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Fernández-Martínez NF, Rodríguez-Barranco M, Huerta JM, Gil F, Olmedo P, Molina-Montes E, Guevara M, Zamora-Ros R, Jiménez-Zabala A, Colorado-Yohar SM, Ardanaz E, Bonet C, Amiano P, Chirlaque MD, Pérez-Gómez B, Jiménez-Moleón JJ, Martín-Jiménez M, de Santiago E, Sánchez MJ. Breast cancer risk for the joint exposure to metals and metalloids in women: Results from the EPIC-Spain cohort. Sci Total Environ 2024; 912:168816. [PMID: 38036124 DOI: 10.1016/j.scitotenv.2023.168816] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 11/21/2023] [Accepted: 11/21/2023] [Indexed: 12/02/2023]
Abstract
Environmental factors play a role in breast cancer development. While metals and metalloids (MMs) include some carcinogens, their association with breast cancer depends on the element studied. Most studies focus on individual MMs, but the combined effects of metal mixtures remain unclear. The aim of this study was to analyze the relationship between the joint exposure to MMs and the risk of developing female breast cancer. We conducted a case-control study within the multicenter prospective EPIC-Spain cohort. Study population comprised 292 incident cases and 286 controls. Plasma concentrations of 16 MMs were quantified at recruitment. Potential confounders were collected using a questionnaire and anthropometric measurements. Mixed-effects logistic regression models were built to explore the effect of individual MMs. Quantile-based g computation models were applied to identify the main mixture components and to estimate the joint effect of the metal mixture. The geometric means were highest for Cu (845.6 ng/ml) and Zn (604.8 ng/ml). Cases had significantly higher Cu concentrations (p = 0.010) and significantly lower Zn concentrations (p < 0.001). Cu (+0.42) and Mn (+0.13) showed the highest positive weights, whereas Zn (-0.61) and W (-0.16) showed the highest negative weights. The joint effect of the metal mixture was estimated at an OR = 4.51 (95%CI = 2.32-8.79), suggesting a dose-response relationship. No evidence of non-linearity or non-additivity was found. An unfavorable exposure profile, primarily characterized by high Cu and low Zn levels, could lead to a significant increase in the risk of developing female breast cancer. Further studies are warranted to confirm these findings.
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Affiliation(s)
- Nicolás Francisco Fernández-Martínez
- Instituto de Investigación Biosanitaria ibs, GRANADA, 18012 Granada, Spain; Escuela Andaluza de Salud Pública (EASP), 18011 Granada, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Miguel Rodríguez-Barranco
- Instituto de Investigación Biosanitaria ibs, GRANADA, 18012 Granada, Spain; Escuela Andaluza de Salud Pública (EASP), 18011 Granada, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain.
| | - José María Huerta
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia University, 30008 Murcia, Spain
| | - Fernando Gil
- Department of Preventive Medicine and Public Health, University of Granada, 18071 Granada, Spain
| | - Pablo Olmedo
- Department of Preventive Medicine and Public Health, University of Granada, 18071 Granada, Spain
| | - Esther Molina-Montes
- Instituto de Investigación Biosanitaria ibs, GRANADA, 18012 Granada, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; Department of Nutrition and Food Science, University of Granada, 18011 Granada, Spain; Institute of Nutrition and Food Technology (INYTA) 'Jose Mataix', Biomedical Research Center, University of Granada, 18071 Granada, Spain
| | - Marcela Guevara
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; Instituto de Salud Pública y Laboral de Navarra, 31003 Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain
| | - Raúl Zamora-Ros
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), 08908 Bellvitge, Spain; Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain
| | - Ana Jiménez-Zabala
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, 20013 San Sebastian, Spain; BioGipuzkoa Health Research Institute, Epidemiology of Chronic and Communicable Diseases Group, 20014 San Sebastián, Spain
| | - Sandra Milena Colorado-Yohar
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia University, 30008 Murcia, Spain; Research Group on Demography and Health, National Faculty of Public Health, University of Antioquia, Medellín, Colombia
| | - Eva Ardanaz
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; Instituto de Salud Pública y Laboral de Navarra, 31003 Pamplona, Spain; Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain
| | - Catalina Bonet
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), 08908 Bellvitge, Spain; Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain
| | - Pilar Amiano
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, 20013 San Sebastian, Spain; BioGipuzkoa Health Research Institute, Epidemiology of Chronic and Communicable Diseases Group, 20014 San Sebastián, Spain
| | - María Dolores Chirlaque
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia University, 30008 Murcia, Spain
| | - Beatriz Pérez-Gómez
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; Department of Epidemiology for Chronic Diseases, National Center of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - José Juan Jiménez-Moleón
- Instituto de Investigación Biosanitaria ibs, GRANADA, 18012 Granada, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; Department of Legal Medicine and Toxicology, University of Granada, 18016 Granada, Spain
| | - Miguel Martín-Jiménez
- Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense, 28007 Madrid, Spain; GEICAM, Spanish Breast Cancer Group, 28703 Madrid, Spain; Consorcio de Investigación Biomédica en Red de Oncología (CIBERONC), 28029 Madrid, Spain
| | - Esperanza de Santiago
- GENYO, Centre for Genomics and Oncological Research: Pfizer, University of Granada, Andalusian Regional Government, PTS Granada, 18016 Granada, Spain
| | - María-José Sánchez
- Instituto de Investigación Biosanitaria ibs, GRANADA, 18012 Granada, Spain; Escuela Andaluza de Salud Pública (EASP), 18011 Granada, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; Department of Legal Medicine and Toxicology, University of Granada, 18016 Granada, Spain
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Fernández-Martínez NF, Rodríguez-Barranco M, Zamora-Ros R, Guevara M, Colorado-Yohar SM, Jiménez-Zabala A, Arrebola JP, Iribarne-Durán LM, Molina G, Agudo A, Trobajo-Sanmartín C, Chirlaque MD, Amiano P, Sánchez MJ. Relationship between exposure to parabens and benzophenones and prostate cancer risk in the EPIC-Spain cohort. Environ Sci Pollut Res Int 2024; 31:6186-6199. [PMID: 38147240 DOI: 10.1007/s11356-023-31682-3] [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] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/19/2023] [Indexed: 12/27/2023]
Abstract
The etiology of prostate cancer is not fully elucidated. Among environmental risk factors, endocrine-disrupting chemicals (EDCs) deserve special mention, as they alter metabolic pathways involved in hormone-dependent cancers. Epidemiological evidence assessing the carcinogenicity of EDCs is scarce. The aim of this study was to analyze the relationship between exposure to parabens and benzophenones and prostate cancer risk. We conducted a case-cohort study nested within the EPIC-Spain prospective multi-center cohort. Study population comprised 1,838 sub-cohort participants and 467 non-sub-cohort prostate cancer cases. Serum concentrations of four parabens and two benzophenones were assessed at recruitment. Covariates included age, physical activity, tobacco smoking, alcohol consumption, body mass index, educational level and diabetes. Borgan II weighted Cox proportional hazard models stratified by study center were applied. Median follow-up time was 18.6 years (range = 1.0-21.7 years). Most sub-cohort participants reached primary education at most (65.5%), were overweight (57.7%) and had a low level of physical activity (51.3%). Detection percentages varied widely, being lowest for butyl-paraben (11.3%) and highest for methyl-paraben (80.7%), which also showed the highest geometric mean (0.95 ng/ml). Cases showed significantly higher concentrations of methyl-paraben (p = 0.041) and propyl-paraben (p < 0.001). In the multivariable analysis, methyl-paraben - log-transformed (HR = 1.07; 95%CI = 1.01-1.12) and categorized into tertiles (HR = 1.60 for T3; 95%CI = 1.16-2.20) -, butyl-paraben - linear (HR = 1.19; 95%CI = 1.14-1.23) and log-transformed (HR = 1.17; 95%CI = 1.01-1.35) - and total parabens - log-transformed (HR = 1.09; 95%CI = 1.02-1.17) and categorized into tertiles (HR = 1.62 for T3; 95%CI = 1.10-2.40) - were associated with an increased prostate cancer risk. In this study, higher concentrations of methyl-, butyl-, and total parabens were positively associated with prostate cancer risk. Further research is warranted to confirm these findings.
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Affiliation(s)
- Nicolás Francisco Fernández-Martínez
- Instituto de Investigación Biosanitaria Ibs.GRANADA, 18012, Granada, Spain
- Escuela Andaluza de Salud Pública (EASP), Cuesta del Observatorio, 4. 18011, Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029, Madrid, Spain
| | - Miguel Rodríguez-Barranco
- Instituto de Investigación Biosanitaria Ibs.GRANADA, 18012, Granada, Spain.
- Escuela Andaluza de Salud Pública (EASP), Cuesta del Observatorio, 4. 18011, Granada, Spain.
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029, Madrid, Spain.
| | - Raúl Zamora-Ros
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain
| | - Marcela Guevara
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029, Madrid, Spain
- Navarra Public Health Institute, 31003, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), 31008, Pamplona, Spain
| | - Sandra Milena Colorado-Yohar
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029, Madrid, Spain
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia University, 30008, Murcia, Spain
| | - Ana Jiménez-Zabala
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029, Madrid, Spain
- Sub Directorate for Public Health and Addictions of Gipuzkoa, Ministry of Health of the Basque Government, 20013, San Sebastian, Spain
- Biodonostia Health Research Institute, 20014, San Sebastián, Spain
| | - Juan Pedro Arrebola
- Instituto de Investigación Biosanitaria Ibs.GRANADA, 18012, Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029, Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Granada, 18071, Granada, Spain
| | - Luz María Iribarne-Durán
- Instituto de Investigación Biosanitaria Ibs.GRANADA, 18012, Granada, Spain
- Department of Radiology, School of Medicine, University of Granada, 18071, Granada, Spain
| | - Germán Molina
- Department of Preventive Medicine and Public Health, University Hospital of Santiago de Compostela, 15706 A, Coruña, Spain
| | - Antonio Agudo
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), 08908, Barcelona, Spain
| | - Camino Trobajo-Sanmartín
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029, Madrid, Spain
- Navarra Public Health Institute, 31003, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), 31008, Pamplona, Spain
| | - María Dolores Chirlaque
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029, Madrid, Spain
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia University, 30008, Murcia, Spain
- Department of Health and Social Sciences, Murcia University, 30100, Murcia, Spain
| | - Pilar Amiano
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029, Madrid, Spain
- Sub Directorate for Public Health and Addictions of Gipuzkoa, Ministry of Health of the Basque Government, 20013, San Sebastian, Spain
- Biodonostia Health Research Institute, 20014, San Sebastián, Spain
| | - María-José Sánchez
- Instituto de Investigación Biosanitaria Ibs.GRANADA, 18012, Granada, Spain
- Escuela Andaluza de Salud Pública (EASP), Cuesta del Observatorio, 4. 18011, Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029, Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Granada, 18071, Granada, Spain
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Navarro-Mateu F, Salmerón D, Vilagut G, Husky M, Ballesta M, Chirlaque MD, Huerta JM, Martínez S, Navarro C, Alonso J, Nock M, Kessler RC. Childhood adversities and suicidal behavior in the general population. The cross-sectional PEGASUS-Murcia Project. Span J Psychiatry Ment Health 2024; 17:11-18. [PMID: 33099026 DOI: 10.1016/j.rpsm.2020.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/30/2020] [Accepted: 10/05/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The aim of the present study is to estimate the lifetime prevalence of suicidal ideation, plans, and attempts in a regional representative sample and the association of these outcomes with sociodemographic factors, prior mental disorders, and childhood adversities. MATERIAL AND METHODS The PEGASUS-Murcia project is a cross-sectional survey of a representative sample of adults in Murcia that is part of the WHO World Mental Health Survey Initiative. The Composite International Diagnostic Interview (CIDI 3.0) was administered face-to-face to 2621 participants (67.4% response rate). The main outcomes were suicidal ideation, plans, and attempts. Lifetime prevalence, age of onset, and risk factors (sociodemographic variables, mental disorders, and childhood adversities) were examined using multiple discrete-time survival models. RESULTS Lifetime prevalence of suicidal ideation, plans and attempts were 8.0% (standard error, SE: 1.1), 2.1% (SE: 0.3), and 1.2% (SE: 1.1), respectively. Prevalence of any childhood adversities was 22.1% (SE: 1.3) in the total sample and, even higher, among those with suicide related outcomes (ranging between 36.8% and 53.7%). Female sex, younger age, prior (to onset of the outcome) lifetime prevalence of mood disorders, number of mental disorders, and exposure to childhood adversity were associated with significantly increased odds of suicidal ideation and plans. CONCLUSIONS Lifetime prevalence estimates of suicidality are similar to those in community epidemiological surveys. Childhood adversities and mental disorders, especially mood disorders, are important risk factors for suicidality. Early detection of these adversities and disorders should be targeted in suicide prevention programs.
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Affiliation(s)
- Fernando Navarro-Mateu
- Unidad de Docencia, Investigación y Formación en Salud Mental (UDIF-SM), Servicio Murciano de Salud, Departamento de Psicología Básica y Metodología, Universidad de Murcia, Spain; IMIB-Arrixaca, Murcia, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Diego Salmerón
- IMIB-Arrixaca, Murcia, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Departamento de Ciencias Sociosanitarias, Universidad de Murcia, Murcia, Spain.
| | - Gemma Vilagut
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; IMIM-Institut Hospital del Mar d'Investigacions Médiques, Barcelona, Spain
| | - Mathilde Husky
- Laboratoire de Psychologie, Université de Bordeaux, Burdeos, France
| | - Mónica Ballesta
- Departamento de Ciencias Sociosanitarias, Universidad de Murcia, Murcia, Spain; Servicio de Epidemiología, Consejería de Sanidad y Política Social, Murcia, Spain
| | - María Dolores Chirlaque
- IMIB-Arrixaca, Murcia, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Departamento de Ciencias Sociosanitarias, Universidad de Murcia, Murcia, Spain; Servicio de Epidemiología, Consejería de Sanidad y Política Social, Murcia, Spain
| | - José María Huerta
- IMIB-Arrixaca, Murcia, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Servicio de Epidemiología, Consejería de Sanidad y Política Social, Murcia, Spain
| | | | - Carmen Navarro
- IMIB-Arrixaca, Murcia, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Departamento de Ciencias Sociosanitarias, Universidad de Murcia, Murcia, Spain; Servicio de Epidemiología, Consejería de Sanidad y Política Social, Murcia, Spain
| | - Jordi Alonso
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; IMIM-Institut Hospital del Mar d'Investigacions Médiques, Barcelona, Spain; Departamento de Salud y Ciencias Experimentales, Universidad Pompeu Fabra, Barcelona, Spain
| | - Matthew Nock
- Department of Psychology, Harvard University, Cambridge, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, USA
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Trallero J, Sanvisens A, Almela Vich F, Jeghalef El Karoni N, Saez Lloret I, Díaz-del-Campo C, Marcos-Navarro AI, Aizpurua Atxega A, Sancho Uriarte P, De-la-Cruz Ortega M, Sánchez MJ, Perucha J, Franch P, Chirlaque MD, Guevara M, Ameijide A, Galceran J, Ramírez C, Camblor MR, Alemán MA, Gutiérrez P, Marcos-Gragera R. Incidence and time trends of childhood hematological neoplasms: a 36-year population-based study in the southern European context, 1983-2018. Front Oncol 2023; 13:1197850. [PMID: 37560466 PMCID: PMC10408119 DOI: 10.3389/fonc.2023.1197850] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/07/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Hematological neoplasms (HNs) are the first and most common childhood cancers globally. Currently, there is a lack of updated population-based data on the incidence of these cancers in the Spanish pediatric population. This study aimed to describe the incidence and incidence trends of HNs in children (0-14 years) in Spain using data from the Spanish Network of Cancer Registries and to compare the results with other southern European countries. METHODS Data were extracted from 15 Spanish population-based cancer registries between 1983 and 2018. Cases were coded according to the International Classification of Diseases for Oncology, third edition, first revision, and grouped according to the International Classification of Childhood Cancer, third edition. Crude rates (CRs), age-specific rates, and age-standardized incidence rates using the 2013 European population (ASRE) were calculated and expressed as cases per 1,000,000 child-years. Incidence trends and annual percentage changes (APCs) were estimated. RESULTS A total of 4,747 HNs were recorded (59.5% boys). Age distribution [n (%)] was as follows: <1 year, 266 (5.6%); 1-4 years, 1,726 (36.4%); 5-9 years, 1,442 (30.4%); and 10-14 years, 1,313 (27.6%). Leukemias were the most common group, with a CR and an ASRE of 44.0 (95%CI: 42.5; 45.5) and 44.1 (95%CI: 42.6; 45.7), respectively. The CR and ASRE of lymphomas were 20.1 (95%CI: 19.1; 21.1) and 20.0 (95%CI: 19.0; 21.1), respectively. The comparable incidence rates between our results and those of other southern European countries were similar for lymphomas, while some differences were observed for leukemias. From 1988 to 2016, the trend in leukemia incidence was stable for both sexes, with an APC of 0.0 (95%CI: -0.5; 0.7), whereas a constant overall increase was observed for lymphoma in both sexes, with an APC of 1.0 (95%CI: 0.4; 1.6). CONCLUSION Leukemias are the most common HNs in children, and their incidence has remained stable since 1988, whereas the incidence of lymphomas has increased every year. Lymphoma incidence is like that of other southern European countries, while leukemia incidence is similar only to that of southwestern European countries. Collaborative cancer registry projects allow for assessing epidemiological indicators for cancers such as HNs, which helps health authorities and clinicians provide more knowledge about these malignancies.
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Affiliation(s)
- Jan Trallero
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Catalan Institute of Oncology, Girona Biomedical Research Institute Dr. Josep Trueta (IDIBGI), Girona, Spain
- Josep Carreras Leukaemia Research Institute, Badalona, Spain
| | - Arantza Sanvisens
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Catalan Institute of Oncology, Girona Biomedical Research Institute Dr. Josep Trueta (IDIBGI), Girona, Spain
- Josep Carreras Leukaemia Research Institute, Badalona, Spain
| | - Fernando Almela Vich
- Registry of Childhood and Adolescent Tumors of the Valencian Community, Valencian Community Department of Universal Health and Public Health, València, Spain
- Cancer Information System of the Valencian Community, Valencian Community Department of Universal Health and Public Health, València, Spain
| | - Noura Jeghalef El Karoni
- Registry of Childhood and Adolescent Tumors of the Valencian Community, Valencian Community Department of Universal Health and Public Health, València, Spain
- Cancer Information System of the Valencian Community, Valencian Community Department of Universal Health and Public Health, València, Spain
| | - Isabel Saez Lloret
- Cancer Information System of the Valencian Community, Valencian Community Department of Universal Health and Public Health, València, Spain
- Castellón Cancer Registry, Directorate General of Public Health and Addictions, Valencian Government, Castellón, Spain
| | | | | | | | | | | | - María José Sánchez
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Granada Cancer Registry, Andalusian School of Public Health (EASP), Instituto de Investigación Biosanitaria Ibs. GRANADA, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - Josefina Perucha
- La Rioja Cancer Registry, Epidemiology and Health Prevention Service, Logroño, Spain
| | - Paula Franch
- Mallorca Cancer Registry, Public Health and Participation Department, Palma de Mallorca, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
| | - María Dolores Chirlaque
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Epidemiology, Regional Health Authority, Instituto Murciano de Investigación Biosanitaria (IMIB)-Arrixaca, Murcia University, Murcia, Spain
| | - Marcela Guevara
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Navarra Cancer Registry, Navarra Public Health Institute, Pamplona, Spain
- Epidemiology and Public Health Area, Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Alberto Ameijide
- Tarragona Cancer Registry, Cancer Epidemiology and Prevention Service, Sant Joan de Reus University Hospital, Tarragona, Spain
- Institut d’Investigació Sanitària Pere Virgili (IISPV), Reus, Tarragona, Spain
| | - Jaume Galceran
- Tarragona Cancer Registry, Cancer Epidemiology and Prevention Service, Sant Joan de Reus University Hospital, Tarragona, Spain
- Institut d’Investigació Sanitària Pere Virgili (IISPV), Reus, Tarragona, Spain
| | - Cristina Ramírez
- Albacete Cancer Registry, Health and Social Welfare Authority, Albacete, Spain
| | | | - Maria Araceli Alemán
- Canary Islands Cancer Registry, Public Health Directorate, Canary Islands Government, Tenerife, Spain
| | - Pilar Gutiérrez
- Castilla y León Cancer Registry, Public Health Directorate, Castilla y León Government, Valladolid, Spain
| | - Rafael Marcos-Gragera
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Catalan Institute of Oncology, Girona Biomedical Research Institute Dr. Josep Trueta (IDIBGI), Girona, Spain
- Josep Carreras Leukaemia Research Institute, Badalona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Nursing, University of Girona, Girona, Spain
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Castro-Espin C, Bonet C, Crous-Bou M, Katzke V, Le Cornet C, Jannasch F, Schulze MB, Olsen A, Tjønneland A, Dahm CC, Antoniussen CS, Sánchez MJ, Amiano P, Chirlaque MD, Guevara M, Agnoli C, Tumino R, Sacerdote C, De Magistris MS, Sund M, Bodén S, Jensen TE, Olsen KS, Skeie G, Gunter MJ, Rinaldi S, Gonzalez-Gil EM, Weiderpass E, Christakoudi S, Heath AK, Dossus L, Agudo A. Dietary patterns related to biological mechanisms and survival after breast cancer diagnosis: results from a cohort study. Br J Cancer 2023; 128:1301-1310. [PMID: 36737658 PMCID: PMC10050013 DOI: 10.1038/s41416-023-02169-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 09/23/2022] [Revised: 01/10/2023] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Inflammatory, insulin and oestrogenic pathways have been linked to breast cancer (BC). We aimed to examine the relationship between pre-diagnostic dietary patterns related to these mechanisms and BC survival. METHODS The diabetes risk reduction diet (DRRD), inflammatory score of diet (ISD) and oestrogen-related dietary pattern (ERDP) were calculated using dietary data from the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Cox proportional hazards models were used to assess associations between dietary patterns and overall mortality and competing risk models for associations with BC-specific mortality. RESULTS We included 13,270 BC cases with a mean follow-up after diagnosis of 8.6 years, representing 2340 total deaths, including 1475 BC deaths. Higher adherence to the DRRD score was associated with lower overall mortality (HR1-SD 0.92; 95%CI 0.87-0.96). Greater adherence to pro-inflammatory diets was borderline associated with 6% higher mortality HR1-SD 1.06; 95%CI 1.00-1.12. No significant association with the oestrogen-related dietary pattern was observed. None of the dietary patterns were associated with BC-specific mortality. CONCLUSIONS Greater adherence to an anti-diabetic and anti-inflammatory diet prior to diagnosis is associated with lower overall mortality among BC survivors. Long-term adherence to these dietary patterns could be a means to improve the prognosis of BC survivors.
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Affiliation(s)
- Carlota Castro-Espin
- Unit of Nutrition and Cancer, Catalan Institute of Oncology-ICO, L'Hospitalet de Llobregat, Barcelona, Spain.
