Facteurs alimentaires élevant/diminuant le risque de cancers

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A Prospective Diet-Wide Association Study for Risk of Colorectal Cancer in EPIC
Nikos Papadimitriou Clin Gastroenterol Hepatol. 2021 Apr 24;S1542-3565(21)00462-6.

Background & aims: Evidence regarding the association of dietary exposures with colorectal cancer (CRC) risk is not consistent with a few exceptions. Therefore, we conducted a diet-wide association study (DWAS) in the European Prospective Investigation into Cancer and Nutrition (EPIC) to evaluate the associations between several dietary exposures with CRC risk.

Methods: The association of 92 food and nutrient intakes with CRC risk was assessed in 386,792 participants, 5069 of whom developed incident CRC. Correction for multiple comparisons was performed using the false discovery rate, and emerging associations were examined in the Netherlands Cohort Study (NLCS). Multiplicative gene-nutrient interactions were also tested in EPIC based on known CRC-associated loci.

Results: In EPIC, alcohol, liquor/spirits, wine, beer/cider, soft drinks, and pork were positively associated with CRC, whereas milk, cheese, calcium, phosphorus, magnesium, potassium, riboflavin, vitamin B6, beta carotene, fruit, fiber, nonwhite bread, banana, and total protein intakes were inversely associated. Of these 20 associations, 13 were replicated in the NLCS, for which a meta-analysis was performed, namely alcohol (summary hazard ratio [HR] per 1-SD increment in intake: 1.07; 95% confidence interval [CI], 1.04-1.09), liquor/spirits (HR per 1-SD increment in intake, 1.04; 95% CI, 1.02-1.06), wine (HR per 1-SD increment in intake, 1.04; 95% CI, 1.02-1.07), beer/cider (HR per 1-SD increment in intake, 1.06; 95% CI, 1.04-1.08), milk (HR per 1-SD increment in intake, 0.95; 95% CI, 0.93-0.98), cheese (HR per 1-SD increment in intake, 0.96; 95% CI, 0.94-0.99), calcium (HR per 1-SD increment in intake, 0.93; 95% CI, 0.90-0.95), phosphorus (HR per 1-SD increment in intake, 0.92; 95% CI, 0.90-0.95), magnesium (HR per 1-SD increment in intake, 0.95; 95% CI, 0.92-0.98), potassium (HR per 1-SD increment in intake, 0.96; 95% CI, 0.94-0.99), riboflavin (HR per 1-SD increment in intake, 0.94; 95% CI, 0.92-0.97), beta carotene (HR per 1-SD increment in intake, 0.96; 95% CI, 0.93-0.98), and total protein (HR per 1-SD increment in intake, 0.94; 95% CI, 0.92-0.97). None of the gene-nutrient interactions were significant after adjustment for multiple comparisons.

Conclusions: Our findings confirm a positive association for alcohol and an inverse association for dairy products and calcium with CRC risk, and also suggest a lower risk at higher dietary intakes of phosphorus, magnesium, potassium, riboflavin, beta carotene, and total protein.

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Role of Diet in Colorectal Cancer Incidence: Umbrella Review of Meta-analyses of Prospective Observational Studies
Sajesh K Veettil JAMA Netw Open. 2021 Feb 1;4(2):e2037341.

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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Non-genetic biomarkers and colorectal cancer risk: Umbrella review and evidence triangulation
Xiaomeng Zhang Cancer Med. 2020 Jul;9(13):4823-4835.

Several associations between non-genetic biomarkers and colorectal cancer (CRC) risk have been detected, but the strength of evidence and the direction of associations are not confirmed. We aimed to evaluate the evidence of these associations and integrate results from different approaches to assess causal inference. We searched Medline and Embase for meta-analyses of observational studies, meta-analyses of randomized clinical trials (RCTs), and Mendelian randomization (MR) studies measuring the associations between non-genetic biomarkers and CRC risk and meta-analyses of RCTs on supplementary micronutrients. We repeated the meta-analyses using random-effects models and categorized the evidence based on predefined criteria. We described each MR study and evaluated their credibility. Seventy-two meta-analyses of observational studies and 18 MR studies on non-genetic biomarkers and six meta-analyses of RCTs on micronutrient intake and CRC risk considering 65, 42, and five unique associations, respectively, were identified. No meta-analyses of RCTs on blood level biomarkers have been found. None of the associations were classified as convincing or highly suggestive, three were classified as suggestive, and 26 were classified as weak. For three biomarkers explored in MR studies, there was evidence of causality and seven were classified as likely noncausal. For the first time, results from both observational and MR studies were integrated by triangulating the evidence for a wide variety of non-genetic biomarkers and CRC risk.

