title: Dietary Practices, Addictive Behavior and Bowel Habits and Risk of Early Onset Colorectal Cancer: a Case Control Study.
abstract: BACKGROUND
  The abrupt rise of colorectal cancer in developing countries is raising concern in healthcare settings. Studies on assessing relationships with modifiable and non-modifiable risk factors in the Pakistani population have been limited. The present investigation was designed to examine associations of dietary practices, addictive behavior and bowel habits in developing colorectal cancer (CRC) among patients in a low-resource setup.
  
  
  METHODS
  An age-gender matched case control study was conducted from October 2011 to July 2015 in Karachi, Pakistan. Cases were from the surgical oncology department of a public sector tertiary care hospital, while their two pair-matched controls were recruited from the general population. A structured questionnaire was used which included questions related to demographic characteristics, family history, dietary patterns, addictive behavior and bowel habits.
  
  
  RESULTS
  A family history of cancer was associated with a 2.2 fold higher chance of developing CRC. Weight loss reduced the likelihood 7.6 times. Refraining from a high fat diet and consuming more vegetables showed protective effects for CRC. The risk of CRC was more than twice among smokers and those who consumed Asian specific addictive products as compared to those who avoid using these addictions (ORsmoking: 2.12, 95% CI: 1.08 - 4.17, ORpan: 2.92, 95% CI: 1.6 - 5.33, ORgutka: 2.13, 95% CI: 1.14 - 3.97). Use of NSAID attenuated risk of CRC up to 86% (OR: 0.14, 95% CI: 0.07 - 0.31).
  
  
  CONCLUSIONS
  Most of the findings showed concordance with the literature elucidating protective effects of consuming vegetables and low fat diet while documenting adverse associations with family history, weight loss, constipation and hematochezia. Moreover, this study highlighted Asian specific indigenous addictive products as important factors. Further studies are needed to validate the findings produced by this research.
authors.affiliation: Department of Surgical Oncology, Civil Hospital and Dow University of Health Sciences, Karachi, Pakistan E-mail : mehvish.hussain28@gmail.com.
authors.forename: Naveed Ali
authors.initials: NA
authors.lastname: Khan
authors.forename: Mehwish
authors.initials: M
authors.lastname: Hussain
authors.forename: Ata
authors.initials: A
authors.lastname: ur Rahman
authors.forename: Waqas Ahmed
authors.initials: WA
authors.lastname: Farooqui
authors.forename: Abdur
authors.initials: A
authors.lastname: Rasheed
authors.forename: Amjad Siraj
authors.initials: AS
authors.lastname: Memon
mesh_terms: D000328:Adult; D016739:Behavior, Addictive; D016022:Case-Control Studies; D015179:Colorectal Neoplasms / Q000453:epidemiology*; D003672:Defecation; D004032:Diet; D005191:Family Characteristics; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D008297:Male; D010154:Pakistan / Q000453:epidemiology; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014675:Vegetables