Mediterranean diet and risk of pancreatic cancer in the European Prospective Investigation into Cancer and Nutrition cohort

Esther Molina-Montes^{1

2

3}, María-José Sánchez^{2

3}, Genevieve Buckland⁴, H B As Bueno-de-Mesquita^{5

6

7

8}, Elisabete Weiderpass^{9

10

11

12}, Pilar Amiano^{3

13}, Petra A Wark¹⁴, Tilman Kühn¹⁵, Verena Katzke¹⁵, José María Huerta^{3

16}, Eva Ardanaz^{3

17

18}, José Ramón Quirós¹⁹, Aurélie Affret^{20

21}, Mathilde His^{20

21}, Marie-Christine Boutron-Ruault^{20

21}, Petra H Peeters^{7

22}, Weimin Ye^{23

24}, Malin Sund^{23

24}, Heiner Boeing²⁵, Khalid Iqbal²⁵, Bodil Ohlsson^{26

27}, Emily Sonestedt²⁷, Anne Tjønneland²⁸, Kristina En Petersen²⁸, Ruth C Travis²⁹, Guri Skeie⁹, Claudia Agnoli³⁰, Salvatore Panico³¹, Domenico Palli³², Rosario Tumino³³, Carlotta Sacerdote³⁴, Heinz Freisling³⁵, Inge Huybrechts³⁵, Kim Overvad³⁶, Antonia Trichopoulou^{37

38}, Christina Bamia^{37

38}, Effie Vasilopoulou³⁸, Nick Wareham³⁹, Kay-Tee Khaw⁴⁰, Amanda J Cross⁷, Heather A Ward⁷, Elio Riboli⁷, Eric J Duell⁴

Affiliations

¹ Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (CNIO), Madrid, Spain.
² Andalusian School of Public Health, Instituto de Investigación Biosanitaria ibs.GRANADA. Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain.
³ CIBER Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.
⁴ Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain.
⁵ Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
⁶ Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands.
⁷ Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, UK.
⁸ Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
⁹ Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.
¹⁰ Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway.
¹¹ Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
¹² Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland.
¹³ Public Health Division of Gipuzkoa, BioDonostia Research Institute, San Sebastián, Spain.
¹⁴ Global eHealth Unit, Department of Primary Care and Public Health, The School of Public Health, Imperial College London, London, UK.
¹⁵ Division of Cancer Epidemiology, German Cancer Research Center (DFKZ), Heidelberg, Germany.
¹⁶ Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain.
¹⁷ Navarra Public Health Institute, Pamplona, Spain.
¹⁸ IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.
¹⁹ Public Health Directorate, Asturias, Spain.
²⁰ Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP Generations and Health Team, INSERM, Villejuif, France.
²¹ Gustave Roussy, Villejuif F-94805, France.
²² Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
²³ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
²⁴ The Medical Biobank at Umeå University, Umeå, Sweden.
²⁵ Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
²⁶ Department of Internal Medicine, Skane University Hospital, Malmö, Sweden.
²⁷ Department of Clinical Sciences, Lund University, Malmö, Sweden.
²⁸ Danish Cancer Society Research Center, Unit of Diet, Genes and Environment, Copenhagen, Denmark.
²⁹ Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
³⁰ Epidemiology and Prevention Unit Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
³¹ Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy.
³² Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute-ISPO, Florence, Italy.
³³ Cancer Registry and Histopathology Unit, 'Civic-M.P.Arezzo' Hospital, ASP Ragusa, Ragusa, Italy.
³⁴ Unit of Cancer Epidemiology, Citta' della Salute e della Scienza Hospital, University of Turin and Centre for Cancer Prevention (CPO), Turin, Italy.
³⁵ Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France.
³⁶ Department of Public Health, Section of Epidemiology, Aarhus University, Aarhus, Denmark.
³⁷ Hellenic Health Foundation, Athens, Greece.
³⁸ WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece.
³⁹ Medical Research Council (MCR), Epidemiology Unit, Cambridge, UK.
⁴⁰ University of Cambridge, School of Clinical Medicine, Cambridge, UK.

PMID: 28170373
PMCID: PMC5355922
DOI: 10.1038/bjc.2017.14

Mediterranean diet and risk of pancreatic cancer in the European Prospective Investigation into Cancer and Nutrition cohort

Esther Molina-Montes et al. Br J Cancer. 2017.

