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Search Result (501 REFERENCES)

2014

Dietary Protein Intake and Incidence of Type 2 Diabetes in Europe: The EPIC-InterAct Case-Cohort Study

van Nielen M., Feskens E.J., Mensink M., Sluijs I., Molina E., Amiano P., Ardanaz E., Balkau B., Beulens J.W., Boeing H., Clavel-Chapelon F., Fagherazzi G., Franks P.W., Halkjaer J., Huerta J.M., Katzke V., Key T.J., Khaw K.T., Krogh V., Kuhn T., Menendez V.V., Nilsson P., Overvad K., Palli D., Panico S., Rolandsson O., Romieu I., Sacerdote C., Sanchez M.J., Schulze M.B., Spijkerman A.M., Tjonneland A., Tumino R., van der A.DL, Wurtz A.M., Zamora-Ros R., Langenberg C., Sharp S.J., Forouhi N.G., Riboli E., Wareham N.J.

Diabetes Care; 2014; 37(7): 1854-1862

PMID:24722499

Abstract as provided by PubMed

OBJECTIVE: The long-term association between dietary protein and type 2 diabetes incidence is uncertain. We aimed to investigate the association between total, animal, and plant protein intake and the incidence of type 2 diabetes. RESEARCH DESIGN AND METHODS: The prospective European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct case-cohort study consists of 12,403 incident type 2 diabetes cases and a stratified subcohort of 16,154 individuals from eight European countries, with an average follow-up time of 12.0 years. Pooled country-specific hazard ratios (HRs) and 95% CI of prentice-weighted Cox regression analyses were used to estimate type 2 diabetes incidence according to protein intake. RESULTS: After adjustment for important diabetes risk factors and dietary factors, the incidence of type 2 diabetes was higher in those with high intake of total protein (per 10 g: HR 1.06 [95% CI 1.02-1.09], Ptrend < 0.001) and animal protein (per 10 g: 1.05 [1.02-1.08], Ptrend = 0.001). Effect modification by sex (P < 0.001) and BMI among women (P < 0.001) was observed. Compared with the overall analyses, associations were stronger in women, more specifically obese women with a BMI >30 kg/m(2) (per 10 g animal protein: 1.19 [1.09-1.32]), and nonsignificant in men. Plant protein intake was not associated with type 2 diabetes (per 10 g: 1.04 [0.93-1.16], Ptrend = 0.098). CONCLUSIONS: High total and animal protein intake was associated with a modest elevated risk of type 2 diabetes in a large cohort of European adults. In view of the rapidly increasing prevalence of type 2 diabetes, limiting iso-energetic diets high in dietary proteins, particularly from animal sources, should be considered

Flavonoid and lignan intake in relation to bladder cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study

Zamora-Ros R., Sacerdote C., Ricceri F., Weiderpass E., Roswall N., Buckland G., St-Jules D.E., Overvad K., Kyro C., Fagherazzi G., Kvaskoff M., Severi G., Chang-Claude J., Kaaks R., Nothlings U., Trichopoulou A., Naska A., Trichopoulos D., Palli D., Grioni S., Mattiello A., Tumino R., Gram I.T., Engeset D., Huerta J.M., Molina-Montes E., Arguelles M., Amiano P., Ardanaz E., Ericson U., Lindkvist B., Nilsson L.M., Kiemeney L.A., Ros M., Bueno-de-Mesquita H.B., Peeters P.H., Khaw K.T., Wareham N.J., Knaze V., Romieu I., Scalbert A., Brennan P., Wark P., Vineis P., Riboli E., Gonzalez C.A.

Br J Cancer; 2014; 111(9): 1870-1880

PMID:25121955

Abstract as provided by PubMed

BACKGROUND: There is growing evidence of the protective role of dietary intake of flavonoids and lignans on cancer, but the association with bladder cancer has not been thoroughly investigated in epidemiological studies. We evaluated the association between dietary intakes of total and subclasses of flavonoids and lignans and risk of bladder cancer and its main morphological type, urothelial cell carcinoma (UCC), within the European Prospective Investigation into Cancer and Nutrition (EPIC) study. METHODS: A cohort of 477 312 men and women mostly aged 35-70 years, were recruited in 10 European countries. At baseline, dietary flavonoid and lignan intakes were estimated using centre-specific validated questionnaires and a food composition database based on the Phenol-Explorer, the UK Food Standards Agency and the US Department of Agriculture databases. RESULTS: During an average of 11 years of follow-up, 1575 new cases of primary bladder cancer were identified, of which 1425 were UCC (classified into aggressive (n=430) and non-aggressive (n=413) UCC). No association was found between total flavonoid intake and bladder cancer risk. Among flavonoid subclasses, significant inverse associations with bladder cancer risk were found for intakes of flavonol (hazard ratio comparing fifth with first quintile (HRQ5-Q1) 0.74, 95% confidence interval (CI): 0.61-0.91; P-trend=0.009) and lignans (HRQ5-Q1 0.78, 95% CI: 0.62-0.96; P-trend=0.046). Similar results were observed for overall UCC and aggressive UCC, but not for non-aggressive UCC. CONCLUSIONS: Our study suggests an inverse association between the dietary intakes of flavonols and lignans and risk of bladder cancer, particularly aggressive UCC

Tea and coffee consumption and risk of esophageal cancer: The European prospective investigation into cancer and nutrition study

Zamora-Ros R., Lujan-Barroso L., Bueno-de-Mesquita H.B., Dik V.K., Boeing H., Steffen A., Tjonneland A., Olsen A., Bech B.H., Overvad K., Boutron-Ruault M.C., Racine A., Fagherazzi G., Kuhn T., Katzke V., Trichopoulou A., Lagiou P., Trichopoulos D., Tumino R., Panico S., Vineis P., Grioni S., Palli D., Weiderpass E., Skeie G., Huerta J.M., Sanchez M.J., Arguelles M., Amiano P., Ardanaz E., Nilsson L., Wallner B., Lindkvist B., Wallstrom P., Peeters P.H., Key T.J., Khaw K.T., Wareham N.J., Freisling H., Stepien M., Ferrari P., Gunter M.J., Murphy N., Riboli E., Gonzalez C.A.

Int J Cancer; 2014; 135(6): 1470-1479

PMID:24535727

Abstract as provided by PubMed

Epidemiological data regarding tea and coffee consumption and risk of esophageal cancer (EC) is still inconclusive. We examined the association of tea and coffee consumption with EC risk among 442,143 men and women without cancer at baseline from 9 countries of the European Prospective Investigation into Cancer and Nutrition. Tea and coffee intakes were recorded using country-specific validated dietary questionnaires. Cox regression models were used to analyze the relationships between tea and coffee intake and EC risk. During a mean follow-up of 11.1 years, 339 participants developed EC, of which 142 were esophageal adenocarcinoma (EAC) and 174 were esophageal squamous cell carcinoma (ESCC). In the multivariable models, no significant associations between tea (mostly black tea), and coffee intake and risk of EC, EAC and ESCC were observed. In stratified analyses, among men coffee consumption was inversely related to ESCC (HR for comparison of extreme tertiles 0.42, 95% CI 0.20-0.88; p-trend = 0.022), but not among women. In current smokers, a significant and inverse association was observed between ESCC risk and tea (HR 0.46, 95% CI 0.23-0.93; p-trend = 0.053) and coffee consumption (HR 0.37, 95% CI 0.19-0.73; p-trend = 0.011). However, no statistically significant findings were observed using the continuous variable (per 100 mL/d). These data did not show a significant association between tea and coffee consumption and EC, EAC and ESCC, although a decreased risk of ESCC among men and current smokers is suggested, but need to be confirmed in further prospective studies including more cases

Dietary intakes of individual flavanols and flavonols are inversely associated with incident type 2 diabetes in European populations

Zamora-Ros R., Forouhi N.G., Sharp S.J., Gonzalez C.A., Buijsse B., Guevara M., van der Schouw Y.T., Amiano P., Boeing H., Bredsdorff L., Fagherazzi G., Feskens E.J., Franks P.W., Grioni S., Katzke V., Key T.J., Khaw K.T., Kuhn T., Masala G., Mattiello A., Molina-Montes E., Nilsson P.M., Overvad K., Perquier F., Redondo M.L., Ricceri F., Rolandsson O., Romieu I., Roswall N., Scalbert A., Schulze M., Slimani N., Spijkerman A.M., Tjonneland A., Tormo M.J., Touillaud M., Tumino R., van der A.DL, van Woudenbergh G.J., Langenberg C., Riboli E., Wareham N.J.

