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  • 1
    Keywords: ASSOCIATION ; ACID ; score ; PATTERNS ; WOMEN ; MEN ; PROSPECTIVE COHORT ; FISH ; REGION ; DIET ; FAT ; INDIVIDUALS ; ALCOHOL ; CONSUMPTION ; FRUIT ; nutrition ; VEGETABLES ; HETEROGENEITY ; REGRESSION ; PRODUCTS ; ENERGY-INTAKE ; ADIPOSITY ; metabolic syndrome ; BODY-MASS INDEX ; USA ; EUROPEAN COUNTRIES ; BMI ; FOODS ; WAIST CIRCUMFERENCE ; DAIRY-PRODUCTS ; EPIC-OXFORD PARTICIPANTS ; WEIGHT-LOSS ; Abdominal ; ABDOMINAL ADIPOSITY ; ELDERLY-PEOPLE ; HEALTH-STATUS ; TO-HIP RATIO
    Abstract: Given the lack of consistent evidence of the relationship between Mediterranean dietary patterns and body fat, we assessed the cross-sectional association between adherence to a modified Mediterranean diet, BMI, and waist circumference (WC). A total of 497,308 individuals (70.7% women) aged 25-70 y from 10 European countries participated in this study. Diet was assessed at baseline using detailed validated country-specific questionnaires, and anthropometrical measurements were collected using standardized procedures. The association between the degree of adherence to the modified-Mediterranean Diet Score (mMDS) (including high consumption of vegetables, legumes, fruits and nuts, cereals, fish and seafood, and unsaturated: saturated fatty acids ratio; moderate alcohol intake; and low consumption of meat and meat products and dairy products) and BMI (kg.m(-2)) or WC (cm was modeled through mixed-effects linear regression, controlling for potential confounders. Overall, the mMDS was not significantly associated with BMI. Higher adherence to the Mediterranean diet was significantly associated with lower WC, for a given BMI, in both men (-0.09; 95% CI -0.14 to -0.04) and women (-0.06; 95% CI -0.10 to -0.01). The association was stronger in men (-0.20; 95% CI -0.23 to -0.17) and women (-0.17; 95% CI -0.21 to -0.13) from Northern European countries. Despite the observed heterogeneity among regions, results of this study suggest that adherence to a modified Mediterranean diet, high in foods of vegetable origin and unsaturated fatty acids, is associated with lower abdominal adiposity measured by WC in European men and women. J. Nutr. 139: 1728-1737, 2009
    Type of Publication: Journal article published
    PubMed ID: 19571036
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  • 2
    Keywords: CANCER ; MODEL ; MODELS ; FOLLOW-UP ; COHORT ; POPULATION ; INTERVENTION ; ASSOCIATION ; PATTERNS ; DESIGN ; ENERGY ; AGE ; WOMEN ; MEN ; OBESITY ; smoking ; COUNTRIES ; DIET ; FAT ; BLOOD-PRESSURE ; ALCOHOL ; PROJECT ; CONSUMPTION ; nutrition ; SMOKERS ; CALIBRATION ; MANAGEMENT ; physical activity ; ASSOCIATIONS ; PATTERN ; WEIGHT ; ENERGY-INTAKE ; LOW-CARBOHYDRATE ; PHYSICAL-ACTIVITY ; dietary patterns ; BODY-MASS INDEX ; prospective ; EUROPEAN COUNTRIES ; WAIST CIRCUMFERENCE ; WEIGHT CHANGE ; RANDOMIZED CLINICAL-TRIAL ; Lead ; Follow up ; weight gain ; OBESE ADULTS ; PLASMA LEPTIN ; PROTEIN DIET
    Abstract: Background: Meat intake may be related to weight gain because of its high energy and fat content. Some observational studies have shown that meat consumption is positively associated with weight gain, but intervention studies have shown mixed results. Objective: Our objective was to assess the association between consumption of total meat, red meat, poultry, and processed meat and weight gain after 5 y of follow-up, on average, in the large European population who participated in the European Prospective Investigation into Cancer and Nutrition-Physical Activity, Nutrition, Alcohol, Cessation of Smoking, Eating Out of Home and Obesity (EPIC-PANACEA) project. Design: A total of 103,455 men and 270,348 women aged 25-70 y were recruited between 1992 and 2000 in 10 European countries. Diet was assessed at baseline with the use of country-specific validated questionnaires. A dietary calibration study was conducted in a representative subsample of the cohort. Weight and height were measured at baseline and self-reported at follow-up in most centers. Associations between energy from meat (kcal/d) and annual weight change (g/y) were assessed with the use of linear mixed models, controlled for age, sex, total energy intake, physical activity, dietary patterns, and other potential confounders. Results: Total meat consumption was positively associated with weight gain in men and women, in normal-weight and overweight subjects, and in smokers and nonsmokers. With adjustment for estimated energy intake, an increase in meat intake of 250 g/d (eg, one steak at approximate to 450 kcal) would lead to a 2-kg higher weight gain after 5 y (95% CI: 1.5, 2.7 kg). Positive associations were observed for red meat, poultry, and processed meat. Conclusion: Our results suggest that a decrease in meat consumption may improve weight management. Am J Clin Nutr 2010; 92: 398-407
