Author, Year, WCRF Code, Country Study name, characteristics Study size Follow-up (years) Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Tasevska, 2012 COL40854 USA NIH-AARP, Prospective Cohort, Age: 50-71 M/W, Retired 2 601/ 435 686 US social security administration death master file/national death Index FFQ Incidence colorectal cancer, men q 5 vs q 1 0.99 Ptrend:0.91 Alcohol intake, BMI, calcium intake, calcium supplement, educational level, energy intake, family history of colon cancer, fibre intake, height, marital status, physical activity, race, red meat intake, smoking 1 296/ Incidence colorectal cancer, women q 5 vs q 1 1.05 Ptrend:0.20 McCarl, 2006 COL40633 USA IWHS, Prospective Cohort, Age: 55-69 years, W 954/ 35 197 15 years Seer registry FFQ Incidence, colorectal cancer ≥31.6 vs ≤13.9 g 0.87 Age Michaud, 2005 COL01824 USA NHS-HPFS, Prospective Cohort, M/W 1 096/ 130 719 20 years Self-report, medical record and pathology report reviewed by centrally trained physician FFQ Incidence, colorectal cancer, women 68 vs 22 g/day 0.87 Ptrend:0.2 858/ Incidence, colon cancer, women 68 vs 22 g/day 0.86 Ptrend:0.15 238/ Incidence, rectal cancer, 68 vs 22 g/day 0.92 Ptrend:0.47 683/ Incidence, colorectal cancer, men 72 vs 29 g/day 1.37 Ptrend:0.008 552/ Incidence, colon cancer, men 72 vs 29 g/day 1.38 Ptrend:0.02 1.07)
131/ Incidence, rectal cancer, men 72 vs 29 g/day 1.31 Ptrend:0.33 2004 COL00299 USA WHS, Prospective Cohort, Age: 45- W, nurses 174/ 38 451 7.9 years Cancer registry FFQ Incidence, colorectal cancer q 5 vs q 1 2.09 Ptrend:0.08 Age, alcohol consumption, BMI, energy-adjusted calcium, folate, energy-adjusted total fat, energy-adjusted vitamin d, energy-adjusted total fiber, family history of specific cancer, history of oral contraceptive use, HRT use, nsaid use, physical activity, smoking habits, total energy per 10 g/day 1.04 Bostick, 1994 COL00079 USA IWHS, Prospective Cohort, Age: 55-69 years, W 212/ 35 216 167 447 Driving license FFQ Incidence, colon cancer ≥30.6 vs ≤13.4 g/day 0.93 Ptrend:0.78 Age, energy intake, height, parity, total vitamin e intake, total vitamin e Intake * age, vitamin a supplement Table Glucose intake and colorectal cancer risk. Main characteristics of studies included in the CUP SLR dose-response meta-analysis Author, Year, WCRF Code, Country name, characteristics Cases/ Study size Follow-up (years) Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors McCarl, 2006 COL40633 USA IWHS, Prospective Cohort, Age: 55-69 years, W 954/ 35 197 15 years Seer registry FFQ Incidence, colorectal cancer ≥27.1 vs ≤11.9 g 0.85 Age
Table Lactose intake and colorectal cancer risk. Main characteristics of studies included in the CUP SLR dose-response meta-analysis Author, Year, WCRF Code, Country Study name, characteristics Cases/ size Follow-up (years) Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Jarvinen, 2001 COL00314 Finland Finnish Mobile Clinic Health Examination Survey, Prospective Cohort, Age: 39 years, M/W 72/ 9 959 19.6 years Population Questionnaire Incidence, colorectal cancer q 4 vs q 1 0.91 Ptrend:0.38 Age, sex, area of residence, BMI, energy intake, occupational group, smoking habits 38/ Incidence, colon cancer q 4 vs q 1 0.31 Ptrend:0.03 34/ Incidence, rectal cancer q 4 vs q 1 2.36 Ptrend:0.40 Kearney, 1996 COL00156 USA HPFS, Prospective Cohort, Age: 40-75 years, M, Health professionals 47 935 6 years Responding to mail survey FFQ Incidence, colon cancer, colon cancer q 5 vs q 1 0.84 Ptrend:0.74 Result Number:50410 Age, alcohol consumption, aspirin use, BMI, dietary fiber, family history of colon cancer, past history of smoking, physical activity, previous polyps, red meat intake, saturated fat, screening, total calories
Table Total carbohydrate and colorectal cancer risk. Results of meta-analyses and pooled analyses of prospective studies published after the 2005 SLR. Author, Year Number of cohort studies Total number of cases Studies country, area Outcome Comparison RR (95%CI) P trend Heterogeneity (I2, p value) Meta-analysis Aune, 2012 10 12382 America, Europe and Asia Colorectal cancer Highest vs Lowest 0.93 (0.84–1.04) 40%, 0.08 Per 10 0.95 (0.84-1.07) 57%, 0.01
Prospective Cohort, W, Postmenopausal trained physician adjudicators intake, family history of colorectal cancer, fibre, height, history of diabetes, hormone use, number of cigarettes smoked, observational study participants, physical activity proximal colon cancer ≤131.5 g/day Ptrend:0.28 351/ Incidence, distal colon cancer ≥260.2 vs ≤131.5 g/day 0.66 (0.32-1.37) Ptrend:0.93 303/ Incidence, rectal cancer ≥260.2 vs ≤131.5 g/day 1.33 (0.62-2.85) Ptrend:0.15 Larsson, 2007 COL40705 Sweden SMC, Prospective Cohort, Age: 40-76 W 870/ 61 433 15.7 years Record linkage with cancer registries FFQ Incidence, colorectal cancer ≥246 vs ≤210 g/day 1.10 (0.85-1.44) Ptrend:0.45 Age, alcohol consumption, BMI, calcium intake, cereal fibre, date of enrolment, educational level, folate intake, magnesium, red meat intake, total energy intake Midpoints 594/ Incidence, colon cancer ≥246 vs ≤210 g/day 1.14 (0.83-1.57) Ptrend:0.64 283/ Incidence, rectal cancer ≥246 vs ≤210 g/day 0.94 (0.59-1.50) Ptrend:0.78
d, energy total fibre, family history of specific cancer, history of oral contraceptive use, HRT use, NSAID use, physical activity, smoking habits, total energy Terry, 2003 COL00561 Canada CNBSS, Prospective Cohort, Age: 40-59 years, W 616/ 49 124 810 649 Breast cancer screening centres Quantitative FFQ Incidence, colorectal cancer ≥249 vs ≤142 g/day 1.01 (0.68-1.51) Ptrend:0.66 Age, alcohol consumption, BMI, educational level, energy intake, folic acid intake, hormone replacement therapy, oral contraceptive use, parity, physical activity, red meat intake, smoking habits, study centre, treatment allocation 436/ Incidence, cancer ≥249 vs ≤142 g/day 1.04 (0.63-1.72) Ptrend:0.80 180/ Incidence, rectal cancer ≥249 vs ≤142 g/day 0.98 (0.49-1.97) Ptrend:0.85
Total carbohydrate and colorectal cancer risk. Main characteristics of studies excluded from the CUP SLR dose-response Author, Year, WCRF Code, Country Study name, characteristics Study size Follow-up (years) Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Reasons for exclusion Kato, 1997 CRC00022 USA New York University Women's Health Study, Prospective Cohort, Age: 34-65 years, W 100/ 14 272 105 044 Mammography screening program FFQ Incidence, colorectal cancer Q 4 vs Q 1 1.21 (0.67-2.17) Ptrend:0.7 Age, educational level, place at enrolment, total calorie Intake Only used in highest vs lowest analysis 1996 COL00087 USA HHP, Prospective Cohort, M, Japanese ancestry 330/ 8 006 19 years Selective service draft registration file Recall Incidence, cancer Highest vs Lowest 0.87 ( 0.67-1.12) Age Only used in highest vs lowest analysis Bostick, 1994 COL00079 USA IWHS, Prospective Cohort, Age: 55-69 years, W 212/ 35 216 167 447 Driving license FFQ Incidence, colon cancer ≥274 vs ≤152 g/day 1.30 Ptrend:0.50 Age, energy Intake, height, parity, total vitamin e Intake, total vitamin e Intake, age, vitamin a supplement Superseded by McCarl, 2006 COL40633 analysis
Heilbrun, 1989 COL01555 USA HHP, Nested Case Control, M 102/ 361 controls 16 years Cancer registry & hospital surveillance Recall questionnaire Incidence, colon cancer Age Superseded by Chyou, 1996 COL00087 60/ 361 controls Incidence, rectal cancer Stemmermann, 1984 COL01232 USA HHP, Prospective Cohort, Age: 45-68 years, M 106/ 7 074 15 years Selective service draft registration file Dietary history questionnaire Incidence, colon cancer Age Superseded by 1996 COL00087 59/ Incidence, rectal cancer
Table Glycemic index and colorectal cancer risk. Results of meta-analyses and pooled analyses of prospective studies published after the 2005 SLR. Author, Year Number of cohort studies Total number of cases Studies country, area Outcome Comparison RR (95%CI) P trend Heterogeneity (I2, p Meta-analysis Aune, 2012 10 12382 America, Europe and Asia Colorectal cancer Highest vs Lowest 1.07 (0.99–1.16) 28%, 0.19 Per 10 units/day 1.07 (0.99–1.15) 39%, 0.10
physical activity, total energy Bao, 2010 COL40837 USA NHS+HPFS, Prospective Cohort, M/W 1 420/ 132 886 Self reported/death certificate/ medical records FFQ Incidence, colorectal cancer, women 46 vs 34 0.95 (0.79-1.13) Ptrend:0.22 Age, alcohol intake, aspirin use, BMI, endoscopy, energy intake, family history of colorectal cancer, history of polyps or colitis, multivitamin supplement intake, physical activity, smoking 1 067/ Incidence, colon cancer, women 46 vs 34 0.93 (0.75-1.15) Ptrend:0.13 1 061/ Incidence, colorectal cancer, men 47 vs 34 0.92 (0.74-1.15) Ptrend:0.41 694/ Incidence, colon cancer, men 47 vs 34 0.88 (0.67-1.16) Ptrend:0.44 323/ Incidence, rectal cancer, women 46 vs 34 1.14 (0.79-1.66) Ptrend:0.50 222/ Men 47 vs 34 1.05 (0.65-1.69) Ptrend:0.95 George, 2009 COL40791 USA NIH-AARP, Prospective Cohort, Age: 50-71 years, M/W 3 031/ 446 177 8 years Cancer registry FFQ Incidence, colorectal cancer, men 57.02-84.13 vs 33.51-51.26 1.16 (1.04-1.30) Age, sex, alcohol intake, BMI, educational level, ethnicity, family history of cancer, marital status, physical activity, smoking status, total energy intake Midpoints, distribution of person-years and
1 457/ Women 56.56-83.94 vs 33.61-50.43 1.16 (0.98-1.37) Kabat, 2008 COL40722 USA Women's Health Initiative - Observational study, Prospective Cohort, W, Postmenopausal 1 470/ 158 800 7.8 years Mail or telephone questionnaires verified by trained physician adjudicators FFQ Incidence, colorectal cancer ≥55.5 vs ≤49.3 1.10 (0.92-1.32) Ptrend:0.27 Age, BMI, dietary calcium, educational level, energy intake, family history of colorectal cancer, fibre, height, history of diabetes, hormone use, number of cigarettes smoked, observational study participants, physical activity 798/ Incidence, proximal colon cancer ≥55.5 vs ≤49.3 1.17 (0.90-1.51) Ptrend:0.45 351/ Incidence, distal colon cancer ≥55.5 vs ≤49.3 0.95 (0.64-1.41) Ptrend:0.9 303/ Incidence, rectal cancer ≥55.5 vs ≤49.3 1.07 (0.71-1.62) Ptrend:0.35 Weijenberg, 2008 COL40686 Netherlands NLCS, Case Cohort, Age: 55-69 years, M/W 1 082/ 120 852 11.3 years Cancer registry and database of pathology reports FFQ Incidence, colorectal cancer, men 64.5 vs 56.6 0.81 (0.61-1.08) Ptrend:0.27 Age, alcohol, BMI, calcium intake, educational family history of colon cancer, physical activity, processed meat, smoking status, total energy intake
755/ Women 61.9 vs 53.7 1.20 (0.85-1.67) Ptrend:0.53 674/ Incidence, colon cancer, men 64.5 vs 56.6 0.64 (0.46-0.89) Ptrend:0.01 551/ Women 61.9 vs 53.7 1.34 (0.91-1.96) Ptrend:0.22 361/ Incidence, distal colon cancer, men 64.5 vs 56.6 0.58 (0.38-0.89) Ptrend:0.03 313/ Incidence, proximal colon cancer, men 64.5 vs 56.6 0.71 (0.45-1.12) Ptrend:0.1 310/ Women 61.9 vs 53.7 1.40 (0.87-2.24) Ptrend:0.08 280/ Incidence, rectal cancer, men 64.5 vs 56.6 1.38 (0.85-2.23) Ptrend:0.08 241/ Incidence, distal colon cancer, women 61.9 vs 53.7 1.18 (0.69-1.99) Ptrend:0.80 138/ Incidence, rectal cancer, women 61.9 vs 53.7 1.01 (0.52-1.98) Ptrend:0.81 Larsson, 2007 COL40705 Sweden SMC, Prospective Cohort, Age: 40-76 years, W 870/ 61 433 15.7 Record linkage with cancer registries FFQ Incidence, colorectal cancer ≥83.4 vs ≤75.7 1.00 (0.75-1.33) Ptrend:0.55 Midpoints 594/ Incidence, colon cancer ≥83.4 vs ≤75.7 0.84 (0.60-1.18) Ptrend:0.21 297/ Incidence, ≥83.4 vs ≤75.7 1.95 (1.19-3.20)
per 1 unit 0.98 (0.96-1.00) Fibre intake McCarl, 2006 COL40633 USA IWHS, Prospective Cohort, Age: 55-69 years, W 954/ 35 197 15 years Seer registry FFQ Incidence, colorectal cancer ≥89.4 vs ≤80.9 1.08 (0.88-1.32) Ptrend:0.15 362/ BMI 25-30 ≥89.4 vs ≤80.9 0.85 (0.60-1.18) Ptrend:0.59 323/ BMI < 25 ≥89.4 vs ≤80.9 0.94 (0.66-1.33) Ptrend:0.57 291/ Incidence, colon cancer, BMI ≥89.4 vs ≤80.9 0.93 (0.64-1.34) Ptrend:0.82 269/ Incidence, colorectal cancer, BMI ≥30 ≥89.4 vs ≤80.9 1.66 (1.13-2.43) Ptrend:0.02 250/ Incidence, colon cancer, BMI < 25 ≥89.4 vs ≤80.9 1.03 (0.70-1.51) Ptrend:0.23 228/ Incidence, colorectal cancer, no diabetes & BMI ≥30 ≥89.4 vs ≤80.9 1.82 (1.20-2.76) Ptrend:<0.01 216/ Incidence, colon cancer, BMI ≥30 ≥89.4 vs ≤80.9 1.45 (0.96-2.19) Ptrend:0.21 184/ No diabetes & BMI ≥30 ≥89.4 vs ≤80.9 1.60 (1.02-2.51) Ptrend:0.07 77/ Incidence, rectal ≥89.4 vs ≤80.9 0.58 (0.25-1.33)
total energy Table Glycemic index and colorectal cancer risk. Main characteristics of studies excluded from the CUP SLR dose-response Author, Year, WCRF Code, Country Study name, characteristics Cases/ size Follow-up Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Reasons for exclusion Michaud, 2005 COL01824 USA NHS-HPFS, Prospective Cohort, M/W 1 096/ 130 719 20 years Self-report, medical record and pathology report reviewed by centrally trained physician FFQ Incidence, colorectal cancer, women 81 vs 65 1.08 (0.87-1.34) Ptrend:0.27 858/ Incidence, colon cancer, women 81 vs 65 1.06 (0.83-1.36) Ptrend:0.29 683/ Incidence, colorectal cancer, men 82 vs 69 1.14 (0.88-1.48) Ptrend:0.33 552/ Incidence, colon cancer, men 82 vs 69 1.13 (0.84-1.51) Ptrend:0.40 403/ Incidence, proximal colon cancer, women 81 vs 65 1.11 (0.77-1.58) Ptrend:0.27 326/ Incidence, distal colon cancer, women 81 vs 65 0.91 (0.63-1.34) Ptrend:0.82 analysis
238/ Incidence, rectal cancer, women 81 vs 65 1.14 (0.73-1.78) Ptrend:0.7 228/ Incidence, distal colon cancer, men 82 vs 69 1.06 (0.67-1.68) Ptrend:0.91 227/ Incidence, proximal cancer, men 82 vs 69 0.99 (0.63-1.57) Ptrend:0.72 131/ Incidence, rectal cancer, men 82 vs 69 1.21 (0.68-2.15) Ptrend:0.65
Table Glycemic load and colorectal cancer risk. Results of meta-analyses and pooled analyses of prospective studies published after the 2005 SLR. Author, Year Number of cohort studies Total number of cases Studies country, area Outcome Comparison RR (95%CI) P Heterogeneity (I2, p value) Meta-analysis Aune, 2012 10 12382 America, Europe and Asia Colorectal cancer Highest vs Lowest 1.00 (0.91–1.10) 39%, 0.08 Per 10 units/day 1.01 (0.95–1.08) 47%, 0.04
Table Glycemic load and colorectal cancer risk. Main characteristics of studies included in the CUP SLR dose-response meta-analysis Author, Year, WCRF Code, Country Study name, characteristics Cases/ Study size Follow-up (years) Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Missing data derived for analysis Sieri, 2015 COL41035 Italy EPIC, Prospective Cohort, M/W 426/ 47 749 11.7 years Cancer registry and hospital discharge records FFQ Incidence, colorectal cancer 191 vs 125 1.43 (0.94-2.18) Ptrend:0.153 Sex, alcohol intake, BMI, calcium intake, educational level, energy, folate intake, non-alcohol energy, physical activity, saturated fat intake, smoking status Distribution of person-years 314/ Incidence, colon cancer 191 vs 125 1.60 (0.98-2.60) Ptrend:0.071 107/ Incidence, rectal cancer 191 vs 125 1.03 (0.45-2.37) Ptrend:0.769 Li, 2011 COL40806 SWHS, Prospective Cohort, Age: 40-70 years, W 475/ 73 061 9.1 years Cancer registry and medical records Dietary recall Incidence, colorectal cancer 225.9 vs 159.7 0.94 (0.71-1.24) Ptrend:0.84 Age, birth year, BMI, educational level, family history of colorectal cancer, HRT use, income, physical activity, total energy 287/ Incidence, colon cancer 225.9 vs 159.7 0.92 (0.64-1.32) Ptrend:0.45 188/ Incidence, rectal cancer 225.9 vs 159.7 0.99 (0.64-1.52) Ptrend:0.55 Bao, 2010 COL40837 USA HPFS+NHS, Prospective Cohort, M/W 1 420/ 132 886 certificate/ medical records FFQ Incidence, colorectal cancer, women 745 vs 547 0.92 (0.77-1.11) Ptrend:0.17 1 067/ Incidence, cancer, women 745 vs 547 0.86 (0.70-1.07) Ptrend:0.09
family history of colorectal cancer, history of polyps or colitis, multivitamin supplement intake, physical activity, smoking 1 061/ Incidence, colorectal cancer, men 930 vs 673 0.90 (0.72-1.12) Ptrend:0.29 694/ Incidence, cancer, men 930 vs 673 0.85 (0.65-1.12) Ptrend:0.34 323/ Incidence, rectal cancer, women 745 vs 547 1.21 (0.82-1.77) Ptrend:0.63 222/ Men 930 vs 673 1.11 (0.69-1.77) Ptrend:0.81 George, 2009 COL40791 USA NIH-AARP, Prospective Cohort, Age: 50-71 years, M/W 3 031/ 446 177 8 years Cancer registry FFQ Incidence, colorectal cancer, men 164.44-740.24 vs 7.08-83.2 0.88 (0.72-1.08) Age, sex, alcohol intake, BMI, educational level, ethnicity, family history of cancer, marital status, menopausal hormone use, physical activity, smoking status, total energy Midpoints, distribution of person-years and cases 1 457/ Women 135.31-583.68 vs 4.61-66.91 0.87 (0.64-1.18)
number of cigarettes smoked, observational study participants, physical activity cancer Ptrend:0.05 Weijenberg, 2008 COL40686 Netherlands NLCS, Case Cohort, Age: 55-69 years, M/W 1 082/ 120 852 11.3 Cancer registry and database of pathology reports FFQ Incidence, colorectal cancer, men 165.4 vs 108.7 0.83 (0.64-1.08) Ptrend:0.37 Age, alcohol, BMI, calcium intake, educational level, family history of colon cancer, physical activity, processed meat, smoking status, total energy intake 755/ 123.6 vs 82.5 1.00 (0.73-1.36) Ptrend:0.81 674/ Incidence, colon cancer, men 165.4 vs 108.7 0.72 (0.51-1.00) Ptrend:0.1 551/ 123.6 vs 82.5 1.13 (0.79-1.60) Ptrend:0.32 280/ Incidence, rectal cancer, men 165.4 vs 108.7 1.01 (0.68-1.51) Ptrend:0.37 138/ Women 123.6 vs 82.5 0.79 (0.43-1.43) Ptrend:0.55 Larsson, 2007 COL40705 Sweden SMC, Prospective Cohort, Age: 40-76 years, W 870/ 61 433 15.7 years Record linkage with cancer registries FFQ Incidence, colorectal cancer ≥200 vs ≤163 1.06 (0.81-1.39) Ptrend:0.78 Age, alcohol consumption, BMI, calcium intake, cereal fibre, date of enrolment, educational level, folate intake, Midpoints 594/ Incidence, colon cancer ≥200 vs ≤163 0.97 (0.70-1.32) Ptrend:0.66 283/ Incidence, rectal cancer ≥200 vs ≤163 1.20 (0.74-1.95) Ptrend:0.45
activity, red meat intake, smoking habits, study centre, treatment allocation Table Glycemic load and colorectal cancer risk. Main characteristics of studies excluded from the CUP SLR dose-response Author, Year, WCRF Code, Country name, characteristics Cases/ Study size Follow-up (years) Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Michaud, 2005 COL01824 USA NHS-HPFS, Prospective Cohort, M/W 1 096/ 130 719 20 years Self-report, medical record and pathology report reviewed by centrally trained physician FFQ Incidence, colorectal cancer, women 81 vs 65 1.08 (0.87-1.34) Ptrend:0.27 167 vs 80 0.89 (0.71-1.11) Ptrend:0.15 858/ Incidence, colon cancer, women 81 vs 65 1.06 (0.83-1.36) Ptrend:0.29 167 vs 80 0.89 (0.69-1.15) Ptrend:0.11 683/ Incidence, colorectal cancer, men 82 vs 69 1.14 (0.88-1.48) Ptrend:0.33 223 vs 131 1.32 (0.98-1.79) Ptrend:0.04 analysis
activity, processed meat 552/ Incidence, colon cancer, men 223 vs 131 1.25 (0.88-1.25) Ptrend:0.11 82 vs 69 1.13 (0.84-1.51) Ptrend:0.40 403/ Incidence, proximal colon cancer, women 81 vs 65 1.11 (0.77-1.58) Ptrend:0.27 167 vs 80 0.77 (0.53-1.11) Ptrend:0.02 326/ Incidence, distal colon cancer, women 167 vs 80 0.90 (0.60-1.36) Ptrend:0.59 81 vs 65 0.91 (0.63-1.34) Ptrend:0.82 238/ Incidence, rectal cancer, 81 vs 65 1.14 (0.73-1.78) Ptrend:0.7 167 vs 80 0.87 (0.52-1.44) Ptrend:0.95 228/ Incidence, distal colon cancer, men 82 vs 69 1.06 (0.67-1.68) Ptrend:0.91 223 vs 131 0.87 (0.51-1.49) Ptrend:0.85 227/ Incidence, proximal colon cancer, men 82 vs 69 0.99 (0.63-1.57) Ptrend:0.72 223 vs 131 1.10 (0.64-1.88) Ptrend:0.67 131/ Incidence, cancer, 223 vs 131 1.61 (0.82-3.17) Ptrend:0.17
Table 208 Dietary n-3 fatty acid from fish and colorectal cancer risk. Main characteristics of studies included in the CUP SLR meta-analysis Author, Year, WCRF Code, Country Study name, characteristics Cases/ Study size Follow-up (years) Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Missing data derived for analyses Song, 2014 COL41015 USA NHS, Prospective Cohort, Age: 30-55 W 1 295/ 76 386 26 years questionnaire, national death Index, pathology reports and medical records FFQ Incidence, colorectal cancer ≥0.3 vs ≤0.15 g/day 1.03 (0.89-1.20) Age, alcohol, BMI, calendar year, calories intake, endoscopy, energy-adjusted calcium, folate, energy-adjusted vitamin d, family history, fibre, HRT use, multivitamin supplement intake, nsaid use, pack years of smoking, physical activity, postmenopausal status, processed meat, red meat Mid-point exposure Song, 2014 COL41016 USA Health Professionals Follow-up Study (HPFS), 847/ 47 143 24 Self-report, medical records, pathology family Incidence, colorectal cancer ≥0.41 vs ≤0.16 g/day 1.05 (0.85-1.30) Age, alcohol, BMI, endoscopy, energy-adjusted Mid-point exposure adjusted
Prospective Cohort, Age: 40-75 M, Health professionals members, national death Index calcium, folate, energy-adjusted vitamin d, family history of colon cancer, fibre, multivitamin supplement intake, nsaid use, pack years of smoking, physical activity, red and processed meat, total calories, year Butler, 2009 COL40769 Singapore SCHS, Prospective Cohort, Age: 45-74 years, M/W 375/ 61 321 >10 years Cancer registry Quantitative FFQ Incidence, advanced colorectal cancer, men 0.67 vs 0.36 g/1000 kcal/day 0.77 (0.47-1.26) Ptrend:0.42 Age, alcohol intake, BMI, diabetes, dialect group, educational level, energy intake, family history of colorectal cancer, physical activity, Unit converted to g/day adjusted
smoking habits, year of Interview Daniel, 2009 COL40784 USA CPS II, Prospective Cohort, Age: 69 M/W 452/ 99 080 Cancer registry and death certificates and medical records FFQ Incidence, colorectal cancer, men ≥0.25 vs ≤0.09 g/day 1.00 (0.75-1.33) Ptrend:0.90 Age, BMI, dairy products consumption, energy intake, fruits intake, health screening, HRT use, nsaid use, recreational activity, red and processed meat, vegetable intake Mid-point exposure 417/ 99 080 Incidence, colorectal cancer, women ≥0.24 vs ≤0.09 g/day 0.94 (0.72-1.24) Ptrend:0.83 Pietinen, 1999 COL00176 Finland ATBC, Prospective Cohort, Age: 50-69 years, M, Smokers 185/ 27 111 8 years Population Dietary history questionnaire Incidence, colorectal cancer, 0.70 vs 0.20 g/day 1.20 (0.80-1.90) Age, alcohol consumption, BMI, calcium intake, educational level, energy intake, physical activity, smoking years, supplement group
Table 218 Alcohol (as ethanol) and colorectal cancer risk. Main characteristics of studies included in the CUP SLR dose-response Author, Year, WCRF Code, Country Study name, characteristics Cases/ Study size Follow-up Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Missing data derived for analyses Shin, 2014 COL41023 Korea KNHIC, Prospective Cohort, Age: 30-80 years, M/W 2655 1 326 058 Korean central cancer registry (kccr) & Insurance system questionnaire Incidence, rectal cancer, women ≥25 vs ≤0 g/day 1.48 (1.10-1.99) Age, BMI, cigarette smoking, family history of cancer, fasting blood sugar, height, meat consumption, serum cholesterol Distribution of person-years by exposure category, of exposure categories. 6492 Incidence, colon cancer, men 1.31 (1.19-1.45) 3555 Incidence, colorectal cancer, men 1.26 (1.18, 3146 Incidence, rectal cancer, men 1.26 (1.18-1.35) Nan, 2013 COL40971 USA NHS, Prospective Cohort, Age: 30-55 years, W, Registered nurses 1 628/ 87 856 28 years Medical records, pathology reports, next of kin, certificate, ndi FFQ Incidence, colorectal cancer ≥30 vs ≤0 g/day 1.30 (1.00-1.69) Ptrend:0.15 Age, aspirin use, BMI, dietary calcium, endoscopy, energy intake, family history of colorectal cancer, height, multivitamin supplement intake, pack-yrs of smoking, physical activity, postmenopausal Midpoints analysis
hormone use, red meat Nan, 2013 COL40972 USA HPFS, Prospective Cohort, Age: 40-75 years, M, Health professionals 1 165/ 46 874 22 years Medical records, pathology reports, next of kin, certificate, ndi Incidence, colorectal cancer ≥30 vs ≤0 g/day 1.38 (1.11-1.72) Ptrend:<0.001 Age, aspirin use, BMI, dietary calcium, energy intake, family history of colorectal cancer, height, multivitamin supplement intake, physical activity, postmenopausal hormone use, red meat Midpoints Bamia, 2013 COL40964 Denmark, France, Germany, Greece, Italy, Netherlands, Spain, Sweden, UK EPIC, Prospective Cohort, Age: 25-70 years, M/W 2 479/ 480 308 11.6 Cancer registry, record linkage, health Insurance rec, mortality registry , pathology and active follow up FFQ Incidence, colorectal cancer, women 23.1 vs 0.4 g/day 0.98 (0.88-1.08) Age, sex, BMI, centre location, cereal, dairy products consumption, educational level, ethanol, fish, fruits, legumes, lipids, meat, physical activity, smoking Distribution of by exposure category. 1 876/ Men 23.1 vs 0.4 g/day 1.20 (1.06-1.35) Everatt, 2013 KRIS-MIHDPS, 248/ Cancer registry Questionnaire Incidence, ≥140.1 vs 0.1-10 1.67 (0.98-2.84) Age, BMI, Rescale
