title: Flavonoid and lignan intake and pancreatic cancer risk in the European prospective investigation into cancer and nutrition cohort.
abstract: Despite the potential cancer preventive effects of flavonoids and lignans, their ability to reduce pancreatic cancer risk has not been demonstrated in epidemiological studies. Our aim was to examine the association between dietary intakes of flavonoids and lignans and pancreatic cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. A total of 865 exocrine pancreatic cancer cases occurred after 11.3 years of follow-up of 477,309 cohort members. Dietary flavonoid and lignan intake was estimated through validated dietary questionnaires and the US Department of Agriculture (USDA) and Phenol Explorer databases. Hazard ratios (HR) and 95% confidence intervals (CIs) were calculated using age, sex and center-stratified Cox proportional hazards models, adjusted for energy intake, body mass index (BMI), smoking, alcohol and diabetes status. Our results showed that neither overall dietary intake of flavonoids nor of lignans were associated with pancreatic cancer risk (multivariable-adjusted HR for a doubling of intake = 1.03, 95% CI: 0.95-1.11 and 1.02; 95% CI: 0.89-1.17, respectively). Statistically significant associations were also not observed by flavonoid subclasses. An inverse association between intake of flavanones and pancreatic cancer risk was apparent, without reaching statistical significance, in microscopically confirmed cases (HR for a doubling of intake = 0.96, 95% CI: 0.91-1.00). In conclusion, we did not observe an association between intake of flavonoids, flavonoid subclasses or lignans and pancreatic cancer risk in the EPIC cohort.
authors.affiliation: Andalusian School of Public Health, Instituto De Investigación Biosanitaria Ibs, GRANADA, Hospitales Universitarios De Granada/Universidad De Granada, Granada, Spain.|CIBERESP, CIBER Epidemiología Y Salud Pública, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Molina-Montes
authors.affiliation: Andalusian School of Public Health, Instituto De Investigación Biosanitaria Ibs, GRANADA, Hospitales Universitarios De Granada/Universidad De Granada, Granada, Spain.|CIBERESP, CIBER Epidemiología Y Salud Pública, Spain.
authors.forename: María-José
authors.initials: MJ
authors.lastname: Sánchez
authors.affiliation: Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC), Lyon, France.
authors.forename: Raul
authors.initials: R
authors.lastname: Zamora-Ros
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.|Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands.|Department of Epidemiology and Biostatistics, the School of Public Health, Imperial College London, London, United Kingdom.|Department of Social and 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: Global eHealth Unit, Department of Primary Care and Public Health, the School of Public Health, Imperial College London, London, United Kingdom.
authors.forename: Petra A
authors.initials: PA
authors.lastname: Wark
authors.affiliation: Unit of Nutrition and Cancer, Catalan Institute of Oncology (ICO-Idibell), Barcelona, Spain.
authors.forename: Mireia
authors.initials: M
authors.lastname: Obon-Santacana
authors.affiliation: Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: Tilman
authors.initials: T
authors.lastname: Kühn
authors.affiliation: Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: Verena
authors.initials: V
authors.lastname: Katzke
authors.affiliation: Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
authors.forename: Ruth C
authors.initials: RC
authors.lastname: Travis
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.|The Medical Biobank at Umeå University, Umeå, Sweden.
authors.forename: Weimin
authors.initials: W
authors.lastname: Ye
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.|The Medical Biobank at Umeå University, Umeå, Sweden.
authors.forename: Malin
authors.initials: M
authors.lastname: Sund
authors.affiliation: Molecular and Genetic Epidemiology Unit, HuGeF-Human Genetics Foundation, Torino, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Naccarati
authors.affiliation: Dipartimento Di Medicina Clinica E Chirurgia, Federico II University, Naples, Italy.
authors.forename: Amalia
authors.initials: A
authors.lastname: Mattiello
authors.affiliation: Epidemiology and Prevention Unit Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Krogh
authors.affiliation: Cancer Registry ASP, Ragusa, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Martorana
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: CIBERESP, CIBER Epidemiología Y Salud Pública, Spain.|Public Health Division of Gipuzkoa, BioDonostia Research Institute, San Sebastián, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Amiano
authors.affiliation: CIBERESP, CIBER Epidemiología Y Salud Pública, Spain.|Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain.
authors.forename: José-María
authors.initials: JM
authors.lastname: Huerta
authors.affiliation: CIBERESP, CIBER Epidemiología Y Salud Pública, Spain.|Public Health Institute of Navarra, Pamplona, Spain.