J Nutr; 2014; 144(3): 335-343

PMID:24368432

Abstract as provided by PubMed

Dietary flavanols and flavonols, flavonoid subclasses, have been recently associated with a lower risk of type 2 diabetes (T2D) in Europe. Even within the same subclass, flavonoids may differ considerably in bioavailability and bioactivity. We aimed to examine the association between individual flavanol and flavonol intakes and risk of developing T2D across European countries. The European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct case-cohort study was conducted in 8 European countries across 26 study centers with 340,234 participants contributing 3.99 million person-years of follow-up, among whom 12,403 incident T2D cases were ascertained and a center-stratified subcohort of 16,154 individuals was defined. We estimated flavonoid intake at baseline from validated dietary questionnaires using a database developed from Phenol-Explorer and USDA databases. We used country-specific Prentice-weighted Cox regression models and random-effects meta-analysis methods to estimate HRs. Among the flavanol subclass, we observed significant inverse trends between intakes of all individual flavan-3-ol monomers and risk of T2D in multivariable models (all P-trend < 0.05). We also observed significant trends for the intakes of proanthocyanidin dimers (HR for the highest vs. the lowest quintile: 0.81; 95% CI: 0.71, 0.92; P-trend = 0.003) and trimers (HR: 0.91; 95% CI: 0.80, 1.04; P-trend = 0.07) but not for proanthocyanidins with a greater polymerization degree. Among the flavonol subclass, myricetin (HR: 0.77; 95% CI: 0.64, 0.93; P-trend = 0.001) was associated with a lower incidence of T2D. This large and heterogeneous European study showed inverse associations between all individual flavan-3-ol monomers, proanthocyanidins with a low polymerization degree, and the flavonol myricetin and incident T2D. These results suggest that individual flavonoids have different roles in the etiology of T2D

2013

Dietary intake of vitamin D and calcium and breast cancer risk in the European Prospective Investigation into Cancer and Nutrition

Abbas S., Linseisen J., Rohrmann S., Chang-Claude J., Peeters P.H., Engel P., Brustad M., Lund E., Skeie G., Olsen A., Tjonneland A., Overvad K., Boutron-Ruault M.C., Clavel-Chapelon F., Fagherazzi G., Kaaks R., Boeing H., Buijsse B., Adarakis G., Ouranos V., Trichopoulou A., Masala G., Krogh V., Mattiello A., Tumino R., Sacerdote C., Buckland G., Suarez M.V., Sanchez M.J., Chirlaque M.D., Barricarte A., Amiano P., Manjer J., Wirfalt E., Lenner P., Sund M., Bueno-de-Mesquita H.B., van Duijnhoven F.J., Khaw K.T., Wareham N., Key T.J., Fedirko V., Romieu I., Gallo V., Norat T., Wark P.A., Riboli E.

Nutr. Cancer; 2013; 65(2): 178-187

PMID:23441605

Abstract as provided by PubMed

Studies assessing the effects of vitamin D or calcium intake on breast cancer risk have been inconclusive. Furthermore, few studies have evaluated them jointly. This study is the largest so far examining the association of dietary vitamin D and calcium intake with breast cancer risk in the European Prospective Investigation into Cancer and Nutrition. During a mean follow-up of 8.8 yr, 7760 incident invasive breast cancer cases were identified among 319,985 women. Multivariable Cox proportional hazards regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for pre- and postmenopausal breast cancer risk. Comparing the highest with the lowest quintile of vitamin D intake, HR and 95% CI were 1.07 (0.87-1.32) and 1.02 (0.90-1.16) for pre- and postmenopausal women, respectively. The corresponding HR and 95% CIs for calcium intake were 0.98 (0.80-1.19) and 0.90 (0.79-1.02), respectively. For calcium intake in postmenopausal women, the test for trend was borderline statistically significant (P(trend) = 0.05). There was no significant interaction between vitamin D and calcium intake and cancer risk (P(interaction) = 0.57 and 0.22 in pre- and postmenopausal women, respectively). In this large prospective cohort, we found no evidence for an association between dietary vitamin D or calcium intake and breast cancer risk

Hemochromatosis (HFE) gene mutations and risk of gastric cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) study

Agudo A., Bonet C., Sala N., Munoz X., Aranda N., Fonseca-Nunes A., Clavel-Chapelon F., Boutron-Ruault M.C., Vineis P., Panico S., Palli D., Tumino R., Grioni S., Quiros J.R., Molina E., Navarro C., Barricarte A., Chamosa S., Allen N.E., Khaw K.T., Bueno-de-Mesquita H.B., Siersema P.D., Numans M.E., Trichopoulou A., Lagiou P., Trichopoulos D., Kaaks R., Canzian F., Boeing H., Meidtner K., Johansson M., Sund M., Manjer J., Overvad K., Tjonneland A., Lund E., Weiderpass E., Jenab M., Fedirko V., Offerhaus G.J., Riboli E., Gonzalez C.A., Jakszyn P.

Carcinogenesis; 2013; 34(6): 1244-1250

PMID:23389292

Abstract as provided by PubMed

Hereditary hemochromatosis (HH) is a strong risk factor for hepatocellular cancer, and mutations in the HFE gene associated with HH and iron overload may be related to other tumors, but no studies have been reported for gastric cancer (GC). A nested case-control study was conducted within the European Prospective Investigation into Cancer and Nutrition (EPIC), including 365 incident gastric adenocarcinoma and 1284 controls matched by center, sex, age and date of blood collection. Genotype analysis was performed for two functional polymorphisms (C282Y/rs1800562 and H63D/rs1799945) and seven tagSNPs of the HFE genomic region. Association with all gastric adenocarcinoma, and according to anatomical localization and histological subtype, was assessed by means of the odds ratio (OR) and 95% confidence interval (CI) estimated by unconditional logistic regression adjusted for the matching variables. We observed a significant association for H63D with OR (per rare allele) of 1.32 (CI = 1.03-1.69). In subgroup analyses, the association was stronger for non-cardia anatomical subsite (OR = 1.60, CI = 1.16-2.21) and intestinal histological subtype (OR = 1.82, CI = 1.27-2.62). Among intestinal cases, two tagSNPs (rs1572982 and rs6918586) also showed a significant association that disappeared after adjustment for H63D. No association with tumors located in the cardia or with diffuse subtype was found for any of the nine SNPs analyzed. Our results suggest that H63D variant in HFE gene seems to be associated with GC risk of the non-cardia region and intestinal type, possibly due to its association with iron overload although a role for other mechanisms cannot be entirely ruled out

Adult weight change and risk of colorectal cancer in the European Prospective Investigation into Cancer and Nutrition

Aleksandrova K., Pischon T., Buijsse B., May A.M., Peeters P.H., Bueno-de-Mesquita H.B., Jenab M., Fedirko V., Dahm C.C., Siersema P.D., Freisling H., Ferrari P., Overvad K., Tjonneland A., Trichopoulou A., Lagiou P., Naska A., Pala V., Mattiello A., Ohlsson B., Jirstrom K., Key T.J., Khaw K.T., Riboli E., Boeing H.

