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European Journal of Epidemiology

, Volume 28, Issue 4, pp 317–328 | Cite as

Mediterranean diet and colorectal cancer risk: results from a European cohort

  • Christina Bamia
  • Pagona Lagiou
  • Genevieve Buckland
  • Sara Grioni
  • Claudia Agnoli
  • Aliki J. Taylor
  • Christina C. Dahm
  • Kim Overvad
  • Anja Olsen
  • Anne Tjønneland
  • Vanessa Cottet
  • Marie-Christine Boutron-Ruault
  • Sophie Morois
  • Verena Grote
  • Birgit Teucher
  • Heiner Boeing
  • Brian Buijsse
  • Dimitrios Trichopoulos
  • George Adarakis
  • Rosario Tumino
  • Alessio Naccarati
  • Salvatore Panico
  • Domenico Palli
  • H. Bas Bueno-de-Mesquita
  • Fränzel J. B. van Duijnhoven
  • Petra H. M. Peeters
  • Dagrun Engeset
  • Guri Skeie
  • Eiliv Lund
  • Maria-José Sánchez
  • Aurelio Barricarte
  • Jose-Maria Huerta
  • J. Ramón Quirós
  • Miren Dorronsoro
  • Ingrid Ljuslinder
  • Richard Palmqvist
  • Isabel Drake
  • Timothy J. Key
  • Kay-Tee Khaw
  • Nick Wareham
  • Isabelle Romieu
  • Veronika Fedirko
  • Mazda Jenab
  • Dora Romaguera
  • Teresa Norat
  • Antonia Trichopoulou
CANCER

Abstract

The authors investigated the association of adherence to Mediterranean diet with colorectal cancer (CRC) risk in the European Prospective Investigation into Cancer and nutrition study. Adherence to Mediterranean diet was expressed through two 10-unit scales, the Modified Mediterranean diet score (MMDS) and the Centre-Specific MMDS (CSMMDS). Both scales share the same dietary components but differ in the cut-off values that were used for these components in the construction of the scales. Adjusted hazard ratios (HR) for the associations of these scales with CRC incidence were estimated. After 5,296,617 person-years of follow-up, 4,355 incident CRC cases were identified. A decreased risk of CRC, of 8 and 11 % was estimated when comparing the highest (scores 6–9) with the lowest (scores 0–3) adherence to CSMMDS and MMDS respectively. For MMDS the HR was 0.89 (95 % confidence interval (CI): 0.80, 0.99). A 2-unit increment in either Mediterranean scale was associated with a borderline statistically significant 3 to 4 % reduction in CRC risk (HR for MMDS: 0.96; 95 % CI: 0.92, 1.00). These associations were somewhat more evident, among women, were mainly manifested for colon cancer risk and their magnitude was not altered when alcohol was excluded from MMDS. These findings suggest that following a Mediterranean diet may have a modest beneficial effect on CRC risk.

Keywords

Mediterranean diet Colorectal cancer Cohort study 

Abbreviations

CRC

ColoRectal Cancer

MD

Mediterranean Diet

MMDS

Modified Mediterranean Diet Score

HR

Hazard Ratio

CI

Confidence Intervals

EPIC

European Prospective Investigation into Cancer and nutrition

PA

Physical Activity

BMI

Body Mass Index

CSMMDS

Centre Specific Modified Mediterranean Diet Score

ICD

International Classification of Diseases

Notes

Acknowledgments

This work was supported by the Word Cancer Research Fund (grants number 2003/18 and 2007/13). The coordination of EPIC is financially supported by the European Commission (DG-SANCO) and the International Agency for Research on Cancer. The national cohorts are supported by: Danish Cancer Society (Denmark); Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle Générale de l’Education Nationale, and Institut National de la Santé et de la Recherche Médicale (INSERM) (France); Deutsche Krebshilfe, German Cancer Research Center (DKFZ) and Federal Ministry of Education and Research (Germany); Hellenic Health Foundation and Stavros Niarchos Foundation (Greece); Italian Association for Research on Cancer (AIRC), National Research Council and AIRE-ONLUS Ragusa, AVIS Ragusa, Sicilian Government (Italy); Dutch Ministry of Public Health, Welfare and Sports (VWS), Netherlands Cancer Registry (NKR), LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund (WCRF) and Statistics Netherlands (The Netherlands); ERC-2009-AdG 232997 and Nordforsk and Nordic Center of Excellence programme on Food, Nutrition and Health (Norway); Health Research Fund (FIS), Regional Governments of Andalucía, Asturias, Basque Country, Murcia (No 6236) and Navarra and ISCIII RETIC (RD06/0020) (Spain); Swedish Cancer Society, Swedish Scientific Council and Regional Government of Skåne and Västerbotten (Sweden); Cancer Research UK, Medical Research Council, Stroke Association, British Heart Foundation, Department of Health, Food Standards Agency and Welcome Trust (United Kingdom).

