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1. Serologic markers of Chlamydia trachomatis and other sexually transmitted infections and subsequent ovarian cancer risk : Results from the EPIC cohort

Author: Idahl, Annika, Le Cornet, Charlotte, Gonzalez Maldonado, Sandra, Waterboer, Tim, Bender, Noemi, Tjonneland, Anne, Hansen, Louise, Boutron-Ruault, Marie-Christine, Fournier, Agnes, Kvaskoff, Marina, Boeing, Heiner, Trichopoulou, Antonia, Valanou, Elisavet, Peppa, Eleni, Palli, Domenico, Agnoli, Claudia, Mattiello, Amalia, Tumino, Rosario, Sacerdote, Carlotta, Onland-Moret, N. Charlotte, Gram, Inger T., Weiderpass, Elisabete, Quiros, Jose R., Duell, Eric J., Sanchez, Maria-Jose, Chirlaque, Maria-Dolores, Barricarte, Aurelio, Gil, Leire, Brandstedt, Jenny, Riesbeck, Kristian, Lundin, Eva, Khaw, Kay-Tee, Perez-Cornago, Aurora, Gunter, Marc J., Dossus, Laure, Kaaks, Rudolf, Fortner, Renee T., Idahl, Annika, Le Cornet, Charlotte, Gonzalez Maldonado, Sandra, Waterboer, Tim, Bender, Noemi, Tjonneland, Anne, Hansen, Louise, Boutron-Ruault, Marie-Christine, Fournier, Agnes, Kvaskoff, Marina, Boeing, Heiner, Trichopoulou, Antonia, Valanou, Elisavet, Peppa, Eleni, Palli, Domenico, Agnoli, Claudia, Mattiello, Amalia, Tumino, Rosario, Sacerdote, Carlotta, Onland-Moret, N. Charlotte, Gram, Inger T., Weiderpass, Elisabete, Quiros, Jose R., Duell, Eric J., Sanchez, Maria-Jose, Chirlaque, Maria-Dolores, Barricarte, Aurelio, Gil, Leire, Brandstedt, Jenny, Riesbeck, Kristian, Lundin, Eva, Khaw, Kay-Tee, Perez-Cornago, Aurora, Gunter, Marc J., Dossus, Laure, Kaaks, Rudolf, and Fortner, Renee T.
Abstract: A substantial proportion of epithelial ovarian cancer (EOC) arises in the fallopian tube and other epithelia of the upper genital tract; these epithelia may incur damage and neoplastic transformation after sexually transmitted infections (STI) and pelvic inflammatory disease. We investigated the hypothesis that past STI infection, particularly Chlamydia trachomatis, is associated with higher EOC risk in a nested case‐control study within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort including 791 cases and 1669 matched controls. Serum antibodies against C. trachomatis, Mycoplasma genitalium, herpes simplex virus type 2 (HSV‐2) and human papillomavirus (HPV) 16, 18 and 45 were assessed using multiplex fluorescent bead‐based serology. Conditional logistic regression was used to estimate relative risks (RR) and 95% confidence intervals (CI) comparing women with positive vs. negative serology. A total of 40% of the study population was seropositive to at least one STI. Positive serology to C. trachomatis Pgp3 antibodies was not associated with EOC risk overall, but with higher risk of the mucinous histotype (RR = 2.30 [95% CI = 1.22‐4.32]). Positive serology for chlamydia heat shock protein 60 (cHSP60‐1) was associated with higher risk of EOC overall (1.36 [1.13‐1.64]) and with the serous subtype (1.44 [1.12‐1.85]). None of the other evaluated STIs were associated with EOC risk overall; however, HSV‐2 was associated with higher risk of endometrioid EOC (2.35 [1.24‐4.43]). The findings of our study suggest a potential role of C. trachomatis in the carcinogenesis of serous and mucinous EOC, while HSV‐2 might promote the development of endometrioid disease.
Published: 2020
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2. Replacement of Red and Processed Meat With Other Food Sources of Protein and the Risk of Type 2 Diabetes in European Populations : The EPIC-InterAct Study

Author: Ibsen, Daniel B., Steur, Marinka, Imamura, Fumiaki, Overvad, Kim, Schulze, Matthias B., Bendinelli, Benedetta, Guevara, Marcela, Agudo, Antonio, Amiano, Pilar, Aune, Dagfinn, Barricarte, Aurelio, Ericson, Ulrika, Fagherazzi, Guy, Franks, Paul W., Freisling, Heinz, Quiros, Jose R., Grioni, Sara, Heath, Alicia K., Huybrechts, Inge, Katze, Verena, Laouali, Nasser, Mancini, Francesca, Masala, Giovanna, Olsen, Anja, Papier, Keren, Ramne, Stina, Rolandsson, Olov, Sacerdote, Carlotta, Sánchez, Maria-José, Santiuste, Carmen, Simeon, Vittorio, Spijkerman, Annemieke M. W., Srour, Bernard, Tjønneland, Anne, Tong, Tammy Y. N., Tumino, Rosario, van der Schouw, Yvonne T., Weiderpass, Elisabete, Wittenbecher, Clemens, Sharp, Stephen J., Riboli, Elio, Forouhi, Nita G., Wareham, Nick J., Ibsen, Daniel B., Steur, Marinka, Imamura, Fumiaki, Overvad, Kim, Schulze, Matthias B., Bendinelli, Benedetta, Guevara, Marcela, Agudo, Antonio, Amiano, Pilar, Aune, Dagfinn, Barricarte, Aurelio, Ericson, Ulrika, Fagherazzi, Guy, Franks, Paul W., Freisling, Heinz, Quiros, Jose R., Grioni, Sara, Heath, Alicia K., Huybrechts, Inge, Katze, Verena, Laouali, Nasser, Mancini, Francesca, Masala, Giovanna, Olsen, Anja, Papier, Keren, Ramne, Stina, Rolandsson, Olov, Sacerdote, Carlotta, Sánchez, Maria-José, Santiuste, Carmen, Simeon, Vittorio, Spijkerman, Annemieke M. W., Srour, Bernard, Tjønneland, Anne, Tong, Tammy Y. N., Tumino, Rosario, van der Schouw, Yvonne T., Weiderpass, Elisabete, Wittenbecher, Clemens, Sharp, Stephen J., Riboli, Elio, Forouhi, Nita G., and Wareham, Nick J.
Abstract: OBJECTIVE: There is sparse evidence for the association of suitable food substitutions for red and processed meat on the risk of type 2 diabetes. We modeled the association between replacing red and processed meat with other protein sources and the risk of type 2 diabetes and estimated its population impact. RESEARCH DESIGN AND METHODS: The European Prospective Investigation into Cancer (EPIC)-InterAct case cohort included 11,741 individuals with type 2 diabetes and a subcohort of 15,450 participants in eight countries. We modeled the replacement of self-reported red and processed meat with poultry, fish, eggs, legumes, cheese, cereals, yogurt, milk, and nuts. Country-specific hazard ratios (HRs) for incident type 2 diabetes were estimated by Prentice-weighted Cox regression and pooled using random-effects meta-analysis. RESULTS: There was a lower hazard for type 2 diabetes for the modeled replacement of red and processed meat (50 g/day) with cheese (HR 0.90, 95% CI 0.83-0.97) (30 g/day), yogurt (0.90, 0.86-0.95) (70 g/day), nuts (0.90, 0.84-0.96) (10 g/day), or cereals (0.92, 0.88-0.96) (30 g/day) but not for replacements with poultry, fish, eggs, legumes, or milk. If a causal association is assumed, replacing red and processed meat with cheese, yogurt, or nuts could prevent 8.8%, 8.3%, or 7.5%, respectively, of new cases of type 2 diabetes. CONCLUSIONS: Replacement of red and processed meat with cheese, yogurt, nuts, or cereals was associated with a lower rate of type 2 diabetes. Substituting red and processed meat by other protein sources may contribute to the prevention of incident type 2 diabetes in European populations.
Published: 2020
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3. Serologic markers of Chlamydia trachomatis and other sexually transmitted infections and subsequent ovarian cancer risk : Results from the EPIC cohort

Author: Idahl, Annika, Le Cornet, Charlotte, Gonzalez Maldonado, Sandra, Waterboer, Tim, Bender, Noemi, Tjonneland, Anne, Hansen, Louise, Boutron-Ruault, Marie-Christine, Fournier, Agnes, Kvaskoff, Marina, Boeing, Heiner, Trichopoulou, Antonia, Valanou, Elisavet, Peppa, Eleni, Palli, Domenico, Agnoli, Claudia, Mattiello, Amalia, Tumino, Rosario, Sacerdote, Carlotta, Onland-Moret, N. Charlotte, Gram, Inger T., Weiderpass, Elisabete, Quiros, Jose R., Duell, Eric J., Sanchez, Maria-Jose, Chirlaque, Maria-Dolores, Barricarte, Aurelio, Gil, Leire, Brandstedt, Jenny, Riesbeck, Kristian, Lundin, Eva, Khaw, Kay-Tee, Perez-Cornago, Aurora, Gunter, Marc J., Dossus, Laure, Kaaks, Rudolf, Fortner, Renee T., Idahl, Annika, Le Cornet, Charlotte, Gonzalez Maldonado, Sandra, Waterboer, Tim, Bender, Noemi, Tjonneland, Anne, Hansen, Louise, Boutron-Ruault, Marie-Christine, Fournier, Agnes, Kvaskoff, Marina, Boeing, Heiner, Trichopoulou, Antonia, Valanou, Elisavet, Peppa, Eleni, Palli, Domenico, Agnoli, Claudia, Mattiello, Amalia, Tumino, Rosario, Sacerdote, Carlotta, Onland-Moret, N. Charlotte, Gram, Inger T., Weiderpass, Elisabete, Quiros, Jose R., Duell, Eric J., Sanchez, Maria-Jose, Chirlaque, Maria-Dolores, Barricarte, Aurelio, Gil, Leire, Brandstedt, Jenny, Riesbeck, Kristian, Lundin, Eva, Khaw, Kay-Tee, Perez-Cornago, Aurora, Gunter, Marc J., Dossus, Laure, Kaaks, Rudolf, and Fortner, Renee T.
Abstract: A substantial proportion of epithelial ovarian cancer (EOC) arises in the fallopian tube and other epithelia of the upper genital tract; these epithelia may incur damage and neoplastic transformation after sexually transmitted infections (STI) and pelvic inflammatory disease. We investigated the hypothesis that past STI infection, particularly Chlamydia trachomatis, is associated with higher EOC risk in a nested case‐control study within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort including 791 cases and 1669 matched controls. Serum antibodies against C. trachomatis, Mycoplasma genitalium, herpes simplex virus type 2 (HSV‐2) and human papillomavirus (HPV) 16, 18 and 45 were assessed using multiplex fluorescent bead‐based serology. Conditional logistic regression was used to estimate relative risks (RR) and 95% confidence intervals (CI) comparing women with positive vs. negative serology. A total of 40% of the study population was seropositive to at least one STI. Positive serology to C. trachomatis Pgp3 antibodies was not associated with EOC risk overall, but with higher risk of the mucinous histotype (RR = 2.30 [95% CI = 1.22‐4.32]). Positive serology for chlamydia heat shock protein 60 (cHSP60‐1) was associated with higher risk of EOC overall (1.36 [1.13‐1.64]) and with the serous subtype (1.44 [1.12‐1.85]). None of the other evaluated STIs were associated with EOC risk overall; however, HSV‐2 was associated with higher risk of endometrioid EOC (2.35 [1.24‐4.43]). The findings of our study suggest a potential role of C. trachomatis in the carcinogenesis of serous and mucinous EOC, while HSV‐2 might promote the development of endometrioid disease.
Published: 2020
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4. Dietary and Circulating Fatty Acids and Ovarian Cancer Risk in the European Prospective Investigation into Cancer and Nutrition

Author: Yammine, Sahar, Huybrechts, Inge, Biessy, Carine, Dossus, Laure, Aglago, Elom K., Naudin, Sabine, Ferrari, Pietro, Weiderpass, Elisabete, Tjonneland, Anne, Hansen, Louise, Overvad, Kim, Mancini, Francesca R., Boutron-Ruault, Marie-Christine, Kvaskoff, Marina, Fortner, Renee T., Kaaks, Rudolf, Schulze, Matthias B., Boeing, Heiner, Trichopoulou, Antonia, Karakatsani, Anna, La Vecchia, Carlo, Benetou, Vassiliki, Masala, Giovanna, Krogh, Vittorio, Mattiello, Amalia, Macciotta, Alessandra, Gram, Inger T., Skeie, Guri, Quiros, Jose R., Agudo, Antonio, Sanchez, Maria-Jose, Chirlaque, Maria-Dolores, Ardanaz, Eva, Gil, Leire, Sartor, Hanna, Drake, Isabel, Idahl, Annika, Lundin, Eva, Aune, Dagfinn, Ward, Heather, Merritt, Melissa A., Allen, Naomi E., Gunter, Marc J., Chajes, Veronique, Yammine, Sahar, Huybrechts, Inge, Biessy, Carine, Dossus, Laure, Aglago, Elom K., Naudin, Sabine, Ferrari, Pietro, Weiderpass, Elisabete, Tjonneland, Anne, Hansen, Louise, Overvad, Kim, Mancini, Francesca R., Boutron-Ruault, Marie-Christine, Kvaskoff, Marina, Fortner, Renee T., Kaaks, Rudolf, Schulze, Matthias B., Boeing, Heiner, Trichopoulou, Antonia, Karakatsani, Anna, La Vecchia, Carlo, Benetou, Vassiliki, Masala, Giovanna, Krogh, Vittorio, Mattiello, Amalia, Macciotta, Alessandra, Gram, Inger T., Skeie, Guri, Quiros, Jose R., Agudo, Antonio, Sanchez, Maria-Jose, Chirlaque, Maria-Dolores, Ardanaz, Eva, Gil, Leire, Sartor, Hanna, Drake, Isabel, Idahl, Annika, Lundin, Eva, Aune, Dagfinn, Ward, Heather, Merritt, Melissa A., Allen, Naomi E., Gunter, Marc J., and Chajes, Veronique
Abstract: Background: Fatty acids impact obesity, estrogens, and inflammation, which are risk factors for ovarian cancer. Few epidemiologic studies have investigated the association of fatty acids with ovarian cancer. Methods: Within the European Prospective Investigation into Cancer and Nutrition (EPIC), 1,486 incident ovarian cancer cases were identified. Cox proportional hazard models with adjustment for ovarian cancer risk factors were used to estimate HRs of ovarian cancer across quintiles of intake of fatty acids. False discovery rate was computed to control for multiple testing. Multivariable conditional logistic regression models were used to estimate ORs of ovarian cancer across tertiles of plasma fatty acids among 633 cases and two matched controls in a nested case-control analysis. Results: Apositive association was found between ovarian cancer and intake of industrial trans elaidic acid [HR comparing fifth with first quintile(Q5-Q1) = 1.29; 95% confidence interval (CI) = 1.03-1.62; P-trend = 0.02, q-value = 0.06]. Dietary intakes of n-6 linoleic acid (HRQ5-Q1 = 1.10; 95% CI = 1.01-1.21; P-trend = 0.03) and n-3 alpha-linolenic acid (HRQ5-Q1 = 1.18; 95% CI = 1.05-1.34; P-trend = 0.007) from deep-frying fats were also positively associated with ovarian cancer. Suggestive associations were reported for circulating elaidic (OR comparing third with first tertile(T3-T1) = 1.39; 95% CI = 0.99-1.94; P-trend = 0.06) anda-linolenic acids (ORT3-T1 = 1.30; 95% CI = 0.98-1.72; P-trend = 0.06). Conclusions: Our results suggest that higher intakes and circulating levels of industrial trans elaidic acid, and higher intakes of linoleic acid and alpha-linolenic acid from deep-frying fat, may be associated with greater risk of ovarian cancer. Impact: If causal, eliminating industrial trans-fatty acids could offer a straightforward public health action for reducing ovarian cancer risk.
Published: 2020
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5. Serologic markers of Chlamydia trachomatis and other sexually transmitted infections and subsequent ovarian cancer risk : Results from the EPIC cohort

Author: Idahl, Annika, Le Cornet, Charlotte, Gonzalez Maldonado, Sandra, Waterboer, Tim, Bender, Noemi, Tjonneland, Anne, Hansen, Louise, Boutron-Ruault, Marie-Christine, Fournier, Agnes, Kvaskoff, Marina, Boeing, Heiner, Trichopoulou, Antonia, Valanou, Elisavet, Peppa, Eleni, Palli, Domenico, Agnoli, Claudia, Mattiello, Amalia, Tumino, Rosario, Sacerdote, Carlotta, Onland-Moret, N. Charlotte, Gram, Inger T., Weiderpass, Elisabete, Quiros, Jose R., Duell, Eric J., Sanchez, Maria-Jose, Chirlaque, Maria-Dolores, Barricarte, Aurelio, Gil, Leire, Brandstedt, Jenny, Riesbeck, Kristian, Lundin, Eva, Khaw, Kay-Tee, Perez-Cornago, Aurora, Gunter, Marc J., Dossus, Laure, Kaaks, Rudolf, Fortner, Renee T., Idahl, Annika, Le Cornet, Charlotte, Gonzalez Maldonado, Sandra, Waterboer, Tim, Bender, Noemi, Tjonneland, Anne, Hansen, Louise, Boutron-Ruault, Marie-Christine, Fournier, Agnes, Kvaskoff, Marina, Boeing, Heiner, Trichopoulou, Antonia, Valanou, Elisavet, Peppa, Eleni, Palli, Domenico, Agnoli, Claudia, Mattiello, Amalia, Tumino, Rosario, Sacerdote, Carlotta, Onland-Moret, N. Charlotte, Gram, Inger T., Weiderpass, Elisabete, Quiros, Jose R., Duell, Eric J., Sanchez, Maria-Jose, Chirlaque, Maria-Dolores, Barricarte, Aurelio, Gil, Leire, Brandstedt, Jenny, Riesbeck, Kristian, Lundin, Eva, Khaw, Kay-Tee, Perez-Cornago, Aurora, Gunter, Marc J., Dossus, Laure, Kaaks, Rudolf, and Fortner, Renee T.
Abstract: A substantial proportion of epithelial ovarian cancer (EOC) arises in the fallopian tube and other epithelia of the upper genital tract; these epithelia may incur damage and neoplastic transformation after sexually transmitted infections (STI) and pelvic inflammatory disease. We investigated the hypothesis that past STI infection, particularly Chlamydia trachomatis, is associated with higher EOC risk in a nested case‐control study within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort including 791 cases and 1669 matched controls. Serum antibodies against C. trachomatis, Mycoplasma genitalium, herpes simplex virus type 2 (HSV‐2) and human papillomavirus (HPV) 16, 18 and 45 were assessed using multiplex fluorescent bead‐based serology. Conditional logistic regression was used to estimate relative risks (RR) and 95% confidence intervals (CI) comparing women with positive vs. negative serology. A total of 40% of the study population was seropositive to at least one STI. Positive serology to C. trachomatis Pgp3 antibodies was not associated with EOC risk overall, but with higher risk of the mucinous histotype (RR = 2.30 [95% CI = 1.22‐4.32]). Positive serology for chlamydia heat shock protein 60 (cHSP60‐1) was associated with higher risk of EOC overall (1.36 [1.13‐1.64]) and with the serous subtype (1.44 [1.12‐1.85]). None of the other evaluated STIs were associated with EOC risk overall; however, HSV‐2 was associated with higher risk of endometrioid EOC (2.35 [1.24‐4.43]). The findings of our study suggest a potential role of C. trachomatis in the carcinogenesis of serous and mucinous EOC, while HSV‐2 might promote the development of endometrioid disease.
Published: 2020
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6. Predicted basal metabolic rate and cancer risk in the European Prospective Investigation into Cancer and Nutrition

