title: Prevention of colorectal cancer and dietary management.
abstract: OBJECTIVE
  This systematic review focuses on dietary and lifestyle risk factors for colorectal cancer (CRC) prevention and chemoprevention among high-risk populations.
  
  
  METHODS
  We searched PubMed for English-language articles about dietary components, lifestyle risk factors, and chemoprevention agents in relation to colorectal cancer and their references published from 1980 through 2013. We reviewed articles jointly for the most clinically important information, emphasizing randomized trials and meta-analyses where available.
  
  
  RESULTS
  There is convincing evidence that intake of garlic, vitamin B6 and magnesium, active living, maintaining a healthy weight and waist, avoiding or reducing red meat, alcohol, and smoking, as well as hormone replacement therapy among women may significantly protect against developing colorectal cancer. There is less consistent evidence for fruit and vegetable intake (fiber and folate), fish and Omega-3 fatty acids, selenium, dairy, calcium and vitamin D. For high-risk populations, aspirin have been shown to protect against the development of colonic adenomas and CRC, while a minimal effective dose remains unclear.
  
  
  CONCLUSIONS
  Colorectal cancer can be prevented in general population through dietary and lifestyle interventions, and aspirin may be a good choice of chemoprevention agent among high risk individuals.
authors.affiliation: Department of Health Studies, University of Chicago, Chicago, IL, USA.
authors.forename: Ningqi
authors.initials: N
authors.lastname: Hou
authors.affiliation: Department of Health Studies, University of Chicago, Chicago, IL, USA.
authors.forename: Dezheng
authors.initials: D
authors.lastname: Huo
authors.affiliation: Department of Health Studies, University of Chicago, Chicago, IL, USA. jdignam@health.bsd.uchicago.edu.
authors.forename: James J
authors.initials: JJ
authors.lastname: Dignam
keywords: Colorectal cancer (CRC); aspirin; chemoprevention; dietary; high risk individuals; lifestyle; meta-analyses; prevention
references.citation: Int J Cancer. 2011 Jul 1;129(1):192-203
references.pmid: 21170989
references.citation: Cancer Causes Control. 2005 Oct;16(8):965-73
references.pmid: 16132805
references.citation: Epidemiology. 1996 Nov;7(6):590-7
references.pmid: 8899384
references.citation: Am J Prev Med. 2007 Mar;32(3):210-6
references.pmid: 17296473
references.citation: Int J Epidemiol. 1980 Sep;9(3):227-31
references.pmid: 7440046
references.citation: J Clin Oncol. 2009 Sep 20;27(27):4542-7
references.pmid: 19704062
references.citation: J Natl Cancer Inst. 1993 Aug 4;85(15):1220-4
references.pmid: 8331682
references.citation: N Engl J Med. 2003 Apr 24;348(17):1625-38
references.pmid: 12711737
references.citation: Lancet Oncol. 2009 May;10(5):501-7
references.pmid: 19410194
references.citation: Lancet. 2003 May 3;361(9368):1496-501
references.pmid: 12737858
references.citation: J Natl Cancer Inst. 1992 Jan 15;84(2):91-8
references.pmid: 1310511
references.citation: J Natl Cancer Inst. 2005 Jun 15;97(12 ):906-16
references.pmid: 15956652
references.citation: Hiroshima J Med Sci. 2004 Dec;53(3-4):39-45
references.pmid: 15726891
references.citation: J Natl Cancer Inst. 2012 Oct 17;104(20):1548-61
references.pmid: 22914790
references.citation: J Natl Cancer Inst. 1995 Apr 5;87(7):497-505
references.pmid: 7707436
references.citation: Cancer Epidemiol Biomarkers Prev. 2007 Dec;16(12):2533-47
references.pmid: 18086756
references.citation: N Engl J Med. 2003 Mar 6;348(10):891-9
references.pmid: 12621133
references.citation: Cancer Epidemiol Biomarkers Prev. 2012 Nov;21(11):1974-85
references.pmid: 23001243
references.citation: Am J Gastroenterol. 2002 Aug;97(8):2103-8
references.pmid: 12190184
