The Role of Diet, Alcohol, BMI, and Physical Activity in Cancer Mortality: Summary Findings of the EPIC Study

Evidence on the impact of diet, alcohol, body-mass index (BMI), and physical activity on mortality due to cancer and other cancer-related outcomes is still scarce. Herein, we reviewed the contribution of the European Prospective Investigation into Cancer and Nutrition (EPIC) study to the current state of the art on the role of these factors in cancer mortality. We identified 45 studies using a rapid systematic review methodology. Dietary factors associated with reduced cancer mortality included raw vegetable intake; dietary fiber intake; the Mediterranean diet; other dietary scores; other diet patterns including low meat eaters, vegetarians/vegans, or fish eaters; dietary intake (or biomarkers) of some vitamins (e.g., vitamin D, vitamin K2, or Vitamin C); and intake of lignans. Physical activity and following healthy lifestyle recommendations also reduced cancer mortality risk. In contrast, dietary factors associated with higher cancer mortality risk included poor diet quality, consumption of alcohol and soft drinks including juice, and, to a lesser extent, intake of some fatty acids. Excess weight and obesity also increased the risk of cancer mortality. The EPIC study holds valuable information on diet and lifestyle factors and offers a unique opportunity to identify key diet-related factors for cancer mortality prevention

A faecal microbiota signature with high specificity for pancreatic cancer

Cancer prevention; Intestinal microbiology; Pancreatic tumoursPrevenció del càncer; Microbiologia intestinal; Tumors pancreàticsPrevención de cáncer; Microbiología intestinal; Tumores pancreáticosBackground Recent evidence suggests a role for the microbiome in pancreatic ductal adenocarcinoma (PDAC) aetiology and progression. Objective To explore the faecal and salivary microbiota as potential diagnostic biomarkers. Methods We applied shotgun metagenomic and 16S rRNA amplicon sequencing to samples from a Spanish case–control study (n=136), including 57 cases, 50 controls, and 29 patients with chronic pancreatitis in the discovery phase, and from a German case–control study (n=76), in the validation phase. Results Faecal metagenomic classifiers performed much better than saliva-based classifiers and identified patients with PDAC with an accuracy of up to 0.84 area under the receiver operating characteristic curve (AUROC) based on a set of 27 microbial species, with consistent accuracy across early and late disease stages. Performance further improved to up to 0.94 AUROC when we combined our microbiome-based predictions with serum levels of carbohydrate antigen (CA) 19–9, the only current non-invasive, Food and Drug Administration approved, low specificity PDAC diagnostic biomarker. Furthermore, a microbiota-based classification model confined to PDAC-enriched species was highly disease-specific when validated against 25 publicly available metagenomic study populations for various health conditions (n=5792). Both microbiome-based models had a high prediction accuracy on a German validation population (n=76). Several faecal PDAC marker species were detectable in pancreatic tumour and non-tumour tissue using 16S rRNA sequencing and fluorescence in situ hybridisation. Conclusion Taken together, our results indicate that non-invasive, robust and specific faecal microbiota-based screening for the early detection of PDAC is feasible.We acknowledge funding from EMBL, CNIO, World Cancer Research (#15–0391), the European Research Council (ERC-AdG-669830 MicrobioS), the BMBF-funded Heidelberg CenterCentre for Human Bioinformatics (HD-HuB) within the German Network for Bioinformatics Infrastructure (de.NBI #031A537B), Fondo de Investigaciones Sanitarias (FIS), Instituto de Salud Carlos III-FEDER, Spain (grant numbers PI15/01573, PI18/01347, FIS PI17/02303); Red Temática de Investigación Cooperativa en Cáncer, Spain (grant numbers RD12/0036/0034, RD12/0036/0050, RD12/0036/0073); III beca Carmen Delgado/Miguel Pérez-Mateo de AESPANC-ACANPAN; EU-6FP Integrated Project (#018771-MOLDIAG-PACA); EU-FP7-HEALTH (#259737-CANCERALIA). Funders had no involvement in the study design, patient enrolment, analysis, manuscript writing or reviewing

