Adherence to a Mediterranean diet and risk of gastric adenocarcinoma within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study.
BACKGROUND
The Mediterranean dietary pattern is believed to protect against cancer, although evidence from cohort studies that have examined particular cancer sites is limited.


OBJECTIVE
We aimed to explore the association between adherence to a relative Mediterranean diet (rMED) and incident gastric adenocarcinoma (GC) within the European Prospective Investigation into Cancer and Nutrition study.


METHODS
The study included 485,044 subjects (144,577 men) aged 35-70 y from 10 European countries. At recruitment, dietary and lifestyle information was collected. An 18-unit rMED score, incorporating 9 key components of the Mediterranean diet, was used to estimate rMED adherence. The association between rMED and GC with respect to anatomic location (cardia and noncardia) and histologic types (diffuse and intestinal) was investigated. A calibration study in a subsample was used to control for dietary measurement error.


RESULTS
After a mean follow-up of 8.9 y, 449 validated incident GC cases were identified and used in the analysis. After stratification by center and age and adjustment for recognized cancer risk factors, high compared with low rMED adherence was associated with a significant reduction in GC risk (hazard ratio: 0.67; 95% CI: 0.47, 0.94). A 1-unit increase in the rMED score was associated with a decreased risk of GC of 5% (95% CI: 0.91, 0.99). There was no evidence of heterogeneity between different anatomic locations or histologic types. The calibrated results showed similar trends (overall hazard ratio for GC: 0.93; 95% CI: 0.89, 0.99).


CONCLUSIONS
Greater adherence to an rMED is associated with a significant reduction in the risk of incident GC.
Buckland
Genevieve
G
Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Idibell, Barcelona, Spain.
Agudo
Antonio
A
Luján
Leila
L
Jakszyn
Paula
P
Bueno-de-Mesquita
H Bas
HB
Palli
Domenico
D
Boeing
Heiner
H
Carneiro
Fátima
F
Krogh
Vittorio
V
Sacerdote
Carlotta
C
Tumino
Rosario
R
Panico
Salvatore
S
Nesi
Gabriella
G
Manjer
Jonas
J
Regnér
Sara
S
Johansson
Ingegerd
I
Stenling
Roger
R
Sanchez
María-José
MJ
Dorronsoro
Miren
M
Barricarte
Aurelio
A
Navarro
Carmen
C
Quirós
J Ramón
JR
Allen
Naomi E
NE
Key
Timothy J
TJ
Bingham
Sheila
S
Kaaks
Rudolf
R
Overvad
Kim
K
Jensen
Majken
M
Olsen
Anja
A
Tjønneland
Anne
A
Peeters
Petra H M
PH
Numans
Mattijs E
ME
Ocké
Marga C
MC
Clavel-Chapelon
Françoise
F
Morois
Sophie
S
Boutron-Ruault
Marie-Christine
MC
Trichopoulou
Antonia
A
Lagiou
Pagona
P
Trichopoulos
Dimitrios
D
Lund
Eiliv
E
Couto
Elisabeth
E
Boffeta
Paolo
P
Jenab
Mazda
M
Riboli
Elio
E
Romaguera
Dora
D
Mouw
Traci
T
González
Carlos A
CA
D000230:Adenocarcinoma / Q000453:epidemiology* / Q000517:prevention & control; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D038441:Diet, Mediterranean; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000453:epidemiology* / Q000517:prevention & control; D011795:Surveys and Questionnaires