Download - Kost, kræft og helbred En undersøgelsen til belysning af sammenhængen mellem kost og kræft
Kost, kræft og helbred
En undersøgelsen til belysning af sammenhængen mellem kost og kræft
Anne Tjønneland Kim Overvad
Institut for Epidemiologisk Institut for Epidemiologi ogKræftforskning Socialmedicin
Kræftens Bekæmpelse Aarhus Universitet
Diet, Cancer and Health
Organisation
Principal investigatorsAnne TjønnelandInstitute of Cancer EpidemiologyDanish Cancer Society
Kim OvervadDepartment of Epidemiology and Social MedicineAarhus University
FundingDanish Cancer SocietyEUNCU
Steering CommitteeJørn Olsen (Chairman)Britmarie SandströmPer Kragh AndersenPeter EbbesenTorben KruseHans Sjöström
Beskrivelse af databasen
Demografi
Kost
Baggrund, livsstil
Antropometri/biologiske målinger
Biologisk materiale
En stikprøve af befolkningen• 57.054 personer
27.179 mænd
29.875 kvinder
• Født i Danmark
• 7% af aldersgruppen 50-64 år
• Bosiddende i
Københavns kommune
Frederiksberg kommune
Københavns amt
Århus amt
• Ikke tidligere haft en kræftsygdom
Deltagere
Kostspørgeskema• Semikvantitativt
fødevare-frekvensspørgeskema
• Normalkost gennem det sidste år
196 spørgsmål• Måltider• Fødevarer• Kosttilskud• Fedtstoffer brugt ved
madlavning• Tilberedningsmetode
r
Kostoplysninger
Brød og fedtstof på brød Hvor mange skiver brød spiser De? Når De svarer på spørgsmålene, skal De tænke på brød til alle måltider. Et halvt rundstykke, en halv bolle eller et stykke flûte svarer til en skive franskbrød.
pr. måned pr. uge pr. dag Brød aldrig/
sjældent 1 2-3
1-2 3-4 5-6
8 eller 1 2-3 4-5 6-7 flere
Rugbrød (antal ½ skiver)
Lyst franskbrød (antal hele skiver)
Groft franskbrød (antal hele skiver)
Knækbrød (antal hele skiver)
Hvor mange skiver brød kommer De fedtstof på? (Nogle bruger kun fedtstof en gang imellem).
pr. måned pr. uge pr. dag Fedtstof på brød aldrig/
sjældent 1 2-3
1-2 3-4 5-6
8 eller 1 2-3 4-5 6-7 flere
Rugbrød med fedtstof (antal ½ skiver)
Lyst franskbrød med fedtstof (antal hele skiver)
Groft franskbrød med fedtstof (antal hele skiver)
Knækbrød med fedtstof (antal hele skiver)
Baggrund og livsstil
Spørgeskema om risikofaktorer
Rygevaner Familieoplysninger - tidligere og nuværende Uddannelse
Alkoholvaner Arbejde - tidligere og nuværende Kvindeoplysninger
Hudtype - menstruationsforhold Fysisk aktivitet - graviditeter Sygdomme - svangerskabsforebyggelse
- tidligere og nuværende - hormonbehandling Medicinindtagelse Mandeoplysninger Afføringsvaner - sterilisationsspørgsmål Vægt - antal børn
- tidligere og nuværende
Diet, Cancer and Health
Questionnaire check
