The relationship between the consumption of meat, fat, and coffee and the risk of colon cancer: A prospective study in Japan
Introduction
Colorectal cancer is considered to be a western disease. High incidence of and high mortality from colon cancer are mainly observed in the western world. Colorectal cancer is, nevertheless, a major medical priority in Japan, a non-western country. In Japan, the incidence of colorectal cancer has been increasing rapidly for several decades [1], and colorectal cancer was the third leading cause of cancer-related death in 1999 [2]. The report from Global Cancer Statistics in 2002 showed that the incidence of colorectal cancer tended to be low in Asia, excluding Japan [3]. In Japan, the age standardized incidence rate of colorectal cancer was the highest among men and the 4th highest among women in 21 areas/countries across the world. It was commented in the same report that in high-risk population of colorectal cancer, the ratio of colon to rectal cancer incidence is 2:1 or more, whereas in the low-risk population of colorectal cancer, the magnitude of the both cancers was about the same. Lifestyle changes among the Japanese, particularly with regard to their adoption of the western diet, which is characterized by high fat intake and consumption of meat or meat products, are suspected to be important causes of the rapid increase of this health threat.
Several prospective studies have been conducted to evaluate the relationship between a high fat diet and colorectal cancer and between meat consumption and colorectal cancer [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16]. All of these studies were conducted among western populations, except two recent ones in Japan [15], [16]. The results were inconsistent. On the other hand, a correlation study conducted internationally [17] and a migration study [18] showed that meat and fat intake accounted for an increased risk of colon cancer.
Drinking coffee is another popular habit in western cultures. In comparison to green tea consumption, coffee consumption is relatively new in Japan. Previously conducted case-control studies mainly showed an inverse association between coffee consumption and the risk of colorectal cancer, and cohort studies have demonstrated no association [19].
The present study was designed as a prospective cohort study to examine the relationship between a western diets characterized by high fat intake and meat consumption and the risk of the development of colon cancer. We also studied the relationship between coffee drinking, a popular habit in western cultures, and the risk of colon cancer.
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Design and setting
In September 1992, we established a study cohort with 36,990 men and women who were 35 years old or older and resided in Takayama, Japan [20]. At the baseline, a self-administered questionnaire was conducted within the cohort. The questionnaire contained information regarding demographic characteristics, socio-demographic status, regular diet, alcohol consumption, current and past smoking status, physical exercise, and general medical history. Women participants were also asked about women's
Results
Table 1 is a summary of the demographic characteristics, distribution of factors related to colon cancer, and consumption of specific food items at the baseline. During the study period, 111 male and 102 female subjects were identified to be diagnosed as the colon cancer. The RRs of colon cancer incidence are shown in Table 2 according to the level of food items or nutrients consumed after adjusting for age alone and for age, height, BMI, total pack-years of cigarette smoking, alcohol intake,
Discussion
Our study has several strengths. It is a prospectively designed cohort study, and the information concerning the intake of food, beverages, and nutrients was collected ahead of the diagnosis of colon cancer. Hence, the recall bias of the exposure is supposed to be minimal. The study cohort consisted of a community-based population, and the participation rate was high. The food and nutrient information was collected through a validated semi-quantitative food frequency questionnaire. The
Acknowledgements
This research was partly supported by grants from the Ministry of Education, Culture, Science, and Technology, the Ministry of Health, Labor, and Welfare, and the Japan Coffee Association.
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