Adherence to the Mediterranean Diet and Obesity-Linked Cancer Risk in EPIC

Inmaculada Aguilera-Buenosvinos; Fernanda Morales Berstein; Esther M González-Gil; Laure Dossus; Marc J Gunter; Carine Biessy; Giovanna Masala; Maria Santucci De Magistris; Nasser Laouali; Sanam Shah; Chloé Marques; Alicia K Heath; Konstantinos K Tsilidis; Amanda J Cross; Pietro Ferrari; Carlota Castro-Espin; Charlotte Debras; Rosario Tumino; Anne Tjønneland; Jytte Halkjær; Isabel Drake; Ulrika Ericson; Marcela Guevara; Miguel Rodríguez-Barranco; Guri Skeie; Tonje Braaten; Inger Torhild Gram; Christina C Dahm; Claudia Agnoli; Matthias B Schulze; José María Huerta; Miguel Ángel Martínez-González; Inge Huybrechts; Estefania Toledo Atucha

doi:10.1001/jamanetworkopen.2024.61031

Adherence to the Mediterranean Diet and Obesity-Linked Cancer Risk in EPIC

Inmaculada Aguilera-Buenosvinos, Fernanda Morales Berstein, Esther M González-Gil, Laure Dossus, Marc J Gunter, Carine Biessy, Giovanna Masala, Maria Santucci De Magistris, Nasser Laouali, Sanam Shah, Chloé Marques, Alicia K Heath, Konstantinos K Tsilidis, Amanda J Cross, Pietro Ferrari, Carlota Castro-Espin, Charlotte Debras, Rosario Tumino, Anne Tjønneland, Jytte HalkjærIsabel Drake, Ulrika Ericson, Marcela Guevara, Miguel Rodríguez-Barranco, Guri Skeie, Tonje Braaten, Inger Torhild Gram, Christina C Dahm, Claudia Agnoli, Matthias B Schulze, José María Huerta, Miguel Ángel Martínez-González, Inge Huybrechts, Estefania Toledo Atucha

Section of Environmental Health

Research output: Contribution to journal › Journal article › Research › peer-review

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Abstract

IMPORTANCE: Adherence to the Mediterranean Diet (MedDiet) has been associated with a lower incidence of cancer and reduced weight gain. These associations suggest a potential role for the MedDiet in lowering the risk of obesity-related cancers (ORCs). Obesity is a known risk factor for various cancers and shows an inverse association with MedDiet adherence.

OBJECTIVE: To examine the association between adherence to the MedDiet and the risk of ORCs, considering the possible mediating role of adiposity.

DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study analyzed data from the European Prospective Investigation Into Cancer and Nutrition (EPIC) study, which enrolled participants aged 35 to 70 years from 1992 to 2000 across 23 centers in 10 countries. The data analysis was conducted from March 1 to May 31, 2023.

EXPOSURES: Dietary intake before baseline was evaluated using country-specific, validated questionnaires administered at recruitment. Adherence to the MedDiet was scored on a 9-point scale and categorized as low (0-3 points), medium (4-6 points), or high (7-9 points).

MAIN OUTCOMES AND MEASURES: The primary outcome was the incidence of ORCs, classified according to the 2015 International Agency for Research on Cancer criteria. Multivariable Cox proportional hazards regression models were used to assess the association between MedDiet adherence and ORC incidence. Mediation analyses were conducted to evaluate the role of waist to hip ratio and body mass index in this association.

RESULTS: A total of 450 111 participants were included in the study (mean [SD] age, 51.1 [9.8] years; 70.8% women) and followed up during a median (IQR) time of 14.9 (4.1) years. Among participants, 4.9% experienced an ORC (rates, 0.053, 0.049, and 0.043 per person-year in the low, medium, and high MedDiet adherence groups, respectively). Participants with high adherence to the MedDiet (7-9 points) had a lower risk of ORC compared with those with low adherence (0-3 points) (hazard ratio [HR], 0.94; 95% CI, 0.90-0.98). A similar inverse association was observed for participants with medium adherence (4-6 points vs 0-3 points). However, mediation analyses did not show associations of waist to hip ratio or body mass index between MedDiet adherence and ORC risk.

CONCLUSIONS AND RELEVANCE: These findings indicate that higher adherence to the MedDiet is associated with a modest reduction in the risk of ORCs, independent of adiposity measures. Further research is needed to clarify the mechanisms by which the MedDiet may contribute to cancer prevention.

