Publications by authors named "Kathryn E Bradbury"

71 Publications

Biomarker Concentrations in White and British Indian Vegetarians and Nonvegetarians in the UK Biobank.

J Nutr 2021 Jun 16. Epub 2021 Jun 16.

Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.

Background: Prospective studies have shown differences in some disease risks between vegetarians and nonvegetarians, but the potential biological pathways are not well understood.

Objectives: We aimed to assess differences in concentrations of biomarkers related to disease pathways in people with varying degrees of animal foods exclusion.

Methods: The UK Biobank recruited 500,000 participants aged 40-69 y (54.4% women) throughout the United Kingdom in 2006-2010. Blood and urine were collected at recruitment and assayed for more than 30 biomarkers related to cardiovascular diseases, bone and joint health, cancer, diabetes, renal disease, and liver health. In cross-sectional analyses, we estimated adjusted geometric means of these biomarkers by 6 diet groups (regular meat eaters, low meat eaters, poultry eaters, fish eaters, vegetarians, vegans) in 466,058 white British participants and 2 diet groups (meat eaters, vegetarians) in 5535 British Indian participants.

Results: We observed differences in the concentrations of most biomarkers, with many biomarkers showing a gradient effect from meat eaters to vegetarians/vegans. Of the largest differences, compared with white British regular meat eaters, white British vegans had lower C-reactive protein [adjusted geometric mean (95% CI): 1.13 (1.03, 1.25) compared with 1.43 (1.42, 1.43) mg/L], lower low-density lipoprotein cholesterol [3.13 (3.07, 3.20) compared with 3.65 (3.65, 3.65) mmol/L], lower vitamin D [34.4 (33.1, 35.9) compared with 44.5 (44.4, 44.5) nmol/L], lower serum urea [4.21 (4.11, 4.30) compared with 5.36 (5.36, 5.37) mmol/L], lower urinary creatinine [5440 (5120, 5770) compared with 7280 (7260, 7300) μmol/L], and lower γ-glutamyltransferase [23.5 (22.2, 24.8) compared with 29.6 (29.6, 29.7) U/L]. Patterns were mostly similar in British Indians, and results were consistent between women and men.

Conclusions: The observed differences in biomarker concentrations, including lower C-reactive protein, lower LDL cholesterol, lower vitamin D, lower creatinine, and lower γ-glutamyltransferase, in vegetarians and vegans may relate to differences in future disease risk.
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http://dx.doi.org/10.1093/jn/nxab192DOI Listing
June 2021

Healthiness of foods and non-alcoholic beverages according to store type: A population-based study of household food and drink purchases in New Zealand.

SSM Popul Health 2021 Jun 28;14:100784. Epub 2021 Mar 28.

National Institute for Health Innovation, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand.

Background: Obesity and diet-related noncommunicable diseases (NCDs) account for the largest proportion of disease burden worldwide, and an unhealthy food environment is a key driver. Food retailers play an important role in food environments through the availability and purchases of healthy food products at various stores.

Objectives: To assess whether the healthiness of food and non-alcoholic drink product purchases vary according to retail store type.

Methods: We undertook a cross-sectional analysis of Nielsen New Zealand Homescan® panel data, which is a nationally representative sample of 2500 households in terms of certain key household demographic and socioeconomic characteristics. Panel members were asked to record all food and beverage products that were purchased and brought back to the home between October 2018 and October 2019. Household food and non-alcoholic drink purchases were linked with two food composition databases (Nutritrack, a New Zealand packaged food composition database, and the FOODfiles New Zealand Food Composition Database) to extract data on the nutrient profile of products purchased. We developed a store classification tool, and classified stores as supermarkets, grocery stores, convenience stores, fruit and vegetable stores, meat and fish stores, or bakeries. We estimated the Health Star Rating (HSR) for all products and defined a product with HSR ≥ 3.5 as 'healthy'. We computed estimated mean HSR and conducted multivariate regression analyses.

Results: In total, 3,940,458 product purchases were included in the analyses, consisting of 20,491 unique products purchased at different stores over the one-year period by 1800 panellist households. Supermarket products made up the majority of household food and drink purchases (3,545,141 of 3,940,458; 90%). Overall, the estimated mean HSR was 3.5 stars. In comparison to the reference group of supermarkets, the odds ratio for healthy products purchased at fruit and vegetable stores was 4.62, at grocery stores it was 2.36, and at meat and fish stores it was 1.99. In contrast, the odds ratios from convenience stores and bakeries were 0.58 and 0.03. Except for convenience stores, these differences were statistically significant (p < 0.05).

Discussion: We found significant differences in household purchases of healthy food and beverages according to food retail store type, with healthier food much more likely to be purchased from fruit and vegetable stores, meat and fish stores and grocery stores, and much less likely to be purchased from bakeries and convenience stores as compared with supermarkets.

Conclusion: Policies to improve healthy food retailing should consider all retail store types and focus particularly on increasing the availability of healthy food options at convenience stores and bakeries. Given that supermarkets are the source of most household food purchases (both healthy and unhealthy), strategies are also warranted to increase the relative availability and purchases of healthy foods from supermarkets.
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http://dx.doi.org/10.1016/j.ssmph.2021.100784DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8050937PMC
June 2021

Stepwise tailoring and test-retest of reproducibility of an ethnic-specific FFQ to estimate nutrient intakes for South Asians in New Zealand.

Public Health Nutr 2021 Jun 22;24(9):2447-2454. Epub 2021 Mar 22.

Discipline of Nutrition and Dietetics, University of Auckland, New Zealand.

Objective: To develop and test-retest the reproducibility of an ethnic-specific FFQ to estimate nutrient intakes for South Asians (SA) in New Zealand (NZ).

Design: Using culturally appropriate methods, the NZFFQ, a validated dietary assessment tool for NZ adults, was modified to include SA food items by analysing foods consumed by SA participants of the Adult Nutrition Survey, in-person audit of ethnic food stores and a web scan of ethnic food store websites in NZ. This was further refined via three focus group discussions, and the resulting New Zealand South Asian Food Frequency Questionnaire (NZSAFFQ) was tested for reproducibility.

Setting: Auckland and Dunedin, NZ.

Participants: Twenty-nine and 110 males and females aged 25-59 years of SA ethnicity participated in the focus group discussions and the test-retest, respectively.

Results: The development phase resulted in a SA-specific FFQ comprising of 11 food groups and 180 food items. Test-retest of the NZSAFFQ showed good reproducibility between the two FFQ administrations, 6 months apart. Most reproducibility coefficients were within or higher than the acceptable range of 0·5-0·7. The lowest intraclass correlation coefficients (ICC) were observed for β-carotene (0·47), vitamin B12 (0·50), fructose (0·55), vitamin C (0·57) and selenium (0·58), and the highest ICC were observed for alcohol (0·81), iodine (0·79) and folate (0·77). The ICC for fat ranged from 0·70 for saturated fats to 0·77 for polyunsaturated fats. The ICC for protein and energy were 0·68 and 0·72, respectively.

