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Go To: Home > Archive > Vol. 97, No. 12 > Norat et al., pp. 906-916.



Journal of the National Cancer Institute, Vol. 97, No. 12, 906-916, June 15, 2005
DOI: 10.1093/jnci/dji164
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© 2005 Oxford University Press

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ARTICLE

Meat, Fish, and Colorectal Cancer Risk: The European Prospective Investigation into Cancer and Nutrition
Teresa Norat, Sheila Bingham, Pietro Ferrari, Nadia Slimani, Mazda Jenab, Mathieu Mazuir, Kim Overvad, Anja Olsen, Anne Tjønneland, Francoise Clavel, Marie-Christine Boutron-Ruault, Emmanuelle Kesse, Heiner Boeing, Manuela M. Bergmann, Alexandra Nieters, Jakob Linseisen, Antonia Trichopoulou, Dimitrios Trichopoulos, Yannis Tountas, Franco Berrino, Domenico Palli, Salvatore Panico, Rosario Tumino, Paolo Vineis, H. Bas Bueno-de-Mesquita, Petra H. M. Peeters, Dagrun Engeset, Eiliv Lund, Guri Skeie, Eva Ardanaz, Carlos González, Carmen Navarro, J. Ramón Quirós, María-José Sanchez, Göran Berglund, Irene Mattisson, Göran Hallmans, Richard Palmqvist, Nicholas E. Day, Kay-Tee Khaw, Timothy J. Key, Miguel San Joaquin, Bertrand Hémon, Rodolfo Saracci, Rudolf Kaaks, Elio Riboli

Affiliations of authors: From the Nutrition and Hormones Group, International Agency for Research on Cancer, Lyon, France (TN, PF, NS, MJ, MM, BH, RS, RK, ER); Medical Research Council Dunn Human Nutrition Unit, Cambridge, UK (SB); Department of Clinical Epidemiology, Aalborg Hospital and Aarhus University Hospital, Department of Epidemiology and Social Medicine, University of Aarhus, Denmark (KO); Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark (AO, A. Tjønneland); Institut National de la Santé et de la Recherche Médicale (INSERM) U521, Institut Gustave Roussy, Villejuif, France (FC, M-CB-R, EK); German Institute of Human Nutrition, Postdam-Rehbücke, Germany (HB, MMB); Division of Clinical Epidemiology, Deutches Krebsforschungszentrum, Heidelberg, Germany (AN, JL); Department of Hygiene and Epidemiology, Medical School, University of Athens, Greece (A. Trichopoulou, DT, YT); Epidemiology Unit, Istituto Tumori, Milan, Italy (FB); Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Center, Scientific Institute of Tuscany, Florence, Italy (DP); Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy (SP); Cancer Registry, Azienda Ospedaliera Civile MP, Arezzo, Ragusa, Italy (RT); University of Torino, Italy and Imperial College London, UK (PV); Center for Nutrition and Health, National Institute for Public Health and the Environment, Bilthoven, The Netherlands (HBB); Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands (PHMP); Institute of Community Medicine, University of Tromso, Norway (DE, EL, GS); Department of Epidemiology, Catalan Institute of Oncology, Barcelona, Spain (CG); Epidemiology Department, Health Council of Murcia, Spain (CN); Public Health Institute of Navarra, Pamplona, Spain (EA); Public Health and Health Planning Directorate, Asturias, Spain (JRQ); Andalusian School of Public Health, Granada, Spain (M-JS); Malmö Diet and Cancer Study, Lund University, Malmö, Sweden (GB, IM); Department of Nutritional Research (GH) and Department of Medical Biosciences, Pathology (RP), University of Umeå, Sweden; Strangeways Research Laboratory, Cambridge, UK (NED); the Clinical Gerontology Unit, University of Cambridge, UK (K-TK); Cancer Research UK Epidemiology Unit, University of Oxford, UK (TJK, MSJ)

Correspondence to: Elio Riboli, MD, MPH, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69 372 Lyon cedex 08, France (e-mail: riboli@iarc.fr).

Background: Current evidence suggests that high red meat intake is associated with increased colorectal cancer risk. High fish intake may be associated with a decreased risk, but the existing evidence is less convincing. Methods: We prospectively followed 478 040 men and women from 10 European countries who were free of cancer at enrollment between 1992 and 1998. Information on diet and lifestyle was collected at baseline. After a mean follow-up of 4.8 years, 1329 incident colorectal cancers were documented. We examined the relationship between intakes of red and processed meat, poultry, and fish and colorectal cancer risk using a proportional hazards model adjusted for age, sex, energy (nonfat and fat sources), height, weight, work-related physical activity, smoking status, dietary fiber and folate, and alcohol consumption, stratified by center. A calibration substudy based on 36 994 subjects was used to correct hazard ratios (HRs) and 95% confidence intervals (CIs) for diet measurement errors. All statistical tests were two-sided. Results: Colorectal cancer risk was positively associated with intake of red and processed meat (highest [>160 g/day] versus lowest [<20 g/day] intake, HR = 1.35, 95% CI = 0.96 to 1.88; Ptrend = .03) and inversely associated with intake of fish (>80 g/day versus <10 g/day, HR = 0.69, 95 % CI = 0.54 to 0.88; Ptrend<.001), but was not related to poultry intake. Correcting for measurement error strengthened the associations between colorectal cancer and red and processed meat intake (per 100-g increase HR = 1.25, 95% CI =1.09 to 1.41, Ptrend = .001 and HR = 1.55, 95% CI = 1.19 to 2.02, Ptrend = .001 before and after calibration, respectively) and for fish (per 100 g increase HR = 0.70, 95% CI = 0.57 to 0.87, Ptrend<.001 and HR = 0.46, 95% CI = 0.27 to 0.77, Ptrend = .003; before and after correction, respectively). In this study population, the absolute risk of development of colorectal cancer within 10 years for a study subject aged 50 years was 1.71% for the highest category of red and processed meat intake and 1.28% for the lowest category of intake and was 1.86% for subjects in the lowest category of fish intake and 1.28% for subjects in the highest category of fish intake. Conclusions: Our data confirm that colorectal cancer risk is positively associated with high consumption of red and processed meat and support an inverse association with fish intake.


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