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Dietary intake of total polyphenol and polyphenol classes and the risk of colorectal cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort

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Abstract

Polyphenols may play a chemopreventive role in colorectal cancer (CRC); however, epidemiological evidence supporting a role for intake of individual polyphenol classes, other than flavonoids is insufficient. We evaluated the association between dietary intakes of total and individual classes and subclasses of polyphenols and CRC risk and its main subsites, colon and rectum, within the European Prospective Investigation into Cancer and Nutrition (EPIC) study. The cohort included 476,160 men and women from 10 European countries. During a mean follow-up of 14 years, there were 5991 incident CRC cases, of which 3897 were in the colon and 2094 were in the rectum. Polyphenol intake was estimated using validated centre/country specific dietary questionnaires and the Phenol-Explorer database. In multivariable-adjusted Cox regression models, a doubling in total dietary polyphenol intake was not associated with CRC risk in women (HRlog2 = 1.06, 95% CI 0.99–1.14) or in men (HRlog2 = 0.97, 95% CI 0.90–1.05), respectively. Phenolic acid intake, highly correlated with coffee consumption, was inversely associated with colon cancer in men (HRlog2 = 0.91, 95% CI 0.85–0.97) and positively associated with rectal cancer in women (HRlog2 = 1.10, 95% CI 1.02–1.19); although associations did not exceed the Bonferroni threshold for significance. Intake of other polyphenol classes was not related to colorectal, colon or rectal cancer risks. Our study suggests a possible inverse association between phenolic acid intake and colon cancer risk in men and positive with rectal cancer risk in women.

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Abbreviations

BMI:

Body mass index

CRC:

Colorectal cancer

CI:

Confidence interval

EPIC:

European Prospective Investigation into Cancer and Nutrition

HR:

Hazard ratio

ICD:

International classification of diseases

NOS:

Not otherwise specified

SD:

Standard deviation

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Acknowledgements

We thank Mr Bertrand Hémon for his valuable help with the EPIC database. We also acknowledge the Northern Sweden Diet Database.

Funding

This study was supported by the Institut National du Cancer, Paris (INCa Grants 2011-105). The coordination of EPIC is financially supported by the European Commission (DG-SANCO) and the International Agency for Research on Cancer. The national cohorts are supported by Danish Cancer Society (Denmark); Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle Générale de l’Education Nationale, Institut National de la Santé et de la Recherche Médicale (INSERM) (France); German Cancer Aid, German Cancer Research Center (DKFZ), Federal Ministry of Education and Research (BMBF), Deutsche Krebshilfe, Deutsches Krebsforschungszentrum and Federal Ministry of Education and Research (Germany); the Hellenic Health Foundation (Greece); Associazione Italiana per la Ricerca sul Cancro-AIRC-Italy and National Research Council (Italy); Dutch Ministry of Public Health, Welfare and Sports (VWS), Netherlands Cancer Registry (NKR), LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund (WCRF), Statistics Netherlands (The Netherlands); European Research Council (ERC-2009-AdG 232997); Health Research Fund (FIS): PI13/00061 to Granada; PI13/01162 to EPIC-Murcia, Regional Governments of Andalucía, Asturias, Basque Country, Murcia and Navarra, AGAUR - Generalitat de Catalunya (exp. 2014 SGR 726), The Health Research Funds RD12/0036/0018, cofunded by European Regional Development Fund (ERDF) “A way to build Europe (Spain); the Swedish Research Council for Health, Working Life and Welfare (FORTE), Swedish Cancer Society, Swedish Research Council (VR) and County Councils of Skåne and Västerbotten (Sweden); Cancer Research UK (14136 to EPIC-Norfolk; C570/A16491 and C8221/A19170 to EPIC-Oxford), Medical Research Council (1000143 to EPIC-Norfolk, MR/M012190/1 to EPIC-Oxford) (United Kingdom). RZ-R was supported by the “Miguel Servet” program (CP15/00100) from the Institute of Health Carlos III and European Social Fund (ESF).

