1.
Role of Diet in Colorectal Cancer Incidence: Umbrella Review of Meta-analyses of Prospective Observational Studies.
Veettil, SK, Wong, TY, Loo, YS, Playdon, MC, Lai, NM, Giovannucci, EL, Chaiyakunapruk, N
JAMA network open. 2021;(2):e2037341
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Abstract
IMPORTANCE Several meta-analyses have summarized evidence for the association between dietary factors and the incidence of colorectal cancer (CRC). However, to date, there has been little synthesis of the strength, precision, and quality of this evidence in aggregate. OBJECTIVE To grade the evidence from published meta-analyses of prospective observational studies that assessed the association of dietary patterns, specific foods, food groups, beverages (including alcohol), macronutrients, and micronutrients with the incidence of CRC. DATA SOURCES MEDLINE, Embase, and the Cochrane Library were searched from database inception to September 2019. EVIDENCE REVIEW Only meta-analyses of prospective observational studies with a cohort study design were eligible. Evidence of association was graded according to established criteria as follows: convincing, highly suggestive, suggestive, weak, or not significant. RESULTS From 9954 publications, 222 full-text articles (2.2%) were evaluated for eligibility, and 45 meta-analyses (20.3%) that described 109 associations between dietary factors and CRC incidence were selected. Overall, 35 of the 109 associations (32.1%) were nominally statistically significant using random-effects meta-analysis models; 17 associations (15.6%) demonstrated large heterogeneity between studies (I2 > 50%), whereas small-study effects were found for 11 associations (10.1%). Excess significance bias was not detected for any association between diet and CRC. The primary analysis identified 5 (4.6%) convincing, 2 (1.8%) highly suggestive, 10 (9.2%) suggestive, and 18 (16.5%) weak associations between diet and CRC, while there was no evidence for 74 (67.9%) associations. There was convincing evidence of an association of intake of red meat (high vs low) and alcohol (≥4 drinks/d vs 0 or occasional drinks) with the incidence of CRC and an inverse association of higher vs lower intakes of dietary fiber, calcium, and yogurt with CRC risk. The evidence for convincing associations remained robust following sensitivity analyses. CONCLUSIONS AND RELEVANCE This umbrella review found convincing evidence of an association between lower CRC risk and higher intakes of dietary fiber, dietary calcium, and yogurt and lower intakes of alcohol and red meat. More research is needed on specific foods for which evidence remains suggestive, including other dairy products, whole grains, processed meat, and specific dietary patterns.
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Alcohol Consumption and the Risk of Prostate Cancer: A Dose-Response Meta-Analysis.
Hong, S, Khil, H, Lee, DH, Keum, N, Giovannucci, EL
Nutrients. 2020;(8)
Abstract
Alcohol is widely consumed and is known as a major risk factor for several types of cancers. Yet, it is unclear whether alcohol consumption is associated with the risk of prostate cancer (PCa) or not. We conducted linear and non-linear dose-response meta-analyses of cohort studies on alcohol consumption and PCa risk by types of alcohol (total, wine, beer, and liquor) and PCa (non-aggressive and aggressive). Pubmed and Embase were searched through April 2020 to identify relevant studies. Summary relative risk (RR) and 95% confidence interval (CI) were estimated using a random-effects model. For non-aggressive PCa, by alcohol type, the risk increased linearly with liquor (RR per 14 g/day intake (alcohol content in standard drink) being 1.04 (95% CI = 1.02-1.06, I2 = 0%, three studies) and non-linearly with beer (Pnon-linearity = 0.045, four studies), with increased risk observed in the lower range (RR = 1.03, 95% CI = 1.01-1.05; 14 g/day), with 1.05 (95% CI = 1.01-1.08) at 28 g/day. Wine was not significantly associated with the risk of non-aggressive PCa. For aggressive PCa, a non-linear relationship of diverse shapes was indicated for all types of alcohol in the sensitivity analysis. Compared to non-drinking, a significant positive association was more apparent at lower dose for liquor (RR = 1.12, 95% CI = 1.04-1.20 at 14 g/day; RR = 1.16, 95% CI = 1.03-1.31 at 28 g/day; Pnon-linearity = 0.005, three studies) but at higher doses for wine (RR = 1.02, 95% CI = 0.90-1.16 at 28 g/day, RR = 1.35, 95% CI = 1.08-1.67 at 56 g/day; Pnon-linearity = 0.01, four studies). In contrast, decreased risks were indicated at lower doses of beer (RR = 0.85, 95% CI = 0.79-0.92 at 14 g/day; RR = 0.79, 95% CI = 0.70-0.90 at 28 g/day, Pnon-linearity < 0.001, four studies). Total alcohol consumption was not associated with both types of PCa. In this study, we found heterogeneous associations between alcohol intake and PCa by types of alcohol and PCa.
3.
Association between Alcohol Consumption and Survival in Colorectal Cancer: A Meta-analysis.
Kim, Y, Je, Y, Giovannucci, EL
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2019;(11):1891-1901
Abstract
BACKGROUND Although an association between alcohol consumption and risk of colorectal cancer is well established, little is known about the association between alcohol consumption and colorectal cancer survival. We conducted a meta-analysis of prospective cohort studies to quantitatively assess this association. METHODS Data searches were performed using PubMed and ISI Web of Science databases through December 2018. We estimated pooled RRs with 95% confidence intervals (CI) using random-effects models. RESULTS Twelve studies with 32,846 patients with colorectal cancer were included in the meta-analysis. Compared with no alcohol consumption, light (RR = 0.87; 95% CI, 0.81-0.94) and moderate (RR = 0.92; 95% CI, 0.85-1.00) prediagnostic alcohol consumption were associated with lower risk of all-cause mortality. Light prediagnostic alcohol consumption was associated with lower risk of colorectal cancer-specific mortality (RR = 0.87; 95% CI, 0.78-0.98). However, heavy prediagnostic alcohol consumption was not significantly associated with colorectal cancer survival. In a dose-response analysis, a nonlinear association between prediagnostic alcohol consumption and all-cause mortality was observed (P nonlinearity = 0.0025), showing the reduction in RR at <30 g/day of alcohol consumption. By type of alcohol, wine consumption was associated with lower risk of mortality from all-causes and colorectal cancer, but a positive association was observed between moderate liquor consumption and all-cause mortality. There was no association between postdiagnostic alcohol consumption and colorectal cancer survival. CONCLUSIONS Light and moderate prediagnostic alcohol consumption were associated with better survival in colorectal cancer. IMPACT Our findings suggest that light and moderate alcohol consumption may be associated with better survival in colorectal cancer, but further studies are warranted.