Associations between degree of food processing and colorectal cancer risk in a large-scale European cohort

Aline Al Nahas; Sahar Yammine Ghantous; Fernanda Morales Berstein; Emine Koc Cakmak; Carine Biessy; Genevieve Nicolas; Nathalie Kliemann; Jessica Blanco Lopez; Inarie Jacobs; Esther M. Gonzalez-Gil; Manon Cairat; Maria Gabriela Matias Pinho; Renata Bertazzi Levy; Fernanda Rauber; Eszter P. Vamos; Kiara Chang; Christopher Millett; Mathilde Touvier; Emmanuelle Kesse-Guyot; Gianluca Severi; Chloé Marques; Mariem Hajji; Alessandra Macciotta; Giovanna Masala; Mario Fordellone; Claudia Agnoli; Pilar Amiano; Marcela Guevara; Anne Tjønneland; Cecilie Kyrø; Jeroen W.G. Derksen; Karel C. Smit; Matthias B. Schulze; Franziska Jannasch; Rudolf Kaaks; Verena Katzke; Tonje Braaten; Magritt Brustad; Guri Skeie; Rhea Harewood; Alicia Heath; Paolo Vineis; Elisabete Weiderpass; Pietro Ferrari; Marc J. Gunter; Inge Huybrechts

doi:10.1002/ijc.35361

Associations between degree of food processing and colorectal cancer risk in a large-scale European cohort

Aline Al Nahas^*
, Sahar Yammine Ghantous
, Fernanda Morales Berstein
, Emine Koc Cakmak
, Carine Biessy
, Genevieve Nicolas
, Nathalie Kliemann
, Jessica Blanco Lopez
, Inarie Jacobs
, Esther M. Gonzalez-Gil
, Manon Cairat
, Maria Gabriela Matias Pinho
, Renata Bertazzi Levy
, Fernanda Rauber
, Eszter P. Vamos
, Kiara Chang
, Christopher Millett
, Mathilde Touvier
, Emmanuelle Kesse-Guyot
, Gianluca Severi

Chloé Marques, Mariem Hajji, Alessandra Macciotta, Giovanna Masala, Mario Fordellone, Claudia Agnoli, Pilar Amiano, Marcela Guevara, Anne Tjønneland, Cecilie Kyrø, Jeroen W.G. Derksen, Karel C. Smit, Matthias B. Schulze, Franziska Jannasch, Rudolf Kaaks, Verena Katzke, Tonje Braaten, Magritt Brustad, Guri Skeie, Rhea Harewood, Alicia Heath, Paolo Vineis, Elisabete Weiderpass, Pietro Ferrari, Marc J. Gunter, Inge Huybrechts

^*Corresponding author for this work

Global Ecohydrology and Sustainability

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Industrial food processing has been linked to various health outcomes including cancer. To examine associations between the degree of food processing and risk of colorectal cancer (CRC) and its sub-sites, data from the European Prospective Investigation into Cancer (EPIC) including 6155 incident CRC cases (n = 450,111 participants), were analyzed. Dietary intakes were assessed using baseline food frequency questionnaires. Foods were classified into culinary ingredients, unprocessed, processed (PFs), and ultra-processed foods (UPFs) according to the Nova classification. Cox proportional hazards models, adjusted for established CRC risk factors, were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) associated with a 10% increase in proportion of consumption (%g/d) of each Nova group. Substitution analysis examined the effect of replacing UPFs and PFs with unprocessed foods on CRC risk. A 10% increase in proportion of UPFs was associated with 6% higher CRC risk (95% CI:1.02–1.10). A positive association was also found between PFs and CRC risk (HR per 10% increase: 1.10 [95% CI, 1.05–1.15]). Conversely, unprocessed food consumption was inversely associated with CRC risk (HR per 10% increase: 0.93[95% CI, 0.90–0.95]). Substitution of 10% of the overall proportion of the diet comprising UPFs or PFs with 10% unprocessed foods was associated with a decreased risk of CRC (HR_UPFs: 0.94 [95% CI, 0.90–0.97]; HR_PFs: 0.90 [95% CI, 0.86–0.94]). In conclusion, UPF was positively associated with CRC risk while diets richer in unprocessed foods were associated with lower CRC risk. Further studies are needed to understand the mechanisms by which food processing affects CRC risk.

