Processed and Unprocessed Red Meat and Risk of Colorectal Cancer: Analysis by Tumor Location and Modification by Time

Lipids and adipocytes involvement in tumor progression with a focus on obesity and diet

The adipose tissue is a complex organ that can play endocrine, metabolic, and immune regulatory roles in cancer. In particular, adipocytes provide metabolic substrates for cancer cell proliferation and produce signaling molecules that can stimulate cell adhesion, migration, invasion, angiogenesis, and inflammation. Cancer cells, in turn, can reprogram adipocytes towards a more inflammatory state, resulting in a vicious cycle that fuels tumor growth and evolution. These mechanisms are enhanced in obesity, which is associated with the risk of developing certain tumors. Diet, an exogenous source of lipids with pro- or anti-inflammatory functions, has also been connected to cancer risk. This review analyzes how adipocytes and lipids are involved in tumor development and progression, focusing on the relationship between obesity and cancer. In addition, we discuss how diets with varying lipid intakes can affect the disease outcomes. Finally, we introduce novel metabolism-targeted treatments and adipocyte-based therapies in oncology.

Iron-(Fe3+)-Dependent Reactivation of Telomerase Drives Colorectal Cancers

Over-consumption of iron-rich red meat and hereditary or genetic iron overload are associated with an increased risk of colorectal carcinogenesis, yet the mechanistic basis of how metal-mediated signaling leads to oncogenesis remains enigmatic. Using fresh colorectal cancer samples we identify Pirin, an iron sensor, that overcomes a rate-limiting step in oncogenesis, by reactivating the dormant human telomerase reverse transcriptase (hTERT) subunit of the telomerase holoenzyme in an iron-(Fe3+)-dependent manner and thereby drives colorectal cancers. Chemical genetic screens combined with isothermal dose-response fingerprinting and mass spectrometry identified a small molecule SP2509 that specifically inhibits Pirin-mediated hTERT reactivation in colorectal cancers by competing with iron-(Fe3+) binding. Our findings, first to document how metal ions reactivate telomerase, provide a molecular mechanism for the well-known association between red meat and increased incidence of colorectal cancers. Small molecules like SP2509 represent a novel modality to target telomerase that acts as a driver of 90% of human cancers and is yet to be targeted in clinic. Significance: We show how iron-(Fe3+) in collusion with genetic factors reactivates telomerase, providing a molecular mechanism for the association between iron overload and increased incidence of colorectal cancers. Although no enzymatic inhibitors of telomerase have entered the clinic, we identify SP2509, a small molecule that targets telomerase reactivation and function in colorectal cancers.

Follow-Up Period Affects the Association between Serum 25-Hydroxyvitamin D Concentration and Incidence of Dementia, Alzheimer's Disease, and Cognitive Impairment

BACKGROUND/OBJECTIVES

Vitamin D's effect on risk health outcomes is often evaluated using prospective cohort studies. For vitamin D, risk ratios (RRs) are based on health outcomes with respect to serum 25-hydroxyvitamin D [25(OH)D] concentrations measured at time of enrollment. Serum 25(OH)D concentrations vary over time, thereby diluting the effect of 25(OH)D for long follow-up periods. Inverse relationships between RR and follow-up period have been reported for all-cause mortality rate and cancer incidence rates. Here, the effect for neurological outcomes is evaluated.

METHODS

The analysis examines how follow-up period affected results from nine cohort studies of all-cause dementia, six studies of Alzheimer's disease, and nine for cognitive impairment with respect to vitamin D deficiency.

RESULTS

For all-cause dementia, Alzheimer's disease, and cognitive impairment, respectively, the linear regression fits are RR = 2.9 - 0.14 × years, r = 0.73, p = 0.02; RR = 2.9 - 0.14 × years, r = 0.69, p = 0.13; and RR = 1.8 - 0.066 × years, r = 0.72, p = 0.03. The regression fit to RR for the shortest follow-up period for each outcome is considered the best estimate of vitamin D deficiency's effect on risk. Those values are approximately twice that found by averaging all RRs without considering the effect of follow-up period.

CONCLUSIONS

Vitamin D's effect on risk of neurological conditions is inversely correlated with mean follow-up period in prospective cohort studies. This effect should be considered in the design and analysis of such studies. Additional studies should also be conducted regarding raising serum 25(OH)D concentrations to reduce risk of brain function decline.

A Systematic Review of the Impact of Dietary and Lifestyle Factors on Colorectal Cancer Prevention in Gulf Cooperation Council Countries

Colorectal cancer (CRC) remains a significant health burden in the Gulf Cooperation Council (GCC) countries, necessitating a deeper understanding of modifiable risk factors. Thus, the aim of the study was to evaluate the impact of dietary and lifestyle factors on the prevention of CRC in GCC countries. Studies were identified through electronic searches and reviewed based on relevant keywords. Databases searched included Ovid's MEDLINE, EMBASE, Google Scholar, and Web of Science, covering titles and abstracts published between January 1, 2000 and July 25, 2024. The search strategy encompassed four thematic areas: "colorectal cancer," "adults above 18," "risk factors," and "GCC countries." The primary focus was on dietary and lifestyle factors. Two reviewers screened titles and abstracts to determine whether the inclusion criteria were met. A total of 1,883 records were identified across these databases. After removing 513 duplicate records, 1,370 records were screened based on titles and abstracts. Of these, 1,284 records were excluded, leaving 86 full-text articles for assessment. Eight studies were ultimately included in the final systematic review, consisting of seven case-control studies and one cross-sectional study. In GCC countries, a diet rich in fruits, vegetables, and fiber has shown protective effects against CRC, while high red meat and refined carbohydrate intake may increase risk. Regular physical activity reduces CRC risk, though the impact of smoking remains inconclusive. Evidence regarding dairy products is contradictory. There is a shortage of high-quality longitudinal studies, highlighting gaps in current research and underscoring the need for larger studies with consistent methodologies.

Colorectal cancer prognosis based on dietary pattern using synthetic minority oversampling technique with K-nearest neighbors approach

Generally, a person's life span depends on their food consumption because it may cause deadly diseases like colorectal cancer (CRC). In 2020, colorectal cancer accounted for one million fatalities globally, representing 10% of all cancer casualties. 76,679 males and 78,213 females over the age of 59 from ten states in the United States participated in this analysis. During follow-up, 1378 men and 981 women were diagnosed with colon cancer. This prospective cohort study used 231 food items and their variants as input features to identify CRC patients. Before labelling any foods as colorectal cancer-causing foods, it is ethical to analyse facts like how many grams of food should be consumed daily and how many times a week. This research examines five classification algorithms on real-time datasets: K-Nearest Neighbour (KNN), Decision Tree (DT), Random Forest (RF), Logistic Regression with Classifier Chain (LRCC), and Logistic Regression with Label Powerset (LRLC). Then, the SMOTE algorithm is applied to deal with and identify imbalances in the data. Our study shows that eating more than 10 g/d of low-fat butter in bread (RR 1.99, CI 0.91-4.39) and more than twice a week (RR 1.49, CI 0.93-2.38) increases CRC risk. Concerning beef, eating in excess of 74 g of beef steak daily (RR 0.88, CI 0.50-1.55) and having it more than once a week (RR 0.88, CI 0.62-1.23) decreases the risk of CRC, respectively. While eating beef and dairy products in a daily diet should be cautious about quantity. Consuming those items in moderation on a regular basis will protect us against CRC risk. Meanwhile, a high intake of poultry (RR 0.2, CI 0.05-0.81), fish (RR 0.82, CI 0.31-2.16), and pork (RR 0.67, CI 0.17-2.65) consumption negatively correlates to CRC hazards.

Ameliorative potential of synbiotic combination of Lactobacillus sp. and polyphenols against Benzo[a]pyrene-induced toxicity in Caco-2 cell line

Exposure to benzo[a]pyrene (B[a]P), a major global food safety concern, is often associated with increasing incidence of colorectal cancers. This in-vitro study was focused on the identification of potential B[a]P-adsorbing Lactobacillus strains and evaluation of the ameliorative effect of synbiotic combination of selected Lactobacillus sp. and polyphenols (quercetin or resveratrol) against B[a]P-induced intestinal toxicity in Caco-2 cells. Preliminary studies lead to the selection of Lactiplantibacillus plantarum MTCC 25433 strain that showed 86% of B[a]P adsorption in 2 h as compared to L. rhamnosus GG that showed 74% of B[a]P adsorption. B[a]P adsorption by MTCC 25433 was reduced to 9%, 16% and 20% upon pre-treatment with SDS, NaIO4 and mutanolysin, attributing the involvement of cell wall proteins and polysaccharides in the adsorption. Additionally, peptidoglycan of both strains adsorbed >50% of B[a]P. In-vitro assays revealed that the selected LAB mitigated the B[a]P-induced epithelial cell damage. Among the polyphenols, quercetin, resveratrol and curcumin, varied in their potency to mitigate B[a]P-induced oxidative stress, with curcumin being least effective. Combinations of selected Lactobacillus sp. and polyphenols were more potent in averting B[a]P-induced toxicity via increase in GSH (17-30 %), SOD (50-88 %), catalase (19-45 %), and reduction in IL-8 secretion (14-28 %) and barrier dysfunction. Principal component analysis affirmed the superior potency of combination of L. plantarum MTCC 25433 and quercetin in averting B[a]P-induced toxicity. Overall, this study highlighted a novel promising strategy of synbiotic combination of Lactobacillus sp. and polyphenols (quercetin or resveratrol) in alleviating the B[a]P-induced toxicity in intestinal epithelial cells.

