Diet and cancer_prevention1

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Diet and cancer prevention: Contributions from the European

Prospective Investigation into Cancer and Nutrition (EPIC) study.

Gonzalez CA and Riboli E

Eur J Cancer 2010;46:2555-2562

Page 1 Gonzalez and Riboli, Eur J Cancer 2010;46:2555-2562

http://www.ejcancer.info/article/S0959-8049(10)00703-3/abstract

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Background

• Nutrition and related factors such as alcohol intake, obesity and physical activity, play an important role in cancer occurrence

• Scientific evidence on the relationship between several cancer sites and some foods and nutrients is still insufficient or inconsistent

Gonzalez and Riboli, Eur J Cancer 2010;46:2555-2562 www.pronutritionist.net

Methods

• EPIC is a multicentre prospective study – investigating the relationships between diet, lifestyle,

genetic and environmental factors and the incidence of cancer and other chronic diseases

– carried out in 23 centres in 10 European countries

• n = 519 978

• Diet over the previous 12 months was assessed at recruitment by validated country specific questionnaires– self-administered semiquantitative food-frequency

questionnaire

– diet history questionnaire

– semi-quantitative food-frequency questionnaire combined with dietary record

Page 3 Gonzalez and Riboli, Eur J Cancer 2010;46:2555-2562 www.pronutritionist.net

Factors associated with increased/decreased risk of gastric cancer

www.pronutritionist.netGonzalez and Riboli, Eur J Cancer 2010;46:2555-25624

Results: Gastric cancer

• The association with total meat was strong for Helicobacter pylori infected subjects, whereas no association was observed in uninfected subjects

• For gastric cardia cancer, no association was observed with total, red or processed meat

• A significant reduction of 33% in GC risk was observed when comparing high versus low adherence to Mediterranian diet

• Total fruit or vegetable intake was not associated with reduced risk of GC

Page 5 Gonzalez and Riboli, Eur J Cancer 2010;46:2555-2562 www.pronutritionist.net

Factors associated with increased/decreased risk of colorectal cancer (CRC)


Results: Colorectal cancer (CRC)

• No food source of fibre (cereal, vegetables or fruits) was more protective than another

• High intake of calcium was associated with a lower CRC risk, but dietary vitamin D was not associated– suggesting a relevant role of endogenous formation of

vitamin D


Factors associated with increased/decreased risk of lung cancer


Factors associated with increased/decreased risk of breast cancer


Factors associated with increased/decreased risk of prostate cancer


Pronutritionist’s discussion • Red and processed meat strongly increased the risk of both

gastric and colorectal cancer. Recent findings meat’s negative effect on coronary heart disease make the high use of red and processed meat particularly concerning

• The increased risk of gastric cancer associated with processed meat is consistent with the most recent evidence (Larsson et al. 2006)

• Mediterranean diet pattern decreased incidence of gastric cancer. Because Mediterranean diet pattern has been associated with improved cardiovascular and cognitive outcomes and now with gastric cancer benefit, it may be viewed as one of the best dietary patterns to support overall health and longevity


http://jnci.oxfordjournals.org/content/98/15/1078.short

Pronutritionist’s discussion

• Even if high intake of fruit and vegetables was found to decrease the risk of lung cancer in current smokers, the most effective measure for preventing lung cancer is the cessation of smoking

• Results suggest that diet may not have an important role in prostate carcinogenesis

• In this study, there was only weak (HR 1.13) but significant increased risk of breast cancer associated with higher saturated fat intake. A recent evidence from a meta-analysis has shown an increase of 19% in the risk of breast cancer for the highest level of intake of saturated fat


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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2394401/?tool=pubmed


• Highest intake of dietary fiber decreased incidence of gastric and colorectal cancers by 31-42 %. Taken into consideration also the metabolic and cardiovascular benefits of high dietary fiber intake, increasing fiber intake seems to be beneficial for humans from many perspectives

• High intake of fish was associated with decreased risk of gastric cancer. Fish consumption is associated with improved cardiovascular outcomes in recent meta-analyses, underlining the overall health benefits of fish

• In this study, dietary nitrates were not measured


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• This multicenter cohort study’s strength is the size of the sample (over half a million persons) and prospective nature

• However, cohort studies are always inherent with confounding factors.

• Randomized dietary interventions are extremely difficult to organise in cancer area, due to slow development of cancers and very low incidence (requirement for participating patients would be huge)


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Diet and cancer_prevention1