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Dietary intakes of retinol, β-carotene, vitamin D and vitamin E in the European Prospective Investigation into Cancer and Nutrition cohort

European Journal of Clinical Nutrition volume 63, pages S150–S178 (2009)Cite this article

Abstract

Objectives:

To describe the intake of the fat-soluble nutrients retinol, β-carotene, vitamin E and vitamin D and their food sources among 27 redefined centres in 10 countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study.

Methods:

Between 1995 and 2000, 36 034 subjects (age range: 35–74 years) completed a single standardized 24-h dietary recall using a computerized interview software program (EPIC-SOFT). Intakes of the fat-soluble nutrients were estimated using the standardized EPIC Nutrient Database.

Results:

For all the nutrients, in most centres, men had a higher level of intake than did women, even after adjustments for total energy intake and anthropometric confounders. Distinct regional gradients from northern to southern European countries were observed for all nutrients. The level intake of β-carotene and vitamin E also showed some differences by level of education, smoking status and physical activity. No meaningful differences in the nutrient intake were observed by age range.

Conclusions:

These results show differences by study centre, gender, age and various lifestyle variables in the intake of retinol, β-carotene, vitamin E and vitamin D between 10 European countries.

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References

  • Agudo A, Slimani N, Ocke MC, Naska A, Miller AB, Kroke A et al. (2002). Consumption of vegetables, fruit and other plant foods in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohorts from 10 European countries. Public Health Nutr 5, 1179–1196.

    Article  CAS  Google Scholar 

  • Al-Delaimy WK, van Kappel AL, Ferrari P, Slimani N, Steghens JP, Bingham S et al. (2004). Plasma levels of six carotenoids in nine European countries: Report from the European Prospective Investigation into Cancer and Nutrition (EPIC). Public Health Nutr 7, 713–722.

    Article  Google Scholar 

  • Al-Delaimy WK, Ferrari P, Slimani N, Pala V, Johansson I, Nilsson S et al. (2005a). Plasma carotenoids as biomarkers of intake of fruits and vegetables: individual-level correlations in the European Prospective Investigation into Cancer and Nutrition (EPIC). Eur J Clin Nutr 59, 1387–1396.

    Article  CAS  Google Scholar 

  • Al-Delaimy WK, Slimani N, Ferrari P, Key T, Spencer E, Johansson I et al. (2005b). Plasma carotenoids as biomarkers of intake of fruits and vegetables: ecological-level correlations in the European Prospective Investigation into Cancer and Nutrition (EPIC). Eur J Clin Nutr 59, 1397–1408.

    Article  CAS  Google Scholar 

  • Ali MM, Vaidya V (2007). Vitamin D and cancer. J Cancer Res Ther 3, 225–230.

    Article  CAS  Google Scholar 

  • Bingham S, Riboli E (2004). Diet and cancer—the European Prospective Investigation into Cancer and Nutrition. Nat Rev Cancer 4, 206–215.

    Article  CAS  Google Scholar 

  • Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, Gluud C (2008). Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases. Cochrane Database Systematic Review 2, CD007176.

    Google Scholar 

  • Brustad M, Skeie G, Braaten T, Slimani N, Lund E (2003). Comparison of telephone vs face-to-face interviews in the assessment of dietary intake by the 24 h recall EPIC SOFT program—the Norwegian calibration study. Eur J Clin Nutr 57, 107–113.

    Article  CAS  Google Scholar 

  • Brustad M, Alsaker E, Engelsen O, Aksnes L, Lund E (2004). Vitamin D status of middle-aged women at 65–71 degrees N in relation to dietary intake and exposure to ultraviolet radiation. Public Health Nutr 7, 327–335.

    CAS  PubMed  Google Scholar 

  • Constantinou C, Papas A, Constantinou AI (2008). Vitamin E and cancer: an insight into the anticancer activities of vitamin E isomers and analogs. Int J Cancer 123, 739–752.

