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Diversity of dietary patterns observed in the European Prospective Investigation into Cancer and Nutrition (EPIC) project

Published online by Cambridge University Press:  02 January 2007

N Slimani*
Affiliation:
Unit of Nutrition and Cancer, International Agency for Research on Cancer, 150 cours Albert-Thomas, 69372 Lyon Cedex 08, France
M Fahey
Affiliation:
Unit of Nutrition and Cancer, International Agency for Research on Cancer, 150 cours Albert-Thomas, 69372 Lyon Cedex 08, France
A Welch
Affiliation:
Institute of Public Health, University of Cambridge, UK
E Wirfält
Affiliation:
Department of Medicine, Surgery and Orthopaedics, Lund University, University Hospital Malmö, Sweden
C Stripp
Affiliation:
Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark
E Bergström
Affiliation:
Epidemiology, Department of Public Health and Clinical Medicine, Umeå University, Sweden
J Linseisen
Affiliation:
Division of Clinical Epidemiology, German Cancer Research Centre, Heidelberg, Germany
MB Schulze
Affiliation:
German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany
C Bamia
Affiliation:
Department of Hygiene and Epidemiology, School of Medicine, University of Athens, Greece
Y Chloptsios
Affiliation:
Department of Hygiene and Epidemiology, School of Medicine, University of Athens, Greece
F Veglia
Affiliation:
Institute for Scientific Interchange Foundation, Turin, Italy
S Panico
Affiliation:
Department of Clinical and Experimental Medicine, University Federico II, Naples, Italy
HB Bueno-de-Mesquita
Affiliation:
Department of Chronic Diseases Epidemiology, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
MC Ocké
Affiliation:
Department of Chronic Diseases Epidemiology, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
M Brustad
Affiliation:
Institute of Community Medicine, University of Tromsø, Norway
E Lund
Affiliation:
Institute of Community Medicine, University of Tromsø, Norway
CA González
Affiliation:
Department of Epidemiology, Catalan Institute of Oncology, Barcelona, Spain
A Barcos
Affiliation:
Service of Surveillance and Epidemiological Control, Institute of Public Health of Navarra, Pamplona, Spain
G Berglund
Affiliation:
Department of Medicine, Surgery and Orthopaedics, Lund University, University Hospital Malmö, Sweden
A Winkvist
Affiliation:
Epidemiology, Department of Public Health and Clinical Medicine, Umeå University, Sweden
A Mulligan
Affiliation:
Institute of Public Health, University of Cambridge, UK
P Appleby
Affiliation:
Cancer Research UK, Epidemiology Unit, University of Oxford, UK
K Overvad
Affiliation:
Institute of Epidemiology and Social Medicine, University of Aarhus, Denmark
A Tjønneland
Affiliation:
17Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark
F Clavel-Chapelon
Affiliation:
INSERM, U521, Institute Gustave Roussy, Villejuif, France
E Kesse
Affiliation:
INSERM, U521, Institute Gustave Roussy, Villejuif, France
P Ferrari
Affiliation:
Unit of Nutrition and Cancer, International Agency for Research on Cancer, 150 cours Albert-Thomas, 69372 Lyon Cedex 08, France
WA Van Staveren
Affiliation:
Department of Human Nutrition and Epidemiology, Wageningen Agricultural University, The Netherlands
E Riboli
Affiliation:
Unit of Nutrition and Cancer, International Agency for Research on Cancer, 150 cours Albert-Thomas, 69372 Lyon Cedex 08, France
*
*Corresponding author: Email Slimani@iarc.fr
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Abstract

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Objective:

To describe the diversity in dietary patterns existing across centres/regions participating in the European Prospective Investigation into Cancer and Nutrition (EPIC).

Design and setting:

Single 24-hour dietary recall measurements were obtained by means of standardised face-to-face interviews using the EPIC-SOFT software. These have been used to present a graphic multi-dimensional comparison of the adjusted mean consumption of 22 food groups.

