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2010

Menstrual and reproductive factors, exogenous hormone use, and gastric cancer risk in a cohort of women from the European Prospective Investigation Into Cancer and Nutrition

Duell E.J., Travier N., Lujan-Barroso L., Boutron-Ruault M.C., Clavel-Chapelon F., Palli D., Krogh V., Mattiello A., Tumino R., Sacerdote C., Rodriguez L., Sanchez-Cantalejo E., Navarro C., Barricarte A., Dorronsoro M., Khaw K.T., Wareham N., Allen N.E., Tsilidis K.K., Bueno-de-Mesquita H.B., Jeurnink S.M., Numans M.E., Peeters P.H., Lagiou P., Valanou E., Trichopoulou A., Kaaks R., Lukanova-McGregor A., Bergman M.M., Boeing H., Manjer J., Lindkvist B., Stenling R., Hallmans G., Dahm C.C., Overvad K., Olsen A., Tjonneland A., Bakken K., Lund E., Jenab M., McCormack V., Rinaldi S., Michaud D., Mouw T., Nesi G., Carneiro F., Riboli E., Gonzalez C.A.

Am J Epidemiol; 2010; 172(12): 1384-1393

PMID:21051447

Abstract as provided by PubMed

The worldwide incidence of gastric adenocarcinoma (GC) is lower in women than in men. Furthermore, cancer patients treated with estrogens have been reported to have a lower subsequent risk of GC. The authors conducted a prospective analysis of menstrual and reproductive factors, exogenous hormone use, and GC in 335,216 women from the European Prospective Investigation Into Cancer and Nutrition, a cohort study of individuals aged 35-70 years from 10 European countries. After a mean follow-up of 8.7 years (through 2004), 181 women for whom complete exposure data were available developed GC. Adjusted hazard ratios and 95% confidence intervals were estimated using Cox proportional hazards models. All statistical tests were 2-sided. Women who had ovariectomy had a 79% increased risk of GC (based on 25 cases) compared with women who did not (hazard ratio = 1.79, 95% confidence interval: 1.15, 2.78). Total cumulative years of menstrual cycling was inversely associated with GC risk (fifth vs. first quintile: hazard ratio = 0.55, 95% confidence interval: 0.31, 0.98; P(trend) = 0.06). No other reproductive factors analyzed were associated with risk of GC. The results of this analysis provide some support for the hypothesis that endogenous ovarian sex hormones lower GC incidence in women

Plasma folate, related genetic variants, and colorectal cancer risk in EPIC

Eussen S.J., Vollset S.E., Igland J., Meyer K., Fredriksen A., Ueland P.M., Jenab M., Slimani N., Boffetta P., Overvad K., Tjonneland A., Olsen A., Clavel-Chapelon F., Boutron-Ruault M.C., Morois S., Weikert C., Pischon T., Linseisen J., Kaaks R., Trichopoulou A., Zilis D., Katsoulis M., Palli D., Berrino F., Vineis P., Tumino R., Panico S., Peeters P.H., Bueno-de-Mesquita H.B., van Duijnhoven F.J., Gram I.T., Skeie G., Lund E., Gonzalez C.A., Martinez C., Dorronsoro M., Ardanaz E., Navarro C., Rodriguez L., Van Guelpen B., Palmqvist R., Manjer J., Ericson U., Bingham S., Khaw K.T., Norat T., Riboli E.

Cancer Epidemiol Biomarkers Prev; 2010; 19(5): 1328-1340

PMID:20447924

Abstract as provided by PubMed

BACKGROUND: A potential dual role of folate in colorectal cancer (CRC) is currently subject to debate. We investigate the associations between plasma folate, several relevant folate-related polymorphisms, and CRC risk within the large European Prospective Investigation into Cancer and Nutrition cohort. METHODS: In this nested case-control study, 1,367 incident CRC cases were matched to 2,325 controls for study center, age, and sex. Risk ratios (RR) were estimated with conditional logistic regression and adjusted for smoking, education, physical activity, and intake of alcohol and fiber. RESULTS: Overall analyses did not reveal associations of plasma folate with CRC. The RR (95% confidence interval; Ptrend) for the fifth versus the first quintile of folate status was 0.94 (0.74-1.20; 0.44). The polymorphisms MTHFR677C-->T, MTHFR1298A-->C, MTR2756A-->G, MTRR66A-->G, and MTHFD11958G-->A were not associated with CRC risk. However, in individuals with the lowest plasma folate concentrations, the MTHFR 677TT genotype showed a statistically nonsignificant increased CRC risk [RR (95% CI; Ptrend) TT versus CC=1.39 (0.87-2.21); 0.12], whereas those with the highest folate concentrations showed a nonsignificant decreased CRC risk [RR TT versus CC=0.74 (0.39-1.37); 0.34]. The SLC19A180G-->A showed a positive association with CRC risk [RR AA versus GG 1.30 (1.06-1.59); <0.01]. CONCLUSIONS: This large European prospective multicenter study did not show an association of CRC risk with plasma folate status nor with MTHFR polymorphisms. IMPACT: Findings of the present study tend to weaken the evidence that folate plays an important role in CRC carcinogenesis. However, larger sample sizes are needed to adequately address potential gene-environment interactions

