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2013

Consumption of dairy products and colorectal cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC)

Murphy N., Norat T., Ferrari P., Jenab M., Bueno-de-Mesquita B., Skeie G., Olsen A., Tjonneland A., Dahm C.C., Overvad K., Boutron-Ruault M.C., Clavel-Chapelon F., Nailler L., Kaaks R., Teucher B., Boeing H., Bergmann M.M., Trichopoulou A., Lagiou P., Trichopoulos D., Palli D., Pala V., Tumino R., Vineis P., Panico S., Peeters P.H., Dik V.K., Weiderpass E., Lund E., Garcia J.R., Zamora-Ros R., Perez M.J., Dorronsoro M., Navarro C., Ardanaz E., Manjer J., Almquist M., Johansson I., Palmqvist R., Khaw K.T., Wareham N., Key T.J., Crowe F.L., Fedirko V., Gunter M.J., Riboli E.

PLoS. One; 2013; 8(9): e72715

Abstract as provided by PubMed

BACKGROUND: Prospective studies have consistently reported lower colorectal cancer risks associated with higher intakes of total dairy products, total milk and dietary calcium. However, less is known about whether the inverse associations vary for individual dairy products with differing fat contents. MATERIALS AND METHODS: In the European Prospective Investigation into Cancer and Nutrition (EPIC), we investigated the associations between intakes of total milk and milk subtypes (whole-fat, semi-skimmed and skimmed), yoghurt, cheese, and dietary calcium with colorectal cancer risk amongst 477,122 men and women. Dietary questionnaires were administered at baseline. Multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models, adjusted for relevant confounding variables. RESULTS: During the mean 11 years of follow-up, 4,513 incident cases of colorectal cancer occurred. After multivariable adjustments, total milk consumption was inversely associated with colorectal cancer risk (HR per 200 g/day 0.93, 95% CI: 0.89-0.98). Similar inverse associations were observed for whole-fat (HR per 200 g/day 0.90, 95% CI: 0.82-0.99) and skimmed milk (HR per 200 g/day 0.90, 95% CI: 0.79-1.02) in the multivariable models. Inverse associations were observed for cheese and yoghurt in the categorical models; although in the linear models, these associations were non-significant. Dietary calcium was inversely associated with colorectal cancer risk (HR per 200 mg/day 0.95, 95% CI: 0.91-0.99); this association was limited to dairy sources of calcium only (HR per 200 mg/day 0.95, 95% CI: 0.91-0.99), with no association observed for non-dairy calcium sources (HR per 200 mg/day 1.00, 95% CI: 0.81-1.24). CONCLUSIONS: Our results strengthen the evidence for a possible protective role of dairy products on colorectal cancer risk. The inverse associations we observed did not differ by the fat content of the dairy products considered

Dietary intake of acrylamide and pancreatic cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort

Obon-Santacana M., Slimani N., Lujan-Barroso L., Travier N., Hallmans G., Freisling H., Ferrari P., Boutron-Ruault M.C., Racine A., Clavel F., Saieva C., Pala V., Tumino R., Mattiello A., Vineis P., Arguelles M., Ardanaz E., Amiano P., Navarro C., Sanchez M.J., Molina Montes E., Key T., Khaw K.T., Wareham N., Peeters P.H., Trichopoulou A., Bamia C., Trichopoulos D., Boeing H., Kaaks R., Katzke V., Ye W., Sund M., Ericson U., Wirfalt E., Overvad K., Tjonneland A., Olsen A., Skeie G., Asli L.A., Weiderpass E., Riboli E., Bueno-de-Mesquita H.B., Duell E.J.

Ann. Oncol; 2013; 24(10): 2645-2651

Abstract as provided by PubMed

BACKGROUND: In 1994, acrylamide (AA) was classified as a probable human carcinogen by the International Agency for Research on Cancer. In 2002, AA was discovered at relatively high concentrations in some starchy, plant-based foods cooked at high temperatures. PATIENTS AND METHODS: A prospective analysis was conducted to evaluate the association between the dietary intake of AA and ductal adenocarcinoma of the exocrine pancreatic cancer (PC) risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort using Cox regression modeling. EPIC includes >500,000 men and women aged 35-75 at enrollment from 10 European countries. AA intake was estimated for each participant by combining questionnaire-based food consumption data with a harmonized AA database derived from the EU monitoring database of AA levels in foods, and evaluated in quintiles and continuously. RESULTS: After a mean follow-up of 11 years, 865 first incident adenocarcinomas of the exocrine pancreas were observed and included in the present analysis. At baseline, the mean dietary AA intake in EPIC was 26.22 microg/day. No overall association was found between continuous or quintiles of dietary AA intake and PC risk in EPIC (HR:0.95, 95%CI:0.89-1.01 per 10 microg/day). There was no effect measure modification by smoking status, sex, diabetes, alcohol intake or geographic region. However, there was an inverse association (HR: 0.73, 95% CI: 0.61-0.88 per 10 microg/day) between AA intake and PC risk in obese persons as defined using the body mass index (BMI, >/= 30 kg/m(2)), but not when body fatness was defined using waist and hip circumference or their ratio. CONCLUSIONS: Dietary intake of AA was not associated with an increased risk of PC in the EPIC cohort

N-acetyltransferase 2 Phenotype, Occupation, and Bladder Cancer Risk: Results from the EPIC Cohort

Pesch B., Gawrych K., Rabstein S., Weiss T., Casjens S., Rihs H.P., Ding H., Angerer J., Illig T., Klopp N., Bueno-de-Mesquita B., Ros M.M., Kaaks R., Chang-Claude J., Roswall N., Tjonneland A., Overvad K., Clavel-Chapelon F., Boutron-Ruault M.C., Dossus L., Boeing H., Weikert S., Trichopoulos D., Palli D., Sieri S., Tumino R., Panico S., Quiros J.R., Gonzalez C., Sanchez M.J., Dorronsoro M., Navarro C., Barricarte A., Ljungberg B., Johansson M., Ulmert D., Ehrnstrom R., Khaw K.T., Wareham N., Key T.J., Ferrari P., Romieu I., Riboli E., Bruning T., Vineis P.

Cancer Epidemiol. Biomarkers Prev; 2013; 22(11): 2055-2065

Abstract as provided by PubMed

BACKGROUND: An association between N-acetyltransferase 2 (NAT2) slow acetylation and bladder cancer has been consistently observed in epidemiologic studies. However, evidence has been mainly derived from case-control studies and was sparse from cohort studies. We evaluated the association between NAT2 slow acetylation and bladder cancer in a case-control study nested in the European Prospective Investigation into Cancer and Nutrition. METHODS: Exposure to aromatic amines and polycyclic aromatic hydrocarbons (PAH) could be assessed for 754 cases and 833 controls for whom occupational information was documented. A semiquantitative job-exposure matrix was applied to at-risk occupations to estimate the exposure as low, medium, or high based on tertiles of the distribution of the exposure score in controls. Using a comprehensive genotyping, NAT2 acetylation status could be categorized from 6-single-nucleotide polymorphism genotypes as slow or fast in 607 cases and 695 controls with DNA from archived blood samples. RESULTS: Occupational exposure to aromatic amines and PAH was associated with an increased bladder cancer risk [upper tertile of the distribution of the exposure score: OR = 1.37; 95% confidence interval (CI), 1.02-1.84, and OR = 1.50; 95% CI, 1.09-2.05, respectively]. NAT2 slow acetylation did not modify these risk estimates and was not itself associated with bladder cancer risk (OR = 1.02; 95% CI, 0.81-1.29). CONCLUSIONS: These findings confirm established or suspected occupational risk factors but not the anticipated role of NAT2 slow acetylation in bladder cancer. No interaction was detected between NAT2 and any exposure of interest, including smoking. IMPACT: Genetic testing for NAT2 would be inappropriate in occupational settings. Cancer Epidemiol Biomarkers Prev; 22(11); 2055-65. (c)2013 AACR

Height, age at menarche and risk of hormone receptor-positive and -negative breast cancer: a cohort study

Ritte R., Lukanova A., Tjonneland A., Olsen A., Overvad K., Mesrine S., Fagherazzi G., Dossus L., Teucher B., Steindorf K., Boeing H., Aleksandrova K., Trichopoulou A., Lagiou P., Trichopoulos D., Palli D., Grioni S., Mattiello A., Tumino R., Sacerdote C., Quiros J.R., Buckland G., Molina-Montes E., Chirlaque M.D., Ardanaz E., Amiano P., Bueno-de-Mesquita B., van Duijnhoven F., Van Gils C.H., Peeters P.H., Wareham N., Khaw K.T., Key T.J., Travis R.C., Krum-Hansen S., Gram I.T., Lund E., Sund M., Andersson A., Romieu I., Rinaldi S., McCormack V., Riboli E., Kaaks R.