Original language	English
Pages (from-to)	260-276
Number of pages	17
Journal	International Journal of Cancer
Volume	157
Issue number	2
Early online date	8 Feb 2025
DOIs	https://doi.org/10.1002/ijc.35361
Publication status	Published - 15 Jul 2025

Bibliographical note

Publisher Copyright:
© 2025 UICC.

Funding

This study was supported by Cancer Research UK (C33493/A29678), World Cancer Research Fund International (IIG_FULL_2020_033), and the Institut National du Cancer (INCa number 2021\u2010138). The coordination of EPIC is financially supported by the IARC and the Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, which has additional infrastructure support provided by the UK National Institute for Health and Care Research Imperial Biomedical Research Centre. The national cohorts are supported by the Danish Cancer Society (Denmark); Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle G\u00E9n\u00E9rale de l'Education Nationale, Institut National de la Sant\u00E9 et de la Recherche M\u00E9dicale (INSERM; France); German Cancer Aid, German Cancer Research Center (DKFZ), German Institute of Human Nutrition Potsdam\u2010Rehbruecke (DIfE), Federal Ministry of Education and Research (BMBF; Germany); Associazione Italiana per la Ricerca sul Cancro\u2010AIRC\u2010Italy, Compagnia di SanPaolo and National Research Council (Italy); Dutch Ministry of Public Health, Welfare and Sports (VWS), Netherlands Cancer Registry (NKR), LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund, Statistics Netherlands (Netherlands); Health Research Fund (FIS)\u2014Instituto de Salud Carlos III (ISCIII), Regional Governments of Andaluc\u00EDa, Asturias, Basque Country, Murcia and Navarra, and the Catalan Institute of Oncology (ICO; Spain); Swedish Cancer Society, Swedish Research Council and County Councils of Sk\u00E5ne and V\u00E4sterbotten (Sweden); and Cancer Research UK (14136 to EPIC\u2010Norfolk; C8221/A29017 to EPIC\u2010Oxford) and Medical Research Council (1000143 to EPIC\u2010Norfolk; MR/M012190/1 to EPIC\u2010Oxford, UK). We acknowledge \u2018the National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands, for their contribution and ongoing support to the EPIC Study\u2019. Fernanda Morales Berstein was supported by a Wellcome Trust PhD studentship in Molecular, Genetic and Lifecourse Epidemiology (224982/Z/22/Z). Emine Koc Cakmak was supported by the Ministry of National Education, T\u00FCrkiye, through the YLSY International Graduate Education Scholarship Programme.

Funders	Funder number
NKR
Ministry of National Education, Türkiye
Netherlands Cancer Registry
Department of Epidemiology and Biostatistics, University of California, San Francisco
Dutch Prevention Funds
Catalan Institute of Oncology
Ligue Contre le Cancer
Imperial College London
University of Maryland School of Public Health
Instituto de Salud Carlos III
Associazione Italiana per la Ricerca
German Institute of Human Nutrition Potsdam‐Rehbruecke
Institut national de la santé et de la recherche médicale
National Institute for Health and Care Research Imperial Biomedical Research Centre
Kræftens Bekæmpelse
LK Research Funds
World Cancer Research Fund
Bundesministerium für Bildung und Forschung
Cancerfonden
Centre International de Recherche sur le Cancer
Dutch ZON (Zorg Onderzoek Nederland
Ministerie van Volksgezondheid, Welzijn en Sport
Health Research Fund
National Research Council
Institut Gustave-Roussy
Consejería de Salud y Familias, Junta de Andalucía
Deutsche Krebshilfe
Deutsches Krebsforschungszentrum
Compagnia di SanPaolo
Mutuelle Générale de l'Education Nationale
Vetenskapsrådet
Medical Research Council	1000143, MR/M012190/1
Wellcome Trust	224982/Z/22/Z
World Cancer Research Fund International	IIG_FULL_2020_033
County Councils of Skåne	14136, C8221/A29017
Institut National Du Cancer	2021‐138
Cancer Research UK	C33493/A29678