Vitamins B2 and B6 and genetic polymorphisms related to one-carbon metabolism as risk factors for gastric adenocarcinoma in the European prospective investigation into cancer and nutrition

Eussen S.J., Vollset S.E., Hustad S., Midttun O., Meyer K., Fredriksen A., Ueland P.M., Jenab M., Slimani N., Ferrari P., Agudo A., Sala N., Capella G., Del Giudice G., Palli D., Boeing H., Weikert C., Bueno-de-Mesquita H.B., Buchner F.L., Carneiro F., Berrino F., Vineis P., Tumino R., Panico S., Berglund G., Manjer J., Stenling R., Hallmans G., Martinez C., Arrizola L., Barricarte A., Navarro C., Rodriguez L., Bingham S., Linseisen J., Kaaks R., Overvad K., Tjonneland A., Peeters P.H., Numans M.E., Clavel-Chapelon F., Boutron-Ruault M.C., Morois S., Trichopoulou A., Lund E., Plebani M., Riboli E., Gonzalez C.A.

Cancer Epidemiol Biomarkers Prev; 2010; 19(1): 28-38

PMID:20056620 http://cebp

Abstract as provided by PubMed

B vitamins and polymorphisms in genes coding for enzymes involved in one-carbon metabolism may affect DNA synthesis and methylation and thereby be implicated in carcinogenesis. Previous data on vitamins B2 and B6 and genetic polymorphisms other than those involving MTHFR as risk factors for gastric cancer (GC) are sparse and inconsistent. In this case-control study nested within the European Prospective Investigation into Cancer and Nutrition cohort, cases (n = 235) and controls (n = 601) were matched for study center, age, sex, and time of blood sampling. B2 and B6 species were measured in plasma, and the sum of riboflavin and flavin mononucleotide was used as the main exposure variable for vitamin B2 status, whereas the sum of pyridoxal 5'-phosphate, pyridoxal, and 4-pyridoxic acid was used to define vitamin B6 status. In addition, we determined eight polymorphisms related to one-carbon metabolism. Relative risks for GC risk were calculated with conditional logistic regression, adjusted for Helicobacter pylori infection status and smoking status. Adjusted relative risks per quartile (95% confidence interval, P(trend)) were 0.85 (0.72-1.01, 0.06) for vitamin B2 and 0.78 (0.65-0.93, <0.01) for vitamin B6. Both relations were stronger in individuals with severe chronic atrophic gastritis. The polymorphisms were not associated with GC risk and did not modify the observed vitamin-cancer associations. In summary, results from this large European cohort study showed an inverse association between vitamin B2 and GC risk, which is borderline significant, and a significant inverse association between vitamin B6 and GC risk

Plasma vitamins B2, B6, and B12, and related genetic variants as predictors of colorectal cancer risk

Eussen S.J., Vollset S.E., Hustad S., Midttun O., Meyer K., Fredriksen A., Ueland P.M., Jenab M., Slimani N., Boffetta P., Overvad K., Thorlacius-Ussing O., Tjonneland A., Olsen A., Clavel-Chapelon F., Boutron-Ruault M.C., Morois S., Weikert C., Pischon T., Linseisen J., Kaaks R., Trichopoulou A., Zilis D., Katsoulis M., Palli D., Pala V., Vineis P., Tumino R., Panico S., Peeters P.H., Bueno-de-Mesquita H.B., van Duijnhoven F.J., Skeie G., Munoz X., Martinez C., Dorronsoro M., Ardanaz E., Navarro C., Rodriguez L., Van Guelpen B., Palmqvist R., Manjer J., Ericson U., Bingham S., Khaw K.T., Norat T., Riboli E.

Cancer Epidemiol Biomarkers Prev; 2010; 19(10): 2549-2561

PMID:20813848

Abstract as provided by PubMed

BACKGROUND: B-vitamins are essential for one-carbon metabolism and have been linked to colorectal cancer. Although associations with folate have frequently been studied, studies on other plasma vitamins B2, B6, and B12 and colorectal cancer are scarce or inconclusive. METHODS: We carried out a nested case-control study within the European Prospective Investigation into Cancer and Nutrition, including 1,365 incident colorectal cancer cases and 2,319 controls matched for study center, age, and sex. We measured the sum of B2 species riboflavin and flavin mononucleotide, and the sum of B6 species pyridoxal 5'-phosphate, pyridoxal, and 4-pyridoxic acid as indicators for vitamin B2 and B6 status, as well as vitamin B12 in plasma samples collected at baseline. In addition, we determined eight polymorphisms related to one-carbon metabolism. Relative risks for colorectal cancer were estimated using conditional logistic regression, adjusted for smoking, education, physical activity, body mass index, alcohol consumption, and intakes of fiber and red and processed meat. RESULTS: The relative risks comparing highest to lowest quintile were 0.71 [95% confidence interval (95% CI), 0.56-0.91; P(trend) = 0.02] for vitamin B2, 0.68 (95% CI, 0.53-0.87; P(trend) <0.001) for vitamin B6, and 1.02 (95% CI, 0.80-1.29; P(trend) = 0.19) for vitamin B12. The associations for vitamin B6 were stronger in males who consumed >/=30 g alcohol/day. The polymorphisms were not associated with colorectal cancer. CONCLUSIONS: Higher plasma concentrations of vitamins B2 and B6 are associated with a lower colorectal cancer risk. IMPACT: This European population-based study is the first to indicate that vitamin B2 is inversely associated with colorectal cancer, and is in agreement with previously suggested inverse associations of vitamin B6 with colorectal cancer