Allen, 2009 COL40762 UK MWS, Prospective Cohort, Age: 55 years, W, midlife women 1 914/ 1 280 296 7.2 years Cancer registry Questionnaire Incidence, cancer per 10 g/day 0.97 (0.96-1.11) Age, area of residence, BMI, hormone use, physical activity, smoking status, socio-economic status, use of oral contraception Incidence, rectal cancer 1.10(1.02-1.18) Bongaerts, 2008 COL40635 Netherlands NLCS, Case Cohort, Age: 55-69 years, M/W 557/ 4 774 13.3 years Cancer registry FFQ Incidence, colon cancer, men ≥30 vs ≤0 g/day 1.40 (0.95-2.09) Age, sex, BMI, calcium intake, family history of colorectal cancer, fat intake, fibre intake, physical activity, total energy intake Used for colon and rectal cancer. of exposure categories. 460/ ≥30 vs ≤0 g/day 1.87 (1.03-3.38) 232/ Incidence, rectal cancer, men ≥30 vs ≤0 g/day 2.08 (1.20-3.59) 108/ Women ≥30 vs ≤0 g/day 0.72 (0.16-3.10) Toriola, 2008 COL40664 Finland KIHD, Prospective Cohort, Age: 53 years, M 54/ 2 627 16.7 Cancer registry Questionnaire Incidence, colorectal cancer, men, without first 2 yrs of follow-up 115.5-2853.1 vs 0-3.2 g/week 3.50 (1.20-9.80) Age, family history of cancer, fibre, leisure time physical activity, smoking status, socio-economic status, vegetable intake, year of Interview Mid-points of exposure categories. Conversion from g/week to g/day Mizoue, 2008 Pooled Analysis Incidence, 1.11(1.09-1.14)
Japanese Studies colorectal cancer smoking, body mass index ,energy, red meat, calcium, fiber and folate exposure categories. JPHC I 61595/ 694 Incidence, colon cancer 1.12(1.09-115) JPHC II 78825/781 Incidence, rectal cancer 1.11(1.07-1.15) JCCS 110792/ 662 Miyagi Cohort 47605/ 482 Takayana Study 31552/ 283 Ferrari, 2007 COL40648 Europe EPIC, Prospective Cohort, Age: 35-70 M/W 1 833/ 478 732 6.2 years Cancer registry / database / pathology reports FFQ Incidence, colorectal cancer ≥60 vs 0.1-4.9 g/day 1.64 (1.29-2.08) Ptrend:<0.001 per 15 g/day 1.09 (1.05-1.13) 1 184/ Incidence, colon cancer ≥60 vs 0.1-4.9 g/day 1.43 (1.04-1.97) Ptrend:0.201 per 15 g/day 1.07 (1.02-1.12) 649/ Incidence, rectal cancer ≥60 vs 0.1-4.9 g/day 1.93 (1.35-2.78) Ptrend:0.003 per 15 g/day 1.11 (1.05-1.17) 528/ Incidence, distal colon cancer ≥60 vs 0.1-4.9 g/day 1.68 (1.08-2.62) Ptrend:0.073 per 15 g/day 1.08 (1.01-1.16)
476/ Incidence, proximal colon cancer ≥60 vs 0.1-4.9 g/day 0.92 (0.51-1.66) Ptrend:0.323 per 15 g/day 1.03 (0.95-1.12) Incidence, colorectal cancer, never smoker per 15 g/day 1.15 (1.03-1.28) Former smoker per 15 g/day 1.11 (0.97-1.28) Current smoker per 15 g/day 1.23 (1.12-1.36) Incidence, colon cancer, men per 15 g/day 1.04 (0.98-1.10) per 15 g/day 1.10 (0.96-1.26) Incidence, rectal cancer, men per 15 g/day 1.11 (1.04-1.17) per 15 g/day 1.20 (0.97-1.49) Akhter, 2007 COL40632 Japan MCS, Prospective Cohort, Age: 40-64 years, M 285/ 21 199 11 Cancer registry questionnaire Incidence, colorectal cancer ≥45.6 vs ≤0 g/day 1.91 (1.32-2.78) 164/ Incidence, colon cancer ≥45.6 vs ≤0 g/day 2.03 (1.23-3.33) 124/ Incidence, rectal cancer ≥45.6 vs ≤0 g/day 1.84 (1.05-3.21) 73/ Incidence, distal colon cancer ≥45.6 vs ≤0 g/day 4.17
meat intake, physical activity, smoking status 70/ Incidence, proximal cancer ≥45.6 vs ≤0 g/day 1.40 (0.72-2.75) 285 Incidence, colorectal cancer Current vs 1.56 (1.10-2.22) 124 Incidence, rectal 1.54 (0.91-2.61) Chyou, 1996 COL00087 USA HHP, Prospective Cohort, M, Japanese ancestry 123/ 8 006 19 Selective service draft registration file Recall Incidence, rectal cancer, rectal cancer ≥24 vs ≤0 2.30 (1.43-3.69) Age Distribution of person-years by exposure category. of exposure categories. Conversion from oz/month to g/day Glynn, 1996 COL00431 Finland ATBC, Prospective Cohort, Age: 50-69 years, M, Smokers 140/ 27 109 8 years Cancer registry Food-use questionnaire Incidence, colorectal cancer, per 1 g/day 1.01 (1.00-1.02) Age, calcium, coffee, energy intake, physical activity during work, starch, sweet and sugar Exposure units rescaled to 10g/day Incidence, cancer 27.7 vs 5.3 g/day 3.60(1.60-10.40) Incidence, rectal cancer 1.50(0.30-6.70) Murata, 1996 COL04060 Japan Japan, Chiba cancer association cohort, Nested Case 61/ 122 controls 9 years Screening examinations Questionnaire Incidence, colon cancer, ≥56.7 vs ≤0 g/day 3.20 Age, sex, address Distribution of person-years by exposure category. 43/ Incidence, rectal ≥56.7 vs ≤0 1.40
Control, M Confidence intervals estimation. of exposure categories. 86 controls cancer, g/day Wu, 1987 COL00774 USA Leisure World Cohort, Prospective Cohort, M/W, Retirement community 68/ 11 644 4.5 years Population registries FFQ Incidence, right colon cancer, women ≥31 vs ≤0 ml/day 1.00 (0.40-2.80) Age Distribution of by exposure category. Conversion from ml/day to g/day. Mid-points of exposure categories. ≥31 vs ≤0 ml/day 1.66 (0.80-3.60) 58/ Men ≥31 vs ≤0 ml/day 2.84 (1.20-6.50) ≥31 vs ≤0 ml/day 2.21 (0.80-6.00) ≥31 vs ≤0 ml/day 2.42 (1.30-4.50) Incidence, colorectal cancer, women ≥31 vs ≤0 ml/day 1.45 (0.80-2.60)
Age: 40-79 years, M certificate and symptoms described by family members geographic location, smoking highest versus lowest analysis Gay, 2012 COL40920 UK EPIC-Norfolk, Prospective Cohort, Age: 45-79 M/W 185/ 25 636 11 years Cancer registry 7-day dietary recalls Incidence, colorectal cancer, gc:at mutations per 1 sd units 1.83 (1.10-3.04) Age, sex, smoking Superseded by Bamia, 2013 COL40964 Apc promoter methylation ≥20% per 1 sd units 1.10 (0.75-1.61) Apc mutations per 1 sd 1.63 (1.13-2.35) Bongaerts, 2011 COL40825 Netherlands NLCS, Prospective Cohort, Age: 55-69 years, M/W 594/ 120 852 7.3 years Cancer registry and database of pathology reports FFQ Incidence, colorectal cancer ≥30 vs abstainers g/day 0.91 (0.59-1.41) Age, BMI, calcium, energy intake, intake of fat, family history of colorectal cancer, fibre, gender, physical activity Bongaerts, 2008 was used because it has higher number of cases adjusted
Schernhammer, 2011 COL40882 USA NHS, Prospective Cohort, Age: 30-55 years, W, Registered nurses 386/ 88 691 20 Questionnaire/ medical records/death record FFQ Incidence, colon cancer 15-11 vs ≤0 g/day 1.11 (0.79-1.58) Ptrend:0.87 Age, alcohol, aspirin use, beef intake, BMI, calcium, energy intake, family history of colon cancer, gender, history of polyps, methionine, multivitamin, phyisical activity, sigmoidoscopy, smoking, vitamin b12, vitamin b6 Superseded by Nan, 2013 COL40971 Breslow, 2011 COL40892 USA NHIS, Prospective Cohort, Age: 18- years, M/W 850/ 323 354 2 716 472 person-years National center for health statistics & national death Index Questionnaire Mortality, colonrectal cancer current drinker - heavier vs never drinker 1.01 (0.70-1.47) Ptrend:0.24 Sex, BMI, educational marital status, race/ethnicity, region, smoking status Outcome is mortality. Included only in high versus lowest analysis 367/ Mortality, colorectal cancer, women current drinker - heavier vs never drinker 1.05 (0.61-1.80) Ptrend:0.33 Men current drinker - 1.08 (0.60-1.96)
heavier vs never drinker Ptrend:0.40 Park, 2010 UK Dietary Cohort Consortium 380 7 studies Incidence, colon cancer ≥30 vs <5 g/day 1.21(0.77-1.90) Age, weight, height, smoking status, social intakes of energy, fibre, folate, red meat and processed meat. Mid-points of exposure categories. Overlaps with EPIC (Bamia, 2013) and Ferrari, 2007 COL40648 EPIC Norfolk 25000/318 Incidence, rectal cancer 0.93 (0.48-1.78) EPIC Oxford 65249/121 Incidence, colorectal cancer, men ≥45 vs 0 g/day 1.24(0.69-2.22) Guemsey Study 6127/28 Incidence, colorectal cancer, women 1.52(0.56-4.10) Oxford Vegetarian Study 11140/31 NSHD 5362/ 7 35792/ 25 Whitehall II 10308/ 49 Yi, 2010 COL40798 Korea Kangwha Cohort, Prospective Cohort, Age: 55- years, M/W 26/ 6 291 20.8 Death records/calls or follow up visits/death certificates Questionnaire and Interview Mortality, colorectal cancer, men ≥540 vs ≤0 g/week 2.61 (0.88-7.78) Age, BMI, educational level, ginseng intake, history of chronic disease, pesticide use, smoking habits Outcome is mortality. Included only in high versus lowest 17/ Mortality, colon cancer, men ≥540 vs ≤0 g/week 4.59 9/ Mortality, rectal cancer, men ≥540 vs ≤0 g/week 1.01 (0.16-6.25) Simons, 2010 COL40821 NLCS, Prospective 1 260/ 120 852 Cancer registry and database of FFQ Incidence, colorectal >200 vs 0 ml/day 1.32 (0.94-1.85) Ptrend:0.16
Netherlands Cohort, Age: 55-69 years, M/W 13.3 years pathology reports cancer, men ethanol intake, family history of colorectal cancer, fibre intake, folate intake, meat intake, physical activity, physical activity, processed meat consumption, smoking, total fluid intake, vitamin b6 intake 2011 COL40825 and Bongaerts, 2008 COL40635 939/ Women >200 vs 0 ml/day 0.72 (0.37-1.41) Ptrend:0.14 417/ Incidence, distal cancer, men >200 vs 0 ml/day 0.94 (0.57-1.53) Ptrend:0.96 380/ Incidence, proximal colon cancer, women >200 vs 0 ml/day 1.28 (0.80-2.03) Ptrend:0.84 361/ Men >200 vs 0 ml/day 1.16 (0.79-1.70) Ptrend:0.95 322/ Incidence, rectal cancer, men >200 vs 0 ml/day 1.33 (0.80-2.20) Ptrend:0.28 284/ Incidence, distal colon cancer, women >200 vs 0 ml/day 0.45 (0.16-1.26) Ptrend:0.23 173/ Incidence, rectal cancer, women >200 vs 0 ml/day 1.00 (0.50-2.02) Ptrend:0.86
Kim, 2010 COL40834/ COL40827 Korea KNHIC, Prospective Cohort, Age: 40-69 years, M/W 466/ 1 341 393 5 years National death Index Mortality, colorectal cancer, men ≥90 vs ≤0 g/day 1.31 (0.90-1.91) Age, blood pressure, BMI, fasting serum glucose, physical activity, residential space, smoking, total cholesterol The outcome is mortality, only included on highest versus lowest 153/ Women ≥15 vs ≤0 g/day 2.51 (1.31-4.82) Key, 2009 COL40775 UK EPIC, Prospective Cohort, Age: 20-89 years, M/W, Vegetarians 228/ 63 550 National cancer registers FFQ Incidence, colorectal cancer ≥16 vs 1-7 g/day 1.24 (0.84-1.83) Age, sex, method of recruitment, smoking status Superseded by Bamia, 2013 COL40964 Schernhammer, 2008 COL40729 USA NHS-HPFS, Prospective Cohort, M/W 389/ 136 062 2 566 968 person-years Self report verified by medical record FFQ Incidence, cancer, women ≥15 vs ≤0 g/day 1.14 (0.80-1.61) Ptrend:0.91 310/ Women, ≥15 vs ≤0 g/day 1.17 (0.79-1.73) Ptrend:0.52 277/ Men ≥15 vs ≤0 g/day 1.44 (1.03-2.01) Ptrend:0.01 238/ 136 062 Incidence, cancer, men, msi-low/mss ≥15 vs ≤0 g/day 1.52 (1.06-2.17) Ptrend:0.002
activity, previous polyps, sigmoidoscopy, smoking status, vitamin b12 intake, vitamin B6 intake 2 566 968 person-years 79/ 136 062 2 566 968 person-years Incidence, colon cancer, women, msi-high ≥15 vs ≤0 g/day 1.01 (0.51-2.04) Ptrend:0.26 39/ Men, msi-high ≥15 vs ≤0 g/day 0.99 (0.40-2.43) Ptrend:0.78 Thygesen, 2008 COL40723 USA HPFS, Prospective Cohort, Age: 40-75 M, Health professionals 868/ 47 432 16 Follow up questionnaires, medical records FFQ Incidence, colorectal cancer per 10 g/day 1.08 (1.03-1.13) Age, aspirin use, BMI, calcium intake, colonoscopy, family history, folate intake, methionine, multivitamin, physical activity, processed and red meat, sigmoidoscopy, smoking status, total calories, vitamin d Superseded by Nan, 2013 COL40971
Hansen, 2008 COL40736 Denmark DCH, Case Cohort, Age: 50-64 years, M/W 164/ 1 215 10 Cancer registry Unknown Incidence, colorectal cancer, men, no homozygous carrier per 10 g/day 1.04 (0.97-1.12) Age, BMI, dietary intake, fish intake, fruits and vegetables consumption, HRT use, red meat intake Superseded by Bamia, 2013 COL40964 (component study of EPIC) 121/ Women, no homzygous carrier per 10 g/day 1.15 (0.98-1.36) 51/ Men, homozygous carrier - yes per 10 g/day 1.20 (1.00-1.43) 47/ Women, homozygous carrier - yes per 10 gday 0.87 (0.61-1.25) Schernhammer, 2008 COL40730 USA The Nurses's Health Study Cohort, Prospective Cohort, Age: 30-55 W 399/ 88 691 22 years Self report verified by medical record FFQ Incidence, cancer ≥15 vs ≤0 g/day 1.19 (0.86-1.65) Ptrend:0.72 Age Superseded by Cho, 2012 COL40902 ≥15 vs ≤0 g/day 1.19 (0.85-1.67) Ptrend:0.67 Alcohol intake, beef, pork or lamb as a main dish, BMI, family history of colorectal cancer, history of polyps, multivitamin supplement intake, physical
activity, postmenopausal hormone use, previous endoscopic screening, smoking habits de Vogel S, 2008 COL40734 Netherlands NLCS, Case Cohort, Age: 55-69 years, M/W 32/ 4 717 7.3 Record linkage to cancer registry/histo- and reports FFQ Incidence, colorectal cancer, women, no mlh1 protein ≥30 vs ≤0 g/day 3.38 Ptrend:0.64 Age, BMI, calcium intake, energy intake, family history of colorectal cancer, fat intake, Iron intake, meat intake, smoking habits, vitamin c Superseded Bongaerts, 2008 COL40635 2008 COL40636 Canada CNBSS, Prospective Cohort, Age: 40-59 years, W, Screening Program 617/ 49 654 16.4 years Record linkages to cancer database and to the national mortality database FFQ Incidence, colorectal cancer ≥30 vs ≤0 g/day 1.02 (0.72-1.44) Ptrend:0.48 Age, BMI, calories Intake, educational HRT use, menopausal status, oral contraceptive use, pack-years of smoking Only included in highest vs lowest Bongaerts, 2006 COL40619 NLCS, 417/ 4 076 Cancer registry FFQ Incidence, colon and ≥30 vs ≤0 g/day 1.25 (0.80-1.80)
7.3 rectosigmoid junction cancer, ki-ras- 231/ Ki-ras+ ≥30 vs ≤0 g/day 1.13 (0.70-1.90) 148/ Incidence, colon cancer, men, ≥30 vs ≤0 g/day 1.24 (0.70-2.30) 140/ Women, ki-ras+ ≥30 vs ≤0 g/day 1.83 (0.80-4.10) Women, ki-ras- ≥30 vs ≤0 g/day 0.65 (0.10-5.50) 63/ Incidence, rectal cancer, men, ≥30 vs ≤0 g/day 2.00 (0.80-5.30) 27/ Women, ki-ras+ ≥30 vs ≤0 g/day 1.25 24/ Women, ki-ras- 0.1-29.9 vs ≤0 g/day 0.98 (0.40-2.20) 82 Incidence, cancer, men, 1.15 (0.50-2.60)
Age: 40-59 years, M/W physical activity, public health center, smoking status 195/ Incidence, colorectal cancer, men ≥300 vs ≤0 g/week 2.00 (1.30-3.00) Ptrend:0.024 148/ Incidence, rectal cancer, men ≥300 vs ≤0 g/days/month 2.40 (1.50-4.00) Ptrend:0.015 Shimizu, 2003 COL00529 TCCJ, Prospective Cohort, Age: 35- years, M/W 108/ 29 051 8 years Hospital records and cancer registry FFQ Incidence, colon cancer, men ≥36.8 vs ≤0 g/day 2.67 (1.06-6.76) Ptrend:0.01 Age, alcohol consumption, BMI, educational level, height, smoking habits Superseded by Mizoue, 2008 94/ ≥3.76 vs ≤0 g/day 1.78 (1.00-3.18) Ptrend:0.03 59/ Incidence, rectal cancer, men ≥36.8 vs ≤0 g/day 1.17 (0.50-2.73) Ptrend:0.06 Harnack, 2002 COL00312 USA IWHS, Prospective Cohort, Age: 55-69 years, W 598/ 41 836 13 SEER FFQ Incidence, colon cancer, ≥20 vs 0-20 g/day 1.08 (0.72-1.62) Age, BMI, calcium Intake, energy Intake, estrogen use, pack-years of smoking, vitamin e Oral. contraceptive use Used only in highest vs lowest 123/ 41 836 13 years Incidence, rectal cancer, ≥20 vs 0-20 g/day 0.91 (0.39-2.10) Fuchs, 2002 COL00415 USA The Nurses's Health Study Cohort, Prospective 428/ 88 758 1 375 165 Nurses registry FFQ Incidence, colon cancer, no family history of crc ≥30 vs ≤0 g/day 0.88 (0.56-1.39) Age, alcohol consumption, aspirin use, beef, pork, or lamb, Superseded Nishihara, 2014 COL41036
years Hsing, 1998 COL00458 USA Lutheran Brotherhood Study, Prospective Cohort, Age: 35- years, M, policyholders 73/ 17 633 286 731 Responding to mail survey Questionnaire Mortality, colon cancer, ever vs never 1.30 (0.80-2.00) Age, alcohol Intake, area of residence Outcome is mortality Giovannucci, 1995 COL00112 USA HPFS, Prospective Cohort, Age: 40-75 years, M, Health professionals 35/ 47 931 261 916 Voluntarily responded to mailed questionnaire FFQ Incidence, cancer, folate intake >646 mcg/day ≥20 vs ≤20 g/day 1.03 (0.52-2.06) Age, aspirin use, BMI, energy intake, family history of specific cancer, folate, history of endoscopy, history of previous polyp and prior endoscopy, methionine, physical activity, red meat intake, smoking habits Superseded by Nan, 2013 COL40971 Gapstur, 1994 COL00212 USA IWHS, Prospective Cohort, Age: 55-69 years, W, Postmenopausal 75/ 38 006 5 years SEER FFQ Incidence, rectal cancer, ≥4 vs ≤0 g/day 1.27 (0.72-2.24) Ptrend:0.46 Age Superseded by Razzak, 2011 COL40889 Excluding first year of follow up ≥4 vs ≤0 g/day 0.83 Ptrend:0.23
Goldbohm, 1994 COL00427 Netherlands NLCS, Case Cohort, Age: 55-69 years, M/W 104/ 120 852 3.3 years Cancer registry and pathology reports FFQ Incidence, colon cancer, women ≥30 vs ≤0 g/day 1.30 Ptrend:0.76 Age, BMI, educational level, energy intake, intake of dietary fiber, energy-adjusted intake of fat, energy-adjusted intake of meat, energy-adjusted intake of protein, history of gallbladder surgery, smoking habits Superseded by Bongaerts, 2011 COL40825 101/ Men ≥30 vs ≤0 g/day 0.90 Ptrend:0.77 73/ Incidence, rectal cancer, men ≥30 vs ≤0 g/day 2.80 Ptrend:0.04 33/ Women ≥30 vs ≤0 g/day 1.30 Ptrend:0.97 Kreger, 1992 COL00665 USA FHS, Prospective Cohort, Age: 30-62 M/W 66/ 5 209 40 years Hospital records Questionnaire Incidence, colon cancer, women per 1 oz/week 0.95 (0.87-1.04) Unadjusted results 56/ Men per 1 oz/week 1.00 (0.97-1.04) 20/ Incidence, rectal cancer, women per 1 oz/week 0.92 (0.74-1.13) 19/ Men per 1 oz/week 0.99 (0.92-1.05) Garland, 1985 COL01050 USA Western Electric 1959-78, Prospective Cohort, Age: 40-55 years, M 49/ 1 954 20 years Hospital records Diet history method Incidence, colorectal cancer, (mean exposure) Only has mean exposure adjusted
Stemmermann, 1984 COL01232 USA HHP, Prospective Cohort, Age: 45-68 years, M 106/ 7 074 15 years Cancer registry Dietary history questionnaire Incidence, colon cancer, (mean exposure) Age Only has mean exposure 59/ Incidence, rectal cancer, (mean exposure)
Table 226 Serum vitamin D and colorectal cancer risk. Results of meta-analyses and pooled analyses of prospective studies published after the 2010 SLR. Author, Year Number of cohort studies Total number of cases Studies country, area Outcome Comparison RR (95%CI) P (I2, p Meta-analysis Lee, 2011 8 2 690 North America, Europe, Asia Incidence, colorectal cancer Highest vs lowest 0.66 (0.54-0.81) 9 1 822 Incidence, colon cancer 0.77 (0.56-1.07) 8 868 Incidence, rectal cancer 0.50 (0.28-0.88) Gandini, 2011 9 (case-control and cohort studies) 2 630 USA Incidence, colorectal cancer 0.85 (0.79-0.91) 55%, <0.01 Table 227 Serum vitamin D and colorectal cancer risk. Main characteristics of studies included in the CUP SLR dose-response Author, Year, WCRF Code, Country Study name, characteristics Cases/ Study size Follow-up (years) Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Missing data derived for analyses Weinstein, 2015 COL41025 USA PLCO, Nested Case Control, 476/ 474 controls 5.6 years Self-report verified by medical record Incidence, colorectal cancer ≥100 vs 50-75 nmol/l 0.40 (0.17-0.92) Q 5 vs Q 1 0.59 (0.36-0.95) per 25 nmol/l 0.77 (0.65-0.91) analysis
Age: 55-74 years, M/W history of colorectal cancer, Ibuprofen use, matching variables, physical activity, smoking habits 421/ 419 controls Incidence, colon cancer Q 4 vs Q 1 0.61 (0.40-0.93) 365/ Incidence, colorectal cancer Q5 vs Q1 0.60 (0.35-1.01) 300/ 299 controls Incidence, proximal colon cancer Q 4 vs Q 1 0.49 (0.30-0.82) 273/ 271 controls Incidence, colorectal cancer I-II Q 4 vs Q 1 0.62 (0.37-1.03) 174/ 173 controls Incidence, distal colon & rectal cancer Q 4 vs Q 1 0.74 (0.39-1.41) 119/ 118 controls Incidence, distal colon cancer Q 4 vs Q 1 0.96 (0.42-2.18) 55/ 54 controls Incidence, rectal cancer Q 4 vs Q 1 0.52 (0.17-1.59)
nurses cancer, Infection with HBV and/or HCV, Inflammatory score, matching variables, multivitamin supplement intake, pack years of smoking, physical activity, regular aspirin use Song, 2014 COL41027 USA HPFS, Nested Case Control, Age: 40-75 years, M, Health professionals 274/ 531 controls records/death record Incidence, colorectal cancer 36.6-43.1 vs 14.9-20.8 ng/ml 0.81 (0.50-1.30) Age, alcohol, BMI, dash endoscopy, family history of colorectal cancer, Inflammatory score, matching variables, multivitamin supplement intake, pack years of smoking, Unit converted to nmol/l
physical activity, regular aspirin use 2013 COL40667 WHI, Case Control nested in a RCT of Vit D + Calcium, Age:50-79 years, W 306/ 306 controls 11 years Self-report, verified by medical records Incidence, colorectal cancer ≥58.4 vs <31 nmol/l 2.53 (1.49–4.32) Age, center, race or ethnic group, date of blood sampling Hamling method used to recalculate RR’s Ordonez-Mena, 2013 COL40960 Germany ESTHER, Prospective Cohort, Age: 50-74 years, M/W 136/ 9 482 8 years Self-report, linkage to cancer registries, medical and pathology records Incidence, colorectal cancer Q 4 vs Q 2+3 0.77 (0.50-1.20) Age, sex, BMI, educational family history of cancer, fish consumption, fruit intake, multivitamin supplement intake, physical activity, red meat, smoking, vegetables intake Hamling method used to recalculate RR’s Lee, 2011 COL40861 PHS, 229/ 389 controls Incidence, colorectal cancer 1.08 (0.62-1.87)
Nested Case Control, Age: 40-84 years, M 8.9 years Follow up questionnaire, medical records season, fasting status, vigorous exercise, dairy calcium intake, BMI 172/ 287 controls Incidence, cancer 1.38 (0.73-2.64) 57/ 102 controls Incidence, rectal cancer 0.45 (0.14-1.46) Jenab, 2010 COL40823 multi-national EPIC, Nested Case Control, Age: 35-70 years, M/W 1 248/ 1248 controls 7 Record linkage to cancer registry/histo- and reports Dietary recall Incidence, colorectal cancer ≥100 vs 50-74.9 nmol/l 0.77 (0.56-1.06) Age, sex, alcohol intake, BMI, centre location, educational level, fasting condition, fruits intake, meat intake, menopausal status, phase of menstrual cycle at time of blood collection, smoking status, time, total dietary energy consumption, Hamling method used to recalculate RR’s 785/ 785 controls Incidence, colon cancer 100-123.5 vs nmol/l 0.71 (0.46-1.08) 50-
study area, vitamin use 54/ 102 controls Incidence, rectal cancer, women ≥27 vs ≤18.6 ng/ml 2.70 (0.94-7.60) ≥27 vs ≤18.6 ng/ml 0.33 (0.08-1.30) 44/ 87 controls Incidence, rectal cancer, men ≥32.1 vs ≤22.8 ng/ml 0.07 (0.01-0.99) ≥32.1 vs ≤22.8 ng/ml 4.60 Table 228 Serum vitamin D and colorectal cancer risk. Main characteristics of studies excluded from the CUP SLR dose-response Author, Year, WCRF Code, Country Study name, characteristics Cases/ Study size Follow-up (years) Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Reasons for exclusion Jung, 2014 COL41053 USA NHS-HPFS, Prospective Cohort, Age: 30-75 M/W, Health professionals 1 059/ 140 418 Self-report verified by medical record and pathology report Incidence, colorectal cancer Q 5 vs Q 1 0.55 (0.43-0.71) Age, sex, alcohol, aspirin use, BMI, calcium, endoscopy, family history of colorectal cancer, height, The exposure was predicted vitamin D score analysis
years physical activity, red meat, smoking, total calories, total fruit and vegetable consumption Freedman, 2010 COL40843 USA NHANES III, Prospective Cohort, Age: 17- years, M/W 95/ 16 819 225 212 National death Index Mortality, colorectal cancer ≥100 vs ≤50 nmol/liter 0.35 (0.11-1.14) Age, BMI, ethnicity, gender, smoking Mortality 61/ Men ≥80 vs ≤50 0.71 (0.25-1.99) 44/ Women ≥80 vs ≤50 0.37 (0.11-1.27) Freedman, 2007 COL40709 USA NHANES III, Prospective Cohort, Age: 17- years, M/W 66/ 16 818 146 578 National Index 24 hour recall Mortality, colorectal cancer ≥80 vs ≤49 nmol/l 0.28 (0.11-0.68) Age, sex, of smoking, race Mortality Wu, 2007 COL40683 USA HPFS, Nested Case Control, Age: 66 years, M 179/ 356 controls 8 Medical records FFQ Incidence, colorectal cancer 39.4 vs 18.4 ng/ml 0.83 (0.45-1.52) 139/ 276 controls Incidence, colon cancer 38.8 vs 19.3 ng/ml 0.46 (0.24-0.89)
≥19.4 vs ≤9.8 ng/l 0.80 (0.40-1.60) 55/ 109 controls Incidence, rectal cancer ≥43.2 vs ≤31.7 ng/l 0.50 (0.20-1.50) ≥19.4 vs ≤9.8 ng/l 0.40 (0.10-1.10) 48/ controls Incidence, distal colon cancer ≥19.4 vs ≤9.8 ng/l 0.60 (0.20-1.50) 43/ 86 controls Incidence, proximal colon cancer ≥19.4 vs ≤9.8 ng/l 1.30 (0.40-4.20)
