Diet diversity, diet composition, and risk of colon cancer (United States) (original) (raw)

Abstract

In this study, we evaluate diet diversity, diet composition, and risk of colon cancer in an incident population-based study of 1,993 cases and2,410 controls in the Kaiser Permanente Medical Care Program of Northern California, eight counties in Utah, and the Twin Cities area of Minnesota(United States). Ninety-one and one-half percent of the population were non-Hispanic White. Dietary intake was obtained using an adaptation of the CARDIA diet-history questionnaire. Diet diversity was defined as the number of unique food items reported; diversity also was explored within six major food groups. Composition of the diet was described by estimating the proportion of total number of food items contributed by major food groups. Younger individuals, higher educated individuals, and those who lived in larger households reported eating the most diverse diet. Total diet diversity was not associated with colon cancer. However, eating a diet with greater diversity of meats, poultry, fish, and eggs, was associated with a50 percent increase in risk among all men (95 percent confidence interval[CI] = 1.1-2.0; P trend = 0.01), with slightly stronger associations for younger men and men with distal tumors. A diet with a greater number of refined grain products also was associated with increased risk among men(odds ratio [OR] = 1.7, CI = 1.3-2.3). Women who ate a diet with a more diverse pattern of vegetables were at approximately a 20 percent lower risk than women who had the least diverse diet in vegetables. Assessment of diet composition showed that men who consumed a large proportion of their food items from meat, fish, poultry, and eggs were at an increased risk, with the most marked association being for distal tumors (OR = 1.7, CI = 1.2-2.5).Women who consumed the largest percentage of their food items in the form of plant foods (fruits, vegetables, or whole grains) were at a reduced risk of developing colon cancer (OR = 0.7, CI = 0.5-1.0).

