Am J Epidemiol 1997 (Aug 15); 146 (4): 294–306
Goodman MT, Wilkens LR, Hankin JH, Lyu LC,
Wu AH, Kolonel LN
Cancer Research Center of Hawaii,
University of Hawaii, Honolulu, USA
The authors conducted a case-control study among the multi-ethnic population of Hawaii to examine the role of dietary soy, fiber, and related foods and nutrients on the risk of endometrial cancer. Endometrial cancer cases (n = 332) diagnosed between 1985 and 1993 were identified from the five main ethnic groups in the state (Japanese, Caucasian, Native Hawaiian, Filipino, and Chinese) through the rapid-reporting system of the Hawaii Tumor Registry.
Population controls (n = 511) were selected randomly from lists of female Oahu residents and matched to cases on age ( 2.5 years) and ethnicity. All subjects were interviewed using a diet history questionnaire that included over 250 food items. Non-dietary risk factors for endometrial cancer included nulliparity, never using oral contraceptives, fertility drug use, use of unopposed estrogens, a history of diabetes mellitus or hypertension, and a high Quetelet's index (kg/m2). Energy intake from fat, but not from other sources, was positively associated with the risk of endometrial cancer. The authors also found a positive, monotonic relation of fat intake with the odds ratios for endometrial cancer after adjustment for energy intake.
The consumption o fiber, but not starch, was inversely related to risk after adjustment for energy intake and other confounders. Similar inverse gradients in the odds ratios were obtained for crude fiber, non-starch polysaccharide, and dietary fiber. Sources of fiber, including cereal and vegetable and fruit fiber, were associated with a 29-46% reduction in risk for women in the highest quartiles of consumption. Vitamin A and possibly vitamin C, but not vitamin E, were also inversely associated with endometrial cancer, although trends were not strong.
High consumption of soy products and other legumes was
associated with a decreased risk of endometrial cancer (p for
trend = 0.01; odds ratio = 0.46, 95% confidence interval
0.26-0.83) for the highest compared with the lowest quartile of
Similar reductions in risk were found for increased consumption
of other sources of phytoestrogens such as whole grains,
vegetables, fruits, and seaweeds. Ethnic-specific analyses were
generally consistent with these results. The observed dietary
associations appeared to be largely independent of other risk
factors, although the effects of soy and legumes on risk were
limited to women who were never pregnant or who had never used
These data suggest that plant-based diets low in calories from
fat, high in fiber, and rich in legumes (especially soybeans),
whole grain foods, vegetables, and fruits reduce the risk of
endometrial cancer. These dietary associations may explain in
part the reduced rates of uterine cancer in Asian countries
compared with those in the United States.