Cancer Causes & Control

, Volume 21, Issue 11, pp 1911–1918 | Cite as

Nutrient dietary patterns and the risk of colorectal cancer: a case–control study from Italy

  • Francesca Bravi
  • Valeria Edefonti
  • Cristina Bosetti
  • Renato Talamini
  • Maurizio Montella
  • Attilio Giacosa
  • Silvia Franceschi
  • Eva Negri
  • Monica Ferraroni
  • Carlo La Vecchia
  • Adriano Decarli
Original paper



The role of diet on colorectal cancer has been considered in terms of single foods and nutrients, but less frequently in terms of dietary patterns.


Data were derived from an Italian case–control study, including 1,225 subjects with cancer of the colon, 728 subjects with rectal cancer, and 4,154 hospital controls. We identified dietary patterns on a selected set of nutrients through principal component factor analysis. Odds ratios (OR) and 95% confidence intervals for both cancers were estimated using unconditional multiple logistic regression.


We identified 5 major dietary patterns. Direct associations were observed between the Starch-rich pattern and both cancer of the colon (OR = 1.68) and of the rectum (OR = 1.74). Inverse relationships were found between the Vitamins and fiber pattern and rectal cancer (OR = 0.61), between the Unsaturated fats (animal source) and the Unsaturated fats (vegetable source) and cancer of the colon (OR = 0.80 and OR = 0.79, respectively). No other significant association was found.


The Starch-rich pattern is potentially an unfavorable indicator of risk for both colon and rectal cancer, whereas the Vitamins and fiber pattern is associated with a reduced risk of rectal cancer and the Unsaturated fats patterns with a reduced risk of colon cancer.


Dietary patterns Factor analysis Nutrients Colorectal cancer Case–control study 



The authors thank Mrs I. Garimoldi for editorial assistance. This work was conducted with the contribution of the Italian Association for Cancer Research (AIRC).


