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Int J Cancer. 2019 Jul 1;145(1):122-131. doi: 10.1002/ijc.32091. Epub 2019 Feb 5.

Adherence to the mediterranean diet and lymphoma risk in the european prospective investigation into cancer and nutrition.

Author information

1
Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
2
Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain.
3
Epidemiology Unit and Girona Cancer Registry, Catalan Institute of Oncology, Girona, Spain.
4
Unit of Molecular and Genetic Epidemiology in Infections and Cancer, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain.
5
Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain.
6
Nutritional Methodology and Biostatistics Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France.
7
Institute for Risk Assessment Sciences, Division of Environmental Epidemiology, Utrecht University, Utrecht, The Netherlands.
8
Immunology Department, Erasmus University Medical Center, Rotterdam, The Netherlands.
9
Department of Hematology and Oncology, Hospital of Versailles, Le Chesnay, France.
10
CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, Villejuif, France.
11
Gustave Roussy, Villejuif, France.
12
Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
13
Department of Epidemiology, German Institute of Human Nutrition (DIfE) Postdam-Rehbrücke, Nuthetal, Germany.
14
Department of Functional Biology, Oviedo University, Oviedo, Spain.
15
Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.
16
Public Health Division of Gipuzkoa, Regional Government of the Basque Country, Donostia, Spain.
17
Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain.
18
Navarra Public Health Institute, Pamplona, Spain.
19
IdiSNA Navarra Institute for Health Research, Pamplona, Spain.
20
Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
21
Department of Epidemiology and Biostatistics, MRC-HPA Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom.
22
School of Public Health, Imperial College London, London, United Kingdom.
23
Hellenic Health Foundation, Athens, Greece.
24
WHO Collaborating Center 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.
25
Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network - ISPRO, Florence, Italy.
26
Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
27
Cancer Registry and Histopathology Department, "Civic - M. P. Arezzo" Hospital, ASP Ragusa, Ragusa, Italy.
28
Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy.
29
Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy.
30
Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.
31
Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway.
32
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
33
Genetic Epidemiology Group, Folkhälsan Research Center, Faculty of Medicine, Helsinki University, Helsinki, Finland.
34
Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden.
35
Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden.
36
Public Health and Clinical Medicine, Nutritional Research and Arctic Research Centre, Umeå University, Umeå, Sweden.
37
Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark.
38
Danish Cancer Society Research Center, Copenhagen, Denmark.
39
Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
40
Reproductive Health, PATH, Seattle, WA.
41
NIHR Bristol Biomedical Research Centre Nutrition Theme, Bristol, United Kingdom.
42
Center for Chronic Immunodeficiency (CCI), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.

Abstract

There is a growing evidence of the protective role of the Mediterranean diet (MD) on cancer. However, no prospective study has yet investigated its influence on lymphoma. We evaluated the association between adherence to the MD and risk of lymphoma and its subtypes in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. The analysis included 476,160 participants, recruited from 10 European countries between 1991 and 2001. Adherence to the MD was estimated through the adapted relative MD (arMED) score excluding alcohol. Cox proportional hazards regression models were used while adjusting for potential confounders. During an average follow-up of 13.9 years, 3,136 lymphomas (135 Hodgkin lymphoma [HL], 2,606 non-HL and 395 lymphoma not otherwise specified) were identified. Overall, a 1-unit increase in the arMED score was associated with a 2% lower risk of lymphoma (95% CI: 0.97; 1.00, p-trend = 0.03) while a statistically nonsignificant inverse association between a high versus low arMED score and risk of lymphoma was observed (hazard ratio [HR]: 0.91 [95% CI 0.80; 1.03], p-trend = 0.12). Analyses by lymphoma subtype did not reveal any statistically significant associations. Albeit with small numbers of cases (N = 135), a suggestive inverse association was found for HL (HR 1-unit increase = 0.93 [95% CI: 0.86; 1.01], p-trend = 0.07). However, the study may have lacked statistical power to detect small effect sizes for lymphoma subtype. Our findings suggest that an increasing arMED score was inversely related to the risk of overall lymphoma in EPIC but not by subtypes. Further large prospective studies are warranted to confirm these findings.

KEYWORDS:

Europe; Mediterranean diet; lymphoma; prospective studies; risk

PMID:
30588620
DOI:
10.1002/ijc.32091

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