THE EPICOR STUDY
Vittorio Krogh
Unità di Epidemiologia Nutrizionale
Fondazione IRCCS, Istituto Nazionale Tumori,
Milano
on behalf of all Italian colleagues
AIRTUM, Sabaudia 2010
Esperienze CVD in EPIC
• EPIC-HEART (Mortalità)
• Alcuni centri EPIC Europei hanno
pubblicato importanti lavori su CVD
• EPIC-HEART (Incidenza)
• EPICOR
CHRONOGRAM: EPIC-ITALY COLLABORATION
1990-1993
<2007
<2004
1993-1996
European Union, AIRC
MoH
2008
Compagnia
San Paolo
2009+
Compagnia
San Paolo
Project START
recruitment
Data analysis
CVD
1° follow-up
2° follow-up
Biochemical
analyses
1° follow-up
CVD
3° follow-up
2° follow-up
CVD
DNA Extraction and
Storage & Genetic
Analyses (Epigenetics,
SNPs, GWAS)
1 -- EPICOR -- 2
3° follow-up
CVD
Esperienza EPICOR
• Specifici finanziamenti per
l’implementazione componente CVD in
EPIC
• Sviluppo di procedure ad hoc di attivo
follow-up per la validazione della
diagnosi
• Creazione di un Consorzio di banche
biologiche
Centri EPICOR
• Milano, Fondazione IRCCS, Istituto Nazionale
Tumori
• V. Krogh, F. Berrino, S. Sieri, V. Pala, S. Grioni, C. Agnoli,
A. Evangelista
• Torino, Università di Torino/Imperial College
London
• P. Vineis, C. Sacerdote
• Firenze, ISPO (Screening e Prevenzione
Oncologica)
• D. Palli, G. Masala, B. Bendinelli
• Napoli, Università Federico II Napoli
• S. Panico, A. Mattiello, P. Chiodini
• Ragusa, Registro Tumori Ragusa
• R. Tumino, G. Frasca
Ricercatori Associati and Lab
Centres
EPICOR
• Giuseppe Matullo
Dept. Genetics, Biology and Biochemistry, Turin
University, Turin, Italy
&
ISI Foundation and HuGeF, Turin, Italy
• Licia Iacoviello
Laboratory of Genetic and Environmental
Epidemiology – Catholic University – Campobasso,
Italy
Distribuzione per genere nei centri EPIC
italiani
47.749 recrutati (1993-98)
Age 30-74
Italy
Men
Women
Total
Torino
6,047
4,557
10,604
Varese
2,557
9,526
12,083
Firenze
3,514
10,083
13,597
Napoli
-
5,062
5,062
Ragusa
3,053
3,350
6,403
15,171
32,578
47,749
Total
EPICOR: Procedure di follow-up
EPIC vital statistics database
Linkage agli archivi
Anagrafe
comunale
•Stato in vita
•Data di
morte
Registri di
mortalità
Schede dimissione
ospedaliera
•Data di morte
•Certificato di morte
STATO IN VITA
CAUSE DI MORTE
Documentazione medica
Validazione e data
della diagnosi
CASI INCIDENTI
(CASI PREVALENTI)
Searching for cases…
Incidenza
Diagnosi alla dimissione (in qualsiasi posizione)
410-414 (cardiopatia ischemica)
430-438 (cerebrovasculopatie)
procedure per PTCA, CABG, CEA
Mortalità ICD-IX – Coronarica 410-414, 798, 799 (morte
improvvisa),
oppure 250 (diabete), 401-404 (associate a ipertensione), 428
(insufficienza cardiaca), 440 (arteriosclerosi) nella posizione
principale in associazione con 410-414 in altre
Mortalità ICD-IX – Cerebrovascolare 430-438, 342 (emiplegia)
798, 799 (morte improvvisa),
oppure 250 (diabetes), 401-404 (associata a ipertensione),
427 (aritmie cardiache), 440 (arteriosclerosi) nella posizione
principale in associazione con 430-436 in altre
Gli eventi cardiovascolari maggiori
• Cardiaci
– Infarto miocardico
– Sindrome coronarica acuta
– Rivascolarizzazione coronarica
• Cerebrali
– Ictus ischemico
– Ictus emorragico
– Rivascolarizzazione carotidea
Major cardiovascular events
identified in EPICOR 1 (7,5 yrs.)
