Assessing the role of ultra-processed foods in colorectal cancer incidence: insights from the EPIC cohort
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Background: Studies have reported associations between ultra-processed food (UPF) consumption and colorectal cancer (CRC) incidence, yet the magnitude of these associations remains unclear. This study estimated the cohort-associated fraction (CAF), adapted from the population-attributable fraction metric, between UPF consumption and CRC incidence and explored the potential benefits of substituting UPFs with unprocessed or minimally processed foods. Methods: Using data from 416,081 middle-aged adults in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, including 5,845 incident CRC cases, Cox proportional hazards models were applied to estimate associations between UPF consumption (grams/day) and CRC, colon and rectal cancer risks. Substitution analyses were also carried out to estimate associations of replacing UPFs with unprocessed or minimally processed foods, to reflect potentially more interpretable estimates. CAFs quantified the magnitude of these associations. Results: UPF consumption was positively associated with colon cancer (HR1-SD Increment: 1.04 [95%CI: 1.01; 1.08]) and CRC (HR1-SD Increment: 1.04 [95%CI: 1.01; 1.07]) but not with rectal cancer incidence. The CAF for UPF consumption was 5.58% (95%CI: 0.55; 10.50) for colon, and 5.10% (1.10; 9.02) for CRC incidence. Substituting 1-SD of UPFs with unprocessed or minimally processed foods was inversely associated with colon cancer (HR: 0.93, [95%CI: 0.89; 0.97]) and CRC incidence (HR: 0.94, [95%CI: 0.92; 0.98]), in energy- and nutrient-adjusted models. In substitution models, the CAF increased to 9.67% (4.36; 14.85) for colon cancer and 7.30% (3.05; 11.48) for CRC incidence. Conclusion: We estimated the magnitude of associations between UPF consumption and CRC incidence, highlighting the potential public health relevance of reducing UPF intake. Given the rising consumption of UPFs and burden of CRC incidence, public health interventions and continued research are needed to address this growing issue.
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