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Dietary patterns associated with colon and rectal cancer: results from the Dietary Patterns and Cancer (DIETSCAN) Project^1,2,3

¹ From the New York University, Department of Nutrition, Food Studies, and Public Health, New York (LBD); TNO Nutrition and Food Research, Department of Nutritional Epidemiology, Zeist, Netherlands (HFB and RAG); the National Public Health Institute, Department of Epidemiology and Health Promotion, Helsinki (MJV, SM, PP, and JV); the Karolinska Institutet, Institute of Environmental Epidemiology, Stockholm (BR and AW); the Istituto Nazionale per lo Studio e la Cura dei Tumori, Epidemiology Unit, Milan, Italy (VK); the Departments of Epidemiology (PAvdB) and Methodology and Statistics (FT), Maastricht University, Maastricht, Netherlands; and the National Cancer Institute, Division of Cancer Control and Population Sciences, Bethesda, MD (AMH).

Background: An analysis of dietary patterns or combinations of foods may provide insight regarding the influence of diet on the risk of colon and rectal cancer.

Objective: A primary aim of the Dietary Patterns and Cancer (DIETSCAN) Project was to develop and apply a common methodologic approach to study dietary patterns and cancer in 4 European cohorts: the Alpha-Tocopherol Beta-Carotene Cancer Prevention Study (Finland-ATBC), the Netherlands Cohort Study (NLCS) on Diet and Cancer, the Swedish Mammography Cohort (SMC), and the Ormoni e Dieta nella Eziologia dei Tumori (Italy-ORDET). Three cohorts (ATBC, NLCS, and SMC) provided data on colon and rectal cancer for the present study.

Design: The cohorts were established between 1985 and 1992; follow-up data were obtained from national cancer registries. The participants completed validated semiquantitative food-frequency questionnaires at baseline.

Results: Exploratory factor analysis, conducted within each cohort, identified 3-5 stable dietary patterns. Two dietary patterns—Vegetables and Pork, Processed Meats, Potatoes (PPP)—were common across all cohorts. After adjustment for potential confounders, PPP was associated with an increased risk of colon cancer in the SMC women (quintile 4_multivariate relative risk: 1.62; 95% CI: 1.12, 2.34; P for trend = 0.01). PPP was also associated with an increased risk of rectal cancer in the ATBC men (quintile 4_multivariate relative risk: 2.21; 95% CI: 1.07, 4.57; P for trend = 0.05). Neither pattern was associated with the risk of colon or rectal cancer in the NLCS women and men.

Conclusion: Although certain dietary patterns may be consistent across European countries, associations between these dietary patterns and the risk of colon and rectal cancer are not conclusive.

Key Words: Colorectal cancer • dietary pattern • Dietary Patterns and Cancer Project • DIETSCAN • factor analysis • principal components analysis

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