Consumption of Yoghurt and Other Dairy Products and Risk of Colorectal Cancer in Iran: The IROPICAN Study
Abstract
:1. Introduction
2. Methods
2.1. Study Design and Population
2.2. Dietary Assessment
2.3. Assessment of Other Variables
2.4. Statistical Analyses
2.5. Ethical Considerations
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Controls | Cases | |||
---|---|---|---|---|
Colorectal * | Colon | Rectum | ||
Overall | 3205 | 865 | 434 | 404 |
Province, N (%) | ||||
Tehran | 816 (25.46) | 165 (19.08) | 101 (23.27) | 64 (15.84) |
Fars | 943 (29.42) | 248 (28.67) | 93 (21.43) | 155 (38.37) |
Kerman | 525 (16.38) | 100 (11.56) | 49 (11.29) | 51 (12.62) |
Golestan | 372 (11.61) | 149 (17.23) | 89 (20.51) | 53 (13.12) |
Mazandaran | 136 (4.24) | 59 (6.82) | 34 (7.83) | 25 (6.19) |
Kermanshah | 251 (7.83) | 68 (7.86) | 31 (7.14) | 35 (8.66) |
Mashhad | 162 (5.05) | 76 (8.79) | 37 (8.53) | 21 (5.20) |
Gender, N (%) | ||||
Women | 1002 (31.26) | 368 (42.54) | 193 (44.47) | 169 (41.83) |
Men | 2203 (68.74) | 497 (57.46) | 241 (55.53) | 235 (58.17) |
Age, years, mean (±SD) | 57.18 (11.49) | 58.62 (12.44) | 58.78 (12.29) | 58.3 (12.61) |
Age, years, N (%) | ||||
<50 | 751 (23.43) | 193 (22.31) | 99 (22.81) | 89 (22.03) |
≥50 and <60 | 993 (30.98) | 242 (27.98) | 112 (25.81) | 123 (30.45) |
≥60 and <70 | 1019 (31.79) | 258 (29.83) | 137 (31.57) | 112 (27.72) |
≥70 | 442 (13.79) | 172 (19.88) | 86 (19.82) | 80 (19.80) |
Socio-economic status (SES), N (%) | ||||
Low | 860 (26.83) | 331 (38.27) | 159 (36.64) | 161 (39.85) |
Moderate | 1078 (33.63) | 234 (27.05) | 118 (27.19) | 109 (26.98) |
High | 1267 (39.53) | 300 (34.68) | 157 (36.18) | 134 (33.17) |
Tobacco consumption, N (%) | ||||
No | 2280 (71.14) | 677 (78.27) | 356 (82.03) | 300 (74.26) |
Yes | 925 (28.86) | 188 (21.73) | 78 (17.97) | 104 (25.74) |
Opium consumption, N (%) | ||||
Never use | 2639 (82.34) | 738 (85.32) | 373 (85.94) | 343 (84.90) |
Regular user | 439 (13.70) | 89 (10.29) | 40 (9.22) | 47 (11.63) |
Non-regular user | 127 (3.96) | 38 (4.39) | 21 (4.84) | 14 (3.47) |
Workload Physical activity, N (%) | ||||
Sedentary | 1033 (32.27%) | 287 (33.18%) | 147 (33.87%) | 132 (32.67%) |
Moderate | 701 (21.88%) | 155 (17.92%) | 78 (17.97%) | 72 (17.82%) |
