Abstract A100: Adherence to the WHO's Healthy Diet Indicator and overall cancer risk in the Dutch part of the European Prospective Investigation into Cancer and Nutrition (EPIC-NL) cohort
Authors: May Anne M. , Berentzen Nina E. , Beulens Joline WJ , Hoevenaar-Blom Marieke P. , Kampman Ellen , Bueno-de-Mesquita H B. , Romaguera Dora , Peeters Petra HM 
Published: January 2014

Abstract
Background: A healthy dietary pattern defined by international recommendations of the World Health Organization (WHO) for the prevention of chronic diseases has been shown to reduce overall mortality risk. It is unknown whether this healthy dietary pattern is related to the incidence of cancer. We investigated the association between adherence to the WHO guidelines and overall, nutrition-related and smoking related cancer risk.
Methods: 36,683 men and women (aged 20-70 years) participating in the Dutch part of the European Prospective Investigation into Cancer and Nutrition (EPIC-NL) were included in the present study. At recruitment (1993-1997), diet was assessed through a validated food-frequency questionnaire. Weight and height were measured and detailed lifestyle data were collected through questionnaires. Participants were followed for the occurrence of cancer. The Healthy Diet Indicator (HDI)) score, based on the WHO dietary guidelines for the prevention of chronic diseases published in 2002, was computed for all participants. Seven food groups and nutrients were included: saturated fatty acids, polyunsaturated fatty acids, cholesterol, protein, dietary fiber, fruits and vegetables, and free sugars. Salt intake was not included because data on added salt were not available. A dichotomous variable was generated for each food group or nutrient resulting in a HDI with a range of 0-7 points. Multivariate-adjusted Cox proportional hazards analysis was used to examine the association between adherence to the HDI and subsequent overall, nutrition-related and smoking-related cancer risk. Adjustments were made for age, body mass index, smoking status and intensity, total energy intake excluding energy from alcohol, alcohol intake, physical activity level and educational level. Analyses were done separately in men and women.
Results: During a mean follow-up of 14.3 years 2,994 new cancers were identified. Adherence to the HDI was not associated with a reduced overall cancer risk. The hazard ratio (HR) of overall cancer associated with a one-point increment of the score was 0.96 (95% CI 0.89–1.03) in men, and 1.00 (95% CI 0.96–1.04) in women. We found no associations with adherence to the HDI with nutrition-related cancer risk (HR men: 1.01 (95% CI 0.89–1.13); HR women: 1.03 (95% CI 0.99–1.09)) or with smoking-related cancer risk (HR men: 0.93 (95% CI 0.83-1.03); HR women: 1.00 (95% CI 0.93-1.06)).
Conclusions: Greater adherence to a healthy diet defined by WHO guidelines for the prevention of chronic diseases was not associated with reduced overall, nutrition-related or smoking-related cancer risk in men or women participating in the EPIC-NL study.
Citation Format: Anne M. May, Nina E. Berentzen, Joline WJ Beulens, Marieke P. Hoevenaar-Blom, Ellen Kampman, H B. Bueno-de-Mesquita, Dora Romaguera, Petra HM Peeters. Adherence to the WHO's Healthy Diet Indicator and overall cancer risk in the Dutch part of the European Prospective Investigation into Cancer and Nutrition (EPIC-NL) cohort. [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr A100.