Plasma carotenoids and vitamin C concentrations and risk of urothelial cell carcinoma in the European Prospective Investigation into Cancer and Nutrition

National Institute for Public Health and the Environment, Bilthoven, Netherlands and Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå Sweden.
American Journal of Clinical Nutrition (Impact Factor: 6.77). 09/2012; 96(4):902-10. DOI: 10.3945/ajcn.111.032920
Source: PubMed


Published associations between dietary carotenoids and vitamin C and bladder cancer risk are inconsistent. Biomarkers may provide more accurate measures of nutrient status.
We investigated the association between plasma carotenoids and vitamin C and risk of urothelial cell carcinoma (UCC) in a case-control study nested within the European Prospective Investigation into Cancer and Nutrition.
A total of 856 patients with newly diagnosed UCC were matched with 856 cohort members by sex, age at baseline, study center, date and time of blood collection, and fasting status. Plasma carotenoids (α- and β-carotene, β-cryptoxanthin, lycopene, lutein, and zeaxanthin) were measured by using reverse-phase HPLC, and plasma vitamin C was measured by using a colorimetric assay. Incidence rate ratios (IRRs) were estimated by using conditional logistic regression with adjustment for smoking status, duration, and intensity.
UCC risk decreased with higher concentrations of the sum of plasma carotenoids (IRR for the highest compared with the lowest quartile: 0.64; 95% CI: 0.44, 0.93; P-trend = 0.04). Plasma β-carotene was inversely associated with aggressive UCC (IRR: 0.51; 95% CI: 0.30, 0.88; P-trend = 0.02). Plasma lutein was inversely associated with risk of nonaggressive UCC (IRR: 0.56; 95% CI: 0.32, 0.98; P-trend = 0.05). No association was observed between plasma vitamin C and risk of UCC.
Although residual confounding by smoking or other factors cannot be excluded, higher concentrations of plasma carotenoids may reduce risk of UCC, in particular aggressive UCC. Plasma lutein may reduce risk of nonaggressive UCC.

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    • "It is worth bearing in mind that vegetables were the main food source of flavonols and lignans in this study . In addition , plasma concentrations of carotenoids ( a nutritional biomarker of fruit and vegetable consumption and which are not limited by measurement errors inherent in dietary questionnaires ) were inversely associated with bladder cancer risk ( Ros et al , 2010 ) . Therefore , several authors suggested that polyphenols and other antioxidant micronutrients may be , at least in part , responsible for the protective effect of the Mediterranean diet on health ( Pelucchi et al , 2009 ; Giacosa et al , 2013 ) . "
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    ABSTRACT: Background: There is growing evidence of the protective role of dietary intake of flavonoids and lignans on cancer, but the association with bladder cancer has not been thoroughly investigated in epidemiological studies. We evaluated the association between dietary intakes of total and subclasses of flavonoids and lignans and risk of bladder cancer and its main morphological type, urothelial cell carcinoma (UCC), within the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Methods: A cohort of 477 312 men and women mostly aged 35-70 years, were recruited in 10 European countries. At baseline, dietary flavonoid and lignan intakes were estimated using centre-specific validated questionnaires and a food composition database based on the Phenol-Explorer, the UK Food Standards Agency and the US Department of Agriculture databases. Results: During an average of 11 years of follow-up, 1575 new cases of primary bladder cancer were identified, of which 1425 were UCC (classified into aggressive (n=430) and non-aggressive (n=413) UCC). No association was found between total flavonoid intake and bladder cancer risk. Among flavonoid subclasses, significant inverse associations with bladder cancer risk were found for intakes of flavonol (hazard ratio comparing fifth with first quintile (HRQ5-Q1) 0.74, 95% confidence interval (CI): 0.61-0.91; P-trend=0.009) and lignans (HRQ5-Q1 0.78, 95% CI: 0.62-0.96; P-trend=0.046). Similar results were observed for overall UCC and aggressive UCC, but not for non-aggressive UCC. Conclusions: Our study suggests an inverse association between the dietary intakes of flavonols and lignans and risk of bladder cancer, particularly aggressive UCC.
    Cancer 08/2014; 111(9). DOI:10.1038/bjc.2014.459 · 4.89 Impact Factor
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    • "General anthocyanidin structure and substitution patterns are shown in Fig. 2. According to the literature, these pigments have demonstrated significant health benefits; therefore, the consumption of fruits and vegetables has become increasingly recommended. Several studies have shown that a diet rich in fruits and vegetables can be associated with delay of the aging process and a decreased risk of developing diseases related to lifestyle, such as cardiovascular diseases, atherosclerosis, cancer , diabetes, cataracts, cognitive function disorders, and neurological diseases, including Alzheimer's, by presenting anti-inflammatory, anticarcinogenic and antioxidative effects (Eliassen et al., 2012; Forester, Choy, Waterhouse, & Oteiza, 2012; Lim et al., 2013; Pojer, Mattivi, Johnson, & Stockley, 2013; Ros et al., 2012; Tanaka, Shnimizu, & Moriwaki, 2012; Wallace, 2011). However, when comparing their biological actions and antioxidant activities in vitro and in humans, there is no consensus regarding the best way to consume these foods, especially vegetables, to benefit optimally from these compounds. "
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    ABSTRACT: The aim of this study was to review studies that evaluated the effects of cooking techniques on carotenoids and anthocyanins in vegetables and to release a meta-analysis of the findings. A literature search was conducted to identify studies that evaluated the effects of cooking techniques on the levels of carotenoids and anthocyanins in vegetables. The database search found 404 results, and an additional 18 articles from 1992 to 2013 were selected that met the inclusion criteria. A meta-analysis with a random effect model was conducted using the weighted response ratios (R*) calculated for each experiment. Significant reductions of carotenoid levels after microwaving (R* = 0.79) and frying (R* = 0.59) and an increase after stewing (R* = 1.33) were reported; for anthocyanins, reduction was observed after moist-heat techniques such as pressure boiling (R* = 0.11) and pressure steaming (R* = 0.01), and steaming tended to reduce their concentration (R* = 0.34; p = 0.054). Increases of anthocyanin levels were observed in dry-heat cooking techniques such as microwaving (R* = 3.51) and baking (R* = 2.95). Cooking techniques influence the levels of natural pigments in vegetables, and depending on the technique, their levels may increase or decrease. Carotenoids were most degraded in frying and most increased during the stewing technique, while anthocyanins were most degraded in pressure steaming and most increased in the microwaving technique.
    Food Research International 06/2014; 65. DOI:10.1016/j.foodres.2014.06.015 · 2.82 Impact Factor
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    • "All 25 studies provided REs adjusted for at least age, sex, and smoking. Five reports provided results for blood vitamin A levels [20,24,25,28,32]; three measured plasma vitamin A levels [24,28,32] and two measured serum vitamin A levels [20,25]. Some studies included neoplasms of the urinary tract as cases [11,12,18,20,25,29,32], most of which were found to involve bladder cancer, whereas others selected only bladder cancer. "
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    ABSTRACT: Epidemiological studies have reported the preventive effect of vitamin A intake on bladder cancer. However, the findings are inconsistent. To address this issue we conducted a meta-analysis to investigate the quantitative effects of vitamin A on bladder cancer. We searched MEDLINE and Embase databases and the references of the relevant articles in English to include studies on dietary or blood vitamin A for the risk of bladder cancer. We performed a meta-analysis using both fixed-effects and random-effects models. Twenty-five articles on dietary vitamin A or blood vitamin A were included according to the eligibility criteria. The pooled risk estimates of bladder cancer were 0.82 (95% CI 0.65, 0.95) for total vitamin A intake, 0.88 (95% CI 0.73, 1.02) for retinol intake, and 0.64 (95% CI 0.38, 0.90) for blood retinol levels. We also found inverse associations between subtypes of carotenoids and bladder cancer risk. The findings of this meta-analysis indicate that high vitamin A intake was associated with a lower risk of bladder cancer. Larger studies with prospective design and rigorous methodology should be considered to validate the current findings.
    World Journal of Surgical Oncology 04/2014; 12(1):130. DOI:10.1186/1477-7819-12-130 · 1.41 Impact Factor
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