NSPT Norwegian screening programme for tuberculosis NYSC New York State Cohort Study NYUWHS New York University Women's Health Study Oahu Oahu Cohort Study Ohsaki/OCS Ohsaki Cohort Study OVS Oxford Vegetarian OCS Ohsaki Cohort Study PHS Physicians Health PLCO Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Reykjavik Study Reykjavik Cohort SCHS Singapore Chinese Health Study SCStudy Shanghai Cohort SECS Shizuoka Elderly Cohort SELECT The Selenium and Vitamin E Cancer Prevention Trial (SELECT) Shanghai China Shanghai Cohort SHOW Smoking Health Study of Wisconsin Shell Study Shell Oil Company’s Study SFOSHCIC Swedish Foundation for Occupational Safety and Health of the Construction Industry (Byggha¨ lsan) SMHS Shanghai Men’s Health Study SIMS Swedish Intergenerational Mortality SMART Second Manifestations of ARTerial disease (SMART) study SMC Swedish Mammography Cohort STC Swedish Twin Cohort SWHS Shanghai Women’s Health Study SWSC Sweden mammography screening cohort TAC Taiwan Arsenic Cohort, 1985-2000 TCCJ Japan, Takayama cohort study THIN Health Improvement Network (THIN) VHM&PP The Vorarlberg Health Monitoring and Prevention Program VIP Vӓsterbotten Intervention Project VITAL Vitamins And Lifestyle cohort VCS Vlaardingen cohort study WES Western Electric Company Study WHI-DI & OS Women's Health Initiative - Dietary Modification Trial and Observational Study WS Whitehall Study UK Cohort Study WWCCI WWCCI WACS Women's Antioxidant Cardiovascular Study WLHS Swedish Women Lifestyle Health Cohort Study
Greece, Italy, Netherlands, Spain, Sweden, UK M/W pathology and active follow up Cut-offs were based on the medians activity, smoking 2 753/ Incidence, colon cancer per 2 units 0.95 (0.89-1.00) 6-9 vs 0-3 score 0.95 (0.84-1.07) Ptrend:0.23 2 479/ Incidence, colorectal cancer, women per 2 0.95 (0.90-1.01) 6-9 vs 0-3 0.88 (0.77-1.01) Ptrend:0.05 1 876/ Men per 2 units 0.97 (0.90-1.03) 6-9 vs 0-3 0.89 (0.76-1.04) Ptrend:0.14 1 602/ Incidence, rectal cancer per 2 units 1.00 (0.93-1.07) 6-9 vs 0-3 score 0.97 (0.83-1.13) Ptrend:0.64 1 288/ Incidence, proximal cancer per 2 units 0.97 (0.90-1.05) 6-9 vs 0-3 score 0.95 (0.80-1.12) Ptrend:0.36 1 212/ Incidence, distal cancer per 2 units 0.97 (0.89-1.04) 6-9 vs 0-3 score 0.93 (0.78-1.11) Ptrend:0.31 Tognon, 2012 COL41002 VIP, Prospective 127/ 77 151 Vip database with the Validated FFQ Modified Mortality, colorectal per 1 diet score 0.99 (0.89-1.11) specific trial
Sweden Cohort, Age: 30-60 years, M/W 9 years Swedish national registry Mediterranean score cancer, men and women Age, educational level, obesity, physical activity, smoking status 73/ Men per 1 diet score 1.07 (0.93-1.24) 54/ Women per 1 diet 0.91 (0.77-1.08) Fung, 2010 COL40828 USA NHS+HPFS, Prospective Cohort, M/W 1 435/ 132 746 Self-report verified by medical record FFQ Alternate Mediterranean score Incidence, colorectal cancer, women 6-9 vs 1-2 0.88 (0.74-1.05) Ptrend:0.14 Age, alcohol Intake, aspirin use, BMI, colonoscopy, energy, family history, history of polyps, physical activity, smoking 1 082/ Incidence, cancer, women 6-9 vs 1-2 score 0.91 (0.74-1.11) Ptrend:0.13 1 032/ Incidence, colorectal cancer, men 7-9 vs 0-2 score 0.88 (0.71-1.09) Ptrend:0.25 682/ Incidence, colon cancer, men 7-9 vs 0-2 score 0.87 (0.67-1.13) Ptrend:0.45 323/ Incidence, rectal cancer, women 6-9 vs 1-2 score 0.80 (0.55-1.15) Ptrend:0.64 218/ Men 7-9 vs 0-2 0.75 (0.46-1.23) Ptrend:0.19 trial trial trial
Reedy, 2010 COL40812 USA NIH-AARP, Prospective Cohort, Age: 50-71 years, Retired 492 306 5 years Cancer registry, national Index, pathology reports FFQ Mediterranean Diet Score Incidence, colorectal cancer, women highest quintile vs lowest quintile 0.89 (0.72-1.11) Age, BMI, educational level, ethnicity, physical activity, smoking status, total energy Men highest quintile vs lowest quintile 0.72 (0.63-0.83) Reedy, 2008 COL40738 USA NIH-AARP, Prospective Cohort, Age: 50-71 M/W 492 382 5 years Cancer registry FFQ Mediterranean Diet Score Incidence, colorectal cancer, Mediterranean diet 6-9 vs 0-2 points 0.89 (0.72-1.11) Incidence, distal colon cancer, men 6-9 vs 0-2 points 0.68 (0.53-0.86) Incidence, rectal cancer, 56-88 vs 13-41 points 0.95 (0.61-1.48) Incidence, colorectal cancer, men Mediterranean diet 6-9 vs 0-2 points 0.72 (0.63-0.83) Incidence, rectal cancer, 6-9 vs 0-2 points 0.75 (0.50-1.21) Incidence, colorectal cancer, men 16-38 vs 0-6 points 0.75 (0.65-0.87) report, trial trial
2012 COL41048 France, Spain, UK, Netherlands, Greece, Germany, Sweden, Denmark, Norway Prospective Cohort, Age: 25-70 M/W 386 355 11 years registries, health Insurance records, pathology rec & active follow up WCRF score colorectal cancer disease at baseline, educational energy intake, smoking Intensity, smoking status, study centre 4 Dietary Guideline Index Score and colorectal cancer risk. Main characteristics of studies identified 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 Dartois, 2014 COL41004 France E3N Prospective Cohort, Age: 43-68 W 481/ 64 732 8 years Self-report verified by reviewing medical and pathological records by physicians Index of compliance with the French and WHO guidelines Incidence, colorectal cancer 4.5- 5 vs 0- 2 0.66 (0.45-0.97) Ptrend:0.013 Age at first child birth, age at menarche, educational level, family history of cancer In first degree relatives, menopausal estrogen use, menopausal e EPIC- Trial, Self-
years, M/W to American Cancer Society guidelines (including diet, smoking and physical activity) intake, ethnicity, family history, marital status, smoking status rectal cancer, men 1 287/ Incidence, colon cancer, women 8-11 vs 0-3 0.65 (0.54-0.78) 582/ Incidence, rectal cancer, women 8-11 vs 0-3 score 0.64 (0.49-0.83) 228/ Incidence, small Intestinal cancer 8-11 vs 0-3 score 0.53 (0.36-0.79) Roswall, 2015 COL41039 Sweden WLHS, Prospective Cohort, Age: 29-49 W 314/ 45 222 10 years Cancer registry Nordic Food Index ( wholegrain bread, oatmeal, cabbages, root vegetables and Incidence, colorectal cancer per 1 points 1.04 (0.95-1.12) Alcohol, BMI, educational level, energy, oral contraceptive history, red and processed meat, smoking, time since quitting smoking 4-6 vs 0-1 points 1.09 (0.78-1.52) ,
909/ Men healthy vs unhealthy 0.89 (0.78-1.02) 728/ Incidence, rectal cancer, men healthy vs unhealthy 0.80 (0.68-0.94) 5 vs 0-1 points 0.47 (0.32-0.68) per 1 points 0.86 (0.80-0.91) 662/ Women healthy vs unhealthy 1.00 (0.84-1.18) 5 vs 0-1 points 1.01 (0.68-1.49) per 1 points 0.97 (0.99-1.04) Kyrø, 2013 COL40918 Denmark DCH, Prospective Cohort, Age: 50-64 M/W 567/ 57 053 13 years Cancer registry FFQ Nordic Food Index ( bread, wholegrain oatmeal, cabbages, root vegetables and Incidence, colorectal cancer, men 5-6 vs 0-1 points 0.87 (0.61-1.25) per 1 points 1.00 (0.93-1.07) 458/ Women 5-6 vs 0-1 points 0.65 (0.46-0.94) per 1 points 0.91 (0.84-0.99) 341/ Incidence, colon cancer, men per 1 points 0.97 (0.88-1.06) 324/ per 1 points 0.95 (0.86-1.04) 226/ Incidence, rectal cancer, men per 1 points 1.06 (0.95-1.19) 157/ Incidence, distal cancer, men per 1 points 0.92 (0.80-1.06) 142/ Incidence, proximal cancer, per 1 points 1.00 (0.87-1.15) ,
8 alcohol pattern vs average 1.07 (0.48-2.40) 40 Incidence, rectal cancer alcohol pattern vs average 1.73 (0.59-5.06) bread pattern vs average 1.41 (0.50-3.98) western pattern vs average 1.09 (0.32-3.70) healthy pattern vs average 0.51 (0.15-1.72) fish pattern vs average 1.31 (0.35-4.98) 9 Incidence, colorectal cancer, bread pattern vs average 1.24 (0.47-3.29) 7 healthy pattern vs average 0.65 (0.24-1.73) 6 western pattern vs average 0.81 (0.27-2.43) 5 alcohol pattern vs average 1.02 (0.33-3.14)
Terry, 2001 COL00556 Sweden SMC, Prospective Cohort, Age: 39-76 years, W 460/ 61 463 9.6 Computerized regional cancer registers FFQ A posteriori defined dietary patterns “Healthy” dietary pattern Incidence, colorectal cancer Q 5 vs Q 1 0.79 (0.56-1.10) Age, BMI, educational level, energy intake “Western” dietary pattern 0.97 (0.66-1.44) “Drinker” dietary pattern 1.13 (0.84-1.53) Table 5 A posteriori derived dietary patterns and colorectal cancer risk. Main characteristics of studies identified CUP SLR 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 Kumagai, 2014 COL41050 Japan OCS, Prospective Cohort, Age: 40-79 854/ 44 097 11 Cancer registry A posteriori derived dietary patterns DFA: Incidence, colorectal cancer Q 4 vs Q 1 0.76 (0.60-0.97) 554/ Incidence, colon Q 4 vs Q 1 0.89 (0.66-1.19)
years, M/W low-alcohol cancer 323/ Incidence, rectal cancer Q 4 vs Q 1 0.56 (0.37-0.84) Ollberding, 2012 COL40941 Hawaii, USA MEC, Prospective Cohort, Age: 45-75 years, M/W 3 404/ 165 717 8.1 years Cancer registry and national death Index FFQ A posteriori derived patterns Meat and fat dietary pattern (factor score) Incidence, colorectal cancer 1.33 vs -1.26 1.12 (0.94-1.33) Ptrend:0.099 Age, sex, age at cohort entry In log model, alcohol consumption, BMI, calcium, dietart fibre, energy Intake, ethnicity, family history of colorectal cancer, folate, history of diabetes, history of polyp diagnosis, HRT use, non-steriodal drug use, pack yrs of smoking, vigorous physical activity, vitamin d Kim, 2005 COL01842 Japan JPHC, Prospective Cohort, Age: 40-59 years, M/W 231 cases in men, 139 cases in women / 42 112 10 years Cancer records FFQ A posteriori derived patterns Healthy pattern: high vegetables, fruits, soy products, seaweeds, mushroom, milk, and yogurt Incidence, colorectal cancer Q 4 vs Q 1 Men 0.81 (0.52-1.24) Women 0.98 (0.58-1.65) Incidence, cancer Q 4 vs Q 1 Men 0.83 (0.49-1.41) Women 0.76 (0.39-1.50) Incidence, rectal cancer Q 4 vs Q 1 Men 0.76 (0.37-1.58) Women 1.43 (0.62-3.28) Traditional pattern: high Incidence, colorectal Q 4 vs Q 1 Men 0.88 (0.55-1.42) Women inflammatory
Country Follow-up (years) Orlich, 2015 COL41043 USA Adventist Health Study 2, Prospective Cohort, M/W 490/ 77 659 7.3 years Cancer registry FFQ Incidence, colorectal cancer vegetarian vs non-vegetarian 0.79 (0.64-0.97) Ptrend:0.03 Age, sex, alcohol, aspirin use, BMI, calcium supplement, colonoscopy, diabetes medication use, educational energy, family history of colorectal cancer, fibre Intake, history of Inflammatory bowel disease, history of peptic ulcer, HRT use, moderate activity, race, smoking, vitamin d supplement 380/ Incidence, colon cancer 0.83 (0.66-1.05) Ptrend:0.12 305/ Incidence, colorectal cancer, women 0.79 (0.61-1.03) Ptrend:0.08 185/ Men 0.81 (0.58-1.12) Ptrend:0.20 110/ Incidence, rectal cancer 0.66 (0.43-1.02) Ptrend:0.06 106/ Incidence, colorectal cancer, black 0.73 (0.47-1.14) Ptrend:0.16 384 Incidence, colorectal cancer, 0.81 (0.65-1.03) Ptrend:0.08 Key, 2009 COL40951 UK Oxford Vegetarian Study 384/ 61 566 12.2 years UK national health service central register FFQ Incidence, colorectal cancer vegetarian vs meat 1.49 (0.87, 1.44) non- quantitative
and Prospective Cohort, Age: 20-89 years, M/W BMI, physical activity level, smoking, study/method of recruitment 239/ Incidence, colon cancer vegetarian vs meat 1.12 (0.81-1.54) 145/ Incidence, rectal cancer vegetarian vs meat eater 1.12 (0.75-1.67) Sanjoaquin, 2004 COL01182 UK Oxford Vegetarian Study Prospective Cohort, Age: 18-89 years, M/W 95/ 10 998 17 years FFQ Incidence, colorectal cancer vegetarians vs non-vegetarians 0.85 (0.55-1.32) Ptrend:0.463 Age, sex, alcohol consumption, smoking habits Key, 1996 COL00418 UK British Health Conscious and Vegetarian subjects Prospective Cohort, Age: 16-79 years, M/W, 62/ 10 771 16.8 years Public Questionnaire Mortality, colorectal cancer health conscious cohort vs England and Wales 0.79 (0.47-1.33) Age, sex, smoking 1984
Table 9 Whole grains and colorectal cancer risk. Results of meta-analyses and pooled analyses of prospective studies published after the 2005 SLR. Author, Year Number of studies Total number of cases Studies country, area Outcome Comparison RR (95%CI) P Heterogeneity (I2, p value) Meta-analyses Aune et al, 2012 6 7941 North America, Europe, Asia Incidence High vs. low Per 90 g/d 0.79 (0.72-0.86) 0.83 (0.78-0.89) - - 0%, p=0.98 18%, p=0.30 Pooled analyses Park et al, 2005 13 8081 North America, Europe Incidence High vs. low 0.92 (0.84-1.00) 0.21 NA
Table 10 Whole grain intake 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 Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Adjustment factors Missing data derived for analysis Kyrø, 2013 COL40963 Sweden, Norway HELGA cohort, Prospective Cohort, Age: 40-63 years Includes the Norwegian Women and Cancer Cohort, the Northern Sweden Health and Disease Study Cohort, and the Danish Diet, Cancer, and Health cohort (all part of EPIC) 1 123/ 108 000 11 years Cancer registry FFQ Total Whole grain intake Incidence, colorectal cancer ≥71 vs 0-31 g/day 0.86 (0.69-1.06) Incidence, colorectal cancer per 25 g 0.94 (0.88-1.01) Incidence, colon cancer, men ≥71 vs 0-31 g/day 0.76 (0.51-1.13) Incidence, cancer, men per 25 g 0.96 (0.84-1.09) Incidence, proximal colon cancer, men ≥71 vs 0-31 g/day 0.99 (0.56-1.75) Incidence, proximal colon cancer, men per 25 g 0.99 (0.82-1.20) Incidence, distal colon cancer, men ≥71 vs 0-31 g/day 0.65 (0.37-1.18) Incidence, distal colon cancer, men per 25 g 0.95 (0.79-1.15) analysis quantitative
Incidence, rectal cancer, men ≥71 vs 0-31 g/day 0.76 (0.51-1.13) Incidence, rectal cancer, men per 25 g 0.89 (0.76-1.04) Incidence, colon cancer, women ≥68 vs 0-30 g/day 1.18 (0.80-1.73) Incidence, colon cancer, women per 25 g 0.99 (0.86-1.13) Incidence, proximal colon cancer, women ≥68 vs 0-30 g/day 0.85 (0.49-1.50) Incidence, proximal colon cancer, women per 25 g 0.89 (0.73-1.08) Incidence, distal colon cancer, women ≥68 vs 0-30 g/day 1.31 (0.73-2.33) Incidence, distal colon cancer, women per 25 g 1.00 (0.82-1.22) Incidence, rectal cancer, women ≥68 vs 0-30 g/day 0.53 (0.30-0.91) Incidence, rectal cancer, women per 25 g 0.80 (0.66-0.98) grain products Trial
Incidence, colorectal cancer ≥189 vs 0-85 g/day 0.77 (0.63-0.93) Incidence, colorectal cancer per 50 g 0.94 (0.89-0.99) Incidence, colon cancer, men ≥189 vs 0-85 g/day 0.67 (0.46-0.97) Incidence, colon cancer, men per 50 g 0.92 (0.84-1.00) Incidence, proximal cancer, men ≥189 vs 0-85 g/day 0.55 (0.30-0.99) Incidence, proximal colon cancer, men per 50 g 0.89 (0.77-1.01) Incidence, distal colon cancer, men ≥189 vs 0-85 g/day 0.71 (0.42-1.19) Incidence, distal cancer, men per 50 g 0.94 (0.82-1.06) Incidence, rectal cancer, men ≥189 vs 0-85 g/day 0.77 (0.50-1.21) Incidence, rectal cancer, men per 50 g 0.92 (0.83-1.02) Incidence, colon cancer, women ≥180 vs 0-90 g/day 0.82 (0.58-1.18) Incidence, colon cancer, women per 50 g 0.97 (0.88-1.06)
intake, total energy intake, vegetable intake excluding those with <2y Incidence, colon cancer ≥4.5 vs ≤1.4 servings/day 0.67 (0.47-0.96) Incidence, colon cancer, women, excluding those with <2y ≥4.5 vs ≤1.4 servings/day 0.65 (0.45-0.94) Incidence, proximal colon cancer ≥4.5 vs ≤1.4 servings/day 0.69 (0.40-1.20) Incidence, distal colon cancer ≥4.5 vs ≤1.4 servings/day 0.54 (0.27-1.08) Incidence, rectal cancer ≥4.5 vs ≤1.4 servings/day 1.11 (0.67-1.83) Incidence, rectal cancer, women, excluding those with <2y ≥4.5 vs ≤1.4 servings/day 1.07 (0.62-1.82) McCullough, 2003 COL00367 USA CPS II, Prospective Cohort, Age: 50-74 years, M/W 298/ 133 163 6 years Cancer registry and death certificates and medical records FFQ Incidence, colon cancer, men <0.46 vs 2+ serving/week 1.08 (0.67-1.74) Incidence, colon cancer, men ≥11 vs 0-1.9 serving/week 0.95 (0.64-1.42) Incidence, cancer, women ≥11.2 vs 0-2.4 serving/week 1.17 (0.73-1.87) up up quantitative follow- follow-
physical activity, red meat intake, smoking habits Incidence, cancer, women <.58 vs 2.5+ serving/week 1.04 (0.59-1.83) Table 11 Whole grain intake 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/ size Follow-up (years) Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Reasons for exclusion Egeberg, 2010 COL40841 Denmark DCH, Prospective Cohort, Age: 50-64 M/W 244/ 55 819 10.6 years Cancer registry FFQ Incidence, colon cancer, men ≥161 vs ≤75 g/day 0.61 Alcohol intake, BMI, educational level, leisure time physical activity, red and processed meat Included in HELGA (Kyro, 2013) Incidence, colon cancer, men per 50 g 0.85 Incidence, cancer, women per 50 g 0.98 Incidence, cancer, women ≥161 vs ≤75 g/day 0.92 Incidence, rectal cancer, men ≥161 vs ≤75 g/day 0.88 Incidence, rectal cancer, men per 50 g 0.90 Incidence, rectal cancer, women per 50 g 1.02 Incidence, rectal cancer, women ≥161 vs ≤75 g/day 0.81 (0.88- 1.30) 1.36) 1.10) 1.01) 1.35) 0.86)
Table Fruit and vegetable intake and colorectal cancer risk. Results of meta-analyses and pooled analyses of prospective studies published after the 2005 SLR. Author, Year Number of studies Total number of cases Studies country, area Outcome Comparison RR (95%CI) P trend Heterogeneity (I2, p value) Meta-analyses Aune et al, 2012 11 CRC 11 11 CC 7 RC 11853 North America, Europe, Asia Incidence High vs. low Per 100 g/d High vs. low High vs. low 0.92 (0.86-0.99) 0.99 (0.98-1.00) 0.91 (0.84-0.99) 0.97 (0.86-1.09) - - - - 22%, p=0.24 38%, p=0.10 12.9%, p=0.32 0%, p=0.65 Pooled analyses Koushik, 2007 14 5838 CC North America, Europe Incidence Quintile 5 vs. 1 ≥400 vs. <100 g/d 0.91 (0.82-1.01) 0.90 (0.77-1.05) 0.19 0.06 NA, p=0.31 NA, p=0.46
Fruit and vegetable intake and colorectal cancer risk. Main characteristics of studies included in CUP SLR Author, Year, WCRF Code, Country Study name, Cases/ Study size Follow-up (years) Case Exposure assessment Outcome Comparison RR (95%CI) Adjustment factors Missing data derived for analysis Makarem, 2015 COL41060 USA Cohort, Prospective Cohort, Age: 66 M/W 63/ 2 983 11.5 years Death certificate and medical records FFQ Incidence, colorectal cancer per 1 points 0.96 Age, sex, smoking status Conversion from WCRF score to g/d Wie, 2014 COL41065 Korea Cancer Screening Examination Cohort, Korea (CSECK), Prospective Cohort, M/W 53/ 8 024 7 years Cancer registry and medical records 3-day food record Incidence, colorectal cancer ≥600 vs <600 g/day 0.85 Age, sex, alcohol, BMI, educational level, energy Intake, Income, marital status, physical activity, smoking None Incidence, colorectal cancer per 100 g/day 1.00 Vogtmann, 2013 COL40986 China SMHS, Prospective Cohort, Age: 40-74 years, M 398/ 61 274 6.3 years Cancer registry, shanghai statistics office, medical history FFQ Incidence, colorectal cancer ≥675.15 vs g/day 0.71 Age, alcohol, BMI, diabetes, educational level, energy Intake, family history of colorectal cancer, Income, met-hours per week, occupation, red meat, smoking, total meat Midpoints, distribution of person-years Incidence, colon cancer ≥675.15 vs g/day 0.69 Incidence, rectal cancer ≥675.15 vs g/day 0.75 van Duijnhoven FJ, EPIC, Prospective Cohort, 2 819/ 452 755 8.8 Cancer registry, health FFQ Incidence, colorectal cancer ≥603.6 vs g/day 0.86 221 1.14) 1.09) Offspring 1.00) 0-
Age: 35-70 years, M/W Insurance records, active follow and mortality registry from fat, energy from nonfat sources, fish, height, physical activity, processed meat, red meat Intake, smoking status, weight Incidence, colorectal cancer per 100 g/day 0.98 Incidence, colon cancer ≥603.6 vs g/day 0.76 Incidence, colon cancer per 100 g/day 0.96 Incidence, proximal colon cancer ≥603.6 vs g/day 0.77 Incidence, distal colon cancer ≥603.6 vs g/day 0.70 Incidence, rectal cancer ≥603.6 vs g/day 1.09 Incidence, rectal cancer per 100 g/day 1.00 85 221 221 1.02) 221 221 1.04)
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 ≥663 vs ≤324.9 g/day 1.20 Age, energy Intake Midpoints Incidence, colon cancer ≥663 vs ≤324.9 g/day 1.30 Incidence, rectal cancer ≥663 vs ≤324.9 g/day 1.00 Nomura, 2008 COL40663 USA MEC, Prospective Cohort, Age: 45-75 years, M/W 1 023/ 191 011 7.3 Cancer registry Incidence, colorectal cancer, men 483.2 vs 134.7 g1000 kcal/day 0.74 Incidence, colorectal cancer, women 608.1 vs 176.3 g1000 kcal/day 1.04 Incidence, colon cancer, men 483.2 vs 134.7 g1000 kcal/day 0.72 Incidence, colon cancer, women 608.1 vs 176.3 g1000 kcal/day 1.03 Incidence, rectal cancer, men 483.2 vs 134.7 g1000 kcal/day 0.72 1.33) 1.38) (0.47-
Incidence, rectal cancer, women 608.1 vs 176.3 g1000 kcal/day 1.10 Park, 2007 COL40697 USA NIH-AARP, Prospective Cohort, Age: 50-71 M/W 2 048/ 488 043 2 121 664 person-years Cancer registry FFQ Incidence, colorectal cancer, men 5.2 vs 1.4 servings1000 kcal/day 0.91 Incidence, colorectal cancer, women 6.5 vs 1.8 servings1000 kcal/day 1.08 Incidence, distal colon cancer, women 6.5 vs 1.8 servings1000 kcal/day 1.12 Incidence, rectal cancer, 6.5 vs 1.8 servings1000 kcal/day 1.26 Incidence, distal colon cancer, men 5.2 vs 1.4 servings1000 kcal/day 0.89 Incidence, rectal cancer, men 5.2 vs 1.4 servings1000 kcal/day 0.93 (0.86- 1.22) 1.05)
questionnaire Incidence, cancer, men 5.2 vs 1.4 servings1000 kcal/day 0.92 Incidence, proximal colon cancer, men 5.2 vs 1.4 servings1000 kcal/day 0.92 Incidence, colon cancer, women 6.5 vs 1.8 servings1000 kcal/day 1.04 Incidence, proximal colon cancer, women 6.5 vs 1.8 servings1000 kcal/day 1.01 McCarl, 2006 COL40633 USA IWHS, Prospective Cohort, Age: 55-69 years, W 954/ 35 197 15 years Seer registry FFQ Incidence, colorectal cancer ≥58.01 vs ≤27.4 servings/week 0.90 Age Midpoints, conversion of serv/wk to g/d Lin, 2005 COL01831 USA WHS, Prospective Cohort, Age: 45- years, 223/ 36 976 10 Follow up (self report), medical record and FFQ Incidence, colorectal cancer, women 10 vs 2.6 serving/day 0.96 Age, alcohol consumption, aspirin use, BMI, family history of cancer, history of previous and prior endoscopy, menopausal Distribution of person-years, conversion of serv/d to g/d 1.18) s
Incidence, distal colon cancer, ≥5 vs 0-2.5 serving/day 0.87 Michels, 2000 COL00365 USA NHS, Prospective Cohort, Age: 30-55 years, W, Registred nurses 569/ 88 764 1 327 029 person-years Population registries FFQ Incidence, colon cancer, ≥6 vs 0-2 serving/day 0.96 Age, alcohol consumption, aspirin use, BMI, family history of colorectal cancer, height, menopausal status, pack-years of smoking, physical activity, postmenopausal hormone use, red meat Intake, sigmoidoscopy, supplement Intake, total caloric Intake Included in the dose-response analysis. No confidence intervals were provided for high vs. low Incidence, colon cancer, per 1 serving/day 1.00 Incidence, rectal cancer, ≥6 vs 0-2 serving/day 0.88 Incidence, rectal cancer, per 1 serving/day 1.00 Michels, 2000 COL00365 USA HPFS, Prospective Cohort, Age: 40-75 years, M, Health professionals 368/ 47 325 416 616 FFQ Incidence, colon cancer, ≥6 vs 0-2 serving/day 1.28 Family history of specific cancer, smoking status, total energy, vitamin supplement Included in the dose-response analysis. No confidence intervals were provided for high vs. low Incidence, colon cancer, per 1 serving/day 1.05 Incidence, rectal cancer, ≥6 vs 0-2 serving/day 1.20 Incidence, rectal cancer, per 1 serving/day 1.06 Voorrips, 2000 COL00578 NLCS, Case Cohort, 266/ 120 852 6.3 years Cancer registry FFQ Incidence, cancer, men 519 vs 177 g/day 0.95 1.41) 1.54)
