Colorectal cancer (CRC) is the fourth most common cancer diagnosed in the United States. It is estimated that in 2014 there will be 136,830 new cases of and 50,310 deaths from CRC, second only to lung cancer.1 Worldwide, CRC is the second most common cancer diagnosed in women and the third in men.
The genesis of CRC is multifactorial and complex; genetic, familial, dietary, lifestyle, and environmental factors all play important roles. It is clear that in well-defined inherited forms of CRC, such as familial polyposis and Lynch syndrome, the inherited genetic predisposition is decisive and the role of other factors may be limited to nonexistent. However, in most CRC cases—the so called “sporadic” cases—the effect of other factors such as diet may be important. To add to the complexity, it is clear that genetic-environmental interactions may ultimately determine the effects of genetic, nutritional, or environmental factors. Most studies on diet and cancer have analyzed data with little or no consideration of these interactions, which have only recently become evident. Despite these difficulties, current information implicates significant effects of diet on CRC risk. Given that diet is modifiable, it is an area that deserves consideration and investigation.
The purpose of studies on diet and specific diseases is to formulate dietary recommendations. These recommendations should also promote general health and do not consider reduction of CRC risk in isolation. Countries where dietary patterns have become more Westernized have seen a parallel incremental increase in CRC incidence.2,3 Migration studies show that immigrants from low-incidence regions who move to high-incidence industrialized regions may incur an elevated lifetime risk for CRC compared with those who remain in the low-incidence regions.4,5 Considering that approximately 75% of patients with CRC have sporadic disease,6 these findings highlight the potential impact of dietary and environmental influences on the overall incidence of and mortality from CRC.
Epidemiologic and laboratory animal studies performed during the past 40 years suggest a link between nutritional factors and colorectal carcinogenesis.7,8 In 2007, the World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) published an exhaustive evaluation of the literature on the association between diet and various cancers and suggested that changes in diet could significantly reduce the risk of cancer.9 The evaluation of food and nutrition in the prevention of CRC, in particular, was updated in 2011.10
Research on nutrition, however, is extremely challenging because dietary assessment techniques are imprecise in extracting data on consumption of single foods and nutrients. Traditional nutritional analyses of individual foods and nutrients have been valuable but have conceptual and methodologic limitations.11 People do not eat isolated nutrients. Meals are complex combinations of specific nutrients that are likely to interact synergistically.12 Changes in the consumption of one food item can trigger significant changes in other items. Given that dietary consumption varies from meal to meal and day to day, dietary consumption is extremely difficult to survey. This article provides a critical review of the literature on the role of individual foods and nutrients and the effect of dietary patterns and physical activity on the primary prevention of CRC.
The authors have disclosed that they have no financial interests, arrangements, affiliations, or commercial interests with the manufacturers of any products discussed in this article or their competitors.
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