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Zhang Y, Song M, Chan AT, Schernhammer ES, Wolpin BM, Stampfer MJ, Meyerhardt JA, Fuchs CS, Roberts SB, Willett WC, Hu FB, Giovannucci EL, Ng K. Unrestrained eating behavior and risk of digestive system cancers: a prospective cohort study. Am J Clin Nutr 2021; 114:1612-1624. [PMID: 34293086 PMCID: PMC8588850 DOI: 10.1093/ajcn/nqab235] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/18/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Unrestrained eating behavior, as a potential proxy for diet frequency, timing, and caloric intake, has been questioned as a plausible risk factor for digestive system cancers, but epidemiological evidence remains sparse. OBJECTIVES We investigated prospectively the associations between unrestrained eating behavior and digestive system cancer risk. METHODS Participants in the Nurses' Health Study who were free of cancer and reported dietary information in 1994 were followed for ≤18 y. Cox models were used to estimate HRs and 95% CIs for unrestrained eating (eating anything at any time, no concern with figure change, or both) and risk of digestive system cancers. RESULTS During follow-up, 2064 digestive system cancer cases were documented among 70,450 eligible participants in analyses of eating anything at any time, In total, 2081 digestive system cancer cases were documented among 72,468 eligible participants in analyses of no concern with figure change. In fully adjusted analyses, women with the behavior of eating anything at any time had a higher risk of overall digestive system cancer (HR: 1.22; 95% CI: 1.10, 1.35), overall gastrointestinal tract cancer ((HR: 1.33; 95% CI: 1.18, 1.50), buccal cavity and pharynx cancer (HR: 1.50; 95% CI: 1.02, 2.21), esophageal cancer (HR: 1.62; 95% CI: 1.01, 2.62), small intestine cancer (HR: 1.92; 95% CI: 1.02,3. 59), and colorectal cancer (HR: 1.20; 95% CI: 1.04, 1.38), and a non-statistically significant increased risk of stomach cancer (HR: 1.54; 95% CI: 0.96,2.48), compared with women without this behavior. No statistically significant association was observed for pancreatic cancer and liver and gallbladder cancer. The combined effect of eating anything at any time and having no concern with figure change was associated with a significantly increased risk of overall digestive system cancer (HR: 1.27; 95% CI: 1.10, 1.46), overall gastrointestinal tract cancer (HR: 1.45; 95% CI: 1.23, 1.71), and colorectal cancer (HR: 1.34; 95% CI: 1.11, 1.63), compared with women exhibiting the opposite. CONCLUSIONS Unrestrained eating behavior was independently associated with increased risk of gastrointestinal tract cancers. The potential importance of unrestrained eating behavior modification in preventing gastrointestinal tract cancers should be noted.
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Affiliation(s)
- Yin Zhang
- Address correspondence to YZ (emails: and )
| | - Mingyang Song
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Clinical and Translational Epidemiology Unit and Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Andrew T Chan
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Clinical and Translational Epidemiology Unit and Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Eva S Schernhammer
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Center of Public Health, Medical University of Vienna, Vienna, Austria
| | - Brian M Wolpin
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Meir J Stampfer
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Jeffrey A Meyerhardt
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Charles S Fuchs
- Department of Medical Oncology, Smilow Cancer Hospital and Yale Cancer Center, New Haven, CT, USA
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Susan B Roberts
- USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Walter C Willett
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Frank B Hu
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Edward L Giovannucci
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Kimmie Ng
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
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Diet and PPARG2 Pro12Ala Polymorphism Interactions in Relation to Cancer Risk: A Systematic Review. Nutrients 2021; 13:nu13010261. [PMID: 33477496 PMCID: PMC7831057 DOI: 10.3390/nu13010261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/12/2021] [Accepted: 01/15/2021] [Indexed: 12/12/2022] Open
Abstract
Peroxisome proliferator-activated receptor-γ2 gene Pro12Ala allele polymorphism (PPARG2 Pro12Ala; rs1801282) has been linked to both cancer risk and dietary factors. We conducted the first systematic literature review of studies published before December 2020 using the PubMed database to summarize the current evidence on whether dietary factors for cancer may differ by individuals carrying C (common) and/or G (minor) alleles of the PPARG2 Pro12Ala allele polymorphism. The inclusion criteria were observational studies that investigated the association between food or nutrient consumption and risk of incident cancer stratified by PPARG2 Pro12Ala allele polymorphism. From 3815 identified abstracts, nine articles (18,268 participants and 4780 cancer cases) covering three cancer sites (i.e., colon/rectum, prostate, and breast) were included. CG/GG allele carriers were more impacted by dietary factors than CC allele carriers. High levels of protective factors (e.g., carotenoids and prudent dietary patterns) were associated with a lower cancer risk, and high levels of risk factors (e.g., alcohol and refined grains) were associated with a higher cancer risk. In contrast, both CG/GG and CC allele carriers were similarly impacted by dietary fats, well-known PPAR-γ agonists. These findings highlight the complex relation between PPARG2 Pro12Ala allele polymorphism, dietary factors, and cancer risk, which warrant further investigation.
