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2009

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

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

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

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

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)

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

Dietary fat intake and risk of prostate cancer in the European Prospective Investigation into Cancer and Nutrition

Crowe F.L., Key T.J., Appleby P.N., Travis R.C., Overvad K., Jakobsen M.U., Johnsen N.F., Tjonneland A., Linseisen J., Rohrmann S., Boeing H., Pischon T., Trichopoulou A., Lagiou P., Trichopoulos D., Sacerdote C., Palli D., Tumino R., Krogh V., Bueno-de-Mesquita H.B., Kiemeney L.A., Chirlaque M.D., Ardanaz E., Sanchez M.J., Larranaga N., Gonzalez C.A., Quiros J.R., Manjer J., Wirfalt E., Stattin P., Hallmans G., Khaw K.T., Bingham S., Ferrari P., Slimani N., Jenab M., Riboli E.

Am J Clin Nutr; 2008; 87(5): 1405-1413

Abstract as provided by PubMed

BACKGROUND: Findings from early observational studies have suggested that the intake of dietary fat might be a contributing factor in the etiology of prostate cancer. However, the results from more recent prospective studies do not support this hypothesis, and the possible association between different food sources of fat and prostate cancer risk also remains unclear. OBJECTIVE: The objectives were to assess whether intakes of dietary fat, subtypes of fat, and fat from animal products were associated with prostate cancer risk. DESIGN: This was a multicenter prospective study of 142,520 men in the European Prospective Investigation into Cancer and Nutrition (EPIC). Dietary fat intake was estimated with the use of country-specific validated food questionnaires. The association between dietary fat and risk of prostate cancer was assessed by using Cox regression, stratified by recruitment center and adjusted for height, weight, smoking, education, marital status, and energy intake. RESULTS: After a median follow-up time of 8.7 y, prostate cancer was diagnosed in 2727 men. There was no significant association between dietary fat (total, saturated, monounsaturated, and polyunsaturated fat and the ratio of polyunsaturated to saturated fat) and risk of prostate cancer. The hazard ratio for prostate cancer for the highest versus the lowest quintile of total fat intake was 0.96 (95% CI: 0.84, 1.09; P for trend = 0.155). There were no significant associations between prostate cancer risk and fat from red meat, dairy products, and fish. CONCLUSION: The results from this large multicenter study suggest that there is no association between dietary fat and prostate cancer risk

Cytokine gene polymorphisms and the risk of adenocarcinoma of the stomach in the European prospective investigation into cancer and nutrition (EPIC-EURGAST)

Crusius J.B., Canzian F., Capella G., Pena A.S., Pera G., Sala N., Agudo A., Rico F., Del Giudice G., Palli D., Plebani M., Boeing H., Bueno-de-Mesquita H.B., Carneiro F., Pala V., Save V.E., Vineis P., Tumino R., Panico S., Berglund G., Manjer J., Stenling R., Hallmans G., Martinez C., Dorronsoro M., Barricarte A., Navarro C., Quiros J.R., Allen N., Key T.J., Binghan S., Caldas C., Linseisen J., Kaaks R., Overvad K., Tjonneland A., Buchner F.C., Peeters P.H., Numans M.E., Clavel-Chapelon F., Trichopoulou A., Lund E., Jenab M., Rinaldi S., Ferrari P., Riboli E., Gonzalez C.A.

Ann Oncol; 2008; 19(11): 1894-1902

Abstract as provided by PubMed

BACKGROUND: The relative contribution to gastric cancer (GC) risk of variants in genes that determine the inflammatory response remains mostly unknown and results from genotyping studies are inconsistent. PATIENTS AND METHODS: A nested case-control study within the prospective European Prospective Investigation into Cancer and Nutrition cohort was carried out, including 248 gastric adenocarcinomas and 770 matched controls. Twenty common polymorphisms at cytokine genes [interleukin (IL)1A, IL1B, IL1RN, IL4, IL4R, IL6, IL8, IL10, IL12A, IL12B, lymphotoxin alpha and tumor necrosis factor (TNF)] were analyzed. Antibodies against Helicobacter pylori (Hp) and CagA were measured. RESULTS: IL1RN 2R/2R genotype [odds ratio (OR) 2.43; 95% confidence interval (CI) 1.19-4.96] and allele IL1RN Ex5-35C were associated with an increased risk of Hp(+) non-cardia GC. IL8 -251AA genotype was associated with a decreased risk of Hp(+) non-cardia GC (OR 0.51; 95% CI 0.32-0.81), mainly of the intestinal type. These associations were not modified by CagA status. Carriers of IL1B -580C and TNF -487A alleles did not associate with an increased risk. A moderately increased risk of Hp(+) non-cardia GC for IL4R -29429T variant was observed (OR 1.74; 95% CI 1.15-2.63). CONCLUSION: This prospective study confirms the association of IL1RN polymorphisms with the risk of non-cardia GC and indicates that IL8 -251T>A may modify the risk for GC

