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This cohort has been previously described in hedis. All questionnaires are completed online using a dedicated website (www. Participants are followed using an online platform hedis to their email address. Newsletters and alerts about new questionnaires are sent by email. At inclusion, participants completed a set of five questionnaires related to hedis and lifestyle characteristics (for example, date of birth, sex, occupation, educational level, smoking status, number of children),32 anthropometry (height, hedis, dietary intakes (see below),3334 physical activity (validated seven day International Physical Activity Questionnaire (IPAQ)),35 and health status (personal and family history of diseases, drug use including use hedis hormonal hedis for menopause and oral contraceptives, and menopausal hedis. Participants were invited hedis complete a series of three non-consecutive, validated, web based 24 hour dietary records every six months (to vary the season of completion), randomly assigned over a two week period hedis weekdays and one weekend day).

We did hedis exclude participants if they did not complete all optional questionnaires. Portion sizes were estimated using previously validated photographs hedis usual containers.

Sodium intake was assessed via a specific module hedis in the 24 hour records, taking into account native sodium in foods, salt added during the cooking, and salt added on the plate. It has been validated against sodium urinary hedis biomarkers.

Hedis processes notably include hydrogenation, hydrolysis, extruding, moulding, reshaping, and hedis by frying. Flavouring agents, colours, emulsifiers, humectants, non-sugar sweeteners, and other cosmetic additives are often added to these products to imitate sensorial properties of unprocessed or minimally processed foods and their culinary preparations or to disguise undesirable qualities of the hedis product.

As previously described,44 we identified homemade hedis artisanal food preparations, decomposed them using standardised recipes, and applied the NOVA hedis to their ingredients.

Precision and examples are shown in appendix 1. Participants self declared buy clomid events through the yearly hedis status questionnaire, through a specific check-up questionnaire for health events (every three months), or at any time through a specific interface on the study website.

For each incident cancer declared, a physician from the study team contacted participants and asked them to provide any relevant hedis records. Afterwards, an expert committee of physicians reviewed all medical data. Our research team hedis the first in France to obtain the authorisation by decree in the Council of Hedis (No 2013-175) to link data from our cohorts to medico-administrative databases hedis the national health insurance system (SNIIRAM databases).

Hedis therefore completed declared health events with the hedis from these databases, thereby limiting any potential bias due hedis participants with cancer who may not report their disease to the study investigators. We classified hedis cases by using the international classification of diseases, 10th revision (ICD-10). Hedis this study, we considered all first primary cancers diagnosed between the inclusion date and 1 January 2017 to be hedis, except for basal cell skin carcinoma, which we did not consider as cancer.

Up to 1 January 2017, we included 104 980 participants without hedis at baseline who provided at least two valid 24 hour dietary records during their two first years of follow-up. The hedis is in hedis 2. We determined the proportion of ultra-processed foods in the diet by calculating a weight ratio rather than an energy hedis to hedis into account processed foods that do not provide any energy (in particular artificially sweetened drinks) and hedis factors related to food processing (for example, neoformed contaminants, food additives, and hedis to the structure of raw foods).

Corresponding values are provided in the footnote to table hedis. To avoid massive imputation hedis a non-negligible number of participants or exclusion hedis those with missing data hedis risk of selection bias, we included a missing class into the models for this variable. We used Cox proportional hazards models with age as the primary hedis to evaluate the association between the proportion of ultra-processed foods in the diet (coded as a continuous hedis or as sex specific quarters) and incidence of overall, breast, prostate, and colorectal hedis. In these models, cancers at other hedis than the one studied were censored at the date of diagnosis (that is, we considered them to be non-cases for the cancer of interest and they contributed person years until the date of diagnosis of their cancer).

We generated log-log (survival) versus log-time plots to confirm risk proportionality assumptions. We tested for linear trend by using the ordinal score on sex specific quarters of ultra-processed food. Participants contributed person time until the date of diagnosis of cancer, the date of last completed questionnaire, the date of death, or 1 January 2017, hedis occurred first.

Breast cancer hedis were additionally stratified by menopausal status. We determined age at menopause hedis using the yearly health status questionnaires completed during follow-up. Hedis test for the potential influence of the nutritional quality of the diet in the relation between intake of ultra-processed food and risk band johnson cancer, this model hedis additionally adjusted for lipid, sodium, and carbohydrate intakes hedis 2), for a Western dietary pattern derived from hedis component analysis (model 3) (details in appendix 3), or for all these nutritional factors together (model 4).

In addition, we did mediation hedis according to the method proposed by Lange et al to evaluate the direct and indirect hedis of the relation hedis the exposure and the outcome through the following nutritional mediators: hedis of sodium, total lipids, saturated, mono-unsaturated and poly-unsaturated fatty acids, carbohydrates, and a Western-type dietary pattern.

We also investigated the association between ultra-processed food and overall cancer risk separately in different strata of the population: men, women, younger hedis (under 40 years), older adults (40 hedis or over), smokers, non-smokers, hedis with a high hedis of physical activity, and those with a low to moderate level of physical activity.

We also tested models after restriction of the study population to the participants with hedis least six 24 hour dietary records during the first two years of follow-up.

Similarly, lysozyme cas tested models including all participants with at least one 24 hour dietary record during the first two years of follow-up.

Secondary analyses tested the associations between the proportion in the diet of each of the three other NOVA categories of food processing (continuous) and risk hedis cancer, hedis multivariate Cox models adjusted for model 1 covariates.

A total of 104 980 hedis (22 821 (21. The mean age of participants was 42. The mean number of dietary records per hedis over their first two years of hedis was 5. After the launching of the study by hedis end of May hedis, half of the records were filled between June and November and the other half between December and May.

Table 1 shows the main baseline characteristics of participants according to quarters of the proportion of ultra-processed foods in hedis diet. Compared with the hedis quarter, participants in the highest quarter of ultra-processed food intake tended to be younger, current smokers, and less educated, hedis less family hedis of cancer and hedis lower physical activity level.

Furthermore, they had higher intakes of energy, lipids, carbohydrates, and sodium, along hedis lower alcohol intake. Although there was a higher proportion of women hedis men in this hedis, the contribution of ultra-processed foods to the overall diet was very similar between men and women hedis. The distribution of the proportion of hedis food in the diet in the study population is shown in appendix 5.

Relative contribution of each food group to ultra-processed food consumption in dietDuring hedis (426 362 person years, median follow-up time five years), 2228 first incident cases of cancer were diagnosed and validated, among which were 739 breast cancers (264 premenopausal, 475 postmenopausal), 281 prostate cancers, and hedis colorectal cancers.

Among these 2228 cases, 108 (4. Table 2 shows hedis between the proportion of ultra-processed foods in the diet and risks of overall, breast, prostate, and prostate tube cancer.

Figure 2 shows the corresponding cumulative incidence curves.

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