Food biodiversity and gastrointestinal cancer risk in nine European countries: Analysis within a prospective cohort study
Inge Huybrechts
(1)
,
Bernadette Chimera
(1)
,
Giles Hanley-Cook
(2)
,
Carine Biessy
(1)
,
Mélanie Deschasaux-Tanguy
(3, 4)
,
Mathilde Touvier
(3)
,
Emmanuelle Kesse-Guyot
(3)
,
Bernard Srour
(3, 4)
,
Julia Baudry
(3)
,
Justine Berlivet
(3)
,
Corinne Casagrande
(1)
,
Geneviève Nicolas
(1)
,
Jessica Blanco Lopez
(1)
,
Christopher Millett
(5, 6)
,
Emine Koc Cakmak
(5)
,
Oliver J.K. Robinson
(5)
,
Kris Murray
(7)
,
Matthias Schulze
(8, 9)
,
Giovanna Masala
(10)
,
Marcela Guevara
(11, 12)
,
Stina Bodén
(13)
,
Amanda Cross
(5)
,
Kostas Tsilidis
(5)
,
Alicia Heath
(5)
,
Salvatore Panico
(14)
,
Pilar Amiano
(15)
,
José Ma Huerta
(11, 16)
,
Tim Key
(17)
,
Ulrika Ericson
(18)
,
Tanja Stocks
(18)
,
Marie Wasmuth Lundblad
(19)
,
Guri Skeie
(19)
,
Carlotta Sacerdote
(20, 21)
,
Verena Katzke
(22)
,
Mary Playdon
(23, 24)
,
Pietro Ferrari
(1)
,
Paolo Vineis
(5)
,
Carl Lachat
(2)
,
Marc Gunter
(5, 1)
1
CIRC - IARC -
Centre International de Recherche contre le Cancer - International Agency for Research on Cancer
2 Faculty of Bioscience Engineering [Ghent]
3 EREN [CRESS - U1153 / UMR_A 1125] - Nutritional Epidemiology Research Team | Equipe de Recherche en Epidémiologie Nutritionnelle
4 Réseau National Alimentation Cancer Recherche (réseau NACRe)
5 Imperial College London
6 NOVA - Universidade Nova de Lisboa = NOVA University Lisbon
7 London School of Hygiene and Tropical Medicine [Fajara, Gambia]
8 University of Potsdam = Universität Potsdam
9 DIfE - German Institute of Human Nutrition Potsdam-Rehbrücke
10 ISPRO - Istituto per lo studio, la prevenzione e la rete oncologica = Institute for Cancer Research, Prevention and Clinical Network
11 CIBERESP - Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública = Consortium for Biomedical Research of Epidemiology and Public Health
12 IdiSNA - Navarra Institute for Health Research / Instituto de Investigación Sanitaria de Navarra
13 Umeå University = Umeå Universitet
14 University of Naples Federico II = Università degli studi di Napoli Federico II
15 Osakidetza-Basque Health Service
16 IMIB - Instituto Murciano de Investigación Biosanitaria Pascual Parrilla
17 Nuffield Department of Population Health [Oxford]
18 Lund University
19 UiT - The Arctic University of Norway [Tromsø, Norway]
20 Azienda Ospedalerio - Universitaria Città della Salute e della Scienza di Torino = University Hospital Città della Salute e della Scienza di Torino
21 CPO Piemonte - Centro di Riferimento per l'Epidemiologia e la Prevenzione Oncologica in Piemonte = Center for Cancer Prevention-Piemonte
22 DKFZ - German Cancer Research Center - Deutsches Krebsforschungszentrum [Heidelberg]
23 University of Utah
24 Huntsman Cancer Institute [Salt Lake City]
2 Faculty of Bioscience Engineering [Ghent]
3 EREN [CRESS - U1153 / UMR_A 1125] - Nutritional Epidemiology Research Team | Equipe de Recherche en Epidémiologie Nutritionnelle
4 Réseau National Alimentation Cancer Recherche (réseau NACRe)
5 Imperial College London
6 NOVA - Universidade Nova de Lisboa = NOVA University Lisbon
7 London School of Hygiene and Tropical Medicine [Fajara, Gambia]
8 University of Potsdam = Universität Potsdam
9 DIfE - German Institute of Human Nutrition Potsdam-Rehbrücke
10 ISPRO - Istituto per lo studio, la prevenzione e la rete oncologica = Institute for Cancer Research, Prevention and Clinical Network
11 CIBERESP - Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública = Consortium for Biomedical Research of Epidemiology and Public Health
12 IdiSNA - Navarra Institute for Health Research / Instituto de Investigación Sanitaria de Navarra
13 Umeå University = Umeå Universitet
14 University of Naples Federico II = Università degli studi di Napoli Federico II
15 Osakidetza-Basque Health Service
16 IMIB - Instituto Murciano de Investigación Biosanitaria Pascual Parrilla
17 Nuffield Department of Population Health [Oxford]
18 Lund University
19 UiT - The Arctic University of Norway [Tromsø, Norway]
20 Azienda Ospedalerio - Universitaria Città della Salute e della Scienza di Torino = University Hospital Città della Salute e della Scienza di Torino
21 CPO Piemonte - Centro di Riferimento per l'Epidemiologia e la Prevenzione Oncologica in Piemonte = Center for Cancer Prevention-Piemonte
22 DKFZ - German Cancer Research Center - Deutsches Krebsforschungszentrum [Heidelberg]
23 University of Utah
24 Huntsman Cancer Institute [Salt Lake City]
Résumé
Background: Food biodiversity in human diets has potential co-benefits for both public health and sustainable food systems. However, current evidence on the potential relationship between food biodiversity and cancer risk, and particularly gastrointestinal cancers typically related to diet, remains limited. This study evaluated how dietary species richness (DSR) was associated with gastrointestinal cancer risk in a pan-European population. Methods: Associations between DSR and subsequent gastrointestinal cancer risk were examined among 450,111 adults enrolled in the European Prospective Investigation into Cancer and Nutrition cohort (EPIC, initiated in 1992), free of cancer at baseline. Usual dietary intakes were assessed at recruitment with country-specific dietary questionnaires. DSR of an individual's yearly diet was calculated based on the absolute number of unique biological species in each food and drink item. Associations between DSR and cancer risk were assessed by multivariable Cox proportional hazards regression models. Findings: During a median follow-up time of 14.1 years (SD=3.9), 10,705 participants were diagnosed with gastrointestinal cancer. Hazard ratios (HRs) and 95 % confidence intervals (CIs) comparing overall gastrointestinal cancer risk in the highest versus lowest quintiles of DSR indicated inverse associations in multivariable-adjusted models [HR (95 % CI): 0.77 (0.69–0.87); P-value < 0·0001] (Table 2). Specifically, inverse associations were observed between DSR and oesophageal squamous cell carcinoma, proximal colon, colorectal, and liver cancer risk (p-trend<0.05 for all cancer types). Interpretation: Greater food biodiversity in the diet may lower the risk of certain gastrointestinal cancers. Further research is needed to replicate these novel findings and to understand potential mechanisms.