Polymorphisms of genes coding for ghrelin and its receptor in relation to anthropometry, circulating levels of IGF-I and IGFBP-3, and breast cancer risk: a case-control study nested within the European Prospective Investigation into Cancer and Nutrition (EPIC)

Dossus L., McKay J.D., Canzian F., Wilkening S., Rinaldi S., Biessy C., Olsen A., Tjonneland A., Jakobsen M.U., Overvad K., Clavel-Chapelon F., Boutron-Ruault M.C., Fournier A., Linseisen J., Lukanova A., Boeing H., Fisher E., Trichopoulou A., Georgila C., Trichopoulos D., Palli D., Krogh V., Tumino R., Vineis P., Quiros J.R., Sala N., Martinez-Garcia C., Dorronsoro M., Chirlaque M.D., Barricarte A., van Duijnhoven F.J., Bueno-de-Mesquita H.B., Van Gils C.H., Peeters P.H., Hallmans G., Lenner P., Bingham S., Khaw K.T., Key T.J., Travis R.C., Ferrari P., Jenab M., Riboli E., Kaaks R.

Carcinogenesis; 2008; 29(7): 1360-1366

Abstract as provided by PubMed

Ghrelin, an endogenous ligand for the growth hormone secretagogue receptor, has two major functions: the stimulation of the growth hormone production and the stimulation of food intake. Accumulating evidence also suggests a role of ghrelin in cancer development. We conducted a case-control study on 1359 breast cancer cases and 2389 matched controls, nested within the European Prospective Investigation into Cancer and Nutrition, to examine the association of common genetic variants in the genes coding for ghrelin (GHRL) and its receptor (GHSR) with anthropometric measures, circulating insulin growth factor I (IGF-I) and insulin-like growth factor-binding protein 3 and breast cancer risk. Pair-wise tagging was used to select the 15 polymorphisms that represent the majority of common genetic variants across the GHRL and GHSR genes. A significant increase in breast cancer risk was observed in carriers of the GHRL rs171407-G allele (odds ratio: 1.2; 95% confidence interval: 1.0-1.4; P = 0.02). The GHRL single-nucleotide polymorphism rs375577 was associated with a 5% increase in IGF-I levels (P = 0.01). A number of GHRL and GHSR polymorphisms were associated with body mass index (BMI) and height (P between <0.01 and 0.04). The false-positive report probability (FPRP) approach suggests that these results are noteworthy (FPRP < 0.20). The results presented here add to a growing body of evidence that GHRL variations are associated with BMI. Furthermore, we have observed evidence for association of GHRL polymorphisms with circulating IGF-I levels and with breast cancer risk. These associations, however, might also be due to chance findings and further large studies are needed to confirm our results

The evaluation of the diet/disease relation in the EPIC study: considerations for the calibration and the disease models

Ferrari P., Day N.E., Boshuizen H.C., Roddam A., Hoffmann K., Thiebaut A., Pera G., Overvad K., Lund E., Trichopoulou A., Tumino R., Gullberg B., Norat T., Slimani N., Kaaks R., Riboli E.

Int J Epidemiol; 2008; 37(2): 368-378

Abstract as provided by PubMed

BACKGROUND: International multicentre studies on diet and cancer are relatively new in epidemiological research. They offer a series of challenging methodological issues for the evaluation of the association between dietary exposure and disease outcomes, which can both be quite heterogeneous across different geographical regions. This requires considerable work to standardize dietary measurements at the food and the nutrient levels. METHODS: Within the European Prospective Investigation into Cancer and Nutrition (EPIC), a calibration study was set up to express individual dietary intakes according to the same reference scale. A linear regression calibration model was used to correct the association between diet and disease for measurement errors in dietary exposures. In the present work, we describe an approach for analysing the EPIC data, using as an example the evaluation of the association between fish intake and colorectal cancer incidence. RESULTS: Sex- and country-specific attenuation factors ranged from 0.083 to 0.784, with values overall higher for men compared with women. Hazard ratio estimates of colorectal cancer for a 10 g/day increase in fish intake were 0.97 [95% confidence interval (CI): 0.95-0.99] and 0.93 (0.88-0.98), before and after calibration, respectively. CONCLUSIONS: In a multicentre study, the diet/disease association can be evaluated by exploiting the whole variability of intake over the entire study. Calibration may reduce between-centre heterogeneity in the diet-disease relationship caused by differential impact of measurement errors across cohorts

A Bayesian multilevel model for estimating the diet/disease relationship in a multicenter study with exposures measured with error: The EPIC study

Ferrari P., Carroll R.J., Gustafson P., Riboli E.

