Objectives

Shifting from animal-based to plant-based diets could reduce colorectal cancer (CRC) incidence. Currently, the impacts of these dietary shifts on CRC risk are ill-defined. Therefore, we examined partial substitutions of red or processed meat with whole grains, vegetables, fruits or a combination of these in relation to CRC risk in Finnish adults.

Methods

We pooled five Finnish cohorts, resulting in 43 788 participants aged ≥ 25 years (79% men). Diet was assessed by validated food frequency questionnaires at study enrolment. We modelled partial substitutions of red (100 g/week) or processed meat (50 g/week) with corresponding amounts of plant-based foods. Cohort-specific hazard ratios (HR) for CRC were calculated using Cox proportional hazards models and pooled together using random-effects models. Adjustments included age, sex, energy intake and other relevant confounders.

Results

During the median follow-up of 28.8 years, 1124 CRCs were diagnosed. We observed small risk reductions when red meat was substituted with vegetables (HR 0.97, 95% CI 0.95 − 0.99), fruits (0.97, 0.94 − 0.99), or whole grains, vegetables and fruits combined (0.97, 0.95 − 0.99). For processed meat, these substitutions yielded 1% risk reductions. Substituting red or processed meat with whole grains was associated with a decreased CRC risk only in participants with < median whole grain intake (0.92, 0.86 − 0.98; 0.96, 0.93 − 0.99, respectively; p_interaction=0.001).

Conclusions

Even small, easily implemented substitutions of red or processed meat with whole grains, vegetables or fruits could lower CRC risk in a population with high meat consumption. These findings broaden our insight into dietary modifications that could foster CRC primary prevention.

中文翻译：

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用植物性食品部分替代红肉或加工肉类与结直肠癌的风险

 目标

从动物性饮食转向植物性饮食可以降低结直肠癌（CRC）的发病率。目前，这些饮食变化对结直肠癌风险的影响尚不明确。因此，我们研究了用全谷物、蔬菜、水果或这些肉类的组合部分替代红肉或加工肉类与芬兰成年人的结直肠癌风险之间的关系。

 方法

我们汇集了五个芬兰队列，共有 43,788 名年龄 ≥ 25 岁的参与者（79% 为男性）。在研究登记时通过经过验证的食物频率问卷评估饮食。我们模拟了用相应数量的植物性食品部分替代红肉（100 克/周）或加工肉（50 克/周）。使用 Cox 比例风险模型计算 CRC 的特定队列风险比 (HR)，并使用随机效应模型汇总在一起。调整包括年龄、性别、能量摄入和其他相关混杂因素。

 结果

在中位随访 28.8 年期间，诊断出 1124 例 CRC。我们观察到，当用蔬菜（HR 0.97，95% CI 0.95 – 0.99）、水果（0.97，0.94 – 0.99）或全谷物、蔬菜和水果的组合（0.97，0.95 – 0.99）替代红肉时，风险略有降低。对于加工肉类，这些替代品使风险降低了 1%。仅在全谷物摄入量<中位数的参与者中，用全谷物替代红肉或加工肉类与结直肠癌风险降低相关（分别为0.92、0.86 - 0.98；0.96、0.93 - 0.99； p_交互作用= 0.001）。

 结论

即使是小规模、易于实施的用全谷物、蔬菜或水果替代红肉或加工肉类，也可以降低高肉类消费人群的结直肠癌风险。这些发现拓宽了我们对饮食改变的认识，从而促进结直肠癌的一级预防。