    Type of Publication: Journal article published
    PubMed ID: 20592131
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  • 3
    Keywords: CANCER ; LUNG-CANCER ; MORTALITY ; MEN ; smoking ; TOBACCO ; OBSTRUCTIVE PULMONARY-DISEASE ; cigar ; pipe
    Abstract: The carcinogenicity of cigar and pipe smoking is established but the effect of detailed smoking characteristics is less well defined. We examined the effects on cancer incidence of exclusive cigar and pipe smoking, and in combination with cigarettes, among 102,395 men from Denmark, Germany, Spain, Sweden and the United Kingdom in the EPIC cohort. Hazard ratios (HR) and their 95% confidence intervals (CI) for cancer during a median 9-year follow-up from ages 35 to 70 years were estimated using proportional hazards models. Compared to never smokers, HR of cancers of lung, upper aerodigestive tract and bladder combined was 2.2 (95% CI: 1.3, 3.8) for exclusive cigar smokers (16 cases), 3.0 (2.1, 4.5) for exclusive pipe smokers (33 cases) and 5.3 (4.4, 6.4) for exclusive cigarette smokers (1,069 cases). For each smoking type, effects were stronger in current smokers than in ex-smokers and in inhalers than in non-inhalers. Ever smokers of both cigarettes and cigars [HR 5.7 (4.4, 7.3), 120 cases] and cigarettes and pipes [5.1 (4.1, 6.4), 247 cases] had as high a raised risk as had exclusive cigarette smokers. In these smokers, the magnitude of the raised risk was smaller if they had switched to cigars or pipes only (i.e., quit cigarettes) and had not compensated with greater smoking intensity. Cigar and pipe smoking is not a safe alternative to cigarette smoking. The lower cancer risk of cigar and pipe smokers as compared to cigarette smokers is explained by lesser degree of inhalation and lower smoking intensity
    Type of Publication: Journal article published
    PubMed ID: 20162568
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  • 4
    Keywords: INFECTION ; POLYMORPHISMS ; MEN ; COLORECTAL-CANCER ; DNA methylation ; INDOLEAMINE 2,3-DIOXYGENASE ; FOLATE ; ONE-CARBON METABOLISM ; SYSTEM ACTIVATION ; NEOPTERIN
    Abstract: The one-carbon metabolism (OCM) is considered key in maintaining DNA integrity and regulating gene expression, and may be involved in the process of carcinogenesis. Several B-vitamins and amino acids have been implicated in lung cancer risk, via the OCM directly as well as immune system activation. However it is unclear whether these factors act independently or through complex mechanisms. The current study applies structural equations modelling (SEM) to further disentangle the mechanisms involved in lung carcinogenesis. SEM allows simultaneous estimation of linear relations where a variable can be the outcome in one equation and the predictor in another, as well as allowing estimation using latent variables (factors estimated by correlation matrix). A large number of biomarkers have been analysed from 891 lung cancer cases and 1,747 controls nested within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Four putative mechanisms in the OCM and immunity were investigated in relation to lung cancer risk: methionine-homocysteine metabolism, folate cycle, transsulfuration, and mechanisms involved in inflammation and immune activation, all adjusted for tobacco exposure. The hypothesized SEM model confirmed a direct and protective effect for factors representing methionine-homocysteine metabolism (p = 0.020) and immune activation (p = 0.021), and an indirect protective effect of folate cycle (p = 0.019), after adjustment for tobacco smoking. In conclusion, our results show that in the investigation of the involvement of the OCM, the folate cycle and immune system in lung carcinogenesis, it is important to consider complex pathways (by applying SEM) rather than the effects of single vitamins or nutrients (e.g. using traditional multiple regression). In our study SEM were able to suggest a greater role of the methionine-homocysteine metabolism and immune activation over other potential mechanisms.
