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Palomar-Cros A, Straif K, Romaguera D, Aragonés N, Castaño-Vinyals G, Martin V, Moreno V, Gómez-Acebo I, Guevara M, Aizpurua A, Molina-Barceló A, Jiménez-Moleón JJ, Tardón A, Contreras-Llanes M, Marcos-Gragera R, Huerta JM, Pérez-Gómez B, Espinosa A, Hernández-Segura N, Obón-Santacana M, Alonso-Molero J, Burgui R, Amiano P, Pinto-Carbó M, Olmedo-Requena R, Fernández-Tardón G, Santos-Sánchez V, Fernández de Larrea-Baz N, Fernández-Villa T, Casabonne D, Dierssen-Sotos T, Ardanaz E, Dorronsoro A, Pollán M, Kogevinas M, Lassale C. Consumption of aspartame and other artificial sweeteners and risk of cancer in the Spanish multicase-control study (MCC-Spain). Int J Cancer 2023. [PMID: 37323037 DOI: 10.1002/ijc.34577] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 06/17/2023]
Abstract
Use of artificial sweeteners (AS) such as aspartame, cyclamate, saccharin and sucralose is widespread. We evaluated the association of use of aspartame and other AS with cancer. In total 1881 colorectal, 1510 breast, 972 prostate and 351 stomach cancer and 109 chronic lymphocytic leukaemia (CLL) cases and 3629 population controls from the Spanish Multicase-Control (MCC-Spain) study were recruited (2008-2013). The consumption of AS, from table-top sweeteners and artificially sweetened beverages, was assessed through a self-administered and validated food frequency questionnaire (FFQ). Sex-specific quartiles among controls were determined to compare moderate consumers (<third quartile) and high consumers (≥ third quartile) vs non consumers (reference category), distinguishing aspartame-containing products and other AS. Unconditional logistic regression models were used to estimate adjusted OR and 95%CI, and results were stratified by diabetes status. Overall, we found no associations between the consumption of aspartame or other AS and cancer. Among participants with diabetes, high consumption of other AS was associated with colorectal cancer (OR = 1.58, 95% CI 1.05-2.41, P trend = .03) and stomach cancer (OR = 2.27 [0.99-5.44], P trend = .06). High consumption of aspartame, was associated with stomach cancer (OR = 2.04 [0.7-5.4], P trend = .05), while a lower risk was observed for breast cancer (OR = 0.28 [0.08-0.83], P trend = .03). In some cancers, the number of cases in participants with diabetes were small and results should be interpreted cautiously. We did not find associations between use of AS and cancer, but found associations between high consumption of aspartame and other AS and different cancer types among participants with diabetes.
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Affiliation(s)
- Anna Palomar-Cros
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiology and Public Health CIBERESP ISCIII, Madrid, Spain
| | - Kurt Straif
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Boston College, Boston, Massachusetts, USA
| | - Dora Romaguera
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Madrid, Spain
| | - Nuria Aragonés
- CIBER Epidemiology and Public Health CIBERESP ISCIII, Madrid, Spain
- Public Health Division, Department of Health, Madrid, Spain
| | - Gemma Castaño-Vinyals
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiology and Public Health CIBERESP ISCIII, Madrid, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Vicente Martin
- CIBER Epidemiology and Public Health CIBERESP ISCIII, Madrid, Spain
- The Research Group in Gene-Environment and Health Interactions (GIIGAS)/Institute of Biomedicine (IBIOMED), Universidad de León, León, Spain
| | - Victor Moreno
- CIBER Epidemiology and Public Health CIBERESP ISCIII, Madrid, Spain
- Cancer Epidemiology Research Program, Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
- Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Inés Gómez-Acebo
- CIBER Epidemiology and Public Health CIBERESP ISCIII, Madrid, Spain
- Faculty of Medicine, University of Cantabria, Santander, Spain
- IDIVAL-Instituto de investigación sanitaria Valdecilla, Santander, Spain
| | - Marcela Guevara
- CIBER Epidemiology and Public Health CIBERESP ISCIII, Madrid, Spain
- Institute of Public and Occupational Health of Navarre (ISPLN), Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Amaia Aizpurua
- Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, San Sebastian, Spain
- Biodonostia Health Research Institute, Epidemiology of Chronic and Communicable Diseases Group, San Sebastián, Spain
| | - Ana Molina-Barceló
- Cancer and Public Health Research Unit, Foundation for the Promotion of Health and Biomedical Research, (FISABIO-Public Health), Valencia, Spain
| | - José-Juan Jiménez-Moleón
- CIBER Epidemiology and Public Health CIBERESP ISCIII, Madrid, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Complejo Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, Granada, Spain
| | - Adonina Tardón
- CIBER Epidemiology and Public Health CIBERESP ISCIII, Madrid, Spain
- University of Oviedo, Health Research Institute of Asturias (ISPA), Asturias, Spain
| | - Manuel Contreras-Llanes
- Centro de Investigación en Recursos Naturales, Salud y Medio Ambiente (RENSMA), Universidad de Huelva, Huelva, Spain