Eur. J Cancer; 2013; 49(16): 3526-3536

PMID:23867126

Abstract as provided by PubMed

AIM: Weight change during adult life may reflect metabolic changes and influence colorectal cancer (CRC) development, but such role is not well established. We aimed to explore the association between adult weight change (from age 20 to 50) and CRC risk. In particular, we investigated differences according to colon and rectal cancer, sex and measures of attained adiposity. METHODS: We included 201,696 participants from six participating countries in the European Prospective Investigation into Cancer and Nutrition (1992-2010). During a mean follow-up of 11.2 years 2384 (1194 in men and 1190 in women) incident CRC cases occurred. Cox proportional hazard models adjusted for body mass index at age 20 and lifestyle factors at study recruitment were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: After multivariable adjustment, each kg of weight gained annually from age 20 to 50 was associated with a 60% higher risk of colon cancer (95% CI 1.20-2.09), but not rectal cancer (HR 1.13, 95% CI 0.79-1.62, P(interaction)=0.04). The higher risk of colon cancer was restricted to people with high attained waist circumference at age 50 (HR 1.82, 95%CI 1.14-2.91, P(interaction)=0.02). Results were not different in men and women (P(interaction)=0.81). CONCLUSION(S): Adult weight gain, as reflected by attained abdominal obesity at age 50, increases colon cancer risk in both men and women. These data underline the importance of weight management and metabolic health maintenance in early adult life years for colon cancer prevention

Macronutrient intake and risk of urothelial cell carcinoma in the European prospective investigation into cancer and nutrition

Allen N.E., Appleby P.N., Key T.J., Bueno-de-Mesquita H.B., Ros M.M., Kiemeney L.A., Tjonneland A., Roswall N., Overvad K., Weikert S., Boeing H., Chang-Claude J., Teucher B., Panico S., Sacerdote C., Tumino R., Palli D., Sieri S., Peeters P., Quiros J.R., Jakszyn P., Molina-Montes E., Chirlaque M.D., Ardanaz E., Dorronsoro M., Khaw K.T., Wareham N., Ljungberg B., Hallmans G., Ehrnstrom R., Ericson U., Gram I.T., Parr C.L., Trichopoulou A., Karapetyan T., Dilis V., Clavel-Chapelon F., Boutron-Ruault M.C., Fagherrazzi G., Romieu I., Gunter M.J., Riboli E.

Int J Cancer; 2013; 132(3): 635-644

PMID:22618737

Abstract as provided by PubMed

Previous studies have suggested that dietary factors may be important in the development of bladder cancer. We examined macronutrient intake in relation to risk of urothelial cell carcinoma among 469,339 men and women in the European Prospective Investigation into Cancer and Nutrition. Associations were examined using Cox regression, stratified by sex, age at recruitment and centre and further adjusted for smoking status and duration, body mass index and total energy intake. After an average of 11.3 years of follow-up, 1,416 new cases of urothelial cell carcinoma were identified. After allowing for measurement error, a 3% increase in the consumption of energy intake from animal protein was associated with a 15% higher risk (95% confidence interval [CI]: 3-30%; p(trend) = 0.01) and a 2% increase in energy from plant protein intake was associated with a 23% lower risk (95% CI: 36-7%, p(trend) = 0.006). Dietary intake of fat, carbohydrate, fibre or calcium was not associated with risk. These findings suggest that animal and/or plant protein may affect the risk of urothelial cell carcinoma, and examination of these associations in other studies is needed

A structural equation modelling approach to explore the role of B vitamins and immune markers in lung cancer risk

Baltar V.T., Xun W.W., Johansson M., Ferrari P., Chuang S.C., Relton C., Ueland P.M., Midttun O., Slimani N., Jenab M., Clavel-Chapelon F., Boutron-Ruault M.C., Fagherazzi G., Kaaks R., Rohrmann S., Boeing H., Weikert C., Bueno-de-Mesquita B., Boshuizen H., Van Gils C.H., Onland-Moret N.C., Agudo A., Barricarte A., Navarro C., Rodriguez L., Castano J.M., Larranaga N., Khaw K.T., Wareham N., Allen N.E., Crowe F., Gallo V., Norat T., Krogh V., Masala G., Panico S., Sacerdote C., Tumino R., Trichopoulou A., Lagiou P., Trichopoulos D., Rasmuson T., Hallmans G., Roswall N., Tjonneland A., Riboli E., Brennan P., Vineis P.

Eur. J Epidemiol; 2013; 28(8): 677-688

PMID:23532743

Abstract as provided by PubMed

The one-carbon metabolism (OCM) is considered key in maintaining DNA integrity and regulating gene expression, and may be involved in the process of carcinogenesis. Several B-vitamins and amino acids have been implicated in lung cancer risk, via the OCM directly as well as immune system activation. However it is unclear whether these factors act independently or through complex mechanisms. The current study applies structural equations modelling (SEM) to further disentangle the mechanisms involved in lung carcinogenesis. SEM allows simultaneous estimation of linear relations where a variable can be the outcome in one equation and the predictor in another, as well as allowing estimation using latent variables (factors estimated by correlation matrix). A large number of biomarkers have been analysed from 891 lung cancer cases and 1,747 controls nested within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Four putative mechanisms in the OCM and immunity were investigated in relation to lung cancer risk: methionine-homocysteine metabolism, folate cycle, transsulfuration, and mechanisms involved in inflammation and immune activation, all adjusted for tobacco exposure. The hypothesized SEM model confirmed a direct and protective effect for factors representing methionine-homocysteine metabolism (p = 0.020) and immune activation (p = 0.021), and an indirect protective effect of folate cycle (p = 0.019), after adjustment for tobacco smoking. In conclusion, our results show that in the investigation of the involvement of the OCM, the folate cycle and immune system in lung carcinogenesis, it is important to consider complex pathways (by applying SEM) rather than the effects of single vitamins or nutrients (e.g. using traditional multiple regression). In our study SEM were able to suggest a greater role of the methionine-homocysteine metabolism and immune activation over other potential mechanisms

Mediterranean diet and colorectal cancer risk: results from a European cohort

Bamia C., Lagiou P., Buckland G., Grioni S., Agnoli C., Taylor A.J., Dahm C.C., Overvad K., Olsen A., Tjonneland A., Cottet V., Boutron-Ruault M.C., Morois S., Grote V., Teucher B., Boeing H., Buijsse B., Trichopoulos D., Adarakis G., Tumino R., Naccarati A., Panico S., Palli D., Bueno-de-Mesquita H.B., van Duijnhoven F.J., Peeters P.H., Engeset D., Skeie G., Lund E., Sanchez M.J., Barricarte A., Huerta J.M., Quiros J.R., Dorronsoro M., Ljuslinder I., Palmqvist R., Drake I., Key T.J., Khaw K.T., Wareham N., Romieu I., Fedirko V., Jenab M., Romaguera D., Norat T., Trichopoulou A.