Subjects:

In total, 35 955 men and women, aged 35–74 years, participating in the EPIC nested calibration study.

Results:

Although wide differences were observed across centres, the countries participating in EPIC are characterised by specific dietary patterns. Overall, Italy and Greece have a dietary pattern characterised by plant foods (except potatoes) and a lower consumption of animal and processed foods, compared with the other EPIC countries. France and particularly Spain have more heterogeneous dietary patterns, with a relatively high consumption of both plant foods and animal products. Apart from characteristics specific to vegetarian groups, the UK ‘health-conscious’ group shares with the UK general population a relatively high consumption of tea, sauces, cakes, soft drinks (women), margarine and butter. In contrast, the diet in the Nordic countries, The Netherlands, Germany and the UK general population is relatively high in potatoes and animal, processed and sweetened/refined foods, with proportions varying across countries/centres. In these countries, consumption of vegetables and fruit is similar to, or below, the overall EPIC means, and is low for legumes and vegetable oils. Overall, dietary patterns were similar for men and women, although there were large gender differences for certain food groups.

Conclusions:

There are considerable differences in food group consumption and dietary patterns among the EPIC study populations. This large heterogeneity should be an advantage when investigating the relationship between diet and cancer and formulating new aetiological hypotheses related to dietary patterns and disease.

