Consumption of Whole-Grain Bread and Risk of Colorectal Cancer among Norwegian Women (the NOWAC Study)
Abstract
:1. Introduction
2. Methods
2.1. The NOWAC Study, Exclusion Criteria and Study Sample
2.2. Assessment of Dietary and Non-Dietary Exposures
2.3. Vital Status and Classification of CRC Cases
2.4. Statistical Analysis
3. Results
Variables | Whole-Grain Bread Consumption Group 1 | p2 | |||
---|---|---|---|---|---|
Zero/Seldom 0 g·Day−1 n = 8095 | Low 14 or 34 g·Day−1 n = 17,396 | Medium 100 g·Day−1 n = 33,994 | High 180 or 240 g·Day−1 n = 18,769 | ||
Median (5th–95th Percentile) | |||||
Age at start of follow-up (years) | 55 (47–70) | 55 (47–68) | 55 (48–69) | 55 (47–67) | ˂0.001 |
BMI (kg·m−2) | 25 (20–33) | 25 (20–33) | 25 (20–33) | 24 (20–33) | ˂0.001 |
% | |||||
Current HRT use | 21 | 21 | 22 | 20 | ˂0.02 |
Smoking: | ˂0.001 | ||||
Never | 33 | 33 | 37 | 38 | |
<30 years | 33 | 38 | 37 | 35 | |
≥30 years | 34 | 29 | 26 | 26 | |
Physical activity level: 3 | ˂0.001 | ||||
Low | 18 | 13 | 10 | 9 | |
Moderate | 69 | 70 | 72 | 71 | |
High | 13 | 17 | 17 | 20 | |
Education: 4 | ˂0.001 | ||||
<10 years | 31 | 21 | 21 | 22 | |
10–12 years | 36 | 36 | 35 | 34 | |
>12 years | 33 | 43 | 44 | 45 | |
Median (5th–95th Percentile) | |||||
Partly refined bread (g·day−1) | 75 (0–135) | 0 (0–135) | 0 (0–75) | 0 (0–26) | ˂0.001 |
Refined bread (g·day−1) | 0 (0–21) | 0 (0–9) | 0 (0–9) | 0 (0–9) | ˂0.001 |
Crisp bread (g·day−1) | 4 (0–55) | 4 (0–55) | 4 (0–31) | 4 (0–31) | ˂0.001 |
Breakfast cereals (g·day−1) | 0 (0–72) | 0 (0–72) | 0 (0–72) | 0 (0–51) | ˂0.001 |
Fruit (g·day−1) | 150 (14–481) | 192 (26–506) | 208 (33–506) | 208 (33–508) | ˂0.001 |
Vegetables (g·day−1) | 111 (24–313) | 148 (40–364) | 148 (43–350) | 150 (44–352) | ˂0.001 |
Potatoes (g·day−1) | 126 (0–189) | 63 (0–189) | 63 (22–189) | 126 (22–189) | ˂0.001 |
Red meat (g·day−1) | 14 (0–41) | 13 (0–38) | 13 (0–36) | 13 (0–37) | ˂0.001 |
Processed meat (g·day−1) | 30 (4–74) | 24 (4–65) | 26 (4–63) | 31 (4–74) | ˂0.001 |
Fiber other than whole-grain bread (g·day−1) | 16 (8–27) | 16 (8–27) | 15 (7–26) | 15 (8–26) | ˂0.001 |
Calcium from food (mg·day−1) | 613 (270–1250) | 580 (291–1155) | 650 (333–1213) | 761 (364–1367) | ˂0.001 |
Folate other than whole-grain bread (µg·day−1) | 175 (97–282) | 172 (92–287) | 174 (96–288) | 180 (100–294) | ˂0.001 |
Alcohol (g·day−1) | 2 (0–13) | 2 (0–13) | 2 (0–13) | 2 (0–12) | ˂0.001 |
Energy intake (kJ·day−1) | 6325 (3614–9761) | 6005 (3514–9381) | 6811 (4476–9974) | 8176 (5704–11,612) | ˂0.001 |
