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Meat, poultry and fish and risk of colorectal cancer: Pooled analysis of data from the UK dietary cohort consortium

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Abstract

Some but not all epidemiological studies have reported that high intakes of red and processed meat are associated with an increased risk of colorectal cancer. In the UK Dietary Cohort Consortium, we examined associations of meat, poultry and fish intakes with colorectal cancer risk using standardised individual dietary data pooled from seven UK prospective studies. Four- to seven-day food diaries were analysed, disaggregating the weights of meat, poultry and fish from composite foods to investigate dose-response relationships. We identified 579 cases of colorectal cancer and matched with 1,996 controls on age, sex and recruitment date. Conditional logistic regression models were used to estimate odds ratios for colorectal cancer associated with meat, poultry and fish intakes, adjusting for relevant covariables. Disaggregated intakes were moderately low, e.g. mean red meat intakes were 38.2 g/day among male and 28.7 g/day among female controls. There was little evidence of association between the food groups examined and risk for colorectal cancer: Odds ratios (95% confidence intervals) for a 50 g/day increase were 1.01 (0.84-1.22) for red meat, 0.88 (0.68-1.15) for processed meat, 0.97 (0.84-1.12) for red and processed meat combined, 0.80 (0.65-1.00) for poultry, 0.92 (0.70-1.21) for white fish and 0.89 (0.70-1.13) for fatty fish. This study using pooled data from prospective food diaries, among cohorts with low to moderate meat intakes, shows little evidence of association between consumption of red and processed meat and colorectal cancer risk.

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... associated with colorectal cancer risk (15)(16)(17), possibly through the effects of ω-3 polyunsaturated fatty acids, which are abundant in fatty fish (18). Poultry intake has been associated with decreased risk of colorectal cancer (16,19,20), but for colorectal adenomas, the evidence is less consistent (4-6, 10, 21, 22). ...
... associated with colorectal cancer risk (15)(16)(17), possibly through the effects of ω-3 polyunsaturated fatty acids, which are abundant in fatty fish (18). Poultry intake has been associated with decreased risk of colorectal cancer (16,19,20), but for colorectal adenomas, the evidence is less consistent (4-6, 10, 21, 22). The ratio of red meat to poultry and fish has been consistently positively associated with the risks of colorectal cancer (20,23,24) and adenomas (21). ...
... We are not aware of any study relating poultry intake during adolescence to the risk of adenoma in later life. Significant inverse associations between poultry intake during adulthood and the risk of colorectal cancer have been observed in several studies (16,19,20), although most studies have reported nonsignificant inverse associations (17,23,(44)(45)(46). We observed only slightly decreased odds ratios for distal and rectal adenomas associated with higher fish intake during high school, but intake ranges were low, and dark meat fish (a good source of ω-3 fatty acids), which may inhibit colorectal carcinogenesis (18), was rarely consumed during high school. ...
Article
Adolescent diet may be etiologically relevant for colorectal carcinogenesis. We examined the association between meat and fish intakes during adolescence and the risk of colorectal adenomas later in life among 19,771 women participating in the Nurses' Health Study II. Subjects had completed a validated food frequency questionnaire in 1998 (when aged 34-51 years) about their diets during high school and subsequently underwent at least 1 lower-bowel endoscopy during the study period (1998-2007). During this period, 1,494 subjects were diagnosed with colorectal adenomas. Intake of red meat during adolescence was not associated with colorectal adenoma risk when comparing those in the highest versus lowest category of intake (odds ratio (OR) = 1.04, 95% confidence interval (CI): 0.81, 1.35). Similarly, intake of fish during adolescence was not associated with colorectal adenoma risk (OR = 0.96, 95% CI: 0.78, 1.17). Intake of poultry during adolescence was associated with a lower risk of total colorectal (OR = 0.80, 95% CI: 0.64, 0.99), distal (OR = 0.71, 95% CI: 0.51, 0.99), rectal (OR = 0.51, 95% CI: 0.29, 0.90), and advanced (OR = 0.60, 95% CI: 0.38, 0.93) adenomas. Replacement of 1 serving per day of red meat with 1 serving per day of poultry or fish was associated with 41% and 35% decreased risks for rectal adenomas and advanced adenomas, respectively. Our findings do not suggest an association between red meat intake during adolescence and colorectal adenomas later in life, but higher poultry intake during this time was associated with a lower risk of colorectal adenomas.
... A total of 2873 and 131 papers were screened out based on their titles and abstract, and the remaining 240 papers were read in full copy. Finally, 25 articles reporting on the association between fish consumption and CRC risk met the inclusion criteria for the present meta-analysis [8][9][10][11]13,14,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] The papers by Bamia et al. [22] and Engeset et al. [23] were totally and partially overlapping, respectively, with the larger and more recent paper by Aglago et al. [13], which reported from the large, multi-country European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study. Likewise, the two papers by Murff et al. [24] and Lee et al. [11] were based on the same prospective cohort (Shanghai Women's Health Study). ...
... Likewise, the two papers by Murff et al. [24] and Lee et al. [11] were based on the same prospective cohort (Shanghai Women's Health Study). The study by Spencer et al. [25], a case-control study nested within a consortium of UK-based dietary cohorts including the EPIC-Norfolk and the EPIC-Oxford cohorts, had only a limited overlap with that by Aglago et al. [13], to which the two English cohorts contributed around 15.5% of the total size. Since the overlap between the two papers was limited, and in order not to discard valuable information, both papers were included in the meta-analysis and treated as if they were completely independent. ...
... The papers were published between 1994 and 2020 and reported on studies conducted in Europe (n = 12), the USA (n = 7), Asia (n = 5), and Australia (n = 1). In terms of design, all were prospective cohort studies, except for Spencer et al. [25], Siezen et al. [31], and Tiemersma et al. [36], which were nested case-control studies, and Pietinen et al., whose study population consisted of subjects previously enrolled in a randomized controlled trial testing the effect of alpha-tocopherol and beta-carotene supplementation on lung cancer risk among male smokers [38]. The 25 studies included 2,228,377 individuals altogether, aged between 15 and 99 years at cohort inception, among which a total of 25,777 CRC cases were diagnosed during an average follow-up that varied between 4.8 and 14.9 across the studies. ...
Article
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Background: Epidemiological studies on the association between fish consumption and colorectal cancer (CRC) risk have yielded inconsistent results, despite evidence from preclinical studies that long-chain ω-3 polyunsaturated fatty acids inhibit colorectal carcinogenesis. We conducted a meta-analysis of prospective epidemiological studies investigating the association between fish consumption and CRC risk among humans and reviewed studies examining the link between fish components and colorectal carcinogenesis in animal models. Methods: We included studies published until November 2020. We calculated the summary risk ratio (SRR) and 95% confidence intervals (CI) through random effects meta-analysis models in order to summarize evidence from studies among humans. Results: Twenty-five prospective epidemiological studies encompassing 25,777 CRC cases were included. Individuals in the highest (vs. lowest) category of fish consumption had a significantly reduced risk of CRC (SRR 0.94, 95%CI 0.89–0.99). In dose–response meta-analysis, a 50-g increment in the daily consumption of fish was associated with a statistically significant 4% reduction in CRC risk (SRR 0.96, 95%CI 0.92–0.99). Preclinical studies (n = 25) identified multiple mechanisms of action of fish and fish components on colorectal carcinogenesis. Conclusions: Dietary recommendations for cancer prevention should take into account the evidence from epidemiological and preclinical studies that increasing fish consumption may be effective in preventing CRC.
... 1,2 In this study, we analysed dietary data from food diaries collected in the United Kingdom (UK) Dietary Cohort Consortium. 3 Previous analyses of food diary data from this consortium have shown that the risk for colorectal cancer is inversely associated with the intake of fiber, but not associated with intakes of fat or moderately high intakes of meat or fish. [3][4][5] Here, we describe the associations of colorectal cancer risk with intakes of selected vitamins, minerals and essential fatty acids. ...
... It is possible that heme iron might be more important, but in a previous publication from this dataset we reported no association of red meat, the main source of heme iron, with colorectal cancer risk. 4 Previous studies have been inconclusive on magnesium, 18,19 and little research has been published on potassium. 2 We have previously reported that in this study the risk for colorectal cancer is not significantly associated with intakes of total fat, saturated fat, monounsaturated fat or polyunsaturated fat, 5 or with the intake of fish. 4 Here we extend these analyses by reporting on n À 6 and n À 3 fatty acids, and the ratio n À 6:n À 3. None of these measures of fat intake were associated with the risk for colorectal cancer, which is consistent with the results of several other prospective studies, [20][21][22] although some have reported a reduction in risk in association with a high intake of n À 3 fatty acids or a high ratio of n À 3 to n À 6 polyunsaturated fatty acids. ...
... 2 We have previously reported that in this study the risk for colorectal cancer is not significantly associated with intakes of total fat, saturated fat, monounsaturated fat or polyunsaturated fat, 5 or with the intake of fish. 4 Here we extend these analyses by reporting on n À 6 and n À 3 fatty acids, and the ratio n À 6:n À 3. None of these measures of fat intake were associated with the risk for colorectal cancer, which is consistent with the results of several other prospective studies, [20][21][22] although some have reported a reduction in risk in association with a high intake of n À 3 fatty acids or a high ratio of n À 3 to n À 6 polyunsaturated fatty acids. 23,24 Strengths of this study are that dietary intakes were measured prospectively by food diaries using similar methods in the seven contributing studies, and that we were able to allow for the influence of several potential confounding factors. ...
Article
The risk for colorectal cancer may be influenced by the dietary intake of various vitamins, minerals and essential fatty acids. We conducted a pooled analysis of dietary data collected using food diaries in seven prospective studies in the United Kingdom Dietary Cohort Consortium. Five hundred sixty-five cases of colorectal cancer were matched with 1,951 controls on study centre, age, sex and recruitment date. Dietary intakes of retinol, vitamin A, thiamin, riboflavin, vitamin B6, folate, vitamin B12, vitamin D, calcium, iron, magnesium, potassium, n - 6 fatty acids, n - 3 fatty acids and the ratio of n - 6 to n - 3 fatty acids were estimated and their associations with colorectal cancer examined using conditional logistic regression models, adjusting for exact age, height, weight, energy intake, alcohol intake, fiber intake, smoking, education, social class and physical activity. There were no statistically significant associations between colorectal cancer risk and dietary intake of any of the vitamins, minerals or essential fatty acids examined.
... Spencer et al. [10] matched 579 cases of CRC with 1,996 controls and used food diaries to examine dietary intake over 4-7 days. The results showed limited evidence to support the association between consumption of red (OR 0.88, 95% CI 0.68-1.15) ...
... and processed meat (OR 0.97, 95% CI 0.84-1.12) and risk of CRC [10]. The authors noted that disaggregated intakes of red meat, or estimated amounts separated from mixed dishes (which tend to lead to overestimation of amounts consumed), were moderately low with mean red meat intakes of 38.2 g/day for male and 28.7 g/day for female controls [10]. ...
... and risk of CRC [10]. The authors noted that disaggregated intakes of red meat, or estimated amounts separated from mixed dishes (which tend to lead to overestimation of amounts consumed), were moderately low with mean red meat intakes of 38.2 g/day for male and 28.7 g/day for female controls [10]. ...
Article
Diet serves as a primary prevention approach to reduce the global burden of cancer. In 2007, the World Cancer Research Fund and the American Institute for Cancer Research published the Second Expert Report (SER) Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective outlining lifestyle recommendations for primary cancer prevention. Results support a strong link between red and processed meat and colorectal carcinogenesis. Findings from the Colorectal Cancer 2011 Report: Food, Nutrition, Physical Activity, and the Prevention of Colorectal Cancer, a review conducted through the WCRF Continuous Update Project (CUP), strengthened the evidence and supported the conclusions found in the SER. This review explored the available evidence since the publication of the 2011 CUP report and provides an update of the literature, specific to colorectal cancer (CRC) and diet. Furthermore, several proposed mechanisms, including heterocyclic amines (HCAs), polyaromatic hydrocarbons (PAHs), N-nitroso compounds (NOCs), and heme iron, may explain the effects of meat on the cancer process. The studies reviewed continue to support the causal link between red and processed meat consumption and CRC. The most recent literature supports the preventative role of consuming a plant-based diet low in red and processed meat for overall cancer prevention.
... Une troisième méta-analyse s'est intéressée au fer héminique et a conclu également à une augmentation du risque de CCR de 18 % chez les sujets ayant les plus forts apports [19]. Les données « poolées » des sept cohortes anglaises, analysées comme une étude cas/témoins nichée, n'ont quant à elles montré aucun lien entre consommation de viandes rouges et CCR [20]. ...
... Dans la méta-analyse de Chan et al. [18], la linéarité de la relation a été démontrée avec un risque relatif augmenté de 18 % par 50 g/j supplémentaire de viandes transformées. Les données « poolées » des sept cohortes anglaises n'ont quant à elles montré aucun lien entre consommation de viandes transformées et CCR [20]. ...
... études prospectives et 19 rétrospectives, a montré une réduction du risque de CCR, significative seulement en isolant les études cas/témoins mais pas à partir des études de cohorte. Les données « poolées » des sept cohortes anglaises n'ont quant à elles montré aucun lien entre consommation de poisson blanc et CCR[20].En conclusionEn conclusion, les données sont toujours insuffisantes pour conclure sur le lien entre la consommation de poisson et le risque de CCR et des études prospectives supplémentaires sont nécessaires. ...
Article
Le cancer colorectal, un des principaux cancers en termes d’incidence et de mortalité, en France, est associé au mode de vie occidental. Les études prospectives et les méta-analyses publiées entre 2010 et 2013 confirment les conclusions de l’expertise du WCRF/AICR parue en 2011 sur les liens entre cancer colorectal et consommations alimentaires. Les relations dont le niveau de preuve est soit convaincant ou soit probable concernent, d’une part, les consommations de viandes rouges, de viandes transformées et d’alcool associées à un risque augmenté de cancer colorectal, et d’autre part, les consommations de fibres et de produits céréaliers complets et de lait quant à elles liées à un risque réduit de cancer colorectal. Le niveau de preuve des relations entre une réduction de risque de cancer colorectal et les consommations de fruits et de légumes est suggéré. La modification des habitudes alimentaires, associée à la réduction de la sédentarité, du surpoids et de l’obésité, du tabagisme, à l’augmentation de l’activité physique, et à la pratique du dépistage devraient permettre de réduire considérablement le poids du cancer colorectal en France.
