A Prospective Study of Dietary Fat & Risk of Prostate Cancer

The strong correlation between national consumption of fat and national rate of mortality from prostate cancer has raised the hypothesis that dietary fat increases the risk of this malignancy. Case-control and cohort studies have not consistently supported this hypothesis. We examined prospectively the relationship between prostate cancer and dietary fat, including specific fatty acids and dietary sources of fat. We examined the relationship of fat consumption to the incidence of advanced prostate cancer (stages C, D, or fatal cases) and to the total incidence of prostate cancer. We used data from the Health Professionals Follow-up Study, which is a prospective cohort of 51529 U.S. men, aged 40 through 75, who completed a validated food-frequency questionnaire in 1986. We sent follow-up questionnaires to the entire cohort in 1988 and 1990 to document new cases of a variety of diseases and to update exposure information. As of January 31, 1990, 300 new cases of prostate cancer, including 126 advanced cases, were documented in 47855 participants initially free of diagnosed cancer. The Mantel-Haenszel summary estimator was used to adjust for age and other potentially confounding variables. Multiple logistic regression was used to estimate relative risks (RRs) when controlling simultaneously for more than two covariates. Total fat consumption was directly related to risk of advanced prostate cancer (age- and energy adjusted RR = 1.79, with 95% confidence interval [CI] =1.04-3.07, for high versus low quintile of intake; P [trend] = .06). This association was due primarily to animal fat (RR = 1.63; 95% CI = 0.95-2.78; P [trend] = .08), but not vegetable fat. Red meat represented the food group with the strongest positive association with advanced cancer (RR = 2.64; 95% CI = 1.21-5.77; P = .02). Fat from dairy products (with the exception of butter) or fish was unrelated to risk. Saturated fat, monounsaturated fat, and alpha-linolenic acid, but not linoleic acid, were associated with advanced prostate cancer risk; only the association with alpha-linolenic acid persisted when saturated fat, monounsaturated fat, linoleic acid, and alpha-linolenic acid were modeled simultaneously (multivariate RR = 3.43; 95% CI = 1.67-7.04; P [trend] = .002). The results support the hypothesis that animal fat, especially fat from red meat, is associated with an elevated risk of advanced prostate cancer.
These findings support recommendations to lower intake of meat to reduce the risk of prostate cancer. The potential roles of carcinogens formed in cooking animal fat and of alpha-linolenic acid in the progression of prostate cancer need to be explored. (Author's abstract)
It has been suggested that dietary fat may be a major cause of prostate cancer.  However, many of these studies have the following major limitations: (a) the inability to adequately control for potential confounders, (b) the reliance on food “disappearance” data rather than directly assessing consumption by individuals at risk, and (c) the marked variability in detection of prostate cancer among various countries. Prospective cohort studies avoid most of the potential source of methodological bias associated with case-control studies. This study describes the results of a prospective cohort study of dietary fat and risk of prostate cancer among U.S. health professionals. The study showed that consumption of animal fat, especially fat from red meat, was associated with an increased risk of advanced cancers (stage C and D and fatal cancers). Of specific types of fatty acids, alpha-linolenic acid  was associated with increased risk of prostate cancer.  Fat from vegetable sources and fat from dairy products (with the exception of butter) and fish were not related to prostate cancer risk. More recent investigations in humans have provided conflicting evidence regarding alpha-linolenic acid intake and risk of prostate cancer. Although vegetable oil supplied most of the alpha-linolenic acid in our cohort, only fat from animal sources was related to risk of prostate cancer, an observation that requires further assessment.  The roles of alpha-linolenic acid and of carcinogens produced during the cooking of meat in the progression of prostate cancer need to be further explored. (Editor's comments)