Original language	English
Article number	e2461031
Journal	JAMA network open
Volume	8
Issue number	2
Number of pages	15
ISSN	2574-3805
DOIs	https://doi.org/10.1001/jamanetworkopen.2024.61031
Publication status	Published - 2025

Keywords

Humans
Diet, Mediterranean/statistics & numerical data
Middle Aged
Female
Male
Neoplasms/prevention & control
Obesity/epidemiology
Prospective Studies
Adult
Aged
Europe/epidemiology
Risk Factors
Incidence
Patient Compliance/statistics & numerical data
Body Mass Index
Proportional Hazards Models

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Cite this

Aguilera-Buenosvinos, I., Morales Berstein, F., González-Gil, E. M., Dossus, L., Gunter, M. J., Biessy, C., Masala, G., Santucci De Magistris, M., Laouali, N., Shah, S., Marques, C., Heath, A. K., Tsilidis, K. K., Cross, A. J., Ferrari, P., Castro-Espin, C., Debras, C., Tumino, R., Tjønneland, A., ... Toledo Atucha, E. (2025). Adherence to the Mediterranean Diet and Obesity-Linked Cancer Risk in EPIC. JAMA network open, 8(2), Article e2461031. https://doi.org/10.1001/jamanetworkopen.2024.61031

Aguilera-Buenosvinos, I, Morales Berstein, F, González-Gil, EM, Dossus, L, Gunter, MJ, Biessy, C, Masala, G, Santucci De Magistris, M, Laouali, N, Shah, S, Marques, C, Heath, AK, Tsilidis, KK, Cross, AJ, Ferrari, P, Castro-Espin, C, Debras, C, Tumino, R, Tjønneland, A, Halkjær, J, Drake, I, Ericson, U, Guevara, M, Rodríguez-Barranco, M, Skeie, G, Braaten, T, Gram, IT, Dahm, CC, Agnoli, C, Schulze, MB, Huerta, JM, Martínez-González, MÁ, Huybrechts, I & Toledo Atucha, E 2025, 'Adherence to the Mediterranean Diet and Obesity-Linked Cancer Risk in EPIC', JAMA network open, vol. 8, no. 2, e2461031. https://doi.org/10.1001/jamanetworkopen.2024.61031

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title = "Adherence to the Mediterranean Diet and Obesity-Linked Cancer Risk in EPIC",

abstract = "IMPORTANCE: Adherence to the Mediterranean Diet (MedDiet) has been associated with a lower incidence of cancer and reduced weight gain. These associations suggest a potential role for the MedDiet in lowering the risk of obesity-related cancers (ORCs). Obesity is a known risk factor for various cancers and shows an inverse association with MedDiet adherence.OBJECTIVE: To examine the association between adherence to the MedDiet and the risk of ORCs, considering the possible mediating role of adiposity.DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study analyzed data from the European Prospective Investigation Into Cancer and Nutrition (EPIC) study, which enrolled participants aged 35 to 70 years from 1992 to 2000 across 23 centers in 10 countries. The data analysis was conducted from March 1 to May 31, 2023.EXPOSURES: Dietary intake before baseline was evaluated using country-specific, validated questionnaires administered at recruitment. Adherence to the MedDiet was scored on a 9-point scale and categorized as low (0-3 points), medium (4-6 points), or high (7-9 points).MAIN OUTCOMES AND MEASURES: The primary outcome was the incidence of ORCs, classified according to the 2015 International Agency for Research on Cancer criteria. Multivariable Cox proportional hazards regression models were used to assess the association between MedDiet adherence and ORC incidence. Mediation analyses were conducted to evaluate the role of waist to hip ratio and body mass index in this association.RESULTS: A total of 450 111 participants were included in the study (mean [SD] age, 51.1 [9.8] years; 70.8% women) and followed up during a median (IQR) time of 14.9 (4.1) years. Among participants, 4.9% experienced an ORC (rates, 0.053, 0.049, and 0.043 per person-year in the low, medium, and high MedDiet adherence groups, respectively). Participants with high adherence to the MedDiet (7-9 points) had a lower risk of ORC compared with those with low adherence (0-3 points) (hazard ratio [HR], 0.94; 95% CI, 0.90-0.98). A similar inverse association was observed for participants with medium adherence (4-6 points vs 0-3 points). However, mediation analyses did not show associations of waist to hip ratio or body mass index between MedDiet adherence and ORC risk.CONCLUSIONS AND RELEVANCE: These findings indicate that higher adherence to the MedDiet is associated with a modest reduction in the risk of ORCs, independent of adiposity measures. Further research is needed to clarify the mechanisms by which the MedDiet may contribute to cancer prevention.",