... It should be noted that the Basque Country population has a higher consumption of total fish and fatty fish compared to other Spanish autonomous communities [55,56] . Recent cohort studies have observed that fatty fish was inversely associated with CRC incidence [57,58] and they have related this association with exposure to long-chain n-3 polyunsaturated fatty acids [57] . Evidence from animal and in vitro studies indicates that n-3 fatty acids present in fatty fish may inhibit carcinogenesis [59] . ...
... It should be noted that the Basque Country population has a higher consumption of total fish and fatty fish compared to other Spanish autonomous communities [55,56] . Recent cohort studies have observed that fatty fish was inversely associated with CRC incidence [57,58] and they have related this association with exposure to long-chain n-3 polyunsaturated fatty acids [57] . Evidence from animal and in vitro studies indicates that n-3 fatty acids present in fatty fish may inhibit carcinogenesis [59] . ...
Article
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Background: The results obtained to date concerning food groups, diet quality and colorectal cancer (CRC) risk vary according to criteria used and the study populations. Aim: To study the relationships between food groups, diet quality and CRC risk, in an adult population of the Basque Country (North of Spain). Methods: This observational study included 308 patients diagnosed with CRC and 308 age- and sex-matched subjects as controls. During recruitment, dietary, anthropometric, lifestyle, socioeconomic, demographic and health status information was collected. Adherence to the dietary recommendations was evaluated utilizing the Healthy Eating Index for the Spanish Diet and the MedDietScore. Conditional logistic regressions were used to evaluate the associations of food group intakes, diet quality scores, categorized in tertiles, with CRC risk. Results: The adjusted models for potential confounding factors showed a direct association between milk and dairy products consumption, in particular high-fat cheeses [odds ratio (OR) third tertile vs first tertile = 1.87, 95% confidence intervals (CI): 1.11-3.16], and CRC risk. While the consumption of fiber-containing foods, especially whole grains (OR third tertile vs first tertile = 0.62, 95%CI: 0.39-0.98), and fatty fish (OR third tertile vs first tertile = 0.53, 95%CI: 0.27-0.99) was associated with a lower risk for CRC. Moreover, higher MD adherence was associated with a reduced CRC risk in adjusted models (OR third tertile vs first tertile = 0.40, 95%CI: 0.20-0.80). Conclusion: Direct associations were found for high-fat cheese, whereas an inverse relation was reported for fiber-containing foods and fatty fish, as well as adherence to a Mediterranean dietary pattern.
... Consistent with this review, a previous meta-analysis of 6 cohort studies and 18 case -control studies (11) including three Japanese investigations in the present review (30,37,46) revealed no significant increase in risk of colorectal cancer for the highest versus lowest category of total meat consumption; pooled RR were 1.03 and 1.18 for cohort studies and case -control ones, respectively. Similarly, null association was observed in a meta-analysis of seven case -cohort studies in the UK (summary OR for the highest versus lowest category was 0.97) (19). Furthermore, a recent individual-level meta-analysis of eight cohort studies in Asia reporting no association between total meat consumption and risk of cancer mortality (66); summary hazard ratio and 95% confidence interval (CI) in the highest level of consumption versus lowest level was 1.11 (0.94 -1.30) in men and 0.90 (0.78 -1.04) in women. ...
... Furthermore, a recent individual-level meta-analysis of eight cohort studies in Asia reporting no association between total meat consumption and risk of cancer mortality (66); summary hazard ratio and 95% confidence interval (CI) in the highest level of consumption versus lowest level was 1.11 (0.94 -1.30) in men and 0.90 (0.78 -1.04) in women. The present review and previous ones (11,19) suggest that total meat intake may not increase risk of colorectal cancer. ...
Article
Full-text available
Objective: The association between meat consumption and colorectal cancer remains inconsistent among Asians. The present study systematically evaluated and meta-analyzed epidemiologic studies on the association between consumption of total and specific meats and colorectal cancer risk among Japanese. Methods: Original data were obtained from MEDLINE searched using PubMed or from searches of the Ichushi database, complemented with manual searches. The associations were evaluated based on the strength of evidence, the magnitude of association and biologic plausibility. A meta-analysis was performed according to total meat, red and processed meat as well as poultry and site-specific cancers. Results: Six cohort studies and 13 case-control studies were identified. In cohort studies, most investigations found no association between total meat consumption and colon/rectal cancer, and several studies showed a weak-to-moderate positive association of red meat and processed meat consumption with colon/rectal cancer. The majority of case-control studies showed no association between total meat consumption and colon and rectal cancer; however, several ones reported a weak-to-strong positive association of red and processed consumption with colon and rectal cancer. In meta-analysis, the summary relative risks (95% confidence interval) for the highest versus lowest categories of red meat consumption were 1.16 (1.001-1.34) and 1.21 (1.03-1.43) for colorectal and colon cancer, respectively, and those for processed meat consumption were 1.17 (1.02-1.35) and 1.23 (1.03-1.47) for colorectal and colon cancer, respectively. Poultry consumption was associated with lower risk of rectal cancer; summary relative risk (95% confidence interval) was 0.80 (0.67-0.96). Conclusions: High consumption of red meat and processed meat possibly increases risk of colorectal cancer or colon cancer among the Japanese population.
... There is insufficient evidence for associations of white meat with chronic diseases. 29,32,35,36,38,39 Guideline. Limit the consumption of red meat, particularly processed meat. ...
Article
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p>The objective of this study was to derive food-based dietary guidelines for the Dutch population. The dietary guidelines are based on 29 systematic reviews of English language meta-analyses in PubMed summarizing randomized controlled trials and prospective cohort studies on nutrients, foods and food patterns and the risk of 10 major chronic diseases: coronary heart disease, stroke, heart failure, diabetes, breast cancer, colorectal cancer, lung cancer, chronic obstructive pulmonary disease, dementia and depression. The committee also selected three causal risk factors for cardiovascular diseases or diabetes: systolic blood pressure, low-density lipoprotein cholesterol and body weight. Findings were categorized as strong or weak evidence, inconsistent effects, too little evidence or effect unlikely for experimental and observational data separately. Next, the committee selected only findings with a strong level of evidence for deriving the guidelines. Convincing evidence was based on strong evidence from the experimental data either or not in combination with strong evidence from prospective cohort studies. Plausible evidence was based on strong evidence from prospective cohort studies only. A general guideline to eat a more plant food-based dietary pattern and limit consumption of animal-based food and 15 specific guidelines have been formulated. There are 10 new guidelines on legumes, nuts, meat, dairy produce, cereal products, fats and oils, tea, coffee and sugar-containing beverages. Three guidelines on vegetables, fruits, fish and alcoholic beverages have been sharpened, and the 2006 guideline on salt stayed the same. A separate guideline has been formulated on nutrient supplements. Completely food-based dietary guidelines can be derived in a systematic and transparent way.</p
... No obstante, existe un amplio debate al respecto, ya que diversos autores argumentan que muchas evidencias son inconsistentes, lo que impide categóricamente emitir dicha asociación (50,63,64). Es más, revisiones recientes descartan, que con la evidencia científica actual, se pueda asegurar que exista una relación significativa y relevante entre el consumo de carne roja y el riesgo de padecer cáncer colorrectal (65,66). Parece, por tanto, que existe cierta dificultad a la hora de establecer dicha relación y que la comparación entre estudios es controvertida, ya que muchos estudios difieren entre sí en infinidad de variables (33). ...
Article
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The excessive intake of meat and meat products has been related with increased morbimortality incidence of chronic diseases, particularly with cardiovascular diseases and various types of cancer. Very recently the WHO has published a preliminary inform associating meat products consumption with colorectal cancer, suggesting that this association is based in the presence of different compounds (e.g. nitrites, nitrates) that are normally present in in those foods, especially in modified meat products that are suggested to culinary procedures. Nonetheless, although risk and alarm exist, several items pointed out in this inform has, to the best of our knowledge, limitations that we will try to indicate and review, particularly those of derived from observational studies where the causeeffect relationship found did not fit the criteria demanded By Hill for Epidemiological studies. Thus, present review discuses in the frame of the meat and meat products the following items: 1) definition; 2) consumption in Spain; 3) nutritional importance; 4) consumption health risks; 5) potential toxic products in meat products, the WHO inform; 6) other dietary compounds and their palliative role in the meatpathology relationship; 7; the role and importance of the media in the news; 8) conclusions and future remarks.
... There is insufficient evidence for associations of white meat with chronic diseases. 29,32,35,36,38,39 Guideline. Limit the consumption of red meat, particularly processed meat. ...
Article
Full-text available
The objective of this study was to derive food-based dietary guidelines for the Dutch population. The dietary guidelines are based on 29 systematic reviews of English language meta-analyses in PubMed summarizing randomized controlled trials and prospective cohort studies on nutrients, foods and food patterns and the risk of 10 major chronic diseases: coronary heart disease, stroke, heart failure, diabetes, breast cancer, colorectal cancer, lung cancer, chronic obstructive pulmonary disease, dementia and depression. The committee also selected three causal risk factors for cardiovascular diseases or diabetes: systolic blood pressure, low-density lipoprotein cholesterol and body weight. Findings were categorized as strong or weak evidence, inconsistent effects, too little evidence or effect unlikely for experimental and observational data separately. Next, the committee selected only findings with a strong level of evidence for deriving the guidelines. Convincing evidence was based on strong evidence from the experimental data either or not in combination with strong evidence from prospective cohort studies. Plausible evidence was based on strong evidence from prospective cohort studies only. A general guideline to eat a more plant food-based dietary pattern and limit consumption of animal-based food and 15 specific guidelines have been formulated. There are 10 new guidelines on legumes, nuts, meat, dairy produce, cereal products, fats and oils, tea, coffee and sugar-containing beverages. Three guidelines on vegetables, fruits, fish and alcoholic beverages have been sharpened, and the 2006 guideline on salt stayed the same. A separate guideline has been formulated on nutrient supplements. Completely food-based dietary guidelines can be derived in a systematic and transparent way.European Journal of Clinical Nutrition advance online publication, 6 April 2016; doi:10.1038/ejcn.2016.52.
... Scientists suggested that simply increasing fish or poultry intake, without reducing red meat intake, may be less beneficial for cancer prevention. 17,76,77,78 ...
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Consumption of Red and Processed Meat and Elevated Risk of Cancer to Humans Formation of carcinogenic substances, mechanisms of carcinogenesis and risk assessment for colorectal and other types of cancer Athanasios Valavanidis Dpt of Chemistry, University of Athens, University Campus, 15784 Athens, Greece Abstract Epidemiological studies established that diet and obesity are responsible for a considerable proportion of human cancers. Studies in the last decade provided an overwhelming support that high consumption of fresh red meat and processed meat are associated with an elevated risk of developing bowel cancer, especially colorectal carcinoma, as well as stomach, pancreas and prostate cancers. Red meat is very important for human diet, because of high biological value proteins, animal fat and important micronutrients such as B vitamins, iron (both free iron and haem iron), selenium and zinc. In October, 2015, a Working Group at the International Agency for Research on Cancer (IARC) in Lyon (France) evaluated the carcinogenicity of the consumption of red and processed meat. Red meat includes all fresh, minced and frozen beef, veal, pork and lamb. Processed red meat is any type that is preserved by smoking, curing, salting, air-drying, heating, etc, and includes ham, bacon, sausages, tinned meat, etc. The Working Group assessed more than 800 epidemiological (mostly prospective cohort studies) and other studies that investigated the association of cancer with consumption of red or processed meat in many countries, from several continents, with diverse ethnicities and diets. Epidemiological data from 14 cohort studies found positive associations for colorectal cancer. Findings were seen with high versus low consumption of red meat in half of those studies, including a cohort from ten European countries spanning a wide range of meat consumption, Sweden and Australia. Also, positive associations of colorectal cancer with consumption of processed meat were reported in 12 of the 18 cohort studies, including studies in Europe, Japan, and the USA. The working group used also other studies. A metaanalysis of colorectal cancer in 10 cohort studies reported a statistically significant dose–response relationship, with a 17% increased risk per 100 g per day (consumption) of red meat and an 18% increase per 50 g per day of processed meat. Also, there were positive associations between consumption of red meat and cancers of the pancreas and the prostate (mainly advanced prostate cancer), and between consumption of processed meat and cancer of the stomach. The mechanistic evidence for carcinogenicity of red and processed meat was assessed. Formation of carcinogenic substances (including cooking at high temperature), genotoxicity, oxidative stress, lipid peroxidation products and increases the bacterial mutagenicity of human urine after consumption of red meat was established. Overall, the working group classified (according to standards of IARC Monographs) the consumption of processed meat as ―carcinogenic to humans‖ (Group 1) on the basis of sufficient evidence for colorectal cancer. Additionally, a positive association with the consumption of processed meat was found for stomach cancer. The Working Group classified consumption of red meat as ―probably carcinogenic to humans‖ (Group 2A). These results were widely published all over the world, appeared in the international news, newspapers, television and radio. This review examines the most important findings of epidemiological studies, and explains why carcinogenic substances are formed in red meet during the phase of processing, cooking and preservation. Finally, this review presents the recommendations of scientists for the prevention of colorectal cancer by decreasing the amounts of weekly consumption of red and processed meat.
... Red meat and processed meat have been analyzed separately, and the WCRF/AICR CUP qualified the level of evidence for a causal association between red meat and processed meat and colorectal cancer as convincing [145]. Since this study, six prospective studies [193][194][195][196][197][198], three meta-analyses [199][200][201] and one analysis of pooled studies [202] have shown some inconsistencies in relation to processed meat which might be related to different processing methods of meat between countries. However, the level of evidence for the association remains probable to convincing and underlines the importance of processing methods. ...
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The benefits of the Mediterranean diet (MD) for protecting against chronic disorders such as cardiovascular disease are usually attributed to high consumption of certain food groups such as vegetables, and low consumption of other food groups such as meat. The influence of food processing techniques such as food preparation and cooking on the nutrient composition and nutritional value of these foods is not generally taken into consideration. In this narrative review, we consider the mechanistic and epidemiological evidence that food processing influences phytochemicals in selected food groups in the MD (olives, olive oil, vegetables and nuts), and that this influences the protective effects of these foods against chronic diseases associated with inflammation. We also examine how the pro-inflammatory properties of meat consumption can be modified by Mediterranean cuisine. We conclude by discussing whether food processing should be given greater consideration, both when recommending a MD to the consumer and when evaluating its health properties.
