title: Adherence to a Mediterranean diet and risk of gastric adenocarcinoma within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study.
abstract: 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.
authors.affiliation: Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Idibell, Barcelona, Spain.
authors.forename: Genevieve
authors.initials: G
authors.lastname: Buckland
authors.forename: Antonio
authors.initials: A
authors.lastname: Agudo
authors.forename: Leila
authors.initials: L
authors.lastname: Luján
authors.forename: Paula
authors.initials: P
authors.lastname: Jakszyn
authors.forename: H Bas
authors.initials: HB
authors.lastname: Bueno-de-Mesquita
authors.forename: Domenico
authors.initials: D
authors.lastname: Palli
authors.forename: Heiner
authors.initials: H
authors.lastname: Boeing
authors.forename: Fátima
authors.initials: F
authors.lastname: Carneiro
authors.forename: Vittorio
authors.initials: V
authors.lastname: Krogh
authors.forename: Carlotta
authors.initials: C
authors.lastname: Sacerdote
authors.forename: Rosario
authors.initials: R
authors.lastname: Tumino
authors.forename: Salvatore
authors.initials: S
authors.lastname: Panico
authors.forename: Gabriella
authors.initials: G
authors.lastname: Nesi
authors.forename: Jonas
authors.initials: J
authors.lastname: Manjer
authors.forename: Sara
authors.initials: S
authors.lastname: Regnér
authors.forename: Ingegerd
authors.initials: I
authors.lastname: Johansson
authors.forename: Roger
authors.initials: R
authors.lastname: Stenling
authors.forename: María-José
authors.initials: MJ
authors.lastname: Sanchez
authors.forename: Miren
authors.initials: M
authors.lastname: Dorronsoro
authors.forename: Aurelio
authors.initials: A
authors.lastname: Barricarte
authors.forename: Carmen
authors.initials: C
authors.lastname: Navarro
authors.forename: J Ramón
authors.initials: JR
authors.lastname: Quirós
authors.forename: Naomi E
authors.initials: NE
authors.lastname: Allen
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Key
authors.forename: Sheila
authors.initials: S
authors.lastname: Bingham
authors.forename: Rudolf
authors.initials: R
authors.lastname: Kaaks
authors.forename: Kim
authors.initials: K
authors.lastname: Overvad
authors.forename: Majken
authors.initials: M
authors.lastname: Jensen
authors.forename: Anja
authors.initials: A
authors.lastname: Olsen
authors.forename: Anne
authors.initials: A
authors.lastname: Tjønneland
authors.forename: Petra H M
authors.initials: PH
authors.lastname: Peeters
authors.forename: Mattijs E
authors.initials: ME
authors.lastname: Numans
authors.forename: Marga C
authors.initials: MC
authors.lastname: Ocké
authors.forename: Françoise
authors.initials: F
authors.lastname: Clavel-Chapelon
authors.forename: Sophie
authors.initials: S
authors.lastname: Morois
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Boutron-Ruault
authors.forename: Antonia
authors.initials: A
authors.lastname: Trichopoulou
authors.forename: Pagona
authors.initials: P
authors.lastname: Lagiou
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Trichopoulos
authors.forename: Eiliv
authors.initials: E
authors.lastname: Lund
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Couto
authors.forename: Paolo
authors.initials: P
authors.lastname: Boffeta
authors.forename: Mazda
authors.initials: M
authors.lastname: Jenab
authors.forename: Elio
authors.initials: E
authors.lastname: Riboli
authors.forename: Dora
authors.initials: D
authors.lastname: Romaguera
authors.forename: Traci
authors.initials: T
authors.lastname: Mouw
authors.forename: Carlos A
authors.initials: CA
authors.lastname: González
mesh_terms: 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