Conclusions: The developed FFQ showed good reproducibility to estimate nutrient intakes and warrants the need for validation of the instrument.
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http://dx.doi.org/10.1017/S1368980021001208DOI Listing
June 2021

Plant foods, dietary fibre and risk of ischaemic heart disease in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort.

Int J Epidemiol 2021 03;50(1):212-222

Department of Public Health and Clinical Medicine, Section of Sustainable Health/Nutritional Research, Umeå University, Umeå, Sweden.

Background: Epidemiological evidence indicates that diets rich in plant foods are associated with a lower risk of ischaemic heart disease (IHD), but there is sparse information on fruit and vegetable subtypes and sources of dietary fibre. This study examined the associations of major plant foods, their subtypes and dietary fibre with risk of IHD in the European Prospective Investigation into Cancer and Nutrition (EPIC).

Methods: We conducted a prospective analysis of 490 311 men and women without a history of myocardial infarction or stroke at recruitment (12.6 years of follow-up, n cases = 8504), in 10 European countries. Dietary intake was assessed using validated questionnaires, calibrated with 24-h recalls. Multivariable Cox regressions were used to estimate hazard ratios (HR) of IHD.

Results: There was a lower risk of IHD with a higher intake of fruit and vegetables combined [HR per 200 g/day higher intake 0.94, 95% confidence interval (CI): 0.90-0.99, P-trend = 0.009], and with total fruits (per 100 g/day 0.97, 0.95-1.00, P-trend = 0.021). There was no evidence for a reduced risk for fruit subtypes, except for bananas. Risk was lower with higher intakes of nuts and seeds (per 10 g/day 0.90, 0.82-0.98, P-trend = 0.020), total fibre (per 10 g/day 0.91, 0.85-0.98, P-trend = 0.015), fruit and vegetable fibre (per 4 g/day 0.95, 0.91-0.99, P-trend = 0.022) and fruit fibre (per 2 g/day 0.97, 0.95-1.00, P-trend = 0.045). No associations were observed between vegetables, vegetables subtypes, legumes, cereals and IHD risk.

Conclusions: In this large prospective study, we found some small inverse associations between plant foods and IHD risk, with fruit and vegetables combined being the most strongly inversely associated with risk. Whether these small associations are causal remains unclear.
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http://dx.doi.org/10.1093/ije/dyaa155DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7938513PMC
March 2021

Genetic, lifestyle, and health-related characteristics of adults without celiac disease who follow a gluten-free diet: a population-based study of 124,447 participants.

Am J Clin Nutr 2021 03;113(3):622-629

Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.

Background: The number of gluten-free diet followers without celiac disease (CD) is increasing. However, little is known about the characteristics of these individuals.

Objectives: We address this issue by investigating a wide range of genetic and phenotypic characteristics in association with following a gluten-free diet.

Methods: The cross-sectional association between lifestyle and health-related characteristics and following a gluten-free diet was investigated in 124,447 women and men aged 40-69 y from the population-based UK Biobank study. A genome-wide association study (GWAS) of following a gluten-free diet was performed.

Results: A total of 1776 (1.4%) participants reported following a gluten-free diet. Gluten-free diet followers were more likely to be women, nonwhite, highly educated, living in more socioeconomically deprived areas, former smokers, have lost weight in the past year, have poorer self-reported health, and have made dietary changes as a result of illness. Conversely, these individuals were less likely to consume alcohol daily, be overweight or obese, have hypertension, or use cholesterol-lowering medication. Participants with hospital inpatient diagnosed blood and immune mechanism disorders (OR: 1.62; 95% CI: 1.18, 2.21) and non-CD digestive system diseases (OR: 1.58; 95% CI: 1.42, 1.77) were more likely to follow a gluten-free diet. The GWAS demonstrated that no genetic variants were associated with being a gluten-free diet follower.

Conclusions: Gluten-free diet followers have a better cardiovascular risk profile than non-gluten-free diet followers but poorer self-reported health and a higher prevalence of blood and immune disorders and digestive conditions. Reasons for following a gluten-free diet warrant further investigation.
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http://dx.doi.org/10.1093/ajcn/nqaa291DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7948866PMC
March 2021

Relative Validity and Reproducibility of a Short FoodFrequency Questionnaire to Assess Nutrient Intakesof New Zealand Adults.

Nutrients 2020 Feb 27;12(3). Epub 2020 Feb 27.

Department of Social and Preventive Medicine, University of Otago, PO Box 56, Dunedin, New Zealand.

There is no recent validated short food frequency questionnaire (FFQ) for use in NewZealand (NZ) adults. This study aimed to evaluate the relative validity and reproducibility of a shortFFQ in free-living NZ adults aged 30-59 years. A 57-item, semi-quantitative FFQ was developedand pre-tested. During a 12-month study period the FFQ was administrated twice with a 9-monthinterval between administrations. Four two-day diet records were collected at months 0, 3, 6, and 9and a blood sample was taken at month 9. Spearman correlations were used to evaluate the validityof the FFQ with the eight-day diet records and selected biomarkers. Cross-classification analysisand the Bland-Altman method were used to assess the agreement between the FFQ and the dietrecord. Reproducibility over nine months was assessed using intra-class correlations. A total of 132males and females completed both FFQs, the eight-day diet record, and provided a blood sample.The highest energy-adjusted correlation coefficients were observed for alcohol (0.81), cholesterol(0.61), and carbohydrate (0.61), with the lowest for sodium (0.29), thiamin (0.33), and niacinequivalents (0.34). More than three quarters of the participants were correctly classified into thesame or adjacent quartile for most nutrients, with a low proportion of participants being grosslymisclassified (< 10%). For most nutrients, the limits of agreement from the Bland-Altman analyseswere between 50% and 250%. A positive correlation was observed between dietary intakes andplasma biomarkers for all selected nutrients. The FFQ showed moderate to good reproducibility,with almost all reliability coefficients ranging from 0.60 to 0.80. This short FFQ was shown to validlyand reliably rank individuals by their habitual intake of most major nutrients, indicating that theFFQ will offer a time-efficient way to assess the nutrient intake of NZ adults in future research.
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http://dx.doi.org/10.3390/nu12030619DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7146506PMC
February 2020

Circulating Levels of Insulin-like Growth Factor 1 and Insulin-like Growth Factor Binding Protein 3 Associate With Risk of Colorectal Cancer Based on Serologic and Mendelian Randomization Analyses.

