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. 2025 Jul 21;17(14):2386.
doi: 10.3390/nu17142386.

Acceptability of a Colorectal Cancer-Preventive Diet Promoting Red Meat Reduction and Increased Fiber and Micronutrient Intake: A Cross-Sectional Study in Romanian Adults

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Acceptability of a Colorectal Cancer-Preventive Diet Promoting Red Meat Reduction and Increased Fiber and Micronutrient Intake: A Cross-Sectional Study in Romanian Adults

Marius-Cătălin Belean et al. Nutrients. .

Abstract

Background/Objectives: Colorectal cancer is a leading cause of cancer-related death worldwide, with rising incidence in younger adults. Unhealthy diets high in red and processed meat and low in fiber are key modifiable risk factors, highlighting the need for preventive nutritional strategies targeting CRC through dietary interventions. Methods: A one-day sample diet for colorectal cancer prevention, consisting of fiber-rich meals excluding red meat and incorporating whole grains, legumes, vegetables, fruits, nuts, and lean protein alternatives (such as fish and poultry), was developed. Its acceptability was assessed in a cross-sectional study using an online questionnaire among healthy Romanian adults aged 18-50, with a total of 395 included participants. Results: Of the 395 respondents meeting the inclusion criteria (aged 18-50, no cancer or chronic gastrointestinal disorders), 63.5% were females, predominantly urban (90.1%), and highly educated. Mean age was 32.4 years; mean BMI was 25.07 kg/m2. The proposed colorectal cancer-preventive diet was rated as "quite attractive" and "very attractive" by 74.9% of participants. All meals received high ratings, with dinner and the first snack being most favored. Most respondents (77.2%) found the diet satisfying and the satiety level and energy adequate, and 90.4% were willing to adopt it at least a few times per week. Financial accessibility was affirmed by 77.2% of the respondents. However, 61.8% reported difficulty eliminating red meat consumption. Female participants rated the diet significantly more attractive than males did (p = 0.041). Willingness to adopt the diet strongly correlated with higher acceptability (p < 0.0001), while BMI and education level showed no significant effect. Conclusions: The proposed colorectal cancer-preventive diet was well accepted by Romanian adults aged 18-50, with higher receptivity among women and those with higher education; willingness to adopt the diet at least a few days per week was high, especially among those psychologically ready for dietary change, while key barriers included red meat reduction and perceived cost, underscoring the need for gender-sensitive, culturally adapted interventions and further research on long-term adherence and clinical impact.

Keywords: colorectal cancer; diet acceptability; nutrition; preventive diet; primary prevention.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Proposed one-day dietary plan of approximately 2100 kcal in alignment with recommendations for colorectal cancer prevention. On the right, detailed macro- and micronutrient content.
Figure 2
Figure 2
Summary of respondent demographics included in the diet acceptability study for colorectal cancer prevention.
Figure 3
Figure 3
Summary of respondents’ perceived attractiveness of the proposed colorectal cancer-preventive diet, evaluated using a 5-point Likert scale, where 1 indicated “not attractive at all” and 5 indicated “very attractive”.
Figure 4
Figure 4
Summary of respondents’ perceived attractiveness of the proposed colorectal cancer-preventive diet, evaluated for every meal using a 5-point Likert scale, where 1 indicated “not attractive at all” and 5 indicated “very attractive”.
Figure 4
Figure 4
Summary of respondents’ perceived attractiveness of the proposed colorectal cancer-preventive diet, evaluated for every meal using a 5-point Likert scale, where 1 indicated “not attractive at all” and 5 indicated “very attractive”.
Figure 5
Figure 5
Summary of respondents perceived willingness to consume the proposed snacks of the colorectal cancer-preventive diet.
Figure 6
Figure 6
Summary of respondents’ perceived adequacy of satiety and energy provided by the proposed colorectal cancer prevention diet.
Figure 6
Figure 6
Summary of respondents’ perceived adequacy of satiety and energy provided by the proposed colorectal cancer prevention diet.
Figure 7
Figure 7
Summary of respondents’ perceived readiness for partial or full integration of the proposed colorectal cancer-preventive diet in the routine.
Figure 8
Figure 8
Summary of respondents’ perceived financial accessibility of the proposed colorectal cancer-preventive diet.
Figure 9
Figure 9
Summary of respondent willingness to eliminate red meat for a colorectal cancer-preventive diet.
Figure 10
Figure 10
Perceived attractiveness of the proposed colorectal cancer-preventive diet by gender. Violin plots show the distribution of attractiveness ratings (1–5 Likert scale) for female (red) and male (blue) participants. The bold horizontal line within each violin indicates the group mean. Note: Statistically significant difference in Mann–Whitney U test as indicated by the significance line above the plot.
Figure 11
Figure 11
Perceived attractiveness of each proposed meal in the colorectal cancer-preventive diet by gender. Violin plots show the distribution of attractiveness ratings (1–5 Likert scale) for female (red) and male (blue) participants. The bold horizontal line within each violin indicates the group mean. Note: Statistically significant difference in Mann–Whitney U test as indicated by the asterisk and significance line above the plot.
Figure 11
Figure 11
Perceived attractiveness of each proposed meal in the colorectal cancer-preventive diet by gender. Violin plots show the distribution of attractiveness ratings (1–5 Likert scale) for female (red) and male (blue) participants. The bold horizontal line within each violin indicates the group mean. Note: Statistically significant difference in Mann–Whitney U test as indicated by the asterisk and significance line above the plot.
Figure 11
Figure 11
Perceived attractiveness of each proposed meal in the colorectal cancer-preventive diet by gender. Violin plots show the distribution of attractiveness ratings (1–5 Likert scale) for female (red) and male (blue) participants. The bold horizontal line within each violin indicates the group mean. Note: Statistically significant difference in Mann–Whitney U test as indicated by the asterisk and significance line above the plot.
Figure 12
Figure 12
Perceived attractiveness of the proposed colorectal cancer-preventive diet by educational level. Violin plots show the distribution of attractiveness ratings (1–5 Likert scale) for high school graduates (blue), university graduates (grey), and postgraduates (white). The bold horizontal line within each violin indicates the group mean. Note: Mann–Whitney U test revealed no statistically significant differences between groups (n.s.).
Figure 13
Figure 13
Perceived attractiveness of the proposed colorectal cancer-preventive diet by willingness to replace the usual menu. Violin plots show the distribution of attractiveness ratings (1–5 Likert scale). The bold horizontal line within each violin indicates the group mean. Note: Statistically significant difference in Mann–Whitney U test as indicated by the asterisk and significance line above the plot.

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