- Nutrition and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Catalina Bonet
- Unit of Nutrition and Cancer, Catalan Institute of Oncology-ICO, L'Hospitalet de Llobregat, Barcelona, Spain
- Nutrition and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marta Crous-Bou
- Unit of Nutrition and Cancer, Catalan Institute of Oncology-ICO, L'Hospitalet de Llobregat, Barcelona, Spain
- Nutrition and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Verena Katzke
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Charlotte Le Cornet
- German Institute of Human Nutrition Potsdam-Rehbruecke, Dept. of Molecular Epidemiology, Arthur-Scheunert-Allee, Nuthetal, Germany
| | - Franziska Jannasch
- German Institute of Human Nutrition Potsdam-Rehbruecke, Dept. of Molecular Epidemiology, Arthur-Scheunert-Allee, Nuthetal, Germany
| | - Matthias B Schulze
- German Institute of Human Nutrition Potsdam-Rehbruecke, Dept. of Molecular Epidemiology, Arthur-Scheunert-Allee, Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany
| | - Anja Olsen
- Danish Cancer Society Research Center, Diet, Cancer and Health, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Diet, Cancer and Health, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Maria Jose 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
| | - Pilar Amiano
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 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
| | - María Dolores Chirlaque
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia University, Murcia, Spain
| | - Marcela Guevara
- 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
| | - Claudia Agnoli
- Epidemiology and Prevention Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rosario Tumino
- Hyblean Association for Epidemiological Research, AIRE ONLUS Ragusa, Ragusa, Italy
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital, Turin, Italy
| | | | - Malin Sund
- Department of Surgical and Perioperative Sciences/ Surgery, Umeå University, Umeå, Sweden
- Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Stina Bodén
- Department of Clinical Sciences - Pediatrics, Umeå University, Umeå, Sweden
| | - Torill Enget Jensen
- Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Karina Standahl Olsen
- Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Guri Skeie
- Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Marc J Gunter
- Nutrition and Metabolism Branch, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Sabina Rinaldi
- Nutrition and Metabolism Branch, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Esther M Gonzalez-Gil
- Nutrition and Metabolism Branch, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Elisabete Weiderpass
- Nutrition and Metabolism Branch, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Sofia Christakoudi
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Inflammation Biology, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Alicia K Heath
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Laure Dossus
- Nutrition and Metabolism Branch, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Antonio Agudo
- Unit of Nutrition and Cancer, Catalan Institute of Oncology-ICO, L'Hospitalet de Llobregat, Barcelona, Spain
- Nutrition and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
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6
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Lujan-Barroso L, Iglesias L, Zamora-Ros R, Lasheras C, Sánchez MJ, Cabrera-Castro N, Delfrad J, Amiano P, Molina-Montes E, Colorado-Yohar S, Moreno-Iribas C, Dorronsoro A, Rodríguez-Barranco M, Chirlaque MD, Aizpurua A, Agudo A, Quirós JR, Jakszyn P. Breakfast Size and Prevalence of Metabolic Syndrome in the European Prospective Investigation into Cancer and Nutrition (EPIC) Spanish Cohort. Nutrients 2023; 15:nu15030630. [PMID: 36771336 PMCID: PMC9919450 DOI: 10.3390/nu15030630] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/30/2022] [Accepted: 01/11/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Recent evidence suggest that energy distribution during the daytimecould be a potential determinant for the development of metabolic syndrome (MetS). OBJECTIVE To cross-sectionally assess the association between breakfast size and the prevalence of MetS in Spanish adults. METHODS Our study included a subset of 3644 participants from the European Prospective Investigation into Cancer and Nutrition Spain study recontacted between 2017-2018. Information on diet, sociodemographic, lifestyle, sleep quality, and chronotype was collected using standardized questionnaires, while anthropometric and blood pressure data were measured in a face-to-face personal interview by a nurse. MetS was defined according to the Adult Treatment Panel III (ATPIII) definition by measuring serum levels of total cholesterol, tryglycerides and glucose. Breakfast size was calculated as: (energy from breakfast/total energy intake) * 2000 kcal. To evaluate the association between breakfast size and MetS prevalence, a multivariable logistic regression model adjusted by potential confounders was used to estimate OR and 95% CI. RESULTS Prevalence of MetS in our study was 40.7%. The mean breakfast size was 306.6 * 2000 kcal (15% of the total daily energy intake), with 14 (0.4%) participants skipping breakfast. Participants in the highest quartile of breakfast size had a lower MetS prevalence compared to participants in the lowest quartile (ORQ4vsQ1 = 0.62; 95% CI = 0.51-0.76; p-trend < 0.001). No modification of the estimated ORs by sex, breakfast time, and number of eating occasions per day were observed. CONCLUSION Our results suggest that higher breakfast size is associated with lower prevalence of MetS in Spanish adults, supporting the importance of a high energy breakfast. Further prospective studies are necessary to confirm these findings.
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Affiliation(s)
- Leila Lujan-Barroso
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology—IDIBELL, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- Department of Public Health, Mental Health and Mother-Infant Nursing, School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, 08907 Barcelona, Spain
| | - Lucia Iglesias
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology—IDIBELL, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Raúl Zamora-Ros
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology—IDIBELL, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Cristina Lasheras
- Department of Functional Biology, University of Oviedo, 33007 Oviedo, Spain
| | - María-José Sánchez
- Escuela Andaluza de Salud Pública (EASP), 18011 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Granada, 18071 Granada, Spain
| | - Natalia Cabrera-Castro
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, 30120 Murcia, Spain
| | - Josu Delfrad
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Navarra Public Health Institute, 31003 Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain
| | - Pilar Amiano
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Sub-Directorate for Public Health and Addictions of Gipuzkoa, 20010 Donostia, Spain
- Biodonostia Health Research Institute, Epidemiology of Chronic and Communicable Diseases Group, 20014 San Sebastián, Spain
| | - Esther Molina-Montes
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Department of Nutrition and Food Science, Campus of Cartuja, University of Granada, 18071 Granada, Spain
- Institute of Nutrition and Food Technology (INYTA) ‘José Mataix’, Biomedical Research Centre, University of Granada, 18071 Granada, Spain
| | - Sandra Colorado-Yohar
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, 30120 Murcia, Spain
- Research Group on Demography and Health, National Faculty of Public Health, University of Antioquia, Medellín 050010, Colombia
| | - Conchi Moreno-Iribas
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Navarra Public Health Institute, 31003 Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain
| | - Ane Dorronsoro
- Sub-Directorate for Public Health and Addictions of Gipuzkoa, 20010 Donostia, Spain
| | - Miguel Rodríguez-Barranco
- Escuela Andaluza de Salud Pública (EASP), 18011 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - María Dolores Chirlaque
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, 30120 Murcia, Spain
- Sociohealth Sciences Department, Murcia University, 30100 Murcia, Spain
| | - Amaia Aizpurua
- Sub-Directorate for Public Health and Addictions of Gipuzkoa, 20010 Donostia, Spain
- Biodonostia Health Research Institute, Epidemiology of Chronic and Communicable Diseases Group, 20014 San Sebastián, Spain
| | - Antonio Agudo
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology—IDIBELL, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - José Ramón Quirós
- Department of Functional Biology, University of Oviedo, 33007 Oviedo, Spain
| | - Paula Jakszyn
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology—IDIBELL, L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- Blanquerna Health Sciences Faculty, Ramon Llull University, 08022 Barcelona, Spain
- Correspondence:
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7
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Fortuin-de Smidt MC, Sewe MO, Lassale C, Weiderpass E, Andersson J, Huerta JM, Ekelund U, Aleksandrova K, Tong TY, Dahm CC, Tjønneland A, Kyrø C, Steindorf K, Schulze MB, Katzke V, Sacerdote C, Agnoli C, Masala G, Tumino R, Panico S, Boer JM, Onland-Moret NC, Wendel-Vos GW, van der Schouw YT, Borch KB, Agudo A, Petrova D, Chirlaque MD, Conchi MI, Amiano P, Melander O, Heath AK, Aune D, Forouhi NG, Langenberg C, Brage S, Riboli E, Wareham NJ, Danesh J, Butterworth AS, Wennberg P. Physical activity attenuates but does not eliminate coronary heart disease risk amongst adults with risk factors: EPIC-CVD case-cohort study. Eur J Prev Cardiol 2022; 29:1618-1629. [PMID: 35403197 DOI: 10.1093/eurjpc/zwac055] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 02/02/2023]
Abstract
AIMS This study aimed to evaluate the association between physical activity and the incidence of coronary heart disease (CHD) in individuals with and without CHD risk factors. METHODS AND RESULTS EPIC-CVD is a case-cohort study of 29 333 participants that included 13 582 incident CHD cases and a randomly selected sub-cohort nested within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Self-reported physical activity was summarized using the Cambridge physical activity index (inactive, moderately inactive, moderately active, and active). Participants were categorized into sub-groups based on the presence or the absence of the following risk factors: obesity (body mass index ≥30 kg/m2), hypercholesterolaemia (total cholesterol ≥6.2 mmol/L), history of diabetes, hypertension (self-reported or ≥140/90 mmHg), and current smoking. Prentice-weighted Cox regression was used to assess the association between physical activity and incident CHD events (non-fatal and fatal).Compared to inactive participants without the respective CHD risk factor (referent), excess CHD risk was highest in physically inactive and lowest in moderately active participants with CHD risk factors. Corresponding excess CHD risk estimates amongst those with obesity were 47% [95% confidence interval (CI) 32-64%] and 21% (95%CI 2-44%), with hypercholesterolaemia were 80% (95%CI 55-108%) and 48% (95%CI 22-81%), with hypertension were 80% (95%CI 65-96%) and 49% (95%CI 28-74%), with diabetes were 142% (95%CI 63-260%), and 100% (95%CI 32-204%), and amongst smokers were 152% (95%CI 122-186%) and 109% (95%CI 74-150%). CONCLUSIONS In people with CHD risk factors, moderate physical activity, equivalent to 40 mins of walking per day, attenuates but does not completely offset CHD risk.
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Affiliation(s)
- Melony C Fortuin-de Smidt
- Department of Public Health and Clinical Medicine, Umeå University, Universitetstorget 4, 901 87, Umeå, Sweden
| | - Maquins Odhiambo Sewe
- Department of Public Health and Clinical Medicine, Umeå University, Universitetstorget 4, 901 87, Umeå, Sweden
| | - Camille Lassale
- Cardiovascular epidemiology and genetics, Hospital del Mar Research Institute (IMIM), Carrer del Dr. Aiguader, 88, 08003, Barcelona, Spain
- CIBER of Pathophysiology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III, C. de Melchor Fernández Almagro, 3, 28029 Madrid, Spain
| | - Elisabete Weiderpass
- International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372, Lyon, France
| | - Jonas Andersson
- Department of Public Health and Clinical Medicine, Skellefteå Research Unit, Umeå University, Lasarettsvägen 29, 931 41, Skellefteå, Sweden
| | - José María Huerta
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, 30120 El Palmar, Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, C. de Melchor Fernández Almagro, 3, 28029 Madrid, Spain
| | - Ulf Ekelund
- Department of Sports Medicine, Norwegian School of Sport Science, Sognsveien 220, 0863 Oslo, Norway
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Lovisenberggata 8, 0456, Oslo, Norway
| | - Krasimira Aleksandrova
- Department Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany
- Faculty of Human and Health Sciences, University of Bremen, Grazer Straße 2, 28359, Bremen, Germany
| | - Tammy Yn Tong
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, United Kingdom
| | - Christina C Dahm
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus, Denmark
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353, Copenhagen, Denmark
| | - Cecilie Kyrø
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany
- Institute for Nutritional Science, University of Potsdam, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany
| | - Verena Katzke
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital, Via Santena 7, 10126, Turin, Italy
| | - Claudia Agnoli
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy
| | - Giovanna Masala
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Via Cosimo II Vecchio 2, 50139, Florence, Italy
| | - Rosario Tumino
- Hyblean Association for Epidemiological Research, AIRE-ONLUS, Via Giuseppe di Vittoria 49, 97100, Ragusa, Italy
| | - Salvatore Panico
- Dipartimento di medicina clinica e chirurgia, Federico II University, Corso Umberto I 40, 80138, Naples, Italy
| | - Jolanda Ma Boer
- National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands
| | - N Charlotte Onland-Moret
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Gc Wanda Wendel-Vos
- National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Kristin Benjaminsen Borch
- Department of Community Medicine, UiT, The Arctic University of Norway, Hansine Hansens veg 18, 9019, Tromsø, Norway
| | - Antonio Agudo
- Unit of Nutrition and Cancer, Catalan Institute of Oncology - ICO, L'Hospitalet de Llobregat, Avinguda de la Granvia de l'Hospitalet, 199-203, 08908, Barcelona, Spain
- Nutrition and Cancer Group; Epidemiology, Public Health, Cancer Prevention and Palliative Care Program; Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, Avinguda de la Granvia de l'Hospitalet, 199, 08908, Barcelona, Spain
| | - Dafina Petrova
- Escuela Andaluza de Salud Pública (EASP), Cta. del Observatorio 4,18011 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Av. De Madrid 15, 18012 Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), C/ Montforte de Lemos 3-5, 28029 Madrid, Spain
| | - María Dolores Chirlaque
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, 30120 El Palmar, Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, C. de Melchor Fernández Almagro, 3, 28029 Madrid, Spain
| | - Moreno Iribas Conchi
- Navarra Public Health Institute, IdiSNA, C. de Irunlarrea, 3, 31008, Pamplona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), C. de Irunlarrea, 3, 31008 Pamplona, Spain
| | - Pilar Amiano
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, C. de Melchor Fernández Almagro, 3, 28029 Madrid, Spain
- Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, 20013 San Sebastian, Spain
- Biodonostia Health Research Institute, Epidemiology of Chronic and Communicable Diseases Group, Paseo Dr Bergiristain, s/n, 20014, San Sebastián, Spain
| | - Olle Melander
- Department of Clinical Sciences Malmö, Lund University, Jan Waldenströms gata 35, Malmö, Sweden
- Department of Emergency and Internal Medicine, Skåne University Hospital, Carl-Bertil Laurells gata 9, 214 28, Malmö, Sweden
| | - Alicia K Heath
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, United Kingdom
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, United Kingdom
- Department of Nutrition, Bjørknes University College, Lovisenberggata 13, 0456, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Trondheimsveien 235, 0586, Oslo, Norway
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Nobels väg 6, 171 77, Stockholm, Sweden
| | - Nita G Forouhi
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge CB2 0SL, United Kingdom
| | - Claudia Langenberg
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge CB2 0SL, United Kingdom
- Computational Medicine, Berlin Institute of Health, Charité-University Medicine Berlin, Anna-Louisa-Karsch-Straße 2, 10178, Berlin, Germany
| | - Soren Brage
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge CB2 0SL, United Kingdom
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, United Kingdom
| | - Nicholas J Wareham
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge CB2 0SL, United Kingdom
| | - John Danesh
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, 2 Worts's Causeway, Cambridge CB1 8RN, United Kingdom
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, 2 Worts's Causeway, Cambridge CB1 8RN, United Kingdom
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Hills Road, Cambridge CB2 0QQ, United Kingdom
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Saffron Walden CB10 1SA, United Kingdom
- Department of Human Genetics, Wellcome Sanger Institute, Hinxton, CB10 1SA, United Kingdom
| | - Adam S Butterworth
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, 2 Worts's Causeway, Cambridge CB1 8RN, United Kingdom
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, 2 Worts's Causeway, Cambridge CB1 8RN, United Kingdom
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Hills Road, Cambridge CB2 0QQ, United Kingdom
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Saffron Walden CB10 1SA, United Kingdom
| | - Patrik Wennberg
- Department of Public Health and Clinical Medicine, Umeå University, Universitetstorget 4, 901 87, Umeå, Sweden
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Grenville ZS, Noor U, His M, Viallon V, Rinaldi S, Aglago EK, Amiano P, Brunkwall L, Chirlaque MD, Drake I, Eichelmann F, Freisling H, Grioni S, Heath AK, Kaaks R, Katzke V, Mayén-Chacon AL, Milani L, Moreno-Iribas C, Pala V, Olsen A, Sánchez MJ, Schulze MB, Tjønneland A, Tsilidis KK, Weiderpass E, Winkvist A, Zamora-Ros R, Key TJ, Smith-Byrne K, Travis RC, Schmidt JA. Diet and BMI Correlate with Metabolite Patterns Associated with Aggressive Prostate Cancer. Nutrients 2022; 14:3306. [PMID: 36014812 PMCID: PMC9415102 DOI: 10.3390/nu14163306] [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: 07/19/2022] [Revised: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 11/16/2022] Open
Abstract
Three metabolite patterns have previously shown prospective inverse associations with the risk of aggressive prostate cancer within the European Prospective Investigation into Cancer and Nutrition (EPIC). Here, we investigated dietary and lifestyle correlates of these three prostate cancer-related metabolite patterns, which included: 64 phosphatidylcholines and three hydroxysphingomyelins (Pattern 1), acylcarnitines C18:1 and C18:2, glutamate, ornithine, and taurine (Pattern 2), and 8 lysophosphatidylcholines (Pattern 3). In a two-stage cross-sectional discovery (n = 2524) and validation (n = 518) design containing 3042 men free of cancer in EPIC, we estimated the associations of 24 dietary and lifestyle variables with each pattern and the contributing individual metabolites. Associations statistically significant after both correction for multiple testing (False Discovery Rate = 0.05) in the discovery set and at p < 0.05 in the validation set were considered robust. Intakes of alcohol, total fish products, and its subsets total fish and lean fish were positively associated with Pattern 1. Body mass index (BMI) was positively associated with Pattern 2, which appeared to be driven by a strong positive BMI-glutamate association. Finally, both BMI and fatty fish were inversely associated with Pattern 3. In conclusion, these results indicate associations of fish and its subtypes, alcohol, and BMI with metabolite patterns that are inversely associated with risk of aggressive prostate cancer.
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Affiliation(s)
- Zoe S. Grenville
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Urwah Noor
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Mathilde His
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, World Health Organization, 69008 Lyon, France
| | - Vivian Viallon
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, World Health Organization, 69008 Lyon, France
| | - Sabina Rinaldi
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, World Health Organization, 69008 Lyon, France
| | - Elom K. Aglago
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Pilar Amiano
- Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, 20013 San Sebastian, Spain
- Biodonostia Health Research Institute, Epidemiology of Chronic and Communicable Diseases Group, 20014 San Sebastián, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Louise Brunkwall
- Department of Clinical Sciences, Lund University, 221 84 Malmö, Sweden
| | - María Dolores Chirlaque
- CIBER of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia University, 30008 Murcia, Spain
| | - Isabel Drake
- Department of Clinical Sciences, Lund University, 221 84 Malmö, Sweden
- Skåne University Hospital, 214 28 Malmö, Sweden
| | - Fabian Eichelmann
- Department of Molecular Epidemiology, German Institute of Human Nutrition, 14558 Nuthetal, Germany
| | - Heinz Freisling
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, World Health Organization, 69008 Lyon, France
| | - Sara Grioni
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Alicia K. Heath
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Rudolf Kaaks
- Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Verena Katzke
- Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Ana-Lucia Mayén-Chacon
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, World Health Organization, 69008 Lyon, France
| | - Lorenzo Milani
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, 10124 Turin, Italy
| | - Conchi Moreno-Iribas
- CIBER of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Navarra Public Health Institute, 31003 Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain
| | - Valeria Pala
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Anja Olsen
- Danish Cancer Society Research Center, DK-2100 Copenhagen, Denmark
- Department of Public Health, Aarhus University, DK-8000 Aarhus, Denmark
| | - Maria-Jose Sánchez
- Escuela Andaluza de Salud Pública (EASP), 18011 Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Granada, 18071 Granada, Spain
| | - Matthias B. Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition, 14558 Nuthetal, Germany
| | - Anne Tjønneland
- Danish Cancer Society Research Center, DK-2100 Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, DK-1353 Copenhagen, Denmark
| | - Konstantinos K. Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London W2 1PG, UK
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, 45110 Ioannina, Greece
| | - Elisabete Weiderpass
- International Agency for Research on Cancer, World Health Organization, 69008 Lyon, France
| | - Anna Winkvist
- Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden
- Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden
| | - Raul Zamora-Ros
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Timothy J. Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Karl Smith-Byrne
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Ruth C. Travis
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Julie A. Schmidt
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
- Department of Clinical Epidemiology, Department of Clinical Medicine, University Hospital, Aarhus University and Aarhus, DK-8200 Aarhus N, Denmark
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9
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Yang JJ, Yu D, White E, Lee DH, Blot W, Robien K, Sinha R, Park Y, Takata Y, Gao YT, Smith-Byrne K, Monninkhof EM, Kaaks R, Langhammer A, Borch KB, Al-Shaar L, Lan Q, Sørgjerd EP, Zhang X, Zhu C, Chirlaque MD, Severi G, Overvad K, Sacerdote C, Aune D, Johansson M, Smith-Warner SA, Zheng W, Shu XO. Prediagnosis Leisure-Time Physical Activity and Lung Cancer Survival: A Pooled Analysis of 11 Cohorts. JNCI Cancer Spectr 2022; 6:pkac009. [PMID: 35603841 PMCID: PMC8962711 DOI: 10.1093/jncics/pkac009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 08/08/2021] [Revised: 10/13/2021] [Accepted: 12/10/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Little is known about the association between physical activity before cancer diagnosis and survival among lung cancer patients. In this pooled analysis of 11 prospective cohorts, we investigated associations of prediagnosis leisure-time physical activity (LTPA) with all-cause and lung cancer-specific mortality among incident lung cancer patients. METHODS Using self-reported data on regular engagement in exercise and sports activities collected at study enrollment, we assessed metabolic equivalent hours (MET-h) of prediagnosis LTPA per week. According to the Physical Activity Guidelines for Americans, prediagnosis LTPA was classified into inactivity, less than 8.3 and at least 8.3 MET-h per week (the minimum recommended range). Cox regression was used to estimate hazard ratios (HRs) and 95% confidence interval (CIs) for all-cause and lung cancer-specific mortality after adjustment for major prognostic factors and lifetime smoking history. RESULTS Of 20 494 incident lung cancer patients, 16 864 died, including 13 596 deaths from lung cancer (overall 5-year relative survival rate = 20.9%, 95% CI = 20.3% to 21.5%). Compared with inactivity, prediagnosis LTPA of more than 8.3 MET-h per week was associated with a lower hazard of all-cause mortality (multivariable-adjusted HR = 0.93, 95% CI = 0.88 to 0.99), but not with lung cancer-specific mortality (multivariable-adjusted HR = 0.99, 95% CI = 0.95 to 1.04), among the overall population. Additive interaction was found by tumor stage (Pinteraction = .008 for all-cause mortality and .003 for lung cancer-specific mortality). When restricted to localized cancer, prediagnosis LTPA of at least 8.3 MET-h per week linked to 20% lower mortality: multivariable-adjusted HRs were 0.80 (95% CI = 0.67 to 0.97) for all-cause mortality and 0.80 (95% CI = 0.65 to 0.99) for lung cancer-specific mortality. CONCLUSIONS Regular participation in LTPA that met or exceeded the minimum Physical Activity Guidelines was associated with reduced hazards of mortality among lung cancer patients, especially those with early stage cancer.
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Affiliation(s)
- Jae Jeong Yang
- Vanderbilt Epidemiology Center, Division of Epidemiology, Department of
Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical
Center, Nashville, TN, USA
| | - Danxia Yu
- Vanderbilt Epidemiology Center, Division of Epidemiology, Department of
Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical
Center, Nashville, TN, USA
| | - Emily White
- Cancer Prevention Program, Fred Hutchinson Cancer Research
Center, Seattle, WA, USA
| | - Dong Hoon Lee
- Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public
Health, Boston, MA, USA
| | - William Blot
- Vanderbilt Epidemiology Center, Division of Epidemiology, Department of
Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical
Center, Nashville, TN, USA
| | - Kim Robien
- Department of Exercise and Nutrition Sciences, Milken Institute School of
Public Health, George Washington University, Washington, DC, USA
| | - Rashmi Sinha
- Division of Epidemiology & Genetics, National Cancer
Institute, Bethesda, MD, USA
| | - Yikyung Park
- Division of Public Health Sciences, Department of Surgery, Washington
University School of Medicine, St. Louis, MO, USA
| | - Yumie Takata
- Program of Nutrition, School of Biological and Population Health, College of
Public Health and Human Sciences, Oregon State University, Corvallis, OR,
USA
| | - Yu-Tang Gao
- Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai
Jiaotong University School of Medicine, Shanghai, China
| | - Karl Smith-Byrne
- Genetic Epidemiology Group, International Agency for Research on
Cancer, Lyons, France
| | - Evelyn M Monninkhof
- Julius Center for Health Sciences and Primary Care, University Medical Center,
Utrecht University, Utrecht, the
Netherlands
| | - Rudolf Kaaks
- Department of Cancer Epidemiology, German Cancer Research Center
(DKFZ), Heidelberg, Germany
- Translational Lung Research Center (TLRC), Member of the German Center for Lung
Research (DZL), Heidelberg, Germany
| | - Arnulf Langhammer
- HUNT Research Centre, Department of Public Health and Nursing, NTNU, Norwegian
University of Science and Technology, Levanger, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger,
Norway
| | | | - Laila Al-Shaar
- Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public
Health, Boston, MA, USA
- Department of Public Health Sciences, Penn State College of
Medicine, Hershey, PA, USA
| | - Qing Lan
- Division of Epidemiology & Genetics, National Cancer
Institute, Bethesda, MD, USA
| | - Elin Pettersen Sørgjerd
- Department of Public Health and General Practice, Norwegian University of
Science and Technology, Trondheim, Norway
| | - Xuehong Zhang
- Channing Division of Network Medicine, Department of Medicine, Brigham and
Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Clair Zhu
- Division of Epidemiology & Genetics, National Cancer
Institute, Bethesda, MD, USA
| | - María Dolores Chirlaque
- Department of Epidemiology, Murcia Regional Health Council IMIBArrixaca, Ronda
de Levante, Murcia, Spain
- Department of Health and Social Sciences, University of Murcia Campus de
Espinardo, Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Calle de Melchor Fernández
Almagro, Madrid, Spain
| | - Gianluca Severi
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, “Exposome and Heredity”
Team, CESP UMR1018, Villejuif, France
- Department of Statistics, Computer Science and Applications “G. Parenti”
(DISIA), University of Florence, Italy
| | - Kim Overvad
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Città della Salute e della Scienza
University-Hospital, Turin, Italy
| | - Dagfinn 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
| | - Mattias Johansson
- Genetic Epidemiology Group, International Agency for Research on
Cancer, Lyons, France
| | - Stephanie A Smith-Warner
- Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public
Health, Boston, MA, USA
| | - Wei Zheng
- Vanderbilt Epidemiology Center, Division of Epidemiology, Department of
Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical
Center, Nashville, TN, USA
| | - Xiao-Ou Shu
- Vanderbilt Epidemiology Center, Division of Epidemiology, Department of
Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical
Center, Nashville, TN, USA
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10
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Ibarrondo O, Huerta JM, Amiano P, Andreu-Reinón ME, Mokoroa O, Ardanaz E, Larumbe R, Colorado-Yohar SM, Navarro-Mateu F, Chirlaque MD, Mar J. Dementia Risk Score for a Population in Southern Europe Calculated Using Competing Risk Models. J Alzheimers Dis 2022; 86:1751-1762. [PMID: 35253747 PMCID: PMC9108562 DOI: 10.3233/jad-215211] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Dementia prevention can be addressed if the intervention is applied early. Objective: The objective of this study was to develop and validate competing risk models to predict the late risk of dementia based on variables assessed in middle age in a southern European population. Methods: We conducted a prospective observational study of the EPIC-Spain cohort that included 25,015 participants. Dementia cases were identified from electronic health records and validated by neurologists. Data were gathered on sociodemographic characteristics and cardiovascular risk factors. To stratify dementia risk, Fine and Gray competing risk prediction models were constructed for the entire sample and for over-55-year-olds. Risk scores were calculated for low (the 30% of the sample with the lowest risk), moderate (> 30% –60%), and high (> 60% –100%) risk. Results: The 755 cases of dementia identified represented a cumulative incidence of 3.1% throughout the study period. The AUC of the model for over-55-year-olds was much higher (80.8%) than the overall AUC (68.5%) in the first 15 years of follow-up and remained that way in the subsequent follow-up. The weight of the competing risk of death was greater than that of dementia and especially when the entire population was included. Conclusion: This study presents the first dementia risk score calculated in a southern European population in mid-life and followed up for 20 years. The score makes it feasible to achieve the early identification of individuals in a southern European population who could be targeted for the prevention of dementia based on the intensive control of risk factors.
