Diet and vitamin or mineral supplementation and risk of rectal cancer in Canada

Figures & data

Table I.  Distribution of rectal cancer by age and sex, NECSS Study, Canada, 1994–1997.

	Males		Females
Age group	Controls n (%)	Cases n (%)	Controls n (%)	Cases n (%)
20–29	99 (6.1)	1 (0.1)	42 (2.9)	1 (0.2)
30–39	176 (10.7)	16 (1.9)	97 (6.6)	15 (2.7)
40–49	137 (8.4)	76 (9.2)	287 (19.6)	67 (12.2)
50–59	239 (14.6)	172 (20.7)	366 (25.0)	140 (25.5)
60–69	581 (35.5)	369 (44.5)	462 (31.6)	205 (37.2)
≥70	403 (24.7)	196 (23.6)	208 (14.2)	122 (22.2)
Total	1635	830	1462	550

Table II.  Odds ratios and mean values (standard deviation) for rectal cancer by sex, NECSS Study, Canada, 1994–1997.

	Males				Females
	Controls n	Cases n	Age and province adjusted OR (95% CI)	p-value for trend	Controls n	Cases n	Age and province adjusted OR (95% CI)	p-value for trend
Family income
Low	284	135	1.0 ref.	0.43	300	118	1.0 ref.	0.84
Lower middle	313	159	0.9 (0.7–1.2)		272	85	1.1 (0.7–1.6)
Upper middle	424	206	1.1 (0.8–1.5)		355	123	0.9 (0.6–1.3)
High	273	157	1.1 (0.8–1.4)		167	58	1.1 (0.7–1.6)
Not reported	341	173			368	166
Education
Mean (SD)	12.0 (3.9)	11.4 (3.5)			12.0 (3.1)	11.5 (3.3)
1–8 yrs	299	163	1.0 ref.	0.003	172	85	1.0 ref.	0.06
9–13 yrs	803	447	1.0 (0.8–1.2)		886	342	0.9 (0.6–1.2)
≥14 yrs	511	203	0.7 (0.5–0.9)		389	114	0.7 (0.5–1.0)
Not reported	22	17			15	9
Body mass index (kg/m^2)*
<25	639	260	1.0 ref.	<0.0001	822	254	1.0 ref.	0.001
25–29	753	408	1.4 (1.1–1.7)		423	185	1.3 (1.1–1.7)
≥30.00	235	160	1.7 (1.3–2.2)		212	105	1.5 (1.2–2.1)
Not reported	8	2			5	6
Moderate activity (hr/month)**
Mean (SD)	16.1 (15.0)	18.5 (16.7)			15.3 (13.2)	16.9 (15.0)
≤4.2	572	269	1.0 ref.	0.25	321	112	1.0 ref.	0.72
4.3–11.6	354	165	1.0 (0.8–1.3)		321	114	0.9 (0.7–1.2)
11.7–24.4	355	176	1.0 (0.8–1.2)		322	104	0.8 (0.6–1.2)
≥24.5	354	220	1.2 (0.9–1.5)		320	140	1.1 (0.8–1.5)
Not reported	0	0			178	80
Strenuous activity (hr/month)**
Mean (SD)	5.7 (11.1)	5.5 (11.1)			2.9 (6.8)	2.9 (7.0)
None	575	316	1.0 ref.	0.75	571	252	1.0 ref.	0.63
≤1.9	277	149	1.0 (0.8–1.3)		217	68	0.9 (0.6–1.2)
2.0–9	249	108	0.9 (0.7–1.2)		208	63	0.8 (0.6–1.1)
≥9.1	265	126	1.0 (0.8–1.4)		237	92	1.0 (0.7–1.4)
Not reported	269	131			229	75
Smoking status**
Never	414	164	1.0 ref.		709	256	1.0 ref.
Ever	1182	629	1.2 (1.0–1.5)		736	267	1.0 (0.8–1.3)
Not reported	39	37			17	27
Total alcohol (servings/week)**
Mean (SD)	6.4 (11.1)	8.4 (12.0)			2.4 (5.4)	2.7 (5.7)
Never	502	220	1.0 ref.	< 0.0001	706	281	1.0 ref.	0.57
1–6	625	273	1.0 (0.8–1.3)		582	194	0.8 (0.6–1.0)
7–17	288	164	1.4 (1.0–1.8)		108	45	0.9 (0.4–1.4)
≥18	218	173	1.7 (1.3–2.2)		64	30	1.0 (0.6–1.7)
Not reported	2	0			2	0

*Adjusted for 10-year age group, province and education.