references.citation: Cancer Causes Control. 2000 May;11(5):403-11
references.pmid: 10877333
references.citation: Int J Mol Sci. 2012;13(8):9649-72
references.pmid: 22949823
references.citation: Cancer Epidemiol Biomarkers Prev. 2008 May;17(5):1136-43
references.pmid: 18483335
references.citation: Int J Epidemiol. 2003 Apr;32(2):234-9
references.pmid: 12714542
references.citation: Cancer Epidemiol Biomarkers Prev. 2005 Apr;14(4):850-5
references.pmid: 15824155
references.citation: J Natl Cancer Inst. 2010 May 5;102(9):614-26
references.pmid: 20407088
references.citation: Lancet. 2003 May 3;361(9368):1491-5
references.pmid: 12737857
references.citation: N Engl J Med. 1999 Jan 21;340(3):169-76
references.pmid: 9895396
references.citation: Ann Intern Med. 2004 Apr 20;140(8):603-13
references.pmid: 15096331
references.citation: Lancet. 2011 Jan 1;377(9759):31-41
references.pmid: 21144578
references.citation: J Nutr. 2007 Oct;137(10):2264-9
references.pmid: 17885009
references.citation: Cancer Res. 2010 Mar 15;70(6):2406-14
references.pmid: 20215514
references.citation: Ann Nutr Metab. 2008;53(3-4):295-302
references.pmid: 19169007
references.citation: Cancer Epidemiol Biomarkers Prev. 2004 Sep;13(9):1509-14
references.pmid: 15342453
references.citation: JAMA. 2005 Dec 14;294(22):2849-57
references.pmid: 16352792
references.citation: Ann Intern Med. 2004 Feb 3;140(3):157-66
references.pmid: 14757613
references.citation: J Natl Cancer Inst. 1997 Jul 2;89(13):948-55
references.pmid: 9214674
references.citation: J Clin Oncol. 2006 Aug 1;24(22):3535-41
references.pmid: 16822843
references.citation: Arch Intern Med. 2003 Feb 10;163(3):309-14
references.pmid: 12578511
references.citation: Proc Nutr Soc. 2001 Feb;60(1):91-106
references.pmid: 11310428
references.citation: Lancet Oncol. 2006 Feb;7(2):149-56
references.pmid: 16455479
references.citation: Cancer Epidemiol Biomarkers Prev. 2004 Sep;13(9):1502-8
references.pmid: 15342452
references.citation: N Engl J Med. 2004 Mar 4;350(10):991-1004
references.pmid: 14999111
references.citation: Cancer Epidemiol Biomarkers Prev. 2008 Oct;17(10):2609-18
references.pmid: 18829444
references.citation: Mutat Res. 2001 Apr 18;475(1-2):113-21
references.pmid: 11295157
references.citation: Obstet Gynecol. 1999 May;93(5 Pt 2):880-8
references.pmid: 10912438
references.citation: JAMA. 2005 Jan 12;293(2):172-82
references.pmid: 15644544
references.citation: Nutr Cancer. 2010;62(4):413-24
references.pmid: 20432162
references.citation: Lancet. 2011 Dec 17;378(9809):2081-7
references.pmid: 22036019
references.citation: J Natl Cancer Inst. 2004 Nov 17;96(22):1669-75
references.pmid: 15547179
references.citation: N Engl J Med. 2003 Mar 6;348(10):883-90
references.pmid: 12621132
references.citation: J Natl Cancer Inst. 1999 Apr 7;91(7):620-5
references.pmid: 10203281
references.citation: N Engl J Med. 2006 Aug 31;355(9):885-95
references.pmid: 16943401
references.citation: Cancer Epidemiol Biomarkers Prev. 2000 Apr;9(4):345-9
references.pmid: 10794477
references.citation: J Nutr Biochem. 2003 May;14(5):246-50
references.pmid: 12832027
references.citation: J Nutr. 2006 Mar;136(3 Suppl):864S-869S
references.pmid: 16484582
references.citation: PLoS One. 2011;6(6):e20456
references.pmid: 21674008
references.citation: Nutr Rev. 2010 Jul;68(7):389-408
references.pmid: 20591107
references.citation: Int J Cancer. 2013 Sep 1;133(5):1033-41
references.pmid: 23338728
references.citation: J Natl Cancer Inst. 2004 Apr 7;96(7):546-53
references.pmid: 15069117
references.citation: N Engl J Med. 2006 Aug 31;355(9):873-84
references.pmid: 16943400
references.citation: Br J Cancer. 2012 Jan 31;106(3):608-16
references.pmid: 22166801
references.citation: Br J Cancer. 2009 Sep 1;101(5):849-54
references.pmid: 19638981
references.citation: J Clin Oncol. 2005 Apr 20;23(12):2840-55
