Risk of cancer in regular and low meat-eaters, fish-eaters, and vegetarians: a prospective analysis of UK Biobank participants

Abstract Background Following a vegetarian diet has become increasingly popular and some evidence suggests that being vegetarian may be associated with a lower risk of cancer overall. However, for specific cancer sites, the evidence is limited. Our aim was to assess the associations of vegetarian an...

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Main Authors: Cody Z. Watling, Julie A. Schmidt, Yashvee Dunneram, Tammy Y. N. Tong, Rebecca K. Kelly, Anika Knuppel, Ruth C. Travis, Timothy J. Key, Aurora Perez-Cornago
Format: Article
Language:English
Published: BMC 2022-02-01
Series:BMC Medicine
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Online Access:https://doi.org/10.1186/s12916-022-02256-w
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author Cody Z. Watling
Julie A. Schmidt
Yashvee Dunneram
Tammy Y. N. Tong
Rebecca K. Kelly
Anika Knuppel
Ruth C. Travis
Timothy J. Key
Aurora Perez-Cornago
author_facet Cody Z. Watling
Julie A. Schmidt
Yashvee Dunneram
Tammy Y. N. Tong
Rebecca K. Kelly
Anika Knuppel
Ruth C. Travis
Timothy J. Key
Aurora Perez-Cornago
author_sort Cody Z. Watling
collection DOAJ
description Abstract Background Following a vegetarian diet has become increasingly popular and some evidence suggests that being vegetarian may be associated with a lower risk of cancer overall. However, for specific cancer sites, the evidence is limited. Our aim was to assess the associations of vegetarian and non-vegetarian diets with risks of all cancer, colorectal cancer, postmenopausal breast cancer, and prostate cancer and to explore the role of potential mediators between these associations. Methods We conducted a prospective analysis of 472,377 UK Biobank participants who were free from cancer at recruitment. Participants were categorised into regular meat-eaters (n = 247,571), low meat-eaters (n = 205,385), fish-eaters (n = 10,696), and vegetarians (n = 8685) based on dietary questions completed at recruitment. Multivariable-adjusted Cox regressions were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for all cancer incidence and separate cancer sites across diet groups. Results After an average follow-up of 11.4 years, 54,961 incident cancers were identified, including 5882 colorectal, 7537 postmenopausal breast, and 9501 prostate cancers. Compared with regular meat-eaters, being a low meat-eater, fish-eater, or vegetarian were all associated with a lower risk of all cancer (HR: 0.98, 95% CI: 0.96–1.00; 0.90, 0.84–0.96; 0.86, 0.80–0.93, respectively). Being a low meat-eater was associated with a lower risk of colorectal cancer in comparison to regular meat-eaters (0.91, 0.86–0.96); however, there was heterogeneity in this association by sex (p = 0.007), with an inverse association across diet groups in men, but not in women. Vegetarian postmenopausal women had a lower risk of breast cancer (0.82, 0.68–0.99), which was attenuated and non-significant after adjusting for body mass index (BMI; 0.87, 0.72–1.05); in mediation analyses, BMI was found to possibly mediate the observed association. In men, being a fish-eater or a vegetarian was associated with a lower risk of prostate cancer (0.80, 0.65–0.99 and 0.69, 0.54–0.89, respectively). Conclusion The lower risk of colorectal cancer in low meat-eaters is consistent with previous evidence suggesting an adverse impact of meat intake. The lower risk of postmenopausal breast cancer in vegetarian women may be explained by their lower BMI. It is not clear whether the other differences observed for all cancers and for prostate cancer reflect any causal relationships or are due to other factors such as residual confounding or differences in cancer detection.
