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2010

Mediterranean dietary patterns and prospective weight change in participants of the EPIC-PANACEA project

Romaguera D., Norat T., Vergnaud A.C., Mouw T., May A.M., Agudo A., Buckland G., Slimani N., Rinaldi S., Couto E., Clavel-Chapelon F., Boutron-Ruault M.C., Cottet V., Rohrmann S., Teucher B., Bergmann M., Boeing H., Tjonneland A., Halkjaer J., Jakobsen M.U., Dahm C.C., Travier N., Rodriguez L., Sanchez M.J., Amiano P., Barricarte A., Huerta J.M., Luan J., Wareham N., Key T.J., Spencer E.A., Orfanos P., Naska A., Trichopoulou A., Palli D., Agnoli C., Mattiello A., Tumino R., Vineis P., Bueno-de-Mesquita H.B., Buchner F.L., Manjer J., Wirfalt E., Johansson I., Hellstrom V., Lund E., Braaten T., Engeset D., Odysseos A., Riboli E., Peeters P.H.

Am J Clin Nutr; 2010; 92(4): 912-921

Abstract as provided by PubMed

BACKGROUND: There is an association between a greater adherence to a Mediterranean diet and a reduced risk of developing chronic diseases. However, it is not clear whether this dietary pattern may be protective also against the development of obesity. OBJECTIVE: We assessed the association between the adherence to the Mediterranean dietary pattern (MDP), prospective weight change, and the incidence of overweight or obesity. DESIGN: We conducted a prospective cohort study [the European Prospective Investigation into Cancer and Nutrition-Physical Activity, Nutrition, Alcohol Consumption, Cessation of Smoking, Eating Out of Home, and Obesity (EPIC-PANACEA) project] in 373,803 individuals (103,455 men and 270,348 women; age range: 25-70 y) from 10 European countries. Anthropometric measurements were obtained at recruitment and after a median follow-up time of 5 y. The relative Mediterranean Diet Score (rMED; score range: 0-18) was used to assess adherence to the MDP according to the consumption of 9 dietary components that are characteristic of the Mediterranean diet. The association between the rMED and 5-y weight change was modeled through multiadjusted mixed-effects linear regression. RESULTS: Individuals with a high adherence to the MDP according to the rMED (11-18 points) showed a 5-y weight change of -0.16 kg (95% CI: -0.24, -0.07 kg) and were 10% (95% CI: 4%, 18%) less likely to develop overweight or obesity than were individuals with a low adherence to the MDP (0-6 points). The low meat content of the Mediterranean diet seemed to account for most of its positive effect against weight gain. CONCLUSION: This study shows that promoting the MDP as a model of healthy eating may help to prevent weight gain and the development of obesity

Plasma cytokines and future risk of non-Hodgkin lymphoma (NHL): a case-control study nested in the Italian European Prospective Investigation into Cancer and Nutrition

Saberi Hosnijeh F., Krop E.J., Scoccianti C., Krogh V., Palli D., Panico S., Tumino R., Sacredote C., Nawroly N., Portengen L., Linseisen J., Vineis P., Vermeulen R.

Cancer Epidemiol Biomarkers Prev; 2010; 19(6): 1577-1584

Abstract as provided by PubMed

BACKGROUND: Recently, biological markers related to the immune system such as cytokines have been studied to further understand the etiology of non-Hodgkin Lymphoma (NHL). However, to date, there are no studies that have studied cytokine levels prospectively in relation to NHL risk in the general population. METHODS: Using bead-based immunoassays, plasma levels of 11 cytokines, 4 chemokines, and 1 adhesion molecules were measured in prediagnostic blood samples of 86 NHL cases and 86 matched controls (average time between blood collection and diagnosis, 4.5 y). Conditional logistic regression adjusted for body mass index and alcohol consumption was used to analyze the association between individual plasma cytokine levels and the risk of developing NHL. RESULTS: In multivariate models, excluding cases diagnosed within 2 years after inclusion, we observed a significant association for interleukin 2 (IL2; P trend = 0.004), interferon (IFN)-gamma (P trend = 0.05), and intercellular adhesion molecule (ICAM) (P trend = 0.04). Subanalyses of B-cell NHL patients showed a significant association with IL2 (P trend = 0.003), tumor necrosis factor-alpha (TNF-alpha; P trend = 0.03), and ICAM (P trend = 0.04) and a borderline association with IL5 (P trend = 0.07) and IFN-gamma (P trend = 0.08). CONCLUSIONS: The results of this study suggest, in a prospective setting, a possible association between plasma levels of IL2, ICAM, IFN-gamma, and TNF-alpha with NHL risk and provide some evidence that risk of NHL might be related to a downregulation of T helper 1 cytokines. IMPACT: Identification of subtle changes in immune response regulation quantified by plasma cytokine levels possibly provides new insights in the etiology of NHL

Oral contraceptives, reproductive history and risk of colorectal cancer in the European Prospective Investigation into Cancer and Nutrition

Tsilidis K.K., Allen N.E., Key T.J., Bakken K., Lund E., Berrino F., Fournier A., Olsen A., Tjonneland A., Overvad K., Boutron-Ruault M.C., Clavel-Chapelon F., Byrnes G., Chajes V., Rinaldi S., Chang-Claude J., Kaaks R., Bergmann M., Boeing H., Koumantaki Y., Stasinopoulou G., Trichopoulou A., Palli D., Tagliabue G., Panico S., Tumino R., Vineis P., Bueno-de-Mesquita H.B., van Duijnhoven F.J., Van Gils C.H., Peeters P.H., Rodriguez L., Gonzalez C.A., Sanchez M.J., Chirlaque M.D., Barricarte A., Dorronsoro M., Borgquist S., Manjer J., Van Guelpen B., Hallmans G., Rodwell S.A., Khaw K.T., Norat T., Romaguera D., Riboli E.

Br J Cancer; 2010; 103(11): 1755-1759

Abstract as provided by PubMed

Background:Oral contraceptive use and reproductive factors may initiate long-term changes to the hormonal milieu and thereby, possibly influence colorectal cancer risk.Methods:We examined the association of hormonal and reproductive factors with risk of colorectal cancer among 337 802 women in the European Prospective Investigation into Cancer and Nutrition, of whom 1878 developed colorectal cancer.Results:After stratification for center and age, and adjustment for body mass index, smoking, diabetes mellitus, physical activity and alcohol consumption, ever use of oral contraceptives was marginally inversely associated with colorectal cancer risk (hazard ratio (HR), 0.92; 95% confidence interval (CI), 0.83-1.02), although this association was stronger among post-menopausal women (HR, 0.84; 95% CI: 0.74-0.95). Duration of oral contraceptive use and reproductive factors, including age at menarche, age at menopause, type of menopause, ever having an abortion, parity, age at first full-term pregnancy and breastfeeding, were not associated with colorectal cancer risk.Conclusion:Our findings provide limited support for a potential inverse association between oral contraceptives and colorectal cancer risk

No association between educational level and pancreatic cancer incidence in the European Prospective Investigation into Cancer and Nutrition

van Boeckel P.G., Boshuizen H.C., Siersema P.D., Vrieling A., Kunst A.E., Ye W., Sund M., Michaud D.S., Gallo V., Spencer E.A., Trichopoulou A., Benetou V., Orfanos P., Cirera L., Duell E.J., Rohrmann S., Hemann S., Masala G., Manjer J., Mattiello A., Lindkvist B., Sanchez M.J., Pala V., Peeters P.H., Braaten T., Tjonneland A., Dalton S.O., Larranaga N., Dorronsoro M., Overvad K., Illner A.K., Ardanaz E., Marron M., Straif K., Riboli E., Bueno-de-Mesquita B.