Type
Research Article
Copyright
Copyright © CABI Publishing 2002

References

1Murcott, A. You are what you eat: anthropological factors influencing food choice. In: Ritson, C, Gofon, L, McKenzie, J, eds. The Food Consumer. New York: John Wiley & Sons Ltd, 1986.Google Scholar
2Bingham, SA. The dietary assessment of individuals; methods, accuracy, new techniques and recommendations. Nutr. Abstr. Rev. (Ser. A) 1987; 57: 705–42.Google Scholar
3Archer, VE. Cooking methods, carcinogens, and diet–cancer studies. Nutr. Cancer 1988; 11: 75–9.CrossRefGoogle ScholarPubMed
4Prentice, RL. Measurement error and results from analytic epidemiology: dietary fat and breast cancer. J. Natl. Cancer Inst. 1996; 88: 1738–47.CrossRefGoogle ScholarPubMed
5Rosner, B, Spiegelman, D, Willett, WC. Correction of logistic regression relative risk estimates and confidence intervals for random within-person measurement error. Am. J. Epidemiol. 1992; 136: 1400–13.CrossRefGoogle ScholarPubMed
6Willett, WC. Nutritional Epidemiology, 2nd ed. New York: Oxford University Press, 1998.CrossRefGoogle Scholar
7Kipnis, V, Midthune, D, Freedman, LS, Bingham, S, Schatzkin, A, Subar, A, et al. Empirical evidence of correlated biases in dietary assessment instruments and its implications. Am. J. Epidemiol. 2001; 153: 394403.CrossRefGoogle ScholarPubMed
8Ursin, G, Ziegler, RG, Subar, AF, Graubard, BI, Haile, RW, Hoover, R. Dietary patterns associated with a low-fat diet in the National Health Examination Follow-up Study: identification of potential confounders for epidemiologic analysis. Am. J. Epidemiol. 1993; 137: 916–27.CrossRefGoogle Scholar
9Weinberg, CR. Toward a clearer definition of confounding [letter to the editor]. Am. J. Epidemiol. 1994; 140: 583–4.CrossRefGoogle Scholar
10Wu, AH, Yang, D, Pike, MC. A meta-analysis of soyfoods and risk of stomach cancer: the problem of potential confounders. Cancer Epidemiol. Biomark. Prev. 2000; 9: 1051–8.Google ScholarPubMed
11Klatsky, AL. Diet, alcohol, and health: a story of connections, confounders, and cofactors. Am. J. Clin. Nutr. 2001; 74: 279–80.CrossRefGoogle Scholar
12Peto, J. Cancer epidemiology in the last century and the next decade. Nature 2001; 411: 390–5.CrossRefGoogle ScholarPubMed
13World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR). Food, Nutrition and the Prevention of Cancer: A Global Perspective. Washington, DC: WCRF/AICR, 1997.Google Scholar
14Tarasuk, V, Beaton, GH. The nature and individuality of within-subject variation in energy intake. Am. J. Clin. Nutr. 1991; 54: 464–70.CrossRefGoogle ScholarPubMed
15Tarasuk, V, Beaton, GH. Day-to-day variation in energy and nutrient intake: evidence of individuality in eating behaviour? Appetite 1992; 18: 4354.CrossRefGoogle ScholarPubMed
16Hair, JF, Anderson, RE, Tatham, RL, Black, WC. Multivariate Data Analysis with Readings. New York: Macmillan Publishing Co., 1992.Google Scholar
17Ciampi, A, Ferrari, P, Slimani, N, Overvad, K, Ocké, M, Wirfält, E, et al. Discovering dietary patterns in nutritional epidemiology: towards a strategy integrating several techniques of multivariate analysis. Manuscript in preparation.Google Scholar
18Huijbregts, PPCW, Feskens, EJM, Kromhout, D. Dietary patterns and cardiovascular risk factors in elderly men: the Zutphen elderly study. Int. J. Epidemiol. 1995; 24: 313–20.CrossRefGoogle ScholarPubMed
19Slattery, ML, Boucher, KM, Caan, BJ, Potter, JD, Ma, KN. Eating patterns and risk of colon cancer. Am. J. Epidemiol. 1998; 148: 416.CrossRefGoogle ScholarPubMed
20Hu, FB, Rimm, EB, Stampfer, MJ, Ascherio, A, Spiegelman, D, Willett, WC. Prospective study of major dietary patterns and risk of coronary heart disease in men. Am. J. Clin. Nutr. 2000; 72: 912–21.CrossRefGoogle ScholarPubMed
