Vitamin C is an antioxidant and inhibitor of carcinogenic N-nitroso compound production in the stomach. Higher dietary vitamin C consumption is associated with decreased risk of gastric cancer (GC) ...in numerous case–control studies, but data from prospective studies are limited, particularly so for blood measures of vitamin C. The objective of this study was to determine the association of plasma and dietary vitamin C levels with the risk of GC in a case–control study nested within the European Prospective Investigation into Cancer and Nutrition (EPIC), a large cohort involving 10 European countries. Using a fluorometric method, vitamin C was measured in pre-diagnostic plasma from 215 GC cases (matched controls = 416). Conditional logistic regression models adjusted by body mass index, total energy intake, smoking status/duration/intensity and Helicobacter pylori infection status were used to estimate relative cancer risks. No association with GC risk was observed for dietary vitamin C, whereas an inverse GC risk was observed in the highest versus lowest quartile of plasma vitamin C odds ratio (OR) = 0.55, 95% confidence interval (CI) = 0.31–0.97, Ptrend = 0.043, which was maintained after exclusion of cases with ≤2 years follow-up (OR = 0.40, 95% CI = 0.19–0.83, Ptrend = 0.064). The inverse association was more pronounced in subjects consuming higher levels of red and processed meats, a factor that may increase endogenous N-nitroso compound production. The effect of plasma vitamin C was not different by GC anatomical subsite (cardia/non-cardia) or histological subtype (diffuse/intestinal), and there was no significant interaction of effect with H.pylori. The results of this study show, in a prospective setting, an inverse association of GC risk with high levels of plasma vitamin C and suggest an interaction with the intake of red and processed meats, whose consumption may elevate endogenous N-nitroso compound production.
Objectives: Cross-sectional data suggest a strong association between low levels of physical activity and obesity. The EPIC-PANACEA (European Prospective Investigation into Cancer-Physical Activity, ...Nutrition, Alcohol, Cessation of Smoking, Eating out of home And obesity) project was designed to investigate the associations between physical activity and body mass index (BMI) and waist circumference based on individual data collected across nine European countries. Methods: In the European Prospective Investigation into Cancer and Nutrition (EPIC), 519 931 volunteers were recruited between 1992 and 2000, of whom 405 819 had data on main variables of interest. Height, body weight and waist circumference were measured using standardized procedures. Physical activity was assessed using a validated four-category index reflecting a self-reported usual activity during work and leisure time. The associations between physical activity and BMI and waist circumference were estimated using multilevel mixed effects linear regression models, adjusted for age, total energy intake, smoking status, alcohol consumption and educational level. Results: A total of 125 629 men and 280 190 women with a mean age of 52.9 (s.d. 9.7) and 51.5 (s.d. 10.0) years, respectively were included. The mean BMI was 26.6 kg/m2 (s.d. 3.6) in men and 25.0 kg/m2 (s.d. 4.5) in women. Fifty percent of men and 30% of women were categorized as being active or moderately active. A one-category difference in the physical activity index was inversely associated with a difference of 0.18 kg/m2 in the mean BMI (95% confidence interval, CI, 0.11, 0.24) and 1.04-cm (95% CI 0.82, 1.26) difference in waist circumference in men. The equivalent figures for women were 0.31 kg/m2 (95% CI 0.23, 0.38) and 0.90 cm (95% CI 0.71, 1.08), respectively. Conclusions: Physical activity is inversely associated with both BMI and waist circumference across nine European countries. Although we cannot interpret the association causally, our results were observed in a large and diverse cohort independently from many potential confounders.
L’hypertension (artérielle) pulmonaire « HT(A)P » est une complication qui émaille l’évolution de nombreuses affections génétiques. Elle répond à divers mécanismes volontiers intriqués et complexes ...qui rendent sa prise en charge ardue. Certaines des affections possèdent des signes prédictifs de risques survenue de l’HT(A)P que le clinicien doit connaître et reconnaître afin de lui opposer une thérapeutique à même de retarder sa survenue.
Revoir à travers l’expérience du service de médecine interne certaines affections génétiques pourvoyeuses potentielles d’une HT(A)P.
Étude prospective colligeant les cas d’hypertension (artérielle) pulmonaire associées à une affection génétique observées sur les 5 dernières années dans un service de médecine interne. Sont exclues de ce travail les malformations cardiaques congénitales pourvoyeuses d’hypertension pulmonaire associées aux affections génétiques.
