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2009

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

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

Meat, eggs, dairy products, and risk of breast cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort

Pala V., Krogh V., Berrino F., Sieri S., Grioni S., Tjonneland A., Olsen A., Jakobsen M.U., Overvad K., Clavel-Chapelon F., Boutron-Ruault M.C., Romieu I., Linseisen J., Rohrmann S., Boeing H., Steffen A., Trichopoulou A., Benetou V., Naska A., Vineis P., Tumino R., Panico S., Masala G., Agnoli C., Engeset D., Skeie G., Lund E., Ardanaz E., Navarro C., Sanchez M.J., Amiano P., Svatetz C.A., Rodriguez L., Wirfalt E., Manjer J., Lenner P., Hallmans G., Peeters P.H., Van Gils C.H., Bueno-de-Mesquita H.B., van Duijnhoven F.J., Key T.J., Spencer E., Bingham S., Khaw K.T., Ferrari P., Byrnes G., Rinaldi S., Norat T., Michaud D.S., Riboli E.

Am J Clin Nutr; 2009; 90(3): 602-612

Abstract as provided by PubMed

BACKGROUND: A Western diet is associated with breast cancer risk. OBJECTIVE: We investigated the relation of meat, egg, and dairy product consumption with breast cancer risk by using data from the European Prospective Investigation into Cancer and Nutrition (EPIC). DESIGN: Between 1992 and 2003, information on diet was collected from 319,826 women. Disease hazard ratios were estimated with multivariate Cox proportional hazard models. RESULTS: Breast cancer cases (n = 7119) were observed during 8.8 y (median) of follow-up. No consistent association was found between breast cancer risk and the consumption of any of the food groups under study, when analyzed by both categorical and continuous exposure variable models. High processed meat consumption was associated with a modest increase in breast cancer risk in the categorical model (hazard ratio: 1.10; 95% CI: 1.00, 1.20; highest compared with lowest quintile: P for trend = 0.07). Subgroup analyses suggested an association with butter consumption, limited to premenopausal women (hazard ratio: 1.28; 95% CI: 1.06, 1.53; highest compared with lowest quintile: P for trend = 0.21). Between-country heterogeneity was found for red meat (Q statistic = 18.03; P = 0.05) and was significantly explained (P = 0.023) by the proportion of meat cooked at high temperature. CONCLUSIONS: We have not consistently identified intakes of meat, eggs, or dairy products as risk factors for breast cancer. Future studies should investigate the possible role of high-temperature cooking in the relation of red meat intake with breast cancer risk

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

Rohrmann S., Linseisen J., Vrieling A., Boffetta P., Stolzenberg-Solomon R.Z., Lowenfels A.B., Jensen M.K., Overvad K., Olsen A., Tjonneland A., Boutron-Ruault M.C., Clavel-Chapelon F., Fagherazzi G., Misirli G., Lagiou P., Trichopoulou A., Kaaks R., Bergmann M.M., Boeing H., Bingham S., Khaw K.T., Allen N., Roddam A., Palli D., Pala V., Panico S., Tumino R., Vineis P., Peeters P.H., Hjartaker A., Lund E., Redondo Cornejo M.L., Agudo A., Arriola L., Sanchez M.J., Tormo M.J., Barricarte Gurrea A., Lindkvist B., Manjer J., Johansson I., Ye W., Slimani N., Duell E.J., Jenab M., Michaud D.S., Mouw T., Riboli E., Bueno-de-Mesquita H.B.

Cancer Causes Control; 2009; 20(5): 785-794

Abstract as provided by PubMed

OBJECTIVE: To examine the association of baseline and lifetime ethanol intake with cancer of the pancreas in the European Prospective Investigation into Cancer and Nutrition (EPIC). METHODS: Included in this analysis were 478,400 subjects, of whom detailed information on the intake of alcoholic beverages at baseline and over lifetime was collected between 1992 and 2000. During a median follow-up time of 8.9 years, 555 non-endocrine pancreatic cancer cases were observed. Multivariate Cox proportional hazard models were used to examine the association of ethanol intake at recruitment and average lifetime ethanol intake and pancreatic cancer adjusting for smoking, height, weight, and history of diabetes. RESULTS: Overall, neither ethanol intake at recruitment (relative risk (RR) = 0.94, 95% confidence interval (CI) 0.69-1.27 comparing 30+ g/d vs. 0.1-4.9 g/d) nor average lifetime ethanol intake (RR = 0.95, 95% CI 0.65-1.39) was associated with pancreatic cancer risk. High lifetime ethanol intake from spirits/liquor at recruitment tended to be associated with a higher risk (RR = 1.40, 95% CI 0.93-2.10 comparing 10+ g/d vs. 0.1-4.9 g/d), but no associations were observed for wine and beer consumption. CONCLUSION: These results suggest no association of alcohol consumption with the risk of pancreatic cancer

