Mathilde Touvier

Fruit and vegetable consumption and lung cancer risk: updated information from the European Prospective Investigation into Cancer and Nutrition (EPIC).

The association of fruit and vegetable consumption and lung cancer incidence was evaluated using the most recent data from the European Prospective Investigation into Cancer and Nutrition (EPIC), applying a refined statistical approach (calibration) to account for measurement error potentially introduced by using food frequency questionnaire data. Between 1992 and 2000, detailed information on diet and life‐style of 478,590 individuals participating in EPIC was collected. During a median follow‐up of 6.4 years, 1,126 lung cancer cases were observed. Multivariate Cox proportional hazard models were applied for statistical evaluation. In the whole study population, fruit consumption was significantly inversely associated with lung cancer risk while no association was found for vegetable consumption. In current smokers, however, lung cancer risk significantly decreased with higher vegetable consumption; this association became more pronounced after calibration, the hazard ratio (HR) being 0.78 (95% CI 0.62–0.98) per 100 g increase in daily vegetable consumption. In comparison, the HR per 100 g fruit was 0.92 (0.85–0.99) in the entire cohort and 0.90 (0.81–0.99) in smokers. Exclusion of cases diagnosed during the first 2 years of follow‐up strengthened these associations, the HR being 0.71 (0.55–0.94) for vegetables (smokers) and 0.86 (0.78–0.95) for fruit (entire cohort). Cancer incidence decreased with higher consumption of apples and pears (entire cohort) as well as root vegetables (smokers). In addition to an overall inverse association with fruit intake, the results of this evaluation add evidence for a significant inverse association of vegetable consumption and lung cancer incidence in smokers.

Eating out of home: energy, macro- and micronutrient intakes in 10 European countries. The European Prospective Investigation into Cancer and Nutrition

Objectives:To assess the contribution of out-of-home (OH) energy and nutrient intake to total dietary intake, and to compare out- versus in-home nutrient patterns among 27 centres in 10 countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study.Methods:Between 1995 and 2000, 36u2009034 participants aged between 35–74 years completed a standardized 24-h dietary recall using a software programme (EPIC-Soft) that recorded the place of food/drink consumption. Eating OH was defined as the consumption of foods and beverages anywhere other than in household premises, irrespective of the place of purchase/preparation. Nutrient intakes were estimated using a standardized nutrient database. Mean intakes were adjusted for age and weighted by season and day of recall.Results:Among women, OH eating contributed more to total fat intake than to intakes of protein and carbohydrates. Among both genders, and particularly in southern Europe, OH eating contributed more to sugar and starch intakes and less to total fibre intake. The contribution of OH eating was also lower for calcium and vitamin C intakes. The composition of diet at home was different from that consumed out of home in southern countries, but was relatively similar in the north.Conclusions:In northern Europe, OH and in-home eating are homogeneous, whereas southern Europeans consider OH eating as a distinctive occasion. In most centres, women selected more fat-rich items when eating out.

Determinants of vitamin D status in Caucasian adults: influence of sun exposure, dietary intake, sociodemographic, lifestyle, anthropometric, and genetic factors.

Very few studies have investigated the determinants of serum vitamin D levels using a set of variables that include simultaneously sun exposure, phototype, dietary intake, sociodemographics, anthropometric, lifestyle data, and genetic polymorphisms. Our objective was to investigate the associations between all these parameters and vitamin D status in a large sample of French adults. This cross-sectional survey was based on 1,828 middle-aged Caucasian adults from the SU.VI.MAX (SUpplémentation en VItamines et Minéraux AntioXydants) study. Plasma 25-hydroxyvitamin D (25OHD) concentration was lower among women (P<0.0001), older subjects (P=0.04), obese/underweight (P<0.0001), those living at higher latitudes (P<0.0001), those whose blood draw occurred in early spring (P<0.0001), less physically active (P<0.0001), with low sun exposure (P<0.0001), and with no-to-low alcohol intake (P=0.0001). Mutant GC rs4588 and rs7041 single nucleotide polymorphisms were associated with lower and higher 25OHD concentrations, respectively (P<0.0001). Dietary intake was not a major determinant of vitamin D status (P=0.7). This study provides an overall picture of determinants of vitamin D status. Several modifiable factors were identified, such as daily-life moderate sun exposure, physical activity, and normal-weight maintenance, which should be targeted by public health policies in order to improve vitamin D status in the general population, while avoiding active/intensive sun exposure, in line with recommendations for skin cancer prevention.

