Dietary flavonoid and lignan intake and gastric adenocarcinoma risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study

Raul Zamora-Ros; Antonio Agudo; Leila Luján-Barroso; Isabelle Romieu; Pietro Ferrari; Viktoria Knaze; H. Bas Bueno-de-Mesquita; Max Leenders; Ruth C. Travis; Carmen Navarro; Emilio Sánchez-Cantalejo; Nadia Slimani; Augustin Scalbert; Veronika Fedirko; Anette Hjartaker; Dagrun Engeset; Guri Skeie; Heiner Boeing; Jana Förster; Kuanrong Li; Birgit Teucher; Claudia Agnoli; Rosario Tumino; Amalia Mattiello; Calogero Saieva; Ingegerd Johansson; Roger Stenling; Maria Luisa Redondo; Peter Wallström; Ulrika Ericson; Kay Tee Khaw; Angela A. Mulligan; Antonia Trichopoulou; Vardis Dilis; Michael Katsoulis; Petra H M Peeters; Lazslo Igali; Anne Tjønneland; Jytte Halkjær; Marina Touillaud; Florence Perquier; Guy Fagherazzi; Pilar Amiano; Eva Ardanaz; Lea Bredsdorff; Kim Overvad; Fulvio Ricceri; Elio Riboli; Carlos A. González

doi:10.3945/ajcn.112.037358

Dietary flavonoid and lignan intake and gastric adenocarcinoma risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study

Raul Zamora-Ros^*
, Antonio Agudo
, Leila Luján-Barroso
, Isabelle Romieu
, Pietro Ferrari
, Viktoria Knaze
, H. Bas Bueno-de-Mesquita
, Max Leenders
, Ruth C. Travis
, Carmen Navarro
, Emilio Sánchez-Cantalejo
, Nadia Slimani
, Augustin Scalbert
, Veronika Fedirko
, Anette Hjartaker
, Dagrun Engeset
, Guri Skeie
, Heiner Boeing
, Jana Förster
, Kuanrong Li

Birgit Teucher, Claudia Agnoli, Rosario Tumino, Amalia Mattiello, Calogero Saieva, Ingegerd Johansson, Roger Stenling, Maria Luisa Redondo, Peter Wallström, Ulrika Ericson, Kay Tee Khaw, Angela A. Mulligan, Antonia Trichopoulou, Vardis Dilis, Michael Katsoulis, Petra H M Peeters, Lazslo Igali, Anne Tjønneland, Jytte Halkjær, Marina Touillaud, Florence Perquier, Guy Fagherazzi, Pilar Amiano, Eva Ardanaz, Lea Bredsdorff, Kim Overvad, Fulvio Ricceri, Elio Riboli, Carlos A. González

^*Corresponding author for this work

Veterinary Medicine

National Institute of Public Health and the Environment
Institute Catala Oncologia
Aarhus University
Murcia Regional Health Council
Institut national de la santé et de la recherche médicale
International Agency for Research on Cancer
CIBER Epidemiología y Salud Pública
Public Health Direction
Human Genetics Foundation
Cancer Epidemiology Research Programme
Environment and Cancer
Slingeland Hospital
Unit of Cancer Epidemiology
University of Oxford
External unknown
Andalusian School of Public Health
University of Oslo
UiT The Arctic University of Norway
MD Anderson Cancer Center
Molecular and Nutritional Epidemiology Unit
Cancer registry and Histopathology Unit
'Civile
University of Naples Federico II
Cariology
Umeå University
Lund University
National and Kapodistrian University of Athens
The Medical School of Athens
University Medical Center Utrecht
Douglass Hanly Moir Pathology
Danish Cancer Society
The Spanish National Institute for Agricultural and Food Research and Technology
Technical University of Denmark
Section of Biostatistics and Epidemiology
Institute of Basic Medical Sciences
German Institute of Human Nutrition Potsdam-Rehbruecke
German Cancer Research Center
Fondazione IRCCS- Istituto Nazionale dei Tumori
Public Health Directorate
Nutrition Epidemiology Research Group
Diabetes and Cardiovascular Disease
University of Cambridge
Hellenic Health Foundation
Imperial College London
Norfolk and Norwich University Hospitals NHS Foundation Trust
Center for Research in Epidemiology and Population Health (CESP)
Navarre Public Health Institute