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Affiliation(s)
- Oliver Ibarrondo
- Basque Health Service (Osakidetza), Debagoiena Integrated Healthcare Organisation, Research Unit, Arrasate-Mondragón, Spain
- Biodonostia Health Research Institute, Epidemiology and Public Health Area, San Sebastián, Spain
| | - José María Huerta
- Murcia Biomedical Research Institute (IMIB-Arrixaca), Murcia, Spain
- Department of Epidemiology. Murcia Regional Health Council, Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Pilar Amiano
- Biodonostia Health Research Institute, Epidemiology and Public Health Area, San Sebastián, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Ministry of Health of the Basque Government, Sub-Directorate for Public Health and Addictions of Gipuzkoa, SanSebastián, Spain
| | - María Encarnación Andreu-Reinón
- Murcia Biomedical Research Institute (IMIB-Arrixaca), Murcia, Spain
- Section of Neurology, Department of Internal Medicine, Rafael Méndez Hospital, Murcian Health Service, Lorca, Spain
| | - Olatz Mokoroa
- Biodonostia Health Research Institute, Epidemiology and Public Health Area, San Sebastián, Spain
- Ministry of Health of the Basque Government, Sub-Directorate for Public Health and Addictions of Gipuzkoa, SanSebastián, Spain
| | - Eva Ardanaz
- Public Health Institute of Navarra, IdiSNA, Pamplona, Spain
- Neuroepigenetics Laboratory, Navarrabiomed, Public University of Navarre (UPNA), Navarre, Spain
| | - Rosa Larumbe
- Public Health Institute of Navarra, IdiSNA, Pamplona, Spain
- Neuroepigenetics Laboratory, Navarrabiomed, Public University of Navarre (UPNA), Navarre, Spain
- Department of Neurology, Complejo Hospitalario deNavarra, Pamplona, Spain
| | - Sandra M. Colorado-Yohar
- Murcia Biomedical Research Institute (IMIB-Arrixaca), Murcia, Spain
- Department of Epidemiology. Murcia Regional Health Council, Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Research Group on Demography and Health, National Faculty of Public Health, University of Antioquia, Medellín, Colombia
| | - Fernando Navarro-Mateu
- Murcia Biomedical Research Institute (IMIB-Arrixaca), Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Unidad deDocencia, Investigación y Formación en Salud Mental(UDIF-SM), Murcian Health Service, IMIB-Arrixaca, Murcia, Spain
| | - María Dolores Chirlaque
- Murcia Biomedical Research Institute (IMIB-Arrixaca), Murcia, Spain
- Department of Epidemiology. Murcia Regional Health Council, Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Health and Social Sciences, University of Murcia, Murcia, Spain
| | - Javier Mar
- Basque Health Service (Osakidetza), Debagoiena Integrated Healthcare Organisation, Research Unit, Arrasate-Mondragón, Spain
- Biodonostia Health Research Institute, Epidemiology and Public Health Area, San Sebastián, Spain
- Kronikgune Health Services Research Institute, Barakaldo, Spain
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11
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Álvarez-Álvarez L, Vitelli-Storelli F, Rubín-García M, Aragonés N, Ardanaz E, Castaño-Vinyals G, Obón-Santacana M, Dierssen-Sotos T, Salas-Trejo D, Tardón A, Moleón JJJ, Alguacil J, Chirlaque MD, Pérez-Gómez B, Pollán M, Kogevinas M, Martín V. Relationship between the Risk of Gastric Cancer and Adherence to the Mediterranean Diet According to Different Estimators. MCC-Spain Study. Cancers (Basel) 2021; 13:cancers13215281. [PMID: 34771444 PMCID: PMC8582518 DOI: 10.3390/cancers13215281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/22/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 01/22/2023] Open
Abstract
Simple Summary Dietary habits are one of the factors that influence the development of gastric cancer and, although it has been seen that the Mediterranean diet has a protective effect on this type of cancer, there are different indexes to assess the degree of adherence to this dietary pattern; this implies differences in the results obtained in the reduction of risk. The aim of this work was to assess the effect of adherence to the Mediterranean diet, measured with five different indexes, on the risk of gastric cancer. Abstract The aim was to assess the effect of adherence to the Mediterranean Diet, measured with five different indexes, on the risk of gastric cancer. Data come from the multicase-control study MCC—Spain, which included 354 gastric cancer cases and 3040 controls with data on diet. We used five indexes to evaluate adherence to the Mediterranean diet and assess the association between each pattern with the risk of gastric cancer, using multivariate logistic regression. The analyses were performed for the whole set of gastric cancer cases, by anatomical location (cardia and non-cardia) and by histological type (intestinal and diffuse). According to the used index, a high adherence protects one from gastric cancer (between 48% (aOR = 0.52; CI 95% = 0.28–0.94) and 75% (aOR = 0.25; CI 95% = 0.12–0.52)), from non-cardia (between 48% (aOR = 0.52; CI 95% = 0.36–0.75) and 65% (aOR = 0.35; CI 95% = 0.23–0.52)), and from the intestinal type (between 41% (aOR = 0.59; CI 95% = 0.36–0.95) and 72% (aOR = 0.28; CI 95% = 0.16–0.50)), but not from the diffuse type. In conclusion, high adherence to a Mediterranean diet pattern is a protective factor for the risk of gastric cancer, with greater adherence leading to greater protection.
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Affiliation(s)
- Laura Álvarez-Álvarez
- Group of Investigation in Interactions Gene-Environment and Health (GIIGAS), Institute of Biomedicine (IBIOMED), University of León, 24071 León, Spain; (L.Á.-Á.); (F.V.-S.); (V.M.)
| | - Facundo Vitelli-Storelli
- Group of Investigation in Interactions Gene-Environment and Health (GIIGAS), Institute of Biomedicine (IBIOMED), University of León, 24071 León, Spain; (L.Á.-Á.); (F.V.-S.); (V.M.)
| | - María Rubín-García
- Group of Investigation in Interactions Gene-Environment and Health (GIIGAS), Institute of Biomedicine (IBIOMED), University of León, 24071 León, Spain; (L.Á.-Á.); (F.V.-S.); (V.M.)
- Correspondence: ; Tel.: +34-653252471
| | - Nuria Aragonés
- Consortium for Biomedical Research in Epidemiology & Public Health, CIBERESP, 28029 Madrid, Spain; (N.A.); (E.A.); (G.C.-V.); (T.D.-S.); (D.S.-T.); (A.T.); (J.J.J.M.); (J.A.); (M.D.C.); (B.P.-G.); (M.P.); (M.K.)
- Cancer Epidemiology Section, Public Health Division, Department of Health of Madrid, 28035 Madrid, Spain
| | - Eva Ardanaz
- Consortium for Biomedical Research in Epidemiology & Public Health, CIBERESP, 28029 Madrid, Spain; (N.A.); (E.A.); (G.C.-V.); (T.D.-S.); (D.S.-T.); (A.T.); (J.J.J.M.); (J.A.); (M.D.C.); (B.P.-G.); (M.P.); (M.K.)
- Navarra Institute for Health Research (IdiSNA) Navarra Public Health Institute, 31008 Pamplona, Spain
| | - Gemma Castaño-Vinyals
- Consortium for Biomedical Research in Epidemiology & Public Health, CIBERESP, 28029 Madrid, Spain; (N.A.); (E.A.); (G.C.-V.); (T.D.-S.); (D.S.-T.); (A.T.); (J.J.J.M.); (J.A.); (M.D.C.); (B.P.-G.); (M.P.); (M.K.)
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), 08036 Barcelona, Spain
| | - Mireia Obón-Santacana
- Oncology Data Analytics Program (ODAP), Catalan Institute of Oncology (ICO), L’Hospitalet Del Llobregat, 08908 Barcelona, Spain;
| | - Trinidad Dierssen-Sotos
- Consortium for Biomedical Research in Epidemiology & Public Health, CIBERESP, 28029 Madrid, Spain; (N.A.); (E.A.); (G.C.-V.); (T.D.-S.); (D.S.-T.); (A.T.); (J.J.J.M.); (J.A.); (M.D.C.); (B.P.-G.); (M.P.); (M.K.)
- Universidad de Cantabria—IDIVAL, 39005 Santander, Spain
| | - Dolores Salas-Trejo
- Consortium for Biomedical Research in Epidemiology & Public Health, CIBERESP, 28029 Madrid, Spain; (N.A.); (E.A.); (G.C.-V.); (T.D.-S.); (D.S.-T.); (A.T.); (J.J.J.M.); (J.A.); (M.D.C.); (B.P.-G.); (M.P.); (M.K.)
- Valencian Breast Cancer Screening Program, General Directorate of Public Health, 46020 València, Spain
| | - Adonina Tardón
- Consortium for Biomedical Research in Epidemiology & Public Health, CIBERESP, 28029 Madrid, Spain; (N.A.); (E.A.); (G.C.-V.); (T.D.-S.); (D.S.-T.); (A.T.); (J.J.J.M.); (J.A.); (M.D.C.); (B.P.-G.); (M.P.); (M.K.)
- Department of Medicine, University of Oviedo, 33003 Oviedo, Spain
| | - José Juan Jiménez Moleón
- Consortium for Biomedical Research in Epidemiology & Public Health, CIBERESP, 28029 Madrid, Spain; (N.A.); (E.A.); (G.C.-V.); (T.D.-S.); (D.S.-T.); (A.T.); (J.J.J.M.); (J.A.); (M.D.C.); (B.P.-G.); (M.P.); (M.K.)
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Hospitales Universitarios de Granada, Universidad de Granada, 18012 Granada, Spain
| | - Juan Alguacil
- Consortium for Biomedical Research in Epidemiology & Public Health, CIBERESP, 28029 Madrid, Spain; (N.A.); (E.A.); (G.C.-V.); (T.D.-S.); (D.S.-T.); (A.T.); (J.J.J.M.); (J.A.); (M.D.C.); (B.P.-G.); (M.P.); (M.K.)
- Centro de Investigación en Recursos Naturales, Salud y Medio Ambiente (RENSMA), Universidad de Huelva, Campus Universitario de El Carmen, 21004 Huelva, Spain
| | - María Dolores Chirlaque
- Consortium for Biomedical Research in Epidemiology & Public Health, CIBERESP, 28029 Madrid, Spain; (N.A.); (E.A.); (G.C.-V.); (T.D.-S.); (D.S.-T.); (A.T.); (J.J.J.M.); (J.A.); (M.D.C.); (B.P.-G.); (M.P.); (M.K.)
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia University, 30008 Murcia, Spain
| | - Beatriz Pérez-Gómez
- Consortium for Biomedical Research in Epidemiology & Public Health, CIBERESP, 28029 Madrid, Spain; (N.A.); (E.A.); (G.C.-V.); (T.D.-S.); (D.S.-T.); (A.T.); (J.J.J.M.); (J.A.); (M.D.C.); (B.P.-G.); (M.P.); (M.K.)
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, 28029 Madrid, Spain
| | - Marina Pollán
- Consortium for Biomedical Research in Epidemiology & Public Health, CIBERESP, 28029 Madrid, Spain; (N.A.); (E.A.); (G.C.-V.); (T.D.-S.); (D.S.-T.); (A.T.); (J.J.J.M.); (J.A.); (M.D.C.); (B.P.-G.); (M.P.); (M.K.)
- Cancer and Environmental Epidemiology Unit, Department of Epidemiology and Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, 28029 Madrid, Spain
| | - Manolis Kogevinas
- Consortium for Biomedical Research in Epidemiology & Public Health, CIBERESP, 28029 Madrid, Spain; (N.A.); (E.A.); (G.C.-V.); (T.D.-S.); (D.S.-T.); (A.T.); (J.J.J.M.); (J.A.); (M.D.C.); (B.P.-G.); (M.P.); (M.K.)
- Institute of Global Health (ISGlobal), 08036 Barcelona, Spain
| | - Vicente Martín
- Group of Investigation in Interactions Gene-Environment and Health (GIIGAS), Institute of Biomedicine (IBIOMED), University of León, 24071 León, Spain; (L.Á.-Á.); (F.V.-S.); (V.M.)
- Consortium for Biomedical Research in Epidemiology & Public Health, CIBERESP, 28029 Madrid, Spain; (N.A.); (E.A.); (G.C.-V.); (T.D.-S.); (D.S.-T.); (A.T.); (J.J.J.M.); (J.A.); (M.D.C.); (B.P.-G.); (M.P.); (M.K.)
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12
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Navarro-Mateu F, Husky M, Cayuela-Fuentes P, Álvarez FJ, Roca-Vega A, Rubio-Aparicio M, Chirlaque MD, Cayuela ML, Martínez S, Sánchez-Meca J. The association of telomere length with substance use disorders: a systematic review and meta-analysis of observational studies. Addiction 2021; 116:1954-1972. [PMID: 33140537 DOI: 10.1111/add.15312] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/09/2020] [Accepted: 10/28/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS Several recent studies have investigated the relationship between telomere length and substance use disorders with inconsistent results. We aimed to assess this association and to identify moderators of the relationship. METHODS Systematic review and meta-analysis. Selection criteria were observational studies reporting telomere length in people with a substance use disorder compared with a control group. Studies focused solely on nicotine addiction, employing other study designs, and non-human studies were excluded. Study selection and data extraction were independently conducted by two researchers following a standardized protocol and included studies until December 2019. Standardized mean differences were used as the effect size index [d; 95% confidence interval (CI)] and random-effects models were used for the meta-analysis. Cochran's Q-statistic, I2 index, visual inspection of the forest plot and a 95% prediction interval were applied to verify study heterogeneity. Subgroup analyses and meta-regressions were conducted to explore heterogeneity. Small study effects were examined using the 'funnel plot', the Egger test, Duval & Tweedie's trim-and-fill method and the precision-effect test-precision-effect estimate with standard error (PET-PEESE) method. The risk of bias and the quality of evidence were assessed. RESULTS Ten studies (12 analysis units with 2671 cases and 4532 controls) met the selection criteria. An overall effect size of moderate magnitude was found (d+ = -0.63; 95% CI = -1.00 and -0.26; P = 0.0008). A potential small study effect was detected, as well as large heterogeneity between studies (Q-statistic P < 0.001, I2 = 97.3%). Selection of controls, reporting laboratory quality control procedures and total sample size significantly affected the effect size. The quality of the evidence was very low, based on risk of bias analysis and the grading of recommendations assessment, development and evaluation (GRADE) system. CONCLUSIONS People with substance use disorders appear to have shorter telomere length than controls; however, this finding should be interpreted with caution due to the poor quality of the evidence.
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Affiliation(s)
- Fernando Navarro-Mateu
- Servicio Murciano de Salud, Unidad de Docencia, Investigación y Formación en Salud Mental (UDIF-SM), Murcia, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,IMIB-Arrixaca, Murcia, Spain.,Departamento de Psicología Básica y Metodología, University of Murcia, Murcia, Spain
| | - Mathilde Husky
- Université de Bordeaux, Laboratoire de Psychologie EA4139, Bordeaux, France
| | - Pedro Cayuela-Fuentes
- Escuela Universitaria de Enfermería de Cartagena, University of Murcia, Murcia, Spain
| | - Francisco-Javier Álvarez
- Servicio Murciano de Salud, Unidad de Docencia, Investigación y Formación en Salud Mental (UDIF-SM), Murcia, Spain
| | - Agustín Roca-Vega
- Biblioteca Virtual MurciaSalud, Centro Tecnológico de Información y Documentación Sanitaria, Servicio Murciano de Salud, Murcia, Spain
| | | | - María Dolores Chirlaque
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,IMIB-Arrixaca, Murcia, Spain.,Servicio de Epidemiología, Consejería de Salud, Murcia, Spain.,Departamento de Ciencias Sociosanitarias, University of Murcia, Murcia, Spain
| | - María Luisa Cayuela
- Grupo Telomerasa, Cáncer y Envejecimiento, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.,CIBER de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Salvador Martínez
- Instituto de Neurociencias, UMH-CSIC, Alicante, Spain.,and CIBER de Salud Mental (CIBERSAM), Madrid, Spain
| | - Julio Sánchez-Meca
- Departamento de Psicología Básica y Metodología, University of Murcia, Murcia, Spain
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13
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González CA, Bonet C, de Pablo M, Sanchez MJ, Salamanca-Fernandez E, Dorronsoro M, Amiano P, Huerta JM, Chirlaque MD, Ardanaz E, Barricarte A, Quirós JR, Agudo A, Rivera Ferrer MG. Greenhouse gases emissions from the diet and risk of death and chronic diseases in the EPIC-Spain cohort. Eur J Public Health 2021; 31:130-135. [PMID: 33001211 DOI: 10.1093/eurpub/ckaa167] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Evidence from the scientific literature shows a significant variation in greenhouse gas (GHG) emissions from the diet, according to the type of food consumed. We aim to analyze the relationship between the daily dietary GHG emissions according to red meat, fruit and vegetables consumption and their relationship with risk of total mortality, and incident risk of chronic diseases. METHODS We examined data on the EPIC-Spain prospective study, with a sample of 40 621 participants. Dietary GHG emission values were calculated for 57 food items of the EPIC study using mean emission data from a systematic review of 369 published studies. RESULTS Dietary GHG emissions (kgCO2eq/day), per 2000 kcal, were 4.7 times higher in those with high red-meat consumption (>140 g/day) than those with low consumption (<70 g/day). The average dietary GHG emissions were similar in males and females, but it was significantly higher in youngest people and in those individuals with lower educational level, as well as for northern EPIC centers of Spain. We found a significant association with the risk of mortality comparing the third vs. the first tertile of dietary GHG emissions [hazard ratio (HR) 1.095; 95% confidence interval (CI) 1.007-1.19; trend test 0.037]. Risk of coronary heart disease (HR 1.26; 95% CI 1.08-1.48; trend test 0.003) and risk of type 2 diabetes (HR 1.24; 95% CI 1.11-1.38; trend test 0.002) showed significant association as well. CONCLUSIONS Decreasing red-meat consumption would lead to reduce GHG emissions from diet and would reduce risk of mortality, coronary heart disease and type 2 diabetes.
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Affiliation(s)
- Carlos A González
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO)-IDIBELL, Barcelona, Spain
| | - Catalina Bonet
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO)-IDIBELL, Barcelona, Spain
| | - Miguel de Pablo
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO)-IDIBELL, Barcelona, Spain
| | - María José Sanchez
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain.,CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Elena Salamanca-Fernandez
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - Miren Dorronsoro
- BioDonostia Research Institute, San Sebastian, Spain.,Public Health Department of Gipuzkoa, Government of the Basque Country, San Sebastian, Spain
| | - Pilar Amiano
- BioDonostia Research Institute, San Sebastian, Spain.,Public Health Department of Gipuzkoa, Government of the Basque Country, San Sebastian, Spain.,Subdireccion de Salud Pública de Gipuzkoa, Gobierno Vasco, San Sebastian, Spain
| | - Jose María Huerta
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain.,Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain
| | - María Dolores Chirlaque
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain.,Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain
| | - Eva Ardanaz
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Navarra Public Health Institute, Pamplona, Spain.,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Aurelio Barricarte
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Navarra Public Health Institute, Pamplona, Spain.,Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | | | - Antonio Agudo
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO)-IDIBELL, Barcelona, Spain
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14
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Guevara M, Salamanca-Fernández E, Miqueleiz E, Gavrila D, Amiano P, Bonet C, Rodríguez-Barranco M, Huerta JM, Bujanda L, Sánchez MJ, Chirlaque MD, Agudo A, Ardanaz E, Castilla J. Inflammatory Potential of the Diet and Incidence of Crohn's Disease and Ulcerative Colitis in the EPIC-Spain Cohort. Nutrients 2021; 13:nu13072201. [PMID: 34206846 PMCID: PMC8308349 DOI: 10.3390/nu13072201] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 11/16/2022] Open
Abstract
Diet may influence the development of inflammatory bowel disease through the modulation of inflammation. We investigated whether the inflammatory potential of the diet is associated with the risk of Crohn’s disease (CD) and ulcerative colitis (UC) in the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Spain). The study included 32,633 participants aged 29–69 years. The inflammatory potential of the diet was measured by using an inflammatory score of the diet (ISD) based on a baseline dietary history questionnaire. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). During 21 years (674,547 person-years) of follow-up, 32 and 57 participants developed CD and UC, respectively. In multivariable analysis, a one-standard deviation (SD) increment in the ISD (two-unit increase) was associated with a higher risk of CD (HR of 1.71; 95% CI: 1.05–2.80; p = 0.031). By contrast, ISD was not associated with UC (HR for one-SD increment of 0.89; 95% CI: 0.66–1.19; p = 0.436). Our results suggest that consuming a more pro-inflammatory diet may contribute to the risk of CD, supporting that a healthy diet might be beneficial in its prevention. Further, larger studies are needed to verify these findings.
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Affiliation(s)
- Marcela Guevara
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (E.M.); (E.A.); (J.C.)
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (D.G.); (P.A.); (M.R.-B.); (J.M.H.); (M.J.S.); (M.D.C.)
- Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain
- Correspondence:
| | | | - Estrella Miqueleiz
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (E.M.); (E.A.); (J.C.)
| | - Diana Gavrila
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (D.G.); (P.A.); (M.R.-B.); (J.M.H.); (M.J.S.); (M.D.C.)
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, 30008 Murcia, Spain
| | - Pilar Amiano
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (D.G.); (P.A.); (M.R.-B.); (J.M.H.); (M.J.S.); (M.D.C.)
- Sub-Directorate for Public Health and Addictions of Gipuzkoa, Ministry of Health of the Basque Government, 20013 San Sebastian, Spain
- Epidemiology and Public Health Area, Biodonostia Health Research Institute, 20014 San Sebastian, Spain
| | - Catalina Bonet
- Unit of Nutrition and Cancer, Catalan Institute of Oncology—ICO, and Nutrition and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Bellvitge Biomedical Research Institute-IDIBELL, 08908 L’Hospitalet de Llobregat, Spain; (C.B.); (A.A.)
| | - Miguel Rodríguez-Barranco
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (D.G.); (P.A.); (M.R.-B.); (J.M.H.); (M.J.S.); (M.D.C.)
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain;
- Andalusian School of Public Health (EASP), 18011 Granada, Spain
| | - José María Huerta
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (D.G.); (P.A.); (M.R.-B.); (J.M.H.); (M.J.S.); (M.D.C.)
