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Summary Public health technical expertise is of crucial importance to inform decision makers’ action in the field of health and its broader determinants. Improving education and training of public health professionals for both practice and research is the starting point to strengthen the role of public health so that current health challenges can be efficiently tackled. At the Association of Schools of Public Health in the European Region (ASPHER) Deans’ & Directors’ 2017 Annual Retreat, we presented the structure and management of public health training system in Italy, and we reported recent data on Italian public health specialists’ educational experience, employment opportunities and job satisfaction. Public health training in Italy is implemented in the context of the post-graduate medical education residency programme in Hygiene and Preventive Medicine, delivered by 34 University-based Schools of Public Health. We report relatively high employment rates across the county and wide spectrum of career opportunities for young public health specialists. However, job security is low and training expectations only partially met. We call upon other Schools of Public Health to scale up the survey within the broad ASPHER community in a shared and coordinated action of systematically collecting useful data that can inform the development of public health education and training models, their implementation and fruitful interaction with population health, health systems and services.

We studied the influence of age, sex, education and time between interviews on the reproducibility of a semiquantitative food frequency questionnaire (FFQ) developed in Italy for a case-control study on cancers of the breast and digestive tract, The questionnaire had been administered twice to 452 Italian men and women and included the weekly consumption of 77 food items or groups of foods, seven summary questions and three questions on some general dietary habits, Spearman correlation coefficients for the 77 dietary items plus the seven summary questions did not differ between males (median 0.61) and females (median 0.58), volunteers younger than 50 years (median 0.58) and aged 50 or more (median 0.59), volunteers with fewer than 10 years of education (median 0.58) and with 10 or more (median 0.59), A slightly higher Spearman correlation coefficient was found when the two interviews were conducted 5-6 months apart (median 0.60) or more than 6 (median 0.59) than when less than 5 (median 0.55), Similarly, Pearson correlation coefficients for the intake of 27 nutrients or micronutrients, plus caloric intake, computed from the FFQ showed no differences between males (median 0.65) and females (median 0.64), two age groups (median 0.67 for subjects aged < 50 years and 0.65 for those aged greater than or equal to 50), and two educational levels (median 0.68 for < 10 years and 0.65 for greater than or equal to 10 years), The median Pearson correlation coefficient for nutrients was slightly higher for those subjects who were interviewed with the planned interval (5-6 months, median 0.71) than when the interval was shorter (median 0.57) or longer (median 0.64), Thus, age, sex and educational level of the volunteers did not have a large or systematic impact on the concordance of the two measurements. RI Parpinel, Maria/B-1605-2012

BACKGROUND: A few papers have considered reproducibility of a posteriori dietary patterns across populations, as well as pattern associations with head and neck cancer risk when multiple populations are available. METHODS: We used individual-level pooled data from seven case-control studies (3844 cases; 6824 controls) participating in the International Head and Neck Cancer Epidemiology consortium. We simultaneously derived shared and study-specific a posteriori patterns with a novel approach called multi-study factor analysis applied to 23 nutrients. We derived odds ratios (ORs) and 95% confidence intervals (CIs) for cancers of the oral cavity and pharynx combined, and larynx, from logistic regression models. RESULTS: We identified three shared patterns that were reproducible across studies (75% variance explained): the Antioxidant vitamins and fiber (OR = 0.57, 95% CI = 0.41, 0.78, highest versus lowest score quintile) and the Fats (OR = 0.80, 95% CI = 0.67, 0.95) patterns were inversely associated with oral and pharyngeal cancer risk. The Animal products and cereals (OR = 1.5, 95% CI = 1.1, 2.1) and the Fats (OR = 1.8, 95% CI = 1.4, 2.3) patterns were positively associated with laryngeal cancer risk, whereas a linear inverse trend in laryngeal cancer risk was evident for the Antioxidant vitamins and fiber pattern. We also identified four additional study-specific patterns, one for each of the four US studies examined. We named them all as Dairy products and breakfast cereals, and two were associated with oral and pharyngeal cancer risk. CONCLUSION: Multi-study factor analysis provides insight into pattern reproducibility and supports previous evidence on cross-country reproducibility of dietary patterns and on their association with head and neck cancer risk. See video abstract at, http://links.lww.com/EDE/B430.

Background: The issue of diet and laryngeal cancer has been rarely addressed considering the potential role of dietary patterns. Methods: We examined this association using data from a case-control study carried out between 1992 and 2000. Cases were 460 histologically confirmed incident laryngeal cancers hospitalized in two Italian areas. Controls were 1,088 subjects hospitalized for acute nonneoplastic diseases unrelated to tobacco or alcohol consumption. Dietary habits were investigated through a 78-item food frequency questionnaire. A posteriori dietary patterns were identified through principal component factor analysis carried out on a selected set of 28 major nutrients. The internal reproducibility, robustness, and reliability of the identified patterns were evaluated. Odds ratios (OR) of laryngeal cancer and 95% confidence intervals (95% CI) were estimated using unconditional multiple logistic regression models on quartiles of factor scores. Results: We identified five major dietary patterns named “animal products,” “starch-rich,” “vitamins and fiber,” “vegetable unsaturated fatty acids,” and “animal unsaturated fatty acids.” The vitamins and fiber dietary pattern was inversely associated with laryngeal cancer (OR, 0.35; 95% CI, 0.24-0.52 for the highest versus the lowest score quartile), whereas the animal products (OR, 2.34; 95% CI, 1.59-3.45) and the animal unsaturated fatty acids (OR, 2.07; 95% CI, 1.42-3.01) patterns were directly associated with it. There was no significant association between the vegetable unsaturated fatty acids and the starch-rich patterns and laryngeal cancer risk. Conclusion: These findings suggest that diets rich in animal products and animal fats are directly related, and those rich in fruit and vegetables inversely related, to laryngeal cancer risk. Cancer Epidemiol Biomarkers Prev; 19(1); 18–27

