An umbrella review of the evidence associating diet and cancer risk at 11 anatomical sites

Nikos Papadimitriou^{1

2}, Georgios Markozannes^{1

3}, Afroditi Kanellopoulou¹, Elena Critselis⁴, Sumayah Alhardan³, Vaia Karafousia¹, John C Kasimis¹, Chrysavgi Katsaraki⁴, Areti Papadopoulou¹, Maria Zografou¹, David S Lopez⁵, Doris S M Chan³, Maria Kyrgiou^{6

7}, Evangelia Ntzani^{1

8}, Amanda J Cross^{3

9}, Michael T Marrone¹⁰, Elizabeth A Platz^{10

11

12}, Marc J Gunter², Konstantinos K Tsilidis^{13

14}

Affiliations

¹ Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece.
² Section of Nutrition and Metabolism, International Agency for Research on Cancer, Lyon, France.
³ Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
⁴ Proteomics Facility, Center for Systems Biology, Biomedical Research Foundation of the Academy of Athens, Athens, Greece.
⁵ Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA.
⁶ Department of Gut, Metabolism and Reproduction and Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London, UK.
⁷ West London Gynaecological Cancer Centre, Imperial College Healthcare NHS Trust, London, UK.
⁸ Center for Evidence-Based Medicine, Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI, USA.
⁹ Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK.
¹⁰ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
¹¹ Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA.
¹² Department of Urology and the James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
¹³ Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece. ktsilidi@uoi.gr.
¹⁴ Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK. ktsilidi@uoi.gr.

PMID: 34321471
PMCID: PMC8319326
DOI: 10.1038/s41467-021-24861-8

Meta-Analysis

An umbrella review of the evidence associating diet and cancer risk at 11 anatomical sites

Nikos Papadimitriou et al. Nat Commun. 2021.

. 2021 Jul 28;12(1):4579.

doi: 10.1038/s41467-021-24861-8.

Authors

Affiliations

¹ Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece.
² Section of Nutrition and Metabolism, International Agency for Research on Cancer, Lyon, France.
³ Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
⁴ Proteomics Facility, Center for Systems Biology, Biomedical Research Foundation of the Academy of Athens, Athens, Greece.
⁵ Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA.
⁶ Department of Gut, Metabolism and Reproduction and Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London, UK.
⁷ West London Gynaecological Cancer Centre, Imperial College Healthcare NHS Trust, London, UK.
⁸ Center for Evidence-Based Medicine, Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI, USA.
⁹ Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, UK.
¹⁰ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
¹¹ Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA.
¹² Department of Urology and the James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
¹³ Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece. ktsilidi@uoi.gr.
¹⁴ Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK. ktsilidi@uoi.gr.

PMID: 34321471
PMCID: PMC8319326
DOI: 10.1038/s41467-021-24861-8

Abstract

There is evidence that diet and nutrition are modifiable risk factors for several cancers, but associations may be flawed due to inherent biases. Nutritional epidemiology studies have largely relied on a single assessment of diet using food frequency questionnaires. We conduct an umbrella review of meta-analyses of observational studies to evaluate the strength and validity of the evidence for the association between food/nutrient intake and risk of developing or dying from 11 primary cancers. It is estimated that only few single food/nutrient and cancer associations are supported by strong or highly suggestive meta-analytic evidence, and future similar research is unlikely to change this evidence. Alcohol consumption is positively associated with risk of postmenopausal breast, colorectal, esophageal, head & neck and liver cancer. Consumption of dairy products, milk, calcium and wholegrains are inversely associated with colorectal cancer risk. Coffee consumption is inversely associated with risk of liver cancer and skin basal cell carcinoma.

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Conflict of interest statement

The authors declare no competing interests.

Figures

**Fig. 1. Scatter plot showing results from the umbrella review grading the evidence on diet and cancer risk.**
The Y-axis shows the strength of the evidence. The upper half displays associations that increase cancer risk (in red), whereas the bottom half shows associations that reduce cancer risk (in green). The different point symbols and color intensity represent the different levels of evidence grading. Points colored in gray denote no statistically significant associations. The X-axis corresponds to the different cancer sites. BCC basal cell carcinoma, MHT menopausal hormone therapy, UADT upper aerodigestive tract.

**Fig. 2. Forest plot showing results that achieved strong or highly suggestive evidence from the umbrella review on diet and cancer risk.**
Data are presented as relative risks and 95% confidence intervals. BCC basal cell carcinoma, MHT menopausal hormone therapy, UADT upper aerodigestive tract.

See this image and copyright information in PMC

References

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An umbrella review of the evidence associating diet and cancer risk at 11 anatomical sites

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An umbrella review of the evidence associating diet and cancer risk at 11 anatomical sites

Authors

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Abstract

Conflict of interest statement

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References

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