* Optically readable* Missing marking. double marking* Limits* Logical checks
Antropometri og biologiske målinger
Ståhøjde
Siddehøjde Vægt Taljemål Hoftemål Bioimpedans Blodtryk Totalkolesterol Urin
blod protein sukker
Biologisk materiale
Blodprøve 30 ml filterpapir
serum 4 x 1 ml plasma 6 x 1 ml buffy coat 2 x 1 ml erytrocytter 2 x 1 ml
Urinprøve 4 x 1 ml Fedtbiopsi Tånegleklip
Diet, Cancer and Health
Tube
Rack
Liquid nitrogen container
Box
Section of the biological bank
Monitoring of the nitrogen containers
Spare nitrogen container in case of break down
Liquid nitrogen container
Kost, kræft og helbred
Registerkoblinger hvert år* Det Centrale Personregister (CPR)* Cancerregisteret* Dødsårsagsregisteret* Landspatientregisteret
Spørgeskemadata med 3-5 års interval* Ændringer for eksponering* Information om nye eksponeringer* Oplysninger om sygdomsudfald
Antal kræfttilfælde blandt deltagerne(primo 2003)
Mænd Kvinder Total
Total 1713 2052 3765
Colon/rectum
241 208
Breast 5 836
Lung 234 209
Prostate 325 -
I.A.R.C.LYON
PARIS
FLORENCE
MILAN
RAGUSA
TURIN
NAPLES
UK: OXFORD
CAMBRIDGE
NETHERLANDS: UTRECHT
RIVM
GERMANY: POTSDAM
HEIDELBERG
FRANCE: PARIS
ITALY: TURIN
MILAN
FLORENCE
NAPLES
RAGUSA
SPAIN OVIEDO
SAN SEBASTIAN
PAMPLONA
MURCIA
GRANADA
GREECE ATHENS SWEDEN: UMEA
MALMO
DENMARK: AARHUS
COPENHAGEN
NORWAY: TROMSO
EPIC collaborating centres
Subject Recruitment in the EPIC Study
Subjects included End of subject recruitment
Questionnaire Blood
Spain 41 529 40 040 1996
I taly 47 822 47 822 1998
UK 76 041 40 901 1998
Netherlands 40 659 36 924 1998
France 72 000 24 000 1993
Germany 55 000 53 000 1998
Greece 24 200 24 104 1999
Sweden 57 932 62 122 1996
Denmark 57 100 56 800 1997
Total 9 countries 472 283 385713
Expected Cancer Cases in the EPIC Study
after 5 and 10 Years’ Follow-up Cancer
M e n 5 years 10 years
W o m e n 5years 10 years
Stomach 268 639 195 483 Colorectum 530 1241 731 1748 Colon 305 719 466 1120 Rectum 225 522 265 628 Pancreas 143 333 132 323 Larynx 133 297 24 52 Lung 1037 2423 394 866 Bladder 289 701 105 256 Kidney 124 280 127 293 Prostate 447 1156 - - Breast - - 2156 4477 Cervix - - 283 582 Uterus - - 472 1054 Ovary - - 389 833 All cancers 4069 9480 6323 13979
Two dietary measurements: Dietary questionnaire on usual diet from all 470.000 subjects• Very detailed, 150 to 300 foods per questionnaire• To relate diet to cancer risk
One day “actual” diet from a 7% sample of subjects (32.000) • Computerized, 3000 foods and 700 recipes per country• To calibrate dietary measurements between countries
EPIC data on diet
• Estimated final size of the database = 150 giga bytes.