Region-specific nutrient intake patterns exhibit a geographical gradient within and between European countries

Freisling H., Fahey M.T., Moskal A., Ocke M.C., Ferrari P., Jenab M., Norat T., Naska A., Welch A.A., Navarro C., Schulz M., Wirfalt E., Casagrande C., Amiano P., Ardanaz E., Parr C., Engeset D., Grioni S., Sera F., Bueno-de-Mesquita B., van der Schouw Y.T., Touvier M., Boutron-Ruault M.C., Halkjaer J., Dahm C.C., Khaw K.T., Crowe F., Linseisen J., Kroger J., Huybrechts I., Deharveng G., Manjer J., Agren A., Trichopoulou A., Tsiotas K., Riboli E., Bingham S., Slimani N.

J Nutr; 2010; 140(7): 1280-1286

PMID:20484545

Abstract as provided by PubMed

Until recently, the study of nutrient patterns was hampered at an international level by a lack of standardization of both dietary methods and nutrient databases. We aimed to describe the diversity of nutrient patterns in the European Prospective Investigation into Cancer and Nutrition (EPIC) study at population level as a starting point for future nutrient pattern analyses and their associations with chronic diseases in multi-center studies. In this cross-sectional study, 36,034 persons aged 35-74 y were administered a single, standardized 24-h dietary recall. Intake of 25 nutrients (excluding intake from dietary supplements) was estimated using a standardized nutrient database. We used a graphic presentation of mean nutrient intakes by region and sex relative to the overall EPIC means to contrast patterns within and between 10 European countries. In Mediterranean regions, including Greece, Italy, and the southern centers of Spain, the nutrient pattern was dominated by relatively high intakes of vitamin E and monounsaturated fatty acids (MUFA), whereas intakes of retinol and vitamin D were relatively low. In contrast, in Nordic countries, including Norway, Sweden, and Denmark, reported intake of these same nutrients resulted in almost the opposite pattern. Population groups in Germany, The Netherlands, and the UK shared a fatty acid pattern of relatively high intakes of PUFA and SFA and relatively low intakes of MUFA, in combination with a relatively high intake of sugar. We confirmed large variability in nutrient intakes across the EPIC study populations and identified 3 main region-specific patterns with a geographical gradient within and between European countries

Second-hand Smoke, Cotinine Levels, and Risk of Circulatory Mortality in a Large Cohort Study of Never-Smokers

Gallo V., Neasham D., Airoldi L., Ferrari P., Jenab M., Boffetta P., Overvad K., Tjonneland A., Clavel-Chapelon F., Boeing H., Pala V., Palli D., Panico S., Tumino R., Arriola L., Lund E., Bueno-de-Mesquita B., Peeters P.H., Melander O., Hallmans G., Riboli E., Saracci R., Vineis P.

Epidemiology; 2010; 21(2): 207-214

PMID:20081539

Abstract as provided by PubMed

BACKGROUND:: Exposure to second-hand smoke has been shown to be associated with increased cardiovascular mortality in several, but not all, epidemiologic studies. Our aim was to investigate the risk of circulatory death associated with exposure to second-hand smoke in never-smokers in a very large prospective study, the European Prospective Investigation into Cancer and Nutrition. A secondary aim was to use cotinine levels for cross-validating self-reported second-hand smoke exposure. METHODS:: Cox proportional hazard models were used to investigate the risk of death due to circulatory causes associated with second-hand smoke exposure in 135,233 never-smokers. Exposure to second-hand smoke was assessed through a questionnaire at enrollment and then validated against plasma cotinine measurements in a subsample. RESULTS:: Study participants who reported second-hand smoke exposure at home had higher cotinine levels (median plasma cotinine concentration in exposed = 0.82 mug/L; in those unexposed 0.02 mug/L). Second-hand smoke exposure at home was associated with an increased risk of dying from cardiovascular diseases (hazard ratio [HR] = 1.38 [95% confidence interval = 1.01-1.90]), all circulatory diseases (1.28 [0.98-1.69]), and coronary heart disease (1.31 [0.83-2.08]) after adjustment for age, sex, education, physical activity, and body mass index. Dose-response relationships were observed between exposure to second-hand smoke at home and risk of circulatory death (HR per each additional hour/d = 1.25 [1.04-1.50]). Having a partner who smokes more than 30 cigarettes per day considerably increased the risk of a circulatory death (2.94 [1.11-7.78]). Second-hand smoke exposure at home was not associated with total mortality (1.03 [0.93-1.13]). DISCUSSION:: Exposure to second-hand smoke at home (as confirmed by plasma cotinine levels) increases the risk of cardiovascular mortality

Level of education and the risk of lymphoma in the European prospective investigation into cancer and nutrition

