The Role of Diet, Alcohol, BMI, and Physical Activity in Cancer Mortality: Summary Findings of the EPIC Study
Abstract
:1. Introduction
2. Materials and Methods
- Population: Adults participating in the EPIC study and/or cancer patients.
- Interventions: exposure to diet and diet-related factors.
- Comparisons: differences in survival and other outcomes between cancer and non-cancer subjects by the exposure factors.
- Outcomes: Cancer mortality, Cancer cause-specific mortality, and other cancer-related outcomes.
- Study design: longitudinal studies (cohort, nested case-control, or case-cohort studies).
2.1. Search Strategy
2.2. Study Elegibility Criteria
2.3. Data Collection and Analysis
2.4. Data Extration and Management
- (1)
- Regarding exposure assessment: Diet information regarding the previous 12 months was collected at the time of recruitment using validated country/center-specific dietary questionnaires [27,28]. According to each center’s protocol, self-administered quantitative or semi-quantitative methods were applied: food-frequency questionnaires (with approximately 260 food items), diet history questionnaires (with more than 600 food items) administered by means of interviews, and semi-quantitative food-frequency questionnaires combined with dietary record [21]. To calibrate the dietary measurement and to correct the errors produced by overestimation or underestimation of food intake, a 24-h recall was performed by a computerized program (EPICSOFT) in a random subsample of 8% of the cohort [29]. Nutrients were analyzed using a standardised Food Composition Table (EPIC Nutrient Database ENDB) [30]. Lifestyle questionnaires were used to obtain information on education, habits, lifestyles, and medical history. Anthropometry (height, weight, waist, and hip circumference) was measured using standard study protocols [22]. For example, weight and height was measured in light clothing without shoes. Information on physical activity was gathered by means of a validated questionnaire using accelerometers [21,22].
- (2)
- Regarding outcome assessment: Information on deaths occurred during follow-up (the date and underlying cause of death) was obtained through linkage to national or regional mortality registries or active follow-up (in France, Germany, and Greece), depending on the study center. The 10th edition of the International Classification of Diseases (ICD-10) [31] was used to define cause-specific mortality. For post-diagnosis association studies, the date of cancer diagnosis was used as the start date of follow-up (i.e., from diagnosis to death), whereas for pre-diagnosis association studies the follow-up was started at the date of recruitment (i.e., from recruitment to death). Of note, no study accounted for exposure assessments at the date of diagnosis; thus, all association studies were based on diet and lifestyle habits long before the diagnosis of cancer. Participants were censored at date of death, last date of contact, or the date at which follow-up data were considered to be complete at each study center.
2.5. Quality Assessment
2.6. Presentation of Results
3. Results
3.1. Study Quality
3.2. Protective Factors
Tumour Site and EPIC Subcohort (If Applicable) | No. of Cases (No. of Deaths) | Mean Follow-Up (Years) | Results, Relative Risk [95% Confidence Interval (CI)] | Reference |
---|---|---|---|---|
Cancer overall among diabetics (confirmed at recruitment) | 10,449 (1346 total deaths/319 from cancer) | 9.0 years since recruitment | No significant association between intake of total vegetables, legumes, and fruits and cancer mortality risk in subjects diagnosed with diabetes at recruitment (per 80 g/d intake): Vegetables, legumes, and fruits: HR 1.08 (0.99–1.17) Vegetables: HR 1.09 (0.87–1.33) Legumes: HR 1.09 (0.96–1.24) Fruits: HR 1.08 (0.98–1.19) | Nöthlings 2008 [33] |
Cancer overall EPIC-Heidelberg | 24,340 (458 deaths from cancer) | 10.7 years since recruitment | Dietary intake of menaquinones (vitamin K2) was significantly associated with cancer mortality (highest vs. lowest intake): HR 0.72 (0.53–0.98), while intake of phylloquinone (vimtain K1) was not associated with cancer mortality. | Nimptsch 2010 [52] |
