Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Dietary patterns derived from principal component analysis (PCA) and risk of colorectal cancer: a systematic review and meta-analysis

Abstract

Background and aim

Colorectal cancer (CRC) is highly prevalent worldwide, with dietary habits being a major risk factor. We systematically reviewed and meta-analysed the observational evidence on the association between CRC and dietary patterns (DP) derived from principal component analysis.

Design

PRISMA guidelines were followed. Web of Science, Medline/PubMed, EMBASE, and The Cochrane Library were searched to identify all eligible papers published up to the 31st July 2017. Any pre-defined cancer of the colon was included, namely colon-rectal cancer (CRC), colon cancer (CC), rectal cancer (RC), or proximal and distal CC, if available. Western (WDP) and prudent (PDP) dietary patterns were compared as a proxy to estimate “unhealthy” (Rich in meat and processed foods) and “healthy” diets (containing fruits or vegetables), respectively. Meta-analyses were carried out using random effects model to calculate overall risk estimates. Relative risks (RR) and 95% confidence intervals were estimated comparing the highest versus the lowest categories of dietary patterns for any of the forms of colon cancer studied.

Results

28 studies were meta-analysed. A WDP was associated with increased risk of CRC (RR 1.25; 95% CI 1.11, 1.40), and of CC (RR 1.30; 95% CI 1.11, 1.52). A PDP was negatively associated with CRC (RR 0.81; 95% CI 0.73, 0.91). Sensitivity analyses showed that individuals from North-and South-American countries had a significantly higher risk of CRC than those from other continents.

Conclusion

A PDP might reduce the risk of CRC. Conversely, a WDP is associated with a higher risk of disease.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Purchase on Springer Link

Instant access to full article PDF

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. GLOBOCAN. Estimated incidence, mortality and prevalence worldwide in 2012 (2012). Colorectal cancer estimated incidence, mortality and prevalence worldwide in 2012.

  2. Parkin DM. International variation. Oncogene. 2004;23:6329–40.

    Article  CAS  Google Scholar 

  3. Arnold M, Sierra MS, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global patterns and trends in colorectal cancer incidence and mortality. Gut. 2017;66:683–91.

    Article  Google Scholar 

  4. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. Cancer J Clin. 2005;55:74–108.

    Article  Google Scholar 

  5. Research WAWCRFaAIfC. Food, nutrition, physical activity, and the prevention of cancer: a global perspective. 2007.

  6. Willett WC. Balancing life-style and genomics research for disease prevention. Science. 2002;296:695–8.

    Article  CAS  Google Scholar 

  7. Durko L, Malecka-Panas E. Lifestyle modifications and colorectal cancer. Curr Colorectal Cancer Rep. 2014;10:45–54.

    Article  Google Scholar 

  8. Research WAWCRFaAIfC. Systematic literature review continuous update project report: the associations between food, nutrition and physical acitivity and the risk of colorectal cancer. 2012.

  9. Dixon LB, Subar AF, Peters U, Weissfeld JL, Bresalier RS, Risch A, et al. Adherence to the USDA Food Guide, DASH Eating Plan, and Mediterranean dietary pattern reduces risk of colorectal adenoma. J Nutr. 2007;137:2443–50.

    Article  CAS  Google Scholar 

  10. Kontou N, Psaltopoulou T, Soupos N, Polychronopoulos E, Xinopoulos D, Linos A, et al. Metabolic syndrome and colorectal cancer: the protective role of Mediterranean diet—a case–control study. Angiology. 2012;63:390–6.

    Article  Google Scholar 

  11. Reedy J, Mitrou PN, Krebs-Smith SM, Wirfalt E, Flood A, Kipnis V, et al. Index-based dietary patterns and risk of colorectal cancer: the NIH-AARP Diet and Health Study. Am J Epidemiol. 2008;168:38–48.

    Article  CAS  Google Scholar 

  12. Cottet V, Bonithon-Kopp C, Kronborg O, Santos L, Andreatta R, Boutron-Ruault MC, et al. Dietary patterns and the risk of colorectal adenoma recurrence in a European intervention trial. Eur J Cancer Prev. 2005;14:21–29.

    Article  CAS  Google Scholar 

  13. Slattery ML, Boucher KM, Caan BJ, Potter JD, Ma KN. Eating patterns and risk of colon cancer. Am J Epidemiol. 1998;148:4–16.