21Palli, D, Russo, A, Decarli, A. Dietary patterns, nutrient intake and gastric cancer in a high-risk area of Italy. Cancer Causes Control 2001; 12: 163–72.CrossRefGoogle Scholar
22Terry, P, Suzuki, R, Hu, FB, Wolk, A. A prospective study of major dietary patterns and the risk of breast cancer. Cancer Epidemiol. Biomark. Prev. 2001; 10: 1281–5.Google ScholarPubMed
23Martinez, ME, Marshall, JR, Sechrest, L. Factor analysis and the search for objectivity [invited commentary]. Am. J. Epidemiol. 1998; 148: 17–9.CrossRefGoogle ScholarPubMed
24Wirfält, E, Mattisson, I, Gullberg, B, Berglund, G. Food patterns defined by cluster analysis and their utility as dietary exposure variables: a report from the Malmö Diet and Cancer Study. Public Health Nutr. 2000; 3: 159–73.CrossRefGoogle Scholar
25Jacques, PF, Tucker, KL. Are dietary patterns useful for understanding the role of diet in chronic disease? Am. J. Clin. Nutr. 2001; 73: 61–7.Google Scholar
26Riboli, E, Hunt, KJ, Slimani, N, Ferrari, P, Norat, T, Fahey, M, et al. European Prospective Investigation into Cancer and Nutrition (EPIC): study populations and data collection. Public Health Nutr. 2002; 5(6B): 1113–24.CrossRefGoogle Scholar
27Tjønneland, A, Overvad, K, Haraldsdóttir, J, Bang, S, Ewertz, M, Jensen, OM. Validation of a semiquantitative food frequency questionnaire developed in Denmark. Int. J. Epidemiol. 1991; 20: 906–12.CrossRefGoogle ScholarPubMed
28Bingham, SA, Gill, C, Welch, A, Day, K, Cassidy, A, Khaw, KT, et al. Comparison of dietary assessment methods in nutritional epidemiology: weighted records v. 24 h recalls, food-frequency questionnaires and estimated-diet records. Br. J. Nutr. 1994; 72: 619–43.CrossRefGoogle Scholar
29Riboli, E, Elmståhl, S, Saracci, R, Gullberg, B, Lindgärde, F. The Malmö Food Study: validity of two dietary assessment methods for measuring nutrient intakes. Int. J. Epidemiol 1997; 26(Suppl. 1): 161S–71.CrossRefGoogle Scholar
30Margetts, BM, Pietinen, P, Riboli, E, eds. EPIC: European Prospective Investigation into Cancer and Nutrition: validity studies on dietary assessment methods [special issue]. Int. J. Epidemiol. 1997; 26 (Suppl. 1): S1–189.Google Scholar
31Slimani, N, Kaaks, K, Ferrari, P, Casagrande, C, Clavel-Chapelon, F, Lotze, G, et al. European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study: rationale, design and population characteristics. Public Health Nutr. 2002; 5(6B): 1125–45.CrossRefGoogle ScholarPubMed
32Slimani, N, Deharveng, G, Charrondière, RU, van Kappel, AL, Ocké, MC, Welch, A, et al. Structure of the standardized computerized 24-hour diet recall interview used as reference method in the 22 centers participating in the EPIC project. European Prospective Investigation into Cancer and Nutrition. Comput. Meth. Programs Biomed. 1999; 58: 251–66.CrossRefGoogle Scholar
33Slimani, N, Ferrari, P, Ocké, M, Welch, A, Boeing, H, van Liere, M, et al. Standardization of the 24-hour diet recall calibration method used in the European Prospective Investigation into Cancer and Nutrition (EPIC): general concepts and preliminary results. Eur. J. Clin. Nutr. 2000; 54: 900–17.CrossRefGoogle ScholarPubMed
34Brustad, M, Skeie, G, Braaten, T, Slimani, N, Lund, E. Comparison of telephone versus face-to-face interview in the assessment of dietary intake by the 24-hour recall EPIC-SOFT programme – the Norwegian calibration study. Eur. J. Clin. Nutr. 2002; in pressGoogle ScholarPubMed
35Sieri, S, Agudo, A, Kesse, E, Klipstein-Grobush, K, San-José, B, Welch, A, et al. Patterns of alcohol consumption in 10 European countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) project. Public Health Nutr. 2002; 5(6B): 1287–96.CrossRefGoogle ScholarPubMed
36Riboli, E. Nutrition and cancer: background and rationale of the European Prospective Investigation into Cancer and Nutrition (EPIC). Ann. Oncol. 1992; 3: 783–91.CrossRefGoogle ScholarPubMed