Evidence Update on the Relationship between Diet and the Most Common Cancers from the European Prospective Investigation into Cancer and Nutrition (EPIC) Study: A Systematic Review

FundingE.U.-G. is supported by the Programa Operativo Fondo Social Europeo (FSE) de Andalucia (20142020) and Junta de Andalucia (reference DOC_01618).The European Prospective Investigation into Cancer and Nutrition (EPIC) is a multicentre prospective study conducted in 23 centres in 10 European countries. Here we review the findings from EPIC on the relationship between diet-related exposures and incidence or mortality from the four most frequent cancers in the European population: colorectal, breast, lung, and prostate cancer. We conducted a systematic review following PRISMA guidelines and identified 110 high-quality studies based on the EPIC cohort. Fruit and vegetable consumption had a protective effect against colorectal, breast, and lung cancer, whereas only fruit had a protective effect against prostate cancer. A higher consumption of fish and lower consumption of red and processed meat were related with a lower risk of colorectal cancer; and higher consumption of fatty fish with lower risk of breast cancer. Calcium and yogurt intake were found to protect against colorectal and prostate cancer. Alcohol consumption increased the risk for colorectal and breast cancer. Finally, adherence to the Mediterranean diet emerged as a protective factor for colorectal and breast cancer. The EPIC study results are in agreement with the latest evidence from leading authorities on cancer prevention and help to inform public prevention policies and strategies.Programa Operativo Fondo Social Europeo (FSE) de Andalucia (20142020)Junta de Andalucia DOC_0161

Oxidative Balance Scores (OBSs) Integrating Nutrient, Food and Lifestyle Dimensions: Development of the NutrientL-OBS and FoodL-OBS

This research was co-funded by the Health Research Found (FIS), Accion Estrategica en Salud (AES), of the Spanish Ministry of Economy and Competitiveness, grant number PI12/00002, and the European Regional Development Fund (ERDF).Oxidative Balance Scores (OBS) are tools that allow us to assess the individual's antioxidant state by ranking both antioxidant and pro-oxidant components of dietary and lifestyle factors. Our aim was to develop novel OBSs accounting for either the global supply of nutrient antioxidants in the diet, or the intake of antioxidant-rich foods, in combination with lifestyle factors. Pro-oxidant factors were also considered. Within two centers of the Spanish European Prospective Investigation into Cancer and Nutrition (EPIC) study, EPIC-Granada and EPIC-Gipuzkoa (N = 14,756 participants), we developed the Nurient, Food and Lifestyle OBS (NutrientL-OBS and FoodL-OBS), and their simplified versions (solely with dietary or lifestyle factors, the Nutrient-OBS, Food-OBS and L-OBS). Their antioxidant potential was evaluated considering their relationship with: (i) 20 scores of adherence to the Mediterranean Diet (MD); and, (ii) 25 biomarkers of antioxidant nutrients (ascorbic acid, beta-carotene, etc.), inflammation (CRP, TNF-alpha, etc.) and oxidative stress (uric acid), among 210 participants. Spearman correlation and multivariate linear regression analyses were applied to analyze these associations. Some statistically significant relationships were encountered between the NutrientL-OBS and the FoodL-OBS with the MD scores, and with ascorbic acid (per one-unit increase in OBS: beta = 0.012 and 0.015; p = 0.022 and 0.008, respectively) and CRP (per one-unit increase in both OBS: beta = -0.02; p = 0.02); the latter appeared to be restricted to the OBS ' s lifestyle components. In conclusion, the NutrientL- and FoodL-OBSs and their sub-versions are related to antioxidant-rich dietary patterns and to biomarkers of antioxidant nutrient intake and inflammation, supporting that these tools are valid to assess the individual ' s oxidative/antioxidant status.Health Research Found (FIS), Accion Estrategica en Salud (AES), of the Spanish Ministry of Economy and Competitiveness PI12/00002European Commissio

A review of a priori defined oxidative balance scores relative to their components and impact on health outcomes

