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Background: Alcohol is a risk factor for cancer of the oral cavity, pharynx, oesophagus, colorectum, liver, larynx and female breast, whereas its impact on other cancers remains controversial. Methods: We investigated the effect of alcohol on 23 cancer types through a meta-analytic approach. We used dose–response meta-regression models and investigated potential sources of heterogeneity. Results: A total of 572 studies, including 486 538 cancer cases, were identified. Relative risks (RRs) for heavy drinkers compared with nondrinkers and occasional drinkers were 5.13 for oral and pharyngeal cancer, 4.95 for oesophageal squamous cell carcinoma, 1.44 for colorectal, 2.65 for laryngeal and 1.61 for breast cancer; for those neoplasms there was a clear dose–risk relationship. Heavy drinkers also had a significantly higher risk of cancer of the stomach (RR 1.21), liver (2.07), gallbladder (2.64), pancreas (1.19) and lung (1.15). There was indication of a positive association between alcohol consumption and risk of melanoma and prostate cancer. Alcohol consumption and risk of Hodgkin’s and Non-Hodgkin’s lymphomas were inversely associated. Conclusions: Alcohol increases risk of cancer of oral cavity and pharynx, oesophagus, colorectum, liver, larynx and female breast. There is accumulating evidence that alcohol drinking is associated with some other cancers such as pancreas and prostate cancer and melanoma.

Aims/hypothesis The role of diet in the prevention of diabetes remains uncertain. The aim of this study was to investigate two different dietary aspects, i.e. adherence to the Mediterranean diet and glycaemic load (GL), in relation to diabetes occurrence. Methods We analysed data from the Greek cohort of the population-based European Prospective Investigation into Cancer and Nutrition (EPIC). From a total of 22,295 participants, actively followed for a median of 11.34 years, 2,330 cases of incident type 2 diabetes were recorded. All participants completed a validated, interviewer-administered semi-quantitative food frequency questionnaire at enrolment. From this information, we calculated a ten point Mediterranean diet score (MDS), reflecting adherence to the traditional Mediterranean diet, as well as the dietary GL. We estimated HRs and the corresponding 95% CIs of diabetes using Cox proportional hazards regression models adjusted for potential confounders. Results A higher MDS was inversely associated with diabetes risk (HR 0.88 [95% CI 0.78, 0.99] for MDS ≥6 vs MDS ≤3). GL was positively associated with diabetes (HR 1.21 [95% CI 1.05, 1.40] for the highest vs the lowest GL quartile). A significant protection of about 20% was found for a diet with a high MDS and a low GL. Conclusions/interpretation A low GL diet that also adequately adheres to the principles of the traditional Mediterranean diet may reduce the incidence of type 2 diabetes.

Background: Hepatocellular carcinoma (HCC) has been associated to diabetes and obesity, but a possible association with the metabolic syndrome (MetS) and its potential interaction with hepatitis is open to discussion. Methods: We analysed data from an Italian case–control study, including 185 HCC cases and 404 controls. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed from unconditional logistic regression models. Results: Among the MetS components, diabetes and obesity (i.e, body mass index (BMI)⩾30 kg m −2 ) were positively associated to HCC risk, with ORs of 4.33 (95% CI, 1.89–9.86) and 1.97 (95% CI, 1.03–3.79), respectively. The ORs for the MetS were 4.06 (95% CI, 1.33–12.38) defining obesity as BMI⩾25, and 1.92 (95% CI, 0.38–9.76) defining it as BMI⩾30. The risk increased with the number of MetS components, up to an almost four-fold excess risk among subjects with ⩾2 MetS factors. Among subjects without chronic infection with hepatitis B and/or C, the OR for those with ⩾2 MetS components was over six-fold elevated. There was no consistent association in subjects with serological evidence of hepatitis B and/or C infection. Conclusion: This study found that the risk of HCC increases with the number of MetS components in subjects not chronically infected with hepatitis viruses.

Lipases are promising enzymes that catalyze the hydrolysis of triacylglycerol ester bonds at the oil/water interface. Apart from allowing biocatalyst reuse, immobilization can also affect enzyme structure consequently influencing its activity, selectivity, and stability. The lipase from Penicillium sp. section Gracilenta (CBMAI 1583) was successfully immobilized on supports bearing butyl, phenyl, octyl, octadecyl, and divinylbenzyl hydrophobic moieties wherein lipases were adsorbed through the highly hydrophobic opened active site. The highest activity in aqueous medium was observed for the enzyme adsorbed on octyl support, with a 150% hyperactivation regarding the soluble enzyme activity, and the highest adsorption strength was verified with the most hydrophobic support (octadecyl Sepabeads), requiring 5% Triton X-100 to desorb the enzyme from the support. Most of the derivatives presented improved properties such as higher stability to pH, temperature, and organic solvents than the covalently immobilized CNBr derivative (prepared under very mild experimental conditions and thus a reference mimicking free-enzyme behavior). A 30.8- and 46.3-fold thermostabilization was achieved in aqueous medium, respectively, by the octyl Sepharose and Toyopearl butyl derivatives at 60 °C, in relation to the CNBr derivative. The octyl- and phenyl-agarose derivatives retained 50% activity after four and seven cycles of p-nitrophenyl palmitate hydrolysis, respectively. Different derivatives exhibited different properties regarding their properties for fish oil hydrolysis in aqueous medium and ethanolysis in anhydrous medium. The most active derivative in ethanolysis of fish oil was the enzyme adsorbed on a surface covered by divinylbenzyl moieties and it was 50-fold more active than the enzyme adsorbed on octadecyl support. Despite having identical mechanisms of immobilization, different hydrophobic supports seem to promote different shapes of the adsorbed open active site of the lipase and hence different functional properties.