The Association between Red Meat Consumption and Advanced Colorectal Adenomas in a Population Undergoing a Screening-Related Colonoscopy in Alberta, Canada

The association between red meat consumption and colorectal cancer has been rigorously examined. However, a more comprehensive understanding of how the intake of unprocessed red meat contributes to the development of early precancerous colorectal lesions, such as advanced colorectal adenomas (ACRAs), requires further investigation. We examined the associations between different types of red meat intake and ACRAs in a sample population of 1083 individuals aged ≥ 50 years undergoing an initial screening colonoscopy in Calgary, Alberta, Canada. Associations between grams per day of total, processed, and unprocessed red meat from diet history questionnaires and ACRAs were evaluated with multivariable logistic regression models. We also applied cubic spline models fitted with three knots (10th, 50th, and 90th percentiles) to identify potential nonlinear associations. We did not observe a meaningful association between unprocessed red meat intake and the presence of ACRAs. In contrast, for every 10 g/d increase in total and processed meat intake, we observed an increase in the odds of ACRAs at the screening colonoscopy (adjusted odds ratio (OR) = 1.05, 95% [CI = 1.01-1.09], p = 0.04) and (adjusted OR = 1.11, 95% [CI = 1.02-1.20], p = 0.02), respectively. This study highlights the importance of differentiating between types of red meat consumption in the context of dietary risks associated with ACRAs.

Properties and physiological effects of dietary fiber-enriched meat products: a review

Meat is a rich source of high biological proteins, vitamins, and minerals, but it is devoid of dietary fiber, an essential non-digestible carbohydrate component such as cellulose, hemicellulose, pectin, lignin, polysaccharides, and oligosaccharides. Dietary fibers are basically obtained from various cereals, legumes, fruits, vegetables, and their by-products and have numerous nutritional, functional, and health-benefiting properties. So, these fibers can be added to meat products to enhance their physicochemical properties, chemical composition, textural properties, and organoleptic qualities, as well as biological activities in controlling various lifestyle ailments such as obesity, certain cancers, type-II diabetes, cardiovascular diseases, and bowel disorders. These dietary fibers can also be used in meat products as an efficient extender/binder/filler to reduce the cost of production by increasing the cooking yield as well as by reducing the lean meat content and also as a fat replacer to minimize unhealthy fat content in the developed meat products. So, growing interest has been observed among meat processors, researchers, and scientists in exploring various new sources of dietary fibers for developing dietary fiber-enriched meat products in recent years. In the present review, various novel sources of dietary fibers, their physiological effects, their use in meat products, and their impact on various physicochemical, functional, and sensory attributes have been focused.

Comprehensive Review of Red Meat Consumption and the Risk of Cancer

Red and processed meat consumption rates are increasing in the United States. In this review, we present the current evidence that links red meat consumption and cancer development. A literature search was conducted in the PubMed and Google Scholar databases to review red meat consumption and its association with breast cancer and gastrointestinal cancer. Due to the presence of heme iron, which triggers oxidative reactions that eventually result in tumor formation, red meat consumption is strongly associated with the development of breast cancer. Ingestion of red meat increases Helicobacter pylori infections, resulting in enhanced expression of the CagA gene and the secretion of pro-inflammatory cytokines. This is the leading cause of gastric cancer. There is a strong correlation between heterocyclic amines and polycyclic aromatic hydrocarbons in red meat and the development of pancreatic cancer. However, additional research is necessary to confirm this finding. Adult colorectal cancer is caused by the formation of heterocyclic amines and DNA adducts due to the intake of red and processed meats cooked at higher temperatures. The consumption of poultry is associated with a reduced risk of breast and gastrointestinal cancers, but the results are inconsistent. The evidence is strong for the association between red meat and breast cancer and most gastric cancers. The presence of aromatic hydrocarbons, heterocyclic amines, and heme iron in red meat has been found to be behind tumorigenesis. Poultry has been shown to have a low association with cancer, but additional research is needed.

Association of meat consumption with the risk of gastrointestinal cancers: a systematic review and meta-analysis

BACKGROUND

The association between gastrointestinal cancer and types of meat consumption, including red meat, processed meat, or a combination of both, remains disputable. Therefore, we performed a systematic review and meta-analysis of prospective cohort studies to estimate the association between meat consumption and gastrointestinal cancer risk.

METHODS

PubMed, EmBase, and the Cochrane library databases were searched systematically for eligible studies that investigated the relation between meat consumption and the risk of developing gastrointestinal cancers, including esophageal cancer (EC), gastric cancer (GC), colorectal cancer (CRC), colon cancer (CC), rectal cancer (RC), pancreatic cancer (PC), and hepatocellular carcinoma (HCC) throughout February, 2023. The pooled relative risk (RR) with 95% confidence interval (CI) was assigned as an effect estimate and calculated using a random-effects model with inverse variance weighting.

RESULTS

Forty cohorts comprising 3,780,590 individuals were selected for the final quantitative analysis. The summary results indicated that a higher red meat consumption was associated with an increased risk of CRC (RR: 1.09; 95% CI: 1.02-1.16; P = 0.007) and CC (RR: 1.13; 95% CI: 1.03-1.25; P = 0.011). Moreover, a higher processed meat consumption was associated with an increased risk of CRC (RR: 1.19; 95% CI: 1.13-1.26; P < 0.001), CC (RR: 1.24; 95% CI: 1.13-1.26; P < 0.001), and RC (RR: 1.24; 95% CI: 1.08-1.42; P = 0.002). Furthermore, a higher total consumption of red and processed meat was associated with an increased risk of CRC (RR: 1.13; 95% CI: 1.06-1.20; P < 0.001), CC (RR: 1.17; 95% CI: 1.04-1.33; P = 0.012), and RC (RR: 1.20; 95% CI: 1.04-1.39; P = 0.016). Finally, the strength of higher consumption of total red and processed meat with the risk of GC, and higher consumption of red meat with the risk of RC in subgroup of high adjusted level was lower than subgroup of moderate adjusted level, while the strength of higher consumption of processed meat with the risk of RC and HCC in subgroup of follow-up ≥ 10.0 years was higher than subgroup of follow-up < 10.0 years.

CONCLUSIONS

This study found that meat consumption was associated with an increased risk of CRC, CC, and RC, and dietary intervention could be considered an effective strategy in preventing CRC.

Food Intake and Colorectal Cancer

Colorectal cancer (CRC) accounts for considerable mortalities worldwide. Several modifiable risk factors, including a high intake of certain foods and beverages can cause CRC. This review summarized the latest findings on the intake of various foods, nutrients, ingredients, and beverages on CRC development, with the objective of classifying them as a risk or protective factor. High-risk food items include red meat, processed meat, eggs, high alcohol consumption, sugar-sweetened beverages, and chocolate candy. Food items that are protective include milk, cheese and other dairy products, fruits, vegetables (particularly cruciferous), whole grains, legumes (particularly soy beans), fish, tea (particularly green tea), coffee (particularly among Asians), chocolate, and moderate alcohol consumption (particularly wine). High-risk nutrients/ingredients include dietary fat from animal sources and industrial trans-fatty acids (semisolid/solid hydrogenated oils), synthetic food coloring, monosodium glutamate, titanium dioxide, and high-fructose corn sirup. Nutrients/ingredients that are protective include dietary fiber (particularly from cereals), fatty acids (medium-chain and odd-chain saturated fatty acids and highly unsaturated fatty acids, including omega-3 polyunsaturated fatty acids), calcium, polyphenols, curcumin, selenium, zinc, magnesium, and vitamins A, C, D, E, and B (particularly B6, B9, and B2). A combination of micronutrients and multi-vitamins also appears to be beneficial in reducing recurrent adenoma incidence.

Substituting meat for mycoprotein reduces genotoxicity and increases the abundance of beneficial microbes in the gut: Mycomeat, a randomised crossover control trial

PURPOSE

The high-meat, low-fibre Western diet is strongly associated with colorectal cancer risk. Mycoprotein, produced from Fusarium venanatum, has been sold as a high-fibre alternative to meat for decades. Hitherto, the effects of mycoprotein in the human bowel have not been well considered. Here, we explored the effects of replacing a high red and processed meat intake with mycoprotein on markers of intestinal genotoxicity and gut health.

METHODS

Mycomeat (clinicaltrials.gov NCT03944421) was an investigator-blind, randomised, crossover dietary intervention trial. Twenty healthy male adults were randomised to consume 240 g day^-1 red and processed meat for 2 weeks, with crossover to 2 weeks 240 g day^-1 mycoprotein, separated by a 4-week washout period. Primary end points were faecal genotoxicity and genotoxins, while secondary end points comprised changes in gut microbiome composition and activity.

RESULTS

The meat diet increased faecal genotoxicity and nitroso compound excretion, whereas the weight-matched consumption of mycoprotein decreased faecal genotoxicity and nitroso compounds. In addition, meat intake increased the abundance of Oscillobacter and Alistipes, whereas mycoprotein consumption increased Lactobacilli, Roseburia and Akkermansia, as well as the excretion of short chain fatty acids.

CONCLUSION

Replacing red and processed meat with the Fusarium-based meat alternative, mycoprotein, significantly reduces faecal genotoxicity and genotoxin excretion and increases the abundance of microbial genera with putative health benefits in the gut. This work demonstrates that mycoprotein may be a beneficial alternative to meat within the context of gut health and colorectal cancer prevention.