CORONARY
CEREBROVASCULAR
Men
Women
Men
Women
331
182
96
150
PRIMI RISULTATI DEL
PROGETTO EPICOR - 1
Dietary glycemic load and index and risk of coronary heart disease in a
large italian cohort: the EPICOR study.
Sabina Sieri 1, PhD, Vittorio Krogh1, MD, Franco Berrino2, MD, Alberto Evangelista1,
BSc, Claudia Agnoli1, PhD, Furio Brighenti3, PhD, Nicoletta Pellegrini3, PhD,
Domenico Palli4, MD, Giovanna Masala4, MD , Carlotta Sacerdote5, MD, Fabrizio
Veglia5,6, MD, Rosario Tumino7, MD, Graziella Frasca, PhD 8, Sara Grioni1, BSc,
Valeria Pala1, PhD, Amalia Mattiello9, MD, Paolo Chiodini10, PhD, Salvatore Panico9,
MD
1Nutritional
Epidemiology Unit, National Cancer Institute, Milan, Italy.
2Etiological and Preventive Epidemiology Unit, National Cancer Institute, Italy.
3Department of Public Health, University of Parma, Italy.
4Molecular and Nutritional Epidemiology Unit, ISPO-Cancer Research and Prevention Institute, Florence, Italy.
5ISI Foundation and Department of Genetics, Biology and Biochemistry, University of Turin, Turin, Italy.
6Centro Cardiologico Monzino IRCCS, Milan, Italy.
7Cancer Registry and Histopathology Unit Department of Oncology "Civile - M.P.Arezzo" Hospital, Ragusa,
Italy.
8Cancer Registry Department of Oncology "Civile - M.P. Arezzo" Hospital, Ragusa, Italy.
9Department of Clinical and Experimental Medicine, University of Naples Federico II , Naples, Italy
10 Department of Public Health and Preventive Medicine, University of Naples Federico II ,
Naples, Italy.
Arch Intern Med. 2010 Apr 12;170(7):640-7.
INDICE GLICEMICO
L’indice glicemico (GI) degli alimenti è
un indice basato sul loro effetto
immediato sui livelli di glucosio nel
sangue.
Il GI è un test in vivo (su soggetti umani) che si basa sul calcolo dell’area
sottesa alla curva di risposta glicemica quando un alimento test ed un alimento
standard vengono consumati in quantità isoglucidiche (tali cioè da contenere la
stessa porzione di carboidrati - di solito 50g).
Indice Glicemico = (Area Alimento / Area Glucosio) * 100
CARICO GLICEMICO
• Il carico glicemico (GI) degli alimenti è
basato sul loro effetto generale sui livelli
di glucosio (e di insulina) nel sangue. Viene
calcolato moltiplicando il contenuto in
carboidrati di un alimento per il suo IG.
