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Association of total energy intake and macronutrient consumption with colorectal cancer risk: results from a large population-based case-control study in Newfoundland and Labrador and Ontario, Canada

Zhuoyu Sun1, Lin Liu1, Peizhong Peter Wang123*, Barbara Roebothan1, Jin Zhao1, Elizabeth Dicks4, Michelle Cotterchio5, Sharon Buehler1, Peter T Campbell6, John R Mclaughlin1 and Patrick S Parfrey4

  • * Corresponding author: Peizhong P Wang

  • † Equal contributors

Author Affiliations

1 Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada

2 School of Public Health, Tianjin Medical University, Tianjin, China

3 First Affiliated Hospital, Wenzhou Medical College, Wenzhou, China

4 Clinical Epidemiology Unit, Memorial University of Newfoundland, St. John's, NL, Canada

5 Population Study and Surveillance, Cancer Care Ontario, Toronto, ON, Canada

6 Epidemiology Research Program, American Cancer Society, Atlanta, GA, USA

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Nutrition Journal 2012, 11:18  doi:10.1186/1475-2891-11-18

Published: 26 March 2012



Diet is regarded as one of the most important environmental factors associated with colorectal cancer (CRC) risk. A recent report comprehensively concluded that total energy intake does not have a simple relationship with CRC risk, and that the data were inconsistent for carbohydrate, cholesterol and protein. The objective of this study was to identify the associations of CRC risk with dietary intakes of total energy, protein, fat, carbohydrate, fiber, and alcohol using data from a large case-control study conducted in Newfoundland and Labrador (NL) and Ontario (ON), Canada.


Incident colorectal cancer cases (n = 1760) were identified from population-based cancer registries in the provinces of ON (1997-2000) and NL (1999-2003). Controls (n = 2481) were a random sample of residents in each province, aged 20-74 years. Family history questionnaire (FHQ), personal history questionnaire (PHQ), and food frequency questionnaire (FFQ) were used to collect study data. Logistic regression was used to evaluate the association of intakes of total energy, macronutrients and alcohol with CRC risk.


Total energy intake was associated with higher risk of CRC (OR: 1.56; 95% CI: 1.21-2.01, p-trend = 0.02, 5th versus 1st quintile), whereas inverse associations emerged for intakes of protein (OR: 0.85, 95%CI: 0.69-1.00, p-trend = 0.06, 5th versus 1st quintile), carbohydrate (OR: 0.81, 95%CI: 0.63-1.00, p-trend = 0.05, 5th versus 1st quintile) and total dietary fiber (OR: 0.84, 95% CI:0.67-0.99, p-trend = 0.04, 5th versus 1st quintile). Total fat, alcohol, saturated fatty acids, monounsaturated fatty acids, polyunsaturated fatty acids, and cholesterol were not associated with CRC risk.


This study provides further evidence that high energy intake may increase risk of incident CRC, whereas diets high in protein, fiber, and carbohydrate may reduce the risk of the disease.

Colorectal cancer; Total energy; Macronutrient; Case-control study