Int J Cancer; 2013; 132(11): 2619-2629

Abstract as provided by PubMed

Associations of breast cancer overall with indicators of exposures during puberty are reasonably well characterized; however, uncertainty remains regarding the associations of height, leg length, sitting height and menarcheal age with hormone receptor-defined malignancies. Within the European Prospective Investigation into Cancer and Nutrition cohort, Cox proportional hazards models were used to describe the relationships of adult height, leg length and sitting height and age at menarche with risk of estrogen and progesterone receptor negative (ER-PR-) (n = 990) and ER+PR+ (n = 3,524) breast tumors. Height as a single risk factor was compared to a model combining leg length and sitting height. The possible interactions of height, leg length and sitting height with menarche were also analyzed. Risk of both ER-PR- and ER+PR+ malignancies was positively associated with standing height, leg length and sitting height and inversely associated with increasing age at menarche. For ER+PR+ disease, sitting height (hazard ratios: 1.14[95% confidence interval: 1.08-1.20]) had a stronger risk association than leg length (1.05[1.00-1.11]). In comparison, for ER-PR- disease, no distinct differences were observed between leg length and sitting height. Women who were tall and had an early menarche (</=13 years) showed an almost twofold increase in risk of ER+PR+ tumors but no such increase in risk was observed for ER-PR- disease. Indicators of exposures during rapid growth periods were associated with risks of both HR-defined breast cancers. Exposures during childhood promoting faster development may establish risk associations for both HR-positive and -negative malignancies. The stronger associations of the components of height with ER+PR+ tumors among older women suggest possible hormonal links that could be specific for postmenopausal women

Meat consumption and mortality--results from the European Prospective Investigation into Cancer and Nutrition

Rohrmann S., Overvad K., Bueno-de-Mesquita H.B., Jakobsen M.U., Egeberg R., Tjonneland A., Nailler L., Boutron-Ruault M.C., Clavel-Chapelon F., Krogh V., Palli D., Panico S., Tumino R., Ricceri F., Bergmann M.M., Boeing H., Li K., Kaaks R., Khaw K.T., Wareham N.J., Crowe F.L., Key T.J., Naska A., Trichopoulou A., Trichopoulos D., Leenders M., Peeters P.H., Engeset D., Parr C.L., Skeie G., Jakszyn P., Sanchez M.J., Huerta J.M., Redondo M.L., Barricarte A., Amiano P., Drake I., Sonestedt E., Hallmans G., Johansson I., Fedirko V., Romieux I., Ferrari P., Norat T., Vergnaud A.C., Riboli E., Linseisen J.

BMC. Med; 2013; 63

Abstract as provided by PubMed

BACKGROUND: Recently, some US cohorts have shown a moderate association between red and processed meat consumption and mortality supporting the results of previous studies among vegetarians. The aim of this study was to examine the association of red meat, processed meat, and poultry consumption with the risk of early death in the European Prospective Investigation into Cancer and Nutrition (EPIC). METHODS: Included in the analysis were 448,568 men and women without prevalent cancer, stroke, or myocardial infarction, and with complete information on diet, smoking, physical activity and body mass index, who were between 35 and 69 years old at baseline. Cox proportional hazards regression was used to examine the association of meat consumption with all-cause and cause-specific mortality. RESULTS: As of June 2009, 26,344 deaths were observed. After multivariate adjustment, a high consumption of red meat was related to higher all-cause mortality (hazard ratio (HR) = 1.14, 95% confidence interval (CI) 1.01 to 1.28, 160+ versus 10 to 19.9 g/day), and the association was stronger for processed meat (HR = 1.44, 95% CI 1.24 to 1.66, 160+ versus 10 to 19.9 g/day). After correction for measurement error, higher all-cause mortality remained significant only for processed meat (HR = 1.18, 95% CI 1.11 to 1.25, per 50 g/d). We estimated that 3.3% (95% CI 1.5% to 5.0%) of deaths could be prevented if all participants had a processed meat consumption of less than 20 g/day. Significant associations with processed meat intake were observed for cardiovascular diseases, cancer, and 'other causes of death'. The consumption of poultry was not related to all-cause mortality. CONCLUSIONS: The results of our analysis support a moderate positive association between processed meat consumption and mortality, in particular due to cardiovascular diseases, but also to cancer

Smoking and the risk of prostate cancer in the European Prospective Investigation into Cancer and Nutrition

Rohrmann S., Linseisen J., Allen N., Bueno-de-Mesquita H.B., Johnsen N.F., Tjonneland A., Overvad K., Kaaks R., Teucher B., Boeing H., Pischon T., Lagiou P., Trichopoulou A., Trichopoulos D., Palli D., Krogh V., Tumino R., Ricceri F., Arguelles Suarez M.V., Agudo A., Sanchez M.J., Chirlaque M.D., Barricarte A., Larranaga N., Boshuizen H., van Kranen H.J., Stattin P., Johansson M., Bjartell A., Ulmert D., Khaw K.T., Wareham N.J., Ferrari P., Romieux I., Gunter M.J., Riboli E., Key T.J.

Br J Cancer; 2013; 108(3): 708-714

Abstract as provided by PubMed

BACKGROUND: Smoking is not associated with prostate cancer incidence in most studies, but associations between smoking and fatal prostate cancer have been reported. METHODS: During 1992 and 2000, lifestyle information was assessed via questionnaires and personal interview in a cohort of 145,112 European men. Until 2009, 4623 incident cases of prostate cancer were identified, including 1517 cases of low-grade, 396 cases of high grade, 1516 cases of localised, 808 cases of advanced disease, and 432 fatal cases. Multivariable Cox proportional hazards regression models were used to examine the association of smoking status, smoking intensity, and smoking duration with the risk of incident and fatal prostate cancer. RESULTS: Compared with never smokers, current smokers had a reduced risk of prostate cancer (RR=0.90, 95% CI: 0.83-0.97), which was statistically significant for localised and low-grade disease, but not for advanced or high-grade disease. In contrast, heavy smokers (25+ cigarettes per day) and men who had smoked for a long time (40+ years) had a higher risk of prostate cancer death (RR=1.81, 95% CI: 1.11-2.93; RR=1.38, 95% CI: 1.01-1.87, respectively). CONCLUSION: The observation of an increased prostate cancer mortality among heavy smokers confirms the results of previous prospective studies

Meat and fish consumption and risk of pancreatic cancer: results from the European Prospective Investigation into Cancer and Nutrition

Rohrmann S., Linseisen J., Nothlings U., Overvad K., Egeberg R., Tjonneland A., Boutron-Ruault M.C., Clavel-Chapelon F., Cottet V., Pala V., Tumino R., Palli D., Panico S., Vineis P., Boeing H., Pischon T., Grote V., Teucher B., Khaw K.T., Wareham N.J., Crowe F.L., Goufa I., Orfanos P., Trichopoulou A., Jeurnink S.M., Siersema P.D., Peeters P.H., Brustad M., Engeset D., Skeie G., Duell E.J., Amiano P., Barricarte A., Molina-Montes E., Rodriguez L., Tormo M.J., Sund M., Ye W., Lindkvist B., Johansen D., Ferrari P., Jenab M., Slimani N., Ward H., Riboli E., Norat T., Bueno-de-Mesquita H.B.