keywords = "Humans, Diet, Mediterranean/statistics & numerical data, Middle Aged, Female, Male, Neoplasms/prevention & control, Obesity/epidemiology, Prospective Studies, Adult, Aged, Europe/epidemiology, Risk Factors, Incidence, Patient Compliance/statistics & numerical data, Body Mass Index, Proportional Hazards Models",

author = "Inmaculada Aguilera-Buenosvinos and {Morales Berstein}, Fernanda and Gonz{\'a}lez-Gil, {Esther M} and Laure Dossus and Gunter, {Marc J} and Carine Biessy and Giovanna Masala and {Santucci De Magistris}, Maria and Nasser Laouali and Sanam Shah and Chlo{\'e} Marques and Heath, {Alicia K} and Tsilidis, {Konstantinos K} and Cross, {Amanda J} and Pietro Ferrari and Carlota Castro-Espin and Charlotte Debras and Rosario Tumino and Anne Tj{\o}nneland and Jytte Halkj{\ae}r and Isabel Drake and Ulrika Ericson and Marcela Guevara and Miguel Rodr{\'i}guez-Barranco and Guri Skeie and Tonje Braaten and Gram, {Inger Torhild} and Dahm, {Christina C} and Claudia Agnoli and Schulze, {Matthias B} and Huerta, {Jos{\'e} Mar{\'i}a} and Mart{\'i}nez-Gonz{\'a}lez, {Miguel {\'A}ngel} and Inge Huybrechts and {Toledo Atucha}, Estefania",