Author: Kliemann, Nathalie, Murphy, Neil, Viallon, Vivian, Freisling, Heinz, Tsilidis, Konstantinos K., Rinaldi, Sabina, Mancini, Francesca R., Fagherazzi, Guy, Boutron-Ruault, Marie-Christine, Boeing, Heiner, Schulze, Matthias B., Masala, Giovanna, Krogh, Vittorio, Sacerdote, Carlotta, de Magistris, Maria S., Bueno-de-Mesquita, Bas, Weiderpass, Elisabete, Kuehn, Tilman, Kaaks, Rudolf, Jakszyn, Paula, Redondo-Sanchez, Daniel, Amiano, Pilar, Chirlaque, Maria-Dolores, Gurrea, Aurelio B., Ericson, Ulrica, Drake, Isabel, Nost, Therese H., Aune, Dagfinn, May, Anne M., Tjonneland, Anne, Dahm, Christina C., Overvad, Kim, Tumino, Rosario, Quiros, Jose R., Trichopoulou, Antonia, Karakatsani, Anna, La Vecchia, Carlo, Nilsson, Lena M., Riboli, Elio, Huybrechts, Inge, Gunter, Marc J., Kliemann, Nathalie, Murphy, Neil, Viallon, Vivian, Freisling, Heinz, Tsilidis, Konstantinos K., Rinaldi, Sabina, Mancini, Francesca R., Fagherazzi, Guy, Boutron-Ruault, Marie-Christine, Boeing, Heiner, Schulze, Matthias B., Masala, Giovanna, Krogh, Vittorio, Sacerdote, Carlotta, de Magistris, Maria S., Bueno-de-Mesquita, Bas, Weiderpass, Elisabete, Kuehn, Tilman, Kaaks, Rudolf, Jakszyn, Paula, Redondo-Sanchez, Daniel, Amiano, Pilar, Chirlaque, Maria-Dolores, Gurrea, Aurelio B., Ericson, Ulrica, Drake, Isabel, Nost, Therese H., Aune, Dagfinn, May, Anne M., Tjonneland, Anne, Dahm, Christina C., Overvad, Kim, Tumino, Rosario, Quiros, Jose R., Trichopoulou, Antonia, Karakatsani, Anna, La Vecchia, Carlo, Nilsson, Lena M., Riboli, Elio, Huybrechts, Inge, and Gunter, Marc J.
Abstract: Emerging evidence suggests that a metabolic profile associated with obesity may be a more relevant risk factor for some cancers than adiposity per se. Basal metabolic rate (BMR) is an indicator of overall body metabolism and may be a proxy for the impact of a specific metabolic profile on cancer risk. Therefore, we investigated the association of predicted BMR with incidence of 13 obesity-related cancers in the European Prospective Investigation into Cancer and Nutrition (EPIC). BMR at baseline was calculated using the WHO/FAO/UNU equations and the relationships between BMR and cancer risk were investigated using multivariable Cox proportional hazards regression models. A total of 141,295 men and 317,613 women, with a mean follow-up of 14 years were included in the analysis. Overall, higher BMR was associated with a greater risk for most cancers that have been linked with obesity. However, among normal weight participants, higher BMR was associated with elevated risks of esophageal adenocarcinoma (hazard ratio per 1-standard deviation change in BMR [HR1-SD]: 2.46; 95% CI 1.20; 5.03) and distal colon cancer (HR1-SD: 1.33; 95% CI 1.001; 1.77) among men and with proximal colon (HR1-SD: 1.16; 95% CI 1.01; 1.35), pancreatic (HR1-SD: 1.37; 95% CI 1.13; 1.66), thyroid (HR1-SD: 1.65; 95% CI 1.33; 2.05), postmenopausal breast (HR1-SD: 1.17; 95% CI 1.11; 1.22) and endometrial (HR1-SD: 1.20; 95% CI 1.03; 1.40) cancers in women. These results indicate that higher BMR may be an indicator of a metabolic phenotype associated with risk of certain cancer types, and may be a useful predictor of cancer risk independent of body fatness.
Published: 2020
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7. Serologic markers of Chlamydia trachomatis and other sexually transmitted infections and subsequent ovarian cancer risk : Results from the EPIC cohort

Author: Idahl, Annika, Le Cornet, Charlotte, Gonzalez Maldonado, Sandra, Waterboer, Tim, Bender, Noemi, Tjonneland, Anne, Hansen, Louise, Boutron-Ruault, Marie-Christine, Fournier, Agnes, Kvaskoff, Marina, Boeing, Heiner, Trichopoulou, Antonia, Valanou, Elisavet, Peppa, Eleni, Palli, Domenico, Agnoli, Claudia, Mattiello, Amalia, Tumino, Rosario, Sacerdote, Carlotta, Onland-Moret, N. Charlotte, Gram, Inger T., Weiderpass, Elisabete, Quiros, Jose R., Duell, Eric J., Sanchez, Maria-Jose, Chirlaque, Maria-Dolores, Barricarte, Aurelio, Gil, Leire, Brandstedt, Jenny, Riesbeck, Kristian, Lundin, Eva, Khaw, Kay-Tee, Perez-Cornago, Aurora, Gunter, Marc J., Dossus, Laure, Kaaks, Rudolf, Fortner, Renee T., Idahl, Annika, Le Cornet, Charlotte, Gonzalez Maldonado, Sandra, Waterboer, Tim, Bender, Noemi, Tjonneland, Anne, Hansen, Louise, Boutron-Ruault, Marie-Christine, Fournier, Agnes, Kvaskoff, Marina, Boeing, Heiner, Trichopoulou, Antonia, Valanou, Elisavet, Peppa, Eleni, Palli, Domenico, Agnoli, Claudia, Mattiello, Amalia, Tumino, Rosario, Sacerdote, Carlotta, Onland-Moret, N. Charlotte, Gram, Inger T., Weiderpass, Elisabete, Quiros, Jose R., Duell, Eric J., Sanchez, Maria-Jose, Chirlaque, Maria-Dolores, Barricarte, Aurelio, Gil, Leire, Brandstedt, Jenny, Riesbeck, Kristian, Lundin, Eva, Khaw, Kay-Tee, Perez-Cornago, Aurora, Gunter, Marc J., Dossus, Laure, Kaaks, Rudolf, and Fortner, Renee T.
Abstract: A substantial proportion of epithelial ovarian cancer (EOC) arises in the fallopian tube and other epithelia of the upper genital tract; these epithelia may incur damage and neoplastic transformation after sexually transmitted infections (STI) and pelvic inflammatory disease. We investigated the hypothesis that past STI infection, particularly Chlamydia trachomatis, is associated with higher EOC risk in a nested case‐control study within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort including 791 cases and 1669 matched controls. Serum antibodies against C. trachomatis, Mycoplasma genitalium, herpes simplex virus type 2 (HSV‐2) and human papillomavirus (HPV) 16, 18 and 45 were assessed using multiplex fluorescent bead‐based serology. Conditional logistic regression was used to estimate relative risks (RR) and 95% confidence intervals (CI) comparing women with positive vs. negative serology. A total of 40% of the study population was seropositive to at least one STI. Positive serology to C. trachomatis Pgp3 antibodies was not associated with EOC risk overall, but with higher risk of the mucinous histotype (RR = 2.30 [95% CI = 1.22‐4.32]). Positive serology for chlamydia heat shock protein 60 (cHSP60‐1) was associated with higher risk of EOC overall (1.36 [1.13‐1.64]) and with the serous subtype (1.44 [1.12‐1.85]). None of the other evaluated STIs were associated with EOC risk overall; however, HSV‐2 was associated with higher risk of endometrioid EOC (2.35 [1.24‐4.43]). The findings of our study suggest a potential role of C. trachomatis in the carcinogenesis of serous and mucinous EOC, while HSV‐2 might promote the development of endometrioid disease.
Published: 2020
Full Text: View/download PDF

8. Replacement of red and processed meat with other food sources of protein and the risk of type 2 diabetes in European populations:The epic-interact study

Author: Ibsen, Daniel B., Steur, Marinka, Imamura, Fumiaki, Overvad, Kim, Schulze, Matthias B., Bendinelli, Benedetta, Guevara, Marcela, Agudo, Antonio, Amiano, Pilar, Aune, Dagfinn, Barricarte, Aurelio, Ericson, Ulrika, Fagherazzi, Guy, Franks, Paul W., Freisling, Heinz, Quiros, Jose R., Grioni, Sara, Heath, Alicia K., Huybrechts, Inge, Katze, Verena, Laouali, Nasser, Mancini, Francesca, Masala, Giovanna, Olsen, Anja, Papier, Keren, Ramne, Stina, Rolandsson, Olov, Sacerdote, Carlotta, Sánchez, Maria José, Santiuste, Carmen, Simeon, Vittorio, Spijkerman, Annemieke M.W., Srour, Bernard, Tjønneland, Anne, Tong, Tammy Y.N., Tumino, Rosario, van der Schouw, Yvonne T., Weiderpass, Elisabete, Wittenbecher, Clemens, Sharp, Stephen J., Riboli, Elio, Forouhi, Nita G., Wareham, Nick J., Ibsen, Daniel B., Steur, Marinka, Imamura, Fumiaki, Overvad, Kim, Schulze, Matthias B., Bendinelli, Benedetta, Guevara, Marcela, Agudo, Antonio, Amiano, Pilar, Aune, Dagfinn, Barricarte, Aurelio, Ericson, Ulrika, Fagherazzi, Guy, Franks, Paul W., Freisling, Heinz, Quiros, Jose R., Grioni, Sara, Heath, Alicia K., Huybrechts, Inge, Katze, Verena, Laouali, Nasser, Mancini, Francesca, Masala, Giovanna, Olsen, Anja, Papier, Keren, Ramne, Stina, Rolandsson, Olov, Sacerdote, Carlotta, Sánchez, Maria José, Santiuste, Carmen, Simeon, Vittorio, Spijkerman, Annemieke M.W., Srour, Bernard, Tjønneland, Anne, Tong, Tammy Y.N., Tumino, Rosario, van der Schouw, Yvonne T., Weiderpass, Elisabete, Wittenbecher, Clemens, Sharp, Stephen J., Riboli, Elio, Forouhi, Nita G., and Wareham, Nick J.
Abstract: OBJECTIVE There is sparse evidence for the association of suitable food substitutions for red and processed meat on the risk of type 2 diabetes. We modeled the association between replacing red and processed meat with other protein sources and the risk of type 2 diabetes and estimated its population impact. RESEARCH DESIGN AND METHODS The European Prospective Investigation into Cancer (EPIC)-InterAct case cohort included 11,741 individuals with type 2 diabetes and a subcohort of 15,450 participants in eight countries. We modeled the replacement of self-reported red and processed meat with poultry, fish, eggs, legumes, cheese, cereals, yogurt, milk, and nuts. Country-specific hazard ratios (HRs) for incident type 2 diabetes were estimated by Prentice-weighted Cox regression and pooled using random-effects meta-analysis. RESULTS There was a lower hazard for type 2 diabetes for the modeled replacement of red and processed meat (50 g/day) with cheese (HR 0.90, 95% CI 0.83–0.97) (30 g/day), yogurt (0.90, 0.86–0.95) (70 g/day), nuts (0.90, 0.84–0.96) (10 g/day), or cereals (0.92, 0.88–0.96) (30 g/day) but not for replacements with poultry, fish, eggs, legumes, or milk. If a causal association is assumed, replacing red and processed meat with cheese, yogurt, or nuts could prevent 8.8%, 8.3%, or 7.5%, respectively, of new cases of type 2 diabetes. CONCLUSIONS Replacement of red and processed meat with cheese, yogurt, nuts, or cereals was associated with a lower rate of type 2 diabetes. Substituting red and processed meat by other protein sources may contribute to the prevention of incident type 2 diabetes in European populations.
Published: 2020

9. Dietary and Circulating Fatty Acids and Ovarian Cancer Risk in the European Prospective Investigation into Cancer and Nutrition

Author: Yammine, Sahar, Huybrechts, Inge, Biessy, Carine, Dossus, Laure, Aglago, Elom K., Naudin, Sabine, Ferrari, Pietro, Weiderpass, Elisabete, Tjønneland, Anne, Hansen, Louise, Overvad, Kim, Mancini, Francesca R., Boutron-Ruault, Marie-Christine, Kvaskoff, Marina, Fortner, Renee T., Kaaks, Rudolf, Schulze, Matthias B., Boeing, Heiner, Trichopoulou, Antonia, Karakatsani, Anna, La Vecchia, Carlo, Benetou, Vassiliki, Masala, Giovanna, Krogh, Vittorio, Mattiello, Amalia, Macciotta, Alessandra, Gram, Inger T., Skeie, Guri, Quiros, Jose R., Agudo, Antonio, Sanchez, Maria-Jose, Chirlaque, Maria-Dolores, Ardanaz, Eva, Gil, Leire, Sartor, Hanna, Drake, Isabel, Idahl, Annika, Lundin, Eva, Aune, Dagfinn, Ward, Heather, Merritt, Melissa A., Allen, Naomi E., Gunter, Marc J., Chajes, Veronique, Yammine, Sahar, Huybrechts, Inge, Biessy, Carine, Dossus, Laure, Aglago, Elom K., Naudin, Sabine, Ferrari, Pietro, Weiderpass, Elisabete, Tjønneland, Anne, Hansen, Louise, Overvad, Kim, Mancini, Francesca R., Boutron-Ruault, Marie-Christine, Kvaskoff, Marina, Fortner, Renee T., Kaaks, Rudolf, Schulze, Matthias B., Boeing, Heiner, Trichopoulou, Antonia, Karakatsani, Anna, La Vecchia, Carlo, Benetou, Vassiliki, Masala, Giovanna, Krogh, Vittorio, Mattiello, Amalia, Macciotta, Alessandra, Gram, Inger T., Skeie, Guri, Quiros, Jose R., Agudo, Antonio, Sanchez, Maria-Jose, Chirlaque, Maria-Dolores, Ardanaz, Eva, Gil, Leire, Sartor, Hanna, Drake, Isabel, Idahl, Annika, Lundin, Eva, Aune, Dagfinn, Ward, Heather, Merritt, Melissa A., Allen, Naomi E., Gunter, Marc J., and Chajes, Veronique
Abstract: Background: Fatty acids impact obesity, estrogens, and inflammation, which are risk factors for ovarian cancer. Few epidemiologic studies have investigated the association of fatty acids with ovarian cancer.Methods: Within the European Prospective Investigation into Cancer and Nutrition (EPIC), 1,486 incident ovarian cancer cases were identified. Cox proportional hazard models with adjustment for ovarian cancer risk factors were used to estimate HRs of ovarian cancer across quintiles of intake of fatty acids. False discovery rate was computed to control for multiple testing. Multivariable conditional logistic regression models were used to estimate ORs of ovarian cancer across tertiles of plasma fatty acids among 633 cases and two matched controls in a nested case-control analysis.Results: Apositive association was found between ovarian cancer and intake of industrial trans elaidic acid [HR comparing fifth with first quintile(Q5-Q1) = 1.29; 95% confidence interval (CI) = 1.03-1.62; P-trend = 0.02, q-value = 0.06]. Dietary intakes of n-6 linoleic acid (HRQ5-Q1 = 1.10; 95% CI = 1.01-1.21; P-trend = 0.03) and n-3 alpha-linolenic acid (HRQ5-Q1 = 1.18; 95% CI = 1.05-1.34; P-trend = 0.007) from deep-frying fats were also positively associated with ovarian cancer. Suggestive associations were reported for circulating elaidic (OR comparing third with first tertile(T3-T1) = 1.39; 95% CI = 0.99-1.94; P-trend = 0.06) anda-linolenic acids (ORT3-T1 = 1.30; 95% CI = 0.98-1.72; P-trend = 0.06).Conclusions: Our results suggest that higher intakes and circulating levels of industrial trans elaidic acid, and higher intakes of linoleic acid and alpha-linolenic acid from deep-frying fat, may be associated with greater risk of ovarian cancer.Impact: If causal, eliminating industrial trans-fatty acids could offer a straightforward public health action for reducing ovarian cancer risk.
Published: 2020

10. Serologic markers of Chlamydia trachomatis and other sexually transmitted infections and subsequent ovarian cancer risk : Results from the EPIC cohort

