Objective
The Mediterranean diet has been reported to be associated with a significant reduction in risk of noncommunicable diseases. We undertook this study to assess the relationship between ...adherence to the Mediterranean diet and the risk of rheumatoid arthritis (RA), especially in high‐risk individuals.
Methods
The E3N study (Etude Epidémiologique Auprès des Femmes de la Mutuelle Générale de l’Education Nationale) is a French prospective cohort study that has included 98,995 women since 1990. Dietary data were collected via a validated food frequency questionnaire in 1993. Adherence to the Mediterranean diet was assessed using a 9‐unit dietary score evaluating consumption of vegetables, legumes, cereal products, fish, meat, dairy products, olive oil, and alcohol. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) for incident RA were estimated using Cox proportional hazards regression models adjusted for age and the main potential confounders, including smoking.
Results
Among 62,629 women, we identified 480 incident cases of RA. In the entire study population, the Mediterranean diet adherence score was not associated with RA risk (HR 0.86 95% CI 0.67–1.09 for high score versus low score; P for trend = 0.09); however, among ever‐smokers, a higher score was associated with a decreased risk of RA (HR 0.91 95% CI 0.84–0.99 for 1‐point increase in score; P = 0.03). In ever‐smokers, the absolute risks of RA in those with high scores and those with low scores were 38.3 and 51.5 per 100,000 person‐years, respectively, compared to 35.8 per 100,000 person‐years in never‐smokers with high Mediterranean diet scores.
Conclusion
Our results suggest that adherence to the Mediterranean diet could reduce the high risk of RA among ever‐smoking women. Our results must be confirmed in future research.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Endocrine‐disrupting chemicals are proposed to increase breast cancer (BC) incidence. Perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA), two perfluorinated alkylated substances ...(PFASs), are suspected to be ubiquitously present in the blood of human population worldwide. We investigated the associations between serum concentrations of these substances and BC risk. Etude Epidémiologique auprès de femmes de l'Education Nationale is a cohort of 98,995 French women born in 1925–1950 and followed up since 1990. We sampled 194 BC cases and 194 controls from women with available blood samples. Serum concentrations of PFASs were measured by liquid chromatography coupled to tandem mass spectrometry (LC–MS/MS). Adjusted conditional logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). All statistical tests were two sided. While PFASs concentrations were not associated with BC risk overall, we found positively linear associations between PFOS concentrations and the risk of ER+ (3rd quartile: OR = 2.22 CI = 1.05–4.69; 4th quartile: OR = 2.33 CI = 1.11–4.90); Ptrend = 0.04) and PR+ tumors (3rd quartile: OR = 2.47 CI = 1.07–5.65; 4th quartile: OR = 2.76 CI = 1.21–6.30; Ptrend = 0.02). When considering receptor‐negative tumors, only the 2nd quartile of PFOS was associated with risk (ER−: OR = 15.40 CI = 1.84–129.19; PR−: OR = 3.47 CI = 1.29–9.15). While there was no association between PFOA and receptor‐positive BC risk, the 2nd quartile of PFOA was positively associated with the risk of receptor‐negative tumors (ER−: OR = 7.73 CI = 1.46–41.08; PR−: OR = 3.44 CI = 1.30–9.10). PFAS circulating levels were differentially associated with BC risk. While PFOS concentration was linearly associated with receptor‐positive tumors, only low concentrations of PFOS and PFOA were associated with receptor‐negative tumors. Our findings highlight the importance of considering exposure to PFASs as a potential risk factor for BC.
What's new?
Perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA) are two environmental endocrine‐disrupting chemicals suspected to be ubiquitously present in the blood of the human population. This nested case‐control study including non‐occupationally exposed postmenopausal French women suggests a linear dose‐response relationship between PFOS serum concentrations and the risk of developing hormone receptor‐positive breast cancer. Furthermore, an increased risk of developing ER– and PR– tumors is associated to middle‐low serum concentrations of PFOA and PFOS. Exposure to endocrine‐disrupting chemicals should be considered as a potential risk factor for breast cancer, thus a serious public health issue.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
•Previous studies have reported that obesity and type 2 diabetes (T2D) are associated with low adherence to the 2017 French food-based dietary guidelines.•Our findings suggest that higher adherence ...to the simplified French dietary guidelines is associated with a lower risk of T2D in women.•A significant proportion of this association was mediated by obesity as measured by the BMI or WHR.•These results improve our understanding of the pathways in the French dietary guidelines-T2D association.
Obesity and type 2 diabetes (T2D) have been associated with low adherence to the 2017 French food-based dietary guidelines, as assessed by the Programme National Nutrition Santé - guidelines score 2 (PNNS-GS2). Whether the association between T2D and PNNS-GS2 is direct or mediated by obesity has been little investigated.
The study included 71,450 women from the E3N-EPIC cohort, mean age of 52.9 y (SD 6.7). The simplified PNNS-GS2 was derived via food history questionnaire. Multivariable Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of T2D. Causal mediation analyses were used to decompose the total effect of sPNNS-GS2 on T2D into a direct effect and indirect effect mediated by body mass index (BMI) or the waist-hip ratio (WHR).
During a mean follow-up of 19 y, 3679 incident T2D cases were identified and validated. There was a linear association between adherence to sPNNS-GS2 and T2D (P-nonlinearity = 0.92). In the fully adjusted model, each 1-SD increase in the sPNNS-GS2 was associated with a lower T2D risk HR (95% CI), 0.92 (0.89, 0.95). The overall associations were mainly explained by sPNNS-GS2-associated excess weight, with BMI and WHR mediating 52% and 58% of the associations, respectively.
Higher adherence to French food-based dietary guidelines was associated with a lower risk of T2D in women, and a significant portion of this effect could be attributed to excess weight measured by BMI or WHR. This finding helps better understand the mechanisms underlying the diet-T2D association.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
While ultraviolet (UV) radiation exposure is a recognized risk factor for skin cancer, associations are complex and few studies have allowed a direct comparison of exposure profiles associated with ...cutaneous melanoma, basal-cell carcinoma (BCC), and squamous-cell carcinoma (SCC) within a single population.
We examined associations between UV exposures and skin cancer risk in a nested case-control study within E3N, a prospective cohort of 98,995 French women born in 1925-1950. In 2008, a lifetime UV exposure questionnaire was sent to all reported skin cancer cases and three controls per case, which were matched on age, county of birth, and education. Analyses were performed using conditional logistic regression and included 366 melanoma cases, 1,027 BCC cases, 165 SCC cases, and 3,647 controls.
A history of severe sunburns <25 years was associated with increased risks of all skin cancers (melanoma: OR 2.7; BCC: OR 1.7; SCC: OR 2.0 for ≥6 sunburns vs. none), while sunburns ≥25 years were associated with BCC and SCC only. While high-sun protection factor sunscreen use before age 25 was associated with lower BCC risk (P
= 0.02), use since age 25 and reapplication of sunscreen were associated with higher risks of all three types of skin cancer. There were positive linear associations between total UV score and risks of BCC (P
= 0.01) and SCC (P
= 0.09), but not melanoma. While recreational UV score was strongly associated with BCC, total and residential UV scores were more strongly associated with SCC.
Melanoma, BCC, and SCC are associated with different sun exposure profiles in women.
