European Prospective Investigation into Cancer and Nutrition explained

The European Prospective Investigation into Cancer and Nutrition (EPIC) study is a Europe-wide prospective cohort study of the relationships between diet and cancer, as well as other chronic diseases, such as cardiovascular disease. With over half a million participants, it is the largest study of diet and disease to be undertaken.^[1]

EPIC is coordinated by the International Agency for Research on Cancer (IARC), part of the World Health Organization, and funded by the "Europe Against Cancer" programme of the European Commission as well as multiple nation-specific grants and charities.

521,457 healthy adults, mostly aged 35–70 years, were enrolled in 23 centres in ten European countries: Denmark (11%), France (14%), Germany (10%), Greece (5%), Italy (9%), The Netherlands (8%), Norway (7%), Spain (8%), Sweden (10%) and the United Kingdom (17%). One UK centre (Oxford) recruited 27,000 vegetarians and vegans; this subgroup forms the largest study of this dietary group. Recruitment to the study took place between 1993 and 1999, and follow-up is planned for at least ten years, with repeat interview/questionnaires every three to five years. The main prospective data collected are standardised dietary questionnaires (self-administered or interview-based), seven-day food diaries, blood samples and anthropometric measurements, such as body mass index and waist-to-hip ratio. Additionally, the GenAir case-control study is studying the relationship of passive smoking and air pollution with cancers and respiratory diseases.

Up to 2004, there were over 26,000 new cases of cancer recorded among participants, with the most common being cancers of the breast, colorectum, prostate and lung. Current analyses are focusing particularly on stomach, colorectal, breast, prostate and lung cancers. The different dietary patterns in the different countries should enable reliable associations to be made between particular diets and cancers. The analysis of stored blood samples should also allow dissection of genetic factors involved in cancers, as well as the effects of hormones and hormone-like factors.

Key findings

The study and its analysis is ongoing, but key results of the study retrieved in 2008 are:

Lowered sodium from salt intake, high potassium from fruit and vegetable consumption promote healthy blood pressure levels
High physical activity, involving some high impact activities is a good indicator of longevity and low risk of bone fractures
High dietary fibre protects against bowel cancer
Obesity increases a number of cancer risks
High levels of sex hormones increase risk of breast cancer
Increased fat intake increases the risk of breast cancer
Increases in eating fruit and vegetables reduces the risk from all causes of an early death
High blood glucose levels are associated with increased risk of heart disease
The combined impact of four behaviours – not smoking, being physically active, moderate alcohol intake and the consumption of at least five fruit and vegetable servings a day – was estimated to amount to 14 additional years of life (Khaw et al. 2008)

Subsequent findings from 2012 and 2013 are:

Dietary flavonoid intake is associated with reduced gastric carcinoma risk in women but not men^[2]
Regular consumption of processed meat increases the risk of cardiovascular diseases and death from cancer^[3]

Subsequent findings from 2021 are:

Dietary factors associated with reduced cancer mortality included raw vegetable intake; dietary fiber intake; the Mediterranean diet; other diet patterns included low meat eaters, vegetarians/vegans, or fish eaters.^[4]

Selected papers

Review

Riboli E . The European Prospective Investigation into Cancer and Nutrition (EPIC): plans and progress . J. Nutr. . 131 . 1 . 170S–175S . January 2001 . 11208958 . 10.1093/jn/131.1.170S . free .

Primary

10.1016/S0140-6736(03)13174-1 . Bingham SA, Day NE, Luben R . Dietary fibre in food and protection against colorectal cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC): an observational study . Lancet . 361 . 9368 . 1496–501 . May 2003 . 12737858 . 44459032 . etal.
González CA, Jakszyn P, Pera G, etal . Meat intake and risk of stomach and esophageal adenocarcinoma within the European Prospective Investigation Into Cancer and Nutrition (EPIC) . J. Natl. Cancer Inst. . 98 . 5 . 345–54 . March 2006 . 16507831 . 10.1093/jnci/djj071 . free . 10029/7178 . free .
10.1016/S0140-6736(00)04128-3 . Khaw KT, Bingham S, Welch A, etal . Relation between plasma ascorbic acid and mortality in men and women in EPIC-Norfolk prospective study: a prospective population study. European Prospective Investigation into Cancer and Nutrition . Lancet . 357 . 9257 . 657–63 . March 2001 . 11247548 . 34752014 .
Khaw KT, Wareham N, Bingham S, Welch A, Luben R, Day N . Combined impact of health behaviours and mortality in men and women: the EPIC-Norfolk prospective population study . PLOS Med. . 5 . 1 . e12 . January 2008 . 18184033 . 2174962 . 10.1371/journal.pmed.0050012 . free .
Miller AB, Altenburg HP, Bueno-de-Mesquita B, etal . Fruits and vegetables and lung cancer: Findings from the European Prospective Investigation into Cancer and Nutrition . Int. J. Cancer . 108 . 2 . 269–76 . January 2004 . 14639614 . 10.1002/ijc.11559. free .
Norat T, Bingham S, Ferrari P, etal . Meat, fish, and colorectal cancer risk: the European Prospective Investigation into cancer and nutrition . J. Natl. Cancer Inst. . 97 . 12 . 906–16 . June 2005 . 15956652 . 1913932 . 10.1093/jnci/dji164 .
Trichopoulou A, Orfanos P, Norat T, etal . Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study . BMJ . 330 . 7498 . 991 . April 2005 . 15820966 . 557144 . 10.1136/bmj.38415.644155.8F .
van Gils CH, Peeters PH, Bueno-de-Mesquita HB, etal . Consumption of vegetables and fruits and risk of breast cancer . JAMA . 293 . 2 . 183–93 . January 2005 . 15644545 . 10.1001/jama.293.2.183 . 1874/11581 . free . free .
Verheus M, Peeters PH, Rinaldi S, etal . Serum C-peptide levels and breast cancer risk: results from the European Prospective Investigation into Cancer and Nutrition (EPIC) . Int. J. Cancer . 119 . 3 . 659–67 . August 2006 . 16572422 . 10.1002/ijc.21861. 1874/19269 . 25233808 . free .

