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Association of Nut and Seed Intake with Colorectal Cancer Risk in the European Prospective Investigation into Cancer and Nutrition

¹ Nutrition and Hormones Group, IARC-WHO, Lyon, France; ² Department of Clinical Epidemiology, Aalborg Hospital and Aarhus University Hospital, and Department of Epidemiology and Social Medicine, University of Aarhus, Aarhus, Denmark; ³ Danish Cancer Society, Institute of Cancer Epidemiology, Copenhagen, Denmark; ⁴ Institut National de la Santé et de la Recherche Médicale, U521, Institut Gustave Roussy, Villejuif, France; ⁵ Institut National de la Santé et de la Recherche Médicale, U557, Institut Scientifique et Technique de la Nutrition et de l'Alimentation, Conservatoire National des Arts et Métiers, Paris, France; ⁶ Division of Clinical Epidemiology, German Cancer Research Center, Heidelberg, Germany; ⁷ Deutsches Institut für Ernährungsforschung, Potsdam, Germany; ⁸ University of Athens Medical School, Athens, Greece; ⁹ Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Center (CSPO), Scientific Institute of Tuscany, Florence, Italy; ¹⁰ National Cancer Institute, Milan, Italy; ¹¹ Istituto Nazionale Tumori di Napoli, Naples, Italy; ¹² Cancer Registry, Azienda Ospedaliera "Civile M.P. Arezzo," Ragusa, Italy; ¹³ University of Torino and CPO-Piemonte, Turin, Italy; ¹⁴ Center for Nutrition and Health, National Institute for Public Health and the Environment, Bilthoven, Netherlands; ¹⁵ Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, Netherlands; ¹⁶ Institute of Community Medicine, University of Tromsø, Tromsø, Norway; ¹⁷ Sección Información Sanitaria, Consejería de Salud y Servicios Sanitarios de Asturias, Asturias, Spain; ¹⁸ Department of Epidemiology, Catalan Institute of Oncology, Barcelona, Spain; ¹⁹ Andalusian School of Public Health, Granada, Spain; ²⁰ Servicio de Epidemiología, Consejería de Sanidad y Consumo, Murcia, Spain; ²¹ Public Health Institute, Navarra, Spain; ²² Department of Public Health of Guipuzkoa, San Sebastian, Spain; ²³ Medical Research Center, Malmö University Hospital, Malmö, Sweden; ²⁴ Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden; ²⁵ Medical Research Council Dunn Human Nutrition Unit, Cambridge, United Kingdom; and ²⁶ Epidemiology Unit, Cancer Research UK, University of Oxford, Oxford, United Kingdom

Requests for reprints: Mazda Jenab, Nutrition and Hormones Group, IARC-WHO, 150 cours Albert-Thomas, 69372 Lyon Cedex 08, France. Phone: 33-472-73-80-82; Fax: 33-472-73-83-61. E-mail: jenab{at}iarc.fr

A link between unsaturated fatty acids or phytonutrients and reduced risk of colorectal cancer has been suggested. However, the effects of higher intake of dietary sources of these nutrients, such as the nuts and seeds food group, are less clear. The objective of this study was to determine the effects of nut and seed intake on colorectal cancer risk within the European Prospective Investigation into Cancer and Nutrition study, a large prospective cohort study involving 10 European countries. Total nut and seed intake was determined from country-specific dietary questionnaires. The data set included 478,040 subjects (141,988 men, 336,052 women) with a total of 855 (327 men, 528 women) colon and 474 (215 men, 259 women) rectal cancer cases. A multivariate Cox proportional hazards model, stratified by center and controlled for fruit intake, dietary fiber, energy, height, weight, sex, age, physical activity, and smoking, was used. The data show no association between higher intake of nuts and seeds and risk of colorectal, colon, and rectal cancers in men and women combined, but a significant inverse association was observed in subgroup analyses for colon cancer in women at the highest (>6.2 g/d) versus the lowest (nonconsumers; hazard ratio, 0.69; 95% confidence interval, 0.50-0.95) category of intake and for the linear effect of log-transformed intake (hazard ratio, 0.89; 95% confidence interval, 0.80-0.98), with no associations in men. It is not evident from this data why there may be a stronger association in women or why it may be limited to the colon, suggesting that much further research is necessary.

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