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Blood lipid and lipoprotein concentrations and colorectal cancer risk in the European Prospective Investigation into Cancer and Nutrition
  1. Fränzel J B van Duijnhoven1,2,
  2. H Bas Bueno-De-Mesquita1,3,
  3. Miriam Calligaro1,
  4. Mazda Jenab4,
  5. Tobias Pischon5,
  6. Eugène H J M Jansen1,
  7. Jiri Frohlich6,
  8. Amir Ayyobi6,
  9. Kim Overvad7,8,
  10. Anne Pernille Toft-Petersen8,
  11. Anne Tjønneland9,
  12. Louise Hansen9,
  13. Marie-Christine Boutron-Ruault10,
  14. Françoise Clavel-Chapelon10,
  15. Vanessa Cottet10,
  16. Domenico Palli11,
  17. Giovanna Tagliabue12,
  18. Salvatore Panico13,
  19. Rosario Tumino14,
  20. Paolo Vineis15,16,
  21. Rudolf Kaaks17,
  22. Birgit Teucher17,
  23. Heiner Boeing5,
  24. Dagmar Drogan5,
  25. Antonia Trichopoulou18,19,
  26. Pagona Lagiou18,
  27. Vardis Dilis19,
  28. Petra H M Peeters2,20,
  29. Peter D Siersema3,
  30. Laudina Rodríguez21,
  31. Carlos A González22,
  32. Esther Molina-Montes23,24,
  33. Miren Dorronsoro25,
  34. Maria-Jose Tormo24,26,
  35. Aurelio Barricarte24,27,
  36. Richard Palmqvist28,
  37. Göran Hallmans29,
  38. Kay-Tee Khaw30,
  39. Kostas K Tsilidis31,
  40. Francesca L Crowe31,
  41. Veronique Chajes4,
  42. Veronika Fedirko4,
  43. Sabina Rinaldi4,
  44. Teresa Norat20,
  45. Elio Riboli20
  1. 1National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
  2. 2Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
  3. 3Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, The Netherlands
  4. 4International Agency for Research on Cancer (IARC-WHO), Lyon, France
  5. 5Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany
  6. 6University of British Columbia, St Paul's Hospital, Vancouver, Canada
  7. 7Department of Epidemiology, School of Public Health, Aarhus University, Aarhus, Denmark
  8. 8Department of Cardiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
  9. 9Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark
  10. 10INSERM, UMRS 1018, Team 9, Centre for Research in Epidemiology and Population Health, Paris South University, Institut Gustave Roussy, F-94805 Villejuif, France
  11. 11Molecular and Nutritional Epidemiology Unit, ISPO-Cancer Research and Prevention Institute, Florence, Italy
  12. 12Cancer Registry and Environmental Epidemiology Unit, Fondazione IRCCS Instituto Nazionale dei Tumori, Milan, Italy
  13. 13Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy
  14. 14Cancer Registry and Histopathology Unit, Department of Oncology, “Civile M.P. Arezzo” Hospital, Ragusa, Italy
  15. 15HuGeF Foundation Torino, Torino, Italy
  16. 16MRC/HPA Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
  17. 17Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
  18. 18WHO Collaborating Center for Food and Nutrition Policies, Department of Hygeine, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
  19. 19Hellenic Health Foundation, Athens, Greece
  20. 20Division of Epidemiology, Public Health and Primary Care, Imperial College London, London, UK
  21. 21Public Health and Participation Directorate, Health and Health Care Services Council, Asturias, Spain
  22. 22Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology, Barcelona, Spain
  23. 23Andalusia School of Public Health, Granada, Spain
  24. 24CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
  25. 25Department of Public Health of Guipuzkoa, San Sebastian, Spain
  26. 26Department of Epidemiology, Murcia Regional Health Council, Spain
  27. 27Public Health Institute of Navarra, Pamplona, Spain
  28. 28Pathology, Department of Medical Biosciences, Umeå University, Umeå, Sweden
  29. 29Nutritional Research, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
  30. 30Clinical Gerontology, Department of Public Health and Primary Care, University of Cambridge, UK
  31. 31Cancer Epidemiology Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
  1. Correspondence to Fränzel J B van Duijnhoven, Centre for Nutrition and Health, National Institute for Public Health and the Environment, P O Box 1, 3720 BA Bilthoven, The Netherlands; franzel.van.duijnhoven{at}


Objective To examine the association between serum concentrations of total cholesterol, high density lipoprotein cholesterol (HDL), low density lipoprotein cholesterol, triglycerides, apolipoprotein A-I (apoA), apolipoprotein B and the incidence of colorectal cancer (CRC).

