Carbohydrate intake and incidence of type 2 diabetes in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam Study

It remains unclear what long-term effects of substituting carbohydrates at the expense of protein or fat may have with regard to diabetes risk. Our objective was to evaluate carbohydrate intake in predicting type 2 diabetes using substitution models for fat and protein. We conducted a prospective cohort study of 9,702 men and 15,365 women aged 35-65 years and free of diabetes at baseline (1994-8) who were followed for incident type 2 diabetes until 2005. Dietary intake of macronutrients was estimated with a validated FFQ. We estimated the relative risk (RR) using Cox proportional hazards analysis. During 176,117 person-years of follow-up we observed 844 incident cases of physician-confirmed type 2 diabetes. After adjustment for age, BMI, waist circumference, potential lifestyle and dietary confounders, substituting 5 % of energy intake from total, saturated, or monounsaturated fat with carbohydrates was not associated with diabetes risk. In contrast, substituting carbohydrates for protein or PUFA was inversely related to diabetes risk (RR for 5 % energy substitution of protein 0.77 (95 % CI 0.64, 0.91); RR for PUFA 0.83 (95 % CI 0.70, 0.98)). These associations appeared to be similar for men and women, but gained statistical significance only among men for protein (RR 0.78 (95 % CI 0.61, 0.99)). Restricted cubic spline regression did not indicate non-linearity of these associations (P for non-linearity in full cohort was 0.353 and 0.349). In conclusion, a higher carbohydrate intake at the expense of protein and PUFA might be associated with decreased diabetes risk.     

Dietary patterns and their association with food and nutrient intake in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam study

Dietary pattern analysis has recently received growing attention, as it might be more appropriate in studies of diet-disease associations than the single food or nutrient approach that has dominated past epidemiological research. Factor analysis is a technique which is commonly used to identify dietary patterns within study populations. However, the ability of factor solutions to account for variance of food and nutrient intake has so far remained unclear. The present study therefore explored the statistical properties of dietary patterns with regard to the explained variance. Food intake of 8975 men and 13 379 women, assessed by a food-frequency questionnaire, was aggregated into forty-seven separate food groups. Dietary patterns were identified by principal component analysis and subsequent varimax rotation. Seven factors were retained for both men and women, which accounted for about 31 % of the total variance. The explained variance was relatively high (>40 %) for cooked vegetables, sauce, meat, dessert, cake, bread other than wholemeal, raw vegetables, processed meat, high-fat cheese, butter and margarine. Factor scores were used to investigate associations between the factors and nutrient intake. The patterns accounted for relatively large proportions of variance of energy and macronutrient intake, but for less variance of alcohol and micronutrient intake, especially of retinol, beta-carotene, vitamin E, Ca and ascorbic acid. In addition, factors were related to age, BMI, physical activity, education, smoking and vitamin and mineral supplement use.     

Body mass index history and risk of type 2 diabetes: results from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam Study

BACKGROUND: Obesity and increases in body weight in adults are considered to be among the most important risk factors for type 2 diabetes. OBJECTIVE: The objective was to evaluate and compare the associations between weight changes during 2 different periods of adult life and the risk of type 2 diabetes and age at diagnosis. DESIGN: The study included 7720 men and 10 371 women from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam Study with information on weight history; 390 men and 303 women of these participants received a clinical diagnosis of type 2 diabetes during 7 y of follow-up. Multivariate Cox regression models were used to estimate the relative risk (RR) of weight changes between ages 25 and 40 y and ages 40 and 55 y. RESULTS: RR estimates in men and women were slightly higher for each unit of BMI gain between ages 25 and 40 y [men: 1.25 (95% CI: 1.21, 1.30); women: 1.24 (1.20, 1.27)] than between ages 40 and 55 y [men: 1.13 (1.10, 1.16); women: 1.11 (1.08, 1.14)]. Severe weight gain between ages 25 and 40 y was associated with a higher diabetes risk in men (1.5 times) and in women (4.3 times) than were stable weight in early adulthood and weight gain in later life, and it resulted in an average lower age at diabetes diagnosis in men (5 y) and in women (3 y). CONCLUSION: Weight gain in early adulthood is related to a higher risk and earlier onset of type 2 diabetes than is weight gain between 40 and 55 y of age.     

Ethanol intake and risk of lung cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC)

Within the European Prospective Investigation into Cancer and Nutrition (EPIC), the authors examined the association of ethanol intake at recruitment (1,119 cases) and mean lifelong ethanol intake (887 cases) with lung cancer. Information on baseline and past alcohol consumption, lifetime tobacco smoking, diet, and the anthropometric characteristics of 478,590 participants was collected between 1992 and 2000. Cox proportional hazards regression was used to calculate multivariate-adjusted hazard ratios and 95% confidence intervals. Overall, neither ethanol intake at recruitment nor mean lifelong ethanol intake was significantly associated with lung cancer. However, moderate intake (5-14.9 g/day) at recruitment (hazard ratio (HR) = 0.76, 95% confidence interval (CI): 0.63, 0.90) and moderate mean lifelong intake (HR = 0.80, 95% CI: 0.66, 0.97) were associated with a lower lung cancer risk in comparison with low consumption (0.1-4.9 g/day). Compared with low intake, a high (> or =60 g/day) mean lifelong ethanol intake tended to be related to a higher risk of lung cancer (HR = 1.29, 95% CI: 0.93, 1.74), but high intake at recruitment was not. Although there was no overall association between ethanol intake and risk of lung cancer, the authors cannot rule out a lower risk for moderate consumption and a possibly increased risk for high lifelong consumption.     