Stat Med; 2008; 27(29): 6037-6054

Abstract as provided by PubMed

In a multicenter study, the overall relationship between diet and cancer risk can be broken down into: (a) within-center relationships, which reflect the relationships at the individual level in each of the centers, and (b) a between-center relationship, which captures the association between exposure and disease risk at the aggregate level. In this work, we propose the use of a Bayesian multilevel model that takes into account the within- and between-center levels of evidence, using information at the individual and aggregate level. Correction for measurement error is performed in order to correct for systematic between-center measurement error in dietary exposure, and for attenuation biases in relative risk estimates within centers. The estimation of the parameters is carried out in a Bayesian framework using Gibbs sampling. The model entails a measurement, an exposure, and a disease component. Within the European Prospective Investigation into Cancer and Nutrition (EPIC) the association between lipid intake, assessed through dietary questionnaire and 24-hour dietary recall, and breast cancer incidence was evaluated. This analysis involved 21 534 women and 334 incident breast cancer cases from the EPIC calibration study. In this study, total energy intake was positively associated with breast cancer incidence at the aggregate level, whereas no effect was observed for fat. At the individual level, height was positively related to breast cancer incidence, whereas a weaker association was observed for fat. The use of multilevel models, which constitute a very powerful approach to estimating individual vs aggregate levels of evidence should be considered in multicenter studies. Copyright (c) 2008 John Wiley & Sons, Ltd

CDH1 gene polymorphisms, smoking, Helicobacter pylori infection and the risk of gastric cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC-EURGAST)

Jenab M., McKay J.D., Ferrari P., Biessy C., Laing S., Capella Munar G.M., Sala N., Pena S., Crusius J.B., Overvad K., Jensen M.K., Olsen A., Tjonneland A., Clavel-Chapelon F., Boutron-Ruault M.C., Kaaks R., Linseisen J., Boeing H., Bergmann M.M., Trichopoulou A., Georgila C., Psaltopoulou T., Mattiello A., Vineis P., Pala V., Palli D., Tumino R., Numans M.E., Peeters P.H., Bueno-de-Mesquita H.B., Lund E., Ardanaz E., Sanchez M.J., Dorronsoro M., Navarro Sanchez C., Quiros J.R., Hallmans G., Stenling R., Manjer J., Regner S., Key T., Bingham S., Khaw K.T., Slimani N., Rinaldi S., Boffetta P., Carneiro F., Riboli E., Gonzalez C.

Eur J Cancer; 2008; 44(6): 774-780

Abstract as provided by PubMed

Despite declining incidence rates, gastric cancer (GC) is a major cause of death worldwide. E-Cadherin is an adhesion molecule that is thought to be involved in GC. Germline mutations in the E-Cadherin gene (CDH1) have been identified in hereditary diffuse GC. Also, a promoter polymorphism at position -160 C/A has been suggested to lead to transcriptional down regulation and has been shown to affect GC risk in some studies. However, very little information exists on the GC risk association of other CDH1 polymorphisms and it is unclear whether any associations may be different by GC anatomical sites or histological types. Thus, a case-control study (cases=245/controls=950) nested within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort was conducted to assess the GC risk association of eight CDH1 gene polymorphisms. None of the CDH1 polymorphisms or haplotypes analysed were associated with GC risk and no differences of effect were observed by Helicobacter pylori infection status. However, three CDH1 polymorphisms in the same haplotype block, including the CDH1-160C/A, interacted with smoking to increase GC risk in smokers but not in never smokers. These findings should be confirmed in larger independent studies

Circulating concentrations of folate and vitamin B12 in relation to prostate cancer risk: results from the European prospective investigation into cancer and nutrition study

Johansson M., Appleby P.N., Allen N.E., Travis R.C., Roddam A.W., Egevad L., Jenab M., Rinaldi S., Kiemeney L.A., Bueno-de-Mesquita H.B., Vollset S.E., Ueland P.M., Sanchez M.J., Quiros J.R., Gonzalez C.A., Larranaga N., Chirlaque M.D., Ardanaz E., Sieri S., Palli D., Vineis P., Tumino R., Linseisen J., Kaaks R., Boeing H., Pischon T., Psaltopoulou T., Trichopoulou A., Trichopoulos D., Khaw K.T., Bingham S., Hallmans G., Riboli E., Stattin P., Key T.J.

