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Solans M, Benavente Y, Saez M, Agudo A, Jakszyn P, Naudin S, Hosnijeh FS, Gunter M, Huybrechts I, Ferrari P, Besson C, Mahamat-Saleh Y, Boutron-Ruault MC, Kühn T, Kaaks R, Boeing H, Lasheras C, Sánchez MJ, Amiano P, Chirlaque MD, Ardanaz E, Schmidt JA, Vineis P, Riboli E, Trichopoulou A, Karakatsani A, Valanou E, Masala G, Agnoli C, Tumino R, Sacerdote C, Mattiello A, Skeie G, Weiderpass E, Jerkeman M, Dias JA, Späth F, Nilsson LM, Dahm CC, Overvad K, Petersen KEN, Tjønneland A, de Sanjose S, Vermeulen R, Nieters A, Casabonne D. Inflammatory potential of diet and risk of lymphoma in the European Prospective Investigation into Cancer and Nutrition. Eur J Nutr 2020; 59:813-823. [PMID: 30903361 DOI: 10.1007/s00394-019-01947-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 03/11/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Chronic inflammation plays a critical role in lymphomagenesis and several dietary factors seem to be involved its regulation. The aim of the current study was to assess the association between the inflammatory potential of the diet and the risk of lymphoma and its subtypes in the European Investigation into Cancer and Nutrition (EPIC) study. METHODS The analysis included 476,160 subjects with an average follow-up of 13.9 years, during which 3,136 lymphomas (135 Hodgkin lymphoma (HL), 2606 non-Hodgkin lymphoma (NHL) and 395 NOS) were identified. The dietary inflammatory potential was assessed by means of an inflammatory score of the diet (ISD), calculated using 28 dietary components and their corresponding inflammatory weights. The association between the ISD and lymphoma risk was estimated by hazard ratios (HR) and 95% confidence intervals (CI) calculated by multivariable Cox regression models adjusted for potential confounders. RESULTS The ISD was not associated with overall lymphoma risk. Among lymphoma subtypes, a positive association between the ISD and mature B-cell NHL (HR for a 1-SD increase: 1.07 (95% CI 1.01; 1.14), p trend = 0.03) was observed. No statistically significant association was found among other subtypes. However, albeit with smaller number of cases, a suggestive association was observed for HL (HR for a 1-SD increase = 1.22 (95% CI 0.94; 1.57), p trend 0.13). CONCLUSIONS Our findings suggested that a high ISD score, reflecting a pro-inflammatory diet, was modestly positively associated with the risk of B-cell lymphoma subtypes. Further large prospective studies on low-grade inflammation induced by diet are warranted to confirm these findings.
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Affiliation(s)
- Marta Solans
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
- Epidemiology Unit and Girona Cancer Registry, Catalan Institute of Oncology, Girona, Spain
| | - Yolanda Benavente
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Unit of Molecular and Genetic Epidemiology in Infections and Cancer, Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology (ICO-IDIBELL), Av. Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
| | - Marc Saez
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
| | - Antonio Agudo
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - Paula Jakszyn
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - Sabine Naudin
- Nutritional Methodology and Biostatistics Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Fatemeh Saberi Hosnijeh
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
- Immunology Department, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marc Gunter
- Nutritional Epidemiology Group (NEP), International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Inge Huybrechts
- Nutritional Epidemiology Group (NEP), International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Pietro Ferrari
- Nutritional Methodology and Biostatistics Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Caroline Besson
- Department of Hematology and Oncology, Hospital of Versailles, Le Chesnay, France
- CESP, Fac. de médecine-Univ. Paris-Sud, Fac. de médecine-UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Yahya Mahamat-Saleh
- CESP, Fac. de médecine-Univ. Paris-Sud, Fac. de médecine-UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Marie-Christine Boutron-Ruault
- CESP, Fac. de médecine-Univ. Paris-Sud, Fac. de médecine-UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Tilman Kühn
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition (DIfE) Postdam-Rehbrücke, Nuthetal, Germany
| | | | - Maria-Jose Sánchez
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain
| | - Pilar Amiano
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Public Health Division of Gipuzkoa, Regional Government of the Basque Country, Donostia, Spain
| | - María Dolores Chirlaque
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
| | - Eva Ardanaz
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Navarra Public Health Institute, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Julie A Schmidt
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Paolo Vineis
- Department of Epidemiology and Biostatistics, MRC-HPA Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Elio Riboli
- School of Public Health, Imperial College London, London, UK
| | | | - Anna Karakatsani
- Hellenic Health Foundation, Athens, Greece
- Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Haidari, Greece
| | | | - Giovanna Masala
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network-ISPRO, 50141, Florence, Italy
| | - Claudia Agnoli
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, "Civic-M. P. Arezzo" Hospital, ASP, Ragusa, Ragusa, Italy
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy
| | - Amalia Mattiello
- Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy
| | - Guri Skeie
- Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Elisabete Weiderpass
- Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
- Department of Research, Cancer Registry of Norway-Institute of Population-Based Cancer Research, Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Genetic Epidemiology Group, Folkhälsan Research Center, Faculty of Medicine, Helsinki University, Helsinki, Finland
| | - Mats Jerkeman
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Joana Alves Dias
- Department of Clinical Sciences, Research Group in Nutritional Epidemiology, Lund University, Malmö, Sweden
| | - Florentin Späth
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Lena Maria Nilsson
- Public Health and Clinical Medicine, Nutritional Research and Arctic Research Centre, Umeå University, Umeå, Sweden
| | - Christina C Dahm
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Kim Overvad
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Anne Tjønneland
- Unit of Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Silvia de Sanjose
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Unit of Molecular and Genetic Epidemiology in Infections and Cancer, Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology (ICO-IDIBELL), Av. Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
- PATH, Reproductive Health, Seattle, USA
| | - Roel Vermeulen
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Alexandra Nieters
- Center for Chronic Immunodeficiency (CCI), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Delphine Casabonne
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
- Unit of Molecular and Genetic Epidemiology in Infections and Cancer, Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology (ICO-IDIBELL), Av. Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain.
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Zamora-Ros R, Alghamdi MA, Cayssials V, Franceschi S, Almquist M, Hennings J, Sandström M, Tsilidis KK, Weiderpass E, Boutron-Ruault MC, Hammer Bech B, Overvad K, Tjønneland A, Petersen KEN, Mancini FR, Mahamat-Saleh Y, Bonnet F, Kühn T, Fortner RT, Boeing H, Trichopoulou A, Bamia C, Martimianaki G, Masala G, Grioni S, Panico S, Tumino R, Fasanelli F, Skeie G, Braaten T, Lasheras C, Salamanca-Fernández E, Amiano P, Chirlaque MD, Barricarte A, Manjer J, Wallström P, Bueno-de-Mesquita HB, Peeters PH, Khaw KT, Wareham NJ, Schmidt JA, Aune D, Byrnes G, Scalbert A, Agudo A, Rinaldi S. Coffee and tea drinking in relation to the risk of differentiated thyroid carcinoma: results from the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Eur J Nutr 2019; 58:3303-3312. [PMID: 30535794 PMCID: PMC6850907 DOI: 10.1007/s00394-018-1874-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 12/01/2018] [Indexed: 01/12/2023]
Abstract
PURPOSE Coffee and tea constituents have shown several anti-carcinogenic activities in cellular and animal studies, including against thyroid cancer (TC). However, epidemiological evidence is still limited and inconsistent. Therefore, we aimed to investigate this association in a large prospective study. METHODS The study was conducted in the EPIC (European Prospective Investigation into Cancer and Nutrition) cohort, which included 476,108 adult men and women. Coffee and tea intakes were assessed through validated country-specific dietary questionnaires. RESULTS During a mean follow-up of 14 years, 748 first incident differentiated TC cases (including 601 papillary and 109 follicular TC) were identified. Coffee consumption (per 100 mL/day) was not associated either with total differentiated TC risk (HRcalibrated 1.00, 95% CI 0.97-1.04) or with the risk of TC subtypes. Tea consumption (per 100 mL/day) was not associated with the risk of total differentiated TC (HRcalibrated 0.98, 95% CI 0.95-1.02) and papillary tumor (HRcalibrated 0.99, 95% CI 0.95-1.03), whereas an inverse association was found with follicular tumor risk (HRcalibrated 0.90, 95% CI 0.81-0.99), but this association was based on a sub-analysis with a small number of cancer cases. CONCLUSIONS In this large prospective study, coffee and tea consumptions were not associated with TC risk.
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Affiliation(s)
- Raul Zamora-Ros
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), Av Gran Via 199-203, 08908, L'Hospitalet de Llobregat, Spain.
| | - Muath A Alghamdi
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), Av Gran Via 199-203, 08908, L'Hospitalet de Llobregat, Spain
- College of Medicine, Al Imam Mohammed Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Valerie Cayssials
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), Av Gran Via 199-203, 08908, L'Hospitalet de Llobregat, Spain
| | | | - Martin Almquist
- Department of Surgery, Skåne University Hospital Malmö, Lund University, Lund, Sweden
- Malmö Diet and Cancer Study, University Hospital Malmö, Malmö, Sweden
| | - Joakim Hennings
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Maria Sandström
- Department for Radiation Sciences, Umeå University, Umeå, Sweden
| | - Konstantinos K Tsilidis
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
- School of Public Health, Imperial College London, London, UK
| | - Elisabete Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, UiT, The Arctic University of Tromsø, Tromsö, Norway
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
| | - Marie-Christine Boutron-Ruault
- CESP, Université Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Institut Gustave Roussy, Villejuif, France
| | - Bodil Hammer Bech
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Kim Overvad
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Anne Tjønneland
- Unit of Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Kristina E N Petersen
- Unit of Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Francesca Romana Mancini
- CESP, Université Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Institut Gustave Roussy, Villejuif, France
| | - Yahya Mahamat-Saleh
- CESP, Université Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Institut Gustave Roussy, Villejuif, France
| | - Fabrice Bonnet
- CESP, Université Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Institut Gustave Roussy, Villejuif, France
- CHU Rennes, Université de Rennes 1, Rennes, France
| | - Tilman Kühn
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Renée T Fortner
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Antonia Trichopoulou
- Hellenic Health Foundation, Athens, Greece
- Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, WHO Collaborating Center for Nutrition and Health, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Christina Bamia
- Hellenic Health Foundation, Athens, Greece
- Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, WHO Collaborating Center for Nutrition and Health, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Giovanna Masala
- Cancer Risk Factors and Life-Style Epidemiology Unit, Cancer Research and Prevention Institute-ISPO, Florence, Italy
| | - Sara Grioni
- Nutritional Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Salvatore Panico
- Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy
| | - Rosario Tumino
- Cancer Registry and Histopathology Unit, "Civic M.P. Arezzo" Hospital, ASP Ragusa, Ragusa, Italy
| | - Francesca Fasanelli
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and University of Turin, Turin, Italy
| | - Guri Skeie
- Department of Community Medicine, Faculty of Health Sciences, UiT, The Arctic University of Tromsø, Tromsö, Norway
| | - Tonje Braaten
- Department of Community Medicine, Faculty of Health Sciences, UiT, The Arctic University of Tromsø, Tromsö, Norway
| | - Cristina Lasheras
- Department of Functional Biology, Faculty of Medicine, University of Oviedo, Asturias, Spain
| | - Elena Salamanca-Fernández
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs.Granada, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Pilar Amiano
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Public Health Division of Gipuzkoa, Regional Government of the Basque Country, Donostia, Spain
| | - Maria-Dolores Chirlaque
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain
| | - Aurelio Barricarte
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Navarra Public Health Institute, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Jonas Manjer
- Department of Surgery, Skåne University Hospital Malmö, Lund University, Lund, Sweden
| | - Peter Wallström
- Nutrition Epidemiology Research Group, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - H Bas Bueno-de-Mesquita
- School of Public Health, Imperial College London, London, UK
- Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Petra H Peeters
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kay-Thee Khaw
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Nicholas J Wareham
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | - Dagfinn Aune
- School of Public Health, Imperial College London, London, UK
| | - Graham Byrnes
- International Agency for Research on Cancer (IARC), Lyon, France
| | | | - Antonio Agudo
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), Av Gran Via 199-203, 08908, L'Hospitalet de Llobregat, Spain
| | - Sabina Rinaldi
- International Agency for Research on Cancer (IARC), Lyon, France
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3
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Solans M, Benavente Y, Saez M, Agudo A, Naudin S, Hosnijeh FS, Noh H, Freisling H, Ferrari P, Besson C, Mahamat-Saleh Y, Boutron-Ruault MC, Kühn T, Kaaks R, Boeing H, Lasheras C, Rodríguez-Barranco M, Amiano P, Huerta JM, Barricarte A, Schmidt JA, Vineis P, Riboli E, Trichopoulou A, Bamia C, Peppa E, Masala G, Agnoli C, Tumino R, Sacerdote C, Panico S, Skeie G, Weiderpass E, Jerkeman M, Ericson U, Späth F, Nilsson LM, Dahm CC, Overvad K, Bolvig AK, Tjønneland A, de Sanjose S, Buckland G, Vermeulen R, Nieters A, Casabonne D. Adherence to the mediterranean diet and lymphoma risk in the european prospective investigation into cancer and nutrition. Int J Cancer 2019; 145:122-131. [PMID: 30588620 DOI: 10.1002/ijc.32091] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/21/2018] [Indexed: 12/18/2022]
Abstract
There is a growing evidence of the protective role of the Mediterranean diet (MD) on cancer. However, no prospective study has yet investigated its influence on lymphoma. We evaluated the association between adherence to the MD and risk of lymphoma and its subtypes in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. The analysis included 476,160 participants, recruited from 10 European countries between 1991 and 2001. Adherence to the MD was estimated through the adapted relative MD (arMED) score excluding alcohol. Cox proportional hazards regression models were used while adjusting for potential confounders. During an average follow-up of 13.9 years, 3,136 lymphomas (135 Hodgkin lymphoma [HL], 2,606 non-HL and 395 lymphoma not otherwise specified) were identified. Overall, a 1-unit increase in the arMED score was associated with a 2% lower risk of lymphoma (95% CI: 0.97; 1.00, p-trend = 0.03) while a statistically nonsignificant inverse association between a high versus low arMED score and risk of lymphoma was observed (hazard ratio [HR]: 0.91 [95% CI 0.80; 1.03], p-trend = 0.12). Analyses by lymphoma subtype did not reveal any statistically significant associations. Albeit with small numbers of cases (N = 135), a suggestive inverse association was found for HL (HR 1-unit increase = 0.93 [95% CI: 0.86; 1.01], p-trend = 0.07). However, the study may have lacked statistical power to detect small effect sizes for lymphoma subtype. Our findings suggest that an increasing arMED score was inversely related to the risk of overall lymphoma in EPIC but not by subtypes. Further large prospective studies are warranted to confirm these findings.