... Many epidemiological data indicate an increased risk of colorectal cancer through consumption of red or processed meat but not white. 4,[6][7] Among these factors, the inflammatory response has been indicated by findings that antiinflammatory agents including aspirin reduce the risk of colorectal cancer. [8][9] 1,2-Dimethylhydrazine (DMH) is a potent colon carcinogen inducing colorectal tumors in experimental animals 1,4,10 and is the most widely used model of chemically induced colon carcinogenesis. ...
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Ionizing radiation is a widely used therapy for solid tumors. However, high-dose ionizing radiation causes apoptosis, transforms normal cells into tumor cells, and impairs immune functions, leading to the defects in the removal of damaged or tumor cells. In contrast, low-dose radiation has been reported to exert various beneficial effects in cells. This experimental study investigated the effect of γ rays at low dose on the development of colorectal tumor in a 1,2-dimethylhydrazine (DMH)-induced colon cancer. Colorectal tumor model was induced in Wistar rats by subcutaneous injection of DMH (20 mg/kg) once a week for 15 weeks. Starting from zero day of DMH injection, a single low dose of whole-body γ irradiation of 0.5 Gy/week was applied to the rats. A significant reduction in lipid peroxidation, nitric oxide, and elevation in the glutathione content and antioxidant enzyme activity (superoxide dismutase and catalase) were observed after γ irradiation comparing with DMH group. Moreover, γ ray reduced the expressions of multidrug resistance 1 (MDR1), β-catenin, and cytokeratin 20 (CK20) those increased in DMH-treated rats. However, survivin did not change with γ ray treatment. A histopathological examination of the DMH-injected rats revealed ulcerative colitis, dysplasia, anaplasia, and hyperchromasia. An improvement in the histopathological picture was seen in the colon of rats exposed to γ rays. In conclusion, the present results showed that low-dose γ ray significantly inhibited DMH-induced colon carcinogenesis in rats by modulating CK20, MDR1, and β-catenin expression but not survivin expression. © The Author(s) 2015.
... In some recent studies, food records have been used as the main instrument in case-control studies nested within cohorts [19,20]. One example, the UK Dietary Cohort Consortium, is a collaboration between several UK cohorts, which have collected diet diaries for all or a subset of participants [9,[21][22][23][24][25][26][27]. Repeated measures were available in a subset. ...
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Exposure measurement error is a problem in many epidemiological studies, including those using biomarkers and measures of dietary intake. Measurement error typically results in biased estimates of exposure-disease associations, the severity and nature of the bias depending on the form of the error. To correct for the effects of measurement error, information additional to the main study data is required. Ideally, this is a validation sample in which the true exposure is observed. However, in many situations, it is not feasible to observe the true exposure, but there may be available one or more repeated exposure measurements, for example, blood pressure or dietary intake recorded at two time points. The aim of this paper is to provide a toolkit for measurement error correction using repeated measurements. We bring together methods covering classical measurement error and several departures from classical error: systematic, heteroscedastic and differential error. The correction methods considered are regression calibration, which is already widely used in the classical error setting, and moment reconstruction and multiple imputation, which are newer approaches with the ability to handle differential error. We emphasize practical application of the methods in nutritional epidemiology and other fields. We primarily consider continuous exposures in the exposure-outcome model, but we also outline methods for use when continuous exposures are categorized. The methods are illustrated using the data from a study of the association between fibre intake and colorectal cancer, where fibre intake is measured using a diet diary and repeated measures are available for a subset. © 2014 The Authors. Statistics in Medicine Published by John Wiley & Sons, Ltd.
... Substantial data from epidemiologic studies support a dose-response relationship between increased red meat consumption and colorectal adenoma and colorectal cancer risk (1)(2)(3), although no adverse association between white meat and colorectal neoplasia has been documented (4)(5)(6)(7). Compared with white meat, red meat contains 5-fold higher levels of iron (8). ...
Article
Dietary iron intake and variation in iron homeostasis genes may affect colorectal neoplasia risk. We conducted two nested case-control studies within the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial: one of advanced colorectal adenoma (1205 cases; 1387 controls) and one of colorectal cancer (370 cases; 401 controls). Iron intake was estimated with a food frequency questionnaire and genotyping was performed for 21 genes. Unconditional logistic regression was used to estimate odds ratio (OR) and 95% confidence intervals (95% CIs) for colorectal neoplasia risk within quartiles of intake. Several single nucleotide polymorphisms (SNPs) modified the association between iron intake and the risk of adenoma or cancer. Dietary iron was positively associated with colorectal adenoma among three SNPs of HEPHL1, including carriers of the AA genotype at rs7946162 (ORQ4-Q1 = 2.22, 95% CI 1.15-4.27, Ptrend = 0.03; Pinteraction = 0.10), the TT genotype at rs2460063 (ORQ4-Q1 = 2.39, 95% CI 1.26-4.54, Ptrend = 0.02; Pinteraction = 0.04) and the GG genotype at rs7127348 (ORQ4-Q1 = 2.40, 95% CI 1.23-4.67, Ptrend = 0.02; Pinteraction = 0.09). Heme iron was positively associated with colorectal cancer among those with GG genotypes for ACO1 rs10970985 (ORQ4-Q 1 = 2.45, 95% CI 3.40-8.06, Ptrend = 0.004; Pinteraction = 0.05). However, none of the associations were statistically significant after adjustment for multiple comparisons. Future studies should target the specific genes and SNPs for which the association was significant prior to multiple comparison correction. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: [email protected] /* */
... times/wk 0.9 (0.7-1.1) gender, fat, ≥ 2.5 times/wk 0.9 (0.7-1.2) cereal intake Kojima et al [25] 2004 Japan 9.9 yr 107824 457 Colorectal 0-2 times/wk 1 Age, family history, BMI, 3-4 times/wk 0.88 (0.65-1.12) smoking, physical activity, every day 0.96 (0.71-1.16) education, alcohol intake, region Sanjoaquin et al [26] 2004 [32] 2009 China 7.4 yr 73224 F 394 F Colorectal < 20 g/d 1 Age, education, income, < 33 g/d 1.2 (0.9-1.5) survey season, tea < 49 g/d 1.2 (0.8-1.6) consumption, NSAID < 74 g/d 1.5 (1.1-1.9) use, energy intake, ≥ 74 g/d 1.3 (0.9-1.9) fiber intake Sugawara et al [33] 2009 [34] 2010 [35] 2011 United States 9 yr 492186 6979 Colorectal 3.6 g/1000 kcal 1 Red meat intake, age, sex, 7.0 g/1000 kcal 0.97 (0.90-1.04) education, marital status, 9.9 g/1000 kcal 0.92 (0.85-0.99) family history of cancer, 13.4 g/1000 kcal 0.93 (0.86-1.00) race, BMI, smoking status, 21.4 g/1000 kcal 0.95 (0.88-1.03) frequency of vigorous physical activity, MHT in women, intake of alcohol, fruit, vegetables, and total energy Nomura et al [36] 1990 United States 19 yr 7990 M 150 Gastric ≤ 1 time/wk 1 Age 2-4 times/wk 1.4 (1.0-1.9) ≥ 5 times/wk 0.9 (0.5-1.8) Ngoan et al [37] 2002 [38] 2005 Japan 20 yr 38576 1270 Gastric > 2 times/wk 1 Sex, sex-specific age, 2-4 times/wk 1.09 (0.96-1. ...
Article
Aim: To assess quantitatively the relationship between fish intake and the incidence of gastrointestinal cancers in a meta-analysis of cohort studies. Methods: We searched MEDLINE, Embase, Science Citation Index Expanded, and the bibliographies of retrieved articles. Prospective cohort studies were included if they reported relative risks (RRs) and corresponding 95% confidence intervals (CIs) of various cancers with respect to fish intake. When RRs were not available in the published article, they were computed from the exposure distributions. Two investigators extracted the data independently and discrepancies were resolved by discussion with a third investigator. We performed random-effect meta-analyses and meta-regressions of study-specific incremental estimates to determine the risk of cancer associated with a 20-g/d increment of fish consumption. Results: Forty-two studies, comprising 27 independent cohorts, met our inclusion criteria. The studies included 2325040 participants and 24115 incident cases of gastrointestinal cancer, with an average follow-up of 13.6 years. Compared with individuals who did not eat, or seldom ate, fish, the pooled RR of gastrointestinal cancers was 0.93 (95%CI: 0.88-0.98) for regular fish consumers, 0.94 (0.89-0.99) for low to moderate fish consumers, and 0.91 (0.84-0.97) for high fish consumers. Overall, a 20-g increase in fish consumption per day was associated with a 2% reduced risk of gastrointestinal cancers (RR = 0.98; 95%CI: 0.96-1.01). In subgroup analyses, we noted that fish consumption was associated with reduced risk of colorectal (RR = 0.93; 95%CI: 0.87-0.99; P < 0.01), esophageal (RR = 0.91; 95%CI: 0.83-0.99; P < 0.05) and hepatocellular cancers (RR = 0.71; 95%CI: 0.48-0.95; P < 0.01). Conclusion: This meta-analysis suggested that fish consumption may reduce total gastrointestinal cancer incidence. Inverse relationships were also detected between fish consumption and specific types of cancers.
... We found no strong associations for total nonprocessed red meat or total processed meats. Our findings suggest that consideration of individual types of meats and cooking practices is important in order to understand the meat and cancer risk association, and this may explain why other studies failed to find positive associations with total red meat [24,26,[38][39][40] or found weak associations [27,41,42]. Pan-frying involves frying foods on a flat pan using just enough cooking oil or fat to lubricate the pan. ...
Article
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Diets high in red meat and processed meats are established colorectal cancer (CRC) risk factors. However, it is still not well understood what explains this association. We conducted comprehensive analyses of CRC risk and red meat and poultry intakes, taking into account cooking methods, level of doneness, estimated intakes of heterocyclic amines (HCAs) that accumulate during meat cooking, tumor location, and tumor mismatch repair proficiency (MMR) status. We analyzed food frequency and portion size data including a meat cooking module for 3364 CRC cases, 1806 unaffected siblings, 136 unaffected spouses, and 1620 unaffected population-based controls, recruited into the CRC Family Registry. Odds ratios (OR) and 95% confidence intervals (CI) for nutrient density variables were estimated using generalized estimating equations. We found no evidence of an association between total nonprocessed red meat or total processed meat and CRC risk. Our main finding was a positive association with CRC for pan-fried beefsteak (Ptrend < 0.001), which was stronger among MMR deficient cases (heterogeneity P = 0.059). Other worth noting associations, of borderline statistical significance after multiple testing correction, were a positive association between diets high in oven-broiled short ribs or spareribs and CRC risk (Ptrend = 0.002), which was also stronger among MMR-deficient cases, and an inverse association with grilled hamburgers (Ptrend = 0.002). Our results support the role of specific meat types and cooking practices as possible sources of human carcinogens relevant for CRC risk. © 2015 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
... In this study, the majority (77%) of colorectal cancer incidences were observed in the ages higher than 40 years. This finding is in parallel with some previous studies that indicated the incidence of colorectal cancer, higher in patients older than 45 years [19][20][21] . It is worth stating that the number of affected people per year has increased during 2005-2014. ...
Article
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Introduction: Colorectal cancer is the third and fourth major cause of cancer prevalence and also mortality among males and females, respectively in Iran. The number of Lymph Nodes which are remain associated after surgery, are one of the pre-notice aspects which influence on patients. This study aimed to investigate the rate of adequacy of lymph node in patients with colorectal cancer in Tehran, Iran. This study was a retrospective investigation and the studied population was the patients who had been hospitalized with colorectal cancer in Imam Khomeini Hospital, Tehran, Iran. Data on patient and tumor variables were collected from charts of 1095 patients aged, diagnosed at our hospital in 2005-2014. 877 colorectal cancer patients were evaluated for involvement of lymph nodes during study. 495 subjects (56.4%) were male with the mean age of 51.34±12.23 and 382 patients (43.6%) were female with average age of 50.51±13.41. The mean number of evaluated lymph nodes in total period of the study was 8. The minimum number of involved lymph nodes in the patients was 0 and 91 cases showed such situation and maximum number of involved lymph nodes in patients was 25 that included 1.03% of the patients. with regards to importance of definition of involved lymph nodes in prognosis and chance of survival in the patients and also suggestion of national cancer institute to define at least 12 lymph nodes for determination of disease stage, it is advised that definition of involved lymph nodes conduct with higher accuracy.
... This findings support the associations reported in the correlation studies in southern Mediterranean countries (30), China (31), Japan (32), Brazil (33), Iran (34), and some East Asian countries (7). Our results stand in contrast to the pattern seen in developed countries, such as some comparisons in United States and most Western European countries (10,16,(35)(36)(37). ...
Article
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The purpose of this study was to investigate the association between pro capite food consumption and mortality rates of the five commonest cancers in Serbia. Materials and methods: The correlation between the age-adjusted mortality rates of breast, prostate, lung, colon and pancreatic cancer and pro capite food consumption was calculated by Pearson’ correlation coefficient. Results: The coefficients of correlation indicate that pro capite consumption of animal fat (r=-0.67), beef (r=-0.80), milk (r=-0.47), wine (r=0.72) and hard drinks (r=-0.81) were significantly negatively correlated with female breast cancer mortality rates, while consumption of poultry (r=0.61), dried and processed meat (r=0.57), fish (r=0.53), eggs (r=0.71), and yogurt (r=0.66) were positively correlated. A positive correlation was apparent in the four cancers (prostate, lung, colon and pancreatic cancer) mortality rates with pro capite consumption of vegetable oil, poultry, dried and processed meat, fish, eggs, yogurt and other dairy products, and coffee. Consumption of beer was correlated only with pancreatic cancer mortality rates (r=0.52). Conclusions: Striking changes in mortality rates of breast, prostate, lung, colon and pancreatic cancers have been shown, which may be at least in part attributable to the concurrent nutrition transition.
... According to the American Institute for Cancer Research, eating more than 550 g of red meat per week may increase cancer risk. However, there is insufficient evidence to link white meat (poultry, domestic rabbit) to chronic diseases [19][20][21][22][23][24]. ...
Article
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Recently, attention has been drawn to the fact that increasing the consumption of edible insects may positively impact the state of the natural environment and reduce the problem of malnutrition in large parts of society. Indeed, insects are seen as an alternative to traditional meat products, primarily meat. This article aimed to compare the nutritional value of edible insects and meat. Based on tables of composition and nutritional value and on the licensed computer program Diet 6D, data on the nutritional value of 10 commonly consumed meat types were compiled. Based on a literature review, data on the nutritional value of seven commercially available edible insect species were collected and collated. There was a comparison of 100 g of edible insects with 100 g of meat (fresh weight). In addition, the atherogenic index thrombogenic index, the hypocholesterolemic/hypercholesterolemic ratio, and the nutritional quality index were calculated. It was found that both meat and insects are rich in nutrients, including those considered essential for the proper development and functioning of the human body. At the same time, it has been shown that the content of individual nutrients in both insects and meat varies significantly.