Background: The Mediterranean diet has been shown to have a beneficial role on various neoplasms, but data are scanty on pancreatic cancer. Methods: We analysed data from two case–control studies conducted in Italy between 1983 and 2008, including 362 and 326 pancreatic cancer cases and 1552 and 652 hospital-controls, respectively. A Mediterranean Diet Score (MDS) summarising major characteristics of the Mediterranean diet was used in the two studies separately and overall. Two further scores of adherence to the Mediterranean diet were applied in the second study only, the Mediterranean Dietary Pattern Adherence Index (MDP) and the Mediterranean Adequacy Index (MAI). Results: Odds ratios (ORs) for increasing levels of the scores (i.e., increasing adherence) were estimated using multiple logistic regression models. Odds ratio for a MDS score ⩾6 compared with <3 was 0.57 (95% confidence interval (CI) 0.34–0.95) in the first study, 0.51 (95% CI 0.29–0.92) in the second study, and 0.48 (95% CI 0.35–0.67) overall. A trend of decreasing risk was observed also for the MDP and MAI the ORs for the highest vs the lowest quintile being 0.44 (95% CI 0.27–0.73) for MDP and 0.68 (95% CI 0.42–1.11) for the MAI. The results were consistent across strata of age, sex, education, body mass index, alcohol drinking, tobacco smoking, and diabetes. Conclusion: Our study provides evidence that a priori -defined scores measuring adherence to the Mediterranean diet are favourably associated with pancreatic cancer risk.

Background: Evidence for the possible effect of vitamin E on head and neck cancers (HNCs) is limited. Methods: We used individual-level pooled data from 10 case–control studies (5959 cases and 12 248 controls) participating in the International Head and Neck Cancer Epidemiology (INHANCE) consortium to assess the association between vitamin E intake from natural sources and cancer of the oral cavity/pharynx and larynx. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using unconditional logistic regression models applied to quintile categories of nonalcohol energy-adjusted vitamin E intake. Results: Intake of vitamin E was inversely related to oral/pharyngeal cancer (OR for the fifth vs the first quintile category=0.59, 95% CI: 0.49–0.71; P for trend <0.001) and to laryngeal cancer (OR=0.67, 95% CI: 0.54–0.83, P for trend <0.001). There was, however, appreciable heterogeneity of the estimated effect across studies for oral/pharyngeal cancer. Inverse associations were generally observed for the anatomical subsites of oral and pharyngeal cancer and within covariate strata for both sites. Conclusion: Our findings suggest that greater vitamin E intake from foods may lower HNC risk, although we were not able to explain the heterogeneity observed across studies or rule out certain sources of bias.

Background: Diabetes mellitus has been associated with an increased risk of bladder cancer, although the evidence is still open to discussion. Methods: We examined this association using data from a multicentre Italian case–control study, conducted between 2003 and 2014 on 690 bladder cancer cases and 665 frequency-matched hospital controls. Odds ratios (ORs) for diabetes were estimated by unconditional multiple logistic regression models, after allowance for major known risk factors for bladder cancer. Results: One hundred and twelve (16.2%) cases and 57 (8.6%) controls reported a diagnosis of diabetes mellitus, corresponding to a multivariate OR of 2.09 (95% confidence interval (CI): 1.46–3.01). Bladder cancer risk increased with duration of diabetes (OR 1.92 for 1–<5 years, 1.63 for 5–<10 years, 2.39 for 10–<15 years, and 2.58 for ⩾15 years). The increased risk of bladder cancer was consistent in strata of age and education, whereas it was somewhat lower (although not significantly) in women (OR 1.18), in never (OR 1.31) and current (OR 1.42) smokers, and in subjects with a body mass index <25 kg m −2 (OR 1.48). Conclusion: The present study provides further support of a role of diabetes in bladder cancer aetiology, although some residual confounding by tobacco, body mass index, or other unmeasured covariates may partly explain the association observed.