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Affiliation(s)
- Marta Solans
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
- Epidemiology Unit and Girona Cancer Registry, Catalan Institute of Oncology, Girona, Spain
| | - Yolanda Benavente
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Unit of Molecular and Genetic Epidemiology in Infections and Cancer, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - Marc Saez
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
| | - Antonio Agudo
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - Sabine Naudin
- Nutritional Methodology and Biostatistics Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Fatemeh Saberi Hosnijeh
- Institute for Risk Assessment Sciences, Division of Environmental Epidemiology, Utrecht University, Utrecht, The Netherlands
- Immunology Department, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Hwayoung Noh
- Nutritional Methodology and Biostatistics Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Heinz Freisling
- Nutritional Methodology and Biostatistics Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Pietro Ferrari
- Nutritional Methodology and Biostatistics Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Caroline Besson
- Department of Hematology and Oncology, Hospital of Versailles, Le Chesnay, France
- CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Yahya Mahamat-Saleh
- CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Marie-Christine Boutron-Ruault
- CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Tilman Kühn
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition (DIfE) Postdam-Rehbrücke, Nuthetal, Germany
| | | | - Miguel Rodríguez-Barranco
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Pilar Amiano
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Public Health Division of Gipuzkoa, Regional Government of the Basque Country, Donostia, Spain
| | - Jose Maria Huerta
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
| | - Aurelio Barricarte
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Navarra Public Health Institute, Pamplona, Spain
- IdiSNA Navarra Institute for Health Research, Pamplona, Spain
| | - Julie A Schmidt
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Paolo Vineis
- Department of Epidemiology and Biostatistics, MRC-HPA Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Elio Riboli
- School of Public Health, Imperial College London, London, United Kingdom
| | - Antonia Trichopoulou
- Hellenic Health Foundation, Athens, Greece
- WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Christina Bamia
- Hellenic Health Foundation, Athens, Greece
- WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Peppa
- Hellenic Health Foundation, Athens, Greece
- WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Giovanna Masala
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network - ISPRO, Florence, Italy
| | - Claudia Agnoli
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, "Civic - M. P. Arezzo" Hospital, ASP Ragusa, Ragusa, Italy
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy
| | - Salvatore Panico
- Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy
| | - Guri Skeie
- Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Elisabete Weiderpass
- Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Genetic Epidemiology Group, Folkhälsan Research Center, Faculty of Medicine, Helsinki University, Helsinki, Finland
| | - Mats Jerkeman
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Ulrika Ericson
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Florentin Späth
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Lena Maria Nilsson
- Public Health and Clinical Medicine, Nutritional Research and Arctic Research Centre, Umeå University, Umeå, Sweden
| | - Christina C Dahm
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Kim Overvad
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Silvia de Sanjose
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Unit of Molecular and Genetic Epidemiology in Infections and Cancer, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
- Reproductive Health, PATH, Seattle, WA
| | - Genevieve Buckland
- NIHR Bristol Biomedical Research Centre Nutrition Theme, Bristol, United Kingdom
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Division of Environmental Epidemiology, Utrecht University, Utrecht, The Netherlands
| | - Alexandra Nieters
- Center for Chronic Immunodeficiency (CCI), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Delphine Casabonne
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Unit of Molecular and Genetic Epidemiology in Infections and Cancer, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
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4
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Gormley IC, Bai Y, Brennan L. Combining biomarker and self-reported dietary intake data: A review of the state of the art and an exposition of concepts. Stat Methods Med Res 2019; 29:617-635. [PMID: 30943855 DOI: 10.1177/0962280219837698] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Classical approaches to assessing dietary intake are associated with measurement error. In an effort to address inherent measurement error in dietary self-reported data there is increased interest in the use of dietary biomarkers as objective measures of intake. Furthermore, there is a growing consensus of the need to combine dietary biomarker data with self-reported data. A review of state of the art techniques employed when combining biomarker and self-reported data is conducted. Two predominant methods, the calibration method and the method of triads, emerge as relevant techniques used when combining biomarker and self-reported data to account for measurement errors in dietary intake assessment. Both methods crucially assume measurement error independence. To expose and understand the performance of these methods in a range of realistic settings, their underpinning statistical concepts are unified and delineated, and thorough simulation studies are conducted. Results show that violation of the methods' assumptions negatively impacts resulting inference but that this impact is mitigated when the variation of the biomarker around the true intake is small. Thus there is much scope for the further development of biomarkers and models in tandem to achieve the ultimate goal of accurately assessing dietary intake.
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Affiliation(s)
- Isobel Claire Gormley
- School of Mathematics and Statistics, University College Dublin, Dublin, Ireland.,Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | - Yuxin Bai
- School of Mathematics and Statistics, University College Dublin, Dublin, Ireland.,School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
| | - Lorraine Brennan
- School of Agriculture and Food Science, University College Dublin, Dublin, Ireland.,Institute of Food and Health, University College Dublin, Dublin, Ireland.,Conway Institute, University College Dublin, Dublin, Ireland
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5
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Khalili H, Chan SSM, Lochhead P, Ananthakrishnan AN, Hart AR, Chan AT. The role of diet in the aetiopathogenesis of inflammatory bowel disease. Nat Rev Gastroenterol Hepatol 2018; 15:525-535. [PMID: 29789682 PMCID: PMC6397648 DOI: 10.1038/s41575-018-0022-9] [Citation(s) in RCA: 162] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Crohn's disease and ulcerative colitis, collectively known as IBD, are chronic inflammatory disorders of the gastrointestinal tract. Although the aetiopathogenesis of IBD is largely unknown, it is widely thought that diet has a crucial role in the development and progression of IBD. Indeed, epidemiological and genetic association studies have identified a number of promising dietary and genetic risk factors for IBD. These preliminary studies have led to major interest in investigating the complex interaction between diet, host genetics, the gut microbiota and immune function in the pathogenesis of IBD. In this Review, we discuss the recent epidemiological, gene-environment interaction, microbiome and animal studies that have explored the relationship between diet and the risk of IBD. In addition, we highlight the limitations of these prior studies, in part by explaining their contradictory findings, and review future directions.
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Affiliation(s)
- Hamed Khalili
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School.,Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston MA, USA
| | - Simon S. M. Chan
- Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, United Kingdom.,Department of Gastroenterology, Norfolk and Norwich University Hospital NHS Trust, Norwich, United Kingdom
| | - Paul Lochhead
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School
| | - Ashwin N. Ananthakrishnan
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School.,Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston MA, USA
| | - Andrew R. Hart
- Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, United Kingdom.,Department of Gastroenterology, Norfolk and Norwich University Hospital NHS Trust, Norwich, United Kingdom
| | - Andrew T. Chan
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School.,Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston MA, USA.,Channing Division of Network Medicine, Harvard Medical School, Boston MA, USA.,Broad Institute, Cambridge MA, USA.,
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6
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Landais E, Moskal A, Mullee A, Nicolas G, Gunter MJ, Huybrechts I, Overvad K, Roswall N, Affret A, Fagherazzi G, Mahamat-Saleh Y, Katzke V, Kühn T, La Vecchia C, Trichopoulou A, Valanou E, Saieva C, Santucci de Magistris M, Sieri S, Braaten T, Skeie G, Weiderpass E, Ardanaz E, Chirlaque MD, Garcia JR, Jakszyn P, Rodríguez-Barranco M, Brunkwall L, Huseinovic E, Nilsson L, Wallström P, Bueno-de-Mesquita B, Peeters PH, Aune D, Key T, Lentjes M, Riboli E, Slimani N, Freisling H. Coffee and Tea Consumption and the Contribution of Their Added Ingredients to Total Energy and Nutrient Intakes in 10 European Countries: Benchmark Data from the Late 1990s. Nutrients 2018; 10:E725. [PMID: 29874819 PMCID: PMC6024313 DOI: 10.3390/nu10060725] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 05/31/2018] [Accepted: 06/01/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Coffee and tea are among the most commonly consumed nonalcoholic beverages worldwide, but methodological differences in assessing intake often hamper comparisons across populations. We aimed to (i) describe coffee and tea intakes and (ii) assess their contribution to intakes of selected nutrients in adults across 10 European countries. METHOD Between 1995 and 2000, a standardized 24-h dietary recall was conducted among 36,018 men and women from 27 European Prospective Investigation into Cancer and Nutrition (EPIC) study centres. Adjusted arithmetic means of intakes were estimated in grams (=volume) per day by sex and centre. Means of intake across centres were compared by sociodemographic characteristics and lifestyle factors. RESULTS In women, the mean daily intake of coffee ranged from 94 g/day (~0.6 cups) in Greece to 781 g/day (~4.4 cups) in Aarhus (Denmark), and tea from 14 g/day (~0.1 cups) in Navarra (Spain) to 788 g/day (~4.3 cups) in the UK general population. Similar geographical patterns for mean daily intakes of both coffee and tea were observed in men. Current smokers as compared with those who reported never smoking tended to drink on average up to 500 g/day more coffee and tea combined, but with substantial variation across centres. Other individuals' characteristics such as educational attainment or age were less predictive. In all centres, coffee and tea contributed to less than 10% of the energy intake. The greatest contribution to total sugar intakes was observed in Southern European centres (up to ~20%). CONCLUSION Coffee and tea intake and their contribution to energy and sugar intake differed greatly among European adults. Variation in consumption was mostly driven by geographical region.
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Affiliation(s)
- Edwige Landais
- UMR Nutripass, IRD-UM-Sup'Agro, 34394 Montpellier, France.
| | - Aurélie Moskal
- Nutrition and Metabolism Section, International Agency for Research on Cancer, 69372 Lyon, France.
| | - Amy Mullee
- Nutrition and Metabolism Section, International Agency for Research on Cancer, 69372 Lyon, France.
- School of Public Health, Physiotherapy and Sports Science, Woodview House, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Geneviève Nicolas
- Nutrition and Metabolism Section, International Agency for Research on Cancer, 69372 Lyon, France.
| | - Marc J Gunter
- Nutrition and Metabolism Section, International Agency for Research on Cancer, 69372 Lyon, France.
| | - Inge Huybrechts
- Nutrition and Metabolism Section, International Agency for Research on Cancer, 69372 Lyon, France.
| | - Kim Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, Bartholins Alle 2, room 2.26, DK-8000 Aarhus, Denmark.
| | - Nina Roswall
- Danish Cancer Society Research Center, Diet, Genes and Environment, Strandboulevarden 49, DK-2100 Copenhagen, Denmark.
| | - Aurélie Affret
- Inserm CESP U1018, Gustave Roussy, Université Paris-Sud, Paris-Saclay, 94800 Villejuif, France.
| | - Guy Fagherazzi
- Inserm CESP U1018, Gustave Roussy, Université Paris-Sud, Paris-Saclay, 94800 Villejuif, France.
| | - Yahya Mahamat-Saleh
- Inserm CESP U1018, Gustave Roussy, Université Paris-Sud, Paris-Saclay, 94800 Villejuif, France.
| | - Verena Katzke
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, 69120 Heidelberg, Germany.
| | - Tilman Kühn
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, 69120 Heidelberg, Germany.
| | - Carlo La Vecchia
- Hellenic Health Foundation, 115 27 Athens, Greece.
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milano, Italy.
| | | | | | - Calogero Saieva
- Molecular and Nutritional Epidemiology Unit, ISPO Cancer Prevention and Research Institute, 50139 Florence, Italy.
| | | | - Sabina Sieri
- Epidemiology and Prevention Unit Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy.
| | - Tonje Braaten
- Department of Community Medicine UiT, The Arctic University of Norway, 9037 Tromsø, Norway.
| | - Guri Skeie
- Department of Community Medicine UiT, The Arctic University of Norway, 9037 Tromsø, Norway.
| | - Elisabete Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, 9037 Tromsø, Norway.
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, NO-0304 Oslo, Norway.
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
- Genetic Epidemiology Group, Folkhälsan Research Center and Faculty of Medicine, University of Helsinki, 00014 Helsinkiv, Finland.
| | - Eva Ardanaz
- Navarra Public Health Institute, Pamplona, Spain IdiSNA, Navarra Institute for Health Research, 31003 Pamplona, Spain.
- CIBER Epidemiology and Public Health CIBERESP, 28029 Madrid, Spain.
| | - Maria-Dolores Chirlaque
- CIBER Epidemiology and Public Health CIBERESP, 28029 Madrid, Spain.
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, 30008 Murcia, Spain.
- Department of Health and Social Sciences, Universidad de Murcia, 30008 Murcia, Spain.
| | - Jose Ramon Garcia
- EPIC Asturias, Public Health Directorate, Asturias, 33006 Oviedo, Spain.
| | - Paula Jakszyn
- Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology, 08908 Barcelona, Spain.
| | - Miguel Rodríguez-Barranco
- CIBER Epidemiology and Public Health CIBERESP, 28029 Madrid, Spain.
- Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria ibs, 18011 Granada, Spain.
- Hospitales Universitarios de Granada, Universidad de Granada, 18014 Granada, Spain.
| | | | - Ena Huseinovic
- Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, SE-405 30 Gothenburg, Sweden.
| | - Lena Nilsson
- Public Health and Clinical Medicine, Nutritional Research, Umeå University, and Arctic Research Centre at Umeå University, SE-901 85 Umeå, Sweden.
| | | | - Bas Bueno-de-Mesquita
- Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London W2 1PG, UK.
- Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
| | - Petra H Peeters
- University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands.
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London W2 1PG, UK.
| | - Tim Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK.
| | - Marleen Lentjes
- Strangeways Research Laboratories, Department of Public Health & Primary Care, University of Cambridge, Cambridge CB1 8RN, UK.
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London W2 1PG, UK.
| | - Nadia Slimani
- Nutrition and Metabolism Section, International Agency for Research on Cancer, 69372 Lyon, France.
| | - Heinz Freisling
- Nutrition and Metabolism Section, International Agency for Research on Cancer, 69372 Lyon, France.
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7
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Zamora-Ros R, Béraud V, Franceschi S, Cayssials V, Tsilidis KK, Boutron-Ruault MC, Weiderpass E, Overvad K, Tjønneland A, Eriksen AK, Bonnet F, Affret A, Katzke V, Kühn T, Boeing H, Trichopoulou A, Valanou E, Karakatsani A, Masala G, Grioni S, de Magistris MS, Tumino R, Ricceri F, Skeie G, Parr CL, Merino S, Salamanca-Fernández E, Chirlaque MD, Ardanaz E, Amiano P, Almquist M, Drake I, Hennings J, Sandström M, Bueno-de-Mesquita HB, Peeters PH, Khaw KT, Wareham NJ, Schmidt JA, Perez-Cornago A, Aune D, Riboli E, Slimani N, Scalbert A, Romieu I, Agudo A, Rinaldi S. Consumption of fruits, vegetables and fruit juices and differentiated thyroid carcinoma risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Int J Cancer 2018; 142:449-459. [PMID: 28688112 PMCID: PMC6198931 DOI: 10.1002/ijc.30880] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 05/29/2017] [Accepted: 06/20/2017] [Indexed: 12/21/2022]
Abstract
Fruit and vegetable (F&V) intake is considered as probably protective against overall cancer risk, but results in previous studies are not consistent for thyroid cancer (TC). The purpose of this study is to examine the association between the consumption of fruits, vegetables, fruit juices and differentiated thyroid cancer risk within the European Prospective Investigation into Cancer and Nutrition (EPIC) study. The EPIC study is a cohort including over half a million participants, recruited between 1991 and 2000. During a mean follow-up of 14 years, 748 incident first primary differentiated TC cases were identified. F&V and fruit juice intakes were assessed through validated country-specific dietary questionnaires. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox regression models adjusted for potential confounding factors. Comparing the highest versus lowest quartile of intake, differentiated TC risk was not associated with intakes of total F&V (HR: 0.89; 95% CI: 0.68-1.15; p-trend = 0.44), vegetables (HR: 0.89; 95% CI: 0.69-1.14; p-trend = 0.56), or fruit (HR: 1.00; 95% CI: 0.79-1.26; p-trend = 0.64). No significant association was observed with any individual type of vegetable or fruit. However, there was a positive borderline trend with fruit juice intake (HR: 1.23; 95% CI: 0.98-1.53; p-trend = 0.06). This study did not find any significant association between F&V intakes and differentiated TC risk; however a positive trend with fruit juice intake was observed, possibly related to its high sugar content.