Plasma phospholipid fatty acid profiles and their association with food intakes: results from a cross-sectional study within the European Prospective Investigation into Cancer and Nutrition

Saadatian-Elahi M., Slimani N., Chajes V., Jenab M., Goudable J., Biessy C., Ferrari P., Byrnes G., Autier P., Peeters P.H., Ocke M., Bueno de Mesquita B., Johansson I., Hallmans G., Manjer J., Wirfalt E., Gonzalez C.A., Navarro C., Martinez C., Amiano P., Suarez L.R., Ardanaz E., Tjonneland A., Halkjaer J., Overvad K., Jakobsen M.U., Berrino F., Pala V., Palli D., Tumino R., Vineis P., Santucci de Magistris M., Spencer E.A., Crowe F.L., Bingham S., Khaw K.T., Linseisen J., Rohrmann S., Boeing H., Noethlings U., Olsen K.S., Skeie G., Lund E., Trichopoulou A., Oustoglou E., Clavel-Chapelon F., Riboli E.

Am J Clin Nutr; 2009; 89(1): 331-346

Abstract as provided by PubMed

BACKGROUND: Plasma phospholipid fatty acids have been correlated with food intakes in populations with homogeneous dietary patterns. However, few data are available on populations with heterogeneous dietary patterns. OBJECTIVE: The objective was to investigate whether plasma phospholipid fatty acids are suitable biomarkers of dietary intakes across populations involved in a large European multicenter study. DESIGN: A cross-sectional study design nested to the European Prospective Investigation into Cancer and Nutrition (EPIC) was conducted to determine plasma fatty acid profiles in >3,000 subjects from 16 centers, who had also completed 24-h dietary recalls and dietary questionnaires. Plasma fatty acids were assessed by capillary gas chromatography. Ecological and individual correlations were calculated between fatty acids and select food groups. RESULTS: The most important determinant of plasma fatty acids was region, which suggests that the variations across regions are largely due to different food intakes. Strong ecological correlations were observed between fish intake and long-chain n-3 polyunsaturated fatty acids (r = 0.78, P < 0.01), olive oil and oleic acid (r = 0.73, P < 0.01), and margarine and elaidic acid (r = 0.76, P < 0.01). Individual correlations varied across the regions, particularly between olive oil and oleic acid and between alcohol and the saturation index, as an indicator of stearoyl CoA desaturase activity. CONCLUSIONS: These findings indicate that specific plasma phospholipid fatty acids are suitable biomarkers of some food intakes in the EPIC Study. Moreover, these findings suggest complex interactions between alcohol intake and fatty acid metabolism, which warrants further attention in epidemiologic studies relating dietary fatty acids to alcohol-related cancers and other chronic diseases

Alcohol consumption patterns, diet and body weight in 10 European countries

Sieri S., Krogh V., Saieva C., Grobbee D.E., Bergmann M., Rohrmann S., Tjonneland A., Ferrari P., Chloptsios Y., Dilis V., Jenab M., Linseisen J., Wallstrom P., Johansson I., Chirlaque M.D., Sanchez M.J., Niravong M., Clavel-Chapelon F., Welch A.A., Allen N.E., Bueno-de-Mesquita H.B., van der Schouw Y.T., Sacerdote C., Panico S., Parr C.L., Braaten T., Olsen A., Jensen M.K., Bingham S., Riboli E., Slimani N.