Gastroenterology 2020 04 27;158(5):1300-1312.e20. Epub 2019 Dec 27.

Department of Cancer Biology and Genetics and the Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio.

Background & Aims: Human studies examining associations between circulating levels of insulin-like growth factor 1 (IGF1) and insulin-like growth factor binding protein 3 (IGFBP3) and colorectal cancer risk have reported inconsistent results. We conducted complementary serologic and Mendelian randomization (MR) analyses to determine whether alterations in circulating levels of IGF1 or IGFBP3 are associated with colorectal cancer development.

Methods: Serum levels of IGF1 were measured in blood samples collected from 397,380 participants from the UK Biobank, from 2006 through 2010. Incident cancer cases and cancer cases recorded first in death certificates were identified through linkage to national cancer and death registries. Complete follow-up was available through March 31, 2016. For the MR analyses, we identified genetic variants associated with circulating levels of IGF1 and IGFBP3. The association of these genetic variants with colorectal cancer was examined with 2-sample MR methods using genome-wide association study consortia data (52,865 cases with colorectal cancer and 46,287 individuals without [controls]) RESULTS: After a median follow-up period of 7.1 years, 2665 cases of colorectal cancer were recorded. In a multivariable-adjusted model, circulating level of IGF1 associated with colorectal cancer risk (hazard ratio per 1 standard deviation increment of IGF1, 1.11; 95% confidence interval [CI] 1.05-1.17). Similar associations were found by sex, follow-up time, and tumor subsite. In the MR analyses, a 1 standard deviation increment in IGF1 level, predicted based on genetic factors, was associated with a higher risk of colorectal cancer risk (odds ratio 1.08; 95% CI 1.03-1.12; P = 3.3 × 10). Level of IGFBP3, predicted based on genetic factors, was associated with colorectal cancer risk (odds ratio per 1 standard deviation increment, 1.12; 95% CI 1.06-1.18; P = 4.2 × 10). Colorectal cancer risk was associated with only 1 variant in the IGFBP3 gene region (rs11977526), which also associated with anthropometric traits and circulating level of IGF2.

Conclusions: In an analysis of blood samples from almost 400,000 participants in the UK Biobank, we found an association between circulating level of IGF1 and colorectal cancer. Using genetic data from 52,865 cases with colorectal cancer and 46,287 controls, a higher level of IGF1, determined by genetic factors, was associated with colorectal cancer. Further studies are needed to determine how this signaling pathway might contribute to colorectal carcinogenesis.
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http://dx.doi.org/10.1053/j.gastro.2019.12.020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7152801PMC
April 2020

Risks of ischaemic heart disease and stroke in meat eaters, fish eaters, and vegetarians over 18 years of follow-up: results from the prospective EPIC-Oxford study.

BMJ 2019 09 4;366:l4897. Epub 2019 Sep 4.

Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Oxford OX3 7LF, UK.

Objective: To examine the associations of vegetarianism with risks of ischaemic heart disease and stroke.

Design: Prospective cohort study.

Setting: The EPIC-Oxford study, a cohort in the United Kingdom with a large proportion of non-meat eaters, recruited across the country between 1993 and 2001.

Participants: 48 188 participants with no history of ischaemic heart disease, stroke, or angina (or cardiovascular disease) were classified into three distinct diet groups: meat eaters (participants who consumed meat, regardless of whether they consumed fish, dairy, or eggs; n=24 428), fish eaters (consumed fish but no meat; n=7506), and vegetarians including vegans (n=16 254), based on dietary information collected at baseline, and subsequently around 2010 (n=28 364).

Main Outcome Measures: Incident cases of ischaemic heart disease and stroke (including ischaemic and haemorrhagic types) identified through record linkage until 2016.

Results: Over 18.1 years of follow-up, 2820 cases of ischaemic heart disease and 1072 cases of total stroke (519 ischaemic stroke and 300 haemorrhagic stroke) were recorded. After adjusting for sociodemographic and lifestyle confounders, fish eaters and vegetarians had 13% (hazard ratio 0.87, 95% confidence interval 0.77 to 0.99) and 22% (0.78, 0.70 to 0.87) lower rates of ischaemic heart disease than meat eaters, respectively (P<0.001 for heterogeneity). This difference was equivalent to 10 fewer cases of ischaemic heart disease (95% confidence interval 6.7 to 13.1 fewer) in vegetarians than in meat eaters per 1000 population over 10 years. The associations for ischaemic heart disease were partly attenuated after adjustment for self reported high blood cholesterol, high blood pressure, diabetes, and body mass index (hazard ratio 0.90, 95% confidence interval 0.81 to 1.00 in vegetarians with all adjustments). By contrast, vegetarians had 20% higher rates of total stroke (hazard ratio 1.20, 95% confidence interval 1.02 to 1.40) than meat eaters, equivalent to three more cases of total stroke (95% confidence interval 0.8 to 5.4 more) per 1000 population over 10 years, mostly due to a higher rate of haemorrhagic stroke. The associations for stroke did not attenuate after further adjustment of disease risk factors.

Conclusions: In this prospective cohort in the UK, fish eaters and vegetarians had lower rates of ischaemic heart disease than meat eaters, although vegetarians had higher rates of haemorrhagic and total stroke.
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http://dx.doi.org/10.1136/bmj.l4897DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6724406PMC
September 2019

Validation of the Oxford WebQ Online 24-Hour Dietary Questionnaire Using Biomarkers.

Am J Epidemiol 2019 10;188(10):1858-1867

Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, United Kingdom.

The Oxford WebQ is an online 24-hour dietary questionnaire that is appropriate for repeated administration in large-scale prospective studies, including the UK Biobank study and the Million Women Study. We compared the performance of the Oxford WebQ and a traditional interviewer-administered multiple-pass 24-hour dietary recall against biomarkers for protein, potassium, and total sugar intake and total energy expenditure estimated by accelerometry. We recruited 160 participants in London, United Kingdom, between 2014 and 2016 and measured their biomarker levels at 3 nonconsecutive time points. The measurement error model simultaneously compared all 3 methods. Attenuation factors for protein, potassium, total sugar, and total energy intakes estimated as the mean of 2 applications of the Oxford WebQ were 0.37, 0.42, 0.45, and 0.31, respectively, with performance improving incrementally for the mean of more measures. Correlation between the mean value from 2 Oxford WebQs and estimated true intakes, reflecting attenuation when intake is categorized or ranked, was 0.47, 0.39, 0.40, and 0.38, respectively, also improving with repeated administration. These correlations were similar to those of the more administratively burdensome interviewer-based recall. Using objective biomarkers as the standard, the Oxford WebQ performs well across key nutrients in comparison with more administratively burdensome interviewer-based 24-hour recalls. Attenuation improves when the average value is taken over repeated administrations, reducing measurement error bias in assessment of diet-disease associations.
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http://dx.doi.org/10.1093/aje/kwz165DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7254925PMC
October 2019

Hematological parameters and prevalence of anemia in white and British Indian vegetarians and nonvegetarians in the UK Biobank.