Cancer Epidemiol Biomarkers Prev; 2008; 17(2): 279-285

Abstract as provided by PubMed

BACKGROUND: Determinants of one-carbon metabolism, such as folate and vitamin B(12), have been implicated in cancer development. Previous studies have not provided conclusive evidence for the importance of circulating concentrations of folate and vitamin B(12) in prostate cancer etiology. The aim of the present study was to investigate the relationship between prostate cancer risk and circulating concentrations of folate and vitamin B(12) in a large prospective cohort. METHODS: We analyzed circulating concentrations of folate and vitamin B(12) in 869 cases and 1,174 controls, individually matched on center, age, and date of recruitment, nested within the European Prospective Investigation into Cancer and Nutrition cohort. Relative risks (RR) for prostate cancer were estimated using conditional logistic regression models. RESULTS: Overall, no significant associations were observed for circulating concentrations of folate (P(trend) = 0.62) or vitamin B(12) (P(trend) = 0.21) with prostate cancer risk. RRs for a doubling in folate and vitamin B(12) concentrations were 1.03 [95% confidence interval (95% CI), 0.92-1.16] and 1.12 (95% CI, 0.94-1.35), respectively. In the subgroup of cases diagnosed with advanced stage prostate cancer, elevated concentrations of vitamin B(12) were associated with increased risk (RR for a doubling in concentration, 1.69; 95% CI, 1.05-2.72, P(trend) = 0.03). No other subgroup analyses resulted in a statistically significant association. CONCLUSION: This study does not provide strong support for an association between prostate cancer risk and circulating concentrations of folate or vitamin B(12). Elevated concentrations of vitamin B(12) may be associated with an increased risk for advanced stage prostate cancer, but this association requires examination in other large prospective studies. (Cancer Epidemiol Biomarkers Prev 2007;17(2):279-85)

Diabetes and the risk of non-Hodgkin's lymphoma and multiple myeloma in the European Prospective Investigation into Cancer and Nutrition

Khan A.E., Gallo V., Linseisen J., Kaaks R., Rohrmann S., Raaschou-Nielsen O., Tjonneland A., Johnsen H.E., Overvad K., Bergmann M.M., Boeing H., Benetou V., Psaltopoulou T., Trichopoulou A., Masala G., Mattiello A., Grioni S., Tumino R., Vermeulen R.C., Peeters P.H., Bueno-de-Mesquita H.B., Ros M.M., Lund E., Ardanaz E., Chirlaque M.D., Jakszyn P., Larranaga N., Losada A., Becker N., Nieters A., Martinez-Garcia C., Agren A., Hallmans G., Berglund G., Manjer J., Allen N.E., Key T.J., Bingham S., Khaw K.T., Slimani N., Ferrari P., Boffetta P., Norat T., Vineis P., Riboli E.

Haematologica; 2008; 93(6): 842-850

Abstract as provided by PubMed

BACKGROUND: Non-Hodgkin's lymphomas are a heterogeneous group of neoplasms arising from the lymphopoietic system including a wide range of subtypes of either B-cell or T-cell lymphomas. The few established risk factors for the development of these neoplasms include viral infections and immunological abnormalities, but their etiology remains largely unknown. Evidence suggests that certain medical conditions may be linked, through immunosuppression, to the risk of non-Hodgkin's lymphoma. Multiple myeloma is a neoplasm of plasma cells that accounts for approximately 15% of lymphopoietic cancers. Increases in the incidence of non-Hodgkin's lymphoma and multiple myeloma in the past implicate environmental factors as potential causal agents. DESIGN AND METHODS: In the European Prospective Investigation into Cancer and Nutrition (EPIC), 1,213 histologically confirmed incident cases of non-Hodgkin's lymphoma and multiple myeloma (594 men; 619 women) were identified during a follow-up of 8.5 years. Cox proportional hazard models were used to explore the association between self-reported diabetes, diagnosed after 30 years of age, and the risk of non-Hodgkin's lymphoma overall and multiple myeloma and various lymphoma subtypes. RESULTS: We found no association between a personal history of diabetes and the risk of non-Hodgkin's lymphoma overall in men (HR: 1.28, 95% CI: 0.89-1.84), in women (HR: 0.71, 95% CI: 0.41- 1.24), or in men and women combined (HR: 1.09, 95% CI: 0.80-1.47). Among the B-non-Hodgkin's lymphoma subtypes, we observed a statistically significant increased risk of B-cell chronic lymphocytic leukemia (HR: 2.0, 95% CI: 1.04-3.86) in men, but not in women (HR: 1.07, 95% CI: 0.33-3.43). CONCLUSIONS: This prospective study did not provide evidence for a role of self-reported diabetes in the etiology of non-Hodgkin's lymphoma overall or multiple myeloma. We found an increased risk of B-cell chronic lymphocytic leukemia among men with diabetes, but not among women. We hypothesize that diabetes may not play a causal role in the etiology of B-cell chronic lymphocytic leukemia, though the underlying pathogenic mechanisms of both disorders may include shared genetic, host and/or environmental susceptibility factors

Smoking and lymphoma risk in the European prospective investigation into cancer and nutrition

Nieters A., Rohrmann S., Becker N., Linseisen J., Ruediger T., Overvad K., Tjonneland A., Olsen A., Allen N.E., Travis R.C., Bingham S., Khaw K.T., Ardanaz E., Redondo M.L., Basterrechea M., Martinez C., Tormo M.J., Rosso S., Tagliabue G., Masala G., Mattiello A., Tumino R., Boeing H., Bergmann M., Kaaks R., Trichopoulou A., Trichopoulos D., Peeters P.H., Bueno-de-Mesquita B., Boffetta P., Brennan P., Ferrari P., Neasham D., Lund E., Berglund G., Manjer J., Hallmans G., Johansson I., Vineis P., Riboli E.

