Dietary Patterns and Colorectal Cancer Risk: a Review of 17 Years of Evidence (2000–2016)
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Purpose of Review
Colorectal cancer (CRC) is a global public health problem, with an estimated 1.4 million cases diagnosed worldwide in 2012. Evidence suggests that diet may be important for primary prevention.
The 2017 WCRF/AICR Continuous Update Project on colorectal cancer concluded that there is convincing evidence linking several individual dietary factors with CRC risk but the evidence for dietary patterns was limited and inconclusive. In addition, previous reviews and meta-analyses have not critically synthesized various dietary patterns. This review synthesized data from dietary patterns studies over a 17-year period from 2000 to 2016.
We included 49 studies (28 cohort and 21 case-control) that examined the association of index-based and empirically derived dietary patterns and CRC risk. A synthesis of food group components comprising the different index-based and empirically derived patterns revealed two distinct dietary patterns associated with CRC risk. A “healthy” pattern, generally characterized by high intake of fruits and vegetables, whole grains, nuts and legumes, fish and other seafood, milk, and other dairy products, was associated with lower CRC risk. In contrast, the “unhealthy” pattern, characterized by high intakes of red meat, processed meat, sugar-sweetened beverages, refined grains, desserts, and potatoes was associated with higher CRC risk. It is notable that the number of food groups, the intake quantity, and the exact types of foods in each food group differed between populations, yet the two dietary patterns remained consistent across regions, especially in empirically derived patterns, an indication of the high reproducibility of these patterns. However, findings for CRC risk in both index-based and empirically derived patterns, differed by sex, with stronger associations among men than women; study design, a higher proportion of case-control studies reported significant findings compared to prospective studies. Consuming a dietary pattern high in fruits and vegetables and low in meats and sweets is protective against CRC risk. However, important questions remain about the mechanisms underlying differences by sex; life-course timing of exposure to dietary patterns; interaction of dietary patterns with the microbiome or with lifestyle factors including physical activity; and elucidation of subsite differences.
KeywordsColorectal cancer Dietary patterns Dietary quality Dietary indices
Alternative healthy eating index
Body mass index (kg/m2)
Dietary approaches to stop hypertension
Dietary inflammatory index
Food frequency questionnaire
Healthy eating index
Principal components analysis
World Cancer Research Fund/American Institute for Cancer Research
Compliance with Ethical Standards
Conflict of Interest
Fred K. Tabung, Lisa S. Brown, and Teresa T. Fung declare they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Dr. Fred K. Tabung was supported by National Institutes of Health (NIH) grant no. K99CA207736.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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