Am J Clin Nutr 2019 08;110(2):461-472

Cancer Epidemiology Unit, Nuffield Department of Population Health, Oxford, United Kingdom.

Background: There may be differences in hematological parameters between meat-eaters and vegetarians.

Objective: The aim of this study was to perform cross-sectional analyses of hematological parameters by diet group in a large cohort in the United Kingdom.

Methods: A complete blood count was carried out in all UK Biobank participants at recruitment (2006-2010). We examined hemoglobin, red and white blood cell counts, and platelet counts and volume in regular meat eaters (>3 times/wk of red/processed meat consumption, n = 212,831), low meat eaters (n = 213,092), poultry eaters (n = 4815), fish eaters (n = 10,042), vegetarians (n = 6548), and vegans (n = 398) of white ethnicity and meat eaters (n = 3875) and vegetarians (n = 1362) of British Indian ethnicity.

Results: In both white and British Indian populations, compared with regular meat eaters (or meat eaters in Indians), the other diet groups had up to 3.7% lower age-adjusted hemoglobin concentrations (difference not significant in white vegan women) and were generally more likely to have anemia (e.g., 8.7% of regular meat eaters compared with 12.8% of vegetarians in white premenopausal women; P < 0.05 after Bonferroni correction). In the white population, compared with regular meat eaters, all other diet groups had lower age- and sex-adjusted total white cells, neutrophils, lymphocytes, monocytes, and eosinophils (P-heterogeneity < 0.001 for all), but basophil counts were similar across diet groups; in British Indians, there was no significant difference in any of the white blood cell counts by diet group. Compared with white regular meat eaters, the low meat eaters, poultry eaters, fish eaters, and vegans had significantly lower platelet counts and higher platelet volume, whereas vegetarians had higher counts and lower volume. Compared with British Indian meat eaters, vegetarians had higher platelet count and lower volume.

Conclusions: In the UK Biobank, people with low or no red meat intake generally had lower hemoglobin concentrations and were slightly more likely to be anemic. The lower white blood cell counts observed in low and non-meat eaters, and differences in mean platelet counts and volume between diet groups, warrant further investigation. This observational study was registered at http://www.isrctn.com/ as ISRCTN10125697.
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http://dx.doi.org/10.1093/ajcn/nqz072DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6669054PMC
August 2019

Adult cancer risk in women who were breastfed as infants: large UK prospective study.

Eur J Epidemiol 2019 Sep 11;34(9):863-870. Epub 2019 Jun 11.

Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK.

There are known short-term benefits in breastfed infants versus bottle-fed infants in terms of lower risks of infection and obesity in infancy and childhood, but the long-term effect on the risk of adult cancers is unclear. In a cohort of 1 in 4 UK women born in 1935-1950 we report the incidence of adult cancers in relation to having been breastfed in infancy. In median year 2001 (interquartile range 2000-2003) 548,741 women without prior cancer reported whether they had been breastfed. There was 81% agreement between women's report of having been breastfed and information on breastfeeding recorded when they were 2 years old. Participants were followed by record-linkage to national cancer registration, hospital admission and death databases. Cox regression yielded adjusted relative risks (RRs) and 95% confidence intervals (CI) by having been breastfed or not for eight cancer sites with > 2000 incident cases and for related conditions, where appropriate. Of the eight cancers examined here one association was highly statistically significant: an increase in colorectal cancer incidence among women who had been breastfed versus not (RR 1.18, 95% CI 1.12-1.24, n = 8651). To investigate further the findings for colorectal cancer, we studied eight other gastro-intestinal conditions, and found increased risks in women who had been breastfed versus not for benign colorectal polyps (RR 1.09, 95% CI 1.05-1.13, n = 17,677) and for appendicitis (RR 1.19, 95% CI 1.07-1.31, n = 2108). The greater risks of adult colorectal cancer, colorectal polyps and appendicitis associated with having been breastfed in infancy suggest possible long-term effects of infant feeding practices on the gastrointestinal tract. Further studies are required to clarify this novel association.
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http://dx.doi.org/10.1007/s10654-019-00528-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6759744PMC
September 2019

Fluid Intake and Dietary Factors and the Risk of Incident Kidney Stones in UK Biobank: A Population-based Prospective Cohort Study.

Eur Urol Focus 2020 07 10;6(4):752-761. Epub 2019 May 10.

Oxford Stone Group, Oxford University Hospitals NHS Trust, Oxford, UK.

Background: Fluid intake and diet are thought to influence kidney stone risk. However, prospective studies have been limited to small samples sizes and/or restricted measures.

Objective: To investigate whether fluid intake and dietary factors are associated with the risk of developing a first kidney stone.

Design, Setting, And Participants: Participants were selected from UK Biobank, a population-based prospective cohort study.

Outcome Measurements And Statistical Analysis: Cox proportional hazards models were used to investigate the association between fluid intake and dietary factors and the risk of a first incident kidney stone, ascertained from hospital inpatient records.

Results And Limitations: After exclusion, 439 072 participants were available for the analysis, of whom 2057 had hospital admission with an incident kidney stone over a mean of 6.1 yr of follow-up. For every additional drink (200 ml) consumed per day of total fluid, the risk of kidney stones declined by 13% (hazard ratio [HR] = 0.87, 95% confidence interval [CI] 0.85-0.89). Similar patterns of associations were observed for tea, coffee, and alcohol, although no association was observed for water intake. Fruit and fibre intake was also associated with a lower risk (HR per 100 g increase of fruits per day = 0.88, 95% CI 0.83-0.93, and HR per 10 g fibre per day = 0.82, 95% CI 0.77-0.87), whereas meat and salt intake was associated with a higher risk (HR per 50 g increase in meat per week = 1.17, 95% CI 1.05-1.29, and HR for always vs never/rarely added salt to food = 1.33, 95% CI 1.12-1.58). Vegetable, fish, and cheese intake was not associated with kidney stone risk.

Conclusions: The finding that high intake of total fluid, fruit, and fibre was associated with a lower risk of hospitalisation for a first kidney stone suggests that modifiable dietary factors could be targeted to prevent kidney stone development.

