To define a low-risk diet for breast cancer in Italy, a multicentric case-control study of 2569 incident cases of breast cancer and 2588 controls from Italy was analyzed. A logistic regression model was applied to the estimated intake of five macronutrients and used to compute a diet-related risk score (RS). The pattern of macronutrient and food group intake across RS deciles was defined. The mean of diet-related RSs across subsequent risk deciles ranged from 0.83 to 1.44. Total energy intake first decreased slightly, from the first to the second decile, and then increased, mostly in the last three risk deciles. Intake of starch increased in absolute and relative terms, whereas saturated fat intake rose in absolute terms but remained stable as a proportion. A relative decline was observed for unsaturated fat and sugars, with a hint, however, of U-shape effect. From a food group viewpoint, there was a marked increase in the intake of bread and cereal dishes, cakes and desserts, and refined sugar across subsequent deciles, whereas the consumption of vegetables, olive and seed oils, and fruit decreased.

Italian cancer mortality rates in 1993 were moderately favorable in males, due to the leveling of the tobacco-related epidemic, whereas no appreciable change was registered in females. The persisting unfavorable trends in childhood cancer mortality should be investigated.

Exposure to a few selected and potentially modifiable risk indicators explained about one third of the cases of breast cancer in this Italian population, indicating the theoretical scope for prevention of the disease.

A new mutagen, 2-chloro-4-methylthiobutanoic acid, has recently been identified from a nitrite-treated Japanese salted fish. Its structure suggests that it derives from methionine in the presence of salt and nitrite. We thus considered the interaction between intake of methionine, salt, and nitrites on gastric cancer risk using data from a case-control study conducted in Northern Italy on 746 cases of incident histologically confirmed gastric cancer and 2,053 controls in hospital for acute nonneoplastic nondigestive tract disorders. Compared with subjects reporting low-methionine and low-salt intake, the odds ratios (ORs) were 2.4 [95% confidence interval (CI) = 1.5 - 4.0] for those reporting low-salt and high-methionine, 1.5 (95% CI = 1.0 - 2.2) for those with high-salt and low-methionine, and 2.8 (95% CI = 1.9 - 4.2) for those with high-salt and high-methionine intake. Likewise, with reference to nitrites, compared with subjects with low-methionine and low-nitrite intake, the ORs were 1.9 (95% CI = 1.3 - 2.6) in the high-methionine and low-nitrite stratum, 1.5 (95% CI = 1.0 - 2.1) in the low-methionine and high-nitrite stratum, and 2.5 (95% CI = 1.9 - 3.2) in the high-methionine and high-nitrite stratum. All these estimates were statistically significant. Thus the present findings from a large case-control study conducted in a relatively high-incidence area for gastric cancer suggest that a diet rich in methionine, salt, and nitrite is associated with increased gastric cancer risk.

The knowledge of major sources of macro- and micronutrients is essential in order to interpret differences in the diet-cancer link in various geographical areas and to provide better nutritional guidelines. For this purpose we took advantage of the control group of a case-control study on breast cancer carried out in six Italian areas. The dietary habits of 2,588 cancer-free women aged 20-74 years (median age 56) were elicited between 1991 and 1994 by means of an interviewer-administered food frequency questionnaire (FFQ) that included 78 foods or food groups, in addition to several questions on general dietary pattern (e.g., fat in seasoning). Bread was the first contributor for total energy (12%), protein (8%) and starch (32%) intake, whereas, for saturated fatty acid, the first sources were different types of cheese (28%); for monounsaturated fatty acids the dressing oils of salad and tomatoes (12%); and, for sugars, apples and pears (19%). Raw vegetables and fresh fruit represented the most important source of most vitamins. The first contributors of vitamin C and beta-carotene were citrus fruits (29%) and raw carrots (17%), respectively. Thus, between 40 and 80% of specific macronutrient intake and up to 90% intake of several micronutrients were derived from the first ten foods or food groups. Often, the major contributors to the intake of a specific component were foods with a relatively low content, but eaten in large quantities. This work further highlights the specificity of nutrient sources in southern European populations.

The relationship between various micronutrients and colorectal cancer risk was investigated using data from a case-control study conducted between January 1992 and June 1996 in Italy. Cases were 1,953 incident, histologically confirmed colorectal cancers (1,225 of the colon and 728 of the rectum), admitted to the major teaching and general hospitals in the study areas, and 4,154 controls with no history of cancer, admitted to hospitals in the same catchment areas for acute, non-neoplastic diseases unrelated to the digestive tract and requiring no long-term modifications of the diet. Dietary habits were investigated using a validated food-frequency questionnaire. Odds ratio (ORs) were computed after allowance for age, sex and other potential confounding factors, including physical activity, total energy and fibre intake. For most micronutrients, ORs were below unity with increasing quintile of intake. The most consistent protective effects were for carotene, riboflavin and vitamin C (Multivariate ORs from the continuous model, with unit set as the difference between the upper cut-point of the 4th quintile and that of the 1st one, were 0.65, 0.73 and 0.80, respectively). Inverse relationships were observed also for calcium and vitamin D (ORs of 0.85 and 0.93, respectively). When the combined effect of calcium and vitamin D and selected anti-oxidants was considered, the OR reached 0.46 in subjects reporting high calcium/vitamin D and high anti-oxidant intake compared to those reporting low intake of both groups of micronutrients. Most results were apparently stronger for colon cancer and among females. Our results provide further support for a protective effect of several micronutrients on colorectal cancer risk and some indications for a specific and stronger effect of selected anti-oxidants.

