Adherence to the mediterranean diet and lymphoma risk in the european prospective investigation into cancer and nutrition

Marta Solans, Yolanda Benavente, Marc Saez, Antonio Agudo, Sabine Naudin, Fatemeh Saberi Hosnijeh, Hwayoung Noh, Heinz Freisling, Pietro Ferrari, Caroline Besson, Yahya Mahamat-Saleh, Marie Christine Boutron-Ruault, Tilman Kühn, Rudolf Kaaks, Heiner Boeing, Cristina Lasheras, Miguel Rodríguez-Barranco, Pilar Amiano, Jose Maria Huerta, Aurelio BarricarteJulie A. Schmidt, Paolo Vineis, Elio Riboli, Antonia Trichopoulou, Christina Bamia, Eleni Peppa, Giovanna Masala, Claudia Agnoli, Rosario Tumino, Carlotta Sacerdote, Salvatore Panico, Guri Skeie, Elisabete Weiderpass, Mats Jerkeman, Ulrika Ericson, Florentin Späth, Lena Maria Nilsson, Christina C. Dahm, Kim Overvad, Anne Katrine Bolvig, Anne Tjønneland, Silvia de Sanjose, Genevieve Buckland, Roel Vermeulen, Alexandra Nieters, Delphine Casabonne

Research output: Contribution to journalArticlepeer-review


There is a growing evidence of the protective role of the Mediterranean diet (MD) on cancer. However, no prospective study has yet investigated its influence on lymphoma. We evaluated the association between adherence to the MD and risk of lymphoma and its subtypes in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. The analysis included 476,160 participants, recruited from 10 European countries between 1991 and 2001. Adherence to the MD was estimated through the adapted relative MD (arMED) score excluding alcohol. Cox proportional hazards regression models were used while adjusting for potential confounders. During an average follow-up of 13.9 years, 3,136 lymphomas (135 Hodgkin lymphoma [HL], 2,606 non-HL and 395 lymphoma not otherwise specified) were identified. Overall, a 1-unit increase in the arMED score was associated with a 2% lower risk of lymphoma (95% CI: 0.97; 1.00, p-trend = 0.03) while a statistically nonsignificant inverse association between a high versus low arMED score and risk of lymphoma was observed (hazard ratio [HR]: 0.91 [95% CI 0.80; 1.03], p-trend = 0.12). Analyses by lymphoma subtype did not reveal any statistically significant associations. Albeit with small numbers of cases (N = 135), a suggestive inverse association was found for HL (HR 1-unit increase = 0.93 [95% CI: 0.86; 1.01], p-trend = 0.07). However, the study may have lacked statistical power to detect small effect sizes for lymphoma subtype. Our findings suggest that an increasing arMED score was inversely related to the risk of overall lymphoma in EPIC but not by subtypes. Further large prospective studies are warranted to confirm these findings.

Original languageEnglish
Pages (from-to)122-131
Number of pages10
JournalInternational Journal of Cancer
Issue number1
Publication statusPublished - Jul 1 2019


  • Europe
  • lymphoma
  • Mediterranean diet
  • prospective studies
  • risk

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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