Int J Cancer; 2013; 132(3): 617-624

Abstract as provided by PubMed

Pancreatic cancer is the fourth most common cause of cancer death worldwide with large geographical variation, which implies the contribution of diet and lifestyle in its etiology. We examined the association of meat and fish consumption with risk of pancreatic cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC). A total of 477,202 EPIC participants from 10 European countries recruited between 1992 and 2000 were included in our analysis. Until 2008, 865 nonendocrine pancreatic cancer cases have been observed. Calibrated relative risks (RRs) and 95% confidence intervals (CIs) were computed using multivariable-adjusted Cox hazard regression models. The consumption of red meat (RR per 50 g increase per day = 1.03, 95% CI = 0.93-1.14) and processed meat (RR per 50 g increase per day = 0.93, 95% CI = 0.71-1.23) were not associated with an increased pancreatic cancer risk. Poultry consumption tended to be associated with an increased pancreatic cancer risk (RR per 50 g increase per day = 1.72, 95% CI = 1.04-2.84); however, there was no association with fish consumption (RR per 50 g increase per day = 1.22, 95% CI = 0.92-1.62). Our results do not support the conclusion of the World Cancer Research Fund that red or processed meat consumption may possibly increase the risk of pancreatic cancer. The positive association of poultry consumption with pancreatic cancer might be a chance finding as it contradicts most previous findings

Consumption of sweet beverages and type 2 diabetes incidence in European adults: results from EPIC-InterAct

Romaguera D., Norat T., Wark P. A., Vergnaud A. C., Schulze M. B., van Woudenbergh G. J., Drogan D., Amiano P., Molina-Montes E., Sanchez M. J., Balkau B., Barricarte A., Beulens J. W., Clavel-Chapelon F., Crispim S. P., Fagherazzi G., Franks P. W., Grote V. A., Huybrechts I., Kaaks R., Key T. J., Khaw K. T., Nilsson P., Overvad K., Palli D., Panico S., Quiros J. R., Rolandsson O., Sacerdote C., Sieri S., Slimani N., Spijkerman A. M., Tjonneland A., Tormo M. J., Tumino R., van den Berg S. W., Wermeling P. R., Zamara-Ros R., Feskens E. J., Langenberg C., Sharp S. J., Forouhi N. G., Riboli E., Wareham N. J.

Diabetologia; 2013; 56(7): 1520-30

PMID:23620057

Abstract as provided by PubMed

AIMS/HYPOTHESIS: Consumption of sugar-sweetened beverages has been shown, largely in American populations, to increase type 2 diabetes incidence. We aimed to evaluate the association of consumption of sweet beverages (juices and nectars, sugar-sweetened soft drinks and artificially sweetened soft drinks) with type 2 diabetes incidence in European adults. METHODS: We established a case-cohort study including 12,403 incident type 2 diabetes cases and a stratified subcohort of 16,154 participants selected from eight European cohorts participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. After exclusions, the final sample size included 11,684 incident cases and a subcohort of 15,374 participants. Cox proportional hazards regression models (modified for the case-cohort design) and random-effects meta-analyses were used to estimate the association between sweet beverage consumption (obtained from validated dietary questionnaires) and type 2 diabetes incidence. RESULTS: In adjusted models, one 336 g (12 oz) daily increment in sugar-sweetened and artificially sweetened soft drink consumption was associated with HRs for type 2 diabetes of 1.22 (95% CI 1.09, 1.38) and 1.52 (95% CI 1.26, 1.83), respectively. After further adjustment for energy intake and BMI, the association of sugar-sweetened soft drinks with type 2 diabetes persisted (HR 1.18, 95% CI 1.06, 1.32), but the association of artificially sweetened soft drinks became statistically not significant (HR 1.11, 95% CI 0.95, 1.31). Juice and nectar consumption was not associated with type 2 diabetes incidence. CONCLUSIONS/INTERPRETATION: This study corroborates the association between increased incidence of type 2 diabetes and high consumption of sugar-sweetened soft drinks in European adults.

Anthropometric characteristics and risk of lymphoid and myeloid leukemia in the European Prospective Investigation into Cancer and Nutrition (EPIC)

Saberi Hosnijeh F., Romieu I., Gallo V., Riboli E., Tjonneland A., Halkjaer J., Fagherazzi G., Clavel-Chapelon F., Dossus L., Lukanova A., Kaaks R., Trichopoulou A., Lagiou P., Katsoulis M., Panico S., Tagliabue G., Bonet C., Dorronsoro M., Huerta J.M., Ardanaz E., Sanchez M.J., Johansen D., Borgquist S., Peeters P., Bueno-de-Mesquita H.B., Ros M.M., Travis R.C., Key T.J., Vineis P., Vermeulen R.

Cancer Causes Control; 2013; 24(3): 427-438

Abstract as provided by PubMed

PURPOSE: Overweight and obesity have been suggested as a risk factor for leukemia. Impaired immune function associated with obesity, increased insulin-like growth factor-I activity and stimulating effects of leptin suggest a possible biological link between anthropometric measures and leukemia. However, evidence from epidemiological studies has been inconsistent. We examined the potential association between prospective measurements of body size and risk of leukemia among participants of the European Prospective Investigation into Cancer and Nutrition (EPIC). METHODS: During follow-up (mean = 11.52 years, standard deviation = 2.63), 671 leukemia (lymphoid leukemia = 50.1 %, myeloid leukemia = 43.2 %) cases were identified. Anthropometric measures including weight, height, body mass index (BMI), waist circumference (WC), hip circumference, and waist-to-hip ratio (WHR) were measured. Cox proportional hazard models were used to explore the association between anthropometric measures and risk of leukemia. RESULTS: No associations were observed between anthropometric measures and total leukemia, and lymphoid leukemia. Risk of myeloid leukemia significantly increased for higher categories of BMI and WC among women. Analyses by subtype of myeloid leukemia showed an increased risk of acute myeloid leukemia (AML) for higher categories of WHR among women. This association seemed to be reversed for chronic myeloid leukemia. No association between anthropometric measures and myeloid leukemia were observed among men except an increased risk of AML with height. CONCLUSION: The study showed no associations between anthropometric measures and total leukemia, and lymphoid leukemia among men and women. A possible association between BMI as general obesity and WC as abdominal obesity and increased risk of myeloid leukemia among women were observed

Occupation and risk of lymphoid and myeloid leukaemia in the European Prospective Investigation into Cancer and Nutrition (EPIC)

Saberi Hosnijeh F., Christopher Y., Peeters P., Romieu I., Xun W., Riboli E., Raaschou-Nielsen O., Tjonneland A., Becker N., Nieters A., Trichopoulou A., Bamia C., Orfanos P., Oddone E., Lujan-Barroso L., Dorronsoro M., Navarro C., Barricarte A., Molina-Montes E., Wareham N., Vineis P., Vermeulen R.