references.pmid: 15837998
references.citation: Cancer Epidemiol Biomarkers Prev. 2009 Jun;18(6):1688-94
references.pmid: 19505900
references.citation: Nat Rev Cancer. 2004 Aug;4(8):579-91
references.pmid: 15286738
references.citation: Ann Intern Med. 2007 Mar 6;146(5):361-4
references.pmid: 17339621
references.citation: Lancet. 2007 May 12;369(9573):1603-13
references.pmid: 17499602
references.citation: N Engl J Med. 2000 Apr 20;342(16):1156-62
references.pmid: 10770980
references.citation: J Natl Cancer Inst. 1993 Jun 2;85(11):912-6
references.pmid: 8492320
references.citation: Br J Cancer. 2007 Dec 3;97(11):1486-92
references.pmid: 17987040
references.citation: Aliment Pharmacol Ther. 2009 Jul 1;30(2):113-25
references.pmid: 19392870
references.citation: Cancer Epidemiol Biomarkers Prev. 2002 Jul;11(7):630-9
references.pmid: 12101110
references.citation: Lancet. 1989 Nov 18;2(8673):1176-8
references.pmid: 2572900
references.citation: Int J Cancer. 1999 Sep 24;83(1):15-7
references.pmid: 10449601
references.citation: Proc Nutr Soc. 2008 Aug;67(3):253-6
references.pmid: 18452640
references.citation: N Engl J Med. 2000 Apr 20;342(16):1149-55
references.pmid: 10770979
references.citation: J Natl Cancer Inst. 2000 Oct 4;92(19):1592-600
references.pmid: 11018095
references.citation: Colorectal Dis. 2011 Feb;13(2):132-7
references.pmid: 19863600
references.citation: Lancet. 2005 Jan 8-14;365(9454):153-65
references.pmid: 15639298
references.citation: Am J Epidemiol. 2008 Jun 15;167(12):1397-406
references.pmid: 18420544
references.citation: J Natl Cancer Inst. 1993 Feb 3;85(3):224-9
references.pmid: 8423627
references.citation: J Natl Cancer Inst. 2006 Nov 15;98(22):1647-54
references.pmid: 17105987
references.citation: J Natl Cancer Inst. 1999 Jul 7;91(13):1147-54
references.pmid: 10393723
references.citation: Nutr Cancer. 2004;49(1):32-40
references.pmid: 15456633
references.citation: Cancer Causes Control. 2003 Jun;14(5):403-11
references.pmid: 12946034
references.citation: Ann Intern Med. 1998 May 1;128(9):713-20
references.pmid: 9556464
references.citation: Cancer Epidemiol Biomarkers Prev. 2011 Sep;20(9):1822-30
references.pmid: 21765007
references.citation: Int J Cancer. 2007 Feb 1;120(3):664-71
references.pmid: 17096321
references.citation: Am J Med. 2006 Aug;119(8):624-38
references.pmid: 16887404
references.citation: Eur J Cancer Prev. 1998 Dec;7(6):427-38
references.pmid: 9926290
references.citation: Ann Oncol. 2011 Sep;22(9):1958-72
references.pmid: 21307158
references.citation: JAMA. 2008 Dec 17;300(23):2765-78
references.pmid: 19088354
references.citation: J Natl Cancer Inst. 2001 Apr 4;93(7):525-33
references.pmid: 11287446
references.citation: J Natl Cancer Inst. 1995 Feb 15;87(4):265-73
references.pmid: 7707417
references.citation: Ann Intern Med. 1995 Mar 1;122(5):327-34
references.pmid: 7847643
references.citation: Cancer Causes Control. 2011 Jun;22(6):811-26
references.pmid: 21461921
references.citation: BMJ. 2002 Jan 12;324(7329):71-86
references.pmid: 11786451
references.citation: N Engl J Med. 1985 Nov 28;313(22):1381-4
references.pmid: 4058532
references.citation: Lancet. 2010 Nov 20;376(9754):1741-50
references.pmid: 20970847
references.citation: Am J Clin Nutr. 2000 Oct;72(4):1047-52
references.pmid: 11010950
references.citation: JAMA. 2007 Aug 15;298(7):754-64
references.pmid: 17699009
references.citation: Arch Med Sci. 2010 Aug 30;6(4):605-10
references.pmid: 22371807
references.citation: Nutr Cancer. 2009;61(2):165-78
references.pmid: 19235033
references.citation: JAMA. 2005 Aug 24;294(8):914-23
references.pmid: 16118381
references.citation: J Inorg Biochem. 2007 Jul;101(7):1028-35
references.pmid: 17531322
references.citation: Cancer Prev Res (Phila). 2012 Feb;5(2):164-78
references.pmid: 22084361
