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Role of Diet in Colorectal Cancer Incidence

  • Veettil, Sajesh K.1
  • Wong, Tse Yee2
  • Loo, Yee Shen2
  • Playdon, Mary C.3, 4
  • Lai, Nai Ming5, 6
  • Giovannucci, Edward L.7, 8
  • Chaiyakunapruk, Nathorn1
  • 1 Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City
  • 2 School of Pharmacy, International Medical University, Bukit Jalil, Kuala Lumpur, Malaysia
  • 3 Department of Nutrition and Integrative Physiology, University of Utah, Salt Lake City
  • 4 Huntsman Cancer Institute, Cancer Control and Population Sciences Program, University of Utah, Salt Lake City
  • 5 School of Medicine, Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya, Selangor, Malaysia
  • 6 School of Pharmacy, Monash University Malaysia, Bandar Sunway, Subang Jaya, Selangor, Malaysia
  • 7 Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
  • 8 Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
Published Article
JAMA Network Open
American Medical Association
Publication Date
Feb 16, 2021
DOI: 10.1001/jamanetworkopen.2020.37341
PMID: 33591366
PMCID: PMC7887658
PubMed Central
  • Oncology
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Importance Several meta-analyses have summarized evidence for the association between dietary factors and the incidence of colorectal cancer (CRC). However, to date, there has been little synthesis of the strength, precision, and quality of this evidence in aggregate. Objective To grade the evidence from published meta-analyses of prospective observational studies that assessed the association of dietary patterns, specific foods, food groups, beverages (including alcohol), macronutrients, and micronutrients with the incidence of CRC. Data Sources MEDLINE, Embase, and the Cochrane Library were searched from database inception to September 2019. Evidence Review Only meta-analyses of prospective observational studies with a cohort study design were eligible. Evidence of association was graded according to established criteria as follows: convincing, highly suggestive, suggestive, weak, or not significant. Results From 9954 publications, 222 full-text articles (2.2%) were evaluated for eligibility, and 45 meta-analyses (20.3%) that described 109 associations between dietary factors and CRC incidence were selected. Overall, 35 of the 109 associations (32.1%) were nominally statistically significant using random-effects meta-analysis models; 17 associations (15.6%) demonstrated large heterogeneity between studies ( I 2 > 50%), whereas small-study effects were found for 11 associations (10.1%). Excess significance bias was not detected for any association between diet and CRC. The primary analysis identified 5 (4.6%) convincing, 2 (1.8%) highly suggestive, 10 (9.2%) suggestive, and 18 (16.5%) weak associations between diet and CRC, while there was no evidence for 74 (67.9%) associations. There was convincing evidence of an association of intake of red meat (high vs low) and alcohol (≥4 drinks/d vs 0 or occasional drinks) with the incidence of CRC and an inverse association of higher vs lower intakes of dietary fiber, calcium, and yogurt with CRC risk. The evidence for convincing associations remained robust following sensitivity analyses. Conclusions and Relevance This umbrella review found convincing evidence of an association between lower CRC risk and higher intakes of dietary fiber, dietary calcium, and yogurt and lower intakes of alcohol and red meat. More research is needed on specific foods for which evidence remains suggestive, including other dairy products, whole grains, processed meat, and specific dietary patterns.

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