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Eur J Clin Nutr. 2018 Oct 18. doi: 10.1038/s41430-018-0271-2. [Epub ahead of print]

Haem iron intake and risk of lung cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort.

Author information

1
School of Public Health, Imperial College London, London, UK. heather.ward@imperial.ac.uk.
2
School of Public Health, Imperial College London, London, UK.
3
International Agency for Research on Cancer, Lyon, France.
4
Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology, Barcelona, Spain.
5
Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.
6
Department of Research, 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 and Faculty of Medicine, University of Helsinki, Helsinki, Finland.
9
Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network, Florence, Italy.
10
Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.
11
Danish Cancer Society Research Centre, Copenhagen, Denmark.
12
Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark.
13
Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
14
Human Genetics Foundation, Torino, Italy.
15
CESP Inserm, Facultés de Medicine Université Paris-Sud, UVSQ, Université Paris-Saclay, Gustave Roussy, Villejuif, France.
16
Division of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany.
17
Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany.
18
Hellenic Health Foundation, Athens, Greece.
19
WHO Collaborating Centre for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
20
Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
21
1st Department of Critical Care Medicine & Pulmonary Services, University of Athens Medical School, Evangelismos Hospital, Athens, Greece.
22
Fondazione IRCCS National Cancer Institute, Milan, Italy.
23
Cancer Registry and Histopathology Unit, "Civic - M.P.Arezzo" Hospital, ASP Ragusa, Italy.
24
Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy.
25
Unit of Epidemiology, Regional Health Service, ASL TO3, Grugliasco, Italy.
26
Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
27
Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
28
Department of Epidemiology, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.
29
Public Health Directorate, Asturias, Spain.
30
Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology-IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain.
31
Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain.
32
CIBER Epidemiology and Public Health CIBERESP, Madrid, Spain.
33
Public Health Division and BioDonostia Research Institute, San Sebastian, Spain.
34
Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain.
35
Public Health Institute, Pamplona, Spain.
36
IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.
37
Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden.
38
Department of Clinical Sciences Lund, Division of Oncology and Pathology, Lund University, Malmö, Sweden.
39
Laboratory Medicine, Department of Pathology, Lund University, Malmö, Sweden.
40
Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden.
41
Department of Medical Biosciences, Clinical Chemistry, Umeå University, Umeå, Sweden.
42
Cancer Epidemiology Unit, Nuffield Department of Population Health University of Oxford, Oxford, UK.

Abstract

BACKGROUND:

Epidemiological studies suggest that haem iron, which is found predominantly in red meat and increases endogenous formation of carcinogenic N-nitroso compounds, may be positively associated with lung cancer. The objective was to examine the relationship between haem iron intake and lung cancer risk using detailed smoking history data and serum cotinine to control for potential confounding.

METHODS:

In the European Prospective Investigation into Cancer and Nutrition (EPIC), 416,746 individuals from 10 countries completed demographic and dietary questionnaires at recruitment. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident lung cancer (n = 3731) risk relative to haem iron, non-haem iron, and total dietary iron intake. A corresponding analysis was conducted among a nested subset of 800 lung cancer cases and 1489 matched controls for whom serum cotinine was available.

RESULTS:

Haem iron was associated with lung cancer risk, including after adjustment for details of smoking history (time since quitting, number of cigarettes per day): as a continuous variable (HR per 0.3 mg/1000 kcal 1.03, 95% CI 1.00-1.07), and in the highest versus lowest quintile (HR 1.16, 95% CI 1.02-1.32; trend across quintiles: P = 0.035). In contrast, non-haem iron intake was related inversely with lung cancer risk; however, this association attenuated after adjustment for smoking history. Additional adjustment for serum cotinine did not considerably alter the associations detected in the nested case-control subset.

CONCLUSIONS:

Greater haem iron intake may be modestly associated with lung cancer risk.

PMID:
30337714
DOI:
10.1038/s41430-018-0271-2

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