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Eur J Clin Nutr. 2020 Feb 6. doi: 10.1038/s41430-020-0576-9. [Epub ahead of print]

Processed meat intake and incidence of colorectal cancer: a systematic review and meta-analysis of prospective observational studies.

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The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark.
The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark.
Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark.
Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark.
EpidStat Institute, Ann Arbor, MI, USA.
National Institute of Public Health, University of Southern Denmark, Odense, Denmark.
The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, Sydney, NSW, Australia.
Department of Public Health, Section for Clinical Practice, University of Copenhagen, Copenhagen, Denmark.


The objective was to use accumulated evidence to explore the association between processed meat intake and risk of colorectal cancer (CRC) and to investigate the reliability of associations by evaluating patterns of risk by study population characteristics and research quality parameters. We included 29 observational prospective cohort studies with relative risk estimates and 95% confidence intervals for CRC according to various levels of processed meat consumption. Risk of bias was assessed using Risk Of Bias In Non-randomized Studies-of Interventions (ROBINS-I) tool. Data sources were PubMed and Embase up to January 2017. The summary relative risks for high versus low processed meat consumption and risk of CRC, colon, and rectal cancer were 1.13 (95% CI: 1.01, 1.26), 1.19 (95% CI: 1.09, 1.31), and 1.21 (95% CI: 0.98, 1.49), respectively. Similar estimates were observed for the dose-response analyses. Heterogeneity across studies was detected in most analytical models. The overall judgment showed that two out of 29 studies had a moderate risk of bias, 25 had a serious risk of bias, and 2 had a critical risk of bias. The bias domains most often rated critical were bias due to risk of confounding, bias due to missing data, and selective outcome reporting bias. Although this meta-analysis indicates a modest association between processed meat intake and an increased risk of CRC, our assessment of internal validity warrants a cautious interpretation of these results, as most of the included studies were judged to have serious or critical risks of bias.


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