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2009

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

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

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

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

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

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

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
Fruit and vegetable consumption and pancreatic cancer risk in the European Prospective Investigation into Cancer and Nutrition

Vrieling A., Verhage B.A., van Duijnhoven F.J., Jenab M., Overvad K., Tjonneland A., Olsen A., Clavel-Chapelon F., Boutron-Ruault M.C., Kaaks R., Rohrmann S., Boeing H., Nothlings U., Trichopoulou A., John T., Dimosthenes Z., Palli D., Sieri S., Mattiello A., Tumino R., Vineis P., Van Gils C.H., Peeters P.H., Engeset D., Lund E., Rodriguez Suarez L., Jakszyn P., Larranaga N., Sanchez M.J., Chirlaque M.D., Ardanaz E., Manjer J., Lindkvist B., Hallmans G., Ye W., Bingham S., Khaw K.T., Roddam A., Key T., Boffetta P., Duell E.J., Michaud D.S., Riboli E., Bueno-de-Mesquita H.B.

Int J Cancer; 2009; 124(8): 1926-1934

Abstract as provided by PubMed

Many case-control studies have suggested that higher consumption of fruit and vegetables is associated with a lower risk of pancreatic cancer, whereas cohort studies do not support such an association. We examined the associations of the consumption of fruits and vegetables and their main subgroups with pancreatic cancer risk within the European Prospective Investigation into Cancer and Nutrition (EPIC). EPIC is comprised of over 520,000 subjects recruited from 10 European countries. The present study included 555 exocrine pancreatic cancer cases after an average follow-up of 8.9 years. Estimates of risk were obtained by Cox proportional hazard models, stratified by age at recruitment, gender, and study center, and adjusted for total energy intake, weight, height, history of diabetes mellitus, and smoking status. Total consumption of fruit and vegetables, combined or separately, as well as subgroups of vegetables and fruits were unrelated to risk of pancreatic cancer. Hazard ratios (95% CI) for the highest versus the lowest quartile were 0.92 (0.68-1.25) for total fruit and vegetables combined, 0.99 (0.73-1.33) for total vegetables, and 1.02 (0.77-1.36) for total fruits. Stratification by gender or smoking status, restriction to microscopically verified cases, and exclusion of the first 2 years of follow-up did not materially change the results. These results from a large European prospective cohort suggest that higher consumption of fruit and vegetables is not associated with decreased risk of pancreatic cancer

Lifetime and baseline alcohol intake and risk of cancer of the upper aero-digestive tract in the European Prospective Investigation into Cancer and Nutrition (EPIC) study

Weikert C., Dietrich T., Boeing H., Bergmann M.M., Boutron-Ruault M.C., Clavel-Chapelon F., Allen N., Key T., Lund E., Olsen A., Tjonneland A., Overvad K., Rohrmann S., Linseisen J., Pischon T., Trichopoulou A., Weinehall L., Johansson I., Sanchez M.J., Agudo A., Barricarte A., Amiano P., Chirlaque M.D., Quiros J.R., Wirfalt E., Peeters P.H., Bueno-de-Mesquita H.B., Vrieling A., Pala V., Palli D., Vineis P., Tumino R., Panico S., Bingham S., Khaw K.T., Norat T., Jenab M., Ferrari P., Slimani N., Riboli E.