• Carico Glicemico = (Indice Glicemico *
Carboidrati) / 100
Relative risk (with 95% confidence intervals) of coronary heart
disease in women by increasing quartiles of carbohydrate,
carbohydrate high and low GI, and glycemic load
P for
trend
I
II
III
IV
Carbohydrate
N° cases
Median (g/day)
Multivariate risk (95% CI)*
25
216.3
1
39
256.2
1.62 (0.97-2.70)
44
280.1
1.87 (1.12-3.10)
50
316.9
1.99 (1.18-3.36)
0.010
Carbohydrate high GI
N° cases
Median (g/day)
Multivariate risk (95% CI)*
28
78.6
1
37
114.4
1.33 (0.80-2.18)
45
139.6
1.57 (0.96-2.55)
48
188.9
1.68 (1.03-2.75)
0.030
Carbohydrate low GI
N° cases
Median (g/day)
Multivariate risk (95% CI)*
39
94.2
1
46
125.5
1.15 (0.74-1.78)
33
146.2
0.86 (0.53-1.40)
40
182.0
1.01 (0.63-1.62)
0.725
Glycemic Load
N° cases
22
39
46
51
Median
112.8
135.6
150.2
174.2
Multivariate risk (95% CI)*
1
1.97 (1.13-3.45) 2.47 (1.37-4.44)
2.77 (1.40-5.48) 0.004
* adjusted for hypertension, education, smoking, body mass index, alcohol, non alcohol energy intake, saturated
fat intake, fiber intake, menopausal status and physical activity
Relative risk (with 95% confidence intervals) of coronary heart
disease in men by increasing quartiles of carbohydrate,
carbohydrate high and low GI, and glycemic load
P for
trend
I
II
III
IV
Carbohydrate
N° cases
Median (g/day)
Multivariate risk (95% CI)*
88
263.1
1
67
312.6
0.82 (0.59-1.14)
89
342.8
1.19 (0.86-1.65)
61
389.5
0.82 (0.56-1.21)
0.829
Carbohydrate high GI
N° cases
Median (g/day)
Multivariate risk (95% CI)*
79
103.8
1
76
146.9
0.96 (0.70-1.33)
80
177.7
1.00 (0.72-1.38)
70
237.9
0.96 (0.68-1.37)
0.896
Carbohydrate low GI
N° cases
Median (g/day)
Multivariate risk (95% CI)*
75
107.8
1
85
148.2
1.13(0.82-1.55)
79
175.6
1.09 (0.78-1.52)
66
221.3
1.01 (0.70-1.45)
0.980
Glycemic Load
N° cases
79
84
78
64
Median
139.7
167.2
185.0
214.6
Multivariate risk (95% CI)*
1
1.18 (0.84-1.65) 1.15 (0.79-1.69)
1.03 (0.64-1.67) 0.891
* adjusted for hypertension, education, smoking, body mass index, alcohol, non alcohol energy intake, saturated
fat intake, fiber intake and physical activity
Healthy Eating Index (2005)
• Basato sulle raccomandazioni contenute nelle Dietary Guidelines
for Americans 2005
• 12 componenti con score da 0 a 5, 10 o 20
• Score complessivo da 0 a 100
4
5
Healthy Eating Index 2005
Solid Fat, Alcohol, and Added Sugar
Guenther PM, 2008, J Am Diet Assoc
DASH (Dietary Approaches to Stop
Hypertension) diet
• Dieta mirata alla riduzione della pressione e del colesterolo
LDL
• Inclusa nelle Dietary Guidelines for Americans 2005 come esempio di
dieta salutare
• Basato su 8 componenti con score da 1 a 5
• Lo score di ogni componente è calcolato dividendo la
variabile in quintili:
– frutta, verdura, legumi e frutta secca, latticini a basso contenuto di
grasso, cereali integrali:
lo score rispecchia il ranking dei soggetti
1 per il quintile più basso – 5 per il pù alto
– bevande zuccherate, carne rossa e lavorata, sodio:
lo score è invertito
1 per il quintile più alto – 5 per il pù basso
• Score complessivo da 0 a 40
Fung TT, 2008, Arch Intern Med
Indice Mediterraneo Greco
• Basato sull’indice mediterraneo sviluppato da Trichopoulou et
al.
• Comprende 9 componenti con score 1 o 0
• Verdura, legumi, frutta fresca e secca, latticini, cereali, pesce e
rapporto monoinsaturi/saturi:
score=1 per intake superiore alla mediana
• Carne rossa e lavorata: score=1 per intake inferiore alla
mediana
• Mediane sesso-specifiche
• Alcool: score=1 per intake di 5-25 (donne) o 10-50 (uomini)
g/d
• Score complessivo da 0 a 9
Trichopoulou A, 2003, N Engl J Med
Indice Mediterraneo Italiano
• Sviluppato adattando l’Indice Mediterraneo Greco alle
abitudini alimentari italiane
• Comprende 11 componenti con score 1 o 0.
