Dietary flavonoid intake and colorectal cancer risk in the European prospective investigation into cancer and nutrition (EPIC) cohort

Research output: Contribution to journalArticle


Flavonoids have been shown to inhibit colon cancer cell proliferation in vitro and protect against colorectal carcinogenesis in animal models. However, epidemiological evidence on the potential role of flavonoid intake in colorectal cancer (CRC) development remains sparse and inconsistent. We evaluated the association between dietary intakes of total flavonoids and their subclasses and risk of development of CRC, within the European Prospective Investigation into Cancer and Nutrition (EPIC) study. A cohort of 477,312 adult men and women were recruited in 10 European countries. At baseline, dietary intakes of total flavonoids and individual subclasses were estimated using centre-specific validated dietary questionnaires and composition data from the Phenol-Explorer database. During an average of 11 years of follow-up, 4,517 new cases of primary CRC were identified, of which 2,869 were colon (proximal = 1,298 and distal = 1,266) and 1,648 rectal tumours. No association was found between total flavonoid intake and the risk of overall CRC (HR for comparison of extreme quintiles 1.05, 95% CI 0.93–1.18; p-trend = 0.58) or any CRC subtype. No association was also observed with any intake of individual flavonoid subclasses. Similar results were observed for flavonoid intake expressed as glycosides or aglycone equivalents. Intake of total flavonoids and flavonoid subclasses, as estimated from dietary questionnaires, did not show any association with risk of CRC development.


  • Raul Zamora-Ros
  • Dinesh Kumar Barupal
  • Joseph A. Rothwell
  • Mazda Jenab
  • Veronika Fedirko
  • Isabelle Romieu
  • Krasimira Aleksandrova
  • Kim Overvad
  • Cecilie Kyrø
  • Anne Tjønneland
  • Aurélie Affret
  • Mathilde His
  • Marie-Christine Boutron-Ruault
  • Verena Katzke
  • Tilman Kühn
  • Heiner Boeing
  • Antonia Trichopoulou
  • Androniki Naska
  • Maria Kritikou
  • Calogero Saieva
  • Claudia Agnoli
  • Maria Santucci de Magistris
  • Rosario Tumino
  • Francesca Fasanelli
  • Elisabete Weiderpass
  • Guri Skeie
  • Susana Merino
  • Paula Jakszyn
  • Maria-José Sánchez
  • Miren Dorronsoro
  • Carmen Navarro
  • Eva Ardanaz
  • Lena Maria Nilsson
  • Stina Bodén
  • Bas H. Bueno-De-Mesquita
  • Petra H. Peeters
  • Aurora Perez-Cornago
  • Nicholas J Wareham
  • Kay-Thee Khaw
  • Heinz Freisling
  • Amanda J Cross
  • Elio Riboli
  • Augustin Scalbert
External organisations
  • International Agency for Research on Cancer, World Health Organization
  • Bellvitge Biomedical Research Institute
  • University of California, Davis
  • Emory University
  • German Institute of Human Nutrition
  • Aarhus University
  • Danish Cancer Society Research Center
  • University of Paris-Saclay
  • University of Paris-Sud
  • Institut Gustave Roussy
  • German Cancer Research Centre
  • Hellenic Health Foundation, Athens
  • National and Kapodistrian University of Athens
  • Cancer Research and Prevention Institute (ISPO)
  • Istituto Nazionale dei Tumori
  • University of Naples Federico II
  • Civic and M.P Arezzo Hospital
  • Citta' della Salute e della Scienza Hospital-University of Turin
  • University of Turin
  • UiT The Arctic University of Norway, Tromsø
  • Cancer Registry of Norway Institute of Population-Based Cancer Research
  • Karolinska Institutet
  • Folkhälsan Research Center
  • CIBER Epidemiology and Public Health (CIBERESP)
  • University of Granada
  • Murcia Regional Health Council
  • University of Murcia
  • Health Research Institute of Navarra (IDISNA)
  • Umeå University
  • National Institute for Public Health and the Environment (RIVM)
  • Imperial College London
  • University of Malaya
  • University Medical Center Utrecht
  • University of Oxford
  • University of Cambridge
  • Public Health Directorate
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cancer and Oncology
  • Nutrition and Dietetics


  • colorectal cancer, diet, EPIC, flavonoids, prospective cohort
Original languageEnglish
Pages (from-to)1836-1844
Number of pages9
JournalInternational Journal of Cancer
Issue number8
Publication statusPublished - 2017 Apr 15
Publication categoryResearch