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Mahamat‐Saleh Y, Rinaldi S, Kaaks R, Biessy C, Gonzalez‐Gil EM, Murphy N, Le Cornet C, Huerta JM, Sieri S, Tjønneland A, Mellemkjær L, Guevara M, Overvad K, Perez‐Cornago A, Tin Tin S, Padroni L, Simeon V, Masala G, May A, Monninkhof E, Christakoudi S, Heath AK, Tsilidis K, Agudo A, Schulze MB, Rothwell J, Cadeau C, Severi S, Weiderpass E, Gunter MJ, Dossus L. Metabolically defined body size and body shape phenotypes and risk of postmenopausal breast cancer in the European Prospective Investigation into Cancer and Nutrition. Cancer Med 2023; 12:12668-12682. [PMID: 37096432 PMCID: PMC10278526 DOI: 10.1002/cam4.5896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/06/2023] [Accepted: 03/23/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Excess body fatness and hyperinsulinemia are both associated with an increased risk of postmenopausal breast cancer. However, whether women with high body fatness but normal insulin levels or those with normal body fatness and high levels of insulin are at elevated risk of breast cancer is not known. We investigated the associations of metabolically defined body size and shape phenotypes with the risk of postmenopausal breast cancer in a nested case-control study within the European Prospective Investigation into Cancer and Nutrition. METHODS Concentrations of C-peptide-a marker for insulin secretion-were measured at inclusion prior to cancer diagnosis in serum from 610 incident postmenopausal breast cancer cases and 1130 matched controls. C-peptide concentrations among the control participants were used to define metabolically healthy (MH; in first tertile) and metabolically unhealthy (MU; >1st tertile) status. We created four metabolic health/body size phenotype categories by combining the metabolic health definitions with normal weight (NW; BMI < 25 kg/m2 , or WC < 80 cm, or WHR < 0.8) and overweight or obese (OW/OB; BMI ≥ 25 kg/m2 , or WC ≥ 80 cm, or WHR ≥ 0.8) status for each of the three anthropometric measures separately: (1) MHNW, (2) MHOW/OB, (3) MUNW, and (4) MUOW/OB. Conditional logistic regression was used to compute odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Women classified as MUOW/OB were at higher risk of postmenopausal breast cancer compared to MHNW women considering BMI (OR = 1.58, 95% CI = 1.14-2.19) and WC (OR = 1.51, 95% CI = 1.09-2.08) cut points and there was also a suggestive increased risk for the WHR (OR = 1.29, 95% CI = 0.94-1.77) definition. Conversely, women with the MHOW/OB and MUNW were not at statistically significant elevated risk of postmenopausal breast cancer risk compared to MHNW women. CONCLUSION These findings suggest that being overweight or obese and metabolically unhealthy raises risk of postmenopausal breast cancer while overweight or obese women with normal insulin levels are not at higher risk. Additional research should consider the combined utility of anthropometric measures with metabolic parameters in predicting breast cancer risk.
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Affiliation(s)
| | - S. Rinaldi
- International Agency for Research on CancerLyonFrance
| | - R. Kaaks
- Division of Cancer EpidemiologyGerman Cancer Research Center (DFKZ)HeidelbergGermany
| | - C. Biessy
- International Agency for Research on CancerLyonFrance
| | | | - N. Murphy
- International Agency for Research on CancerLyonFrance
| | - C. Le Cornet
- Division of Cancer EpidemiologyGerman Cancer Research Center (DFKZ)HeidelbergGermany
| | - J. M. Huerta
- Department of EpidemiologyMurcia Regional Health CouncilMurciaSpain
- CIBER Epidemiología y Salud Pública (CIBERESP)MadridSpain
| | - S. Sieri
- Epidemiology and Prevention UnitFondazione IRCCS Istituto Nazionale dei Tumori20133MilanItaly
| | - A. Tjønneland
- Danish Cancer Society Research CenterCopenhagenDenmark
- Department of Public HealthUniversity of CopenhagenCopenhagenDenmark
| | - L. Mellemkjær
- Danish Cancer Society Research CenterCopenhagenDenmark
| | - M. Guevara
- Navarra Public Health Institute31003PamplonaSpain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP)28029MadridSpain
- Navarra Institute for Health Research (IdiSNA)31008PamplonaSpain
| | - K. Overvad
- Department of Public Health, Section for EpidemiologyAarhus UniversityAarhusDenmark
| | - A. Perez‐Cornago
- Cancer Epidemiology UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - S. Tin Tin
- Cancer Epidemiology UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - L. Padroni
- Department of Clinical and Biological SciencesUniversity of TurinTurinItaly
| | - V. Simeon
- Dipartimento di Salute Mentale e Fisica e Medicina PreventivaUniversità degli Studi della Campania 'Luigi Vanvitelli'80121NaplesItaly
| | - G. Masala
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO)FlorenceItaly
| | - A. May
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - E. Monninkhof
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - S. Christakoudi
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- Department of Inflammation BiologySchool of Immunology and Microbial SciencesKing's College LondonLondonUK
| | - A. K. Heath
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - K. Tsilidis
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - A. Agudo
- Unit of Nutrition and CancerCatalan Institute of Oncology – ICOL'Hospitalet de LlobregatSpain
- Nutrition and Cancer Group; Epidemiology, Public Health, Cancer Prevention and Palliative Care ProgramBellvitge Biomedical Research Institute – IDIBELLL'Hospitalet de LlobregatSpain
| | - M. B. Schulze
- Department of Molecular EpidemiologyGerman Institute of Human Nutrition Potsdam‐RehbrueckeNuthetalGermany
- Institute of Nutritional ScienceUniversity of PotsdamNuthetalGermany
| | - J. Rothwell
- Paris‐Saclay UniversityUVSQ, Inserm, Gustave Roussy, “Exposome and Heredity” team, CESPVillejuifFrance
| | - C. Cadeau
- Paris‐Saclay UniversityUVSQ, Inserm, Gustave Roussy, “Exposome and Heredity” team, CESPVillejuifFrance
| | - S. Severi
- Paris‐Saclay UniversityUVSQ, Inserm, Gustave Roussy, “Exposome and Heredity” team, CESPVillejuifFrance
| | - E. Weiderpass
- International Agency for Research on CancerLyonFrance
| | - M. J. Gunter
- International Agency for Research on CancerLyonFrance
| | - L. Dossus
- International Agency for Research on CancerLyonFrance
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Yammine SG, Huybrechts I, Biessy C, Dossus L, Panico S, Sánchez MJ, Benetou V, Turzanski-Fortner R, Katzke V, Idahl A, Skeie G, Olsen KS, Tjønneland A, Halkjaer J, Colorado-Yohar S, Heath AK, Sonestedt E, Sartor H, Schulze MB, Palli D, Crous-Bou M, Dorronsoro A, Overvad K, Gurrea AB, Severi G, Vermeulen RCH, Sandanger TM, Travis RC, Key T, Amiano P, Van Guelpen B, Johansson M, Sund M, Tumino R, Wareham N, Sacerdote C, Krogh V, Brennan P, Riboli E, Weiderpass E, Gunter MJ, Chajès V. Dietary fatty acids and endometrial cancer risk within the European Prospective Investigation into Cancer and Nutrition. BMC Cancer 2023; 23:159. [PMID: 36797668 PMCID: PMC9936701 DOI: 10.1186/s12885-023-10611-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 02/06/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Diet may impact important risk factors for endometrial cancer such as obesity and inflammation. However, evidence on the role of specific dietary factors is limited. We investigated associations between dietary fatty acids and endometrial cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC). METHODS This analysis includes 1,886 incident endometrial cancer cases and 297,432 non-cases. All participants were followed up for a mean of 8.8 years. Multivariable Cox proportional hazard models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) of endometrial cancer across quintiles of individual fatty acids estimated from various food sources quantified through food frequency questionnaires in the entire EPIC cohort. The false discovery rate (q-values) was computed to control for multiple comparisons. RESULTS Consumption of n-6 γ-linolenic acid was inversely associated with endometrial cancer risk (HR comparing 5th with 1st quintileQ5-Q1=0.77, 95% CI = 0.64; 0.92, ptrend=0.01, q-value = 0.15). This association was mainly driven by γ-linolenic acid derived from plant sources (HRper unit increment=0.94, 95%CI= (0.90;0.98), p = 0.01) but not from animal sources (HRper unit increment= 1.00, 95%CI = (0.92; 1.07), p = 0.92). In addition, an inverse association was found between consumption of n-3 α-linolenic acid from vegetable sources and endometrial cancer risk (HRper unit increment= 0.93, 95%CI = (0.87; 0.99), p = 0.04). No significant association was found between any other fatty acids (individual or grouped) and endometrial cancer risk. CONCLUSION Our results suggest that higher consumption of γ-linolenic acid and α-linoleic acid from plant sources may be associated with lower risk of endometrial cancer.
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Affiliation(s)
- S G Yammine
- Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS) , Nutritional Epidemiology Research Team (EREN), F-93017, Bobigny, France.
| | - I Huybrechts
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - C Biessy
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - L Dossus
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - S Panico
- Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy
| | - M J Sánchez
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - V Benetou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Grèce
| | | | - V Katzke
- The German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - A Idahl
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | - G Skeie
- Faculty of Health Sciences, Department of Community Medicine, UiT The Arctic University of Norway, N - 9037, Tromsø, Norway
| | - K Standahl Olsen
- Faculty of Health Sciences, Department of Community Medicine, UiT The Arctic University of Norway, N - 9037, Tromsø, Norway
| | - A Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - J Halkjaer
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - S Colorado-Yohar
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- Research Group on Demography and Health, National Faculty of Public Health, University of Antioquia, Medellín, Colombia
| | - A K Heath
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, United Kingdom
| | - E Sonestedt
- Department of Clinical Sciences Malmö, Lund University, Sweden
| | - H Sartor
- Department of Clinical Sciences Malmö, Lund University, Sweden
| | - M B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam- Rehbruecke, Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam, Potsdam, Germany
| | - D Palli
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - M Crous-Bou
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO) - Bellvitge Biomedical Research Institute (IDIBELL). L'Hospitalet de Llobregat, 08908, Barcelona, Spain
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 02115, Boston, MA, USA
| | - A Dorronsoro
- Ministry of Health of the Basque Government, Sub-Directorate for Public Health and Addictions of Gipuzkoa, San Sebastian, Spain
| | - K Overvad
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - A Barricarte Gurrea
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Navarra Public Health Institute, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - G Severi
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, VIC, Australia
- Centre for Research in Epidemiology and Population Health, INSERM U1018, Université Paris-Saclay, Villejuif, France
- Human Genetics Foundation, Turin, Italy
| | - R C H Vermeulen
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
- Institute for Risk Assessment Sciences (IRAS), Department of Population Health Sciences, Utrecht University, Utrecht, The Netherlands
| | - T M Sandanger
- Faculty of Health Sciences, Department of Community Medicine, UiT The Arctic University of Norway, N - 9037, Tromsø, Norway
| | - R C Travis
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - T Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - P Amiano
- Ministry of Health of the Basque Government, Sub-Directorate for Public Health and Addictions of Gipuzkoa, San Sebastian, Spain
| | - B Van Guelpen
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - M Johansson
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - M Sund
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - R Tumino
- Cancer Registry and Histopathology Department, Provincial Health Authority (ASP 7), Ragusa, Italy
| | - N Wareham
- MRC Epidemiology Unit, University of Cambridge, Cambridge, England, U.K
| | - C Sacerdote
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital, Via Santena 7, 10126, Turin, Italy
| | - V Krogh
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori Di, Milano, Italy
| | - P Brennan
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - E Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, United Kingdom
| | - E Weiderpass
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - M J Gunter
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - V Chajès
- International Agency for Research on Cancer, World Health Organization, Lyon, France
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3
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Vissers LET, Sluijs I, Burgess S, Forouhi NG, Freisling H, Imamura F, Nilsson TK, Renström F, Weiderpass E, Aleksandrova K, Dahm CC, Perez-Cornago A, Schulze MB, Tong TYN, Aune D, Bonet C, Boer JMA, Boeing H, Chirlaque MD, Conchi MI, Imaz L, Jäger S, Krogh V, Kyrø C, Masala G, Melander O, Overvad K, Panico S, Sánches MJ, Sonestedt E, Tjønneland A, Tzoulaki I, Verschuren WMM, Riboli E, Wareham NJ, Danesh J, Butterworth AS, van der Schouw YT. Milk intake and incident stroke and CHD in populations of European descent: a Mendelian randomisation study. Br J Nutr 2022; 128:1789-1797. [PMID: 34670632 PMCID: PMC9592953 DOI: 10.1017/s0007114521004244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 07/01/2021] [Accepted: 09/22/2021] [Indexed: 12/29/2022]
Abstract
Higher milk intake has been associated with a lower stroke risk, but not with risk of CHD. Residual confounding or reverse causation cannot be excluded. Therefore, we estimated the causal association of milk consumption with stroke and CHD risk through instrumental variable (IV) and gene-outcome analyses. IV analysis included 29 328 participants (4611 stroke; 9828 CHD) of the European Prospective Investigation into Cancer and Nutrition (EPIC)-CVD (eight European countries) and European Prospective Investigation into Cancer and Nutrition-Netherlands (EPIC-NL) case-cohort studies. rs4988235, a lactase persistence (LP) SNP which enables digestion of lactose in adulthood was used as genetic instrument. Intake of milk was first regressed on rs4988235 in a linear regression model. Next, associations of genetically predicted milk consumption with stroke and CHD were estimated using Prentice-weighted Cox regression. Gene-outcome analysis included 777 024 participants (50 804 cases) from MEGASTROKE (including EPIC-CVD), UK Biobank and EPIC-NL for stroke, and 483 966 participants (61 612 cases) from CARDIoGRAM, UK Biobank, EPIC-CVD and EPIC-NL for CHD. In IV analyses, each additional LP allele was associated with a higher intake of milk in EPIC-CVD (β = 13·7 g/d; 95 % CI 8·4, 19·1) and EPIC-NL (36·8 g/d; 95 % CI 20·0, 53·5). Genetically predicted milk intake was not associated with stroke (HR per 25 g/d 1·05; 95 % CI 0·94, 1·16) or CHD (1·02; 95 % CI 0·96, 1·08). In gene-outcome analyses, there was no association of rs4988235 with risk of stroke (OR 1·02; 95 % CI 0·99, 1·05) or CHD (OR 0·99; 95 % CI 0·95, 1·03). Current Mendelian randomisation analysis does not provide evidence for a causal inverse relationship between milk consumption and stroke or CHD risk.
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Affiliation(s)
- L. E. T. Vissers
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - I. Sluijs
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - S. Burgess
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - N. G. Forouhi
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - H. Freisling
- International Agency for Research on Cancer, Lyon, France
| | - F. Imamura
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - T. K. Nilsson
- Department of Medical Biosciences/Clinical Chemistry, Umeå University, Umeå, Sweden
| | - F. Renström
- Department of Biobank Research, Umeå University, Umeå, Sweden
- Division of Endocrinology and Diabetes, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - E. Weiderpass
- International Agency for Research on Cancer, Lyon, France
| | - K. Aleksandrova
- Germany Institute of Nutritional Sciences, University of Potsdam, Nuthetal, Germany
| | - C. C. Dahm
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - A. Perez-Cornago
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - M. B. Schulze
- German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Germany Institute of Nutritional Sciences, University of Potsdam, Nuthetal, Germany
| | - T. Y. N. Tong
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - D. Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Nutrition, Bjørknes University College, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - C. Bonet
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - J. M. A. Boer
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - H. Boeing
- German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - M. D. Chirlaque
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia University, Murcia, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - M. I. Conchi
- Navarra Public Health Institute – IdiSNA, Pamplona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Pamplona, Spain
| | - L. Imaz
- Ministry of Health of the Basque Government, Public Health Division of Gipuzkoa, Donostia-San Sebastian, Spain
- Biodonostia Health Research Institute, Donostia-San Sebastian, Spain
| | - S. Jäger
- German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - V. Krogh
- Epidemiology and prevention Unit, Fondazione IRCCS Instituto Nazionale dei Tumori, Milano, Italy
| | - C. Kyrø
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - G. Masala
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network – ISPRO, Florence, Italy
| | - O. Melander
- Lund University, Department of Clinical Sciences, Malmö, Sweden
| | - K. Overvad
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - S. Panico
- Dipartemento di medicina clinica e chirurgia, Federico II University, Naples, Italy
| | - M. J. Sánches
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Andalusian School of Public Health (EASP), Granada, Spain
- Instituto de Investigación Biosanitaria de Granada, Granada, Spain
- Universidad de Granada, Granada, Spain
| | - E. Sonestedt
- Lund University, Department of Clinical Sciences, Malmö, Sweden
| | - A. Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - I. Tzoulaki
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - W. M. M. Verschuren
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - E. Riboli
- School of Public Health, Imperial College London, UK
| | - N. J. Wareham
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - J. Danesh
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - A. S. Butterworth
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Y. T. van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
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4
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Cordova R, Knaze V, Viallon V, Rust P, Schalkwijk CG, Weiderpass E, Wagner KH, Mayen-Chacon AL, Aglago EK, Dahm CC, Overvad K, Tjønneland A, Halkjær J, Mancini FR, Boutron-Ruault MC, Fagherazzi G, Katzke V, Kühn T, Schulze MB, Boeing H, Trichopoulou A, Karakatsani A, Thriskos P, Masala G, Krogh V, Panico S, Tumino R, Ricceri F, Spijkerman A, Boer J, Skeie G, Rylander C, Borch KB, Quirós JR, Agudo A, Redondo-Sánchez D, Amiano P, Gómez-Gómez JH, Barricarte A, Ramne S, Sonestedt E, Johansson I, Esberg A, Tong T, Aune D, Tsilidis KK, Gunter MJ, Jenab M, Freisling H. Dietary intake of advanced glycation end products (AGEs) and changes in body weight in European adults. Eur J Nutr 2020; 59:2893-2904. [PMID: 31701336 DOI: 10.1007/s00394-019-02129-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 10/23/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE Advanced glycation end products (AGEs) can be formed in foods by the reaction of reducing sugars with proteins, and have been shown to induce insulin resistance and obesity in experimental studies. We examined the association between dietary AGEs intake and changes in body weight in adults over an average of 5 years of follow-up. METHODS A total of 255,170 participants aged 25-70 years were recruited in ten European countries (1992-2000) in the PANACEA study (Physical Activity, Nutrition, Alcohol, Cessation of smoking, Eating out of home in relation to Anthropometry), a sub-cohort of the EPIC (European Prospective Investigation into Cancer and Nutrition). Body weight was measured at recruitment and self-reported between 2 and 11 years later depending on the study center. A reference database for AGEs was used containing UPLC-MS/MS-measured Nε-(carboxymethyl)-lysine (CML), Nε-(1-carboxyethyl)-lysine (CEL), and Nδ-(5-hydro-5-methyl-4-imidazolon-2-yl)-ornithine (MG-H1) in 200 common European foods. This reference database was matched to foods and decomposed recipes obtained from country-specific validated dietary questionnaires in EPIC and intake levels of CEL, CML, and MG-H1 were estimated. Associations between dietary AGEs intake and body weight change were estimated separately for each of the three AGEs using multilevel mixed linear regression models with center as random effect and dietary AGEs intake and relevant confounders as fixed effects. RESULTS A one-SD increment in CEL intake was associated with 0.111 kg (95% CI 0.087-0.135) additional weight gain over 5 years. The corresponding additional weight gain for CML and MG-H1 was 0.065 kg (0.041-0.089) and 0.034 kg (0.012, 0.057), respectively. The top six food groups contributing to AGEs intake, with varying proportions across the AGEs, were cereals/cereal products, meat/processed meat, cakes/biscuits, dairy, sugar and confectionary, and fish/shellfish. CONCLUSION In this study of European adults, higher intakes of AGEs were associated with marginally greater weight gain over an average of 5 years of follow-up.
