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Emily Sonestedt

Emily Sonestedt

Associate senior lecturer

Emily Sonestedt

Novel Biomarkers of Habitual Alcohol Intake and Associations with Risk of Pancreatic and Liver Cancers and Liver Disease Mortality


  • Erikka Loftfield
  • Magdalena Stepien
  • Vivian Viallon
  • Laura Trijsburg
  • Joseph A Rothwell
  • Nivonirina Robinot
  • Carine Biessy
  • Ingvar A Bergdahl
  • Stina Bodén
  • Matthias B Schulze
  • Manuela Bergman
  • Elisabete Weiderpass
  • Julie A Schmidt
  • Raul Zamora-Ros
  • Therese H Nøst
  • Torkjel M Sandanger
  • Emily Sonestedt
  • Bodil Ohlsson
  • Verena Katzke
  • Rudolf Kaaks
  • Fulvio Ricceri
  • Anne Tjønneland
  • Christina C Dahm
  • Maria-Jose Sánchez
  • Antonia Trichopoulou
  • Rosario Tumino
  • María-Dolores Chirlaque
  • Giovanna Masala
  • Eva Ardanaz
  • Roel Vermeulen
  • Paul Brennan
  • Demetrius Albanes
  • Stephanie J Weinstein
  • Augustin Scalbert
  • Neal D Freedman
  • Marc J Gunter
  • Mazda Jenab
  • Rashmi Sinha
  • Pekka Keski-Rahkonen
  • Pietro Ferrari

Summary, in English

BACKGROUND: Alcohol is an established risk factor for several cancers, but modest alcohol-cancer associations may be missed due to measurement error in self-reported assessments. Biomarkers of habitual alcohol intake may provide novel insight into the relationship between alcohol and cancer risk.

METHODS: Untargeted metabolomics was used to identify metabolites correlated with self-reported habitual alcohol intake in a discovery dataset from the European Prospective Investigation into Cancer and Nutrition (EPIC; n = 454). Statistically significant correlations were tested in independent datasets of controls from case-control studies nested within EPIC (n = 280) and the Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC; n = 438) study. Conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations of alcohol-associated metabolites and self-reported alcohol intake with risk of pancreatic cancer, hepatocellular carcinoma (HCC), liver cancer, and liver disease mortality in the contributing studies.

RESULTS: Two metabolites displayed a dose-response association with self-reported alcohol intake 2-hydroxy-3-methylbutyric acid and an unidentified compound. A 1-SD (log2) increase in levels of 2-hydroxy-3-methylbutyric acid was associated with risk of HCC (OR = 2.54; 95% CI = 1.51-4.27) and pancreatic cancer (OR = 1.43; 95% CI = 1.03-1.99) in EPIC and liver cancer (OR = 2.00; 95% CI = 1.44-2.77) and liver disease mortality (OR = 2.16; 95% CI = 1.63-2.86) in ATBC. Conversely, a 1-SD (log2) increase in questionnaire-derived alcohol intake was not associated with HCC or pancreatic cancer in EPIC or liver cancer in ATBC but was associated with liver disease mortality (OR = 2.19; 95% CI = 1.60-2.98) in ATBC.

CONCLUSIONS: 2-Hydroxy-3-methylbutyric acid is a candidate biomarker of habitual alcohol intake that may advance the study of alcohol and cancer risk in population-based studies.


  • Nutrition Epidemiology
  • EXODIAB: Excellence of Diabetes Research in Sweden
  • EpiHealth: Epidemiology for Health
  • Internal Medicine - Epidemiology

Publishing year







Journal of the National Cancer Institute





Document type

Journal article


Oxford University Press


  • Cancer and Oncology



Research group

  • Nutrition Epidemiology
  • Internal Medicine - Epidemiology


  • ISSN: 1460-2105