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Adherence to Mediterranean Diet and Risk of Cancer: An Updated Systematic Review and Meta-Analysis.

Abstract

The aim of the present systematic review and meta-analysis was to gain further insight into the effects of adherence to Mediterranean Diet (MedD) on risk of overall cancer mortality, risk of different types of cancer, and cancer mortality and recurrence risk in cancer survivors. Literature search was performed using the electronic databases PubMed, and Scopus until 25 August 2017. We included randomized trials (RCTs), cohort (for specific tumors only incidence cases were used) studies, and case-control studies. Study-specific risk ratios, hazard ratios, and odds ratios (RR/HR/OR) were pooled using a random effects model. Observational studies (cohort and case-control studies), and intervention trials were meta-analyzed separately. The updated review process showed 27 studies that were not included in the previous meta-analysis (total number of studies evaluated: 83 studies). An overall population of 2,130,753 subjects was included in the present update. The highest adherence score to a MedD was inversely associated with a lower risk of cancer mortality (RRcohort: 0.86, 95% CI 0.81 to 0.91, I² = 82%; n = 14 studies), colorectal cancer (RRobservational: 0.82, 95% CI 0.75 to 0.88, I² = 73%; n = 11 studies), breast cancer (RRRCT: 0.43, 95% CI 0.21 to 0.88, n = 1 study) (RRobservational: 0.92, 95% CI 0.87 to 0.96, I² = 22%, n = 16 studies), gastric cancer (RRobservational: 0.72, 95% CI 0.60 to 0.86, I² = 55%; n = 4 studies), liver cancer (RRobservational: 0.58, 95% CI 0.46 to 0.73, I² = 0%; n = 2 studies), head and neck cancer (RRobservational: 0.49, 95% CI 0.37 to 0.66, I² = 87%; n = 7 studies), and prostate cancer (RRobservational: 0.96, 95% CI 0.92 to 1.00, I² = 0%; n = 6 studies). Among cancer survivors, the association between the adherence to the highest MedD category and risk of cancer mortality, and cancer recurrence was not statistically significant. Pooled analyses of individual components of the MedD revealed that the protective effects appear to be most attributable to fruits, vegetables, and whole grains. The updated meta-analysis confirms an important inverse association between adherence to a MedD and cancer mortality and risk of several cancer types, especially colorectal cancer. These observed beneficial effects are mainly driven by higher intakes of fruits, vegetables, and whole grains. Moreover, we were able to report for the first time a small decrease in breast cancer risk (6%) by pooling seven cohort studies.

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  • Authors+Show Affiliations

    ,

    Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany. lukas.schwingshackl@dife.de.

    ,

    Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Arthur-Scheunert-Allee 114-116, 14558 Nuthetal, Germany. carolina.schwedhelm@dife.de.

    ,

    Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, 14558 Nuthetal, Germany. Cecilia.Galbete@dife.de.

    Department of Nutritional Sciences, University of Vienna, Althanstraβe 14, 1090 Vienna, Austria. georg.hoffmann@univie.ac.at.

    Source

    Nutrients 9:10 2017 Sep 26 pg

    MeSH

    Adult
    Aged
    Aged, 80 and over
    Diet, Mediterranean
    Female
    Fruit
    Healthy Diet
    Humans
    Male
    Middle Aged
    Neoplasms
    Odds Ratio
    Patient Compliance
    Protective Factors
    Risk Assessment
    Risk Factors
    Risk Reduction Behavior
    Time Factors
    Vegetables
    Whole Grains