Keywords

Colorectal cancer
EPIC
Nova classification
obesity
UPFs

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1002/ijc.35361

Intl Journal of Cancer - 2025 - Al Nahas - Associations between degree of food processing and colorectal cancer risk in aFinal published version, 1.12 MBLicence: Taverne

Cite this

Al Nahas, A., Yammine Ghantous, S., Morales Berstein, F., Cakmak, E. K., Biessy, C., Nicolas, G., Kliemann, N., Lopez, J. B., Jacobs, I., Gonzalez-Gil, E. M., Cairat, M., Pinho, M. G. M., Bertazzi Levy, R., Rauber, F., Vamos, E. P., Chang, K., Millett, C., Touvier, M., Kesse-Guyot, E., ... Huybrechts, I. (2025). Associations between degree of food processing and colorectal cancer risk in a large-scale European cohort. International Journal of Cancer, 157(2), 260-276. https://doi.org/10.1002/ijc.35361

@article{ae26fa323fb34aa1b6e974f3716c2bd7,

title = "Associations between degree of food processing and colorectal cancer risk in a large-scale European cohort",

abstract = "Industrial food processing has been linked to various health outcomes including cancer. To examine associations between the degree of food processing and risk of colorectal cancer (CRC) and its sub-sites, data from the European Prospective Investigation into Cancer (EPIC) including 6155 incident CRC cases (n = 450,111 participants), were analyzed. Dietary intakes were assessed using baseline food frequency questionnaires. Foods were classified into culinary ingredients, unprocessed, processed (PFs), and ultra-processed foods (UPFs) according to the Nova classification. Cox proportional hazards models, adjusted for established CRC risk factors, were used to estimate hazard ratios (HRs) and 95\% confidence intervals (95\% CIs) associated with a 10\% increase in proportion of consumption (\%g/d) of each Nova group. Substitution analysis examined the effect of replacing UPFs and PFs with unprocessed foods on CRC risk. A 10\% increase in proportion of UPFs was associated with 6\% higher CRC risk (95\% CI:1.02–1.10). A positive association was also found between PFs and CRC risk (HR per 10\% increase: 1.10 [95\% CI, 1.05–1.15]). Conversely, unprocessed food consumption was inversely associated with CRC risk (HR per 10\% increase: 0.93[95\% CI, 0.90–0.95]). Substitution of 10\% of the overall proportion of the diet comprising UPFs or PFs with 10\% unprocessed foods was associated with a decreased risk of CRC (HRUPFs: 0.94 [95\% CI, 0.90–0.97]; HRPFs: 0.90 [95\% CI, 0.86–0.94]). In conclusion, UPF was positively associated with CRC risk while diets richer in unprocessed foods were associated with lower CRC risk. Further studies are needed to understand the mechanisms by which food processing affects CRC risk.",