233 Dietary vitamin E and colorectal cancer risk. Main characteristics of studies excluded from the CUP SLR dose-response Author, Year, WCRF Code, Country Study name, characteristics Cases/ Study size Follow-up (years) Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Reasons for exclusion McCarl, 2006 COL40633 USA IWHS, Prospective Cohort, Age: 55-69 years, W 954/ 35 197 15 years SEER registry FFQ Incidence, colorectal cancer ≥37.5 vs ≤5.9 mg/day 0.70 (0.57-0.87) Age Included in the Pooling Project. Park, 2010 Malila, 2002 COL00336 Finland ATBC, Prospective Cohort, Age: 50-69 years, M, Male Smokers 184/ 26 951 8 years Hospital records Dietary history questionnaire Incidence, colorectal cancer, 17.7 vs 7.5 mg/day 1.26 (0.83-1.89) Age, alcohol consumption, BMI, energy intake, physical activity, serum cholesterol, smoking habits, supplementation Included in the Pooling Project. Park, 2010 Wu, 2002 COL00905 USA NHS, Prospective Cohort, Age: 30-55 years, W, nurses 336/ 87 998 16 years Self-reported, hospital records and National Death Index FFQ Incidence, colon cancer, nhs (women) and no supplemental vit e Q 5 vs Q 1 0.78 (0.55-1.11) Age, alcohol consumption, aspirin use, BMI, family history of colorectal cancer, menopausal status, of smoking, physical activity, postmenopausal hormone use, Included in the Pooling Project. Park, 2010 analysis
Table 236 Supplemental vitamin E and colorectal cancer risk. Main characteristics of RCT studies identified in the CUP SLR Author, Year, WCRF Code, Country Study name, characteristics Cases/ Study size Follow-up Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Virtamo, 2013 COL41003 Finland ATBC, Randomised Control Age: 50-69 years, M, Male Smokers 676/ 25 563 18 years Finnish cancer registry and death certificates Incidence, colorectal cancer alpha-tocopherol vs no 1.02 (0.87-1.18) 347/ vs placebo 1.03 (0.83-1.27) Klein, 2011 COL40894 North America SELECT, Randomised Control Age: years, M, healthy men 160/ 34 887 54 646 Self-report verified by medical record and pathology report Questionnaire Incidence vitamin e supplement vs placebo 1.09 (0.72-1.64) Ptrend:0.60 Lippman, 2009 COL40767 USA SELECT, Randomised Control Age: 50- years, M 137/ 35 533 5.46 years reports FFQ Incidence, colorectal cancer vit e and selenium vs placebo 1.28 (0.82-2.00) 126/ vitamin e from suppl vs placebo 1.09 (0.69-1.73) 23/ Mortality, colorectal cancer vitamin e from vs placebo 1.30 (0.44-3.83) Gaziano, 2009 COL40770 USA PHS II, Randomised Control Age: 50- years, M, 162/ 13 983 8 Self report verified by medical record FFQ Incidence, colorectal cancer vit e assignment vs placebo 0.88 (0.64-1.19) Age, other design Issue, randomized treatment assignment, 53/ Mortality, colorectal cancer vit e assignment vs placebo 0.68 (0.39-1.18) report/hospital
years 237 Supplemental vitamin E and colorectal cancer risk. Main characteristics of cohort studies identified in the CUP SLR Author, Year, WCRF Code, Country name, characteristics Cases/ Study size Follow-up (years) Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Roswall, 2010 COL40797 Denmark DCH, Prospective Cohort, Age: 50-64 M/W 465 56 332 10.6 years Cancer registry FFQ Incidence, cancer ≥10.1 vs ≤0 mg/day 1.06 (0.73-1.56) Ptrend:0.15 Age, alcohol intake, beta carotene, BMI, educational level, folate intake, hormone use, physical activity, processed meat, red meat intake, smoking status, smoking status, vitamin c, vitamin e supplement per 10 mg/day 1.01 (1.00-1.03) +Vitamin e intake Hansen, 2009 COL40855 Denmark DCH, Case Cohort, Age: 50-64 years 73/ 57 053 Cancer registry FFQ Incidence, colorectal cancer, gpx1 pro198leu ct per 10 mg/day 0.96 (0.89-1.03) Alcohol intake, BMI, fruits and vegetables consumption, HRT use, smoking, 72/ Gpx1 pro198leu cc per 10 mg/day 0.99 (0.94-1.04) 22/ Gpx1 pro198leu tt per 10 mg/day 1.26 (0.98-1.62) Iso, 2007 COL40707 JACC, Prospective 209/ 105 500 Municipal resident FFQ Mortality, colon cancer, men use vs no use 1.76 (0.98-3.17)
Japan Cohort, Age: 40-79 years, M/W 15 years registration records, certificates use vs no use 0.86 (0.46-1.59) 158/ Mortality, rectal cancer, men use vs no use 0.61 (0.19-1.92) 84/ use vs no use 1.36 (0.62-3.00) Wu, 2002 COL00905 USA NHS, Prospective Cohort, Age: 30-55 years, W, nurses 626/ 87 998 16 years Self-reported, hospital records and National Death Index FFQ Incidence, colon cancer vitamin E and multivitamin vs never users 0.88 (0.66-1.16) Alcohol consumption, aspirin use, BMI, family history of colorectal cancer, menopausal status, of smoking, physical activity, postmenopausal hormone use, red meat intake ≥99 vs ≤0 iu/day 0.87 (0.68-1.11) Ptrend:37 ≥600 vs ≤0 iu/day 0.78 (0.43-1.42) Ptrend:0.29 HPFS, Prospective Cohort, Age: 40-75 years, M, Health professionals 370/ 47 344 10 FFQ Incidence, colon cancer vitamin E suppl and multivitamin vs never users 0.82 (0.60–1.11) 355/ ≥99 vs ≤0 iu/day 0.77 (0.57-1.02) Ptrend:0.06 ≥600 vs ≤0 iu/day 0.70 (0.38-1.29) Ptrend:0.06 Jacobs, 2001 COL00296 USA, Puerto Rico CPS II, Prospective Cohort, Age: 30- years, 4 336/ 711 891 14 years Self-reported and National Death Index Questionnaire Mortality, colorectal cancer, ≥10 vs ≤0 year 1.08 (0.85-1.38) 2 430/ Men ≥10 vs ≤0 year 1.13 (0.82-1.57)
M/W level, high-fiber grain food consumption, HRT use, vegetable consumption, vitamin supplement uses 1 906/ Women ≥10 vs ≤0 year 1.05 (0.73-1.49) 264/ Mortality, colon cancer, ≥10 vs ≤0 year 1.02 (0.79-1.31) 37/ Mortality, rectal cancer, ≥10 vs ≤0 year 1.78 (0.94-3.35) Sellers, 1998 COL01974 USA IWHS, Prospective Cohort, Age: 55-69 years, W, Postmenopausal 180/ 35 216 10 years SEER registry FFQ Incidence, colon cancer, no family history of crc ≥31 vs ≤0 mg/day 0.60 (0.40-0.90) Ptrend:0.03 Age, history of polyps, total energy intake 61/ Family history of crc ≥31 vs ≤0 mg/day 0.80 (0.40-1.60) Ptrend:0.5 Bostick, 1993 COL00483 USA IWHS, Prospective Cohort, Age: 55-69 W 212/ 35 216 167 447 SEER FFQ Incidence, colon cancer, ≥31 vs ≤0 iu/day 0.44 (0.28-0.71) Ptrend:0.0002 Age ≥31 vs ≤0 iu/day 0.50 (0.28-0.87) Ptrend:0.01 Age, calories intake, height, low-fat meat intake, parity, vitamin a supplement intake Shibata, 1992 COL00740 USA Leisure Cohort, Prospective 105/ 11 580 70 159 Hospital records and National Death Index FFQ Incidence, colon cancer, women yes vs no 0.76 (0.52-1.12)
Table 240 Multivitamin use and colorectal cancer risk. Results of meta-analyses and pooled analyses of prospective studies published after the 2005 SLR. Author, Year Number of cohort studies Total number of cases Studies country, area Outcome Comparison RR (95%CI) P trend Heterogeneity (I2, p value) Pooled analysis Park, 2010 13 ATBC CPS II HPFS NLCS NYSC CNBSS IWHS NLCS NYUWHS NHS SMC WHS 5454 44 467+349 456 393 335+223 349 431 799 353 96 162+429 43 485 40 North America and Europe Colon cancer incidence Users vs non users 0.88(0.81-0.96) 0.17 Meta-analysis 7 8737 North America and Europe Colorectal and colon cancer incidence Users vs 0.92(0.87-0.97) 4.9%, 0.39
Table 241 Multivitamin supplements and colorectal cancer risk. Main characteristics of studies included in the CUP SLR dose-response meta-analysis Author, Year, WCRF Code, Country Study name, characteristics Cases/ Study size Follow-up (years) Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Hutchinson, 2014 COL41052 UK UKWCS, Prospective Cohort, Age: 33-74 years, W 362/ 32 665 15 years National statistics office Questionnaire Vitamins, minerals, fish oils or other food supplements (14% of the 8915 women who were currently taking supplements at the second survey, were taking calcium supplements on a daily basis) Incidence, colorectal cancer users vs non users 1.13 (0.87-1.46) Age, alcohol, BMI, educational level, exercise, smoking Park, 2011 COL40853 USA MEC, Prospective Cohort, Age: 45-75 years, M/W, Japanese, Caucasian, or Hawaiian 1 494/ 182 099 Surveillance registry/end results cancer registry Questionnaire Multivitamins: with or without minerals, at least weekly Single supplement use: one or more of vitamin A, vitamin C, vitamin E, calcium, selenium, or iron at least once a week during the past year. Incidence colorectal cancer, men use vs no use 1.08 (0.66-1.75) Age at baseline, BMI, educational level, energy from fat, ethnicity, family history of colorectal cancer, fruit intake, HRT use, menopausal status, physical activity, pre-existing disease, smoking status, single supplement use, vegetable intake, yogurt consumption 1 292/ Women use vs no use 0.71 (0.43-1.18) Lee, 2011 USA NHS+HPFS 2299/ 87891men and women Self-reported and medical records FFQ Multivitamins (no details) Incidence, colorectal cancer ≥20 years vs never 0.77(0.64-0.94) Age, calendar year, pack-years of smoking before age 30 y, physical activity, aspirin dose, height, BMI, family
higher doses (often>200% of US RDA) of several B vitamins and often large doses of vitamin C or selected minerals, such as selenium or zinc. Supplement mixtures : < 10 components, such as B complex or antioxidant mixtures, were not considered multivitamins supplements (nyes=30) 0.89 (0.57-1.37) McCarl, 2006 COL40633 USA IWHS, Prospective Cohort, Age: 55-69 years, W 936/ 35 197 15 years SEER registry FFQ Multivitamins (no details) Incidence, colorectal cancer yes vs no 0.82 (0.71-0.94) Age Zhang, 2006 COL40742 USA WHS, Prospective Cohort, Age: 45- years, W, Health professionals 220/ 37 916 10.1 Self-report, report, national death Index, medical records reviewed by physicians FFQ Multivitamins (no details) Incidence, colorectal cancer current use vs never use 1.07 (0.72-1.61) Age, alcohol abuse, aspirin use, BMI, family history of colorectal cancer In first degree relatives, folate intake, history of polyps, menopausal status, physical activity, postmenopausal
Table 242 Multivitamin supplements and colorectal cancer risk. Main characteristics of studies excluded from the CUP SLR meta-analysis Author, Year, WCRF Code, Country Study name, characteristics Cases/ Study size Follow-up (years) Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Reasons for exclusion Iso, 2007 COL40707 Japan JACC, Prospective Cohort, Age: 40-79 years, M/W 214/ 105 500 15 years Municipal resident registration records, death certificates FFQ Multivitamin Mortality, colon cancer, men use vs no use 1.52 (1.03-2.27) Age, centre location Outcome is mortality 179/ use vs no use 1.42 (0.92-2.19) 159/ Mortality, rectal cancer, men use vs no use 1.09 (0.64-1.86) 84/ Women use vs no use 0.96 (0.41-2.24) Feskanich, 2004 COL01680 USA NHS, Nested Case Control, Age: 46-78 years, W 193/ 383 controls 11 years Medical records and writing or by telephone FFQ Incidence, colorectal cancer, user vs non-user 39% and 36% users in cases and non-cases respectively Month of blood draw, year of birth Superseded by Fuchs, 2002 COL00415 Wu, 2002 COL00905 USA HPFS, Prospective Cohort, Age: 40-75 years, M, Health professionals 328/ 47 344 10 years Hospital and pathology reports National Death Index FFQ Multivitamins and individual vitamins Incidence, cancer, no past users Vitamin E supplement and multivitamin vs never users Multivitamin only users vs never users 0.82 (0.60-1.11) 0.97 (0.75–1.24) Age, family history of colorectal cancer, BMI, physical activity , of smoking before age 30, aspirin use , red meat intake, alcohol consumption Not enough studies to conduct analysis on colon cancer only Fuchs, 2002 COL00415 NHS, Prospective 428/ 88 758 Hospital and pathology FFQ Multivitamin Incidence, colon cancer, no yes vs no 0.89 (0.72-1.10) Age, alcohol consumption, Not enough studies to
USA Cohort, Age: 30-55 years, W, nurses 1 375 165 person-years reports National Death Index use (no details) family history of crc aspirin use, beef, pork, or lamb, BMI, energy-adjusted levels of methionine, physical activity, screening endoscopy, smoking habits conduct analysis on colon cancer only Wu, 2002 COL00905 USA NHS, Prospective Cohort, Age: 30-55 years, W, nurses 600/ 87 998 16 years Hospital and pathology reports National Death Index FFQ Multivitamins and individual vitamins Incidence, colon cancer, no past users Vitamin E supplement and multivitamin users vs never users Multivitamin only vs never users 0.88 (0.66-1.16) 0.83 (0.68–1.01) Age, alcohol consumption, aspirin use, BMI, family history of colorectal cancer, menopausal status, of smoking, physical activity, postmenopausal hormone use, red meat intake Not enough studies to conduct analysis on cancer only Jacobs, 2001 COL00295 USA, Puerto Rico CPS II, Prospective Cohort, Age: 30- years, 5 093/ 806 379 16 years Self-reported and National Death Index Questionnaire Multivitamin use Mortality, colon cancer, users vs nonusers 0.92 (0.86-1.00) 2 740/ Men Daily users vs 0.91 (0.82-1.00)
M/W level, high-fiber grain food consumption, HRT use, vegetable consumption, vitamin c supplement use, vitamin e supplement use nonusers 2 353/ Women vs nonusers 0.93 (0.84-1.00) Number:53151 Giovannucci, 1998 COL00113 USA NHS, Prospective Cohort, Age: 30-55 years, W, nurses 655/ 88 756 1 215 392 person-years Hospital and pathology reports National Death Index FFQ Multivitamins containing acid Incidence, colorectal cancer, ≥15 vs ≤15 year 0.53 (0.35-0.80) Age, alcohol consumption, aspirin use, beef, pork, or lamb as main dish intake, BMI, family history of specific cancer, fibre, methionine, physical activity, smoking habits Superseded by Lee, 2011 USA 224/ Incidence, distal colon cancer, ≥15 vs ≤15 year 0.37 (0.15-0.90) 218/ Incidence, proximal colon cancer, ≥15 vs ≤15 year 0.16 (0.06-0.52) 143/ Incidence, rectal cancer, ≥15 vs ≤15 year 1.27 (0.67-2.46)
drug use, race, red meat, smoking Kim, 2010 Pooling Project BCDDP CPS II HPFS IWHS NYS NYUWHS NHS WHS NLCS ORDET SMC CNBSS ATBC 349 816 456 799 558 96 591 163 746 43 485 349 187 Follow-up questionnaires and medical records FFQ Incidence, colon cancer Highest vs lowest 0.92 (0.84-1.00) Education, BMI, height, smoking, energy intake, alcohol, red meat, milk intake, multivitamin, history of colorectal cancer, NSAID, physical activity, HRT, age Used continuous results in of colon cancer. Per 100mcg/day 0.98(0.95-1.01) Roswall, 2010 COL40797 Denmark DCH, Prospective Cohort, Age: 50-64 years, M/W 465 56 332 10.6 years Cancer registry 192-items FFQ Incidence, colon cancer ≥386.95 vs mcg/day 0.83 (0.57-1.21) Age, BMI, smoking status, educational level, hormone use, physical activity, and intakes of alcohol, red meat, processed meat, vitamin C, vitamin E beta carotene, per 100 mcg/day 0.85 (0.73-0.99) 283/ Incidence, rectal cancer ≥398.43 vs mcg/day 1.25 (0.78-2.00) per 100 mcg/day 0.95 (0.83-1.09) analysis
folate supplement Shrubsole, 2009 COL40773 China SWHS, Prospective Cohort, Age: 40-70 W 394/ 72 861 Cancer registry/death FFQ Incidence, colorectal cancer 419 vs 213 mcg/day 1.10 (0.80-1.70) Age, educational level, household income, BMI, smoking, HRT use, drinking status, physical activity, menopausal status, family history colorectal cancer, NSAID use, B vitamin supplement, history of colorectal polyps, diabetes, intakes of energy, fruits, vegetables, red meats, and calcium Distribution of person-years by exposure category. Kabat, 2008 COL40636 Canada Prospective Cohort, Age: 40-59 years, W, Screening Program 617/ 49 654 16.4 years Record linkages to cancer database and to the national mortality database 86 items FFQ Incidence, colorectal cancer ≥374 vs ≤236 mcg/day 0.89 (0.68-1.17) Age, alcohol, BMI, calories intake, educational level, HRT use, menopausal status, oral contraceptive Distribution of person-years by exposure category. of exposure categories.
use, pack-years of smoking de Vogel S, 2008 COL40646 Netherlands NLCS, Prospective Cohort, Age: 55-69 years, M/W 1 389/ 4 774 13.3 years Cancer registry FFQ Incidence, Colorectal cancer, men 297.2 vs 160.8 mcg/day 0.87 (0.65-1.15) Age, alcohol intake, BMI, smoking status, family history of colorectal cancer, and daily intakes of energy, calcium, fat, fibre, iron, meat, methionine, riboflavin, vitamin b6 intake Superseded by Pooling Project Kim, 2010 for colon cancer dose response meta-analysis. 960/ Colorectal, Women 267.3 vs 139 mcg/day 1.25 (0.89-1.76) 467/ Distal colon cancer, men 297.2 vs 160.8 mcg/day 0.71 (0.46-1.08) 296/ Distal cancer, women 267.3 vs 139 mcg/day 1.34 (0.81-2.22) 386/ Proximal cancer, women 267.3 vs 139 mcg/day 1.24 (0.76-2.02) 382/ Proximal cancer, men 297.2 vs 160.8 mcg/day 0.97 (0.62-1.52) 360/ Rectal cancer, men 297.2 vs 160.8 mcg/day 1.01 (0.64-1.60) 176/ Rectal cancer, women 267.3 vs 139 mcg/day 1.06 (0.53-2.11) Ishihara, 2007 COL40641 Japan JPHC, Prospective Cohort, M/W 335/ 81 184 5.8 years Periodic Institutional reports from hospitals, cancer registries, cert. 138 items FFQ Incidence, colorectal cancer, men Q 4 vs Q 1 1.20 (0.85-1.71) Age, BMI, physical activity, smoking status, study area, alcohol consumption, intakes of calcium, meat, Mid-points of exposure categories. 191/ Q 4 vs Q 1 1.33 (0.85-2.09)
vitamin D supplements Zhang, 2006 COL40742 USA WHS, Prospective Cohort, Age: 45- years, W, Health professionals 220/ 37 916 10.1 years Self-report, report, national death Index, medical records reviewed by physicians 131-item FFQ Incidence, colorectal cancer ≥385 vs ≤243 mcg/day 0.67 (0.43-1.03) Age, alcohol consumption, aspirin use, BMI, family history of colorectal cancer in first degree relatives, history of polyps, menopausal status, physical activity, postmenopausal hormone use, randomized treatment assignment, red meat intake, smoking status, total energy intake Distribution of person-years by exposure category. of exposure categories. Jiang, 2005 COL01846 China, Haining City of Zhejiang Province, Nested Case Control, Age: 40- years, M/W 73/ 343 controls 12 Cancer registry FFQ Incidence, rectal cancer ≥172.08 vs ≤115.63 mcg/1000 kcal/day 1.39 (0.56-3.50) Age, sex, alcohol intake, methionine intake, smoking habits, zinc intake Distribution of Non-cases. Mid-points of exposure categories. intakes in converted to mcg/day using
years average energy intake per each quantile 53/ 343 controls Incidence, cancer ≥172.08 vs ≤115.63 mcg1000 kcal/day 0.91 (0.69-1.19) Larsson, 2005 COL01852 Sweden SMC, Prospective Cohort, Age: 40-75 years, W 805/ 61 433 911 042 Cancer registry Questionnaire Incidence, colorectal cancer ≥212 vs 0-149 mcg/day 0.80 (0.60-1.06) Age, beta carotene, BMI, calcium, cereal fibre, educational level, methionine, red meat intake, saturated fat, total energy, vitamin b6 Distribution of person-years by exposure category. of exposure categories 252/ Incidence, rectal cancer ≥212 vs 0-149 mcg/day 0.93 (0.55-1.56) 547/ Incidence, cancer ≥212 vs 0-149 mcg/day 0.61 (0.41-0.91) Superseded by Pooling Project Kim, 2010 for colon cancer dose response meta-analysis Flood, 2002 COL00411 USA BCDDP, 1973, Prospective Cohort, Age: 40-93 years, W 485 45 264 8.5 years Breast cancer screening centres FFQ Incidence, colorectal cancer, ≥272 vs ≤142 mcg/1000 kcal 0.86 (0.65-1.13) Alcohol consumption, energy intake, methionine 2002 COL01158 Canada CNBSS, Case Cohort, Age: 40-59 198/ 56 837 10.4 years Breast cancer screening centres Quantitative FFQ Incidence, cancer, ≥367 vs ≤233 mcg/day 0.60 (0.30-1.10) Superseded by Pooling Project Kim, 2010 for
years, W intake, physical activity, smoking habits, total fat intake colon cancer dose response meta-analysis 97/ Incidence, rectal cancer, ≥367 vs ≤233 mcg/day 0.70 (0.30-1.80) Distribution of person-years by exposure category. Su, 2001 COL00547 USA NHANES I, Prospective Cohort, Age: 25-74 years, M/W 219/ 10 011 Population registry 24h-Recall questionnaire Incidence, colon cancer, ≥249 vs ≤103.3 mcg/day 0.57 (0.34-0.97) Age, sex, alcohol consumption, educational level, ethnicity, intakes of energy, fat, vitamin B12, vitamin B6 Distribution of person-years by exposure category. of exposure categories. 120/ Women ≥249 vs ≤103.3 mcg/day 0.74 (0.36-1.51) 99/ Men ≥249 vs ≤103.3 mcg/day 0.40 (0.18-0.88) Giovannucci, 1998 COL00113 USA NHS, Prospective Cohort, Age: 30-55 years, W, nurses 219/ 88 756 1 215 392 person-years Hospital rectods and National Index FFQ Incidence, colon cancer, using supplements <15 years ≥300 vs ≤200 mcg/day 0.82 (0.56-1.20) Age, alcohol consumption, aspirin use, beef, pork or lamb intake, BMI, family history of specific cancer, methionine, physical activity, smoking habits Superseded by Pooling Project Kim, 2010 for colon cancer dose response meta-analysis.
Table 250 Dietary folate and colorectal cancer risk. Main characteristics of studies excluded from the CUP SLR dose-response Author, Year, WCRF Code, Country name, characteristics Cases/ Study size Follow-up (years) Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Reasons for exclusion Gay, 2012 COL40920 UK EPIC-Norfolk, Prospective Cohort, Age: 45-79 years, M/W 185/ 25 636 11 years Cancer registry 7-day dietary recalls Incidence, colorectal cancer, gc:at mutations per 1 sd 0.92 (0.52-1.65) Age, sex, smoking Case-only study, only interaction results Apc promoter methylation ≥20% per 1 sd units 0.55 (0.35-0.85) Apc mutations per 1 sd units 0.91 (0.65-1.27) Lee, 2011 USA NHS+HPFS 2299/ 87891men and 47290 women Self-reported and medical records FFQ Incidence, colorectal cancer ≥500 years vs <250 mcg/d 1.02 (0.84, 1.24) Age, calendar year, pack-years of smoking before age 30 y, physical activity, aspirin dose, height, BMI, family history of colorectal cancer in parents and siblings, menopausal status and hormone therapy use, history of endoscopy, and intakes of red meat, alcohol, Superseded by Pooling Project Kim, 2010 analysis
calcium from foods, and total energy. de S, 2011 COL40867 Netherlands Netherlands Cohort on Diet and Cancer, 1986-1997, Nested Case Control, Age: 55-69 M/W 502/ 1 663 Cancer registry / database / pathology reports FFQ Incidence colorectal cancer, more than 3 variant alleles of folate metabolizing enzymes 255 vs 162 mcg/day 0.89 (0.51–1.54) Age, sex, alcohol consumption, BMI, family history of colon cancer, methionine, smoking status, total energy intake, vitamin B2, vitamin B6 Superseded by Pooling Project Kim, 2010 for colon cancer dose response meta-analysis. Wei, 2009 COL40777 USA NHS, Prospective Cohort, Age: 30-54 years, W 701/ 83 767 24 years report verified by medical record FFQ Incidence, colon cancer 600 vs 150 mcg/day 0.84 (0.69-1.02) Age, aspirin use, BMI, family history of colorectal cancer, height, of smoking, physical activity, postmenopausal hormone use, red or processed meat intake, year of endoscopy Superseded by Pooling Project Kim, 2010 for cancer dose response Butler, 2008 COL40639 SCHS, Prospective 961/ 61 321 Cancer registry FFQ Incidence, colorectal cancer Q 4 vs Q 1 0.86 (0.71-1.04) Age, sex, alcohol intake, Used only in highest
years, M/W reports cancer, energy 54/ Hmlh1- cases ≥225.6 vs mcg/day 0.92 (0.43-2.00) 2002 COL00415 USA NHS, Prospective Cohort, Age: 30-55 W, nurses 368/ 88 758 1 375 165 Self-reported and National Death Index FFQ Incidence, colon cancer, no family history of crc ≥400 vs ≤200 mcg/day 0.98 (0.72-1.33) Age, alcohol consumption, aspirin use, beef, pork, or lamb, BMI, energy-adjusted levels of methionine, physical activity, screening endoscopy, smoking habits Superseded by the Pooling Project Kim, 2010 for colon cancer dose response 295/ No family history of crc ≥5 vs ≤0 year 1.12 (0.83-1.50) Konings, 2002 COL01271 Netherlands NLCS, Case Cohort, Age: 55-69 years, M/W 400/ 120 852 7.3 years Cancer registries FFQ Incidence, cancer, men per 50 mcg/day 0.88 (0.78-0.99) ≥266 vs ≤168 mcg/day 0.73 (0.46-1.17) 360/ Colon cancer, women ≥243 vs ≤150 mcg/day 0.68 (0.39-1.20) per 50 mcg/day 0.96 (0.81-1.13) 259/ Incidence, rectal cancer, men ≥266 vs ≤168 mcg/day 0.66 (0.35-1.21) per 50 mcg/day 0.87 (0.74-1.02) 194/ Distal colon cancer, men ≥266 vs ≤168 mcg/day 0.74 (0.40-1.35) 186/ Proximal colon cancer, men ≥266 vs ≤168 mcg/day 0.75 (0.39-1.44)
Razzak, 2012 COL40928 USA IWHS, Prospective Cohort, Age: 55-69 years, W 1 298/ 35 216 Cancer registry and national death Index 126 items Willett FFQ Incidence, colorectal cancer ≥573.5 vs ≤250 mcg/day 0.95 (0.76-1.20) Age, BMI, waist to hip ratio, diabetes, exogenous estrogen use, physical activity, smoking status, and daily intakes of total energy, total fat, sucrose, red meat, calcium, vitamin E and alcohol Mid-points of exposure categories. 673/ Incidence, proximal cancer ≥573.5 vs ≤250 mcg/day 0.81 (0.59-1.11) Superseded by Pooling Project Kim, 2010 for colon cancer dose response meta-analysis. 597/ Incidence, distal colon cancer ≥573.5 vs ≤250 mcg/day 1.08 (0.77-1.49) Schernhammer, 2011 COL40882 USA NHS, Prospective Cohort, Age: 30-55 years, W, Registered nurses 386/ 88 691 20 records/death record FFQ Incidence, cancer ≥400 vs ≤200 mcg 0.81 (0.61-1.08) Age, alcohol, aspirin use, beef intake, BMI, calcium, energy intake, family history of colon cancer, gender, history of polyps, methionine, multivitamin, physical activity, sigmoidoscopy, smoking, vitamin b12, Superseded by Pooling Project Kim, 2010 for dose meta-analysis on cancer.