At blood level, lower vitamin D, higher homeostatic model assessment-insulin resistance, and human papillomavirus infection were associated with higher CRC risk while increased linoleic acid and oleic acid and decreased arachidonic acid were likely causally associated with lower CRC risk. No association was found convincing in both study types.

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Nutrient-wide association study of 92 foods and nutrients and breast cancer risk
Alicia K Heath Breast Cancer Res. 2020 Jan 13;22(1):5.

Background: Several dietary factors have been reported to be associated with risk of breast cancer, but to date, unequivocal evidence only exists for alcohol consumption. We sought to systematically assess the association between intake of 92 foods and nutrients and breast cancer risk using a nutrient-wide association study.

Methods: Using data from 272,098 women participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study, we assessed dietary intake of 92 foods and nutrients estimated by dietary questionnaires. Cox regression was used to quantify the association between each food/nutrient and risk of breast cancer. A false discovery rate (FDR) of 0.05 was used to select the set of foods and nutrients to be replicated in the independent Netherlands Cohort Study (NLCS).

Results: Six foods and nutrients were identified as associated with risk of breast cancer in the EPIC study (10,979 cases). Higher intake of alcohol overall was associated with a higher risk of breast cancer (hazard ratio (HR) for a 1 SD increment in intake = 1.05, 95% CI 1.03-1.07), as was beer/cider intake and wine intake (HRs per 1 SD increment = 1.05, 95% CI 1.03-1.06 and 1.04, 95% CI 1.02-1.06, respectively), whereas higher intakes of fibre, apple/pear, and carbohydrates were associated with a lower risk of breast cancer (HRs per 1 SD increment = 0.96, 95% CI 0.94-0.98; 0.96, 95% CI 0.94-0.99; and 0.96, 95% CI 0.95-0.98, respectively). When evaluated in the NLCS (2368 cases), estimates for each of these foods and nutrients were similar in magnitude and direction, with the exception of beer/cider intake, which was not associated with risk in the NLCS.

Conclusions: Our findings confirm a positive association of alcohol consumption and suggest an inverse association of dietary fibre and possibly fruit intake with breast cancer risk.

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Traduction de l'étude

Étude d'association à l'échelle des nutriments de 92 aliments et nutriments et risque de cancer du sein
Alicia K Heath Cancer du sein Res. 13 janvier 2020;22(1):5.

Contexte : Plusieurs facteurs alimentaires ont été rapportés comme étant associés au risque de cancer du sein, mais à ce jour, des preuves sans équivoque n'existent que pour la consommation d'alcool. Nous avons cherché à évaluer systématiquement l'association entre la consommation de 92 aliments et nutriments et le risque de cancer du sein à l'aide d'une étude d'association à l'échelle des nutriments.

Méthodes : À l'aide des données de 272 098 femmes participant à l'étude European Prospective Investigation into Cancer and Nutrition (EPIC), nous avons évalué l'apport alimentaire de 92 aliments et nutriments estimés par des questionnaires alimentaires. La régression de Cox a été utilisée pour quantifier l'association entre chaque aliment/nutriment et le risque de cancer du sein. Un taux de fausses découvertes (FDR) de 0,05 a été utilisé pour sélectionner l'ensemble d'aliments et de nutriments à reproduire dans l'étude de cohorte néerlandaise indépendante (NLCS).

