title: Dietary flavonoid intake and colorectal cancer risk in the European prospective investigation into cancer and nutrition (EPIC) cohort.
abstract: Flavonoids have been shown to inhibit colon cancer cell proliferation in vitro and protect against colorectal carcinogenesis in animal models. However, epidemiological evidence on the potential role of flavonoid intake in colorectal cancer (CRC) development remains sparse and inconsistent. We evaluated the association between dietary intakes of total flavonoids and their subclasses and risk of development of CRC, within the European Prospective Investigation into Cancer and Nutrition (EPIC) study. A cohort of 477,312 adult men and women were recruited in 10 European countries. At baseline, dietary intakes of total flavonoids and individual subclasses were estimated using centre-specific validated dietary questionnaires and composition data from the Phenol-Explorer database. During an average of 11 years of follow-up, 4,517 new cases of primary CRC were identified, of which 2,869 were colon (proximal = 1,298 and distal = 1,266) and 1,648 rectal tumours. No association was found between total flavonoid intake and the risk of overall CRC (HR for comparison of extreme quintiles 1.05, 95% CI 0.93-1.18; p-trend = 0.58) or any CRC subtype. No association was also observed with any intake of individual flavonoid subclasses. Similar results were observed for flavonoid intake expressed as glycosides or aglycone equivalents. Intake of total flavonoids and flavonoid subclasses, as estimated from dietary questionnaires, did not show any association with risk of CRC development.
authors.affiliation: Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France.|Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.
authors.forename: Raul
authors.initials: R
authors.lastname: Zamora-Ros
authors.affiliation: Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France.|Genome Center, University of California, Davis, CA.
authors.forename: Dinesh K
authors.initials: DK
authors.lastname: Barupal
authors.affiliation: Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Rothwell
authors.affiliation: Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France.
authors.forename: Mazda
authors.initials: M
authors.lastname: Jenab
authors.affiliation: Rollins School of Public Health, Winship Cancer Institute, Emory University, Atlanta, GA.
authors.forename: Veronika
authors.initials: V
authors.lastname: Fedirko
authors.affiliation: Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Romieu
authors.affiliation: Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
authors.forename: Krasimira
authors.initials: K
authors.lastname: Aleksandrova
authors.affiliation: Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark.
authors.forename: Kim
authors.initials: K
authors.lastname: Overvad
authors.affiliation: Danish Cancer Society Research Center, Copenhagen, Denmark.
authors.forename: Cecilie
authors.initials: C
authors.lastname: Kyrø
authors.affiliation: Danish Cancer Society Research Center, Copenhagen, Denmark.
authors.forename: Anne
authors.initials: A
authors.lastname: Tjønneland
authors.affiliation: Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France.|Institut Gustave Roussy, Villejuif, F-94805, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Affret
authors.affiliation: Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France.|Institut Gustave Roussy, Villejuif, F-94805, France.
authors.forename: Mathilde
authors.initials: M
authors.lastname: His
authors.affiliation: Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France.|Institut Gustave Roussy, Villejuif, F-94805, France.
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Boutron-Ruault
authors.affiliation: Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany.
authors.forename: Verena
authors.initials: V
authors.lastname: Katzke
authors.affiliation: Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany.
authors.forename: Tilman
authors.initials: T
authors.lastname: Kühn
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, Dept. of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Greece.
authors.forename: Antonia
authors.initials: A
authors.lastname: Trichopoulou
authors.affiliation: Hellenic Health Foundation, Athens, Greece.|WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Dept. of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Greece.
authors.forename: Androniki
authors.initials: A
authors.lastname: Naska
authors.affiliation: Hellenic Health Foundation, Athens, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Kritikou
authors.affiliation: Cancer Risk Factors and Life-Style Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy.
authors.forename: Calogero
authors.initials: C
authors.lastname: Saieva
authors.affiliation: Nutritional Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Agnoli
authors.affiliation: Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Santucci de Magistris
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: Unit of Cancer Epidemiology, Department of Medical Sciences, University of Turin, Turin, Italy.|Città della Salute e della Scienza Hospital, Turin, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Fasanelli
authors.affiliation: Department of Community Medicine, Faculty of Health Sciences, UiT The Artic University of Tromsø, Tromsø, Norway.|Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway.|Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.|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, UiT The Artic University of Tromsø, Tromsø, Norway.
authors.forename: Guri
authors.initials: G
authors.lastname: Skeie
authors.affiliation: Public Health Directorate, Asturias, Spain.
authors.forename: Susana
authors.initials: S
authors.lastname: Merino
authors.affiliation: Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.
authors.forename: Paula
authors.initials: P
authors.lastname: Jakszyn
authors.affiliation: Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs, Granada Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain.|CIBER de Epidemiología y Salud Pública (CIBERESP), Spain.
authors.forename: Maria-José
authors.initials: MJ
authors.lastname: Sánchez
authors.affiliation: CIBER de Epidemiología y Salud Pública (CIBERESP), Spain.|Public Health Division of Gipuzkoa, Regional Government of the Basque Country, Spain.
authors.forename: Miren
authors.initials: M
authors.lastname: Dorronsoro
authors.affiliation: CIBER de Epidemiología y Salud Pública (CIBERESP), Spain.|Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain.|Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Navarro
authors.affiliation: CIBER de Epidemiología y Salud Pública (CIBERESP), Spain.|Navarre Public Health Institute, Pamplona, Spain.|IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Ardanaz
authors.affiliation: Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
authors.forename: Emily
authors.initials: E
authors.lastname: Sonestedt
authors.affiliation: Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
authors.forename: Ulrika
authors.initials: U
authors.lastname: Ericson
authors.affiliation: Nutritional Research and Arcum, Arctic Research Centre at Umeå University, Umeå, Sweden.
authors.forename: Lena
authors.initials: L
authors.lastname: Maria Nilsson
authors.affiliation: Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden.
authors.forename: Stina
authors.initials: S
authors.lastname: Bodén
authors.affiliation: Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.|School of Public Health, Imperial College London, London, United Kingdom.|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: 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
authors.initials: PH
authors.lastname: Peeters
authors.affiliation: Cancer Epidemiology Unit, University of Oxford, United Kingdom.
authors.forename: Aurora
authors.initials: A
authors.lastname: Perez-Cornago
authors.affiliation: MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Wareham
authors.affiliation: Department of Public Health and Primary Care, University of Cambridge, United Kingdom.
authors.forename: Kay-Thee
authors.initials: KT
authors.lastname: Khaw
authors.affiliation: Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France.
authors.forename: Heinz
authors.initials: H
authors.lastname: Freisling
authors.affiliation: School of Public Health, Imperial College London, London, United Kingdom.
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Cross
authors.affiliation: School of Public Health, Imperial College London, London, United Kingdom.
authors.forename: Elio
authors.initials: E
authors.lastname: Riboli
authors.affiliation: Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France.
authors.forename: Augustin
authors.initials: A
authors.lastname: Scalbert
mesh_terms: D000328:Adult; D000368:Aged; D049109:Cell Proliferation / Q000187:drug effects; D015179:Colorectal Neoplasms / Q000139:chemically induced / Q000178:diet therapy* / Q000453:epidemiology / Q000473:pathology; D004032:Diet / Q000009:adverse effects*; D019587:Dietary Supplements / Q000009:adverse effects*; D005060:Europe; D005260:Female; D005419:Flavonoids / Q000009:adverse effects / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D044465:White People
chemical_list: D005419:Flavonoids
keywords: EPIC; colorectal cancer; diet; flavonoids; prospective cohort