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European journal of nutrition
Mar, 2024;63 (2): 377-396.

Ultra-processed foods, adiposity and risk of head and neck cancer and oesophageal adenocarcinoma in the European Prospective Investigation into Cancer and Nutrition study: a mediation analysis.

Fernanda Morales-Berstein, Carine Biessy, Vivian Viallon, Ana Goncalves-Soares, Corinne Casagrande, Bertrand Hémon, Nathalie Kliemann, Manon Cairat, Jessica Blanco Lopez, Aline Al Nahas, Kiara Chang, Eszter Vamos, Fernanda Rauber, Renata Bertazzi Levy, Diana Barbosa Cunha, Paula Jakszyn, Pietro Ferrari, Paolo Vineis, Giovanna Masala, Alberto Catalano, Emily Sonestedt, Yan Borné, Verena Katzke, Rashmita Bajracharya, Claudia Agnoli, Marcela Guevara, Alicia Heath, Loredana Radoï, Francesca Mancini, Elisabete Weiderpass, José María Huerta, María-José Sánchez, Anne Tjønneland, Cecilie Kyrø, Matthias B Schulze, Guri Skeie, Marko Lukic, Tonje Braaten, Marc Gunter, Christopher Millett, Antonio Agudo, Paul Brennan, M Carolina Borges, Rebecca C Richmond, Tom G Richardson, George Davey Smith, Caroline L Relton, Inge Huybrechts, EPIC Network
Author Information
  1. Fernanda Morales-Berstein: MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK. dy20206@bristol.ac.uk. ORCID
  2. Carine Biessy: Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France.
  3. Vivian Viallon: Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France.
  4. Ana Goncalves-Soares: MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
  5. Corinne Casagrande: Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France.
  6. Bertrand Hémon: Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France.
  7. Nathalie Kliemann: Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France.
  8. Manon Cairat: Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France.
  9. Jessica Blanco Lopez: Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France.
  10. Aline Al Nahas: Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France.
  11. Kiara Chang: Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK.
  12. Eszter Vamos: Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK.
  13. Fernanda Rauber: Preventive Medicine Department of the Medical School, University of São Paulo, São Paulo, Brazil.
  14. Renata Bertazzi Levy: Preventive Medicine Department of the Medical School, University of São Paulo, São Paulo, Brazil.
  15. Diana Barbosa Cunha: Hésio Cordeiro Institute of Social Medicine, Department of Epidemiology, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil.
  16. Paula Jakszyn: Unit of Nutrition and Cancer, Catalan Institute of Oncology-ICO, L'Hospitalet de Llobregat, Spain.
  17. Pietro Ferrari: Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France.
  18. Paolo Vineis: MRC Centre for Environment and Health, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.
  19. Giovanna Masala: Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy.
  20. Alberto Catalano: Centre for Biostatistics, Epidemiology, and Public Health, Department of Clinical and Biological Sciences, University of Turin, 10043, Orbassano, TO, Italy. ORCID
  21. Emily Sonestedt: Nutrition Epidemiology, Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Lund, Sweden.
  22. Yan Borné: Nutrition Epidemiology, Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Lund, Sweden.
  23. Verena Katzke: Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
  24. Rashmita Bajracharya: Department of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
  25. Claudia Agnoli: Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
  26. Marcela Guevara: Instituto de Salud Pública y Laboral de Navarra, 31003, Pamplona, Spain.
  27. Alicia Heath: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
  28. Loredana Radoï: Paris-Saclay University, UVSQ, Inserm "Exposome, Heredity, Cancer and Health" Team, CESP U1018, Gustave Roussy, Villejuif, France.
  29. Francesca Mancini: Paris-Saclay University, UVSQ, Inserm "Exposome, Heredity, Cancer and Health" Team, CESP U1018, Gustave Roussy, Villejuif, France.
  30. Elisabete Weiderpass: International Agency for Research on Cancer, World Health Organization, Lyon, France.
  31. José María Huerta: Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029, Madrid, Spain.
  32. María-José Sánchez: Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029, Madrid, Spain.
  33. Anne Tjønneland: Danish Cancer Society Research Center, Diet, Cancer and Health, Strandboulevarden 49, DK-2100, Copenhagen, Denmark.
  34. Cecilie Kyrø: Danish Cancer Society Research Center, Diet, Cancer and Health, Strandboulevarden 49, DK-2100, Copenhagen, Denmark.
  35. Matthias B Schulze: Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
  36. Guri Skeie: Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
  37. Marko Lukic: Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
  38. Tonje Braaten: Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
  39. Marc Gunter: Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France.
  40. Christopher Millett: Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK.
  41. Antonio Agudo: Unit of Nutrition and Cancer, Catalan Institute of Oncology-ICO, L'Hospitalet de Llobregat, Spain.
  42. Paul Brennan: Genetic Epidemiology Group, International Agency for Research on Cancer, World Health Organization, Lyon, France.
  43. M Carolina Borges: MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
  44. Rebecca C Richmond: MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
  45. Tom G Richardson: MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
  46. George Davey Smith: MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
  47. Caroline L Relton: MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
  48. Inge Huybrechts: Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France.
PMID: 37989797 DOI: 10.1007/s00394-023-03270-1

