Nutrition and colorectal cancer - The role of BMI, sex, biomarkers and dietary index

Research output: ThesisDoctoral Thesis (compilation)


Colorectal cancer (CRC) is one of the most common forms of cancer. The cause of CRC is multifactorial, and lifestyle factors are thought to be a major contributor to the development of CRC. It can be hypothesised that the association between food intake and the risk of developing CRC depends not only on the food consumed, but what it is consumed in combination with. The associations between food and CRC may also depend on other lifestyle-related factors, such as blood glucose and insulin levels, insulin resistance, and body composition, or sex and clinicopathological characteristics, such as tumour location and tumour-stage. It is not confirmed that the association between a nutrient and CRC is equal to the associations between the different food groups that a nutrient comes from or that the food sources of the nutrients all creates the same associations.
The aim of this thesis is therefore to examine associations between dietary intakes and CRC in the Malmö Diet and Cancer cohort, and whether the associations are modified by different preconditions.
In the Malmö Diet and Cancer study (MDC) we examined food intake and levels of blood glucose, plasma insulin and insulin resistance by hazard regression regarding incident CRC. In MDC, baseline examinations were performed between 1991 and 1996, where information on body composition, and socioeconomic- and lifestyle factors was obtained, together with collection of blood samples. Food intake was recorded by a modified diet history method. Information on incident cases of CRC was identified via the Swedish cancer registry.
We found that high fibre intake was associated with lower risk for CRC, especially with lower risk for colon cancer in women, and that high intake of fruits and berries was associated with lower risk of CRC in women. Regarding meat intake, we found that high intake of pork, as well as intake of processed meat, was associated with risk of CRC. In addition, we found that high fasting blood glucose was associated with higher risk of CRC, especially in colon cancer in men.
Finally, we found that high adherence to a predefined CRC-specific diet quality index, based on World Cancer Research Found’s conclusions regarding diet, was inversely associated with risk of CRC, and gave a stronger association with CRC than when analysing the components of the index individually.
In conclusion, this thesis found different preconditions for associations between food intake and CRC, dependent on sex, meat subtype, fibre source, and the location of the tumour, but not for presence of overweight and diabetes in this population of inhabitants in Malmö.


  • Alexandra Vulcan
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cancer and Oncology


Translated title of the contributionNutrition och kolorektalcancer: BMI, kön, bimarkörer och kostindex roll
Original languageEnglish
Awarding Institution
Supervisors/Assistant supervisor
Award date2018 Jun 15
Place of PublicationLund
  • Lund University: Faculty of Medicine
Print ISBNs978-91-7619-638-0
Publication statusPublished - 2018
Publication categoryResearch

Bibliographic note

Defence details Date: 2018-06-15 Time: 13:00 Place: Jubileumsaulan, Jan Waldenströms gata 5, Skånes Universitetssjukhus i Malmö External reviewer(s) Name: Hultcrantz, Rolf Title: senior professor Affiliation: Karolinska Institutet, Stockholm --- ISSN: 1652-8220 Lund University, Faculty of Medicine Doctoral Dissertation Series 2018:72

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Related research output

Alexandra Vulcan, Jonas Manjer & Bodil Ohlsson, 2017 Dec 12, In: BMC Cancer. 17, 1, 842.

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