Am J Epidemiol; 2008; 167(9): 1081-1089

Abstract as provided by PubMed

Lymphomas are one of the few cancers that have been increasing in incidence over the past decades. So far, only a few established risk factors have been identified, including immunosuppression and viral infections. Recent evidence suggests etiologic heterogeneity of different lymphoma subtypes. Smoking may affect risk differently, depending on the lymphoma entity. The European Prospective Investigation into Cancer and Nutrition was used to study the role of smoking in the etiology of lymphomas and individual subtypes within a prospective study. Information on baseline and lifetime tobacco smoking by 478,590 participants was collected between 1992 and 2000. Cox proportional hazards regression was used to calculate multivariate-adjusted hazard ratios and 95% confidence intervals. During 3,567,410 person-years of follow-up, 1,371 lymphoma cases (1,304 non-Hodgkin's lymphomas and 67 Hodgkin's lymphomas) were identified. Relative risk for smokers at recruitment was more than twofold higher for Hodgkin's lymphoma (hazard ratio = 2.14, 95% confidence interval: 1.18, 3.87) but was not elevated for non-Hodgkin's lymphoma (hazard ratio = 1.06, 95% confidence interval: 0.94, 1.19) and individual B-cell non-Hodgkin's lymphoma subtypes. In this prospective study, smoking appeared to increase Hodgkin's lymphoma risk consistently in both genders, whereas B-cell non-Hodgkin's lymphoma risk was not associated. Future analysis should involve viral biomarkers and genetic susceptibility markers to elucidate potential mechanisms of smoking-induced carcinogenesis, particularly for Hodgkin's lymphoma

A food pattern that is predictive of flavonol intake and risk of pancreatic cancer

Nothlings U., Murphy S.P., Wilkens L.R., Boeing H., Schulze M.B., Bueno-de-Mesquita H.B., Michaud D.S., Roddam A., Rohrmann S., Tjonneland A., Clavel-Chapelon F., Trichopoulou A., Sieri S., Rodriguez L., Ye W., Jenab M., Kolonel L.N.

Am J Clin Nutr; 2008; 88(6): 1653-1662

Abstract as provided by PubMed

BACKGROUND: In the Multiethnic Cohort (MEC) study, we showed inverse associations between flavonols and pancreatic cancer risk. OBJECTIVE: We aimed to define a food pattern associated with intakes of quercetin, kaempferol, and myricetin; to examine the association of that pattern with pancreatic cancer risk; and to investigate the associations in an independent study. DESIGN: Reduced rank regression was applied to dietary data for 183 513 participants in the MEC. A food group pattern was extracted and simplified and applied to dietary data of 424 978 participants in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Dietary intake in both studies was assessed by using specially developed questionnaires. Multivariate Cox proportional hazards models were used to estimate relative risks for pancreatic cancer in the MEC (610 cases) and the EPIC (517 cases) studies. RESULTS: The food group pattern consisted mainly of tea, fruit, cabbage, and wine. In the MEC, inverse associations with pancreatic cancer in smokers were observed for the food group pattern [relative risk: 0.59 (95% CI: 0.31, 1.12) when extreme quintiles were compared; P for trend = 0.03]. In the EPIC study, the simplified pattern was not associated with pancreatic cancer risk (P for trend = 0.78). CONCLUSIONS: A food pattern associated with the intake of quercetin, kaempferol, and myricetin was associated with lower pancreatic cancer risk in smokers in a US-based population. However, failure to replicate the associations in an independent study weakens the conclusions and raises questions about the utility of food patterns for flavonols across populations

Intake of vegetables, legumes, and fruit, and risk for all-cause, cardiovascular, and cancer mortality in a European diabetic population

Nothlings U., Schulze M.B., Weikert C., Boeing H., van der Schouw Y.T., Bamia C., Benetou V., Lagiou P., Krogh V., Beulens J.W., Peeters P.H., Halkjaer J., Tjonneland A., Tumino R., Panico S., Masala G., Clavel-Chapelon F., de Lauzon B., Boutron-Ruault M.C., Vercambre M.N., Kaaks R., Linseisen J., Overvad K., Arriola L., Ardanaz E., Gonzalez C.A., Tormo M.J., Bingham S., Khaw K.T., Key T.J., Vineis P., Riboli E., Ferrari P., Boffetta P., Bueno-de-Mesquita H.B., van der A D.L., Berglund G., Wirfalt E., Hallmans G., Johansson I., Lund E., Trichopoulo A.

