Associations of Evolutionary-Concordance Diet and Lifestyle Pattern Scores with Incident, Sporadic Colorectal Adenoma in a Pooled Case-Control Study

Differences in diet and lifestyle relative to those of our Paleolithic-era ancestors may explain current high incidences of chronic diseases, including colorectal cancer (CRC), in Westernized countries. Previously reported evolutionary-concordance diet and lifestyle pattern scores, reflecting closeness of diet and lifestyle patterns to those of Paleolithic-era humans, were associated with lower CRC incidence. Separate and joint associations of the scores with colorectal adenoma among men and women are unknown. To address this, we pooled data from three case-control studies of incident, sporadic colorectal adenomas (n = 771 cases, 1,990 controls), used participants' responses to food frequency and lifestyle questionnaires to calculate evolutionary-concordance diet and lifestyle pattern scores, and estimated the scores' associations with adenomas using multivariable unconditional logistic regression. The multivariable-adjusted odds ratios comparing those in the highest relative to the lowest diet and lifestyle score quintiles were 0.84 (95% confidence interval [CI] 0.62, 1.12; P-trend:0.03) and 0.41 (95% CI 0.29, 0.59; P-trend:<0.0001), respectively. The inverse associations were stronger for high-risk adenomas, and among those with both high relative to those with both low diet and lifestyle scores. These results suggest that more evolutionary-concordant diet and lifestyle patterns, separately and jointly, may be associated with lower risk for incident, sporadic colorectal adenoma. Supplemental data for this article is available online at https://doi.org/10.1080/01635581.2021.2002919 .

Automated summary

Differences in diet and lifestyle compared to our ancestors may contribute to the high incidence of chronic diseases in Western countries, including colorectal cancer. Previous studies have shown that diet and lifestyle patterns consistent with those of our ancestors are associated with a lower risk of colorectal cancer. This study found that the associations between diet and lifestyle pattern scores and colorectal adenomas in both men and women are still unclear, but inverse associations were observed between high-risk adenomas and high scores compared to low scores.