[Relationship of demographic and dietary hygiene factors with the pathology found in outpatient colonoscopies performed in a Castilla y León Health Service center]

Introduction

Background: colorectal cancer (CRC) is one of the most frequent tumors in terms of incidence and mortality. Several elements, both inherited and environmental, have been related with its pathogenesis. Aims: to analyze the influence of age, gender and nutritional factors on the diagnosis of colonic polyps and CRC. Methods: a prospective, descriptive study over outpatients from the Health Area of León who took a colonoscopy between 09/09/2012 and 06/30/2013. Patients were asked to fill a semiquantitative food frecuency questionnaire with data such a sociodemographic, toxic and dietetic facts. Differences in diagnosis according to sociodemographic and hygiene-dietetic data were analyzed with a multivariate analysis by forward stepwise logistic regression. Results: data were collected from 1390 patients. Mean age was 57.88 (15.17) years and 47.8 % were male. CRC was diagnosed in 5 % of colonoscopies, and polyps in 20.4 %, with 9.4 % of them being HRA. Risk of polyps and HRA was higher in males (26.9 % vs 14.5 %) and (12.6 % vs 6.3 %), respectively (p < 0.001). Mean age was significantly higher in patients who presented polyps (56.51 (15.45) vs 63.22 (12.69) years; p < 0.001). Among the group who reported intake of smoked and salted food, the risk of polyps doubled (2.9 % vs 6.7 %, p = 0.002). In relation to alcohol intake we found that subjects with daily alcohol consumption showed a higher incidence of polyps whe compared to occasional drinkers and teetotallers (32 % vs 20 % vs 18.6 %, p = 0.002) Conclusions: age correlated with higher risk of polyps, HRA and CRC. Moreover, male gender also was associated with a high risk of polyps and HRA. Alcohol and red and processed meat intake increased polyp risk.

Gut Microbiota in Colorectal Cancer: Biological Role and Therapeutic Opportunities

Colorectal cancer (CRC) is the second-leading cause of cancer-related deaths worldwide. While CRC is thought to be an interplay between genetic and environmental factors, several lines of evidence suggest the involvement of gut microbiota in promoting inflammation and tumor progression. Gut microbiota refer to the ~40 trillion microorganisms that inhabit the human gut. Advances in next-generation sequencing technologies and metagenomics have provided new insights into the gut microbial ecology and have helped in linking gut microbiota to CRC. Many studies carried out in humans and animal models have emphasized the role of certain gut bacteria, such as Fusobacterium nucleatum, enterotoxigenic Bacteroides fragilis, and colibactin-producing Escherichia coli, in the onset and progression of CRC. Metagenomic studies have opened up new avenues for the application of gut microbiota in the diagnosis, prevention, and treatment of CRC. This review article summarizes the role of gut microbiota in CRC development and its use as a biomarker to predict the disease and its potential therapeutic applications.

Association of plant-based dietary patterns with the risk of colorectal cancer: a large-scale case-control study

Plant-based diets are associated with a lower risk of colorectal cancer, but the risk might differ by the quality of plant-based diets. This study aimed to investigate the association between different types of plant-based dietary patterns and colorectal cancer risk in the Chinese population. We conducted a case-control study with 2799 eligible colorectal cancer cases and 2799 sex- and age-matched controls in Guangzhou, China. A validated food frequency questionnaire was used to collect dietary data, from which we derived plant-based diet indices, including the plant-based diet index (PDI), the healthy PDI (hPDI), and the unhealthy PDI (uPDI). The PDI, hPDI, and uPDI assess the adherence to overall, healthy, and unhealthy plant-based dietary patterns, respectively. The odds ratios (ORs) and 95% confidence intervals (CIs) for colorectal cancer risk were estimated using unconditional logistic regression models. Higher adherence to the PDI, particularly the hPDI, was associated with a lower risk of colorectal cancer, whereas greater adherence to the uPDI was associated with a higher risk of colorectal cancer. Compared with the lowest quintile, the adjusted ORs in the highest quintile were 0.79 (95% CI: 0.66-0.95) for the PDI, 0.45 (95% CI: 0.38-0.55) for the hPDI, and 1.45 (95% CI: 1.18-1.78) for the hPDI, respectively. In stratified analysis, the inverse association between the PDI and colorectal cancer risk was not observed in women, and the positive association between the uPDI and colorectal cancer risk was not observed in men. In conclusion, these results support recommendations that shifting to a healthy plant-based dietary pattern is important for the prevention of colorectal cancer, particularly in the Chinese population that habitually consumes plant foods.

A comparative analysis of factors influencing colorectal cancer’s age standardized mortality ratio among Korean women in the hot and cold spots

The study aimed at exploring factors that most influence colorectal cancer (CRC) age standardized mortality ratio (ASMR) among Korean women, as reported in previous studies. The factors used the data of 250 municipalities from the Korean Statistical Information Service (KOSIS) from 2010 to 2018. In the exploratory survey, over 70% of women aged 65 and above died of colorectal cancer. After investigating the existing literature and theories, 250 regions were classified into hot and cold spots according to age standardized mortality ratio (ASMR). The Nearest Neighbor Index (NNI), Moran’s I index and The Durbin-Watson test were also utilized. The ASMR’s regional cluster analysis showed that the inland areas were the hot spots and the cold spots were in the southwest coastal areas. The result also showed the differences in dwellers’ lifestyles between these two regions as well as the mean difference between the two. In addition, there was no significant difference in ASMR for breast cancer, CRC deaths, and agricultural product shipments between the two regions. In the multiple regression model, CRC mortality, diabetes, and CRC age standardized incidence ratio (ASIR) were analyzed as major influencing factors, demonstrated a significant result with 30.6% by examining the adjusted R-squared. However, this study showed that factors such as smoking, alcohol consumption, abdominal obesity, breast cancer, and food consumption indicated to have less influence on the occurrence of CRC. The aging rate, amount of food consumption, seafood production, livestock product shipments, and drinking rate were higher in the cold spot than in the hot spot.

Association of ultra-processed food consumption with colorectal cancer risk among men and women: results from three prospective US cohort studies

OBJECTIVE

To examine the association between consumption of ultra-processed foods and risk of colorectal cancer among men and women from three large prospective cohorts.

DESIGN

Prospective cohort study with dietary intake assessed every four years using food frequency questionnaires.

SETTING

Three large US cohorts.

PARTICIPANTS

Men (n= 46 341) from the Health Professionals Follow-up Study (1986-2014) and women (n=159 907) from the Nurses' Health Study (1986-2014; n=67 425) and the Nurses' Health Study II (1991-2015; n=92 482) with valid dietary intake measurement and no cancer diagnosis at baseline.

MAIN OUTCOME MEASURE

Association between ultra-processed food consumption and risk of colorectal cancer, estimated using time varying Cox proportional hazards regression models adjusted for potential confounding factors.

RESULTS

3216 cases of colorectal cancer (men, n=1294; women, n=1922) were documented during the 24-28 years of follow-up. Compared with those in the lowest fifth of ultra-processed food consumption, men in the highest fifth of consumption had a 29% higher risk of developing colorectal cancer (hazard ratio for highest versus lowest fifth 1.29, 95% confidence interval 1.08 to 1.53; P for trend=0.01), and the positive association was limited to distal colon cancer (72% increased risk; hazard ratio 1.72, 1.24 to 2.37; P for trend<0.001). These associations remained significant after further adjustment for body mass index or indicators of nutritional quality of the diet (that is, western dietary pattern or dietary quality score). No association was observed between overall ultra-processed food consumption and risk of colorectal cancer among women. Among subgroups of ultra-processed foods, higher consumption of meat/poultry/seafood based ready-to-eat products (hazard ratio for highest versus lowest fifth 1.44, 1.20 to 1.73; P for trend<0.001) and sugar sweetened beverages (1.21, 1.01 to 1.44; P for trend=0.013) among men and ready-to-eat/heat mixed dishes among women (1.17, 1.01 to 1.36; P for trend=0.02) was associated with increased risk of colorectal cancer; yogurt and dairy based desserts were negatively associated with the risk of colorectal cancer among women (hazard ratio 0.83, 0.71 to 0.97; P for trend=0.002).

CONCLUSIONS

In the three large prospective cohorts, high consumption of total ultra-processed foods in men and certain subgroups of ultra-processed foods in men and women was associated with an increased risk of colorectal cancer. Further studies are needed to better understand the potential attributes of ultra-processed foods that contribute to colorectal carcinogenesis.

The nutritional impact of replacing dietary meat with meat alternatives in the UK: a modelling analysis using nationally representative data

Dietary patterns high in meat compromise both planetary and human health. Meat alternatives may help to facilitate meat reduction; however, the nutritional implications of displacing meat with meat alternatives does not appear to have been evaluated. Here, the ninth cycle of the National Diet and Nutrition Survey was used as the basis of models to assess the effect of meat substitution on nutritional intake. We implemented three models; model 1 replaced 25 %, 50 %, 75 % or 100 % of the current meat intake with a weighted mean of meat alternatives within the UK market. Model 2 compared different ingredient categories of meat alternative; vegetable, mycoprotein, a combination of bean and pea, tofu, nut and soya. Model 3 compared fortified v. unfortified meat alternatives. The models elicited significant shifts in nutrients. Overall, carbohydrate, fibre, sugars and Na increased, whereas reductions were found for protein, total and saturated fat, Fe and B₁₂. Greatest effects were seen for vegetable-based (+24·63g/d carbohydrates), mycoprotein-based (-6·12g/d total fat), nut-based (-19·79g/d protein, +10·23g/d fibre; -4·80g/d saturated fat, +7·44g/d sugars), soya-based (+495·98mg/d Na) and tofu-based (+7·63mg/d Fe, -2·02μg/d B₁₂). Our results suggest that meat alternatives can be a healthful replacement for meat if chosen correctly. Consumers should choose meat alternatives low in Na and sugar, high in fibre, protein and with high micronutrient density, to avoid compromising nutritional intake if reducing meat intake. Manufacturers and policy makers should consider fortification of meat alternatives with nutrients such as Fe and B₁₂ and focus on reducing Na and sugar content.

