Nutrition and colorectal cancer - The role of BMI, sex, biomarkers and dietary index

Colorectal cancer (CRC) is one of the most common forms of cancer. The cause of CRC is multifactorial, and lifestyle factors are thought to be a major contributor to the development of CRC. It can be hypothesised that the association between food intake and the risk of developing CRC depends not only on the food consumed, but what it is consumed in combination with. The associations between food and CRC may also depend on other lifestyle-related factors, such as blood glucose and insulin levels, insulin resistance, and body composition, or sex and clinicopathological characteristics, such as tumour location and tumour-stage. It is not confirmed that the association between a nutrient and CRC is equal to the associations between the different food groups that a nutrient comes from or that the food sources of the nutrients all creates the same associations.The aim of this thesis is therefore to examine associations between dietary intakes and CRC in the Malmö Diet and Cancer cohort, and whether the associations are modified by different preconditions.In the Malmö Diet and Cancer study (MDC) we examined food intake and levels of blood glucose, plasma insulin and insulin resistance by hazard regression regarding incident CRC. In MDC, baseline examinations were performed between 1991 and 1996, where information on body composition, and socioeconomic- and lifestyle factors was obtained, together with collection of blood samples. Food intake was recorded by a modified diet history method. Information on incident cases of CRC was identified via the Swedish cancer registry.We found that high fibre intake was associated with lower risk for CRC, especially with lower risk for colon cancer in women, and that high intake of fruits and berries was associated with lower risk of CRC in women. Regarding meat intake, we found that high intake of pork, as well as intake of processed meat, was associated with risk of CRC. In addition, we found that high fasting blood glucose was associated with higher risk of CRC, especially in colon cancer in men.Finally, we found that high adherence to a predefined CRC-specific diet quality index, based on World Cancer Research Found’s conclusions regarding diet, was inversely associated with risk of CRC, and gave a stronger association with CRC than when analysing the components of the index individually.In conclusion, this thesis found different preconditions for associations between food intake and CRC, dependent on sex, meat subtype, fibre source, and the location of the tumour, but not for presence of overweight and diabetes in this population of inhabitants in Malmö

Är ägg bra vid typ 2 diabetes, fetma och fettlever?

Att ägg är en bra del i en för övrigt sund kost för friska är okontroversiellt. Men hur långt kan man generalisera? När kosten i sin helhet är bra försämrar ägg i normalfallet inte blodfetterna hos personer med typ 2-diabetes och övervikt. Ägg kan då tvärtom bidra till en förbättrad viktkontroll, glukostolerans och mindre leverpåverkan. Om helheten däremot inte är bra, om vikten är på uppåtgående och den fysiska aktiviteten låg, ökar osäkerheten betydligt i fråga om vad kolesterol i ägg kan åstadkomma

High blood glucose levels are associated with higher risk of colon cancer in men : A cohort study

Background: High levels of blood glucose are thought to be associated with colorectal cancer (CRC) and hyperinsulinemia, an interstage in the development of CRC. The purpose of this study was to examine associations between incident CRC and blood glucose; plasma insulin; and the homeostasis model assessment for insulin resistance (HOMA2-IR), respectively, and to determine whether these associations were dependent on sex and cancer site. Methods: The Malmö Diet and Cancer cardiovascular cohort comprises 6103 individuals. During 81,781 person-years of follow-up, 145 cases of CRC were identified. The hazard ratio of measured blood glucose and plasma insulin and calculated HOMA2-IR were estimated with Cox proportional hazard regression. Results: An association was found between high levels of blood glucose and risk of CRC (HR: 1.72 for the highest compared with the lowest quartile 95% CI: 1.05, 2.84; ptrend=0.044), and colon cancer (HR: 1.70 for the highest compared with the lowest quartile 95% CI: 0.87, 3.33; ptrend=0.032). In men, an association was found between blood glucose and CRC (HR: 2.80 for the highest compared with the lowest quartile 95% CI: 1.37, 5.70; ptrend=0.001), and colon cancer (HR: 4.48 for the highest compared with the lowest quartile 95% CI: 1.27, 15.84; ptrend=0.007), but this was not found in women. No associations between plasma insulin, or HOMA2-IR, and CRC, were found. Conclusion: High levels of blood glucose in men are associated with risk of colon cancer. The findings contribute to facilitating to identify those most in need of prevention and screening

Intake of different types of red meat, poultry, and fish and incident colorectal cancer in women and men: results from the Malmö Diet and Cancer Study.