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Perrigue MM, Drewnowski A, Wang CY, Song X, Kratz M, Neuhouser ML. Randomized Trial Testing the Effects of Eating Frequency on Two Hormonal Biomarkers of Metabolism and Energy Balance. Nutr Cancer 2016; 69:56-63. [PMID: 27918854 DOI: 10.1080/01635581.2017.1247888] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Eating frequency (EF) may influence obesity-related disease risk by attenuating postprandial fluctuations in hormones involved in metabolism, appetite regulation, and inflammation. MATERIALS/METHODS This randomized crossover intervention trial tested the effects of EF on fasting plasma insulin-like growth factor-I (IGF-1) and leptin. Fifteen subjects (4 males, 11 females) completed two eucaloric intervention phases lasting 21 days each: low EF ("low-EF"; 3 eating occasions/day) and high EF ("high-EF"; 8 eating occasions/day). Subjects were free-living and consumed their own meals using individualized structured meal plans with instruction from study staff. Subjects completed fasting blood draws and anthropometry on the first and last day of each study phase. The generalized estimated equations modification of linear regression tested the intervention effect on fasting serum IGF-1 and leptin. RESULTS Mean (± SD) age was 28.5 ± 8.70 years, and mean (± SD) Body Mass Index was 23.3 (3.4) kg/m2. We found lower mean serum IGF-1 following the high-EF condition compared to the low-EF condition (P < 0.001). There was no association between EF and plasma leptin (P = 0.83). CONCLUSION These results suggest that increased EF may lower serum IGF-1, which is a hormonal biomarker linked to increased risk of breast, prostate, and colorectal cancer.
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Affiliation(s)
- Martine M Perrigue
- a Cancer Prevention Program , Fred Hutchinson Cancer Research Center , Seattle , Washington , USA
| | - Adam Drewnowski
- b Nutritional Sciences Program , School of Public Health, University of Washington , Seattle , Washington , USA
| | - Ching-Yun Wang
- a Cancer Prevention Program , Fred Hutchinson Cancer Research Center , Seattle , Washington , USA
| | - Xiaoling Song
- a Cancer Prevention Program , Fred Hutchinson Cancer Research Center , Seattle , Washington , USA.,c Translational Research Program , Fred Hutchinson Cancer Research Center , Seattle , Washington , USA
| | - Mario Kratz
- a Cancer Prevention Program , Fred Hutchinson Cancer Research Center , Seattle , Washington , USA.,d Department of Epidemiology , School of Public Health, University of Washington , Seattle , Washington , USA.,e Department of Medicine , University of Washington , Seattle , Washington , USA
| | - Marian L Neuhouser
- a Cancer Prevention Program , Fred Hutchinson Cancer Research Center , Seattle , Washington , USA.,b Nutritional Sciences Program , School of Public Health, University of Washington , Seattle , Washington , USA
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Liu Y, Tang W, Zhai L, Yang S, Wu J, Xie L, Wang J, Deng Y, Qin X, Li S. Meta-analysis: eating frequency and risk of colorectal cancer. Tumour Biol 2013; 35:3617-25. [PMID: 24307626 DOI: 10.1007/s13277-013-1479-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Accepted: 11/26/2013] [Indexed: 12/14/2022] Open
Abstract
Eating frequency has been implicated in the risk of colorectal cancer (CRC) in several epidemiological studies with contradictory and inconclusive findings. We performed a meta-analysis to evaluate their relationship. The pooled relative risk (RR) with 95% confidence interval (CI) was calculated to estimate the effects. A total of 15 eligible studies with 141,431 subjects and 11,248 cases were retrieved after a comprehensive search of the PubMed, Cochrane Library, and Web of Science databases up to October 2013. The overall meta-analysis revealed no strong significant association between eating frequency and risk of CRC in different eating occasion categories (1 meal/day): RR = 1.01, 95% CI 0.94-1.09, P = 0.709; 3 vs. <3 daily meals: RR = 1.17, 95% CI 0.93-1.46; 4 vs. <3 daily meals: RR = 1.13, 95% CI 0.92-1.38; ≥ 5 vs. <3 daily meals: RR = 0.95, 95% CI 0.61-1.47; 4 vs. ≤ 3 daily meals: RR = 1.18, 95% CI 0.92-1.51; and 1-2 vs. 3 or 4 daily meals: RR = 0.82, 95% CI 0.63-1.06). However, modest evidence of an increased risk of CRC in case-control studies (RR = 1.30; 95% CI, 1.11-1.52) and ≥ 5 vs. ≤ 3 meals group (RR = 1.30; 95% CI, 1.11-1.52) was observed. Our meta-analysis results do not support the hypothesis that eating frequency strongly reduced or increased the risk of CRC. Clinical randomized trials are required to evaluate this relationship further.