Dietary Intakes of Animal and Plant Proteins and Risk of Colorectal Cancer: The EPIC-Italy Cohort

We prospectively investigated the associations of protein intake with colorectal cancer (CRC) risk in middle-aged Italian men and women. Food consumption was assessed by validated Epic semiquantitative food-frequency questionnaires. Multivariable Cox models stratified by center, age, and sex, adjusted for confounders, estimated the associations of animal and plant protein consumption with CRC risk by subsite. Among 44,824 men and women, we identified 539 incident CRCs after a median follow-up of 14 years. Replacing animal proteins with plant proteins was associated with a decreased risk of rectal (HR, 0.71; 95% CI, 0.55-0.92) but not colon cancer. By contrast, replacing animal proteins with plant proteins from high-glycemic-index (GI) foods was associated with an increased risk of proximal and distal (including sigma) colon cancer (HR, 1.23; 95% CI, 1.07-1.40) but not when animal proteins were replaced with plant proteins from low-GI foods (HR, 0.93; 95% CI, 0.79-1.11). Further evaluation revealed that the increased colon cancer risk was limited to the substitution of proteins from red and processed meat, as well as dairy and eggs, with vegetable proteins from high-GI foods. Participants in the highest quintile of animal protein intake had higher plasma glucose and cholesterol levels than those in the lowest quintile. By contrast, higher intake of plant proteins from low-GI foods was inversely associated with fasting insulin and HOMA-IR levels. In conclusion, replacing animal proteins with plant proteins from high-GI foods was associated with an increased risk of colon cancer.

Oral administration of TRAIL-inducing small molecule ONC201/TIC10 prevents intestinal polyposis in the Apc min/+ mouse model

Colorectal cancer (CRC) incidence is rising globally. Hence, preventing this disease is a high priority. With this aim, we determined the CRC prevention potential of the TRAIL-inducing small molecule ONC201/TIC10 using a preclinical model representing high-risk familial adenomatous polyposis (FAP) patients, Apc min/+ mice. Prior to the efficacy study, optimal and non-toxic doses of ONC201 were determined by testing five different doses of ONC201 (0-100 mg/kg body weight (BW); twice weekly by oral gavage) in C57BL/6J mice (n=6/group) for 6 weeks. BW gain, organ weights and histopathology, blood profiling, and the plasma liver enzyme profile suggested no toxicities of ONC201 at doses up to 100 mg/kg BW. For efficacy determination, beginning at six weeks of age, groups of Apc min/+ male and female mice (n≥20) treated with colon carcinogen azoxymethane (AOM) (AOM-Apc min/+) were administered ONC201 (0, 25, and 50 mg/kg BW) as above up to 20 weeks of age. At termination, efficacy was determined by comparing the incidence and multiplicity of intestinal tumors between vehicle- and drug-treated groups. ONC201 showed a strong suppressive effect against the development of both large and small intestinal tumors in male and female mice. Apc min/+ mice treated with ONC201 (50 mg/kg BW) showed >50% less colonic tumor incidence (P<0.0002) than controls. Colonic tumor multiplicity was also significantly reduced by 68% in male mice (0.44 ± 0.11 in treated vs. 1.4 ± 0.14 in controls; P<0.0001) and by 75% in female mice (0.30 ± 0.10 in treated vs. 1.19 ± 0.19 in controls; P<0.0003) with ONC201 treatment (50 mg/kg BW). Small intestinal polyps were reduced by 68% in male mice (11.40 ± 1.19 in treated vs. 36.08 ± 2.62 in controls; P<0.0001) and female mice (9.65 ± 1.15 in treated vs. 29.24 ± 2.51 in controls; P<0.0001). Molecular analysis of the tumors suggested an increase in TRAIL, DR5, cleaved caspases 3/7/8, Fas-associated death domain protein (FADD), and p21 (WAF1) in response to drug treatment. Serum analysis indicated a decrease in pro-inflammatory serum biomarkers, such as IL1β, IL6, TNFα, G-CSF, and GM-CSF, in the ONC201-treated mice compared with controls. Our data demonstrated excellent chemopreventive potential of orally administered ONC201 against intestinal tumorigenesis in the AOM-Apc min/+ mouse model.

A Prospective Analysis of Red and Processed Meat Intake in Relation to Colorectal Cancer in the Black Women's Health Study

BACKGROUND

Black Americans have the highest incidence of colorectal cancer (CRC) of any racial/ethnic group in the United States. High intake of red and processed meats has been associated with an increased CRC risk in predominately White populations. However, 3 prior studies in Black populations, who have been reported to have high intakes of red and processed meats, have reported no associations. Data on a possible association between CRC risk and SFAs and MUFAs, the primary types of fat in red and processed meats, are inconclusive.

OBJECTIVES

We prospectively assessed intakes of processed and unprocessed red meat, SFAs, and MUFAs in relation to CRC risk, utilizing data from the Black Women's Health Study (BWHS, 1995-2018).

METHODS

Dietary data were derived from validated FFQs completed in 1995 and 2001. Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression.

RESULTS

Among 52,695 BWHS participants aged 21-69 y at baseline and followed for ≤22 y, 564 women developed incident CRC. Unprocessed red meat intake was associated with a 33% increased CRC risk per 100 g/d (HR: 1.33; 95% CI: 1.03-1.71). Examination of CRC anatomic sites revealed that unprocessed red meat was associated with 2-times increased rectal cancer risk (HR: 2.22; 95% CI: 1.15-4.26). There was no evidence of an interaction with age (pinteraction = 0.4), but unprocessed red meat intake was only associated with a significant increased risk of late-onset CRC (≥50 y of age, HR: 1.41; 95% CI: 1.05-1.88). Processed red meat and total SFA and MUFA intakes were not associated with CRC risk.

CONCLUSIONS

Unprocessed red meat intake was associated with an increased CRC risk in the present study, the first positive evidence that red meat plays a role in the etiology of CRC in Black women. The findings suggest prevention opportunities.

Adult-Attained Height and Colorectal Cancer Risk: A Cohort Study, Systematic Review, and Meta-Analysis

BACKGROUND

The influence of anthropometric characteristics on colorectal neoplasia biology is unclear. We conducted a systematic review and meta-analysis to determine if adult-attained height is independently associated with the risk of colorectal cancer or adenoma.

METHODS

We searched MEDLINE, EMBASE, the Cochrane Library, and Web of Science from inception to August 2020 for studies on the association between adult-attained height and colorectal cancer or adenoma. The original data from the Johns Hopkins (Baltimore, MD) Colon Biofilm study was also included. The overall HR/OR of colorectal cancer/adenoma with increased height was estimated using random-effects meta-analysis.

RESULTS

We included 47 observational studies involving 280,644 colorectal cancer and 14,139 colorectal adenoma cases. Thirty-three studies reported data for colorectal cancer incidence per 10-cm increase in height; 19 yielded an HR of 1.14 [95% confidence interval (CI), 1.11-1.17; P < 0.001), and 14 engendered an OR of 1.09 (95% CI, 1.05-1.13; P < 0.001). Twenty-six studies compared colorectal cancer incidence between individuals within the highest versus the lowest height percentile; 19 indicated an HR of 1.24 (95% CI, 1.19-1.30; P < 0.001), and seven resulting in an OR of 1.07 (95% CI, 0.92-1.25; P = 0.39). Four studies reported data for assessing colorectal adenoma incidence per 10-cm increase in height, showing an overall OR of 1.06 (95% CI, 1.00-1.12; P = 0.03).

CONCLUSIONS

Greater adult attained height is associated with an increased risk of colorectal cancer and adenoma.

IMPACT

Height should be considered as a risk factor for colorectal cancer screening.

Molecular Biologic and Epidemiologic Insights for Preventability of Colorectal Cancer

The etiology of colorectal cancer (CRC) has been informed from both a molecular biology perspective, which concerns the study of the nature, timing, and consequences of mutations in driver genes, and epidemiology, which focuses on identifying risk factors for cancer. For the most part, these fields have developed independently, and it is thus important to consider them in a more integrated manner. The molecular mutational perspective has stressed the importance of mutations due to replication of adult stem cells, and the molecular fingerprint of most CRCs does not suggest the importance of direct carcinogens. Epidemiology has identified numerous modifiable risk factors that account for most CRCs, most of which are not direct mutagens. The distribution of CRCs across the large bowel is not uniform, which is possibly caused by regional differences in the microbiota. Some risk factors are likely to act through or interact with the microbiota. The mutational perspective informs when risk factors may begin to operate in life and when they may cease to operate. Evidence from the mutational model and epidemiology supports that CRC risk factors begin early in life and may contribute to the risk of early-onset CRC. Later in carcinogenesis, there may be a "point of no return" when sufficient mutations have accumulated, and some risk factors do not affect cancer risk. This period may be at least 5-15 years for some risk factors. A more precise knowledge of timing of risk factor to cancer is required to inform preventive efforts.

