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Adherence to the Mediterranean diet and risk of bladder cancer in the EPIC cohort study

Buckland, G.; Ros, M. M.; Roswall, N.; Bueno-de-Mesquita, H. B.; Travier, N.; Tjonneland, A.; Kiemeney, L. A.; Sacerdote, C.; Tumino, R. and Ljungberg, B., et al. (2014) In International Journal of Cancer 134(10). p.2504-2511
Abstract
There is growing evidence of the protective role of the Mediterranean diet (MD) on cancer. However, to date no epidemiological study has investigated the influence of the MD on bladder cancer. We evaluated the association between adherence to the MD and risk of urothelial cell bladder cancer (UCC), according to tumor aggressiveness, in the European Prospective Investigation into Cancer and Nutrition (EPIC). The analysis included 477,312 participants, recruited from ten European countries between 1991 and 2000. Information from validated dietary questionnaires was used to develop a relative Mediterranean diet score (rMED), including nine dietary components. Cox regression models were used to assess the effect of the rMED on UCC risk, while... (More)
There is growing evidence of the protective role of the Mediterranean diet (MD) on cancer. However, to date no epidemiological study has investigated the influence of the MD on bladder cancer. We evaluated the association between adherence to the MD and risk of urothelial cell bladder cancer (UCC), according to tumor aggressiveness, in the European Prospective Investigation into Cancer and Nutrition (EPIC). The analysis included 477,312 participants, recruited from ten European countries between 1991 and 2000. Information from validated dietary questionnaires was used to develop a relative Mediterranean diet score (rMED), including nine dietary components. Cox regression models were used to assess the effect of the rMED on UCC risk, while adjusting for dietary energy and tobacco smoking of any kind. Stratified analyses were performed by sex, BMI, smoking status, European region and age at diagnosis. During an average follow-up of 11 years, 1,425 participants (70.9% male) were diagnosed with a first primary UCC. There was a negative but non-significant association between a high versus low rMED score and risk of UCC overall (HR: 0.84 [95% CI 0.69, 1.03]) and risk of aggressive (HR: 0.88 [95% CI 0.61, 1.28]) and non-aggressive tumors (HR: 0.78 [95% CI 0.54, 1.14]). Although there was no effect modification in the stratified analyses, there was a significant 34% (p = 0.043) decreased risk of UCC in current smokers with a high rMED score. In EPIC, the MD was not significantly associated with risk of UCC, although we cannot exclude that a MD may reduce risk in current smokers. What's new? Urothelial cell carcinoma (UCC) is the most common form of bladder cancer. Previous studies suggested that plasma carotenoids, antioxidants found in fruit and vegetables, were associated with a decreased risk of UCC while a high intake of animal protein was associated with an increased cancer risk. Here, the authors conducted the first study to investigate the association between the Mediterranean diet, a diet rich in fresh fruits and vegetables and low in animal products, and UCC in Europe. They found that adherence to a Mediterranean diet was not significantly associated with UCC, regardless of level of tumour aggressiveness. They point out that these findings are in line with the rather weak evidence for questionnaire-based associations between dietary factors and bladder cancer risk. (Less)
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keywords
bladder cancer, mediterranean diet, cohort studies, European prospective, investigation into cancer and nutrition cohort study
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International Journal of Cancer
volume
134
issue
10
pages
2504 - 2511
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John Wiley & Sons
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  • wos:000332309700025
  • scopus:84895924824
ISSN
0020-7136
DOI
10.1002/ijc.28573
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English
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e17ac59b-13b0-432f-9659-beaf2fc37879 (old id 4414183)
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@article{e17ac59b-13b0-432f-9659-beaf2fc37879,
  abstract     = {There is growing evidence of the protective role of the Mediterranean diet (MD) on cancer. However, to date no epidemiological study has investigated the influence of the MD on bladder cancer. We evaluated the association between adherence to the MD and risk of urothelial cell bladder cancer (UCC), according to tumor aggressiveness, in the European Prospective Investigation into Cancer and Nutrition (EPIC). The analysis included 477,312 participants, recruited from ten European countries between 1991 and 2000. Information from validated dietary questionnaires was used to develop a relative Mediterranean diet score (rMED), including nine dietary components. Cox regression models were used to assess the effect of the rMED on UCC risk, while adjusting for dietary energy and tobacco smoking of any kind. Stratified analyses were performed by sex, BMI, smoking status, European region and age at diagnosis. During an average follow-up of 11 years, 1,425 participants (70.9% male) were diagnosed with a first primary UCC. There was a negative but non-significant association between a high versus low rMED score and risk of UCC overall (HR: 0.84 [95% CI 0.69, 1.03]) and risk of aggressive (HR: 0.88 [95% CI 0.61, 1.28]) and non-aggressive tumors (HR: 0.78 [95% CI 0.54, 1.14]). Although there was no effect modification in the stratified analyses, there was a significant 34% (p = 0.043) decreased risk of UCC in current smokers with a high rMED score. In EPIC, the MD was not significantly associated with risk of UCC, although we cannot exclude that a MD may reduce risk in current smokers. What's new? Urothelial cell carcinoma (UCC) is the most common form of bladder cancer. Previous studies suggested that plasma carotenoids, antioxidants found in fruit and vegetables, were associated with a decreased risk of UCC while a high intake of animal protein was associated with an increased cancer risk. Here, the authors conducted the first study to investigate the association between the Mediterranean diet, a diet rich in fresh fruits and vegetables and low in animal products, and UCC in Europe. They found that adherence to a Mediterranean diet was not significantly associated with UCC, regardless of level of tumour aggressiveness. They point out that these findings are in line with the rather weak evidence for questionnaire-based associations between dietary factors and bladder cancer risk.},
  author       = {Buckland, G. and Ros, M. M. and Roswall, N. and Bueno-de-Mesquita, H. B. and Travier, N. and Tjonneland, A. and Kiemeney, L. A. and Sacerdote, C. and Tumino, R. and Ljungberg, B. and Gram, I. T. and Weiderpass, E. and Skeie, G. and Malm, Johan and Ehrnström, Roy and Chang-Claude, J. and Mattiello, A. and Agnoli, C. and Peeters, P. H. and Boutron-Ruault, M. C. and Fagherazzi, G. and Clavel-Chapelon, F. and Nilsson, L. M. and Amiano, P. and Trichopoulou, A. and Oikonomou, E. and Tsiotas, K. and Sanchez, M. J. and Overvad, K. and Quiros, J. R. and Chirlaque, M. D. and Barricarte, A. and Key, T. J. and Allen, N. E. and Khaw, K. T. and Wareham, N. and Riboli, E. and Kaaks, R. and Boeing, H. and Palli, D. and Romieu, I. and Romaguera, D. and Gonzalez, C. A.},
  issn         = {0020-7136},
  keyword      = {bladder cancer,mediterranean diet,cohort studies,European prospective,investigation into cancer and nutrition cohort study},
  language     = {eng},
  number       = {10},
  pages        = {2504--2511},
  publisher    = {John Wiley & Sons},
  series       = {International Journal of Cancer},
  title        = {Adherence to the Mediterranean diet and risk of bladder cancer in the EPIC cohort study},
  url          = {http://dx.doi.org/10.1002/ijc.28573},
  volume       = {134},
  year         = {2014},
}