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Affiliation(s)
- Yanqiong Liu
- Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
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Eating frequency and risk of colorectal cancer. Cancer Causes Control 2013; 24:2107-15. [PMID: 24057417 DOI: 10.1007/s10552-013-0288-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 09/04/2013] [Indexed: 12/20/2022]
Abstract
PURPOSE Eating frequency is a modifiable aspect of dietary behavior that may affect risk of colorectal cancer (CRC). Although most previous case-control studies indicate a positive association, two prospective studies suggest an inverse association between eating frequency and CRC risk, with evidence of effect modification by diet composition. We examined the association between eating frequency and CRC in a large, prospective cohort study, and explored whether this relationship was modified by sex, coffee consumption, or dietary glycemic load. METHODS Between 2000 and 2002, 67,912 western Washington residents aged 50-76 reported average daily meal and snack frequency using a mailed questionnaire as part of the vitamins and lifestyle study. Participants were followed for CRC through linkage with SEER through 2008, over which time 409 CRC cases developed. Hazard Ratios and 95 % Confidence Intervals were obtained using Cox regression. RESULTS In age- and sex-adjusted models higher (5+ times/d) vs. lower (1-2 times/d) eating frequency was associated with a HR of 0.62 (95 % CI 0.43-0.88, Ptrend = 0.001). However, following further adjustment for BMI, race/ethnicity, alcohol, and other known CRC risk factors, the relationship was no longer statistically significant (HR: 0.76; 95 % CI 0.51, 1.14). No effect modification was observed by sex (Pinteraction = 0.45), coffee consumption (Pinteraction = 0.44), or dietary glycemic load (Pinteraction = 0.90). In subgroup analyses by tumor site, higher vs. lower eating frequency was associated with lower risk for colon (HR 0.65 95 % CI 0.39-1.07, Ptrend = 0.04), but not rectal cancers (HR = 1.08 95 % CI 0.54-2.18, Ptrend = 0.94). CONCLUSION The weak inverse association observed between eating frequency and CRC is consistent with findings from other prospective studies. Modification of this relationship by diet quality and participant characteristics should be considered in the future studies.
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Mekary RA, Hu FB, Willett WC, Chiuve S, Wu K, Fuchs C, Fung TT, Giovannucci E. The joint association of eating frequency and diet quality with colorectal cancer risk in the Health Professionals Follow-up Study. Am J Epidemiol 2012; 175:664-72. [PMID: 22387430 DOI: 10.1093/aje/kwr363] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The results of most case-control studies have suggested a positive association between eating frequency and colorectal cancer risk. Because no prospective cohort studies have done so to date, the authors prospectively examined this association. In 1992, eating frequency was assessed in a cohort of 34,968 US men in the Health Professionals Follow-up Study. Cox proportional hazards regression models were used to estimate relative risks and 95% confidence intervals for various levels of eating frequency. Effect modifications by overall dietary quality (assessed using the Diet Approaches to Stop Hypertension score) and by factors that influence insulin resistance were further assessed. Between 1992 and 2006, a total of 583 cases of colorectal cancer were diagnosed. When comparing the highest eating frequency category (5-8 times/day) with the reference category (3 times/day), the authors found no evidence of an increased risk of colorectal cancer (multivariate relative risk = 0.88, 95% confidence interval: 0.62, 1.26) or colon cancer (multivariate relative risk = 0.78, 95% confidence interval: 0.49, 1.25). There was an implied inverse association with eating frequency among participants who had healthier diets (high Diet Approaches to Stop Hypertension score; P for interaction = 0.01), especially among men in the high-insulin-sensitivity group (body mass index (weight (kg)/height (m)(2)) <25, ≥2 cups of coffee/day, and more physical activity; P for interaction < 0.01, P for trend = 0.01). There was an implied protective association between increased eating frequency of healthy meals and colorectal cancer risk and in men with factors associated with higher insulin sensitivity.
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Affiliation(s)
- Rania A Mekary
- Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA.
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Abstract
BACKGROUND/OBJECTIVES The association between meat consumption and the risk of colorectal cancer (CRC) has been controversial. One of the difficulties in determining this association has been measurement of different attributes of meat consumption, including cooking methods and level of doneness. SUBJECTS/METHODS We investigated the association between meat consumption and cooking practices and the risk of CRC in a population-based case-control study in the Western Australian Bowel Health Study. From July 2005 to February 2007, 567 incident CRC cases and 713 controls, who were frequency matched to cases for age- and sex, completed questionnaires on lifestyle and meat consumption. Estimated odds ratios (ORs) comparing meat consumption quartile groups were obtained from multivariate logistic regression models. RESULTS The amount of red baked meat consumed had a statistically significant inverse trend of association with CRC (Q4 OR=0.73 95% confidence interval 0.53-1.01). When frequency was multiplied by serving size and by doneness, the association remained protective but was no longer statistically significant. The protective trends for red pan-fried meat were also borderline statistically significant. There were no other statistically significant or meaningful associations with any of the types of meat cooked by any method and the risk of CRC. CONCLUSIONS Our data do not support the hypothesis that meat consumption is a risk factor for CRC.