• 90 screens havebeen developed tofacilitate thetransfer, standardization,control andexportof the data
• 500.000 subjects * 2000 common variables
1 Billion values to be stored
EPIC Database on ORACLE system
Diet and cancer hypothesis 1:
FOODS
Increased risk• Meat (red?)• Processed meat• Salted food• Sweets and sugar
Reduced risk• Vegetables• Fruits• Whole grain
cereals• Oily fish
Diet and cancer hypothesis
2 :NUTRIENTS
Increased Risk• Total fat• Saturated fat• (Animal) protein• Sugars• Cooking products
Reduced Risk• Poly Unsaturated
Fats.• Fibre• Vitamins and
minerals• Various non-nutrient
components
Diet/Nutrition and cancer hypothesis 3 :
ENERGY BALANCE
Increased risk• Overweight• Abdominal obesity• Sedentary life
Reduced risk• Normal weight• Low waist/hip ratio• Physical activity
Diet/Nutrition and cancer hypothesis 4 :
Endogenous hormones
• Androgens, • Estrogens,• Insulin, • Growth Factors (IGFs)
– and their binding proteins
• Focused on genetic polymorphisms,– e.g. genes involved in hormones
metabolism, DNA repair, carcinogens metabolisms, prostaglandins synthesis…
• Interactions between genes, lifestyle and
environment
• Rare mutations in cancer associated genes (e.g. BRCA1, BRCA2, HNPCC)
Hypotheses 5 : GENETIC FACTORS
EPIC Biorepository
Country No. of subjects No. of aliquots
France 20,749 290,486
Italy 47,726 668,164
Spain 39,963 559,482
United Kingdom 43,273 605,822
Netherlands 36,320 508,480
Greece 28,560 399,840
Germany 50,700 709,800
Total at IARC 267,291 3,742,074
Samples stored only at the EPIC collaborating centres
Sweden 53,785
Denmark 56,131
Total EPIC 377,207
EPIC BIOREPOSITORY: TUBES AND GOBLETS USED TO HOLD PLASTIC STROWS
EPIC BIOREPOSITORY AT IARC-WHO
EPIC BUILDING, LYON, IARC-WHO
u
Total fruit consumption (grams/day) in EPIC adjusted for age, season and day of the week : MEN
0
50
100
150
200
250
300
350
400
450
500
Mur
cia
Ragus
aTr
in
Flor
ence
San
Seba
stia
n
Grana
da
Vares
e
Ovi
edo
Pam
plon
a
Greec
e
UK - Hea
lth
cons
ciou
s
Pots
dam
Aarhu
s
Hei
delb
erg
Biltho
ven
UK: Gen
eral
pop
ulat
ion
Cope
nhag
en
Umea
Mal
mo
centres
gra
ms/d
ay
Fatty Acids in Epic Cross Sectional Study (men)
% of Eicosapentaenoic acid (C20:5, n- 3)
0
0,5
1
1,5
2
2,5
3
3,5
4
Denmar
k
Malm
oUmea
Cambr
idge
North
Spa
in
Mur
cia
Pots
dam
Greec
e
Heide
lber
g
Nethe
rland
s
Grana
da
Ragu
sa/N
aples
Mila
n/Va
resa
/ tur
in
Flor
ence
Oxfor
d
Epic center
% o
f Eic
osap
enta
enoi
c ac
id
( C20:5
, n-
3)
Variations of biomarkers of diet between EPIC cohorts
Lycopene, men 45-64 years
0
10
20
30
40
50
60
70
80
90
100
Ragus
a/Nap
les
Vares
e/Tu
rin
Flor
ence
Oxfor
d (*Veg
)
Greec
e
Grana
da
Cambr
idge
Mur
cia
Heide
lber
g
Pots
dam
Denm
ark
The
Nethe
rland
s
Umeå
North
ern
Spain
Malm
ö
mic
rog
/dl
Variations of biomarkers of diet between EPIC cohorts
Dietary patterns associated with participating countries
Country 150% or greater than mean overall intake
Italy Vegetables, fruits, cereal products, vegetable oils, sauces
Greece Vegetable, legumes, vegetable oils
Spain Vegetables, fruits, legumes, vegetable oils, milk, eggs, fresh meat, fish
France Sugars, butter, dairy products
Bingham & Riboli, 2004
Dietary patterns associated with participating countriesCountry 150% or greater than mean overall intake
Germany Butter, processed meat, coffee, juices
The Netherlands Potatoes, margarines, dairy products, processed meat, tea, coffee
