Adherence to the Mediterranean Diet and Risks of Prostate and Bladder Cancer in the Netherlands Cohort Study

Abstract

Background: Prostate cancer and urinary bladder cancer are frequently occurring cancers with few risk factors identified. We examined the relation of Mediterranean diet (MD) adherence with risks of prostate and bladder cancer in the Netherlands Cohort Study (NLCS). Methods: Data were available for 58,279 men and 62,573 women, who completed a baseline questionnaire on diet and other cancer risk factors. Multiple MD scores, including the alternate Mediterranean diet score without alcohol (aMEDr), were calculated to assess MD adherence. After 20.3 years of follow-up, 3,868 prostate cancer cases (advanced: 1,256) and 1,884 bladder cancer cases could be included in multivariable Cox proportional hazards analyses. Results: aMEDr was not associated with advanced prostate cancer risk [hazard ratio (HR) per 2-point increment (95% confidence interval, 95% CI) ¼ 1.06 (0.96-1.17)]. In contrast, higher aMEDr values were associated with a significantly increased risk of nonadvanced prostate cancer (P trend ¼ 0.04). For bladder cancer risk, no association was observed with aMEDr [HR per 2-point increment (95% CI) ¼ 1.00 (0.92-1.09)]. Absolute scores based on the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) dietary recommendations were not associated with prostate or bladder cancer risk. Conclusions: MD adherence, measured by aMEDr or other MD scores, was not associated with decreased risks of advanced prostate cancer and bladder cancer in the NLCS. Higher levels of care-seeking behavior, screening attendance, and prostate cancer awareness in higher educated men with healthier lifestyles could potentially explain the positive associations observed for nonadvanced prostate cancer risk. Impact: MD adherence does not seem to reduce the risk of (advanced) prostate cancer or bladder cancer.

Healthy lifestyle, genetic risk, and incidence of cancer: A prospective cohort study of 13 cancer types

“…We found a healthy lifestyle was associated with a higher risk of prostate cancer. This finding is inconsistent with the majority of previous research suggesting either a negative association or no relationship for combined or individual components of a healthy lifestyle (6,(23)(24)(25)(26)(27)(28), and may be the result of healthy volunteer bias. This large prospective cohort study has some limitations.…”

An updated systematic review and meta-analysis on adherence to mediterranean diet and risk of cancer

“…Although our results suggested a small reduction in overall cancer risk for alcohol intake within the range, compared to higher alcohol consumption, the benefit from light-to-moderate consumption of wine on cancer risk in observational studies is inconclusive [174][175][176]. Risk estimates for several cancers based on MedDiet scores including alcohol did not differ from those simply adjusted for total alcohol intake [122,[145][146][147][148][149]. Consumption of wine together with meals is a part of the cultural heritage in Mediterranean countries, but it is less common in other countries [177].…”

Compliance with the 2018 World Cancer Research Fund/American Institute for Cancer Research Cancer Prevention Recommendations and Prostate Cancer

“…To date the association between compliance with the 2018 WCRF/AICR recommendations and PCa has not been evaluated, but it has already been explored for the 2007 WCRF/AICR recommendations. The studies that use the previous recommendations do not find an association between these recommendations and PCa when the aggressiveness of the tumor is not considered [21][22][23]29,31]. The absence of predefined cut-off points for the different items of the 2007 recommendations might also have contributed to these negative results.…”

“…Since 2007, several studies have evaluated the association of the recommendations of the Second Expert Report and cancer mortality [17], as well as the risk of developing cancer [18]; especially with breast cancer, colorectal cancer, head and neck cancer, pancreatic cancer, lymphocytic leukemia, and PCa [19][20][21][22][23][24][25][26][27][28][29][30][31]. However, as we have commented previously, the comparison of the results is not easy because of the absence of standard criteria.…”