Abstract
Mediterranean diet (MD) adherence has been associated with a large variety of health benefits. However, prospective studies investigating the relation between MD adherence and colorectal cancer risk had inconsistent results. In this analysis of the Netherlands Cohort Study (NLCS), we evaluated sex- and subsite-specific associations of MD adherence with colorectal cancer risk. In 1986, 120,852 subjects filled out the NLCS baseline questionnaire, which incorporated a 150-item food frequency questionnaire. MD adherence was estimated through alternate Mediterranean diet scores including and excluding alcohol (aMED and aMEDr, respectively). Using 20.3 year follow-up data, 1993 male and 1574 female colorectal cancer cases could be included in multivariable case-cohort analyses. aMEDr was not significantly associated with colorectal cancer risk, regardless of sex. Hazard ratios (95% confidence intervals) per two-point increment were 1.04 (0.95–1.13) for men and 0.97 (0.88–1.07) for women. Additionally, there was no evidence of an inverse association with any of the colorectal cancer subsites (colon, proximal colon, distal colon, and rectum). In women, the association between aMEDr and colorectal cancer risk was significantly modified by smoking status (Pinteraction = 0.015). Comparable results were obtained for the original aMED including alcohol. In conclusion, higher MD adherence was not associated with a reduced risk of colorectal cancer or anatomical subsites in the context of a Dutch population.
Highlights
Colorectal cancer was an important contributor to the total cancer burden in 2018, ranking third and second in terms of incidence and mortality, respectively [1]
We aimed to investigate associations of Mediterranean diet (MD) adherence with risks of colorectal cancer and anatomical subsites in the prospective Netherlands Cohort Study (NLCS)
Median daily intakes of beneficial components increased with higher levels of MD adherence, whereas the opposite was observed for the intake of red and processed meats
Summary
Colorectal cancer was an important contributor to the total cancer burden in 2018, ranking third and second in terms of incidence and mortality, respectively [1]. The global burden of colorectal cancer is expected to increase even further in the decade. The traditional Mediterranean diet (MD), typical for the olive-cultivating areas bordering the Mediterranean basin in the early 1960s, has been associated with a large variety of health benefits, including decreases in all-cause mortality as well as cardiovascular disease risk and mortality [4,5,6,7,8]. This dietary pattern is characterized by the consumption of large quantities of vegetables, legumes, fruits, nuts, whole grains, and olive oil (rich in monounsaturated fatty acids, MUFA). Wine is consumed in moderate amounts, during meals [4, 5]
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