Imperial College London

DrDagfinnAune

Faculty of MedicineSchool of Public Health

Research Associate
 
 
 
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Contact

 

+44 (0)20 7594 8478d.aune

 
 
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Location

 

Norfolk PlaceSt Mary's Campus

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Summary

 

Publications

Publication Type
Year
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144 results found

Aune D, Yahya M-S, Norat T, Riboli Eet al., 2019, Body mass index, abdominal fatness, weight gain and the risk of urinary incontinence: A systematic review and dose-response meta-analysis of prospective studies., BJOG

BACKGROUND: Adiposity has been associated with elevated risk of urinary incontinence in epidemiological studies, however, the strength of the association has differed between studies. OBJECTIVES: To conduct a systematic literature review and dose-response meta-analysis of prospective studies on adiposity and risk of urinary incontinence. SEARCH STRATEGY: We searched PubMed and Embase databases up to July 19th 2017. SELECTION CRITERIA: Prospective cohort studies were included. DATA COLLECTION AND ANALYSIS: Data were extracted by one reviewer and checked for accuracy by a second reviewer. Summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated using random effects models. MAIN RESULTS: Twenty four prospective studies were included. The summary RR per 5 kg/m2 increment in BMI was 1.20 (95% confidence interval: 1.16-1.25, I2 =58%, n=13) for population-based studies and 1.19 (95% CI: 1.08-1.30, I2 =87.1%, n=8) for pregnancy-based studies, 1.18 (95% CI: 1.14-1.22, I2 =0%, n=2) per 10 cm increase in waist circumference and 1.34 (95% CI: 1.11-1.62, I2 =90%, n=2) per 10 kg of weight gain. Although the test for nonlinearity was significant for BMI, p=0.04, the association was approximately linear. For subtypes of urinary incontinence the summary RR per 5 BMI units was 1.45 (95% CI: 1.25-1.68, I2 =85%, n=3) for frequent incontinence, 1.52 (95% CI: 1.37-1.68, I2 =34%, n=4) for severe incontinence, 1.33 (95% CI: 1.26-1.41, I2 =0%, n=8) for stress incontinence, 1.26 (95% CI: 1.14-1.40, I2 =70%, n=7) for urge incontinence, and 1.52 (95% CI: 1.36-1.69, I2 =0%, n=3) for mixed incontinence. CONCLUSION: These results suggest excess weight may increase risk of urinary incontinence. This article is protected by copyright. All rights reserved.

Journal article

Jochem C, Leitzmann M, Volaklis K, Aune D, Strasser Bet al., 2019, Association Between Muscular Strength and Mortality in Clinical Populations: A Systematic Review and Meta-Analysis., J Am Med Dir Assoc

OBJECTIVES: To assess the relationship between muscular strength measures and mortality in outpatient populations with chronic diseases such as cancer, chronic obstructive pulmonary disease, renal disease, and metabolic and vascular diseases, and in critically ill hospitalized patients. DESIGN: A systematic review and random-effects meta-analysis of prospective cohort studies was performed. SETTING AND PARTICIPANTS: The databases Medline, Embase, Clinical Trial Register, and Cochrane Trial Register were searched from inception until September 30, 2018. The systematic literature review yielded 39 studies with a total of 39,852 participants. RESULTS: Lowest vs highest category of muscular strength revealed a statistically significant increased risk of all-cause mortality with a hazard ratio (HR) and 95% confidence intervals (CI) of 1.80 (95% CI 1.54-2.10). Lower muscular strength was associated with enhanced mortality in patients with cancer (HR 2.40; 95% CI 1.57-3.69), critical illness (HR 2.06; 95% CI 1.33-3.21), renal disease (HR 1.84; 95% CI 1.37-2.47), metabolic and vascular diseases (HR 1.64; 95% CI 1.26-2.14), and chronic obstructive pulmonary disease (HR 1.36; 95% CI 1.16-1.61). Conversely, a 5-kg higher level of muscular strength conferred a reduced risk of overall mortality (HR 0.72; 95% CI 0.59-0.89) and was accompanied by a reduction in mortality in patients with metabolic and vascular diseases (HR 0.52; 95% CI 0.29-0.91), critical illness (HR 0.78; 95% CI 0.61-0.99), and renal disease (HR 0.82; 95% CI 0.73-0.91). CONCLUSIONS AND IMPLICATIONS: Muscular strength is inversely associated with mortality risk in various acute and chronic conditions. Future trials should focus on developing validated cut-points for diagnosing low muscular strength and their predictive value for hard end-points.

Journal article

Christakoudi S, Kakourou A, Markozannes G, Tzoulaki I, Weiderpass E, Brennan P, Gunter M, Dahm CC, Overvad K, Olsen A, Tjønneland A, Boutron-Ruault M-C, Madika A-L, Severi G, Katzke V, Kühn T, Bergmann MM, Boeing H, Karakatsani A, Martimianaki G, Thriskos P, Masala G, Sieri S, Panico S, Tumino R, Ricceri F, Agudo A, Redondo-Sánchez D, Colorado-Yohar SM, Mokoroa O, Melander O, Stocks T, Häggström C, Harlid S, Bueno-de-Mesquita B, van Gils CH, Vermeulen RCH, Khaw K-T, Wareham N, Tong TYN, Freisling H, Johansson M, Lennon H, Aune D, Riboli E, Trichopoulos D, Trichopoulou A, Tsilidis KKet al., Blood pressure and risk of cancer in the European prospective investigation into cancer and nutrition, International Journal of Cancer, ISSN: 0020-7136

Several studies have reported associations of hypertension with cancer, but not allresults were conclusive. We examined the association of systolic (SBP) and diastolic (DBP)blood pressure with the development of incident cancer at all anatomical sites in theEuropean Prospective Investigation into Cancer and Nutrition (EPIC). Hazard ratios (HR)(95% confidence intervals) were estimated using multivariable Cox proportional hazardsmodels, stratified by EPIC-participating centre and age at recruitment, and adjusted for sex,education, smoking, body mass index, physical activity, diabetes and dietary (in women alsoreproductive) factors. The study included 307,318 men and women, with an average followup of 13.7 (standard deviation 4.4) years and 39,298 incident cancers. We confirmed theexpected positive association with renal cell carcinoma: HR=1.12 (1.08-1.17) per 10mmHghigher SBP and HR=1.23 (1.14-1.32) for DBP. We additionally found positive associationsfor esophageal squamous cell carcinoma (SCC): HR=1.16 (1.07-1.26) (SBP), HR=1.31 (1.13-1.51) (DBP), weaker for head and neck cancers: HR=1.08 (1.04-1.12) (SBP), HR=1.09(1.01-1.17) (DBP) and, similarly, for skin SCC, colon cancer, post-menopausal breast cancerand uterine adenocarcinoma (AC), but not for esophageal AC, lung SCC, lung AC, or uterineendometroid cancer. We observed weak inverse associations of SBP with cervical SCC:HR=0.91 (0.82-1.00) and lymphomas: HR=0.97 (0.93-1.00). There were no consistentassociations with cancers in other locations.Our results are largely compatible with published studies and support weak associations ofblood pressure with cancers in specific locations and morphologies.