... 45 A pooled analysis of the UK dietary cohort consortium did not show an association between meat intake and colorectal cancers. 46 However, the highest category of red meat intake in this pooled analysis was much lower than in similar studies with a positive finding, and the authors believed that the study was underpowered to detect small effect sizes. In another pooled analysis of red meat intake and colorectal cancer, although an overall association between high red meat intake and colorectal cancer was found, the association was not significant among prospective case-control studies. ...
Article
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Objective To determine the association of different types of meat intake and meat associated compounds with overall and cause specific mortality. Design Population based cohort study. Setting Baseline dietary data of the NIH-AARP Diet and Health Study (prospective cohort of the general population from six states and two metropolitan areas in the US) and 16 year follow-up data until 31 December 2011. Participants 536 969 AARP members aged 50-71 at baseline. Exposures Intake of total meat, processed and unprocessed red meat (beef, lamb, and pork) and white meat (poultry and fish), heme iron, and nitrate/nitrite from processed meat based on dietary questionnaire. Adjusted Cox proportional hazards regression models were used with the lowest fifth of calorie adjusted intakes as reference categories. Main outcome measure Mortality from any cause during follow-up. Results An increased risk of all cause mortality (hazard ratio for highest versus lowest fifth 1.26, 95% confidence interval 1.23 to 1.29) and death due to nine different causes associated with red meat intake was observed. Both processed and unprocessed red meat intakes were associated with all cause and cause specific mortality. Heme iron and processed meat nitrate/nitrite were independently associated with increased risk of all cause and cause specific mortality. Mediation models estimated that the increased mortality associated with processed red meat was influenced by nitrate intake (37.0-72.0%) and to a lesser degree by heme iron (20.9-24.1%). When the total meat intake was constant, the highest fifth of white meat intake was associated with a 25% reduction in risk of all cause mortality compared with the lowest intake level. Almost all causes of death showed an inverse association with white meat intake. Conclusions The results show increased risks of all cause mortality and death due to nine different causes associated with both processed and unprocessed red meat, accounted for, in part, by heme iron and nitrate/nitrite from processed meat. They also show reduced risks associated with substituting white meat, particularly unprocessed white meat.
... and the OR for people eating, on average, more than 30 g processed meat per day vs. those who ate less than 5 g per day was 0.76 (95% CI 0.56-1.03) (Spencer et al. 2010). ...
Article
This paper provides an update of a previous review ‘Red Meat in the Diet’ published in the Nutrition Bulletin in 2005. An update on red meat consumption levels in the UK and other countries is provided, and a summary of the nutritional content of red meat in the diet is given. Current evidence on dietary and lifestyle factors associated with red meat consumption and the effects of red meat intake on health and chronic disease outcomes are discussed. As there is now continued debate about the environmental impact of different aspects of our diet, sustainability issues regarding red meat were also discussed.
... 13,14 Analysis from pooled data from prospective food diaries, among UK cohorts with low to moderate meat intakes, showed little evidence of association between consumption of red and processed meat and CRC risk. 15 However, the prospective cohort trial of Seventh Day Adventist in the USA has found that vegetarian diets, especially pesco-vegetarians, those who eat fish but no meat, are associated with an overall lower incidence of CRC. 16 Recently, fish intake has also been found to be inversely associated with the risk of rectal cancer. ...
Article
Full-text available
Few prospective cohort studies in the UK have specifically focused on the associations between commonly consumed dietary patterns and colorectal cancer (CRC). The aim of this study was to assess whether red meat, poultry, fish and vegetarian dietary patterns are associated with differences in the incidence of cancers of colon and rectum in the UKWCS. Four common dietary patterns were defined based on a hierarchy of consumption of red meat, poultry, and fish for each cohort participant, using a 217-item food frequency questionnaire. Cox proportional hazards regression was used to provide adjusted hazard ratios (HR) and 95% confidence intervals (CI) for CRC. A total of 32,147 women recruited and surveyed between 1995 and 1998 were followed up for a mean of 17.2 years (426,798 person-years). A total of 462 incident CRC cases were documented; 335 colon cancers (172 proximal and 119 distal) and 152 in the rectum. In multivariable-adjusted models, there was no evidence of a reduction in risk of overall CRC (HR=0.86, 95% CI: 0.66 to 1.12), colon cancer (HR=0.77, 95% CI: 0.56 to 1.05), or rectal cancer (HR=1.04, 95% CI: 0.66 to 1.63) when comparing grouped red meat free diets with diets containing red meat. Exploratory analysis suggested a reduced risk of distal colon cancer in grouped red meat free diets (HR=0.56, 95% CI: 0.34 to 0.95), though numbers with this outcome were small. These results indicate that a protective association of red meat free diets specifically on distal colon cancer merits confirmation in a larger study. This article is protected by copyright. All rights reserved.
... The inconsistencies probably are due to differences in the range of meat intakes in different studies. In fact, a statistically significant effect can be found only when population of high meat eaters are included [20][21][22]. There are some mechanisms by which meat acts as a carcinogen. ...
Article
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Introduction Colorectal cancer is the third cause of death in industrialized countries. Genetic susceptibility and diet are determinant of cancer risk and tumor behavior. Variation in cancer incidence among and within populations with similar dietary patterns suggests that an individual response may reflect interactions with genetic factors, which may modify gene, protein, and metabolite expression patterns. Nutrigenomics, defined as the interaction between nutrition and an individual genome, will likely provide important clues about responders and non-responders to nutritional intervention. Discussion Epidemiological and experimental studies suggest a protective role of some normal components of daily diet (fish oil, milk, and vegetables), estrogens, and phytoestrogens in colorectal cancer. The effect of estrogen seems to be mediated by their binding to estrogen receptor beta (ER-β), one of the two estrogen receptors with high affinity for these hormones. Very recently, the demonstration of an involvement of ER-β in the development of adenomatous polyps of the colon has also been documented, suggesting the use of selective ER-β agonists in primary colorectal cancer prevention. Phytoestrogens are plant-derived compounds that structurally and functionally act as estrogen agonists in mammals. They are characterized by a higher binding affinity to ER-β as compared to estrogen receptor alpha (ER-α), the other estrogen receptor subtype. These biological characteristics explain why the administration of phytoestrogens does not produce the classical side effects associated to estrogen administration (cerebro- and cardiovascular accidents, higher incidence of endometrial and breast cancer) and makes these substances potential candidates for colorectal cancer prevention.
... association. 23,24 However, to our knowledge, this is the first study to formally test the trend of the association between red meat and colorectal cancer across anatomical subsites. The observed "right-to-left" trend may be due to several factors, including different exposures to bowel contents, variations in the gut microbiome and/or differences in susceptibility to carcinogens by anatomical subsite. ...
Article
Distal and proximal colon tumors have distinct incidence trends and embryonic origins; whether these sub‐sites have distinct susceptibilities to known risk factors is unclear. We used pooled data from 407,270 participants in three US‐based studies, with overall median follow‐up of 13.8 years. We used adjusted Cox models to analyze the association between dietary intakes (from diet history questionnaire) of total, processed and unprocessed red meat; total white meat, poultry and fish; and meat‐related compounds: heme iron, nitrate, nitrite, the heterocyclic amines (HCAs), and benzo(a)pyrene (B(a)P) and incidence of colorectal cancer subsites. The risk of colorectal cancer (n=6,640) increased by 35% for each 50 g/1000 kcal higher daily intake of total red meat, with a significant right‐to‐left trend from proximal colon (HR:1.24; 95%CI:1.09‐1.39) to distal colon (HR:1.34; 95%CI:1.13‐1.55) and rectum (HR:1.53; 95%CI:1.28‐1.79). Only unprocessed red meat showed a significant right‐to‐left trend. Each 50 g/1000 kcal increase in white meat intake was associated with a 26% reduction in total colorectal cancer risk (HR: 0.74; 95%CI: 0.68‐0.80), with a significant inverse right‐to‐left trend. The highest quintile of heme iron was associated with increased cancer risk only in the distal colon (HR:1.20; 95%CI: 1.02‐1.42) and rectum (HR:1.27; 95%CI: 1.07‐1.52). The highest quintile of HCAs, and nitrate/nitrite were associated with increased risk of total colorectal cancer, but these associations did not vary across anatomical subsites. In summary, right and left subsites of the colon may have distinct susceptibilities to meat and possibly other dietary risk factors, suggesting that the causes of colorectal cancer may vary across anatomical subsites. This article is protected by copyright. All rights reserved.
... Intake of fish or poultry has not been associated with higher risks for colon or rectal cancer (1,3,26), consistent with our findings. The higher heme iron content of red meat represents one main difference between red meat and fish and poultry. ...
Article
Cancer prevention guidelines recommend limiting intake of red meat and avoiding processed meat; however, few studies have been conducted on the effects of specific red meat subtypes on colon cancer or rectal cancer risk. The study aim was to evaluate associations between intake of red meat and its subtypes, processed meat, fish, and poultry and risk for colon cancer or rectal cancer in the Danish Diet, Cancer and Health cohort study. We also evaluated whether fish or poultry should replace red meat intake to prevent colon cancer or rectal cancer. During follow-up (13.4 y), 644 cases of colon cancer and 345 cases of rectal cancer occurred among 53,988 participants. Cox proportional hazards models were used to compute incidence rate ratio (IRRs) and 95% CIs. No associations were found between intake of red meat, processed meat, fish, or poultry and risk for colon cancer or rectal cancer. The risk associated with specific red meat subtypes depended on the animal of origin and cancer subsite; thus, the risk for colon cancer was significantly elevated for higher intake of lamb [IRR(per 5g/d) = 1.07 (95% CI: 1.02-1.13)], whereas the risk for rectal cancer was elevated for higher intake of pork [IRR(per 25g/d) = 1.18 (95% CI: 1.02-1.36)]. Substitution of fish for red meat was associated with a significantly lower risk for colon cancer [IRR(per 25g/d) = 0.89 (95% CI: 0.80-0.99)] but not rectal cancer. Substitution of poultry for red meat did not reduce either risk. This study suggests that the risks for colon cancer and potentially for rectal cancer differ according to the specific red meat subtype consumed.
... According to the systematic reviews and meta-analyses, some observed a significant positive association, [6][7][8][9] whereas others failed to confirm the associations of CRC with intake of red meat [10][11][12] and processed meat. 13 Given that the fat content and the total amount of heme iron, which is a potent carcinogenic agent, 14 vary according to red meat subtypes, 15,16 the risk of CRC and its subsites could vary across red meat subtypes. ...
Article
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Red meat and processed meat have been suggested to increase risk of colorectal cancer (CRC), especially colon cancer. However, it remains unclear whether these associations differ according to meat subtypes or colon subsites. The present study addressed this issue by conducting a pooled analysis of large population-based cohort studies in Japan: 5 studies comprising 232,403 participants (5,694 CRC cases) for analysis based on frequency of meat intake and 2 studies comprising 123,635 participants (3,550 CRC cases) for analysis based on intake quantity. Study-specific hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards model and then pooled using the random effect model. Comparing the highest versus lowest quartile, beef intake was associated with an increased risk of colon cancer in women (pooled HR 1.20, 95% CI 1.01-1.44) and distal colon cancer (DCC) risk in men (pooled HR 1.38, 95% CI 1.08-1.75). Frequent intake of pork was associated with an increased risk of DCC in women (pooled HR 1.44, 95% CI 1.10-1.87) for "3 times/week or more" versus "<1 time/week". Frequent intake of processed red meat was associated with an increased risk of colon cancer in women (pooled HR 1.39, 95% CI 0.97-2.00; p-trend=0.04) for "almost every day" versus "<1 time/week". No association was observed for the chicken consumption. The present findings support that intake of beef, pork (women only), and processed red meat (women only) may be associated with a higher risk of colon (distal colon) cancer in Japanese. This article is protected by copyright. All rights reserved.
... The risk of having colorectal cancer was found to increase with increasing frequency of consumption of red meat and processed meat. Spencer et al. [17] and Pham et al. [18] reported the association [19] and Alexander et al. [20] also reported positive association between consumption of processed meat and colorectal cancer. ...
Article
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Introduction: Colorectal cancer is the third most common cancer in men and the second in women worldwide. The objective of the present study was to determine and quantify important modifiable risk factors attributable to colorectal cancer, in order to explore the ways to reduce the incidence of colorectal cancer in this region. Materials and methods: A case-control study was conducted at a tertiary care hospital in Goa, India. The study subjects were group matched for age and sex so as to include 110 cases and 110 controls. Only incident cases of colorectal cancer were recruited in the study. Predesigned structured questionnaire was utilized for data collection, while anthropometric measurements and laboratory investigations were conducted. Statistical analysis was conducted using SPSS software package. The study was approved by the Institutional Ethics Committee of the institute. Informed written consent was obtained from the study participants. Results: Smoking, smokeless tobacco use, alcohol consumption, red meat consumption, high body mass index (BMI), and the presence of Type 2 diabetes mellitus were found to be the risk factors for colorectal cancer on univariate analysis, while fruit and vegetable consumption were found to be the protective factors. Multiple logistic regression analysis identified Type 2 diabetes mellitus and high BMI as risk factors for colorectal cancer and consumption of fruits and vegetables as protective factors. Conclusion: Identification of risk factors for colorectal cancer would help in setting of colorectal cancer screening guidelines as well as for creating awareness regarding prevention of colorectal cancer among the general population.
... Although some studies have demonstrated an inverse relationship between fish consumption and colorectal cancer [4,12,13], others have not found a clear association [14][15][16]. In line with previous meta-analyses and pooled analyses that did not find an inverse association between fish intake and colorectal cancer risk [17,18], a comprehensive review by the World Cancer Research Fund concluded that the association between fish and colorectal cancer is "limited-suggestive" [3]. In a recent study from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohorts, the total intakes of fish, fatty fish and lean fish were associated with a reduced risk for colorectal cancer [19]. ...
