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Processed meat intake and incidence of colorectal cancer: a systematic review and meta-analysis of prospective observational studies

Abstract

The objective was to use accumulated evidence to explore the association between processed meat intake and risk of colorectal cancer (CRC) and to investigate the reliability of associations by evaluating patterns of risk by study population characteristics and research quality parameters. We included 29 observational prospective cohort studies with relative risk estimates and 95% confidence intervals for CRC according to various levels of processed meat consumption. Risk of bias was assessed using Risk Of Bias In Non-randomized Studies—of Interventions (ROBINS-I) tool. Data sources were PubMed and Embase up to January 2017. The summary relative risks for high versus low processed meat consumption and risk of CRC, colon, and rectal cancer were 1.13 (95% CI: 1.01, 1.26), 1.19 (95% CI: 1.09, 1.31), and 1.21 (95% CI: 0.98, 1.49), respectively. Similar estimates were observed for the dose-response analyses. Heterogeneity across studies was detected in most analytical models. The overall judgment showed that two out of 29 studies had a moderate risk of bias, 25 had a serious risk of bias, and 2 had a critical risk of bias. The bias domains most often rated critical were bias due to risk of confounding, bias due to missing data, and selective outcome reporting bias. Although this meta-analysis indicates a modest association between processed meat intake and an increased risk of CRC, our assessment of internal validity warrants a cautious interpretation of these results, as most of the included studies were judged to have serious or critical risks of bias.

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Acknowledgements

The authors thank Ahmed Saaid for performing Supplementary Table 3, which is indexing the definitions of processed meat types provided by the included studies. Moreover, the authors thank Katrine Rasmussen and Nanna Katrine Andersen for contributing to development of the search strategy.

Funding

The Parker Institute, Bispebjerg and Frederiksberg Hospital is supported by a core grant from the Oak Foundation (OCAY-13-309). MatPrat—the Norwegian consumer organization consulting on meat and egg consumption provided support for MNH, JFR, RJ and DDA. The sources of support had no influence on the content of the manuscript.

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Designed research: MNH, JFR, RJ, RC, PF, BLH. Conducted research: MNH, JR. Provided essential reagents or provided essential materials: MNH, JFR. Analyzed data or performed statistical analysis: MNH, JFR, PF. Wrote paper: MNH with contributions from all authors. Had primary responsibility for final content: MNH

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Correspondence to M. N. Händel.

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Conflict of interest

MNH, JFR and RJ: Support from MatPrat paid to the Parker Institute; SMN: None; RC: None; DDA: Partial support from MatPrat; PF: None; BLH: None.

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Händel, M.N., Rohde, J.F., Jacobsen, R. et al. Processed meat intake and incidence of colorectal cancer: a systematic review and meta-analysis of prospective observational studies. Eur J Clin Nutr 74, 1132–1148 (2020). https://doi.org/10.1038/s41430-020-0576-9

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