Occup. Environ. Med; 2013; 70(7): 464-470

Abstract as provided by PubMed

OBJECTIVES: Established risk factors for leukaemia do not explain the majority of leukaemia cases. Previous studies have suggested the importance of occupation and related exposures in leukaemogenesis. We evaluated possible associations between job title and selected hazardous agents and leukaemia in the European Prospective Investigation into Cancer and Nutrition. METHODS: The mean follow-up time for 241 465 subjects was 11.20 years (SD 2.42 years). During the follow-up period, 477 incident cases of myeloid and lymphoid leukaemia occurred. Data on 52 occupations considered a priori to be at high risk of developing cancer were collected through standardised questionnaires. Occupational exposures were estimated by linking the reported occupations to a job exposure matrix. Cox proportional hazard models were used to explore the association between occupation and related exposures and risk of leukaemia. RESULTS: The risk of lymphoid leukaemia significantly increased for working in chemical laboratories (HR 8.35, 95% CI 1.58 to 44.24), while the risk of myeloid leukaemia increased for working in the shoe or other leather goods industry (HR 2.54, 95% CI 1.28 to 5.06). Exposure-specific analyses showed a non-significant increased risk of myeloid leukaemias for exposure to benzene (HR 1.15, 95% CI 0.75 to 1.40; HR=1.60, 95% CI 0.95 to 2.69 for the low and high exposure categories, respectively). This association was present both for acute and chronic myeloid leukaemia at high exposure levels. However, numbers were too small to reach statistical significance. CONCLUSIONS: Our findings suggest a possible role of occupational exposures in the development of both lymphoid and myeloid leukaemia. Exposure to benzene seemed to be associated with both acute and chronic myeloid leukaemia

Abdominal obesity, weight gain during adulthood and risk of liver and biliary tract cancer in a European cohort

Schlesinger S., Aleksandrova K., Pischon T., Fedirko V., Jenab M., Trepo E., Boffetta P., Dahm C.C., Overvad K., Tjonneland A., Halkjaer J., Fagherazzi G., Boutron-Ruault M.C., Carbonnel F., Kaaks R., Lukanova A., Boeing H., Trichopoulou A., Bamia C., Lagiou P., Palli D., Grioni S., Panico S., Tumino R., Vineis P., Bueno-de-Mesquita H.B., van den Berg S., Peeters P.H., Braaten T., Weiderpass E., Quiros J.R., Travier N., Sanchez M.J., Navarro C., Barricarte A., Dorronsoro M., Lindkvist B., Regner S., Werner M., Sund M., Khaw K.T., Wareham N., Travis R.C., Norat T., Wark P.A., Riboli E., Nothlings U.

Int J Cancer; 2013; 132(3): 645-657

Abstract as provided by PubMed

General obesity has been positively associated with risk of liver and probably with biliary tract cancer, but little is known about abdominal obesity or weight gain during adulthood. We used multivariable Cox proportional hazard models to investigate associations between weight, body mass index, waist and hip circumference, waist-to-hip and waist-to-height ratio (WHtR), weight change during adulthood and risk of hepatocellular carcinoma (HCC), intrahepatic (IBDC) and extrahepatic bile duct system cancer [EBDSC including gallbladder cancer (GBC)] among 359,525 men and women in the European Prospective Investigation into Cancer and Nutrition study. Hepatitis B and C virus status was measured in a nested case-control subset. During a mean follow-up of 8.6 years, 177 cases of HCC, 58 cases of IBDC and 210 cases of EBDSC, including 76 cases of GBC, occurred. All anthropometric measures were positively associated with risk of HCC and GBC. WHtR showed the strongest association with HCC [relative risk (RR) comparing extreme tertiles 3.51, 95% confidence interval (95% CI): 2.09-5.87; p(trend) < 0.0001] and with GBC (RR: 1.56, 95% CI: 1.12-2.16 for an increment of one unit in WHtR). Weight gain during adulthood was also positively associated with HCC when comparing extreme tertiles (RR: 2.48, 95% CI: 1.49-4.13; <0.001). No statistically significant association was observed between obesity and risk of IBDC and EBDSC. Our results provide evidence of an association between obesity, particularly abdominal obesity, and risk of HCC and GBC. Our findings support public health recommendations to reduce the prevalence of obesity and weight gain in adulthood for HCC and GBC prevention in Western populations

Dietary glycemic index, glycemic load, and digestible carbohydrate intake are not associated with risk of type 2 diabetes in eight European countries

Sluijs I., Beulens J.W., van der Schouw Y.T., van der A.D.L., Buckland G., Kuijsten A., Schulze M.B., Amiano P., Ardanaz E., Balkau B., Boeing H., Gavrila D., Grote V.A., Key T.J., Li K., Nilsson P., Overvad K., Palli D., Panico S., Quiros J.R., Rolandsson O., Roswall N., Sacerdote C., Sanchez M.J., Sieri S., Slimani N., Spijkerman A.M., Tjonneland A., Tumino R., Sharp S.J., Langenberg C., Feskens E.J., Forouhi N.G., Riboli E., Wareham N.J.

J Nutr; 2013; 143(1): 93-99

Abstract as provided by PubMed

The association of glycemic index (GI) and glycemic load (GL) with the risk of type 2 diabetes remains unclear. We investigated associations of dietary GI, GL, and digestible carbohydrate with incident type 2 diabetes. We performed a case-cohort study nested within the European Prospective Investigation into Cancer and Nutrition Study, including a random subcohort (n = 16,835) and incident type 2 diabetes cases (n = 12,403). The median follow-up time was 12 y. Baseline dietary intakes were assessed using country-specific dietary questionnaires. Country-specific HR were calculated and pooled using random effects meta-analysis. Dietary GI, GL, and digestible carbohydrate in the subcohort were (mean +/- SD) 56 +/- 4, 127 +/- 23, and 226 +/- 36 g/d, respectively. After adjustment for confounders, GI and GL were not associated with incident diabetes [HR highest vs. lowest quartile (HR(Q4)) for GI: 1.05 (95% CI = 0.96, 1.16); HR(Q4) for GL: 1.07 (95% CI = 0.95, 1.20)]. Digestible carbohydrate intake was not associated with incident diabetes [HR(Q4): 0.98 (95% CI = 0.86, 1.10)]. In additional analyses, we found that discrepancies in the GI value assignment to foods possibly explain differences in GI associations with diabetes within the same study population. In conclusion, an expansion of the GI tables and systematic GI value assignment to foods may be needed to improve the validity of GI values derived in such studies, after which GI associations may need reevaluation. Our study shows that digestible carbohydrate intake is not associated with diabetes risk and suggests that diabetes risk with high-GI and -GL diets may be more modest than initial studies suggested

Physical activity and risk of breast cancer overall and by hormone receptor status: the European prospective investigation into cancer and nutrition

Steindorf K., Ritte R., Eomois P.P., Lukanova A., Tjonneland A., Johnsen N.F., Overvad K., Ostergaard J.N., Clavel-Chapelon F., Fournier A., Dossus L., Teucher B., Rohrmann S., Boeing H., Wientzek A., Trichopoulou A., Karapetyan T., Trichopoulos D., Masala G., Berrino F., Mattiello A., Tumino R., Ricceri F., Quiros J.R., Travier N., Sanchez M.J., Navarro C., Ardanaz E., Amiano P., Bueno-de-Mesquita H.B., van Duijnhoven F., Monninkhof E., May A.M., Khaw K.T., Wareham N., Key T.J., Travis R.C., Borch K.B., Sund M., Andersson A., Fedirko V., Rinaldi S., Romieu I., Wahrendorf J., Riboli E., Kaaks R.