    Article  CAS  Google Scholar 

  14. Terry P, Suzuki R, Hu FB, Wolk A. A prospective study of major dietary patterns and the risk of breast cancer. Cancer Epidemiol Biomark Prev. 2001;10:1281–5.

    CAS  Google Scholar 

  15. Terry P, Hu FB, Hansen H, Wolk A. Prospective study of major dietary patterns and colorectal cancer risk in women. Am J Epidemiol. 2001;154:1143–9.

    Article  CAS  Google Scholar 

  16. Dixon LB, Balder HF, Virtanen MJ, Rashidkhani B, Mannisto S, Krogh V, et al. Dietary patterns associated with colon and rectal cancer: results from the Dietary Patterns and Cancer (DIETSCAN) Project. Am J Clin Nutr. 2004;80:1003–11.

    Article  CAS  Google Scholar 

  17. Flood A, Rastogi T, Wirfalt E, Mitrou PN, Reedy J, Subar AF, et al. Dietary patterns as identified by factor analysis and colorectal cancer among middle-aged Americans. Am J Clin Nutr. 2008;88:176–84.

    Article  CAS  Google Scholar 

  18. Kesse E, Clavel-Chapelon F, Boutron-Ruault MC. Dietary patterns and risk of colorectal tumors: a cohort of French women of the National Education System (E3N). Am J Epidemiol. 2006;164:1085–93.

    Article  CAS  Google Scholar 

  19. Pham NM, Mizoue T, Tanaka K, Tsuji I, Tamakoshi A, Matsuo K, et al. Meat consumption and colorectal cancer risk: an evaluation based on a systematic review of epidemiologic evidence among the Japanese population. Jpn J Clin Oncol. 2014;44:641–50.

    Article  Google Scholar 

  20. Slattery ML. Defining dietary consumption: is the sum greater than its parts? Am J Clin Nutr. 2008;88:14–15.

    Article  CAS  Google Scholar 

  21. Hu FB. Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol. 2002;13:3–9.

    Article  CAS  Google Scholar 

  22. Newby PK, Tucker KL. Empirically derived eating patterns using factor or cluster analysis: a review. Nutr Rev. 2004;62:177–203.

    Article  CAS  Google Scholar 

  23. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D.The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.

    Article  Google Scholar 

  24. Brennan SF, Cantwell MM, Cardwell CR, Velentzis LS, Woodside JV. Dietary patterns and breast cancer risk: a systematic review and meta-analysis. Am J Clin Nutr. 2010;91:1294–302.

    Article  CAS  Google Scholar 

  25. Gandini S, Merzenich H, Robertson C, Boyle P. Meta-analysis of studies on breast cancer risk and diet: the role of fruit and vegetable consumption and the intake of associated micronutrients. Eur J Cancer. 2000;36:636–46.

    Article  CAS  Google Scholar 

  26. Schwingshackl L, Hoffmann G. Adherence to Mediterranean diet and risk of cancer: a systematic review and meta-analysis of observational studies. Int J Cancer. 2014;135:1884–97.

    Article  CAS  Google Scholar 

  27. Magalhaes B, Peleteiro B, Lunet N. Dietary patterns and colorectal cancer: systematic review and meta-analysis. Eur J Cancer Prev. 2012;21:15–23.

    Article  CAS  Google Scholar 

  28. Bertuccio P, Rosato V, Andreano A, Ferraroni M, Decarli A, Edefonti V, et al. Dietary patterns and gastric cancer risk: a systematic review and meta-analysis. Ann Oncol. 2013;24:1450–8.

    Article  CAS  Google Scholar 

  29. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–88.

    Article  CAS  Google Scholar 

  30. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–60.

    Article  Google Scholar 

  31. Sterne JA, Egger M. Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. J Clin Epidemiol. 2001;54:1046–55.

    Article  CAS  Google Scholar 

  32. Botma A, Vasen HF, van Duijnhoven FJ, Kleibeuker JH, Nagengast FM, Kampman E. Dietary patterns and colorectal adenomas in Lynch syndrome: the GEOLynch cohort study. Cancer. 2013;119:512–21.

    Article  Google Scholar 

  33. Butler LM, Wang R, Koh WP, Yu MC. Prospective study of dietary patterns and colorectal cancer among Singapore Chinese. Br J Cancer. 2008;99:1511–6.

