Dietary intake and plasma phospholipid concentrations of saturated, monounsaturated and trans fatty acids and colorectal cancer risk in the European Prospective Investigation into Cancer and Nutrition cohort

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Epidemiologic studies examining the association between specific fatty acids and colorectal cancer (CRC) risk are inconclusive. We investigated the association between dietary estimates and plasma levels of individual and total saturated (SFA), monounsaturated (MUFA), industrial-processed trans (iTFA), and ruminant-sourced trans (rTFA) fatty acids, and CRC risk in the European Prospective Investigation into Cancer and Nutrition (EPIC). Baseline fatty acid intakes were estimated in 450 112 participants (6162 developed CRC, median follow-up = 15 years). In a nested case-control study, plasma phospholipid fatty acids were determined by gas chromatography in 433 colon cancer cases and 433 matched controls. Multivariable-adjusted hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CIs) were computed using Cox and conditional logistic regression, respectively. Dietary total SFA (highest vs lowest quintile, HRQ5vsQ1 = 0.80; 95%CI:0.69-0.92), myristic acid (HRQ5vsQ1 = 0.83, 95%CI:0.74-0.93) and palmitic acid (HRQ5vsQ1 = 0.81, 95%CI:0.70-0.93) were inversely associated with CRC risk. Plasma myristic acid was also inversely associated with colon cancer risk (highest vs lowest quartile, ORQ4vsQ1 = 0.51; 95%CI:0.32-0.83), whereas a borderline positive association was found for plasma stearic acid (ORQ4vsQ1 = 1.63; 95%CI:1.00-2.64). Dietary total MUFA was inversely associated with colon cancer (per 1-SD increment, HR1-SD = 0.92, 95%CI: 0.85-0.98), but not rectal cancer (HR1-SD = 1.04, 95%CI:0.95-1.15, Pheterogeneity = 0.027). Dietary iTFA, and particularly elaidic acid, was positively associated with rectal cancer (HR1-SD = 1.07, 95%CI:1.02-1.13). Our results suggest that total and individual saturated fatty acids and fatty acids of industrial origin may be relevant to the aetiology of CRC. Both dietary and plasma myristic acid levels were inversely associated with colon cancer risk, which warrants further investigation.


  • Elom K. Aglago
  • Neil Murphy
  • Inge Huybrechts
  • Geneviève Nicolas
  • Corinne Casagrande
  • Veronika Fedirko
  • Elisabete Weiderpass
  • Joseph A. Rothwell
  • Christina C. Dahm
  • Anja Olsen
  • Anne Tjønneland
  • Rudolf Kaaks
  • Verena Katzke
  • Matthias B. Schulze
  • Giovanna Masala
  • Claudia Agnoli
  • Salvatore Panico
  • Rosario Tumino
  • Carlotta Sacerdote
  • Bas H. Bueno-de-Mesquita
  • Jeroen W.G. Derksen
  • Guri Skeie
  • Inger Torhild Gram
  • Magritt Brustad
  • Paula Jakszyn
  • Maria Jose Sánchez
  • Pilar Amiano
  • José María Huerta
  • Maria Wennberg
  • Aurora Perez-Cornago
  • Alicia K. Heath
  • Mazda Jenab
  • Veronique Chajes
  • Marc J. Gunter
External organisations
  • International Agency for Research on Cancer, World Health Organization
  • Emory University Rollins School of Public Health
  • Versailles Saint-Quentin-en-Yvelines University
  • Stabilite genetique et oncogenese
  • Aarhus University
  • Danish Cancer Society Research Center
  • University of Copenhagen
  • German Cancer Research Centre
  • German Institute of Human Nutrition
  • University of Potsdam
  • Institute for Cancer Research, Prevention and Clinical Network (ISPRO)
  • Istituto Nazionale dei Tumori
  • University of Naples Federico II
  • Citta' della Salute e della Scienza Hospital-University of Turin
  • National Institute for Public Health and the Environment (RIVM)
  • University Medical Center Utrecht
  • UiT The Arctic University of Norway, Tromsø
  • Catalan Institute of Oncology
  • Ramon Llull University
  • Andalusian School Of Public Health (EASP)
  • University of Granada
  • Biodonostia Health Research Institute
  • Murcia Regional Health Council
  • Umeå University
  • University of Oxford
  • Imperial College London
Research areas and keywords

Subject classification (UKÄ)

  • Cancer and Oncology
  • Nutrition and Dietetics


  • biomarker, colorectal cancer, dietary intake, fatty acids
Original languageEnglish
Pages (from-to)865-882
Number of pages18
JournalInternational Journal of Cancer
Issue number4
Early online date2021
Publication statusPublished - 2021 Aug 15
Publication categoryResearch