@article{5145891f8fb34bce8aa49a30e9497120,
title = "Mediterranean diet adherence and risk of pancreatic cancer: A pooled analysis of two Dutch cohorts",
abstract = "3w?>Studies investigating the association of Mediterranean diet (MD) adherence with pancreatic cancer risk are limited and had inconsistent results. We examined the association between MD adherence and pancreatic cancer incidence by pooling data from the Netherlands Cohort Study (NLCS, 120,852 subjects) and the Dutch cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-NL, 40,011 subjects). MD adherence was assessed using alternate and modified Mediterranean diet scores (aMED and mMED, respectively), including and excluding alcohol. After median follow-ups of 20.3 (NLCS) and 19.2 (EPIC-NL) years, 449 microscopically confirmed pancreatic cancer (MCPC) cases were included in study-specific multivariable Cox models. Study-specific estimates were pooled using a random-effects model. MD adherence was not significantly associated with MCPC risk in pooled and study-specific analyses, regardless of sex and MD score. Pooled hazard ratios (95% confidence interval) for high (6-8) compared to low (0-3) values of mMED excluding alcohol were 0.66 (0.40-1.10) in men and 0.94 (0.63-1.40) in women. In never smokers, mMED excluding alcohol seemed to be inversely associated with MCPC risk (nonsignificant). However, no association was observed in ever smokers (p(heterogeneity) = 0.03). Hazard ratios were consistent across strata of other potential effect modifiers. Considering MD scores excluding alcohol, mMED-containing models generally fitted better than aMED-containing models, particularly in men. Although associations somewhat differed when all pancreatic cancers were considered instead of MCPC, the overall conclusion was similar. In conclusion, MD adherence was not associated with pancreatic cancer risk in a pooled analysis of two Dutch cohorts.",
keywords = "Mediterranean diet, pancreatic cancer, cohort study, epidemiology, FOOD FREQUENCY QUESTIONNAIRE, SCALE PROSPECTIVE COHORT, MORTALITY, SURVIVAL, REPRODUCIBILITY, DISEASE, DESIGN, SCORE, MODEL",
author = "Maya Schulpen and Peeters, {Petra H.} and {van den Brandt}, {Piet A.}",
note = "Funding Information: Key words: Mediterranean diet, pancreatic cancer, cohort study, epidemiology Abbreviations: 95% CIs: 95% confidence intervals; AIC: Akaike{\textquoteright}s Information Criterion; aMED: alternate Mediterranean diet score; aMEDr: alternate Mediterranean diet score without alcohol; BMI: body mass index; EPIC: European Prospective Investigation into Cancer and Nutrition; EPIC-NL: the Dutch EPIC cohort; FFQ: food frequency questionnaire; g/day: grams per day; HRs: hazard ratios; ICD-O-3: International Classification of Diseases for Oncology, Third Edition; kcal: kilocalories; MCPC: microscopically confirmed pancreatic cancer; MD: Mediterranean dietary pattern; mMED: modified Mediterranean diet score; mMEDr: modified Mediterranean diet score without alcohol; MUFA: monounsaturated fatty acids; NIH-AARP: National Institutes of Health-American Association of Retired Persons; NLCS: Netherlands Cohort Study; PH: proportional hazards; PUFA: polyunsaturated fatty acids; SFA: saturated fatty acids; tMED: traditional Mediterranean diet score; US: United States; WCRF/AICR: World Cancer Research Fund/American Institute for Cancer Research Additional Supporting Information may be found in the online version of this article. Conflict of interest: The authors declare that there are no conflicts of interest. Grant sponsor: Ministerie van Volksgezondheid, Welzijn en Sport; Grant sponsor: The Dutch Prevention Funds; Grant sponsor: The Dutch ZON (Zorg Onderzoek Nederland); Grant numbers: 2015/1390; Grant sponsor: Wereld Kanker Onderzoek Fonds Nederland (WCRF-NL); Grant numbers: 2015/1390; Grant sponsor: World Cancer Research Fund DOI: 10.1002/ijc.31872 This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. History: Received 22 May 2018; Accepted 10 Sep 2018; Online 19 Sep 2018 Correspondence to: Maya Schulpen, Maastricht University Medical Centre, GROW-School for Oncology and Developmental Biology, Department of Epidemiology, P.O. Box 616, 6200 MD Maastricht, the Netherlands; E-mail: maya.schulpen@maastrichtuniversity.nl; Tel.: +31 (0)43 3882391; Fax: +31 (0)43 3884128 Funding Information: We are indebted to the participants of the Netherlands Cohort Study (NLCS) and the Dutch cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-NL), and further wish to thank the Netherlands Cancer Registry (NKR) and the Dutch Pathology Registry (PALGA). Additionally, we thank the National Institute for Public Health and the Environment for their contribution to data collection and follow-up of the EPIC-NL cohort. We also thank Statistics Netherlands for data handling of the EPIC-NL cohort. Finally, NLCS and EPIC-NL staff members are acknowledged for their valuable assistance and advice. Publisher Copyright: {\textcopyright} 2018 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.",
year = "2019",
month = apr,
day = "1",
doi = "10.1002/ijc.31872",
language = "English",
volume = "144",
pages = "1550--1560",
journal = "International Journal of Cancer",
issn = "0020-7136",
publisher = "Wiley",
number = "7",
}