Six dossiers sont colligés. Le sex-ratio est de 1. L’âge moyen de survenue de l’HT(A)P est de 25 ans (17–51). Les affections génétiques étaient identifiées avant la survenue de l’HT(A)P dans 66 % alors que l’HT(A)P était révélatrice de l’affection dans 34 %. Les affections génétiques ont été identifiées sur des dosages enzymatiques et génétiques. Elle regroupaient une maladie de Gaucher de type 1 (1F), une MPS de type 1 (1H), une neurofibromatose de type 1 (1H), une maladie de Rendu-Osler (1F) et une sphérocytose héréditaire (1H et 1F). Le diagnostic d’hypertension pulmonaire pré-capillaire a été confirmé par cathétérisme droit (83 %). Il s’agissait d’HT(A)P sévère justifiant une thérapie spécifique dans 50 % des cas. Les facteurs de risque de survenue étaient variables en fonction de l’affection génétique : splénectomie (1), grossesse (1), atteinte des petits vaisseaux pulmonaires liée soit aux conséquences des forces de cisaillement imposées par un hyperdébit cardiaque induit par une malformation artério-veineuse « MAV » (1) ou à des micro-thrombi (3), hypoxémie par un shunt droit-gauche due à divers mécanismes dont une MAV pulmonaire (1), des lésions pulmonaires kystiques étendues (1), des déformations thoraciques avec hypoventilation (2), une cardiomyopathie hypertrophique (1) ; un hyperdébit (3), une mutation génétique apparentée aux HTAP du groupe 1 et (protéines de la famille du TGFβ, angiogenèse impliquant le vascular endothelial growth factor « VEGF » 1). On notait la survenue d’une MVTE documentée (1H). En dépit de l’intensification du traitement l’HT(A) P a été la cause de décès dans 50 %.
Selon les classifications de l’hypertension pulmonaire les affections génétiques sont tantôt positionnées dans la classe 5 du fait d’une physiopathologie de mécanismes imparfaitement élucidée (neurofibromatoses, maladie de gaucher…) ou dans la classe 1 si celles-ci s’apparentent davantage aux hypertensions artérielles pulmonaires primitives ou génétiques (cas de la maladie de Rendu-Osler). Du fait des atteintes viscérales (poumon, cœur, foie…) qui leur sont associées la classification reste complexe et impose des explorations dans un centre de compétence et de référence. Elles constituent une cause de morbimortalité non négligeable en dépit de l’arsenal thérapeutique dont nous disposons aujourd’hui.
The relation between lifetime use of alcohol and measures of abdominal and general adiposity is unknown.
Among 99,381 men and 158,796 women of the European Prospective Investigation into Cancer and ...Nutrition (EPIC) study, means of waist circumference (WC), waist-to-hip-ratio (WHR) and body mass index (BMI), and odds ratios (OR) for a larger WC than predicted for a given BMI (WClp=positive residuals of gender specific linear regression of BMI on WC) across categories of average lifetime use of alcohol (total, from wine and from beer) were calculated, all adjusted for socio-demographic, lifestyle and health factors.
WC, WHR and BMI in men using lifetime ≤6 g/d alcohol were 95.1 cm, 0.942 and 27.3 kg/m(2), and 96.2 cm, 0.961 and 28.3 kg/m(2) when using >96 g/d. WC and WHR in women was 83.2 cm and 0.813 for ≤6 g/d, and 84.6 cm and 0.830 for >60 g/d, whereas BMI deviated only slightly with the lowest BMI (26.7 kg/m(2)) observed for >6-24 g/d. Compared with ≤6 g/d, OR for a WClp in both genders increased steadily across categories of alcohol use (up to 1.40 (95% confidence interval 1.32, 1.49) in men using >60 g/d and 1.63 (1.54, 1.73) in women using >24 g/d), though increase was higher for alcohol from beer than from wine (P for difference between beer and wine<0.001 (men) and=0.002 (women)).
Lifetime alcohol use is positively related to abdominal and general adiposity in men, possibly following the male weight gain pattern; in women, it is positively related only to abdominal adiposity. In this context, beer may contribute additionally to abdominal adiposity.
To evaluate the usefulness of a computerized 24 h diet recall programme (EPIC-SOFT) for pan-European dietary surveys.
The perspectives of using EPIC-SOFT in study contexts other than EPIC were ...evaluated. In order to estimate the usefulness of existing EPIC-SOFT material for developing new versions for non-EPIC countries, a comparison of food and recipe lists and portion pictures between a country participating in EPIC (Sweden, n=2311 foods, 140 photo series) and a non-EPIC country (Finland, FINDIET 1997 Study, n=1373 foods, 126 photo series) was performed.
