Having worked at the VA Medical Center for a good chunk of my career, I’ve witnessed some pretty awful conditions, including multiple types of cancer. One of the worst ones I’ve encountered is mouth and throat cancers.

In addition to smoking and excessive alcohol consumption, new research links ultra-processed foods with mouth, throat and esophageal cancers.  

According to research from the University of Bristol and the International Agency for Research on Cancer (IARC), consuming more ultra-processed foods (UPFs) may be linked with more risk of developing cancers of the mouth, esophagus, and throat. Diet and lifestyle data was analyzed in a global group of over 450,100 adults that were monitored for roughly 14 years. 2

While obesity related to UPF intake is a risk factor for these aerodigestive cancers, it’s not the soul factor to blame. The study was published in the November 22 issue of the European Journal of Nutrition.

This is not the first study to link UPFs with cancer. The largest cohort study in Europe known as EPIC (the European Prospective Investigation into Cancer and Nutrition) found an association between UPF intake and 34 different cancers. 2

While more data comes out regarding the link between intake of UPFs and poor outcomes, scientists from the Bristol Medical School and IARC wanted to investigate this more

As several UPFs are high in fat and calories, Bristol’s team wanted to connect the link between UPF intake and head and neck cancer and esophageal adenocarcinoma (a type of esophageal cancer) through EPIC and to see if this was due to increases in body at.

According to the team’s data from EPIC, eating 10% more UPFs is linked with a 23% higher risk of head and neck cancer and a 24% higher risk of esophageal adenocarcinoma.

A small part of the statistical link between UPF intake and the risk of these types of cancers as linked to higher body fat.

According to Fernanda Morales-Berstein, a Wellcome Trust PhD student at the University of Bristol and the study's lead author, “UPFs have been associated with excess weight and increased body fat in several observational studies. This makes sense, as they are generally tasty, convenient and cheap, favoring the consumption of large portions and an excessive number of calories. However, it was interesting that in our study the link between eating UPFs and upper-aerodigestive tract cancer didn't seem to be greatly explained by body mass index and waist-to-hip ratio."

The authors believe other mechanisms could explain the link. Additives including emulsifiers and artificial sweeteners which have been linked in the past with disease risk, and contaminants from food packaging and the manufacturing process, may partly explain the association between UPF intake and upper-aerodigestive tract cancer in this study.

But Fernanda Morales-Berstein and colleagues did warrant caution regarding their findings and add that the links between UPF consumption and upper-aerodigestive tract cancers found in the study could be impacted by certain types of bias.

They found evidence of a link between higher UPF intake and higher rates of accidental deaths, which is very unlikely to be causal.

George Davey Smith, Professor of Clinical Epidemiology and Director of the MRC Integrative Epidemiology Unit at the University of Bristol, and co-author on the paper, said: "UPFs are clearly associated with many adverse health outcomes, yet whether they actually cause these, or whether underlying factors such as general health-related behaviors and socioeconomic position are responsible for the link, is still unclear, as the association with accidental deaths draws attention to."

Inge Huybrechts, Team head of the Lifestyle exposures and interventions team at IARC, added: "Cohorts with long-term dietary follow-up intake assessments, considering also contemporary consumption habits, are needed to replicate these study's findings, as the EPIC dietary data were collected in the 1990s, when the consumption of UPFs was still relatively low. As such associations may potentially be stronger in cohorts including recent dietary follow-up assessments."

More research is required to pinpoint other causes including food additives and contaminants, which could be the reason for the connection of UPFs and cancer.

Based on the evidence that body fat didn’t exactly explain the link between UPF intake and upper aerodigestive tract cancers in this study, Fernanda Morales-Berstein, suggested: "Focusing solely on weight loss treatment, such as Semaglutide, is unlikely to greatly contribute to the prevention of upper-aerodigestive tract cancers related to eating UPFs."