Int J Cancer; 2009; 125(2): 406-412

Abstract as provided by PubMed

Recent alcohol consumption is an established risk factor for squamous cell carcinoma (SCC) of the upper aero-digestive tract. In contrast, the role of lifetime exposure to alcohol with regard to risk of SCC is not well established. Historical data on alcohol use are available in 271,253 participants of the European Prospective Investigation into Cancer and Nutrition (EPIC). During 2,330,381 person years, 392 incident SCC cases (279 men and 113 women) were identified. Cox regression was applied to model sex-specific associations between lifetime alcohol intake and SCC risk adjusting for potential confounders including smoking. Compared to men who drank 0.1-6.0 g/day alcohol at lifetime, the relative risks (RR) for developing SCC were significantly increased for men who drank 30.1-60.0 g/day (RR 1.65, 95% confidence interval:1.00-2.71), 60.1-96.0 g/day (RR 2.20, 95%CI 1.23-3.95), and >96.0 g/day, (RR 4.63, 95% CI 2.52-8.48), and for former drinkers (RR 4.14, 95%CI 2.38-7.19). These risk estimates did not considerably change when baseline alcohol intake was analyzed. Compared to women who drank 0.1-6.0 g/day alcohol intake at lifetime, the RR were significantly increased for women who drank >30 g/d (RR 6.05, 95%CI 2.98-12.3). Applying similar categories, the relative risk for baseline alcohol intake was 3.26 (95%CI 1.82-5.87). We observed a stronger association between alcohol intake at lifetime and risk of SCC in women compared to men (p for interaction = 0.045). The strong dose-response relation for lifetime alcohol use underscores that alcohol is an important risk factor of SCC of the upper aero-digestive tract throughout life. (c) 2009 UICC

Variation in intakes of calcium, phosphorus, magnesium, iron and potassium in 10 countries in the European Prospective Investigation into Cancer and Nutrition study

Welch A.A., Fransen H., Jenab M., Boutron-Ruault M.C., Tumino R., Agnoli C., Ericson U., Johansson I., Ferrari P., Engeset D., Lund E., Lentjes M., Key T., Touvier M., Niravong M., Larranaga N., Rodriguez L., Ocke M.C., Peeters P.H.M., Tjonneland A., Bjerregaard L., Vasilopoulou E., Dilis V., Linseisen J., Nothlings U., Riboli E., Slimani N., Bingham S.

Eur J Clin Nutr; 2009; S101-S121

Abstract as provided by PubMed

Background/objectives: Adequate mineral intake is important for the maintenance of bone health, cellular function and general metabolism, and possibly in the aetiology of cancer and other chronic diseases. This study aimed at investigating variation in intakes of selected minerals across 10 European countries participating in the EPIC (European Prospective Investigation into Cancer and Nutrition) study. Methods: Nutrient intakes for 36 034 subjects, aged between 35 and 74 years, in 27 centres were obtained using standardized 24-h dietary recall software (EPIC-SOFT). Mean intakes of calcium, phosphorus, magnesium, iron and potassium were calculated by centre and weighted by season and day of the week and were also stratified by age group. The contribution of food groups to total nutrient intake was calculated. Results: There was clear geographical variability in intakes, with differences ranging from 35% for magnesium to 90% for iron in men and 36% for potassium to 75% for calcium in women, and a twofold difference in sources of haem iron (meat and fish). There was a geographical gradient in iron intake, with higher intakes in Southern than in Northern Europe and also around a twofold north-south gradient in the contribution of fruits and vegetables to potassium intake. Compared with reference intakes, the majority of age groups and centres had intakes above the recommended levels. Dairy foods and products contributed the most to calcium and phosphorus intake in almost all centres. Cereals and cereal products contributed the most to magnesium and iron intakes, except in Greece and Germany. Conclusions: Intakes of minerals vary substantially throughout Europe, with some geographical variability in their food sources. European Journal of Clinical Nutrition (2009) 63, S101-S121; doi: 10.1038/ejcn.2009.77

2008

Animal foods, protein, calcium and prostate cancer risk: the European Prospective Investigation into Cancer and Nutrition

Allen N.E., Key T.J., Appleby P.N., Travis R.C., Roddam A.W., Tjonneland A., Johnsen N.F., Overvad K., Linseisen J., Rohrmann S., Boeing H., Pischon T., Bueno-de-Mesquita H.B., Kiemeney L., Tagliabue G., Palli D., Vineis P., Tumino R., Trichopoulou A., Kassapa C., Trichopoulos D., Ardanaz E., Larranaga N., Tormo M.J., Gonzalez C.A., Quiros J.R., Sanchez M.J., Bingham S., Khaw K.T., Manjer J., Berglund G., Stattin P., Hallmans G., Slimani N., Ferrari P., Rinaldi S., Riboli E.