Cancer overall EPIC-Spain | 40,622 (1855 total deaths/913 from cancer) | 13.4 years since recruitment | No significant association between adherence to the relative Mediterranean diet score and cancer mortality. However, in analyses including only cancers with greater evidence of being causally related to dietary factors (oesophageal, stomach, intestinal, colorectal and other digestive organ cancers, pancreatic, breast, and prostate cancer) (570 cases), the relative Mediterranean diet score was associated with a borderline reduction in risk of death for high versus low score: HR 0.79 (0.61–1.01) p = 0.056 | Buckland 2011 [41] |
Colorectal cancer Lung cancer Prostate cancer Breast cancer EPIC-Heidelberg | 24,323 (1101 total deaths/513 from cancer) | 11.0 years since recruitment | No association between dietary intake of calcium and magnesium and cancer-related mortality risk (highest vs. lowest intake): HR 0.90 (0.68–1.20) and HR 1.04 (0.79–1.36), respectively. | Li 2011 [57] |
Cancer overall EPIC-Spain | 40,622 (1915 total deaths/956 from cancer) | 13.4 years since recruitment | No significant association was observed between olive oil and cancer mortality (highest vs. lowest intake): HR 0.90 (0.72–1.13). | Buckland 2012 [58] |
Cancer overall among diabetics (confirmed at recruitment) | 6192 (791 total deaths/163 from cancer) | 9.2 years since recruitment | An inverse, though non-significant, association was observed for dietary fiber in analyses of mortality risk due to cancer: HR 0.82 (0.66–1.02). | Burger 2012 [36] |
Cancer overall Smoking-related cancers | 452,717 (23,582 total deaths) | 12.7 years since recruitment | Dietary fiber intake was not related with risk of death from cancer. An inverse association with smoking-related cancers was found (per 10 g/d increase): HR 0.89 (0.80–0.99). | Chuang 2012 [37] |
Colorectal cancer | 1202 (541 total deaths/444 from cancer) | 6.0 years since diagnosis | Higher 25(OH)D levels were associated with a reduction in colorectal-specific mortality. Participants with 25(OH)D levels in the highest quintile had an adjusted HR of 0.69 (0.50–0.93) for colorectal cancer-specific compared with the lowest quintile. By tumor location, higher 25(OH)D was associated with reduced mortality for rectal cancers, comparing the highest versus the lowest levels: HR 0.48 (0.29–0.80) for colorectal cancer-specific mortality. Participants with high dietary calcium intake (≥928 mg/d) and high pre-diagnosis vitamin D levels (>100 nmol/L) showed a HR of 0.24 (0.11–0.54) for colorectal cancer-specific mortality, compared with participants with the lowest 25(OH)D levels (<25 nmol/L). Among participants with low calcium intake, the corresponding HRs were 0.86 (0.41–1.82) for colorectal cancer-specific mortality compared with participants with the lowest 25(OH)D levels. | Fedirko 2012 [50] |
Cancer overall EPIC-Heidelberg | 23,943 (1101 total deaths/513 from cancer) | 11.0 years since recruitment | Neither any vitamin/mineral supplementation nor multivitamin supplementation at baseline was statistically significantly associated with cancer mortality. However, baseline users of antioxidant vitamin supplements had a significantly reduced risk of cancer mortality: HR 0.52 (0.28–0.97). In comparison with never users, baseline non-users who started taking vitamin/mineral supplements during follow-up had significantly increased risks of cancer mortality: HR 1.74 (1.09–2.77). | Li 2012 [55] |
Cancer overall | 451,151 (25,682 total deaths/10,438 from cancer) | ~13.0 years since recruitment | No association between cancer mortality and fruit and vegetable intake (highest vs. lowest intake): HR 0.96 (0.90–1.03) or intake of vegetables or fruits: HR 0.95 (0.89–1.02) and HR 0.98 (0.92–1.05), respectively. A significant association was seen for raw vegetable intake (highest vs. lowest quartile): HR 0.90 (0.84–0.96), but not for cooked vegetables (highest vs. lowest quartile): HR 0.98 (0.91–1.06). | Leenders 2013 [34] |