keywords = "Colorectal cancer, EPIC, Nova classification, obesity, UPFs",

author = "\{Al Nahas\}, Aline and \{Yammine Ghantous\}, Sahar and \{Morales Berstein\}, Fernanda and Cakmak, \{Emine Koc\} and Carine Biessy and Genevieve Nicolas and Nathalie Kliemann and Lopez, \{Jessica Blanco\} and Inarie Jacobs and Gonzalez-Gil, \{Esther M.\} and Manon Cairat and Pinho, \{Maria Gabriela Matias\} and \{Bertazzi Levy\}, Renata and Fernanda Rauber and Vamos, \{Eszter P.\} and Kiara Chang and Christopher Millett and Mathilde Touvier and Emmanuelle Kesse-Guyot and Gianluca Severi and Chlo{\'e} Marques and Mariem Hajji and Alessandra Macciotta and Giovanna Masala and Mario Fordellone and Claudia Agnoli and Pilar Amiano and Marcela Guevara and Anne Tj{\o}nneland and Cecilie Kyr{\o} and Derksen, \{Jeroen W.G.\} and Smit, \{Karel C.\} and Schulze, \{Matthias B.\} and Franziska Jannasch and Rudolf Kaaks and Verena Katzke and Tonje Braaten and Magritt Brustad and Guri Skeie and Rhea Harewood and Alicia Heath and Paolo Vineis and Elisabete Weiderpass and Pietro Ferrari and Gunter, \{Marc J.\} and Inge Huybrechts",

note = "Publisher Copyright: {\textcopyright} 2025 UICC.",

year = "2025",

month = jul,

day = "15",

doi = "10.1002/ijc.35361",

language = "English",

volume = "157",

pages = "260--276",

journal = "International Journal of Cancer",

issn = "0020-7136",

publisher = "John Wiley and Sons Inc.",

number = "2",

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Al Nahas, A, Yammine Ghantous, S, Morales Berstein, F, Cakmak, EK, Biessy, C, Nicolas, G, Kliemann, N, Lopez, JB, Jacobs, I, Gonzalez-Gil, EM, Cairat, M, Pinho, MGM, Bertazzi Levy, R, Rauber, F, Vamos, EP, Chang, K, Millett, C, Touvier, M, Kesse-Guyot, E, Severi, G, Marques, C, Hajji, M, Macciotta, A, Masala, G, Fordellone, M, Agnoli, C, Amiano, P, Guevara, M, Tjønneland, A, Kyrø, C, Derksen, JWG, Smit, KC, Schulze, MB, Jannasch, F, Kaaks, R, Katzke, V, Braaten, T, Brustad, M, Skeie, G, Harewood, R, Heath, A, Vineis, P, Weiderpass, E, Ferrari, P, Gunter, MJ & Huybrechts, I 2025, 'Associations between degree of food processing and colorectal cancer risk in a large-scale European cohort', International Journal of Cancer, vol. 157, no. 2, pp. 260-276. https://doi.org/10.1002/ijc.35361

TY - JOUR

T1 - Associations between degree of food processing and colorectal cancer risk in a large-scale European cohort

AU - Al Nahas, Aline

AU - Yammine Ghantous, Sahar

AU - Morales Berstein, Fernanda

AU - Cakmak, Emine Koc

AU - Biessy, Carine

AU - Nicolas, Genevieve

AU - Kliemann, Nathalie

AU - Lopez, Jessica Blanco

AU - Jacobs, Inarie

AU - Gonzalez-Gil, Esther M.

AU - Cairat, Manon

AU - Pinho, Maria Gabriela Matias

AU - Bertazzi Levy, Renata

AU - Rauber, Fernanda

AU - Vamos, Eszter P.

AU - Chang, Kiara

AU - Millett, Christopher

AU - Touvier, Mathilde

AU - Kesse-Guyot, Emmanuelle

AU - Severi, Gianluca

AU - Marques, Chloé

AU - Hajji, Mariem

AU - Macciotta, Alessandra

AU - Masala, Giovanna

AU - Fordellone, Mario

AU - Agnoli, Claudia

AU - Amiano, Pilar

AU - Guevara, Marcela

AU - Tjønneland, Anne

AU - Kyrø, Cecilie

AU - Derksen, Jeroen W.G.

AU - Smit, Karel C.

AU - Schulze, Matthias B.

AU - Jannasch, Franziska

AU - Kaaks, Rudolf

AU - Katzke, Verena

AU - Braaten, Tonje

AU - Brustad, Magritt

AU - Skeie, Guri

AU - Harewood, Rhea

AU - Heath, Alicia

AU - Vineis, Paolo

AU - Weiderpass, Elisabete

AU - Ferrari, Pietro

AU - Gunter, Marc J.