United Kingdom Potatoes, cakes, sugar, margarine, butter, tea, soft drinks
Denmark Sugars, margarines, tea, coffee, soft drinks, alcohol
Sweden, Norway Potatoes, cakes, sugars, margarine, dairy products, coffee, soft drinks
Bingham & Riboli, 2004
Lifestyle factors and risk of breast cancer in postmenopausal women
24,650 postmenopausal
23,778
Follow up – 31 December 2000- 425 cases of postmenopausal breast cancer
29,875 women
326 prevalent cancers 55 missing information
(alcohol)4,844 premenopausal
872 excluded due to missing information on co-factors
Delprojekter i brystkræftstudiet
Kohortestudier
Indtag af alkohol
Indtag af frugt og grøntsager
Indtag af kulhydrater/GI/GL
Indtag af fisk
Fysisk aktivitet
Kropssammensætning
Brug af hormoner i forbindelse med overgangsalderen
Delprojekter i brystkræftstudiet
Nestede case-control studier
Enterolactone i plasma
Oxiadation af lipider og proteiner i plasma
Estrogenmetabolitter (16a-OHE1 + 2-OHE) i urin
DNA-reparationsprodukter i urin
IGF1+2 samt IGFBP2+3 i serum
Estradiol, SHBG, estron og FSH i serum
Delprojekter i brystkræftstudiet
Nestede case-control studier, fortsat
Antioxidant enzymer i røde blodlegemer
Genetiske polymorfier vedr. metaboliske enzymer
Genetiske polymorfier vedr. reparations enzymer
Organochloriner i fedtvæv
Risikofaktorer for brystkræft (internt justerede)
IRR (95% CI)
En ekstra fødsel 0.87 (0.77-1.00)
Alder ved første fødsel (5 års stigning) 1.02 (0.89-1.16)
Tidligere benign brystsygdom 1.65 (1.30-2.09)
Skolegang 7 år 18-10 år 1.00 (0.80-
1.26) 11 år 1.35 (1.02-1.79)
HRTTidligere 1.10 (0.80-1.51)Nuværende 1.97 (1.50-2.58)
Varighed af HRT (5 års stigning) 1.07 (0.97-1.19)
BMI (5 kg/m2 stigning) 1.07 (0.96-1.20)
Frugt og grøntsager
De kræftforebyggende effekter af frugt og grøntsager har været tilskrevet en række vitaminer, mineraler og andre fytokemikalier
Antioxidative effekter har været i fokus
Epidemiologisk baggrund
En lang række case-kontrol studier
Primære fund: beskyttende effekt
11 kohorte studier
Ingen association til brystkræft
Relativ risiko for brystkræft pr. 100 stigning i indtag af frugt, grøntsager og juice
1,02 (0,98-1,06)Total (f rugt, grøntsager og juice)
1,04 (0,91-1,19)J uice (f rugt og grøntsags)
0,98 (0,89-1,09)Grøntsager
1,05 (0,98-1,11)Frugt
IRR (95% CI )
Olsen, J. Nutr. 2004
Relativ risiko for brystkræft for indtag af grupper af frugt og grøntsager per 100 gram stigning
1,00 (0,99-1,01)Andre f rugter
1,02 (1,00-1,03)Citrusf rugter
1,05 (0,89-1,26)”Stængelgrøntsager”
1,01 (0,94-1,09)Løg, hvidløg
1,01 (0,90-1,14)Svampe
1,01 (0,93-1,09)Kål
0,98 (0,96-1,00)Rodf rugter (ikke kartofler)
1,01 (0,97-1,05)”Frugtgrøntsager”
1,02 (0,91-1,12)Bladgrøntsager
IRR (95% CI )
Olsen, J. Nutr. 2004
Relativ risiko, I RR (95% CI ) for brystkræft for ind-tagelsen af frugt, grøntsager og juice i relation til østrogen receptorstatus
J usteret f or alder, tid i studiet, paritet, benign brysttumor, skoleuddannelse, brug af HRT, alkoholindtagelse, BMI
0,90 (0,81-0,99)1,05 (1,00-1,10)Total
0,67 (0,42-1,08)1,04 (0,89-1,22)J uice
0,92 (0,73-1,16)1,01 (0,90-1,13)Grøntsager
0,92 (0,79-1,08)1,07 (1,00-1,15)Frugt
Østrogen- receptor negativ
Østrogen- receptor positiv
Olsen, J. Nutr. 2004
Konklusion
Ingen sammenhæng mellem indtag af frugt og grøntsager og risiko for brystkræft
- I overensstemmelse med alle tidligere kohortestudier
Måske forskellige effekter for ER+ og ER- brystkræft?
