TY - JOUR
T1 - Food processing and cancer risk in Europe
T2 - results from the prospective EPIC cohort study
AU - Kliemann, Nathalie
AU - Rauber, Fernanda
AU - Bertazzi Levy, Renata
AU - Viallon, Vivian
AU - Vamos, Eszter P
AU - Cordova, Reynalda
AU - Freisling, Heinz
AU - Casagrande, Corinne
AU - Nicolas, Genevieve
AU - Aune, Dagfinn
AU - Tsilidis, Konstantinos K
AU - Heath, Alicia
AU - Schulze, Matthias B
AU - Jannasch, Franziska
AU - Srour, Bernard
AU - Kaaks, Rudolf
AU - Rodriguez-Barranco, Miguel
AU - Tagliabue, Giovanna
AU - Agudo, Antonio
AU - Panico, Salvatore
AU - Ardanaz, Eva
AU - Chirlaque, María-Dolores
AU - Vineis, Paolo
AU - Tumino, Rosario
AU - Perez-Cornago, Aurora
AU - Andersen, Julie Louise Munk
AU - Tjønneland, Anne
AU - Skeie, Guri
AU - Weiderpass, Elisabete
AU - Monteiro, Carlos Augusto
AU - Gunter, Marc J
AU - Millett, Christopher
AU - Huybrechts, Inge
N1 - © 2023 World Health Organization; licensee Elsevier. This is an Open Access article published under the CC BY NC ND 3.0 IGO license which permits users to download and share the article for non-commercial purposes, so long as the article is reproduced in the whole without changes, and provided the original source is properly cited. This article shall not be used or reproduced in association with the promotion of commercial products, services, or any entity. There should be no suggestion that WHO endorses any specific organisation, products, or services. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.
PY - 2023/3
Y1 - 2023/3
N2 - BACKGROUND: Food processing has been hypothesised to play a role in cancer development; however, data from large-scale epidemiological studies are scarce. This study investigated the association between dietary intake according to amount of food processing and risk of cancer at 25 anatomical sites using data from the European Prospective Investigation into Cancer and Nutrition (EPIC) study.METHODS: This study used data from the prospective EPIC cohort study, which recruited participants between March 18, 1991, and July 2, 2001, from 23 centres in ten European countries. Participant eligibility within each cohort was based on geographical or administrative boundaries. Participants were excluded if they had a cancer diagnosis before recruitment, had missing information for the NOVA food processing classification, or were within the top and bottom 1% for ratio of energy intake to energy requirement. Validated dietary questionnaires were used to obtain information on food and drink consumption. Participants with cancer were identified using cancer registries or during follow-up from a combination of sources, including cancer and pathology centres, health insurance records, and active follow-up of participants. We performed a substitution analysis to assess the effect of replacing 10% of processed foods and ultra-processed foods with 10% of minimally processed foods on cancer risk at 25 anatomical sites using Cox proportional hazard models.FINDINGS: 521 324 participants were recruited into EPIC, and 450 111 were included in this analysis (318 686 [70·8%] participants were female individuals and 131 425 [29·2%] were male individuals). In a multivariate model adjusted for sex, smoking, education, physical activity, height, and diabetes, a substitution of 10% of processed foods with an equal amount of minimally processed foods was associated with reduced risk of overall cancer (hazard ratio 0·96, 95% CI 0·95-0·97), head and neck cancers (0·80, 0·75-0·85), oesophageal squamous cell carcinoma (0·57, 0·51-0·64), colon cancer (0·88, 0·85-0·92), rectal cancer (0·90, 0·85-0·94), hepatocellular carcinoma (0·77, 0·68-0·87), and postmenopausal breast cancer (0·93, 0·90-0·97). The substitution of 10% of ultra-processed foods with 10% of minimally processed foods was associated with a reduced risk of head and neck cancers (0·80, 0·74-0·88), colon cancer (0·93, 0·89-0·97), and hepatocellular carcinoma (0·73, 0·62-0·86). Most of these associations remained significant when models were additionally adjusted for BMI, alcohol and dietary intake, and quality.INTERPRETATION: This study suggests that the replacement of processed and ultra-processed foods and drinks with an equal amount of minimally processed foods might reduce the risk of various cancer types.FUNDING: Cancer Research UK, l'Institut National du Cancer, and World Cancer Research Fund International.
AB - BACKGROUND: Food processing has been hypothesised to play a role in cancer development; however, data from large-scale epidemiological studies are scarce. This study investigated the association between dietary intake according to amount of food processing and risk of cancer at 25 anatomical sites using data from the European Prospective Investigation into Cancer and Nutrition (EPIC) study.METHODS: This study used data from the prospective EPIC cohort study, which recruited participants between March 18, 1991, and July 2, 2001, from 23 centres in ten European countries. Participant eligibility within each cohort was based on geographical or administrative boundaries. Participants were excluded if they had a cancer diagnosis before recruitment, had missing information for the NOVA food processing classification, or were within the top and bottom 1% for ratio of energy intake to energy requirement. Validated dietary questionnaires were used to obtain information on food and drink consumption. Participants with cancer were identified using cancer registries or during follow-up from a combination of sources, including cancer and pathology centres, health insurance records, and active follow-up of participants. We performed a substitution analysis to assess the effect of replacing 10% of processed foods and ultra-processed foods with 10% of minimally processed foods on cancer risk at 25 anatomical sites using Cox proportional hazard models.FINDINGS: 521 324 participants were recruited into EPIC, and 450 111 were included in this analysis (318 686 [70·8%] participants were female individuals and 131 425 [29·2%] were male individuals). In a multivariate model adjusted for sex, smoking, education, physical activity, height, and diabetes, a substitution of 10% of processed foods with an equal amount of minimally processed foods was associated with reduced risk of overall cancer (hazard ratio 0·96, 95% CI 0·95-0·97), head and neck cancers (0·80, 0·75-0·85), oesophageal squamous cell carcinoma (0·57, 0·51-0·64), colon cancer (0·88, 0·85-0·92), rectal cancer (0·90, 0·85-0·94), hepatocellular carcinoma (0·77, 0·68-0·87), and postmenopausal breast cancer (0·93, 0·90-0·97). The substitution of 10% of ultra-processed foods with 10% of minimally processed foods was associated with a reduced risk of head and neck cancers (0·80, 0·74-0·88), colon cancer (0·93, 0·89-0·97), and hepatocellular carcinoma (0·73, 0·62-0·86). Most of these associations remained significant when models were additionally adjusted for BMI, alcohol and dietary intake, and quality.INTERPRETATION: This study suggests that the replacement of processed and ultra-processed foods and drinks with an equal amount of minimally processed foods might reduce the risk of various cancer types.FUNDING: Cancer Research UK, l'Institut National du Cancer, and World Cancer Research Fund International.
KW - Humans
KW - Male
KW - Female
KW - Prospective Studies
KW - Cohort Studies
KW - Risk Factors
KW - Carcinoma, Hepatocellular
KW - Europe/epidemiology
KW - Food Handling
KW - Colonic Neoplasms
KW - Liver Neoplasms
UR - http://www.scopus.com/inward/record.url?scp=85149473291&partnerID=8YFLogxK
U2 - 10.1016/S2542-5196(23)00021-9
DO - 10.1016/S2542-5196(23)00021-9
M3 - Article
C2 - 36889863
VL - 7
SP - e219-e232
JO - The Lancet. Planetary Health
JF - The Lancet. Planetary Health
SN - 2542-5196
IS - 3
ER -
