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Dietary patterns among older Europeans: the EPIC-Elderly study

Bamia Christina, Orfanos Philippos, Ferrari Pietro, Overvad Kim, Hundborg Heidi H., Tjonneland Anne, Olsen Anja, Kesse Emmanuelle, Boutron-Ruault Marie Christine, Clavel-Chapelon Francoise, Nagel Gabriele, Boffetta Paolo, Boeing Heiner, Hoffmann Kurt, Trichopoulos Dimitrios, Baibas Nikos, Psaltopoulou Theodora, Norat Teresa, Slimani Nadia, Palli Domenico, Krogh Vittorio, Panico Salvatore, Tumino Rosario, Sacerdote Carlotta, Bueno-de-Mesquita H.B., Ocke Marga C., Peeters Petra H., van Rossum Caroline T., Quiros Jose Ramon, Sanchez Maria Jose, Navarro Carmen, Barricarte Aurelio, Dorronsoro Miren, Berglund Goran, Wirfalt Elisabet, Hallmans Goran, Johansson Ingegerd, Bingham Sheila, Khaw Kay Tee, Spencer Elizabeth A., Roddam Andrew W., Riboli Elio, Trichopoulou Antonia

Br J Nutr; 2005; 94(1): 100-113


Abstract as provided by PubMed

Overall dietary patterns have been associated with health and longevity. We used principal component (PC) and cluster analyses to identify the prevailing dietary patterns of 99 744 participants, aged 60 years or older, living in nine European countries and participating in the European Prospective Investigation into Cancer and Nutrition (EPIC-Elderly cohort) and to examine their socio-demographic and lifestyle correlates. Two PC were identified: PC1 reflects a 'vegetable-based' diet with an emphasis on foods of plant origin, rice, pasta and other grain rather than on margarine, potatoes and non-alcoholic beverages. PC2 indicates a 'sweet- and fat-dominated' diet with a preference for sweets, added fat and dairy products but not meat, alcohol, bread and eggs. PC1 was associated with a younger age, a higher level of education, physical activity, a higher BMI, a lower waist:hip ratio and never and past smoking. PC2 was associated with older age, less education, never having smoked, a lower BMI and waist:hip ratio and lower levels of physical activity. Elderly individuals in southern Europe scored positively on PC1 and about zero on PC2, whereas the elderly in northern Europe scored negatively on PC1 and variably on PC2. The results of cluster analysis were compatible with the indicated dietary patterns. 'Vegetable-based' and a 'sweet- and fat-dominated' diets are prevalent among the elderly across Europe, and there is a north-south gradient regarding their dietary choices. Our study contributes to the identification of groups of elderly who are likely to have different prospects for long-term disease occurrence and survival

C-peptide, IGF-I, sex-steroid hormones and adiposity: a cross-sectional study in healthy women within the European Prospective Investigation into Cancer and Nutrition (EPIC)

Bezemer I.D., Rinaldi S., Dossus L., Gils C.H., Peeters P.H.M., Noord P.A.H., Bueno-de-Mesquita H.B., Johnsen S.P., Overvad K., Olsen A., Tjonneland A., Boeing H., Lahmann P.H., Linseisen J., Nagel G., Allen N., Roddam A., Bingham S., Khaw K.T., Kesse E., Tehard B., Clavel-Chapelon F., Agudo A., Ardanaz E., Quiros J.R., Amiano P., Martinez G., Tormo M.J., Pala V., Panico S., Vineis P., Palli D., Tumino R., Trichopoulou A., Baibas N., Zilis D., Hemon B., Norat T., Riboli E., Kaaks R.

Cancer Causes Control; 2005; 16(5): 561-572


An approach to estimate between- and within-group correlation coefficients in multicenter studies: plasma carotenoids as biomarkers of intake of fruits and vegetables

Ferrari P., Al Delaimy W.K., Slimani N., Boshuizen H.C., Roddam A., Orfanos P., Skeie G., Rodriguez-Barranco M., Thiebaut A., Johansson G., Palli D., Boeing H., Overvad K., Riboli E.