Author: Idahl, Annika, Le Cornet, Charlotte, Gonzalez Maldonado, Sandra, Waterboer, Tim, Bender, Noemi, Tjonneland, Anne, Hansen, Louise, Boutron-Ruault, Marie-Christine, Fournier, Agnes, Kvaskoff, Marina, Boeing, Heiner, Trichopoulou, Antonia, Valanou, Elisavet, Peppa, Eleni, Palli, Domenico, Agnoli, Claudia, Mattiello, Amalia, Tumino, Rosario, Sacerdote, Carlotta, Onland-Moret, N. Charlotte, Gram, Inger T., Weiderpass, Elisabete, Quiros, Jose R., Duell, Eric J., Sanchez, Maria-Jose, Chirlaque, Maria-Dolores, Barricarte, Aurelio, Gil, Leire, Brandstedt, Jenny, Riesbeck, Kristian, Lundin, Eva, Khaw, Kay-Tee, Perez-Cornago, Aurora, Gunter, Marc J., Dossus, Laure, Kaaks, Rudolf, Fortner, Renee T., Idahl, Annika, Le Cornet, Charlotte, Gonzalez Maldonado, Sandra, Waterboer, Tim, Bender, Noemi, Tjonneland, Anne, Hansen, Louise, Boutron-Ruault, Marie-Christine, Fournier, Agnes, Kvaskoff, Marina, Boeing, Heiner, Trichopoulou, Antonia, Valanou, Elisavet, Peppa, Eleni, Palli, Domenico, Agnoli, Claudia, Mattiello, Amalia, Tumino, Rosario, Sacerdote, Carlotta, Onland-Moret, N. Charlotte, Gram, Inger T., Weiderpass, Elisabete, Quiros, Jose R., Duell, Eric J., Sanchez, Maria-Jose, Chirlaque, Maria-Dolores, Barricarte, Aurelio, Gil, Leire, Brandstedt, Jenny, Riesbeck, Kristian, Lundin, Eva, Khaw, Kay-Tee, Perez-Cornago, Aurora, Gunter, Marc J., Dossus, Laure, Kaaks, Rudolf, and Fortner, Renee T.
Abstract: A substantial proportion of epithelial ovarian cancer (EOC) arises in the fallopian tube and other epithelia of the upper genital tract; these epithelia may incur damage and neoplastic transformation after sexually transmitted infections (STI) and pelvic inflammatory disease. We investigated the hypothesis that past STI infection, particularly Chlamydia trachomatis, is associated with higher EOC risk in a nested case‐control study within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort including 791 cases and 1669 matched controls. Serum antibodies against C. trachomatis, Mycoplasma genitalium, herpes simplex virus type 2 (HSV‐2) and human papillomavirus (HPV) 16, 18 and 45 were assessed using multiplex fluorescent bead‐based serology. Conditional logistic regression was used to estimate relative risks (RR) and 95% confidence intervals (CI) comparing women with positive vs. negative serology. A total of 40% of the study population was seropositive to at least one STI. Positive serology to C. trachomatis Pgp3 antibodies was not associated with EOC risk overall, but with higher risk of the mucinous histotype (RR = 2.30 [95% CI = 1.22‐4.32]). Positive serology for chlamydia heat shock protein 60 (cHSP60‐1) was associated with higher risk of EOC overall (1.36 [1.13‐1.64]) and with the serous subtype (1.44 [1.12‐1.85]). None of the other evaluated STIs were associated with EOC risk overall; however, HSV‐2 was associated with higher risk of endometrioid EOC (2.35 [1.24‐4.43]). The findings of our study suggest a potential role of C. trachomatis in the carcinogenesis of serous and mucinous EOC, while HSV‐2 might promote the development of endometrioid disease.
Published: 2020
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11. Replacement of Red and Processed Meat With Other Food Sources of Protein and the Risk of Type 2 Diabetes in European Populations: The EPIC-InterAct Study

Author: UMC Utrecht, Cardiovasculaire Epi Team 1, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Ibsen, Daniel B., Steur, Marinka, Imamura, Fumiaki, Overvad, Kim, Schulze, Matthias B., Bendinelli, Benedetta, Guevara, Marcela, Agudo, Antonio, Amiano, Pilar, Aune, Dagfinn, Barricarte, Aurelio, Ericson, Ulrika, Fagherazzi, Guy, Franks, Paul W., Freisling, Heinz, Quiros, Jose R., Grioni, Sara, Heath, Alicia K., Huybrechts, Inge, Katze, Verena, Laouali, Nasser, Mancini, Francesca, Masala, Giovanna, Olsen, Anja, Papier, Keren, Ramne, Stina, Rolandsson, Olov, Sacerdote, Carlotta, Sanchez, Maria-Jose, Santiuste, Carmen, Simeon, Vittorio, Spijkerman, Annemieke M. W., Srour, Bernard, Tjonneland, Anne, Tong, Tammy Y. N., Tumino, Rosario, van der Schouw, Yvonne T., Weiderpass, Elisabete, Wittenbecher, Clemens, Sharp, Stephen J., Riboli, Elio, Forouhi, Nita G., Wareham, Nick J., UMC Utrecht, Cardiovasculaire Epi Team 1, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Ibsen, Daniel B., Steur, Marinka, Imamura, Fumiaki, Overvad, Kim, Schulze, Matthias B., Bendinelli, Benedetta, Guevara, Marcela, Agudo, Antonio, Amiano, Pilar, Aune, Dagfinn, Barricarte, Aurelio, Ericson, Ulrika, Fagherazzi, Guy, Franks, Paul W., Freisling, Heinz, Quiros, Jose R., Grioni, Sara, Heath, Alicia K., Huybrechts, Inge, Katze, Verena, Laouali, Nasser, Mancini, Francesca, Masala, Giovanna, Olsen, Anja, Papier, Keren, Ramne, Stina, Rolandsson, Olov, Sacerdote, Carlotta, Sanchez, Maria-Jose, Santiuste, Carmen, Simeon, Vittorio, Spijkerman, Annemieke M. W., Srour, Bernard, Tjonneland, Anne, Tong, Tammy Y. N., Tumino, Rosario, van der Schouw, Yvonne T., Weiderpass, Elisabete, Wittenbecher, Clemens, Sharp, Stephen J., Riboli, Elio, Forouhi, Nita G., and Wareham, Nick J.
Published: 2020

12. Main nutrient patterns and colorectal cancer risk in the European Prospective Investigation into Cancer and Nutrition study

Author: Moskal, Aurelie, Freisling, Heinz, Byrnes, Graham, Assi, Nada, Fahey, Michael T., Jenab, Mazda, Ferrari, Pietro, Tjonneland, Anne, Petersen, Kristina E. N., Dahm, Christina C., Plambeck Hansen, Camilla, Affret, Aurelie, Boutron-Ruault, Marie-Christine, Cadeau, Claire, Kuhn, Tilman, Katzke, Verena, Iqbal, Khalid, Boeing, Heiner, Trichopoulou, Antonia, Bamia, Christina, Naska, Androniki, Masala, Giovanna, de Magistris, Maria Santucci, Sieri, Sabina, Tumino, Rosario, Sacerdote, Carlotta, Peeters, Petra H., Bueno-De-Mesquita, Bas H., Engeset, Dagrun, Licaj, Idlir, Skeie, Guri, Ardanaz, Eva, Buckland, Genevieve, Huerta Castano, Jose M., Quiros, Jose R., Amiano, Pilar, Molina-Portillo, Elena, Winkvist, Anna, Myte, Robin, Ericson, Ulrika, Sonestedt, Emily, Perez-Cornago, Aurora, Wareham, Nick, Khaw, Kay-Tee, Huybrechts, Inge, Tsilidis, Konstantinos K., Ward, Heather, Gunter, Marc J., Slimani, Nadia, Moskal, Aurelie, Freisling, Heinz, Byrnes, Graham, Assi, Nada, Fahey, Michael T., Jenab, Mazda, Ferrari, Pietro, Tjonneland, Anne, Petersen, Kristina E. N., Dahm, Christina C., Plambeck Hansen, Camilla, Affret, Aurelie, Boutron-Ruault, Marie-Christine, Cadeau, Claire, Kuhn, Tilman, Katzke, Verena, Iqbal, Khalid, Boeing, Heiner, Trichopoulou, Antonia, Bamia, Christina, Naska, Androniki, Masala, Giovanna, de Magistris, Maria Santucci, Sieri, Sabina, Tumino, Rosario, Sacerdote, Carlotta, Peeters, Petra H., Bueno-De-Mesquita, Bas H., Engeset, Dagrun, Licaj, Idlir, Skeie, Guri, Ardanaz, Eva, Buckland, Genevieve, Huerta Castano, Jose M., Quiros, Jose R., Amiano, Pilar, Molina-Portillo, Elena, Winkvist, Anna, Myte, Robin, Ericson, Ulrika, Sonestedt, Emily, Perez-Cornago, Aurora, Wareham, Nick, Khaw, Kay-Tee, Huybrechts, Inge, Tsilidis, Konstantinos K., Ward, Heather, Gunter, Marc J., and Slimani, Nadia
Abstract: Background: Much of the current literature on diet-colorectal cancer (CRC) associations focused on studies of single foods/nutrients, whereas less is known about nutrient patterns. We investigated the association between major nutrient patterns and CRC risk in participants of the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Methods: Among 477 312 participants, intakes of 23 nutrients were estimated from validated dietary questionnaires. Using results from a previous principal component (PC) analysis, four major nutrient patterns were identified. Hazard ratios (HRs) and 95% confidence intervals (CIs) were computed for the association of each of the four patterns and CRC incidence using multivariate Cox proportional hazards models with adjustment for established CRC risk factors. Results: During an average of 11 years of follow-up, 4517 incident cases of CRC were documented. A nutrient pattern characterised by high intakes of vitamins and minerals was inversely associated with CRC (HR per 1 s.d. = 0.94, 95% CI: 0.92-0.98) as was a pattern characterised by total protein, riboflavin, phosphorus and calcium (HR (1 s.d.) = 0.96, 95% CI: 0.93-0.99). The remaining two patterns were not significantly associated with CRC risk. Conclusions: Analysing nutrient patterns may improve our understanding of how groups of nutrients relate to CRC.
Published: 2016
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13. Pre-diagnostic concordance with the WCRF/AICR guidelines and survival in European colorectal cancer patients

Author: University of Helsinki, Department of Medical Genetics, Romaguera, Dora, Ward, Heather, Wark, Petra A., Vergnaud, Anne-Claire, Peeters, Petra H., van Gils, Carla H., Ferrari, Pietro, Fedirko, Veronika, Jenab, Mazda, Boutron-Ruault, Marie-Christine, Dossus, Laure, Dartois, Laureen, Hansen, Camilla Plambeck, Dahm, Christina Catherine, Buckland, Genevieve, Sanchez, Maria Jose, Dorronsoro, Miren, Navarro, Carmen, Barricarte, Aurelio, Key, Timothy J., Trichopoulou, Antonia, Tsironis, Christos, Lagiou, Pagona, Masala, Giovanna, Pala, Valeria, Tumino, Rosario, Vineis, Paolo, Panico, Salvatore, Bueno-de-Mesquita, H. Bas, Siersema, Peter D., Ohlsson, Bodil, Jirstrom, Karin, Wennberg, Maria, Nilsson, Lena M., Weiderpass, Elisabete, Kuehn, Tilman, Katzke, Verena, Khaw, Kay-Tee, Wareham, Nick J., Tjonneland, Anne, Boeing, Heiner, Quiros, Jose R., Gunter, Marc J., Riboli, Elio, Norat, Teresa, University of Helsinki, Department of Medical Genetics, Romaguera, Dora, Ward, Heather, Wark, Petra A., Vergnaud, Anne-Claire, Peeters, Petra H., van Gils, Carla H., Ferrari, Pietro, Fedirko, Veronika, Jenab, Mazda, Boutron-Ruault, Marie-Christine, Dossus, Laure, Dartois, Laureen, Hansen, Camilla Plambeck, Dahm, Christina Catherine, Buckland, Genevieve, Sanchez, Maria Jose, Dorronsoro, Miren, Navarro, Carmen, Barricarte, Aurelio, Key, Timothy J., Trichopoulou, Antonia, Tsironis, Christos, Lagiou, Pagona, Masala, Giovanna, Pala, Valeria, Tumino, Rosario, Vineis, Paolo, Panico, Salvatore, Bueno-de-Mesquita, H. Bas, Siersema, Peter D., Ohlsson, Bodil, Jirstrom, Karin, Wennberg, Maria, Nilsson, Lena M., Weiderpass, Elisabete, Kuehn, Tilman, Katzke, Verena, Khaw, Kay-Tee, Wareham, Nick J., Tjonneland, Anne, Boeing, Heiner, Quiros, Jose R., Gunter, Marc J., Riboli, Elio, and Norat, Teresa
Abstract: Background: Cancer survivors are advised to follow lifestyle recommendations on diet, physical activity, and body fatness proposed by the World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) for cancer prevention. Previous studies have demonstrated that higher concordance with these recommendations measured using an index score (the WCRF/AICR score) was associated with lower cancer incidence and mortality. The aim of this study was to evaluate the association between pre-diagnostic concordance with WCRF/AICR recommendations and mortality in colorectal cancer (CRC) patients. Methods: The association between the WCRF/AICR score (score range 0-6 in men and 0-7 in women; higher scores indicate greater concordance) assessed on average 6.4 years before diagnosis and CRC-specific (n = 872) and overall mortality (n = 1,113) was prospectively examined among 3,292 participants diagnosed with CRC in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort (mean follow-up time after diagnosis 4.2 years). Multivariable Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality. Results: The HRs (95% CIs) for CRC-specific mortality among participants in the second (score range in men/women: 2.25-2.75/3.25-3.75), third (3-3.75/4-4.75), and fourth (4-6/5-7) categories of the score were 0.87 (0.72-1.06), 0.74 (0.61-0.90), and 0.70 (0.56-0.89), respectively (P for trend Conclusions: Greater concordance with the WCRF/AICR recommendations on diet, physical activity, and body fatness prior to CRC diagnosis is associated with improved survival among CRC patients.
Published: 2015

14. Nutrient Patterns and Their Food Sources in an International Study Setting : Report from the EPIC Study

Author: Moskal, Aurelie, Pisa, Pedro T., Ferrari, Pietro, Byrnes, Graham, Freisling, Heinz, Boutron-Ruault, Marie-Christine, Cadeau, Claire, Nailler, Laura, Wendt, Andrea, Kuehn, Tilman, Boeing, Heiner, Buijsse, Brian, Tjonneland, Anne, Halkjaer, Jytte, Dahm, Christina C., Chiuve, Stephanie E., Quiros, Jose R., Buckland, Genevieve, Molina-Montes, Esther, Amiano, Pilar, Huerta Castano, Jose M., Barricarte Gurrea, Aurelio, Khaw, Kay-Tee, Lentjes, Marleen A., Key, Timothy J., Romaguera, Dora, Vergnaud, Anne-Claire, Trichopoulou, Antonia, Bamia, Christina, Orfanos, Philippos, Palli, Domenico, Pala, Valeria, Tumino, Rosario, Sacerdote, Carlotta, de Magistris, Maria Santucci, Bueno-de-Mesquita, H. Bas, Ocke, Marga C., Beulens, Joline W. J., Ericson, Ulrika, Drake, Isabel, Nilsson, Lena M., Winkvist, Anna, Weiderpass, Elisabete, Hjartaker, Anette, Riboli, Elio, Slimani, Nadia, Moskal, Aurelie, Pisa, Pedro T., Ferrari, Pietro, Byrnes, Graham, Freisling, Heinz, Boutron-Ruault, Marie-Christine, Cadeau, Claire, Nailler, Laura, Wendt, Andrea, Kuehn, Tilman, Boeing, Heiner, Buijsse, Brian, Tjonneland, Anne, Halkjaer, Jytte, Dahm, Christina C., Chiuve, Stephanie E., Quiros, Jose R., Buckland, Genevieve, Molina-Montes, Esther, Amiano, Pilar, Huerta Castano, Jose M., Barricarte Gurrea, Aurelio, Khaw, Kay-Tee, Lentjes, Marleen A., Key, Timothy J., Romaguera, Dora, Vergnaud, Anne-Claire, Trichopoulou, Antonia, Bamia, Christina, Orfanos, Philippos, Palli, Domenico, Pala, Valeria, Tumino, Rosario, Sacerdote, Carlotta, de Magistris, Maria Santucci, Bueno-de-Mesquita, H. Bas, Ocke, Marga C., Beulens, Joline W. J., Ericson, Ulrika, Drake, Isabel, Nilsson, Lena M., Winkvist, Anna, Weiderpass, Elisabete, Hjartaker, Anette, Riboli, Elio, and Slimani, Nadia
Abstract: Background: Compared to food patterns, nutrient patterns have been rarely used particularly at international level. We studied, in the context of a multi-center study with heterogeneous data, the methodological challenges regarding pattern analyses. Methodology/Principal Findings: We identified nutrient patterns from food frequency questionnaires (FFQ) in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study and used 24-hour dietary recall (24-HDR) data to validate and describe the nutrient patterns and their related food sources. Associations between lifestyle factors and the nutrient patterns were also examined. Principal component analysis (PCA) was applied on 23 nutrients derived from country-specific FFQ combining data from all EPIC centers (N = 477,312). Harmonized 24-HDRs available for a representative sample of the EPIC populations (N = 34,436) provided accurate mean group estimates of nutrients and foods by quintiles of pattern scores, presented graphically. An overall PCA combining all data captured a good proportion of the variance explained in each EPIC center. Four nutrient patterns were identified explaining 67% of the total variance: Principle component (PC) 1 was characterized by a high contribution of nutrients from plant food sources and a low contribution of nutrients from animal food sources; PC2 by a high contribution of micro-nutrients and proteins; PC3 was characterized by polyunsaturated fatty acids and vitamin D; PC4 was characterized by calcium, proteins, riboflavin, and phosphorus. The nutrients with high loadings on a particular pattern as derived from country-specific FFQ also showed high deviations in their mean EPIC intakes by quintiles of pattern scores when estimated from 24-HDR. Center and energy intake explained most of the variability in pattern scores. Conclusion/Significance: The use of 24-HDR enabled internal validation and facilitated the interpretation of the nutrient patterns derived from FFQs in term
Published: 2014
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15. Nutrient Patterns and Their Food Sources in an International Study Setting : Report from the EPIC Study