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spelling doaj.art-d104e1db8df440dc849d85ffd4dda8122022-12-21T19:29:05ZengBMCBMC Medicine1741-70152022-02-0120111310.1186/s12916-022-02256-wRisk of cancer in regular and low meat-eaters, fish-eaters, and vegetarians: a prospective analysis of UK Biobank participantsCody Z. Watling0Julie A. Schmidt1Yashvee Dunneram2Tammy Y. N. Tong3Rebecca K. Kelly4Anika Knuppel5Ruth C. Travis6Timothy J. Key7Aurora Perez-Cornago8Cancer Epidemiology Unit, Nuffield Department of Population Health, University of OxfordCancer Epidemiology Unit, Nuffield Department of Population Health, University of OxfordCancer Epidemiology Unit, Nuffield Department of Population Health, University of OxfordCancer Epidemiology Unit, Nuffield Department of Population Health, University of OxfordCancer Epidemiology Unit, Nuffield Department of Population Health, University of OxfordCancer Epidemiology Unit, Nuffield Department of Population Health, University of OxfordCancer Epidemiology Unit, Nuffield Department of Population Health, University of OxfordCancer Epidemiology Unit, Nuffield Department of Population Health, University of OxfordCancer Epidemiology Unit, Nuffield Department of Population Health, University of OxfordAbstract Background Following a vegetarian diet has become increasingly popular and some evidence suggests that being vegetarian may be associated with a lower risk of cancer overall. However, for specific cancer sites, the evidence is limited. Our aim was to assess the associations of vegetarian and non-vegetarian diets with risks of all cancer, colorectal cancer, postmenopausal breast cancer, and prostate cancer and to explore the role of potential mediators between these associations. Methods We conducted a prospective analysis of 472,377 UK Biobank participants who were free from cancer at recruitment. Participants were categorised into regular meat-eaters (n = 247,571), low meat-eaters (n = 205,385), fish-eaters (n = 10,696), and vegetarians (n = 8685) based on dietary questions completed at recruitment. Multivariable-adjusted Cox regressions were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for all cancer incidence and separate cancer sites across diet groups. Results After an average follow-up of 11.4 years, 54,961 incident cancers were identified, including 5882 colorectal, 7537 postmenopausal breast, and 9501 prostate cancers. Compared with regular meat-eaters, being a low meat-eater, fish-eater, or vegetarian were all associated with a lower risk of all cancer (HR: 0.98, 95% CI: 0.96–1.00; 0.90, 0.84–0.96; 0.86, 0.80–0.93, respectively). Being a low meat-eater was associated with a lower risk of colorectal cancer in comparison to regular meat-eaters (0.91, 0.86–0.96); however, there was heterogeneity in this association by sex (p = 0.007), with an inverse association across diet groups in men, but not in women. Vegetarian postmenopausal women had a lower risk of breast cancer (0.82, 0.68–0.99), which was attenuated and non-significant after adjusting for body mass index (BMI; 0.87, 0.72–1.05); in mediation analyses, BMI was found to possibly mediate the observed association. In men, being a fish-eater or a vegetarian was associated with a lower risk of prostate cancer (0.80, 0.65–0.99 and 0.69, 0.54–0.89, respectively). Conclusion The lower risk of colorectal cancer in low meat-eaters is consistent with previous evidence suggesting an adverse impact of meat intake. The lower risk of postmenopausal breast cancer in vegetarian women may be explained by their lower BMI. It is not clear whether the other differences observed for all cancers and for prostate cancer reflect any causal relationships or are due to other factors such as residual confounding or differences in cancer detection.https://doi.org/10.1186/s12916-022-02256-wDietVegetarianPescatarianColorectalBreastProstate
spellingShingle Cody Z. Watling
Julie A. Schmidt
Yashvee Dunneram
Tammy Y. N. Tong
Rebecca K. Kelly
Anika Knuppel
Ruth C. Travis
Timothy J. Key
Aurora Perez-Cornago
Risk of cancer in regular and low meat-eaters, fish-eaters, and vegetarians: a prospective analysis of UK Biobank participants
BMC Medicine
Diet
Vegetarian
Pescatarian
Colorectal
Breast
Prostate
title Risk of cancer in regular and low meat-eaters, fish-eaters, and vegetarians: a prospective analysis of UK Biobank participants
title_full Risk of cancer in regular and low meat-eaters, fish-eaters, and vegetarians: a prospective analysis of UK Biobank participants
title_fullStr Risk of cancer in regular and low meat-eaters, fish-eaters, and vegetarians: a prospective analysis of UK Biobank participants
title_full_unstemmed Risk of cancer in regular and low meat-eaters, fish-eaters, and vegetarians: a prospective analysis of UK Biobank participants
title_short Risk of cancer in regular and low meat-eaters, fish-eaters, and vegetarians: a prospective analysis of UK Biobank participants
title_sort risk of cancer in regular and low meat eaters fish eaters and vegetarians a prospective analysis of uk biobank participants
topic Diet
Vegetarian
Pescatarian
Colorectal
Breast
Prostate
url https://doi.org/10.1186/s12916-022-02256-w
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