Article
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Purpose: We aimed to assess the association between the dietary intake of fish-derived omega-3 polyunsaturated fatty acids and the risk of colorectal cancer among Swedish women. Materials and methods: A total of 48,233 women with information on dietary intake were included in the analysis. Participants were followed for incident colorectal cancer until 31 December 2012. Cox proportional hazard models were used to assess the association between baseline fatty acid intake and colorectal cancer risk. All analyses were stratified by colon and rectal cancers. Results: During a median of 21.3 years of follow-up, a total of 344 colorectal cancer cases were ascertained. Although there was no overall association between omega-3 fatty acid intake and colorectal cancer risk, high intake of fish-derived docosahexaenoic acid was associated with reduced risk of rectal cancer (hazard ratios for the third and the highest quartiles were 0.59 (95% confidence interval [CI], 0.37 to 0.96) and 0.62 (95% CI, 0.39 to 0.98), respectively). Conclusion: In conclusion, we found only limited support for an association between omega-3 polyunsaturated fatty acids and colorectal cancer in a large Swedish cohort of middle-aged women.
Article
Poultry intake has been inconsistently associated with incidence or mortality of colorectal cancer (CRC) in epidemiologic studies. The purpose of this study was to assess their relationships by performing a dose-response meta-analysis. We conducted a search of PubMed database between January 1966 and July 2013 for prospective studies that reported relative risks (RRs) with 95 % confidence interval (CIs) of CRC for at least three categories of poultry intake. Dose-response relationships were examined with the generalized least-squares trend estimation. Study-specific results were pooled with a random-effects model. Subgroup, sensitivity, and meta-regression analyses were also conducted to explore heterogeneity. Sixteen studies on poultry intake and CRC incidence, and four studies regarding poultry intake and CRC mortality were identified. These studies involved a total of 13,949 incident CRC cases and 983 CRC deaths. The RRs of CRC for higher compared with lower intake of poultry were reported in these studies, and the reported levels of poultry intake varied substantially. Results of the dose-response meta-analysis conferred a RR of 0.89 (95 % CI 0.81-0.97) for an increase in poultry intake of 50 g/day. The results were not sensitive to any individual studies and were similar for colon and rectal cancer. Poultry intake was not associated with CRC mortality (RR for 50 g/day = 0.97, 95 % CI 0.79-1.20). This meta-analysis indicates that poultry intake may be moderately associated with reduced incidence of CRC.
Article
Fish plays a useful role in a healthy and balanced diet, and its consumption has long been associated with several health benefits. Fish provides a variety of nutrients, including protein and long-chain omega-3 polyunsaturated fatty acids (n-3 PUFAs), as well as micronutrients including selenium, iodine, potassium, vitamin D and B-vitamins. Intakes of some of these micronutrients, including iodine and vitamin D, are low in some population groups in the UK, which makes fish a valuable contributor to intakes of these. The long-chain n-3 PUFA eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), present in oil-rich fish and fish oil, have been suggested to be associated with beneficial health outcomes. In this paper, we review the evidence associating fish and long-chain n-3 PUFAs with various health outcomes.
Article
An increased risk for colorectal cancer has been consistently reported for long-time consumption of cooked and processed red meat. This has frequently been attributed to chemical carcinogens arising during the cooking process of meat. Long-time fish or poultry consumption apparently does not increase the risk, although similar or higher concentrations of chemical carcinogens were recorded in their preparation for consumption. The geographic epidemiology of colorectal cancer seems to correspond to regions with a high rate of beef consumption. Countries with a virtual absence of beef in the diet (India) or where preferably lamb or goat meat is consumed (several Arabic countries) reveal low rates of colorectal cancer. In China, pork consumption has a long tradition, with an intermediate colorectal cancer rate. In Japan and Korea, large scale beef and pork imports started after World War II or after the Korean War. A steep rise in colorectal cancer incidence was noted after 1970 in Japan and 1990 in Korea. The consumption of undercooked beef (e.g., shabu-shabu, Korean yukhoe and Japanese yukke) became very popular in both countries. The available data are compatible with the interpretation that a specific beef factor, suspected to be one or more thermoresistant potentially oncogenic bovine viruses (e.g., polyoma-, papilloma- or possibly single-stranded DNA viruses) may contaminate beef preparations and lead to latent infections in the colorectal tract. Preceding, concomitant or subsequent exposure to chemical carcinogens arising during cooking procedures should result in increased risk for colorectal cancer synergistic with these infections.
Article
Epidemiological evidence of red meat and processed meat consumption and colorectal cancer risk has accumulated during the past decades. Meta-analyses of case-control and prospective cohort studies have shown a moderate increased risk, but the association is controversial. Because diet is one of the modifiable lifestyle factors for colorectal cancer prevention, the relationship has an important public health perspective. Three prospective cohort studies and one case-control study of total red meat and processed meat and colorectal cancer were published in 2011 and 2012. The findings were in general supportive of an increased risk with higher consumption. The same applies to the four studies each on fresh red meat and processed meat. Associations with dietary heterocyclic amines, nitroso-compounds, and heme iron intake are inconsistent, but evidence suggested a positive association between heme iron intake and colorectal cancer risk.
Article
Purpose: Observational studies on the association between white meat (including fish and poultry) intake and the risk of colorectal adenoma (CRA), the precursor of colorectal cancer, have reported mixed results. To provide a quantitative assessment of this association, we summarized the evidence from observational studies. Methods: Relevant studies published on or before April 30, 2012 were identified from MEDLINE and EMBASE. Summary effect size estimates with 95% confidence intervals (CIs) were calculated with a random-effects model. Between-study heterogeneity was assessed using the Cochran Q and I(2) statistics. Results: A total of 23 publications from 21 independent studies (16 case-control and 5 cohort studies) were included in this meta-analysis. Based on high versus low analysis, the summary effect size estimate of CRA was 0.96 (95% CI, 0.84-1.09) for white meat intake, 0.98 (95% CI, 0.80-1.19) for fish intake, and 0.98 (95% CI, 0.80-1.18) for poultry intake. Subgroup analyses revealed that the null associations of CRA with intake of white meat (fish/poultry) were independent of geographic locations, study design, type of food frequency questionnaire, number of cases, and adjustments for confounders, such as body mass index, use of nonsteroidal anti-inflammatory drugs, dietary energy intake, smoking, and physical activity. Conclusions: Intake of white meat (fish/poultry) is not associated with the risk of CRA.
Article
Fish consumption may protect against colorectal cancer, but results from observational studies are inconsistent; therefore, a systematic review with a meta-analysis was conducted. Relevant studies were identified by a search of MEDLINE and EMBASE databases to May 2011, with no restrictions. Reference lists from retrieved articles also were reviewed. Studies that reported odds ratio (OR) or relative risk estimates with 95% confidence intervals (CIs) for the association between the consumption of fish and the risk of colorectal, colon, or rectal cancer were included. Two authors independently extracted data and assessed study quality. The risk estimate (hazard ratio, relative risk, or OR) of the highest and lowest reported categories of fish intake were extracted from each study and analyzed using a random-effects model. Twenty-two prospective cohort and 19 case-control studies on fish consumption and colorectal cancer risk met the inclusion criteria and were included in the meta-analysis. Our analysis found that fish consumption decreased the risk of colorectal cancer by 12% (summary OR, 0.88; 95% CI, 0.80-0.95). The pooled ORs of colorectal cancer for the highest versus lowest fish consumption in case-control studies and cohort studies were 0.83 (95% CI, 0.72-0.95) and 0.93 (95% CI, 0.86-1.01), respectively. There was heterogeneity among case-control studies (P<.001) but not among cohort studies. A significant inverse association was found between fish intake and rectal cancer (summary OR, 0.79; 95% CI, 0.65-0.97), and there was a modest trend seen between fish consumption and colon cancer (summary OR, 0.96; 95% CI, 0.81-1.14). This study had no publication bias. Our findings from this meta-analysis suggest that fish consumption is inversely associated with colorectal cancer.
Article
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There is limited evidence to support the relationship between the consumption of animal-source foods other than red meat and processed meat and colorectal cancer (CRC) risk. We aimed to examine the recent available evidence from observational studies about the association between these food groups’ intake and CRC risk. For this systematic review, we searched the PubMed database for the last five years. A total of fourteen cohort studies and seven case–control studies comprising a total of >60,000 cases were included. The studies showed a consistent significant decrease in CRC risk, overall and by subsites, associated with a high consumption of total dairy products. Less strong effects associated with the consumption of any subtype of dairy product were observed. Fish consumption, overall and by subtypes (oily or non-oily and fresh or canned), showed a mild inverse association with CRC risk. The association between white meat and egg intake and CRC risk was low and based on a small number of studies; thus, these findings should be interpreted with caution. In conclusion, a high consumption of total dairy products was associated with a lower CRC risk. However, evidence for fish, white meat, and eggs and the CRC risk were not as strong.
Chapter
Colorectal cancer (CRC) is the third most common cancer worldwide after lung and breast cancer with an estimated 1.24 million new cases diagnosed in 2008. It has been suggested that changes in dietary habits might reduce up to 70% of this cancer burden. Processed meat, red meat, alcohol, body fatness and in particular abdominal fatness are associated with cancer risk. Impaired nutritional status is a frequent complication in patients with CRC and can negatively affect the outcome of treatment and quality of life. The consequences of underlying pathology or disease-associated symptoms such as diarrhoea, nausea or vomiting all contribute to the high incidence of protein energy malnutrition (PEM). All causes of excessive nutrient loss with or without increased metabolic needs will influence nutritional status. Medical treatment of CRC focuses on the administration of cytotoxic agents with or without radiation therapy.
Conference Paper
The purpose of this study was to investigate the association between pro capite food consumption and mortality rates of the five commonest cancers in Serbia. Materials and methods: The correlation between the age-adjusted mortality rates of breast, prostate, lung, colon and pancreatic cancer and pro capite food consumption was calculated by Pearson’ correlation coefficient. Results: The coefficients of correlation indicate that pro capite consumption of animal fat (r=-0.67), beef (r=-0.80), milk (r=-0.47), wine (r=0.72) and hard drinks (r=-0.81) were significantly negatively correlated with female breast cancer mortality rates, while consumption of poultry (r=0.61), dried and processed meat (r=0.57), fish (r=0.53), eggs (r=0.71), and yogurt (r=0.66) were positively correlated. A positive correlation was apparent in the four cancers (prostate, lung, colon and pancreatic cancer) mortality rates with pro capite consumption of vegetable oil, poultry, dried and processed meat, fish, eggs, yogurt and other dairy products, and coffee. Consumption of beer was correlated only with pancreatic cancer mortality rates (r=0.52). Conclusions: Striking changes in mortality rates of breast, prostate, lung, colon and pancreatic cancers have been shown, which may be at least in part attributable to the concurrent nutrition transition.
Data
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Associations between food and beverage groups and the risk of diet-related chronic disease (DRCD) have been the subject of intensive research in preventive nutrition. Pooled/meta-analyses and systematic reviews (PMASRs) aim to better characterize these associations. To date, however, there has been no attempt to synthesize all PMASRs that have assessed the relationship between food and beverage groups and DRCDs. The objectives of this review were to aggregate PMASRs to obtain an overview of the associations between food and beverage groups (n = 17) and DRCDs (n = 10) and to establish new directions for future research needs. The present review of 304 PMASRs published between 1950 and 2013 confirmed that plant food groups are more protective than animal food groups against DRCDs. Within plant food groups, grain products are more protective than fruits and vegetables. Among animal food groups, dairy/milk products have a neutral effect on the risk of DRCDs, while red/processed meats tend to increase the risk. Among beverages, tea was the most protective and soft drinks the least protective against DRCDs. For two of the DRCDs examined, sarcopenia and kidney disease, no PMASR was found. Overweight/obesity, type 2 diabetes, and various types of cardiovascular disease and cancer accounted for 289 of the PMASRs. There is a crucial need to further study the associations between food and beverage groups and mental health, skeletal health, digestive diseases, liver diseases, kidney diseases, obesity, and type 2 diabetes. © 2014 International Life Sciences Institute.
Article
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Colorectal cancers are a leading cause of cancer mortality, and their primary prevention by diet is highly desirable. The relationship of vegetarian dietary patterns to colorectal cancer risk is not well established. To evaluate the association between vegetarian dietary patterns and incident colorectal cancers. The Adventist Health Study 2 (AHS-2) is a large, prospective, North American cohort trial including 96 354 Seventh-Day Adventist men and women recruited between January 1, 2002, and December 31, 2007. Follow-up varied by state and was indicated by the cancer registry linkage dates. Of these participants, an analytic sample of 77 659 remained after exclusions. Analysis was conducted using Cox proportional hazards regression, controlling for important demographic and lifestyle confounders. The analysis was conducted between June 1, 2014, and October 20, 2014. Diet was assessed at baseline by a validated quantitative food frequency questionnaire and categorized into 4 vegetarian dietary patterns (vegan, lacto-ovo vegetarian, pescovegetarian, and semivegetarian) and a nonvegetarian dietary pattern. The relationship between dietary patterns and incident cancers of the colon and rectum; colorectal cancer cases were identified primarily by state cancer registry linkages. During a mean follow-up of 7.3 years, 380 cases of colon cancer and 110 cases of rectal cancer were documented. The adjusted hazard ratios (HRs) in all vegetarians combined vs nonvegetarians were 0.78 (95% CI, 0.64-0.95) for all colorectal cancers, 0.81 (95% CI, 0.65-1.00) for colon cancer, and 0.71 (95% CI, 0.47-1.06) for rectal cancer. The adjusted HR for colorectal cancer in vegans was 0.84 (95% CI, 0.59-1.19); in lacto-ovo vegetarians, 0.82 (95% CI, 0.65-1.02); in pescovegetarians, 0.57 (95% CI, 0.40-0.82); and in semivegetarians, 0.92 (95% CI, 0.62-1.37) compared with nonvegetarians. Effect estimates were similar for men and women and for black and nonblack individuals. Vegetarian diets are associated with an overall lower incidence of colorectal cancers. Pescovegetarians in particular have a much lower risk compared with nonvegetarians. If such associations are causal, they may be important for primary prevention of colorectal cancers.
Chapter
Noncommunicable chronic diseases such as inflammatory bowel diseases, cancer, diabetes, obesity, and pulmonary, cardiovascular, and neurodegenerative diseases are becoming the leading cause of death throughout the world. Unhealthy diet, smoking, lack of exercise, stress, radiation exposure, and environmental pollution are among the common causes of chronic diseases. Most of these risk factors are closely linked to chronic inflammation, which leads to the development of various chronic diseases. Diets high in fruits, vegetables, legumes, fiber, and certain spices have been shown to suppress chronic inflammation and prevent the development of chronic diseases. In this review we discuss the evidence for the molecular basis of inflammation and how inflammation mediates most chronic diseases. We also present clinical and experimental models showing the molecular effects of selected spices and spice-derived nutraceuticals such as cardamonin, curcumin, capsaicin, gingerol, thymoquinone, and piperine on these inflammatory pathways and the potential role of nutraceuticals in preventing chronic diseases.
