Abstract
BackgroundThe rising incidence of colorectal cancer in sub-Saharan Africa may be partly caused by changing dietary patterns. We sought to establish the association between dietary patterns and colorectal cancer in Zimbabwe. MethodsOne hundred colorectal cancer cases and 200 community-based controls were recruited. Data were collected using a food frequency questionnaire, and dietary patterns derived by principal component analysis. Generalised linear and logistic regression models were used to assess the associations between dietary patterns, participant characteristics and colorectal cancer. ResultsThree main dietary patterns were identified: traditional African, urbanised and processed food. The traditional African diet appeared protective against colorectal cancer (Odds Ratio (OR) 0.35; 95% Confidence Interval (CI), 0.21 – 0.58), which had no association with the urban (OR 0.68; 95% CI, 0.43–1.08), or processed food (OR 0.91; 0.58–1.41) patterns. The traditional African diet was associated with rural domicile, (OR 1.26; 95% CI, 1.00–1.59), and a low income (OR1.48; 95% CI, 1.06–2.08). The urbanised diet was associated with urban domicile (OR 1.70; 95% CI, 1.38–2.10), secondary (OR 1.30; 95% CI, 1.07–1.59) or tertiary education (OR 1.48; 95% CI, 1.11–1.97), and monthly incomes of $201–500 (OR 1.30; 95% CI, 1.05–1.62), and the processed food pattern with tertiary education (OR 1.42; 95% CI, 1.05–1.92), and income >$1000/month (OR 1.48; 95% CI, 1.02–2.15). ConclusionA shift away from protective, traditional African dietary patterns may partly explain the rising incidence of colorectal cancer in sub-Saharan Africa.
Highlights
Colorectal cancer is the 3rd most common cancer globally, and the 6th most common in Africa [1,2]
This study confirms that a traditional African dietary pattern, which is predominantly plant and grain based, is associated with a reduced risk of colorectal cancer
While ecological studies suggested that African diets are protective as far back as the 1960s [19], this has never been assessed in a case-control or cohort study [10]
Summary
Colorectal cancer is the 3rd most common cancer globally, and the 6th most common in Africa [1,2]. It is generally accepted that dietary factors account for the majority of sporadic colorectal cancers [11]. Other dietary factors associated with an increased risk of colorectal cancer include a high intake of alcohol, animal fat and sugar [11]. The rising incidence of colorectal cancer in sub-Saharan Africa may be partly caused by changing dietary patterns. The traditional African diet appeared protective against colorectal cancer (Odds Ratio (OR) 0.35; 95% Confidence Interval (CI), 0.21 – 0.58), which had no association with the urban (OR 0.68; 95% CI, 0.43–1.08), or processed food (OR 0.91; 0.58–1.41) patterns. Conclusion: A shift away from protective, traditional African dietary patterns may partly explain the rising incidence of colorectal cancer in sub-Saharan Africa
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