    Type of Publication: Journal article published
    PubMed ID: 23532743
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  • 5
    Keywords: COHORT ; RISK ; INTERVENTION ; HEALTH ; REPRODUCIBILITY ; MEN ; COLON-CANCER ; dietary fiber ; POSTMENOPAUSAL WOMEN ; PRODUCTS
    Abstract: BACKGROUND: Few studies have investigated the association between whole-grain intake and colorectal cancer. Because whole-grain intake estimation might be prone to measurement errors, more objective measures (eg, biomarkers) could assist in investigating such associations. METHODS: The association between alkylresorcinols, biomarkers of whole-grain rye and wheat intake, and colorectal cancer incidence were investigated using prediagnostic plasma samples from colorectal cancer case patients and matched control subjects nested within the European Prospective Investigation into Cancer and Nutrition. We included 1372 incident colorectal cancer case patients and 1372 individual matched control subjects and calculated the incidence rate ratios (IRRs) for overall and anatomical subsites of colorectal cancer using conditional logistic regression adjusted for potential confounders. Regional differences (Scandinavia, the Mediterranean, Central Europe) were also explored. RESULTS: High plasma total alkylresorcinol concentration was associated with lower incidence of distal colon cancer; the adjusted incidence rate ratio of distal colon cancer for the highest vs lowest quartile of plasma total alkylresorcinols was 0.48 (95% confidence interval [CI] = 0.28 to 0.83). An inverse association between plasma total alkylresorcinol concentrations and colon cancer was found for Scandinavian participants (IRR per doubling = 0.83; 95% CI = 0.70 to 0.98). However, plasma total alkylresorcinol concentrations were not associated with overall colorectal cancer, proximal colon cancer, or rectal cancer. Plasma alkylresorcinols concentrations were associated with colon and distal colon cancer only in Central Europe and Scandinavia (ie, areas where alkylresorcinol levels were higher). CONCLUSIONS: High concentrations of plasma alkylresorcinols were associated with a lower incidence of distal colon cancer but not with overall colorectal cancer, proximal colon cancer, and rectal cancer.
    Type of Publication: Journal article published
    PubMed ID: 24317181
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  • 6
    Keywords: CANCER ; CELLS ; BLOOD ; CELL ; FOLLOW-UP ; INFORMATION ; COHORT ; cohort study ; DISEASE ; DISEASES ; HISTORY ; LONG-TERM ; POPULATION ; RISK ; SAMPLES ; HEART ; RISK-FACTORS ; CYCLE ; ASSOCIATION ; FREQUENCY ; FREQUENCIES ; HEALTH ; PLASMA ; WOMEN ; MEN ; risk factors ; smoking ; COUNTRIES ; COMPONENT ; DATABASE ; PRESSURE ; DIET ; nutrition ; SERUM ; ASSOCIATIONS ; RE ; fat distribution ; development ; EVENTS ; PLASMA-LEVELS ; prospective ; prospective study ; DIETARY ASSESSMENT METHODS ; RISK-FACTOR ; study protocol ; CORONARY-ARTERY-DISEASE ; EPIC heart ; HIGH BLOOD-PRESSURE ; NORFOLK COHORT
    Abstract: EPIC-Heart is the cardiovascular component of the European Prospective Investigation into Cancer and Nutrition ( EPIC), a multi-centre prospective cohort study investigating the relationship between nutrition and major chronic disease outcomes. Its objective is to advance understanding about the separate and combined influences of lifestyle ( especially dietary), environmental, metabolic and genetic factors in the development of cardiovascular diseases by making best possible use of the unusually informative database and biological samples in EPIC. Between 1992 and 2000, 519,978 participants ( 366,521 women and 153,457 men, mostly aged 35 - 70 years) in 23 centres in 10 European countries commenced follow-up for causespecific mortality, cancer incidence and major cardiovascular morbidity. Dietary information was collected with quantitative questionnaires or semi-quantitative food frequency questionnaires, including a 24-h dietary recall sub-study to help calibrate the dietary measurements. Information was collected on physical activity, tobacco smoking, alcohol consumption, occupational history, socio-economic status, and history of previous illnesses. Anthropometric measurements and blood pressure recordings were made in the majority of participants. Blood samples were taken from 385,747 individuals, from which plasma, serum, red cells, and buffy coat fractions were separated and aliquoted for long-term storage. By 2004, an estimated 10,000 incident fatal and non-fatal coronary and stroke events had been recorded. The first cycle of EPIC-Heart analyses will assess associations of coronary mortality with several prominent dietary hypotheses and with established cardiovascular risk factors. Subsequent analyses will extend this approach to non-fatal cardiovascular outcomes and to further dietary, biochemical and genetic factors
