Diet and lifestyle in relation to small intestinal cancer risk: findings from the European Prospective Investigation into Cancer and Nutrition (EPIC)

Zeynep Ersoy Guller, Rhea N. Harewood, Elisabete Weiderpass, Inge Huybrechts, Mazda Jenab, José María Huerta, Maria Jose Sánchez, Paula Jakszyn, Pilar Amiano, Eva Ardanaz, Claudia Agnoli, Rosario Tumino, Domenico Palli, Guri Skeie, Jonas Manjer, Keren Papier, Anne Tjønneland, Anne Kirstine Eriksen, Matthias B. Schulze, Rudolf KaaksVerena Katzke, Manuela M. Bergmann, Elio Riboli, Marc J. Gunter, Amanda J. Cross

Research output: Indexed journal article Articlepeer-review

1 Citation (Scopus)

Abstract

Purpose: The incidence of small intestinal cancer (SIC) is increasing, however, its aetiology remains unclear due to a lack of data from large-scale prospective cohorts. We examined modifiable risk factors in relation to SIC overall and by histological subtype. Methods: We analysed 450,107 participants enrolled in the European Prospective Investigation into Cancer and Nutrition cohort. Cox proportional hazards models were used to estimate univariable and multivariable hazard ratios (HRs) and 95% confidence intervals (CIs). Results: During an average of 14.1 years of follow-up, 160 incident SICs (62 carcinoids, 51 adenocarcinomas) were identified. Whilst univariable models revealed a positive association for current versus never smokers and SIC (HR, 95% CI: 1.77, 1.21–2.60), this association attenuated in multivariable models. In energy-adjusted models, there was an inverse association across vegetable intake tertiles for SIC overall (HRT3vsT1, 95% CI: 0.48, 0.32–0.71, p-trend: < 0.001) and for carcinoids (HRT3vsT1, 95% CI: 0.44, 0.24–0.82, p-trend: 0.01); however, these attenuated in multivariable models. Total fat was also inversely associated with total SIC and both subtypes but only in the second tertile (SIC univariable HRT2vsT1, 95% CI: 0.57, 0.38–0.84; SIC multivariable HRT2vsT1, 95% CI: 0.55, 0.37–0.81). Physical activity, intake of alcohol, red or processed meat, dairy products, or fibre were not associated with SIC. Conclusion: These exploratory analyses found limited evidence for a role of modifiable risk factors in SIC aetiology. However, sample size was limited, particularly for histologic subtypes; therefore, larger studies are needed to delineate these associations and robustly identify risk factors for SIC.

Original languageEnglish
Pages (from-to)927-937
Number of pages11
JournalCancer Causes and Control
Volume34
Issue number10
Early online dateJun 2023
DOIs
Publication statusPublished - Oct 2023

Keywords

  • Adenocarcinoma
  • Alcohol
  • Cancer
  • Carcinoid
  • Diet
  • Lifestyle
  • Small intestine
  • Smoking

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