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Affiliation(s)
- R Cordova
- Department of Nutritional Sciences, University of Vienna, Vienna, Austria
| | - V Knaze
- Section of Early Detection and Prevention, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - V Viallon
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - P Rust
- Department of Nutritional Sciences, University of Vienna, Vienna, Austria
| | - C G Schalkwijk
- Department of Internal Medicine, Laboratory of Metabolism and Vascular Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - E Weiderpass
- International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - K-H Wagner
- Department of Nutritional Sciences, University of Vienna, Vienna, Austria
| | - A-L Mayen-Chacon
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - E K Aglago
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - C C Dahm
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - K Overvad
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - A Tjønneland
- Danish Cancer Society Research Center Copenhagen, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - J Halkjær
- Danish Cancer Society Research Center Copenhagen, Copenhagen, Denmark
| | - F R Mancini
- CESP, Fac. de médecine, Univ. Paris-Sud, Fac. de médecine-UVSQ-INSERM, Université Paris-Saclay, Villejuif, France
- Institut Gustave Roussy, Villejuif, France
| | - M-C Boutron-Ruault
- CESP, Fac. de médecine, Univ. Paris-Sud, Fac. de médecine-UVSQ-INSERM, Université Paris-Saclay, Villejuif, France
- Institut Gustave Roussy, Villejuif, France
| | - G Fagherazzi
- CESP, Fac. de médecine, Univ. Paris-Sud, Fac. de médecine-UVSQ-INSERM, Université Paris-Saclay, Villejuif, France
- Institut Gustave Roussy, Villejuif, France
| | - V Katzke
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - T Kühn
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - M B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- Institute of Nutrition Science, University of Potsdam, Nuthetal, Germany
| | - H Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | | | - A Karakatsani
- Hellenic Health Foundation, Athens, Greece
- 2nd Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, ATTIKON University Hospital, Haidari, Greece
| | - P Thriskos
- Hellenic Health Foundation, Athens, Greece
| | - G Masala
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network-ISPRO, Florence, Italy
| | - V Krogh
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - S Panico
- Dipartimento di Medicina Clinica E Chirurgia, Federico II University, Naples, Italy
| | - R Tumino
- Cancer Registry and Histopathology Unit, Azienda Sanitaria Provinciale (ASP) Ragusa, Ragusa, Italy
| | - F Ricceri
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
- Unit of Epidemiology, Regional Health Service ASL TO3, Turin, TO, Italy
| | - A Spijkerman
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - J Boer
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - G Skeie
- Department of Community Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
| | - C Rylander
- Department of Community Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
| | - K B Borch
- Department of Community Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
| | - J R Quirós
- Public Health Directorate, Asturias, Spain
| | - A Agudo
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - D Redondo-Sánchez
- Andalusian School of Public Health. Biomedical Research Institute ibs.GRANADA, University of Granada, Granada, Spain
- CIBER of Epidemiology and Public Health, Madrid, Spain
| | - P Amiano
- CIBER of Epidemiology and Public Health, Madrid, Spain
- Public Health Division of Gipuzkoa, BioDonostia Research Institute, San Sebastian, Spain
| | - J-H Gómez-Gómez
- Department of Epidemiology and Murcia Regional Health Council, Universidad de Murcia, Murcia, Spain
| | - A Barricarte
- CIBER of Epidemiology and Public Health, Madrid, Spain
- Navarra Public Health Institute, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - S Ramne
- Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - E Sonestedt
- Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - I Johansson
- Department of Odontology, Umeå University, Umeå, Sweden
| | - A Esberg
- Department of Odontology, Umeå University, Umeå, Sweden
| | - T Tong
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - D Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - K K Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine University Campus Ioannina, Ioannina, Greece
| | - M J Gunter
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - M Jenab
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Heinz Freisling
- International Agency for Research on Cancer (IARC-WHO), 150 cours Albert Thomas, CEDEX 08, 69372, Lyon, France.
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Kreimer AR, Ferreiro-Iglesias A, Nygard M, Bender N, Schroeder L, Hildesheim A, Robbins HA, Pawlita M, Langseth H, Schlecht NF, Tinker LF, Agalliu I, Smoller SW, Ness-Jensen E, Hveem K, D'Souza G, Visvanathan K, May B, Ursin G, Weiderpass E, Giles GG, Milne RL, Cai Q, Blot WJ, Zheng W, Weinstein SJ, Albanes D, Brenner N, Hoffman-Bolton J, Kaaks R, Barricarte A, Tjønneland A, Sacerdote C, Trichopoulou A, Vermeulen RCH, Huang WY, Freedman ND, Brennan P, Waterboer T, Johansson M. Timing of HPV16-E6 antibody seroconversion before OPSCC: findings from the HPVC3 consortium. Ann Oncol 2019; 30:1335-1343. [PMID: 31185496 PMCID: PMC6683856 DOI: 10.1093/annonc/mdz138] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Human papillomavirus type 16 (HPV16)-E6 antibodies are detectable in peripheral blood before diagnosis in the majority of HPV16-driven oropharyngeal squamous cell carcinoma (OPSCC), but the timing of seroconversion is unknown. PATIENTS AND METHODS We formed the HPV Cancer Cohort Consortium which comprises nine population cohorts from Europe, North America and Australia. In total, 743 incident OPSCC cases and 5814 controls provided at least one pre-diagnostic blood sample, including 111 cases with multiple samples. Median time between first blood collection and OPSCC diagnosis was 11.4 years (IQR = 6-11 years, range = 0-40 years). Antibodies against HPV16-E6 were measured by multiplex serology (GST fusion protein based Luminex assay). RESULTS HPV16-E6 seropositivity was present in 0.4% of controls (22/5814; 95% CI 0.2% to 0.6%) and 26.2% (195/743; 95% CI 23.1% to 29.6%) of OPSCC cases. HPV16-E6 seropositivity increased the odds of OPSCC 98.2-fold (95% CI 62.1-155.4) in whites and 17.2-fold (95% CI 1.7-170.5) in blacks. Seropositivity in cases was more frequent in recent calendar periods, ranging from 21.9% pre-1996 to 68.4% in 2005 onwards, in those with blood collection near diagnosis (lead time <5 years). HPV16-E6 seropositivity increased with lead time: 0.0%, 13.5%, 23.7%, and 38.9% with lead times of >30 years (N = 24), 20-30 years (N = 148), 10-20 years (N = 228), and <10 years (N = 301 cases) (p-trend < 0.001). Of the 47 HPV16-E6 seropositive cases with serially-collected blood samples, 17 cases seroconverted during follow-up, with timing ranging from 6 to 28 years before diagnosis. For the remaining 30 cases, robust seropositivity was observed up to 25 years before diagnosis. CONCLUSIONS The immune response to HPV16-driven tumorigenesis is most often detectable several decades before OPSCC diagnosis. HPV16-E6 seropositive individuals face increased risk of OPSCC over several decades.
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Affiliation(s)
- A R Kreimer
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, USA.
| | - A Ferreiro-Iglesias
- Genetic Epidemiology Group (GEP), International Agency for Research on Cancer (IARC), Lyon, France
| | - M Nygard
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
| | - N Bender
- Infections and Cancer Epidemiology, Research Program Infection, Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - L Schroeder
- Infections and Cancer Epidemiology, Research Program Infection, Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - A Hildesheim
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - H A Robbins
- Genetic Epidemiology Group (GEP), International Agency for Research on Cancer (IARC), Lyon, France
| | - M Pawlita
- Infections and Cancer Epidemiology, Research Program Infection, Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - H Langseth
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
| | - N F Schlecht
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx
| | - L F Tinker
- Public Health Sciences, Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, USA
| | - I Agalliu
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx
| | - S W Smoller
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx
| | - E Ness-Jensen
- HUNT Research Center, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Levanger, Norway
| | - K Hveem
- HUNT Research Center, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Levanger, Norway
| | - G D'Souza
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - K Visvanathan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - B May
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - G Ursin
- Cancer Registry of Norway, Institute of Population-Based Cancer Research, Majorstuen, Oslo; Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - E Weiderpass
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; Genetic Epidemiology Group, Folkhälsan Research Center, and Faculty of Medicine, Helsinki University, Helsinki, Finland; Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - G G Giles
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne; Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Parkville; School of Public Health and Preventive Medicine, Monash University Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne
| | - R L Milne
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne; Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Parkville; Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Q Cai
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, USA
| | - W J Blot
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, USA
| | - W Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, USA
| | - S J Weinstein
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - D Albanes
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - N Brenner
- Infections and Cancer Epidemiology, Research Program Infection, Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - R Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - A Barricarte
- Navarra Public Health Institute, Pamplona; Navarra Institute for Health Research (IdiSNA), Pamplona; CIBER Epidemiology and Public Health CIBERESP, Madrid, Spain
| | - A Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - C Sacerdote
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy
| | | | - R C H Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University; Julius Centre for Public Health Sciences and Primary Care, Utrecht University Medical Centre, Utrecht, the Netherlands
| | - W-Y Huang
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - N D Freedman
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - P Brennan
- Genetic Epidemiology Group (GEP), International Agency for Research on Cancer (IARC), Lyon, France
| | - T Waterboer
- Infections and Cancer Epidemiology, Research Program Infection, Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - M Johansson
- Genetic Epidemiology Group (GEP), International Agency for Research on Cancer (IARC), Lyon, France.
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6
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Holm M, Olsen A, Au Yeung SL, Overvad K, Lidegaard Ø, Kroman N, Tjønneland A. Pattern of mortality after menopausal hormone therapy: long-term follow up in a population-based cohort. BJOG 2018; 126:55-63. [PMID: 30106241 DOI: 10.1111/1471-0528.15433] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate long-term pattern of mortality in menopausal women according to different modalities of hormone therapy. DESIGN Population-based prospective cohort study. SETTING Denmark 1993-2013. POPULATION A total of 29 243 women aged 50-64 years at entry into the Diet, Cancer and Health Cohort, enrolled 1993-97 and followed through 31 December 2013. METHODS Cox' proportional hazards models for increasingly longer periods of follow-up time were used to estimate mortality pattern according to baseline hormone use adjusted for relevant potential confounders. MAIN OUTCOME(S) All-cause and cause-specific mortality. Outcome information was obtained from the Danish Register of Causes of Death (linkage 99.6%). RESULTS A total of 4098 women died during a median follow up of 17.6 years. After adjustment for relevant lifestyle risk factors, hormone use had no impact on all-cause mortality, regardless of modality. Among baseline users, lower cardiovascluar disease mortality was only evident after 5 years [hazard ratio (HR) 0.54; 95% CI 0.32-0.92], but dissipated with additional follow up. Conversely, lower colorectal cancer mortality (HR 0.64; 95% CI 0.46-0.89) and higher breast cancer mortality (HR 1.34; 95% CI 1.05-1.72) only became evident after 15 years of follow up. There were no significant associations for mortality from other types of cancer or from stroke. CONCLUSIONS In this long-term follow-up study, taking hormones during menopause was not associated with overall mortality among middle-aged women. Investigating cause-specific mortality revealed significant, albeit weak, differential associations according to both causes of death and over time, underlining the importance of carefully considering individual risks and duration of treatment when making decisions on hormone therapy. TWEETABLE ABSTRACT Long-term follow-up study confirms no association between menopausal hormone therapy and overall mortality.
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Affiliation(s)
- M Holm
- Unit of Diet, Genes and Environment, Danish Cancer Society Research Centre, Copenhagen, Denmark
| | - A Olsen
- Unit of Diet, Genes and Environment, Danish Cancer Society Research Centre, Copenhagen, Denmark
| | - S L Au Yeung
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
| | - K Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
| | - Ø Lidegaard
- Gynaecological Clinic, Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - N Kroman
- Department of Breast Surgery, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - A Tjønneland
- Unit of Diet, Genes and Environment, Danish Cancer Society Research Centre, Copenhagen, Denmark
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7
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Blix K, Gran OV, Severinsen MT, Cannegieter SC, Jensvoll H, Overvad K, Hammerstrøm J, Tjønneland A, Naess IA, Braekkan SK, Rosendaal FR, Kristensen SR, Hansen JB. Impact of time since diagnosis and mortality rate on cancer-associated venous thromboembolism: the Scandinavian Thrombosis and Cancer (STAC) cohort. J Thromb Haemost 2018; 16:1327-1335. [PMID: 29691978 DOI: 10.1111/jth.14130] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Indexed: 12/13/2022]
Abstract
Essentials Competing risk by death may lead to overestimation of venous thromboembolism (VTE) risk in cancers. We assessed the risk of VTE in cancer with and without accounting for competing risk by death. The risk of VTE was influenced by the mortality rate and the time since cancer diagnosis. Competing risk by death should be taken into account when exploring VTE risk in cancer. SUMMARY Background Venous thromboembolism (VTE) is a common complication in cancer, and studies have suggested that aggressive cancers create the highest risk of VTE. However, competing risk by death may result in overestimation of VTE risk in patients with cancers associated with high mortality. Therefore, we estimated the risk of VTE by cancer site, accounting for the differential mortality between cancers. Methods The Scandinavian Thrombosis and Cancer cohort included 144 952 participants followed from 1993-1997 to 2008-2012. Incidence rates, cause-specific hazard ratios (HRs) and subdistribution HRs (SHRs) were assessed for overall cancer and by cancer site according to time intervals since cancer diagnosis. Results During follow-up, 14 272 subjects developed cancer, and 567 had cancer-related VTE. In cause-specific analyses, the VTE risk was highest in the first 6 months after cancer diagnosis (HR 17.5, 95% confidence interval [CI] 15.1-20.3), and declined rapidly thereafter. However, when mortality was taken into account, the risk was similar in the periods 6 months before (SHR 4.8, 95% CI 3.6-6.4) and 6 months after (SHR 4.6, 95% CI 3.9-5.4) cancer diagnosis. The range of the 2-year cumulative VTE incidence rates was substantially narrowed for all cancer sites after competing risk by death was taken into account (from 1-10% to 1-4%). Conclusion VTE risk by cancer site was influenced by the mortality rate and the time since cancer diagnosis. Our findings suggest that the cancer itself is a major contributor to VTE risk, and that competing risk by death should be taken into account when VTE risk in cancer is explored.
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Affiliation(s)
- K Blix
- K. G. Jebsen Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT - the Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - O V Gran
- K. G. Jebsen Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT - the Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - M T Severinsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
| | - S C Cannegieter
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - H Jensvoll
- K. G. Jebsen Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT - the Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - K Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
| | - J Hammerstrøm
- Department of Hematology, Trondheim University Hospital, Trondheim, Norway
| | - A Tjønneland
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - I A Naess
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - S K Braekkan
- K. G. Jebsen Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT - the Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - F R Rosendaal
- K. G. Jebsen Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT - the Arctic University of Norway, Tromsø, Norway
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - S R Kristensen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - J-B Hansen
- K. G. Jebsen Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT - the Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
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8
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Ordóñez-Mena JM, Walter V, Schöttker B, Jenab M, O'Doherty MG, Kee F, Bueno-de-Mesquita B, Peeters PHM, Stricker BH, Ruiter R, Hofman A, Söderberg S, Jousilahti P, Kuulasmaa K, Freedman ND, Wilsgaard T, Wolk A, Nilsson LM, Tjønneland A, Quirós JR, van Duijnhoven FJB, Siersema PD, Boffetta P, Trichopoulou A, Brenner H. Impact of prediagnostic smoking and smoking cessation on colorectal cancer prognosis: a meta-analysis of individual patient data from cohorts within the CHANCES consortium. Ann Oncol 2018; 29:472-483. [PMID: 29244072 PMCID: PMC6075220 DOI: 10.1093/annonc/mdx761] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background Smoking has been associated with colorectal cancer (CRC) incidence and mortality in previous studies and might also be associated with prognosis after CRC diagnosis. However, current evidence on smoking in association with CRC prognosis is limited. Patients and methods For this individual patient data meta-analysis, sociodemographic and smoking behavior information of 12 414 incident CRC patients (median age at diagnosis: 64.3 years), recruited within 14 prospective cohort studies among previously cancer-free adults, was collected at baseline and harmonized across studies. Vital status and causes of death were collected for a mean follow-up time of 5.1 years following cancer diagnosis. Associations of smoking behavior with overall and CRC-specific survival were evaluated using Cox regression and standard meta-analysis methodology. Results A total of 5229 participants died, 3194 from CRC. Cox regression revealed significant associations between former [hazard ratio (HR) = 1.12; 95 % confidence interval (CI) = 1.04-1.20] and current smoking (HR = 1.29; 95% CI = 1.04-1.60) and poorer overall survival compared with never smoking. Compared with current smoking, smoking cessation was associated with improved overall (HR<10 years = 0.78; 95% CI = 0.69-0.88; HR≥10 years = 0.78; 95% CI = 0.63-0.97) and CRC-specific survival (HR≥10 years = 0.76; 95% CI = 0.67-0.85). Conclusion In this large meta-analysis including primary data of incident CRC patients from 14 prospective cohort studies on the association between smoking and CRC prognosis, former and current smoking were associated with poorer CRC prognosis compared with never smoking. Smoking cessation was associated with improved survival when compared with current smokers. Future studies should further quantify the benefits of nonsmoking, both for cancer prevention and for improving survival among CRC patients, in particular also in terms of treatment response.
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Affiliation(s)
- J M Ordóñez-Mena
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; Network Aging Research, University of Heidelberg, Heidelberg, Germany; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - V Walter
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - B Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; Network Aging Research, University of Heidelberg, Heidelberg, Germany; Institute of Health Care and Social Sciences, FOM University, Essen, Germany
| | - M Jenab
- International Agency for Research on Cancer (IARC), Lyon, France
| | - M G O'Doherty
- UKCRC Centre of Excellence for Public Health, Queens University of Belfast, Belfast, UK
| | - F Kee
- UKCRC Centre of Excellence for Public Health, Queens University of Belfast, Belfast, UK
| | - B Bueno-de-Mesquita
- Department of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands; Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands; Division of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, UK; Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - P H M Peeters
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - B H Stricker
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - R Ruiter
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - A Hofman
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA
| | - S Söderberg
- Department of Public Health and Clinical Medicine, Cardiology, and Heart Center, Umeå University, Umeå, Sweden
| | - P Jousilahti
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - K Kuulasmaa
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - N D Freedman
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, USA
| | - T Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - A Wolk
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - L M Nilsson
- Nutritional Research, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; Arcum, Arctic Research Centre at Umeå University, Umeå, Sweden
| | - A Tjønneland
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - J R Quirós
- Public Health Directorate, Asturias, Spain
| | | | - P D Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - P Boffetta
- Hellenic Health Foundation, Athens, Greece; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - A 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, University of Athens Medical School, Athens, Greece
| | - H Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany; German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
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9
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Botteri E, Ferrari P, Roswall N, Tjønneland A, Hjartåker A, Huerta JM, Fortner RT, Trichopoulou A, Karakatsani A, La Vecchia C, Pala V, Perez-Cornago A, Sonestedt E, Liedberg F, Overvad K, Sánchez MJ, Gram IT, Stepien M, Trijsburg L, Börje L, Johansson M, Kühn T, Panico S, Tumino R, Bueno-de-Mesquita HBA, Weiderpass E. Alcohol consumption and risk of urothelial cell bladder cancer in the European prospective investigation into cancer and nutrition cohort. Int J Cancer 2017; 141:1963-1970. [PMID: 28722206 DOI: 10.1002/ijc.30894] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/16/2017] [Accepted: 06/28/2017] [Indexed: 11/11/2022]
Abstract
Findings on the association between alcohol consumption and bladder cancer are inconsistent. We investigated that association in the European Prospective Investigation into Cancer and Nutrition cohort. We included 476,160 individuals mostly aged 35-70 years, enrolled in ten countries and followed for 13.9 years on average. Hazard ratios (HR) for developing urothelial cell carcinoma (UCC; 1,802 incident cases) were calculated using Cox proportional hazards models. Alcohol consumption at baseline and over the life course was analyzed, as well as different types of beverages (beer, wine, spirits). Baseline alcohol intake was associated with a statistically nonsignificant increased risk of UCC (HR 1.03; 95% confidence interval (CI) 1.00-1.06 for each additional 12 g/day). HR in smokers was 1.04 (95% CI 1.01-1.07). Men reporting high baseline intakes of alcohol (>96 g/day) had an increased risk of UCC (HR 1.57; 95% CI 1.03-2.40) compared to those reporting moderate intakes (<6 g/day), but no dose-response relationship emerged. In men, an increased risk of aggressive forms of UCC was observed even at lower doses (>6 to 24 g/day). Average lifelong alcohol intake was not associated with the risk of UCC, however intakes of spirits > 24 g/day were associated with an increased risk of UCC in men (1.38; 95% CI 1.01-1.91) and smokers (1.39; 95% CI 1.01-1.92), compared to moderate intakes. We found no association between alcohol and UCC in women and never smokers. In conclusion, we observed some associations between alcohol and UCC in men and in smokers, possibly because of residual confounding by tobacco smoking.