Variables | Total Sample n = 78,254 | Total CRC n = 795 | Total Colon n = 577 | Proximal Colon n = 316 | Distal Colon n = 193 | Rectal n = 218 |
---|---|---|---|---|---|---|
Median (5th–95th Percentile) | ||||||
Age at start of follow-up (years) | 55 (47–68) | 59 (49–73) | 59 (50–74) | 60 (50–74) | 58 (49–73) | 57 (49–71) |
BMI (kg·m−2) | 25 (20–33) | 25 (20–33) | 25 (20–34) | 25 (20–34) | 25 (21–33) | 25 (20–33) |
% | ||||||
Current HRT use | 21 | 22 | 21 | 20 | 23 | 26 |
Smoking: | ||||||
Never | 36 | 32 | 31 | 32 | 31 | 33 |
<30 years | 36 | 37 | 36 | 33 | 40 | 40 |
≥30 years | 28 | 31 | 33 | 35 | 29 | 27 |
Physical activity level: 1 | ||||||
Low | 11 | 13 | 13 | 12 | 16 | 12 |
Moderate | 71 | 72 | 72 | 75 | 67 | 72 |
High | 17 | 15 | 15 | 13 | 17 | 16 |
Education: 2 | ||||||
<10 years | 22 | 33 | 36 | 39 | 33 | 28 |
10–12 years | 35 | 36 | 36 | 36 | 35 | 34 |
>12 years | 43 | 31 | 28 | 25 | 32 | 39 |
Median (5th–95th Percentile) | ||||||
Whole-grain bread (g·day−1) | 100 (0–180) | 100 (0–180) | 100 (0–180) | 100 (0–180) | 100 (0–180) | 100 (0–180) |
Partly refined bread (g·day−1) | 0 (0–135) | 0 (0–75) | 0 (0–75) | 0 (0–75) | 0 (0–75) | 0 (0–135) |
Refined bread (g·day−1) | 0 (0–9) | 0 (0–9) | 0 (0–9) | 0 (0–9) | 0 (0–9) | 0 (0–9) |
Fruit (g·day−1) | 201 (29–500) | 185 (23–486) | 191 (23–486) | 192 (19–472) | 181 (33–481) | 182 (26–486) |
Vegetables (g·day−1) | 145 (40–351) | 131 (33–360) | 130 (33–346) | 122 (30–366) | 135 (39–307) | 134 (31–366) |
Potatoes (g·day−1) | 63 (0–189) | 126 (22–189) | 126 (22–189) | 126 (22–189) | 126 (22–189) | 126 (0–189) |
Red meat (g·day−1) | 13 (0–37) | 13 (0–41) | 13 (0–42) | 13 (0–43) | 13 (0–36) | 13 (0–41) |
Processed meat (g·day−1) | 26 (4–68) | 26 (4–67) | 26 (4–66) | 26 (4–66) | 25 (4–66) | 26 (2–74) |
Fiber other than whole-grain bread (g·day−1) | 16 (8–27) | 15 (7–26) | 15 (7–26) | 15 (7–27) | 15 (7–25) | 15 (8–26) |
Calcium from food (mg·day−1) | 653 (318–1254) | 627 (306–1195) | 627 (306–1175) | 613 (300–1151) | 637 (332–1219) | 626 (287–1264) |
Folate other than whole-grain bread (µg·day−1) | 175 (96–289) | 169 (89–286) | 167 (89–284) | 166 (87–294) | 167 (88–261) | 174 (89–295) |
Alcohol (g·day−1) | 2 (0–13) | 2 (0–12) | 2 (0–12) | 1 (0–11) | 2 (0–12) | 2 (0–11) |
Energy intake (kJ·day−1) | 6931 (4135–10,468) | 6690 (3937–10,341) | 6670 (3894–10,439) | 6678 (3758–10,540) | 6540 (3867–9793) | 6767 (3947–10,223) |
Whole-Grain Bread Consumption Group 1 | p For Linear Trend | ||||
---|---|---|---|---|---|