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FFLJ, NUK, ODKLJ, UL, UM, UPUK
Advanced breast cancer (BC) is associated with heavier treatments and poorer prognosis than early BC. Despite mammographic screening, advanced BC incidence remains stable. Little is known about risk ...factors differentially associated with advanced BC. We analyzed factors predicting for postmenopausal advanced vs. early BC in the E3N cohort. E3N has been prospectively following 98,995 French women aged 50–65 years at baseline since 1990. Hazard ratios (HRs) and 95% confidence intervals (CIs) for advanced and early invasive BC were estimated with multivariate Cox competing risk hazard models. With a median follow‐up of 15.7 years, 4,941 postmenopausal BC were diagnosed, including 1,878 (38%) advanced BC. Compared to early BC, advanced BC was differentially associated with excess weight (HR 1.39 95% CI = 1.26–1.53 vs. 1.08 95% CI = 1.00–1.17, phomogeneity < 0.0001) and living in a rural area (HR 1.14 95% CI = 1.00–1.31 vs. 0.93 95% CI = 0.82–1.04, phomogeneity 0.02). Excess weight was the only differential risk factor for advanced BC for hormone‐dependent BC and for women compliant with screening recommendations. Previous mammography was associated with reduced advanced BC risk (HR 0.86 95% CI = 0.73–1.00) and increased early BC risk (HR 1.36 95% CI = 1.18–1.56, phomogeneity < 0.0001), but only for hormone‐dependent BC. Excess weight appears to be mostly associated with advanced BC, especially hormone‐dependent BC. These results add to the evidence for maintaining weight within the recommended limits.
What's new?
Targeting women at high risk of advanced‐stage diagnosis for personalized screening and prevention could help decrease the incidence of advanced breast cancers (BC). However, little is known about risk factors differentially associated with advanced BC. In this large prospective study, postmenopausal advanced BC is differentially associated with excess weight and living in a rural area, compared to early BC. Excess weight is the only differential risk factor for advanced hormone‐dependent BC, and for women compliant with screening recommendations. These results further support maintaining weight within the WHO recommended limits and enforcing mammographic screening as well as personalized prevention.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Summary
Background
Nutri‐score is now widely available in food packages in Europe.
Aim
To study the overall nutritional quality of the diet in relation to risks of Crohn's disease (CD) and ulcerative ...colitis (UC), in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort
Methods
We collected dietary data at baseline from validated food frequency questionnaires. We used a dietary index based on the UK Food Standards Agency modified nutrient profiling system (FSAm‐NPS‐DI) underlying the Nutri‐Score label, to measure the nutritional quality of the diet. We estimated the association between FSAm‐NPS‐DI score, and CD and UC risks using Cox models stratified by centre, sex and age; and adjusted for smoking status, BMI, physical activity, energy intake, educational level and alcohol intake.
Results
We included 394,255 participants (68.1% women; mean age at recruitment 52.1 years). After a mean follow‐up of 13.6 years, there were 184 incident cases of CD and 459 incident cases of UC. Risk of CD was higher in those with a lower nutritional quality, that is higher FSAm‐NPS‐DI Score (fourth vs. first quartile: aHR: 2.04, 95% CI: 1.24–3.36; p‐trend: <0.01). Among items of the FSAm‐NPS‐DI Score, low intakes of dietary fibre and fruits/vegetables/legumes/nuts were associated with higher risk of CD. Nutritional quality was not associated with risk of UC (fourth vs. first quartile of the FSAm‐NPS‐DI Score: aHR: 0.91, 95% CI: 0.69–1.21; p‐trend: 0.76).
Conclusions
A diet with low nutritional quality as measured by the FSAm‐NPS‐DI Score is associated with a higher risk of CD but not UC.
Dietary index based on the Food Standards Agency nutrient profiling system and risk of Crohn's disease and ulcerative colitis.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Summary
Background
Thyroid cancers are threefold more frequent in women than in men. A role of reproductive or hormonal factors has been suggested but with contradictory results. We investigated ...potential associations between history of hysterectomy, with or without oophorectomy, and history of benign gynaecological disease (uterine fibroids, endometriosis) and the incidence of differentiated thyroid cancer, in a large French prospective cohort.
Methods
A total of 89 340 women from the E3N cohort were followed up between 1990 and 2012. Gynaecological diseases treated by surgery were self‐reported. Thyroid cancers were validated by histological reports. Time‐dependent covariates included smoking status, BMI and history of benign thyroid disease. Cox proportional hazard models with age as timescale were used to estimate Hazard Ratios (HR) and 95% confidence intervals (CI).