Eur J Clin Nutr; 2009; S81-S100

Abstract as provided by PubMed

Background/objectives: Europe has the highest level of alcohol consumption in the world. As drinking patterns are important determinants of the beneficial and harmful effects of alcohol consumption, we investigated alcohol consumption in relation to nutrient intake, place of consumption, education and body weight in a sample of adults from 10 European countries. Methods: A 24-h dietary recall interview was conducted on 13 025 men and 23 009 women, aged 35-74 years, from 27 centres participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Means and standard errors of alcohol consumption, adjusted for age, were calculated, stratified by gender and centre. Results: In many centres, higher level drinkers (males consuming 424 g of ethanol/day, equivalent to 42 standard drinks and females consuming 412 g of ethanol/day equivalent to 41 standard drink) obtained more energy from fat and protein and less from sugar than did abstainers. The proportion of energy from starch tended to be higher for male and lower for female higher level drinkers than for abstainers. Female higher level drinkers had a lower body mass index than did abstainers, whereas male higher level drinkers generally weighed more. Male higher level drinkers were less educated than abstainers in Mediterranean countries, but were more educated elsewhere. Female higher level drinkers were usually more educated than were abstainers. Outside the home, consumption (both genders) tended to be at friends' homes, particularly among men in Northern and Central Europe, and in bars in Spain. Conclusions: This study reveals clear geographical differences in drinking habits across Europe, and shows that the characteristics of different alcohol consumption categories also vary. European Journal of Clinical Nutrition (2009) 63, S81-S100; doi: 10.1038/ejcn.2009.76

Use of dietary supplements in the European Prospective Investigation into Cancer and Nutrition calibration study

Skeie G., Braaten T., Hjartaker A., Lentjes M., Amiano P., Jakszyn P., Pala V., Palanca A., Niekerk E.M., Verhagen H., Avloniti K., Psaltopoulou T., Niravong M., Touvier M., Nimptsch K., Haubrock J., Walker L., Spencer E.A., Roswall N., Olsen A., Wallstrom P., Nilsson S., Casagrande C., Deharveng G., Hellstrom V., Boutron-Ruault M.C., Tjonneland A., Joensen A.M., Clavel-Chapelon F., Trichopoulou A., Martinez C., Rodriguez L., Frasca G., Sacerdote C., Peeters P.H.M., Linseisen J., Schienkiewitz A., Welch A.A., Manjer J., Ferrari P., Riboli E., Bingham S., Engeset D., Lund E., Slimani N.

Eur J Clin Nutr; 2009; S226-S238

Abstract as provided by PubMed

Background: Dietary supplement use is increasing, but there are few comparable data on supplement intakes and how they affect the nutrition and health of European consumers. The aim of this study was to describe the use of dietary supplements in subsamples of the 10 countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC). Methods: Specific questions on dietary supplement use were asked as a part of single 24-h recalls performed on 36 034 men and women aged 35-74 years from 1995 to 2000. Results: Between countries, the mean percentage of dietary supplement use varied almost 10-fold among women and even more among men. There was a clear north-south gradient in use, with a higher consumption in northern countries. The lowest crude mean percentage of use was found in Greece (2.0% among men, 6.7% among women), and the highest was in Denmark (51.0% among men, 65.8% among women). Use was higher in women than in men. Vitamins, minerals or combinations of them were the predominant types of supplements reported, but there were striking differences between countries. Conclusions: This study indicates that there are wide variations in supplement use in Europe, which may affect individual and population nutrient intakes. The results underline the need to monitor consumption of dietary supplements in Europe, as well as to evaluate the risks and benefits. European Journal of Clinical Nutrition (2009) 63, S226-S238; doi: 10.1038/ejcn.2009.83

Contribution of highly industrially processed foods to the nutrient intakes and patterns of middle-aged populations in the European Prospective Investigation into Cancer and Nutrition study

Slimani N., Deharveng G., Southgate D.A.T., Biessy C., Chajes V., van Bakel M.M.E., Boutron-Ruault M.C., McTaggart A., Grioni S., Verkaik-Kloosterman J., Huybrechts I., Amiano P., Jenab M., Vignat J., Bouckaert K., Casagrande C., Ferrari P., Zourna P., Trichopoulou A., Wirfalt E., Johansson G., Rohrmann S., Illner A.K., Barricarte A., Rodriguez L., Touvier M., Niravong M., Mulligan A., Crowe F., Ocke M.C., van der Schouw Y.T., Bendinelli B., Lauria C., Brustad M., Hjartaker A., Tjonneland A., Jensen A.M., Riboli E., Bingham S.