    Article  CAS  Google Scholar 

  • Debier C, Larondelle Y (2005). Vitamins A and E: metabolism, roles and transfer to offspring. Br J Nutr 93, 153–174.

    Article  CAS  Google Scholar 

  • Dunnigan MG, Henderson JB, Hole DJ, Barbara ME, Berry JL (2005). Meat consumption reduces the risk of nutritional rickets and osteomalacia. Br J Nutr 94, 983–991.

    Article  CAS  Google Scholar 

  • Fairfield KM, Fletcher RH (2002). Vitamins for chronic disease prevention in adults: scientific review. JAMA 287, 3116–3126.

    Article  CAS  Google Scholar 

  • Giovannucci E (2007). Epidemiological evidence for vitamin D and colorectal cancer. J Bone Miner Res 22 (Suppl 2), V81–V85.

    Article  CAS  Google Scholar 

  • Giovannucci E (2008). Vitamin D status and cancer incidence and mortality. Adv Exp Med Biol 624, 31–42.

    Article  CAS  Google Scholar 

  • Goodman GE, Alberts DS, Meyskens FL (2008). Retinol, vitamins, and cancer prevention: 25 years of learning and relearning. J Clin Oncol 26, 5495–5496.

    Article  Google Scholar 

  • Harris S (2008). Emerging roles of vitamin D: more reasons to address widespread vitamin D insufficiency. Mol Aspects Med 29, 359–360.

    Article  Google Scholar 

  • Heaney RP (2008). Vitamin D: criteria for safety and efficacy. Nutr Rev 66, S178–S181.

    Article  Google Scholar 

  • Holick MF (2002). Vitamin D: the underappreciated D-lightful hormone that is important for skeletal and cellular health. Curr Opin Endocrinol Diabetes 9, 87–98.

    Article  CAS  Google Scholar 

  • Holick MF (2005). The vitamin D epidemic and its health consequences. J Nutr 135, 2739S–2748S.

    Article  CAS  Google Scholar 

  • Holick MF (2007). Vitamin D deficiency. N Engl J Med 357, 266–281.

    Article  CAS  Google Scholar 

  • Jenab M, Riboli E, Ferrari P, Friesen M, Sabate J, Norat T et al. (2006). Plasma and dietary carotenoid, retinol and tocopherol levels and the risk of gastric adenocarcinomas in the European prospective investigation into cancer and nutrition. Br J Cancer 95, 406–415.

    Article  CAS  Google Scholar 

  • Kimlin MG (2008). Geographic location and vitamin D synthesis. Mol Aspects Med 29, 453–461.

    Article  CAS  Google Scholar 

  • Linseisen J, Bergstrom E, Gafa L, Gonzalez CA, Thiebaut A, Trichopoulou A et al. (2002a). Consumption of added fats and oils in the European Prospective Investigation into Cancer and Nutrition (EPIC) centres across 10 European countries as assessed by 24-hour dietary recalls. Public Health Nutr 5, 1227–1242.

    Article  CAS  Google Scholar 

  • Linseisen J, Kesse E, Slimani N, Bueno-De-Mesquita HB, Ocke MC, Skeie G et al. (2002b). Meat consumption in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohorts: results from 24-hour dietary recalls. Public Health Nutr 5, 1243–1258.

    Article  CAS  Google Scholar 

  • Linseisen J, Rohrmann S, Norat T, Gonzalez CA, Dorronsoro IM, Morote GP et al. (2006). Dietary intake of different types and characteristics of processed meat which might be associated with cancer risk–results from the 24-hour diet recalls in the European Prospective Investigation into Cancer and Nutrition (EPIC). Public Health Nutr 9, 449–464.

    Article  Google Scholar 

  • Love JM, Gudas LJ (1994). Vitamin A, differentiation and cancer. Curr Opin Cell Biol 6, 825–831.

    Article  CAS  Google Scholar 

  • Marceau G, Gallot D, Lemery D, Sapin V (2007). Metabolism of retinol during mammalian placental and embryonic development. Vitam Horm 75, 97–115.

