TY - JOUR

T1 - Energy and macronutrient intake and risk of differentiated thyroid carcinoma in the European Prospective Investigation into Cancer and Nutrition study

AU - Zamora-Ros, Raul

AU - Rinaldi, Sabina

AU - Tsilidis, Konstantinos K.

AU - Weiderpass, Elisabete

AU - Boutron-Ruault, Marie Christine

AU - Rostgaard-Hansen, Agnetha Linn

AU - Tjønneland, Anne

AU - Clavel-Chapelon, Françoise

AU - Mesrine, Sylvie

AU - Katzke, Verena A.

AU - Kühn, Tilman

AU - Förster, Jana

AU - Boeing, Heiner

AU - Trichopoulou, Antonia

AU - Lagiou, Pagona

AU - Klinaki, Eleni

AU - Masala, Giovanna

AU - Sieri, Sabina

AU - Ricceri, Fulvio

AU - Tumino, Rosario

AU - Mattiello, Amalia

AU - Peeters, Petra H.M.

AU - Bueno-De-Mesquita, H. B.

AU - Engeset, Dagrun

AU - Skeie, Guri

AU - Argüelles, Marcial

AU - Agudo, Antonio

AU - Sánchez, María José

AU - Chirlaque, María Dolores

AU - Barricarte, Aurelio

AU - Chamosa, Saioa

AU - Almquist, Martin

AU - Tosovic, Ada

AU - Hennings, Joakim

AU - Sandström, Maria

AU - Schmidt, Julie A.

AU - Khaw, Kay Thee

AU - Wareham, Nicholas J.

AU - Cross, Amanda J.

AU - Slimani, Nadia

AU - Byrnes, Graham

AU - Romieu, Isabelle

AU - Riboli, Elio

AU - Franceschi, Silvia

PY - 2016

Y1 - 2016

N2 - Incidence rates of differentiated thyroid carcinoma (TC) have increased in many countries. Adiposity and dietary risk factors may play a role, but little is known on the influence of energy intake and macronutrient composition. The aim of this study was to investigate the associations between TC and the intake of energy, macronutrients, glycemic index (GI) and glycemic load in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. The study included 477,274 middle-age participants (70.2% women) from ten European countries. Dietary data were collected using country-specific validated dietary questionnaires. Total carbohydrates, proteins, fats, saturated, monounsaturated and polyunsaturated fats (PUFA), starch, sugar, and fiber were computed as g/1,000 kcal. Multivariable Cox regression was used to calculate multivariable adjusted hazard ratios (HR) and 95% confidence interval (CI) by intake quartile (Q). After a mean follow-up time of 11 years, differentiated TC was diagnosed in 556 participants (90% women). Overall, we found significant associations only with total energy (HR Q4 vs .Q1 , 1.29; 95% CI, 1.00-1.68) and PUFA intakes (HR Q4 vs .Q1 , 0.74; 95% CI, 0.57-0.95). However, the associations with starch and sugar intake and GI were significantly heterogeneous across body mass index (BMI) groups, i.e., positive associations with starch and GI were found in participants with a BMI≥25 and with sugar intake in those with BMI<25. Moreover, inverse associations with starch and GI were observed in subjects with BMI<25. In conclusion, our results suggest that high total energy and low PUFA intakes may increase the risk of differentiated TC. Positive associations with starch intake and GI in participants with BMI≥25 suggest that those persons may have a greater insulin response to high starch intake and GI than lean people. What's New? The role of lifestyle factors in the growing numbers of thyroid cancer remains unclear. Here, the authors uncover associations with high total energy intake and low consumption of polyunsaturated fatty acids in a large European cohort (EPIC). They further find positive associations with starch intake and glycemic index only in people with a body mass index equal or larger than 25, possibly implicating an altered insulin response in the etiology of this cancer.

AB - Incidence rates of differentiated thyroid carcinoma (TC) have increased in many countries. Adiposity and dietary risk factors may play a role, but little is known on the influence of energy intake and macronutrient composition. The aim of this study was to investigate the associations between TC and the intake of energy, macronutrients, glycemic index (GI) and glycemic load in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. The study included 477,274 middle-age participants (70.2% women) from ten European countries. Dietary data were collected using country-specific validated dietary questionnaires. Total carbohydrates, proteins, fats, saturated, monounsaturated and polyunsaturated fats (PUFA), starch, sugar, and fiber were computed as g/1,000 kcal. Multivariable Cox regression was used to calculate multivariable adjusted hazard ratios (HR) and 95% confidence interval (CI) by intake quartile (Q). After a mean follow-up time of 11 years, differentiated TC was diagnosed in 556 participants (90% women). Overall, we found significant associations only with total energy (HR Q4 vs .Q1 , 1.29; 95% CI, 1.00-1.68) and PUFA intakes (HR Q4 vs .Q1 , 0.74; 95% CI, 0.57-0.95). However, the associations with starch and sugar intake and GI were significantly heterogeneous across body mass index (BMI) groups, i.e., positive associations with starch and GI were found in participants with a BMI≥25 and with sugar intake in those with BMI<25. Moreover, inverse associations with starch and GI were observed in subjects with BMI<25. In conclusion, our results suggest that high total energy and low PUFA intakes may increase the risk of differentiated TC. Positive associations with starch intake and GI in participants with BMI≥25 suggest that those persons may have a greater insulin response to high starch intake and GI than lean people. What's New? The role of lifestyle factors in the growing numbers of thyroid cancer remains unclear. Here, the authors uncover associations with high total energy intake and low consumption of polyunsaturated fatty acids in a large European cohort (EPIC). They further find positive associations with starch intake and glycemic index only in people with a body mass index equal or larger than 25, possibly implicating an altered insulin response in the etiology of this cancer.

KW - Differentiated thyroid carcinomas

KW - EPIC

KW - Glycemic index

KW - Macronutrients

KW - Total energy

U2 - 10.1002/ijc.29693

DO - 10.1002/ijc.29693

M3 - Journal article

C2 - 26190646

AN - SCOPUS:84944232067

VL - 138

SP - 65

EP - 73

JO - Acta - Unio Internationalis Contra Cancrum

JF - Acta - Unio Internationalis Contra Cancrum

SN - 0898-6924

IS - 1

ER -