Meat, fish, and colorectal cancer risk: the European Prospective Investigation into cancer and nutrition.
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.
Norat
Teresa
T
International Agency for Research on Cancer, 150 Cours Albert Thomas, 69 372 Lyon cedex 08, France.
Bingham
Sheila
S
Ferrari
Pietro
P
Slimani
Nadia
N
Jenab
Mazda
M
Mazuir
Mathieu
M
Overvad
Kim
K
Olsen
Anja
A
Tjønneland
Anne
A
Clavel
Francoise
F
Boutron-Ruault
Marie-Christine
MC
Kesse
Emmanuelle
E
Boeing
Heiner
H
Bergmann
Manuela M
MM
Nieters
Alexandra
A
Linseisen
Jakob
J
Trichopoulou
Antonia
A
Trichopoulos
Dimitrios
D
Tountas
Yannis
Y
Berrino
Franco
F
Palli
Domenico
D
Panico
Salvatore
S
Tumino
Rosario
R
Vineis
Paolo
P
Bueno-de-Mesquita
H Bas
HB
Peeters
Petra H M
PH
Engeset
Dagrun
D
Lund
Eiliv
E
Skeie
Guri
G
Ardanaz
Eva
E
González
Carlos
C
Navarro
Carmen
C
Quirós
J Ramón
JR
Sanchez
María-José
MJ
Berglund
Göran
G
Mattisson
Irene
I
Hallmans
Göran
G
Palmqvist
Richard
R
Day
Nicholas E
NE
Khaw
Kay-Tee
KT
Key
Timothy J
TJ
San Joaquin
Miguel
M
Hémon
Bertrand
B
Saracci
Rodolfo
R
Kaaks
Rudolf
R
Riboli
Elio
E
D000328:Adult; D000368:Aged; D000818:Animals; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000209:etiology*; D004043:Dietary Fiber / Q000008:administration & dosage*; D005060:Europe / Q000453:epidemiology; D005247:Feeding Behavior; D005260:Female; D005399:Fishes; D006801:Humans; D008019:Life Style; D008297:Male; D008460:Meat; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011200:Poultry; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires