Head & Neck Cancer: data for foods & supplements

Mediterranean Diet and Healthy Eating Index (HEI)

A prospective study of 494,967 participants from the NIH-AARP Diet and Health study, spanning from 1995-2006, was conducted to assess the the association of diet type and head & neck cancer (HNC) risk. (1) The main outcome was the incidence of developing HNC, including types such as cancer of the larynx, oral cavity, and throat. 

Diet types were assessed by food questionnaires, specifically measuring the adherence to either an “alternative Mediterranean diet” (aMED score) or scored for a “Healthy Eating Index” (the HEI-2005 score). 

HEI-2005 was designed to assess compliance with the 2005 Dietary Guidelines for Americans (20), with 12 components for a maximum of 100 points (optimal adherence). Six components (total grains, whole grains, total vegetables, dark-green and orange vegetables and legumes, total fruit, and whole fruit) were awarded 0–5 points. Five components (milk, meat and beans, oils, saturated fat, and sodium) were worth 0–10 points. The component of calories from solid fat, alcohol, and added sugar was awarded 0–20 points. Components and scoring standards were measured by using the density per 1000 kcal. Higher scores indicate lower intakes of components of saturated fat, sodium, and calories from fat/alcohol/added sugar but indicated higher intakes of other components.

The aMED was modified from the original Mediterranean diet score to adapt to an American population (11, 21) to evaluate 9 components with a maximum score of 9 (optimal adherence). Components were energy adjusted and standardized to 2500 cal for men and 2000 cal for women. Participants received one point for an intake above the sex-specific median for 7 components, including vegetables (excluding potatoes), legumes, fruit, nuts, whole grains, fish, and the ratio of monounsaturated to saturated fat and one point for red and processed meat intake below the median.

During the follow up period, 1,868 HNC cases were identified. Results showed that a benefit for participants who adhered to both diet types from HNC, with the trends being stronger for women. For the HEI-2005 score, in comparing the highest versus lowest quintiles, higher scores were associated with reduced risk of HNC in men [HR: 0.74 (95% CI: 0.61, 0.89), P-trend = 0.0008] and women [HR: 0.48; 95% CI: 0.33, 0.70; P-trend < 0.0001]. 

Higher aMED scores were also associated with lower HNC risk in men (HR: 0.80; 95% CI: 0.64, 1.01; P-trend = 0.002) and women (HR: 0.42; 95% CI: 0.24, 0.74; P-trend < 0.0001).

Importantly, the benefit appeared to be independent of interactions with smoking or alcohol intake in the authors’ analysis. 

This is a very interesting large prospective study showing particularly strong trends for women for both the HEI-2005 and aMED scores. Specifically the hazard ratios for benefit from head & neck cancer were 0.48 and 0.42 for the HEI-2005 and aMED diets, respectively.    

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Selenium

Patients being treated for head and neck cancer often receive therapies that disrupt the immune system, including radiation and cytotoxic chemotherapy. A randomized double-blind placebo-controlled trial was undertaken to determine whether oral intake of a form of selenium - 200 microg/d of sodium selenite – will improve immune function in humans. (3) Immune function was measured by assessing the response of lymphocytes to stimulation by mitogen, and to see the production of cytotoxic T-lymphocytes. 

Patients were given one selenium or placebo tablet daily for 8 weeks, beginning on the day of their first treatment. Immune function was monitored in patients as above, both during therapy and afterwards. Subjects enrolled had significantly lower blood selenium levels than healthy individuals, and patients with earlier stage disease (stage I or II) had significantly higher plasma selenium levels than more advanced stage cancer (stage III or IV).

In the selenium group, an enhanced immune response was found during therapy and following conclusion of therapy. However in the placebo arm, a decline in immune responsiveness was seen during therapy and significantly lower than baseline functioning. 

This well conducted human randomized trial shows improved immune functioning in patients taking a safe dose of selenium (based on US FDA recommendations) compared to a placebo arm. Immune dysfunction is a known issue with radiation and chemotherapy, and this simple intervention could be of benefit for patients dealing with treatment for head and neck cancer.

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Zinc

Zinc is utilized clinically in situations calling for immune function augmentation, such as for fighting common colds. A study was undertaken in patients newly diagnosed with squamous cell carcinoma of the head & neck, to correlate zinc status (e.g., deficiency) with immune function and outcome. (5) Patients with metastatic disease were excluded on this study.

47 patients were assessed for production of TH1 and TH2 cytokines, as well as cutaneous delayed hypersensitivity reaction to common antigens. At baseline, approximately 50% of subjects were zinc-deficient based on cellular zinc criteria and had decreased production of TH1 cytokines but not TH2 cytokines, decreased NK cell lytic activity. 

The tumor size and overall stage of the disease correlated with baseline zinc status but not with a nutritional index, alcohol intake, or smoking. Zinc deficiency was associated with increased unplanned hospitalizations also.

Outcomes showed that the disease-free interval was highest for the group which had both zinc sufficient and nutrition sufficient status. In this group of patients, zinc deficiency was found to have immune dysfunction, with an imbalance of TH1 and TH2 functions. This immune dysfunction persisted during their treatment as well, including with increased hospitalizations.

This study of zinc in a human population of newly diagnosed squamous cell carcinoma of the head & neck builds on the body of evidence for immune dysfunction with zinc deficiency. There was also a correlation between zinc deficiency and higher stage of cancer, as well as persistent immune dysfunction. There was not an arm of the study testing zinc repletion, but this publication provides a valid hypothesis for testing supplementation. 

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