NYUWHS NHS WHS 96 591 163 intake, multivitamin, history of colorectal cancer, physical activity, HRT, age Per 100mcg/day 0.99(0.96-1.02) Roswall, 2010 COL40797 Denmark DCH, Prospective Cohort, Age: 50-64 years, M/W 178/ 56 332 10.6 years Cancer registry FFQ Incidence, rectal cancer ≥461.23 vs mcg/day per 100 mcg/day 1.06 (0.67-1.70) 0.95 (0.83-1.09) Age, alcohol intake, beta carotene, BMI, educational level, hormone use, physical activity, processed meat, red meat intake, smoking status, smoking status, vitamin c, vitamin e Reported for colon cancer in continuous increment. 105/ Incidence, colon cancer ≥441.67 vs mcg/day 0.67 (0.46-1.00) per 100 mcg/day 0.94 (0.85-1.04) 2005 COL40742 USA WHS, Prospective Cohort, Age: 45- years, W, Health professionals 220/ 37 916 10.1 years Self-report, death report, national death Index, medical records reviewed by physicians FFQ Incidence, colorectal cancer 1.16 (0.76-1.79)
of polyps, menopausal status, physical activity, postmenopausal hormone use, randomized treatment assignment, red meat intake, smoking status, total energy intake 44 Incidence, rectal cancer 0.94(0.43-2.03) Wei, 2004 COL00581 USA NHS, Prospective Cohort, W, nurses 672/ 87 733 24 years Self-reported verified by medical records and National Death Index FFQ Incidence, colon cancer, women ≥401 vs ≤200 mcg/day 0.82 (0.66-1.03) Age, alcohol consumption, beef, pork or lamb as a main dish, BMI, calcium, family history of colorectal cancer, height, history of endoscopy, of smoking before age 30, physical activity, processed meat Schernhammer, 2011 was used COL40882 The Pooling Project Kim, 2010 was used for dose response on colon cancer HPFS, Prospective Cohort, M, Health professionals 467/ 46 632 14 years Incidence, colon cancer, men ≥400 vs ≤200 mcg/day 0.72 (0.45-1.16) NHS 204/ Incidence, rectal cancer, women ≥401 vs ≤200 mcg/day 1.32 (0.86-2.05) Distribution of person-years by exposure category. HPFS 135/ Incidence, rectal cancer, men ≥400 vs ≤200 mcg/day 0.67 (0.26-1.72) Flood, 2002 COL00411 BCDDP, 1973, Prospective 485 45 264 Breast cancer screening FFQ Incidence, colorectal ≥633 vs ≤188 mcg/day 1.01 (0.75-1.35) Alcohol consumption, Distribution of by analysis
USA Cohort, Age: 40-93 years, W 8.5 years centres cancer, energy intake, methionine, total fat exposure category. of exposure categories. Harnack, 2002 COL00312 USA IWHS, Prospective Cohort, Age: 55-69 years, W 598/ 41 836 13 years SEER FFQ Incidence, cancer, 634.03-2555.2 vs 32.14-231.12 mcg/day 1.12 (0.77-1.63) Age, BMI, calcium intake, energy intake, estrogen use, pack-years of smoking, vitamin e Oral contraceptive use The Pooling Project Kim, 2010 was used for dose response on colon cancer 123/ Incidence, rectal cancer, 463.37-2555.2 vs 32.14-281.85 mcg/day 0.89 (0.52-1.51) Mid-points of exposure categories. Kato, 1999 COL00436 USA New York University Women's Health Study, Nested Case Control, Age: 62 years, W 150/ 81 Follow-up questionnaire FFQ Incidence, colorectal cancer, ≥626 vs ≤224 mcg/day 0.88 (0.46-1.69) Age, beer consumption, date of enrolment, date of subsequent blood, family history of specific cancer, menopausal status, occult blood testing, physical activity Mid-points of exposure categories. 1996 COL00161 Finland ATBC, Nested Case Control, 86/ 159 controls 8 Cancer registry FFQ Incidence, colon cancer 388 vs 268 mcg/day 0.51 (0.20-1.31) analysis
Table 258 Total folate and colorectal cancer risk. Main characteristics of studies excluded from the CUP SLR dose-response Author, Year, WCRF Code, Country Study name, characteristics size Follow-up Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Reasons for exclusion Lee, 2011 USA NHS+HPFS 2299/ 87891men and 47290 women Self-reported and medical records FFQ Incidence, colorectal cancer ≥800 vs <250 mcg/d 0.89 (0.74, Age, calendar year, pack-years of smoking before age 30 y, physical activity, aspirin dose, height, BMI, family history of colorectal cancer in parents and siblings, menopausal status and hormone therapy use, history of endoscopy, and intakes of red meat, alcohol, calcium from foods, and total energy. Superseded by Pooling Project Kim, 2010 Schernhammer, 2008 COL40729 USA NHS-HPFS, Prospective Cohort, M/W 277/ 136 062 2 566 968 Self-report verified by medical record FFQ Incidence, colon cancer, men ≥662 vs ≤284 mcg/day 0.80 (0.54-1.19) Age, aspirin use, BMI, intakes of calcium, beef, methionine, Superseded by Wei, 2004 analysis
nurses levels of methionine, physical activity, screening endoscopy, smoking habits Giovannucci, 1998 COL00113 USA NHS, Prospective Cohort, Age: 30-55 W, nurses 442/ 88 756 1 215 392 person-years Self-reported verified by medical records and National Death Index FFQ Incidence, colon cancer, ≥401 vs ≤200 mcg/day 0.69 (0.52-0.93) Age, alcohol consumption, aspirin use, beef, pork, or lamb as main dish intake, BMI, family history of specific cancer, fibre, methionine, physical activity, smoking habits Superseded by Wei, 2004, COL00581 and Kim, 2010 Giovannucci, 1995 COL00112 USA HPFS, Prospective Cohort, Age: 40-75 years, M, Health professionals 205/ 47 931 261 916 FFQ Incidence, cancer, Q 5 vs Q 1 0.86 (0.54-1.36) Age, aspirin use, BMI, energy intake, family history of specific cancer, folate, history of endoscopy, history of previous polyp and prior Only highest compared to lowest and interaction results. Superseded by Kim, 2010 149/ Aspirin ≥646 vs ≤269 mcg/day 0.86 (0.50-1.47) 56/ Aspirin use ≥646 vs ≤269 mcg/day 0.82 (0.33-2.08)
260 Serum/plasma folate and colorectal cancer risk. Results of meta-analyses and pooled analyses of prospective studies published after the 2010 SLR. Author, Year Number of cohort studies Total number of cases Studies country, area Outcome Comparison RR (95%CI) P (I2, p value) Meta-analysis Chuang, 2013 10 3,477 cases and 7,039 controls North America, Europe, Asia Colorectal cancer Per 10 nmol/L 0.96 (0.91-1.02)
Age: 40-75 M, Health professionals radioassay kit (Bio-Rad, Richmond, CA) exposure category Eussen, 2010 COL40822 EPIC, Nested Case Control, Age: 35-70 years, M/W 1 327/ 2239 controls Cancer registry, contact with cancer and pathology registries and active contact of subjects Plasma folate was determinated by lactobacillus casei microbiological assay. Incidence, colorectal cancer >18.3 vs <7.6 nmol/L 0.91 (0.73-1.14) Age, sex, alcohol, BMI, date of blood draw, educational level, fibre intake, physical activity, red and processed meat, smoking status, study centre Distribution of person-years by exposure category. of exposure categories. Le Marchand L, 2009 COL40774 USA MEC, Nested Case Control, Age: 45-75 years, M/W 223/ 407 controls SEER registry Plasma folate, method using a commercially available kit from Biorad. Incidence, colorectal cancer ≥26.2 vs ≤9.94 ng/ml 0.61 (0.33-1.13) Age, sex, BMI, date of blood collection, ethanol intake, ethnicity, family history of colorectal cancer, fasting condition, health screening, laboratory batch, physical activity, processed meat, smoking, study centre Mid-points of exposure categories.
Shrubsole, 2009 COL40772 China SWHS, Nested Case Control, Age: 40-70 years, W 303/ 1188 controls Cancer registry/death Plasma folate level were analysed using microbiological assay Incidence, colorectal cancer 11.1-304 vs 2.04-7.54 ng/ml 1.20 (0.80-1.70) Age, alcohol consumption, BMI, calcium intake, diabetes, educational attainment, energy intake, family history of colorectal cancer, intake, history of polyps, HRT use, Income, menopausal status, nsaid use, physical activity, red meat intake, smoking status, vegetable intake, vitamin use Mid-points of exposure categories. Otani, 2008 COL40673 JPHC, Nested Case Control, Age: 40-69 years, M/W 163/ 324 controls 11.5 years Cancer registry and certificates Plasma folate measured by immunoassay, Incidence, colorectal cancer, men ≥8.6 vs ≤5.5 ng/ml 0.86 (0.45-1.60) 160/ 297 controls Women ≥10.6 vs ≤6.7 ng/ml 1.00 (0.56-1.90) 119/ 237 controls Incidence, colon cancer, men ≥8.6 vs ≤5.5 ng/ml 0.82 (0.39-1.70) 106/ 195 controls Women ≥10.6 vs ≤6.7 ng/ml 0.97 (0.47-2.00)
physical activity, study area, vitamin use 54/ 102 controls Incidence, rectal cancer, women ≥10.6 vs ≤6.7 ng/ml 1.50 (0.38-5.50) 44/ 87 controls Men ≥8.6 vs ≤5.5 ng/ml 0.63 (0.11-3.60) Weinstein, 2008 COL40687 Finland ATBC, Nested Case Control, Age: 50-69 years, M 275/ 275 controls 14.2 years Cancer registry Serum folate by radioassay Incidence, colorectal cancer 12.9 vs 5.7 nmol/l 1.07 (0.60-1.91) Age, BMI, date of blood collection, Iron intake, physical activity, vitamin d Exposure unit in nmol/l, divided by conversion factor 2.266 to convert to ng/ml 151/ 151 controls Incidence, colon cancer 12.9 vs 5.7 nmol/l 1.41 (0.62-3.23) 126/ 126 controls Incidence, rectal cancer 12.9 vs 5.7 nmol/l 0.67 (0.27-1.71) Rossi, 2006 COL40759 Australia Busselton (Western Australia) Health Survey, 1969, Prospective Cohort, Age: 40-90 years, M/W 41/ 1 988 29 years Death register Serum folate By microbiological assay system Incidence, colorectal cancer per 2 mcg/litre 0.83 (0.62-1.10) Age, sex, alcohol intake, BMI, smoking habits Van Guelpen B, 2006 COL40681 Sweden NSHDC, Nested Case Control, Age: 25-74 years, M/W 221/ 432 controls 4.2 years Cancer registry Plasma folate by Quantaphase II radioassay Incidence, colorectal cancer ≥15 vs ≤4.9 nmol/l 1.01 (0.47-2.19) Age, sex, alcohol intake, BMI, date of enrolment, fasting condition, physical activity, Mid-points of exposure categories. 82/ 157 controls Incidence, rectal cancer Q 5 vs Q 1 0.50 (0.15-1.55)
smoking status, centre Kato, 1999 COL00436 USA New York University Health Study, Nested Case Control, Age: 62 W 150/ 81 Follow-up questionnaire Serum folate was measure by immunoassay Incidence, colorectal cancer, ≥31.04 vs ≤12.23 nmol/l 0.52 (0.27-0.97) Age, beer consumption, date of enrolment, date of subsequent blood, family history of specific cancer, menopausal status, occult blood testing, physical activity Distribution of cases and non cases by exposure category. of exposure categories.
268 Serum/plasma folate and colorectal cancer risk. Main characteristics of studies excluded from the CUP SLR dose-response meta-analysis Author, Year, WCRF Code, Country Study name, characteristics Cases/ Study size Follow-up (years) Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Reasons for exclusion Ma, 1997 COL40780 USA PHS, Nested Case Control, Age: 40-84 years, M 202/ 326 controls 12 years Medical records Plasma measured Incidence, colorectal cancer deficient vs adequate ng/ml 1.78 (0.93-3.42) Age, alcohol consumption, aspirin use, BMI, multivitamin supplement intake, physical activity, smoking status Binary result only. Superseded by Lee, 2012 COL40917 Glynn, 1996 COL00161 Finland ATBC, Nested Case Control, Age: 50-69 years, M, Male Smokers 86/ 159 controls 8 years Cancer registry Serum folate Incidence, colon cancer >2.9 vs ≤ 2.9ng/ml 0.73 Unadjusted Superseded by Weinstein, 2008 COL40687. Reviewed in text, CI mentioned to include 1.0 50/ 90 controls Incidence, rectal cancer 2.43
Table 272 Dietary vitamin B6 and colorectal cancer risk. Results of meta-analyses and pooled analyses of prospective studies published after the 2010 SLR. Author, Year Number of cohort studies Total number of cases Studies country, area Outcome Comparison RR (95%CI) P (I2, p value) Meta-analysis Larsson, 2010 8 Worldwide Incidence, colorectal cancer Highest vs lowest 0.90 (0.75-1.07) 56.2%, 0.01
and daily intakes of total energy, total fat, sucrose, red meat, calcium, vitamin E and alcohol Shrubsole, 2009 COL40773 SWHS, Prospective Cohort, Age: 40-70 years, W 394/ 72 861 Cancer registry/death FFQ Incidence, colorectal cancer 2.33 vs 1.36 mg/day 0.7 (0.4-1.2) Age, educational level, household income, BMI, smoking, HRT use,drinking status, physical activity, menopausal status, family history colorectal cancer, NSAID use, B vitamin supplement, history of colorectal polyps, diabetes, intakes of energy, fruits, vegetables, red meats, and calcium Distribution of person-years by exposure category de Vogel, 2008 COL40646 Netherlands NLCS, Prospective Cohort, 1 389/ 4 774 13.3 years Cancer registry FFQ Incidence, Colorectal cancer, men 1.88 vs 1.22 mg/day 1.29 (0.90–1.84)
Age: 55-69 years, M/W family history of colorectal cancer, and dialy intakes of energy, calcium, fat, fibre, iron, meat, methionine, riboflavin, vitamin b6 intake 960/ Colorectal, Women 1.63 vs 1.05 mg/day 1.39 (0.92-2.08) 467/ Distal cancer, men 1.88 vs 1.22 mg/day 1.03 (0.60–1.76) 296/ Distal colon cancer, women 1.63 vs 1.05 mg/day 1.06 (0.56–2.03) 386/ Proximal colon cancer, women 1.63 vs 1.05 mg/day 1.15 (0.65–2.04) 382/ Proximal colon cancer, men 1.88 vs 1.22 mg/day 1.50 (0.86–2.62) 360/ Rectal cancer, men 1.88 vs 1.22 mg/day 1.35 (0.76–2.41) 176/ Rectal cancer, 1.63 vs 1.05 mg/day 3.57 (1.56–8.17) Ishihara, 2007 COL40641 Japan JPHC, Prospective Cohort, M/W 335/ 81 184 5.8 years Periodic Institutional reports from hospitals, cancer registries, cert. 138 FFQ Incidence, colorectal cancer, men 1.91 vs 1.09 mg/day 0.69 (0.48-0.98) Age, BMI, physical activity, smoking status, study area, alcohol 191/ Incidence, colorectal cancer, women 1.8 vs 1.02 mg/day 1.10 (0.67-1.83)
consumption, intakes of calcium, meat, vitamin D supplements 2006 COL40742 USA WHS, Prospective Cohort, Age: 45- years, W, Health professionals 220/ 37 916 10.1 years Self-report, death report, national death Index, medical records reviewed by physicians 131-item FFQ Incidence, colorectal cancer ≥2.40 vs <1.69 mg/day 0.84 (0.56-1.27) Age, alcohol consumption, aspirin use, BMI, family history of colorectal cancer in first degree relatives, history of polyps, menopausal status, physical activity, postmenopausal hormone use, randomized treatment assignment, red meat intake, smoking status, total energy intake Distribution of person-years by exposure category Mid-points of exposure categories Larsson, 2005 COL01852 Sweden SMC, Prospective Cohort, Age: 40-75 years, 805/ 61 433 911 042 Cancer registry Questionnaire Incidence, colorectal cancer 0.66 (0.50–0.86) 252/ Incidence, rectal 0.75 (0.54–1.04)
Table 278 Dietary vitamin C and colorectal cancer risk. Main characteristics of studies included in the CUP SLR dose-response Author, Year, WCRF Code, Country Study name, characteristics Cases/ Study size Follow-up (years) Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Missing data derived for Leenders, 2014 COL41012 Europe EPIC, Nested Case Control, Age: 35-70 years, M/W 898/ 898 controls Cancer registry FFQ Incidence, cancer ≥151 vs ≤79 mg/day 0.76 (0.57-1.01) Ptrend:0.05 Alcohol consumption, educational matching variables, number of cigarettes smoked, physical activity, smoking duration, smoking status, time since smoking cessation, waist circumference Distribution of by exposure categories. of exposure categories. 501/ 501 controls Incidence, rectal cancer ≥151 vs ≤79 mg/day 1.01 (0.68-1.51) Ptrend:0.90 Ruder, 2011 COL40896 USA NIH-AARP, Prospective Cohort, Age: 50-71 Retired 2 819/ 292 797 985/ Cancer registry and national health database FFQ Incidence, colon cancer 169 vs 31 mg/1000kcal 0.83 (0.72-0.95) Ptrend:0.02 Sex, age at baseline, alcohol consumption, aspirin use, BMI, educational level, energy, energy, history of colon cancer, HRT use, physical activity, race, Distribution of person-years by exposure category. Intakes in converted to mg/day using average energy intake per each quantile Incidence, rectal cancer 169 vs 31 mg/1000kcal 0.96 (0.77-1.21) Ptrend:0.48 analysis
smoking, vitamin c Shin, 2006 COL40665 China SWHS, Prospective Cohort, Age: 40-70 years, W 283/ 73 314 5.74 Follow up survey/cancer statistics registry FFQ Incidence, colorectal cancer ≥127.2 vs 0-53.4 mg/day 1.10 (0.70-1.60) Ptrend:0.681 Age, alcohol, calories intake, educational level, family history of colorectal cancer, menopausal status, multivitamin supplement intake, physical activity, smoking status Distribution of person-years by exposure categories. of exposure categories. 129/ Incidence, colon cancer ≥127.2 vs 0-53.4 mg/day 1.00 (0.50-1.90) Ptrend:0.976 91/ Incidence, rectal cancer ≥127.2 vs 0-53.4 mg/day 1.20 (0.60-2.40) Ptrend:0.662 Sellers, 1998 COL01974 USA IWHS, Prospective Cohort, Age: 55-69 years, W, Postmenopausal 180/ 35 216 10 SEER registry FFQ Incidence, colon cancer, no family history of crc ≥168.4 vs ≤115 mg/day 0.80 (0.60-1.20) Ptrend:0.3 Age, history of polyps, total energy intake Distribution of by exposure categories. 61/ Family history of crc ≥168.4 vs ≤115 mg/day 1.10 (0.50-2.20) Ptrend:0.8 Shibata, 1992 COL00740 USA Leisure Cohort, Prospective Cohort, M/W, retirement community, upper middle social class 105/ 11 580 70 159 Community registry FFQ Incidence, cancer, women ≥225 vs 0-155 mg/day 0.61 (0.38-0.99) Ptrend:<0.05 Age, smoking habits Mid-points of exposure categories. 97/ Men ≥210 vs 0-145 mg/day 1.15 (0.70-1.88)
Table 279 Dietary vitamin C and colorectal cancer risk. Main characteristics of studies excluded from the CUP SLR dose-response meta-analysis Author, Year, WCRF Code, Country Study name, characteristics Cases/ Study size Follow-up (years) Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Reasons for exclusion Park, 2010 Pooling Project Studies ATBC CPS II HPFS NLCS NYSC BCDDP CNBSS IWHS NLCS NYUWHS NHS ORDET SMC WHS 5454/676141 44 467+349 456 393 335+223 349 431 799 353 96 162+429 43 485 40 Self-reported questionnaire and medical record FFQ Incidence, colon cancer Q5 vs Q1 1.06(0.95-1.18) P 0.12 Age, body mass index, education, physical activity, family history of colorectal cancer, use of nonsteroidal drugs, multivitamin use, smoking, alcohol consumption, intakes of red meat, total milk, dietary folate and total energy, and use of postmenopausal hormone therapy (premenopausal, never, ever) and oral Only included in highest compared to lowest analysis
contraceptive use (never, ever) in women Roswall, 2010 COL40797 Denmark DCH, Prospective Cohort, Age: 50-64 M/W 56 332 10.6 years Cancer registry FFQ Incidence, colon cancer ≥172.89 vs ≤83.92 mg/day 1.33 (0.87–2.03) Age, alcohol intake, BMI, educational level, hormone use, physical activity, processed meat, red meat intake, smoking status, vitamin e Component of EPIC study Superseded by Leenders, 2014 COL41012 per 100 mg/day 1.09 (0.82-1.44) Hansen, 2009 COL40855 Denmark DCH, Case Cohort, Age: 50-64 years 173/ 57 053 Cancer registry FFQ Incidence, colorectal cancer, gpx1 pro198leu cc per 100 mg/day 0.58 (0.34-0.98) Alcohol intake, BMI, fibre, fruits and vegetables consumption, HRT use, smoking, Component of EPIC Superseded by Leenders, 2014 COL41012 164/ Gpx1 pro198leu ct per 100 mg/day 0.98 (0.60-1.62) 38/ Gpx1 pro198leu tt per 100 mg/day 1.31 (0.49-3.49) Wark, 2005 COL01807 NLCS, Case Cohort, Age: 55-69 years, M/W 387/ 120 852 7.3 years Cancer registry and database of pathology reports FFQ Incidence, colon cancer, hmlh1+ cases ≥115.7 vs 0-80.6 mg/day 1.08 (0.81-1.43) Ptrend:0.67 Age, sex, family history of specific cancer, energy Case-only study
Table 280 Total iron and colorectal cancer risk. Main characteristics of studies identified in the CUP SLR Author, Year, WCRF Code, Country Study name, characteristics Cases/ Study size Follow-up Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Gay, 2012 COL40920 UK EPIC-Norfolk, Case-only Age: 45-79 years, M/W 185/ 25 636 11 years Cancer registry 7-day dietary recalls Incidence, colorectal cancer, gc:at mutations per 1 sd units 1.05 (0.59-1.88) Age, sex, smoking Apc promoter methylation ≥20% per 1 sd units 0.77 (0.51-1.16) Apc mutations per 1 sd 1.18 (0.84-1.69) Zhang, 2011 COL40891 USA NHS-HPFS, Prospective Cohort, M/W, nurses & health professionals 1 079/ 115 061 22 years Medical records and pathology reports FFQ Incidence, colorectal cancer, women ≥22.7 vs 0-10.9 mg/day 1.11 (0.88-1.41) Ptrend:0.44 Age, alcohol consumption, aspirin use, BMI, calcium Intake, endoscopy, energy-adjusted folate, history of colorectal cancer, HRT use, physical activity, smoking, vitamin d, zinc intake 1 035/ Men ≥24.6 vs 0-12.6 mg/day 1.08 (0.84-1.38) Ptrend:0.61 837/ Incidence, colon cancer, women ≥22.7 vs 0-10.9 mg/day 1.03 (0.79-1.36) Ptrend:0.87 815/ Men ≥24.6 vs 0-12.6 mg/day 1.14 (0.85-1.51) Ptrend:0.59 242/ Incidence, rectal cancer, women ≥22.7 vs 0-10.9 mg/day 1.44 (0.90-2.33) Ptrend:0.05 208/ Men ≥24.6 vs 0-12.6 mg/day 0.94 (0.55-1.60) Ptrend:0.91
Cross, 2010 COL40794 USA NIH-AARP, Prospective Cohort, Age: 50-71 years, M/W 2 719/ 300 948 7.2 Cancer registry and death certificates and questionnaires FFQ Incidence, colorectal cancer 36.1 vs 10.8 mg/day 0.75 (0.66-0.86) Ptrend:<0.001 Sex, BMI, dietary calcium intake, dietary fiber intake, educational level, smoking habits, total energy intake 1 995/ Incidence, colon cancer 36.1 vs 10.8 mg/day 0.73 (0.62-0.84) Ptrend:<0.001 724/ Incidence, rectal cancer 36.1 vs 10.8 mg/day 0.84 (0.65-1.08) Ptrend:0.070 Kato, 1999 COL00434 USA New York University Women's Health Study, Nested Case Control, Age: 34-65 years, W 105/ 523 controls 4.7 years Questionnaires FFQ Incidence, colorectal cancer, Q 4 vs Q 1 1.17 (0.60-2.30) Ptrend:0.44 Beer consumption, family history of colorectal cancer, hours spent In sports In their early thirties, prior occult blood testing 49/ Incidence, distal colon cancer, Q 4 vs Q 1 0.95 (0.30-2.80) Ptrend:0.82 33/ Incidence, proximal colon cancer, Q 4 vs Q 1 3.29 Ptrend:0.04 17/ Incidence, rectal cancer, Q 4 vs Q 1 0.85 (0.20-4.70) Ptrend:0.87
cancer, recreational activity, smoking status, total energy intake, vegetable intake 539/ Incidence, colon cancer, men 17 vs 9.5 mg/day 1.30 (0.84-2.01) Ptrend:0.43 484/ Women 15 vs 8.5 mg/day 1.14 (0.73-1.80) Ptrend:0.91 333/ Incidence, rectal cancer, men 17 vs 9.5 mg/day 1.44 (0.85-2.45) Ptrend:0.08 185/ 15 vs 8.5 mg/day 1.11 (0.53-2.30) Ptrend:0.63 Cross, 2006 COL40621 Finland ATBC, Nested Case Control, Age: 50-69 years, M 117/ 260 controls 14.2 years Cancer registry FFQ Incidence, colorectal cancer ≥22.1 vs ≤14.4 mg/day 0.40 (0.10-1.10) Ptrend:0.06 Age, alcohol consumption, aspirin use, BMI, educational level, energy intake, other laboratory factors, physical activity, smoking habits Wurzelmann, 1996 COL00221 USA NHANES I, Prospective Cohort, Age: 31- years, M/W 98/ 11 317 15 years Population registry Recall questionnaire + FFQ Incidence, colon cancer, Q 4 vs Q 1 3.35 (1.74-6.46) Ptrend:<0.001 57/ Incidence, distal cancer, Q 4 vs Q 1 1.03 (0.80-1.32)
52/ Incidence, proximal colon cancer, Q 4 vs Q 1 1.44 (1.23-1.69) 38/ Incidence, rectal cancer, Q 4 vs Q 1 1.01 (0.42-2.42) Ptrend:0.98
activity, smoking status, total energy intake, vegetable intake cancer, men mg/day Ptrend:0.10 484/ Women 1.54 vs 0.47 mg/day 1.20 (0.83-1.74) Ptrend:0.56 333/ Incidence, rectal cancer, men 1.85 vs 0.6 mg/day 0.98 (0.64-1.50) Ptrend:0.84 185/ Women 1.54 vs 0.47 mg/day 1.23 (0.73-2.07) Ptrend:0.11 Larsson, 2005 COL40745 Sweden SMC, Prospective Cohort, Age: 40-75 years, W 547/ 61 433 14.8 years Cancer Registry FFQ Incidence, colon cancer ≥2.06 vs ≤0.66 mg/day 1.31 (0.98-1.75) Ptrend:0.03 Age, BMI, calcium intake, calendar period, dietary fibre intake, educational level, folate intake, saturated fat, total energy intake, zinc intake Distribution of person-years by exposure category. of exposure categories Alcohol intake ≥20g/week 2.29 (1.25- 4.21) Ptrend:0.007 Lee, 2004 COL00285 USA IWHS, Prospective Cohort, Age: 55-69 years, W, Postmenopausal 438/ 34 708 15 years SEER FFQ Incidence, proximal colon cancer, ≥2.05 vs ≤0.76 mg/day 2.18 (1.24-3.86) Ptrend:0.01 Age, alcohol consumption, BMI, calcium, diabetes, fibre, folate, HRT use, multivitamin supplement intake, physical activity, Mid-points of exposure categories 303/ Incidence, distal colon cancer, ≥2.05 vs ≤0.76 mg/day 0.90 (0.45-1.81) Ptrend:0.77
Table 290 Heme-iron and colorectal cancer risk. Main characteristics of studies excluded from the CUP SLR dose-response Author, Year, WCRF Code, Country name, characteristics Cases/ Study size Follow-up (years) Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Reasons for exclusion Gilsing, 2013 COL40987 Netherlands Netherlands Cohort Study on Diet and Cancer (NLCS), Case Cohort, Age: 55-69 years, M/W 644/ 4 026 7.3 years Cancer registry and pathology register FFQ Incidence, colorectal cancer, kras negative Kras positive per 1 mg/day 1.27 (0.86-1.69) 1.35 (0.93–1.94) Age, sex, alcohol consumption, BMI, energy intake, family history of colorectal cancer, meat intake, physical activity, physical activity, processed meat, smoking, vegetable consumption Only has interaction results. Superseded by Balder, 2006 COL40622 (higher number cases) 435 Incidence, colon cancer, kras negative Kras positive per 1 mg/day 1.31 (0.92–1.87) 1.43 (0.98–2.09) 140 Incidence, rectal cancer, kras negative Kras positive per 1 mg/day 1.41 (0.85–2.35) 0.58 (0.27–1.25) Gay, 2012 COL40920 UK EPIC-Norfolk, Prospective Cohort, Age: 45-79 years, M/W 185/ 25 636 11 years Cancer registry 7-day dietary recalls Incidence, colorectal cancer, gc:at mutations per 1 sd units 1.64 (0.97-2.75) Age, sex, smoking Case-only study with interaction results Apc promoter methylation ≥20% per 1 sd units 1.13 (0.79-1.62) Apc mutations per 1 sd units 1.50 (1.09-2.09) analysis
