Systematic review and meta-analysis of diet quality and colorectal cancer risk: is the evidence of sufficient quality to develop recommendations?

• Published in: Critical reviews in food science and nutrition Vol. 61; no. 16; pp. 2773 - 2782
• Main Authors: Moazzen, Sara, van der Sloot, Kimberley W. J, Bock, Geertruida H. de, Alizadeh, Behrooz Z.
• Format: Journal Article
• Language: English
• Published: United States Taylor & Francis 08.09.2021; Taylor & Francis Ltd
• Subjects: Cancer; Colorectal cancer; Colorectal carcinoma; Colorectal neoplasms; Confidence intervals; Diet; Evaluation; gastrointestinal neoplasms; Health risks; healthy diet; Hypertension; Inflammation; Meta-analysis; Nutrient deficiency; Quality assessment; Quality control; Risk; healthy diet; Colorectal neoplasms; gastrointestinal neoplasms
• ISSN: 1040-8398; 1549-7852
• DOI: 10.1080/10408398.2020.1786353

The quality of existing evidence about the impact of diet quality on colorectal cancer (CRC) risk has only rarely been assessed. In the current review, we searched PubMed, EMBASE, Web of Science, Cochrane, and the resulting references (up to January 2020) for studies that evaluated the role of high diet quality by extreme dietary index categorization and the risk of CRC. Two researchers independently performed the study selection, data extraction, and quality assessment. We then applied a random-effects meta-analysis to estimate the pooled odds ratios (ORs) and 95% confidence intervals (CIs) for CRC at the extremes of each dietary index, and we assessed the quality of the pooled results using the Grading of Recommendations Assessment, Development and Evaluation approach. A high diet quality was significantly associated with reduced CRC risk when patients had a low Diet Inflammatory Index score (OR, 0.66; 95%CI, 0.56-0.78), a high Mediterranean Diet Score (OR, 0.84; 95%CI, 0.78-0.90), high Dietary Approaches to Stop Hypertension adherence (OR, 0.83; 95%CI, 0.78-0.89), and a high Healthy Eating Index score (OR, 0.72; 95%CI, 0.64-0.80). The pooled results for all dietary indices were rated as being of low quality due to concerns over inconsistency or imprecision. We conclude that, despite a high diet quality appearing to have a preventive role in CRC, the evidence is currently of insufficient quality to develop dietary recommendations.