Eur J Clin Nutr; 2009; S206-S225

Abstract as provided by PubMed

Objectives: To describe the contribution of highly processed foods to total diet, nutrient intakes and patterns among 27 redefined centres in the 10 countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC). Methods: Single 24-hour dietary recalls were collected from 36 034 individuals (aged 35-74 years) using a standardized computerized interview programme (EPIC-SOFT). Centre-specific mean food intakes (g/day) were computed according to their degree of food processing (that is, highly, moderately and non-processed foods) using a specifically designed classification system. The contribution (%) of highly processed foods to the centre mean intakes of diet and 26 nutrients (including energy) was estimated using a standardized nutrient database (ENDB). The effect of different possible confounders was also investigated. Results: Highly processed foods were an important source of the nutrients considered, contributing between 61% (Spain) and 78-79% (the Netherlands and Germany) of mean energy intakes. Only two nutrients, beta-carotene (34-46%) and vitamin C (28-36%), had a contribution from highly processed foods below 50% in Nordic countries, in Germany, the Netherlands and the United Kingdom, whereas for the other nutrients, the contribution varied from 50 to 91% (excluding alcohol). In southern countries (Greece, Spain, Italy and France), the overall contribution of highly processed foods to nutrient intakes was lower and consisted largely of staple or basic foods (for example, bread, pasta/rice, milk, vegetable oils), whereas highly processed foods such as crisp bread, breakfast cereals, margarine and other commercial foods contributed more in Nordic and central European centres. Conclusions: Highly industrially processed foods dominate diets and nutrient patterns in Nordic and central European countries. The greater variations observed within southern countries may reflect both a larger contribution of non/moderately processed staple foods along with a move from traditional to more industrialized dietary patterns. European Journal of Clinical Nutrition (2009) 63, S206-S225; doi: 10.1038/ejcn.2009.82

Prospective study of the association between grapefruit intake and risk of breast cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC)

Spencer E.A., Key T.J., Appleby P.N., Van Gils C.H., Olsen A., Tjonneland A., Clavel-Chapelon F., Boutron-Ruault M.C., Touillaud M., Sanchez M.J., Bingham S., Khaw K.T., Slimani N., Kaaks R., Riboli E.

Cancer Causes Control; 2009; 20(6): 803-809

Abstract as provided by PubMed

Grapefruit inhibits cytochrome P450 3A4 and may affect estrogen metabolism. In the European Prospective Investigation into Cancer and Nutrition (EPIC), we examined the relationships of grapefruit intake with risk of breast cancer and with serum sex hormone levels. 114,504 women with information on dietary intake of grapefruit and on reproductive and lifestyle risk factors were followed for a median 9.5 years and 3,747 incident breast cancers were identified. Fifty-nine percent of women reported eating grapefruit, 4% ate > or = 60 g/day. Cox proportional hazard models were used to estimate the hazard ratio (HR) for breast cancer according to grapefruit intake, adjusting for study centre, reproductive factors, body mass index, energy intake, and alcohol intake. Grapefruit intake was not related to the risk of breast cancer: compared with women who ate no grapefruit, women with the highest intake of > or =60 g/day had a HR of 0.93 (95% CI 0.77-1.13), p for linear trend = 0.5. There was no relationship between grapefruit intake and breast cancer risk among premenopausal women, all postmenopausal women, or postmenopausal women categorized by hormone replacement therapy use (all p>0.05). There was no association between grapefruit intake and estradiol or estrone among postmenopausal women. In this study, we found no evidence of an association between grapefruit intake and risk of breast cancer

Anthropometry and esophageal cancer risk in the European prospective investigation into cancer and nutrition

Steffen A., Schulze M.B., Pischon T., Dietrich T., Molina E., Chirlaque M.D., Barricarte A., Amiano P., Quiros J.R., Tumino R., Mattiello A., Palli D., Vineis P., Agnoli C., Misirli G., Boffetta P., Kaaks R., Rohrmann S., Bueno-de-Mesquita H.B., Peeters P.H., May A.M., Spencer E.A., Allen N.E., Bingham S., Tjonneland A., Halkjaer J., Overvad K., Stegger J., Manjer J., Lindkvist B., Hallmanns G., Stenling R., Lund E., Riboli E., Gonzalez C.A., Boeing H.