Inconsistent results on the relationship between alcohol drinking and prostate cancer have been found. In order to provide a definite quantification of the dose–risk relation, we investigated the risk of prostate cancer at different levels of alcohol consumption, by conducting a meta-analysis of epidemiological studies. We performed a literature search using PubMed of all case–control and cohort studies published as original articles in English up to December 2010. We identified 50 case–control and 22 cohort studies, including a total of 52 899 prostate cancer cases. We derived pooled meta-analytic estimates using random-effects models, taking into account the correlation between estimates. We performed a dose–risk analysis using nonlinear random-effects meta-regression models. The overall relative risk for any alcohol drinking compared with non/occasional drinking was 1.06 [95% confidence interval (CI), 1.01–1.10]. The relative risks were 1.05 (95% CI, 1.02–1.08), 1.06 (95% CI, 1.01–1.11), and 1.08 (95% CI, 0.97–1.20) for light (≤ 1 drink/day), moderate (>1 to <4 drinks/day), and heavy alcohol drinking (≥ 4 drinks/day), respectively. This comprehensive meta-analysis provided no evidence of a material association between alcohol drinking and prostate cancer, even at high doses.

Background/Objective: The European Food Safety Authority (EFSA) recently published dietary guidelines for the intakes of carbohydrates, fiber, fats and water. We evaluated their role on the risk of a specific disease, known to be related to diet. Subjects/Methods: We used data from an Italian case-control study including 1953 colorectal cancer (CRC) cases and 4154 controls. We developed a so-called EFSA index summing up 1 point for adherence to each EFSA guideline. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) of CRC and its subsites were derived from unconditional multiple logistic regression models, for both the index and its components. Results: When each EFSA index component was analyzed separately, we found significant increased risks of CRC for non adherence to the guidelines on linoleic (OR=1.20, 95% CI, 1.07–1.36) and alpha-linolenic fatty acids (OR=1.19, 95% CI, 1.06–1.34). When all the guidelines were included in the same model, no significant association emerged. Compared with minimal adherence, the ORs of CRC for subsequent EFSA index scores were 1.03 (95% CI, 0.72–1.47), 1.05 (95% CI, 0.75–1.48), 1.04 (95% CI, 0.81–1.60), 0.99 (95% CI, 0.69–1.43), and 1.04 (95% CI, 0.67–1.61). No significant association emerged for colon and rectal cancer separately, and for males and females. Conclusions: Overall adherence to the EFSA dietary guidelines is not associated to colorectal, colon and rectal cancer risk in our population. Adherence to guidelines on linoleic and alpha-linolenic fatty acids may have a modest beneficial role on CRC risk.

Abstract Background In 2019, the EAT-Lancet Commission proposed a diet promoting plant-based foods, while reducing red meat and added sugars, aiming to improve health outcomes for both humans and the environment. Within the StoP Project, a global consortium of epidemiologic studies on gastric cancer (GC), we investigated the association between adherence to the EAT-Lancet Diet and the risk of GC. Methods We included four Southern European studies (two from Italy, one from Portugal and Spain) with available Food Frequency Questionnaire data and total energy intake (TEI). Adherence to the EAT-Lancet Diet was evaluated using four different indices: EAT-Lancet Index (EATL), Planetary Health Diet Indexes (PHDI) developed by Cacau and Bui, and World Index for Sustainability and Health (WISH). A two-stage approach was applied: study-specific odds ratios (ORs) for GC per 1-SD increase in score were estimated using multiple logistic regression models adjusted for confounders (age, sex, BMI, socioeconomic status, smoking, alcohol and TEI), and pooled using random-effects meta-analysis. Heterogeneity assessed with I². Results Among 6031 individuals (2271 cases, 3760 controls), 63.4% of cases and 54.2% of controls were male, with a mean age of 65.0 ± 11.1 and 60.2 ± 12.3 years, and BMI of 25.3 ± 4.1 of 26.3 ± 4.3 kg/m², respectively. Low socioeconomic status was 78.9% and 57.4%, never smokers 43.7% and 47.2%, and intermediate alcohol consumers 54.4% and 44.7%, respectively. Higher adherence to EAT-Lancet Diet was associated with lower GC risk across all indices: EATL (OR = 0.92; 95% CI: 0.85-0.99; I² = 0.0%), PHDI by Cacau (OR = 0.87; 95% CI: 0.81-0.94; I² = 0.0%), PHDI by Bui (OR = 0.81; 95% CI: 0.72-0.91; I² = 40.6%), and WISH (OR = 0.86; 95% CI: 0.79-0.93; I² = 0.0%). Conclusions Adherence to plant-based, sustainable dietary patterns may protect from GC. These results highlight the potential role of dietary changes in cancer prevention, particularly in reducing the burden of GC. Key messages • Sustainable dietary patterns are associated with a lower risk of gastric cancer in Southern Europe. • Diets rich in plant-based foods and low in red meat and added sugars may reduce the risk of gastric cancer.