La Vecchia C, Negri E, Franceschi S, Parazzini F, Decarli A
Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy.
Nutr Cancer. 1992;17(3):297-304. doi: 10.1080/01635589209514199.
Differences in the frequency of consumption of 30 selected foods and in the estimated intake of total calories and selected nutrients in relation to alcohol drinking, tobacco smoking, and education were described using information obtained from 1,774 controls of a case-control study of digestive tract cancers conducted in northern Italy. Heavy alcohol consumption, tobacco smoking, and lower level of education were associated with a diet poorer in several aspects, including lower consumption of fresh fruit and green vegetables and higher intake of specific indicator foods, such as sausages and canned meat. For instance, the mean number of portions of fresh fruit per week was 10.5 among male nondrinkers vs. 9.0 among heavy drinkers, 10.4 among male nonsmokers vs. 8.1 among heavy smokers, and 8.8 in less educated individuals vs. 10.7 among those more educated. Consequently, intake of beta-carotene, ascorbic acid, and calcium tended to be inversely related to alcohol and tobacco and directly related to education. Most associations were stronger in males, for whom alcohol consumption was also more common in less educated individuals. Calorie intake was directly related to alcohol consumption, largely reflecting calories provided by alcohol itself. However, alcohol drinking was also directly related to fat consumption. In both sexes, there was a strong positive correlation between cigarette smoking and coffee drinking. These results provide quantitative documentation that alcohol drinking, tobacco smoking, and education, three of the major determinants of cancer risks, were also correlates of dietary patterns and, hence, may exert an important confounding or modifying effect on the diet and cancer relationship.
利用从意大利北部开展的一项消化道癌症病例对照研究的1774名对照者中获取的信息，描述了30种选定食物的消费频率以及总热量和选定营养素的估计摄入量与饮酒、吸烟和教育程度之间的差异。大量饮酒、吸烟以及较低的教育水平与在几个方面较差的饮食有关，包括新鲜水果和绿色蔬菜的消费量较低以及特定指示性食物（如香肠和罐装肉类）的摄入量较高。例如，男性不饮酒者每周新鲜水果的平均份数为10.5份，而大量饮酒者为9.0份；男性不吸烟者为10.4份，而大量吸烟者为8.1份；受教育程度较低者为8.8份，而受教育程度较高者为10.7份。因此，β-胡萝卜素、抗坏血酸和钙的摄入量往往与酒精和烟草呈负相关，与教育程度呈正相关。大多数关联在男性中更强，对于男性而言，饮酒在受教育程度较低者中也更为常见。热量摄入与饮酒直接相关，这在很大程度上反映了酒精本身提供的热量。然而，饮酒也与脂肪消费直接相关。在男女两性中，吸烟与咖啡饮用之间存在很强的正相关性。这些结果提供了定量证据，表明饮酒、吸烟和教育程度这三个癌症风险的主要决定因素也是饮食模式的相关因素，因此可能对饮食与癌症的关系产生重要的混杂或调节作用。