references.citation: Am J Clin Nutr. 2004 Jul;80(1):154-62
references.pmid: 15213043
references.citation: BMJ. 1993 Jul 31;307(6899):285-9
references.pmid: 8374373
references.citation: JAMA. 2006 Feb 8;295(6):643-54
references.pmid: 16467233
references.citation: Am J Clin Nutr. 2009 Aug;90(2):354-61
references.pmid: 19553301
references.citation: J Natl Cancer Inst. 1993 Jun 2;85(11):875-84
references.pmid: 8492316
references.citation: Am J Med. 2012 Jun;125(6):551-9.e5
references.pmid: 22513196
references.citation: Am J Clin Nutr. 2004 Apr;79(4):691-7
references.pmid: 15051616
references.citation: Curr Oncol. 2008 Dec;15(6):279-85
references.pmid: 19079628
references.citation: Int J Cancer. 2009 May 15;124(10):2406-15
references.pmid: 19142968
references.citation: Clin Ther. 2010 May;32(5):789-803
references.pmid: 20685491
references.citation: Clin Nutr. 2011 Oct;30(5):653-8
references.pmid: 21612847
references.citation: JAMA. 1996 Dec 25;276(24):1957-63
references.pmid: 8971064
references.citation: Lancet Oncol. 2012 May;13(5):518-27
references.pmid: 22440112
references.citation: Am J Clin Nutr. 2010 Feb;91(2):337-42
references.pmid: 19955400
references.citation: CA Cancer J Clin. 2011 Mar-Apr;61(2):69-90
references.pmid: 21296855
references.citation: N Engl J Med. 2006 Feb 16;354(7):684-96
references.pmid: 16481636
references.citation: Am J Clin Nutr. 2011 Apr;93(4):817-25
references.pmid: 21270374
references.citation: BMJ. 2011 Nov 10;343 :d6617
references.pmid: 22074852
references.citation: Eur J Cancer Prev. 2011 Jul;20(4):293-307
references.pmid: 21540747
references.citation: J Natl Cancer Inst. 1981 Jun;66(6):1191-308
references.pmid: 7017215
references.citation: Am J Clin Nutr. 2007 May;85(5):1353-60
references.pmid: 17490973
references.citation: JAMA. 2010 Mar 17;303(11):1077-83
references.pmid: 20233826
references.citation: J Natl Cancer Inst. 2004 Nov 17;96(22):1645-7
references.pmid: 15547171
references.citation: Eur J Cancer. 2001 Nov;37(16):2091-6
references.pmid: 11597389
references.citation: J Nutr. 2001 Mar;131(3s):1061S-6S
references.pmid: 11238817
references.citation: Cancer Res. 1994 Aug 1;54(15):4057-64
references.pmid: 8033137
references.citation: Cancer Epidemiol Biomarkers Prev. 1998 Feb;7(2):163-8
references.pmid: 9488592
references.citation: Nutr Cancer. 1992;18(3):231-5
references.pmid: 1296196
references.citation: Cancer. 2003 Aug 1;98(3):484-95
references.pmid: 12879464
references.citation: Br J Cancer. 2009 Feb 24;100(4):611-6
references.pmid: 19209175
references.citation: J Nutr. 2002 Nov;132(11 Suppl):3522S-3525S
references.pmid: 12421881
references.citation: J Nutr. 2006 Mar;136(3 Suppl):821S-826S
references.pmid: 16484573
references.citation: Int J Cancer. 2008 Feb 1;122(3):643-6
references.pmid: 17847020
references.citation: J Natl Cancer Inst. 2012 Nov 21;104(22):1702-11
references.pmid: 23136358
references.citation: Epidemiology. 2001 Jan;12 (1):88-93
references.pmid: 11138826
references.citation: Obes Rev. 2010 Jan;11(1):19-30
references.pmid: 19538439
references.citation: Cancer Res. 1999 Sep 1;59(17):4320-4
references.pmid: 10485479
references.citation: Gut. 2006 Jan;55(1):62-7
references.pmid: 15972299
references.citation: Cancer Epidemiol Biomarkers Prev. 1993 Jan-Feb;2(1):41-6
references.pmid: 8420611
references.citation: Nutr Cancer. 1997;28(3):276-81
references.pmid: 9343837
references.citation: J Nutr Health Aging. 2002;6(1):39-42
references.pmid: 11813080
references.citation: Am J Epidemiol. 1995 Sep 15;142(6):608-11
references.pmid: 7653469
references.citation: Eur J Clin Nutr. 2012 Nov;66(11):1182-6
references.pmid: 23031849
references.citation: Am J Med. 1999 Jan 25;106(1A):11S-15S; discussion 50S-51S
references.pmid: 10089108
references.citation: JAMA. 2005 Jul 6;294(1):47-55
references.pmid: 15998890