Mediterranean diet and risk of pancreatic cancer in the European Prospective Investigation into Cancer and Nutrition cohort.
BACKGROUND
The Mediterranean diet (MD) has been proposed as a means for cancer prevention, but little evidence has been accrued regarding its potential to prevent pancreatic cancer. We investigated the association between the adherence to the MD and pancreatic cancer risk within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort.


METHODS
Over half a million participants from 10 European countries were followed up for over 11 years, after which 865 newly diagnosed exocrine pancreatic cancer cases were identified. Adherence to the MD was estimated through an adapted score without the alcohol component (arMED) to discount alcohol-related harmful effects. Cox proportional hazards regression models, stratified by age, sex and centre, and adjusted for energy intake, body mass index, smoking status, alcohol intake and diabetes status at recruitment, were used to estimate hazard ratios (HRs) associated with pancreatic cancer and their corresponding 95% confidence intervals (CIs).


RESULTS
Adherence to the arMED score was not associated with risk of pancreatic cancer (HR high vs low adherence=0.99; 95% CI: 0.77-1.26, and HR per increments of two units in adherence to arMED=1.00; 95% CI: 0.94-1.06). There was no convincing evidence for heterogeneity by smoking status, body mass index, diabetes or European region. There was also no evidence of significant associations in analyses involving microscopically confirmed cases, plausible reporters of energy intake or other definitions of the MD pattern.


CONCLUSIONS
A high adherence to the MD is not associated with pancreatic cancer risk in the EPIC study.
Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (CNIO), Madrid, Spain.|Andalusian School of Public Health, Instituto de Investigación Biosanitaria ibs.GRANADA. Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain.|CIBER Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.
Esther
E
Molina-Montes
Andalusian School of Public Health, Instituto de Investigación Biosanitaria ibs.GRANADA. Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain.|CIBER Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.
María-José
MJ
Sánchez
Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain.
Genevieve
G
Buckland
Department for Determinants of Chronic Diseases (DCD), 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, UK.|Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
H B As
HB
Bueno-de-Mesquita
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, Institute of Population-Based Cancer Research, Oslo, Norway.|Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.|Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland.
Elisabete
E
Weiderpass
CIBER Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.|Public Health Division of Gipuzkoa, BioDonostia Research Institute, San Sebastián, Spain.
Pilar
P
Amiano
Global eHealth Unit, Department of Primary Care and Public Health, The School of Public Health, Imperial College London, London, UK.
Petra A
PA
Wark
Division of Cancer Epidemiology, German Cancer Research Center (DFKZ), Heidelberg, Germany.
Tilman
T
Kühn
Division of Cancer Epidemiology, German Cancer Research Center (DFKZ), Heidelberg, Germany.
Verena
V
Katzke
CIBER Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.|Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain.
José María
JM
Huerta
CIBER Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.|Navarra Public Health Institute, Pamplona, Spain.|IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.
Eva
E
Ardanaz
Public Health Directorate, Asturias, Spain.
José Ramón
JR
Quirós
Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP Generations and Health Team, INSERM, Villejuif, France.|Gustave Roussy, Villejuif F-94805, France.
Aurélie
A
Affret
Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP Generations and Health Team, INSERM, Villejuif, France.|Gustave Roussy, Villejuif F-94805, France.
Mathilde
M
His
Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP Generations and Health Team, INSERM, Villejuif, France.|Gustave Roussy, Villejuif F-94805, France.
Marie-Christine
MC
Boutron-Ruault
Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, UK.|Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Petra H
PH
Peeters
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.|The Medical Biobank at Umeå University, Umeå, Sweden.
Weimin
W
Ye
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.|The Medical Biobank at Umeå University, Umeå, Sweden.
Malin
M
Sund
Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
Heiner
H
Boeing
Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
Khalid
K
Iqbal
Department of Internal Medicine, Skane University Hospital, Malmö, Sweden.|Department of Clinical Sciences, Lund University, Malmö, Sweden.
Bodil
B
Ohlsson
Department of Clinical Sciences, Lund University, Malmö, Sweden.
Emily
E
Sonestedt
Danish Cancer Society Research Center, Unit of Diet, Genes and Environment, Copenhagen, Denmark.
Anne
A
Tjønneland
Danish Cancer Society Research Center, Unit of Diet, Genes and Environment, Copenhagen, Denmark.
Kristina En
KE
Petersen
Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Ruth C
RC
Travis
Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.
Guri
G
Skeie
Epidemiology and Prevention Unit Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Claudia
C
Agnoli
Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy.
Salvatore
S
Panico
Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute-ISPO, Florence, Italy.
Domenico
D
Palli
Cancer Registry and Histopathology Unit, 'Civic-M.P.Arezzo' Hospital, ASP Ragusa, Ragusa, Italy.
Rosario
R
Tumino
Unit of Cancer Epidemiology, Citta' della Salute e della Scienza Hospital, University of Turin and Centre for Cancer Prevention (CPO), Turin, Italy.
Carlotta
C
Sacerdote
Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France.
Heinz
H
Freisling
Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France.
Inge
I
Huybrechts
Department of Public Health, Section of Epidemiology, Aarhus University, Aarhus, Denmark.
Kim
K
Overvad
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.
Antonia
A
Trichopoulou
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.
Christina
C
Bamia
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.
Effie
E
Vasilopoulou
Medical Research Council (MCR), Epidemiology Unit, Cambridge, UK.
Nick
N
Wareham
University of Cambridge, School of Clinical Medicine, Cambridge, UK.
Kay-Tee
KT
Khaw
Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, UK.
Amanda J
AJ
Cross
Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, UK.
Heather A
HA
Ward
Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, UK.
Elio
E
Riboli
Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain.
Eric J
EJ
Duell
D038441:Diet, Mediterranean; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D015596:Nutrition Assessment; D010190:Pancreatic Neoplasms / Q000517:prevention & control*; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D044465:White People