Hermann S., Rohrmann S., Linseisen J., Nieters A., Khan A., Gallo V., Overvad K., Tjonneland A., Raaschou-Nielsen O., Bergmann M.M., Boeing H., Becker N., Kaaks R., Bueno-de-Mesquita H.B., May A.M., Vermeulen R.C., Bingham S., Khaw K.T., Key T.J., Travis R.C., Trichopoulou A., Georgila C., Triantafylou D., Celentano E., Krogh V., Masala G., Tumino R., Agudo A., Altzibar J.M., Ardanaz E., Martinez-Garcia C., Suarez M.V., Tormo M.J., Braaten T., Lund E., Manjer J., Zackrisson S., Hallmans G., Malmer B., Boffetta P., Brennan P., Slimani N., Vineis P., Riboli E.

J Cancer Res Clin Oncol; 2010; 136(1): 71-77

PMID:19582474

Abstract as provided by PubMed

INTRODUCTION: Lymphomas belong to the few cancer sites with increasing incidence over past decades, and only a few risk factors have been established. We explored the association between education and the incidence of lymphoma in the prospective EPIC study. MATERIALS AND METHODS: Within 3,567,410 person-years of follow-up, 1,319 lymphoma cases [1,253 non-Hodgkin lymphomas (NHL) and 66 Hodgkin lymphomas (HL)] were identified. Cox proportional hazard regression was used to examine the association between highest educational level (primary school or less, technical/professional school, secondary school, university) and lymphoma risk. RESULTS: Overall, no consistent associations between educational level and lymphoma risk were observed; however, associations were found for sub-groups of the cohort. We observed a higher risk of B-NHL (HR = 1.31, 95% CI = 1.02-1.68; n = 583) in women with the highest education level (university) but not in men. Concerning sub-classes of B-NHL, a positive association between education and risk of B cell chronic lymphatic leukaemia (BCLL) was observed only in women. In both genders, the risk of diffuse large B cell lymphoma (DLBCL) was significantly lower for subjects with university degree (HR = 0.46, 95% CI = 0.27-0.79) versus lowest educational level. No association was found for HL. CONCLUSION: We could not confirm an overall consistent association of education and risk of HL or NHL in this large prospective study; although, education was positively related to the incidence of BCLL and B-NHL (in women) but inversely to incidence of DLBCL. Due to limited number of cases in sub-classes and the large number of comparisons, the possibility of chance findings can not be excluded

Polymorphisms in fatty acid metabolism-related genes are associated with colorectal cancer risk

Hoeft B., Linseisen J., Beckmann L., Muller-Decker K., Canzian F., Husing A., Kaaks R., Vogel U., Jakobsen M.U., Overvad K., Hansen R.D., Knuppel S., Boeing H., Trichopoulou A., Koumantaki Y., Trichopoulos D., Berrino F., Palli D., Panico S., Tumino R., Bueno-de-Mesquita H.B., van Duijnhoven F.J., Van Gils C.H., Peeters P.H., Dumeaux V., Lund E., Huerta Castano J.M., Munoz X., Rodriguez L., Barricarte A., Manjer J., Jirstrom K., Van Guelpen B., Hallmans G., Spencer E.A., Crowe F.L., Khaw K.T., Wareham N., Morois S., Boutron-Ruault M.C., Clavel-Chapelon F., Chajes V., Jenab M., Boffetta P., Vineis P., Mouw T., Norat T., Riboli E., Nieters A.

Carcinogenesis; 2010; 31(3): 466-472

PMID:20042636

Abstract as provided by PubMed

Colorectal cancer (CRC) is the third most common malignant tumor and the fourth leading cause of cancer death worldwide. The crucial role of fatty acids for a number of important biological processes suggests a more in-depth analysis of inter-individual differences in fatty acid metabolizing genes as contributing factor to colon carcinogenesis. We examined the association between genetic variability in 43 fatty acid metabolism-related genes and colorectal risk in 1225 CRC cases and 2032 controls participating in the European Prospective Investigation into Cancer and Nutrition study. Three hundred and ninety two single-nucleotide polymorphisms were selected using pairwise tagging with an r(2) cutoff of 0.8 and a minor allele frequency of >5%. Conditional logistic regression models were used to estimate odds ratios and corresponding 95% confidence intervals. Haplotype analysis was performed using a generalized linear model framework. On the genotype level, hydroxyprostaglandin dehydrogenase 15-(NAD) (HPGD), phospholipase A2 group VI (PLA2G6) and transient receptor potential vanilloid 3 were associated with higher risk for CRC, whereas prostaglandin E receptor 2 (PTGER2) was associated with lower CRC risk. A significant inverse association (P < 0.006) was found for PTGER2 GGG haplotype, whereas HPGD AGGAG and PLA2G3 CT haplotypes were significantly (P < 0.001 and P = 0.003, respectively) associated with higher risk of CRC. Based on these data, we present for the first time the association of HPGD variants with CRC risk. Our results support the key role of prostanoid signaling in colon carcinogenesis and suggest a relevance of genetic variation in fatty acid metabolism-related genes and CRC risk