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Background/objectives: The influence of dietary factors remains controversial for screen-detected prostate cancer and inconclusive for clinically detected disease. We aimed to examine these associations using prospectively collected food diaries. Subjects/methods: A total of 1,717 prostate cancer cases in middle-aged and older UK men were pooled from four prospective cohorts with clinically detected disease (n=663), with routine data follow-up (means 6.6-13.3 years) and a case-control study with screen-detected disease (n=1054), nested in a randomised trial of prostate cancer treatments (ISCTRN 20141297). Multiple-day food diaries (records) completed by men prior to diagnosis were used to estimate intakes of 37 selected nutrients, food groups and items, including carbohydrate, fat, protein, dairy products, fish, meat, fruit and vegetables, energy, fibre, alcohol, lycopene and selenium. Cases were matched on age and diary date to at least one control within study (n=3528). Prostate cancer risk was calculated, using conditional logistic regression (adjusted for baseline covariates) and expressed as odds ratios in each quintile of intake (±95% confidence intervals). Prostate cancer risk was also investigated by localised or advanced stage and by cancer detection method. Results: There were no strong associations between prostate cancer risk and 37 dietary factors. Conclusions: Prostate cancer risk, including by disease stage, was not strongly associated with dietary factors measured by food diaries in middle-aged and older UK men.European Journal of Clinical Nutrition advance online publication, 28 September 2016; doi:10.1038/ejcn.2016.162.
Technical Report
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Ce travail se situe dans le cadre d’un travail global relatif à la mise à jour des repères de consommations alimentaires, présidé par M. Jean-Louis BRESSON.
Article
Objective: As part of the World Cancer Research Fund International Continuous Update Project, we updated the systematic review and meta-analysis of prospective studies to quantify the dose-response between foods and beverages intake and colorectal cancer risk. Data sources: PubMed and several databases up to May 31 st 2015. Study selection: Prospective studies reporting adjusted relative risk estimates for the association of specific food groups and beverages and risk of colorectal, colon and rectal cancer. Data synthesis: Dose-response meta-analyses using random effect models to estimate summary relative risks (RRs). Results: Results: 400 individual study estimates from 111 unique cohort studies were included. Overall, the risk increase of colorectal cancer is 12% for each 100g/day increase of red and processed meat intake (95%CI=4-21%, I2 =70%, pheterogeneity (ph)<0.01) and 7% for 10 g/day increase of ethanol intake in alcoholic drinks (95%CI=5-9%, I2 =25%, ph = 0.21). Colorectal cancer risk decrease in 17% for each 90g/day increase of whole grains (95%CI=11-21%, I2 =0%, ph = 0.30, 6 studies). For each 400 g/day increase of dairy products intake (95%CI=10-17%, I2 =18%, ph = 0.27, 10 studies). Inverse associations were also observed for vegetables intake (RR per 100 g/day =0.98 (95%CI=0.96-0.99, I2 =0%, ph = 0.48, 11 studies) and for fish intake (RR for 100g/day=0.89(95%CI=0.80-0.99, I2 =0%, ph = 0.52, 11 studies), that were weak for vegetables and driven by one study for fish. Intakes of fruits, coffee, tea, cheese, poultry and legumes were not associated with colorectal cancer risk. Conclusions: Our results reinforce the evidence that high intake of red and processed meat and alcohol increase the risk of colorectal cancer. Milk and whole grains may have a protective role against colorectal cancer. The evidence for vegetables and fish was less convincing.
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This review is devoted to formation of the integrated scientific foundation based on the data of different statistical publications (meta data) that are linked to «onko-« risks associated with meat products. In October 2015, World Health Organization (WHO) published a report, in which red meat was classified as probably carcinogenic to humans. In addition, the WHO experts made a conclusion about carcinogenicity of processed meat (meat that has been processed by smoking, salting, fermentation or other processes to extend storage). However, globally, there is no standardized method for reviewing the vast amount of studies on the mechanisms, by which lifestyle factors can cause cancer. At present, the work was begun on the development and testing of new methodology for performing systematic reviews of mechanistic investigations associated with a diet, nutrition, physical activity, and the development and progression of different types of cancer.A topical analysis of research in this direction will allow formation of basic meta data associated with «onko-» risks, linked to meat products, detection of basic and accompanying factors influencing «onko-» risks. The obtained information will enable the creation of a scientific reserve for further work on studying an effect of components entering into or developing in meat products associated with «onko-» risks.
Article
Grainyhead-like 2 (GRHL2) transcription factor is implicated in many types of cancers. However, the role of GRHL2 in colorectal cancer (CRC) has not been fully understood. The present study aimed to evaluate the expression and functional roles of GRHL2 in CRC. The expression of GRHL2 in normal human intestinal epithelial cells and colorectal cancer cells was measured by qRT-PCR and western blot. For knockdown of GRHL2, two small interfere RNAs (siRNAs) targeting GRHL2 or control siRNA was transfected into CRC cell lines (HCT116 and HT29). For GRHL2 overexpression, the GRHL2-overexpressing vector or empty lentiviral vector was infected into HCT116 and HT29 cells. Cell proliferation was measured by MTT assay. Cell apoptosis rate was analyzed by flow cytometry. The expression of proliferating cell nuclear antigen (PCNA), Bax, and Bcl-2 was detected by western blot. We found that GRHL2 was upregulated in CRC cells compared to normal human intestinal epithelial cells. Knockdown of GRHL2 inactivated the PI3K/Akt pathway in HCT116 and HT29 cells. Knockdown of GRHL2 inhibited cell viability, elevated the apoptosis rates, suppressed the expression of PCNA and Bcl-2, and induced the expression of Bax in HCT116 and HT29 cells, and these effects were reversed by activation of the PI3K/Akt pathway. Inhibition of PI3K/Akt pathway blocked the effects of GRHL2 overexpression on cell proliferation and apoptosis. In conclusion, GRHL2 acted as an oncoprotein through regulating cell proliferation and apoptosis in CRC cells. The PI3K/Akt pathway was closely involved in the effects of GRHL2. Therefore, GRHL2 might be a therapeutic target for the CRC treatment.
Chapter
Colorectal cancer (CRC) is the second commonest fatal cancer in developed countries. Early-onset CRC incidence in individuals aged <50 years is rising steadily. Histological stage at diagnosis determines CRC prognosis. Genetic instability, either chromosomal or microsatellite instability, underlies most cases. CRCs arise from benign adenomatous polyps and sessile serrated adenomas. Physical inactivity and diet are risk factors, linked through obesity-related metabolic disturbance causing chronic inflammation. Distinct from the autosomal dominantly inherited familial forms of CRC, a family history of CRC in first-degree relatives increases risk of CRC. Ulcerative and Crohn’s colitis and cystic fibrosis increase CRC risk. Prolonged aspirin use reduces CRC risk. Screening substantially reduces CRC mortality in the older population through subsequent adenoma removal and treatment of early-stage CRCs in screen-positive individuals; accepted modalities include fecal blood tests, flexible sigmoidoscopy, colonoscopy, and computed tomographic colonography. Despite much research, chemoprevention for CRC has yet to enter clinical practice.
Article
Background & Aims Processed meat and high sodium intake are common in Western diet. The objective was to examine their independent effects on the risk of colorectal cancer (CRC). Methods We performed both observational analysis with UK Biobank and genetic analysis with Mendelian randomization (MR). The 24-hour urinary sodium (UNa) and reported intake of processed meat were fitted on incident CRC by multivariable Cox proportional hazard model, adjusted for covariates, such as age, gender, family history, etc. Different sodium measures were used for sensitivity analyses. Two-sample MR analyses were performed using summary data from genome-wide association studies of UNa and CRC. Multivariable MR was adjusted for body mass index. Results We included 415 524 eligible participants from UK Biobank. During a median follow-up of 11.1 years, 2 663 participants were diagnosed with CRC. High intake of processed meat independently increased risk of CRC by 23% (HR 1.23; 95% CI: 1.03 to 1.46), but 24-hour UNa was not significantly associated with CRC (HR 0.96; 95% CI: 0.87 to 1.06). Furthermore, MR also showed little evidence for the effect of UNa on CRC (OR 1.02; 95% CI: 0.11 to 9.42). Sensitivity analyses showed consistent results across different measurements of sodium intake. Conclusions Intake of processed meat had an independent effect on the risk of CRC, but the risk was not associated with sodium level. Reduction of processed meat intake may be an effective strategy for CRC prevention, while sodium reduction should still be recommended to achieve other health benefits.
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Purpose of the Review Colorectal cancer is the second most common cause of cancer death in the world. The aim of this review is to provide an update on recent epidemiological studies, the molecular mechanisms involved, and ongoing clinical trials investigating the relationship between red meat consumption and colorectal cancer. Recent Findings Evidence in the literature proposes an association between red meat consumption and development of colorectal cancer, and there is some insight with regard to the mechanisms involved. Summary Twenty studies of the IARC report (1990–2015) showed that red meat is positively associated with colorectal cancer whereas 14 studies either supported no positive association or no statistically significant association between red meat consumption and risk for CRC. More recent epidemiological studies conducted from 2016 and onwards provided further evidence that adherence to diets low in red and/or processed meat reduces the risk of colorectal cancer. Evidence from recent studies supports that quantity, doneness, and preparation of red meat play a role in colorectal carcinogenesis. Red meat’s degradation products allow for the creation of a pro-inflammatory colonic microenvironment, and the gut microbiome plays a role in colorectal carcinogenesis. Heme, hydrogen sulfide, lipid peroxidation, nitroso compounds, and the bacterium Fusobacterium Nucleatum (as well as possibly other bacteria such as Akkermansia muciniphila, Eubacterium cylindroides, Eubacterium eligens 1 and 2, and Eubacterium rectale 1 and 2) also partake in the process of colorectal carcinogenesis. Several clinical trials are underway investigating the effects of different diets and red meat substitution products on colorectal cancer incidence as well as the underlying molecular mechanisms involved in the process.
Article
Dietary guidelines advise consumers to limit intake of red meat and choose lean protein sources, such as poultry and fish. Poultry consumption has been steadily increasing in the United States, but the effect on cancer risk remains unclear. In a large U.S. cohort, we prospectively investigated poultry and fish intake and cancer risk across a range of malignancies in men and women. Diet was assessed at baseline (1995-1996) with a food frequency questionnaire in 492,186 participants of the NIH-AARP Diet and Health Study. Over a mean follow-up of 9 years, we identified 74,418 incident cancer cases. In multivariable Cox proportional hazards regression models, we estimated the substitution and addition effects of white meat (poultry and fish) intake in relation to cancer risk. In substitution models with total meat intake held constant, a 10-g (per 1,000 kcal) increase in white meat intake offset by an equal decrease in red meat intake was associated with a statistically significant reduced (3%-20%) risk of cancers of the esophagus, liver, colon, rectum, anus, lung, and pleura. In addition models with red meat intake held constant, poultry intake remained inversely associated with esophageal squamous cell carcinoma, liver cancer, and lung cancer, but we observed mixed findings for fish intake. As the dietary recommendations intend, the inverse association observed between white meat intake and cancer risk may be largely due to the substitution of red meat. Simply increasing fish or poultry intake, without reducing red meat intake, may be less beneficial for cancer prevention.
Article
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Results from analysis of 24 h urine collections, verified for completeness with para-amino benzoic acid, and blood samples collected over 1 year were compared with 16 d weighed records of all food consumed collected over the year, and with results from 24 h recalls, food-frequency questionnaires and estimated food records in 160 women. Using the weighed records, individuals were sorted into quintiles of the distribution of the urine N excretion:dietary N intake ratio (UN:DN). UN exceeded DN in the top quintile of this ratio; mean ratio UN:DN = 1.13. Individuals in this top quintile were heavier, had significantly greater body mass indices, were reportedly more restrained eaters, had significantly lower energy intake:basal metabolic rate ratios (EI:BMR), and had correlated ratios of UN:DN and EI:BMR (r -0.62). Those in the top quintile reported lower intakes of energy and energy-yielding nutrients, Ca, fats, cakes, breakfast cereals, milk and sugars than individuals in the other quintiles but not lower intakes of non-starch polysaccharides, vitamin C, vegetables, potatoes or meat. Correlations between dietary intake from weighed records and 24 h urine K were 0.74 and 0.82, and between dietary vitamin C and beta-carotene and plasma vitamin C and beta-carotene 0.86 and 0.48. Correlations between dietary N intake from weighed records and 24 h urine excretion were high (0.78-0.87). Those between N from estimated food records and urine N were r 0.60-0.70. Correlations between urine N and 24 h recalls and food-frequency questionnaires were in the order of 0.01 to 0.5. Despite problems of underreporting in overweight individuals in 20% of this sample, weighed records remained the most accurate method of dietary assessment, and only an estimated 7 d diary was able to approach this accuracy.
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Women (n 160) aged 50 to 65 years were asked to weigh their food for 4 d on four occasions over the period of 1 year, using the PETRA (Portable Electronic Tape Recorded Automatic) scales. Throughout the year, they were asked to complete seven other dietary assessment methods: a simple 24 h recall, a structured 24 h recall with portion size assessments using photographs, two food-frequency questionnaires, a 7 d estimated record or open-ended food diary, a structured food-frequency (menu) record, and a structured food-frequency (menu) record with portion sizes assessed using photographs. Comparisons between the average of the 16 d weighed records and the first presentation of each method indicated that food-frequency questionnaires were not appreciably better at placing individuals in the distribution of habitual diet than 24 h recalls, due partly to inaccuracies in the estimation of frequency of food consumption. With a 7 d estimated record or open-ended food diary, however, individual values of nutrients were most closely associated with those obtained from 16 d weighed records, and there were no significant differences in average food or nutrient intakes.
