Mediterraan dieet tegen maagkanker*
Uit een grote studie onder ruim 485.000 deelnemers uit 10 Europese landen blijkt dat een
mediterraandieet goed is ter voorkoming van maagkanker. Zij die zich het meest aan een mediterraandieet hielden hadden 33% minder kans op het krijgen van maagkanker dan zij die
maar zo af en toe een mediterraandieet volgden.
Mediterranean Diet Linked to Lower Risk for Stomach Cancer
Greater adherence to a relative Mediterranean diet is associated with a significantly lower risk for incident gastric adenocarcinoma, according to the results of a prospective cohort study reported in the American Journal of Clinical Nutrition.
"The Mediterranean dietary pattern is believed to protect against cancer, although evidence from cohort studies that have examined particular cancer sites is limited," write Genevieve Buckland, BS, from the Catalan Institute of Oncology, Idibell, in Barcelona, Spain, and colleagues from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study.
The goal of this study was to evaluate the association between adherence to a relative Mediterranean diet and incident gastric adenocarcinoma. The study cohort consisted of 485,044 participants from 10 European countries who provided dietary and lifestyle information at recruitment into EPIC. Age range was 35 to 70 years, and 144,577 subjects were men. An 18-unit relative Mediterranean diet score, which included information regarding 9 key components of the Mediterranean diet, allowed estimation of relative Mediterranean diet adherence.
The investigators evaluated the association between a relative Mediterranean diet and gastric adenocarcinoma with respect to anatomic location (cardia and noncardia) and histologic types (diffuse and intestinal). To control for dietary measurement error, they performed a calibration study in a subsample.
During mean follow-up of 8.9 years, there were 449 validated cases of incident gastric adenocarcinoma that could be analyzed. Compared with low relative Mediterranean diet adherence, high adherence was associated with a significant decrease in gastric adenocarcinoma risk (hazard ratio [HR], 0.67; 95% confidence interval [CI], 0.47 - 0.94), after stratification by center and age and after adjustment for known cancer risk factors.
For every 1-unit increase in relative Mediterranean diet score, the risk for gastric adenocarcinoma decreased by 5% to 7% (95% CI, 0.91 - 0.99). Different anatomic locations and histologic types showed no evidence of heterogeneity. Trends were similar for the calibrated results (overall HR for gastric adenocarcinoma, 0.93; 95% CI, 0.89 - 0.99).
"Greater adherence to an rMED [relative Mediterranean diet] is associated with a significant reduction in the risk of incident GC [gastric adenocarcinoma]," the study authors write. "To our knowledge, this is the first study to evaluate the Mediterranean diet and GC."
Limitations of this study include possible errors in measuring dietary intake, possible residual confounding, lack of information on intake of legumes in Norway and olive oil in Umea, and limitations of the Mediterranean diet score. In addition, some participants may have modified their diet during the early prediagnostic period of the disease.
"The results add to the evidence for the role of the Mediterranean diet in reducing cancer risk and add further support for the need to continue to promote the Mediterranean diet in areas where it is disappearing," the study authors conclude. "Moreover, the 5-y relative survival rate of GC is very poor (23%), and the prognosis may be even worse for cardia GC, the incidence of which is increasing in Europe. Therefore, identifying dietary recommendations that can help reduce incidence is important for the effective management of this cancer."
The European Commission supported this study. The EPIC study was funded by the "Europe Against Cancer" Programme of the European Commission; ISCIII of the Spanish Ministry of Health; Ligue contre le Cancer (France); Société 3M (France); Mutuelle Générale de l'Education Nationale; Institut National de la Santé et de la Recherche Médicale (INSERM); German Cancer Aid; German Cancer Research Center; German Federal Ministry of Education and Research; Danish Cancer Society; Health Research Fund (FIS) of the Spanish Ministry of Health; the participating regional governments and institutions of Spain; Cancer Research United Kingdom; Medical Research Council, United Kingdom; the Stroke Association, United Kingdom; British Heart Foundation; Department of Health, United Kingdom; Food Standards Agency, United Kingdom; the Wellcome Trust, United Kingdom; the Greek Ministry of Health; the Stavros Niarchos Foundation; Hellenic Health Foundation; Italian Association for Research on Cancer; Dutch Ministry of Health, Welfare and Sports; Dutch Ministry of Health; Dutch Prevention Funds; LK Research Funds; Dutch Zorg Onderzoek Nederland; World Cancer Research Fund; Swedish Cancer Society; Swedish Scientific Council; Regional Government of Skane, Sweden; and the Norwegian Cancer Society. Some of the study authors are partners of ECNIS, a network of excellence of the EC.
