A case-control study of diet and bladder cancer in men was conducted in five regions of Spain (117). Each of 432 case-patients was matched with one hospital and one community control. The average dietary pattern was typical for Mediterranean populations. Subjects in the highest quartile of intake of saturated fat were at significantly increased risk of bladder cancer. Smaller risks associated with high intake of monounsaturated fats and calcium and a protective effect of iron disappeared after correcting for saturated fat. Vitamin E remained slightly protective after correction for saturated fat. No association was seen for intake of retinol, vitamin C, total vitamin A, or carotene. Tobacco smoking and occupational exposures were major risk factors but failed to explain all cases of bladder cancer in this study. Smoking and occupational exposures were also the major risk factors for bladder cancer in a German study (118). A significant twofold increase in risk was associated with heavy coffee consumption in men and women and with beer and total fluid consumption in men. Chronic urinary infection and family history of bladder cancer were also risk factors. For men, frequent consumption of high fat meals was a significant risk factor. Frequent consumption of canned foods increased risk for   both   men and women. Dietary, smoking, family history, and medical history variables did not interact with risk attributable to occupational exposure.