Dr Helen Croker, Assistant Director of Research and Policy at World Cancer Research Fund, noted: "This study adds to a growing pool of evidence suggesting a link between UPFs and cancer risk. The association between a higher consumption of UPFs and an increased risk of developing upper-aerodigestive tract cancer supports our Cancer Prevention Recommendations to eat a healthy diet, rich in whole grains, vegetables, fruit, and beans."

As mentioned about, mouth and throat cancer is no joke. To reduce your risk, follow the tips below:

1.    Don’t smoke or quit if you do. Smoking is linked with several types of cancer, including aerodigestive cancers.

2.    Drink alcohol in moderation or not at all. Like smoking, alcohol intake is associated with several types of gastrointestinal and other cancers.

3.    Reduce or avoid UPFs. This includes fast food, fried snacks, high fat/high sugar treats and snacks, and highly processed meats such as bacon, sausage, and lunch meat.

4.    Focus on fruits and vegetables- especially those high in vitamin C and beta-carotene such as berries, melon, citrus fruit, green leafy vegetables, cabbage family vegetables and bell peppers.

5.    Reduce red meat and processed meat intake. Both are associated with colorectal and other cancers.

6.    Include more beans and lentils in your diet for adequate fiber and protein.

7.    Choose whole grains over processed grains.

8.    Maintain a healthy body weight if possible.

9.    Swap out chips and other snacks with nuts or seeds which contain the antioxidants vitamin E and selenium.

10. Do regular physical activity. Find exercise you enjoy and be consistent with it.

Lisa Andrews, MEd, RD, LD

References:

1.    Fernanda Morales-Berstein, Carine Biessy, Vivian Viallon, Ana Goncalves-Soares, Corinne Casagrande, Bertrand Hémon, Nathalie Kliemann, Manon Cairat, Jessica Blanco Lopez, Aline Al Nahas, Kiara Chang, Eszter Vamos, Fernanda Rauber, Renata Bertazzi Levy, Diana Barbosa Cunha, Paula Jakszyn, Pietro Ferrari, Paolo Vineis, Giovanna Masala, Alberto Catalano, Emily Sonestedt, Yan Borné, Verena Katzke, Rashmita Bajracharya, Claudia Agnoli, Marcela Guevara, Alicia Heath, Loredana Radoï, Francesca Mancini, Elisabete Weiderpass, José María Huerta, María-José Sánchez, Anne Tjønneland, Cecilie Kyrø, Matthias B. Schulze, Guri Skeie, Marko Lukic, Tonje Braaten, Marc Gunter, Christopher Millett, Antonio Agudo, Paul Brennan, M. Carolina Borges, Rebecca C. Richmond, Tom G. Richardson, George Davey Smith, Caroline L. Relton, Inge Huybrechts. Ultra-processed foods, adiposity and risk of head and neck cancer and oesophageal adenocarcinoma in the European Prospective Investigation into Cancer and Nutrition study: a mediation analysis. European Journal of Nutrition, 2023; DOI: 10.1007/s00394-023-03270-1

2.    Kliemann N, Rauber F, Bertazzi Levy R, Viallon V, Vamos EP, Cordova R, Freisling H, Casagrande C, Nicolas G, Aune D, Tsilidis KK, Heath A, Schulze MB, Jannasch F, Srour B, Kaaks R, Rodriguez-Barranco M, Tagliabue G, Agudo A, Panico S, Ardanaz E, Chirlaque MD, Vineis P, Tumino R, Perez-Cornago A, Andersen JLM, Tjønneland A, Skeie G, Weiderpass E, Monteiro CA, Gunter MJ, Millett C, Huybrechts I. Food processing and cancer risk in Europe: results from the prospective EPIC cohort study. Lancet Planet Health. 2023 Mar;7(3):e219-e232. doi: 10.1016/S2542-5196(23)00021-9. Erratum in: Lancet Planet Health. 2023 May;7(5):e357. PMID: 36889863; PMCID: PMC10009757.