J Nutr; 2008; 138(4): 775-781

Abstract as provided by PubMed

We examined the associations of intake of vegetables, legumes and fruit with all-cause and cause-specific mortality in a population with prevalent diabetes in Europe. A cohort of 10,449 participants with self-reported diabetes within the European Prospective Investigation into Cancer and Nutrition study was followed for a mean of 9 y. Intakes of vegetables, legumes, and fruit were assessed at baseline between 1992 and 2000 using validated country-specific questionnaires. A total of 1346 deaths occurred. Multivariate relative risks (RR) for all-cause mortality were estimated in Cox regression models and RR for cause-specific mortality were derived in a competing risk model. An increment in intake of total vegetables, legumes, and fruit of 80 g/d was associated with a RR of death from all causes of 0.94 [95% CI 0.90-0.98]. Analyzed separately, vegetables and legumes were associated with a significantly reduced risk, whereas nonsignificant inverse associations for fruit intake were observed. Cardiovascular disease (CVD) mortality and mortality due to non-CVD/non-cancer causes were significantly inversely associated with intake of total vegetables, legumes, and fruit (RR 0.88 [95% CI 0.81-0.95] and 0.90 [0.82-0.99], respectively) but not cancer mortality (1.08 [0.99-1.17]). Intake of vegetables, legumes, and fruit was associated with reduced risks of all-cause and CVD mortality in a diabetic population. The findings support the current state of evidence from general population studies that the protective potential of vegetable and fruit intake is larger for CVD than for cancer and suggest that diabetes patients may benefit from a diet high in vegetables and fruits

Bulky DNA adducts, 4-aminobiphenyl-haemoglobin adducts and diet in the European Prospective Investigation into Cancer and Nutrition (EPIC) prospective study

Peluso M., Airoldi L., Munnia A., Colombi A., Veglia F., Autrup H., Dunning A., Garte S., Gormally E., Malaveille C., Matullo G., Overvad K., Raaschou-Nielsen O., Clavel-Chapelon F., Linseisen J., Boeing H., Trichopoulou A., Palli D., Krogh V., Tumino R., Panico S., Bueno-de-Mesquita B.H., Peeters P.H., Kumle M., Agudo A., Martinez C., Dorronsoro M., Barricarte A., Tormo M.J., Quiros J.R., Berglund G., Jarvholm B., Day N.E., Key T.J., Saracci R., Kaaks R., Riboli E., Bingham S., Vineis P.

Br J Nutr; 2008; 100(3): 489-495

Abstract as provided by PubMed

In contrast to some extensively examined food mutagens, for example, aflatoxins, N-nitrosamines and heterocyclic amines, some other food contaminants, in particular polycyclic aromatic hydrocarbons (PAH) and other aromatic compounds, have received less attention. Therefore, exploring the relationships between dietary habits and the levels of biomarkers related to exposure to aromatic compounds is highly relevant. We have investigated in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort the association between dietary items (food groups and nutrients) and aromatic DNA adducts and 4-aminobiphenyl-Hb adducts. Both types of adducts are biomarkers of carcinogen exposure and possibly of cancer risk, and were measured, respectively, in leucocytes and erythrocytes of 1086 (DNA adducts) and 190 (Hb adducts) non-smokers. An inverse, statistically significant, association has been found between DNA adduct levels and dietary fibre intake (P = 0.02), vitamin E (P = 0.04) and alcohol (P = 0.03) but not with other nutrients or food groups. Also, an inverse association between fibre and fruit intake, and BMI and 4-aminobiphenyl-Hb adducts (P = 0.03, 0.04, and 0.03 respectively) was observed. After multivariate regression analysis these inverse correlations remained statistically significant, except for the correlation adducts v. fruit intake. The present study suggests that fibre intake in the usual range can modify the level of DNA or Hb aromatic adducts, but such role seems to be quantitatively modest. Fibres could reduce the formation of DNA adducts in different manners, by diluting potential food mutagens and carcinogens in the gastrointestinal tract, by speeding their transit through the colon and by binding carcinogenic substances

Body size and risk of prostate cancer in the European prospective investigation into cancer and nutrition

Pischon T., Boeing H., Weikert S., Allen N., Key T., Johnsen N.F., Tjonneland A., Severinsen M.T., Overvad K., Rohrmann S., Kaaks R., Trichopoulou A., Zoi G., Trichopoulos D., Pala V., Palli D., Tumino R., Sacerdote C., Bueno-de-Mesquita H.B., May A., Manjer J., Wallstrom P., Stattin P., Hallmans G., Buckland G., Larranaga N., Chirlaque M.D., Martinez C., Redondo Cornejo M.L., Ardanaz E., Bingham S., Khaw K.T., Rinaldi S., Slimani N., Jenab M., Riboli E.

