Abstract
Objectives: Based on previous epidemiological studies, high fat and meat consumption may increase and fiber, calcium, and vegetable consumption may decrease the risk of colorectal cancer. We sought to address these hypotheses in a male Finnish cohort.
Methods: We analyzed data from the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study (ATBC Study) where 27, 111 male smokers completed a validated dietary questionnaire at baseline. After an average of 8 years of follow-up, we documented 185 cases of colorectal cancer. The analyses were carried out using the Cox proportional hazards model.
Results: The relative risk (RR) for men in the highest quartile of calcium intake compared with men in the lowest quartile was 0.6 (95% CI 0.4–0.9, p for trend 0.04). Likewise, the intake of milk protein and the consumption of milk products was inversely associated with risk of colorectal cancer. However, intake of dietary fiber was not associated with risk, nor was fat intake. Consumption of meat or different types of meat, and fried meat, fruits or vegetables were not associated with risk.
Conclusions: In this cohort of men consuming a diet high in fat, meat, and fiber and low in vegetables, high calcium intake was associated with lowered risk of colorectal cancer.
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Potter JD, Slattery ML, Bostick RM, Gapstur SM (1993) Colon cancer: a review of the epidemiology. Epidemiol Rev 15: 499-545.
Fearon ER, Vogelstein B (1990) A genetic model for colorectal tumorigenesis. Cell 61: 759-767.
Giovannucci E, Willett WC (1994) Dietary factors and risk of colon cancer. Ann Med 26: 443-452.
Bergsma-Kadijk JA, van't Veer P, Kampman E, Burema J (1996) Calcium does not protect against colorectal neoplasia. Epidemiology 7: 590-597.
Martinez ME, Willett WC (1998) Calcium, vitamin D, and colorectal cancer: a review of epidemiological evidence. Cancer Epidemiol Biomarkers Prev 7: 163-168.
Glynn SA, Albanes D, Pietinen P et al. (1996) Alcohol consumption and risk of colorectal cancer in a cohort of Finnish men. Cancer Causes Control 7: 214-223.
Glynn SA, Albanes D, Pietinen P et al. (1996) Colorectal cancer and folate status: a nested case-control study among male smokers. Cancer Epidemiol Biomarkers Prev 5: 487-494.
Tangrea J, Helzlsouer K, Pietinen P et al. (1997) Serum levels of vitamin D metabolites and the subsequent risk of colon and rectal cancer in Finnish men. Cancer Causes Control 8: 615-625.
The ATBC Cancer Prevention Study Group (1994) The Alpha-Tocopherol, Beta-Carotene Lung Cancer Prevention Study: design, methods, participant characteristics, and compliance. Ann Epidemiol 4: 1-10.
Pietinen P, Hartman AM, Haapa E et al. (1988) Reproducibility and validity of dietary assessment instruments, I: a self-administered food use questionnaire with a portion size picture booklet. Am J Epidemiol 128: 655-666.
Englyst H (1981) Determination of carbohydrate and its composition in plant materials. In: James WPT, Theander O, eds. The Analysis of Dietary Fiber in Food. New York, NY: Marcel Decker, pp. 71-93.
Willett W, Stampfer MJ (1986) Total energy intake: implications for epidemiologic analyses. Am J Epidemiol 124: 17-27.
The Alpha-Tocopherol Beta Carotene Cancer Prevention Group. (1994) The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. N Engl J Med 330: 1029-1035.
Grambsch PM, Therneau TM (1994) Proportional hazards tests and diagnostics based on weighted residuals. Biometrika 81: 515-524.
Garland C, Shekelle RB, Barrett-Connor E, Criqui MH, Rossof AH, Paul O (1985) Dietary vitamin D and calcium and risk of colorectal cancer: a 19-year prospective study in men. Lancet 1: 307-309.
Wu AH, Paganini-Hill A, Ross RK, Henderson BE (1987) Alcohol, physical activity, and other risk factors for colorectal cancer: a prospective study. Br J Cancer 55: 687-694.
Heibrun LK, Nomura A, Hankin JH, Stemmermann GN (1985) Dietary vitamin D and calcium and risk of colorectal cancer (letter). Lancet 1: 925.
Stemmermann GN, Nomura A, Chyou P-H (1990) The influence of dairy and non-dairy calcium on subsite large-bowel cancer risk. Dis Colon Rectum 33: 190-194.
Bostick RM, Potter JD, Sellers TA, McKenzie DR, Kushi LH, Folsom AR (1993) Relation of calcium, vitamin D, and dairy food intake to incidence of colon cancer among older women: The Iowa Women's Health Study. Am J Epidemiol 137: 1302-1317.
Kampman E, Goldbohm A, van den Brandt PA, van't Veer P (1994) Fermented dairy products, calcium, and colorectal cancer in the Netherlands cohort study. Cancer Res 54: 3186-3190.
Kearney J, Giovannucci E, Rimm EB et al. (1996) Calcium, vitamin D and dairy foods and the occurrence of colon cancer in men. Am J Epidemiol 143: 907-917.
