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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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Middleton LT, Riboli E. Editorial: Dietary Cholesterol and Dementia Risk. J Prev Alzheimers Dis 2023; 10:746-747. [PMID: 37874095 DOI: 10.14283/jpad.2023.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Affiliation(s)
- L T Middleton
- Lefkos T Middleton, Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK,
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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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Deschasaux-Tanguy M, Huybrechts I, Julia C, Hercberg S, Srour B, Danesh J, Riboli E, Gunter MJ, Touvier M. Food choices characterized by the Nutri-Score nutrient profile and risk of cardiovascular diseases. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Nutrition is a well-established risk factor for cardiovascular diseases (CVD) that can be leveraged by public health prevention strategies. In addition to dietary guidelines, front-of-pack nutrition labels (FoPNL) can help consumers make healthier food choices. Nutri-Score, a scientifically validated 5-color FopNL based on the nutrient profile FSAm-NPS has been adopted by several European countries but remains optional under current EU labeling regulation, which is to be revised end of 2022. Scientific evidence is therefore needed on the relevance of the Nutri-Score at the European level. Our objective was to study the association between the consumption of food as graded by the FSAm-NPS and CVD risk in a large European population.
Methods
This prospective analysis was conducted on a case-cohort comprising 13,308 participants without CVD risk factors at baseline, among which 5,326 first incident cases of CVD from the EPIC-CVD study (8 European countries). Food intakes were assessed using country-specific dietary questionnaires. The FSAm-NPS was calculated for each food based on its 100g content in energy, sugar, saturated fatty acid, sodium, fibre, protein, and fruits/vegetables/legumes/nuts. Multi-adjusted Cox models were computed.
Results
Overall, associations were observed between the consumption of foods with a higher FSAm-NPS score (lower nutritional value) and a higher risk of myocardial infarction (MI; HR1-SD=1.12 [1.05,1.21]; HRQ5/Q1=1.23 [1.00,1.52]). Associations with stroke were not significant. Overall, associations were more particularly observed in men.
Conclusions
In this large European population, a higher risk of MI was observed in individuals consuming on average a diet with higher FSAm-NPS foods (reflecting consumption of foods with a lower nutritional value/less favourable Nutri-Score). This adds to the evidence on the relevance of Nutri-Score as a public health tool to help consumers choose healthier food products.
Key messages
• The consumption of foods with a lower nutritional quality as graded by the Nutri-Score was associated with a higher risk of myocardial infarction in the large European EPIC-CVD case-cohort study.
• This adds to the evidence supporting the relevance of the Nutri-Score as a complementary tool to dietary guidelines to help consumers make healthier food choices.
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Affiliation(s)
- M Deschasaux-Tanguy
- Nutritional Epidemiology Research Team, Inserm U1153, Inrae U1125, Cnam, Sorbonne Paris Nord University , Bobigny, France
| | - I Huybrechts
- Nutrition and Metabolism Section, International Agency for Research on Cancer , Lyon, France
| | - C Julia
- Nutritional Epidemiology Research Team, Inserm U1153, Inrae U1125, Cnam, Sorbonne Paris Nord University , Bobigny, France
- Public Health Department, Avicenne Hospital , Bobigny, France
| | - S Hercberg
- Nutritional Epidemiology Research Team, Inserm U1153, Inrae U1125, Cnam, Sorbonne Paris Nord University , Bobigny, France
- Public Health Department, Avicenne Hospital , Bobigny, France
| | - B Srour
- Nutritional Epidemiology Research Team, Inserm U1153, Inrae U1125, Cnam, Sorbonne Paris Nord University , Bobigny, France
| | - J Danesh
- Department of Public Health and Primary Care, University of Cambridge , Cambridge, UK
| | - E Riboli
- Faculty of Medicine, School of Public Health, Imperial College London , London, UK
| | - MJ Gunter
- Nutrition and Metabolism Section, International Agency for Research on Cancer , Lyon, France
| | - M Touvier
- Nutritional Epidemiology Research Team, Inserm U1153, Inrae U1125, Cnam, Sorbonne Paris Nord University , Bobigny, France
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Papadimitriou N, Bouras E, van den Brandt PA, Muller DC, Papadopoulou A, Heath AK, Critselis E, Gunter MJ, Vineis P, Ferrari P, Weiderpass E, Boeing H, Bastide N, Merritt MA, Lopez DS, Bergmann MM, Perez-Cornago A, Schulze M, Skeie G, Srour B, Eriksen AK, Boden S, Johansson I, Nøst TH, Lukic M, Ricceri F, Ericson U, Huerta JM, Dahm CC, Agnoli C, Amiano PE, Tjønneland A, Gurrea AB, Bueno-de-Mesquita B, Ardanaz E, Berntsson J, Sánchez MJ, Tumino R, Panico S, Katzke V, Jakszyn P, Masala G, Derksen JWG, Quirós JR, Severi G, Cross AJ, Riboli E, Tzoulaki I, Tsilidis KK. A Prospective Diet-Wide Association Study for Risk of Colorectal Cancer in EPIC. Clin Gastroenterol Hepatol 2022; 20:864-873.e13. [PMID: 33901663 DOI: 10.1016/j.cgh.2021.04.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/23/2021] [Accepted: 04/19/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Evidence regarding the association of dietary exposures with colorectal cancer (CRC) risk is not consistent with a few exceptions. Therefore, we conducted a diet-wide association study (DWAS) in the European Prospective Investigation into Cancer and Nutrition (EPIC) to evaluate the associations between several dietary exposures with CRC risk. METHODS The association of 92 food and nutrient intakes with CRC risk was assessed in 386,792 participants, 5069 of whom developed incident CRC. Correction for multiple comparisons was performed using the false discovery rate, and emerging associations were examined in the Netherlands Cohort Study (NLCS). Multiplicative gene-nutrient interactions were also tested in EPIC based on known CRC-associated loci. RESULTS In EPIC, alcohol, liquor/spirits, wine, beer/cider, soft drinks, and pork were positively associated with CRC, whereas milk, cheese, calcium, phosphorus, magnesium, potassium, riboflavin, vitamin B6, beta carotene, fruit, fiber, nonwhite bread, banana, and total protein intakes were inversely associated. Of these 20 associations, 13 were replicated in the NLCS, for which a meta-analysis was performed, namely alcohol (summary hazard ratio [HR] per 1-SD increment in intake: 1.07; 95% confidence interval [CI], 1.04-1.09), liquor/spirits (HR per 1-SD increment in intake, 1.04; 95% CI, 1.02-1.06), wine (HR per 1-SD increment in intake, 1.04; 95% CI, 1.02-1.07), beer/cider (HR per 1-SD increment in intake, 1.06; 95% CI, 1.04-1.08), milk (HR per 1-SD increment in intake, 0.95; 95% CI, 0.93-0.98), cheese (HR per 1-SD increment in intake, 0.96; 95% CI, 0.94-0.99), calcium (HR per 1-SD increment in intake, 0.93; 95% CI, 0.90-0.95), phosphorus (HR per 1-SD increment in intake, 0.92; 95% CI, 0.90-0.95), magnesium (HR per 1-SD increment in intake, 0.95; 95% CI, 0.92-0.98), potassium (HR per 1-SD increment in intake, 0.96; 95% CI, 0.94-0.99), riboflavin (HR per 1-SD increment in intake, 0.94; 95% CI, 0.92-0.97), beta carotene (HR per 1-SD increment in intake, 0.96; 95% CI, 0.93-0.98), and total protein (HR per 1-SD increment in intake, 0.94; 95% CI, 0.92-0.97). None of the gene-nutrient interactions were significant after adjustment for multiple comparisons. CONCLUSIONS Our findings confirm a positive association for alcohol and an inverse association for dairy products and calcium with CRC risk, and also suggest a lower risk at higher dietary intakes of phosphorus, magnesium, potassium, riboflavin, beta carotene, and total protein.
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Affiliation(s)
- Nikos Papadimitriou
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece; International Agency for Research on Cancer, Lyon, France
| | - Emmanouil Bouras
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Piet A van den Brandt
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - David C Muller
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Areti Papadopoulou
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Alicia K Heath
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Elena Critselis
- Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Marc J Gunter
- International Agency for Research on Cancer, Lyon, France
| | - Paolo Vineis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Pietro Ferrari
- International Agency for Research on Cancer, Lyon, France
| | | | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Bergholz-Rehbrücke, Germany
| | - Nadia Bastide
- U1018, Nutrition, Hormones and Women's Health Team, Centre for Research in Epidemiology and Population Health, Inserm, Villejuif, France
| | | | - David S Lopez
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch School of Medicine, Galveston, Texas; Division of Urology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Manuela M Bergmann
- German Institute of Human Nutrition Potsdam-Rehbrücke, Bergholz-Rehbrücke, Germany
| | - Aurora Perez-Cornago
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Matthias Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Institute of Nutrition Science, University of Potsdam, Nuthetal, Germany
| | - Guri Skeie
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø-The Arctic University of Norway, Tromsø, Norway
| | - Bernard Srour
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Anne Kirstine Eriksen
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Stina Boden
- Department of Radiation Sciences-Oncology, Umeå University, Umeå, Sweden
| | | | - Therese Haugdahl Nøst
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø-The Arctic University of Norway, Tromsø, Norway
| | - Marco Lukic
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø-The Arctic University of Norway, Tromsø, Norway
| | - Fulvio Ricceri
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy; Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco, Italy
| | - Ulrika Ericson
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - José María Huerta
- Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain; CIBER of Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Claudia Agnoli
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Pilar Exezarreta Amiano
- CIBER of Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain; Public Health Division of Gipuzkoa, Biodonostia Research Institute, San Sebastián, Spain
| | - Anne Tjønneland
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Bas Bueno-de-Mesquita
- Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Eva Ardanaz
- CIBER of Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain; Instituto de Salud Pública de Navarra, Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Jonna Berntsson
- Oncology and Pathology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Maria-Jose Sánchez
- CIBER of Epidemiology and Public Health, Instituto de Salud Carlos III, Madrid, Spain; Escuela Andaluza de Salud Pública, Granada, Spain; Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain; Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, Provincial Health Authority, Ragusa, Italy
| | - Salvatore Panico
- Dipartimento di Medicina Clinica e Chirurgia, University of Naples Federico II, Naples, Italy
| | - Verena Katzke
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Paula Jakszyn
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Barcelona, Spain; Blanquerna School of Health Sciences, Ramon Llull University, Barcelona, Spain
| | - Giovanna Masala
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network, Florence, Italy
| | - Jeroen W G Derksen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | - Gianluca Severi
- CESP UMR1018, Gustave Roussy, Équipe "Exposome et Hérédité," Inserm-UVSQ, Université Paris-Saclay, Villejuif, France; Department of Statistics, Computer Science and Applications, University of Florence, Florence, Italy
| | - Amanda J Cross
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Ellio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Ioanna Tzoulaki
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Konstantinos K Tsilidis
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
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6
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Zheng B, Su B, Udeh-Momoh C, Price G, Tzoulaki I, Vamos EP, Majeed A, Riboli E, Ahmadi-Abhari S, Middleton LT. Associations of Cardiovascular and Non-Cardiovascular Comorbidities with Dementia Risk in Patients with Diabetes: Results from a Large UK Cohort Study. J Prev Alzheimers Dis 2022; 9:86-91. [PMID: 35098977 DOI: 10.14283/jpad.2022.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Indexed: 06/14/2023]
Abstract
BACKGROUND Type 2 diabetes (T2D) is an established risk factor for dementia. However, it remains unclear whether the presence of comorbidities could further increase dementia risk in diabetes patients. OBJECTIVES To examine the associations between cardiovascular and non-cardiovascular comorbidities and dementia risk in T2D patients. DESIGN Population-based cohort study. SETTING The UK Clinical Practice Research Datalink (CPRD). PARTICIPANTS 489,205 T2D patients aged over 50 years in the UK CPRD. MEASUREMENTS Major cardiovascular and non-cardiovascular comorbidities were extracted as time-varying exposure variables. The outcome event was dementia incidence based on dementia diagnosis or dementia-specific drug prescription. RESULTS During a median of six years follow-up, 33,773 (6.9%) incident dementia cases were observed. Time-varying Cox regressions showed T2D patients with stroke, peripheral vascular disease, atrial fibrillation, heart failure or hypertension were at higher risk of dementia compared to those without such comorbidities (HR [95% CI] = 1.64 [1.59-1.68], 1.37 [1.34-1.41], 1.26 [1.22-1.30], 1.15 [1.11-1.20] or 1.10 [1.03-1.18], respectively). Presence of chronic obstructive pulmonary disease or chronic kidney disease was also associated with increased dementia risk (HR [95% CI] = 1.05 [1.01-1.10] or 1.11 [1.07-1.14]). CONCLUSIONS A range of cardiovascular and non-cardiovascular comorbidities were associated with further increases of dementia risk in T2D patients. Prevention and effective management of these comorbidities may play a significant role in maintaining cognitive health in T2D patients.
