Association of ultra-processed food consumption with colorectal cancer risk among men and women: results from three prospective US cohort studies.

Lu Wang, Mengxi Du, Kai Wang, Neha Khandpur, Sinara Laurini Rossato, Jean-Philippe Drouin-Chartier, Euridice Martínez Steele, Edward Giovannucci, Mingyang Song, Fang Fang Zhang
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Abstract

Objective: To examine the association between consumption of ultra-processed foods and risk of colorectal cancer among men and women from three large prospective cohorts.

Design: Prospective cohort study with dietary intake assessed every four years using food frequency questionnaires.

Setting: Three large US cohorts.

Participants: Men (n= 46 341) from the Health Professionals Follow-up Study (1986-2014) and women (n=159 907) from the Nurses' Health Study (1986-2014; n=67 425) and the Nurses' Health Study II (1991-2015; n=92 482) with valid dietary intake measurement and no cancer diagnosis at baseline.

Main outcome measure: Association between ultra-processed food consumption and risk of colorectal cancer, estimated using time varying Cox proportional hazards regression models adjusted for potential confounding factors.

Results: 3216 cases of colorectal cancer (men, n=1294; women, n=1922) were documented during the 24-28 years of follow-up. Compared with those in the lowest fifth of ultra-processed food consumption, men in the highest fifth of consumption had a 29% higher risk of developing colorectal cancer (hazard ratio for highest versus lowest fifth 1.29, 95% confidence interval 1.08 to 1.53; P for trend=0.01), and the positive association was limited to distal colon cancer (72% increased risk; hazard ratio 1.72, 1.24 to 2.37; P for trend<0.001). These associations remained significant after further adjustment for body mass index or indicators of nutritional quality of the diet (that is, western dietary pattern or dietary quality score). No association was observed between overall ultra-processed food consumption and risk of colorectal cancer among women. Among subgroups of ultra-processed foods, higher consumption of meat/poultry/seafood based ready-to-eat products (hazard ratio for highest versus lowest fifth 1.44, 1.20 to 1.73; P for trend<0.001) and sugar sweetened beverages (1.21, 1.01 to 1.44; P for trend=0.013) among men and ready-to-eat/heat mixed dishes among women (1.17, 1.01 to 1.36; P for trend=0.02) was associated with increased risk of colorectal cancer; yogurt and dairy based desserts were negatively associated with the risk of colorectal cancer among women (hazard ratio 0.83, 0.71 to 0.97; P for trend=0.002).

Conclusions: In the three large prospective cohorts, high consumption of total ultra-processed foods in men and certain subgroups of ultra-processed foods in men and women was associated with an increased risk of colorectal cancer. Further studies are needed to better understand the potential attributes of ultra-processed foods that contribute to colorectal carcinogenesis.

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超加工食品消费与男性和女性患结直肠癌风险的关系:美国三项前瞻性队列研究的结果。
目的研究三个大型前瞻性队列中男性和女性食用超加工食品与罹患结直肠癌风险之间的关系:前瞻性队列研究,每四年使用食物频率问卷评估一次膳食摄入量:三个大型美国队列:主要结果测量指标:超加工食品摄入量与癌症发病率之间的关系:主要结果测量:超加工食品摄入量与结直肠癌风险之间的关系,采用时间变化的考克斯比例危害回归模型进行估计,并对潜在的混杂因素进行调整:在 24-28 年的随访期间,共记录了 3216 例结直肠癌病例(男性,n=1294;女性,n=1922)。与超加工食品消费量最低的五分之一的男性相比,消费量最高的五分之一的男性罹患结直肠癌的风险高出 29%(最高与最低五分之一的危险比为 1.29,95% 置信区间为 1.08 至 1.53;P 为趋势=0.01),并且这种正相关关系仅限于远端结肠癌(风险增加 72%;危险比为 1.72,1.24 至 2.37;P 为趋势):在三个大型前瞻性队列中,男性超加工食品总消费量高以及男性和女性超加工食品某些亚群的消费量高与结直肠癌风险增加有关。要更好地了解超加工食品导致结直肠癌发生的潜在属性,还需要进一步的研究。
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