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Affiliation(s)
- E Botteri
- Department of Bowel Cancer Screening, Cancer Registry of Norway, Oslo University Hospital, Oslo, Norway
- National Advisory Unit for Women's Health, Women's Clinic, Oslo University Hospital, Oslo, Norway
| | - P Ferrari
- International Agency for Research on Cancer, Lyon, France
| | - N Roswall
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - A Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - A Hjartåker
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - J M Huerta
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - R T Fortner
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - A Trichopoulou
- Hellenic Health Foundation, Athens, Greece
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Athens, Greece
| | - A Karakatsani
- Hellenic Health Foundation, Athens, Greece
- 2nd Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Haidari, Greece
| | - C La Vecchia
- Hellenic Health Foundation, Athens, Greece
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy
| | - V Pala
- Epidemiology and Prevention Unit, Department of Preventive & Predictive Medicine. Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - A Perez-Cornago
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - E Sonestedt
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - F Liedberg
- Department of Translational Medicine, Division of Clinical and Experimental Urothelial Carcinoma Research, Lund University, Malmö, Sweden
| | - K Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
| | - M J Sánchez
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
- Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria ibs. Granada. Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - I T Gram
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - M Stepien
- International Agency for Research on Cancer, Lyon, France
| | - L Trijsburg
- International Agency for Research on Cancer, Lyon, France
| | - L Börje
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - M Johansson
- International Agency for Research on Cancer, Lyon, France
- Department for biobank research, Umeå University, Umeå, Sweden
| | - T Kühn
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - S Panico
- Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy
| | - R Tumino
- Cancer Registry and Histopathology Unit "Civic - M.P. Arezzo" Hospital ASP, Ragusa, Italy
| | - H B As Bueno-de-Mesquita
- Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, United Kingdom
| | - E Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, 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, Helsinki, Finland
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10
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Gade IL, Braekkan SK, Naess IA, Hansen JB, Cannegieter SC, Overvad K, Jensvoll H, Hammerstrøm J, Blix K, Tjønneland A, Kristensen SR, Severinsen MT. The impact of initial cancer stage on the incidence of venous thromboembolism: the Scandinavian Thrombosis and Cancer (STAC) Cohort. J Thromb Haemost 2017; 15:1567-1575. [PMID: 28585779 DOI: 10.1111/jth.13752] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Indexed: 12/13/2022]
Abstract
Essentials Impact of cancer stage on venous thromboembolism (VTE) risk is not well-known in all cancers. The Scandinavian Thrombosis and Cancer Cohort provides person-time data and validated VTEs. Impact of cancer stage on VTE incidence tended to vary with cancer type. Cancer stage may not per se be a risk factor for VTE in all cancer types. SUMMARY Background Absolute measures of the impact of cancer stage on the incidence of venous thromboembolism (VTE) in patients with distinct cancer types have not been investigated in a large population-based cohort study. Objectives To investigate differences in the incidence rates of objectively confirmed VTE according to the development of cancer in a large population-based cohort study. Cancer type and stage at the time of diagnosis were taken into account. Patients and Methods The Scandinavian Thrombosis and Cancer Cohort includes data regarding cancer types, stages and objectively confirmed VTE diagnoses among 144 952 participants followed from 1993 to 2012. We studied stage-specific incidence rates of VTE, and calculated incidence rate differences (IRDs) for VTE according to stages in patients with 10 types of solid cancer. Results During the entire follow-up, 335 VTEs occurred, of which 293 occurred within 5 years. The IRD of VTE in patients with distant metastasis as compared with those with localized disease indicated large variation depending on cancer type. The highest IRD was observed for pancreatic cancer (IRD of 187.0 × 10-3 person-years [p-y]; 95% confidence interval [CI] - 6.7 to 380.8), and the lowest IRD was observed for prostate cancer (IRD of 3.7 × 10-3 p-y; 95% CI - 7 to 15.2). Regional spread as compared with localized disease also indicated large variation depending on cancer type; the highest IRD was observed for uterine cancer (IRD of 37.6 × 10-3 p-y; 95% CI - 23.7 to 99), and the IRDs for breast and prostate cancer were close to zero. Conclusion More advanced cancer at the time of diagnosis was associated with a higher risk of VTE, but the strength of the associations differed substantially between cancer types.
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Affiliation(s)
- I L Gade
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - S K Braekkan
- Department of Clinical Medicine, K. G. Jebsen Thrombosis Research and Expertise Center (TREC), UiT The Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - I A Naess
- Department of Hematology, Trondheim University Hospital, Trondheim, Norway
| | - J-B Hansen
- Department of Clinical Medicine, K. G. Jebsen Thrombosis Research and Expertise Center (TREC), UiT The Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - S C Cannegieter
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - K Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - H Jensvoll
- Department of Clinical Medicine, K. G. Jebsen Thrombosis Research and Expertise Center (TREC), UiT The Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - J Hammerstrøm
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - K Blix
- Department of Clinical Medicine, K. G. Jebsen Thrombosis Research and Expertise Center (TREC), UiT The Arctic University of Norway, Tromsø, Norway
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - A Tjønneland
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - S R Kristensen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - M T Severinsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
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11
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Kyrø C, Kristensen M, Jakobsen MU, Halkjær J, Landberg R, Bueno-de-Mesquita HA, Christensen J, Romieu I, Tjønneland A, Olsen A. Dietary intake of whole grains and plasma alkylresorcinol concentrations in relation to changes in anthropometry: the Danish diet, cancer and health cohort study. Eur J Clin Nutr 2017; 71:944-952. [PMID: 28176776 DOI: 10.1038/ejcn.2016.233] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 09/29/2016] [Accepted: 10/19/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND/OBJECTIVES Whole grain intake has been associated with a small but significant lower body weight gain in observational studies, but there is limited knowledge about the associations with specific whole grain types. The objective was to investigate the association between whole grains, different sources of whole grains and biomarkers of whole grain intake (alkylresorcinols) in relation to subsequent changes in waist circumference (WC) and body weight. SUBJECTS/METHODS Cohort study of 57 053 participants with baseline information on whole grain intake from questionnaires (FFQ) and biomarkers of whole grain rye and wheat intake, plasma alkylresorcinols, for a subset. WC and body weight were measured at baseline and again at follow-up. The associations were estimated using multiple linear regression analyses and logistic regression. RESULTS For women, overall whole grain intake was not related to changes in WC or body weight. For men, total whole grain intake was associated with gains in WC (ΔWC per 25 g increment: 0.44 cm, 95% CI: 0.34 cm; 0.54 cm) and body weight (Δweight per 25 g increment: 150 g, 95% CI: 78 g; 222 g), but the results changed to null or changed direction when adjusting for baseline anthropometry. For the different sources of whole grains, rye (women) and crispbread was significantly associated with gains in WC and body weight. Plasma alkylresorcinol concentration was associated with reduced WC, but not body weight, for women (ΔWC per 50 nmol/l increment: -0.69 cm, 95% CI:-1.26 cm;-0.13 cm), but no association was found for men. CONCLUSIONS Overall, no strong relationship between whole grain intake, measured from questionnaires or using biomarkers was found in relation to changes in body weight and WC.
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Affiliation(s)
- C Kyrø
- Unit of Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
- Nutrition and Metabolism Section, International Agency for Research on Cancer (WHO-IARC), Lyon, France
| | - M Kristensen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - M U Jakobsen
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
| | - J Halkjær
- Unit of Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - R Landberg
- Department of Food Science, BioCenter, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Hb As Bueno-de-Mesquita
- Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Department of Gastroenterology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - J Christensen
- Unit of Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - I Romieu
- Nutrition and Metabolism Section, International Agency for Research on Cancer (WHO-IARC), Lyon, France
| | - A Tjønneland
- Unit of Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - A Olsen
- Unit of Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
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12
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Lasota A, Overvad K, Eriksen H, Tjønneland A, Schmidt E, Grønholdt ML. Validity of Peripheral Arterial Disease Diagnoses in the Danish National Patient Registry. Eur J Vasc Endovasc Surg 2017; 53:679-685. [DOI: 10.1016/j.ejvs.2016.12.031] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 12/24/2016] [Indexed: 01/03/2023]
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13
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Eriksen AK, Kyrø C, Nørskov N, Bolvig AK, Christensen J, Tjønneland A, Overvad K, Landberg R, Olsen A. Prediagnostic enterolactone concentrations and mortality among Danish men diagnosed with prostate cancer. Eur J Clin Nutr 2017; 71:1235-1240. [PMID: 28378849 DOI: 10.1038/ejcn.2017.42] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 11/03/2016] [Accepted: 02/28/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Evidence on the role of diet in relation to prostate cancer progression is sparse. Foods rich in lignans have shown beneficial effects on prostate cancer progression in both animal studies and small human intervention studies, including beneficial effects on prostate-specific antigen levels and tumour growth. The lignan metabolite, enterolactone, has further shown to slow prostate cancer cell growth in vitro. The aim was to investigate the association between prediagnostic enterolactone concentrations and mortality among men with prostate cancer.Subljects/Methods:Prediagnostic plasma concentrations of enterolactone from 1390 men diagnosed with prostate cancer from the Danish Diet, Cancer and Health cohort were related to all-cause or prostate cancer-specific death, using Cox proportional hazards models with follow-up time (from the date of diagnose until the date of death, emigration or end of follow-up by December 2013) as the underlying time axis. RESULTS The hazard ratios for enterolactone concentrations assessed linearly by 20 nmol/l increments was 0.95 (0.90, 1.02) for all-cause mortality and 0.98 (0.92, 1.05) for prostate cancer-specific mortality. Categorisation of enterolactone concentrations into quartiles did not reveal a different pattern. No effect modifications by smoking, body mass index or sport were observed, and the associations did not differ by prostate cancer aggressiveness. CONCLUSIONS We found no association between enterolactone concentrations and mortality among men diagnosed with prostate cancer.
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Affiliation(s)
- A K Eriksen
- Unit of Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - C Kyrø
- Unit of Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - N Nørskov
- Department of Animal Science, Aarhus University, Tjele, Denmark
| | - A K Bolvig
- Department of Animal Science, Aarhus University, Tjele, Denmark
| | - J Christensen
- Unit of Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - A Tjønneland
- Unit of Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - K Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus C, Denmark
| | - R Landberg
- Department of Molecular Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden.,Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - A Olsen
- Unit of Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
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14
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Lerche L, Olsen A, Petersen KEN, Rostgaard-Hansen AL, Dragsted LO, Nordsborg NB, Tjønneland A, Halkjaer J. Validity of physical activity and cardiorespiratory fitness in the Danish cohort "Diet, Cancer and Health-Next Generations". Scand J Med Sci Sports 2017; 27:1864-1872. [PMID: 28267247 DOI: 10.1111/sms.12873] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2017] [Indexed: 11/29/2022]
Abstract
Valid assessments of physical activity (PA) and cardiorespiratory fitness (CRF) are essential in epidemiological studies to define dose-response relationship for formulating thorough recommendations of an appropriate pattern of PA to maintain good health. The aim of this study was to validate the Danish step test, the physical activity questionnaire Active-Q, and self-rated fitness against directly measured maximal oxygen uptake (VO2 max). A population-based subsample (n=125) was included from the "Diet, Cancer and Health-Next Generations" (DCH-NG) cohort which is under establishment. Validity coefficients, which express the correlation between measured and "true" exposure, were calculated, and misclassification across categories was evaluated. The validity of the Danish step test was moderate (women: r=.66, and men: r=.56); however, men were systematically underestimated (43% misclassification). When validating the questionnaire-derived measures of PA, leisure-time physical activity was not correlated with VO2 max. Positive correlations were found for sports overall, but these were only significant for men: total hours per week of sports (r=.26), MET-hours per week of sports (r=.28) and vigorous sports (0.28) alone were positively correlated with VO2 max. Finally, the percentage of misclassification was low for self-rated fitness (women: 9% and men: 13%). Thus, self-rated fitness was found to be a superior method to the Danish step test, as well as being less cost prohibitive and more practical than the VO2 max method. Finally, even if correlations were low, they support the potential for questionnaire outcomes, particularly sports, vigorous sports, and self-rated fitness to be used to estimate CRF.
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Affiliation(s)
- L Lerche
- Unit of Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen Ø, Denmark
| | - A Olsen
- Unit of Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen Ø, Denmark
| | - K E N Petersen
- Unit of Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen Ø, Denmark
| | - A L Rostgaard-Hansen
- Unit of Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen Ø, Denmark
| | - L O Dragsted
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen N, Denmark
| | - N B Nordsborg
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen N, Denmark
| | - A Tjønneland
- Unit of Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen Ø, Denmark
| | - J Halkjaer
- Unit of Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen Ø, Denmark
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15
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Jay R, Brennan P, Brenner, Overvad K, Olsen A, Tjønneland A, Boutron-Ruault MC, Clavel-Chapelon F, Fagherazzi, Katzke V, Kühn T, Boeing H, Bergmann MM, Steffen A, Naska A, Trichopoulou A, Trichopoulos D, Saieva C, Grioni S, Panico S, Tumino R, Vineis P, Bueno-de-Mesquita HB, Peeters PH, Hjartåker A, Weiderpass E, Arriola L, Molina-Montes E, Duell EJ, Santiuste C, Alonso de la Torre R, Barricarte Gurrea A, Stocks T, Johansson M, Ljungberg B, Wareham N, Khaw KT, Travis RC, Cross AJ, Murphy N, Riboli E, Scelo G. Alcohol consumption and the risk of renal cancers in the European Prospective Investigation into Cancer and Nutrition (EPIC). Wozniak MB, Brennan P, Brenner DR, Overvad K, Olsen A, Tjønneland A, Boutron-Ruault MC, Clavel-Chapelon F, Fagherazzi G, Katzke V, Kühn T, Boeing H, Bergmann MM, Steffen A, Naska A, Trichopoulou A, Trichopoulos D, Saieva C, Grioni S, Panico S, Tumino R, Vineis P, Bueno-de-Mesquita HB, Peeters PH, Hjartåker A, Weiderpass E, Arriola L, Molina-Montes E, Duell EJ, Santiuste C, Alonso de la Torre R, Barricarte Gurrea A, Stocks T, Johansson M, Ljungberg B, Wareham N, Khaw KT, Travis RC, Cross AJ, Murphy N, Riboli E, Scelo G.Int J Cancer. 2015 Oct 15;137(8):1953-66. [Epub 2015 Apr 28]. doi: 10.1002/ijc.29559. Urol Oncol 2017; 35:117. [PMID: 28159493 DOI: 10.1016/j.urolonc.2016.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Epidemiologic studies have reported that moderate alcohol consumption is inversely associated with the risk of renal cancer. However, there is no information available on the associations in renal cancer subsites. From 1992 to 2010, 477,325 men and women in the European Prospective Investigation into Cancer and Nutrition cohort were followed for incident renal cancers (n = 931). Baseline and lifetime alcohol consumption was assessed by country-specific, validated dietary questionnaires. Information on past alcohol consumption was collected by lifestyle questionnaires. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated from Cox proportional hazard models. In multivariate analysis, total alcohol consumption at baseline was inversely associated with renal cancer; the HR and 95% CI for the increasing categories of total alcohol consumption at recruitment vs. the light drinkers category were 0.78 (0.62-0.99), 0.82 (0.64-1.04), 0.70 (0.55-0.90), and 0.91 (0.63-1.30), respectively, (ptrend = 0.001). A similar relationship was observed for average lifetime alcohol consumption and for all renal cancer subsites combined or for renal parenchyma subsite. The trend was not observed in hypertensive individuals and not significant in smokers. In conclusion, moderate alcohol consumption was associated with a decreased risk of renal cancer.
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16
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Christensen HN, Diderichsen F, Hvidtfeldt UA, Lange T, Andersen PK, Osler M, Prescott E, Tjønneland A, Rod NH, Andersen I. Educational inequality in alcohol-attributable events: A Danish register-based cohort study. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw166.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Larsen S, Brasso K, Christensen J, Johansen C, Tjønneland A, Friis S, Iversen P, Dalton S. Socioeconomic position and mortality among patients with prostate cancer: influence of mediating factors. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw387.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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18
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Huseinovic E, Winkvist A, Slimani N, Park MK, Freisling H, Boeing H, Buckland G, Schwingshackl L, Weiderpass E, Rostgaard-Hansen AL, Tjønneland A, Affret A, Boutron-Ruault MC, Fagherazzi G, Katzke V, Kühn T, Naska A, Orfanos P, Trichopoulou A, Pala V, Palli D, Ricceri F, Santucci de Magistris M, Tumino R, Engeset D, Enget T, Skeie G, Barricarte A, Bonet CB, Chirlaque MD, Amiano P, Quirós JR, Sánchez MJ, Dias JA, Drake I, Wennberg M, Boer JMA, Ocké MC, Verschuren WMM, Lassale C, Perez-Cornago A, Riboli E, Ward H, Forslund HB. Meal patterns across ten European countries - results from the European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study. Public Health Nutr 2016; 19:2769-80. [PMID: 27194183 PMCID: PMC10271196 DOI: 10.1017/s1368980016001142] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 03/23/2016] [Accepted: 04/14/2016] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To characterize meal patterns across ten European countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study. DESIGN Cross-sectional study utilizing dietary data collected through a standardized 24 h diet recall during 1995-2000. Eleven predefined intake occasions across a 24 h period were assessed during the interview. In the present descriptive report, meal patterns were analysed in terms of daily number of intake occasions, the proportion reporting each intake occasion and the energy contributions from each intake occasion. SETTING Twenty-seven centres across ten European countries. SUBJECTS Women (64 %) and men (36 %) aged 35-74 years (n 36 020). RESULTS Pronounced differences in meal patterns emerged both across centres within the same country and across different countries, with a trend for fewer intake occasions per day in Mediterranean countries compared with central and northern Europe. Differences were also found for daily energy intake provided by lunch, with 38-43 % for women and 41-45 % for men within Mediterranean countries compared with 16-27 % for women and 20-26 % for men in central and northern European countries. Likewise, a south-north gradient was found for daily energy intake from snacks, with 13-20 % (women) and 10-17 % (men) in Mediterranean countries compared with 24-34 % (women) and 23-35 % (men) in central/northern Europe. CONCLUSIONS We found distinct differences in meal patterns with marked diversity for intake frequency and lunch and snack consumption between Mediterranean and central/northern European countries. Monitoring of meal patterns across various cultures and populations could provide critical context to the research efforts to characterize relationships between dietary intake and health.
