Diet-wide analyses for risk of colorectal cancer: prospective study of 12,251 incident cases among 542,778 women in the UK.

Authors

Papier K, Bradbury KE, Balkwill A, Barnes I, Smith-Byrne K, Gunter MJ, Berndt SI, Le Marchand L, Wu AH, Peters U, Beral V, Key TJ, Reeves GK

Affiliations

• Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK. Keren.Papier@ndph.ox.ac.uk.
• Department of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
• Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
• Cancer Epidemiology and Prevention Research Unit, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
• Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
• University of Hawaii Cancer Center, Honolulu, HI, USA.
• University of Southern California, Department of Population and Public Health Sciences, Los Angeles, CA, USA.
• Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA.

Abstract

Uncertainty remains regarding the role of diet in colorectal cancer development. We examined associations of 97 dietary factors with colorectal cancer risk in 542,778 Million Women Study participants (12,251 incident cases over 16.6 years), and conducted a targeted genetic analysis in the ColoRectal Transdisciplinary Study, Colon Cancer Family Registry, and Genetics and Epidemiology of Colorectal Cancer Consortium (GECCO). Alcohol (relative risk per 20 g/day=1.15, 95% confidence interval 1.09-1.20) and calcium (per 300 mg/day=0.83, 0.77-0.89) intakes had the strongest associations, followed by six dairy-related factors associated with calcium. We showed a positive association with red and processed meat intake and weaker inverse associations with breakfast cereal, fruit, wholegrains, carbohydrates, fibre, total sugars, folate, and vitamin C. Genetically predicted milk consumption was inversely associated with risk of colorectal, colon, and rectal cancers. We conclude that dairy products help protect against colorectal cancer, and that this is driven largely or wholly by calcium.