Br J Cancer; 2008; 98(9): 1574-1581

Abstract as provided by PubMed

We examined consumption of animal foods, protein and calcium in relation to risk of prostate cancer among 142 251 men in the European Prospective Investigation into Cancer and Nutrition. Associations were examined using Cox regression, stratified by recruitment centre and adjusted for height, weight, education, marital status and energy intake. After an average of 8.7 years of follow-up, there were 2727 incident cases of prostate cancer, of which 1131 were known to be localised and 541 advanced-stage disease. A high intake of dairy protein was associated with an increased risk, with a hazard ratio for the top versus the bottom fifth of intake of 1.22 (95% confidence interval (CI): 1.07-1.41, P(trend)=0.02). After calibration to allow for measurement error, we estimated that a 35-g day(-1) increase in consumption of dairy protein was associated with an increase in the risk of prostate cancer of 32% (95% CI: 1-72%, P(trend)=0.04). Calcium from dairy products was also positively associated with risk, but not calcium from other foods. The results support the hypothesis that a high intake of protein or calcium from dairy products may increase the risk for prostate cancer

Endogenous sex hormones and endometrial cancer risk in women in the European Prospective Investigation into Cancer and Nutrition (EPIC)

Allen N.E., Key T.J., Dossus L., Rinaldi S., Cust A., Lukanova A., Peeters P.H., Onland-Moret N.C., Lahmann P.H., Berrino F., Panico S., Larranaga N., Pera G., Tormo M.J., Sanchez M.J., Ramon Quiros J., Ardanaz E., Tjonneland A., Olsen A., Chang-Claude J., Linseisen J., Schulz M., Boeing H., Lundin E., Palli D., Overvad K., Clavel-Chapelon F., Boutron-Ruault M.C., Bingham S., Khaw K.T., Bas Bueno-de-Mesquita H., Trichopoulou A., Trichopoulos D., Naska A., Tumino R., Riboli E., Kaaks R.

Endocr Relat Cancer; 2008; 15(2): 485-497

Abstract as provided by PubMed

Epidemiological data show that reproductive and hormonal factors are involved in the etiology of endometrial cancer, but there is little data on the association with endogenous sex hormone levels. We analyzed the association between prediagnostic serum concentrations of sex steroids and endometrial cancer risk in the European Prospective Investigation into Cancer and Nutrition using a nested case-control design of 247 incident endometrial cancer cases and 481 controls, matched on center, menopausal status, age, variables relating to blood collection, and, for premenopausal women, phase of menstrual cycle. Using conditional regression analysis, endometrial cancer risk among postmenopausal women was positively associated with increasing levels of total testosterone, free testosterone, estrone, total estradiol, and free estradiol. The odds ratios (ORs) for the highest versus lowest tertile were 2.66 (95% confidence interval (CI) 1.50-4.72; P=0.002 for a continuous linear trend) for estrone, 2.07 (95% CI 1.20-3.60; P=0.001) for estradiol, and 1.66 (95% CI 0.98-2.82; P=0.001) for free estradiol. For total and free testosterone, ORs for the highest versus lowest tertile were 1.44 (95% CI 0.88-2.36; P=0.05) and 2.05 (95% CI 1.23-3.42; P=0.005) respectively. Androstenedione and dehydroepiandrosterone sulfate were not associated with risk. Sex hormone-binding globulin was significantly inversely associated with risk (OR for the highest versus lowest tertile was 0.57, 95% CI 0.34-0.95; P=0.004). In premenopausal women, serum sex hormone concentrations were not clearly associated with endometrial cancer risk, but numbers were too small to draw firm conclusions. In conclusion, relatively high blood concentrations of estrogens and free testosterone are associated with an increased endometrial cancer risk in postmenopausal women

Plasma selenium concentration and prostate cancer risk: results from the European Prospective Investigation into Cancer and Nutrition (EPIC)

Allen N.E., Appleby P.N., Roddam A.W., Tjonneland A., Johnsen N.F., Overvad K., Boeing H., Weikert S., Kaaks R., Linseisen J., Trichopoulou A., Misirli G., Trichopoulos D., Sacerdote C., Grioni S., Palli D., Tumino R., Bueno-de-Mesquita H.B., Kiemeney L.A., Barricarte A., Larranaga N., Sanchez M.J., Agudo A., Tormo M.J., Rodriguez L., Stattin P., Hallmans G., Bingham S., Khaw K.T., Slimani N., Rinaldi S., Boffetta P., Riboli E., Key T.J.