**Adjusted for 10-year age group, province, education, body mass index (<25, 25–29.9, ≥30); physical activity in females: ≤5.2, 5.3–12, 12.1–22.8, ≥22.9 for moderate activity (hr/month), none, ≤0.8, 0.9–3.7, ≥3.8 for strenuous activity.

Table III.  Odds ratios* for rectal cancer in males by consumption of selected foods and food groups**, NECSS Study, Canada, 1994–1997.

	Quartiles n for cases/controls					Mean & (Standard Deviation)
Foods or food groups** (servings/per week)	I (low)	II	III	IV (high)	p-value for trend	Cases	Controls
Total fruit	189/411	199/412	216/402	226/408
OR (95% CI)	1.0	1.1 (0.9–1.5)	1.2 (0.9–1.6)	1.3 (1.0–1.7)	0.45	10.6 (8.9)	10.2 (9.4)
Total vegetables	187/408	210/409	226/410	207/406
OR (95% CI)	1.0	1.0 (0.7–1.3)	0.9 (0.7–1.2)	0.8 (0.6–1.1)	0.19	13.2 (11.5)	13.4 (9.9)
Total juices	188/440	217/385	204/407	221/401
OR (95% CI)	1.0	1.4 (1.1–1.9)	1.3 (1.0–1.7)	1.6 (1.2–2.2)	0.002	9.4 (12.6)	8.6 (10.5)
Yellow-orange vegetables	347/656	285/529	187/427
OR (95% CI)	1.0	1.0 (0.8–1.3)	0.8 (0.6–1.1)		0.15	2.8 (3.3)	2.9 (3.1)
Dark green vegetables	142/302	326/624	163/305	188/367
OR (95% CI)	1.0	1.0 (0.8–1.4)	0.9 (0.7–1.3)	0.8 (0.6–1.1)	0.13	2.4 (3.5)	2.4 (3.1)
Cruciferous vegetables (0.5 cup/week)	102/243	349/618	186/390	193/382
OR (95% CI)	1.0	1.3 (0.9–1.7)	1.0 (0.7–1.4)	0.9 (0.5–1.3)	0.10	2.5 (3.8)	2.5 (3.1)
Tomatoes (Ave. No. of 0.5 cup/week)	77/209	366/707	274/467	87/200
OR (95% CI)	1.0	1.3 (0.9–1.8)	1.2 (0.9–1.7)	0.9 (0.6–1.4)	0.34	2.2 (2.5)	2.2 (2.8)
Total meat	169/423	207/406	239/395	215/409
OR (95% CI)	1.0	1.4 (1.0–1.8)	1.5 (1.2–2.1)	1.3 (0.9–1.8)	0.22	10.5 (9.3)	9.8 (8.6)
Total fish (4 oz/week)	107/208	476/898	247/527
OR (95% CI)	1.0	0.9 (0.7–1.3)	0.8 (0.6–1.2)		0.29	1.4 (2.1)	1.5 (2.0)
Chicken (Ave. No. of 4 oz/week)	565.0	1054	243/511
OR (95% CI)	1.0	0.8 (0.7–1.0)	0.4 (0.2–0.8)		0.01	1.6 (1.6)	1.7 (1.9)
Beef, pork or lamb as a main dish (Ave. No. of 4 oz/week)	331/729	358/688	112/155
OR (95% CI)	1.0	1.0 (0.8–1.3)	1.1 (0.8–1.5)		0.80	2.7 (2.9)	2.4 (2.5)
Hamburger (Ave. No./week)	124/308	540/979	149/312
OR (95% CI)	1.0	1.6 (1.2–2.1)	1.4 (1.0–2.0)		0.06	1.2 (1.9)	1.1 (1.3)
Bacon (Ave. No. of slice/week)	205/472	392/757	206/354
OR (95% CI)	1.0	1.1 (0.9–1.4)	1.2 (0.9–1.6)		0.16	1.4 (2.4)	1.4 (2.9)
Sausage (Ave. No./week)	225/568	478/851	100/160
OR (95% CI)	1.0	1.3 (1.0–1.6)	1.3 (0.9–1.8)		0.05	0.9 (1.8)	0.8 (1.4)
Processed meat products	157/420	216/402	250/408	207/403
OR (95% CI)	1.0	1.3 (1.0–1.8)	1.6 (1.2–2.2)	1.2 (0.9–1.7)	0.10	5.3 (6.1)	5.1 (6.8)
Total milk (8 oz/week)	215/418	371/700	244/515
OR (95% CI)	1.0	1.1 (0.9–1.4)	0.9 (0.7–1.2)		0.65	8.3 (9.0)	8.7 (9.8)
Dairy products	181/412	213/403	246/422	190/396
OR (95% CI)	1.0	1.2 (0.9–1.6)	1.3 (1.0–1.7)	1.0 (0.7–1.4)	0.72	13.0 (10.3)	13.2 (11.1)
Eggs (Ave. No. /week)	286/688	389/646	139/254
OR (95% CI)	1.0	1.3 (1.1–1.6)	1.3 (1.0–1.7)		0.04	3.1 (3.2)	2.8 (3.2)
Cheese (No. of 1 oz/week)	326/676	301/543	180/373
OR (95% CI)	1.0	1.0 (0.8–1.3)	0.9 (0.7–1.2)		0.64	3.0 (3.4)	3.1(3.8)
Butter on bread or vegetables (Ave. No. of tsp/week)	351/714	244/536	209/321
OR (95% CI)	1.0	0.9 (0.7–1.1)	1.1 (0.9–1.4)		0.56	4.6 (8.0)	3.9 (7.2)
Margerine on bread or vegetables (Ave. No. of tsp/week)	163/312	262/561	319/571	64/145	0.72	9.2 (10.0)	9.2 (9.9)
OR (95% CI)	1.0	1.0 (0.8–1.4)	1.2 (0.9–1.5)	0.9 (0.6–1.3)
Used fat /cooking oil to cook (times/week)	367/780	264/489	180/313
OR (95% CI)	1.0	1.0 (0.8–1.2)	0.9 (0.7–1.2)		0.54	3.8 (4.1)	3.6 (3.9)
Whole-grain products	170/416	221/405	256/434	183/378
OR (95% CI)	1.0	1.3 (1.0–1.8)	1.1 (0.9–1.6)	0.9 (0.6–1.2)	0.19	18.3 (19.6)	18.4 (20.3)
Total fat intake (g/week)	141/364	208/364	186/365	207/367
OR (95% CI)	1.0	1.5 (1.1–2.0)	1.4 (1.0–2.0)	1.7 (1.1–2.6)	0.02	395.3 (196.2)	379.2 (203.0)
Total energy intake (kJ/week)	152/362	169/366	222/367	199/365		55500.4	53328.0
OR (95% CI)	1.0	1.0 (0.8–1.4)	1.4 (1.0–1.8)	1.2 (0.9–1.6)	0.05	(22475.2)	(21356.2)