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Affiliation(s)
- E Huseinovic
- Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, Box 459, SE-405 30, Gothenburg, Sweden
| | - A Winkvist
- Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, Box 459, SE-405 30, Gothenburg, Sweden
- Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden
| | - N Slimani
- Dietary Exposure Assessment Group, International Agency for Research on Cancer, Lyon, France
| | - MK Park
- Dietary Exposure Assessment Group, International Agency for Research on Cancer, Lyon, France
| | - H Freisling
- Dietary Exposure Assessment Group, International Agency for Research on Cancer, Lyon, France
| | - H Boeing
- Department of Epidemiology, German Institute of Human Nutrition, Nuthetal, Germany
| | - G Buckland
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - L Schwingshackl
- Department of Epidemiology, German Institute of Human Nutrition, Nuthetal, Germany
| | - E Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, 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, Helsinki, Finland
| | | | - A Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - A Affret
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - MC Boutron-Ruault
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - G Fagherazzi
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - V Katzke
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany
| | - T Kühn
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany
| | - A Naska
- 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, University of Athens Medical School, Athens, Greece
| | - P Orfanos
- 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, University of Athens Medical School, Athens, Greece
| | - A 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, University of Athens Medical School, Athens, Greece
| | - V Pala
- Epidemiology and Prevention Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - D Palli
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute – ISPO, Florence, Italy
| | - F Ricceri
- Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco (TO), Italy
- Unit of Cancer Epidemiology, Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - R Tumino
- Cancer Registry and Histopathology Unit, ‘Civic – M.P. Arezzo’ Hospital, ASP Ragusa, Ragusa, Italy
| | - D Engeset
- Norwegian Food Safety Authority, Head Office, Oslo, Norway
| | - T Enget
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - G Skeie
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - A Barricarte
- Navarra Public Health Institute, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - CB Bonet
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - MD Chirlaque
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain
| | - P Amiano
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Public Health Division of Gipuzkoa, BioDonostia Research Institute, San Sebastian, Spain
| | - JR Quirós
- Public Health Directorate, Asturias, Spain
| | - MJ Sánchez
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - JA Dias
- Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden
| | - I Drake
- Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden
| | - M Wennberg
- Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden
| | - JMA Boer
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - MC Ocké
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - WMM Verschuren
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C Lassale
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - A Perez-Cornago
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - E Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - H Ward
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - H Bertéus Forslund
- Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, Box 459, SE-405 30, Gothenburg, Sweden
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19
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Raaschou-Nielsen O, Beelen R, Wang M, Hoek G, Andersen ZJ, Hoffmann B, Stafoggia M, Samoli E, Weinmayr G, Dimakopoulou K, Nieuwenhuijsen M, Xun WW, Fischer P, Eriksen KT, Sørensen M, Tjønneland A, Ricceri F, de Hoogh K, Key T, Eeftens M, Peeters PH, Bueno-de-Mesquita HB, Meliefste K, Oftedal B, Schwarze PE, Nafstad P, Galassi C, Migliore E, Ranzi A, Cesaroni G, Badaloni C, Forastiere F, Penell J, De Faire U, Korek M, Pedersen N, Östenson CG, Pershagen G, Fratiglioni L, Concin H, Nagel G, Jaensch A, Ineichen A, Naccarati A, Katsoulis M, Trichpoulou A, Keuken M, Jedynska A, Kooter IM, Kukkonen J, Brunekreef B, Sokhi RS, Katsouyanni K, Vineis P. Particulate matter air pollution components and risk for lung cancer. Environ Int 2016; 87:66-73. [PMID: 26641521 DOI: 10.1016/j.envint.2015.11.007] [Citation(s) in RCA: 139] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 11/05/2015] [Accepted: 11/09/2015] [Indexed: 05/06/2023]
Abstract
BACKGROUND Particulate matter (PM) air pollution is a human lung carcinogen; however, the components responsible have not been identified. We assessed the associations between PM components and lung cancer incidence. METHODS We used data from 14 cohort studies in eight European countries. We geocoded baseline addresses and assessed air pollution with land-use regression models for eight elements (Cu, Fe, K, Ni, S, Si, V and Zn) in size fractions of PM2.5 and PM10. We used Cox regression models with adjustment for potential confounders for cohort-specific analyses and random effect models for meta-analysis. RESULTS The 245,782 cohort members contributed 3,229,220 person-years at risk. During follow-up (mean, 13.1 years), 1878 incident cases of lung cancer were diagnosed. In the meta-analyses, elevated hazard ratios (HRs) for lung cancer were associated with all elements except V; none was statistically significant. In analyses restricted to participants who did not change residence during follow-up, statistically significant associations were found for PM2.5 Cu (HR, 1.25; 95% CI, 1.01-1.53 per 5 ng/m(3)), PM10 Zn (1.28; 1.02-1.59 per 20 ng/m(3)), PM10 S (1.58; 1.03-2.44 per 200 ng/m(3)), PM10 Ni (1.59; 1.12-2.26 per 2 ng/m(3)) and PM10 K (1.17; 1.02-1.33 per 100 ng/m(3)). In two-pollutant models, associations between PM10 and PM2.5 and lung cancer were largely explained by PM2.5 S. CONCLUSIONS This study indicates that the association between PM in air pollution and lung cancer can be attributed to various PM components and sources. PM containing S and Ni might be particularly important.
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Affiliation(s)
- O Raaschou-Nielsen
- Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Environmental Science, Aarhus University, Roskilde, Denmark.
| | - R Beelen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - M Wang
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - G Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Z J Andersen
- Danish Cancer Society Research Center, Copenhagen, Denmark; Center for Epidemiology and Screening, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - B Hoffmann
- IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany; University of Düsseldorf, Düsseldorf, Germany
| | - M Stafoggia
- Department of Epidemiology, Lazio Regional Health Service, Local Health Unit ASL RME, Rome, Italy
| | - E Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - G Weinmayr
- IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany; University of Düsseldorf, Düsseldorf, Germany; Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - K Dimakopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - M Nieuwenhuijsen
- Center for Research in Environmental Epidemiology, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain
| | - W W Xun
- MRC-HPA Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - P Fischer
- National Institute for Public Health and the Environment, Center for Sustainability and Environmental Health, Bilthoven, The Netherlands
| | - K T Eriksen
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - M Sørensen
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - A Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - F Ricceri
- Unit of Cancer Epidemiology, AO Citta' della Salute e della Scienza, University of Turin and Center for Cancer Prevention, Turin, Italy
| | - K de Hoogh
- MRC-HPA Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom; Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - T Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - M Eeftens
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands; Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - P H Peeters
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands; School of Public Health, Imperial College London, London, United Kingdom
| | - H B Bueno-de-Mesquita
- Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment, Bilthoven, The Netherlands; Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom; Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - K Meliefste
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - B Oftedal
- Norwegian Institute of Public Health, Oslo, Norway
| | - P E Schwarze
- Norwegian Institute of Public Health, Oslo, Norway
| | - P Nafstad
- Norwegian Institute of Public Health, Oslo, Norway; Institute of Health and Society, University of Oslo, Oslo, Norway
| | - C Galassi
- Unit of Cancer Epidemiology, AO Citta' della Salute e della Scienza, University of Turin and Center for Cancer Prevention, Turin, Italy
| | - E Migliore
- Unit of Cancer Epidemiology, AO Citta' della Salute e della Scienza, University of Turin and Center for Cancer Prevention, Turin, Italy
| | - A Ranzi
- Environmental Health Reference Centre, Regional Agency for Environmental Prevention of Emilia-Romagna, Modena, Italy
| | - G Cesaroni
- Department of Epidemiology, Lazio Regional Health Service, Local Health Unit ASL RME, Rome, Italy
| | - C Badaloni
- Department of Epidemiology, Lazio Regional Health Service, Local Health Unit ASL RME, Rome, Italy
| | - F Forastiere
- Department of Epidemiology, Lazio Regional Health Service, Local Health Unit ASL RME, Rome, Italy
| | - J Penell
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - U De Faire
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - M Korek
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - N Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - C-G Östenson
- Department of Molecular Medicine and Surgery, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - G Pershagen
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - L Fratiglioni
- Aging Research Centre, Department of Neurobiology, Care Sciences and Society, Karolinska Institute and Stockholm University, Stockholm, Sweden
| | - H Concin
- Agency for Preventive and Social Medicine, Bregenz, Austria
| | - G Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany; Agency for Preventive and Social Medicine, Bregenz, Austria
| | - A Jaensch
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - A Ineichen
- Human Genetics Foundation, Molecular and Genetic Epidemiology Unit, Turin, Italy
| | - A Naccarati
- Human Genetics Foundation, Molecular and Genetic Epidemiology Unit, Turin, Italy
| | | | | | - M Keuken
- Netherlands Organisation for Applied Scientific Research, Utrecht, The Netherlands
| | - A Jedynska
- Netherlands Organisation for Applied Scientific Research, Utrecht, The Netherlands
| | - I M Kooter
- Netherlands Organisation for Applied Scientific Research, Utrecht, The Netherlands
| | - J Kukkonen
- Finnish Meteorological Institute, Helsinki, Finland
| | - B Brunekreef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - R S Sokhi
- Centre for Atmospheric and Instrumentation Research, University of Hertfordshire, College Lane, Hatfield, United Kingdom
| | - K Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Department of Primary Care and Public Health Sciences and Environmental Research Group, King's College London, United Kingdom
| | - P Vineis
- MRC-HPA Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
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20
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Buckland G, Travier N, Huerta JM, Bueno-de-Mesquita HBA, Siersema PD, Skeie G, Weiderpass E, Engeset D, Ericson U, Ohlsson B, Agudo A, Romieu I, Ferrari P, Freisling H, Colorado-Yohar S, Li K, Kaaks R, Pala V, Cross AJ, Riboli E, Trichopoulou A, Lagiou P, Bamia C, Boutron-Ruault MC, Fagherazzi G, Dartois L, May AM, Peeters PH, Panico S, Johansson M, Wallner B, Palli D, Key TJ, Khaw KT, Ardanaz E, Overvad K, Tjønneland A, Dorronsoro M, Sánchez MJ, Quirós JR, Naccarati A, Tumino R, Boeing H, Gonzalez CA. Healthy lifestyle index and risk of gastric adenocarcinoma in the EPIC cohort study. Int J Cancer 2015; 137:598-606. [PMID: 25557932 DOI: 10.1002/ijc.29411] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 09/29/2014] [Accepted: 09/30/2014] [Indexed: 12/21/2022]
Abstract
Several modifiable lifestyle factors, including smoking, alcohol, certain dietary factors and weight are independently associated with gastric cancer (GC); however, their combined impact on GC risk is unknown. We constructed a healthy lifestyle index to investigate the joint influence of these behaviors on GC risk within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. The analysis included 461,550 participants (662 first incident GC cases) with a mean follow-up of 11.4 years. A healthy lifestyle index was constructed, assigning 1 point for each healthy behavior related to smoking status, alcohol consumption and diet quality (represented by the Mediterranean diet) for assessing overall GC and also body mass index for cardia GC and 0 points otherwise. Risk of GC was calculated using Cox proportional hazards regression models while adjusting for relevant confounders. The highest versus lowest score in the healthy lifestyle index was associated with a significant lower risk of GC, by 51% overall (HR 0.49 95% CI 0.35, 0.70), by 77% for cardia GC (HR 0.23 95% CI 0.08, 0.68) and by 47% for noncardia GC (HR 0.53 (95% CI 0.32, 0.87), p-trends<0.001. Population attributable risk calculations showed that 18.8% of all GC and 62.4% of cardia GC cases could have been prevented if participants in this population had followed the healthy lifestyle behaviors of this index. Adopting several healthy lifestyle behaviors including not smoking, limiting alcohol consumption, eating a healthy diet and maintaining a normal weight is associated with a large decreased risk of GC.
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Affiliation(s)
- G Buckland
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - N Travier
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - J M Huerta
- Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain
- CIBER Epidemiology and Public Health CIBERESP, Melchor Fernández Almagro, Madrid, Spain
| | - H B As Bueno-de-Mesquita
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands
- The School of Public Health, Imperial College London, London, United Kingdom
| | - P D Siersema
- Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands
| | - G Skeie
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø - the Arctic University of Norway, Tromsø, Norway
| | - E Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø - the Arctic University of Norway, Tromsø, Norway
- Department of Research, Cancer Registry of Norway, Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Samfundet Folkhälsan, Helsinki, Finland
| | - D Engeset
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø - the Arctic University of Norway, Tromsø, Norway
| | - U Ericson
- Diabetes and Cardiovascular Disease, Genetic Epidemiology Department of Clinical Sciences, Malmö Lund University, Clinical Research Center 60:13, Malmö, Sweden
| | - B Ohlsson
- Department of Clinical Sciences, Skåne University Hospital, Malmö, Sweden
- Division of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - A Agudo
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - I Romieu
- International Agency for Research on Cancer (IARC-WHO), Lyon Cedex 08, France
| | - P Ferrari
- International Agency for Research on Cancer (IARC-WHO), Lyon Cedex 08, France
| | - H Freisling
- International Agency for Research on Cancer (IARC-WHO), Lyon Cedex 08, France
| | - S Colorado-Yohar
- Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain
| | - K Li
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany
| | - R Kaaks
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany
| | - V Pala
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milano, Italy
| | - A J Cross
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, London, United Kingdom
| | - E Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, London, United Kingdom
| | - A Trichopoulou
- Hellenic Health Foundation, Athens, Greece
- Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece
| | - P Lagiou
- Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Goudi, Athens, Greece
- Department of Epidemiology, Harvard School of Public Health, Boston, MA
| | - C Bamia
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Goudi, Athens, Greece
| | - M C Boutron-Ruault
- Inserm, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health Team, Villejuif, France
- University of Paris-Sud, Villejuif, France
- IGR, Villejuif, France
| | - G Fagherazzi
- Inserm, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health Team, Villejuif, France
- University of Paris-Sud, Villejuif, France
- IGR, Villejuif, France
| | - L Dartois
- Inserm, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health Team, Villejuif, France
- University of Paris-Sud, Villejuif, France
- IGR, Villejuif, France
| | - A M May
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - P H Peeters
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - S Panico
- Dipartijmento Di Medicina Clinica E Di Chiruigia, Federico II University, Naples, Itlay
| | - M Johansson
- International Agency for Research on Cancer (IARC-WHO), Lyon Cedex 08, France
- Department for Biobank Research, Umeå University, Umeå, Sweden
| | - B Wallner
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - D Palli
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy
| | - T J Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom
| | - K T Khaw
- University of Cambridge CB2 2QQ and Nick Wareham, Professor and Director of MRC Epidemiology Unit, University of Cambridge, United Kingdom
| | - E Ardanaz
- CIBER Epidemiology and Public Health CIBERESP, Melchor Fernández Almagro, Madrid, Spain
- Navarre Public Health Institute, Pamplona, Spain
| | - K Overvad
- Aarhus University, Department of Public Health, Section for Epidemiology, Aarhus, Denmark
| | - A Tjønneland
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - M Dorronsoro
- CIBER Epidemiology and Public Health CIBERESP, Melchor Fernández Almagro, Madrid, Spain
- Public Health Direction and Biodonostia - Ciberesp, Basque Regional Health Department, San Sebatian, Spain
| | - M J Sánchez
- CIBER Epidemiology and Public Health CIBERESP, Melchor Fernández Almagro, Madrid, Spain
- Escuela Andaluza De Salud Pública, Instituto De Investigación Biosanitaria De Granada (Granada.Ibs), Granada, Spain
| | - J R Quirós
- Public Health Directorate, Oviedo, Spain
| | - A Naccarati
- HuGeF-Human Genetics Foundation, Molecular and Genetic Epidemiology Unit, Torino, Italy
| | - R Tumino
- The Cancer Registry, Azienda Ospedaliera "Civile M.P. Arezzo", Ragusa, Italy
| | - H Boeing
- The German Institute of Human Nutrition, Potsdam-Rehbücke, Germany
| | - C A Gonzalez
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
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21
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Brand JS, Onland-Moret NC, Eijkemans MJC, Tjønneland A, Roswall N, Overvad K, Fagherazzi G, Clavel-Chapelon F, Dossus L, Lukanova A, Grote V, Bergmann MM, Boeing H, Trichopoulou A, Tzivoglou M, Trichopoulos D, Grioni S, Mattiello A, Masala G, Tumino R, Vineis P, Bueno-de-Mesquita HB, Weiderpass E, Redondo ML, Sánchez MJ, Castaño JMH, Arriola L, Ardanaz E, Duell EJ, Rolandsson O, Franks PW, Butt S, Nilsson P, Khaw KT, Wareham N, Travis R, Romieu I, Gunter MJ, Riboli E, van der Schouw YT. Diabetes and onset of natural menopause: results from the European Prospective Investigation into Cancer and Nutrition. Hum Reprod 2015; 30:1491-8. [PMID: 25779698 PMCID: PMC6284789 DOI: 10.1093/humrep/dev054] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 12/05/2014] [Indexed: 01/10/2023] Open
Abstract
STUDY QUESTION Do women who have diabetes before menopause have their menopause at an earlier age compared with women without diabetes? SUMMARY ANSWER Although there was no overall association between diabetes and age at menopause, our study suggests that early-onset diabetes may accelerate menopause. WHAT IS KNOWN ALREADY Today, more women of childbearing age are being diagnosed with diabetes, but little is known about the impact of diabetes on reproductive health. STUDY DESIGN, SIZE, DURATION We investigated the impact of diabetes on age at natural menopause (ANM) in 258 898 women from the European Prospective Investigation into Cancer and Nutrition (EPIC), enrolled between 1992 and 2000. PARTICIPANTS/MATERIALS, SETTING, METHODS Determinant and outcome information was obtained through questionnaires. Time-dependent Cox regression analyses were used to estimate the associations of diabetes and age at diabetes diagnosis with ANM, stratified by center and adjusted for age, smoking, reproductive and diabetes risk factors and with age from birth to menopause or censoring as the underlying time scale. MAIN RESULTS AND THE ROLE OF CHANCE Overall, no association between diabetes and ANM was found (hazard ratio (HR) = 0.94; 95% confidence interval (CI) 0.89-1.01). However, women with diabetes before the age of 20 years had an earlier menopause (10-20 years: HR = 1.43; 95% CI 1.02-2.01, <10 years: HR = 1.59; 95% CI 1.03-2.43) compared with non-diabetic women, whereas women with diabetes at age 50 years and older had a later menopause (HR = 0.81; 95% CI 0.70-0.95). None of the other age groups were associated with ANM. LIMITATIONS, REASONS FOR CAUTION Strengths of the study include the large sample size and the broad set of potential confounders measured. However, results may have been underestimated due to survival bias. We cannot be sure about the sequence of the events in women with a late age at diabetes, as both events then occur in a short period. We could not distinguish between type 1 and type 2 diabetes. WIDER IMPLICATIONS OF THE FINDINGS Based on the literature, an accelerating effect of early-onset diabetes on ANM might be plausible. A delaying effect of late-onset diabetes on ANM has not been reported before, and is not in agreement with recent studies suggesting the opposite association. STUDY FUNDING/COMPETING INTERESTS The coordination of EPIC is financially supported by the European Commission (DG-SANCO) and the International Agency for Research on Cancer. The national cohorts are supported by Danish Cancer Society (Denmark); Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle Générale de l'Education Nationale, Institut National de la Santé et de la Recherche Médicale (INSERM) (France); German Cancer Aid, German Cancer Research Center (DKFZ) and Federal Ministry of Education and Research (BMMF) (Germany); Ministry of Health and Social Solidarity, Stavros Niarchos Foundation and Hellenic Health Foundation (Greece); Italian Association for Research on Cancer (AIRC) and National Research Council (Italy); Dutch Ministry of Public Health, Welfare and Sports (VWS), Netherlands Cancer Registry (NKR), LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund (WCRF), Statistics Netherlands (The Netherlands); ERC-2009-AdG 232997 and Nordforsk, Nordic Centre of Excellence programme on Food, Nutrition and Health (Norway); Health Research Fund (FIS), Regional Governments of Andalucía, Asturias, Basque Country, Murcia (no. 6236) and Navarra, ISCIII RETIC (RD06/0020) (Spain); Swedish Cancer Society, Swedish Scientific Council and Regional Government of Skåne and Västerbotten (Sweden); Cancer Research UK, Medical Research Council, Stroke Association, British Heart Foundation, Department of Health, Food Standards Agency, and Wellcome Trust (UK). None of the authors reported a conflict of interest.
