Nutrients and food groups and large bowel cancer in Europe.

Several uncertainties remain with respect to the role of intake of fat and/or total energy in the aetiology of cancer of the colon-rectum. Between 1992 and 1996, 1953 subjects with cancer of the colon-rectum (median age = 62 years) and 4154 hospital controls were interviewed in six Italian areas. The validated food-frequency questionnaire included questions on 78 foods and recipes, and specific questions on individual fat intake pattern. Significant trends of increasing colorectal cancer risk with increasing intake emerged for bread and pasta, cakes and desserts, and refined sugar. Most vegetables, including pulses, were inversely associated with cancer of the colon and rectum. High fruit intake was associated only with a reduction of rectal cancer. Total energy intake was directly associated with colorectal cancer risk. Among macronutrients, a high intake of starch and saturated fat seemed to lead to an increased risk of cancer. High intakes of polyunsaturated fatty acids (chiefly derived from olive oil and seed oils) showed a marginal inverse association with colorectal cancer risk. Among micronutrients, beta-carotene, vitamin E and calcium showed the most consistent inverse associations. An excess of energy intake, particularly from refined bread and pasta, can be an unfavourable feature of the Mediterranean diet with respect to colorectal cancer risk, especially in the presence of sedentary life.