Association of nut and seed intake with colorectal cancer risk in the European prospective investigation into cancer and nutrition

Mazda Jenab, Pietro Ferrari, Nadia Slimani, Teresa Norat, Corinne Casagrande, Kim Overad, Anja Olsen, Connie Stripp, Anne Tjønneland, Marie Christine Boutron-Ruault, Françoise Clavel-Chapelon, Emmanuelle Kesse, Alexandra Nieters, Manuela Bergmann, Heiner Boeing, Androniki Naska, Antonia Trichopoulou, Domenico Palli, Vittorio Krogh, Egidio CelentanoRosario Tumino, Carlotta Sacerdote, Hendrik B. Bueno-De-Mesquita, Marga C. Ocké, Petra H M Peeters, Dagrun Engeset, José R. Quirós, Carlos A. González, Carmen Martínez, Maria D. Chirlaque, Eva Ardanaz, Miren Dorronsoro, Peter Wallström, Richard Palmqvist, Bethany Van Guelpen, Sheila Bingham, Miguel A. San Joaquin, Rodolfo Saracci, Rudolf Kaaks, Elio Riboli

Research output: Contribution to journalArticlepeer-review


A link between unsaturated fatty acids or phytonutrients and reduced risk of colorectal cancer has been suggested. However, the effects of higher intake of dietary sources of these nutrients, such as the nuts and seeds food group, are less clear. The objective of this study was to determine the effects of nut and seed intake on colorectal cancer risk within the European Prospective Investigation into Cancer and Nutrition study, a large prospective cohort study involving 10 European countries. Total nut and seed intake was determined from country-specific dietary questionnaires. The data set included 478,040 subjects (141,988 men, 336,052 women) with a total of 855 (327 men, 528 women) colon and 474 (215 men, 259 women) rectal cancer cases. A multivariate Cox proportional hazards model, stratified by center and controlled for fruit intake, dietary fiber, energy, height, weight, sex, age, physical activity, and smoking, was used. The data show no association between higher intake of nuts and seeds and risk of colorectal, colon, and rectal cancers in men and women combined, but a significant inverse association was observed in subgroup analyses for colon cancer in women at the highest (>6.2 g/d) versus the lowest (nonconsumers; hazard ratio, 0.69; 95% confidence interval, 0.50-0.95) category of intake and for the linear effect of log-transformed intake (hazard ratio, 0.89; 95% confidence interval, 0.80-0.98), with no associations in men. It is not evident from this data why there may be a stronger association in women or why it may be limited to the colon, suggesting that much further research is necessary.

Original languageEnglish
Pages (from-to)1595-1603
Number of pages9
JournalCancer Epidemiology Biomarkers and Prevention
Issue number10
Publication statusPublished - Oct 2004

ASJC Scopus subject areas

  • Epidemiology
  • Oncology


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