Results
A total of 412 cases of thyroid cancer were diagnosed during follow‐up. A history of hysterectomy was associated with an increased risk of differentiated thyroid cancer (adjusted HR=2.05; 95%CI: 1.65‐2.55). The association was not altered after further adjustment for reproductive factors. Endometriosis, uterine polyps, ovarian cysts and oophorectomy without hysterectomy were not associated with the risk of thyroid cancer. A history of fibroids was also significantly related to the risk of thyroid cancer over the follow‐up period (adjusted HR=1.91; 95%CI: 1.50‐2.44) and the increased risk persisted after adjustment for history of hysterectomy.
Conclusions
Women who had either a history of fibroids or hysterectomy had an increased risk of differentiated thyroid cancer. These findings suggest shared biological mechanisms between fibroids and thyroid cancer, which deserve to be further dissected.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Purpose
Patterns of change from the traditional Palaeolithic lifestyle to the modern lifestyle may partly explain the epidemic proportions of non-communicable diseases (NCDs). We investigated to what ...extent adherence to the Palaeolithic diet (PD) and the Palaeolithic-like lifestyle was associated with type 2 diabetes (T2D) and hypertension risks.
Methods
A study of 70,991 women from the E3N (
Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l’Education Nationale
) cohort, followed up for nearly 20 years. There were 3292 incident T2D and 12,504 incident hypertension cases that were validated. Dietary data were collected at baseline in 1993 via a food frequency questionnaire. The PD score and the Palaeolithic-like lifestyle score (PD, physical activity, smoking status, and body mass index BMI) were derived and considered in quintiles. Multivariable Cox regression models were employed to estimate hazard ratios (HR) and 95% confidence intervals (CI) for incident T2D and hypertension.
Results
In the fully adjusted models, a 1-SD increase of the PD score was associated with 4% and 3% lower risks of T2D and hypertension, respectively. Those in the highest versus the lowest quintile of the score had HR (95% CI) of 0.88 (0.79, 0.98) and 0.91 (0.86, 0.96) for T2D and hypertension, respectively (
P
-trend < 0.0001). Associations were stronger for the Palaeolithic-like lifestyle score; in the fully adjusted model, a 1-SD increase of the score was associated with 19% and 6% lower risks of T2D and hypertension, respectively. Risks lowered successively with each increase in quintile; those in the highest versus the lowest quintile had HR (95% CI) of 0.58 (0.52, 0.65) and 0.85 (0.80, 0.90) for T2D and hypertension, respectively (
P
-trend < 0.0001).
Conclusions
Our data suggest that adhering to a PD based on fruit, vegetables, lean meats, fish, and nuts, and incorporating a Palaeolithic-like lifestyle could be promising options to prevent T2D and hypertension.
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DOBA, EMUNI, FIS, FSPLJ, FZAB, GEOZS, GIS, IJS, IMTLJ, IZUM, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, SIK, UILJ, UKNU, UL, UM, UPUK, VKSCE, VSZLJ, ZAGLJ
The Developmental Origins of Health and Disease (DOHaD) framework suggests that early-life experiences affect long-term health outcomes. We tested this hypothesis by estimating the long-run effects ...of exposure to World War II-related food deprivation during childhood and adolescence on the risk of suffering from hypertension and type 2 diabetes at adulthood for 90,226 women from the French prospective cohort study E3N. We found that the experience of food deprivation during early-life was associated with a higher risk of developing type 2 diabetes (+0.7%, 95% CI: 0.073-1.37%) and hypertension (+2.6%, 95% CI: 0.81-4.45%). Effects were stronger for individuals exposed at younger ages. Exposed individuals also achieved lower levels of education, slept less, and were more frequently smokers than unexposed individuals. These results are compatible with both the latency and the pathway models proposed in the DOHaD framework which theorise the association between early life exposure and adult health through both a direct link and an indirect link where changes in health determinants mediate health outcomes.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
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