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Affiliation(s)
- B Zheng
- Prof. Lefkos Middleton, Ageing Epidemiology Research Unit, School of Public Health, Faculty of Medicine, Imperial College London, London W6 8RP, UK. E-mail: ; Tel: +44 20 3311 0216; Fax: +44 20 3311 0216
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7
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Deschasaux M, Huybrechts I, Murphy N, Julia C, Hercberg S, Srour B, Ferrari P, Riboli E, Gunter M, Touvier M. Nutritional quality of food consumed (graded by the FSAm-NPS / Nutri-Score) and mortality in Europe. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Unhealthy diets are major contributors for non-communicable diseases (NCDs) and related deaths. To help consumers make healthier food choices, political authorities are considering implementing a simple label to reflect the nutritional quality of food products. The Nutri-Score, based on the nutrient profiling system of the Food Standards Agency (FSAm-NPS), was chosen by several countries in Europe (France, Belgium, Spain). Yet, its implementation is only voluntary per EU regulation. Scientific evidence is therefore needed regarding the relevance of the FSAm-NPS at the European level. Hence, our objective is to study how the nutritional quality of foods consumed graded by the FSAm-NPS relates to NCDs-related mortality in European populations.
Methods
Our prospective analyses included 501,594 adults from the EPIC cohort (1992-2015, median follow-up: 17.2y). Usual food intakes were assessed with standardized country-specific methods. The FSAm-NPS was calculated using the 100g content of each food in energy, sugar, saturated fatty acid, sodium, fibres, proteins, and fruits/vegetables/legumes/nuts. Multi-adjusted Cox proportional hazards models were computed.
Results
The consumption of foods with a higher FSAm-NPS score (lower nutritional quality) was associated with a higher risk of mortality overall (n = 50,743 events: HRQ5vs.Q1=1.06 [95%CI: 1.02-1.09], P-trend<0.001) and by cancer (n = 21,971 events: HRQ5vs.Q1=1.06 [1.01-1.11], P-trend=0.003), respiratory diseases (n = 2,796 events: HRQ5vs.Q1=1.33 [1.16-1.52], P-trend<0.001) and cardiovascular diseases, although more weakly (n = 12,407 events: HRQ5vs.Q1=1.05 [0.98,1.11], P-trend=0.04).
Conclusions
In this large multinational European cohort, consuming foods with a higher FSAm-NPS score was associated with higher mortality, supporting the relevance of the FSAm-NPS to grade the nutritional quality of food products for public health applications (e.g, Nutri-Score) to guide the consumers towards healthier food choices.
Key messages
The consumption of food products with a lower nutritional quality as graded by the FSAm-NPS score was associated with higher mortality in the large multinational European EPIC cohort. This adds support to the relevance of the FSAm-NPS to grade the nutritional quality of foodstuffs for public health applications (e.g. Nutri-Score label) to help consumers make healthier food choices.
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Affiliation(s)
- M Deschasaux
- Nutritional Epidemiology Research Team (EREN), Inserm U1153, Inra U1125, Cnam, Paris 13 University (CRESS), Bobigny, France
- on behalf of all EPIC collaborators, Bobigny, France
| | - I Huybrechts
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | - N Murphy
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | - C Julia
- Nutritional Epidemiology Research Team (EREN), Inserm U1153, Inra U1125, Cnam, Paris 13 University (CRESS), Bobigny, France
- Public Health Department, Avicenne Hospital (AP-HP), Bobigny, France
| | - S Hercberg
- Nutritional Epidemiology Research Team (EREN), Inserm U1153, Inra U1125, Cnam, Paris 13 University (CRESS), Bobigny, France
- Public Health Department, Avicenne Hospital (AP-HP), Bobigny, France
| | - B Srour
- Nutritional Epidemiology Research Team (EREN), Inserm U1153, Inra U1125, Cnam, Paris 13 University (CRESS), Bobigny, France
| | - P Ferrari
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | - E Riboli
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - M Gunter
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | - M Touvier
- Nutritional Epidemiology Research Team (EREN), Inserm U1153, Inra U1125, Cnam, Paris 13 University (CRESS), Bobigny, France
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8
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Aune D, Mahamat‐Saleh Y, Norat T, Riboli E. Body mass index, abdominal fatness, weight gain and the risk of urinary incontinence: a systematic review and dose–response meta‐analysis of prospective studies. BJOG 2019; 126:1424-1433. [DOI: 10.1111/1471-0528.15897] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2019] [Indexed: 11/27/2022]
Affiliation(s)
- 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
| | - Y Mahamat‐Saleh
- CESP, Fac. de médecine ‐ Univ. Paris‐Sud Fac. demédecine ‐ UVSQ INSERM Université Paris‐Saclay Villejuif France
- Gustave Roussy Villejuif France
| | - T Norat
- 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
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Smith Byrne K, Appleby PN, Key TJ, Holmes MV, Fensom GK, Agudo A, Ardanaz E, Boeing H, Bueno-de-Mesquita HB, Chirlaque MD, Kaaks R, Larrañaga N, Palli D, Perez-Cornago A, Quirós JR, Ricceri F, Sánchez MJ, Tagliabue G, Tsilidis KK, Tumino R, Fortner RT, Ferrari P, Riboli E, Lilja H, Travis RC. The role of plasma microseminoprotein-beta in prostate cancer: an observational nested case-control and Mendelian randomization study in the European prospective investigation into cancer and nutrition. Ann Oncol 2019; 30:983-989. [PMID: 31089709 PMCID: PMC6594452 DOI: 10.1093/annonc/mdz121] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Microseminoprotein-beta (MSP), a protein secreted by the prostate epithelium, may have a protective role in the development of prostate cancer. The only previous prospective study found a 2% reduced prostate cancer risk per unit increase in MSP. This work investigates the association of MSP with prostate cancer risk using observational and Mendelian randomization (MR) methods. PATIENTS AND METHODS A nested case-control study was conducted with the European Prospective Investigation into Cancer and Nutrition (EPIC) with 1871 cases and 1871 matched controls. Conditional logistic regression analysis was used to investigate the association of pre-diagnostic circulating MSP with risk of incident prostate cancer overall and by tumour subtype. EPIC-derived estimates were combined with published data to calculate an MR estimate using two-sample inverse-variance method. RESULTS Plasma MSP concentrations were inversely associated with prostate cancer risk after adjusting for total prostate-specific antigen concentration [odds ratio (OR) highest versus lowest fourth of MSP = 0.65, 95% confidence interval (CI) 0.51-0.84, Ptrend = 0.001]. No heterogeneity in this association was observed by tumour stage or histological grade. Plasma MSP concentrations were 66% lower in rs10993994 TT compared with CC homozygotes (per allele difference in MSP: 6.09 ng/ml, 95% CI 5.56-6.61, r2=0.42). MR analyses supported a potentially causal protective association of MSP with prostate cancer risk (OR per 1 ng/ml increase in MSP for MR: 0.96, 95% CI 0.95-0.97 versus EPIC observational: 0.98, 95% CI 0.97-0.99). Limitations include lack of complete tumour subtype information and more complete information on the biological function of MSP. CONCLUSIONS In this large prospective European study and using MR analyses, men with high circulating MSP concentration have a lower risk of prostate cancer. MSP may play a causally protective role in prostate cancer.
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Affiliation(s)
| | | | | | - M V Holmes
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford; Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Oxford; National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospital, Oxford; Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | | | - A Agudo
- Unit of Nutrition and Cancer, Catalan Institute of Oncology-IDIBELL, Barcelona
| | - E Ardanaz
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid; Navarra Public Health Institute, Pamplona; Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - H Boeing
- Department of Epidemiology, German Institute of Human Nutrition (DIfE), Potsdam-Rehbrücke, Germany
| | - H B Bueno-de-Mesquita
- Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands; Department of Epidemiology and Biostatistics, Imperial College London, London, UK; Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - M D Chirlaque
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid; Department of Epidemiology, IMIB-Arrixaca, Murcia; Department of Health and Social Sciences, University of Murcia, Murcia, Spain
| | - R Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - N Larrañaga
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid; Public Health Division of Gipuzkoa, Regional Government of the Basque Country, Vitoria-Gasteiz, Spain
| | - D Palli
- Cancer Risk Factors and Life-style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | | | - J R Quirós
- Public Health Directorate, Asturias, Spain
| | - F Ricceri
- Unit of Epidemiology, Regional Health Service Azienda Sanitaria Locale Torino 3 (ASL TO3), Grugliasco; Unit of Cancer Epidemiology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - M J Sánchez
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid; Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - G Tagliabue
- Department of Preventative and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - K K Tsilidis
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK; Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - R Tumino
- Cancer Registry and Histopathology Unit, "Civic M.P. Arezzo" Hospital, Ragusa, Italy
| | - R T Fortner
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - P Ferrari
- Nutritional Methodology and Biostatistics Group, International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | - E Riboli
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - H Lilja
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Translational Medicine, Lund University, Malmö, Sweden
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10
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Perrier F, Viallon V, Ambatipudi S, Ghantous A, Cuenin C, Hernandez-Vargas H, Chajès V, Baglietto L, Matejcic M, Moreno-Macias H, Kühn T, Boeing H, Karakatsani A, Kotanidou A, Trichopoulou A, Sieri S, Panico S, Fasanelli F, Dolle M, Onland-Moret C, Sluijs I, Weiderpass E, Quirós JR, Agudo A, Huerta JM, Ardanaz E, Dorronsoro M, Tong TYN, Tsilidis K, Riboli E, Gunter MJ, Herceg Z, Ferrari P, Romieu I. Association of leukocyte DNA methylation changes with dietary folate and alcohol intake in the EPIC study. Clin Epigenetics 2019; 11:57. [PMID: 30940212 PMCID: PMC6444439 DOI: 10.1186/s13148-019-0637-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/20/2019] [Indexed: 12/14/2022] Open
Abstract
Background There is increasing evidence that folate, an important component of one-carbon metabolism, modulates the epigenome. Alcohol, which can disrupt folate absorption, is also known to affect the epigenome. We investigated the association of dietary folate and alcohol intake on leukocyte DNA methylation levels in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Leukocyte genome-wide DNA methylation profiles on approximately 450,000 CpG sites were acquired with Illumina HumanMethylation 450K BeadChip measured among 450 women control participants of a case-control study on breast cancer nested within the EPIC cohort. After data preprocessing using surrogate variable analysis to reduce systematic variation, associations of DNA methylation with dietary folate and alcohol intake, assessed with dietary questionnaires, were investigated using CpG site-specific linear models. Specific regions of the methylome were explored using differentially methylated region (DMR) analysis and fused lasso (FL) regressions. The DMR analysis combined results from the feature-specific analysis for a specific chromosome and using distances between features as weights whereas FL regression combined two penalties to encourage sparsity of single features and the difference between two consecutive features. Results After correction for multiple testing, intake of dietary folate was not associated with methylation level at any DNA methylation site, while weak associations were observed between alcohol intake and methylation level at CpG sites cg03199996 and cg07382687, with qval = 0.029 and qval = 0.048, respectively. Interestingly, the DMR analysis revealed a total of 24 and 90 regions associated with dietary folate and alcohol, respectively. For alcohol intake, 6 of the 15 most significant DMRs were identified through FL. Conclusions Alcohol intake was associated with methylation levels at two CpG sites. Evidence from DMR and FL analyses indicated that dietary folate and alcohol intake may be associated with genomic regions with tumor suppressor activity such as the GSDMD and HOXA5 genes. These results were in line with the hypothesis that epigenetic mechanisms play a role in the association between folate and alcohol, although further studies are warranted to clarify the importance of these mechanisms in cancer. Electronic supplementary material The online version of this article (10.1186/s13148-019-0637-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- F Perrier
- Nutritional Methodology and Biostatistics Group, International Agency for Research on Cancer (IARC), World Health Organization, 150, cours Albert Thomas, 69372, Lyon CEDEX 08, France
| | - V Viallon
- Nutritional Methodology and Biostatistics Group, International Agency for Research on Cancer (IARC), World Health Organization, 150, cours Albert Thomas, 69372, Lyon CEDEX 08, France
| | - S Ambatipudi
- Epigenetics Group, IARC, Lyon, France.,MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - C Cuenin
- Epigenetics Group, IARC, Lyon, France
| | | | - V Chajès
- Nutritional Epidemiology Group, IARC, Lyon, France
| | - L Baglietto
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - M Matejcic
- Nutritional Epidemiology Group, IARC, Lyon, France.,Department of Preventive Medicine, Keck School of Medicine, University of Southern California/Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | | | - T Kühn
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - H Boeing
- Department of Epidemiology, German Institute of Human Nutrition (DIfE), Potsdam-Rehbrücke, 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
| | - A Kotanidou
- Hellenic Health Foundation, Athens, Greece.,1st Department of Critical Care Medicine and Pulmonary Services, University of Athens Medical School, Evangelismos Hospital, Athens, Greece
| | | | - S Sieri
- 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
| | - F Fasanelli
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Via Santena 7, Turin, Italy
| | - M Dolle
- National Institute of Public Health and the Environment (RIVM), Centre for Health Protection (pb12), Bilthoven, The Netherlands
| | - C Onland-Moret
- Department of Epidemiology, Julius Center Research Program Cardiovascular Epidemiology, Utrecht, The Netherlands
| | - I Sluijs
- Department of Epidemiology, Julius Center Research Program Cardiovascular Epidemiology, Utrecht, The Netherlands
| | - E Weiderpass
- 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 and Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Community Medicine, University of Tromsø, 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
| | - J M Huerta
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain.,CIBER Epidemiology and Public Health CIBERESP, Madrid, Spain
| | - E Ardanaz
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain.,CIBER Epidemiology and Public Health CIBERESP, Madrid, Spain.,Navarra Public Health Institute, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - M Dorronsoro
- Public Health Direction and Biodonostia Research Institute and CIBERESP, Basque Regional Health Department, San Sebastian, Spain
| | - T Y N Tong
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - K Tsilidis
- 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
| | - M J Gunter
- Nutritional Epidemiology Group, IARC, Lyon, France
| | - Z Herceg
- Epigenetics Group, IARC, Lyon, France
| | - P Ferrari
- Nutritional Methodology and Biostatistics Group, International Agency for Research on Cancer (IARC), World Health Organization, 150, cours Albert Thomas, 69372, Lyon CEDEX 08, France.