New biomarkers of coffee consumption identified by the non-targeted metabolomic profiling of cohort study subjects.

Coffee contains various bioactives implicated with human health and disease risk. To accurately assess the effects of overall consumption upon health and disease, individual intake must be measured in large epidemiological studies. Metabolomics has emerged as a powerful approach to discover biomarkers of intake for a large range of foods. Here we report the profiling of the urinary metabolome of cohort study subjects to search for new biomarkers of coffee intake. Using repeated 24-hour dietary records and a food frequency questionnaire, 20 high coffee consumers (183–540 mL/d) and 19 low consumers were selected from the French SU.VI.MAX2 cohort. Morning spot urine samples from each subject were profiled by high-resolution mass spectrometry. Partial least-square discriminant analysis of multidimensional liquid chromatography-mass spectrometry data clearly distinguished high consumers from low via 132 significant (p-value<0.05) discriminating features. Ion clusters whose intensities were most elevated in the high consumers were annotated using online and in-house databases and their identities checked using commercial standards and MS-MS fragmentation. The best discriminants, and thus potential markers of coffee consumption, were the glucuronide of the diterpenoid atractyligenin, the diketopiperazine cyclo(isoleucyl-prolyl), and the alkaloid trigonelline. Some caffeine metabolites, such as 1-methylxanthine, were also among the discriminants, however caffeine may be consumed from other sources and its metabolism is subject to inter-individual variation. Receiver operating characteristics curve analysis showed that the biomarkers identified could be used effectively in combination for increased sensitivity and specificity. Once validated in other cohorts or intervention studies, these specific single or combined biomarkers will become a valuable alternative to assessment of coffee intake by dietary survey and finally lead to a better understanding of the health implications of coffee consumption.

Dietary patterns associated with vitamin/mineral supplement use and smoking among women of the E3N-EPIC cohort.

Background/Objectives:An understanding of the relationships between dietary habits and supplement use or smoking is useful for aetiological studies and surveillance purposes. The objective of this study is to describe dietary patterns associated with vitamin/mineral supplement use and smoking habits in French women.Methods:Scores for dietary patterns were obtained by factor analysis in 64u2009252 women from the French E3N–EPIC cohort. The association with supplement and tobacco use was investigated by logistic regression analysis.Results:We identified three dietary patterns: ‘processed meat/starchy foods’ (fast foods, processed meat, rice/pasta/semolina and cakes and few vegetables); ‘fruit/vegetables’ (fruits, vegetables, seafood, vegetable oils and yoghurt); and ‘alcohol/meat products’ (alcohol, meat and meat products, and coffee, and few fruits and soup). Supplement use was positively associated with the fruit/vegetables pattern (multivariate OR for quartile 4 versus 1 (OR4)=1.55, 95% confidence interval: 1.47–1.63), and inversely associated with the processed meat/starchy foods (OR4=0.84; 0.80–0.89) and alcohol/meat products (OR4=0.69; 0.66–0.73) patterns (P trend for all associations <0.0001). As compared with never smoking, current smoking was inversely associated with the fruit/vegetables pattern (OR4=0.85; 0.78–0.92), while former smoking was positively associated with the fruit/vegetables pattern (OR4=1.32; 1.25–1.40); both current and former smoking were inversely associated with the processed meat/starchy foods pattern (OR4=0.57; 0.53–0.62 and 0.64; 0.60–0.67, respectively); whereas current and former smoking were both strongly positively associated with the alcohol/meat products pattern (OR4=5.78; 5.26–6.36 and 2.03; 1.91–2.15, respectively); P trend for all associations was <0.001.Conclusions:Supplement use and smoking are strongly associated with dietary patterns.