Disparities in Health and Economic Burdens of Cancer Attributable to Suboptimal Diet in the United States, 2015‒2018

Objectives. To quantify disparities in health and economic burdens of cancer attributable to suboptimal diet among US adults. Methods. Using a probabilistic cohort state-transition model, we estimated the number of new cancer cases and cancer deaths, and economic costs of 15 diet-related cancers attributable to suboptimal intake of 7 dietary factors (a low intake of fruits, vegetables, dairy, and whole grains and a high intake of red and processed meats and sugar-sweetened beverages) among a closed cohort of US adults starting in 2017. Results. Suboptimal diet was estimated to contribute to 3.04 (95% uncertainty interval [UI] = 2.88, 3.20) million new cancer cases, 1.74 (95% UI = 1.65, 1.84) million cancer deaths, and $254 (95% UI = $242, $267) billion economic costs among US adults aged 20 years or older over a lifetime. Diet-attributable cancer burdens were higher among younger adults, men, non-Hispanic Blacks, and individuals with lower education and income attainments than other population subgroups. The largest disparities were for cancers attributable to high consumption of sugar-sweetened beverages and low consumption of whole grains. Conclusions. Suboptimal diet contributes to substantial disparities in health and economic burdens of cancer among young adults, men, racial/ethnic minorities, and socioeconomically disadvantaged groups. (Am J Public Health. 2021;111(11):2008-2018. https://doi.org/10.2105/AJPH.2021.306475).

Discovery and Features of an Alkylating Signature in Colorectal Cancer

Several risk factors have been established for colorectal cancer, yet their direct mutagenic effects in patients' tumors remain to be elucidated. Here, we leveraged whole-exome sequencing data from 900 colorectal cancer cases that had occurred in three U.S.-wide prospective studies with extensive dietary and lifestyle information. We found an alkylating signature that was previously undescribed in colorectal cancer and then showed the existence of a similar mutational process in normal colonic crypts. This alkylating signature is associated with high intakes of processed and unprocessed red meat prior to diagnosis. In addition, this signature was more abundant in the distal colorectum, predicted to target cancer driver mutations KRAS p.G12D, KRAS p.G13D, and PIK3CA p.E545K, and associated with poor survival. Together, these results link for the first time a colorectal mutational signature to a component of diet and further implicate the role of red meat in colorectal cancer initiation and progression. SIGNIFICANCE: Colorectal cancer has several lifestyle risk factors, but the underlying mutations for most have not been observed directly in tumors. Analysis of 900 colorectal cancers with whole-exome sequencing and epidemiologic annotations revealed an alkylating mutational signature that was associated with red meat consumption and distal tumor location, as well as predicted to target KRAS p.G12D/p.G13D.This article is highlighted in the In This Issue feature, p. 2355.

Vegan Men's Food and Health Practices: A Recipe for a More Health-Conscious Masculinity?

In the age of the Anthropocene, questions of ecological sustainability, animal ethics, and human health are intimately entangled. From a gender perspective, compared to women, men’s diets tend to be less healthy and sustainable. This is linked to worse health outcomes for men. Therefore, alternative, more ethical ways of eating that have the potential to improve men’s health and well-being and simultaneously contribute to better public health and sustainability outcomes should be encouraged. Veganism addresses issues of food, health, climate change, and animal justice simultaneously.

This article explores vegan men’s food practices in relation to health and well-being, drawing on qualitative interviews with 61 vegan men. The interview material was analyzed using the method of thematic analysis. Our findings suggest that becoming vegan encourages positive changes in men’s health behavior. This includes paying more attention to nutrition and taking better care of one’s health. Vegan men report experiencing better physical and mental well-being upon going vegan. Based on these findings, we argue that vegan men’s food and health practices contribute to the emergence of healthier masculinities, as vegan men help to challenge links between risky health behavior and masculinity.

Consumption of red meat and processed meat and cancer incidence: a systematic review and meta-analysis of prospective studies

Red meat and processed meat consumption has been hypothesized to increase risk of cancer, but the evidence is inconsistent. We performed a systematic review and meta-analysis of prospective studies to summarize the evidence of associations between consumption of red meat (unprocessed), processed meat, and total red and processed meat with the incidence of various cancer types. We searched in MEDLINE and EMBASE databases through December 2020. Using a random-effect meta-analysis, we calculated the pooled relative risk (RR) and 95% confidence intervals (CI) of the highest versus the lowest category of red meat, processed meat, and total red and processed meat consumption in relation to incidence of various cancers. We identified 148 published articles. Red meat consumption was significantly associated with greater risk of breast cancer (RR = 1.09; 95% CI = 1.03-1.15), endometrial cancer (RR = 1.25; 95% CI = 1.01-1.56), colorectal cancer (RR = 1.10; 95% CI = 1.03-1.17), colon cancer (RR = 1.17; 95% CI = 1.09-1.25), rectal cancer (RR = 1.22; 95% CI = 1.01-1.46), lung cancer (RR = 1.26; 95% CI = 1.09-1.44), and hepatocellular carcinoma (RR = 1.22; 95% CI = 1.01-1.46). Processed meat consumption was significantly associated with a 6% greater breast cancer risk, an 18% greater colorectal cancer risk, a 21% greater colon cancer risk, a 22% greater rectal cancer risk, and a 12% greater lung cancer risk. Total red and processed meat consumption was significantly associated with greater risk of colorectal cancer (RR = 1.17; 95% CI = 1.08-1.26), colon cancer (RR = 1.21; 95% CI = 1.09-1.34), rectal cancer (RR = 1.26; 95% CI = 1.09-1.45), lung cancer (RR = 1.20; 95% CI = 1.09-1.33), and renal cell cancer (RR = 1.19; 95% CI = 1.04-1.37). This comprehensive systematic review and meta-analysis study showed that high red meat intake was positively associated with risk of breast cancer, endometrial cancer, colorectal cancer, colon cancer, rectal cancer, lung cancer, and hepatocellular carcinoma, and high processed meat intake was positively associated with risk of breast, colorectal, colon, rectal, and lung cancers. Higher risk of colorectal, colon, rectal, lung, and renal cell cancers were also observed with high total red and processed meat consumption.

Evaluation of a risk score based on dietary and lifestyle factors to target a population at risk in colorectal cancer screening

BACKGROUND

The aim of our study was to assess three risk scores to predict lesions, advanced neoplasia (high-risk adenomas and colorectal cancer (CRC)) and CRC in individuals who participate to colorectal cancer screening.

METHODS

The data of dietary and lifestyle risk factors were carried out during 2 mass screening campaigns in France (2013-2016) and the FOBT result was collected until December 2018. The colonoscopy result in positive FOBT was recovered. Three risk scores (Betés score, Kaminski score and adapted-HLI) were calculated to detect individuals at risk of lesions.

RESULTS

The Betés score had an AUROC of 0.63 (95% CI, [0.61-0.66]) for lesions, 0.65 (95% CI, [0.61-0.68]) for advanced neoplasia and 0.65 (95% CI, [0.58-0.72]) for predicting screen-detected CRC. The adapted HLI score had an AUROC of 0.61 (95% CI, [0.58-0.65]) for lesions, 0.61 (95% CI, [0.56-0.65]) for advanced neoplasia and 0.55 (95% CI, [0.45-0.65]) for predicting screen-detected CRC. The Kaminski score had an AUROC of 0.65 (95% CI, [0.63-0.68]) for lesions, 0.65 (95% CI, [0.61-0.68]) for advanced neoplasia and 0.69 (95% CI, [0.62-0.76]) for predicting screen-detected CRC.

CONCLUSION

A simple questionnaire based on CRC risk factors could help general practitioners to identify participants with higher risk of significant colorectal lesions and incite them to perform the fecal occult blood test.

Scoping review of Paleolithic dietary patterns: a definition proposal

The Paleolithic diet (PaleoDiet) is an allegedly healthy dietary pattern inspired by the consumption of wild foods and animals assumed to be consumed in the Paleolithic era. Despite gaining popularity in the media, different operational definitions of this Paleolithic nutritional intake have been used in research. Our hypothesis is that specific components used to define the PaleoDiet may modulate the association of this diet with several health outcomes. We comprehensively reviewed currently applied PaleoDiet scores and suggested a new score based on the food composition of current PaleoDiet definitions and the theoretical food content of a staple dietary pattern in the Paleolithic age. In a PubMed search up to December 2019, fourteen different PaleoDiet definitions were found. We observed some common components of the PaleoDiet among these definitions although we also found high heterogeneity in the list of specific foods that should be encouraged or banned within the PaleoDiet. Most studies suggest that the PaleoDiet may have beneficial effects in the prevention of cardiometabolic diseases (type 2 diabetes, overweight/obesity, CVD and hyperlipidaemias) but the level of evidence is still weak because of the limited number of studies with a large sample size, hard outcomes instead of surrogate outcomes and long-term follow-up. Finally, we propose a new PaleoDiet score composed of eleven food items, based on a high consumption of fruits, nuts, vegetables, fish, eggs and unprocessed meats (lean meats); and a minimum content of dairy products, grains and cereals, and legumes and practical absence of processed (or ultra-processed) foods or culinary ingredients.