Background: Flavonoids may play an important role in explaining the protective effect of vegetables and fruit against cancer. Patients and methods: To investigate the relation between flavonoids and laryngeal cancer risk, we have applied data on the composition of foods and beverages in terms of six principal classes of flavonoids to a case-control study of laryngeal cancer conducted from 1992 to 2000 in Italy. Cases were 460 subjects with incident, histologically confirmed laryngeal cancer; controls were 1088 patients admitted for acute, non-neoplastic diseases. Odds ratios (OR) were estimated through multiple logistic regression models, including terms for sociodemographic and lifestyle factors, tobacco smoking, alcohol consumption and energy intake. Results: Significant inverse relations were found for the highest versus the lowest quintile of intake for flavan-3-ols (OR = 0.64), flavanones (OR = 0.60), flavonols (OR = 0.32) and total flavonoids (OR = 0.60), although the overall trends in risk were significant only for flavanones and flavonols. No consistent associations were observed for isoflavones, anthocyanidins and flavones. The estimates did not differ substantially across strata of alcohol drinking, tobacco smoking, body mass index and education, and tended to persist even after controlling for vegetable and fruit intake. Conclusion: This study provides support for a beneficial effect of selected flavonoids on laryngeal cancer risk. RI Parpinel, Maria/B-1605-2012

High dietary glycaemic index (GI) and glycaemic load (GL) may increase cancer risk. However, limited information was available on GI and/or GL and head and neck cancer (HNC) risk. We conducted a pooled analysis on 8 case-control studies (4081 HNC cases; 7407 controls) from the International Head and Neck Cancer Epidemiology (INHANCE) consortium. We estimated the odds ratios (ORs) and 95% confidence intervals (CIs) of HNC, and its subsites, from fixed- or mixed-effects logistic models including centre-specific quartiles of GI or GL. GI, but not GL, had a weak positive association with HNC (ORQ4 vs. Q1 = 1.16; 95% CI = 1.02–1.31). In subsites, we found a positive association between GI and laryngeal cancer (ORQ4 vs. Q1 = 1.60; 95% CI = 1.30–1.96) and an inverse association between GL and oropharyngeal cancer (ORQ4 vs. Q1 = 0.78; 95% CI = 0.63–0.97). This pooled analysis indicates a modest positive association between GI and HNC, mainly driven by laryngeal cancer.

Background Alcohol and tobacco are the major risk factors for oral and pharyngeal cancer, but diet is likely to have a role, too. Objective The objective was to analyze the relationship between adherence to the 2015-2020 Dietary Guidelines for Americans (DGA), as measured by the Healthy Eating Index 2015 (HEI-2015), and oral and pharyngeal cancer risk. Moreover, this work aimed to quantify the number of avoidable cases under different scenarios of increased adherence to the DGA, with the use of the potential impact fraction. This estimates the proportion of cases that would occur if the distribution of the risk factor in the population followed an alternative distribution. Design A multicenter, case–control study was conducted in Italy between 1991 and 2009. Participants’ usual diet for the 2 years preceding study enrolment was assessed using a food frequency questionnaire. Participants and setting Cases were 946 patients admitted to major hospitals with incident, histologically confirmed oral and pharyngeal cancer. Controls were 2,492 patients admitted to the same hospitals for acute non neoplastic conditions. Main outcome measures The adherence to the DGA was assessed using the HEI-2015 score (range = 0 to 100), based on 13 components. The outcome was oral and pharyngeal cancer. Statistical analyses performed Odds ratios and the corresponding 95% CIs were estimated using multiple logistic regression models adjusted for tobacco, alcohol, and other relevant covariates. The potential impact fraction was estimated under different scenarios of adherence to the DGA. Results In this Italian population the HEI-2015 score ranged from 33.4 to 97.5. A higher HEI-2015 score was associated with a lower risk of oral and pharyngeal cancer, with an odds ratio of 0.70 (95% CI 0.62 to 0.79) for a 10-point increment of the score. The estimated potential impact fraction was 64.8% under the maximum achievable reduction scenario, and it ranged from 9% to 27% following other more feasible scenarios. Conclusions The HEI-2015 score was inversely related to oral and pharyngeal cancer risk in this Italian population. This analysis allowed for the estimation of the fraction of preventable cases, under different feasible scenarios. A share of 9% to 27% of avoidable cases of oral and pharyngeal cancer might be obtained across real-world scenarios of adherence to the DGA as measured by the HEI-2015 score.

BACKGROUND: Dietary habits have been related to the risk of nasopharyngeal carcinoma (NPC), but information on a wide range of macro- and micronutrients is still lacking, particularly for low-incidence countries. METHODS: We conducted a hospital-based case-control study in Italy on 198, histologically confirmed, NPC cases of Caucasian ethnicity of 18-76 years of age. Controls were 594 Caucasian cancer-free patients admitted to general hospitals for acute conditions. Nutrients intake was assessed through a validated food-frequency questionnaire. Adjusted odds ratios (ORs) and the corresponding confidence intervals (CIs) were estimated through logistic regression. RESULTS: Dietary intake of carotenoids were inversely related to NPC risk, notably carotene (OR for highest vs lowest quartile=0.46; 95% CI: 0.26-0.79), α-carotene (OR=0.57; 95% CI: 0.33-0.97), and β-carotene (OR=0.42; 95% CI: 0.24-0.75). Increased NPC risk was observed for elevate cholesterol intake (OR=1.85; 95% CI: 1.12-3.05). CONCLUSION: Study findings suggest a protective effect of carotenoids against NPC in a low-risk population, adding further support to a possible beneficial role of a diet rich in fruits and vegetables in cancers of the head and neck.

