Associations between degree of food processing and colorectal cancer risk in a large-scale European cohort

Aline Al Nahas¹, Sahar Yammine Ghantous², Fernanda Morales Berstein^{3

4}, Emine Koc Cakmak⁵, Carine Biessy¹, Genevieve Nicolas¹, Nathalie Kliemann⁶, Jessica Blanco Lopez¹, Inarie Jacobs¹, Esther M Gonzalez-Gil¹, Manon Cairat⁷, Maria Gabriela Matias Pinho^{8

9}, Renata Bertazzi Levy^{10

11}, Fernanda Rauber^{10

11}, Eszter P Vamos¹², Kiara Chang¹², Christopher Millett^{12

13}, Mathilde Touvier², Emmanuelle Kesse-Guyot², Gianluca Severi^{7

14}, Chloé Marques⁷, Mariem Hajji⁷, Alessandra Macciotta^{15

16}, Giovanna Masala¹⁷, Mario Fordellone¹⁸, Claudia Agnoli¹⁹, Pilar Amiano^{20

21}, Marcela Guevara^{22

23

24}, Anne Tjønneland^{25

26}, Cecilie Kyrø²⁵, Jeroen W G Derksen²⁷, Karel C Smit^{27

28}, Matthias B Schulze^{29

30}, Franziska Jannasch²⁹, Rudolf Kaaks³¹, Verena Katzke³¹, Tonje Braaten^{32

33}, Magritt Brustad^{32

34}, Guri Skeie^{1

32}, Rhea Harewood³⁵, Alicia Heath³⁶, Paolo Vineis^{5

37}, Elisabete Weiderpass¹, Pietro Ferrari¹, Marc J Gunter^{1

36}, Inge Huybrechts¹

Affiliations

¹ Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France.
² INSERM, INRAE, CNAM, Centre for Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Université Sorbonne Paris Nord and Université Paris Cité, Bobigny, France.
³ MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
⁴ Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
⁵ Department of Epidemiology and Biostatistics, School of Public Health, MCR Centre for Environment and Health, Imperial College London, London, UK.
⁶ Centro de Pesquisas Oncológicas (CEPON), Santa Catarina, Brazil.
⁷ Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, CESP, Villejuif, France.
⁸ Copernicus Institute of Sustainable Development, Department Environmental Sciences, Utrecht University, Utrecht, the Netherlands.
⁹ Amsterdam UMC Location Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam, the Netherlands.
¹⁰ Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil.
¹¹ Center for Epidemiological Research in Nutrition and Health, Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil.
¹² Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK.
¹³ NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal.
¹⁴ Department of Statistics, Computer Science, Applications "G. Parenti", University of Florence, Florence, Italy.
¹⁵ Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy.
¹⁶ Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.
¹⁷ Clinical Epidemiology Unit, Institute for Cancer Research, Prevention, and Clinical Network (ISPRO), Florence, Italy.
¹⁸ Medical Statistics Unit, University of Campania Luigi Vanvitelli, Naples, Italy.
¹⁹ Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
²⁰ Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, San Sebastian, Spain.
²¹ BioGipuzkoa (BioDonostia) Health Research Institute, Epidemiology of Chronic and Communicable Diseases Group, San Sebastián, Spain.
²² Instituto de Salud Pública y Laboral de Navarra, Pamplona, Spain.
²³ Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
²⁴ Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.
²⁵ Danish Cancer Institute, Diet, Cancer and Health, Copenhagen, Denmark.
²⁶ Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
²⁷ Department of Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
²⁸ Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
²⁹ Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
³⁰ Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany.
³¹ Division of Cancer Epidemiology (C020), German Cancer Research Center (DKFZ), Heidelberg, Germany.
³² Department of Community Medicine, UIT The Arctic University of Norway, Tromsø, Norway.
³³ Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.
³⁴ The Public Dental Health Service Competence Centre of Northern Norway, Tromsø, Norway.
³⁵ Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK.
³⁶ Cancer Epidemiology and Prevention Research Unit, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
³⁷ Italian Institute for Genomic Medicine (IIGM), Turin, Italy.

PMID: 39921517
DOI: 10.1002/ijc.35361

Associations between degree of food processing and colorectal cancer risk in a large-scale European cohort

Aline Al Nahas et al. Int J Cancer. 2025.

. 2025 Jul 15;157(2):260-276.

doi: 10.1002/ijc.35361. Epub 2025 Feb 8.