Risk of Colorectal Cancer in a Brazilian Population is Differentially Associated with the Intake of Processed Meat and Vitamin E

The incidence and mortality rates of colorectal cancer (CRC) in Northeast Brazil are increasing. To study the association between CRC and diet, data were obtained from 64 patients with CRC and 123 sex- and age-matched controls. The dietary details were recorded using a validated food frequency questionnaire. Nutrient intake was calculated using Dietsys software (National Cancer Institute, Maryland, USA). In a binary logistic regression model of dietary components (model 1), the chance of CRC increased by 0.2% (odds ratio [OR] = 1.002; 95% confidence interval [CI]: 1.000-1.004) for each gram of processed meat intake per week (p < 0.010). Consumption of eggs decreased the chance by 0.1% per gram (OR = 0.999; 95% CI: 0.998-1.000; p < 0.050). The use of oil (including olive oil) for served food decreased the chance by 1.8% (OR = 0.982; 95% CI: 0.970-0.992) for each time consumed (p < 0.010). In a model of nutritional factors (model 2), intake of vitamin E decreased the chance by 16.8% (OR = 0.832; 95% CI: 0.725-0.940) for each milligram intake per week (p < 0.010). In model 1 and 2 smoking increased the chance of CRC by 10.294 (95%CI: 4.240-27.670) and 2.496 (95% CI: 1.425-3.566) times (p < 0.010; p < 0.010), respectively.

Dual role of heme iron in cancer; promotor of carcinogenesis and an inducer of tumour suppression

PURPOSE

Heme is a crucial compound for cell survival but is also equipped with the potential to be toxic and carcinogenic to cells. However, with the recent advancement of knowledge regarding ferroptosis, the iron mediated cell death, heme can be postulated to induce tumour suppression through ferroptosis. This review summarizes the literature on the carcinogenic and anticarcinogenic properties of heme with specific emphasis on the alterations observed on heme synthesis, metabolism and transport in tumour cells.

METHODS

Literature search was performed in PubMed data base using the MeSH terms 'heme iron or heme', 'cancer or carcinogenesis' and 'tumour suppression' or 'anticarcinogenic properties. Out of 189 results, 166 were relevant to the current review.

RESULTS

Heme supports carcinogenesis via modulation of immune cell function, promoting inflammation and gut dysbiosis, impeding tumour suppressive potential of P53 gene, promoting cellular cytotoxicity and reactive oxygen species generation and modulating Nfr2 /HO-1 axis. The carcinogenic and anticarcinogenic properties of heme are both dose and oxygen concentration dependant. At low doses, heme is harmless and even helpful in maintaining the much-needed redox balance within the cell. However, when heme exceeds physiological concentrations, it could initiate and propagate carcinogenesis, due to its ability to produce reactive oxygen species (ROS). The same phenomenon of heme mediated ROS generation could be manipulated to initiate tumour suppression via ferroptosis, but the therapeutic doses are yet to be determined.

CONCLUSION

Heme iron possesses powerful carcinogenic and anticarcinogenic properties which are dosage and oxygen availability dependant.

Towards refining World Cancer Research Fund/American Institute for Cancer Research cancer prevention recommendations for red and processed meat intake: insights from Alberta's Tomorrow Project cohort

Current cancer prevention recommendations advise limiting red meat intake to <500 g/week and avoiding consumption of processed meat, but do not differentiate the source of processed meat. We examined the associations of processed meat derived from red v. non-red meats with cancer risk in a prospective cohort of 26 218 adults who reported dietary intake using the Canadian Diet History Questionnaire. Incidence of cancer was obtained through data linkage with Alberta Cancer Registry with median follow-up of 13·3 (interquartile range (IQR) 5·1) years. Multivariable Cox proportional hazards regression models were adjusted for covariates and stratified by age and sex. The median consumption (g/week) of red meat, processed meat from red meat and processed meat from non-red meat was 267·9 (IQR 269·9), 53·6 (IQR 83·3) and 11·9 (IQR 31·8), respectively. High intakes (4th Quartile) of processed meat from red meat were associated with increased risk of gastrointestinal cancer adjusted hazard ratio (AHR): 1·68 (95 % CI 1·09, 2·57) and colorectal cancers AHR: 1·90 (95 % CI 1·12, 3·22), respectively, in women. No statistically significant associations were observed for intakes of red meat or processed meat from non-red meat. Results suggest that the carcinogenic effect associated with processed meat intake may be limited to processed meat derived from red meats. The findings provide preliminary evidence towards refining cancer prevention recommendations for red and processed meat intake.

Dietary Intake of Red Meat, Processed Meat, and Poultry and Risk of Colorectal Cancer and All-Cause Mortality in the Context of Dietary Guideline Compliance

Meat intake has been linked to increased risk of colorectal cancer (CRC) and mortality. However, diet composition may affect the risks. We aimed to estimate associations between red and processed meat and poultry intake and risk of CRC and all-cause mortality and if they are modified by dietary quality using Cox regression analyses. Baseline dietary data were obtained from three survey rounds of the Danish National Survey on Diet and Physical Activity. Data on CRC and all-cause mortality were extracted from national registers. The cohort was followed from date of survey interview—or for CRC, from age 50 years, whichever came last, until 31 December 2017. Meat intake was analysed categorically and continuously, and stratified by dietary quality for 15–75-year-old Danes at baseline, n 6282 for CRC and n 9848 for mortality analyses. We found no significant association between red and processed meat intake and CRC risk. For poultry, increased CRC risk for high versus low intake (HR 1.62; 95%CI 1.13–2.31) was found, but not when examining risk change per 100 g increased intake. We showed no association between meat intake and all-cause mortality. The association between meat intake and CRC or mortality risk was not modified by dietary quality.

Meat intake and cancer risk: prospective analyses in UK Biobank

BACKGROUND

Red and processed meat have been consistently associated with colorectal cancer risk, but evidence for other cancer sites and for poultry intake is limited. We therefore examined associations between total, red and processed meat and poultry intake and incidence for 20 common cancers.

METHODS

We analyzed data from 474 996 participants (54% women) in UK Biobank. Participants were aged 37-73 years and cancer-free at baseline (2006-10). Multivariable-adjusted Cox proportional hazards models were used to determine associations between baseline meat intake and cancer incidence. Trends in risk across the baseline categories were calculated, assigning re-measured intakes from a subsample.

RESULTS

During a mean follow-up of 6.9 years, 28 955 participants were diagnosed with malignant cancer. After correction for multiple testing, red and processed meat combined, and processed meat, were each positively associated with colorectal cancer risk [hazard ratio (HR) per 70 g/day higher intake of red and processed meat 1.32, 95% confidence interval 1.14-1.53; HR per 20 g/day higher intake of processed meat 1.18, 1.03-1.31] and red meat was associated with colon cancer risk (HR per 50 g/day higher intake of red meat 1.36, 1.13-1.64). Positive associations of red meat intake with colorectal and prostate cancer, processed meat intake with rectal cancer and poultry intake with cancers of the lymphatic and haematopoietic tissues did not survive multiple testing.

CONCLUSIONS

Higher intake of red and processed meat was specifically associated with a higher risk of colorectal cancer; there was little evidence that meat intake was associated with risk of other cancers.

Dietary intake of branched-chain amino acids and colorectal cancer risk

An adequate intake of branched-chain amino acids (BCAA) is required for protein synthesis and metabolic functions, including insulin metabolism. Emerging studies found positive associations between BCAA and the risk of various diseases sharing aetiological aspects with colorectal cancer (CRC), including type 2 diabetes, obesity and pancreatic cancer. We investigated the relation between dietary BCAA and CRC using data from a multicentric Italian case-control study, including 1953 cases of CRC (of these, 442 of sigmoid colon) and 4154 hospital controls with acute, non-neoplastic diseases. A validated FFQ was used to estimate the participants' usual diet and to assess dietary intakes of various nutrients, including energy, BCAA and Ca. OR and corresponding CI were computed by multiple logistic regression models adjusted for age, sex and other confounding factors, including total energy intake. BCAA intake was inversely related to CRC risk (OR for the highest v. the lowest quintile 0·73; 95 % CI 0·55, 0·97), but the association was attenuated after adjustment for Ca intake (OR 0·90; 95 % CI 0·65, 1·25). An inverse association with sigmoid colon cancer risk also remained after adjustment for other dietary factors, including Ca intake (OR 0·49; 95 % CI 0·27, 0·87). This study provides supporting evidence that higher levels of dietary BCAA intake are not associated with an increase of CRC risk, but confirms that they may be related to a reduced risk of sigmoid colon cancer.

Red meat and processed meat intake and risk of colorectal cancer: a population-based case-control study

To examine the association between red meat subtypes intake and risk of colorectal cancer (CRC) among Jewish and Arabs populations in a unique Mediterranean environment. The Molecular Epidemiology of Colorectal Cancer study (n=10 026) is a prospective population-based case-control study in northern Israel. Participants were interviewed in-person about their dietary intake and lifestyle using a questionnaire that included a food-frequency questionnaire. Red meat consumption in Israel was found to be especially low in the Jewish population (1.29±1.45 servings/week), but higher in Arabs (3.0±1.98 servings/week) (P<0.001). Beef was the most commonly consumed red meat by Jews (1.15/1.29 servings/week, 89%) and proportionally less so by Arabs (2.00/3.00, 67%). Processed meat consumption (mostly pork free) was lower among Arabs (0.9±1.56 servings/week) compared with Jews (1.97±2.97 servings/week) (P<0.001). The adjusted odds of CRC per one serving/week of red meat were 1.05 (95% confidence interval: 1.01-1.08) in Jews and 0.94 (0.88-1.01) in Arabs. Compared with no consumption, beef consumption was associated with odds ratio (OR)=0.96 (0.86-1.07) in Jews and 0.94 (0.61-1.45) in Arabs, lamb consumption with OR=1.28 (1.10-1.5) and 1.01 (0.75-1.37), pork consumption with OR=1.44 (1.24-1.67) and 1.07 (0.73-1.56), and processed meat consumption with OR=1.22 (1.10-1.35) and 1.04 (0.82-1.33) in Jews and Arabs, respectively. Overall red meat consumption was associated weakly with CRC risk, significant only for lamb and pork, but not for beef, irrespective of tumor location. Processed meat was associated with mild CRC risk.