Table Selenium supplements and colorectal cancer risk. Main characteristics of studies included in the CUP SLR dose-response Author, Year, WCRF Code, Country name, characteristics Cases/ Study size Follow-up (years) Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Klein, 2011 COL40894 North America SELECT, Randomised Control Trial, Age: 50- years, M, healthy men 168/ 34 887 54 646 Self report verified by medical record and pathology report Questionnaire Incidence selenium and vit e supplement vs placebo 1.21 (0.81-1.81) Ptrend:0.22 149/ selenium supplement vs placebo 0.96 (0.63-1.46) Ptrend:0.79 Lippman, 2009 COL40767 USA SELECT, Randomised Control Age: 50- years, M 123/ 35 533 5.46 years Self reports FFQ Incidence, colorectal cancer selenium from supp vs placebo 1.05 (0.66-1.67) 20/ Mortality, colorectal cancer selenium from suppl vs placebo 1.00 (0.32-3.16) selenium and vit e vs placebo 1.49 (0.52-4.28) Bostick, 1993 COL00483 USA IWHS, Prospective Cohort, Age: 55-69 years, W 212/ 35 216 167 447 Population FFQ Incidence, colon cancer, yes vs no 0.60 (0.27-1.32) Age, calories Intake, height, low-fat meat Intake, parity, total vitamin e Intake, total vitamin e x age, vitamin a supplement Intake analysis
Framingham Study USA Total physical activity 1990 Self-reported weighted sum of time sleeping, sitting or standing, walking, moderate activity (as gardening), heavy (as shoveling). Not indicated Honolulu Heart Program Total physical activity (Severson, 1989) Same as Framingham study: time sleeping, sitting or standing, walking, moderate activity (as gardening), heavy (as shoveling). Not indicated Iowa Women’s Health Study USA Recreational (Bostick, 1994) Two questions on frequency of free-time activities: moderate (bowlimg, golf, light sports, exercise, gardening, long walks) and vigorous (jogging, racket sports, swimming, aerobics, strenuous sports) Not indicated Swedish Twin Follow-up Study physical activity Recreational (Gerhardsson, 1988) Self-reported. Combination of time and intensity of occupational and recreational activities Not indicated Leisure World Cohort (Wu, 1987) Mailed questionnaire; time spent on physical activity (swimming, biking, dancing) Not indicated
Table 299 Total physical activity and colorectal cancer risk. Main characteristics of studies included in the CUP SLR dose-response meta-analysis Author, Year, WCRF Code, Country Study name, characteristics Cases/ size Follow-up Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Aleksandrova, 2014 COL41051 Europe EPIC, Prospective Cohort, Age: 25-70 years, M/W 3 759/ 347 237 12 years Cancer registry (in a few centres, combination of methods) Questionnaire on occupational activity, walking, cycling, gardening, sports, work, housework and climbing Incidence, colorectal cancer high vs low 0.94 (0.87-1.00) Age, sex, overweight and obesity, study centre, alcohol consumption, diet quality index, education, smoking 1390/ Incidence, rectal cancer high vs low 1.03 (0.92-1.15) 2369/ Incidence, colon cancer high vs low 0.88 (0.81-0.96) Odegaard, 2013 COL40948 Singapore SCHS, Prospective Cohort, Age: 45-74 years, M/W 969/ 50 466 579 628 Cancer registry and death registry Interview on strenuous sports vigorous work and moderate activities (e.g., walking, bicycling) Incidence, colon cancer ≥1.5 vs <1.5 hours/week 0.61 (0.42-0.88) Age, sex, BMI, diabetes, dialect group, dietary pattern score, energy intake, sleep time, alcohol intake, education, family history of colorectal cancer, smoking
Norway screening service Prospective Cohort, Age: 20-69 years, M/W 1 305 607 person-years sedentary (r1+o1-2) Rectal cancer 1.20 (0.72-2.02) 98/ Female, colon cancer active (o2-4 + r2-4) vs sedentary (r1+o1-2) 0.63 (0.39-1.04) Age, BMI, geographic region Rectal cancer 1.27 (0.59-2.72) Lee, 1991 COL00678 USA Harvard Alumni Cohort, Prospective Cohort, Age: 30-79 M, Harvard Alumni 225/ 17 148 26 years Harvard alumni questionnaires and certificates Incidence, colon cancer, Highly active vs inactive 0.85 (0.64-1.12) Age Rectal cancer 1.43 (0.78-2.60) Ballard-Barbash, 1990 COL00488 USA FHS, Prospective Cohort, Age: 30-62 years, M/W 73/ 4 124 28 years Hospital records Questionnaire Incidence, colorectal cancer, men 25-29 vs 34-84 1.80 (1.00-3.20) Age 59/ Female 25-29 vs 31-55 1.10 (0.60-1.80)
Severson, 1989 COL00738 USA Honolulu Heart Program, Prospective Cohort, Age: 46-68 years, M 191/ 7 925 31 years Cancer registry & hospital surveillance Interview Incidence, colon cancer, ≥34.3 vs 0-30.1 0.71 (0.51-0.99) Age, BMI Gerhardsson, 1988 COL01044 Sweden Swedish Twin Follow-up Prospective Cohort, M/W, twin individuals 36/ 16 477 14 years Cancer and Death Registries Questionnaire Incidence, cancer, Q21 vs Q22 3.60 (1.30-9.80) Age, sex Rectal cancer 0.83 (0.45-1.43) Singh, 1998 COL00185 USA AHS, Prospective Cohort, Age: years, M/W, Seventh-day Adventists 152/ 32 051 178 544 Medical records Questionnaire Incidence, colon cancer, high vs low vigorous physical activity 1.04 (0.72-1.51) Age, sex, family history of specific cancer
Table 300 Total physical activity and colorectal cancer risk. Main characteristics of studies excluded from the CUP SLR dose-response meta-analysis Author, Year, WCRF Code, Country name, characteristics Cases/ Study size Follow-up (years) Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Exclusion reason Makarem, 2015 COL41060 USA Framingham Heart Study - Cohort, Prospective Cohort, Age: 66.00years, M/W 63/ 2 983 11.5 years Death certificate and medical records Questionnaire Incidence, colorectal cancer per 1 0.95 (0.47-1.93) Age, sex, smoking status Only continuous results per 1 0.88 (0.43-1.78) Age Hughes, 2011 COL40873 Netherlands Netherlands Cohort Study on Diet and Cancer, 1986-1997, Case Cohort, Age: 55-69 years, M/W 321/ 5 000 7.3 years Cancer registry Questionnaire Incidence, colorectal cancer, high vs low 0.69 (0.47-1.01) Age, sex, education level, energy intake, smoking status, socio-economic status, alcohol intake, family history of colorectal cancer, fruit and vegetable, grains intake, physical activity, red meat consumption Superseded by Simmons, 2013 high vs low 0.67 (0.47-0.96)
Age, sex 155/ 2-3 genes methylated high vs low 0.54 (0.31-0.94) 122/ 0-1 genes methylated high vs low 0.72 (0.41-1.28) 108/ Island methylator phenotype (cimp) high vs low 0.81 (0.48-1.36) Age, sex, education level, energy intake, smoking status, socio-economic status, alcohol intake, family history of colorectal cancer, fruit and vegetable, grains intake, phyisical activity, red meat consumption 93/ 4-7 genes methylated high vs low 0.88 (0.50-1.54) Age, sex Friedenreich, 2006 COL40620 EPIC, Prospective Cohort, 1 075/ 413 044 6.38 Cancer registry, record linkage, health insurance Incidence, colon cancer active vs inactive 0.78 (0.59-1.03)
Europe Age: 35-70 years, M/W rec, pathology and active follow up intake, fiber intake, height, smoking status, weight 587/ Incidence, rectal cancer active vs inactive 1.02 (0.73-1.44) Pukkala, 1993 COL01117 Finland Finland, female teachers, Prospective Cohort, W, teachers 26/ 10 118 141 092 Cancer Registries Incidence, colon cancer, language teachers Language teachers vs Finnish population 1.25 (0.81-1.81) Age No level of physical activity measured. Comparison between physical activity teachers and Finnish general population 15/ Incidence, rectal cancer, language teachers Language teachers vs Finnish population 1.10 (0.62-1.81) 9/ Incidence, colon cancer, Physical education teachers Physical education teachers vs Finnish population 1.61 (0.74-3.05) 1/ Incidence, rectal cancer, Physical education teachers Physical education teachers vs Finnish population 0.27 (0.01-1.52)
Table 306 Recreational physical activity and colorectal cancer risk. Results of pooled analyses of prospective studies published after the 2010 SLR. Author, Year Number of cohort studies Total number of cases Studies country, area Outcome Comparison RR (95%CI) P trend Heterogeneity (p value) Boyle, 2012 21 cohort and studies 9512 Europe, North America, Japan, Australia Proximal colon cancer Highest vs lowest 0.73(0.66-0.81) 31.3%, 0.06 0%, 0.47 8171 Distal colon cancer 0.74(0.68-0.80) Yang, 2010 28 cohort studies Europe, North America, Asia Colon cancer Highest vs lowest Men 0.74(0.61 - 0.14 Highest vs lowest Women 0.99(0.95 – 0.41 Harris, 2009 15 7873 Europe, North America, Japan Colon cancer Highest vs lowest Men 0.80 (0.67-0.96) 54.1%, 0.01 Highest vs lowest Women 0.86 (0.76-0.98) 0%, 0.88 Rectal cancer Highest vs lowest Men 1.02 (0.83-1.26) 8.1%, 0.37 Highest vs lowest Women 1.29 (0.82-2.01) 29.5%, 0.24
307 Recreational physical activity and colorectal cancer risk. Main characteristics of studies included in the CUP SLR meta-analysis Author, Year, WCRF Code, Country name, characteristics Cases/ Study size Follow-up (years) Case Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Reasons for exclusion Land, 2014 COL41062 USA NSABP P-1, Prospective Cohort, Age: 54 years, W, High Risk population 35/ 13 388 7 years Follow-up visits Questionnaire Incidence, invasive colon cancer low/no activity vs more active 0.90 Age, alcohol consumption, estrogen use, family history of cancer, menstrual status, race, smoking status, treatment allocation, asprine use, smoking duration, smoking intensity Simons, 2013 COL40956 Netherlands NLCS, Prospective Cohort, Age: 55-69 years, M/W 377/ 4 416 16 years Cancer registry Self-report Incidence, distal cancer, women 0.69 (0.50-0.96) 227/ Incidence, rectal cancer, women 0.59 (0.39-0.90) 1 107/ Incidence, colon cancer, men 1.06 (0.84-1.33) 438/ Incidence, rectal cancer, men 1.10 (0.80-1.52) 581/ Incidence, 1.18 (0.88-1.60)
distal colon cancer, men 480/ Incidence, proximal colon cancer, men 0.92 (0.68-1.25) 517/ Women 0.71 (0.53-0.96) 924/ Incidence, colon cancer, women 0.70 (0.55-0.88) Robsahm, 2010 COL40835 Norway Norwegian World Class Athletes, Prospective Cohort, Age: 17- years, M/W 22/ 3 428 Cancer registry Questionnaire Incidence, colon cancer athlete vs not athlete 0.89(0.56-1.34) Age, sex, birth cohort Wei, 2009 COL40777 USA The Nurses's Health Study Cohort, Prospective Cohort, Age: 30-54 years, W 701/ 83 767 24 years Self-report verified by medical record questionnaire every 4 years (no details) Incidence, colon cancer 21 vs 2 0.51 (0.33-0.78) Age, aspirin use, BMI, folate intake, height, pack-years of smoking, year of endoscopy, family history of colorectal cancer, postmenopausal hormone use, completed hours/week
red or processed meat intake Lee, 2009 COL40764 China SWHS, Prospective Cohort, Age: 40-70 years, W 236/ 73 224 7.4 years Cancer registry and death certificates and participant contact Incidence, colon cancer ≥13.6 vs ≤0 1.20 (0.80-1.70) Age, energy intake 158/ Incidence, rectal cancer ≥13.6 vs ≤0 1.10 (0.70-1.70) Howard, 2008 COL40715 USA NIH- AARP Diet and Health Study, Prospective Cohort, Age: 50-71 years, M/W 1 090/ 488 720 6.9 years Cancer registry Questionnaire Incidence, colon cancer, women ≥5 vs never/rarely 0.87 (0.71-1.06) 2 257/ Men ≥5 times/week vs never/rarely 0.82 (0.71-0.95) 1 190/ Incidence, proximal colon cancer, men ≥5 times/week vs never/rarely 0.83 (0.68-1.02) 923/ Incidence, rectosigmoid and rectum cancer, men ≥5 times/week vs never/rarely 0.76 (0.61-0.95) 971/ Incidence, distal colon cancer, men ≥5 times/week vs never/rarely 0.83 (0.67-1.03) 361/ Incidence, rectosigmoid and rectum cancer, ≥5 times/week vs never/rarely 0.97 (0.67-1.41) hours/week
women 389/ Incidence, distal colon cancer, women ≥5 times/week vs never/rarely 0.82 (0.58-1.14) 670/ Incidence, proximal colon cancer, women ≥5 vs never/rarely 0.91 (0.70-1.17) Nilsen, 2008 COL40731 Norway Norwegian Nord-Trondelag Health Study, Prospective Cohort, Age: 20- M/W 124/ 59 369 17 years Cancer registry Questionnaire Incidence, rectal cancer, women high vs no activity 1.01 (0.58-1.75) Age, alcohol consumption, BMI, educational marital status, smoking status 170/ Men high vs no activity 1.12 (0.65-1.96) Age, alcohol consumption, BMI, educational level, marital status, smoking status 346/ Incidence, colon cancer, men ≥4 vs ≤0 times/week 0.77 (0.54-1.09) Age, alcohol consumption, BMI, educational level, marital status, smoking status Incidence, high vs low 0.56 (0.37-0.83) Age, alcohol
distal colon cancer, women consumption, BMI, educational level, marital status, smoking status high vs low 0.81 (0.59-1.10) Age, alcohol consumption, BMI, educational marital status, smoking status Mai, 2007 COL40658 USA California Teachers Study, 1995, Prospective Cohort, Age: 22-84 years, W 107/ 120 147 6.6 years Cancer registry Self questionnaire Incidence, distal colon cancer ≥4 vs 0-0.5 hrs/week for 1 year 0.78 (0.48-1.25) Age, race 395/ Incidence, invasive cancer ≥4 vs 0-0.5 hrs/week for 1 year 0.81 (0.63-1.05) 272/ Incidence, proximal colon cancer ≥4 vs 0-0.5 hrs/week for 1 year 0.81 (0.59-1.11) Friedenreich, 2006 COL40620 Europe EPIC, Prospective Cohort, Age: 35-70 years, M/W 1 094/ 413 044 6.38 years Cancer registry, record linkage, health insurance rec, pathology and active Incidence, colon cancer ≥42.8 vs ≤11.9 met-hour/week 0.88 (0.74-1.05) Age, center, educational level, energy intake, fiber intake, height, smoking status, weight 599/ Incidence, rectal cancer ≥42.8 vs ≤11.9 met-hour/week 1.21 (0.94-1.54)
follow up Larsson, 2006 COL40625 Sweden COSM, Prospective Cohort, Age: 45-79 years, M 307/ 45 906 7.1 Cancer registry Postal questionnaire Incidence, colon cancer ≥60 vs ≤9 minutes/day ≥60 vs ≤9 minutes/day 0.56 (0.37-0.83) Age, aspirin use, BMI, educational level, history of diabetes, occupational activity, smoking status, family history of colorectal cancer, household physical activity 132/ Incidence, proximal colon cancer 0.72 (0.37-1.40) Age, aspirin use, BMI, educational history of diabetes, occupational activity, smoking status, family history of colorectal cancer, household physical activity 491/ Incidence, colorectal cancer 0.57 (0.41-0.79) 137/ Incidence, distal colon cancer 0.40 (0.22-0.70) 187 Incidence, rectal cancer 0.59 (0.34–1.02) Schnohr, 2005 COL01986 Denmark Prospective Cohort, 215/ 28 259 14 years Questionnaire Incidence, cancer, men vigorous vs low 0.72 (0.47-1.11) Age, alcohol consumption, BMI,
educational level, occupational physical activity, other design issue, smoking habits, birth cohort 127/ Incidence, rectal cancer, men vigorous vs low 0.89 (0.53-1.49) Age, alcohol consumption, BMI, educational level, occupational physical activity, other design issue, smoking habits, birth cohort 180/ Incidence, cancer, women vigorous vs low 0.90 (0.56-1.46) Age, alcohol consumption, BMI, educational level, occupational physical activity, other design issue, smoking habits, birth cohort
Age: 20-93 years, M/W 127/ 28 259 14 years Cancer registry Questionnaire Incidence, rectal cancer, men vigorous vs low 0.89 (0.53-1.49) Age, alcohol consumption, BMI, educational level, occupational physical activity, smoking habits, study, birth cohort Chao, 2004 COL01942 USA CPS II, Prospective Cohort, Age: 50-74 years, M/W 536/ 151 174 19 Cancer registry and medical records Incidence, colorectal cancer, men ≥30 vs ≤0 0.60 (0.41-0.87) Age, alcohol consumption, educational level, multivitamin use in 1982, red meat intake, smoking status, exercise level in 1982, fiber, folate Only included in rectal cancer 390/ Incidence, rectosigmoid and rectum cancer, men ≥7 vs ≤0 0.83 (0.59-1.16) Age, alcohol consumption, educational level, multivitamin use in 1982, red meat intake, smoking status, exercise level in 1982, fiber, hours/week
folate 505/ Incidence, proximal colon cancer, men ≥7 vs ≤0 0.63 (0.45-0.88) Age, alcohol consumption, educational multivitamin use in 1982, red meat intake, smoking status, exercise level in 1982, fiber, folate 339/ Incidence, distal colon cancer, men ≥7 vs ≤0 0.82 (0.55-1.24) Age, alcohol consumption, educational level, multivitamin use in 1982, red meat intake, smoking status, exercise level in 1982, fiber, folate Wei, 2004 COL00581 USA The Nurses's Health Study Cohort, Prospective Cohort, W, nurses 196/ 87 733 24 years verified by medical record and The National Index Questionnaire Incidence, rectal cancer, Q65 vs Q61 1.28 (0.77-2.12)
M/W, Retirement community hours/day ≥2 vs ≤0 hours/day 0.68 (0.30-1.50) 58/ Incidence, right colon cancer, male ≥2 vs ≤0 hours/day 0.50 (0.20-1.30) 68/ Female ≥2 vs ≤0 hours/day 1.16 (0.40-2.50) 58/ Incidence, left colon cancer, male ≥2 vs ≤0 hours/day 0.36 (0.10-1.10)
status, vitamin d Driver, 2007 COL40711 USA PHS, Prospective Cohort, Age: 40-84 years, M, Physicians 21 581 20 years Follow up questionnaires (self report), medical record and pathology reports Incidence, colorectal cancer rarely exercise vs exercise/active /week 1.06 (0.83-1.36) Age, BMI, history of diabetes, multivitamin, physical activity, smoking status, vegetable intake, vitamin c, vitamin e, cereals intake Outcome is colorectal cancer not enough studies to update analysis Suzuki, 2007 COL40949 Japan JACC, Prospective Cohort, Age: 40-79 M/W 127/ 109 778 Death certificate Questionnaire Mortality, rectal cancer, men <1 vs >3 hours/week 1.39 (0.82-2.35) Age, study area Outcome is mortality, insufficient number of studies 177/ Mortality, cancer, men <1 vs >3 0.67 (0.46-0.98) McCarl, 2006 COL40633 USA IWHS, Prospective Cohort, Age: 55-69 years, W 948/ 35 197 15 years SEER registry Incidence, colorectal cancer high vs low 0.83 (0.71-0.97) Age Outcome is colorectal cancer not enough studies to update analysis Johnsen, 2006 COL40629 Denmark DCH, Prospective Cohort, Age: 50-64 years, 157/ 54 478 7.6 years Cancer registry Questionnaire Incidence, cancer, men per 1 hours 1.00 (0.91-1.10) per 10 met score 0.97 (0.93-1.01) 140/ per 1 hours 1.03 (0.93-1.14
M/W activity, red meat intake, smoking status, total energy intake, educational attainment, fibre per 10 met score 1.00 (0.96-1.04) Sanjoaquin, 2004 COL01182 UK OVS, Prospective Cohort, Age: 18-89 years, M/W 95/ 10 998 17 years Incidence, colorectal cancer, ≥2 vs ≤2 0.82 (0.49-1.36) Age, sex, alcohol consumption, smoking habits Outcome is colorectal cancer not enough studies to update analysis Malila, 2002 COL00336 Finland Beta-Carotene Cancer Prevention Study, Prospective Cohort, Age: 50-69 years, M, Male Smokers 184/ 26 951 8 years Population Incidence, colorectal cancer, active vs not active Superseded by Colbert, 2001 Wannamethee, 2001 COL01187 UK BRHS, Prospective Cohort, Age: 40-59 years, M 135/ 7 588 18.8 years General practioners Questionnaire Incidence, colorectal cancer, ≥1 vs ≤1 times/month 0.90 (0.60-1.35) Age, alcohol consumption, BMI, social class, cigarette smoking Outcome is colorectal cancer not enough studies to update analysis
Pukkala, 2000 COL00980 Finland Finland, world class male athletes, Prospective Cohort, M, male athletes 23/ 2 269 53 501 Athletes registry Athletes Incidence, colon cancer, men athletes vs population (0.00-1.27) Sports, endurance Unadjusted results athletes vs population 1.37 (0.59-2.69) Sports, power athletes vs population 1.74 (0.90-3.04) Sports, speed athletes vs population 1.60 (0.33-4.67) Sports, shooting athletes vs population 2.92 (1.07-6.32) Sports, wrestlers Ford, 1999 COL00097 USA NHANES I, Prospective Cohort, Age: 25-74 years, M/W 222/ 13 420 19 years Multistage stratified sampling design Questionnaire Incidence, cancer, little or no exercise vs much exercise No measure of association Martínez, 1997 COL00139 USA The Nurses's Health Cohort, Prospective Cohort, Age: 30-55 W, Registred nurses 161/ 89 448 1 012 375 person-years Nurses registry Questionnaire Incidence, cancer, 1986-1992 follow-up ≥21 vs ≤2 0.52 Age Superseded by Wolin 2007 and Wei 2004 ≥21 vs ≤2 0.54 (0.33-0.90) Age, alcohol consumption, BMI, cigarette smoking, family history of specific cancer, aspirin use, hours/week hours/week
postmenopausal hormone use, red meat intake 73/ Incidence, distal colon cancer, distal cancer ≥21 vs ≤2 0.31 Age ≥21 vs ≤2 0.31 (0.12-0.77) Age, alcohol consumption, BMI, cigarette smoking, family history of specific cancer, aspirin use, postmenopausal hormone use, red meat intake 66/ Incidence, proximal colon cancer, 1986-1992 follow-up, proximal cancer ≥21 vs ≤2 0.77 (0.38-1.58) Age, alcohol consumption, BMI, cigarette smoking, family history of specific cancer, aspirin use, postmenopausal hormone use, red meat intake ≥21 vs ≤2 0.73 Age Glynn, 1996 COL00161 Finland Beta-Carotene 144/ 29 133 8 years Cancer registry Questionnaire Incidence, colorectal cancer, exercise vs reading Age, clinic site, date of collection Superseded by Colbert, 2001 hours/week follow-
sites Incidence, proximal colon cancer, proximal sites 46.8 vs 0.9 0.75 (0.36-1.55) Age Incidence, colon cancer, colon cancer 46.8 vs 0.9 0.41 (0.22-0.74) Age, aspirin use, BMI, energy intake, family history of specific cancer, history of screening, methione intake, physical activity, smoking habits, alcohol intake, dietary fiber intake, folate intake, history of polyp diagnosis, red meat intake Suadicani, 1993 COL01085 Denmark Denmark, Copenhagen fitness and risk of cvd study, Prospective Cohort, 51/ 5 429 18 years Public or private companies questionnaire Incidence, cancer No measure of association Superseded by Schnohr 2005 Incidence, rectal cancer
Age: 40-59 years, M Albanes, 1989 COL00497 USA NHANES I, Prospective Cohort, Age: 25-74 M/W, 84% White 66/ 12 554 NHANES I Questionnaire Incidence, colorectal cancer, women quite inactive vs very active 1.20 (0.60-2.80) Age Outcome is colorectal cancer not enough studies to update analysis 62/ Men quite inactive vs very active 1.00 (0.50-1.90) Garfinkel, 1988 COL01049 USA CPS II, Prospective Cohort, Age: 30- years, M/W 254/ 56 683 Death certificate, and records Questionnaire Mortality, colorectal cancer sports play ≥ 5 hr/wk vs sports play ≤ 5 hr/wk 0.80 Sports Age, sex, birth year Superseded by Chao, 2004 201/ Mortality, colon cancer sports play ≥ 5 hr/wk vs sports play ≤ 5 hr/wk 0.91 Sports 53/ Mortality, rectal cancer sports play ≥ 5 hr/wk vs sports play ≤ 5 hr/wk 0.46 Sports Polednak, 1976 COL01612 USA US, athletic cohort, Prospective Cohort, M 8 393 Registries Mortality, colon cancer major athlete vs non-athlete Mortality rates results, unadjusted results
Table 309 Walking and colorectal cancer risk. Main characteristics of studies identified in the CUP SLR Author, Year, WCRF Code, Country Study name, characteristics Cases/ Study size Follow-up (years) Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Simons, 2013 COL40956 Netherlands NLCS, Prospective Cohort, Age: 55-69 years, M/W 1 107/ 4 416 16 years Cancer registry Self-report Incidence, colon cancer, men >60 vs <10 /day 0.94 (0.76-1.17) Age, BMI, family history of colon cancer, meat intake, processed meat, alcohol, energy, smoking 924/ Women >60 vs ≤10 0.79 (0.60-1.04) 581/ Incidence, distal colon cancer, men >60 vs <10 /day 1.09 (0.83-1.42) 517/ Incidence, proximal colon cancer, women >60 vs ≤10 0.85 (0.60-1.19) 480/ Men >60 vs <10 /day 0.83 (0.62-1.10) 438/ Incidence, rectal cancer, men >60 vs <10 /day 1.03 (0.77-1.38) 377/ Incidence, distal colon cancer, women >60 vs ≤10 0.75 (0.52-1.10) 227/ Incidence, rectal cancer, women >60 vs ≤10 0.47 (0.27-0.83) Lee, 2007 COL40644 Japan JPHC I and II, 290/ 65 022 6 years Active patient notification from hospitals, cancer questionnaire Incidence, colorectal cancer, men ≥3 vs ≤2.9 hours/day 0.82 (0.65-1.05)
Prospective Cohort, Age: 40-69 years, M/W registries and death cert. meat intake, smoking habits, study area, family history of colorectal cancer, fibre 56/ Incidence, rectum cancer, ≥3 vs ≤2.9 hours/day 1.20 (0.65-2.19) Takahashi, 2007 COL40704 Japan MCS, Prospective Cohort, Age: 40-64 years, M/W 166/ 41 988 7 years Record linkage with cancer registries Questionnaire Incidence, colorectal cancer, men ≥1.1 vs ≤0.4 hours/day 0.57 (0.38-0.83) Age, alcohol consumption, BMI, educational meat intake, physical activity, smoking status, vegetable intake, family history of colorectal cancer, oranges 101/ Incidence, cancer, men ≥1.1 vs ≤0.4 hours/day 0.38 (0.23-0.64) 94/ Incidence, colorectal cancer, ≥1.1 vs ≤0.4 hours/day 1.02 (0.60-1.75) 65/ Incidence, rectal cancer, men ≥1.1 vs ≤0.4 hours/day 1.07 (0.55-2.06) 50/ Incidence, colon cancer, women ≥1.1 vs ≤0.4 hours/day 1.33 (0.60-2.94) 44/ Incidence, rectal cancer, women ≥1.1 vs ≤0.4 0.82 (0.39-1.71) Wolin, 2007 COL40700 USA The Nurses's Health Study Cohort, 265/ 79 295 1 230 354 person-years Follow up questionnaires; medical records; pathology Questionnaire Incidence, colon cancer ≥4 vs ≤0 0.73 (0.48-1.10)