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Affiliation(s)
- Raul Zamora-Ros
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Virginie Béraud
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | | | - Valerie Cayssials
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Konstantinos K. Tsilidis
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
- School of Public Health, Imperial College London, London, UK
| | - Marie-Christine Boutron-Ruault
- CESP, Université Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Institut Gustave Roussy, F-94805, Villejuif, France
| | - Elisabete Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, UiT, The Artic University of Tromsø, Tromsø, Norway
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
| | - Kim Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
| | | | | | - Fabrice Bonnet
- CESP, Université Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Institut Gustave Roussy, F-94805, Villejuif, France
- CHU Rennes, Rennes 1 University, Rennes, France
| | - Aurélie Affret
- CESP, Université Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Institut Gustave Roussy, F-94805, Villejuif, France
| | - Verena Katzke
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Tilman Kühn
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Antonia Trichopoulou
- Hellenic Health Foundation, Athens, Greece
- WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Dept. of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece
| | | | - Anna Karakatsani
- Hellenic Health Foundation, Athens, Greece
- 2nd Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, “ATTIKON” University Hospital, Haidari, Greece
| | - Giovanna Masala
- Cancer Risk Factors and Life-Style Epidemiology Unit, Cancer Research and Prevention Institute – ISPO, Florence, Italy
| | - Sara Grioni
- Nutritional Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Rosario Tumino
- Cancer Registry and Histopathology Unit, "Civic M.P. Arezzo" Hospital, ASP Ragusa, Italy
| | - Fulvio Ricceri
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
- Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco (TO), Italy
| | - Guri Skeie
- Department of Community Medicine, Faculty of Health Sciences, UiT, The Artic University of Tromsø, Tromsø, Norway
| | - Christine L Parr
- Domain of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Elena Salamanca-Fernández
- Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria ibs.Granada. Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Maria-Dolores Chirlaque
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain
| | - Eva Ardanaz
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
- Navarra Public Health Institute, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA) Pamplona, Spain
| | - Pilar Amiano
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
- Public Health Division of Gipuzkoa, Regional Government of the Basque Country, Spain
| | - Martin Almquist
- Department of Surgery, University Hospital Lund, Lund, Sweden
- Malmö Diet and Cancer Study, University Hospital Malmö, Malmö, Sweden
| | - Isabel Drake
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Joakim Hennings
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Maria Sandström
- Department for Radiation Sciences, Umeå University, Umeå, Sweden
| | - H. Bas Bueno-de-Mesquita
- School of Public Health, Imperial College London, London, UK
- Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Petra H. Peeters
- School of Public Health, Imperial College London, London, UK
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kay-Thee Khaw
- Department of Public Health and Primary Care, University of Cambridge, UK
| | - Nicholas J. Wareham
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | | | - Dagfinn Aune
- School of Public Health, Imperial College London, London, UK
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
- Bjørknes University College, Oslo, Norway
| | - Elio Riboli
- School of Public Health, Imperial College London, London, UK
| | - Nadia Slimani
- International Agency for Research on Cancer (IARC), Lyon, France
| | | | - Isabelle Romieu
- International Agency for Research on Cancer (IARC), Lyon, France
| | - Antonio Agudo
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Sabina Rinaldi
- International Agency for Research on Cancer (IARC), Lyon, France
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8
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Duarte-Salles T, Fedirko V, Stepien M, Aleksandrova K, Bamia C, Lagiou P, Laursen ASD, Hansen L, Overvad K, Tjønneland A, Boutron-Ruault MC, Fagherazzi G, His M, Boeing H, Katzke V, Kühn T, Trichopoulou A, Valanou E, Kritikou M, Masala G, Panico S, Sieri S, Ricceri F, Tumino R, Bueno-de-Mesquita HBA, Peeters PH, Hjartåker A, Skeie G, Weiderpass E, Ardanaz E, Bonet C, Chirlaque MD, Dorronsoro M, Quirós JR, Johansson I, Ohlsson B, Sjöberg K, Wennberg M, Khaw KT, Travis RC, Wareham N, Ferrari P, Freisling H, Romieu I, Cross AJ, Gunter M, Lu Y, Jenab M. Dietary fat, fat subtypes and hepatocellular carcinoma in a large European cohort. Int J Cancer 2015; 137:2715-28. [PMID: 26081477 DOI: 10.1002/ijc.29643] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 05/21/2015] [Indexed: 02/06/2023]
Abstract
The role of amount and type of dietary fat consumption in the etiology of hepatocellular carcinoma (HCC) is poorly understood, despite suggestive biological plausibility. The associations of total fat, fat subtypes and fat sources with HCC incidence were investigated in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, which includes 191 incident HCC cases diagnosed between 1992 and 2010. Diet was assessed by country-specific, validated dietary questionnaires. A single 24-hr diet recall from a cohort subsample was used for measurement error calibration. Hazard ratios (HR) and 95% confidence intervals (95% CI) were estimated from Cox proportional hazard models. Hepatitis B and C viruses (HBV/HCV) status and biomarkers of liver function were assessed separately in a nested case-control subset with available blood samples (HCC = 122). In multivariable calibrated models, there was a statistically significant inverse association between total fat intake and risk of HCC (per 10 g/day, HR = 0.80, 95% CI: 0.65-0.99), which was mainly driven by monounsaturated fats (per 5 g/day, HR = 0.71, 95% CI: 0.55-0.92) rather than polyunsaturated fats (per 5 g/day, HR = 0.92, 95% CI: 0.68-1.25). There was no association between saturated fats (HR = 1.08, 95% CI: 0.88-1.34) and HCC risk. The ratio of polyunsaturated/monounsaturated fats to saturated fats was not significantly associated with HCC risk (per 0.2 point, HR = 0.86, 95% CI: 0.73-1.01). Restriction of analyses to HBV/HCV free participants or adjustment for liver function did not substantially alter the findings. In this large prospective European cohort, higher consumption of monounsaturated fats is associated with lower HCC risk.
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Affiliation(s)
| | - Veronika Fedirko
- Department of Epidemiology, Rollins School of Public Health, , Winship Cancer Institute, Emory University, Atlanta, GA
| | - Magdalena Stepien
- International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Krasimira Aleksandrova
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Christina Bamia
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - Pagona Lagiou
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
- Department of Epidemiology, Harvard School of Public Health, Boston, MA
- Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece
| | | | - Louise Hansen
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Kim Overvad
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Marie-Christine Boutron-Ruault
- Inserm, Centre for Research in Epidemiology and Population Health, U1018, Gustave Roussy Institute, F-94805, Villejuif, France
- Institut Gustave-Roussy (IGR), Paris South University, UMRS 1018, F-94805, Villejuif, France
| | - Guy Fagherazzi
- Inserm, Centre for Research in Epidemiology and Population Health, U1018, Gustave Roussy Institute, F-94805, Villejuif, France
- Institut Gustave-Roussy (IGR), Paris South University, UMRS 1018, F-94805, Villejuif, France
| | - Mathilde His
- Inserm, Centre for Research in Epidemiology and Population Health, U1018, Gustave Roussy Institute, F-94805, Villejuif, France
- Institut Gustave-Roussy (IGR), Paris South University, UMRS 1018, F-94805, Villejuif, France
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Verena Katzke
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tilman Kühn
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Antonia Trichopoulou
- Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece
- Hellenic Health Foundation, Athens, Greece
| | - Elissavet Valanou
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
- Hellenic Health Foundation, Athens, Greece
| | | | - Giovanna Masala
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute-ISPO, Florence, Italy
| | - Salvatore Panico
- Dipartimento Di Medicina Clinica E Chirurgia, Federico II University, Naples, Italy
| | - Sabina Sieri
- Epidemiology and Prevention Unit, Department of Preventive & Predictive Medicine, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Fulvio Ricceri
- Unit of Cancer Epidemiology, Department of Medical Sciences, University of Turin and Città Della Salute E Della Scienza Hospital-CPO Piedmont, Turin, Italy
- Department of Epidemiology, Local Health Unit To3, Turin, Italy
| | - Rosario Tumino
- Cancer Registy and Histopathology Unit, "Civic - M.P. Arezzo" Hospital, ASP, Ragusa, Italy
| | - H B As Bueno-de-Mesquita
- Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands
- Department of Epidemiology and Biostatistics, the School of Public Health, Imperial College London, London, United Kingdom
- Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Petra H Peeters
- Department of Epidemiology and Biostatistics, the School of Public Health, Imperial College London, London, United Kingdom
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anette Hjartåker
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Guri Skeie
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, the Arctic University of Norway, Tromsø, Norway
| | - Elisabete Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, the Arctic University of Norway, Tromsø, Norway
- Cancer Registry of Norway, Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Group of Genetic Epidemiology, Folkhälsan Research Center, Helsinki, Finland
| | - Eva Ardanaz
- Navarre Public Health Institute, Pamplona, Spain
- CIBER Epidemiology and Public Health CIBERESP, Madrid, Spain
| | - Catalina Bonet
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Institut Català D'oncologia, L'hospitalet De Llobregat, Spain
| | - Maria-Dolores Chirlaque
- CIBER Epidemiology and Public Health CIBERESP, Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Authority, IMIB-Arrixaca, Murcia, Spain
| | - Miren Dorronsoro
- Public Health Direction and Biodonostia Research Institute and CIBERESP, Basque Regional Health Department, San Sebastian, Spain
| | | | | | - Bodil Ohlsson
- Department of Clinical Sciences, Division of Internal Medicine, Lund University, Sweden
| | - Klas Sjöberg
- Department of Clinical Sciences, Division of Internal Medicine, Lund University, Sweden
- Department of Gastroenterology and Nutrition, Skåne University Hospital, Malmö, Sweden
| | - Maria Wennberg
- Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden
| | - Kay-Tee Khaw
- School of Clinical Medicine, Clinical Gerontology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Ruth C Travis
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Nick Wareham
- MRC Epidemiology Unit, Cambridge, United Kingdom
| | - Pietro Ferrari
- International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Heinz Freisling
- International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Isabelle Romieu
- International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Amanda J Cross
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College, London, United Kingdom
| | - Marc Gunter
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College, London, United Kingdom
| | - Yunxia Lu
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College, London, United Kingdom
| | - Mazda Jenab
- International Agency for Research on Cancer (IARC-WHO), Lyon, France
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9
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Bamia C, Lagiou P, Jenab M, Aleksandrova K, Fedirko V, Trichopoulos D, Overvad K, Tjønneland A, Olsen A, Clavel-Chapelon F, Boutron-Ruault MC, Kvaskoff M, Katzke VA, Kühn T, Boeing H, Nöthlings U, Palli D, Sieri S, Panico S, Tumino R, Naccarati A, Bueno-de-Mesquita HB, Peeters PHM, Weiderpass E, Skeie G, Quirós JR, Agudo A, Chirlaque MD, Sanchez MJ, Ardanaz E, Dorronsoro M, Ericson U, Nilsson LM, Wennberg M, Khaw KT, Wareham N, Key TJ, Travis RC, Ferrari P, Stepien M, Duarte-Salles T, Norat T, Murphy N, Riboli E, Trichopoulou A. Fruit and vegetable consumption in relation to hepatocellular carcinoma in a multi-centre, European cohort study. Br J Cancer 2015; 112:1273-82. [PMID: 25742480 PMCID: PMC4385950 DOI: 10.1038/bjc.2014.654] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 11/19/2014] [Accepted: 12/03/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Vegetable and/or fruit intakes in association with hepatocellular carcinoma (HCC) risk have been investigated in case-control studies conducted in specific European countries and cohort studies conducted in Asia, with inconclusive results. No multi-centre European cohort has investigated the indicated associations. METHODS In 486,799 men/women from the European Prospective Investigation into Cancer and nutrition, we identified 201 HCC cases after 11 years median follow-up. We calculated adjusted hazard ratios (HRs) for HCC incidence for sex-specific quintiles and per 100 g d(-1) increments of vegetable/fruit intakes. RESULTS Higher vegetable intake was associated with a statistically significant, monotonic reduction of HCC risk: HR (100 g d(-1) increment): 0.83; 95% CI: 0.71-0.98. This association was consistent in sensitivity analyses with no apparent heterogeneity across strata of HCC risk factors. Fruit intake was not associated with HCC incidence: HR (100 g d(-1) increment): 1.01; 95% CI: 0.92-1.11. CONCLUSIONS Vegetable, but not fruit, intake is associated with lower HCC risk with no evidence for heterogeneity of this association in strata of important HCC risk factors. Mechanistic studies should clarify pathways underlying this association. Given that HCC prognosis is poor and that vegetables are practically universally accessible, our results may be important, especially for those at high risk for the disease.
