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©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Food groups, diet quality and colorectal cancer risk in the Basque Country
Iker Alegria-Lertxundi, Carmelo Aguirre, Luis Bujanda, Francisco J Fernández, Francisco Polo, José Mª Ordovás, Mª Carmen Etxezarraga, Iñaki Zabalza, Mikel Larzabal, Isabel Portillo, Marian M de Pancorbo, Koldo Garcia-Etxebarria, Ana Mª Rocandio, Marta Arroyo-Izaga
Iker Alegria-Lertxundi, Marta Arroyo-Izaga, Department of Pharmacy and Food Sciences, Faculty of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz 01006, Spain
Carmelo Aguirre, Pharmacovigilance Unit, Galdakao-Usansolo University Hospital, Osakidetza, Galdakao 48960, Spain
Luis Bujanda, Department of Gastroenterology, Donostia University Hospital / Biodonostia, University of the Basque Country UPV/EHU, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), San Sebastian 20014, Spain
Francisco J Fernández, Department of Gastroenterology, Galdakao-Usansolo University Hospital, Osakidetza, Galdakao 48960, Spain
Francisco Polo, Department of Gastroenterology, Basurto University Hospital, Osakidetza, Bilbao 48013, Spain
José Mª Ordovás, Nutrition and Genomics Laboratory, Jean Mayer Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts 02111, United States of America; IMDEA Food, Madrid 28049, Spain
Mª Carmen Etxezarraga, Department of Pathology, Basurto University Hospital, Osakidetza, Bilbao 48013, Spain; Department of Physician and Surgeon Specialities, University of the Basque Country UPV/EHU, Leioa 48940, Spain
Iñaki Zabalza, Department of Pathology, Galdakao-Usansolo University Hospital, Osakidetza, Galdakao 48960, Spain
Mikel Larzabal, Department of Pathology, Donostia Hospital / Biodonostia, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), San Sebastian 20014, Spain
Isabel Portillo, Colorectal cancer screening programme, Osakidetza, Bilbao 48011, Spain
Marian M de Pancorbo, Ana Mª Rocandio, BIOMICs Research Group, University of the Basque Country UPV/EHU, Vitoria-Gasteiz 01006, Spain
Koldo Garcia-Etxebarria, Biodonostia, Gastrointestinal genetics group, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), San Sebastian 20014, Spain
Author contributions: Arroyo-Izaga M, de Pancorbo MM, Aguirre C, Alegria-Lertxundi I, Bujanda L, Fernández FJ, Polo F, Etxezarraga MC, Zabalza I, Larzabal M, Rocandio AM, Garcia-Etxebarria K and Portillo I contributed to the conception, design and data acquisition; Arroyo-Izaga M, Alegria-Lertxundi I and Ordovás JM analysed the data, interpreted the results, and drafted the manuscript; and all the authors critically revised the paper and approved the final version of the manuscript.
Supported by the Department of Health and Consumer Affairs, Basque Government, No. 2011111153; Saiotek, Basque Government, No. S-PE12UN058; Pre-doctoral grant from the Basque Government, No. PRE_2015_2_0084; and United States Department of Agriculture— Agricultural Research Service, No. 58-1950-4-003.
Institutional review board statement: This study was approved by the Clinical Research Ethics Committee of the Basque Country (reference numbers PI2011006 and PI2014042).
Informed consent statement: Written informed consent was obtained from all the study participants.
Conflict-of-interest statement: No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
Data sharing statement: Dataset available from the corresponding author at marta.arroyo@ehu.eus.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Marta Arroyo-Izaga, PharmD, Department of Pharmacy and Food Sciences, Faculty of Pharmacy, University of the Basque Country UPV/EHU, Paseo de la Universidad, No. 7, Vitoria-Gasteiz 01006, Spain. marta.arroyo@ehu.eus
Received: February 28, 2020
Peer-review started: February 28, 2020
First decision: March 21, 2020
Revised: April 3, 2020
Accepted: July 16, 2020
Article in press: July 16, 2020
Published online: July 28, 2020
ARTICLE HIGHLIGHTS
Research background
Epidemiological evidence suggests that some foods may both protect against and promote the development of colorectal cancer (CRC). However, foods are not consumed in isolation but as part of a dietary pattern; therefore, the actual effect of diet on disease risk may be observed only when all components are considered jointly. For this purpose, several diet quality indexes have been developed using point systems to measure whole diet quality based on the alignment of food choices with dietary recommendations.
Research motivation
Some diet quality indexes have been used to begin assessing the relationships between overall diet quality and CRC risk, and the results show that high scores in these indices are associated with a lower CRC risk. However, the results vary considerably according to the index used and other factors such as sex and age. Therefore, there is a need to further examine these relationships in diverse population studies.
Research objectives
To study the relationships between food groups, diet quality and CRC risk, in an adult population of the Basque Country (North of Spain).
Research methods
This observational study included 308 patients diagnosed with CRC and 308 age- and sex-matched subjects as controls. During recruitment, dietary, anthropometric, lifestyle, socioeconomic, demographic and health status information was collected. Dietary intake was assessed using a short food frequency questionnaire that was adapted and validated for this population. Adherence to the dietary recommendations was evaluated utilizing the Healthy Eating Index for the Spanish Diet and the MedDietScore. Statistical analyses were performed using IBM SPSS Statistics for Windows, version 22.0 (IBM Corp., Armonk, NY, United States) and STATA 13.0 (StataCorp LP, TX, United States). Conditional logistic regressions were used to evaluate the associations of food group intakes, diet quality scores, categorized in tertiles, with CRC risk.
Research results
The adjusted models for potential confounding factors showed a direct association between milk/dairy products consumption, in particular high-fat cheeses [odds ratio (OR) third tertile vs first tertile = 1.87, 95% confidence intervals (CI): 1.11-3.16], and CRC risk. While the consumption of fiber-containing foods, especially whole grains (OR third tertile vs first tertile = 0.62, 95%CI: 0.39-0.98), and fatty fish (OR = 0.53, 95%CI: 0.27-0.99) was associated with a lower risk for CRC. Moreover, higher MD adherence was associated with a reduced CRC risk in adjusted models (OR = 0.40, 95%CI: 0.20-0.80).
Research conclusions
Direct associations were found for high-fat cheese, whereas an inverse relation was reported for fiber-containing foods and fatty fish, as well as adherence to a Mediterranean dietary pattern.
Research perspectives
Future studies are needed to better understand the influence of the dietary habits on CRC prevention in this population that can provide leads for the design and tailoring of future interventions, and guide counselling strategies for promoting a healthy lifestyle.