- Grupo de investigación en Epidemiología Clínica, Ambiental y Transformación Social (EPICAS), Departamento de Sociología, Trabajo Social y Salud Pública, Universidad de Huelva, Huelva, Spain
| | - Rafael Marcos-Gragera
- CIBER Epidemiology and Public Health CIBERESP ISCIII, Madrid, Spain
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology (ICO), Girona Biomedical Research Institute (IdiBGi), Girona, Spain
| | - José Mª Huerta
- CIBER Epidemiology and Public Health CIBERESP ISCIII, Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council-IMIB, Murcia, Spain
| | - Beatriz Pérez-Gómez
- CIBER Epidemiology and Public Health CIBERESP ISCIII, Madrid, Spain
- National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain
| | - Ana Espinosa
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiology and Public Health CIBERESP ISCIII, Madrid, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Natalia Hernández-Segura
- The Research Group in Gene-Environment and Health Interactions (GIIGAS)/Institute of Biomedicine (IBIOMED), Universidad de León, León, Spain
| | - Mireia Obón-Santacana
- CIBER Epidemiology and Public Health CIBERESP ISCIII, Madrid, Spain
- Cancer Epidemiology Research Program, Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
- Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Jessica Alonso-Molero
- CIBER Epidemiology and Public Health CIBERESP ISCIII, Madrid, Spain
- Faculty of Medicine, University of Cantabria, Santander, Spain
- IDIVAL-Instituto de investigación sanitaria Valdecilla, Santander, Spain
| | - Rosana Burgui
- CIBER Epidemiology and Public Health CIBERESP ISCIII, Madrid, Spain
- Institute of Public and Occupational Health of Navarre (ISPLN), Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Pilar Amiano
- CIBER Epidemiology and Public Health CIBERESP ISCIII, Madrid, Spain
- Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, San Sebastian, Spain
- Biodonostia Health Research Institute, Epidemiology of Chronic and Communicable Diseases Group, San Sebastián, Spain
| | - Marina Pinto-Carbó
- Cancer and Public Health Research Unit, Foundation for the Promotion of Health and Biomedical Research, (FISABIO-Public Health), Valencia, Spain
| | - Rocio Olmedo-Requena
- CIBER Epidemiology and Public Health CIBERESP ISCIII, Madrid, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Complejo Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, Granada, Spain
| | - Guillermo Fernández-Tardón
- CIBER Epidemiology and Public Health CIBERESP ISCIII, Madrid, Spain
- University of Oviedo, Health Research Institute of Asturias (ISPA), Asturias, Spain
| | - Vanessa Santos-Sánchez
- Grupo de investigación en Epidemiología Clínica, Ambiental y Transformación Social (EPICAS), Departamento de Sociología, Trabajo Social y Salud Pública, Universidad de Huelva, Huelva, Spain
| | - Nerea Fernández de Larrea-Baz
- CIBER Epidemiology and Public Health CIBERESP ISCIII, Madrid, Spain
- National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain
| | - Tania Fernández-Villa
- CIBER Epidemiology and Public Health CIBERESP ISCIII, Madrid, Spain
- The Research Group in Gene-Environment and Health Interactions (GIIGAS)/Institute of Biomedicine (IBIOMED), Universidad de León, León, Spain
| | - Delphine Casabonne
- CIBER Epidemiology and Public Health CIBERESP ISCIII, Madrid, Spain
- Cancer Epidemiology Research Program, Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Barcelona, Spain
- Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
| | - Trinidad Dierssen-Sotos
- CIBER Epidemiology and Public Health CIBERESP ISCIII, Madrid, Spain
- Faculty of Medicine, University of Cantabria, Santander, Spain
- IDIVAL-Instituto de investigación sanitaria Valdecilla, Santander, Spain
| | - Eva Ardanaz
- CIBER Epidemiology and Public Health CIBERESP ISCIII, Madrid, Spain
- Institute of Public and Occupational Health of Navarre (ISPLN), Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Ane Dorronsoro
- Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, San Sebastian, Spain
- Biodonostia Health Research Institute, Epidemiology of Chronic and Communicable Diseases Group, San Sebastián, Spain
| | - Marina Pollán
- CIBER Epidemiology and Public Health CIBERESP ISCIII, Madrid, Spain
- National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain
| | - Manolis Kogevinas
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiology and Public Health CIBERESP ISCIII, Madrid, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Camille Lassale
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Madrid, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
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Huerta JM, Chirlaque MD, Molina AJ, Amiano P, Martín V, Fernández-Villa T, Pérez-Gómez B, Moreno V, Burgui R, Gómez-Acebo I, Ramos-Lora M, Fernández-Tardón G, Peiró R, Olmedo-Requena R, Pollán M, Kogevinas M, Castaño-Vinyals G, Aragonés N. Physical activity domains and risk of gastric adenocarcinoma in the MCC-Spain case-control study. PLoS One 2017; 12:e0179731. [PMID: 28683070 PMCID: PMC5500262 DOI: 10.1371/journal.pone.0179731] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 06/02/2017] [Indexed: 01/03/2023] Open