Netherlands Age: 55-69 years, M/W Incidence, colon cancer, women 578 vs 208 g/day 0.66 Incidence, proximal colon cancer, men Q 5 vs Q 1 0.89 Incidence, distal cancer, men Q 5 vs Q 1 1.04 Incidence, distal colon cancer, women Q 5 vs Q 1 0.44 Incidence, proximal colon cancer, women Q 5 vs Q 1 0.89 Incidence, rectal cancer, men 519 vs 177 g/day 0.88 Incidence, rectal cancer, 578 vs 208 g/day 1.17 1.56)
Zheng, 1998 COL00209 USA IWHS, Prospective Cohort, Age: 55-69 years, W, 144/ 34 702 9 Population FFQ Incidence, rectal cancer, ≥48.6 vs ≤33.4 serving/week 0.97 Age Midpoints, conversion from serv/wk to g/d Steinmetz, 1994 COL00178 USA IWHS, Prospective Cohort, Age: 55-69 years, W, 212/ 35 216 167 447 person-years Driving license FFQ Incidence, colon cancer, ≥47.1 vs serving/week 0.89 Age, energy Intake Midpoints, conversion from serv/wk to g/d, distribution of cases and Incidence, proximal colon cancer, ≥47.1 vs serving/week 0.78 Incidence, distal colon cancer, ≥47.1 vs serving/week 0.91 Shibata, 1992 COL00740 USA Leisure World Cohort, Prospective Cohort, M/W, retirement community, 105/ 11 580 70 159 person-years Community registry FFQ Incidence, colon cancer, women ≥8.3 vs 0-5.9 serving/day 0.63 Age, smoking habits Conversion from serv/d to g/d, distribution of person-years Incidence, colon cancer, men ≥7.9 vs 0-5.5 serving/day 1.50 1.64)
Incidence, colorectal cancer, gpx1 pro198leu tt per 100 gday 1.07 (0.89-1.29) McCullough, 2003 COL00367 USA CPS II, Prospective Cohort, Age: 50-74 years, M/W 298/ 133 163 6 Cps-II cohort FFQ Incidence, cancer, men Q 5 vs Q 1 1.23 (0.83-1.83) Age, aspirin use, BMI, calcium, educational energy Intake, family history of colorectal cancer, multivitamin, physical activity, red meat Intake, smoking habits Only high vs. low comparison Incidence, cancer, women Q 5 vs Q 1 0.70 (0.43-1.15) 2002 COL00950 Europe EPIC, Prospective Cohort, M/W 773/ 406 439 Not specified FFQ Incidence, colorectal cancer Q 5 vs Q 1 0.74 Incidence, colorectal cancer, ≥658 vs 0-268 g/day 0.76 Incidence, colorectal cancer, without first 2 years of follow-up Q 5 vs Q 1 0.72
Table Vegetable intake and colorectal cancer risk. Results of meta-analyses and pooled analyses of prospective studies published after the 2005 SLR. Author, Year Number of studies Total number of cases Studies country, area Outcome Comparison RR (95%CI) P trend Heterogeneity (I2, p value) Meta-analyses Huxley et al, 2009 10 CC 8 RC 8 CRC 2651 CC 1005 RC 7916 CRC Europe, Asia Incidence/ mortality High vs. low 0.93 (0.82-1.05) 0.88 (0.69-1.12) 0.95 (0.86-1.04) - - - 19%, p=0.18 - - Aune et al, 2012 15 12 16057 - North America, Europe, Asia Incidence High vs. low Per 100 g/d High vs. low High vs. low 0.91 (0.86-0.96) 0.98 (0.97-0.99) 0.87 (0.81-0.94) 0.94 (0.85-1.04) - - - - 0%, p=0.54 0%, p=0.69 0%, p=0.70 0%, p=0.59 Pooled analyses Koushik, 2007 14 5838 CC North America, Europe Incidence Quintile 5 vs. 1 ≥300 vs. <100 g/d 0.94 (0.86-1.02) 0.96 (0.84-1.09) 0.21 0.24 NA, p=0.91 NA, p=0.33
Table Vegetable intake and colorectal cancer risk. Main characteristics of studies included in the CUP SLR dose-response Author, Year, WCRF Code, Country Study name, Cases/ Study size Follow-up (years) Case Exposure assessment Outcome Comparison RR (95%CI) Adjustment factors Missing data derived for Bamia, 2013 COL40964 EPIC, Prospective Cohort, Age: 25-70 years, M/W 4 355/ 480 308 11.6 years Cancer registry, record linkage, health Insurance rec, mortality registry pathology and active follow up FFQ Incidence, colorectal cancer 331 vs 88.6 g/day 0.98 (0.89-1.08) Age, sex, BMI, centre location, cereal, dairy products consumption, educational level, ethanol, fish, fruits, legumes, lipids, meat, physical activity, smoking Distribution of cases and Incidence, colorectal cancer, 331 vs 88.6 g/day 1.02 (0.90-1.16) Incidence, colorectal cancer, men 331 vs 88.6 g/day 0.91 (0.80-1.06) Vogtmann, 2013 COL40986 China SMHS, Prospective Cohort, Age: 40-74 years, M 398/ 61 274 6.3 Cancer registry, shanghai statistics office, medical history FFQ Incidence, colorectal cancer ≥466.64 vs g/day 1.00 (0.72-1.41) Age, alcohol, BMI, diabetes, educational level, energy Intake, family history of colorectal cancer, Income, met-hours per week, occupation, red meat, smoking, total meat Midpoints, distribution of person-years Incidence, colon cancer ≥466.64 vs g/day 0.95 (0.62-1.47) Incidence, rectal cancer ≥466.64 vs g/day 1.10 (0.64-1.89) Fung, 2010 COL40828 USA HPFS, Prospective Cohort, M/W 132 746 Self report verified by medical record FFQ Incidence, colorectal cancer, men per 1 serving/day 1.00 (0.96-1.04) Age, alcohol Intake, aspirin use, BMI, colonoscopy, energy, family history, history of polyps, physical activity, smoking Conversion of serv/d to g/d analysis
Incidence, proximal cancer ≥284.4 vs g/day 0.86 (0.65-1.14) Incidence, rectal cancer ≥284.4 vs g/day 1.04 (0.81-1.33) Incidence, rectal cancer per 100 g/day 1.04 (0.87-1.23) Nomura, 2008 COL40663 USA MEC, Prospective Cohort, Age: 45-75 years, M/W 1 023/ 191 011 7.3 years Cancer registry Incidence, colorectal cancer, men 236.2 vs 71.9 g1000 kcal/day 0.85 (0.69-1.05) Age, alcohol Intake, aspirin use, BMI, calcium Intake, energy Intake, ethnicity, family history of colorectal cancer, folate Intake, history of polyps, multivitamin, of smoking, physical activity, red meat Intake, time, vitamin d Distribution of and person-years, conversion of g/1000 kcal/d to g/d Incidence, colorectal cancer, women 286.5 vs 85.5 g1000 kcal/day 0.94 (0.75-1.17) Incidence, colon cancer, men 236.2 vs 71.9 g1000 kcal/day 0.80 (0.63-1.03) Incidence, cancer, women 286.5 vs 85.5 g1000 kcal/day 0.90 (0.70-1.17) Incidence, rectal cancer, men 236.2 vs 71.9 g1000 kcal/day 0.97 (0.64-1.46) Incidence, rectal cancer, 286.5 vs 85.5 kcal/day 1.09 (0.67-1.77) 95 95
Park, 2007 COL40697 USA NIH-AARP, Prospective Cohort, Age: 50-71 years, M/W 2 048/ 488 043 2 121 664 person-years Cancer registry FFQ Incidence, colorectal cancer, men 2.8 vs 0.6 servings1000 kcal/day 0.82 (0.71-0.94) Incidence, colorectal cancer, women 3.6 vs 0.8 servings1000 kcal/day 1.12 (0.90-1.38) Incidence, colon cancer, men 2.8 vs 0.6 servings1000 kcal/day 0.84 (0.71-0.99) Incidence, proximal cancer, men 2.8 vs 0.6 servings1000 kcal/day 0.90 (0.72-1.14) Incidence, distal colon cancer, men 2.8 vs 0.6 servings1000 kcal/day 0.76 (0.59-0.98) Incidence, rectal cancer, men 2.8 vs 0.6 servings1000 kcal/day 0.81 (0.62-1.05) Incidence, distal colon cancer, women 3.6 vs 0.8 servings1000 kcal/day 1.15 (0.76-1.73) Incidence, rectal cancer, women 3.6 vs 0.8 servings1000 kcal/day 1.21 (0.80-1.83) Incidence, colon cancer, women 3.6 vs 0.8 servings1000 kcal/day 1.10 (0.86-1.40)
Age: 40-64 years, M energy content, family history of specific cancer, meat consumption, physical activity, smoking status Incidence, rectal cancer, ≥313 vs 0-245 g/day 1.14 (0.67-1.93) McCullough, 2003 COL00367 USA CPS II, Prospective Cohort, Age: 50-74 M/W 298/ 133 163 6 Cps-II cohort FFQ Incidence, colon cancer, men ≥3.3 vs 0-1.2 serving/day 0.69 (0.47-1.03) Incidence, colon cancer, men <0.80 vs 1.3+ serving/day 1.79 (1.22-2.61) Incidence, colon cancer, men per 1 items/month 0.93 (0.87-1.00) Incidence, colon cancer, women ≥3.3 vs 0-1.2 serving/day 0.91 (0.56-1.48) Incidence, colon cancer, women <0.81 vs 1.3+ serving/day 0.78 (0.42-1.44) Incidence, colon cancer, women per 1 items/month 0.99 (0.92-1.07) Incidence, proximal colon cancer, men, proximal cancer Q 2 vs Q 1 0.59 (0.31-1.11)
Incidence, distal cancer, men, distal cancer Q 2 vs Q 1 0.71 (0.38-1.33) 2002 COL00410 USA BCDDP, 1973, Prospective Cohort, W 485/ 45 490 386 142 person-years Breast cancer screening centres FFQ Incidence, colorectal cancer, ≥0.79 vs 0.95 (0.71-1.26) Alcohol consumption, BMI, calcium, educational level, energy Intake, fruits, grains consumption, height, nsaid use, physical activity, red meat, smoking habits, supplements, vitamin d Conversion of serv/d to g/d Terry, 2001 COL00059 Sweden SMC, Prospective Cohort, Age: 40-74 years, W 460/ 61 463 588 270 screening program FFQ Incidence, colorectal cancer ≥2 vs 0-1 serving/day 0.84 (0.65-1.09) Age, red meat & product Intake, total caloric Intake Midpoints, distribution of cases and conversion from serv/d to g/d Incidence, colon cancer ≥2 vs 0-1 serving/day 0.90 (0.66-1.24) Incidence, rectal cancer ≥2 vs 0-1 serving/day 0.71 (0.45-1.12) Incidence, proximal cancer ≥2 vs 0-1 serving/day 0.72 (0.44-1.20) Incidence, distal colon cancer ≥2 vs 0-1 serving/day 1.13 (0.66-1.94) 0.32 trial
Michels, 2000 COL00365 USA NHS, Prospective Cohort, Age: 30-55 W, Registred nurses 569/ 88 764 1 327 029 person-years Population registries FFQ Incidence, cancer, ≥5 vs 0-1 serving/day 0.96 Age, alcohol consumption, aspirin use, BMI, family history of colorectal cancer, height, menopausal status, pack-years of smoking, physical activity, postmenopausal hormone use, red meat Intake, sigmoidoscopy, supplement Intake, total caloric Intake Conversion from serv/d to g/d, distribution of cases and Incidence, colon cancer, per 1 serving/day 1.03 (0.97-1.10) Incidence, rectal cancer, ≥5 vs 0-1 serving/day 1.24 Incidence, rectal cancer, per 1 serving/day 1.03 (0.91-1.17) Michels, 2000 COL00365 USA HPFS, Prospective Cohort, Age: 40-75 M, Health professionals 368/ 47 325 416 616 person-years Population registries FFQ Incidence, colon cancer, ≥5 vs 0-1 serving/day 1.24 Age, alcohol consumption, aspirin use, BMI, family history of colorectal cancer, height, menopausal status, of smoking, physical activity, red meat Intake, sigmoidoscopy, supplement Intake, total caloric Intake Conversion from serv/d to g/d, distribution of cases and Incidence, colon cancer, per 1 serving/day 1.01 (0.90-1.14) Incidence, rectal cancer, ≥5 vs 0-1 serving/day 0.67 Incidence, rectal cancer, per 1 serving/day 1.01 (0.80-1.27)
Voorrips, 2000 COL00578 Netherlands NLCS, Case Cohort, Age: 55-69 years, M/W 312/ 120 852 6.3 years Cancer registry FFQ Incidence, colon cancer, men 285 vs 100 g/day 0.85 (0.57-1.27) Incidence, cancer, women 293 vs 107 g/day 0.83 (0.54-1.26) Incidence, rectal cancer, men 285 vs 100 g/day 0.88 (0.55-1.41) Incidence, distal cancer, men Q 5 vs Q 1 0.76 (0.27-1.30) Incidence, proximal colon cancer, men Q 5 vs Q 1 1.03 (0.59-1.81) Incidence, proximal colon cancer, women Q 5 vs Q 1 0.99 (0.57-1.72) Incidence, distal colon cancer, women Q 5 vs Q 1 0.64 (0.36-1.17) Incidence, rectal cancer, women 293 vs 107 g/day 1.78 (0.94-3.38)
Table Vegetable intake and colorectal cancer risk. Main characteristics of studies excluded from the dose-response meta-analysis Author, Year, WCRF Code, Country Study name, Cases/ Study size Follow-up (years) Case Exposure assessment Outcome Comparison RR (95%CI) Adjustment factors Reasons for exclusion Makarem, 2015 COL41060 USA Cohort, Prospective Cohort, Age: 66 years, M/W 63/ 2 983 11.5 years Death certificate and medical records FFQ Incidence, colorectal cancer per 1 points 0.44 Age, sex, smoking status Not possible to convert WCRF score to intake in grams per day Aoyama, 2014 COL41014 JACC study, Prospective Cohort, Age: 40-79 years, M/W 467/ 14 549 598 605 person-years Cancer registry/ population register Questionnaire Incidence, colorectal cancer Q 3 vs Q 3 1.00 Incidence, colorectal cancer, men ≥1.8 vs ≥1.8 times/week 1.00 Incidence, colorectal cancer, women ≥2.2 vs ≥2.2 times/week 1.00 Incidence, colon cancer Q 3 vs Q 3 1.00 Incidence, cancer, men ≥1.8 vs ≥1.8 1.00 Incidence, colon cancer, women ≥2.2 vs ≥2.2 times/week 1.00 Offspring
Incidence, rectal cancer 2.57 vs 0.39 times/day 1.10 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 0.98 Age, sex, alcohol Intake, BMI, diabetes, dialect group, educational level, energy Intake, exposure assessment, family history of colorectal cancer, physical activity, smoking habits <3 categories of exposure Iso, 2007 COL40707 Japan JACC, Prospective Cohort, Age: 40-79 years, M/W 202/ 105 500 15 years Municipal resident registration records, death certificates FFQ Mortality, colon cancer, men 3-4 vs ≤0 /week 0.83 Age, centre location Mortality as outcome Mortality, cancer, women 3-4 vs ≤0 /week 1.35 Mortality, rectal cancer, men 3-4 vs ≤0 /week 1.24 Wark, 2005 COL01807 Case Cohort, Age: 55-69 M/W 368/ 120 852 7.3 years Population registries FFQ Incidence, colon cancer, hmlh1+ cases ≥209.4 vs g/day 0.94 Age, sex, family history of specific cancer, total energy Duplicate, overlap with Voorrips et al, 2000 COL00578 Incidence, cancer, hmlh1- cases ≥209.4 vs g/day 0.86 Tsubono, 2005 COL40746 JPHC, Prospective Cohort, 377/ 88 658 Histology FFQ Incidence, colorectal cancer Q 4 vs Q 1 1.00 1.39) 1.27) (0.87-
Age: 40-59 M/W 694 074 Intake, fish, meat Intake, physical activity, smoking status, vitamin use Incidence, colon cancer Q 4 vs Q 1 1.08 Incidence, colorectal cancer, men Q 4 vs Q 1 1.18 Incidence, colon cancer, men Q 4 vs Q 1 1.24 Incidence, colorectal cancer, women Q 4 vs Q 1 0.88 Incidence, rectal cancer Q 4 vs Q 1 0.87 Incidence, colon cancer, women Q 4 vs Q 1 1.01 Incidence, cancer, women Q 4 vs Q 1 1.01 Incidence, rectal cancer, men Q 4 vs Q 1 1.06 Sanjoaquin, 2004 COL01182 UK OVS, Prospective Cohort, Age: 18-89 years, M/W 95/ 10 998 17 years FFQ Incidence, colorectal cancer, Q 3 vs Q 1 0.86 Age, sex, alcohol consumption, smoking habits No quantities 1.59) 1.79) Trial
2002 COL00950 Europe EPIC, Prospective Cohort, M/W 773/ 406 439 Not specified FFQ Incidence, colorectal cancer Q 5 vs Q 1 0.71 Age, sex, body weight, centre location, energy Intake, ethanol Intake, fruit Intake, height, physical activity at work, smoking habits Duplicate, overlap with et al, 2013 COL40964 Incidence, colorectal cancer, women ≥316 vs 0-111 g/day 0.78 Incidence, colorectal cancer, men ≥252 vs 0-82 g/day 0.60 Sellers, 1998 COL01974 USA IWHS, Prospective Cohort, Age: 55-69 W, 180/ 35 216 10 years Seer registry FFQ Incidence, colon cancer, no family history of crc ≥27.1 vs ≤18 servings/week 1.10 Age, history of polyps, total energy Intake Duplicate, overlap with Steinmetz et al, 1994 COL00178 Incidence, colon cancer, family history of crc ≥27.1 vs ≤18 servings/week 2.00 Hsing, 1998 COL00458 USA Lutheran Brotherhood Study, Prospective Cohort, Age: 35- M, policyholders 120/ 17 633 286 731 person-years Responding to mail survey Questionnaire Mortality, colon cancer, ≥4.6 vs ≤1.1 1.50 Age, alcohol consumption, smoking habits, total energy Mortality as outcome Kato, 1997 CRC00022 USA New York University Women's Health Study, 100/ 14 272 105 044 person-years screening program FFQ Incidence, colorectal cancer, Q 4 vs Q 1 1.63 Age, educational place at enrollment, total calorie Intake No quantities al
Prospective Cohort, Age: 34-65 years, W Giovannucci, 1994 COL00119 USA HPFS, Prospective Cohort, Age: 40-75 years, M, Health professionals 47 949 6 years Mailing to health professionals FFQ Incidence, cancer, ≥5 vs ≤2 serving/day 1.02 Duplicate, overlap with Michels et al, 2000 COL00365 Thun, 1992 COL01224 USA, Puerto Rico CPS II, Nested Case Control, Age: 30- years, M/W 611/ 3051 controls 6 years Not specified Questionnaire Mortality, colon cancer, men Q 5 vs Q 1 0.80 Age, sex, ethnicity Mortality as outcome, duplicate, overlap with McCullough et al, 2003, COL00367 Mortality, colon cancer, women Q 5 vs Q 1 0.63 Mortality, cancer, women Q 5 vs Q 1 0.66 Hirayama, 1990 COL01508 Japan Japan 6 prefectures cohort study, Prospective Cohort, Age: 40- years, M/W 563/ 265 118 17 years Health centres Interview Mortality, rectal cancer, daily consumption vs no daily consumption 1.05 Age, sex Mortality as outcome Mortality, colon cancer, daily consumption 0.85 0.89) 1.24)
Table Garlic 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 number of cases Studies country, area Outcome Comparison RR (95%CI) P Heterogeneity (I2, p value) Meta-analysis Heine Bröring, 2015 2 802 North America, Europe Colorectal cancer Highest vs Lowest 1.24(0.99-1.54) 0%, 0.36 Table Garlic 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 Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Meng, 2013 COL40930 NHS, Prospective Cohort, Age: 30-55 years, W, nurses 634/ 76 208 24 years Biennial questionnaires and medical records Questionnaire Incidence, proximal cancer ≥1/day vs 1.13 (0.78-1.64) Ptrend:0.33 Age, alcohol consumption, aspirin use, beef, pork or lamb as a main dish, BMI, calcium Intake, endoscopy, energy, folate, history of colorectal cancer, HRT use, physical 397/ Incidence, distal cancer 1.39 (0.88-2.20) Ptrend:0.30 285/ Incidence, rectal cancer 1.14 (0.64-2.03) Ptrend:0.68 1 339 Incidence, colorectal cancer 1.21 (0.94-1.57) Ptrend:0.14 1 054/ Incidence, colon cancer 1.23 (0.92-1.64) Ptrend:0.15 up
gender, history of endoscopy, HRT use, NSAID use, physical activity, red and processed meat, smoking 551/ 1+ vs <1 0.87 (0.58-1.32) Ptrend:0.06 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 ≥1 vs ≤0 servings/week 1.20 (0.80-1.90) Ptrend:0.4 Age, history of polyps, total energy Intake 61/ Family history of crc 1.00 (0.40-2.50) Ptrend:0.9 Giovannucci, 1994 COL00119 USA HPFS, Prospective Cohort, Age: 40-75 years, M, Health professionals 205/ 47 949 6 years Mailing to health professionals FFQ Incidence, colon cancer, ≥2 vs ≤0 serving/week 0.77 (0.51-1.16) Ptrend:0.14 Age Incidence, distal colon cancer, ≥2 vs ≤0 serving/week 0.63 (0.38-1.65) Ptrend:0.07 Steinmetz, 1994 COL00178 IWHS, 212/ 35 216 Seer registry ≥1 vs 0-0.4 serving/week 0.68 (0.46-1.02) Ptrend:<0.1 Age, energy Intake
USA Prospective Cohort, Age: 55-69 years, W, Postmenopausal 167 447 FFQ Q 3 vs Q 1 0.70 (0.46-1.05) Age, age at child birth, alcohol consumption, BMI, educational level, energy Intake, history of polyps or colitis, parity, physical activity, smoking habits 120/ Incidence, distal colon cancer, distal sites ≥1 vs 0-0.4 serving/week 0.52 (0.30-0.93) Ptrend:<0.05 Age, energy Intake 86/ Incidence, proximal colon cancer, proximal sites ≥1 vs 0-0.4 serving/week 1.00 (0.56-1.79)
physical activity, processed meat, smoking, vitamin d 128/ Incidence, rectal cancer yes vs no 1.51 (0.71-3.21) McCullough, 2012 COL40919 USA CPS II, Prospective Cohort, M/W 764/ 99 700 7 years Cancer registry and death certificates and medical records FFQ Incidence, colorectal cancer current vs 1.03 (0.74-1.44) Age, alcohol, BMI, energy, gender, history of endoscopy, HRT use, NSAID use, physical activity, smoking, Calcium, fruits and vegetables consumption, red and processed meat 390/ Men current vs never 0.94 (0.57-1.53) 374/ Women current vs never 1.09 (0.69-1.72) Satia, 2009 COL40962 USA VITAL, Prospective Cohort, Age: 50-76 years, M/W 428/ 76 512 5 years Seer registry Questionnaire Incidence, colorectal cancer any pills/day during the previous 10y vs no use 1.35 (1.01-1.81) Age, BMI, educational level, fruits and vegetables consumption, gender, nsaid use, phyisical activity, sigmoidoscopy Dorant, 1996 COL00095 NLCS, Case Cohort, 252/ 120 852 Population registries FFQ Incidence, colon cancer, exclusively garlic 1.36 (0.79-2.35)
Netherlands Age: 55-69 years, M/W 3.3 years supplements vs no supplement educational level, family history of large Intestinal cancer, gender, history of history of chronic Intestinal disease, smoking status, vitamin c 147/ Incidence, rectal cancer, exclusively garlic supplements vs no supplement 1.28 (0.63-2.60)
Table Fruit intake and colorectal cancer risk. Results of meta-analyses and pooled analyses of prospective studies published after the 2005 SLR. Author, Year Number of studies number of cases Studies country, area Outcome Comparison RR (95%CI) P trend Heterogeneity (I2, p value) Meta-analyses Huxley et al, 2009 8 CC 6 RC 8 CRC 2651 CC 1005 RC 7916 CRC Europe, Asia Incidence/ mortality High vs. Low 0.99 (0.90-1.08) 0.78 (0.63-0.97) 1.01 (0.86-1.18) - - - 25%, p=0.11 NA NA Aune et al, 2012 14 CRC 13 11 CC 7 RC 14876 North America, Europe, Asia Incidence High vs. low Per 100 g/d High vs. low High vs. low 0.90 (0.83-0.98) 0.98 (0.94-1.01) 0.89 (0.81-0.97) 0.91 (0.76-1.09) - - - - 41.6%, p=0.05 64%, p=0.001 30.2%, p=0.16 45.2%, p=0.09 Pooled analyses Koushik, 2007 14 5838 CC North America, Europe Incidence Quintile 5 vs. 1 ≥400 vs. <100 g/d 0.93 (0.85-1.02) 0.87 (0.77-0.97) 0.28 0.04 NA, p=0.62 NA, p=0.90
years Fung, 2010 COL40828 USA NHS, Prospective Cohort, M/W 132 746 Self report verified by medical record FFQ Incidence, colorectal cancer, women per 1 serving/day 0.95 Conversion of serv/d to g/d George, 2009 COL40789 USA NIH-AARP, Prospective Cohort, Age: 615 years, M/W, Retired 5 039/ 483 338 8 years Cancer registry FFQ Incidence, colorectal cancer, women 1.9-5.58 vs 0.93 Age, alcohol, BMI, educational level, energy Intake, family history, marital status, menopausal hormone use, physical activity, race, smoking status, vegetable Intake Conversion of cups/1000 kcal/d to g/d, midpoints, distribution of cases and Incidence, colorectal cancer, men 1.59-5.13 vs ≤0.44 0.94 van Duijnhoven FJ, 2009 COL40785 EPIC, Prospective Cohort, Age: 35-70 M/W 1 667/ 452 755 8.8 years Cancer registry, health Insurance records, active follow and mortality registry FFQ Incidence, colorectal cancer, women ≥342.7 vs g/day 0.87 Incidence, colorectal cancer, men ≥342.7 vs g/day 0.89 Incidence, distal cancer ≥342.7 vs g/day 0.84 Incidence, proximal colon cancer ≥342.7 vs g/day 0.81 Incidence, colorectal cancer ≥342.7 vs g/day 0.88 1.05)
Incidence, colorectal cancer per 100 g/day 0.97 Incidence, colorectal cancer per 100 g/day 0.98 Incidence, cancer ≥342.7 vs g/day 0.84 Incidence, colon cancer per 100 g/day 0.96 Incidence, cancer per 100 g/day 0.97 Incidence, rectal cancer ≥342.7 vs g/day 0.96 Incidence, rectal cancer per 100 g/day 0.99 Incidence, rectal cancer per 100 g/day 0.98 Nomura, 2008 COL40663 USA MEC, Prospective Cohort, Age: 45-75 years, M/W 1 023/ 191 011 7.3 years Cancer registry Incidence, colorectal cancer, men 295.9 vs 30.1 g1000 kcal/day 0.80 Incidence, colorectal cancer, women 381.5 vs 47.5 g1000 kcal/day 0.83 Incidence, colon cancer, men 295.9 vs 30.1 kcal/day 0.75 1.07) 1.06) 1.04) 1.02)
Incidence, cancer, women 381.5 vs 47.5 g1000 kcal/day 0.87 Incidence, rectal cancer, men 295.9 vs 30.1 g1000 kcal/day 0.80 Incidence, rectal cancer, women 381.5 vs 47.5 g1000 kcal/day 0.77 Park, 2007 COL40697 USA NIH-AARP, Prospective Cohort, Age: 50-71 years, M/W 2 048/ 488 043 2 121 664 person-years Cancer registry FFQ Incidence, colorectal cancer, men 0.24 vs ≥1 servings1000 kcal/day 1.24 Incidence, colorectal cancer, men 2.9 vs 0.4 servings1000 kcal/day 1.06 Incidence, colorectal cancer, 0.24 vs ≥1 servings1000 kcal/day 1.06 Incidence, colorectal cancer, women 3.5 vs 0.6 servings1000 kcal/day 1.09 Incidence, distal colon cancer, men 2.9 vs 0.4 servings1000 kcal/day 1.14 Incidence, rectal cancer, men 2.9 vs 0.4 servings1000 kcal/day 0.99