Résultats : Six aliments et nutriments ont été identifiés comme étant associés au risque de cancer du sein dans l'étude EPIC (10 979 cas). Une consommation globale d'alcool plus élevée était associée à un risque plus élevé de cancer du sein (rapport de risque (HR) pour une augmentation de 1 ÉT de la consommation = 1,05, IC à 95 % 1,03-1,07), tout comme la consommation de bière/cidre et de vin (HR par 1 incrément SD = 1,05, IC à 95 % 1,03-1,06 et 1,04, IC à 95 % 1,02-1,06, respectivement), alors que des apports plus élevés en fibres, pomme/poire et glucides étaient associés à un risque plus faible de cancer du sein (RR pour 1 Incrément SD = 0,96, IC à 95 % 0,94-0,98 ; 0,96, IC à 95 % 0,94-0,99 ; et 0,96, IC à 95 % 0,95-0,98, respectivement). Lorsqu'elles ont été évaluées dans le NLCS (2368 cas), les estimations pour chacun de ces aliments et nutriments étaient similaires en ampleur et en direction, à l'exception de la consommation de bière/cidre, qui n'était pas associée au risque dans le NLCS.

Conclusions : Nos résultats confirment une association positive entre la consommation d'alcool et suggèrent une association inverse entre la consommation de fibres alimentaires et éventuellement de fruits et le risque de cancer du sein.

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Dairy Consumption and Liver Cancer Risk: A Systematic Review and Dose–Response Meta-Analysis of Observational Studies
Qihong Zhao Nutrition and Cancer Volume 73, 2021 - Issue 11-12 Pages 2821-2831

The relationship of dairy consumption and liver cancer risk is still controversial. We conducted a meta-analysis of published cohort and case-control studies to summarize the epidemiologic evidence on the relationship between dairy products consumption and the risk of liver cancer. The literatures were screened from PubMed, EMBASE, and Cochrane Library before May 2020. A total of seven cohort studies and eight case-control studies (5,121 cases) were included. The summary relative risks (RRs) were 1.17 (95% CI: 0.87‒1.57) and 1.08 (95% CI: 0.78‒1.51) for milk and total dairy, respectively. 0.50 (95% CI: 0.27–0.91) and 1.16 (95% CI: 0.83–1.52) were yogurt, cheese, and curd. Subgroup analysis revealed that study duration, alcohol, and design were associated the RRs. Dose–response analysis showed that the liver cancer risk was decreased by 5.4% (P for linear trend = 0.002) with a 40 g/day increment of yogurt intake.

These results suggested that total dairy, milk, cheese, and curd were positive associations with the liver cancer risk although they were not statistically significant, however higher yogurt intake would reduce the risk. Further studies are necessary to verify the relationship of dairy foods with cancer.

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Traduction de l'étude

Consommation de produits laitiers et risque de cancer du foie : examen systématique et méta-analyse dose-réponse des études observationnelles
Qihong Zhao Nutrition et Cancer Volume 73, 2021 - Numéro 11-12 Pages 2821-2831

La relation entre la consommation de produits laitiers et le risque de cancer du foie est encore controversée. Nous avons mené une méta-analyse d'études de cohorte et cas-témoins publiées pour résumer les preuves épidémiologiques sur la relation entre la consommation de produits laitiers et le risque de cancer du foie. Les publications ont été examinées dans PubMed, EMBASE et Cochrane Library avant mai 2020. Au total, sept études de cohorte et huit études cas-témoins (5 121 cas) ont été incluses. Les risques relatifs (RR) résumés étaient de 1,17 (IC à 95 % : 0,87‒1,57) et 1,08 (IC à 95 % : 0,78‒1,51) pour le lait et les produits laitiers totaux, respectivement. 0,50 (IC à 95 % : 0,27-0,91) et 1,16 (IC à 95 % : 0,83 à 1,52) étaient du yaourt, du fromage et du caillé. L'analyse en sous-groupes a révélé que la durée de l'étude, l'alcool et la conception étaient associés aux RR. L'analyse dose-réponse a montré que le risque de cancer du foie était diminué de 5,4 % (P pour la tendance linéaire = 0,002) avec une augmentation de 40  g/jour de la consommation de yaourt.

Ces résultats suggèrent que les produits laitiers totaux, le lait, le fromage et le caillé étaient des associations positives avec le risque de cancer du foie bien qu'ils ne soient pas statistiquement significatifs, mais une consommation plus élevée de yaourt réduirait le risque. D'autres études sont nécessaires pour vérifier la relation entre les produits laitiers et le cancer.