Cancer Epidemiol Biomarkers Prev; 2009; 18(7): 2079-2089

Abstract as provided by PubMed

BACKGROUND: Increasing evidence suggests that general obesity [measured by body mass index (BMI)] is positively associated with risk of esophageal adenocarcinoma (EAC). In contrast, previous studies have shown inverse relations with esophageal squamous cell carcinoma (ESCC). However, it is still unclear whether body fat distribution, particularly abdominal obesity, is associated with each type of esophageal cancer. METHODS: We applied multivariable adjusted Cox proportional hazards regression to investigate the association between anthropometric measures and risk of EAC and ESCC among 346,554 men and women participating in the European Prospective Investigation into Cancer and Nutrition. All statistical tests were two sided. RESULTS: During 8.9 years of follow-up, we documented 88 incident cases of EAC and 110 cases of ESCC. BMI, waist circumference, and waist-to-hip ratio (WHR) were positively associated with EAC risk [highest versus lowest quintile; relative risk (RR), 2.60; 95% confidence interval (95% CI), 1.23-5.51; P(trend) < 0.01; RR, 3.07; 95% CI, 1.35-6.98; P(trend) < 0.003; and RR, 2.12; 95% CI, 0.98-4.57; P(trend) < 0.004]. In contrast, BMI and waist circumference were inversely related to ESCC risk, whereas WHR showed no association with ESCC. In stratified analyses, BMI and waist circumference were significantly inversely related to ESCC only among smokers but not among nonsmokers. However, when controlled for BMI, we found positive associations for waist circumference and WHR with ESCC, and these associations were observed among smokers and nonsmokers. CONCLUSION: General and abdominal obesity were associated with higher EAC risk. Further, our study suggests that particularly an abdominal body fat distribution might also be a risk factor for ESCC

Lifestyle factors and serum androgens among 636 middle aged men from seven countries in the European Prospective Investigation into Cancer and Nutrition (EPIC)

Suzuki R., Allen N.E., Appleby P.N., Key T.J., Dossus L., Tjonneland A., Fons Johnsen N., Overvad K., Sacerdote C., Palli D., Krogh V., Tumino R., Rohrmann S., Linseisen J., Boeing H., Trichopoulou A., Makrygiannis G., Misirli G., Bueno-de-Mesquita H.B., May A.M., Diaz M.J., Sanchez M.J., Barricarte Gurrea A., Rodriguez Suarez L., Buckland G., Larranaga N., Bingham S., Khaw K.T., Rinaldi S., Slimani N., Jenab M., Riboli E., Kaaks R.

Cancer Causes Control; 2009; 20(6): 811-821

Abstract as provided by PubMed

OBJECTIVE: To evaluate the association between lifestyle and dietary factors and serum concentrations of androgens in middle-aged healthy men. METHODS: We conducted a cross-sectional analysis of the association of lifestyle factors with circulating concentrations of androstenedione (A-dione), 3-alpha-androstanediol glucuronide (A-diol-g), testosterone (T), SHBG (sex hormone-binding globulin), and free testosterone (FT) among 636 men in the European Prospective Investigation into Cancer and Nutrition. RESULTS: Compared with the youngest age group (40-49 years), the oldest (70-79 years) had a higher mean concentration of SHBG (by 44%) and lower mean concentrations of A-diol-g (by 29%) FT (19%). Men in the highest BMI group (> or =29.83 kg/m(2)) had a higher mean A-diol-g concentration (by 38%) and lower mean concentration of T (by 20%) SHBG (29%) compared with the lowest (<24.16 kg/m(2)). Current smokers had higher mean concentrations of T (by 13%), SHBG (14%), and A-dione (15%) compared with never smokers. Physical activity and dietary factors were not associated with androgen concentrations, although men in the highest fifth of alcohol intake had higher mean concentrations of A-dione (by 9%), FT (11%) compared with the lowest. CONCLUSION: Our results suggest that age, body weight, smoking, and alcohol intake are associated with circulating androgen concentrations in men

A prospective analysis of the association between dietary fiber intake and prostate cancer risk in EPIC

Suzuki R., Allen N.E., Key T.J., Appleby P.N., Tjonneland A., Johnsen N.F., Jensen M.K., Overvad K., Boeing H., Pischon T., Kaaks R., Rohrmann S., Trichopoulou A., Misirli G., Trichopoulos D., Bueno-de-Mesquita H.B., van Duijnhoven F., Sacerdote C., Pala V., Palli D., Tumino R., Ardanaz E., Quiros J.R., Larranaga N., Sanchez M.J., Tormo M.J., Jakszyn P., Johansson I., Stattin P., Berglund G., Manjer J., Bingham S., Khaw K.T., Egevad L., Ferrari P., Jenab M., Riboli E.

