title: Meat, fish, and colorectal cancer risk: the European Prospective Investigation into cancer and nutrition.
abstract: 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.
authors.affiliation: International Agency for Research on Cancer, 150 Cours Albert Thomas, 69 372 Lyon cedex 08, France.
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authors.lastname: Norat
authors.forename: Sheila
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authors.lastname: Bingham
authors.forename: Pietro
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authors.forename: Dimitrios
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authors.lastname: Trichopoulos
authors.forename: Yannis
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authors.lastname: Tountas
authors.forename: Franco
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authors.forename: Domenico
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authors.lastname: Palli
authors.forename: Salvatore
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authors.lastname: Panico
authors.forename: Rosario
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authors.lastname: Tumino
authors.forename: Paolo
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authors.lastname: Vineis
authors.forename: H Bas
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authors.lastname: Bueno-de-Mesquita
authors.forename: Petra H M
authors.initials: PH
authors.lastname: Peeters
authors.forename: Dagrun
authors.initials: D
authors.lastname: Engeset
authors.forename: Eiliv
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authors.lastname: Lund
authors.forename: Guri
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authors.lastname: Skeie
authors.forename: Eva
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authors.lastname: Ardanaz
authors.forename: Carlos
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authors.lastname: González
authors.forename: Carmen
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authors.lastname: Quirós
authors.forename: María-José
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authors.lastname: Sanchez
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authors.lastname: Berglund
authors.forename: Irene
authors.initials: I
authors.lastname: Mattisson
authors.forename: Göran
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authors.lastname: Hallmans
authors.forename: Richard
authors.initials: R
authors.lastname: Palmqvist
authors.forename: Nicholas E
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authors.lastname: Day
authors.forename: Kay-Tee
authors.initials: KT
authors.lastname: Khaw
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Key
authors.forename: Miguel
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authors.lastname: San Joaquin
authors.forename: Bertrand
authors.initials: B
authors.lastname: Hémon
authors.forename: Rodolfo
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authors.lastname: Saracci
authors.forename: Rudolf
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mesh_terms: 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