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Affiliation(s)
- J S Brand
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - N C Onland-Moret
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M J C Eijkemans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - N Roswall
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - K Overvad
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - G Fagherazzi
- Inserm, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health Team, F-94805 Villejuif, France
| | - F Clavel-Chapelon
- Inserm, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health Team, F-94805 Villejuif, France
| | - L Dossus
- Inserm, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health Team, F-94805 Villejuif, France
| | - A Lukanova
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany Department of Medical Biosciences, University of Umeå, Umeå, Sweden
| | - V Grote
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - M M Bergmann
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Potsdam, Germany
| | - H Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Potsdam, Germany
| | - A Trichopoulou
- WHO Collaborating Center for Food and Nutrition Policies, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, 75 M. Asias Street, Goudi GR-115 27, Athens, Greece Hellenic Health Foundation, 13 Kaisareias Street, Athens GR-115 27, Greece
| | - M Tzivoglou
- Hellenic Health Foundation, 13 Kaisareias Street, Athens GR-115 27, Greece
| | - D Trichopoulos
- Hellenic Health Foundation, 13 Kaisareias Street, Athens GR-115 27, Greece Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA Bureau of Epidemiologic Research, Academy of Athens, 28 Panepistimiou Street, Athens GR-106 79, Greece
| | - S Grioni
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - A Mattiello
- Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy
| | - G Masala
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy
| | - R Tumino
- Cancer Registry and Histopathology Unit, 'Civic - M.P. Arezzo' Hospital, ASP Ragusa, Italy
| | - P Vineis
- School of Public Health, Imperial College, London, UK HuGeF Foundation, Torino, Italy
| | - H B Bueno-de-Mesquita
- Dt. for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands Dt. of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands Dt. of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, United Kingdom Dt. of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - E Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway Cancer Registry of Norway, Oslo, Norway Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden Samfundet Folkhälsan, Helsinki, Finland
| | | | - M J Sánchez
- Andalusian School of Public Health, Instituto de Investigación Biosanitaria ibs.GRANADA. Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - J M Huerta Castaño
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain
| | - L Arriola
- Public Health Department of Gipuzkoa, Instituto BIO-Donostia, Basque Government, CIBERESP, San Sebastian, Spain
| | - E Ardanaz
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain Navarre Public Health Institute, Pamplona, Spain
| | - E J Duell
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - O Rolandsson
- Department of Public Health and Clinical Medicine, Family Medicine Umeå University, 901 87 Umeå, Sweden
| | - P W Franks
- Department of Clinical Sciences, Genetic & Molecular Epidemiology Unit, Clinical Research Center, Skåne University Hospital, Lund University, Malmö, Sweden Department of Medicine, Umeå University, Umeå, Sweden
| | - S Butt
- Department of Surgery, Institute of Clinical Sciences, Skåne University Hospital, Lund University, Malmö, Sweden
| | - P Nilsson
- Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmo, Sweden
| | - K T Khaw
- University of Cambridge, Cambridge, UK
| | - N Wareham
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - R Travis
- Cancer Epidemiology Unit, University of Oxford, Oxford, UK
| | - I Romieu
- International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - M J Gunter
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - E Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Y T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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22
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Ammitzbøll G, Søgaard K, Karlsen R, Frederiksen K, Tjønneland A, Johansen K, Envold Bidstrup P. Physical activity and survival in patients with breast cancer. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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23
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Zimmermann E, Ängquist LH, Mirza SS, Zhao JH, Chasman DI, Fischer K, Qi Q, Smith AV, Thinggaard M, Jarczok MN, Nalls MA, Trompet S, Timpson NJ, Schmidt B, Jackson AU, Lyytikäinen LP, Verweij N, Mueller-Nurasyid M, Vikström M, Marques-Vidal P, Wong A, Meidtner K, Middelberg RP, Strawbridge RJ, Christiansen L, Kyvik KO, Hamsten A, Jääskeläinen T, Tjønneland A, Eriksson JG, Whitfield JB, Boeing H, Hardy R, Vollenweider P, Leander K, Peters A, van der Harst P, Kumari M, Lehtimäki T, Meirhaeghe A, Tuomilehto J, Jöckel KH, Ben-Shlomo Y, Sattar N, Baumeister SE, Smith GD, Casas JP, Houston DK, März W, Christensen K, Gudnason V, Hu FB, Metspalu A, Ridker PM, Wareham NJ, Loos RJF, Tiemeier H, Sonestedt E, Sørensen TIA. Is the adiposity-associated FTO gene variant related to all-cause mortality independent of adiposity? Meta-analysis of data from 169,551 Caucasian adults. Obes Rev 2015; 16:327-340. [PMID: 25752329 PMCID: PMC4564522 DOI: 10.1111/obr.12263] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 12/12/2014] [Indexed: 11/28/2022]
Abstract
Previously, a single nucleotide polymorphism (SNP), rs9939609, in the FTO gene showed a much stronger association with all-cause mortality than expected from its association with body mass index (BMI), body fat mass index (FMI) and waist circumference (WC). This finding implies that the SNP has strong pleiotropic effects on adiposity and adiposity-independent pathological pathways that leads to increased mortality. To investigate this further, we conducted a meta-analysis of similar data from 34 longitudinal studies including 169,551 adult Caucasians among whom 27,100 died during follow-up. Linear regression showed that the minor allele of the FTO SNP was associated with greater BMI (n = 169,551; 0.32 kg m(-2) ; 95% CI 0.28-0.32, P < 1 × 10(-32) ), WC (n = 152,631; 0.76 cm; 0.68-0.84, P < 1 × 10(-32) ) and FMI (n = 48,192; 0.17 kg m(-2) ; 0.13-0.22, P = 1.0 × 10(-13) ). Cox proportional hazard regression analyses for mortality showed that the hazards ratio (HR) for the minor allele of the FTO SNPs was 1.02 (1.00-1.04, P = 0.097), but the apparent excess risk was eliminated after adjustment for BMI and WC (HR: 1.00; 0.98-1.03, P = 0.662) and for FMI (HR: 1.00; 0.96-1.04, P = 0.932). In conclusion, this study does not support that the FTO SNP is associated with all-cause mortality independently of the adiposity phenotypes.
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Affiliation(s)
- E Zimmermann
- Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospitals, The Capital Region, Copenhagen, Denmark
| | - L H Ängquist
- Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospitals, The Capital Region, Copenhagen, Denmark
| | - S S Mirza
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - J H Zhao
- MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - D I Chasman
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - K Fischer
- Estonian Genome Center, University of Tartu, Tartu, Estonia
| | - Q Qi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, New York, USA
| | - A V Smith
- Icelandic Heart Association, Kopavogur, Iceland.,University of Icelandic, Reykajvik, Iceland
| | - M Thinggaard
- The Danish Aging Research Center and The Danish Twin Registry, Epidemiology, Biostatistics and Biodemography, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - M N Jarczok
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - M A Nalls
- Laboratory of Neurogenetics, Intramural Research Program, National Institute on Aging, Bethesda, Maryland, USA
| | - S Trompet
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - N J Timpson
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK
| | - B Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany
| | - A U Jackson
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan, Ann Arbor, Michigan, USA
| | - L P Lyytikäinen
- Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland.,School of Medicine, University of Tampere, Tampere, Finland
| | - N Verweij
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M Mueller-Nurasyid
- Department of Medicine I, Ludwig-Maximilians-University, Munich, Germany.,Institute of Medical Informatics, Biometry and Epidemiology, Chair of Genetic Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany.,Institute of Genetic Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.,Deutsches Forschungszentrum für Herz-Kreislauferkrankungen (DZHK), Partner site Munich Heart Alliance, Munich, Germany
| | - M Vikström
- Karolinska Institutet, Institute of Environmental Medicine, Unit of Cardiovascular Epidemiology, Stockholm, Sweden
| | - P Marques-Vidal
- Department of Internal Medicine, Internal Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - A Wong
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - K Meidtner
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany.,Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany
| | - R P Middelberg
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - R J Strawbridge
- Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - L Christiansen
- The Danish Aging Research Center and The Danish Twin Registry, Epidemiology, Biostatistics and Biodemography, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - K O Kyvik
- Institute of Regional Health Services Research and Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - A Hamsten
- Atherosclerosis Research Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - T Jääskeläinen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - A Tjønneland
- Danish Cancer Society Research Centre, Copenhagen, Denmark
| | - J G Eriksson
- Diabetes Prevention Unit, Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland.,Department of General Practice and Primary Health Care, Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland.,Folkhälsan Research Centre, Helsinki, Finland.,Unit of General Practice, Helsinki University Central Hospital, Helsinki, Finland
| | - J B Whitfield
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - H Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany
| | - R Hardy
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - P Vollenweider
- Department of Internal Medicine, Internal Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - K Leander
- Karolinska Institutet, Institute of Environmental Medicine, Unit of Cardiovascular Epidemiology, Stockholm, Sweden
| | - A Peters
- Deutsches Forschungszentrum für Herz-Kreislauferkrankungen (DZHK), Partner site Munich Heart Alliance, Munich, Germany.,Institute of Epidemiology II, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - P van der Harst
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Genetic, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Durrer Center for Cardiogenetic Research, ICIN-Neterlands Heart Institute, Utrecht, The Netherlands
| | - M Kumari
- Department of Epidemiology and Public Health, University College London, London, UK.,ISER, University of Essex, Colchester, UK
| | - T Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland.,School of Medicine, University of Tampere, Tampere, Finland
| | - A Meirhaeghe
- Inserm, U744, Institut Pasteur de Lille, University Lille Nord de France, Lille, France
| | - J Tuomilehto
- Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland.,Centre for Vascular Prevention, Danube-University Krems, Krems, Austria.,Instituto de Investigacion Sanitaria del Hospital Universario LaPaz (IdiPAZ), Madrid, Spain.,Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - K-H Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany
| | - Y Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - N Sattar
- BHF Glasgow Cardiovascular Research Centre, Faculty of Medicine, Glasgow, UK
| | - S E Baumeister
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - G Davey Smith
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK
| | - J P Casas
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,Institute of Cardiovascular Science, University College London, London, UK
| | - D K Houston
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - W März
- Vth Department of Medicine (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology), Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany.,Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.,Synlab Academy, Synlab Services GmbH, Mannheim, Germany
| | - K Christensen
- The Danish Aging Research Center and The Danish Twin Registry, Epidemiology, Biostatistics and Biodemography, Institute of Public Health, University of Southern Denmark, Odense, Denmark.,Department of Clinical Genetics, Odense University Hospital, Odense, Denmark.,Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - V Gudnason
- Icelandic Heart Association, Kopavogur, Iceland.,University of Icelandic, Reykajvik, Iceland
| | - F B Hu
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA.,Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
| | - A Metspalu
- Estonian Genome Center, University of Tartu, Tartu, Estonia
| | - P M Ridker
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - N J Wareham
- MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - R J F Loos
- MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.,The Charles Bronfman Institute for Personalized Medicine, The Mindich Child Health and Development Institute, The Genetics of Obesity and Related Metabolic Traits Program, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - H Tiemeier
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry, Erasmus Medical Centre, Rotterdam, The Netherlands.,Department of Psychiatry, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - E Sonestedt
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - T I A Sørensen
- Institute of Preventive Medicine, Bispebjerg and Frederiksberg Hospitals, The Capital Region, Copenhagen, Denmark.,MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK.,Novo Nordisk Foundation Centre for Basic Metabolic Research, Section on Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
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24
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Li K, Hüsing A, Fortner RT, Tjønneland A, Hansen L, Dossus L, Chang-Claude J, Bergmann M, Steffen A, Bamia C, Trichopoulos D, Trichopoulou A, Palli D, Mattiello A, Agnoli C, Tumino R, Onland-Moret NC, Peeters PH, Bueno-de-Mesquita HB, Gram IT, Weiderpass E, Sánchez-Cantalejo E, Chirlaque MD, Duell EJ, Ardanaz E, Idahl A, Lundin E, Khaw KT, Travis RC, Merritt MA, Gunter MJ, Riboli E, Ferrari P, Terry K, Cramer D, Kaaks R. An epidemiologic risk prediction model for ovarian cancer in Europe: the EPIC study. Br J Cancer 2015; 112:1257-65. [PMID: 25742479 PMCID: PMC4385951 DOI: 10.1038/bjc.2015.22] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 12/22/2014] [Accepted: 12/29/2014] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Ovarian cancer has a high case-fatality ratio, largely due to late diagnosis. Epidemiologic risk prediction models could help identify women at increased risk who may benefit from targeted prevention measures, such as screening or chemopreventive agents. METHODS We built an ovarian cancer risk prediction model with epidemiologic risk factors from 202,206 women in the European Prospective Investigation into Cancer and Nutrition study. RESULTS Older age at menopause, longer duration of hormone replacement therapy, and higher body mass index were included as increasing ovarian cancer risk, whereas unilateral ovariectomy, longer duration of oral contraceptive use, and higher number of full-term pregnancies were decreasing risk. The discriminatory power (overall concordance index) of this model, as examined with five-fold cross-validation, was 0.64 (95% confidence interval (CI): 0.57, 0.70). The ratio of the expected to observed number of ovarian cancer cases occurring in the first 5 years of follow-up was 0.90 (293 out of 324, 95% CI: 0.81-1.01), in general there was no evidence for miscalibration. CONCLUSION Our ovarian cancer risk model containing only epidemiological data showed modest discriminatory power for a Western European population. Future studies should consider adding informative biomarkers to possibly improve the predictive ability of the model.
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Affiliation(s)
- K Li
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - A Hüsing
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - R T Fortner
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - A Tjønneland
- The Danish Cancer Society Research Center, Copenhagen, Denmark
| | - L Hansen
- The Danish Cancer Society Research Center, Copenhagen, Denmark
| | - L Dossus
- Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health team, F-94805 Villejuif, France
- University Paris Sud, UMRS 1018, F-94805 Villejuif, France
| | - J Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - M Bergmann
- German Institute of Human Nutrition in Potsdam-Rehbruecke, Potsdam, Germany
| | - A Steffen
- German Institute of Human Nutrition in Potsdam-Rehbruecke, Potsdam, Germany
| | - C Bamia
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - D Trichopoulos
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
- Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece
- Hellenic Health Foundation, Athens, Greece
| | - A Trichopoulou
- Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece
- Hellenic Health Foundation, Athens, Greece
| | - D Palli
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute—ISPO, Florence, Italy
| | - A Mattiello
- Dipartimento di Medicina Clinica e Chirurgia, University of Naples Federico II, Naples, Italy
| | - C Agnoli
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - R Tumino
- Cancer Registry and Histopathology Unit, ‘Civic—M.P. Arezzo' Hospital, Ragusa, Italy
| | - N C Onland-Moret
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P H Peeters
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - 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
| | - I T Gram
- Department of Community Medicine, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway
| | - E Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway
- Department of Research, Cancer Registry of Norway, Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - E Sánchez-Cantalejo
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria de Granada (Granada.ibs), Granada, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - M-D Chirlaque
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Authority, Murcia, Spain
| | - E J Duell
- Unit of Nutrition, Environment and Cancer Epidemiology Research Program, Bellvitge Biomedical Research Institute (IDIBELL), Catalan Institute of Oncology (ICO), Barcelona, Spain
| | - E Ardanaz
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Navarre Public Health Institute, Pamplona, Spain
| | - A Idahl
- Department of Clinical Sciences, Obstetrics and Gynecology and Department of Public Health and Clinical Medicine, Nutritional Research Umeå University, Umeå, Sweden
| | - E Lundin
- Department of Medical Biosciences, Pathology Umeå University, Umeå, Sweden
| | - K-T Khaw
- University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - R C Travis
- Cancer Epidemiology Unit, Nuffield Department of Population Health University of Oxford, Oxford, UK
| | - M A Merritt
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK
| | - M J Gunter
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK
| | - E Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK
| | - P Ferrari
- International Agency for Research on Cancer, Lyon, France
| | - K Terry
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
- Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - D Cramer
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
- Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - R Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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25
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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26
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de Batlle J, Ferrari P, Chajes V, Park JY, Slimani N, McKenzie F, Overvad K, Roswall N, Tjønneland A, Boutron-Ruault MC, Clavel-Chapelon F, Fagherazzi G, Katzke V, Kaaks R, Bergmann MM, Trichopoulou A, Lagiou P, Trichopoulos D, Palli D, Sieri S, Panico S, Tumino R, Vineis P, Bueno-de-Mesquita HB, Peeters PH, Hjartåker A, Engeset D, Weiderpass E, Sánchez S, Travier N, Sánchez MJ, Amiano P, Chirlaque MD, Barricarte Gurrea A, Khaw KT, Key TJ, Bradbury KE, Ericson U, Sonestedt E, Van Guelpen B, Schneede J, Riboli E, Romieu I. Dietary folate intake and breast cancer risk: European prospective investigation into cancer and nutrition. J Natl Cancer Inst 2015; 107:367. [PMID: 25505228 DOI: 10.1093/jnci/dju367] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND There is limited evidence on the association between dietary folate intake and the risk of breast cancer (BC) by hormone receptor expression in the tumors. We investigated the relationship between dietary folate and BC risk using data from the European Prospective Investigation into Cancer and Nutrition (EPIC). METHODS A total of 367993 women age 35 to 70 years were recruited in 10 European countries. During a median follow-up of 11.5 years, 11575 women with BC were identified. Dietary folate intake was estimated from country-specific dietary questionnaires. Cox proportional hazards regression models were used to quantify the association between dietary variables and BC risk. BC tumors were classified by receptor status. Subgroup analyses were performed by menopausal status and alcohol intake. Intake of other B vitamins was considered. All statistical tests were two-sided. RESULTS A borderline inverse association was observed between dietary folate and BC risk (hazard ratio comparing top vs bottom quintile [HRQ5-Q1] = 0.92, 95% CI = 0.83 to 1.01, P trend = .037). In premenopausal women, we observed a statistically significant trend towards lower risk in estrogen receptor-negative BC (HRQ5-Q1 = 0.66, 95% CI = 0.45 to 0.96, P trend = .042) and progesterone receptor-negative BC (HRQ5-Q1 = 0.70, 95% CI = 0.51 to 0.97, P trend = .021). No associations were found in postmenopausal women. A 14% reduction in BC risk was observed when comparing the highest with the lowest dietary folate tertiles in women having a high (>12 alcoholic drinks/week) alcohol intake (HRT3-T1 = 0.86, 95% CI = 0.75 to 0.98, P interaction = .035). CONCLUSIONS Higher dietary folate intake may be associated with a lower risk of sex hormone receptor-negative BC in premenopausal women.
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Affiliation(s)
- J de Batlle
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - P Ferrari
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - V Chajes
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - J Y Park
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - N Slimani
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - F McKenzie
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - K Overvad
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - N Roswall
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - A Tjønneland
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - M C Boutron-Ruault
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - F Clavel-Chapelon
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - G Fagherazzi
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - V Katzke
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - R Kaaks
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - M M Bergmann
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - A Trichopoulou
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - P Lagiou
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - D Trichopoulos
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - D Palli
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - S Sieri
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - S Panico
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - R Tumino
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - P Vineis
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - H B Bueno-de-Mesquita
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - P H Peeters
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - A Hjartåker
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - D Engeset
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - E Weiderpass
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - S Sánchez
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - N Travier
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - M J Sánchez
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - P Amiano
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - M D Chirlaque
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - A Barricarte Gurrea
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - K T Khaw
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - T J Key
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - K E Bradbury
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - U Ericson
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - E Sonestedt
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - B Van Guelpen
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - J Schneede
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - E Riboli
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
| | - I Romieu
- International Agency for Research on Cancer (IARC), Lyon, France (JdB, PF, VC, JYP, NS, FM, IR); Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark (KO); Danish Cancer Society Research Center, Copenhagen, Denmark (NR, AT); Inserm, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France (MCBR, FCC, GF); Université Paris Sud, Villejuif, France (MCBR, FCC, GF); Institute Gustave Roussy, Villejuif, France (MCBR, FCC, GF); Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (VK, RK); Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany (MMB); Hellenic Health Foundation, Athens, Greece (AT, DT); Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece (PL); Department of Epidemiology, Harvard School of Public Health, Boston, MA (PL, DT); Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece (PL, DT); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy (DP); Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy (SSi); Dipartimento di medicina clinica e chirurgia, Federico II University, Naples, Italy (SP); Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, Ragusa, Italy (RT); Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK (PV, HBBdM, PHP, ER); HuGeF Foundation, Torino, Italy (PV); National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands (HBBdM); Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands (HBBdM); Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands (PHP); Department of Nutrition, Institute of Basic Medical
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27
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Schmidt JA, Gorst-Rasmussen A, Nyström PW, Christensen JH, Schmidt EB, Dethlefsen C, Tjønneland A, Overvad K, Dahm CC. Baseline patterns of adipose tissue fatty acids and long-term risk of breast cancer: a case-cohort study in the Danish cohort Diet, Cancer and Health. Eur J Clin Nutr 2014; 68:1088-94. [PMID: 24642780 DOI: 10.1038/ejcn.2014.28] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 12/23/2013] [Accepted: 01/26/2014] [Indexed: 01/10/2023]
Abstract
BACKGROUND/OBJECTIVES The evidence regarding fatty acids and breast cancer risk is inconclusive. Adipose tissue fatty acids can be used as biomarkers of fatty acid intake and of endogenous fatty acid exposure. Fatty acids in adipose tissue are correlated owing to common dietary sources and shared metabolic pathways, which group fatty acids into naturally occurring patterns. We aimed to prospectively investigate associations between adipose tissue fatty acid patterns and long-term risk of total breast cancer and breast cancer subtypes characterised by oestrogen and progesterone receptor status (ER and PR). SUBJECTS/METHODS This case-cohort study was based on data from the Danish cohort Diet, Cancer and Health. At baseline, a fat biopsy and information on lifestyle and reproductive factors were collected. From the 31 original fatty acids measured, patterns of fatty acids were identified using the treelet transform. During a median follow-up of 5.3 years, 474 breast cancer cases were identified. Hazard ratios and 95% confidence intervals of risk of total breast cancer and of subtypes according to quintiles of factor score were determined by weighted Cox proportional hazards regression. RESULTS After adjustment for potential confounders, factor scores for the seven patterns identified by the treelet transform were not associated with risk of total breast cancer, nor with risk of ER+, ER-, PR+ or PR- tumours. CONCLUSIONS No clear associations between the patterns of fatty acids at baseline and long-term risk of total breast cancer or ER+, ER-, PR+ or PR- tumours were observed.
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Affiliation(s)
- J A Schmidt
- 1] Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK [2] Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - A Gorst-Rasmussen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - P W Nyström
- Department of Oncology, University Hospital of Uppsala, Uppsala, Sweden
| | - J H Christensen
- Department of Nephrology, Aalborg University Hospital, Aalborg, Denmark
| | - E B Schmidt
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - C Dethlefsen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - A Tjønneland
- Diet, Genes and Environment Unit, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - K Overvad
- 1] Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark [2] Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - C C Dahm
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
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28
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Obón-Santacana M, Kaaks R, Slimani N, Lujan-Barroso L, Freisling H, Ferrari P, Dossus L, Chabbert-Buffet N, Baglietto L, Fortner RT, Boeing H, Tjønneland A, Olsen A, Overvad K, Menéndez V, Molina-Montes E, Larrañaga N, Chirlaque MD, Ardanaz E, Khaw KT, Wareham N, Travis RC, Lu Y, Merritt MA, Trichopoulou A, Benetou V, Trichopoulos D, Saieva C, Sieri S, Tumino R, Sacerdote C, Galasso R, Bueno-de-Mesquita HB, Wirfält E, Ericson U, Idahl A, Ohlson N, Skeie G, Gram IT, Weiderpass E, Onland-Moret NC, Riboli E, Duell EJ. Dietary intake of acrylamide and endometrial cancer risk in the European Prospective Investigation into Cancer and Nutrition cohort. Br J Cancer 2014; 111:987-97. [PMID: 24937665 PMCID: PMC4150262 DOI: 10.1038/bjc.2014.328] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 05/12/2014] [Accepted: 05/14/2014] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Three prospective studies have evaluated the association between dietary acrylamide intake and endometrial cancer (EC) risk with inconsistent results. The objective of this study was to evaluate the association between acrylamide intake and EC risk: for overall EC, for type-I EC, and in never smokers and never users of oral contraceptives (OCs). Smoking is a source of acrylamide, and OC use is a protective factor for EC risk. METHODS Cox regression was used to estimate hazard ratios (HRs) for the association between acrylamide intake and EC risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Acrylamide intake was estimated from the EU acrylamide monitoring database, which was matched with EPIC questionnaire-based food consumption data. Acrylamide intake was energy adjusted using the residual method. RESULTS No associations were observed between acrylamide intake and overall EC (n=1382) or type-I EC risk (n=627). We observed increasing relative risks for type-I EC with increasing acrylamide intake among women who both never smoked and were non-users of OCs (HRQ5vsQ1: 1.97, 95% CI: 1.08-3.62; likelihood ratio test (LRT) P-value: 0.01, n=203). CONCLUSIONS Dietary intake of acrylamide was not associated with overall or type-I EC risk; however, positive associations with type I were observed in women who were both non-users of OCs and never smokers.
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Affiliation(s)
- M Obón-Santacana
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO-IDIBELL), Avda Gran Via Barcelona 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
| | - R Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, Heidelberg 69120, Germany
| | - N Slimani
- Dietary Exposure Assessment Group, International Agency for Research on Cancer, 150 Cours Albert Thomas, Lyon 69372, France
| | - L Lujan-Barroso
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO-IDIBELL), Avda Gran Via Barcelona 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
| | - H Freisling
- Dietary Exposure Assessment Group, International Agency for Research on Cancer, 150 Cours Albert Thomas, Lyon 69372, France
| | - P Ferrari
- Nutritional Epidemiology Group, International Agency for Research on Cancer, 150 Cours Albert Thomas, Lyon 69372, France
| | - L Dossus
- Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health team, F-94805 Villejuif, France
- Paris-Sud University, UMRS 1018, F-94805 Villejuif, France
- Institut Gustave Roussy, F-94805 Villejuif, France
| | - N Chabbert-Buffet
- Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health team, F-94805 Villejuif, France
- Paris-Sud University, UMRS 1018, F-94805 Villejuif, France
- Institut Gustave Roussy, F-94805 Villejuif, France
- Obstetrics and Gynecology Department AP-HP, Hopital Tenon, F-75020 Paris, France
| | - L Baglietto
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, VIC, Australia
- Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, The University of Melbourne, Melbourne, VIC, Australia
| | - R T Fortner
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, Heidelberg 69120, Germany
| | - H Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Arthur-Scheunert-Allee 114/116, Nuthetal 14558, Germany
| | - A Tjønneland
- Danish Cancer Society Research Center, Strandboulevarden 49, Copenhagen 2100, Denmark
| | - A Olsen
- Danish Cancer Society Research Center, Strandboulevarden 49, Copenhagen 2100, Denmark
| | - K Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, Nordre Ringgade 1, Aarhus 8000, Denmark
| | - V Menéndez
- Public Health and Participation Directorate, Ciriaco Miguel Vigil 9, Asturias 33009, Spain
| | - E Molina-Montes
- CIBER Epidemiology and Public Health CIBERESP, Melchor Fernández Almagro 3-5, Madrid 28029, Spain
| | - N Larrañaga
- CIBER Epidemiology and Public Health CIBERESP, Melchor Fernández Almagro 3-5, Madrid 28029, Spain
- Public Health Division of Gipuzkoa-BIODONOSTIA, Basque Regional Health Department, Avda. Navarra, 4, San Sebastian 20013, Spain
| | - M-D Chirlaque
- CIBER Epidemiology and Public Health CIBERESP, Melchor Fernández Almagro 3-5, Madrid 28029, Spain
- Department of Epidemiology, Murcia Regional Health Authority, Ronda de Levante, 11, Murcia 30008, Spain
| | - E Ardanaz
- CIBER Epidemiology and Public Health CIBERESP, Melchor Fernández Almagro 3-5, Madrid 28029, Spain
- Navarre Public Health Institute, Polígono de Landaben C/F, Pamplona 31012, Spain
| | - K-T Khaw
- University of Cambridge School of Clinical Medicine, Robinson Way, Cambridge CB2 0SR, UK
| | - N Wareham
- MRC Epidemiology Unit, University of Cambridge, 184 Hills Road, Cambridge CB2 8PQ, UK
| | - R C Travis
- Cancer Epidemiology Unit, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK
| | - Y Lu
- Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK
| | - M A Merritt
- Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK
| | - A Trichopoulou
- Hellenic Health Foundation, 13 Kaisareias Street, Athens GR-115 27, Greece
- Bureau of Epidemiologic Research, Academy of Athens, 23 Alexandroupoleos Street, Athens GR-115 27, Greece
| | - V Benetou
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, 75M. Asias Street, Goudi GR-115 27, Athens, Greece
| | - D Trichopoulos
- Hellenic Health Foundation, 13 Kaisareias Street, Athens GR-115 27, Greece
- Bureau of Epidemiologic Research, Academy of Athens, 23 Alexandroupoleos Street, Athens GR-115 27, Greece
- Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - C Saieva
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute—ISPO, Ponte Nuovo, Via delle Oblate n.2, Florence 50141, Italy
| | - S Sieri
- Epidemiology and Prevention Unit, Fondazione IRCSS Istituto Nazionale dei Tumori, Via Venezian, 1, Milano 20133, Italy
| | - R Tumino
- Cancer Registry and Histopathology Unit, "Civic-M.P.Arezzo" Hospital, Via Civile, Ragusa 97100, Italy
| | - C Sacerdote
- Unit of Cancer Epidemiology, AO Citta' della Salute e della Scienza-University of Turin and Center for Cancer Prevention (CPO-Piemonte), Via Santena 7, 10126 Turin, Italy
- Human Genetics Foundation (HuGeF), Via Nizza 52, 10126 Turin, Italy
| | - R Galasso
- Unit of Clinical Epidemiology, Biostatistics and Cancer Registry IRCCS, Referral Cancer Center of Basilicata, Rionero in Vulture (Pz), Italy
| | - H B Bueno-de-Mesquita
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Department of Gastroenterology and Hepatology, University Medical Centre, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
- The School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK
| | - E Wirfält
- Department of Clinical Sciences, Nutrition Epidemiology, Lund University, Box 117, Malmö 205 02, Sweden
| | - U Ericson
- Department of Clinical Sciences, Diabetes and Cardiovascular Disease, Genetic Epidemiology, Lund University, Clinical Research Centre, Box 117, Malmö 205 02, Sweden
| | - A Idahl
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, 1A, 9 tr, Kirurgcentrum, 952, Umeå 901 85, Sweden
- Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, 1A, 9 tr, Kirurgcentrum, 952, Umeå 901 85, Sweden
| | - N Ohlson
- Departament of Medical Biosciences, Pathology, Umeå University, 1A, 9 tr, Kirurgcentrum, 952, Umeå 901 85, Sweden
| | - G Skeie
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Breivika N-9037, Norway
| | - I T Gram
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Breivika N-9037, Norway
| | - E Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Breivika N-9037, Norway
- Department of Research, Cancer Registry of Norway, P.O. box 5313 Majorstuen Oslo, N-0304 Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Box 281, Stockholm 171 77, Sweden
- Public Health Research Center, Public Health Association, Topeliusgatan 20 (PB 211), 00250 Helsinki, Finland
| | - N C Onland-Moret
- Julius Center for Health Sciences and Primary Care, University Medical Center, Huispost Str. 6.131, 3508GA Utrecht, The Netherlands
| | - E Riboli
- Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK
| | - E J Duell
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO-IDIBELL), Avda Gran Via Barcelona 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain
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Nitter M, Norgård B, de Vogel S, Eussen SJPM, Meyer K, Ulvik A, Ueland PM, Nygård O, Vollset SE, Bjørge T, Tjønneland A, Hansen L, Boutron-Ruault M, Racine A, Cottet V, Kaaks R, Kühn T, Trichopoulou A, Bamia C, Naska A, Grioni S, Palli D, Panico S, Tumino R, Vineis P, Bueno-de-Mesquita HB, van Kranen H, Peeters PH, Weiderpass E, Dorronsoro M, Jakszyn P, Sánchez M, Argüelles M, Huerta JM, Barricarte A, Johansson M, Ljuslinder I, Khaw K, Wareham N, Freisling H, Duarte-Salles T, Stepien M, Gunter MJ, Riboli E. Plasma methionine, choline, betaine, and dimethylglycine in relation to colorectal cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC). Ann Oncol 2014; 25:1609-15. [PMID: 24827130 DOI: 10.1093/annonc/mdu185] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Disturbances in one carbon metabolism may contribute to carcinogenesis by affecting methylation and synthesis of DNA. Choline and its oxidation product betaine are involved in this metabolism and can serve as alternative methyl group donors when folate status is low. PATIENTS AND METHODS We conducted a case-control study nested within the European Prospective Investigation into Cancer and Nutrition (EPIC), to investigate plasma concentrations of the methyl donors methionine, choline, betaine (trimethylglycine), and dimethylglycine (DMG) in relation to colorectal cancer (CRC) risk. Our study included 1367 incident CRC cases (965 colon and 402 rectum) and 2323 controls matched by gender, age group, and study center. Multivariate-adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) for CRC risk were estimated by conditional logistic regression, comparing the fifth to the first quintile of plasma concentrations. RESULTS Overall, methionine (OR: 0.79, 95% CI: 0.63-0.99, P-trend = 0.05), choline (OR: 0.77, 95% CI: 0.60-0.99, P-trend = 0.07), and betaine (OR: 0.85, 95% CI: 0.66-1.09, P-trend = 0.06) concentrations were inversely associated with CRC risk of borderline significance. In participants with folate concentration below the median of 11.3 nmol/l, high betaine concentration was associated with reduced CRC risk (OR: 0.71, 95% CI: 0.50-1.00, P-trend = 0.02), which was not observed for those having a higher folate status. Among women, but not men, high choline concentration was associated with decreased CRC risk (OR: 0.62, 95% CI: 0.43-0.88, P-trend = 0.01). Plasma DMG was not associated with CRC risk. CONCLUSIONS Individuals with high plasma concentrations of methionine, choline, and betaine may be at reduced risk of CRC.
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Affiliation(s)
- M Nitter
- Departments of Global Public Health and Primary Care
| | - B Norgård
- Departments of Global Public Health and Primary Care
| | - S de Vogel
- Departments of Global Public Health and Primary Care
| | - S J P M Eussen
- Departments of Global Public Health and Primary Care Clinical Science, Section for Pharmacology, University of Bergen, Bergen, Norway Department of Epidemiology, School for Public Health and Primary Care, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | | | | | - P M Ueland
- Clinical Science, Section for Pharmacology, University of Bergen, Bergen, Norway Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen
| | - O Nygård
- Departments of Clinical Science, Section of Cardiology, University of Bergen, Bergen Heart Disease, Haukeland University Hospital, Bergen
| | - S E Vollset
- Departments of Global Public Health and Primary Care Norwegian Institute of Public Health, Bergen, Norway
| | - T Bjørge
- Departments of Global Public Health and Primary Care Norwegian Institute of Public Health, Bergen, Norway
| | - A Tjønneland
- Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark
| | - L Hansen
- Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark
| | - M Boutron-Ruault
- INSERM, Centre for Research in Epidemiology and Population Health (CESP), Nutrition, Hormones and Women's Health Team, Villejuif Paris South University, Villejuif IGR, Villejuif
| | - A Racine
- INSERM, Centre for Research in Epidemiology and Population Health (CESP), Nutrition, Hormones and Women's Health Team, Villejuif Paris South University, Villejuif IGR, Villejuif
| | - V Cottet
- INSERM, Research Centre 'Lipids, Nutrition, Cancer', Dijon, France
| | - R Kaaks
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - T Kühn
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - A Trichopoulou
- Hellenic Health Foundation, Athens WHO Collaborating Center for Food and Nutrition Policies, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - C Bamia
- Hellenic Health Foundation, Athens WHO Collaborating Center for Food and Nutrition Policies, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - A Naska
- Hellenic Health Foundation, Athens WHO Collaborating Center for Food and Nutrition Policies, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - S Grioni
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano
| | - D Palli
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute-ISPO, Florence
| | - S Panico
- Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples
| | - R Tumino
- Cancer Registry and Histopathology Unit, 'Civile - M.P. Arezzo' Hospital, ASP, Ragusa
| | - P Vineis
- School of Public Health and HuGeF Foundation, Torino, Italy The School of Public Health, Imperial College London, London, UK
| | - H B Bueno-de-Mesquita
- The School of Public Health, Imperial College London, London, UK National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands Department of Gastroenterology and Hepatology
| | - H van Kranen
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - P H Peeters
- The School of Public Health, Imperial College London, London, UK Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
| | - E Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, UIT The Arctic University of Norway, Tromsø Department of Research, Cancer Registry of Norway, Oslo, Norway Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden Department of Genetic Epidemiology, Samfundet Folkhälsan, Helsinki, Finland
| | - M Dorronsoro
- Basque Regional Health Department, Public Health Direction and Biodonostia Research Institute (CIBERESP), San Sebastian
| | - P Jakszyn
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, Barcelona
| | - M Sánchez
- Andalusian School of Public Health, Granada CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid Instituto de Investigación Biosanitaria de Granada (Granada.ibs), Granada
| | | | - J M Huerta
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid Department of Epidemiology, Regional Health Council, Murcia
| | - A Barricarte
- Public Health Institute of Navarra, Pamplona Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain
| | - M Johansson
- Department of Biobank Research, Umeå University, Umeå, Sweden International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - I Ljuslinder
- Department of Radiation Sciences, Oncology, University of Umeå, Umeå, Sweden
| | - K Khaw
- University of Cambridge School of Clinical Medicine, Cambridge
| | - N Wareham
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - H Freisling
- International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - T Duarte-Salles
- International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - M Stepien
- International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - M J Gunter
- The School of Public Health, Imperial College London, London, UK
| | - E Riboli
- The School of Public Health, Imperial College London, London, UK
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Tikk K, Sookthai D, Johnson T, Rinaldi S, Romieu I, Tjønneland A, Olsen A, Overvad K, Clavel-Chapelon F, Baglietto L, Boeing H, Trichopoulou A, Lagiou P, Trichopoulos D, Palli D, Pala V, Tumino R, Rosso S, Panico S, Agudo A, Menéndez V, Sánchez MJ, Amiano P, Huerta Castaño JM, Ardanaz E, Bueno-de-Mesquita HB, Monninkhof E, Onland-Moret C, Andersson A, Sund M, Weiderpass E, Khaw KT, Key TJ, Travis RC, Gunter MJ, Riboli E, Dossus L, Kaaks R. Circulating prolactin and breast cancer risk among pre- and postmenopausal women in the EPIC cohort. Ann Oncol 2014; 25:1422-1428. [PMID: 24718887 DOI: 10.1093/annonc/mdu150] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Experimental and epidemiological evidence suggests that prolactin might play a role in the etiology of breast cancer. We analyzed the relationship of prediagnostic circulating prolactin levels with the risk of breast cancer by menopausal status, use of postmenopausal hormone replacement therapy (HRT) at blood donation, and by estrogen and progesterone receptor status of the breast tumors. PATIENTS AND METHODS Conditional logistic regression was used to analyze the data from a case-control study nested within the prospective European EPIC cohort, including 2250 invasive breast cancer and their matched control subjects. RESULTS Statistically significant heterogeneity in the association of prolactin levels with breast cancer risk between women who were either pre- or postmenopausal at the time of blood donation was observed (Phet = 0.04). Higher serum levels of prolactin were associated with significant increase in the risk of breast cancer among postmenopausal women [odds ratio (OR)Q4-Q1 = 1.29 (95% confidence interval, CI, 1.05-1.58), Ptrend = 0.09]; however, this increase in risk seemed to be confined to women who used postmenopausal HRT at blood donation [ORQ4-Q1 = 1.45 (95% CI 1.08-1.95), Ptrend = 0.01], whereas no statistically significant association was found for the non-users of HRT [ORQ4-Q1 = 1.11 (95%CI 0.83-1.49), Ptrend = 0.80] (Phet = 0.08). Among premenopausal women, a statistically non-significant inverse association was observed [ORQ4-Q1 = 0.70 (95% CI 0.48-1.03), Ptrend = 0.16]. There was no heterogeneity in the prolactin-breast cancer association by hormone receptor status of the tumor. CONCLUSION Our study indicates that higher circulating levels of prolactin among the postmenopausal HRT users at baseline may be associated with increased breast cancer risk.