Cancer Epidemiol; 2010; 34(6): 696-701

Abstract as provided by PubMed

INTRODUCTION: Until now, studies examining the relationship between socioeconomic status and pancreatic cancer incidence have been inconclusive. AIM: To prospectively investigate to what extent pancreatic cancer incidence varies according to educational level within the European Prospective Investigation into Cancer and Nutrition (EPIC) study. METHODS: In the EPIC study, socioeconomic status at baseline was measured using the highest level of education attained. Hazard ratios by educational level and a summary index, the relative indices of inequality (RII), were estimated using Cox regression models stratified by age, gender, and center and adjusted for known risk factors. In addition, we conducted separate analyses by age, gender and geographical region. RESULTS: Within the source population of 407, 944 individuals at baseline, 490 first incident primary pancreatic adenocarcinoma cases were identified in 9 European countries. The crude difference in risk of pancreatic cancer according to level of education was small and not statistically significant (RII=1.14, 95% CI 0.80-1.62). Adjustment for known risk factors reduced the inequality estimates to only a small extent. In addition, no statistically significant associations were observed for age groups (adjusted RII(</= 60 years)=0.85, 95% CI 0.44-1.64, adjusted RII(>60 years)=1.18, 95% CI 0.73-1.90), gender (adjusted RII(male)=1.20, 95% CI 0.68-2.10, adjusted RII(female)=0.96, 95% CI 0.56-1.62) or geographical region (adjusted RII(Northern Europe)=1.14, 95% CI 0.81-1.61, adjusted RII(Middle Europe)=1.72, 95% CI 0.93-3.19, adjusted RII(Southern Europe)=0.75, 95% CI 0.32-1.80). CONCLUSION: Despite large educational inequalities in many risk factors within the EPIC study, we found no evidence for an association between educational level and the risk of developing pancreatic cancer in this European cohort

Meat consumption and prospective weight change in participants of the EPIC-PANACEA study

Vergnaud A.C., Norat T., Romaguera D., Mouw T., May A.M., Travier N., Luan J., Wareham N., Slimani N., Rinaldi S., Couto E., Clavel-Chapelon F., Boutron-Ruault M.C., Cottet V., Palli D., Agnoli C., Panico S., Tumino R., Vineis P., Agudo A., Rodriguez L., Sanchez M.J., Amiano P., Barricarte A., Huerta J.M., Key T.J., Spencer E.A., Bueno-de-Mesquita B., Buchner F.L., Orfanos P., Naska A., Trichopoulou A., Rohrmann S., Hermann S., Boeing H., Buijsse B., Johansson I., Hellstrom V., Manjer J., Wirfalt E., Jakobsen M.U., Overvad K., Tjonneland A., Halkjaer J., Lund E., Braaten T., Engeset D., Odysseos A., Riboli E., Peeters P.H.

Am J Clin Nutr; 2010; 92(2): 398-407

Abstract as provided by PubMed

BACKGROUND: Meat intake may be related to weight gain because of its high energy and fat content. Some observational studies have shown that meat consumption is positively associated with weight gain, but intervention studies have shown mixed results. OBJECTIVE: Our objective was to assess the association between consumption of total meat, red meat, poultry, and processed meat and weight gain after 5 y of follow-up, on average, in the large European population who participated in the European Prospective Investigation into Cancer and Nutrition-Physical Activity, Nutrition, Alcohol, Cessation of Smoking, Eating Out of Home and Obesity (EPIC-PANACEA) project. DESIGN: A total of 103,455 men and 270,348 women aged 25-70 y were recruited between 1992 and 2000 in 10 European countries. Diet was assessed at baseline with the use of country-specific validated questionnaires. A dietary calibration study was conducted in a representative subsample of the cohort. Weight and height were measured at baseline and self-reported at follow-up in most centers. Associations between energy from meat (kcal/d) and annual weight change (g/y) were assessed with the use of linear mixed models, controlled for age, sex, total energy intake, physical activity, dietary patterns, and other potential confounders. RESULTS: Total meat consumption was positively associated with weight gain in men and women, in normal-weight and overweight subjects, and in smokers and nonsmokers. With adjustment for estimated energy intake, an increase in meat intake of 250 g/d (eg, one steak at approximately 450 kcal) would lead to a 2-kg higher weight gain after 5 y (95% CI: 1.5, 2.7 kg). Positive associations were observed for red meat, poultry, and processed meat. CONCLUSION: Our results suggest that a decrease in meat consumption may improve weight management

Cigarette smoking, environmental tobacco smoke exposure and pancreatic cancer risk in the European Prospective Investigation into Cancer and Nutrition

Vrieling A., Bueno-de-Mesquita H.B., Boshuizen H.C., Michaud D.S., Severinsen M.T., Overvad K., Olsen A., Tjonneland A., Clavel-Chapelon F., Boutron-Ruault M.C., Kaaks R., Rohrmann S., Boeing H., Nothlings U., Trichopoulou A., Moutsiou E., Dilis V., Palli D., Krogh V., Panico S., Tumino R., Vineis P., Van Gils C.H., Peeters P.H., Lund E., Gram I.T., Rodriguez L., Agudo A., Larranaga N., Sanchez M.J., Navarro C., Barricarte A., Manjer J., Lindkvist B., Sund M., Ye W., Bingham S., Khaw K.T., Roddam A., Key T., Boffetta P., Duell E.J., Jenab M., Gallo V., Riboli E.

Int J Cancer; 2010; 126(10): 2394-2403

Abstract as provided by PubMed

Cigarette smoking is an established risk factor for pancreatic cancer. However, prospective data for most European countries are lacking, and epidemiologic studies on exposure to environmental tobacco smoke (ETS) in relation to pancreatic cancer risk are scarce. We examined the association of cigarette smoking and exposure to ETS with pancreatic cancer risk within the European Prospective Investigation into Cancer and Nutrition (EPIC). This analysis was based on 465,910 participants, including 524 first incident pancreatic cancer cases diagnosed after a median follow-up of 8.9 years. Estimates of risk were obtained by Cox proportional hazard models and adjusted for weight, height, and history of diabetes mellitus. An increased risk of pancreatic cancer was found for current cigarette smokers compared with never smokers (HR = 1.71, 95% CI = 1.36-2.15), and risk increased with greater intensity and pack-years. Former cigarette smokers who quit for less than 5 years were at increased risk of pancreatic cancer (HR = 1.78, 95% CI = 1.23-2.56), but risk was comparable to never smokers after quitting for 5 years or more. Pancreatic cancer risk was increased among never smokers daily exposed to ETS (for many hours) during childhood (HR = 2.61, 95% CI = 0.96-7.10) and exposed to ETS at home and/or work (HR = 1.54, 95% CI = 1.00-2.39). These results suggest that both active cigarette smoking, as well as exposure to ETS, is associated with increased risk of pancreatic cancer and that risk is reduced to levels of never smokers within 5 years of quitting