Cancer Epidemiol Biomarkers Prev; 2008; 17(11): 3252-3261

Abstract as provided by PubMed

BACKGROUND: Body size has been hypothesized to influence the risk of prostate cancer; however, most epidemiologic studies have relied on body mass index (BMI) to assess adiposity, whereas only a few studies have examined whether body fat distribution predicts prostate cancer. METHODS: We examined the association of height, BMI, waist and hip circumference, and waist-hip ratio with prostate cancer risk among 129,502 men without cancer at baseline from 8 countries of the European Prospective Investigation into Cancer and Nutrition (EPIC), using Cox regression, with age as time metric, stratifying by study center and age at recruitment, and adjusting for education, smoking status, alcohol consumption, and physical activity. RESULTS: During a mean follow-up of 8.5 years, 2,446 men developed prostate cancer. Waist circumference and waist-hip ratio were positively associated with risk of advanced disease. The relative risk of advanced prostate cancer was 1.06 (95% confidence interval, 1.01-1.1) per 5-cm-higher waist circumference and 1.21 (95% confidence interval, 1.04-1.39) per 0.1-unit-higher waist-hip ratio. When stratified by BMI, waist circumference and waist-hip ratio were positively related to risk of total, advanced, and high-grade prostate cancer among men with lower but not among those with higher BMI (Pinteraction for waist with BMI, 0.25, 0.02, and 0.05, respectively; Pinteraction for waist-hip ratio with BMI, 0.27, 0.22, and 0.14; respectively). CONCLUSIONS: These data suggest that abdominal adiposity may be associated with an increased risk of advanced prostate cancer. This association may be stronger among individuals with lower BMI; however, this finding needs confirmation in future studies

General and abdominal adiposity and risk of death in Europe

Pischon T., Boeing H., Hoffmann K., Bergmann M., Schulze M.B., Overvad K., van der Schouw Y.T., Spencer E., Moons K.G., Tjonneland A., Halkjaer J., Jensen M.K., Stegger J., Clavel-Chapelon F., Boutron-Ruault M.C., Chajes V., Linseisen J., Kaaks R., Trichopoulou A., Trichopoulos D., Bamia C., Sieri S., Palli D., Tumino R., Vineis P., Panico S., Peeters P.H., May A.M., Bueno-de-Mesquita H.B., van Duijnhoven F.J., Hallmans G., Weinehall L., Manjer J., Hedblad B., Lund E., Agudo A., Arriola L., Barricarte A., Navarro C., Martinez C., Quiros J.R., Key T., Bingham S., Khaw K.T., Boffetta P., Jenab M., Ferrari P., Riboli E.

N Engl J Med; 2008; 359(20): 2105-2120

Abstract as provided by PubMed

BACKGROUND: Previous studies have relied predominantly on the body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) to assess the association of adiposity with the risk of death, but few have examined whether the distribution of body fat contributes to the prediction of death. METHODS: We examined the association of BMI, waist circumference, and waist-to-hip ratio with the risk of death among 359,387 participants from nine countries in the European Prospective Investigation into Cancer and Nutrition (EPIC). We used a Cox regression analysis, with age as the time variable, and stratified the models according to study center and age at recruitment, with further adjustment for educational level, smoking status, alcohol consumption, physical activity, and height. RESULTS: During a mean follow-up of 9.7 years, 14,723 participants died. The lowest risks of death related to BMI were observed at a BMI of 25.3 for men and 24.3 for women. After adjustment for BMI, waist circumference and waist-to-hip ratio were strongly associated with the risk of death. Relative risks among men and women in the highest quintile of waist circumference were 2.05 (95% confidence interval [CI], 1.80 to 2.33) and 1.78 (95% CI, 1.56 to 2.04), respectively, and in the highest quintile of waist-to-hip ratio, the relative risks were 1.68 (95% CI, 1.53 to 1.84) and 1.51 (95% CI, 1.37 to 1.66), respectively. BMI remained significantly associated with the risk of death in models that included waist circumference or waist-to-hip ratio (P<0.001). CONCLUSIONS: These data suggest that both general adiposity and abdominal adiposity are associated with the risk of death and support the use of waist circumference or waist-to-hip ratio in addition to BMI in assessing the risk of death

Glycosylated hemoglobin and risk of colorectal cancer in men and women, the European prospective investigation into cancer and nutrition