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Pelucchi C, Bosetti C, Rossi M, Negri E, La Vecchia C. Selected aspects of Mediterranean diet and cancer risk. Nutr Cancer 2010; 61:756-66. [PMID: 20155613 DOI: 10.1080/01635580903285007] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
European Mediterranean populations have a high life expectancy. Several aspects of their diet are considered favorable on health. We considered the role of various aspects of the Mediterranean diet on cancer risk in a series of Italian case-control studies including about 10,000 cases of cancer at 13 different sites and over 17,000 controls. For most epithelial cancers, the risk decreased with increasing vegetable consumption. Allium vegetables were also favorably related to cancer risk. Fruit intake was inversely associated with digestive tract and laryngeal cancers. For digestive tract cancers, the population attributable risks for low intake of vegetables and fruit ranged between 15% and 40%. Olive oil and unsaturated fats, which are typical aspects of the Mediterranean diet, were inversely related to the risk of several cancers, particularly of the upper aerodigestive tract. Whole grain food (and hence possibly fiber) intake was also related to reduced risk of various cancers. In contrast, refined grains and, consequently, glycemic load and index were associated to increased risks. Several micronutrients and food components (including folate, flavonoids, and carotenoids) showed inverse relations with cancer risk, but the main component(s) responsible for the favorable effect of a diet rich in vegetables and fruit remain undefined.
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Alaejos MS, González V, Afonso AM. Exposure to heterocyclic aromatic amines from the consumption of cooked red meat and its effect on human cancer risk: A review. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2007; 25:2-24. [DOI: 10.1080/02652030701474235] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- M. S. Alaejos
- a Department of Analytical Chemistry, Nutrition and Food Science , University of La Laguna , E-38205 La Laguna (Santa Cruz De Tenerife), Spain
| | - V. González
- a Department of Analytical Chemistry, Nutrition and Food Science , University of La Laguna , E-38205 La Laguna (Santa Cruz De Tenerife), Spain
| | - A. M. Afonso
- a Department of Analytical Chemistry, Nutrition and Food Science , University of La Laguna , E-38205 La Laguna (Santa Cruz De Tenerife), Spain
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DeChello LM, Sheehan TJ. Spatial analysis of colorectal cancer incidence and proportion of late-stage in Massachusetts residents: 1995-1998. Int J Health Geogr 2007; 6:20. [PMID: 17547744 PMCID: PMC1904190 DOI: 10.1186/1476-072x-6-20] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Accepted: 06/04/2007] [Indexed: 12/02/2022] Open
Abstract
Background The aims of this study were to determine if observed geographic variations in colorectal cancer incidence are simply random or are statistically significant deviations from randomness, whether statistically significant excesses are temporary or persistent, and whether they can be explained by risk factors such as socioeconomic status (SES) or the percent of the population residing in an urban area rather than a rural area. Between 1995 and 1998, 6360 male and 6628 female invasive colorectal cancer cases were diagnosed in Massachusetts residents. Cases were aggregated to Census tracts and analyzed for deviations from random occurrence with respect to both location and time. Results Six geographic areas that deviated significantly from randomness were uncovered in the age-adjusted analyses of males: three with higher incidence rates than expected and eight lower than expected. In the age-adjusted analyses of females, one area with a higher incidence rate, and one area with a lower incidence rate than expected, were found. After adjustment for SES and percent urban, some of these areas were no longer significantly different. Conclusion Public health practitioners can use the results of this study to focus their attention onto areas in Massachusetts that need to increase colorectal screening or have elevated risk of colorectal cancer incidence.
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Affiliation(s)
- Laurie M DeChello
- Department of Community Medicine and Health Care, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT 06030-6325, USA
| | - T Joseph Sheehan
- Department of Community Medicine and Health Care, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT 06030-6325, USA
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Calton BA, Lacey JV, Schatzkin A, Schairer C, Colbert LH, Albanes D, Leitzmann MF. Physical activity and the risk of colon cancer among women: a prospective cohort study (United States). Int J Cancer 2006; 119:385-91. [PMID: 16489545 DOI: 10.1002/ijc.21840] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Physical activity has frequently been reported to decrease the risk of colon cancer in men, but data on the relation of physical activity to colon cancer risk in women have generally been less consistent. To further investigate the relationship of physical activity with colon cancer risk in women, we studied a cohort of 31,783 US women participating in the Breast Cancer Detection Demonstration Project Follow-up Study. Information on daily physical activity over the past year was ascertained using a self-administered questionnaire at study baseline. The Cox proportional hazards model was used to estimate relative risks (RRs) relating physical activity to the risk of incident colon cancer. During 270,325 person-years of follow-up, 243 colon cancer cases were identified. No association was observed between physical activity and the subsequent risk of colon cancer. The multivariable RRs of colon cancer across increasing quintiles of total physical activity were 1.0, 1.45, 1.16, 1.27 and 1.15 (95% CI: 0.76, 1.75; p(trend) = 0.77). The multivariable RRs comparing women at the extremes of moderate and vigorous physical activity, respectively, were 1.07 (95% CI: 0.70, 1.62) and 1.10 (95% CI: 0.78, 1.55). The relationship between physical activity and colon cancer risk did not vary by anatomic subsite or across subgroups defined by age, body mass, dietary fiber intake, menopausal status, menopausal hormone use or aspirin use. The results of this large prospective cohort study among women do not support the hypothesis that physical activity is related to a lower incidence of colon cancer.
