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Association between grains, gluten and the risk of colorectal cancer in the Cancer Prevention Study-II Nutrition Cohort.
Eur J Nutr. 2020 Jun; 59(4):1739-1749.EJ

Abstract

PURPOSE

Evidence supports a role of whole grains in colorectal cancer (CRC) prevention, but the association between gluten intake and CRC risk in healthy populations is unclear. We examined the association of grain and gluten intake with risk of CRC overall and by subsite among Cancer Prevention Study-II Nutrition Cohort participants.

METHODS

In 1999, 50,118 men and 62,031 women completed food frequency questionnaires assessing grain intake. Gluten intake was estimated using the protein content of grain products. Multivariable-adjusted hazards ratio (HR) and 95% confidence interval (CI) of CRC risk were estimated using Cox proportional hazards regression.

RESULTS

During follow-up through 2013, 1742 verified CRC cases occurred. For the highest vs. lowest quintiles of whole grain intake, HRs (95% CIs) of CRC risk were 0.77 (0.61-0.97; P trend = 0.03) among men and 1.10 (95% CI 0.88-1.36; P trend = 0.14) among women (P interaction by sex = 0.01). Men in the highest vs. lowest quintile of whole grain intake had a 43% lower risk of rectal cancer (HR = 0.57, 95% CI 0.35-0.93, P trend = 0.04). Gluten intake was not associated with CRC risk overall (HR = 1.10, 95% CI 0.93-1.32, P trend = 0.10), but was associated with risk of proximal colon cancer among men and women, combined (HR = 1.37, 95% CI 1.07-1.75, quintile 5 vs. 1, P trend = 0.001) and separately. Refined grains and grain-based sweets were not associated with CRC risk.

CONCLUSIONS

We found that higher whole grain intake was associated with lower CRC risk among older US men, but not women. The positive association of gluten intake with the risk of proximal colon cancer deserves further study.

Authors+Show Affiliations

Behavioral and Epidemiology Research Group, American Cancer Society, 250 Williams St, Atlanta, GA, 30303, USA. caroline.um@cancer.org.Behavioral and Epidemiology Research Group, American Cancer Society, 250 Williams St, Atlanta, GA, 30303, USA.Behavioral and Epidemiology Research Group, American Cancer Society, 250 Williams St, Atlanta, GA, 30303, USA.Behavioral and Epidemiology Research Group, American Cancer Society, 250 Williams St, Atlanta, GA, 30303, USA.Behavioral and Epidemiology Research Group, American Cancer Society, 250 Williams St, Atlanta, GA, 30303, USA.Behavioral and Epidemiology Research Group, American Cancer Society, 250 Williams St, Atlanta, GA, 30303, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31240448

Citation

Um, Caroline Y., et al. "Association Between Grains, Gluten and the Risk of Colorectal Cancer in the Cancer Prevention Study-II Nutrition Cohort." European Journal of Nutrition, vol. 59, no. 4, 2020, pp. 1739-1749.
Um CY, Campbell PT, Carter B, et al. Association between grains, gluten and the risk of colorectal cancer in the Cancer Prevention Study-II Nutrition Cohort. Eur J Nutr. 2020;59(4):1739-1749.
Um, C. Y., Campbell, P. T., Carter, B., Wang, Y., Gapstur, S. M., & McCullough, M. L. (2020). Association between grains, gluten and the risk of colorectal cancer in the Cancer Prevention Study-II Nutrition Cohort. European Journal of Nutrition, 59(4), 1739-1749. https://doi.org/10.1007/s00394-019-02032-2
Um CY, et al. Association Between Grains, Gluten and the Risk of Colorectal Cancer in the Cancer Prevention Study-II Nutrition Cohort. Eur J Nutr. 2020;59(4):1739-1749. PubMed PMID: 31240448.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association between grains, gluten and the risk of colorectal cancer in the Cancer Prevention Study-II Nutrition Cohort. AU - Um,Caroline Y, AU - Campbell,Peter T, AU - Carter,Brian, AU - Wang,Ying, AU - Gapstur,Susan M, AU - McCullough,Marjorie L, Y1 - 2019/06/25/ PY - 2018/12/20/received PY - 2019/06/15/accepted PY - 2019/6/27/pubmed PY - 2021/3/27/medline PY - 2019/6/27/entrez KW - Cohort study KW - Colorectal cancer KW - Gluten KW - Refined grains KW - Whole grains SP - 1739 EP - 1749 JF - European journal of nutrition JO - Eur J Nutr VL - 59 IS - 4 N2 - PURPOSE: Evidence supports a role of whole grains in colorectal cancer (CRC) prevention, but the association between gluten intake and CRC risk in healthy populations is unclear. We examined the association of grain and gluten intake with risk of CRC overall and by subsite among Cancer Prevention Study-II Nutrition Cohort participants. METHODS: In 1999, 50,118 men and 62,031 women completed food frequency questionnaires assessing grain intake. Gluten intake was estimated using the protein content of grain products. Multivariable-adjusted hazards ratio (HR) and 95% confidence interval (CI) of CRC risk were estimated using Cox proportional hazards regression. RESULTS: During follow-up through 2013, 1742 verified CRC cases occurred. For the highest vs. lowest quintiles of whole grain intake, HRs (95% CIs) of CRC risk were 0.77 (0.61-0.97; P trend = 0.03) among men and 1.10 (95% CI 0.88-1.36; P trend = 0.14) among women (P interaction by sex = 0.01). Men in the highest vs. lowest quintile of whole grain intake had a 43% lower risk of rectal cancer (HR = 0.57, 95% CI 0.35-0.93, P trend = 0.04). Gluten intake was not associated with CRC risk overall (HR = 1.10, 95% CI 0.93-1.32, P trend = 0.10), but was associated with risk of proximal colon cancer among men and women, combined (HR = 1.37, 95% CI 1.07-1.75, quintile 5 vs. 1, P trend = 0.001) and separately. Refined grains and grain-based sweets were not associated with CRC risk. CONCLUSIONS: We found that higher whole grain intake was associated with lower CRC risk among older US men, but not women. The positive association of gluten intake with the risk of proximal colon cancer deserves further study. SN - 1436-6215 UR - https://www.unboundmedicine.com/medline/citation/31240448/Association_between_grains_gluten_and_the_risk_of_colorectal_cancer_in_the_Cancer_Prevention_Study_II_Nutrition_Cohort_ L2 - https://dx.doi.org/10.1007/s00394-019-02032-2 DB - PRIME DP - Unbound Medicine ER -