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


METHODS
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.


CONCLUSIONS
Total dietary flavonoid intake is associated with a significant reduction in the risk of GC in women.
Unit of Nutrition, Environment, and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Barcelona, Spain. rzamora@iconcologia.net
Raul
R
Zamora-Ros
Antonio
A
Agudo
Leila
L
Luján-Barroso
Isabelle
I
Romieu
Pietro
P
Ferrari
Viktoria
V
Knaze
H Bas
HB
Bueno-de-Mesquita
Max
M
Leenders
Ruth C
RC
Travis
Carmen
C
Navarro
Emilio
E
Sánchez-Cantalejo
Nadia
N
Slimani
Augustin
A
Scalbert
Veronika
V
Fedirko
Anette
A
Hjartåker
Dagrun
D
Engeset
Guri
G
Skeie
Heiner
H
Boeing
Jana
J
Förster
Kuanrong
K
Li
Birgit
B
Teucher
Claudia
C
Agnoli
Rosario
R
Tumino
Amalia
A
Mattiello
Calogero
C
Saieva
Ingegerd
I
Johansson
Roger
R
Stenling
Maria Luisa
ML
Redondo
Peter
P
Wallström
Ulrika
U
Ericson
Kay-Tee
KT
Khaw
Angela A
AA
Mulligan
Antonia
A
Trichopoulou
Vardis
V
Dilis
Michael
M
Katsoulis
Petra H M
PH
Peeters
Lazslo
L
Igali
Anne
A
Tjønneland
Jytte
J
Halkjær
Marina
M
Touillaud
Florence
F
Perquier
Guy
G
Fagherazzi
Pilar
P
Amiano
Eva
E
Ardanaz
Lea
L
Bredsdorff
Kim
K
Overvad
Fulvio
F
Ricceri
Elio
E
Riboli
Carlos A
CA
González
D000230:Adenocarcinoma / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D000328:Adult; D000368:Aged; D016588:Anticarcinogenic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D015331:Cohort Studies; D004032:Diet / Q000009:adverse effects; D005060:Europe / Q000453:epidemiology; D005260:Female; D005419:Flavonoids / Q000008:administration & dosage* / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008019:Life Style; D017705:Lignans / Q000008:administration & dosage* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012306:Risk; D012737:Sex Factors; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*
D016588:Anticarcinogenic Agents; D005419:Flavonoids; D017705:Lignans