37Agudo, A, Slimani, N, Ocké, MC, Naska, A, Miller, AB, Kroke, A, et al. Consumption of vegetables, fruit and other plant foods in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohorts from 10 European countries. Public Health Nutr. 2002; 5(6B): 1179–96.CrossRefGoogle ScholarPubMed
38Hjartåker, A, Lagiou, A, Slimani, N, Lund, E, Chirlaque, MD, Vasilopoulou, E, et al. Consumption of dairy products in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort: data from 35 955 24-hour dietary recalls in 10 European countries. Public Health Nutr. 2002; 5(6B): 1259–71.CrossRefGoogle ScholarPubMed
39Wirfält, E, McTaggart, A, Pala, V, Gullberg, B, Frasca, G, Panico, S, et al. Food sources of carbohydrates in a European cohort of adults. Public Health Nutr. 2002; 5(6B): 1197–215.CrossRefGoogle Scholar
40Linseisen, J, Kesse, E, Slimani, N, Bueno-de-Mesquita, HB, Ocké, MC, Skiei, G, et al. Meat consumption in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohorts: results from 24-hour dietary recalls. Public Health Nutr. 2002; 5(6B): 1243–58.CrossRefGoogle ScholarPubMed
41Linseisen, J, Bergström, E, Gafá, L, González, CA, Thiébaut, A, Trichopoulou, A, et al. Consumption of added fats and oils in European Prospective Investigation into Cancer and Nutrition (EPIC) centres across 10 European countries as assessed by 24-hour recalls. Public Health Nutr. 2002; 5(6B): 1227–42.CrossRefGoogle Scholar
42Welch, AA, Lund, E, Amiano, P, Dorronsoro, M, Brustad, M, Kumle, M, et al. Fish consumption in 10 European countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Public Health Nutr. 2002; 5(6B): 1273–85.CrossRefGoogle ScholarPubMed
43Keinan-Boker, L, Peeters, PHM, Mulligan, AA, Navarro, C, Slimani N and the EPIC Study Group on Soy Consumption. Soy product consumption in 10 European countries: the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Public Health Nutr. 2002; 5(6B): 1217–26.CrossRefGoogle Scholar
44Ferrari, P, Slimani, N, Ciampi, A, Trichopoulou, A, Naska, A, Lauria, C, et al. Evaluation of under- and overreporting of energy intake in the 24-hour diet recalls in the European Prospective Investigation into Cancer and Nutrition (EPIC). Public Health Nutr. 2002; 5(6B): 1329–45.CrossRefGoogle ScholarPubMed
45Food and Agriculture Organization (FAO). Food Balance Sheets [online]. Available at http://apps.fao.org/lim500wrap.pl ?FoodBalanceSheet&Domain=FoodBalanceSheet& Language=english. Rome: FAO, 2001.Google Scholar
46 University of Athens. DafneSoft (DAta Food NEtworking) [online]. Available at http://www.nut.uoa.gr. Athens: School of Medicine, Public Health and Nutritional Epidemiology Unit, 2001Google Scholar
47Serra-Majem, L. Food availability and consumption at national, household and individual levels: implications for food-based dietary guidelines development. Public Health Nutr. 2001; 4: 673–6.CrossRefGoogle ScholarPubMed
48Hill, MJ. Changing pattern of diet in Europe. Eur. J. Cancer Prev. 1997; 6(Suppl. 1): S11–3.CrossRefGoogle ScholarPubMed
49Rumm-Kreuter, D. Comparison of the eating and cooking habits of Northern Europe and the Mediterranean countries in the past, present and future. Int. J. Vitam. Nutr. Res. 2001; 71: 141–8.CrossRefGoogle ScholarPubMed
50Amorim Cruz, JA. Dietary habits and nutritional status in adolescents over Europe – Southern Europe. Eur. J. Clin. Nutr. 2000; 54(Suppl. 1): S29–35.CrossRefGoogle Scholar
51Rolland-Cachera, MF, Bellisle, F, Deheeger, M. Nutritional status and food intake in adolescents living in Western Europe. Eur. J. Clin. Nutr. 2000; 54(Suppl. 1): S41–6.CrossRefGoogle ScholarPubMed
