The document summarizes findings from the European Prospective Investigation into Cancer and Nutrition (EPIC) study on relationships between diet and cancer risk. It reports that red and processed meat strongly increased gastric and colorectal cancer risk while adherence to a Mediterranean diet decreased gastric cancer risk. Fiber intake reduced gastric and colorectal cancers while calcium intake lowered colorectal cancer risk.

1. Diet and cancer prevention:
Contributions from the European
Prospective Investigation into
Cancer and Nutrition (EPIC) study.
Gonzalez CA and Riboli E
Eur J Cancer 2010;46:2555-2562
Page 1
Gonzalez and Riboli, Eur J Cancer 2010;46:2555-2562
www.pronutritionist.net

2. Background
• Nutrition and related factors such as alcohol intake,
obesity and physical activity, play an important role in
cancer occurrence
• Scientific evidence on the relationship between several
cancer sites and some foods and nutrients is still
insufficient or inconsistent
Page 2
Gonzalez and Riboli, Eur J Cancer 2010;46:2555-2562
www.pronutritionist.net

3. Methods
• EPIC is a multicentre prospective study
– investigating the relationships between diet, lifestyle,
genetic and environmental factors and the incidence of
cancer and other chronic diseases
– carried out in 23 centres in 10 European countries
• n = 519 978
• Diet over the previous 12 months was assessed at
recruitment by validated country specific
questionnaires
– self-administered semiquantitative food-frequency
questionnaire
– diet history questionnaire
– semi-quantitative food-frequency questionnaire combined
with dietary record
Page 3
Gonzalez and Riboli, Eur J Cancer 2010;46:2555-2562
www.pronutritionist.net

4. Factors associated with
increased/decreased risk of gastric cancer
4
Gonzalez and Riboli, Eur J Cancer 2010;46:2555-2562
www.pronutritionist.net

5. Results: Gastric cancer
•
•
•
•
The association with total meat was strong for Helicobacter pylori
infected subjects, whereas no association was observed in
uninfected subjects
For gastric cardia cancer, no association was observed with total,
red or processed meat
A significant reduction of 33% in GC risk was observed when
comparing high versus low adherence to Mediterranian diet
Total fruit or vegetable intake was not associated with reduced risk
of GC
Page 5
Gonzalez and Riboli, Eur J Cancer 2010;46:2555-2562
www.pronutritionist.net

6. Factors associated with increased/decreased
risk of colorectal cancer (CRC)
6
Gonzalez and Riboli, Eur J Cancer 2010;46:2555-2562
www.pronutritionist.net

7. Results: Colorectal cancer (CRC)
• No food source of fibre (cereal, vegetables or
fruits) was more protective than another
• High intake of calcium was associated with a lower
CRC risk, but dietary vitamin D was not associated
– suggesting a relevant role of endogenous formation of
vitamin D
7
Gonzalez and Riboli, Eur J Cancer 2010;46:2555-2562
www.pronutritionist.net

8. Factors associated with
increased/decreased risk of lung cancer
8
Gonzalez and Riboli, Eur J Cancer 2010;46:2555-2562
www.pronutritionist.net

9. Factors associated with
increased/decreased risk of breast cancer
9
Gonzalez and Riboli, Eur J Cancer 2010;46:2555-2562
www.pronutritionist.net

10. Factors associated with
increased/decreased risk of prostate cancer
10
Gonzalez and Riboli, Eur J Cancer 2010;46:2555-2562
www.pronutritionist.net

11. Pronutritionist’s discussion
• Red and processed meat strongly increased the risk of both
gastric and colorectal cancer. Recent findings meat’s negative
effect on coronary heart disease make the high use of red and
processed meat particularly concerning
• The increased risk of gastric cancer associated with processed
meat is consistent with the most recent evidence (
Larsson et al. 2006)
• Mediterranean diet pattern decreased incidence of gastric
cancer. Because Mediterranean diet pattern has been
associated with improved cardiovascular and cognitive
outcomes and now with gastric cancer benefit, it may be viewed
as one of the best dietary patterns to support overall health and
longevity
11
Gonzalez and Riboli, Eur J Cancer 2010;46:2555-2562
www.pronutritionist.net

12. Pronutritionist’s discussion
• Even if high intake of fruit and vegetables was found to
decrease the risk of lung cancer in current smokers, the
most effective measure for preventing lung cancer is the
cessation of smoking
• Results suggest that diet may not have an important role
in prostate carcinogenesis
•
12
In this study, there was only weak (HR 1.13) but significant
increased risk of breast cancer associated with higher
saturated fat intake. A recent evidence from a meta-analysis
has shown an increase of 19% in the risk of breast cancer for
the highest level of intake of saturated fat
Gonzalez and Riboli, Eur J Cancer
2010;46:2555-2562
www.pronutritionist.net

13. Pronutritionist’s discussion
• Highest intake of dietary fiber decreased incidence of
gastric and colorectal cancers by 31-42 %. Taken into
consideration also the metabolic and cardiovascular
benefits of high dietary fiber intake, increasing fiber
intake seems to be beneficial for humans from many
perspectives
• High intake of fish was associated with decreased risk of
gastric cancer. Fish consumption is associated with
improved cardiovascular outcomes in recent metaanalyses, underlining the overall health benefits of fish
• In this study, dietary nitrates were not measured
13
Gonzalez and Riboli, Eur J Cancer
2010;46:2555-2562
www.pronutritionist.net

14. Pronutritionist’s discussion
• This multicenter cohort study’s strength is the size of
the sample (over half a million persons) and
prospective nature
• However, cohort studies are always inherent with
confounding factors.
• Randomized dietary interventions are extremely difficult
to organise in cancer area, due to slow development of
cancers and very low incidence (requirement for
participating patients would be huge)
14
Gonzalez and Riboli, Eur J Cancer
2010;46:2555-2562
www.pronutritionist.net