Dietary Patterns and Risk of Colorectal Cancer: Analysis by Tumor Location and Molecular Subtypes

Raaj S. Mehta, Mingyang Song, Reiko Nishihara, David A. Drew, Kana Wu, Zhi Rong Qian, Teresa T. Fung, Tsuyoshi Hamada, Yohei Masugi, Annacarolina da Silva, Yan Shi, Wanwan Li, Mancang Gu, Walter C. Willett, Charles S. Fuchs, Edward L. Giovannucci, Shuji Ogino, Andrew T. Chan

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Background & Aims Western and prudent dietary patterns have been associated with higher and lower risks of colorectal cancer (CRC), respectively. However, little is known about the associations between dietary patterns and specific anatomic subsites or molecular subtypes of CRC. Methods We used multivariable Cox proportional hazards models to examine the associations between Western and prudent dietary patterns and CRC risk in the Health Professionals Follow-up Study and Nurses’ Health Study. Results After up to 32 years of follow-up of 137,217 men and women, we documented 3260 cases of CRC. Among individuals from whom subsite data were available, we observed 1264 proximal colon, 866 distal colon, and 670 rectal tumors. Western diet was associated with an increased incidence of CRC (Ptrend <.0001), with a relative risk (RR) of 1.31 (95% CI, 1.15–1.48, comparing the highest to lowest quartile). The association of Western diet with CRC was evident for tumors of the distal colon (RR, 1.55; 95% CI, 1.22–1.96; Ptrend =.0004) and rectum (RR, 1.35; 95% CI, 1.03–1.77; Ptrend =.01) but not proximal colon (RR, 1.11; 95% CI, 0.91–1.35; Ptrend =.51) when we comparing extreme quartiles. In contrast, for the prudent pattern, we observed a RR of 0.86 for overall CRC (95% CI, 0.77–0.95; Ptrend =.01), with similar trends at anatomic subsites. However, the trend appeared stronger among men than women. Among 1285 cases (39%) with tissue available for molecular profiling, Western diet appeared to be more strongly associated with some CRC molecular subtypes (no mutations in KRAS [KRAS wildtype] or BRAF [BRAF wildtype], no or a low CpG island methylator phenotype, and microsatellite stability), although formal tests for heterogeneity did not produce statistically significant results. Conclusions Western dietary patterns are associated with an increased risk of CRC, particularly distal colon and rectal tumors. Western dietary patterns also appear more strongly associated with tumors that are KRAS wildtype, BRAF wildtype, have no or a low CpG island methylator phenotype, and microsatellite stability. In contrast, prudent dietary patterns are associated with a lower risk of CRC that does not vary according to anatomic subsite or molecular subtype.

Original languageEnglish
Pages (from-to)1944-1953.e1
JournalGastroenterology
Volume152
Issue number8
DOIs
Publication statusPublished - 2017 Jun 1
Externally publishedYes

Fingerprint

Colorectal Neoplasms
Neoplasms
Colon
CpG Islands
Rectal Neoplasms
Microsatellite Repeats
Phenotype
Health
Western Diet
Proportional Hazards Models
Rectum
Nurses
Mutation
Incidence

Keywords

  • Colon Cancer Risk
  • Molecular Epidemiology
  • Processed Meat
  • Red Meat

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Mehta, R. S., Song, M., Nishihara, R., Drew, D. A., Wu, K., Qian, Z. R., ... Chan, A. T. (2017). Dietary Patterns and Risk of Colorectal Cancer: Analysis by Tumor Location and Molecular Subtypes. Gastroenterology, 152(8), 1944-1953.e1. https://doi.org/10.1053/j.gastro.2017.02.015

Dietary Patterns and Risk of Colorectal Cancer : Analysis by Tumor Location and Molecular Subtypes. / Mehta, Raaj S.; Song, Mingyang; Nishihara, Reiko; Drew, David A.; Wu, Kana; Qian, Zhi Rong; Fung, Teresa T.; Hamada, Tsuyoshi; Masugi, Yohei; da Silva, Annacarolina; Shi, Yan; Li, Wanwan; Gu, Mancang; Willett, Walter C.; Fuchs, Charles S.; Giovannucci, Edward L.; Ogino, Shuji; Chan, Andrew T.

In: Gastroenterology, Vol. 152, No. 8, 01.06.2017, p. 1944-1953.e1.