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Affiliation(s)
- C Bamia
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens 115 27, Greece
| | - P Lagiou
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens 115 27, Greece
- Department of Epidemiology, Harvard School of Public Health, 02115 Boston, MA, USA
- Bureau of Epidemiologic Research, Academy of Athens, Athens 106 79, Greece
| | - M Jenab
- International Agency for Research on Cancer (IARC-WHO), 69372 Lyon, France
| | - K Aleksandrova
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal 14558, Germany
| | - V Fedirko
- Department of Epidemiology, Rollins School of Public Health, Winship Cancer Institute, Emory University, Atlanta 30322, GA, USA
| | - D Trichopoulos
- Department of Epidemiology, Harvard School of Public Health, 02115 Boston, MA, USA
- Bureau of Epidemiologic Research, Academy of Athens, Athens 106 79, Greece
- Hellenic Health Foundation, Athens 115 27, Greece
| | - K Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, DK-8000 Aarhus C, Denmark
| | - A Tjønneland
- Danish Cancer Society Research Center, DK-2100 Copenhagen, Denmark
| | - A Olsen
- Danish Cancer Society Research Center, DK-2100 Copenhagen, Denmark
| | - F Clavel-Chapelon
- Inserm, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health Team, Villejuif, F-94805 Paris, France
- Paris South University, UMRS 1018, Villejuif, F-94805 Paris, France
- IGR, Villejuif, F-94805 Paris, France
| | - M-C Boutron-Ruault
- Inserm, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health Team, Villejuif, F-94805 Paris, France
- Paris South University, UMRS 1018, Villejuif, F-94805 Paris, France
- IGR, Villejuif, F-94805 Paris, France
| | - M Kvaskoff
- Inserm, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health Team, Villejuif, F-94805 Paris, France
- Paris South University, UMRS 1018, Villejuif, F-94805 Paris, France
- IGR, Villejuif, F-94805 Paris, France
| | - V A Katzke
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - T Kühn
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - H Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal 14558, Germany
| | - U Nöthlings
- Department of Nutrition and Food Sciences, University of Bonn, 53111 Bonn, Germany
| | - D Palli
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute–ISPO, 50139 Florence, Italy
| | - S Sieri
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - S Panico
- Dipartimento di Medicina Clinica e Chirurgia Federico II University, 80131 Naples, Italy
| | - R Tumino
- Cancer Registry and Histopathology Unit, ‘Civic–M.P. Arezzo' Hospital, ASP 97100 Ragusa, Italy
| | - A Naccarati
- HuGeF–Human Genetics Foundation–Torino Molecular and Genetic Epidemiology Unit, 10126 Torino, Italy
| | - HB(as) Bueno-de-Mesquita
- Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, 3508 GA Utrecht, The Netherlands
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College, W2 1NY UK London, UK
| | - P H M Peeters
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College, W2 1NY UK London, UK
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - E Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, N-9037 Tromsø, Norway
- Cancer Registry of Norway, NO-0304 Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-171 Stockholm, Sweden
- Department of Genetic Epidemiology, Folkhälsan Research Center, 00250 Helsinki, Finland
| | - G Skeie
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, N-9037 Tromsø, Norway
| | - J R Quirós
- Public Health Directorate, CP 33006 Oviedo, Asturias, Spain
| | - A Agudo
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), 08908 Barcelona, Spain
| | - M-D Chirlaque
- Epidemiology Department, Murcia Regional Health Council, E-30008 Murcia, Spain
- CIBER Epidemiology and Public Health CIBERESP, 28029 Madrid, Spain
| | - M-J Sanchez
- CIBER Epidemiology and Public Health CIBERESP, 28029 Madrid, Spain
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs, GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, 18080 Granada, Spain
| | - E Ardanaz
- CIBER Epidemiology and Public Health CIBERESP, 28029 Madrid, Spain
- Navarre Public Health Institute, 31003 Pamplona, Spain
| | - M Dorronsoro
- Basque Regional Health Department, Public Health Direction, 4-20013 Donostia, San Sebastian, Spain
- Biodonostia Research Institute CIBER Epidemiology and Public Health CIBERESP, s/n 20014 San Sebastian, Spain
| | - U Ericson
- Diabetes and Cardiovascular disease, Genetic Epidemiology Department of Clinical Sciences in Malmö Lund University, SE-205 92 Malmo, Sweden
| | - L M Nilsson
- Department of Nutritional Research, Public Health and Clinical Medicine, Umeå University, SE-901 85 Umeå, Sweden
- Arcum, Arctic Research Centre at Umeå University, SE-901 85 Umeå, Sweden
| | - M Wennberg
- Department of Nutritional Research, Public Health and Clinical Medicine, Umeå University, SE-901 85 Umeå, Sweden
| | - K-T Khaw
- University of Cambridge, CB2 0SR Cambridge, UK
| | - N Wareham
- University of Cambridge, CB2 0SR Cambridge, UK
- MRC Epidemiology Unit, CB2 0QQ Cambridge, UK
| | - T J Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, OX3 7LF Oxford, UK
| | - R C Travis
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, OX3 7LF Oxford, UK
| | - P Ferrari
- International Agency for Research on Cancer (IARC-WHO), 69372 Lyon, France
| | - M Stepien
- International Agency for Research on Cancer (IARC-WHO), 69372 Lyon, France
| | - T Duarte-Salles
- International Agency for Research on Cancer (IARC-WHO), 69372 Lyon, France
| | - T Norat
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College, W2 1NY UK London, UK
| | - N Murphy
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College, W2 1NY UK London, UK
| | - E Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College, W2 1NY UK London, UK
| | - A Trichopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens 115 27, Greece
- Hellenic Health Foundation, Athens 115 27, Greece
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10
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Sera F, Ferrari P. A multilevel model to estimate the within- and the between-center components of the exposure/disease association in the EPIC study. PLoS One 2015; 10:e0117815. [PMID: 25785729 PMCID: PMC4365026 DOI: 10.1371/journal.pone.0117815] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 01/02/2015] [Indexed: 01/12/2023] Open
Abstract
In a multicenter study, the overall relationship between exposure and the risk of cancer can be broken down into a within-center component, which reflects the individual level association, and a between-center relationship, which captures the association at the aggregate level. A piecewise exponential proportional hazards model with random effects was used to evaluate the association between dietary fiber intake and colorectal cancer (CRC) risk in the EPIC study. During an average follow-up of 11.0 years, 4,517 CRC events occurred among study participants recruited in 28 centers from ten European countries. Models were adjusted by relevant confounding factors. Heterogeneity among centers was modelled with random effects. Linear regression calibration was used to account for errors in dietary questionnaire (DQ) measurements. Risk ratio estimates for a 10 g/day increment in dietary fiber were equal to 0.90 (95%CI: 0.85, 0.96) and 0.85 (0.64, 1.14), at the individual and aggregate levels, respectively, while calibrated estimates were 0.85 (0.76, 0.94), and 0.87 (0.65, 1.15), respectively. In multicenter studies, over a straightforward ecological analysis, random effects models allow information at the individual and ecologic levels to be captured, while controlling for confounding at both levels of evidence.
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Affiliation(s)
- Francesco Sera
- Molecular and Nutritional Epidemiology Unit, Cancer Prevention and Research, ISPO, Florence, Italy
| | - Pietro Ferrari
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
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11
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Rohrmann S, Linseisen J, Overvad K, Lund Würtz AM, Roswall N, Tjonneland A, Boutron-Ruault MC, Racine A, Bastide N, Palli D, Agnoli C, Panico S, Tumino R, Sacerdote C, Weikert S, Steffen A, Kühn T, Li K, Khaw KT, Wareham NJ, Bradbury KE, Peppa E, Trichopoulou A, Trichopoulos D, Bueno-de-Mesquita HB, Peeters PHM, Hjartåker A, Skeie G, Weiderpass E, Jakszyn P, Dorronsoro M, Barricarte A, Santiuste de Pablos C, Molina-Montes E, de la Torre RA, Ericson U, Sonestedt E, Johansson M, Ljungberg B, Freisling H, Romieu I, Cross AJ, Vergnaud AC, Riboli E, Boeing H. Meat and fish consumption and the risk of renal cell carcinoma in the European prospective investigation into cancer and nutrition. Int J Cancer 2015; 136:E423-31. [PMID: 25258006 DOI: 10.1002/ijc.29236] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 08/20/2014] [Accepted: 08/21/2014] [Indexed: 01/11/2023]
Abstract
Renal cell cancer (RCC) incidence varies worldwide with a higher incidence in developed countries and lifestyle is likely to contribute to the development of this disease. We examined whether meat and fish consumption were related to the risk of RCC in the European Prospective Investigation into Cancer and Nutrition (EPIC). The analysis included 493,179 EPIC participants, recruited between 1992 and 2000. Until December 2008, 691 RCC cases have been identified. Meat and fish consumption was assessed at baseline using country-specific dietary assessment instruments; 24-hour recalls were applied in an 8% subsample for calibration purposes. Cox proportional hazards regression was used to calculate multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (CI). Women with a high consumption of red meat (HR = 1.36, 95% CI 1.14-1.62; calibrated, per 50 g/day) and processed meat (HR = 1.78, 95% CI 1.05-3.03; calibrated, per 50 g/day) had a higher risk of RCC, while no association existed in men. For processed meat, the association with RCC incidence was prominent in premenopausal women and was lacking in postmenopausal women (p interaction = 0.02). Neither poultry nor fish consumption were statistically significantly associated with the risk of RCC. The results show a distinct association of red and processed meat consumption with incident RCC in women but not in men. A biological explanation for these findings remains unclear.
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Affiliation(s)
- Sabine Rohrmann
- Division of Cancer Epidemiology and Prevention, Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland; Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
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12
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Engeset D, Braaten T, Teucher B, Kühn T, Bueno-de-Mesquita HB, Leenders M, Agudo A, Bergmann MM, Valanou E, Naska A, Trichopoulou A, Key TJ, Crowe FL, Overvad K, Sonestedt E, Mattiello A, Peeters PH, Wennberg M, Jansson JH, Boutron-Ruault MC, Dossus L, Dartois L, Li K, Barricarte A, Ward H, Riboli E, Agnoli C, Huerta JM, Sánchez MJ, Tumino R, Altzibar JM, Vineis P, Masala G, Ferrari P, Muller DC, Johansson M, Luisa Redondo M, Tjønneland A, Olsen A, Olsen KS, Brustad M, Skeie G, Lund E. Fish consumption and mortality in the European Prospective Investigation into Cancer and Nutrition cohort. Eur J Epidemiol 2015; 30:57-70. [PMID: 25377533 PMCID: PMC4356893 DOI: 10.1007/s10654-014-9966-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 10/23/2014] [Indexed: 12/25/2022]
Abstract
Fish is a source of important nutrients and may play a role in preventing heart diseases and other health outcomes. However, studies of overall mortality and cause-specific mortality related to fish consumption are inconclusive. We examined the rate of overall mortality, as well as mortality from ischaemic heart disease and cancer in relation to the intake of total fish, lean fish, and fatty fish in a large prospective cohort including ten European countries. More than 500,000 men and women completed a dietary questionnaire in 1992-1999 and were followed up for mortality until the end of 2010. 32,587 persons were reported dead since enrolment. Hazard ratios and their 99% confidence interval were estimated using Cox proportional hazard regression models. Fish consumption was examined using quintiles based on reported consumption, using moderate fish consumption (third quintile) as reference, and as continuous variables, using increments of 10 g/day. All analyses were adjusted for possible confounders. No association was seen for fish consumption and overall or cause-specific mortality for both the categorical and the continuous analyses, but there seemed to be a U-shaped trend (p < 0.000) with fatty fish consumption and total mortality and with total fish consumption and cancer mortality (p = 0.046).
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Affiliation(s)
- Dagrun Engeset
- Department of Community Medicine, UiT-The Arctic University of Norway, Tromsö, Norway,
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13
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Bergmann MM, Rehm J, Klipstein-Grobusch K, Boeing H, Schütze M, Drogan D, Overvad K, Tjønneland A, Halkjær J, Fagherazzi G, Boutron-Ruault MC, Clavel-Chapelon F, Teucher B, Kaaks R, Trichopoulou A, Benetou V, Trichopoulos D, Palli D, Pala V, Tumino R, Vineis P, Beulens JW, Redondo ML, Duell EJ, Molina-Montes E, Navarro C, Barricarte A, Arriola L, Allen NE, Crowe FL, Khaw KT, Wareham N, Romaguera D, Wark PA, Romieu I, Nunes L, Riboli E, Ferrari P. The association of pattern of lifetime alcohol use and cause of death in the European prospective investigation into cancer and nutrition (EPIC) study. Int J Epidemiol 2014; 42:1772-90. [PMID: 24415611 DOI: 10.1093/ije/dyt154] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND There is limited evidence for an association between the pattern of lifetime alcohol use and cause-specific risk of death. METHODS Multivariable hazard ratios were estimated for different causes of death according to patterns of lifetime alcohol consumption using a competing risks approach: 111 953 men and 268 442 women from eight countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study were included. Self-reported alcohol consumption at ages 20, 30, 40 or 50 years and at enrollment were used for the analysis; 26 411 deaths were observed during an average of 12.6 years of follow-up. RESULTS The association between lifetime alcohol use and death from cardiovascular diseases was different from the association seen for alcohol-related cancers, digestive, respiratory, external and other causes. Heavy users (>5 drinks/day for men and >2.5 drinks/day for women), regardless of time of cessation, had a 2- to 5-times higher risk of dying due to alcohol-related cancers, compared with subjects with lifetime light use (≤1 and ≤0.5 drink/week for men and women, respectively). Compared with lifetime light users, men who used <5 drinks/day throughout their lifetime had a 24% lower cardiovascular disease mortality (95% confidence interval 2-41). The risk of death from coronary heart disease was also found to be 34-46% lower among women who were moderate to occasionally heavy alcohol users compared with light users. However, this relationship was only evident among men and women who had no chronic disease at enrollment. CONCLUSIONS Limiting alcohol use throughout life is associated with a lower risk of death, largely due to cardiovascular disease but also other causes. However, the potential health benefits of alcohol use are difficult to establish due to the possibility of selection bias and competing risks related to diseases occurring later in life.
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Affiliation(s)
- Manuela M Bergmann
- German Institute of Human Nutrition Potsdam-Rehbrücke, Division of Epidemiology, Nuthetal, Germany, Centre for Addiction and Mental Health (CAMH), Toronto, Canada, Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany, Julius Center for Health Sciences and Primary Care University Medical Center Utrecht, Utrecht, The Netherlands, Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Department of Epidemiology, School of Public Health, Aarhus University, Aarhus, Denmark, Danish Cancer Society Research Center, Copenhagen, Denmark, Nutrition, Hormones and Women's Health, CESP Centre for Research in Epidemiology and Public Health, and Paris South University, Villejuif, France, Department of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany, WHO Collaborating Center for Food and Nutrition Policies, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece, Hellenic Health Foundation, Athens, Greece, Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA, Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece, Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy, Nutritional Epidemiology Unit Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy, Cancer Registry and Histopathology Unit, Civile-M.P. Arezzo Hospital, Ragusa, Italy, MRC/HPA Centre for Environment and Health, School of Public Health, Imperial College London, London, UK, HuGeF Foundation, Torino, Italy, Public Health Directorate, Asturias, Spain, Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Program, Bellvitge Biomedical Research Institute, Catalan Institute of Oncology, Barcelona, Spain, Andalusian School of Public Health and CIBER de Epidemiología y Salud Pública, Granada, Spain, Departmen
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Agogo GO, van der Voet H, Veer PV, Ferrari P, Leenders M, Muller DC, Sánchez-Cantalejo E, Bamia C, Braaten T, Knüppel S, Johansson I, van Eeuwijk FA, Boshuizen H. Use of two-part regression calibration model to correct for measurement error in episodically consumed foods in a single-replicate study design: EPIC case study. PLoS One 2014; 9:e113160. [PMID: 25402487 PMCID: PMC4234679 DOI: 10.1371/journal.pone.0113160] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 10/20/2014] [Indexed: 01/25/2023] Open
Abstract
In epidemiologic studies, measurement error in dietary variables often attenuates association between dietary intake and disease occurrence. To adjust for the attenuation caused by error in dietary intake, regression calibration is commonly used. To apply regression calibration, unbiased reference measurements are required. Short-term reference measurements for foods that are not consumed daily contain excess zeroes that pose challenges in the calibration model. We adapted two-part regression calibration model, initially developed for multiple replicates of reference measurements per individual to a single-replicate setting. We showed how to handle excess zero reference measurements by two-step modeling approach, how to explore heteroscedasticity in the consumed amount with variance-mean graph, how to explore nonlinearity with the generalized additive modeling (GAM) and the empirical logit approaches, and how to select covariates in the calibration model. The performance of two-part calibration model was compared with the one-part counterpart. We used vegetable intake and mortality data from European Prospective Investigation on Cancer and Nutrition (EPIC) study. In the EPIC, reference measurements were taken with 24-hour recalls. For each of the three vegetable subgroups assessed separately, correcting for error with an appropriately specified two-part calibration model resulted in about three fold increase in the strength of association with all-cause mortality, as measured by the log hazard ratio. Further found is that the standard way of including covariates in the calibration model can lead to over fitting the two-part calibration model. Moreover, the extent of adjusting for error is influenced by the number and forms of covariates in the calibration model. For episodically consumed foods, we advise researchers to pay special attention to response distribution, nonlinearity, and covariate inclusion in specifying the calibration model.