Int J Cancer; 2009; 124(1): 245-249

Abstract as provided by PubMed

Few studies have examined the association between dietary fiber intake and prostate cancer risk. We evaluated the association between dietary fiber intake and the risk of prostate cancer among 142,590 men in the European Prospective Investigation into Cancer and Nutrition (EPIC). Consumption of dietary fiber (total, cereal, fruit and vegetable fiber) was estimated by validated dietary questionnaires and calibrated using 24-hr dietary recalls. Incidence rate ratios were estimated using Cox regression and adjusted for potential confounding factors. During an average of 8.7 years follow-up, prostate cancer was diagnosed in 2,747 men. Overall, there was no association between dietary fiber intake (total, cereal, fruit or vegetable fiber) and prostate cancer risk, although calibrated intakes of total fiber and fruit fiber were associated with nonstatistically significant reductions in risk. There was no association between fiber derived from cereals or vegetables and risk and no evidence for heterogeneity in any of the risk estimates by stage or grade of disease. Our results suggest that dietary fiber intake is not associated with prostate cancer risk. (c) 2008 Wiley-Liss, Inc

Smoking and body fatness measurements: a cross-sectional analysis in the EPIC-PANACEA study

Travier N., Agudo A., May A.M., Gonzalez C., Luan J., Besson H., Wareham N.J., Slimani N., Rinaldi S., Clavel-Chapelon F., Boutron-Ruault M.C., Palli D., Agnoli C., Mattiello A., Tumino R., Vineis P., Rodriguez L., Sanchez M.J., Dorronsoro M., Barricarte A., Tormo M.J., Norat T., Mouw T., Key T.J., Spencer E.A., Bueno-de-Mesquita H.B., Vrieling A., Orfanos P., Naska A., Trichopoulou A., Rohrmann S., Kaaks R., Bergmann M., Boeing H., Hallmans G., Johansson I., Manjer J., Lindkvist B., Jakobsen M.U., Overvad K., Tjonneland A., Halkjaer J., Lund E., Braaten T., Odysseos A., Riboli E., Peeters P.H.

Prev Med; 2009; 49(5): 365-373

Abstract as provided by PubMed

OBJECTIVE: The present study investigates the cross-sectional relationship between tobacco smoking and body fatness. METHODS: This cross-sectional study consisted of 469,543 men and women who participated in the European Prospective Investigation into Cancer and Nutrition (EPIC) study between 1992 and 2000 providing anthropometric measurements and information on smoking. Adjusted multilevel mixed-effects linear regression models were used to assess the association between smoking and body fat mass. RESULTS: The analyses showed that BMI and WC were positively associated with smoking intensity in current smokers but negatively associated with time since quitting in former smokers. When compared to never smokers, average current smokers (17 and 13 cig/day for men and women, respectively) showed a lower BMI. When average former smokers (men and women who had stopped smoking for 16 and 15 years, respectively) were compared to never smokers, higher BMI and WC were observed in men, whereas no significant associations were observed in women. CONCLUSIONS: This cross-sectional study suggests that smoking may be associated with body fatness and fat distribution. Although our findings cannot establish cause and effect, they suggest that providing information and support to those who want to stop may help in preventing weight gain and therefore weaken a barrier against stopping smoking

Serum vitamin D and risk of prostate cancer in a case-control analysis nested within the European Prospective Investigation into Cancer and Nutrition (EPIC)

Travis R.C., Crowe F.L., Allen N.E., Appleby P.N., Roddam A.W., Tjonneland A., Olsen A., Linseisen J., Kaaks R., Boeing H., Kroger J., Trichopoulou A., Dilis V., Trichopoulos D., Vineis P., Palli D., Tumino R., Sieri S., Bueno-de-Mesquita H.B., van Duijnhoven F.J., Chirlaque M.D., Barricarte A., Larranaga N., Gonzalez C.A., Arguelles M.V., Sanchez M.J., Stattin P., Hallmans G., Khaw K.T., Bingham S., Rinaldi S., Slimani N., Jenab M., Riboli E., Key T.J.

