Basic Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jan 15, 2024; 16(1): 182-196
Published online Jan 15, 2024. doi: 10.4251/wjgo.v16.i1.182
Colorectal cancer’s burden attributable to a diet high in processed meat in the Belt and Road Initiative countries
Gu Liu, Chang-Min Li, Fei Xie, Qi-Lai Li, Liang-Yan Liao, Wen-Jun Jiang, Xiao-Pan Li, Guan-Ming Lu
Gu Liu, Chang-Min Li, Guan-Ming Lu, Department of Gastrointestinal Surgery, The First Affiliated Hospital, Jinan University, Guangzhou 510630, Guangdong Province, China
Gu Liu, Fei Xie, Qi-Lai Li, Department of Gastrointestinal Surgery, Chenzhou Third People’s Hospital, Chenzhou 423000, Hunan Province, China
Chang-Min Li, Department of Gastrointestinal Surgery, Chenzhou First People’s Hospital and the First Affiliated Hospital of Xiangnan University, Chenzhou, 423000 Hunan Province, China
Liang-Yan Liao, Wen-Jun Jiang, Guan-Ming Lu, Department of Breast and Thyroid Surgery, the Affiliated Hospital of Youjiang Medical University for Nationalities, Baise 533000, Guangxi Zhuang Autonomous Region, China
Xiao-Pan Li, Department of Health Management Center, Zhongshan Hospital, Shanghai Medical College of Fudan University, Shanghai 200032, China
Co-first authors: Gu Liu and Chang-Min Li.
Co-corresponding authors: Xiao-Pan Li and Guan-Ming Lu.
Author contributions: Li XP and Lu GM conceived and designed the study; Liu G and Li XP collected and assessed the data; Lu CM, Xie F, Li QL, Liao LY, Jiang WJ and Li XP analyzed the data; Lu GM, Liu G and Li CM provided advice and consultation; Liu G, Li XP and Lu CM wrote the manuscript; Liu G and Li XP worked together to finalize the submission; Lu GM provided the fund support; Liu G and Li CM have contributed equally to this work being the co-first authors, Lu GM and Li XP are the co-corresponding authors; all authors contributed to the article and approved the submitted version.
Supported by National Natural Science Foundation of China, No. 82260532, and No. 32060208.
Conflict-of-interest statement: The authors of this manuscript having no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
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:
Corresponding author: Xiao-Pan Li, PhD, Adjunct Associate Professor, Department of Health Management Center, Zhongshan Hospital, Shanghai Medical College of Fudan University, No. 180 Fenlin Road, Shanghai 200032, China.
Received: October 1, 2023
Peer-review started: October 1, 2023
First decision: October 18, 2023
Revised: October 20, 2023
Accepted: December 11, 2023
Article in press: December 11, 2023
Published online: January 15, 2024

Colorectal cancer (CRC) plays a significant role in morbidity, mortality, and economic cost in the Belt and Road Initiative (“B and R”) countries. In addition, these countries have a substantial consumption of processed meat. However, the burden and trend of CRC in relation to the consumption of a diet high in processed meat (DHPM-CRC) in these “B and R” countries remain unknown.


To analyze the burden and trend of DHPM-CRC in the “B and R” countries from 1990 to 2019.


We used the 2019 Global Burden of Disease Study to collate information regarding the burden of DHPM-CRC. Numbers and age-standardized rates (ASRs) of deaths along with the disability-adjusted life years (DALYs) were determined among the “B and R” countries in 1990 and 2019. Using joinpoint regression analysis, the average annual percent change (AAPC) was used to analyze the temporal trends of age-standardized DALYs rate (ASDALR) from 1990 to 2019 and in the final decade (2010–2019).


We found geographical differences in the burden of DHPM-CRC among “B and R” countries, with the three highest-ranking countries being the Russian Federation, China, and Ukraine in 1990, and China, the Russian Federation, and Poland in 2019. The burden of DHPM-CRC generally increased in most member countries from 1990 to 2019 (all P < 0.05). The absolute number of deaths and DALYs in DHPM-CRC were 3151.15 [95% uncertainty interval (UI) 665.74-5696.64] and 83249.31 (95%UI 15628.64-151956.31) in China in 2019. However, the number of deaths (2627.57-2528.51) and DALYs (65867.39-55378.65) for DHPM-CRC in the Russian Federation has declined. The fastest increase in ASDALR for DHPM-CRC was observed in Vietnam, Southeast Asia, with an AAPC value of 3.90% [95% confidence interval (CI): 3.63%-4.16%], whereas the fastest decline was observed in Kyrgyzstan, Central Asia, with an AAPC value of -2.05% (95% CI: -2.37% to -1.73%). A substantial upward trend in ASR of mortality, years lived with disability, years of life lost, and DALYs from DHPM-CRC changes in 1990-2019 and the final decade (2010-2019) for most Maritime Silk Route members in East Asia, South Asia, Southeast Asia, North Africa, and the Middle East, as well as Central Europe, while those of the most Land Silk Route members in Central Asia and Eastern Europe have decreased markedly (all P < 0.05). The ASDALR for DHPM-CRC increased more in males than in females (all P < 0.05). For those aged 50-74 years, the ASDALR for DHPM-CRC in 40 members exhibited an increasing trend, except for 20 members, including 7 members in Central Asia, Maldives, and 12 high or high-middle social development index (SDI) members in other regions (all P < 0.05).


The burden of DHPM-CRC varies substantially across “B and R” countries and threatens public health. Relevant evidence-based policies and interventions tailored to the different trends of countries in SDIs or Silk Routes should be adopted to reduce the future burden of CRC in “B and R” countries via extensive collaboration.

Keywords: Belt and Road Initiative countries, Colorectal cancer, Burden of disease, Dietary risk factors, Processed meat, Disability-adjusted life years, Trend analysis

Core Tip: This article analyzes the burden diet high in processed colorectal cancer attributable to a diet high in processed meat (DHPM-CRC) from the perspective of the organization of “B and R” countries with long-term political and economic ties. It focuses on the burden of DHPM-CRC through the strong horizontal link of trade and analyzes the differences between countries and their respective social development indexs (SDIs) via the vertical sharing of experience between countries with different SDI levels. The study explores the potential benefits of controlling the quantity and quality of DHPM with regard to deepening regional cooperation and high-quality trade development, thus advancing the initiative of a community of shared destiny in the field of health.