Patient Summary: We found that higher intake of total fluid, specifically tea, coffee, and alcohol (but not water), and consumption of fruit and foods high in fibre are linked with a reduced likelihood of developing kidney stones.
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http://dx.doi.org/10.1016/j.euf.2019.05.002DOI Listing
July 2020

Association of Selenoprotein and Selenium Pathway Genotypes with Risk of Colorectal Cancer and Interaction with Selenium Status.

Nutrients 2019 Apr 25;11(4). Epub 2019 Apr 25.

Unit of Nutrition and Cancer, Catalan Institute of Oncology (ICO-IDIBELL), L'Hospitalet de Llobregat, 08908 Barcelona, Spain.

Selenoprotein genetic variations and suboptimal selenium (Se) levels may contribute to the risk of colorectal cancer (CRC) development. We examined the association between CRC risk and genotype for single nucleotide polymorphisms (SNPs) in selenoprotein and Se metabolic pathway genes. assays were designed and resulted in the genotyping of 1040 variants in 154 genes from 1420 cases and 1421 controls within the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Multivariable logistic regression revealed an association of 144 individual SNPs from 63 Se pathway genes with CRC risk. However, regarding the selenoprotein genes, only rs11111979 retained borderline statistical significance after adjustment for correlated tests ( = 0.10; significance threshold was < 0.1). SNPs in Wingless/Integrated (Wnt) and Transforming growth factor (TGF) beta-signaling genes (, , ) from pathways affected by Se intake were also associated with CRC risk after multiple testing adjustments. Interactions with Se status (using existing serum Se and Selenoprotein P data) were tested at the SNP, gene, and pathway levels. Pathway analyses using the modified Adaptive Rank Truncated Product method suggested that genes and gene x Se status interactions in antioxidant, apoptosis, and TGF-beta signaling pathways may be associated with CRC risk. This study suggests that SNPs in the Se pathway alone or in combination with suboptimal Se status may contribute to CRC development.
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http://dx.doi.org/10.3390/nu11040935DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6520820PMC
April 2019

Consumption of Meat, Fish, Dairy Products, and Eggs and Risk of Ischemic Heart Disease.

Circulation 2019 06 22;139(25):2835-2845. Epub 2019 Apr 22.

Instituto de Salud Pública de Navarra, IdiSNA-Navarre Institute for Health Research, Pamplona, Spain (C.M.-I.).

Background: There is uncertainty about the relevance of animal foods to the pathogenesis of ischemic heart disease (IHD). We examined meat, fish, dairy products, and eggs and risk for IHD in the pan-European EPIC cohort (European Prospective Investigation Into Cancer and Nutrition).

Methods: In this prospective study of 409 885 men and women in 9 European countries, diet was assessed with validated questionnaires and calibrated with 24-hour recalls. Lipids and blood pressure were measured in a subsample. During a mean of 12.6 years of follow-up, 7198 participants had a myocardial infarction or died of IHD. The relationships of animal foods with risk were examined with Cox regression with adjustment for other animal foods and relevant covariates.

Results: The hazard ratio (HR) for IHD was 1.19 (95% CI, 1.06-1.33) for a 100-g/d increment in intake of red and processed meat, and this remained significant after exclusion of the first 4 years of follow-up (HR, 1.25 [95% CI, 1.09-1.42]). Risk was inversely associated with intakes of yogurt (HR, 0.93 [95% CI, 0.89-0.98] per 100-g/d increment), cheese (HR, 0.92 [95% CI, 0.86-0.98] per 30-g/d increment), and eggs (HR, 0.93 [95% CI, 0.88-0.99] per 20-g/d increment); the associations with yogurt and eggs were attenuated and nonsignificant after exclusion of the first 4 years of follow-up. Risk was not significantly associated with intakes of poultry, fish, or milk. In analyses modeling dietary substitutions, replacement of 100 kcal/d from red and processed meat with 100 kcal/d from fatty fish, yogurt, cheese, or eggs was associated with ≈20% lower risk of IHD. Consumption of red and processed meat was positively associated with serum non-high-density lipoprotein cholesterol concentration and systolic blood pressure, and consumption of cheese was inversely associated with serum non-high-density lipoprotein cholesterol.

Conclusions: Risk for IHD was positively associated with consumption of red and processed meat and inversely associated with consumption of yogurt, cheese, and eggs, although the associations with yogurt and eggs may be influenced by reverse causation bias. It is not clear whether the associations with red and processed meat and cheese reflect causality, but they were consistent with the associations of these foods with plasma non-high-density lipoprotein cholesterol and for red and processed meat with systolic blood pressure, which could mediate such effects.
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http://dx.doi.org/10.1161/CIRCULATIONAHA.118.038813DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6629175PMC
June 2019

Diet and colorectal cancer in UK Biobank: a prospective study.

Int J Epidemiol 2020 02;49(1):246-258

Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.

Background: Most of the previous studies on diet and colorectal cancer were based on diets consumed during the 1990s.

Methods: We used Cox-regression models to estimate adjusted hazard ratios for colorectal cancer by dietary factors in the UK Biobank study. Men and women aged 40-69 years at recruitment (2006-10) reported their diet on a short food-frequency questionnaire (n = 475 581). Dietary intakes were re-measured in a large sub-sample (n = 175 402) who completed an online 24-hour dietary assessment during follow-up. Trends in risk across the baseline categories were calculated by assigning re-measured intakes to allow for measurement error and changes in intake over time.

Results: During an average of 5.7 years of follow-up, 2609 cases of colorectal cancer occurred. Participants who reported consuming an average of 76 g/day of red and processed meat compared with 21 g/day had a 20% [95% confidence interval (CI): 4-37] higher risk of colorectal cancer. Participants in the highest fifth of intake of fibre from bread and breakfast cereals had a 14% (95% CI: 2-24) lower risk of colorectal cancer. Alcohol was associated with an 8% (95% CI: 4-12) higher risk per 10 g/day higher intake. Fish, poultry, cheese, fruit, vegetables, tea and coffee were not associated with colorectal-cancer risk.

Conclusions: Consumption of red and processed meat at an average level of 76 g/d that meets the current UK government recommendation (≤90 g/day) was associated with an increased risk of colorectal cancer. Alcohol was also associated with an increased risk of colorectal cancer, whereas fibre from bread and breakfast cereals was associated with a reduced risk.
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http://dx.doi.org/10.1093/ije/dyz064DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7124508PMC
February 2020

Comparison of Major Protein-Source Foods and Other Food Groups in Meat-Eaters and Non-Meat-Eaters in the EPIC-Oxford Cohort.

Nutrients 2019 Apr 11;11(4). Epub 2019 Apr 11.

Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK.