Early-onset colorectal cancer: initial clues and current views

Over the past several decades, the incidence of early-onset colorectal cancer (EOCRC; in patients <50 years old) has increased at an alarming rate. Although robust and scientifically rigorous epidemiological studies have sifted out environmental elements linked to EOCRC, our knowledge of the causes and mechanisms of this disease is far from complete. Here, we highlight potential risk factors and putative mechanisms that drive EOCRC and suggest likely areas for fruitful research. In addition, we identify inconsistencies in the evidence implicating a strong effect of increased adiposity and suggest that certain behaviours (such as diet and stress) might place nonobese and otherwise healthy people at risk of this disease. Key risk factors are reviewed, including the global westernization of diets (usually involving a high intake of red and processed meats, high-fructose corn syrup and unhealthy cooking methods), stress, antibiotics, synthetic food dyes, monosodium glutamate, titanium dioxide, and physical inactivity and/or sedentary behaviour. The gut microbiota is probably at the crossroads of these risk factors and EOCRC. The time course of the disease and the fact that relevant exposures probably occur in childhood raise important methodological issues that are also discussed.

Computed tomography colonography versus colonoscopy for detection of colorectal cancer: a diagnostic performance study

BACKGROUND

Colonoscopy is the reference standard for the detection of colorectal cancer but it is an invasive technique and has the risk of bowel perforation and bleeding. Unlike colonoscopy, sedation is not required in computed tomography colonography and requires additional reassurance endoscopy. The objectives of the study were to compare the diagnostic performance of computed tomography colonography against colonoscopy for a diagnosis of colorectal cancer.

METHODS

Data regarding any polyp ≥10 mm diameter (ø) and < 10 mm ø but suspicious polyps of computed tomography colonography (n = 318), colonoscopy (n = 318), and surgical pathology (n = 77) for symptomatic colorectal cancer patients were collected and analyzed. Lesion ulceration, extramural invasion, and/ or lesion shouldering was considered as a suspicious polyp. Beneficial scores for decision making of curative surgeries were evaluated for each modality. The cost of diagnosis of colorectal cancer was also evaluated.

RESULTS

Either of diagnosis showed polyps ≥10 mm ø in 27 patients and polyps of 50 patients were < 10 mm ø but suspicious. Therefore, a total of 77 patients were subjected to surgery. With respect to surgical pathology, sensitivities for computed tomographic colonography and colonoscopy were 0.961 and 0.831. For detection of ≥10 mm ø polyp, benefit score for computed tomographic colonography and colonoscopy were 0-0.906 diagnostic confidence and 0.035-0.5 diagnostic confidence. For polyps, ≥ 10 mm ø but not too many large polyps, colonoscopy had the risk of underdiagnosis. For < 10 mm ø but suspicious polyps, < 0.6 mm ø and < 2.2 mm ⌀ polyps could not be detected by computed tomographic colonography and colonoscopy, respectively. The computed tomographic colonography had less cost than colonoscopy (1345 ± 135 ¥/ patient vs. 1715 ± 241 ¥/ patient, p < 0.0001) for diagnosis of colorectal cancer.

CONCLUSION

Computed tomographic colonography would be a non-inferior alternative than colonoscopy for a diagnosis of colorectal cancer.

LEVEL OF EVIDENCE

III.

Nutritional status and follicular-derived thyroid cancer: An update

The incidence of differentiated thyroid cancer has been increasing in the last decades all over the world. Such a steady growth cannot be entirely attributable to more intensive thyroid nodule screening and more sensitive diagnostic procedures. Several environmental factors have changed with sufficient rapidity in the same time frame and may represent credible candidates for this increase. They include modified iodine intake, lifestyle-associated risk factors, exposure to various toxic compounds, pollutants and xenobiotics, nutritional deficiencies, eating habits and comorbidities. Foremost, nutritional patterns have gained high interest as possible promoters and modifiable risk factors for thyroid cancer in recent years. The aim of this narrative review is to focus on the relationship between thyroid cancer and nutritional factors, dietary habits and obesity. Low iodine intake has been associated to increased risk of thyroid cancer, favoring the development of more aggressive histotypes. Moreover, correction of iodine deficiency can shift thyroid cancer subtypes toward less aggressive forms, without affecting the overall risk for cancer. Actually, evidence regarding the association between selenium and vitamin D deficiency and thyroid cancer is very limited, despite their well-known anti-cancer potentials, and the clinical usefulness of their supplementation is still uncertain in this setting. Albeit the relationship between single foods and thyroid cancer is difficult to examine, fish and iodine-rich foods, vegetables, and fruits might exert protective effects on thyroid cancer risk. Conversely, no clear association has been found for other foods to date. Lastly, a clear association between obesity and the risk of thyroid cancer, with more aggressive behavior, seems to emerge from most studies, likely involving variations in thyroid function and chronic inflammation mediated by cytokines, insulin, leptin and adiponectins. Although no definite association between dietary factors and thyroid cancer has been firmly established so far, some nutritional patterns, together with excessive weight, seem to play a relevant role in thyroid cancer carcinogenesis as well as in its severity and aggressiveness. These effects may play an additive role to the well-established one exerted by environmental carcinogens, such as pollutants and radiation exposure.

Metabolite profile comparisons between ascending and descending colon tissue in healthy adults

BACKGROUND

Obesity is a risk factor for colorectal cancer, yet metabolic distinctions between healthy right and left colon tissue, before cancer is diagnosed, remains largely unknown. This study compared right-ascending and left-descending colon tissue metabolomes to identify differences from the stool metabolome in normal weight, overweight, and obese adults.

AIM

To examine right and left colon tissue metabolites according to body mass index that may serve as mechanistic targets for interventions and biomarkers for colon cancer risk.

METHODS

Global, non-targeted metabolomics was applied to assess right-ascending and left-descending colon tissue collected from healthy adults undergoing screening colonoscopies to test the hypothesis that BMI differentially impacts colon tissue metabolite profiles. The colon tissue and stool metabolome of healthy adults (n = 24) was analyzed for metabolite signatures and metabolic pathway networks implicated in progression of colorectal cancer.

RESULTS

Ascending and descending colon contained 504 host, food, and microbiota-derived metabolites from normal weight, overweight and obese adults grouped according to body mass index. Amino acids, lipids, and nucleotides were among the chemical types that further differentiated from the stool metabolite profiles. Normal weight adults had 46 significantly different metabolites between ascending and descending colon tissue locations, whereas there were 37 metabolite differences in overweight and 28 metabolite differences for obese adults (P < 0.05). Obese adults had trimethylamine N-oxide, endocannabinoids and monoacylglycerols with different relative abundances identified between ascending and descending colon. Primary and secondary bile acids, vitamins, and fatty acids also showed marked relative abundance differences in colon tissue from overweight/obese adults.

CONCLUSION

There were metabolite profile differences between right-ascending and left-descending colon tissue in healthy adults. Colon lipids and other metabolites in obese and overweight adults were distinguished from normal weight participants and associated with gut inflammation, nutrient absorption, and products of microbiota metabolism.

Behavioral, Nutritional, and Genetic Risk Factors of Colorectal Cancers in Morocco: Protocol for a Multicenter Case-Control Study

BACKGROUND

Colorectal cancer (CRC) has been reported as the third most commonly diagnosed cancer worldwide and is currently considered as a major public health concern. A peak increase in incidence has been noted in economically transitioning countries like Morocco where industrialization started shifting from a traditional lifestyle and diet toward a more westernized diet and lifestyle.

OBJECTIVE

This paper aims to present the protocol of a large-scale Moroccan case-control study that aims at investigating associations of diet, other lifestyle factors, and genetic traits with CRC risk in Morocco.

METHODS

A case-control study was conducted between 2009 and 2017, including 3032 case-control pairs (1516 cases and 1516 controls) matched on sex, age, and center in 5 major public health hospitals in Morocco. Questionnaires on sociodemographic data, lifestyle, family history of CRC, and nonsteroidal anti-inflammatory drugs (NSAIDs) were completed by trained investigators during face-to-face interviews. In addition, participants completed a semiquantitative food-frequency questionnaire, developed to assess food intake in the Moroccan population. Information regarding genetic factors was recorded for cases, and paraffin blocks (with embedded tumor tissues) are available in 3 collaborating hospitals. Conditional logistic regression analysis is planned to assess associations between diet and CRC risk. Binary logistic regression is considered to predict associations between mutations and nutritional risk factors including only CRC case series.

