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Published in: European Journal of Epidemiology 4/2013

01-04-2013 | CANCER

Mediterranean diet and colorectal cancer risk: results from a European cohort

Authors: Christina Bamia, Pagona Lagiou, Genevieve Buckland, Sara Grioni, Claudia Agnoli, Aliki J. Taylor, Christina C. Dahm, Kim Overvad, Anja Olsen, Anne Tjønneland, Vanessa Cottet, Marie-Christine Boutron-Ruault, Sophie Morois, Verena Grote, Birgit Teucher, Heiner Boeing, Brian Buijsse, Dimitrios Trichopoulos, George Adarakis, Rosario Tumino, Alessio Naccarati, Salvatore Panico, Domenico Palli, H. Bas Bueno-de-Mesquita, Fränzel J. B. van Duijnhoven, Petra H. M. Peeters, Dagrun Engeset, Guri Skeie, Eiliv Lund, Maria-José Sánchez, Aurelio Barricarte, Jose-Maria Huerta, J. Ramón Quirós, Miren Dorronsoro, Ingrid Ljuslinder, Richard Palmqvist, Isabel Drake, Timothy J. Key, Kay-Tee Khaw, Nick Wareham, Isabelle Romieu, Veronika Fedirko, Mazda Jenab, Dora Romaguera, Teresa Norat, Antonia Trichopoulou