Carotenoids, retinol, tocopherols, and prostate cancer risk : pooled analysis of 15 studies

BACKGROUNDnIndividual studies have suggested that circulating carotenoids, retinol, or tocopherols may be associated with prostate cancer risk, but the studies have not been large enough to provide precise estimates of associations, particularly by stage and grade of disease.nnnOBJECTIVEnThe objective of this study was to conduct a pooled analysis of the associations of the concentrations of 7 carotenoids, retinol, α-tocopherol, and γ-tocopherol with risk of prostate cancer and to describe whether any associations differ by stage or grade of the disease or other factors.nnnDESIGNnPrincipal investigators of prospective studies provided individual participant data for prostate cancer cases and controls. Risk by study-specific fifths of each biomarker was estimated by using multivariable-adjusted conditional logistic regression in matched case-control sets.nnnRESULTSnData were available for up to 11,239 cases (including 1654 advanced stage and 1741 aggressive) and 18,541 controls from 15 studies. Lycopene was not associated with overall risk of prostate cancer, but there was statistically significant heterogeneity by stage of disease, and the OR for aggressive disease for the highest compared with the lowest fifth of lycopene was 0.65 (95% CI: 0.46, 0.91; P-trend = 0.032). No other carotenoid was significantly associated with overall risk of prostate cancer or with risk of advanced-stage or aggressive disease. For retinol, the OR for the highest compared with the lowest fifth was 1.13 (95% CI: 1.04, 1.22; P-trend = 0.015). For α-tocopherol, the OR for the highest compared with the lowest fifth was 0.86 (95% CI: 0.78, 0.94; P-trend < 0.001), with significant heterogeneity by stage of disease; the OR for aggressive prostate cancer was 0.74 (95% CI: 0.59, 0.92; P-trend = 0.001). γ-Tocopherol was not associated with risk.nnnCONCLUSIONSnOverall prostate cancer risk was positively associated with retinol and inversely associated with α-tocopherol, and risk of aggressive prostate cancer was inversely associated with lycopene and α-tocopherol. Whether these associations reflect causal relations is unclear.

Prospective associations between serum biomarkers of lipid metabolism and overall, breast and prostate cancer risk

AbstractnExperimental studies provided evidence about mechanisms by which cholesterol, especially high density lipoprotein cholesterol (HDL-C), could influence carcinogenesis, notably through antioxidant and anti-inflammatory properties. However, prospective studies that investigated the associations between specific lipid metabolism biomarkers and cancer risk provided inconsistent results. The objective was to investigate the prospective associations between total cholesterol (T-C), HDL-C, low density lipoprotein cholesterol, apolipoproteins A1 (apoA1) and B, and triglycerides and overall, breast and prostate cancer risk. Analyses were performed on 7,557 subjects of the Supplémentation en Vitamines et Minéraux Antioxydants Study, a nationwide French cohort study. Biomarkers of lipid metabolism were measured at baseline and analyzed regarding the risk of first primary incident cancer (Nxa0=xa0514 cases diagnosed during follow-up, 1994–2007), using Cox proportional hazards models. T-C was inversely associated with overall (HR1mmol/L incrementxa0=xa00.91, 95xa0% CI 0.82–1.00; Pxa0=xa00.04) and breast (HR1mmol/L incrementxa0=xa00.83, 95xa0% CI 0.69–0.99; Pxa0=xa00.04) cancer risk. HDL-C was also inversely associated with overall (HR1mmol/L incrementxa0=xa00.61, 95xa0% CI 0.46–0.82; Pxa0=xa00.0008) and breast (HR1mmol/L incrementxa0=xa00.48, 95xa0% CI 0.28–0.83; Pxa0=xa00.009) cancer risk. Consistently, apoA1 was inversely associated with overall (HR1g/L incrementxa0=xa00.56, 95xa0% CI 0.39–0.82; Pxa0=xa00.003) and breast (HR1g/L incrementxa0=xa00.36, 95xa0% CI 0.18–0.73; Pxa0=xa00.004) cancer risk. This prospective study suggests that pre-diagnostic serum levels of T-C, HDL-C and ApoA1 are associated with decreased overall and breast cancer risk. The confirmation of a role of cholesterol components in cancer development, by further large prospective and experimental studies, may have important implications in terms of public health, since cholesterol is already crucial in cardiovascular prevention.