2009

A prospective analysis of the association between macronutrient intake and renal cell carcinoma in the European Prospective Investigation into Cancer and Nutrition

Allen N.E., Roddam A.W., Sieri S., Boeing H., Jakobsen M.U., Overvad K., Tjonneland A., Halkjaer J., Vineis P., Contiero P., Palli D., Tumino R., Mattiello A., Kaaks R., Rohrmann S., Trichopoulou A., Zilis D., Koumantaki Y., Peeters P.H., Bueno-de-Mesquita H.B., Barricarte A., Rodriguez L., Dorronsoro M., Sanchez M.J., Chirlaque M.D., Esquius L., Manjer J., Wallstrom P., Ljungberg B., Hallmans G., Bingham S., Khaw K.T., Boffetta P., Norat T., Mouw T., Riboli E.

Int J Cancer; 2009; 125(4): 982-987

Abstract as provided by PubMed

Previous case-control studies have suggested that a high intake of animal foods and its associated nutrients are associated with an increased risk of renal cell carcinoma, although data from prospective studies are limited. We report here on the relationship between macronutrient intake and renal cell carcinoma incidence among 435,293 participants enrolled in the European Prospective Investigation into Cancer and Nutrition. Cox proportional hazard models were used to examine the association of dietary intake of fat, protein, carbohydrate, fiber and cholesterol and risk of renal cell carcinoma adjusted for age, sex, center, height, body mass index, physical activity, education, smoking, menopausal status, alcohol and energy intake. During an average 8.8 years of follow-up, 507 renal cell carcinoma cases occurred. Risk of renal cell carcinoma was not associated with macronutrient intake, including nutrients derived from animal sources. Our results indicate that macronutrient intake is not associated with risk of renal cell carcinoma in this cohort of European men and women

A cross-sectional analysis of physical activity and obesity indicators in European participants of the EPIC-PANACEA study

Besson H., Ekelund U., Luan J., May A.M., Sharp S., Travier N., Agudo A., Slimani N., Rinaldi S., Jenab M., Norat T., Mouw T., Rohrmann S., Kaaks R., Bergmann M., Boeing H., Clavel-Chapelon F., Boutron-Ruault M.C., Overvad K., Andreasen E.L., Johnsen N.F., Halkjaer J., Gonzalez C., Rodriguez L., Sanchez M.J., Arriola L., Barricarte A., Navarro C., Key T.J., Spencer E.A., Orfanos P., Naska A., Trichopoulou A., Manjer J., Wirfalt E., Lund E., Palli D., Agnoli C., Vineis P., Panico S., Tumino R., Bueno-de-Mesquita H.B., van den Berg S.W., Odysseos A.D., Riboli E., Wareham N.J., Peeters P.H.

Int J Obes (Lond); 2009; 33(4): 497-506

Abstract as provided by PubMed

OBJECTIVES: Cross-sectional data suggest a strong association between low levels of physical activity and obesity. The EPIC-PANACEA (European Prospective Investigation into Cancer-Physical Activity, Nutrition, Alcohol, Cessation of Smoking, Eating out of home And obesity) project was designed to investigate the associations between physical activity and body mass index (BMI) and waist circumference based on individual data collected across nine European countries. METHODS: In the European Prospective Investigation into Cancer and Nutrition (EPIC), 519 931 volunteers were recruited between 1992 and 2000, of whom 405 819 had data on main variables of interest. Height, body weight and waist circumference were measured using standardized procedures. Physical activity was assessed using a validated four-category index reflecting a self-reported usual activity during work and leisure time. The associations between physical activity and BMI and waist circumference were estimated using multilevel mixed effects linear regression models, adjusted for age, total energy intake, smoking status, alcohol consumption and educational level. RESULTS: A total of 125 629 men and 280 190 women with a mean age of 52.9 (s.d. 9.7) and 51.5 (s.d. 10.0) years, respectively were included. The mean BMI was 26.6 kg/m(2) (s.d. 3.6) in men and 25.0 kg/m(2) (s.d. 4.5) in women. Fifty percent of men and 30% of women were categorized as being active or moderately active. A one-category difference in the physical activity index was inversely associated with a difference of 0.18 kg/m(2) in the mean BMI (95% confidence interval, CI, 0.11, 0.24) and 1.04-cm (95% CI 0.82, 1.26) difference in waist circumference in men. The equivalent figures for women were 0.31 kg/m(2) (95% CI 0.23, 0.38) and 0.90 cm (95% CI 0.71, 1.08), respectively. CONCLUSIONS: Physical activity is inversely associated with both BMI and waist circumference across nine European countries. Although we cannot interpret the association causally, our results were observed in a large and diverse cohort independently from many potential confounders

Consumption of vegetables and fruit and the risk of bladder cancer in the European Prospective Investigation into Cancer and Nutrition

Buchner F.L., Bueno-de-Mesquita H.B., Ros M.M., Kampman E., Egevad L., Overvad K., Raaschou-Nielsen O., Tjonneland A., Roswall N., Clavel-Chapelon F., Boutron-Ruault M.C., Touillaud M., Chang-Claude J., Kaaks R., Boeing H., Weikert S., Trichopoulou A., Lagiou P., Trichopoulos D., Palli D., Sieri S., Vineis P., Tumino R., Panico S., Vrieling A., Peeters P.H., Van Gils C.H., Lund E., Gram I.T., Engeset D., Martinez C., Gonzalez C.A., Larranaga N., Ardanaz E., Navarro C., Rodriguez L., Manjer J., Ehrnstrom R.A., Hallmans G., Ljungberg B., Allen N.E., Roddam A.W., Bingham S., Khaw K.T., Slimani N., Boffetta P., Jenab M., Mouw T., Michaud D.S., Kiemeney L.A., Riboli E.

Int J Cancer; 2009; 125(11): 2643-2651

Abstract as provided by PubMed

Previous epidemiologic studies found inconsistent associations between vegetables and fruit consumption and the risk of bladder cancer. We therefore investigated the association between vegetable and fruit consumption and the risk of bladder cancer among participants of the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Data on food consumption and complete follow-up for cancer occurrence was available for a total of 478,533 participants, who were recruited in 10 European countries. Estimates of rate ratios were obtained by Cox proportional hazard models, stratified by age at recruitment, gender and study centre, and adjusted for total energy intake, smoking status, duration of smoking and lifetime intensity of smoking. A calibration study in a subsample was used to control for dietary measurement errors. After a mean follow-up of 8.7 years, 1015 participants were newly diagnosed with bladder cancer. Increments of 100 g/day in fruit and vegetable consumption combined did not affect bladder cancer risk (i.e., calibrated HR = 0.98; 95%CI: 0.95-1.01). Borderline statistically significant lower bladder cancer risks were found among never smokers with increased consumption of fruit and vegetables combined (HR = 0.94 95%CI: 0.87-1.00 with increments of 100 g/day; calibrated HR = 0.92 95%CI 0.79-1.06) and increased consumption of apples and pears (hard fruit; calibrated HR = 0.90 95%CI: 0.82-0.98 with increments of 25 g/day). For none of the associations a statistically significant interaction with smoking status was found. Our findings do not support an effect of fruit and vegetable consumption, combined or separately, on bladder cancer risk