Author: Moskal, Aurelie, Pisa, Pedro T., Ferrari, Pietro, Byrnes, Graham, Freisling, Heinz, Boutron-Ruault, Marie-Christine, Cadeau, Claire, Nailler, Laura, Wendt, Andrea, Kuehn, Tilman, Boeing, Heiner, Buijsse, Brian, Tjonneland, Anne, Halkjaer, Jytte, Dahm, Christina C., Chiuve, Stephanie E., Quiros, Jose R., Buckland, Genevieve, Molina-Montes, Esther, Amiano, Pilar, Huerta Castano, Jose M., Barricarte Gurrea, Aurelio, Khaw, Kay-Tee, Lentjes, Marleen A., Key, Timothy J., Romaguera, Dora, Vergnaud, Anne-Claire, Trichopoulou, Antonia, Bamia, Christina, Orfanos, Philippos, Palli, Domenico, Pala, Valeria, Tumino, Rosario, Sacerdote, Carlotta, de Magistris, Maria Santucci, Bueno-de-Mesquita, H. Bas, Ocke, Marga C., Beulens, Joline W. J., Ericson, Ulrika, Drake, Isabel, Nilsson, Lena M., Winkvist, Anna, Weiderpass, Elisabete, Hjartaker, Anette, Riboli, Elio, Slimani, Nadia, Moskal, Aurelie, Pisa, Pedro T., Ferrari, Pietro, Byrnes, Graham, Freisling, Heinz, Boutron-Ruault, Marie-Christine, Cadeau, Claire, Nailler, Laura, Wendt, Andrea, Kuehn, Tilman, Boeing, Heiner, Buijsse, Brian, Tjonneland, Anne, Halkjaer, Jytte, Dahm, Christina C., Chiuve, Stephanie E., Quiros, Jose R., Buckland, Genevieve, Molina-Montes, Esther, Amiano, Pilar, Huerta Castano, Jose M., Barricarte Gurrea, Aurelio, Khaw, Kay-Tee, Lentjes, Marleen A., Key, Timothy J., Romaguera, Dora, Vergnaud, Anne-Claire, Trichopoulou, Antonia, Bamia, Christina, Orfanos, Philippos, Palli, Domenico, Pala, Valeria, Tumino, Rosario, Sacerdote, Carlotta, de Magistris, Maria Santucci, Bueno-de-Mesquita, H. Bas, Ocke, Marga C., Beulens, Joline W. J., Ericson, Ulrika, Drake, Isabel, Nilsson, Lena M., Winkvist, Anna, Weiderpass, Elisabete, Hjartaker, Anette, Riboli, Elio, and Slimani, Nadia
Abstract: Background: Compared to food patterns, nutrient patterns have been rarely used particularly at international level. We studied, in the context of a multi-center study with heterogeneous data, the methodological challenges regarding pattern analyses. Methodology/Principal Findings: We identified nutrient patterns from food frequency questionnaires (FFQ) in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study and used 24-hour dietary recall (24-HDR) data to validate and describe the nutrient patterns and their related food sources. Associations between lifestyle factors and the nutrient patterns were also examined. Principal component analysis (PCA) was applied on 23 nutrients derived from country-specific FFQ combining data from all EPIC centers (N = 477,312). Harmonized 24-HDRs available for a representative sample of the EPIC populations (N = 34,436) provided accurate mean group estimates of nutrients and foods by quintiles of pattern scores, presented graphically. An overall PCA combining all data captured a good proportion of the variance explained in each EPIC center. Four nutrient patterns were identified explaining 67% of the total variance: Principle component (PC) 1 was characterized by a high contribution of nutrients from plant food sources and a low contribution of nutrients from animal food sources; PC2 by a high contribution of micro-nutrients and proteins; PC3 was characterized by polyunsaturated fatty acids and vitamin D; PC4 was characterized by calcium, proteins, riboflavin, and phosphorus. The nutrients with high loadings on a particular pattern as derived from country-specific FFQ also showed high deviations in their mean EPIC intakes by quintiles of pattern scores when estimated from 24-HDR. Center and energy intake explained most of the variability in pattern scores. Conclusion/Significance: The use of 24-HDR enabled internal validation and facilitated the interpretation of the nutrient patterns derived from FFQs in term
Published: 2014
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16. t(14;18) Translocation : a predictive blood biomarker for follicular lymphoma

Author: Roulland, Sandrine, Kelly, Rachel S., Morgado, Ester, Sungalee, Stephanie, Solal-Celigny, Philippe, Colombat, Philippe, Jouve, Nathalie, Palli, Domenico, Pala, Valeria, Tumino, Rosario, Panico, Salvatore, Sacerdote, Carlotta, Quiros, Jose R., Gonzales, Carlos A., Sanchez, Maria-Jose, Dorronsoro, Miren, Navarro, Carmen, Barricarte, Aurelio, Tjønneland, Anne, Olsen, Anja, Overvad, Kim, Canzian, Federico, Kaaks, Rudolf, Boeing, Heiner, Drogan, Dagmar, Nieters, Alexandra, Clavel-Chapelon, Francoise, Trichopoulou, Antonia, Trichopoulos, Dimitrios, Lagiou, Pagona, Bueno-de-Mesquita, H. Bas, Peeters, Petra H. M., Vermeulen, Roel, Hallmans, Göran, Melin, Beatrice, Borgquist, Signe, Carlson, Joyce, Lund, Eiliv, Weiderpass, Elisabete, Khaw, Kay-Tee, Wareham, Nick, Key, Timothy J., Travis, Ruth C., Ferrari, Pietro, Romieu, Isabelle, Riboli, Elio, Salles, Gilles, Vineis, Paolo, Nadel, Bertrand, Roulland, Sandrine, Kelly, Rachel S., Morgado, Ester, Sungalee, Stephanie, Solal-Celigny, Philippe, Colombat, Philippe, Jouve, Nathalie, Palli, Domenico, Pala, Valeria, Tumino, Rosario, Panico, Salvatore, Sacerdote, Carlotta, Quiros, Jose R., Gonzales, Carlos A., Sanchez, Maria-Jose, Dorronsoro, Miren, Navarro, Carmen, Barricarte, Aurelio, Tjønneland, Anne, Olsen, Anja, Overvad, Kim, Canzian, Federico, Kaaks, Rudolf, Boeing, Heiner, Drogan, Dagmar, Nieters, Alexandra, Clavel-Chapelon, Francoise, Trichopoulou, Antonia, Trichopoulos, Dimitrios, Lagiou, Pagona, Bueno-de-Mesquita, H. Bas, Peeters, Petra H. M., Vermeulen, Roel, Hallmans, Göran, Melin, Beatrice, Borgquist, Signe, Carlson, Joyce, Lund, Eiliv, Weiderpass, Elisabete, Khaw, Kay-Tee, Wareham, Nick, Key, Timothy J., Travis, Ruth C., Ferrari, Pietro, Romieu, Isabelle, Riboli, Elio, Salles, Gilles, Vineis, Paolo, and Nadel, Bertrand
Abstract: Purpose The (14;18) translocation constitutes both a genetic hallmark and critical early event in the natural history of follicular lymphoma (FL). However, t(14;18) is also detectable in the blood of otherwise healthy persons, and its relationship with progression to disease remains unclear. Here we sought to determine whether t(14;18)-positive cells in healthy individuals represent tumor precursors and whether their detection could be used as an early predictor for FL. Participants and Methods Among 520,000 healthy participants enrolled onto the EPIC (European Prospective Investigation Into Cancer and Nutrition) cohort, we identified 100 who developed FL 2 to 161 months after enrollment. Prediagnostic blood from these and 218 controls were screened for t(14;18) using sensitive polymerase chain reaction-based assays. Results were subsequently validated in an independent cohort (65 case participants; 128 controls). Clonal relationships between t(14;18) cells and FL were also assessed by molecular backtracking of paired prediagnostic blood and tumor samples. Results Clonal analysis of t(14;18) junctions in paired prediagnostic blood versus tumor samples demonstrated that progression to FL occurred from t(14;18)-positive committed precursors. Furthermore, healthy participants at enrollment who developed FL up to 15 years later showed a markedly higher t(14;18) prevalence and frequency than controls (P < .001). Altogether, we estimated a 23-fold higher risk of subsequent FL in blood samples associated with a frequency > 10(-4) (odds ratio, 23.17; 95% CI, 9.98 to 67.31; P < .001). Remarkably, risk estimates remained high and significant up to 15 years before diagnosis. Conclusion High t(14;18) frequency in blood from healthy individuals defines the first predictive biomarker for FL, effective years before diagnosis.
Published: 2014
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17. Nutrient Patterns and Their Food Sources in an International Study Setting : Report from the EPIC Study

Author: Moskal, Aurelie, Pisa, Pedro T., Ferrari, Pietro, Byrnes, Graham, Freisling, Heinz, Boutron-Ruault, Marie-Christine, Cadeau, Claire, Nailler, Laura, Wendt, Andrea, Kuehn, Tilman, Boeing, Heiner, Buijsse, Brian, Tjonneland, Anne, Halkjaer, Jytte, Dahm, Christina C., Chiuve, Stephanie E., Quiros, Jose R., Buckland, Genevieve, Molina-Montes, Esther, Amiano, Pilar, Huerta Castano, Jose M., Barricarte Gurrea, Aurelio, Khaw, Kay-Tee, Lentjes, Marleen A., Key, Timothy J., Romaguera, Dora, Vergnaud, Anne-Claire, Trichopoulou, Antonia, Bamia, Christina, Orfanos, Philippos, Palli, Domenico, Pala, Valeria, Tumino, Rosario, Sacerdote, Carlotta, de Magistris, Maria Santucci, Bueno-de-Mesquita, H. Bas, Ocke, Marga C., Beulens, Joline W. J., Ericson, Ulrika, Drake, Isabel, Nilsson, Lena M., Winkvist, Anna, Weiderpass, Elisabete, Hjartaker, Anette, Riboli, Elio, Slimani, Nadia, Moskal, Aurelie, Pisa, Pedro T., Ferrari, Pietro, Byrnes, Graham, Freisling, Heinz, Boutron-Ruault, Marie-Christine, Cadeau, Claire, Nailler, Laura, Wendt, Andrea, Kuehn, Tilman, Boeing, Heiner, Buijsse, Brian, Tjonneland, Anne, Halkjaer, Jytte, Dahm, Christina C., Chiuve, Stephanie E., Quiros, Jose R., Buckland, Genevieve, Molina-Montes, Esther, Amiano, Pilar, Huerta Castano, Jose M., Barricarte Gurrea, Aurelio, Khaw, Kay-Tee, Lentjes, Marleen A., Key, Timothy J., Romaguera, Dora, Vergnaud, Anne-Claire, Trichopoulou, Antonia, Bamia, Christina, Orfanos, Philippos, Palli, Domenico, Pala, Valeria, Tumino, Rosario, Sacerdote, Carlotta, de Magistris, Maria Santucci, Bueno-de-Mesquita, H. Bas, Ocke, Marga C., Beulens, Joline W. J., Ericson, Ulrika, Drake, Isabel, Nilsson, Lena M., Winkvist, Anna, Weiderpass, Elisabete, Hjartaker, Anette, Riboli, Elio, and Slimani, Nadia
Abstract: Background: Compared to food patterns, nutrient patterns have been rarely used particularly at international level. We studied, in the context of a multi-center study with heterogeneous data, the methodological challenges regarding pattern analyses. Methodology/Principal Findings: We identified nutrient patterns from food frequency questionnaires (FFQ) in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study and used 24-hour dietary recall (24-HDR) data to validate and describe the nutrient patterns and their related food sources. Associations between lifestyle factors and the nutrient patterns were also examined. Principal component analysis (PCA) was applied on 23 nutrients derived from country-specific FFQ combining data from all EPIC centers (N = 477,312). Harmonized 24-HDRs available for a representative sample of the EPIC populations (N = 34,436) provided accurate mean group estimates of nutrients and foods by quintiles of pattern scores, presented graphically. An overall PCA combining all data captured a good proportion of the variance explained in each EPIC center. Four nutrient patterns were identified explaining 67% of the total variance: Principle component (PC) 1 was characterized by a high contribution of nutrients from plant food sources and a low contribution of nutrients from animal food sources; PC2 by a high contribution of micro-nutrients and proteins; PC3 was characterized by polyunsaturated fatty acids and vitamin D; PC4 was characterized by calcium, proteins, riboflavin, and phosphorus. The nutrients with high loadings on a particular pattern as derived from country-specific FFQ also showed high deviations in their mean EPIC intakes by quintiles of pattern scores when estimated from 24-HDR. Center and energy intake explained most of the variability in pattern scores. Conclusion/Significance: The use of 24-HDR enabled internal validation and facilitated the interpretation of the nutrient patterns derived from FFQs in term
Published: 2014
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18. Nutrient Patterns and Their Food Sources in an International Study Setting : Report from the EPIC Study

Author: Moskal, Aurelie, Pisa, Pedro T., Ferrari, Pietro, Byrnes, Graham, Freisling, Heinz, Boutron-Ruault, Marie-Christine, Cadeau, Claire, Nailler, Laura, Wendt, Andrea, Kuehn, Tilman, Boeing, Heiner, Buijsse, Brian, Tjonneland, Anne, Halkjaer, Jytte, Dahm, Christina C., Chiuve, Stephanie E., Quiros, Jose R., Buckland, Genevieve, Molina-Montes, Esther, Amiano, Pilar, Huerta Castano, Jose M., Barricarte Gurrea, Aurelio, Khaw, Kay-Tee, Lentjes, Marleen A., Key, Timothy J., Romaguera, Dora, Vergnaud, Anne-Claire, Trichopoulou, Antonia, Bamia, Christina, Orfanos, Philippos, Palli, Domenico, Pala, Valeria, Tumino, Rosario, Sacerdote, Carlotta, de Magistris, Maria Santucci, Bueno-de-Mesquita, H. Bas, Ocke, Marga C., Beulens, Joline W. J., Ericson, Ulrika, Drake, Isabel, Nilsson, Lena M., Winkvist, Anna, Weiderpass, Elisabete, Hjartaker, Anette, Riboli, Elio, Slimani, Nadia, Moskal, Aurelie, Pisa, Pedro T., Ferrari, Pietro, Byrnes, Graham, Freisling, Heinz, Boutron-Ruault, Marie-Christine, Cadeau, Claire, Nailler, Laura, Wendt, Andrea, Kuehn, Tilman, Boeing, Heiner, Buijsse, Brian, Tjonneland, Anne, Halkjaer, Jytte, Dahm, Christina C., Chiuve, Stephanie E., Quiros, Jose R., Buckland, Genevieve, Molina-Montes, Esther, Amiano, Pilar, Huerta Castano, Jose M., Barricarte Gurrea, Aurelio, Khaw, Kay-Tee, Lentjes, Marleen A., Key, Timothy J., Romaguera, Dora, Vergnaud, Anne-Claire, Trichopoulou, Antonia, Bamia, Christina, Orfanos, Philippos, Palli, Domenico, Pala, Valeria, Tumino, Rosario, Sacerdote, Carlotta, de Magistris, Maria Santucci, Bueno-de-Mesquita, H. Bas, Ocke, Marga C., Beulens, Joline W. J., Ericson, Ulrika, Drake, Isabel, Nilsson, Lena M., Winkvist, Anna, Weiderpass, Elisabete, Hjartaker, Anette, Riboli, Elio, and Slimani, Nadia
Abstract: Background: Compared to food patterns, nutrient patterns have been rarely used particularly at international level. We studied, in the context of a multi-center study with heterogeneous data, the methodological challenges regarding pattern analyses. Methodology/Principal Findings: We identified nutrient patterns from food frequency questionnaires (FFQ) in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study and used 24-hour dietary recall (24-HDR) data to validate and describe the nutrient patterns and their related food sources. Associations between lifestyle factors and the nutrient patterns were also examined. Principal component analysis (PCA) was applied on 23 nutrients derived from country-specific FFQ combining data from all EPIC centers (N = 477,312). Harmonized 24-HDRs available for a representative sample of the EPIC populations (N = 34,436) provided accurate mean group estimates of nutrients and foods by quintiles of pattern scores, presented graphically. An overall PCA combining all data captured a good proportion of the variance explained in each EPIC center. Four nutrient patterns were identified explaining 67% of the total variance: Principle component (PC) 1 was characterized by a high contribution of nutrients from plant food sources and a low contribution of nutrients from animal food sources; PC2 by a high contribution of micro-nutrients and proteins; PC3 was characterized by polyunsaturated fatty acids and vitamin D; PC4 was characterized by calcium, proteins, riboflavin, and phosphorus. The nutrients with high loadings on a particular pattern as derived from country-specific FFQ also showed high deviations in their mean EPIC intakes by quintiles of pattern scores when estimated from 24-HDR. Center and energy intake explained most of the variability in pattern scores. Conclusion/Significance: The use of 24-HDR enabled internal validation and facilitated the interpretation of the nutrient patterns derived from FFQs in term
Published: 2014
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19. Nutrient Patterns and Their Food Sources in an International Study Setting : Report from the EPIC Study

