title: Energy and macronutrient intake and risk of differentiated thyroid carcinoma in the European Prospective Investigation into Cancer and Nutrition study.
abstract: Incidence rates of differentiated thyroid carcinoma (TC) have increased in many countries. Adiposity and dietary risk factors may play a role, but little is known on the influence of energy intake and macronutrient composition. The aim of this study was to investigate the associations between TC and the intake of energy, macronutrients, glycemic index (GI) and glycemic load in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. The study included 477,274 middle-age participants (70.2% women) from ten European countries. Dietary data were collected using country-specific validated dietary questionnaires. Total carbohydrates, proteins, fats, saturated, monounsaturated and polyunsaturated fats (PUFA), starch, sugar, and fiber were computed as g/1,000 kcal. Multivariable Cox regression was used to calculate multivariable adjusted hazard ratios (HR) and 95% confidence interval (CI) by intake quartile (Q). After a mean follow-up time of 11 years, differentiated TC was diagnosed in 556 participants (90% women). Overall, we found significant associations only with total energy (HRQ4 vs .Q1 , 1.29; 95% CI, 1.00-1.68) and PUFA intakes (HRQ4 vs .Q1 , 0.74; 95% CI, 0.57-0.95). However, the associations with starch and sugar intake and GI were significantly heterogeneous across body mass index (BMI) groups, i.e., positive associations with starch and GI were found in participants with a BMI ≥ 25 and with sugar intake in those with BMI < 25. Moreover, inverse associations with starch and GI were observed in subjects with BMI < 25. In conclusion, our results suggest that high total energy and low PUFA intakes may increase the risk of differentiated TC. Positive associations with starch intake and GI in participants with BMI ≥ 25 suggest that those persons may have a greater insulin response to high starch intake and GI than lean people.
authors.affiliation: International Agency for Research on Cancer (IARC), Lyon, France.
authors.forename: Raul
authors.initials: R
authors.lastname: Zamora-Ros
authors.affiliation: International Agency for Research on Cancer (IARC), Lyon, France.
authors.forename: Sabina
authors.initials: S
authors.lastname: Rinaldi
authors.affiliation: Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece.|School of Public Health, Imperial College London, London, United Kingdom.
authors.forename: Konstantinos K
authors.initials: KK
authors.lastname: Tsilidis
authors.affiliation: Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.|Department of Etiological Cancer Research, Cancer Registry of Norway, Oslo, Norway.|Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.|Department of Genetic Epidemiology, Folkhälsan Research Center, Helsinki, Finland.
authors.forename: Elisabete
authors.initials: E
authors.lastname: Weiderpass
authors.affiliation: Inserm, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health Team, Villejuif, France.|Université Paris Sud, UMRS 1018, Villejuif, France.|Institut Gustave Roussy, Villejuif, France.
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Boutron-Ruault
authors.affiliation: Danish Cancer Society Research Center, Copenhagen, Denmark.
authors.forename: Agnetha Linn
authors.initials: AL
authors.lastname: Rostgaard-Hansen
authors.affiliation: Danish Cancer Society Research Center, Copenhagen, Denmark.
authors.forename: Anne
authors.initials: A
authors.lastname: Tjønneland
authors.affiliation: Inserm, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health Team, Villejuif, France.|Université Paris Sud, UMRS 1018, Villejuif, France.|Institut Gustave Roussy, Villejuif, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Clavel-Chapelon
authors.affiliation: Inserm, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health Team, Villejuif, France.|Université Paris Sud, UMRS 1018, Villejuif, France.|Institut Gustave Roussy, Villejuif, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Mesrine
authors.affiliation: Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: Verena A
authors.initials: VA
authors.lastname: Katzke
authors.affiliation: Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: Tilman
authors.initials: T
authors.lastname: Kühn
authors.affiliation: Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany.
authors.forename: Jana
authors.initials: J
authors.lastname: Förster
authors.affiliation: Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany.
authors.forename: Heiner
authors.initials: H
authors.lastname: Boeing
authors.affiliation: Hellenic Health Foundation, Athens, Greece.|Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece.|Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece.
authors.forename: Antonia
authors.initials: A
authors.lastname: Trichopoulou
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece.|Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece.|Department of Epidemiology, Harvard School of Public Health, Boston, MA.
authors.forename: Pagona
authors.initials: P
authors.lastname: Lagiou
authors.affiliation: Hellenic Health Foundation, Athens, Greece.