Journal article

Neuenschwander M, Ballon A, Weber KS, Norat T, Aune D, Schwingshackl L, Schlesinger Set al., 2019, Role of diet in type 2 diabetes incidence: umbrella review of meta-analyses of prospective observational studies, BMJ, Vol: 366, ISSN: 0959-8138

OBJECTIVE: To summarise the evidence of associations between dietary factors and incidence of type 2 diabetes and to evaluate the strength and validity of these associations. DESIGN: Umbrella review of systematic reviews with meta-analyses of prospective observational studies. DATA SOURCES: PubMed, Web of Science, and Embase, searched up to August 2018. ELIGIBILITY CRITERIA: Systematic reviews with meta-analyses reporting summary risk estimates for the associations between incidence of type 2 diabetes and dietary behaviours or diet quality indices, food groups, foods, beverages, alcoholic beverages, macronutrients, and micronutrients. RESULTS: 53 publications were included, with 153 adjusted summary hazard ratios on dietary behaviours or diet quality indices (n=12), food groups and foods (n=56), beverages (n=10), alcoholic beverages (n=12), macronutrients (n=32), and micronutrients (n=31), regarding incidence of type 2 diabetes. Methodological quality was high for 75% (n=115) of meta-analyses, moderate for 23% (n=35), and low for 2% (n=3). Quality of evidence was rated high for an inverse association for type 2 diabetes incidence with increased intake of whole grains (for an increment of 30 g/day, adjusted summary hazard ratio 0.87 (95% confidence interval 0.82 to 0.93)) and cereal fibre (for an increment of 10 g/day, 0.75 (0.65 to 0.86)), as well as for moderate intake of total alcohol (for an intake of 12-24 g/day v no consumption, 0.75 (0.67 to 0.83)). Quality of evidence was also high for the association for increased incidence of type 2 diabetes with higher intake of red meat (for an increment of 100 g/day, 1.17 (1.08 to 1.26)), processed meat (for an increment of 50 g/day, 1.37 (1.22 to 1.54)), bacon (per two slices/day, 2.07 (1.40 to 3.05)), and sugar sweetened beverages (for an increase of one serving/day, 1.26 (1.11 to 1.43)). CONCLUSIONS: Overall, the association between dietary factors and type 2 diabetes has been extensively studied, but few of the assoc

Journal article

Feng T, Vegard M, Strand LB, Laugsand LE, Mørkedal B, Aune D, Vatten L, Ellekjær H, Loennechen JP, Mukamal K, Janszky Iet al., 2019, Weight and weight change and risk of atrial fibrillation: the HUNT study., Eur Heart J

AIMS: Although obesity has been associated with risk of atrial fibrillation (AF), the associations of long-term obesity, recent obesity, and weight change with AF risk throughout adulthood are uncertain. METHODS AND RESULTS: An ambispective cohort study was conducted which included 15 214 individuals. The cohort was created from 2006 to 2008 (the baseline) and was followed for incident AF until 2015. Weight and height were directly measured at baseline. Data on previous weight and height were retrieved retrospectively from measurements conducted 10, 20, and 40 years prior to baseline. Average body mass index (BMI) over time and weight change was calculated. During follow-up, 1149 participants developed AF. The multivariable-adjusted hazard ratios were 1.2 (95% confidence interval 1.0-1.4) for average BMI 25.0-29.9 kg/m2 and 1.6 (1.2-2.0) for average BMI ≥30 kg/m2 when compared with normal weight. The association of average BMI with AF risk was only slightly attenuated after adjustment for most recent BMI. In contrast, current BMI was not strongly associated with the risk of AF after adjustment for average BMI earlier in life. Compared with stable BMI, both loss and gain in BMI were associated with increased AF risk. After adjustment for most recent BMI, the association of BMI gain with AF risk was largely unchanged, while the association of BMI loss with AF risk was weakened. CONCLUSION: Long-term obesity and BMI change are associated with AF risk. Obesity earlier in life and weight gain over time exert cumulative effects on AF development even after accounting for most recent BMI.

Journal article

Kobeissi E, Hibino M, Pan H, Aune Det al., 2019, Blood pressure, hypertension and the risk of abdominal aortic aneurysms: a systematic review and meta-analysis of cohort studies, EUROPEAN JOURNAL OF EPIDEMIOLOGY, Vol: 34, Pages: 547-555, ISSN: 0393-2990

Journal article

Cirera L, Huerta JM, Chirlaque MD, Overvad K, Lindström M, Regnér S, Tjønneland A, Boutron-Ruault M-C, Rebours V, Fagherazzi G, Katzke VA, Boeing H, Peppa E, Trichopoulou A, Valanou E, Palli D, Grioni S, Panico S, Tumino R, Ricceri F, van Gils C, Vermeulen RCH, Skeie G, Braaten T, Weiderpass E, Merino S, Sánchez MJ, Larrañaga N, Ardanaz E, Sund M, Khaw K-T, Key TJ, Jenab M, Naudin S, Murphy N, Aune D, Ward H, Riboli E, Bueno-de-Mesquita B, Navarro C, Duell EJet al., 2019, Socioeconomic Effect of Education on Pancreatic Cancer Risk in Western Europe: An Update on the EPIC Cohorts Study., Cancer Epidemiol Biomarkers Prev, Vol: 28, Pages: 1089-1092

BACKGROUND: To analyze the potential effect of social inequality on pancreatic cancer risk in Western Europe, by reassessing the association within the European Prospective Investigation into Cancer and Nutrition (EPIC) Study, including a larger number of cases and an extended follow-up. METHODS: Data on highest education attained were gathered for 459,170 participants (70% women) from 10 European countries. A relative index of inequality (RII) based on adult education was calculated for comparability across countries and generations. Cox regression models were applied to estimate relative inequality in pancreatic cancer risk, stratifying by age, gender, and center, and adjusting for known pancreatic cancer risk factors. RESULTS: A total of 1,223 incident pancreatic cancer cases were included after a mean follow-up of 13.9 (±4.0) years. An inverse social trend was found in models adjusted for age, sex, and center for both sexes [HR of RII, 1.27; 95% confidence interval (CI), 1.02-1.59], which was also significant among women (HR, 1.42; 95% CI, 1.05-1.92). Further adjusting by smoking intensity, alcohol consumption, body mass index, prevalent diabetes, and physical activity led to an attenuation of the RII risk and loss of statistical significance. CONCLUSIONS: The present reanalysis does not sustain the existence of an independent social inequality influence on pancreatic cancer risk in Western European women and men, using an index based on adult education, the most relevant social indicator linked to individual lifestyles, in a context of very low pancreatic cancer survival from (quasi) universal public health systems. IMPACT: The results do not support an association between education and risk of pancreatic cancer.

Journal article

Obón-Santacana M, Luján-Barroso L, Freisling H, Naudin S, Boutron-Ruault M-C, Mancini FR, Rebours V, Kühn T, Katzke V, Boeing H, Tjønneland A, Olsen A, Overvad K, Lasheras C, Rodríguez-Barranco M, Amiano P, Santiuste C, Ardanaz E, Khaw K-T, Wareham NJ, Schmidt JA, Aune D, Trichopoulou A, Thriskos P, Peppa E, Masala G, Grioni S, Tumino R, Panico S, Bueno-de-Mesquita B, Sciannameo V, Vermeulen R, Sonestedt E, Sund M, Weiderpass E, Skeie G, González CA, Riboli E, Duell EJet al., 2019, Consumption of nuts and seeds and pancreatic ductal adenocarcinoma risk in the European Prospective Investigation into Cancer and Nutrition, International Journal of Cancer, ISSN: 0020-7136

Four epidemiologic studies have assessed the association between nut intake and pancreatic cancer risk with contradictory results. The present study aims to investigate the relation between nut intake (including seeds) and pancreatic ductal adenocarcinoma (PDAC) risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Cox proportional hazards models were used to estimate hazards ratio (HR) and 95% confidence intervals (95% CI) for nut intake and PDAC risk. Information on intake of nuts was obtained from the EPIC country-specific dietary questionnaires. After a mean follow-up of 14 years, 476,160 participants were eligible for the present study and included 1,283 PDAC cases. No association was observed between consumption of nuts and PDAC risk (highest intake vs nonconsumers: HR, 0.89; 95% CI, 0.72-1.10; p-trend = 0.70). Furthermore, no evidence for effect-measure modification was observed when different subgroups were analyzed. Overall, in EPIC, the highest intake of nuts was not statistically significantly associated with PDAC risk.