Am J Epidemiol; 2009; 169(10): 1223-1232

Abstract as provided by PubMed

Results from the majority of studies show little association between circulating concentrations of vitamin D and prostate cancer risk, a finding that has not been demonstrated in a wider European population, however. The authors examined whether vitamin D concentrations were associated with prostate cancer risk in a case-control study nested within the European Prospective Investigation into Cancer and Nutrition (1994-2000). Serum concentrations of 25-hydroxyvitamin D were measured in 652 prostate cancer cases matched to 752 controls from 7 European countries after a median follow-up time of 4.1 years. Conditional logistic regression models were used to calculate odds ratios for prostate cancer risk in relation to serum 25-hydroxyvitamin D after standardizing for month of blood collection and adjusting for covariates. No significant association was found between 25-hydroxyvitamin D and risk of prostate cancer (highest vs. lowest quintile: odds ratio = 1.28, 95% confidence interval: 0.88, 1.88; P for trend = 0.188). Subgroup analyses showed no significant heterogeneity by cancer stage or grade, age at diagnosis, body mass index, time from blood collection to diagnosis, or calcium intake. In summary, the results of this large nested case-control study provide no evidence in support of a protective effect of circulating concentrations of vitamin D on the risk of prostate cancer

Dietary glycaemic index and glycaemic load in the European Prospective Investigation into Cancer and Nutrition

van Bakel M.M., Kaaks R., Feskens E.J.M., Rohrmann S., Welch A.A., Pala V., Avloniti K., van der Schouw Y.T., van der A D.L., Du H., Halkjaer J., Tormo M.J., Cust A.E., Brighenti F., Beulens J.W., Ferrari P., Biessy C., Lentjes M., Spencer E.A., Panico S., Masala G., Bueno-de-Mesquita H.B., Peeters P.H.M., Trichopoulou A., Psaltopoulou T., Clavel-Chapelon F., Touvier M., Skeie G., Rinaldi S., Sonestedt E., Johansson I., Schulze M., Ardanaz E., Buckland G., Tjonneland A., Overvad K., Bingham S., Riboli E., Slimani N.

Eur J Clin Nutr; 2009; S188-S205

Abstract as provided by PubMed

Objectives: To describe dietary glycaemic index (GI) and glycaemic load (GL) values in the population participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study according to food groups, nutrients and lifestyle characteristics. Methods: Single 24-h dietary recalls (24-HDRs) from 33 566 subjects were used to calculate dietary GI and GL, and an ad hoc database was created as the main reference source. Mean GI and GL intakes were adjusted for age, total energy intake, height and weight, and were weighted by season and day of recall. Results: GI was the lowest in Spain and Germany, and highest in the Netherlands, United Kingdom and Denmark for both genders. In men, GL was the lowest in Spain and Germany and highest in Italy, whereas in women, it was the lowest in Spain and Greece and highest in the UK health-conscious cohort. Bread was the largest contributor to GL in all centres (15-45%), but it also showed the largest inter-individual variation. GL, but not GI, tended to be lower in the highest body mass index category in both genders. GI was positively correlated with starch and intakes of bread and potatoes, whereas it was correlated negatively with intakes of sugar, fruit and dairy products. GL was positively correlated with all carbohydrate components and intakes of cereals, whereas it was negatively correlated with fat and alcohol and with intakes of wine, with large variations across countries. Conclusions: GI means varied modestly across countries and genders, whereas GL means varied more, but it may possibly act as a surrogate of carbohydrate intake. European Journal of Clinical Nutrition (2009) 63, S188-S205; doi: 10.1038/ejcn.2009.81

Methodological challenges in the application of the glycemic index in epidemiological studies using data from the European Prospective Investigation into Cancer and Nutrition

van Bakel M.M., Slimani N., Feskens E.J., Du H., Beulens J.W., van der Schouw Y.T., Brighenti F., Halkjaer J., Cust A.E., Ferrari P., Brand-Miller J., Bueno-de-Mesquita H.B., Peeters P., Ardanaz E., Dorronsoro M., Crowe F.L., Bingham S., Rohrmann S., Boeing H., Johansson I., Manjer J., Tjonneland A., Overvad K., Lund E., Skeie G., Mattiello A., Salvini S., Clavel-Chapelon F., Kaaks R.

