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Meta-Analysis
. 2016 Jul;95(27):e4121.
doi: 10.1097/MD.0000000000004121.

Dietary fat intake and endometrial cancer risk: A dose response meta-analysis

Jing Zhao  1 , Chen Lyu, Jian Gao, Li Du, Boer Shan, Hong Zhang, Hua-Ying Wang, Ying Gao
Affiliations
Meta-Analysis

Dietary fat intake and endometrial cancer risk: A dose response meta-analysis

Jing Zhao et al. Medicine (Baltimore). 2016 Jul.

Abstract

Since body fatness is a convincing risk factor for endometrial cancer, dietary fat intake was speculated to be associated with endometrial cancer risk. However, epidemiological studies are inconclusive. We aimed to conduct a meta-analysis to assess the associations between dietary fat intake and endometrial cancer risk. We searched the PubMed, Embase, and Web of science databases updated to September 2015. In total, 7 cohort and 14 case-control studies were included. Pooled analysis of case-control studies suggested that endometrial cancer risk was significantly increased by 5% per 10% kilocalories from total fat intake (P=0.02) and by 17% per 10 g/1000 kcal of saturated fat intake (P < 0.001). Summary of 3 cohort studies showed significant inverse association between monounsaturated fatty acids and endometrial cancer risk (odds ratio = 0.84, 95% confidence interval = 0.73-0.98) with a total of 524583 participants and 3503 incident cases. No significant associations were found for polyunsaturated fatty acids and linoleic acid. In conclusion, positive associations with endometrial cancer risk were observed for total fat and saturated fat intake in the case-control studies. Results from the cohort studies suggested higher monounsaturated fatty acids intake was significantly associated with lower endometrial cancer risk.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Study flow diagram.
Figure 2
Figure 2
Forest plot of the summary risk estimate of endometrial cancer in the highest category of dietary total fat intake compared with those in the lowest category. Covariates: A = Age, B = BMI/weight, E = Total Energy, H = HRT/ERT use, R = Reproductive factors, S = Smoking. (A): matched on age. (E) Energy from carbohydrate calories. Weights are from random effects analysis. Summary OR1 was the summary risk estimate from all the studies. Summary OR2 was the risk estimate from studies after exclusion. Excluding studies: ∗Hospital-based study; §Less than 200 cases; †Exclusion of hysterectomies not clearly specified; &not adjusted for total energy intake; #not adjusted for BMI/weight.
Figure 3
Figure 3
Dose–response relationship for total fat intake level and the OR of endometrial cancer for the case–control studies based on generalized least squares regression model. The smallest mean value of the lowest category interval (16% kcal from total fat intake) was used as referent baseline level (P for linearity = 0.015).
Figure 4
Figure 4
Forest plot of the summary risk estimate of endometrial cancer in the highest category of dietary saturated fat intake compared with those in the lowest category. Covariates: A = Age, B = BMI/weight, E = Total Energy, S = Smoking, H = HRT/ERT use, R = Reproductive factors. (A) Matched on age. (E) Energy from carbohydrate calories. Weights are from random effects analysis. Summary OR1 was the summary risk estimate from all the studies. Summary OR2 was the risk estimate from studies after exclusion. Excluding studies: ∗Hospital-based study; §Less than 200 cases; †Exclusion of hysterectomies not clearly specified; &not adjusted for total energy intake; #not adjusted for BMI/weight.
Figure 5
Figure 5
Dose–response relationship for saturated fat intake level and the OR of endometrial cancer for the case–control studies based on generalized least squares regression model. The smallest mean value of the lowest category interval (3 g per 1000 kcal) was used as referent baseline level (P for linearity < 0.001).
Figure 6
Figure 6
Forest plot of the summary risk estimate of endometrial cancer in the highest category of dietary monounsaturated fatty acids intake compared with those in the lowest category. The result in Goodman et al 1997 without 95% CI was excluded from the analysis. Covariates: A = Age, B = BMI/weight, E = Total Energy, S = Smoking, H = HRT/ERT use, R = Reproductive factors. (A) Matched on age. Weights are from random effects analysis.
Figure 7
Figure 7
Forest plot of the summary risk estimate of endometrial cancer in the highest category of dietary polyunsaturated fatty acids intake compared with those in the lowest category. The result in Goodman et al 1997 without 95% CI was excluded from the analysis. Covariates: A = Age, B = BMI/weight, E = Total energy, S = Smoking, H = HRT/ERT use, R = Reproductive factors. (A) Matched on age. Weights are from fix effects analysis.
Figure 8
Figure 8
Forest plot of the summary risk estimate of endometrial cancer in the highest category of dietary linoleic acid intake compared with those in the lowest category. Covariates: A = Age, B = BMI/weight, E = Total Energy, S = Smoking, H = HRT/ERT use, R = Reproductive factors. (A) Matched on age. Weights are from fix effects analysis.
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