An epidemiological model for prediction of endometrial cancer risk in Europe.

Endometrial cancer (EC) is the fourth most frequent cancer in women in Europe, and as its incidence is increasing, prevention strategies gain further pertinence. Risk prediction models can be a useful tool for identifying women likely to benefit from targeted prevention measures. On the basis of data from 201,811 women (mostly aged 30-65 years) including 855 incident EC cases from eight countries in the European Prospective Investigation into Cancer and Nutrition cohort, a model to predict EC was developed. A step-wise model selection process was used to select confirmed predictive epidemiologic risk factors. Piece-wise constant hazard rates in 5-year age-intervals were estimated in a cause-specific competing risks model, five-fold-cross-validation was applied for internal validation. Risk factors included in the risk prediction model were body-mass index (BMI), menopausal status, age at menarche and at menopause, oral contraceptive use, overall and by different BMI categories and overall duration of use, parity, age at first full-term pregnancy, duration of menopausal hormone therapy and smoking status (specific for pre, peri- and post-menopausal women). These variables improved the discriminating capacity to predict risk over 5 years from 71% for a model based on age alone to 77% (overall C statistic), and the model was well-calibrated (ratio of expected to observed cases = 0.99). Our model could be used for the identification of women at increased risk of EC in Western Europe. To achieve an EC-risk model with general validity, a large-scale cohort-consortium approach would be needed to assess and adjust for population variation.

Mediterranean diet and cognitive decline over time in an elderly Mediterranean population.

PURPOSE: Evidence suggests that dietary patterns compatible with the traditional Mediterranean diet (MD) may protect against cognitive decline. We prospectively assessed whether adherence to MD in the Mediterranean country of Greece is inversely associated with cognitive decline in the elderly and whether any particular MD component may play a key role. METHODS: Elderly men and women (N = 401) residing in the greater Athens area had dietary variables ascertained in 1994-1999. Adherence to MD was represented by the MD score [MDS, 0-3 (low), 4-5 (intermediate), 6-9 (high)]. The mini-mental state examination (MMSE) was administered by trained professionals to individuals aged 65 years or older in 2004-2006 (first assessment) and re-administered in 2011-2012 (second assessment). MMSE change (cMMSE) was categorized as: improved/unchanged (cMMSE ≥ 0), mildly lower (cMMSE -1 to -4) or substantially lower (cMMSE ≤ -5). Associations were evaluated through multinomial logistic regression. RESULTS: Decline in MMSE performance was inversely associated with adherence to MD. For mild versus no decline, odds ratio (OR) comparing high to low MD adherence was 0.46 [95% confidence interval (CI) 0.25-0.87, p = 0.012]. For substantial versus no decline, OR comparing high to low MD adherence was 0.34 (95% CI 0.13-0.89, p = 0.025). Among the nine MDS components, only vegetable consumption exhibited a significant inverse association with cognitive decline. CONCLUSIONS: Closer adherence to the traditional MD is highly likely to protect against cognitive decline in this elderly Mediterranean population. Higher vegetable consumption appears to play a key role, possibly in synergy with additional components of the diet.

Pre-diagnostic anthropometry and survival after colorectal cancer diagnosis in Western European populations.

General and abdominal adiposity are associated with a high risk of developing colorectal cancer (CRC), but the role of these exposures on cancer survival has been less studied. The association between pre-diagnostic anthropometric characteristics and CRC-specific and all-cause death was examined among 3,924 men and women diagnosed with CRC between 1992 and 2009 in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Multivariable Cox proportional hazards models were used to calculate hazard ratios (HRs) and corresponding 95% confidence intervals (CIs). Over a mean follow-up period of 49 months, 1,309 deaths occurred of which 1,043 (79.7%) were due to CRC. In multivariable analysis, pre-diagnostic BMI ≥ 30 kg/m(2) was associated with a high risk for CRC-specific (HR = 1.26, 95% CI = 1.04-1.52) and all-cause (HR = 1.32, 95% CI = 1.12-1.56) death relative to BMI <25 kg/m(2). Every 5 kg/m(2) increase in BMI was associated with a high risk for CRC-specific (HR = 1.10, 95% CI = 1.02-1.19) and all-cause death (HR = 1.12, 95% CI = 1.05-1.20); and every 10 cm increase in waist circumference was associated with a high risk for CRC-specific (HR = 1.09, 95% CI = 1.02-1.16) and all-cause death (HR = 1.11, 95% CI = 1.05-1.18). Similar associations were observed for waist-to-hip and waist-to-height ratios. Height was not associated with CRC-specific or all-cause death. Associations tended to be stronger among men than in women. Possible interactions by age at diagnosis, cancer stage, tumour location, and hormone replacement therapy use among postmenopausal women were noted. Pre-diagnostic general and abdominal adiposity are associated with lower survival after CRC diagnosis.