Effects on Health Outcomes of a Mediterranean Diet With No Restriction on Fat Intake

Bloomfield, Hanna E.; Koeller, Eva; Greer, Nancy; MacDonald, Roderick; Kane, Robert L; Wilt, Timothy J

doi:10.7326/m16-0361

Cited by 152 publications

(113 citation statements)

References 106 publications

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“…5 A pooled analysis of nine cohort studies studying adherence to a Mediterranean diet showed a 9% reduction (95% CI for HR: 0.84–0.98) in colorectal cancer incidence for the highest vs. lowest quantile. 6 A systematic literature review of five case-control and seven cohort studies also supported the association between a higher overall diet quality, including Mediterranean diet score and HEI, and a lower risk of colorectal cancer, and suggested similar associations for men and women. 8 …”

Section: Discussionmentioning

confidence: 77%

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High-Quality Diets Associate With Reduced Risk of Colorectal Cancer: Analyses of Diet Quality Indexes in the Multiethnic Cohort

et al. 2017

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Background & Aims Healthy eating patterns assessed by diet quality indexes (DQIs) have been related to lower risk of colorectal cancer—mostly among whites. We investigated the associations between 4 DQI scores (the Healthy Eating Index 2010 [HEI-2010], the Alternative Healthy Eating Index 2010 [AHEI-2010], the alternate Mediterranean diet score [aMED], and the Dietary Approaches to Stop Hypertension score) and colorectal cancer risk in the Multiethnic Cohort. Methods We analyzed data from 190,949 African Americans, Native Hawaiians, Japanese Americans, Latinos and whites, 45–75 years old, who entered the Multiethnic Cohort study from 1993 through 1996. During an average 16 years of follow up, 4770 invasive colorectal cancer cases were identified. Results Scores from all 4 DQIs associated inversely with colorectal cancer risk; higher scores associated with decreasing colorectal cancer risk (all P's for trend ≤ .003). Associations were not significant for AHEI-2010 and aMED scores in women after adjustment for covariates: for the highest vs lowest quintiles, the hazard ratio for the HEI-2010 score in men was 0.69 (95% CI, 0.59–0.80) and in women was 0.82 (95% CI , 0.70–0.96); for the AHEI-2010 score the hazard ratio in men was 0.75 (95% CI , 0.65–0.85) and in women was 0.90 (95% CI , 0.78–1.04); for the aMED score the hazard ratio in men was 0.84 (95% CI , 0.73–0.97) and in women was 0.96 (95% CI , 0.82–1.13); for the Dietary Approaches to Stop Hypertension score the hazard ratio in men was 0.75 (95% CI , 0.66–0.86) and in women was 0.86 (95% CI , 0.75–1.00). Associations were limited to the left colon and rectum for all indexes. The inverse associations were less strong in African Americans than in the other 4 racial/ethnic groups. Conclusions Based on an analysis of data from the Multiethnic Cohort Study, high-quality diets are associated with a lower risk of colorectal cancer in most racial/ethnic subgroups.

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Section: Discussionmentioning

confidence: 77%

“…1–3 Several indexes have been applied to evaluate the role of diet in various health outcomes. 4–6 Indeed, they have been associated with a lower risk of colorectal cancer, 7–10 the third most common cancer in the United States. 11 …”

Section: Introductionmentioning

confidence: 99%

High-Quality Diets Associate With Reduced Risk of Colorectal Cancer: Analyses of Diet Quality Indexes in the Multiethnic Cohort

et al. 2017

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“…Diet may be another confounder. A high meat intake increases and a Mediterranean diet decreases both the risk of DM and of CRC [45]. …”

Section: Epidemiological Association Between Diabetes and Crcmentioning

confidence: 99%

2017 update on the relationship between diabetes and colorectal cancer: epidemiology, potential molecular mechanisms and therapeutic implications

et al. 2017

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Worldwide deaths from diabetes mellitus (DM) and colorectal cancer increased by 90% and 57%, respectively, over the past 20 years. The risk of colorectal cancer was estimated to be 27% higher in patients with type 2 DM than in non-diabetic controls. However, there are potential confounders, information from lower income countries is scarce, across the globe there is no correlation between DM prevalence and colorectal cancer incidence and the association has evolved over time, suggesting the impact of additional environmental factors. The clinical relevance of these associations depends on understanding the mechanism involved. Although evidence is limited, insulin use has been associated with increased and metformin with decreased incidence of colorectal cancer. In addition, colorectal cancer shares some cellular and molecular pathways with diabetes target organ damage, exemplified by diabetic kidney disease. These include epithelial cell injury, activation of inflammation and Wnt/β-catenin pathways and iron homeostasis defects, among others. Indeed, some drugs have undergone clinical trials for both cancer and diabetic kidney disease. Genome-wide association studies have identified diabetes-associated genes (e.g. TCF7L2) that may also contribute to colorectal cancer. We review the epidemiological evidence, potential pathophysiological mechanisms and therapeutic implications of the association between DM and colorectal cancer. Further studies should clarify the worldwide association between DM and colorectal cancer, strengthen the biological plausibility of a cause-and-effect relationship through characterization of the molecular pathways involved, search for specific molecular signatures of colorectal cancer under diabetic conditions, and eventually explore DM-specific strategies to prevent or treat colorectal cancer.

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“…The association between the MED and cancer focused on the most recent meta-analysis by Schwingshackl and colleagues 24 along with a review and analysis by Bloomfield and colleagues 38 and a meta-analysis focused on breast cancer by van den Brandt and colleagues. 39 Based on these three metaanalyses, greater conformance with a Mediterranean-style eating pattern was consistently found to be inversely associated with total cancer as well as site-specific cancers, including colorectal, breast, and prostate.…”

Section: Research Snapshotmentioning

confidence: 99%

Health Economic Evaluation Modeling Shows Potential Health Care Cost Savings with Increased Conformance with Healthy Dietary Patterns among Adults in the United States

Scrafford¹,

Bi²,

Multani³

et al. 2019

Journal of the Academy of Nutrition and Dietetics

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Effects on Health Outcomes of a Mediterranean Diet With No Restriction on Fat Intake

Abstract: Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative. (PROSPERO: CRD42015020262).

Cited by 152 publications

References 106 publications

High-Quality Diets Associate With Reduced Risk of Colorectal Cancer: Analyses of Diet Quality Indexes in the Multiethnic Cohort

High-Quality Diets Associate With Reduced Risk of Colorectal Cancer: Analyses of Diet Quality Indexes in the Multiethnic Cohort

2017 update on the relationship between diabetes and colorectal cancer: epidemiology, potential molecular mechanisms and therapeutic implications

Health Economic Evaluation Modeling Shows Potential Health Care Cost Savings with Increased Conformance with Healthy Dietary Patterns among Adults in the United States

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