Int J Cancer; 2013; 132(7): 1667-1678

Abstract as provided by PubMed

Physical activity is associated with reduced risks of invasive breast cancer. However, whether this holds true for breast cancer subtypes defined by the estrogen receptor (ER) and the progesterone receptor (PR) status is controversial. The study included 257,805 women from the multinational EPIC-cohort study with detailed information on occupational, recreational and household physical activity and important cofactors assessed at baseline. During 11.6 years of median follow-up, 8,034 incident invasive breast cancer cases were identified. Data on ER, PR and combined ER/PR expression were available for 6,007 (67.6%), 4,814 (54.2%) and 4,798 (53.9%) cases, respectively. Adjusted hazard ratios (HR) were estimated by proportional hazards models. Breast cancer risk was inversely associated with moderate and high levels of total physical activity (HR = 0.92, 95% confidence interval (CI): 0.86-0.99, HR = 0.87, 95%-CI: 0.79-0.97, respectively; p-trend = 0.002), compared to the lowest quartile. Among women diagnosed with breast cancer after age 50, the largest risk reduction was found with highest activity (HR = 0.86, 95%-CI: 0.77-0.97), whereas for cancers diagnosed before age 50 strongest associations were found for moderate total physical activity (HR = 0.78, 95%-CI: 0.64-0.94). Analyses by hormone receptor status suggested differential associations for total physical activity (p-heterogeneity = 0.04), with a somewhat stronger inverse relationship for ER+/PR+ breast tumors, primarily driven by PR+ tumors (p-heterogeneity < 0.01). Household physical activity was inversely associated with ER-/PR- tumors. The results of this largest prospective study on the protective effects of physical activity indicate that moderate and high physical activity are associated with modest decreased breast cancer risk. Heterogeneities by receptor status indicate hormone-related mechanisms

Genetic variation in the lactase gene, dairy product intake and risk for prostate cancer in the European prospective investigation into cancer and nutrition

Travis R.C., Appleby P.N., Siddiq A., Allen N.E., Kaaks R., Canzian F., Feller S., Tjonneland A., Fons Johnsen N., Overvad K., Ramon Quiros J., Gonzalez C.A., Sanchez M.J., Larranaga N., Chirlaque M.D., Barricarte A., Khaw K.T., Wareham N., Trichopoulou A., Valanou E., Oustoglou E., Palli D., Sieri S., Tumino R., Sacerdote C., Bueno-de-Mesquita H.B., Stattin P., Ferrari P., Johansson M., Norat T., Riboli E., Key T.J.

Int J Cancer; 2013; 132(8): 1901-1910

Abstract as provided by PubMed

High dairy protein intake has been found to be associated with increased prostate cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC). To further examine this possible relationship, we investigated the hypothesis that a genetic polymorphism in the lactase (LCT) gene might be associated with elevated dairy product intake and increased prostate cancer risk in a case-control study nested in EPIC. The C/T-13910 lactase variant (rs4988235) was genotyped in 630 men with prostate cancer and 873 matched control participants. Dairy product consumption was assessed by diet questionnaire. Odds ratios (ORs) for prostate cancer in relation to lactase genotype were estimated by conditional logistic regression. Lactase genotype frequency varied significantly between countries, with frequencies of the T (lactase persistence) allele ranging from 7% in Greece to 79% in Denmark. Intake of milk and total dairy products varied significantly by lactase genotype after adjustment for recruitment center; adjusted mean intakes of milk were 44.4, 69.8 and 82.3 g/day among men with CC, CT and TT genotypes, respectively. The lactase variant was not significantly associated with prostate cancer risk, both in our data (adjusted OR for TT vs. CC homozygotes: 1.10, 95% CI: 0.76-1.59) and in a meta-analysis of all the published data (combined OR for T allele carriers vs. CC homozygotes: 1.12, 0.96-1.32). These findings show that while variation in the lactase gene is associated with milk intake in men, the lactase polymorphism does not have a large effect on prostate cancer risk

The association between dietary energy density and type 2 diabetes in Europe: results from the EPIC-InterAct Study

van den Berg S.W., van der A D.L., Spijkerman A.M., van Woudenbergh G.J., Tijhuis M.J., Amiano P., Ardanaz E., Beulens J.W., Boeing H., Clavel-Chapelon F., Crowe F.L., de Lauzon-Guillain B., Fagherazzi G., Franks P.W., Freisling H., Gonzalez C., Grioni S., Halkjaer J., Huerta J.M., Huybrechts I., Kaaks R., Khaw K.T., Masala G., Nilsson P.M., Overvad K., Panico S., Quiros J.R., Rolandsson O., Sacerdote C., Sanchez M.J., Schulze M.B., Slimani N., Struijk E.A., Tjonneland A., Tumino R., Sharp S.J., Langenberg C., Forouhi N.G., Feskens E.J., Riboli E., Wareham N.J.

PLoS. One; 2013; 8(5): e59947

Abstract as provided by PubMed

BACKGROUND: Observational studies implicate higher dietary energy density (DED) as a potential risk factor for weight gain and obesity. It has been hypothesized that DED may also be associated with risk of type 2 diabetes (T2D), but limited evidence exists. Therefore, we investigated the association between DED and risk of T2D in a large prospective study with heterogeneity of dietary intake. METHODOLOGY/PRINCIPAL FINDINGS: A case-cohort study was nested within the European Prospective Investigation into Cancer (EPIC) study of 340,234 participants contributing 3.99 million person years of follow-up, identifying 12,403 incident diabetes cases and a random subcohort of 16,835 individuals from 8 European countries. DED was calculated as energy (kcal) from foods (except beverages) divided by the weight (gram) of foods estimated from dietary questionnaires. Prentice-weighted Cox proportional hazard regression models were fitted by country. Risk estimates were pooled by random effects meta-analysis and heterogeneity was evaluated. Estimated mean (sd) DED was 1.5 (0.3) kcal/g among cases and subcohort members, varying across countries (range 1.4-1.7 kcal/g). After adjustment for age, sex, smoking, physical activity, alcohol intake, energy intake from beverages and misreporting of dietary intake, no association was observed between DED and T2D (HR 1.02 (95% CI: 0.93-1.13), which was consistent across countries (I(2) = 2.9%). CONCLUSIONS/SIGNIFICANCE: In this large European case-cohort study no association between DED of solid and semi-solid foods and risk of T2D was observed. However, despite the fact that there currently is no conclusive evidence for an association between DED and T2DM risk, choosing low energy dense foods should be promoted as they support current WHO recommendations to prevent chronic diseases

Adherence to the World Cancer Research Fund/American Institute for Cancer Research guidelines and risk of death in Europe: results from the European Prospective Investigation into Nutrition and Cancer cohort study1,4

Vergnaud A.C., Romaguera D., Peeters P.H., Van Gils C.H., Chan D.S., Romieu I., Freisling H., Ferrari P., Clavel-Chapelon F., Fagherazzi G., Dartois L., Li K., Tikk K., Bergmann M.M., Boeing H., Tjonneland A., Olsen A., Overvad K., Dahm C.C., Redondo M.L., Agudo A., Sanchez M.J., Amiano P., Chirlaque M.D., Ardanaz E., Khaw K.T., Wareham N.J., Crowe F., Trichopoulou A., Orfanos P., Trichopoulos D., Masala G., Sieri S., Tumino R., Vineis P., Panico S., Bueno-de-Mesquita H.B., Ros M.M., May A., Wirfalt E., Sonestedt E., Johansson I., Hallmans G., Lund E., Weiderpass E., Parr C.L., Riboli E., Norat T.