Prospective Cohort, Age: 40-65 years, W, nurses reports; national death index family history of colon cancer, history of endoscopy, history of polyps, multivitamin use, red meat intake, smoking status, vitamin d 141/ Incidence, proximal polyps ≥4 vs ≤0 hours/week 0.89 (0.52-1.51) 124/ Incidence, distal colon cancer ≥4 vs ≤0 hours/week 0.54 (0.28-1.06) Chao, 2004 COL01942 USA CPS II, Prospective Cohort, Age: 50-74 years, M/W 594/ 151 174 19 years Cancer registry and medical records Incidence, colorectal cancer, men ≥7 vs ≤0 0.96 (0.72-1.29) Age, alcohol consumption, educational multivitamin use in 1982, red meat intake, smoking status, exercise level in 1982, fiber, folate 320/ Incidence, proximal colon cancer, men ≥7 vs ≤0 0.83 (0.56-1.25) 240/ Incidence, rectosigmoid and rectum cancer, men ≥7 vs ≤0 0.89 (0.59-1.34) 214/ Incidence, distal colon cancer, men ≥7 vs ≤0 1.08 (0.67-1.73)
Wannamethee, 2001 COL01187 UK BRHS, Prospective Cohort, Age: 40-59 years, M 135/ 7 588 18.8 years General practitioners Questionnaire Incidence, colorectal cancer, ≥60 vs ≤20 minutes/day 0.76 (0.28-2.07) pace Age, alcohol consumption, BMI, social class, cigarette smoking
310 Walking and colorectal cancer risk. Main characteristics of studies excluded from the CUP SLR dose-response meta-analysis Author, Year, WCRF Code, Country Study name, characteristics Cases/ Study size Follow-up (years) Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Exclusion reason 2010 COL40838 UK Whitehall Study, Prospective Cohort, Age: 40-69 M, Employed men 104/ 6 928 40 years UKNHS central registry Questionnaire Mortality, colon cancer slower vs faster 1.22 (0.47-3.19) Age, BMI, job classification, forced expiratory volume in 1 second, smoking Outcome is mortality not enough studies to update analysis 43/ Mortality, rectal cancer 4.85 (1.7-13.8) Akhter, 2007 COL40632 MCS, Prospective Cohort, Age: 40-64 years, M 307/ 21 199 11 years Cancer registry Incidence, colorectal cancer >1h/day vs <30min/day 1.35 (1.02-1.79) Age Outcome is colorectal cancer not enough studies to update analysis Suzuki, 2007 COL40949 Japan JACC, Prospective Cohort, Age: 40-79 M/W 167/ 109 778 Death certificate Questionnaire Mortality, cancer, women <1 vs >3 hours/day 1.28 (0.88-1.84) Age, study area Outcome is mortality not enough studies to update analysis 165/ Men <1 vs >3 0.96 (0.67-1.38) 117/ Mortality, rectum cancer, men <1 vs >3 1.01 (0.66-1.54) 61/ Women <1 vs >3 hours/day 0.68 (0.34-1.33)
Johnsen, 2006 COL40629 Denmark DCH, Prospective Cohort, Age: 50-64 years, M/W 157/ 54 478 7.6 years Cancer registry Questionnaire Incidence, cancer, men per 1 1.01 (0.98-1.04) Age, alcohol, BMI, fat consumption, hrt use, nsaids, recreational activity, red meat intake, smoking status, total energy intake, educational attainment, fibre 140/ Women per 1 hours 0.99 (0.95-1.03) Davey Smith G, 2000 COL00391 UK Whitehall Study, Prospective Cohort, Age: 40-64 M, civil servants 89/ 6 702 25 years UKNHS central registry Questionnaire Mortality, colorectal cancer, slower vs faster 2.35 (1.10-5.10) Age Outcome is mortality not enough studies to update analysis slower vs faster 2.46 (1.10-5.40) Age, BMI, smoking habits, forced expiratory volume in 1 second, grade 64/ Apparently healthy at study entry slower vs faster 1.98 (0.60-6.80)
Table 315 Energy intake and colorectal cancer risk. Main characteristics of studies included in the CUP SLR dose-response Author, Year, WCRF Code, Country Study name, characteristics Study size Follow-up Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Lee, 2009 COL40764 China SWHS, Prospective Cohort, Age: 40-70 years, W 394/ 73 224 7.4 years Cancer registry and death certificates and participant contact Quantitative FFQ Incidence, colorectal cancer ≥1844 vs ≤1406.9 kcal/day 1.20 (0.90-1.60) Ptrend:0.08 Age, energy intake 236/ Incidence, colon cancer ≥1844 vs ≤1406.9 kcal/day 1.40 (1.00-2.00) Ptrend:0.06 158/ Incidence, rectal cancer ≥1844 vs ≤1406.9 kcal/day 1.00 (0.60-1.50) Ptrend:0.69 Prentice, 2009 COL40811 USA WHI, Prospective Cohort, Age: 50-79 years, W, Postmenopausal 363/ 80 816 11.3 years Self-report, medical record and pathology report reviewed by centrally trained physician FFQ Incidence, colon cancer, dm and observation study Q 4 vs Q 1 1.51 (1.03-2.21) Age-underlying cox models, alcohol, family history of colon cancer, history of polyp diagnosis, Intervention assignment, physical activity, race, smoking status per 20 % kcal/day 1.47 (1.11-1.94) Butler, 2008 COL40639 Singapore SCHS, Prospective Cohort, Age: 45-74 years, M/W 961/ 61 321 9.8 years Cancer registry FFQ Incidence, colorectal cancer Q 4 vs Q 1 0.97 (0.80-1.18) Ptrend:0.77 Age, sex, alcohol intake, BMI, diabetes, dialect educational level, energy analysis
intake, exposure assessment, family history of colorectal cancer, physical activity, smoking habits McCarl, 2006 COL40633 USA IWHS, Prospective Cohort, Age: 55-69 years, W 954/ 35 197 15 SEER registry FFQ Incidence, colorectal cancer ≥2232 vs ≤1298.3 kcal/day 0.80 (0.66-0.97) Age Oba, 2006 COL40626 Japan TCCJ, Prospective Cohort, Age: 35-101 years, M/W 111/ 30 221 8 years Hospital records and cancer registry FFQ Incidence, colon cancer, men 3339.6 vs 1814.6 kcal 1.00 (0.60-1.69) Age, alcohol intake, BMI, height, of smoking, physical activity 102/ Women 2782.7 vs 1423.9 kcal 0.77 (0.47-1.27) Jarvinen, 2001 COL00852 Finland Finnish Mobile Clinic Health Examination Survey, Prospective Cohort, Age: 39 years, M/W 109/ 9 959 Questionnaire Incidence, colorectal cancer, Q 4 vs Q 1 0.78 (0.42-1.44) Age, sex, BMI, geographic location, occupational group, smoking 63/ Incidence, colon cancer, Q 4 vs Q 1 0.74 (0.32-1.71) 46/ Incidence, rectal cancer, Q 4 vs Q 1 0.82 (0.33-2.04) Pietinen, 1999 COL00176 Finland ATBC, Prospective Cohort, Age: 50-69 185/ 27 111 8 years Cancer registry Dietary history questionnaire Incidence, colorectal cancer, 3696 vs 1984 kcal/day 1.70 (1.00-2.90) Ptrend:0.05 Age, alcohol consumption, BMI, calcium intake,
years, M, Smokers educational physical activity, smoking years, supplement group Kato, 1997 CRC00022 USA New York University Women's Health Study, Prospective Cohort, Age: 34-65 years, W 100/ 14 272 105 044 Questionnaire, medical records, cancer registries FFQ Incidence, colorectal cancer, Q 4 vs Q 1 1.20 (0.69-2.08) Ptrend:0.788 Age, educational level, place at enrolment Gaard, 1996 CRC00008 Norway Norwegian national health screening service study, Prospective Cohort, Age: 20-53 years, M/W 83/ 50 535 11.4 years Enrolment by volunteers FFQ Incidence, colon cancer, men ≥9999 vs ≤6857 kj/day 1.13 (0.58-2.22) Ptrend:0.83 Age, attained age, BMI, height, smoking status 60/ Women ≥6654 vs ≤4453 kj/day 1.49 (0.70-3.19) Ptrend:0.72 Martinez, 1996 COL00131 USA NHS, Prospective Cohort, Age: 30-55 years, W, Registered nurses 157 89 448 1 012 280 person-years Nurses registry FFQ Incidence, cancer, Q 5 vs Q 1 1.18 (0.89-1.57) Age
Bostick, 1994 COL00079 USA IWHS, Prospective Cohort, Age: 55-69 years, W 212/ 35 216 167 447 SEER FFQ Incidence, colon cancer ≥2239 vs ≤1300 kcal/day 0.60 (0.39-0.92) Ptrend:0.05 Age, height, parity, total vitamin e intake, total vitamin e intake age, vitamin a supplement Goldbohm, 1994 COL00025 Netherlands NLCS, Case Cohort, Age: 55-69 years, M/W 215/ 120 852 3.3 years Population registries FFQ Incidence, colon cancer, Q 5 vs Q 1 0.74 (0.47-1.18) Ptrend:0.24 Age, sex, dietary intake 110/ 2200 vs 1163 kcal/day 0.75 (0.40-1.41) Ptrend:0.23 105/ Men 2791 vs 1510 kcal/day 0.72 (0.36-1.45) Ptrend:0.62
Guo, 2014 COL41041 China Northern 2006-2011, Prospective Cohort, Age: 18- years, M/W 149/ 133 273 4.28 years Self-report, next of kin, medical and pathological records Weight and height were measured Incidence, colorectal cancer ≥ 28 vs <18.5kg/m2 1.39 (0.83-2.34) Age, alcohol consumption, education level, smoking Mid-point categories Person-years of follow up 62/ Colon cancer ≥ 28 vs kg/m2 2.75 (1.25-6.06) 86/ Rectal cancer ≥ 28 vs <18.5kg/m2 0.86 (0.42-1.80) Wie, 2014 COL41065 Korea 2004-2008, Prospective Cohort, M/W 53/ 8024 7 years Cancer registry and medical records Weight and height were measured Incidence, Colorectal cancer Per 1 kg/m2 1.00 (0.89-1.13) Age, sex, energy intake, smoking, physical activity, alcohol use, income, education and marital status Mid-point Increment unit converted to 5 kg/m2 ≥ 25 vs < 25 kg/m2 0.64 (0.32-1.26) Song, 2014 COL41018 Finland FINRISK, Prospective Cohort, Age: 24-74 years, M/W 203/ 54 725 20.6 Cancer and mortality registries Height and weight were measured on site by specially trained nurses Incidence Colon cancer, men ≥ 35 vs < 18.5 kg/m2 3.24 (1.45-7.24) Age, leisure - physical activity, area, education, smoking Mid-point categories, number of cases per quintiles, person years Hamling method used to recalculate the RR’s 184/ 203/ Colon, women 2.02 (1.13-3.62) 184/ Rectum, men 1.14 (0.34-3.81) 103/ Rectum, women 1.14 (0.40-3.24) 23.9
menopausal Kabat, 2013 COL40965 USA WHI, Prospective Cohort, Age: 50-79 years, W, 166/ 11 124 12.9 years Self-report verified by reviewing medical and pathological records by physicians Weight, height, and waist and hip circumferences measured by trained staff Incidence, colorectal cancer ≥ 31.4 vs ≤ 24 kg/m2 1.07 (0.66-1.75) Ptrend:0.55 Diabetes, ethnicity, HRT use, physical activity, alcohol, education, family history colorectal cancer, pack smoking randomisation group Mid-point categories Kitahara, 2013 COL40966 USA PLCO, Prospective Cohort, Age: 55-74 years, M/W 962/ 74 474 11.9 years certificate/ medical records Questionnaire Incidence, colorectal cancer, all 1.24 (1.04-1.47) Ptrend:0.02 546/ Colorectal, men 1.48 (1.16-1.89) Ptrend:0.002 416/ Colorectal, women 1.03 (0.80-1.33) Ptrend:0.74 529/ Proximal colon, all 1.32 (1.04-1.66) Ptrend:0.02 275/ Proximal men 1.48 (1.05-2.09) Ptrend:0.02 254/ Proximal women 1.23 (0.89-1.69) Ptrend:0.21 219/ Distal colon, all 1.07 (0.73-1.55) Post-
Ptrend:0.70 131/ Distal colon, men 1.48 (0.90-2.42) Ptrend:0.12 85/ Distal colon, women 0.66 (0.36-1.21) Ptrend:0.25 200/ Rectum, all 1.20 (0.81-1.78) Ptrend:0.35 134/ Rectum, men 1.38 (0.83-2.27) Ptrend:0.21 66/ Rectum, women 0.95 (0.50-1.79) Ptrend:0.89 Morikawa, 2013 COL40958 & COL40959 USA NHS & HPFS, Pooled analysis, (W) nurses and (M) health professionals 861/ 156 703 2 631 423 person-years Self-report (provided evidence of treatment), medical records and pathology reports, national death Index Weight measured, height was in 1976 Incidence, colorectal cancer ≥ 30 vs < 18.5 kg/m2 1.52 (1.19-1.93) Ptrend:0.0001 Age, aspirin, calcium, caloric intake, folate, red meat, vit D, multivitamin, smoking status, alcohol, family history CRC, sigmoidoscopy, physical activity smoking, HRT use Used in stratified analysis by sex only Mid-point categories Hamling method used to recalculate the RR’s NHS, Prospective Cohort, W 493/ 109 046 1.55 (1.16-2.06) Ptrend:0.001 HPFS, Prospective Cohort, M 368/ 47 684 1.30 (0.83-2.03) Ptrend:0.14
Poynter, 2013 COL40952 USA IWHS, Prospective Cohort, Age: 55-71 years, W, 707/ 37 459 22 years SEER BMI was calculated from self-reported current weight and height Incidence, cancer, aged ≥75 years ≥ 30 vs < 25 kg/m2 1.38 (1.13-1.69) Ptrend:0.001 Estrogen use, physical activity, age at baseline, smoking Mid-point categories 604/ Incidence, colon cancer, aged < 75 years ≥ 30 vs < 25 kg/m2 1.44 (1.16-1.78) Ptrend:0.0006 Li, 2012 COL40937 SWHS, Prospective Cohort, Age: 40-70 years, W 621/ 72 972 11 years Follow up survey/cancer registry/vital statistics registry Anthropometric measurements, measured by trained Interviewers at baseline Incidence, colorectal cancer ≥ 26.71 vs ≤ 21.1 kg/m2 1.08 (0.82-1.43) Ptrend:0.75 Alcohol consumption, energy intake, fruit, Income, menopausal status, physical activity, tea consumption, age at baseline, cigarette, education, family history of colorectal cancer, red meat, vegetables Mid-point categories ≥ 30 vs ≤ 25 kg/m2 0.89 (0.63-1.25) Ptrend:0.73 381/ Incidence, colon cancer ≥ 26.71 vs ≤ 21.1 kg/m2 1.00 (0.70-1.43) Ptrend:0.97 ≥ 30 vs ≤ 25 kg/m2 0.78 (0.50-1.23) Ptrend:0.43 240/ Incidence, rectal cancer ≥ 26.71 vs ≤ 21.1 kg/m2 1.22 (0.78-1.90) Ptrend:0.64 ≥ 30 vs ≤ 25 kg/m2 1.07 (0.63-1.81) Ptrend:0.66 Li, 2012 COL40936 SMHS, 313/ 61 283 Follow up survey/cancer Anthropometric measurements, ≥ 26.2 vs ≤ 21.13 1.71 (1.20-2.44) Ptrend:0.003 Post-
China Prospective Cohort, Age: 40-74 years, M 5.5 years registry/vital statistics registry measured by trained Interviewers at baseline kg/m2 energy intake, fruits, Income, physical activity, tea consumption, age at baseline, education, family history of colorectal cancer, pack years of smoking, red meat, vegetables ≥ 30 vs < 25 kg/m2 1.74 (1.01-3.01) Ptrend:0.014 180/ Incidence, colon cancer ≥ 26.2 vs ≤ 21.13 kg/m2 2.15 (1.35-3.43) Ptrend:0.0006 133/ Incidence, rectal cancer ≥ 30 vs < 25 kg/m2 1.84 (0.85-3.99) Ptrend:0.88 ≥ 26.2 vs ≤ 21.13 kg/m2 1.20 (0.69-2.10) Ptrend:0.61 Renehan, 2012 COL40925 USA NIH-AARP, Prospective Cohort, 4 076/ 273 679 2 509 662 person years Cancer registry Assessed by questionnaire, recalled weights at ages 18, 35, per 5 kg/m2 1.14 (1.08-1.20)
2 804/ ≥ 35 vs < 18.5 kg/m2 1.50 (1.18-1.91) Ptrend:<0.0001 1 240/ Incidence, colorectal cancer, women ≥ 35 vs < 18.5 kg/m2 1.25 (0.97-1.60) Ptrend:0.13 per 5 kg/m2 1.05 (0.99-1.11) 2 070/ Incidence, cancer, men ≥ 35 vs < 18.5 kg/m2 1.53 (1.16-2.03) Ptrend:<0.0001 per 5 kg/m2 1.18 (1.11-1.25) 1 145/ Incidence, proximal colon cancer, men ≥ 35 vs < 18.5 kg/m2 1.57 (1.09-2.25) Ptrend:< 0.0001 per 5 kg/m2 1.20 (1.11-1.30) 855/ Incidence, distal colon cancer, men ≥ 35 vs < 18.5 kg/m2 1.68 (1.05-2.68) Ptrend:0.003 per 5 kg/m2 1.15 (1.05-1.27) 962/ Incidence, colon cancer, women ≥ 35 vs < 18.5 kg/m2 1.23 (0.93-1.64) Ptrend:0.20 per 5 kg/m2 1.05 (0.98-1.12) 607/ Incidence, proximal cancer, women ≥ 35 vs < 18.5 kg/m2 1.15 (0.82-1.63) Ptrend: 0.67 per 5 kg/m2 1.02 (0.93-1.11) 329/ ≥ 35 vs < 18.5 1.35 (0.812.25)
Age: 50-71 years, M/W and 50 years and self-reported height smoking, alcohol consumption, HRT use (in women) of follow up in each category Incidence, distal colon cancer, women kg/m2 Ptrend: 0.23 per 5 kg/m2 1.07 (0.96-1.20) 762/ Incidence, rectal cancer, men ≥ 35 vs < 18.5 kg/m2 1.43 (0.90-2.28) Ptrend:0.51 per 5 kg/m2 1.03 (0.93-1.14) 282/ Incidence, rectal cancer, women ≥ 35 vs < 18.5 kg/m2 1.28 (0.76-2.16) Ptrend:0.45 per 5 kg/m2 1.05 (0.92-1.19) Gray, 2012 COL40981 USA HAHS, Prospective Cohort, Age: 46.1 (mean age) years, M/W 228/ 19 593 56.5 years Death certificate Height and weight were measured Mortality, Colorectal cancer Per 2.55 kg/m2 1.12 (1.00-1.26) Age Hughes, 2011 COL40895 Netherlands NLCS, Prospective Cohort, Age: 55-69 years, 1 211/ 120 852 16.3 years Cancer registry Self-reported height and weight Incidence, colorectal cancer, men 27.1-39.6 vs 16.1-23 kg/m2 1.25 (0.96-1.62) Ptrend:0.08 1 211/ per 5 kg/m2 1.25 (1.05-1.46)
1 106/ Incidence, colorectal cancer, women 27.6-41.4 vs 15.4-22.1 kg/m2 0.97 (0.76-1.24) Ptrend:0.90 per 5 kg/m2 0.98 (0.88-1.10) 327/ Incidence, proximal colon cancer, men 27.1-39.6 vs 16.1-23 kg/m2 1.35 (0.90-1.98) Ptrend: 0.43 per 5 kg/m2 1.19 (0.92-1.54) 427 Incidence, distal colon cancer, men 27.1-39.6 vs 16.1-23 kg/m2 1.38 (0.95-1.98) Ptrend: 0.05 per 5 kg/m2 1.42 (1.13-1.79) 459/ Incidence, proximal cancer, women 27.6-41.4 vs 15.4-22.1 kg/m2 0.91 (0.65-1.28) Ptrend: 0.84 per 5 kg/m2 1.02 (0.87-1.18) 327/ Incidence, distal colon cancer, women 27.6-41.4 vs 15.4-22.1 kg/m2 1.04 (0.72-1.50) Ptrend: 0.84 per 5 kg/m2 0.95 (0.79-1.14) 299/ Incidence, rectal cancer, men 27.1-39.6 vs 16.1-23 kg/m2 1.01 (0.67-1.51) Ptrend:0.96 per 5 kg/m2 1.02 (0.79-1.32)
M/W education, family history of colorectal cancer, smoking Number of in each category 205/ Incidence, rectal cancer, women 27.6-41.4 vs 15.4-22.1 kg/m2 1.07 (0.67-1.60) Ptrend:0.90 per 5 kg/m2 1.05 (0.83-1.31) Dehal, 2011 COL40893 USA NHEFS, Prospective Cohort, Age: 25-75 years, M/W 52/ 7 016 118 998 Death index & social security administration death file Weight and height were measured Mortality, colorectal cancer obese vs normal weight kg/m2 2.04 (1.08-3.83) Ptrend:0.02 Marital status, race/ethnicity, alcohol, baseline residence type area, education, family income, smoking Park, 2011 COL41069 UK EPIC-Norfolk, Prospective Cohort, Age: 40-79 years, M/W 357/ 20 608 11 years Record linkage to cancer registration and death certificates Self-reported and measured Incidence, colorectal cancer, men (measured BMI) ≥ 28.9 vs < kg/m2 1.06 (0.67-1.69) Ptrend:0.52 Incidence, colorectal cancer, men (self-reported BMI) 0.97 (0.61-1.54) Ptrend:0.85 Incidence, colorectal cancer, women 1.57 (0.91–2.73) Ptrend:0.05
(measured BMI) Incidence, colorectal cancer, women (self-reported BMI) 1.97 (1.18–3.30) Ptrend:0.02 Men (measured BMI) Per 4 unit increase 0.86 (0.60-1.24) Age, sex, moking, alcohol, education, exercise, family history of CRC, energy intake, folate, fibre, total meat and processed meat, intakes, waist and hip circumferences Men (self-reported BMI) 0.97 (0.70-1.34) Women (measured BMI) 0.84 (0.58-1.19) (self-reported BMI) 1.16 (0.90-1.51) Odegaard, 2011 COL40883 Singapore SCHS, Prospective Cohort, Age: 45-74 years, M/W, 980/ 51 251 11.5 years Cancer registry and death registry Self-reported height and weight Incidence, colorectal cancer 1.25 (1.01-1.55) Ptrend:0.44 596/ Incidence, cancer 1.48 (1.13-1.92) Ptrend:0.31 384/ Incidence, rectal cancer 0.93 (0.64-1.36) Ptrend:0.92
middle-aged adults alcohol intake, education, energy, smoking, year Person-years of follow up in each category 589/ Incidence, colorectal cancer, never smokers 1.35 (1.04-1.76) Ptrend:0.46 Ever smokers 1.08 (0.74-1.58) Ptrend:0.61 391/ Incidence, colon cancer, never smokers 1.59 (1.16-2.16) Ptrend: 0.58 205/ Incidence, colon cancer, ever smokers 1.26 (0.76-2.08) Ptrend: 0.35 198/ Incidence, rectal cancer, never smokers 0.96 (0.59-1.56) Ptrend:0.63 176/ Ever smokers 0.90 (0.50-1.61) Ptrend:0.80 Oxentenko, 2010 COL40849 USA IWHS, Prospective Cohort, Age: 55-69 years, W 1 464/ 36 941 619 961 SEER Self-reported height and weight at baseline Incidence, colorectal cancer ≥ 29.52 vs ≤ 23.45 kg/m2 1.29 (1.10-1.51) Ptrend:0.001 obese III vs normal 1.56 (1.10-2.22) Ptrend:<0.001 771/ ≥ 29.52 vs 1.17 (0.94-1.46)
per 5 kg/m2 1.07 (0.86-1.33) 174/ Incidence, distal colon cancer, men ≥ 30 vs kg/m2 3.26 (1.79-5.95) Ptrend:<0.01 per 5 kg/m2 1.49 (1.19-1.87) 237/ Incidence, proximal colon cancer, women ≥ 30 vs kg/m2 1.43 (0.94-2.19) Ptrend:0.07 per 5 kg/m2 1.15 (0.99-1.34) 159/ Incidence, distal colon cancer, women ≥ 30 vs kg/m2 1.65 (1.01-2.70) Ptrend:0.01 per 5 kg/m2 1.25 (1.05-1.49) Prentice, 2009 COL40811 USA WHI Prospective Cohort, Age: 50-79 years, W, postmenopausal women 363/ 80 816 11 87/ Self-report, medical record and pathology report reviewed by centrally trained physician Incidence, colon cancer per 10 1.81 (1.19-2.76) Age, family history of colon cancer, physical activity, smoking status, alcohol, total energy intake Incidence, rectal cancer per 10 units 0.62 (0.26-1.52) Jee, 2008 COL40643 Korea KNHIC, Prospective Cohort, 4 671/ 1 213 829 10.8 years National cancer registries, hospitalisation Weight and height measurements Incidence, colon cancer, men ≥ 30 vs < 20 kg/m2 1.42 (1.02-1.98) Ptrend:<0.0001 per 1 kg/m2 1.06
Age: 30-95 M/W records and admission files were recorded during health examination at hospital Person-years of follow up 4 032/ Incidence, rectum cancer, men ≥ 30 vs < 20 kg/m2 1.16 (0.77-1.74) Ptrend:0.001 per 1 kg/m2 1.03 1 959/ Incidence, cancer, women ≥ 30 vs < 20 kg/m2 1.01 (0.72-1.42) Ptrend:0.0114 1 681/ Incidence, rectum cancer, per 1 kg/m2 1.03 ≥ 30 vs < 20 kg/m2 1.14 (0.78-1.68) Ptrend:0.0184 per 1 kg/m2 1.03 Song, 2008 COL40659 Korea Prospective Cohort, Age: 40-64 years, W, 453/ 170 481 8.75 years Self-report, cancer registry, report Weights and heights were measured Incidence, cancer ≥ 30 vs <18.5 kg/m2 2.43 (1.40-4.23) Age, alcohol, height, physical activity, smoking status, pay level at study entry Mid-point categories Person-years of follow up per 1 kg/m2 1.05 (1.02-1.09) Thygesen, 2008 COL40728 USA HPFS, Prospective Cohort, Age: 40-75 years, 693/ 46 349 18 years Self-report verified by medical record Self-reported data Incidence, colon cancer > 35.1 vs ≤ 20 kg/m2 2.29 (1.23-4.26) Age, alcohol consumption, aspirin use, intakes of calcium, energy, Mid-point categories Hamling method used to Post-
402/ Incidence, colon cancer, men 1.93 (1.14-3.28) Ptrend:0.01 1.18 (0.59–2.38) Ptrend:0.92 (adjusted for WC) 314/ Incidence, colon cancer, women 1.40 (0.84-2.36) Ptrend:0.18 1.07 (0.54–2.09) Ptrend:0.88 (adjusted for WC) 142/ Incidence, rectal cancer, men 1.38 (0.58-3.28) Ptrend:0.7 1.74 (0.55-5.50) Ptrend:0.5 (adjusted for WC) 93/ Incidence, rectal cancer, 2.67 (1.09-6.54) Ptrend:0.001 1.88 (0.60–5.93) Ptrend:0.13 (adjusted for WC) Reeves, 2007 MWS, 4 008/ Self-reported ≥ 30 vs < 22.5 1.01 (0.94-1.09)
COL40670 UK Prospective Cohort, Age: 50-64 years, W 1 222 630 5 years National health records Incidence, colorectal cancer kg/m2 Age, alcohol consumption, geographical area, physical activity, reproductive factors, smoking status, status categories Person-years of follow up per 10 unit 1.00 (0.92-1.08) 1 884/ Never smoked per 10 unit 1.04 (0.92-1.18) 1 743/ Postmenopausal users of HRT per 10 unit 0.99 (0.88-1.12) 1 548/ Mortality, colorectal cancer per 10 unit 0.99 (0.87-1.13) ≥ 30 vs < 22.5 kg/m2 1.03 (0.92-1.16) 136/ Incidence, colorectal cancer, premenopausal never users of HRT per 10 unit 1.61 (1.05-2.48) Bowers, 2006 COL40699 Finland ATBC, Prospective Cohort, Age: 58 M, 410/ 28 983 14.1 years Cancer registry Measured by trained staff Incidence, colorectal cancer > 30 vs < 18.5 kg/m2 1.66 (1.27-2.18) 29.21-54.36 vs 12.97-23.11 kg/m2 1.70 (1.01-2.85) Ptrend:0.01
Lukanova, 2006 COL40752 Sweden NSHDC, Prospective Cohort, Age: 29-61 years, M/W 136/ 68 786 8.2 years Medical records Weight and height measured by Incidence, colorectal cancer, men ≥ 27.7 vs kg/m2 1.20 (0.76-1.94) Ptrend:0.25 Age, smoking habits, calendar year Mid-point categories Person-years of follow up ≥ 30 vs kg/m2 1.61 (0.95-2.65) Ptrend:0.08 108/ Women ≥ 27 vs kg/m2 1.54 (0.90-2.74) Ptrend:0.04 ≥ 30 vs kg/m2 2.01 (1.22-3.27) Ptrend:0.005 76/ Incidence, cancer, women ≥ 27.1 vs kg/m2 2.05 (1.04-4.41) Ptrend:0.02 73/ Men ≥ 27.7 vs kg/m2 1.28 (0.66-2.60) Ptrend:0.42 58/ Incidence, rectal cancer, men ≥ 27.7 vs kg/m2 1.23 (0.63-2.51) Ptrend:0.36 ≥ 30 vs kg/m2 1.96 (0.96-3.86) Ptrend:0.13 31/ Women ≥ 27 vs kg/m2 0.86 (0.33-2.30) Ptrend:0.93 ≥ 30 vs kg/m2 1.30 (0.42-3.45) Ptrend:0.54 MacInnis, 2006 COL40751 Australia MCCS, Prospective Cohort, 117/ 24 072 10.4 years Cancer registry Height, weight, waist and hip were measured Incidence, proximal cancer ≥ 30 vs < 25 kg/m2 1.0 (0.7–1.4) 23.4 24.9
Age: 27-75 years, W educational level, HRT use 79/ Incidence, distal colon cancer per 5 kg/m2 1.04 (0.90–1.20) MacInnis, 2006 COL40627 Australia MCCS, Prospective Cohort, Age: 27-75 years, M/W 229/ 41 114 10.3 Cancer registry Measured Incidence, rectal cancer ≥ 30 vs < 25 kg/m2 1.20 (0.80-1.70) Age, sex, country of Person-years of follow up per 5 kg/m2 1.03 (0.88-1.21) 134/ Incidence, rectal cancer , men ≥ 30 vs < 25 kg/m2 1.30 (0.80-2.40) per 5 kg/m2 1.09 (0.86-1.38) 120/ Incidence, stage I/II rectal cancer per 5 kg/m2 1.07 (0.86-1.34) 102/ Incidence, stage III/iv rectal cancer per 5 kg/m2 1.02 (0.80-1.29) 95/ Incidence, rectal cancer, women ≥ 30 vs < 25 kg/m2 1.10 (0.70-1.90) per 5 kg/m2 0.98 (0.80-1.22) Pischon, 2006 COL01985 Europe EPIC, Prospective Cohort, 563/ 368 277 2 254 727 person-years Population registries Self-reported questionnaires Incidence, colon cancer, women ≥ 28.9 vs < 21.7 kg/m2 1.06 (0.79-1.42) Ptrend:0.40
Age: 30-65 M/W residence, smoking status Person-years of follow up 39/ Incidence, colorectal cancer, women ≥ 28.6 vs ≤ 24.2 kg/m2 2.19 (0.77-6.23) Ptrend:0.012 Tsai, 2006 COL41001 USA Shell employees cohort study, Prospective Cohort, Age: 30-69 years 43/ 7 139 20 years Death index & social security administration death file Recorded through the shell health surveillance system Mortality, colorectal cancer ≥ 30 vs kg/m2 1.84 (0.76-4.45) Age, sex, blood pressure, cholesterol, fasting blood sugar, smoking Mid-point categories Person of follow up Engeland, 2005 COL01941 Norway norwegian composite cohort consisting of 3 groups, Prospective Cohort, Age: 20-74 years, M/W 24 130/ 1 999 978 23 years Health survey, cancer registry, death registry Height and weight measured by trained Incidence, colorectal cancer, women 1.06 (1.02-1.10) Ptrend:0.01 22 987/ Men 1.40 (1.32-1.48) Ptrend:<0.001 16 638/ Incidence, colon cancer, women 1.07 (1.02-1.12) Ptrend:0.006 13 805/ Incidence, colon cancer, men 1.49 (1.39-1.60) Ptrend:<0.001 9 182/ Incidence, rectum cancer, men 1.27 (1.16-1.38) Ptrend:<0.001 7 492/ Incidence, rectum cancer, women 1.04 (0.97-1.11) Ptrend:0.6