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Affiliation(s)
- George O. Agogo
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Biometris, Wageningen University and Research Center, Wageningen, The Netherlands
| | - Hilko van der Voet
- Biometris, Wageningen University and Research Center, Wageningen, The Netherlands
| | - Pieter van’t Veer
- Department of Human Nutrition, Wageningen University and Research Center, Wageningen, The Netherlands
| | - Pietro Ferrari
- Nutritional Epidemiology Group, International Agency for Research on Cancer, Lyon, France
| | - Max Leenders
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - David C. Muller
- Genetic Epidemiology Group, International Agency for Research on Cancer, 150 cours Albert Thomas, Lyon, 69008, France
| | - Emilio Sánchez-Cantalejo
- Andalusian School of Public Health, Granada, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Christina Bamia
- WHO Collaborating Center for Food and Nutrition Policies, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - Tonje Braaten
- Department of Community Medicine, University of Tromsø, N-9037, Tromsø, Norway
| | - Sven Knüppel
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Potsdam, Germany
| | | | - Fred A. van Eeuwijk
- Biometris, Wageningen University and Research Center, Wageningen, The Netherlands
| | - Hendriek Boshuizen
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Biometris, Wageningen University and Research Center, Wageningen, The Netherlands
- Department of Human Nutrition, Wageningen University and Research Center, Wageningen, The Netherlands
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15
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Bradbury KE, Appleby PN, Key TJ. Fruit, vegetable, and fiber intake in relation to cancer risk: findings from the European Prospective Investigation into Cancer and Nutrition (EPIC). Am J Clin Nutr 2014; 100 Suppl 1:394S-8S. [PMID: 24920034 DOI: 10.3945/ajcn.113.071357] [Citation(s) in RCA: 192] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Fruit, vegetables, and certain components of plant foods, such as fiber, have long been thought to protect against cancer. The European Prospective Investigation into Cancer and Nutrition (EPIC) is a prospective cohort that includes >500,000 participants from 10 European countries and has made a substantial contribution to knowledge in this research area. The purpose of this article is to summarize the findings published thus far from the EPIC study on the associations between fruit, vegetable, or fiber consumption and the risk of cancer at 14 different sites. The risk of cancers of the upper gastrointestinal tract was inversely associated with fruit intake but was not associated with vegetable intake. The risk of colorectal cancer was inversely associated with intakes of total fruit and vegetables and total fiber, and the risk of liver cancer was also inversely associated with the intake of total fiber. The risk of cancer of the lung was inversely associated with fruit intake but was not associated with vegetable intake; this association with fruit intake was restricted to smokers and might be influenced by residual confounding due to smoking. There was a borderline inverse association of fiber intake with breast cancer risk. For the other 9 cancer sites studied (stomach, biliary tract, pancreas, cervix, endometrium, prostate, kidney, bladder, and lymphoma) there were no reported significant associations of risk with intakes of total fruit, vegetables, or fiber.
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Affiliation(s)
- Kathryn E Bradbury
- From the Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Paul N Appleby
- From the Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Timothy J Key
- From the Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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16
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Jakszyn P, Luján-Barroso L, Agudo A, Bueno-de-Mesquita HB, Molina E, Sánchez MJ, Fonseca-Nunes A, Siersema PD, Matiello A, Tumino R, Saieva C, Pala V, Vineis P, Boutron-Ruault MC, Racine A, Bastide N, Travis RC, Khaw KT, Riboli E, Murphy N, Vergnaud AC, Trichopoulou A, Valanou E, Oikonomidou E, Weiderpass E, Skeie G, Johansen D, Lindkvist B, Johansson M, Duarte-Salles T, Freisling H, Barricarte A, Huerta JM, Amiano P, Tjonneland A, Overvad K, Kuehn T, Grote V, Boeing H, Peeters PHM, González CA. Meat and heme iron intake and esophageal adenocarcinoma in the European Prospective Investigation into Cancer and Nutrition study. Int J Cancer 2013; 133:2744-50. [PMID: 23728954 DOI: 10.1002/ijc.28291] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 03/18/2013] [Indexed: 01/03/2023]
Abstract
Although recent studies suggest that high intakes of meat and heme iron are risk factors for several types of cancer, studies in relation to esophageal adenocarcinoma (EAC) are scarce. Previous results in the European Prospective Investigation into Cancer and Nutrition (EPIC) based on a relatively small number of cases suggested a positive association between processed meat and EAC. In this study, we investigate the association between intake of different types of meats and heme iron intake and EAC risk in a larger number of cases from EPIC. The study included 481,419 individuals and 137 incident cases of EAC that occurred during an average of 11 years of follow-up. Dietary intake of meat (unprocessed/processed red and white meat) was assessed by validated center-specific questionnaires. Heme iron was calculated as a type-specific percentage of the total iron content in meat. After adjusting for relevant confounders, we observed a statistically significant positive association of EAC risk with heme iron and processed meat intake, with HR: 1.67, 95% CI: 1.05-2.68 and HR: 2.27, 95% CI:1.33-3.89, respectively, for comparison of the highest vs. lowest tertile of intake. Our results suggest a potential association between higher intakes of processed meat and heme iron and risk of EAC.
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Affiliation(s)
- Paula Jakszyn
- Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology, ICO-IDIBELL, L'Hospitalet de Llobregat, Spain
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17
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Rohrmann S, Overvad K, Bueno-de-Mesquita HB, Jakobsen MU, Egeberg R, Tjønneland A, Nailler L, Boutron-Ruault MC, Clavel-Chapelon F, Krogh V, Palli D, Panico S, Tumino R, Ricceri F, Bergmann MM, Boeing H, Li K, Kaaks R, Khaw KT, Wareham NJ, Crowe FL, Key TJ, Naska A, Trichopoulou A, Trichopoulos D, Leenders M, Peeters PHM, Engeset D, Parr CL, Skeie G, Jakszyn P, Sánchez MJ, Huerta JM, Redondo ML, Barricarte A, Amiano P, Drake I, Sonestedt E, Hallmans G, Johansson I, Fedirko V, Romieux I, Ferrari P, Norat T, Vergnaud AC, Riboli E, Linseisen J. Meat consumption and mortality--results from the European Prospective Investigation into Cancer and Nutrition. BMC Med 2013; 11:63. [PMID: 23497300 PMCID: PMC3599112 DOI: 10.1186/1741-7015-11-63] [Citation(s) in RCA: 234] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 03/07/2013] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Recently, some US cohorts have shown a moderate association between red and processed meat consumption and mortality supporting the results of previous studies among vegetarians. The aim of this study was to examine the association of red meat, processed meat, and poultry consumption with the risk of early death in the European Prospective Investigation into Cancer and Nutrition (EPIC). METHODS Included in the analysis were 448,568 men and women without prevalent cancer, stroke, or myocardial infarction, and with complete information on diet, smoking, physical activity and body mass index, who were between 35 and 69 years old at baseline. Cox proportional hazards regression was used to examine the association of meat consumption with all-cause and cause-specific mortality. RESULTS As of June 2009, 26,344 deaths were observed. After multivariate adjustment, a high consumption of red meat was related to higher all-cause mortality (hazard ratio (HR) = 1.14, 95% confidence interval (CI) 1.01 to 1.28, 160+ versus 10 to 19.9 g/day), and the association was stronger for processed meat (HR = 1.44, 95% CI 1.24 to 1.66, 160+ versus 10 to 19.9 g/day). After correction for measurement error, higher all-cause mortality remained significant only for processed meat (HR = 1.18, 95% CI 1.11 to 1.25, per 50 g/d). We estimated that 3.3% (95% CI 1.5% to 5.0%) of deaths could be prevented if all participants had a processed meat consumption of less than 20 g/day. Significant associations with processed meat intake were observed for cardiovascular diseases, cancer, and 'other causes of death'. The consumption of poultry was not related to all-cause mortality. CONCLUSIONS The results of our analysis support a moderate positive association between processed meat consumption and mortality, in particular due to cardiovascular diseases, but also to cancer.
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Affiliation(s)
- Sabine Rohrmann
- Division of Cancer Epidemiology and Prevention, Institute of Social and Preventive Medicine, University of Zurich, 8001 Zurich, Switzerland.
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18
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Fedirko V, Lukanova A, Bamia C, Trichopolou A, Trepo E, Nöthlings U, Schlesinger S, Aleksandrova K, Boffetta P, Tjønneland A, Johnsen NF, Overvad K, Fagherazzi G, Racine A, Boutron-Ruault MC, Grote V, Kaaks R, Boeing H, Naska A, Adarakis G, Valanou E, Palli D, Sieri S, Tumino R, Vineis P, Panico S, Bueno-de-Mesquita HBA, Siersema PD, Peeters PH, Weiderpass E, Skeie G, Engeset D, Quirós JR, Zamora-Ros R, Sánchez MJ, Amiano P, Huerta JM, Barricarte A, Johansen D, Lindkvist B, Sund M, Werner M, Crowe F, Khaw KT, Ferrari P, Romieu I, Chuang SC, Riboli E, Jenab M. Glycemic index, glycemic load, dietary carbohydrate, and dietary fiber intake and risk of liver and biliary tract cancers in Western Europeans. Ann Oncol 2013; 24:543-553. [PMID: 23123507 PMCID: PMC3551485 DOI: 10.1093/annonc/mds434] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 07/20/2012] [Accepted: 07/24/2012] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The type and quantity of dietary carbohydrate as quantified by glycemic index (GI) and glycemic load (GL), and dietary fiber may influence the risk of liver and biliary tract cancers, but convincing evidence is lacking. PATIENTS AND METHODS The association between dietary GI/GL and carbohydrate intake with hepatocellular carcinoma (HCC; N = 191), intrahepatic bile duct (IBD; N = 66), and biliary tract (N = 236) cancer risk was investigated in 477 206 participants of the European Prospective Investigation into Cancer and Nutrition cohort. Dietary intake was assessed by country-specific, validated dietary questionnaires. Hazard ratios and 95% confidence intervals were estimated from proportional hazard models. HBV/HCV status was measured in a nested case-control subset. RESULTS Higher dietary GI, GL, or increased intake of total carbohydrate was not associated with liver or biliary tract cancer risk. For HCC, divergent risk estimates were observed for total sugar = 1.43 (1.17-1.74) per 50 g/day, total starch = 0.70 (0.55-0.90) per 50 g/day, and total dietary fiber = 0.70 (0.52-0.93) per 10 g/day. The findings for dietary fiber were confirmed among HBV/HCV-free participants [0.48 (0.23-1.01)]. Similar associations were observed for IBD [dietary fiber = 0.59 (0.37-0.99) per 10 g/day], but not biliary tract cancer. CONCLUSIONS Findings suggest that higher consumption of dietary fiber and lower consumption of total sugars are associated with lower HCC risk. In addition, high dietary fiber intake could be associated with lower IBD cancer risk.
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Affiliation(s)
- V Fedirko
- Nutritional Epidemiology Group, Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France.