authors.forename: Eleni
authors.initials: E
authors.lastname: Klinaki
authors.affiliation: Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Masala
authors.affiliation: Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy.
authors.forename: Sabina
authors.initials: S
authors.lastname: Sieri
authors.affiliation: Unit of Cancer Epidemiology - CERMS, Department of Medical Sciences, University of Turin and Città Della Salute E Della Scienza Hospital, Turin, Italy.
authors.forename: Fulvio
authors.initials: F
authors.lastname: Ricceri
authors.affiliation: Cancer Registry and Histopathology Unit, "Civic M.P. Arezzo" Hospital, ASP Ragusa, Italy.
authors.forename: Rosario
authors.initials: R
authors.lastname: Tumino
authors.affiliation: Dipartimento Di Medicina Clinica E Chirurgia, Federico II University, Naples, Italy.
authors.forename: Amalia
authors.initials: A
authors.lastname: Mattiello
authors.affiliation: School of Public Health, Imperial College London, London, United Kingdom.|Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Petra H M
authors.initials: PH
authors.lastname: Peeters
authors.affiliation: School of Public Health, Imperial College London, London, United Kingdom.|National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.|Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.|Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: H B As
authors.initials: HB
authors.lastname: Bueno-de-Mesquita
authors.affiliation: The Norwegian Scientific Committee for Food Safety (VKM), Oslo, Norway.
authors.forename: Dagrun
authors.initials: D
authors.lastname: Engeset
authors.affiliation: Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
authors.forename: Guri
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authors.lastname: Skeie
authors.affiliation: Public Health Directorate, Asturias, Spain.
authors.forename: Marcial
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authors.affiliation: Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, Barcelona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Agudo
authors.affiliation: Escuela Andaluza De Salud Pública, Instituto De Investigación Biosanitaria (ibs.GRANADA), Hospitales Universitarios De Granada/Universidad De Granada, Granada, Spain.|CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain.
authors.forename: María-José
authors.initials: MJ
authors.lastname: Sánchez
authors.affiliation: CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain.|Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain.
authors.forename: María-Dolores
authors.initials: MD
authors.lastname: Chirlaque
authors.affiliation: CIBER Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain.|Public Health Institute of Navarra, Pamplona, Spain.
authors.forename: Aurelio
authors.initials: A
authors.lastname: Barricarte
authors.affiliation: Public Health Division of Gipuzkoa, BioDonostia Research Institute, Health Department of Basque Region, San Sebastian.
authors.forename: Saioa
authors.initials: S
authors.lastname: Chamosa
authors.affiliation: Department of Surgery, University Hospital Lund, Lund, Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Almquist
authors.affiliation: Department of Surgery, University Hospital Malmö, Malmö, Sweden.
authors.forename: Ada
authors.initials: A
authors.lastname: Tosovic
authors.affiliation: Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
authors.forename: Joakim
authors.initials: J
authors.lastname: Hennings
authors.affiliation: Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Sandström
authors.affiliation: Cancer Epidemiology Unit, University of Oxford, Oxford, United Kingdom.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Schmidt
authors.affiliation: Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Kay-Thee
authors.initials: KT
authors.lastname: Khaw
authors.affiliation: MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Wareham
authors.affiliation: School of Public Health, Imperial College London, London, United Kingdom.
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Cross
authors.affiliation: International Agency for Research on Cancer (IARC), Lyon, France.
authors.forename: Nadia
authors.initials: N
authors.lastname: Slimani
authors.affiliation: International Agency for Research on Cancer (IARC), Lyon, France.
authors.forename: Graham
authors.initials: G
authors.lastname: Byrnes
authors.affiliation: International Agency for Research on Cancer (IARC), Lyon, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Romieu
authors.affiliation: School of Public Health, Imperial College London, London, United Kingdom.
authors.forename: Elio
authors.initials: E
authors.lastname: Riboli
authors.affiliation: International Agency for Research on Cancer (IARC), Lyon, France.
authors.forename: Silvia
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mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000453:epidemiology* / Q000209:etiology* / Q000473:pathology; D004032:Diet; D002149:Energy Intake; D005060:Europe / Q000453:epidemiology; D005260:Female; D038321:Glycemic Index; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors; D013964:Thyroid Neoplasms / Q000453:epidemiology* / Q000209:etiology* / Q000473:pathology
keywords: EPIC; differentiated thyroid carcinomas; glycemic index; macronutrients; total energy