Flavonoids belong to a vast group of polyphenols widely distributed in all foods of plant origin. Because of their antioxidant, antimutagenic and antiproliferative properties, they have been hypothesized to contribute to the favorable effects of fruit and vegetables against cancer. The aim of this study is to investigate the relation of 6 classes of flavonoids (flavan-3-ols, flavanones, flavonols, flavones, anthocyanidins and isoflavones) with ovarian cancer risk, using data from a multicentric case-control study conducted in Italy between 1992 and 1999. The study included 1,031 cases with incident, histologically confirmed epithelial ovarian cancer and 2,411 controls admitted for acute, nonneoplastic conditions to major hospitals in the same catchment areas. In logistic regression models including study center, education, year of interview, parity, oral contraceptive use and family history of ovarian or breast cancer or both, an inverse relation with significant trend in risk was found between ovarian cancer and flavonols [odds ratio (OR), 0.63; 95% confidence intervals (CI) 0.47-0.84] as well as isoflavones (OR, 0.51; 95% CI, 0.37-0.69), comparing the highest versus the lowest quintile. Further adjustment for fruit and vegetable intake did not modify these associations, suggesting that isoflavones and flavonols may have a distinct role in explaining the effect of fruit and vegetable against ovarian cancer. On the basis of our findings and the relevant literature, we infer that isoflavones, and perhaps flavonols, may have favorable effects with respect to ovarian cancer risk. ' 2008 Wiley-Liss, Inc.Key words: flavonoids; ovarian cancer; isoflavones; case-control study; risk factors Flavonoids belong to a vast group of polyphenols that are widely distributed in all foods of plant origin such as fruit, vegetable, tea and wine.1,2 Originally known only for their role in plant pigmentation, flavonoids have been shown to have antioxidant, antimutagenic and antiproliferative properties in vitro 3-5 and have thus been hypothesized to contribute to the favorable effects of fruit and vegetable against various chronic diseases including cancer. [6][7][8][9] Recently, the availability of detailed and reliable food composition tables for flavonoids published by the US Department of Agriculture on their 6 major classes (flavan-3-ols, flavanones, flavonols, flavones, anthocyanidins and isoflavones) 10,11 has allowed epidemiological studies to further investigate the role of flavonoids in cancer etiology. Intake of various flavonoids has been inversely related to the risk of cancers of the upper aerodigestive tract, 12-14 stomach, 15,16 colorectum, 17 urinary tract 18,19 and breast. [20][21][22] As concerns ovarian cancer, of particular interest are isoflavones given their antiestrogenic effects.
23The aim of this study is to investigate the relation of 6 major classes of flavonoids and total flavonoids with ovarian cancer risk, using data from a large multicentric case-control study conducted in Italy.
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Material and metho...