Adherence to the Mediterranean diet and risk of bladder cancer in the EPIC cohort study |
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| Authors: | G. Buckland M.M. Ros N. Roswall H.B. Bueno‐de‐Mesquita N. Travier A. Tjonneland L.A. Kiemeney C. Sacerdote R. Tumino B. Ljungberg I.T. Gram E. Weiderpass G. Skeie J. Malm R. Ehrnström J. Chang‐Claude A. Mattiello C. Agnoli P.H. Peeters M.C. Boutron‐Ruault G. Fagherazzi F. Clavel‐Chapelon L.M. Nilsson P. Amiano A. Trichopoulou E. Oikonomou K. Tsiotas M.J. Sánchez K. Overvad J.R. Quirós M.D Chirlaque A. Barricarte T.J. Key N.E. Allen K.T. Khaw N. Wareham E. Riboli R. Kaaks H. Boeing D. Palli I. Romieu D. Romaguera C.A. Gonzalez |
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| Affiliation: | 1. Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO‐IDIBELL), Barcelona, Spain;2. The National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands;3. Diet, Genes and Environment, Danish Cancer Society, Copenhagen, Denmark;4. Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands;5. School of Public Health, Imperial College London, London, United Kingdom;6. Department for Health Evidence and Department of Urology, Radboud University Medical Centre, Nijmegen, The Netherlands;7. Center for Cancer Prevention (CPO‐Piemonte), Torino, Italy;8. Human Genetic Foundation (HuGeF), Torino, Italy;9. Cancer Registry and Histopatholgy Unit, “Civile M.P. Arezzo” Hospital, ASP Ragusa, Ragusa, Italy;10. Department of Surgical and Perioperative Sciences, Urology and Andrology, Ume? University, Ume?, Sweden;11. University of Hawaii, Cancer Center, Honolulu, Hawaii, USA;12. Department of Community Medicine, Faculty of Health Sciences, University of Troms?, Troms?, Norway;13. Department of Research, Cancer Registry of Norway, Oslo, Norway;14. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden;15. Samfundet Folkh?lsan, Helsinki, Finland;16. Department of Laboratory Medicine, Section for Clinical Chemistry, Lund University, Sk?ne University Hospital, Malm?, Sweden;17. University and Regional Laboratories Region Sk?ne, Department of Pathology, Sk?ne University Hospital Malm?, Sweden;18. S?dra F?rstadsgatan, Malm?, Sweden;19. Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany;20. Dipartimento Di Medicina Clinica E Chirurgia, Deparment of Clinical Medicine and Surgery, Federico II University, Naples, Italy;21. Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy;22. Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands;23. Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health Team, Villejuif, France;24. Univ Paris Sud, UMRS 1018, Villejuif, France;25. IGR, Villejuif, France;26. Public Health and Clinical Medicine/Nutritional Research, Ume? University, Ume?, Sweden;27. Public Health Division of Gipuzkoa, BioDonostia Research Institute, Health Department of Basque Region, San Sebastian, Spain;28. CIBERESP, CIBER Epidemiologia y Salud Publica, Madrid, Spain;29. Hellenic Health Foundation, Athens, Greece;30. WHO Collaborating Centre for Food and Nutrition Policies, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece;31. Andalusian School of Public Health, Granada, Spain;32. Department of Epidemiology, Institute of Public Health, Aarhus University, Aarhus, Denmark;33. Public Health Directorate, Asturias, Spain;34. Department of Epidemiology, Murcia Regional Health Council, Spain;35. Public Health Institute, Government of Navarra, Navarra, Spain;36. Cancer Epidemiology Unit, University of Oxford, Oxford, United Kingdom;37. Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, United Kingdom;38. Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom;39. MRC Epidemiology Unit, Cambridge, United Kingdom;40. Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom;41. Department of Epidemiology, Deutsches Institut für Ern?hrungsforschung, Potsdam, Germany;42. Molecular and Nutritional Epidemiology Unit, ISPO, Cancer Prevention and Research Institute, Florence, Italy;43. Nutrition and Metabolism Section, International Agency of Research on Cancer, Lyon, France;44. CIBER Fisiopatología de la Obesidad y Nutrición (CIBER‐OBN), Santiago de Compostela Spain |
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| Abstract: | There is growing evidence of the protective role of the Mediterranean diet (MD) on cancer. However, to date no epidemiological study has investigated the influence of the MD on bladder cancer. We evaluated the association between adherence to the MD and risk of urothelial cell bladder cancer (UCC), according to tumor aggressiveness, in the European Prospective Investigation into Cancer and Nutrition (EPIC). The analysis included 477,312 participants, recruited from ten European countries between 1991 and 2000. Information from validated dietary questionnaires was used to develop a relative Mediterranean diet score (rMED), including nine dietary components. Cox regression models were used to assess the effect of the rMED on UCC risk, while adjusting for dietary energy and tobacco smoking of any kind. Stratified analyses were performed by sex, BMI, smoking status, European region and age at diagnosis. During an average follow‐up of 11 years, 1,425 participants (70.9% male) were diagnosed with a first primary UCC. There was a negative but non‐significant association between a high versus low rMED score and risk of UCC overall (HR: 0.84 [95% CI 0.69, 1.03]) and risk of aggressive (HR: 0.88 [95% CI 0.61, 1.28]) and non‐aggressive tumors (HR: 0.78 [95% CI 0.54, 1.14]). Although there was no effect modification in the stratified analyses, there was a significant 34% (p = 0.043) decreased risk of UCC in current smokers with a high rMED score. In EPIC, the MD was not significantly associated with risk of UCC, although we cannot exclude that a MD may reduce risk in current smokers. |
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| Keywords: | bladder cancer mediterranean diet cohort studies European prospective investigation into cancer and nutrition cohort study |
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