Food preparation methods, drinking water source, and esophageal squamous cell carcinoma in the high-risk area of Golestan, Northeast Iran

Asieh Golozar, Arash Etemadi, Farin Kamangar, Akbar Fazeltabar Malekshah, Farhad Islami, Dariush Nasrollahzadeh, Behnoosh Abedi-Ardekani, Masoud Khoshnia, Akram Pourshams, Shahriar Semnani, Haji Amin Marjani, Ramin Shakeri, Masoud Sotoudeh, Paul Brennan, Philip Taylor, Paolo Boffetta, Christian Abnet, Sanford Dawsey, Reza Malekzadeh

Research output: Contribution to journalArticlepeer-review


Cooking practices and water sources have been associated with an increased risk of cancer, mainly through exposure to carcinogens such as heterocyclic amines, polycyclic aromatic hydrocarbons, and nitrates. Using data from the Golestan case-control study, carried out between 2003 and 2007 in a high-risk region for esophageal squamous cell carcinoma (ESCC), we sought to investigate the association between food preparation and drinking water sources and ESCC. Information on food preparation methods, sources of drinking water, and dietary habits was gathered from 300 cases and 571 controls matched individually for age, sex, and neighborhood using a structured questionnaire and a semiquantitative food frequency questionnaire. Multivariate conditional logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) adjusted for potential confounders and other known risk factors including socioeconomic status and smoking. More than 95% of the participants reported eating meat, mostly red meat. Red meat consumption above the 75th percentile increased the odds of ESCC by 2.82-fold (95% CI: 1.21-6.57). Fish intake was associated with a significant 68% decrease in ESCC odds (26%, 86%). Among meat eaters, ORs (95% CI) for frying meat (red or white) and fish were 3.34 (1.32-8.45) and 2.62 (1.24-5.5). Drinking unpiped water increased ESCC odds by 4.25 times (2.23-8.11). The OR for each 10-year increase in the duration of drinking unpiped water was 1.47 (1.22-1.78). Our results suggest roles for red meat intake, drinking water source, and food preparation methods in ESCC, even after adjusting for a large number of potential confounders.

Original languageEnglish (US)
Pages (from-to)123-129
Number of pages7
JournalEuropean Journal of Cancer Prevention
Issue number2
StatePublished - Mar 1 2016


  • cooking methods
  • dietary habits
  • environmental carcinogens
  • environmental exposure
  • esophageal squamous cell carcinoma
  • food preparation
  • water sources

ASJC Scopus subject areas

  • Epidemiology
  • Oncology
  • Public Health, Environmental and Occupational Health
  • Cancer Research

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