Eur. J Epidemiol; 2013; 28(4): 317-328

PMID:23579425

Abstract as provided by PubMed

The authors investigated the association of adherence to Mediterranean diet with colorectal cancer (CRC) risk in the European Prospective Investigation into Cancer and nutrition study. Adherence to Mediterranean diet was expressed through two 10-unit scales, the Modified Mediterranean diet score (MMDS) and the Centre-Specific MMDS (CSMMDS). Both scales share the same dietary components but differ in the cut-off values that were used for these components in the construction of the scales. Adjusted hazard ratios (HR) for the associations of these scales with CRC incidence were estimated. After 5,296,617 person-years of follow-up, 4,355 incident CRC cases were identified. A decreased risk of CRC, of 8 and 11 % was estimated when comparing the highest (scores 6-9) with the lowest (scores 0-3) adherence to CSMMDS and MMDS respectively. For MMDS the HR was 0.89 (95 % confidence interval (CI): 0.80, 0.99). A 2-unit increment in either Mediterranean scale was associated with a borderline statistically significant 3 to 4 % reduction in CRC risk (HR for MMDS: 0.96; 95 % CI: 0.92, 1.00). These associations were somewhat more evident, among women, were mainly manifested for colon cancer risk and their magnitude was not altered when alcohol was excluded from MMDS. These findings suggest that following a Mediterranean diet may have a modest beneficial effect on CRC risk

The association of pattern of lifetime alcohol use and cause of death in the European Prospective Investigation into Cancer and Nutrition (EPIC) study

Bergmann M.M., Rehm J., Klipstein-Grobusch K., Boeing H., Schutze M., Drogan D., Overvad K., Tjonneland A., Halkjaer J., Fagherazzi G., Boutron-Ruault M.C., Clavel-Chapelon F., Teucher B., Kaaks R., Trichopoulou A., Benetou V., Trichopoulos D., Palli D., Pala V., Tumino R., Vineis P., Beulens J.W., Redondo M.L., Duell E.J., Molina-Montes E., Navarro C., Barricarte A., Arriola L., Allen N.E., Crowe F.L., Khaw K.T., Wareham N., Romaguera D., Wark P.A., Romieu I., Nunes L., Riboli E., Ferrari P.

Int. J Epidemiol; 2013; 42(6): 1772-1790

PMID:24415611

Abstract as provided by PubMed

BACKGROUND: There is limited evidence for an association between the pattern of lifetime alcohol use and cause-specific risk of death. METHODS: Multivariable hazard ratios were estimated for different causes of death according to patterns of lifetime alcohol consumption using a competing risks approach: 111 953 men and 268 442 women from eight countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study were included. Self-reported alcohol consumption at ages 20, 30, 40 or 50 years and at enrolment were used for the analysis; 26 411 deaths were observed during an average of 12.6 years of follow-up. RESULTS: The association between lifetime alcohol use and death from cardiovascular diseases was different from the association seen for alcohol-related cancers, digestive, respiratory, external and other causes. Heavy users (>5 drinks/day for men and >2.5 drinks/day for women), regardless of time of cessation, had a 2- to 5-times higher risk of dying due to alcohol-related cancers, compared with subjects with lifetime light use (</=1 and </=0.5 drink/week for men and women, respectively). Compared with lifetime light users, men who used <5 drinks/day throughout their lifetime had a 24% lower cardiovascular disease mortality (95% confidence interval 2-41). The risk of death from coronary heart disease was also found to be 34-46% lower among women who were moderate to occasionally heavy alcohol users compared with light users. However, this relationship was only evident among men and women who had no chronic disease at enrolment. CONCLUSIONS: Limiting alcohol use throughout life is associated with a lower risk of death, largely due to cardiovascular disease but also other causes. However, the potential health benefits of alcohol use are difficult to establish due to the possibility of selection bias and competing risks related to diseases occurring later in life

Age at menopause, reproductive life span, and type 2 diabetes risk: results from the EPIC-InterAct study

Brand J.S., van der Schouw Y.T., Onland-Moret N.C., Sharp S.J., Ong K.K., Khaw K.T., Ardanaz E., Amiano P., Boeing H., Chirlaque M.D., Clavel-Chapelon F., Crowe F.L., de Lauzon-Guillain B., Duell E.J., Fagherazzi G., Franks P.W., Grioni S., Groop L.C., Kaaks R., Key T.J., Nilsson P.M., Overvad K., Palli D., Panico S., Quiros J.R., Rolandsson O., Sacerdote C., Sanchez M.J., Slimani N., Teucher B., Tjonneland A., Tumino R., van der A.DL, Feskens E.J., Langenberg C., Forouhi N.G., Riboli E., Wareham N.J.

Diabetes Care; 2013; 36(4): 1012-1019

PMID:23230098

Abstract as provided by PubMed

OBJECTIVE: Age at menopause is an important determinant of future health outcomes, but little is known about its relationship with type 2 diabetes. We examined the associations of menopausal age and reproductive life span (menopausal age minus menarcheal age) with diabetes risk. RESEARCH DESIGN AND METHODS: Data were obtained from the InterAct study, a prospective case-cohort study nested within the European Prospective Investigation into Cancer and Nutrition. A total of 3,691 postmenopausal type 2 diabetic case subjects and 4,408 subcohort members were included in the analysis, with a median follow-up of 11 years. Prentice weighted Cox proportional hazards models were adjusted for age, known risk factors for diabetes, and reproductive factors, and effect modification by BMI, waist circumference, and smoking was studied. RESULTS: Mean (SD) age of the subcohort was 59.2 (5.8) years. After multivariable adjustment, hazard ratios (HRs) of type 2 diabetes were 1.32 (95% CI 1.04-1.69), 1.09 (0.90-1.31), 0.97 (0.86-1.10), and 0.85 (0.70-1.03) for women with menopause at ages <40, 40-44, 45-49, and >/=55 years, respectively, relative to those with menopause at age 50-54 years. The HR per SD younger age at menopause was 1.08 (1.02-1.14). Similarly, a shorter reproductive life span was associated with a higher diabetes risk (HR per SD lower reproductive life span 1.06 [1.01-1.12]). No effect modification by BMI, waist circumference, or smoking was observed (P interaction all > 0.05). CONCLUSIONS: Early menopause is associated with a greater risk of type 2 diabetes

Adherence to the mediterranean diet and risk of breast cancer in the European prospective investigation into cancer and nutrition cohort study

Buckland G., Travier N., Cottet V., Gonzalez C.A., Lujan-Barroso L., Agudo A., Trichopoulou A., Lagiou P., Trichopoulos D., Peeters P.H., May A., Bueno-de-Mesquita H.B., Bvan Duijnhoven F.J., Key T.J., Allen N., Khaw K.T., Wareham N., Romieu I., McCormack V., Boutron-Ruault M., Clavel-Chapelon F., Panico S., Agnoli C., Palli D., Tumino R., Vineis P., Amiano P., Barricarte A., Rodriguez L., Sanchez M.J., Chirlaque M.D., Kaaks R., Teucher B., Boeing H., Bergmann M.M., Overvad K., Dahm C.C., Tjonneland A., Olsen A., Manjer J., Wirfalt E., Hallmans G., Johansson I., Lund E., Hjartaker A., Skeie G., Vergnaud A.C., Norat T., Romaguera D., Riboli E.