Cancer overall EPIC-Spain | 40,622 (1915 total deaths/956 from cancer) | 13.6 years since recruitment | No association between total flavonoid intake, flavonoid subclasses, or lignan intake and cancer-related mortality risk: HR for log2 (doubling of intake of total flavonoids) = 0.96 (0.89–1.04). | Zamora-Ros 2013 [59] |
Renal cancer | 560 (205 deaths from cancer) | 3.2 years since diagnosis | Plasma levels of 25(OH)D3 (vitamin D) were nonlinearly associated with risk of death. High concentrations of pre-diagnostic 25(OH)D3 were associated with decreased hazards of death among renal cancer patients (statistical results not reported). | Muller 2014 [51] |
Cancer overall | 480,535 (32,587 total deaths) | 7.0–18.0 years since recruitment | No associations were found for consumption of total fish, lean, or fatty fish and cancer mortality. However, there seemed to be a U-shaped (p = 0.046) trend with total fish consumption in the analyses of cancer mortality (highest vs. lowest intake). | Engeset 2015 [39] |
Breast cancer | 11,782 (1482 total deaths/753 from cancer) | 6.0 years since diagnosis | Among postmenopausal women, an intake of lignans was related to a 28% lower risk of dying from breast cancer (highest vs. lowest intake): HR 0.72 (0.53–0.98). | Kyrø 2015 [56] |
Cancer overall Colorectal cancer Pancreatic cancer Lung cancer Breast cancer Ovarian cancer Lympathic/hematopoietic cancer EPIC-Oxford | 65,429 (2137 deaths from cancer) | ~5.0 years since recruitment | There was a significantly reduced cancer mortality risk due to pancreatic cancer for low meat eaters and vegetarians/vegans (compared with regular meat eaters): HR 0.55 (0.36–0.86) and HR 0.48 (0.28–0.82), respectively. Additionally, for cancers of the lymphatic/hematopoietic tissue, for vegetarians/vegans (compared with regular meat eaters): HR 0.50 (0.32–0.79). Cancer-related overall mortality risk was significantly lower in fish eaters than in regular meat eaters: HR 0.82 (0.70–0.97). | Appleby 2016 [43] |
Cancer overall | 451,256 (15,200 total deaths/7475 from cancer) | 12.8 years since recruitment | All dietary scores showed inverse associations with cancer mortality (highest vs. lowest score). Mediterranean Diet Scale: HR 0.93 (0.91–0.95); relative Mediterranean diet score: HR 0.92 (0.90–0.94); Mediterranean Style Dietary Pattern Score: HR 0.94 (0.92–0.96); Diet Quality Index–International: HR 0.91 (0.89–0.93); Healthy Nordic Food Index: HR 0.95 (0.92–0.97); Healthy Eating Index 2010: HR 0.93 (0.90–0.95); Dietary Approaches to Stop Hypertension: HR 0.94 (0.92–0.96). | Lassale 2016 [42] |
Colorectal cancer | 3789 (1262 total deaths/1008 from cancer) | 4.1 years since diagnosis | No association between pre-diagnostic intakes of fibre (defined as quartiles and continuous grams per day) and death due to colorectal cancer: HR 1.00 (0.87–1.15). | Ward 2016 [38] |
Prostate cancer | 7036 (936 from cancer) | 13.9 years since recruitment | No association between intake of vegetables and fruits with death due to prostate cancer (per 100 g intake): HR 1.11 (0.95–1.30) and HR 0.97 (0.91–1.04), respectively. | Perez-Cornago 2017 [35] |
Cancer overall Lung cancer EPIC- Netherlands | 33,289 (2863 total deaths/1346 from cancer) | 16.8 years since recruitment | None of the forms of vitamin K intake were associated with overall cancer mortality (highest vs. lowest intake): HR 1.01 (0.85–1.19) for phylloquinone, HR 0.96 (0.78–1.18) for menaquinones, HR 1.20 (0.93–1.54) for short chain, and HR 1.01 (0.84–1.23) for long chain. No associations were found between vitamin K intake and lung cancer mortality (highest vs. lowest intake): HR 0.99 (0.86–1.23). | Zwakenberg 2017 [53] |
Lung cancer EPIC-Norfolk | 19,336 (687 total deaths/280 from cancer) | 16.5 years since recruitment | Significant risk reduction of lung cancer mortality for plasma vitamin C concentrations (highest vs. lowest quartile): HR 0.54 (0.35–0.81). | Myint 2019 [54] |
