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@ARTICLE{Kliemann:274185,
      author       = {N. Kliemann and F. Rauber and R. Bertazzi Levy and V.
                      Viallon and E. P. Vamos and R. Cordova and H. Freisling and
                      C. Casagrande and G. Nicolas and D. Aune and K. K. Tsilidis
                      and A. Heath and M. B. Schulze and F. Jannasch and B.
                      Srour$^*$ and R. Kaaks$^*$ and M. Rodriguez-Barranco and G.
                      Tagliabue and A. Agudo and S. Panico and E. Ardanaz and
                      M.-D. Chirlaque and P. Vineis and R. Tumino and A.
                      Perez-Cornago and J. L. M. Andersen and A. Tjønneland and
                      G. Skeie and E. Weiderpass and C. A. Monteiro and M. J.
                      Gunter and C. Millett and I. Huybrechts},
      title        = {{F}ood processing and cancer risk in {E}urope: results from
                      the prospective {EPIC} cohort study.},
      journal      = {The lancet / Planetary health},
      volume       = {7},
      number       = {3},
      issn         = {2542-5196},
      address      = {Amsterdam},
      publisher    = {Elsevier},
      reportid     = {DKFZ-2023-00480},
      pages        = {e219 - e232},
      year         = {2023},
      abstract     = {Food processing has been hypothesised to play a role in
                      cancer development; however, data from large-scale
                      epidemiological studies are scarce. This study investigated
                      the association between dietary intake according to amount
                      of food processing and risk of cancer at 25 anatomical sites
                      using data from the European Prospective Investigation into
                      Cancer and Nutrition (EPIC) study.This study used data from
                      the prospective EPIC cohort study, which recruited
                      participants between March 18, 1991, and July 2, 2001, from
                      23 centres in ten European countries. Participant
                      eligibility within each cohort was based on geographical or
                      administrative boundaries. Participants were excluded if
                      they had a cancer diagnosis before recruitment, had missing
                      information for the NOVA food processing classification, or
                      were within the top and bottom $1\%$ for ratio of energy
                      intake to energy requirement. Validated dietary
                      questionnaires were used to obtain information on food and
                      drink consumption. Participants with cancer were identified
                      using cancer registries or during follow-up from a
                      combination of sources, including cancer and pathology
                      centres, health insurance records, and active follow-up of
                      participants. We performed a substitution analysis to assess
                      the effect of replacing $10\%$ of processed foods and
                      ultra-processed foods with $10\%$ of minimally processed
                      foods on cancer risk at 25 anatomical sites using Cox
                      proportional hazard models.521 324 participants were
                      recruited into EPIC, and 450 111 were included in this
                      analysis (318 686 $[70·8\%]$ participants were female
                      individuals and 131 425 $[29·2\%]$ were male individuals).
                      In a multivariate model adjusted for sex, smoking,
                      education, physical activity, height, and diabetes, a
                      substitution of $10\%$ of processed foods with an equal
                      amount of minimally processed foods was associated with
                      reduced risk of overall cancer (hazard ratio 0·96, $95\%$
                      CI 0·95-0·97), head and neck cancers (0·80, 0·75-0·85),
                      oesophageal squamous cell carcinoma (0·57, 0·51-0·64),
                      colon cancer (0·88, 0·85-0·92), rectal cancer (0·90,
                      0·85-0·94), hepatocellular carcinoma (0·77, 0·68-0·87),
                      and postmenopausal breast cancer (0·93, 0·90-0·97). The
                      substitution of $10\%$ of ultra-processed foods with $10\%$
                      of minimally processed foods was associated with a reduced
                      risk of head and neck cancers (0·80, 0·74-0·88), colon
                      cancer (0·93, 0·89-0·97), and hepatocellular carcinoma
                      (0·73, 0·62-0·86). Most of these associations remained
                      significant when models were additionally adjusted for BMI,
                      alcohol and dietary intake, and quality.This study suggests
                      that the replacement of processed and ultra-processed foods
                      and drinks with an equal amount of minimally processed foods
                      might reduce the risk of various cancer types.Cancer
                      Research UK, l'Institut National du Cancer, and World Cancer
                      Research Fund International.},
      cin          = {C020},
      ddc          = {000},
      cid          = {I:(DE-He78)C020-20160331},
      pnm          = {313 - Krebsrisikofaktoren und Prävention (POF4-313)},
      pid          = {G:(DE-HGF)POF4-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:36889863},
      doi          = {10.1016/S2542-5196(23)00021-9},
      url          = {https://inrepo02.dkfz.de/record/274185},
}