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Affiliation(s)
- Brook A Calton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20852, USA.
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Abstract
Colorectal cancer appears to have rapidly increased over the past two decades in Korea. Environmental factors, characterized by a western life style, seem to be closely related to the increased risk of colorectal cancer. Higher intakes of meat, a lower vegetable intake, a lack of physical activity, obesity, and alcohol drinking have been suggested to be risk factors for colorectal cancer in the numerous epidemiologic studies. Several specific associations have also been observed between genetic polymorphisms and colorectal cancer. Moreover, it has been postulated that environmental factors and a genetic predisposition work in concert in colorectal cancer development. A stronger association between red meat intake and colorectal cancer among those with rapid acetylators at either the NAT1 or NAT2 locus was reported, particularly for colorectal cancer associated with K-ras mutations. The protective effect of the homozygous variant TT form of the MTHFR genotype on the risk of colon cancer seems to be modified by the level of methyl diets, i.e., by folate, which has a protective effect, or conversely by alcohol. The insulin-related pathway, which possibly explains at a mechanistic level the effect of physical activity and obesity on colon cancer, appears to be a common denominator in colon cancer and in other metabolic disorders, such as diabetes mellitus and dyslipidemia. Hyperinsulinemia has been proposed as an explanation for the association between a Western lifestyle and colon cancer risk. Further studies, that incorporate both genetic and environmental factors, are needed to fully explain and identify the underlying pathway of colorectal carcinogenesis.
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Affiliation(s)
- Dong-Hyun Kim
- Department of Social and Preventive Medicine, Hallym University College of Medicine, Korea
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Ahmed FE. Effect of diet, life style, and other environmental/chemopreventive factors on colorectal cancer development, and assessment of the risks. JOURNAL OF ENVIRONMENTAL SCIENCE AND HEALTH. PART C, ENVIRONMENTAL CARCINOGENESIS & ECOTOXICOLOGY REVIEWS 2004; 22:91-147. [PMID: 16291519 DOI: 10.1081/lesc-200038263] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
This review presents a comprehensive, evenhanded evaluation of the evidence from experimental, in vitro and human studies associating environmental and therapeutic factors with risk of colorectal cancer. Life styles correlated with the greatest increase in colorectal cancer risk are the ones that typify a diet rich in fat and calories, alcohol drinking and tobacco smoking, and low intake of vegetable, fruits and fibers, referred to as a "western diet," as well as sedentary style (i.e., no- or low-exercise). This kind of life style has also been associated with other chronic diseases (other cancers, obesity, dyslipedemia, diabetes, hypertension cardiovascular, and hypertension). The evidence does not implicated red meat as a risk factor, and fiber has been shown to protect against colorectal adenomas and carcinomas. Calcium, vitamin D, folate, and some antioxidant vitamins and minerals (gamma-tocopherol and selenium) have protective effects, and daily exercise for > or =30 min results in a significant decrease in risk. Estrogen use (hormone replacement therapy) substantially reduces colorectal cancer risk in postmenopausal women. Nonsteroidal anti-inflammatory drugs (e.g., aspirin) in excessive doses is protective, especially in high risk populations, but the side effects of its use and cost incurred due to its continued intake over long periods must be carefully scrutinized before any recommendations are made for the general public.
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Affiliation(s)
- Farid E Ahmed
- Department of Radiation Oncology, Leo W. Jenkins Cancer Center, The Brody School of Medicine, East Carolina University, Greenville, NC 27858, USA.
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Fernandez E, La Vecchia C, Talamini R, Negri E. Joint effects of family history and adult life dietary risk factors on colorectal cancer risk. Epidemiology 2002; 13:360-3. [PMID: 11964940 DOI: 10.1097/00001648-200205000-00019] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We analyzed the joint effects of family history of colorectal cancer and adult life dietary risk factors on colorectal cancer risk. METHODS We used data from a case-control study conducted in northern Italy between 1985 and 1992, including 1584 cases with colorectal cancer and 2879 controls. We created an adult life dietary risk factor score. RESULTS Among subjects with family history of colorectal cancer, those in the lowest risk score tertile were not at elevated risk of colorectal cancer (odds ratio = 1.2; 95% confidence interval = 0.7-2.1), whereas those in the highest score tertile were at increased risk (odds ratio = 5.5; 95% confidence interval = 3.5-8.7). CONCLUSIONS These findings indicate that the expression of familial susceptibility can be substantially modified by adult life risk factors.
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Affiliation(s)
- Esteve Fernandez
- Cancer Prevention and Control Unit, Institut Català d'Oncologia, L'Hospitalet, Barcelona, Spain.