*Adjusted for 10-year age group, province, education, body mass index (<25, 25–29.9, ≥30), smoking status (never, ever), alcohol use and total energy intake.

**Total fruit: apples, pears, oranges, bananas, cantaloupe or other fruit, fresh or canned.

Total vegetables: tomatoes, carrots, broccoli, cabbage, cauliflower, brussel sprouts, spinach or other greens, yellow squash, green beans, corn, peas or any other vegetable.

Total juice: fresh or frozen fruit end vegetable juices, and drinks from powdered drink crystals.

Total meat: beef, pork, lamb, hamburger, hotdogs, bacon, sausage, smoked meat, luncheon meat and liver.

Processed meat products: hotdogs, lunch meat, smoked meat, bacon and sausage.

Total milk: 1% milk, 2% milk and skim milk.

Dairy products: milk, cheese and ice cream.

Whole-grain products: dark or whole grain bread, granola and cooked cereals.

Note: Totals may vary due to missing values.

Table IV.  Odds ratios* for rectal cancer in females by consumption of selected foods and food groups**, NECSS Study, Canada, 1994–1997.

	Quartiles n for cases/controls					Mean & (Standard Deviation) (servings/per week)
Foods or food groups** (servings/per week)	I (low)	II	III	IV (high)	p-value for trend	Cases	Controls
Total fruit	183/552	141/440	129/278	97/190
OR (95% CI)	1.0	0.8 (0.6–1.1)	1.1 (0.8–1.4)	1.2 (0.9–1.8)	0.16	13.7 (10.4)	11.9 (8.8)
Total vegetables	145/376	110/356	148/364	147/364
OR (95% CI)	1.0	0.7 (0.5–1.0)	0.8 (0.6–1.1)	0.8 (0.5–1.1)	0.27	16.7 (13.9)	15.8 (13.5)
Total juices	129/365	111/365	155/367	155/363
OR (95% CI)	1.0	0.8 (0.6–1.1)	1.0 (0.8–1.4)	1.1 (0.8–1.5)	0.26	10.6 (12.3)	9.1 (10.8)
Yellow-orange vegetables	141/376	194/517	117/264	93/295
OR (95% CI)	1.0	0.9 (0.7–1.2)	1.0 (0.8–1.5)	0.7 (0.5–1.0)	0.16	3.7 (4.5)	3.7 (3.9)
Dark green vegetables	119/301	180/503	107/321	136/321
OR (95% CI)	1.0	0.8 (0.6–1.1)	0.8 (0.5–1.1)	0.9 (0.6–1.3)	0.60	3.2 (3.3)	3.1 (3.9)
Cruciferous vegetables (0.5 cup/week)	100/201	227/659	95/267	128/333
OR (95% CI)	1.0	0.6 (0.4–0.8)	0.6 (0.4–0.8)	0.6 (0.4–0.8)	0.03	3.1(3.5)	3.1 (3.6)
Tomatoes (Ave. No. of 0.5 cup/week)	48/141	213/617	185/468	91/205
OR (95% CI)	1.0	0.9 (0.6–1.3)	0.9 (0.6–1.4)	1.0 (0.6–1.5)	0.83	2.6 (3.3)	2.4 (2.9)
Total meat	108/367	143/357	129/371	170/365
OR (95% CI)	1.0	1.4 (1.0–2.0)	1.2 (0.9–1.7)	1.6 (1.1–2.2)	0.05	8.0 (6.8)	7.5 (10.1)