  1. 1.
    Giovannucci E, Wu K (2006) Cancers of the colon and rectum. In: Schottenfeld D, Fraumeni JF Jr (eds) Cancer epidemiology and prevention, 3rd edn. Oxford University Press, New York, pp 809–829Google Scholar
  2. 2.
    Newby PK, Muller D, Tucker KL (2004) Associations of empirically derived eating patterns with plasma lipid biomarkers: a comparison of factor and cluster analysis methods. Am J Clin Nutr 80:759–767PubMedGoogle Scholar
  3. 3.
    World Cancer Research Fund/American Institute for Cancer Research (2007) Food, nutrition, physical activity, and the prevention of cancer: a global prospective. American Institute for Cancer Research, Washington, DCGoogle Scholar
  4. 4.
    Hu FB (2002) Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol 13:3–9CrossRefPubMedGoogle Scholar
  5. 5.
    Dixon LB, Balder HF, Virtanen MJ et al (2004) Dietary patterns associated with colon and rectal cancer: results from the dietary patterns and cancer (DIETSCAN) project. Am J Clin Nutr 80:1003–1011PubMedGoogle Scholar
  6. 6.
    Flood A, Rastogi T, Wirfalt E et al (2008) Dietary patterns as identified by factor analysis and colorectal cancer among middle-aged Americans. Am J Clin Nutr 88:176–184PubMedGoogle Scholar
  7. 7.
    Fung T, Hu FB, Fuchs C et al (2003) Major dietary patterns and the risk of colorectal cancer in women. Arch Intern Med 163:309–314CrossRefPubMedGoogle Scholar
  8. 8.
    Kesse E, Clavel-Chapelon F, Boutron-Ruault MC (2006) Dietary patterns and risk of colorectal tumours: a cohort of French women of the national education system (E3 N). Am J Epidemiol 164:1085–1093CrossRefPubMedGoogle Scholar
  9. 9.
    Kim MK, Sasaki S, Otani T, Tsugane S (2005) Dietary patterns and subsequent colorectal cancer risk by subsite: a prospective cohort study. Int J Cancer 115:790–798CrossRefPubMedGoogle Scholar
  10. 10.
    Satia JA, Tseng M, Galanko JA et al (2009) Dietary patterns and colon cancer risk in Whites and African Americans in the North Carolina Colon Cancer Study. Nutr Cancer 61:179–193CrossRefPubMedGoogle Scholar
  11. 11.
    Terry P, Hu FB, Hansen H, Wolk A (2001) Prospective study of major dietary patterns and colorectal cancer risk in women. Am J Epidemiol 154:1143–1149CrossRefPubMedGoogle Scholar
  12. 12.
    Wu K, Hu FB, Fuchs C et al (2004) Dietary patterns and risk of colon cancer and adenoma in a cohort of men (United States). Cancer Causes Control 15:853–862CrossRefPubMedGoogle Scholar
  13. 13.
    Butler LM, Wang R, Koh WP, Yu MC (2008) Prospective study of dietary patterns and colorectal cancer among Singapore Chinese. Br J Cancer 99:1511–1516CrossRefPubMedGoogle Scholar
  14. 14.
    Mizoue T, Yamaji T, Tabata S et al (2005) Dietary patterns and colorectal adenomas in Japanese men: the self-defence forces health study. Am J Epidemiol 161:338–345CrossRefPubMedGoogle Scholar
  15. 15.
    Randall E, Marshall JR, Brasure J, Graham S (1992) Dietary patterns and colon cancer in western New York. Nutr Cancer 18:265–276CrossRefPubMedGoogle Scholar
  16. 16.
    Slattery ML, Boucher KM, Caan BJ et al (1998) Eating patterns and risk of colon cancer. Am J Epidemiol 148:4–16PubMedGoogle Scholar
  17. 17.
    Slattery ML, Potter JD, Ma KN et al (2000) Western diet, family history of colorectal cancer, NAT2, GSTM-1 and risk of colon cancer. Cancer Causes Control 11:1–8CrossRefPubMedGoogle Scholar
  18. 18.
    Franceschi S, La Vecchia C, Russo A et al (1998) Macronutrient intake and risk of colorectal cancer in Italy. Int J Cancer 76:321–324CrossRefPubMedGoogle Scholar
  19. 19.
    La Vecchia C, Braga C, Negri E et al (1997) Intake of selected micronutrients and risk of colorectal cancer. Int J Cancer 73:525–530CrossRefPubMedGoogle Scholar
  20. 20.
    Franceschi S, Favero A, La Vecchia C et al (1997) Food groups and risk of colorectal cancer in Italy. Int J Cancer 72:56–61CrossRefPubMedGoogle Scholar
  21. 21.
    Decarli A, Franceschi S, Ferraroni M et al (1996) Validation of a food-frequency questionnaire to assess dietary intakes in cancer studies in Italy. Results for specific nutrients. Ann Epidemiol 6:110–118CrossRefPubMedGoogle Scholar
  22. 22.
    Franceschi S, Negri E, Salvini S et al (1993) Reproducibility of an Italian food frequency questionnaire for cancer studies: results for specific food items. Eur J Cancer 29A:2298–2305CrossRefPubMedGoogle Scholar
  23. 23.
    Gnagnarella P, Parpinel M, Salvini S et al (2004) The update of the Italian food composition database. J Food Comp Analysis 17:509–522CrossRefGoogle Scholar
  24. 24.
    Salvini S, Parpinel M, Gnagnarella P et al (1998) Banca dati di composizione degli alimenti per studi epidemiologici in Italia. Istituto Europeo di Oncologia, MilanoGoogle Scholar
  25. 25.
    Johnson R, Wichern D (2002) Applied multivariate statistical analysis. Prentice Hall, Upper Saddler River, NJGoogle Scholar
  26. 26.
    Pett MA, Lackey NR, Sullivan JJ (2003) Making sense of factor analysis: the use of factor analysis for instrument development in health care research. Sage, CAGoogle Scholar
  27. 27.
    Kaiser HF (1974) An index of factorial simplicity. Psychometrika 39:32–35CrossRefGoogle Scholar
  28. 28.
    Comrey A, Lee HB (1992) A first course in factor analysis. Lawrence Erlbaum Associates, Hillsdale, NJGoogle Scholar
  29. 29.
    Cronbach LJ (1951) Coefficient alpha and the internal structure of tests. Psychometrika 16:297–334CrossRefGoogle Scholar
  30. 30.
    R development Core Team (2008) A language and environment for statistical computing. R foundation for statistical computing, Vienna, Austria, 2008. Available at URL:
  31. 31.
    Edefonti V, Decarli A, La Vecchia C et al (2008) Nutrient dietary patterns and the risk of breast and ovarian cancers. Int J Cancer 122:609–613CrossRefPubMedGoogle Scholar
  32. 32.
    Breslow NE, Day NE (1980) Statistical methods in cancer research. Vol. I. The analysis of case-control studies. IARC Sci Publ No. 32. IARC, LyonGoogle Scholar
  33. 33.
    D’Avanzo B, La Vecchia C, Katsouyanni K et al (1997) An assessment, and reproducibility of food frequency data provided by hospital controls. Eur J Cancer Prev 6:288–293CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  • Francesca Bravi
    • 1
    • 2
  • Valeria Edefonti
    • 2
  • Cristina Bosetti
    • 1
  • Renato Talamini
    • 3
  • Maurizio Montella
    • 4
  • Attilio Giacosa
    • 5
  • Silvia Franceschi
    • 6
  • Eva Negri
    • 1
  • Monica Ferraroni
    • 2
  • Carlo La Vecchia
    • 1
    • 2
  • Adriano Decarli
    • 2
    • 7
  1. 1.Dipartimento di EpidemiologiaIstituto di Ricerche Farmacologiche “Mario Negri”MilanItaly
  2. 2.Facoltà di Medicina e Chirurgia, Dipartimento di Medicina del Lavoro “Clinica del Lavoro Luigi Devoto”, Sezione di Statistica Medica e Biometria “G.A. Maccacaro”Università degli Studi di MilanoMilanItaly
  3. 3.Centro di Riferimento OncologicoUnità di Epidemiologia e BiostatisticaAviano (PN)Italy
  4. 4.Servizio di Epidemiologia, Istituto Tumori “Fondazione Pascale”NaplesItaly
  5. 5.Policlinico di MonzaMonzaItaly
  6. 6.International Agency for Research on CancerLyonFrance
  7. 7.S.C. Statistica Medica, Biometria e BioinformaticaFondazione IRCSS Istituto Nazionale dei TumoriMilanItaly

Personalised recommendations