American journal of epidemiology; 2005; 162(6): 591-598


Abstract as provided by PubMed

In a multicenter study, the overall correlation between two variables can be broken down into a within- and a between-group correlation reflecting associations at the individual and aggregate levels, respectively. A random-effects model is used to estimate variance components of nutrition-related variables and the within- and between-group correlation coefficients. Using data from the European Prospective Investigation into Cancer and Nutrition (EPIC), the authors analyzed the association between levels of three plasma carotenoids (alpha-carotene, beta-cryptoxanthin, and lycopene) and dietary intake of three items (total fruits, carrots, and tomatoes), assessed through dietary questionnaire and single 24-hour dietary recall measurements, in a cross-sectional study involving 3,089 subjects from nine European countries. Intraclass correlation coefficients were 0.178 for alpha-carotene, 0.216 for beta-cryptoxanthin, and 0.299 for lycopene. The between-group correlation coefficients were higher than the within-group coefficients for all three carotenoids. For beta-cryptoxanthin and fruit intake, the between-group versus the within-group correlations were 0.78 and 0.26 for the dietary questionnaire and 0.85 and 0.19 for the 24-hour dietary recall. Results indicate that variability of exposure is driven mainly by the individual compared with the aggregate variation and that biomarker levels perform fairly accurately in discriminating population-level consumption of fruits and vegetables

Variations in lycopene blood levels and tomato consumption across European countries based on the European Prospective Investigation into Cancer and Nutrition (EPIC) study

Jenab M., Ferrari Pietro, Mazuir Mathieu, Tjonneland Anne, Clavel-Chapelon Francoise, Linseisen Jakob, Trichopoulou Antonia, Tumino Rosario, Bueno-De-Mesquita Hendrik B., Lund Eiliv, Gonzalez Carlos A., Johansson Gerd, Key Timothy J., Riboli Elio

J Nutr; 2005; 135(8): 2032S-2036S


Long term cryoconservation and stability of vitamin C in serum samples of the European prospective investigation into cancer and nutrition

Jenab M., Bingham S., Ferrari P., Friesen M.D., Al-Delaimy W., Luben R., Wareham N., Khaw K.T., Riboli E.

Cancer Epidemiol Biomarkers Prev; 2005; 14(7): 1837-1840


Postmenopausal serum androgens, oestrogens and breast cancer risk: the European prospective investigation into cancer and nutrition

Kaaks R., Rinaldi S., Key T.J., Berrino F., Peeters P.H.M., Biessy C., Dossus L., Lukanova A., Bingham S., Khaw K.T., Allen N.E., Bueno-de-Mesquita H.B., Van Gils C.H., Grobbee D., Boeing H., Lahmann P.H., Nagel G., Chang-Claude J., Clavel-Chapelon F., Fournier A., Thiebaut A., Gonzalez C.A., Quiros J.R., Tormo M.J., Ardanaz E., Amiano P., Krogh V., Palli D., Panico S., Tumino R., Vineis P., Trichopoulou A., Kalapothaki V., Trichopoulos D., Ferrari P., Norat T., Saracci R., Riboli E.

Endocr Relat Cancer; 2005; 12(4): 1071-1082


Abstract as provided by PubMed

Considerable experimental and epidemiological evidence suggests that elevated endogenous sex steroids -- notably androgens and oestrogens -- promote breast tumour development. In spite of this evidence, postmenopausal androgen replacement therapy with dehydroepiandrosterone (DHEA) or testosterone has been advocated for the prevention of osteoporosis and improved sexual well-being. We have conducted a case-control study nested within the European Prospective Investigation into Cancer and Nutrition. Levels of DHEA sulphate (DHEAS), ({Delta}4-androstenedione), testosterone, oestrone, oestradiol and sex-hormone binding globulin (SHBG) were measured in prediagnostic serum samples of 677 postmenopausal women who subsequently developed breast cancer and 1309 matched control subjects. Levels of free testosterone and free oestradiol were calculated from absolute concentrations of testosterone, oestradiol and SHBG. Logistic regression models were used to estimate relative risks of breast cancer by quintiles of hormone concentrations. For all sex steroids -the androgens as well as the oestrogens - elevated serum levels were positively associated with breast cancer risk, while SHBG levels were inversely related to risk. For the androgens, relative risk estimates (95% confidence intervals) between the top and bottom quintiles of the exposure distribution were: DHEAS 1.69 (1.23-2.33), androstenedione 1.94 (1.40-2.69), testosterone 1.85 (1.33-2.57) and free testosterone 2.50 (1.76-3.55). For the oestrogens, relative risk estimates were: oestrone 2.07 (1.42-3.02), oestradiol 2.28 (1.61-3.23) and free oestradiol (odds ratios 2.13 (1.52-2.98)). Adjustments for body mass index or other potential confounding factors did not substantially alter any of these relative risk estimates. Our results have shown that, among postmenopausal women, not only elevated serum oestrogens but also serum androgens are associated with increased breast cancer risk. Since DHEAS and androstenedione are largely of adrenal origin in postmenopausal women, our results indicated that elevated adrenal androgen synthesis is a risk factor for breast cancer. The results from this study caution against the use of DHEA(S), or other androgens, for postmenopausal androgen replacement therapy