    Type of Publication: Journal article published
    PubMed ID: 17295097
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  • 7
    Keywords: DIAGNOSIS ; cohort study ; MORTALITY ; WOMEN ; CIGARETTE-SMOKING ; MEN ; OBESITY ; diabetes ; GLUCOSE ; EPIC ; pancreatic cancer ; METAANALYSIS ; INSULIN-RESISTANCE ; OVERWEIGHT ; C-PEPTIDE ; HbA(1c)
    Abstract: Aims/hypothesis There has been long-standing debate about whether diabetes is a causal risk factor for pancreatic cancer or a consequence of tumour development. Prospective epidemiological studies have shown variable relationships between pancreatic cancer risk and blood markers of glucose and insulin metabolism, overall and as a function of lag times between marker measurements (blood donation) and date of tumour diagnosis. Methods Pre-diagnostic levels of HbA(1c) and C-peptide were measured for 466 participants with pancreatic cancer and 466 individually matched controls within the European Prospective Investigation into Cancer and Nutrition. Conditional logistic regression models were used to estimate ORs for pancreatic cancer. Results Pancreatic cancer risk gradually increased with increasing pre-diagnostic HbA(1c) levels up to an OR of 2.42 (95% CI 1.33, 4.39 highest [〉= 6.5%, 48 mmol/mol] vs lowest [〈= 5.4%, 36 mmol/mol] category), even for individuals with HbA(1c) levels within the non-diabetic range. C-peptide levels showed no significant relationship with pancreatic cancer risk, irrespective of fasting status. Analyses showed no clear trends towards increasing hyperglycaemia (as marked by HbA(1c) levels) or reduced pancreatic beta cell responsiveness (as marked by C-peptide levels) with decreasing time intervals from blood donation to cancer diagnosis. Conclusions/interpretation Our data on HbA(1c) show that individuals who develop exocrine pancreatic cancer tend to have moderate increases in HbA(1c) levels, relatively independently of obesity and insulin resistance-the classic and major risk factors for type 2 diabetes. While there is no strong difference by lag time, more data are needed on this in order to reach a firm conclusion
    Type of Publication: Journal article published
    PubMed ID: 21953276
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  • 8
    Keywords: DISEASE ; HEPATOCELLULAR-CARCINOMA ; POPULATION ; BODY-WEIGHT ; MEN ; nutrition ; EPIDEMIOLOGIC EVIDENCE ; FATTY LIVER ; cholangiocarcinoma ; VISCERAL FAT
    Abstract: General obesity has been positively associated with risk of liver and probably with biliary tract cancer, but little is known about abdominal obesity or weight gain during adulthood. We used multivariable Cox proportional hazard models to investigate associations between weight, body mass index, waist and hip circumference, waist-to-hip and waist-to-height ratio (WHtR), weight change during adulthood and risk of hepatocellular carcinoma (HCC), intrahepatic (IBDC) and extrahepatic bile duct system cancer [EBDSC including gallbladder cancer (GBC)] among 359,525 men and women in the European Prospective Investigation into Cancer and Nutrition study. Hepatitis B and C virus status was measured in a nested case-control subset. During a mean follow-up of 8.6 years, 177 cases of HCC, 58 cases of IBDC and 210 cases of EBDSC, including 76 cases of GBC, occurred. All anthropometric measures were positively associated with risk of HCC and GBC. WHtR showed the strongest association with HCC [relative risk (RR) comparing extreme tertiles 3.51, 95% confidence interval (95% CI): 2.09-5.87; p(trend) 〈 0.0001] and with GBC (RR: 1.56, 95% CI: 1.12-2.16 for an increment of one unit in WHtR). Weight gain during adulthood was also positively associated with HCC when comparing extreme tertiles (RR: 2.48, 95% CI: 1.49-4.13; 〈0.001). No statistically significant association was observed between obesity and risk of IBDC and EBDSC. Our results provide evidence of an association between obesity, particularly abdominal obesity, and risk of HCC and GBC. Our findings support public health recommendations to reduce the prevalence of obesity and weight gain in adulthood for HCC and GBC prevention in Western populations.