. 2017 Mar 14;116(6):811-820.

doi: 10.1038/bjc.2017.14. Epub 2017 Feb 7.

Authors

Affiliations

¹ Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (CNIO), Madrid, Spain.
² Andalusian School of Public Health, Instituto de Investigación Biosanitaria ibs.GRANADA. Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain.
³ CIBER Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.
⁴ Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain.
⁵ Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
⁶ Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands.
⁷ Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, UK.
⁸ Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
⁹ Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.
¹⁰ Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway.
¹¹ Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
¹² Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland.
¹³ Public Health Division of Gipuzkoa, BioDonostia Research Institute, San Sebastián, Spain.
¹⁴ Global eHealth Unit, Department of Primary Care and Public Health, The School of Public Health, Imperial College London, London, UK.
¹⁵ Division of Cancer Epidemiology, German Cancer Research Center (DFKZ), Heidelberg, Germany.
¹⁶ Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain.
¹⁷ Navarra Public Health Institute, Pamplona, Spain.
¹⁸ IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.
¹⁹ Public Health Directorate, Asturias, Spain.
²⁰ Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP Generations and Health Team, INSERM, Villejuif, France.
²¹ Gustave Roussy, Villejuif F-94805, France.
²² Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
²³ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
²⁴ The Medical Biobank at Umeå University, Umeå, Sweden.
²⁵ Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
²⁶ Department of Internal Medicine, Skane University Hospital, Malmö, Sweden.
²⁷ Department of Clinical Sciences, Lund University, Malmö, Sweden.
²⁸ Danish Cancer Society Research Center, Unit of Diet, Genes and Environment, Copenhagen, Denmark.
²⁹ Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
³⁰ Epidemiology and Prevention Unit Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
³¹ Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy.
³² Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute-ISPO, Florence, Italy.
³³ Cancer Registry and Histopathology Unit, 'Civic-M.P.Arezzo' Hospital, ASP Ragusa, Ragusa, Italy.
³⁴ Unit of Cancer Epidemiology, Citta' della Salute e della Scienza Hospital, University of Turin and Centre for Cancer Prevention (CPO), Turin, Italy.
³⁵ Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France.
³⁶ Department of Public Health, Section of Epidemiology, Aarhus University, Aarhus, Denmark.
³⁷ Hellenic Health Foundation, Athens, Greece.
³⁸ WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece.
³⁹ Medical Research Council (MCR), Epidemiology Unit, Cambridge, UK.
⁴⁰ University of Cambridge, School of Clinical Medicine, Cambridge, UK.

PMID: 28170373
PMCID: PMC5355922
DOI: 10.1038/bjc.2017.14

Abstract

Background: The Mediterranean diet (MD) has been proposed as a means for cancer prevention, but little evidence has been accrued regarding its potential to prevent pancreatic cancer. We investigated the association between the adherence to the MD and pancreatic cancer risk within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort.

Methods: Over half a million participants from 10 European countries were followed up for over 11 years, after which 865 newly diagnosed exocrine pancreatic cancer cases were identified. Adherence to the MD was estimated through an adapted score without the alcohol component (arMED) to discount alcohol-related harmful effects. Cox proportional hazards regression models, stratified by age, sex and centre, and adjusted for energy intake, body mass index, smoking status, alcohol intake and diabetes status at recruitment, were used to estimate hazard ratios (HRs) associated with pancreatic cancer and their corresponding 95% confidence intervals (CIs).

Results: Adherence to the arMED score was not associated with risk of pancreatic cancer (HR high vs low adherence=0.99; 95% CI: 0.77-1.26, and HR per increments of two units in adherence to arMED=1.00; 95% CI: 0.94-1.06). There was no convincing evidence for heterogeneity by smoking status, body mass index, diabetes or European region. There was also no evidence of significant associations in analyses involving microscopically confirmed cases, plausible reporters of energy intake or other definitions of the MD pattern.

Conclusions: A high adherence to the MD is not associated with pancreatic cancer risk in the EPIC study.

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Conflict of interest statement

The authors declare conflict of interest.

References

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Mediterranean diet and risk of pancreatic cancer in the European Prospective Investigation into Cancer and Nutrition cohort

Affiliations

Mediterranean diet and risk of pancreatic cancer in the European Prospective Investigation into Cancer and Nutrition cohort

Authors

Affiliations

Abstract

Conflict of interest statement

References

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