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Association of healthy diet score and adiposity with risk of colorectal cancer: findings from the UK Biobank prospective cohort study

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Abstract

Purpose

To explore the joint association of dietary patterns and adiposity with colorectal cancer (CRC), and whether adiposity mediates the relationship between dietary patterns and CRC risk, which could provide deeper insights into the underlying pathogenesis of CRC.

Methods

The data of 307,023 participants recruited between 2006 and 2010 were extracted from the UK Biobank study. Healthy diet scores were calculated based on self-reported dietary data at baseline, and participants were categorized into three groups, namely, low, intermediate, and high diet score groups. Cox regression models with hazard ratios (HRs) and 95% confidence intervals (CIs) were used to estimate the effects of the healthy diet score on CRC incidence, adjusting for various covariates. Furthermore, the mediation roles of obesity and central obesity between the healthy diet score and CRC risk were assessed using a counterfactual causal analysis based on Cox regression model. Additionally, joint association between dietary patterns and adiposity on CRC risks was assessed on the additive and multiplicative scales.

Results

Over a median 6.2-year follow-up, 3,276 participants developed CRC. After adjusting for sociodemographic and lifestyle factors, a lower risk of CRC incidence was found for participants with intermediate (HR = 0.83, 95% CI: 0.72 to 0.95) and high diet scores (HR = 0.73, 95% CI: 0.62 to 0.87) compared to those with low diet scores. When compared with the low diet score group, obesity accounted for 4.13% and 7.93% of the total CRC effect in the intermediate and high diet score groups, respectively, while central obesity contributed to 3.68% and 10.02% of the total CRC risk in the intermediate and high diet score groups, respectively. The mediating effect of adiposity on CRC risk was significant in men but not in women. Concurrent unhealthy diet and adiposity multiplied CRC risk.

Conclusion

Adiposity-mediated effects were limited in the link between dietary patterns and CRC incidence, implying that solely addressing adiposity may not sufficiently reduce CRC risk. Interventions, such as improving dietary quality in people with adiposity or promoting weight control in those with unhealthy eating habits, may provide an effective strategy to reduce CRC risk.

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Data availability

Data can be requested from the UK Biobank (http://www.ukbiobank.ac.uk).

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Acknowledgements

We are grateful to UK Biobank participants.

Funding

This study was funded by the Affiliated Hospital of Guangdong Medical University Clinical Research Program (LCYJ2019B007).

Author information

Author notes

  1. Jiasheng Huang and Enlin Ye were equally contributed.

Authors and Affiliations

  1. Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, 524001, China

    Jiasheng Huang, Enlin Ye, Xiaolin Li, Dongdong Niu, Jia Wang, Yumei Zhao, Yiling Hu, Suru Yue, Xuefei Hou & Jiayuan Wu

  2. Collaborative Innovation Engineering Technology Research Center of Clinical Medical Big Data Cloud Service in Medical Consortium of West Guangdong Province, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, 524001, China

    Jiasheng Huang, Enlin Ye, Suru Yue, Xuefei Hou & Jiayuan Wu

  3. Department of Gastrointestinal Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, 524001, China

    Zhe Huang

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  1. Jiasheng Huang
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Contributions

HJS and YEL were responsible for the article design, data analysis, and writing of the first draft; NDD and WJ were responsible for data extraction, screening, and analysis; ZYM, LXL, and HYL were responsible for data proofreading and interpretation; YSR and HXF were responsible for the production of graphs and charts; HZ and WJY was responsible for the study design and interpretation of the results; HJS and WJY was responsible for reviewing and revising the article. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Zhe Huang or Jiayuan Wu.

Ethics declarations

Ethics approval and consent to participate

The UK Biobank study obtained approval from the Northwest Multicenter Research Ethics Committee on June 17, 2011 (Ref. 11/NW/0382), and all participants provided informed consent by signing a consent document. The UK Biobank data used in this study were accessed under application number 97101.

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Not applicable.

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The authors declare that they have no competing interests.

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Huang, J., Ye, E., Li, X. et al. Association of healthy diet score and adiposity with risk of colorectal cancer: findings from the UK Biobank prospective cohort study. Eur J Nutr (2024). https://doi.org/10.1007/s00394-024-03418-7

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