Prospective study of physical activity and risk of primary adenocarcinomas of the oesophagus and stomach in the EPIC (European Prospective Investigation into Cancer and nutrition) cohort

Huerta J.M., Navarro C., Chirlaque M.D., Tormo M.J., Steindorf K., Buckland G., Carneiro F., Johnsen N.F., Overvad K., Stegger J., Tjonneland A., Boutron-Ruault M.C., Clavel-Chapelon F., Morois S., Boeing H., Kaaks R., Rohrmann S., Vigl M., Lagiou P., Trichopoulos D., Trichopoulou A., Bas Bueno-de-Mesquita H., Monninkhof E.M., Numans M.E., Peeters P.H., Mattiello A., Pala V., Palli D., Tumino R., Vineis P., Agudo A., Ardanaz E., Arriola L., Molina-Montes E., Rodriguez L., Lindkvist B., Manjer J., Stenling R., Lund E., Crowe F.L., Key T.J., Khaw K.T., Wareham N.J., Jenab M., Norat T., Romaguera D., Riboli E., Gonzalez C.A.

Cancer Causes Control; 2010; 21(5): 657-669

PMID:20052611

Abstract as provided by PubMed

OBJECTIVE: To analyse the association between types of physical activity (occupational, recreational and household, vigorous and overall) and risk of primary oesophageal (OAC) or gastric adenocarcinoma (GAC). METHODS: From nine European countries, 420,449 participants were recruited between 1991 and 2000 and followed-up for a mean of 8.8 years to register incident GAC and OAC. Information on physical activity (PA), diet, lifestyle and health-related variables was obtained at baseline. Helicobacter pylori infection status was considered in a subset of 1,211 participants. Analyses were repeated by tumour site (cardia/non-cardia) and histological type (intestinal/diffuse). RESULTS: During the follow-up, 410 GAC and 80 OAC occurred. A lower risk of overall and non-cardia GAC was found for increasing levels of a PA index which combined occupational PA with weekly time spent in sports and cycling. The hazard ratio (HR) of GAC was 0.69, 95% CI: 0.50-0.94, for the comparison between active and inactive participants according to the PA index (HR = 0.44, 95% CI:0.26-0.74, for non-cardia GAC). No effect was found for cardia tumours or histological subtypes of GAC. PA of any kind was not associated with OAC. CONCLUSIONS: Overall and distal (non-cardia) gastric tumours were inversely associated with time spent on cycling and sports and a total PA index. No association was found for any type of PA and risk of cardia cancers of the stomach

Serum B vitamin levels and risk of lung cancer

Johansson M., Relton C., Ueland P.M., Vollset S.E., Midttun O., Nygard O., Slimani N., Boffetta P., Jenab M., Clavel-Chapelon F., Boutron-Ruault M.C., Fagherazzi G., Kaaks R., Rohrmann S., Boeing H., Weikert C., Bueno-de-Mesquita H.B., Ros M.M., Van Gils C.H., Peeters P.H., Agudo A., Barricarte A., Navarro C., Rodriguez L., Sanchez M.J., Larranaga N., Khaw K.T., Wareham N., Allen N.E., Crowe F., Gallo V., Norat T., Krogh V., Masala G., Panico S., Sacerdote C., Tumino R., Trichopoulou A., Lagiou P., Trichopoulos D., Rasmuson T., Hallmans G., Riboli E., Vineis P., Brennan P.

JAMA; 2010; 303(23): 2377-2385

PMID:20551408

Abstract as provided by PubMed

CONTEXT: B vitamins and factors related to 1-carbon metabolism help to maintain DNA integrity and regulate gene expression and may affect cancer risk. OBJECTIVE: To investigate if 1-carbon metabolism factors are associated with onset of lung cancer. DESIGN, SETTING, AND PARTICIPANTS: The European Prospective Investigation into Cancer and Nutrition (EPIC) recruited 519,978 participants from 10 countries between 1992 and 2000, of whom 385,747 donated blood. By 2006, 899 lung cancer cases were identified and 1770 control participants were individually matched by country, sex, date of birth, and date of blood collection. Serum levels were measured for 6 factors of 1-carbon metabolism and cotinine. MAIN OUTCOME MEASURE: Odds ratios (ORs) of lung cancer by serum levels of 4 B vitamins (B(2), B(6), folate [B(9)], and B(12)), methionine, and homocysteine. RESULTS: Within the entire EPIC cohort, the age-standardized incidence rates of lung cancer (standardized to the world population, aged 35-79 years) were 6.6, 44.9, and 156.1 per 100,000 person-years among never, former, and current smokers for men, respectively. The corresponding incidence rates for women were 7.1, 23.9, and 100.9 per 100,000 person-years, respectively. After accounting for smoking, a lower risk for lung cancer was seen for elevated serum levels of B(6) (fourth vs first quartile OR, 0.44; 95% confidence interval [CI], 0.33-0.60; P for trend <.000001), as well as for serum methionine (fourth vs first quartile OR, 0.52; 95% CI, 0.39-0.69; P for trend <.000001). Similar and consistent decreases in risk were observed in never, former, and current smokers, indicating that results were not due to confounding by smoking. The magnitude of risk was also constant with increasing length of follow-up, indicating that the associations were not explained by preclinical disease. A lower risk was also seen for serum folate (fourth vs first quartile OR, 0.68; 95% CI, 0.51-0.90; P for trend = .001), although this was apparent only for former and current smokers. When participants were classified by median levels of serum methionine and B(6), having above-median levels of both was associated with a lower lung cancer risk overall (OR, 0.41; 95% CI, 0.31-0.54), as well as separately among never (OR, 0.36; 95% CI, 0.18-0.72), former (OR, 0.51; 95% CI, 0.34-0.76), and current smokers (OR, 0.42; 95% CI, 0.27-0.65). CONCLUSION: Serum levels of vitamin B(6) and methionine were inversely associated with risk of lung cancer