Martinez ME, Giovannucci EL, Colditz GA et al. (1996) Calcium, vitamin D, and the occurrence of colorectal cancer among women. J Natl Cancer Inst 88: 1375-1382.
Kato I, Akhmedkhanov A, Koenig K, Toniolo PG, Shore RE, Riboli E (1997) Prospective study of diet and female colorectal cancer: The New York University Women's Health Study. Nutr Cancer 28: 276-281.
Newmark HL, Wargovich MJ, Bruce WR (1984) Colon cancer and dietary fat, phosphate, and calcium: a hypothesis. J Natl Cancer Inst 72: 1323-1325.
Bostick RM (1997) Human studies of calcium supplementation and colorectal epithelial cell proliferation. Cancer Epidemiol Biomarkers Prev 6: 971-980.
van Boekel MA, Goeptar AR, Alink GM (1997) Antimutagenic activity of casein against MNNG in the E. Coli DNA repair host-mediated assay. Cancer Letters 114: 85-87.
Willett WC, Stampfer MJ, Colditz GA et al. (1990) Relation of meat and fiber intake to the risk of colon cancer in a prospective study among women. N Engl J Med 323: 1664-1672.
Bostick RM, Potter JD, Kushi LH et al. (1994) Sugar, meat, and fat intake and non-dietary risk factors for colon cancer incidence in Iowa women (United States). Cancer Causes Control 5: 38-52.
Giovannucci E, Rimm EB, Stampfer MJ, Colditz GA, Ascherio A, Willett WC (1994) Intake of fat, meat and fiber in relation to risk of colon cancer in men. Cancer Res 54: 2930-2937.
Goldbohm RA, van den Brandt PA, van't Veer P et al. (1994) A prospective cohort study on the relation between meat consumption and the risk of colon cancer. Cancer Res 54: 718-723.
Howe GR, Aronson KJ, Benito E et al. (1997) The relationship between dietary fat intake and risk of colorectal cancer: evidence from the combined analysis of 13 case-control studies. Cancer Causes Control 8: 215-228.
Howe GR, Benito E, Castellato R et al. (1992) Dietary intake of fiber and decreased risk of cancers of the colon and rectum: evidence from the combined analysis of 13 case-control studies. J Natl Cancer Inst 84: 1887-1896.
Fuchs CS, Giovannucci EL, Colditz GA et al. (1999) Dietary fiber and the risk of colorectal cancer and adenoma in women. N Engl J Med 340: 169-176.
Heilbrun LK, Nomura A, Hankin JH, Stemmermann GN (1989) Diet and colorectal cancer with special reference to fiber intake. Int J Cancer 44: 1-6.
Steinmetz KA, Kushi LH, Bostick RM, Folsom AR, Potter JD (1994) Vegetables, fruit and colon cancer in the Iowa Women's Health Study. Am J Epidemiol 139: 1-15.
Pietinen P, Rimm EB, Korhonen P et al. (1996) Intake of dietary fiber and risk of coronary heart disease in a cohort of Finnish men. The Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. Circulation 94: 2720-2727.
Le Marchand L, Hankin JH, Wilkens LR, Kolonel LN, Englyst HN, Lyu L-C (1997) Dietary fiber and colorectal cancer risk. Epidemiology 8: 658-665.
Jacobs DR, Slavin J, Marquart L (1995) Whole grain intake and cancer: a review of the literature. Nutr Cancer 24: 221-229.
Adlercreutz H, Mazur W (1997) Phyto-oestrogens and Western diseases. Ann Med 29: 95-120.
Slavin J, Jacobs D, Marquart L (1997) Whole-grain consumption and chronic disease: protective mechanisms. Nutr Cancer 27: 14-21.
World Cancer Research Fund/American Institute for Cancer Research. (1997) Food, Nutrition and the Prevention of Cancer: A Global Perspective. Washington, DC: American Institute for Cancer Research.
Thun MJ, Calle EE, Namboodiri MM et al. (1992) Risk factors for fatal colorectal cancer in a large prospective study. J Natl Cancer Inst 84: 1491-1500.
Phillips RL, Snowdon DA (1985) Dietary relationships with fatal colorectal cancer among Seventh-Day Adventists. J Natl Cancer Inst 74: 307-317.
Knekt P, Steineck G, Järvinen R, Hakulinen T, Aromaa A (1994) Intake of fried meat and risk of cancer: a follow-up study in Finland. Int J Cancer 59: 756-760.
Gerhardsson de Verdier M, Hagman U, Peters RK et al. (1992) Meat, cooking methods, and colorectal cancer: a case-referent study in Stockholm. Int J Cancer 49: 520-525.
Schiffman MH, Andrews AW, Van Tassell RL et al. (1989) Case-control study of colorectal cancer and fecal mutagenicity. Cancer Res 49: 3420-3424.
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Pietinen, P., Malila, N., Virtanen, M. et al. Diet and risk of colorectal cancer in a cohort of Finnish men. Cancer Causes Control 10, 387–396 (1999). https://doi.org/10.1023/A:1008962219408
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DOI: https://doi.org/10.1023/A:1008962219408