Mediterranean Dietary Pattern is Associated with Low Risk of Aggressive Prostate Cancer: MCC-Spain Study

PURPOSE: We explored the association of the previously described Western, prudent and Mediterranean dietary patterns with prostate cancer risk by tumor aggressiveness and extension. MATERIALS AND METHODS: MCC-Spain (Multicase-Control Study on Common Tumors in Spain) is a population based, multicase-control study that was done in 7 Spanish provinces between September 2008 and December 2013. It collected anthropometric, epidemiological and dietary information on 754 histologically confirmed incident cases of prostate cancer and 1,277 controls 38 to 85 years old. Three previously identified dietary patterns, including Western, prudent and Mediterranean, were reconstructed using MCC-Spain data. The association of each pattern with prostate cancer risk was assessed by logistic regression models with random, province specific intercepts. Risk according to tumor aggressiveness (Gleason score 6 vs greater than 6) and extension (cT1-cT2a vs cT2b-cT4) was evaluated by multinomial regression models. RESULTS: High adherence to a Mediterranean dietary pattern rich not only in fruits and vegetables but also in fish, legumes and olive oil was specifically associated with a lower risk of Gleason score greater than 6 prostate cancer (quartile 3 vs 1 relative RR 0.66, 95% CI 0.46-0.96 and quartile 4 vs 1 relative RR 0.68, 95% CI 0.46-1.01, p-trend = 0.023) or with higher clinical stage (cT2b-T4 quartile 4 vs 1 relative RR 0.49, 95% CI 0.25-0.96, p-trend = 0.024). This association was not observed with the prudent pattern, which combines vegetables and fruits with low fat dairy products, whole grains and juices. The Western pattern did not show any association with prostate cancer risk. CONCLUSIONS: Nutritional recommendations for prostate cancer prevention should consider whole dietary patterns instead of individual foods. We found important differences between the Mediterranean dietary pattern, which was associated with a lower risk of aggressive prostate cancer, and Western and prudent dietary patterns, which had no relationship with prostate cancer risk.Supported by Acción Transversal del Cáncer approved in Spanish Ministry Council on 11th October 2007 by Consortium for Biomedical Research in Epidemiology and Public Health, Instituto de Salud Carlos III co-funded by FEDER Funds Grants PI08/1770 (MK), PI09/0773 and FIS 12/00715 (JL), PI09/1903 (RP), PI09/2078 (FJC), PI09/1662 (JJJ-M), PI11/01403 (NA), PI12/00150 (BP-G) and PI12/00488 (MP), Fundación Marqués de Valdecilla Grant API 10/09 (JL), Consejería de Salud of the Junta de Andalucía Grant 2009-S0143 (JA), Conselleria de Sanitat of Generalitat Valenciana Grant AP061/10 (RP), Regional Government of the Basque Country, Fundación Caja de Ahorros de Asturias, University of Oviedo and Spanish Ministry of Economy and Competitiveness Juan de la Cierva de Incorporación Grant IJCI-2014-20900 (AC).S