Background: There is some evidence that dietary habits may influence the risk of endometrial cancer independently of body mass, although the role of diet on endometrial carcinogenesis is unclear. Patients and methods: We carried out a multicenter case-control study from 1992 to 2006 in Italy on 454 women with incident, histologically confirmed endometrial cancer (age range 18-79 years) and 908 controls (age range 19-79 years) admitted to hospitals for acute, non-neoplastic diseases. A validated food-frequency questionnaire was used to estimate macronutrients, fatty acids and cholesterol intake. Logistic regression models, conditioned on age and study centre, and adjusted for major known risk factor of endometrial cancer and residual of energy intake were used to estimate odds ratios (OR) and 95% confidence intervals (CI). Results: Significant direct associations were observed with intake of energy (OR = 1.7 for the highest versus the lowest quintile, 95% CI = 1.1-2.5), and cholesterol (OR = 2.1, 95% CI = 1.4-3.2), while a direct borderline association emerged with saturated fatty acids (OR = 1.3, 95% CI = 0.9-2.0). There was no association with proteins, sugars, starch, total fat and other selected fatty acids. Conclusion: Energy and cholesterol intake were associated with endometrial cancer. RI Parpinel, Maria/B-1605-2012

Background:Physical education (PE) can be considered an instrument for active lifestyle promotion, and PE teachers can motivate youths to continue their studies in the field of Movement Sciences (MS).Methods:To evaluate the role of PE in higher secondary school in promoting physical activity (PA) and MS careers, previous PE experiences and current PA practice were investigated in a sample of Italian freshmen enrolled in different university degree courses.Results:A total of 7033 questionnaires were completed by students from 14 universities (41.3% males, mean age 20 ± 2.76 years). Recreation seemed to be the principal aim (42.2%) pursued during PE lessons, which are based mainly on practical activities (51.7%). Of all respondents, 67.2% were satisfied with the PE received during higher secondary school, and 51.6% participated in extracurricular PA. Current practice of PA was reported by 58.1% of the sample. Extracurricular activities were associated with choice of MS curricula (odds ratio: 2.15; 95% confidence interval, 1.85–2.50) and with current practice of PA (odds ratio: 1.68, 95% confidence interval, 1.51–1.87). Geographical differences concerning lessons organization and satisfaction were registered (P < .01).Conclusions:To enhance its role in health promotion, PE teaching should be improved by increasing the time allocated to PE and by strengthening the provision of school-based extracurricular PA.

Purpose: To investigate the role of the overall antioxidant activity of diet, we estimated the relation between three dietary indices of total antioxidant capacity (TAC) and endometrial cancer risk Methods: We analyzed data from an Italian case–control study including 454 women with incident, histologically confirmed endometrial cancer, and 908 frequency-matched controls admitted to the same hospitals as cases for acute non-neoplastic conditions. A reproducible and valid food frequency questionnaire was used to assess subjects’ habitual diet. TAC was measured using Italian food composition tables in terms of Ferric-reducing antioxidant power (FRAP), Trolox equivalent antioxidant capacity (TEAC), and total radical-trapping antioxidant parameter (TRAP). We computed odds ratios (OR) and corresponding 95 % confidence intervals (CIs) using conditional multiple logistic regression models, including terms for recognized endometrial cancer risk factors and total energy intake. Results: TAC was inversely related to endometrial cancer risk with ORs for the highest versus the lowest quartile of 0.69 (95 % CI 0.47–1.00) for FRAP, 0.68 (95 % CI 0.46–0.99) for TEAC, and 0.68 (95 % CI 0.47–0.98) for TRAP. The relations appeared consistent in strata of selected risk factors and decreased when considering TAC without the contribution of coffee. Conclusions: Our findings suggest a favorable role of a diet high in TAC on endometrial cancer risk, which can be partially driven by coffee consumption.

Because of their several biological activities, flavonoids may have an important role in explaining the protective effects of vegetables, fruit, and, possibly, tea against cancer. The potential relation between flavonoids and colorectal cancer risk was investigated using data from a multicentric Italian case-control study, including 1,953 cases of colorectal cancers (1,225 colon cancers and 728 rectal cancers) and 4,154 hospital controls admitted for acute nonneoplastic diseases. We have applied recently published data on the composition of foods and beverages, in terms of six principal classes of flavonoids, on dietary information collected through a validated food-frequency questionnaire. Odds ratios (OR) were estimated by multiple logistic regression models, including terms for sex, age, study center, family history of colorectal cancer, education, alcohol consumption, body mass index, physical activity, and energy intake. A reduced risk of colorectal cancer was found for increasing intake of isoflavones (OR, 0.76, for the highest versus the lowest quintile, Ptrend = 0.001), anthocyanidins (OR, 0.67, Ptrend < 0.001), flavones (OR, 0.78, Ptrend = 0.004), and flavonols (OR, 0.64, Ptrend < 0.001). No significant association was found for flavan-3-ols (OR, 0.98), flavanones (OR, 0.96), and total flavonoids (OR, 0.97). The estimates did not substantially differ for colon and rectal cancers, as well as in strata of sex, age, and body mass index. The findings of this large study provide support for an inverse association of selected classes of flavonoids with colorectal cancer risk. (Cancer Epidemiol Biomarker Prev 2006;15(8):1555–8)

Few epidemiologic studies have investigated the potential relation between flavonoids and breast cancer risk. We have applied recently published data on the composition of foods and beverages in terms of six principal classes of flavonoids (i.e., flavanones, flavan-3-ols, flavonols, flavones, anthocyanidines, and isoflavones) on dietary information collected in a large-case control study of breast cancer conducted in Italy between 1991 and 1994. The study included 2,569 women with incident, histologically confirmed breast cancer, and 2,588 hospital controls. Odds ratios (OR) and 95% confidence intervals were estimated by multiple logistic regression models. After allowance for major confounding factors and energy intake, a reduced risk of breast cancer was found for increasing intake of flavones (OR, 0.81, for the highest versus the lowest quintile; P-trend, 0.02), and flavonols (OR, 0.80; P-trend, 0.06). No significant association was found for other flavonoids, including flavanones (OR, 0.95), flavan-3-ols (OR, 0.86), anthocyanidins (OR, 1.09), as well as for isoflavones (OR, 1.05). The findings of this large study of an inverse association between flavones and breast cancer risk confirm the results of a Greek study. Copyright (copyright) 2005 American Association for Cancer Research.