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, 30008 Murcia, Spain
| | - Luis Bujanda
- Department of Liver and Gastrointestinal Diseases, Biodonostia Health Research Institute, 20014 San Sebastian, Spain;
- Department of Gastroenterology, University of the Basque Country (UPV/EHU), 20018 San Sebastian, Spain
- Consortium for Biomedical Research in Hepatic and Digestive Diseases, CIBEREHD, 28029 Madrid, Spain
| | - María José Sánchez
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (D.G.); (P.A.); (M.R.-B.); (J.M.H.); (M.J.S.); (M.D.C.)
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18012 Granada, Spain;
- Andalusian School of Public Health (EASP), 18011 Granada, Spain
- Department of Preventive Medicine and Public Health, University of Granada, 18071 Granada, Spain
| | - María Dolores Chirlaque
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (D.G.); (P.A.); (M.R.-B.); (J.M.H.); (M.J.S.); (M.D.C.)
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, 30008 Murcia, Spain
- Departamento de Ciencias Sociosanitarias, Facultad de Medicina, Universidad de Murcia, 30100 Murcia, Spain
| | - Antonio Agudo
- Unit of Nutrition and Cancer, Catalan Institute of Oncology—ICO, and Nutrition and Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Bellvitge Biomedical Research Institute-IDIBELL, 08908 L’Hospitalet de Llobregat, Spain; (C.B.); (A.A.)
| | - Eva Ardanaz
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (E.M.); (E.A.); (J.C.)
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (D.G.); (P.A.); (M.R.-B.); (J.M.H.); (M.J.S.); (M.D.C.)
- Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain; (E.M.); (E.A.); (J.C.)
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain; (D.G.); (P.A.); (M.R.-B.); (J.M.H.); (M.J.S.); (M.D.C.)
- Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain
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15
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Colorado-Yohar SM, Castillo-González AC, Sánchez-Meca J, Rubio-Aparicio M, Sánchez-Rodríguez D, Salamanca-Fernández E, Ardanaz E, Amiano P, Fernández MF, Mendiola J, Navarro-Mateu F, Chirlaque MD. Concentrations of bisphenol-A in adults from the general population: A systematic review and meta-analysis. Sci Total Environ 2021; 775:145755. [PMID: 34132197 DOI: 10.1016/j.scitotenv.2021.145755] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 01/22/2021] [Accepted: 02/06/2021] [Indexed: 05/21/2023]
Abstract
BACKGROUND Human bisphenol-A (BPA) exposure has been linked to adverse health effects even at low doses, which may be of potential public health concern. OBJECTIVE To summarize BPA concentrations in general human population and their variability according to sex, geographic area, and analytical method. METHODS Systematic review and meta-analysis of studies reporting BPA concentrations in adult human populations. Separate meta-analyses of median values were carried out for BPA in serum, creatinine-adjusted urinary BPA, and unadjusted urinary BPA concentrations using a random-effects model. Cochran's Q-statistic, I2 index, 95% prediction intervals (PIs), between-studies standard deviation (τ), and forest plots were applied to verify study heterogeneity. Sensitivity and subgroup analyses and weighted ANOVAs and meta-regressions were conducted. Funnel plots and Egger's tests were used to examine publication bias. RESULTS Fifteen studies were included in the meta-analysis, totaling 28,353 participants. BPA was detected in over 90% of participants. The pooled creatinine-adjusted urinary BPA concentration was 1.76 μg/g (95% PI: 0.79-2.73), with individual estimates ranging between 1.20 and 2.41. The pooled estimate for unadjusted urinary BPA was 1.91 μg/l (95% PI: 0-3.97), ranging between 0.81 and 3.50, while the pooled estimate for serum BPA was 1.75 μg/l (95% PI: 0-10.58), ranging between 0.34 and 3.76. No differences were found by sex, geographic area or analytical technique. Larger sample sizes were associated with lower BPA concentrations. There was large heterogeneity across studies, whereas data for urinary BPA levels suggested a publication bias affecting research in low exposed populations. CONCLUSION This first meta-analysis of human BPA concentrations highlights a widespread population exposure to BPA. Although there was high heterogeneity across studies, the expected range of estimated human BPA concentrations suggests that potential health risks are unlikely. Further studies are warranted to better characterize the epidemiology of human BPA exposure, accounting for ethnic, geographic, individual and environmental variability.
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Affiliation(s)
- Sandra M Colorado-Yohar
- Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain; CIBER Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Research Group on Demography and Health, National Faculty of Public Health, University of Antioquia, Medellín, Colombia; Murcia Biomedical Research Institute (IMIB-Arrixaca), Murcia, Spain.
| | | | - Julio Sánchez-Meca
- Department of Basic Psychology and Methodology, University of Murcia, Murcia, Spain
| | | | | | - Elena Salamanca-Fernández
- Andalusian School of Public Health (EASP), Granada, Spain; Instituto de Investigación Biosanitaria de Granada, ibs, Granada, Spain
| | - Eva Ardanaz
- CIBER Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Navarra Public Health Institute, IdiSNA, Pamplona, Spain
| | - Pilar Amiano
- CIBER Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Public Health Division of Gipuzkoa, Basque Government, Donostia-San Sebastián, Spain; Biodonostia Health Research Institute, Donostia-San Sebastián, Spain
| | - Mariana F Fernández
- CIBER Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Instituto de Investigación Biosanitaria de Granada, ibs, Granada, Spain; Center for Biomedical Research (CIBM), University of Granada, Granada, Spain
| | - Jaime Mendiola
- CIBER Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Department of Health and Social Sciences, University of Murcia, Murcia, Spain; Murcia Biomedical Research Institute (IMIB-Arrixaca), Murcia, Spain
| | - Fernando Navarro-Mateu
- CIBER Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Department of Basic Psychology and Methodology, University of Murcia, Murcia, Spain; Murcia Biomedical Research Institute (IMIB-Arrixaca), Murcia, Spain; Unidad de Docencia, Investigación y Formación en Salud Mental, Servicio Murciano de Salud, Murcia, Spain
| | - María Dolores Chirlaque
- Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain; CIBER Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Department of Health and Social Sciences, University of Murcia, Murcia, Spain; Murcia Biomedical Research Institute (IMIB-Arrixaca), Murcia, Spain
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16
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Andreu-Reinón ME, Huerta JM, Gavrila D, Amiano P, Mar J, Tainta M, Ardanaz E, Larumbe R, Navarro C, Colorado-Yohar SM, Navarro-Mateu F, Chirlaque MD. Incidence of Dementia and Associated Factors in the EPIC-Spain Dementia Cohort. J Alzheimers Dis 2021; 78:543-555. [PMID: 33016917 DOI: 10.3233/jad-200774] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Dementia has become a public health priority as the number of cases continues to grow worldwide. OBJECTIVE To assess dementia incidence and determinants in the EPIC-Spain Dementia Cohort. METHODS 25,015 participants (57% women) were recruited from three Spanish regions between 1992-1996 and followed-up for over 20 years. Incident cases were ascertained through individual revision of medical records of potential cases. Crude and age-adjusted incidence rates (IR) of dementia and sub-types (Alzheimer's disease (AD), and non-AD) were calculated by sex. Neelson-Aalen cumulative incidence estimates at 10, 15, and 20 years were obtained for each sex and age group. Multivariate Royston-Parmar models were used to assess independent determinants. RESULTS Global IR were higher in women for dementia and AD, and similar by sex for non-AD. IR ranged from 0.09 cases of dementia (95% confidence interval: 0.06-0.13) and 0.05 (0.03-0.09) of AD per 1000 person-years (py) in participants below 60 years, to 23.2 (15.9-33.8) cases of dementia and 14.6 (9.1-33.5) of AD (per 1000 py) in those ≥85 years. Adjusted IR were consistently higher in women than men for overall dementia and AD. Up to 12.5% of women and 9.1% of men 60-65 years-old developed dementia within 20 years. Low education, diabetes, and hyperlipidemia were the main independent predictors of dementia risk, whereas alcohol showed an inverse association. CONCLUSION Dementia incidence increased with age and was higher among women, but showed no geographical pattern. Dementia risk was higher among subjects with lower education, not drinking alcohol, and presenting cardiovascular risk factors.
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Affiliation(s)
- María Encarnación Andreu-Reinón
- Section of Neurology, Department of Internal Medicine, Rafael Méndez Hospital, Murcia Health Service, Lorca, Murcia, Spain.,Murcia Biomedical Research Institute (IMIB-Arrixaca), Murcia, Spain
| | - José María Huerta
- Murcia Biomedical Research Institute (IMIB-Arrixaca), Murcia, Spain.,Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Diana Gavrila
- Murcia Biomedical Research Institute (IMIB-Arrixaca), Murcia, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Pilar Amiano
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Public Health Division of Gipuzkoa, Basque Government, Donostia-San Sebastián, Spain.,Biodonostia Health Research Institute, San Sebastián, Spain
| | - Javier Mar
- Biodonostia Health Research Institute, San Sebastián, Spain.,Clinical Management Unit, OSI Alto Deba, Arrasate-Mondragón, Spain.,AP-OSIs Gipuzkoa Research Unit, OSI Alto Deba, Arrasate-Mondragón, Spain.,Health Services Research Network on Chronic Patients (REDISSEC), Bilbao, Spain
| | - Mikel Tainta
- CITA Alzheimer Foundation, Donostia-San Sebastián, Spain.,Neurology Service, OSI Goierri-Alto Urola, Zumárraga, Spain
| | - Eva Ardanaz
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Public Health Institute of Navarra, IdiSNA, Pamplona, Spain
| | - Rosa Larumbe
- Public Health Institute of Navarra, IdiSNA, Pamplona, Spain.,Neuroepigenetics Laboratory, Navarrabiomed, Public University of Navarre (UPNA), Pamplona, Spain.,Department of Neurology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Carmen Navarro
- Murcia Biomedical Research Institute (IMIB-Arrixaca), Murcia, Spain.,Department of Health and Social Sciences, University of Murcia, Murcia, Spain
| | - Sandra M Colorado-Yohar
- Murcia Biomedical Research Institute (IMIB-Arrixaca), Murcia, Spain.,Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Research Group on Demography and Health, National Faculty of Public Health, University of Antioquia, Medellín, Colombia
| | - Fernando Navarro-Mateu
- Murcia Biomedical Research Institute (IMIB-Arrixaca), Murcia, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Unidad de Docencia, Investigación y Formación en Salud Mental (UDIF-SM). Servicio Murciano de Salud, Murcia, Spain
| | - María Dolores Chirlaque
- Murcia Biomedical Research Institute (IMIB-Arrixaca), Murcia, Spain.,Department of Epidemiology, Murcia Regional Health Council, 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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17
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Luque-Fernández MÁ, Redondo-Sánchez D, Fernández P, Salamanca-Fernández E, Marcos-Gragera R, Guevara M, Carulla Aresté M, Jiménez R, Núñez O, Sabater C, López de Munain Marqués A, Chirlaque MD, Mateos A, Rodríguez-Barranco M, Espín Balbino J, Pollán M, Sánchez MJ. [Study protocol on Socioeconomic and Geographic Inequalities in Cancer Incidence, Mortality and Survival in Spain: Multilevel Population-Base Study: DESOCANES study]. Gac Sanit 2021; 35:199-203. [PMID: 32674866 DOI: 10.1016/j.gaceta.2020.02.015] [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] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 02/25/2020] [Accepted: 02/27/2020] [Indexed: 11/30/2022]
Abstract
Incidence and mortality provide information on the burden of cancer morbidity and the potential years of life lost due to cancer. The Spanish Deprivation Index (SDI) has been developed as a standardized measure to study socioeconomic deprivation in Spain at the census tract level. In addition, SDI information can be combined with ecological variables at the population level and data from the High-Resolution European Studies in Cancer. The aim of this study is to characterize socioeconomic inequalities in incidence, excess mortality, premature mortality and net survival for three of the most incident cancers (lung, colon-rectum and breast) in Spain using the SDI. This national population-based study will assess the impact of socioeconomic inequalities using a multilevel modelling approach. Spatial analysis, multilevel modeling, net survival and economic impact assessment will be used. The results will be useful for supporting decision-making, planning, and management of public health interventions aimed at reducing the impact of socioeconomic inequalities in the diagnosis and prognosis of cancer patients in Spain.
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Affiliation(s)
- Miguel Ángel Luque-Fernández
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España
| | - Daniel Redondo-Sánchez
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Escuela Andaluza de Salud Pública, Granada, España.
| | - Pablo Fernández
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, España
| | - Elena Salamanca-Fernández
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, España; Escuela Andaluza de Salud Pública, Granada, España
| | - Rafael Marcos-Gragera
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Unitat d'Epidemiologia i Registre de Cáncer de Girona, Pla Director d'Oncologia, Departament de Salut, Generalitat de Catalunya, Institut Català de Oncologia, Girona, España; Instituto de Investigación Biomédica de Girona (IDIBGI), Grupo de Epidemiología. Descriptiva, Genética y Prevención del Cáncer, Girona, España
| | - Marcela Guevara
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Instituto de Salud Pública de Navarra, Pamplona, España; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, España
| | | | | | - Olivier Núñez
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, España
| | | | | | | | | | - Miguel Rodríguez-Barranco
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Escuela Andaluza de Salud Pública, Granada, España
| | - Jaime Espín Balbino
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Escuela Andaluza de Salud Pública, Granada, España
| | - Marina Pollán
- CIBER de Epidemiología y Salud Pública (CIBERESP), España; Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, España
| | - María-José Sánchez
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Escuela Andaluza de Salud Pública, Granada, España; Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, Granada, España
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18
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Andreu-Reinón ME, Chirlaque MD, Gavrila D, Amiano P, Mar J, Tainta M, Ardanaz E, Larumbe R, Colorado-Yohar SM, Navarro-Mateu F, Navarro C, Huerta JM. Mediterranean Diet and Risk of Dementia and Alzheimer's Disease in the EPIC-Spain Dementia Cohort Study. Nutrients 2021; 13:nu13020700. [PMID: 33671575 PMCID: PMC7927039 DOI: 10.3390/nu13020700] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/12/2021] [Accepted: 02/18/2021] [Indexed: 01/10/2023] Open
Abstract
The Mediterranean diet (MD) has shown to reduce the occurrence of several chronic diseases. To evaluate its potential protective role on dementia incidence we studied 16,160 healthy participants from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Spain Dementia Cohort study recruited between 1992-1996 and followed up for a mean (±SD) of 21.6 (±3.4) years. A total of 459 incident cases of dementia were ascertained through expert revision of medical records. Data on habitual diet was collected through a validated diet history method to assess adherence to the relative Mediterranean Diet (rMED) score. Hazard ratios (HR) of dementia by rMED levels (low, medium and high adherence levels: ≤6, 7-10 and ≥11 points, respectively) were estimated using multivariable Cox models, whereas time-dependent effects were evaluated using flexible parametric Royston-Parmar (RP) models. Results of the fully adjusted model showed that high versus low adherence to the categorical rMED score was associated with a 20% (HR = 0.80, 95%CI: 0.60-1.06) lower risk of dementia overall and HR of dementia was 8% (HR = 0.92, 0.85-0.99, p = 0.021) lower for each 2-point increment of the continuous rMED score. By sub-types, a favorable association was also found in women for non-AD (HR per 2-points = 0.74, 95%CI: 0.62-0.89), while not statistically significant in men for AD (HR per 2-points = 0.88, 0.76-1.01). The association was stronger in participants with lower education. In conclusion, in this large prospective cohort study MD was inversely associated with dementia incidence after accounting for major cardiovascular risk factors. The results differed by dementia sub-type, sex, and education but there was no significant evidence of effect modification.
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Affiliation(s)
- María Encarnación Andreu-Reinón
- Section of Neurology, Department of Internal Medicine, Rafael Méndez Hospital, Murcia Health Service, 30813 Lorca, Murcia, Spain
- Murcia Biomedical Research Institute (IMIB-Arrixaca), 30120 Murcia, Spain; (M.D.C.); (D.G.); (S.M.C.-Y.); (F.N.-M.); (C.N.); (J.M.H.)
- Correspondence: ; Tel.: +34-622-642-260; Fax: +34-968-44-24-21
| | - María Dolores Chirlaque
- Murcia Biomedical Research Institute (IMIB-Arrixaca), 30120 Murcia, Spain; (M.D.C.); (D.G.); (S.M.C.-Y.); (F.N.-M.); (C.N.); (J.M.H.)
- Department of Epidemiology, Murcia Regional Health Council, 30008 Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (P.A.); (E.A.)
- Department of Health and Social Sciences, University of Murcia, 30100 Murcia, Spain
| | - Diana Gavrila
- Murcia Biomedical Research Institute (IMIB-Arrixaca), 30120 Murcia, Spain; (M.D.C.); (D.G.); (S.M.C.-Y.); (F.N.-M.); (C.N.); (J.M.H.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (P.A.); (E.A.)
- Murcia Health Service, 30100 Murcia, Spain
| | - Pilar Amiano
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (P.A.); (E.A.)
- Public Health Division of Gipuzkoa, Basque Government, 20013 Donostia-San Sebastián, Spain
- Biodonostia Health Research Institute, 20014 San Sebastián, Spain;
| | - Javier Mar
- Biodonostia Health Research Institute, 20014 San Sebastián, Spain;
- Clinical Management Unit, OSI Alto Deba, 20500 Arrasate-Mondragón, Spain
- AP-OSIs Gipuzkoa Research Unit, OSI Alto Deba, 20500 Arrasate-Mondragón, Spain
- Health Services Research Network on Chronic Patients (REDISSEC), 48902 Bilbao, Spain
| | - Mikel Tainta
- CITA Alzheimer Foundation, 20019 Donostia-San Sebastián, Spain;
- Neurology Service, OSI Goierri-Alto Urola, 20700 Zumárraga, Spain
| | - Eva Ardanaz
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (P.A.); (E.A.)
- Public Health Institute of Navarra, IdiSNA, 31008 Pamplona, Spain;
| | - Rosa Larumbe
- Public Health Institute of Navarra, IdiSNA, 31008 Pamplona, Spain;
- Neuroepigenetics Laboratory, Navarrabiomed, Public University of Navarre (UPNA), 31008 Pamplona, Spain
- Department of Neurology, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain
| | - Sandra M. Colorado-Yohar
- Murcia Biomedical Research Institute (IMIB-Arrixaca), 30120 Murcia, Spain; (M.D.C.); (D.G.); (S.M.C.-Y.); (F.N.-M.); (C.N.); (J.M.H.)
- Department of Epidemiology, Murcia Regional Health Council, 30008 Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (P.A.); (E.A.)
- Research Group on Demography and Health, National Faculty of Public Health, University of Antioquia, Medellín 050010, Colombia
| | - Fernando Navarro-Mateu
- Murcia Biomedical Research Institute (IMIB-Arrixaca), 30120 Murcia, Spain; (M.D.C.); (D.G.); (S.M.C.-Y.); (F.N.-M.); (C.N.); (J.M.H.)
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (P.A.); (E.A.)
- Unidad de Docencia, Investigación y Formación en Salud Mental (UDIF-SM), Servicio Murciano de Salud, 30120 Murcia, Spain
| | - Carmen Navarro
- Murcia Biomedical Research Institute (IMIB-Arrixaca), 30120 Murcia, Spain; (M.D.C.); (D.G.); (S.M.C.-Y.); (F.N.-M.); (C.N.); (J.M.H.)
- Department of Health and Social Sciences, University of Murcia, 30100 Murcia, Spain
| | - José María Huerta
- Murcia Biomedical Research Institute (IMIB-Arrixaca), 30120 Murcia, Spain; (M.D.C.); (D.G.); (S.M.C.-Y.); (F.N.-M.); (C.N.); (J.M.H.)
- Department of Epidemiology, Murcia Regional Health Council, 30008 Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain; (P.A.); (E.A.)
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19
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De Salazar PM, Lu F, Hay JA, Gómez-Barroso D, Fernández-Navarro P, Martínez E, Astray-Mochales J, Amillategui R, García-Fulgueiras A, Chirlaque MD, Sánchez-Migallón A, Larrauri A, Sierra MJ, Lipsitch M, Simón F, Santillana M, Hernán MA. Near real-time surveillance of the SARS-CoV-2 epidemic with incomplete data. medRxiv 2021:2021.01.25.20230094. [PMID: 33532788 PMCID: PMC7852239 DOI: 10.1101/2021.01.25.20230094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Designing public health responses to outbreaks requires close monitoring of population-level health indicators in real-time. Thus, an accurate estimation of the epidemic curve is critical. We propose an approach to reconstruct epidemic curves in near real time. We apply this approach to characterize the early SARS-CoV-2 outbreak in two Spanish regions between March and April 2020. We address two data collection problems that affected the reliability of the available real-time epidemiological data, namely, the frequent missing information documenting when a patient first experienced symptoms, and the frequent retrospective revision of historical information (including right censoring). This is done by using a novel back-calculating procedure based on imputing patients' dates of symptom onset from reported cases, according to a dynamically-estimated "backward" reporting delay conditional distribution, and adjusting for right censoring using an existing package, NobBS , to estimate in real time (nowcast) cases by date of symptom onset. This process allows us to obtain an approximation of the time-varying reproduction number ( R t ) in real-time. At each step, we evaluate how different assumptions affect the recovered epidemiological events and compare the proposed approach to the alternative procedure of merely using curves of case counts, by report day, to characterize the time-evolution of the outbreak. Finally, we assess how these real-time estimates compare with subsequently documented epidemiological information that is considered more reliable and complete that became available later in time. Our approach may help improve accuracy, quantify uncertainty, and evaluate frequently unstated assumptions when recovering the epidemic curves from limited data obtained from public health surveillance systems in other locations.
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Affiliation(s)
- PM De Salazar
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, United States
| | - F Lu
- Machine Intelligence Lab, Boston Children’s Hospital, Boston, United States
- Computational Health Informatics Program, Boston Children’s Hospital, Boston, United States
| | - JA Hay
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, United States
| | - D Gómez-Barroso
- Centro Nacional de Epidemiología, Carlos III Health Institute, Madrid, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)
| | - P Fernández-Navarro
- Centro Nacional de Epidemiología, Carlos III Health Institute, Madrid, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)
| | - E Martínez
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)
- Centro de Coordinación de Alertas y Emergencias Sanitarias, Ministry of Health, Madrid, Spain
| | - J Astray-Mochales
- Directorate-General for Public Health, Madrid General Health Authority, Spain
| | - R Amillategui
- Centro Nacional de Epidemiología, Carlos III Health Institute, Madrid, Spain
| | - A García-Fulgueiras
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia, Spain CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - MD Chirlaque
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia, Spain CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - A Sánchez-Migallón
- Directorate-General for Public Health, Madrid General Health Authority, Spain
| | - A Larrauri
- Computational Health Informatics Program, Boston Children’s Hospital, Boston, United States
- Centro Nacional de Epidemiología, Carlos III Health Institute, Madrid, Spain
| | - MJ Sierra
- Centro de Coordinación de Alertas y Emergencias Sanitarias, Ministry of Health, Madrid, Spain
| | - M Lipsitch
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, United States
| | - F Simón
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)
- Centro de Coordinación de Alertas y Emergencias Sanitarias, Ministry of Health, Madrid, Spain
| | - M Santillana
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, United States
- Machine Intelligence Lab, Boston Children’s Hospital, Boston, United States
- Computational Health Informatics Program, Boston Children’s Hospital, Boston, United States
- Department of Pediatrics, Harvard Medical School, Harvard University, Boston, United States
| | - MA Hernán
- Department of Epidemiology and Department of Biostatistics, Harvard T.H. Chan School of Public Health; Harvard-MIT Division of Health Sciences and Technology, Boston, United States
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20
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García-Pérez J, Fernández de Larrea-Baz N, Lope V, Molina AJ, O'Callaghan-Gordo C, Alonso MH, Rodríguez-Suárez MM, Mirón-Pozo B, Alguacil J, Gómez-Acebo I, Ascunce N, Vanaclocha-Espi M, Amiano P, Chirlaque MD, Simó V, Jiménez-Moleón JJ, Tardón A, Moreno V, Castaño-Vinyals G, Martín V, Aragonés N, Pérez-Gómez B, Kogevinas M, Pollán M. Residential proximity to industrial pollution sources and colorectal cancer risk: A multicase-control study (MCC-Spain). Environ Int 2020; 144:106055. [PMID: 32827807 DOI: 10.1016/j.envint.2020.106055] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/16/2020] [Accepted: 08/08/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Colorectal cancer is the third most frequent tumor in males and the second in females worldwide. In Spain, it is an important and growing health problem, and epidemiologic research focused on potential risk factors, such as environmental exposures, is necessary. OBJECTIVES To analyze the association between colorectal cancer risk and residential proximity to industries, according to pollution discharge route, industrial groups, categories of carcinogens and other toxic substances, and specific pollutants released, in the context of a population-based multicase-control study of incident cancer carried out in Spain (MCC-Spain). METHODS MCC-Spain included 557 colorectal cancer cases and 2948 controls in 11 provinces, frequency matched by sex, age, and region of residence. Distances were computed from subjects' residences to each of the 134 industries located in the study area. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95%CIs) for categories of distance (from 1 km to 3 km) to industrial facilities, adjusting for matching variables and other confounders. RESULTS Excess risk (OR; 95%CI) of colorectal cancer was detected near industries overall for all distances analyzed, from 1 km (2.03; 1.44-2.87) to 3 km (1.26; 1.00-1.59). In general, industries releasing pollutants to air showed higher excess risks than facilities releasing pollution to water. By industrial sector, excess risk (OR; 95%CI) was found near (≤3 km) production of metals (2.66; 1.77-4.00), surface treatment of metals (1.48; 1.08-2.02), glass and mineral fibers (2.06; 1.39-3.07), organic chemical industry (4.80; 3.20-7.20), inorganic chemical industry (6.74; 4.38-10.36), food/beverage sector (3.34; 2.38-4.68), and surface treatment using organic solvents (6.16; 4.06-9.36). By pollutants, the main excess risks (OR; 95%CI) were found near (≤3 km) industries releasing nonylphenol (9.19; 5.91-14.28), antimony (5.30; 3.45-8.15), naphthalene (3.11; 2.16-4.49), organotin compounds (2.64; 1.76-3.98), manganese (2.53; 1.63-3.93), dichloromethane (2.52; 1.74-3.66), and vanadium (2.49; 1.59-3.91). CONCLUSIONS Our results support the hypothesis that residing in the proximity of industries may be a risk factor for colorectal cancer.