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

10654_2013_9795_MOESM1_ESM.docx (38 kb)
Supplementary material 1 (DOCX 38 kb)
10654_2013_9795_MOESM2_ESM.pdf (14 kb)
Supplementary Fig. 1. Selection Of Subjects To-Be-Included In Current Analyses (PDF 14 kb)

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Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Christina Bamia
    • 1
  • Pagona Lagiou
    • 1
    • 2
    • 3
  • Genevieve Buckland
    • 4
  • Sara Grioni
    • 5
  • Claudia Agnoli
    • 6
  • Aliki J. Taylor
    • 7
  • Christina C. Dahm
    • 8
  • Kim Overvad
    • 8
  • Anja Olsen
    • 9
  • Anne Tjønneland
    • 9
  • Vanessa Cottet
    • 10
    • 11
  • Marie-Christine Boutron-Ruault
    • 10
    • 11
  • Sophie Morois
    • 10
    • 11
  • Verena Grote
    • 12
  • Birgit Teucher
    • 12
  • Heiner Boeing
    • 13
  • Brian Buijsse
    • 13
  • Dimitrios Trichopoulos
    • 2
    • 3
    • 14
  • George Adarakis
    • 14
  • Rosario Tumino
    • 15
  • Alessio Naccarati
    • 16
  • Salvatore Panico
    • 17
  • Domenico Palli
    • 18
  • H. Bas Bueno-de-Mesquita
    • 19
    • 20
  • Fränzel J. B. van Duijnhoven
    • 19
    • 21
  • Petra H. M. Peeters
    • 22
    • 23
  • Dagrun Engeset
    • 24
  • Guri Skeie
    • 24
  • Eiliv Lund
    • 24
  • Maria-José Sánchez
    • 25
    • 26
  • Aurelio Barricarte
    • 26
    • 27
    • 28
  • Jose-Maria Huerta
    • 26
    • 29
  • J. Ramón Quirós
    • 30
  • Miren Dorronsoro
    • 26
    • 31
  • Ingrid Ljuslinder
    • 32
  • Richard Palmqvist
    • 33
  • Isabel Drake
    • 34
  • Timothy J. Key
    • 35
  • Kay-Tee Khaw
    • 36
  • Nick Wareham
    • 37
  • Isabelle Romieu
    • 38
  • Veronika Fedirko
    • 38
  • Mazda Jenab
    • 38
  • Dora Romaguera
    • 23
  • Teresa Norat
    • 23
  • Antonia Trichopoulou
    • 1
    • 3
    • 14
  1. 1.Department of Hygiene, Epidemiology and Medical Statistics, WHO Collaborating Center for Food and Nutrition PoliciesUniversity of Athens Medical SchoolAthensGreece
  2. 2.Department of EpidemiologyHarvard School of Public HealthBostonUSA
  3. 3.Bureau of Epidemiologic ResearchAcademy of AthensAthensGreece
  4. 4.Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research ProgrammeCatalan Institute of Oncology (ICO)BarcelonaSpain
  5. 5.Nutritional Epidemiology UnitIRCCS Istituto Nazionale TumoriMilanItaly
  6. 6.Epidemiology and Prevention UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
  7. 7.Department of Public Health, Epidemiology and BiostatisticsUniversity of BirminghamEdgbaston, BirminghamUK
  8. 8.Section of Epidemiology, Department of Public HealthAarhus UniversityAarhusDenmark
  9. 9.Danish Cancer Society Research CenterCopenhagenDenmark
  10. 10.Inserm, Centre for Research in Epidemiology and Population HealthVillejuifFrance
  11. 11.Paris South UniversityVillejuifFrance
  12. 12.German Cancer Research Center (DKFZ)HeidelbergGermany
  13. 13.Department of EpidemiologyGerman Institute of Human Nutrition (DIfE)Potsdam-RehbrueckeGermany
  14. 14.Hellenic Health FoundationAthensGreece
  15. 15.Cancer Registry Histopathology Unit“Civile M.P.Arezzo” Hospital, ASPRagusaItaly
  16. 16.Human Genetics Foundation (HuGeF)TurinItaly
  17. 17.Department of Clinical and Experimental MedicineFederico II UniversityNaplesItaly
  18. 18.Molecular and Nutritional Epidemiology UnitCancer Research and Prevention Institute, ISPOFlorenceItaly
  19. 19.National Institute for Public Health and the Environment (RIVM)BilthovenThe Netherlands
  20. 20.Department of Gastroenterology and HepatologyUniversity Medical CentreUtrechtThe Netherlands
  21. 21.Division of Human NutritionWageningen UniversityWageningenThe Netherlands
  22. 22.Julius CenterUniversity Medical Center UtrechtUtrechtThe Netherlands
  23. 23.Department of Epidemiology and Biostatistics, School of Public Health, Faculty of MedicineImperial CollegeLondonUK
  24. 24.Department of Community MedicineUniversity of TromsøTromsøNorway
  25. 25.Andalusian School of Public HealthGranadaSpain
  26. 26.CIBER Epidemiología y Salud Pública CIBERESPMadridSpain
  27. 27.Navarre Public Health InstitutePamplonaSpain
  28. 28.Navarre Public UniversityNavarraSpain
  29. 29.Department of EpidemiologyMurcia Regional Health CouncilMurciaSpain
  30. 30.Public Health DirectorateAsturiasSpain
  31. 31.Public Health Division of Gipuzkoa, BioDonostia Research Institute, Health DepartmentSan SebastianSpain
  32. 32.Department of Radiation Sciences, OncologyUmea UniversityUmeaSweden
  33. 33.Department of Medical Biosciences, PathologyUmea UniversityUmeaSweden
  34. 34.Nutrition Epidemiology Research Group, Department of Clinical SciencesLund UniversityMalmöSweden
  35. 35.Cancer Epidemiology Unit, Nuffield Department of Clinical MedicineUniversity of OxfordOxfordUK
  36. 36.University of CambridgeCambridgeUK
  37. 37.MRC Epidemiology UnitCambridgeUK
  38. 38.International Agency for Research on Cancer (IARC-WHO)LyonFrance

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