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Int J Cancer. 2019 Apr 1;144(7):1511-1521. doi: 10.1002/ijc.31830. Epub 2018 Dec 21.

Dietary folate intake and pancreatic cancer risk: Results from the European prospective investigation into cancer and nutrition.

Author information

1
International Agency for Research on Cancer, Lyon, France.
2
National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
3
Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands.
4
School of Public Health, Imperial College London, London, United Kingdom.
5
Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway.
6
Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway.
7
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
8
Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland.
9
Group of Translational Research in Respiratory Medicine, IRBLleida, Hospital Universitari Arnau de Vilanova and Santa Maria, Lleida, Spain.
10
Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
11
Danish Cancer Society Research Center, Copenhagen, Denmark.
12
Pancreatology Unit, Beaujon Hospital, Clichy, France.
13
INSERM-UMR 1149, University Paris 7, France.
14
CESP, INSERM U1018, University of Paris-Sud, UVSQ, Université Paris-Saclay, France.
15
Gustave Roussy, Villejuif, France.
16
German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany.
17
Department of Epidemiology, German Institute of Human Nutrition (DIfE) Potsdam-Rehbrücke, Germany.
18
Hellenic Health Foundation, Athens, Greece.
19
Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
20
Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network-ISPRO, Florence, Italy.
21
Epidemiology and Prevention Unit, IRCCS Foundation National Cancer Institute, Milan, Italy.
22
Cancer Registry and Histopathology Department, 'Civic-M.P. Arezzo' Hospital, ASP Ragusa, Italy.
23
Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
24
Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht.
25
Public Health Directorate, Asturias, Spain.
26
Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
27
Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain.
28
CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
29
Dirección de Salud Pública y Adicciones, Gobierno Vasco, Vitoria, Spain.
30
Instituto de Investigación Sanitaria Biodonostia, San Sebastián, Spain.
31
Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia, Spain.
32
Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain.
33
Navarra Public Health Institute, Pamplona, Spain.
34
IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.
35
Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden.
36
Department of Clinical Pharmacology, Pharmacology and Clinical Neurosciences, Umeå University, Umeå, Sweden.
37
Diabetes and Cardiovascular disease, Genetic Epidemiology, Department of Clinical Sciences in Malmö, Lund University, Sweden.
38
Department of Surgery, Institution of Clinical Sciences Malmö, Lund University, Sweden.
39
Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.
40
Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom.
41
Bjørknes University College, Oslo, Norway.
42
IIGM Foundation, Turin, Italy.

Abstract

Pancreatic cancer (PC) has an exceptionally low survival rate and primary prevention strategies are limited. Folate plays an important role in one-carbon metabolism and has been associated with the risk of several cancers, but not consistently with PC risk. We aimed to investigate the association between dietary folate intake and PC risk, using the standardised folate database across 10 European countries. A total of 477,206 participants were followed up for 11 years, during which 865 incident primary PC cases were recorded. Folate intake was energy-adjusted using the residual method. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models. In multivariable analyses stratified by age, sex, study centre and adjusted for energy intake, smoking status, BMI, educational level, diabetes status, supplement use and dietary fibre intake, we found no significant association between folate intake and PC risk: the HR of PC risk for those in the highest quartile of folate intake (≥353 μg/day) compared to the lowest (<241 μg/day) was 0.81 (95% CI: 0.51, 1.31; ptrend = 0.38). In current smokers, a positive trend was observed in PC risk across folate quartiles [HR = 4.42 (95% CI: 1.05, 18.62) for ≥353 μg/day vs. <241 μg/day, ptrend = 0.01]. Nonetheless, there was no significant interaction between smoking and dietary folate intake (pinteraction = 0.99). We found no association between dietary folate intake and PC risk in this large European study.

KEYWORDS:

EPIC study; dietary folate intake; pancreatic cancer

PMID:
30178496
DOI:
10.1002/ijc.31830

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