| | - A Lukanova
- Division of Cancer Epidemiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - C Bamia
- WHO Collaborating Center for Food and Nutrition Policies, Department of Hygiene, Epidemiology, Medical Statistics, University of Athens Medical School, Athens
| | - A Trichopolou
- WHO Collaborating Center for Food and Nutrition Policies, Department of Hygiene, Epidemiology, Medical Statistics, University of Athens Medical School, Athens; Hellenic Health Foundation, Athens, Greece
| | - E Trepo
- Centre de Bioloqie Republique, Lyon, France
| | - U Nöthlings
- Section of Epidemiology, Institute for Experimental Medicine, Christian-Albrechts University of Kiel, Kiel
| | - S Schlesinger
- Section of Epidemiology, Institute for Experimental Medicine, Christian-Albrechts University of Kiel, Kiel
| | - K Aleksandrova
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - P Boffetta
- Institute for Translational Epidemiology, Mount Sinai School of Medicine, The Tisch Cancer Institute, New York, USA
| | - A Tjønneland
- Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen
| | - N F Johnsen
- Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen
| | - K Overvad
- Department of Epidemiology, School of Public Health, Aarhus University, Aarhus, Denmark
| | - G Fagherazzi
- Centre for Research in Epidemiology and Population Health, Inserm (Institut National de la Santé et de la Recherche Médicale), Institut Gustave Roussy Villejuif; Paris South University, UMRS 1018 Villejuif, France
| | - A Racine
- Centre for Research in Epidemiology and Population Health, Inserm (Institut National de la Santé et de la Recherche Médicale), Institut Gustave Roussy Villejuif; Paris South University, UMRS 1018 Villejuif, France
| | - M C Boutron-Ruault
- Centre for Research in Epidemiology and Population Health, Inserm (Institut National de la Santé et de la Recherche Médicale), Institut Gustave Roussy Villejuif; Paris South University, UMRS 1018 Villejuif, France
| | - V Grote
- Division of Cancer Epidemiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - R Kaaks
- Division of Cancer Epidemiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - H Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - A Naska
- WHO Collaborating Center for Food and Nutrition Policies, Department of Hygiene, Epidemiology, Medical Statistics, University of Athens Medical School, Athens
| | - G Adarakis
- Hellenic Health Foundation, Athens, Greece
| | - E Valanou
- Hellenic Health Foundation, Athens, Greece
| | - D Palli
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence
| | - S Sieri
- Nutritional Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - R Tumino
- Cancer Registry and Histopathology Unit, "Civile M.P.Arezzo" Hospital, Ragusa, Italy
| | - P Vineis
- School of Public Health, Imperial College, London, UK; HuGeF Foundation, Turin
| | - S Panico
- Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy
| | - H B As Bueno-de-Mesquita
- Centre for Nutrition and Health, National Institute for Public Health and the Environment (RIVM), Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre Utrecht (UMCU), Utrecht
| | - P D Siersema
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht (UMCU), Utrecht
| | - P H Peeters
- Department of Epidemiology Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, the Netherlands; School of Public Health, Imperial College, London, UK
| | - E Weiderpass
- Department of Community Medicine, University of Tromsø, Tromsø; Cancer Registry of Norway, Oslo, Norway; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Samfundet Folkhälsan, Genetic Epidemiology Group, Folkhälsan Research Center, University of Helsinki, Helsinki, Finland
| | - G Skeie
- Department of Community Medicine, University of Tromsø, Tromsø
| | - D Engeset
- Department of Community Medicine, University of Tromsø, Tromsø
| | - J R Quirós
- Public Health Directorate, Health and Health Care Services Council, Asturias
| | - R Zamora-Ros
- Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona
| | - M J Sánchez
- Andalusian School of Public Health, Granada; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP) Granada
| | - P Amiano
- Public Health Division of Gipuzkoa, BIODonostia Research Institute, Department ofHealth of the regional Government of the Basque Country, San Sebastian; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP) Granada
| | - J M Huerta
- Department of Epidemiology, Murcia Regional Health Council, Murcia; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP) Granada
| | - A Barricarte
- Navarre Public Health Institute, Pamplona, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiología y Salud Pública-CIBERESP) Granada
| | | | - B Lindkvist
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg
| | - M Sund
- Department of Surgical and Perioperative Sciences, Umea University
| | - M Werner
- Department of Public Health and Clinical Medicine, Umea University, Sweden
| | - F Crowe
- Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford
| | - K T Khaw
- Clinical Gerontology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - P Ferrari
- Nutritional Epidemiology Group, Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - I Romieu
- Nutritional Epidemiology Group, Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - S C Chuang
- School of Public Health, Imperial College, London, UK
| | - E Riboli
- School of Public Health, Imperial College, London, UK
| | - M Jenab
- Nutritional Epidemiology Group, Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France
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19
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Buckland G, Travier N, Cottet V, González C, Luján-Barroso L, Agudo A, Trichopoulou A, Lagiou P, Trichopoulos D, Peeters P, May A, Bueno-de-Mesquita H, Bvan Duijnhoven F, Key T, Allen N, Khaw K, Wareham N, Romieu I, McCormack V, Boutron-Ruault M, Clavel-Chapelon F, Panico S, Agnoli C, Palli D, Tumino R, Vineis P, Amiano P, Barricarte A, Rodríguez L, Sanchez M, Chirlaque M, Kaaks R, Teucher B, Boeing H, Bergmann M, Overvad K, Dahm C, Tjønneland A, Olsen A, Manjer J, Wirfält E, Hallmans G, Johansson I, Lund E, Hjartåker A, Skeie G, Vergnaud A, Norat T, Romaguera D, Riboli E. Adherence to the mediterranean diet and risk of breast cancer in the European prospective investigation into cancer and nutrition cohort study. Int J Cancer 2012. [DOI: 10.1002/ijc.27958] [Citation(s) in RCA: 154] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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20
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Freisling H, Moskal A, Ferrari P, Nicolas G, Knaze V, Clavel-Chapelon F, Boutron-Ruault MC, Nailler L, Teucher B, Grote VA, Boeing H, Clemens M, Tjønneland A, Olsen A, Overvad K, Quirós JR, Duell EJ, Sánchez MJ, Amiano P, Chirlaque MD, Barricarte A, Khaw KT, Wareham NJ, Crowe FL, Gallo V, Oikonomou E, Naska A, Trichopoulou A, Palli D, Agnoli C, Tumino R, Polidoro S, Mattiello A, Bueno-de-Mesquita HB, Ocké MC, Peeters PHM, Wirfält E, Ericson U, Bergdahl IA, Johansson I, Hjartåker A, Engeset D, Skeie G, Riboli E, Slimani N. Dietary acrylamide intake of adults in the European Prospective Investigation into Cancer and Nutrition differs greatly according to geographical region. Eur J Nutr 2012; 52:1369-80. [DOI: 10.1007/s00394-012-0446-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 09/10/2012] [Indexed: 11/24/2022]
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21
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Chuang SC, Norat T, Murphy N, Olsen A, Tjønneland A, Overvad K, Boutron-Ruault MC, Perquier F, Dartois L, Kaaks R, Teucher B, Bergmann MM, Boeing H, Trichopoulou A, Lagiou P, Trichopoulos D, Grioni S, Sacerdote C, Panico S, Palli D, Tumino R, Peeters PHM, Bueno-de-Mesquita B, Ros MM, Brustad M, Åsli LA, Skeie G, Quirós JR, González CA, Sánchez MJ, Navarro C, Ardanaz Aicua E, Dorronsoro M, Drake I, Sonestedt E, Johansson I, Hallmans G, Key T, Crowe F, Khaw KT, Wareham N, Ferrari P, Slimani N, Romieu I, Gallo V, Riboli E, Vineis P. Fiber intake and total and cause-specific mortality in the European Prospective Investigation into Cancer and Nutrition cohort. Am J Clin Nutr 2012; 96:164-74. [PMID: 22648726 DOI: 10.3945/ajcn.111.028415] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Previous studies have shown that high fiber intake is associated with lower mortality. However, little is known about the association of dietary fiber with specific causes of death other than cardiovascular disease (CVD). OBJECTIVE The aim of this study was to assess the relation between fiber intake, mortality, and cause-specific mortality in a large European prospective study of 452,717 men and women. DESIGN HRs and 95% CIs were estimated by using Cox proportional hazards models, stratified by age, sex, and center and adjusted for education, smoking, alcohol consumption, BMI, physical activity, total energy intake, and, in women, ever use of menopausal hormone therapy. RESULTS During a mean follow-up of 12.7 y, a total of 23,582 deaths were recorded. Fiber intake was inversely associated with total mortality (HR(per 10-g/d increase): 0.90; 95% CI: 0.88, 0.92); with mortality from circulatory (HR(per 10-g/d increase): 0.90 and 0.88 for men and women, respectively), digestive (HR: 0.61 and 0.64), respiratory (HR: 0.77 and 0.62), and non-CVD noncancer inflammatory (HR: 0.85 and 0.80) diseases; and with smoking-related cancers (HR: 0.86 and 0.89) but not with non-smoking-related cancers (HR: 1.05 and 0.97). The associations were more evident for fiber from cereals and vegetables than from fruit. The associations were similar across BMI and physical activity categories but were stronger in smokers and participants who consumed >18 g alcohol/d. CONCLUSIONS Higher fiber intake is associated with lower mortality, particularly from circulatory, digestive, and non-CVD noncancer inflammatory diseases. Our results support current recommendations of high dietary fiber intake for health maintenance.
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Affiliation(s)
- Shu-Chun Chuang
- School of Public Health, Imperial College London, London, United Kingdom
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22
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Gonzalez CA, Lujan-Barroso L, Bueno-de-Mesquita HB, Jenab M, Duell EJ, Agudo A, Tjønneland A, Boutron-Ruault MC, Clavel-Chapelon F, Touillaud M, Teucher B, Kaaks R, Boeing H, Steffen A, Trichopoulou A, Roukos D, Karapetyan T, Palli D, Tagliabue G, Mattiello A, Tumino R, Ricceri F, Siersema PD, Numans ME, Peeters PPH, Parr CL, Skeie G, Lund E, Quirós JR, Sánchez-Cantalejo E, Navarro C, Barricarte A, Dorronsoro M, Ehrnström R, Regner S, Khaw KT, Wareham N, Key TJ, Crowe FL, Blaker H, Romieu I, Riboli E. Fruit and vegetable intake and the risk of gastric adenocarcinoma: A reanalysis of the european prospective investigation into cancer and nutrition (EPIC-EURGAST) study after a longer follow-up. Int J Cancer 2012; 131:2910-9. [PMID: 22473701 DOI: 10.1002/ijc.27565] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 01/05/2012] [Indexed: 12/13/2022]
Affiliation(s)
- Carlos A Gonzalez
- Unit of Nutrition, Environment and Cancer, Programme of Epidemiological Research, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain.
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Llargues E, Franco R, Recasens A, Nadal A, Vila M, Pérez MJ, Manresa JM, Recasens I, Salvador G, Serra J, Roure E, Castells C. Assessment of a school-based intervention in eating habits and physical activity in school children: the AVall study. J Epidemiol Community Health 2011; 65:896-901. [PMID: 21398682 PMCID: PMC3171977 DOI: 10.1136/jech.2009.102319] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Obesity has become a global public health problem, which also affects children. It has been proposed that the educational interventions during childhood could be a key strategy in the prevention of obesity. OBJECTIVE To evaluate the efficacy of an intervention on food habits and physical activity in school children. METHODS A 2-year cluster-randomised prospective study with two parallel arms was used to evaluate an intervention programme in children in their first year of primary schooling (5-6 years of age) in schools in the city of Granollers. The intervention consisted of the promotion of healthy eating habits and physical activity by means of the educational methodology Investigation, Vision, Action and Change (IVAC). At the beginning and at the end of the study (2006 and 2008) the weight and height of each child was measured in situ, while the families were given a self-report physical activity questionnaire and the Krece Plus quick test. RESULTS Two years after the beginning of the study, the body mass index of the children in the control group was 0.8 kg/m(2) higher than that of the intervention schools. The intervention reduced by 62% the prevalence of overweight children. Similarly, the proportion of children that ate a second piece of fruit and took part in an after-school physical activity increased in the intervention group. In the control group, the weekly consumption of fish was reduced. CONCLUSIONS The educational intervention in healthy eating habits and physical activity in the school could contribute to lessen the current increase in child obesity.
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Affiliation(s)
- Esteve Llargues
- Internal Medicine Department, Granollers General Hospital, Av Francesc Ribes s/n, 08402 Granollers, Spain.
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Jakszyn P, Agudo A, Lujan-Barroso L, Bueno-de-Mesquita HB, Jenab M, Navarro C, Palli D, Boeing H, Manjer J, Numans ME, Igali L, Boutron-Ruault MC, Clavel-Chapelon F, Morois S, Grioni S, Panico CS, Tumino R, Sacerdote C, Quirós JR, Molina-Montes E, Huerta Castaño JM, Barricarte A, Amiano P, Khaw KT, Wareham N, Allen NE, Key TJ, Jeurnink SM, Peeters PHM, Bamia C, Valanou E, Trichopoulou A, Kaaks R, Lukanova A, Bergmann MM, Lindkvist B, Stenling R, Johansson I, Dahm CC, Overvad K, Olsen A, Tjonneland A, Skeie G, Broderstad AR, Lund E, Michaud DS, Mouw T, Riboli E, González CA. Dietary intake of heme iron and risk of gastric cancer in the European prospective investigation into cancer and nutrition study. Int J Cancer 2011; 130:2654-63. [PMID: 21717452 DOI: 10.1002/ijc.26263] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Accepted: 05/05/2011] [Indexed: 12/14/2022]
Abstract
Even though recent studies suggest that a high intake of heme iron is associated with several types of cancer, epidemiological studies in relation to gastric cancer (GC) are lacking. Our previous results show a positive association between red and processed meat and non cardia gastric cancer, especially in Helicobacter pylori infected subjects. The aim of the study is to investigate the association between heme iron intake and GC risk in the European prospective investigation into cancer and nutrition (EURGAST-EPIC). Dietary intake was assessed by validated center-specific questionnaires. Heme iron was calculated as a type-specific percentage of the total iron content in meat intake, derived from the literature. Antibodies of H. pylori infection and vitamin C levels were measured in a sub-sample of cases and matched controls included in a nested case-control study within the cohort. The study included 481,419 individuals and 444 incident cases of GC that occurred during an average of 8.7 years of followup. We observed a statistically significant association between heme iron intake and GC risk (HR 1.13 95% CI: 1.01-1.26 for a doubling of intake) adjusted by sex, age, BMI, education level, tobacco smoking and energy intake. The positive association between heme iron and the risk of GC was statistically significant in subjects with plasma vitamin C <39 mmol/l only (log2 HR 1.54 95% CI (1.01-2.35). We found a positive association between heme iron intake and gastric cancer risk.
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Affiliation(s)
- Paula Jakszyn
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, (ICO-IDIBELL) Barcelona, Spain.
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25
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The standardized computerized 24-h dietary recall method EPIC-Soft adapted for pan-European dietary monitoring. Eur J Clin Nutr 2011; 65 Suppl 1:S5-15. [DOI: 10.1038/ejcn.2011.83] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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26
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Estimated dietary intakes of flavonols, flavanones and flavones in the European Prospective Investigation into Cancer and Nutrition (EPIC) 24 hour dietary recall cohort. Br J Nutr 2011; 106:1915-25. [DOI: 10.1017/s000711451100239x] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Flavonols, flavanones and flavones (FLAV) are sub-classes of flavonoids that exert cardioprotective and anti-carcinogenic propertiesin vitroandin vivo. We aimed to estimate the FLAV dietary intake, their food sources and associated lifestyle factors in ten European countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. FLAV intake and their food sources for 36 037 subjects, aged between 35 and 74 years, in twenty-seven study centres were obtained using standardised 24 h dietary recall software (EPIC-SOFT). Anad hocfood composition database on FLAV was compiled using data from US Department of Agriculture and Phenol-Explorer databases and was expanded using recipes, estimations and flavonoid retention factors in order to increase its correspondence with the 24 h dietary recall. Our results showed that the highest FLAV-consuming centre was the UK health-conscious group, with 130·9 and 97·0 mg/d for men and women, respectively. The lowest FLAV intakes were 36·8 mg/d in men from Umeå and 37·2 mg/d in women from Malmö (Sweden). The flavanone sub-class was the main contributor to the total FLAV intake ranging from 46·6 to 52·9 % depending on the region. Flavonols ranged from 38·5 to 47·3 % and flavones from 5·8 to 8·6 %. FLAV intake was higher in women, non-smokers, increased with level of education and physical activity. The major food sources were citrus fruits and citrus-based juices (especially for flavanones), tea, wine, other fruits and some vegetables. We concluded that the present study shows heterogeneity in intake of these three sub-classes of flavonoids across European regions and highlights differences by sex and other sociodemographic and lifestyle factors.
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Linseisen J, Rohrmann S, Bueno-de-Mesquita B, Büchner FL, Boshuizen HC, Agudo A, Gram IT, Dahm CC, Overvad K, Egeberg R, Tjønneland A, Boeing H, Steffen A, Kaaks R, Lukanova A, Berrino F, Palli D, Panico S, Tumino R, Ardanaz E, Dorronsoro M, Huerta JM, Rodríguez L, Sánchez MJ, Rasmuson T, Hallmans G, Manjer J, Wirfält E, Engeset D, Skeie G, Katsoulis M, Oikonomou E, Trichopoulou A, Peeters PHM, Khaw KT, Wareham N, Allen N, Key T, Brennan P, Romieu I, Slimani N, Vergnaud AC, Xun WW, Vineis P, Riboli E. Consumption of meat and fish and risk of lung cancer: results from the European Prospective Investigation into Cancer and Nutrition. Cancer Causes Control 2011; 22:909-18. [PMID: 21479828 DOI: 10.1007/s10552-011-9764-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Accepted: 03/25/2011] [Indexed: 11/25/2022]
Abstract
Evidence from case-control studies, but less so from cohort studies, suggests a positive association between meat intake and risk of lung cancer. Therefore, this association was evaluated in the frame of the European Prospective Investigation into Cancer and Nutrition, EPIC. Data from 478,021 participants, recruited from 10 European countries, who completed a dietary questionnaire in 1992-2000 were evaluated; 1,822 incident primary lung cancer cases were included in the present evaluation. Relative risk estimates were calculated for categories of meat intake using multi-variably adjusted Cox proportional hazard models. In addition, the continuous intake variables were calibrated by means of 24-h diet recall data to account for part of the measurement error. There were no consistent associations between meat consumption and the risk of lung cancer. Neither red meat (RR = 1.06, 95% CI 0.89-1.27 per 50 g intake/day; calibrated model) nor processed meat (RR = 1.13, 95% CI 0.95-1.34 per 50 g/day; calibrated model) was significantly related to an increased risk of lung cancer. Also, consumption of white meat and fish was not associated with the risk of lung cancer. These findings do not support the hypothesis that a high intake of red and processed meat is a risk factor for lung cancer.
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Affiliation(s)
- Jakob Linseisen
- Institute of Epidemiology, Helmholtz Zentrum München, Ingolstädter Landstr. Neuherberg, Germany.