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Affiliation(s)
- Javier García-Pérez
- Cancer and Environmental Epidemiology Unit, Department of Epidemiology and Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Avda. Monforte de Lemos 5, 28029 Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Av. de Monforte de Lemos 3-5, 28029 Madrid, Spain.
| | - Nerea Fernández de Larrea-Baz
- Cancer and Environmental Epidemiology Unit, Department of Epidemiology and Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Avda. Monforte de Lemos 5, 28029 Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Av. de Monforte de Lemos 3-5, 28029 Madrid, Spain.
| | - Virginia Lope
- Cancer and Environmental Epidemiology Unit, Department of Epidemiology and Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Avda. Monforte de Lemos 5, 28029 Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Av. de Monforte de Lemos 3-5, 28029 Madrid, Spain.
| | - Antonio J Molina
- The Research Group in Gene - Environment and Health Interactions (GIIGAS)/Institute of Biomedicine (IBIOMED), Universidad de León, Campus Universitario de Vegazana, 24071 León, Spain; Faculty of Health Sciences, Department of Biomedical Sciences, Area of Preventive Medicine and Public Health, Universidad de León, Campus Universitario de Vegazana, 24071 León, Spain.
| | - Cristina O'Callaghan-Gordo
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Av. de Monforte de Lemos 3-5, 28029 Madrid, Spain; Faculty of Health Sciences, Universitat Oberta de Catalunya, Rambla de Poblenou 156, 08018 Barcelona, Spain; Institute of Global Health (ISGlobal), Carrer del Rosselló 132, 08036 Barcelona, Spain; Universitat Pompeu Fabra (UPF), Campus del Mar, Carrer del Dr. Aiguader 80, 08003 Barcelona, Spain.
| | - María Henar Alonso
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Av. de Monforte de Lemos 3-5, 28029 Madrid, Spain; Unit of Biomarkers and Susceptibility, Oncology Data Analytics Program, Catalan Institute of Oncology (ICO), Hospital Duran i Reynals, Avinguda de la Gran Via de l'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Colorectal Cancer Group, ONCOBELL Program, Bellvitge Biomedical Research Institute (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Carrer de Casanova 143, 08036 Barcelona, Spain.
| | - Marta María Rodríguez-Suárez
- Hospital Universitario Central de Asturias (HUCA), Av. Roma s/n, 33011 Oviedo, Spain; Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain; Public Health Department, Universidad de Oviedo, 33003 Oviedo, Spain
| | - Benito Mirón-Pozo
- Service of Surgery, Hospital Universitario Clínico San Cecilio, Av. del Conocimiento s/n, 18016 Granada, Spain.
| | - Juan Alguacil
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Av. de Monforte de Lemos 3-5, 28029 Madrid, Spain; Centro de Investigación en Recursos Naturales, Salud y Medio Ambiente (RENSMA), Universidad de Huelva, Campus Universitario de El Carmen, 21071 Huelva, Spain.
| | - Inés Gómez-Acebo
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Av. de Monforte de Lemos 3-5, 28029 Madrid, Spain; Universidad de Cantabria - IDIVAL, Avenida Cardenal Herrera Oria s/n, 39011 Santander, Spain.
| | - Nieves Ascunce
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Av. de Monforte de Lemos 3-5, 28029 Madrid, Spain; Navarra Public Health Institute, Calle Leyre, 15, 31003 Pamplona, Navarra; IdiSNA, Navarra Institute for Health Research, Calle Leyre 15, 31003 Pamplona, Spain.
| | - Mercedes Vanaclocha-Espi
- Cancer and Public Health Area, FISABIO - Public Health, Avda. de Catalunya 21, 46020 Valencia, Spain.
| | - Pilar Amiano
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Av. de Monforte de Lemos 3-5, 28029 Madrid, Spain; Public Health Division of Gipuzkoa, Biodonostia Health Research Institute, Ministry of Health of the Basque Government, Paseo Dr. Beguiristain s/n, 20014 San Sebastian, Spain.
| | - María Dolores Chirlaque
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Av. de Monforte de Lemos 3-5, 28029 Madrid, Spain; Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia University, Campus de Ciencias de la Salud, Carretera Buenavista s/n, 30120 El Palmar, Murcia, Spain.
| | - Vicente Simó
- Department of General Surgery, León University Hospital (CAULE), Altos de Nava s/n, 24071 León, Spain.
| | - José J Jiménez-Moleón
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Av. de Monforte de Lemos 3-5, 28029 Madrid, Spain; Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, Av. de la Investigación 11, 18016 Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Doctor Azpitarte 4 4ª Planta, Edificio Licinio de la Fuente, 18012 Granada, Spain.
| | - Adonina Tardón
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Av. de Monforte de Lemos 3-5, 28029 Madrid, Spain; Instituto Universitario de Oncología (IUOPA), Universidad de Oviedo, Facultad de Medicina, Campus de El Cristo B, 33006 Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Av. Roma s/n, 33011 Oviedo, Spain.
| | - Víctor Moreno
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Av. de Monforte de Lemos 3-5, 28029 Madrid, Spain; Unit of Biomarkers and Susceptibility, Oncology Data Analytics Program, Catalan Institute of Oncology (ICO), Hospital Duran i Reynals, Avinguda de la Gran Via de l'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Colorectal Cancer Group, ONCOBELL Program, Bellvitge Biomedical Research Institute (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Carrer de Casanova 143, 08036 Barcelona, Spain.
| | - Gemma Castaño-Vinyals
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Av. de Monforte de Lemos 3-5, 28029 Madrid, Spain; Institute of Global Health (ISGlobal), Carrer del Rosselló 132, 08036 Barcelona, Spain; Universitat Pompeu Fabra (UPF), Campus del Mar, Carrer del Dr. Aiguader 80, 08003 Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Carrer del Dr. Aiguader 88, 08003 Barcelona, Spain.
| | - Vicente Martín
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Av. de Monforte de Lemos 3-5, 28029 Madrid, Spain; The Research Group in Gene - Environment and Health Interactions (GIIGAS)/Institute of Biomedicine (IBIOMED), Universidad de León, Campus Universitario de Vegazana, 24071 León, Spain; Faculty of Health Sciences, Department of Biomedical Sciences, Area of Preventive Medicine and Public Health, Universidad de León, Campus Universitario de Vegazana, 24071 León, Spain.
| | - Nuria Aragonés
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Av. de Monforte de Lemos 3-5, 28029 Madrid, Spain; Epidemiology Section, Public Health Division, Department of Health of Madrid, C/San Martín de Porres, 6, 28035 Madrid, Spain.
| | - Beatriz Pérez-Gómez
- Cancer and Environmental Epidemiology Unit, Department of Epidemiology and Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Avda. Monforte de Lemos 5, 28029 Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Av. de Monforte de Lemos 3-5, 28029 Madrid, Spain.
| | - Manolis Kogevinas
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Av. de Monforte de Lemos 3-5, 28029 Madrid, Spain; Institute of Global Health (ISGlobal), Carrer del Rosselló 132, 08036 Barcelona, Spain; Universitat Pompeu Fabra (UPF), Campus del Mar, Carrer del Dr. Aiguader 80, 08003 Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Carrer del Dr. Aiguader 88, 08003 Barcelona, Spain.
| | - Marina Pollán
- Cancer and Environmental Epidemiology Unit, Department of Epidemiology and Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Avda. Monforte de Lemos 5, 28029 Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Av. de Monforte de Lemos 3-5, 28029 Madrid, Spain.
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21
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Salamanca-Fernández E, Rodríguez-Barranco M, Arrebola JP, Vela F, Díaz C, Chirlaque MD, Colorado-Yohar S, Jiménez-Zabala A, Irizar A, Guevara M, Ardanaz E, Iribarne-Durán LM, Pérez Del Palacio J, Olea N, Agudo A, Sánchez MJ. Bisphenol-A in the European Prospective Investigation into Cancer and Nutrition cohort in Spain: Levels at recruitment and associated dietary factors. Environ Res 2020; 182:109012. [PMID: 31837551 DOI: 10.1016/j.envres.2019.109012] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/26/2019] [Accepted: 12/05/2019] [Indexed: 06/10/2023]
Abstract
Bisphenol A (BPA) is considered an endocrine disruptor and it is present in numerous products of daily use. The aim of this study was to analyze serum BPA concentrations in a subcohort of the Spanish European Prospective Investigation into Cancer and Nutrition (EPIC), as well as to identify potential predictors of the exposure. The population consisted on 3553 subjects from 4 EPIC-Spain centres and BPA levels were measured in serum samples by UHPLC-MS/MS. Almost 70% of the participants showed detectable BPA values (>0.2 ng/ml), with a geometric mean of 1.19 ng/ml (95% CI: 1.12-1.25). By sex, detectable percentages were similar (p = 0.56) but with higher serum levels in men (1.27 vs 1.11 ng/ml, p = 0.01). Based on the adjusted regression models, a 50 g/day increase in the consumption of added fats and oils were associated with 43% lower BPA serum levels, while sugar and confectionary was associated with 25% higher levels of serum BPA. We evidenced differential exposure levels by province, sex and age, but not by anthropometric or lifestyle characteristics. Further investigation is needed to understand the influence of diet in BPA exposure.
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Affiliation(s)
- Elena Salamanca-Fernández
- Andalusian School of Public Health (EASP). Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA. Granada, Spain
| | - Miguel Rodríguez-Barranco
- Andalusian School of Public Health (EASP). Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA. Granada, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP). Madrid, Spain.
| | - Juan Pedro Arrebola
- Instituto de Investigación Biosanitaria ibs.GRANADA. Granada, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP). Madrid, Spain; Department of Public Health, School of Medicine, University of Granada. Granada, Spain
| | - Fernando Vela
- Instituto de Investigación Biosanitaria ibs.GRANADA. Granada, Spain
| | - Caridad Díaz
- MEDINA Foundation, Center of Excellence in Research into Innovative Medicines in Andalusia, Technology Park of Health Sciences, Granada, Spain
| | - María Dolores Chirlaque
- CIBER de Epidemiología y Salud Pública (CIBERESP). Madrid, Spain; Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain; Department of Health and Social Sciences, University of Murcia, Spain
| | - Sandra Colorado-Yohar
- CIBER 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
| | - Ana Jiménez-Zabala
- CIBER de Epidemiología y Salud Pública (CIBERESP). Madrid, Spain; Public Health Division of Gipuzkoa, Basque Government, Avenida Navarra No 4, 20013, San Sebastián, Gipuzkoa, Spain; Health Research Institute, Biodonostia, San Sebastián, Spain
| | - Amaia Irizar
- Health Research Institute, Biodonostia, San Sebastián, Spain
| | - Marcela Guevara
- CIBER de Epidemiología y Salud Pública (CIBERESP). Madrid, Spain; Navarra Public Health Institute, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Eva Ardanaz
- CIBER de Epidemiología y Salud Pública (CIBERESP). Madrid, Spain; Navarra Public Health Institute, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Luz María Iribarne-Durán
- Instituto de Investigación Biosanitaria ibs.GRANADA. Granada, Spain; Department of Radiology, School of Medicine, University of Granada. Granada, Spain
| | - José Pérez Del Palacio
- MEDINA Foundation, Center of Excellence in Research into Innovative Medicines in Andalusia, Technology Park of Health Sciences, Granada, Spain
| | - Nicolás Olea
- Instituto de Investigación Biosanitaria ibs.GRANADA. Granada, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP). Madrid, Spain; Department of Radiology, School of Medicine, University of Granada. Granada, Spain
| | - Antonio Agudo
- Unit of Nutrition and Cancer, Catalan Institute of Oncology - ICO, Nutrition and Cancer Group, Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, Barcelona 08908, Spain
| | - Maria-José Sánchez
- Andalusian School of Public Health (EASP). Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA. Granada, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP). Madrid, Spain; Universidad de Granada. Granada, Spain
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22
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Solans M, Benavente Y, Saez M, Agudo A, Jakszyn P, Naudin S, Hosnijeh FS, Gunter M, Huybrechts I, Ferrari P, Besson C, Mahamat-Saleh Y, Boutron-Ruault MC, Kühn T, Kaaks R, Boeing H, Lasheras C, Sánchez MJ, Amiano P, Chirlaque MD, Ardanaz E, Schmidt JA, Vineis P, Riboli E, Trichopoulou A, Karakatsani A, Valanou E, Masala G, Agnoli C, Tumino R, Sacerdote C, Mattiello A, Skeie G, Weiderpass E, Jerkeman M, Dias JA, Späth F, Nilsson LM, Dahm CC, Overvad K, Petersen KEN, Tjønneland A, de Sanjose S, Vermeulen R, Nieters A, Casabonne D. Inflammatory potential of diet and risk of lymphoma in the European Prospective Investigation into Cancer and Nutrition. Eur J Nutr 2020; 59:813-823. [PMID: 30903361 DOI: 10.1007/s00394-019-01947-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 03/11/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Chronic inflammation plays a critical role in lymphomagenesis and several dietary factors seem to be involved its regulation. The aim of the current study was to assess the association between the inflammatory potential of the diet and the risk of lymphoma and its subtypes in the European Investigation into Cancer and Nutrition (EPIC) study. METHODS The analysis included 476,160 subjects with an average follow-up of 13.9 years, during which 3,136 lymphomas (135 Hodgkin lymphoma (HL), 2606 non-Hodgkin lymphoma (NHL) and 395 NOS) were identified. The dietary inflammatory potential was assessed by means of an inflammatory score of the diet (ISD), calculated using 28 dietary components and their corresponding inflammatory weights. The association between the ISD and lymphoma risk was estimated by hazard ratios (HR) and 95% confidence intervals (CI) calculated by multivariable Cox regression models adjusted for potential confounders. RESULTS The ISD was not associated with overall lymphoma risk. Among lymphoma subtypes, a positive association between the ISD and mature B-cell NHL (HR for a 1-SD increase: 1.07 (95% CI 1.01; 1.14), p trend = 0.03) was observed. No statistically significant association was found among other subtypes. However, albeit with smaller number of cases, a suggestive association was observed for HL (HR for a 1-SD increase = 1.22 (95% CI 0.94; 1.57), p trend 0.13). CONCLUSIONS Our findings suggested that a high ISD score, reflecting a pro-inflammatory diet, was modestly positively associated with the risk of B-cell lymphoma subtypes. Further large prospective studies on low-grade inflammation induced by diet are warranted to confirm these findings.
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Affiliation(s)
- Marta Solans
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
- Epidemiology Unit and Girona Cancer Registry, Catalan Institute of Oncology, Girona, Spain
| | - Yolanda Benavente
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Unit of Molecular and Genetic Epidemiology in Infections and Cancer, Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology (ICO-IDIBELL), Av. Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
| | - Marc Saez
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
| | - Antonio Agudo
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - Paula Jakszyn
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - Sabine Naudin
- Nutritional Methodology and Biostatistics Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Fatemeh Saberi Hosnijeh
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
- Immunology Department, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marc Gunter
- Nutritional Epidemiology Group (NEP), International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Inge Huybrechts
- Nutritional Epidemiology Group (NEP), International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Pietro Ferrari
- Nutritional Methodology and Biostatistics Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Caroline Besson
- Department of Hematology and Oncology, Hospital of Versailles, Le Chesnay, France
- CESP, Fac. de médecine-Univ. Paris-Sud, Fac. de médecine-UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Yahya Mahamat-Saleh
- CESP, Fac. de médecine-Univ. Paris-Sud, Fac. de médecine-UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Marie-Christine Boutron-Ruault
- CESP, Fac. de médecine-Univ. Paris-Sud, Fac. de médecine-UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Tilman Kühn
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition (DIfE) Postdam-Rehbrücke, Nuthetal, Germany
| | | | - Maria-Jose Sánchez
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain
| | - Pilar Amiano
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Public Health Division of Gipuzkoa, Regional Government of the Basque Country, Donostia, Spain
| | - María Dolores Chirlaque
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
| | - Eva Ardanaz
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Navarra Public Health Institute, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Julie A Schmidt
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Paolo Vineis
- Department of Epidemiology and Biostatistics, MRC-HPA Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Elio Riboli
- School of Public Health, Imperial College London, London, UK
| | | | - Anna Karakatsani
- Hellenic Health Foundation, Athens, Greece
- Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, "ATTIKON" University Hospital, Haidari, Greece
| | | | - Giovanna Masala
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network-ISPRO, 50141, Florence, Italy
| | - Claudia Agnoli
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, "Civic-M. P. Arezzo" Hospital, ASP, Ragusa, Ragusa, Italy
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy
| | - Amalia Mattiello
- Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy
| | - Guri Skeie
- Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Elisabete Weiderpass
- Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
- Department of Research, Cancer Registry of Norway-Institute of Population-Based Cancer Research, Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Genetic Epidemiology Group, Folkhälsan Research Center, Faculty of Medicine, Helsinki University, Helsinki, Finland
| | - Mats Jerkeman
- Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Joana Alves Dias
- Department of Clinical Sciences, Research Group in Nutritional Epidemiology, Lund University, Malmö, Sweden
| | - Florentin Späth
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Lena Maria Nilsson
- Public Health and Clinical Medicine, Nutritional Research and Arctic Research Centre, Umeå University, Umeå, Sweden
| | - Christina C Dahm
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Kim Overvad
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Anne Tjønneland
- Unit of Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Silvia de Sanjose
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Unit of Molecular and Genetic Epidemiology in Infections and Cancer, Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology (ICO-IDIBELL), Av. Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
- PATH, Reproductive Health, Seattle, USA
| | - Roel Vermeulen
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Alexandra Nieters
- Center for Chronic Immunodeficiency (CCI), Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Delphine Casabonne
- Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
- Unit of Molecular and Genetic Epidemiology in Infections and Cancer, Cancer Epidemiology Research Programme, IDIBELL, Catalan Institute of Oncology (ICO-IDIBELL), Av. Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain.
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23
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O'Callaghan-Gordo C, Espinosa A, Valentin A, Tonne C, Pérez-Gómez B, Castaño-Vinyals G, Dierssen-Sotos T, Moreno-Iribas C, de Sanjose S, Fernandez-Tardón G, Vanaclocha-Espi M, Chirlaque MD, Cirach M, Aragonés N, Gómez-Acebo I, Ardanaz E, Moreno V, Pollan M, Bustamante M, Nieuwenhuijsen MJ, Kogevinas M. Green spaces, excess weight and obesity in Spain. Int J Hyg Environ Health 2020; 223:45-55. [DOI: 10.1016/j.ijheh.2019.10.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 10/17/2019] [Accepted: 10/18/2019] [Indexed: 12/19/2022]
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24
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Navarro-Mateu F, Rubio-Aparicio M, Cayuela P, Álvarez FJ, Roca-Vega A, Chirlaque MD, Cayuela ML, Husky M, Martínez S, Sánchez-Meca J. The association of telomere length with substance use disorders: systematic review and meta-analysis protocol. Syst Rev 2019; 8:298. [PMID: 31787100 PMCID: PMC6886210 DOI: 10.1186/s13643-019-1199-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 10/15/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The present protocol was designed for a systematic review and meta-analysis aimed at determining the association of telomere length with substance use disorders with the exclusion of nicotine addiction, and to identify potential moderators of the effect of telomere length. Such methodological information may provide guidance to improve the quality of future research on this important topic. METHODS Potential studies will be identified through electronic databases (PubMed/MEDLINE, EMBASE, PsycINFO, and Web of Science) up from inception onwards. The inclusion criteria will include published or unpublished observational studies (cohort, case-control, and cross-sectional studies) reporting telomere length in adult patients with substance use disorder compared with a control group. Non-human studies or other study designs such as reviews, case-only, family-based, and/or population studies with only healthy participants will be excluded, as well as those focused solely on nicotine addiction. The main outcome will be telomere length in adults with substance use disorder (primary) and, specifically, in those with alcohol use disorder (secondary). Two investigators will independently evaluate the preselected studies for possible inclusion and will extract data following a standardized protocol. Disagreements will be resolved by consensus. The risk of bias of all included studies will be assessed using the Newcastle-Ottawa Quality Assessment Scale for non-randomized studies. Data will be converted into standardized mean differences as effect size index, and random-effects models will be used for the meta-analysis. Cochran's Q statistic, I2 index, and visual inspection of the forest plot will be used to verify study heterogeneity. Subgroup analyses and meta-regressions will be conducted to ascertain heterogeneity. Several sensitivity analyses will be conducted to address the influence of potential confounding factors. Publication bias will be examined using the "funnel plot" method with Duval and Tweedie's trim-and-fill method and Egger test. DISCUSSION This systematic review will assess the association of telomere length with substance use disorders aside from nicotine addiction. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number CRD42019119785.
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Affiliation(s)
- Fernando Navarro-Mateu
- Unidad de Docencia, Investigación y Formación en Salud Mental (UDIF-SM), Servicio Murciano de Salud, c/ Lorca, n° 58, 30120, Murcia, Spain. .,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. .,IMIB-Arrixaca, Murcia, Spain. .,Departamento de Psicología Básica y Metodología, University of Murcia, Murcia, Spain.
| | | | - Pedro Cayuela
- Escuela Universitaria de Enfermería de Cartagena, University of Murcia, Murcia, Spain
| | - Francisco-Javier Álvarez
- Unidad de Docencia, Investigación y Formación en Salud Mental (UDIF-SM), Servicio Murciano de Salud, c/ Lorca, n° 58, 30120, Murcia, Spain
| | - Agustín Roca-Vega
- Biblioteca Virtual MurciaSalud, Centro Tecnológico de Información y Documentación Sanitaria, Servicio Murciano de Salud, Murcia, Spain
| | - María Dolores Chirlaque
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,IMIB-Arrixaca, Murcia, Spain.,Servicio de Epidemiología, Consejería de Salud, Murcia, Spain.,Departamento de Ciencias Sociosanitarias, University of Murcia, Murcia, Spain
| | - María Luisa Cayuela
- IMIB-Arrixaca, Murcia, Spain.,Grupo Telomerasa, Cáncer y Envejecimiento, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Mathilde Husky
- Laboratoire de Psychologie EA4139, Université de Bordeaux, Bordeaux, France
| | | | - Julio Sánchez-Meca
- Departamento de Psicología Básica y Metodología, University of Murcia, Murcia, Spain
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25
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Cirera L, Huerta JM, Chirlaque MD, Overvad K, Lindström M, Regnér S, Tjønneland A, Boutron-Ruault MC, Rebours V, Fagherazzi G, Katzke VA, Boeing H, Peppa E, Trichopoulou A, Valanou E, Palli D, Grioni S, Panico S, Tumino R, Ricceri F, van Gils C, Vermeulen RCH, Skeie G, Braaten T, Weiderpass E, Merino S, Sánchez MJ, Larrañaga N, Ardanaz E, Sund M, Khaw KT, Key TJ, Jenab M, Naudin S, Murphy N, Aune D, Ward H, Riboli E, Bueno-de-Mesquita B, Navarro C, Duell EJ. Socioeconomic Effect of Education on Pancreatic Cancer Risk in Western Europe: An Update on the EPIC Cohorts Study. Cancer Epidemiol Biomarkers Prev 2019; 28:1089-1092. [PMID: 31160392 DOI: 10.1158/1055-9965.epi-18-1153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 03/05/2019] [Accepted: 03/07/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To analyze the potential effect of social inequality on pancreatic cancer risk in Western Europe, by reassessing the association within the European Prospective Investigation into Cancer and Nutrition (EPIC) Study, including a larger number of cases and an extended follow-up. METHODS Data on highest education attained were gathered for 459,170 participants (70% women) from 10 European countries. A relative index of inequality (RII) based on adult education was calculated for comparability across countries and generations. Cox regression models were applied to estimate relative inequality in pancreatic cancer risk, stratifying by age, gender, and center, and adjusting for known pancreatic cancer risk factors. RESULTS A total of 1,223 incident pancreatic cancer cases were included after a mean follow-up of 13.9 (±4.0) years. An inverse social trend was found in models adjusted for age, sex, and center for both sexes [HR of RII, 1.27; 95% confidence interval (CI), 1.02-1.59], which was also significant among women (HR, 1.42; 95% CI, 1.05-1.92). Further adjusting by smoking intensity, alcohol consumption, body mass index, prevalent diabetes, and physical activity led to an attenuation of the RII risk and loss of statistical significance. CONCLUSIONS The present reanalysis does not sustain the existence of an independent social inequality influence on pancreatic cancer risk in Western European women and men, using an index based on adult education, the most relevant social indicator linked to individual lifestyles, in a context of very low pancreatic cancer survival from (quasi) universal public health systems. IMPACT The results do not support an association between education and risk of pancreatic cancer.