Background : Colorectal cancer (CRC) is considered one of the most common forms of cancer in the Western world. High intake of red and processed meat is considered to increase CRC development. Objective : This study examined associations between intake of red meats, poultry, and fish and incident CRC, and if weight status modifies the associations. Design : In the Malmö Diet and Cancer Study, dietary data was collected through a modified diet history method. Via the Swedish Cancer Registry, 728 cases of CRC were identified during 428 924 person-years of follow-up of 16 944 women and 10 987 men. Results : Beef intake was inversely associated with colon cancer. However, in men high intake of beef was associated with increased risk of rectal cancer. High intake of pork was associated with increased incidence of CRC, and colon cancer. Processed meat was associated with increased risk of CRC in men. Fish intake was inversely associated with risk of rectal cancer. No significant interactions were found between different types of meat and weight status. Conclusions : Findings suggest that associations between meat intake and CRC differ depending on meat type, sex, and tumor location in the bowel. Weight status did not modify observed associations

Fibre intake and incident colorectal cancer depending on fibre source, sex, tumour location and Tumour, Node, Metastasis stage.

Studies on fibre intake and incident colorectal cancer (CRC) indicate inverse associations. Differences by tumour stage have not been examined. We examined associations between fibre intake and its sources, and incidental CRC. Separate analyses were carried out on the basis of sex, tumour location and the Tumour, Node, Metastasis (TNM) classification. The Malmö Diet and Cancer Study is a population-based cohort study, including individuals aged 45-74 years. Dietary data were collected through a modified diet history method. The TNM classification was obtained from pathology/clinical records and re-evaluated. Among 27 931 individuals (60 % women), we found 728 incident CRC cases during 428 924 person-years of follow-up. Fibre intake was inversely associated with CRC risk (P trend=0·026). Concerning colon cancer, we observed borderline interaction between fibre intake and sex (P=0·052) and significant protective association restricted to women (P trend=0·013). Intake of fruits and berries was inversely associated with colon cancer in women (P trend=0·022). We also observed significant interactions between intakes of fibre (P=0·048) and vegetables (P=0·039) and sex on rectal cancer, but no significant associations were seen between intake of fibre, or its sources, in either of the sexes. Except for inverse associations between intake of fibre-rich cereal products and N0- and M0-tumours, we did not observe significant associations with different TNM stages. Our findings suggest different associations between fibre intake and CRC depending on sex, tumour site and fibre source. High fibre intake, especially from fruits and berries, may, above all, prevent tumour development in the colon in women. No clear differences by TNM classification were detected

Inflammatory potential of the diet and risk of colorectal cancer in the European Prospective Investigation into Cancer and Nutrition study

International audienceProinflammatory diets are associated with risk of developing colorectal cancer (CRC), however, inconsistencies exist in subsite- and sex-specific associations. The relationship between CRC and combined lifestyle-related factors that contribute toward a low-grade inflammatory profile has not yet been explored. We examined the association between the dietary inflammatory potential and an inflammatory profile and CRC risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. This cohort included 476,160 participants followed-up of 14 years and 5,991 incident CRC cases (3,897 colon and 2,094 rectal tumors). Dietary inflammatory potential was estimated using an Inflammatory Score of the Diet (ISD). An Inflammatory Profile Score (IPS) was constructed, incorporating the ISD, physical activity level and abdominal obesity. The associations between the ISD and CRC and IPS and CRC were assessed using multivariable regression models. More proinflammatory diets were related to a higher CRC risk, particularly for colon cancer; hazard ratio (HR) for highest versus lowest ISD quartile was 1.15 (95% confidence interval [CI] 1.04–1.27) for CRC, 1.24 (95% CI 1.09–1.41) for colon cancer and 0.99 (95% CI 0.83–1.17) for rectal cancer. Associations were more pronounced in men and not significant in women. The IPS was associated with CRC risk, particularly colon cancer among men; HRs for the highest versus lowest IPS was 1.62 (95% CI 1.31–2.01) for colon cancer overall and 2.11 (95% CI 1.50–2.97) for colon cancer in men. Our study shows that more proinflammatory diets and a more inflammatory profile are associated with higher risk of CRC, principally colon cancer and in men