediction model for different stages of esophageal disease.

Methods: We analyzed data from a multicenter cross-sectional study carried out in ESCC high incidence areas between 2017 and 2018, which included 34,707 individuals aged 40-69 years. Dietary patterns and severity of symptom classes were derived by applying a latent class analysis (LCA). A multiple logistic regression model was used to derive the odds ratio (ORs) and corresponding 95% confidence intervals (CIs) for ESCC and the different stages of esophageal disease according to the dietary patterns and severity of symptom classes identified. We built the risk prediction model by using a nomogram.

Results: We identified five dietary patterns and three severity of symptom classes. The dietary patterns were classified as follows: "Healthy", "Western", "Lower consumers-combination", "Medium consumers-combination" and "Higher consumers-combination" patterns based on the intake of foods such as red meat, vegetables and fruits. The severity of symptoms was categorized into "Asymptomatic", "Mild symptoms" and "Overt symptoms" classes based on health-related symptoms reported by the participants. Compared to the "Healthy" pattern, the other four patterns were all associated with an increased risk of esophageal disease. Similarly, the other two symptom classes present different degrees of increased risk of esophageal disease compared to the "Asymptomatic". The nomograms reflect the good predictive ability of the model.

Conclusion: Among individuals aged 40-69 years in high incidence regions of upper gastrointestinal cancer, the results supplied that subjects with diets rich in livestock and poultry meat and low in fruits and vegetables and subjects with typical symptoms were at increased ESCC risk. The findings highlight the importance of considering food and symptom combinations in cancer risk evaluation.

Keywords: Dietary patterns; Esophageal squamous cell carcinoma; Latent class analysis; Precancerous lesions; Symptom.

Fig. 1

Flow chart of participant selection. Note: LGIN = low-grade intraepithelial neoplasia; HGIN = high-grade intraepithelial neoplasia; ESCC = esophageal squamous cell carcinoma

Fig. 2

A: Nomogram predicting the risk for the normal control group vs esophagitis; B: Nomogram predicting the risk for the normal control group vs LGIN; C: Nomogram predicting the risk for the normal control group vs HGIN and ESC. Note: LGIN: low-grade intraepithelial neoplasia; HGIN: high-grade intraepithelial neoplasia; ESCC: esophageal squamous cell carcinoma

Fig. 3

A-C: Calibration curves showing the probability of the normal control vs esophagitis/LGIN/HGIN and ESCC three groups between the nomogram prediction and the actual observation. Perfect prediction would correspond to a slope of 1 (diagonal 45-degree gray line). D-F: Decision curves of the nomogram predicting the risk. The x-axis represents the threshold probabilities, and the y-axis measures the net benefit calculated by adding the true positives and subtracting the false positives. Note: LGIN: low-grade intraepithelial neoplasia; HGIN: high-grade intraepithelial neoplasia; ESCC: esophageal squamous cell carcinoma