Rinaldi S., Rohrmann S., Jenab M., Biessy C., Sieri S., Palli D., Tumino R., Mattiello A., Vineis P., Nieters A., Linseisen J., Pischon T., Boeing H., Hallmans G., Palmqvist R., Manjer J., Wirfalt E., Crowe F.L., Khaw K.T., Bingham S., Tjonneland A., Olsen A., Overvad K., Lund E., Skeie G., Clavel-Chapelon F., Boutron-Ruault M.C., de Lauzon-Guillain B., Ardanaz E., Jakszyn P., Ramon Quiros J., Chirlaque M.D., Sanchez M.J., Dorronsoro M., Trichopoulou A., Lagiou P., Trichopoulos D., Bueno-de-Mesquita H.B., van Duijnhoven F.J., Peeters P.H., Slimani N., Ferrari P., Byrnes G.B., Riboli E., Kaaks R.

Cancer Epidemiol Biomarkers Prev; 2008; 17(11): 3108-3115

Abstract as provided by PubMed

Although large-scale prospective cohort studies have related hyperglycemia to increased risk of cancer overall, studies specifically on colorectal cancer have been generally small. We investigated the association between prediagnostic levels of glycosylated hemoglobin (HbA1c), a marker for average glucose level in blood, and colorectal cancer risk in a case-control study nested within the European Prospective Investigation into Cancer and Nutrition cohort. One thousand and twenty-six incident colorectal cancer cases (561 men and 465 women) and 1,026 matched controls were eligible for the study. Multivariate conditional logistic regression was used to estimate odds ratios (ORS) adjusted for possible confounders. Increasing HbA1c percentages were statistically significantly associated with a mild increase in colorectal cancer risk in the whole population [OR, 1.10; 95% confidence interval (CI), 1.01,1.19 for a 10% increase in HbA1c]. In women, increasing HbA1c percentages were associated with a statistically significant increase in colorectal cancer risk (OR, 1.16; 95% CI, 1.01, 1.32 for a 10% increase in HbA1c) and with a borderline statistically significant increase in rectum cancer (OR, 1.22; 95% CI, 0.99,1.50 for a 10% increase in HbA1c). No significant association with cancer risk was observed in men. The results of the current study suggest a mild implication of hyperglycemia in colorectal cancer, which seems more important in women than in men, and more for cancer of the rectum than of the colon

Alcohol consumption and the risk for prostate cancer in the European prospective investigation into cancer and nutrition

Rohrmann S., Linseisen J., Key T.J., Jensen M.K., Overvad K., Johnsen N.F., Tjonneland A., Kaaks R., Bergmann M.M., Weikert C., Naska A., Trichopoulou A., Trichopoulos D., Pala V., Sacerdote C., Palli D., Tumino R., Bueno-de-Mesquita H.B., Vrieling A., Gonzalez C.A., Larranaga N., Navarro C., Barricarte A., Quiros J.R., Martinez-Garcia C., Hallmans G., Stattin P., Manjer J., Wirfalt E., Bingham S., Khaw K.T., Egevad L., Ferrari P., Jenab M., Riboli E.

Cancer Epidemiol Biomarkers Prev; 2008; 17(5): 1282-1287

Abstract as provided by PubMed

Alcohol is a risk factor for several types of cancer. However, the results for prostate cancer have been inconsistent, with most studies showing no association. Within the European Prospective Investigation into Cancer and Nutrition, detailed information were collected from 142,607 male participants on the intake of alcoholic beverages at recruitment (for 100% of the cohort) and over lifetime (for 76% of the cohort) between 1992 and 2000. During a median follow-up of 8.7 years, 2,655 prostate cancer cases were observed. Multivariate Cox proportional hazard models were used to examine the association of alcohol consumption at recruitment and average lifetime alcohol consumption with prostate cancer adjusted for age, center, smoking, height, weight, physical activity, and nonalcohol energy intake. Overall, neither alcohol consumption at baseline nor average lifetime alcohol consumption was associated with the risk for prostate cancer in this cohort of men. Men who consumed >/=60 g alcohol per day had a relative risk of 0.88 [95% confidence interval (95% CI) 0.72-1.08] compared with men with an intake of 0.1-4.9 g/d; the respective relative risk for average lifetime intake was 1.09 (95% CI, 0.86-1.39). For advanced prostate cancer (n = 537), the relative risks for >/=60 and 0.1-4.9 g alcohol per day at baseline were 0.98 (95% CI, 0.66-1.44) and 1.28 (95% CI, 0.79-2-07), respectively, for average lifetime intake. No statistically significant association was observed for alcohol intake from specific alcoholic beverages. Our results indicate no association between the consumption of alcohol and prostate cancer in this cohort of European men. (Cancer Epidemiol Biomarkers Prev 2008;17(5):1282-7)

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