Skip to main content

Advertisement

Log in

Nuts and legumes consumption and risk of colorectal cancer: a systematic review and meta-analysis

  • META-ANALYSIS
  • Published:
European Journal of Epidemiology Aims and scope Submit manuscript

Abstract

Several case–control and prospective cohort studies have examined the association between the consumption of nuts and legumes and the risk of colorectal cancer. For the quantitative assessment of this association, we conducted a meta-analysis of observational studies. We searched PubMed and Web of Science databases along with hand searches for eligible studies published up to January 2022. A total of 13 studies (8 cohort studies and 5 case–control studies) on nuts consumption and 29 studies (16 cohort studies and 13 case–control studies) on legumes consumption were included in the meta-analysis. The pooled relative risks (RRs) of colorectal cancer for the highest versus lowest categories of nuts consumption and legumes consumption were 0.84 (95% CI: 0.71–0.99) and 0.90 (95% CI: 0.83–0.98), respectively. Based on the dose–response analysis, a 28 g/day (1 serving/day) increment of nut consumption was associated with a 33% lower risk of colorectal cancer, and 100 g/day (1 serving/day) increment of legumes consumption was associated with a 21% lower risk of colorectal cancer. By geographic region for nuts consumption, however, the inverse association for the highest versus lowest categories was only observed in Asia (RR = 0.44; 95% CI: 0.29–0.68) from 3 studies, and no association was found in America (RR = 1.01; 95% CI: 0.92–1.11) (Pdifference = 0.003) or Europe (RR = 1.02; 95% CI: 0.84–1.25) (Pdifference = 0.003). In addition, the associations tended to be weak when stratified by adjustment for confounders. Our findings suggest that the evidence for an association is currently weak, and thus further well-designed prospective studies are needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Code availability

Available from the corresponding author on reasonable request.

References

  1. Ferlay JEM, Lam F, Colombet M, Mery L, Piñeros M, Znaor A, Soerjomataram I, Bray F. Global cancer observatory: cancer today. Lyon, France: International Agency for Research on Cancer. 2020. https://gco.iarc.fr/today. Accessed 23 July 2021

  2. Ferlay JLM, Ervik M, Lam F, Colombet M, Mery L, Piñeros M, Znaor A, Soerjomataram I, Bray F. Global cancer observatory: cancer tomorrow. Lyon, France: International Agency for Research on Cancer. 2020. https://gco.iarc.fr/tomorrow. Accessed 23 July 2021

  3. Arnold M, Sierra MS, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global patterns and trends in colorectal cancer incidence and mortality. Gut. 2017;66(4):683–91. https://doi.org/10.1136/gutjnl-2015-310912.

    Article  PubMed  Google Scholar 

  4. Martini D, Godos J, Marventano S, et al. Nut and legume consumption and human health: an umbrella review of observational studies. Int J Food Sci Nutr 2021;1–8. https://doi.org/10.1080/09637486.2021.1880554

  5. González CA, Salas-Salvadó J. The potential of nuts in the prevention of cancer. Br J Nutr. 2006;96(Suppl 2):S87-94. https://doi.org/10.1017/bjn20061868.

    Article  PubMed  Google Scholar 

  6. Alasalvar C, Bolling BW. Review of nut phytochemicals, fat-soluble bioactives, antioxidant components and health effects. Br J Nutr. 2015;113(Suppl 2):S68-78. https://doi.org/10.1017/s0007114514003729.

    Article  CAS  PubMed  Google Scholar 

  7. Naghshi S, Sadeghian M, Nasiri M, Mobarak S, Asadi M, Sadeghi O. Association of total nut, tree nut, peanut, and peanut butter consumption with cancer incidence and mortality: a comprehensive systematic review and dose-response meta-analysis of observational studies. Adv Nutr (Bethesda, Md.). 2021;12(3):793–808. https://doi.org/10.1093/advances/nmaa152

  8. Messina M. Soy and health update: evaluation of the clinical and epidemiologic literature. Nutrients. 2016;8(12). https://doi.org/10.3390/nu8120754

  9. Hu JF, Liu YY, Yu YK, Zhao TZ, Liu SD, Wang QQ. Diet and cancer of the colon and rectum: a case-control study in China. Int J Epidemiol. 1991;20(2):362–7. https://doi.org/10.1093/ije/20.2.362.