W Lin, 2005 COL01831 USA WHS, Prospective Cohort, Age: 45- years, W, professionals 223/ 36 976 10 years Follow up questionnaires (self report), medical record and pathology reports FFQ Incidence, colorectal cancer, women 3.8 vs 0.6 serving/day 0.79 Age, alcohol consumption, aspirin use, BMI, family history of specific cancer, history of previous and prior endoscopy, menopausal status, physical activity, postmenopausal hormone use, randomized treatment assignment, red meat Intake, smoking status, total energy Distribution of person-years, conversion of serv/d to g/d Sato, 2005 COL01930 MCS, Prospective Cohort, Age: 40-64 M 165/ 41 835 7 Population registry Questionnaire Incidence, cancer, ≥242 vs 0-95 g/day 1.45 Age, sex, alcohol consumption, BMI, educational level, energy content, family history of specific cancer, meat consumption, physical activity, smoking status Midpoints Incidence, rectal cancer, ≥242 vs 0-95 g/day 1.41 Sanjoaquin, 2004 COL01182 UK OVS, Prospective Cohort, Age: 18-89 years, M/W 91/ 10 998 17 years FFQ Incidence, colorectal cancer, ≥10 vs ≤4 times/week 0.60 Age, sex, alcohol consumption, smoking habits Midpoints, distribution of person-years McCullough, 2003 COL00367 CPS II, Prospective Cohort, 298/ 133 163 6 years Cps-II cohort FFQ Incidence, colon cancer, men ≥6.2 vs 0-1.1 serving/day 1.11
Pietinen, 1999 COL00176 Finland ATBC, Prospective Cohort, Age: 50-69 M, Smokers 185/ 27 111 8 years Population Dietary history questionnaire Incidence, colorectal cancer, 216 vs 30 g/day 1.10 Age, alcohol consumption, BMI, calcium Intake, educational level, energy Intake, physical activity, smoking years, supplement group Distribution of person-years Steinmetz, 1994 COL00178 USA IWHS, Prospective Cohort, Age: 55-69 years, W, 212/ 35 216 167 447 person-years Driving license FFQ Incidence, colon cancer, ≥17.5 vs 0-7.4 serving/week 0.86 Age, energy Intake Midpoints, conversion from serv/wk to g/d, distribution of cases and Incidence, distal colon cancer, distal sites ≥17.5 vs 0-7.4 serving/week 0.97 Incidence, proximal colon cancer, proximal sites ≥17.5 vs 0-7.4 serving/week 0.80 Shibata, 1992 COL00740 USA Leisure Cohort, Prospective Cohort, M/W, retirement community, uppermiddle social class 105/ 11 580 70 159 Community registry FFQ Incidence, colon cancer, women ≥3.7 vs 0-2.4 serving/day 0.50 Age, smoking habits Conversion from serv/d to g/d, distribution of person-years Incidence, colon cancer, men ≥3.5 vs 0-2.2 serving/day 1.12 Table Fruit intake and colorectal cancer risk. Main characteristics of studies excluded from the CUP SLR al
Author, Year, WCRF Code, Country name, characteristics Cases/ size Follow-up (years) Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Adjustment factors Reasons for exclusion Aoyama, 2014 COL41014 Japan JACC study, Prospective Cohort, Age: 40-79 years, M/W 806/ 14 549 598 605 person-years Cancer registry/ population register Questionnaire Incidence, colorectal cancer Q 3 vs Q 3 1.00 Age, age, sex, beef, pork, or lamb, BMI, drinking amount, educational level, family history of colorectal cancer, local area, smoking, walking time No quantities Incidence, colon cancer Q 3 vs Q 3 1.00 Incidence, colorectal cancer, women ≥3.2 vs ≥3.2 times/week 1.00 Incidence, colon cancer, men ≥1.7 vs ≥1.7 times/week 1.00 Incidence, rectal cancer Q 3 vs Q 3 1.00 Incidence, colon cancer, women ≥3.2 vs ≥3.2 times/week 1.00 Incidence, rectal cancer, men ≥1.7 vs ≥1.7 times/week 1.00 Incidence, colorectal cancer, men ≥1.7 vs ≥1.7 1.00 Incidence, rectal cancer, women ≥3.2 vs ≥3.2 times/week 1.00 Agnoli, 2013 COL40938 EPIC-Italy, Prospective Cohort, 435/ 45 275 11.28 years Cancer registry and hospital records FFQ Incidence, colorectal cancer 391.9-3790.5 vs 0-249.2 g/day 0.87 Age, BMI, educational gender, non-alcoholic Overlap with Bamia, 2013 COL40964
M/W beverage Intake, physical activity, smoking, study center Ruder, 2011 COL40896 USA NIH-AARP, Prospective Cohort, Age: 50-71 Retired 2 819/ 292 797 Cancer registry and national health database FFQ Incidence, cancer 2.1 vs 0.16 0.84 Sex, age at baseline, alcohol consumption, aspirin use, BMI, educational level, energy, energy, fruits, history of colon cancer, HRT use, physical activity, race, smoking Overlap with Park, 2007 COL40697 Incidence, colon cancer 2.1 vs 0.16 times/day 0.82 Incidence, rectal cancer 2.1 vs 0.16 times/day 1.05 Incidence, rectal cancer 2.1 vs 0.16 0.91 Butler, 2008 COL40639 Singapore SCHS, Prospective Cohort, Age: 45-74 M/W 961/ 61 321 9.8 years Cancer registry FFQ Incidence, colorectal cancer Q 4 vs Q 1 0.89 Age, sex, alcohol Intake, BMI, diabetes, dialect group, educational level, energy Intake, exposure assessment, family history of colorectal cancer, physical activity, smoking habits <3 categories Tsubono, 2005 COL40746 Japan JPHC, Prospective Cohort, Age: 40-59 years, M/W 377/ 88 658 694 074 Histology FFQ Incidence, colorectal cancer Q 4 vs Q 1 0.92 Incidence, colon cancer Q 4 vs Q 1 0.92 Incidence, colorectal cancer, men Q 4 vs Q 1 1.06
Incidence, colon cancer, men Q 4 vs Q 1 1.02 Incidence, colorectal cancer, women Q 4 vs Q 1 0.93 Incidence, rectal cancer Q 4 vs Q 1 0.91 Incidence, cancer, women Q 4 vs Q 1 0.87 Incidence, rectal cancer, men Q 4 vs Q 1 1.19 Incidence, rectal cancer, women Q 4 vs Q 1 0.84 Wark, 2005 COL01807 NLCS, Case Cohort, Age: 55-69 M/W 387/ 120 852 7.3 Population registries FFQ Incidence, colon cancer, hmlh1+ cases ≥204.6 vs g/day 1.03 Age, sex, family history of specific cancer, total energy Overlap with Voorrips, 2000 COL00578 Incidence, colon cancer, hmlh1- cases ≥204.6 vs g/day 0.46 Khan, 2004 COL01606 Japan HCS, Prospective Cohort, Age: 40-97 years, M/W 15/ 3 458 14.3 years Area residency Questionnaire Mortality, colorectal cancer, men Q 2 vs Q 1 0.40 Age, smoking habits Mortality Mortality, colorectal cancer, Q 2 vs Q 1 0.50 Health education, health screening, health status 0.90)
Incidence, colorectal cancer, men ≥312 vs 0-68 g/day 0.79 Sellers, 1998 COL01974 USA IWHS, Prospective Cohort, Age: 55-69 years, W, 180/ 35 216 10 years Seer registry FFQ Incidence, colon cancer, no family history of crc ≥20.1 vs ≤13 servings/week 0.90 Age, history of polyps, total energy Intake Overlap with McCarl, 2006 COL40633 USA Incidence, colon cancer, family history of crc ≥20.1 vs ≤13 servings/week 1.40 1998 COL00458 USA Lutheran Brotherhood Study, Prospective Cohort, Age: 35- years, M, Policyholders 145/ 17 633 286 731 person-years Responding to mail survey Questionnaire Mortality, colorectal cancer, ≥67.1 vs ≤29.2 times/month 1.60 Age, alcohol consumption, smoking habits, total energy Mortality Mortality, colon cancer, ≥67.1 vs ≤29.2 times/month 1.60 Kato, 1997 CRC00022 USA New York University Health Study, Prospective Cohort, Age: 34-65 years, W 100/ 14 272 105 044 person-years Mammography screening program FFQ Incidence, colorectal cancer, Q 4 vs Q 1 1.49 Age, educational place at enrollment, total calorie Intake No quantities
Figure Relative risk of colorectal cancer and intake estimated using non-linear models Fruits g/day RR (95% CI) 2 1.21 (1.15-1.26) 100 1.07 (1.05-1.09) 200 1.00 300 0.99 (0.98-0.99) 400 0.99 (0.98-0.99) 500 0.99 (0.98-1.00) 600 0.99 (0.98-1.01) 700 0.99 (0.97-1.01)
years, M/W level, physical activity, red meat intake, smoking status, total energy intake Intakes in converted to g/day using average energy intake per each quantile servings1000 kcal/day Ptrend:0.85 Lin, 2005 COL01831 USA WHS, Prospective Cohort, Age: 45- years, W, professionals 223/ 36 976 10 years Follow up questionnaires (self-report), medical record and pathology reports FFQ Incidence, colorectal cancer, women 0.9 vs 0.1 serving/day 0.83 (0.54-1.28) Ptrend:0.19 Age, alcohol consumption, aspirin use, BMI, family history of specific cancer, history of previous polyp and prior endoscopy, menopausal status, physical activity, postmenopausal hormone use, randomized treatment assignment, red meat intake, smoking status, total energy Distribution of person-years by exposure category. Intakes in servings/day converted to g/day Michels, 2000 COL00365 USA NHS, Prospective Cohort, Age: 30-55 937/ 136089 1 743 645 person-years Population registries FFQ Incidence, colon cancer, per 1 serving/day ≥4 vs <1 servings/day 1.23 (0.93–1.63) 1.12 (0.89–1.42)
years, W, Registered nurses And HPFS, Prospective Cohort, Age: 40-75 years, M, Health professionals history of colorectal cancer, height, menopausal status, of smoking, physical activity, postmenopausal hormone use, red meat intake, sigmoidoscopy, supplement intake, total caloric intake Family history of specific cancer, smoking status, total energy, vitamin supplement 244/ Incidence, rectal cancer, per 1 serving/day ≥4 vs <1 servings/day 1.52 (0.99–2.32) 1.38 (0.87–2.18) Voorrips, 2000 COL00578 Netherlands NLCS, Case Cohort, Age: 55-69 M/W 313 120 852 6.3 Cancer registry FFQ Incidence, colon cancer, men 62 vs 11 g/day 1.13 (0.77-1.64) Ptrend:0.41 Age, alcohol consumption, family history of specific cancer Distribution of person-years by exposure category. 201/ Incidence, rectal cancer, men 62 vs 11 g/day 0.92 (0.58-1.47) Ptrend:0.97 274/ Incidence, colon cancer, women 58 vs 10 g/day 0.79 (0.52-1.20) Ptrend:0.58 122/ Incidence, rectal cancer, women 58 vs 10 g/day 1.01 (0.53-1.94) Ptrend:0,59
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 ≥3.6 vs ≤2 servings/week 1.00 (0.70-1.50) Ptrend:0.9 Age, history of polyps, total energy intake Distribution of by exposure category. Intakes in servings/week converted to g/day 61/ Family history of crc ≥3.6 vs ≤2 servings/week 1.50 (0.80-2.70) Ptrend:0.2 Singh, 1998 COL00185 USA AHS, Prospective Cohort, Age: 25- years, M/W, Seventh-day Adventists 144/ 32 051 178 544 Census list FFQ Incidence, colon cancer, ≥3 vs ≤1 times/week 0.53 (0.33-0.86) Ptrend:0.03 Age, sex, alcohol consumption, aspirin use, BMI, family history of specific cancer, physical activity, smoking habits Intakes in times/week converted to g/day
Table 47 Legumes 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 Agnoli, 2013 COL40938 Italy EPIC-Italy, Prospective Cohort, M/W 435/ 45 275 11.28 years Cancer registry and hospital records FFQ Incidence, colorectal cancer 23.6-281.4 vs g/day 0.89 (0.70-1.15) Ptrend:0.353 Age, BMI, educational level, gender, non-alcoholic beverage intake, physical activity, smoking, study centre Superseded by 2013 COL40964 2002 COL00950 Europe EPIC, Prospective Cohort, M/W 773/ 406 439 Not specified FFQ Incidence, colorectal cancer, Q 5 vs Q 1 1.41 Ptrend:0.54 Age, sex, body weight, centre location, energy intake, ethanol intake, height, physical activity at work, smoking habits Superseded by Bamia, 2013 COL40964 493/ Women ≥26 vs 0-1 g/day 1.66 Ptrend:0.35 279/ Men ≥23 vs 0-1 g/day 0.95 Ptrend:0.72 Fraser, 1999 COL00102 USA AHS, Prospective Cohort, Age: 25-100 years, M/W, Seventh-day Adventists 34 198 6 Census list FFQ Incidence, colon cancer, consumers of red meat ≥3 vs 0-1 times/week 0.33 (0.13-0.83) Unadjusted Superseded by Singh, 1998 COL00185 (adjusted results) Steinmetz, 1994 COL00178 USA IWHS, Prospective Cohort, Age: 55-69 212/ 35 216 167 447 SEER FFQ Incidence, colon cancer, ≥1 vs ≤0 serving/week 0.95 (0.66-1.36) Trial,
Table 54 Red and processed meat 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 Spencer, 2010 7 579 cases 1996 controls UK Colorectal cancer ≥75 vs <25 g/day Per 50g/day 0.88 (0.65–1.20) 0.97 (0.84–1.12) 0.68 Colon cancer 0.88 (0.60–1.29) 1.03 (0.86–1.24) 0.74 Rectal cancer 0.83 (0.49–1.42) 0.85 (0.66–1.10) 0.22 Meta-analysis Alexander, 2015 27 Europe, Asia and America Colorectal, colon and rectal cancer combined Highest vs lowest 1.11(1.03-1.19) 33.6%, 0.01 Chan, 2011 10 11358 Europe, Asia and North America Colorectal cancer Highest vs lowest 1.22 (1.11-1.34) 56%, 0.01 Per 100g/day 1.14(1.04-1.24) 8 5426 cancer Per 100g/day 1.25 (1.10–1.43) 60%, 0.02 5 2091 Rectal cancer Per 100g/day 1.31 (1.13–1.52) 18%, 0.30
M/W pathology and active follow up educational level, ethanol, fish, fruits, legumes, lipids, meat, physical activity, smoking 1 876/ Men 151.5 vs 43.9 g/day 1.07 (0.94-1.22) Parr, 2013 COL40955 Norway NOWAC, Prospective Cohort, Age: 41-70 years, W 666/ 84 538 11.1 years Cancer registry FFQ Incidence, colorectal cancer ≥90 vs ≤30 g/day 1.40 (1.01-1.95) Age, alcohol, BMI, calcium, energy, fibre, physical activity, smoking Only included in subgroup analysis. Component of the EPIC study. Superseded by Norat, 2005 COL01698 and 2013 COL40964. Mid-points of exposure categories. 459 Incidence, cancer ≥90 vs ≤30 g/day 1.42 (0.95-2.14) 215/ Incidence, rectal cancer ≥90 vs ≤30 g/day 1.36 (0.77-2.38) Ollberding, 2012 COL40941 Hawaii, USA MEC, Prospective Cohort, Age: 45-75 years, M/W 3 404/ 165 717 8.1 Cancer registry and national death Index FFQ Incidence, colorectal cancer 68.96 vs 16.18 g/1000 kcal/day 0.93 (0.83-1.05) Age, sex, age at cohort entry, alcohol consumption, BMI, calcium, dietart fibre, energy intake, ethnicity, family history of colorectal cancer, folate, history of Mid-points of exposure categories. Intakes in g/1000kcal/day converted to g/day using average energy intake per each quantile
physical activity, race, red meat, smoking of exposure categories. Conversion from times/day to g/day. Takachi, 2011 COL41056 Japan JPHC, Prospective Cohort, Age: 45-74 years, M/W 481/ 80 658 9 years Hospital records + cancer registry FFQ Incidence, colon cancer, men 117 vs 20 g/day 1.44 (1.06-1.98) Age, alcohol consumption, area, BMI, calcium, diabetes, energy, fibre, folate, physical activity, salted fish consumption, screening exams, smoking status, vitamin b6, vitamin d Distribution of person-years and cases by exposure category. 307/ Women 107 vs 18 g/day 1.35 (0.92-1.98) 233/ Incidence, rectal cancer, men 117 vs 20 g/day 0.83 (0.52-1.30) 124/ Women 107 vs 18 g/day 0.78 (0.41-1.46) 2010 COL40794 USA NIH-AARP, Prospective Cohort, Age: 50-71 years, M/W 2 719/ 300 948 7.2 years Cancer registry and death certificates and questionnaires FFQ Incidence, colorectal cancer 61.6 vs 9.5 g/1000 kcal/day 1.24 (1.09-1.42) Dietary calcium intake, dietary fibre intake, smoking habits, white meat Used only for colorectal cancer, because reported baseline intake of meat and has higher number of cases than Ruder, 2011 COL40896. Distribution of person-years by
of smoking, physical activity, total calories Berndt, 2006 COL40795 USA CLUE II, Case Cohort, Age: 48 years, M/W 202/ 2 224 13.5 years Cancer registry FFQ Incidence, colorectal cancer ≥86.3 vs ≤43.9 g/day 1.32 (0.86-2.02) Age, energy intake, race Distribution of person-years and cases by exposure category. of exposure categories. Oba, 2006 COL40626 Japan TCCJ, Prospective Cohort, Age: 35-101 years, M/W 111/ 30 8 years Hospital records and cancer registry FFQ Incidence, colon cancer, men 102.2 vs 33.3 g 1.56 (0.98-2.49) Age, alcohol intake, BMI, energy intake, height, of smoking, physical activity Distribution of by exposure category. 102/ Women 80.8 vs 22.4 g 0.94 (0.50-1.43) Chao, 2005 COL01689 USA CPS II, Prospective Cohort, Age: 50-74 M/W 665/ 148 610 19 Cancer registry and certificates and medical records FFQ Incidence, cancer, men ≥800 vs ≤180 g/week 1.30 (0.93-1.81) Age, aspirin use, beer intake, BMI, educational level, fibre, fruits, liquor intake, multivitamin supplement intake, physical activity, smoking habits, trial Mid-
total energy, vegetable (total), wine intake 532/ ≥560 vs ≤90 g/week 0.98 (0.68-1.40) HRT use Larsson, 2005 COL01849 Sweden SMC, Prospective Cohort, Age: 40-75 years, W 733/ 61 433 855 585 Cancer registry Questionnaire Incidence, colorectal cancer, ≥94 vs 0-49 g/day 1.32 (1.03-1.68) Age, alcohol consumption, BMI, calcium, educational level, energy intake, fish, folate, fruits, poultry, saturated fat, vegetables, whole-grain foods Used continuous results per 100 g/day 1.20 (0.99-1.45) Norat, 2005 COL01698 Europe EPIC, Prospective Cohort, Age: 21-83 years, M/W 855/ 478 040 2 279 075 person-years Questionnaire Incidence, colon cancer, ≥160 vs ≤10 g/day 1.17 (0.78-1.77) Age, sex, alcohol consumption, body weight, centre location, energy from fat sources, energy from nonfat sources, fibre, height, physical activity, smoking status Used for colon and rectal cancer. Superseded by Bamia, 2013 COL40964 474/ Incidence, rectal cancer, ≥160 vs ≤10 g/day 1.75 (0.98-3.10) Lin, 2004 COL01834 WHS, Prospective 202/ 37 547 Self-report verified by FFQ Incidence, colorectal cancer 1.42 vs 0.13 servings/day 0.66 (0.40-1.09) Age, alcohol consumption, Distribution of person-years by
Age: 50-69 years, M, Smokers intake, educational physical activity, smoking years, supplement group category. of exposure categories Chen, 1998 COL01940 USA PHS, Nested Case Control, M, physicians, 93% Caucasian 208/ 217 controls 13 years Medical records Questionnaire Incidence, colorectal cancer, men ≥1.1 vs 0-0.5 serving/day 1.17 (0.68-2.02) Alcohol consumption, BMI, physical activity Distribution of by exposure category. of exposure categories. Conversion from servings/day to g/day Bostick, 1994 COL00079 USA IWHS, Prospective Cohort, Age: 55-69 years, W 212/ 35 216 167 447 SEER FFQ Incidence, colon cancer, ≥11 vs ≤4 serving/week 1.04 (0.62-1.76) Age, energy intake, height, parity, total vitamin intake, total vitamin e intake, vitamin a supplement Mid-points of exposure categories. Conversion from servings/week to g/day Willett, 1990 CRC00026 USA NHS, Prospective Cohort, Age: 34-59 years, W, Registered 150/ 88 751 512 488 Population FFQ Incidence, colon cancer, ≥134 vs ≤58 g/day 1.77 (1.09-2.88) Age, energy intake Mid-points of exposure categories. Mid- Mid-
nurses Table 56 Red and processed meat 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 Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Reasons for exclusion 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 ≥89 vs ≤32.9 g/day 0.90 (0.70-1.40) Age, educational level, energy intake, fibre intake, Income, NSAID use, season of Interview, tea consumption Used only in highest versus lowest 236/ Incidence, colon cancer ≥89 vs ≤32.9 g/day 1.10 (0.70-1.80) 158/ Incidence, rectal cancer ≥89 vs ≤32.9 g/day 0.70 (0.40-1.30) Wei, 2009 COL40777 USA NHS, Prospective Cohort, Age: 30-54 years, W 701/ 83 767 24 years Self report verified by medical record FFQ Incidence, colon cancer 1 vs 0 serving/day 1.20 (0.95-1.51) Age, aspirin use, BMI, family history of colorectal cancer, folate intake, height, pack-years of smoking, physical activity, postmenopausal Used only in highest versus lowest
hormone use, year of endoscopy Cross, 2008 COL40701 USA NIH-AARP, Prospective Cohort, Age: 50-71 years, M/W 80/ 494 000 7.5 60/ Cancer registry FFQ Incidence, small Intestinal carcinoids 53.9 vs 14.2 g/1000 kcal 1.44 (0.78-2.69) Sex, alcohol intake, BMI, educational family history of cancer, fruit intake, marital status, at risk, physical activity, race, smoking habits, total energy intake, vegetable intake Superseded by Ruder, 2011 COL40896 and Cross, 2010 COL40794 Incidence, small Intestinal 53.9 vs 14.2 g/1000 kcal 1.65 (0.80-3.38) 2007 COL40640 USA NIH-AARP, Prospective Cohort, Age: 50-71 M/W 5 107/ 494 036 6.8 years Cancer registry FFQ Incidence, colorectal cancer, men 62.7 vs 9.8 g/1000 kcal 1.24 (1.12-1.36) Age, sex, alcohol consumption, BMI, educational level, energy intake, family history of cancer, fruits, marital status, physical activity, race, smoking habits, vegetable intake Used only in highest compared to lowest analysis because it is the publication of NIH-AARP with higher number of cases. Superseded by Ruder, 2011 COL40896 and Cross, 2010 COL40794 3 689/ Incidence, colon cancer, men 62.7 vs 9.8 g/1000 kcal 1.17 (1.05-1.31) 1 418/ Incidence, rectal cancer, men 62.7 vs 9.8 g/1000 kcal 1.45 (1.20-1.75) Trial, adenocarcinoma
Khan, 2004 COL01606 Japan HCS, Prospective Cohort, Age: 40-97 M/W 15/ 3 458 14.3 years Area residency lists Questionnaire Mortality, colorectal cancer, men Q 2 vs Q 1 2.00 (0.60-6.30) Age, smoking habits Outcome is mortality 14/ Women Q 2 vs Q 1 1.00 (0.30-3.00) Health education, health screening, health status Ma, 2001 COL00374 USA PHS, Nested Case Control, Age: 40-84 M, Physicians 193/ 318 controls 13 years Colorectal cancer diagnosis Unknown Incidence, colorectal cancer, 0.9-2.1 vs 0-0.5 serving/day 0.98 (0.60-1.60) Age, alcohol consumption, aspirin use, BMI, molar ratio of Igf-i to physical activity, smoking habits, supplement intake Superseded by Chen, 1998 COL01940 55/ 106 controls Tertile 1 of molar ratio 0.9-2.1 vs 0-0.5 serving/day 1.14 (0.48-2.71) Hsing, 1998 COL00458 USA Lutheran Brotherhood Prospective Cohort, Age: 35- years, M, policyholders 145/ 17 633 286 731 Responding to mail survey Questionnaire Mortality, colorectal cancer, ≥60 vs ≤14 1.90 (0.90-4.30) Age, alcohol consumption, smoking habits, total energy Outcome is mortality 120/ Mortality, colon cancer, ≥60 vs ≤14 times/month 1.80 (0.80-4.40) Sellers, 1998 COL01974 USA IWHS, Prospective Cohort, Age: 55-69 W, Postmenopausal 180/ 35 216 10 years SEER registry FFQ Incidence, cancer, no family history of crc ≥15.1 vs ≤10 servings/week 1.20 (0.80-1.90) Age, history of polyps, total energy intake Superseded by Bostick, 1994 COL00079 61/ Family history ≥15.1 vs ≤10 0.80 (0.40-1.80)
RR (95%CI) 1.12 (0.99-1.28) 1.08(1.00-1.18) Heterogeneity (I2, p-value) 0%, 0.56 0%, 0.77 Stratified analysis by sex (no analysis in 2005 or 2010 SLR) 2015 SLR Men Women Studies (n) 3 5 RR (95%CI) 0.82(0.52-1.29) 1.12(0.86-1.46) Heterogeneity (I2, 0%, 0.63 0%, 0.82 Stratified by geographic location (no analysis in 2005 or 2010 SLR) 2015 SLR Asia Europe North America Studies (n) 3 3 3 RR (95%CI) 1.25(0.64-2.45) 1.08(0.92-1.26) 1.08(0.98-1.19) Heterogeneity (I2, p-value) 26.7%, 0.26 0%, 0.84 0%, 0.61
drug use, pack yrs of smoking, vigorous physical activity, vitamin d Ruder, 2011 COL40896 USA NIH-AARP, Prospective Cohort, Age: 50-71 years, Retired 2 819/ 292 797 Cancer registry and national health database FFQ Incidence, colon cancer 1.02 vs 0.05 1.24 (1.06-1.45) Sex, age at baseline, alcohol consumption, aspirin use, BMI, educational level, energy, energy, history of colon cancer, HRT use, physical activity, processed meat, race, smoking Distribution of person-years by exposure category. of exposure categories. Conversion from times/day to g/day 985/ Incidence, rectal cancer 1.02 vs 0.05 1.30 (0.99-1.70) Takachi, 2011 COL41056 Japan JPHC, Prospective Cohort, Age: 45-74 years, M/W 481/ 80 658 9 years Hospital records + cancer registry FFQ Incidence, cancer, men 16 vs 0.2 g/day 1.27 (0.95-1.71) Age, alcohol consumption, area, BMI, calcium, diabetes, energy, fibre, folate, physical activity, salted fish consumption, Distribution of by exposure category. 307/ Women 15 vs 0.4 g/day 1.19 (0.82-1.74) 233/ Incidence, rectal cancer, men 16 vs 0.2 g/day 0.70 (0.45-1.09) 124/ Women 15 vs 0.4 g/day 0.98 (0.53-1.79)