| | - I Romieu
- Nutritional Epidemiology Group, IARC, Lyon, France
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11
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Gunter MJ, Alhomoud S, Arnold M, Brenner H, Burn J, Casey G, Chan AT, Cross AJ, Giovannucci E, Hoover R, Houlston R, Jenkins M, Laurent-Puig P, Peters U, Ransohoff D, Riboli E, Sinha R, Stadler ZK, Brennan P, Chanock SJ. Meeting report from the joint IARC-NCI international cancer seminar series: a focus on colorectal cancer. Ann Oncol 2019; 30:510-519. [PMID: 30721924 PMCID: PMC6503626 DOI: 10.1093/annonc/mdz044] [Citation(s) in RCA: 28] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Despite significant progress in our understanding of the etiology, biology and genetics of colorectal cancer, as well as important clinical advances, it remains the third most frequently diagnosed cancer worldwide and is the second leading cause of cancer death. Based on demographic projections, the global burden of colorectal cancer would be expected to rise by 72% from 1.8 million new cases in 2018 to over 3 million in 2040 with substantial increases anticipated in low- and middle-income countries. In this meeting report, we summarize the content of a joint workshop led by the National Cancer Institute and the International Agency for Research on Cancer, which was held to summarize the important achievements that have been made in our understanding of colorectal cancer etiology, genetics, early detection and treatment and to identify key research questions that remain to be addressed.
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Affiliation(s)
- M J Gunter
- Section of Nutrition and Metabolism, International Agency for Research on Cancer, Lyon, France.
| | - S Alhomoud
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - M Arnold
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - H Brenner
- Division of Clinical Epidemiology and Aging Research, Division of Preventive Oncology and German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg; National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - J Burn
- Institute of Genetic Medicine, Newcastle University, Newcastle, UK
| | - G Casey
- Center for Public Health Genomics, University of Virginia, Charlottesville
| | - A T Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, USA
| | - A J Cross
- School of Public Health, Imperial College London, London, UK
| | | | - R Hoover
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - R Houlston
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK
| | - M Jenkins
- Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, Australia
| | - P Laurent-Puig
- SIRIC CARPEM, APHP European Georges Pompidou Hospital Paris, Universite Paris Descartes, Paris, France
| | - U Peters
- Public Health Science Division, Fred Hutchinson Cancer Research Center, Seattle
| | - D Ransohoff
- Lineberger Comprehensive Cancer Center, UNC School of Medicine, University of North Carolina, Chapel Hill
| | - E Riboli
- School of Public Health, Imperial College London, London, UK
| | - R Sinha
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Z K Stadler
- Memorial Sloan Kettering Cancer Center, New York, USA
| | - P Brennan
- Section of Genetics, International Agency for Research on Cancer, Lyon, France
| | - S J Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, USA
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Deschasaux M, Huybrechts I, Murphy N, Julia C, Hercberg S, Srour B, Kesse-Guyot E, Latino-Martel P, Biessy C, Casagrande C, Jenab M, Ward H, Weiderpass E, Ferrari P, Riboli E, Gunter M, Touvier M. Qualité nutritionnelle des aliments définie par le score FSAm-NPS sous-tendant le logo Nutri-Score et risque de cancer en Europe : résultats de la cohorte EPIC. NUTR CLIN METAB 2019. [DOI: 10.1016/j.nupar.2019.01.229] [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: 11/30/2022]
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Schoemaker MJ, Nichols HB, Wright LB, Brook MN, Jones ME, O'Brien KM, Adami HO, Baglietto L, Bernstein L, Bertrand KA, Boutron-Ruault MC, Chen Y, Connor AE, Dorronsoro M, Dossus L, Eliassen AH, Giles GG, Gram IT, Hankinson SE, Kaaks R, Key TJ, Kirsh VA, Kitahara CM, Koh WP, Larsson SC, Linet MS, Ma H, Masala G, Merritt MA, Milne RL, Overvad K, Ozasa K, Palmer JR, Riboli E, Rohan TE, Sadakane A, Sund M, Tamimi RM, Trichopoulou A, Ursin G, Van Gils CH, Visvanathan K, Weiderpass E, Willett WC, Wolk A, Yuan JM, Zeleniuch-Jacquotte A, Sandler DP, Swerdlow AJ. Abstract P1-08-01: Withdrawn. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-08-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was withdrawn by the authors.
Citation Format: Schoemaker MJ, Nichols HB, Wright LB, Brook MN, Jones ME, O'Brien KM, Adami H-O, Baglietto L, Bernstein L, Bertrand KA, Boutron-Ruault M-C, Chen Y, Connor AE, Dorronsoro M, Dossus L, Eliassen AH, Giles GG, Gram IT, Hankinson SE, Kaaks R, Key TJ, Kirsh VA, Kitahara CM, Koh W-P, Larsson SC, Linet MS, Ma H, Masala G, Merritt MA, Milne RL, Overvad K, Ozasa K, Palmer JR, Riboli E, Rohan TE, Sadakane A, Sund M, Tamimi RM, Trichopoulou A, Ursin G, Van Gils CH, Visvanathan K, Weiderpass E, Willett WC, Wolk A, Yuan J-M, Zeleniuch-Jacquotte A, Sandler DP, Swerdlow AJ. Withdrawn [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-08-01.
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Affiliation(s)
- MJ Schoemaker
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - HB Nichols
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - LB Wright
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - MN Brook
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - ME Jones
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - KM O'Brien
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - H-O Adami
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - L Baglietto
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - L Bernstein
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - KA Bertrand
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - M-C Boutron-Ruault
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - Y Chen
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - AE Connor
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - M Dorronsoro
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - L Dossus
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - AH Eliassen
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - GG Giles
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - IT Gram
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - SE Hankinson
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - R Kaaks
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - TJ Key
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - VA Kirsh
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - CM Kitahara
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - W-P Koh
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - SC Larsson
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - MS Linet
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - H Ma
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - G Masala
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - MA Merritt
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - RL Milne
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - K Overvad
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - K Ozasa
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - JR Palmer
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - E Riboli
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - TE Rohan
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - A Sadakane
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - M Sund
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - RM Tamimi
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - A Trichopoulou
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - G Ursin
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - CH Van Gils
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - K Visvanathan
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - E Weiderpass
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - WC Willett
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - A Wolk
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - J-M Yuan
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - A Zeleniuch-Jacquotte
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - DP Sandler
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
| | - AJ Swerdlow
- The Institute of Cancer Research, London, United Kingdom; University of North Carolina Gillings School of Global Public Health, Chapel Hill; National Institute of Environmental Health Sciences, Durham; Harvard T.H. Chan School of Public Health, Boston; University of Pisa, Pisa, Italy; Beckman Research Institute of City of Hope, Duarte; Slone Epidemiology Center at Boston University, Boston; CESP Center for Research in Epidemiology and Population Health, Paris, France; New York University School of Medicine, New York; Johns Hopkins Bloomberg School of Public Health, Baltimore; Public Health Direction and Biodonostia Research Institute and Ciberesp, San Sebastian, Spain; International Agency for Research on Cancer, Lyon, France; The University of Melbourne, Melbourne, Australia; University of Tromsø (UiT) The Arctic University of Norway, Tromsø, Norway; University of Massachusetts, Amherst; German Cancer Research Center (DKFZ), Heidelberg, Germany; University of Oxford, Oxford, United Kingdom; University of To
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14
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Matejcic M, Lesueur F, Biessy C, Renault AL, Mebirouk N, Yammine S, Keski-Rahkonen P, Li K, Hémon B, Weiderpass E, Rebours V, Boutron-Ruault MC, Carbonnel F, Kaaks R, Katzke V, Kuhn T, Boeing H, Trichopoulou A, Palli D, Agnoli C, Panico S, Tumino R, Sacerdote C, Quirós JR, Duell EJ, Porta M, Sánchez MJ, Chirlaque MD, Barricarte A, Amiano P, Ye W, Peeters PH, Khaw KT, Perez-Cornago A, Key TJ, Bueno-de-Mesquita HB, Riboli E, Vineis P, Romieu I, Gunter MJ, Chajès V. Circulating plasma phospholipid fatty acids and risk of pancreatic cancer in a large European cohort. Int J Cancer 2018; 143:2437-2448. [PMID: 30110135 DOI: 10.1002/ijc.31797] [Citation(s) in RCA: 26] [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] [Received: 03/20/2018] [Revised: 07/06/2018] [Accepted: 07/09/2018] [Indexed: 02/11/2024]
Abstract
There are both limited and conflicting data on the role of dietary fat and specific fatty acids in the development of pancreatic cancer. In this study, we investigated the association between plasma phospholipid fatty acids and pancreatic cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. The fatty acid composition was measured by gas chromatography in plasma samples collected at recruitment from375 incident pancreatic cancer cases and375 matched controls. Associations of specific fatty acids with pancreatic cancer risk were evaluated using multivariable conditional logistic regression models with adjustment for established pancreatic cancer risk factors. Statistically significant inverse associations were found between pancreatic cancer incidence and levels of heptadecanoic acid (ORT3-T1 [odds ratio for highest versus lowest tertile] =0.63; 95%CI[confidence interval] = 0.41-0.98; ptrend = 0.036), n-3 polyunsaturated α-linolenic acid (ORT3-T1 = 0.60; 95%CI = 0.39-0.92; ptrend = 0.02) and docosapentaenoic acid (ORT3-T1 = 0.52; 95%CI = 0.32-0.85; ptrend = 0.008). Industrial trans-fatty acids were positively associated with pancreatic cancer risk among men (ORT3-T1 = 3.00; 95%CI = 1.13-7.99; ptrend = 0.029), while conjugated linoleic acids were inversely related to pancreatic cancer among women only (ORT3-T1 = 0.37; 95%CI = 0.17-0.81; ptrend = 0.008). Among current smokers, the long-chain n-6/n-3 polyunsaturated fatty acids ratio was positively associated with pancreatic cancer risk (ORT3-T1 = 3.40; 95%CI = 1.39-8.34; ptrend = 0.007). Results were robust to a range of sensitivity analyses. Our findings suggest that higher circulating levels of saturated fatty acids with an odd number of carbon atoms and n-3 polyunsaturated fatty acids may be related to lower risk of pancreatic cancer. The influence of some fatty acids on the development of pancreatic cancer may be sex-specific and modulated by smoking.
