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Objective:We evaluated the relationship between food availability, as the only dietary exposure data available across Africa, and age-standardised cancer incidence rates (ASR) in eighteen countries.Design:Ecological study.Setting:Availability of food groups and dietary energy was considered for five hypothetical time points: years of collection of ASR (T 0) and 5, 10, 15 and 20 preceding years (T –5, T –10, T –15, T –20). Ecological correlations adjusted for human development index, smoking and obesity rates were calculated to evaluate the relationship between food availability and ASR of breast, prostate, colorectal, oesophageal, pancreatic, stomach and thyroid cancer.Results:Red meat was positively correlated with pancreatic cancer in men (T –20: r –20 = 0·61, P < 0·05), stomach cancer in women (T 0: r 0 = 0·58, P < 0·05), and colorectal cancer in men (T 0: r 0 = 0·53, P < 0·05) and women (T –20: r –20 = 0·58, P < 0·05). Animal products including meat, animal fats and higher animal-sourced energy supply tended to be positively correlated with breast, colorectal, pancreatic, stomach and thyroid cancer. Alcoholic beverages were positively correlated to oesophageal cancer in men (r 0 = 0·69, P < 0·001) and women (r –20 = 0·72, P < 0·001).Conclusions:The present analysis provides initial insights into the impact of alcoholic beverages, and increasing use of animal over plant products, on the incidence of specific cancers in Africa. The findings support the need for epidemiological studies to investigate the role of diet in cancer development in Africa.

ObjectiveThe present study describes the procedure and approaches needed to adapt and harmonise the GloboDiet methodology, a computer- and interview-based 24 h dietary recall, for use in two Latin American pilot countries, Brazil and Mexico.DesignAbout seventy common and country-specific databases on foods, recipes, dietary supplements, quantification methods and coefficients were customised and translated following standardised guidelines, starting from existing Spanish and Portuguese versions.SettingBrazil and Mexico.SubjectsNot applicable.ResultsNew subgroups were added into the existing common food classification together with new descriptors required to better classify and describe specific Brazilian and Mexican foods. Quantification methods were critically evaluated and adapted considering types and quantities of food consumed in these two countries, using data available from previous surveys. Furthermore, the photos to be used for quantification purposes were identified for compilation in country-specific but standardised picture booklets.ConclusionsThe completion of the customisation of the GloboDiet Latin America versions in these two pilot countries provides new insights into the adaptability of this dietary international tool to the Latin American context. The ultimate purpose is to enable dietary intake comparisons within and between Latin American countries, support building capacities and foster regional and international collaborations. The development of the GloboDiet methodology could represent a major benefit for Latin America in terms of standardised dietary methodologies for multiple surveillance, research and prevention purposes.

Objective To characterize meal patterns across ten European countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study. Design Cross-sectional study utilizing dietary data collected through a standardised 24-h diet recall during 1995-2000. Eleven predefined intake occasions across a 24-h period were assessed during the interview. In this descriptive report, meal patterns were analysed in terms of daily number of intake occasions, the proportion reporting each intake occasion and the energy contributions from each intake occasion. Setting Twenty-seven centres across ten European countries. Subjects 36020 women (64%) and men (36%) aged 35-74 years. Results Pronounced differences in meal patterns emerged both across centres within the same country and across different countries with a trend for fewer intake occasions/day in countries as compared to central and northern Europe. Differences were also found for daily energy intake provided by lunch, with 38-43% for women and 41-45% for men within Mediterranean countries compared to 16-27% for women and 20-26% for men in central and northern European countries. Likewise, a south-north gradient was found for daily energy intake from snacks, with 13-20% (women) and 10-17% (men) in Mediterranean countries compared to 24-34% (women) and 23-35% (men) in central/northern Europe. Conclusion We found distinct differences in meal patterns with marked diversity for intake frequency and lunch and snack consumption between Mediterranean and central/northern European countries. Monitoring of meal patterns across various cultures and populations could provide critical context to the research efforts to characterize relationships between dietary intake and health.