screening exams, smoking status, vitamin b6, vitamin d 2010 COL40794 USA NIH-AARP, Prospective Cohort, Age: 50-71 years, M/W 2 719/ 300 948 7.2 years Cancer registry and death certificates and questionnaires FFQ Incidence, colorectal cancer 22.3 vs 1.6 g/1000 kcal/day 1.16 (1.01-1.32) Sex, BMI, dietary calcium intake, educational level, meat, smoking habits, total energy intake Used for colorectal cancer, superseded by Ruder, 2011 COL40896 Distribution of by exposure category. of exposure categories. Intakes in g/1000kcal/day converted to g/day using average energy intake per each quantile Balder, 2006 COL40622 Netherlands NLCS, Case Cohort, Age: 55-69 years, M/W 869/ 120 852 9.3 years Cancer registry FFQ Incidence, colorectal cancer, men ≥20 vs ≤0 g/day 1.18 (0.84-1.64) 666/ Women ≥20 vs ≤0 g/day 1.05 (0.74-1.48) 539/ Incidence, colon cancer, men ≥20 vs ≤0 g/day 1.33 (0.89-1.99) Trial,
activity, smoking status, total energy intake, vegetable intake 484/ ≥20 vs ≤0 g/day 1.07 (0.73-1.57) 333/ Incidence, rectal cancer, men ≥20 vs ≤0 g/day 0.96 (0.60-1.53) 185/ Incidence, rectal cancer women ≥20 vs ≤0 g/day 1.01 (0.54-1.90) Oba, 2006 COL40626 Japan TCCJ, Prospective Cohort, Age: 35-101 years, M/W 111/ 30 8 Hospital records and cancer registry FFQ Incidence, colon cancer, men 20.3 vs 3.9 g 1.98 (1.24-3.16) Age, alcohol intake, BMI, energy intake, height, of smoking, physical activity Distribution of person-years by exposure category. 102/ Women 16.3 vs 3 g 0.85 (0.50-1.43) Sato, 2006 COL40671 Japan MCS, Prospective Cohort, Age: 40-64 years, M/W 358/ 41 835 11 years Cancer registry FFQ Incidence, colorectal cancer 3-4 times/wk vs almost never g/day 0.91 (0.61-1.35) Age, sex, alcohol consumption, BMI, calcium intake, dietary fibre intake, educational level, energy intake, family history of cancer, fat consumption, physical activity, smoking status Conversion from times/week to g/day 217/ Incidence, colon cancer 3-4 times/wk vs almost never g/day 0.75 (0.45-1.27) 144/ Incidence, rectal cancer 3-4 times/wk vs almost never g/day 1.10 (0.60-2.03)
Chao, 2005 COL01689 USA CPS II, Prospective Cohort, Age: 50-74 years, M/W 665/ 148 610 19 years Cancer registry and death certificates and medical records FFQ Incidence, colon cancer ≥240 vs ≤0 g/week 1.11 (0.80-1.54) 1.26(0.86-1.83) Age, aspirin use, beer intake, BMI, educational level, fibre, fruits, liquor intake, multivitamin supplement intake, physical activity, smoking habits, total energy, vegetable (total), wine intake Distribution of by exposure category. Conversion from g/week to g/day Incidence, rectal cancer Larsson, 2005 COL01849 Sweden SMC, Prospective Cohort, Age: 40-75 W 733/ 61 433 855 585 Cancer registry Questionnaire Incidence, colorectal cancer, ≥32 vs 0-11 g/day 1.07 (0.85-1.33) Age, alcohol consumption, BMI, calcium, educational energy intake, fish, folate, fruits, poultry, saturated fat, vegetables, whole-grain foods Distribution of person-years by exposure category. of exposure categories. Conversion from servings/week to g/day. 234/ Incidence, proximal cancer, ≥32 vs 0-11 g/day 1.02 (0.69-1.52) 230/ Incidence, rectal cancer, ≥32 vs 0-11 g/day 0.90 (0.60-1.34) 155/ Incidence, distal colon cancer, ≥32 vs 0-11 g/day 1.39 (0.86-2.24) Norat, 2005 COL01698 Europe EPIC, Prospective Cohort, Age: 21-83 years, 1 329/ 478 040 2 279 075 person-years Questionnaire Incidence, colorectal cancer, per 100 g/day 1.32 (1.07-1.63) ≥80 vs ≤10 g/day 1.42 (1.09-1.86) 855/ Incidence, per 100 g/day 1.39 (1.06-1.82)
M/W energy from fat sources, energy from nonfat sources, fibre, height, physical activity, smoking status cancer, ≥80 vs ≤10 g/day 1.30 (0.92-1.84) 474/ Incidence, rectal cancer, per 100 g/day 1.22 (0.87-1.71) ≥80 vs ≤10 g/day 1.62 (1.04-2.50) English, 2004 COL00019 australia MCCS, Prospective Cohort, Age: 27-75 years, M/W 452/ 37 112 9 years rolls FFQ Incidence, colorectal cancer, ≥4 vs ≤1.5 times/week 1.50 (1.10-2.00) Sex, cereal intake, county of birth, energy intake, fat intake Distribution of person-years by exposure category. of exposure categories. Conversion from times/week to g/day 283/ Incidence, colon cancer, ≥4 vs ≤1.5 times/week 1.30 (0.90-1.90) 169/ Incidence, rectal cancer, ≥4 vs ≤1.5 times/week 2.00 (1.10-3.40) Lin, 2004 COL01834 USA WHS, Prospective Cohort, Age: 45- years, W 202/ 37 547 8.7 years Self report verified by medical record FFQ Incidence, colorectal cancer 0.5 vs 0 servings/day 0.85 (0.53-1.35) Age, alcohol consumption, BMI, family history of colorectal cancer, history of polyps, physical activity, postmenopausal hormone use, Distribution of person-years by exposure category. of exposure categories. Conversion from servings/day to g/day
randomized treatment assignment, smoking habits, total energy intake Wei, 2004 COL00581 USA NHS, Prospective Cohort, W, nurses 668/ 87 733 24 years Self-reported verified by medical record and The National Death Index FFQ Incidence, colon cancer, ≥5 vs ≤0 serving/month 1.32 (0.95-1.83) Age, alcohol consumption, beef, pork or lamb as a main dish, BMI, calcium, family history of colorectal cancer, folate, height, history of endoscopy, of smoking before age 30, physical activity Family history, folate intake, pack-years of smoking, total calcium Distribution of person-years by exposure category. of exposure categories. Conversion from servings/week to g/day 202/ 87 733 24 years FFQ Incidence, rectal cancer, ≥5 vs ≤0 serving/month 0.73 (0.33-1.59) HPFS, Prospective Cohort, M, Health professionals 467/ 46 632 14 years FFQ Incidence, colon cancer, ≥5 vs ≤0 times 1.27 (0.87-1.85) 135/ 46 632 14 years Population registries FFQ Incidence, rectal cancer, ≥5 vs ≤0 times 1.06 (0.48-2.33) Flood, 2003 COL00412 USA BCDDP, 1973, Prospective Cohort, Age: 62 years, W 487/ 45 496 386 716 Breast cancer screening centres FFQ Incidence, colorectal cancer, 22.2 vs 0.02 g/1000 kcal 0.97 (0.73-1.28) Total energy, total meat Distribution of person-years by exposure category. of exposure
categories. intakes in g/1000kcal/day converted to g/day using average energy intake per each quantile Pietinen, 1999 COL00176 Finland ATBC, Prospective Cohort, Age: 50-69 years, M, Smokers 185/ 27 111 8 Cancer registry Dietary history questionnaire Incidence, colorectal cancer, 122 vs 26 g/day 1.20 (0.70-1.80) Age, alcohol consumption, BMI, calcium intake, educational level, physical activity, smoking years, supplement group Distribution of by exposure category Bostick, 1994 COL00079 USA IWHS, Prospective Cohort, Age: 55-69 years, W 212/ 35 216 167 447 SEER FFQ Incidence, colon cancer, ≥3 vs ≤0 serving/week 1.51 (0.72-3.17) Age, energy intake, height, parity, total vitamin e intake, total vitamin e intake age, vitamin a supplement Distribution of by exposure category. of exposure categories. Conversion from servings/week to g/day
Table 68 Processed meat 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 Egeberg, 2013 COL40953 Denmark DCH, Prospective Cohort, Age: 50-64 M/W 644/ 53 988 13.4 years Cancer registry FFQ Incidence, colon cancer ≥42 vs 0-16 g/day 1.02 (0.78-1.34) Age, alcohol, beef consumption, cold cuts, educational level, energy, fibre, fish, HRT use, lamb intake, liver, NSAID use, poultry, processed meat, red meat, sausages, smoking, sport, veal meat, waist circumference Component of EPIC. Superseded by Norat, 2005 COL01698 per 25 g/day 1.03 (0.94-1.13) Incidence, rectal cancer ≥42 vs 0-16 g/day 0.88 (0.60-1.30) per 25 g/day 0.93 (0.81-1.07) 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 1.68 (1.03-2.75) Apc promoter methylation ≥20% per 1 sd 1.30 (0.91-1.85) analysis
years Apc mutations per 1 sd units 1.25 (0.91-1.72) per 1 sd units 1.25 (0.91-1.72) Nöthlings, 2009 COL40763 USA MEC, Nested Case Control, Age: 45-75 years, M/W 1 009/ 1522 controls Surveillance registry/end results cancer registry FFQ Incidence, colorectal cancer ≥11 vs 0-3.4 g/1000kcal/day 1.08 (0.83-1.39) BMI, calcium intake, ethanol, family history of colorectal cancer, fibre intake, folic acid intake, of smoking, physical activity, smoking status, vitamin d intake Superseded by Ollberding, 2012 COL40941
Denmark Age: 50-64 years, M/W 10 years fiber intake, HRT use, smoking status Component of EPIC. Superseded by Norat, 2005 COL01698 Nat2 slow phenotype per 25 g/day 1.04 (0.89-1.23) Nat2 fast phenotype per 25 g/day 0.92 (0.74-1.14) Nat1 slow phenotype per 25 g/day 1.01 (0.86-1.18) Nat1 fast per 25 g/day 0.96 (0.77-1.20) Cross, 2007 COL40640 USA NIH-AARP, Prospective Cohort, Age: 50-71 years, M/W 5 107/ 494 036 6.8 years Cancer registry FFQ Incidence, colorectal cancer, men 22.6 vs 1.6 g/1000 kcal 1.20 (1.09-1.32) Age, sex, alcohol consumption, BMI, educational level, energy intake, family history of cancer, fruits, marital status, physical activity, race, smoking habits, vegetable intake Superseded by Ruder, 2011 COL40896 Incidence, rectal cancer, men 22.6 vs 1.6 g/1000 kcal 1.18 (1.06-1.32)
Iso, 2007 COL40707 JACC, Prospective Cohort, Age: 40-79 years, M/W 182/ 105 500 15 years Municipal resident registration records, death certificates FFQ Mortality, colon cancer, men 3-4 vs ≤0 /week 1.41 (0.95-2.08) Age, centre location Outcome is mortality 172 3-4 vs ≤0 /week 0.90 (0.56-1.44) 153/ Mortality, rectal cancer, men 3-4 vs ≤0 /week 0.89 (0.55-1.46) 71/ Women 3-4 vs ≤0 /week 1.30 (0.69-2.46) Brink, 2005 COL40717 Netherlands NLCS, Case Cohort, Age: 55-69 years, M/W 448/ 2 948 7.3 years Cancer registry FFQ Incidence, colon cancer Q 4 vs Q 1 0.77 (0.57-1.04) Age, sex, BMI, energy intake, family history of colorectal cancer, smoking habits Superseded by Balder, 2006 COL40622 per 30.3 g/day 0.93 (0.83-1.04) 160/ Incidence, rectal cancer Q 4 vs Q 1 0.70 (0.43-1.13) per 30.3 g/day 0.87 (0.72-1.03) Luchtenborg, 2005 COL01830 NLCS, Case Cohort, Age: 55-69 years, M/W 434/ 2 948 7.3 years Population registries FFQ Incidence, cancer, Q 4 vs Q 1 0.77 (0.57-1.04) per 30.3 g/day 0.93 (0.84-1.04) 274/ Apc- per 30.3 g/day 0.95 (0.83-1.08) Q 4 vs Q 1 0.84 (0.58-1.20) 154/ Incidence, rectal cancer, Q 4 vs Q 1 0.70 (0.44-1.13) per 30.3 g/day 0.87 (0.73-1.03) 127/ per 30.3 g/day 0.93 (0.77-1.14)
Incidence, colon cancer, apc+ cases Q 4 vs Q 1 0.69 (0.40-1.19) 73/ Incidence, rectal cancer, apc- cases per 30.3 g/day 0.73 (0.57-0.93) Q 4 vs Q 1 0.56 (0.27-1.16) 57/ Apc+ cases per 30.3 g/day 0.99 (0.74-1.31) Q 4 vs Q 1 0.80 (0.39-1.67) Khan, 2004 COL01606 Japan HCS, Prospective Cohort, Age: 40-97 M/W 15/ 3 458 14.3 years Area residency Questionnaire Mortality, colorectal cancer, men Q 2 vs Q 1 0.50 (0.10-2.20) Age, smoking habits Outcome is mortality 14/ Women Q 2 vs Q 1 1.40 (0.40-4.50) Health education, health screening, health status Kojima, 2004 COL01840 Japan JACC, Prospective Cohort, Age: 40-79 years, M/W 116/ 107 824 10 years Resident registry and death certificates Questionnaire Mortality, cancer, men 3-7 vs 0-0.5 times/week 1.44 (0.90-2.31) Age, alcohol consumption, BMI, educational level, family history of specific cancer, physical activity, region Outcome is mortality 111/ Women 3-7 vs 0-0.5 times/week 0.94 (0.53-1.66) 93/ Mortality, rectal cancer, men 3-7 vs 0-0.5 times/week 1.00 (0.56-1.78) 37/ Women 3-7 vs 0-0.5 times/week 1.56 (0.69-3.53)
of enrolment, smoking status Knekt, 1999 COL01699 finland Cohort, M/W 73/ 9 985 24 years Social Insurance Institution Diet history method Incidence, colorectal cancer, Q 4 vs Q 1 1.84 (0.98-3.47) Age, sex, energy intake, municipality, smoking Used only in highest vs lowest analysis Kato, 1997 CRC00022 USA NY 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 1.09 (0.59-2.02) Age, educational level, place at enrolment, total calorie intake Used only in highest vs lowest analysis Giovannucci, 1994 COL00119 USA HPFS, Prospective Cohort, Age: 40-75 years, M, Health professionals 202/ 47 949 6 Self-reported verified by medical record and The National Death Index FFQ Incidence, colon cancer, ≥5 vs ≤0 serving/month 1.16 (0.44-3.04) Age, total energy Superseded by Wei, 2004 COL00581 Goldbohm, 1994 COL00025 Netherlands NLCS, Case Cohort, 215/ 120 852 3.3 years Population registries FFQ Incidence, colon cancer, ≥20 vs ≤0 g/day 1.72 (1.03-2.87)
Age: 55-69 years, M/W 110/ Women ≥20 vs ≤0 g/day per 15 g/day 1.66 (0.82-3.35) 0.99 (0.92-1.06) 105/ Men ≥20 vs ≤0 g/day per 15 g/day 1.84 (0.85-3.95) 1.17 (1.03-1.33)
Table 78 Red meat 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 Kantor, 2014 7 nested studies HPFS, MEC, NHS, PHS, PLCO, VITAL, WHI 3 488 North America Colorectal cancer Per 1 serving/day 1.05 (0.94–1.18) 2014 5 nested studies HPFS, NHS, PLCO, VITAL, WHI 2564 North America Colorectal cancer Highest vs lowest 1.06 (0.90–1.24) Spencer, 2010 7 Guernsey Study, EPIC- Norfolk, EPIC-Oxford, NSHD, Oxford Vegetarian Oxford Vegetarian 579 cases 1996 controls UK Colorectal cancer ≥50 vs <5 g/day Per 50g/day 0.91 (0.66–1.24) 1.01 (0.84–1.22) 0.89 Colon cancer ≥50 vs <5 g/day Per 50g/day 0.92 (0.62–1.35) 1.04 (0.83–1.31) 0.72 Rectal cancer ≥50 vs <5 g/day Per 50g/day 0.87 (0.50–1.52) 0.96 (0.70–1.31) 0.78 Ananthakrishnan
Chan, 2011 8 11358 Europe, Asia and North America Colorectal cancer Per 100g/day 1.17(1.05-1.31) 0%, 0.48 10 5426 Colon cancer Per 100g/day 1.17(1.02-1.33) 0%, 0.64 7 2091 Rectal cancer Per 100g/day 1.18(0.98-1.42) 0%, 0.66
79 Red meat 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 analyses Parr, 2013 COL40955 Norway NOWAC, Prospective Cohort, Age: 41-70 years, W 666/ 84 538 11.1 years Cancer registry FFQ Incidence, colorectal cancer ≥35 vs ≤5 g/day 0.92 (0.61-1.39) Age, alcohol, BMI, calcium, energy, fibre, physical activity, smoking Only included in subgroup analysis. Component of the EPIC Superseded by Norat, 2005 COL01698 and Bamia, 2013 COL40964 per 100 g/day 0.70 (0.33-1.48) 455/ Incidence, colon cancer 25-35 vs ≤5 g/day 0.83 (0.58-1.18) per 100 g/day 0.76 (0.31-1.86) 211/ Incidence, rectal cancer per 100 g/day 0.59 (0.15-2.25) 25-35 vs ≤5 g/day 0.92 (0.53-1.59) Ollberding, 2012 COL40941 Hawaii, USA MEC, Prospective Cohort, Age: 45-75 years, M/W 3 404/ 165 717 8.1 years Cancer registry and national death Index FFQ Incidence, colorectal cancer 47.99 vs 7.41 g/1000 kcal/day 1.02 (0.91-1.16) Age, sex, age at cohort entry In log model, alcohol consumption, BMI, calcium, dietary fibre, energy intake, ethnicity, family history of colorectal cancer, folate, history of diabetes, history of polyp diagnosis, HRT use, drug use, pack Distribution of person-years by exposure category. of exposure categories. Intakes in g/1000kcal/day converted to g/day using average energy intake per each quantile trial.
yrs of smoking, vigorous physical activity, vitamin d Takachi, 2011 COL41056 JPHC, Prospective Cohort, Age: 45-74 years, M/W 307/ 80 658 9 years Hospital records + cancer registry FFQ Incidence, cancer, women 93 vs 14 g/day 1.48 (1.01-2.17) Age, alcohol consumption, area, BMI, calcium, diabetes, energy, fibre, folate, physical activity, salted fish consumption, screening exams, smoking status, vitamin b6, vitamin d Distribution of person-years by exposure category. 259/ Men 117 vs 20 g/day 1.27 (0.93-1.74) 233/ Incidence, rectal cancer, men 117 vs 20 g/day 0.93 (0.58-1.49) 124/ Women 93 vs 14 g/day 0.81 (0.43-1.52) 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 ≥67 vs ≤23.9 g/day 0.80 (0.60-1.10) Age, educational level, energy intake, fibre intake, Income, NSAID use, season of Interview, tea consumption Estimate confidence intervals, distribution of person-years by exposure category. of exposure categories. 236/ Incidence, cancer ≥67 vs ≤23.9 g/day 0.90 (0.60-1.50) 158/ Incidence, rectal cancer ≥67 vs ≤23.9 g/day 0.60 (0.30-1.10) Oba, 2006 COL40626 TCCJ, Prospective Cohort, 111/ 30 8 Hospital records and cancer registry FFQ Incidence, cancer, men 56.6 vs 18.7 g 1.03 (0.64-1.66)
Netherlands Cardiovascular Disease Risk Factors, Nested Case Control, Age: 20-59 years, M/W energy intake, study centre category. of exposure categories. Conversion from times/week to g/day 48/ 245 controls Women ≥5 vs 0-3 times/week 1.20 (0.50-2.80) Jarvinen, 2001 COL00852 Finland Finnish Mobile Clinic Health Examination Survey, Prospective Cohort, Age: 39 M/W 109/ 9 959 Questionnaire Incidence, colorectal cancer, Q 4 vs Q 1 1.50 (0.77-2.94) Age, sex, BMI, cereal intake, energy intake, fruits intake, geographic location, occupational group, smoking, vegetable intake Distribution of person-years by exposure category 63/ Incidence, cancer, Q 4 vs Q 1 1.34 (0.57-3.15) 46/ Incidence, rectal cancer, Q 4 vs Q 1 1.82 (0.60-5.52) Pietinen, 1999 COL00176 Finland ATBC, Prospective Cohort, Age: 50-69 years, M, Smokers 185/ 27 111 8 years Cancer registry Dietary history questionnaire Incidence, colorectal cancer, 99 vs 35 g/day 0.80 (0.50-1.20) Age, alcohol consumption, BMI, calcium intake, educational level, physical activity, smoking years, supplement group Distribution of by exposure category
1998 COL00185 USA AHS, Prospective Cohort, Age: 25- years, M/W, Seventh-day Adventists 127/ 32 051 178 544 Census list FFQ Incidence, colon cancer, ≥1 vs ≤0 times/week 1.41 (0.90-2.21) Age, sex, alcohol consumption, aspirin use, BMI, family history of specific cancer, physical activity, smoking habits Mid-points of exposure categories. Conversion from times/week to g/day Bostick, 1994 COL00079 USA IWHS, Prospective Cohort, Age: 55-69 W 212/ 35 216 167 447 SEER FFQ Incidence, colon cancer, ≥3 vs ≤1 serving/week 1.21 (0.75-1.96) Age, energy intake, height, parity, total vitamin e intake, total vitamin e intake, vitamin a supplement Mid-points of exposure categories. Conversion from servings/week to g/day
80 Red meat 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 Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Reasons for exclusion Wie, 2014 COL41065 Korea Cancer Screening Examination Cohort, Korea (CSECK), Prospective Cohort, M/W 53/ 8 024 7 years Cancer registry and medical records 3-day food record Incidence, colorectal cancer ≥43 vs <43 g/day 1.31 (0.60-2.61) Age, sex, alcohol, BMI, educational level, energy intake, Income, marital status, physical activity, smoking Used only in highest versus lowest analysis. Agnoli, 2013 COL40938 Prospective Cohort, M/W 435/ 45 275 11.28 years Cancer registry and hospital records FFQ Incidence, colorectal cancer 112-665.6 vs g/day 0.94 (0.72-1.23) Age, BMI, educational level, gender, non-alcoholic beverage intake, physical activity, smoking, study center Superseded by Norat, 2005 COL01698 112-665.6 vs g/day 0.97 (0.74-1.26) Egeberg, 2013 COL40953 Denmark DCH, Prospective Cohort, Age: 50-64 years, M/W 644/ 53 988 13.4 years Cancer registry FFQ Incidence, cancer per 50 g/day 1.01 (0.87-1.19) Age, alcohol, beef consumption, cold cuts, educational level, energy, fiber, fish, HRT use, lamb intake, liver, meat, nsaid use, pork, Component of EPIC Superseded by Norat, 2005 COL01698 345/ Incidence, rectal cancer per 50 g/day 1.01 (0.87-1.19) 69
poultry, processed meat, sausages, smoking, sport, veal meat, waist circumference 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 0.68 (0.37-1.28) Age, sex, smoking Superseded by Norat, 2005 COL01698 Apc promoter methylation ≥20% per 1 sd units 1.07 (0.75-1.53) Apc mutations per 1 sd units 1.17 (0.85-1.59) Cross, 2010 COL40794 USA NIH-AARP, Prospective Cohort, Age: 50-71 years, Retired 2719/ 300 948 7.0 years Cancer registry and national health database FFQ Incidence, colorectal cancer Q5 vs Q1 1.13(0.98-1.30) Sex, age at baseline, alcohol consumption, aspirin use, BMI, educational level, energy, history of colon cancer, HRT use, physical activity, race, smoking Used in highest compared to lowest analysis for colorectal cancer. report most results on red and processed meat combined. Nöthlings, 2009 COL40763 USA MEC, Nested Case Control, Age: 45-75 1 009/ 1522 controls Surveillance registry/end results cancer registry FFQ Incidence, colorectal cancer ≥26 vs 0-10.3 g/1000kcal/day 0.96 (0.74-1.23) Age, sex, calcium intake, ethanol, ethnicity, folic Superseded by Ollberding, 2012 COL40941 ≥26 vs 0-10.3 g/1000kcal/day 1.07 (0.84-1.35)
M/W acid intake, pack-years of smoking 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 1.01 (0.82-1.26) Age, sex, alcohol intake, BMI, diabetes, dialect group, educational level, energy intake, exposure assessment, family history of colorectal cancer, physical activity, smoking habits Used only in highest versus lowest analysis. Sorensen, 2008 COL40690 Denmark DCH, Case Cohort, Age: 50-64 years, M/W 379/ 57 000 10 years Cancer registry FFQ Incidence, colorectal cancer, nat1 fast per 25 g/day 1.06 (0.97-1.17) Alcohol intake, BMI, dietary fiber intake, fish, HRT use, poultry, smoking status Component of EPIC Superseded by Norat, 2005 COL01698 Nat2 slow phenotype per 25 g/day 1.06 (0.97-1.14) Nat1 slow phenotype per 25 g/day 1.02 (0.95-1.09) Nat2 fast phenotype per 25 g/day 1.01 (0.93-1.09) Iso, 2007 COL40707 Japan JACC, Prospective Cohort, Age: 40-79 199/ 105 500 15 years Municipal resident registration records, death FFQ Mortality, cancer, women 3-4 vs ≤0 /week 0.80 (0.43-1.50) 197/ Men 3-4 vs ≤0 /week 1.30 (0.74-2.29)
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 1.23 (0.68-2.22) Age, educational level, place at enrolment, total calorie intake Used only in highest versus lowest analysis. Fraser, 1999 COL00102 USA AHS, Prospective Cohort, Age: 25-100 years, M/W, Seventh-day Adventists 112/ 34 198 6 years Census list FFQ Incidence, colon cancer, consumption white meat < 1 time/week ≥1 vs ≤0 times/day 1.86 (1.15-3.02) Subgroup analysis only, superseded by Singh, 1998 COL00185 Infrequent consumers of legumes yes vs no times/week 2.68 (1.24-5.78) Hirayama, 1990 COL01508 Japan 6 prefectures cohort study, Prospective Cohort, Age: 40- years, M/W 563/ 265 118 17 years Health centres Interview Mortality, rectal cancer, daily consumption vs no daily consumption 0.73 (0.55-0.99) Age, sex Outcome is mortality 558/ Mortality, colon cancer, consumption vs no daily consumption 0.87 (0.66-1.14) Willett, 1990 CRC00026 USA NHS, Prospective Cohort, Age: 34-59 150/ 88 751 512 488 Self-reported verified by medical record and The FFQ Incidence, colon cancer, ≥7 vs ≤1 times/month 2.49 (1.24-5.03) Age Superseded by Wei, 2004 COL00581
Table 90 Poultry 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 Spencer, 2010 7 579 cases 1996 controls UK Colorectal cancer ≥30 vs <1 g/day Per 30g/day 0.80 (0.62–1.04) 0.80(0.65-1.00) 0.05 Colon cancer 0.87 (0.63–1.19) 0.80 (0.61–1.05) 0.11 Rectal cancer 0.69 (0.44–1.09) 0.83 (0.57–1.20) Meta-analysis Shi, 2015 16 13949 North America, Europe, Australia, Japan Colorectal cancer incidence Per 50g/day 0.89(0.81-0.97) 41.2%, 0.04 4 Colorectal cancer mortality 0.97(0.79-1.20) 0%, 0.70 * Heterogeneity (I2, p value) only reported when available
