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Sweetened beverages are associated with a higher risk of differentiated thyroid cancer in the EPIC cohort: a dietary pattern approach

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Abstract

Background

Dietary pattern analysis has gained particular interest, because it reflects the complexity of dietary intake. The aim of this study was to explore the associations between a posteriori dietary patterns, derived using a data-driven approach, and the risk of differentiated thyroid cancer (TC) in Europe.

Methods

This investigation included 450,064 adults from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Dietary intake was assessed using validated country-specific dietary questionnaires. A posteriori dietary patterns were computed using principal component analyses. Cox regression was used to calculate multivariable adjusted hazard ratios (HRs) and 95% confidence intervals (CIs).

Results

After a mean follow-up time of 14 years, 712 first differentiated TCs were diagnosed. In the fully adjusted model, a dietary pattern characterized by alcohol consumption (basically beer and wine) was negatively associated with differentiated TC risk (HRQ4vs.Q1 = 0.75; 95% CI:0.60–0.94, P-trend = 0.005), while a dietary pattern rich in sweetened beverages was positively associated with differentiated TC risk (HRQ4vs.Q1 = 1.26; 95% CI:0.99–1.61; P-trend = 0.07). The remaining 8 dietary patterns were not related to differentiated TC risk. The intake of sweetened beverages was positively associated with differentiated TC risk (HR100mL/d = 1.05; 95% CI:1.00–1.11), especially with papillary TC risk (HR100mL/d = 1.07; 95% CI:1.01–1.13). Similar results were observed with sugary and artificially sweetened beverages.

Conclusions

The investigation of dietary patterns detected that the consumption of sweetened beverages was associated with a higher risk of differentiated thyroid cancer. Our results are in line with the general dietary recommendations of reducing the consumption of sweetened beverages.

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Abbreviations

BMI:

Body mass index

DQ:

Dietary questionnaire

EPIC:

European Prospective Investigation into Cancer and Nutrition

TC:

Thyroid cancer

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Acknowledgements

We thank Mr Bertrand Hémon for his valuable help with the EPIC database. We also thank Aarhus University, Denmark; German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, and the National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands; Public Health Directorate, Asturias, Spain; Oxford University, and Cambridge University, UK, for their contribution and on-going support to the EPIC Study. The authors also express their gratitude to all participants in the EPIC cohorts for their invaluable contribution to the study.

Funding

This research was funded by the Instituto de Salud Carlos III through the grant CP15/00100 (Co-funded by European Regional Development Fund. ERDF, a way to build Europe). The coordination of EPIC is financially supported by International Agency for Research on Cancer (IARC) and also by the Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London which has additional infrastructure support provided by the NIHR Imperial Biomedical Research Centre (BRC). The national cohorts are supported by: Danish Cancer Society (Denmark); Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle Générale de l’Education Nationale, Institut National de la Santé et de la Recherche Médicale (INSERM) (France); German Cancer Aid, German Cancer Research Center (DKFZ), German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Federal Ministry of Education and Research (BMBF) (Germany); Associazione Italiana per la Ricerca sul Cancro-AIRC-Italy, Compagnia di San Paolo and National Research Council (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), Statistics Netherlands (The Netherlands); Health Research Fund (FIS)—Instituto de Salud Carlos III (ISCIII), Regional Governments of Andalucía, Asturias, Basque Country, Murcia and Navarra, and the Catalan Institute of Oncology—ICO (Spain); Swedish Cancer Society, Swedish Research Council and County Councils of Skåne and Västerbotten (Sweden); Cancer Research UK (14136 to EPIC-Norfolk; C8221/A29017 to EPIC-Oxford), Medical Research Council (1000143 to EPIC-Norfolk; MR/M012190/1 to EPIC-Oxford). (United Kingdom). We thank the CERCA Program / Generalitat de Catalunya for the institutional support to IDIBELL. RZ-R was supported by the “Miguel Servet” program (CPII20/00009) from the Institute of Health Carlos III (Co-funded by the European Social Fund (ESF)—ESF investing in your future).