Enterolactone
Enterolactone er det primære fytoøstrogen i den danske kost
Enterolactone tilskrives antioxidative effekter og har været relateret til reducerende effekter vedr. tumor progression og metastaseren
Forskningen er dog yderst begrænset og stammer fra in vitro og dyreeksperimentelle studier
Enterolactone
Enterolactone stammer fra plantelignaner der indgår som en del af fiberkomponenten i planters cellevægge
Lignanerne fermenteres i tyktarmen og optages som enterolactone
Kilder til enterolactone
Fuldkornsprodukter
Grøntsager
Kaffe
Rygning
Fedt
BMI
Johnsen & Hausner 2003
Epidemiologisk baggrund
Relativ risiko for brystkræft pr. 20 nmol/ l stigning i plasma enterolactone
Er- brystkræft
Total brystkræft
0,74 (0,55-1,00)Enterolactone (per 20 nmol/ l)
0,96 (0,88-1,06)Enterolactone (per 20 nmol/ l)
ER+ brystkræft
0,93 (0,86-1,01)Enterolactone (per 20 nmol/ l)
IRR (95% CI )
Olsen, CEBP. 2004
Kvartiler af enterolactone i plasma
0.1- 14.4 nmol/ l
I RR (95% CI )
14.5- 28.1 nmol/ l
I RR (95% CI )
28.2- 47.9 nmol/ l
I RR (95% CI )
48.0- 454.6 nmol/ l
I RR (95% CI )
Total brystkræf t 0.78 (0.52-1.17) 1 0.81 (0.54-1.22) 0.56 (0.37-0.86)
ER+ brystkræf t 0.79 (0.49-1.28) 1 0.96 (0.59-1.55) 0.68 (0.42-1.10)
ER- brystkræf t 0.61 (0.25-1.53) 1 0.43 (0.16-1.15) 0.26 (0.09-0.77)
Enterolactone og brystkræft, kvartiler
Olsen, CEBP 2004
Hvorfor reference i 2. Kvartil?
Enterolactoneniveauet afhænger af fermentering i tyktarmen
Antibiotikabehandling ødelægger tarmfloraen
De kvinder der er i laveste kvartil er måske en blanding af kvinder med ”sande” lave enterolactoneniveauer og kvinder med akut lave niveauer pga. nylig antibiotikabehandling
Konklusion
Der er lavere incidens af brystkræft blandt kvinder med høje niveauer er enterolactone i plasma
Den beskyttende effekt ses primært i forhold til ER- brystkræft
Skyldes den øgede risiko for brystkræft ved langvarigt forbrug af antibiotika en nedsat produktion af enterolactone?
Hvorfor ER- brystkræft?
Hypoteser
1) Den beskyttende effekt af enterolactone er primær antioxidativ. Effekten på ER+ bliver ”overskygget” af østrogene risikofaktorer (fra enterolactone eller andet)?
2) ER- brystkræft er et senere stadie af ER+ brystkræft. Enterolactone ”bremser” progressionen fra ER+ til ER- brystkræft?
Kostspørgeskema
Hvor ofte drikker De den angivne mængde?
- Lys øl (flaske)- Almindelig øl (flaske)- Stærk øl (flaske)- Vin (rød, hvid,rosé) (glas) - Hedvin (ex. portvin) (genstand)
- Spiritus (ex. snaps) (genstand)
Angives i kategorier fra aldrig til 8 gange/dag
Alkoholoplysninger
Alkoholoplysninger
Livsstilsskema
Hvor ofte drikker De almindeligvis alkohol (øl, vin, hedvin eller spiritus)?