M/W intake, dietary intake, educational level, energy intake, family history of cancer, fat consumption, physical activity, smoking status Conversion from times/wk to g/day cancer almost never g/day Ptrend:0.03 157/ Incidence, rectal cancer 3-4 vs almost never g/day 0.97 (0.51-1.86) Ptrend:0.92 Brink, 2005 COL40717 Netherlands NLCS, Case Cohort, Age: 55-69 years, M/W 448/ 2 948 7.3 years Cancer registry FFQ (exposure: chicken) Incidence, colon cancer per 15.6 g/day 0.95 (0.85-1.07) Age, sex, BMI, energy intake, family history of colorectal cancer, smoking habits Mid-points of exposure categories. ≥22.8 vs ≤0 g/day 0.87 (0.66-1.15) Ptrend:0.34 160/ Incidence, rectal cancer per 15.6 g/day 0.98 (0.83-1.14) ≥22.8 vs ≤0 g/day 1.12 (0.70-1.79) Ptrend:0.96 Larsson, 2005 COL01849 Sweden SMC, Prospective Cohort, Age: 40-75 W 733/ 61 433 855 585 Cancer registry Questionnaire (exposure: poultry) Incidence, colorectal cancer, ≥0.5 vs ≤0 servings/week 0.75 (0.55-1.02) Ptrend:0.04 Age, alcohol consumption, BMI, calcium, educational level, energy intake, fish, folate, fruits, saturated fat, vegetables, whole-grain foods Distribution of person-years by exposure category. Conversion from servings/wk to g/day 234/ Incidence, proximal cancer, ≥0.5 vs ≤0 servings/week 0.77 (0.44-1.36) Ptrend:0.26 155/ Incidence, distal cancer, ≥0.5 vs ≤0 servings/week 0.86 (0.46-1.62) Ptrend:0.76
Giovannucci, 1994 COL00119 USA HPFS, Prospective Cohort, Age: 40-75 years, M, Health professionals 205/ 47 949 6 years Mailing to health professionals FFQ (exposure: poultry) Incidence, colon cancer, 63.1 vs 8.8 g/day 0.82 (0.54-1.24) Ptrend:0.27 Age, energy Willett, 1990 CRC00026 USA NHS, Prospective Cohort, Age: 34-59 years, W, Registered nurses 150/ 88 751 512 488 Population FFQ (exposure: chicken) Incidence, colon cancer, ≥5 vs ≤1 0.47 (0.27-0.82) Ptrend:0.03 Age Conversion times/month to g/day
cancer, g/day Ptrend:0.96 Incidence, rectal cancer per 15.5 g/day 0.98 (0.83-1.14) 127/ Incidence, colon cancer, apc+ cases ≥22.8 vs ≤0 g/day 0.94 (0.59-1.50) Ptrend:0.95 per 15.5 g/day 1.06 (0.89-1.25) 73/ Incidence, rectal cancer, apc- cases ≥22.8 vs ≤0 g/day 1.29 (0.66-2.50) Ptrend:0.55 per 15.5 g/day 1.08 (0.88-1.32) 57/ Incidence, rectal cancer, apc+ cases ≥22.8 vs ≤0 g/day 0.90 (0.40-2.01) Ptrend:0.64 per 15.5 g/day 0.79 (0.59-1.05) 54/ Incidence, colon cancer, hmlh1- cases ≥22.8 vs ≤0 g/day 0.72 (0.34-1.50) Ptrend:0.34 per 15.5 g/day 0.93 (0.69-1.27) Khan, 2004 COL01606 Japan HCS, Prospective Cohort, Age: 40-97 years, M/W 15/ 3 458 14.3 years Area residency Questionnaire Mortality, colorectal cancer, men Q 2 vs Q 1 1.00 (0.30-2.80) Age, smoking habits Outcome is mortality 14/ Mortality, colorectal cancer, women Q 2 vs Q 1 1.70 (0.60-5.20) Health education, health screening, health status Kojima, 2004 COL01840 Japan JACC, Prospective Cohort, Age: 40-79 124/ 107 824 10 years Resident registry and death certificates Questionnaire Mortality, colon cancer, women 3-7 vs 0-0.5 0.68 (0.38-1.21) Ptrend:0.60 113/ Mortality, colon 3-7 vs 0-0.5 1.55 (0.90-2.66)
years Study, Prospective Cohort, Age: 34-65 years, W calorie intake lowest analysis Goldbohm, 1994 COL00025 Netherlands NLCS, Case Cohort, Age: 55-69 years, M/W 120 852 3.3 Population registries FFQ Incidence, colon cancer, per 15 g/day 1.03 (0.90-1.17) Age, sex, energy intake Superseded by Brink, 2005 COL40717 Heilbrun, 1989 COL01555 USA HHP, Nested Case Control, M 102/ 361 controls 16 years Cancer registry & hospital surveillance Recall questionnaire Incidence, colon cancer, (mean exposure) Age Mean exposure only 60/ 361 controls Incidence, rectal cancer, (mean exposure)
99 Fish 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 (I2, p value) Pooled-analysis Spencer, 2010 7 Guernsey Study, EPIC- Norfolk, EPIC-Oxford, NSHD, Oxford Vegetarian, UKWCS, Whitehall 579 cases 1996 controls UK Colorectal cancer White fish Per 50g/day ≥30 vs <1 g/day Fatty fish Per 50g/day ≥30 vs <1 g/day 0.92 (0.70–1.21) 0.86 (0.64–1.16) 0.89 (0.70–1.13) 0.73 (0.54–0.98) 0.53 0.33 Colon cancer White fish Per 50g/day ≥30 vs <1 g/day fish Per 50g/day ≥30 vs <1 g/day 0.84 (0.59–1.19) 0.80 (0.56–1.14) 0.82 (0.61–1.11) 0.73 (0.51–1.04) 0.32 0.21 Rectal cancer fish Per 50g/day ≥30 vs <1 g/day fish Per 50g/day ≥30 vs <1 g/day 1.12 (0.70–1.81) 1.04 (0.61–1.78) 0.99 (0.68–1.44) 0.68 (0.39–1.18) 0.63 0.95 Meta-analysis
Yu, 2014 20 Europe (Denmark, France, Germany, Greece, the Netherlands, Norway, Spain, Sweden, Europe, North America and Asia Colorectal cancer Fish consumers vs non/lowest consumers Per 20g/day 0.93 (0.87-0.99) 0.99(0.97-1.01) 64.7%, <0.001 Trial,
Table 100 Fish 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 size Follow-up (years) Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Missing data derived for analysis Song, 2014 COL41015 USA NHS, Prospective Cohort, Age: 30-55 years, W 1 469/ 76 386 26 years questionnaire, national death Index, pathology reports and medical records FFQ Incidence, colorectal cancer ≥40 vs ≤15 g/day 1.02 (0.86-1.20) 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 713/ 76 386 26 years questionnaire, national death Index, pathology reports and medical records FFQ Incidence, proximal colon cancer ≥40 vs ≤15 g/day 0.89 (0.70-1.14) 416/ Incidence, distal colon cancer ≥40 vs ≤15 g/day 1.36 (1.00-1.85) 310/ 76 386 26 years Incidence, rectal cancer ≥40 vs ≤15 g/day 0.98 (0.69-1.40) Song, 2014 COL41016 Health Professionals 342/ 47 143 Self-report, medical records, FFQ Incidence, distal cancer ≥46 vs ≤16 g/day 1.12 (0.77-1.64)
USA Follow-up Study (HPFS), Prospective Cohort, Age: 40-75 years, M, Health professionals 24 years pathology family members, national Index endoscopy, energy-adjusted 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 Incidence, proximal colon cancer ≥46 vs ≤16 g/day 0.95 (0.68-1.34) 215/ 47 143 24 years Incidence, rectal cancer ≥46 vs ≤16 g/day 0.60 (0.39-0.93) 987/ 47 143 24 years Incidence, colorectal cancer ≥46 vs ≤16 g/day 0.88 (0.72-1.08) Bamia, 2013 COL40964 EPIC, 4 355/ 480 308 Cancer registry, record linkage, FFQ Incidence, colorectal cancer 63.8 vs 8.6 g/day 0.90 (0.82-0.99)
Denmark, France, Germany, Greece, Italy, Netherlands, Spain, Sweden, UK Prospective Cohort, Age: 25-70 years, M/W 11.6 years health Insurance rec, mortality registry , pathology and active follow up cereal, products consumption, educational level, ethanol, fish, fruits, legumes, lipids, meat, physical activity, smoking exposure category. 2 479/ Women 63.8 vs 8.6 g/day 0.94 (0.83-1.06) 1 876/ Men 63.8 vs 8.6 g/day 0.85 (0.74-0.97) Daniel, 2011 COL40884 USA NIH-AARP, Prospective Cohort, Age: 50-71 years, M/W 5 095/ 492 186 9.1 years Cancer registry FFQ Incidence, cancer 21.4 vs 3.6 g/1000 kcal 0.95 (0.87-1.04) Age, sex, BMI, educational level, energy intake, family history of cancer, HRT use, marital status, poultry, race, red meat, smoking, vigorous activity Intakes in g/1000kcal/day converted to g/day average energy intake per each quantile 1 884/ Incidence, rectal cancer 21.4 vs 3.6 g/1000 kcal 0.96 (0.83-1.11) 164/ Incidence, anal cancer 21.4 vs 3.6 g/1000 kcal 0.71 (0.41-1.23) 2009 COL40782 SWHS, 396/ 73 242 Cancer registry FFQ Incidence, colorectal cancer 104.52 vs 14.91 g/day 1.28 (0.87-1.90)
Prospective Cohort, Age: 40-70 W 11 years aspirin use, BMI, energy intake, HRT use, menopausal status, multivitamin supplement intake, physical activity, polyunsaturated fat, red meat intake, smoking status exposure category. 332/ >2 yrs follow-up 104.52 vs 14.91 g/day 1.05 (0.66-1.65) 200/ Incidence, colon cancer, >2 yrs follow-up 104.52 vs 14.91 g/day 0.94 (0.53-1.65) 132/ Incidence, rectal cancer, >2 yrs follow-up 104.52 vs 14.91 g/day 1.32 (0.61-2.84) Sugawara, 2009 COL40781 Japan OCS, Prospective Cohort, Age: 40-79 years, M/W 379/ 39 498 9 years Cancer registry and death certificates FFQ Incidence, colorectal cancer, men ≥96.4 vs 0-26.2 g/day 1.07 (0.78-1.46) 229/ Incidence, colon cancer, men ≥96.4 vs 0-26.2 g/day 1.11 (0.75-1.64)
Age: 54 years, M diabetes, multivitamin supplement intake, physical activity, randomized treatment assignment, red meat intake, smoking habits Conversion from times/week to g/day 388/ Incidence, colon cancer ≥5 vs ≤0.9 times/week 0.62 (0.38-1.00) 112/ Incidence, rectal cancer ≥5 vs ≤0.9 times/week 0.65 (0.30-1.41) 2005 COL40717 Netherlands NLCS, Case Cohort, Age: 55-69 years, M/W 448/ 2 948 7.3 years Cancer registry FFQ Incidence, colon cancer per 15 g/day 0.93 (0.83-1.04) ≥20 vs ≤0 g/day 1.03 (0.76-1.40) 290/ Ki-ras- ≥20 vs ≤0 g/day 0.87 (0.60-1.26) per 15 g/day 0.88 (0.77-1.02) 160/ Incidence, rectal cancer per 15 g/day 0.93 (0.80-1.08) ≥20 vs ≤0 g/day 0.94 (0.59-1.52)
144/ Incidence, colon cancer, ki-ras+ ≥20 vs ≤0 g/day 1.38 (0.85-2.25) per 15 g/day 1.00 (0.85-1.19) 89/ Incidence, rectal cancer, ki-ras- ≥20 vs ≤0 g/day 1.06 (0.58-1.94) per 15 g/day 0.97 (0.81-1.17) 65/ Incidence, colon cancer, Ki-ras+ ≥20 vs ≤0 g/day 0.78 (0.37-1.65) per 15 g/day 0.86 (0.69-1.07) Larsson, 2005 COL01849 Sweden SMC, Prospective Cohort, Age: 40-75 years, W 733/ 61 433 855 585 Cancer registry Questionnaire Incidence, colorectal cancer, ≥2 vs 0-0.4 serving/week 1.08 (0.81-1.43) Age, alcohol consumption, BMI, calcium, educational level, energy intake, folate, fruits, poultry, red meat intake, saturated fat, vegetables, whole-grain foods Distribution of person-years by exposure category. Conversion from servings/week to g/day 234/ Incidence, proximal colon cancer, ≥2 vs 0-0.4 serving/week 1.03 (0.63-1.67) 230/ Incidence, rectal cancer, ≥2 vs 0-0.4 serving/week 1.08 (0.63-1.86) 155/ Incidence, distal colon cancer, ≥2 vs 0-0.4 serving/week 0.83 (0.45-1.51) Norat, 2005 COL01698 Europe EPIC, Prospective Cohort, Age: 21-83 years, 1 329/ 478 040 2 279 075 person-years Questionnaire Incidence, colorectal cancer, per 100 g/day 0.70 (0.57-0.87) ≥80 vs ≤10 g/day 0.71 (0.55-0.91)
M/W energy from fat sources, energy from non-fat sources, height, physical activity, smoking status and rectal cancer. Continuous results were used. 855/ Incidence, colon cancer, per 100 g/day 0.76 (0.59-0.99) ≥80 vs ≤10 g/day 0.82 (0.60-1.11) 474/ Incidence, rectal cancer, per 100 g/day 0.61 (0.43-0.87) ≥80 vs ≤10 g/day 0.49 (0.32-0.76) 391/ Incidence, left colon cancer, ≥80 vs ≤10 g/day 0.70 (0.44-1.11) 351/ Incidence, right colon cancer, ≥80 vs ≤10 g/day 0.85 (0.53-1.37) Incidence, colorectal cancer, low red and processed meat intake Q 1 vs Q 3 1.46 English, 2004 COL00019 Australia MCCS, Prospective Cohort, 452/ 37 112 9 years rolls FFQ Incidence, colorectal cancer, ≥2.5 vs ≤1 times/week 0.90 (0.70-1.20) per 1 times/week 0.99 (0.91-1.08) oral
Age: 27-75 years, M/W and cereal products 283/ Incidence, colon cancer, ≥2.5 vs ≤1 times/week 1.00 (0.70-1.40) per 1 1.01 (0.90-1.12) 169/ Incidence, rectal cancer, ≥2.5 vs ≤1 0.90 (0.60-1.40) per 1 0.97 (0.84-1.12) Kobayashi, 2004 COL01687 JPHC, Prospective Cohort, Age: 40-69 years, M/W 300/ 88 658 9 years Cancer registry and death certificates FFQ Incidence, colon cancer, men Q 4 vs Q 1 1.07 (0.72-1.58) Age, alcohol intake, area, BMI, cereal intake, family history of colorectal cancer, meat intake, physical activity, smoking status, total energy intake, vegetable intake, vitamin use Weighted average mid-exposure value per category from Cohort I and II 156/ Women Q 4 vs Q 1 1.05 (0.61-1.82) 154/ Incidence, rectal cancer, men Q 4 vs Q 1 1.31 (0.78-2.22) 95/ Q 4 vs Q 1 0.69 (0.35-1.36)
Lin, 2004 COL01834 USA WHS, Prospective Cohort, Age: 45- years, W 202/ 37 547 8.7 years Self report verified by medical record FFQ Incidence, colorectal cancer 0.56 vs 0.07 servings/day 1.23 (0.77-1.91) Age, alcohol consumption, BMI, family history of colorectal cancer, history of polyps, physical activity, postmenopausal hormone use, randomized treatment assignment, smoking habits, energy intake Distribution of by exposure category. Conversion from servings/day to g/day Tiemersma, 2002 COL00563 Netherlands Dutch prospective Monitoring Project on Cardiovascular Disease Risk Factors, Nested Case Control, 102/ 537 controls 8.5 Population registry FFQ Incidence, colorectal cancer, ≥4 vs 0-1 times/month 0.70 (0.40-1.30) 54/ 292 controls Men ≥4 vs 0-1 times/month 1.20 (0.60-2.40) 48/ 145 controls Women ≥4 vs 0-1 times/month 0.50 (0.20-1.00) Nat1 slow phenotype ≥4 vs 0-1 times/week 0.60 (0.30-1.20)
Age: 20-59 years, M/W Nat2 slow phenotype ≥4 vs 0-1 0.90 (0.50-1.80) Gstm1 present ≥4 vs 0-1 times/week 0.50 (0.20-1.10) 63 Incidence, colon cancer, ≥4 vs 0-1 times/month 0.50 (0.30-0.90) ≥4 vs 0-1 times/month 1.60 (0.70-3.60) ≥4 vs 0-1 0.40 (0.10-0.90) Pietinen, 1999 COL00176 Finland ATBC, Prospective Cohort, Age: 50-69 years, M, Smokers 185/ 27 111 8 years Cancer registry Dietary history questionnaire Incidence, colorectal cancer, 68 vs 13 g/day 0.90 (0.60-1.40) Alcohol consumption, BMI, calcium intake, educational level, physical activity, smoking years Distribution of person-years by exposure category. Gaard, 1996 CRC00008 Norway Norwegian national health screening service study, Prospective Cohort, 87/ 50 535 11.4 years Enrolment by volunteers FFQ Incidence, colon cancer, men ≥5 vs 0-2 times/week 0.46 (0.19-1.11) Age, attained age Conversion from times/week to g/day 63/ Women ≥5 vs ≤2 times/week 0.81 (0.30-1.94)
Age: 20-53 years, M/W Bostick, 1994 COL00079 USA IWHS, Prospective Cohort, Age: 55-69 years, W 212/ 35 216 167 447 SEER FFQ Incidence, colon cancer ≥2.5 vs ≤1 serving/week 0.76 (0.49-1.19) Energy intake, height, parity, total vitamin e intake, total vitamin e intake age, vitamin a supplement Distribution of person-years by exposure category. Conversion from serving/week to g/day ≥2.5 vs ≤1 serving/week 0.76 (0.49-1.19)
Table 101 Fish 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 Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Reasons for exclusion Egeberg, 2013 COL40953 Denmark DCH, Prospective Cohort, Age: 50-64 years, M/W 644/ 53 988 13.4 years Cancer registry FFQ Incidence, colon cancer ≥55 vs 0-27 g/day 0.86 (0.68-1.08) Age, alcohol, beef consumption, cold cuts, educational level, energy, fiber, HRT use, lamb intake, liver, NSAIS use, pork, poultry, processed meat, red meat, sausages, smoking, sport, veal meat, waist circumference Superseded by Norat, 2005 COL01698 (component of EPIC ≥55 vs 0-27 g/day 0.87 (0.70-1.08) per 25 g/day 0.93 (0.85-1.01) per 25 g/day 0.94 (0.87-1.01) 345/ Incidence, rectal cancer ≥55 vs 0-27 g/day 1.01 (0.72-1.40) ≥55 vs 0-27 g/day 0.97 (0.71-1.32) per 25 g/day 0.99 (0.88-1.10) per 25 g/day 0.97 (0.88-1.08) Agnoli, 2013 COL40938 EPIC-Italy, Prospective Cohort, M/W 435/ 45 275 11.28 years Cancer registry and hospital records FFQ Incidence, colorectal cancer 38.6-340.3 vs g/day 0.88 (0.68-1.13) Age, BMI, educational level, gender, non-alcoholic beverage intake, physical activity, Superseded by Bamia, 2013 COL40964 Trial
smoking, study centre Cross, 2010 COL40794 USA NIH-AARP, Prospective Cohort, Age: 50-71 M/W 2 719/ 300 948 7.2 years Cancer registry and death certificates and questionnaires FFQ Incidence, colorectal cancer Q 5 vs Q 1 0.95 (0.84-1.08) Sex, BMI, dietary calcium intake, educational level, red meat intake, smoking habits, total energy intake Only included in highest vs lowest analysis Lee, 2009 COL40764 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 ≥26 vs ≤3.9 g/day water fish 0.90 (0.60-1.20) ≥32 vs ≤3.9 g/day Marine fish 1.00 (0.70-1.40) ≥74 vs ≤19.9 g/day Total fish 1.30 (0.90-1.90) ≥3.5 vs ≤0 g/day Eel 1.30 (0.90-1.70)
Age: 45-74 years, M/W educational level, energy intake, exposure assessment, family history of colorectal cancer, physical activity, smoking habits Iso, 2007 COL40707 JACC, Prospective Cohort, Age: 40-79 years, M/W 211/ 105 500 15 years Municipal resident registration records, death certificates FFQ Mortality, cancer, men ≥5 vs ≤2 /week 1.05 (0.73-1.50) Age, centre location Outcome is mortality 198/ Women ≥5 vs ≤2 /week 1.00 (0.69-1.44) 156/ Mortality, rectal cancer, men ≥5 vs ≤2 /week 0.98 (0.65-1.48) 79/ Women ≥5 vs ≤2 /week 1.02 (0.58-1.80) Engeset, 2007 COL40696 Norway NOWAC, Prospective Cohort, Age: 40-71 years, W 254/ 63 914 13 years Cancer registry FFQ Incidence, colon cancer ≥118 vs ≤70.7 g/day 1.28 (0.90-1.81) Age, fats and sauces, energy intake, fibre intake, fish liver, fruits and vegetables consumption, smoking status Superseded by 2013 COL40964 Component study of EPIC Siezen, 2006 COL40714 Netherlands Dutch prospective Monitoring 160/ 397 controls 16 years Cancer registry FFQ Incidence, colorectal cancer ≥1 vs ≤0.9 times/week 0.83 (0.57-1.20) Age, sex, centre location Only included in highest
57/ Apc+ cases ≥20 vs ≤0 g/day 0.56 (0.24-1.30) per 15.1 g/day 0.83 (0.63-1.07) 54/ Incidence, colon cancer, hmlh1- cases ≥20 vs ≤0 g/day 0.73 (0.73-2.53) per 15.1 g/day 0.81 (0.58-1.14) Sanjoaquin, 2004 COL01182 UK OVS, Prospective Cohort, Age: 18-89 M/W 95/ 10 998 17 years FFQ Incidence, colorectal cancer, ≥1 vs ≤0 1.17 (0.71-1.92) Alcohol consumption, smoking habits Only included in highest compared to lowest analysis Khan, 2004 COL01606 HCS, Prospective Cohort, Age: 40-97 years, M/W 15/ 3 458 14.3 years Area residency lists Questionnaire Mortality, colorectal cancer, men Q 2 vs Q 1 0.30 (0.00-2.30) Age, smoking habits Outcome is mortality 14/ Women Q 2 vs Q 1 1.90 (0.50-6.90) Health education, health screening, health status Outcome is mortality Kojima, 2004 COL01840 Japan JACC, Prospective Cohort, Age: 40-79 years, M/W 129/ 107 824 10 years Resident registry and certificates Questionnaire Mortality, colon cancer, women ≥5 vs 0-2 times/week 0.97 (0.62-1.50) Age, alcohol consumption, BMI, educational level, family history of specific cancer, physical activity, region of enrolment, Outcome is mortality 123/ Men ≥5 vs 0-2 times/week 1.04 (0.65-1.66) 103/ Mortality, rectal cancer, men ≥5 vs 0-2 times/week 0.95 (0.60-1.51) 48/ Women ≥5 vs 0-2 0.90 (0.44-1.84)
smoking status times/week Ma, 2001 COL00374 USA PHS, Nested Case Control, Age: 40-84 years, M, Physicians 193/ 318 controls 13 years Colorectal cancer diagnosis Unknown Incidence, colorectal cancer, 0.35-2.03 vs serving/day 0.92 (0.56-1.51) Age, alcohol consumption, aspirin use, BMI, molar ratio of IGF-i to IGFbp-3, physical activity, smoking habits, supplement intake Superseded Hall, 2008 COL40720 55/ 106 controls Tertile 1 of molar ratio 0.35-2.03 vs serving/day 0.86 (0.33-2.26) 1999 COL01699 finland Finnish follow up, Prospective Cohort, M/W 73/ 9 985 24 years Social Insurance Institution Diet history method Incidence, colorectal cancer, Q 4 vs Q 1 1.11 (0.55-2.28) Age, sex, energy intake, municipality, smoking Only included in highest compared to lowest Hsing, 1998 COL00458 USA Lutheran Brotherhood Study, Prospective Cohort, Age: 35- years, M, policyholders 145/ 17 633 286 731 Responding to mail survey Questionnaire Mortality, colorectal cancer, ≥4.1 vs ≤0.7 times/month 1.50 (0.90-2.60) Age, alcohol consumption, smoking habits, total energy Outcome is mortality 120/ Mortality, colon cancer, ≥4.1 vs ≤0.7 times/month 1.40 (0.80-2.50) Kato, 1997 CRC00022 USA New York University Women's Health Study, 100/ 14 272 105 044 Questionnaire, medical records, cancer registries FFQ Incidence, colorectal cancer, Q 4 vs Q 1 0.49 (0.27-0.89) Age, educational place at enrolment, total calorie intake Only included in highest compared to lowest analysis
Prospective Cohort, Age: 34-65 years, W Kearney, 1996 COL00156 USA HPFS, Prospective Cohort, Age: 40-75 years, M, Health professionals 203/ 47 935 6 years Responding to mail survey FFQ Incidence, colon cancer, ≥2 vs ≤0 times/month 0.85 (0.48-1.51) Age Superseded by Giovannucci, 1994 COL00119 Giovannucci, 1994 COL00119 USA HPFS, Prospective Cohort, Age: 40-75 years, M, Health professionals 205/ 47 949 6 years Mailing to health professionals FFQ Incidence, colon cancer, 83.4 vs 8.4 g/day 1.06 (0.70-1.60) Age, total energy Song, 2014 COL41016 Goldbohm, 1994 COL00025 Netherlands NLCS, Case Cohort, Age: 55-69 years, M/W 215/ 120 852 3.3 Population registries FFQ Incidence, colon cancer, ≥20 vs ≤0 g/day 0.81 (0.56-1.17) Age, sex, dietary fiber intake, energy intake Superseded by Brink, 2005 COL40717 110/ Women ≥20 vs ≤0 g/day 0.87 (0.52-1.45) 105/ Men ≥20 vs ≤0 g/day 0.73 (0.44-1.21)
Willett, 1990 CRC00026 USA NHS, Prospective Cohort, Age: 34-59 years, W, Registered nurses 150/ 88 751 512 488 Population registry FFQ Incidence, colon cancer, ≥5 vs ≤1 times/month 1.06 (0.36-3.12) Age Superseded by Song, 2014 COL41015 Hirayama, 1990 COL01508 Japan 6 prefectures cohort study, Prospective Cohort, Age: 40- years, M/W 563/ 265 118 17 years Health centres Interview Mortality, rectal cancer, daily consumption vs no daily consumption 0.90 (0.78-1.04) Age, sex Outcome is mortality 558/ Mortality, cancer, daily consumption vs no daily consumption 1.01 (0.87-1.16) Hirayama, 1989 COL01024 Japan Japan 6 prefectures cohort study, Prospective Cohort, Age: 40- years, M/W 91/ 265 118 17 Population registry Quantitative FFQ Mortality, sigmoid cancer, vs infrequent/never 0.76 (0.29-2.02) Age Outcome is mortality Mortality, proximal colon cancer, daily/occasional vs infrequent/never 1.29 (0.74-2.26) Heilbrun, 1989 COL01555 USA HHP, Nested Case Control, M 102/ 361 controls 16 years Cancer registry & hospital surveillance Recall questionnaire Incidence, colon cancer, (mean exposure) Age Mean exposure values only 60/ 361 controls Incidence, rectal cancer, (mean exposure)
Phillips, 1975 COL00717 USA AHS, Nested Case Control, M/W, Seventh-day Adventists 41/ 105 controls 2 years Hospital registry Interview Incidence, cancer, any vs none 1.60 Age, sex, ethnicity Unadjusted results 35/ 82 controls Q 3 vs Q 1 3.40
Giovannucci, 1994 COL00119 USA HPFS, Prospective Cohort, Age: 40-75 M, Health professionals 205/ 47 949 6 Mailing to health professionals FFQ Incidence, cancer 56 vs 25 g/day 0.87 (0.55-1.38) Ptrend:0.67 Age, energy intake Goldbohm, 1994 COL00025 Netherlands NLCS, Case Cohort, Age: 55-69 years, M/W 215/ 120 852 3.3 years Population registries FFQ Incidence, cancer q 5 vs q 1 0.98 (0.64-1.49) Ptrend:0.67 Age, sex, dietary intake, energy Intake 110/ Women 25 vs 7 g/day 0.94 (0.52-1.72) Ptrend:0.47 105/ Men 31 vs 10 g/day 1.13 (0.63-2.02) Ptrend:0.72 Willett, 1990 CRC00026 USA NHS, Prospective Cohort, Age: 34-59 years, W, Registered nurses 189/ 88 751 512 488 Population FFQ Incidence, colorectal cancer ≥65 vs ≤38 g/day 1.64 (1.04-2.57) Ptrend:0.03 Age, energy intake 150/ Incidence, colon cancer ≥65 vs ≤38 g/day 1.89 (1.13-3.15) Ptrend:0.01 103/ Incidence, colon cancer: Excluding first four years of follow-up ≥65 vs ≤38 g/day 2.52 (1.34-4.76) Ptrend:0.002 trial