Differences in health outcomes between meat-eaters and non-meat-eaters might relate to differences in dietary intakes between these diet groups. We assessed intakes of major protein-source foods and other food groups in six groups of meat-eaters and non-meat-eaters participating in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Oxford study. The data were from 30,239 participants who answered questions regarding their consumption of meat, fish, dairy or eggs and completed a food frequency questionnaire (FFQ) in 2010. Participants were categorized as regular meat-eaters, low meat-eaters, poultry-eaters, fish-eaters, vegetarians and vegans. FFQ foods were categorized into 45 food groups and analysis of variance was used to test for differences between age-adjusted mean intakes of each food group by diet group. Regular meat-eaters, vegetarians and vegans, respectively, consumed about a third, quarter and a fifth of their total energy intake from high protein-source foods. Compared with regular meat-eaters, low and non-meat-eaters consumed higher amounts of high-protein meat alternatives (soy, legumes, pulses, nuts, seeds) and other plant-based foods (whole grains, vegetables, fruits) and lower amounts of refined grains, fried foods, alcohol and sugar-sweetened beverages. These findings provide insight into potential nutritional explanations for differences in health outcomes between diet groups.
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http://dx.doi.org/10.3390/nu11040824DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521004PMC
April 2019

Understanding the relation between BMI and mortality.

BMJ 2019 03 26;364:l1219. Epub 2019 Mar 26.

MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.

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http://dx.doi.org/10.1136/bmj.l1219DOI Listing
March 2019

RE: "ASSOCIATIONS OF DIETARY PROTEIN INTAKE WITH FAT-FREE MASS AND GRIP STRENGTH: A CROSS-SECTIONAL STUDY IN 146,816 UK BIOBANK PARTICIPANTS".

Am J Epidemiol 2019 05;188(5):977-978

Cancer Epidemiology Unit, Nuffield Department of Population Health, Medical Sciences Division, University of Oxford, Oxford, United Kingdom.

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http://dx.doi.org/10.1093/aje/kwz029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6664385PMC
May 2019

Foods, macronutrients and breast cancer risk in postmenopausal women: a large UK cohort.

Int J Epidemiol 2019 04;48(2):489-500

Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.

Background: The role of diet in breast cancer aetiology is unclear; recent studies have suggested associations may differ by estrogen receptor status.

Methods: Baseline diet was assessed in 2000-04 using a validated questionnaire in 691 571 postmenopausal UK women without previous cancer, who had not changed their diet recently. They were followed by record linkage to national cancer and death databases. Cox regression yielded adjusted relative risks for breast cancer for 10 food items and eight macronutrients, subdivided mostly into five categories of baseline intake. Trends in risk across the baseline categories were calculated, assigning re-measured intakes to allow for measurement error and changes in intake over time; P-values allowed for multiple testing.

Results: Women aged 59.9 (standard deviation (SD 4.9)) years at baseline were followed for 12 (SD 3) years; 29 005 were diagnosed with invasive breast cancer. Alcohol intake had the strongest association with breast cancer incidence: relative risk (RR) 1.08 [99% confidence interval (CI) 1.05-1.11] per 10 g/day higher intake, P = 5.8 × 10-14. There were inverse associations with fruit: RR 0.94 (99% CI 0.92-0.97) per 100 g/day higher intake, P = 1.1 × 10-6, and dietary fibre: RR 0.91 (99% CI 0.87-0.96) per 5 g/day increase, P = 1.1 × 10-4. Fruit and fibre intakes were correlated (ρ = 0.62) and were greater among women who were not overweight, so residual confounding cannot be excluded. There was no heterogeneity for any association by estrogen receptor status.

Conclusions: By far the strongest association was between alcohol intake and an increased risk of breast cancer. Of the other 17 intakes examined, higher intakes of fruit and fibre were associated with lower risks of breast cancer, but it is unclear whether or not these associations are causal.
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http://dx.doi.org/10.1093/ije/dyy238DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6469308PMC
April 2019

Nutritional quality of food as represented by the FSAm-NPS nutrient profiling system underlying the Nutri-Score label and cancer risk in Europe: Results from the EPIC prospective cohort study.

PLoS Med 2018 09 18;15(9):e1002651. Epub 2018 Sep 18.

Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy.

Background: Helping consumers make healthier food choices is a key issue for the prevention of cancer and other diseases. In many countries, political authorities are considering the implementation of a simplified labelling system to reflect the nutritional quality of food products. The Nutri-Score, a five-colour nutrition label, is derived from the Nutrient Profiling System of the British Food Standards Agency (modified version) (FSAm-NPS). How the consumption of foods with high/low FSAm-NPS relates to cancer risk has been studied in national/regional cohorts but has not been characterized in diverse European populations.

Methods And Findings: This prospective analysis included 471,495 adults from the European Prospective Investigation into Cancer and Nutrition (EPIC, 1992-2014, median follow-up: 15.3 y), among whom there were 49,794 incident cancer cases (main locations: breast, n = 12,063; prostate, n = 6,745; colon-rectum, n = 5,806). Usual food intakes were assessed with standardized country-specific diet assessment methods. The FSAm-NPS was calculated for each food/beverage using their 100-g content in energy, sugar, saturated fatty acid, sodium, fibres, proteins, and fruits/vegetables/legumes/nuts. The FSAm-NPS scores of all food items usually consumed by a participant were averaged to obtain the individual FSAm-NPS Dietary Index (DI) scores. Multi-adjusted Cox proportional hazards models were computed. A higher FSAm-NPS DI score, reflecting a lower nutritional quality of the food consumed, was associated with a higher risk of total cancer (HRQ5 versus Q1 = 1.07; 95% CI 1.03-1.10, P-trend < 0.001). Absolute cancer rates in those with high and low (quintiles 5 and 1) FSAm-NPS DI scores were 81.4 and 69.5 cases/10,000 person-years, respectively. Higher FSAm-NPS DI scores were specifically associated with higher risks of cancers of the colon-rectum, upper aerodigestive tract and stomach, lung for men, and liver and postmenopausal breast for women (all P < 0.05). The main study limitation is that it was based on an observational cohort using self-reported dietary data obtained through a single baseline food frequency questionnaire; thus, exposure misclassification and residual confounding cannot be ruled out.

Conclusions: In this large multinational European cohort, the consumption of food products with a higher FSAm-NPS score (lower nutritional quality) was associated with a higher risk of cancer. This supports the relevance of the FSAm-NPS as underlying nutrient profiling system for front-of-pack nutrition labels, as well as for other public health nutritional measures.
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http://dx.doi.org/10.1371/journal.pmed.1002651DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6143197PMC
September 2018

Circulating insulin-like growth factor I in relation to melanoma risk in the European prospective investigation into cancer and nutrition.

Int J Cancer 2019 03 7;144(5):957-966. Epub 2018 Dec 7.

Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs, GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain.

Insulin-like growth factor-I (IGF-I) regulates cell proliferation and apoptosis, and is thought to play a role in tumour development. Previous prospective studies have shown that higher circulating concentrations of IGF-I are associated with a higher risk of cancers at specific sites, including breast and prostate. No prospective study has examined the association between circulating IGF-I concentrations and melanoma risk. A nested case-control study of 1,221 melanoma cases and 1,221 controls was performed in the European Prospective Investigation into Cancer and Nutrition cohort, a prospective cohort of 520,000 participants recruited from 10 European countries. Conditional logistic regression was used to estimate odds ratios (ORs) for incident melanoma in relation to circulating IGF-I concentrations, measured by immunoassay. Analyses were conditioned on the matching factors and further adjusted for age at blood collection, education, height, BMI, smoking status, alcohol intake, marital status, physical activity and in women only, use of menopausal hormone therapy. There was no significant association between circulating IGF-I concentration and melanoma risk (OR for highest vs lowest fifth = 0.93 [95% confidence interval [CI]: 0.71 to 1.22]). There was no significant heterogeneity in the association between IGF-I concentrations and melanoma risk when subdivided by gender, age at blood collection, BMI, height, age at diagnosis, time between blood collection and diagnosis, or by anatomical site or histological subtype of the tumour (Pheterogeneity≥0.078). We found no evidence for an association between circulating concentrations of IGF-I measured in adulthood and the risk of melanoma.
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http://dx.doi.org/10.1002/ijc.31854DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6481548PMC
March 2019

Dietary folate intake and pancreatic cancer risk: Results from the European prospective investigation into cancer and nutrition.

Int J Cancer 2019 04 21;144(7):1511-1521. Epub 2018 Dec 21.

Department of Clinical Pharmacology, Pharmacology and Clinical Neurosciences, Umeå University, Umeå, Sweden.

Pancreatic cancer (PC) has an exceptionally low survival rate and primary prevention strategies are limited. Folate plays an important role in one-carbon metabolism and has been associated with the risk of several cancers, but not consistently with PC risk. We aimed to investigate the association between dietary folate intake and PC risk, using the standardised folate database across 10 European countries. A total of 477,206 participants were followed up for 11 years, during which 865 incident primary PC cases were recorded. Folate intake was energy-adjusted using the residual method. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models. In multivariable analyses stratified by age, sex, study centre and adjusted for energy intake, smoking status, BMI, educational level, diabetes status, supplement use and dietary fibre intake, we found no significant association between folate intake and PC risk: the HR of PC risk for those in the highest quartile of folate intake (≥353 μg/day) compared to the lowest (<241 μg/day) was 0.81 (95% CI: 0.51, 1.31; p = 0.38). In current smokers, a positive trend was observed in PC risk across folate quartiles [HR = 4.42 (95% CI: 1.05, 18.62) for ≥353 μg/day vs. <241 μg/day, p = 0.01]. Nonetheless, there was no significant interaction between smoking and dietary folate intake (p = 0.99). We found no association between dietary folate intake and PC risk in this large European study.
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http://dx.doi.org/10.1002/ijc.31830DOI Listing
April 2019

Heterogeneity of Colorectal Cancer Risk Factors by Anatomical Subsite in 10 European Countries: A Multinational Cohort Study.

Clin Gastroenterol Hepatol 2019 06 26;17(7):1323-1331.e6. Epub 2018 Jul 26.

Hellenic Health Foundation, Athens, Greece; Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Haidari, Greece.

Background & Aims: Colorectal cancer located at different anatomical subsites may have distinct etiologies and risk factors. Previous studies that have examined this hypothesis have yielded inconsistent results, possibly because most studies have been of insufficient size to identify heterogeneous associations with precision.

Methods: In the European Prospective Investigation into Cancer and Nutrition study, we used multivariable joint Cox proportional hazards models, which accounted for tumors at different anatomical sites (proximal colon, distal colon, and rectum) as competing risks, to examine the relationships between 14 established/suspected lifestyle, anthropometric, and reproductive/menstrual risk factors with colorectal cancer risk. Heterogeneity across sites was tested using Wald tests.

Results: After a median of 14.9 years of follow-up of 521,330 men and women, 6291 colorectal cancer cases occurred. Physical activity was related inversely to proximal colon and distal colon cancer, but not to rectal cancer (P heterogeneity = .03). Height was associated positively with proximal and distal colon cancer only, but not rectal cancer (P heterogeneity = .0001). For men, but not women, heterogeneous relationships were observed for body mass index (P heterogeneity = .008) and waist circumference (P heterogeneity = .03), with weaker positive associations found for rectal cancer, compared with proximal and distal colon cancer. Current smoking was associated with a greater risk of rectal and proximal colon cancer, but not distal colon cancer (P heterogeneity = .05). No heterogeneity by anatomical site was found for alcohol consumption, diabetes, nonsteroidal anti-inflammatory drug use, and reproductive/menstrual factors.

Conclusions: The relationships between physical activity, anthropometry, and smoking with colorectal cancer risk differed by subsite, supporting the hypothesis that tumors in different anatomical regions may have distinct etiologies.
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http://dx.doi.org/10.1016/j.cgh.2018.07.030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6542674PMC
June 2019

Anthropometric and physiologic characteristics in white and British Indian vegetarians and nonvegetarians in the UK Biobank.

Am J Clin Nutr 2018 06;107(6):909-920

Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.

Background: A detailed description of anthropometric and physiologic characteristics of persons in different diet groups is lacking.

Objective: We aimed to perform cross-sectional analyses of diet group with anthropometric and physiologic characteristics in a large cohort in the United Kingdom.

Design: The UK Biobank recruited ∼500,000 middle-aged participants throughout the United Kingdom in 2006-2010. Anthropometric indexes (height, weight, waist and hip circumference, body composition) and other physiologic characteristics (heel bone mineral density, grip strength, blood pressure, pulse rate) were measured following standardized protocols. We estimated the age-adjusted means of each characteristic in 6 diet groups (198,166 regular meat eaters, 199,784 low meat eaters, 4381 poultry eaters, 9674 fish eaters, 6366 vegetarians, and 378 vegans) in white women and men, and in 2 diet groups (3322 meat eaters and 1186 vegetarians) in British Indian women and men.

Results: In white women, after adjustment for age and compared with regular meat eaters, non-red meat eaters had lower adiposity (e.g., 4.5% lower body fat in vegan women) and lower systolic and diastolic blood pressure (-4.2 and -3.3 mm Hg, respectively), and generally lower heel bone mineral density t-score (-0.26). Patterns of differences by diet group were similar in white men. In the Indian population, compared with meat eaters, vegetarian women were shorter (-1.1 cm) and had lower lean mass (-0.5 kg), and both vegetarian women and men had lower grip strength (-1.3 and -1.4 kg, respectively). No significant differences in the other characteristics were observed.