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Affiliation(s)
- Lluís Cirera
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain. .,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Department of Health and Social Sciences, University of Murcia, Murcia, Spain
| | - José María Huerta
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - María Dolores Chirlaque
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Department of Health and Social Sciences, University of Murcia, Murcia, Spain
| | - Kim Overvad
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Martin Lindström
- Department of Clinical Sciences, Social Medicine and Health Policy, Lund University, Malmö, Sweden
| | - Sara Regnér
- Department of Clinical Sciences, Social Medicine and Health Policy, Lund University, Malmö, Sweden
| | - Anne Tjønneland
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marie-Christine Boutron-Ruault
- CESP, Faculté de Médecine - Université Paris-Sud, Faculté de Médecine - UVSQ, INSERM, Université Paris-Saclay, Villejuif, France.,Gustave Roussy Institute, Villejuif, France
| | - Vinciane Rebours
- Pancreatology Unit, Beaujon Hospital, Clichy, France.,INSERM - UMR 1149, University Paris 7, France
| | - Guy Fagherazzi
- CESP, Faculté de Médecine - Université Paris-Sud, Faculté de Médecine - UVSQ, INSERM, Université Paris-Saclay, Villejuif, France.,Gustave Roussy Institute, Villejuif, France
| | | | - Heiner Boeing
- Department of Epidemiology German Institute of Human Nutrition (DIfE), Potsdam-Rehbrücke, Germany
| | | | | | | | - Domenico Palli
- Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network - ISPRO, Florence, Italy
| | - Sara Grioni
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Salvatore Panico
- Dipartimento di Medicina Clinica e Chirurgia, Federico ii University, Naples, Italy
| | - Rosario Tumino
- Department of Cancer Registry and Histopathology, "Civic - M.P. Arezzo" Hospital, ASP Ragusa, Italy
| | - Fulvio Ricceri
- Department of Clinical and Biological Sciences, University of Turin, Italy.,Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco (TO), Italy
| | - Carla van Gils
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Roel C H Vermeulen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.,Environmental Epidemiology Division, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Guri Skeie
- Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Tonje Braaten
- Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Elisabete Weiderpass
- Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.,Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Genetic Epidemiology Group, Folkhälsan Research Center, and Faculty of Medicine, Helsinki University, Helsinki, Finland
| | - Susana Merino
- Public Health Directorate, Regional Government of Asturias, Oviedo, Spain
| | - María José Sánchez
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - Nerea Larrañaga
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Public Health Division of Gipuzkoa, Regional Government of the Basque Country, Donostia, Spain
| | - Eva Ardanaz
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Navarra Public Health Institute, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Malin Sund
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Kay-Tee Khaw
- University of Cambridge, School of Clinical Medicine Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Timothy J Key
- Nuffield Department of Population Health, Cancer Epidemiology Unit, University of Oxford, Oxford, United Kingdom
| | - Mazda Jenab
- Section of Nutrition and Metabolism, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Sabine Naudin
- Section of Nutrition and Metabolism, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Neil Murphy
- Section of Nutrition and Metabolism, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, Faculty of Medicine, School of Public Health, Imperial College London, United Kingdom
| | - Heather Ward
- Department of Epidemiology and Biostatistics, Faculty of Medicine, School of Public Health, Imperial College London, United Kingdom
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, Faculty of Medicine, School of Public Health, Imperial College London, United Kingdom
| | - Bas Bueno-de-Mesquita
- Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.,Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands.,Department of Epidemiology and Biostatistics, Faculty of Medicine, School of Public Health, Imperial College London, United Kingdom.,Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Carmen Navarro
- Department of Health and Social Sciences, University of Murcia, Murcia, Spain
| | - Eric J Duell
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO-IDIBELL), L'Hospitalet de Llobregat, Spain
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26
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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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27
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Vitelli Storelli F, Molina AJ, Zamora-Ros R, Fernández-Villa T, Roussou V, Romaguera D, Aragonés N, Obón-Santacana M, Guevara M, Gómez-Acebo I, Fernández-Tardón G, Molina-Barceló A, Olmedo-Requena R, Capelo R, Chirlaque MD, Pérez-Gómez B, Moreno V, Castilla J, Rubín-García M, Pollán M, Kogevinas M, Lera JPB, Martín V. Flavonoids and the Risk of Gastric Cancer: An Exploratory Case-Control Study in the MCC-Spain Study. Nutrients 2019; 11:nu11050967. [PMID: 31035601 PMCID: PMC6566880 DOI: 10.3390/nu11050967] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 04/19/2019] [Accepted: 04/24/2019] [Indexed: 12/12/2022] Open
Abstract
Several epidemiological studies have investigated the association between the dietary flavonoid intake and gastric cancer (GC) risk; however, the results remain inconclusive. Investigating the relationship between the different classes of flavonoids and the histological types and origin of GC can be of interest to the research community. We used data from a population-based multi-case control study (MCC-Spain) obtained from 12 different regions of Spain. 2700 controls and 329 GC cases were included in this study. Odds ratios (ORs) were calculated using the mixed effects logistic regression considering quartiles of flavonoid intakes and log2. Flavonoid intake was associated with a lower GC risk (ORlog2 = 0.76; 95% CI = 0.65-0.89; ORq4vsq1 = 0.60; 95%CI = 0.40-0.89; ptrend = 0.007). Inverse and statistically significant associations were observed with anthocyanidins, chalcones, dihydroflavonols and flavan-3-ols. The isoflavanoid intake was positively associated with higher cancer risk, but without reaching a statistical significance. In general, no differences were observed in the GC risk according to the location and histological type. The flavonoid intake seems to be a protective factor against GC within the MCC-study. This effect may vary depending on the flavonoid class but not by the histological type and location of the tumor. Broader studies with larger sample size and greater geographical variability are necessary.
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Affiliation(s)
- Facundo Vitelli Storelli
- Grupo de Investigación en Interacciones Gen-Ambiente y Salud (GIIGAS)/Instituto de Biomedicina (IBIOMED), Universidad de León, 24071 León, Spain.
| | - Antonio José Molina
- Grupo de Investigación en Interacciones Gen-Ambiente y Salud (GIIGAS)/Instituto de Biomedicina (IBIOMED), Universidad de León, 24071 León, Spain.
| | - Raul Zamora-Ros
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), 08908 L'Hospitalet de Llobregat (Barcelona), Spain.
| | - Tania Fernández-Villa
- Grupo de Investigación en Interacciones Gen-Ambiente y Salud (GIIGAS)/Instituto de Biomedicina (IBIOMED), Universidad de León, 24071 León, Spain.
| | - Vasiliki Roussou
- Grupo de Investigación en Interacciones Gen-Ambiente y Salud (GIIGAS)/Instituto de Biomedicina (IBIOMED), Universidad de León, 24071 León, Spain.
| | - Dora Romaguera
- Instituto de Investigación Sanitaria Illes Balears (IdISBa), Spain.
- Instituto de Salud Global de Barcelona (ISGlobal), 08003 Barcelona, Spain.
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), 28029 Madrid, Spain.
| | - Nuria Aragonés
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), 28029 Madrid, Spain.
- Cancer Epidemiology Section, Public Health Division, Department of Health of Madrid, 28035 Madrid, Spain.
| | - Mireia Obón-Santacana
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), 28029 Madrid, Spain.
- Oncology Data Analytics Program (ODAP), Catalan Institute of Oncology (ICO), L'Hospitalet del Llobregat, 08003 Barcelona, Spain.
- ONCOBELL Program, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain.
| | - Marcela Guevara
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), 28029 Madrid, Spain.
- Public Health Institute of Navarra-IDISNA, 31003 Pamplona, Spain.
| | - Inés Gómez-Acebo
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), 28029 Madrid, Spain.
- University of Cantabria⁻IDIVAL, Santander, Spain.
| | - Guillermo Fernández-Tardón
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), 28029 Madrid, Spain.
- University of Cantabria⁻IDIVAL, Santander, Spain.
| | - Ana Molina-Barceló
- Cancer and Public Health Area, FISABIO-Public Health, 46020 Valencia, Spain.
| | - Rocío Olmedo-Requena
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), 28029 Madrid, Spain.
- Department of Preventive Medicine and Public Health, University of Granada, 18071 Granada, Spain.
| | - Rocío Capelo
- Centro de Investigación en Recursos Naturales, Salud, y Medio Ambiente (RENSMA), Universidad de Huelva, 21071 Huelva, Spain.
| | - María Dolores Chirlaque
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), 28029 Madrid, Spain.
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia University, 30007 Murcia, Spain.
| | - Beatriz Pérez-Gómez
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), 28029 Madrid, Spain.
- Department of Epidemiology of Chronic Diseases, National Centre for Epidemiology, Carlos III Institute of Health, 28029 Madrid, Spain.
| | - Victor Moreno
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), 28029 Madrid, Spain.
- Oncology Data Analytics Program (ODAP), Catalan Institute of Oncology (ICO), L'Hospitalet del Llobregat, 08908 Barcelona, Spain.
- ONCOBELL Program, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08908 Barcelona, Spain.
- Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, 08907 Barcelona, Spain.
| | - Jesús Castilla
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), 28029 Madrid, Spain.
- Public Health Institute of Navarra-IDISNA, 31003 Pamplona, Spain.
| | - María Rubín-García
- Grupo de Investigación en Interacciones Gen-Ambiente y Salud (GIIGAS)/Instituto de Biomedicina (IBIOMED), Universidad de León, 24071 León, Spain.
| | - Marina Pollán
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), 28029 Madrid, Spain.
- Department of Epidemiology of Chronic Diseases, National Centre for Epidemiology, Carlos III Institute of Health, 28029 Madrid, Spain.
| | - Manolis Kogevinas
- Instituto de Salud Global de Barcelona (ISGlobal), 08003 Barcelona, Spain.
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), 28029 Madrid, Spain.
- IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain.
- Universitat Pompeu Fabra (UPF), Departament de Ciències Experimentals i de la Salut, 08002 Barcelona, Spain.
| | - Juan Pablo Barrio Lera
- Grupo de Investigación en Interacciones Gen-Ambiente y Salud (GIIGAS)/Instituto de Biomedicina (IBIOMED), Universidad de León, 24071 León, Spain.
| | - Vicente Martín
- Grupo de Investigación en Interacciones Gen-Ambiente y Salud (GIIGAS)/Instituto de Biomedicina (IBIOMED), Universidad de León, 24071 León, Spain.
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública-CIBERESP), 28029 Madrid, Spain.
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28
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Honda K, Katzke VA, Hüsing A, Okaya S, Shoji H, Onidani K, Olsen A, Tjønneland A, Overvad K, Weiderpass E, Vineis P, Muller D, Tsilidis K, Palli D, Pala V, Tumino R, Naccarati A, Panico S, Aleksandrova K, Boeing H, Bueno-de-Mesquita HB, Peeters PH, Trichopoulou A, Lagiou P, Khaw KT, Wareham N, Travis RC, Merino S, Duell EJ, Rodríguez-Barranco M, Chirlaque MD, Barricarte A, Rebours V, Boutron-Ruault MC, Romana Mancini F, Brennan P, Scelo G, Manjer J, Sund M, Öhlund D, Canzian F, Kaaks R. CA19-9 and apolipoprotein-A2 isoforms as detection markers for pancreatic cancer: a prospective evaluation. Int J Cancer 2019; 144:1877-1887. [PMID: 30259989 PMCID: PMC6760974 DOI: 10.1002/ijc.31900] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [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: 02/21/2018] [Revised: 07/06/2018] [Accepted: 07/13/2018] [Indexed: 12/24/2022]
Abstract
Recently, we identified unique processing patterns of apolipoprotein A2 (ApoA2) in patients with pancreatic cancer. Our study provides a first prospective evaluation of an ApoA2 isoform ("ApoA2-ATQ/AT"), alone and in combination with carbohydrate antigen 19-9 (CA19-9), as an early detection biomarker for pancreatic cancer. We performed ELISA measurements of CA19-9 and ApoA2-ATQ/AT in 156 patients with pancreatic cancer and 217 matched controls within the European EPIC cohort, using plasma samples collected up to 60 months prior to diagnosis. The detection discrimination statistics were calculated for risk scores by strata of lag-time. For CA19-9, in univariate marker analyses, C-statistics to distinguish future pancreatic cancer patients from cancer-free individuals were 0.80 for plasma taken ≤6 months before diagnosis, and 0.71 for >6-18 months; for ApoA2-ATQ/AT, C-statistics were 0.62, and 0.65, respectively. Joint models based on ApoA2-ATQ/AT plus CA19-9 significantly improved discrimination within >6-18 months (C = 0.74 vs. 0.71 for CA19-9 alone, p = 0.022) and ≤ 18 months (C = 0.75 vs. 0.74, p = 0.022). At 98% specificity, and for lag times of ≤6, >6-18 or ≤ 18 months, sensitivities were 57%, 36% and 43% for CA19-9 combined with ApoA2-ATQ/AT, respectively, vs. 50%, 29% and 36% for CA19-9 alone. Compared to CA19-9 alone, the combination of CA19-9 and ApoA2-ATQ/AT may improve detection of pancreatic cancer up to 18 months prior to diagnosis under usual care, and may provide a useful first measure for pancreatic cancer detection prior to imaging.
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Affiliation(s)
- Kazufumi Honda
- Department of Biomarker for Early Detection of Cancer, National Cancer Center Research Institute, Tokyo, Japan
- Japan Agency for Medical Research and Development (AMED) CREST, Tokyo, Japan
| | - Verena A Katzke
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Anika Hüsing
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Shinobu Okaya
- Department of Biomarker for Early Detection of Cancer, National Cancer Center Research Institute, Tokyo, Japan
| | - Hirokazu Shoji
- Department of Biomarker for Early Detection of Cancer, National Cancer Center Research Institute, Tokyo, Japan
- Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan
| | - Kaoru Onidani
- Department of Biomarker for Early Detection of Cancer, National Cancer Center Research Institute, Tokyo, Japan
| | - Anja Olsen
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Anne Tjønneland
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Kim Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
| | - Elisabete 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
| | - Paolo Vineis
- Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, United Kingdom
| | - David Muller
- Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, United Kingdom
| | - Kostas Tsilidis
- Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, United Kingdom
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Domenico Palli
- Cancer Risk Factors and Life-Style Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy
| | - Valeria Pala
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Rosario Tumino
- Cancer Registry and Histopathology Unit, "Civic - M.P. Arezzo" Hospital, Ragusa, Italy
| | - Alessio Naccarati
- Department of Molecular and Genetic Epidemiology, IIGM - Italian Institute for Genomic Medicine, Torino, Italy
| | - Salvatore Panico
- Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy
| | - Krasimira Aleksandrova
- Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
| | - H Bas Bueno-de-Mesquita
- Department of Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands
- Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, United Kingdom
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Petra H Peeters
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, United Kingdom
| | - Antonia Trichopoulou
- Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, School of Medicine, WHO Collaborating Center for Nutrition and Health
| | - Pagona Lagiou
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
| | - Kay-Tee Khaw
- Cancer Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Nick Wareham
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Ruth C Travis
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Susana Merino
- Public Health Directorate, Asturias, Spain, Acknowledgment of funds: Regional Government of Asturias
| | - Eric J Duell
- PanC4 Consortium, Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO-IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Miguel Rodríguez-Barranco
- Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
- CIBER Epidemiology and Public Health CIBERESP, Madrid, Spain
| | - María Dolores Chirlaque
- Department of Epidemiology, Murcia Regional Health Council, CIBER Epidemiología y Salud Pública (CIBERESP), Spain, Ronda de Levante, Murcia, Spain
| | - Aurelio Barricarte
- CIBER Epidemiology and Public Health CIBERESP, Madrid, Spain
- Navarra Public Health Institute, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Vinciane Rebours
- Pancreatology Unit, Beaujon Hospital, Clichy, France
- INSERM - UMR 1149, University Paris 7, Paris, France
| | - Marie-Chiristine Boutron-Ruault
- CESP, INSERM U1018, Univ. Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif, France
- Lifestyle, Genes and Health: Integrative Trans-Generational Epidemiology, Gustave Roussy, Villejuif, France
| | - Francesca Romana Mancini
- INSERM - UMR 1149, University Paris 7, Paris, France
- CESP, INSERM U1018, Univ. Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif, France
| | - Paul Brennan
- Section of Genetics, International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | - Ghislaine Scelo
- Section of Genetics, International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | - Jonas Manjer
- Department of Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Malin Sund
- Department of Surgical and Preoperative Sciences, Umeå University, Umeå, Sweden
| | - Daniel Öhlund
- Department of Radiation Sciences and Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - Federico Canzian
- Genomic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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29
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Fernández-Caballero M, Salmerón D, Dolores Chirlaque M, Chen-Liang TH, Hurtado AM, García Malo MD, Ortuño FJ, Roldán V, Vicente V, Jerez A, De Arriba F. Increasing therapy-related myeloid neoplasms in multiple myeloma. Eur J Clin Invest 2019; 49:e13050. [PMID: 30422316 DOI: 10.1111/eci.13050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 11/07/2018] [Accepted: 11/08/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite the longer survival achieved in multiple myeloma (MM) patients due to new therapy strategies, a concern is emerging regarding an increased risk of secondary primary malignancies (SPMs) and how to characterize those patients at risk. We performed a retrospective study covering a 28-year follow-up period (1991-2018) in a tertiary single institution. MATERIAL AND METHODS Data of 403 MM patients were recorded and compared with the epidemiologic register of the population area covered by our centre, calculating the standardize incidence ratio (SIR) for the different types of SPMs diagnosed in the MM cohort. Fine and Gray regression models were used to identify risk factors for SPMs. RESULTS Out of the 403 MM patients, 23 (5.7%) developed SPMs: 13 therapy-related myeloid (TRM) malignancies (10 of them (77%) myelodysplastic syndrome (MDS), 1 acute lymphoid leukaemia and 9 solid neoplasms. In the MM cohort, the relative risk of MDS was significantly higher than in the general population. Survival of patients with TRM malignancies was poor with a median of 4 months from the diagnosis, and most of them showed complex karyotype. Within the MM subset, multivariable analysis showed a higher risk of TRM malignancies in patients that previously received prolonged treatment with lenalidomide (>18 months). CONCLUSIONS Though the improvement in MM outcome during the last decades is an unprecedented achievement, it has been accompanied by the rise in TRM malignancies with complex cytogenetic profile and poor prognosis that are in the need of an improved biologic and therapeutic approach.
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Affiliation(s)
- Mariana Fernández-Caballero
- Servicio de Hematología y Oncología Médica, Hospital General Universitario Morales Meseguer, Centro Regional de Hemodonación, Universidad de Murcia, IMIB-Arrixaca, Murcia, Spain
| | - Diego Salmerón
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain.,Departamento de Ciencias Sociosanitarias, IMIB-Arrixaca, Universidad de Murcia, Murcia, Spain
| | - María Dolores Chirlaque
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain.,Servicio de Epidemiología, Consejería de Sanidad, IMIB-Arrixaca, Universidad de Murcia, Murcia, Spain
| | - Tzu H Chen-Liang
- Servicio de Hematología y Oncología Médica, Hospital General Universitario Morales Meseguer, Centro Regional de Hemodonación, Universidad de Murcia, IMIB-Arrixaca, Murcia, Spain
| | - Ana M Hurtado
- Servicio de Hematología y Oncología Médica, Hospital General Universitario Morales Meseguer, Centro Regional de Hemodonación, Universidad de Murcia, IMIB-Arrixaca, Murcia, Spain
| | - María D García Malo
- Servicio de Hematología y Oncología Médica, Hospital General Universitario Morales Meseguer, Centro Regional de Hemodonación, Universidad de Murcia, IMIB-Arrixaca, Murcia, Spain
| | - Francisco J Ortuño
- Servicio de Hematología y Oncología Médica, Hospital General Universitario Morales Meseguer, Centro Regional de Hemodonación, Universidad de Murcia, IMIB-Arrixaca, Murcia, Spain
| | - Vanessa Roldán
- Servicio de Hematología y Oncología Médica, Hospital General Universitario Morales Meseguer, Centro Regional de Hemodonación, Universidad de Murcia, IMIB-Arrixaca, Murcia, Spain
| | - Vicente Vicente
- Servicio de Hematología y Oncología Médica, Hospital General Universitario Morales Meseguer, Centro Regional de Hemodonación, Universidad de Murcia, IMIB-Arrixaca, Murcia, Spain
| | - Andrés Jerez
- Servicio de Hematología y Oncología Médica, Hospital General Universitario Morales Meseguer, Centro Regional de Hemodonación, Universidad de Murcia, IMIB-Arrixaca, Murcia, Spain
| | - Felipe De Arriba
- Servicio de Hematología y Oncología Médica, Hospital General Universitario Morales Meseguer, Centro Regional de Hemodonación, Universidad de Murcia, IMIB-Arrixaca, Murcia, Spain
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30
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Vallès X, Alonso MH, López-Caleya JF, Díez-Obrero V, Dierssen-Sotos T, Lope V, Molina-Barceló A, Chirlaque MD, Jiménez-Moleón JJ, Fernández Tardón G, Castilla J, Amiano P, Capelo R, Castaño-Vinyals G, Guinó E, Molina de la Torre AJ, Moreno-Iribas C, Pérez Gómez B, Aragonés N, Llorca J, Martín V, Kogevinas M, Pollán M, Moreno V. Colorectal cancer, sun exposure and dietary vitamin D and calcium intake in the MCC-Spain study. Environ Int 2018; 121:428-434. [PMID: 30266013 DOI: 10.1016/j.envint.2018.09.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/17/2018] [Accepted: 09/17/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To explore the association of colorectal cancer with environmental solar radiation and sun exposure behavior, considering phenotypic variables (eye color, hair color and skin phenotype), dietary intake of vitamin D and calcium, and socio-demographic factors. STUDY DESIGN Multicenter population-based frequency matched case-control study in Spain (MCC-Spain), with 2140 CRC cases and 3950 controls. METHODS Data were obtained through personal interviews using a structured epidemiological questionnaire that included socio-demographic data, residential history, environmental exposures, behavior, phenotypic and dietary information. An environmental-lifetime sun exposure score was constructed combining residential history and average daily solar radiation, direct and diffuse. Logistic regression was used to explore the association between different variables. A structural equation model was used to verify the associations of the conceptual model. RESULTS We found a lower risk of CRC in subjects frequently exposed to sunlight during the previous summer and skin burning due to sun exposure. No association was observed in relation to the residential solar radiation scores. Subjects with light eye or light hair colors had a lower risk of CRC that those with darker colors. Dietary calcium and vitamin D were also protective factors, but not in the multivariate model. The structural equation model analysis suggested that higher sun exposure was associated with a decreased risk of CRC, as well as dietary intake of calcium and vitamin D, and these factors are correlated among themselves and with environmental solar radiation and skin phenotypes. CONCLUSION The results agree with previous observations that sun exposure, dietary vitamin D and calcium intake, and serum 25(OH)D concentration reduce the risk of CRC and indicate that these factors may be relevant for cancer prevention.