    Type of Publication: Journal article published
    PubMed ID: 22618881
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  • 9
    Keywords: CANCER ; BLOOD ; Germany ; THERAPY ; RISK ; RISKS ; PROTEIN ; colon ; CYCLE ; ASSOCIATION ; hormone ; HEALTH ; resistance ; AGE ; WOMEN ; MEN ; OBESITY ; smoking ; COLORECTAL-CANCER ; cancer risk ; COLON-CANCER ; cholesterol ; C-REACTIVE PROTEIN ; body mass index ; nutrition ; education ; NESTED CASE-CONTROL ; CROHNS-DISEASE ; inflammation ; insulin ; SERUM ; case-control study ; REGRESSION ; ASSOCIATIONS ; colon cancer ; METAANALYSIS ; PHASE ; INSULIN-RESISTANCE ; metabolic syndrome ; REPLACEMENT THERAPY ; prospective ; CANCER-RISK ; colorectal neoplasms ; C-PEPTIDE ; REPLACEMENT ; WAIST CIRCUMFERENCE ; INFLAMMATORY MARKERS ; nested case-control study ; BODY-MASS ; COLLECTION ; HORMONE-THERAPY ; Abdominal ; Hyperinsulinism ; journals ; nested case control study ; hyperglycemia ; hyperlipidemias
    Abstract: The authors investigated associations between serum C-reactive protein (CRP) concentrations and colon and rectal cancer risk in a nested case-control study within the European Prospective Investigation into Cancer and Nutrition (1992-2003) among 1,096 incident cases and 1,096 controls selected using risk-set sampling and matched on study center, age, sex, time of blood collection, fasting status, menopausal status, menstrual cycle phase, and hormone replacement therapy. In conditional logistic regression with adjustment for education, smoking, nutritional factors, body mass index, and waist circumference, CRP showed a significant nonlinear association with colon cancer risk but not rectal cancer risk. Multivariable-adjusted relative risks for CRP concentrations of 〉= 3.0 mg/L versus 〈 1.0 mg/L were 1.36 (95% confidence interval (CI): 1.00, 1.85; P-trend = 0.01) for colon cancer and 1.02 (95% CI: 0.67, 1.57; P-trend = 0.65) for rectal cancer. Colon cancer risk was significantly increased in men (relative risk = 1.74, 95% CI: 1.11, 2.73; P-trend = 0.01) but not in women (relative risk = 1.06, 95% CI: 0.67, 1.68; P-trend = 0.13). Additional adjustment for C-peptide, glycated hemoglobin, and high density lipoprotein cholesterol did not attenuate these results. These data provide evidence that elevated CRP concentrations are related to a higher risk of colon cancer but not rectal cancer, predominantly among men and independently of obesity, insulin resistance, and dyslipidemia
    Type of Publication: Journal article published
    PubMed ID: 20634278
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  • 10
    Keywords: MEN ; COLORECTAL-CANCER ; MASS-SPECTROMETRY ; DIETARY ; SERUM ; HOMOCYSTEINE ; MALE SMOKERS ; SWEDISH WOMEN ; MICROBIOLOGICAL ASSAY ; FORTIFICATION
    Abstract: Folate intake has shown an inverse association with pancreatic cancer; nevertheless, results from plasma measurements were inconsistent. The aim of this study is to examine the association between plasma total homocysteine, methionine, folate, cobalamin, pyridoxal 5'-phosphate, riboflavin, flavin mononucleotide and pancreatic cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC). We conducted a nested case-control study in the EPIC cohort, which has an average of 9.6 years of follow-up (1992-2006), using 463 incident pancreatic cancer cases. Controls were matched to each case by center, sex, age (+/- 1 year), date (+/- 1 year) and time (+/- 3 h) at blood collection and fasting status. Conditional logistic regression was used to calculate the odds ratios (OR) and 95% confidence intervals (CI), adjusting for education, smoking status, plasma cotinine concentration, alcohol drinking, body mass index and diabetes status. We observed a U-shaped association between plasma folate and pancreatic cancer risk. The ORs for plasma folate 〈= 5, 5-10, 10-15 (reference), 15-20, and 〉 20 nmol/L were 1.58 (95% CI = 0.72-3.46), 1.39 (0.93-2.08), 1.0 (reference), 0.79 (0.52-1.21), and 1.34 (0.89-2.02), respectively. Methionine was associated with an increased risk in men (per quintile increment: OR = 1.17, 95% CI = 1.00-1.38) but not in women (OR = 0.91, 95% CI = 0.78-1.07; p for heterogeneity 〈 0.01). Our results suggest a U-shaped association between plasma folate and pancreatic cancer risk in both men and women. The positive association that we observed between methionine and pancreatic cancer may be sex dependent and may differ by time of follow-up. However, the mechanisms behind the observed associations warrant further investigation.
    Type of Publication: Journal article published
    PubMed ID: 21411310
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