year = "2025",

doi = "10.1001/jamanetworkopen.2024.61031",

language = "English",

volume = "8",

journal = "JAMA network open",

issn = "2574-3805",

publisher = "American Medical Association",

number = "2",

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TY - JOUR

T1 - Adherence to the Mediterranean Diet and Obesity-Linked Cancer Risk in EPIC

AU - Aguilera-Buenosvinos, Inmaculada

AU - Morales Berstein, Fernanda

AU - González-Gil, Esther M

AU - Dossus, Laure

AU - Gunter, Marc J

AU - Biessy, Carine

AU - Masala, Giovanna

AU - Santucci De Magistris, Maria

AU - Laouali, Nasser

AU - Shah, Sanam

AU - Marques, Chloé

AU - Heath, Alicia K

AU - Tsilidis, Konstantinos K

AU - Cross, Amanda J

AU - Ferrari, Pietro

AU - Castro-Espin, Carlota

AU - Debras, Charlotte

AU - Tumino, Rosario

AU - Tjønneland, Anne

AU - Halkjær, Jytte

AU - Drake, Isabel

AU - Ericson, Ulrika

AU - Guevara, Marcela

AU - Rodríguez-Barranco, Miguel

AU - Skeie, Guri

AU - Braaten, Tonje

AU - Gram, Inger Torhild

AU - Dahm, Christina C

AU - Agnoli, Claudia

AU - Schulze, Matthias B

AU - Huerta, José María

AU - Martínez-González, Miguel Ángel

AU - Huybrechts, Inge

AU - Toledo Atucha, Estefania

PY - 2025

Y1 - 2025

N2 - IMPORTANCE: Adherence to the Mediterranean Diet (MedDiet) has been associated with a lower incidence of cancer and reduced weight gain. These associations suggest a potential role for the MedDiet in lowering the risk of obesity-related cancers (ORCs). Obesity is a known risk factor for various cancers and shows an inverse association with MedDiet adherence.OBJECTIVE: To examine the association between adherence to the MedDiet and the risk of ORCs, considering the possible mediating role of adiposity.DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study analyzed data from the European Prospective Investigation Into Cancer and Nutrition (EPIC) study, which enrolled participants aged 35 to 70 years from 1992 to 2000 across 23 centers in 10 countries. The data analysis was conducted from March 1 to May 31, 2023.EXPOSURES: Dietary intake before baseline was evaluated using country-specific, validated questionnaires administered at recruitment. Adherence to the MedDiet was scored on a 9-point scale and categorized as low (0-3 points), medium (4-6 points), or high (7-9 points).MAIN OUTCOMES AND MEASURES: The primary outcome was the incidence of ORCs, classified according to the 2015 International Agency for Research on Cancer criteria. Multivariable Cox proportional hazards regression models were used to assess the association between MedDiet adherence and ORC incidence. Mediation analyses were conducted to evaluate the role of waist to hip ratio and body mass index in this association.RESULTS: A total of 450 111 participants were included in the study (mean [SD] age, 51.1 [9.8] years; 70.8% women) and followed up during a median (IQR) time of 14.9 (4.1) years. Among participants, 4.9% experienced an ORC (rates, 0.053, 0.049, and 0.043 per person-year in the low, medium, and high MedDiet adherence groups, respectively). Participants with high adherence to the MedDiet (7-9 points) had a lower risk of ORC compared with those with low adherence (0-3 points) (hazard ratio [HR], 0.94; 95% CI, 0.90-0.98). A similar inverse association was observed for participants with medium adherence (4-6 points vs 0-3 points). However, mediation analyses did not show associations of waist to hip ratio or body mass index between MedDiet adherence and ORC risk.CONCLUSIONS AND RELEVANCE: These findings indicate that higher adherence to the MedDiet is associated with a modest reduction in the risk of ORCs, independent of adiposity measures. Further research is needed to clarify the mechanisms by which the MedDiet may contribute to cancer prevention.

AB - IMPORTANCE: Adherence to the Mediterranean Diet (MedDiet) has been associated with a lower incidence of cancer and reduced weight gain. These associations suggest a potential role for the MedDiet in lowering the risk of obesity-related cancers (ORCs). Obesity is a known risk factor for various cancers and shows an inverse association with MedDiet adherence.OBJECTIVE: To examine the association between adherence to the MedDiet and the risk of ORCs, considering the possible mediating role of adiposity.DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study analyzed data from the European Prospective Investigation Into Cancer and Nutrition (EPIC) study, which enrolled participants aged 35 to 70 years from 1992 to 2000 across 23 centers in 10 countries. The data analysis was conducted from March 1 to May 31, 2023.EXPOSURES: Dietary intake before baseline was evaluated using country-specific, validated questionnaires administered at recruitment. Adherence to the MedDiet was scored on a 9-point scale and categorized as low (0-3 points), medium (4-6 points), or high (7-9 points).MAIN OUTCOMES AND MEASURES: The primary outcome was the incidence of ORCs, classified according to the 2015 International Agency for Research on Cancer criteria. Multivariable Cox proportional hazards regression models were used to assess the association between MedDiet adherence and ORC incidence. Mediation analyses were conducted to evaluate the role of waist to hip ratio and body mass index in this association.RESULTS: A total of 450 111 participants were included in the study (mean [SD] age, 51.1 [9.8] years; 70.8% women) and followed up during a median (IQR) time of 14.9 (4.1) years. Among participants, 4.9% experienced an ORC (rates, 0.053, 0.049, and 0.043 per person-year in the low, medium, and high MedDiet adherence groups, respectively). Participants with high adherence to the MedDiet (7-9 points) had a lower risk of ORC compared with those with low adherence (0-3 points) (hazard ratio [HR], 0.94; 95% CI, 0.90-0.98). A similar inverse association was observed for participants with medium adherence (4-6 points vs 0-3 points). However, mediation analyses did not show associations of waist to hip ratio or body mass index between MedDiet adherence and ORC risk.CONCLUSIONS AND RELEVANCE: These findings indicate that higher adherence to the MedDiet is associated with a modest reduction in the risk of ORCs, independent of adiposity measures. Further research is needed to clarify the mechanisms by which the MedDiet may contribute to cancer prevention.

KW - Humans

KW - Diet, Mediterranean/statistics & numerical data

KW - Middle Aged

KW - Female

KW - Male

KW - Neoplasms/prevention & control

KW - Obesity/epidemiology

KW - Prospective Studies

KW - Adult

KW - Aged

KW - Europe/epidemiology

KW - Risk Factors

KW - Incidence

KW - Patient Compliance/statistics & numerical data

KW - Body Mass Index

KW - Proportional Hazards Models

U2 - 10.1001/jamanetworkopen.2024.61031

DO - 10.1001/jamanetworkopen.2024.61031

M3 - Journal article

C2 - 39998833

SN - 2574-3805

VL - 8

JO - JAMA network open

JF - JAMA network open

IS - 2

M1 - e2461031

ER -