• Pasta, verdure mediterranee (pomodori crudi, verdure
a foglia, verdure a frutto, cipolla e aglio), legumi, frutta,
pesce, olio d’oliva:
score=1 se appartenenti al 3° terzile di intake
• Bevande gasate, burro, carne rossa e patate: score=1
se appartenenti al 1° terzile di intake
• Alcool: score=1 per intake ≤1 porzione/giorno
• Score complessivo da 0 a 11
A priori - defined dietary patterns and risk of stroke in
the EPICOR study
Claudia Agnoli1, Vittorio Krogh1, Franco Berrino2, Sara Grioni1, Sabina Sieri1,
Domenico Palli3, Giovanna Masala3, Carlotta Sacerdote4, Paolo Vineis5, Rosario
Tumino6, Graziella Frasca6, Valeria Pala1, Paolo Chiodini7, Amalia Mattiello8,
Salvatore Panico8
1Nutritional
Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
and Preventive Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
3Molecular and Nutritional Epidemiology Unit, ISPO-Cancer Research and Prevention Institute, Florence, Italy.
4ISI Foundation and Department of Genetics, Biology and Biochemistry, University of Turin, Turin, Italy.
5Imperial College London, UK, and University of Torino, Italy.
6Cancer Registry Department of Oncology "Civile - M.P. Arezzo" Hospital, Ragusa, Italy.
7Department of Medicine and Public Health, Second University of Naples, Naples, Italy.
8Department of Clinical and Experimental Medicine, University of Naples Federico II, Naples, Italy.
2 Etiological
Hazard ratios (HR) for developing all types of stroke (cases=178) in
relation to adherence to the Healthy Eating Index (HEI 2005), the Dietary
Approaches to Stop Hypertension (DASH) diet, the Greek Mediterranean
Index and the Italian Mediterranean Index.
I
Tertile of intake
II
III
P trend
HEI 2005
Range
Cases
HR*
19-59
66
1
60-71
62
1.05 (0.73-1.49)
72-97
50
0.89 (0.60-1.31)
0.581
8-21
76
1
22-26
55
0.67 (0.47-0.95)
27-40
47
0.75 (0.51-1.10)
0.101
0-4
95
1
5
37
0.93 (0.63-1.36)
6-9
46
0.82 (0.57-1.19)
0.293
0-3
91
1
4-5
61
0.68 (0.48-0.94)
6-11
26
0.47 (0.30-0.75)
0.001
DASH diet
Range
Cases
HR*
Greek Mediterranean Index
Range
Cases
HR*
Italian Mediterranean Index
Range
Cases
HR*
*Adjusted for sex, smoking status, education, non-alcoholic energy intake and BMI; stratified for center and age (3year classes).
Hazard ratios (HR) for developing ischemic stroke (cases=100) in relation
to adherence to the Healthy Eating Index (HEI 2005), the Dietary
Approaches to Stop Hypertension (DASH) diet, the Greek Mediterranean
Index and the Italian Mediterranean Index.
I
Tertile of intake
II
III
P trend
HEI 2005
Range
Cases
HR*
19-59
46
1
60-71
34
0.85 (0.54-1.35)
72-97
20
0.54 (0.31-0.94)
0.033
8-21
50
1
22-26
30
0.60 (0.38-0.95)
27-40
20
0.53 (0.30-0.91)
0.012
0-4
56
1
5
22
0.90 (0.55-1.49)
6-9
22
0.62 (0.37-1.04)
0.075
0-3
53
1
4-5
35
0.65 (0.42-1.00)
6-11
12
0.37 (0.19-0.70)
0.001
DASH diet
Range
Cases
HR*
Greek Mediterranean Index
Range
Cases
HR*
Italian Mediterranean Index
Range
Cases
HR*
*Adjusted for sex, smoking status, education, non-alcoholic energy intake and BMI; stratified for center and age (3year classes).