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Affiliation(s)
- M Matejcic
- International Agency for Research on Cancer, Lyon, France
| | - F Lesueur
- Genetic Epidemiology of Cancer team, Inserm, U900, Paris, France
- Institut Curie, Paris, France
- PSL University, Paris, France
- Mines ParisTech, Fontainebleau, France
| | - C Biessy
- International Agency for Research on Cancer, Lyon, France
| | - A L Renault
- Genetic Epidemiology of Cancer team, Inserm, U900, Paris, France
- Institut Curie, Paris, France
- PSL University, Paris, France
- Mines ParisTech, Fontainebleau, France
| | - N Mebirouk
- Genetic Epidemiology of Cancer team, Inserm, U900, Paris, France
- Institut Curie, Paris, France
- PSL University, Paris, France
- Mines ParisTech, Fontainebleau, France
| | - S Yammine
- International Agency for Research on Cancer, Lyon, France
| | | | - K Li
- International Agency for Research on Cancer, Lyon, France
| | - B Hémon
- International Agency for Research on Cancer, Lyon, France
| | - E Weiderpass
- Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
- 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
- Public Health Division of Gipuzkoa, BioDonostia Research institute, San Sebastian, Spain
| | - V Rebours
- Department of Gastroenterology and Pancreatology, Beaujon Hospital, University Paris 7, Clichy, France
| | - M C Boutron-Ruault
- INSERM, Centre for Research in Epidemiology and Population Health, U1018, Health across Generations Team, Institut Gustave Roussy, Villejuif, France
- Université Paris Sud, UMRS, Villejuif, France
| | - F Carbonnel
- INSERM, Centre for Research in Epidemiology and Population Health, U1018, Health across Generations Team, Institut Gustave Roussy, Villejuif, France
- Université Paris Sud, UMRS, Villejuif, France
- Department of Gastroenterology, Bicêtre University Hospital, Assistance Publique des Hôpitaux de Paris, Le Kremlin Bicêtre, France
| | - R Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - V Katzke
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - T Kuhn
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - H Boeing
- Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
| | - 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
| | - D Palli
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy
| | - C Agnoli
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - S Panico
- Clinical Medicine and Surgery Department, Università degli Studi di Napoli Federico II, Naples, Italy
| | - R Tumino
- Cancer Registry and Histopathology Department, ASP, "Civic - M.P. Arezzo" Hospital, Ragusa, Italy
| | - C Sacerdote
- Unit of Cancer Epidemiology, Citta' della Salute e della Scienza Hospital, University of Turin and Centre for Cancer Prevention (CPO), Turin, Italy
| | - J R Quirós
- EPIC Asturias, Public Health Directorate, Asturias, Spain
| | - E J Duell
- Unit of Nutrition and Cancer, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - M Porta
- Hospital del Mar Research Institute - IMIM, CIBER Epidemiología y Salud Pública (CIBERESP) and Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M J Sánchez
- Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria ibs.GRANADA. Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - M D Chirlaque
- CIBER in 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
| | - A Barricarte
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
- Navarra Public Health Institute, Pamplona, Spain
| | - P Amiano
- Public Health Division of Gipuzkoa, BioDonostia Research institute, San Sebastian, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - W Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- The Medical Biobank at Umeå University, Umeå, Sweden
| | - P H Peeters
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, United Kingdom
| | - K T Khaw
- University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - A Perez-Cornago
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - T J Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - H B Bueno-de-Mesquita
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, United Kingdom
- Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - E Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, United Kingdom
| | - P Vineis
- MRC-PHE Center for Environment and Health, School of Public Health, Imperial College, London, United Kingdom
| | - I Romieu
- International Agency for Research on Cancer, Lyon, France
| | - M J Gunter
- International Agency for Research on Cancer, Lyon, France
| | - V Chajès
- International Agency for Research on Cancer, Lyon, France
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15
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Aune D, Schlesinger S, Neuenschwander M, Feng T, Janszky I, Norat T, Riboli E. Diabetes mellitus, blood glucose and the risk of heart failure: A systematic review and meta-analysis of prospective studies. Nutr Metab Cardiovasc Dis 2018; 28:1081-1091. [PMID: 30318112 DOI: 10.1016/j.numecd.2018.07.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/17/2018] [Accepted: 07/17/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIM The strength of the association between diabetes and risk of heart failure has differed between previous studies and the available studies have not been summarized in a meta-analysis. We therefore quantified the association between diabetes and blood glucose and heart failure in a systematic review and meta-analysis. METHODS AND RESULTS PubMed and Embase databases were searched up to May 3rd 2018. Prospective studies on diabetes mellitus or blood glucose and heart failure risk were included. A random effects model was used to calculate summary relative risks (RRs) and 95% confidence intervals (CIs). Seventy seven studies were included. Among the population-based prospective studies, the summary RR for individuals with diabetes vs. no diabetes was 2.06 (95% CIs: 1.73-2.46, I2 = 99.8%, n = 30 studies, 401495 cases, 21416780 participants). The summary RR was 1.23 (95% CI: 1.15-1.32, I2 = 78.2%, n = 10, 5344 cases, 91758 participants) per 20 mg/dl increase in blood glucose and there was evidence of a J-shaped association with nadir around 90 mg/dl and increased risk even within the pre-diabetic blood glucose range. Among the patient-based studies the summary RR was 1.69 (95% CI: 1.57-1.81, I2 = 85.5%, pheterogeneity<0.0001) for diabetes vs. no diabetes (n = 41, 100284 cases and >613925 participants) and 1.25 (95% CI: 0.89-1.75, I2 = 95.6%, pheterogeneity<0.0001) per 20 mg/dl increase in blood glucose (1016 cases, 34309 participants, n = 2). In the analyses of diabetes and heart failure there was low or no heterogeneity among the population-based studies that adjusted for alcohol intake and physical activity and among the patient-based studies there was no heterogeneity among studies with ≥10 years follow-up. CONCLUSIONS These results suggest that individuals with diabetes are at an increased risk of developing heart failure and there is evidence of increased risk even within the pre-diabetic range of blood glucose.
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Affiliation(s)
- D Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom; Department of Nutrition, Bjørknes University College, Oslo, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.
| | - S Schlesinger
- Institute for Biometry and Epidemiology, German Diabetes Center, Leibniz Institute for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - M Neuenschwander
- Institute for Biometry and Epidemiology, German Diabetes Center, Leibniz Institute for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - T Feng
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - I Janszky
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Regional Center for Health Care Improvement, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - T Norat
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - E Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
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Veronesi G, Ghislandi S, Vanni E, Dieci E, Toschi L, Velutti L, Solinas M, Novellis P, Alloisio M, Riboli E, Navone N. P3.11-25 Analysis Indicates Low Incremental Cost-Effectiveness Ratio for Implementation of Lung Cancer Screening in Italy. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hughes D, Fedirko V, Umesh S, Schomburg L, Méplan C, Hybsier S, Riboli E, Jenab M. Selenium status and survival from colorectal cancer in the European prospective investigation of cancer and nutrition. Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.05.142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Hughes D, Fedirko V, Umesh S, Schomburg L, Méplan C, Hybsier S, Riboli E. PO-052 Selenium status and survival from colorectal cancer in the european prospective investigation of cancer and nutrition. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.585] [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: 11/03/2022] Open
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Aune D, Schlesinger S, Norat T, Riboli E. Diabetes mellitus and the risk of sudden cardiac death: A systematic review and meta-analysis of prospective studies. Nutr Metab Cardiovasc Dis 2018; 28:543-556. [PMID: 29730085 DOI: 10.1016/j.numecd.2018.02.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 02/09/2018] [Accepted: 02/18/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although diabetes mellitus is an established risk factor for myocardial infarction and stroke, data on the association with sudden cardiac death are less extensive and the findings have not been entirely consistent. We therefore conducted a systematic review and meta-analysis of prospective studies on diabetes mellitus and risk of sudden cardiac death. METHODS AND RESULTS PubMed and Embase databases were searched up to July 18th 2017. Prospective studies that reported adjusted relative risk (RR) estimates and 95% confidence intervals (CIs) for the association between a diabetes diagnosis or pre-diabetes and risk of sudden cardiac death were included. Summary RRs were estimated by use of a random effects model. Nineteen population-based prospective studies (11 publications) (3610 cases, 249,225 participants) and 10 patient-based prospective studies (2713 cases, 55,098 participants) were included. The summary RR for diabetes patients vs. persons without diabetes was 2.02 (95% CI: 1.81-2.25, I2 = 0%, pheterogeneity = 0.91) in the population-based studies. The summary RR was 1.23 (95% CI: 1.05-1.44, I2 = 6%, pheterogeneity = 0.34) for the association between pre-diabetes and sudden cardiac death (n = 3 studies, 1000 sudden cardiac deaths, 18,360 participants). In the patient-based studies, the summary RR of sudden cardiac death for diabetes patients vs. patients without diabetes was 1.75 (95% CI: 1.51-2.03, I2 = 39%, pheterogeneity = 0.10) for all patients combined, 1.63 (95% CI: 1.36-1.97, I2 = 39%, n = 5) for coronary heart disease patients, and 1.85 (95% CI: 1.48-2.33, I2 = 0%, n = 3) for heart failure patients. CONCLUSIONS These results suggest that diabetes patients are at an increased risk of sudden cardiac death both in the general population and among different patient groups.
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Affiliation(s)
- D Aune
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom; Bjørknes University College, Oslo, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.
| | - S Schlesinger
- Institute for Biometry and Epidemiology, German Diabetes Center, Leibniz Institute for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Germany
| | - T Norat
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - E Riboli
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
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Vineis P, Faggiano F, Riboli E, Berrino F, Pisani P, Crosignani P. Dietary Habits, Internal Migration and Social Class in a Sample of a Northern Italian Population. Tumori 2018; 78:235-8. [PMID: 1466077 DOI: 10.1177/030089169207800403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 11/17/2022]
Abstract
The study of migrants has generated interesting hypotheses on the etiology of different types of cancer. In particular, it has been suggested that both colon and breast cancer could be related to living conditions, including diet, in the country of immigration. Considerable internal migration occurred in Italy in the sixties. We studied a random sample of 1,400 subjects living in the city of Torino and the province of Varese. They were interviewed with a detailed questionnaire about their dietary habits, and the consumption of several nutrients was considered according to the area of birth and social class. The hypothesis we tested was whether, after controlling for social class, there were different dietary habits among the migrants and the native population, and whether such differences could help in the formulation of etiologic hypotheses on cancer. We found that the intake of saturated fatty acids and cholesterol was lower among the migrants from the south, whereas they consumed higher levels of vegetables than people born in the north. The different intake of saturated fatty acids and cholesterol seemed to be attributable mainly to the consumption of butter, for which the south/north ratio was as low as 0.47 in men and 0.56 in women. Important gradients by social class were also suggested for several nutrients.
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Affiliation(s)
- P Vineis
- Dipartimento di Scienze Biomediche e Oncologia Umana, Torino, Italy
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Chajès V, Assi N, Biessy C, Ferrari P, Rinaldi S, Slimani N, Lenoir GM, Baglietto L, His M, Boutron-Ruault MC, Trichopoulou A, Lagiou P, Katsoulis M, Kaaks R, Kühn T, Panico S, Pala V, Masala G, Bueno-de-Mesquita HB, Peeters PH, van Gils C, Hjartåker A, Standahl Olsen K, Borgund Barnung R, Barricarte A, Redondo-Sanchez D, Menéndez V, Amiano P, Wennberg M, Key T, Khaw KT, Merritt MA, Riboli E, Gunter MJ, Romieu I. A prospective evaluation of plasma phospholipid fatty acids and breast cancer risk in the EPIC study. Ann Oncol 2017; 28:2836-2842. [PMID: 28950350 DOI: 10.1093/annonc/mdx482] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [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: 08/08/2023] Open
Abstract
BACKGROUND Intakes of specific fatty acids have been postulated to impact breast cancer risk but epidemiological data based on dietary questionnaires remain conflicting. MATERIALS AND METHODS We assessed the association between plasma phospholipid fatty acids and breast cancer risk in a case-control study nested within the European Prospective Investigation into Cancer and Nutrition study. Sixty fatty acids were measured by gas chromatography in pre-diagnostic plasma phospholipids from 2982 incident breast cancer cases matched to 2982 controls. Conditional logistic regression models were used to estimate relative risk of breast cancer by fatty acid level. The false discovery rate (q values) was computed to control for multiple comparisons. Subgroup analyses were carried out by estrogen receptor (ER) and progesterone receptor expression in the tumours. RESULTS A high level of palmitoleic acid [odds ratio (OR) for the highest quartile compared with the lowest OR (Q4-Q1) 1.37; 95% confidence interval (CI), 1.14-1.64; P for trend = 0.0001, q value = 0.004] as well as a high desaturation index (DI16) (16:1n-7/16:0) [OR (Q4-Q1), 1.28; 95% C, 1.07-1.54; P for trend = 0.002, q value = 0.037], as biomarkers of de novo lipogenesis, were significantly associated with increased risk of breast cancer. Levels of industrial trans-fatty acids were positively associated with ER-negative tumours [OR for the highest tertile compared with the lowest (T3-T1)=2.01; 95% CI, 1.03-3.90; P for trend = 0.047], whereas no association was found for ER-positive tumours (P-heterogeneity =0.01). No significant association was found between n-3 polyunsaturated fatty acids and breast cancer risk, overall or by hormonal receptor. CONCLUSION These findings suggest that increased de novo lipogenesis, acting through increased synthesis of palmitoleic acid, could be a relevant metabolic pathway for breast tumourigenesis. Dietary trans-fatty acids derived from industrial processes may specifically increase ER-negative breast cancer risk.