The Association between Diet and Serum Concentrations of IGF-I, IGFBP-1, IGFBP-2, and IGFBP-3 in the European Prospective Investigation into Cancer and Nutrition

Crowe F.L., Key T.J., Allen N.E., Appleby P.N., Roddam A., Overvad K., Gronbaek H., Tjonneland A., Halkjaer J., Dossus L., Boeing H., Kroger J., Trichopoulou A., Dilis V., Trichopoulos D., Boutron-Ruault M.C., De Lauzon B., Clavel-Chapelon F., Palli D., Berrino F., Panico S., Tumino R., Sacerdote C., Bueno-de-Mesquita H.B., Vrieling A., Van Gils C.H., Peeters P.H., Gram I.T., Skeie G., Lund E., Rodriguez L., Jakszyn P., Molina-Montes E., Tormo M.J., Barricarte A., Larranaga N., Khaw K.T., Bingham S., Rinaldi S., Slimani N., Norat T., Gallo V., Riboli E., Kaaks R.

Cancer Epidemiol Biomarkers Prev; 2009; 18(5): 1333-1340

Abstract as provided by PubMed

Circulating concentrations of insulin-like growth factor I (IGF-I) and IGF binding proteins (IGFBP) have been associated with the risk of several types of cancer. Dietary correlates of IGF-I and IGFBPs are not yet well established. The objective of this study was to assess the association between dietary intake and serum concentrations of IGF-I, IGFBP-1, IGFBP-2, and IGFBP-3 in a cross-sectional analysis of 4,731 men and women taking part in the European Prospective Investigation into Cancer and Nutrition. Diet was assessed using country-specific validated dietary questionnaires. Serum concentrations of IGF-I, IGFBP-1, IGFBP-2 and IGFBP-3 were measured, and the associations between diet and IGF-I and IGFBPs were assessed using multiple linear regression adjusting for sex, age, body mass index, smoking status, and alcohol and energy intake. Each 1 SD increment increase in total and dairy protein and calcium intake was associated with an increase in IGF-I concentration of 2.5%, 2.4%, and 3.3%, respectively (P for trend <0.001 for all) and a decrease in IGFBP-2 of 3.5%, 3.5%, and 5.4% (P for trend <0.001 for all), respectively. There were no significant associations between the intake of protein or calcium from nondairy sources and IGF-I. The results from this large cross-sectional analysis show that either the intake of dairy protein or calcium is an important dietary determinant of IGF-I and IGFBP-2 concentrations; however, we suggest that it is more likely to be protein from dairy products. (Cancer Epidemiol Biomarkers Prev 2009;18(5):1333-40)

Total dietary carbohydrate, sugar, starch and fibre intakes in the European Prospective Investigation into Cancer and Nutrition

Cust A.E., Skilton M.R., van Bakel M.M.E., Halkjaer J., Olsen A., Agnoli C., Psaltopoulou T., Buurma E., Sonestedt E., Chirlaque M.D., Rinaldi S., Tjonneland A., Jensen M.K., Clavel-Chapelon F., Boutron-Ruault M.C., Kaaks R., Nothlings U., Chloptsios Y., Zylis D., Mattiello A., Caini S., Ocke M.C., van der Schouw Y.T., Skeie G., Parr C.L., Molina-Montes E., Manjer J., Johansson I., McTaggart A., Key T.J., Bingham S., Riboli E., Slimani N.

Eur J Clin Nutr; 2009; S37-S60

Abstract as provided by PubMed

Objective: To describe dietary carbohydrate intakes and their food sources among 27 centres in 10 countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Methods: Between 1995 and 2000, 36 034 subjects, aged between 35-74 years, were administered a standardized, 24-h dietary recall using a computerized interview software programme (EPIC-SOFT). Intakes (g/day) of total carbohydrate, sugars, starch and fibre were estimated using the standardized EPIC Nutrient Database (ENDB). Mean intakes were adjusted for age, total energy intake, height and weight, and were weighted by season and day of recall. Results: Adjusted mean total carbohydrate intakes were highest in Italy and in the UK health-conscious cohort, and were lowest in Spain, Greece and France. Total fibre intakes were highest in the UK health-conscious cohort and lowest in Sweden and the UK general population. Bread contributed the highest proportion of carbohydrates (mainly starches) in every centre. Fruit consumption contributed a greater proportion of total carbohydrates (mainly sugars) among women than among men, and in southern centres compared with northern centres. Bread, fruits and vegetables represented the largest sources of fibre, but food sources varied considerably between centres. In stratified analyses, carbohydrate intakes tended to be higher among subjects who were physically active, never-smokers or non-drinkers of alcohol. Conclusions: Dietary carbohydrate intakes and in particular their food sources varied considerably between these 10 European countries. Intakes also varied according to gender and lifestyle factors. These data will form the basis for future aetiological analyses of the role of dietary carbohydrates in influencing health and disease. European Journal of Clinical Nutrition (2009) 63, S37-S60; doi: 10.1038/ejcn.2009.74

Reproducibility and relative validity of dietary glycaemic index and glycaemic load assessed by the food-frequency questionnaire used in the Dutch cohorts of the European Prospective Investigation into Cancer and Nutrition

Du H., van der A D.L., van Bakel M.M., Verberne L.D., Ocke M., Feskens E.J.

Br J Nutr; 2009; 102(4): 601-604

Abstract as provided by PubMed

Limited information is available on the reproducibility and validity of dietary glycaemic index (GI) and glycaemic load (GL) estimated by habitual diet assessment methods such as FFQ, including the FFQ used in the Dutch cohorts of the European Prospective Investigation into Cancer and Nutrition study. To examine the reproducibility and relative validity of GI and GL, we used data from 121 Dutch men and women aged 23-72 years. They completed the FFQ three times at intervals of 6 months and twelve 24-h dietary recalls (24HDR) monthly during 1991-2. GI and GL were calculated using published values. Intra-class correlation coefficients of the three repeated FFQ were 0.78 for GI and 0.74 for GL. Pearson correlation coefficients between the first FFQ and the weighted average of the 24HDR were 0.63 for both GI and GL. Weighted kappa values between the first FFQ and the average of the 24HDR (in quintiles) were 0.40 for GI and 0.41 for GL. Bland-Altman plots showed a proportional bias in GI (beta = 0.46), but not in GL (beta = 0.06). In conclusion, this FFQ can be used in epidemiological studies to investigate the relationship of GI and GL with disease risks, but the proportional bias should be taken into account when using this FFQ to assess the absolute GI values

A bivariate measurement error model for nitrogen and potassium intakes to evaluate the performance of regression calibration in the European Prospective Investigation into Cancer and Nutrition study

Ferrari P., Roddam A., Fahey M.T., Jenab M., Bamia C., Ocke M., Amiano P., Hjartaker A., Biessy C., Rinaldi S., Huybrechts I., Tjonneland A., Dethlefsen C., Niravong M., Clavel-Chapelon F., Linseisen J., Boeing H., Oikonomou E., Orfanos P., Palli D., de Magistris M.S., Bueno-de-Mesquita H.B., Peeters P.H.M., Parr C.L., Braaten T., Dorronsoro M., Berenguer T., Gullberg B., Johansson I., Welch A.A., Riboli E., Bingham S., Slimani N.