Am J Clin Nutr.. Abstract
Clinical Context
The Mediterranean diet includes a proportionately high intake of fruit, nuts, fiber, seeds, vegetables, olive oil, and a moderate intake of wine. These foods are rich in antioxidants that may help prevent cancer, such as vitamin C, carotenoids, phenols, and flavonoids. In addition, consumption of red and processed meat is relatively low.
Several studies have shown a protective effect of the Mediterranean diet on health and its association with a reduced risk for cancer and other chronic diseases. However, only breast cancer and colorectal cancer risks have been examined separately, and no studies to date have evaluated the association between adherence to a Mediterranean diet and the risk for gastric adenocarcinoma.
Study Highlights
· The objective of the study was to determine the association between adherence to a relative Mediterranean diet and incident gastric adenocarcinoma.
· Of 485,044 EPIC study participants who provided dietary and lifestyle information at recruitment, 144,577 subjects were men.
· The prospective study cohort represented 10 European countries.
· Age range was 35 to 70 years; mean follow-up was 8.9 years.
· The researchers estimated adherence to a relative Mediterranean diet using an 18-unit relative Mediterranean diet score, including questions regarding 9 key components of the Mediterranean diet.
· Associations between a relative Mediterranean diet and gastric adenocarcinoma were determined with respect to anatomic location (cardia and noncardia) and histologic types (diffuse and intestinal).
· A calibration study in a subsample allowed controlling for dietary measurement error.
· 449 validated, incident cases of gastric adenocarcinoma during follow-up were included in the analysis.
· After stratification by center and age and after adjustment for known cancer risk factors, high vs low adherence to a relative Mediterranean diet was associated with a significant (33%) decrease in the risk for gastric adenocarcinoma (HR, 0.67; 95% CI, 0.47 - 0.94).
· A 1-unit increase in relative Mediterranean diet score was associated with a 5% to 7% decreased risk for gastric adenocarcinoma (95% CI, 0.91 - 0.99).
· In individual components of the relative Mediterranean diet score, citrus fruit and cereal fiber were associated with a decreased gastric adenocarcinoma risk, and meat was associated with an increased gastric adenocarcinoma risk.
· There was no evidence of heterogeneity in findings for different anatomic locations and histologic types.
· However, this may have been the result of insufficient statistical power because of the relatively low number of patients with cardia and noncardia gastric adenocarcinoma and diffuse and intestinal gastric adenocarcinoma.
· For the calibrated results, trends were similar (overall HR for gastric adenocarcinoma, 0.93; 95% CI, 0.89 - 0.99).
· Limitations of the study include measurement errors, possible residual confounding, some missing dietary information, limitations of the Mediterranean diet score, and possible dietary modification shortly before gastric adenocarcinoma was diagnosed.
· The investigators concluded that adherence to a relative Mediterranean diet pattern was associated with a substantial and significant reduction in gastric adenocarcinoma incidence.
· They suggested that these results add to the evidence for the role of the Mediterranean diet in reducing cancer risk and the need to continue to promote the Mediterranean diet in areas where it is disappearing.
Clinical Implications
· In a large prospective study, adherence to a relative Mediterranean diet dietary pattern was associated with a substantial and significant 33% reduction in the incidence of gastric adenocarcinoma. Each 1-unit increase in a calibrated 18-unit relative Mediterranean diet score was related to a 5% to 7% decreased risk.
· In this study, there was no evidence of heterogeneity between different anatomic locations or histologic types, although statistical power may have been insufficient to demonstrate
this. (Maart 2010)