Am J Clin Nutr; 2008; 88(6): 1567-1575

Abstract as provided by PubMed

BACKGROUND: Some evidence indicates that a low selenium intake may be associated with an increased risk of prostate cancer. OBJECTIVE: The aim of this study was to investigate the association of plasma selenium concentration with subsequent prostate cancer risk and to examine this association by stage and grade of disease and other factors. DESIGN: A nested case-control study was performed among men in the European Prospective Investigation into Cancer and Nutrition (EPIC). The association between plasma selenium concentration and prostate cancer risk was assessed in 959 men with incident prostate cancer and 1059 matched controls. RESULTS: Overall, plasma selenium concentration was not associated with prostate cancer risk; the multivariate relative risk for men in the highest fifth of selenium concentration compared with the lowest fifth was 0.96 (95% CI: 0.70, 1.31; P for trend = 0.25). There were no significant differences in the association of plasma selenium with risk when analyzed by stage or grade of disease. Similarly, the association of selenium with risk did not differ by smoking status or by plasma alpha- or gamma-tocopherol concentration. CONCLUSION: Plasma selenium concentration was not associated with prostate cancer risk in this large cohort of European men

Vegetables and fruits in relation to cancer risk: Evidence from the Greek EPIC cohort study

Benetou V., Orfanos P., Lagiou P., Trichopoulos D., Boffetta P., Trichopoulou A.

Cancer Epidemiol Biomarkers Prev; 2008; 17(2): 387-392

Abstract as provided by PubMed

INTRODUCTION: Vegetables and fruits have long been considered as conducive to cancer prevention, but this view has recently been challenged. We investigated the relation of vegetable and fruit intake with total cancer occurrence in the population-based cohort of the Greek component of the European Prospective Investigation into Cancer and nutrition (EPIC), which is characterized by high consumption of these foods. MATERIALS AND METHODS: For a median of 7.9 years, 25,623 participants (10,582 men, 15,031 women) were actively followed-up, contributing 188,042 person-years. Cancer at any site was diagnosed in 851 participants (421 men, 430 women). Dietary intakes were ascertained at enrollment through an extensive, validated, interviewer-administered food frequency questionnaire. Data were analyzed through Cox regression, controlling for potential confounders. RESULTS: An inverse association of cancer incidence with vegetables and fruits (mutually adjusted) was noted, reaching statistical significance for vegetables among women. When vegetables and fruits were combined, the inverse association with cancer occurrence was statistically significant for the entire cohort [hazard ratio per increasing quintile, 0.94; 95% confidence interval (95% CI), 0.88-0.99], as well as among women (hazard ratio per increasing quintile, 0.90; 95% CI, 0.83-0.98), but not among men (hazard ratio per increasing quintile, 0.95; 95% CI, 0.87-1.04). CONCLUSIONS: In a general population-based Greek cohort, we have found evidence that consumption of vegetables and fruits is inversely associated with incidence of cancer overall, although the associations seem to be weaker than expected on the basis of case-control studies previously undertaken in Greece. (Cancer Epidemiol Biomarkers Prev 2008;17(2):387-92)

Conformity to traditional Mediterranean diet and cancer incidence: the Greek EPIC cohort

Benetou V., Trichopoulou A., Orfanos P., Naska A., Lagiou P., Boffetta P., Trichopoulos D.