Eur J Clin Nutr; 2009; S179-S187

Abstract as provided by PubMed

Objectives: Within the European Prospective Investigation into Cancer and Nutrition (EPIC) study, the performance of 24-h dietary recall (24-HDR) measurements as reference measurements in a linear regression calibration model is evaluated critically at the individual (within-centre) and aggregate (between-centre) levels by using unbiased estimates of urinary measurements of nitrogen and potassium intakes. Methods: Between 1995 and 1999, 1072 study subjects (59% women) from 12 EPIC centres volunteered to collect 24-h urine samples. Log-transformed questionnaire, 24-HDR and urinary measurements of nitrogen and potassium intakes were analysed in a multivariate measurement error model to estimate the validity of coefficients and error correlations in self-reported dietary measurements. In parallel, correlations between means of 24-HDR and urinary measurements were computed. Linear regression calibration models were used to estimate the regression dilution (attenuation) factors. Results: After adjustment for sex, centre, age, body mass index and height, the validity coefficients for 24-HDRs were 0.285 (95% confidence interval: 0.194, 0.367) and 0.371 (0.291, 0.446) for nitrogen and potassium intakes, respectively. The attenuation factors estimated in a linear regression calibration model were 0.368 (0.228, 0.508) for nitrogen and 0.500 (0.361, 0.639) for potassium intakes; only the former was different from the estimate obtained using urinary measurements in the measurement error model. The aggregate-level correlation coefficients between means of urinary and 24-HDR measurements were 0.838 (0.637, 0.932) and 0.756 (0.481, 0.895) for nitrogen and potassium intakes, respectively. Conclusions: This study suggests that 24-HDRs can be used as reference measurements at the individual and aggregate levels for potassium intake, whereas, for nitrogen intake, good performance is observed for between-centre calibration, but some limitations are apparent at the individual level. European Journal of Clinical Nutrition (2009) 63, S179-S187; doi: 10.1038/ejcn.2009.80

Intake of total, animal and plant proteins, and their food sources in 10 countries in the European Prospective Investigation into Cancer and Nutrition

Halkjaer J., Olsen A., Bjerregaard L.J., Deharveng G., Tjonneland A., Welch A.A., Crowe F.L., Wirfalt E., Hellstrom V., Niravong M., Touvier M., Linseisen J., Steffen A., Ocke M.C., Peeters P.H.M., Chirlaque M.D., Larranaga N., Ferrari P., Contiero P., Frasca G., Engeset D., Lund E., Misirli G., Kosti M., Riboli E., Slimani N., Bingham S.

Eur J Clin Nutr; 2009; S16-S36

Abstract as provided by PubMed

Objective: To describe dietary protein intakes and their food sources among 27 redefined centres in 10 countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC). Methods: Between 1995 and 2000, 36 034 persons, aged between 35 and 74 years, were administered a standardized 24-h dietary recall (24-HDR) using a computerized interview software programme (EPIC-SOFT). Intakes (g/day) of total, animal and plant proteins were estimated using the standardized EPIC Nutrient Database (ENDB). Mean intakes were adjusted for age, and weighted by season and day of recall. Results: Mean total and animal protein intakes were highest in the Spanish centres among men, and in the Spanish and French centres among women; the lowest mean intakes were observed in the UK health-conscious group, in Greek men and women, and in women in Potsdam. Intake of plant protein was highest among the UK health-conscious group, followed by some of the Italian centres and Murcia, whereas Sweden and Potsdam had the lowest intake. Cereals contributed to the highest proportion of plant protein in all centres. The combined intake of legumes, vegetables and fruit contributed to a greater proportion of plant protein in the southern than in the northern centres. Total meat intake (with some heterogeneity across subtypes of meat) was, with few exceptions, the most important contributor to animal protein in all centres, followed by dairy and fish products. Conclusions: This study shows that intake of protein, especially of animal origin, differs across the 10 European countries, and also shows some differences in food sources of protein across Europe. European Journal of Clinical Nutrition (2009) 63, S16-S36; doi: 10.1038/ejcn.2009.73

Vitamin D receptor and calcium sensing receptor polymorphisms and the risk of colorectal cancer in European populations

Jenab M., McKay J., Bueno-de-Mesquita H.B., van Duijnhoven F.J., Ferrari P., Slimani N., Jansen E.H., Pischon T., Rinaldi S., Tjonneland A., Olsen A., Overvad K., Boutron-Ruault M.C., Clavel-Chapelon F., Engel P., Kaaks R., Linseisen J., Boeing H., Fisher E., Trichopoulou A., Dilis V., Oustoglou E., Berrino F., Vineis P., Mattiello A., Masala G., Tumino R., Vrieling A., Van Gils C.H., Peeters P.H., Brustad M., Lund E., Chirlaque M.D., Barricarte A., Suarez L.R., Molina E., Dorronsoro M., Sala N., Hallmans G., Palmqvist R., Roddam A., Key T.J., Khaw K.T., Bingham S., Boffetta P., Autier P., Byrnes G., Norat T., Riboli E.

Cancer Epidemiol Biomarkers Prev; 2009; 18(9): 2485-2491

Abstract as provided by PubMed

Increased levels of vitamin D and calcium may play a protective role in colorectal cancer (CRC) risk. It has been suggested that these effects may be mediated by genetic variants of the vitamin D receptor (VDR) and the calcium sensing receptor (CASR). However, current epidemiologic evidence from European populations for a role of these genes in CRC risk is scarce. In addition, it is not clear whether these genes may modulate CRC risk independently or by interaction with blood vitamin D concentration and level of dietary calcium intake. A case-control study was conducted nested within the European Prospective Investigation into Cancer and Nutrition. CRC cases (1,248) were identified and matched to 1,248 control subjects. Genotyping for the VDR (BsmI: rs1544410; Fok1: rs2228570) and CASR (rs1801725) genes was done by Taqman, and serum vitamin D (25OHD) concentrations were measured. Conditional logistic regression was used to estimate the incidence rate ratio (RR). Compared with the wild-type bb, the BB genotype of the VDR BsmI polymorphism was associated with a reduced risk of CRC [RR, 0.76; 95% confidence interval (CI), 0.59-0.98). The association was observed for colon cancer (RR, 0.69; 95% CI, 0.45-0.95) but not rectal cancer (RR, 0.97; 95% CI, 0.62-1.49). The Fok1 and CASR genotypes were not associated with CRC risk in this study. No interactions were noted for any of the polymorphisms with serum 25OHD concentration or level of dietary calcium. These results confirm a role for the BsmI polymorphism of the VDR gene in CRC risk, independent of serum 25OHD concentration and dietary calcium intake

Dietary intakes of retinol, beta-carotene, vitamin D and vitamin E in the European Prospective Investigation into Cancer and Nutrition cohort

Jenab M., Salvini S., Van Gils C.H., Brustad M., Shakya-Shrestha S., Buijsse B., Verhagen H., Touvier M., Biessy C., Wallstrom P., Bouckaert K., Lund E., Waaseth M., Roswall N., Joensen A.M., Linseisen J., Boeing H., Vasilopoulou E., Dilis V., Sieri S., Sacerdote C., Ferrari P., Manjer J., Nilsson S., Welch A.A., Travis R., Boutron-Ruault M.C., Niravong M., Bueno-de-Mesquita H.B., van der Schouw Y.T., Tormo M.J., Barricarte A., Riboli E., Bingham S., Slimani N.