    Article  CAS  PubMed  Google Scholar 

  10. Hoshiyama Y, Sekine T, Sasaba T. A case-control study of colorectal cancer and its relation to diet, cigarettes, and alcohol consumption in Saitama Prefecture, Japan. Tohoku J Exp Med. 1993;171(2):153–65. https://doi.org/10.1620/tjem.171.153.

    Article  CAS  PubMed  Google Scholar 

  11. Steinmetz KA, Potter JD. Food-group consumption and colon cancer in the Adelaide Case-Control Study. I. Vegetables and fruit. Int J Cancer. 1993;53(5):711–9. https://doi.org/10.1002/ijc.2910530502

  12. Singh PN, Fraser GE. Dietary risk factors for colon cancer in a low-risk population. Am J Epidemiol. 1998;148(8):761–74. https://doi.org/10.1093/oxfordjournals.aje.a009697.

    Article  CAS  PubMed  Google Scholar 

  13. Deneo-Pellegrini H, Boffetta P, De Stefani E, Ronco A, Brennan P, Mendilaharsu M. Plant foods and differences between colon and rectal cancers. Eur J Cancer Prev Off J Eur Cancer Prev Org (ECP). 2002;11(4):369–75. https://doi.org/10.1097/00008469-200208000-00009.

    Article  CAS  Google Scholar 

  14. Yeh CC, You SL, Chen CJ, Sung FC. Peanut consumption and reduced risk of colorectal cancer in women: a prospective study in Taiwan. World J Gastroenterol. 2006;12(2):222–7. https://doi.org/10.3748/wjg.v12.i2.222.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Yang G, Shu XO, Li H, et al. Prospective cohort study of soy food intake and colorectal cancer risk in women. Am J Clin Nutr. 2009;89(2):577–83. https://doi.org/10.3945/ajcn.2008.26742.

    Article  CAS  PubMed  Google Scholar 

  16. Shin A, Lee J, Lee J, et al. Isoflavone and soyfood intake and colorectal cancer risk: a case-control study in Korea. PLoS ONE. 2015;10(11): e0143228. https://doi.org/10.1371/journal.pone.0143228.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Lee J, Shin A, Oh JH, Kim J. The relationship between nut intake and risk of colorectal cancer: a case control study. Nutr J. 2018;17(1):37. https://doi.org/10.1186/s12937-018-0345-y.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Zhang D, Dai C, Zhou L, et al. Meta-analysis of the association between nut consumption and the risks of cancer incidence and cancer-specific mortality. Aging. 2020;12(11):10772–94. https://doi.org/10.18632/aging.103292

  19. Long J, Ji Z, Yuan P, et al. Nut consumption and risk of cancer: a meta-analysis of prospective studies. Cancer Epidemiol Biom Prev. 2020;29(3):565–73. https://doi.org/10.1158/1055-9965.epi-19-1167.

    Article  Google Scholar 

  20. Zhu B, Sun Y, Qi L, Zhong R, Miao X. Dietary legume consumption reduces risk of colorectal cancer: evidence from a meta-analysis of cohort studies. Sci Rep. 2015;5:8797. https://doi.org/10.1038/srep08797.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Vieira AR, Abar L, Chan DSM, et al. Foods and beverages and colorectal cancer risk: a systematic review and meta-analysis of cohort studies, an update of the evidence of the WCRF-AICR continuous update project. Ann Oncol. 2017;28(8):1788–802. https://doi.org/10.1093/annonc/mdx171.

    Article  CAS  PubMed  Google Scholar 

  22. Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology. A proposal for reporting. JAMA. 2000;283(15):2008–12. https://doi.org/10.1001/jama.283.15.2008.

    Article  CAS  PubMed  Google Scholar 

  23. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177–88. https://doi.org/10.1016/0197-2456(86)90046-2.

    Article  CAS  PubMed  Google Scholar 

  24. Inoue M, Tajima K, Hirose K, et al. Subsite-specific risk factors for colorectal cancer: a hospital-based case-control study in Japan. Cancer Causes Control CCC. 1995;6(1):14–22. https://doi.org/10.1007/bf00051676.