Research output: Contribution to journalArticle

Mehta, RS, Song, M, Nishihara, R, Drew, DA, Wu, K, Qian, ZR, Fung, TT, Hamada, T, Masugi, Y, da Silva, A, Shi, Y, Li, W, Gu, M, Willett, WC, Fuchs, CS, Giovannucci, EL, Ogino, S & Chan, AT 2017, 'Dietary Patterns and Risk of Colorectal Cancer: Analysis by Tumor Location and Molecular Subtypes', Gastroenterology, vol. 152, no. 8, pp. 1944-1953.e1. https://doi.org/10.1053/j.gastro.2017.02.015
Mehta, Raaj S. ; Song, Mingyang ; Nishihara, Reiko ; Drew, David A. ; Wu, Kana ; Qian, Zhi Rong ; Fung, Teresa T. ; Hamada, Tsuyoshi ; Masugi, Yohei ; da Silva, Annacarolina ; Shi, Yan ; Li, Wanwan ; Gu, Mancang ; Willett, Walter C. ; Fuchs, Charles S. ; Giovannucci, Edward L. ; Ogino, Shuji ; Chan, Andrew T. / Dietary Patterns and Risk of Colorectal Cancer : Analysis by Tumor Location and Molecular Subtypes. In: Gastroenterology. 2017 ; Vol. 152, No. 8. pp. 1944-1953.e1.
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abstract = "Background & Aims Western and prudent dietary patterns have been associated with higher and lower risks of colorectal cancer (CRC), respectively. However, little is known about the associations between dietary patterns and specific anatomic subsites or molecular subtypes of CRC. Methods We used multivariable Cox proportional hazards models to examine the associations between Western and prudent dietary patterns and CRC risk in the Health Professionals Follow-up Study and Nurses’ Health Study. Results After up to 32 years of follow-up of 137,217 men and women, we documented 3260 cases of CRC. Among individuals from whom subsite data were available, we observed 1264 proximal colon, 866 distal colon, and 670 rectal tumors. Western diet was associated with an increased incidence of CRC (Ptrend <.0001), with a relative risk (RR) of 1.31 (95{\%} CI, 1.15–1.48, comparing the highest to lowest quartile). The association of Western diet with CRC was evident for tumors of the distal colon (RR, 1.55; 95{\%} CI, 1.22–1.96; Ptrend =.0004) and rectum (RR, 1.35; 95{\%} CI, 1.03–1.77; Ptrend =.01) but not proximal colon (RR, 1.11; 95{\%} CI, 0.91–1.35; Ptrend =.51) when we comparing extreme quartiles. In contrast, for the prudent pattern, we observed a RR of 0.86 for overall CRC (95{\%} CI, 0.77–0.95; Ptrend =.01), with similar trends at anatomic subsites. However, the trend appeared stronger among men than women. Among 1285 cases (39{\%}) with tissue available for molecular profiling, Western diet appeared to be more strongly associated with some CRC molecular subtypes (no mutations in KRAS [KRAS wildtype] or BRAF [BRAF wildtype], no or a low CpG island methylator phenotype, and microsatellite stability), although formal tests for heterogeneity did not produce statistically significant results. Conclusions Western dietary patterns are associated with an increased risk of CRC, particularly distal colon and rectal tumors. Western dietary patterns also appear more strongly associated with tumors that are KRAS wildtype, BRAF wildtype, have no or a low CpG island methylator phenotype, and microsatellite stability. In contrast, prudent dietary patterns are associated with a lower risk of CRC that does not vary according to anatomic subsite or molecular subtype.",
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TY - JOUR

T1 - Dietary Patterns and Risk of Colorectal Cancer

T2 - Analysis by Tumor Location and Molecular Subtypes

AU - Mehta, Raaj S.

AU - Song, Mingyang

AU - Nishihara, Reiko

AU - Drew, David A.

AU - Wu, Kana

AU - Qian, Zhi Rong

AU - Fung, Teresa T.

AU - Hamada, Tsuyoshi

AU - Masugi, Yohei

AU - da Silva, Annacarolina

AU - Shi, Yan

AU - Li, Wanwan

AU - Gu, Mancang

AU - Willett, Walter C.

AU - Fuchs, Charles S.

AU - Giovannucci, Edward L.

AU - Ogino, Shuji

AU - Chan, Andrew T.

