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Heath AK, Muller DC, van den Brandt PA, Critselis E, Gunter M, Vineis P, Weiderpass E, Boeing H, Ferrari P, Merritt MA, Rostgaard‐Hansen AL, Tjønneland A, Overvad K, Katzke V, Srour B, Masala G, Sacerdote C, Ricceri F, Pasanisi F, Bueno‐de‐Mesquita B, Downward GS, Skeie G, Sandanger TM, Crous‐Bou M, Rodríguez‐Barranco M, Amiano P, Huerta JM, Ardanaz E, Drake I, Johansson M, Johansson I, Key T, Papadimitriou N, Riboli E, Tzoulaki I, Tsilidis KK. Diet-wide association study of 92 foods and nutrients and lung cancer risk in the European Prospective Investigation into Cancer and Nutrition study and the Netherlands Cohort Study. Int J Cancer 2022; 151:1935-1946. [PMID: 35830197 PMCID: PMC9804326 DOI: 10.1002/ijc.34211] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 01/05/2023]
Abstract
It is unclear whether diet, and in particular certain foods or nutrients, are associated with lung cancer risk. We assessed associations of 92 dietary factors with lung cancer risk in 327 790 participants in the European Prospective Investigation into Cancer and Nutrition (EPIC). Cox regression yielded adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) per SD higher intake/day of each food/nutrient. Correction for multiple comparisons was performed using the false discovery rate and identified associations were evaluated in the Netherlands Cohort Study (NLCS). In EPIC, 2420 incident lung cancer cases were identified during a median of 15 years of follow-up. Higher intakes of fibre (HR per 1 SD higher intake/day = 0.91, 95% CI 0.87-0.96), fruit (HR = 0.91, 95% CI 0.86-0.96) and vitamin C (HR = 0.91, 95% CI 0.86-0.96) were associated with a lower risk of lung cancer, whereas offal (HR = 1.08, 95% CI 1.03-1.14), retinol (HR = 1.06, 95% CI 1.03-1.10) and beer/cider (HR = 1.04, 95% CI 1.02-1.07) intakes were positively associated with lung cancer risk. Associations did not differ by sex and there was less evidence for associations among never smokers. None of the six associations with overall lung cancer risk identified in EPIC were replicated in the NLCS (2861 cases), however in analyses of histological subtypes, inverse associations of fruit and vitamin C with squamous cell carcinoma were replicated in the NLCS. Overall, there is little evidence that intakes of specific foods and nutrients play a major role in primary lung cancer risk, but fruit and vitamin C intakes seem to be inversely associated with squamous cell lung cancer.
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Affiliation(s)
- Alicia K. Heath
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
| | - David C. Muller
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
| | | | - Elena Critselis
- Biomedical Research Foundation of the Academy of AthensAthensGreece
- Department of Nutrition and DieteticsHarokopio UniversityAthensGreece
- Department of Primary Care and Population HealthUniversity of Nicosia Medical SchoolNicosiaCyprus
| | - Marc Gunter
- International Agency for Research on CancerWorld Health OrganizationLyonFrance
| | - Paolo Vineis
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
| | | | - Heiner Boeing
- Department of EpidemiologyGerman Institute of Human Nutrition Potsdam‐RehbrückeBergholz‐RehbrückeGermany
| | - Pietro Ferrari
- International Agency for Research on CancerWorld Health OrganizationLyonFrance
| | - Melissa A. Merritt
- Cancer Epidemiology ProgramUniversity of Hawaii Cancer CenterHonoluluHawaiiUSA
| | | | | | - Kim Overvad
- Department of Public HealthAarhus UniversityAarhusDenmark
| | - Verena Katzke
- Division of Cancer EpidemiologyGerman Cancer Research Center (DKFZ)HeidelbergGermany
| | - Bernard Srour
- Division of Cancer EpidemiologyGerman Cancer Research Center (DKFZ)HeidelbergGermany
| | - Giovanna Masala
- Institute of Cancer ResearchPrevention and Clinical Network (ISPRO)FlorenceItaly
| | - Carlotta Sacerdote
- Unit of Cancer EpidemiologyCittà della Salute e della Scienza University‐HospitalTurinItaly
| | - Fulvio Ricceri
- Department of Clinical and Biological SciencesUniversity of TurinTurinItaly
- Unit of EpidemiologyRegional Health Service ASL TO3GrugliascoItaly
| | - Fabrizio Pasanisi
- Dipartimento di Medicina Clinica e ChirurgiaFederico II UniversityNaplesItaly
| | - Bas Bueno‐de‐Mesquita
- Centre for Nutrition, Prevention and Health ServicesNational Institute for Public Health and the Environment (RIVM)BilthovenThe Netherlands
| | - George S. Downward
- Institute for Risk Assessment Sciences, Division of Environmental EpidemiologyUtrecht UniversityUtrechtThe Netherlands
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Guri Skeie
- Department of Community Medicine, Faculty of Health SciencesUiT‐The Arctic University of NorwayTromsøNorway
| | - Torkjel M. Sandanger
- Department of Community Medicine, Faculty of Health SciencesUiT‐The Arctic University of NorwayTromsøNorway
| | - Marta Crous‐Bou
- Unit of Nutrition and Cancer, Cancer Epidemiology Research ProgramCatalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de LlobregatBarcelonaSpain
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Miguel Rodríguez‐Barranco
- Escuela Andaluza de Salud Pública (EASP)GranadaSpain
- Instituto de Investigación Biosanitaria ibs.GranadaGranadaSpain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)MadridSpain
| | - Pilar Amiano
- Ministry of Health of the Basque GovernmentSub‐Directorate for Public Health and Addictions of GipuzkoaSan SebastiánSpain
- Biodonostia Health Research InstituteEpidemiology and Public Health AreaSan SebastiánSpain
- CIBER Epidemiology and Public Health (CIBERESP)Instituto de Salud Carlos III (ISCIII)MadridSpain
| | - José María Huerta
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)MadridSpain
- Department of EpidemiologyMurcia Regional Health Council, IMIB‐ArrixacaMurciaSpain
| | - Eva Ardanaz
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)MadridSpain
- Navarra Public Health InstitutePamplonaSpain
- IdiSNANavarra Institute for Health ResearchPamplonaSpain
| | - Isabel Drake
- Department of Clinical Sciences in MalmöLund UniversityMalmöSweden
| | - Mikael Johansson
- Department of Radiation Sciences, OncologyUmeå UniversityUmeåSweden
| | - Ingegerd Johansson
- Department of Odontology, Section of CardiologyUmeå UniversityUmeåSweden
| | - Tim Key
- Cancer Epidemiology Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Nikos Papadimitriou
- Nutrition and Metabolism BranchInternational Agency for Research on CancerLyonFrance
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
| | - Ioanna Tzoulaki
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
- Department of Hygiene and EpidemiologyUniversity of Ioannina School of MedicineIoanninaGreece
| | - Konstantinos K. Tsilidis
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
- Department of Hygiene and EpidemiologyUniversity of Ioannina School of MedicineIoanninaGreece
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