Am J Clin Nutr; 2013; 97(5): 1107-1120

Abstract as provided by PubMed

BACKGROUND: In 2007, the World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) issued recommendations on diet, physical activity, and weight management for cancer prevention on the basis of the most comprehensive collection of available evidence. OBJECTIVE: We investigated whether concordance with WCRF/AICR recommendations is related to risk of death. DESIGN: The current study included 378,864 participants from 9 European countries enrolled in the European Prospective Investigation into Cancer and Nutrition study. At recruitment (1992-1998), dietary, anthropometric, and lifestyle information was collected. A WCRF/AICR score, which incorporated 6 of the WCRF/AICR recommendations for men [regarding body fatness, physical activity, foods and drinks that promote weight gain, plant foods, animal foods, and alcoholic drinks (score range: 0-6)] and 7 WCRF/AICR recommendations for women [plus breastfeeding (score range: 0-7)], was constructed. Higher scores indicated greater concordance with WCRF/AICR recommendations. Associations between the WCRF/AICR score and risks of total and cause-specific death were estimated by using Cox regression analysis. RESULTS: After a median follow-up time of 12.8 y, 23,828 deaths were identified. Participants within the highest category of the WCRF/AICR score (5-6 points in men; 6-7 points in women) had a 34% lower hazard of death (95% CI: 0.59, 0.75) compared with participants within the lowest category of the WCRF/AICR score (0-2 points in men; 0-3 points in women). Significant inverse associations were observed in all countries. The WCRF/AICR score was also significantly associated with a lower hazard of dying from cancer, circulatory disease, and respiratory disease. CONCLUSION: Results of this study suggest that following WCRF/AICR recommendations could significantly increase longevity

Dietary flavonoid intake and esophageal cancer risk in the European prospective investigation into cancer and nutrition cohort

Vermeulen E., Zamora-Ros R., Duell E.J., Lujan-Barroso L., Boeing H., Aleksandrova K., Bueno-de-Mesquita H.B., Scalbert A., Romieu I., Fedirko V., Touillaud M., Fagherazzi G., Perquier F., Molina-Montes E., Chirlaque M.D., Vicente Arguelles M., Amiano P., Barricarte A., Pala V., Mattiello A., Saieva C., Tumino R., Ricceri F., Trichopoulou A., Vasilopoulou E., Ziara G., Crowe F.L., Khaw K.T., Wareham N.J., Lukanova A., Grote V.A., Tjonneland A., Halkjaer J., Bredsdorff L., Overvad K., Siersema P.D., Peeters P.H., May A.M., Weiderpass E., Skeie G., Hjartaker A., Landberg R., Johansson I., Sonestedt E., Ericson U., Riboli E., Gonzalez C.A.

Am. J Epidemiol; 2013; 178(4): 570-581

Abstract as provided by PubMed

We prospectively investigated dietary flavonoid intake and esophageal cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. The study included 477,312 adult subjects from 10 European countries. At baseline, country-specific validated dietary questionnaires were used. During a mean follow-up of 11 years (1992-2010), there were 341 incident esophageal cancer cases, of which 142 were esophageal adenocarcinoma (EAC), 176 were esophageal squamous cell carcinoma (ESCC), and 23 were other types of esophageal cancer. In crude models, a doubling in total dietary flavonoid intake was inversely associated with esophageal cancer risk (hazard ratio (HR) (log(2)) = 0.87, 95% confidence interval (CI): 0.78, 0.98) but not in multivariable models (HR (log(2)) = 0.97, 95% CI: 0.86, 1.10). After covariate adjustment, no statistically significant association was found between any flavonoid subclass and esophageal cancer, EAC, or ESCC. However, among current smokers, flavonols were statistically significantly associated with a reduced esophageal cancer risk (HR (log(2)) = 0.72, 95% CI: 0.56, 0.94), whereas total flavonoids, flavanols, and flavan-3-ol monomers tended to be inversely associated with esophageal cancer risk. No associations were found in either never or former smokers. These findings suggest that dietary flavonoid intake was not associated with overall esophageal cancer, EAC, or ESCC risk, although total flavonoids and some flavonoid subclasses, particularly flavonols, may reduce the esophageal cancer risk among current smokers

Differences in dietary intakes, food sources and determinants of total flavonoids between Mediterranean and non-Mediterranean countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study

Zamora-Ros R., Knaze V., Lujan-Barroso L., Romieu I., Scalbert A., Slimani N., Hjartaker A., Engeset D., Skeie G., Overvad K., Bredsdorff L., Tjonneland A., Halkjaer J., Key T.J., Khaw K.T., Mulligan A.A., Winkvist A., Johansson I., Bueno-de-Mesquita H.B., Peeters P.H., Wallstrom P., Ericson U., Pala V., de Magistris M.S., Polidoro S., Tumino R., Trichopoulou A., Dilis V., Katsoulis M., Huerta J.M., Martinez V., Sanchez M.J., Ardanaz E., Amiano P., Teucher B., Grote V., Bendinelli B., Boeing H., Forster J., Touillaud M., Perquier F., Fagherazzi G., Gallo V., Riboli E., Gonzalez C.A.

Br J Nutr; 2013; 109(8): 1498-1507

Abstract as provided by PubMed

A greater adherence to the traditional Mediterranean (MED) diet is associated with a reduced risk of developing chronic diseases. This dietary pattern is based on higher consumption of plant products that are rich in flavonoids. We compared the total flavonoid dietary intakes, their food sources and various lifestyle factors between MED and non-MED countries participating in the EPIC study. Flavonoid intakes and their food sources for 35,628 subjects, aged 35-74 years and recruited between 1992 and 2000, in twenty-six study centres were estimated using standardised 24 h dietary recall software (EPIC-Soft(R)). An ad hoc food composition database on flavonoids was compiled using analytical data from the United States Department of Agriculture and Phenol-Explorer databases. Moreover, it was expanded to include using recipes, estimations of missing values and flavonoid retention factors. No significant differences in total flavonoid mean intake between non-MED countries (373.7 mg/d) and MED countries (370.2 mg/d) were observed. In the non-MED region, the main contributors were proanthocyanidins (48.2%) and flavan-3-ol monomers (24.9%) and the principal food sources were tea (25.7%) and fruits (32.8%). In the MED region, proanthocyanidins (59.0%) were by far the most abundant contributor and fruits (55.1%), wines (16.7%) and tea (6.8%) were the main food sources. The present study shows similar results for total dietary flavonoid intakes, but significant differences in flavonoid class intakes, food sources and some characteristics between MED and non-MED countries. These differences should be considered in studies about the relationships between flavonoid intake and chronic diseases

Dietary intakes and food sources of phenolic acids in the European Prospective Investigation into Cancer and Nutrition (EPIC) study

Zamora-Ros R., Rothwell J.A., Scalbert A., Knaze V., Romieu I., Slimani N., Fagherazzi G., Perquier F., Touillaud M., Molina-Montes E., Huerta J.M., Barricarte A., Amiano P., Menendez V., Tumino R., de Magistris M.S., Palli D., Ricceri F., Sieri S., Crowe F.L., Khaw K.T., Wareham N.J., Grote V., Li K., Boeing H., Forster J., Trichopoulou A., Benetou V., Tsiotas K., Bueno-de-Mesquita H.B., Ros M., Peeters P.H., Tjonneland A., Halkjaer J., Overvad K., Ericson U., Wallstrom P., Johansson I., Landberg R., Weiderpass E., Engeset D., Skeie G., Wark P., Riboli E., Gonzalez C.A.