PY - 2017/6/1

Y1 - 2017/6/1

N2 - Background & Aims Western and prudent dietary patterns have been associated with higher and lower risks of colorectal cancer (CRC), respectively. However, little is known about the associations between dietary patterns and specific anatomic subsites or molecular subtypes of CRC. Methods We used multivariable Cox proportional hazards models to examine the associations between Western and prudent dietary patterns and CRC risk in the Health Professionals Follow-up Study and Nurses’ Health Study. Results After up to 32 years of follow-up of 137,217 men and women, we documented 3260 cases of CRC. Among individuals from whom subsite data were available, we observed 1264 proximal colon, 866 distal colon, and 670 rectal tumors. Western diet was associated with an increased incidence of CRC (Ptrend <.0001), with a relative risk (RR) of 1.31 (95% CI, 1.15–1.48, comparing the highest to lowest quartile). The association of Western diet with CRC was evident for tumors of the distal colon (RR, 1.55; 95% CI, 1.22–1.96; Ptrend =.0004) and rectum (RR, 1.35; 95% CI, 1.03–1.77; Ptrend =.01) but not proximal colon (RR, 1.11; 95% CI, 0.91–1.35; Ptrend =.51) when we comparing extreme quartiles. In contrast, for the prudent pattern, we observed a RR of 0.86 for overall CRC (95% CI, 0.77–0.95; Ptrend =.01), with similar trends at anatomic subsites. However, the trend appeared stronger among men than women. Among 1285 cases (39%) with tissue available for molecular profiling, Western diet appeared to be more strongly associated with some CRC molecular subtypes (no mutations in KRAS [KRAS wildtype] or BRAF [BRAF wildtype], no or a low CpG island methylator phenotype, and microsatellite stability), although formal tests for heterogeneity did not produce statistically significant results. Conclusions Western dietary patterns are associated with an increased risk of CRC, particularly distal colon and rectal tumors. Western dietary patterns also appear more strongly associated with tumors that are KRAS wildtype, BRAF wildtype, have no or a low CpG island methylator phenotype, and microsatellite stability. In contrast, prudent dietary patterns are associated with a lower risk of CRC that does not vary according to anatomic subsite or molecular subtype.

AB - Background & Aims Western and prudent dietary patterns have been associated with higher and lower risks of colorectal cancer (CRC), respectively. However, little is known about the associations between dietary patterns and specific anatomic subsites or molecular subtypes of CRC. Methods We used multivariable Cox proportional hazards models to examine the associations between Western and prudent dietary patterns and CRC risk in the Health Professionals Follow-up Study and Nurses’ Health Study. Results After up to 32 years of follow-up of 137,217 men and women, we documented 3260 cases of CRC. Among individuals from whom subsite data were available, we observed 1264 proximal colon, 866 distal colon, and 670 rectal tumors. Western diet was associated with an increased incidence of CRC (Ptrend <.0001), with a relative risk (RR) of 1.31 (95% CI, 1.15–1.48, comparing the highest to lowest quartile). The association of Western diet with CRC was evident for tumors of the distal colon (RR, 1.55; 95% CI, 1.22–1.96; Ptrend =.0004) and rectum (RR, 1.35; 95% CI, 1.03–1.77; Ptrend =.01) but not proximal colon (RR, 1.11; 95% CI, 0.91–1.35; Ptrend =.51) when we comparing extreme quartiles. In contrast, for the prudent pattern, we observed a RR of 0.86 for overall CRC (95% CI, 0.77–0.95; Ptrend =.01), with similar trends at anatomic subsites. However, the trend appeared stronger among men than women. Among 1285 cases (39%) with tissue available for molecular profiling, Western diet appeared to be more strongly associated with some CRC molecular subtypes (no mutations in KRAS [KRAS wildtype] or BRAF [BRAF wildtype], no or a low CpG island methylator phenotype, and microsatellite stability), although formal tests for heterogeneity did not produce statistically significant results. Conclusions Western dietary patterns are associated with an increased risk of CRC, particularly distal colon and rectal tumors. Western dietary patterns also appear more strongly associated with tumors that are KRAS wildtype, BRAF wildtype, have no or a low CpG island methylator phenotype, and microsatellite stability. In contrast, prudent dietary patterns are associated with a lower risk of CRC that does not vary according to anatomic subsite or molecular subtype.

KW - Colon Cancer Risk

KW - Molecular Epidemiology

KW - Processed Meat

KW - Red Meat

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