Dietary patterns and risk of colorectal tumors: a cohort of French women of the National Education System (E3N)
01 Dec 2006-American Journal of Epidemiology (Oxford University Press)-Vol. 164, Iss: 11, pp 1085-1093
TL;DR: Dietary patterns that reflect a Western way of life are associated with a higher risk of colorectal tumors.
Abstract: Little is known about the dietary patterns associated with colorectal tumors along the adenoma-carcinoma sequence. Scores for dietary patterns were obtained by factor analysis in women from the French cohort of the European Prospective Investigation into Cancer and Nutrition (1993-2000). Their association with colorectal tumors was investigated in 516 adenoma cases (175 high-risk adenomas) and 4,804 polyp-free women and in 172 colorectal cancer cases and 67,312 cancer-free women. The authors identified four dietary patterns: "healthy" (vegetables, fruit, yogurt, sea products, and olive oil); "Western" (potatoes, pizzas and pies, sandwiches, sweets, cakes, cheese, cereal products, processed meat, eggs, and butter); "drinker" (sandwiches, snacks, processed meat, and alcoholic beverages); and "meat eaters" (meat, poultry, and margarine). For quartile 4 versus quartile 1, an increased risk of adenoma was observed with high scores of the Western pattern (multivariate relative risk (RR) = 1.39, 95% confidence interval: 1.00, 1.94; p(trend) = 0.03) and the drinker pattern (RR = 1.42, 95% confidence interval: 1.10, 1.83; p(trend) = 0.01). The meat-eaters pattern was positively associated with colorectal cancer risk (for quartile 4 vs. quartile 1: RR = 1.58, 95% confidence interval: 0.98, 2.53; p(trend) = 0.02). Dietary patterns that reflect a Western way of life are associated with a higher risk of colorectal tumors.
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TL;DR: Public‐health strategies that promote modest alcohol consumption, smoking cessation, weight loss, increased physical activity and moderate consumption of red and processed meat are likely to have significant benefits at the population level for reducing the incidence of colorectal cancer.
Abstract: Colorectal cancer is a major cause of cancer mortality and is considered to be largely attributable to inappropriate lifestyle and behavior patterns. The purpose of this review was to undertake a comparison of the strength of the associations between known and putative risk factors for colorectal cancer by conducting 10 independent meta-analyses of prospective cohort studies. Studies published between 1966 and January 2008 were identified through EMBASE and MEDLINE, using a combined text word and MESH heading search strategy. Studies were eligible if they reported estimates of the relative risk for colorectal cancer with any of the following: alcohol, smoking, diabetes, physical activity, meat, fish, poultry, fruits and vegetables. Studies were excluded if the estimates were not adjusted at least for age. Overall, data from 103 cohort studies were included. The risk of colorectal cancer was significantly associated with alcohol: individuals consuming the most alcohol had 60% greater risk of colorectal cancer compared with non- or light drinkers (relative risk 1.56, 95% CI 1.42-1.70). Smoking, diabetes, obesity and high meat intakes were each associated with a significant 20% increased risk of colorectal cancer (compared with individuals in the lowest categories for each) with little evidence of between-study heterogeneity or publication bias. Physical activity was protective against colorectal cancer. Public-health strategies that promote modest alcohol consumption, smoking cessation, weight loss, increased physical activity and moderate consumption of red and processed meat are likely to have significant benefits at the population level for reducing the incidence of colorectal cancer.
628 citations
Cites background from "Dietary patterns and risk of colore..."
...A high consumption of different processed foods and alcohol intakes have also been associated with a higher colorectal cancer risk.(11) The proportion of colorectal cancer attributed to dietary factors has been estimated to be about 50%....
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TL;DR: Diet modification has the promise of reducing colorectal cancer incidence and emerging evidence also implicates the gut microbiota as an important effector in the relationship between diet and cancer.
466 citations
TL;DR: In addition, the excess risk in the highest category of processed meat eaters is comprised between 20% and 50% compared with non-eaters in colorectal cancer.
Abstract: Processed meat intake may be involved in the etiology of colorectal cancer, a major cause of death in affluent countries. The epidemiologic studies published to date conclude that the excess risk in the highest category of processed meat-eaters is comprised between 20% and 50% compared with non-eaters. In addition, the excess risk per gram of intake is clearly higher than that of fresh red meat. Several hypotheses, which are mainly based on studies carried out on red meat, may explain why processed meat intake is linked to cancer risk. Those that have been tested experimentally are (i) that high-fat diets could promote carcinogenesis via insulin resistance or fecal bile acids; (ii) that cooking meat at a high temperature forms carcinogenic heterocyclic amines and polycyclic aromatic hydrocarbons; (iii) that carcinogenic N-nitroso compounds are formed in meat and endogenously; (iv) that heme iron in red meat can promote carcinogenesis because it increases cell proliferation in the mucosa, through lipoperoxidation and/or cytotoxicity of fecal water. Nitrosation might increase the toxicity of heme in cured products. Solving this puzzle is a challenge that would permit to reduce cancer load by changing the processes rather than by banning processed meat.
377 citations
Cites background from "Dietary patterns and risk of colore..."
...In Europe, the intake of processed meat was 27 g/d [11–48] in women (median and range of 23 EPIC centers from ten European countries), and 48 g/d [19-88] in men (12)....
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...Kesse et al. (2006) studied food patterns in a French cohort of women, already reported in the EPIC study....
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TL;DR: Higher intake of a Western dietary pattern may be associated with a higher risk of recurrence and mortality among patients with stage III colon cancer treated with surgery and adjuvant chemotherapy.