Journal article

Sanikini H, Muller DC, Sophiea M, Rinaldi S, Agudo A, Duell EJ, Weiderpass E, Overvad K, Tjønneland A, Halkjaer J, Boutron-Ruault M-C, Carbonnel F, Cervenka I, Boeing H, Kaaks R, Kühn T, Trichopoulou A, Martimianaki G, Karakatsani A, Pala V, Palli D, Mattiello A, Tumino R, Sacerdote C, Skeie G, Rylander C, López MDC, Sánchez M-J, Ardanaz E, Regnér S, Stocks T, Bueno-de-Mesquita B, Vermeulen RCH, Aune D, Tong TYN, Kliemann N, Murphy N, Chadeau-Hyam M, Gunter MJ, Cross AJet al., 2019, Anthropometric and reproductive factors and risk of esophageal and gastric cancer by subtype and subsite: results from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, International Journal of Cancer, ISSN: 0020-7136

Obesity has been associated with upper gastrointestinal cancers; however, there are limited prospective data on associations by subtype/subsite. Obesity can impact hormonal factors, which have been hypothesized to play a role in these cancers. We investigated anthropometric and reproductive factors in relation to esophageal and gastric cancer by subtype and subsite for 476,160 participants from the European Prospective Investigation into Cancer and Nutrition cohort. Multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox models. During a mean follow‐up of 14 years, 220 esophageal adenocarcinomas (EA), 195 esophageal squamous cell carcinomas, 243 gastric cardia (GC) and 373 gastric noncardia (GNC) cancers were diagnosed. Body mass index (BMI) was associated with EA in men (BMI ≥30 vs. 18.5–25 kg/m2: HR = 1.94, 95% CI: 1.25–3.03) and women (HR = 2.66, 95% CI: 1.15–6.19); however, adjustment for waist‐to‐hip ratio (WHR) attenuated these associations. After mutual adjustment for BMI and HC, respectively, WHR and waist circumference (WC) were associated with EA in men (HR = 3.47, 95% CI: 1.99–6.06 for WHR >0.96 vs. <0.91; HR = 2.67, 95% CI: 1.52–4.72 for WC >98 vs. <90 cm) and women (HR = 4.40, 95% CI: 1.35–14.33 for WHR >0.82 vs. <0.76; HR = 5.67, 95% CI: 1.76–18.26 for WC >84 vs. <74 cm). WHR was also positively associated with GC in women, and WC was positively associated with GC in men. Inverse associations were observed between parity and EA (HR = 0.38, 95% CI: 0.14–0.99; >2 vs. 0) and age at first pregnancy and GNC (HR = 0.54, 95% CI: 0.32–0.91; >26 vs. <22 years); whereas bilateral ovariectomy was positively associated with GNC (HR = 1.87, 95% CI: 1.04–3.36). These findings support a role for hormonal pathways in upper gastrointestinal cancers.

Journal article

Aune D, Sen A, Norat T, Riboli Eet al., 2019, Dietary fibre intake and the risk of diverticular disease: a systematic review and meta-analysis of prospective studies, European Journal of Nutrition, ISSN: 0044-264X

BACKGROUND: A high intake of dietary fibre has been associated with a reduced risk of diverticular disease in several studies; however, the dose-response relationship between fibre intake and diverticular disease risk has varied, and the available studies have not been summarised in a meta-analysis. We conducted a systematic review and meta-analysis of prospective cohort studies to clarify the association between dietary fibre intake, fibre subtypes, and the risk of diverticular disease. METHODS: PubMed and Embase databases were searched up to August 9th 2018. Summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated using a random-effects model and nonlinear associations were modelled using fractional polynomial models. RESULTS: Five prospective cohort studies with 19,282 cases and 865,829 participants were included in the analysis of dietary fibre and diverticular disease risk. The summary RR was 0.74 (95% CI 0.71-0.78, I2 = 0%) per 10 g/day. There was no evidence of a nonlinear association between dietary fibre intake and diverticular disease risk, pnonlinearity = 0.35, and there was a 23%, 41% and 58% reduction in risk for an intake of 20, 30, and 40 g/day, respectively, compared to 7.5 g/day. There was no evidence of publication bias with Egger's test, p = 0.58 and the association persisted in subgroup and sensitivity analyses. The summary RR per 10 g/day was 0.74 (95% CI 0.67-0.81, I2 = 60%, n = 4) for cereal fibre, 0.56 (95% CI 0.37-0.84, I2 = 73%, n = 2) for fruit fibre, and 0.80 (95% CI 0.45-1.44, I2 = 87%, n = 2) for vegetable fibre. CONCLUSIONS: These results suggest that a high fibre intake may reduce the risk of diverticular disease and individuals consuming 30 g of fibre per day have a 41% reduction in risk compared to persons with a low fibre intake. Further studies are needed on f

Journal article

Abar L, Sobiecki JG, Cariolou M, Nanu N, Vieira AR, Stevens C, Aune D, Greenwood DC, Chan DSM, Norat Tet al., 2019, Body size and obesity during adulthood, and risk of lympho-hematopoietic cancers: an update of the WCRF-AICR systematic review of published prospective studies., Annals of Oncology, Vol: 30, ISSN: 0923-7534

Background: To summarise the evidence on the associations between body mass index (BMI) and BMI in early adulthood, height, waist circumference (WC) and waist to hip ratio (WHR), and risk of lympho-hematopoietic cancers. Method: We conducted a meta-analysis of prospective studies and identified relevant studies published up to December 2017 by searching PubMed. A random effects model was used to calculate dose-response summary relative risks (RRs). Results: Our findings showed BMI, and BMI in early adulthood (aged 18-21 years) is associated with the risk of Hodgkin's and Non-Hodgkin's lymphoma (HL and NHL), Diffuse Large Beta Cell Lymphoma (DLBCL), Leukaemia including Acute and Chronic Myeloid Lymphoma (AML and CML), and Chronic Lymphocytic Leukaemia (CLL) and Multiple Myeloma. The summary RR per 5 kg/m2 increase in BMI were 1.12 (95% CI: 1.05-1.20) for HL, 1.05 (95% CI:1.03-1.08) for NHL, 1.11 (95% CI:1.05-1.16) for DLBCL, 1.06 (95% CI:1.03-1.09) for ML, 1.09 (95% CI:1.03-1.15) for leukaemia, 1.13 (95% CI:1.04-1.24) for AML, 1.13 (95% CI:1.05-1.22) for CML and 1.04 (95% CI:1.00-1.09) for CLL, and were1.12 (95% CI:1.05-1.19) for NHL, 1.22 (95% CI:1.09-1.37) for DLBCL, and 1.19 (95% CI:1.03-1.38) for FL for BMI in early adulthood analysis.Results on mortality showed a 15%, 16% and 17% increased risk of NHL, multiple myeloma and leukaemia, respectively. Greater height increased the risk of NHL by 7%, DLBCL by 10%, FL by 9%, multiple myeloma by 5%, and Leukaemia by 7%. WHR was associated with increased risk of DLBCL by 12%. No association was found between higher WC and risk of multiple myeloma. Conclusion: Our results revealed that general adiposity in adulthood and early adulthood, and greater height may increase the risk of almost all types of lympho-hematopoietic cancers and this adds to a growing body of evidence linking body fatness to several types of cancers.