ObjectiveTo assess the feasibility of combining short-term and long-term dietary assessment instruments as new concept for improving usual dietary intake assessment on the individual level.DesignFeasibility study of completing three 24 h dietary recalls (24-HDR) and a self-administered food propensity questionnaire (FPQ). The 24-HDR was conducted by monthly telephone interviews, using EPIC-SOFT software. The FPQ was completely standardized across cohorts and offered either as a web-based tool or in paper format.SettingRandom sample derived from five ongoing European cohort studies (EPIC-San Sebastian, EPIC-Florence, EPIC-Potsdam, Estonia Genome Center (EGC) and Norwegian Women and Cancer study (NOWAC)).SubjectsA total of 400 participants.ResultsOverall, the total participation rate for the present study was 65·3 % (n 261). On average, completion of the 24-HDR was highest for the first 24-HDR (63·0 %) and decreased slightly for the second (60·3 %) and third 24-HDR (56·3 %). The proportions of selecting the web-based FPQ varied among the study centres, with the highest in EGC (92·9 %) and NOWAC (70·0 %) and the lowest in EPIC-San Sebastian (25·5 %) and EPIC-Potsdam (33·9 %). Web users rarely requested support and were younger and more highly educated than those who completed the paper format.ConclusionsThe present study supports the feasibility of a combined application of three 24-HDR and an FPQ in culturally different populations. The varying acceptance of the web-based instrument across populations requires a flexible application of assessment instruments.

bjective:The aim of this study was to compare the quantities of alcohol and types of alcoholic beverages consumed, and the timing of consumption, in centres participating in the European Prospective Investigation into Cancer and Nutrition (EPIC). These centres, in 10 European countries, are characterised by widely differing drinking habits and frequencies of alcohol-related diseases.Methods:We collected a single standardised 24-hour dietary recall per subject from a random sample of the EPIC cohort (36 900 persons initially and 35 955 after exclusion of subjects under 35 and over 74 years of age). This provided detailed information on the distribution of alcohol consumption during the day in relation to main meals, and was used to determine weekly consumption patterns. The crude and adjusted (by age, day of week and season) means of total ethanol consumption and consumption according to type of beverage were stratified by centre and sex.Results:Sex was a strong determinant of drinking patterns in all 10 countries. The highest total alcohol consumption was observed in the Spanish centres (San Sebastian, 41.4 g day−1) for men and in Danish centres (Copenhagen, 20.9 g day−1) for women. The lowest total alcohol intake was in the Swedish centres (Umeå, 10.2 g day−1) in men and in Greek women (3.4 g day−1). Among men, the main contributor to total alcohol intake was wine in Mediterranean countries and beer in the Dutch, German, Swedish and Danish centres. In most centres, the main source of alcohol for women was wine except for Murcia (Spain), where it was beer. Alcohol consumption, particularly by women, increased markedly during the weekend in nearly all centres. The German, Dutch, UK (general population) and Danish centres were characterised by the highest percentages of alcohol consumption outside mealtimes.Conclusions:The large variation in drinking patterns among the EPIC centres provides an opportunity to better understand the relationship between alcohol and alcohol-related diseases.

Objective:To describe and compare the consumption of the main groups and sub-groups of vegetables and fruits (V&F) in men and women from the centres participating in the European Prospective Investigation into Cancer and Nutrition (EPIC).Design:Cross-sectional analysis. Dietary intake was assessed by means of a 24-hour dietary recall using computerised interview software and standardised procedures. Crude and adjusted means were computed for the main groups and sub-groups of V&F by centre, separately for men and women. Adjusted means by season, day of the week and age were estimated using weights and covariance analysis.Setting:Twenty-seven centres in 10 European countries participating in the EPIC project.Subjects:In total, 35 955 subjects (13 031 men and 22 924 women), aged 35–74 years, randomly selected from each EPIC cohort.Results:The centres from southern countries had the highest consumption of V&F, while the lowest intake was seen in The Netherlands and Scandinavia for both genders. These differences were more evident for fruits, particularly citrus. However, slightly different patterns arose for some sub-groups of vegetables, such as root vegetables and cabbage. Adjustment for body mass index, physical activity, smoking habits and education did not substantially modify the mean intakes of vegetables and fruits.Conclusions:Total vegetable and fruit intake follows a south–north gradient in both genders, whereas for several sub-groups of vegetables a different geographic distribution exists. Differences in mean intake of V&F by centre were not explained by lifestyle factors associated with V&F intake.