Int J Cancer; 2013; 132(12): 2918-2927

PMID:23180513

Abstract as provided by PubMed

Epidemiological evidence suggests that the Mediterranean diet (MD) could reduce the risk of breast cancer (BC). As evidence from the prospective studies remains scarce and conflicting, we investigated the association between adherence to the MD and risk of BC among 335,062 women recruited from 1992 to 2000, in ten European countries, and followed for 11 years on average. Adherence to the MD was estimated through an adapted relative Mediterranean diet (arMED) score excluding alcohol. Cox proportional hazards regression models were used while adjusting for BC risk factors. A total of 9,009 postmenopausal and 1,216 premenopausal first primary incident invasive BC were identified (5,862 estrogen or progesterone receptor positive [ER+/PR+] and 1,018 estrogen and progesterone receptor negative [ER-/PR-]). The arMED was inversely associated with the risk of BC overall and in postmenopausal women (high vs. low arMED score; hazard ratio [HR] = 0.94 [95% confidence interval [CI]: 0.88, 1.00] ptrend = 0.048, and HR = 0.93 [95% CI: 0.87, 0.99] ptrend = 0.037, respectively). The association was more pronounced in ER-/PR- tumors (HR = 0.80 [95% CI: 0.65, 0.99] ptrend = 0.043). The arMED score was not associated with BC in premenopausal women. Our findings show that adherence to a MD excluding alcohol was related to a modest reduced risk of BC in postmenopausal women, and this association was stronger in receptor-negative tumors. The results support the potential scope for BC prevention through dietary modification

Hormonal, metabolic, and inflammatory profiles and endometrial cancer risk within the EPIC cohort--a factor analysis

Dossus L., Lukanova A., Rinaldi S., Allen N., Cust A.E., Becker S., Tjonneland A., Hansen L., Overvad K., Chabbert-Buffet N., Mesrine S., Clavel-Chapelon F., Teucher B., Chang-Claude J., Boeing H., Drogan D., Trichopoulou A., Benetou V., Bamia C., Palli D., Agnoli C., Galasso R., Tumino R., Sacerdote C., Bueno-de-Mesquita H.B., van Duijnhoven F.J., Peeters P.H., Onland-Moret N.C., Redondo M.L., Travier N., Sanchez M.J., Altzibar J.M., Chirlaque M.D., Barricarte A., Lundin E., Khaw K.T., Wareham N., Fedirko V., Romieu I., Romaguera D., Norat T., Riboli E., Kaaks R.

Am J Epidemiol; 2013; 177(8): 787-799

PMID:23492765

Abstract as provided by PubMed

A "Western" lifestyle characterized by physical inactivity and excess weight is associated with a number of metabolic and hormonal dysregulations, including increased circulating estrogen levels, hyperinsulinemia, hyperglycemia, and chronic inflammation. The same hormonal and metabolic axes might mediate the association between this lifestyle and the development of endometrial cancer. Using data collected within the European Prospective Investigation into Cancer and Nutrition (EPIC), a prospective cohort study carried out in 10 European countries during 1992-2000, we conducted a factor analysis to delineate important components that summarize the variation explained by a set of biomarkers and to examine their association with endometrial cancer risk. Prediagnostic levels of testosterone, androstenedione, dehydroepiandrosterone sulfate, sex hormone-binding globulin, estrone, estradiol, C-peptide, insulin-like growth factor-binding proteins 1 and 2, adiponectin, high- and low-density lipoprotein cholesterol, glucose, triglycerides, tumor necrosis factor (TNF) alpha, soluble TNF receptors 1 and 2, C-reactive protein, interleukin-6, and interleukin-1 receptor antagonist were measured in 233 incident endometrial cancer cases and 446 matched controls. Factor analysis identified 3 components associated with postmenopausal endometrial cancer risk that could be labeled "insulin resistance/metabolic syndrome,""steroids," and "inflammation" factors. A fourth component, "lipids," was not significantly associated with endometrial cancer. In conclusion, besides the well-known associations of risk with sex hormones and insulin-regulated physiological axes, our data further support the hypothesis that inflammation factors play a role in endometrial carcinogenesis

Menstrual and reproductive factors in women, genetic variation in CYP17A1, and pancreatic cancer risk in the European prospective investigation into cancer and nutrition (EPIC) cohort

Duell E.J., Travier N., Lujan-Barroso L., Dossus L., Boutron-Ruault M.C., Clavel-Chapelon F., Tumino R., Masala G., Krogh V., Panico S., Ricceri F., Redondo M.L., Dorronsoro M., Molina-Montes E., Huerta J.M., Barricarte A., Khaw K.T., Wareham N.J., Allen N.E., Travis R., Siersema P.D., Peeters P.H., Trichopoulou A., Fragogeorgi E., Oikonomou E., Boeing H., Schuetze M., Canzian F., Lukanova A., Tjonneland A., Roswall N., Overvad K., Weiderpass E., Gram I.T., Lund E., Lindkvist B., Johansen D., Ye W., Sund M., Fedirko V., Jenab M., Michaud D.S., Riboli E., Bueno-de-Mesquita H.B.

Int J Cancer; 2013; 132(9): 2164-2175

PMID:23015357

Abstract as provided by PubMed

Menstrual and reproductive factors and exogenous hormone use have been investigated as pancreatic cancer risk factors in case-control and cohort studies, but results have been inconsistent. We conducted a prospective examination of menstrual and reproductive factors, exogenous hormone use and pancreatic cancer risk (based on 304 cases) in 328,610 women from the EPIC cohort. Then, in a case-control study nested within the EPIC cohort, we examined 12 single nucleotide polymorphisms (SNPs) in CYP17A1 (an essential gene in sex steroid metabolism) for association with pancreatic cancer in women and men (324 cases and 353 controls). Of all factors analyzed, only younger age at menarche (<12 vs. 13 years) was moderately associated with an increased risk of pancreatic cancer in the full cohort; however, this result was marginally significant (HR = 1.44; 95% CI = 0.99-2.10). CYP17A1 rs619824 was associated with HRT use (p value = 0.037) in control women; however, none of the SNPs alone, in combination, or as haplotypes were associated with pancreatic cancer risk. In conclusion, with the possible exception of an early age of menarche, none of the menstrual and reproductive factors, and none of the 12 common genetic variants we evaluated at the CYP17A1 locus makes a substantial contribution to pancreatic cancer susceptibility in the EPIC cohort

Vitamin C transporter gene (SLC23A1 and SLC23A2) polymorphisms, plasma vitamin C levels, and gastric cancer risk in the EPIC cohort

Duell E.J., Lujan-Barroso L., Llivina C., Munoz X., Jenab M., Boutron-Ruault M.C., Clavel-Chapelon F., Racine A., Boeing H., Buijsse B., Canzian F., Johnson T., Dalgard C., Overvad K., Tjonneland A., Olsen A., Sanchez S.C., Sanchez-Cantalejo E., Huerta J.M., Ardanaz E., Dorronsoro M., Khaw K.T., Travis R.C., Trichopoulou A., Trichopoulos D., Rafnsson S., Palli D., Sacerdote C., Tumino R., Panico S., Grioni S., Bueno-de-Mesquita H.B., Ros M.M., Numans M.E., Peeters P.H., Johansen D., Lindkvist B., Johansson M., Johansson I., Skeie G., Weiderpass E., Duarte-Salles T., Stenling R., Riboli E., Sala N., Gonzalez C.A.

Genes Nutr; 2013; 8(6): 549-560

PMID:23737080

Abstract as provided by PubMed

Vitamin C is known to protect mucosal tissues from oxidative stress and inhibit nitrosamine formation in the stomach. High consumption of fruits, particularly citrus, and higher circulating vitamin C concentrations may be inversely associated with gastric cancer (GC) risk. We investigated 20 polymorphisms in vitamin C transporter genes SCL23A1 and SCL23A2 and GC risk in 365 cases and 1,284 controls nested within the European Prospective Investigation into Cancer and Nutrition cohort. We also evaluated the association between these polymorphisms and baseline plasma vitamin C levels in a subset of participants. Four SNPs were predictors of plasma vitamin C levels (SLC23A1 rs11950646 and rs33972313; SLC23A2 rs6053005 and rs6133175) in multivariable linear regression models. One SNP (SLC23A2 rs6116569) was associated with GC risk, in particular non-cardia GC (OR = 1.63, 95 % CI = 1.11-2.39, based on 178 non-cardia cases), but this association was attenuated when plasma vitamin C was included in the logistic regression model. Haplotype analysis of SLC23A1 yielded no associations with GC. In SLC23A2, one haplotype was associated with both overall and non-cardia GC, another haplotype was associated with GC overall, and a third was associated with intestinal-type GC. Common variants in SLC23A1 and SLC23A2 may influence plasma vitamin C concentration independent of dietary intake, and variation in SLC23A2 may influence GC risk. Additional prospective studies in large populations and consortia are recommended. Investigation of variation in vitamin C transporter genes may shed light on the preventative properties of vitamin C in gastric carcinogenesis