Despite certain limitations, the EPIC-SOFT programme is a promising tool for pan-European Dietary Surveys. About 12-17 man-months would be needed to develop a new version for a non-EPIC country, depending on the extra work required. A 95% coverage of food and mixed recipes was found between the EPIC-Sweden and FINDIET 1997 databases. Of the pictures in the Finnish portion size book, 62% had an equivalent in the EPIC-SOFT picture book, but the range and size of photo series was larger in the latter than in the former, especially for vegetables. A tendency was observed that, if the central serving in a given picture book was larger, the consumers in that country also reported a larger mean portion.
This report shows that the EPIC-SOFT programme is already available for use in 11 European countries and could be extended easily to other countries if resources are made available. However, further developments are required to obtain standardized nutrient estimates and make the maintenance of the EPIC-SOFT databases independent from the EPIC logistics. The available EPIC-SOFT material would be useful for developing new versions for countries of similar food culture.
We examined plasma concentrations of phyto-oestrogens in relation to risk for subsequent prostate cancer in a case-control study nested in the European Prospective Investigation into Cancer and ...Nutrition. Concentrations of isoflavones genistein, daidzein and equol, and that of lignans enterolactone and enterodiol, were measured in plasma samples for 950 prostate cancer cases and 1042 matched control participants. Relative risks (RRs) for prostate cancer in relation to plasma concentrations of these phyto-oestrogens were estimated by conditional logistic regression. Higher plasma concentrations of genistein were associated with lower risk of prostate cancer: RR among men in the highest vs the lowest fifth, 0.71 (95% confidence interval (CI) 0.53-0.96, P trend=0.03). After adjustment for potential confounders this RR was 0.74 (95% CI 0.54-1.00, P trend=0.05). No statistically significant associations were observed for circulating concentrations of daidzein, equol, enterolactone or enterodiol in relation to overall risk for prostate cancer. There was no evidence of heterogeneity in these results by age at blood collection or country of recruitment, nor by cancer stage or grade. These results suggest that higher concentrations of circulating genistein may reduce the risk of prostate cancer but do not support an association with plasma lignans.
La maladie cœliaque (MC) de l’adulte est une pathologie fréquente dont la présentation clinique est polymorphe. Les manifestations extradigestives sont multiples et rendent le diagnostic difficile ...lorsqu’elles sont isolées. Les manifestations neurologiques atteignant le système nerveux central (SNC)au cours de MC sont nombreuses et de physiopathologie imparfaitement élucidée.
Étude rétrospective de dossiers colligés dans un service de médecine interne sur 5 années consécutives. Tous diagnostic reposent sur une IRM cérébrale attestant de l’atteinte neurologique et des critères (immunologiques et anatomopathologiques) requis pour le diagnostic de MC.
Quatre «4» dossiers colligés, il s’agissait de femmes 4, d’âge moyen de 37 ans, explorés pour une hémiplégie 2 et/ou de crises convulsives généralisées 2 en absence de signes digestifs. L’IRM cérébrale identifie un AVC ischémique ‘AVCI’ 2 et une thrombose veineuse cérébrale ‘TVC’ 2. L’exploration exhaustive exclut une cause embolique (AVCI) et une infection locorégionale (TVC). Il n’y a pas d’orientation clinico-biologique vers une maladie auto-immune (lupus, Behçet, SAPL) ou thrombophilie constitutionnelle (AAN, bilan d’hémostase et de thrombophilie normaux….). Les perturbations biologiques se résument à une anémie ferriprive 2, et un syndrome de malabsorption 1. La confirmation de la MC est sérologique fortement positive type d’IgA anti-gliadine et anti-endomisium 3 et d’IgA anti-transglutaminase 1. Les biopsies duodénales objectivent une atrophie villositaire totale 2. En plus de traitement anticoagulant/antiagrégant plaquettaire, un régime alimentaire sans gluten (RSG) est instauré avec une bonne évolution 4.
L’atteinte vasculaire dans le cadre de la MC reste un sujet de nombreuses controverses. Une vascularité auto-immune du SNC dans laquelle le tissu transglutaminase interviendrait comme un auto-antigène altérant l’intégrité du tissu endothélial serait le principal mécanisme mais d’autres mécanismes tels que les carences vitaminiques seraient également impliqués.
