Energy and macronutrient intake and risk of differentiated thyroid carcinoma in the European Prospective Investigation into Cancer and Nutrition (EPIC) study.

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Incidence rates of differentiated thyroid carcinoma (TC) have increased in many countries. Adiposity and dietary risk factors may play a role, but little is known on the influence of energy intake and macronutrient composition. The aim of this study is to investigate associations between TC and the intake of energy, macronutrients, glycemic index (GI) and glycemic load in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. The study included 477,274 middle-age participants (70.2% women) from 10 European countries. Dietary data were collected using country-specific validated dietary questionnaires. Total carbohydrates, proteins, fats, saturated, monounsaturated and polyunsaturated fats (PUFA), starch, sugar, fiber and glycemic load were computed as g/1000kcal. Multivariable Cox regression was used to calculate multivariable adjusted hazard ratios (HR) and 95% confidence interval (CI) by intake quartile (Q). After a mean follow-up time of 11 years, differentiated TC was diagnosed in 556 participants (90% women). Overall, we only found significant associations with total energy (HRQ4vsQ1 1.29; 95% CI 1.00-1.68) and PUFA intakes (HRQ4vsQ1 0.74, 95% CI 0.57-0.95). However, the associations with starch and sugar intake and GI were significantly heterogeneous across BMI groups, i.e., positive associations with starch and GI were found in participants with a body mass index (BMI) ≥25 and with sugar intake in those with BMI <25. Moreover, inverse associations with starch and GI were observed in subjects with BMI<25. In conclusion, our results suggest that high total energy and low PUFA intakes may increase the risk of differentiated TC. Positive associations with starch intake and GI in participants with BMI ≥25 suggest that those persons may have a greater insulin response to high starch intake and GI than lean people. This article is protected by copyright. All rights reserved.


  • Raul Zamora-Ros
  • Sabina Rinaldi
  • Konstantinos K Tsilidis
  • Elisabete Weiderpass
  • Marie-Christine Boutron-Ruault
  • Agnetha Linn Rostgaard-Hansen
  • Anne Tjønneland
  • Françoise Clavel-Chapelon
  • Sylvie Mesrine
  • Verena A Katzke
  • Tilman Kühn
  • Jana Förster
  • Heiner Boeing
  • Antonia Trichopoulou
  • Pagona Lagiou
  • Eleni Klinaki
  • Giovanna Masala
  • Sabina Sieri
  • Fulvio Ricceri
  • Rosario Tumino
  • Amalia Mattiello
  • Petra H M Peeters
  • H Bas Bueno-de-Mesquita
  • Dagrun Engeset
  • Guri Skeie
  • Marcial Argüelles
  • Antonio Agudo
  • María-José Sánchez
  • María-Dolores Chirlaque
  • Aurelio Barricarte
  • Saioa Chamosa
  • Joakim Hennings
  • Maria Sandström
  • Julie A Schmidt
  • Kay-Thee Khaw
  • Nicholas J Wareham
  • Amanda J Cross
  • Nadia Slimani
  • Graham Byrnes
  • Isabelle Romieu
  • Elio Riboli
  • Silvia Franceschi
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cancer and Oncology
Original languageEnglish
Pages (from-to)65-73
JournalInternational Journal of Cancer
Issue number1
Publication statusPublished - 2016
Publication categoryResearch