Journal article

Fedirko V, Jenab M, Meplan C, Jones JS, Zhu W, Schomburg L, Siddiq A, Hybsier S, Overvad K, Tjonneland A, Omichessan H, Perduca V, Boutron-Ruault M-C, Kuehn T, Katzke V, Aleksandrova K, Trichopoulou A, Karakatsani A, Kotanidou A, Tumino R, Panico S, Masala G, Agnoli C, Naccarati A, Bueno-de-Mesquita B, Vermeulen RCH, Weiderpass E, Skeie G, Nost TH, Lujan-Barroso L, Ramon Quiros J, Maria Huerta J, Rodriguez-Barranco M, Barricarte A, Gylling B, Harlid S, Bradbury KE, Wareham N, Khaw K-T, Gunter M, Murphy N, Freisling H, Tsilidis K, Aune D, Riboli E, Hesketh JE, Hughes DJet al., 2019, Association of Selenoprotein and Selenium Pathway Genotypes with Risk of Colorectal Cancer and Interaction with Selenium Status, 4th International Conference on Selenium in the Environment and Human Health, Publisher: MDPI, Pages: 53-54, ISSN: 2072-6643

Conference paper

Perez-Cornago A, Huybrechts I, Appleby PN, Schmidt JA, Crowe FL, Overvad K, Tjønneland A, Kühn T, Katzke V, Trichopoulou A, Karakatsani A, Peppa E, Grioni S, Palli D, Sacerdote C, Tumino R, Bueno-de-Mesquita HB, Larrañaga N, Sánchez M-J, Quirós JR, Ardanaz E, Chirlaque M-D, Agudo A, Bjartell A, Wallström P, Chajes V, Tsilidis KK, Aune D, Riboli E, Travis RC, Key TJet al., 2019, Intake of individual fatty acids and risk of prostate cancer in the European prospective investigation into cancer and nutrition, International Journal of Cancer, ISSN: 0020-7136

The associations of individual dietary fatty acids with prostate cancer risk have not been examined comprehensively. We examined the prospective association of individual dietary fatty acids with prostate cancer risk overall, by tumor subtypes, and prostate cancer death. 142,239 men from the European Prospective Investigation into Cancer and Nutrition who were free from cancer at recruitment were included. Dietary intakes of individual fatty acids were estimated using center-specific validated dietary questionnaires at baseline and calibrated with 24-hour recalls. Multivariable Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). After an average follow-up of 13.9 years, 7,036 prostate cancer cases and 936 prostate cancer deaths were ascertained. Intakes of individual fatty acids were not related to overall prostate cancer risk. There was evidence of heterogeneity in the association of some short chain saturated fatty acids with prostate cancer risk by tumor stage (Pheterogeneity <0.015), with a positive association with risk of advanced stage disease for butyric acid (4:0; HR1SD =1.08; 95%CI=1.01-1.15; P-trend=0.026). There were no associations with fatal prostate cancer, with the exception of a slightly higher risk for those who consumed more eicosenoic acid (22:1n-9c; HR1SD =1.05; 1.00-1.11; P-trend=0.048) and eicosapentaenoic acid (20:5n-3c; HR1SD =1.07; 1.00-1.14; P-trend=0.045). There was no evidence that dietary intakes of individual fatty acids were associated with overall prostate cancer risk. However, a higher intake of butyric acid might be associated with a higher risk of advanced, whereas intakes of eicosenoic and eicosapentaenoic acids might be positively associated with fatal prostate cancer risk. This article is protected by copyright. All rights reserved.

Journal article

Aasdahl L, Iversen VM, Skovlund E, Aune D, Fimland MSet al., 2019, What should be the preferred exercise modality for overweight and obese individuals? Protocol for a systematic review and network meta-analysis, Systematic Reviews, Vol: 8, ISSN: 2046-4053

BackgroundObesity is a global epidemic with profound consequences for individuals and societies. Physical exercise is important to weight reduction and weight loss maintenance. However, results on what the most effective type of exercise are unclear. The aim of this systematic review is to evaluate the effects of various exercise modalities with and without caloric restriction on body composition and metabolic health outcomes in overweight and obese adults.MethodsWe will perform a comprehensive literature search in PubMed, Embase (via Ovid) and CENTRAL (through the Cochrane Library). Relevant papers will be screened in two stages: first, by title and abstract and then the full text of the remaining papers. Two reviewers will screen all the studies, and any disagreements will be discussed with and resolved by a third reviewer. Data extraction and risk of bias assessment will be performed using a pre-piloted form. A network meta-analysis combining direct and indirect treatment effect estimates will be conducted if adequate data are available. The quality of the evidence will be judged using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.DiscussionThe results of this proposed systematic review and meta-analysis will identify whether any exercise modality should be preferred for overweight and obese adults, as well as assess the quality of the evidence. This knowledge has potential importance for clinicians and patients.

Journal article

Feng T, Vegard M, Strand LB, Laugsand LE, Morkedal B, Aune D, Vatten L, Ellekjaer H, Loennechen JP, Mukamal K, Janszky Iet al., 2019, Metabolically Healthy Obesity and Risk for Atrial Fibrillation: The HUNT Study, OBESITY, Vol: 27, Pages: 332-338, ISSN: 1930-7381

Journal article

Gasull M, Pumarega J, Kiviranta H, Rantakokko P, Raaschou-Nielsen O, Bergdahl IA, Sandanger TM, Goñi F, Cirera L, Donat-Vargas C, Alguacil J, Iglesias M, Tjønneland A, Overvad K, Mancini FR, Boutron-Ruault M-C, Severi G, Johnson T, Kühn T, Trichopoulou A, Karakatsani A, Peppa E, Palli D, Pala V, Tumino R, Naccarati A, Panico S, Verschuren M, Vermeulen R, Rylander C, Nøst TH, Rodríguez-Barranco M, Molinuevo A, Chirlaque M-D, Ardanaz E, Sund M, Key T, Ye W, Jenab M, Michaud D, Matullo G, Canzian F, Kaaks R, Nieters A, Nöthlings U, Jeurnink S, Chajes V, Matejcic M, Gunter M, Aune D, Riboli E, Agudo A, Gonzalez CA, Weiderpass E, Bueno-de-Mesquita B, Duell EJ, Vineis P, Porta Met al., 2019, Methodological issues in a prospective study on plasma concentrations of persistent organic pollutants and pancreatic cancer risk within the EPIC cohort, Environmental Research, Vol: 169, Pages: 417-433, ISSN: 0013-9351