Anthropometric measures and epithelial ovarian cancer risk in the European Prospective Investigation into Cancer and Nutrition

Lahmann P.H., Cust A.E., Friedenreich C.M., Schulz M., Lukanova A., Kaaks R., Lundin E., Tjonneland A., Halkjaer J., Severinsen M.T., Overvad K., Fournier A., Chabbert-Buffet N., Clavel-Chapelon F., Dossus L., Pischon T., Boeing H., Trichopoulou A., Lagiou P., Naska A., Palli D., Grioni S., Mattiello A., Tumino R., Sacerdote C., Redondo M.L., Jakszyn P., Sanchez M.J., Tormo M.J., Ardanaz E., Arriola L., Manjer J., Jirstrom K., Bas Bueno-de-Mesquita H., May A.M., Peeters P.H., Onland-Moret N.C., Bingham S., Khaw K.T., Allen N.E., Spencer E., Rinaldi S., Slimani N., Chajes V., Michaud D., Norat T., Riboli E.

Int J Cancer; 2010; 126(10): 2404-2415

PMID:19821492

Abstract as provided by PubMed

We examined the associations of measured anthropometric factors, including general and central adiposity and height, with ovarian cancer risk. We also investigated these associations by menopausal status and for specific histological subtypes. Among 226,798 women in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, there were 611 incident cases of primary, malignant, epithelial ovarian cancer diagnosed during a mean 8.9 years of follow-up. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusted for potential confounders. Compared to women with body mass index (BMI) < 25 kg/m2, obesity (BMI > or = 30 kg/m2) was associated with excess ovarian cancer risk for all women combined (HR = 1.33, 95% CI = 1.05-1.68; p(trend) = 0.02) and postmenopausal women (HR = 1.59, 95% CI = 1.20-2.10; p(trend) = 0.001), but the association was weaker for premenopausal women (HR = 1.16, 95% CI = 0.65-2.06; p(trend) = 0.65). Neither height or weight gain, nor BMI-adjusted measures of fat distribution assessed by waist circumference, waist-hip ratio (WHR) or hip circumference were associated with overall risk. WHR was related to increased risk of mucinous tumors (BMI-adjusted HR per 0.05 unit increment = 1.17, 95% CI = 1.00-1.38). For all women combined, no other significant associations with risk were observed for specific histological subtypes. This large, prospective study provides evidence that obesity is an important modifiable risk factor for epithelial ovarian cancer, particularly among postmenopausal women

Cigar and pipe smoking and cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC)

McCormack V.A., Agudo A., Dahm C.C., Overvad K., Olsen A., Tjonneland A., Kaaks R., Boeing H., Manjer J., Almquist M., Hallmans G., Johansson I., Chirlaque M.D., Barricarte A., Dorronsoro M., Rodriguez L., Redondo M.L., Khaw K.T., Wareham N., Allen N., Key T., Riboli E., Boffetta P.

Int J Cancer; 2010; 127(10): 2402-2411

PMID:20162568

Abstract as provided by PubMed

The carcinogenicity of cigar and pipe smoking is established but the effect of detailed smoking characteristics is less well defined. We examined the effects on cancer incidence of exclusive cigar and pipe smoking, and in combination with cigarettes, among 102,395 men from Denmark, Germany, Spain, Sweden and the United Kingdom in the EPIC cohort. Hazard ratios (HR) and their 95% confidence intervals (CI) for cancer during a median 9-year follow-up from ages 35 to 70 years were estimated using proportional hazards models. Compared to never smokers, HR of cancers of lung, upper aerodigestive tract and bladder combined was 2.2 (95% CI: 1.3, 3.8) for exclusive cigar smokers (16 cases), 3.0 (2.1, 4.5) for exclusive pipe smokers (33 cases) and 5.3 (4.4, 6.4) for exclusive cigarette smokers (1,069 cases). For each smoking type, effects were stronger in current smokers than in ex-smokers and in inhalers than in non-inhalers. Ever smokers of both cigarettes and cigars [HR 5.7 (4.4, 7.3), 120 cases] and cigarettes and pipes [5.1 (4.1, 6.4), 247 cases] had as high a raised risk as had exclusive cigarette smokers. In these smokers, the magnitude of the raised risk was smaller if they had switched to cigars or pipes only (i.e., quit cigarettes) and had not compensated with greater smoking intensity. Cigar and pipe smoking is not a safe alternative to cigarette smoking. The lower cancer risk of cigar and pipe smokers as compared to cigarette smokers is explained by lesser degree of inhalation and lower smoking intensity

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., Bas Bueno-de-Mesquita H.