52Samuelson, G. Dietary habits and nutritional status in adolescents over Europe. An overview of current studies in the Nordic countries. Eur. J. Clin. Nutr. 2000; 54(Suppl. 1): S21–8.CrossRefGoogle ScholarPubMed
53Simopoulos, AP, Sidossis, LS. What is so special about the traditional diet of Greece. World Rev. Nutr. Diet. 2000; 87: 2442.CrossRefGoogle ScholarPubMed
54Ferro-Luzzi, A, Branca, F. Mediterranean diet, Italian-style: prototype of a healthy diet. Am. J. Clin. Nutr. 1995; 61(Suppl.): S1338–45.CrossRefGoogle ScholarPubMed
55Serra-Majem, L, Santana-Armas, JF, Salmona, E. Dietary habits and nutritional status in Spain. World Rev. Nutr. Diet. 2000; 87: 127–59.CrossRefGoogle ScholarPubMed
56Trygg, K. Food patterns in Nordic countries. Ann. Nutr. Metab. 1991; 35(Suppl. 1): 311.CrossRefGoogle ScholarPubMed
57Oshaug, A. Historical perspective and problem analysis of nutrition security in Norway. Is nutrition security in Norway? A situation analysis. Scand. J. Nutr. 1994; 28(Suppl.): 629.Google Scholar
58Helsing, E. Trends in fat consumption in Europe and their influence on the Mediterranean diet. Eur. J. Clin. Nutr. 1993; 47(Suppl. 1): S412.Google ScholarPubMed
59Johansson, L, Drevon, CA, Bjørneboe, G-EA. The Norwegian diet during the last hundred years in relation to coronary heart disease. Eur. J. Clin. Nutr. 1996; 50: 277–83.Google ScholarPubMed
60De Graaf, C, Van der Gaag, M, Kafatos, A, Lennernas, M, Kearney, JM. Stages of dietary changes among nationally representative samples of adults in the European Union. Eur. J. Clin. Nutr. 1997; 51(Suppl. 2): S47–56.Google ScholarPubMed
61Ferro-Luzzi, A, Sette, S. The Mediterranean diet: an attempt to define its present and past composition. Eur. J. Clin. Nutr. 1989; 43: 1329.Google ScholarPubMed
62Helsing, E. Traditional diets and disease patterns of the Mediterranean, circa 1960. Am. J. Clin. Nutr. 1995; 61(Suppl.): S1329–37.CrossRefGoogle ScholarPubMed
63Simopoulos, AP. The Mediterranean diets: what is so special about the diet of Greece? The scientific evidence. J. Nutr. 2001; 131: S3065–73.CrossRefGoogle ScholarPubMed
64Noah, A, Truswell, AS. There are many Mediterranean diets. Asia Pacific J. Clin. Nutr. 2001; 10: 29.CrossRefGoogle ScholarPubMed
65Kafatos, A, Verhagen, H, Moschandreas, J, Apostolaki, I, Van Westerop, JJ. Mediterranean diet of Crete: foods and nutrient content. J. Am. Diet. Assoc. 2000; 100: 1487–93.CrossRefGoogle ScholarPubMed
66Moreiras, O, Cuadrado, C. Mediterranean diet and lifestyle: special aspects of Spain. Int. J. Vitam. Nutr. Res. 2001; 71: 154–8.CrossRefGoogle ScholarPubMed
67Keys, A, ed. Seven Countries: A Multivariate Analysis of Death and Coronary Heart Disease. Cambridge, MA: Harvard University Press, 1980.CrossRefGoogle Scholar
68Hulsholf, KFA, Wedel, M, Löwik, MRH, Kok, FJ, Kistemaker, C, Hermus, RJJ, et al. Clustering of dietary variables and other lifestyle factors (Dutch Nutritional Surveillance System). J. Epidemiol. Community Health 1992; 46: 417–24.CrossRefGoogle Scholar
69SENECA Investigators. Food patterns of elderly Europeans. Eur. J. Clin. Nutr. 1996; 50(Suppl. 2): S86–100.Google Scholar
70Winkler, G, Brasche, S, Döring, A, Heinrich, J. Dietary intake of middle-aged men from an East and West German city after the German reunification: do differences still exist? Eur. J. Clin. Nutr. 1998; 52: 98103.CrossRefGoogle Scholar
71Vlatier, JL, Verger, P. Recent national French food and nutrient intake data. Br. J. Nutr. 1999; 81(Suppl. 2): S57–9.CrossRefGoogle Scholar
72Pryer, JA, Nichols, R, Elliott, P, Thakrar, B, Brunner, E, Marmot, M. Dietary patterns among a national random sample of British adults. J. Epidemiol. Community Health 2001; 55: 2937.CrossRefGoogle ScholarPubMed
73Willett, WC. Nutritional epidemiology issues in chronic disease at the turn of the century. Epidemiol. Rev. 2000; 22: 82–6.CrossRefGoogle ScholarPubMed