Diet was evaluated repeatedly across three U.S. cohorts with long-term follow-up.
Original article
Poor Diet and Oral Cavity Cancer Risk in Smoking and Non-Smoking Men and Women: An Analysis of Three US Cohorts
1Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA, USA. 2Department of Otolaryngology-Head and Neck Surgery, University of Texas Houston, Houston, TX, USA. 3Arthur Dugoni School of Dentistry, University of the Pacific, San Francisco, CA, USA. 4Division of Hematology and Oncology, University of Washington, Seattle, WA, USA. 5Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA. 6Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, USA.
Received: 5 February 2025
Revised: 4 April 2025
Accepted: 4 May 2025
Abstract
Introduction: Oral cavity cancer incidence is rising among non-smokers and younger individuals without traditional risk factors. This study evaluated whether dietary patterns are associated with oral cavity cancer risk in men and women.
Methods: The study used data from three large U.S. longitudinal cohorts: the Nurses' Health Study, Nurses' Health Study II, and Health Professionals Follow-up Study. Dietary intake was assessed every four years using validated food frequency questionnaires. Western, Prudent, and Alternative Healthy Eating Index-2010 dietary patterns were evaluated.
Results: Over 30 years of follow-up, 226 incident oral cavity cancer cases were identified. Among women, lower adherence to Prudent and AHEI dietary patterns was associated with higher risk. No associations were observed among men.
Conclusions: Lower adherence to Prudent and AHEI dietary patterns was associated with higher oral cavity cancer risk in women, warranting additional investigation in larger pooled studies.
AHEI
Dietary patterns
Healthy diet
Oral cancer risk
Oral cavity cancer
Prudent diet
Highlights
Lower Prudent and AHEI scores were associated with higher OCC risk among women.
The Prudent diet association was stronger among women with non- or light-smoking and non- or light-drinking profiles.
Methods at a glance
| Element | Detail |
|---|---|
| Population | 162,602 women from NHS/NHSII and 47,923 men from HPFS without cancer at baseline. |
| Dietary assessment | Validated semi-quantitative food frequency questionnaires collected every four years. |
| Dietary patterns | Western, Prudent, and Alternative Healthy Eating Index-2010. |
| Analysis | Cox proportional hazards regression models estimated hazard ratios and 95% confidence intervals. |
Key results
Among women, the lowest quartile of Prudent diet adherence had higher oral cavity cancer risk compared with the highest quartile. The lowest quartile of AHEI adherence also had higher risk. Among men, no significant association was observed for Western, Prudent, or AHEI dietary patterns.
Interpretation: The article frames these findings as hypothesis-generating because oral cavity cancer was rare in the cohorts and formal sex-interaction tests were not statistically significant.
Discussion summary
The authors note that healthier dietary patterns rich in fruits, vegetables, legumes, whole grains, and fish may contribute to lower oral cavity cancer risk, possibly through antioxidant, inflammatory, or local mucosal pathways. They also emphasize limitations including small case numbers, residual confounding, self-reported diet, and limited generalizability due to the predominantly non-Hispanic White cohort composition.
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