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Nöthlings U, Boeing H, Maskarinec G, Sluik D, Teucher B, Kaaks R, Tjønneland A, Halkjaer J, Dethlefsen C, Overvad K, Amiano P, Toledo E, Bendinelli B, Grioni S, Tumino R, Sacerdote C, Mattiello A, Beulens JWJ, Iestra JA, Spijkerman AMW, van der A DL, Nilsson P, Sonestedt E, Rolandsson O, Franks PW, Vergnaud AC, Romaguera D, Norat T, Kolonel LN. Food intake of individuals with and without diabetes across different countries and ethnic groups. Eur J Clin Nutr 2011; 65:635-41. [PMID: 21346715 DOI: 10.1038/ejcn.2011.11] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND/OBJECTIVES Given the importance of nutrition therapy in diabetes management, we hypothesized that food intake differs between individuals with and without diabetes. We investigated this hypothesis in two large prospective studies including different countries and ethnic groups. SUBJECTS/METHODS Study populations were the European Prospective Investigation into Cancer and Nutrition Study (EPIC) and the Multiethnic Cohort Study (MEC). Dietary intake was assessed by food frequency questionnaires, and calibrated using 24h-recall information for the EPIC Study. Only confirmed self-reports of diabetes at cohort entry were included: 6192 diabetes patients in EPIC and 13 776 in the MEC. For the cross-sectional comparison of food intake and lifestyle variables at baseline, individuals with and without diabetes were matched 1:1 on sex, age in 5-year categories, body mass index in 2.5 kg/m(2) categories and country. RESULTS Higher intake of soft drinks (by 13 and 44% in the EPIC and MEC), and lower consumption of sweets, juice, wine and beer (>10% difference) were observed in participants with diabetes compared with those without. Consumption of vegetables, fish and meat was slightly higher in individuals with diabetes in both studies, but the differences were <10%. Findings were more consistent across different ethnic groups than countries, but generally showed largely similar patterns. CONCLUSIONS Although diabetes patients are expected to undergo nutritional education, we found only small differences in dietary behavior in comparison with cohort members without diabetes. These findings suggest that emphasis on education is needed to improve the current behaviors to assist in the prevention of complications.
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Affiliation(s)
- U Nöthlings
- Epidemiology Section, Institute for Experimental Medicine, Christian-Albrechts-University of Kiel, Kiel, Germany.
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Rohrmann S, Linseisen J, Jakobsen MU, Overvad K, Raaschou-Nielsen O, Tjonneland A, Boutron-Ruault MC, Kaaks R, Becker N, Bergmann M, Boeing H, Khaw KT, Wareham NJ, Key TJ, Travis R, Benetou V, Naska A, Trichopoulou A, Pala V, Tumino R, Masala G, Mattiello A, Brustad M, Lund E, Skeie G, Bueno-de-Mesquita HB, Peeters PHM, Vermeulen RCH, Jakszyn P, Dorronsoro M, Barricarte A, Tormo MJ, Molina E, Argüelles M, Melin B, Ericson U, Manjer J, Rinaldi S, Slimani N, Boffetta P, Vergnaud AC, Khan A, Norat T, Vineis P. Consumption of meat and dairy and lymphoma risk in the European Prospective Investigation into Cancer and Nutrition. Int J Cancer 2011; 128:623-34. [PMID: 20473877 DOI: 10.1002/ijc.25387] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The consumption of meat and other foods of animal origin is a risk factor for several types of cancer, but the results for lymphomas are inconclusive. Therefore, we examined these associations among 411,097 participants of the European Prospective Investigation into Cancer and Nutrition. During a median follow-up of 8.5 years, 1,334 lymphomas (1,267 non-Hodgkin lymphoma (NHL) and 67 Hodgkin lymphomas) were identified. Consumption of red and processed meat, poultry, milk and dairy products was assessed by dietary questionnaires. Cox proportional hazard regression was used to evaluate the association of the consumption of these food groups with lymphoma risk. Overall, the consumption of foods of animal origin was not associated with an increased risk of NHLS or HL, but the associations with specific subgroups of NHL entities were noted. A high intake of processed meat was associated with an increased risk of B-cell chronic lymphocytic leukemia (BCLL) [relative risk (RR) per 50 g intake = 1.31, 95% confidence interval (CI) 1.06-1.63], but a decreased risk of follicular lymphomas (FL) (RR = 0.58; CI 0.38-0.89). A high intake of poultry was related to an increased risk of B-cell lymphomas (RR = 1.22; CI 1.05-1.42 per 10 g intake), FL (RR = 1.65; CI 1.18-2.32) and BCLL (RR = 1.54; CI 1.18-2.01) in the continuous models. In conclusion, no consistent associations between red and processed meat consumption and lymphoma risk were observed, but we found that the consumption of poultry was related to an increased risk of B-cell lymphomas. Chance is a plausible explanation of the observed associations, which need to be confirmed in further studies.
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Affiliation(s)
- Sabine Rohrmann
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany.
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Zhang S, Krebs-Smith SM, Midthune D, Perez A, Buckman DW, Kipnis V, Freedman LS, Dodd KW, Carroll RJ. Fitting a bivariate measurement error model for episodically consumed dietary components. Int J Biostat 2011; 7:1. [PMID: 22848190 PMCID: PMC3406506 DOI: 10.2202/1557-4679.1267] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
There has been great public health interest in estimating usual, i.e., long-term average, intake of episodically consumed dietary components that are not consumed daily by everyone, e.g., fish, red meat and whole grains. Short-term measurements of episodically consumed dietary components have zero-inflated skewed distributions. So-called two-part models have been developed for such data in order to correct for measurement error due to within-person variation and to estimate the distribution of usual intake of the dietary component in the univariate case. However, there is arguably much greater public health interest in the usual intake of an episodically consumed dietary component adjusted for energy (caloric) intake, e.g., ounces of whole grains per 1000 kilo-calories, which reflects usual dietary composition and adjusts for different total amounts of caloric intake. Because of this public health interest, it is important to have models to fit such data, and it is important that the model-fitting methods can be applied to all episodically consumed dietary components.We have recently developed a nonlinear mixed effects model (Kipnis, et al., 2010), and have fit it by maximum likelihood using nonlinear mixed effects programs and methodology (the SAS NLMIXED procedure). Maximum likelihood fitting of such a nonlinear mixed model is generally slow because of 3-dimensional adaptive Gaussian quadrature, and there are times when the programs either fail to converge or converge to models with a singular covariance matrix. For these reasons, we develop a Monte-Carlo (MCMC) computation of fitting this model, which allows for both frequentist and Bayesian inference. There are technical challenges to developing this solution because one of the covariance matrices in the model is patterned. Our main application is to the National Institutes of Health (NIH)-AARP Diet and Health Study, where we illustrate our methods for modeling the energy-adjusted usual intake of fish and whole grains. We demonstrate numerically that our methods lead to increased speed of computation, converge to reasonable solutions, and have the flexibility to be used in either a frequentist or a Bayesian manner.
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Intake of total, animal and plant protein and subsequent changes in weight or waist circumference in European men and women: the Diogenes project. Int J Obes (Lond) 2010; 35:1104-13. [PMID: 21139559 DOI: 10.1038/ijo.2010.254] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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González CA, Travier N, Luján-Barroso L, Castellsagué X, Bosch FX, Roura E, Bueno-de-Mesquita HB, Palli D, Boeing H, Pala V, Sacerdote C, Tumino R, Panico S, Manjer J, Dillner J, Hallmans G, Kjellberg L, Sanchez MJ, Altzibar JM, Barricarte A, Navarro C, Rodriguez L, Allen N, Key TJ, Kaaks R, Rohrmann S, Overvad K, Olsen A, Tjønneland A, Munk C, Kjaer SK, Peeters PH, van Duijnhoven FJ, Clavel-Chapelon F, Boutron-Ruault MC, Trichopoulou A, Benetou V, Naska A, Lund E, Engeset D, Skeie G, Franceschi S, Slimani N, Rinaldi S, Riboli E. Dietary factors and in situ and invasive cervical cancer risk in the European prospective investigation into cancer and nutrition study. Int J Cancer 2010; 129:449-59. [DOI: 10.1002/ijc.25679] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 06/10/2010] [Indexed: 11/09/2022]
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Vergnaud AC, Norat T, Romaguera D, Mouw T, May AM, Travier N, Luan J, Wareham N, Slimani N, Rinaldi S, Couto E, Clavel-Chapelon F, Boutron-Ruault MC, Cottet V, Palli D, Agnoli C, Panico S, Tumino R, Vineis P, Agudo A, Rodriguez L, Sanchez MJ, Amiano P, Barricarte A, Huerta JM, Key TJ, Spencer EA, Bueno-de-Mesquita B, Büchner FL, Orfanos P, Naska A, Trichopoulou A, Rohrmann S, Hermann S, Boeing H, Buijsse B, Johansson I, Hellstrom V, Manjer J, Wirfält E, Jakobsen MU, Overvad K, Tjonneland A, Halkjaer J, Lund E, Braaten T, Engeset D, Odysseos A, Riboli E, Peeters PHM. Meat consumption and prospective weight change in participants of the EPIC-PANACEA study. Am J Clin Nutr 2010; 92:398-407. [PMID: 20592131 DOI: 10.3945/ajcn.2009.28713] [Citation(s) in RCA: 131] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Meat intake may be related to weight gain because of its high energy and fat content. Some observational studies have shown that meat consumption is positively associated with weight gain, but intervention studies have shown mixed results. OBJECTIVE Our objective was to assess the association between consumption of total meat, red meat, poultry, and processed meat and weight gain after 5 y of follow-up, on average, in the large European population who participated in the European Prospective Investigation into Cancer and Nutrition-Physical Activity, Nutrition, Alcohol, Cessation of Smoking, Eating Out of Home and Obesity (EPIC-PANACEA) project. DESIGN A total of 103,455 men and 270,348 women aged 25-70 y were recruited between 1992 and 2000 in 10 European countries. Diet was assessed at baseline with the use of country-specific validated questionnaires. A dietary calibration study was conducted in a representative subsample of the cohort. Weight and height were measured at baseline and self-reported at follow-up in most centers. Associations between energy from meat (kcal/d) and annual weight change (g/y) were assessed with the use of linear mixed models, controlled for age, sex, total energy intake, physical activity, dietary patterns, and other potential confounders. RESULTS Total meat consumption was positively associated with weight gain in men and women, in normal-weight and overweight subjects, and in smokers and nonsmokers. With adjustment for estimated energy intake, an increase in meat intake of 250 g/d (eg, one steak at approximately 450 kcal) would lead to a 2-kg higher weight gain after 5 y (95% CI: 1.5, 2.7 kg). Positive associations were observed for red meat, poultry, and processed meat. CONCLUSION Our results suggest that a decrease in meat consumption may improve weight management.
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Affiliation(s)
- Anne-Claire Vergnaud
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
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Freisling H, Fahey MT, Moskal A, Ocké MC, Ferrari P, Jenab M, Norat T, Naska A, Welch AA, Navarro C, Schulz M, Wirfält E, Casagrande C, Amiano P, Ardanaz E, Parr C, Engeset D, Grioni S, Sera F, Bueno-de-Mesquita B, van der Schouw YT, Touvier M, Boutron-Ruault MC, Halkjaer J, Dahm CC, Khaw KT, Crowe F, Linseisen J, Kröger J, Huybrechts I, Deharveng G, Manjer J, Agren A, Trichopoulou A, Tsiotas K, Riboli E, Bingham S, Slimani N. Region-specific nutrient intake patterns exhibit a geographical gradient within and between European countries. J Nutr 2010; 140:1280-6. [PMID: 20484545 DOI: 10.3945/jn.110.121152] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Until recently, the study of nutrient patterns was hampered at an international level by a lack of standardization of both dietary methods and nutrient databases. We aimed to describe the diversity of nutrient patterns in the European Prospective Investigation into Cancer and Nutrition (EPIC) study at population level as a starting point for future nutrient pattern analyses and their associations with chronic diseases in multi-center studies. In this cross-sectional study, 36,034 persons aged 35-74 y were administered a single, standardized 24-h dietary recall. Intake of 25 nutrients (excluding intake from dietary supplements) was estimated using a standardized nutrient database. We used a graphic presentation of mean nutrient intakes by region and sex relative to the overall EPIC means to contrast patterns within and between 10 European countries. In Mediterranean regions, including Greece, Italy, and the southern centers of Spain, the nutrient pattern was dominated by relatively high intakes of vitamin E and monounsaturated fatty acids (MUFA), whereas intakes of retinol and vitamin D were relatively low. In contrast, in Nordic countries, including Norway, Sweden, and Denmark, reported intake of these same nutrients resulted in almost the opposite pattern. Population groups in Germany, The Netherlands, and the UK shared a fatty acid pattern of relatively high intakes of PUFA and SFA and relatively low intakes of MUFA, in combination with a relatively high intake of sugar. We confirmed large variability in nutrient intakes across the EPIC study populations and identified 3 main region-specific patterns with a geographical gradient within and between European countries.
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Affiliation(s)
- Heinz Freisling
- Dietary Exposure Assessment Group, International Agency for Research on Cancer, Lyon 69372, France
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Fruits and vegetables consumption and the risk of histological subtypes of lung cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC). Cancer Causes Control 2010; 21:357-71. [PMID: 19924549 PMCID: PMC2835631 DOI: 10.1007/s10552-009-9468-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Accepted: 11/03/2009] [Indexed: 01/12/2023]
Abstract
Objective To examine the association between fruit and vegetable consumption and risk of different histological subtypes of lung cancer among participants of the European Prospective Investigation into Cancer and Nutrition study. Methods Multivariable Cox proportional hazard models were used to analyze the data. A calibration study in a subsample was used to reduce dietary measurement errors. Results During a mean follow-up of 8.7 years, 1,830 incident cases of lung cancer (574 adenocarcinoma, 286 small cell, 137 large cell, 363 squamous cell, 470 other histologies) were identified. In line with our previous conclusions, we found that after calibration a 100 g/day increase in fruit and vegetables consumption was associated with a reduced lung cancer risk (HR 0.94; 95% CI 0.89–0.99). This was also seen among current smokers (HR 0.93; 95% CI 0.90–0.97). Risks of squamous cell carcinomas in current smokers were reduced for an increase of 100 g/day of fruit and vegetables combined (HR 0.85; 95% CI 0.76–0.94), while no clear effects were seen for the other histological subtypes. Conclusion We observed inverse associations between the consumption of vegetables and fruits and risk of lung cancer without a clear effect on specific histological subtypes of lung cancer. In current smokers, consumption of vegetables and fruits may reduce lung cancer risk, in particular the risk of squamous cell carcinomas.
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Alcohol consumption patterns, diet and body weight in 10 European countries. Eur J Clin Nutr 2010; 63 Suppl 4:S81-100. [PMID: 19888282 DOI: 10.1038/ejcn.2009.76] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
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 >24 g of ethanol/day, equivalent to >2 standard drinks and females consuming >12 g of ethanol/day equivalent to >1 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.
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Energy intake and sources of energy intake in the European Prospective Investigation into Cancer and Nutrition. Eur J Clin Nutr 2010; 63 Suppl 4:S3-15. [PMID: 19888279 DOI: 10.1038/ejcn.2009.72] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To describe energy intake and its macronutrient and food sources among 27 regions in 10 countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. METHODS Between 1995 and 2000, 36 034 subjects aged 35-74 years were administered a standardized 24-h dietary recall. Intakes of macronutrients (g/day) and energy (kcal/day) were estimated using standardized national nutrient databases. Mean intakes were weighted by season and day of the week and were adjusted for age, height and weight, after stratification by gender. Extreme low- and high-energy reporters were identified using Goldberg's cutoff points (ratio of energy intake and estimated basal metabolic rate <0.88 or >2.72), and their effects on macronutrient and energy intakes were studied. RESULTS Low-energy reporting was more prevalent in women than in men. The exclusion of extreme-energy reporters substantially lowered the EPIC-wide range in mean energy intake from 2196-2877 to 2309-2866 kcal among men. For women, these ranges were 1659-2070 and 1873-2108 kcal. There was no north-south gradient in energy intake or in the prevalence of low-energy reporting. In most centres, cereals and cereal products were the largest contributors to energy intake. The food groups meat, dairy products and fats and oils were also important energy sources. In many centres, the highest mean energy intakes were observed on Saturdays. CONCLUSIONS These data highlight and quantify the variations and similarities in energy intake and sources of energy intake among 10 European countries. The prevalence of low-energy reporting indicates that the study of energy intake is hampered by the problem of underreporting.
