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Association between grains, gluten and the risk of colorectal cancer in the Cancer Prevention Study-II Nutrition Cohort

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Abstract

Purpose

Evidence supports a role of whole grains in colorectal cancer (CRC) prevention, but the association between gluten intake and CRC risk in healthy populations is unclear. We examined the association of grain and gluten intake with risk of CRC overall and by subsite among Cancer Prevention Study-II Nutrition Cohort participants.

Methods

In 1999, 50,118 men and 62,031 women completed food frequency questionnaires assessing grain intake. Gluten intake was estimated using the protein content of grain products. Multivariable-adjusted hazards ratio (HR) and 95% confidence interval (CI) of CRC risk were estimated using Cox proportional hazards regression.

Results

During follow-up through 2013, 1742 verified CRC cases occurred. For the highest vs. lowest quintiles of whole grain intake, HRs (95% CIs) of CRC risk were 0.77 (0.61–0.97; P trend = 0.03) among men and 1.10 (95% CI 0.88–1.36; P trend = 0.14) among women (P interaction by sex = 0.01). Men in the highest vs. lowest quintile of whole grain intake had a 43% lower risk of rectal cancer (HR = 0.57, 95% CI 0.35–0.93, P trend = 0.04). Gluten intake was not associated with CRC risk overall (HR = 1.10, 95% CI 0.93–1.32, P trend = 0.10), but was associated with risk of proximal colon cancer among men and women, combined (HR = 1.37, 95% CI 1.07–1.75, quintile 5 vs. 1, P trend = 0.001) and separately. Refined grains and grain-based sweets were not associated with CRC risk.

Conclusions

We found that higher whole grain intake was associated with lower CRC risk among older US men, but not women. The positive association of gluten intake with the risk of proximal colon cancer deserves further study.

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Acknowledgments

The authors express sincere appreciation to all Cancer Prevention Study-II Nutrition Cohort participants and to each member of the study and biospecimen management group. The authors would like to acknowledge the contribution to this study from central cancer registries supported through the Centers for Disease Control and Prevention’s National Program of Cancer Registries and cancer registries supported by the National Cancer Institute’s Surveillance Epidemiology and End Results Program.

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  1. Behavioral and Epidemiology Research Group, American Cancer Society, 250 Williams St, Atlanta, GA, 30303, USA

    Caroline Y. Um, Peter T. Campbell, Brian Carter, Ying Wang, Susan M. Gapstur & Marjorie L. McCullough

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  1. Caroline Y. Um
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The American Cancer Society funds the creation, maintenance, and updating of the Cancer Prevention Study-II Nutrition Cohort.

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The views expressed here are those of the authors and do not necessarily represent the American Cancer Society or the American Cancer Society–Cancer Action Network.

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Um, C.Y., Campbell, P.T., Carter, B. et al. Association between grains, gluten and the risk of colorectal cancer in the Cancer Prevention Study-II Nutrition Cohort. Eur J Nutr 59, 1739–1749 (2020). https://doi.org/10.1007/s00394-019-02032-2

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