Author information

Authors and Affiliations

  1. Unit of Nutrition and Cancer, Epidemiology Research Program, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat (Barcelona) , Av Gran Via 199-203, 08908, Barcelona, Spain

    Raul Zamora-Ros, Valerie Cayssials, Maria Torrents & Antonio Agudo

  2. Department of Veterinary Public Health, Faculty of Veterinary, University of the Republic, Montevideo, Uruguay

    Valerie Cayssials

  3. Department of Quantitative Methods, Faculty of Medicine, University of the Republic, Montevideo, Uruguay

    Valerie Cayssials

  4. Pla Director d’Oncologia, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat (Barcelona),, Barcelona, Spain

    Ramon Clèries

  5. Department of Clinical Sciences, University of Barcelona, Barcelona, Spain

    Ramon Clèries

  6. International Agency for Research On Cancer (IARC-WHO), Lyon, France

    Graham Byrnes, Elisabete Weiderpass, Heinz Freisling & Sabina Rinaldi

  7. Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden

    Maria Sandström

  8. Department of Surgery, Skåne University Hospital Malmö, Lund University, Lund, Sweden

    Martin Almquist

  9. Centre for Research in Epidemiology and Population Health (CESP), Université Paris-Saclay, Université Paris-Sud, INSERM U1018, Villejuif, France

    Marie-Christine Boutron-Ruault

  10. Institut Gustave Roussy, Villejuif, France

    Marie-Christine Boutron-Ruault

  11. Danish Cancer Society Research Center, Copenhagen, Denmark

    Anne Tjønneland & Cecilie Kyrø

  12. Department of Public Health, University of Copenhagen, Copenhagen, Denmark

    Anne Tjønneland

  13. Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany

    Verena A. Katzke & Charlotte Le Cornet

  14. Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network - ISPRO, Florence, Italy

    Giovanna Masala

  15. Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy

    Vittorio Krogh

  16. Dipartimento Di Medicina Clinica E Chirurgia, Federico II University, Naples, Italy

    Gabriella Iannuzzo

  17. AIRE - ONLUS, Hyblean Association for Epidemiological Research, Ragusa, Italy

    Rosario Tumino

  18. Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy

    Lorenzo Milani

  19. Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway

    Guri Skeie

  20. Escuela Andaluza de Salud Pública (EASP), Granada, Spain

    Esther Ubago-Guisado

  21. Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain

    Esther Ubago-Guisado

  22. CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain

    Esther Ubago-Guisado, Pilar Amiano, María-Dolores Chirlaque & Eva Ardanaz

  23. Sub Directorate for Public Health and Addictions of Gipuzkoa, Ministry of Health of the Basque Government, Biodonostia Health Research Institute, San Sebastian, Spain

    Pilar Amiano

  24. Department of Epidemiology, IMIB-Arrixaca, Murcia Regional Health Council, Murcia University, Murcia, Spain

    María-Dolores Chirlaque

  25. Navarra Public Health Institute, Pamplona, Spain

    Eva Ardanaz

  26. IdiSNA, Navarra Institute for Health Research, Pamplona, Spain

    Eva Ardanaz

  27. Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden

    Suzanne Janzi

  28. Department of Odontology, Umeå University, Umeå, Sweden

    Linda Eriksson

  29. Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK

    Alicia K. Heath

Authors
  1. Raul Zamora-Ros
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  2. Valerie Cayssials
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  3. Ramon Clèries
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Contributions

RZ-R, RC, AA designed the research; RZ-R obtained the fundings; VC, RC, MT performed the statistical analyses and prepared the database; EW, MS, MA, MCBR, AT, CK, VAK, CLC, GM, VK, GI, RT, LM, GS, EUG, PA, M-DC, EA, SJ, LE, HF, AKH, SR, AA provided data; RZ-R drafted the manuscript; RC, GB, EW, SR, AA largely contributed to the discussion. All authors reviewed, edited, and approved the final manuscript.

Corresponding author

Correspondence to Raul Zamora-Ros.

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Conflict of interest

The authors are not aware of any conflicts of interest. DISCLAIMER: Where authors are identified as personnel of the International Agency for Research on Cancer / World Health Organization, the authors alone are responsible for the views expressed in this article and they do not necessarily represent the decisions, policy or views of the International Agency for Research on Cancer / World Health Organization.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. The study was approved by the ethical review boards from the International Agency for Research on Cancer and from all participating EPIC centres.

Consent to participate

All participants provided written informed consent.

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Zamora-Ros, R., Cayssials, V., Clèries, R. et al. Sweetened beverages are associated with a higher risk of differentiated thyroid cancer in the EPIC cohort: a dietary pattern approach. Eur J Nutr 62, 105–114 (2023). https://doi.org/10.1007/s00394-022-02953-5

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