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Red Meat and Colorectal Cancer: A Quantitative Update on the State of the Epidemiologic Science.

Abstract

The potential relationship between red meat consumption and colorectal cancer (CRC) has been the subject of scientific debate. Given the high degree of resulting uncertainty, our objective was to update the state of the science by conducting a systematic quantitative assessment of the epidemiologic literature. Specifically, we updated and expanded our previous meta-analysis by integrating data from new prospective cohort studies and conducting a broader evaluation of the relative risk estimates by specific intake categories. Data from 27 independent prospective cohort studies were meta-analyzed using random-effects models, and sources of potential heterogeneity were examined through subgroup and sensitivity analyses. In addition, a comprehensive evaluation of potential dose-response patterns was conducted. In the meta-analysis of all cohorts, a weakly elevated summary relative risk was observed (1.11, 95% CI: 1.03-1.19); however, statistically significant heterogeneity was present. In general, summary associations were attenuated (closer to the null and less heterogeneous) in models that isolated fresh red meat (from processed meat), adjusted for more relevant factors, analyzed women only, and were conducted in countries outside of the United States. Furthermore, no clear patterns of dose-response were apparent. In conclusion, the state of the epidemiologic science on red meat consumption and CRC is best described in terms of weak associations, heterogeneity, an inability to disentangle effects from other dietary and lifestyle factors, lack of a clear dose-response effect, and weakening evidence over time. KEY TEACHING POINTS: •The role of red meat consumption in colorectal cancer risk has been widely contested among the scientific community.•In the current meta-analysis of red meat intake and colorectal cancer, we comprehensively examined associations by creating numerous sub-group stratifications, conducting extensive sensitivity analyses, and evaluating dose-response using several different methods.•Overall, all summary associations were weak in magnitude with no clear dose-response patterns.•Interpretation of findings from epidemiologic studies investigating diet and health outcomes involves numerous methodological considerations, such as accurately measuring food intake, dietary pattern differences across populations, food definitions, outcome classifications, bias and confounding, multicollinearity, biological mechanisms, genetic variation in metabolizing enzymes, and differences in analytical metrics and statistical testing parameters.

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  • Authors+Show Affiliations

    ,

    a EpidStat Institute , Evergreen , Colorado. b EpidStat Institute , Ann Arbor , Michigan.

    ,

    c DLW Consulting Services , Salt Lake City , Utah.

    ,

    b EpidStat Institute , Ann Arbor , Michigan.

    d Doctors Without Borders , Bellevue , Washington.

    Source

    MeSH

    Case-Control Studies
    Cohort Studies
    Colorectal Neoplasms
    Diet
    Female
    Health Status
    Humans
    MEDLINE
    Male
    Prospective Studies
    Red Meat
    Risk
    Risk Factors

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Research Support, Non-U.S. Gov't
    Review

    Language

    eng

    PubMed ID

    25941850

    Citation

    Alexander, Dominik D., et al. "Red Meat and Colorectal Cancer: a Quantitative Update On the State of the Epidemiologic Science." Journal of the American College of Nutrition, vol. 34, no. 6, 2015, pp. 521-43.
    Alexander DD, Weed DL, Miller PE, et al. Red Meat and Colorectal Cancer: A Quantitative Update on the State of the Epidemiologic Science. J Am Coll Nutr. 2015;34(6):521-43.
    Alexander, D. D., Weed, D. L., Miller, P. E., & Mohamed, M. A. (2015). Red Meat and Colorectal Cancer: A Quantitative Update on the State of the Epidemiologic Science. Journal of the American College of Nutrition, 34(6), pp. 521-43. doi:10.1080/07315724.2014.992553.
    Alexander DD, et al. Red Meat and Colorectal Cancer: a Quantitative Update On the State of the Epidemiologic Science. J Am Coll Nutr. 2015;34(6):521-43. PubMed PMID: 25941850.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Red Meat and Colorectal Cancer: A Quantitative Update on the State of the Epidemiologic Science. AU - Alexander,Dominik D, AU - Weed,Douglas L, AU - Miller,Paula E, AU - Mohamed,Muhima A, Y1 - 2015/05/05/ PY - 2015/5/6/entrez PY - 2015/5/6/pubmed PY - 2016/7/14/medline KW - cancer KW - cohort studies KW - colorectal cancer KW - epidemiology KW - meta-analysis SP - 521 EP - 43 JF - Journal of the American College of Nutrition JO - J Am Coll Nutr VL - 34 IS - 6 N2 - The potential relationship between red meat consumption and colorectal cancer (CRC) has been the subject of scientific debate. Given the high degree of resulting uncertainty, our objective was to update the state of the science by conducting a systematic quantitative assessment of the epidemiologic literature. Specifically, we updated and expanded our previous meta-analysis by integrating data from new prospective cohort studies and conducting a broader evaluation of the relative risk estimates by specific intake categories. Data from 27 independent prospective cohort studies were meta-analyzed using random-effects models, and sources of potential heterogeneity were examined through subgroup and sensitivity analyses. In addition, a comprehensive evaluation of potential dose-response patterns was conducted. In the meta-analysis of all cohorts, a weakly elevated summary relative risk was observed (1.11, 95% CI: 1.03-1.19); however, statistically significant heterogeneity was present. In general, summary associations were attenuated (closer to the null and less heterogeneous) in models that isolated fresh red meat (from processed meat), adjusted for more relevant factors, analyzed women only, and were conducted in countries outside of the United States. Furthermore, no clear patterns of dose-response were apparent. In conclusion, the state of the epidemiologic science on red meat consumption and CRC is best described in terms of weak associations, heterogeneity, an inability to disentangle effects from other dietary and lifestyle factors, lack of a clear dose-response effect, and weakening evidence over time. KEY TEACHING POINTS: •The role of red meat consumption in colorectal cancer risk has been widely contested among the scientific community.•In the current meta-analysis of red meat intake and colorectal cancer, we comprehensively examined associations by creating numerous sub-group stratifications, conducting extensive sensitivity analyses, and evaluating dose-response using several different methods.•Overall, all summary associations were weak in magnitude with no clear dose-response patterns.•Interpretation of findings from epidemiologic studies investigating diet and health outcomes involves numerous methodological considerations, such as accurately measuring food intake, dietary pattern differences across populations, food definitions, outcome classifications, bias and confounding, multicollinearity, biological mechanisms, genetic variation in metabolizing enzymes, and differences in analytical metrics and statistical testing parameters. SN - 1541-1087 UR - https://www.unboundmedicine.com/medline/citation/25941850/full_citation L2 - http://www.tandfonline.com/doi/full/10.1080/07315724.2014.992553 DB - PRIME DP - Unbound Medicine ER -