Conclusions: Differences in anthropometric and physiologic characteristics were observed across diet groups in white participants, but fewer differences were observed in British Indian participants. The observed differences may be important as intermediate markers of long-term health in different diet groups. This observational study was registered at http://www.isrctn.com/ as ISRCTN10125697.
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http://dx.doi.org/10.1093/ajcn/nqy042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5985736PMC
June 2018

A prospective evaluation of plasma polyphenol levels and colon cancer risk.

Int J Cancer 2018 10 11;143(7):1620-1631. Epub 2018 Jun 11.

Dipartimento di Medicina Clinica e Sperimentale, Federico II University, Naples, Italy.

Polyphenols have been shown to exert biological activity in experimental models of colon cancer; however, human data linking specific polyphenols to colon cancer is limited. We assessed the relationship between pre-diagnostic plasma polyphenols and colon cancer risk in a case-control study nested within the European Prospective Investigation into Cancer and Nutrition study. Using high pressure liquid chromatography coupled to tandem mass spectrometry, we measured concentrations of 35 polyphenols in plasma from 809 incident colon cancer cases and 809 matched controls. We used multivariable adjusted conditional logistic regression models that included established colon cancer risk factors. The false discovery rate (q ) was computed to control for multiple comparisons. All statistical tests were two-sided. After false discovery rate correction and in continuous log -transformed multivariable models, equol (odds ratio [OR] per log -value, 0.86, 95% confidence interval [95% CI] = 0.79-0.93; q  = 0.01) and homovanillic acid (OR per log -value, 1.46, 95% CI = 1.16-1.84; q  = 0.02) were associated with colon cancer risk. Comparing extreme fifths, equol concentrations were inversely associated with colon cancer risk (OR = 0.61, 95% CI = 0.41-0.91, p  = 0.003), while homovanillic acid concentrations were positively associated with colon cancer development (OR = 1.72, 95% CI = 1.17-2.53, p  < 0.0001). No heterogeneity for these associations was observed by sex and across other colon cancer risk factors. The remaining polyphenols were not associated with colon cancer risk. Higher equol concentrations were associated with lower risk, and higher homovanillic acid concentrations were associated with greater risk of colon cancer. These findings support a potential role for specific polyphenols in colon tumorigenesis.
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http://dx.doi.org/10.1002/ijc.31563DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6175205PMC
October 2018

Comparison of prognostic models to predict the occurrence of colorectal cancer in asymptomatic individuals: a systematic literature review and external validation in the EPIC and UK Biobank prospective cohort studies.

Gut 2019 04 3;68(4):672-683. Epub 2018 Apr 3.

Department of Community Medicine, Faculty of Health Sciences, University of Tromso, The Arctic University of Norway, Tromso, Norway.

Objective: To systematically identify and validate published colorectal cancer risk prediction models that do not require invasive testing in two large population-based prospective cohorts.

Design: Models were identified through an update of a published systematic review and validated in the European Prospective Investigation into Cancer and Nutrition (EPIC) and the UK Biobank. The performance of the models to predict the occurrence of colorectal cancer within 5 or 10 years after study enrolment was assessed by discrimination (C-statistic) and calibration (plots of observed vs predicted probability).

Results: The systematic review and its update identified 16 models from 8 publications (8 colorectal, 5 colon and 3 rectal). The number of participants included in each model validation ranged from 41 587 to 396 515, and the number of cases ranged from 115 to 1781. Eligible and ineligible participants across the models were largely comparable. Calibration of the models, where assessable, was very good and further improved by recalibration. The C-statistics of the models were largely similar between validation cohorts with the highest values achieved being 0.70 (95% CI 0.68 to 0.72) in the UK Biobank and 0.71 (95% CI 0.67 to 0.74) in EPIC.

Conclusion: Several of these non-invasive models exhibited good calibration and discrimination within both external validation populations and are therefore potentially suitable candidates for the facilitation of risk stratification in population-based colorectal screening programmes. Future work should both evaluate this potential, through modelling and impact studies, and ascertain if further enhancement in their performance can be obtained.
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http://dx.doi.org/10.1136/gutjnl-2017-315730DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6580880PMC
April 2019

Lifetime and baseline alcohol intakes and risk of pancreatic cancer in the European Prospective Investigation into Cancer and Nutrition study.

Int J Cancer 2018 08 30;143(4):801-812. Epub 2018 Mar 30.

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

Recent evidence suggested a weak relationship between alcohol consumption and pancreatic cancer (PC) risk. In our study, the association between lifetime and baseline alcohol intakes and the risk of PC was evaluated, including the type of alcoholic beverages and potential interaction with smoking. Within the European Prospective Investigation into Cancer and Nutrition (EPIC) study, 1,283 incident PC (57% women) were diagnosed from 476,106 cancer-free participants, followed up for 14 years. Amounts of lifetime and baseline alcohol were estimated through lifestyle and dietary questionnaires, respectively. Cox proportional hazard models with age as primary time variable were used to estimate PC hazard ratios (HR) and their 95% confidence interval (CI). Alcohol intake was positively associated with PC risk in men. Associations were mainly driven by extreme alcohol levels, with HRs comparing heavy drinkers (>60 g/day) to the reference category (0.1-4.9 g/day) equal to 1.77 (95% CI: 1.06, 2.95) and 1.63 (95% CI: 1.16, 2.29) for lifetime and baseline alcohol, respectively. Baseline alcohol intakes from beer (>40 g/day) and spirits/liquors (>10 g/day) showed HRs equal to 1.58 (95% CI: 1.07, 2.34) and 1.41 (95% CI: 1.03, 1.94), respectively, compared to the reference category (0.1-2.9 g/day). In women, HR estimates did not reach statistically significance. The alcohol and PC risk association was not modified by smoking status. Findings from a large prospective study suggest that baseline and lifetime alcohol intakes were positively associated with PC risk, with more apparent risk estimates for beer and spirits/liquors than wine intake.
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http://dx.doi.org/10.1002/ijc.31367DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6481554PMC
August 2018

Physical activity, sedentary behaviour and colorectal cancer risk in the UK Biobank.

Br J Cancer 2018 03 8;118(6):920-929. Epub 2018 Mar 8.

Section of Nutrition and Metabolism, International Agency for Research on Cancer, Lyon, France.

This corrects the article DOI: 10.1038/bjc.2017.85.
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http://dx.doi.org/10.1038/bjc.2017.496DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5886126PMC
March 2018
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