ObjectiveTo evaluate the impact of different modes of administration (face-to-facev. telephone), recall days (firstv. second), days of the week (weekdayv. weekend) and interview days (1 d laterv. 2 d later) on bias in protein and K intakes collected with 24 h dietary recalls (24-HDR).DesignTwo non-consecutive 24-HDR (collected with standardised EPIC-Soft software) were used to estimate protein and K intakes by a face-to-face interview at the research centres and a telephone interview, and included all days of the week. Two 24 h urine collections were used to determine biomarkers of protein and K intake. The bias in intake was defined as the ratio between the 24-HDR estimate and the biomarker.SettingFive centres in Belgium, Czech Republic, France, the Netherlands and Norway in the European Food Consumption Validation (EFCOVAL) study.SubjectsAbout 120 adults (aged 45–65 years) per centre.ResultsThe bias in protein intake in the Czech Republic and Norway was smaller for telephone than face-to-face interviews (P= 0·01). The second 24-HDR estimates of protein intake in France and K intake in Belgium had a larger bias than the first 24-HDR (P= 0·01 and 0·04, respectively). In the Czech Republic, protein intake estimated during weekends and K intake estimated during weekdays had a larger bias than during other days of the week (P= 0·01). In addition, K intake collected 2 d later in the Czech Republic was likely to be overestimated.ConclusionsThe biases in protein and K intakes were comparable between modes of administration, recall days, days of the week and interview days in some, but not all, study centres.

ObjectivePattern analysis has emerged as a tool to depict the role of multiple nutrients/foods in relation to health outcomes. The present study aimed at extracting nutrient patterns with respect to breast cancer (BC) aetiology.DesignNutrient patterns were derived with treelet transform (TT) and related to BC risk. TT was applied to twenty-three log-transformed nutrient densities from dietary questionnaires. Hazard ratios (HR) and 95 % confidence intervals computed using Cox proportional hazards models quantified the association between quintiles of nutrient pattern scores and risk of overall BC, and by hormonal receptor and menopausal status. Principal component analysis was applied for comparison.SettingThe European Prospective Investigation into Cancer and Nutrition (EPIC).SubjectsWomen (n 334 850) from the EPIC study.ResultsThe first TT component (TC1) highlighted a pattern rich in nutrients found in animal foods loading on cholesterol, protein, retinol, vitamins B12 and D, while the second TT component (TC2) reflected a diet rich in β-carotene, riboflavin, thiamin, vitamins C and B6, fibre, Fe, Ca, K, Mg, P and folate. While TC1 was not associated with BC risk, TC2 was inversely associated with BC risk overall (HRQ5 v. Q1=0·89, 95 % CI 0·83, 0·95, PtrendQ5 v. Q1=0·89, 95 % CI 0·81, 0·98, Ptrend=0·02) and progesterone receptor-positive tumours (HRQ5 v. Q1=0·87, 95 % CI 0·77, 0·98, PtrendConclusionsTT produces readily interpretable sparse components explaining similar amounts of variation as principal component analysis. Our results suggest that participants with a nutrient pattern high in micronutrients found in vegetables, fruits and cereals had a lower risk of BC.

Objective:The aim of this study was to describe the variation of soy product intake in 10 European countries by using a standardised reference dietary method. A subsidiary aim was to characterise the pattern of soy consumption among a sub-group of participants with a habitual health-conscious lifestyle (HHL), i.e. non-meat eaters who are fish eaters, vegetarians and vegans.Design:A 24-hour dietary recall interview (24-HDR) was conducted among a sample (5–12%) of all cohorts (n = 36 900) in the European Prospective Investigation into Cancer and Nutrition (EPIC). Study participants totalled 35 955 after exclusion of subjects younger than 35 or older than 74 years of age. Soy products were subdivided into seven sub-groups by similarity. Distribution of consumption and crude and adjusted means of intake were computed per soy product group across countries. Intake of soy products was also investigated among participants with an HHL.Results:In total, 195 men and 486 women reported consuming soy products in the 24-HDR interview. Although soy product intake was generally low across all countries, the highest intake level was observed in the UK, due to over-sampling of a large number of participants with an HHL. The most frequently consumed soy foods were dairy substitutes in the UK and France and beans and sprouts among mid-European countries. For both genders, the sub-group of soy dairy substitutes was consumed in the highest quantities (1.2 g day−1 for men; 1.9 g day−1 for women). Participants with an HHL differed substantially from others with regard to demographic, anthropometric and nutritional factors. They consumed higher quantities of almost all soy product groups.Conclusions:Consumption of soy products is low in centres in Western Europe. Soy dairy substitutes are most frequently consumed. Participants with an HHL form a distinct sub-group with higher consumptions of fruit, vegetables, legumes, cereals and soy products compared with the other participants.