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background: Several experimental studies have suggested potential anticarcinogenic effects of flavonoids, although epidemiologic evidence for the impact of dietary flavonoids on risk of gastric cancer (GC) is limited. Objective: We investigated the association between intake of dietary flavonoids and lignans and incident GC. Design: The study followed 477,312 subjects (29.8% men) aged 35-70 y from 10 European countries who participated in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Validated dietary questionnaires and lifestyle information were collected at baseline. A food-composition database on flavonoids and lignans was compiled by using data from USDA and Phenol-Explorer databases. Results: During an average follow-up of 11 y, 683 incident GC cases (57.8% men) were mostly validated by a panel of pathologists and used in this analysis. We observed a significant inverse association between total flavonoid intake and GC risk in women (HR: 0.81; 95% CI: 0.70, 0.94; for the continuous variable after log₂ transformation) but not in men (HR: 0.97; 95% CI: 0.85, 1.09). In women, significant inverse associations with GC risk were also observed for intakes of some flavonoid subgroups (anthocyanidins, flavonols, flavones, and flavanols), particularly with intestinal type tumors for total flavonoid and flavanol intakes (P-heterogeneity < 0.1). After stratification by smoking status and sex, there was no significant heterogeneity in these associations between ever- and never-smokers. Conclusion: Total dietary flavonoid intake is associated with a significant reduction in the risk of GC in women.

Original language	English
Pages (from-to)	1398-1408
Number of pages	11
Journal	American Journal of Clinical Nutrition
Volume	96
Issue number	6
DOIs	https://doi.org/10.3945/ajcn.112.037358
Publication status	Published - 1 Dec 2012

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SDG 3 Good Health and Well-being

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10.3945/ajcn.112.037358

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Zamora-Ros, R., Agudo, A., Luján-Barroso, L., Romieu, I., Ferrari, P., Knaze, V., Bueno-de-Mesquita, H. B., Leenders, M., Travis, R. C., Navarro, C., Sánchez-Cantalejo, E., Slimani, N., Scalbert, A., Fedirko, V., Hjartaker, A., Engeset, D., Skeie, G., Boeing, H., Förster, J., ... González, C. A. (2012). Dietary flavonoid and lignan intake and gastric adenocarcinoma risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. American Journal of Clinical Nutrition, 96(6), 1398-1408. https://doi.org/10.3945/ajcn.112.037358

@article{38db39df82d94816981586ec2881acd7,

title = "Dietary flavonoid and lignan intake and gastric adenocarcinoma risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study",

abstract = "Background: Several experimental studies have suggested potential anticarcinogenic effects of flavonoids, although epidemiologic evidence for the impact of dietary flavonoids on risk of gastric cancer (GC) is limited. Objective: We investigated the association between intake of dietary flavonoids and lignans and incident GC. Design: The study followed 477,312 subjects (29.8\% men) aged 35-70 y from 10 European countries who participated in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Validated dietary questionnaires and lifestyle information were collected at baseline. A food-composition database on flavonoids and lignans was compiled by using data from USDA and Phenol-Explorer databases. Results: During an average follow-up of 11 y, 683 incident GC cases (57.8\% men) were mostly validated by a panel of pathologists and used in this analysis. We observed a significant inverse association between total flavonoid intake and GC risk in women (HR: 0.81; 95\% CI: 0.70, 0.94; for the continuous variable after log2 transformation) but not in men (HR: 0.97; 95\% CI: 0.85, 1.09). In women, significant inverse associations with GC risk were also observed for intakes of some flavonoid subgroups (anthocyanidins, flavonols, flavones, and flavanols), particularly with intestinal type tumors for total flavonoid and flavanol intakes (P-heterogeneity < 0.1). After stratification by smoking status and sex, there was no significant heterogeneity in these associations between ever- and never-smokers. Conclusion: Total dietary flavonoid intake is associated with a significant reduction in the risk of GC in women.",