authors.forename: Aurelio
authors.initials: A
authors.lastname: Barricarte
authors.affiliation: Public Health Directorate, Asturias, Spain.
authors.forename: José-Ramón
authors.initials: JR
authors.lastname: Quirós
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.|Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, the Arctic University of Norway, Tromsø, Norway.|Department of Research, Cancer Registry of Norway, Oslo, Norway.|Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland.
authors.forename: Elisabete
authors.initials: E
authors.lastname: Weiderpass
authors.affiliation: Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, the Arctic University of Norway, Tromsø, Norway.
authors.forename: Lene
authors.initials: L
authors.lastname: Angell Åsli
authors.affiliation: Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, the Arctic University of Norway, Tromsø, Norway.
authors.forename: Guri
authors.initials: G
authors.lastname: Skeie
authors.affiliation: Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden.
authors.forename: Ulrika
authors.initials: U
authors.lastname: Ericson
authors.affiliation: Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden.
authors.forename: Emily
authors.initials: E
authors.lastname: Sonestedt
authors.affiliation: Department of Epidemiology and Biostatistics, the 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, The Netherlands.
authors.forename: Petra H
authors.initials: PH
authors.lastname: Peeters
authors.affiliation: Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC), Lyon, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Romieu
authors.affiliation: Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC), Lyon, France.
authors.forename: Augustin
authors.initials: A
authors.lastname: Scalbert
authors.affiliation: Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark.
authors.forename: Kim
authors.initials: K
authors.lastname: Overvad
authors.affiliation: Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Clemens
authors.affiliation: Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
authors.forename: Heiner
authors.initials: H
authors.lastname: Boeing
authors.affiliation: Hellenic Health Foundation, Athens, Greece.|WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology, and Medical Statistics, University of Athens Medical School, Athens, Greece.
authors.forename: Antonia
authors.initials: A
authors.lastname: Trichopoulou
authors.affiliation: Hellenic Health Foundation, Athens, Greece.
authors.forename: Eleni
authors.initials: E
authors.lastname: Peppa
authors.affiliation: Hellenic Health Foundation, Athens, Greece.
authors.forename: Pavlos
authors.initials: P
authors.lastname: Vidalis
authors.affiliation: University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom.
authors.forename: Kay-Tee
authors.initials: KT
authors.lastname: Khaw
authors.affiliation: Epidemiology Unit, Medical Research Council, Cambridge, United Kingdom.
authors.forename: Nick
authors.initials: N
authors.lastname: Wareham
authors.affiliation: Danish Cancer Society Research Center, Copenhagen, Denmark.
authors.forename: Anja
authors.initials: A
authors.lastname: Olsen
authors.affiliation: Danish Cancer Society Research Center, Copenhagen, Denmark.
authors.forename: Anne
authors.initials: A
authors.lastname: Tjønneland
authors.affiliation: Inserm, CESP Centre for Research in Epidemiology and Population Health, France.
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Boutroun-Rualt
authors.affiliation: Inserm, CESP Centre for Research in Epidemiology and Population Health, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Clavel-Chapelon
authors.affiliation: Department of Epidemiology and Biostatistics, the School of Public Health, Imperial College London, London, United Kingdom.
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Cross
authors.affiliation: Department of Epidemiology and Biostatistics, the School of Public Health, Imperial College London, London, United Kingdom.
authors.forename: Yunxia
authors.initials: Y
authors.lastname: Lu
authors.affiliation: Department of Epidemiology and Biostatistics, the School of Public Health, Imperial College London, London, United Kingdom.
authors.forename: Elio
authors.initials: E
authors.lastname: Riboli
authors.affiliation: Unit of Nutrition and Cancer, Catalan Institute of Oncology (ICO-Idibell), Barcelona, Spain.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Duell
mesh_terms: D015331:Cohort Studies; D004032:Diet / Q000706:statistics & numerical data; D015930:Diet Records; D005060:Europe / Q000453:epidemiology; D005260:Female; D005419:Flavonoids / Q000008:administration & dosage*; D006801:Humans; D008019:Life Style; D017705:Lignans / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000453:epidemiology*; D016016:Proportional Hazards Models; D011446:Prospective Studies
chemical_list: D005419:Flavonoids; D017705:Lignans
keywords: cohort; diet; flavonoids; lignans; pancreatic cancer