Author: Moskal, Aurelie, Pisa, Pedro T., Ferrari, Pietro, Byrnes, Graham, Freisling, Heinz, Boutron-Ruault, Marie-Christine, Cadeau, Claire, Nailler, Laura, Wendt, Andrea, Kuehn, Tilman, Boeing, Heiner, Buijsse, Brian, Tjonneland, Anne, Halkjaer, Jytte, Dahm, Christina C., Chiuve, Stephanie E., Quiros, Jose R., Buckland, Genevieve, Molina-Montes, Esther, Amiano, Pilar, Huerta Castano, Jose M., Barricarte Gurrea, Aurelio, Khaw, Kay-Tee, Lentjes, Marleen A., Key, Timothy J., Romaguera, Dora, Vergnaud, Anne-Claire, Trichopoulou, Antonia, Bamia, Christina, Orfanos, Philippos, Palli, Domenico, Pala, Valeria, Tumino, Rosario, Sacerdote, Carlotta, de Magistris, Maria Santucci, Bueno-de-Mesquita, H. Bas, Ocke, Marga C., Beulens, Joline W. J., Ericson, Ulrika, Drake, Isabel, Nilsson, Lena M., Winkvist, Anna, Weiderpass, Elisabete, Hjartaker, Anette, Riboli, Elio, Slimani, Nadia, Moskal, Aurelie, Pisa, Pedro T., Ferrari, Pietro, Byrnes, Graham, Freisling, Heinz, Boutron-Ruault, Marie-Christine, Cadeau, Claire, Nailler, Laura, Wendt, Andrea, Kuehn, Tilman, Boeing, Heiner, Buijsse, Brian, Tjonneland, Anne, Halkjaer, Jytte, Dahm, Christina C., Chiuve, Stephanie E., Quiros, Jose R., Buckland, Genevieve, Molina-Montes, Esther, Amiano, Pilar, Huerta Castano, Jose M., Barricarte Gurrea, Aurelio, Khaw, Kay-Tee, Lentjes, Marleen A., Key, Timothy J., Romaguera, Dora, Vergnaud, Anne-Claire, Trichopoulou, Antonia, Bamia, Christina, Orfanos, Philippos, Palli, Domenico, Pala, Valeria, Tumino, Rosario, Sacerdote, Carlotta, de Magistris, Maria Santucci, Bueno-de-Mesquita, H. Bas, Ocke, Marga C., Beulens, Joline W. J., Ericson, Ulrika, Drake, Isabel, Nilsson, Lena M., Winkvist, Anna, Weiderpass, Elisabete, Hjartaker, Anette, Riboli, Elio, and Slimani, Nadia
Abstract: Background: Compared to food patterns, nutrient patterns have been rarely used particularly at international level. We studied, in the context of a multi-center study with heterogeneous data, the methodological challenges regarding pattern analyses. Methodology/Principal Findings: We identified nutrient patterns from food frequency questionnaires (FFQ) in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study and used 24-hour dietary recall (24-HDR) data to validate and describe the nutrient patterns and their related food sources. Associations between lifestyle factors and the nutrient patterns were also examined. Principal component analysis (PCA) was applied on 23 nutrients derived from country-specific FFQ combining data from all EPIC centers (N = 477,312). Harmonized 24-HDRs available for a representative sample of the EPIC populations (N = 34,436) provided accurate mean group estimates of nutrients and foods by quintiles of pattern scores, presented graphically. An overall PCA combining all data captured a good proportion of the variance explained in each EPIC center. Four nutrient patterns were identified explaining 67% of the total variance: Principle component (PC) 1 was characterized by a high contribution of nutrients from plant food sources and a low contribution of nutrients from animal food sources; PC2 by a high contribution of micro-nutrients and proteins; PC3 was characterized by polyunsaturated fatty acids and vitamin D; PC4 was characterized by calcium, proteins, riboflavin, and phosphorus. The nutrients with high loadings on a particular pattern as derived from country-specific FFQ also showed high deviations in their mean EPIC intakes by quintiles of pattern scores when estimated from 24-HDR. Center and energy intake explained most of the variability in pattern scores. Conclusion/Significance: The use of 24-HDR enabled internal validation and facilitated the interpretation of the nutrient patterns derived from FFQs in term
Published: 2014
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20. Multiple Miscarriages Are Associated with the Risk of Ovarian Cancer : Results from the European Prospective Investigation into Cancer and Nutrition

Author: Braem, Marieke G. M., Onland-Moret, N. Charlotte, Schouten, Leo J., Kruitwagen, Roy F. P. M., Lukanova, Annekatrin, Allen, Naomi E., Wark, Petra A., Tjonneland, Anne, Hansen, Louise, Brauner, Christina Marie, Overvad, Kim, Clavel-Chapelon, Francoise, Chabbert-Buffet, Nathalie, Teucher, Birgit, Floegel, Anna, Boeing, Heiner, Trichopoulou, Antonia, Adarakis, George, Plada, Maria, Rinaldi, Sabina, Fedirko, Veronika, Romieu, Isabelle, Pala, Valeria, Galasso, Rocco, Sacerdote, Carlotta, Palli, Domenico, Tumino, Rosario, Bueno-de-Mesquita, H. Bas, Gram, Inger Torhild, Gavrilyuk, Oxana, Lund, Eiliv, Sanchez, Maria-Jose, Bonet, Catalina, Chirlaque, Maria-Dolores, Larranaga, Nerea, Barricarte Gurrea, Aurelio, Quiros, Jose R., Idahl, Annika, Ohlson, Nina, Lundin, Eva, Jirstrom, Karin, Butt, Salma, Tsilidis, Konstantinos K., Khaw, Kay-Tee, Wareham, Nick, Riboli, Elio, Kaaks, Rudolf, Peeters, Petra H. M., Braem, Marieke G. M., Onland-Moret, N. Charlotte, Schouten, Leo J., Kruitwagen, Roy F. P. M., Lukanova, Annekatrin, Allen, Naomi E., Wark, Petra A., Tjonneland, Anne, Hansen, Louise, Brauner, Christina Marie, Overvad, Kim, Clavel-Chapelon, Francoise, Chabbert-Buffet, Nathalie, Teucher, Birgit, Floegel, Anna, Boeing, Heiner, Trichopoulou, Antonia, Adarakis, George, Plada, Maria, Rinaldi, Sabina, Fedirko, Veronika, Romieu, Isabelle, Pala, Valeria, Galasso, Rocco, Sacerdote, Carlotta, Palli, Domenico, Tumino, Rosario, Bueno-de-Mesquita, H. Bas, Gram, Inger Torhild, Gavrilyuk, Oxana, Lund, Eiliv, Sanchez, Maria-Jose, Bonet, Catalina, Chirlaque, Maria-Dolores, Larranaga, Nerea, Barricarte Gurrea, Aurelio, Quiros, Jose R., Idahl, Annika, Ohlson, Nina, Lundin, Eva, Jirstrom, Karin, Butt, Salma, Tsilidis, Konstantinos K., Khaw, Kay-Tee, Wareham, Nick, Riboli, Elio, Kaaks, Rudolf, and Peeters, Petra H. M.
Abstract: While the risk of ovarian cancer clearly reduces with each full-term pregnancy, the effect of incomplete pregnancies is unclear. We investigated whether incomplete pregnancies (miscarriages and induced abortions) are associated with risk of epithelial ovarian cancer. This observational study was carried out in female participants of the European Prospective Investigation into Cancer and Nutrition (EPIC). A total of 274,442 women were followed from 1992 until 2010. The baseline questionnaire elicited information on miscarriages and induced abortions, reproductive history, and lifestyle-related factors. During a median follow-up of 11.5 years, 1,035 women were diagnosed with incident epithelial ovarian cancer. Despite the lack of an overall association (ever vs. never), risk of ovarian cancer was higher among women with multiple incomplete pregnancies (HR >= 4vs.0: 1.74, 95% CI: 1.20-2.70; number of cases in this category: n = 23). This association was particularly evident for multiple miscarriages (HR >= 4vs.0: 1.99, 95% CI: 1.06-3.73; number of cases in this category: n = 10), with no significant association for multiple induced abortions (HR >= 4vs.0: 1.46, 95% CI: 0.68-3.14; number of cases in this category: n = 7). Our findings suggest that multiple miscarriages are associated with an increased risk of epithelial ovarian cancer, possibly through a shared cluster of etiological factors or a common underlying pathology. These findings should be interpreted with caution as this is the first study to show this association and given the small number of cases in the highest exposure categories.
Published: 2012
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21. Dietary fibre intake and risks of Cancers of the Colon and Rectum in the European prospective investigation into Cancer and Nutrition (EPIC)

Author: Murphy, Neil, Norat, Teresa, Ferrari, Pietro, Jenab, Mazda, Bueno-de-Mesquita, Bas, Skeie, Guri, Dahm, Christina C., Overvad, Kim, Olsen, Anja, Tjonneland, Anne, Clavel-Chapelon, Francoise, Boutron-Ruault, Marie Christine, Racine, Antoine, Kaaks, Rudolf, Teucher, Birgit, Boeing, Heiner, Bergmann, Manuela M., Trichopoulou, Antonia, Trichopoulos, Dimitrios, Lagiou, Pagona, Palli, Domenico, Pala, Valeria, Panico, Salvatore, Tumino, Rosario, Vineis, Paolo, Siersema, Peter, van Duijnhoven, Franzel, Peeters, Petra H. M., Hjartaker, Anette, Engeset, Dagrun, Gonzalez, Carlos A., Sanchez, Maria-Jose, Dorronsoro, Miren, Navarro, Carmen, Ardanaz, Eva, Quiros, Jose R., Sonestedt, Emily, Ericson, Ulrika, Nilsson, Lena, Palmqvist, Richard, Khaw, Kay-Tee, Wareham, Nick, Key, Timothy J., Crowe, Francesca L., Fedirko, Veronika, Wark, Petra A., Chuang, Shu-Chun, Riboli, Elio, Murphy, Neil, Norat, Teresa, Ferrari, Pietro, Jenab, Mazda, Bueno-de-Mesquita, Bas, Skeie, Guri, Dahm, Christina C., Overvad, Kim, Olsen, Anja, Tjonneland, Anne, Clavel-Chapelon, Francoise, Boutron-Ruault, Marie Christine, Racine, Antoine, Kaaks, Rudolf, Teucher, Birgit, Boeing, Heiner, Bergmann, Manuela M., Trichopoulou, Antonia, Trichopoulos, Dimitrios, Lagiou, Pagona, Palli, Domenico, Pala, Valeria, Panico, Salvatore, Tumino, Rosario, Vineis, Paolo, Siersema, Peter, van Duijnhoven, Franzel, Peeters, Petra H. M., Hjartaker, Anette, Engeset, Dagrun, Gonzalez, Carlos A., Sanchez, Maria-Jose, Dorronsoro, Miren, Navarro, Carmen, Ardanaz, Eva, Quiros, Jose R., Sonestedt, Emily, Ericson, Ulrika, Nilsson, Lena, Palmqvist, Richard, Khaw, Kay-Tee, Wareham, Nick, Key, Timothy J., Crowe, Francesca L., Fedirko, Veronika, Wark, Petra A., Chuang, Shu-Chun, and Riboli, Elio
Abstract: Background: Earlier analyses within the EPIC study showed that dietary fibre intake was inversely associated with colorectal cancer risk, but results from some large cohort studies do not support this finding. We explored whether the association remained after longer follow-up with a near threefold increase in colorectal cancer cases, and if the association varied by gender and tumour location. Methodology/Principal Findings: After a mean follow-up of 11.0 years, 4,517 incident cases of colorectal cancer were documented. Total, cereal, fruit, and vegetable fibre intakes were estimated from dietary questionnaires at baseline. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models stratified by age, sex, and centre, and adjusted for total energy intake, body mass index, physical activity, smoking, education, menopausal status, hormone replacement therapy, oral contraceptive use, and intakes of alcohol, folate, red and processed meats, and calcium. After multivariable adjustments, total dietary fibre was inversely associated with colorectal cancer (HR per 10 g/day increase in fibre 0.87, 95% CI: 0.79-0.96). Similar linear associations were observed for colon and rectal cancers. The association between total dietary fibre and risk of colorectal cancer risk did not differ by age, sex, or anthropometric, lifestyle, and dietary variables. Fibre from cereals and fibre from fruit and vegetables were similarly associated with colon cancer; but for rectal cancer, the inverse association was only evident for fibre from cereals. Conclusions/Significance: Our results strengthen the evidence for the role of high dietary fibre intake in colorectal cancer prevention., Ytterligare finansiärer: European Commission (DG-SANCO) och International Agency for Research on Cancer
Published: 2012
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22. Multiple Miscarriages Are Associated with the Risk of Ovarian Cancer : Results from the European Prospective Investigation into Cancer and Nutrition

Author: Braem, Marieke G. M., Onland-Moret, N. Charlotte, Schouten, Leo J., Kruitwagen, Roy F. P. M., Lukanova, Annekatrin, Allen, Naomi E., Wark, Petra A., Tjonneland, Anne, Hansen, Louise, Brauner, Christina Marie, Overvad, Kim, Clavel-Chapelon, Francoise, Chabbert-Buffet, Nathalie, Teucher, Birgit, Floegel, Anna, Boeing, Heiner, Trichopoulou, Antonia, Adarakis, George, Plada, Maria, Rinaldi, Sabina, Fedirko, Veronika, Romieu, Isabelle, Pala, Valeria, Galasso, Rocco, Sacerdote, Carlotta, Palli, Domenico, Tumino, Rosario, Bueno-de-Mesquita, H. Bas, Gram, Inger Torhild, Gavrilyuk, Oxana, Lund, Eiliv, Sanchez, Maria-Jose, Bonet, Catalina, Chirlaque, Maria-Dolores, Larranaga, Nerea, Barricarte Gurrea, Aurelio, Quiros, Jose R., Idahl, Annika, Ohlson, Nina, Lundin, Eva, Jirstrom, Karin, Butt, Salma, Tsilidis, Konstantinos K., Khaw, Kay-Tee, Wareham, Nick, Riboli, Elio, Kaaks, Rudolf, Peeters, Petra H. M., Braem, Marieke G. M., Onland-Moret, N. Charlotte, Schouten, Leo J., Kruitwagen, Roy F. P. M., Lukanova, Annekatrin, Allen, Naomi E., Wark, Petra A., Tjonneland, Anne, Hansen, Louise, Brauner, Christina Marie, Overvad, Kim, Clavel-Chapelon, Francoise, Chabbert-Buffet, Nathalie, Teucher, Birgit, Floegel, Anna, Boeing, Heiner, Trichopoulou, Antonia, Adarakis, George, Plada, Maria, Rinaldi, Sabina, Fedirko, Veronika, Romieu, Isabelle, Pala, Valeria, Galasso, Rocco, Sacerdote, Carlotta, Palli, Domenico, Tumino, Rosario, Bueno-de-Mesquita, H. Bas, Gram, Inger Torhild, Gavrilyuk, Oxana, Lund, Eiliv, Sanchez, Maria-Jose, Bonet, Catalina, Chirlaque, Maria-Dolores, Larranaga, Nerea, Barricarte Gurrea, Aurelio, Quiros, Jose R., Idahl, Annika, Ohlson, Nina, Lundin, Eva, Jirstrom, Karin, Butt, Salma, Tsilidis, Konstantinos K., Khaw, Kay-Tee, Wareham, Nick, Riboli, Elio, Kaaks, Rudolf, and Peeters, Petra H. M.
Abstract: While the risk of ovarian cancer clearly reduces with each full-term pregnancy, the effect of incomplete pregnancies is unclear. We investigated whether incomplete pregnancies (miscarriages and induced abortions) are associated with risk of epithelial ovarian cancer. This observational study was carried out in female participants of the European Prospective Investigation into Cancer and Nutrition (EPIC). A total of 274,442 women were followed from 1992 until 2010. The baseline questionnaire elicited information on miscarriages and induced abortions, reproductive history, and lifestyle-related factors. During a median follow-up of 11.5 years, 1,035 women were diagnosed with incident epithelial ovarian cancer. Despite the lack of an overall association (ever vs. never), risk of ovarian cancer was higher among women with multiple incomplete pregnancies (HR >= 4vs.0: 1.74, 95% CI: 1.20-2.70; number of cases in this category: n = 23). This association was particularly evident for multiple miscarriages (HR >= 4vs.0: 1.99, 95% CI: 1.06-3.73; number of cases in this category: n = 10), with no significant association for multiple induced abortions (HR >= 4vs.0: 1.46, 95% CI: 0.68-3.14; number of cases in this category: n = 7). Our findings suggest that multiple miscarriages are associated with an increased risk of epithelial ovarian cancer, possibly through a shared cluster of etiological factors or a common underlying pathology. These findings should be interpreted with caution as this is the first study to show this association and given the small number of cases in the highest exposure categories.
Published: 2012
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23. Fatty acid patterns and risk of prostate cancer in a case-control study nested within the European Prospective Investigation into Cancer and Nutrition

Author: Dahm, Christina C., Gorst-Rasmussen, Anders, Crowe, Francesca L., Roswall, Nina, Tjonneland, Anne, Drogan, Dagmar, Boeing, Heiner, Teucher, Birgit, Kaaks, Rudolf, Adarakis, George, Zylis, Dimosthenes, Trichopoulou, Antonia, Fedirko, Veronika, Chajes, Veronique, Jenab, Mazda, Palli, Domenico, Pala, Valeria, Tumino, Rosario, Ricceri, Fulvio, van Kranen, Henk, Bueno-de-Mesquita, H. Bas, Quiros, Jose R., Sanchez, Maria-Jose, Lujan-Barroso, Leila, Larranaga, Nerea, Chirlaque, Maria-Dolores, Ardanaz, Eva, Johansson, Mattias, Stattin, Pär, Khaw, Kay-Tee, Wareham, Nick, Wark, Petra A., Norat, Teresa, Riboli, Elio, Key, Tim J., Overvad, Kim, Dahm, Christina C., Gorst-Rasmussen, Anders, Crowe, Francesca L., Roswall, Nina, Tjonneland, Anne, Drogan, Dagmar, Boeing, Heiner, Teucher, Birgit, Kaaks, Rudolf, Adarakis, George, Zylis, Dimosthenes, Trichopoulou, Antonia, Fedirko, Veronika, Chajes, Veronique, Jenab, Mazda, Palli, Domenico, Pala, Valeria, Tumino, Rosario, Ricceri, Fulvio, van Kranen, Henk, Bueno-de-Mesquita, H. Bas, Quiros, Jose R., Sanchez, Maria-Jose, Lujan-Barroso, Leila, Larranaga, Nerea, Chirlaque, Maria-Dolores, Ardanaz, Eva, Johansson, Mattias, Stattin, Pär, Khaw, Kay-Tee, Wareham, Nick, Wark, Petra A., Norat, Teresa, Riboli, Elio, Key, Tim J., and Overvad, Kim
Abstract: Background: Fatty acids in blood may be related to the risk of prostate cancer, but epidemiologic evidence is inconsistent. Blood fatty acids are correlated through shared food sources and common endogenous desaturation and elongation pathways. Studies of individual fatty acids cannot take this into account, but pattern analysis can. Treelet transform (TT) is a novel method that uses data correlation structures to derive sparse factors that explain variation. Objective: The objective was to gain further insight in the association between plasma fatty acids and risk of prostate cancer by applying TT to take data correlations into account. Design: We reanalyzed previously published data from a case-control study of prostate cancer nested within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. TT was used to derive factors explaining the variation in 26 plasma phospholipid fatty acids of 962 incident prostate cancer cases matched to 1061 controls. Multiple imputation was used to deal with missing data in covariates. ORs of prostate cancer according to factor scores were determined by using multivariable conditional logistic regression. Results: Four simple factors explained 38% of the variation in plasma fatty acids. A high score on a factor reflecting a long-chain n-3 PUFA pattern was associated with greater risk of prostate cancer (OR for highest compared with lowest quintile: 1.36; 95% CI: 0.99, 1.86; P-trend = 0.041). Conclusion: Pattern analyses using TT groupings of correlated fatty acids indicate that intake or metabolism of long-chain n-3 PUFAs may be relevant to prostate cancer etiology. Am J Clin Nutr 2012;96:1354-61.
Published: 2012
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24. Multiple Miscarriages Are Associated with the Risk of Ovarian Cancer : Results from the European Prospective Investigation into Cancer and Nutrition