Authors

Affiliations

¹ Nutrition and Metabolism Branch, International Agency for Research on Cancer/World Health Organization, Lyon, France.
² INSERM, INRAE, CNAM, Centre for Research in Epidemiology and StatisticS (CRESS), Nutritional Epidemiology Research Team (EREN), Université Sorbonne Paris Nord and Université Paris Cité, Bobigny, France.
³ MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
⁴ Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
⁵ Department of Epidemiology and Biostatistics, School of Public Health, MCR Centre for Environment and Health, Imperial College London, London, UK.
⁶ Centro de Pesquisas Oncológicas (CEPON), Santa Catarina, Brazil.
⁷ Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, CESP, Villejuif, France.
⁸ Copernicus Institute of Sustainable Development, Department Environmental Sciences, Utrecht University, Utrecht, the Netherlands.
⁹ Amsterdam UMC Location Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam, the Netherlands.
¹⁰ Department of Preventive Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil.
¹¹ Center for Epidemiological Research in Nutrition and Health, Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil.
¹² Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK.
¹³ NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal.
¹⁴ Department of Statistics, Computer Science, Applications "G. Parenti", University of Florence, Florence, Italy.
¹⁵ Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy.
¹⁶ Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.
¹⁷ Clinical Epidemiology Unit, Institute for Cancer Research, Prevention, and Clinical Network (ISPRO), Florence, Italy.
¹⁸ Medical Statistics Unit, University of Campania Luigi Vanvitelli, Naples, Italy.
¹⁹ Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
²⁰ Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, San Sebastian, Spain.
²¹ BioGipuzkoa (BioDonostia) Health Research Institute, Epidemiology of Chronic and Communicable Diseases Group, San Sebastián, Spain.
²² Instituto de Salud Pública y Laboral de Navarra, Pamplona, Spain.
²³ Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
²⁴ Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.
²⁵ Danish Cancer Institute, Diet, Cancer and Health, Copenhagen, Denmark.
²⁶ Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
²⁷ Department of Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
²⁸ Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
²⁹ Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
³⁰ Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany.
³¹ Division of Cancer Epidemiology (C020), German Cancer Research Center (DKFZ), Heidelberg, Germany.
³² Department of Community Medicine, UIT The Arctic University of Norway, Tromsø, Norway.
³³ Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.
³⁴ The Public Dental Health Service Competence Centre of Northern Norway, Tromsø, Norway.
³⁵ Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK.
³⁶ Cancer Epidemiology and Prevention Research Unit, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
³⁷ Italian Institute for Genomic Medicine (IIGM), Turin, Italy.

PMID: 39921517
DOI: 10.1002/ijc.35361

Abstract

Industrial food processing has been linked to various health outcomes including cancer. To examine associations between the degree of food processing and risk of colorectal cancer (CRC) and its sub-sites, data from the European Prospective Investigation into Cancer (EPIC) including 6155 incident CRC cases (n = 450,111 participants), were analyzed. Dietary intakes were assessed using baseline food frequency questionnaires. Foods were classified into culinary ingredients, unprocessed, processed (PFs), and ultra-processed foods (UPFs) according to the Nova classification. Cox proportional hazards models, adjusted for established CRC risk factors, were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) associated with a 10% increase in proportion of consumption (%g/d) of each Nova group. Substitution analysis examined the effect of replacing UPFs and PFs with unprocessed foods on CRC risk. A 10% increase in proportion of UPFs was associated with 6% higher CRC risk (95% CI:1.02-1.10). A positive association was also found between PFs and CRC risk (HR per 10% increase: 1.10 [95% CI, 1.05-1.15]). Conversely, unprocessed food consumption was inversely associated with CRC risk (HR per 10% increase: 0.93[95% CI, 0.90-0.95]). Substitution of 10% of the overall proportion of the diet comprising UPFs or PFs with 10% unprocessed foods was associated with a decreased risk of CRC (HR_UPFs: 0.94 [95% CI, 0.90-0.97]; HR_PFs: 0.90 [95% CI, 0.86-0.94]). In conclusion, UPF was positively associated with CRC risk while diets richer in unprocessed foods were associated with lower CRC risk. Further studies are needed to understand the mechanisms by which food processing affects CRC risk.

Keywords: Colorectal cancer; EPIC; Nova classification; UPFs; obesity.

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References

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1. World Cancer Research Fund, American Institute for Cancer Research. Diet, nutrition, physical activity and colorectal cancer: a global perspective. Continuous Update Project Report. 2018 https://www.wcrf.org/wp-content/uploads/2021/02/Colorectal-cancer-report...
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Associations between degree of food processing and colorectal cancer risk in a large-scale European cohort

Affiliations

Associations between degree of food processing and colorectal cancer risk in a large-scale European cohort

Authors

Affiliations

Abstract

References

REFERENCES

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical