Colorectal cancer (CRC) is distinctive for its strikingly high correlation with the diet. Heme-iron from red and processed meat was found to strongly increase the risk of CRC, yet only 20% of the ...total dietary iron is heme-iron. However, the results are still inconclusive in terms of the total dietary iron and CRC risk. On the other hand, vitamin B12 has been proposed as cytoprotector, and iron and vitamin B12 share their dietary sources. Meat and animal-derived products are the only foods that naturally provide vitamin B12. While iron is abundant in a variety of foods, its bioavailability (i.e. utilization) is the highest from meat and animal foods.
We hypothesize that specific combinations of foods of animal origin could alter the risk of CRC, and even modulate the progression of CRC, by simultaneously altering iron and vitamin B12.
All cells are iron dependent but iron’s metabolism is one of the most complex, and tightly regulated. No nutrient has so many dietary factors that inhibit its bioavailability which results in almost 80% of all dietary iron ending in the feces, which is 10-fold higher than in most tissues. Luminal exposure to iron, which was found to affect crypt fission and increases the risk of CRC, is influenced by colonic transit time, the composition of feces, and the pH in the large bowel. Therefore, “inactivating” iron in the feces by specific dietary inhibitors disables adverse alterations during the luminal exposure. Only one inhibitor has the ability to bind both forms of iron, heme and non-heme to insoluble complexes, calcium. Milk and dairy as the best dietary sources of calcium contain vitamin B12 of the highest bioavailability. While calcium (both dietary and supplemental) has been studied separately on the risk of CRC, it has not been considered from the aspect of iron bioavailability or supplying vitamin B12.
Preliminary, the hypothesis was tested on the diet quality assessment in adults from two Croatia’s regions with distinctive dietary characteristics and CRC risk. Diet in the first region is considered to increase the risk of CRC (e.g. high intake of red and processed meat), while a traditional Mediterranean pattern prevails in the second region. However, CRC incidence rate is higher in the second region. Comparison of the regions showed that in the first region adults have significantly higher intake of vitamin B12, and as expected, the highest contribution is from meat. Still, the contribution of milk and dairy is significantly higher in the first than in the second region. These results suggest that high intake of vitamin B12 could have a protective role on CRC, when dietary intake of meat is high.
Therefore, by specifically designing a diet to combine dietary sources with high content of both iron and vitamin B12 could result with a cumulative effect: the cytoprotective effect of vitamin B12, and diminished negative effect of high iron content in the feces. Clarifying the relevance of various dietary sources of iron from the aspect of high vitamin B12 content might provide answers we are still missing in the CRC.
Objectives
Aging is associated with changes in body composition. Excess adiposity among older adults has been linked with metabolic syndromes and aggravated age-associated decline in physical ...functioning. Few longitudinal studies have explored the association between dual-energy X-ray absorptiometry (DXA)-derived total as well as central adiposity measures and frailty. We examined the association of DXA-derived total and central adiposity with pre-frailty/frailty among Norwegian adults after 8 years of follow-up.
Design
Prospective observational study.
Setting
Community-dwelling adults from Tromsø, Norway.
Measurements
Adiposity was defined by fat mass index (FMI) and visceral adipose tissue (VAT) mass assessed using DXA measures. Frailty status was assessed by low grip strength, slow walking speed, exhaustion, unintentional weight loss and low physical activity level. Pre-frail and frail participants at baseline were excluded. Sex-stratified multivariable logistic regression models were used to investigate the association.
Results
Participants comprised 234 women (mean age 68 years) and 146 men (mean age 69 years) attending the population-based Tromsø Study in 2007–2008 (Tromsø6) and 2015–2016 (Tromsø7). At the end of follow-up, 25.6% of the women and 27.4% of the men were pre-frail/frail. Compared with women in the lowest tertiles, those in the highest tertile of baseline FMI (odds ratio OR 4.42, 95% confidence interval CI 1.88–10.35) and VAT mass (OR 2.47, 95% CI 1.10–5.50), respectively had higher odds for pre-frailty/frailty at follow-up.
Conclusion
We found a higher likelihood of pre-frailty/frailty in later years among women with general and central adiposity in adulthood, highlighting the importance of preventing excess adiposity for healthy aging.
To describe anthropometric characteristics of participants of the European Prospective Investigation into Cancer and Nutrition (EPIC).