Int J Cancer; 2010; 126(8): 1928-1935

PMID:19810107

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

Coffee and tea intake and risk of brain tumors in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study

Michaud D.S., Gallo V., Schlehofer B., Tjonneland A., Olsen A., Overvad K., Dahm C.C., Teucher B., Lukanova A., Boeing H., Schutze M., Trichopoulou A., Lagiou P., Kyrozis A., Sacerdote C., Krogh V., Masala G., Tumino R., Mattiello A., Bueno-de-Mesquita H.B., Ros M.M., Peeters P.H., Van Gils C.H., Skeie G., Engeset D., Parr C.L., Ardanaz E., Chirlaque M.D., Dorronsoro M., Sanchez M.J., Arguelles M., Jakszyn P., Nilsson L.M., Melin B.S., Manjer J., Wirfalt E., Khaw K.T., Wareham N., Allen N.E., Key T.J., Romieu I., Vineis P., Riboli E.

Am J Clin Nutr; 2010; 92(5): 1145-1150

PMID:20844074

Abstract as provided by PubMed

BACKGROUND: In a recent US cohort study, total coffee and tea consumption was inversely associated with risk of glioma, and experimental studies showed that caffeine can slow the invasive growth of glioblastoma. OBJECTIVE: The objective was to examine the relation between coffee and tea intake and the risk of glioma and meningioma in a large European cohort study, the European Prospective Investigation into Cancer and Nutrition (EPIC). DESIGN: Data on coffee and tea intake were collected from men and women recruited into the EPIC cohort study. Over an average of 8.5 y of follow-up, 343 cases of glioma and 245 cases of meningioma were newly diagnosed in 9 countries. We used Cox proportional hazards models to examine the relation between coffee and tea and brain tumors. RESULTS: We observed no associations between coffee, tea, or combined coffee and tea consumption and risk of either type of brain tumor when using quantiles based on country-specific distributions of intake. However, a significant inverse association was observed for glioma risk among those consuming >/=100 mL coffee and tea per day compared with those consuming <100 mL/d (hazard ratio: 0.66; 95% CI: 0.44, 0.97; P = 0.03). The association was slightly stronger in men (hazard ratio: 0.59; 95% CI: 0.34, 1.01) than in women (hazard ratio: 0.74; 95% CI: 0.42, 1.31), although neither was statistically significant. CONCLUSIONS: In this large cohort study, we observed an inverse association between total coffee and tea consumption and risk of glioma that was consistent with the findings of a recent study. These findings, if further replicated in other studies, may provide new avenues of research on gliomas

Reproductive factors and exogenous hormone use in relation to risk of glioma and meningioma in a large European cohort study

Michaud D.S., Gallo V., Schlehofer B., Tjonneland A., Olsen A., Overvad K., Dahm C.C., Kaaks R., Lukanova A., Boeing H., Schutze M., Trichopoulou A., Bamia C., Kyrozis A., Sacerdote C., Agnoli C., Palli D., Tumino R., Mattiello A., Bueno-de-Mesquita H.B., Ros M.M., Peeters P.H., Van Gils C.H., Lund E., Bakken K., Gram I.T., Barricarte A., Navarro C., Dorronsoro M., Sanchez M.J., Rodriguez L., Duell E.J., Hallmans G., Melin B.S., Manjer J., Borgquist S., Khaw K.T., Wareham N., Allen N.E., Tsilidis K.K., Romieu I., Rinaldi S., Vineis P., Riboli E.

Cancer Epidemiol Biomarkers Prev; 2010; 19(10): 2562-2569

PMID:20802020

Abstract as provided by PubMed

BACKGROUND: The etiologies of glioma and meningioma tumors are largely unknown. Although reproductive hormones are thought to influence the risk of these tumors, epidemiologic data are not supportive of this hypothesis; however, few cohort studies have published on this topic. We examined the relation between reproductive factors and the risk of glioma and meningioma among women in the European Prospective Investigation into Cancer and Nutrition (EPIC). METHODS: After a mean of 8.4 years of follow-up, 193 glioma and 194 meningioma cases were identified among 276,212 women. Information on reproductive factors and hormone use was collected at baseline. Cox proportional hazard regression was used to determine hazard ratios (HR) and 95% confidence intervals (95% CI). RESULTS: No associations were observed between glioma or meningioma risk and reproductive factors, including age at menarche, parity, age at first birth, menopausal status, and age at menopause. A higher risk of meningioma was observed among postmenopausal women who were current users of hormone replacement therapy (HR, 1.79; 95% CI, 1.18-2.71) compared with never users. Similarly, current users of oral contraceptives were at higher risk of meningioma than never users (HR, 3.61; 95% CI, 1.75-7.46). CONCLUSION: Our results do not support a role for estrogens and glioma risk. Use of exogenous hormones, especially current use, seems to increase meningioma risk. However, these findings could be due to diagnostic bias and require confirmation. IMPACT: Elucidating the role of hormones in brain tumor development has important implications and needs to be further examined using biological measurements

Dietary beta-carotene, vitamin C and E intake and breast cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC)