External links

EPIC project (IARC)
EPIC study (CR UK)
EPIC (Oxford centre) (preferentially recruited vegetarians & vegans)
EPIC-Norfolk (UK Norfolk cohort)

Notes and References

10.1038/nrc1298. Diet and cancer — the European Prospective Investigation into Cancer and Nutrition. Nature Reviews Cancer. 4. 3. 206–15. 2004. Bingham . S. . Riboli . E. . https://web.archive.org/web/20160305050712/http://www.angelfire.com/scary/lancelot/pdf/diet_and_cancer.pdf . dead . March 5, 2016 . 14993902. 2887530.
Zamora-Ros R, Agudo A, Luján-Barroso L, Romieu I, Ferrari P, Knaze V, Bueno-de-Mesquita HB, Leenders M, Travis RC, Navarro C, Sánchez-Cantalejo E, Slimani N, Scalbert A, Fedirko V, Hjartåker A, Engeset D, Skeie G, Boeing H, Förster J, Li K, Teucher B, Agnoli C, Tumino R, Mattiello A, Saieva C, Johansson I, Stenling R, Redondo ML, Wallström P, Ericson U, Khaw KT, Mulligan AA, Trichopoulou A, Dilis V, Katsoulis M, Peeters PH, Igali L, Tjønneland A, Halkjær J, Touillaud M, Perquier F, Fagherazzi G, Amiano P, Ardanaz E, Bredsdorff L, Overvad K, Ricceri F, Riboli E, González CA . Dietary flavonoid and lignan intake and gastric adenocarcinoma risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study . American Journal of Clinical Nutrition . 2012 . 96 . 6 . 1398–1408 . 23076618 . 10.3945/ajcn.112.037358. free .
Sabine Rohrmann. Kim Overvad. H Bas Bueno-de-Mesquita. Marianne U Jakobsen. Rikke Egeberg. Anne Tjønneland. Laura Nailler. Marie-Christine Boutron-Ruault. Françoise Clavel-Chapelon. Vittorio Krogh. Domenico Palli. Salvatore Panico. Rosario Tumino. Fulvio Ricceri. Manuela M Bergmann. Heiner Boeing. Kuanrong Li. Rudolf Kaaks. Kay-Tee Khaw. Nicholas J Wareham. Francesca L Crowe. Timothy J Key. Androniki Naska. Antonia Trichopoulou. Dimitirios Trichopoulos. Max Leenders. Petra HM Peeters. Dagrun Engeset. Christine L Parr. Guri Skeie. Paula Jakszyn. María-José Sánchez. José M Huerta. M Luisa Redondo. Aurelio Barricarte. Pilar Amiano. Isabel Drake. Emily Sonestedt. Göran Hallmans. Ingegerd Johansson. Veronika Fedirko. Isabelle Romieux. Pietro Ferrari. Teresa Norat. Anne C Vergnaud. Elio Riboli. Jakob Linseisen. Meat consumption and mortality – results from the European Prospective Investigation into Cancer and Nutrition. BMC Medicine. 7 March 2013. 11. 63. 10.1186/1741-7015-11-63. The results of our analysis support a moderate positive association between processed meat consumption and mortality, in particular due to cardiovascular diseases, but also to cancer.. 23497300. 3599112 . free .
Molina-Montes. Esther. Ubago-Guisado. Esther. Petrova. Dafina. Amiano. Pilar. Chirlaque. María-Dolores. Agudo. Antonio. Sánchez. María-José. 2021-11-28. The Role of Diet, Alcohol, BMI, and Physical Activity in Cancer Mortality: Summary Findings of the EPIC Study. Nutrients. 13. 12. 4293. 10.3390/nu13124293. 2072-6643. 34959845. 8709081. free.