RESULTS

Altogether, 2966 cases-control pairs (1483 cases and 1483 controls) were considered eligible and included in this study. Both cases and controls did not differ significantly with respect to age (P=.36), sex (P=.51), center (P>.99), marital status (P=.30), and NSAID use (P=.08). However, participants in the control group were significantly more likely to have a high income level and live in urban areas and to have a high level of education than cases.

CONCLUSIONS

This is the first study investigating potential risk factors of CRC such as lifestyle, diet, and genetic factors, originating from a southern Mediterranean country with low but increasing CRC prevalence. Identified risk factors allow the establishment of evidence-based preventive actions regarding nutrition and other lifestyle habits adapted to the Moroccan context. In brief, this study will promote cancer research and prevention in Morocco.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR1-10.2196/13998.

Influence of the Gut Microbiome, Diet, and Environment on Risk of Colorectal Cancer

Researchers have discovered associations between elements of the intestinal microbiome (including specific microbes, signaling pathways, and microbiota-related metabolites) and risk of colorectal cancer (CRC). However, it is unclear whether changes in the intestinal microbiome contribute to the development of sporadic CRC or result from it. Changes in the intestinal microbiome can mediate or modify the effects of environmental factors on risk of CRC. Factors that affect risk of CRC also affect the intestinal microbiome, including overweight and obesity; physical activity; and dietary intake of fiber, whole grains, and red and processed meat. These factors alter microbiome structure and function, along with the metabolic and immune pathways that mediate CRC development. We review epidemiologic and laboratory evidence for the influence of the microbiome, diet, and environmental factors on CRC incidence and outcomes. Based on these data, features of the intestinal microbiome might be used for CRC screening and modified for chemoprevention and treatment. Integrated prospective studies are urgently needed to investigate these strategies.

Dietary intake of fiber, whole grains and risk of colorectal cancer: An updated analysis according to food sources, tumor location and molecular subtypes in two large US cohorts

Epidemiologic evidence relating fiber intake to colorectal cancer (CRC) remains inconclusive and data are limited on different food sources of fiber and heterogeneity by tumor subsite and molecular profile. We prospectively followed for CRC incidence 90,869 women from the Nurses' Health Study (1980-2012) and 47,924 men from the Health Professionals Follow-up Study (1986-2012), who completed a validated food frequency questionnaire every 4 years. Cox proportional hazards regression was used to examine the associations with CRC risk for total, cereal, fruit and vegetable fiber and whole grains. We also assessed the associations according to tumor subsites (proximal colon, distal colon and rectum) and molecular markers (microsatellite instability, BRAF mutation, CpG island methylator phenotype and KRAS mutation). We documented 3,178 CRC cases during 3,685,903 person-years of follow-up in the NHS and HPFS. Intake of total dietary fiber was not associated with CRC risk after multivariable adjustment in either women (hazard ratio [HR] comparing extreme deciles, 1.17; 95% CI, 0.92-1.48, ptrend = 0.55) or men (HR, 0.90; 95% CI, 0.67-1.21, ptrend = 0.47). Higher intake of cereal fiber and whole grains was associated with lower CRC risk in men with an HR of 0.75 (95% CI, 0.57-1.00) and 0.72 (95% CI, 0.54-0.96), respectively. No heterogeneity was detected by tumor subsite or molecular markers (pheterogeneity  > 0.05). Higher intake of total dietary fiber within the range of a typical American diet is unlikely to substantially reduce CRC risk. The potential benefit of cereal fiber and whole grains in men warrants further confirmation.

Cost Effectiveness of Nutrition Policies on Processed Meat: Implications for Cancer Burden in the U.S

INTRODUCTION

Processed meats are associated with increased risk of colorectal and stomach cancers, but health and economic impacts of policies to discourage processed meats are not well established. This paper aims to evaluate the cost effectiveness of implementing tax and warning labels on processed meats.

METHODS

A probabilistic cohort-state transition model was developed in 2018, including lifetime and short-term horizons, healthcare, and societal perspectives, and 3% discount rates for costs and health outcomes. The model simulated 32 subgroups by age, gender, and race/ethnicity from the U.S. adult population and integrated nationally representative 2011-2014 data on processed meat consumption, with etiologic effects of processed meat consumption on cancer incidence, medical and indirect societal costs, and policy costs.

RESULTS

Over a lifetime, the 10% excise tax would prevent 77,000 cases of colorectal cancer (95% uncertainty interval=56,800, 107,000) and 12,500 cases of stomach cancer (95% uncertainty interval=6,880, 23,900), add 593,000 quality-adjusted life years (95% uncertainty interval=419,000, 827,000), and generate net savings of $2.7 billion from a societal perspective, including $1.1 billion healthcare costs saved. The warning label policy would avert 85,400 cases of colorectal cancer (95% uncertainty interval=56,600, 141,000) and 15,000 cases of stomach cancer (95% uncertainty interval=6,860, 34,500), and add 660,000 quality-adjusted life years (95% uncertainty interval=418,000, 1,070,000), with net savings of $4.5 billion from a societal perspective, including $1.3 billion healthcare costs saved. In subgroup analyses, greater health and economic benefits accrued to (1) younger subpopulations, (2) subpopulations with greater cancer risk, and (3) those with higher baseline processed meat consumption.

CONCLUSIONS

The model shows that implementing tax or warning labels on processed meats would be a cost-saving strategy with substantial health and economic benefits. The findings should encourage policy makers to consider nutrition-related policies to reduce cancer burden.

Meat subtypes and colorectal cancer risk: A pooled analysis of 6 cohort studies in Japan

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 undertaking a pooled analysis of large population-based cohort studies in Japan: 5 studies comprising 232 403 participants (5694 CRC cases) for analysis based on frequency of meat intake, and 2 studies comprising 123 635 participants (3550 CRC cases) for analysis based on intake quantity. Study-specific hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using the Cox proportional hazards model and then pooled using the random effect model. Comparing the highest vs 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 1.30; 95% CI, 1.05-1.61). Frequent intake of pork was associated with an increased risk of distal colon cancer in women (pooled HR 1.44; 95% CI, 1.10-1.87) for "3 times/wk or more" vs "less than 1 time/wk". 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 = .04) for "almost every day" vs "less than 1 time/wk". No association was observed for chicken consumption. The present findings support that intake of beef, pork (women only), and processed red meat (women only) might be associated with a higher risk of colon (distal colon) cancer in Japanese.

Gallbladder Polyps Are Associated with Proximal Colon Polyps

Background

The association between gallbladder (GB) disease and colorectal precancerous lesions remains elusive. This study sought to explore the association between GB disease and colorectal neoplasms at different locations.

Methods

Patients who received general health checkup from January to December 2008 were included and subgrouped into three groups by polyp location: proximal, distal, and whole colon. GB disease and other known risk factors for colon cancer were compared and analyzed. Different types of polyps at different locations were further investigated.

Results

Of a total of 3136 patients (1776 men and 1360 women; mean age, 49.3 years) who had colon polyps, 212 (6.8%) had GB stone and 512 (16.3%) had GB polyps. Patients in the proximal colon polyp group had higher rates of GB polyps and stones. GB polyps were independently associated with proximal colon polyps, including both hyperplastic polyps (odds ratio, 1.523; P = 0.034) and adenomatous polyps (odds ratio, 1.351; P = 0.048). No relationship between GB polyps and distal or any colon polyps was observed. Irrespective of the polyp location (i.e., proximal, distal, or any part of the colon), GB stone did not show any association with colon polyp.

Conclusions

We suggested that GB polyps are associated with proximal colon polyps. Colonoscopy may be a more effective strategy for screening proximal precancerous lesions among patients with GB polyps. The association between GB disease and colon polyps demands further prospective investigation.

A healthy lifestyle pattern has a protective association with colorectal polyps

BACKGROUND

Colorectal cancer is associated with lifestyle characteristics such as diet, physical inactivity, obesity, and smoking, but these are not incorporated in screening recommendations. Moreover, the joint association of these factors with various colorectal polyps is not established.

METHODS

A case-control study, among consecutive subjects aged 40-70 years, undergoing colonoscopy. Cases with colorectal polyps were compared with controls. Detailed information was gathered regarding polyp histology and anatomic location, demographics, medical history, anthropometrics, and lifestyle. The healthy lifestyle index was estimated as the sum of: non-smoking, maintaining a healthy weight, healthy diet, and physical activity.

RESULTS

A total of 788 participants were included (cases n = 403, controls n = 385). The healthy lifestyle index had a negative association with colorectal polyps (OR = 0.72, 95% CI 0.62-0.85, P < 0.001), both adenomas and serrated polyps (OR = 0.75, 0.64-0.89, and OR = 0.59, 0.44-0.79, respectively), and both proximal and distal adenomas (OR = 0.77, 0.62-0.95, and OR = 0.73, 0.59-0.90, respectively). Adherence to ≥ 2 healthy lifestyle components was strongly related with colorectal polyps (OR = 0.50, 0.34-0.75, P = 0.001). Abstinence from smoking, and a healthy diet were the factors most strongly associated with lower odds of colorectal polyps (OR = 0.58, 0.42-0.79, and OR = 0.61, 0.44-0.85, respectively).

CONCLUSIONS

Adherence to a healthy lifestyle (≥2 healthy lifestyle components) is inversely associated with colorectal polyps, especially serrated and distal polyps, with no dose-response association. Components most strongly associated with lower odds of colorectal polyps were maintaining a healthy diet and abstinence from smoking. Lifestyle-related characteristics may assist in risk stratification and are potential goals for colorectal neoplasia prevention.