    Article  CAS  Google Scholar 

  34. Fung T, Hu FB, Fuchs C, Giovannucci E, Hunter DJ, Stampfer MJ, et al. Major dietary patterns and the risk of colorectal cancer in women. Arch Intern Med. 2003;163:309–14.

    Article  Google Scholar 

  35. Kim MK, Sasaki S, Otani T, Tsugane S. Japan Public Health Center-based Prospective Study G. Dietary patterns and subsequent colorectal cancer risk by subsite: a prospective cohort study. Int J Cancer. 2005;115:790–8.

    Article  CAS  Google Scholar 

  36. Kumagai Y, Chou WT, Tomata Y, Sugawara Y, Kakizaki M, Nishino Y, et al. Dietary patterns and colorectal cancer risk in Japan: the Ohsaki Cohort Study. Cancer Causes Control. 2014;25:727–36.

    Article  Google Scholar 

  37. Meyerhardt JA, Niedzwiecki D, Hollis D, Saltz LB, Hu FB, Mayer RJ, et al. Association of dietary patterns with cancer recurrence and survival in patients with stage III colon cancer. JAMA. 2007;298:754–64.

    Article  CAS  Google Scholar 

  38. Nimptsch K, Malik VS, Fung TT, Pischon T, Hu FB, Willett WC, et al. Dietary patterns during high school and risk of colorectal adenoma in a cohort of middle-aged women. Int J Cancer. 2014;134:2458–67.

    Article  CAS  Google Scholar 

  39. Zhu Y, Wu H, Wang PP, Savas S, Woodrow J, Wish T et al. Dietary patterns and colorectal cancer recurrence and survival: a cohort study. BMJ Open 2013; 3.pii:e002270.

  40. Mehta RS, Song M, Nishihara R, Drew DA, Wu K, Qian ZR, et al. Dietary patterns and risk of colorectal cancer: analysis by tumor location and molecular subtypes. Gastroenterology. 2017;152:1944–53.

    Article  CAS  Google Scholar 

  41. Shin S, Saito E, Sawada N, Ishihara J, Takachi R, Nanri A, et al. Dietary patterns and colorectal cancer risk in middle-aged adults: a large population-based prospective cohort study. Clin Nutr. 2018;37:1019–26.

    Article  Google Scholar 

  42. Wu K, Hu FB, Fuchs C, Rimm EB, Willett WC, Giovannucci E. Dietary patterns and risk of colon cancer and adenoma in a cohort of men (United States). Cancer Causes Control. 2004;15:853–62.

    Article  Google Scholar 

  43. Chen Z, Wang PP, Woodrow J, Zhu Y, Roebothan B, McLaughlin JR, et al. Dietary patterns and colorectal cancer: results from a Canadian population-based study. Nutr J. 2015;14:8.

    Article  CAS  Google Scholar 

  44. Stefani ED, Deneo-Pellegrini H, Ronco AL, Correa P, Boffetta P, Aune D, et al. Dietary patterns and risk of colorectal cancer: a factor analysis in uruguay. Asian Pac J Cancer Prev. 2011;12:753–9.

    PubMed  Google Scholar 

  45. Kurotani K, Budhathoki S, Joshi AM, Yin G, Toyomura K, Kono S, et al. Dietary patterns and colorectal cancer in a Japanese population: the Fukuoka Colorectal Cancer Study. Br J Nutr. 2010;104:1703–11.

    Article  CAS  Google Scholar 

  46. Miller PE, Lazarus P, Lesko SM, Muscat JE, Harper G, Cross AJ, et al. Diet index-based and empirically derived dietary patterns are associated with colorectal cancer risk. J Nutr. 2010;140:1267–73.

    Article  CAS  Google Scholar 

  47. Park Y, Lee J, Oh JH, Shin A, Kim J. Dietary patterns and colorectal cancer risk in a Korean population: a case–control study. Medicine. 2016;95:e3759.

    Article  CAS  Google Scholar 

  48. Randall E, Marshall JR, Brasure J, Graham S. Dietary patterns and colon cancer in western New York. Nutr Cancer. 1992;18:265–76.

    Article  CAS  Google Scholar 

  49. Safari A, Shariff ZM, Kandiah M, Rashidkhani B, Fereidooni F. Dietary patterns and risk of colorectal cancer in Tehran Province: a case–control study. BMC Public Health. 2013;13:222.