BACKGROUND: The use of biomarkers of environmental exposure to explore new risk factors for pancreatic cancer presents clinical, logistic, and methodological challenges that are also relevant in research on other complex diseases. OBJECTIVES: First, to summarize the main design features of a prospective case-control study -nested within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort- on plasma concentrations of persistent organic pollutants (POPs) and pancreatic cancer risk. And second, to assess the main methodological challenges posed by associations among characteristics and habits of study participants, fasting status, time from blood draw to cancer diagnosis, disease progression bias, basis of cancer diagnosis, and plasma concentrations of lipids and POPs. Results from etiologic analyses on POPs and pancreatic cancer risk, and other analyses, will be reported in future articles. METHODS: Study subjects were 1533 participants (513 cases and 1020 controls matched by study centre, sex, age at blood collection, date and time of blood collection, and fasting status) enrolled between 1992 and 2000. Plasma concentrations of 22 POPs were measured by gas chromatography - triple quadrupole mass spectrometry (GC-MS/MS). To estimate the magnitude of the associations we calculated multivariate-adjusted odds ratios by unconditional logistic regression, and adjusted geometric means by General Linear Regression Models. RESULTS: There were differences among countries in subjects' characteristics (as age, gender, smoking, lipid and POP concentrations), and in study characteristics (as time from blood collection to index date, year of last follow-up, length of follow-up, basis of cancer diagnosis, and fasting status). Adjusting for centre and time of blood collection, no factors were significantly associated with fasting status. Plasma concentrations of lipids were related to age, body mass index, fasting, country, and smoking. We detected and quan

Journal article

Ward HA, Murphy N, Weiderpass E, Leitzmann MF, Aglago E, Gunter MJ, Freisling H, Jenab M, Boutron-Ruault M-C, Severi G, Carbonnel F, Kühn T, Kaaks R, Boeing H, Tjønneland A, Olsen A, Overvad K, Merino S, Zamora-Ros R, Rodríguez-Barranco M, Dorronsoro M, Chirlaque M-D, Barricarte A, Perez-Cornago A, Trichopoulou A, Bamia C, Lagiou P, Masala G, Grioni S, Tumino R, Sacerdote C, Mattiello A, Bueno-de-Mesquita B, Vermeulen R, Van Gils C, Nyström H, Rutegård M, Aune D, Riboli E, Cross AJet al., 2019, Gallstones and incident colorectal cancer in a large pan-European cohort study, International Journal of Cancer, ISSN: 0020-7136

Gallstones, a common gastrointestinal condition, can lead to several digestive complications and can result in inflammation. Risk factors for gallstones include obesity, diabetes, smoking and physical inactivity, all of which are known risk factors for colorectal cancer (CRC), as is inflammation. However, it is unclear whether gallstones are a risk factor for CRC. We examined the association between history of gallstones and CRC in the European Prospective Investigation into Cancer and Nutrition (EPIC) study, a prospective cohort of over half a million participants from ten European countries. History of gallstones was assessed at baseline using a self-reported questionnaire. The analytic cohort included 334,986 participants; a history of gallstones was reported by 3,917 men and 19,836 women, and incident CRC was diagnosed among 1,832 men and 2,178 women (mean follow-up: 13.6 years). Hazard ratios (HR) and 95% confidence intervals (CI) for the association between gallstones and CRC were estimated using Cox proportional hazards regression models, stratified by sex, study centre and age at recruitment. The models were adjusted for body mass index, diabetes, alcohol intake and physical activity. A positive, marginally significant association was detected between gallstones and CRC among women in multivariable analyses (HR = 1.14, 95%CI 0.99-1.31, p = 0.077). The relationship between gallstones and CRC among men was inverse but not significant (HR = 0.81, 95%CI 0.63-1.04, p = 0.10). Additional adjustment for details of reproductive history or waist circumference yielded minimal changes to the observed associations. Further research is required to confirm the nature of the association between gallstones and CRC by sex.

Journal article

Zamora-Ros R, Alghamdi MA, Cayssials V, Franceschi S, Almquist M, Hennings J, Sandström M, Tsilidis KK, Weiderpass E, Boutron-Ruault M-C, Hammer Bech B, Overvad K, Tjønneland A, Petersen KEN, Mancini FR, Mahamat-Saleh Y, Bonnet F, Kühn T, Fortner RT, Boeing H, Trichopoulou A, Bamia C, Martimianaki G, Masala G, Grioni S, Panico S, Tumino R, Fasanelli F, Skeie G, Braaten T, Lasheras C, Salamanca-Fernández E, Amiano P, Chirlaque M-D, Barricarte A, Manjer J, Wallström P, Bueno-de-Mesquita HB, Peeters PH, Khaw K-T, Wareham NJ, Schmidt JA, Aune D, Byrnes G, Scalbert A, Agudo A, Rinaldi Set al., 2018, Coffee and tea drinking in relation to the risk of differentiated thyroid carcinoma: results from the European Prospective Investigation into Cancer and Nutrition (EPIC) study, European Journal of Nutrition, ISSN: 0044-264X

PURPOSE: Coffee and tea constituents have shown several anti-carcinogenic activities in cellular and animal studies, including against thyroid cancer (TC). However, epidemiological evidence is still limited and inconsistent. Therefore, we aimed to investigate this association in a large prospective study. METHODS: The study was conducted in the EPIC (European Prospective Investigation into Cancer and Nutrition) cohort, which included 476,108 adult men and women. Coffee and tea intakes were assessed through validated country-specific dietary questionnaires. RESULTS: During a mean follow-up of 14 years, 748 first incident differentiated TC cases (including 601 papillary and 109 follicular TC) were identified. Coffee consumption (per 100 mL/day) was not associated either with total differentiated TC risk (HRcalibrated 1.00, 95% CI 0.97-1.04) or with the risk of TC subtypes. Tea consumption (per 100 mL/day) was not associated with the risk of total differentiated TC (HRcalibrated 0.98, 95% CI 0.95-1.02) and papillary tumor (HRcalibrated 0.99, 95% CI 0.95-1.03), whereas an inverse association was found with follicular tumor risk (HRcalibrated 0.90, 95% CI 0.81-0.99), but this association was based on a sub-analysis with a small number of cancer cases. CONCLUSIONS: In this large prospective study, coffee and tea consumptions were not associated with TC risk.

Journal article

Li K, Anderson G, Viallon V, Arveux P, Kvaskoff M, Fournier A, Krogh V, Tumino R, Sánchez MJ, Ardanaz E, Chirlaque MD, Agudo A, Muller DC, Smith T, Tzoulaki I, Key TJ, Bueno-De-Mesquita B, Trichopoulou A, Bamia C, Orfanos P, Kaaks R, Hüsing A, Fortner RT, Zeleniuch-Jacquotte A, Sund M, Dahm CC, Overvad K, Aune D, Weiderpass E, Romieu I, Riboli E, Gunter MJ, Dossus L, Prentice R, Ferrari Pet al., 2018, Risk prediction for estrogen receptor-specific breast cancers in two large prospective cohorts, Breast Cancer Research, Vol: 20, ISSN: 1465-5411

Background: Few published breast cancer (BC) risk prediction models consider the heterogeneity of predictor variables between estrogen-receptor positive (ER+) and negative (ER-) tumors. Using data from two large cohorts, we examined whether modeling this heterogeneity could improve prediction. Methods: We built two models, for ER+ (ModelER+) and ER- tumors (ModelER-), respectively, in 281,330 women (51% postmenopausal at recruitment) from the European Prospective Investigation into Cancer and Nutrition cohort. Discrimination (C-statistic) and calibration (the agreement between predicted and observed tumor risks) were assessed both internally and externally in 82,319 postmenopausal women from the Women's Health Initiative study. We performed decision curve analysis to compare ModelER+ and the Gail model (ModelGail) regarding their applicability in risk assessment for chemoprevention. Results: Parity, number of full-term pregnancies, age at first full-term pregnancy and body height were only associated with ER+ tumors. Menopausal status, age at menarche and at menopause, hormone replacement therapy, postmenopausal body mass index, and alcohol intake were homogeneously associated with ER+ and ER- tumors. Internal validation yielded a C-statistic of 0.64 for ModelER+ and 0.59 for ModelER-. External validation reduced the C-statistic of ModelER+ (0.59) and ModelGail (0.57). In external evaluation of calibration, ModelER+ outperformed the ModelGail: the former led to a 9% overestimation of the risk of ER+ tumors, while the latter yielded a 22% underestimation of the overall BC risk. Compared with the treat-all strategy, ModelER+ produced equal or higher net benefits irrespective of the benefit-to-harm ratio of chemoprevention, while ModelGail did not produce higher net benefits unless the benefit-to-harm ratio was below 50. The clinical applicability, i.e. the area defined by the net benefit curve and the treat-all and treat-none strategies, was 12.7 × 10- 6 for Mod