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In the UK EPIC validation studies, the accuracy of several methods was assessed by comparison with to-day weighed records and the biomarkers, 24-hour urine nitrogen (N) and potassium (K), plasma carotenoids and plasma vitamin C. Comparisons between methods were made on 156 women, studied over 1 year at 3-monthly intervals at home. On each of four occasions, volunteers completed 4 days of weighed records and provided two 24-hour urine collections and a fasting blood sample. In comparison with the 16 days of weighed records, a food frequency questionnaire (FFQ) yielded higher values mainly due to greater reported consumption of milk and of vegetables. A 24-hour recall was as good as the FFQ in placing individuals in the distribution of habitual diet from weighed records. Results obtained from a 7-day estimated record were closest to those obtained from the weighed record. Correlations between 24-hour urine excretion and dietary N intake from weighed records were high (0.78-0.87) as were those with estimated food diaries (0.60-0.70). Correlations between urine N and the FFQ and 24-hour recall were lower (0.10 to 0.27), but improved by energy adjustment using residuals for N and K which are correlated with total energy intake. Comparisons between dietary estimates and urinary K and serum carotenoids and vitamin C showed broadly similar results. Limited biomarker information amongst 200 UK EPIC participants supported the findings of the validation study. UK EPIC uses three methods (the 7-day diary, an improved FFQ, and the 24-hour recall) to assess diet. 93% of first food diaries are returned completed by participants. Repeated diaries are the main dietary assessment method for nested case-control analyses.
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The associations between serum concentrations of oestradiol, testosterone and sex hormone-binding globulin (SHBG) and risk of breast cancer in post-menopausal women were investigated in a prospective study on the island of Guernsey. Sixty-one women who developed breast cancer an average of 7.8 years after blood collection were matched for age, year of blood collection and number of years post-menopausal with 179 control subjects. Women using exogenous hormones at the time of blood collection were excluded from the study. Women who subsequently developed breast cancer had a 29% higher geometric mean oestradiol concentration than control women (P = 0.004). The odds ratio for breast cancer in the top third compared with the lowest third of the oestradiol concentration distribution was 5.03 (95% confidence interval 2.02-12.49, P for trend < 0.001). Adjusting for testosterone and SHBG concentrations did not substantially alter the odds ratio for oestradiol. Although testosterone and SHBG concentrations were associated with breast cancer risk, the concentrations of these hormones were correlated with those of oestradiol; the associations were not statistically significant after adjusting for oestradiol concentration. These data provide evidence that serum oestradiol concentrations in post-menopausal women may have a substantial effect on breast cancer risk.
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A new data-entry system (DINER - Data Into Nutrients for Epidemiological Research) for food record methods has been devised for the European Prospective Investigation into Cancer (EPIC) cohort study of 25,000 men and women in Norfolk. DINER has been developed to address the problems of efficiency and consistency of data entry, comparability of data, maximising information and future flexibility in large long-term population studies of diet and disease that use record methods to assess dietary intakes. DINER captures more detail than traditional systems and enables provision of new variables for specific food types or groups. The system has been designed to be fully flexible and easy to update. Analysis of consistency of data entry was tested in a group of 3525 participants entered by 25 coders. A food list of 9000 food items and values for 24,000 portion sizes have been incorporated into the database, using information from the 5979 diaries coded since 1995. Analysis of consistency of entry indicated that this has largely been achieved. The effect of coders in a multivariate regression model was significant only if the three coders involved in early use of the program were included (P < 0.013). The development of DINER has facilitated the use of more accurate record methods in large-scale epidemiological studies of diet and disease. Furthermore, the retention of original information as an extensive food list allows greater flexibility in later analyses of data of multiple dietary hypotheses.
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To describe the lifestyle characteristics and nutrient intakes of the Oxford cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC). Cohort of men and women recruited through general practices or by post to include a high proportion of non meat-eaters. Dietary, anthropometric and lifestyle data were collected at baseline and four diet groups were defined. United Kingdom. In total, 65 429 men and women aged 20 to 97 years, comprising 33 883 meat-eaters, 10 110 fish-eaters, 18 840 lacto-ovo vegetarians and 2596 vegans. Nutrient intakes and lifestyle factors differed across the diet groups, with striking differences between meat-eaters and vegans, and fish-eaters and vegetarians usually having intermediate values. Mean fat intake in each diet group was below the UK dietary reference value of 33% of total energy intake. The mean intake of saturated fatty acids in vegans was approximately 5% of energy, less than half the mean intake among meat-eaters (10-11%). Vegans had the highest intakes of fibre, vitamin B1, folate, vitamin C, vitamin E, magnesium and iron, and the lowest intakes of retinol, vitamin B12, vitamin D, calcium and zinc. The EPIC-Oxford cohort includes 31 546 non meat-eaters and is one of the largest studies of vegetarians in the world. The average nutrient intakes in the whole cohort are close to those currently recommended for good health. Comparisons of the diet groups show wide ranges in the intakes of major nutrients such as saturated fat and dietary fibre. Such variation should increase the ability of the study to detect associations of diet with major cancers and causes of death.
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This paper describes the development of the UK Women's Cohort Study and presents cohort baseline characteristics. In total, 35,372 women, aged 35-69 years at recruitment, were selected to ensure a wide range of dietary intakes. Diet was assessed by a 217-item food-frequency questionnaire (FFQ). Detailed lifestyle information was collected by postal questionnaire. Vegetarians, fish-eaters and meat-eaters were compared. The cohort women are mainly white, well-educated, middle-class and married with children. They are health-conscious with only 11% current smokers and 58% taking dietary supplements. Twenty-eight per cent of subjects self-report as being vegetarian and 1% as vegan. However, only 18% are defined as 'vegetarian' from the FFQ. Fat provides 32% of energy; vitamin and mineral intakes are high, with a broad range of intakes. Meat-eaters are older, with a higher body mass index (BMI) and the lowest intakes of carbohydrate, fibre, vitamin C, folate, iron and calcium. Other fish-eaters are similar to vegetarians. Vegetarians have the lowest intakes of protein, fat and saturated fat. Oily fish-eaters have the lowest BMI; are the least likely to smoke or use full-fat milk; and are the most likely to use dietary supplements and consume the most fruit and vegetables. Oily fish-eaters have the highest total energy intake and vegetarians the lowest. Semi-skimmed milk, bread, potatoes, wine, bananas and muesli are important contributors to energy for all groups. A large cohort of middle-aged women has been created encompassing a wide range of different eating patterns, including diets currently of interest to research into protection against cancer and coronary heart disease. Participants will be followed up to study the effects of different food and nutrient intakes on long-term health outcomes.
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Consumption of red and processed meat has been associated with colorectal cancer in many but not all epidemiological studies; few studies have examined risk in relation to long-term meat intake or the association of meat with rectal cancer. To examine the relationship between recent and long-term meat consumption and the risk of incident colon and rectal cancer. A cohort of 148 610 adults aged 50 to 74 years (median, 63 years), residing in 21 states with population-based cancer registries, who provided information on meat consumption in 1982 and again in 1992/1993 when enrolled in the Cancer Prevention Study II (CPS II) Nutrition Cohort. Follow-up from time of enrollment in 1992/1993 through August 31, 2001, identified 1667 incident colorectal cancers. Participants contributed person-years at risk until death or a diagnosis of colon or rectal cancer. Incidence rate ratio (RR) of colon and rectal cancer. High intake of red and processed meat reported in 1992/1993 was associated with higher risk of colon cancer after adjusting for age and energy intake but not after further adjustment for body mass index, cigarette smoking, and other covariates. When long-term consumption was considered, persons in the highest tertile of consumption in both 1982 and 1992/1993 had higher risk of distal colon cancer associated with processed meat (RR, 1.50; 95% confidence interval [CI], 1.04-2.17), and ratio of red meat to poultry and fish (RR, 1.53; 95% CI, 1.08-2.18) relative to those persons in the lowest tertile at both time points. Long-term consumption of poultry and fish was inversely associated with risk of both proximal and distal colon cancer. High consumption of red meat reported in 1992/1993 was associated with higher risk of rectal cancer (RR, 1.71; 95% CI, 1.15-2.52; P = .007 for trend), as was high consumption reported in both 1982 and 1992/1993 (RR, 1.43; 95% CI, 1.00-2.05). Our results demonstrate the potential value of examining long-term meat consumption in assessing cancer risk and strengthen the evidence that prolonged high consumption of red and processed meat may increase the risk of cancer in the distal portion of the large intestine.
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Current evidence suggests that high red meat intake is associated with increased colorectal cancer risk. High fish intake may be associated with a decreased risk, but the existing evidence is less convincing. We prospectively followed 478 040 men and women from 10 European countries who were free of cancer at enrollment between 1992 and 1998. Information on diet and lifestyle was collected at baseline. After a mean follow-up of 4.8 years, 1329 incident colorectal cancers were documented. We examined the relationship between intakes of red and processed meat, poultry, and fish and colorectal cancer risk using a proportional hazards model adjusted for age, sex, energy (nonfat and fat sources), height, weight, work-related physical activity, smoking status, dietary fiber and folate, and alcohol consumption, stratified by center. A calibration substudy based on 36 994 subjects was used to correct hazard ratios (HRs) and 95% confidence intervals (CIs) for diet measurement errors. All statistical tests were two-sided. Colorectal cancer risk was positively associated with intake of red and processed meat (highest [>160 g/day] versus lowest [<20 g/day] intake, HR = 1.35, 95% CI = 0.96 to 1.88; Ptrend = .03) and inversely associated with intake of fish (>80 g/day versus <10 g/day, HR = 0.69, 95 % CI = 0.54 to 0.88; Ptrend<.001), but was not related to poultry intake. Correcting for measurement error strengthened the associations between colorectal cancer and red and processed meat intake (per 100-g increase HR = 1.25, 95% CI =1.09 to 1.41, Ptrend = .001 and HR = 1.55, 95% CI = 1.19 to 2.02, Ptrend = .001 before and after calibration, respectively) and for fish (per 100 g increase HR = 0.70, 95% CI = 0.57 to 0.87, Ptrend<.001 and HR = 0.46, 95% CI = 0.27 to 0.77, Ptrend = .003; before and after correction, respectively). In this study population, the absolute risk of development of colorectal cancer within 10 years for a study subject aged 50 years was 1.71% for the highest category of red and processed meat intake and 1.28% for the lowest category of intake and was 1.86% for subjects in the lowest category of fish intake and 1.28% for subjects in the highest category of fish intake. Our data confirm that colorectal cancer risk is positively associated with high consumption of red and processed meat and support an inverse association with fish intake.
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To develop a concise, simple tool for use by non-specialists to assess diet in children aged 3-7 years attending primary schools. A 24-hour food tick list covering all aspects of the diet and with a focus on fruit and vegetable consumption was developed. This was compared against a 24-hour semi-weighed food diary obtained for the same day as the tick list. Six primary schools with a range of socio-economic and ethnic backgrounds from a large city in the north of England (Leeds). One hundred and eighty children returned completed packs of information; a response rate of 77% of those who were willing to take part, 48% of those approached. On average, 2.4 items of fruit including juice (2.1 items as 5-a-day count) were eaten and 1.6 items of vegetables (excluding potato). Twenty-seven per cent and 36% of boys and 23% and 24% of girls reported not eating any fruit or vegetables, respectively, on the recording day. Correlations comparing the diary and tick list were high for both foods (range r=0.44 to 0.89) and nutrients (range r=0.41 to 0.68). The level of misclassification was much less than would be expected by chance. Parent and teacher evaluation of the tick list was very positive. Parents felt the tick list was easy and quick to complete. The Child and Diet Evaluation Tool (CADET) tick list has been used successfully for rapid collection of food and nutrient information from children aged 3-7 years from diverse social and ethnic backgrounds. The tool has performed better than many food-frequency questionnaires in comparison to a food diary.
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The n-3 polyunsaturated fatty acids (n-3 PUFAs) docosahexaenoic acid and eicosapentaenoic acid, found in fish and fish-oil supplements and also formed by conversion of alpha-linolenic acid in soy and rapeseed (canola) oils, are thought to have cardioprotective effects. Because the relative feasibility and measurement error of dietary methods varies, this study compared fish and fish-oil intakes obtained from 4 dietary methods with plasma n-3 PUFAs in men and women in a general population. The study participants were 4949 men and women aged 40-79 y from the European Prospective Investigation into Cancer-Norfolk United Kingdom cohort. Measurements of plasma phospholipid n-3 PUFA concentrations and fish intakes were made with the use of 4 dietary methods (food-frequency questionnaire, health and lifestyle questionnaire, 7-d diary, and first-day recall from the 7-d diary). Amounts of fish consumed and relations with plasma phospholipid n-3 PUFAs were not substantially different between the 4 dietary methods. Plasma n-3 PUFA concentrations were significantly higher in women than in men, were 20% higher in fish-oil consumers than in non-fish-oil consumers, and were twice as high in fatty fish consumers as in total fish consumers. Only approximately 25% of the variation in plasma n-3 PUFA was explained by fish and fish-oil consumption. This large study found no substantial differences between dietary methods and observed clear sex differences in plasma n-3 PUFAs. Because variation in n-3 PUFA was only partially determined by fish and fish-oil consumption, this could explain the inconsistent results of observational and intervention studies on coronary artery disease protection.
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Animal studies show favorable effects of n-3 fatty acids on inflammation and cancer, but results from epidemiologic studies appear to be inconsistent. The authors conducted meta-analyses of prospective cohort studies that evaluated the association between fish consumption or n-3 fatty acids and colorectal cancer incidence or mortality. Random-effects models were used, and heterogeneity between study results was explored through stratified analyses. The pooled relative risks for the highest compared with the lowest fish consumption category were 0.88 (95% confidence interval: 0.78, 1.00) for colorectal cancer incidence (14 studies) and 1.02 (95% confidence interval: 0.90, 1.16) for colorectal cancer mortality (four studies). The pooled relative risks for colorectal cancer incidence were 0.96 (95% confidence interval: 0.92, 1.00) for each extra occurrence of fish consumption per week (seven studies) and 0.97 (95% confidence interval: 0.92, 1.03) for each extra 100 g of fish consumed per week (four studies). Stratified analysis showed that the pooled relative risk for colorectal cancer incidence was more pronounced for women and in studies with a large exposure contrast. In cohort studies, fish consumption was shown to slightly reduce colorectal cancer risk. Existing evidence that n-3 fatty acids inhibit colorectal carcinogenesis is in line with these results, but few data are available addressing this association.
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Red meat and processed meat have been associated with carcinogenesis at several anatomic sites, but no prospective study has examined meat intake in relation to a range of malignancies. We investigated whether red or processed meat intake increases cancer risk at a variety of sites. The National Institutes of Health (NIH)-AARP (formerly the American Association for Retired Persons) Diet and Health Study is a cohort of approximately 500,000 people aged 50-71 y at baseline (1995-1996). Meat intake was estimated from a food frequency questionnaire administered at baseline. Cox proportional hazards regression was used to estimate hazard ratios and 95% confidence intervals within quintiles of red and processed meat intake. During up to 8.2 y of follow-up, 53,396 incident cancers were ascertained. Statistically significant elevated risks (ranging from 20% to 60%) were evident for esophageal, colorectal, liver, and lung cancer, comparing individuals in the highest with those in the lowest quintile of red meat intake. Furthermore, individuals in the highest quintile of processed meat intake had a 20% elevated risk for colorectal and a 16% elevated risk for lung cancer. Both red and processed meat intakes were positively associated with cancers of the colorectum and lung; furthermore, red meat intake was associated with an elevated risk for cancers of the esophagus and liver.