Cancer overall EPIC-Italy | 45,009 (2468 total deaths/1464 from cancer) | 14.9 years since recruitment | No association between intake of dairy products and cancer death (highest vs. lowest intake): HR for intake of milk 1.05 (0.89–1.23), HR for intake of yogurt 1.00 (0.83–1.20), HR for intake of cheese 1.08 (0.88–1.32), HR for intake of butter 0.90 (0.79–1.11), HR for intake of calcium from dairy 1.18 (0.99–1.40), HR for intake of full-fat milk 1.08 (0.89–1.32), and HR for intake of reduced-fat milk 1.10 (0.89–1.35). | Pala 2019 [40] |
Cancer overall EPIC-Oxford | 65,429 (2137 deaths from cancer) | ~5 years since recruitment | Relative to regular meat eaters, a reduced risk of cancer-related mortality was observed for fish eaters (HR 0.83, 0.70–0.97), though not for low meat eaters (HR 0.96, 0.87–1.08), vegetarians (HR 0.91, 0.80–1.03), or vegans (HR 1.14, 0.88–1.47). | Segovia-Siapco 2018 [44] |
Tumour Site and EPIC Subcohort If Applicable | No. of Cases (No. of Deaths) | Mean Follow-Up (Years) | Results, Relative Risk [95% Confidence Interval (CI)] | Reference |
---|---|---|---|---|
Cancer overall EPIC-Norfolk | 22,450 (4398 total deaths/1639 from cancer) | ~7.0 years since recruitment | Relative to non-cycling, cycling up to 1 h/week or cycling for more than 1 h/week were not associated with cancer-related mortality risk: HR 0.99 (0.73–1.34) and HR 0.93 (0.81–1.06), respectively. | Sahlqvist 2013 [46] |
Cancer overall | 378,864 (23,828 total deaths/9388 from cancer) | 12.8 years since recruitment | Adherence to the WCRF recommendations was associated with a reduced risk of cancer-related mortality (highest vs. lowest category): HR 0.80 (0.69–0.93). HR per unit increase in the score = 0.91 (0.89–0.93). | Vergnaud 2013 [48] |
Colorectal cancer | 3293 (1113 total deaths/872 from cancer) | 4.2 years since diagnosis | Adherence to WCRF cancer prevention recommendations was associated with lower risk of rectal cancer mortality (highest vs. lowest category): HR 0.70 (0.56–0.89) | Romaguera 2015 [49] |
Cancer overall EPIC-Spain | 38,379 (1371 total deaths/758 from cancer) | 13.6 years since recruitment | Household physical activity was inversely associated with cancer mortality in men and women (highest vs. lowest levels of MET-h/week): HR 0.72 (0.54–0.94) and HR 0.52 (0.34–0.79), respectively. | Huerta 2016 [47] |
Cancer overall | 451,256 (15,200 total deaths/7475 from cancer) | 12.8 years since recruitment | Healthy Lifestyle Index and WCRF/AICR adherence scores showed significant associations with cancer mortality (highest vs. lowest score): HR 0.80 (0.78–0.82) and HR 0.90 (0.88–0.92), respectively. | Lassale 2016 [42] |
Cancer-overall EPIC-Norfolk | 14,599 (3148 total deaths/1091 from cancer) | 15.0 years since recruitment | Higher physical activity levels (a minimum of 150 min/week of moderate-intensity physical activity vs. being inactive) were inversely associated with cancer-related mortality risk (for each 1 kJ/kg/day per year increase in physical activity energy expenditure): HR 0.89 (0.79–0.99). | Mok 2019 [45] |
3.3. Risk Factors
Tumour Site and EPIC Subcohort If Applicable | No. of Cases (No. of Deaths) | Mean Follow-Up (Years) | Results, Relative Risk [95% Confidence Interval (CI)] | Reference | |
---|---|---|---|---|---|
Cancer overall | 448,568 (26,344 total deaths/9861 from cancer) | 12.7 years since recruitment | No association between intake of red meat, processed meat, or poultry and cancer-related mortality risk. Very high consumption of red meat was associated with non-significantly increased cancer mortality (more than 160 g/d intake vs. low intake): HR 1.21 (1.00–1.46). Very high intakes of processed meat and poultry were also not significantly associated with this risk: HR 1.15 (0.90–1.46) and HR 1.00 (0.83–1.20), respectively. | Rohrmann 2013 [61] | |
Cancer overall EPIC-Norfolk EPIC-Oxford | 75,046 (8158 total deaths) | ~17.0 years since recruitment | Tinned fruit consumption was not associated with cancer mortality (compared to the reference category of less than one serving of tinned fruit per month): HR 1.01 (0.90–1.12) and HR 1.07 (0.94–1.21) for one to three servings per month in EPIC-Norfolk and EPIC-Oxford, respectivey; HR 1.08 (0.94–1.24) and HR 0.87 (0.72–1.06) for one serving per week in EPIC-Norfolk and EPIC-Oxford, respectivey; and HR 0.90 (0.73–1.11) and HR 0.90 (0.70–1.17) for two or more servings per week in EPIC-Norfolk and EPIC-Oxford, respectivey. | Aasheim 2015 [60] | |
