title: Dietary polyunsaturated fatty acids intake modifies the positive association between serum total cholesterol and colorectal cancer risk: the Rotterdam Study.
abstract: It remains unclear whether serum total cholesterol is associated with colorectal cancer (CRC) risk. Interplay between dietary fatty acids and serum total cholesterol on CRC risk may be present as well. We aimed to investigate the association between serum total cholesterol with CRC. Furthermore, we investigated whether this association was modified by intake of dietary polyunsaturated fatty acids (PUFAs).
  
  
  
  We analysed data from 6628 participants of the Rotterdam Study, a prospective population-based follow-up study among patients aged 55 years and older. Serum total cholesterol was measured at baseline. During a mean follow-up time of 12.9 years, we identified 248 new CRC cases based on pathology data and medical records. Multivariable HRs were calculated using Cox regression models.
  
  
  
  After adjustment, serum total cholesterol levels were associated with a higher risk of CRC (HR 1.49; 95% CI 1.08 to 2.06 for highest vs lowest tertile). Statistically significant effect modification was present for PUFAs intake (P-interaction=0.04). After stratification by median PUFAs intake, an increased risk with increasing tertiles of serum total cholesterol was observed among patients with low PUFAs intake (3rd tertile vs 1st tertile: HR 2.43; 95% CI 1.41 to 4.18), whereas no association was observed among patients with high PUFAs intake (3rd tertile vs 1st tertile: HR 0.93; 95% CI 0.55 to 1.58).
  
  
  
  Taken together, these findings suggest that high levels of serum total cholesterol increase CRC risk, but this risk may be reduced by high dietary PUFAs intake.
authors.affiliation: Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Taulant
authors.initials: T
authors.lastname: Muka
authors.affiliation: Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands Department of Biomedical Sciences, Faculty of Medicine, University of Medicine, Tirana, Albania University Clinic of Gastrohepatology, University Hospital Center Mother Teresa, Tirana, Albania.
authors.forename: Bledar
authors.initials: B
authors.lastname: Kraja
authors.affiliation: Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands Department of Internal Medicine, Groene Hart Hospital, Gouda, The Netherlands.
authors.forename: Rikje
authors.initials: R
authors.lastname: Ruiter
authors.affiliation: Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Catherine E
authors.initials: CE
authors.lastname: de Keyser
authors.affiliation: Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Albert
authors.initials: A
authors.lastname: Hofman
authors.affiliation: Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands Department of Internal Medicine, Groene Hart Hospital, Gouda, The Netherlands Health Care Inspectorate, The Hague, The Netherlands.
authors.forename: Bruno H
authors.initials: BH
authors.lastname: Stricker
authors.affiliation: Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands Leiden University College, The Hague, The Netherlands.
authors.forename: Jessica C
authors.identifier: 0000-0002-8136-0918
authors.initials: JC
authors.lastname: Kiefte-de Jong
authors.affiliation: Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Oscar H
authors.initials: OH
authors.lastname: Franco
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002784:Cholesterol / Q000097:blood*; D015179:Colorectal Neoplasms / Q000453:epidemiology*; D004042:Dietary Fats, Unsaturated; D005231:Fatty Acids, Unsaturated; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D004042:Dietary Fats, Unsaturated; D005231:Fatty Acids, Unsaturated; D002784:Cholesterol
keywords: Cancer epidemiology; Cohort studies; ELDERLY; GASTROENTEROLOGY