Eur J Clin Nutr; 2009; S150-S178

Abstract as provided by PubMed

Objectives: To describe the intake of the fat-soluble nutrients retinol, beta-carotene, vitamin E and vitamin D and their food sources among 27 redefined centres in 10 countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Methods: Between 1995 and 2000, 36 034 subjects (age range: 35-74 years) completed a single standardized 24-h dietary recall using a computerized interview software program (EPIC-SOFT). Intakes of the fat-soluble nutrients were estimated using the standardized EPIC Nutrient Database. Results: For all the nutrients, in most centres, men had a higher level of intake than did women, even after adjustments for total energy intake and anthropometric confounders. Distinct regional gradients from northern to southern European countries were observed for all nutrients. The level intake of beta-carotene and vitamin E also showed some differences by level of education, smoking status and physical activity. No meaningful differences in the nutrient intake were observed by age range. Conclusions: These results show differences by study centre, gender, age and various lifestyle variables in the intake of retinol, beta-carotene, vitamin E and vitamin D between 10 European countries. European Journal of Clinical Nutrition (2009) 63, S150-S178; doi: 10.1038/ejcn.2009.79

Physical activity and risk of prostate cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort

Johnsen N.F., Tjonneland A., Thomsen B.L., Christensen J., Loft S., Friedenreich C., Key T.J., Allen N.E., Lahmann P.H., Mejlvig L., Overvad K., Kaaks R., Rohrmann S., Boing H., Misirli G., Trichopoulou A., Zylis D., Tumino R., Pala V., Bueno-de-Mesquita H.B., Kiemeney L.A., Suarez L.R., Gonzalez C.A., Sanchez M.J., Huerta J.M., Gurrea A.B., Manjer J., Wirfalt E., Khaw K.T., Wareham N., Boffetta P., Egevad L., Rinaldi S., Riboli E.

Int J Cancer; 2009; 125(4): 902-908

Abstract as provided by PubMed

The evidence concerning the possible association between physical activity and the risk of prostate cancer is inconsistent and additional data are needed. We examined the association between risk of prostate cancer and physical activity at work and in leisure time in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. In our study, including 127,923 men aged 20-97 years from 8 European countries, 2,458 cases of prostate cancer were identified during 8.5 years of followup. Using the Cox proportional hazards model, we investigated the associations between prostate cancer incidence rate and occupational activity and leisure time activity in terms of participation in sports, cycling, walking and gardening; a metabolic equivalent (MET) score based on weekly time spent on the 4 activities; and a physical activity index. MET hours per week of leisure time activity, higher score in the physical activity index, participation in any of the 4 leisure time activities, and the number of leisure time activities in which the participants were active were not associated with prostate cancer incidence. However, higher level of occupational physical activity was associated with lower risk of advanced stage prostate cancer (p(trend) = 0.024). In conclusion, our data support the hypothesis of an inverse association between advanced prostate cancer risk and occupational physical activity, but we found no support for an association between prostate cancer risk and leisure time physical activity

Specific food group combinations explaining the variation in intakes of nutrients and other important food components in the European Prospective Investigation into Cancer and Nutrition: an application of the reduced rank regression method

Kroger J., Ferrari P., Jenab M., Bamia C., Touvier M., Bueno-de-Mesquita H.B., Fahey M.T., Benetou V., Schulz M., Wirfalt E., Boeing H., Hoffmann K., Schulze M.B., Orfanos P., Oikonomou E., Huybrechts I., Rohrmann S., Pischon T., Manjer J., Agren A., Navarro C., Jakszyn P., Boutron-Ruault M.C., Niravong M., Khaw K.T., Crowe F., Ocke M.C., van der Schouw Y.T., Mattiello A., Bellegotti M., Engeset D., Hjartaker A., Egeberg R., Overvad K., Riboli E., Bingham S., Slimani N.

Eur J Clin Nutr; 2009; S263-S274

Abstract as provided by PubMed

Objective: To identify combinations of food groups that explain as much variation in absolute intakes of 23 key nutrients and food components as possible within the country-specific populations of the European Prospective Investigation into Cancer and Nutrition (EPIC). Subjects/Methods: The analysis covered single 24-h dietary recalls (24-HDR) from 36 034 subjects (13 025 men and 23 009 women), aged 35-74 years, from all 10 countries participating in the EPIC study. In a set of 39 food groups, reduced rank regression (RRR) was used to identify those combinations (RRR factors) that explain the largest proportion of variation in intake of 23 key nutrients and food components, namely, proteins, saturated fatty acids, monounsaturated fatty acids, polyunsaturated fatty acids, cholesterol, sugars (sum of mono-and disaccharides), starch, fibre, alcohol, calcium, iron, potassium, phosphorus, magnesium, vitamin D, beta-carotene, retinol and vitamins E, B1, B2, B6, B12 and C (RRR responses). Analyses were performed at the country level and for all countries combined. Results: In the country-specific analyses, the first RRR factor explained a considerable proportion of the total nutrient intake variation in all 10 countries (27.4-37.1%). The subsequent RRR factors were much less important in explaining the variation (<= 6%). Strong similarities were observed for the first country-specific RRR factor between the individual countries, largely characterized by consumption of bread, vegetable oils, red meat, milk, cheese, potatoes, margarine and processed meat. The highest explained variation was seen for protein, potassium, phosphorus and magnesium (50-70%), whereas sugars, beta-carotene, retinol and alcohol were only marginally explained (<= 5%). The explained proportion of the other nutrients ranged between these extremes. Conclusions: A combination of food groups was identified that explained a considerable proportion of the nutrient intake variation in 24-HDRs in every country-specific EPIC population in a similar manner. This indicates that, despite the large variability in food and nutrient intakes reported in the EPIC, the variance of intake of important nutrients is explained, to a large extent, by similar food group combinations across countries. European Journal of Clinical Nutrition (2009) 63, S263-S274; doi: 10.1038/ejcn.2009.85

Physical activity and ovarian cancer risk: the European Prospective Investigation into Cancer and Nutrition

Lahmann P.H., Friedenreich C., Schulz M., Cust A.E., Lukanova A., Kaaks R., Tjonneland A., Johnsen N.F., Overvad K., Fournier A., Boutron-Ruault M.C., Clavel Chapelon F., Boeing H., Linseisen J., Rohrmann S., Trichopoulou A., Lagiou P., Trichopoulos D., Palli D., Mattiello A., Sacerdote C., Agnoli C., Tumino R., Quiros J.R., Larranaga N., Agudo A.T., Sanchez M.J., Berglund G., Manjer J., Monninkhof E.M., Peeters P.H., Bueno-de-Mesquita H.B., May A.M., Allen N., Khaw K.T., Bingham S., Rinaldi S., Ferrari P., Riboli E.

