Research Papers: Gastrointestinal CancerConsumption of garlic and its interactions with tobacco smoking and alcohol drinking on esophageal cancer in a Chinese populationJin, Zi-Yia,*; Wallar, Ginah,*; Zhou, Jin-Yib; Yang, Jieb; Han, Ren-Qiangb; Wang, Pei-Huab; Liu, Ai-Minc; Gu, Xiao-Pingc; Zhang, Xiao-Fengd; Wang, Xu-Shand; Su, Minge; Hu, Xue; Sun, Zhengf; Li, Gangf; Mu, Li-Naj; Lu, Qing-Yii; Liu, Xinga; Li, Li-Mingg; He, Naa; Wu, Mingb,†; Zhao, Jin-Koub,†; Zhang, Zuo-Fengh,†Author Information aDepartment of Epidemiology, School of Public Health, Fudan University, Shanghai bJiangsu Provincial Center for Disease Control and Prevention, Nanjing cDafeng Center for Disease Control and Prevention, Dafeng dGanyu Center for Disease Control and Prevention, Ganyu eChuzhou County Center for Disease Control and Prevention, Chuzhou fTongshan County Center for Disease control and Prevention, Tongshan gDepartment of Epidemiology, School of Public Health, Peking University, Beijing, China hDepartment of Epidemiology, Fielding School of Public Health, University of California iDepartment of Medicine, Center for Human Nutrition, UCLA David Geffen School of Medicine, Los Angeles, California jDepartment of Social and Preventive Medicine, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, New York, USA *Zi-Yi Jin and Gina Wallar contributed equally to the writing of this article. †Ming Wu, Jin-Kou Zhao and Zuo-Feng Zhang contributed equally to the writing of this article. Correspondence to Jin-Kou Zhao, MD, PhD, Department of Non-communicable Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, No. 172 Jiangsu Road, Nanjing 210009, China Tel/fax: +86 258 375 9411; e-mail: [email protected] European Journal of Cancer Prevention: July 2019 - Volume 28 - Issue 4 - p 278-286 doi: 10.1097/CEJ.0000000000000456 Buy Metrics Abstract Garlic consumption has been associated inversely with esophageal cancer (EC); however, its interactions with tobacco smoking and alcohol consumption have never been evaluated in an epidemiological study. We evaluated the potential interactions between garlic intake and tobacco smoking as well as alcohol consumption in a population-based case–control study with 2969 incident EC cases and 8019 healthy controls. Epidemiologic data were collected by face-to-face interviews using a questionnaire. The adjusted odds ratio (OR) and 95% confidence interval (CI) were estimated and additive and multiplicative interactions were evaluated using unconditional logistic regression models, adjusting for potential confounding factors. Semi-Bayes (SB) adjustments were used to reduce potential false-positive findings. EC was associated inversely with raw garlic intake [SB-adjusted OR for more than once a week=0.68, 95% CI: 0.57–0.80], with a strong dose–response pattern in the overall analysis and in the stratified analyses by smoking and drinking. EC was associated positively with smoking and alcohol drinking, with SB-adjusted OR of 1.73 (95% CI: 1.62–1.85) and 1.37 (95% CI: 1.28–1.46) in dose–response effects of increased intensity and longer duration of smoking/drinking. Moreover, garlic intake interacts with smoking [synergy index (S)=0.83, 95% CI: 0.67–1.02; ratio of OR=0.88, 95% CI: 0.80–0.98] and alcohol drinking (S=0.73, 95% CI: 0.57–0.93; ratio of OR=0.86, 95% CI: 0.77–0.95) both multiplicatively and additively. Our findings suggested that high intake of raw garlic may reduce EC risk and may interact with tobacco smoking and alcohol consumption, which might shed a light on the development of EC as well as a potential dietary intervention among high-risk smokers and drinkers for EC prevention in the Chinese population. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.