Zero/Seldom | Low | Medium | High | ||
Person-years | 74,397 | 159,394 | 312,445 | 171,246 | |
Total CRC | |||||
Cases | 87 | 196 | 336 | 176 | |
Age-adjusted model 2 | 0.89 (0.69–1.14) | 1 (ref) | 0.83 (0.70–0.99) | 0.85 (0.69–1.04) | 0.17 |
Full model 3 | 0.87 (0.68–1.12) | 1 (ref) | 0.86 (0.72–1.02) | 0.89 (0.72–1.09) | 0.44 |
Full model + energy 4 | 0.87 (0.67–1.12) | 1 (ref) | 0.84 (0.70–1.01) | 0.85 (0.66–1.09) | 0.34 |
Total Colon | |||||
Cases | 61 | 146 | 238 | 132 | |
Age-adjusted model | 0.82 (0.61–1.11) | 1 (ref) | 0.79 (0.64–0.97) | 0.86 (0.68–1.08) | 0.37 |
Full model | 0.81 (0.60–1.09) | 1 (ref) | 0.81 (0.66–1.00) | 0.91 (0.71–1.16) | 0.76 |
Full model + energy | 0.81 (0.60–1.09) | 1 (ref) | 0.80 (0.65–1.00) | 0.88 (0.66–1.18) | 0.67 |
Proximal Colon | |||||
Cases | 36 | 85 | 128 | 67 | |
Age-adjusted model | 0.82 (0.55–1.21) | 1 (ref) | 0.72 (0.55–0.95) | 0.75 (0.55–1.04) | 0.12 |
Full model | 0.78 (0.52–1.15) | 1 (ref) | 0.75 (0.57–0.99) | 0.79 (0.57–1.10) | 0.33 |
Full model + energy | 0.77 (0.52–1.14) | 1 (ref) | 0.69 (0.52–0.93) | 0.66 (0.44–0.98) | 0.09 |
Distal Colon | |||||
Cases | 20 | 50 | 74 | 49 | |
Age-adjusted model | 0.80 (0.47–1.34) | 1 (ref) | 0.72 (0.50–1.03) | 0.92 (0.62–1.37) | 0.90 |
Full model | 0.83 (0.49–1.40) | 1 (ref) | 0.73 (0.51–1.05) | 0.96 (0.64–1.45) | 0.98 |
Full model + energy | 0.83 (0.49–1.41) | 1 (ref) | 0.78 (0.53–1.15) | 1.14 (0.69–1.88) | 0.55 |
Rectal | |||||
Cases | 26 | 50 | 98 | 44 | |
Age-adjusted model | 1.07 (0.67–1.73) | 1 (ref) | 0.97 (0.69–1.36) | 0.82 (0.55–1.23) | 0.24 |
Full model | 1.06 (0.66–1.71) | 1 (ref) | 0.98 (0.70–1.38) | 0.84 (0.55–1.28) | 0.33 |
Full model + energy | 1.06 (0.66–1.71) | 1 (ref) | 0.95 (0.66–1.36) | 0.78 (0.47–1.27) | 0.26 |
4. Discussion
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Bakken, T.; Braaten, T.; Olsen, A.; Kyrø, C.; Lund, E.; Skeie, G. Consumption of Whole-Grain Bread and Risk of Colorectal Cancer among Norwegian Women (the NOWAC Study). Nutrients 2016, 8, 40. https://doi.org/10.3390/nu8010040
Bakken T, Braaten T, Olsen A, Kyrø C, Lund E, Skeie G. Consumption of Whole-Grain Bread and Risk of Colorectal Cancer among Norwegian Women (the NOWAC Study). Nutrients. 2016; 8(1):40. https://doi.org/10.3390/nu8010040
Chicago/Turabian StyleBakken, Toril, Tonje Braaten, Anja Olsen, Cecilie Kyrø, Eiliv Lund, and Guri Skeie. 2016. "Consumption of Whole-Grain Bread and Risk of Colorectal Cancer among Norwegian Women (the NOWAC Study)" Nutrients 8, no. 1: 40. https://doi.org/10.3390/nu8010040