Long-term weight change and breast cancer risk: the European prospective investigation into cancer and nutrition (EPIC)

Lahmann P.H., Schulz M., Hoffmann K., Boeing H., Tjonneland A., Olsen A., Overvad K., Key T.J., Allen N.E., Khaw K.T., Bingham S., Berglund G., Wirfalt E., Berrino F., Krogh V., Trichopoulou A., Lagiou P., Trichopoulos D., Kaaks R., Riboli E.

Br J Cancer; 2005; 93(5): 582-589


Abstract as provided by PubMed

We examined prospectively the association between weight change during adulthood and breast cancer risk, using data on 1358 incident cases that developed during 5.8 years of follow-up among 40,429 premenopausal and 57,923 postmenopausal women from six European countries, taking part in the European prospective investigation into cancer and nutrition study. Multivariate Cox regression models were used to calculate hazard ratios according to weight change (kg), defined as the weight difference between age at enrollment and age 20 adjusted for other risk factors. Changes in weight were not associated with premenopausal breast cancer risk. In postmenopausal women, weight gain was positively associated with breast cancer risk only among noncurrent hormone replacement therapy (HRT) users (P-trend < or = 0.0002). Compared to women with a stable weight (+/-2 kg), the relative risk for women who gained 15-20 kg was 1.50 (95% confidence interval (CI) 1.06-2.13). The pooled RR per weight gain increment of 5 kg was 1.08 (95% CI 1.04-1.12). Weight gain was not associated with breast cancer risk in current HRT users, although, overall, these women experienced a much higher risk of breast cancer compared with nonusers. Our findings suggest that large adult weight gain was a significant predictor of breast cancer in postmenopausal women not taking exogenous hormones

Re: Meat, fish, and colorectal cancer risk: The European prospective investigation into cancer and nutrition - Reply

Norat T., Bingham S., Riboli E.

J Natl Cancer Inst; 2005; 97(23): 1788-1789
DNA adducts and lung cancer risk: a prospective study

Peluso M., Munnia Armelle, Hoek Gerard, Krzyzanowski Michal, Veglia Fabrizio, Airoldi Luisa, Autrup Herman, Dunning Alison, Garte Seymour, Hainaut Pierre, Malaveille Christian, Gormally Emmanuelle, Matullo Giuseppe, Overvad Kim, Raaschou-Nielsen Ole, Clavel-Chapelon Francoise, Linseisen Jacob, Boeing Heiner, Trichopoulou Antonia, Trichopoulos Dimitrios, Kaladidi Anna, Palli Domenico, Krogh Vittorio, Tumino Rosario, Panico Salvatore, Bueno-De-Mesquita H.Bas, Peeters Petra H., Kumle Merethe, Gonzalez Carlos A., Martinez Carmen, Dorronsoro Miren, Barricarte Aurelio, Navarro Carmen, Quiros J.Ramon, Berglund Goran, Janzon Lars, Jarvholm Bengt, Day Nicholas E., Key Tim J., Saracci Rodolfo, Kaaks Rudolf, Riboli Elio, Vineis Paolo