Heavy | 694 (21.66%) | 184 (21.27%) | 87 (20.05%) | 87 (21.53%) |
Unknown | 775 (24.19%) | 239 (27.63%) | 122 (28.11%) | 113 (27.97%) |
BMI, kg/m2, mean (±SD) | 26.59 (4.72) | 26.93 (4.99) | 26.91 (5.07) | 26.83 (4.85) |
Dietary Intake, g/day, Mean (SD) | Controls N = 3205 | Cases | ||
---|---|---|---|---|
Colorectal * N = 865 | Colon N = 434 | Rectum N = 404 | ||
Red and processed meat | 18.66 (19.29) | 24.30 (27.06) | 24.26 (26.48) | 24.00 (27.65) |
Fiber | 24.72 (11.25) | 25.86 (12.38) | 25.28 (12.16) | 26.34 (12.73) |
Total fat | 68.53 (29.92) | 77.39 (39.70) | 79.40 (39.71) | 74.19 (39.29) |
Dietary intakes of Dairy Products, g/day, mean (SD) | ||||
Total dairy products | 337.40 (193.26) | 362.49 (214.98) | 372.72 (217.27) | 341.14 (203.38) |
Yoghurt | 142.98 (93.71) | 148.23 (98.86) | 148.89 (99.44) | 142.18 (94.58) |
Milk | 95.72 (96.73) | 101.69 (103.66) | 109.45 (103.58) | 91.74 (102.74) |
Cheeses | 23.48 (19.99) | 24.03 (21.04) | 26.50 (23.63) | 21.15 (17.76) |
Kashk | 3.20 (9.07) | 4.92 (12.43) | 5.26 (13.76) | 4.48 (10.96) |
Dough | 62.65 (75.45) | 72.54 (83.93) | 70.52 (80.96) | 72.22 (82.70) |
Cream | 1.01 (3.25) | 1.52 (4.08) | 1.56 (4.47) | 1.31 (3.35) |
Ice cream | 4.66 (7.70) | 5.03 (9.75) | 4.92 (7.89) | 5.16 (11.33) |
Other milk products * | 4.25 (24.25) | 6.41 (28.14) | 6.95 (30.39) | 5.37 (23.60) |
Dairy Products Types | Cancer Type | Mean (g/Day) | T2 OR (95%CI) | Mean (g/Day) | T3 OR (95% CI) | OR (95% CI) (For One Tertile Increase) | p-Value (For One Tertile Increase) | p-Value (Continuous) |
---|---|---|---|---|---|---|---|---|
Total Dairy products | Colorectal Cancer | 313.17 | 1.00 (0.81–1.22) | 562.87 | 1.06 (0.85–1.32) | 1.03 (0.92–1.15) | 0.557 | 0.293 |
Colon Cancer | 320.87 | 0.86 (0.65–1.13) | 577.42 | 1.00 (0.75–1.34) | 1.00 (0.87–1.16) | 0.911 | 0.661 | |
Proximal colon | 317.463 | 0.82 (0.51–1.31) | 559.76 | 0.98 (0.61–1.58) | 1.00 (0.79–1.28) | 0.974 | 0.820 | |
Distal colon | 322.59 | 0.98 (0.66–1.46) | 569.40 | 0.96 (0.62–1.47) | 0.98 (0.79–1.20) | 0.858 | 0.941 | |
Rectum Cancer | 314.28 | 1.11 (0.85–1.45) | 584.86 | 1.06 (0.78–1.44) | 1.03 (0.88–1.20) | 0.671 | 0.461 | |
Yoghurt | Colorectal Cancer | 110.30 | 1.06 (0.86–1.32) | 238.69 | 0.96 (0.77–1.20) | 0.97 (0.87–1.08) | 0.629 | 0.450 |