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Affiliation(s)
- Xavier Vallès
- Cancer Prevention and Control Program, Catalan Institute of Oncology (ICO) and Oncobell Program, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - M Henar Alonso
- Cancer Prevention and Control Program, Catalan Institute of Oncology (ICO) and Oncobell Program, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Clinical Sciences, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Juan Francisco López-Caleya
- Instituto de Biomedicina (IBIOMED), Universidad de León, Spain; Servicio de Medicina Interna, Hospital de Cabueñes, Gijón, Asturias, Spain
| | - Virginia Díez-Obrero
- Cancer Prevention and Control Program, Catalan Institute of Oncology (ICO) and Oncobell Program, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Trinidad Dierssen-Sotos
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Universidad de Cantabria - IDIVAL, Santander, Spain
| | - Virginia Lope
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Environmental and Cancer Epidemiology Unit, National Center of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | | | - María Dolores Chirlaque
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain; Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain
| | - José Juan Jiménez-Moleón
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, Spain; Instituto de Investigación Biosanitaria de Granada ibs.GRANADA, Hospitales Universitarios de Granada, Universidad de Granada, Granada, Spain
| | - Guillermo Fernández Tardón
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Oncology Institute IUOPA (Instituto Universitario de Oncología del Principado de Asturias), Universidad de Oviedo, Asturias, Spain
| | - Jesús Castilla
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Instituto de Salud Pública Navarra - IdiSNA, Pamplona, Navarra, Spain
| | - Pilar Amiano
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Public Health Division of Gipuzkoa, BioDonostia Research Institute, San Sebastián, Spain
| | - Rocío Capelo
- Centro de Investigación en Recursos Naturales, Salud, y Medio Ambiente (RENSMA), Universidad de Huelva, Huelva, Spain
| | - Gemma Castaño-Vinyals
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; ISGlobal, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Elisabet Guinó
- Cancer Prevention and Control Program, Catalan Institute of Oncology (ICO) and Oncobell Program, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - Conchi Moreno-Iribas
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Instituto de Salud Pública Navarra - IdiSNA, Pamplona, Navarra, Spain
| | - Beatriz Pérez Gómez
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Environmental and Cancer Epidemiology Unit, National Center of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Nuria Aragonés
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Epidemiology Section, Public Health Division, Department of Health of Madrid, Madrid, Spain
| | - Javier Llorca
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Universidad de Cantabria - IDIVAL, Santander, Spain
| | - Vicente Martín
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Instituto de Biomedicina (IBIOMED), Universidad de León, Spain
| | - Manolis Kogevinas
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; ISGlobal, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Marina Pollán
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Environmental and Cancer Epidemiology Unit, National Center of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Victor Moreno
- Cancer Prevention and Control Program, Catalan Institute of Oncology (ICO) and Oncobell Program, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Clinical Sciences, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
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Andreu-Reinón ME, Gavrila D, Chirlaque MD, Colorado-Yohar SM, Amiano P, Ardanaz E, Navarro-Mateu F, Navarro C, Huerta JM. Ascertainment of Dementia Cases in the Spanish European Prospective Investigation into Cancer and Nutrition-Murcia Cohort. Neuroepidemiology 2018; 52:63-73. [PMID: 30476922 DOI: 10.1159/000493209] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 08/25/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cohort studies generally focus on a particular disease, although they offer the possibility of evaluating different outcomes with minimal additional investment. The objective of this study was to describe the methodology used to assess dementia in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Murcia study. METHODS The EPIC-Murcia cohort consists of 8,515 healthy participants (68% women, aged 30-70 years), recruited between 1992 and 1996 and followed up for over 20 years. Incident cases were ascertained by a 2-step protocol: a record linkage with health databases to identify potential events and a review of medical records of potential cases to validate incident cases. RESULTS Overall, 1,202 potential cases were identified, and 275 dementia cases were validated. Medical reports were the source of information in 243 cases, with complete neurological information in 227, and a high degree of certainty of the diagnosis in 229 cases. P70 (dementia code) and/or antidementia drugs and/or ICD codes identified 259 cases (sensitivity: 94.2%, 95% CI 90.7-96.6; specificity: 98.1%, 95% CI 97.8-98.4). CONCLUSION Ascertainment of incident dementia in the EPIC-Murcia cohort study was feasible using information from medical records. This systematic 2-step validation protocol is proposed as a feasible way to ascertain dementia in cohort studies originally designed for other endpoints.
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Affiliation(s)
- María Encarnación Andreu-Reinón
- Murcia Regional Health Council, Murcia, Spain, .,Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain,
| | - Diana Gavrila
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - 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
| | - Sandra M Colorado-Yohar
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Research Group on Demography and Health, National Faculty of Public Health, University of Antioquia, Medellín, Colombia
| | - Pilar Amiano
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Public Health Division of Gipuzkoa, Instituto BIO-Donostia, Basque Government, Donostia/San Sebastián, Spain
| | - Eva Ardanaz
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Public Health Institute of Navarra, IDISNA, Pamplona, Spain
| | - Fernando Navarro-Mateu
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Unidad de Docencia, Investigación y Formación en Salud Mental (UDIF-SM), Servicio Murciano de Salud, IMIB-Arrixaca, Murcia, Spain
| | - Carmen 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
| | - José María Huerta
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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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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Lujan-Barroso L, Gibert K, Obón-Santacana M, Chirlaque MD, Sánchez MJ, Larrañaga N, Barricarte A, Quirós JR, Salamanca-Fernández E, Colorado-Yohar S, Gómez-Pozo B, Agudo A, Duell EJ. The influence of lifestyle, diet, and reproductive history on age at natural menopause in Spain: Analysis from the EPIC-Spain sub-cohort. Am J Hum Biol 2018; 30:e23181. [DOI: 10.1002/ajhb.23181] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 07/06/2018] [Accepted: 08/12/2018] [Indexed: 01/14/2023] Open
Affiliation(s)
| | - Karina Gibert
- Catalan Institute of Oncology (ICO-IDIBELL); Barcelona Spain
| | | | | | | | - Nerea Larrañaga
- Catalan Institute of Oncology (ICO-IDIBELL); Barcelona Spain
| | | | | | | | | | | | - Antonio Agudo
- Catalan Institute of Oncology (ICO-IDIBELL); Barcelona Spain
| | - Eric J Duell
- Catalan Institute of Oncology (ICO-IDIBELL); Barcelona Spain
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Solans M, Coenders G, Marcos-Gragera R, Castelló A, Gràcia-Lavedan E, Benavente Y, Moreno V, Pérez-Gómez B, Amiano P, Fernández-Villa T, Guevara M, Gómez-Acebo I, Fernández-Tardón G, Vanaclocha-Espi M, Chirlaque MD, Capelo R, Barrios R, Aragonés N, Molinuevo A, Vitelli-Storelli F, Castilla J, Dierssen-Sotos T, Castaño-Vinyals G, Kogevinas M, Pollán M, Saez M. Compositional analysis of dietary patterns. Stat Methods Med Res 2018; 28:2834-2847. [PMID: 30045678 DOI: 10.1177/0962280218790110] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 11/16/2022]
Abstract
Instead of looking at individual nutrients or foods, dietary pattern analysis has emerged as a promising approach to examine the relationship between diet and health outcomes. Despite dietary patterns being compositional (i.e. usually a higher intake of some foods implies that less of other foods are being consumed), compositional data analysis has not yet been applied in this setting. We describe three compositional data analysis approaches (compositional principal component analysis, balances and principal balances) that enable the extraction of dietary patterns by using control subjects from the Spanish multicase-control (MCC-Spain) study. In particular, principal balances overcome the limitations of purely data-driven or investigator-driven methods and present dietary patterns as trade-offs between eating more of some foods and less of others.
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Affiliation(s)
- M Solans
- 1 Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,2 Research Group on Statistics, Econometrics and Health (GRECS), Universitat de Girona, Girona, Spain.,3 Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology, Girona, Spain
| | - G Coenders
- 1 Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,2 Research Group on Statistics, Econometrics and Health (GRECS), Universitat de Girona, Girona, Spain
| | - R Marcos-Gragera
- 2 Research Group on Statistics, Econometrics and Health (GRECS), Universitat de Girona, Girona, Spain.,3 Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology, Girona, Spain
| | - A Castelló
- 1 Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,4 Cancer Epidemiology Unit, National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain.,5 Faculty of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - E Gràcia-Lavedan
- 1 Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,6 ISGlobal, Barcelona, Spain.,7 ISGlobal, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Y Benavente
- 8 Unit of molecular and genetic epidemiology in infections and cancer, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - V Moreno
- 1 Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,9 Unit of Biomarkers and Susceptibility, Cancer Prevention and Control Program, Catalan Institute of Oncology (ICO). Hospitalet de Llobregat, Barcelona, Spain.,10 Colorectal Cancer Group, ONCOBELL Program, Bellvitge Biomedical Research Institute (IDIBELL). Hospitalet de Llobregat, Barcelona, Spain.,11 Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - B Pérez-Gómez
- 1 Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,12 Cardiovascular and Metabolic Diseases Epidemiology Unit, National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain
| | - P Amiano
- 1 Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,13 Public Health Division of Gipuzkoa, BioDonostia Research Institute, Health Department, Basque Country, San Sebastian, Spain
| | | | - M Guevara
- 1 Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,15 Instituto de Salud Pública de Navarra, IdiSNA, Pamplona, Spain
| | - I Gómez-Acebo
- 1 Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,16 Universidad de Cantabria - IDIVAL, Santander, Spain
| | - G Fernández-Tardón
- 1 Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,17 IUOPA, Universidad de Oviedo, Asturias, Spain
| | - M Vanaclocha-Espi
- 18 Cancer and Public Health Area, FISABIO - Public Health, Valencia, Spain
| | - M D Chirlaque
- 1 Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,19 Department of Epidemiology, Regional Health Authority, IMIB-Arrixaca, Murcia University, Murcia, Spain
| | - R Capelo
- 20 Centro de Investigación en Recursos Naturales, Salud y medio Ambiente (RENSMA), Universidad de Huelva, Huelva, Spain
| | - R Barrios
- 21 Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad de Granada, Granada, Spain
| | - N Aragonés
- 1 Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,22 Epidemiology Section, Public Health Division, Department of Health of Madrid, Madrid, Spain
| | - A Molinuevo
- 1 Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - J Castilla
- 1 Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,15 Instituto de Salud Pública de Navarra, IdiSNA, Pamplona, Spain
| | - T Dierssen-Sotos
- 1 Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,16 Universidad de Cantabria - IDIVAL, Santander, Spain
| | - G Castaño-Vinyals
- 1 Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,6 ISGlobal, Barcelona, Spain.,7 ISGlobal, Universitat Pompeu Fabra (UPF), Barcelona, Spain.,23 IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - M Kogevinas
- 1 Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,6 ISGlobal, Barcelona, Spain.,7 ISGlobal, Universitat Pompeu Fabra (UPF), Barcelona, Spain.,23 IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - M Pollán
- 1 Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,4 Cancer Epidemiology Unit, National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain
| | - M Saez
- 1 Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,2 Research Group on Statistics, Econometrics and Health (GRECS), Universitat de Girona, Girona, Spain
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Zamora-Ros R, Cayssials V, Cleries R, Redondo ML, Sánchez MJ, Rodríguez-Barranco M, Sánchez-Cruz JJ, Mokoroa O, Gil L, Amiano P, Navarro C, Chirlaque MD, Huerta JM, Barricarte A, Ardanaz E, Moreno-Iribas C, Agudo A. Moderate egg consumption and all-cause and specific-cause mortality in the Spanish European Prospective into Cancer and Nutrition (EPIC-Spain) study. Eur J Nutr 2018; 58:2003-2010. [DOI: 10.1007/s00394-018-1754-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/11/2018] [Indexed: 12/29/2022]
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36
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Marcos-Gragera R, Solans M, Galceran J, Fernández-Delgado R, Fernández-Teijeiro A, Mateos A, Quirós-Garcia JR, Fuster-Camarena N, De Castro V, Sánchez MJ, Franch P, Chirlaque MD, Ardanaz E, Martos C, Salmerón D, Peris-Bonet R. Childhood and adolescent lymphoma in Spain: incidence and survival trends over 20 years. Clin Transl Oncol 2018; 20:1289-1301. [PMID: 29623582 DOI: 10.1007/s12094-018-1860-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 03/10/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Lymphoma is the third most common malignancy in children (0-14 years) and the first in adolescents (15-19 years). This population-based study-the largest ever done in Spain-analyses incidence and survival of lymphomas among Spanish children and adolescents. PATIENTS AND METHODS 1664 lymphoma cases (1983-2007) for incidence and 1030 for survival (1991-2005) followed until 31/12/2010, were provided by 11 cancer registries. Age-adjusted incidence rates (ASRw) to the world standard population were obtained; incidence trends were modelled using the Joinpoint programme, observed survival (OS) was estimated with Kaplan-Meier and trends tested with a log-rank test. Results are presented according to the International Classification of Childhood Cancer-3. RESULTS In Spain, the ASRw0-14 for lymphomas was 17.5 per 1.000.000 child-years and 50.0 the specific rate for adolescents. Overall incidence increased significantly during 1983-1997 with no increases thereafter. Patients over 9 years old showed significant rising trends for all subtypes, except for Burkitt lymphoma (BL) in adolescents. During 2001-2005 (age 0-19 years), 5-year OS was 94 (90-98), 73 (64-83) and 86 (78-94) for Hodgkin lymphoma (HL), non-Hodgkin lymphoma (NHL) and BL, respectively. No improvement in survival was found. The incidence in Spain was higher than overall European rates, but within the range of that in Southern Europe. Comparing OS in Spain 1991-1995 and 2001-2005 with results for Europe of the Automated Childhood Cancer Information System (ACCIS) (1988-1997) and the European cancer registry-based study on survival and care of cancer patients (EUROCARE) (2000-2007), it was similar for HL and lower for NHL and BL. CONCLUSIONS Systematic monitoring and analysis of lymphoma paediatric data would provide clinical and epidemiological information to improve the health care of these patients and the outcomes for these malignancies in Spain.
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Affiliation(s)
- R Marcos-Gragera
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology, Girona, Spain. .,Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain.
| | - M Solans
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology, Girona, Spain.,Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain.,CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - J Galceran
- Tarragona Cancer Registry, Foundation Society for Cancer Research and Prevention (FUNCA), Reus, Spain.,Pere Virgili Health Research Institute, Reus, Spain.,Rovira i Virgili University (URV), Reus, Spain
| | - R Fernández-Delgado
- Department of Paediatrics, Obstetrics and Gynaecology, University of Valencia, Valencia, Spain.,Non-Hodgkin Lymphoma Working Group, Spanish Society of Paediatric Haematology and Oncology (SEHOP), Madrid, Spain
| | - A Fernández-Teijeiro
- University Hospital Virgen de la Macarena, Sevilla, Spain.,Hodgkin Lymphoma Working Group, Spanish Society of Paediatric Haematology and Oncology, (SEHOP), Madrid, Spain
| | - A Mateos
- Albacete Cancer Registry, Health and Social Welfare Authority, Albacete, Spain
| | - J R Quirós-Garcia
- Asturias Cancer Registry. Public Health Directorate, Asturias, Spain
| | - N Fuster-Camarena
- Childhood Cancer Registry of the C. Valenciana, Public Health Directorate, Health Department, Government of C.Valenciana, Valencia, Spain
| | - V De Castro
- Basque Country Cancer Registry, Basque Government, Bilbao, Spain
| | - M J Sánchez
- CIBER in 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
| | - P Franch
- Mallorca Cancer Registry, Epidemiology Department, Directorate-General of Public Health and Participation, Palma de Mallorca, Spain
| | - M D Chirlaque
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia University, Murcia, Spain
| | - E Ardanaz
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Navarra Public Health Institute, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - C Martos
- Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain.,Centre of Public Health Research-FISABIO, Valencia, Spain
| | - D Salmerón
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Department of Health and Social Sciences, University of Murcia, Murcia, Spain.,IMIB-Arrixaca, Murcia, Spain
| | - R Peris-Bonet
- Spanish Registry of Childhood Tumours (RETI-SEHOP), University of Valencia, Valencia, Spain
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Sacchetto L, Zanetti R, Comber H, Bouchardy C, Brewster DH, Broganelli P, Chirlaque MD, Coza D, Galceran J, Gavin A, Hackl M, Katalinic A, Larønningen S, Louwman MWJ, Morgan E, Robsahm TE, Sanchez MJ, Tryggvadóttir L, Tumino R, Van Eycken E, Vernon S, Zadnik V, Rosso S. Trends in incidence of thick, thin and in situ melanoma in Europe. Eur J Cancer 2018; 92:108-118. [PMID: 29395684 DOI: 10.1016/j.ejca.2017.12.024] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 12/14/2017] [Accepted: 12/21/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND We analysed trends in incidence for in situ and invasive melanoma in some European countries during the period 1995-2012, stratifying for lesion thickness. MATERIAL AND METHODS Individual anonymised data from population-based European cancer registries (CRs) were collected and combined in a common database, including information on age, sex, year of diagnosis, histological type, tumour location, behaviour (invasive, in situ) and lesion thickness. Mortality data were retrieved from the publicly available World Health Organization database. RESULTS Our database covered a population of over 117 million inhabitants and included about 415,000 skin lesions, recorded by 18 European CRs (7 of them with national coverage). During the 1995-2012 period, we observed a statistically significant increase in incidence for both invasive (average annual percent change (AAPC) 4.0% men; 3.0% women) and in situ (AAPC 7.7% men; 6.2% women) cases. DISCUSSION The increase in invasive lesions seemed mainly driven by thin melanomas (AAPC 10% men; 8.3% women). The incidence of thick melanomas also increased, although more slowly in recent years. Correction for lesions of unknown thickness enhanced the differences between thin and thick cases and flattened the trends. Incidence trends varied considerably across registries, but only Netherlands presented a marked increase above the boundaries of a funnel plot that weighted estimates by their precision. Mortality from invasive melanoma has continued to increase in Norway, Iceland (but only for elder people), the Netherlands and Slovenia.
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Affiliation(s)
- L Sacchetto
- Piedmont Cancer Registry, A.O.U, Città della Salute e della Scienza di Torino, Turin, Italy; Politecnico di Torino, Turin, Italy; Università degli Studi di Torino, Turin, Italy.
| | - R Zanetti
- Piedmont Cancer Registry, A.O.U, Città della Salute e della Scienza di Torino, Turin, Italy
| | - H Comber
- National Cancer Registry Ireland, Ireland
| | | | | | - P Broganelli
- A.O.U, Città della Salute e della Scienza di Torino, Turin, Italy
| | - M D Chirlaque
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia, CIBERESP, Spain
| | - D Coza
- Cluj Regional Cancer Registry, Oncology Institute Cluj, Romania
| | - J Galceran
- Tarragona Cancer Registry, Foundation Society for Cancer Research and Prevention, (FUNCA), Pere Virgili Health Research Institute (IISPV), Reus, Spain
| | - A Gavin
- Northern Ireland Cancer Registry, Queens University Belfast, Belfast, UK
| | - M Hackl
- Austrian National Cancer Registry, Wien, Austria
| | - A Katalinic
- Institute for Social Medicine and Epidemiology, University Lübeck, Lubeck, Germany
| | - S Larønningen
- Cancer Registry of Norway, Institute of Population Based Cancer Research, Oslo, Norway
| | - M W J Louwman
- Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - E Morgan
- Northern Ireland Cancer Registry, Queens University Belfast, Belfast, UK
| | - T E Robsahm
- Cancer Registry of Norway, Institute of Population Based Cancer Research, Oslo, Norway
| | - M J Sanchez
- Escuela Andaluza de Salud Pública, CIBER de Epidemiología y Salud Pública, (CIBERESP), Ibs, Granada, Spain
| | - L Tryggvadóttir
- Icelandic Cancer Registry, Icelandic Cancer Society, Reykjavik, Iceland
| | - R Tumino
- Cancer Registry and Histopathology Department, "Civic - M.P.Arezzo" Hospital, ASP, Ragusa, Italy
| | | | - S Vernon
- National Cancer Registration Service - Public Health England, Cambridge, UK
| | - V Zadnik
- Epidemiology and Cancer Registry, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - S Rosso
- Piedmont Cancer Registry, A.O.U, Città della Salute e della Scienza di Torino, Turin, Italy
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38
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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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Dal Maso L, Tavilla A, Pacini F, Serraino D, van Dijk BAC, Chirlaque MD, Capocaccia R, Larrañaga N, Colonna M, Agius D, Ardanaz E, Rubió-Casadevall J, Kowalska A, Virdone S, Mallone S, Amash H, De Angelis R. Survival of 86,690 patients with thyroid cancer: A population-based study in 29 European countries from EUROCARE-5. Eur J Cancer 2017; 77:140-152. [PMID: 28410490 DOI: 10.1016/j.ejca.2017.02.023] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 02/17/2017] [Accepted: 02/20/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Incidence rates of thyroid cancer (TC) increased in several countries during the last 30 years, while mortality rates remained unchanged, raising important questions for treatment and follow-up of TC patients. This study updates population-based estimates of relative survival (RS) after TC diagnosis in Europe by sex, country, age, period and histology. METHODS Data from 87 cancer registries in 29 countries were extracted from the EUROCARE-5 dataset. One- and 5-year RS were estimated using the cohort approach for 86,690 adult TC patients diagnosed in 2000-2007 and followed-up to 12/31/2008. RS trends in 1999-2007 and 10-year RS in 2005-2007 were estimated using the period approach. RESULTS In Europe 2000-2007, 5-year RS after TC was 88% in women and 81% in men. Survival rates varied by country and were strongly correlated (Pearson ρ = 75%) with country-specific incidence rates. Five-year RS decreased with age (in women from >95% at age 15-54 to 57% at age 75+), from 98% in women and 94% in men with papillary TC to 14% in women and 12% in men with anaplastic TC. Proportion of papillary TC varied by country and increased over time, while survival rates were similar across areas and periods. In 1999-2007, 5-year RS increased by five percentage points for all TCs but only by two for papillary and by four for follicular TC. Ten-year RS in 2005-2007 was 89% in women and 79% in men. CONCLUSIONS The reported increasing TC survival trend and differences by area are mainly explained by the varying histological case-mix of cases.