Published in: European Journal of Epidemiology | Issue 4/2013

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Abstract

The authors investigated the association of adherence to Mediterranean diet with colorectal cancer (CRC) risk in the European Prospective Investigation into Cancer and nutrition study. Adherence to Mediterranean diet was expressed through two 10-unit scales, the Modified Mediterranean diet score (MMDS) and the Centre-Specific MMDS (CSMMDS). Both scales share the same dietary components but differ in the cut-off values that were used for these components in the construction of the scales. Adjusted hazard ratios (HR) for the associations of these scales with CRC incidence were estimated. After 5,296,617 person-years of follow-up, 4,355 incident CRC cases were identified. A decreased risk of CRC, of 8 and 11 % was estimated when comparing the highest (scores 6–9) with the lowest (scores 0–3) adherence to CSMMDS and MMDS respectively. For MMDS the HR was 0.89 (95 % confidence interval (CI): 0.80, 0.99). A 2-unit increment in either Mediterranean scale was associated with a borderline statistically significant 3 to 4 % reduction in CRC risk (HR for MMDS: 0.96; 95 % CI: 0.92, 1.00). These associations were somewhat more evident, among women, were mainly manifested for colon cancer risk and their magnitude was not altered when alcohol was excluded from MMDS. These findings suggest that following a Mediterranean diet may have a modest beneficial effect on CRC risk.
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Literature
1.
go back to reference Keys A. Seven countries: a multivariate analysis of death and coronary heart disease. Cambridge: Harvard University Press; 1980. Keys A. Seven countries: a multivariate analysis of death and coronary heart disease. Cambridge: Harvard University Press; 1980.
2.
go back to reference Willett WC, Sacks F, Trichopoulou A, et al. Mediterranean diet pyramid: a cultural model for healthy eating. Am J Clin Nutr. 1995;61(6 Suppl):1402S–6S.PubMed Willett WC, Sacks F, Trichopoulou A, et al. Mediterranean diet pyramid: a cultural model for healthy eating. Am J Clin Nutr. 1995;61(6 Suppl):1402S–6S.PubMed
3.
go back to reference Trichopoulou A, Lagiou P. Healthy traditional Mediterranean diet: an expression of culture, history, and lifestyle. Nutr Rev. 1997;55(11 Pt 1):383–9.PubMed Trichopoulou A, Lagiou P. Healthy traditional Mediterranean diet: an expression of culture, history, and lifestyle. Nutr Rev. 1997;55(11 Pt 1):383–9.PubMed
4.
go back to reference Trichopoulou A, Kouris-Blazos A, Wahlqvist M, et al. Diet and overall survival in elderly people. BMJ. 1995;311(7018):1457–60.PubMedCrossRef Trichopoulou A, Kouris-Blazos A, Wahlqvist M, et al. Diet and overall survival in elderly people. BMJ. 1995;311(7018):1457–60.PubMedCrossRef
5.
go back to reference Trichopoulou A, Costacou T, Bamia C, et al. Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med. 2003;348(26):2599–608.PubMedCrossRef Trichopoulou A, Costacou T, Bamia C, et al. Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med. 2003;348(26):2599–608.PubMedCrossRef
6.
go back to reference Trichopoulou A, Orfanos P, Norat T, et al Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study. BMJ. 2005;330(7498):991. (Epub 2005 Apr 8). Trichopoulou A, Orfanos P, Norat T, et al Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study. BMJ. 2005;330(7498):991. (Epub 2005 Apr 8).
7.
go back to reference Fung TT, Hu FB, McCullough ML, et al. Diet quality is associated with the risk of estrogen receptor-negative breast cancer in postmenopausal women. J Nutr. 2006;136(2):466–4672.PubMed Fung TT, Hu FB, McCullough ML, et al. Diet quality is associated with the risk of estrogen receptor-negative breast cancer in postmenopausal women. J Nutr. 2006;136(2):466–4672.PubMed
8.
go back to reference Mitrou PN, Kipnis V, Thiébaut ACM, et al. Mediterranean dietary pattern and prediction of all-cause mortality in a US population. Results from the NIH-AARP Diet and Health Study. Arch Intern Med. 2007;167(22):2461–8.PubMedCrossRef Mitrou PN, Kipnis V, Thiébaut ACM, et al. Mediterranean dietary pattern and prediction of all-cause mortality in a US population. Results from the NIH-AARP Diet and Health Study. Arch Intern Med. 2007;167(22):2461–8.PubMedCrossRef
9.
go back to reference Buckland G, Agudo A, Luján L, et al. Adherence to a Mediterranean diet and risk of gastric adenocarcinoma within the European Prospective Investigation into Cancer and nutrition (EPIC) cohort study. Am J Clin Nutr. 2010;91(2):381–90.PubMedCrossRef Buckland G, Agudo A, Luján L, et al. Adherence to a Mediterranean diet and risk of gastric adenocarcinoma within the European Prospective Investigation into Cancer and nutrition (EPIC) cohort study. Am J Clin Nutr. 2010;91(2):381–90.PubMedCrossRef
10.
go back to reference Sofi F, Abbate R, Gensini GF, et al. Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr. 2010;92(5):1189–96.PubMedCrossRef Sofi F, Abbate R, Gensini GF, et al. Accruing evidence on benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. Am J Clin Nutr. 2010;92(5):1189–96.PubMedCrossRef
11.
