Food habits of the people of the Caspian Littoral of Iran in relation to esophageal cancer.

A dietary survey was carried out in Mazanderan Province of the Caspian Littoral of Iran. The inhabitants of this province have the highest rate of esophageal cancer in the world. A total of 1,501 individuals, in 197 households, from 35 villages in different regions were studied. These regions, which were based on the staple food of the region, included the low-to-moderate risk areas of Shahsavar and Babol in central and western Mazanderan, where the staple diet is rice, and the high- and moderately high-risk areas of Turkoman Sahara (Gonbad and Gorgan) in the east, where the main food is local bread. Perhaps because of poverty and simplicity of the local dishes in the high-risk region, the inhabitants of Turkoman Sahara eat their food three to four times faster than do the people in the moderate- and low-risk regions. In this high-risk area, where the frequency of esophageal cancer is higher among females than among males, a special diet known as "majoweh" or "majum" is given to pregnant women. This food is a crushed mixture of sour pomegranate seeds, black pepper, dried raisins, and occasionally garlic; this combination irritates the esophagus because of the hot black pepper and the sharp, crushed pomegranate seeds. People in the high-risk region preserve their meat by sun drying, and a higher proportion of households in this region keep the preserved food for longer periods of time. Also, the inhabitants of the high-risk region drink more tea at a much higher temperature. Very little fruit and vegetables are consumed by the Turkomans of the high-risk region, whereas inhabitants in the low-risk area keep vegetables and citrus fruits as an important part of their usual diets.