Author information

Authors and Affiliations

  1. Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), Bellvitge Biomedical Research Institute (IDIBELL), Av Gran Via 199-203, 08908, L’Hospitalet De Llobregat, Barcelona, Spain

    Raul Zamora-Ros, Valerie Cayssials & Antonio Agudo

  2. Nutrition and Metabolism Section, International Agency for Research on Cancer (IARC), Lyon, France

    Mazda Jenab, Joseph A. Rothwell, Heinz Freisling, Isabelle Romieu & Augustin Scalbert

  3. Rollins School of Public Health, Winship Cancer Institute, Emory University, Atlanta, GA, USA

    Veronika Fedirko

  4. Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany

    Krasimira Aleksandrova & Heiner Boeing

  5. Danish Cancer Society Research Center, Copenhagen, Denmark

    Anne Tjønneland & Cecilie Kyrø

  6. Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark

    Kim Overvad

  7. CESP (Centre de Recherche en Epidémiologie et Santé des Populations), Université Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France

    Marie-Christine Boutron-Ruault, Franck Carbonnel & Yahya Mahamat-Saleh

  8. Institut Gustave Roussy, Villejuif, France

    Marie-Christine Boutron-Ruault, Franck Carbonnel & Yahya Mahamat-Saleh

  9. Department of Gastroenterology, Bicêtre University Hospital, Assistance Publique des Hôpitaux de Paris, Le Kremlin Bicêtre, France

    Franck Carbonnel

  10. Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany

    Rudolf Kaaks & Tilman Kühn

  11. Hellenic Health Foundation, Athens, Greece

    Antonia Trichopoulou, Elissavet Valanou & Effie Vasilopoulou

  12. WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

    Antonia Trichopoulou & Effie Vasilopoulou

  13. Cancer Risk Factors and Life-Style Epidemiology Unit, Cancer Research and Prevention Institute – ISPO, Florence, Italy

    Giovanna Masala

  14. Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    Valeria Pala

  15. Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy

    Salvatore Panico

  16. Cancer Registry and Histopathology Unit, “Civic M.P. Arezzo” Hospital, ASP Ragusa, Italy

    Rosario Tumino

  17. Department of Clinical and Biological Sciences, University of Turin, Turin, Italy

    Fulvio Ricceri

  18. Unit of Epidemiology, Regional Health Service ASL TO3, Grugliasco (TO), Italy

    Fulvio Ricceri

  19. Department of Community Medicine, Faculty of Health Sciences, UiT, The Artic University of Tromsø, Tromsø, Norway

    Elisabete Weiderpass, Marko Lukic & Torkjel M. Sandanger

  20. Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway

    Elisabete Weiderpass

  21. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

    Elisabete Weiderpass

  22. Genetic Epidemiology Group, Folkhälsan Research Center and Faculty of Medicine, University of Helsinki, Helsinki, Finland

    Elisabete Weiderpass

  23. Department of Functional Biology, Faculty of Medicine, University of Oviedo, Oviedo, Spain

    Cristina Lasheras

  24. Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs.Granada. Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain

    Maria-Jose Sánchez

  25. CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain

    Maria-Jose Sánchez, Pilar Amiano, Carmen Navarro & Eva Ardanaz

  26. Public Health Division of Gipuzkoa, Regional Government of the Basque Country, Donostia, Spain

    Pilar Amiano

  27. Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain

    Carmen Navarro

  28. Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain

    Carmen Navarro

  29. Navarra Public Health Institute, Pamplona, Spain

    Eva Ardanaz

  30. IdiSNA, Navarra Institute for Health Research, Pamplona, Spain

    Eva Ardanaz

  31. Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden

    Emily Sonestedt

  32. Department of Internal Medicine, Skåne University Hospital, Lund University, Malmö, Sweden

    Bodil Ohlsson

  33. Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden

    Lena Maria Nilsson

  34. Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden

    Martin Rutegård

  35. Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands

    Bas Bueno-de-Mesquita

  36. Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, The Netherlands

    Bas Bueno-de-Mesquita

  37. Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, UK

    Bas Bueno-de-Mesquita, Petra H. Peeters, Amanda J. Cross & Paolo Vineis

  38. Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

    Bas Bueno-de-Mesquita

  39. Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands

    Petra H. Peeters

  40. Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK

    Kay-Thee Khaw

  41. MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK

    Nicholas J. Wareham

  42. Cancer Epidemiology Unit, University of Oxford, Oxford, UK

    Kathryn Bradbury

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  1. Raul Zamora-Ros
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  2. Valerie Cayssials
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  37. Bas Bueno-de-Mesquita
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Corresponding author

Correspondence to Raul Zamora-Ros.

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Zamora-Ros, R., Cayssials, V., Jenab, M. et al. Dietary intake of total polyphenol and polyphenol classes and the risk of colorectal cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Eur J Epidemiol 33, 1063–1075 (2018). https://doi.org/10.1007/s10654-018-0408-6

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