Author: Braem, Marieke G. M., Onland-Moret, N. Charlotte, Schouten, Leo J., Kruitwagen, Roy F. P. M., Lukanova, Annekatrin, Allen, Naomi E., Wark, Petra A., Tjonneland, Anne, Hansen, Louise, Brauner, Christina Marie, Overvad, Kim, Clavel-Chapelon, Francoise, Chabbert-Buffet, Nathalie, Teucher, Birgit, Floegel, Anna, Boeing, Heiner, Trichopoulou, Antonia, Adarakis, George, Plada, Maria, Rinaldi, Sabina, Fedirko, Veronika, Romieu, Isabelle, Pala, Valeria, Galasso, Rocco, Sacerdote, Carlotta, Palli, Domenico, Tumino, Rosario, Bueno-de-Mesquita, H. Bas, Gram, Inger Torhild, Gavrilyuk, Oxana, Lund, Eiliv, Sanchez, Maria-Jose, Bonet, Catalina, Chirlaque, Maria-Dolores, Larranaga, Nerea, Barricarte Gurrea, Aurelio, Quiros, Jose R., Idahl, Annika, Ohlson, Nina, Lundin, Eva, Jirstrom, Karin, Butt, Salma, Tsilidis, Konstantinos K., Khaw, Kay-Tee, Wareham, Nick, Riboli, Elio, Kaaks, Rudolf, Peeters, Petra H. M., Braem, Marieke G. M., Onland-Moret, N. Charlotte, Schouten, Leo J., Kruitwagen, Roy F. P. M., Lukanova, Annekatrin, Allen, Naomi E., Wark, Petra A., Tjonneland, Anne, Hansen, Louise, Brauner, Christina Marie, Overvad, Kim, Clavel-Chapelon, Francoise, Chabbert-Buffet, Nathalie, Teucher, Birgit, Floegel, Anna, Boeing, Heiner, Trichopoulou, Antonia, Adarakis, George, Plada, Maria, Rinaldi, Sabina, Fedirko, Veronika, Romieu, Isabelle, Pala, Valeria, Galasso, Rocco, Sacerdote, Carlotta, Palli, Domenico, Tumino, Rosario, Bueno-de-Mesquita, H. Bas, Gram, Inger Torhild, Gavrilyuk, Oxana, Lund, Eiliv, Sanchez, Maria-Jose, Bonet, Catalina, Chirlaque, Maria-Dolores, Larranaga, Nerea, Barricarte Gurrea, Aurelio, Quiros, Jose R., Idahl, Annika, Ohlson, Nina, Lundin, Eva, Jirstrom, Karin, Butt, Salma, Tsilidis, Konstantinos K., Khaw, Kay-Tee, Wareham, Nick, Riboli, Elio, Kaaks, Rudolf, and Peeters, Petra H. M.
Abstract: While the risk of ovarian cancer clearly reduces with each full-term pregnancy, the effect of incomplete pregnancies is unclear. We investigated whether incomplete pregnancies (miscarriages and induced abortions) are associated with risk of epithelial ovarian cancer. This observational study was carried out in female participants of the European Prospective Investigation into Cancer and Nutrition (EPIC). A total of 274,442 women were followed from 1992 until 2010. The baseline questionnaire elicited information on miscarriages and induced abortions, reproductive history, and lifestyle-related factors. During a median follow-up of 11.5 years, 1,035 women were diagnosed with incident epithelial ovarian cancer. Despite the lack of an overall association (ever vs. never), risk of ovarian cancer was higher among women with multiple incomplete pregnancies (HR >= 4vs.0: 1.74, 95% CI: 1.20-2.70; number of cases in this category: n = 23). This association was particularly evident for multiple miscarriages (HR >= 4vs.0: 1.99, 95% CI: 1.06-3.73; number of cases in this category: n = 10), with no significant association for multiple induced abortions (HR >= 4vs.0: 1.46, 95% CI: 0.68-3.14; number of cases in this category: n = 7). Our findings suggest that multiple miscarriages are associated with an increased risk of epithelial ovarian cancer, possibly through a shared cluster of etiological factors or a common underlying pathology. These findings should be interpreted with caution as this is the first study to show this association and given the small number of cases in the highest exposure categories.
Published: 2012
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25. The amount and type of dairy product intake and incident type 2 diabetes : results from the EPIC-InterAct Study

Author: Sluijs, Ivonne, Forouhi, Nita G, Beulens, Joline WJ, van der Schouw, Yvonne T, Agnoli, Claudia, Arriola, Larraitz, Balkau, Beverley, Barricarte, Aurelio, Boeing, Heiner, Bueno-de-Mesquita, H Bas, Clavel-Chapelon, Francoise, Crowe, Francesca L, de Lauzon-Guillain, Blandine, Drogan, Dagmar, Franks, Paul W, Gavrila, Diana, Gonzalez, Carlos, Halkjaer, Jytte, Kaaks, Rudolf, Moskal, Aurelie, Nilsson, Peter, Overvad, Kim, Palli, Domenico, Panico, Salvatore, Quiros, Jose R, Ricceri, Fulvio, Rinaldi, Sabina, Rolandsson, Olov, Sacerdote, Carlotta, Sanchez, Maria-Jose, Slimani, Nadia, Spijkerman, Annemieke MW, Teucher, Birgit, Tjonneland, Anne, Tormo, Maria-Jose, Tumino, Rosario, van der A, Daphne L, Sharp, Stephen J, Langenberg, Claudia, Feskens, Edith JM, Riboli, Elio, Wareham, Nicholas J, Sluijs, Ivonne, Forouhi, Nita G, Beulens, Joline WJ, van der Schouw, Yvonne T, Agnoli, Claudia, Arriola, Larraitz, Balkau, Beverley, Barricarte, Aurelio, Boeing, Heiner, Bueno-de-Mesquita, H Bas, Clavel-Chapelon, Francoise, Crowe, Francesca L, de Lauzon-Guillain, Blandine, Drogan, Dagmar, Franks, Paul W, Gavrila, Diana, Gonzalez, Carlos, Halkjaer, Jytte, Kaaks, Rudolf, Moskal, Aurelie, Nilsson, Peter, Overvad, Kim, Palli, Domenico, Panico, Salvatore, Quiros, Jose R, Ricceri, Fulvio, Rinaldi, Sabina, Rolandsson, Olov, Sacerdote, Carlotta, Sanchez, Maria-Jose, Slimani, Nadia, Spijkerman, Annemieke MW, Teucher, Birgit, Tjonneland, Anne, Tormo, Maria-Jose, Tumino, Rosario, van der A, Daphne L, Sharp, Stephen J, Langenberg, Claudia, Feskens, Edith JM, Riboli, Elio, and Wareham, Nicholas J
Abstract: Background: Dairy product intake may be inversely associated with risk of type 2 diabetes, but the evidence is inconclusive for total dairy products and sparse for types of dairy products. Objective: The objective was to investigate the prospective association of total dairy products and different dairy subtypes with incidence of diabetes in populations with marked variation of intake of these food groups. Design: A nested case-cohort within 8 European countries of the European Prospective Investigation into Cancer and Nutrition Study (n = 340,234; 3.99 million person-years of follow-up) included a random subcohort (n = 16,835) and incident diabetes cases (n = 12,403). Baseline dairy product intake was assessed by using dietary questionnaires. Country-specific Prentice-weighted Cox regression HRs were calculated and pooled by using a random-effects meta-analysis. Results: Intake of total dairy products was not associated with diabetes (HR for the comparison of the highest with the lowest quintile of total dairy products: 1.01; 95% CI: 0.83, 1.34; P-trend = 0.92) in an analysis adjusted for age, sex, BMI, diabetes risk factors, education, and dietary factors. Of the dairy subtypes, cheese intake tended to have an inverse association with diabetes (HR: 0.88; 95% CI: 0.76, 1.02; P-trend = 0.01), and a higher combined intake of fermented dairy products (cheese, yogurt, and thick fermented milk) was inversely associated with diabetes (HR: 0.88; 95% CI: 0.78, 0.99; P-trend = 0.02) in adjusted analyses that compared extreme quintiles. Conclusions: This large prospective study found no association between total dairy product intake and diabetes risk. An inverse association of cheese intake and combined fermented dairy product intake with diabetes is suggested, which merits further study. Ant J Clin Nutr 2012;96:382-90.
Published: 2012
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26. Dietary fibre intake and risks of Cancers of the Colon and Rectum in the European prospective investigation into Cancer and Nutrition (EPIC)

Author: Murphy, Neil, Norat, Teresa, Ferrari, Pietro, Jenab, Mazda, Bueno-de-Mesquita, Bas, Skeie, Guri, Dahm, Christina C., Overvad, Kim, Olsen, Anja, Tjonneland, Anne, Clavel-Chapelon, Francoise, Boutron-Ruault, Marie Christine, Racine, Antoine, Kaaks, Rudolf, Teucher, Birgit, Boeing, Heiner, Bergmann, Manuela M., Trichopoulou, Antonia, Trichopoulos, Dimitrios, Lagiou, Pagona, Palli, Domenico, Pala, Valeria, Panico, Salvatore, Tumino, Rosario, Vineis, Paolo, Siersema, Peter, van Duijnhoven, Franzel, Peeters, Petra H. M., Hjartaker, Anette, Engeset, Dagrun, Gonzalez, Carlos A., Sanchez, Maria-Jose, Dorronsoro, Miren, Navarro, Carmen, Ardanaz, Eva, Quiros, Jose R., Sonestedt, Emily, Ericson, Ulrika, Nilsson, Lena, Palmqvist, Richard, Khaw, Kay-Tee, Wareham, Nick, Key, Timothy J., Crowe, Francesca L., Fedirko, Veronika, Wark, Petra A., Chuang, Shu-Chun, Riboli, Elio, Murphy, Neil, Norat, Teresa, Ferrari, Pietro, Jenab, Mazda, Bueno-de-Mesquita, Bas, Skeie, Guri, Dahm, Christina C., Overvad, Kim, Olsen, Anja, Tjonneland, Anne, Clavel-Chapelon, Francoise, Boutron-Ruault, Marie Christine, Racine, Antoine, Kaaks, Rudolf, Teucher, Birgit, Boeing, Heiner, Bergmann, Manuela M., Trichopoulou, Antonia, Trichopoulos, Dimitrios, Lagiou, Pagona, Palli, Domenico, Pala, Valeria, Panico, Salvatore, Tumino, Rosario, Vineis, Paolo, Siersema, Peter, van Duijnhoven, Franzel, Peeters, Petra H. M., Hjartaker, Anette, Engeset, Dagrun, Gonzalez, Carlos A., Sanchez, Maria-Jose, Dorronsoro, Miren, Navarro, Carmen, Ardanaz, Eva, Quiros, Jose R., Sonestedt, Emily, Ericson, Ulrika, Nilsson, Lena, Palmqvist, Richard, Khaw, Kay-Tee, Wareham, Nick, Key, Timothy J., Crowe, Francesca L., Fedirko, Veronika, Wark, Petra A., Chuang, Shu-Chun, and Riboli, Elio
Abstract: Background: Earlier analyses within the EPIC study showed that dietary fibre intake was inversely associated with colorectal cancer risk, but results from some large cohort studies do not support this finding. We explored whether the association remained after longer follow-up with a near threefold increase in colorectal cancer cases, and if the association varied by gender and tumour location. Methodology/Principal Findings: After a mean follow-up of 11.0 years, 4,517 incident cases of colorectal cancer were documented. Total, cereal, fruit, and vegetable fibre intakes were estimated from dietary questionnaires at baseline. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models stratified by age, sex, and centre, and adjusted for total energy intake, body mass index, physical activity, smoking, education, menopausal status, hormone replacement therapy, oral contraceptive use, and intakes of alcohol, folate, red and processed meats, and calcium. After multivariable adjustments, total dietary fibre was inversely associated with colorectal cancer (HR per 10 g/day increase in fibre 0.87, 95% CI: 0.79-0.96). Similar linear associations were observed for colon and rectal cancers. The association between total dietary fibre and risk of colorectal cancer risk did not differ by age, sex, or anthropometric, lifestyle, and dietary variables. Fibre from cereals and fibre from fruit and vegetables were similarly associated with colon cancer; but for rectal cancer, the inverse association was only evident for fibre from cereals. Conclusions/Significance: Our results strengthen the evidence for the role of high dietary fibre intake in colorectal cancer prevention., Ytterligare finansiärer: European Commission (DG-SANCO) och International Agency for Research on Cancer
Published: 2012
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27. Dietary fibre intake and risks of Cancers of the Colon and Rectum in the European prospective investigation into Cancer and Nutrition (EPIC)

Author: Murphy, Neil, Norat, Teresa, Ferrari, Pietro, Jenab, Mazda, Bueno-de-Mesquita, Bas, Skeie, Guri, Dahm, Christina C., Overvad, Kim, Olsen, Anja, Tjonneland, Anne, Clavel-Chapelon, Francoise, Boutron-Ruault, Marie Christine, Racine, Antoine, Kaaks, Rudolf, Teucher, Birgit, Boeing, Heiner, Bergmann, Manuela M., Trichopoulou, Antonia, Trichopoulos, Dimitrios, Lagiou, Pagona, Palli, Domenico, Pala, Valeria, Panico, Salvatore, Tumino, Rosario, Vineis, Paolo, Siersema, Peter, van Duijnhoven, Franzel, Peeters, Petra H. M., Hjartaker, Anette, Engeset, Dagrun, Gonzalez, Carlos A., Sanchez, Maria-Jose, Dorronsoro, Miren, Navarro, Carmen, Ardanaz, Eva, Quiros, Jose R., Sonestedt, Emily, Ericson, Ulrika, Nilsson, Lena, Palmqvist, Richard, Khaw, Kay-Tee, Wareham, Nick, Key, Timothy J., Crowe, Francesca L., Fedirko, Veronika, Wark, Petra A., Chuang, Shu-Chun, Riboli, Elio, Murphy, Neil, Norat, Teresa, Ferrari, Pietro, Jenab, Mazda, Bueno-de-Mesquita, Bas, Skeie, Guri, Dahm, Christina C., Overvad, Kim, Olsen, Anja, Tjonneland, Anne, Clavel-Chapelon, Francoise, Boutron-Ruault, Marie Christine, Racine, Antoine, Kaaks, Rudolf, Teucher, Birgit, Boeing, Heiner, Bergmann, Manuela M., Trichopoulou, Antonia, Trichopoulos, Dimitrios, Lagiou, Pagona, Palli, Domenico, Pala, Valeria, Panico, Salvatore, Tumino, Rosario, Vineis, Paolo, Siersema, Peter, van Duijnhoven, Franzel, Peeters, Petra H. M., Hjartaker, Anette, Engeset, Dagrun, Gonzalez, Carlos A., Sanchez, Maria-Jose, Dorronsoro, Miren, Navarro, Carmen, Ardanaz, Eva, Quiros, Jose R., Sonestedt, Emily, Ericson, Ulrika, Nilsson, Lena, Palmqvist, Richard, Khaw, Kay-Tee, Wareham, Nick, Key, Timothy J., Crowe, Francesca L., Fedirko, Veronika, Wark, Petra A., Chuang, Shu-Chun, and Riboli, Elio
Abstract: Background: Earlier analyses within the EPIC study showed that dietary fibre intake was inversely associated with colorectal cancer risk, but results from some large cohort studies do not support this finding. We explored whether the association remained after longer follow-up with a near threefold increase in colorectal cancer cases, and if the association varied by gender and tumour location. Methodology/Principal Findings: After a mean follow-up of 11.0 years, 4,517 incident cases of colorectal cancer were documented. Total, cereal, fruit, and vegetable fibre intakes were estimated from dietary questionnaires at baseline. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models stratified by age, sex, and centre, and adjusted for total energy intake, body mass index, physical activity, smoking, education, menopausal status, hormone replacement therapy, oral contraceptive use, and intakes of alcohol, folate, red and processed meats, and calcium. After multivariable adjustments, total dietary fibre was inversely associated with colorectal cancer (HR per 10 g/day increase in fibre 0.87, 95% CI: 0.79-0.96). Similar linear associations were observed for colon and rectal cancers. The association between total dietary fibre and risk of colorectal cancer risk did not differ by age, sex, or anthropometric, lifestyle, and dietary variables. Fibre from cereals and fibre from fruit and vegetables were similarly associated with colon cancer; but for rectal cancer, the inverse association was only evident for fibre from cereals. Conclusions/Significance: Our results strengthen the evidence for the role of high dietary fibre intake in colorectal cancer prevention., Ytterligare finansiärer: European Commission (DG-SANCO) och International Agency for Research on Cancer
Published: 2012
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28. Multiple Miscarriages Are Associated with the Risk of Ovarian Cancer : Results from the European Prospective Investigation into Cancer and Nutrition