Colon Cancer | 109.37 | 1.12 (0.83–1.49) | 244.72 | 0.78 (0.58–1.06) | 0.87 (0.76–1.01) | 0.074 | 0.042 | |
Proximal colon | 108.31 | 0.63 (0.39–1.01) | 250.56 | 0.43 (0.27–0.70) | 0.66 (0.52–0.84) | 0.001 | 0.007 | |
Distal colon | 110.66 | 1.27 (0.83–1.94) | 238.47 | 0.81 (0.52–1.26) | 0.88 (0.71–1.08) | 0.259 | 0.085 | |
Rectum Cancer | 109.14 | 0.97 (0.72–1.30) | 237.89 | 1.07 (0.80–1.45) | 1.03 (0.88–1.19) | 0.671 | 0.819 | |
Milk | Colorectal Cancer | 90.30 | 0.84 (0.69–1.01) | 242.22 | 0.98 (0.79–1.21) | 0.97 (0.88–1.09) | 0.708 | 0.848 |
Colon Cancer | 93.13 | 0.95 (0.73–1.23) | 244.47 | 1.06 (0.80–1.41) | 1.03 (0.90–1.20) | 0.596 | 0.632 | |
Proximal colon | 96.48 | 1.11 (0.72–1.70) | 245.28 | 1.18 (0.74–1.88) | 1.10 (0.88–1.40) | 0.406 | 0.394 | |
Distal colon | 90.16 | 0.97 (0.66–1.42) | 232.16 | 1.30 (0.87–1.96) | 1.14 (0.93–1.39) | 0.202 | 0.374 | |
Rectum Cancer | 86.71 | 0.75 (0.58–0.98) | 247.17 | 0.97 (0.72–1.31) | 0.95 (0.82–1.10) | 0.531 | 0.741 | |
Dough | Colorectal Cancer | 59.18 | 1.17 (0.97–1.42) | 197.08 | 1.26 (0.98–1.61) | 1.14 (1.01–1.29) | 0.025 | 0.034 |
Colon Cancer | 63.55 | 1.04 (0.81–1.33) | 198.23 | 1.15 (0.83–1.60) | 1.09 (0.93–1.28) | 0.289 | 0.165 | |
Proximal colon | 63.03 | 1.21 (0.81–1.83) | 174.45 | 1.52 (0.88–2.61) | 1.23 (0.94–1.61) | 0.120 | 0.368 | |
Distal colon | 61.64 | 1.02 (0.71–1.46) | 197.91 | 1.06 (0.65–1.73) | 1.05 (0.83–1.33) | 0.684 | 0.554 | |
Rectum Cancer | 61.06 | 1.28 (0.99–1.65) | 200.07 | 1.36 (0.96–1.91) | 1.18 (1.00–1.40) | 0.041 | 0.092 | |
Kashk | Colorectal Cancer | 1.165 | 0.70 (0.57–0.85) | 11.58 | 1.03 (0.81–1.31) | 0.99 (0.88–1.13) | 0.949 | 0.005 |
Colon Cancer | 1.13 | 0.66 (0.50–0.87) | 14.08 | 1.09 (0.79–1.49) | 1.01 (0.86–1.20) | 0.856 | 0.019 | |
Proximal colon | 1.16 | 0.79 (0.51–1.21) | 10.38 | 0.90 (0.52–1.58) | 0.93 (0.70–1.23) | 0.625 | 0.514 | |
Distal colon | 1.13 | 0.64 (0.43–0.94) | 12.98 | 0.91 (0.57–1.44) | 0.91 (0.72–1.17) | 0.486 | 0.101 | |
Rectum Cancer | 1.19 | 0.73 (0.55–0.97) | 14.44 | 1.01 (0.73–1.40) | 0.99 (0.84–1.18) | 0.926 | 0.068 | |
Cheese | Colorectal Cancer | 26.73 | 0.89 (0.74–1.08) | 63.27 | 1.08 (0.81–1.44) | 0.98 (0.86–1.12) | 0.849 | 0.946 |
Colon Cancer | 26.87 | 1.00 (0.78–1.29) | 70.21 | 1.08 (0.74–1.56) | 1.03 (0.87–1.24) | 0.724 | 0.418 | |