Journal article

Aune D, Snekvik I, Schlesinger S, Norat T, Riboli E, Vatten LJet al., 2018, Body mass index, abdominal fatness, weight gain and the risk of psoriasis: a systematic review and dose-response meta-analysis of prospective studies, European Journal of Epidemiology, Vol: 33, Pages: 1163-1178, ISSN: 0393-2990

Greater body mass index (BMI) has been associated with increased risk of psoriasis in case-control and cross-sectional studies, however, the evidence from prospective studies has been limited. We conducted a systematic review and dose-response meta-analysis of different adiposity measures and the risk of psoriasis to provide a more robust summary of the evidence based on data from prospective studies. PubMed and Embase databases were searched for relevant studies up to August 8th 2017. Summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated using a random effects model. The summary relative risk (RR) for a 5 unit increment in BMI was 1.19 (95% CI 1.10-1.28, I2 = 83%, n = 7). The association appeared to be stronger at higher compared to lower levels of BMI, pnonlinearity < 0.0001, and the lowest risk was observed at a BMI around 20. The summary RR was 1.24 (95% CI 1.17-1.31, I2 = 0%, pheterogeneity = 0.72, n = 3) per 10 cm increase in waist circumference, 1.37 (95% CI 1.23-1.53, I2 = 0%, pheterogeneity = 0.93, n = 3) per 0.1 unit increase in waist-to-hip ratio, and 1.11 (95% CI 1.07-1.16, I2 = 47%, pheterogeneity = 0.15, n = 3) per 5 kg of weight gain. Adiposity as measured by BMI, waist circumference, waist-to-hip ratio, and weight gain is associated with increased risk of psoriasis.

Journal article

Aune D, Schlesinger S, Norat T, Riboli Eet al., 2018, Diabetes mellitus and the risk of abdominal aortic aneurysm: A systematic review and meta-analysis of prospective studies, Journal of Diabetes and its Complications, Vol: 32, Pages: 1169-1174, ISSN: 1056-8727

BACKGROUND: Diabetes mellitus has been associated with reduced risk of abdominal aortic aneurysm in a number of epidemiological studies, however, until recently little data from prospective studies have been available. We therefore conducted a systematic review and meta-analysis of prospective studies to quantify the association. MATERIAL AND METHODS: Two investigators searched the PubMed and Embase databases for studies of diabetes and abdominal aortic aneurysm up to May 8th 2018. Prospective studies were included if they reported adjusted relative risk (RR) estimates and 95% confidence intervals (95% CIs) of abdominal aortic aneurysm associated with a diabetes diagnosis. Summary relative risks were estimated by use of a random effects model. RESULTS: We identified 16 prospective studies with 16,572 cases among 4,563,415 participants that could be included in the meta-analysis. The summary RR for individuals with diabetes compared to individuals without diabetes was 0.58 (95% CI: 0.51-0.66, I2 = 40.4%, pheterogeneity = 0.06). The results persisted when stratified by sex, duration of follow-up, and in most of the other subgroup analyses. There was no evidence of publication bias with Egger's test, p = 0.64 or by inspection of the funnel plots. CONCLUSIONS: These results suggest that individuals with diabetes mellitus are at a reduced risk of abdominal aortic aneurysm, however, whether pharmacological agents for diabetes mellitus explain this observation needs to be clarified in future studies.

Journal article

Aune D, Keum N, Giovannucci E, Fadnes LT, Boffetta P, Greenwood DC, Tonstad S, Vatten LJ, Riboli E, Norat Tet al., 2018, Dietary intake and blood concentrations of antioxidants and the risk of cardiovascular disease, total cancer, and all-cause mortality: a systematic review and dose-response meta-analysis of prospective studies, American Journal of Clinical Nutrition, Vol: 108, Pages: 1069-1091, ISSN: 1938-3207

Background: High dietary intake or blood concentrations (as biomarkers of dietary intake) of vitamin C, carotenoids, and vitamin E have been associated with reduced risk of cardiovascular disease, cancer, and mortality, but these associations have not been systematically assessed. Objective: We conducted a systematic review and meta-analysis of prospective studies of dietary intake and blood concentrations of vitamin C, carotenoids, and vitamin E in relation to these outcomes. Design: We searched PubMed and Embase up to 14 February 2018. Summary RRs and 95% CIs were calculated with the use of random-effects models. Results: Sixty-nine prospective studies (99 publications) were included. The summary RR per 100-mg/d increment of dietary vitamin C intake was 0.88 (95% CI: 0.79, 0.98, I2 = 65%, n = 11) for coronary heart disease, 0.92 (95% CI: 0.87, 0.98, I2 = 68%, n = 12) for stroke, 0.89 (95% CI: 0.85, 0.94, I2 = 27%, n = 10) for cardiovascular disease, 0.93 (95% CI: 0.87, 0.99, I2 = 46%, n = 8) for total cancer, and 0.89 (95% CI: 0.85, 0.94, I2 = 80%, n = 14) for all-cause mortality. Corresponding RRs per 50-μmol/L increase in blood concentrations of vitamin C were 0.74 (95% CI: 0.65, 0.83, I2 = 0%, n = 4), 0.70 (95% CI: 0.61, 0.81, I2 = 0%, n = 4), 0.76 (95% CI: 0.65, 0.87, I2 = 56%, n = 6), 0.74 (95% CI: 0.66, 0.82, I2 = 0%, n = 5), and 0.72 (95% CI: 0.66, 0.79, I2 = 0%, n = 8). Dietary intake and/or blood concentrations of carotenoids (total, β-carotene, α-carotene, β-cryptoxanthin, lycopene) and α-tocopherol, but not dietary vitamin E, were similarly inversely associated with coronary heart disease, stroke, cardiovascular disease, cancer, and/or all-cause mortality. Conclusions: Higher dietary intake and/or blood concentrations of vitamin C

Journal article

Aune D, Schlesinger S, Neuenschwander M, Feng T, Janszky I, Norat T, Riboli Eet al., 2018, Diabetes mellitus, blood glucose and the risk of heart failure: A systematic review and meta-analysis of prospective studies, Nutrition, Metabolism and Cardiovascular Diseases, Vol: 28, Pages: 1081-1091, ISSN: 0939-4753