Oxidative Balance Scores (OBSs) are tools that have emerged to evaluate the global balance of individuals’ oxidation—reduction status. The aim was to compare OBSs available in the literature regarding their characteristics and associations with chronic diseases in epidemiological studies. Studies that developed OBSs were searched in PubMed until August 2018. A total of 21 OBSs were identified. These OBSs presented different scoring schemes and different types of anti- and pro-oxidant components, including dietary factors (dietary intake and/or nutrient biomarkers), lifestyle factors, and medications. Most OBSs were based on over 10 components, and some included only dietary factors. Few considered weighted components in the score. Only three OBSs were validated as potential surrogates of oxidative balance through inflammation and OS-related biomarkers. Notably, all the OBSs were associated—to a varying degree—with a reduced risk of cardiovascular diseases, chronic kidney disease, colorectal adenomas, and different cancer types (colorectal and breast cancer), as well as with all-cause and cancer-related mortality. For other outcomes, e.g., prostate cancer, contradictory results were reported. In summary, there is a great heterogeneity in the definition of OBSs. Most studies are concordant in supporting that excessive OS reflected by a lower OBS has deleterious effects on health. Unified criteria for defining the proper OBSs, valuable to gauge OS-related aspects of the diet and lifestyle that may lead to adverse health outcomes, are needed

El papel de la vitamina K: un estudio transversal de la ingesta de los menús ofertados en un centro geriátrico: El papel de la vitamina K en geriatría

Introduction: The aims of the present study were to estimate the vitamin K1 content of the menu offered in a nursing home and its adequacy to the recommendations, to determine its dietary sources and to classify the dishes on the menu. Material and methods: Cross-sectional descriptive study. The dietary intake of vitamin K1 from the dietary menu offered in a public nursing home (Valladolid, Spain) was studied. The dietary study was performed by estimating the theoretical dietary intake of the basal menu offered during 14 consecutive days consumed by 138 elderly individuals. Vitamin K1 intake was estimated using data from the food composition table of Ortega-Anta et al, 2010. Results: The mean vitamin K1 intake was 224 (standard deviation, 128 µg/day) with a very similar amount between weeks and a great variation between days (97-586 µg/day). The main source of this micronutrient was vegetables, especially green leafy vegetables (chard, cabbage, lettuce). The vitamin K1 content of the menu offered was more than three times higher (320%) than the adequate intake recommended by EFSA and more than double (249-280%) the AESAN dietary intakes. The food groups that contributed most vitamin K1 to the diet were vegetables (41.7%) and fruits (28.6%). Based on the Nutrition Care Manual classification, dishes were categorised into 4 free of vitamin K1, 23 with low, 13 with moderate and 4 with a high amount of this micronutrient. Conclusions: In the menu offered in this nursing home, the estimated dietary intake of vitamin K1 was between two and three times higher than recommended (AESAN and EFSA). In the long term, high intakes of vitamin K1 could have health benefits associated with age-related diseases.Introducción: Los objetivos de la presente investigación han sido estimar el contenido de vitamina K1 del menú ofertado en una residencia de ancianos y su adecuación a las recomendaciones, determinar sus fuentes dietéticas y clasificar los platos del menú. Material y métodos: Estudio descriptivo transversal. Se ha estudiado la ingesta dietética de vitamina K1 de la planificación dietética en un centro asistencial público (Valladolid, España) El estudio dietético se realizó estimando la ingesta dietética teórica del menú basal ofertado durante 14 días consecutivos que consumían 138 personas mayores. El aporte de vitamina K1 se estimó mediante los datos de la tabla de composición de alimentos de Ortega-Anta y cols., 2010. Resultados: El aporte medio de vitamina K1 fue de 224 (desviación estándar, 128 µg/día) con una cantidad muy similar entre semanas y una gran variación entre días (97-586 µg/día). La principal fuente de este micronutriente fueron las verduras, en especial, las de hoja verde (acelgas, repollo, lechuga). El contenido de vitamina K1 del menú ofertado fue más de tres veces superior (320%) a la ingesta adecuada recomendada por la EFSA y más del doble (249-280%) según las ingestas dietéticas de la AESAN. Los grupos de alimentos que aportaron más vitamina K1 a la dieta fueron las verduras (41,7%) y las frutas (28,6%). Mediante la clasificación del Nutrition Care Manual se categorizaron los platos en 4 libres de vitamina K1, 23 con bajo contenido, 13 con un aporte moderado y 4 con una cantidad alta de este micronutriente. Conclusiones: En el menú ofertado en este centro residencial, la estimación del aporte dietético de vitamina K1 fue entre dos veces y tres veces superior a la recomendada (AESAN y EFSA). A largo plazo, la alta ingesta de vitamina K1 podría suponer beneficios en la salud asociados con enfermedades relacionadas con el envejecimiento