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Norat T, Lukanova A, Ferrari P, Riboli E. Meat consumption and colorectal cancer risk: dose-response meta-analysis of epidemiological studies. Int J Cancer 2002; 98:241-56. [PMID: 11857415 DOI: 10.1002/ijc.10126] [Citation(s) in RCA: 298] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The hypothesis that consumption of red and processed meat increases colorectal cancer risk is reassessed in a meta-analysis of articles published during 1973-99. The mean relative risk (RR) for the highest quantile of intake vs. the lowest was calculated and the RR per gram of intake was computed through log-linear models. Attributable fractions and preventable fractions for hypothetical reductions in red meat consumption in different geographical areas were derived using the RR log-linear estimates and prevalence of red meat consumption from FAO data and national dietary surveys. High intake of red meat, and particularly of processed meat, was associated with a moderate but significant increase in colorectal cancer risk. Average RRs and 95% confidence intervals (CI) for the highest quantile of consumption of red meat were 1.35 (CI: 1.21-1.51) and of processed meat, 1.31 (CI: 1.13-1.51). The RRs estimated by log-linear dose-response analysis were 1.24 (CI: 1.08-1.41) for an increase of 120 g/day of red meat and 1.36 (CI: 1.15-1.61) for 30 g/day of processed meat. Total meat consumption was not significantly associated with colorectal cancer risk. The risk fraction attributable to current levels of red meat intake was in the range of 10-25% in regions where red meat intake is high. If average red meat intake is reduced to 70 g/week in these regions, colorectal cancer risk would hypothetically decrease by 7-24%.
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Affiliation(s)
- Teresa Norat
- Unit of Nutrition and Cancer, International Agency for Research on Cancer, Lyon, France
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16
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Nakaji S, Shimoyama T, Umeda T, Sakamoto J, Katsura S, Sugawara K, Baxter D. Dietary fiber showed no preventive effect against colon and rectal cancers in Japanese with low fat intake: an analysis from the results of nutrition surveys from 23 Japanese prefectures. BMC Cancer 2001; 1:14. [PMID: 11701093 PMCID: PMC59673 DOI: 10.1186/1471-2407-1-14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2001] [Accepted: 10/29/2001] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Since Fuchs' report in 1999, the reported protective effect of dietary fiber from colorectal carcinogenesis has led many researchers to question its real benefit. The aim of this study is to evaluate the association between diet, especially dietary fiber and fat and colorectal cancer in Japan. METHODS A multiple regression analysis (using the stepwise variable selection method) was performed using the standardized mortality ratios (SMRs) of colon and rectal cancer in 23 Japanese prefectures as objective variables and dietary fiber, nutrients and food groups as explanatory variables. RESULTS As for colon cancer, the standardized partial correlation coefficients were positively significant for fat (1,13, P = 0.000), seaweeds (0.41, P = 0.026) and beans (0.45, P = 0.017) and were negatively significant for vitamin A (-0.63, P = 0.003), vitamin C (-0.42, P = 0.019) and yellow-green vegetables (-0.37, P = 0.046). For rectal cancer, the standardized partial correlation coefficient in fat (0.60, P = 0.002) was positively significant. Dietary fiber was not found to have a significant relationship with either colon or rectal cancers. CONCLUSIONS This study failed to show any protective effect of dietary fiber in subjects with a low fat intake (Japanese) in this analysis, which supports Fuchs' findings in subjects with a high fat intake (US Americans).
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Affiliation(s)
- Shigeyuki Nakaji
- Department of Hygiene, Hirosaki University School of Medicine Zaifu-cho 5, Hirosaki, 036-8562 Japan
| | - Tadashi Shimoyama
- Department of Hygiene, Hirosaki University School of Medicine Zaifu-cho 5, Hirosaki, 036-8562 Japan
| | - Takashi Umeda
- Department of Hygiene, Hirosaki University School of Medicine Zaifu-cho 5, Hirosaki, 036-8562 Japan
| | - Juichi Sakamoto
- First Department of Internal Medicine, Hirosaki University School of Medicine, Hirosaki, 036-8562 Japan
| | - Shuji Katsura
- Department of Hygiene, Hirosaki University School of Medicine Zaifu-cho 5, Hirosaki, 036-8562 Japan
| | - Kazuo Sugawara
- Department of Hygiene, Hirosaki University School of Medicine Zaifu-cho 5, Hirosaki, 036-8562 Japan
| | - David Baxter
- Research Graduate School, Faculty of Social and Health Sciences and Education, The University of Ulster, Shore Road, Newtownabbey, County Antrim, BT37 OQB, Northern Ireland, UK
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17
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Abstract
This article reviews the epidemiologic evidence on colorectal cancer risk and meat consumption from 32 case-control and 13 cohort studies published in English from 1970 to 1999 and retrieved from the Medline database. The results support the hypothesis that meat consumption is associated with a modest increase in colorectal cancer risk. This association, however, seems to have been more consistently found for red meat and processed meat. The studies on cooking methods and meat "doneness" are not consistent and the evidence is not conclusive.