go back to reference Reedy J, Mitrou PN, Krebs-Smith SM, et al. Index-based dietary patterns and risk of colorectal cancer: the NIH-AARP Diet and Health Study. Am J Epidemiol. 2008;168(1):38–48.PubMedCrossRef Reedy J, Mitrou PN, Krebs-Smith SM, et al. Index-based dietary patterns and risk of colorectal cancer: the NIH-AARP Diet and Health Study. Am J Epidemiol. 2008;168(1):38–48.PubMedCrossRef
12.
go back to reference Fung TT, Hu FB, Wu K, et al. The Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets and colorectal cancer. Am J Clin Nutr. 2010;92(6):1429–35.PubMedCrossRef Fung TT, Hu FB, Wu K, et al. The Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets and colorectal cancer. Am J Clin Nutr. 2010;92(6):1429–35.PubMedCrossRef
13.
go back to reference Dixon LB, Subar AF, Peters U, et al. Adherence to the USDA Food Guide, DASH Eating Plan, and Mediterranean dietary pattern reduces risk of colorectal adenoma. J Nutr. 2007;137(11):2443–50.PubMed Dixon LB, Subar AF, Peters U, et al. Adherence to the USDA Food Guide, DASH Eating Plan, and Mediterranean dietary pattern reduces risk of colorectal adenoma. J Nutr. 2007;137(11):2443–50.PubMed
14.
go back to reference Gonzalez CA, Riboli E. Diet and cancer prevention: contributions from the European Prospective Investigation into Cancer and nutrition (EPIC) study. Eur J Cancer. 2010;46(14):2555–62.PubMedCrossRef Gonzalez CA, Riboli E. Diet and cancer prevention: contributions from the European Prospective Investigation into Cancer and nutrition (EPIC) study. Eur J Cancer. 2010;46(14):2555–62.PubMedCrossRef
15.
go back to reference Couto E, Boffetta P, Lagiou P, et al. Mediterranean dietary pattern and cancer risk in the EPIC cohort. Br J Cancer. 2011;104(9):1493–9.PubMedCrossRef Couto E, Boffetta P, Lagiou P, et al. Mediterranean dietary pattern and cancer risk in the EPIC cohort. Br J Cancer. 2011;104(9):1493–9.PubMedCrossRef
16.
go back to reference Riboli E, Hunt KJ, Slimani N, et al. European Prospective Investigation into Cancer and nutrition (EPIC): study populations and data collection. Public Health Nutr. 2002;5(6B):1113–24. Riboli E, Hunt KJ, Slimani N, et al. European Prospective Investigation into Cancer and nutrition (EPIC): study populations and data collection. Public Health Nutr. 2002;5(6B):1113–24.
17.
go back to reference Margetts BM, Pietinen P. European Prospective Investigation into Cancer and nutrition: validity studies on dietary assessment methods. Int J Epidemiol. 1997;26(suppl 1):S1–5.PubMedCrossRef Margetts BM, Pietinen P. European Prospective Investigation into Cancer and nutrition: validity studies on dietary assessment methods. Int J Epidemiol. 1997;26(suppl 1):S1–5.PubMedCrossRef
18.
go back to reference Slimani N, Fahey M, Welch AA, et al. Diversity of dietary patterns observed in the European Prospective Investigation into Cancer and nutrition (EPIC) project. Public Health Nutr. 2002;5(6B):1311–28.PubMedCrossRef Slimani N, Fahey M, Welch AA, et al. Diversity of dietary patterns observed in the European Prospective Investigation into Cancer and nutrition (EPIC) project. Public Health Nutr. 2002;5(6B):1311–28.PubMedCrossRef
19.
go back to reference Slimani N, Deharveng G, Unwin I, et al. The EPIC nutrient database project (ENDB): a first attempt to standardize nutrient databases across the 10 European countries participating in the EPIC study. Eur J Clin Nutr. 2007;61(9):1037–56.PubMedCrossRef Slimani N, Deharveng G, Unwin I, et al. The EPIC nutrient database project (ENDB): a first attempt to standardize nutrient databases across the 10 European countries participating in the EPIC study. Eur J Clin Nutr. 2007;61(9):1037–56.PubMedCrossRef
20.
go back to reference Friedenreich C, Norat T, Steindorf K, et al. Physical activity and risk of colon and rectal cancers: the European Prospective Investigation into Cancer and nutrition. Cancer Epidemiol Biomarkers Prev. 2006;15(12):2398–407.PubMedCrossRef Friedenreich C, Norat T, Steindorf K, et al. Physical activity and risk of colon and rectal cancers: the European Prospective Investigation into Cancer and nutrition. Cancer Epidemiol Biomarkers Prev. 2006;15(12):2398–407.PubMedCrossRef
21.
go back to reference Pischon T, Boeing H, Hoffmann K, et al. General and abdominal adiposity and risk of death in Europe. N Engl J Med. 2008;359(20):2105–20.PubMedCrossRef Pischon T, Boeing H, Hoffmann K, et al. General and abdominal adiposity and risk of death in Europe. N Engl J Med. 2008;359(20):2105–20.PubMedCrossRef
22.
go back to reference Samad AK, Taylor RS, Marshall T, et al. A meta-analysis of the association of physical activity with reduced risk of colorectal cancer. Colorectal Dis. 2005;7(3):204–13.PubMedCrossRef Samad AK, Taylor RS, Marshall T, et al. A meta-analysis of the association of physical activity with reduced risk of colorectal cancer. Colorectal Dis. 2005;7(3):204–13.PubMedCrossRef
23.
go back to reference Tsoi KK, Pau CY, Wu WK, et al. Cigarette smoking and the risk of colorectal cancer: a meta-analysis of prospective cohort studies. Clin Gastroenterol Hepatol. 2009;7(6):682–8.PubMedCrossRef Tsoi KK, Pau CY, Wu WK, et al. Cigarette smoking and the risk of colorectal cancer: a meta-analysis of prospective cohort studies. Clin Gastroenterol Hepatol. 2009;7(6):682–8.PubMedCrossRef
24.
go back to reference Hosseinpoor AR, Stewart Williams J, Itani L, et al. Socioeconomic inequality in domains of health: results from the World Health Surveys. BMC Public Health. 2012;12(1):198. (Epub ahead of print). Hosseinpoor AR, Stewart Williams J, Itani L, et al. Socioeconomic inequality in domains of health: results from the World Health Surveys. BMC Public Health. 2012;12(1):198. (Epub ahead of print).
25.
go back to reference Stata Corporation. Stata statistical software, release 11. College Station: Stata Corporation; 2009. Stata Corporation. Stata statistical software, release 11. College Station: Stata Corporation; 2009.
27.
go back to reference Gerber M. The comprehensive approach to diet: a critical review. J Nutr. 2001;131(suppl):3051S–5S.PubMed Gerber M. The comprehensive approach to diet: a critical review. J Nutr. 2001;131(suppl):3051S–5S.PubMed
28.
go back to reference Jacques PF, Tucker KL. Are dietary patterns useful for understanding the role of diet in chronic disease? Am J Clin Nutr. 2001;73(1):1–2.PubMed Jacques PF, Tucker KL. Are dietary patterns useful for understanding the role of diet in chronic disease? Am J Clin Nutr. 2001;73(1):1–2.PubMed
29.
go back to reference Pauwels EK. The protective effect of the Mediterranean diet: focus on cancer and cardiovascular risk. Med Prince Pract. 2011;20(2):103–11.CrossRef Pauwels EK. The protective effect of the Mediterranean diet: focus on cancer and cardiovascular risk. Med Prince Pract. 2011;20(2):103–11.CrossRef
30.
go back to reference Fung TT, McCullough ML, Newby PK, et al. Diet-quality scores and plasma concentrations of markers of inflammation and endothelial dysfunction. Am J Clin Nutr. 2005;82(1):163–73.PubMed Fung TT, McCullough ML, Newby PK, et al. Diet-quality scores and plasma concentrations of markers of inflammation and endothelial dysfunction. Am J Clin Nutr. 2005;82(1):163–73.PubMed
31.
go back to reference Norat T, Bingham S, Ferrari P, et al. Meat, fish, and colorectal cancer risk: the European Prospective Investigation into Cancer and nutrition. J Natl Cancer Inst. 2005;97(12):906–16.PubMedCrossRef Norat T, Bingham S, Ferrari P, et al. Meat, fish, and colorectal cancer risk: the European Prospective Investigation into Cancer and nutrition. J Natl Cancer Inst. 2005;97(12):906–16.PubMedCrossRef
32.
go back to reference Ferrari P, Jenab M, Norat T, et al. Lifetime and baseline alcohol intake and risk of colon and rectal cancers in the European Prospective Investigation into Cancer and nutrition (EPIC). Int J Cancer. 2007;121(9):2065–72.PubMedCrossRef Ferrari P, Jenab M, Norat T, et al. Lifetime and baseline alcohol intake and risk of colon and rectal cancers in the European Prospective Investigation into Cancer and nutrition (EPIC). Int J Cancer. 2007;121(9):2065–72.PubMedCrossRef
33.
go back to reference van Duijnhoven FJ, Bueno-De-Mesquita HB, Ferrari P, et al. Fruit, vegetables, and colorectal cancer risk: the European Prospective Investigation into Cancer and nutrition. Am J Clin Nutr. 2009;89(5):1441–52.PubMedCrossRef van Duijnhoven FJ, Bueno-De-Mesquita HB, Ferrari P, et al. Fruit, vegetables, and colorectal cancer risk: the European Prospective Investigation into Cancer and nutrition. Am J Clin Nutr. 2009;89(5):1441–52.PubMedCrossRef
34.
go back to reference Ferrari P, Day NE, Boshuizen HC, et al. The evaluation of the diet/disease relation in the EPIC study: considerations for the calibration and the disease models. Int J Epidemiol. 2008;37(2):368–78.PubMedCrossRef Ferrari P, Day NE, Boshuizen HC, et al. The evaluation of the diet/disease relation in the EPIC study: considerations for the calibration and the disease models. Int J Epidemiol. 2008;37(2):368–78.PubMedCrossRef
35.
go back to reference Poole C. Exposure opportunity in case-control studies. Am J Epidemiol. 1986;123(2):352–8. Poole C. Exposure opportunity in case-control studies. Am J Epidemiol. 1986;123(2):352–8.
Metadata
Title
Mediterranean diet and colorectal cancer risk: results from a European cohort
Authors
Christina Bamia
Pagona Lagiou
Genevieve Buckland
Sara Grioni
Claudia Agnoli
Aliki J. Taylor
Christina C. Dahm
Kim Overvad
Anja Olsen
Anne Tjønneland
Vanessa Cottet
Marie-Christine Boutron-Ruault
Sophie Morois
Verena Grote
Birgit Teucher
Heiner Boeing
Brian Buijsse
Dimitrios Trichopoulos
George Adarakis
Rosario Tumino
Alessio Naccarati
Salvatore Panico
Domenico Palli
H. Bas Bueno-de-Mesquita
Fränzel J. B. van Duijnhoven
Petra H. M. Peeters
Dagrun Engeset
Guri Skeie
Eiliv Lund
Maria-José Sánchez
Aurelio Barricarte
Jose-Maria Huerta
J. Ramón Quirós
Miren Dorronsoro
Ingrid Ljuslinder
Richard Palmqvist
Isabel Drake
Timothy J. Key
Kay-Tee Khaw
Nick Wareham
Isabelle Romieu
Veronika Fedirko
Mazda Jenab
Dora Romaguera
Teresa Norat
Antonia Trichopoulou
Publication date
01-04-2013
Publisher
Springer Netherlands
Published in
European Journal of Epidemiology / Issue 4/2013
Print ISSN: 0393-2990
Electronic ISSN: 1573-7284
DOI
https://doi.org/10.1007/s10654-013-9795-x

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