Clustering of Dietary Patterns and Lifestyles Among Spanish Children in the EsNuPI Study

Dietary patterns (DPs) are known to be tied to lifestyle behaviors. Understanding DPs and their relationships with lifestyle factors can help to prevent children from engaging in unhealthy dietary practices. We aimed to describe DPs in Spanish children aged 1 to <10 years and to examine their associations with sociodemographic and lifestyle variables. The consumption of toddler and young children milk formulas, enriched and fortified milk within the Spanish pediatric population is increasing, and there is a lack of evidence whether the consumption of this type of milk is causing an impact on nutrient intakes and if they are helping to reach the nutrient recommendations. Within the Nutritional Study in the Spanish Pediatric Population (EsNuPI), we considered two study cohorts and three different age groups in three year-intervals in each of them. The study cohort included 740 children in a representative sample of the urban non-vegan Spanish population and 772 children in a convenience cohort of adapted milk consumers (AMS) (including follow-on formula, toddler’s milk, growing up milk, and fortified and enriched milks) who provided information about sociodemographics, lifestyle, and dietary habits; a food frequency questionnaire was used for the latter. Principal component analysis was performed to identify DPs from 18 food groups. Food groups and sociodemographic/lifestyle variables were combined through a hierarchical cluster algorithm. Three DPs predominated in every age group and study sample: a palatable energy-dense food dietary pattern, and two Mediterranean-like DPs. However, children from the AMS showed a predominant dietary pattern markedly related to the Mediterranean diet, with high consumption of cereals, fruits and vegetables, as well as milk and dairy products. The age of children and certain lifestyle factors, namely level of physical activity, parental education, and household income, correlated closely with the dietary clusters. Thus, the findings provide insight into designing lifestyle interventions that could reverse the appearance of unhealthy DPs in the Spanish child populationThis research was funded by Instituto Puleva de Nutrición (IPN)S

Circadian clock gene variants and their link with chronotype, chrononutrition, sleeping patterns and obesity in the European prospective investigation into cancer and nutrition (EPIC) study

Background & aims: The circadian clock is involved in the control of daily rhythms and is related to the individual's chronotype, i.e., the morningness-eveneningness preference. Knowledge is limited on the relationship between circadian genes, chronotype, sleeping patterns, chronutrition and obesity. The aim was to explore these associations within the EPIC-Spain cohort study. Methods: There were 3183 subjects with information on twelve genetic variants of six genes (PER1, PER2, PER3, CRY1, NR1D1, CLOCK). Their association was evaluated with: chronotype and sleeping duration/ quality (assessed by questionnaires), chrononutrition (number of meals and timing of intake assessed by a diet history), and also anthropometric measures of obesity at early and late adulthood (in two points in time), such as weight and waist circumference (assessed by physical measurements). Multivariable logistic and linear regression as well as additive genetic models were applied. Odds ratios (ORs), b coefficients, and p-values corrected for multiple comparisons were estimated. Genetic risk scores (GRS) were built to test gene-outcome associations further. Results: At nominal significance level, the variant rs2735611 (PER1 gene) was associated with a 11.6% decrease in long-term weight gain (per-allele b beta - -0.12), whereas three CLOCK gene variants (rs12649507, rs3749474 and rs4864548), were associated with a similar to 20% decrease in waist circumference gain (per-allele beta similar to -0.19). These and other associations with body measures did not hold after multiple testing correction, except waist-to-hip ratio and rs1801260, rs2070062 and rs4580704 (CLOCK gene). Associations with chrononutrition variables, chronotype and sleep duration/quality failed to reach statistical significance. Conversely, a weighted GRS was associated with the evening/late chronotype and with all other outcomes (p < 0.05). The chronotype-GRS was associated with an increased overweight/ obesity risk (vs normal weight) in both early and late adulthood (OR = 2.2; p = 0.004, and OR = 2.1; p = 0.02, respectively). Conclusion: Genetic variants of some circadian clock genes could explain the link between genetic susceptibility to the individual's chronotype and obesity risk