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Affiliation(s)
- K Tikk
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
| | - D Sookthai
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
| | - T Johnson
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany
| | - S Rinaldi
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC), Lyon, France
| | - I Romieu
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC), Lyon, France
| | - A Tjønneland
- Danish Cancer Society Research Center, Copenhagen
| | - A Olsen
- Danish Cancer Society Research Center, Copenhagen
| | - K Overvad
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - F Clavel-Chapelon
- INSERM, Centre for Research in Epidemiology and Population Health [CESP], Nutrition, Hormones and Women's Health Team, Villejuif; University of Paris Sud, UMRS, Villejuif; IGR, Villejuif, France
| | - L Baglietto
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne; Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, The University of Melbourne, Melbourne, Australia
| | - H Boeing
- Department of Epidemiology, German Institute of Human Nutrition (DIfE) Potsdam-Rehbrücke, Nuthetal, Germany
| | - A Trichopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens; Hellenic Health Foundation, Athens, Greece
| | - P Lagiou
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens; Department of Epidemiology, Harvard School of Public Health, Boston, USA; Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece
| | - D Trichopoulos
- Hellenic Health Foundation, Athens, Greece; Department of Epidemiology, Harvard School of Public Health, Boston, USA; Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece
| | - D Palli
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute-ISPO, Florence, Italy
| | - V Pala
- Epidemiology and Prevention Unit, National Tumor Institute (IRCCS), Milano
| | - R Tumino
- Cancer Registry and Histopathology Unit, 'Civic-M. P. Arezzo' Hospital ASP, Ragusa
| | - S Rosso
- Piedmont Cancer Registry, Centre for Epidemiology and Prevention in Oncology in Piedmont, Torino
| | - S Panico
- Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy
| | - A Agudo
- Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology-ICO, IDIBELL, Barcelona
| | | | - M-J Sánchez
- Granada Cancer Registry, Andalusian School of Public Health, Granada; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER), Madrid
| | - P Amiano
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER), Madrid; Public Health Division of Gipuzkoa, Basque Regional Health Department, San Sebastian
| | - J M Huerta Castaño
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER), Madrid; Department of Epidemiology, Murcia Regional Health Authority, Murcia
| | - E Ardanaz
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER), Madrid; Navarre Public Health Institute, Pamplona, Spain
| | - H B Bueno-de-Mesquita
- National Institute for Public Health and the Environment (RIVM), Bilthoven; Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands; School of Public Health, Imperial College, London, UK
| | - E Monninkhof
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
| | - C Onland-Moret
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
| | - A Andersson
- Department of Radiation Sciences, University of Umeå, Umeå
| | - M Sund
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - E Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø; Department of Research, Cancer Registry of Norway, Oslo, Norway; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; Society of Public Health, Helsinki, Finland
| | - K-T Khaw
- School of Clinical Medicine, University of Cambridge, Cambridge
| | - T J Key
- Cancer Epidemiology Unit, University of Oxford, Oxford, UK
| | - R C Travis
- Cancer Epidemiology Unit, University of Oxford, Oxford, UK
| | - M J Gunter
- School of Public Health, Imperial College, London, UK
| | - E Riboli
- School of Public Health, Imperial College, London, UK
| | - L Dossus
- INSERM, Centre for Research in Epidemiology and Population Health [CESP], Nutrition, Hormones and Women's Health Team, Villejuif; University of Paris Sud, UMRS, Villejuif; IGR, Villejuif, France
| | - R Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ) Heidelberg, Heidelberg, Germany.
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Rinaldi S, Kaaks R, Friedenreich CM, Key TJ, Travis R, Biessy C, Slimani N, Overvad K, Østergaard JN, Tjønneland A, Olsen A, Mesrine S, Fournier A, Dossus L, Lukanova A, Johnson T, Boeing H, Vigl M, Trichopoulou A, Benetou V, Trichopoulos D, Masala G, Krogh V, Tumino R, Ricceri F, Panico S, Bueno-de-Mesquita HB, Monninkhof EM, May AM, Weiderpass E, Quirós JR, Travier N, Molina-Montes E, Amiano P, Huerta JM, Ardanaz E, Sund M, Johansson M, Khaw KT, Wareham N, Scalbert A, Gunter MJ, Riboli E, Romieu I. Physical activity, sex steroid, and growth factor concentrations in pre- and post-menopausal women: a cross-sectional study within the EPIC cohort. Cancer Causes Control 2014; 25:111-24. [PMID: 24173534 DOI: 10.1007/s10552-013-0314-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 10/14/2013] [Indexed: 01/13/2023]
Abstract
PURPOSE Increased physical activity (PA) is associated with a reduced risk of several cancers. PA may reduce cancer risk by changing endogenous hormones levels, but relatively little research has focused on this topic. The purpose of this study was to elucidate the relation between PA and endogenous hormone concentrations. METHODS A cross-sectional analysis of 798 pre- and 1,360 post-menopausal women included as controls in case-control studies on endogenous hormones (steroids, progesterone, sex-hormone-binding globulin (SHBG), and growth factors) levels, and cancer risk nested within European Prospective Investigation into Cancer and Nutrition cohort was performed. Multivariate regression analyses were performed to compare geometric mean levels of hormones and SHBG by categories of PA. RESULTS In pre-menopausal women, active women had 19 % significantly lower concentrations of androstenedione, 14 % lower testosterone, and 20 % lower free testosterone than inactive women, while no differences were observed for estrogens, progesterone, SHBG, and growth factors. In post-menopausal women, active women had 18 % significantly lower estradiol and 20 % lower free estradiol concentrations than inactive women, while no differences were observed for the other hormones and SHBG. More vigorous forms of physical activity were associated with higher insulin-like growth factor-I concentrations. Adjustment for body mass index did not alter the associations. Overall, the percentage of variance in hormone concentrations explained by PA levels was <2 %. CONCLUSIONS Our results support the hypothesis of an influence, although small in magnitude, of PA on sex hormone levels in blood, independent of body size.
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Affiliation(s)
- S Rinaldi
- International Agency for Research on Cancer (IARC), Lyon, France,
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32
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Obón-Santacana M, Slimani N, Lujan-Barroso L, Travier N, Hallmans G, Freisling H, Ferrari P, Boutron-Ruault M, Racine A, Clavel F, Saieva C, Pala V, Tumino R, Mattiello A, Vineis P, Argüelles M, Ardanaz E, Amiano P, Navarro C, Sánchez M, Molina Montes E, Key T, Khaw KT, Wareham N, Peeters P, Trichopoulou A, Bamia C, Trichopoulos D, Boeing H, Kaaks R, Katzke V, Ye W, Sund M, Ericson U, Wirfält E, Overvad K, Tjønneland A, Olsen A, Skeie G, Åsli L, Weiderpass E, Riboli E, Bueno-de-Mesquita H, Duell E. Dietary intake of acrylamide and pancreatic cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Ann Oncol 2013; 24:2645-2651. [DOI: 10.1093/annonc/mdt255] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Schlesinger S, Aleksandrova K, Pischon T, Jenab M, Fedirko V, Trepo E, Overvad K, Roswall N, Tjønneland A, Boutron-Ruault MC, Fagherazzi G, Racine A, Kaaks R, Grote VA, Boeing H, Trichopoulou A, Pantzalis M, Kritikou M, Mattiello A, Sieri S, Sacerdote C, Palli D, Tumino R, Peeters PH, Bueno-de-Mesquita HB, Weiderpass E, Quirós JR, Zamora-Ros R, Sánchez MJ, Arriola L, Ardanaz E, Tormo MJ, Nilsson P, Lindkvist B, Sund M, Rolandsson O, Khaw KT, Wareham N, Travis RC, Riboli E, Nöthlings U. Diabetes mellitus, insulin treatment, diabetes duration, and risk of biliary tract cancer and hepatocellular carcinoma in a European cohort. Ann Oncol 2013; 24:2449-55. [PMID: 23720454 DOI: 10.1093/annonc/mdt204] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Evidence on associations between self-reported diabetes mellitus, diabetes duration, age at diabetes diagnosis, insulin treatment, and risk of biliary tract cancer (BTC) and hepatocellular carcinoma (HCC), independent of general and abdominal obesity is scarce. PATIENTS AND METHODS We conducted a prospective analysis in the EPIC-cohort study among 363 426 participants with self-reported diabetes data. Multivariable adjusted relative risks and 95% confidence intervals were estimated from Cox regression models. In a nested case-control subset, analyses were carried out in HCV/HBV-negative individuals. RESULTS During 8.5 years of follow-up, 204 BTC cases [including 75 gallbladder cancer (GBC) cases], and 176 HCC cases were identified. Independent of body mass index and waist-to-height ratio diabetes status was associated with higher risk of BTC and HCC [1.77 (1.00-3.13) and 2.17 (1.36-3.47)]. For BTC, the risk seemed to be higher in participants with shorter diabetes duration and those not treated with insulin. Regarding cancer subsites, diabetes was only associated with GBC [2.72 (1.17-6.31)]. The risk for HCC was particularly higher in participants treated with insulin. The results were not appreciably different in HCV/HBV-negative individuals. CONCLUSION(S) This study supports the hypothesis that diabetes is a risk factor for BTC (particularly GBC) and HCC. Further research is required to establish whether diabetes treatment or duration is associated with these cancers.
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Affiliation(s)
- S Schlesinger
- Institute of Epidemiology, Christian-Albrechts University of Kiel, Kiel, Germany.
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Fedirko V, Trichopolou A, Bamia C, Duarte-Salles T, Trepo E, Aleksandrova K, Nöthlings U, Lukanova A, Lagiou P, Boffetta P, Trichopoulos D, Katzke VA, Overvad K, Tjønneland A, Hansen L, Boutron-Ruault MC, Fagherazzi G, Bastide N, Panico S, Grioni S, Vineis P, Palli D, Tumino R, Bueno-de-Mesquita HB, Peeters PH, Skeie G, Engeset D, Parr CL, Jakszyn P, Sánchez MJ, Barricarte A, Amiano P, Chirlaque M, Quirós JR, Sund M, Werner M, Sonestedt E, Ericson U, Key TJ, Khaw KT, Ferrari P, Romieu I, Riboli E, Jenab M. Consumption of fish and meats and risk of hepatocellular carcinoma: the European Prospective Investigation into Cancer and Nutrition (EPIC). Ann Oncol 2013; 24:2166-73. [PMID: 23670094 DOI: 10.1093/annonc/mdt168] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND While higher intake of fish and lower consumption of red/processed meats have been suggested to play a protective role in the etiology of several cancers, prospective evidence for hepatocellular carcinoma (HCC) is limited, particularly in Western European populations. METHODS The associations of fish and meats with HCC risk were analyzed in the EPIC cohort. Between 1992 and 2010, 191 incident HCC were identified among 477 206 participants. Baseline diet was assessed using validated dietary questionnaires. A single 24-h diet recall from a cohort subsample was used for calibration. Multivariable proportional hazard regression was utilized to estimate hazard ratios (HR) and 95% confidence intervals (CI). In a nested case-control subset (HCC = 122), HBV/HCV status and liver function biomarkers were measured. RESULTS HCC risk was inversely associated with intake of total fish (per 20 g/day increase, HR = 0.83, 95% CI 0.74-0.95 and HR = 0.80, 95% CI 0.69-0.97 before and after calibration, respectively). This inverse association was also suggested after adjusting for HBV/HCV status and liver function score (per 20-g/day increase, RR = 0.86, 95% CI 0.66-1.11 and RR = 0.74, 95% CI 0.50-1.09, respectively) in a nested case-control subset. Intakes of total meats or subgroups of red/processed meats, and poultry were not associated with HCC risk. CONCLUSIONS In this large European cohort, total fish intake is associated with lower HCC risk.
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Affiliation(s)
- V Fedirko
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France.
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Zamora-Ros R, Knaze V, Romieu I, Scalbert A, Slimani N, Clavel-Chapelon F, Touillaud M, Perquier F, Skeie G, Engeset D, Weiderpass E, Johansson I, Landberg R, Bueno-de-Mesquita HB, Sieri S, Masala G, Peeters PHM, Grote V, Huerta JM, Barricarte A, Amiano P, Crowe FL, Molina-Montes E, Khaw KT, Argüelles MV, Tjønneland A, Halkjær J, de Magistris MS, Ricceri F, Tumino R, Wirfält E, Ericson U, Overvad K, Trichopoulou A, Dilis V, Vidalis P, Boeing H, Förster J, Riboli E, González CA. Impact of thearubigins on the estimation of total dietary flavonoids in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Eur J Clin Nutr 2013; 67:779-82. [PMID: 23612513 DOI: 10.1038/ejcn.2013.89] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 03/18/2013] [Accepted: 03/29/2013] [Indexed: 11/09/2022]
Abstract
Thearubigins (TR) are polymeric flavanol-derived compounds formed during the fermentation of tea leaves. Comprising ∼70% of total polyphenols in black tea, TR may contribute majorly to its beneficial effects on health. To date, there is no appropriate food composition data on TR, although several studies have used data from the US Department of Agriculture (USDA) database to estimate TR intakes. We aimed to estimate dietary TR in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort and assess the impact of including TR or not in the calculation of the total dietary flavonoid intake. Dietary data were collected using a single standardized 24-h dietary recall interviewer-administered to 36 037 subjects aged 35-74 years. TR intakes were calculated using the USDA database. TR intakes ranged from 0.9 mg/day in men from Navarra and San Sebastian in Spain to 532.5 mg/day in men from UK general population. TR contributed <5% to the total flavonoid intake in Greece, Spain and Italy, whereas in the UK general population, TR comprised 48% of the total flavonoids. High heterogeneity in TR intake across the EPIC countries was observed. This study shows that total flavonoid intake may be greatly influenced by TR, particularly in high black tea-consuming countries. Further research on identification and quantification of TR is needed to get more accurate dietary TR estimations.
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Affiliation(s)
- R Zamora-Ros
- Catalan Institute of Oncology, Barcelona, Spain.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Raaschou-Nielsen O, Sørensen M, Ketzel M, Hertel O, Loft S, Tjønneland A, Overvad K, Andersen ZJ. Long-term exposure to traffic-related air pollution and diabetes-associated mortality: a cohort study. Diabetologia 2013; 56:36-46. [PMID: 22918192 DOI: 10.1007/s00125-012-2698-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 07/25/2012] [Indexed: 01/09/2023]
Abstract
AIMS/HYPOTHESIS The aim of this study was to investigate whether air pollution from traffic at a residence is associated with mortality related to type 1 or type 2 diabetes. METHODS We followed up 52,061 participants in the Danish Diet, Cancer and Health cohort for diabetes-related mortality in the nationwide Register of Causes of Death, from baseline in 1993-1997 up to the end of 2009, and traced their residential addresses since 1971 in the Central Population Registry. We used dispersion-modelled concentration of nitrogen dioxide (NO₂) since 1971 and amount of traffic at the baseline residence as indicators of traffic-related air pollution and used Cox regression models to estimate mortality-rate ratios (MRRs) with adjustment for potential confounders. RESULTS Mean levels of NO₂ at the residence since 1971 were significantly associated with mortality from diabetes. Exposure above 19.4 μg/m³ (upper quartile) was associated with a MRR of 2.15 (95% CI 1.21, 3.83) when compared with below 13.6 μg/m³ (lower quartile), corresponding to an MRR of 1.31 (95% CI 0.98, 1.76) per 10 μg/m³ NO₂ after adjustment for potential confounders. CONCLUSIONS/INTERPRETATION This study suggests that traffic-related air pollution is associated with mortality from diabetes. If confirmed, reduction in population exposure to traffic-related air pollution could be an additional strategy against the global public health burden of diabetes.
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Affiliation(s)
- O Raaschou-Nielsen
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen Ø, Denmark.
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Ferrari P, McKay JD, Jenab M, Brennan P, Canzian F, Vogel U, Tjønneland A, Overvad K, Tolstrup JS, Boutron-Ruault MC, Clavel-Chapelon F, Morois S, Kaaks R, Boeing H, Bergmann M, Trichopoulou A, Katsoulis M, Trichopoulos D, Krogh V, Panico S, Sacerdote C, Palli D, Tumino R, Peeters PH, van Gils CH, Bueno-de-Mesquita B, Vrieling A, Lund E, Hjartåker A, Agudo A, Suarez LR, Arriola L, Chirlaque MD, Ardanaz E, Sánchez MJ, Manjer J, Lindkvist B, Hallmans G, Palmqvist R, Allen N, Key T, Khaw KT, Slimani N, Rinaldi S, Romieu I, Boffetta P, Romaguera D, Norat T, Riboli E. Alcohol dehydrogenase and aldehyde dehydrogenase gene polymorphisms, alcohol intake and the risk of colorectal cancer in the European Prospective Investigation into Cancer and Nutrition study. Eur J Clin Nutr 2012; 66:1303-8. [PMID: 23149980 DOI: 10.1038/ejcn.2012.173] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND/OBJECTIVES Heavy alcohol drinking is a risk factor of colorectal cancer (CRC), but little is known on the effect of polymorphisms in the alcohol-metabolizing enzymes, alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) on the alcohol-related risk of CRC in Caucasian populations. SUBJECTS/METHODS A nested case-control study (1269 cases matched to 2107 controls by sex, age, study centre and date of blood collection) was conducted within the European Prospective Investigation into Cancer and Nutrition (EPIC) to evaluate the impact of rs1229984 (ADH1B), rs1573496 (ADH7) and rs441 (ALDH2) polymorphisms on CRC risk. Using the wild-type variant of each polymorphism as reference category, CRC risk estimates were calculated using conditional logistic regression, with adjustment for matching factors. RESULTS Individuals carrying one copy of the rs1229984(A) (ADH1B) allele (fast metabolizers) showed an average daily alcohol intake of 4.3 g per day lower than subjects with two copies of the rs1229984(G) allele (slow metabolizers) (P(diff)<0.01). None of the polymorphisms was associated with risk of CRC or cancers of the colon or rectum. Heavy alcohol intake was more strongly associated with CRC risk among carriers of the rs1573496(C) allele, with odds ratio equal to 2.13 (95% confidence interval: 1.26-3.59) compared with wild-type subjects with low alcohol consumption (P(interaction)=0.07). CONCLUSIONS The rs1229984(A) (ADH1B) allele was associated with a reduction in alcohol consumption. The rs1229984 (ADH1B), rs1573496 (ADH7) and rs441 (ALDH2) polymorphisms were not associated with CRC risk overall in Western-European populations. However, the relationship between alcohol and CRC risk might be modulated by the rs1573496 (ADH7) polymorphism.
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Affiliation(s)
- P Ferrari
- International Agency for Research on Cancer (IARC-WHO), Lyon, France.