There was evidence of a nonlinear association between total dairy intake and rectal cancer, pnonlinearity=0.02, with a flattening of the dose-response slope at higher levels of intake. Study quality: Total dairy intake was estimated from food intake assessed by FFQ in all studies, and in one of the studies a combination of FFQ, food records and 24 hour recalls were used (Murphy et al, 2013). Loss to follow-up was low for the studies that reported such data, although some studies did not provide data. Cancers were identified by record linkages to health registries, cancer registries, mortality registries, or death indexes. All studies adjusted for at least age, and most of the studies adjusted for most of the established colorectal cancer risk factors, including: age, physical activity, BMI, and alcohol consumption, smoking, red meat and hormone replacement therapy in women. 103 Total dairy product intake and colorectal cancer risk. Number of studies in the CUP SLR Number Studies identified 13 studies (18 publications) Studies included in forest plot of highest compared with lowest intake Colorectal cancer: 12 studies cancer: 6 Rectal cancer: 6 Studies included in dose-response Colorectal cancer: 10 studies cancer: 6 Rectal cancer: 5 Studies included in non-linear dose-response Colorectal cancer: 10 studies Colon cancer: 6 Rectal cancer: 5 Table 104 Total dairy product intake and colorectal cancer risk. Summary of the linear dose-response meta-analysis in the 2005 SLR, 2010 SLR and 2015 SLR 2005 SLR Colorectal cancer Colon cancer Rectal cancer Increment unit used Per 1 serving/day Per 200 g/d Per 1 serving/day Per 1 serving/day Studies (n) 8 2 5 - (total number) - - - - RR (95%CI) 0.97 (0.93-1.01) 0.95 0.95 (0.86-1.06) - Heterogeneity (I2, 11.5%, p=0.34 0%, p=0.86 49.5%, p=0.95 - analysis analysis
Table 105 Dairy intake and colorectal cancer risk. Results of meta-analyses and pooled analyses of prospective studies published after the 2005 SLR. Author, Year Number of studies Total number of cases Studies country, area Outcome Comparison RR (95%CI) P trend Heterogeneity (I2, p value) Meta-analyses Huncharek, 2009 12 - America, Europe Incidence, mortality High vs. low 0.84 (0.75-0.95) - - Aune et al, 2012 12 CRC 10 CRC 5 CC 4 RC 11579 North America, Europe Incidence High vs. low Per 400 g/d High vs. low Per 400 g/d High vs. low Per 400 g/d 0.81 (0.74-0.90) 0.83 (0.78-0.88) 0.72 (0.51-1.02) 0.84 (0.72-0.97) 0.96 (0.65-1.41) 1.00 (0.77-1.28) - - - - - - 42%, p=0.06 24.8%, p=0.22 50%, p=0.09 35.4%, p=0.19 44%, p=0.13 68.9%, p=0.02
Park, 2009 COL40783 NIH-AARP, 3 463/ 492 810 Cancer registry FFQ Incidence, men 1.4 vs 0.2 servings per 0.85 (0.76-0.94)
Sweden Prospective Cohort, 6.7 educational family history of serv/d to g/d, distribution of Incidence, rectal cancer ≥7 vs ≤1.9 servings/day 0.48 (0.23-0.99)
McCarl, 2006 COL40633 IWHS, 954/ 35 197 Seer registry FFQ Incidence, colorectal ≥25.5 vs ≤7.5 0.71 (0.58-0.87) Age Midpoints, conversion from
USA Prospective Cohort, 10 energy intake, family history of specific serv/d to g/d, distribution of Incidence, colorectal 2.71 vs 0.13 servings/day 1.02 (0.65-1.59)
USA Prospective Cohort, 5 years death certificates energy intake, family history of specific serv/wk to g/d, distribution of Incidence, rectal cancer, ≥14 vs ≤2 serving/day 1.22 (0.64-2.33)
Sweden Prospective Cohort, 695 438 educational level, folic acid, red meat serv/wk to g/d, distribution of Incidence, rectal cancer 25-56 vs 1.04 (0.64-1.71)
Table 107 Dairy intake 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 (years) Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Reasons for exclusion Bamia, 2013 COL40964 EPIC, Prospective Cohort, Age: 25-70 M/W 4 355/ 480 308 11.6 years Cancer registry, record linkage, health Insurance rec, mortality registry , pathology and active follow up FFQ Incidence, colorectal cancer 529.8 vs 114 g/day 0.85 (0.78-0.92) Age, sex, BMI, centre location, cereal, dairy products consumption, educational level, ethanol, fish, fruits, legumes, lipids, meat, physical activity, smoking Duplicate, overlap with Murphy et al, 2013, COL41070 Incidence, colorectal cancer, women 529.8 vs 114 g/day 0.84 (0.75-0.93) Incidence, colorectal cancer, men 529.8 vs 114 g/day 0.88 (0.78-1.00) 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 0.98 (0.82-1.17) Age, sex, alcohol intake, BMI, diabetes, dialect group, educational level, energy intake, exposure assessment, family history of colorectal cancer, physical activity, smoking habits van der Pols JC, 2007 COL40680 UK BOCS, Historical Cohort, Age: 8 years, M/W 76/ 4 374 57 years National health records 7-day food records Incidence, colorectal cancer 471 vs 89 g/day 2.90 (1.26-6.65) Age, sex, energy intake, fruit intake Household dietary intake 2005 POL16753 EPIC-E3N, 516/ 5 320 Questionnaire Adenoma Incidence, ≥424.3 vs g/day 0.80 (0.62-1.05) analysis
France Prospective Cohort, Age: 40-65 years, W, part of nat. health insurance scheme for teachers 3.7 years National health Insurance scheme colorectal adenoma, women consumption, BMI, educational level, family history of specific cancer, physical activity, smoking status, total energy Duplicate, overlap with Murphy et al, 2013, COL41070 Adenoma Incidence, high-risk colorectal adenomas (>1cm), ≥424.3 vs g/day 0.85 (0.54-1.33) Incidence, colorectal cancer, women ≥409.22 vs g/day 0.78 (0.49-1.22) Hsing, 1998 COL00458 USA Lutheran Brotherhood Study, Prospective Cohort, Age: 35- years, M, policyholders 145/ 17 633 286 731 person-years Responding to mail survey Questionnaire Mortality, colorectal cancer ≥85.1 vs ≤25.9 times/month 0.60 (0.30-1.30) Age, alcohol consumption, smoking habits, total energy Mortality as outcome Mortality, colon cancer ≥85.1 vs ≤25.9 times/month 0.60 (0.30-1.30)
Zheng, 1998 COL00209 USA IWHS, Prospective Cohort, Age: 55-69 years, W, 144/ 34 702 9 years SEER FFQ Incidence, rectal cancer, Q 3 vs Q 1 0.72 Age, HRT use, pack-years of smoking, smoking habits, total energy No quantities Sellers, 1998 COL01974 USA IWHS, Prospective Cohort, Age: 55-69 years, W, 180/ 35 216 10 Seer registry FFQ Incidence, cancer, no family history of crc ≥20.1 vs ≤10 servings/week 0.70 (0.40-1.00) Duplicate, Bostick et al, 1993 COL01450 was used as it provided results for cancer overall (not stratified by family history of CRC) Incidence, colon cancer, family history of crc ≥20.1 vs ≤10 servings/week 0.70 (0.40-1.40)
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 0.69 (0.40-1.20) Age, educational level, place at enrollment, total calorie intake No quantities
Cho et al, 2004 10 CRC CC PCC DCC RC 7157 2912 1505 1238 1208 America, Europe Incidence ≥250 vs. <70g/d ≥250 vs. <70g/d ≥250 vs. <70g/d ≥250 vs. <70g/d ≥250 vs. <70g/d 0.85 (0.78-0.94) 0.88 (0.79-0.99) 0.99 (0.85-1.15) 0.73 (0.62-0.87) 0.80 (0.66-0.96) <0.001 0.01 0.56 <0.001 0.02 NA, p=0.63 NA, p=0.10 NA, p=0.78 NA, p=0.61 NA, p=0.31
Table 114 Total milk intake 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) Adjustment factors Missing data derived for analysis Murphy, 2013 COL41070 EPIC, Prospective Cohort, Age: 30- M/W 4 513/ 477 122 11 years Cancer registries, health Insurance records, pathology rec & active follow up Dietary questionnaire Incidence, colorectal cancer ≥325 vs 0-8.9 g/d 0.81 (0.73-0.90) Incidence, colorectal cancer per 200 g/day 0.94 (0.91 Incidence, cancer ≥325 vs 0-8.9 g/d 0.80 (0.70-0.91) Incidence, colon cancer per 200 g/d 0.93 (0.90-0.97) Incidence, proximal colon cancer ≥325 vs 0-8.9 g/d 0.84 (0.69-1.02) Incidence, proximal colon cancer per 200 g/day 0.95 (0.89-1.01) Incidence, distal colon cancer ≥325 vs 0-8.9 g/d 0.78 (0.63-0.96) Incidence, distal colon cancer per 200 g/day 0.94 (0.88-0.99) Incidence, rectal cancer ≥325 vs 0-8.9 g/d 0.84 (0.70-0.99) analysis
Incidence, rectal cancer per 200 g/day 0.95 (0.90-1.00) Ruder, 2011 COL40896 USA NIH-AARP, Prospective Cohort, Age: 50-71 years, Retired 2 819/ 292 797 Cancer registry and national health database FFQ Incidence, cancer 2 vs 0.03 times/day 0.78 (0.67-0.90) Sex, age at baseline, alcohol consumption, aspirin use, BMI, educational energy, energy, history of colon cancer, HRT use, milk, physical activity, race, smoking Distribution of conversion from times/d to g/d Incidence, colon cancer 2 vs 0.03 times/day 0.70 (0.61-0.79) Incidence, colon cancer 3 vs 0 times/day 0.92 (0.78-1.10) Incidence, colon cancer 3 vs 0 times/day 0.84 (0.71-0.99) Incidence, rectal cancer 2 vs 0.03 0.75 (0.58-0.96) Incidence, rectal cancer 2 vs 0.03 0.74 (0.59-0.92) Incidence, rectal cancer 3 vs 0 times/day 0.99 (0.73-1.34) Incidence, rectal cancer 3 vs 0 0.94 (0.70-1.26) Simons, 2010 COL40821 Netherlands NLCS, Prospective Cohort, Age: 55-69 years, M/W 1 260/ 120 852 13.3 years Cancer registry and database of pathology reports FFQ Incidence, colorectal cancer, men >2 vs 0 glasses/day 0.68 (0.50-0.92) Incidence, colorectal cancer, women >2 vs 0 glasses/day 0.94 (0.68-1.30)
intake, meat intake, non-occupational physical activity, physical activity, processed meat consumption, smoking, total fluid intake, vitamin b6 intake Incidence, proximal colon cancer, women >2 vs 0 glasses/day 1.08 (0.70-1.68) Incidence, proximal colon cancer, men >2 vs 0 glasses/day 0.84 (0.53-1.32) Incidence, distal colon cancer, men >2 vs 0 glasses/day 0.67 (0.42-1.07) Incidence, distal colon cancer, women >2 vs 0 glasses/day 1.14 (0.66-1.94) Incidence, rectal cancer, men >2 vs 0 glasses/day 0.79 (0.49-1.27) Incidence, rectal cancer, >2 vs 0 glasses/day 0.68 (0.38-1.23) Lee, 2009 COL40764 China SWHS, Prospective Cohort, Age: 40-70 W 394/ 73 224 7.4 Cancer registry and death certificates and participant contact Quantitative FFQ Incidence, colorectal cancer ≥200 vs ≤0 g/day 0.80 (0.50-1.20) Incidence, colon cancer ≥200 vs ≤0 g/day 0.80 (0.40-1.30)
physical activity, red meat intake, saturated fat, smoking status, total energy intake, vegetable intake, vitamin d Incidence, colon cancer ≥1.1 vs ≤0 servings/day 1.17 (0.88-1.56) Incidence, distal colon cancer ≥1.5 vs ≤1.9 glasses/week 0.53 (0.33-0.87) Incidence, distal colon cancer ≥1.1 vs ≤0 servings/day 1.26 (0.84-1.91) Incidence, proximal colon cancer ≥1.5 vs ≤1.9 glasses/week 0.76 (0.45-1.30) Incidence, proximal cancer ≥1.1 vs ≤0 servings/day 1.10 (0.72-1.69) Incidence, rectal cancer ≥1.5 vs ≤1.9 glasses/week 0.69 (0.45-1.06) Incidence, rectal cancer ≥1.1 vs ≤0 servings/day 0.94 (0.66-1.33) Lin, 2005 COL01690 USA WHS, Prospective Cohort, Age: 45- W, professionals 223/ 36 976 10 years SEER FFQ Incidence, colorectal cancer, ≥1 vs ≤0.1 serving/day 1.12 (0.72-1.74) Age, alcohol consumption, BMI, energy intake, family history of specific cancer, history of previous Midpoints, conversion from serv/d to g/d, distribution of person-years
polyp and prior endoscopy, menopausal status, multivitamin, physical activity, postmenopausal hormone use, randomized treatment assignment, red meat intake, saturated fat, smoking status Sanjoaquin, 2004 COL01182 UK OVS, Prospective Cohort, Age: 18-89 years, M/W 93/ 10 998 17 years FFQ Incidence, colorectal cancer, ≥0.5 vs ≤0.5 pints/day 1.10 (0.65-1.87) Age, sex, alcohol consumption, smoking habits Midpoints, distribution of conversion from pints/d to g/d McCullough, 2003 COL00366 USA CPS II, Prospective Cohort, Age: 50-74 years, M/W, subgroup of CPS-II cohort 683/ 127 749 5 years Cancer registry and death certificates and medical records FFQ Incidence, colorectal cancer, ≥1.1 vs ≤0 serving/day 0.96 (0.78-1.18) Incidence, colorectal cancer, men ≥1.1 vs ≤0 serving/day 0.86 (0.66-1.11) Incidence, colon cancer, men ≥1.1 vs ≤0 serving/day 0.81 (0.60-1.10)
Kearney, 1996 COL00156 USA HPFS, Prospective Cohort, Age: 40-75 years, M, Health professionals 203/ 47 935 6 years Responding to mail survey FFQ Incidence, cancer, ≥1 vs 0-1 times/month 0.87 (0.52-1.44) 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 Conversion from frequency to g/d 115 Total milk intake and colorectal cancer risk. Main characteristics of studies excluded from the CUP SLR dose-response Author, Year, WCRF Code, Country Study name, Cases/ Study size Follow-up (years) Case Exposure assessment Outcome Comparison RR (95%CI) Adjustment factors Inclusion/ exclusion Iso, 2007 COL40707 Japan JACC, Prospective Cohort, Age: 40-79 years, M/W 193/ 105 500 15 years Municipal resident registration records, death certificates FFQ Mortality, cancer, women ≥5 vs ≤2 /week 1.00 (0.69-1.43) Mortality, cancer, men ≥5 vs ≤2 /week 1.17 (0.82-1.66) analysis
Mortality, rectal cancer, men ≥5 vs ≤2 /week 1.16 (0.79-1.71) Mortality, rectal cancer, women ≥5 vs ≤2 /week 1.13 (0.64-1.97) van der Pols JC, 2007 COL40680 UK BOCS, Historical Cohort, Age: 8 years, M/W 76/ 4 374 57 National health records 7-day food records Incidence, colorectal cancer ≥282 vs ≤117.9 ml/day 2.45 (1.11-5.41) Age, sex, energy intake, fruit intake Household dietary intake Kesse, 2005 POL16753 France EPIC-E3N, Prospective Cohort, Age: 40-65 years, W, part of nat. health insurance scheme for teachers 516/ 5 320 3.7 years National health Insurance scheme Adenoma Incidence, colorectal adenoma, ≥211 vs ≤0 g/day 0.93 (0.73-1.19) Alcohol consumption, BMI, educational level, family history of specific cancer, physical activity, smoking status, total energy Duplicate, overlap with Murphy, 2013 COL41070 Adenoma Incidence, high-risk colorectal adenomas (>1cm), ≥211 vs ≤0 g/day 0.80 (0.51-1.23) Incidence, colorectal cancer, ≥210 vs ≤0 g/day 0.54 (0.33-0.89) Khan, 2004 COL01606 Japan HCS, Prospective Cohort, 15/ 3 458 14.3 years Area residency lists Mortality, colorectal cancer, men Q 2 vs Q 1 0.70 (0.30-2.00)
Age: 40-97 M/W Mortality, colorectal cancer, Q 2 vs Q 1 0.50 (0.20-1.30) Kojima, 2004 COL01840 Japan JACC, Prospective Cohort, Age: 40-79 years, M/W 132/ 107 824 10 years Resident registry and certificates Mortality, colon cancer, women 5-7 vs 0-0.4 times/week 1.16 (0.71-1.90) Age, alcohol consumption, BMI, educational level, family history of specific cancer, physical activity, region of enrollment, smoking status Mortality as outcome Mortality, colon cancer, men 5-7 vs 0-0.4 times/week 1.22 (0.74-2.02) Mortality, rectal cancer, men 5-7 vs 0-0.4 1.05 (0.64-1.71) Mortality, rectal cancer, women 5-7 vs 0-0.4 times/week 1.64 (0.70-3.82) Wu, 2002 COL00587 USA NHS, Prospective Cohort, Age: 30-55 years, W 87 998 16 years Nurses registry FFQ Incidence, cancer, ≥1.1 vs ≤0.5 serving/day 0.93 (0.76-1.15) Age, alcohol consumption, aspirin use, BMI, family history of specific cancer, HRT use, menopausal status, physical activity, red meat intake, smoking habits <3 categories Wu, 2002 COL00587 USA HPFS, Prospective Cohort, 47 344 10 years Mailing to health professionals FFQ Incidence, cancer, ≥1.1 vs ≤0.5 serving/day 0.58 (0.27-1.17) Age, alcohol consumption, aspirin use, BMI, family history of specific <3 categories
Age: 40-75 M, Health professionals cancer, physical activity, red meat intake, smoking habits Martinez, 1996 COL00131 USA NHS, Prospective Cohort, Age: 30-55 years, W, Registred nurses 89 448 1 012 280 person-years Nurses registry FFQ Incidence, colorectal cancer, ≥2 vs ≤1 0.88 (0.65-1.19) Age, alcohol consumption, aspirin use, BMI, family history of specific cancer, physical activity, red-meat intake, smoking habits <3 categories Kampman, 1994 COL00155 Netherlands NLCS, Case Cohort, Age: 55-69 years, M/W 326/ 120 852 3.3 years Population registries FFQ Incidence, colorectal cancer, ≥240 vs ≤0 g/day 0.86 (0.57-1.29) Age, sex, BMI, energy intake, energy-adjusted intake of dietary fiber, energy-adjusted intake of fat, family history of specific cancer, history of gallbladder surgery Duplicate, overlap with Simons Ursin, 1990 COL41068 Norway Combined Norwegian Cohorts, Prospective Cohort, Age: 35-75 years 92/ 15 914 11.5 years Cancer registry (general) Mortality, colon cancer ≥2 vs 0.1-0.9 glasses/day 0.85 Age, sex, area of residence No CIs, <3 categories Mortality, rectum ≥2 vs 0.1-0.9 glasses/day 0.85
Hirayama, 1990 COL01508 Japan Japan 6 prefectures cohort study, Prospective Cohort, Age: 40- M/W 563/ 265 118 17 years Health centres Interview Mortality, colon cancer, daily consumption vs no daily consumption 1.08 (0.19-1.28) Age, sex Mortality as outcome Mortality, rectal cancer, daily consumption vs no daily consumption 1.02 (0.86-1.21) Hirayama, 1989 COL01024 6 prefectures cohort study, Prospective Cohort, Age: 40- years, M/W 91/ 265 118 17 Population Quatitative FFQ Mortality, sigmoid cancer, occasional drinkers vs infrequent/ nondrinkers 2.20 (1.22-3.95) Age, alcohol consumption Mortality as outcome Mortality, proximal colon cancer, vs 1.04 (0.83-1.32) Mortality, sigmoid cancer, alcohol consumption: daily & occasional daily/ occasional drinkers vs infrequent/ nondrinkers 2.21 (1.16-4.21) Mortality, sigmoid cancer, alcohol consumption: daily/ occasional drinkers vs infrequent/ nondrinkers 2.11 (0.50-8.87)
Infrequent & non drinkers Phillips, 1985 COL00719 USA AHS, Prospective Cohort, Age: 30- M/W, Seventh-day Adventists 179/ 25 493 21 years Quatitative FFQ Mortality, colorectal cancer ≥3 vs ≤1 glasses/day 0.70 (0.40-1.20) Age, sex Mortality as outcome Mortality, colon cancer, women ≥3 vs ≤1 glasses/day 1.10 (0.50-2.20) Mortality, cancer, men ≥3 vs ≤1 glasses/day 0.50 (0.20-1.10) Mortality, rectal cancer, ≥1 vs ≤1 glasses/day 1.20 (0.60-2.70)
Table 121 Cheese intake 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) Adjustment factors Missing data derived for analysis Murphy, 2013 COL41070 EPIC, Prospective Cohort, Age: 30- years, M/W 4 513/ 477 122 11 years Cancer registries, health Insurance records, pathology rec & active follow up Dietary questionnaire Incidence, colorectal cancer ≥56 vs 0-4.9 g/d 0.87 Incidence, colorectal cancer per 50 g/day 0.95 Incidence, colon cancer ≥56 vs 0-4.9 g/d 0.83 Incidence, colon cancer per 50 g/day 0.93 Incidence, proximal cancer ≥56 vs 0-4.9 g/d 0.73 Incidence, proximal cancer per 50 g/day 0.95 Incidence, distal colon cancer ≥56 vs 0-4.9 g/d 0.91 Incidence, distal cancer per 50 g/day 0.94 Incidence, rectal cancer ≥56 vs 0-4.9 g/d 0.95 analysis
Incidence, rectal cancer per 50 g/day 0.95 Larsson, 2006 COL40624 Sweden COSM, Prospective Cohort, Age: 45-79 years, M 449/ 45 306 6.7 years Cancer registry FFQ Incidence, colorectal cancer ≥3 slices/day vs <4 slices/wk slices 0.79 Age, alcohol intake, aspirin use, educational level, family history of colorectal cancer, fruits, history of diabetes, multivitamin supplement intake, physical activity, red meat intake, saturated fat, smoking status, total energy intake, vegetable intake, vitamin d Midpoints, conversion from serv/d to g/d, distribution of cases and person-years Incidence, colon cancer ≥3 slices/day vs <4 slices/wk slices 0.78 Incidence, rectal cancer ≥3 slices/day vs <4 slices/wk slices 0.80 Incidence, distal colon cancer ≥3 slices/day vs <4 slices/wk slices 0.87 Incidence, proximal colon cancer ≥3 slices/day vs <4 slices/wk slices 0.76 Larsson, 2005 COL01835 Sweden SMC, Prospective Cohort, Age: 40-75 years, W 798/ 61 433 14.8 years Mammography screening program Questionnaire Incidence, colorectal cancer ≥1 vs ≤0 servings/day 0.65 Incidence, proximal colon cancer ≥1 vs ≤0 servings/day 0.76 Incidence, distal colon cancer ≥1 vs ≤0 servings/day 0.24 1.43)
Incidence, rectal cancer ≥1 vs ≤0 servings/day 0.89 Lin, 2005 COL01690 USA WHS, Prospective Cohort, Age: 45- W, professionals 223/ 36 976 10 years SEER FFQ Incidence, colorectal cancer ≥0.7 vs ≤0.1 serving/day 1.38 Age, alcohol consumption, BMI, energy intake, family history of specific cancer, history of previous polyp and prior endoscopy, menopausal status, multivitamin, physical activity, postmenopausal hormone use, randomized treatment assignment, red meat intake, saturated fat, smoking status Midpoints, conversion from serv/d to g/d, distribution of person-years Sanjoaquin, 2004 COL01182 UK OVS, Prospective Cohort, Age: 18-89 years, M/W 92/ 10 998 17 years FFQ Incidence, colorectal cancer ≥10 vs ≤4 0.98 Age, sex, alcohol consumption, smoking habits Midpoints, conversion from pints/d to g/d, distribution of person-years Jarvinen, 2001 COL00314 Finland Finnish Mobile Clinic Health 72/ 9 959 19.6 years Population Questionnaire Incidence, colorectal cancer Q 4 vs Q 1 1.65 2.19)
Examination Survey, Prospective Cohort, Age: 39 M/W occupational group, smoking habits Incidence, colon cancer Q 4 vs Q 1 2.42 Incidence, rectal cancer Q 4 vs Q 1 1.12 Singh, 1998 COL00185 USA AHS, Prospective Cohort, Age: 25- years, M/W, Seventh-day Adventists 142/ 32 051 178 544 person-years Census list FFQ Incidence, colon cancer, ≥2 vs ≤0.5 times/week 1.31 Age, sex, alcohol consumption, aspirin use, BMI, family history of specific cancer, physical activity, smoking habits Midpoints, conversion from serv/wk to g/d Kearney, 1996 COL00156 USA HPFS, Prospective Cohort, Age: 40-75 years, M, Health professionals 203/ 47 935 6 years Responding to mail survey FFQ Incidence, colon cancer ≥5 vs 0-1 1.35 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 Midpoints, conversion from serv/wk to g/d
Kampman, 1994 COL00155 Netherlands NLCS, Case Cohort, Age: 55-69 years, M/W 326/ 120 852 3.3 years Population registries FFQ Incidence, colorectal cancer, men ≥30 vs ≤0 g/day 0.88 Age, sex, BMI, energy intake, energy-adjusted intake of dietary fiber, intake of fat, family history of specific cancer, history of gallbladder surgery Midpoint, distribution of person-years Incidence, colorectal cancer, Q 4 vs Q 1 0.61 Table 122 Cheese intake and colorectal cancer risk. Main characteristics of studies excluded from the CUP SLR dose-response Author, Year, WCRF Code, Country Study name, Cases/ Study size Follow-up (years) Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Adjustment factors Reasons for exclusion Iso, 2007 COL40707 Japan JACC, Prospective Cohort, Age: 40-79 years, M/W 176/ 105 500 15 years Municipal resident registration records, death certificates FFQ Mortality, cancer, women ≥5 vs ≤2 /week 0.81 (0.41-1.61) Age, centre location Mortality as outcome Mortality, colon cancer, men ≥5 vs ≤2 /week 1.10 (0.62-1.96) Mortality, rectal cancer, men ≥5 vs ≤2 /week 1.48 (0.78-2.79) Mortality, rectal cancer, women ≥5 vs ≤2 /week 0.80 (0.25-2.61) analysis
Table 132 Coffee 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 Outcome Comparison RR (95%CI) P trend Heterogeneity (I2, p value) Pooled analysis Zhang, 2010 13 5 604 Incidence, colon cancer > 1400 g/day (8-oz cups) 1.07 (0.89-1.30) 0.68 4 439 Per 250 g/day 0.99 (0.97-1.02) 0.45 2 295 proximal cancer 0.99 (0.96-1.02) 0.98 1 820 distal cancer 0.99 (0.96-1.03) 0.71 Meta-analysis Tian, 2013 12 NA Incidence, colorectal cancer For 1 cup/day increment 1.02 (0.97–1.07) Non-linear models NA 8 Colon cancer 1.01 (0.94–1.08) 8 Rectal cancer 1.04 (0.93–1.16) Li, 2013 16 10 443 Incidence, colorectal cancer Highest vs lowest 0.94 (0.88-1.01) Incidence, colon cancer 0.93 (0.86-1.01)