Nagel G., Linseisen J., Van Gils C.H., Peeters P.H., Boutron-Ruault M.C., Clavel-Chapelon F., Romieu I., Tjonneland A., Olsen A., Roswall N., Witt P.M., Overvad K., Rohrmann S., Kaaks R., Drogan D., Boeing H., Trichopoulou A., Stratigakou V., Zylis D., Engeset D., Lund E., Skeie G., Berrino F., Grioni S., Mattiello A., Masala G., Tumino R., Zanetti R., Ros M.M., Bueno-de-Mesquita H.B., Ardanaz E., Sanchez M.J., Huerta J.M., Amiano P., Rodriguez L., Manjer J., Wirfalt E., Lenner P., Hallmans G., Spencer E.A., Key T.J., Bingham S., Khaw K.T., Rinaldi S., Slimani N., Boffetta P., Gallo V., Norat T., Riboli E.

Breast Cancer Res Treat; 2010; 119(3): 753-765

PMID:19565333

Abstract as provided by PubMed

So far, studies on dietary antioxidant intake, including beta-carotene, vitamin C and vitamin E, and breast cancer risk are inconclusive. Thus, we addressed this question in the European Prospective Investigation into Cancer and Nutrition. During a median follow-up time of 8.8 years, 7,502 primary invasive breast cancer cases were identified. Cox proportional hazard models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI). All analyses were run stratified by menopausal status at recruitment and, additionally, by smoking status, alcohol intake, use of exogenous hormones and use of dietary supplements. In the multivariate analyses, dietary intake of beta-carotene, vitamin C and E was not associated with breast cancer risk in premenopausal [highest vs. lowest quintile: HR, 1.04 (95% CI, 0.85-1.27), 1.12 (0.92-1.36) and 1.11 (0.84-1.46), respectively] and postmenopausal women [0.93 (0.82-1.04), 0.98 (0.87-1.11) and 0.92 (0.77-1.11), respectively]. However, in postmenopausal women using exogenous hormones, high intake of beta-carotene [highest vs. lowest quintile; HR 0.79 (95% CI, 0.66-0.96), P (trend) 0.06] and vitamin C [0.88 (0.72-1.07), P (trend) 0.05] was associated with reduced breast cancer risk. In addition, dietary beta-carotene was associated with a decreased risk in postmenopausal women with high alcohol intake. Overall, dietary intake of beta-carotene, vitamin C and E was not related to breast cancer risk in neither pre- nor postmenopausal women. However, in subgroups of postmenopausal women, a weak protective effect between beta-carotene and vitamin E from food and breast cancer risk cannot be excluded

Plasma phytanic acid concentration and risk of prostate cancer: results from the European Prospective Investigation into Cancer and Nutrition

Price A.J., Allen N.E., Appleby P.N., Crowe F.L., Jenab M., Rinaldi S., Slimani N., Kaaks R., Rohrmann S., Boeing H., Pischon T., Benetou V., Naska A., Trichopoulou A., Palli D., Sieri S., Tumino R., Vineis P., Bueno-de-Mesquita H.B., Donate I., Gonzalez C.A., Sanchez M.J., Chirlaque M.D., Ardanaz E., Larranaga N., Khaw K.T., Rodwell S., Gallo V., Michaud D.S., Riboli E., Key T.J.

Am J Clin Nutr; 2010; 91(6): 1769-1776

PMID:20427733

Abstract as provided by PubMed

BACKGROUND: Phytanic acid, a fatty acid predominantly obtained from foods high in ruminant fat, may have a biological role in the up-regulation of the protein alpha-methylacyl-coenzyme A racemase, which is overexpressed in prostate cancer tissue. OBJECTIVE: This study aimed to examine the association between plasma concentrations of phytanic acid and subsequent risk of prostate cancer. DESIGN: Within the European Prospective Investigation into Cancer and Nutrition cohort, 566 incident prostate cancer cases from Germany, Greece, Italy, the Netherlands, Spain, and the United Kingdom were individually matched to 566 controls by study center, age at recruitment, and time of day and duration of fasting at blood collection. Phytanic acid concentrations were measured by using a gas chromatography-mass spectrometry assay. RESULTS: In controls, plasma phytanic acid concentration was strongly correlated with dairy fat intake (r = 0.49, P < 0.0001), varied significantly by country (P for heterogeneity < 0.0001), and decreased with age (P for trend = 0.02) and duration of fasting at blood collection (P for trend = 0.002). There was no significant association of phytanic acid with prostate cancer risk overall (odds ratio for a doubling in concentration: 1.05; 95% CI: 0.91, 1.21; P for trend = 0.53) or by stage or grade of disease. However, in men who had fasted (>3 h) at blood collection, the odds ratio for prostate cancer was 1.27 (95% CI: 1.01, 1.60; P for trend = 0.04). CONCLUSION: Plasma phytanic acid concentration is significantly associated with intake of dairy fat but not with overall risk of prostate cancer in this European population

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

PMID:20810975

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

PMID:20501772

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

PMID:21045829

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

PMID:20829145

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

PMID:20592131

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

PMID:19790196

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

PMID:19415751

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

PMID:19223851

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

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