Meat, fish, and colorectal cancer risk: The European prospective investigation into cancer and nutrition
Norat T., Bingham S., Ferrari P., Slimani N., Jenab M., Mazuir M., Overvad K., Olsen A., Tjønneland A., Clavel F., Boutron-Ruault MC., Kesse E., Boeing H., Bergmann MM., Nieters A., Linseisen J., Trichopoulou A., Trichopoulos D., Tountas Y., Berrino F., Palli D., Panico S., Tumino R., Vineis P., Bueno-de-Mesquita HB., Peeters PHM., Engeset D., Lund E., Skeie G., Ardanaz E., González C., Navarro C., Quirós JR., Sanchez MJ., Berglund G., Mattisson I., Hallmans G., Palmqvist R., Day NE., Khaw KT., Key TJ., San Joaquin M., Hémon B., Saracci R., Kaaks R., Riboli E.
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