BACKGROUND AND AIM: The strength of the association between diabetes and risk of heart failure has differed between previous studies and the available studies have not been summarized in a meta-analysis. We therefore quantified the association between diabetes and blood glucose and heart failure in a systematic review and meta-analysis. METHODS AND RESULTS: PubMed and Embase databases were searched up to May 3rd 2018. Prospective studies on diabetes mellitus or blood glucose and heart failure risk were included. A random effects model was used to calculate summary relative risks (RRs) and 95% confidence intervals (CIs). Seventy seven studies were included. Among the population-based prospective studies, the summary RR for individuals with diabetes vs. no diabetes was 2.06 (95% CIs: 1.73-2.46, I2 = 99.8%, n = 30 studies, 401495 cases, 21416780 participants). The summary RR was 1.23 (95% CI: 1.15-1.32, I2 = 78.2%, n = 10, 5344 cases, 91758 participants) per 20 mg/dl increase in blood glucose and there was evidence of a J-shaped association with nadir around 90 mg/dl and increased risk even within the pre-diabetic blood glucose range. Among the patient-based studies the summary RR was 1.69 (95% CI: 1.57-1.81, I2 = 85.5%, pheterogeneity<0.0001) for diabetes vs. no diabetes (n = 41, 100284 cases and >613925 participants) and 1.25 (95% CI: 0.89-1.75, I2 = 95.6%, pheterogeneity<0.0001) per 20 mg/dl increase in blood glucose (1016 cases, 34309 participants, n = 2). In the analyses of diabetes and heart failure there was low or no heterogeneity among the population-based studies that adjusted for alcohol intake and physical activity and among the patient-based studies there was no heterogeneity among studies with ≥10 years follow-up. CONCLUSIONS: These results suggest that individuals with diabetes are at an increased risk of developing heart failure and there is eviden

Journal article

Sarink D, Schock H, Johnson T, Chang-Claude J, Overvad K, Olsen A, Tjonneland A, Arveux P, Fournier A, Kvaskoff M, Boeing H, Karakatsani A, Trichopoulou A, La Vecchia C, Masala G, Agnoli C, Panico S, Tumino R, Sacerdote C, van Gils CH, Peeters PHM, Weiderpass E, Agudo A, Rodriguez-Barranco M, Maria Huerta J, Ardanaz E, Gil L, Kaw KT, Schmidt JA, Dossus L, His M, Aune D, Riboli E, Kaaks R, Fortner RTet al., 2018, Receptor activator of nuclear factor kB ligand, osteoprotegerin, and risk of death following a breast cancer diagnosis: results from the EPIC cohort, BMC Cancer, Vol: 18, ISSN: 1471-2407

BackgroundReceptor activator of nuclear factor kappa-B (RANK)-signaling is involved in tumor growth and spread in experimental models. Binding of RANK ligand (RANKL) to RANK activates signaling, which is inhibited by osteoprotegerin (OPG). We have previously shown that circulating soluble RANKL (sRANKL) and OPG are associated with breast cancer risk. Here we extend these findings to provide the first data on pre-diagnosis concentrations of sRANKL and OPG and risk of breast cancer-specific and overall mortality after a breast cancer diagnosis.MethodsTwo thousand six pre- and postmenopausal women with incident invasive breast cancer (1620 (81%) with ER+ disease) participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort were followed-up for mortality. Pre-diagnosis concentrations of sRANKL and OPG were quantified in baseline serum samples using an enzyme-linked immunosorbent assay and electrochemiluminescent assay, respectively. Hazard ratios (HRs) and 95% confidence intervals (CIs) for breast cancer-specific and overall mortality were calculated using Cox proportional hazards regression models.ResultsEspecially in women with ER+ disease, higher circulating OPG concentrations were associated with higher risk of breast cancer-specific (quintile 5 vs 1 HR 1.77 [CI 1.03, 3.04]; ptrend 0.10) and overall mortality (q5 vs 1 HR 1.39 [CI 0.94, 2.05]; ptrend 0.02). sRANKL and the sRANKL/OPG ratio were not associated with mortality following a breast cancer diagnosis.ConclusionsHigh pre-diagnosis endogenous concentrations of OPG, the decoy receptor for RANKL, were associated with increased risk of death after a breast cancer diagnosis, especially in those with ER+ disease. These results need to be confirmed in well-characterized patient cohorts.

Journal article

Aune D, Schlesinger S, Norat T, Riboli Eet al., 2018, Tobacco smoking and the risk of heart failure: a systematic review and meta-analysis of prospective studies, European Journal of Preventive Cardiology, ISSN: 2047-4873

Background We conducted a systematic review and meta-analysis to clarify the association between smoking and the risk of developing heart failure. Methods PubMed and Embase databases were searched up to 24 July 2018. Prospective studies were included if they reported adjusted relative risk (RR) estimates and 95% confidence intervals (CIs) of heart failure associated with smoking. Summary RRs and 95% CIs were estimated using a random effects model. Results Twenty-six studies were included. The summary RR was 1.75 (95% CI: 1.54-1.99, I2 = 81%, n = 10) for current smokers, 1.16 (95% CI: 1.08-1.24, I2 = 51%, n = 9) for former smokers, and 1.44 (1.34-1.55, I2 = 83%, n = 10) for ever smokers compared with never smokers. The summary RR was 1.41 (95% CI: 1.01-1.96, I2 = 82%, n = 2) per 10 cigarettes per day, 1.11 (95% CI: 1.04-1.18, I2 = 70%, n = 3) and 1.08 (95% CI: 1.02-1.14, I2 = 34%, n = 2) per 10 pack-years among ever smokers and former smokers, respectively, and 0.79 (95% CI: 0.63-1.00, I2 = 96%, n = 2) per 10 years since quitting smoking. The association between smoking cessation and heart failure reached significance at 15 years of smoking cessation, and at 30 years the summary RR was 0.72 (95% CI: 0.57-0.90), only slightly higher than the summary RR for never smokers (0.64 (95% CI: 0.57-0.72)) when compared with current smokers. Conclusion Smoking is associated with increased risk of heart failure, but the risk decreases with increasing duration since smoking cessation. Any further studies should investigate the association between number of cigarettes per day, duration, pack-years and time since quitting smoking and risk of heart failure.

Journal article

Huseinovic E, Winkvist A, Freisling H, Slimani N, Boeing H, Buckland G, Schwingshackl L, Olsen A, Tjønneland A, Stepien M, Boutron-Ruault M-C, Mancini F, Artaud F, Kühn T, Katzke V, Trichopoulou A, Naska A, Orfanos P, Tumino R, Masala G, Krogh V, Santucci de Magistris M, Ocké MC, Brustad M, Jensen TE, Skeie G, Rodríguez-Barranco M, Huerta JM, Ardanaz E, Quirós JR, Jakszyn P, Sonestedt E, Ericson U, Wennberg M, Key TJ, Aune D, Riboli E, Weiderpass E, Bertéus Forslund Het al., 2018, Timing of eating across ten European countries - results from the European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study, Public Health Nutrition, ISSN: 1368-9800

OBJECTIVE: To examine timing of eating across ten European countries. DESIGN: Cross-sectional analysis of the European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study using standardized 24 h diet recalls collected during 1995-2000. Eleven predefined food consumption occasions were assessed during the recall interview. We present time of consumption of meals and snacks as well as the later:earlier energy intake ratio, with earlier and later intakes defined as 06.00-14.00 and 15.00-24.00 hours, respectively. Type III tests were used to examine associations of sociodemographic, lifestyle and health variables with timing of energy intake. SETTING: Ten Western European countries. SUBJECTS: In total, 22 985 women and 13 035 men aged 35-74 years (n 36 020). RESULTS: A south-north gradient was observed for timing of eating, with later consumption of meals and snacks in Mediterranean countries compared with Central and Northern European countries. However, the energy load was reversed, with the later:earlier energy intake ratio ranging from 0·68 (France) to 1·39 (Norway) among women, and from 0·71 (Greece) to 1·35 (the Netherlands) among men. Among women, country, age, education, marital status, smoking, day of recall and season were all independently associated with timing of energy intake (all P<0·05). Among men, the corresponding variables were country, age, education, smoking, physical activity, BMI and day of recall (all P<0·05). CONCLUSIONS: We found pronounced differences in timing of eating across Europe, with later meal timetables but greater energy load earlier during the day in Mediterranean countries compared with Central and Northern European countries.