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    28954418

    Citation

    Schwingshackl, Lukas, et al. "Adherence to Mediterranean Diet and Risk of Cancer: an Updated Systematic Review and Meta-Analysis." Nutrients, vol. 9, no. 10, 2017.
    Schwingshackl L, Schwedhelm C, Galbete C, et al. Adherence to Mediterranean Diet and Risk of Cancer: An Updated Systematic Review and Meta-Analysis. Nutrients. 2017;9(10).
    Schwingshackl, L., Schwedhelm, C., Galbete, C., & Hoffmann, G. (2017). Adherence to Mediterranean Diet and Risk of Cancer: An Updated Systematic Review and Meta-Analysis. Nutrients, 9(10), doi:10.3390/nu9101063.
    Schwingshackl L, et al. Adherence to Mediterranean Diet and Risk of Cancer: an Updated Systematic Review and Meta-Analysis. Nutrients. 2017 Sep 26;9(10) PubMed PMID: 28954418.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Adherence to Mediterranean Diet and Risk of Cancer: An Updated Systematic Review and Meta-Analysis. AU - Schwingshackl,Lukas, AU - Schwedhelm,Carolina, AU - Galbete,Cecilia, AU - Hoffmann,Georg, Y1 - 2017/09/26/ PY - 2017/08/16/received PY - 2017/09/05/revised PY - 2017/09/21/accepted PY - 2017/9/29/entrez PY - 2017/9/29/pubmed PY - 2018/6/5/medline KW - Mediterranean Diet KW - cancer KW - meta-analysis KW - systematic review update JF - Nutrients JO - Nutrients VL - 9 IS - 10 N2 - The aim of the present systematic review and meta-analysis was to gain further insight into the effects of adherence to Mediterranean Diet (MedD) on risk of overall cancer mortality, risk of different types of cancer, and cancer mortality and recurrence risk in cancer survivors. Literature search was performed using the electronic databases PubMed, and Scopus until 25 August 2017. We included randomized trials (RCTs), cohort (for specific tumors only incidence cases were used) studies, and case-control studies. Study-specific risk ratios, hazard ratios, and odds ratios (RR/HR/OR) were pooled using a random effects model. Observational studies (cohort and case-control studies), and intervention trials were meta-analyzed separately. The updated review process showed 27 studies that were not included in the previous meta-analysis (total number of studies evaluated: 83 studies). An overall population of 2,130,753 subjects was included in the present update. The highest adherence score to a MedD was inversely associated with a lower risk of cancer mortality (RRcohort: 0.86, 95% CI 0.81 to 0.91, I² = 82%; n = 14 studies), colorectal cancer (RRobservational: 0.82, 95% CI 0.75 to 0.88, I² = 73%; n = 11 studies), breast cancer (RRRCT: 0.43, 95% CI 0.21 to 0.88, n = 1 study) (RRobservational: 0.92, 95% CI 0.87 to 0.96, I² = 22%, n = 16 studies), gastric cancer (RRobservational: 0.72, 95% CI 0.60 to 0.86, I² = 55%; n = 4 studies), liver cancer (RRobservational: 0.58, 95% CI 0.46 to 0.73, I² = 0%; n = 2 studies), head and neck cancer (RRobservational: 0.49, 95% CI 0.37 to 0.66, I² = 87%; n = 7 studies), and prostate cancer (RRobservational: 0.96, 95% CI 0.92 to 1.00, I² = 0%; n = 6 studies). Among cancer survivors, the association between the adherence to the highest MedD category and risk of cancer mortality, and cancer recurrence was not statistically significant. Pooled analyses of individual components of the MedD revealed that the protective effects appear to be most attributable to fruits, vegetables, and whole grains. The updated meta-analysis confirms an important inverse association between adherence to a MedD and cancer mortality and risk of several cancer types, especially colorectal cancer. These observed beneficial effects are mainly driven by higher intakes of fruits, vegetables, and whole grains. Moreover, we were able to report for the first time a small decrease in breast cancer risk (6%) by pooling seven cohort studies. SN - 2072-6643 UR - https://www.unboundmedicine.com/medline/citation/28954418/Adherence_to_Mediterranean_Diet_and_Risk_of_Cancer:_An_Updated_Systematic_Review_and_Meta_Analysis_ L2 - http://www.mdpi.com/resolver?pii=nu9101063 DB - PRIME DP - Unbound Medicine ER -