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Affiliation(s)
- V Chajès
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon.
| | - N Assi
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon
| | - C Biessy
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon
| | - P Ferrari
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon
| | - S Rinaldi
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon
| | - N Slimani
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon
| | | | - L Baglietto
- Institut Gustave Roussy, Villejuif; Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
| | - M His
- Institut Gustave Roussy, Villejuif; Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
| | - M C Boutron-Ruault
- Institut Gustave Roussy, Villejuif; Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
| | - A Trichopoulou
- Hellenic Health Foundation, Athens; 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 Lagiou
- Hellenic Health Foundation, Athens; 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; Department of Epidemiology, Harvard School of Public Health, Boston, USA
| | | | - R Kaaks
- The German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - T Kühn
- The German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - S Panico
- Dipartimento Di Medicina Clinica E Chirurgia, Federico II University, Naples
| | - V Pala
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - G Masala
- Cancer Risk Factors and Life-Style Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy
| | - H B Bueno-de-Mesquita
- Department for Determinants of Chronic Diseases (DCD), 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, UK; Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - P H Peeters
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - C van Gils
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A Hjartåker
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo
| | - K Standahl Olsen
- Department of Community Medicine, University of Tromsø-UiT-The Artic University of Norway, Tromsø, Norway
| | - R Borgund Barnung
- Department of Community Medicine, University of Tromsø-UiT-The Artic University of Norway, Tromsø, Norway
| | - A Barricarte
- Navarra Public Health Institute, Pamplona; Navarra Institute for Health Research (IdiSNA), Pamplona; CIBER Epidemiology and Public Health CIBERESP, Madrid
| | - D Redondo-Sanchez
- CIBER Epidemiology and Public Health CIBERESP, Madrid; Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs.Granada, Hospitales Universitarios de Granada, Granada; Universidad de Granada, Granada
| | | | - P Amiano
- CIBER Epidemiology and Public Health CIBERESP, Madrid; Public Health Division of Gipuzkoa, Health Department, Basque Region, San Sebastian, Spain
| | - M Wennberg
- Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden
| | - T Key
- The Cancer Epidemiology Unit, University of Oxford, Oxford
| | - K T Khaw
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - M A Merritt
- Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, UK
| | - E Riboli
- Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, UK
| | - M J Gunter
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon
| | - I Romieu
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon
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22
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Aleksandrova K, Jenab M, Leitzmann M, Bueno-de-Mesquita B, Kaaks R, Riboli E, Boeing H. Mediating Factors of the Association between Physical Activity and Colon Cancer: Lessons from the EPIC Cohort. Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- K Aleksandrova
- DIfE-Potsdam-Rehbrücke, Ernährung, Immunität und Metabolismus Start-up Lab, Epidemiologie, Nuthetal
| | - M Jenab
- International Agency for Research on Cancer (IARC-WHO), Lyon
| | - M Leitzmann
- Department of Epidemiology and Preventive Medicine, Regensburg University Medical Center, Regensburg
| | | | - R Kaaks
- Division of Cancer Epidemiology, German Cancer Research Centre, Heidelberg
| | - E Riboli
- Division of Epidemiology, Public Health and Primary Care, Imperial College, London
| | - H Boeing
- DIFE-Potsdam-Rehbrücke, Epidemiologie, Nuthetal
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Al-Dabhani K, Tsilidis KK, Murphy N, Ward HA, Elliott P, Riboli E, Gunter M, Tzoulaki I. Prevalence of vitamin D deficiency and association with metabolic syndrome in a Qatari population. Nutr Diabetes 2017; 7:e263. [PMID: 28394362 PMCID: PMC5436094 DOI: 10.1038/nutd.2017.14] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 01/26/2017] [Accepted: 02/13/2017] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Despite long hours of sunlight in Qatar and other regions of the Middle East, vitamin D deficiency has been rising. In parallel, the prevalence of metabolic syndrome has also been increasing in Qatar. Vitamin D levels have been associated with metabolic syndrome but the data are inconsistent and no studies have addressed these inter-relationships in a Middle Eastern population where the prevalence of these conditions is high. The objective is to investigate the prevalence of vitamin D deficiency and its association with metabolic syndrome and its components in the Qatar Biobank population. METHODS A cross-sectional study of 1205 participants (702 women and 503 men) from the Qatar Biobank, comprising Qataris and non-Qataris between the ages of 18 and 80 years, was used to perform multivariate linear regression analyses to examine the association between metabolic syndrome and prevalence of vitamin D deficiency (defined as <20 ng ml-1 serum vitamin D levels) adjusting for age, sex, ethnicity, season of blood collection, physical activity and education. Odds ratios and 95% confidence intervals were calculated for all analyses. RESULTS Approximately 64% of participants were vitamin D deficient (<20 ng ml-1) with more men being deficient (68.6%) than women (61.3%). Serum vitamin D was 8% lower in individuals with metabolic syndrome (RR: 0.92, 95%CI: 0.87-0.98, P-value: 0.01) compared to individuals without metabolic syndrome. Waist circumference and HDL as well as high triglyceride levels were also significantly positively associated with vitamin D deficiency. No association was found between the other components of metabolic syndrome or diabetes and the presence of vitamin D deficiency. CONCLUSIONS Vitamin D deficiency is prevalent in this Qatari population. Presence of metabolic syndrome was associated with presence of vitamin D deficiency. Future prospective studies need to be conducted to investigate the potential for causality.
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Affiliation(s)
- K Al-Dabhani
- Department of Biostatistics and Epidemiology, School of Public Health, Imperial College London, London, UK
| | - K K Tsilidis
- Department of Biostatistics and Epidemiology, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - N Murphy
- Department of Biostatistics and Epidemiology, School of Public Health, Imperial College London, London, UK
- Nutritional Epidemiology Group, International Agency for Research on Cancer
| | - H A Ward
- Department of Biostatistics and Epidemiology, School of Public Health, Imperial College London, London, UK
| | - P Elliott
- Department of Biostatistics and Epidemiology, School of Public Health, Imperial College London, London, UK
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - E Riboli
- Department of Biostatistics and Epidemiology, School of Public Health, Imperial College London, London, UK
| | - M Gunter
- Nutritional Epidemiology Group, International Agency for Research on Cancer
| | - I Tzoulaki
- Department of Biostatistics and Epidemiology, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
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Bergmann MM, Hernandez V, Bernigau W, Boeing H, Chan SSM, Luben R, Khaw KT, van Schaik F, Oldenburg B, Bueno-de-Mesquita B, Overvad K, Palli D, Masala G, Carbonnel F, Boutron-Ruault MC, Olsen A, Tjonneland A, Kaaks R, Katzke V, Riboli E, Hart AR. Erratum: No association of alcohol use and the risk of ulcerative colitis or Crohn’s disease: data from a European Prospective cohort study (EPIC). Eur J Clin Nutr 2017; 71:566. [DOI: 10.1038/ejcn.2017.16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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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Matejcic M, de Batlle J, Ricci C, Biessy C, Perrier F, Huybrechts I, Weiderpass E, Boutron-Ruault MC, Cadeau C, His M, Cox DG, Boeing H, Fortner RT, Kaaks R, Lagiou P, Trichopoulou A, Benetou V, Tumino R, Panico S, Sieri S, Palli D, Ricceri F, Bueno-de-Mesquita HBA, Skeie G, Amiano P, Sánchez MJ, Chirlaque MD, Barricarte A, Quirós JR, Buckland G, van Gils CH, Peeters PH, Key TJ, Riboli E, Gylling B, Zeleniuch-Jacquotte A, Gunter MJ, Romieu I, Chajès V. Biomarkers of folate and vitamin B12 and breast cancer risk: report from the EPIC cohort. Int J Cancer 2017; 140:1246-1259. [PMID: 27905104 DOI: 10.1002/ijc.30536] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [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: 08/05/2016] [Accepted: 10/18/2016] [Indexed: 01/13/2023]
Abstract
Epidemiological studies have reported inconsistent findings for the association between B vitamins and breast cancer (BC) risk. We investigated the relationship between biomarkers of folate and vitamin B12 and the risk of BC in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Plasma concentrations of folate and vitamin B12 were determined in 2,491 BC cases individually matched to 2,521 controls among women who provided baseline blood samples. Multivariable logistic regression models were used to estimate odds ratios by quartiles of either plasma B vitamin. Subgroup analyses by menopausal status, hormone receptor status of breast tumors (estrogen receptor [ER], progesterone receptor [PR] and human epidermal growth factor receptor 2 [HER2]), alcohol intake and MTHFR polymorphisms (677C > T and 1298A > C) were also performed. Plasma levels of folate and vitamin B12 were not significantly associated with the overall risk of BC or by hormone receptor status. A marginally positive association was found between vitamin B12 status and BC risk in women consuming above the median level of alcohol (ORQ4-Q1 = 1.26; 95% CI 1.00-1.58; Ptrend = 0.05). Vitamin B12 status was also positively associated with BC risk in women with plasma folate levels below the median value (ORQ4-Q1 = 1.29; 95% CI 1.02-1.62; Ptrend = 0.03). Overall, folate and vitamin B12 status was not clearly associated with BC risk in this prospective cohort study. However, potential interactions between vitamin B12 and alcohol or folate on the risk of BC deserve further investigation.
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Affiliation(s)
- M Matejcic
- International Agency for Research on Cancer, Lyon, France
| | - J de Batlle
- International Agency for Research on Cancer, Lyon, France
| | - C Ricci
- International Agency for Research on Cancer, Lyon, France
| | - C Biessy
- International Agency for Research on Cancer, Lyon, France
| | - F Perrier
- International Agency for Research on Cancer, Lyon, France
| | - I Huybrechts
- International Agency for Research on Cancer, Lyon, France
| | - E Weiderpass
- Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
- Department of Community Medicine, University of Tromsø - The Arctic University of Norway, Tromsø, Norway
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - M C Boutron-Ruault
- Institut Gustave Roussy, Villejuif, France
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
| | - C Cadeau
- Institut Gustave Roussy, Villejuif, France
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
| | - M His
- Institut Gustave Roussy, Villejuif, France
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
| | - D G Cox
- Centre Léon Bérard, INSERM U1052, Cancer Research Center of Lyon, Lyon, France
| | - H Boeing
- Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
| | - R T Fortner
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - R Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - P Lagiou
- Hellenic Health Foundation, Athens, Greece
- WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - 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, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - V Benetou
- WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - R Tumino
- Cancer Registry and Histopathology Unit, Civic - M.P. Arezzo Hospital, ASP Ragusa, Ragusa, Italy
| | - S Panico
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Naples, Italy
| | - S Sieri
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - D Palli
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy
| | - F Ricceri
- Unit of Cancer Epidemiology, Department of Medical Sciences, University of Turin, Turin, Italy
- Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco, Italy
| | - H B As Bueno-de-Mesquita
- Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department for Determinants of Chronic Diseases (DCD), 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
| | - G Skeie
- Department of Community Medicine, University of Tromsø - The Arctic University of Norway, Tromsø, Norway
| | - P Amiano
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Public Health Division of Gipuzkoa, BioDonostia Research Institute, San Sebastian, Spain
| | - M J Sánchez
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs, GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - M D Chirlaque
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain
| | - A Barricarte
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
- Navarra Public Health Institute, Pamplona, Spain
| | - J R Quirós
- Public Health Directorate, Asturias, Spain
| | - G Buckland
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - C H van Gils
- 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
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, United Kingdom
| | - T J Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - E Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, United Kingdom
| | - B Gylling
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | | | - M J Gunter
- International Agency for Research on Cancer, Lyon, France
| | - I Romieu
- International Agency for Research on Cancer, Lyon, France
| | - V Chajès
- International Agency for Research on Cancer, Lyon, France
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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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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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Hughes D, Fedirko V, Jones J, Méplan C, Schomburg L, Hybsier S, Riboli E, Hesketh J, Jenab M. 1056 Association of selenoprotein and selenium pathway gene variation with colorectal cancer risk and modification by selenium status. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30482-8] [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: 11/29/2022]
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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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Key TJ, Appleby PN, Reeves GK, Travis RC, Brinton LA, Helzlsouer KJ, Dorgan JF, Gapstur SM, Gaudet MM, Kaaks R, Riboli E, Rinaldi S, Manjer J, Hallmans G, Giles GG, Le Marchand L, Kolonel LN, Henderson BE, Tworoger SS, Hankinson SE, Zeleniuch-Jacquotte A, Koenig K, Krogh V, Sieri S, Muti P, Ziegler RG, Schairer C, Fuhrman BJ, Barrett-Connor E, Laughlin GA, Grant EJ, Cologne J, Ohishi W, Hida A, Cauley JA, Fourkala EO, Menon U, Rohan TE, Strickler HD, Gunter MJ. Steroid hormone measurements from different types of assays in relation to body mass index and breast cancer risk in postmenopausal women: Reanalysis of eighteen prospective studies. Steroids 2015; 99:49-55. [PMID: 25304359 PMCID: PMC4502556 DOI: 10.1016/j.steroids.2014.09.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 08/22/2014] [Indexed: 12/20/2022]
Abstract
Epidemiological studies have examined breast cancer risk in relation to sex hormone concentrations measured by different methods: "extraction" immunoassays (with prior purification by organic solvent extraction, with or without column chromatography), "direct" immunoassays (no prior extraction or column chromatography), and more recently with mass spectrometry-based assays. We describe the associations of estradiol, estrone and testosterone with both body mass index and breast cancer risk in postmenopausal women according to assay method, using data from a collaborative pooled analysis of 18 prospective studies. In general, hormone concentrations were highest in studies that used direct assays and lowest in studies that used mass spectrometry-based assays. Estradiol and estrone were strongly positively associated with body mass index, regardless of the assay method; testosterone was positively associated with body mass index for direct assays, but less clearly for extraction assays, and there were few data for mass spectrometry assays. The correlations of estradiol with body mass index, estrone and testosterone were lower for direct assays than for extraction and mass spectrometry assays, suggesting that the estimates from the direct assays were less precise. For breast cancer risk, all three hormones were strongly positively associated with risk regardless of assay method (except for testosterone by mass spectrometry where there were few data), with no statistically significant differences in the trends, but differences may emerge as new data accumulate. Future epidemiological and clinical research studies should continue to use the most accurate assays that are feasible within the design characteristics of each study.
