Year of Publication



Public Health

Date Available


Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Dr. W. Jay Christian

Committee Member

Dr. Steven Browning

Committee Member

Dr. Sarah Wackerbarth


Background and Objectives

Lung cancer is the most common cause of cancer-related deaths world-wide. Recent studies suggest a possible association between nutrition and risk for specific histological subtypes of cancer. We examined the relationship between nutrition and lung cancer histology in Kentucky, a largely rural U.S. state that ranks among the highest in the nation in lung cancer rates, as well as diseases related to diet, such as diabetes and obesity. The objective of this study was to examine the impact of nutrition on lung cancer risk and histology in Kentucky. More specifically, we wanted to investigate potential associations with high sugar foods using their responses to a brief food frequency questionnaire


In this case-control study, we used secondary data from a previous population-based case-control study that examined possible environmental exposures to trace elements such as arsenic, chromium, and radon. The original data consisted of 520 surveys completed by 150 cases and 370 controls, and linked data from the Kentucky Cancer Registry. The original study enrolled subjects from January 2012 to August 2014 who resided in the 5th Congressional District and had eligibility requirements for selecting both cases and controls. We tabulated median and interquartile ranges by participant characteristics and by histological type (including controls) to examine consumption patterns for specific types of foods. We also created a logistic model to compare odds of significant covariates from our bivariate analysis and lung cancer among cases and controls while controlling for smoking. Our tertiles for the high sugar variable was based on the distribution of number of times eaten per month.


Our findings show controls ate higher amounts of fruits, vegetables, and whole grains compared to cases, and to cases in each histology group. Cases tended to eat high-sugar and highly processed foods more often than controls. This relationship was mostly similar when examined separately for each specific histological type. The results of this study suggest a possible association between lung cancer risk and high-sugar and highly processed foods.


Our study showed that controls generally had healthier diets, consuming fewer sugary foods and more fruits and vegetables per month compared to cases, though much of this effect was attenuated by controlling for confounding. Future research in this area could benefit from a more comprehensive dietary survey and a larger sample size to enable stratification by histological type.

Included in

Public Health Commons