    Article  CAS  Google Scholar 

  • McCullough FS, Northrop-Clewes CA, Thurnham DI (1999). The effect of vitamin A on epithelial integrity. Proc Nutr Soc 58, 289–293.

    Article  CAS  Google Scholar 

  • Miller III ER, Pastor-Barriuso R, Dalal D, Riemersma RA, Appel LJ, Guallar E (2005). Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality. Ann Intern Med 142, 37–46.

    Article  CAS  Google Scholar 

  • Mullie P, Gandini S, Boniol M, Autier P (2008). Latitude of residence in Europe and serum 25-hydroxy vitamin D levels: a systematic review. In: Vitamin D and Cancer. IARC Working Group Reports, vol. 5. WHO-International Agency for Research on Cancer, Lyon. pp 201–210.

  • Nesby-O'Dell S, Scanlon KS, Cogswell ME, Gillespie C, Hollis BW, Looker AC et al. (2002). Hypovitaminosis D prevalence and determinants among African American and white women of reproductive age: third National Health and Nutrition Examination Survey, 1988–1994. Am J Clin Nutr 76, 187–192.

    Article  CAS  Google Scholar 

  • Palace VP, Khaper N, Qin Q, Singal PK (1999). Antioxidant potentials of vitamin A and carotenoids and their relevance to heart disease. Free Radic Biol Med 26, 746–761.

    Article  CAS  Google Scholar 

  • Riboli E, Kaaks R (1997). The EPIC Project: rationale and study design. European Prospective Investigation into Cancer and Nutrition. Int J Epidemiol 26 (Suppl 1), S6–S14.

    Article  Google Scholar 

  • Riboli E, Hunt KJ, Slimani N, Ferrari P, Norat T, Fahey M et al. (2002). European Prospective Investigation into Cancer and Nutrition (EPIC): study populations and data collection. Public Health Nutr 5, 1113–1124.

    Article  CAS  Google Scholar 

  • Singh U, Devaraj S, Jialal I (2005). Vitamin E, oxidative stress, and inflammation. Annu Rev Nutr 25, 151–174.

    Article  CAS  Google Scholar 

  • Skeie G, Braaten T, Hjartåker A, Lentjes M, Amiano P, Jakszyn P et al. (2009). Use of dietary supplements in the European Prospective Investigation into Cancer and Nutrition calibration study. Eur J Clin Nutr 63 (Suppl 4), S226–S238.

    Article  CAS  Google Scholar 

  • Slimani N, Deharveng G, Charrondiere RU, van Kappel AL, Ocke MC, Welch A et al. (1999). Structure of the standardized computerized 24-h diet recall interview used as reference method in the 22 centers participating in the EPIC project. European Prospective Investigation into Cancer and Nutrition. Comput Methods Programs Biomed 58, 251–266.

    Article  CAS  Google Scholar 

  • Slimani N, Ferrari P, Ocke M, Welch A, Boeing H, Liere M et al. (2000). Standardization of the 24-h diet recall calibration method used in the European prospective investigation into cancer and nutrition (EPIC): general concepts and preliminary results. Eur J Clin Nutr 54, 900–917.

    Article  CAS  Google Scholar 

  • Slimani N, Kaaks R, Ferrari P, Casagrande C, Clavel-Chapelon F, Lotze G et al. (2002a). European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study: rationale, design and population characteristics. Public Health Nutr 5, 1125–1145.

    Article  CAS  Google Scholar 

  • Slimani N, Fahey M, Welch AA, Wirfalt E, Stripp C, Bergstrom E et al. (2002b). Diversity of dietary patterns observed in the European Prospective Investigation into Cancer and Nutrition (EPIC) project. Public Health Nutr 5, 1311–1328.

    Article  CAS  Google Scholar 

  • Slimani N, Deharveng G, Unwin I, Southgate DA, Vignat J, Skeie G et al. (2007). The EPIC nutrient database project (ENDB): a first attempt to standardize nutrient databases across the 10 European countries participating in the EPIC study. Eur J Clin Nutr 61, 1037–1056.