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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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Buijsse B, Boeing H, Drogan D, Schulze MB, Feskens EJ, Amiano P, Barricarte A, Clavel-Chapelon F, de Lauzon-Guillain B, Fagherazzi G, Fonseca-Nunes A, Franks PW, Huerta JM, Jakobsen MU, Kaaks R, Key TJ, Khaw KT, Masala G, Moskal A, Nilsson PM, Overvad K, Pala V, Panico S, Redondo ML, Ricceri F, Rolandsson O, Sánchez MJ, Sluijs I, Spijkerman AM, Tjonneland A, Tumino R, van der A DL, van der Schouw YT, Langenberg C, Sharp SJ, Forouhi NG, Riboli E, Wareham NJ. Consumption of fatty foods and incident type 2 diabetes in populations from eight European countries. Eur J Clin Nutr 2015; 69:455-61. [PMID: 25424603 DOI: 10.1038/ejcn.2014.249] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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: 01/09/2014] [Revised: 09/08/2014] [Accepted: 09/19/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND/OBJECTIVES Diets high in saturated and trans fat and low in unsaturated fat may increase type 2 diabetes (T2D) risk, but studies on foods high in fat per unit weight are sparse. We assessed whether the intake of vegetable oil, butter, margarine, nuts and seeds and cakes and cookies is related to incident T2D. SUBJECTS/METHODS A case-cohort study was conducted, nested within eight countries of the European Prospective Investigation into Cancer (EPIC), with 12,403 incident T2D cases and a subcohort of 16,835 people, identified from a cohort of 340,234 people. Diet was assessed at baseline (1991-1999) by country-specific questionnaires. Country-specific hazard ratios (HRs) across four categories of fatty foods (nonconsumers and tertiles among consumers) were combined with random-effects meta-analysis. RESULTS After adjustment not including body mass index (BMI), nonconsumers of butter, nuts and seeds and cakes and cookies were at higher T2D risk compared with the middle tertile of consumption. Among consumers, cakes and cookies were inversely related to T2D (HRs across increasing tertiles 1.14, 1.00 and 0.92, respectively; P-trend <0.0001). All these associations attenuated upon adjustment for BMI, except the higher risk of nonconsumers of cakes and cookies (HR 1.57). Higher consumption of margarine became positively associated after BMI adjustment (HRs across increasing consumption tertiles: 0.93, 1.00 and 1.12; P-trend 0.03). Within consumers, vegetable oil, butter and nuts and seeds were unrelated to T2D. CONCLUSIONS Fatty foods were generally not associated with T2D, apart from weak positive association for margarine. The higher risk among nonconsumers of cakes and cookies needs further explanation.
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Affiliation(s)
- B Buijsse
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - H Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - D Drogan
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - M B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - E J Feskens
- Division of Human Nutrition-Section Nutrition and Epidemiology, University of Wageningen, Wageningen, The Netherlands
| | - P Amiano
- 1] Public Health Division of Gipuzkoa, San Sebastian, Spain [2] Instituto BIO-Donostia, San Sebastian, Spain [3] Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain
| | - A Barricarte
- 1] Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain [2] Navarre Public Health Institute, Pamplona, Spain
| | - F Clavel-Chapelon
- 1] INSERM, Centre for Research in Epidemiology and Population Health, Villejuif, France [2] Paris South University, Villejuif, France
| | - B de Lauzon-Guillain
- 1] INSERM, Centre for Research in Epidemiology and Population Health, Villejuif, France [2] Paris South University, Villejuif, France
| | - G Fagherazzi
- 1] INSERM, Centre for Research in Epidemiology and Population Health, Villejuif, France [2] Paris South University, Villejuif, France
| | - A Fonseca-Nunes
- Unit Nutrition, Environment and Cancer, Department of Epidemiology, Catalan Institute of Oncology, Barcelona, Spain
| | - P W Franks
- 1] Department of Clinical Sciences, Clinical Research Center, Skåne University Hospital, Lund University, Malmö, Sweden [2] Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - J M Huerta
- 1] Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain [2] Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain
| | - M U Jakobsen
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
| | - R Kaaks
- Division of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany
| | - T J Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - K T Khaw
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - G Masala
- Cancer Research and Prevention Institute, Florence, Italy
| | - A Moskal
- International Agency for Research on Cancer, Lyon, France
| | - P M Nilsson
- Department of Clinical Sciences, Clinical Research Center, Skåne University Hospital, Lund University, Malmö, Sweden
| | - K Overvad
- 1] Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark [2] Department of Cardiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
| | - V Pala
- 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
| | - M L Redondo
- Consejería de Sanidad, Public Health Directorate, Oviedo-Asturias, Spain
| | - F Ricceri
- Human Genetics Foundation, Turin, Italy
| | - O Rolandsson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - M-J Sánchez
- 1] Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain [2] Andalusian School of Public Health, Instituto de Investigación Biosanitaria (IBS GRANADA) and Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - I Sluijs
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A M Spijkerman
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - A Tjonneland
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - R Tumino
- 1] Histopathology Unit, 'Civic MP Arezzo' Hospital, ASP Ragusa, Italy [2] Associazone Iblea per la Ricerca Epidemiologica-Onlus, Ragusa, Italy
| | - D L van der A
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Y T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C Langenberg
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - S J Sharp
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - N G Forouhi
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - E Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK
| | - N J Wareham
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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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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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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35
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Ose J, Fortner RT, Schock H, Peeters PH, Onland-Moret NC, Bueno-de-Mesquita HB, Weiderpass E, Gram IT, Overvad K, Tjonneland A, Dossus L, Fournier A, Baglietto L, Trichopoulou A, Benetou V, Trichopoulos D, Boeing H, Masala G, Krogh V, Matiello A, Tumino R, Popovic M, Obón-Santacana M, Larrañaga N, Ardanaz E, Sánchez MJ, Menéndez V, Chirlaque MD, Travis RC, Khaw KT, Brändstedt J, Idahl A, Lundin E, Rinaldi S, Kuhn E, Romieu I, Gunter MJ, Merritt MA, Riboli E, Kaaks R. Insulin-like growth factor I and risk of epithelial invasive ovarian cancer by tumour characteristics: results from the EPIC cohort. Br J Cancer 2015; 112:162-6. [PMID: 25349976 PMCID: PMC4453611 DOI: 10.1038/bjc.2014.566] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 05/28/2014] [Revised: 09/24/2014] [Accepted: 10/08/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Prospective studies on insulin-like growth factor I (IGF-I) and epithelial ovarian cancer (EOC) risk are inconclusive. Data suggest risk associations vary by tumour characteristics. METHODS We conducted a nested case-control study in the European Prospective Investigation into Cancer and Nutrition (EPIC) to evaluate IGF-I concentrations and EOC risk by tumour characteristics (n=565 cases). Multivariable conditional logistic regression models were used to estimate associations. RESULTS We observed no association between IGF-I and EOC overall or by tumour characteristics. CONCLUSIONS In the largest prospective study to date was no association between IGF-I and EOC risk. Pre-diagnostic serum IGF-I concentrations may not influence EOC risk.