Cancer Res; 2005; 65(17): 8042-8048


Abstract as provided by PubMed

Objectives were to investigate prospectively the ability of DNA adducts to predict cancer and to study the determinants of adducts, especially air pollutants. DNA adducts were measured in a case-control study nested in the European Prospective Investigation into Cancer and Nutrition (EPIC) investigation. Cases included newly diagnosed lung cancer (n = 115), upper respiratory cancers (pharynx and larynx; n = 82), bladder cancer (n = 124), leukemia (n = 166), and chronic obstructive pulmonary disease or emphysema deaths (n = 77) accrued after a median follow-up of 7 years among the EPIC former smokers and never-smokers. Three controls per case were matched for questionnaire analyses and two controls per case for laboratory analyses. Matching criteria were gender, age, smoking status, country of recruitment, and follow-up time. Individual exposure to air pollution was assessed using concentration data from monitoring stations in routine air quality monitoring networks. Leukocyte DNA adducts were analyzed blindly using 32P postlabeling technique. Adducts were associated with the subsequent risk of lung cancer, with an odds ratio (OR) of 1.86 [95% confidence interval (95% CI), 0.88-3.93] when comparing detectable versus nondetectable adducts. The association with lung cancer was stronger in never-smokers (OR, 4.04; 95% CI, 1.06-15.42) and among the younger age groups. After exclusion of the cancers occurring in the first 36 months of follow-up, the OR was 4.16 (95% CI, 1.24-13.88). A positive association was found between DNA adducts and ozone (O3) concentration. Our prospective study suggests that leukocyte DNA adducts may predict lung cancer risk of never-smokers. Besides, the association of DNA adduct levels with O3 indicates a possible role for photochemical smog in determining DNA damage

Fruit and vegetable consumption and risk of epithelial ovarian cancer: the European Prospective Investigation into Cancer and Nutrition

Schulz M., Lahmann P.H., Boeing H., Hoffmann K., Allen N., Key T.J., Bingham S., Wirfalt E., Berglund G., Lundin E., Hallmans G., Lukanova A., Martinez Garcia C., Gonzalez C.A., Tormo M.J., Quiros J.R., Ardanaz E., Larranaga N., Lund E., Gram I.T., Skeie G., Peeters P.H., Van Gils C.H., Bueno-de-Mesquita H.B., Buchner F.L., Pasanisi P., Galasso R., Palli D., Tumino R., Vineis P., Trichopoulou A., Kalapothaki V., Trichopoulos D., Chang-Claude J., Linseisen J., Boutron-Ruault M.C., Touillaud M., Clavel-Chapelon F., Olsen A., Tjonneland A., Overvad K., Tetsche M., Jenab M., Norat T., Kaaks R., Riboli E.

Cancer Epidemiol Biomarkers Prev; 2005; 14(11): 2531-2535


Abstract as provided by PubMed

OBJECTIVE: The association between consumption of fruit and vegetables and risk of ovarian cancer is still unclear from a prospective point of view. METHODS: Female participants (n = 325,640) of the European Prospective Investigation into Cancer and Nutrition study, free of any cancer at baseline, were followed on average for 6.3 years to develop ovarian cancer. During 2,049,346 person-years, 581 verified cases of primary, invasive epithelial ovarian cancer were accrued. Consumption of fruits and vegetables as well as subgroups of vegetables, estimated from validated dietary questionnaires and calibrated thereafter, was related to ovarian cancer incidence in multivariable hazard regression models. Histologic subtype specific analyses were done. RESULTS: Total intake of fruit and vegetables, separately or combined, as well as subgroups of vegetables (fruiting, root, leafy vegetables, cabbages) was unrelated to risk of ovarian cancer. A high intake of garlic/onion vegetables was associated with a borderline significant reduced risk of this cancer. The examination by histologic subtype indicated some differential effects of fruit and vegetable intake on ovarian cancer risk. CONCLUSION: Overall, a high intake of fruits and vegetables did not seem to protect from ovarian cancer. Garlic/onion vegetables may exert a beneficial effect. The study of the histologic subtype of the tumor warrants further investigation


Diet and cancer - the European Prospective Investigation into Cancer and Nutrition

Bingham S., Riboli E.

