Dietary intake of total, heme and non-heme iron and the risk of colorectal cancer in a European prospective cohort study

Research output: Contribution to journalJournal articleResearchpeer-review

  • Elom K. Aglago
  • Amanda J. Cross
  • Elio Riboli
  • Veronika Fedirko
  • David J. Hughes
  • Agnes Fournier
  • Paula Jakszyn
  • Heinz Freisling
  • Marc J. Gunter
  • Christina C. Dahm
  • Kim Overvad
  • Cecilie Kyrø
  • Marie Christine Boutron-Ruault
  • Joseph A. Rothwell
  • Gianluca Severi
  • Verena Katzke
  • Bernard Srour
  • Matthias B. Schulze
  • Clemens Wittenbecher
  • Domenico Palli
  • Sabina Sieri
  • Fabrizio Pasanisi
  • Rosario Tumino
  • Fulvio Ricceri
  • Bas Bueno-de-Mesquita
  • Jeroen W.G. Derksen
  • Guri Skeie
  • Torill Enget Jensen
  • Marko Lukic
  • Maria Jose Sánchez
  • Pilar Amiano
  • Sandra Colorado-Yohar
  • Aurelio Barricarte
  • Ulrika Ericson
  • Bethany van Guelpen
  • Keren Papier
  • Anika Knuppel
  • Corinne Casagrande
  • Inge Huybrechts
  • Alicia K. Heath
  • Konstantinos K. Tsilidis
  • Mazda Jenab

Background: Iron is an essential micronutrient with differing intake patterns and metabolism between men and women. Epidemiologic evidence on the association of dietary iron and its heme and non-heme components with colorectal cancer (CRC) development is inconclusive. Methods: We examined baseline dietary questionnaire-assessed intakes of total, heme, and non-heme iron and CRC risk in the EPIC cohort. Sex-specific multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were computed using Cox regression. We modelled substitution of a 1 mg/day of heme iron intake with non-heme iron using the leave one-out method. Results: Of 450,105 participants (318,680 women) followed for 14.2 ± 4.0 years, 6162 (3511 women) developed CRC. In men, total iron intake was not associated with CRC risk (highest vs. lowest quintile, HRQ5vs.Q1:0.88; 95%CI:0.73, 1.06). An inverse association was observed for non-heme iron (HRQ5vs.Q1:0.80, 95%CI:0.67, 0.96) whereas heme iron showed a non-significant association (HRQ5vs.Q1:1.10; 95%CI:0.96, 1.27). In women, CRC risk was not associated with intakes of total (HRQ5vs.Q1:1.11, 95%CI:0.94, 1.31), heme (HRQ5vs.Q1:0.95; 95%CI:0.84, 1.07) or non-heme iron (HRQ5vs.Q1:1.03, 95%CI:0.88, 1.20). Substitution of heme with non-heme iron demonstrated lower CRC risk in men (HR:0.94; 95%CI: 0.89, 0.99). Conclusions: Our findings suggest potential sex-specific CRC risk associations for higher iron consumption that may differ by dietary sources.

Original languageEnglish
JournalBritish Journal of Cancer
Volume128
Issue number8
Pages (from-to)1529-1540
Number of pages12
ISSN0007-0920
DOIs
Publication statusPublished - 2023

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© 2023, The Author(s), under exclusive licence to Springer Nature Limited.

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