Hazard ratios (HR) for developing hemorrhagic stroke (cases=47) in
relation to adherence to the Healthy Eating Index (HEI 2005), the Dietary
Approaches to Stop Hypertension (DASH) diet, the Greek Mediterranean
Index and the Italian Mediterranean Index.
I
Tertile of intake
II
III
P trend
HEI 2005
Range
Cases
HR*
19-59
11
1
60-71
19
1.79 (0.84-3.81)
72-97
17
1.72 (0.78-3.79)
0.190
8-21
15
1
22-26
17
0.87 (0.42-1.77)
27-40
15
0.97 (0.45-2.07)
0.937
0-4
22
1
5
10
1.14 (0.53-2.45)
6-9
15
1.40 (0.70-2.81)
0.340
0-3
25
1
4-5
14
0.58 (0.30-1.14)
6-11
8
0.51 (0.22-1.20)
0.073
DASH diet
Range
Cases
HR*
Greek Mediterranean Index
Range
Cases
HR*
Italian Mediterranean Index
Range
Cases
HR*
*Adjusted for sex, smoking status, education, non-alcoholic energy intake and BMI; stratified for center and age (3year classes).
A priori - defined dietary patterns and the risk of acute
myocardial infarction in Italy. Results of the EPICOR
study.
Sara Grioni1, Vittorio Krogh1, Franco Berrino2, Claudia Agnoli1, Sabina Sieri1,
Benedetta Bendinelli 3, Giovanna Masala3, Carlotta Sacerdote4, Paolo Vineis5,
Rosario Tumino6, Graziella Frasca6, Valeria Pala1, Paolo Chiodini7, Amalia
Mattiello8, Salvatore Panico8
1 Nutritional Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
2 Etiological and Preventive Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
3 Molecular and Nutritional Epidemiology Unit, ISPO-Cancer Research and Prevention Institute, Florence,
Italy.
4 ISI Foundation and Department of Genetics, Biology and Biochemistry, University of Turin, Turin, Italy.
5 Imperial College London, UK, and University of Torino, Italy.
6 Cancer Registry Department of Oncology "Civile - M.P. Arezzo" Hospital, Ragusa, Italy.
7 Department of Medicine and Public Health, Second University of Naples, Naples, Italy.
8 Department of Clinical and Experimental Medicine, University of Naples Federico II, Naples, Italy.
HR for developing CHD (cases=396) in relation to Healthy Eating Index (HEI 2005),
Dietary Approaches to Stop Hypertension (DASH) diet, Greek Mediterranean Index
and new Italian Mediterranean Index.
Tertile of intake
I
II
III
P trend
19-59
152
1
60-71
130
0.99 (0.78-1.26)
72-97
114
1.02 (0.79-1.32)
0.895
HEI 2005
Range
Cases
HR**
DASH diet
Range
8-21
22-26
27-40
Cases
159
149
88
HR**
1
1.03 (0.82-1.30) 0.84 (0.63-1.11)
0.290
Greek Mediterranean Index
Range
0-4
5
6-9
Cases
195
86
115
HR**
1
1.03(0.79-1.33) 0.91(0.72-1.17)
0.502
Italian Mediterranean Index
Range
0-3
4-5
6-11
Cases
167
161
68
HR**
1
1.04 (0.84-1.30) 0.76 (0.57-1.02)
0.135
** Adjusted by BMI category, smoking, education, sex, energy not from alcohol. Stratified by age and center.
HR for developing CHD (cases=126) in relation to Healthy Eating Index
(HEI 2005), Dietary Approaches to Stop Hypertension (DASH) diet, Greek
Mediterranean Index and new Italian Mediterranean Index. Women
Tertile of intake
I
II
III
P trend
20-61
43
1
62-73
38
0.88 (0.56-1.38)
74-97
45
1.03 (0.66-1.62)
0.882
HEI 2005
Range
Cases
HR**
DASH diet
Range
8-22
23-26
27-40
Cases
43
44
39
HR**
1
1.16 (0.75-1.78) 0.77 (0.48-1.23)
0.274
Greek Mediterranean Index
Range
0-4
5
6-9
Cases
61
28
37
HR**
1
1.07(0.67-1.70) 0.97 (0.62-1.52)
0.925
Italian Mediterranean Index
Range
0-3
4-5
6-11
Cases
45
58
23
HR**
1
1.05 (0.70-1.57) 0.58 (0.34-0.99)
