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

Research output: Contribution to journalArticle

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.

Details

Authors
  • Marta Solans
  • Yolanda Benavente
  • Marc Saez
  • Antonio Agudo
  • Sabine Naudin
  • Fatemeh Saberi Hosnijeh
  • Hwayoung Noh
  • Heinz Freisling
  • Pietro Ferrari
  • Caroline Besson
  • Yahya Mahamat-Saleh
  • Marie Christine Boutron-Ruault
  • Tilman Kühn
  • Rudolf Kaaks
  • Heiner Boeing
  • Cristina Lasheras
  • Miguel Rodríguez-Barranco
  • Pilar Amiano
  • Jose Maria Huerta
  • Aurelio Barricarte
  • Julie A. Schmidt
  • Paolo Vineis
  • Elio Riboli
  • Antonia Trichopoulou
  • Christina Bamia
  • Eleni Peppa
  • Giovanna Masala
  • Claudia Agnoli
  • Rosario Tumino
  • Carlotta Sacerdote
  • Salvatore Panico
  • Guri Skeie
  • Elisabete Weiderpass
  • Florentin Späth
  • Lena Maria Nilsson
  • Christina C. Dahm
  • Kim Overvad
  • Anne Katrine Bolvig
  • Anne Tjønneland
  • Silvia de Sanjose
  • Genevieve Buckland
  • Roel Vermeulen
  • Alexandra Nieters
  • Delphine Casabonne
Organisations
External organisations
  • CIBER Epidemiology and Public Health (CIBERESP)
  • University of Girona
  • Catalan Institute of Oncology
  • International Agency for Research on Cancer, World Health Organization
  • Utrecht University
  • Erasmus University Medical Center
  • Centre Hospitalier de Versailles
  • University of Paris-Sud
  • Stabilite genetique et oncogenese
  • German Cancer Research Centre
  • German Institute of Human Nutrition
  • University of Oviedo
  • Andalusian School of Public Health
  • Public Health Division of Gipuzkoa
  • Murcia Regional Health Council
  • Health Research Institute of Navarra (IDISNA)
  • University of Oxford
  • Imperial College London
  • Hellenic Health Foundation, Athens
  • National and Kapodistrian University of Athens
  • Istituto Nazionale dei Tumori
  • Civic and M.P Arezzo Hospital
  • Citta' della Salute e della Scienza Hospital-University of Turin
  • University of Naples Federico II
  • UiT The Arctic University of Norway, Tromsø
  • Cancer Registry of Norway Institute of Population-Based Cancer Research
  • Karolinska Institutet
  • University of Helsinki
  • Umeå University
  • Aarhus University
  • Danish Cancer Society Research Center
  • University of Copenhagen
  • PATH (global health organization)
  • Albert-Ludwigs University Freiburg
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Nutrition and Dietetics
  • Cancer and Oncology

Keywords

  • Europe, lymphoma, Mediterranean diet, prospective studies, risk
Original languageEnglish
Pages (from-to)122-131
JournalInternational Journal of Cancer
Volume145
Issue number1
Early online date2018 Dec 26
Publication statusPublished - 2019
Publication categoryResearch
Peer-reviewedYes