Nutritional and socioeconomic factors in relation to prostate cancer mortality: a cross-national study

Background: Large international variations in rates of prostate cancer incidence and mortality suggest that environmental factors have a strong influence on the development of this disease. The purpose of this study was to identify predictive variables for prostate cancer mortality in data from 59 countries, Methods: Data on prostate cancer mortality, food consumption, tobacco use, socioeconomic factors, reproductive factors, and health indicators were obtained from United Nations sources, Linear regression models were fit to these data. The influence of each variable fit in the regression models was assessed by multiplying the regression coefficient b by the 75th (X-75) and 25th (X-25) percentile values of the variable. The difference, bX(75) - bX(25), is the estimated effect of the variable across its interquartile range on mortality rates measured as deaths per 100 000 males aged 45-74 years. Reported P values are two-sided. Results: Prostate cancer mortality was inversely associated with estimated consumption of cereals (bX(75) - bX(25) = -7.31 deaths; P = .001), nuts and oilseeds (bX(75) - bX(25) = -1.72 deaths; P = .003), and fish (bX(75) - bX(25) = -1.47 deaths; (P = .001). In the 42 countries for which we had appropriate data, soy products were found to be significantly protective (P = .0001), with an effect size per kilocalorie at least four times as large as that of any other dietary factor. Besides variables related to diet, we observed an association between prostate cancer mortality rates and a composite of other health-related, sanitation, and economic variables (P = .003). Conclusions: The specific food-related results from this study are consistent with previous information and support the current dietary guidelines and hypothesis that grains, cereals, and nuts are protective against prostate cancer. The findings also provide a rationale for future study of soy products in prostate cancer prevention trials.