Colorectal cancer | 3789 (1262 total deaths/1008 from cancer) | 4.1 years since diagnosis | No association between pre-diagnostic intakes of red meat and poultry and death due to colorectal cancer, for high vs. low intake: HR red and processed meat = 0.99 (0.84–1.15); HR red meat = 0.99 (0.89–1.10); HR processed meat = 1.00 (0.95–1.05); HR poultry = 0.96 (0.89–1.03). For processed meat and colorectal cancer mortality, a borderline significant trend was detected across quartiles (p = 0.053). | Ward 2016 [38] | |
Cancer overall EPIC-Spain | 41,199 (3316 total deaths) | 18.0 years since recruitment | There was an association between Inflammatory Score of the Diet and cancer mortality (high vs. low score): HR 1.44 (1.22–1.69). | Agudo 2017 [63] | |
Cancer overall Colorectal cancer Breast cancer Prostate cancer | 451,743 (41,693 total deaths/18,003 from cancer) | 16.4 years since recruitment | No association between intake of soft drinks and cancer mortality risk. By cancer site, total soft drink consumption was positively associated with colorectal cancer deaths (≥1 glass per day vs. <1 glass per month): HR 1.25 (1.07–1.47). No association between colorectal cancer mortality and sugar-sweetened or artificially sweetened soft drinks: HR 1.22 (0.91–1.64), and HR 1.10 (0.86–1.40), respectively. No associations were found for breast or prostate cancer mortality risk. | Mullee 2019 [67] | |
Cancer overall EPIC-Spain | 40,621 (3561 total deaths/1694 from cancer) | 18.0 years since recruitment | No association was observed between egg consumption and cancer-related mortality (highest vs. lowest intake): HR 1.11 (0.96–1.28). HR per eggs/week = 1.01 (1.00–1.03). | Zamora-Ros 2019 [62] | |
Cancer overall | 501,594 (54,951 total deaths/23,143 from cancer) | 17.2 years since recruitment | Those with a higher Food Standards Agency nutrient profiling system dietary index score (high vs. low score) showed an increased risk of mortality from cancer: HR 1.08 (1.03–1.13) | Deschasaux 2020 [64] | |
Prostate cancer | 7036 (936 deaths from cancer) | 13.9 years since recruitment | No association between intake of individual fatty acids with death due to prostate cancer, except for eicosenoic and eicosapentaenoic acid (per 1 SD increase in intake): HR 1.05 (1.00–1.11) and HR 1.07 (1.00–1.14), respectively. | Perez-Cornago 2020 [75] | |
Cancer overall EPIC-Spain | 40,621 (3561 total deaths) | 18.0 years since recruitment | A borderline association between daily mean dietary greenhouse emission (third vs. the first tertile) and cancer mortality risk was found: HR 1.07 (0.99–1.15). | González 2021 [76] | |
Renal cell carcinoma | 389,220 (356 deaths from cancer) | 16.0 years since recruitment | Total and artificially sweetened soft drinks were positively associated with renal cell carcinoma mortality in models unadjusted for BMI and energy intake, but not after adjustment. Juice consumption was positively associated with renal cell carcinoma mortality in women, even after adjustment for BMI and energy intake (per 100 g/day increment): HR 1.17 (1.05–1.29) | Heath 2021 [68] |
Tumour Site and EPIC Subcohort If Applicable | No. of Cases (No. of Deaths) | Mean Follow-Up (Years) | Results, Relative Risk [95% Confidence Interval (CI)] | Reference |
---|---|---|---|---|
Cancer overall | 359,387 (total deaths/5429 from cancer) | 9.7 years since recruitment | Nonlinear association between BMI and cancer-related mortality risk. High BMI (>35 kg/m2) vs. low BMI (23.5 kg/m2): HR in men = 1.24 (0.97–1.60) and HR in women = 1.38 (1.14–1.68). Higher waist circumference was also associated with increased risk of cancer-related mortality. High (>103 cm in men and >89 cm in women) vs. low waist circumference (<86 cm in men and <70 cm in women): HR in men = 1.89 (1.51–2.36) and HR in women = 1.30 (1.05–1.60). | Pischon 2008 [69] |
