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@ARTICLE{AlNahas:298612,
      author       = {A. Al Nahas and S. Yammine Ghantous and F. Morales Berstein
                      and E. K. Cakmak and C. Biessy and G. Nicolas and N.
                      Kliemann and J. B. Lopez and I. Jacobs and E. M.
                      Gonzalez-Gil and M. Cairat and M. G. M. Pinho and R.
                      Bertazzi Levy and F. Rauber and E. P. Vamos and K. Chang and
                      C. Millett and M. Touvier and E. Kesse-Guyot and G. Severi
                      and C. Marques and M. Hajji and A. Macciotta and G. Masala
                      and M. Fordellone and C. Agnoli and P. Amiano and M. Guevara
                      and A. Tjønneland and C. Kyrø and J. W. G. Derksen and K.
                      C. Smit and M. B. Schulze and F. Jannasch and R. Kaaks$^*$
                      and V. Katzke$^*$ and T. Braaten and M. Brustad and G. Skeie
                      and R. Harewood and A. Heath and P. Vineis and E. Weiderpass
                      and P. Ferrari and M. J. Gunter and I. Huybrechts},
      title        = {{A}ssociations between degree of food processing and
                      colorectal cancer risk in a large-scale {E}uropean cohort.},
      journal      = {International journal of cancer},
      volume       = {157},
      number       = {2},
      issn         = {0020-7136},
      address      = {Bognor Regis},
      publisher    = {Wiley-Liss},
      reportid     = {DKFZ-2025-00312},
      pages        = {260-276},
      year         = {2025},
      note         = {Volume157, Issue2, 15 July 2025, Pages 260-276},
      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 (Other) / EPIC (Other) / Nova
                      classification (Other) / UPFs (Other) / obesity (Other)},
      cin          = {C020},
      ddc          = {610},
      cid          = {I:(DE-He78)C020-20160331},
      pnm          = {313 - Krebsrisikofaktoren und Prävention (POF4-313)},
      pid          = {G:(DE-HGF)POF4-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:39921517},
      doi          = {DOI:10.1002/ijc.35361},
      url          = {https://inrepo02.dkfz.de/record/298612},
}