A cross-sectional analysis of baseline data of a European ...prospective cohort study.
This analysis includes study populations from 25 centres in nine European countries. The British populations comprised both a population-based and a 'health-conscious' group. The analysis was restricted to 83 178 men and 163 851 women aged 50-64 years, this group being represented in all centres.
Anthropometric examinations were undertaken by trained observers using standardised methods and included measurements of weight, height, and waist and hip circumferences. In the 'health-conscious' group (UK), anthropometric measures were predicted from self-reports.
Except in the 'health-conscious' group (UK) and in the French centres, mean body mass index (BMI) exceeded 25.0 kg m-2. The prevalence of obesity (BMI> or =30 kg m(-2)) varied from 8% to 40% in men, and from 5% to 53% in women, with high prevalences (>25%) in the centres from Spain, Greece, Ragusa and Naples (Italy) and the lowest prevalences (<10%) in the French centres and the 'health-conscious' group (UK). The prevalence of a large waist circumference or a high waist-to-hip ratio was high in centres from Spain, Greece, Ragusa and Naples (Italy) and among women from centres in Germany and Bilthoven (The Netherlands).
Anthropometric measures varied considerably within the EPIC population. These data provide a strong base for further investigation of anthropometric measures in relation to the risk of chronic diseases, especially cancer.
Intakes of specific fatty acids have been postulated to impact breast cancer risk but epidemiological data based on dietary questionnaires remain conflicting.
We assessed the association between ...plasma phospholipid fatty acids and breast cancer risk in a case–control study nested within the European Prospective Investigation into Cancer and Nutrition study. Sixty fatty acids were measured by gas chromatography in pre-diagnostic plasma phospholipids from 2982 incident breast cancer cases matched to 2982 controls. Conditional logistic regression models were used to estimate relative risk of breast cancer by fatty acid level. The false discovery rate (q values) was computed to control for multiple comparisons. Subgroup analyses were carried out by estrogen receptor (ER) and progesterone receptor expression in the tumours.
A high level of palmitoleic acid odds ratio (OR) for the highest quartile compared with the lowest OR (Q4–Q1) 1.37; 95% confidence interval (CI), 1.14–1.64; P for trend=0.0001, q value=0.004 as well as a high desaturation index (DI16) (16:1n–7/16:0) OR (Q4–Q1), 1.28; 95% C, 1.07–1.54; P for trend=0.002, q value=0.037, as biomarkers of de novo lipogenesis, were significantly associated with increased risk of breast cancer. Levels of industrial trans-fatty acids were positively associated with ER-negative tumours OR for the highest tertile compared with the lowest (T3–T1)=2.01; 95% CI, 1.03–3.90; P for trend=0.047, whereas no association was found for ER-positive tumours (P-heterogeneity=0.01). No significant association was found between n-3 polyunsaturated fatty acids and breast cancer risk, overall or by hormonal receptor.
These findings suggest that increased de novo lipogenesis, acting through increased synthesis of palmitoleic acid, could be a relevant metabolic pathway for breast tumourigenesis. Dietary trans-fatty acids derived from industrial processes may specifically increase ER-negative breast cancer risk.
To describe physical activity of participants in the European Prospective Investigation into Cancer and Nutrition (EPIC).
A cross-sectional analysis of baseline data of a European prospective cohort ...study.
This analysis was restricted to participants in the age group 50-64 years, which was represented in all EPIC centres. It involved 236 386 participants from 25 centres in nine countries. In each EPIC centre, physical activity was assessed by standardised and validated questions. Frequency distribution of type of professional activity and participation in non-professional activities, and age-adjusted means, medians and percentiles of time dedicated to non-professional activities are presented for men and women from each centre.
Professional activity was most frequently classified as sedentary or standing in all centres. There was a wide variation regarding participation in different types of non-professional activities and time dedicated to these activities across EPIC centres. Over 80% of all EPIC participants engaged in walking, while less than 50% of the subjects participated in sport. Total time dedicated to recreational activities was highest among the Dutch participants and lowest among men from Malmö (Sweden) and women from Naples (Italy). In all centres, total time dedicated to recreational activity in the summer was higher than in the winter. Women from southern Europe spent the most time on housekeeping.
There is a considerable variation of physical activity across EPIC centres. This variation was especially evident for recreational activities in both men and women.
