Nutrient-derived Dietary Patterns and Risk of Colorectal Cancer: a Factor Analysis in Uruguay

  • Stefani, Eduardo De ;
  • Ronco, Alvaro L. ;
  • Boffetta, Paolo ;
  • Deneo-Pellegrini, Hugo ;
  • Correa, Pelayo ;
  • Acosta, Gisele ;
  • Mendilaharsu, Maria
  • Published : 2012.01.31


In order to explore the role of nutrients and bioactive related substances in colorectal cancer, we conducted a case-control in Uruguay, which is the country with the highest production of beef in the world. Six hundred and eleven (611) cases afflicted with colorectal cancer and 1,362 controls drawn from the same hospitals in the same time period were analyzed through unconditional multiple logistic regression. This base population was submitted to a principal components factor analysis and three factors were retained. They were labeled as the meat-based, plant-based, and carbohydrates patterns. They were rotated using orthogonal varimax method. The highest risk was positively associated with the meat-based pattern (OR for the highest quartile versus the lowest one 1.63, 95 % CI 1.22-2.18, P value for trend = 0.001), whereas the plant-based pattern was strongly protective (OR 0.60, 95 % CI 0.45-0.81, P value for trend <0.0001. The carbohydrates pattern was only positively associated with colon cancer risk (OR 1.46, 95 % CI 1.02-2.09). The meat-based pattern was rich in saturated fat, animal protein, cholesterol, and phosphorus, nutrients originated in red meat. Since herocyclic amines are formed in the well-done red meat through the action of amino acids and creatine, it is suggestive that this pattern could be an important etiologic agent for colorectal cancer.


Nutrient patterns;meat-based;plant-based;carbohydrate;colorectal cancer;well-done meat


