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Meta-Analysis
. 2016 Jan;103(1):161-7.
doi: 10.3945/ajcn.115.118588. Epub 2015 Nov 25.

Nutrient-wide association study of 57 foods/nutrients and epithelial ovarian cancer in the European Prospective Investigation into Cancer and Nutrition study and the Netherlands Cohort Study

Melissa A Merritt  1 , Ioanna Tzoulaki  2 , Piet A van den Brandt  3 , Leo J Schouten  3 , Konstantinos K Tsilidis  4 , Elisabete Weiderpass  5 , Chirag J Patel  6 , Anne Tjønneland  7 , Louise Hansen  7 , Kim Overvad  8 , Mathilde His  9 , Laureen Dartois  9 , Marie-Christine Boutron-Ruault  9 , Renée T Fortner  10 , Rudolf Kaaks  10 , Krasimira Aleksandrova  11 , Heiner Boeing  11 , Antonia Trichopoulou  12 , Pagona Lagiou  13 , Christina Bamia  14 , Domenico Palli  15 , Vittorio Krogh  16 , Rosario Tumino  17 , Fulvio Ricceri  18 , Amalia Mattiello  19 , H Bas Bueno-de-Mesquita  20 , N Charlotte Onland-Moret  21 , Petra H Peeters  22 , Guri Skeie  23 , Mie Jareid  23 , J Ramón Quirós  24 , Mireia Obón-Santacana  25 , María-José Sánchez  26 , Saioa Chamosa  27 , José M Huerta  28 , Aurelio Barricarte  29 , Joana A Dias  30 , Emily Sonestedt  30 , Annika Idahl  31 , Eva Lundin  32 , Nicholas J Wareham  33 , Kay-Tee Khaw  34 , Ruth C Travis  35 , Pietro Ferrari  36 , Elio Riboli  2 , Marc J Gunter  2
Affiliations
Meta-Analysis

Nutrient-wide association study of 57 foods/nutrients and epithelial ovarian cancer in the European Prospective Investigation into Cancer and Nutrition study and the Netherlands Cohort Study

Melissa A Merritt et al. Am J Clin Nutr. 2016 Jan.

Abstract

Background: Studies of the role of dietary factors in epithelial ovarian cancer (EOC) development have been limited, and no specific dietary factors have been consistently associated with EOC risk.

Objective: We used a nutrient-wide association study approach to systematically test the association between dietary factors and invasive EOC risk while accounting for multiple hypothesis testing by using the false discovery rate and evaluated the findings in an independent cohort.

Design: We assessed dietary intake amounts of 28 foods/food groups and 29 nutrients estimated by using dietary questionnaires in the EPIC (European Prospective Investigation into Cancer and Nutrition) study (n = 1095 cases). We selected 4 foods/nutrients that were statistically significantly associated with EOC risk when comparing the extreme quartiles of intake in the EPIC study (false discovery rate = 0.43) and evaluated these factors in the NLCS (Netherlands Cohort Study; n = 383 cases). Cox regression models were used to estimate HRs and 95% CIs.

Results: None of the 4 dietary factors that were associated with EOC risk in the EPIC study (cholesterol, polyunsaturated and saturated fat, and bananas) were statistically significantly associated with EOC risk in the NLCS; however, in meta-analysis of the EPIC study and the NLCS, we observed a higher risk of EOC with a high than with a low intake of saturated fat (quartile 4 compared with quartile 1; overall HR: 1.21; 95% CI: 1.04, 1.41).

Conclusion: In the meta-analysis of both studies, there was a higher risk of EOC with a high than with a low intake of saturated fat.

Keywords: diet; nutrition; ovarian cancer; prospective cohort; saturated fat; serous.