author = "Raul Zamora-Ros and Antonio Agudo and Leila Luj{\'a}n-Barroso and Isabelle Romieu and Pietro Ferrari and Viktoria Knaze and Bueno-de-Mesquita, \{H. Bas\} and Max Leenders and Travis, \{Ruth C.\} and Carmen Navarro and Emilio S{\'a}nchez-Cantalejo and Nadia Slimani and Augustin Scalbert and Veronika Fedirko and Anette Hjartaker and Dagrun Engeset and Guri Skeie and Heiner Boeing and Jana F{\"o}rster and Kuanrong Li and Birgit Teucher and Claudia Agnoli and Rosario Tumino and Amalia Mattiello and Calogero Saieva and Ingegerd Johansson and Roger Stenling and Redondo, \{Maria Luisa\} and Peter Wallstr{\"o}m and Ulrika Ericson and Khaw, \{Kay Tee\} and Mulligan, \{Angela A.\} and Antonia Trichopoulou and Vardis Dilis and Michael Katsoulis and Peeters, \{Petra H M\} and Lazslo Igali and Anne Tj{\o}nneland and Jytte Halkj{\ae}r and Marina Touillaud and Florence Perquier and Guy Fagherazzi and Pilar Amiano and Eva Ardanaz and Lea Bredsdorff and Kim Overvad and Fulvio Ricceri and Elio Riboli and Gonz{\'a}lez, \{Carlos A.\}",

year = "2012",

month = dec,

day = "1",

doi = "10.3945/ajcn.112.037358",

language = "English",

volume = "96",

pages = "1398--1408",

journal = "American Journal of Clinical Nutrition",

issn = "0002-9165",

publisher = "Elsevier BV",

number = "6",

}

Zamora-Ros, R, Agudo, A, Luján-Barroso, L, Romieu, I, Ferrari, P, Knaze, V, Bueno-de-Mesquita, HB, Leenders, M, Travis, RC, Navarro, C, Sánchez-Cantalejo, E, Slimani, N, Scalbert, A, Fedirko, V, Hjartaker, A, Engeset, D, Skeie, G, Boeing, H, Förster, J, Li, K, Teucher, B, Agnoli, C, Tumino, R, Mattiello, A, Saieva, C, Johansson, I, Stenling, R, Redondo, ML, Wallström, P, Ericson, U, Khaw, KT, Mulligan, AA, Trichopoulou, A, Dilis, V, Katsoulis, M, Peeters, PHM, Igali, L, Tjønneland, A, Halkjær, J, Touillaud, M, Perquier, F, Fagherazzi, G, Amiano, P, Ardanaz, E, Bredsdorff, L, Overvad, K, Ricceri, F, Riboli, E & González, CA 2012, 'Dietary flavonoid and lignan intake and gastric adenocarcinoma risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study', American Journal of Clinical Nutrition, vol. 96, no. 6, pp. 1398-1408. https://doi.org/10.3945/ajcn.112.037358

Dietary flavonoid and lignan intake and gastric adenocarcinoma risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. / Zamora-Ros, Raul; Agudo, Antonio; Luján-Barroso, Leila et al.
In: American Journal of Clinical Nutrition, Vol. 96, No. 6, 01.12.2012, p. 1398-1408.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Dietary flavonoid and lignan intake and gastric adenocarcinoma risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study

AU - Zamora-Ros, Raul

AU - Agudo, Antonio

AU - Luján-Barroso, Leila

AU - Romieu, Isabelle

AU - Ferrari, Pietro

AU - Knaze, Viktoria

AU - Bueno-de-Mesquita, H. Bas

AU - Leenders, Max

AU - Travis, Ruth C.

AU - Navarro, Carmen

AU - Sánchez-Cantalejo, Emilio

AU - Slimani, Nadia

AU - Scalbert, Augustin

AU - Fedirko, Veronika

AU - Hjartaker, Anette

AU - Engeset, Dagrun

AU - Skeie, Guri

AU - Boeing, Heiner

AU - Förster, Jana

AU - Li, Kuanrong

AU - Teucher, Birgit

AU - Agnoli, Claudia

AU - Tumino, Rosario

AU - Mattiello, Amalia

AU - Saieva, Calogero

AU - Johansson, Ingegerd

AU - Stenling, Roger

AU - Redondo, Maria Luisa

AU - Wallström, Peter

AU - Ericson, Ulrika

AU - Khaw, Kay Tee

AU - Mulligan, Angela A.