Evidence for the possible effect of vitamin E on head and neck cancers (HNCs) is limited.Methods:We used individual-level pooled data from 10 case-control studies (5959 cases and 12 248 controls) participating in the International Head and Neck Cancer Epidemiology (INHANCE) consortium to assess the association between vitamin E intake from natural sources and cancer of the oral cavity/pharynx and larynx. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using unconditional logistic regression models applied to quintile categories of nonalcohol energy-adjusted vitamin E intake.Results:Intake of vitamin E was inversely related to oral/pharyngeal cancer (OR for the fifth vs the first quintile category=0.59, 95% CI: 0.49-0.71; P for trend

Background Consumption of fruit and vegetables has been inversely related to gastric cancer. Two studies found that dietary antioxidant capacity has some role in explaining this association. We investigated the overall antioxidant effect from diet on gastric cancer using three measures of non-enzymatic antioxidant capacity (NEAC). Methods We used data from an Italian case-control study including 230 patients with incident, histologically confirmed gastric cancer, and 547 frequency matched controls admitted to the same hospitals for acute non-neoplastic diseases. A reproducible and valid food frequency questionnaire was used to assess subjects’ usual diet. NEAC was measured using Italian food composition tables in terms of Trolox equivalent antioxidant capacity (TEAC), Ferric reducing-antioxidant power (FRAP) and Total radical-trapping antioxidant parameter (TRAP). We estimated the odds ratios (OR) of gastric cancer and the corresponding 95% confidence intervals (CI) using conditional logistic regression models including terms for recognized gastric cancer risk factors and total energy intake. Results NEAC was inversely related with gastric cancer risk with ORs for the highest versus the lowest quintile of 0.54 (95%CI, 0.33–0.88) for TEAC, 0.67 (95%CI, 0.42–1.07) for FRAP and 0.57 (95%CI, 0.36–0.90) for TRAP. Conclusions A diet rich in antioxidant capacity reduced gastric cancer risk, suggesting a high consumption of fruit and vegetables and a moderate consumption of wine and whole cereals.

Food and nutrition play an important role in head and neck cancer (HNC) etiology; however, the role of carotenoids remains largely undefined. We explored the relation of HNC risk with the intake of carotenoids within the International Head and Neck Cancer Epidemiology Consortium. We pooled individual-level data from 10 case-control studies conducted in Europe, North America, and Japan. The analysis included 18,207 subjects (4414 with oral and pharyngeal cancer, 1545 with laryngeal cancer, and 12,248 controls), categorized by quintiles of carotenoid intake from natural sources. Comparing the highest with the lowest quintile, the risk reduction associated with total carotenoid intake was 39% (95% CI 29-47%) for oral/pharyngeal cancer and 39% (95% CI 24-50%) for laryngeal cancer. Intakes of β-carotene equivalents, β-cryptoxanthin, lycopene, and lutein plus zeaxanthin were associated with at least 18% reduction in the rate of oral and pharyngeal cancer (95% CI 6-29%) and 17% reduction in the rate of laryngeal cancer (95% CI 0-32%). The overall protective effect of carotenoids on HNC was stronger for subjects reporting greater alcohol consumption (p&nbsp

Background: The role of selected micronutrients, vitamins and minerals in the aetiology of epithelial ovarian cancer was investigated using data from a case-control study conducted between 1992 and 1999 in five Italian areas. Patients and methods:Cases were 1031 patients with histologically confirmed incident epithelial ovarian cancer. Controls were 2411 subjects admitted for acute, non-neoplastic diseases to major hospitals in the same catchment areas. Dietary habits were elicited using a validated food frequency questionnaire including 78 food groups and recipes. Odds ratios (OR) and 95% confidence intervals (95% CI) were computed by quintiles of intake of nutrients. Results: Inverse associations emerged for vitamin E (OR = 0.6; 95% CI: 0.5-0.8), beta-carotene (OR = 0.8; 95% CI: 0.6-1.0), lutein/zeaxanthin (OR = 0.6; 95% CI: 0.5-0.8 for the highest vs. the lowest quintile of intake), and calcium intake (OR = 0.7; 95% CI: 0.6-1.0). When the combined effect of calcium and vitamin E was considered, the OR reached 0.4 (95% CI: 0.3-0.7) for subjects in the highest compared to those in the lowest intake tertile of both micronutrients. Results were consistent across strata of menopausal status, parity and family history of ovarian or breast cancer. Conclusions: The intake of selected micronutrients, which were positively correlated to a diet rich in vegetables and fruits, was inversely associated with ovarian cancer. RI Parpinel, Maria/B-1605-2012

Background: Certain types of carbohydrates increase glucose and insulin levels to a greater extent than others. In turn, insulin may raise levels of insulin-like growth factors, which may influence breast cancer risk. We analyzed the effect of type and amount of carbohydrates on breast cancer risk, using the glycemic index and the glycemic load measures in a large case-control study conducted in Italy. Patients and methods: Cases were 2569 women with incident, histologically-confirmed breast cancer interviewed between 1991 and 1994. Controls were 2588 women admitted to the same hospital network for a variety of acute, non-neoplastic conditions. Average daily glycemic index and glycemic load were calculated from a validated 78-item food frequency questionnaire. Results: Direct associations with breast cancer risk emerged for glycemic index (odds ratio, OR for highest vs. lowest quintile = 1.4; P for trend

Background and aims Oxidative processes have been related to atherosclerosis, but there is scanty information on the role of dietary antioxidants in the prevention of acute myocardial infarction (AMI). Methods and results The relationship between non-enzymatic antioxidant capacity (NEAC) and the risk of nonfatal AMI was investigated in a case-control study conducted in Milan, Italy, between 1995 and 2003. Cases were 760 patients below 75 years with a first episode of AMI and controls were 682 patients admitted to hospitals for acute conditions, who completed an interviewer-administered food frequency questionnaire, tested for validity and reproducibility. NEAC (excluding coffee) was measured using Italian food composition tables in terms of ferric reducing-antioxidant power (FRAP), Trolox equivalent antioxidant capacity (TEAC) and total radical-trapping antioxidant parameter (TRAP). The odds ratios (OR) of AMI, and the corresponding 95% confidence intervals (CI), were obtained by multiple logistic regression models including terms for main risk factors of AMI and total energy intake. NEAC was inversely related with the risk of AMI. The ORs for the highest quintile compared with the lowest one were 0.41 (95% CI, 0.27–0.63) for FRAP, 0.42 (95% CI, 0.27–0.65) for TEAC and 0.41 (95% CI, 0.27–0.62) for TRAP, with significant trends in risk. The inverse relationship was apparently stronger in women and in subjects aged ≥60 years. Conclusions Our results support a favorable role of dietary NEAC in the prevention of AMI, and encourage a high consumption of fruit and vegetables and a moderate consumption of wine and whole cereals.