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Affiliation(s)
- T Norat
- Unit of Nutrition and Cancer, International Agency for Research on Cancer, Lyon, France
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18
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Affiliation(s)
- K Krishnan
- Department of Internal Medicine, East Tennessee State University, Johnson City 37614-70622, USA
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19
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Xue KX, Wu JZ, Ma GJ, Yuan S, Qin HL. Comparative studies on genotoxicity and antigenotoxicity of natural and synthetic beta-carotene stereoisomers. Mutat Res 1998; 418:73-8. [PMID: 9756999 DOI: 10.1016/s1383-5718(98)00109-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
To evaluate the practical value of natural beta-carotene (NbetaC) and to elucidate the apparent discrepancy between epidemiological observations and intervention trials on the role of beta-carotene (betaC) in tumor prevention, the genotoxicity and the antigenotoxicity of NbetaC and synthetic betaC crystal (SbetaCC) stereoisomers were studied comparatively using chromosome aberration analysis and the micronucleus test in human lymphocytes in vitro. NbetaC was extracted from the halotolerant algae Dunaliella salina. The NbetaC crystal (NbetaCC) preparation is about 70% all-trans (TbetaC) and 8% 9-cis (CbetaC). The NbetaC oil (NbetaCO) preparation is about 40% all-trans and 38% 9-cis. SbetaCC is more than 97% all-trans, and the 9-cis can not be detected. The mixture of betaC (betaCM) preparation is 74% SbetaCC and 26% NbetaC. Our results show no genotoxicity of 1-30 microg/ml NbetaCC, but this concentration of NbetaCC inhibited significantly gamma-ray-induced micronucleus formation in human lymphocytes in vitro. One to thirty microg/ml NbetaCO was most effective against both gamma-ray-induced and spontaneous micronucleus formation. However, no influence of NbetaCO on spontaneous chromosome aberrations in human lymphocytes in vitro was observed. NbetaCO suppressed significantly mitomycin C (MMC)-induced chromosome aberrations. One to thirty microg/ml SbetaCC induced a dose-dependent increase in micronucleus frequency, and also inhibited gamma-ray-induced micronucleus formation. No effect of betaCM on spontaneous chromosome aberrations was found. One to thirty microg/ml betaCM is more effective against MMC-induced chromosome aberrations than NbetaCO. These results suggest that CbetaC might play a critical role in the genotoxicity and antigenotoxicity of SbetaCC and NbetaC. The genotoxic activity of SbetaCC might be involved in carcinogenesis. NbetaC or betaCM could be of practical value in tumor prevention and supplementary treatment.
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Affiliation(s)
- K X Xue
- Jiangsu Institute of Cancer Research, 210009, Nanjing, China
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20
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Krishnan K, Ruffin MT, Brenner DE. Clinical models of chemoprevention for colon cancer. Hematol Oncol Clin North Am 1998; 12:1079-113, viii. [PMID: 9888022 DOI: 10.1016/s0889-8588(05)70042-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Colon cancer is a common malignancy in the westernized world and is incurable in its advanced stages. This article summarizes the currently available information on colorectal cancer chemoprevention. A brief outline of the incidence and etiologic factors is followed by a discussion of the evidence on which chemopreventive strategies for colon cancer are modeled. This includes a description of the development of surrogate endpoint biomarkers and experimental models to study colorectal cancer chemopreventives, a review of the promising colorectal cancer chemopreventives, and a discussion of the issues to be addressed in the design of future chemoprevention trials. The article concludes with an emphasis on the development and validation of biomarkers and selection of high-risk cohorts using genetic and epidemiologic tools as the main goals of future colon cancer chemoprevention trials before large-scale, risk-reduction trials are conducted.
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Affiliation(s)
- K Krishnan
- Department of Internal Medicine, East Tennessee State University, Johnson City, USA
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21
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Ghadirian P, Maisonneuve P, Perret C, Lacroix A, Boyle P. Epidemiology of sociodemographic characteristics, lifestyle, medical history, and colon cancer: a case-control study among French Canadians in Montreal. CANCER DETECTION AND PREVENTION 1998; 22:396-404. [PMID: 9727620 DOI: 10.1046/j.1525-1500.1998.00058.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Colon cancer is the second most common cancer in both men and women in North America and other developed countries. In a population-based case-control study of colon cancer among French Canadians in greater Montreal, a total of 402 cases and 668 controls were interviewed. The cancer cases were identified through the admission offices of five major Francophone teaching hospitals in Montreal from 1989 to 1993. The controls, matched by age, sex, place of residence, and language, were selected by a modified random digit dialing method. The results show that subjects who had ever been married had a lower risk for colon cancer (odds ratio [OR]: 0.58; 95% confidence interval [95% CI]: 0.48-0.84) than did individuals who had never been married. A significant association (OR: 1.90; p for trend = 0.003) was found between the height of subjects and the risk of colon cancer. The OR for individuals with a family history of colorectal cancer was 2.78 with a p value of 0.01. A direct and significant association (OR: 2.01) was found among constipation, use of laxatives (OR: 1.41), and the risk of colon cancer. Among women, a suggestive inverse association was detected between the number of full-term pregnancies and the risk of colon cancer in female subjects (the OR for five or more pregnancies was 0.58 with a p for trend of 0.08). There was also a suggestive linear trend (increased age-decreased risk) between age at menarche and the risk of colon cancer. No association was apparent between other sociodemographic characteristics and the risk of colon cancer. In conclusion, married individuals had lower risk for colon cancer, perhaps due to food habits or other characteristics of being single. Higher height and weight history 10 years before the diagnosis of cancer are risk factors for breast cancer, while both current weight and body mass index seem to be protective. Positive family history of colon cancer increased the risk of colon cancer significantly.