Alcoholic beverages, obesity, physical activity and other nutritional factors, and cancer risk: A review of the evidence

PURPOSEnPrevention is a priority in the fight against cancers, especially nutritional prevention. To update the levels of evidence of relationships between 10 nutritional factors and cancer risk, the scientific literature published from 2006 to 2014 was reviewed by an expert group.nnnMETHODSnData from 133 meta-analyses, pooled analyses or intervention trials were examined. Nearly 150 relationships between nutritional factors and cancer at various sites were evaluated.nnnRESULTSnAccording to the evidence graded as convincing or probable, these factors were divided in two groups. Factors which increase the risk of cancer are alcoholic beverages, overweight and obesity, red meat and processed meat, salt and salted foods and beta-carotene supplements. Factors which decrease the risk of cancer are physical activity, fruits and vegetables, dietary fiber, dairy products and breastfeeding.nnnCONCLUSIONnThree main nutritional objectives should be attained to improve cancer prevention: to reduce alcoholic beverages consumption, to have a balanced and diversified diet and to be physically active.

Interpretation of Plasma PTH Concentrations According to 25OHD Status, Gender, Age, Weight Status, and Calcium Intake: Importance of the Reference Values

CONTEXTnReference values for plasma PTH assessment were generally established on small samples of apparently healthy subjects, without considering their 25-hydroxyvitamin D (25OHD) status or other potential modifiers of PTH concentration.nnnOBJECTIVEnOur objective was to assess ranges of plasma PTH concentration in a large sample of adults, stratifying by 25OHD status, age, gender, weight status, and calcium intake.nnnDESIGN, SETTING, AND PARTICIPANTSnThis cross-sectional survey is based on 1824 middle-aged Caucasian adults from the Supplémentation en Vitamines et Minéraux Antioxydants study (1994).nnnMAIN OUTCOME MEASURESnPlasma PTH and 25OHD concentrations were measured by an electrochemoluminescent immunoassay. Extreme percentiles of plasma PTH concentrations were assessed specifically in subjects who had plasmatic values of 25OHD of 20 ng/mL or greater and 30 ng/mL or greater.nnnRESULTSnAmong subjects with 25OHD status of 20 ng/mL or greater, the 97.5th percentile of plasma PTH concentration was 45.5 ng/L. By using this value as a reference, 5% of the subjects with plasma 25OHD less than 20 nmol/L had a high plasma PTH level, reflecting secondary hyperparathyroidism. Among vitamin D-replete subjects (25OHD status of 20 ng/mL or greater), the 97.5th percentile of plasma PTH was higher in overweight/obese subjects (51.9 vs 43.5 ng/L among normal weight subjects).nnnCONCLUSIONSnThe reference value for plasma PTH defined in this vitamin D-replete population was far below the value currently provided by the manufacturer (65 ng/L) and varied according to overweight status. These results may contribute to improve the diagnosis of primary and secondary hyperparathyroidism and subsequent therapeutic indication.

Dietary Total and Insoluble Fiber Intakes Are Inversely Associated with Prostate Cancer Risk

Although experimental data suggest a potentially protective involvement of dietary fiber in prostate carcinogenesis, very few prospective studies have investigated the relation between dietary fiber intake and prostate cancer risk, and those have had inconsistent results. Our objective was to study the association between dietary fiber intake (overall, insoluble, soluble, and from different sources, such as cereals, vegetables, fruits, and legumes) and prostate cancer risk. Stratifications by excess weight status, insulin-like growth factors, and amount of alcohol intake were also considered. This prospective analysis included 3313 men from the Supplémentation en Vitamines et Minéraux Antioxydants (SU.VI.MAX) cohort who completed at least 3 24-h dietary records. One hundred thirty-nine incident prostate cancers were diagnosed between 1994 and 2007 (median follow-up of 12.6 y). Associations between quartiles of energy-adjusted dietary fiber intake and prostate cancer risk were characterized by multivariate Cox proportional hazards models. Prostate cancer risk was inversely associated with total dietary fiber intake (HR of quartile 4 vs. quartile 1 = 0.47; 95% CI: 0.27, 0.81; P = 0.001), insoluble (HR = 0.46; 95% CI: 0.27, 0.78; P = 0.001), and legume (HR = 0.55; 95% CI: 0.32, 0.95; P = 0.04) fiber intakes. In contrast, we found no association between prostate cancer risk and soluble (P = 0.1), cereal (P = 0.7), vegetable (P = 0.9), and fruit (P = 0.4) fiber intakes. In conclusion, dietary fiber intake (total, insoluble, and from legumes but not soluble or from cereals, vegetables, and fruits) was inversely associated with prostate cancer risk, consistent with mechanistic data.