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Affiliation(s)
- J Ose
- Division of Cancer Epidemiology, German Cancer Research Center, 69120 Heidelberg, Germany
| | - R T Fortner
- Division of Cancer Epidemiology, German Cancer Research Center, 69120 Heidelberg, Germany
| | - H Schock
- Division of Cancer Epidemiology, German Cancer Research Center, 69120 Heidelberg, Germany
| | - P H Peeters
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3584 Utrecht, The Netherlands
| | - N C Onland-Moret
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3584 Utrecht, The Netherlands
| | - H B Bueno-de-Mesquita
- National Institute for Public Health and the Environment (RIVM), 3720 Bilthoven, The Netherlands
- Department of Gastroenterology and Hepatology, University Medical Centre, 3542 Utrecht, The Netherlands
- Department of Epidemiology and Statistics, the School of Public Health, Imperial College London, SW72AZ London, UK
| | - E Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, 90109 Tromsø, Norway
- Cancer Registry of Norway, 0304 Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17177 Stockholm, Sweden
- Department of Genetic Epidemiology, Folkhälsan Research Center, 00014 Helsinki, Finland
| | - I T Gram
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, 9037 Tromsø, Norway
| | - K Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, 8000 Aarhus, Denmark
| | - A Tjonneland
- Institute of Cancer Epidemiology, Danish Cancer Society Research Center, 2100 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
- Univ Paris Sud, UMRS 1018, F-94805 Villejuif, France
- IGR, F-94805 Villejuif, France
| | - A Fournier
- Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health team, F-94805 Villejuif, France
- Univ Paris Sud, UMRS 1018, F-94805 Villejuif, France
- IGR, F-94805 Villejuif, France
| | - L Baglietto
- Cancer Epidemiology Centre, Cancer Council of Victoria, Melbourne, 3004 Victoria, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, 3004 Victoria, Australia
| | - A Trichopoulou
- Bureau of Epidemiologic Research, Academy of Athens, 23 Alexandroupoleos Street, Athens GR-115 27, Greece
- Hellenic Health Foundation, 13 Kaisareias Street, Athens GR-115 27, Greece
| | - V Benetou
- Hellenic Health Foundation, 13 Kaisareias Street, Athens GR-115 27, Greece
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, 75M Asias Street, Goudi, Athens GR-115 27, Greece
| | - D Trichopoulos
- Bureau of Epidemiologic Research, Academy of Athens, 23 Alexandroupoleos Street, Athens GR-115 27, Greece
- 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
| | - H Boeing
- Department of Epidemiology, German Institute of Human Nutrition (DIfE) 14558 Potsdam-Rehbrücke, Nuthetal, Germany
| | - G Masala
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute—ISPO, 50139 Florence, Italy
| | - V Krogh
- Epidemiology and Prevention Unit, Fondazione IRCCS Instituto Nazionale dei Tumori, Via Veneziani 1, 20133 Milano, Italy
| | - A Matiello
- Department of Clinical and Experimental Medicine, Federico II University, 80131 Naples, Italy
| | - R Tumino
- Cancer Registry and Histopathology Unit, ‘Civic - M.P. Arezzo' Hospita, ASP 97100 Ragusa, Italy
| | - M Popovic
- Unit of Cancer Epidemiology, AO Citta' della Salute e della Scienza, Department of Medical Sciences, University of Turin and Center for Cancer Prevention (CPO-Piemonte), 10126 Turin, Italy
| | - M Obón-Santacana
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO-IDIBELL), 08908 Barcelona, Spain
| | - N Larrañaga
- Public Health Division of Gipuzkoa-BIODonostia Research Institute, Basque Regional Health Department, 20013 San Sebastian, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER), 28029 Madrid, Spain
| | - E Ardanaz
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER), 28029 Madrid, Spain
- Navarre Public Health Institute, 31006 Pamplona, Spain
| | - M-J Sánchez
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER), 28029 Madrid, Spain
- Andalusian School of Public Health, 18011 Granada, Spain
| | - V Menéndez
- Public Health Directorate, 33006 Asturias, Spain
| | - M-D Chirlaque
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER), 28029 Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Authority, 30008 Murcia, Spain
| | - R C Travis
- Cancer Epidemiology Unit, University of Oxford, OX30NR Oxford, UK
| | - K-T Khaw
- Department of Public Health and Primary Care, University of Cambridge, CB22QQ Cambridge, UK
| | - J Brändstedt
- Medical Department of Surgery, Malmö University Hospital, 20502 Malmö, Sweden
| | - A Idahl
- Department of Clinical Sciences, Obstetrics and Gynecology and Department of Public Health and Clinical Medicine, Nutritional Research Umeå University, 90185 Umeå, Sweden
| | - E Lundin
- Department of Medical Biosciences, Pathology Umeå University, 90185 Umeå, Sweden
| | - S Rinaldi
- International Agency for Research on Cancer, 69372 Lyon, France
| | - E Kuhn
- International Agency for Research on Cancer, 69372 Lyon, France
| | - I Romieu
- International Agency for Research on Cancer, 69372 Lyon, France
| | - M J Gunter
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, SW72AZ London, UK
| | - M A Merritt
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, SW72AZ London, UK
| | - E Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, SW72AZ London, UK
| | - R Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center, 69120 Heidelberg, Germany
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36
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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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Zamora-Ros R, Sacerdote C, Ricceri F, Weiderpass E, Roswall N, Buckland G, St-Jules DE, Overvad K, Kyrø C, Fagherazzi G, Kvaskoff M, Severi G, Chang-Claude J, Kaaks R, Nöthlings U, Trichopoulou A, Naska A, Trichopoulos D, Palli D, Grioni S, Mattiello A, Tumino R, Gram IT, Engeset D, Huerta JM, Molina-Montes E, Argüelles M, Amiano P, Ardanaz E, Ericson U, Lindkvist B, Nilsson LM, Kiemeney LA, Ros M, Bueno-de-Mesquita HB, Peeters PHM, Khaw KT, Wareham NJ, Knaze V, Romieu I, Scalbert A, Brennan P, Wark P, Vineis P, Riboli E, González CA. Flavonoid and lignan intake in relation to bladder cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Br J Cancer 2014; 111:1870-80. [PMID: 25121955 PMCID: PMC4453722 DOI: 10.1038/bjc.2014.459] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [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: 03/03/2014] [Revised: 07/16/2014] [Accepted: 07/20/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND There is growing evidence of the protective role of dietary intake of flavonoids and lignans on cancer, but the association with bladder cancer has not been thoroughly investigated in epidemiological studies. We evaluated the association between dietary intakes of total and subclasses of flavonoids and lignans and risk of bladder cancer and its main morphological type, urothelial cell carcinoma (UCC), within the European Prospective Investigation into Cancer and Nutrition (EPIC) study. METHODS A cohort of 477 312 men and women mostly aged 35-70 years, were recruited in 10 European countries. At baseline, dietary flavonoid and lignan intakes were estimated using centre-specific validated questionnaires and a food composition database based on the Phenol-Explorer, the UK Food Standards Agency and the US Department of Agriculture databases. RESULTS During an average of 11 years of follow-up, 1575 new cases of primary bladder cancer were identified, of which 1425 were UCC (classified into aggressive (n=430) and non-aggressive (n=413) UCC). No association was found between total flavonoid intake and bladder cancer risk. Among flavonoid subclasses, significant inverse associations with bladder cancer risk were found for intakes of flavonol (hazard ratio comparing fifth with first quintile (HRQ5-Q1) 0.74, 95% confidence interval (CI): 0.61-0.91; P-trend=0.009) and lignans (HRQ5-Q1 0.78, 95% CI: 0.62-0.96; P-trend=0.046). Similar results were observed for overall UCC and aggressive UCC, but not for non-aggressive UCC. CONCLUSIONS Our study suggests an inverse association between the dietary intakes of flavonols and lignans and risk of bladder cancer, particularly aggressive UCC.
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Affiliation(s)
- R Zamora-Ros
- Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC), Lyon, France
| | - C Sacerdote
- Center for Cancer Prevention (CPO-Piemonte), and Human Genetic Foundation (HuGeF), Torino, Italy
| | - F Ricceri
- Center for Cancer Prevention (CPO-Piemonte), and Human Genetic Foundation (HuGeF), Torino, Italy
| | - E Weiderpass
- Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
- Cancer Registry of Norway, Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Samfundet Folkhälsan, Helsinki, Finland
| | - N Roswall
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - G Buckland
- Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - D E St-Jules
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
| | - K Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
| | - C Kyrø
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - G Fagherazzi
- Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health team, Villejuif, France
- Paris South University, UMRS 1018, Villejuif, France
- IGR, F-94805, Villejuif, France
| | - M Kvaskoff
- Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health team, Villejuif, France
- Paris South University, UMRS 1018, Villejuif, France
- IGR, F-94805, Villejuif, France
| | - G Severi
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, The University of Melbourne, Melbourne, Victoria, Australia
| | - J Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - R Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - U Nöthlings
- Department of Nutrition and Food Sciences, Nutritional Epidemiology, University of Bonn, Bonn, Germany
| | - A Trichopoulou
- Hellenic Health Foundation, Athens, Greece
- Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece
| | - A Naska
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - D Trichopoulos
- Hellenic Health Foundation, Athens, Greece
- Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - D Palli
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute-ISPO, Florence, Italy
| | - S Grioni
- Nutritional Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - A Mattiello
- Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy
| | - R Tumino
- Cancer Registry and Histopathology Unit, ‘Civic MP Arezzo' Hospital, ASP Ragusa, Italy
| | - I T Gram
- Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - D Engeset
- Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - J M Huerta
- Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - E Molina-Montes
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Andalusian School of Public Health, Granada, Spain
| | | | - P Amiano
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Public Health Department of Gipuzkoa, BioDonostia Research Institute, Health Department of Basque Region, San Sebastián, Spain
| | - E Ardanaz
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Public Health Institute of Navarra, Pamplona, Spain
| | - U Ericson
- Diabetes and Cardiovascular disease, Genetic Epidemiology, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - B Lindkvist
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - L M Nilsson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Arcum, Arctic Research Centre at Umeå University, Umeå, Sweden
| | - L A Kiemeney
- Department for Health Evidence and Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M Ros
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - 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, Utrecht, The Netherlands
- School of Public Health, Imperial College, London, UK
| | - P H M Peeters
- School of Public Health, Imperial College, London, UK
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - K-T Khaw
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - N J Wareham
- MRC Epidemiology Unit, Cambridge University, Institute of Metabolic Science, Cambridge, UK
| | - V Knaze
- 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 Scalbert
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC), Lyon, France
| | - P Brennan
- Genetic Epidemiology Group, Section of Genetics, International Agency for Research on Cancer (IARC), Lyon, France
| | - P Wark
- School of Public Health, Imperial College, London, UK
| | - P Vineis
- School of Public Health, Imperial College, London, UK
| | - E Riboli
- School of Public Health, Imperial College, London, UK
| | - C A González
- Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
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Jeurnink SM, Ros MM, Leenders M, van Duijnhoven FJB, Siersema PD, Jansen EHJM, van Gils CH, Bakker MF, Overvad K, Roswall N, Tjønneland A, Boutron-Ruault MC, Racine A, Cadeau C, Grote V, Kaaks R, Aleksandrova K, Boeing H, Trichopoulou A, Benetou V, Valanou E, Palli D, Krogh V, Vineis P, Tumino R, Mattiello A, Weiderpass E, Skeie G, Castaño JMH, Duell EJ, Barricarte A, Molina-Montes E, Argüelles M, Dorronsoro M, Johansen D, Lindkvist B, Sund M, Crowe FL, Khaw KT, Jenab M, Fedirko V, Riboli E, Bueno-de-Mesquita HB. Plasma carotenoids, vitamin C, retinol and tocopherols levels and pancreatic cancer risk within the European Prospective Investigation into Cancer and Nutrition: a nested case-control study: plasma micronutrients and pancreatic cancer risk. Int J Cancer 2014; 136:E665-76. [PMID: 25175624 DOI: 10.1002/ijc.29175] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 06/19/2014] [Accepted: 06/23/2014] [Indexed: 01/21/2023]
Abstract
Evidence of a protective effect of several antioxidants and other nutrients on pancreatic cancer risk is inconsistent. The aim of this study was to investigate the association for prediagnostic plasma levels of carotenoids, vitamin C, retinol and tocopherols with risk of pancreatic cancer in a case-control study nested within the European Prospective Investigation into Cancer and Nutrition (EPIC). 446 incident exocrine pancreatic cancer cases were matched to 446 controls by age at blood collection, study center, sex, date and time of blood collection, fasting status and hormone use. Plasma carotenoids (α- and β-carotene, lycopene, β-cryptoxanthin, canthaxanthin, zeaxanthin and lutein), α- and γ-tocopherol and retinol were measured by reverse phase high-performance liquid chromatography and plasma vitamin C by a colorimetric assay. Incidence rate ratios (IRRs) with 95% confidence intervals (95%CIs) for pancreatic cancer risk were estimated using a conditional logistic regression analysis, adjusted for smoking status, smoking duration and intensity, waist circumference, cotinine levels and diabetes status. Inverse associations with pancreatic cancer risk were found for plasma β-carotene (IRR highest vs. lowest quartile 0.52, 95%CI 0.31-0.88, p for trend = 0.02), zeaxanthin (IRR highest vs. lowest quartile 0.53, 95%CI 0.30-0.94, p for trend = 0.06) and α-tocopherol (IRR highest vs. lowest quartile 0.62, 95%CI 0.39-0.99, p for trend = 0.08. For α- and β-carotene, lutein, sum of carotenoids and γ-tocopherol, heterogeneity between geographical regions was observed. In conclusion, our results show that higher plasma concentrations of β-carotene, zeaxanthin and α-tocopherol may be inversely associated with risk of pancreatic cancer, but further studies are warranted.
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Affiliation(s)
- Suzanne M Jeurnink
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, the Netherlands; National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
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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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40
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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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Buckland G, Ros MM, Roswall N, Bueno-de-Mesquita HB, Travier N, Tjonneland A, Kiemeney LA, Sacerdote C, Tumino R, Ljungberg B, Gram IT, Weiderpass E, Skeie G, Malm J, Ehrnström R, Chang-Claude J, Mattiello A, Agnoli C, Peeters PH, Boutron-Ruault MC, Fagherazzi G, Clavel-Chapelon F, Nilsson LM, Amiano P, Trichopoulou A, Oikonomou E, Tsiotas K, Sánchez MJ, Overvad K, Quirós JR, Chirlaque MD, Barricarte A, Key TJ, Allen NE, Khaw KT, Wareham N, Riboli E, Kaaks R, Boeing H, Palli D, Romieu I, Romaguera D, Gonzalez CA. Adherence to the Mediterranean diet and risk of bladder cancer in the EPIC cohort study. Int J Cancer 2014; 134:2504-11. [PMID: 24226765 DOI: 10.1002/ijc.28573] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [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: 05/07/2013] [Revised: 09/09/2013] [Accepted: 09/11/2013] [Indexed: 12/19/2022]
Abstract
There is growing evidence of the protective role of the Mediterranean diet (MD) on cancer. However, to date no epidemiological study has investigated the influence of the MD on bladder cancer. We evaluated the association between adherence to the MD and risk of urothelial cell bladder cancer (UCC), according to tumor aggressiveness, in the European Prospective Investigation into Cancer and Nutrition (EPIC). The analysis included 477,312 participants, recruited from ten European countries between 1991 and 2000. Information from validated dietary questionnaires was used to develop a relative Mediterranean diet score (rMED), including nine dietary components. Cox regression models were used to assess the effect of the rMED on UCC risk, while adjusting for dietary energy and tobacco smoking of any kind. Stratified analyses were performed by sex, BMI, smoking status, European region and age at diagnosis. During an average follow-up of 11 years, 1,425 participants (70.9% male) were diagnosed with a first primary UCC. There was a negative but non-significant association between a high versus low rMED score and risk of UCC overall (HR: 0.84 [95% CI 0.69, 1.03]) and risk of aggressive (HR: 0.88 [95% CI 0.61, 1.28]) and non-aggressive tumors (HR: 0.78 [95% CI 0.54, 1.14]). Although there was no effect modification in the stratified analyses, there was a significant 34% (p = 0.043) decreased risk of UCC in current smokers with a high rMED score. In EPIC, the MD was not significantly associated with risk of UCC, although we cannot exclude that a MD may reduce risk in current smokers.
