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A food pattern that is predictive of flavonol intake and risk of pancreatic cancer ^1,2,3

¹ From the Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (UN, HB, and MBS); the Cancer Research Center of Hawaii, University of Hawaii, Honolulu, HI (SPM, LRW, and LNK); the National Institute for Public Health and the Environment, Bilthoven, Netherlands (HBB-d-M); the Imperial College London, London, United Kingdom (DSM); the Cancer Epidemiology Unit, University of Oxford, Oxford, United Kingdom (AR); the German Cancer Research Center, Heidelberg, Germany (SR); the Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark (ATj); Inserm ERI20, Institut Gustave-Roussy, Villejuif, France (FC-C); the Department of Hygiene and Epidemiology, University of Athens Medical School and the Hellenic Health Foundation., Athens, Greece (ATr); the Nutritional Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy (SS); the Public Health Directorate for Health and Social Services of Asturias, Oviedo, Spain (LR); the Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden (WY); and the International Agency for Research on Cancer, Lyon, France (MJ)

² Supported (the Multiethnic Cohort study) by grant no. R37 CA054281 from the National Cancer Institute and by a fellowship from the German Research Foundation (to UN); and (the European Prospective Investigation into Cancer and Nutrition) by the European Commission, Public Health and Consumer Protection Directorate 1993–2004 and Research Directorate-General 2005; Ligue contre le Cancer, France; Société 3M, France; Mutuelle Générale de l'Education Nationale; Institut National de la Santé et de la Recherche Médicale; German Cancer Aid; German Cancer Research Center; German Federal Ministry of Education and Research; Danish Cancer Society; Health Research Fund of the Spanish Ministry of Health; the participating regional governments and institutions of Spain; Instituto de Salud Carlos III (ISCIII) Network Red Centros de Investigación Cooperativa en Epidemiologia y Salud Pública, Spain grant C03/09; Cancer Research UK; Medical Research Council, United Kingdom; Food Standards Agency, United Kingdom; the Wellcome Trust, United Kingdom; Greek Ministry of Health and Social Solidarity; Hellenic Health Foundation; Italian Association for Research on Cancer; Italian National Research Council; Dutch Ministry of Public Health, Welfare, and Sports; Dutch Ministry of Health; Dutch Prevention Funds; LK Research Funds; Dutch Zorg Onderzoek Nederland; World Cancer Research Fund; Swedish Cancer Society; Swedish Scientific Council; Regional Government of Skane, Sweden; and the Norwegian Cancer Society.

³ Reprints not available. Address correspondence to U Nöthlings, Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Arthur Scheunert-Allee 114-116, 14558 Nuthetal, Germany. E-mail: ute.noethlings{at}dife.de.

Background: In the Multiethnic Cohort (MEC) study, we showed inverse associations between flavonols and pancreatic cancer risk.

Objective: We aimed to define a food pattern associated with intakes of quercetin, kaempferol, and myricetin; to examine the association of that pattern with pancreatic cancer risk; and to investigate the associations in an independent study.

Design: Reduced rank regression was applied to dietary data for 183 513 participants in the MEC. A food group pattern was extracted and simplified and applied to dietary data of 424 978 participants in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Dietary intake in both studies was assessed by using specially developed questionnaires. Multivariate Cox proportional hazards models were used to estimate relative risks for pancreatic cancer in the MEC (610 cases) and the EPIC (517 cases) studies.

Results: The food group pattern consisted mainly of tea, fruit, cabbage, and wine. In the MEC, inverse associations with pancreatic cancer in smokers were observed for the food group pattern [relative risk: 0.59 (95% CI: 0.31, 1.12) when extreme quintiles were compared; P for trend = 0.03]. In the EPIC study, the simplified pattern was not associated with pancreatic cancer risk (P for trend = 0.78).

Conclusions: A food pattern associated with the intake of quercetin, kaempferol, and myricetin was associated with lower pancreatic cancer risk in smokers in a US-based population. However, failure to replicate the associations in an independent study weakens the conclusions and raises questions about the utility of food patterns for flavonols across populations.

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