Post-diagnosis dietary factors, supplement use and colorectal cancer prognosis: A Global Cancer Update Programme (CUP Global) systematic literature review and meta-analysis.
Study Goal
The researchers aimed to evaluate the association between supplemental calcium and colorectal cancer survival outcomes, including all-cause and cancer-specific mortality.
Results Summary
The study found limited evidence for an association between supplemental calcium and colorectal cancer-specific mortality, with the overall evidence graded as 'limited-no conclusion.' No strong or clinically meaningful effects were demonstrated.
Population
Colorectal cancer survivors (30,242 cases included in the analysis).
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
healthy dietary and/or lifestyle patterns (including diets that comprised plant-based foods) | decrease | all-cause mortality | colorectal cancer survivors | - | inverse associations | #1 |
whole grains | decrease | all-cause mortality | colorectal cancer survivors | - | inverse associations | #2 |
total coffee | decrease | all-cause mortality | colorectal cancer survivors | - | inverse associations | #3 |
caffeinated coffee | decrease | all-cause mortality | colorectal cancer survivors | - | inverse associations | #4 |
decaffeinated coffee | decrease | all-cause mortality | colorectal cancer survivors | - | inverse associations | #5 |
unhealthy dietary patterns | increase | all-cause mortality | colorectal cancer survivors | - | positive associations | #6 |
sugary drinks | increase | all-cause mortality | colorectal cancer survivors | - | positive associations | #7 |
whole grains | neutral | all-cause mortality | colorectal cancer survivors | - | - | #8 |
nuts/peanuts | neutral | all-cause mortality | colorectal cancer survivors | - | - | #9 |
red and processed meat | neutral | all-cause mortality | colorectal cancer survivors | - | - | #10 |
dairy products | neutral | all-cause mortality | colorectal cancer survivors | - | - | #11 |
sugary drinks | neutral | all-cause mortality | colorectal cancer survivors | - | - | #12 |
artificially sweetened beverages | neutral | all-cause mortality | colorectal cancer survivors | - | - | #13 |
coffee | neutral | all-cause mortality | colorectal cancer survivors | - | - | #14 |
alcohol | neutral | all-cause mortality | colorectal cancer survivors | - | - | #15 |
dietary glycaemic load/index | neutral | all-cause mortality | colorectal cancer survivors | - | - | #16 |
insulin load/index | neutral | all-cause mortality | colorectal cancer survivors | - | - | #17 |
marine omega-3 polyunsaturated fatty acids | neutral | all-cause mortality | colorectal cancer survivors | - | - | #18 |
supplemental calcium | neutral | all-cause mortality | colorectal cancer survivors | - | - | #19 |
circulating 25-hydroxyvitamin D (25[OH]D) | neutral | all-cause mortality | colorectal cancer survivors | - | - | #20 |
alcohol | neutral | colorectal cancer-specific mortality | colorectal cancer survivors | - | - | #21 |
supplemental calcium | neutral | colorectal cancer-specific mortality | colorectal cancer survivors | - | - | #22 |
circulating 25(OH)D | neutral | colorectal cancer-specific mortality | colorectal cancer survivors | - | - | #23 |
circulating 25(OH)D | neutral | recurrence/disease-free survival | colorectal cancer survivors | - | - | #24 |
The role of diet in colorectal cancer prognosis is not well understood and specific lifestyle recommendations are lacking. We searched for randomised controlled trials (RCTs) and longitudinal observational studies on post-diagnosis dietary factors, supplement use and colorectal cancer survival outcomes in PubMed and Embase from inception until 28th February 2022. Random-effects dose-response meta-analyses were conducted when at least three studies had sufficient information. The evidence was interpreted and graded by the CUP Global independent Expert Committee on Cancer Survivorship and Expert Panel. Five RCTs and 35 observational studies were included (30,242 cases, over 8700 all-cause and 2100 colorectal cancer deaths, 3700 progression, recurrence, or disease-free events). Meta-analyses, including 3-10 observational studies each, were conducted for: whole grains, nuts/peanuts, red and processed meat, dairy products, sugary drinks, artificially sweetened beverages, coffee, alcohol, dietary glycaemic load/index, insulin load/index, marine omega-3 polyunsaturated fatty acids, supplemental calcium, circulating 25-hydroxyvitamin D (25[OH]D) and all-cause mortality; for alcohol, supplemental calcium, circulating 25(OH)D and colorectal cancer-specific mortality; and for circulating 25(OH)D and recurrence/disease-free survival. The overall evidence was graded as 'limited'. The inverse associations between healthy dietary and/or lifestyle patterns (including diets that comprised plant-based foods), whole grains, total, caffeinated, or decaffeinated coffee and all-cause mortality and the positive associations between unhealthy dietary patterns, sugary drinks and all-cause mortality provided 'limited-suggestive' evidence. All other exposure-outcome associations provided 'limited-no conclusion' evidence. Additional, well-conducted cohort studies and carefully designed RCTs are needed to develop specific lifestyle recommendations for colorectal cancer survivors.