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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
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43
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Chan SSM, Luben R, Olsen A, Tjonneland A, Kaaks R, Lindgren S, Grip O, Bergmann MM, Boeing H, Hallmans G, Karling P, Overvad K, Venø SK, van Schaik F, Bueno‐de‐Mesquita B, Oldenburg B, Khaw K, Riboli E, Hart AR. Association between high dietary intake of the n-3 polyunsaturated fatty acid docosahexaenoic acid and reduced risk of Crohn's disease. Aliment Pharmacol Ther 2014; 39:834-42. [PMID: 24611981 PMCID: PMC4114542 DOI: 10.1111/apt.12670] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 11/18/2013] [Accepted: 01/30/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND There are plausible mechanisms for how dietary docosahexaenoic acid (DHA), an n-3 polyunsaturated fatty acid, could prevent Crohn's disease (CD). AIM To conduct a prospective study to investigate the association between increased intake of DHA and risk of CD. METHODS Overall, 229 702 participants were recruited from nine European centres between 1991 and 1998. At recruitment, dietary intakes of DHA and fatty acids were measured using validated food frequency questionnaires. The cohort was monitored through to June 2004 to identify participants who developed incident CD. In a nested case-control analysis, each case was matched with four controls; odds ratios (ORs) were calculated for quintiles of DHA intake, adjusted for total energy intake, smoking, other dietary fatty acids, dietary vitamin D and body mass index. RESULTS Seventy-three participants developed incident CD. All higher quintiles of DHA intake were inversely associated with development of CD; the highest quintile had the greatest effect size (OR = 0.07; 95% CI = 0.02-0.81). The OR trend across quintiles of DHA was 0.54 (95% CI = 0.30-0.99, Ptrend = 0.04). Including BMI in the multivariate analysis, due to its correlation with dietary fat showed similar associations. There were no associations with the other dietary fatty acids studied. CONCLUSION There were inverse associations, with a biological gradient between increasing dietary docosahexaenoic acid intakes and incident Crohn's disease. Further studies in other populations should measure docosahexaenoic acid to determine if the association is consistent and the hypothesis tested in randomised controlled trials of purely docosahexaenoic acid supplementation.
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Affiliation(s)
- S. S. M. Chan
- Department of MedicineNorwich Medical School University of East AngliaNorwichUK
- Norfolk & Norwich University Hospitals NHS TrustNorwichUK
| | - R. Luben
- Strangeways Research LaboratoryInstitute of Public HealthUniversity of CambridgeCambridgeUK
| | - A. Olsen
- Institute of Cancer EpidemiologyDanish Cancer SocietyCopenhagenDenmark
| | - A. Tjonneland
- Institute of Cancer EpidemiologyDanish Cancer SocietyCopenhagenDenmark
| | - R. Kaaks
- Division of Clinical EpidemiologyDKFZ‐German Cancer Research CentreHeidelbergGermany
| | - S. Lindgren
- Department of Clinical SciencesUniversity HospitalMalmöSweden
| | - O. Grip
- Department of Clinical SciencesUniversity HospitalMalmöSweden
| | - M. M. Bergmann
- Department of EpidemiologyGerman Institute of Human NutritionPotsdamGermany
| | - H. Boeing
- Department of EpidemiologyGerman Institute of Human NutritionPotsdamGermany
| | - G. Hallmans
- Department of Public Health and Clinical MedicineNutritional ResearchUmeå UniversityUmeåSweden
| | - P. Karling
- Department of Public Health and Clinical MedicineGI unitUmeå UniversityUmeåSweden
| | - K. Overvad
- Section for EpidemiologyDepartment of Public HealthAarhus UniversityAarhusDenmark
| | - S. K. Venø
- Department of CardiologyAalborg University HospitalAalborgDenmark
| | - F. van Schaik
- Department of Gastroenterology and HepatologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - B. Bueno‐de‐Mesquita
- Department of Gastroenterology and HepatologyUniversity Medical Center UtrechtUtrechtThe Netherlands
- National Institute of Public Health and the Environment (RIVM)BilthovenThe Netherlands
- The School of Public HealthImperial College LondonLondonUK
| | - B. Oldenburg
- Department of Gastroenterology and HepatologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - K.‐T. Khaw
- Strangeways Research LaboratoryInstitute of Public HealthUniversity of CambridgeCambridgeUK
| | - E. Riboli
- Division of EpidemiologyImperial College LondonLondonUK
| | - A. R. Hart
- Department of MedicineNorwich Medical School University of East AngliaNorwichUK
- Norfolk & Norwich University Hospitals NHS TrustNorwichUK
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44
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Blein S, Berndt S, Joshi AD, Campa D, Ziegler RG, Riboli E, Cox DG. Factors associated with oxidative stress and cancer risk in the Breast and Prostate Cancer Cohort Consortium. Free Radic Res 2014; 48:380-6. [PMID: 24437375 DOI: 10.3109/10715762.2013.875168] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Both endogenous factors (genomic variations) and exogenous factors (environmental exposures, lifestyle) impact the balance of reactive oxygen species (ROS). Variants of the ND3 (rs2853826; G10398A) gene of the mitochondrial genome, manganese superoxide dismutase (MnSOD; rs4880 Val16Ala) and glutathione peroxidase (GPX-1; rs1050450 Pro198Leu), are purported to have functional effects on regulation of ROS balance. In this study, we examined associations of breast and prostate cancer risks and survival with these variants, and interactions between rs4880-rs1050450, and alcohol consumption-rs2853826. Nested case-control studies were conducted in the Breast and Prostate Cancer Cohort Consortium (BPC3), consisting of nine cohorts. The analyses included over 10726 post-menopausal breast and 7532 prostate cancer cases with matched controls. Logistic regression models were used to evaluate associations with risk, and proportional hazard models were used for survival outcomes. We did not observe significant interactions between polymorphisms in MnSOD and GPX-1, or between mitochondrial polymorphisms and alcohol intake and risk of either breast (p-interaction of 0.34 and 0.98, respectively) or prostate cancer (p-interaction of 0.49 and 0.50, respectively). We observed a weak inverse association between prostate cancer risk and GPX-1 Leu198Leu carriers (OR 0.87, 95% CI 0.79-0.97, p = 0.01). Overall survival among women with breast cancer was inversely associated with G10398 carriers who consumed alcohol (HR 0.66 95% CI 0.49-0.88). Given the high power in our study, it is unlikely that interactions tested have more than moderate effects on breast or prostate cancer risk. Observed associations need both further epidemiological and biological confirmation.
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Affiliation(s)
- S Blein
- Université de Lyon , Lyon , France
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45
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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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46
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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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47
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Key TJ, Appleby PN, Reeves GK, Travis RC, Alberg AJ, Barricarte A, Berrino F, Krogh V, Sieri S, Brinton LA, Dorgan JF, Dossus L, Dowsett M, Eliassen AH, Fortner RT, Hankinson SE, Helzlsouer KJ, Hoff man-Bolton J, Comstock GW, Kaaks R, Kahle LL, Muti P, Overvad K, Peeters PHM, Riboli E, Rinaldi S, Rollison DE, Stanczyk FZ, Trichopoulos D, Tworoger SS, Vineis P. Sex hormones and risk of breast cancer in premenopausal women: a collaborative reanalysis of individual participant data from seven prospective studies. Lancet Oncol 2013; 14:1009-19. [PMID: 23890780 DOI: 10.1016/s1470-2045(13)70301-2] [Citation(s) in RCA: 239] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Associations between circulating concentrations of oestrogens, progesterone, and androgens with breast cancer and related risk factors in premenopausal women are not well understood. We aimed to characterise these associations with a pooled analysis of data from seven studies. METHODS Individual participant data for prediagnostic sex hormone and sex hormone-binding globulin (SHBG) concentrations were contributed from seven prospective studies. We restricted analyses to women who were premenopausal and younger than 50 years at blood collection, and to women with breast cancer diagnosed before age 50 years. We estimated odds ratios (ORs) with 95% CIs for breast cancer associated with hormone concentrations by conditional logistic regression in cases and controls matched for age, date of blood collection, and day of cycle, with stratification by study and further adjustment for cycle phase. We examined associations of hormones with risk factors for breast cancer in control women by comparing geometric mean hormone concentrations in categories of these risk factors, adjusted for study, age, phase of menstrual cycle, and body-mass index (BMI). All statistical tests were two-sided. FINDINGS We included data for up to 767 women with breast cancer and 1699 controls in the risk analyses. Breast cancer risk was associated with a doubling in concentrations of oestradiol (OR 1·19, 95% CI 1·06-1·35), calculated free oestradiol (1·17, 1·03-1·33), oestrone (1·27, 1·05-1·54), androstenedione (1·30, 1·10-1·55), dehydroepiandrosterone sulphate (1·17, 1·04-1·32), testosterone (1·18, 1·03-1·35), and calculated free testosterone (1·08, 0·97-1·21). Breast cancer risk was not associated with luteal phase progesterone (doubling in concentration OR 1·00, 95% CI 0·92-1·09), and adjustment for other factors had little effect on any of these ORs. Cross-sectional analyses in control women showed several associations of sex hormones with breast cancer risk factors. INTERPRETATION Circulating oestrogens and androgens are positively associated with the risk for breast cancer in premenopausal women.
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48
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Romaguera D, Norat T, Wark PA, Vergnaud AC, Schulze MB, van Woudenbergh GJ, Drogan D, Amiano P, Molina-Montes E, Sánchez MJ, Balkau B, Barricarte A, Beulens JWJ, Clavel-Chapelon F, Crispim SP, Fagherazzi G, Franks PW, Grote VA, Huybrechts I, Kaaks R, Key TJ, Khaw KT, Nilsson P, Overvad K, Palli D, Panico S, Quirós JR, Rolandsson O, Sacerdote C, Sieri S, Slimani N, Spijkerman AMW, Tjonneland A, Tormo MJ, Tumino R, van den Berg SW, Wermeling PR, Zamara-Ros R, Feskens EJM, Langenberg C, Sharp SJ, Forouhi NG, Riboli E, Wareham NJ. Consumption of sweet beverages and type 2 diabetes incidence in European adults: results from EPIC-InterAct. Diabetologia 2013; 56:1520-30. [PMID: 23620057 DOI: 10.1007/s00125-013-2899-8] [Citation(s) in RCA: 179] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 03/11/2013] [Indexed: 01/08/2023]
Abstract
AIMS/HYPOTHESIS Consumption of sugar-sweetened beverages has been shown, largely in American populations, to increase type 2 diabetes incidence. We aimed to evaluate the association of consumption of sweet beverages (juices and nectars, sugar-sweetened soft drinks and artificially sweetened soft drinks) with type 2 diabetes incidence in European adults. METHODS We established a case-cohort study including 12,403 incident type 2 diabetes cases and a stratified subcohort of 16,154 participants selected from eight European cohorts participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. After exclusions, the final sample size included 11,684 incident cases and a subcohort of 15,374 participants. Cox proportional hazards regression models (modified for the case-cohort design) and random-effects meta-analyses were used to estimate the association between sweet beverage consumption (obtained from validated dietary questionnaires) and type 2 diabetes incidence. RESULTS In adjusted models, one 336 g (12 oz) daily increment in sugar-sweetened and artificially sweetened soft drink consumption was associated with HRs for type 2 diabetes of 1.22 (95% CI 1.09, 1.38) and 1.52 (95% CI 1.26, 1.83), respectively. After further adjustment for energy intake and BMI, the association of sugar-sweetened soft drinks with type 2 diabetes persisted (HR 1.18, 95% CI 1.06, 1.32), but the association of artificially sweetened soft drinks became statistically not significant (HR 1.11, 95% CI 0.95, 1.31). Juice and nectar consumption was not associated with type 2 diabetes incidence. CONCLUSIONS/INTERPRETATION This study corroborates the association between increased incidence of type 2 diabetes and high consumption of sugar-sweetened soft drinks in European adults.
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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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50
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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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