0.07
** Adjusted by BMI category, smoking, education, energy not from alcohol. Stratified by age and center.
HR for developing CHD (cases=266) in relation to Healthy Eating Index
(HEI 2005), Dietary Approaches to Stop Hypertension (DASH) diet, Greek
Mediterranean Index and new Italian Mediterranean Index. Men
Tertile of intake
I
II
III
P trend
21-56
99
1
57-67
82
0.92 (0.68-1.23)
68-93
85
0.90 (0.66-1.21)
0.474
8-21
94
1
22-25
99
1.26 (0.94-1.68)
26-40
73
0.94 (0.69-1.30)
0.810
0-4
132
1
5
57
1.02(0.74-1.40)
6-9
77
0.89(0.66-1.19)
0.457
0-3
127
1
4
55
0.90 (0.65-1.24)
5-11
84
0.88 (0.65-1.24)
0.383
HEI 2005
Range
Cases
HR**
DASH diet
Range
Cases
HR**
Greek Mediterranean Index
Range
Cases
HR**
Italian Mediterranean Index
Range
Cases
HR**
** Adjusted by BMI category, smoking, education, energy not from alcohol. Stratified by age and center.
Different measures of body mass and risk of coronary
events a large Mediterranean cohort of men and
women: findings from the EPICOR Study.
Paolo Chiodini1, Amalia Mattiello2, Vittorio Krogh3, Claudia Agnoli3, Sabina Sieri3,
Franco Berrino4, Maria Santucci de Magistris2, Carlotta Sacerdote5, Paolo Vineis6,
Domenico Palli7, Giovanna Masala7, Rosario Tumino8, Graziella Frasca8, Salvatore
Panico2.
1Department of Medicine and Public Health, Second University of Naples, Naples, Italy.
2Department of Clinical and Experimental Medicine, University of Naples Federico II, Naples, Italy.
3Nutritional Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
4 Etiological and Preventive Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
5ISI Foundation and Department of Genetics, Biology and Biochemistry, University of Turin, Turin, Italy.
6Imperial College London, UK, and University of Torino, Italy.
7Molecular and Nutritional Epidemiology Unit, ISPO-Cancer Research and Prevention Institute, Florence, Italy.
8Cancer Registry Department of Oncology "Civile - M.P. Arezzo" Hospital, Ragusa, Italy.
WHR and risk of CHD - EPICOR
1.50 2.00
0.50
1.00
Hazard Ratio
1.00
0.50
Age-adjusted
Multivariate
Multivariate+BMI
0.25
Age-adjusted
Multivariate
Multivariate+BMI
0.25
Hazard Ratio
1.50 2.00
3.00 4.00
Women
3.00 4.00
Men
1
2
3
Quartiles of WHR
4
1
2
3
Quartiles of WHR
4
Total antioxidant capacity of the diet and risk of stroke:
findings from the EPICOR prospective cohort study.
Daniele Del Rio1, Claudia Agnoli2, Nicoletta Pellegrini1*, Vittorio Krogh2, Furio
Brighenti1, Teresa Mazzeo1, Giovanna Masala3, Benedetta Bendinelli3, Franco
Berrino2, Sabina Sieri2, Rosario Tumino4, Patrizia Concetta Rollo4, Valentina Gallo5,6,
Carlotta Sacerdote6, Amalia Mattiello7, Paolo Chiodini8, Salvatore Panico7
1Department
of Public Health, University of Parma, 43100 Italy.
Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, 20133 Italy.
3Molecular and Nutritional Epidemiology Unit ISPO -Cancer Prevention and Research Institute, Florence, Italy.
4Cancer Registry, Azienda Ospedaliera "Civile - M.P.Arezzo", Ragusa, Italy.
