Adherence to the Mediterranean diet and lymphoma risk in the European Prospective Investigation into Cancer and Nutrition

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  • Marta Solans, Epidemiology Unit and Girona Cancer Registry, Catalan Institute of Oncology, Girona, Spain., Spain
  • Yolanda Benavente, Unit of molecular and genetic epidemiology in infections and cancer, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain., Spain
  • Marc Saez, Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain., Spain
  • Antonio Agudo, Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO-IDIBELL), 08908 Barcelona, Spain., Spain
  • Sabine Naudin, Nutritional Methodology and Biostatistics Group, Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), 150, Cours Albert Thomas, 69372, Lyon Cedex 08, France. freislingh@iarc.fr., France
  • Fatemeh Saberi Hosnijeh, 1] Department of Pediatric Oncology/Hematology, Sophia Children's Hospital-Erasmus University Medical Center, Rotterdam, The Netherlands [2] Department of Immunology, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands., Netherlands
  • Hwayoung Noh, Nutritional Methodology and Biostatistics Group, Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), 150, Cours Albert Thomas, 69372, Lyon Cedex 08, France. freislingh@iarc.fr., France
  • Heinz Freisling, Nutritional Methodology and Biostatistics Group, Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), 150, Cours Albert Thomas, 69372, Lyon Cedex 08, France. freislingh@iarc.fr., France
  • Pietro Ferrari, Nutritional Methodology and Biostatistics Group, Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), 150, Cours Albert Thomas, 69372, Lyon Cedex 08, France. freislingh@iarc.fr., France
  • Caroline Besson, 1] Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health team, F-94805 Villejuif, France [2] Paris-Sud University, UMRS 1018, F-94805 Villejuif, France [3] Institut Gustave Roussy, F-94805 Villejuif, France., France
  • Yahya Mahamat-Saleh, 1] Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health team, F-94805 Villejuif, France [2] Paris-Sud University, UMRS 1018, F-94805 Villejuif, France [3] Institut Gustave Roussy, F-94805 Villejuif, France., France
  • Marie-Christine Boutron-Ruault, 1] Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health team, F-94805 Villejuif, France [2] Paris-Sud University, UMRS 1018, F-94805 Villejuif, France [3] Institut Gustave Roussy, F-94805 Villejuif, France., France
  • Tilman Kühn, Division of Cancer Epidemiology, German Cancer Research Center, DKFZ, Heidelberg, Germany., Germany
  • Rudolf Kaaks, Division of Cancer Epidemiology, German Cancer Research Center, DKFZ, Heidelberg, Germany., Germany
  • Heiner Boeing, Department of Epidemiology, German Institute of Human Nutrition (DIfE) Postdam-Rehbrücke, Nuthetal, Germany., Germany
  • Cristina Lasheras, Department of Functional Biology, Faculty of Medicine, University of Oviedo, CP 33006 Oviedo, Asturias, Spain., Spain
  • Miguel Rodríguez-Barranco, Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, 18014 Granada, Spain., Spain
  • Pilar Amiano, Public Health Division of Gipuzkoa, Regional Government of the Basque Country, Donostia, Spain., Spain
  • Jose Maria Huerta, Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia, Spain., Spain
  • Aurelio Barricarte, IdiSNA, Navarra Institute for Health Research, Pamplona, Spain., Spain
  • Julie A Schmidt, Cancer Epidemiology Unit, Nuffield Department of Population Health University of Oxford, United Kingdom.
  • ,
  • Paolo Vineis, Department of Epidemiology and Biostatistics, MRC-HPA Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom., United Kingdom
  • Elio Riboli, School of Public Health, Imperial College London, London, United Kingdom., United Kingdom
  • Antonia Trichopoulou, WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Dept. of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece., Greece
  • Christina Bamia, WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Dept. of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece., Greece
  • Eleni Peppa, WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Dept. of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece., Greece
  • Giovanna Masala, Cancer Risk Factors and Life-Style Epidemiology Unit. Institute for Cancer Research, Prevention and Clinical Network - ISPRO, 50141, Florence, Italy., Italy
  • Claudia Agnoli, Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, Milano, Italy., Italy
  • Rosario Tumino, Civic-M.P. Arezzo Hospital, Italy
  • Carlotta Sacerdote, Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy., Italy
  • Salvatore Panico, Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy., Italy
  • Guri Skeie, Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway., Norway
  • Elisabete Weiderpass, Genetic Epidemiology Group, Folkhälsan Research Center and Faculty of Medicine, University of Helsinki, 00014 Helsinkiv, Finland. Elisabete.Weiderpass@kreftregisteret.no., Finland
  • Mats Jerkeman, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden., Sweden
  • Ulrika Ericson, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden., Sweden
  • Florentin Späth, Umeå University, Sweden
  • Lena Maria Nilsson, Department of Public Health and Clinical Medicine, Nutritional research and Arcum-Arctic Research Centre, Umeå University, Umeå, Sweden., Sweden
  • Christina C Dahm
  • Kim Overvad
  • Anne Katrine Bolvig, Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark.
  • ,
  • Anne Tjønneland, University of Copenhagen, Denmark
  • Silvia de Sanjose, PATH, Reproductive Health, Seattle, United States., United States
  • Genevieve Buckland, NIHR Bristol Biomedical Research Centre Nutrition Theme, Bristol, United Kingdom., United Kingdom
  • Roel Vermeulen, Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands., Netherlands
  • Alexandra Nieters, Center for Chronic Immunodeficiency (CCI), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany., Germany
  • Delphine Casabonne, Unit of molecular and genetic epidemiology in infections and cancer, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain., Spain

There is 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 ten European countries between 1991 and 2001. Adherence to the MD was estimated through an adapted relative Mediterranean diet (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-Hodgkin lymphoma and 395 lymphoma NOS) 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 non-significant inverse association between a high versus low arMED score and risk of lymphoma was observed (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. This article is protected by copyright. All rights reserved.

Original languageEnglish
JournalInternational Journal of Cancer
Volume145
Issue1
Pages (from-to)122-131
Number of pages11
ISSN0020-7136
DOIs
Publication statusPublished - 1 Jul 2019

    Research areas

  • Europe, Mediterranean diet, lymphoma, prospective studies, risk

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