AU - Huybrechts, Inge

PY - 2025/7/15

Y1 - 2025/7/15

N2 - Industrial food processing has been linked to various health outcomes including cancer. To examine associations between the degree of food processing and risk of colorectal cancer (CRC) and its sub-sites, data from the European Prospective Investigation into Cancer (EPIC) including 6155 incident CRC cases (n = 450,111 participants), were analyzed. Dietary intakes were assessed using baseline food frequency questionnaires. Foods were classified into culinary ingredients, unprocessed, processed (PFs), and ultra-processed foods (UPFs) according to the Nova classification. Cox proportional hazards models, adjusted for established CRC risk factors, were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) associated with a 10% increase in proportion of consumption (%g/d) of each Nova group. Substitution analysis examined the effect of replacing UPFs and PFs with unprocessed foods on CRC risk. A 10% increase in proportion of UPFs was associated with 6% higher CRC risk (95% CI:1.02–1.10). A positive association was also found between PFs and CRC risk (HR per 10% increase: 1.10 [95% CI, 1.05–1.15]). Conversely, unprocessed food consumption was inversely associated with CRC risk (HR per 10% increase: 0.93[95% CI, 0.90–0.95]). Substitution of 10% of the overall proportion of the diet comprising UPFs or PFs with 10% unprocessed foods was associated with a decreased risk of CRC (HRUPFs: 0.94 [95% CI, 0.90–0.97]; HRPFs: 0.90 [95% CI, 0.86–0.94]). In conclusion, UPF was positively associated with CRC risk while diets richer in unprocessed foods were associated with lower CRC risk. Further studies are needed to understand the mechanisms by which food processing affects CRC risk.

AB - Industrial food processing has been linked to various health outcomes including cancer. To examine associations between the degree of food processing and risk of colorectal cancer (CRC) and its sub-sites, data from the European Prospective Investigation into Cancer (EPIC) including 6155 incident CRC cases (n = 450,111 participants), were analyzed. Dietary intakes were assessed using baseline food frequency questionnaires. Foods were classified into culinary ingredients, unprocessed, processed (PFs), and ultra-processed foods (UPFs) according to the Nova classification. Cox proportional hazards models, adjusted for established CRC risk factors, were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) associated with a 10% increase in proportion of consumption (%g/d) of each Nova group. Substitution analysis examined the effect of replacing UPFs and PFs with unprocessed foods on CRC risk. A 10% increase in proportion of UPFs was associated with 6% higher CRC risk (95% CI:1.02–1.10). A positive association was also found between PFs and CRC risk (HR per 10% increase: 1.10 [95% CI, 1.05–1.15]). Conversely, unprocessed food consumption was inversely associated with CRC risk (HR per 10% increase: 0.93[95% CI, 0.90–0.95]). Substitution of 10% of the overall proportion of the diet comprising UPFs or PFs with 10% unprocessed foods was associated with a decreased risk of CRC (HRUPFs: 0.94 [95% CI, 0.90–0.97]; HRPFs: 0.90 [95% CI, 0.86–0.94]). In conclusion, UPF was positively associated with CRC risk while diets richer in unprocessed foods were associated with lower CRC risk. Further studies are needed to understand the mechanisms by which food processing affects CRC risk.

KW - Colorectal cancer

KW - EPIC

KW - Nova classification

KW - obesity

KW - UPFs

UR - https://www.scopus.com/pages/publications/85217237276

U2 - 10.1002/ijc.35361

DO - 10.1002/ijc.35361

M3 - Article

AN - SCOPUS:85217237276

SN - 0020-7136

VL - 157

SP - 260

EP - 276

JO - International Journal of Cancer

JF - International Journal of Cancer

IS - 2

ER -

Associations between degree of food processing and colorectal cancer risk in a large-scale European cohort

Abstract

Bibliographical note

Funding

Keywords

UN SDGs

Access to Document

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