5Imperial College London, Department of Epidemiology and Public Health, UK.
6ISI Foundation, Turin, Italy.
7Dipartimento di Medicina Clinica e Sperimentale, Università “Federico II”, Napoli, Italy.
8Dipartimento di Medicina Pubblica, Clinica e Preventiva, Seconda Università, Napoli, Italy
2Nutritional
Dietary antioxidant capacity, single antioxidants
and hazard ratio (HR)* for developing
cerebrovascular disease
Antioxidants by tertile
TAC
1st
2nd
3rd
P for trend
Vitamin C
1st
2nd
3rd
P for trend
β-carotene
st
1
2nd
3rd
P for trend
Vitamin E
1st
2nd
3rd
P for trend
All types of stroke
Ischemic stroke
Hemorrhagic stroke
Median
Cases, n HR (95% CI) Cases, n HR (95% CI) Cases, n HR (95% CI)
daily intake
mmol of Trolox equivalents
3.96
61
1
40
1
11
1
6.06
66
0.94 (0.65-1.37)
34
0.67 (0.41-1.10)
21
2.08 (0.96-4.48)
8.60
69
39
16
1.53 (0.59-3.96)
0.62 (0.40-0.98)
0.41 (0.23-0.74)
0.419
0.035
0.003
mg
83
132
201
73
65
58
1
0.93 (0.65-1.31)
0.90 (0.61-1.33)
0.603
48
35
30
1
0.71 (0.45-1.12)
0.59 (0.35-0.99)
0.050
12
18
18
1
1.74 (0.81-3.72)
2.02 (0.88-4.72)
0.115
µg
1828
2952
4790
67
70
59
1
1.14 (0.80-1.62)
0.96 (0.65-1.42)
0.736
41
39
33
1
1.00 (0.63-1.59)
0.81 (0.48-1.34)
0.373
12
18
18
1
1.59 (0.74-3.39)
1.57 (0.70-3.52)
0.343
mg
5.85
8.06
10.97
65
67
64
1
1.13 (0.78-1.64)
1.05 (0.66-1.67)
0.874
38
39
36
1
0.96 (0.59-1.56)
0.71 (0.38-1.33)
0.267
12
17
1
1.98 (0.88-4.44)
3.03 (1.17-7.85)
0.025
*Adjusted for hypertension, smoking status, education, non alcohol energy intake, alcohol drinking, waist circumference and obesity; stratified by sex, age, center.
Fruit, vegetables, olive oil and risk of coronary heart
disease (CHD) in Italian women: the EPICOR study
Benedetta Bendinelli1, Giovanna Masala1, Melania Assedi1, Simonetta Salvini1,
Calonico C1, Carlotta Sacerdote2, Sabina Sieri3, Graziella Frasca4, Amalia
Mattiello5, Paolo Chiodini6, Rosario Tumino4, Paolo Vineis7, Vittorio Krogh3,
Domenico Palli1 , Salvatore Panico5
Molecular and Nutritional Epidemiology Unit Cancer Prevention and Research Institute (ISPO), Florence, Italy
ISI Foundation and Department of Genetics, Biology and Biochemistry, University of Turin , Turin, Italy
3 Nutritional Epidemiology Unit, Fondazione IRCSS Istituto Nazionale dei Tumori, Milan, Italy
4 Cancer Registry and Histopathology Unit, “ Civile –M.P. Arezzo” , Ragusa, Italy
5 Department of Clinical and Experimental Medicine University Federico II, Naples, Italy
6 Department of Medicine and Public Health, Second University of Naples, Naples, Italy.
7 Imperial College London, UK, and University of Turin, Italy.
1
2
•A reduction in CHD risk among women in the highest
quartile of intake of leafy vegetables (HR=0.59; 95%CI
0.36-0.97) was shown.
•After further adjustment for red meat consumption the
risk reduction in CHD for increasing consumption of
leafy vegetables was more evident (p-value for
trend=0.03).
•Suggestion of a protective effect of olive oil was found
(p-value for trend=0.06).