title: Flavonoid and lignan intake in relation to bladder cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study.
abstract: BACKGROUND
  There is growing evidence of the protective role of dietary intake of flavonoids and lignans on cancer, but the association with bladder cancer has not been thoroughly investigated in epidemiological studies. We evaluated the association between dietary intakes of total and subclasses of flavonoids and lignans and risk of bladder cancer and its main morphological type, urothelial cell carcinoma (UCC), within the European Prospective Investigation into Cancer and Nutrition (EPIC) study.
  
  
  METHODS
  A cohort of 477 312 men and women mostly aged 35-70 years, were recruited in 10 European countries. At baseline, dietary flavonoid and lignan intakes were estimated using centre-specific validated questionnaires and a food composition database based on the Phenol-Explorer, the UK Food Standards Agency and the US Department of Agriculture databases.
  
  
  RESULTS
  During an average of 11 years of follow-up, 1575 new cases of primary bladder cancer were identified, of which 1425 were UCC (classified into aggressive (n=430) and non-aggressive (n=413) UCC). No association was found between total flavonoid intake and bladder cancer risk. Among flavonoid subclasses, significant inverse associations with bladder cancer risk were found for intakes of flavonol (hazard ratio comparing fifth with first quintile (HRQ5-Q1) 0.74, 95% confidence interval (CI): 0.61-0.91; P-trend=0.009) and lignans (HRQ5-Q1 0.78, 95% CI: 0.62-0.96; P-trend=0.046). Similar results were observed for overall UCC and aggressive UCC, but not for non-aggressive UCC.
  