Age at Menarche and Type 2 Diabetes Risk: The EPIC-InterAct study

Elks C.E., Ong K.K., Scott R.A., van der Schouw Y.T., Brand J.S., Wark P.A., Amiano P., Balkau B., Barricarte A., Boeing H., Fonseca-Nunes A., Franks P.W., Grioni S., Halkjaer J., Kaaks R., Key T.J., Khaw K.T., Mattiello A., Nilsson P.M., Overvad K., Palli D., Quiros J.R., Rinaldi S., Rolandsson O., Romieu I., Sacerdote C., Sanchez M.J., Spijkerman A.M., Tjonneland A., Tormo M.J., Tumino R., van der A.DL, Forouhi N.G., Sharp S.J., Langenberg C., Riboli E., Wareham N.J.

Diabetes Care; 2013; 36(11): 3526-3534

PMID:24159179

Abstract as provided by PubMed

OBJECTIVE Younger age at menarche, a marker of pubertal timing in girls, is associated with higher risk of later type 2 diabetes. We aimed to confirm this association and to examine whether it is explained by adiposity. RESEARCH DESIGN AND METHODS The prospective European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct case-cohort study consists of 12,403 incident type 2 diabetes cases and a stratified subcohort of 16,154 individuals from 26 research centers across eight European countries. We tested the association between age at menarche and incident type 2 diabetes using Prentice-weighted Cox regression in 15,168 women (n = 5,995 cases). Models were adjusted in a sequential manner for potential confounding and mediating factors, including adult BMI. RESULTS Mean menarcheal age ranged from 12.6 to 13.6 years across InterAct countries. Each year later menarche was associated with 0.32 kg/m(2) lower adult BMI. Women in the earliest menarche quintile (8-11 years, n = 2,418) had 70% higher incidence of type 2 diabetes compared with those in the middle quintile (13 years, n = 3,634), adjusting for age at recruitment, research center, and a range of lifestyle and reproductive factors (hazard ratio [HR], 1.70; 95% CI, 1.49-1.94; P < 0.001). Adjustment for BMI partially attenuated this association (HR, 1.42; 95% CI, 1.18-1.71; P < 0.001). Later menarche beyond the median age was not protective against type 2 diabetes. CONCLUSIONS Women with history of early menarche have higher risk of type 2 diabetes in adulthood. Less than half of this association appears to be mediated by higher adult BMI, suggesting that early pubertal development also may directly increase type 2 diabetes risk

North-south gradients in plasma concentrations of B-vitamins and other components of one-carbon metabolism in Western Europe: results from the European Prospective Investigation into Cancer and Nutrition (EPIC) Study

Eussen S.J., Nilsen R.M., Midttun O., Hustad S., IJssennagger N., Meyer K., Fredriksen A., Ulvik A., Ueland P.M., Brennan P., Johansson M., Bueno-de-Mesquita B., Vineis P., Chuang S.C., Boutron-Ruault M.C., Dossus L., Perquier F., Overvad K., Teucher B., Grote V.A., Trichopoulou A., Adarakis G., Plada M., Sieri S., Tumino R., de Magistris M.S., Ros M.M., Peeters P.H., Redondo M.L., Zamora-Ros R., Chirlaque M.D., Ardanaz E., Sonestedt E., Ericson U., Schneede J., Van Guelpen B., Wark P.A., Gallo V., Norat T., Riboli E., Vollset S.E.

Br. J Nutr; 2013; 110(2): 363-374

PMID:23228223

Abstract as provided by PubMed

Different lifestyle patterns across Europe may influence plasma concentrations of B-vitamins and one-carbon metabolites and their relation to chronic disease. Comparison of published data on one-carbon metabolites in Western European regions is difficult due to differences in sampling procedures and analytical methods between studies. The present study aimed, to compare plasma concentrations of one-carbon metabolites in Western European regions with one laboratory performing all biochemical analyses. We performed the present study in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort among 5446 presumptively healthy individuals. Quantile regression was used to compare sex-specific median concentrations between Northern (Denmark and Sweden), Central (France, Germany, The Netherlands and United Kingdom) and Southern (Greece, Spain and Italy) European regions. The lowest folate concentrations were observed in Northern Europe (men, 10.4 nmol/l; women, 10.7 nmol/l) and highest concentrations in Central Europe. Cobalamin concentrations were slightly higher in Northern Europe (men, 330 pmol/l; women, 352 pmol/l) compared with Central and Southern Europe, but did not show a clear north-south gradient. Vitamin B(2) concentrations were highest in Northern Europe (men, 22.2 nmol/l; women, 26.0 nmol/l) and decreased towards Southern Europe (P trend< 0.001). Vitamin B(6) concentrations were highest in Central Europe in men (77.3 nmol/l) and highest in the North among women (70.4 nmol/l), with decreasing concentrations towards Southern Europe in women (P trend< 0.001). In men, concentrations of serine, glycine and sarcosine increased from the north to south. In women, sarcosine increased from Northern to Southern Europe. These findings may provide relevant information for the study of regional differences of chronic disease incidence in association with lifestyle

Consumption of fish and meats and risk of hepatocellular carcinoma: the European Prospective Investigation into Cancer and Nutrition (EPIC)

Fedirko V., Trichopolou A., Bamia C., Duarte-Salles T., Trepo E., Aleksandrova K., Nothlings U., Lukanova A., Lagiou P., Boffetta P., Trichopoulos D., Katzke V.A., Overvad K., Tjonneland A., Hansen L., Boutron-Ruault M.C., Fagherazzi G., Bastide N., Panico S., Grioni S., Vineis P., Palli D., Tumino R., Bueno-de-Mesquita H.B., Peeters P.H., Skeie G., Engeset D., Parr C.L., Jakszyn P., Sanchez M.J., Barricarte A., Amiano P., Chirlaque M., Quiros J.R., Sund M., Werner M., Sonestedt E., Ericson U., Key T.J., Khaw K.T., Ferrari P., Romieu I., Riboli E., Jenab M.

Ann. Oncol; 2013; 24(8): 2166-2173

PMID:23670094

Abstract as provided by PubMed

BACKGROUND: While higher intake of fish and lower consumption of red/processed meats have been suggested to play a protective role in the etiology of several cancers, prospective evidence for hepatocellular carcinoma (HCC) is limited, particularly in Western European populations. METHODS: The associations of fish and meats with HCC risk were analyzed in the EPIC cohort. Between 1992 and 2010, 191 incident HCC were identified among 477 206 participants. Baseline diet was assessed using validated dietary questionnaires. A single 24-h diet recall from a cohort subsample was used for calibration. Multivariable proportional hazard regression was utilized to estimate hazard ratios (HR) and 95% confidence intervals (CI). In a nested case-control subset (HCC = 122), HBV/HCV status and liver function biomarkers were measured. RESULTS: HCC risk was inversely associated with intake of total fish (per 20 g/day increase, HR = 0.83, 95% CI 0.74-0.95 and HR = 0.80, 95% CI 0.69-0.97 before and after calibration, respectively). This inverse association was also suggested after adjusting for HBV/HCV status and liver function score (per 20-g/day increase, RR = 0.86, 95% CI 0.66-1.11 and RR = 0.74, 95% CI 0.50-1.09, respectively) in a nested case-control subset. Intakes of total meats or subgroups of red/processed meats, and poultry were not associated with HCC risk. CONCLUSIONS: In this large European cohort, total fish intake is associated with lower HCC risk