AU - Trichopoulou, Antonia

AU - Dilis, Vardis

AU - Katsoulis, Michael

AU - Peeters, Petra H M

AU - Igali, Lazslo

AU - Tjønneland, Anne

AU - Halkjær, Jytte

AU - Touillaud, Marina

AU - Perquier, Florence

AU - Fagherazzi, Guy

AU - Amiano, Pilar

AU - Ardanaz, Eva

AU - Bredsdorff, Lea

AU - Overvad, Kim

AU - Ricceri, Fulvio

AU - Riboli, Elio

AU - González, Carlos A.

PY - 2012/12/1

Y1 - 2012/12/1

N2 - Background: Several experimental studies have suggested potential anticarcinogenic effects of flavonoids, although epidemiologic evidence for the impact of dietary flavonoids on risk of gastric cancer (GC) is limited. Objective: We investigated the association between intake of dietary flavonoids and lignans and incident GC. Design: The study followed 477,312 subjects (29.8% men) aged 35-70 y from 10 European countries who participated in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Validated dietary questionnaires and lifestyle information were collected at baseline. A food-composition database on flavonoids and lignans was compiled by using data from USDA and Phenol-Explorer databases. Results: During an average follow-up of 11 y, 683 incident GC cases (57.8% men) were mostly validated by a panel of pathologists and used in this analysis. We observed a significant inverse association between total flavonoid intake and GC risk in women (HR: 0.81; 95% CI: 0.70, 0.94; for the continuous variable after log2 transformation) but not in men (HR: 0.97; 95% CI: 0.85, 1.09). In women, significant inverse associations with GC risk were also observed for intakes of some flavonoid subgroups (anthocyanidins, flavonols, flavones, and flavanols), particularly with intestinal type tumors for total flavonoid and flavanol intakes (P-heterogeneity < 0.1). After stratification by smoking status and sex, there was no significant heterogeneity in these associations between ever- and never-smokers. Conclusion: Total dietary flavonoid intake is associated with a significant reduction in the risk of GC in women.

AB - Background: Several experimental studies have suggested potential anticarcinogenic effects of flavonoids, although epidemiologic evidence for the impact of dietary flavonoids on risk of gastric cancer (GC) is limited. Objective: We investigated the association between intake of dietary flavonoids and lignans and incident GC. Design: The study followed 477,312 subjects (29.8% men) aged 35-70 y from 10 European countries who participated in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Validated dietary questionnaires and lifestyle information were collected at baseline. A food-composition database on flavonoids and lignans was compiled by using data from USDA and Phenol-Explorer databases. Results: During an average follow-up of 11 y, 683 incident GC cases (57.8% men) were mostly validated by a panel of pathologists and used in this analysis. We observed a significant inverse association between total flavonoid intake and GC risk in women (HR: 0.81; 95% CI: 0.70, 0.94; for the continuous variable after log2 transformation) but not in men (HR: 0.97; 95% CI: 0.85, 1.09). In women, significant inverse associations with GC risk were also observed for intakes of some flavonoid subgroups (anthocyanidins, flavonols, flavones, and flavanols), particularly with intestinal type tumors for total flavonoid and flavanol intakes (P-heterogeneity < 0.1). After stratification by smoking status and sex, there was no significant heterogeneity in these associations between ever- and never-smokers. Conclusion: Total dietary flavonoid intake is associated with a significant reduction in the risk of GC in women.

UR - https://www.scopus.com/pages/publications/84869843035

U2 - 10.3945/ajcn.112.037358

DO - 10.3945/ajcn.112.037358

M3 - Article

C2 - 23076618

AN - SCOPUS:84869843035

SN - 0002-9165

VL - 96

SP - 1398

EP - 1408

JO - American Journal of Clinical Nutrition

JF - American Journal of Clinical Nutrition

IS - 6

ER -

Dietary flavonoid and lignan intake and gastric adenocarcinoma risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study

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