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. 2026 Feb 15;158(4):895-908.
doi: 10.1002/ijc.70113. Epub 2025 Sep 18.

Pre- and post-diagnostic meat intake in relation to risk of recurrence and mortality among individuals with stage I-III colorectal cancer

Anne-Sophie van Lanen  1 , Dieuwertje E Kok  1 , Evertine Wesselink  1 , Jeroen W G Derksen  2 , Anne M May  2 , Karel C Smit  2   3 , Miriam Koopman  3 , Johannes H W de Wilt  4 , Ellen Kampman  1 , Fränzel J B van Duijnhoven  1 ; COLON and PLCRC studies
Collaborators, Affiliations

Pre- and post-diagnostic meat intake in relation to risk of recurrence and mortality among individuals with stage I-III colorectal cancer

Anne-Sophie van Lanen et al. Int J Cancer. .

Abstract

Processed meat and unprocessed red meat intakes are associated with increased colorectal cancer (CRC) risk, but evidence on associations with mortality after a CRC diagnosis is inconsistent. To date, no studies examined associations between unprocessed poultry intake and mortality, or assessed cancer recurrence risk as a separate outcome measure. We included data from 2484 individuals, who were newly diagnosed with stage I-III CRC, participating in 2 prospective cohort studies. Dietary intake was assessed at diagnosis and 6 months after diagnosis. Multivariable Cox proportional hazards regression models and restricted cubic splines were used to examine associations between pre- and post-diagnostic meat intake and risk of recurrence and all-cause mortality. We performed subgroup analyses by sex, disease stage and primary tumour location. During a median follow-up time of 5.0 years for recurrence analyses and 6.4 years for mortality analyses, 336 recurrences and 409 deaths occurred. Pre- and post-diagnostic processed meat and unprocessed red meat intakes were not associated with risk of recurrence nor all-cause mortality. At both timepoints, a higher unprocessed poultry intake was non-linearly associated with a decreased mortality risk, with the lowest risk observed at 20 g/day (hazard ratio: 0.63, 95% confidence interval: 0.47-0.85), compared to 0 g/day. Results were not substantially different by sex, disease stage and primary tumour location. To conclude, a higher pre- and post-diagnostic intake of unprocessed poultry, but not processed meat and unprocessed red meat, was associated with a decreased all-cause mortality risk in individuals with stage I-III CRC. Future studies in independent study populations should confirm these findings.

Keywords: all‐cause mortality; colorectal cancer recurrence; processed meat; unprocessed poultry; unprocessed red meat.

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Conflict of interest statement

JWGD was employed at the University Medical Center Utrecht (The Netherlands) at the time of the conduction of the study and writing of the paper, but is currently also employed at Danone Global Research and Innovation. MK reports to have institutional financial interests with Amgen, Bayer, Bristol Myers Squibb, GSK, Merck‐Serono, Nordic Farma, Personal Genome Diagnostics (PGDx), Pierre Fabre, Roche, Sirtex, Servier and Sanofi‐Aventis. MK is PI of PLCRC (national observational cohort study) and of the international cohort study PROMETCO with Servier as sponsor. MK is chair of the ESMO RWD and digital health working group and is involved in several clinical trials as PI or co‐investigator in CRC. The other co‐authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Flow chart.
FIGURE 2
FIGURE 2
Pre‐ and post‐diagnostic intake of processed meat (A, D), unprocessed red meat (B, E) and unprocessed poultry (C, F) in relation to risk of recurrence. The fully adjusted model included age, sex, education level, disease stage, primary tumour location and total daily intakes of energy, low‐fat dairy, and high‐fat dairy.
FIGURE 3
FIGURE 3
Pre‐ and post‐diagnostic intake of processed meat (A, D), unprocessed red meat (B, E) and unprocessed poultry (C, F) in relation to risk of all‐cause mortality. The fully adjusted model included age, sex, education level, disease stage, primary tumour location and total daily intakes of energy, low‐fat dairy and high‐fat dairy.
FIGURE 4
FIGURE 4
Pre‐ and post‐diagnostic intakes of unprocessed poultry in relation to risk of recurrence stratified by sex (A, D), disease stage (B, E) and primary tumour location (C, F). The fully adjusted model included age, sex (except for analyses stratified by sex), education level, disease stage (except for analyses stratified by disease stage), primary tumour location (except for analyses stratified by primary tumour location) and total daily intakes of energy, low‐fat dairy and high‐fat dairy. The numbers presented under each figure represent the number of recurrences in this subgroup and the total number of participants in this subgroup. The median follow‐up times (interquartile range [IQR]) were as follows for analyses concerning pre‐diagnostic intake: female: 5.0 [3.2, 7.5] years; male: 5.0 [2.9, 7.0] years; stage I + II: 5.4 [3.5, 7.4] years; stage III: 4.8 [2.5, 6.9] years; colon: 5.1 [3.2, 7.4] years; rectum: 4.8 [2.6, 7.2] years. The median follow‐up times [IQR] were as follows for analyses concerning post‐diagnostic intake: Female: 4.8 [3.1, 7.1] years; male: 4.8 [2.8, 7.0] years; stage I + II: 5.1 [3.2, 7.1] years; stage III: 4.5 [2.1, 7.0] years; colon: 4.9 [3.0, 7.0] years; rectum: 4.7 [2.9, 7.0] years.
FIGURE 5
FIGURE 5
Pre‐ and post‐diagnostic intakes of unprocessed poultry in relation to the risk of all‐cause mortality stratified by sex (A, D), disease stage (B, E) and primary tumour location (C, F). The fully adjusted model included age, sex (except for analyses stratified by sex), education level, disease stage (except for analyses stratified by disease stage), primary tumour location (except for analyses stratified by primary tumour location) and total daily intakes of energy, low‐fat dairy and high‐fat dairy. The numbers presented under each figure represent the number of deaths in this subgroup and the total number of participants in this subgroup. The median follow‐up times [IQR] were as follows for analyses concerning pre‐diagnostic intake: female: 6.4 [4.4, 8.7] years; male: 6.4 [4.2, 8.3] years; stage I + II: 6.5 [4.5, 8.5] years; stage III: 6.2 [4.0, 8.3] years; colon: 6.4 [4.3, 8.4] years; rectum: 6.3 [4.2, 8.4] years. The median follow‐up times [IQR] were as follows for analyses concerning post‐diagnostic intake: Female: 6.4 [4.1, 8.4] years; male: 6.3 [4.0, 8.0] years; stages I + II: 6.5 [4.2, 8.2] years; stage III: 6.2 [3.8, 8.1] years; colon: 6.4 [4.1, 8.1] years; rectum: 6.4 [4.1, 8.1] years.
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