Glycemic index, glycemic load, dietary carbohydrate, and dietary fiber intake and risk of liver and biliary tract cancers in Western Europeans

Fedirko V., Lukanova A., Bamia C., Trichopolou A., Trepo E., Nothlings U., Schlesinger S., Aleksandrova K., Boffetta P., Tjonneland A., Johnsen N.F., Overvad K., Fagherazzi G., Racine A., Boutron-Ruault M.C., Grote V., Kaaks R., Boeing H., Naska A., Adarakis G., Valanou E., Palli D., Sieri S., Tumino R., Vineis P., Panico S., Bueno-de-Mesquita H.B., Siersema P.D., Peeters P.H., Weiderpass E., Skeie G., Engeset D., Quiros J.R., Zamora-Ros R., Sanchez M.J., Amiano P., Huerta J.M., Barricarte A., Johansen D., Lindkvist B., Sund M., Werner M., Crowe F., Khaw K.T., Ferrari P., Romieu I., Chuang S.C., Riboli E., Jenab M.

Ann. Oncol; 2013; 24(2): 543-553

PMID:23123507

Abstract as provided by PubMed

BACKGROUND: The type and quantity of dietary carbohydrate as quantified by glycemic index (GI) and glycemic load (GL), and dietary fiber may influence the risk of liver and biliary tract cancers, but convincing evidence is lacking. PATIENTS AND METHODS: The association between dietary GI/GL and carbohydrate intake with hepatocellular carcinoma (HCC; N = 191), intrahepatic bile duct (IBD; N = 66), and biliary tract (N = 236) cancer risk was investigated in 477 206 participants of the European Prospective Investigation into Cancer and Nutrition cohort. Dietary intake was assessed by country-specific, validated dietary questionnaires. Hazard ratios and 95% confidence intervals were estimated from proportional hazard models. HBV/HCV status was measured in a nested case-control subset. RESULTS: Higher dietary GI, GL, or increased intake of total carbohydrate was not associated with liver or biliary tract cancer risk. For HCC, divergent risk estimates were observed for total sugar = 1.43 (1.17-1.74) per 50 g/day, total starch = 0.70 (0.55-0.90) per 50 g/day, and total dietary fiber = 0.70 (0.52-0.93) per 10 g/day. The findings for dietary fiber were confirmed among HBV/HCV-free participants [0.48 (0.23-1.01)]. Similar associations were observed for IBD [dietary fiber = 0.59 (0.37-0.99) per 10 g/day], but not biliary tract cancer. CONCLUSIONS: Findings suggest that higher consumption of dietary fiber and lower consumption of total sugars are associated with lower HCC risk. In addition, high dietary fiber intake could be associated with lower IBD cancer risk

Alcohol drinking and endometrial cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study

Fedirko V., Jenab M., Rinaldi S., Biessy C., Allen N.E., Dossus L., Onland-Moret N.C., Schutze M., Tjonneland A., Hansen L., Overvad K., Clavel-Chapelon F., Chabbert-Buffet N., Kaaks R., Lukanova A., Bergmann M.M., Boeing H., Trichopoulou A., Oustoglou E., Barbitsioti A., Saieva C., Tagliabue G., Galasso R., Tumino R., Sacerdote C., Peeters P.H., Bueno-de-Mesquita H.B., Weiderpass E., Gram I.T., Sanchez S., Duell E.J., Molina-Montes E., Arriola L., Chirlaque M.D., Ardanaz E., Manjer J., Lundin E., Idahl A., Khaw K.T., Romaguera-Bosch D., Wark P.A., Norat T., Romieu I.

Ann Epidemiol; 2013; 23(2): 93-98

PMID:23273691

Abstract as provided by PubMed

PURPOSE: Alcohol intake may adversely affect the concentrations of endogenous sex hormones, and thus increase the risk of endometrial cancer. However, epidemiologic studies have provided conflicting results. Therefore, we investigated the association between alcohol intake and endometrial cancer risk a large, multicenter, prospective study. METHODS: From 1992 through 2010, 301,051 women in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort were followed for incident endometrial cancer (n = 1382). Baseline alcohol consumption was assessed by country-specific, validated dietary questionnaires. Information on past alcohol consumption was collected by lifestyle questionnaires. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated from Cox proportional hazard models. RESULTS: The multivariable HRs (and 95% CIs) compared with light drinkers (0.1-6 g/d) were 1.03 (0.88-1.20) for 0 g of alcohol per day at baseline, 1.01 (0.86-1.17) for 6.1-12 g/d, 1.03 (0.87-1.22) for 12.1-24 g/d, 1.07 (0.87-1.38) for 24.1-36 g/d, and 0.85 (0.61-1.18) for more than 36 g/d (p(trend) = 0.77). No association was observed among former drinkers (OR, 1.28; 95% CI, 0.98-1.68 compared with light drinkers). Null associations were also found between alcohol consumption at age 20 years, lifetime pattern of alcohol drinking, and baseline alcohol intake from specific alcoholic beverages and endometrial cancer risk. CONCLUSIONS: Our findings suggest no association between alcohol intake and endometrial cancer risk

Dietary fiber intake and risk of hormonal receptor-defined breast cancer in the European Prospective Investigation into Cancer and Nutrition study

Ferrari P., Rinaldi S., Jenab M., Lukanova A., Olsen A., Tjonneland A., Overvad K., Clavel-Chapelon F., Fagherazzi G., Touillaud M., Kaaks R., von Rusten A., Boeing H., Trichopoulou A., Lagiou P., Benetou V., Grioni S., Panico S., Masala G., Tumino R., Polidoro S., Bakker M.F., Van Gils C.H., Ros M.M., Bueno-de-Mesquita H.B., Krum-Hansen S., Engeset D., Skeie G., Pilar A., Sanchez M.J., Buckland G., Ardanaz E., Chirlaque D., Rodriguez L., Travis R., Key T., Khaw K.T., Wareham N.J., Sund M., Lenner P., Slimani N., Norat T., Aune D., Riboli E., Romieu I.

Am J Clin. Nutr; 2013; 97(2): 344-353

PMID:23269820

Abstract as provided by PubMed

BACKGROUND: Limited scientific evidence has characterized the association between dietary fiber intake and risk of breast cancer (BC) by menopausal status and hormone receptor expression in tumors. OBJECTIVE: We investigated the relation between total dietary fiber and its main food sources (vegetables, fruit, cereals, and legumes) and BC risk by using data from the European Prospective Investigation into Cancer and Nutrition (EPIC). DESIGN: A total of 11,576 invasive BC cases in 334,849 EPIC women mostly aged 35-70 y at baseline were identified over a median follow-up of 11.5 y. Dietary fiber was estimated from country-specific dietary questionnaires. Multivariable Cox proportional hazards regression models were used to quantify the association between dietary variables and BC risk with energy adjustment by using the residual method. Subgroup analyses were performed by menopausal status and estrogen receptor (ER) and progesterone receptor (PR) expression in tumors. RESULTS: BC risk was inversely associated with intakes of total dietary fiber [hazard ratio comparing fifth quintile to first quintile (HR(Q5-Q1)): 0.95; 95% CI: 0.89, 1.01; P-trend = 0.03] and fiber from vegetables (0.90; 0.84, 0.96; P-trend < 0.01) but not with fiber from fruit, cereals, or legumes. Overall, associations were homogeneous by menopausal status and ER and PR expression in tumors. For vegetable fiber, stronger associations were observed for estrogen receptor-negative and progesterone receptor-negative (HR(Q5-Q1):0.74; 95% CI: 0.59, 0.93; P-trend = 0.01) than for estrogen receptor-positive and progesterone receptor-positive tumors (0.92: 0.81, 1.03; P-trend = 0.05), with P-heterogeneity = 0.09. CONCLUSION: Diets rich in dietary fiber and, particularly, fiber from vegetables may be associated with a small reduction in risk of BC, independently of menopausal status