Nat Rev Cancer; 2004; 4(3): 206-215



Relationship between plasma fatty acid composition and diet over previous years in the Italian centers of the European Prospective Investigation into Cancer and Nutrition (EPIC)

Fusconi E., Pala V., Riboli E., Vineis P., Sacerdote C., Del Pezzo M., Santucci de Magistris M., Palli D., Masala G., Sieri S., Foggetti C.E., Giurdanella M.C., Tumino R., Krogh V.

Tumori; 2003; 89(6): 624-635


Abstract as provided by PubMed

Fatty acid levels in plasma phospholipids were related to food intake over the previous year as estimated by semiquantitative food frequency questionnaires compiled by 280 men and 246 women from the EPIC centers of Varese, Turin, Florence and Ragusa (Italy). Fatty acid content was determined by gas chromatography and analyzed in relation to age, sex and center. The most important finding was that plasma monounsaturated fatty acid levels, mainly oleic acid, were associated with olive oil consumption (r = 0.28 men, r = 0.19 women, both P <0.01). To our knowledge, this is the first time that these non-essential plasma fatty acids have been related to their dietary source in a population eating a varied and freely chosen diet. We confirmed that long-chain n-3 fatty acids in plasma phospholipids are associated with fish consumption and that odd chain 15 : 0 and 17 : 0 fatty acid levels are associated with dairy products and pizza-with-mozzarella consumption. N-6 polyunsaturated fatty acid levels reflected dietary intake of seed oils, mayonnaise and biscuits. Alcohol intake was positively associated with palmitic and palmitoleic acid and negatively associated with linoleic acid. These associations suggest indirect relations between alcohol consumption and other features of diet, and also that ethanol has an effect on fat metabolism. We found numerous indirect relationships (ie, not due to dietary consumption of food sources of the fatty acids) between plasma fatty acids and diet, which we propose as due to the influence of complex life-style factors

Quantity and quality of dietary fat, carbohydrate, and fiber intake in the German EPIC cohorts

Linseisen J., Schulze M.B., Saadatian-Elahi M., Kroke A., Miller A.B., Boeing H.

Ann Nutr Metab; 2003; 47(1): 37-46


Abstract as provided by PubMed

AIM: This evaluation aims to describe the quantity and quality of dietary fat, carbohydrate and fiber intake in both German cohorts participating in the European Prospective Investigation into Cancer and Nutrition (EPIC). METHODS: Estimates are based on standardized computer-guided 24-hour dietary recalls from 1,078 women and 1,013 men in Heidelberg and 898 women and 1,032 men in Potsdam. In a subsample, plasma phospholipid (PL) fatty acids were analyzed as well. RESULTS: Adjusted mean dietary intake estimates demonstrated that the contribution of fat as well as n-6 and n-3 polyunsaturated fatty acids (PUFA) to the total daily energy intake was higher in both women and men of EPIC-Potsdam compared to EPIC-Heidelberg. Surprisingly, the dietary n-6/n-3 PUFA ratio was lower in the Potsdam cohort. These results were confirmed by means of the PL fatty acid pattern. Besides the higher contribution of polysaccharides to total energy intake in EPIC-Heidelberg, women of the Heidelberg cohort revealed a significantly lower contribution of mono- and disaccharides (sucrose) to total energy intake. Although total fiber intake data were similar in both cohorts, analysis by food groups showed differences in dietary fiber intake originating from the food groups cereals, fruits and potatoes. CONCLUSION: The results demonstrate distinct differences in the dietary fat, carbohydrate and fiber intake between both German EPIC cohorts, which contribute to the exposure variation in the whole of EPIC

Group level validation of protein intakes estimated by 24-hour diet recall and dietary questionnaires against 24-hour urinary nitrogen in the European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study

Slimani N., Bingham S., Runswick S., Ferrari P., Day N.E., Welch A.A., Key T.J., Miller A.B., Boeing H., Sieri S., Veglia F., Palli D., Panico S., Tumino R., Bueno-de-Mesquita B., Ocke M.C., Clavel-Chapelon F., Trichopoulou A., van Staveren W.A., Riboli E.

Cancer Epidemiol Biomarkers Prev; 2003; 12(8): 784-795


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