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Br J Cancer. 2014 Oct 28;111(9):1870-80. doi: 10.1038/bjc.2014.459. Epub 2014 Aug 14.

Flavonoid and lignan intake in relation to bladder cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study.

Author information

1
1] Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain [2] Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC), Lyon, France.
2
Center for Cancer Prevention (CPO-Piemonte), and Human Genetic Foundation (HuGeF), Torino, Italy.
3
1] Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway [2] Cancer Registry of Norway, Oslo, Norway [3] Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden [4] Samfundet Folkhälsan, Helsinki, Finland.
4
Danish Cancer Society Research Center, Copenhagen, Denmark.
5
Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.
6
Department of Nutrition, Harvard School of Public Health, Boston, MA, USA.
7
Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark.
8
1] Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health team, Villejuif, France [2] Paris South University, UMRS 1018, Villejuif, France [3] IGR, F-94805, Villejuif, France.
9
1] Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Victoria, Australia [2] Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, The University of Melbourne, Melbourne, Victoria, Australia.
10
Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany.
11
Department of Nutrition and Food Sciences, Nutritional Epidemiology, University of Bonn, Bonn, Germany.
12
1] Hellenic Health Foundation, Athens, Greece [2] Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece.
13
Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece.
14
1] Hellenic Health Foundation, Athens, Greece [2] Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece [3] Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
15
Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute-ISPO, Florence, Italy.
16
Nutritional Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
17
Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy.
18
Cancer Registry and Histopathology Unit, 'Civic MP Arezzo' Hospital, ASP Ragusa, Italy.
19
Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.
20
1] Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain [2] CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
21
1] CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain [2] Andalusian School of Public Health, Granada, Spain.
22
Public Health Directorate, Asturias, Spain.
23
1] CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain [2] Public Health Department of Gipuzkoa, BioDonostia Research Institute, Health Department of Basque Region, San Sebastián, Spain.
24
1] CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain [2] Public Health Institute of Navarra, Pamplona, Spain.
25
Diabetes and Cardiovascular disease, Genetic Epidemiology, Department of Clinical Sciences, Lund University, Malmö, Sweden.
26
Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
27
1] Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden [2] Arcum, Arctic Research Centre at Umeå University, Umeå, Sweden.
28
Department for Health Evidence and Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands.
29
1] National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands [2] Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
30
1] National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands [2] Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands [3] School of Public Health, Imperial College, London, UK.
31
1] School of Public Health, Imperial College, London, UK [2] Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
32
Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
33
MRC Epidemiology Unit, Cambridge University, Institute of Metabolic Science, Cambridge, UK.
34
Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC), Lyon, France.
35
Genetic Epidemiology Group, Section of Genetics, International Agency for Research on Cancer (IARC), Lyon, France.
36
School of Public Health, Imperial College, London, UK.

Abstract

BACKGROUND:

There is growing evidence of the protective role of dietary intake of flavonoids and lignans on cancer, but the association with bladder cancer has not been thoroughly investigated in epidemiological studies. We evaluated the association between dietary intakes of total and subclasses of flavonoids and lignans and risk of bladder cancer and its main morphological type, urothelial cell carcinoma (UCC), within the European Prospective Investigation into Cancer and Nutrition (EPIC) study.

METHODS:

A cohort of 477 312 men and women mostly aged 35-70 years, were recruited in 10 European countries. At baseline, dietary flavonoid and lignan intakes were estimated using centre-specific validated questionnaires and a food composition database based on the Phenol-Explorer, the UK Food Standards Agency and the US Department of Agriculture databases.

RESULTS:

During an average of 11 years of follow-up, 1575 new cases of primary bladder cancer were identified, of which 1425 were UCC (classified into aggressive (n=430) and non-aggressive (n=413) UCC). No association was found between total flavonoid intake and bladder cancer risk. Among flavonoid subclasses, significant inverse associations with bladder cancer risk were found for intakes of flavonol (hazard ratio comparing fifth with first quintile (HRQ5-Q1) 0.74, 95% confidence interval (CI): 0.61-0.91; P-trend=0.009) and lignans (HRQ5-Q1 0.78, 95% CI: 0.62-0.96; P-trend=0.046). Similar results were observed for overall UCC and aggressive UCC, but not for non-aggressive UCC.

CONCLUSIONS:

Our study suggests an inverse association between the dietary intakes of flavonols and lignans and risk of bladder cancer, particularly aggressive UCC.

PMID:
25121955
PMCID:
PMC4453722
DOI:
10.1038/bjc.2014.459
[Indexed for MEDLINE]
Free PMC Article

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