    Article  CAS  Google Scholar 

  • Sommer A (2008). Vitamin A deficiency and clinical disease: an historical overview. J Nutr 138, 1835–1839.

    Article  CAS  Google Scholar 

  • Traber MG, Atkinson J (2007). Vitamin E, antioxidant and nothing more. Free Radic Biol Med 43, 4–15.

    Article  CAS  Google Scholar 

  • van der Wielen RP, Lowik MR, van den BH, de Groot LC, Haller J, Moreiras O et al. (1995). Serum vitamin D concentrations among elderly people in Europe. Lancet 346, 207–210.

    Article  CAS  Google Scholar 

  • Voutilainen S, Nurmi T, Mursu J, Rissanen TH (2006). Carotenoids and cardiovascular health. Am J Clin Nutr 83, 1265–1271.

    Article  CAS  Google Scholar 

  • Wallis DE, Penckofer S, Sizemore GW (2008). The ‘sunshine deficit’ and cardiovascular disease. Circulation 118, 1476–1485.

    Article  Google Scholar 

  • Welch AA, Lund E, Amiano P, Dorronsoro M, Brustad M, Kumle M et al. (2002). Variability of fish consumption within the 10 European countries participating in the European Investigation into Cancer and Nutrition (EPIC) study. Public Health Nutr 5, 1273–1285.

    Article  CAS  Google Scholar 

  • Yetley EA (2008). Assessing the vitamin D status of the US population. Am J Clin Nutr 88, 558S–564S.

    Article  CAS  Google Scholar 

  • Zittermann A, Schleithoff SS, Koerfer R (2005). Putting cardiovascular disease and vitamin D insufficiency into perspective. Br J Nutr 94, 483–492.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The work described in this paper was carried out with the financial support of the European Commission: Public Health and Consumer Protection Directorate 1993–2004; Research Directorate-General 2005; Ligue contre le Cancer (France); Société 3M (France); Mutuelle Générale de l’Education Nationale; Institut National de la Santé et de la Recherche Médicale (INSERM); Institut Gustave Roussy; German Cancer Aid; German Cancer Research Center; German Federal Ministry of Education and Research; Danish Cancer Society; Health Research Fund (FIS) of the Spanish Ministry of Health; Spanish Regional Governments of Andalucía, Asturias, Basque Country, Murcia and Navarra and the Catalan Institute of Oncology; and ISCIII RETIC (RD06/0020), Spain; Cancer Research UK; Medical Research Council, UK; the Stroke Association, UK; British Heart Foundation; Department of Health, UK; Food Standards Agency, UK; the Wellcome Trust, UK; Greek Ministry of Health; Hellenic Health Foundation; Italian Association for Research on Cancer; Italian National Research Council, Regione Sicilia (Sicilian government); Associazione Iblea per la Ricerca Epidemiologica - ONLUS (Hyblean association for epidemiological research, NPO); Dutch Ministry of Health, Welfare and Sport; Dutch Prevention Funds; LK Research Funds; Dutch ZON (Zorg Onderzoek Nederland); World Cancer Research Fund (WCRF); Swedish Cancer Society; Swedish Research Council; Regional Government of Skane and the County Council of Vasterbotten, Sweden; Norwegian Cancer Society; the Norwegian Research Council and the Norwegian Foundation for Health and Rehabilitation. We thank Sarah Somerville, Nicole Suty and Karima Abdedayem for their assistance with editing and Kimberley Bouckaert and Heinz Freisling for their technical assistance.

