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Dietary patterns derived from principal component analysis (PCA) and risk of colorectal cancer: a systematic review and meta-analysis


Background and aim

Colorectal cancer (CRC) is highly prevalent worldwide, with dietary habits being a major risk factor. We systematically reviewed and meta-analysed the observational evidence on the association between CRC and dietary patterns (DP) derived from principal component analysis.


PRISMA guidelines were followed. Web of Science, Medline/PubMed, EMBASE, and The Cochrane Library were searched to identify all eligible papers published up to the 31st July 2017. Any pre-defined cancer of the colon was included, namely colon-rectal cancer (CRC), colon cancer (CC), rectal cancer (RC), or proximal and distal CC, if available. Western (WDP) and prudent (PDP) dietary patterns were compared as a proxy to estimate “unhealthy” (Rich in meat and processed foods) and “healthy” diets (containing fruits or vegetables), respectively. Meta-analyses were carried out using random effects model to calculate overall risk estimates. Relative risks (RR) and 95% confidence intervals were estimated comparing the highest versus the lowest categories of dietary patterns for any of the forms of colon cancer studied.


28 studies were meta-analysed. A WDP was associated with increased risk of CRC (RR 1.25; 95% CI 1.11, 1.40), and of CC (RR 1.30; 95% CI 1.11, 1.52). A PDP was negatively associated with CRC (RR 0.81; 95% CI 0.73, 0.91). Sensitivity analyses showed that individuals from North-and South-American countries had a significantly higher risk of CRC than those from other continents.


A PDP might reduce the risk of CRC. Conversely, a WDP is associated with a higher risk of disease.

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We are indebted to Dr Siavash Saremi-Yarahmadi for his help translating a study from Farsi.

Author contributions

VGL and IB conceived the study, and VGL designed the systematic review following the PRISMA guidelines. TR designed the search strategies. VGL and VM piloted and carried out the search strategies of eligible studies. VM and VGL extracted the data independently, and discrepancies were discussed and harmonized with IB. VGL, VM, and IB agreed on the final list of eligible papers. VGL and IB discussed the statistical approach for data synthesis and analysis, and IB carried out the statistical analyses. TN, AM, and JP advised on the quality assessment of the studies, and on the interpretation of the results. VGL wrote the first and revised drafts of the manuscript, with contributions from all co-authors. All authors approved the final version of the manuscript.


Victoria Morton was a Master of Public Health (MPH) at Imperial College London and did this work as part of her Dissertation (Distinction). She was funded through a BUPA Foundation Grant No TBP-PPW10-064 awarded to Dr Vanessa Garcia-Larsen. Dr Ioannis Bakolis is funded by the National Institute for Health Research (NIHR) Biomedical Research at South London and Maudsley NHS Foundation Trust and King”s College London, and by National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South London at King”s College Hospital NHS Foundation Trust and King” College London. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health.

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Correspondence to Vanessa Garcia-Larsen.

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Garcia-Larsen, V., Morton, V., Norat, T. et al. Dietary patterns derived from principal component analysis (PCA) and risk of colorectal cancer: a systematic review and meta-analysis. Eur J Clin Nutr 73, 366–386 (2019).

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