Challenges in estimating the validity of dietary acrylamide measurements

Ferrari P., Freisling H., Duell E.J., Kaaks R., Lujan-Barroso L., Clavel-Chapelon F., Boutron-Ruault M.C., Nailler L., Polidoro S., Mattiello A., Palli D., Tumino R., Grioni S., Knuppel S., Tjonneland A., Olsen A., Overvad K., Orfanos P., Katsoulis M., Trichopoulou A., Quiros J.R., Ardanaz E., Huerta J.M., Etxezarreta P.A., Sanchez M.J., Crowe F., Khaw K.T., Wareham N.J., Ocke M., Bueno-de-Mesquita B., Peeters P.H., Ericson U., Wirfalt E., Hallmans G., Johansson I., Engeset D., Nicolas G., Gallo V., Norat T., Riboli E., Slimani N.

Eur. J Nutr; 2013; 52(5): 1503-1512

PMID:23114503

Abstract as provided by PubMed

BACKGROUND: Acrylamide is a chemical compound present in tobacco smoke and food, classified as a probable human carcinogen and a known human neurotoxin. Acrylamide is formed in foods, typically carbohydrate-rich and protein-poor plant foods, during high-temperature cooking or other thermal processing. The objectives of this study were to compare dietary estimates of acrylamide from questionnaires (DQ) and 24-h recalls (R) with levels of acrylamide adduct (AA) in haemoglobin. METHODS: In the European Prospective Investigation into Cancer and Nutrition (EPIC) study, acrylamide exposure was assessed in 510 participants from 9 European countries, randomly selected and stratified by age, sex, with equal numbers of never and current smokers. After adjusting for country, alcohol intake, smoking status, number of cigarettes and energy intake, correlation coefficients between various acrylamide measurements were computed, both at the individual and at the aggregate (centre) level. RESULTS: Individual level correlation coefficient between DQ and R measurements (r DQ,R) was 0.17, while r DQ,AA and r R,AA were 0.08 and 0.06, respectively. In never smokers, r DQ,R, r DQ,AA and r R,AA were 0.19, 0.09 and 0.02, respectively. The correlation coefficients between means of DQ, R and AA measurements at the centre level were larger (r > 0.4). CONCLUSIONS: These findings suggest that estimates of total acrylamide intake based on self-reported diet correlate weakly with biomarker AA Hb levels. Possible explanations are the lack of AA levels to capture dietary acrylamide due to individual differences in the absorption and metabolism of acrylamide, and/or measurement errors in acrylamide from self-reported dietary assessments, thus limiting the possibility to validate acrylamide DQ measurements

Dietary acrylamide intake of adults in the European Prospective Investigation into Cancer and Nutrition differs greatly according to geographical region

Freisling H., Moskal A., Ferrari P., Nicolas G., Knaze V., Clavel-Chapelon F., Boutron-Ruault M.C., Nailler L., Teucher B., Grote V.A., Boeing H., Clemens M., Tjonneland A., Olsen A., Overvad K., Quiros J.R., Duell E.J., Sanchez M.J., Amiano P., Chirlaque M.D., Barricarte A., Khaw K.T., Wareham N.J., Crowe F.L., Gallo V., Oikonomou E., Naska A., Trichopoulou A., Palli D., Agnoli C., Tumino R., Polidoro S., Mattiello A., Bueno-de-Mesquita H.B., Ocke M.C., Peeters P.H., Wirfalt E., Ericson U., Bergdahl I.A., Johansson I., Hjartaker A., Engeset D., Skeie G., Riboli E., Slimani N.

Eur. J Nutr; 2013; 52(4): 1369-1380

PMID:23238529

Abstract as provided by PubMed

PURPOSE: Methodological differences in assessing dietary acrylamide (AA) often hamper comparisons of intake across populations. Our aim was to describe the mean dietary AA intake in 27 centers of 10 European countries according to selected lifestyle characteristics and its contributing food sources in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. METHODS: In this cross-sectional analysis, 36 994 men and women, aged 35-74 years completed a single, standardized 24-hour dietary recall using EPIC-Soft. Food consumption data were matched to a harmonized AA database. Intake was computed by gender and center, and across categories of habitual alcohol consumption, smoking status, physical activity, education, and body mass index (BMI). Adjustment was made for participants' age, height, weight, and energy intake using linear regression models. RESULTS: Adjusted mean AA intake across centers ranged from 13 to 47 mug/day in men and from 12 to 39 mug/day in women; intakes were higher in northern European centers. In most centers, intake in women was significantly higher among alcohol drinkers compared with abstainers. There were no associations between AA intake and physical activity, BMI, or education. At least 50 % of AA intake across centers came from two food groups "bread, crisp bread, rusks" and "coffee." The third main contributing food group was "potatoes". CONCLUSIONS: Dietary AA intake differs greatly among European adults residing in different geographical regions. This observed heterogeneity in AA intake deserves consideration in the design and interpretation of population-based studies of dietary AA intake and health outcomes

Prediagnostic body fat and risk of death from amyotrophic lateral sclerosis: the EPIC cohort

Gallo V., Wark P.A., Jenab M., Pearce N., Brayne C., Vermeulen R., Andersen P.M., Hallmans G., Kyrozis A., Vanacore N., Vahdaninia M., Grote V., Kaaks R., Mattiello A., Bueno-de-Mesquita H.B., Peeters P.H., Travis R.C., Petersson J., Hansson O., Arriola L., Jimenez-Martin J.M., Tjonneland A., Halkjaer J., Agnoli C., Sacerdote C., Bonet C., Trichopoulou A., Gavrila D., Overvad K., Weiderpass E., Palli D., Quiros J.R., Tumino R., Khaw K.T., Wareham N., Barricante-Gurrea A., Fedirko V., Ferrari P., Clavel-Chapelon F., Boutron-Ruault M.C., Boeing H., Vigl M., Middleton L., Riboli E., Vineis P.

Neurology; 2013; 80(9): 829-838

PMID:23390184

Abstract as provided by PubMed

OBJECTIVES: The aim of this study was to investigate for the first time the association between body fat and risk of amyotrophic lateral sclerosis (ALS) with an appropriate prospective study design. METHODS: The EPIC (European Prospective Investigation into Cancer and Nutrition) study included 518,108 individuals recruited from the general population across 10 Western European countries. At recruitment, information on lifestyle was collected and anthropometric characteristics were measured. Cox hazard models were fitted to investigate the associations between anthropometric measures and ALS mortality. RESULTS: Two hundred twenty-two ALS deaths (79 men and 143 women) occurred during the follow-up period (mean follow-up = 13 years). There was a statistically significant interaction between categories of body mass index and sex regarding ALS risk (p = 0.009): in men, a significant linear decrease of risk per unit of body mass index was observed (hazard ratio = 0.93, 95% confidence interval 0.86-0.99 per kg/m(2)); among women, the risk was more than 3-fold increased for underweight compared with normal-weight women. Among women, a significant risk reduction increasing the waist/hip ratio was also evident: women in the top quartile had less than half the risk of ALS compared with those in the bottom quartile (hazard ratio = 0.48, 95% confidence interval 0.25-0.93) with a borderline significant p value for trend across quartiles (p = 0.056). CONCLUSION: Increased prediagnostic body fat is associated with a decreased risk of ALS mortality

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