Background. The reproducibility and validity of alcohol consumption has not been adequately studied, particularly in Mediterranean countries, where alcohol drinking is a widespread habit, especially during meals. Methods. We compared alcohol consumption measured by two interviewer-administered food frequency questionnaires (FFQ) with average intake derived from two 7-day dietary (7-DD) records (the reference method) on 395 volunteers. Different types of alcoholic beverages were considered separately in order to verify the ability of the questionnaire to assess detailed patterns of alcohol intake. Results. A satisfactory level of reproducibility and validity of the pattern of alcohol consumption across different levels and types of alcoholic beverage intake was observed. The reproducibility of wine and total alcohol intake showed correlation coefficients >0.75 in both sexes. The validity was somewhat higher for wine (around 0.70) than for other alcoholic beverages and total alcohol intake. This is probably accounted for by the more regular pattern of wine consumption during the year as compared to other alcoholic beverages (beer, grappa, etc) which are more strongly influenced by seasonal and daily variations. However, about 30% of abstainers according to FFQ were drinkers by the reference method. The opposite was observed in only 4% of subjects. Conclusion. The FFQ is a reliable and valid instrument for collecting alcohol intake in regular drinkers. Lower validity in irregular drinkers may be due to seasonal variation and/or inadequacy of the FFQ to capture irregular patterns of consumption and/or inadequacy of the average of two 7-DD as a reference method. Furthermore, a considerable degree of misclassification was observed between non-drinkers and moderate drinkers. RI Parpinel, Maria/B-1605-2012

Edefonti, V Hashibe, M Ambrogi, F Parpinel, M Bravi, F Talamini, R Levi, F Yu, G Morgenstern, H Kelsey, K McClean, M Schantz, S Zhang, Z Chuang, S Boffetta, P La Vecchia, C Decarli, A eng CA100679/CA/NCI NIH HHS/ CA78609/CA/NCI NIH HHS/ P50CA90388/CA/NCI NIH HHS/ R01CA51845/CA/NCI NIH HHS/ R01DA11386/DA/NIDA NIH HHS/ R03CA113157/CA/NCI NIH HHS/ R03CA77954/CA/NCI NIH HHS/ R21ES011667/ES/NIEHS NIH HHS/ T32CA09142/CA/NCI NIH HHS/ U01CA96134/CA/NCI NIH HHS/ Meta-Analysis Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't England 2011/11/30 06:00 Ann Oncol. 2012 Jul;23(7):1869-80. doi: 10.1093/annonc/mdr548. Epub 2011 Nov 28.; International audience; BACKGROUND: The association between dietary patterns and head and neck cancer has rarely been addressed. PATIENTS AND METHODS: We used individual-level pooled data from five case-control studies (2452 cases and 5013 controls) participating in the International Head and Neck Cancer Epidemiology consortium. A posteriori dietary patterns were identified through a principal component factor analysis carried out on 24 nutrients derived from study-specific food-frequency questionnaires. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were estimated using unconditional logistic regression models on quintiles of factor scores. RESULTS: We identified three major dietary patterns named 'animal products and cereals', 'antioxidant vitamins and fiber', and 'fats'. The 'antioxidant vitamins and fiber' pattern was inversely related to oral and pharyngeal cancer (OR=0.57, 95% CI 0.43-0.76 for the highest versus the lowest score quintile). The 'animal products and cereals' pattern was positively associated with laryngeal cancer (OR=1.54, 95% CI 1.12-2.11), whereas the 'fats' pattern was inversely associated with oral and pharyngeal cancer (OR=0.78, 95% CI 0.63-0.97) and positively associated with laryngeal cancer (OR=1.69, 95% CI 1.22-2.34). CONCLUSIONS: These findings suggest that diets rich in animal products, cereals, and fats are positively related to laryngeal cancer, and those rich in fruit and vegetables inversely related to oral and pharyngeal cancer.

Proanthocyanidins are a group of polymers of flavanols. Animal and in vitro studies suggest they decrease cancer risk, particularly of colorectal cancer. We used data from an Italian case-control study to investigate whether proanthocyanidins are related to colorectal cancer risk. Cases were 1,953 patients with incident, histologically confirmed colorectal cancer (1,225 colon cancers, 728 rectal cancers). Controls were 4,154 patients admitted for acute, non-neoplastic conditions. A reproducible and valid food frequency questionnaire was used. We estimated odds ratios (ORs) through multiple logistic regression models, including terms for potential confounding factors, and energy intake. A trend of decreasing risk with increasing intake of proanthocyanidins emerged for all classes except monomers. The OR for the highest vs. the lowest quintile of intake was 0.82 for monomers and dimers combined, 0.88 for monomers, 0.75 for dimers, 0.74 for all polymers with three or more mers, 0.84 for trimers, 0.80 for 4-6 mers, 0.79 for 7-10 mers, 0.69 for more than 10 mers, and 0.74 for total proanthocyanidins. The associations were apparently stronger for rectal than for colon cancer, in the absence of significant heterogeneity. These results may explain the protective effect of vegetables and fruit on colorectal cancer. RI Parpinel, Maria/B-1605-2012

