Within the Seven Countries Study, we investigated whether population differences in 25-year cancer mortality and mortality due to cancer of the lung, stomach, and colorectum could be explained by population differences in adherence to the European Code Against Cancer. Baseline surveys were carried out around 1960 on 12,763 middle-aged men constituting 16 cohorts in seven countries; small samples of the cohorts kept dietary records. In 1987, food equivalent composites representing the average food intake of each cohort at baseline were collected locally and analyzed in one central laboratory. The vital status of all participants was verified after 25 years of follow-up. Overall adherence to the first four recommendations of the European Code Against Cancer was inversely related to 25-year total cancer mortality but not to all-cause mortality. The association with cancer mortality was essentially due to the inverse association for adherence to the guideline on smoking only. Each decrease in the percentage of smokers of 3.4% (10% of range) was associated with a relative risk of 0.93 of dying from cancer. Adherence to the recommendation on consumption of vegetables, fruits, and fiber-rich cereals was inversely related to stomach cancer mortality, whereas adherence to the recommendation on body weight, physical activity, and intake of fat was associated with higher stomach cancer mortality.
Bibliographical noteFunding Information:
The authors thank Annemarie Jansen, Ester Goddijn, Ronald Schlemper, Monique Verschuren, and Bennie Bloemberg for contributions to the collection and preparation of the equivalent food composites, Martijn B. Katan and his team (Dept. of Human Nutrition, Agricultural University, Wagen-ingen) for preparation and macronutrient analyses of the equivalent food composites, and the principal investigators who initiated the Seven Countries Study and, especially, Dr. Ancel Keys for initiative and efforts in continuing the study for >25 years. Financial support was received from the Europe Against Cancer Programme of the European Commission. Neither the European Commission nor any person acting on its behalf is liable for any use of the information in this article. Address reprint requests to Dr. Marga C. Ocké, Dept. of Chronic Disease and Environmental Epidemiology, National Institute of Public Health and the Environment, PO Box 1, NL-3720 BA Bilthoven, The Netherlands. FAX: +31 30 2744407. E-mail: MC.Ocke@rivm.nl.