Table 133 Coffee consumption 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 Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Missing data derived for analyses Dik, 2014 COL40993 Denmark, France, Germany, Greece, Italy ,Netherlands, Norway, Spain, Sweden, UK EPIC, Prospective Cohort, Age: 25-70 years, M/W 4 234/ 477 071 11.6 years Cancer registry/ population register Questionnaire Incidence, colorectal cancer per 100 ml/day 1.01 (0.99-1.02) Age, sex, alcohol consumption, BMI, centre location, dairy products consumption, diabetes, educational level, energy from fat, energy from non-fat sources, fibre, HRT use, menopausal status, physical activity, red and processed meat, smoking Unit converted to cups/day High vs non/low consumption 1.06 (0.95-1.18) 2 691 Incidence, cancer per 100 ml/day 1.00 (0.99-1.01) High vs non/low consumption 0.99 (0.86-1.13) 1 242 Incidence, proximal colon cancer per 100 ml/day 1.01 (0.99–1.03) High vs non/low consumption 1.06 (0.87–1.30) 1 202 Incidence, distal colon cancer per 100 ml/day 0.99 (0.97–1.01) High vs non/low consumption 0.94 (0.76–1.15) 1 563/ Incidence, rectal cancer per 100 ml/day 1.02 (1.00-1.03) High vs non/low consumption 1.2 (1.00-1.44) Yamada, 2014 COL41013 Japan JACC, Prospective Cohort, M/W 557/ 58 738 669 Cancer registry and hospital records questionnaire Incidence, colorectal cancer, men 1.57 (0.97-2.55) Ptrend:0.03 analysis
frequency, educational level, history of colorectal cancer, meat consumption, smoking, walking time Incidence, colorectal cancer, women 1.42 (0.57–3.50) Incidence, colon, men 1.79 (1.01–3.18) Incidence, colon, women 2.02 (0.81–5.03) Incidence, rectal cancer, men 1.19 (0.48–2.95) Incidence, rectal cancer, women 2-3 vs <1 cups/day 1.55 (0.89–2.69) Dominianni, 2013 COL40982 USA PLCO, Prospective Cohort, Age: 55-74 years, M/W 681/ 57 398 11.4 years Histology and medical records FFQ Incidence, colorectal cancer 1.08 (0.78-1.49) Incidence, proximal cancer 1.33 (0.86, 2.05 Incidence, distal colon cancer 1.11 (0.58, 2.13)
colorectal cancer, fruit intake, gender, hormone use, meat intake, nsaid use, physical activity, race, sigmoidoscopy, smoking, vegetable intake Incidence, rectal cancer 0.72 (0.36, 1.44) Sinha, 2012 COL40909 USA NIH-AARP, Prospective Cohort, Age: 50-71 years, M/W, Retired 6 946/ 489 706 10.5 years Cancer registry FFQ Incidence, colorectal cancer ≥6 cups/day vs <1 cups/week 0.80 (0.69-0.94) Age, sex, alcohol, BMI, calcium, diabetes, educational level, energy intake, family history of colorectal cancer, fruits and vegetables consumption, HRT use, marital satus, nsaid use, race, red meat, screening, Mid-point categories Person-years of follow up in each category 5 072 Incidence, colon cancer 0.74 (0.61, 2 863 Incidence, proximal colon cancer 0.62 (0.48, 0.81) 1 993 Incidence, distal cancer 0.86 (0.64, 1 874 Incidence, rectal cancer 1.01 (0.76,
smoking, time since quitting smoking, vigorous activity Nilsson LM, 2010 COL40816 Sweden VIP, Prospective Cohort, M/W 321/ 64 603 15 years Cancer registry FFQ Incidence, colorectal cancer ≥4 vs <1 servings/day 1.43 (0.86-2.38) Age, sex, BMI, educational level, recreational physical activity, smoking Mid-point categories 2010 COL40848 Sweden Finland, 1972-2002, Prospective Cohort, Age: 25-74 years, M/W 538/ 62 013 34 years Cancer registry Questionnaire Incidence, colorectal cancer ≥10 vs 0 cups/day 1.03 (0.58-1.83) Age, alcohol consumption, BMI, diabetes mellitus, education years, leisure time physical activity, smoking, study, tea consumption Mid-point categories Incidence, colon cancer 0.72 (0.35–1.47) Incidence, rectal cancer 1.99 (0.71–5.55) Simons, 2010 COL40821 Netherlands NLCS, Prospective Cohort, Age: 55-69 years, M/W 1 260/ 120 852 13.3 years Cancer registry and database of pathology reports FFQ Incidence, colorectal cancer, men 1.00 (0.74-1.36) Incidence, colorectal cancer, women 1.07 (0.74–1.55)
Incidence, proximal colon cancer, men 0.91 (0.58–1.44) Incidence, proximal colon cancer, women 1.12 (0.67–1.88) Incidence, distal colon cancer, men 0.93 (0.59–1.47) Incidence, distal colon cancer, women 0.96 (0.51–1.80) Incidence, rectal cancer, men 1.60 (0.96–2.66)
intake, folate intake, meat intake, physical activity, physical activity, processed meat consumption, smoking, total fluid intake, vitamin b6 intake Incidence, rectal cancer, women 1.41 (0.75–2.63) Lee, 2007 COL40654 Japan JPHC, Prospective Cohort, Age: 52 years, M/W 726/ 96 162 10 years Active patient notification from hospitals, cancer registries and cert. Questionnaire Incidence, colorectal cancer, men 1.10 (0.82-1.47) Ptrend:0.91 437/ Incidence, colorectal cancer, women 0.68 (0.40–1.15) 447/ Incidence, colon cancer, men 1.15 (0.80–1.66) 286/ Incidence, colon cancer, women 0.60(0.31–1.19) 249/ Incidence, rectal cancer, men 1.01 (0.61–1.66)
Prospective Cohort, M/W intake, vegetable intake per 1 cup/day 1.00 (0.95-1.05) Incidence, rectal cancer ≥4 vs <1 cups/day 1.06 (0.71-1.75) per 1 cup/day 1.00 (0.94-1.07) Oba, 2006 COL40626 TCCJ, Prospective Cohort, Age: 35-101 years, M/W 111/ 30 221 8 Hospital records and cancer registry FFQ Incidence, colon cancer, men 1cup/day or more vs 0.81 (0.46-1.42) Age, alcohol intake, BMI, energy intake, height, of smoking, physical activity categories Incidence, colon cancer, women 0.43 (0.22–0.85) Michels, 2005 COL40754 USA NHS-HPFS, Prospective Cohort, Age: 30-75 years, M/W 886/ 133 893 1 991 605 person-years Self-report verified by medical record FFQ Incidence, colorectal cancer > 5 cup/day vs never 0.98 (0.69-1.38) Age, alcohol consumption, aspirin use, BMI, energy intake, family history of colorectal cancer, height, HRT use, menopausal status, of smoking, physical Mid-point categories Per 1 cup/day 0.99 (0.96-1.03) Incidence, colon cancer > 5 cup/day vs never 0.98 (0.68-1.41) Per 1 cup/day 0.98 (0.95-1.02) Incidence, rectal cancer ≥ 4-5 cup/day vs never 1.55 (0.97-2.45) Per 1 cup/day 1.04 (0.96-1.13)
activity, previous sigmoidoscopy, red meat intake, vitamin use Hartman, 1998 COL00214 Finland ATBC, Nested Case Control, Age: 50-69 years, M, Male Smokers 106/ controls 6.1 years Cancer registry Recall questionnaire + FFQ Incidence, colon cancer > 6 vs ≤ 4 cups/day 0.84 (0.50-1.40) Age, BMI, calcium, Intervention group, occupational physical activity Mid-point categories 79/ Incidence, rectal cancer 0.77 (0.43-1.40) Stensvold, 1994 COL00321 Norway Norwegian health survey for cardiovascular disease, Prospective Cohort, Age: 35-54 years, M/W 78/ 42 973 432 773 Population registries FFQ Incidence, colon cancer, men ≥7 vs ≤2 cups/day 1.20 Age, county of residence, smoking habits Confidence intervals were calculated Incidence, colon cancer, women 0.8 Incidence, rectal cancer, men 0.7 Incidence, rectal cancer, women 0.7 Klatsky, 1988 COL00656 KPMCP, 203/ 2 410 Hospital records Questionnaire Incidence, colon cancer 0.92 (0.80-1.06)
USA Nested Case Control, M/W Age, sex, smoking, race, education 66/ Incidence, rectal cancer 0.84 (0.66-1.07) Wu, 1987 COL00774 USA Leisure World Cohort, Prospective Cohort, M/W, Retirement community 68/ 11 644 4.5 years Population registries FFQ Incidence, colorectal cancer, women ≥4 vs 0-1 cups/day 1.17 (0.40-3.10) Age Mid-point categories Incidence, colorectal cancer, men 1.54 (0.6-3.7)
Table 134 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 Peterson, 2010 COL40820 Singapore SCHS, Prospective Cohort, Age: 45-74 M/W 325/ 61 321 9.8 years Cancer registry and pathology register Incidence, advanced cancer >2 vs <1 cups/day 0.89 (0.66-1.19) Ptrend:0.40 Age, alcohol, BMI, diabetes, dialect group, educational level, family history of colorectal cancer, gender, green tea, physical activity, smoking, year Advanced and localized colon cancer 229/ 61 321 9.8 years Incidence, localized colon cancer >2 vs <1 cups/day 0.82 (0.59-1.14) Ptrend:0.24 Mucci, 2006 COL40750 Sweden SMC, Prospective Cohort, Age: 40-75 years, W 741/ 61 467 823 072 Cancer registry FFQ Incidence, colorectal cancer ≥4 vs ≤1 cups/day 1.00 (0.70-1.30) Age, alcohol intake, BMI, educational level, energy intake, fibre intake, saturated fat Superseded by Larsson, 2006 COL40628 504/ 61 467 823 072 Incidence, cancer ≥4 vs ≤1 cups/day 1.10 (0.80-1.50) 237/ 61 467 823 072 Incidence, rectal cancer ≥4 vs ≤1 cups/day 0.90 (0.60-1.40)
Terry, 2001 COL00553 Sweden SMC, Prospective Cohort, Age: 40-74 years, W 460/ 61 463 588 270 Cancer registry Questionnaire Incidence, colorectal cancer, ≥4 vs ≤1 cups/day 1.04 (0.70-1.54) Ptrend:0.95 Age, alcohol consumption, BMI, calcium, dietary fibre, educational level, energy intake, folic acid, red meat intake, total fat, vitamin c, vitamin d Superseded by Larsson, 2006 COL40628 Suadicani, 1993 COL01085 Denmark Denmark, Copenhagen fitness and risk of cvd study, Prospective Cohort, Age: 40-59 years, M 51/ 5 429 18 years Public or private companies Questionnaire Incidence, cancer Age No RR reported Jacobsen, 1986 COL01385 Norway, USA Norwegian composite cohort consisting of 3 groups, Prospective Cohort, M/W 97/ 10 517 11.5 years Questionnaire Questionnaire Incidence, colon cancer ≥7 vs 0-2 cups/day 0.54 Ptrend:0.10 Age, sex, alcohol consumption, residence Description of cancer outcome is not the same as other studies included in the meta-analysis (colon cancer is including 63/ 10 517 11.5 years Incidence, rectal cancer ≥7 vs 0-2 cups/day 1.07 Ptrend:0.94
rectosigmoid and rectal cancer excluding rectosigmiod) Nomura, 1986 COL00708 USA HHP, Prospective Cohort, Age: 45-68 M, Japanese ancestry 108/ 7 355 Population Dietary history questionnaire Incidence, colon cancer, ≥5 vs 0 cups/day Ptrend:0.984 Age No RR available
Table 144 Tea 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 Heterogeneity (I2, p value) Pooled-analysis Zhang, 2010 13 4 394 Worldwide Incidence, colon cancer > 1400 g/day (8-oz cups) 1.28 (1.02-1.61) Per 250 g/day 1.04 (1.00-1.07) 0.50 2 277 proximal colon cancer 1.04 (1.00-1.09) 0.64 1 795 distal cancer 1.04 (0.99-1.10) 0.34 Meta-analysis Yu, 2014 15 Worldwide Incidence, colorectal cancer 0.98 (0.93-1.03) 15%, 0.29 12 Incidence, colon cancer 1.00 (0.95-1.07) 28.3%, 0.17 10 Incidence, rectal cancer 0.96 (0.88-1.04) 17.5%, 0.28
Sinha, 2012 COL40909 USA NIH-AARP, Prospective Cohort, Age: 50-71 years, M/W, Retired 6 946/ 489 706 10.5 years Cancer registry FFQ Incidence, colorectal cancer ≥1 cup/day vs none 0.97 (0.90, Ptrend:0.700 Age, sex, alcohol, BMI, calcium, diabetes, educational level, energy intake, family history of colorectal cancer, fruits and vegetables consumption, HRT use, marital satus, nsaid use, race, red meat, screening, smoking, time since quitting smoking, vigorous activity Mid-point categories Person-years of follow up in each category 5 072 Incidence, colon cancer 0.99 (0.91, Ptrend:0.500 2 863 Incidence, proximal colon cancer 0.98 (0.88, Ptrend:0.600 1 993 Incidence, distal colon cancer 1.02 (0.88, Ptrend:0.600 1 874 Incidence, rectal cancer 0.92 (0.80, Ptrend:0.800 Simons, 2010 COL40821 Netherlands NLCS, Prospective Cohort, Age: 55-69 M/W 1 260/ 120 852 13.3 Cancer registry and database of pathology reports FFQ Incidence, colorectal cancer, men 0.92 (0.75-1.13) Ptrend:0.49 939/ Incidence, colorectal cancer, women 0.92 (0.74-1.14) Ptrend:0.66
361/ Incidence, proximal colon cancer, men 1.03 (0.75-1.41) Ptrend:0.64 380/ Incidence, proximal colon cancer, women 0.89 (0.67-1.20) Ptrend:0.65 417/ Incidence, distal cancer, men 0.99 (0.73-1.33) Ptrend:0.78 284/ Incidence, distal colon cancer, women 1.05 (0.74-1.49) Ptrend:0.87 322/ Incidence, rectal cancer, men 0.85 (0.63-1.16) Ptrend:0.36
intake, folate intake, meat intake, physical activity, physical activity, processed meat consumption, smoking, total fluid intake, vitamin b6 intake 173/ Incidence, rectal cancer, women 1.00 (0.66-1.51) Ptrend:0.98 Michels, 2005 COL40754 USA NHS-HPFS, Prospective Cohort, Age: 30-75 years, M/W 1 431/ 133 893 1 991 605 person-years Self-report verified by medical record FFQ Incidence, colorectal cancer > 5 cup/day vs never 0.98 (0.69-1.38) Age, alcohol consumption, aspirin use, BMI, energy intake, family history of colorectal cancer, height, HRT use, menopausal status, of smoking, physical Mid-point categories Per 1 cup/day 0.99 (0.96-1.03) 1170/ Incidence, cancer > 5 cup/day vs never 0.98 (0.68-1.41) Per 1 cup/day 0.98 (0.95-1.02) 260/ Incidence, rectal cancer ≥ 4-5 cup/day vs never 1.55 (0.97-2.45) Per 1 cup/day 1.04 (0.96 to 1.13) non-
activity, previous sigmoidoscopy, red meat intake, vitamin use Su, 2002 COL00548 USA NHEFS I, Prospective Cohort, Age: 25-74 years, M/W 267/ 12 335 10 years Population Questionnaire Incidence, colon cancer, ≥1.5 cups/day vs non-drinkers 0.85 (0.56-1.30) Ptrend:0.76 Age, alcohol consumption, aspirin use, BMI, calcium intake, educational level, energy intake, ethnicity, fat intake, fibre categories Person-years of follow up NHEFS II, 323/ 0.59 (0.35-1.00) Ptrend: <0.01 Terry, 2001 COL00555 Sweden SMC, Prospective Cohort, Age: 40-74 years, W 460/ 61 463 588 270 Mammography screening program Questionnaire Incidence, colorectal cancer 0.98 (0.64–1.51) 291/ Incidence, colon cancer 0.74 (0.42–1.31) 118/ Incidence, proximal cancer 0.92 (0.39–2.13) 101/ Incidence, distal colon cancer 0.85 (0.34–2.12)
159 Incidence, rectal cancer 1.53 (0.77–3.03) Hartman, 1998 COL00214 Finland ATBC, Nested Case Control, Age: 50-69 years, M, Male Smokers 106/ 27002 controls 6.1 years Cancer registry Recall questionnaire + FFQ Incidence, colon cancer ≥1 vs 0 cups/day 2.09 (1.34-3.26) Age, BMI, calcium, Intervention occupational physical activity Mid-point categories 79/ Incidence, rectal cancer 0.87 (0.47-1.60) 146Main 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 categories assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Reasons for exclusion Peterson, 2010 COL40820 Singapore SCHS, Prospective Cohort, Age: 45-74 years, M/W 325/ 61 321 9.8 years Cancer registry and pathology register Incidence, advanced colon cancer >2 vs <1 cups/day 0.89 (0.66-1.19) Ptrend:0.40 Age, alcohol, BMI, diabetes, dialect group, educational level, family history of colorectal cancer, gender, green tea, physical Advanced and localized colon cancer 229/ 61 321 9.8 years Incidence, localized colon cancer >2 vs <1 cups/day 0.82 (0.59-1.14) Ptrend:0.24
activity, smoking, year 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 yes vs no 0.80 (0.60-1.00) Ptrend:0.03 Age, energy intake Superseded by Nechuta, 2012 COL40923 236 Incidence, cancer 0.80 (0.60-1.20) 158 Incidence, rectal cancer 0.70 (0.40-1.00) Sun, 2007 COL40660 Singapore SCHS, Prospective Cohort, Age: 45-74 years, M/W 1 115/ 61 320 8.9 Cancer registry and mortality registry FFQ Incidence, colorectal cancer daily vs non drinker 0.92 (0.73-1.16) Ptrend:0.50 794/ Incidence, localised colorectal cancer, men daily vs non drinker 0.99 (0.64-1.55) Ptrend:0.59 648/ Incidence, colorectal cancer, men daily vs non drinker 0.87 (0.66-1.15) Ptrend:0.41 467/ Incidence, colorectal cancer, women daily vs non drinker 1.03 (0.67-1.57) Ptrend:0.95 355/ Incidence, advanced vs non drinker 0.83 (0.57-1.20) Ptrend:0.29
activity, smoking status, total energy, total fat, vitamin c, year of Interview colorectal cancer, men 195/ Incidence, advanced colon cancer, men vs non drinker 0.84 (0.51-1.38) Ptrend:0.43 135/ Incidence, localized cancer, men vs non drinker 0.75 (0.38-1.49) Ptrend:0.71 Lin, 2006 COL40703 USA NHS-HPFS, Prospective Cohort, Age: 30-75 years, M/W 498/ 107 401 10 years Self-report verified by medical record FFQ Incidence, colorectal cancer, women ≥1 vs 0-0.5 servings/week 0.90 (0.72-1.13) Ptrend:0.65 Age, alcohol intake, aspirin use, BMI, calcium intake, family history of colorectal cancer, fibre intake, folate intake, history of polyps, multivitamin supplement intake, physical activity, postmenopausal hormone use, Supersded by Michels, 2005 COL40754 & Zhang, 2010 (Pooling project study) 380/ Incidence, colorectal cancer, men ≥1 vs 0-0.5 servings/week 1.15 (0.88-1.52) Ptrend:0.11
red meat intake, sigmoidoscopy, smoking status, total energy intake Zheng, 1996 COL00210 USA IWHS, Prospective Cohort, Age: 55-69 years, W, Postmenopausal 350/ 35 369 8 years SEER FFQ Incidence, cancer, ≥2 vs 0-3 0.71 (0.45-1.11) Ptrend:0.16 Age, educational level, family history of specific cancer, pack-years cigarette smoking, physical activity, smoking status, waist-hip circumference ratio Fruits and vegetables intake Superseded by Zhang, 2010 (Pooling project 124/ 35 369 8 years Incidence, rectum and anus cancer, ≥2 vs 0-3 cups/month 0.70 (0.34-1.46) Ptrend:0.31 Goldbohm, 1996 COL00120 Netherlands NLCS, Case Cohort, Age: 55-69 years, M/W 564/ 120 852 4.3 years Cancer registry and database of pathology reports FFQ Incidence, colorectal cancer, 0.94 (0.66-1.34) Ptrend:0.748 184/ Incidence, colon cancer, men 1.01 (0.53-1.91) Ptrend:0.796
specific cancer, fibre intake, folate intake, gallbladder surgery 163/ Incidence, colon cancer, women 0.69 (0.37-1.29) Ptrend:0.264 140/ Incidence, rectal cancer, men 1.49 (0.78-2.85) Ptrend:0.212 127/ Incidence, colorectal cancer, 2 lowest quintiles of vegetable& fruit consumption 0.96 (0.45-2.11) Ptrend:0.982 63/ 10 517 11.5 years Incidence, rectal cancer ≥7 vs 0-2 cups/day 1.07 Ptrend:0.94 Heilbrun, 1986 COL01022 USA HHP, Prospective Cohort, Age: 45- years, M, Japanese ancestry 76/ 7 833 126 613 Unknown Interview Incidence, rectal cancer, > once/day vs almost never times 4.20 Ptrend:0.0007 Alcohol consumption The exposure is Black tea
Table 150 Green tea 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 number of cases Studies country, area Outcome Comparison RR (95%CI) P (I2, p value) Meta-analysis Wang, 2012 6 1 675 Worldwide Incidence, colorectal cancer Highest vs lowest 0.90 (0.72-1.08) Per 1 cup/day 0.97 (0.91-1.03)
Table 151 Green tea consumption and colon cancer risk. Main characteristics of studies included in the CUP SLR dose-response Author, Year, WCRF Code, Country name, characteristics Study size Follow-up (years) Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Missing data derived for analyses Yang, 2011 COL40885 China SMHS, Prospective Cohort, Age: 40-74 years, M 133/ 60 567 4.6 years Cancer registry and medical records Survey Incidence, colon cancer Yes vs no 0.69 (0.48-0.98) Age, education, cigarette smoking, of cigarette smoking, alcohol consumption, regular exercise, Body Mass Index, history of diabetes, family history of colorectal cancer and intakes of vegetables, fruits and red meat Mid-point exposure ≥250 vs ≤0 0.85 (0.62-1.15) Ptrend:0.27 Lee, 2007 COL40654 Japan JPHC, Prospective Cohort, Age: 52 years, M/W 476/ 96 162 10 Active patient notification from hospitals, cancer registries and death cert. Questionnaire FFQ Incidence, colon cancer, men ≥5 cups/day vs almost never 0.92 (0.63–1.33) Age, alcohol drinking, beef consumption, black tea consumption, BMI, Chinese tea, family Mid-point exposure Person-years of follow up 284/ Incidence, colon cancer, women 1.1 (0.7-1.73) analysis
history of colorectal cancer, green tea consumption, green vegetables, physical activity, pork, smoking status, study centre Oba, 2006 COL40626 Japan TCCJ, Prospective Cohort, Age: 35-101 M/W 111/ 30 221 8 years Hospital records and cancer registry FFQ Incidence, colon cancer, men 1cup/day or more vs 0.75 (0.49-1.16) Age, alcohol intake, BMI, energy intake, height, of smoking, physical activity exposure Person-years of follow up 102/ Incidence, colon cancer, women 1.08 (0.67-1.76) Suzuki, 2005 COL01931 Japan Miyagi perfecture cohort I, Prospective Cohort, Age: 40- M/W 158/ 65 915 9 years Cancer registry/ population register Questionnaire Incidence, colon cancer, Cohort I 5 vs 0 cups/day 0.82 (0.49-1.39) Age, sex, alcohol consumption, black tea intake, BMI, coffee intake, family history of colorectal cancer, fruits, green and yellow vegetables Mid-point exposure Miyagi perfecture cohort II 147 Incidence, cancer, Cohort II 0.84 (0.48-1.45)
consumption, meat intake, other vegetables intake, smoking status Table 152 Green tea consumption and colon 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 Inclusion/ exclusion reason Nechuta, 2012 COL40923 China SWHS, Prospective Cohort, Age: 40-70 years, W 586/ 69 310 11 years Medical records and cancer registries Interview Incidence, colon cancer, non Current vs never 0.96 (0.74, Age, BMI, diabetes, educational level, exercise, family history of cancer, fruits and vegetables consumption, marital status, meat, occupation Included in HvsL analysis only Yang, 2007 COL40676 China SWHS, Prospective Cohort, 255/ 69 710 6 years Cancer registry Questionnaire Incidence, colon cancer ≥5 vs ≤0 g/day 0.56 (0.32-0.98) Ptrend:0.01 Superseded by Nechuta, 2012 COL40923
Age: 40-70 years, W Sun, 2007 COL40660 Singapore SCHS, Prospective Cohort, Age: 45-74 years, M/W 1 208/ 61 320 8.9 years Cancer registry and mortality registry Incidence, localized colon cancer daily vs non drinker 0.78 (0.4-1.5) Ptrend:0.08 Sex, age at Interview, tea consumption, BMI, calcium intake, coffee, dialect group, dietary fibre intake, educational level, family history of colorectal cancer, history of diabetes, moderate activity, smoking status, total energy, total fat, vitamin c, year of Interview Included in HvsL nalysis only No specific ranges Nagano, 2001 COL00359 Japan Life Span Study, Prospective Cohort, 412/ 38 540 Responding to mail survey Questionnaire Incidence, cancer, ≥5 vs 0-1 times/day 1.00 (0.76-1.4) Participants are Atomic Bomb Survivors
Table 159 Total alcoholic drinks 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 size Follow-up (years) Case ascertainment Exposure assessment Outcome Comparison RR (95%CI) Ptrend Adjustment factors Missing data derived for analyses Hippisley-Cox, 2015 COL41058 England QResearch database study, UK, Prospective Cohort, Age: 25-84 years, M/W 18 130/ 4 943 765 15 years Cancer registry/death records Medical records Incidence, colorectal cancer, men ≥9.1 vs ≤0 units/day 1.56 (1.33-1.83) Age, cancer diagnosis, ethnicity, family history of colorectal cancer, presence of other disease, smoking status, type 2 diabetes mellitus Distribution of by exposure category, of exposure categories. 14 496/ Women ≥9.1 vs ≤0 units/day 1.36 (0.80-2.32) Klatsky, 2015 COL41059 USA Prospective Cohort, Age: 41 years, M/W 2 148/ 124 193 17.8 Cancer registry Questionnaire Incidence, colorectal cancer ≥3 vs ≤0 drinks 1.40 (1.10-1.70) Age, sex, BMI, educational level, marital status, race/ethnicity, smoking Distribution of person-years by exposure category, of exposure categories. Land, 2014 COL41062 USA NSABP, Prospective Cohort, Age: 54 years, W, High Risk population 35/ 13 388 7 Follow-up visits Questionnaire Incidence, Invasive colon cancer ≥1.1 vs ≤0 drinks/day 0.61 (0.23-1.63) Age, aspirin use, BMI, estrogen use, family history of cancer, leisure time physical activity, menstrual status, race, smoking duration, smoking Intensity, smoking status, Distribution of by exposure category, of exposure categories.