Cancer Epidemiol Biomarkers Prev; 2009; 18(1): 351-354
Dietary fat intake in the European Prospective Investigation into Cancer and Nutrition: results from the 24-h dietary recalls

Linseisen J., Welch A.A., Ocke M., Amiano P., Agnoli C., Ferrari P., Sonestedt E., Chajes V., Bueno-de-Mesquita H.B., Kaaks R., Weikert C., Dorronsoro M., Rodriguez L., Ermini I., Mattiello A., van der Schouw Y.T., Manjer J., Nilsson S., Jenab M., Lund E., Brustad M., Halkjaer J., Jakobsen M.U., Khaw K.T., Crowe F., Georgila C., Misirli G., Niravong M., Touvier M., Bingham S., Riboli E., Slimani N.

Eur J Clin Nutr; 2009; S61-S80

Abstract as provided by PubMed

Objectives: This paper describes the dietary intake of total fat, saturated (SFA), monounsaturated (MUFA) and polyunsaturated fatty acids (PUFA) and cholesterol of participants in the European Prospective Investigation into Cancer and Nutrition (EPIC) in 27 centres across 10 countries. Methods: Between 1995 and 2000, a stratified random sample of 36 034 participants (age range 35-74 years) completed a standardized 24-h dietary recall, assessed by means of the computer software EPIC-SOFT. Lipid intake data were calculated using a standardized nutrient database. Results: On average, the contribution of fat to total energy intake was >= 34% of energy intake (% en) in women and >= 36% en in men for most EPIC centres, except for the British, Dutch and most Italian cohorts. Total fat (> 40% en) and MUFA intakes (21% en, mainly from olive oil) were highest in Greece. Except for the Greek, Spanish and Italian centres, the average MUFA intake ranged between 10 and 13% en, with a high proportion derived from animal sources. SFA intake in women and men was lowest in the Greek, Spanish, Italian and UK cohorts with an average of <= 13% en (down to 9% en), and highest in the Swedish centres (16% en). The mean PUFA intake was in the range of 4-8% en, being highest in the UK health-conscious cohort. The average cholesterol intake across EPIC varied from 140 to 384 mg/d in women and 215-583 mg/d in men. Conclusions: The presented data show differences and similarities in lipid intake across the European EPIC cohorts and also show differences in food sources of dietary lipids. European Journal of Clinical Nutrition (2009) 63, S61-S80; doi: 10.1038/ejcn.2009.75

The role of smoking and diet in explaining educational inequalities in lung cancer incidence

Menvielle G., Boshuizen H., Kunst A.E., Dalton S.O., Vineis P., Bergmann M.M., Hermann S., Ferrari P., Raaschou-Nielsen O., Tjonneland A., Kaaks R., Linseisen J., Kosti M., Trichopoulou A., Dilis V., Palli D., Krogh V., Panico S., Tumino R., Buchner F.L., Van Gils C.H., Peeters P.H., Braaten T., Gram I.T., Lund E., Rodriguez L., Agudo A., Sanchez M.J., Tormo M.J., Ardanaz E., Manjer J., Wirfalt E., Hallmans G., Rasmuson T., Bingham S., Khaw K.T., Allen N., Key T., Boffetta P., Duell E.J., Slimani N., Gallo V., Riboli E., Bueno-de-Mesquita H.B.

J Natl Cancer Inst; 2009; 101(5): 321-330

Abstract as provided by PubMed

BACKGROUND: Studies in many countries have reported higher lung cancer incidence and mortality in individuals with lower socioeconomic status. METHODS: To investigate the role of smoking in these inequalities, we used data from 391,251 participants in the European Prospective Investigation into Cancer and Nutrition study, a cohort of individuals in 10 European countries. We collected information on smoking (history and quantity), fruit and vegetable consumption, and education through questionnaires at study entry and gathered data on lung cancer incidence for a mean of 8.4 years. Socioeconomic status was defined as the highest attained level of education, and participants were grouped by sex and region of residence (Northern Europe, Germany, or Southern Europe). Relative indices of inequality (RIIs) of lung cancer risk unadjusted and adjusted for smoking were estimated using Cox regression models. Additional analyses were performed by histological type. RESULTS: During the study period, 939 men and 692 women developed lung cancer. Inequalities in lung cancer risk (RII(men) = 3.62, 95% confidence interval [CI] = 2.77 to 4.73, 117 vs 52 per 100,000 person-years for lowest vs highest education level; RII(women) = 2.39, 95% CI = 1.77 to 3.21, 46 vs 25 per 100,000 person-years) decreased after adjustment for smoking but remained statistically significant (RII(men) = 2.29, 95% CI = 1.75 to 3.01; RII(women) = 1.59, 95% CI = 1.18 to 2.13). Large RIIs were observed among men and women in Northern European countries and among men in Germany, but inequalities in lung cancer risk were reverse (RIIs < 1) among women in Southern European countries. Inequalities differed by histological type. Adjustment for smoking reduced inequalities similarly for all histological types and among men and women in all regions. In all analysis, further adjustment for fruit and vegetable consumption did not change the estimates. CONCLUSION: Self-reported smoking consistently explains approximately 50% of the inequalities in lung cancer risk due to differences in education

Occupational exposures contribute to educational inequalities in lung cancer incidence among men: Evidence from the EPIC prospective cohort study

Menvielle G., Boshuizen H., Kunst A.E., Vineis P., Dalton S.O., Bergmann M.M., Hermann S., Veglia F., Ferrari P., Overvad K., Raaschou-Nielsen O., Tjonneland A., Kaaks R., Linseisen J., Palli D., Krogh V., Tumino R., Rodriguez L., Agudo A., Sanchez M.J., Arozena J.M., Cirera L., Ardanaz E., Bingham S., Khaw K.T., Boffetta P., Duell E., Slimani N., Gallo V., Riboli E., Bueno-de-Mesquita H.B.