Br. J Nutr; 2013; 110(8): 1500-1511

Abstract as provided by PubMed

Phenolic acids are secondary plant metabolites that may have protective effects against oxidative stress, inflammation and cancer in experimental studies. To date, limited data exist on the quantitative intake of phenolic acids. We estimated the intake of phenolic acids and their food sources and associated lifestyle factors in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Phenolic acid intakes were estimated for 36 037 subjects aged 35-74 years and recruited between 1992 and 2000 in ten European countries using a standardised 24 h recall software (EPIC-Soft), and their food sources were identified. Dietary data were linked to the Phenol-Explorer database, which contains data on forty-five aglycones of phenolic acids in 452 foods. The total phenolic acid intake was highest in Aarhus, Denmark (1265.5 and 980.7 mg/d in men and women, respectively), while the intake was lowest in Greece (213.2 and 158.6 mg/d in men and women, respectively). The hydroxycinnamic acid subclass was the main contributor to the total phenolic acid intake, accounting for 84.6-95.3 % of intake depending on the region. Hydroxybenzoic acids accounted for 4.6-14.4 %, hydroxyphenylacetic acids 0.1-0.8 % and hydroxyphenylpropanoic acids </= 0.1 % for all regions. An increasing south-north gradient of consumption was also found. Coffee was the main food source of phenolic acids and accounted for 55.3-80.7 % of the total phenolic acid intake, followed by fruits, vegetables and nuts. A high heterogeneity in phenolic acid intake was observed across the European countries in the EPIC cohort, which will allow further exploration of the associations with the risk of diseases

Dietary flavonoid and lignan intake and breast cancer risk according to menopause and hormone receptor status in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study

Zamora-Ros R., Ferrari P., Gonzalez C.A., Tjonneland A., Olsen A., Bredsdorff L., Overvad K., Touillaud M., Perquier F., Fagherazzi G., Lukanova A., Tikk K., Aleksandrova K., Boeing H., Trichopoulou A., Trichopoulos D., Dilis V., Masala G., Sieri S., Mattiello A., Tumino R., Ricceri F., Bueno-de-Mesquita H.B., Peeters P.H., Weiderpass E., Skeie G., Engeset D., Menendez V., Travier N., Molina-Montes E., Amiano P., Chirlaque M.D., Barricarte A., Wallstrom P., Sonestedt E., Sund M., Landberg R., Khaw K.T., Wareham N.J., Travis R.C., Scalbert A., Ward H.A., Riboli E., Romieu I.

Breast Cancer Res. Treat; 2013; 139(1): 163-176

Abstract as provided by PubMed

Evidence on the association between dietary flavonoids and lignans and breast cancer (BC) risk is inconclusive, with the possible exception of isoflavones in Asian countries. Therefore, we investigated prospectively dietary total and subclasses of flavonoid and lignan intake and BC risk according to menopause and hormonal receptor status in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. The study included 334,850 women, mostly aged between 35 and 70 years from ten European countries. At baseline, country-specific validated dietary questionnaires were used. A flavonoid and lignan food composition database was developed from the US Department of Agriculture, the Phenol-Explorer and the UK Food Standards Agency databases. Cox regression models were used to analyse the association between dietary flavonoid/lignan intake and the risk of developing BC. During an average 11.5-year follow-up, 11,576 incident BC cases were identified. No association was observed between the intake of total flavonoids [hazard ratio comparing fifth to first quintile (HRQ5-Q1) 0.97, 95 % confidence interval (CI): 0.90-1.04; P trend = 0.591], isoflavones (HRQ5-Q1 1.00, 95 % CI: 0.91-1.10; P trend = 0.734), or total lignans (HRQ5-Q1 1.02, 95 % CI: 0.93-1.11; P trend = 0.469) and overall BC risk. The stratification of the results by menopausal status at recruitment or the differentiation of BC cases according to oestrogen and progesterone receptors did not affect the results. This study shows no associations between flavonoid and lignan intake and BC risk, overall or after taking into account menopausal status and BC hormone receptors

The Association Between Dietary Flavonoid and Lignan Intakes and Incident Type 2 Diabetes in European Populations: The EPIC-InterAct study

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., Clavel-Chapelon F., 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., Quiros J.R., Romieu I., Sacerdote C., Scalbert A., Schulze M., Slimani N., Spijkerman A.M., Tjonneland A., Tormo M.J., Tumino R., van der A.DL, Langenberg C., Riboli E., Wareham N.J.

Diabetes Care; 2013; 36(12): 3961-3970

Abstract as provided by PubMed

OBJECTIVE To study the association between dietary flavonoid and lignan intakes, and the risk of development of type 2 diabetes among European populations. RESEARCH DESIGN AND METHODS The European Prospective Investigation into Cancer and Nutrition-InterAct case-cohort study included 12,403 incident type 2 diabetes cases and a stratified subcohort of 16,154 participants from among 340,234 participants with 3.99 million person-years of follow-up in eight European countries. At baseline, country-specific validated dietary questionnaires were used. A flavonoid and lignan food composition database was developed from the Phenol-Explorer, the U.K. Food Standards Agency, and the U.S. Department of Agriculture databases. Hazard ratios (HRs) from country-specific Prentice-weighted Cox regression models were pooled using random-effects meta-analysis. RESULTS In multivariable models, a trend for an inverse association between total flavonoid intake and type 2 diabetes was observed (HR for the highest vs. the lowest quintile, 0.90 [95% CI 0.77-1.04]; P value trend = 0.040), but not with lignans (HR 0.88 [95% CI 0.72-1.07]; P value trend = 0.119). Among flavonoid subclasses, flavonols (HR 0.81 [95% CI 0.69-0.95]; P value trend = 0.020) and flavanols (HR 0.82 [95% CI 0.68-0.99]; P value trend = 0.012), including flavan-3-ol monomers (HR 0.73 [95% CI 0.57-0.93]; P value trend = 0.029), were associated with a significantly reduced hazard of diabetes. CONCLUSIONS Prospective findings in this large European cohort demonstrate inverse associations between flavonoids, particularly flavanols and flavonols, and incident type 2 diabetes. This suggests a potential protective role of eating a diet rich in flavonoids, a dietary pattern based on plant-based foods, in the prevention of type 2 diabetes

Impact of thearubigins on the estimation of total dietary flavonoids in the European Prospective Investigation into Cancer and Nutrition (EPIC) study

Zamora-Ros R., Knaze V., Romieu I., Scalbert A., Slimani N., Clavel-Chapelon F., Touillaud M., Perquier F., Skeie G., Engeset D., Weiderpass E., Johansson I., Landberg R., Bueno-de-Mesquita H.B., Sieri S., Masala G., Peeters P.H., Grote V., Huerta J.M., Barricarte A., Amiano P., Crowe F.L., Molina-Montes E., Khaw K.T., Arguelles M.V., Tjonneland A., Halkjaer J., de Magistris M.S., Ricceri F., Tumino R., Wirfalt E., Ericson U., Overvad K., Trichopoulou A., Dilis V., Vidalis P., Boeing H., Forster J., Riboli E., Gonzalez C.A.

Eur. J Clin Nutr; 2013; 67(7): 779-782

Abstract as provided by PubMed

Thearubigins (TR) are polymeric flavanol-derived compounds formed during the fermentation of tea leaves. Comprising approximately 70% of total polyphenols in black tea, TR may contribute majorly to its beneficial effects on health. To date, there is no appropriate food composition data on TR, although several studies have used data from the US Department of Agriculture (USDA) database to estimate TR intakes. We aimed to estimate dietary TR in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort and assess the impact of including TR or not in the calculation of the total dietary flavonoid intake. Dietary data were collected using a single standardized 24-h dietary recall interviewer-administered to 36 037 subjects aged 35-74 years. TR intakes were calculated using the USDA database. TR intakes ranged from 0.9 mg/day in men from Navarra and San Sebastian in Spain to 532.5 mg/day in men from UK general population. TR contributed <5% to the total flavonoid intake in Greece, Spain and Italy, whereas in the UK general population, TR comprised 48% of the total flavonoids. High heterogeneity in TR intake across the EPIC countries was observed. This study shows that total flavonoid intake may be greatly influenced by TR, particularly in high black tea-consuming countries. Further research on identification and quantification of TR is needed to get more accurate dietary TR estimations

Dietary flavonoid, lignan and antioxidant capacity and risk of hepatocellular carcinoma in the European prospective investigation into cancer and nutrition study

Zamora-Ros R., Fedirko V., Trichopoulou A., Gonzalez C.A., Bamia C., Trepo E., Nothlings U., Duarte-Salles T., Serafini M., Bredsdorff L., Overvad K., Tjonneland A., Halkjaer J., Fagherazzi G., Perquier F., Boutron-Ruault M.C., Katzke V., Lukanova A., Floegel A., Boeing H., Lagiou P., Trichopoulos D., Saieva C., Agnoli C., Mattiello A., Tumino R., Sacerdote C., Bueno-de-Mesquita H.B., Peeters P.H., Weiderpass E., Engeset D., Skeie G., Arguelles M.V., Molina-Montes E., Dorronsoro M., Tormo M.J., Ardanaz E., Ericson U., Sonestedt E., Sund M., Landberg R., Khaw K.T., Wareham N.J., Crowe F.L., Riboli E., Jenab M.