We considered the role of monounsaturated and other types of fats on breast carcinogenesis, using data from a case-control study of 2,569 incident, histologically confirmed cases of breast cancer and 2,588 controls from six Italian areas. The multivariate odds ratios, adjusted for age, education, parity, menopausal status plus various sources of energy and types of fats, were 1.10 (95% confidence interval 0.99-1.23) for an increase of 10 g/day of saturated fat intake, 0.99 (0.94-1.04) for an increase of 10 g/day of monounsaturated fats, and 0.91 (0.87-0.96) for an increase of 5 g/day of polyunsaturated fats. The present data confirm that saturated, but not mono- or polyunsaturated fats, are directly, though moderately, related to breast cancer risk.

We have previously shown a substantial rise in total mortality for Italian men aged 20–39 years, mainly for those aged 25–34 years, in 1990 compared with 1985, although in the absence of appreciable changes in women [1]. This was attributed to the impact of the AIDS epidemic on male mortality. Although the spread of AIDS has occurred a few years later in women than in men, upward trends in AIDS incidence and mortality have been seen in the last decade in European and Northern American women, including Italian women [2–5]. These increases in AIDS and AIDS-related mortality have been reflected in total mortality trends in younger women over the last few years. Table 1 gives age- specific total mortality rates in Italian men and women aged 20–39 years between 1985 and 1994. For men aged 20–24 and 25–29 years, total mortality peaked in 1990, with rates for 1994 over 10% lower than those for 1990. However, steady upward trends were still present in the early 1990s in men aged 30–34 and 35–39 years, whose respective total mortality rates were 68 and 16% higher in 1994 compared with 1985. For women, total mortality was lower in 1994 than in 1985 at ages of 20–24 and 35–39 years. However, in the same period, rates increased by 19% at age 25–29 years and 28% at age 30–34 years (i.e., age groups where 64% of female AIDS cases had occurred [5]). Most of the increases were observed during the last few years, confirming that the AIDS epidemic was still spreading in Italian women up to the early 1990s [2–5].Table 1: . Age-specific total mortality in Italian men and women aged 20–39 years, 1985–1994.In 1994, deaths attributed specifically to AIDS accounted for 24 (3.9%) out of 611 of all deaths in women aged 20–24 years, 250 (24.4%) out of 1025 of those aged 25–29 years, 342 (25.7%) out of 1333 of those aged 30–34 years, and 161 (11.1%) out of 1448 of those aged 35–39 years. It is also worth bearing in mind that misclassification of cause of death and high competing risks (e.g., overdose, suicide, infections, and neoplasms), particularly amongst injecting drug users, lead to underestimates of AIDS-specific mortality. Finally, trends in AIDS mortality should be viewed against the recent decreases in death rates from motor vehicle accidents and cardiovascular diseases in young Italian men and women [6–8], suggesting that the real impact of the AIDS epidemic has probably been even larger than indicated by inspection of total mortality rates.

The control group of a hospital-based case-control study on breast cancer was used to assess the relationships between education, smoking habits, alcohol consumption, and intake of selected macro- and micronutrients in Italian women. The study subjects were 2,588 women admitted to a network of hospitals in various Italian regions for nonneoplastic, acute diseases unrelated to long-term changes in the diet. Although relatively few differences were observed, less educated subjects consumed more linoleic acid and polyunsaturated fats than did more educated women. Smoking habits were associated with the largest differences in selected antioxidant vitamins. Significant differences were observed for beta-carotene and vitamin C intake, with an 11% higher intake of beta-carotene and a 12% higher intake of vitamin C in ex-smokers than in current smokers. Heavier alcohol drinkers tended to consume more retinol and iron but less beta-carotene than did moderate or nondrinkers. Thus the differences in macro- and micronutrient intake were generally moderate across categories of education, smoking, and alcohol consumption in this data set of Italian women. Nonetheless, they confirm the importance of allowing for these variables in analyzing the relationship between nutritional factors and disease risk.

Most studies of diet and colorectal cancer have considered nutrients and micronutrients, but the role of foods or food groups remains open to debate. To elucidate the issue, we examined data from a case-control study conducted between 1992 and 1997 in the Swiss canton of Vaud. Cases were 223 patients (142 men, 81 women) with incident, histologically confirmed colon (n= 119) or rectal (n= 104) cancer (median age 63 years), linked with the Cancer Registry of the Swiss Canton of Vaud, and controls were 491 subjects (211 men, 280 women, median age 58 years) admitted to the same university hospital for a wide spectrum of acute non-neoplastic conditions unrelated to long-term modifications of diet. Odds ratios (OR) were obtained after allowance for age, sex, education, smoking, alcohol, body mass index, physical activity and total energy intake. Significant associations were observed for refined grain (OR = 1.32 for an increase of one serving per day), and red meat (OR = 1.54), pork and processed meat (OR = 1.27), alcohol (OR = 1.28), and significant protections for whole grain (OR = 0.85), raw (OR = 0.85) and cooked vegetables (OR = 0.69), citrus (OR = 0.86) and other fruits (OR = 0.85), and for coffee (OR = 0.73). Garlic was also protective (OR = 0.32 for the highest tertile of intake). These findings in a central European population support the hypothesis that a diet rich in refined grains and red meat increases the risk of colorectal cancer; they, therefore, support the recommendation to substitute whole grains for refined grain, to limit meat intake, and to increase fruit and vegetable consumption.