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Epidemiology

Adherence to the Danish food-based dietary guidelines and risk of colorectal cancer: a cohort study

British Journal of Cancer volume 125, pages 1726–1733 (2021)Cite this article

Subjects

Abstract

Background

National dietary guidelines contribute to primary prevention of a wide range of diseases. Yet, the importance of adhering to the Danish dietary guidelines for colorectal cancer prevention is unclear.

Methods

We used the Danish Diet, Cancer and Health cohort (n = 55,744) to investigate adherence to the Danish dietary guidelines and the risk of colorectal cancer. Cox proportional hazard models were used to estimate hazard ratios (HRs) for colorectal cancer and subtypes across the Danish Dietary Guidelines Index score (ranging 0–6 points, 6 being the greatest adherence). Effect modification by BMI was explored on multiplicative and additive scales.

Results

During a median follow-up of 18.9 years, 1030 men and 849 women developed colorectal cancer. Higher index scores were associated with a lower risk of colorectal cancer (HR 0.66; 95% confidence interval (CI) 0.53, 0.84, highest (≥5) versus lowest index score (<3 points) group). Similar inverse associations were observed between index scores and colon cancer. The risk difference was −0.8% (95% CI: −1.6, −0.1) among the overweight/obese group and 0.1% (95% CI: −0.7, 1.0) in the normal weight group for high compared to low adherence.

Conclusion

Adherence to the Danish Dietary Guidelines was associated with a lower risk of colorectal cancer, particularly among people with overweight/obesity.

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Data availability

Data are available upon request to the Danish Cancer Society (dchdata@cancer.dk).

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Acknowledgements

The authors thank the Danish Cancer Society and staff at the Diet, Cancer and Health study for the collection and administration of data.

Funding

NA.

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Author notes

  1. These authors contributed equally: Jie Zhang, Dorthe Nyvang.

Authors and Affiliations

  1. Department of Public Health, Aarhus University, Aarhus, Denmark

    Jie Zhang, Dorthe Nyvang, Daniel B. Ibsen, Anja Olsen, Kim Overvad & Christina C. Dahm

  2. Danish Cancer Society Research Center, Copenhagen, Denmark

    Anja Olsen & Anne Tjønneland

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  1. Jie Zhang
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Contributions

JZ and DN contributed to study conceptualisation, analysis, methodology and writing. AT and KO contributed to data collection. DBI contributed to analysis, methodology and writing. AO and AT contributed to methodology, data curation, review and editing. KO contributed to methodology, validation, review and editing. CCD contributed to study conceptualisation, methodology and writing.

Corresponding author

Correspondence to Christina C. Dahm.

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Ethics approval and consent to participate

The Diet, Cancer and Health Cohort Study and the present study were approved by the Regional Ethical Committees on human studies and by the Danish Data Protection Agency. Informed consent was obtained from all participants. Data are handled through the study process under the Data Protection Regulation [64].

Competing interests

The authors declare no competing interests.

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Zhang, J., Nyvang, D., Ibsen, D.B. et al. Adherence to the Danish food-based dietary guidelines and risk of colorectal cancer: a cohort study. Br J Cancer 125, 1726–1733 (2021). https://doi.org/10.1038/s41416-021-01556-x

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