6 145/ Men, 45-74 years 1.26 (1.14-1.39) 5 013/ Women, 45-74 years 1.03 (0.95-1.11) 3 037/ Men, 20-44 years 1.24 (1.03-1.49) 2 479/ Women, 20-44 years 1.05 (0.90-1.23) Rapp, 2005 COL01878 Austria VHM&PP, Prospective Cohort, Age: 19-94 years, M/W 271/ 1 450 000 person-years Local physicians Recorded by medical staff Incidence, colon cancer, women ≥ 35 vs kg/m2 0.88 (0.43-1.81) Ptrend:0.73 Age, smoking status, occupational group Mid-point categories 260/ Incidence, cancer, men ≥ 35 vs kg/m2 2.48 (1.15-5.39) Ptrend:0.005 138/ Incidence, rectal cancer, men ≥ 30 vs kg/m2 1.66 (1.01-2.73) Ptrend:0.053 133/ Incidence, rectal cancer, women ≥ 35 vs kg/m2 0.96 (0.38-2.39) Ptrend:0.005 Lin, 2004 COL01832 USA WHS, Prospective Cohort, Age: 45- years, W, 202/ 36 876 8.7 years Incidence, colorectal cancer, 1.67 (1.08-2.59) Ptrend:0.018 158/ Incidence, colon cancer 1.73 (1.05-2.85) Ptrend:0.029
83/ Incidence, proximal 2.59 (1.34–5.01) Ptrend:0.004 75/ Incidence, colon, distal 0.93 (0.41–2.14) Ptrend:0.91 67/ Post-menop & HRT nonusers 2.91 (1.40-6.06) Ptrend:0.018 62/ Post-menop & HRT users 1.41 (0.65-3.06) Ptrend:0.128 40/ Incidence, rectal cancer 1.55 (0.64-3.77) Ptrend:0.25 Incidence, colorectal cancer, ER+ 1.36 (0.69-2.68) Ptrend:0.11
professionals previous polyp and prior endoscopy, menopausal status, physical activity, randomized treatment assignment, red meat intake, smoking status, aspirin use, postmenopausal hormone use, total energy Er- 2.42 (1.31-4.49) Ptrend:0.02 Moore, 2004 COL00362 US FHS, Prospective Cohort, Age: 30-79 years, M/W, members of original Framingham study 306/ Self-report, health check, National Death Index Height and weight were measured Incidence, colon cancer ≥ 30 vs 18.5-< 25 kg/m2 1.60 (1.00-2.50) Age, sex, alcohol consumption, educational level, physical activity, smoking habits, height categories 97/ Incidence, proximal colon cancer, age: yrs 1.60 (0.90-3.00) 91/ Age: 55-79 yr 2.90 (1.60-5.20) 56/ Incidence, distal colon cancer, age: 30-54 yrs 1.40 (0.55-3.60) 53/ Age: 55-79 yr 1.80 (0.75-4.30)
Sanjoaquin, 2004 COL01182 UK OVS, Prospective Cohort, Age: 18-89 years, M/W 92/ 10 998 17 Self-reported Incidence, colorectal cancer, ≥ 25 vs < 20 kg/m2 0.83 (0.40-1.70) Ptrend:0.535 Age, sex categories Person-years of follow up ≥ 25 vs < 20 kg/m2 0.74 (0.36-1.53) Ptrend:0.791 Alcohol consumption, smoking habits Wei, 2004 COL00581 USA NHS, Prospective Cohort, W, nurses 672/ 87 733 24 years Self-report, medical records and National Death Index Self-reported Incidence, colon cancer, > 30 vs < 23 kg/m2 1.28 (1.10-1.62) Ptrend:0.05 Age, family history, BMI, physical activity, beef, pork or lamb as a main dish, processed meat, alcohol, calcium, folate, height, smoking before age 30, history of endoscopy categories Person-years of follow up 204/ Incidence, rectal cancer 1.56 (1.01-2.42) Ptrend:0.04 HPFS, Prospective Cohort, M, Health professionals 135/ 46 632 14 years Incidence, rectal cancer 1.03 (0.49-2.14) Ptrend:0.70 467/ Incidence, cancer 1.85 (1.26-2.72) Ptrend:0.001 HPFS & NHS 1123/ 134 356 Incidence, colon cancer, 1.39 (1.14-1.69) Ptrend:0.001 336/ Incidence, rectal cancer 1.40 (0.96-2.03) Ptrend:0.11 1459/ Incidence, colorectal cancer Per 5 kg/m2 1.06 (1.03-1.10)
Saydah, 2003 COL00522 USA CLUE II, Nested Case Control, Age: 45- years, M/W 173/ 346 controls Cancer registry Self-report Incidence, colorectal cancer, ≥ 30 vs < 25 kg/m2 1.70 (1.01-2.86) Ptrend:0.08 Age, sex, date of blood draw, race, time since last meal Mid-point categories 132/ Incidence, cancer, 1.79 (1.02-3.13) Ptrend:0.06 Incidence, proximal colon cancer 1.46 (0.71–2.98) Ptrend:0.52 Incidence, distal colon cancer 2.60 (1.18–5.70) Ptrend:0.02 Incidence, rectal cancer 1.64 (0.68-3.94) Ptrend:0.41 Calle, 2003 COL00375 Colombia, USA, Puerto Rico CPS II, Prospective Cohort, Age: 30- years, M/W 3 494/ 900 053 16 years Hospital records and death certificates Self-reported Mortality, colorectal cancer, men ≥35.0-39.9 vs 18.5-24.9 kg/m2 1.84 (1.39-2.41) Ptrend:<0.001 Age, alcohol consumption, educational number of cigarettes smoked, physical activity, aspirin use, fat consumption, marital status, race, smoking status, vegetable consumption Mid-point categories Person-years of follow up 3 012/ ≥ 40.0 vs kg/m2 1.46 (0.94-2.24) Ptrend:<0.001
replacement therapy Colangelo, 2002 COL00383 USA CHA Detection Project in Industry, Prospective Cohort, Age: ≥ 40 years 191/ 35 582 866 926 National Index Height and weight were measured Mortality, colorectal cancer Q4 vs Q1 0.91 (0.52-1.61) Ptrend:0.76 Age,race, education, sex Mid-point categories 126/ 1.22 (0.87-1.72) Ptrend:0.22 362/ Incidence, colorectal cancer, men > 27.1 vs < 23 kg/m2 1.07 (0.80-1.42) Ptrend:0.51 Terry, 2002 COL00558 Canada CNBSS, Prospective Cohort, Age: 40-59 years, W 527/ 89 835 936 433 National Mortality Database and to the Canadian Cancer Database Self-reported Incidence, colorectal cancer > 30 vs < 25 kg/m2 1.08 (0.82-1.41) Ptrend:0.57 Age, educational level, oral contraceptive use, parity, physical activity, smoking habits, HRT Mid-point categories Person-years of follow up 363/ Incidence, colon cancer 0.95 (0.67-1.34) Ptrend:0.97 172/ Incidence, proximal colon cancer 0.81 (0.48-1.38) Ptrend:0.61 164/ Incidence, rectal cancer 1.35 (0.87-2.07) Ptrend:0.35 148/ Incidence, distal cancer 1.31 (0.79-2.16) Ptrend:0.22
years Terry, 2001 COL00554 Sweden SWSC, Prospective Cohort, Age: 40-76 years, W 460/ 61 463 588 270 Cancer registry Self-reported Incidence, colorectal cancer, > 26.7 vs < 22 kg/m2 1.24 (0.95-1.62) Ptrend:0.06 Age, alcohol consumption, educational level, energy intake, red meat intake, vitamin d, calcium, folate, total fat, vitamin c categories of follow up 291/ Incidence, cancer, 1.21 (0.86-1.70) Ptrend:0.25 159/ Incidence, rectal cancer, 1.32 (0.83-2.08) Ptrend:0.13 118/ Incidence, proximal colon cancer, 1.13 (0.66-1.94) Ptrend:0.53 101/ Incidence, distal colon cancer, 1.21 (0.67-2.19) Ptrend:0.45 2000 COL40787 USA NYUWHS, Nested Case Control, Age: 35-65 years, W, Screening Program 100/ 196 controls Active follow up by questionnaire; cancer registry and national death Index Self-reported height and weight Incidence, colorectal cancer 31.98 vs 20.91 kg/m2 2.83 (1.23-6.54) Ptrend:0.006 Age, menopausal status, reproductive factors, smoking status, time categories 73/ 144 controls Incidence, colon cancer 32.81 vs 21.25 kg/m2 3.07 (1.12-8.41) Ptrend:0.01 Ford, 1999 COL00097 USA NHANES I, Prospective Cohort, 222/ 13 420 19 years Multistage stratified sampling design Weight and height were measured Incidence, cancer 2.79 (1.22,6.35) Incidence, colon cancer, men 2.95 (0.99, 8.74)
Age: 25-74 years, M/W Incidence, colon cancer, women 2.74(1.04, 7.25) Schoen, 1999 COL00183 USA CHS, Prospective Cohort, Age: 65- years, M/W 102/ 5 849 Medicare enrolment lists Weight and height were measured Incidence, colorectal cancer Q 4 vs Q 1 1.40 (0.80-2.50) Age, sex, physical activity Mid-point categories Person-years of follow up Singh, 1998 COL00185 USA AHS, Prospective Cohort, Age: 25- years, M/W, Seventh-day Adventists 142/ 32 051 178 544 Hospital records and cancer registry Self-reported Incidence, colon cancer > 25 vs < 22.5 kg/m2 1.33 (0.88-2.06) Age, sex, family history of specific cancer Mid-point categories 83/ Incidence, colon cancer, women 1.05 (0.63-1.75) 59/ Incidence, colon cancer, men 2.63 (1.12-6.13) Tulinius, 1997 COL00622 Iceland ICRF, Prospective Cohort, M/W 193/ 22 946 Population registry Anthropometrics measured Incidence, colorectal cancer, men per 1 kg/m2 1.04 (0.99-1.08) Age Chyou, 1996 COL00087 USA HHP, Prospective Cohort, M, Japanese ancestry 330/ 8 006 19 years Hospital records + cancer registry Self-reported Incidence, colon cancer ≥ 25.8 vs < 21.7 kg/m2 1.38 (1.01-1.90) Ptrend:0.0046 Age Mid-point categories 123/ Incidence, rectal cancer 0.63 (0.38-1.04) Ptrend:0.1697
Thune, 1996 COL00269 Norway NHSCD, Prospective Cohort, Age: 20-69 years, M/W 230/ 81 516 1 305 607 person-years Cancer registry Height and weight were measured Incidence, cancer, men per 1 g/cm2 1.25 (1.01-1.53) Age Unit converted to kg/m2 169/ Incidence, rectal cancer, men per 1 g/cm2 0.99 (0.60-1.63) 99/ Incidence, colon cancer, women per 1 g/cm2 0.93 (0.57-1.52) 55/ Incidence, rectal cancer, women per 1 g/cm2 0.96 (0.51-1.82) Lee, 1992 COL00679 USA HAHS, Prospective Cohort, Age: 48 years, M 290/ 17 595 26 years Health examination check Height and weight were measured Incidence, colon cancer, ≥ 26 vs < 22.5 kg/m2 1.52 (1.06-2.17) Ptrend:0.03 Age, physical activity, parental history of cancer Mid-point categories per 1 kg/m2 1.08 (1.04-1.13) Wu, 1987 COL00774 USA LWC, Prospective Cohort, M/W, Retirement community 68/ 11 644 4.5 years Population registries Incidence, colorectal cancer, women ≥ 34 vs ≤ 29 lbs/m2 1.19 (0.70-2.20) Age Mid-point categories 1.80 (1.00-3.20) 58/ Incidence, colorectal cancer, men ≥ 35 vs ≤ 31 lbs/m2 2.40 (1.10-5.40) 2.65 (1.25-5.60) Alcohol consumption, physical activity, smoking habits
Table 323 BMI and colorectal cancer risk. Main characteristics of studies excluded from the CUP SLR dose-response meta-analysis Author, Year, WCRF Code, Country Study name, characteristics Study size Follow-up (years) Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Reasons for exclusion Heo, 2015 COL41057 USA WHI, Prospective Cohort, Age: 50-79 years, W, postmenopausal 1 904/ 144 701 12 years Self-report verified by medical record and pathology report Height and weight were measured Incidence, colorectal cancer per 1 1.12 (1.06-1.17) high risk vs low risk kg/m2 1.12 (1.02-1.24) 1 516/ Incidence, colon cancer per 1 1.12 (1.06-1.18) high risk vs low risk kg/m2 1.18 (1.05-1.33)
red meat intake, alcohol, Asprine use, education, family history of colorectal cancer, smoking 257/ Incidence, rectal cancer per 1 score 1.07 (0.94-1.22) Shin, 2014 COL41023 KNHIC, Prospective Cohort, Age: 30-80 years, M/W 9 084/ 1 326 058 Cancer registry & Insurance system Height and weight were measured Incidence, colorectal cancer, male ≥ 25 vs ≤ 25 kg/m2 1.13 (1.07-1.19) Age, cigarette smoking, family history of cancer, fasting blood sugar, height, alcohol, meat consumption, serum cholesterol Used in HvL analysis, only 2 categories Kabat, 2015 COL41034 USA WHI Prospective Cohort, Age: 50-79 W, postmenopausal women 1 908/ 143 901 13 years Self-report verified by medical record and pathology report Weight and height were measured by trained staff at baseline Incidence, colorectal cancer Q5 vs Q1 1.28 (1.10-1.50) Ptrend:0.001 Age, aspirin, diabetes, family history of cancer, HRT use, met-hours per week, treatment allocation, waist circumference, alcohol, education, No specific ranges of quintiles No number of cases in each quintile Kabat, 2013 Col40965 used instead Ever used HRT Q5 vs Q1 1.60 (1.26-2.03) Ptrend:<0.001 used HRT Q2 vs Q2 1.10 (0.90-1.36) Never used HRT Q5 vs Q1 1.25 (1.02-1.54) Ptrend:< 0.01
> 27.1 vs < 23.8 kg/m2 1.15 (0.64-2.08) Ptrend:0.63 45/ Women braf mutated > 26.6 vs < 23.2 kg/m2 1.20 (0.50-2.87) Ptrend:0.94 26/ Men braf mutated > 27.5 vs < 24.7 kg/m2 0.97 (0.39-2.44) Ptrend:0.94 Miao Jonasson, 2014 COL41049 Sweden Swedish National Diabetes Register Cohort Study, Prospective Cohort, Age: 30-90 years, M/W, Other 591/ 11 093 9 years Swedish cancer registry & record linkage with swedish cause-of-death registry From registry records Incidence, colorectal cancer per 5 kg/m2 1.11 (1.01-1.21) Age, diabetes, diabetes medication use, smoking Participants are type 2 diabetes patients ≥ 30 vs kg/m2 1.52 (1.20-1.93) 357/ Incidence, colorectal cancer, men per 5 kg/m2 1.10 (0.96-1.25) 263/ ≥ 30 vs kg/m2 1.62 (1.17-2.24) 234/ Incidence, colorectal cancer, women ≥ 30 vs kg/m2 1.39 (0.98-1.96) per 5 kg/m2 1.11 (0.99-1.26) Simons, 2014 COL41029 Netherlands NLCS, Case Cohort, Age: 55-69 years 204/ Cancer registry Incidence, colorectal cancer, igfbp 2 genes methylated Q3 vs Q1 1.67 (1.17-2.38) Ptrend:< 0.01 per 5 kg/m2 1.39 (1.11-1.74) 178/ Igfbp 1 gene methylated Q3 vs Q1 1.11 (0.77-1.62) Ptrend:0.57 per 5 kg/m2 1.19 (0.93-1.71)
121/ 3 genes methylated Q3 vs Q1 2.07 (1.29-3.33) Ptrend:0.27 per 5 kg/m2 1.34 (1.07-1.67) 112/ Igfbp 0 genes methylated Q33 vs Q31 1.39 (0.88-2.19) Ptrend:0.16 per 5 kg/m2 1.26 (0.93-1.71) Semmens, 2013 COL40929 Japan Life Span Study, Prospective Cohort, M/W 1 142/ 56 064 Cancer registry Self-reported Incidence, cancer Q3 vs Q1 1.30 (1.09-1.54) Sex, city Age, attained age Participants are atomic bomb survivors per 5 kg/m2 1.14 (1.03-1.26) 577/ Incidence, colon cancer, women 21.65-24 vs < 19.63 kg/m2 1.16 (0.92-1.46) per 5 kg/m2 1.07 (0.94-1.22) 565/ Incidence, colon cancer, men 21.64-23.71 vs < 19.74 kg/m2 1.46 (1.14-1.88) per 5 kg/m2 1.25 (1.07-1.45) van Kruijsdijk RC, 2013 COL40974 Netherlands Prospective Cohort, Age: 18-80 years, M/W, High Risk population 71/ 6 172 6 years Cancer registry Height and weight measured Incidence, colorectal cancer per 4 kg/m2 0.96 (0.76-1.22) Age, sex, alcohol consumption, smoking status, pack years of smoking Participants are CVD patients
Hartz, 2012 COL40901 USA WHI, Prospective Cohort, Age: 50-79 years, W, 1 181/ 141 652 8 years Measured Incidence, colon cancer per 1 sd units 1.15 Age, income, physical activity, race, treatment allocation, alcohol, education, region, smoking No Confidence Intervals Hughes, 2012 COL40943 Netherlands NLCS, Case Cohort, Age: 55-69 years, M/W 550/ 4 654 7 Cancer registry and pathology database Self-reported Incidence, colorectal cancer, braf wildtype per 5 kg/m2 1.28 (1.12-1.45) Sex, ethnicity Only has gene interactions results Hughes, 2011 COL40895 used instead Q4 vs Q1 1.40 (1.09-1.80) Ptrend:<0.001 544/ Ms-stable per 5 kg/m2 1.22 (1.08-1.39) Q4 vs Q1 1.33 (1.03-1.70) Ptrend:0.04 Hughes, 2012 COL40944 Australia MCCS, Prospective Cohort, Age: 27-75 years, M/W 495/ 40 154 Cancer registry/death records/national death index Height (cm), weight (kg) and waist circumference (cm) were measured Incidence, colorectal cancer, per 5 kg/m2 1.10 (1.00-1.22) Sex, ethnicity Only has gene interactions results Q4 vs Q1 1.31 (1.01-1.71) Ptrend:0.04 487/ Braf wildtype per 5 kg/m2 1.10 (0.99-1.21) Q4 vs Q1 1.35 (1.03-1.78) Ptrend:0.04 Kuchiba, 2012 COL40903 USA NHS, Prospective Cohort, 536/ 109 051 18 years Questionnaire and mortality register Self-reported Incidence, colorectal cancer 30 vs 18.5-22.9 kg/m2 1.61 (1.22-2.13) Ptrend:0.001 Age, aspirin use, calcium, energy intake, folate Superseded by Morikawa, 2013 COL40958 stable Post-
smoking status, fibre intake, history of colorectal cancer, month of blood draw, region, saturated fat intake, Hughes, 2011 COL40873 Netherlands NLCS, Case Cohort, Age: 55-69 years, M/W 318/ 5 000 7 years Cancer registry Self-reported Incidence, colorectal cancer, Q4 vs Q1 1.22 (0.84-1.75) Ptrend:0.18 Age, sex, education level, energy intake, smoking status, socio-economic status, alcohol intake, family history of colorectal cancer, fruit and vegetable, grains intake, phyisical activity, red meat consumption Only has phenotype results Hughes, 2011 COL40895 used per 5 kg/m2 1.19 (0.98-1.14) Levi, 2011 COL40897 Israel Jewish Israeli male study, 537/ 1 109 864 18 years Cancer registry Weight and height were measured Incidence, colorectal cancer > 23.63 vs < 19.01 kg/m2 1.43 (1.09-1.89) Ptrend:< 0.01 mucinous
kg/m2 per 1 kg/m2 1.03 (0.96-1.11) Cnattingius, 2009 COL40776 Sweden STC, Prospective Cohort, M/W, Twins 210/ 23 337 33 Population cancer registries and other procedures Self-reported by questionnaires Incidence, colorectal cancer ≥ 25 vs kg/m2 1.60 (1.15-2.23) Age Used in HvL analysis Key, 2009 COL40775 UK EPIC-Oxford, Prospective Cohort, Age: 20-89 years, M/W, Vegetarians 218/ 63 550 National cancer registers Self-reported height and weight Incidence, colorectal cancer > 27.5 vs kg/m2 0.85 (0.54-1.33) Age, sex, smoking status, method of recruitment No specific range of quintiles reported Used in HvL analysis Lee, 2009 COL40764 China SWHS, Prospective Cohort, Age: 40-70 years, W 394/ 73 224 7 years Cancer registry and death certificates and participant contact Incidence, colorectal cancer > 26.1 vs < 21.5 kg/m2 1.10 (0.80-1.50) Ptrend:0.50 Age, energy intake Age-underlying cox models, family history of colon cancer, physical activity, race, smoking status, alcohol, history of polyp diagnosis, Superseded by Li, 2012 COL40937 236/ Incidence, colon cancer 0.90 (0.60-1.30) Ptrend:0.98 158/ Incidence, rectal cancer 1.40 (0.90-2.20) Ptrend:0.27
intervention assignment Wei, 2009 COL40777 USA NHS, Prospective Cohort, Age: 30-54 years, W 701/ 83 767 24 years Self-report verified by medical record Incidence, cancer 30 vs 20 kg/m2 1.16 (0.98-1.38) Age, aspirin use, folate intake, height, of smoking, year of endoscopy, family history of colorectal cancer, postmenopausal hormone use, red or processed meat intake Cumulative risk estimates reported Wei, 2004 COL00581 used consistently high vs average kg/m2 1.68 (1.39-2.03) Stocks, 2008 COL40691 Sweden NSHDC, Nested Case Control, Age: 60.00years, M/W 218/ 901 4 years Cancer registry Measured Incidence, colorectal cancer > 28.3 vs < kg/m2 1.20 (0.75-1.93) Ptrend:0.41 Age, sex, date of collection, fasting condition Supersede by Lukanova, 2006 COL40752 obese vs under to normal weight kg/m2 1.79 (1.09-2.95) Ptrend:0.07 yes vs no kg/m2 1.77 (1.11-2.82) Ptrend:0.02 Adams, 2007 COL40630 USA NIH- AARP Diet and Health Study, 2 314/ 517 144 5 Cancer registry questionnaire Incidence, colorectal cancer, men 2.05 (1.45-2.91) Ptrend:<0.0005
Prospective Cohort, Age: 50-71 years, M/W intake, red meat intake, smoking status HRT use 1 676/ Incidence, colon cancer, men 2.39 (1.59-3.58) Ptrend:<0.0005 1 029/ Incidence, colorectal cancer, women 1.28 (0.88-1.85) Ptrend:0.03 769/ Incidence, cancer, women 1.49 (0.98-2.25) Ptrend:0.02 677/ Incidence, rectal cancer, men ≥ 35 vs 18.5-< 23 kg/m2 1.00 (0.68-1.58) Ptrend:0.31 278/ Incidence, rectal cancer, women 1.44 (0.92-2.25) Ptrend:0.20 Akhter, 2007 COL40632 Japan MCS, Prospective Cohort, Age: 40-64 years, M 307/ 21 199 11 Cancer registry Incidence, colorectal cancer ≥ 25.0 vs < 18.5 kg/m2 1.61 (0.59-4.40) Age Superseded by Matsuo, 20122012 Wang, 2007 COL40679 USA CPS II, Prospective Cohort, Age: 63 W, 814/ 73 842 11 years Medical records, cancer registries, national death Index questionnaire - Incidence, colorectal cancer, postmenopausal women ≥ 30 vs kg/m2 1.19 (0.97-1.45) Ptrend:0.04
postmenopausal women multivitamin use, NSAID use, physical activity, smoking status per 5 unit 1.08 (1.00-1.17) 386/ Postmenopausal years without HRT ≥ 15 ≥ 30 vs kg/m2 1.20 (0.92-1.57) per 5 unit 1.07 (0.96-1.19) 365/ HRT never ≥ 30 vs kg/m2 1.36 (1.04-1.79) per 5 unit 1.13 (1.02-1.25) 216/ HRT former ≥ 30 vs kg/m2 0.92 (0.61-1.39) Lundqvist, 2007 COL40692 &COL40693 Sweden, Finland Sweden, Finland Co-twin study,1975, Prospective Cohort, Age: 44.00years, M/W 513/ 68 149 25 years National cancer registers Measured Incidence, colon cancer, older subjects ≥ 30.0 vs 18.5-< 25.0 kg/m2 1.30 (0.90-1.80) per 1 kg/m2 1.02 (0.99-1.05) 327/ Incidence, colon cancer, older subjects ≥ 30.0 vs 18.5-< 25.0 kg/m2 1.90 (0.80-4.50) per 1 kg/m2 1.09 (1.02-1.17) 324/ 68 149 25 years Incidence, rectal cancer, subjects ≥ 30.0 vs 18.5-< 25.0 kg/m2 0.70 (0.40-1.20) per 1 kg/m2 1.00 (0.97-1.04)
226/ Incidence, rectal cancer, older subjects ≥ 30.0 vs 18.5-< 25.0 kg/m2 3.80 per 1 kg/m2 1.06 (0.97-1.15) per 1 kg/m2 1.01 (0.89-1.15) Driver, 2007 COL40711 USA PHS, Prospective Cohort, Age: 40-84 years, M, Physicians 21 581 20 years Follow up questionnaires (self-report), medical record and pathology reports Height and weight assessed by questionnaire Incidence, colorectal cancer ≥ 30 vs ≤ 25 kg/m2 1.62 (1.09-2.42) Age, alcohol, history of diabetes, multivitamin, physical activity, smoking status, vegetable intake, vitamin c, vitamin e, cereals intake Used in HvL analysis 1.60 (1.07-2.38) Ahmed, 2006 COL40617 USA Atherosclerosis Risk in Communities (ARIC) 1987, Prospective Cohort, Age: 45-64 years, M/W 194/ 14 109 12 years Cancer registry & hospital surveillance Measured Incidence, colorectal cancer Highest vs lowest 1.54 (0.90-2.80) Age, sex, alcohol consumption, aspirin use, HRT use, NSAID use, pack-years of smoking, physical activity, family history of colorectal cancer Used in HvsL analysis 107/ Incidence, colorectal cancer, men 1.52 (0.90-2.70) 87/ Incidence, colorectal cancer, women 1.26 (0.60-2.60)
Berndt, 2006 COL40795 USA CLUE II, Case Cohort, Age: 48.00years, M/W 250/ 2 224 14 years Cancer registry Incidence, colorectal cancer > 25 vs kg/m2 1.18 (0.88-1.56) Age, race Results on genotype Superseded by Saydah, 2003 COL00522 which included in HvsL analysis only McCarl, 2006 COL40633 USA IWHS, Prospective Cohort, Age: 55-69 years, W 954/ 35 197 15 years SEER registry Incidence, colorectal cancer > 30.64 vs < 22.8 kg/m2 1.43 (1.17-1.76) Age Superseded by Poynter, 2013 COL40952 Stürmer, 2006 COL40710 USA PHS, Prospective Cohort, Age: 40-84 years, M, Health professionals 494/ 22 071 19 years Self-report verified by medical record Self-reported Incidence, colorectal cancer ≥ 27 vs < 27 kg/m2 1.40 (1.10-1.70) Alcohol consumption, fruit and vegetable intake, multivitamin use, NSAID use, physical activity, disease, smoking habits Superseded by Driver, 2007 COL40711
Yeh, 2006 COL40675 Taiwan 7 township Taiwanese cohort, Prospective Cohort, Age: 30-65 M/W 68/ 23 943 10 years Cancer registry and death certificates Incidence, colorectal cancer, men ≥ 28.6 vs < 24.2 kg/m2 1.98 (0.91-4.30) Age, nutritional factors (nos), residence, smoking status Used in HvsL Kuriyama, 2005 COL01837 Japan MCS, Prospective Cohort, Age: 40-64 years, M/W 155/ 27 539 9 years Population registry questionnaire Incidence, colorectal cancer, men 1.78 (0.73-4.38) Ptrend:0.10 Age, alcohol consumption, fruit (total), smoking status, bean-paste soup consumption, fish consumption, green en yellow vegetable consumption, meat consumption, type of health Insurance 115/ Incidence, colorectal cancer, 2.06 (1.03-4.13) Ptrend:0.06 88/ Incidence, colon cancer, men 1.30 (0.32-5.37) Ptrend:0.37
82/ Incidence, colorectal cancer, postmenopausal 2.08 (0.88-4.90) Ptrend:0.06 72/ Incidence, colon cancer, women 2.25 (0.95-5.33) Ptrend:0.06 67/ Incidence, rectal cancer, men 2.41 (0.74-7.85) Ptrend:0.09 42/ Incidence, rectal cancer, women 1.21 (0.29-5.14) Ptrend:0.77 Incidence, distal colon cancer, men 1.41 Ptrend:0.54 35/ Incidence, distal cancer, women 2.86 (0.98-8.37) Ptrend:0.48 34/ Incidence, proximal colon cancer, men 1.71 Ptrend:0.29 30/ Incidence, rectal cancer, postmenopausal women 2.07 (0.47-9.09) Ptrend:0.33
end of first pregnancy 28/ Incidence, proximal colon cancer, women 1.03 (0.13-8.01) Ptrend:0.11 Oh, 2005 COL01868 Korea KNHIC, Prospective Cohort, Age: 20- years, M 1 563/ 781 283 10 years General health status examinations Incidence, rectosigmoid cancer, men > 30 vs kg/m2 1.08 (0.56-2.10) Ptrend:0.025 Age, alcohol consumption, area of residence, family history of specific cancer, physical activity, smoking status Superseded by Jee, 2008 COL40643 997/ Incidence, of colon and rectum, men 1.20 (0.62-2.32) Ptrend:0.006 953/ Incidence, colon cancer, men 1.92 (1.15-3.22) Ptrend:0.003 487/ Incidence, of colon, men 1.64 (0.90-2.98) Ptrend:0.007 291/ Incidence, cancer, nonsmokers 1.75 (0.64-4.78) Ptrend:0.04 272/ Incidence, rectosigmoid cancer, nonsmokers 1.72 (1.21-2.48) Ptrend:0.168 204/ Incidence, adenocarcinoma 1.89 (0.55-5.63) Ptrend:0.039
of colon, nonsmokers 2005 COL01891 Japan JPHC I and II, Prospective Cohort, Age: 40-69 years, M/W 626/ 102 949 9 years Population registries Incidence, colorectal cancer, men 1.50 (0.90-2.50) Ptrend:0.004 424/ Incidence, colon cancer, men 1.40 (0.70-2.80) Ptrend:0.003 418/ Incidence, invasive colorectal cancer, men 1.90 (1.05-3.40) Ptrend:0.001 360/ Incidence, colorectal cancer, women 0.80 (0.40-1.50) Ptrend:0.94 262/ Incidence, invasive colon cancer, men 2.20 (1.10-4.40) Ptrend:<0.001 244/ Incidence, distal colon cancer, men 1.30 (0.50-3.20) Ptrend:0.13 229/ Incidence, cancer, women 0.50 (0.20-1.40) Ptrend:0.73 202/ Incidence, rectal cancer, men 1.60 (0.60-3.90) Ptrend:0.40
Age: 18-100 years, M, veterans 10 568/ Incidence, rectal cancer, white men obese vs 1.23 (1.14-1.33) 4 092/ Incidence, colon cancer, black men obese vs 1.45 (1.28-1.64) 1 866/ Incidence, rectal cancer, black men obese vs 1.11 (0.90-1.37) Feskanich, 2004 COL01680 USA NHS, Nested Case Control, Age: 46-78 years, W 193/ 121 700 11 years Medical records and writing or by telephone Self-reported Incidence, colorectal cancer (mean exposure) Month of blood draw, year of birth Supersede by Morikawa, 2013 COL40958 Koh, 2004 COL00053 China SCHS, Nested Case Control, Age: 45-74 years, M/W 310/ 63 257 Cancer registry Incidence, colorectal cancer ≥ 28 vs ≤ 20 kg/m2 Ptrend:0.04 No RR available MacInnis, 2004 COL00373 Australia MCCS, Prospective Cohort, 153/ 16 566 Measured by interviewer Incidence, > 29.3 vs < 24.7 kg/m2 1.70 (1.10-2.80) Age, educational level, country of birth
