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Open Access 18-06-2023 | Carcinoid Tumor | Original Paper

Diet and lifestyle in relation to small intestinal cancer risk: findings from the European Prospective Investigation into Cancer and Nutrition (EPIC)

Authors: Zeynep Ersoy Guller, Rhea N. Harewood, Elisabete Weiderpass, Inge Huybrechts, Mazda Jenab, José María Huerta, Maria-Jose Sánchez, Paula Jakszyn, Pilar Amiano, Eva Ardanaz, Claudia Agnoli, Rosario Tumino, Domenico Palli, Guri Skeie, Jonas Manjer, Keren Papier, Anne Tjønneland, Anne Kirstine Eriksen, Matthias B. Schulze, Rudolf Kaaks, Verena Katzke, Manuela M. Bergmann, Elio Riboli, Marc J. Gunter, Amanda J. Cross

Published in: Cancer Causes & Control | Issue 10/2023

Abstract

Purpose

The incidence of small intestinal cancer (SIC) is increasing, however, its aetiology remains unclear due to a lack of data from large-scale prospective cohorts. We examined modifiable risk factors in relation to SIC overall and by histological subtype.

Methods

We analysed 450,107 participants enrolled in the European Prospective Investigation into Cancer and Nutrition cohort. Cox proportional hazards models were used to estimate univariable and multivariable hazard ratios (HRs) and 95% confidence intervals (CIs).

Results

During an average of 14.1 years of follow-up, 160 incident SICs (62 carcinoids, 51 adenocarcinomas) were identified. Whilst univariable models revealed a positive association for current versus never smokers and SIC (HR, 95% CI: 1.77, 1.21–2.60), this association attenuated in multivariable models. In energy-adjusted models, there was an inverse association across vegetable intake tertiles for SIC overall (HR_T3vsT1, 95% CI: 0.48, 0.32–0.71, p-trend: < 0.001) and for carcinoids (HR_T3vsT1, 95% CI: 0.44, 0.24–0.82, p-trend: 0.01); however, these attenuated in multivariable models. Total fat was also inversely associated with total SIC and both subtypes but only in the second tertile (SIC univariable HR_T2vsT1, 95% CI: 0.57, 0.38–0.84; SIC multivariable HR_T2vsT1, 95% CI: 0.55, 0.37–0.81). Physical activity, intake of alcohol, red or processed meat, dairy products, or fibre were not associated with SIC.

Conclusion

These exploratory analyses found limited evidence for a role of modifiable risk factors in SIC aetiology. However, sample size was limited, particularly for histologic subtypes; therefore, larger studies are needed to delineate these associations and robustly identify risk factors for SIC.

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Title: Diet and lifestyle in relation to small intestinal cancer risk: findings from the European Prospective Investigation into Cancer and Nutrition (EPIC)
Authors: Zeynep Ersoy Guller
Rhea N. Harewood
Elisabete Weiderpass
Inge Huybrechts
Mazda Jenab
José María Huerta
Maria-Jose Sánchez
Paula Jakszyn
Pilar Amiano
Eva Ardanaz
Claudia Agnoli
Rosario Tumino
Domenico Palli
Guri Skeie
Jonas Manjer
Keren Papier
Anne Tjønneland
Anne Kirstine Eriksen
Matthias B. Schulze
Rudolf Kaaks
Verena Katzke
Manuela M. Bergmann
Elio Riboli
Marc J. Gunter
Amanda J. Cross
Publication date: 18-06-2023
Publisher: Springer International Publishing
Keywords: Carcinoid Tumor
Nutrition
Colorectal Cancer
Colorectal Cancer
Published in: Cancer Causes & Control / Issue 10/2023
Print ISSN: 0957-5243
Electronic ISSN: 1573-7225
DOI: https://doi.org/10.1007/s10552-023-01731-w

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