Joint Effect of Diet and Environmental Tobacco Smoke on Risk of Lung Cancer Among Nonsmokers

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Abstract
A recent meta-analysis based on 4626 cases concluded that the relative risk of lung cancer in lifelong nonsmokers who lived with a smoker was 1.24 (95% confidence interval [CI] = 1.13-1.36) (1). Subsequently, we reported in the Journal (2) the results from a large case-control study of environmental tobacco smoke (ETS) and lung cancer based in 12 European centers. This study provided an odds ratio (OR) for lung cancer of 1.14 (95% CI = 0.88-1.47) for spousal and workplace exposure to ETS; the increase was most apparent among those in the top quartile of exposure (OR = 1.31; 95% CI = 0.88-1.94) and the top decile of exposure (OR = 1.46; 95% CI = 0.96-2.22) (P value for trend = .01). It could be argued that such increased risks associated with ETS might not represent a causal effect but may be due to confounding by dietary factors. To further elucidate this critical issue, we have analyzed the data of the European study by examining the joint relationship between dietary consumption, exposure to ETS, and lung cancer.

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