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Figures

FIGURE 1
FIGURE 1
“Manhattan plot” showing results from the nutrient-wide association study method to evaluate the association between dietary intake of various foods and nutrients and epithelial ovarian cancer risk in the EPIC study. The y axis shows the −log10P values from the multivariate-adjusted Cox proportional hazards regression coefficient for the comparison of the highest with the lowest quartiles of dietary intake (red horizontal line indicates P = 0.05). Each x axis label represents a dietary category (for visualization purposes only; each dietary factor was analyzed one at a time), and within each category, dietary items were ordered left to right according to the lowest to highest HR. The 4 dietary factors that were selected for confirmation in the NLCS were labeled with the HR from the EPIC study for the comparison of the highest and the lowest quartiles of dietary intake in relation to risk of epithelial ovarian cancer. EPIC, European Prospective Investigation into Cancer and Nutrition; NLCS, Netherlands Cohort Study.
FIGURE 2
FIGURE 2
Forest plots showing multivariate HRs and 95% CIs for comparisons of the highest and lowest categories of intake of 4 foods and nutrients in relation to epithelial ovarian cancer risk in the EPIC study and the NLCS. Foods and nutrients were evaluated if they had a P value <0.05 for the comparison of extreme quartiles of dietary intake in the EPIC study based on results from multivariate-adjusted Cox proportional hazards regression. Overall risk estimates were estimated from random-effects meta-analysis. P-heterogeneity comparing the EPIC study and the NLCS were ≥0.14 with the following exceptions: PUFAs (P-heterogeneity = 0.01) and bananas (P-heterogeneity = 0.04). Multivariate models were adjusted for total energy intake, oral contraceptive use, menopausal status, and parity and were stratified by age (both studies) and study center (EPIC only). Contrasts and median intake values were cholesterol (EPIC: quartile 4, 334.7 mg/d compared with quartile 1, 148.5 mg/d; NLCS: quartile 4, 292.3 mg/d compared with quartile 1, 164.1 mg/d), polyunsaturated fat (EPIC: quartile 4, 14.5 g/d compared with quartile 1, 7.0 g/d; NLCS: quartile 4, 21.1 g/d compared with quartile 1, 7.9 g/d), saturated fat (EPIC: quartile 4, 29.6 g/d compared with quartile 1, 17.4 g/d; NLCS: quartile 4, 34.3 g/d compared with quartile 1, 22.0 g/d), and bananas (EPIC: quartile 4, 62.4 g/d compared with quartile 1, 0 g/d; NLCS: highest, 32.1 g/d compared with lowest, 0 g/d). EPIC, European Prospective Investigation into Cancer and Nutrition; NLCS, Netherlands Cohort Study.
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References

    1. World Cancer Research Fund/American Institute for Cancer Research. Food, nutrition, physical activity, and the prevention of cancer: a global perspective [Internet]. 2007. [cited 2014 Sep 12]. Washington (DC): American Institute for Cancer Research; 2007. Available from: http://www.dietandcancerreport.org/cancer_resource_center/downloads/Seco....
    1. Allemani C, Weir HK, Carreira H, Harewood R, Spika D, Wang XS, Bannon F, Ahn JV, Johnson CJ, Bonaventure A, et al. . Global surveillance of cancer survival 1995–2009: analysis of individual data for 25 676 887 patients from 279 population-based registries in 67 countries (CONCORD-2). Lancet 2015;385:977–1010. - PMC - PubMed
    1. World Cancer Research Fund/American Institute for Cancer Research. Continuous update project report: food, nutrition, physical activity, and the prevention of ovarian cancer [Internet]. 2014 [cited 2015 Apr 3]. Washington (DC): American Institute for Cancer Research; 2014. Available from: http://www.dietandcancerreport.org/cup/cup_resources.php.
    1. Crane TE, Khulpateea BR, Alberts DS, Basen-Engquist K, Thomson CA.. Dietary intake and ovarian cancer risk: a systematic review. Cancer Epidemiol Biomarkers Prev 2014;23:255–73. - PMC - PubMed
    1. Benjamini Y, Hochberg Y.. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc, B 1995;57:289–300.

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