    Article  Google Scholar 

  50. Satia JA, Tseng M, Galanko JA, Martin C, Sandler RS. Dietary patterns and colon cancer risk in Whites and African Americans in the North Carolina Colon Cancer Study. Nutr Cancer. 2009;61:179–93.

    Article  Google Scholar 

  51. Williams CD, Satia JA, Adair LS, Stevens J, Galanko J, Keku TO, et al. Dietary patterns, food groups, and rectal cancer risk in Whites and African-Americans. Cancer Epidemiol Biomark Prev. 2009;18:1552–61.

    Article  CAS  Google Scholar 

  52. Mizoue T, Yamaji T, Tabata S, Yamaguchi K, Shimizu E, Mineshita M, et al. Dietary patterns and colorectal adenomas in Japanese men: the Self-Defense Forces Health Study. Am J Epidemiol. 2005;161:338–45.

    Article  Google Scholar 

  53. Tazhibi M, Khalil-Tahmasebi, H, Adeli, M, Abdar, N, Loghmani, L, Maghroun, M. Association between major dietray patterns and risk of colon cancer. J Isfahan Med School. 2011; 28.

  54. Magalhaes B, Bastos J, Lunet N. Dietary patterns and colorectal cancer: a case-control study from Portugal. Eur J Cancer Prev. 2011;20:389–95.

    Article  CAS  Google Scholar 

  55. Carr PR, Jansen L, Bienert S, Roth W, Herpel E, Kloor M, et al. Associations of red and processed meat intake with major molecular pathological features of colorectal cancer. Eur J Epidemiol. 2017;32:409–18.

    Article  CAS  Google Scholar 

  56. Vulcan A, Manjer J, Ericson U, Ohlsson B. Intake of different types of red meat, poultry, and fish and incident colorectal cancer in women and men: results from the Malmo Diet and Cancer Study. Food Nutr Res. 2017;61:1341810.

    Article  Google Scholar 

  57. Foster-Powell K, Miller JB. International tables of glycemic index. Am J Clin Nutr. 1995;62:871S–890S.

    Article  CAS  Google Scholar 

  58. Giovannucci E. Insulin, insulin-like growth factors and colon cancer: a review of the evidence. J Nutr. 2001;131:3109S–3120S.

    Article  CAS  Google Scholar 

  59. Tayyem RF, Bawadi HA, Shehadah I, Agraib LM, Al-Awwad NJ, Heath DD, et al. Consumption of whole grains, refined cereals, and legumes and its association with colorectal cancer among Jordanians. Integr Cancer Ther. 2016;15:318–25.

    Article  CAS  Google Scholar 

  60. Sieri S, Krogh V, Agnoli C, Ricceri F, Palli D, Masala G, et al. Dietary glycemic index and glycemic load and risk of colorectal cancer: results from the EPIC-Italy study. Int J Cancer. 2015;136:2923–31.

    Article  CAS  Google Scholar 

  61. Voortman T, Kiefte-de Jong JC, Ikram MA, Stricker BH, van Rooij FJA, Lahousse L, et al. Adherence to the 2015 Dutch dietary guidelines and risk of non-communicable diseases and mortality in the Rotterdam Study. Eur J Epidemiol. 2017;32:993–1005.

    Article  CAS  Google Scholar 

  62. Xu M, Chen YM, Huang J, Fang YJ, Huang WQ, Yan B, et al. Flavonoid intake from vegetables and fruits is inversely associated with colorectal cancer risk: a case-control study in China. Br J Nutr. 2016;116:1275–87.

    Article  CAS  Google Scholar 

  63. Fabiani R, Minelli L, Rosignoli P. Apple intake and cancer risk: a systematic review and meta-analysis of observational studies. Public Health Nutr. 2016;19:2603–17.

    Article  Google Scholar 

  64. Chen HM, Yu YN, Wang JL, Lin YW, Kong X, Yang CQ, et al. Decreased dietary fiber intake and structural alteration of gut microbiota in patients with advanced colorectal adenoma. Am J Clin Nutr. 2013;97:1044–52.

    Article  CAS  Google Scholar 

  65. Mathew A,Peters U,Chatterjee N,Kulldorff M,Sinha R, Fat, fiber, fruits, vegetables, and risk of colorectal adenomas. Int J Cancer. 2004;108:287–92.