Abstract
Background Evidence for a protective role of physical activity against development of stomach cancer is yet inconclusive. We studied the association of domain-specific physical activity and the risk of gastric adenocarcinoma (GAC), by site and histology, in the MCC-Spain case-control study. Methods 428 histologically confirmed GAC cases (67% men) including the gastro-esophageal region and 3225 controls were included. Cases were recruited in hospitals from 10 different Spanish regions, whereas population controls were randomly selected within the respective hospitals' catchment areas. A physical activity (PA) questionnaire was used to gather information on household and recreational activities, allowing estimation of PA volume (in metabolic equivalents (MET)-min/week). Participants also reported the intensity of working PA and daily sitting time. Questionnaire data on diet, lifestyles and clinical variables including Helicobacter pylori serology were available. Adjusted odds ratios (OR) of GAC were estimated for domains of physical activity, stratifying by sex, site (cardia vs. non-cardia), and Lauren classification (intestinal vs. diffuse). Results Household physical activity (HPA) showed a strong inverse association with GAC, observed for both cardia and non-cardia tumours. Risk of overall gastric cancer was 50% lower risk among participants in the highest HPA category (OR = 0.50, 95%CI: 0.38, 0.66). Recreational physical activity (RPA) was also associated with lower overall GAC risk (OR = 0.68, 95% CI: 0.52, 0.88), particularly at moderate levels of intensity such as walking (OR = 0.61, 95% CI: 0.46, 0.79). The protective effect of RPA was strongest for non-cardia tumours. Sedentary time was not related to GAC risk (p-trend = 0.392), but the potential protective effect of RPA was restricted to non-sedentary participants. Conclusions Both household and recreational physical activities were independently related to lower GAC risk in the MCC-Spain study.
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Affiliation(s)
- José M. Huerta
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- * E-mail:
| | - María Dolores Chirlaque
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Health and Social Sciences, University of Murcia, Murcia, Spain
| | - Antonio J. Molina
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Research Group on Gene-Environment Interactions and Health, University of León, León, Spain
| | - Pilar Amiano
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Public Health Division of Gipuzkoa, BioDonostia Research Institute, Government of the Basque Country, San Sebastián, Spain
| | - Vicente Martín
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Research Group on Gene-Environment Interactions and Health, University of León, León, Spain
| | - Tania Fernández-Villa
- Research Group on Gene-Environment Interactions and Health, University of León, León, Spain
| | - Beatriz Pérez-Gómez
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Cancer Epidemiology Unit, National Center for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
- Cancer Epidemiology Research Group, Oncology and Hematology Area, IIS Puerta de Hierro, Madrid, Spain
| | - Víctor Moreno
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Cancer Prevention and Control Program, Catalan Institute of Oncology- IDIBELL, L’Hospitalet de Llobregat, Spain
- Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Rosana Burgui
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Navarra Public Health Institute, IdiSNA (Navarra Institute for Health Research), Pamplona, Spain
| | - Inés Gómez-Acebo
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Universidad de Cantabria-IDIVAL, Santander, Spain
| | - Manuel Ramos-Lora
- Department of Gastroenterology, Hospital Juan Ramón Jiménez, Huelva, Spain
- Centro de Investigación en Salud y Medio Ambiente (CYSMA), University of Huelva
| | | | - Rosana Peiró
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Area de Cáncer y Salud Pública, Fundación FISABIO-Salud Pública, Valencia, Spain
| | - Rocío Olmedo-Requena
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs, Granada, Complejo Hospitales Universitarios de Granada, University of Granada, Granada, Spain
| | - Marina Pollán
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Cancer Epidemiology Unit, National Center for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
- Cancer Epidemiology Research Group, Oncology and Hematology Area, IIS Puerta de Hierro, Madrid, Spain
| | - Manolis Kogevinas
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Gemma Castaño-Vinyals
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Nuria Aragonés
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Cancer Epidemiology Unit, National Center for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
- Cancer Epidemiology Research Group, Oncology and Hematology Area, IIS Puerta de Hierro, Madrid, Spain
| | - Navarro
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Health and Social Sciences, University of Murcia, Murcia, Spain
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