Objectives: Within the European Prospective Investigation into Cancer and Nutrition (EPIC) study, the performance of 24-h dietary recall (24-HDR) measurements as reference measurements in a linear ...regression calibration model is evaluated critically at the individual (within-centre) and aggregate (between-centre) levels by using unbiased estimates of urinary measurements of nitrogen and potassium intakes. Methods: Between 1995 and 1999, 1072 study subjects (59% women) from 12 EPIC centres volunteered to collect 24-h urine samples. Log-transformed questionnaire, 24-HDR and urinary measurements of nitrogen and potassium intakes were analysed in a multivariate measurement error model to estimate the validity of coefficients and error correlations in self-reported dietary measurements. In parallel, correlations between means of 24-HDR and urinary measurements were computed. Linear regression calibration models were used to estimate the regression dilution (attenuation) factors. Results: After adjustment for sex, centre, age, body mass index and height, the validity coefficients for 24-HDRs were 0.285 (95% confidence interval: 0.194, 0.367) and 0.371 (0.291, 0.446) for nitrogen and potassium intakes, respectively. The attenuation factors estimated in a linear regression calibration model were 0.368 (0.228, 0.508) for nitrogen and 0.500 (0.361, 0.639) for potassium intakes; only the former was different from the estimate obtained using urinary measurements in the measurement error model. The aggregate-level correlation coefficients between means of urinary and 24-HDR measurements were 0.838 (0.637, 0.932) and 0.756 (0.481, 0.895) for nitrogen and potassium intakes, respectively. Conclusions: This study suggests that 24-HDRs can be used as reference measurements at the individual and aggregate levels for potassium intake, whereas, for nitrogen intake, good performance is observed for between-centre calibration, but some limitations are apparent at the individual level.
Findings on the association between alcohol consumption and bladder cancer are inconsistent. We investigated that association in the European Prospective Investigation into Cancer and Nutrition ...cohort. We included 476,160 individuals mostly aged 35–70 years, enrolled in ten countries and followed for 13.9 years on average. Hazard ratios (HR) for developing urothelial cell carcinoma (UCC; 1,802 incident cases) were calculated using Cox proportional hazards models. Alcohol consumption at baseline and over the life course was analyzed, as well as different types of beverages (beer, wine, spirits). Baseline alcohol intake was associated with a statistically nonsignificant increased risk of UCC (HR 1.03; 95% confidence interval (CI) 1.00–1.06 for each additional 12 g/day). HR in smokers was 1.04 (95% CI 1.01–1.07). Men reporting high baseline intakes of alcohol (>96 g/day) had an increased risk of UCC (HR 1.57; 95% CI 1.03–2.40) compared to those reporting moderate intakes (<6 g/day), but no dose–response relationship emerged. In men, an increased risk of aggressive forms of UCC was observed even at lower doses (>6 to 24 g/day). Average lifelong alcohol intake was not associated with the risk of UCC, however intakes of spirits > 24 g/day were associated with an increased risk of UCC in men (1.38; 95% CI 1.01–1.91) and smokers (1.39; 95% CI 1.01–1.92), compared to moderate intakes. We found no association between alcohol and UCC in women and never smokers. In conclusion, we observed some associations between alcohol and UCC in men and in smokers, possibly because of residual confounding by tobacco smoking.
What's new?
Findings from the EPIC cohort do not suggest a clear detrimental effect of alcohol on bladder cancer risk. However, we found some association between alcohol and risk of the most aggressive forms of bladder cancer in men and in smokers. Among the different beverages, high intakes of spirits were associated with an increased risk of bladder cancer in men and in smokers, while beer and wine were not. Further studies confirming these results are warranted.