Cancer overall | 34,239 (1712 total deaths) | 7.0–15.0 years since recruitment | There was an association between annual weight loss by more than 1 kg and cancer death within 1 year in elderly population: OR 4.57 (2.36–8.85) | Bamia 2010 [70] |
Cancer overall among diabetics (confirmed at recruitment) | 5435 (641 total deaths/133 from cancer) | 9.3 years since recruitment | No association between any anthropometric measure of obesity and cancer-related mortality risk in subjects diagnosed with diabetes. For instance, HR for obese (BMI > ~30kg/m2) vs. normal weight subjects (BMI< ~26 kg/m2) = 1.35 (0.70–2.58) in men and HR 1.46 (0.63–3.40) in women | Sluik 2011 [72] |
Cancer overall EPIC-Norfolk | 13,197 (1270 total deaths/570 from cancer) | 9.5 years since recruitment | No association between television viewing time and cancer-related mortality risk (per 1 h/day increase in television time): HR 1.04 (0.98–1.10). | Wijndaele 2011 [73] |
Cancer overall among diabetics (confirmed at recruitment) | 4797 (533 total deaths/109 from cancer) | 9.2 years since recruitment | No association between alcohol intake in the past and cancer-related mortality risk in subjects diagnosed with diabetes. For instance, HR for high (6 g/d intake) vs. low alcohol intake (abstainers: 0 g/d intake) = 0.88 (0.47–1.65) in men and HR 0.54 (0.19–1.54) in women. | Sluik 2012 [77] |
Alcohol-related cancers | 380,395 (26,411 total deaths/2764 from cancer) | 12.6 years since recruitment | Heavy alcohol users (>5 drinks/day for men and >2.5 drinks/day for women), regardless of time of cessation, had a 2 to 5 times higher risk of dying due to alcohol-related cancers, compared with subjects with lifetime light alcohol use (≤1 and ≤0.5 drink/week for men and women, respectively): HR 3.82 (2.09–6.97) in men and HR 2.20 (1.16–4.18) in women. | Bergmann 2013 [66] |
Cancer overall Alcohol-related cancers | 380,395 (20,453 total deaths/2053 from cancer) | 12.6 years since recruitment | In men, extreme alcohol use (≥60 g/day) compared to moderate drinkers (0.1–4.9 g/day) was associated with mortality due to alcohol-related cancers and with other cancers: HR 2.62 (1.90–3.62) and HR 1.34 (1.13–1.59), respectively. Among women, heavy drinkers (≥30 g/day) compared to moderate drinkers (0.1–4.9 g/day) were associated with mortality due to alcohol-related cancers: HR 1.49 (1.07–2.06). | Ferrari 2014 [65] |
Cancer overall | 409,748 (29,810 total deaths/11,931 from cancer) | 12.5 years since recruitment | Height was positively associated with cancer mortality (highest vs. lowest quartile): HR in men = 1.11 (1.00–1.24) and HR in women = 1.17 (1.07–1.28). Sitting height was not associated with cancer mortality. | Sawada 2017 [71] |
Cancer overall EPIC-Norfolk | 12,580 (2603 total deaths/981 from cancer) | 15.0 years since recruitment | Neither weight loss nor weight gain were associated with risk of cancer-related mortality in men (for >5 kg): HR 1.45 (0.98–2.15) and HR 1.34 (0.66–2.72), respectively. In women, associations were also not significant (for >5 kg): HR for weight loss = 1.36 (0.92–2.01) and HR for weight gain = 0.64 (0.26–1.55). | Mulligan 2018 [74] |
4. Discussion
4.1. Protective Factors against Cancer Mortality
4.2. Risk Factors for Cancer Mortality
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Molina-Montes, E.; Ubago-Guisado, E.; Petrova, D.; Amiano, P.; Chirlaque, M.-D.; Agudo, A.; Sánchez, M.-J. The Role of Diet, Alcohol, BMI, and Physical Activity in Cancer Mortality: Summary Findings of the EPIC Study. Nutrients 2021, 13, 4293. https://doi.org/10.3390/nu13124293
Molina-Montes E, Ubago-Guisado E, Petrova D, Amiano P, Chirlaque M-D, Agudo A, Sánchez M-J. The Role of Diet, Alcohol, BMI, and Physical Activity in Cancer Mortality: Summary Findings of the EPIC Study. Nutrients. 2021; 13(12):4293. https://doi.org/10.3390/nu13124293
Chicago/Turabian StyleMolina-Montes, Esther, Esther Ubago-Guisado, Dafina Petrova, Pilar Amiano, María-Dolores Chirlaque, Antonio Agudo, and María-José Sánchez. 2021. "The Role of Diet, Alcohol, BMI, and Physical Activity in Cancer Mortality: Summary Findings of the EPIC Study" Nutrients 13, no. 12: 4293. https://doi.org/10.3390/nu13124293