Carcinogenesis Advance Access published online on June 14, 2006
Carcinogenesis, doi:10.1093/carcin/bgl096
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1 Nutrition and Hormones Group, IARC-WHO, Lyon, France
* To whom correspondence should be addressed. Vitamin C is an antioxidant and inhibitor of carcinogenic N-nitroso compound production in the stomach. Higher dietary vitamin C consumption is associated with decreased risk of gastric cancer (GC) in numerous case-control studies but data from prospective studies is limited, particularly so for blood measures of vitamin C. The objective of this study was to determine the association of plasma and dietary vitamin C levels with the risk of GC in a case-control study nested within the European Prospective Investigation into Cancer and Nutrition (EPIC), a large cohort involving 10 European countries. Using a fluorometric method, vitamin C was measured in pre-diagnostic plasma from 215 GC cases (matched controls=416). Conditional logistic regression models adjusted by body mass index, total energy intake, smoking status/duration/intensity and Helicobacter pylori (Hp) infection status were used to estimate relative cancer risks. No association with GC risk was observed for dietary vitamin C whereas an inverse GC risk was observed in the highest versus lowest quartile of plasma vitamin C (OR=0.55, 95%CI=0.31-0.97, Ptrend=0.043) which was maintained after exclusion of cases with
Received March 30, 2006
Revised May 5, 2006
Accepted May 24, 2006
MOLECULAR EPIDEMIOLOGY AND CANCER PREVENTION
Plasma and dietary vitamin C levels and risk of gastric cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC-EURGAST)
Mazda Jenab 1 *,
Elio Riboli 2,
Pietro Ferrari 1,
Joan Sabate 3,
Nadia Slimani 1,
Teresa Norat 1,
Marlin Friesen 1,
Anne Tjønneland 4,
Anja Olsen 4,
Kim Overvad 5,
Marie-Christine Boutron-Ruault 6,
Françoise Clavel-Chapelon 6,
Mathilde Touvier 6,
Heiner Boeing 7,
Mandy Schulz 7,
Jakob Linseisen 8,
Gabriele Nagel 8,
Antonia Trichopoulou 9,
Androniki Naska 9,
Eleni Oikonomou 9,
Vittorio Krogh 10,
Salvatore Panico 11,
Giovanna Masala 12,
Carlotta Sacerdote 13,
Rosario Tumino 14,
Petra H. Peeters 15,
Mattijs E. Numans 15,
Hendrik B. Bueno-de-Mesquita 16,
Frederike L. Buchner 16,
Eiliv Lund 17,
Guillem Pera 18,
Carmen Navarro Sanchez 19,
Maria-José Sánchez 20,
Larraitz Arriola 21,
Aurelio Barricarte 22,
José Ramón Quirós 23,
Göran Hallmans 24,
Roger Stenling 25,
Göran Berglund 26,
Sheila Bingham 27,
Kay-Tee Khaw 28,
Timothy Key 29,
Naomi Allen 29,
Fatima Carneiro 30,
U. Mahlke 31,
Guiseppe Del Giudice 32,
Domenico Palli 12,
Rudolf Kaaks 1,
and
Carlos A. Gonzalez 18
2 Imperial College, London, United Kingdom
3 Nutrition and Hormones Group, IARC-WHO, Lyon, France; Department of Nutrition, Loma Linda University, Loma Linda, CA, USA
4 Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark
5 Department of Clinical Epidemiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
6 INSERM, Institut Gustave Roussy, Villejuif, France
7 German Institute of Human Nutrition, Potsdam-Rehbücke, Germany
8 Division of Clinical Epidemiology, Deutsches Krebsforschungszentrum, Heidelberg, Germany
9 Department of Hygiene and Epidemiology, Medical School, University of Athens, Greece
10 Nutritional Epidemiology Unit, National Cancer Institute, Milan, Italy
11 Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy
12 Molecular and Nutritional Epidemiology Unit, CSPO-Scientific Institute of Tuscany, Italy
13 University of Turin and CPO-Piemonte, Turin, Italy
14 Cancer Registry, Azienda Ospedaliera "Civile M.P. Arezzo", Ragusa, Italy
15 Julius Centre for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
16 Centre for Nutrition and Health, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
17 Institute of Community Medicine, University of Tromso, Norway
18 Department of Epidemiology, Catalan Institute of Oncology, Barcelona (ICO-IDIBELL), Spain
19 Servicio de Epidemiología, Consejería de Sanidad y Consumo, Murcia, Spain
20 Andalusian School of Public Health, Granada, Spain
21 Public Health Department of Guipuzkoa, San Sebastian, Spain
22 Public Health Institute of Navarra, Pamplona, Spain
23 Sección Información Sanitaria, Consejería de Salud y Servicios Sanitarios de Asturias, Asturias, Spain
24 Department of Public Health and Clinical Nutrition, Nutrition Research, Umeå University, Umeå, Sweden
25 Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
26 Department of Medical Epidemiology, Karolinska Instututet, Stockholm, Sweden
27 MRC Dunn Human Nutrition Unit, Welcome Trust/MRC Building, Cambridge, UK
28 Clinical Gerontology Unit, University of Cambridge, Cambrdge, UK
29 Cancer Epidemiology Unit. University of Oxford, UK
30 Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP) and Medical Faculty of Porto/H.S. Joao, Porto, Portugal
31 Institute of Pathology, Potsdam, Germany
32 IRIS Research Center, Chiron-Vaccines, Siena, Italy
Mazda Jenab, E-mail: Jenab{at}iarc.fr
Abstract 
2yrs follow-up (OR=0.40, 95%CI=0.19-0.83, Ptrend=0.064). The inverse association was more pronounced in subjects consuming higher levels of red and processed meats, a factor that may increase endogenous N-nitroso compound production. The effect of plasma vitamin C was not different by GC anatomical sub-site (cardia/non-cardia) or histological sub-type (diffuse/intestinal) and there was no significant interaction of effect with Hp. The results of this study show, in a prospective setting, an inverse association of GC risk with high levels of plasma vitamin C and suggest an interaction with the intake of red and processed meats, whose consumption may elevate endogenous N-nitroso compound production.
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