title: Association of total energy intake and macronutrient consumption with colorectal cancer risk: results from a large population-based case-control study in Newfoundland and Labrador and Ontario, Canada.
abstract: BACKGROUND
  Diet is regarded as one of the most important environmental factors associated with colorectal cancer (CRC) risk. A recent report comprehensively concluded that total energy intake does not have a simple relationship with CRC risk, and that the data were inconsistent for carbohydrate, cholesterol and protein. The objective of this study was to identify the associations of CRC risk with dietary intakes of total energy, protein, fat, carbohydrate, fiber, and alcohol using data from a large case-control study conducted in Newfoundland and Labrador (NL) and Ontario (ON), Canada.
  
  
  METHODS
  Incident colorectal cancer cases (n = 1760) were identified from population-based cancer registries in the provinces of ON (1997-2000) and NL (1999-2003). Controls (n = 2481) were a random sample of residents in each province, aged 20-74 years. Family history questionnaire (FHQ), personal history questionnaire (PHQ), and food frequency questionnaire (FFQ) were used to collect study data. Logistic regression was used to evaluate the association of intakes of total energy, macronutrients and alcohol with CRC risk.
  
  
  RESULTS
  Total energy intake was associated with higher risk of CRC (OR: 1.56; 95% CI: 1.21-2.01, p-trend = 0.02, 5th versus 1st quintile), whereas inverse associations emerged for intakes of protein (OR: 0.85, 95%CI: 0.69-1.00, p-trend = 0.06, 5th versus 1st quintile), carbohydrate (OR: 0.81, 95%CI: 0.63-1.00, p-trend = 0.05, 5th versus 1st quintile) and total dietary fiber (OR: 0.84, 95% CI:0.67-0.99, p-trend = 0.04, 5th versus 1st quintile). Total fat, alcohol, saturated fatty acids, monounsaturated fatty acids, polyunsaturated fatty acids, and cholesterol were not associated with CRC risk.
  
  
  CONCLUSIONS
  This study provides further evidence that high energy intake may increase risk of incident CRC, whereas diets high in protein, fiber, and carbohydrate may reduce the risk of the disease.
authors.affiliation: Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St, John's, NL, Canada.
authors.forename: Zhuoyu
authors.initials: Z
authors.lastname: Sun
authors.forename: Lin
authors.initials: L
authors.lastname: Liu
authors.forename: Peizhong Peter
authors.initials: PP
authors.lastname: Wang
authors.forename: Barbara
authors.initials: B
authors.lastname: Roebothan
authors.forename: Jin
authors.initials: J
authors.lastname: Zhao
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Dicks
authors.forename: Michelle
authors.initials: M
authors.lastname: Cotterchio
authors.forename: Sharon
authors.initials: S
authors.lastname: Buehler
authors.forename: Peter T
authors.initials: PT
authors.lastname: Campbell
authors.forename: John R
authors.initials: JR
authors.lastname: McLaughlin
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Parfrey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002784:Cholesterol / Q000008:administration & dosage; D015179:Colorectal Neoplasms / Q000453:epidemiology*; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004043:Dietary Fiber / Q000008:administration & dosage; D004044:Dietary Proteins / Q000008:administration & dosage; D002149:Energy Intake; D005227:Fatty Acids / Q000008:administration & dosage; D005231:Fatty Acids, Unsaturated / Q000008:administration & dosage; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009523:Newfoundland and Labrador / Q000453:epidemiology; D009864:Ontario / Q000453:epidemiology; D012307:Risk Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D004040:Dietary Carbohydrates; D004043:Dietary Fiber; D004044:Dietary Proteins; D005227:Fatty Acids; D005231:Fatty Acids, Unsaturated; D002784:Cholesterol