Association of dietary patterns derived by reduced-rank regression with colorectal cancer risk and mortality

Purpose: Unhealthy dietary patterns contribute to an increased risk of colorectal cancer (CRC). Limited prior research has used reduced rank regression (RRR) to assess dietary patterns relative to CRC risk. This study aimed to identify dietary patterns derived by RRR and assess their associations with CRC risk and mortality. 

Methods: We used data from the multicentre Prostate, Lung, Colorectal, and Ovarian Cancer Screening (PLCO) trial. Dietary intake was assessed using a Dietary History Questionnaire. In the RRR intake of fibre, folate, and the percentage of energy from carbohydrates, saturated and unsaturated fatty acids were used as response variables. Cox models and competing risk survival regression, with age as the time scale, were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for CRC risk and mortality, respectively. 

Results: The median follow-up time for CRC risk (n = 1044) and mortality (n = 499) was 9.4 years (Interquartile Range: 8. 0, 10.1) and 16.9 years (11.9, 18.6), respectively. Two dietary patterns were identified: the first was characterised by high carbohydrate, folate and low fatty acid intake, and the second by high fibre and unsaturated fatty acid. Compared to participants in the first tertile of the high fibre and unsaturated fatty acid pattern, those in the third tertile had a lower risk of CRC (HR = 0.88; 95% CI: 0.76, 1.03), and colon cancer (HR = 0.85; 95% CI: 0.72, 1.01). Conversely, the high carbohydrate, high folate and low fatty acid pattern had no association with CRC outcomes. None of the dietary patterns showed associations with rectal cancer or CRC mortality. 

Conclusion: A diet enriched with high fibre and unsaturated fatty acids may reduce the risk of CRC. These results highlight the potential protective effect of adequate fibre intake in conjunction with high consumption of unsaturated fatty acids against CRC.