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Affiliation(s)
- P Ghadirian
- Research Center, CHUM, Department of Nutrition, University of Montreal, Quebec, Canada
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22
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Favero A, Franceschi S, La Vecchia C, Negri E, Conti E, Montella M. Meal frequency and coffee intake in colon cancer. Nutr Cancer 1998; 30:182-5. [PMID: 9631488 DOI: 10.1080/01635589809514661] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Several studies suggested that frequent eating may increase colon cancer risk. To further clarify this issue, a case-control study was carried out in six areas of Italy on 1,225 incident cases < 75 years of age with histologically confirmed colon cancer and 4,154 control subjects. The controls were hospitalized for acute, nonneoplastic conditions unrelated to long-term dietary modifications. After allowance for education, physical activity, intake of vegetables, and major energy sources, there was a trend of increasing risk with increasing eating frequency (odds ratio for > or = 4 vs. < or = 2 daily meals = 1.24). Coffee intake, which was inversely associated with cancer risk, exerted a modification effect, with an odds ratio of 1.89 for frequent eaters who drank fewer than two cups of coffee per day. Frequent eating increases, whereas high coffee intake decreases, the excretion of bile acids, which are suspected to be carcinogenic to the colon. Thus, it is conceivable that frequent coffee intake may counterbalance the effect of frequent eating.
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Affiliation(s)
- A Favero
- Servizio di Epidemiologia, Centro di Riferimento Oncologico, Aviano, Italy
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23
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Klurfeld DM. Fiber and cancer protection--mechanisms. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1997; 427:249-57. [PMID: 9361850 DOI: 10.1007/978-1-4615-5967-2_26] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
There is no reason to believe that a single lumenal or tissue factor will hold the key to understanding the of dietary fiber's effect on reducing the risk of colon cancer. In fact, the data suggest that multiple, interacting factors will be revealed. After years of research, it appears that the bile acid hypothesis is not nearly as strong as first envisaged. Additionally, the theory that SCFA protect against colon cancer has little clinical or experimental support. There is no doubt that identification of genetic alterations, and their controlling factors, will play a major role in our understanding of this issue. The appeal of the original fiber hypothesis has not diminished but simply requires updating based on discoveries made since it was first proposed. It is this author's opinion that dietary fiber will likely be found to modulate human colon cancer and the mechanisms of its beneficial effect will probably be through multiple actions within the lumen and at the level of the target tissue. Based on our current knowledge of the pathogenesis of colon cancer we cannot make definitive statements about what percentage of colon cancer might be prevented by a specific type or amount of dietary fiber but it is reasonable to conclude that consumption of fiber-rich diets is associated with reduced risk of colon cancer. It is quite plausible that the combination of dietary fiber, or its metabolites, in conjunction with other phytochemicals may be necessary to realize inhibition of the tumorigenic process.
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Affiliation(s)
- D M Klurfeld
- Department of Nutrition and Food Science, Wayne State University, Detroit, Michigan 48202, USA
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24
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Fernandez E, La Vecchia C, D'Avanzo B, Negri E, Franceschi S. Risk factors for colorectal cancer in subjects with family history of the disease. Br J Cancer 1997; 75:1381-4. [PMID: 9155063 PMCID: PMC2228225 DOI: 10.1038/bjc.1997.234] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The relationship between lifestyle factors, past medical conditions, daily meal frequency, diet and the risk of 'familial' colorectal cancer has been analysed using data from a case-control study conducted in northern Italy. A total of 1584 colorectal cancer patients and 2879 control subjects were admitted to a network of hospitals in the Greater Milan area and the Pordenone province. The subjects included for analysis were the 112 cases and the 108 control subjects who reported a family history of colorectal cancer in first-degree relatives. Colorectal cancer cases and control subjects with family history were similarly distributed according to sex, age, marital status, years of schooling and social class. Familial colorectal cancer was associated with meal frequency, medical history of diabetes (relative risk, RR = 4.6) and cholelithiasis (RR = 5.2). Significant positive trends of increasing risk with more frequent consumption were observed for pasta (RR = 2.5, for the highest vs the lowest intake tertile), pastries (RR = 2.4), red meat (RR = 2.9), canned meat (RR = 1.9), cheese (RR = 3.5) and butter (RR = 1.9). Significant inverse associations and trends in risk were observed for consumption of poultry (RR = 0.4), tomatoes (RR = 0.2), peppers (RR = 0.3) and lettuce (RR = 0.3). Significant inverse trends in risk with increasing consumption for beta-carotene and ascorbic acid were observed (RR = 0.5 and 0.4 respectively, highest vs lowest intake tertile). These results suggest that risk factors for subjects with a family history of colorectal cancer in first-degree relatives are not appreciably different from recognized risk factors of the disease in the general population.
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Affiliation(s)
- E Fernandez
- Institut de Salut Pública de Catalunya, Campus de Bellvitge, Universitat de Barcelona, L'Hospitalet, Catalonia, Spain
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