العوامل الغذائية ومخاطرها على الإصابة بمرض الورم الليمفاوي غير الهودجكن بين الفلسطينيين
Nutritional Factors and the Risk of Non-Hodgkin Lymphoma among Palestinians
مرام محمد شاكر دحدول
maram mohammed shaker dahdol
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Background: The incidence of Non-Hodgkin Lymphoma (NHL) increased worldwide during the second half of the last century and then stabilized during the nineties but subsequently increased. Environmental factors and dietary habits have been reported to play an important role in the etiology of NHL by influencing the immune system. However, no such data are available from Palestine. Objectives: To participate in establishing a platform to study B-NHL in Palestine and further to examine the association between dietary factors and the risk of B-NHL among Palestinian B-NHL patients versus controls. Design: Case-control study. Methods: A case-control study was conducted between 2009-2013 including 306- histological confirmed B-NHL cases and 392 cancer-free controls among adult Palestinians recruited from three major Palestinian hospitals in the West Bank and Jerusalem which have an oncology department in addition to Hadassah Hospital in West Jerusalem. In the primary study analysis, an imbalance was encountered in the regional distribution of cases and controls in the central area. In order to correct for this imbalance, I recruited 71 controls from the primary health care centers in Jericho, Ramallah and Al-Azaria on the basis of frequency matched case-control study in terms of age and gender and region. The study participants were administered a questionnaire which is based on the international Epi-Lymph questionnaire, which focuses on demographic characteristics, types of environmental exposure and on diet and nutritional intake, specifically meat, milk, dairy,vegetables and fruits. Blood samples were also collected from participants for the purpose of DNA purification and viral serology testing. The overall data-base was used to study the association between nutritional factors and the risk of NHL. The data was analyzed by Statistical Package for the SocialSciences(SPSS)and associations were examined by multivariate logistic regression. For food intake analysis, the median value for each food group was calculated from overall distribution of the study population in order to use the value below the median as a reference value to detect associations by logistic regression. Results: High consumption of meat (OR=1.8; 95% CI: 0.8-4.3) and milk (OR=1.3; 95% CI: 0.7-2.6) was found to be positively associated with the risk of B-NHL. Vegetable intake was also positively associated with the risk of B-NHL (OR=1.3; 95% CI: 0.4-4). Similarly, dairy products were significantly associated with an increased risk of B-NHL (OR=2.3; 95% CI: 1.2-4.4). In contrast, a significantly inverse association was encountered between fish consumption and B-NHL risk (OR=0.4; 95% CI: 0.2-0.8), and an inverse association was found between the consumption of fruits and B-NHL risk (OR=0.7; 95% CI: 0.2-2.1). Conclusion:The results of this study showed that dietary intake may affect the risk of NHL as positive associations were found with meat, milk, dairy products and vegetables consumption, while an inverse association with fish and fruits consumption was encountered. Keywords: dietary factors, non-Hodgkin lymphoma, case–control study, Palestine.