Abstract: ContextDietary factors have been associated with the risk of developing colon cancer but the influence of diet on patients with established disease is unknown.ObjectiveTo determine the association of dietary patterns with cancer recurrences and mortality of colon cancer survivors.Design, Setting, and PatientsProspective observational study of 1009 patients with stage III colon cancer who were enrolled in a randomized adjuvant chemotherapy trial (CALGB 89803) between April 1999 and May 2001. Patients reported on dietary intake using a semiquantitative food frequency questionnaire during and 6 months after adjuvant chemotherapy. We identified 2 major dietary patterns, prudent and Western, by factor analysis. The prudent pattern was characterized by high intakes of fruits and vegetables, poultry, and fish; the Western pattern was characterized by high intakes of meat, fat, refined grains, and dessert. Patients were followed up for cancer recurrence or death.Main Outcome MeasuresDisease-free survival, recurrence-free survival, and overall survival by dietary pattern.ResultsDuring a median follow-up of 5.3 years for the overall cohort, 324 patients had cancer recurrence, 223 patients died with cancer recurrence, and 28 died without documented cancer recurrence. A higher intake of a Western dietary pattern after cancer diagnosis was associated with a significantly worse disease-free survival (colon cancer recurrences or death). Compared with patients in the lowest quintile of Western dietary pattern, those in the highest quintile experienced an adjusted hazard ratio (AHR) for disease-free survival of 3.25 (95% confidence interval [CI], 2.04-5.19; P for trend <.001). The Western dietary pattern was associated with a similar detriment in recurrence-free survival (AHR, 2.85; 95% CI, 1.75-4.63) and overall survival (AHR, 2.32; 95% CI, 1.36-3.96]), comparing highest to lowest quintiles (both with P for trend <.001). The reduction in disease-free survival with a Western dietary pattern was not significantly modified by sex, age, nodal stage, body mass index, physical activity level, baseline performance status, or treatment group. In contrast, the prudent dietary pattern was not significantly associated with cancer recurrence or mortality.ConclusionsHigher intake of a Western dietary pattern may be associated with a higher risk of recurrence and mortality among patients with stage III colon cancer treated with surgery and adjuvant chemotherapy. Further studies are needed to delineate which components of such a diet show the strongest association.
371 citations
TL;DR: The most convincing evidence supported an association between healthy dietary patterns and decreased risk of colon and breast cancer, especially in postmenopausal, hormone receptor‐negative women, and an associations between unhealthy dietary patternsand increased risk of Colon cancer.
Abstract: Context Evidence of an association between dietary patterns derived a posteriori and risk of cancer has not been reviewed comprehensively Objective The aim of this review was to investigate the relation between a posteriori-derived dietary patterns, grouped as healthy or unhealthy, and cancer risk The relation between cancer risk and background characteristics associated with adherence to dietary patterns was also examined Data sources PubMed and Embase electronic databases were searched Study selection A total of 93 studies including over 85 000 cases, 100 000 controls, and 2 000 000 exposed individuals were selected Data extraction Data were extracted from each identified study using a standardized form by two independent authors Results The most convincing evidence (significant results from prospective cohort studies) supported an association between healthy dietary patterns and decreased risk of colon and breast cancer, especially in postmenopausal, hormone receptor-negative women, and an association between unhealthy dietary patterns and increased risk of colon cancer Limited evidence of a relation between an unhealthy dietary pattern and risk of upper aerodigestive tract, pancreatic, ovarian, endometrial, and prostatic cancers relied only on case-control studies Unhealthy dietary patterns were associated with higher body mass index and energy intake, while healthy patterns were associated with higher education, physical activity, and less smoking Potential differences across geographical regions require further evaluation Conclusions The results suggest a potential role of diet in certain cancers, but the evidence is not conclusive and may be driven or mediated by lifestyle factors
293 citations
References
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TL;DR: The rationale for studying dietary patterns is described, quantitative methods for analysing dietary patterns and their reproducibility and validity are discussed, and the available evidence regarding the relationship between major Dietary patterns and the risk of cardiovascular disease is discussed.
Abstract: Recently, dietary pattern analysis has emerged as an alternative and complementary approach to examining the relationship between diet and the risk of chronic diseases. Instead of looking at individual nutrients or foods, pattern analysis examines the effects of overall diet. Conceptually, dietary patterns represent a broader picture of food and nutrient consumption, and may thus be more predictive of disease risk than individual foods or nutrients. Several studies have suggested that dietary patterns derived from factor or cluster analysis predict disease risk or mortality. In addition, there is growing interest in using dietary quality indices to evaluate whether adherence to a certain dietary pattern (e.g. Mediterranean pattern) or current dietary guidelines lowers the risk of disease. In this review, we describe the rationale for studying dietary patterns, and discuss quantitative methods for analysing dietary patterns and their reproducibility and validity, and the available evidence regarding the relationship between major dietary patterns and the risk of cardiovascular disease.
3,383 citations
"Dietary patterns and risk of colore..." refers background or methods in this paper
...The identification of dietary patterns by factor analysis has some limitations ( 12 , 30), in particular as it involves subjective decisions such as the choice and definition of the food groups included in the factor analysis step,...
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...Thus, the specific effect of a dietary component of interest may be difficult to identify and can be partly confounded by other dietary components ( 12 ), introducing bias into the estimation of the relation between diet and the studied disease....
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...Recently, the more global approach of dietary pattern assessment has emerged, including ‘‘a posteriori’’ analyses such as cluster and factor analyses and ‘‘a priori’’ analyses based on dietary recommendations ( 12 )....
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TL;DR: Prospective studies provide weaker evidence than case-control studies of the association of fruit and vegetable consumption with reduced cancer risk, and the association may have been underestimated in prospective studies because of the combined effects of imprecise dietary measurements and limited variability of dietary intakes within each cohort.
1,146 citations