Flavonoids have been suggested to be responsible for the potential beneficial properties of fruit and vegetables on stomach cancer risk. To provide further information on flavonoids, proanthocyanidins, and gastric cancer risk, we analyzed data from a case-control study conducted in Italy. Subjects were 230 cases with incident, histologically confirmed gastric cancer and 547 frequency-matched controls, admitted to the same hospitals of cases for acute, non-neoplastic conditions. Subjects were interviewed using a reproducible and valid food frequency questionnaire. We estimated the odds ratios (ORs) of gastric cancer and their corresponding 95% confidence intervals (CIs) using unconditional logistic regression models including terms for major recognized gastric cancer risk factors. The ORs of the highest quintile of intake compared to the lowest were below unity for all classes of flavonoids, in the absence, however, of significant associations. Strong inverse relations were found for proanthocyanidins. The OR was 0.44 (95% CI, 0.25-0.76) for monomers and dimers combined and 0.36 (95% CI, 0.21-0.63) for polymers with three or more mers. Further adjustment for fruit and vegetables, or vitamin C, did not materially change these associations. This is the first epidemiological study to suggest that dietary proanthocyanidins have a favorable role on gastric cancer risk. RI Parpinel, Maria/B-1605-2012

Objectives: To provide information on the relation between intake of carotenoids and retinol and endometrial cancer, since available data are inconsistent. Further, carotenoids other than beta-carotene have been rarely investigated. Methods: We conducted a multi-centric case-control study in various areas of Italy between 1992 and 2006 on 454 women with incident, histologically confirmed endometrial cancer and 908 controls admitted to the same network of hospitals of cases for acute, non-neoplastic conditions. Intake of carotenoids and retinol was computed from a validated and reproducible food frequency questionnaire. We adjusted for selected covariates, including energy intake, and calculated multivariate odds ratios (OR) and 95% confidence intervals (CI) using conditional logistic regression. Results: Comparing the highest to the lowest quartile of intake, the ORs of endometrial cancer were 0.69 (95% CI, 0.48-0.99) for beta-carotene, 0.65 (95% CI, 0.45-0.94) for beta-cryptoxanthin, and 0.59 (95% CI, 0.41-0.85) for lutein plus zeaxanthin intake. No association emerged with retinol (OR = 1.31, 95% CI, 0.94-1.84), alpha-carotene (OR = 0.94, 95% CI, 0.66-1.34), and lycopene (OR = 0.95, 95% CI, 0.68-1.34). Conclusions: Our results support a favorable role of selected dietary carotenoids on endometrial cancer risk.

ObjectiveThe relation between several measures of body iron and atherosclerotic disease, particularly acute myocardial infarction (AMI), is debated. This is of specific interest since iron is frequently included in supplementation and fortification of foods. We assessed the relation between dietary iron intake and the risk of non-fatal AMI.DesignCase–control study. The information was collected by interviewers using a food-frequency questionnaire tested for validity and reproducibility. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were obtained by multiple unconditional logistic regression models, including terms for energy and alcohol intakea, as well as for sociodemographic factors, tobacco and other major recognised risk factors for AMI.SettingMilan, Italy, between 1995 and 1999.SubjectsCases were 507 patients, below age 79 years, with a first episode of non-fatal AMI, and controls were 478 patients admitted to hospital for a wide spectrum of acute conditions unrelated to known or potential AMI risk factors.ResultsCompared with patients in the lowest tertile of total iron intake, the OR was 0.48 (95% CI 0.29–0.82) for those in the highest tertile. The corresponding value for haem iron was 0.71 (95% CI 0.48–1.06), for non-haem, non-alcohol iron was 0.80 (95% CI 0.51–1.24) and for iron derived from alcoholic beverages was 0.60 (95% CI 0.40–0.90). Sex-specific OR for total iron intake were not heterogeneous.ConclusionsIn this Italian population dietary iron intake was inversely related to AMI risk. This inverse association may depend on other nutrients present in the major sources of iron in the Italian diet.

Flavonoids have been associated with a reduced risk of lung, digestive tract, and certain hormone-related cancers. With reference to prostate cancer a few epidemiological studies have found an inverse relation with intake of isoflavones, flavonols, and flavones, although the evidence remains limited and inconsistent. The role of six principal classes of flavonoids on prostate cancer was investigated using data from a multicentric case-control study conducted between 1991 and 2002 in Italy. This included 1,294 incident, histologically confirmed carcinomas of the prostate and 1,451 controls admitted to the same hospitals as cases for a wide spectrum of acute, non-neoplastic conditions. The patients' usual diet was assessed using a validated and reproducible food-frequency questionnaire; food and beverage content of six major classes of flavonoids was obtained from the US. Department of Agriculture. No association between prostate cancer risk was found with any of the flavonoids analyzed: the multivariate odds ratios for the highest versus the lowest quintile of intake were 0.96 (95% confidence interval,, CI = 0.75-1.23) for flavanones, 1.3 (95% CI = 1.01-1.69) for flavan-3-ols, 1.23 (95% CI = 0.95-1.61) for flavonols. 1.09 (95% CI = 0.85-1.40) for flavonols, 1.18 (95% CI = 0.91-1.53)for anthocyanidins, 0.98 (95% CI = 0.76-1.26) for isoflavones, and 1.20 (95% CI = 0.92-1.58) for total flavonoids, all nonstatistically significant. Thus, the results of the present study do not support a protective effect of flavonoids on prostate cancer in this Italian population, characterized by a high intake of flavonoid-containing foods (except isoflavone-rich foods). RI Parpinel, Maria/B-1605-2012

