Adherence to the mediterranean diet and lymphoma risk in the european prospective investigation into cancer and nutrition

Benavente, Yolanda
Agudo, Antonio
Naudin, Sabine
Hosnijeh, Fatemeh Saberi
Noh, Hwayoung
Freisling, Heinz
Ferrari, Pietro
Besson, Caroline
Mahamat-Saleh, Yahya
Kühn, Tilman
Kaaks, Rudolf
Boeing, Heiner
Lasheras, Cristina
Rodríguez Barranco, Miguel
Amiano, Pilar
Huerta, Jose Maria
Barricarte, Aurelio
Schmidt, Julie A.
Vineis, Paolo
Riboli, Elio
Trichopoulou, Antonia
Bamia, Christina
Peppa, Eleni
Masala, Giovanna
Agnoli, Claudia
Tumino, Rosario
Sacerdote, Carlotta
Panico, Salvatore
Skeie, Guri
Weiderpass, Elisabete
Jerkeman, Mats
Ericson, Ulrika
Späth, Florentin
Nilsson, Lena Maria
Dahm, Christina C.
Overvad, Kim
Bolvig, Anne Katrine
Tjønneland, Anne
Buckland, Genevieve
Vermeulen, Roel
Nieters, Alexandra
Casabonne, Delphine
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There is a growing evidence of the protective role of the Mediterranean diet (MD) on cancer. However, no prospective study has yet investigated its influence on lymphoma. We evaluated the association between adherence to the MD and risk of lymphoma and its subtypes in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. The analysis included 476,160 participants, recruited from 10 European countries between 1991 and 2001. Adherence to the MD was estimated through the adapted relative MD (arMED) score excluding alcohol. Cox proportional hazards regression models were used while adjusting for potential confounders. During an average follow-up of 13.9 years, 3,136 lymphomas (135 Hodgkin lymphoma [HL], 2,606 non-HL and 395 lymphoma not otherwise specified) were identified. Overall, a 1-unit increase in the arMED score was associated with a 2% lower risk of lymphoma (95% CI: 0.97; 1.00, p-trend = 0.03) while a statistically nonsignificant inverse association between a high versus low arMED score and risk of lymphoma was observed (hazard ratio [HR]: 0.91 [95% CI 0.80; 1.03], p-trend = 0.12). Analyses by lymphoma subtype did not reveal any statistically significant associations. Albeit with small numbers of cases (N = 135), a suggestive inverse association was found for HL (HR 1-unit increase = 0.93 [95% CI: 0.86; 1.01], p-trend = 0.07). However, the study may have lacked statistical power to detect small effect sizes for lymphoma subtype. Our findings suggest that an increasing arMED score was inversely related to the risk of overall lymphoma in EPIC but not by subtypes. Further large prospective studies are warranted to confirm these findings ​
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