  1. Barrios E, Vassallo JA, Alonso R, Garau M, Musetti C (2010). III Atlas de Incidencia de Cancer en el Uruguay 2002-2006. Registro Nacional de Cancer. Comision Honoraria de Lucha contra el Cancer, Ed. Barreiro & Ramos, Montevideo, (In Spanish).
  2. Bravi F, Edefonti V, Bosetti C, et al (2010). Nutrient dietary patterns and the risk of colorectal cancer: a case-control study from Italy. Cancer Causes Control, 21, 1911-8.
  3. Butler LM, Wang R, Koh W-P, Yu MC (2008). Prospective study of dietary patterns and colorectal cancer among Singapore Chinese. Br J Cancer, 99, 1511-6.
  4. Dixon LB, Balder HF, Virtanen MJ, et al (2004). Dietary patterns associated with colon and rectal cancer: results from the Dietary Patterns and Cancer (DIETSCAN) Project. Am J Clin Nutr, 80, 1003-11.
  5. English DR, MacInnis RJ, Hodge AM, et al (2004). Red meat, chicken, and fish consumption and risk of colorectal cancer. Cancer Epidemiol Biomarkers Prev, 13, 1509-14.
  6. Flood A, Rastogi, T, Wirfält E, et al (2008). Dietary patterns as identified by factor analysis and colorectal cancer among middle-aged Americans. Am J Clin Nutr, 88, 176-84.
  7. Fung T, Hu FB, Fuchs C, et al (2003). Major dietary patterns and the risk of colorectal cancer in women. Arch Intern Med, 163, 309-14.
  8. Giovannucci E, Rimm EB, Stampfer MJ, et al (1994). Intake of fat, meat, and fiber in relation to risk of colon cancer in men. Cancer Res, 54, 2390-7.
  9. Gorsuch RL (2008). Factor Analysis. Second Edition. Psychology Press. Taylor & Francis Group, London, pp 175-206.
  10. Kesse E, Clavel-Chapelon F, Boutron-Rualt MC (2006). Dietary patterns and risk of colorectal tumors: A cohort of French women of the National Education System (E3N). Am J Epidemiol, 164, 1085-93.
  11. Kim MK, Sasaki S, Otani T, Tsugane S, for the Japan Public Health Center-based Prospective Study Group (2005). Dietary patterns and subsequent colorectal cancer risk by subsite: A prospective cohort study. Int J Cancer, 115, 790-8.
  12. Le Marchand L, Hankin JH, Pierce LM, et al (2002). Well-done red meat, metabolic phenotypes and colorectal cancer in Hawaii. Mutat Res, 506-507, 205-14.
  13. Matos E, Brandani A (2002). Review on meat consumption and cancer in South America. Mutat Res, 506-507, 243-9.
  14. Martinez ME, Marshall JR, Sechrest L (1998). Invited commentary: factor analysis and the search for objectivity. Am J Epidemiol, 148, 17-9.
  15. Mulaik SA (2010). Foundations of Factor Analysis. Second Edition. CRC Press, Taylor & Francis Group, Boca Raton, pp 369-80.
  16. Norat T, Bingham S, Ferrari P et al, (2005). Meat, fish and colorectal cancer risk: the EPIC study. J Natl Cancer Inst, 97, 906-16.
  17. Norat T, Lukanova A, Ferrari P, Riboli E (2002). Meat consumption and colorectal cancer risk: dose-response metaanalysis of epidemiological studies. Int J Cancer, 98, 241-56.
  18. Nowell S, Coles B, Sinha R, et al (2002). Analysis of total meat intake and exposure to individual heterocyclic amines in a case-control study of colorectal cancer: contribution of metabolic variation to risk. Mutat Res, 506-507, 175-85.
  19. Randall E, Marshall JR, Brasure J, Graham S (1992). Dietary patterns and colon cancer in Western New York. Nutr Cancer, 18, 265-76.
  20. Rothman KJ, Greenland S, Lash TL (editors) (2008). Modern Epidemiology. Third Edition. Lippincott Williams & Wilkins, Philadelphia.
  21. Sinha R (2002). An epidemiologic approach to studying heterocyclic amines. Mutat Res, 506-507, 197-204.
  22. Sinha R, Chow WH, Kulldorff M, et al (1999). Well done, grilled red meat increases the risk of colorectal adenomas. Cancer Res, 59, 4320-4.
  23. Sinha R, Kulldorff M, Chow WH, Denobile J, Rothman N (2001). Dietary intake of heterocyclic amines, meat-derived mutagenic activity, and risk of colorectal adenomas. Cancer Epidemiol Biomarkers Prev, 10, 559-62.
  24. Slattery ML, Boucher KM, Caan BJ, Potter JD, Ma K-N (1998). Eating patterns and risk of colon cancer. Am J Epidemiol, 148, 4-16.
  25. StataCorp (2007). Stata Statistical Software: Release 10. College Station, Texas, StataCorp.
  26. Terry P, Hu FB, Hansen H, Wolk A (2001). Prospective study of major dietary patterns and colorectal cancer risk in women. Am J Epidemiol, 154, 1143-9.
  27. Thomson GH (1951). The Factorial Analysis of Human Ability. London: University of London Press.
  28. Tiemersma EW, Kapman E, Bueno de Mesquita HB, et al (2002). Meat consumption, cigarette smoking, and genetic susceptibility in the etiology of colorectal cancer: results from a Dutch prospective study. Cancer Causes Control, 13, 383-93.
  29. Weisburger JH (2002). Comments on the history and importance of aromatic and heterocyclic amines in public health. Mutat Res, 506-507, 9-20.
  30. Willett WC, Stampfer MJ, Colditz GA, et al (1990). Relation of meat, fat, and fiber intake to the risk of colon cancer in a prospective study among women. New Engl J Med, 323, 1664-72.
  31. World Cancer Research Fund/American Institute for Cancer Research (2007). Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington DC: AICR, pp 200-88.

Cited by

  1. Dietary Patterns and the Risk of Colorectal Cancer vol.2, pp.1, 2013,
  2. Processed Meat Consumption and Squamous Cell Carcinoma of the Oesophagus in a Large Case-Control Study in Uruguay vol.15, pp.14, 2014,
  3. XRCC1 Gene Polymorphism, Diet and Risk of Colorectal Cancer in Thailand vol.15, pp.17, 2014,
  4. Nutrient Patterns and Their Food Sources in an International Study Setting: Report from the EPIC Study vol.9, pp.6, 2014,
  5. Risk Factors for Colorectal Cancer in Thailand vol.16, pp.14, 2015,
  6. Nutrient Patterns and Their Association with Socio-Demographic, Lifestyle Factors and Obesity Risk in Rural South African Adolescents vol.7, pp.5, 2015,
  7. Main nutrient patterns and colorectal cancer risk in the European Prospective Investigation into Cancer and Nutrition study vol.115, pp.11, 2016,
  8. Helicobacter Pylori Associated Gastritis Increases Risk of Colorectal Polyps: a Hospital Based-Cross-Sectional Study in Nakhon Ratchasima Province, Northeastern Thailand vol.17, pp.1, 2016,
  9. Relationships between nutrient patterns and geodemographic characteristics in Korea vol.73, pp.5, 2016,
  10. Dietary Patterns and Colorectal Cancer Risk: a Review of 17 Years of Evidence (2000–2016) vol.13, pp.6, 2017,
  11. Hot infusions and risk of colorectal cancer in Uruguay: a case–control study pp.1476-5640, 2017,