Background: The 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Third Expert Report, including studies up to 2015, determined 'limited-no conclusion' evidence on dietary patterns and colorectal cancer (CRC) risk due to insufficient data and varying pattern definitions.
Objective: This updated review synthesized literature on dietary patterns and CRC risk/mortality.
Methods: PubMed and Embase were searched through 31 March 2023 for randomized controlled trials (RCTs) and prospective cohort studies on adulthood dietary patterns. Patterns were categorized by derivation method: a priori, a posteriori, or hybrid; and were then descriptively reviewed in relation to the primary outcomes: CRC risk or mortality. The Global Cancer Update Programme Expert Committee and Expert Panel independently graded the evidence on the likelihood of causality using pre-defined criteria.
Results: Thirty-two dietary scores from 53 observational studies and three RCTs were reviewed. 'Limited-suggestive' evidence was concluded for higher alignment with a priori-derived patterns: Mediterranean, healthful plant-based index, Healthy Eating Index (HEI)/alternate HEI (AHEI), and Dietary Approaches to Stop Hypertension (DASH) in relation to lower CRC risk. Common features across these diets included high plant-based food intake and limited red/processed meat. Hybrid-derived patterns: the Empirical Dietary Pattern for Hyperinsulinemia (EDIH) and Empirical Dietary Inflammatory Pattern (EDIP) showed 'strong-probable' evidence for increased CRC risk. Evidence for a priori-derived low-fat dietary interventions and a posteriori-derived patterns was graded as 'limited-no conclusion'. By cancer subsite, higher alignment with Mediterranean diet showed 'limited-suggestive' evidence for lower rectal cancer risk, and with HEI/AHEI and DASH showed 'limited-suggestive' evidence for lower colon and rectal cancer risks. EDIH and EDIP showed 'strong-probable' evidence for increased colon cancer risks. All exposure-mortality pairs and other pattern-outcome associations were graded as 'limited-no conclusion'.
Conclusions: This review highlights the role of dietary patterns in CRC risk/mortality, providing insights for future research and public health strategies. This review was registered at PROSPERO as CRD42022324327 (Link: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022324327).
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