Objective:To describe physical activity of participants in the European Prospective Investigation into Cancer and Nutrition (EPIC).Design:A cross-sectional analysis of baseline data of a European prospective cohort study.Subjects:This analysis was restricted to participants in the age group 50–64 years, which was represented in all EPIC centres. It involved 236 386 participants from 25 centres in nine countries. In each EPIC centre, physical activity was assessed by standardised and validated questions. Frequency distribution of type of professional activity and participation in non-professional activities, and age-adjusted means, medians and percentiles of time dedicated to non-professional activities are presented for men and women from each centre.Results:Professional activity was most frequently classified as sedentary or standing in all centres. There was a wide variation regarding participation in different types of non-professional activities and time dedicated to these activities across EPIC centres. Over 80% of all EPIC participants engaged in walking, while less than 50% of the subjects participated in sport. Total time dedicated to recreational activities was highest among the Dutch participants and lowest among men from Malmö (Sweden) and women from Naples (Italy). In all centres, total time dedicated to recreational activity in the summer was higher than in the winter. Women from southern Europe spent the most time on housekeeping.Conclusions:There is a considerable variation of physical activity across EPIC centres. This variation was especially evident for recreational activities in both men and women.

Objective:To evaluate meat intake patterns in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohorts.Design and setting:24-Hour dietary recalls were assessed within the framework of a prospective cohort study in 27 centres across 10 European countries by means of standardised computer-assisted interviews.Subjects:In total, 22 924 women and 13 031 men aged 35–74 years.Results:Mean total meat intake was lowest in the ‘health-conscious’ cohort in the UK (15 and 21 g day−1 in women and men, respectively) and highest in the north of Spain, especially in San Sebastian (124 and 234 g day−1, respectively). In the southern Spanish centres and in Naples (Italy), meat consumption was distinctly lower than in the north of these countries. Central and northern European centres/countries showed rather similar meat consumption patterns, except for the British and French cohorts. Differences in the intake of meat sub-groups (e.g. red meat, processed meat) across EPIC were even higher than found for total meat intake. With a few exceptions, the Mediterranean EPIC centres revealed a higher proportion of beef/veal and poultry and less pork or processed meat than observed in central or northern European centres. The highest sausage consumption was observed for the German EPIC participants, followed by the Norwegians, Swedish, Danish and Dutch.Conclusions:The results demonstrate distinct differences in meat consumption patterns between EPIC centres across Europe. This is an important prerequisite for obtaining further insight into the relationship between meat intake and the development of chronic diseases.

The European Prospective Investigation into Cancer and Nutrition (EPIC) is an ongoing multi-centre prospective cohort study designed to investigate the relationship between nutrition and cancer, with the potential for studying other diseases as well. The study currently includes 519 978 participants (366 521 women and 153 457 men, mostly aged 35–70 years) in 23 centres located in 10 European countries, to be followed for cancer incidence and cause-specific mortality for several decades. At enrolment, which took place between 1992 and 2000 at each of the different centres, information was collected through a non-dietary questionnaire on lifestyle variables and through a dietary questionnaire addressing usual diet. Anthropometric measurements were performed and blood samples taken, from which plasma, serum, red cells and buffy coat fractions were separated and aliquoted for long-term storage, mostly in liquid nitrogen. To calibrate dietary measurements, a standardised, computer-assisted 24-hour dietary recall was implemented at each centre on stratified random samples of the participants, for a total of 36 900 subjects. EPIC represents the largest single resource available today world-wide for prospective investigations on the aetiology of cancers (and other diseases) that can integrate questionnaire data on lifestyle and diet, biomarkers of diet and of endogenous metabolism (e.g. hormones and growth factors) and genetic polymorphisms. First results of case–control studies nested within the cohort are expected early in 2003. The present paper provides a description of the EPIC study, with the aim of simplifying reference to it in future papers reporting substantive or methodological studies carried out in the EPIC cohort.