Les atteintes du SNC décrites dans la MC sont surtout cérébelleuses. Nous avons focalisé nos observations sur des atteintes vasculaires artérielles(AVCI) et veineuses (TVC), dont le mécanisme semble multifactoriel. Le régime sans gluten reste la pierre angulaire du traitement de la MC.
Objective: To describe dietary carbohydrate intakes and their food sources among 27 centres in 10 countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) ...study. Methods: Between 1995 and 2000, 36 034 subjects, aged between 35–74 years, were administered a standardized, 24-h dietary recall using a computerized interview software programme (EPIC-SOFT). Intakes (g/day) of total carbohydrate, sugars, starch and fibre were estimated using the standardized EPIC Nutrient Database (ENDB). Mean intakes were adjusted for age, total energy intake, height and weight, and were weighted by season and day of recall. Results: Adjusted mean total carbohydrate intakes were highest in Italy and in the UK health-conscious cohort, and were lowest in Spain, Greece and France. Total fibre intakes were highest in the UK health-conscious cohort and lowest in Sweden and the UK general population. Bread contributed the highest proportion of carbohydrates (mainly starches) in every centre. Fruit consumption contributed a greater proportion of total carbohydrates (mainly sugars) among women than among men, and in southern centres compared with northern centres. Bread, fruits and vegetables represented the largest sources of fibre, but food sources varied considerably between centres. In stratified analyses, carbohydrate intakes tended to be higher among subjects who were physically active, never-smokers or non-drinkers of alcohol. Conclusions: Dietary carbohydrate intakes and in particular their food sources varied considerably between these 10 European countries. Intakes also varied according to gender and lifestyle factors. These data will form the basis for future aetiological analyses of the role of dietary carbohydrates in influencing health and disease.
Objective: The aim of this study was to examine the association of body mass index (BMI) and weight gain with eating at restaurants and similar establishments or eating at work among 10 European ...countries of the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Subjects: This study included a representative sample of 24 310 randomly selected EPIC participants. Methods: Single 24-h dietary recalls with information on the place of consumption were collected using standardized procedures between 1995 and 2000. Eating at restaurants was defined to include all eating and drinking occasions at restaurants, cafeterias, bars and fast food outlets. Eating at work included all eating and drinking occasions at the workplace. Associations between eating at restaurants or eating at work and BMI or annual weight changes were assessed using sex-specific linear mixed-effects models, controlling for potential confounders. Results: In southern Europe energy intake at restaurants was higher than intake at work, whereas in northern Europe eating at work appeared to contribute more to the mean daily intake than eating at restaurants. Cross-sectionally, eating at restaurants was found to be positively associated with BMI only among men (β=+0.24, P=0.003). Essentially no association was found between BMI and eating at work among both genders. In a prospective analysis among men, eating at restaurants was found to be positively, albeit nonsignificantly, associated with weight gain (β=+0.05, P=0.368). No association was detected between energy intake at restaurants and weight changes, controlling for total energy intake. Conclusion: Among men, eating at restaurants and similar establishments was associated with higher BMI and possibly weight gain.
In 1994, acrylamide (AA) was classified as a probable human carcinogen by the International Agency for Research on Cancer. In 2002, AA was discovered at relatively high concentrations in some ...starchy, plant-based foods cooked at high temperatures.
A prospective analysis was conducted to evaluate the association between the dietary intake of AA and ductal adenocarcinoma of the exocrine pancreatic cancer (PC) risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort using Cox regression modeling. EPIC includes >500 000 men and women aged 35–75 at enrollment from 10 European countries. AA intake was estimated for each participant by combining questionnaire-based food consumption data with a harmonized AA database derived from the EU monitoring database of AA levels in foods, and evaluated in quintiles and continuously.
After a mean follow-up of 11 years, 865 first incident adenocarcinomas of the exocrine pancreas were observed and included in the present analysis. At baseline, the mean dietary AA intake in EPIC was 26.22 µg/day. No overall association was found between continuous or quintiles of dietary AA intake and PC risk in EPIC (HR:0.95, 95%CI:0.89–1.01 per 10 µg/day). There was no effect measure modification by smoking status, sex, diabetes, alcohol intake or geographic region. However, there was an inverse association (HR: 0.73, 95% CI: 0.61–0.88 per 10 µg/day) between AA intake and PC risk in obese persons as defined using the body mass index (BMI, ≥30 kg/m2), but not when body fatness was defined using waist and hip circumference or their ratio.
Dietary intake of AA was not associated with an increased risk of PC in the EPIC cohort.
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