Int J Cancer; 2009; 126(8): 1928-1935

Abstract as provided by PubMed

The aim of this study is to investigate to what extent occupational exposures may explain socioeconomic inequalities in lung cancer incidence after adjusting for smoking and dietary factors. Analyses were based on a subsample of the European Prospective Investigation into Cancer and Nutrition (EPIC study), a prospective cohort. The analyses included 703 incident lung cancer cases among men in Denmark, the United Kingdom, Germany, Italy, Spain and Greece. The socioeconomic position was measured using the highest level of education. The estimates of relative indices of inequality (RII) were computed with Cox regression models. We first adjusted for smoking (with detailed information on duration and quantity) and dietary factors (fruits and vegetables consumption) and then for occupational exposures. The exposure to three carcinogens [asbestos, heavy metals and polycyclic aromatic hydrocarbons (PAH)] was analyzed. The occupational exposures explained 14% of the socioeconomic inequalities remaining after adjustment for smoking and fruits and vegetables consumption. The inequalities remained nevertheless statistically significant. The RII decreased from 1.87 (95% CI: 1.36-2.56) to 1.75 (1.27-2.41). The decrease was more pronounced when adjusting for asbestos than for heavy metals or PAH. Analyses by birth cohort suggested an effect of occupational exposures among older men, while due to small number of endpoints, no conclusion could be drawn about the role of occupational exposures in educational inequalities among younger men. Our study revealed that the impact of occupational exposures on socioeconomic inequalities in cancer incidence, rarely studied until now, exists while of modest magnitude

Energy intake and sources of energy intake in the European Prospective Investigation into Cancer and Nutrition

Ocke M.C., Larranaga N., Grioni S., van den Berg S.W., Ferrari P., Salvini S., Benetou V., Linseisen J., Wirfalt E., Rinaldi S., Jenab M., Halkjaer J., Jakobsen M.U., Niravong M., Clavel-Chapelon F., Kaaks R., Bergmann M., Moutsiou E., Trichopoulou A., Lauria C., Sacerdote C., Bueno-de-Mesquita H.B., Peeters P.H.M., Hjartaker A., Parr C.L., Tormo M.J., Sanchez M.J., Manjer J., Hellstrom V., Mulligan A., Spencer E.A., Riboli E., Bingham S., Slimani N.

Eur J Clin Nutr; 2009; S3-S15

Abstract as provided by PubMed

Objectives: To describe energy intake and its macronutrient and food sources among 27 regions in 10 countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Methods: Between 1995 and 2000, 36 034 subjects aged 35-74 years were administered a standardized 24-h dietary recall. Intakes of macronutrients (g/day) and energy (kcal/day) were estimated using standardized national nutrient databases. Mean intakes were weighted by season and day of the week and were adjusted for age, height and weight, after stratification by gender. Extreme low- and high-energy reporters were identified using Goldberg's cutoff points (ratio of energy intake and estimated basal metabolic rate <0.88 or >2.72), and their effects on macronutrient and energy intakes were studied. Results: Low-energy reporting was more prevalent in women than in men. The exclusion of extreme-energy reporters substantially lowered the EPIC-wide range in mean energy intake from 2196-2877 to 2309-2866 kcal among men. For women, these ranges were 1659-2070 and 1873-2108 kcal. There was no north-south gradient in energy intake or in the prevalence of low-energy reporting. In most centres, cereals and cereal products were the largest contributors to energy intake. The food groups meat, dairy products and fats and oils were also important energy sources. In many centres, the highest mean energy intakes were observed on Saturdays. Conclusions: These data highlight and quantify the variations and similarities in energy intake and sources of energy intake among 10 European countries. The prevalence of low-energy reporting indicates that the study of energy intake is hampered by the problem of underreporting. European Journal of Clinical Nutrition (2009) 63, S3-S15; doi: 10.1038/ejcn.2009.72

Dietary intake of the water-soluble vitamins B1, B2, B6, B12 and C in 10 countries in the European Prospective Investigation into Cancer and Nutrition

Olsen A., Halkjaer J., Van Gils C.H., Buijsse B., Verhagen H., Jenab M., Boutron-Ruault M.C., Ericson U., Ocke M.C., Peeters P.H.M., Touvier M., Niravong M., Waaseth M., Skeie G., Khaw K.T., Travis R., Ferrari P., Sanchez M.J., Agudo A., Overvad K., Linseisen J., Weikert C., Sacerdote C., Evangelista A., Zylis D., Tsiotas K., Manjer J., Van Guelpen B., Riboli E., Slimani N., Bingham S.

Eur J Clin Nutr; 2009; S122-S149

Abstract as provided by PubMed

Objectives: To describe the intake of vitamins thiamine (B1), riboflavin (B2), B6 (pyridoxine), B12 (cobalamine) and C (ascorbic acid) and their food sources among 27 centres in 10 countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Methods: Between 1995 and 2000, 36 034 persons aged between 35 and 74 years were administered a standardized 24-h dietary recall using a computerized interview software programme (EPIC-SOFT). Intakes of the four B vitamins and vitamin C were estimated using the standardized EPIC Nutrient Database (ENDB). Mean intakes were adjusted for age and weighted by season and day of recall. Results: Intake of B vitamins did not vary considerably between centres, except in the UK health-conscious cohort, in which substantially higher intakes of thiamine and lower intakes of vitamin B12 were reported compared with other centres. Overall, meat was the most important contributor to the B vitamins in all centres except in the UK health-conscious group. Vitamin C showed a clear geographical gradient, with higher intakes in the southern centres as compared with the northern ones; this was more pronounced in men than in women. Vegetables and fruits were major contributors to vitamin C in all centres, but juices and potatoes were also important sources in the northern centres. Conclusions: This study showed no major differences across centres in the mean intakes of B vitamins (thiamine, riboflavin, B6, B12), whereas a tendency towards a north-south gradient was observed for vitamin C. European Journal of Clinical Nutrition (2009) 63, S122-S149; doi: 10.1038/ejcn.2009.78

Eating out of home: energy, macro- and micronutrient intakes in 10 European countries. The European Prospective Investigation into Cancer and Nutrition

Orfanos P., Naska A., Trichopoulou A., Grioni S., Boer J.M.A., van Bakel M.M.E., Ericson U., Rohrmann S., Boeing H., Rodriguez L., Ardanaz E., Sacerdote C., Giurdanella M.C., Niekerk E.M., Peeters P.H.M., Manjer J., Van Guelpen B., Deharveng G., Skeie G., Engeset D., Halkjaer J., Jensen A.M., McTaggart A., Crowe F., Stratigakou V., Oikonomou E., Touvier M., Niravong M., Riboli E., Bingham S., Slimani N.

Eur J Clin Nutr; 2009; S239-S262

Abstract as provided by PubMed

Objectives: To assess the contribution of out-of-home (OH) energy and nutrient intake to total dietary intake, and to compare out-versus in-home nutrient patterns among 27 centres in 10 countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Methods: Between 1995 and 2000, 36 034 participants aged between 35-74 years completed a standardized 24-h dietary recall using a software programme (EPIC-Soft) that recorded the place of food/drink consumption. Eating OH was defined as the consumption of foods and beverages anywhere other than in household premises, irrespective of the place of purchase/preparation. Nutrient intakes were estimated using a standardized nutrient database. Mean intakes were adjusted for age and weighted by season and day of recall. Results: Among women, OH eating contributed more to total fat intake than to intakes of protein and carbohydrates. Among both genders, and particularly in southern Europe, OH eating contributed more to sugar and starch intakes and less to total fibre intake. The contribution of OH eating was also lower for calcium and vitamin C intakes. The composition of diet at home was different from that consumed out of home in southern countries, but was relatively similar in the north. Conclusions: In northern Europe, OH and in-home eating are homogeneous, whereas southern Europeans consider OH eating as a distinctive occasion. In most centres, women selected more fat-rich items when eating out. European Journal of Clinical Nutrition (2009) 63, S239-S262; doi: 10.1038/ejcn.2009.84

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