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Affiliation(s)
- L Dal Maso
- Cancer Epidemiology Unit, CRO Aviano National Cancer Institute IRCCS, Aviano, Italy.
| | - A Tavilla
- Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute (CNESPS), Istituto Superiore di Sanità (ISS), Rome, Italy
| | - F Pacini
- Section of Endocrinology and Metabolism, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - D Serraino
- Cancer Epidemiology Unit, CRO Aviano National Cancer Institute IRCCS, Aviano, Italy
| | - B A C van Dijk
- Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research, Utrecht, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, The Netherlands
| | - M D Chirlaque
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia, Spain; Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain; CIBER Epidemiology and Public Health CIBERESP, Madrid, Spain
| | - R Capocaccia
- Evaluative Epidemiology Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - N Larrañaga
- CIBER Epidemiology and Public Health CIBERESP, Madrid, Spain; Basque Cancer Registry, Public Health Division of Gipuzkoa, Basque Health Department, Spain
| | - M Colonna
- Isere Cancer Registry (Grenoble), France; Francim Network (Toulouse), France
| | - D Agius
- Malta National Cancer Registry, Lecturer Public Health and Family Medicine, University of Malta, Malta
| | - E Ardanaz
- CIBER Epidemiology and Public Health CIBERESP, Madrid, Spain; Navarra Public Health Institute, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - J Rubió-Casadevall
- Medical Oncology Department, Epidemiology Unit and Girona Cancer Registry, Catalan Institute of Oncology, Girona, Spain
| | - A Kowalska
- Department of Endocrinology, Holycross Cancer Centre, Kielce, Poland
| | - S Virdone
- Cancer Epidemiology Unit, CRO Aviano National Cancer Institute IRCCS, Aviano, Italy
| | - S Mallone
- Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute (CNESPS), Istituto Superiore di Sanità (ISS), Rome, Italy
| | - H Amash
- Analytical Epidemiology and Health Impact Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - R De Angelis
- Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute (CNESPS), Istituto Superiore di Sanità (ISS), Rome, Italy
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Buckland G, Pastor A, Lujan-Barroso L, Gonzalez CA, Travier N, Amiano P, Huerta JM, Agudo A, Navarro C, Chirlaque MD, Sánchez MJ, Rodríguez-Barranco M, Barricarte A, Ardanaz E, Dorronsoro M, Molinuevo A, Quirós JR, de la Torre R. Determination of oleanolic acid in human plasma and its association with olive oil intake in healthy Spanish adults within the EPIC Spain cohort study. Mol Nutr Food Res 2017; 61. [DOI: 10.1002/mnfr.201600927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 01/16/2017] [Accepted: 01/25/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Genevieve Buckland
- Unit of Nutrition and Cancer; Cancer Epidemiology Research Programme; Catalan Institute of Oncology (ICO-IDIBELL); Barcelona Spain
| | - Antoni Pastor
- Integrative Pharmacology and Systems Neuroscience Research Group, Neurosciences Research Program; IMIM (Hospital del Mar Medical Research Institute); Barcelona Spain
- CIBER Fisiopatologia de la Obesidad y la Nutrición (CIBERobn); Santiago de Compostela Spain
| | - Leila Lujan-Barroso
- Unit of Nutrition and Cancer; Cancer Epidemiology Research Programme; Catalan Institute of Oncology (ICO-IDIBELL); Barcelona Spain
- Department of Nursing of Public Health; Mental Health and Maternity and Child Health, School of Nursing; University of Barcelona; Barcelona Spain
| | - Carlos Alberto Gonzalez
- Unit of Nutrition and Cancer; Cancer Epidemiology Research Programme; Catalan Institute of Oncology (ICO-IDIBELL); Barcelona Spain
| | - Noemie Travier
- Unit of Nutrition and Cancer; Cancer Epidemiology Research Programme; Catalan Institute of Oncology (ICO-IDIBELL); Barcelona Spain
| | - Pilar Amiano
- CIBER Epidemiology and Public Health (CIBERESP); Madrid Spain
- Public Health Division of Gipuzkoa; BioDonostia Research Institute; Donostia-San Sebastian; Spain
| | - José María Huerta
- CIBER Epidemiology and Public Health (CIBERESP); Madrid Spain
- Department of Epidemiology; Murcia Regional Health Council; IMIB-Arrixaca Murcia Spain
| | - Antonio Agudo
- Unit of Nutrition and Cancer; Cancer Epidemiology Research Programme; Catalan Institute of Oncology (ICO-IDIBELL); Barcelona Spain
| | - Carmen Navarro
- CIBER Epidemiology and Public Health (CIBERESP); Madrid Spain
- Department of Epidemiology; Murcia Regional Health Council; IMIB-Arrixaca Murcia Spain
- Department of Health and Social Sciences; Universidad de Murcia; Murcia; Spain
| | - María Dolores Chirlaque
- CIBER Epidemiology and Public Health (CIBERESP); Madrid Spain
- Department of Epidemiology; Murcia Regional Health Council; IMIB-Arrixaca Murcia Spain
- Department of Health and Social Sciences; Universidad de Murcia; Murcia; Spain
| | - Maria-José Sánchez
- CIBER Epidemiology and Public Health (CIBERESP); Madrid Spain
- Andaluzian School of Public Health, Instituto de Investigación Biosanitaria ibs; Granada Spain
| | | | - Aurelio Barricarte
- CIBER Epidemiology and Public Health (CIBERESP); Madrid Spain
- Department of Epidemiology; Navarra Public Health Institute; Pamplona Spain
- IdiSNA; Navarra Institute for Health Research; Pamplona Spain
| | - Eva Ardanaz
- CIBER Epidemiology and Public Health (CIBERESP); Madrid Spain
- Department of Epidemiology; Navarra Public Health Institute; Pamplona Spain
- IdiSNA; Navarra Institute for Health Research; Pamplona Spain
| | - Miren Dorronsoro
- CIBER Epidemiology and Public Health (CIBERESP); Madrid Spain
- Public Health Division of Gipuzkoa; BioDonostia Research Institute; Donostia-San Sebastian; Spain
| | - Amaia Molinuevo
- CIBER Epidemiology and Public Health (CIBERESP); Madrid Spain
| | | | - Rafael de la Torre
- Integrative Pharmacology and Systems Neuroscience Research Group, Neurosciences Research Program; IMIM (Hospital del Mar Medical Research Institute); Barcelona Spain
- CIBER Fisiopatologia de la Obesidad y la Nutrición (CIBERobn); Santiago de Compostela Spain
- Department of Experimental and Health Sciences (DCEXS); Pompeu Fabra University (UPF); Barcelona Spain
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Fortner RT, Vitonis AF, Schock H, Hüsing A, Johnson T, Fichorova RN, Fashemi T, Yamamoto HS, Tjønneland A, Hansen L, Overvad K, Boutron-Ruault MC, Kvaskoff M, Severi G, Boeing H, Trichopoulou A, Benetou V, La Vecchia C, Palli D, Sieri S, Tumino R, Matullo G, Mattiello A, Onland-Moret NC, Peeters PH, Weiderpass E, Gram IT, Jareid M, Quirós JR, Duell EJ, Sánchez MJ, Chirlaque MD, Ardanaz E, Larrañaga N, Nodin B, Brändstedt J, Idahl A, Khaw KT, Allen N, Gunter M, Johansson M, Dossus L, Merritt MA, Riboli E, Cramer DW, Kaaks R, Terry KL. Correlates of circulating ovarian cancer early detection markers and their contribution to discrimination of early detection models: results from the EPIC cohort. J Ovarian Res 2017; 10:20. [PMID: 28320479 PMCID: PMC5360038 DOI: 10.1186/s13048-017-0315-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 01/30/2017] [Accepted: 03/08/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Ovarian cancer early detection markers CA125, CA15.3, HE4, and CA72.4 vary between healthy women, limiting their utility for screening. METHODS We evaluated cross-sectional relationships between lifestyle and reproductive factors and these markers among controls (n = 1910) from a nested case-control study in the European Prospective Investigation into Cancer and Nutrition (EPIC). Improvements in discrimination of prediction models adjusting for correlates of the markers were evaluated among postmenopausal women in the nested case-control study (n = 590 cases). Generalized linear models were used to calculate geometric means of CA125, CA15.3, and HE4. CA72.4 above vs. below limit of detection was evaluated using logistic regression. Early detection prediction was modeled using conditional logistic regression. RESULTS CA125 concentrations were lower, and CA15.3 higher, in post- vs. premenopausal women (p ≤ 0.02). Among postmenopausal women, CA125 was higher among women with higher parity and older age at menopause (ptrend ≤ 0.02), but lower among women reporting oophorectomy, hysterectomy, ever use of estrogen-only hormone therapy, or current smoking (p < 0.01). CA15.3 concentrations were higher among heavier women and in former smokers (p ≤ 0.03). HE4 was higher with older age at blood collection and in current smokers, and inversely associated with OC use duration, parity, and older age at menopause (≤ 0.02). No associations were observed with CA72.4. Adjusting for correlates of the markers in prediction models did not improve the discrimination. CONCLUSIONS This study provides insights into sources of variation in ovarian cancer early detection markers in healthy women and informs about the utility of individualizing marker cutpoints based on epidemiologic factors.
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Affiliation(s)
- Renée T. Fortner
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120 Germany
| | - Allison F. Vitonis
- Ob/Gyn Epidemiology Center, Brigham and Women’s Hospital, Boston, MA USA
| | - Helena Schock
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120 Germany
| | - Anika Hüsing
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120 Germany
| | - Theron Johnson
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120 Germany
| | - Raina N. Fichorova
- Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA USA
- Laboratory of Genital Tract Biology, Brigham and Women’s Hospital, Boston, MA USA
| | - Titilayo Fashemi
- Laboratory of Genital Tract Biology, Brigham and Women’s Hospital, Boston, MA USA
| | - Hidemi S. Yamamoto
- Laboratory of Genital Tract Biology, Brigham and Women’s Hospital, Boston, MA USA
| | - Anne Tjønneland
- Unit of Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Louise Hansen
- Unit of Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Kim Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
| | - Marie-Christine Boutron-Ruault
- INSERM, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women’s Health team, Villejuif, F-94805 France
- Université Paris Sud, UMRS 1018, Villejuif, F-94805 France
- Gustave Roussy, Villejuif, F-94805 France
| | - Marina Kvaskoff
- INSERM, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women’s Health team, Villejuif, F-94805 France
- Université Paris Sud, UMRS 1018, Villejuif, F-94805 France
- Gustave Roussy, Villejuif, F-94805 France
| | - Gianluca Severi
- INSERM, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women’s Health team, Villejuif, F-94805 France
- Université Paris Sud, UMRS 1018, Villejuif, F-94805 France
- Gustave Roussy, Villejuif, F-94805 France
- Human Genetics Foundation (HuGeF), Torino, Italy
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Antonia Trichopoulou
- Hellenic Health Foundation, Athens, Greece
- WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Dept. of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Vassiliki Benetou
- Hellenic Health Foundation, Athens, Greece
- WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Dept. of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Carlo La Vecchia
- Hellenic Health Foundation, Athens, Greece
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Domenico Palli
- Cancer Risk Factors and Life-Style Epidemiology Unit, Cancer Research and Prevention Institute – ISPO, Florence, Italy
| | - Sabina Sieri
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rosario Tumino
- Cancer Registry and Histopathology Unit, “Civic - M.P-Arezzo” Hospital, ASP, Ragusa, Italy
| | - Giuseppe Matullo
- Department of Medical Sciences, University of Torino and Human Genetics Foundation – HuGeF, Torino, Italy
| | - Amalia Mattiello
- Dipartimeno di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy
| | - N. Charlotte Onland-Moret
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Petra H. Peeters
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK
| | - Elisabete 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
| | - Inger Torhild Gram
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Mie Jareid
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | | | - Eric J. Duell
- Cancer Epidemiology Research Program, Bellvitge Biomedical Research Institute (IDIBELL), Catalan Institute of Oncology (ICO), Barcelona, Spain
| | - Maria-Jose Sánchez
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - María Dolores Chirlaque
- Department of Epidemiology/Murcia Health Authority, Murcia, Spain
- IMIB-Arrixaca, Murcia University, CIBERESP, Murcia, Spain
| | - Eva Ardanaz
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Navarra Public Health Institute, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Nerea Larrañaga
- Public Health Division and BioDonostia Research Institute and CIBERESP, Basque Regional Health Department, San Sebastian, Spain
| | - Björn Nodin
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Jenny Brändstedt
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Division of Surgery, Skåne University Hospital, Lund, Sweden
| | - Annika Idahl
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | - Kay-Tee Khaw
- Cancer Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Naomi Allen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Marc Gunter
- International Agency for Research on Cancer, Lyon, France
| | | | - Laure Dossus
- International Agency for Research on Cancer, Lyon, France
| | - Melissa A. Merritt
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Daniel W. Cramer
- Ob/Gyn Epidemiology Center, Brigham and Women’s Hospital, Boston, MA USA
- Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA USA
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120 Germany
| | - Kathryn L. Terry
- Ob/Gyn Epidemiology Center, Brigham and Women’s Hospital, Boston, MA USA
- Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA USA
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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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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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Patiño-Villena B, Chirlaque MD, Salmerón D, González E, Navarro C. [Validity of anthropometric measurements and weight perceptions reported by relatives of children under 4 years old]. Gac Sanit 2016; 30:300-3. [PMID: 27268022 DOI: 10.1016/j.gaceta.2016.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 03/21/2016] [Accepted: 03/30/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess the validity of weight and height measurements reported by parents and the perception of their children's weight status in order to assess the prevalence of overweight children under 4 years old. METHODS Cross-sectional study. Anthropometric data was collected by self-report questionnaires completed by parents of children 3-45 months old: 1) information from paediatric check-ups (gold standard); 2) information reported from the home environment; and 3) data from individual perceptions. WHO standards were used. RESULTS Reported height was underestimated, thus reported weight/height and BMI/age were overestimated. Overweight prevalence according to paediatric check-ups was 18.6%, compared to 26.5% reported prevalence, showing a moderate concordance (Kappa: 0.47 [0.34-0.60]), 70% sensitivity and 84% specificity. Subjective perception was 11.2%, representing 30% sensitivity and 93% specificity. CONCLUSIONS The reported information has little validity for population-based studies, as height is underestimated and overweight status is not correctly perceived due to distortion of individual perception. Questionnaires must be validated and awareness raised among families.
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Affiliation(s)
| | - María Dolores Chirlaque
- Servicio de Epidemiología, Consejería de Sanidad, IMIB-Arrixaca, Murcia, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Departamento de Ciencias Socio-Sanitarias, Universidad de Murcia, Murcia, España
| | - Diego Salmerón
- Servicio de Epidemiología, Consejería de Sanidad, IMIB-Arrixaca, Murcia, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Departamento de Ciencias Socio-Sanitarias, Universidad de Murcia, Murcia, España
| | - Eduardo González
- Servicios Municipales de Salud, Ayuntamiento de Murcia, Murcia, España
| | - Carmen Navarro
- Servicio de Epidemiología, Consejería de Sanidad, IMIB-Arrixaca, Murcia, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Departamento de Ciencias Socio-Sanitarias, Universidad de Murcia, Murcia, España
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Huerta JM, Chirlaque MD, Tormo MJ, Buckland G, Ardanaz E, Arriola L, Gavrila D, Salmerón D, Cirera L, Carpe B, Molina-Montes E, Chamosa S, Travier N, Quirós JR, Barricarte A, Agudo A, Sánchez MJ, Navarro C. Work, household, and leisure-time physical activity and risk of mortality in the EPIC-Spain cohort. Prev Med 2016; 85:106-112. [PMID: 26861751 DOI: 10.1016/j.ypmed.2016.02.009] [Citation(s) in RCA: 29] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 01/29/2016] [Accepted: 02/01/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Large-scale longitudinal data on the association of domain-specific physical activity (PA) and mortality is limited. Our objective was to evaluate the association of work, household (HPA), and leisure time PA (LTPA) with overall and cause-specific mortality in the EPIC-Spain study. METHODS 38,379 participants (62.4% women), 30-65years old, and free of chronic disease at baseline were followed-up from recruitment (1992 - 1996) to December 31st, 2008 to ascertain vital status and cause of death. PA was evaluated at baseline and at a 3-year follow-up with a validated questionnaire (EPIC-PAQ) and combined variables were used to classify the participants by sub-domains of PA. Associations with overall, cancer, and cardiovascular mortality risks were assessed using competing risk Cox regression models adjusted by potential confounders. RESULTS After 13.6years of mean follow-up, 1371 deaths were available for analyses. HPA was strongly associated to reduced overall (hazard ratio (HR) for Q4 vs. Q1=0.47 (0.34, 0.64)) and cause-specific mortalities in women and to lower cancer mortality in men (P for trend=0.004), irrespective of age, education, and lifestyle and morbidity variables. LTPA was associated with lower mortality in women (HR for Q4 vs. Q1=0.71 (0.52, 0.98)), but not men. No relationships were found between sedentariness at work and overall mortality. CONCLUSIONS HPA was associated to lower mortality risk in men and women from the EPIC-Spain cohort, whereas LTPA also contributed to reduce risk of death in women. Considering the large proportion of total daily PA that HPA represents in some population groups, these results are of public health importance.
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Affiliation(s)
- José Mª Huerta
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Ronda de Levante, 11, 30008, Murcia, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain.
| | - María Dolores Chirlaque
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Ronda de Levante, 11, 30008, Murcia, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain; Department of Health and Social Sciences, University of Murcia, Campus Universitario de Espinardo, 30100, Murcia, Spain.
| | - María José Tormo
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Ronda de Levante, 11, 30008, Murcia, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain.
| | - Genevieve Buckland
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Gran Via de l'Hospitalet, 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Eva Ardanaz
- CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain; Navarre Public Health Institute, Leyre, 15, 31003 Pamplona, Spain.
| | - Larraitz Arriola
- CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain; Public Health Division of Gipuzkoa, Health Research Institute BIO-Donostia, Basque Government, Avenida de Navarra, 4, 20013 Donostia-San Sebastián, Spain.
| | - Diana Gavrila
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Ronda de Levante, 11, 30008, Murcia, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain.
| | - Diego Salmerón
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Ronda de Levante, 11, 30008, Murcia, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain; Department of Health and Social Sciences, University of Murcia, Campus Universitario de Espinardo, 30100, Murcia, Spain.
| | - Lluís Cirera
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Ronda de Levante, 11, 30008, Murcia, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain; Department of Health and Social Sciences, University of Murcia, Campus Universitario de Espinardo, 30100, Murcia, Spain.
| | - Bienvenida Carpe
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Ronda de Levante, 11, 30008, Murcia, Spain.
| | - Esther Molina-Montes
- CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain; Andalusian School of Public Health, Cuesta del Observatorio, 4, 18011, Granada, Spain.
| | - Saioa Chamosa
- Public Health Division of Gipuzkoa, Health Research Institute BIO-Donostia, Basque Government, Avenida de Navarra, 4, 20013 Donostia-San Sebastián, Spain.
| | - Noemie Travier
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Gran Via de l'Hospitalet, 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain.
| | - José R Quirós
- Public Health Directorate, Ciriaco Miguel Vigil, 9, 33006 Oviedo, Spain.
| | - Aurelio Barricarte
- CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain; Navarre Public Health Institute, Leyre, 15, 31003 Pamplona, Spain.
| | - Antonio Agudo
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO), Gran Via de l'Hospitalet, 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain.
| | - María José Sánchez
- CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain; Andalusian School of Public Health, Cuesta del Observatorio, 4, 18011, Granada, Spain.
| | - Carmen Navarro
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Ronda de Levante, 11, 30008, Murcia, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, 28029, Madrid, Spain; Department of Health and Social Sciences, University of Murcia, Campus Universitario de Espinardo, 30100, Murcia, Spain.
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Cirera L, Huerta JM, Chirlaque MD, Molina-Montes E, Altzibar JM, Ardanaz E, Gavrila D, Colorado-Yohar S, Barricarte A, Arriola L, Quirós JR, Sánchez-Cantalejo E, Sánchez MJ, Agudo A, Navarro C. Life-course social position, obesity and diabetes risk in the EPIC-Spain Cohort. Eur J Public Health 2015; 26:439-45. [PMID: 26635012 DOI: 10.1093/eurpub/ckv218] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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
BACKGROUND The literature has consistently shown that extreme social-economic groups predicted type 2 diabetes mellitus (T2D), rather than summarising the social gradient throughout all society stratification. Body mass index (BMI) was established as the principal mediator, with little support for other anthropometries. Our aim was to investigate an individual life-course social position (LiSoP) gradient and its mediators with T2D risk in the EPIC-Spain cohort. METHODS 36 296 participants (62% women), mostly aged 30-65 years, and free of T2D at baseline (1992-1996) were followed up for a mean of 12.1 years. A combined score of paternal occupation in childhood and own adult education assessed individual life-course social risk accumulation. Hazard ratios of T2D were estimated using Cox regression, stratifying by centre and age, and adjusting for different explanatory models, including anthropometric indices; dietary history; smoking and physical activity lifestyles; and clinical information. RESULTS Final models evidenced significant risks in excess of 63% for middle and 90% for lower classes of LiSoP in men; and of 104 and 126%, respectively, in women. Concurrently, LiSoP presented significant social gradients for T2D risk (P < 0.01) in both sexes. Waist circumference (WC) accounted for most of the risk excess in women, and BMI and WC in men. CONCLUSIONS LiSoP gradient was related to T2D risk in Spanish men and women. WC mostly explained the relationship in both genders, together with BMI in men, yet LiSoP retained an independent effect in final models.
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Affiliation(s)
- Lluís Cirera
- Department of Epidemiology, Murcia Regional Health Council, IMIB - Arrixaca, Murcia, Spain CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain Department of Health and Social Sciences, University of Murcia, Murcia, Spain
| | - José María Huerta
- Department of Epidemiology, Murcia Regional Health Council, IMIB - Arrixaca, Murcia, Spain CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - María Dolores Chirlaque
- Department of Epidemiology, Murcia Regional Health Council, IMIB - Arrixaca, Murcia, Spain CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain Department of Health and Social Sciences, University of Murcia, Murcia, Spain
| | - Esther Molina-Montes
- 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
| | - Jone Miren Altzibar
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain Public Health Division of Gipuzkoa, Instituto BIO-Donostia, Basque Government, Donostia-San Sebastián, Spain
| | - Eva Ardanaz
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain Public Health Institute of Navarra, Pamplona, Spain
| | - Diana Gavrila
- Department of Epidemiology, Murcia Regional Health Council, IMIB - Arrixaca, Murcia, Spain CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Sandra Colorado-Yohar
- 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
| | - Aurelio Barricarte
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain Public Health Institute of Navarra, Pamplona, Spain
| | - Larraitz Arriola
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain Public Health Division of Gipuzkoa, Instituto BIO-Donostia, Basque Government, Donostia-San Sebastián, Spain
| | | | - Emilio Sánchez-Cantalejo
- 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
| | - María José 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
| | - Antonio Agudo
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, l'Hospitalet de Llobregat, Barcelona, Spain
| | - Carmen Navarro
- Department of Epidemiology, Murcia Regional Health Council, IMIB - Arrixaca, Murcia, Spain CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain Department of Health and Social Sciences, University of Murcia, Murcia, Spain
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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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Stiller CA, Trama A, Brewster DH, Verne J, Bouchardy C, Navarro C, Chirlaque MD, Marcos-Gragera R, Visser O, Serraino D, Weiderpass E, Dei Tos AP, Ascoli V. Descriptive epidemiology of Kaposi sarcoma in Europe. Report from the RARECARE project. Cancer Epidemiol 2014; 38:670-8. [PMID: 25454979 DOI: 10.1016/j.canep.2014.09.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 08/06/2014] [Accepted: 09/26/2014] [Indexed: 11/18/2022]
Abstract
Kaposi sarcoma (KS) is a virus-related malignancy which most frequently arises in skin, though visceral sites can also be involved. Infection with Kaposi sarcoma herpes virus (KSHV or HHV-8) is required for development of KS. Nowadays, most cases worldwide occur in persons who are immunosuppressed, usually because of HIV infection or as a result of therapy to combat rejection of a transplanted organ, but classic Kaposi sarcoma is predominantly a disease of the elderly without apparent immunosuppression. We analyzed 2667 KS incident cases diagnosed during 1995-2002 and registered by 75 population-based European cancer registries contributing to the RARECARE project. Total crude and age-standardized incidence rate was 0.3 per 100,000 per year with an estimated 1642 new cases per year in the EU27 countries. Age-standardized incidence rate was 0.8 per 100,000 in Southern Europe but below 0.3 per 100,000 in all other regions. The elevated rate in southern Europe was attributable to a combination of classic Kaposi sarcoma in some Mediterranean countries and the relatively high incidence of AIDS in several countries. Five-year relative survival for 2000-2002 by the period method was 75%. More than 10,000 persons were estimated to be alive in Europe at the beginning of 2008 with a past diagnosis of KS. The aetiological link with suppressed immunity means that many people alive following diagnosis of KS suffer comorbidity from a pre-existing condition. While KS is a rare cancer, it has a relatively good prognosis and so the number of people affected by it is quite large. Thus it provides a notable example of the importance of networking in diagnosis, therapy and research for rare cancers.
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Affiliation(s)
- C A Stiller
- Childhood Cancer Research Group, Department of Paediatrics, University of Oxford, Oxford, UK.
| | - A Trama
- Department of Preventive and Predictive Medicine, Fondazione IRCSS, Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy
| | - D H Brewster
- Scottish Cancer Registry, Information Services Division, National Services Scotland Gyle Square, 1 South Gyle Crescent, Edinburgh EH12 9EB, Scotland, UK
| | - J Verne
- Public Health England Knowledge & Intelligence Team (South West), Grosvenor House, 149 Whiteladies Road, Bristol BS8 2RA, UK
| | - C Bouchardy
- Geneva Cancer Registry, IMSP - University of Geneva 55, Bd de la Cluse, CH-1205 Geneva, Switzerland
| | - C Navarro
- Department of Epidemiology, Murcia Regional Health Authority, Ronda de Levante 11, 30008 Murcia, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain
| | - M D Chirlaque
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - R Marcos-Gragera
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia and Descriptive Epidemiology, Genetics and Cancer Prevention Group [Girona Biomedical Research Institute (IdIBGi)], Catalan Institute of Oncology, Carrer del Sol, 15, 17004 Girona, Spain
| | - O Visser
- Comprehensive Cancer Centre the Netherlands, Registration & Research, PO Box 19.079, 3501 DB Utrecht, The Netherlands
| | - D Serraino
- SOC Epidemiologia e Biostatistica, Friuli Venezia Giulia Cancer Registry, IRCCS Centro di Riferimento Oncologico, Aviano, Italy
| | - E Weiderpass
- Department of Research, Cancer Registry of Norway, Oslo, Norway; Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Samfundet Folkhälsan, Helsinki, Finland
| | - A P Dei Tos
- Department of Oncology and Anatomic Pathology and General Hospital of Treviso, Piazza Ospedale 1, Treviso, Italy
| | - V Ascoli
- Dipartimento di Scienze Radiologiche, Oncologiche ed Anatomopatologiche, Università Sapienza, Viale Regina Elena 324, 00161 Roma, Italy
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Chirlaque MD, Moldenhauer F, Salmerón D, Navarro C. Patrón evolutivo de la incidencia de cáncer de tiroides en la Región de Murcia de 1984 a 2008. Gaceta Sanitaria 2014; 28:397-400. [DOI: 10.1016/j.gaceta.2014.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 05/06/2014] [Accepted: 05/06/2014] [Indexed: 11/29/2022]
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50
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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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