treatment allocation Everatt, 2013 COL40967 Lithuania KRIS-MIHDPS, Prospective Cohort, Age: 40-59 years, M 141/ 7 150 30 years Cancer registry and death registry Questionnaire Incidence, colorectal cancer 2-7/week vs few times year times 1.62 (0.88-2.99) Age, BMI, educational level, smoking, study Conversion from drinks/week to drinks/day, of exposure categories. Odegaard, 2013 COL40948 Singapore SCHS, Prospective Cohort, Age: 45-74 years, M/W 969/ 50 466 579 628 Cancer registry and death registry Incidence, cancer 8-14 vs >14 drinks/week 0.73 (0.40-1.33) Age, sex, BMI, diabetes, dialect dietary pattern score, educational level, energy intake, family history of colorectal cancer, physical activity, sleep, smoking, time of recruitment Distribution of person-years by exposure category, of exposure categories. Recalculate RR using Hamling’s method Allen, 2009 COL40762 UK MWS, Prospective Cohort, Age: 55 years, W, midlife women 2129 1 280 296 7.2 years Cancer registry Questionnaire Incidence, cancer ≥15 vs ≤2 drinks/day 1.00 (0.87-1.15) Age, area of residence, BMI, hormone use, physical activity, smoking status, status, use of oral contraception Distribution of person-years by exposure category, of exposure categories. Recalculated floated RR’s
337 Incidence, rectal cancer ≥15 vs ≤2 drinks/day 1.25 (1.06-1.49) Park, 2009 COL40771 UK EPIC-Norfolk, Prospective Cohort, Age: 40-79 years, M/W 386/ 24 244 11 years Routine record linkage with cancer registration and certification FFQ Incidence, colorectal cancer ≥21 vs ≤0 units/week 0.70 (0.44-1.13) Age, sex, calcium intake, dietary fibre intake, educational level, energy intake, family history of colorectal cancer, fat intake, folate intake, height, physical activity, processed meat, smoking status, total meat intake, weight Distribution of person-years by exposure category, of exposure categories. Conversion from drinks/week to drinks/day Aleksandrova, 2014 COL41051 used in highest vs lowest for colon and rectal cancer 256/ Incidence, colon cancer ≥21 vs ≤0 0.59 (0.32-1.09) 213/ Incidence, colorectal cancer, men ≥21 vs ≤0 units/week 0.85 (0.45-1.58) 173/ Women 14-20 vs ≤0 units/week 0.83 (0.44-1.56) 137/ Incidence, colon cancer, men ≥21 vs ≤0 units/week 0.69 (0.32-1.50) 122/ Incidence, rectal cancer ≥21 vs ≤0 units/week 0.94 (0.43-2.09) 119/ Incidence, colon cancer, women 14-20 vs ≤0 units/week 1.00 (0.48-2.08) 69/ Incidence, rectal cancer, men ≥21 vs ≤0 units/week 1.14 (0.38-3.43) 53/ 14-20 vs ≤0 units/week 0.55 (0.15-2.02) Tsong, 2007 COL40685 Singapore SCHS, Prospective Cohort, Age: 45-74 years, 845/ 61 321 8.9 years Cancer registry FFQ Incidence, colorectal cancer ≥7 vs ≤0 drinks/week 1.84 (1.31-2.58) 516/ Incidence, colon cancer ≥7 vs ≤0 drinks/week 1.84 (1.31-2.35)
M/W history of colorectal cancer, physical activity, smoking status, year of recruitment drinks/day Superseded by Odegaard, 2013 COL40948 for colon cancer analysis 329/ Incidence, rectal cancer ≥7 vs ≤0 drinks/week 1.59 (1.07-2.35) Wakai, 2005 COL40727 JACC, Prospective Cohort, Age: 40-79 M/W 382/ 57 736 7.6 years Record linkage with cancer registries, population registries, death cert, medical records Questionnaire Incidence, cancer, men ≥3.0 vs 0 drinks/day 2.40 (1.31-4.40) Age, area, beef consumption, BMI, educational level, family history of colorectal cancer, green vegetables, sedentary behaviour, smoking habits, walking time, walking time Mid-points of exposure categories 242/ Incidence, rectal cancer, men ≥3.0 vs 0 drinks/day 1.32 (0.67-2.63) 225/ Incidence, colon cancer, women ≥1.0 vs 0 drinks/day 1.22(0.49-3.03) 68/ Incidence, rectal cancer, women ≥1.0 vs 0 drinks/day 1.01 (0.67-1.51) Sanjoaquin, 2004 COL01182 UK OVS, Prospective Cohort, Age: 18-89 years, M/W 95/ 10 998 17 years FFQ Incidence, colorectal cancer, ≥8 vs ≤1 unit/week 1.53 (0.87-2.69) Age, sex, alcohol consumption, smoking habits Distribution of by exposure category, of exposure categories. of exposure categories. Conversion from
drinks/week to drinks/day Su, 2004 COL01929 USA NHEFS, Prospective Cohort, Age: 25-74 years 111/ 10 220 10 years General population (survey) FFQ Incidence, colon cancer ≥1 vs ≤0 drinks/day 1.69 (1.03-2.79) Age, sex, BMI, educational level, meat intake, meat intake, multivitamin supplement intake, previous polyps, race, smoking status Mid-points of exposure categories. Pedersen, 2003 COL00350 Denmark Prospective Cohort, M/W, on 3 comprehensive Danish programmes 411/ 33 264 426 934 Population Questionnaire Incidence, colon cancer, ≥41 vs ≤1 drinks/week 0.80 (0.50-1.50) Age, sex, BMI, smoking habits, study of origin Distribution of person-years by exposure category, of exposure categories. of exposure categories. 202/ Incidence, rectal cancer, ≥41 vs ≤1 drinks/week 2.20 (1.00-4.60) Flood, 2002 COL00411 USA Breast Cancer Detection Demonstration Project cohort, Prospective Cohort, Age: 40-93 years, 490/ 45 264 8.5 years Breast cancer screening centres FFQ Incidence, colorectal cancer, ≥2 vs ≤0 serving/day 1.16 (0.63-2.14) Dietary folate, energy intake, methionine, smoking habits Distribution of by exposure category, of exposure categories. of exposure points points
W categories. Chen, 2001 COL00379 USA PHS, Nested Case Control, M, physicians, 93% Caucasian 211/ 1104 controls 13 years Medical records Questionnaire Incidence, colorectal cancer, ≥5 vs ≤1 drinks/week 1.25 (0.85-1.84) Age, multivitamin, randomized treatment assignment, smoking status Distribution of person-years by exposure category, of exposure categories. of exposure categories. Conversion from drinks/week to drinks/day Driver, 2007 COL40711 Used in highest versus lowest analysis Klatsky, 1988 COL00656 USA KPMCP, Nested Case Control, M/W 173/ 2 410 Hospital records Questionnaire Incidence, colon cancer, excluding cases with history of bowel symptoms ≥3 vs never drinker drinks/day 1.20 (0.51-2.81) Age, sex, BMI, cholesterol, coffee, educational level, ethnicity Distribution of person-years by exposure category, of exposure categories. of exposure categories. 66 Rectal cancer 3.17(1.05-9.37) points
Table 160 Total alcoholic drinks 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 Aleksandrova, 2014 COL41051 Europe EPIC, Prospective Cohort, Age: 25-70 years, M/W 728/ 347 237 12 years Cancer registry Incidence, colon men limited vs heavy 0.85(0.74-0.97) Age, sex, body fat, diet quality, educational physical activity, smoking Only included in highest versus lowest analysis Incidence, colon, women 0.99(0.88-1.14) Incidence, rectal cancer, men 0.76 (0.64-0.89) Incidence, rectal cancer, women 0.91(0.76-1.09) Shen, 2013 COL40995 Chinese elderly cohort study HK, Prospective Cohort, Age: 65- years, M/W, Elderly 944/ 66 820 10.5 years Hospital records and register Questionnaire Mortality, colorectal cancer High vs never 1.25 (0.68 to 2.30) Age, sex, BMI, educational level, exercise, health status, housing, monthly expenditure, smoking status Outcome is mortality 516/ Men 1.48 (0.80 to 2.74) 428/ Women Moderate vs never 0.46 (0.11 to 1.83) Yang, 2012 COL40922 CNRPCS, Prospective Cohort, Age: 40-79 years, M 193/ 218 189 15 Annual follow up by trained staff, death certificate and symptoms Questionnaire Mortality, colorectal cancer ≥700 vs g/week 1.06 (0.55-2.06) Ptrend:0.5 5-year educational level, geographic area, smoking Outcome is mortality all drinkers vs non-drinkers 0.90 (0.65-1.24) age-
described by family members Breslow, 2011 COL40892 USA NHIS, Prospective Cohort, Age: 18- 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) Sex, BMI, educational level, marital status, race/ethnicity, region, smoking status The outcome is mortality, only included on highest versus lowest analysis 367/ Mortality, colorectal cancer, women >7 vs 0 drinks/week 1.05 (0.61-1.80) Men >14 vs 0 drinks/week 1.08 (0.60-1.96) Cnattingius, 2009 COL40776 Sweden Swedish Twin Cohort, Prospective Cohort, M/W, Twins 207/ 23 337 33 years Population cancer registries and other procedures FFQ Incidence, colorectal cancer moderately high vs none 1.01 (0.53-1.91) Age Included only in highest vs lowest analysis 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 ≥7 vs ≥0 drinks/week 1.58 (1.23-2.04) Ptrend:0.001 Age, sex, alcohol intake, BMI, diabetes, dialect group, educational level, energy intake, exposure assessment, family history of colorectal cancer, physical Superseded by Odegaard, 2013 COL40948
158/ Mortality, colon cancer, men ≥81 vs ≤0 ml/day 1.75 (0.97-3.14) 115/ Mortality, rectal cancer, men ≥81 vs ≤0 ml/day 2.25 (1.22-4.14) 77/ Women ex-drinkers vs rare/none 1.51 (0.36-6.21) 68/ Women 1-53 vs ≤0 ml/day 0.62 (0.24-1.57) ex-drinkers vs rare/none 1.57 (0.90-2.75) McCarl, 2006 COL40633 USA IWHS, Prospective Cohort, Age: 55-69 W 954/ 35 197 15 years SEER registry FFQ Incidence, colorectal cancer yes vs no 1.00 (0.88-1.14) Age Included only in highest versus lowest Yeh, 2006 COL40675 Taiwan Taiwanese Cohort, Prospective Cohort, Age: 30-65 years, M/W 68/ 23 943 10 years Cancer registry and certificates Dietary record Incidence, colorectal cancer, men yes vs no 1.23 (0.71-2.16) Age, BMI, cholesterol, smoking, Included only in highest versus lowest analysis Jiang, 2005 COL01846 73/ 343 controls Cancer registry FFQ Incidence, rectal cancer 0.65 (0.30-1.41)
China China, Haining City of Zhejiang Province, Nested Case Control, Age: 40- years, M/W 12 years methionine intake, smoking habits, energy intake, zinc intake Included only in highest vs lowest analysis Incidence, cancer 1.04(0.46-2.39) Chen, 2005 COL40724 China Chinese Jiashan screening study, Prospective Cohort, Age: 30- years, M/W, Screening Program 121/ 64 100 10.6 years Cancer registry and death registry Questionnaire and Interview Incidence, colorectal cancer, women vs (never or almost never) 1.06 (0.33-3.48) Age, educational level, marital status, occupation, smoking status Included only in highest vs lowest analysis Men daily vs (never or almost never) 1.03 (0.65-1.64) Incidence, colon cancer, women occasional vs non-drinker (never or almost never) 1.00 Incidence, rectal cancer, men daily vs (never or almost never) 1.37 (0.71-2.65) Wei, 2004 COL00581 USA The Nurses's Health Study Cohort, Prospective Cohort, W, 61/ 87 733 24 years Self-reported verified by medical record and The National Death Index FFQ 0.72 (0.29-1.81)
nurses cancer, folate, height, history of endoscopy, pack-years of smoking before age 30, physical activity, processed meat Health Professionals Study 135 1.06(0.5-2.27) Koh, 2004 COL00053 SCHS, Nested Case Control, Age: 45-74 years, M/W 310/ 1177 controls Cancer registry Questionnaire Incidence, colorectal cancer, daily vs nondrinkers Ptrend:0.14 Unadjusted results Superseded by Tsong, 2007 COL40685 Konings, 2002 COL01271 Netherlands NLCS, Case Cohort, Age: 55-69 years, M/W 400/ 120 852 7.3 years Cancer registry and database of pathology reports FFQ Incidence, cancer, men alcohol drinkers vs nonalcohol drinkers Unadjusted results 360/ Women alcohol drinkers vs nonalcohol drinkers 259/ Incidence, rectal cancer, men alcohol drinkers vs nonalcohol drinkers 152/ Women alcohol drinkers vs nonalcohol drinkers
years years Hsing, 1998 COL00458 USA Lutheran Brotherhood Study, Prospective Cohort, Age: 35- years, M, policyholders 87/ 17 633 286 731 Responding to mail survey Questionnaire Mortality, colorectal cancer, ≥14 vs ≤0 drinks/month 1.20 (0.60-2.70) Age, alcohol intake, area of residence Outcome is mortality, only included in highest versus lowest analysis Singh, 1998 COL00185 USA AHS, Prospective Cohort, Age: 25- years, M/W, Seventh-day Adventists 146/ 32 051 178 544 Census list FFQ Incidence, colon cancer, ≥1 vs ≤1 times/week 2.05 (1.00-4.23) Age, sex, family history of specific cancer Included only in HvL analysis 1996 COL00431 Finland ATBC, Prospective Cohort, Age: 50-69 years, M, Smokers 119/ 27 109 8 years Cancer registry Food-use questionnaire Incidence, colorectal cancer, alcohol consumption:yes Q 4 vs Q 1 1.70 (1.00-2.90) Age Included only in highest versus lowest analysis Suadicani, 1993 COL01085 Denmark Denmark, Copenhagen fitness and risk of cvd study, Prospective Cohort, Age: 40-59 51/ 5 429 18 years Public or private companies Questionnaire Incidence, colon cancer, (mean exposure) Age No measure of the relationship. Only mean values. 42/ Incidence, rectal cancer, (mean exposure)
M/W Sidney, 1986 COL01239 USA KPMCP, Nested Case Control, M/W 245/ 1225 controls 348 000 Medical records Questionnaire Incidence, colorectal cancer, current alcohol drinker vs no current alcohol use Age, sex, race, time of examination No risk estimate provided Superseded by Klatsky, 2015 COL41059 Hirayama, 1985 COL01652 Japan Japanese cohort study, Prospective Cohort, Age: 40- M 122 261 16 Population Questionnaire Mortality, colon cancer, yes vs no 0.66 Outcome is mortality, insufficient data to do analysis Smokers yes vs no 0.78 Pollack, COL00720 Hawaii HHP, Prospective Cohort, M, Honolulu Heart Study subjects 92/ 7 837 104 881 Hospital records + cancer registry Questionnaire Incidence, colon cancer, ≥40 vs ≤0 oz/month Ptrend:0.480 Age, cigarette smoking No risk estimate provided Superseded by Stemmermann, 1990 COL00816 Williams, 1981 COL01163 USA FHS, Prospective Cohort, Age: 35-69 years, M 30/ 5 209 24 years Population Questionnaire Incidence, colon cancer, women yes vs no 1.35 Age, educational level, smoking status Insufficient data to compute confidence intervals 28/ Men yes vs no 1.45 Metropolitan relative weight, cholesterol, systolic blood pressure
Table Dietary Fibre 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, 2011 16 colorectal cancer North America, Europe and Asia Colorectal cancer Per 10 g/day 0.90 (0.86–0.94) 0%, 0.48 13 Colon cancer 0.89(0.81-0.97) 35%, 0.11 10 Rectal cancer 0.91(0.83-1.03) 15%, 0.31
746/ Incidence, distal colon cancer, women ≥27.5 vs ≤16.1 g/day 0.76 (0.53-1.09) Ptrend:0.12 per 10 g/day 0.87 (0.73-1.05) 520/ Incidence, distal colon cancer, Men per 10 g/day 0.89 (0.73-1.08) ≥30.6 vs ≤17.3 g/day 0.68 (0.44-1.05) Ptrend:0.061 478/ Incidence, proximal colon cancer, men per 10 g/day 0.96 (0.79-1.16) ≥30.6 vs ≤17.3 g/day 0.95 (0.62-1.47) Ptrend:0.77 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 ≥21.3 vs ≤9.8 g/day 1.06 (0.67-1.70) Ptrend:0.97 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 Mid-points of exposure categories 798/ Incidence, proximal colon cancer ≥21.3 vs ≤9.8 g/day 1.20 (0.73-1.95) Ptrend:0.97 351/ Incidence, distal cancer ≥21.3 vs ≤9.8 g/day 0.97 (0.46-2.05) Ptrend:0.94 303/ Incidence, rectal cancer ≥21.3 vs ≤9.8 g/day 0.88 (0.39-2.01) Ptrend:0.39 Schatzkin, 2007 NIH-AARP, 2 974/ Cancer registry FFQ Incidence, 15.9 vs 6.6 0.99 (0.85-1.15)
multivitamin supplement intake, of smoking, physical activity, red meat intake, vitamin d, hormone use intake per each quantile cancer, men g/kcal/day Ptrend:<0.0001 802/ Women 18.6 vs 7.5 g/kcal/day 0.92 (0.68–1.25) Ptrend:0.361 308/ Incidence, rectal cancer, men 16.5 vs 6.1 g/kcal/day 0.52 (0.32-0.84) Ptrend:0.004 207/ Women 18.6 vs 7.5 g/kcal/day 0.82 (0.48-1.43) Ptrend:0.639 Wakai, 2007 COL40674 Japan JACC, Prospective Cohort, Age: 40-79 years, M/W 443/ 43 115 7.6 years Cancer registry and death certificates and medical records FFQ Incidence, colorectal cancer Q 4 vs Q 1 0.73 (0.51-1.03) Ptrend:0.028 Age, sex, alcohol consumption, area, beef consumption, BMI, calcium intake, walking habits, educational level, energy intake, family history of colorectal cancer, folate, energy adjusted, physical Estimated weighted average exposure values from sex-specific cut-points. 291/ Incidence, colon cancer Q 4 vs Q 1 0.74 (0.53-1.03) Ptrend:0.019 Q 4 vs Q 1 0.58 (0.38-0.88) Ptrend:0.002 142/ Incidence, rectal cancer Q 4 vs Q 1 1.10 (0.59-2.07) Ptrend:0.67
up activity, pork, sedentary behaviour, vitamin d Otani, 2006 COL40623 JPHC, Prospective Cohort, Age: 40-69 years, M/W 567/ 86 412 10 years Cancer registry and death certificates FFQ Incidence, colorectal cancer, men Q 5 vs Q 1 0.92 (0.67-1.30) Ptrend:0.30 Age, alcohol consumption, BMI, calcium intake, energy intake, folate intake, time, physical activity, red meat intake, smoking habits, area, vitamin d 340/ Q 5 vs Q 1 1.40 (0.95-2.20) Ptrend:0.90 Q 5 vs Q 1 1.40 (0.94-2.20) Ptrend:0.087 335/ Men 18.7 vs 6.4 g/day 0.85 (0.53-1.40) Ptrend:0.48 18.7 vs 6.4 g/day 0.68 (0.48-0.96) Ptrend:0.021 231/ Incidence, colon cancer, men 18.7 vs 6.4 g/day 0.80 (0.45-1.40) Ptrend:0.39 187/ Incidence, colorectal cancer, women 20 vs 8.3 g/day 0.86 (0.54-1.40) Ptrend:0.95 20 vs 8.3 g/day 0.58 (0.31-1.10) Ptrend:0.21 136/ Incidence, colon cancer, women 20 vs 8.3 g/day 0.48 (0.23-1.00) Ptrend:0.12 104/ Incidence, rectal cancer, men 18.7 vs 6.4 g/day 0.95 (0.40-2.30) Ptrend:0.99 51/ Incidence, rectal cancer, Women 20 vs 8.3 g/day 1.00 (0.32-3.30) Ptrend:0.82
Shin, 2006 COL40665 China SWHS, Prospective Cohort, Age: 40-70 years, W 283/ 73 314 5.74 years Follow up survey/cancer registry/vital statistics registry FFQ Incidence, colorectal cancer ≥13.46 vs 0-7.3 g/day 1.10 (0.60-1.80) Ptrend:0.652 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 category. of exposure categories 129/ Incidence, colon cancer ≥13.46 vs 0-7.3 g/day 1.20 (0.60-2.40) Ptrend:0.835 91/ Incidence, rectal cancer ≥13.46 vs 0-7.3 g/day 0.90 (0.40-2.10) Ptrend:0.335 Park, 2005 Pooling Project 13 cohort studies ATBC CPS II HPFS NLCS NYSC BCDDP 6-20 8081 321 720+479 597 646+501 492+296 436 questionnaire, medical record, cancer registry Study specific FFQ Incidence, colorectal cancer Highest vs Lowest ≥30 vs <10 g/day 0.94(0.86-1.03) 1.00(0.85-1.17) Ptrend:0.68 Incidence, colon cancer (5724 ≥30 vs <10 g/day 1.04(0.86-1.26) Ptrend:0.17
CNBSS IWHS NYUWHS NHS SMC WHS 612 1010 127 220+648 61 714 201 hormone therapy; oral contraceptive use; use of nonsteroidal drugs; multivitamin use; smoking habits; alcohol; dietary intake of folate, red meat, total milk, and total energy Incidence, rectal cancer (2031 cases) ≥25 vs <10 g/day 0.87(0.68-1.09) Ptrend:0.27 Sanjoaquin, 2004 COL01182 UK OVS, Prospective Cohort, Age: 18-89 M/W 63/ 10 998 17 years FFQ Incidence, colorectal cancer, Q 3 vs Q 1 0.82 (0.43-1.56) Ptrend:0.424 Age, sex, alcohol consumption, smoking habits Gaard, 1996 COL00008 Norway Norwegian national health screening service study(NNHS), Prospective Cohort, Age: 20-53 years, M/W 83/ 50 535 11.4 years Enrolment by volunteers FFQ Incidence, colon cancer, men ≥17.9 vs ≤13.5 g/day 0.82 (0.46-1.46) Ptrend:.6 Age, attained age, BMI, energy intake, height, smoking status Mid-points of exposure categories 59/ Women ≥11.3 vs ≤8.5 g/day 2.10 (0.90-4.87) Ptrend:.12
Heilbrun, 1989 COL01555 USA HHP, Nested Case Control, M 102/ 361 controls 16 Cancer registry & hospital surveillance Recall questionnaire Incidence, colon cancer, ≤7.5 vs ≥14.8 g/day 1.40 Ptrend:0.354 Age Alcohol consumption Estimation of confidence intervals. of exposure categories 60/ 361 controls Incidence, rectal cancer, ≤7.5 vs ≥14.8 g/day 0.83 Ptrend:0.192 51/ Incidence, cancer, fat intake, ≥61 g/day ≤7.5 vs ≥14.8 g/day 0.82 Ptrend:0.237 Fat intake, <61 g/day ≤7.5 vs ≥14.8 g/day 2.28 Ptrend:0.042
Age: 50-71 years, Retired consumption, aspirin use, BMI, educational level, energy, energy, fibre, history of colon cancer, HRT use, physical activity, race, smoking baseline. Schatzkin, 2007 COL40662 was used. 985/ Incidence, rectal cancer 13 vs 5 g/1000 kcal 1.26 (1.00-1.58) Ptrend:0.06 Dahm, 2010 COL40866 UK UK Dietary Cohort Consortium 7 UK cohort studies, Guernsey Study, EPIC- Norfolk, EPIC-Oxford, NSHD, Oxford Vegetarian, UKWCS, Whitehall M/W 579/ 1996 controls Cancer registry Food and FFQ Incidence, colorectal cancer per 1 quintile 0.92 (0.83 to Alcohol intake, dietary folate, energy from fat, energy from non-fat sources, height, weight Includes EPIC Norfolk and EPIC Oxford. Superseded by by Murphy, 2012 COL40914 and Bradbury, 2014 COL41009 Q5 vs Q1 0.67 (0.42 to Hansen, 2009 COL40855 Denmark DCH, Case Cohort, Age: 50-64 years 173/ 57 053 Cancer registry FFQ Incidence, colorectal cancer, gpx1 pro198leu cc per 10 g/day 0.78 (0.55-1.10) 164/ Gpx1 pro198leu ct per 10 g/day 0.93 (0.66-1.31)
smoking, COL41009 38/ Gpx1 pro198leu tt per 10 g/day 1.02 (0.53-1.97) 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 0.98 (0.81-1.19) Ptrend:0.78 Age, sex, alcohol intake, BMI, diabetes, dialect educational level, energy intake, exposure assessment, family history of colorectal cancer, physical activity, smoking habits Only included in highest versus lowest analysis McCarl, 2006 COL40633 USA IWHS, Prospective Cohort, Age: 55-69 years, W 954/ 35 197 15 years SEER registry FFQ Incidence, colorectal cancer ≥25.4 vs ≤13.2 g/day 0.75 (0.61-0.92) Age Included in Pooling Project (Park, 2005) Bingham, 2005 COL40747 Europe EPIC, Prospective Cohort, Age: 25-70 years, M/W 1 118/ 519 978 2 279 075 person-years registries, mortality registries, health Insurance records, active follow up FFQ Incidence, colon cancer, men ≥29.5 vs ≤15.9 g/day 0.77 (0.58-1.02) Ptrend:0.01 603/ Incidence, rectal cancer, men ≥29.5 vs ≤15.9 g/day 0.81 (0.55-1.21) Ptrend:0.5 496/ Incidence, left colon cancer, ≥29.5 vs ≤15.9 g/day 0.58 (0.39-0.86) Ptrend:<0.001
1 776 498 person-years cancer, women 593/ Men per 5 g 0.97 (0.89-1.05) Incidence, rectal cancer, women per 5 g 0.95 (0.75-1.20) Men per 5 g 0.99 (0.83-1.18) Incidence, colon cancer, women per 5 g 0.98 (0.88-1.10)
Age: 21-83 years, M/W 2 279 075 and processed meat intake body weight, centre location, energy from fat sources, energy from non-fat sources, fibre, height, physical activity, smoking status Higginbotham, 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 0.79 (0.45-1.38) Ptrend:0.50 Age, alcohol consumption, BMI, calcium, energy-adjusted folate, total fat, vitamin d, family history of specific cancer, history of oral contraceptive use, HRT use, NSAID use, physical Included in Pooling Project (Park, 2005) per 10 g/day 0.83 (0.61-1.14)
M/W intake, family history of colorectal cancer, multivitamin, physical activity, red meat intake, smoking habits 210/ ≥14.4 vs 0-7.9 g/day 0.86 (0.52-1.42) Ptrend:0,71 + HRT use Konings, 2002 COL01271 Netherlands NLCS, Case Cohort, Age: 55-69 years, M/W 120 852 7.3 years Cancer registry and database of pathology reports FFQ Incidence, colon and rectal cancer Mean exposure Included in Pooling Project (Park, 2005) Terry, 2001 COL00059 Sweden SMC, Prospective Cohort, Age: 40-74 years, W 460/ 61 463 588 270 Mammography screening program FFQ Incidence, colorectal cancer, 21.8 vs 12.3 g/day 0.96 (0.70-1.33) Ptrend:0.98 Age, alcohol consumption, BMI, calcium, educational energy intake, folic acid intake, red meat intake, total fat intake, vitamin c, vitamin d Included in Pooling Project (Park, 2005) Colbert, 2001 COL00384 Finland ATBC, Prospective Cohort, 152/ 29 133 12 years Cancer registry Food-use questionnaire Incidence,
Age: 50-69 years, M, Male Smokers 104/ Fuchs, 1999 COL00103 USA NHS, Prospective Cohort, Age: 34-59 years, W 281/ 88 757 1 408 232 person-years Nurses registry FFQ Incidence, proximal cancer, 24.9 vs 9.8 g/day 1.00 (0.61-1.61) Ptrend:0.96 Age, alcohol consumption, aspirin use, BMI, consumption of beef pork, lamb as main dish, energy intake, energy-adjusted intake, family history of specific cancer, history of colorectal adenoma, physical activity, screening endoscopy during study period, smoking status Included in Pooling Project (Park, 2005) 255/ Incidence, distal colon cancer, 24.9 vs 9.8 g/day 1.08 (0.67-1.72) Ptrend:0.99 Pietinen, 1999 COL00176 Finland ATBC, Prospective Cohort, Age: 50-69 M, Smokers 185/ 27 111 8 years Cancer registry Dietary history questionnaire Incidence, colorectal cancer, 34.1 vs 16 g/day 1.00 (0.60-1.50) Ptrend:0.79 Age, alcohol consumption, BMI, calcium intake, educational level, energy Included in Pooling Project (Park, 2005)
intake, physical activity, smoking years, supplement group 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 ≥22.6 vs ≤16.17 servings/week 0.80 (0.50-1.20) Ptrend:0.3 Age, history of polyps, total energy intake Included in Pooling Project (Park, 2005) /65 Family history of crc ≥22.6 vs ≤16.17 servings/week 1.20 (0.60-2.60) Ptrend:0.6 Kato, 1997 COL00022 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 1.51 (0.85-2.68) Ptrend:0.137 Age, educational level, place at enrolment, total calorie intake Included in Pooling Project (Park, 2005) Tangrea, 1997 COL00267 Finland ATBC, Nested Case Control, Age: 50-69 years, M, 146/ 292 controls Cancer registry Questionnaire Incidence, colorectal cancer, (mean exposure) Age, clinic site, date of blood draw Included in Pooling Project (Park, 2005)
Smokers 1996 COL00161 Finland ATBC, Nested Case Control, Age: 50-69 years, M, Male Smokers 136/ 249 controls 8 years Cancer registry FFQ Incidence, colorectal cancer, (mean exposure) Age, clinic site, date of collection Included in Pooling Project (Park, 2005) Steinmetz, 1994 COL00178 USA IWHS, Prospective Cohort, Age: 55-69 years, W, Postmenopausal 212/ 35 216 167 447 SEER FFQ Incidence, cancer, ≥24.8 vs 0-14.4 g/day 0.80 (0.49-1.31) Age, energy intake Included in Pooling Project (Park, 2005) 120/ Incidence, distal colon cancer ≥24.8 vs 0-14.4 g/day 0.66 (0.34-1.29) 86/ Incidence, proximal colon cancer ≥24.8 vs 0-14.4 g/day 1.03 (0.48-2.22)
Giovannucci, 1994 COL00119 USA HPFS, Prospective Cohort, Age: 40-75 years, M, Health professionals 205/ 47 949 6 Mailing to health professionals FFQ Incidence, colon cancer 32.8 vs 14.2 g/day 1.08 (0.68-1.70) Ptrend:0.12 Age, alcohol consumption, aspirin use, energy intake, family history of specific cancer, methionine, of smoking, previous endoscopic screening, previous polyps, red meat intake Included in Pooling Project (Park, 2005) Bostick, 1993 COL01450 USA IWHS, Prospective Cohort, Age: 55-69 years, W 35 216 167 447 SEER FFQ Incidence, colon cancer (mean exposure) Included in Pooling Project (Park, 2005) Willett, 1990 COL00026 USA NHS, Prospective Cohort, Age: 34-59 years, W, 150/ 88 751 512 488 Population FFQ Incidence, colon cancer, ≥21.3 vs ≤11.5 g/day 0.90 (0.54-1.49) Ptrend:0.70 Age, energy intake Included in Pooling Project (Park, 2005)
Registered nurses Wu, 1987 COL00774 USA Leisure World Cohort, Prospective Cohort, M/W, Retirement community 68/ 11 644 4.5 years Population registries FFQ Incidence, colorectal cancer, women Q 3 vs Q 1 0.64 (0.40-1.20) Age Only included in highest compared to lowest analysis 58/ Men Q 3 vs Q 1 1.13 (0.60-2.10)
Figure Relative risk of colorectal cancer and dietary fibre estimated using non-linear models Table Table with dietary fibre values and corresponding RRs (95% CIs) for non-linear of dietary fibre and colorectal cancer Dietary fibre(g/day) RR (95%CI) 4 1.09(1.04-1.14) 7 1.04(1.02-1.06) 10 1 15 0.94(0.92-0.96) 20 0.89(0.86-0.93) 30 0.82(0. 67-0.87) Figure RR (95% CI) of colorectal cancer for 10g/day increase of dietary fibre including individual study results and not the Pooling Project
Table Foods containing sugars 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 Tasevska, 2012 COL40854 USA NIH-AARP, Prospective Cohort, Age: 50-71 years, 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 1.02 Ptrend:0.55 Alcohol intake, BMI, calcium Intake, calcium supplement, educational level, energy intake, family history of colon cancer, fibre intake, fruit juice, fruits intake, height, marital status, physical activity, race, red meat intake, smoking 1 296/ Incidence, colorectal cancer, women q 5 vs q 1 0.99 Ptrend:0.87 Sellers, 1998 COL01974 USA IWHS, Prospective Cohort, Age: 55-69 W, Postmenopausal 180/ 35 216 10 Seer registry FFQ Incidence, colon cancer, no family history of colorectal cancer ≥21.1 vs ≤14 servings/week 1.00 Ptrend:0.9 Age, history of polyps, energy Intake 61/ Incidence, colon cancer, Family history of colorectal cancer ≥21.1 vs ≤14 servings/week 1.20 Ptrend:0.6 Bostick, 1994 COL00079 USA IWHS, Prospective Cohort, Age: 55-69 years, W 212/ 35 216 167 447 person-years Driving license FFQ Incidence, cancer ≥20.5 vs ≤5.5 serving/week 1.74 Ptrend:0.12 Age, energy intake, height, parity, total vitamin e Intake, total vitamin e Intake * age, vitamin a supplement analysis
cancer, women Ptrend:0.17 683/ Incidence, colorectal cancer, men 67 vs 26 g/day 1.30 Ptrend:0.03 552/ Incidence, colon cancer, men 67 vs 26 g/day 1.25 Ptrend:0.13 131/ Incidence, rectal cancer, men 67 vs 26 g/day 1.47 Ptrend:0.11 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 1.51 Ptrend:0.06 Age, alcohol consumption, BMI, energy-adjusted calcium, folate, energy-adjusted 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 1.08 Bostick, 1994 COL00079 USA IWHS, Prospective Cohort, Age: 55-69 W 212/ 35 216 167 447 Driving license FFQ Incidence, colon cancer ≥62.5 vs ≤25.8 g/day 1.45 Ptrend:0.14 Age, energy intake, height, parity, total vitamin e intake, total vitamin e intake * age, vitamin a supplement Table Fructose intake and colorectal cancer risk. Main characteristics of studies included in the CUP SLR dose-response meta-analysis