Total fish (4 oz/week)	65/187	307/858	178/415
OR (95% CI)	1.0	0.9 (0.6–1.3)	1.1 (0.7–1.6)		0.38	1.5 (1.8)	1.4 (2.9)
Chicken (Ave. No. of 4 oz/week)	333/852	191/555	23/47
OR (95% CI)	1.0	0.8 (0.7–1.0)	1.0 (0.6–1.8)		0.22	1.9 (2.3)	1.9 (2.3)
Beef, pork or lamb as a main dish	362/778	214/526	56/120
(Ave. No. of 4 oz/week)
OR (95% CI)	1.0	1.2 (0.9–1.5)	1.2 (0.8–1.7)		0.20	2.4 (2.7)	2.1 (2.3)
Hamburger (Ave. No./week)	103/247	363/998	74/201
OR (95% CI)	1.0	0.9 (0.7–1.2)	0.9 (0.6–1.3)		0.47	0.9 (1.0)	1.0 (1.5)
Bacon (Ave. No. of slice/week)	173/513	286/755	75/143
OR (95% CI)	1.0	1.0 (0.8–1.3)	1.6 (1.1–2.3)		0.04	0.8 (1.1)	0.7 (1.7)
Sausage (Ave. No. /week)	224/643	277/732	29/47
OR (95% CI)	1.0	1.0 (0.8–1.3)	1.4 (0.8–2.3)		0.40	0.5 (0.8)	0.5 (1.4)
Processed meat products	118/359	148/421	122/316	162/364
OR (95% CI)	1.0	1.1 (0.8–1.5)	1.3 (0.9–1.8)	1.4 (1.0–1.9)	0.05	3.3 (3.8)	3.1 (6.5)
Total milk (8 oz/week)	163/409	204/580	183/471
OR (95% CI)	1.0	0.8 (0.6–1.1)	0.9 (0.7–1.2)		0.53	8.8 (10.3)	8.4 (9.8)
Dairy products	134/370	154/383	125/348	137/359
OR (95% CI)	1.0	1.1 (0.8–1.5)	0.8 (0.5–1.0)	0.9 (0.6–1.3)	0.24	12.9 (11.1)	12.6 (10.9)
Eggs (Ave. No./week)	35/100	215/719	250/515	40/107
OR (95% CI)	1.0	0.7 (0.5–1.1)	1.1 (0.7–1.7)	0.9 (0.5–1.6)	0.10	2.2 (2.1)	2.0 (2.3)
Cheese (No. of 1 oz/week)	211/585	228/521	104/337
OR (95% CI)	1.0	1.1 (0.9–1.5)	0.7 (0.5–1.0)		0.11	2.9 (2.8)	3.1 (3.4)
Butter on bread or vegetables	351/714	244/536	209/321
(Ave. No. of tsp/week)
OR (95% CI)	1.0	0.9 (0.7–1.1)	1.1 (0.9–1.4)		0.56	4.4 (7.6)	4.5 (7.4)
Margerine on bread or vegetables (Ave. No. of tsp/week)	163/312	262/561	319/571	64/145	0.72	8.8 (9.7)	8.5 (9.1)
OR (95% CI)	1.0	1.0 (0.8–1.4)	1.2 (0.9–1.5)	0.9 (0.6–1.3)
Used fat /cooking oil to cook
(times/ week)	254/740	174/467	110/246
OR (95% CI)	1.0	1.1 (0.8–1.4)	1.2 (0.9–1.6)		0.29	3.6 (3.4)	3.3 (3.5)
Whole-grain products	109/355	133/377	175/391	133/337
OR (95% CI)	1.0	1.2 (0.9–1.7)	1.3 (0.9–1.8)	1.0 (0.7–1.5)	0.87	19.6 (18.1)	17.6 (17.3)
Total fat intake (g/week)	104/338	143/335	128/338	128/337
OR (95% CI)	1.0	1.2 (0.9–1.7)	1.0 (0.7–1.5)	0.8 (0.5–1.3)	0.29	339.0 (151.1)	334.5 (267.3)
Total energy intake (kJ/week)	104/338	125/336	111/336	163/338		50623.6	48386.6
OR (95% CI)	1.0	1.2 (0.9–1.7)	1.1 (0.8–1.5)	1.7 (1.2–2.2)	0.003	(18071.5)	(26778.3)