Author information

Author notes

  1. J Linseisen

    Present address: 26Current address: Institute of Epidemiology, Helmholtz Centre Munich, Neuherberg, Germany.,

  2. P Ferrari

    Present address: 27Current address: Data Collection and Exposure Unit (DATEX), European Food Safety Authority, Parma, Italy.,

  3. A A Welch

    Present address: 28Current address: School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK.,

  4. S Bingham: The author is deceased.

Authors and Affiliations

  1. Lifestyle and Cancer Group, International Agency for Research on Cancer, Lyon, France

    M Jenab & P Ferrari

  2. Molecular and Nutritional Epidemiology Unit, ISPO, Florence, Italy

    S Salvini

  3. Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands

    C H van Gils & Y T van der Schouw

  4. Institute of Community Medicine, University of Tromsø, Tromsø, Norway

    M Brustad, E Lund & M Waaseth

  5. Strangeways Research Laboratory, University of Cambridge, Cambridge, UK

    S Shakya-Shrestha

  6. Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany

    B Buijsse & H Boeing

  7. National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands

    H Verhagen & H B Bueno-de-Mesquita

  8. Inserm, ERI 20, Institut Gustave Roussy, Villejuif, France

    M Touvier, M C Boutron-Ruault & M Niravong

  9. AFSSA (French Food Safety Agency), DERNS/PASER, Maisons-Alfort, France

    M Touvier

  10. Dietary Exposure Assessment Group, International Agency for Research on Cancer, Lyon, France

    C Biessy, K Bouckaert & N Slimani

  11. Department of Clinical Sciences, Lund University, Malmö, Sweden

    P Wallström

  12. Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark

    N Roswall

  13. Department of Cardiology, Center for Cardiovascular Research, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark

    A M Joensen

  14. Division of Clinical Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany

    J Linseisen

  15. Department of Hygiene and Epidemiology, University of Athens Medical School, Athens, Greece

    E Vasilopoulou & V Dilis

  16. Nutritional Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    S Sieri

  17. Institute for Scientific Interchange Foundation, Turin, Italy

    C Sacerdote

  18. Department of Surgery, Malmö University Hospital, Malmö, Sweden

    J Manjer

  19. Department of Nutritional Research, University of Umeå, Umeå, Sweden

    S Nilsson

  20. Department of Public Health and Primary Care, MRC Centre for Nutritional Epidemiology in Cancer Prevention and Survival (CNC), Cambridge, UK

    A A Welch & S Bingham

  21. Cancer Research UK Epidemiology Unit, University of Oxford, Oxford, UK

    R Travis

  22. Epidemiology Department, Murcia Health Council, Murcia

    M J Tormo

  23. CIBER Epidemiología y Salud Pública (CIBERESP), Spain

    M J Tormo

  24. Institute of Public Health of Navarra, Pamplona, Spain

    A Barricarte

  25. Department of Epidemiology, Public Health and Primary Care, Imperial College, London, UK

    E Riboli

  26. Diet and Cancer Group, MRC Dunn Mitochondrial Biology Unit, Cambridge, UK

    S Bingham

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  1. M Jenab
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  2. S Salvini
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  35. N Slimani
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Corresponding author

Correspondence to M Jenab.

Additional information

Guarantors: M Jenab.

Contributors: MJ carried out the statistical analysis, preparation of tables and figures, and wrote the paper, taking into account the comments from all co-authors. NS was the overall coordinator of this project and the EPIC Nutrient Database project. CB assisted in the statistical analysis and preparation of the tables and figures. SS, CHvG, MB, SS-S, BB, HV, MT, CB and PW were members of the writing group and gave inputs on the statistical analysis, drafting of the manuscript and interpretation of the results. EL, MW, NR, AMJ, JL, HB, EV, VD, SS, CS, PF, JM, SN, AAW, RT, MCB-R, MN, HBB-de-M, YTvdS, MJT, AB, ER and SB were local EPIC collaborators involved in the collection of dietary and other data, and contributed to the ENDB project. ER is the overall coordinator of the EPIC study. All co-authors provided comments and suggestions on the paper and approved the final version.

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Jenab, M., Salvini, S., van Gils, C. et al. Dietary intakes of retinol, β-carotene, vitamin D and vitamin E in the European Prospective Investigation into Cancer and Nutrition cohort. Eur J Clin Nutr 63 (Suppl 4), S150–S178 (2009). https://doi.org/10.1038/ejcn.2009.79

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