Br J Cancer; 2008; 99(1): 191-195

Abstract as provided by PubMed

Adherence to traditional Mediterranean diet (MD) has been reported to be inversely associated with total, as well as cardiovascular, mortality. We have examined the relation between degree of such adherence and incidence of cancer overall in a general population sample of 25 623 participants (10 582 men, 15 041 women) of the Greek segment of the European Prospective Investigation into Cancer and nutrition (EPIC). All subjects completed a validated, interviewer-administered, semi-quantitative food-frequency questionnaire at enrolment. Degree of adherence to the traditional MD was assessed through a 10-point scale (0 minimal; 9 maximal) that incorporated key dietary characteristics. During a median follow-up of 7.9 years and 188 042 total person-years, 851 medically confirmed incident cancer cases (421 men, 430 women) were recorded. Using proportional hazards regression with adjustment for potential confounders, we found that a higher degree of MD adherence was associated with lower overall cancer incidence. A two-point increase in the score corresponded to a 12% reduction in cancer incidence (adjusted hazard ratio, 0.88 (95% confidence interval 0.80, 0.95)). The association was exposure-dependent and stronger among women. This inverse association with MD adherence was considerably stronger than that predicted on the basis of the associations of the individual components of this diet and points to the value of analysing dietary patterns in cancer studies

Anthropometric characteristics and non-Hodgkin's lymphoma and multiple myeloma risk in the European Prospective Investigation into Cancer and Nutrition (EPIC)

Britton J.A., Khan A.E., Rohrmann S., Becker N., Linseisen J., Nieters A., Kaaks R., Tjonneland A., Halkjaer J., Severinsen M.T., Overvad K., Pischon T., Boeing H., Trichopoulou A., Kalapothaki V., Trichopoulos D., Mattiello A., Tagliabue G., Sacerdote C., Peeters P.H., Bueno-de-Mesquita H.B., Ardanaz E., Navarro C., Jakszyn P., Altzibar J.M., Hallmans G., Malmer B., Berglund G., Manjer J., Allen N., Key T., Bingham S., Besson H., Ferrari P., Jenab M., Boffetta P., Vineis P., Riboli E.

Haematologica; 2008; 93(11): 1666-1677

Abstract as provided by PubMed

BACKGROUND: The incidences of non-Hodgkin's lymphoma and multiple myeloma are increasing steadily. It has been hypothesized that this may be due, in part, to the parallel rising prevalence of obesity. It is biologically plausible that anthropometric characteristics can infuence the risk of non-Hodgkin's lymphoma and multiple myeloma. DESIGN AND METHODS: In the context of the European Prospective Investigation into Cancer and Nutrition (EPIC), anthropometric characteristics were assessed in 371,983 cancer-free individuals at baseline. During the 8.5 years of follow-up, 1,219 histologically confirmed incident cases of non-Hodgkin's lymphoma and multiple myeloma occurred in 609 men and 610 women. Gender-specific proportional hazards models were used to estimate relative risks and 95% confidence intervals (95% CI) of development of non-Hodgkin's lymphoma and multiple myeloma in relation to the anthropometric characteristics. RESULTS: Height was associated with overall non-Hodgkin's lymphoma and multiple myeloma in women (RR 1.50, 95% CI 1.14-1.98) for highest versus lowest quartile; p-trend < 0.01) but not in men. Neither obesity (weight and body mass index) nor abdominal fat (waist-to-hip ratio, waist or hip circumference) measures were positively associated with overall non-Hodgkin's lymphoma and multiple myeloma. Relative risks for highest versus lowest body mass index quartile were 1.09 (95% CI 0.85-1.38) and 0.92 (95% CI 0.71-1.19) for men and women, respectively. Women in the upper body mass index quartile were at greater risk of diffuse large B-cell lymphoma (RR 2.18, 95% CI 1.05-4.53) and taller women had an elevated risk of follicular lymphoma (RR 1.25, 95% CI 0.59-2.62). Among men, height and body mass index were non-significantly, positively related to follicular lymphoma. Multiple myeloma risk alone was elevated for taller women (RR 2.34, 95% CI 1.29-4.21) and heavier men (RR 1.77, 95% CI 1.02-3.05). CONCLUSIONS: The EPIC analyses support an association between height and overall non-Hodgkin's lymphoma and multiple myeloma among women and suggest heterogeneous subtype associations. This is one of the first prospective studies focusing on central adiposity and non-Hodgkin's lymphoma subtypes

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