Evidence Update on the Relationship between Diet and the Most Common Cancers from the European Prospective Investigation into Cancer and Nutrition (EPIC) Study: A Systematic Review

Abstract

The European Prospective Investigation into Cancer and Nutrition (EPIC) is a multicentre prospective study conducted in 23 centres in 10 European countries. Here we review the findings from EPIC on the relationship between diet-related exposures and incidence or mortality from the four most frequent cancers in the European population: colorectal, breast, lung, and prostate cancer. We conducted a systematic review following PRISMA guidelines and identified 110 high-quality studies based on the EPIC cohort. Fruit and vegetable consumption had a protective effect against colorectal, breast, and lung cancer, whereas only fruit had a protective effect against prostate cancer. A higher consumption of fish and lower consumption of red and processed meat were related with a lower risk of colorectal cancer; and higher consumption of fatty fish with lower risk of breast cancer. Calcium and yogurt intake were found to protect against colorectal and prostate cancer. Alcohol consumption increased the risk for colorectal and breast cancer. Finally, adherence to the Mediterranean diet emerged as a protective factor for colorectal and breast cancer. The EPIC study results are in agreement with the latest evidence from leading authorities on cancer prevention and help to inform public prevention policies and strategies.

The Role of Diet, Alcohol, BMI, and Physical Activity in Cancer Mortality: Summary Findings of the EPIC Study

“…Table S3 shows the percentage of studies meeting the quality criteria and provides detailed information on the quality score of each study. As observed previously [24], high-quality scores were reached given that the study populations emerged from the same study (the EPIC study), considering the same research protocols and data.…”

“…In the previously mentioned EPIC review on cancer incidence [24], the methodological assessment resulted in generally high and highly homogenous methodological quality scores; similarly, in the current review, a methodological quality assessment was performed using the same tool (Joanna Briggs Institute Critical Appraisal Tool for Systematic Reviews) [32]. This tool considers 11 items, each of them with four possible answers: "yes" (criterion met), "no" (criterion not met), "unclear", and "not applicable" (N/A).…”

“…This kind of review is, therefore, subject to bias. However, we conducted an assessment of the methodological quality of all included studies, similar to that performed in our previous systematic review on cancer incidence in the EPIC study [24]. Similarly, this assessment resulted in generally high and highly homogenous scores.…”

“…As part of a special issue on "Diet and Nutrition in Cancer Epidemiology", we set out to summarize the evidence generated by the EPIC study regarding the influence of diverse lifestyle factors on cancer outcomes. Following a previous review focused on diet and cancer incidence [24], this review aimed to summarize the findings derived from the EPIC study regarding the associations between dietary factors and other lifestyle exposures such as alcohol, BMI, and physical activity with cancer mortality.…”

The DAMA25 Study: Feasibility of a Lifestyle Intervention Programme for Cancer Risk Reduction in Young Italian Women with Breast Cancer Family History

“…The consumption of red and processed meat is considered a probable risk factor for several tumours including breast cancer also among premenopausal women [ 7 , 20 , 21 , 22 ]. At the same time an increased intake of wholegrains, vegetables, fruit, and legumes seems to protect against cancer including breast cancer [ 7 , 23 ].…”