Int. J Cancer; 2013; 133(10): 2429-2443

Abstract as provided by PubMed

Limited epidemiological evidence suggests a protective role for plant foods rich in flavonoids and antioxidants in hepatocellular cancer (HCC) etiology. Our aim was to prospectively investigate the association between dietary intake of flavonoids, lignans and nonenzymatic antioxidant capacity (NEAC) and HCC risk. Data from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort including 477,206 subjects (29.8% male) recruited from ten Western European countries, was analyzed. Flavonoid, lignan and NEAC intakes were calculated using a compilation of existing food composition databases linked to dietary information from validated dietary questionnaires. Dietary NEAC was based on ferric reducing antioxidant capacity (FRAP) and total radical-trapping antioxidant parameter (TRAP). Hepatitis B/C status was measured in a nested case-control subset. During a mean follow-up of 11-years, 191 incident HCC cases (66.5% men) were identified. Using Cox regression, multivariable adjusted models showed a borderline nonsignificant association of HCC with total flavonoid intake (highest versus lowest tertile, HR = 0.65, 95% CI: 0.40-1.04; p(trend) = 0.065), but not with lignans. Among flavonoid subclasses, flavanols were inversely associated with HCC risk (HR = 0.62, 95% CI: 0.39-0.99; p(trend) = 0.06). Dietary NEAC was inversely associated with HCC (FRAP: HR 0.50, 95% CI: 0.31-0.81; p(trend) = 0.001; TRAP: HR 0.49, 95% CI: 0.31-0.79; p(trend) = 0.002), but statistical significance was lost after exclusion of the first 2 years of follow-up. This study suggests that higher intake of dietary flavanols and antioxidants may be associated with a reduced HCC risk

2012

Impact of cigarette smoking on cancer risk in the European prospective investigation into cancer and nutrition study

Agudo A., Bonet C., Travier N., Gonzalez C.A., Vineis P., Bueno-de-Mesquita H.B., Trichopoulos D., Boffetta P., Clavel-Chapelon F., Boutron-Ruault M.C., Kaaks R., Lukanova A., Schutze M., Boeing H., Tjonneland A., Halkjaer J., Overvad K., Dahm C.C., Quiros J.R., Sanchez M.J., Larranaga N., Navarro C., Ardanaz E., Khaw K.T., Wareham N.J., Key T.J., Allen N.E., Trichopoulou A., Lagiou P., Palli D., Sieri S., Tumino R., Panico S., Boshuizen H., Buchner F.L., Peeters P.H., Borgquist S., Almquist M., Hallmans G., Johansson I., Gram I.T., Lund E., Weiderpass E., Romieu I., Riboli E.

J Clin Oncol; 2012; 30(36): 4550-4557

Abstract as provided by PubMed

PURPOSE: Our aim was to assess the impact of cigarette smoking on the risk of the tumors classified by the International Agency for Research on Cancer as causally associated with smoking, referred to as tobacco-related cancers (TRC). METHODS: The study population included 441,211 participants (133,018 men and 308,193 women) from the European Prospective Investigation Into Cancer and Nutrition. We investigated 14,563 participants who developed a TRC during an average follow-up of 11 years. The impact of smoking cigarettes on cancer risk was assessed by the population attributable fraction (AF(p)), calculated using the adjusted hazard ratios and 95% CI for current and former smokers, plus either the prevalence of smoking among cancer cases or estimates from surveys in representative samples of the population in each country. RESULTS: The proportion of all TRC attributable to cigarette smoking was 34.9% (95% CI, 32.5 to 37.4) using the smoking prevalence among cases and 36.2% (95% CI, 33.7 to 38.6) using the smoking prevalence from the population. The AF(p) were above 80% for cancers of the lung and larynx, between 20% and 50% for most respiratory and digestive cancers and tumors from the lower urinary tract, and below 20% for the remaining TRC. CONCLUSION: Using data on cancer incidence for 2008 and our AF(p) estimates, about 270,000 new cancer diagnoses per year can be considered attributable to cigarette smoking in the eight European countries with available data for both men and women (Italy, Spain, United Kingdom, the Netherlands, Greece, Germany, Sweden, Denmark)

Leptin and soluble leptin receptor in risk of colorectal cancer in the European Prospective Investigation into Cancer and Nutrition cohort

Aleksandrova K., Boeing H., Jenab M., Bueno-de-Mesquita H.B., Jansen E., van Duijnhoven F.J., Rinaldi S., Fedirko V., Romieu I., Riboli E., Gunter M.J., Westphal S., Overvad K., Tjonneland A., Halkjaer J., Racine A., Boutron-Ruault M.C., Clavel-Chapelon F., Kaaks R., Lukanova A., Trichopoulou A., Lagiou P., Trichopoulos D., Mattiello A., Pala V., Palli D., Tumino R., Vineis P., Buckland G., Sanchez M.J., Amiano P., Huerta J.M., Barricarte A., Menendez V., Peeters P.H., Soderberg S., Palmqvist R., Allen N.E., Crowe F.L., Khaw K.T., Wareham N., Pischon T.

Cancer Res; 2012; 72(20): 5328-5337

Abstract as provided by PubMed

Leptin, a peptide hormone produced primarily by the adipocytes, is hypothesized to play a role in the pathogenesis of colorectal cancer (CRC). Soluble leptin receptor (sOB-R) may regulate leptin's physiologic functions; however its relation to CRC risk is unknown. This study explored the association of leptin and sOB-R with risk of CRC in a prospective nested case-control study within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. A total of 1,129 incident CRC cases (713 colon, 416 rectal) were matched within risk sets to 1,129 controls. Conditional logistic regression was used to calculate relative risks (RR) and 95% confidence intervals (CI). After multivariable adjustment including body mass index (BMI), waist circumference, and baseline leptin concentrations, sOB-R was strongly inversely associated with CRC (RR comparing the highest quintile vs. the lowest, 0.55; 95% CI, 0.40-0.76; P(trend) = 0.0004) and colon cancer (RR, 0.42; 95% CI, 0.28-0.63, P(trend) = 0.0001); whereas no association was seen for rectal cancer (RR adjusted for BMI and waist circumference, 0.83; 95% CI, 0.48-1.44, P(trend) = 0.38). In contrast, leptin was not associated with risk of CRC (RR adjusted for BMI and waist circumference, 0.85; 95% CI, 0.56-1.29, P(trend) = 0.23). Additional adjustments for circulating metabolic biomarkers did not attenuate these results. These novel findings suggest a strong inverse association between circulating sOB-R and CRC risk, independent of obesity measures, leptin concentrations, and other metabolic biomarkers. Further research is needed to confirm the potentially important role of sOB-R in CRC pathogenesis

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