    Article  CAS  Google Scholar 

  66. Kritchevsky D. Epidemiology of fibre, resistant starch and colorectal cancer. Eur J Cancer Prev. 1995;4:345–52.

    Article  CAS  Google Scholar 

  67. Fuchs CS, Giovannucci EL, Colditz GA, Hunter DJ, Stampfer MJ, Rosner B, et al. Dietary fiber and the risk of colorectal cancer and adenoma in women. N Engl J Med. 1999;340:169–76.

    Article  CAS  Google Scholar 

  68. Platz EA, Giovannucci E, Rimm EB, Rockett HR, Stampfer MJ, Colditz GA, et al. Dietary fiber and distal colorectal adenoma in men. Cancer Epidemiol Biomark Prev. 1997;6:661–70.

    CAS  Google Scholar 

  69. Yusof AS, Isa ZM, Shah SA. Dietary patterns and risk of colorectal cancer: a systematic review of cohort studies (2000-11). Asian Pac J Cancer Prev. 2012;13:4713–7.

    Article  Google Scholar 

  70. Willett WC, Stampfer MJ, Colditz GA, Rosner BA, Speizer FE. Relation of meat, fat, and fiber intake to the risk of colon cancer in a prospective study among women. N Engl J Med. 1990;323:1664–72.

    Article  CAS  Google Scholar 

  71. Trock B, Lanza E, Greenwald P. Dietary fiber, vegetables, and colon cancer: critical review and meta-analyses of the epidemiologic evidence. J Natl Cancer Inst. 1990;82:650–61.

    Article  CAS  Google Scholar 

  72. Turati F, Guercio V, Pelucchi C, Vecchia CL, Galeone C, Colorectal cancer and adenomatous polyps in relation to allium vegetables intake: a meta-analysis of observational studies.Mol Nutr Food Res.2014;58:1907–14.

    Article  CAS  Google Scholar 

  73. Giovannucci E, Willett WC. Dietary factors and risk of colon cancer. Ann Med. 1994;26:443–52.

    Article  CAS  Google Scholar 

  74. Naing C, Lai PK, Mak JW. Immediately modifiable risk factors attributable to colorectal cancer in Malaysia. BMC Public Health. 2017;17:637.

    Article  Google Scholar 

  75. Klarich DS, Penprase J, Cintora P, Medrano O, Erwin D, Brasser SM, et al. Effects of moderate alcohol consumption on gene expression related to colonic inflammation and antioxidant enzymes in rats. Alcohol. 2017;61:25–31.

    Article  CAS  Google Scholar 

  76. Bakolis I, Burney P, Hooper R. Principal components analysis of diet and alternatives for identifying the combination of foods that are associated with the risk of disease: a simulation study. Br J Nutr. 2014;112:61–69.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We are indebted to Dr Siavash Saremi-Yarahmadi for his help translating a study from Farsi.

Author contributions

VGL and IB conceived the study, and VGL designed the systematic review following the PRISMA guidelines. TR designed the search strategies. VGL and VM piloted and carried out the search strategies of eligible studies. VM and VGL extracted the data independently, and discrepancies were discussed and harmonized with IB. VGL, VM, and IB agreed on the final list of eligible papers. VGL and IB discussed the statistical approach for data synthesis and analysis, and IB carried out the statistical analyses. TN, AM, and JP advised on the quality assessment of the studies, and on the interpretation of the results. VGL wrote the first and revised drafts of the manuscript, with contributions from all co-authors. All authors approved the final version of the manuscript.

Funding

Victoria Morton was a Master of Public Health (MPH) at Imperial College London and did this work as part of her Dissertation (Distinction). She was funded through a BUPA Foundation Grant No TBP-PPW10-064 awarded to Dr Vanessa Garcia-Larsen. Dr Ioannis Bakolis is funded by the National Institute for Health Research (NIHR) Biomedical Research at South London and Maudsley NHS Foundation Trust and King”s College London, and by National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South London at King”s College Hospital NHS Foundation Trust and King” College London. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Vanessa Garcia-Larsen.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Garcia-Larsen, V., Morton, V., Norat, T. et al. Dietary patterns derived from principal component analysis (PCA) and risk of colorectal cancer: a systematic review and meta-analysis. Eur J Clin Nutr 73, 366–386 (2019). https://doi.org/10.1038/s41430-018-0234-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41430-018-0234-7

This article is cited by

Search

Quick links