- Aldrig- Mindre end 1 gang om måneden- 1-3 gange om måneden- 1 gang om ugen - 2-4 gange om ugen
- 5-6 gange om ugen- Hver dag
Characteristics of 23,778 women in the Danish Diet, Cancer and Health cohort, 1993-2000
No. of cases = 426 (%)
No. of cohort = 23,778 (%)
Alcohol groups
Abstainers 1 10 (2.3) 560 (2.4)
Occasional drinkers 2 10 (2.3) 437 (1.8)
Drinkers (grams per day)
0 to 6 122 (28.6) 7,875 (33.1)
>6 to <12 89 (20.9) 5,812 (24.4)
12 to 24 93 (21.8) 4,903 (20.6)
>24 to <60 93 (21.8) 3,794 (16.1)
60 9 (2.1) 357 (1.7)
Median(5-95 percentiles)
Median (5-95 percentiles)
Age (years) 57 (51-64) 57 (51-64)
Age at first birth (years) 23 (18-32) 23 (18-31)
BMI + 24.8 (19.7-33.6)
24.9 (19.9-33.8)
Alcohol (grams per day) * 11.5 (1.3-43.8) 9.7 (0.8-42.1)
Alcohol from different types of beverages
Wine 5.5 (1.3-43.8) 5.4 (0.4-30.7)
Beer 1.1 (0-12.7) 1.0 (0-12.2)
Spirits 0.3 (0-7.8) 0.3 (0-7.8)
* Abstainers and occasional drinkers not included + Weight (kg)/height (m2)
Characteristics of 23,778 women in the Danish Diet, Cancer and Health cohort, 1993-2000
Rate ratio for increases of 10 g alcohol per day by type of alcohol among 23,778 women in the Danish
Diet, Cancer and Health cohort, 1993-2000
Type of alcohol
Adjusted*Rate ratio (95% CI)
Mutually adjusted**Rate ratio (95% CI)
P for similar effect
Total alcohol 1.10 (1.04-1.16) -
Wine 1.14 (1.06-1.22) 1.13 (1.06-1.22)
Beer 1.01 (0.87-1.17) 0.98 (0.50-1.14) 0.21
Spirits 1.15 (0.92-1.43) 1.09 (0.87-1.36)
* Rate ratio were adjusted for parous/nulliparous and number of births (continuous), age at first birth (in years), benign breast tumour removed (yes/no), years at school categorized, (7, 8-10, >10), use of HRT (never,
past, current), duration of HRT (in years), and BMI (continuous)
** The beverage specific estimates were in addition adjusted for each other (wine, beer, spirits)
Tjønneland, CCC 2003
Rate ratio* (RR) in each category of drinking pattern among 23,778 women in the Danish Diet, Cancer and Health cohort, 1993-2000
Drinking occasions nIntake (g/day)
(5-95% percentile) RR (95% CI)
Every day 3,188 (12-70) 1.02 (0.72-1.44)
5-6 times/week 2,471 (10-47) 0.96 (0.68-1.35)
2-4 times/week 7,443 (5-32) 1
Once/week 3,467 (2-15) 0.99 (0.73-1.35)
Less than once/week 6,212 (0.35-8) 0.87 (0.65-1.15)
* Adjusted for total alcohol intake as well as for parous/nulliparous and number of births (continuous), age at first birth (in years), benign breast tumour removed (yes/no), years at school categorized, (7, 8-10, >10), use of HRT (never, past, current), duration of HRT (in years), and BMI (continuous)
* Adjusted for total alcohol intake as week as well as
Tjønneland, CCC 2003
Rate ratio of breast cancer by frequency of alcohol consumption
Tjønneland, CCC 2003
Rate ratio (RR) of breast cancer according to an increase of 10 grams of alcohol intake for different exposure periods among postmenopausal women in the “Diet, Cancer and Health” cohort, 1993-2000
Exposure period RR 1 (95% CI) RR 2 (95% CI)
Twenties 0.97 (0.79-1.20) 0.97 (0.78-1.20)
Thirties 0.94 (0.79-1.11) 0.94 (0.79-1.12)
Forties 1.01 (0.88-1.16) 1.01 (0.88-1.16)
Fifties – baseline 1.11 (1.00-1.24) 1.04 (0.91-1.19)
Cumulative intake 3 1.03 (0.99-1.07) 4 0.99 (0.94-1.04)1. Adjusted for parity, age at first birth, benign breast tumour, years of school education, HRT
use, duration of HRT use, BMI, total alcohol intake in other exposure periods
2. Further adjusted for current alcohol intake
3. Cumulative intake, calculated from year 20 to baseline, excluding periods without drinking alcohol
4. Rate ratio of breast cancer according to an increase of 1 drink/day/year 1 drink-year of alcohol intake. Adjusted for the same variables as in 1) except adjustment for other exposure periods
Tjønneland, J. Nutr. 2004
Rate ratio of breast cancer per 10 g/day of alcohol intake according to age at drinking start among 21,901 postmenopausal women in the “Diet, Cancer and Health” cohort, 1993-2000
Age at drinking start
RR (95% CI)
<16 0.84 (0.55-1.28)
17-18 1.00
19-20 0.99 (0.75-1.32)
21-25 1.06 (0.79-1.42)
26-30 1.38 (0.96-1.99)
>30 1.01 (0.72-1.43)
Adjusted for parous/nulliparous, no. of births, age at first birth, benign breast tumour removed, school education, use of HRT, duration of HRT and BMI
Tjønneland, J. Nutr. 2004
Rate ratio of breast cancer per 10 g/day of alcohol intake according to drinking start among 21,901 postmenopausal women in the “Diet, Cancer and Health” cohort, 1993-2000
Started drinking:Cases/cohort RR (5-95% CI)
- before 1st birth 203/11,409 1.00
- app. at the same time of 1st birth 56/3,136 1.10(0.81-1.49)
- after the 1st birth 135/7,356 1.11(0.84-1.46)
Rate ratios were adjusted for parous/nullliparous, no. of births, age at first birth, benign breast tumour removed, years at school, use of HRT, duration of HRT, and BMI; current alcohol intake and mutually adjusted
Tjønneland, J. Nutr. 2004
Incidence Rate Ratio 1 of breast cancer per each additional 10 g/d of average daily alcohol intake according to categories for cumulative average intake of total folate among 388 cases and 388 controls, nested in the Danish “Diet, Cancer and Health” cohort
Median Total folate intake
5-95% percentiles Uni
t300 301-350 <351-400 400
P forinteracti
on
Alcohol intake 11.0 (0.8-43.8) 10 g 1.21 (1.01-1.45) 1.12 (0.84-
1.48)1.02 (0.83-1.25)
1.03 (0.86-1.22)
0.48
1 Adjusted for vitamin C (food-frequency questionnaire and supplements), school education (low, median, high), body mass index (linear), parous/nulliparous and number of births (linear), age at birth of first child (linear), history of benign breast tumour surgery (yes/no).
Tjønneland,subm 2004
<=300301-350
351-400>400
<=15
>15 g/d0
0,2
0,4
0,6
0,8
1
1,2
1,4
1,6
1,8
IRR
Total folate intake
<=15
>15 g/d
Alcohol intake
Incidence Rare Ratio of breast cancer by total folate and alcohol intake among
388 cases and 388 controls, nested in the Danish “Diet, Cancer and Health” cohort.
The reference group for all comparisons was women who consumed 300 mcg/d or less total folate and 15 g/d or less
alcohol. The Incidence Rate Ratio was adjusted for vitamin C, school education (low, median, high), body mass index
(linear), parous/nulliparous and number of births (linear), age at first child (linear), history of benign breast tumor surgery
(yes/no).
Konklusion
Alkoholindtagelse øger risikoen for brystkræft med 10% for hver gang indtagelsen øges med 10 g/dag
Drikkemønsteret har ikke betydning for risikoen
Tidlig drikkestart øger ikke risikoen for brystkræft blandt postmenopausale kvinder