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El-Galaly TC, Kristensen SR, Overvad K, Steffensen R, Tjønneland A, Severinsen MT. Interaction between blood type, smoking and factor V Leiden mutation and risk of venous thromboembolism: a Danish case-cohort study. J Thromb Haemost 2012; 10:2191-3. [PMID: 22577971 DOI: 10.1111/j.1538-7836.2012.04772.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Zamora-Ros R, Knaze V, Luján-Barroso L, Kuhnle GGC, Mulligan AA, Touillaud M, Slimani N, Romieu I, Powell N, Tumino R, Peeters PHM, de Magistris MS, Ricceri F, Sonestedt E, Drake I, Hjartåker A, Skie G, Mouw T, Wark PA, Romaguera D, Bueno-de-Mesquita HB, Ros M, Molina E, Sieri S, Quirós JR, Huerta JM, Tjønneland A, Halkjær J, Masala G, Teucher B, Kaas R, Travis RC, Dilis V, Benetou V, Trichopoulou A, Amiano P, Ardanaz E, Boeing H, Förster J, Clavel-Chapelon F, Fagherazzi G, Perquier F, Johansson G, Johansson I, Cassidy A, Overvad K, González CA. Dietary intakes and food sources of phytoestrogens in the European Prospective Investigation into Cancer and Nutrition (EPIC) 24-hour dietary recall cohort. Eur J Clin Nutr 2012; 66:932-41. [PMID: 22510793 DOI: 10.1038/ejcn.2012.36] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 01/26/2012] [Accepted: 01/26/2012] [Indexed: 01/18/2023]
Abstract
BACKGROUND/OBJECTIVES Phytoestrogens are estradiol-like natural compounds found in plants that have been associated with protective effects against chronic diseases, including some cancers, cardiovascular diseases and osteoporosis. The purpose of this study was to estimate the dietary intake of phytoestrogens, identify their food sources and their association with lifestyle factors in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. SUBJECTS/METHODS Single 24-hour dietary recalls were collected from 36,037 individuals from 10 European countries, aged 35-74 years using a standardized computerized interview programe (EPIC-Soft). An ad hoc food composition database on phytoestrogens (isoflavones, lignans, coumestans, enterolignans and equol) was compiled using data from available databases, in order to obtain and describe phytoestrogen intakes and their food sources across 27 redefined EPIC centres. RESULTS Mean total phytoestrogen intake was the highest in the UK health-conscious group (24.9 mg/day in men and 21.1 mg/day in women) whereas lowest in Greece (1.3 mg/day) in men and Spain-Granada (1.0 mg/day) in women. Northern European countries had higher intakes than southern countries. The main phytoestrogen contributors were isoflavones in both UK centres and lignans in the other EPIC cohorts. Age, body mass index, educational level, smoking status and physical activity were related to increased intakes of lignans, enterolignans and equol, but not to total phytoestrogen, isoflavone or coumestan intakes. In the UK cohorts, the major food sources of phytoestrogens were soy products. In the other EPIC cohorts the dietary sources were more distributed, among fruits, vegetables, soy products, cereal products, non-alcoholic and alcoholic beverages. CONCLUSIONS There was a high variability in the dietary intake of total and phytoestrogen subclasses and their food sources across European regions.
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Affiliation(s)
- R Zamora-Ros
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
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Hansen CP, Berentzen TL, Halkjær J, Tjønneland A, Sørensen TIA, Overvad K, Jakobsen MU. Intake of ruminant trans fatty acids and changes in body weight and waist circumference. Eur J Clin Nutr 2012; 66:1104-9. [PMID: 22805493 DOI: 10.1038/ejcn.2012.87] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Follow-up studies have suggested that total intake of trans fatty acids (TFA) is a risk factor for gain in body weight and waist circumference (WC). However, in a cross-sectional study individual TFA isomers in adipose tissue had divergent associations with anthropometry. Our objective was to investigate the association between intake of TFA from ruminant dairy and meat products and subsequent changes in weight and WC. Furthermore, potential effect modification by sex, age, body mass index and WC at baseline was investigated. SUBJECTS/METHODS Data on weight, WC, habitual diet and lifestyle were collected at baseline in a Danish cohort of 30,851 men and women aged 50-64 years. Follow-up information on weight and WC was collected 5 years after enrolment. The associations between intake of ruminant TFA (R-TFA) and changes in weight and WC were analysed using multiple linear regression with cubic spline modelling. RESULTS Intake of R-TFA, both absolute and energy-adjusted intake, was significantly associated with weight change. Inverse associations were observed at lower intakes with a levelling-off at intakes >1.2 g/day and 0.4 energy percentage (E %). Absolute, but not energy-adjusted, intake of R-TFA was significantly associated with WC change. An inverse association was observed at lower intakes with a plateau above an intake of 1.2 g/day. CONCLUSIONS The present study suggests that intake of R-TFA is weakly inversely associated with changes in weight, whereas no substantial association with changes in WC was found.
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Affiliation(s)
- C P Hansen
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark.
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Hansen R, Larsen R, Borre M, Friis S, Åman P, Steingrimsdottir L, Hallmans G, Overgaard K, Borre M, Tjønneland A. 1186 Nordic Lifestyle Intervention Trial on Prostate Cancer Progression (NILS). Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)71780-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Rohrmann S, Steinbrecher A, Linseisen J, Hermann S, May A, Luan J, Ekelund U, Overvad K, Tjønneland A, Halkjær J, Fagherazzi G, Boutron-Ruault MC, Clavel-Chapelon F, Agnoli C, Tumino R, Masala G, Mattiello A, Ricceri F, Travier N, Amiano P, Ardanaz E, Chirlaque MD, Sanchez MJ, Rodríguez L, Nilsson LM, Johansson I, Hedblad B, Rosvall M, Lund E, Braaten T, Naska A, Orfanos P, Trichopoulou A, van den Berg S, Bueno-de-Mesquita HB, Bergmann MM, Steffen A, Kaaks R, Teucher B, Wareham NJ, Khaw KT, Crowe FL, Illner AK, Slimani N, Gallo V, Mouw T, Norat T, Peeters PHM. The association of education with long-term weight change in the EPIC-PANACEA cohort. Eur J Clin Nutr 2012; 66:957-63. [PMID: 22669330 DOI: 10.1038/ejcn.2012.55] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Cross-sectionally, educational attainment is strongly associated with the prevalence of obesity, but this association is less clear for weight change during adult life. The objective of this study is to examine the association between educational attainment and weight change during adult life in the European Prospective Investigation into Cancer and Nutrition (EPIC). SUBJECTS/METHODS EPIC is a cohort study with 361,467 participants and up to 10 years of follow-up. Educational attainment was categorized according to the highest obtained school level (primary school or less, vocational secondary training, other secondary education and university). Multivariate mixed-effects linear regression models were used to study education in relation to weight at age 20 years (self-reported), to annual change in weight between age 20 years and measured weight at recruitment, and to annual change in weight during follow-up time. RESULTS Higher educational attainment was associated with on average a lower body mass index (BMI) at age 20 years and a lower increase in weight up to recruitment (highest vs lowest educational attainment in men: -60 g per year (95% confidence interval (CI) -80; -40), women -110 g per year (95% CI -130; -80)). Although during follow-up after recruitment an increase in body weight was observed in all educational levels, gain was lowest in men and women with a university degree (high vs low education -120 g per year (95% CI -150; -90) and -70 g per year (95% CI -90; -60), respectively). CONCLUSIONS Existing differences in BMI between higher and lower educated individuals at early adulthood became more pronounced during lifetime, which possibly impacts on obesity-related chronic disease risk in persons with lower educational attainment.
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Affiliation(s)
- S Rohrmann
- Department of Cancer Epidemiology and Prevention, Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland.
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45
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Crowe FL, Key TJ, Appleby PN, Overvad K, Schmidt EB, Egeberg R, Tjønneland A, Kaaks R, Teucher B, Boeing H, Weikert C, Trichopoulou A, Ouranos V, Valanou E, Masala G, Sieri S, Panico S, Tumino R, Matullo G, Bueno-de-Mesquita HB, Boer JMA, Beulens JWJ, van der Schouw YT, Quirós JR, Buckland G, Sánchez MJ, Dorronsoro M, Huerta JM, Moreno-Iribas C, Hedblad B, Jansson JH, Wennberg P, Khaw KT, Wareham N, Ferrari P, Illner AK, Chuang SC, Norat T, Danesh J, Riboli E. Dietary fibre intake and ischaemic heart disease mortality: the European Prospective Investigation into Cancer and Nutrition-Heart study. Eur J Clin Nutr 2012; 66:950-6. [DOI: 10.1038/ejcn.2012.51] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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46
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Grote VA, Kaaks R, Nieters A, Tjønneland A, Halkjær J, Overvad K, Skjelbo Nielsen MR, Boutron-Ruault MC, Clavel-Chapelon F, Racine A, Teucher B, Becker S, Pischon T, Boeing H, Trichopoulou A, Cassapa C, Stratigakou V, Palli D, Krogh V, Tumino R, Vineis P, Panico S, Rodríguez L, Duell EJ, Sánchez MJ, Dorronsoro M, Navarro C, Gurrea AB, Siersema PD, Peeters PHM, Ye W, Sund M, Lindkvist B, Johansen D, Khaw KT, Wareham N, Allen NE, Travis RC, Fedirko V, Jenab M, Michaud DS, Chuang SC, Romaguera D, Bueno-de-Mesquita HB, Rohrmann S. Inflammation marker and risk of pancreatic cancer: a nested case-control study within the EPIC cohort. Br J Cancer 2012; 106:1866-74. [PMID: 22617158 PMCID: PMC3364108 DOI: 10.1038/bjc.2012.172] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: Established risk factors for pancreatic cancer include smoking, long-standing diabetes, high body fatness, and chronic pancreatitis, all of which can be characterised by aspects of inflammatory processes. However, prospective studies investigating the relation between inflammatory markers and pancreatic cancer risk are scarce. Methods: We conducted a nested case–control study within the European Prospective Investigation into Cancer and Nutrition, measuring prediagnostic blood levels of C-reactive protein (CRP), interleukin-6 (IL-6), and soluble receptors of tumour necrosis factor-α (sTNF-R1, R2) in 455 pancreatic cancer cases and 455 matched controls. Odds ratios (ORs) were estimated using conditional logistic regression models. Results: None of the inflammatory markers were significantly associated with risk of pancreatic cancer overall, although a borderline significant association was observed for higher circulating sTNF-R2 (crude OR=1.52 (95% confidence interval (CI) 0.97–2.39), highest vs lowest quartile). In women, however, higher sTNF-R1 levels were significantly associated with risk of pancreatic cancer (crude OR=1.97 (95% CI 1.02–3.79)). For sTNF-R2, risk associations seemed to be stronger for diabetic individuals and those with a higher BMI. Conclusion: Prospectively, CRP and IL-6 do not seem to have a role in our study with respect to risk of pancreatic cancer, whereas sTNF-R1 seemed to be a risk factor in women and sTNF-R2 might be a mediator in the risk relationship between overweight and diabetes with pancreatic cancer. Further large prospective studies are needed to clarify the role of proinflammatory proteins and cytokines in the pathogenesis of exocrine pancreatic cancer.
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Affiliation(s)
- V A Grote
- Division of Cancer Epidemiology (c020), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, Heidelberg 69120, Germany
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47
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Jeurnink SM, Büchner FL, Bueno-de-Mesquita HB, Siersema PD, Boshuizen HC, Numans ME, Dahm CC, Overvad K, Tjønneland A, Roswall N, Clavel-Chapelon F, Boutron-Ruault MC, Morois S, Kaaks R, Teucher B, Boeing H, Buijsse B, Trichopoulou A, Benetou V, Zylis D, Palli D, Sieri S, Vineis P, Tumino R, Panico S, Ocké MC, Peeters PHM, Skeie G, Brustad M, Lund E, Sánchez-Cantalejo E, Navarro C, Amiano P, Ardanaz E, Ramón Quirós J, Hallmans G, Johansson I, Lindkvist B, Regnér S, Khaw KT, Wareham N, Key TJ, Slimani N, Norat T, Vergnaud AC, Romaguera D, Gonzalez CA. Variety in vegetable and fruit consumption and the risk of gastric and esophageal cancer in the European Prospective Investigation into Cancer and Nutrition. Int J Cancer 2012; 131:E963-73. [PMID: 22392502 DOI: 10.1002/ijc.27517] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Accepted: 01/12/2012] [Indexed: 01/13/2023]
Abstract
Diets high in vegetables and fruits have been suggested to be inversely associated with risk of gastric cancer. However, the evidence of the effect of variety of consumption is limited. We therefore investigated whether consumption of a variety of vegetables and fruit is associated with gastric and esophageal cancer in the European Prospective Investigation into Cancer and Nutrition study. Data on food consumption and follow-up on cancer incidence were available for 452,269 participants from 10 European countries. After a mean follow-up of 8.4 years, 475 cases of gastric and esophageal adenocarcinomas (180 noncardia, 185 cardia, gastric esophageal junction and esophagus, 110 not specified) and 98 esophageal squamous cell carcinomas were observed. Diet Diversity Scores were used to quantify the variety in vegetable and fruit consumption. We used multivariable Cox proportional hazard models to calculate risk ratios. Independent from quantity of consumption, variety in the consumption of vegetables and fruit combined and of fruit consumption alone were statistically significantly inversely associated with the risk of esophageal squamous cell carcinoma (continuous hazard ratio per 2 products increment 0.88; 95% CI 0.79-0.97 and 0.76; 95% CI 0.62-0.94, respectively) with the latter particularly seen in ever smokers. Variety in vegetable and/or fruit consumption was not associated with risk of gastric and esophageal adenocarcinomas. Independent from quantity of consumption, more variety in vegetable and fruit consumption combined and in fruit consumption alone may decrease the risk of esophageal squamous cell carcinoma. However, residual confounding by lifestyle factors cannot be excluded.
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Affiliation(s)
- S M Jeurnink
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands
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48
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Grote VA, Rohrmann S, Nieters A, Dossus L, Tjønneland A, Halkjær J, Overvad K, Fagherazzi G, Boutron-Ruault MC, Morois S, Teucher B, Becker S, Sluik D, Boeing H, Trichopoulou A, Lagiou P, Trichopoulos D, Palli D, Pala V, Tumino R, Vineis P, Panico S, Rodríguez L, Duell EJ, Molina-Montes E, Dorronsoro M, Huerta JM, Ardanaz E, Jeurnink SM, Beulens JWJ, Peeters PHM, Sund M, Ye W, Lindkvist B, Johansen D, Khaw KT, Wareham N, Allen N, Crowe F, Jenab M, Romieu I, Michaud DS, Riboli E, Romaguera D, Bueno-de-Mesquita HB, Kaaks R. Diabetes mellitus, glycated haemoglobin and C-peptide levels in relation to pancreatic cancer risk: a study within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Diabetologia 2011; 54:3037-46. [PMID: 21953276 DOI: 10.1007/s00125-011-2316-0] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 08/31/2011] [Indexed: 02/06/2023]
Abstract
AIMS/HYPOTHESIS There has been long-standing debate about whether diabetes is a causal risk factor for pancreatic cancer or a consequence of tumour development. Prospective epidemiological studies have shown variable relationships between pancreatic cancer risk and blood markers of glucose and insulin metabolism, overall and as a function of lag times between marker measurements (blood donation) and date of tumour diagnosis. METHODS Pre-diagnostic levels of HbA(1c) and C-peptide were measured for 466 participants with pancreatic cancer and 466 individually matched controls within the European Prospective Investigation into Cancer and Nutrition. Conditional logistic regression models were used to estimate ORs for pancreatic cancer. RESULTS Pancreatic cancer risk gradually increased with increasing pre-diagnostic HbA(1c) levels up to an OR of 2.42 (95% CI 1.33, 4.39 highest [≥ 6.5%, 48 mmol/mol] vs lowest [≤ 5.4%, 36 mmol/mol] category), even for individuals with HbA(1c) levels within the non-diabetic range. C-peptide levels showed no significant relationship with pancreatic cancer risk, irrespective of fasting status. Analyses showed no clear trends towards increasing hyperglycaemia (as marked by HbA(1c) levels) or reduced pancreatic beta cell responsiveness (as marked by C-peptide levels) with decreasing time intervals from blood donation to cancer diagnosis. CONCLUSIONS/INTERPRETATION Our data on HbA(1c) show that individuals who develop exocrine pancreatic cancer tend to have moderate increases in HbA(1c) levels, relatively independently of obesity and insulin resistance-the classic and major risk factors for type 2 diabetes. While there is no strong difference by lag time, more data are needed on this in order to reach a firm conclusion.
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Affiliation(s)
- V A Grote
- Division of Cancer Epidemiology c020, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120 Heidelberg, Germany
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Rasmussen LH, Larsen TB, Due KM, Tjønneland A, Overvad K, Lip GYH. Impact of vascular disease in predicting stroke and death in patients with atrial fibrillation: the Danish Diet, Cancer and Health cohort study. J Thromb Haemost 2011; 9:1301-7. [PMID: 21535388 DOI: 10.1111/j.1538-7836.2011.04308.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The presence of vascular disease (peripheral artery disease [PAD] and/or myocardial infarction [MI]) may impact on the risk of stroke and death among patients with incident atrial fibrillation (AF). To test this hypothesis, we analyzed data from a large Danish prospective cohort, the Danish Diet, Cancer and Health (DCH) study, to assess the risk of stroke or death among those who developed AF according to concomitant presence of vascular disease. METHODS A prospective cohort study of 57, 053 persons (27, 178 men and 29, 876 women, respectively), aged between 50 and 64 years. The risk of stroke or death for patients with vascular disease was assessed amongst 3315 patients with incident AF (mean age, 67.1years; 2130 men, 1185 women) using Cox proportional hazard models, after a median follow-up of 4.8 years. RESULTS Of the subjects with AF, 417 (12.6%) had 'vascular disease' (PAD and/or prior MI). The risk of the primary endpoint (stroke or death) was significantly higher in patients with vascular disease at 1-year follow-up (crude hazard ratio [HR] 2.51 [1.91-3.29]), with corresponding crude HRs for PAD and MI being 3.51 (2.40-5.13), and 1.99 (1.46-2.72), respectively. For the secondary endpoints of death or stroke individually, these risk estimates were similar (crude HR 2.48 [1.89-3.26] and 1.77 [1.18-2.66], respectively). After adjustment for risk factors within the CHADS(2) score, the adjusted HR for the primary endpoint (stroke or death) in patients with vascular disease was 1.91 (1.44-2.54), which was also significant for death (1.97 [1.48-2.62]). CONCLUSION Vascular disease (prior MI and PAD) is an independent risk factor for the primary endpoint of 'stroke or death' in patients with AF, even after adjustment for the CHADS(2) risk score, although this is driven by the impact on mortality. This reaffirms that patients with vascular disease represent a 'high-risk' population, which necessitates proactive management of all cardiovascular risk factors and effective thromboprophylaxis (i.e. oral anticoagulation), which has been shown to significantly reduce the risk of stroke and death in AF.
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Affiliation(s)
- L H Rasmussen
- Department of Cardiology, Aalborg AF Study Group, Aarhus University Hospital, Aalborg, Denmark.
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Kornum JB, Due KM, Nørgaard M, Tjønneland A, Overvad K, Sørensen HT, Thomsen RW. Alcohol drinking and risk of subsequent hospitalisation with pneumonia. Eur Respir J 2011; 39:149-55. [PMID: 21659417 DOI: 10.1183/09031936.00000611] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The dose-response relationship between alcohol consumption and pneumonia risk in healthy individuals is poorly understood. We examined 22,485 males and 24,682 females from Denmark who were aged 50-64 yrs. Subjects were without major chronic diseases at baseline and had a median follow-up of 12 yrs for first-time hospitalisation with pneumonia. 1,091 (males) and 944 (females) had pneumonia-related hospitalisation. Among males, the risk of pneumonia was increased for alcohol abstainers and those who drank large weekly amounts. The adjusted hazard ratios (HRs) for 0, 7-20, 21-34, 35-50 and >50 drinks·week(-1) were 1.49 (95% CI 1.00-2.21), 0.88 (95% CI 0.76-1.03), 0.87 (95% CI 0.72-1.05), 1.15 (95% CI 0.93-1.44) and 1.81 (95% CI 1.40-2.33), respectively, compared with 1-6 drinks·week(-1). The association between high alcohol intake and pneumonia persisted after controlling for subsequent chronic diseases. Among females, HRs for 0, 7-20, 21-35 and >35 drinks·week(-1) were 1.26 (95% CI 0.89-1.79), 1.01 (95% CI 0.88-1.17), 1.10 (95% CI 0.88-1.37) and 0.54 (95% CI 0.29-1.01), respectively. For the same moderate to high weekly alcohol amount, infrequent intake yielded higher pneumonia HRs than more regular intake in both sexes. Regular moderate alcohol intake is not associated with increased risk of hospitalisation for pneumonia. High weekly alcohol consumption in males and infrequent heavy drinking in both sexes may increase pneumonia risk.
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Affiliation(s)
- J B Kornum
- Dept of Clinical Epidemiology, Aarhus University Hospital, Sdr. Skovvej 15, DK-9000 Aalborg, Denmark.
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