The effect of lactose maldigestion on the relationship between dairy food intake and colorectal cancer: a systematic review.
Dairy food consumption has been inconsistently shown to protect against colorectal cancer (CRC) in case-based studies, and no clear benefits against recurrent colonic polyps (CRP) have been reported. Based on population-based studies we have hypothesized that dairy food intake may have anti-CRC effects at both low intake lactase non-persistent (LNP) populations and at high intake lactase persistent (LP) subjects. We separately analyse existing case-based studies and divide origins into high LNP (>or= 80% LNP prevalence), low LNP (prevalence <or= 20%) and mid LNP countries (21-79% prevalence), which coincide with low, high, and mid quantity dairy food intake regions, respectively. Odds ratios and relative risks (RR) of highest versus lowest dairy intake within each group are analyzed together for assessment of protection against CRC and CRP. Eighty studies met stipulated criteria. Thirteen analyzed the effect on recurrent polyps. Forest plots from 2 regions, high LNP (low dairy food intake) RR = 0.84 [95% confidence interval (CI) = 0.73-0.97) and low LNP (high dairy food intake) RR = 0.80 (95% CI = 0.73-0.88) demonstrated significant protection against CRC. In mixed LNP/LP populations (mid dairy food intake) nonsignificant protection was found RR = 0.92 (95% CI = 0.79-1.06). Similar regional analysis for CRP failed to show significant protective effect in any region. This meta-analysis supports that the highest level of dairy food consumption protects subjects in both high and low LNP regions but not in areas with significant mixed LNP/LP populations. In both groups, dairy foods had no effect on polyp formation, suggesting it may only protect against CRC at late stages of promotion. These results raise the possibility that LNP/LP status may be partly responsible for the discrepant results with respect to the relationship between dairy food consumption and CRC.
Szilagyi
Andrew
A
Division of Gastroenterology, Department of Medicine, The Sir Mortimer B Davis Jewish General Hospital, McGill University, Canada. aszilagy@gas.jgh.mcgill.ca
Nathwani
Usha
U
Vinokuroff
Christina
C
Correa
José A
JA
Shrier
Ian
I
D016022:Case-Control Studies; D015331:Cohort Studies; D003111:Colonic Polyps / Q000453:epidemiology* / Q000517:prevention & control; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000517:prevention & control; D016001:Confidence Intervals; D003611:Dairy Products; D016021:Epidemiologic Studies; D006801:Humans; D043322:Lactase / Q000378:metabolism*; D007787:Lactose Intolerance / Q000503:physiopathology*; D009364:Neoplasm Recurrence, Local; D016017:Odds Ratio; D012307:Risk Factors
D043322:Lactase