Abstract

PURPOSE: To investigate the role of adiposity in the associations between ultra-processed food (UPF) consumption and head and neck Cancer (HNC) and oesophageal adenocarcinoma (OAC) in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort.
METHODS: Our study included 450,111 EPIC participants. We used Cox regressions to investigate the associations between the consumption of UPFs and HNC and OAC risk. A mediation analysis was performed to assess the role of body mass index (BMI) and waist-to-hip ratio (WHR) in these associations. In sensitivity analyses, we investigated accidental death as a negative control outcome.
RESULTS: During a mean follow-up of 14.13 ± 3.98 years, 910 and 215 participants developed HNC and OAC, respectively. A 10% g/d higher consumption of UPFs was associated with an increased risk of HNC (hazard ratio [HR] = 1.23, 95% confidence interval [CI] 1.14-1.34) and OAC (HR = 1.24, 95% CI 1.05-1.47). WHR mediated 5% (95% CI 3-10%) of the association between the consumption of UPFs and HNC risk, while BMI and WHR, respectively, mediated 13% (95% CI 6-53%) and 15% (95% CI 8-72%) of the association between the consumption of UPFs and OAC risk. UPF consumption was positively associated with accidental death in the negative control analysis.
CONCLUSIONS: We reaffirmed that higher UPF consumption is associated with greater risk of HNC and OAC in EPIC. The proportion mediated via adiposity was small. Further research is required to investigate other mechanisms that may be at play (if there is indeed any causal effect of UPF consumption on these cancers).

Keywords

Adiposity Epidemiology Food processing Head and neck cancer Mediation analysis NOVA classification Oesophageal cancer

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Grants

  1. MC_UU_00011/6/Medical Research Council
  2. MC_UU_00032/1/Medical Research Council
  3. MC_UU_00011/5/Medical Research Council
  4. 29019/Cancer Research UK
  5. C33493/A29678/Cancer Research UK
  6. /Wellcome Trust
  7. 29678/Cancer Research UK
  8. 001/World Health Organization
  9. AA/18/1/34219/British Heart Foundation
  10. 224982/Z/22/Z/Wellcome Trust
  11. MR/M012190/1/Medical Research Council
  12. MC_UU_00011/1/Medical Research Council
  13. C18281/A29019/Cancer Research UK

MeSH Term

Humans
Adiposity
Prospective Studies
Food, Processed
Mediation Analysis
Obesity
Head and Neck Neoplasms
Adenocarcinoma
Fast Foods
Diet
Food Handling
Esophageal Neoplasms
Journal Article
Article has an altmetric score of 1137

Word Cloud

Created with Highcharts 10.0.0consumptionHNCOACrisk95%UPFcancerUPFsanalysisCIinvestigateadiposityassociationsneckEPICWHRassociatedmediatedroleheadoesophagealadenocarcinomaEuropeanProspectiveInvestigationCancerNutritionparticipantsmediationBMIratioaccidentaldeathnegativecontrolrespectivelyhigher1associationPURPOSE:ultra-processedfoodcohortMETHODS:studyincluded450111usedCoxregressionsperformedassessbodymassindexwaist-to-hipsensitivityanalysesinvestigatedoutcomeRESULTS:meanfollow-up1413 ± 398 years910215developed10%g/dincreasedhazard[HR] = 123confidenceinterval[CI]14-134HR = 12405-1475%3-10%13%6-53%15%8-72%positivelyCONCLUSIONS:reaffirmedgreaterproportionviasmallresearchrequiredmechanismsmayplayindeedcausaleffectcancersUltra-processedfoodsstudy:AdiposityEpidemiologyFoodprocessingHeadMediationNOVAclassificationOesophageal

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