What Dietary Patterns and Nutrients are Associated with Pancreatic Cancer? Literature Review

Figures & data

Table 1 The Search Strategy Summary

Items	Specification
Date of Search (specified to date, month and year)	February–April, 2022
Databases and other sources searched	MEDLINE (PubMed), ScienceDirect, Google Scholar, and Scopus
Search terms used (including MeSH and free text search terms and filters) Note: please use an independent supplement table to present the detailed search strategy of one database as an example	Dietary carbohydrates, carbohydrates rich diet, sugar and sugar-sweetened soft drink, dietary fibers, high fiber diet, protein-rich diet, red meat and processed meat-rich dietary pattern, high fat diet, water-soluble vitamins, fat-soluble vitamins, major minerals, trace minerals, Mediterranean diet, plant-based diets, vegetable-rich diet, fruit-rich diet—and the risk of PC.
Timeframe	1985 to 2022
Inclusion and exclusion criteria (study type, language restrictions etc.)	Studies from different designs including cross-sectional studies, case-control, and cohorts, as well as systematic reviews and meta-analyses. Articles published in the English language
Selection process (who conducted the selection, whether it was conducted independently, how consensus was obtained, etc.)	All of the authors conducted the literature search independently
Any additional considerations, if applicable	–

Table 2 Summarization of the Studies on Trace Minerals and PC

Trace Minerals	Findings
Iron	In an exploratory analysis in the US, it was found that there is no association between iron intake and the risk of PC.^Citation56 This was also reported by the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort on studying the association between total iron and heme-iron and the risk of PC.^Citation101
Zinc	Li and Gai^Citation97 conducted a meta-analysis that included seven studies to investigate the association between zinc intake and the risk of PC. Their results indicated the protective role of zinc against the risk of PC. In addition, they found that the risk of PC significantly decreased in the group with the highest zinc intake as the PC risk for the highest versus the lowest categories of zinc intake was (RR= 0.798, 95% CI: 0.621–0.984).
Chromium	Most of the studies confirm the significant role of chromium in enhancing insulin action and improving glucose tolerance and such roles require a healthy pancreas.^Citation98 Another study indicated the antioxidant capabilities of chromium in reducing oxidative stress.^Citation99
Iodine	Epidemiological studies found a relationship between thyroid dysfunction and pancreas pathology and that thyroiditis could increase the risk of PC.^Citation100 Therefore, adequate iodine intake is associated with normal thyroid hormone levels and normal pancreatic function which may reduce the risk of PC.^Citation101
Selenium	Several studies indicated that a high intake of selenium was associated with a reduced risk of PC.^Citation102–104
Lead, cadmium and arsenic	Lead, cadmium and arsenic were significantly associated with increased risks of PC in the highest quartile.^Citation102
Nickel	Nickel was inversely associated with the risk of PC with (OR = 0.27, 95% CI: 0.12 to 0.59).^Citation102

Figure 1 Carcinogens, oxidative stress and inflammation can trigger inflammatory pathways that promote cell proliferation, anti-apoptosis, angiogenesis, epithelial-to-mesenchymal transition (EMT), invasion and metastasis. The presence of antioxidant nutrients (carotenoids and vitamin C), dietary fiber, and other phytochemicals (eg, flavonoids) provide a potential explanation for the protective effect of fruits and vegetables on PC by preventing the carcinogens, oxidative stress, and inflammation which initiate cancer pathogenesis. Cruciferous vegetables specifically have other potent antioxidants such as glucosinolate, indole-3-carbinol (ITCs), glucaric acid, and isothiocyanates. On the other hand, mechanisms that link red or processed meat to pancreatic carcinogenesis, include by-products of cooking methods such as polycyclic aromatic hydrocarbons (PAHs), heterocyclic amines (HCAs), N-nitroso compounds (NOCs), advanced glycation end-products (AGEs), increased fat intake, and insulin resistance.

Heinen MM, Verhage BA, Goldbohm RA, et al. Meat and fat intake and pancreatic cancer risk in the Netherlands Cohort Study. Int J Cancer. 2009;125(5):1118–1126. doi:10.1002/ijc.24387

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Molina‐Montes E, Wark PA, Sánchez MJ, et al. Dietary intake of iron, heme‐iron and magnesium and pancreatic cancer risk in the European prospective investigation into cancer and nutrition cohort. Int J Cancer. 2012;131(7):E1134–E47. doi:10.1002/ijc.27547

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Shibayama-Imazu T, Sakairi S, Watanabe A, et al. Vitamin K2 selectively induced apoptosis in ovarian TYK-nu and pancreatic MIA PaCa-2 cells out of eight solid tumor cell lines through a mechanism different from geranylgeraniol. J Cancer Res Clin Oncol. 2003;129(1):1–11. doi:10.1007/s00432-002-0393-7

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Wei G, Wang M, Carr BI. Sorafenib combined vitamin K induces apoptosis in human pancreatic cancer cell lines through RAF/MEK/ERK and c‐Jun NH2‐terminal kinase pathways. J Cell Physiol. 2010;224(1):112–119. doi:10.1002/jcp.22099

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Fan H, Yu Y, Nan H, et al. Associations between intake of calcium, magnesium and phosphorus and risk of pancreatic cancer: a population-based, case–control study in Minnesota. Br J Nutr. 2021;126(10):1549–1557. doi:10.1017/S0007114521000283

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Kesavan Y, Giovannucci E, Fuchs CS, et al. A prospective study of magnesium and iron intake and pancreatic cancer in men. Am J Epidemiol. 2010;171(2):233–241. doi:10.1093/aje/kwp373

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Li L, Gai X. The association between dietary zinc intake and risk of pancreatic cancer: a meta-analysis. Biosci Rep. 2017;37(3):114.

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