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Welch AA, Fransen H, Jenab M, Boutron-Ruault MC, Tumino R, Agnoli C, Ericson U, Johansson I, Ferrari P, Engeset D, Lund E, Lentjes M, Key T, Touvier M, Niravong M, Larrañaga N, Rodríguez L, Ocké MC, Peeters PHM, Tjønneland A, Bjerregaard L, Vasilopoulou E, Dilis V, Linseisen J, Nöthlings U, Riboli E, Slimani N, Bingham S. Variation in intakes of calcium, phosphorus, magnesium, iron and potassium in 10 countries in the European Prospective Investigation into Cancer and Nutrition study. Eur J Clin Nutr 2010; 63 Suppl 4:S101-21. [PMID: 19888269 DOI: 10.1038/ejcn.2009.77] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
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.
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Affiliation(s)
- A A Welch
- Department of Public Health and Primary Care, MRC Centre for Nutritional Epidemiology in Cancer Prevention and Survival, University of Cambridge, Cambridge, UK.
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Dietary intake of the water-soluble vitamins B1, B2, B6, B12 and C in 10 countries in the European Prospective Investigation into Cancer and Nutrition. Eur J Clin Nutr 2010; 63 Suppl 4:S122-49. [PMID: 19888270 DOI: 10.1038/ejcn.2009.78] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To describe the intake of vitamins thiamine (B1), riboflavin (B2), B6 (pyridoxine), B12 (cobalamine) and C (ascorbic acid) and their food sources among 27 centres in 10 countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. METHODS Between 1995 and 2000, 36 034 persons aged between 35 and 74 years were administered a standardized 24-h dietary recall using a computerized interview software programme (EPIC-SOFT). Intakes of the four B vitamins and vitamin C were estimated using the standardized EPIC Nutrient Database (ENDB). Mean intakes were adjusted for age and weighted by season and day of recall. RESULTS Intake of B vitamins did not vary considerably between centres, except in the UK health-conscious cohort, in which substantially higher intakes of thiamine and lower intakes of vitamin B12 were reported compared with other centres. Overall, meat was the most important contributor to the B vitamins in all centres except in the UK health-conscious group. Vitamin C showed a clear geographical gradient, with higher intakes in the southern centres as compared with the northern ones; this was more pronounced in men than in women. Vegetables and fruits were major contributors to vitamin C in all centres, but juices and potatoes were also important sources in the northern centres. CONCLUSIONS This study showed no major differences across centres in the mean intakes of B vitamins (thiamine, riboflavin, B6, B12), whereas a tendency towards a north-south gradient was observed for vitamin C.
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Buckland G, Agudo A, Luján L, Jakszyn P, Bueno-de-Mesquita HB, Palli D, Boeing H, Carneiro F, Krogh V, Sacerdote C, Tumino R, Panico S, Nesi G, Manjer J, Regnér S, Johansson I, Stenling R, Sanchez MJ, Dorronsoro M, Barricarte A, Navarro C, Quirós JR, Allen NE, Key TJ, Bingham S, Kaaks R, Overvad K, Jensen M, Olsen A, Tjønneland A, Peeters PHM, Numans ME, Ocké MC, Clavel-Chapelon F, Morois S, Boutron-Ruault MC, Trichopoulou A, Lagiou P, Trichopoulos D, Lund E, Couto E, Boffeta P, Jenab M, Riboli E, Romaguera D, Mouw T, González CA. Adherence to a Mediterranean diet and risk of gastric adenocarcinoma within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study. Am J Clin Nutr 2010; 91:381-90. [PMID: 20007304 DOI: 10.3945/ajcn.2009.28209] [Citation(s) in RCA: 148] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The Mediterranean dietary pattern is believed to protect against cancer, although evidence from cohort studies that have examined particular cancer sites is limited. OBJECTIVE We aimed to explore the association between adherence to a relative Mediterranean diet (rMED) and incident gastric adenocarcinoma (GC) within the European Prospective Investigation into Cancer and Nutrition study. DESIGN The study included 485,044 subjects (144,577 men) aged 35-70 y from 10 European countries. At recruitment, dietary and lifestyle information was collected. An 18-unit rMED score, incorporating 9 key components of the Mediterranean diet, was used to estimate rMED adherence. The association between rMED and GC with respect to anatomic location (cardia and noncardia) and histologic types (diffuse and intestinal) was investigated. A calibration study in a subsample was used to control for dietary measurement error. RESULTS After a mean follow-up of 8.9 y, 449 validated incident GC cases were identified and used in the analysis. After stratification by center and age and adjustment for recognized cancer risk factors, high compared with low rMED adherence was associated with a significant reduction in GC risk (hazard ratio: 0.67; 95% CI: 0.47, 0.94). A 1-unit increase in the rMED score was associated with a decreased risk of GC of 5% (95% CI: 0.91, 0.99). There was no evidence of heterogeneity between different anatomic locations or histologic types. The calibrated results showed similar trends (overall hazard ratio for GC: 0.93; 95% CI: 0.89, 0.99). CONCLUSION Greater adherence to an rMED is associated with a significant reduction in the risk of incident GC.
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Affiliation(s)
- Genevieve Buckland
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Idibell, Barcelona, Spain
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Forouhi NG, Sharp SJ, Du H, van der A DL, Halkjaer J, Schulze MB, Tjønneland A, Overvad K, Jakobsen MU, Boeing H, Buijsse B, Palli D, Masala G, Feskens EJM, Sørensen TIA, Wareham NJ. Dietary fat intake and subsequent weight change in adults: results from the European Prospective Investigation into Cancer and Nutrition cohorts. Am J Clin Nutr 2009; 90:1632-41. [PMID: 19828709 DOI: 10.3945/ajcn.2009.27828] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND It is unclear from the inconsistent epidemiologic evidence whether dietary fat intake is associated with future weight change. OBJECTIVE The objective was to assess the association between the amount and type of dietary fat and subsequent weight change (follow-up weight minus baseline weight divided by duration of follow-up). DESIGN We analyzed data from 89,432 men and women from 6 cohorts of the EPIC (European Prospective Investigation into Cancer and Nutrition) study. Using country-specific food-frequency questionnaires, we examined the association between baseline fat intake (amount and type of total, saturated, polyunsaturated, and monounsaturated fats) and annual weight change by using the residual, nutrient density, and energy-partition methods. We used random-effects meta-analyses to obtain pooled estimates across centers. RESULTS Mean total fat intake as a percentage of energy intake ranged between 31.5% and 36.5% across the 6 cohorts (58% women; mean +/- SD age: 53.2 +/- 8.6 y). The mean (+/-SD) annual weight change was 109 +/- 817 g/y in men and 119 +/- 823 g/y in women. In pooled analyses adjusted for anthropometric, dietary, and lifestyle factors and follow-up period, no significant association was observed between fat intake (amount or type) and weight change. The difference in mean annual weight change was 0.90 g/y (95% CI: -0.54, 2.34 g/y) for men and -1.30 g/y (95% CI: -3.70, 1.11 g/y) for women per 1 g/d energy-adjusted fat intake (residual method). CONCLUSIONS We found no significant association between the amount or type of dietary fat and subsequent weight change in this large prospective study. These findings do not support the use of low-fat diets to prevent weight gain.
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Affiliation(s)
- Nita G Forouhi
- MRC Epidemiology Unit Institute of Metabolic Science, Cambridge, United Kingdom.
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Intake of total, animal and plant proteins, and their food sources in 10 countries in the European Prospective Investigation into Cancer and Nutrition. Eur J Clin Nutr 2009; 63 Suppl 4:S16-36. [DOI: 10.1038/ejcn.2009.73] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Dietary glycaemic index and glycaemic load in the European Prospective Investigation into Cancer and Nutrition. Eur J Clin Nutr 2009; 63 Suppl 4:S188-205. [PMID: 19888274 DOI: 10.1038/ejcn.2009.81] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Linseisen J, Welch AA, Ocké M, Amiano P, Agnoli C, Ferrari P, Sonestedt E, Chajès V, Bueno-de-Mesquita HB, Kaaks R, Weikert C, Dorronsoro M, Rodríguez L, Ermini I, Mattiello A, van der Schouw YT, Manjer J, Nilsson S, Jenab M, Lund E, Brustad M, Halkjær J, Jakobsen MU, Khaw KT, Crowe F, Georgila C, Misirli G, Niravong M, Touvier M, Bingham S, Riboli E, Slimani N. Dietary fat intake in the European Prospective Investigation into Cancer and Nutrition: results from the 24-h dietary recalls. Eur J Clin Nutr 2009; 63 Suppl 4:S61-80. [DOI: 10.1038/ejcn.2009.75] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Ferrari P, Roddam A, Fahey MT, Jenab M, Bamia C, Ocké M, Amiano P, Hjartåker A, Biessy C, Rinaldi S, Huybrechts I, Tjønneland A, Dethlefsen C, Niravong M, Clavel-Chapelon F, Linseisen J, Boeing H, Oikonomou E, Orfanos P, Palli D, Santucci de Magistris M, Bueno-de-Mesquita HB, Peeters PHM, Parr CL, Braaten T, Dorronsoro M, Berenguer T, Gullberg B, Johansson I, Welch AA, Riboli E, Bingham S, Slimani N. A bivariate measurement error model for nitrogen and potassium intakes to evaluate the performance of regression calibration in the European Prospective Investigation into Cancer and Nutrition study. Eur J Clin Nutr 2009; 63 Suppl 4:S179-87. [DOI: 10.1038/ejcn.2009.80] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Total dietary carbohydrate, sugar, starch and fibre intakes in the European Prospective Investigation into Cancer and Nutrition. Eur J Clin Nutr 2009; 63 Suppl 4:S37-60. [DOI: 10.1038/ejcn.2009.74] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Predicting the value of a variable Y corresponding to a future value of an explanatory variable X, based on a sample of previously observed independent data pairs (X(1), Y(1)), …, (X(n), Y(n)) distributed like (X, Y), is very important in statistics. In the error-free case, where X is observed accurately, this problem is strongly related to that of standard regression estimation, since prediction of Y can be achieved via estimation of the regression curve E(Y|X). When the observed X(i)s and the future observation of X are measured with error, prediction is of a quite different nature. Here, if T denotes the future (contaminated) available version of X, prediction of Y can be achieved via estimation of E(Y|T). In practice, estimating E(Y|T) can be quite challenging, as data may be collected under different conditions, making the measurement errors on X(i) and X non-identically distributed. We take up this problem in the nonparametric setting and introduce estimators which allow a highly adaptive approach to smoothing. Reflecting the complexity of the problem, optimal rates of convergence of estimators can vary from the semiparametric n(-1/2) rate to much slower rates that are characteristic of nonparametric problems. Nevertheless, we are able to develop highly adaptive, data-driven methods that achieve very good performance in practice.
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Affiliation(s)
- Raymond J Carroll
- Department of Statistics, 3143 TAMU, Texas A&M University, College Station, Texas 77843, USA
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Ferrari P, Carroll RJ, Gustafson P, Riboli E. A Bayesian multilevel model for estimating the diet/disease relationship in a multicenter study with exposures measured with error: the EPIC study. Stat Med 2009; 27:6037-54. [PMID: 18951369 DOI: 10.1002/sim.3444] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
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.
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Buijsse B, Feskens EJM, Schulze MB, Forouhi NG, Wareham NJ, Sharp S, Palli D, Tognon G, Halkjaer J, Tjønneland A, Jakobsen MU, Overvad K, van der A DL, Du H, Sørensen TIA, Boeing H. Fruit and vegetable intakes and subsequent changes in body weight in European populations: results from the project on Diet, Obesity, and Genes (DiOGenes). Am J Clin Nutr 2009; 90:202-9. [PMID: 19458016 DOI: 10.3945/ajcn.2008.27394] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND High fruit and vegetable intakes may limit weight gain, particularly in susceptible persons, such as those who stop smoking. OBJECTIVE The objective was to assess the association of fruit and vegetable intake with subsequent weight change in a large-scale prospective study. DESIGN The data used were from 89,432 men and women from 5 countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC). The association between fruit and vegetable intake and weight change after a mean follow-up of 6.5 y was assessed by linear regression. Polytomous logistic regression was used to evaluate whether fruit and vegetable intake relates to weight gain, weight loss, or both. RESULTS Per 100-g intake of fruit and vegetables, weight change was -14 g/y (95% CI: -19, -9 g/y). In those who stopped smoking during follow-up, this value was -37 g/y (95% CI: -58, -15 g/y; P for interaction < 0.0001). When weight gain and loss were analyzed separately per 100-g intake of fruit and vegetables in a combined model, the odds ratios (95% CIs) were 0.97 (0.95, 0.98) for weight gain > or =0.5 and <1 kg/y, 0.94 (0.92, 0.96) for weight gain > or =1 kg/y, and 0.97 (0.95, 0.99) for weight loss > or =0.5 kg/y. In those who stopped smoking during follow-up, the odds ratios (95% CIs) were 0.93 (0.88, 0.99), 0.87 (0.81, 0.92), and 0.97 (0.88, 1.07), respectively (P for interaction < 0.0001). CONCLUSIONS Fruit and vegetable intake relates significantly, albeit weakly inversely, to weight change. For persons who stop smoking, high fruit and vegetable intakes may be recommended to reduce the risk of weight gain.
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Affiliation(s)
- Brian Buijsse
- German Institute of Human Nutrition Potsdam-Rehbrücke, Department of Epidemiology, Nuthetal, Germany.
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Vrieling A, Verhage BAJ, van Duijnhoven FJB, Jenab M, Overvad K, Tjønneland A, Olsen A, Clavel-Chapelon F, Boutron-Ruault MC, Kaaks R, Rohrmann S, Boeing H, Nöthlings U, Trichopoulou A, John T, Dimosthenes Z, Palli D, Sieri S, Mattiello A, Tumino R, Vineis P, van Gils CH, Peeters PHM, Engeset D, Lund E, Rodríguez Suárez L, Jakszyn P, Larrañaga N, Sánchez MJ, Chirlaque MD, Ardanaz E, Manjer J, Lindkvist B, Hallmans G, Ye W, Bingham S, Khaw KT, Roddam A, Key T, Boffetta P, Duell EJ, Michaud DS, Riboli E, Bueno-de-Mesquita HB. Fruit and vegetable consumption and pancreatic cancer risk in the European Prospective Investigation into Cancer and Nutrition. Int J Cancer 2009; 124:1926-34. [PMID: 19107929 DOI: 10.1002/ijc.24134] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
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.
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Affiliation(s)
- Alina Vrieling
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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