Background: Diet-disease association studies increasingly use dietary patterns (DPs) to account for the complexity of the exposure. We assessed if a DP associated with type 2 diabetes mellitus, CVD, and all-cause mortality is also associated with colorectal cancer (CRC). Methods: We used reduced rank regression on 24-h recall data to identify DPs explaining the maximum variation in four nutrient-response variables: energy density, saturated fatty acids, free sugars and fibre density. Cox-proportional hazards models examined prospective associations between DP adherence (coded in a continuous scale as z-scores as well as in quintiles) and incident CRC. Subgroup analyses were conducted for tumour site, age, and sex. Results: Post-exclusions, 1,089 CRC cases occurred in 114,443 participants over a median follow-up of 8.0 years. DP1 was characterised by increased intake of chocolate and confectionery, butter, low-fibre bread, red and processed meats and alcohol, as well as low fruit, vegetable, and high-fibre cereal intake. After accounting for confounders, including body mass, there were positive linear associations between DP1 and incident overall CRC (HR of quintile 5 vs. 1: 1.34, 95%CI 1.16–1.53, PTrend=0.005) and rectal cancer (HR of quintile 5 vs. 1: 1.58, 95%CI 1.27–1.96, PTrend=0.009), but not for proximal or distal colon cancers. No DP2-CRC association was observed. Conclusion: A DP previously associated with cardio-metabolic disease is also associated with incident CRC, especially rectal cancers. Impact: These consistent associations of particular food groups with both cardiometabolic disease and this diet-related cancer strengthen the evidence base for holistic population dietary guidelines to prevent ill-health.

This content is only available via PDF.
Copyright held by the owner/author(s).
This open access article is distributed under the Creative Commons Attribution 4.0 International (CC BY 4.0) license
This work is licensed under a Creative Commons Attribution 4.0 International License .
Attribution

Article PDF first page preview

Article PDF first page preview

Supplementary data

Supplementary Table S1

Table S1 Derivation of outcome, exposure of interest, model covariates, exclusion criteria, and sensitivity analysis variables from U.K. Biobank data

- docx file
Supplementary Table S2

Table S2 Food groupings and their constituent food items

- docx file
Supplementary Table S3

Table S3. Univariable associations with colorectal cancer

- docx file
Supplementary Table S4

Table S4 Sequential adjustment of the HRs with 95% CIs for DP1’s association with incident CRC.

- docx file
Supplementary Table S5

Table S5 Hazard ratios and 95% confidence intervals of all variables in the fully-adjusted model for DP1

- docx file
Supplementary Table S6

Table S6 Subgroup analysis of the association between DP1 and incident CRC by anatomic subgroup, fully adjusted and stratified model.

- docx file
Supplementary Table S7

Table S7 Sequential adjustment of the HRs with 95% CIs for DP2’s association with incident CRC

- docx file
Supplementary Table S8

Table S8 Hazard ratios and 95% confidence intervals of all variables in the fully-adjusted model for DP2

- docx file
Supplementary Table S9

Table S9 Sensitivity analyses of the fully adjusted and stratified model for the association between dietary pattern 1 and incident overall CRC

- docx file
Supplementary Table S10

Table S10 Sensitivity analyses of the fully adjusted model for the association between dietary pattern 2 and incident overall CRC

- docx file
Supplementary Table S11

Table S11. Comparison of incident colorectal cancer cases and baseline characteristics between those completing 2 vs. 3+ WebQs

- docx file
Supplementary Figure S1

Figure S1 Directed acyclic graph of variables used in the model.

- docx file
Supplementary Figure S2

Figure S2 U.K. Biobank participant exclusion flow chart

- docx file
Supplementary Figure S3

Figure S3 Hazard ratios and 95% confidence intervals for interactions of DP1 and DP2 with age and sex

- docx file
Supplementary Figure S4

Figure S4 DP2 associations with CRC by anatomic subsite

- docx file
Supplementary Figure S5

Figure S5 DP2 Sensitivity analyses

- docx file