Proximal colon | 26.35 | 1.05 (0.70–1.57) | 74.13 | 0.78 (0.40–1.49) | 0.93 (0.70–1.25) | 0.630 | 0.870 | |
Distal colon | 26.99 | 0.94 (0.65–1.35) | 69.57 | 1.20 (0.70–2.05) | 1.05 (0.81–1.35) | 0.675 | 0.448 | |
Rectum Cancer | 25.79 | 0.77 (0.60–0.99) | 57.30 | 0.96 (0.63–1.47) | 0.90 (0.74–1.08) | 0.299 | 0.119 | |
Cream | Colorectal Cancer | 0.451 | 1.07 (0.87–1.32) | 4.61 | 1.33 (1.08–1.64) | 1.11 (1.01–1.24) | 0.040 | 0.317 |
Colon Cancer | 0.462 | 1.23 (0.94–1.61) | 5.17 | 1.37 (1.03–1.81) | 1.14 (1.00–1.31) | 0.057 | 0.499 | |
Proximal colon | 0.442 | 1.30 (0.83–2.04) | 6.23 | 1.68 (1.08–2.61) | 1.29 (1.04–1.61) | 0.021 | 0.040 | |
Distal colon | 0.41 | 1.07 (0.72–1.58) | 4.97 | 0.93 (0.60–1.43) | 0.93 (0.76–1.15) | 0.527 | 0.516 | |
Rectum Cancer | 0.465 | 0.99 (0.75–1.32) | 4.99 | 1.20 (0.90–1.60) | 1.05 (0.91–1.01) | 0.478 | 0.741 | |
Ice cream | Colorectal Cancer | 3.07 | 0.83 (0.65–1.06) | 22.28 | 0.86 (0.62–1.21) | 0.88 (0.74–1.04) | 0.160 | 0.777 |
Colon Cancer | 3.17 | 0.72 (0.52–0.98) | 22.00 | 0.75 (0.48–1.17) | 0.82 (0.64–1.02) | 0.088 | 0.651 | |
Proximal colon | 3.26 | 1.25 (0.67–2.34) | 22.71 | 1.48 (0.68–3.22) | 1.20 (0.82–1.77) | 0.330 | 0.531 | |
Distal colon | 3.31 | 0.55 (0.36–0.85) | 19.44 | 0.44 (0.23–0.85) | 0.59 (0.43–0.82) | 0.002 | 0.108 | |
Rectum Cancer | 3.16 | 0.92 (0.67–1.28) | 22.02 | 0.98 (0.61–1.55) | 0.95 (0.75–1.20) | 0.719 | 0.400 | |
Other milk products | Colorectal Cancer | 4.17 | 0.70 (0.53–0.93) | 59.17 | 1.00 (0.73–1.37) | 0.91 (0.78–1.05) | 0.204 | 0.233 |
Colon Cancer | 4.18 | 0.66 (0.45–0.97) | 83.54 | 0.99 (0.65–1.50) | 0.89 (0.64–1.02) | 0.260 | 0.145 | |
Proximal colon | 4.41 | 1.07 (0.61–1.87) | 80.55 | 1.04 (0.53–2.03) | 1.02 (0.75–1.38) | 0.853 | 0.208 | |
Distal colon | 4.20 | 0.52 (0.28–0.95) | 65.84 | 1.07 (0.60–1.92) | 0.90 (0.67–1.20) | 0.493 | 0.641 | |
Rectum Cancer | 5.04 | 0.77 (0.53–1.13) | 62.91 | 0.96 (0.63–1.47) | 0.91 (074–1.10) | 0.372 | 0.685 |
Stratification Factors | Total Dairy Products without Yoghurt | Yoghurt | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Colorectal or (95% CI) | Colon or (95% CI) | Proximal Colon or (95% CI) | Distal Colon or (95% CI) | Rectum or (95% CI) | Colorectal or (95% CI) | Colon or (95% CI) | Proximal Colon or (95% CI) | Distal Colon or (95% CI) | Rectum or (95% CI) | ||
