title: Plasma carotenoids and vitamin C concentrations and risk of urothelial cell carcinoma in the European Prospective Investigation into Cancer and Nutrition.
abstract: BACKGROUND
  Published associations between dietary carotenoids and vitamin C and bladder cancer risk are inconsistent. Biomarkers may provide more accurate measures of nutrient status.
  
  
  OBJECTIVE
  We investigated the association between plasma carotenoids and vitamin C and risk of urothelial cell carcinoma (UCC) in a case-control study nested within the European Prospective Investigation into Cancer and Nutrition.
  
  
  METHODS
  A total of 856 patients with newly diagnosed UCC were matched with 856 cohort members by sex, age at baseline, study center, date and time of blood collection, and fasting status. Plasma carotenoids (α- and β-carotene, β-cryptoxanthin, lycopene, lutein, and zeaxanthin) were measured by using reverse-phase HPLC, and plasma vitamin C was measured by using a colorimetric assay. Incidence rate ratios (IRRs) were estimated by using conditional logistic regression with adjustment for smoking status, duration, and intensity.
  
  
  RESULTS
  UCC risk decreased with higher concentrations of the sum of plasma carotenoids (IRR for the highest compared with the lowest quartile: 0.64; 95% CI: 0.44, 0.93; P-trend = 0.04). Plasma β-carotene was inversely associated with aggressive UCC (IRR: 0.51; 95% CI: 0.30, 0.88; P-trend = 0.02). Plasma lutein was inversely associated with risk of nonaggressive UCC (IRR: 0.56; 95% CI: 0.32, 0.98; P-trend = 0.05). No association was observed between plasma vitamin C and risk of UCC.
  
  
  CONCLUSIONS
  Although residual confounding by smoking or other factors cannot be excluded, higher concentrations of plasma carotenoids may reduce risk of UCC, in particular aggressive UCC. Plasma lutein may reduce risk of nonaggressive UCC.
authors.affiliation: National Institute for Public Health and the Environment, Bilthoven, Netherlands. martine.ros@rivm.nl
authors.forename: Martine M
authors.initials: MM
authors.lastname: Ros
authors.forename: H Bas
authors.initials: HB
authors.lastname: Bueno-de-Mesquita
authors.forename: Ellen
authors.initials: E
authors.lastname: Kampman
authors.forename: Katja K H
authors.initials: KK
authors.lastname: Aben
authors.forename: Frederike L
authors.initials: FL
authors.lastname: Büchner
authors.forename: Eugene H J M
authors.initials: EH
authors.lastname: Jansen
authors.forename: Carla H
authors.initials: CH
authors.lastname: van Gils
authors.forename: Lars
authors.initials: L
authors.lastname: Egevad
authors.forename: Kim
authors.initials: K
authors.lastname: Overvad
authors.forename: Anne
authors.initials: A
authors.lastname: Tjønneland
authors.forename: Nina
authors.initials: N
authors.lastname: Roswall
authors.forename: Marie Christine
authors.initials: MC
authors.lastname: Boutron-Ruault
authors.forename: Marina
authors.initials: M
authors.lastname: Kvaskoff
authors.forename: Florence
authors.initials: F
authors.lastname: Perquier
authors.forename: Rudolf
authors.initials: R
authors.lastname: Kaaks
authors.forename: Jenny
authors.initials: J
authors.lastname: Chang-Claude
authors.forename: Steffen
authors.initials: S
authors.lastname: Weikert
authors.forename: Heiner
authors.initials: H
authors.lastname: Boeing
authors.forename: Antonia
authors.initials: A
authors.lastname: Trichopoulou
authors.forename: Pagona
authors.initials: P
authors.lastname: Lagiou
authors.forename: Vardis
authors.initials: V
authors.lastname: Dilis
authors.forename: Domenico
authors.initials: D
authors.lastname: Palli
authors.forename: Valeria
authors.initials: V
authors.lastname: Pala
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: Petra H M
authors.initials: PH
authors.lastname: Peeters
authors.forename: Inger T
authors.initials: IT
authors.lastname: Gram
authors.forename: Guri
authors.initials: G
authors.lastname: Skeie
authors.forename: José María
authors.initials: JM
authors.lastname: Huerta
authors.forename: Aurelio
authors.initials: A
authors.lastname: Barricarte
authors.forename: José Ramón
authors.initials: JR
authors.lastname: Quirós
authors.forename: María José
authors.initials: MJ
authors.lastname: Sánchez
authors.forename: Genevieve
authors.initials: G
authors.lastname: Buckland
authors.forename: Nerea
authors.initials: N
authors.lastname: Larrañaga
authors.forename: Roy
authors.initials: R
authors.lastname: Ehrnström
authors.forename: Peter
authors.initials: P
authors.lastname: Wallström
authors.forename: Börje
authors.initials: B
authors.lastname: Ljungberg
authors.forename: Göran
authors.initials: G
authors.lastname: Hallmans
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Key
authors.forename: Naomi E
authors.initials: NE
authors.lastname: Allen
authors.forename: Kay-Tee
authors.initials: KT
authors.lastname: Khaw
authors.forename: Nick
authors.initials: N
authors.lastname: Wareham
authors.forename: Paul
authors.initials: P
authors.lastname: Brennan
authors.forename: Elio
authors.initials: E
authors.lastname: Riboli
authors.forename: Lambertus A
authors.initials: LA
authors.lastname: Kiemeney
mesh_terms: D000328:Adult; D000368:Aged; D001205:Ascorbic Acid / Q000097:blood* / Q000627:therapeutic use; D002295:Carcinoma, Transitional Cell / Q000097:blood* / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D002338:Carotenoids / Q000097:blood* / Q000627:therapeutic use; D016022:Case-Control Studies; D015331:Cohort Studies; D004032:Diet / Q000009:adverse effects; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D014975:Lutein / Q000097:blood / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010212:Papilloma / Q000097:blood / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D001749:Urinary Bladder Neoplasms / Q000097:blood* / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D019459:Urothelium / Q000473:pathology*
chemical_list: D002338:Carotenoids; D001205:Ascorbic Acid; D014975:Lutein