Objective: As intake of flavonoids has been associated with reduced risk of coronary heart disease but data on the relation with specific classes of flavonoids are scarce, we assessed the relation between dietary intake of specific classes of flavonoids and the risk of acute myocardial infarction (AMI) in an Italian population. Design: Case-control study. Dietary information was collected by interviewers on a questionnaire tested for validity and reproducibility. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were obtained by multiple logistic regression models including terms for energy and alcohol intake, as well as sociodemographic factors, tobacco and other major recognised risk factors for AMI. Setting: Milan, Italy, between 1995 and 2003. Subjects: Cases were 760 patients, below age 79 years, with a first episode of non-fatal AMI, and controls were 682 patients admitted to hospital for acute conditions unrelated to diet. Results: A reduced risk of AMI was found for increasing intake of anthocyanidins (OR=0.45, 95% CI 0.26-0.78 for the highest vs. the lowest quintile, P-trend=0.003) and flavonols (OR=0.65, 95% CI 0.41-1.02, P-trend=0.02). A tendency towards reduced risks, although not significant, was observed for flavan-3-ols (OR=0.73, 95% CI 0.48-1.10) and total flavonoids (OR=0.74, 95% CI 0.49-1.14). No meaningful heterogeneity was found between the sexes. No association emerged for other flavonoids, including isoflavones, flavanones and flavones. Conclusions: High intake of anthocyanidins reduced the risk of AMI even after allowance for alcohol, fruit and vegetables, supporting a real inverse association between this class of flavonoids and AMI risk. RI Parpinel, Maria/B-1605-2012

Background: Carotenoids may reduce the risk of coronary heart disease through their antioxidant properties, but the results of epidemiological studies are controversial. We analysed the relation between the intake of selected carotenoids and retinol and risk of acute myocardial infarction (AMI). Methods: A case-control study was conducted in Milan, Italy, in 1995-2003. Cases were 760 patients with nonfatal AMI, and controls 682 patients admitted to hospital. Results: The risk of AMI decreased with increasing intake of alpha-carotene (odds ratios, OR 0.71, 95% confidence intervals, CI 0.51-0.98, for the highest vs the lowest quartile of intake), beta-carotene (OR 0.71, 95% CI 0.50-1.01) and beta-criptoxanthin (OR 0.64, 95% CI 0.46-0.88). No associations emerged for total carotenoids, lycopene, lutein plus zeaxanthin and retinol. Conclusions: Our study suggests a weak protective effect of alpha-carotene, beta-carotene and beta-criptoxanthin on the risk of AMI. It also indicates that total carotenoids, lycopene, lutein plus zeaxanthin and retinol were not related to the risk of the disease. RI Parpinel, Maria/B-1605-2012

Folate status may affect cancer risk through its role in both methylation and nucleotide synthesis of DNA. A low dietary intake of folate has been linked to risk of several cancers, but epidemiologic studies with reference to prostate cancer are scanty. We therefore analyzed data from a case-control study of prostate cancer conducted between 1991 and 2002 in various areas of Italy. Cases were 1,294 patients with incident, histologically confirmed prostate cancer and controls were 1,451 patients admitted to the same network of hospitals of cases for acute, nonneoplastic conditions. All subjects were

Background: Folate and vitamin B-6 intake has been associated with reduced risk of coronary heart disease, but studies are not consistent. Objective: The relation between folate and vitamin B-6 intake and the risk of acute myocardial infarction (AMI) was assessed in a Mediterranean population. Design: A hospital-based case-control study was conducted in Milan, Italy, between 1995 and 1999. Information was collected by interviewer-administered questionnaires. Adjusted odds ratios (ORs) and 95% confidence intervals (CI) were obtained by multiple logistic regression models. Subjects: Cases were 507 patients with a first episode of nonfatal AMI, and controls were 478 patients admitted to hospital for acute conditions. Results: Compared to patients in the lowest tertile of intake, the ORs for those in the highest tertile were 0.56 (95% CI 0.35-0.88) for folate and 0.34 (95% CI 0.19-0.60) for vitamin B-6. The OR was consistently below unity in strata of sex, age, alcohol, methionine, tobacco smoking, coffee, hypertension and family history of AMI; the inverse association was apparently stronger for vitamin B-6 in regular alcohol drinkers than in no or occasional drinkers. Compared to subjects with a low intake of both micronutrients, the OR was 0.29 for those with a high intake of both. Compared to subjects reporting no or occasional alcohol drinking and low methionine and folate intake, the OR was 0.28 in regular drinkers with high methionine and high folate intake. The corresponding value for vitamin B-6 was 0.25. Conclusions: A high intake of folates, vitamin B-6 and their combination is inversely associated with AMI risk. Sponsorship: Partly supported by "Ministero della Salute'' (Contract No. 177, RF 2001). RI Parpinel, Maria/B-1605-2012

Objective: The reproducibility and validity of coffee, decaffeinated coffee and tea intake has not been adequately studied, particularly in Italy, where coffee drinking is peculiar in terms of type and amount of coffee consumed. Design: We compared coffee and tea consumption, measured by two interviewer-administered food frequency questionnaires (FFQ), with average intake derived from two 7-day dietary (DD) records (the reference method) on 395 volunteers. The Pearson correlation coefficients (r) were used to assess both reproducibility and validity of information on coffee intake. Results: A satisfactory level of reproducibility and validity of the pattern consumption was observed for coffee, decaffeinated coffee and tea. The reproducibility for both sex combined showed r of 0.74-0.78 for coffee, 0.57-0.65 for decaffeinated coffee and 0.61-0.67 for tea. The validity was about 0.70 for coffee, around 0.58 for decaffeinated coffee and 0.56-0.60 for tea intake. Conclusions: The FFQ is a satisfactorily reliable and valid instrument for collecting information on coffee, decaffeinated coffee and tea intake. Sponsorship: Supported by the Italian Association for Research on Cancer, Milan, Italy, and by the Commission of the European Communities (Contract No.: QLKI-CT-2000-00069). RI Parpinel, Maria/B-1605-2012

