Adherence to a healthy Nordic food index is associated with a lower incidence of colorectal cancer in women: The Diet, Cancer and Health cohort study

Colorectal cancer (CRC) is a multi-factorial disease in which diet is believed to play a role. Little is known about the health effects of specific regional diets. The Nordic diet is high in fat and sugar but also includes a range of traditional products with anticipated health-promoting effects. The aim of this cohort study was to determine whether a healthy Nordic food index consisting of fish, cabbage, rye bread, oatmeal, apples, pears and root vegetables was related to CRC incidence. Data were obtained from a prospective cohort study of 57 053 Danish men and women aged 50–64 years, of whom 1025 developed CRC (13 years' follow-up). Incidence rate ratios (IRR) with 95 % CI were calculated from Cox proportional hazard models. Women who strongly adhered to a healthy Nordic food index had a 35 % lower incidence of CRC than women with poor adherence (adjusted IRR, 0·65; 95 % CI 0·46, 0·94); a similar tendency was found for men. Women had a 9 % lower incidence of CRC per point adherence to the healthy Nordic food index, but no significant effect was found for men. A regional diet based on healthy Nordic food items was therefore associated with a lower incidence of CRC in women. The protective effect was of the same magnitude as previously found for the Mediterranean diet, suggesting that healthy regional diets should be promoted in order to ensure health; this will also preserve cultural heredity and the environment.

[1]  R. Lau,et al.  Dietary fibre, whole grains, and risk of colorectal cancer: systematic review and dose-response meta-analysis of prospective studies , 2011, BMJ : British Medical Journal.

[2]  Marianne Lundkjær Gjerstorff,et al.  The Danish Cancer Registry , 2011, Scandinavian journal of public health.

[3]  A. Tjønneland,et al.  Healthy aspects of the Nordic diet are related to lower total mortality. , 2011, The Journal of nutrition.

[4]  F. Hu,et al.  The Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets and colorectal cancer. , 2010, The American journal of clinical nutrition.

[5]  Dayong Wu,et al.  Avenanthramides Inhibit Proliferation of Human Colon Cancer Cell Lines In Vitro , 2010, Nutrition and cancer.

[6]  L. Serra-Majem,et al.  Association Between the Mediterranean Diet and Cancer Risk: A Review of Observational Studies , 2010, Nutrition and cancer.

[7]  A. Tjønneland,et al.  Intake of wholegrain products and risk of colorectal cancers in the Diet, Cancer and Health cohort study , 2010, British Journal of Cancer.

[8]  J. Brug,et al.  Is the term ‘Mediterranean diet’ a misnomer? , 2010, Public Health Nutrition.

[9]  N. Rothman,et al.  Isothiocyanate exposure, glutathione S-transferase polymorphisms, and colorectal cancer risk. , 2010, The American journal of clinical nutrition.

[10]  Robin P Boushey,et al.  Colorectal cancer epidemiology: incidence, mortality, survival, and risk factors. , 2009, Clinics in colon and rectal surgery.

[11]  N. Habermann,et al.  Mechanisms of primary cancer prevention by butyrate and other products formed during gut flora-mediated fermentation of dietary fibre. , 2009, Mutation research.

[12]  S. Gruber,et al.  Smoking attenuates the negative association between carotenoids consumption and colorectal cancer risk , 2009, Cancer Causes & Control.

[13]  A. Astrup,et al.  Comparison of 3 ad libitum diets for weight-loss maintenance, risk of cardiovascular disease, and diabetes: a 6-mo randomized, controlled trial. , 2008, The American journal of clinical nutrition.

[14]  N. Rottmann,et al.  Social inequality and incidence of and survival from cancers of the colon and rectum in a population-based study in Denmark, 1994-2003. , 2008, European journal of cancer.

[15]  M. Stampfer,et al.  Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. , 2008, The New England journal of medicine.

[16]  D. Winter,et al.  Oestrogen and the colon: potential mechanisms for cancer prevention. , 2008, The Lancet. Oncology.

[17]  A F Subar,et al.  Index-based dietary patterns and risk of colorectal cancer: the NIH-AARP Diet and Health Study. , 2007, American journal of epidemiology.

[18]  A. Tjønneland,et al.  Study design, exposure variables, and socioeconomic determinants of participation in Diet, Cancer and Health: A population-based prospective cohort study of 57,053 men and women in Denmark , 2007, Scandinavian journal of public health.

[19]  Paolo Vineis,et al.  Meat, fish, and colorectal cancer risk: the European Prospective Investigation into cancer and nutrition. , 2005, Journal of the National Cancer Institute.

[20]  S. Larsson,et al.  Whole grain consumption and risk of colorectal cancer: a population-based cohort of 60 000 women , 2005, British Journal of Cancer.

[21]  J. Faivre,et al.  Dietary patterns and the risk of colorectal adenoma recurrence in a European intervention trial , 2005, European journal of cancer prevention : the official journal of the European Cancer Prevention Organisation.

[22]  Tina Costacou,et al.  Adherence to a Mediterranean diet and survival in a Greek population. , 2003, The New England journal of medicine.

[23]  M. Schulze,et al.  Diversity of dietary patterns observed in the European Prospective Investigation into Cancer and Nutrition (EPIC) project , 2002, Public Health Nutrition.

[24]  A. Schatzkin,et al.  Fruit and vegetable intakes and the risk of colorectal cancer in the Breast Cancer Detection Demonstration Project follow-up cohort. , 2002, The American journal of clinical nutrition.

[25]  K. Poutanen,et al.  Rye bread improves bowel function and decreases the concentrations of some compounds that are putative colon cancer risk markers in middle-aged women and men. , 2000, The Journal of nutrition.

[26]  Celestino Santos-Buelga,et al.  Proanthocyanidins and tannin‐like compounds – nature, occurrence, dietary intake and effects on nutrition and health , 2000 .

[27]  L. Lipworth,et al.  Diet and overall survival in elderly people , 1995, BMJ.

[28]  S. Greenland Dose‐Response and Trend Analysis in Epidemiology: Alternatives to Categorical Analysis , 1995, Epidemiology.

[29]  S Greenland,et al.  Avoiding power loss associated with categorization and ordinal scores in dose-response and trend analysis. , 1995, Epidemiology.

[30]  J. Faivre,et al.  [Primary prevention of colorectal cancer]. , 1995, Bulletin du cancer.

[31]  A. Tjønneland,et al.  Development of a semiquantitative food frequency questionnaire to assess food, energy and nutrient intake in Denmark. , 1991, International journal of epidemiology.

[32]  C. Roberts,et al.  Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. , 2008, The New England journal of medicine.

[33]  G. Guanti,et al.  Hereditary Colorectal Cancer Syndromes , 2019, Clinical Algorithms in General Surgery.

[34]  S. Sarna,et al.  [Regression models]. , 1988, Duodecim; laaketieteellinen aikakauskirja.