Author: Braem, Marieke G. M., Onland-Moret, N. Charlotte, Schouten, Leo J., Kruitwagen, Roy F. P. M., Lukanova, Annekatrin, Allen, Naomi E., Wark, Petra A., Tjonneland, Anne, Hansen, Louise, Brauner, Christina Marie, Overvad, Kim, Clavel-Chapelon, Francoise, Chabbert-Buffet, Nathalie, Teucher, Birgit, Floegel, Anna, Boeing, Heiner, Trichopoulou, Antonia, Adarakis, George, Plada, Maria, Rinaldi, Sabina, Fedirko, Veronika, Romieu, Isabelle, Pala, Valeria, Galasso, Rocco, Sacerdote, Carlotta, Palli, Domenico, Tumino, Rosario, Bueno-de-Mesquita, H. Bas, Gram, Inger Torhild, Gavrilyuk, Oxana, Lund, Eiliv, Sanchez, Maria-Jose, Bonet, Catalina, Chirlaque, Maria-Dolores, Larranaga, Nerea, Barricarte Gurrea, Aurelio, Quiros, Jose R., Idahl, Annika, Ohlson, Nina, Lundin, Eva, Jirstrom, Karin, Butt, Salma, Tsilidis, Konstantinos K., Khaw, Kay-Tee, Wareham, Nick, Riboli, Elio, Kaaks, Rudolf, Peeters, Petra H. M., Braem, Marieke G. M., Onland-Moret, N. Charlotte, Schouten, Leo J., Kruitwagen, Roy F. P. M., Lukanova, Annekatrin, Allen, Naomi E., Wark, Petra A., Tjonneland, Anne, Hansen, Louise, Brauner, Christina Marie, Overvad, Kim, Clavel-Chapelon, Francoise, Chabbert-Buffet, Nathalie, Teucher, Birgit, Floegel, Anna, Boeing, Heiner, Trichopoulou, Antonia, Adarakis, George, Plada, Maria, Rinaldi, Sabina, Fedirko, Veronika, Romieu, Isabelle, Pala, Valeria, Galasso, Rocco, Sacerdote, Carlotta, Palli, Domenico, Tumino, Rosario, Bueno-de-Mesquita, H. Bas, Gram, Inger Torhild, Gavrilyuk, Oxana, Lund, Eiliv, Sanchez, Maria-Jose, Bonet, Catalina, Chirlaque, Maria-Dolores, Larranaga, Nerea, Barricarte Gurrea, Aurelio, Quiros, Jose R., Idahl, Annika, Ohlson, Nina, Lundin, Eva, Jirstrom, Karin, Butt, Salma, Tsilidis, Konstantinos K., Khaw, Kay-Tee, Wareham, Nick, Riboli, Elio, Kaaks, Rudolf, and Peeters, Petra H. M.
Abstract: While the risk of ovarian cancer clearly reduces with each full-term pregnancy, the effect of incomplete pregnancies is unclear. We investigated whether incomplete pregnancies (miscarriages and induced abortions) are associated with risk of epithelial ovarian cancer. This observational study was carried out in female participants of the European Prospective Investigation into Cancer and Nutrition (EPIC). A total of 274,442 women were followed from 1992 until 2010. The baseline questionnaire elicited information on miscarriages and induced abortions, reproductive history, and lifestyle-related factors. During a median follow-up of 11.5 years, 1,035 women were diagnosed with incident epithelial ovarian cancer. Despite the lack of an overall association (ever vs. never), risk of ovarian cancer was higher among women with multiple incomplete pregnancies (HR >= 4vs.0: 1.74, 95% CI: 1.20-2.70; number of cases in this category: n = 23). This association was particularly evident for multiple miscarriages (HR >= 4vs.0: 1.99, 95% CI: 1.06-3.73; number of cases in this category: n = 10), with no significant association for multiple induced abortions (HR >= 4vs.0: 1.46, 95% CI: 0.68-3.14; number of cases in this category: n = 7). Our findings suggest that multiple miscarriages are associated with an increased risk of epithelial ovarian cancer, possibly through a shared cluster of etiological factors or a common underlying pathology. These findings should be interpreted with caution as this is the first study to show this association and given the small number of cases in the highest exposure categories.
Published: 2012
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29. Dietary fibre intake and risks of Cancers of the Colon and Rectum in the European prospective investigation into Cancer and Nutrition (EPIC)

Author: Murphy, Neil, Norat, Teresa, Ferrari, Pietro, Jenab, Mazda, Bueno-de-Mesquita, Bas, Skeie, Guri, Dahm, Christina C., Overvad, Kim, Olsen, Anja, Tjonneland, Anne, Clavel-Chapelon, Francoise, Boutron-Ruault, Marie Christine, Racine, Antoine, Kaaks, Rudolf, Teucher, Birgit, Boeing, Heiner, Bergmann, Manuela M., Trichopoulou, Antonia, Trichopoulos, Dimitrios, Lagiou, Pagona, Palli, Domenico, Pala, Valeria, Panico, Salvatore, Tumino, Rosario, Vineis, Paolo, Siersema, Peter, van Duijnhoven, Franzel, Peeters, Petra H. M., Hjartaker, Anette, Engeset, Dagrun, Gonzalez, Carlos A., Sanchez, Maria-Jose, Dorronsoro, Miren, Navarro, Carmen, Ardanaz, Eva, Quiros, Jose R., Sonestedt, Emily, Ericson, Ulrika, Nilsson, Lena, Palmqvist, Richard, Khaw, Kay-Tee, Wareham, Nick, Key, Timothy J., Crowe, Francesca L., Fedirko, Veronika, Wark, Petra A., Chuang, Shu-Chun, Riboli, Elio, Murphy, Neil, Norat, Teresa, Ferrari, Pietro, Jenab, Mazda, Bueno-de-Mesquita, Bas, Skeie, Guri, Dahm, Christina C., Overvad, Kim, Olsen, Anja, Tjonneland, Anne, Clavel-Chapelon, Francoise, Boutron-Ruault, Marie Christine, Racine, Antoine, Kaaks, Rudolf, Teucher, Birgit, Boeing, Heiner, Bergmann, Manuela M., Trichopoulou, Antonia, Trichopoulos, Dimitrios, Lagiou, Pagona, Palli, Domenico, Pala, Valeria, Panico, Salvatore, Tumino, Rosario, Vineis, Paolo, Siersema, Peter, van Duijnhoven, Franzel, Peeters, Petra H. M., Hjartaker, Anette, Engeset, Dagrun, Gonzalez, Carlos A., Sanchez, Maria-Jose, Dorronsoro, Miren, Navarro, Carmen, Ardanaz, Eva, Quiros, Jose R., Sonestedt, Emily, Ericson, Ulrika, Nilsson, Lena, Palmqvist, Richard, Khaw, Kay-Tee, Wareham, Nick, Key, Timothy J., Crowe, Francesca L., Fedirko, Veronika, Wark, Petra A., Chuang, Shu-Chun, and Riboli, Elio
Abstract: Background: Earlier analyses within the EPIC study showed that dietary fibre intake was inversely associated with colorectal cancer risk, but results from some large cohort studies do not support this finding. We explored whether the association remained after longer follow-up with a near threefold increase in colorectal cancer cases, and if the association varied by gender and tumour location. Methodology/Principal Findings: After a mean follow-up of 11.0 years, 4,517 incident cases of colorectal cancer were documented. Total, cereal, fruit, and vegetable fibre intakes were estimated from dietary questionnaires at baseline. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models stratified by age, sex, and centre, and adjusted for total energy intake, body mass index, physical activity, smoking, education, menopausal status, hormone replacement therapy, oral contraceptive use, and intakes of alcohol, folate, red and processed meats, and calcium. After multivariable adjustments, total dietary fibre was inversely associated with colorectal cancer (HR per 10 g/day increase in fibre 0.87, 95% CI: 0.79-0.96). Similar linear associations were observed for colon and rectal cancers. The association between total dietary fibre and risk of colorectal cancer risk did not differ by age, sex, or anthropometric, lifestyle, and dietary variables. Fibre from cereals and fibre from fruit and vegetables were similarly associated with colon cancer; but for rectal cancer, the inverse association was only evident for fibre from cereals. Conclusions/Significance: Our results strengthen the evidence for the role of high dietary fibre intake in colorectal cancer prevention., Ytterligare finansiärer: European Commission (DG-SANCO) och International Agency for Research on Cancer
Published: 2012
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30. Multiple Miscarriages Are Associated with the Risk of Ovarian Cancer: Results from the European Prospective Investigation into Cancer and Nutrition

Author: Braem, Marieke G. M., Onland-Moret, N. Charlotte, Schouten, Leo J., Kruitwagen, Roy F. P. M., Lukanova, Annekatrin, Allen, Naomi E., Wark, Petra A., Tjonneland, Anne, Hansen, Louise, Brauner, Christina Marie, Overvad, Kim, Clavel-Chapelon, Francoise, Chabbert-Buffet, Nathalie, Teucher, Birgit, Floegel, Anna, Boeing, Heiner, Trichopoulou, Antonia, Adarakis, George, Plada, Maria, Rinaldi, Sabina, Fedirko, Veronika, Romieu, Isabelle, Pala, Valeria, Galasso, Rocco, Sacerdote, Carlotta, Palli, Domenico, Tumino, Rosario, Bueno-de-Mesquita, H. Bas, Gram, Inger Torhild, Gavrilyuk, Oxana, Lund, Eiliv, Sanchez, Maria-Jose, Bonet, Catalina, Chirlaque, Maria-Dolores, Larranaga, Nerea, Barricarte Gurrea, Aurelio, Quiros, Jose R., Idahl, Annika, Ohlson, Nina, Lundin, Eva, Jirström, Karin, Butt, Salma, Tsilidis, Konstantinos K., Khaw, Kay-Tee, Wareham, Nick, Riboli, Elio, Kaaks, Rudolf, Peeters, Petra H. M., Braem, Marieke G. M., Onland-Moret, N. Charlotte, Schouten, Leo J., Kruitwagen, Roy F. P. M., Lukanova, Annekatrin, Allen, Naomi E., Wark, Petra A., Tjonneland, Anne, Hansen, Louise, Brauner, Christina Marie, Overvad, Kim, Clavel-Chapelon, Francoise, Chabbert-Buffet, Nathalie, Teucher, Birgit, Floegel, Anna, Boeing, Heiner, Trichopoulou, Antonia, Adarakis, George, Plada, Maria, Rinaldi, Sabina, Fedirko, Veronika, Romieu, Isabelle, Pala, Valeria, Galasso, Rocco, Sacerdote, Carlotta, Palli, Domenico, Tumino, Rosario, Bueno-de-Mesquita, H. Bas, Gram, Inger Torhild, Gavrilyuk, Oxana, Lund, Eiliv, Sanchez, Maria-Jose, Bonet, Catalina, Chirlaque, Maria-Dolores, Larranaga, Nerea, Barricarte Gurrea, Aurelio, Quiros, Jose R., Idahl, Annika, Ohlson, Nina, Lundin, Eva, Jirström, Karin, Butt, Salma, Tsilidis, Konstantinos K., Khaw, Kay-Tee, Wareham, Nick, Riboli, Elio, Kaaks, Rudolf, and Peeters, Petra H. M.
Abstract: While the risk of ovarian cancer clearly reduces with each full-term pregnancy, the effect of incomplete pregnancies is unclear. We investigated whether incomplete pregnancies (miscarriages and induced abortions) are associated with risk of epithelial ovarian cancer. This observational study was carried out in female participants of the European Prospective Investigation into Cancer and Nutrition (EPIC). A total of 274,442 women were followed from 1992 until 2010. The baseline questionnaire elicited information on miscarriages and induced abortions, reproductive history, and lifestyle-related factors. During a median follow-up of 11.5 years, 1,035 women were diagnosed with incident epithelial ovarian cancer. Despite the lack of an overall association (ever vs. never), risk of ovarian cancer was higher among women with multiple incomplete pregnancies (HR >= 4vs.0: 1.74, 95% CI: 1.20-2.70; number of cases in this category: n = 23). This association was particularly evident for multiple miscarriages (HR >= 4vs.0: 1.99, 95% CI: 1.06-3.73; number of cases in this category: n = 10), with no significant association for multiple induced abortions (HR >= 4vs.0: 1.46, 95% CI: 0.68-3.14; number of cases in this category: n = 7). Our findings suggest that multiple miscarriages are associated with an increased risk of epithelial ovarian cancer, possibly through a shared cluster of etiological factors or a common underlying pathology. These findings should be interpreted with caution as this is the first study to show this association and given the small number of cases in the highest exposure categories.
Published: 2012

31. Dietary Fibre Intake and Risks of Cancers of the Colon and Rectum in the European Prospective Investigation into Cancer and Nutrition (EPIC)

Author: Murphy, Neil, Norat, Teresa, Ferrari, Pietro, Jenab, Mazda, Bueno-de-Mesquita, Bas, Skeie, Guri, Dahm, Christina C., Overvad, Kim, Olsen, Anja, Tjonneland, Anne, Clavel-Chapelon, Francoise, Boutron-Ruault, Marie Christine, Racine, Antoine, Kaaks, Rudolf, Teucher, Birgit, Boeing, Heiner, Bergmann, Manuela M., Trichopoulou, Antonia, Trichopoulos, Dimitrios, Lagiou, Pagona, Palli, Domenico, Pala, Valeria, Panico, Salvatore, Tumino, Rosario, Vineis, Paolo, Siersema, Peter, van Duijnhoven, Franzel, Peeters, Petra H. M., Hjartaker, Anette, Engeset, Dagrun, Gonzalez, Carlos A., Sanchez, Maria-Jose, Dorronsoro, Miren, Navarro, Carmen, Ardanaz, Eva, Quiros, Jose R., Sonestedt, Emily, Ericson, Ulrika, Nilsson, Lena, Palmqvist, Richard, Khaw, Kay-Tee, Wareham, Nick, Key, Timothy J., Crowe, Francesca L., Fedirko, Veronika, Wark, Petra A., Chuang, Shu-Chun, Riboli, Elio, Murphy, Neil, Norat, Teresa, Ferrari, Pietro, Jenab, Mazda, Bueno-de-Mesquita, Bas, Skeie, Guri, Dahm, Christina C., Overvad, Kim, Olsen, Anja, Tjonneland, Anne, Clavel-Chapelon, Francoise, Boutron-Ruault, Marie Christine, Racine, Antoine, Kaaks, Rudolf, Teucher, Birgit, Boeing, Heiner, Bergmann, Manuela M., Trichopoulou, Antonia, Trichopoulos, Dimitrios, Lagiou, Pagona, Palli, Domenico, Pala, Valeria, Panico, Salvatore, Tumino, Rosario, Vineis, Paolo, Siersema, Peter, van Duijnhoven, Franzel, Peeters, Petra H. M., Hjartaker, Anette, Engeset, Dagrun, Gonzalez, Carlos A., Sanchez, Maria-Jose, Dorronsoro, Miren, Navarro, Carmen, Ardanaz, Eva, Quiros, Jose R., Sonestedt, Emily, Ericson, Ulrika, Nilsson, Lena, Palmqvist, Richard, Khaw, Kay-Tee, Wareham, Nick, Key, Timothy J., Crowe, Francesca L., Fedirko, Veronika, Wark, Petra A., Chuang, Shu-Chun, and Riboli, Elio
Abstract: Background: Earlier analyses within the EPIC study showed that dietary fibre intake was inversely associated with colorectal cancer risk, but results from some large cohort studies do not support this finding. We explored whether the association remained after longer follow-up with a near threefold increase in colorectal cancer cases, and if the association varied by gender and tumour location. Methodology/Principal Findings: After a mean follow-up of 11.0 years, 4,517 incident cases of colorectal cancer were documented. Total, cereal, fruit, and vegetable fibre intakes were estimated from dietary questionnaires at baseline. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models stratified by age, sex, and centre, and adjusted for total energy intake, body mass index, physical activity, smoking, education, menopausal status, hormone replacement therapy, oral contraceptive use, and intakes of alcohol, folate, red and processed meats, and calcium. After multivariable adjustments, total dietary fibre was inversely associated with colorectal cancer (HR per 10 g/day increase in fibre 0.87, 95% CI: 0.79-0.96). Similar linear associations were observed for colon and rectal cancers. The association between total dietary fibre and risk of colorectal cancer risk did not differ by age, sex, or anthropometric, lifestyle, and dietary variables. Fibre from cereals and fibre from fruit and vegetables were similarly associated with colon cancer; but for rectal cancer, the inverse association was only evident for fibre from cereals. Conclusions/Significance: Our results strengthen the evidence for the role of high dietary fibre intake in colorectal cancer prevention.
Published: 2012

32. Multiple Miscarriages Are Associated with the Risk of Ovarian Cancer : Results from the European Prospective Investigation into Cancer and Nutrition

