Journal
INTERNATIONAL JOURNAL OF CANCER
Volume 145, Issue 1, Pages 122-131Publisher
WILEY
DOI: 10.1002/ijc.32091
Keywords
lymphoma; Mediterranean diet; Europe; prospective studies; risk
Categories
Funding
- European Commission (DG-SANCO)
- International Agency for Research on Cancer
- Danish Cancer Society (Denmark)
- Ligue Contre le Cancer
- Institut Gustave Roussy
- Mutuelle Generale de l'Education Nationale
- Institut National de la Sante et de la Recherche Medicale (INSERM) (France)
- German Cancer Aid
- German Cancer Research Center (DKFZ)
- Federal Ministry of Education and Research (BMBF)
- Deutsche Krebshilfe
- Deutsches Krebsforschungszentrum
- Hellenic Health Foundation (Greece)
- Associazione Italiana per la Ricerca sul Cancro-AIRC-Italy
- 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) [ERC2009-AdG 232997]
- Nordforsk, Nordic Centre of Excellence programme on Food, Nutrition and Health (Norway)
- German Federal Ministry of Education and Research [BMBF 01EO1303]
- Spanish Ministry of Economy and Competitiveness - Carlos III Institute of Health
- Centro de Investigacion Biomedica en Red: Epidemiologia y Salud Publica (CIBERESP, Spain)
- Agencia de Gestio d'Ajuts Universitaris i de Recerca (AGAUR)
- CERCA Programme/Generalitat de Catalunya [2017SGR1085]
- ISCIII RETIC [RD06/0020]
- Swedish Cancer Society
- Swedish Research Council
- County Council of Skane (Sweden)
- County Councils of Vasterbotten (Sweden)
- Cancer Research UK [14136, C570/A16491, C8221/A19170]
- Medical Research Council [1000143, MR/M012190/1]
- Federal Ministry of Education and Research (Germany)
- EDER funds/European Regional Develpment Fund (ERDF) - a way to build Europe [PI13/00061, PI13/01162, PI17/01280, PI14/01219]
- MRC [MR/N003284/1, MR/L01341X/1] Funding Source: UKRI
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There is a growing evidence of the protective role of the Mediterranean diet (MD) on cancer. However, no prospective study has yet investigated its influence on lymphoma. We evaluated the association between adherence to the MD and risk of lymphoma and its subtypes in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. The analysis included 476,160 participants, recruited from 10 European countries between 1991 and 2001. Adherence to the MD was estimated through the adapted relative MD (arMED) score excluding alcohol. Cox proportional hazards regression models were used while adjusting for potential confounders. During an average follow-up of 13.9 years, 3,136 lymphomas (135 Hodgkin lymphoma [HL], 2,606 non-HL and 395 lymphoma not otherwise specified) were identified. Overall, a 1-unit increase in the arMED score was associated with a 2% lower risk of lymphoma (95% CI: 0.97; 1.00, p-trend = 0.03) while a statistically nonsignificant inverse association between a high versus low arMED score and risk of lymphoma was observed (hazard ratio [HR]: 0.91 [95% CI 0.80; 1.03], p-trend = 0.12). Analyses by lymphoma subtype did not reveal any statistically significant associations. Albeit with small numbers of cases (N = 135), a suggestive inverse association was found for HL (HR 1-unit increase = 0.93 [95% CI: 0.86; 1.01], p-trend = 0.07). However, the study may have lacked statistical power to detect small effect sizes for lymphoma subtype. Our findings suggest that an increasing arMED score was inversely related to the risk of overall lymphoma in EPIC but not by subtypes. Further large prospective studies are warranted to confirm these findings.
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