Dietary Risk Factors for Esophageal Cancer: A Systematic Review and Meta-Analysis of Case- Control Studies

Background Esophageal cancer (EC) is a major global health challenge with high mortality and poor prognosis. Dietary habits are significant and modifiable risk factors. Despite numerous case-control studies, a comprehensive quantitative synthesis of dietary factors and EC risk has been lacking. This study aimed to systematically review and meta-analyse evidence on these associations. Methods This systematic review and meta-analysis followed PRISMA guidelines and was registered (PROSPERO ID CRD420251026379). A comprehensive search of PubMed, Embase, and Cochrane Library identified English-language case-control studies (2005–2025) on EC and dietary factors. Data from 22 eligible studies were extracted, and bias assessed using Robins − 1. Statistical analyses used R Studio (p < 0.005). Results From 588 initial articles, 22 case-control studies were included. Meta-analysis showed hot food (OR 2.45), pickled food (OR 3.28), fried food (OR 2.40), and untreated water (OR 3.76) significantly increased EC risk. Conversely, vegetable (OR 0.57), fruit (OR 0.41), and fish (OR 0.29) consumption demonstrated protective effects. Meat, egg, and tea consumption showed no significant association. Conclusion This review identifies high-temperature food/beverage consumption, pickling, and frying as carcinogenic risk factors for EC. Conversely, raw fruits, vegetables, and fish intake are protective. These findings offer actionable public health directives, emphasizing dietary modifications and healthier food preparation to mitigate the esophageal cancer burden.