Meat, fish, and colorectal cancer risk: the European Prospective Investigation into cancer and nutrition

Abstract

Background: Current evidence suggests that high red meat intake is associated with increased colorectal cancer risk. High fish intake may be associated with a decreased risk, but the existing evidence is less convincing.

Methods: We prospectively followed 478 040 men and women from 10 European countries who were free of cancer at enrollment between 1992 and 1998. Information on diet and lifestyle was collected at baseline. After a mean follow-up of 4.8 years, 1329 incident colorectal cancers were documented. We examined the relationship between intakes of red and processed meat, poultry, and fish and colorectal cancer risk using a proportional hazards model adjusted for age, sex, energy (nonfat and fat sources), height, weight, work-related physical activity, smoking status, dietary fiber and folate, and alcohol consumption, stratified by center. A calibration substudy based on 36 994 subjects was used to correct hazard ratios (HRs) and 95% confidence intervals (CIs) for diet measurement errors. All statistical tests were two-sided.

Results: Colorectal cancer risk was positively associated with intake of red and processed meat (highest [>160 g/day] versus lowest [<20 g/day] intake, HR = 1.35, 95% CI = 0.96 to 1.88; Ptrend = .03) and inversely associated with intake of fish (>80 g/day versus <10 g/day, HR = 0.69, 95 % CI = 0.54 to 0.88; Ptrend<.001), but was not related to poultry intake. Correcting for measurement error strengthened the associations between colorectal cancer and red and processed meat intake (per 100-g increase HR = 1.25, 95% CI =1.09 to 1.41, Ptrend = .001 and HR = 1.55, 95% CI = 1.19 to 2.02, Ptrend = .001 before and after calibration, respectively) and for fish (per 100 g increase HR = 0.70, 95% CI = 0.57 to 0.87, Ptrend<.001 and HR = 0.46, 95% CI = 0.27 to 0.77, Ptrend = .003; before and after correction, respectively). In this study population, the absolute risk of development of colorectal cancer within 10 years for a study subject aged 50 years was 1.71% for the highest category of red and processed meat intake and 1.28% for the lowest category of intake and was 1.86% for subjects in the lowest category of fish intake and 1.28% for subjects in the highest category of fish intake.

Conclusions: Our data confirm that colorectal cancer risk is positively associated with high consumption of red and processed meat and support an inverse association with fish intake.

Fig. 1

Hazard ratios of colorectal cancer in the European Prospective Investigation into Cancer and Nutrition cohort. Hazard ratios by A) intake of red and processed meat and B) by intake of fish. Hazard ratios were calculated from Cox regression models adjusted for age, sex, energy from nonfat sources (continuous variable), energy from fat sources (continuous variable), height (tertiles defined for each sex and center), weight (tertiles defined for each sex and center), work-related physical activity (no activity, sedentary, standing, manual, or heavy manual) smoking status (never, former, or current smoker), alcohol consumption (grams per day) and stratified for center. Points in the figure represent median intakes in each category of consumption. Curves generated from calibrated data (solid line) and uncalibrated data (hatched line) and upper and lower confidence intervals for calibrated data (dotted lines) are shown.

Fig. 2

Multivariable hazard ratios and 95% confidence intervals from calibrated analyses of colorectal cancer for individual center in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Hazard ratios (HRs) per 100-g increase in intake and 95% confidence intervals (CIs) were calculated for calibrated intakes of A) red and processed meat and B) fish. Hazard ratios were calculated from β coefficients from Cox regression models adjusted for age, sex, energy from nonfat sources (continuous variable), energy from fat sources (continuous variable), height (tertiles defined for each sex and center), weight (tertiles defined for each sex and center), work-related physical activity (no activity, sedentary, standing, manual, or heavy manual) smoking status (never, former, or current smoker), fiber intake (grams per day) and alcohol consumption (grams of day). Centers with fewer than 50 case patients with colorectal cancer are not included. The black squares and horizontal lines correspond to the center-specific hazard ratios (per 100-g increase in intake) and 95% confidence intervals. The area of the square refl ects the center-specific statistical weight (inverse of the variance). The diamond and horizontal lines represent the hazard ratio and 95% confidence intervals in EPIC.

Fig. 3

Multivariable hazard ratios for colorectal cancer in the European Prospective Investigation into Cancer and Nutrition Cohort. Hazard ratios for intakes of A) red and processed meat and fish and B) red and processed meat and fiber. Multivariable analysis was performed using Cox regression models adjusted for age, sex, energy from nonfat sources (continuous variable), energy from fat sources (continuous variable), height (tertiles defined for each sex and center), weight (tertiles defined for each sex and center), work-related physical activity (no activity, sedentary, standing, manual, or heavy manual) smoking status (never, former, or current smoker), alcohol consumption (grams per day) and stratified by center. Low, medium, and high represent sex-specific tertiles. For red meat intake, low was less than 30 g/day of red and processed meat in men and less than 13 g/day in women, medium was 30–129 g/day in men and 13 to 85 g/day in women, and high was more than 129 g/day in men and 85 g/day in women. Cut points for fish intake were the same for men and women, with low being less than 14 g/day, medium being 14–50 g/day, and high being more than 50 g/day. For fiber intake, low was less than 17 g/day in men and women, medium was 17–28 g/day in men and 17–26 g/day in women, and high was more than 28 g/day in men and 26 g/day in women. * P <.05 relative to the group of subjects with low red and processed meat and high fish intake (A) or high fiber intake (B).