Alcohol drinking and endometrial cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study

PurposeAlcohol intake may adversely affect the concentrations of endogenous sex hormones, and thus increase the risk of endometrial cancer. However, epidemiologic studies have provided conflicting results. Therefore, we investigated the association between alcohol intake and endometrial cancer risk a large, multicenter, prospective study.MethodsFrom 1992 through 2010, 301,051 women in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort were followed for incident endometrial cancer (n = 1382). Baseline alcohol consumption was assessed by country-specific, validated dietary questionnaires. Information on past alcohol consumption was collected by lifestyle questionnaires. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated from Cox proportional hazard models.ResultsThe multivariable HRs (and 95% CIs) compared with light drinkers (0.1–6 g/d) were 1.03 (0.88–1.20) for 0 g of alcohol per day at baseline, 1.01 (0.86–1.17) for 6.1–12 g/d, 1.03 (0.87–1.22) for 12.1–24 g/d, 1.07 (0.87–1.38) for 24.1–36 g/d, and 0.85 (0.61–1.18) for more than 36 g/d (p_trend = 0.77). No association was observed among former drinkers (OR, 1.28; 95% CI, 0.98–1.68 compared with light drinkers). Null associations were also found between alcohol consumption at age 20 years, lifetime pattern of alcohol drinking, and baseline alcohol intake from specific alcoholic beverages and endometrial cancer risk.ConclusionsOur findings suggest no association between alcohol intake and endometrial cancer risk.     

Dietary Advanced Glycation End-Products and Colorectal Cancer Risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study

Dietary advanced glycation end-products (dAGEs) have been hypothesized to be associated with a higher risk of colorectal cancer (CRC) by promoting inflammation, metabolic dysfunction, and oxidative stress in the colonic epithelium. However, evidence from prospective cohort studies is scarce and inconclusive. We evaluated CRC risk associated with the intake of dAGEs in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Dietary intakes of three major dAGEs: N^ε-carboxy-methyllysine (CML), N^ε-carboxyethyllysine (CEL), and N^δ-(5-hydro-5-methyl-4-imidazolon-2-yl)-ornithine (MG-H1) were estimated in 450,111 participants (median follow-up = 13 years, with 6162 CRC cases) by matching to a detailed published European food composition database. Hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations of dAGEs with CRC were computed using multivariable-adjusted Cox regression models. Inverse CRC risk associations were observed for CML (HR comparing extreme quintiles: HR_Q5vs._Q1 = 0.92, 95% CI = 0.85–1.00) and MG-H1 (HR_Q5vs._Q1 = 0.92, 95% CI = 0.85–1.00), but not for CEL (HR_Q5vs._Q1 = 0.97, 95% CI = 0.89–1.05). The associations did not differ by sex or anatomical location of the tumor. Contrary to the initial hypothesis, our findings suggest an inverse association between dAGEs and CRC risk. More research is required to verify these findings and better differentiate the role of dAGEs from that of endogenously produced AGEs and their precursor compounds in CRC development.     

Correlations between urinary concentrations and dietary intakes of flavonols in the European Prospective Investigation into Cancer and Nutrition (EPIC) study

In this study, we aimed to study the correlation between acute and habitual intakes of flavonols, their main food sources and their 24-h urinary concentrat     

Diet and risk of kidney stones in the Oxford cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC)

The lifetime prevalence of kidney stones is around 10 % and incidence rates are increasing. Diet may be an important determinant of kidney stone development. Our objective was to investigate the association between diet and kidney stone risk in a population with a wide range of diets. This association was examined among 51,336 participants in the Oxford arm of the European Prospective Investigation into Cancer and Nutrition using data from Hospital Episode Statistics in England and Scottish Morbidity Records. In the cohort, 303 participants attended hospital with a new kidney stone episode. Cox proportional hazards regression was performed to calculate hazard ratios (HR) and their 95 % confidence intervals (95 % CI). Compared to those with high intake of meat (>100 g/day), the HR estimates for moderate meat-eaters (50–99 g/day), low meat-eaters (<50 g/day), fish-eaters and vegetarians were 0.80 (95 % CI 0.57–1.11), 0.52 (95 % CI 0.35–0.8), 0.73 (95 % CI 0.48–1.11) and 0.69 (95 % CI 0.48–0.98), respectively. High intakes of fresh fruit, fibre from wholegrain cereals and magnesium were also associated with a lower risk of kidney stone formation. A high intake of zinc was associated with a higher risk. In conclusion, vegetarians have a lower risk of developing kidney stones compared with those who eat a high meat diet. This information may be important to advise the public about prevention of kidney stone formation.     

Long-term reproducibility of a food-frequency questionnaire and dietary changes in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Heidelberg cohort

Within a prospective cohort study, we explored the long-term reproducibility of the food-frequency questionnaire (FFQ) and dietary changes in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Heidelberg cohort. After a mean follow-up time of 68.8 (sd 4.1) months the dietary assessment by means of a validated FFQ was repeated in 21,462 participants in the EPIC-Heidelberg cohort. The correlation and test-retest reproducibility of both dietary intake measurements was explored. The long-term correlation coefficients ranged from 0.41 (vegetables in men) to 0.77 (alcoholic beverage consumption in women). The median intake of potatoes, added fat, sugar/confectionary, cakes and alcoholic beverages was lower in the second than in the first FFQ, whereas the median intake of fruits, vegetables, cereals/cereal products and non-alcoholic beverages were higher. Consistently for food groups, 60-70 % of the participants in both genders were re-classified to the same or adjacent quintile of intake. The results of fairly high correlation coefficients indicate good agreement between both measurements. It is acknowledged that this result reflects to a substantial extent the measurement error of the FFQ and conclusions on real changes in the diet should be drawn very carefully. For some nutrients the dietary changes were consistent with results from independent national surveys. The performance of the FFQ gives confidence in the dietary data to be used as long-term exposure variables.