SES | Low | 1.23 (1.02–1.48) | 1.26 (0.98–1.63) | 1.45 (0.91–2.30) | 1.32 (0.91–1.93) | 1.25 (0.96–1.61) | 0.90 (0.75–1.08) | 0.80 (0.62–1.03) | 0.57 (0.36–0.88) | 0.83 (0.57–1.19) | 0.95 (0.74–1.21) |
Moderate | 0.99 (0.80–1.22) | 1.08 (0.82–1.42) | 1.02 (0.66–1.60) | 1.20 (0.81–1.78) | 0.95 (0.71–1.27) | 0.90 (0.73–1.10) | 0.75 (0.57–0.99) | 0.75 (0.49–1.17) | 0.67 (0.45–0.97) | 1.02 (0.76–1.36) | |
High | 0.95 (0.79–1.15) | 0.93 (0.73–1.19) | 1.31 (0.89–1.93) | 0.77 (0.54–1.10) | 1.02 (0.79–1.33) | 1.13 (0.94–1.36) | 1.04 (0.32–1.33) | 0.65 (0.45–0.95) | 1.22 (0.85–1.77) | 1.22 (0.94–1.57) | |
ASA | No | 1.06 (0.94–1.20) | 1.09 (0.93–1.28) | 1.25 (0.95–1.63) | 1.07 (0.84–1.35) | 1.06 (0.90–1.26) | 0.98 (0.87–1.11) | 0.87 (0.74–1.01) | 0.67 (0.52–0.87) | 0.85 (0.67–1.07) | 1.06 (0.90–1.24) |
Yes | 1.02 (0.78–1.33) | 1.10 (0.76–1.59) | 1.59 (0.82–3.08) | 1.00 (0.60–1.68) | 0.99 (0.69–1.42) | 0.93 (0.72–1.21) | 0.89 (0.62–1.28) | 0.61 (0.33–1.12) | 1.06 (0.63–1.79) | 0.93 (0.66–1.33) | |
Age | ≤50 | 1.11 (0.89–1.39) | 1.22 (0.90–1.64) | 1.11 (0.67–1.82) | 1.48 (0.94–2.33) | 1.03 (0.76–1.41) | 0.91 (0.74–1.13) | 0.81 (0.61–1.08) | 0.57 (0.35–0.91) | 0.83 (0.53–1.28) | 0.96 (0.71–1.30) |
>50 | 1.01 (0.90–1.16) | 1.02 (0.86–1.21) | 1.28 (0.96–1.69) | 0.91 (0.71–1.16) | 1.04 (0.88–1.24) | 0.99 (0.88–1.13) | 0.89 (0.75–1.05) | 0.69 (0.53–0.91) | 0.91 (0.72–1.16) | 1.05 (0.88–1.25) | |
Opium | No | 1.03 (0.91–1.16) | 1.09 (0.93–1.28) | 1.29 (0.99–1.69) | 1.10 (0.87–1.36) | 1.02 (0.86–1.20) | 1.03 (0.91–1.15) | 0.94 (0.80–1.09) | 0.68 (0.53–0.88) | 0.96 (0.76–1.19) | 1.07 (0.90–1.24) |
Yes | 1.16 (0.85–1.58) | 0.97 (0.65–1.47) | 1.13 (0.57–2.17) | 1.04 (0.55–1.97) | 1.32 (0.84–2.00) | 0.77 (0.57–1.03) | 0.59 (0.40–0.89) | 0.43 (0.22–0.82) | 0.52 (0.27–1.01) | 0.86 (0.57–1.35) | |
Fiber intakeMean (±SD) | 13.17 (±3.02) | 1.07 (0.83–1.33) | 1.18 (0.85–1.54) | 1.24 (0.71–2.20) | 1.15 (0.71–1.71) | 0.97 (0.66–1.32) | 0.99 (0.78–1.23) | 0.97 (0.72–1.28) | 0.54 (0.31–0.91) | 1.03 (0.66–1.58) | 1.00 (0.72–1.39) |
