Dietary flavonoid and lignan intake and gastric adenocarcinoma risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study

Raul Zamora-Ros*, Antonio Agudo, Leila Luján-Barroso, Isabelle Romieu, Pietro Ferrari, Viktoria Knaze, H. Bas Bueno-de-Mesquita, Max Leenders, Ruth C. Travis, Carmen Navarro, Emilio Sánchez-Cantalejo, Nadia Slimani, Augustin Scalbert, Veronika Fedirko, Anette Hjartaker, Dagrun Engeset, Guri Skeie, Heiner Boeing, Jana Förster, Kuanrong LiBirgit Teucher, Claudia Agnoli, Rosario Tumino, Amalia Mattiello, Calogero Saieva, Ingegerd Johansson, Roger Stenling, Maria Luisa Redondo, Peter Wallström, Ulrika Ericson, Kay Tee Khaw, Angela A. Mulligan, Antonia Trichopoulou, Vardis Dilis, Michael Katsoulis, Petra H.M. Peeters, Lazslo Igali, Anne Tjønneland, Jytte Halkjær, Marina Touillaud, Florence Perquier, Guy Fagherazzi, Pilar Amiano, Eva Ardanaz, Lea Bredsdorff, Kim Overvad, Fulvio Ricceri, Elio Riboli, Carlos A. González

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

84 Citations (Scopus)


Background: Several experimental studies have suggested potential anticarcinogenic effects of flavonoids, although epidemiologic evidence for the impact of dietary flavonoids on risk of gastric cancer (GC) is limited. Objective: We investigated the association between intake of dietary flavonoids and lignans and incident GC. Design: The study followed 477,312 subjects (29.8% men) aged 35-70 y from 10 European countries who participated in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Validated dietary questionnaires and lifestyle information were collected at baseline. A food-composition database on flavonoids and lignans was compiled by using data from USDA and Phenol-Explorer databases. Results: During an average follow-up of 11 y, 683 incident GC cases (57.8% men) were mostly validated by a panel of pathologists and used in this analysis. We observed a significant inverse association between total flavonoid intake and GC risk in women (HR: 0.81; 95% CI: 0.70, 0.94; for the continuous variable after log2 transformation) but not in men (HR: 0.97; 95% CI: 0.85, 1.09). In women, significant inverse associations with GC risk were also observed for intakes of some flavonoid subgroups (anthocyanidins, flavonols, flavones, and flavanols), particularly with intestinal type tumors for total flavonoid and flavanol intakes (P-heterogeneity < 0.1). After stratification by smoking status and sex, there was no significant heterogeneity in these associations between ever- and never-smokers. Conclusion: Total dietary flavonoid intake is associated with a significant reduction in the risk of GC in women.

Original languageEnglish
Pages (from-to)1398-1408
Number of pages11
JournalAmerican Journal of Clinical Nutrition
Issue number6
Publication statusPublished - 1 Dec 2012
Externally publishedYes


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