Author: Braem, Marieke G. M., Onland-Moret, N. Charlotte, Schouten, Leo J., Kruitwagen, Roy F. P. M., Lukanova, Annekatrin, Allen, Naomi E., Wark, Petra A., Tjonneland, Anne, Hansen, Louise, Brauner, Christina Marie, Overvad, Kim, Clavel-Chapelon, Francoise, Chabbert-Buffet, Nathalie, Teucher, Birgit, Floegel, Anna, Boeing, Heiner, Trichopoulou, Antonia, Adarakis, George, Plada, Maria, Rinaldi, Sabina, Fedirko, Veronika, Romieu, Isabelle, Pala, Valeria, Galasso, Rocco, Sacerdote, Carlotta, Palli, Domenico, Tumino, Rosario, Bueno-de-Mesquita, H. Bas, Gram, Inger Torhild, Gavrilyuk, Oxana, Lund, Eiliv, Sanchez, Maria-Jose, Bonet, Catalina, Chirlaque, Maria-Dolores, Larranaga, Nerea, Barricarte Gurrea, Aurelio, Quiros, Jose R., Idahl, Annika, Ohlson, Nina, Lundin, Eva, Jirstrom, Karin, Butt, Salma, Tsilidis, Konstantinos K., Khaw, Kay-Tee, Wareham, Nick, Riboli, Elio, Kaaks, Rudolf, Peeters, Petra H. M., Braem, Marieke G. M., Onland-Moret, N. Charlotte, Schouten, Leo J., Kruitwagen, Roy F. P. M., Lukanova, Annekatrin, Allen, Naomi E., Wark, Petra A., Tjonneland, Anne, Hansen, Louise, Brauner, Christina Marie, Overvad, Kim, Clavel-Chapelon, Francoise, Chabbert-Buffet, Nathalie, Teucher, Birgit, Floegel, Anna, Boeing, Heiner, Trichopoulou, Antonia, Adarakis, George, Plada, Maria, Rinaldi, Sabina, Fedirko, Veronika, Romieu, Isabelle, Pala, Valeria, Galasso, Rocco, Sacerdote, Carlotta, Palli, Domenico, Tumino, Rosario, Bueno-de-Mesquita, H. Bas, Gram, Inger Torhild, Gavrilyuk, Oxana, Lund, Eiliv, Sanchez, Maria-Jose, Bonet, Catalina, Chirlaque, Maria-Dolores, Larranaga, Nerea, Barricarte Gurrea, Aurelio, Quiros, Jose R., Idahl, Annika, Ohlson, Nina, Lundin, Eva, Jirstrom, Karin, Butt, Salma, Tsilidis, Konstantinos K., Khaw, Kay-Tee, Wareham, Nick, Riboli, Elio, Kaaks, Rudolf, and Peeters, Petra H. M.
Abstract: While the risk of ovarian cancer clearly reduces with each full-term pregnancy, the effect of incomplete pregnancies is unclear. We investigated whether incomplete pregnancies (miscarriages and induced abortions) are associated with risk of epithelial ovarian cancer. This observational study was carried out in female participants of the European Prospective Investigation into Cancer and Nutrition (EPIC). A total of 274,442 women were followed from 1992 until 2010. The baseline questionnaire elicited information on miscarriages and induced abortions, reproductive history, and lifestyle-related factors. During a median follow-up of 11.5 years, 1,035 women were diagnosed with incident epithelial ovarian cancer. Despite the lack of an overall association (ever vs. never), risk of ovarian cancer was higher among women with multiple incomplete pregnancies (HR >= 4vs.0: 1.74, 95% CI: 1.20-2.70; number of cases in this category: n = 23). This association was particularly evident for multiple miscarriages (HR >= 4vs.0: 1.99, 95% CI: 1.06-3.73; number of cases in this category: n = 10), with no significant association for multiple induced abortions (HR >= 4vs.0: 1.46, 95% CI: 0.68-3.14; number of cases in this category: n = 7). Our findings suggest that multiple miscarriages are associated with an increased risk of epithelial ovarian cancer, possibly through a shared cluster of etiological factors or a common underlying pathology. These findings should be interpreted with caution as this is the first study to show this association and given the small number of cases in the highest exposure categories.
Published: 2012
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33. Dietary fibre intake and risks of Cancers of the Colon and Rectum in the European prospective investigation into Cancer and Nutrition (EPIC)

Author: Murphy, Neil, Norat, Teresa, Ferrari, Pietro, Jenab, Mazda, Bueno-de-Mesquita, Bas, Skeie, Guri, Dahm, Christina C., Overvad, Kim, Olsen, Anja, Tjonneland, Anne, Clavel-Chapelon, Francoise, Boutron-Ruault, Marie Christine, Racine, Antoine, Kaaks, Rudolf, Teucher, Birgit, Boeing, Heiner, Bergmann, Manuela M., Trichopoulou, Antonia, Trichopoulos, Dimitrios, Lagiou, Pagona, Palli, Domenico, Pala, Valeria, Panico, Salvatore, Tumino, Rosario, Vineis, Paolo, Siersema, Peter, van Duijnhoven, Franzel, Peeters, Petra H. M., Hjartaker, Anette, Engeset, Dagrun, Gonzalez, Carlos A., Sanchez, Maria-Jose, Dorronsoro, Miren, Navarro, Carmen, Ardanaz, Eva, Quiros, Jose R., Sonestedt, Emily, Ericson, Ulrika, Nilsson, Lena, Palmqvist, Richard, Khaw, Kay-Tee, Wareham, Nick, Key, Timothy J., Crowe, Francesca L., Fedirko, Veronika, Wark, Petra A., Chuang, Shu-Chun, Riboli, Elio, Murphy, Neil, Norat, Teresa, Ferrari, Pietro, Jenab, Mazda, Bueno-de-Mesquita, Bas, Skeie, Guri, Dahm, Christina C., Overvad, Kim, Olsen, Anja, Tjonneland, Anne, Clavel-Chapelon, Francoise, Boutron-Ruault, Marie Christine, Racine, Antoine, Kaaks, Rudolf, Teucher, Birgit, Boeing, Heiner, Bergmann, Manuela M., Trichopoulou, Antonia, Trichopoulos, Dimitrios, Lagiou, Pagona, Palli, Domenico, Pala, Valeria, Panico, Salvatore, Tumino, Rosario, Vineis, Paolo, Siersema, Peter, van Duijnhoven, Franzel, Peeters, Petra H. M., Hjartaker, Anette, Engeset, Dagrun, Gonzalez, Carlos A., Sanchez, Maria-Jose, Dorronsoro, Miren, Navarro, Carmen, Ardanaz, Eva, Quiros, Jose R., Sonestedt, Emily, Ericson, Ulrika, Nilsson, Lena, Palmqvist, Richard, Khaw, Kay-Tee, Wareham, Nick, Key, Timothy J., Crowe, Francesca L., Fedirko, Veronika, Wark, Petra A., Chuang, Shu-Chun, and Riboli, Elio
Abstract: Background: Earlier analyses within the EPIC study showed that dietary fibre intake was inversely associated with colorectal cancer risk, but results from some large cohort studies do not support this finding. We explored whether the association remained after longer follow-up with a near threefold increase in colorectal cancer cases, and if the association varied by gender and tumour location. Methodology/Principal Findings: After a mean follow-up of 11.0 years, 4,517 incident cases of colorectal cancer were documented. Total, cereal, fruit, and vegetable fibre intakes were estimated from dietary questionnaires at baseline. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models stratified by age, sex, and centre, and adjusted for total energy intake, body mass index, physical activity, smoking, education, menopausal status, hormone replacement therapy, oral contraceptive use, and intakes of alcohol, folate, red and processed meats, and calcium. After multivariable adjustments, total dietary fibre was inversely associated with colorectal cancer (HR per 10 g/day increase in fibre 0.87, 95% CI: 0.79-0.96). Similar linear associations were observed for colon and rectal cancers. The association between total dietary fibre and risk of colorectal cancer risk did not differ by age, sex, or anthropometric, lifestyle, and dietary variables. Fibre from cereals and fibre from fruit and vegetables were similarly associated with colon cancer; but for rectal cancer, the inverse association was only evident for fibre from cereals. Conclusions/Significance: Our results strengthen the evidence for the role of high dietary fibre intake in colorectal cancer prevention., Ytterligare finansiärer: European Commission (DG-SANCO) och International Agency for Research on Cancer
Published: 2012
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34. Physical activity and lung cancer among non-smokers : a pilot molecular epidemiological study within EPIC

Author: Rundle, Andrew, Richie, John, Steindorf, Karen, Peluso, Marco, Overvad, Kim, Raaschou-Nielsen, Ole, Clavel-Chapelon, Francoise, Linseisen, Jacob P., Boeing, Heiner, Trichopoulou, Antonia, Palli, Domenico, Krogh, Vittorio, Tumino, Rosario, Panico, Salvatore, Bueno-De-Mesquita, Hendrik B., Peeters, Petra H., Lund, Eiliv, Gonzalez, Carlos A., Martinez, Carmen, Dorronsoro, Miren, Barricarte, Aurelio, Jose Tormo, M., Quiros, Jose R., Agudo, Antonio, Berglund, Goran, Järvholm, Bengt, Bingham, Sheila, Key, Timothy J., Gormally, Emmanuelle, Saracci, Rodolfo, Kaaks, Rudolf, Riboli, Elio, Vineis, Paolo, Rundle, Andrew, Richie, John, Steindorf, Karen, Peluso, Marco, Overvad, Kim, Raaschou-Nielsen, Ole, Clavel-Chapelon, Francoise, Linseisen, Jacob P., Boeing, Heiner, Trichopoulou, Antonia, Palli, Domenico, Krogh, Vittorio, Tumino, Rosario, Panico, Salvatore, Bueno-De-Mesquita, Hendrik B., Peeters, Petra H., Lund, Eiliv, Gonzalez, Carlos A., Martinez, Carmen, Dorronsoro, Miren, Barricarte, Aurelio, Jose Tormo, M., Quiros, Jose R., Agudo, Antonio, Berglund, Goran, Järvholm, Bengt, Bingham, Sheila, Key, Timothy J., Gormally, Emmanuelle, Saracci, Rodolfo, Kaaks, Rudolf, Riboli, Elio, and Vineis, Paolo
Abstract: The association between physical activity, potential intermediate biomarkers and lung cancer risk was investigated in a study of 230 cases and 648 controls nested within the European Prospective Investigation of Cancer and Nutrition. Data on white blood cell aromatic-DNA adducts by 32P-post-labelling and glutathione (GSH) in red blood cells were available from a subset of cases and controls. Compared with the first quartile, the fourth quartile of recreational physical activity was associated with a lower lung cancer risk (odds ratio (OR) 0.56, 95% confidence interval (CI) 0.35-0.90), higher GSH levels (+1.87 μmol GSH g-1 haemoglobin, p = 0.04) but not with the presence of high levels of adducts (OR 1.05, 95% CI 0.38-2.86). Despite being associated with recreational physical activity, in these small-scale pilot analyses GSH levels were not associated with lung cancer risk (OR 0.95, 95% CI 0.84-1.07 per unit increase in GSH levels). Household and occupational activity was not associated with lung cancer risk or biomarker levels.
Published: 2010
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35. Genetic polymorphisms of the GNRH1 and GNRHR genes and risk of breast cancer in the National Cancer Institute Breast and Prostate Cancer Cohort Consortium (BPC3).

Author: Canzian, Federico, Kaaks, Rudolf, Cox, David G, Henderson, Katherine D, Henderson, Brian E, Berg, Christine, Bingham, Sheila, Boeing, Heiner, Buring, Julie, Calle, Eugenia E, Chanock, Stephen, Clavel-Chapelon, Francoise, Dossus, Laure, Feigelson, Heather Spencer, Haiman, Christopher A, Hankinson, Susan E, Hoover, Robert, Hunter, David J, Isaacs, Claudine, Lenner, Per, Lund, Eiliv, Overvad, Kim, Palli, Domenico, Pearce, Celeste Leigh, Quiros, Jose R, Riboli, Elio, Stram, Daniel O, Thomas, Gilles, Thun, Michael J, Trichopoulos, Dimitrios, van Gils, Carla H, Ziegler, Regina G, Canzian, Federico, Kaaks, Rudolf, Cox, David G, Henderson, Katherine D, Henderson, Brian E, Berg, Christine, Bingham, Sheila, Boeing, Heiner, Buring, Julie, Calle, Eugenia E, Chanock, Stephen, Clavel-Chapelon, Francoise, Dossus, Laure, Feigelson, Heather Spencer, Haiman, Christopher A, Hankinson, Susan E, Hoover, Robert, Hunter, David J, Isaacs, Claudine, Lenner, Per, Lund, Eiliv, Overvad, Kim, Palli, Domenico, Pearce, Celeste Leigh, Quiros, Jose R, Riboli, Elio, Stram, Daniel O, Thomas, Gilles, Thun, Michael J, Trichopoulos, Dimitrios, van Gils, Carla H, and Ziegler, Regina G
Abstract: BACKGROUND: Gonadotropin releasing hormone (GNRH1) triggers the release of follicle stimulating hormone and luteinizing hormone from the pituitary. Genetic variants in the gene encoding GNRH1 or its receptor may influence breast cancer risk by modulating production of ovarian steroid hormones. We studied the association between breast cancer risk and polymorphisms in genes that code for GNRH1 and its receptor (GNRHR) in the large National Cancer Institute Breast and Prostate Cancer Cohort Consortium (NCI-BPC3). METHODS: We sequenced exons of GNRH1 and GNRHR in 95 invasive breast cancer cases. Resulting single nucleotide polymorphisms (SNPs) were genotyped and used to identify haplotype-tagging SNPs (htSNPS) in a panel of 349 healthy women. The htSNPs were genotyped in 5,603 invasive breast cancer cases and 7,480 controls from the Cancer Prevention Study-II (CPS-II), European Prospective Investigation on Cancer and Nutrition (EPIC), Multiethnic Cohort (MEC), Nurses' Health Study (NHS), and Women's Health Study (WHS). Circulating levels of sex steroids (androstenedione, estradiol, estrone and testosterone) were also measured in 4713 study subjects. RESULTS: Breast cancer risk was not associated with any polymorphism or haplotype in the GNRH1 and GNRHR genes, nor were there any statistically significant interactions with known breast cancer risk factors. Polymorphisms in these two genes were not strongly associated with circulating hormone levels. CONCLUSION: Common variants of the GNRH1 and GNRHR genes are not associated with risk of invasive breast cancer in Caucasians.
Published: 2009
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36. Socioeconomic position and the risk of gastric and oesophageal cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC-EURGAST).

Author: Nagel, Gabriele, Linseisen, Jakob, Boshuizen, Hendriek C, Pera, Guillem, Del Giudice, Giuseppe, Westert, Gert P, Bueno-de-Mesquita, H Bas, Allen, Naomi E, Key, Timothy J, Numans, Mattijs E, Peeters, Petra Hm, Sieri, Sabina, Siman, Henrik, Berglund, Goran, Hallmans, Göran, Stenling, Roger, Martinez, Carmen, Arriola, Larraitz, Barricarte, Aurelio, Chirlaque, M Dolores, Quiros, Jose R, Vineis, Paolo, Masala, Giovanna, Palli, Domenico, Panico, Salvatore, Tumino, Rosario, Bingham, Sheila, Boeing, Heiner, Bergmann, Manuela M, Overvad, Kim, Boutron-Ruault, Marie-Christine, Clavel-Chapelon, Francoise, Olsen, Anja, Tjonneland, Anne, Trichopoulou, Antonia, Bamia, Christina, Soukara, Stavroula, Sabourin, Jean-Christoph, Carneiro, Fatima, Slimani, Nadia, Jenab, Mazda, Norat, Teresa, Riboli, Elio, González, Carlos A, Nagel, Gabriele, Linseisen, Jakob, Boshuizen, Hendriek C, Pera, Guillem, Del Giudice, Giuseppe, Westert, Gert P, Bueno-de-Mesquita, H Bas, Allen, Naomi E, Key, Timothy J, Numans, Mattijs E, Peeters, Petra Hm, Sieri, Sabina, Siman, Henrik, Berglund, Goran, Hallmans, Göran, Stenling, Roger, Martinez, Carmen, Arriola, Larraitz, Barricarte, Aurelio, Chirlaque, M Dolores, Quiros, Jose R, Vineis, Paolo, Masala, Giovanna, Palli, Domenico, Panico, Salvatore, Tumino, Rosario, Bingham, Sheila, Boeing, Heiner, Bergmann, Manuela M, Overvad, Kim, Boutron-Ruault, Marie-Christine, Clavel-Chapelon, Francoise, Olsen, Anja, Tjonneland, Anne, Trichopoulou, Antonia, Bamia, Christina, Soukara, Stavroula, Sabourin, Jean-Christoph, Carneiro, Fatima, Slimani, Nadia, Jenab, Mazda, Norat, Teresa, Riboli, Elio, and González, Carlos A
Published: 2007

37. CagA+ Helicobacter pylori infection and gastric cancer risk in the EPIC-EURGAST study.

Author: Palli, Domenico, Masala, Giovanna, Del Giudice, Giuseppe, Plebani, Mario, Basso, Daniela, Berti, Duccio, Numans, Mattijs E, E Numans, Mattijs, Ceroti, Marco, Peeters, Petra H M, Bueno de Mesquita, H Bas, Buchner, Frederike L, Clavel-Chapelon, Francoise, Boutron-Ruault, Marie-Christine, Krogh, Vittorio, Saieva, Calogero, Vineis, Paolo, Panico, Salvatore, Tumino, Rosario, Nyrén, Olof, Simán, Henrik, Berglund, Goran, Hallmans, Göran, Sanchez, Maria-Jose, Larrãnaga, Nerea, Barricarte, Aurelio, Navarro, Carmen, Quiros, Jose R, Key, Tim, Allen, Naomi, Bingham, Sheila, Khaw, Kay Tee, Boeing, Heiner, Weikert, Cornelia, Linseisen, Jakob, Nagel, Gabriele, Overvad, Kim, Thomsen, Reimar W, Tjonneland, Anne, Olsen, Anja, Trichoupoulou, Antonia, Trichopoulos, Dimitrios, Arvaniti, Athina, Pera, Guillem, Kaaks, Rudolf, Jenab, Mazda, Ferrari, Pietro, Nesi, Gabriella, Carneiro, Fatima, Riboli, Elio, Gonzalez, Carlos A, Palli, Domenico, Masala, Giovanna, Del Giudice, Giuseppe, Plebani, Mario, Basso, Daniela, Berti, Duccio, Numans, Mattijs E, E Numans, Mattijs, Ceroti, Marco, Peeters, Petra H M, Bueno de Mesquita, H Bas, Buchner, Frederike L, Clavel-Chapelon, Francoise, Boutron-Ruault, Marie-Christine, Krogh, Vittorio, Saieva, Calogero, Vineis, Paolo, Panico, Salvatore, Tumino, Rosario, Nyrén, Olof, Simán, Henrik, Berglund, Goran, Hallmans, Göran, Sanchez, Maria-Jose, Larrãnaga, Nerea, Barricarte, Aurelio, Navarro, Carmen, Quiros, Jose R, Key, Tim, Allen, Naomi, Bingham, Sheila, Khaw, Kay Tee, Boeing, Heiner, Weikert, Cornelia, Linseisen, Jakob, Nagel, Gabriele, Overvad, Kim, Thomsen, Reimar W, Tjonneland, Anne, Olsen, Anja, Trichoupoulou, Antonia, Trichopoulos, Dimitrios, Arvaniti, Athina, Pera, Guillem, Kaaks, Rudolf, Jenab, Mazda, Ferrari, Pietro, Nesi, Gabriella, Carneiro, Fatima, Riboli, Elio, and Gonzalez, Carlos A
Published: 2007

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