Nested Case Control, Age: 40-84 years, W, Breast cancer patients Meyerhardt, 2003 COL00898 USA Intergroup 0089, Historical Cohort, Age: 62.00years, M/W 3 438 9 years Hospital Measured by clinicians Recurrence, colon cancer, men > 30 vs 21-24.9 kg/m2 0.98 (0.79-1.23) Age, sex, baseline performance status, bowel obstruction, ethnicity/race, bowel perforation, completion of chemotherapy, duke stage of disease, predominant macroscopic pathologic feature, presence of peritoneal implants Recurrence > 30 vs 21-24.9 kg/m2 1.11 (0.94-1.30) Recurrence, colon cancer, women >3 0 vs 21-24.9 kg/m2 1.24 (0.98-1.59) Wong, 2003 COL00586 SCHS, Nested Case Control, 217/ 63 257 Cancer registry Self-reported Incidence, colorectal cancer ≥ 28 vs < 22 kg/m2 No RR available
Age: 45-74 years, M/W Tiemersma COL00563 Netherlands Dutch prospective Monitoring Project on Cardiovascular Disease Risk Factors, Nested Case Control, Age:20-59 years, M/W 102 537 controls 36 000 8.5 years Population register Incidence, colorectal cancer Mean exposure 26.9 (cases) 25.9 (controls) Mean exposure Reported only Nilsen, 2002 COL00306 Norway NHUNT, Prospective Cohort, Age: 20- years, M/W 368/ 75 219 12 years Cancer registry Not specified Incidence, colorectal cancer, > 27.4 vs < 21.8 kg/m2 0.98 (0.71-1.34) Ptrend:0.96 Age It was included in the Engeland, 2005 study COL00306 Malila, 2002 COL00336 Finland ATBC, Prospective Cohort, Age: 50-69 M, Male Smokers 184/ 26 951 8 years Cancer registry Incidence, colorectal cancer Mean exposure Reported only Superseded by Bowers, 2006 COL40699
33/ Incidence, colon cancer, men obese vs population kg/m2 1.20 (0.80-1.60) 30/ Incidence, rectal cancer, men obese vs population kg/m2 1.50 (1.00-2.10) Folsom, 2000 COL01688 USA IWHS, Prospective Cohort, Age: 55-69 years, W 462/ 31 702 10 SEER Self-reported Incidence, colon cancer > 30.21 vs < 22.8 kg/m2 1.70 (1.20-2.40) Age, alcohol consumption, educational energy intake, physical activity, red meat intake, age of first live birth, estrogen use, fish intake, fruit intake, pack-years of cigarette smoking, smoking status, vegetable intake, vitamin use, waist-hip ratio, whole grain intake Superseded by Poynter, 2013 COL40952
Pietinen, 1999 COL00176 Finland ATBC, Prospective Cohort, Age:50-69 years M 185/ 27 111 8 years Cancer registry Incidence, colorectal Mean exposure 26.3 26.0 Mean exposure reported only Bowers, 2006 COL40699 used instead Hara, 1999 COL01012 Japan Japan, Saga prefecture study, Prospective Cohort, Age: 40-69 years, M/W 16/ 2 073 14 years Population Self-reported Incidence, colorectal cancer, women > 24.2 vs kg/m2 1.39 (0.46-4.15) Ptrend:0.47 Age, alcohol consumption, physical activity, smoking habits Superseded by Matsuo, 2012 19.8 vs kg/m2 0.81 (0.17-3.73) Ptrend:0.47 6/ Men > 24.2 vs kg/m2 6.39 Ptrend:<0.05 Robsahm, 1999 COL00180 Norway NSPT, Prospective Cohort, Age: 30-69 M/W, participants of a nation-wide screening programme 7 620/ 1 122 852 19 479 236 person-years Cancer registry Incidence, colon cancer, women Q 5 vs Q 1 1.07 (0.99-1.15) Attained age, birth cohort, county of residence Used in HvsL analysis only 6 397/ Incidence, cancer, men Q 5 vs Q 1 1.39 (1.39-1.50) 4 393/ Incidence, rectal cancer, men Q 5 vs Q 1 1.16 (1.07-1.27) 3 482/ Incidence, rectal cancer, women Q 5 vs Q 1 1.03 (0.93-1.14)
Kato, 1999 COL00436 USA NYUWHS, Nested Case Control, Age: 62.00years, W 105/ 15 785 Questionnaire, medical records, cancer registries Questionnaire, medical records, National Death Index Incidence, colorectal cancer Age, date of enrolment, date of subsequent blood, menopausal status Mean exposure reported only Kaaks, 2000 COL40787 Used in HvsL analysis Gaard, 1997 COL00163 Norway NHSCD, Prospective Cohort, Age: 20-54 years, M/W 62 173 702 010 Cardiovascular screening Measured Incidence, colon cancer, men > 2.71 vs < 2.3 g/cm2 1.64 (0.92-2.92) Ptrend:0.04 Age Thune, 1996 COL00269 used instead > 2.71 vs < 2.3 g/cm2 1.61 (0.76-3.44) Ptrend:0.21 Incidence, colon cancer, women > 2.66 vs < 2.17 g/cm2 1.02 (0.53-1.97) Ptrend:0.88 > 2.66 vs < 2.17 g/cm2 0.64 (0.31-1.33) Ptrend:0.8 Kato, 1997 CRC00022 USA NYUWHS, Prospective Cohort, Age: 34-65 years, W 100/ 14 272 105 044 Questionnaire, medical records, cancer registries Self-reported Incidence, colorectal cancer Q4 vs Q4 1.19 (0.68-2.08) Age, place at enrolment Superseded by Kaaks, 2000 COL40787 Martínez, 1997 COL00139 USA NHS, Prospective Cohort, 393/ 89 448 1 012 375 person-years Medical records, National Death Index Self-reported Incidence, colon cancer 1.45 (1.02-2.07) Ptrend:0.04 Age, alcohol consumption, cigarette smoking, family
smoking habits, aspirin use, dietary fibre intake, folate intake, history endoscopic screening, history polyp diagnosis, methione intake, red meat intake Bostick, 1994 COL00079 USA IWHS, Prospective Cohort, Age: 55-69 years, W 212/ 35 216 167 447 SEER Incidence, colon cancer > 30.62 vs < 22.9 kg/m2 1.41 (0.90-2.23) Ptrend:0.03 Age, energy intake, parity, vitamin A supplement, vitamin E intake Superseded by Poynter, 2013 COL40952 Chyou, 1994 COL00086 USA HHP, Prospective Cohort, M, Japanese ancestry 289/ 7 945 19 Cancer registry & hospital surveillance Incidence, cancer, colon cancer ≥ 26.0 vs < 22.0 kg/m2 1.21 (0.87-1.68) Ptrend:0.006 Age Superseded by 1996 COL00087 108/ Incidence, rectal cancer, rectal cancer (mean exposure) Moller, 1994 COL01056 Denmark Danish study, 195/ 43 965 5 Hospital records Clinical records Incidence, colon cancer obese vs danish population (expected) 1.20 (1.00-1.40)
Age: 40-59 years, M Le Marchand, 1992 COL00676 USA HHCS, Historical Cohort, Age: 15-29 years, M 203/ 3 501 15 years Population registries Incidence, colon cancer Q 3 vs Q 1 1.4 (1.10-1.80) status, ethnic origin of parents, month and year of birth Used in HvsL Incidence, rectal cancer 0.80 (0.52-1.24) Ptrend:0.37 Must, 1992 COL00703 USA HGS, Prospective Cohort, Age: 73 M/W, third Harvard Growth Study 5/ 508 55 years National Death Index Height and weight were measured Incidence, colorectal cancer, men 22-25 vs < 22 kg/m2 5.60 BMI Used in HvsL analysis Kreger, 1992 COL00665 USA FHS, Prospective Cohort, Age: 30-62 years, M/W 66/ 5 209 40 years Population BMI was used as exposure but nothing was specified about assessment technique Incidence, colon cancer, women per 1 kg/m2 1.03 (0.98-1.07) Alcohol consumption, hypertension, sf 0-20, cigarette smoking, glucose intolerance Unadjusted RR Superseded by Moore, 2004 COL00362 56/ Men per 1 kg/m2 1.09 (1.00-1.18) 20/ Incidence, rectal cancer, women per 1 kg/m2 0.99 (0.90-1.10) 19/ Men per 1 kg/m2 0.91 (0.80-1.05)
Sidney, 1986 COL01239 USA KPMCP, Nested Case Control, M/W 245/ 48 314 348 000 Medical records Incidence, colorectal cancer Age, sex, race, time of examination Mean exposure reported only Garland, 1985 COL01050 USA Western Electric Health Study, Prospective Cohort, Age: 40-55 years, M 49/ 1 954 20 Medical records Incidence, colorectal cancer Mean exposure reported only Nomura, 1985 COL00709 USA HHP, Prospective Cohort, Age: 45-68 years, M 101/ 7 868 Cancer registry & hospital surveillance Measured and self-reported Incidence, cancer 26.32-44.59 vs 14.31-21.25 kg/m2 Ptrend:0.167 Age No RRs available Chyou, 1996 COL00087 used instead 63/ Incidence, rectal cancer 26.32-44.59 vs 14.31-21.25 kg/m2 Ptrend:0.294 Tartter, 1984 COL01088 USA New York Sinai Medical Centre Study, Prospective Cohort, M/W 63/ 279 Hospital records Recurrence, colorectal cancer above median vs median and below No RRs available 37/ Recurrence, colorectal cancer, men median vs median and below 26/ Recurrence, colorectal cancer, women median vs median and below
Table 331 Waist circumference and colorectal cancer risk. Results of meta- of prospective studies published after the 2010 SLR. Author, Year Number of cohort studies Studies country, area Outcome Comparison RR (95%CI) Heterogeneity (I2, p value) Ma, 2013 54 Colorectal cancer Highest vs lowest 1.45 (1.33-1.60) 10.8%, 0.32 Colon cancer 1.613 (1.417–1.837) 0.573, 0% Colon cancer, proximal 1.873 (1.118–3.136) 0.773, 0% Colon cancer, distal 1.942 (1.250–3.017) 0.507, 0% Rectal cancer 1.349 (1.114–1.634) 0.582, 0% USA Colorectal cancer 1.612 (1.379–1.885) 0.227, 24.3% Europe Colorectal cancer 1.368 (1.215–1.541) 0.520, 0% Colorectal cancer, men 1.477 (1.300–1.677) 0.135, 30.2% Colorectal cancer, women 1.442 (1.296–1.604) 0.834, 0% cancer, men 1.812 (1.464–2.242) 0.308, 15.9% Colon cancer, women 1.498 (1.253–1.791) 0.955, 0% Rectal cancer, men 1.281 (0.990–1.657) 0.934, 0% Rectal cancer, women 1.495 (1.025–2.181) 0.224, 33.1%
Table 332 Waist circumference and colorectal cancer risk. Main characteristics of studies included in the CUP SLR dose-response Author, Year, WCRF Code, Country Study name, characteristics Cases/ Study size Follow-up (years) Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Missing data derived for analyses Kabat, 2013 COL40965 USA WHI, Prospective Cohort, Age: 50-79 years, W, Postmenopausal 169/ 11 124 12.9 years Self-report verified by reviewing medical and pathological records by physicians Measured Incidence, colorectal cancer ≥ 94.1 vs ≤ 75.9 cm 1.30 (0.82-2.07) Ptrend:0.23 Age, alcohol, diabetes, educational energy, ethnicity, family history of colorectal cancer, HRT use, pack yrs of smoking, physical activity, randomisation Mid-point categories Li, 2013 COL40937 SWHS, Prospective Cohort, Age: 40-70 years, W 622/ 72 962 11 Follow up survey/cancer registry/vital statistics registry Measured Incidence, colorectal cancer ≥ 85 vs < 70 cm 1.26 (0.93-1.72) Ptrend:0.43 Age at baseline, alcohol consumption, cigarette, educational level, energy intake, family history of colorectal cancer, fruits, Income, menopausal status, physical categories 382/ Incidence, colon cancer 1.34 (0.89-2.00) Ptrend:0.46 240/ Incidence, rectal cancer 1.17 (0.73-1.88) Ptrend:0.73 analysis
activity, red meat, tea consumption, vegetables Li, 2013 COL40936 China SMHS, Prospective Cohort, Age: 40-74 years, M 313/ 61 240 5.5 years Follow up survey/cancer registry/vital statistics registry Measured Incidence, colorectal cancer ≥ 92 vs < 78 cm 1.38 (0.97-1.97) Ptrend:0.004 Age at baseline, alcohol consumption, cigarette, educational energy intake, family history of colorectal cancer, fruits, Income, menopausal status, physical activity, red meat, tea consumption, vegetables Mid-point categories 180/ Incidence, colon cancer 2.00 (1.21-3.29) Ptrend:0.0002 133/ Incidence, rectal cancer 0.88 (0.52-1.49) Ptrend:0.95 Park, 2011 COL41069 UK EPIC-Norfolk, Prospective Cohort, Age: 40-79 years, M/W 357/ 20 608 11 years Record linkage to cancer registration and certificates Self-reported and measured Incidence, colorectal cancer, men (measured WC) ≥ 103.3 vs < 88 cm 0.86 (0.55-1.36) Ptrend:0.53 Incidence, colorectal cancer, men 0.95 (0.54-1.64) Ptrend:0.86
total meat and processed meat, intakes (self-reported WC) Incidence, colorectal cancer, women (measured WC) ≥ 90.5 vs < 73 cm 1.65 (0.97–2.86) Ptrend:0.009 Incidence, colorectal cancer, women (self-reported WC) 1.42 (0.85–2.35) Ptrend:0.12 Incidence, colorectal cancer, men (measured WC) 1.06 (0.77-1.46) Incidence, colorectal cancer, men (self-reported WC) 0.99 (0.74-1.32) Incidence, colorectal cancer, women (measured WC) 1.41 (1.06-1.87)
Incidence, colorectal cancer, women (self-reported WC) 0.97 (0.76-1.22) 2012 COL40898 USA WHI, Prospective Cohort, Age: 50-79 years, W, Postmenopausal 81/ 4 862 11.9 years Self-reported validated by pathology report Waist circumference measured Incidence, colorectal cancer per 1 cm 1.00 (0.97-1.04) Age, alcohol, BMI, ethnicity, family history of colorectal cancer, participant type, physical activity Mid-point categories Person-years of follow up 80/ Incidence, colorectal cancer ≥ 88 vs < 79 cm 1.08 (0.50-2.34) Ptrend:0.84 65/ Incidence, cancer per 1 cm 1.00 (0.97-1.03) 65/ Incidence, colon cancer ≥ 88 vs < 79 cm 1.01 (0.43-2.37) Ptrend:0.99 Oxentenko, 2010 COL40849 USA IWHS, Prospective Cohort, Age: 55-69 W 1 464/ 36 941 619 961 SEER Self-reported Incidence, colorectal cancer ≥ 96.53 vs ≤ 77.15 cm 1.32 (1.11-1.56) Ptrend:<0.001 Age, age at menopause, alcohol, calcium, cigarette consumption, contraception, diabetes, energy intake, Oestrogen use, red meat, folate, Mid-point categories Incidence, proximal 1.27 (1.01-1.60) Ptrend:0.02 Incidence distal 1.37 (1.07-1.77) Ptrend:0.008
fruits and vegetables consumption, physical activity level, smoking status, total fat, vitamin E Yamamoto, 2010 COL40807 Japan Nested study, Age: 54 years, M/W 22 cases/ 69 controls 3 years Histology Measured Incidence, colorectal cancer ≥89 vs ≤79 cm 2.03 (0.57-7.25) Ptrend:0.2 Age, sex, alcohol consumption, smoking status, year of examination Wang, 2008 COL40666 USA CPS II, Prospective Cohort, M/W 546/ 95 151 7.7 years Self-report, pathology report, national death Index, death cert, state cancer registries Self-report Incidence, colorectal cancer, men ≥ 120 vs ≤ 94 cm 1.68 (1.12-2.53) Ptrend:0.006 407/ Incidence, colorectal cancer, women ≥ 110 vs ≤ 84 cm 1.75 (1.20-2.54) Ptrend:0.003 402/ Incidence, colon cancer, men ≥ 120 vs ≤ 94 cm 2.05 (1.29-3.25) Ptrend:<0.001 314/ Incidence, cancer, women ≥ 110 vs ≤ 84 cm 1.54 (1.00-2.37) Ptrend:0.09 142/ Incidence, rectal cancer, men ≥ 120 vs ≤ 94 cm 1.02 (0.43-2.42) Ptrend:0.88
93/ Incidence, rectal cancer, ≥ 110 vs ≤ 84 cm 2.65 (1.23-5.71) Ptrend:0.002 Larsson, 2006 COL40625 Sweden COSM, Prospective Cohort, Age: 45-79 years, M 407/ 45 906 7.1 years Cancer registry Self-reported Incidence, colorectal cancer ≥ 104 vs < 88 cm ≥104 vs ≤87 cm 1.29 (0.90-1.85) Ptrend:0.03 Age, aspirin use, height, educational level, family history of colorectal cancer, history of diabetes, recreational activity, recreational activity, smoking status Mid-point categories 252/ Incidence, colon cancer 1.44 (0.93-2.24) Ptrend:0.09 158/ Incidence, rectal cancer 1.24 (0.68-2.25) Ptrend:0.16 112/ Incidence, distal colon cancer 1.62 (0.80-3.27) Ptrend:0.47 110/ Incidence, proximal cancer 1.66 (0.84-3.27) Ptrend:0.08 Pischon, 2006 COL01985 EPIC, Prospective Cohort, 418/ 368 277 6.1 years Population registries Measured Incidence, colon, men ≥ 103 vs < 86 1.39 (1.01-1.93) Ptrend:0.001 Age, centre, height, smoking status education alcohol intake physical activity fibre intake, consumption of red and processed meat , fish and fish and fruits and vegetables 562/ Incidence, colon, ≥ 89 vs < 70.2 1.48 (1.08-2.03) Ptrend:0.008 293/ Incidence, rectal, men ≥ 103 vs < 86 1.27 (0.84-1.91) Ptrend:0.21
COL00373 Australia Prospective Cohort, Age: 27-75 years, M 16 566 145 433 Cancer registry, medical records Incidence, colon cancer Age, country of educational level (main potential confounders tested and not retained in the final models) ≥ 99.3vs < 87 cm 2.1 (1.3-3.5) 70/ Incidence, proximal cancer per 10 cm 1.24 (0.99-1.56) 78/ Incidence, distal colon cancer per 10 cm 1.46 (1.18-1.80) Moore, 2004 COL00362 FRAM, Prospective Cohort, Age: 30-79 years, M/W, members of original Framingham study 157/ Incidence, colon cancer, age: 30-54 yrs 2.00 (1.1-3.7) 149/ Incidence, colon cancer, age: 55-79 yrs 2.6 (1.3-5.2) 71/ Incidence, colon cancer, men age: 30-54 yrs 2.4 (0.99-5.7) 69/ Incidence, cancer, men 3.3 (1.3-8.8)
age: 55-79 yrs 86/ Incidence, colon cancer, women age: 30-54 yrs 1.8 (0.78-4.3) 80/ Incidence, colon cancer, women age: 55-79 yrs 2.3 (0.86-6.3) 157/ Incidence, colon cancer, age: 30-54 yrs 2.9 (1.2-6.7) Age, BMI, sex, alcohol consumption, height, educational level, height, physical activity, smoking habits 149/ Incidence, colon cancer, age: 55-79 yrs 2.4 (1.00-5.6) Folsom, 2000 COL01688 USA IWHS, Prospective Cohort, Age: 55-69 years, W 462/ 31 702 10 years SEER Incidence, colon cancer ≥ 96 vs < 74.4 cm 1.60 (1.20-2.20) Age, age at first child birth, alcohol consumption, educational level, energy intake, oestrogen use, fish intake, fruit intake, of Mid-point categories Person-years of follow up
cigarette smoking, physical activity, red meat intake, smoking status, vegetable intake, vitamin use, whole grain intake Giovannucci, 1995 COL00110 USA HPFS, Prospective Cohort, Age: 40-75 years, M 117/ 31 055 6 years Medical records, national Death Index Incidence, colon cancer, 65% who completed 1987 questionnaire ≥43 vs ≤34.9 inch 2.56 (1.33-4.96) Ptrend:<0.0001 Age, alcohol consumption, aspirin use, dietary fibre intake, energy intake, family history of specific cancer, folate intake, history endoscopic screening, methionine intake, physical activity, previous polyp diagnosis, red Inch converted to cm Mid-point categories
meat intake, smoking habits Table 333 Waist circumference and colorectal cancer risk. Main characteristics of studies excluded from the CUP SLR dose-response meta-analysis Author, Year, WCRF Code, Country name, characteristics Study size Follow-up (years) Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Reasons for exclusion Heo, 2015 COL41057 USA USA WHI, Prospective Cohort, Age: 50-79 W 1 904/ 144 701 12 Self-report verified by medical record and pathology report Measured Incidence, colorectal cancer per 1 z-score 1.18 (1.12-1.23) Age, alcohol, aspirin use, diabetes, educational level, ethnicity, family history of colorectal cancer, folate intake, height, hormone use, physical activity, randomisation, red meat intake, smoking z-scores reported 1 904/ Incidence, colorectal cancer ≥ 87 vs < 87 cm 1.20 (1.08-1.32) 1 516/ Incidence, colon cancer per 1 1.19 (1.12-1.26) 1 516/ Incidence, colon cancer ≥ 76 vs < 76 cm 1.27 (1.13-1.43) 257/ Incidence, rectal cancer per 1 score 1.06 (0.93-1.22) 257/ Incidence, rectal cancer per 1 score 1.06 (0.93-1.21) Kabat, 2015 COL41034 USA WHI, Prospective Cohort, 1 908/ 143 901 12.7 years Self-report verified by medical record Weight, height, and and hip Incidence, colorectal Q 5 vs Q 1 2.50 (1.73-3.63) Ptrend:<0.0001 Age, alcohol, aspirin use, diabetes,
hours cancer, HRT users educational level, ethnicity, family history of colon cancer, HRT use, per week, smoking, treatment allocation Incidence, colorectal cancer Q 5 vs Q 1 1.74 (1.48-2.05) Ptrend:<0.0001 Age, BMI, alcohol, aspirin use, diabetes, educational level, ethnicity, family history of colon cancer, HRT use, per week, smoking, treatment allocation Incidence, colorectal cancer, ever used HRT Q 5 vs Q 1 2.39 (1.64-3.49) Ptrend:<0.0001
Age: 50-79 years, W and pathology report circumferences measured level, ethnicity, family history of colon cancer, HRT use, per week, smoking, treatment allocation Incidence, colorectal cancer, HRT never Q 2 vs Q 1 1.58 (1.26-1.97) Brändstedt, 2014 COL41022 Sweden MDCS, Prospective Cohort, Age: 44-74 M/W 422/ 28 098 18 Cancer registry Incidence, colorectal cancer, braf negative ≥ 101 vs ≤ 95 cm 1.60 (1.18-2.16) Ptrend:0.001 Age, sex, alcohol, educational level, smoking Gene-mutation data 314/ Incidence, colorectal cancer, kras negative 1.29 (0.91-1.83) Ptrend:0.120 179/ Incidence, colorectal cancer, kras positive ≥ 101 vs ≤ 95 cm 1.98 (1.20-3.28) Ptrend:0.004 Simons, 2014 COL41029 Netherlands NLCS, Case Cohort, Age: 55-69 years 188/ Cancer registry Incidence, colorectal cancer, Igfbp 2 genes methylated 1.22 (0.84-1.75)
treatment allocation Hughes, 2012 COL40943 Netherlands NLCS, Case Cohort, Age: 55-69 years, M/W 541/ 4 654 7.3 Cancer registry and pathology database Incidence, colorectal cancer, braf wildtype Q 4 vs Q 1 1.59 (1.23-2.06) Ptrend:0.009 Sex, ethnicity Gene-interaction data Hughes, 2012 COL40944 Australia MCCS, Prospective Cohort, Age: 27-75 M/W 480/ 40 154 Cancer registry and National Death index . Incidence, colorectal cancer, braf wildtype Q 4 vs Q 1 1.66 (1.27-2.18) Ptrend:<0.001 Sex, ethnicity Gene-interaction data Aleksandrova, 2011 COL40878 Denmark, France, Germany, Greece, Netherlands, Spain, Sweden, UK EPIC, Nested Case Control, Age: 25-70 years, M/W 438 case/ 364 controls 9.3 years Cancer registry and pathology register Incidence, cancer high vs low (by criteria of International Diabetes Federation (IDF)) 1.68 (1.31-2.15) 231 cases/ 175 controls Incidence, colon cancer high vs low (by criteria of National Cholesterol Education Treatment Panel III (NCEP/ATPIII)) 1.55 (1.19-2.02)
239 cases/ 231 controls Incidence, rectal cancer high vs low (by criteria of IDF) 1.07 (0.79-1.45) 127 cases/ 105 controls Incidence, rectal cancer high vs low (by criteria of (NCEP/ATPIII)) 1.34 (0.96-1.87) Hughes, 2011 COL40895 Netherlands NLCS, Prospective Cohort, Age: 55-69 years, M/W 1 211/ 120 852 16.3 Cancer registry Self-reported height and weight Incidence, colorectal cancer, men 56-68 vs 28-48 trouser/skirt size 1.63 (1.17-2.29) Ptrend:0.02 Age, alcohol consumption, educational level, energy intake, family history of colorectal cancer, occupational activity, smoking The exposure is rouser/skirt size Gunter, 2008 COL40737 USA WHI, Case-cohort study, Age:50-79 years W 438 805 controls 6.42 Colonoscopy examination Examined at baseline Incidence, colorectal cancer < 75 vs ≥ 93 Kg/m² 1.82 (1.22-2.7) Age, smoking status, ethnicity, family history of colorectal cancer, previous endoscopic screening, physical activity, NSAID Superseded by Kabat, 2013 COL40965
use, alcohol consumption Ahmed, 2006 COL40617 USA ARIC, Prospective Cohort, Age: 45-64 years, M/W 194/ 14 109 11.5 years Cancer registry & hospital surveillance waist and hip were measured once using anthropometric tape Incidence, colorectal cancer high vs low 1.40 (1.00-1.90) Age, sex, alcohol consumption, aspirin use, family history of colorectal cancer, HRT use, NSAID use, pack-years of smoking, physical activity Used in HvsL analysis Schoen, 1999 COL00183 USA Cardiovascular Health Prospective Cohort, Age: > 65 years, M/W 102/ 5849 Medical enrolment list Incidence, colorectal cancer Q4 vs Q1 2.2 (1.2-4.1) Age, sex, physical activity Sex-specific quintiles Used in HvsL analysis Martínez, 1997 COL00139 USA NHS, Prospective Cohort, Age: 30-55 years, W / 89 448 1 012 375 person-years Cancer registry Self-reported Incidence, colon cancer > 34 vs < 27.5 inch 1.48 (1.89-2.46) Age, alcohol consumption, cigarette smoking, family history of specific cancer, aspirin use, Used in HvsL analysis
Table 336 Waist to hip ratio and colorectal cancer risk. Main characteristics of studies included in the CUP SLR dose-response Author, Year, WCRF Code, Country Study name, characteristics Cases/ Study size Follow-up (years) Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Missing data derived for analyses Li, 2013 COL40937 China SWHS, Prospective Cohort, Age: 40-70 W 621/ 72 972 11 years Follow up survey/cancer registry/vital statistics registry Measured Incidence, colorectal cancer ≥0.85 vs ≤0.77 1.01 (0.79-1.31) Ptrend:0.65 Age at baseline, alcohol consumption, cigarette, educational level, energy intake, family history of colorectal cancer, income, menopausal status, physical activity, intakes of red meat, tea, vegetables, fruits Mid-point categories 381/ Incidence, colon cancer 0.96 (0.69-1.34) Ptrend:0.92 240/ Incidence, rectal cancer 1.11 (0.74-1.66) Ptrend:0.40 Li, 2013 COL40936 China SMHS, Prospective Cohort, Age: 40-74 years, M 313/ 61 283 5.5 years Follow up survey/cancer statistics registry Measured Incidence, colorectal cancer ≥0.95 vs ≤0.85 1.65 (1.12-2.41) Ptrend:0.0004 Age at baseline, alcohol consumption, cigarette, educational level, energy intake, family history of colorectal cancer, income, physical activity, intakes of red meat, tea, vegetables,fruits Mid-point categories 169/ Incidence, colon cancer 1.97 (1.19-3.24) Ptrend:0.0004 133/ Incidence, rectal cancer 1.24 (0.69-2.26) Ptrend:0.20 analysis
2013 COL40965 USA WHI, Prospective Cohort, Age: 50-79 years, W, Postmenopausal 166/ 11 124 12.9 years Self-report verified by reviewing medical and pathological records by physicians Measured Incidence, colorectal cancer ≥0.85 vs ≤0.75 1.18 (0.74-1.90) Ptrend:0.40 Age, alcohol, diabetes, educational level, energy, ethnicity, family history of colorectal cancer, HRT use, pack yrs of smoking, physical activity, randomisation Mid-point categories Oxentenko, 2010 COL40849 USA IWHS, Prospective Cohort, Age: 55-69 years, W 1 464/ 36 941 619 961 SEER Self-reported Incidence, colorectal cancer ≥0.9 vs ≤0.78 1.28 (1.08-1.50) Ptrend:0.003 Age, age at menopause, estrogen use, alcohol, physical activity, smoking status and intensity, diabetes, energy intake, intakes of folate, fruits and vegetables, red meat, total fat, vitamin E,calcium Mid-point categories Pischon, 2006 COL01985 EPIC, Prospective Cohort, 416/ 368 277 6.1 years Population registries Measured Incidence, colon, men ≥ 0.990 vs < 0.887 1.51 (1.06 to 2.15) Ptrend:0.006