Objectives: To describe the contribution of highly processed foods to total diet, nutrient intakes and patterns among 27 redefined centres in the 10 countries participating in the European ...Prospective Investigation into Cancer and Nutrition (EPIC). Methods: Single 24-hour dietary recalls were collected from 36 034 individuals (aged 35-74 years) using a standardized computerized interview programme (EPIC-SOFT). Centre-specific mean food intakes (g/day) were computed according to their degree of food processing (that is, highly, moderately and non-processed foods) using a specifically designed classification system. The contribution (%) of highly processed foods to the centre mean intakes of diet and 26 nutrients (including energy) was estimated using a standardized nutrient database (ENDB). The effect of different possible confounders was also investigated. Results: Highly processed foods were an important source of the nutrients considered, contributing between 61% (Spain) and 78-79% (the Netherlands and Germany) of mean energy intakes. Only two nutrients, β-carotene (34-46%) and vitamin C (28-36%), had a contribution from highly processed foods below 50% in Nordic countries, in Germany, the Netherlands and the United Kingdom, whereas for the other nutrients, the contribution varied from 50 to 91% (excluding alcohol). In southern countries (Greece, Spain, Italy and France), the overall contribution of highly processed foods to nutrient intakes was lower and consisted largely of staple or basic foods (for example, bread, pasta/rice, milk, vegetable oils), whereas highly processed foods such as crisp bread, breakfast cereals, margarine and other commercial foods contributed more in Nordic and central European centres. Conclusions: Highly industrially processed foods dominate diets and nutrient patterns in Nordic and central European countries. The greater variations observed within southern countries may reflect both a larger contribution of non/moderately processed staple foods along with a move from traditional to more industrialized dietary patterns.
Objective: To identify combinations of food groups that explain as much variation in absolute intakes of 23 key nutrients and food components as possible within the country-specific populations of ...the European Prospective Investigation into Cancer and Nutrition (EPIC). Subjects/Methods: The analysis covered single 24-h dietary recalls (24-HDR) from 36 034 subjects (13 025 men and 23 009 women), aged 35–74 years, from all 10 countries participating in the EPIC study. In a set of 39 food groups, reduced rank regression (RRR) was used to identify those combinations (RRR factors) that explain the largest proportion of variation in intake of 23 key nutrients and food components, namely, proteins, saturated fatty acids, monounsaturated fatty acids, polyunsaturated fatty acids, cholesterol, sugars (sum of mono- and disaccharides), starch, fibre, alcohol, calcium, iron, potassium, phosphorus, magnesium, vitamin D, β-carotene, retinol and vitamins E, B1, B2, B6, B12 and C (RRR responses). Analyses were performed at the country level and for all countries combined. Results: In the country-specific analyses, the first RRR factor explained a considerable proportion of the total nutrient intake variation in all 10 countries (27.4–37.1%). The subsequent RRR factors were much less important in explaining the variation (<or=6%). Strong similarities were observed for the first country-specific RRR factor between the individual countries, largely characterized by consumption of bread, vegetable oils, red meat, milk, cheese, potatoes, margarine and processed meat. The highest explained variation was seen for protein, potassium, phosphorus and magnesium (50–70%), whereas sugars, β-carotene, retinol and alcohol were only marginally explained (<or=5%). The explained proportion of the other nutrients ranged between these extremes. Conclusions: A combination of food groups was identified that explained a considerable proportion of the nutrient intake variation in 24-HDRs in every country-specific EPIC population in a similar manner. This indicates that, despite the large variability in food and nutrient intakes reported in the EPIC, the variance of intake of important nutrients is explained, to a large extent, by similar food group combinations across countries.
To describe and compare the consumption of the main groups and sub-groups of vegetables and fruits (V&F) in men and women from the centres participating in the European Prospective Investigation into ...Cancer and Nutrition (EPIC).
Cross-sectional analysis. Dietary intake was assessed by means of a 24-hour dietary recall using computerised interview software and standardised procedures. Crude and adjusted means were computed for the main groups and sub-groups of V&F by centre, separately for men and women. Adjusted means by season, day of the week and age were estimated using weights and covariance analysis.
Twenty-seven centres in 10 European countries participating in the EPIC project.
In total, 35 955 subjects (13 031 men and 22 924 women), aged 35-74 years, randomly selected from each EPIC cohort.
The centres from southern countries had the highest consumption of V&F, while the lowest intake was seen in The Netherlands and Scandinavia for both genders. These differences were more evident for fruits, particularly citrus. However, slightly different patterns arose for some sub-groups of vegetables, such as root vegetables and cabbage. Adjustment for body mass index, physical activity, smoking habits and education did not substantially modify the mean intakes of vegetables and fruits.
Total vegetable and fruit intake follows a south-north gradient in both genders, whereas for several sub-groups of vegetables a different geographic distribution exists. Differences in mean intake of V&F by centre were not explained by lifestyle factors associated with V&F intake.
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