*Adjusted for 10-year age group, province, education, body mass index (<25, 25–29.9, ≥30) and total energy intake.

**Foods or food groups are the same as in Table III.

Note: Totals may vary due to missing values.

Table V.  Odds ratios* for rectal cancer by consumption (years) of selected vitamin and mineral spplements, NECSS Study, Canada, 1994–1997.

	Males n for cases/controls				Females n for cases/controls
Vitamin or mineral supplements	Never OR	1–4 OR (95% CI)	≥5 OR (95% CI)	p-value for trend	Never OR	1–4 OR (95% CI)	≥5 OR (95% CI)	p-value for trend
Multiple vitamins	449/890	212/416	120/247		208/506	193/549	111/334
	1.0	1.0 (0.8–1.2)	1.0 (0.6–1.5)	0.34	1.0	0.9 (0.7–1.2)	0.9 (0.6–1.4)	0.03
Vitamin A	624/1272	81/150	40/87		402/1054	49/170	25/89
	1.0	1.0 (0.7–1.3)	0.8 (0.5–1.2)	0.42	1.0	0.7 (0.5–1.0)	0.6 (0.4–1.0)	0.009
Beta-carotene	641/1326	81/113	26/58		392/1049	65/211	18/58
	1.0	1.3 (0.9–1.8)	0.8 (0.5–1.3)	0.95	1.0	0.7 (0.5–1.0)	0.8 (0.4–1.3)	0.06
B-complex vitamins	595/1219	100/180	52/105		335/851	100/313	45/167
	1.0	1.0 (0.8–1.4)	0.9 (0.6–1.3)	0.66	1.0	0.8 (0.6–1.0)	0.6 (0.4–0.8)	0.001
Vitamin C	423/829	217/427	133/271		285/797	110/266	108/305
	1.0	0.9 (0.7–1.1)	0.8 (0.7–1.1)	0.18	1.0	0.8 (0.6–1.0)	0.7 (0.5–1.0)	0.02
Vitamin E	494/1047	178/302	92/175		336/898	85/251	72/197
	1.0	1.0 (0.8–1.2)	0.9 (0.7–1.2)	0.51	1.0	0.7 (0.6–0.9)	0.7 (0.5–1.0)	0.009
Calcium	594/1208	103/201	54/100		256/632	168/524	74/229
	1.0	0.9 (0.7–1.2)	1.0 (0.7–1.4)	0.61	1.0	0.6 (0.5–0.8)	0.5 (0.4–0.7)	<0.0001
Iron	605/1314	113/143	20/50		272/742	166/456	47/131
	1.0	1.7 (1.3–2.3)	0.8 (0.5–1.4)	0.07	1.0	1.0 (0.8–1.3)	1.0 (0.7–1.4)	0.98
Zinc	690/1295	29/68	22/50		421/1092	43/156	15/66
	1.0	0.9 (0.6–1.3)	0.8 (0.5–1.4)	0.32	1.0	0.7 (0.5–1.0)	0.5 (0.3–0.9)	0.004
Selenium	682/1415	41/52	11/30		441/1177	25/89	7/37
	1.0	1.4 (0.9–2.2)	0.7 (0.4–1.5)	0.88	1.0	0.6 (0.4–1.0)	0.4 (0.2–1.0)	0.01

*Adjusted for 10-year age group, province, education and body mass index (<25, 25–29.9, ≥30), plus alcohol intake for males.

Note: Totals may vary due to missing values.