J Nutr; 2009; 139(3): 568-575 + supplement

Abstract as provided by PubMed

Associations between the glycemic index (GI) or glycemic load (GL) and diseases are heterogeneous in epidemiological studies. Differences in assigning GI values to food items may contribute to this inconsistency. Our objective was to address methodological issues related to the use of current GI and GL values in epidemiological studies. We performed ecological comparison and correlation studies by calculating dietary GI and GL from country-specific dietary questionnaires (DQ) from 422,837 participants from 9 countries participating in the European Prospective Investigation into Cancer and Nutrition study and single standardized 24-h dietary recalls (24-HDR) obtained from a representative sample (n = 33,404) using mainly Foster Powell's international table as a reference source. Further, 2 inter-rater and 1 inter-method comparison were conducted, comparing DQ GI values assigned by independent groups with values linked by us. The ecological correlation between DQ and 24-HDR was good for GL (overall r = 0.76; P < 0.005) and moderate for GI (r = 0.57; P < 0.05). Mean GI/GL differences between DQ and 24-HDR were significant for most centers. GL but not GI from DQ was highly correlated with total carbohydrate (r = 0.98 and 0.15, respectively; P < 0.0001) and this was higher for starch (r = 0.72; P < 0.0001) than for sugars (r = 0.36; P < 0.0001). The inter-rater and inter-method variations were considerable for GI (weighted kappa coefficients of 0.49 and 0.65 for inter-rater and 0.25 for inter-method variation, respectively) but only mild for GL (weighted kappa coefficients > 0.80). A more consistent methodology to attribute GI values to foods and validated DQ is needed to derive meaningful GI/GL estimates for nutritional epidemiology

Fruit, vegetables, and colorectal cancer risk: the European Prospective Investigation into Cancer and Nutrition

van Duijnhoven F.J., Bueno-de-Mesquita H.B., Ferrari P., Jenab M., Boshuizen H.C., Ros M.M., Casagrande C., Tjonneland A., Olsen A., Overvad K., Thorlacius-Ussing O., Clavel-Chapelon F., Boutron-Ruault M.C., Morois S., Kaaks R., Linseisen J., Boeing H., Nothlings U., Trichopoulou A., Trichopoulos D., Misirli G., Palli D., Sieri S., Panico S., Tumino R., Vineis P., Peeters P.H., Van Gils C.H., Ocke M.C., Lund E., Engeset D., Skeie G., Suarez L.R., Gonzalez C.A., Sanchez M.J., Dorronsoro M., Navarro C., Barricarte A., Berglund G., Manjer J., Hallmans G., Palmqvist R., Bingham S.A., Khaw K.T., Key T.J., Allen N.E., Boffetta P., Slimani N., Rinaldi S., Gallo V., Norat T., Riboli E.

Am J Clin Nutr; 2009; 89(5): 1441-1452

Abstract as provided by PubMed

BACKGROUND: A high consumption of fruit and vegetables is possibly associated with a decreased risk of colorectal cancer (CRC). However, the findings to date are inconsistent. OBJECTIVE: We examined the relation between self-reported usual consumption of fruit and vegetables and the incidence of CRC. DESIGN: In the European Prospective Investigation into Cancer and Nutrition (EPIC), 452,755 subjects (131,985 men and 320,770 women) completed a dietary questionnaire in 1992-2000 and were followed up for cancer incidence and mortality until 2006. A multivariate Cox proportional hazard model was used to estimate adjusted hazard ratios (HRs) and 95% CIs. RESULTS: After an average follow-up of 8.8 y, 2,819 incident CRC cases were reported. Consumption of fruit and vegetables was inversely associated with CRC in a comparison of the highest with the lowest EPIC-wide quintile of consumption (HR: 0.86; 95% CI: 0.75, 1.00; P for trend = 0.04), particularly with colon cancer risk (HR: 0.76; 95% CI: 0.63, 0.91; P for trend < 0.01). Only after exclusion of the first 2 y of follow-up were these findings corroborated by calibrated continuous analyses for a 100-g increase in consumption: HRs of 0.95 (95% CI: 0.91, 1.00; P = 0.04) and 0.94 (95% CI: 0.89, 0.99; P = 0.02), respectively. The association between fruit and vegetable consumption and CRC risk was inverse in never and former smokers, but positive in current smokers. This modifying effect was found for fruit and vegetables combined and for vegetables alone (P for interaction < 0.01 for both). CONCLUSIONS: These findings suggest that a high consumption of fruit and vegetables is associated with a reduced risk of CRC, especially of colon cancer. This effect may depend on smoking status

Fruit, vegetables, and colorectal cancer risk: the European Prospective Investigation into Cancer and Nutrition - Reply

van Duijnhoven F.J.B., Bueno-de-Mesquita H.B., Jenab M., Riboli E.

Am J Clin Nutr; 2009; 90(4): 1112-1114
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