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References

  1. Potter JD, Slattery ML, Bostick RM, Gapstur SM. Colon cancer: A review of the epidemiology. Epidemiol Rev 1993; 15: 499–545.
    PubMed CAS Google Scholar
  2. Slattery ML, Caan BJ, Potter JD, et al. Dietary energy intake and colon cancer risk: Am J Epidemiol 1997; **145:**199–210.
    PubMed CAS Google Scholar
  3. Drewnowski A, Henderson SA, Shore AB, Fischler C, Prezioki P, Hercberg S. Diet quality and dietary diversity in France: Implications for the French paradox. J Am Diet Assoc 1996; 96: 663–9.
    Article PubMed CAS Google Scholar
  4. Randall E, Marshall J, Graham S, Brasure J. Frequency of food use data and the multidimensionality of diet. J Am Diet Assoc 1989; 89: 1070–5.
    PubMed CAS Google Scholar
  5. Kant AK, Block G, Schatzkin A, Ziegler RG, Nestle M. Dietary diversity in the US population, NHANES II, 1976-80._ J Am Diet Assoc 1991; 91: 1526–31.
    PubMed CAS Google Scholar
  6. Kant AK. Indexes of overall diet quality: A review. J Am Diet Assoc 1996; 96: 785–91.
    Article PubMed CAS Google Scholar
  7. Kant AK, Schatzkin A, Harris TB, Ziegler RG, Block G. Dietary diversity and subsequent mortality in the First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study.Am J Clin Nutr 1993; 57: 434–40.
    PubMed CAS Google Scholar
  8. McCann SE, Randall E, Marshall JR, Graham S, Zielezny M, Freudenheim JL. Diet diversity and risk of colon cancer in Western New York. Nutr Cancer 1994; 21: 133–41.
    Article PubMed CAS Google Scholar
  9. Fernandez E, D'Avanzo B, Negri E, Franceschi S, LaVecchia C. Diet diversity and the risk of colorectal cancer in Northern Italy. Cancer Epidemiol Biomark Prev 1996; **5:**433–6.
    CAS Google Scholar
  10. Krebs-Smith SM, Smiciklas-Wright H, Guthrie HA, Krebs-Smith J. The effects of variety in food choices on dietary quality. J Am Diet Assoc 1987; 87: 897–903.
    PubMed CAS Google Scholar
  11. Hertzler AA, Anderson HL. Food guides in the United States: an historical review. J Am Diet Assoc 1974; 64: 19–28.
    PubMed CAS Google Scholar
  12. Percy C, Van Holten V, Muir C, eds. International Classification of Diseases for Oncology. Geneva, Switzerland: World Health Organization, 1990.
    Google Scholar
  13. Slattery ML, Edwards SL, Caan BJ, Kerber RA, Potter JD. Response rates among control subjects in case-control studies. Ann Epidemiol 1995; 5: 245–9.
    Article PubMed CAS Google Scholar
  14. Slattery ML, Potter JD, Caan BJ, et al. Energy balance and colon cancer-beyond physical activity. Cancer Res 1997; **57:**75–80.
    PubMed CAS Google Scholar
  15. Edwards SL, Slattery ML, Mori M, et al. Objective system for interviewer performance evaluation for use in epidemiologic studies. Am J Epidemiol 1994; 140: 1020–8.
    PubMed CAS Google Scholar
  16. Slattery ML, Caan BJ, Duncan D, Berry TD, Coates A, Kerber R. A computerized diet history questionnaire for epidemiologic studies. J Am Diet Assoc 1994; 94: 761–6.
    Article PubMed CAS Google Scholar
  17. McDonald A, Van Horn L, Slattery ML, et al. The CARDIA diet history: development and implementation. J Am Diet Assoc 1991; 91: 1104–12.
    PubMed CAS Google Scholar
  18. Liu K, Slattery ML, Jacobs DR, et al. A study of the reliability and comparative validity of the CARDIA dietary history. Ethnicity Dis 1994; **4:**15–27.
    CAS Google Scholar
  19. Dennis B, Ernst N, Hjortland M, Tillotson J, Grambsch V. THE NHLBI nutrition system. J Am Diet Assoc 1980; 77: 641–7.
    PubMed CAS Google Scholar
  20. Micozzi MS, Albanes D, Jones DY, Chumlea WC. Correlations of body mass indices with weight, stature, and body composition in men and women NHANES I and II. Am J Clin Nutr 1986; 44: 725–31.
    PubMed CAS Google Scholar
  21. Slattery ML, Edwards SE, Ma KN, Friedman G, Potter JD. Physical activity and colon cancer: A public health perspective_. Ann Epidemiol_ 1997; 7: 137–45.
    Article PubMed CAS Google Scholar
  22. SAS Institute Inc. SASUser'sGuide. Cary,NC (USA): SAS Institute, Inc., 1990.
    Google Scholar
  23. Hill MJ, Aries VC. Faecal steroid composition and its relationship to cancer of the large bowel. J Pathol 1971; 104: 129–39.
    Article CAS Google Scholar
  24. Sugimura T, Sato S. Mutagens-carcinogens in foods. Cancer Res 1983; 43: 2415s–21s.
    PubMed CAS Google Scholar
  25. Steinmetz KA, Potter JD. Vegetables, fruit, and cancer. II. Mechanisms. Cancer Causes Control 1991; 2: 427–42.
    Article PubMed CAS Google Scholar
  26. Willett WC, Stampfer MJ, Colditz GA, Rosner BA, Speizer FE. Relation of meat, fat, and fiber intake to the risk of colon cancer in a prospective study among women. N Engl J Med 1990; **323:**1664–72.
    Article PubMed CAS Google Scholar
  27. Giovannucci E, Rimm EB, Stampfer MJ, Colditz GA, Ascherio A, Willett WC. Intake of fat, meat, and fiber in relation to risk of colon cancer in men. Cancer Res 1994; 54: 2390–7.
    PubMed CAS Google Scholar

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Authors and Affiliations

  1. University of Utah, Salt Lake City, USA
    Martha L. Slattery & T. Dennis Berry
  2. Fred Hutchinson Cancer Research Center, Seattle, USA
    John Potter
  3. Kaiser Permanente Medical Research Program, Oakland, USA
    Bette Caan

Authors

  1. Martha L. Slattery
  2. T. Dennis Berry
  3. John Potter
  4. Bette Caan

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Slattery, M.L., Berry, T.D., Potter, J. et al. Diet diversity, diet composition, and risk of colon cancer (United States).Cancer Causes Control 8, 872–882 (1997). https://doi.org/10.1023/A:1018416412906

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