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Tuesday, April 26, 2016

Dietary fat intake and ovarian cancer risk: a meta-analysis of epidemiological studies

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Observational studies assessing the association of dietary fat and risk of ovarian cancer yield discrepant results. Pertinent prospective cohort studies were identified by a PubMed search from inception to December 2015. Sixteen independent case-control and nine cohort studies on dietary fat intake were included, with approximately 900,000 subjects in total. Relative risks (RRs) with 95% confidence intervals were pooled using a random effects model. Heterogeneity, sensitivity analysis and publication bias were assessed; subgroup analysis and analysis stratified by EOC histology were conducted. The reported studies showed a significant increase of ovarian cancer risk with high consumption of total-, saturated-, and trans-fats, while serous ovarian cancer was more susceptible to dietary fat consumption than other pathological subtypes. No evidence of positive association between dietary fat intake and ovarian cancer risk was provided by cohort studies. Menopausal status, hormone replacement therapy, body mass index (BMI), and pregnancy times, modified the objective associations. In conclusion, the meta-analysis findings indicate that high consumption of total, saturated and trans-fats increase ovarian cancer risk, and different histological subtypes have different susceptibility to dietary fat.

Ovarian cancer is considered the sixth most commonly diagnosed cancer among women and the second cause of gynecologic cancer mortality worldwide [1, 2]. The prognosis of ovarian cancer is poor, with the initial diagnosis in most patients made at an advanced stage [3, 4]. The noticeable relationship between ovarian cancer incidence and geographical regions suggested that dietary habits and ethnic variations are potentially modifiable factors [5], whose etiologic role in ovarian cancer risk, however, remains undefined [6].
Dietary fat, as one of the most controversial dietary factors in nutritional epidemiology, has been reported with positive correlations with breast [7] and gastric [8] cancers in two recent meta-analyses, and elevated ovarian cancer risk in early ecologic studies [5, 9]. Although multiple epidemiologic studies have explored the associations between dietary fat consumption and risk of ovarian cancer, no definite conclusion have been drawn, and the dietary fat varieties as well as pathological types of ovarian cancer increase the complexity of this research topic. The results of two meta-analyses [10, 11] and a pooled analysis [12] that included data from 12 cohort studies also reached inconsistent conclusions. Therefore, we conducted a meta-analysis of case-control and cohort studies with more-detailed analyses of 1) the epidemiologic evidence regarding the association of dietary fat consumption with risk of ovarian cancer, 2) the association between dietary fat intake and the risk of ovarian cancer and pathological subtypes. This analysis was based on dietary fat types, and we extended the previous analyses [10, 11] with more included studies and dietary fat types, and an assessment stratified by EOC histology. 

Materials and Methods
Search strategy
We obtained the literature published in any language to December 2015 by fully searching the PubMed database. The search terms used were “diet”, ‘‘dietary fat’’ in combination with “ovarian cancer,” “ovarian neoplasm” or “ovarian carcinoma”, without restrictions. In addition, we reviewed the reference lists of retrieved studies and recent reviews to supplement electronic database searches......

An important highlight of our meta-analysis is that we analyzed the association between dietary fat intake and the risk of ovarian cancer subtypes. We found that serous ovarian cancer incidence was more susceptible to dietary fat intake. However, these results should be interpreted with caution. The insufficient number of included cases and potential misclassification of pathological subtypes may contribute to the statistical difference observed.
 Future studies should focus more on specific pathological subtypes of ovarian cancer as well as the influence of molecular mechanisms and genetic factors on the association of dietary fat and ovarian cancer.


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