Abstract
Colorectal cancer (CRC) is the third most common cancer diagnosis and the second and third leading cause of cancer mortality in men and women, respectively. However, the majority of CRC cases are the result of sporadic tumorigenesis via the adenoma–carcinoma sequence. This process can take up to 20 years, suggesting an important window of opportunity exists for prevention such as switching toward healthier dietary patterns. The Mediterranean diet (MD) is a dietary pattern associated with various health benefits including protection against cardiovascular disease, diabetes, obesity, and various cancers. In this article, we review publications available in the PubMed database within the last 10 years that report on the impact of a MD eating pattern on prevention of CRC. To assist the reader with interpretation of the results and discussion, we first introduce indexes and scoring systems commonly used to experimentally determine adherence to a MD, followed by a brief introduction of the influence of the MD pattern on inflammatory bowel disease, which predisposes to CRC. Finally, we discuss key biological mechanisms through which specific bioactive food components commonly present in the MD are proposed to prevent or delay the development of CRC. We close with a discussion of future research frontiers in CRC prevention with particular reference to the role of epigenetic mechanisms and microbiome related to the MD eating pattern.
Highlights
Despite advancements in screening and diagnosis, colorectal cancer (CRC) remains the third most common cancer in the USA and the second and third leading cause of cancer mortality in men and women, respectively [1]
Data derived from food-frequency questionnaire (FFQ) were applied against the aMED and the Dietary Approaches to Stop Hypertension (DASH) diet indexes in Cox proportional hazard models adjusted for a number of variables including age, BMI, alcohol intake, family history, physical activity (PA), aspirin use, colonoscopy, history of polyps, multivitamin use, smoking, and TEI
We have summarized evidence suggesting the Mediterranean diet (MD) may reduce Colorectal cancer (CRC) risk by affecting known biological factors associated with inflammation, genetic and epigenetic processes, and the host microbiome
Summary
Despite advancements in screening and diagnosis, colorectal cancer (CRC) remains the third most common cancer in the USA and the second and third leading cause of cancer mortality in men and women, respectively [1]. Only ~5–6% of CRC cases are linked to germline mutations [2], whereas ~70% of CRC tumors are sporadic [3]. These statistics suggest great opportunities may exist for the prevention of CRC. Three major molecular pathways of sporadic CRC have been identified, and include [1] chromosomal instability (CIN), characterized by abnormal karyotypes, aneuploidy, and loss of heterozygosity; [2] microsatellite instability (MSI), characterized by silencing of DNA repair mechanisms, namely mismatch repair pathways; and [3] CpG island methylator phenotype (CIMP), associated with hypermethylation and silencing of tumor suppressor genes [3, 6]. The CIN pathway, known as the adenoma–carcinoma sequence (Figure 1), appears to be predominantly involved
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