The flowchart illustrates the recruitment and screening process for the baseline survey of the National Cohort of Esophageal Cancer (2017–2019). (IMAGE)
Caption
The flowchart illustrates the recruitment and screening process for the baseline survey of the National Cohort of Esophageal Cancer (2017–2019). A total of 61,864 individuals (40–69 years of age) from high-risk regions were initially screened. The exposure assessment flowchart shows that dietary quality was evaluated using the Diet Balance Index (DBI)-16 with three derived indicators: high bound score (HBS); low bound score (LBS); and dietary quality distance (DQD). A total of 29,431 individuals were excluded based on dietary questionnaire responses due to incomplete dietary data. Psychological symptoms were assessed via the GAD-7 and PHQ-9 scales, and an additional 3,365 subjects were excluded for incomplete responses, resulting in a final analytic cohort of 29,068 participants. All included participants underwent clinical endoscopy and pathologic examination. Participants were classified into four groups based on pathologic results: normal (n = 15,430); inflammation (n = 10,641); pre-cancer (n = 2,563); and cancer (n = 434). The statistical analysis involved logistic regression models to examine the associations between dietary quality, psychological symptoms, and UGI lesions. Path analysis was performed to test the mediating role of anxiety and depression symptoms in the association between poor diet and UGI cancer risk. The associative mediation effect of psychological symptoms accounted for 20%–40% of the total association. The current study provides evidence in support of the need for integrated cancer prevention strategies targeting both dietary and mental health factors.
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Cancer Biology & Medicine
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