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

Research output: Contribution to journalArticle


Background: Epidemiological studies suggest that haem iron, which is found predominantly in red meat and increases endogenous formation of carcinogenic N-nitroso compounds, may be positively associated with lung cancer. The objective was to examine the relationship between haem iron intake and lung cancer risk using detailed smoking history data and serum cotinine to control for potential confounding. Methods: In the European Prospective Investigation into Cancer and Nutrition (EPIC), 416,746 individuals from 10 countries completed demographic and dietary questionnaires at recruitment. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident lung cancer (n = 3731) risk relative to haem iron, non-haem iron, and total dietary iron intake. A corresponding analysis was conducted among a nested subset of 800 lung cancer cases and 1489 matched controls for whom serum cotinine was available. Results: Haem iron was associated with lung cancer risk, including after adjustment for details of smoking history (time since quitting, number of cigarettes per day): as a continuous variable (HR per 0.3 mg/1000 kcal 1.03, 95% CI 1.00–1.07), and in the highest versus lowest quintile (HR 1.16, 95% CI 1.02–1.32; trend across quintiles: P = 0.035). In contrast, non-haem iron intake was related inversely with lung cancer risk; however, this association attenuated after adjustment for smoking history. Additional adjustment for serum cotinine did not considerably alter the associations detected in the nested case–control subset. Conclusions: Greater haem iron intake may be modestly associated with lung cancer risk.


  • Heather A. Ward
  • Julia Whitman
  • David C. Muller
  • Mattias Johansson
  • Paula Jakszyn
  • Elisabete Weiderpass
  • Domenico Palli
  • Anouar Fanidi
  • Roel Vermeulen
  • Anne Tjønneland
  • Louise Hansen
  • Christina C. Dahm
  • Kim Overvad
  • Gianluca Severi
  • Marie Christine Boutron-Ruault
  • Aurélie Affret
  • Rudolf Kaaks
  • Renee Fortner
  • Heiner Boeing
  • Antonia Trichopoulou
  • Carlo La Vecchia
  • Anastasia Kotanidou
  • Franco Berrino
  • Vittorio Krogh
  • Rosario Tumino
  • Fulvio Ricceri
  • Salvatore Panico
  • H. Bas Bueno-de-Mesquita
  • Petra H. Peeters
  • Therese Haugdahl Nøst
  • Torkjel M. Sandanger
  • Jose Ramón Quirós
  • Antonio Agudo
  • Miguel Rodríguez-Barranco
  • Nerea Larrañaga
  • Jose Maria Huerta
  • Eva Ardanaz
  • Mikael Johansson
  • Kjell Grankvist
  • Ruth C. Travis
  • Heinz Freisling
  • Magdalena Stepien
  • Melissa A. Merritt
  • Elio Riboli
  • Amanda J. Cross
External organisations
  • Imperial College London
  • International Agency for Research on Cancer, World Health Organization
  • Catalan Institute of Oncology
  • UiT The Arctic University of Norway, Tromsø
  • Cancer Registry of Norway Institute of Population-Based Cancer Research
  • Karolinska Institutet
  • University of Helsinki
  • Utrecht University
  • Danish Cancer Society Research Center
  • Aarhus University
  • University of Paris-Sud
  • German Cancer Research Centre
  • German Institute of Human Nutrition
  • Hellenic Health Foundation, Athens
  • National and Kapodistrian University of Athens
  • University of Milan
  • Istituto Nazionale dei Tumori
  • Azienda Sanitaria Provinciale di Ragusa
  • University of Turin
  • University of Naples Federico II
  • National Institute for Public Health and the Environment (RIVM)
  • University Medical Center Utrecht
  • University of Granada
  • CIBER Epidemiology and Public Health (CIBERESP)
  • Murcia Regional Health Council
  • Health Research Institute of Navarra (IDISNA)
  • Umeå University
  • University of Oxford
  • Cancer Research and Prevention Institute (ISPO)
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Nutrition and Dietetics
  • Cancer and Oncology
Original languageEnglish
Pages (from-to)1122-1132
JournalEuropean Journal of Clinical Nutrition
Issue number73
Early online date2018
Publication statusPublished - 2019
Publication categoryResearch