Data from a series of case-control studies, conducted in Italy and Switzerland between 1991 and 200 1, have been analyzed to evaluate the role of n-3 polyunsaturated fatty acid (PUFA) intake in the etiology of cancer of oral cavity and pharynx (736 cases, 1,772 controls), esophagus (395 cases, 1,066 controls), large bowel (1,394 colon, 886 rectum, 4,765 controls), breast (2,900 cases, 3,122 controls) and ovary (1,031 cases, 2,411 controls). Controls were patients admitted to hospital for acute, non-neoplastic conditions, unrelated to modifications in diet. The multivariate odds ratios (OR) for the highest quintile of n-3 PUFAs compared to the lowest one were 0.5 for oral and pharyngeal cancer, 0.5 for oesophageal cancer, 0.7 for colon cancer, 0.8 for rectal and breast cancer and 0.6 for ovarian cancer; the estimates and the trends in risk were significant for all cancer sites, excluding rectal and breast cancer. The estimates for an increase in n-3 PUFAs of 1 g/week were 0.70 for oral and pharyngeal cancer, 0.71 for oesophageal, 0.88 for colon, 0.91 for rectal, 0.90 for breast and 0.85 for ovarian cancer. All the estimates were statistically significant, excluding that for rectal cancer, and consistent across strata of age and gender. These results suggest that n-3 PUFAs decrease the risk of several cancers. (C) 2003 Wiley-Liss, Inc. RI Parpinel, Maria/B-1605-2012

Background: Consumption of vegetables, fruit and whole grain cereals has been inversely related to laryngeal cancer risk. Among the potential protective agents found in these foods, information on dietary fibres and laryngeal cancer risk are scanty. Patients and methods: A multi-centric, hospital-based case-control study was conducted on 527 patients with squamous-cell carcinoma of the larynx and 1297 non-neoplastic controls. Cases and controls, frequency matched by age, sex and study centre, were interviewed using a validated food frequency questionnaire. Results: Compared with the lowest quintile of fibre intake, the odds ratios (ORs) for the highest quintile were 0.3 [95% confidence interval (CI) 0.2-0.4] for total fibre, 0.3 (95% CI 0.2-0.5) for soluble non-cellulose polysaccharides (NCP) and for total insoluble fibre, including cellulose (OR = 0.3, 95% CI 0.2-0.4) and insoluble NCP (OR = 0.4, 95% CI 0.3-0.7). The ORs were 0.2 (95% CI 0.1-0.4) for fibre from vegetables, 0.5 (95% CI 0.3-0.7) from fruit and 1.1 (95% CI 0.6-1.9) from grains. The inverse association observed was similar among different subsites of laryngeal cancer, and consistent across strata of various covariates. Conclusions: This study found a strong inverse association between fibre intake and laryngeal cancer risk, which points to fibre as one of the beneficial components of vegetables and fruit. RI Parpinel, Maria/B-1605-2012

Background: Insulin and insulin-like growth factors can stimulate proliferation of colorectal cells. High intake of refined carbohydrates and markers of insulin resistance are associated with colorectal cancer. To test the insulin/colon cancer hypothesis, we determined whether the dietary glycemic index and the glycemic load are associated with colorectal cancer risk. Design: A case-control study on colorectal cancer conducted in Italy. Cases included 1125 men and 828 women with histologically confirmed incident cancer of the colon or rectum. Controls were 2073 men and 2081 women hospitalized for acute conditions. We calculated average daily dietary glycemic index and glycemic load, and fiber intake from a validated food frequency questionnaire. Results: Direct associations with colorectal cancer risk emerged for glycemic index (odds ratio (OR) in highest vs. lowest quintile = 1.7; 95% confidence interval (CI): 1.4-2.0) and glycemic load (OR = 1.8; 95% CI: 1.5-2.2), after allowance for sociodemographic factors, physical activity, number of daily meals, and intakes of fiber, alcohol and energy. ORs were more elevated for cancer of the colon than rectum. Overweight and low intake of fiber from vegetables and fruit appeared to amplify the adverse consequences of high glycemic load. Conclusions: The positive associations of glycemic index and load with colorectal cancer suggest a detrimental role of refined carbohydrates in the etiology of the disease. RI Jenkins, David/A-1992-2009; Parpinel, Maria/B-1605-2012

The knowledge of major sources of macro-and micronutrients is essential in order to interpret differences in the diet-cancer link in various geographical areas and to provide better nutritional guidelines, For this purpose we took advantage of the control group of a case-control study on breast cancer carried out in six Italian areas. The dietary habits of 2,588 cancer-free women aged 20-74 years (median age 56) were elicited between 1991 and 1994 by means of an interviewer-administered food frequency questionnaire (FFQ) that included 78 foods or food groups, in addition to several questions on general dietary pattern (eg, fat in seasoning), Bread was the first contributor for total energy (12%), protein (8%) and starch (32%) intake, whereas, for saturated fatty acids, the first sources were different types of cheese (28%); for monounsaturated fatty acids the dressing oils of salad and tomatoes (12%); and, for sugars, apples and pears (19%), Raw vegetables and fresh fruit represented the most important source of most vitamins, The first contributors of vitamin C and beta-carotene were citrus fruits (29%) and raw carrots (17%), respectively, Thus, between 40 and 80% of specific macronutrient intake and up to 90% intake of several micronutrients were derived from the first ten foods or food groups, Often, the major contributors to the intake of a specific component were foods with a relatively low content, but eaten in large quantities, This work further highlights the specificity of nutrient sources in southern European populations. RI Parpinel, Maria/B-1605-2012

The control group of a hospital-based case-control study on breast cancer was used to assess the relationships between education, smoking habits, alcohol consumption, and intake of selected macro- and micronutrients in Italian women. The study subjects were 2,588 women admitted to a network of hospitals in various Italian regions for nonneoplastic, acute diseases unrelated to long-term changes in the diet. Although relatively few differences were observed, less educated subjects consumed more linoleic acid and polyunsaturated fats than did more educated women. Smoking habits were associated with the largest differences in selected antioxidant vitamins. Significant differences were observed for beta-carotene and vitamin C intake, with an 11% higher intake of beta-carotene and a 12% higher intake of vitamin C in ex-smokers than in current smokers. Heavier alcohol drinkers tended to consume more retinol and iron but less beta-carotene than did moderate or nondrinkers. Thus the differences in macro- and micronutrient intake were generally moderate across categories of education, smoking, and alcohol consumption in this data set of Italian women. Nonetheless, they confirm the importance of allowing for these variables in analyzing the relationship between nutritional factors and disease risk. RI Parpinel, Maria/B-1605-2012