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Background: This paper describes the development of the UK Women's Cohort Study and presents cohort baseline characteristics. Methods: In total, 35,372 women, aged 35-69 years at recruitment, were selected to ensure a wide range of dietary intakes. Diet was assessed by a 217-item food-frequency questionnaire (FFQ). Detailed lifestyle information was collected by postal questionnaire. Vegetarians, fish-eaters and meat-eaters were compared. Results: The cohort women are mainly white, well-educated, middle-class and married with children. They are health-conscious with only 11% current smokers and 58% taking dietary supplements. Twenty-eight per cent of subjects self-report as being vegetarian and 1% as vegan. However, only 18% are defined as 'vegetarian' from the FFQ. Fat provides 32% of energy; vitamin and mineral intakes are high, with a broad range of intakes. Meat-eaters are older, with a higher body mass index (BMI) and the lowest intakes of carbohydrate, fibre, vitamin C, folate, iron and calcium. Other fish-eaters are similar to vegetarians. Vegetarians have the lowest intakes of protein, fat and saturated fat. Oily fish-eaters have the lowest BMI; are the least likely to smoke or use full-fat milk; and are the most likely to use dietary supplements and consume the most fruit and vegetables. Oily fish-eaters have the highest total energy intake and vegetarians the lowest. Semi-skimmed milk, bread, potatoes, wine, bananas and muesli are important contributors to energy for all groups. Conclusion: A large cohort of middle-aged women has been created encompassing a wide range of different eating patterns, including diets currently of interest to research into protection against cancer and coronary heart disease. Participants will be followed up to study the effects of different food and nutrient intakes on long-term health outcomes.
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The Whitehall study of British civil servants begun in 1967, showed a steep inverse association between social class, as assessed by grade of employment, and mortality from a wide range of diseases. Between 1985 and 1988 we investigated the degree and causes of the social gradient in morbidity in a new cohort of 10 314 civil servants (6900 men, 3414 women) aged 35-55 (the Whitehall 11 study). Participants were asked to answer a self-administered questionnaire and attend a screening examination. In the 20 years separating the two studies there has been no diminution in social class difference in morbidity: we found an inverse association between employment grade and prevalence of angina, electrocardiogram evidence of ischaemia, and symptoms of chronic bronchitis. Self-perceived health status and symptoms were worse in subjects in lower status jobs. There were clear employment-grade differences in health-risk behaviours including smoking, diet, and exercise, in economic circumstances, in possible effects of early-life environment as reflected by height, in social circumstances at work (eg, monotonous work characterised by low control and low satisfaction), and in social supports. Healthy behaviours should be encouraged across the whole of society; more attention should be paid to the social environments, job design, and the consequences of income inequality.
Article
Background Validation studies of dietary instruments developed for epidemiological studies have typically used some form of diet record as the standard for comparison. Recent work suggests that comparison with diet record may overestimate the ability of the epidemiological instrument to measure habitual dietary intake, due to lack of independence of the measurement errors. The degree of regression dilution in estimating diet-disease association may therefore have been correspondingly underestimated. Use of biochemical measures of intake may mitigate the problem. In this paper, we report on the use of urinary measures of intakes of nitrogen, potassium and sodium to compare the performance of a semi-quantitative food frequency questionnaire (FFQ) and a 7-day diet diary (7DD) to estimate average intake of these nutrients over one year. Methods In all, 179 individuals were asked to complete an FFQ and a 7DD on two occasions separated by approximately 12 months. The individuals were also asked to provide 24-hour urine samples on six occasions over a 6-9-month period, covering the time at which the record FFQ and 7DD were completed. The urine was assayed for nitrogen, potassium and sodium. The protocol was completed by 123 individuals. The data from these individuals were analysed to estimate the covariance structure of the measurement errors of the FFQ, the 7DD and a single 24-hour urine measurement, and to estimate the degree of regression dilution associated with the FFQ and 7DD. Results The results demonstrated that: (I) the error variances for each of the three nutrients was more than twice as great with the FFQ than the 7DD; (2) there was substantial correlation (0.46-0.58) between the error of both the FFQ and the 7DD completed on different occasions; (3) there was moderate correlation (0.24-0.29) between the error in the FFQ and the error in the 7DD for each nutrient; (4) the correlation between errors in different nutrients was higher for the FFQ (0.77-0.80) than for the 7DD (0.52-0.70). Conclusions The regression dilution with the FFQ is considerably greater than with the 7DD and also, for the nutrients considered, greater than would be inferred if validation studies were based solely on record or diary type instruments.
Article
A diary method using household measures was employed to obtain dietary records in a large national prospective survey and a computer program, DIDO (Diet In Data Out), was designed for direct entry of the diaries. The accuracy of this computerized coding system was examined alongside that of the manual coding used for a similar diary in a previous wave, 7 years earlier, of the same survey. Accuracy was assessed by analysis of the errors in the coded and checked records by stringent re-checking of nominal 2% random subsamples of the diet diaries coded by each method. The mean time to code and check each of the 2086 7-day records in the whole survey using DIDO was 58 minutes (SD 30) compared with reported results of 1–4 hours for manual methods. The mean error rate of computerized coding and checking with DIDO was 2.3% (SD 2.1; range 0–8.9) per diary in the subsample. Correcting these mistakes made insignificant changes to the calculated mean energy and nutrient intakes for the subsample. The percentage of individuals changing to an adjacent third of nutrient distribution after correcting unambiguous errors ranged from none (for alcohol) to 11% (for carbohydrate and calcium intake). The mean error rate on a similar subsample of diaries from the earlier survey which had been coded manually was significantly higher at 5.9% (SD 4.1; range 0–17) per diary. Emphasis is laid on the importance, in coding, of dealing with ambiguities in the subjects' records, since this can affect the accuracy and the precision of the nutrient results obtained. We conclude that the DIDO coding method has the advantages of greater accuracy, speed, consistency and efficient data handling, and affords greater data accessibility for checking, compared with manual systems.
Article
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.
Article
The Whitehall study of British civil servants begun in 1967, showed a steep inverse association between social class, as assessed by grade of employment, and mortality from a wide range of diseases. Between 1985 and 1988 we investigated the degree and causes of the social gradient in morbidity in a new cohort of 10,314 civil servants (6900 men, 3414 women) aged 35-55 (the Whitehall II study). Participants were asked to answer a self-administered questionnaire and attend a screening examination. In the 20 years separating the two studies there has been no diminution in social class difference in morbidity: we found an inverse association between employment grade and prevalence of angina, electrocardiogram evidence of ischaemia, and symptoms of chronic bronchitis. Self-perceived health status and symptoms were worse in subjects in lower status jobs. There were clear employment-grade differences in health-risk behaviours including smoking, diet, and exercise, in economic circumstances, in possible effects of early-life environment as reflected by height, in social circumstances at work (eg, monotonous work characterised by low control and low satisfaction), and in social supports. Healthy behaviours should be encouraged across the whole of society; more attention should be paid to the social environments, job design, and the consequences of income inequality.
Article
The Oxford Vegetarian Study is a prospective study of 6000 vegetarians and 5000 nonvegetarian control subjects recruited in the United Kingdom between 1980 and 1984. Cross-sectional analyses of study data showed that vegans had lower total- and LDL-cholesterol concentrations than did meat eaters; vegetarians and fish eaters had intermediate and similar values. Meat and cheese consumption were positively associated, and dietary fiber intake was inversely associated, with total-cholesterol concentration in both men and women. After 12 y of follow-up, all-cause mortality in the whole cohort was roughly half that in the population of England and Wales (standardized mortality ratio, 0.46; 95% CI, 0.42, 0.51). After adjusting for smoking, body mass index, and social class, death rates were lower in non-meat-eaters than in meat eaters for each of the mortality endpoints studied [relative risks and 95% CIs: 0.80 (0. 65, 0.99) for all causes of death, 0.72 (0.47, 1.10) for ischemic heart disease, and 0.61 (0.44, 0.84) for all malignant neoplasms]. Mortality from ischemic heart disease was also positively associated with estimated intakes of total animal fat, saturated animal fat, and dietary cholesterol. Other analyses showed that non-meat-eaters had only half the risk of meat eaters of requiring an emergency appendectomy, and that vegans in Britain may be at risk for iodine deficiency. Thus, the health of vegetarians in this study is generally good and compares favorably with that of the nonvegetarian control subjects. Larger studies are needed to examine rates of specific cancers and other diseases among vegetarians.
Article
Measurement error can have an important impact on the estimation of the true relation between diet and disease. The authors examined the performance of models regressing plasma vitamin C level on fruit and vegetable consumption and the effect of categorization of fruit and vegetable consumption on the association with plasma vitamin C. They used diet information reported by 4,487 participants in the Norfolk, United Kingdom, portion of the European Prospective Investigation into Cancer and Nutrition by means of a 7-day diet diary and a food frequency questionnaire (FFQ) (1993–1998). The authors found substantial differences in mean fruit and vegetable consumption assessed by the two diet instruments. Consumption estimated with the FFQ was about twice as high as that obtained with the 7-day diary, and the ranking of individuals according to estimates of fruit and vegetable consumption from the 7-day diary and the FFQ differed substantially. When fruit and vegetable consumption were categorized into quintiles, the two questionnaires produced similar associations of relative intake with plasma vitamin C, but estimation of the association of absolute intake with plasma vitamin C differed.
Article
Accumulating epidemiologic evidence indicates that high consumption of red meat and of processed meat may increase the risk of colorectal cancer. We quantitatively assessed the association between red meat and processed meat consumption and the risk of colorectal cancer in a meta-analysis of prospective studies published through March 2006. Random-effects models were used to pool study results and to assess dose-response relationships. We identified 15 prospective studies on red meat (involving 7,367 cases) and 14 prospective studies on processed meat consumption (7,903 cases). The summary relative risks (RRs) of colorectal cancer for the highest vs. the lowest intake categories were 1.28 (95% confidence interval (CI) = 1.15-1.42) for red meat and 1.20 (95% CI = 1.11-1.31) for processed meat. The estimated summary RRs were 1.28 (95% CI = 1.18-1.39) for an increase of 120 g/day of red meat and 1.09 (95% CI = 1.05-1.13) for an increase of 30 g/day of processed meat. Consumption of red meat and processed meat was positively associated with risk of both colon and rectal cancer, although the association with red meat appeared to be stronger for rectal cancer. In 3 studies that reported results for subsites in the colon, high consumption of processed meat was associated with an increased risk of distal colon cancer but not of proximal colon cancer. The results of this meta-analysis of prospective studies support the hypothesis that high consumption of red meat and of processed meat is associated with an increased risk of colorectal cancer.
Article
The aim of the study was to quantify more precisely the meat intake of a cohort of adults in the UK by disaggregating composite meat dishes. Subjects were members of the Medical Research Council National Survey of Health and Development, 1946 birth cohort. Five-day diaries were collected from 2256 men and women in 1989 and 1772 men and women in 1999. From the details provided, composite meat dishes were broken down into their constituent parts and the meat fraction was added to meat portions only. Meat intake was classified as red meat, processed meat and poultry. Meat consumption without disaggregation of meat dishes resulted in a mean overestimation of 50% in men and 33% in women. Red meat consumption fell between 1989 and 1999 from 51.7 to 41.5 g per day in men and 35.7 to 30.1 g per day in women. Poultry consumption rose from 21.6 to 32.2 g per day in men and 18.2 to 29.4 g per day in women. Re-calculating red meat intakes resulted in the percentage of subjects in 1999 consuming more than the recommendation of the World Cancer Research Fund falling from 30 to 12%. Increasing consumption of red and processed meat was associated with increased intakes of energy, fat, haem iron, zinc and vitamin B(12), and lower intake of fibre. Increased sodium intake was associated with increased consumption of processed meat. Disaggregation of meat dishes provided a more precise estimate of meat consumption. The quantity of red or processed meat in the diet was reflected in the nutrient content of the entire diet.
EPIC-Oxford: lifestyle characteristics and nutrient intakes in a cohort of 33883 meat-eaters and 31546 non meat-eaters in the UK
  • Davey Gk Appleby
  • Pn
  • Ea Spencer
  • Key
Davey GK, Appleby PN, Spencer EA, Key TJ (2003) EPIC-Oxford: lifestyle characteristics and nutrient intakes in a cohort of 33883 meat-eaters and 31546 non meat-eaters in the UK. Public Health Nutr 6(3):259–268
Protective association of dietary fiber with colorectal cancer risk: results from the UK dietary cohort consortium using food diary data
  • C D Dahm
  • R H Keogh
  • E A Spencer
Dahm CD, Keogh RH, Spencer EA et al (2010) Protective association of dietary fiber with colorectal cancer risk: results from the UK dietary cohort consortium using food diary data. J Natl Cancer Inst. doi:10.1093/jnci/djq151
McCance and Widdowson’s the composition of foods
  • B Holland
  • Aa Welch
  • Id Unwin
  • Dh Buss
  • Aa Paul
  • At Southgate
For the pooling project of prospect studies of diet and cancer investigators. Meat and fat intake and colorectal cancer risk: a pooled analysis of 14 prospective studies [abstract
  • E Cho
  • Sa Smith-Warner
EPIC-Oxford: lifestyle characteristics and nutrient intakes in a cohort of 33883 meat-eaters and 31546 non meat-eaters in the UK
  • G K Davey
  • P N Appleby
  • E A Spencer
  • T J Key
  • GK Davey
Health inequalities among British civil servants: the Whitehall II study
  • M G Marmot
  • G D Smith
  • S Stansfeld
  • MG Marmot
A prospective study of endogenous serum hormone concentrations and breast cancer risk in post-menopausal women on the island of Guernsey
  • H V Thomas
  • T J Key
  • D S Allen
  • HV Thomas
Dietary fish intake and plasma phospholipid n-3 polyunsaturated fatty acid concentrations in men and women in the European prospective investigation into cancer-norfolk United Kingdom cohort
  • A A Welch
  • S A Bingham
  • J Ive
  • AA Welch
Meat and fat intake and colorectal cancer risk: a pooled analysis of 14 prospective studies
  • E Cho
  • S A Smith-Warner