Meat, Fish, And Colorectal Cancer Risk

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Meat, Fish, andColorectal Cancer Risk:

The European

ProspectiveInvestigation into

Cancer and Nutrition


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Introduction

It has been estimated that approximately 70% ofcolorectal cancer could be avoided by changes inlifestyle in Western countries.

To examine whether associations exist betweenintakes of red and processed meat, of poultry, andof fish and colorectal cancer risk, a large WesternEuropean population were prospectively followed

People who eat diets rich in meat also tend to eat

less fiber and less fish , and a statisticallysignificant inverse association between dietary fiberconsumption and colorectal cancer risk in thiscohort has been reported elsewhere

Therefore the risk of colorectal cancer associated


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SUBJECTS AND METHODS


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Study Cohort

EPIC is a prospective study designedto investigate the relationshipsamong diet, lifestyle, genetic and

environmental factors, and theincidence of cancer.

The cohort includes 366 521 women

and 153457 men, aged 35 70 yearsat enrollment (1992 and 1998),recruited from the general population

in 10 European countries


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Study cohort (facts inrelation to this analysis)

478 040 subjects were includedinthis analysis.

For this analysis, 22 432 cohortmembers were excluded due to theprevalent cancer at enrollment (otherthan nonmelanoma skin cancer)

10 208 members who were in thelowest and highest 1% of thedistribution of the ratio of reported

total energy intake to energy


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Dietary and LifestyleQuestionnaires

Diet over the 12 months beforeenrollment was measured between1992 and 1998 by country-specific

validated questionnaires.

Most centers adopted a self-administered dietary questionnaire of

88 to 266 food items (some of thequestionnaires was administrated ata personal interview).

For this analysis, meats were


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Identification of ColorectalCancer Case Patients

The follow-up was based onpopulation cancer registries,(exceptin France, Germany and Greece)

Mortality data were collected fromeither the cancer or mortalityregistries at the regional or national

level. Follow-up began at the date of

enrollment and ended at either the

date of diagnosis of colorectal


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Calibration of the DietaryData

A second dietary measurement wastaken from an 8% random sample ofthe cohort (36994 participants!)

using a very detailed computerized24-hour diet recall method tocalibrate dietarymeasurements

across countries and to correct forsystematic over- or underestimationof dietary intakes


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Results


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Results

A total of 478 040 participantscontributed 2 279 075 person-yearsin a mean follow-up of 4.8 years

During follow-up, 1329 participantswere diagnosed with colorectalcancer (95% were verified

histologically) Increasing red and processed

meat intake was statistically

significantly associated with


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Results

Intake of fish was statisticallysignificantly inversely associatedwith colorectal cancer risk (for

highest versus lowest intake HR =0.69, 95% CI = 0.54 to 0.88, P trend


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Results


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Results


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Discussion


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Discussion

This study found a consistentpositive association between highintake of red and processed meat

and colorectal cancer and an inverseassociation between high intake offish and colorectal cancer.

The mechanisms underlying theassociation between colorectalcancer risk and high intake of red

and processed meat are uncertain


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Discussion

Endogenous nitrosation that arisesfrom ingestion of heme-iron but notof inorganic iron or protein may

account for the increased riskassociated with red and processedmeat consumption

Heterocyclic amines (HCAs) andpolycyclic aromatic hydrocarbons(PAH) in diet may pose a potential

risk of cancer to humans


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Discussion

It has been suggested that processedmeat intake has a strongerassociation with colorectal cancer

than red meat intake. Thesefindings was confirmed by thisstudy

It could not be determined whetherone type of meats (processed or red)were more strongly associated was

colorectal-cancers than others


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Discussion

Endogenous N -nitrosation, arisingfrom ingestion of heme, may accountfor the increased risk of colorectal

cancer associated with highconsumption of red meat and thelack of association with intake of

poultry.


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Discussion

Results from animal and in vitrostudies indicate that n 3 fattyacids, especially the long-chain

polyunsaturated fatty acidseicosapentaenoic anddocosahexaenoic acids, which are

present in fatty cold-water fish andfish oils, inhibit carcinogenesis

This study was unable to distinguish

effect between fatty fish and other


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Study limitations

Dietary assessment methods


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Conclusion

The data generated from this studyconfirm that colorectal cancer riskis positively associated with high

consumption of red andprocessed meatand support aninverse association with fish

intake.

Meat, Fish, And Colorectal Cancer Risk

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