Clustering of Dietary Patterns and Lifestyles among Spanish Children in the EsNuPI Study

Dietary patterns (DPs) are known to be tied to lifestyle behaviors. Understanding DPs and their relationships with lifestyle factors can help to prevent children from engaging in unhealthy dietary practices. We aimed to describe DPs in Spanish children aged 1 to <10 years and to examine their associations with sociodemographic and lifestyle variables. The consumption of toddler and young children milk formulas, enriched and fortified milk within the Spanish pediatric population is increasing, and there is a lack of evidence whether the consumption of this type of milk is causing an impact on nutrient intakes and if they are helping to reach the nutrient recommendations. Within the Nutritional Study in the Spanish Pediatric Population (EsNuPI), we considered two study cohorts and three different age groups in three year-intervals in each of them. The study cohort included 740 children in a representative sample of the urban non-vegan Spanish population and 772 children in a convenience cohort of adapted milk consumers (AMS) (including follow-on formula, toddler’s milk, growing up milk, and fortified and enriched milks) who provided information about sociodemographics, lifestyle, and dietary habits; a food frequency questionnaire was used for the latter. Principal component analysis was performed to identify DPs from 18 food groups. Food groups and sociodemographic/lifestyle variables were combined through a hierarchical cluster algorithm. Three DPs predominated in every age group and study sample: a palatable energy-dense food dietary pattern, and two Mediterranean-like DPs. However, children from the AMS showed a predominant dietary pattern markedly related to the Mediterranean diet, with high consumption of cereals, fruits and vegetables, as well as milk and dairy products. The age of children and certain lifestyle factors, namely level of physical activity, parental education, and household income, correlated closely with the dietary clusters. Thus, the findings provide insight into designing lifestyle interventions that could reverse the appearance of unhealthy DPs in the Spanish child population

Lifestyle, dietary factors and antibody levels to oral bacteria in cancer-free participants of a European cohort study

Background—Increasing evidence suggests that oral microbiota play a pivotal role in chronic diseases, in addition to the well-established role in periodontal disease. Moreover, recent studies suggest that oral bacteria may also be involved in carcinogenesis; periodontal disease has been linked several cancers. In this study, we examined whether lifestyle factors have an impact on antibody levels to oral bacteria. Methods—Data on demographic characteristics, lifestyle factors, and medical conditions were obtained at the time of blood sample collection. For the current analysis, we measured antibody levels to 25 oral bacteria in 395 cancer-free individuals using an immunoblot array. Combined total immunglobin G (IgG) levels were obtained by summing concentrations for all oral bacteria measured. Results—IgG antibody levels were substantially lower among current and former smokers (1697 and 1677 ng/mL, respectively) than never smokers (1960 ng/mL; p-trend = 0.01), but did not vary by other factors, including BMI, diabetes, physical activity, or by dietary factors, after adjusting for age, sex, education, country and smoking status. The highest levels of total IgG were found among individuals with low education (2419 ng/mL). Conclusions—Our findings on smoking are consistent with previous studies and support the notion that smokers have a compromised humoral immune response. Moreover, other major factors known to be associated with inflammatory markers, including obesity, were not associated with antibody levels to a large number of oral bacteria