  
  CONCLUSIONS
  Our study suggests an inverse association between the dietary intakes of flavonols and lignans and risk of bladder cancer, particularly aggressive UCC.
authors.affiliation: 1] Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain [2] Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC), Lyon, France.
authors.forename: R
authors.initials: R
authors.lastname: Zamora-Ros
authors.affiliation: Center for Cancer Prevention (CPO-Piemonte), and Human Genetic Foundation (HuGeF), Torino, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Sacerdote
authors.affiliation: Center for Cancer Prevention (CPO-Piemonte), and Human Genetic Foundation (HuGeF), Torino, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Ricceri
authors.affiliation: 1] Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway [2] Cancer Registry of Norway, Oslo, Norway [3] Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden [4] Samfundet Folkhälsan, Helsinki, Finland.
authors.forename: E
authors.initials: E
authors.lastname: Weiderpass
authors.affiliation: Danish Cancer Society Research Center, Copenhagen, Denmark.
authors.forename: N
authors.initials: N
authors.lastname: Roswall
authors.affiliation: Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Buckland
authors.affiliation: Department of Nutrition, Harvard School of Public Health, Boston, MA, USA.
authors.forename: D E
authors.initials: DE
authors.lastname: St-Jules
authors.affiliation: Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark.
authors.forename: K
authors.initials: K
authors.lastname: Overvad
authors.affiliation: Danish Cancer Society Research Center, Copenhagen, Denmark.
authors.forename: C
authors.initials: C
authors.lastname: Kyrø
authors.affiliation: 1] Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health team, Villejuif, France [2] Paris South University, UMRS 1018, Villejuif, France [3] IGR, F-94805, Villejuif, France.
authors.forename: G
authors.initials: G
authors.lastname: Fagherazzi
authors.affiliation: 1] Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health team, Villejuif, France [2] Paris South University, UMRS 1018, Villejuif, France [3] IGR, F-94805, Villejuif, France.
authors.forename: M
authors.initials: M
authors.lastname: Kvaskoff
authors.affiliation: 1] Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Victoria, Australia [2] Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: G
authors.initials: G
authors.lastname: Severi
authors.affiliation: Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Chang-Claude
authors.affiliation: Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Kaaks
authors.affiliation: Department of Nutrition and Food Sciences, Nutritional Epidemiology, University of Bonn, Bonn, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Nöthlings
authors.affiliation: 1] Hellenic Health Foundation, Athens, Greece [2] Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Trichopoulou
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Naska
authors.affiliation: 1] Hellenic Health Foundation, Athens, Greece [2] Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece [3] Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
authors.forename: D
authors.initials: D
authors.lastname: Trichopoulos
authors.affiliation: Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute-ISPO, Florence, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Palli
authors.affiliation: Nutritional Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Grioni
authors.affiliation: Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Mattiello
authors.affiliation: Cancer Registry and Histopathology Unit, 'Civic MP Arezzo' Hospital, ASP Ragusa, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Tumino
authors.affiliation: Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.
authors.forename: I T
authors.initials: IT
authors.lastname: Gram
authors.affiliation: Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.
authors.forename: D
authors.initials: D
authors.lastname: Engeset
authors.affiliation: 1] Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain [2] CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Huerta
authors.affiliation: 1] CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain [2] Andalusian School of Public Health, Granada, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Molina-Montes
authors.affiliation: Public Health Directorate, Asturias, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Argüelles
authors.affiliation: 1] CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain [2] Public Health Department of Gipuzkoa, BioDonostia Research Institute, Health Department of Basque Region, San Sebastián, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Amiano
authors.affiliation: 1] CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain [2] Public Health Institute of Navarra, Pamplona, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Ardanaz
authors.affiliation: Diabetes and Cardiovascular disease, Genetic Epidemiology, Department of Clinical Sciences, Lund University, Malmö, Sweden.
authors.forename: U
authors.initials: U
authors.lastname: Ericson
authors.affiliation: Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: B
authors.initials: B
authors.lastname: Lindkvist
authors.affiliation: 1] Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden [2] Arcum, Arctic Research Centre at Umeå University, Umeå, Sweden.
authors.forename: L M
authors.initials: LM
authors.lastname: Nilsson
authors.affiliation: Department for Health Evidence and Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: L A
authors.initials: LA
authors.lastname: Kiemeney
authors.affiliation: 1] National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands [2] Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Ros
authors.affiliation: 1] National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands [2] Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands [3] School of Public Health, Imperial College, London, UK.
authors.forename: H B
authors.initials: HB
authors.lastname: Bueno-de-Mesquita
authors.affiliation: 1] School of Public Health, Imperial College, London, UK [2] Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: P H M
authors.initials: PH
authors.lastname: Peeters
authors.affiliation: Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
authors.forename: K-T
authors.initials: KT
authors.lastname: Khaw
authors.affiliation: MRC Epidemiology Unit, Cambridge University, Institute of Metabolic Science, Cambridge, UK.
authors.forename: N J
authors.initials: NJ
authors.lastname: Wareham
authors.affiliation: Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC), Lyon, France.
authors.forename: V
authors.initials: V
authors.lastname: Knaze
authors.affiliation: Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC), Lyon, France.
authors.forename: I
authors.initials: I
authors.lastname: Romieu
authors.affiliation: Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC), Lyon, France.
authors.forename: A
authors.initials: A
authors.lastname: Scalbert
authors.affiliation: Genetic Epidemiology Group, Section of Genetics, International Agency for Research on Cancer (IARC), Lyon, France.
authors.forename: P
authors.initials: P
authors.lastname: Brennan
authors.affiliation: School of Public Health, Imperial College, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Wark
authors.affiliation: School of Public Health, Imperial College, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Vineis
authors.affiliation: School of Public Health, Imperial College, London, UK.
authors.forename: E
authors.initials: E
authors.lastname: Riboli
authors.affiliation: Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.
authors.forename: C A
authors.initials: CA
authors.lastname: González
mesh_terms: D000328:Adult; D000368:Aged; D002278:Carcinoma in Situ / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D004032:Diet; D005060:Europe / Q000453:epidemiology; D005260:Female; D005419:Flavonoids; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008019:Life Style; D017705:Lignans; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control
chemical_list: D005419:Flavonoids; D017705:Lignans