Design Nested case–control study.

Setting The study was conducted within the European Prospective Investigation into Cancer and Nutrition (EPIC), a cohort of more than 520 000 participants from 10 western European countries.

Participants 1238 cases of incident CRC, which developed after enrolment into the cohort, were matched with 1238 controls for age, sex, centre, follow-up time, time of blood collection and fasting status.

Main outcome measures Serum concentrations were quantitatively determined by colorimetric and turbidimetric methods. Dietary and lifestyle data were obtained from questionnaires. Conditional logistic regression models were used to estimate incidence rate ratios (RRs) and 95% CIs which were adjusted for height, weight, smoking habits, physical activity, education, consumption of fruit, vegetables, meat, fish, alcohol, fibre and energy.

Results After adjustments, the concentrations of HDL and apoA were inversely associated with the risk of colon cancer (RR for 1 SD increase of 16.6 mg/dl in HDL and 32.0 mg/dl in apoA of 0.78 (95% CI 0.68 to 0.89) and 0.82 (95% CI 0.72 to 0.94), respectively). No association was observed with the risk of rectal cancer. Additional adjustment for biomarkers of systemic inflammation, insulin resistance and oxidative stress or exclusion of the first 2 years of follow-up did not influence the association between HDL and risk of colon cancer.

Conclusions These findings show that high concentrations of serum HDL are associated with a decreased risk of colon cancer. The mechanism behind this association needs further elucidation.

  • Lipids
  • lipoprotein-cholesterol
  • colorectal cancer

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  • Funding This work was supported by the European Commission: Public Health and Consumer Protection Directorate 1993-2004; Research Directorate-General 2005-.; Ligue contre le Cancer, Societé 3M, Mutuelle Générale de l'Education Nationale, Institut National de la Santé et de la Recherche Médicale (INSERM) (France); German Cancer Aid, German Cancer Research Center, Federal Ministry of Education and Research (Germany); Danish Cancer Society (Denmark); Health Research Fund (FIS) of the Spanish Ministry of Health, The participating regional governments and institutions (Spain); Cancer Research UK, Medical Research Council (UK); Hellenic Ministry of Health, the Stavros Niarchos Foundation and the Hellenic Health Foundation (Greece); Italian Association for Research on Cancer, National Research Council (Italy); Dutch Ministry of Public Health, Welfare and Sports (VWS), Netherlands Cancer Registry (NKR), LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund (WCRF), Statistics Netherlands (the Netherlands); Swedish Cancer Society, Swedish Scientific Council, Regional government of Västerbotten (Sweden); Norwegian Cancer Society (Norway).

  • Competing interests The institution of FvD has received grants from the Ministry of Public Health, Welfare and Sports for the submitted work. The institution of HBBdM has received grants from the Ministry of Public Health, Welfare and Sports for the submitted work. The institution of TP has received grants from German Cancer Aid, Federal Ministry for Education and Research, European Union for the submitted work. The institution of RT has received support from the European Union and AIRC-ITALY for the submitted work. The institution of DD has received grants from German Cancer Aid, Federal Ministry for Education and Research, European Union for the submitted work. The institution of AT has received grants from Stavros Niarchos Foundation for the submitted work. The institution of PL has received grants from the Hellenic Ministry of Health for the submitted work. The institution of VD has received grants from the Hellenic Health Foundation for the submitted work. The institution of K-TK has received grants from MRC and Cancer Research UK for the submitted work. There are no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; and no other relationships or activities that could appear to have influenced the submitted work.

  • Ethics approval This study was conducted with the approval of the ethics review boards of the International Agency for Research on Cancer and individual EPIC centres. EPIC participants provided written consent for the use of their blood samples and all data.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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