20.08 (±1.60) | 1.14 (0.90–1.44) | 1.29 (0.87–1.64) | 1.28 (0.78–2.23) | 1.17 (0.72–1.83) | 1.14 (0.83–1.60) | 1.01 (0.79–1.28) | 0.83 (0.60–1.15) | 0.63 (0.38–1.08) | 0.90 (0.55–1.46) | 1.13 (0.80–1.58) | |
26.18 (±2.18) | 1.06 (0.83–1.35) | 1.06 (0.76–1.45) | 1.29 (0.81–2.07) | 0.90 (0.52–1.48) | 1.11 (0.80–1.55) | 1.18 (0.93–1.50) | 0.89 (0.66–1.22) | 0.75 (0.48–1.22) | 0.85 (0.53–1.40) | 1.47 (1.04–2.05) | |
40.39 (±10.21) | 1.12 (0.89–1.38) | 1.18 (0.87–1.62) | 1.46 (0.85–2.62) | 1.38 (0.84–2.04) | 1.11 (0.82–1.45) | 0.79 (0.64–0.98) | 0.72 (0.55–0.99) | 0.50 (0.31–0.89) | 0.66 (0.47–1.06) | 0.82 (0.62–1.06) | |
Red and processed meat Mean (±SD) | 4.47 (±2.90) | 1.12 (0.93–1.34) | 1.09 (0.80–1.43) | 1.33 (0.81–2.24) | 0.97 (0.81–1.54) | 1.16 (0.72–1.30) | 1.00 (0.84–1.19) | 0.98 (0.63–1.10) | 0.76 (0.30–1.80) | 1.15 (0.77–1.45) | 0.96 (0.83–1.52) |
15.09 (±3.42) | 1.03 (0.82–1.29) | 1.18 (0.85–1.64) | 1.23 (0.80–2.21) | 1.70 (1.03–2.79) | 0.97 (0.72–1.30) | 1.02 (0.81–1.2) | 0.90 (0.63–1.10) | 0.68 (0.56–1.44) | 0.90 (0.52–1.21) | 1.09 (0.84–1.52) | |
40.34 (±24.27) | 1.02 (0.84–1.23) | 1.03 (0.80–1.32) | 1.27 (0.83–1.94) | 0.90 (0.63–1.27) | 1.03 (0.79–1.33) | 0.94 (0.78–1.12) | 0.79 (0.63–1.01) | 0.60 (0.40–0.88) | 0.72 (0.52–1.01) | 1.09 (0.85–1.41) |
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Collatuzzo, G.; Seyyedsalehi, M.S.; Rezaeianzadeh, A.; Marzban, M.; Rashidian, H.; Hadji, M.; Kamangar, F.; Etemadi, A.; Pukkala, E.; Zendehdel, K.; et al. Consumption of Yoghurt and Other Dairy Products and Risk of Colorectal Cancer in Iran: The IROPICAN Study. Nutrients 2022, 14, 2506. https://doi.org/10.3390/nu14122506
Collatuzzo G, Seyyedsalehi MS, Rezaeianzadeh A, Marzban M, Rashidian H, Hadji M, Kamangar F, Etemadi A, Pukkala E, Zendehdel K, et al. Consumption of Yoghurt and Other Dairy Products and Risk of Colorectal Cancer in Iran: The IROPICAN Study. Nutrients. 2022; 14(12):2506. https://doi.org/10.3390/nu14122506
Chicago/Turabian StyleCollatuzzo, Giulia, Monireh Sadat Seyyedsalehi, Abbas Rezaeianzadeh, Maryam Marzban, Hamideh Rashidian, Maryam Hadji, Farin Kamangar, Arash Etemadi, Eero Pukkala, Kazem Zendehdel, and et al. 2022. "Consumption of Yoghurt and Other Dairy Products and Risk of Colorectal Cancer in Iran: The IROPICAN Study" Nutrients 14, no. 12: 2506. https://doi.org/10.3390/nu14122506