Journal article

Aune D, Schlesinger S, Norat T, Riboli Eet al., 2018, Tobacco smoking and the risk of abdominal aortic aneurysm: A systematic review and meta-analysis of prospective studies, Scientific Reports, Vol: 8, ISSN: 2045-2322

Several studies have found that smoking increases the risk of abdominal aortic aneurysm, however, the strength of the association has differed between studies and data from cohort studies have not yet been summarized. A systematic review and meta-analysis was therefore conducted to clarify this association. We searched PubMed and Embase databases up to May 2nd 2018. A random effects model was used to estimate summary relative risks (RRs) and 95% confidence intervals (CIs). Twenty three prospective studies were included. Comparing current, former and ever smokers with never smokers the summary RRs were 4.87 (95% CI: 3.93–6.02, I2 = 92%, n = 20), 2.10 (95% CI: 1.76–2.50, I2 = 71%, n = 15) and 3.28 (95% CI: 2.60–4.15, I2 = 96%, n = 18), respectively. The summary RR was 1.87 (95% CI: 1.45–2.40, I2 = 97%) per 10 cigarettes per day, 1.78 (95% CI: 1.54–2.06, I2 = 83%) per 10 pack-years was and 0.45 (95% CI: 0.32–0.63, I2 = 92.3%) per 10 years of smoking cessation. There was evidence of nonlinearity for cigarettes per day and pack-years (pnonlinearity < 0.0001 and pnonlinearity = 0.02, respectively), but not for smoking cessation, pnonlinearity = 0.85. Among smokers who quit, the RR was similar to that of never smokers by 25 years of smoking cessation. These findings confirm a strong association between smoking and the risk of developing abdominal aortic aneurysms.

Journal article

Freisling H, Noh H, Slimani N, Chajès V, May AM, Peeters PH, Weiderpass E, Cross AJ, Skeie G, Jenab M, Mancini FR, Boutron-Ruault M-C, Fagherazzi G, Katzke VA, Kühn T, Steffen A, Boeing H, Tjønneland A, Kyrø C, Hansen CP, Overvad K, Duell EJ, Redondo-Sánchez D, Amiano P, Navarro C, Barricarte A, Perez-Cornago A, Tsilidis KK, Aune D, Ward H, Trichopoulou A, Naska A, Orfanos P, Masala G, Agnoli C, Berrino F, Tumino R, Sacerdote C, Mattiello A, Bueno-de-Mesquita HB, Ericson U, Sonestedt E, Winkvist A, Braaten T, Romieu I, Sabaté Jet al., 2018, Nut intake and 5-year changes in body weight and obesity risk in adults: results from the EPIC-PANACEA study, European Journal of Nutrition, Vol: 57, Pages: 2399-2408, ISSN: 0044-264X

PURPOSE: There is inconsistent evidence regarding the relationship between higher intake of nuts, being an energy-dense food, and weight gain. We investigated the relationship between nut intake and changes in weight over 5 years. METHODS: This study includes 373,293 men and women, 25-70 years old, recruited between 1992 and 2000 from 10 European countries in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Habitual intake of nuts including peanuts, together defined as nut intake, was estimated from country-specific validated dietary questionnaires. Body weight was measured at recruitment and self-reported 5 years later. The association between nut intake and body weight change was estimated using multilevel mixed linear regression models with center/country as random effect and nut intake and relevant confounders as fixed effects. The relative risk (RR) of becoming overweight or obese after 5 years was investigated using multivariate Poisson regressions stratified according to baseline body mass index (BMI). RESULTS: On average, study participants gained 2.1 kg (SD 5.0 kg) over 5 years. Compared to non-consumers, subjects in the highest quartile of nut intake had less weight gain over 5 years (-0.07 kg; 95% CI -0.12 to -0.02) (P trend = 0.025) and had 5% lower risk of becoming overweight (RR 0.95; 95% CI 0.92-0.98) or obese (RR 0.95; 95% CI 0.90-0.99) (both P trend <0.008). CONCLUSIONS: Higher intake of nuts is associated with reduced weight gain and a lower risk of becoming overweight or obese.

Journal article

Cairat M, Fournier A, Murphy N, Biessy C, Scalbert A, Rinaldi S, Tjønneland A, Olsen A, Overvad K, Arveux P, Boutron-Ruault M-C, Cadeau C, Fortner RT, Kaaks R, Boeing H, Aleksandrova K, Peeters PHM, Van Gils CH, Wareham NJ, Khaw K-T, Aune D, Riboli E, Gunter MJ, Dossus Let al., 2018, Nonsteroidal anti-inflammatory drug use and breast cancer risk in a European prospective cohort study, International Journal of Cancer, Vol: 143, Pages: 1688-1695, ISSN: 0020-7136

Experimental studies have shown a protective effect of nonsteroidal anti-inflammatory drugs (NSAIDs) on breast cancer development. However, results from epidemiological cohort studies are less consistent. Our objective was to assess the association between NSAID use and breast cancer risk within the European Prospective Investigation into Cancer and Nutrition (EPIC). EPIC is a prospective cohort study initiated in 1992 in 10 European countries. Self-reported information on NSAID use at baseline has been collected in five EPIC countries. Multivariable Cox regression models were used to estimate hazard ratios for the association of NSAID use with breast cancer incidence with adjustment for potential confounders. We also assessed effect modification by breast cancer risk factors and examined the associations within specific breast cancer subtypes. Among the 140,981 women included in the analysis, 7% were regularly using NSAIDs at baseline. During a median follow-up time period of 13 years, 7,379 incident breast cancer cases were diagnosed (816 in situ and 6,563 invasive). There were no statistically significant associations between NSAID use and breast cancer risk, overall and by subtypes. However, a statistically significant interaction was observed for invasive cases between NSAID use and ever use of menopausal hormonal therapy (MHT) among postmenopausal women [MHT users: HRNSAID use =0.84 (0.73 - 0.96); non MHT users: HRNSAID use = 1.08 (0.93 - 1.25); Pinteraction = 0.05]. Our results indicate potential effect modification of MHT use on the association between use of NSAIDs and breast cancer risk which deserves in-depth investigation in studies with accurate data on both NSAID and MHT use.

Journal article

Bradbury KE, Appleby PN, Tipper SJ, Travis RC, Allen NE, Kvaskoff M, Overvad K, Tjønneland A, Halkjaer J, Cevenka I, Mahamat-Saleh Y, Bonnet F, Kaaks R, Turzanski Fortner R, Boeing H, Trichopoulou A, La Vecchia C, Stratigos AJ, Palli D, Grioni S, Matullo G, Panico S, Tumino R, Peeters PH, Bueno-de-Mesquita B, Ghiasvand R, Veierød MB, Weiderpass E, Bonet C, Molina E, Huerta JM, Larrañaga N, Barricarte A, Merino S, Isaksson K, Stocks T, Ljuslinder I, Hemmingsson O, Wareham N, Khaw K-T, Gunter MJ, Rinaldi S, Tsilidis KK, Aune D, Riboli E, Key TJet al., 2018, Circulating insulin-like growth factor I in relation to melanoma risk in the European Prospective Investigation into Cancer and Nutrition, International Journal of Cancer, ISSN: 0020-7136

Insulin-like growth factor (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 1221 melanoma cases and 1221 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 sex, 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. This article is protected by copyright. All rights reserved.

Journal article

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