    Article  CAS  PubMed  Google Scholar 

  25. Nishi M, Yoshida K, Hirata K, Miyake H. Eating habits and colorectal cancer. Oncol Rep. 1997;4(5):995–8. https://doi.org/10.3892/or.4.5.995.

    Article  CAS  PubMed  Google Scholar 

  26. Voorrips LE, Goldbohm RA, van Poppel G, Sturmans F, Hermus RJ, van den Brandt PA. Vegetable and fruit consumption and risks of colon and rectal cancer in a prospective cohort study: the Netherlands cohort study on diet and cancer. Am J Epidemiol. 2000;152(11):1081–92. https://doi.org/10.1093/aje/152.11.1081.

    Article  CAS  PubMed  Google Scholar 

  27. Budhathoki S, Joshi AM, Ohnaka K, et al. Soy food and isoflavone intake and colorectal cancer risk: the Fukuoka colorectal cancer study. Scand J Gastroenterol. 2011;46(2):165–72. https://doi.org/10.3109/00365521.2010.522720.

    Article  CAS  PubMed  Google Scholar 

  28. Michels KB, Edward G, Joshipura KJ, et al. Prospective study of fruit and vegetable consumption and incidence of colon and rectal cancers. J Natl Cancer Inst. 2000;92(21):1740–52. https://doi.org/10.1093/jnci/92.21.1740.

    Article  CAS  PubMed  Google Scholar 

  29. Nieuwenhuis L, Simons C, Weijenberg MP, van den Brandt PA. Nut and peanut butter intake and the risk of colorectal cancer and its anatomical and molecular subtypes: the Netherlands Cohort Study. Carcinogenesis. 2020;41(10):1368–84. https://doi.org/10.1093/carcin/bgaa080.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Oba S, Nagata C, Shimizu N, et al. Soy product consumption and the risk of colon cancer: a prospective study in Takayama. Japan Nutr Cancer. 2007;57(2):151–7. https://doi.org/10.1080/01635580701274475.

    Article  CAS  PubMed  Google Scholar 

  31. Park Y, Subar AF, Kipnis V, et al. Fruit and vegetable intakes and risk of colorectal cancer in the NIH-AARP diet and health study. Am J Epidemiol. 2007;166(2):170–80. https://doi.org/10.1093/aje/kwm067.

    Article  PubMed  Google Scholar 

  32. Akhter M, Inoue M, Kurahashi N, Iwasaki M, Sasazuki S, Tsugane S. Dietary soy and isoflavone intake and risk of colorectal cancer in the Japan public health center-based prospective study. Cancer Epidemiol Biom Prev. 2008;17(8):2128–35. https://doi.org/10.1158/1055-9965.epi-08-0182.

    Article  CAS  Google Scholar 

  33. Le Marchand L, Hankin JH, Wilkens LR, Kolonel LN, Englyst HN, Lyu LC. Dietary fiber and colorectal cancer risk. Epidemiology. 1997;8(6):658–65. https://doi.org/10.1097/00001648-199710000-00008

  34. Young TB, Wolf DA. Case-control study of proximal and distal colon cancer and diet in Wisconsin. Int J Cancer. 1988;42(2):167–75. https://doi.org/10.1002/ijc.2910420205.

    Article  CAS  PubMed  Google Scholar 

  35. Williams CD, Satia JA, Adair LS, et al. Dietary patterns, food groups, and rectal cancer risk in Whites and African-Americans. Cancer Epidemiol Biom Prev. 2009;18(5):1552–61. https://doi.org/10.1158/1055-9965.epi-08-1146.

    Article  CAS  Google Scholar 

  36. Sellers TA, Bazyk AE, Bostick RM, et al. Diet and risk of colon cancer in a large prospective study of older women: an analysis stratified on family history (Iowa, United States). Cancer Causes Control CCC. 1998;9(4):357–67. https://doi.org/10.1023/a:1008886715597.

    Article  CAS  PubMed  Google Scholar 

  37. Huang XE, Hirose K, Wakai K, et al. Comparison of lifestyle risk factors by family history for gastric, breast, lung and colorectal cancer. Asian Pacific J Cancer Prev APJCP. 2004;5(4):419–27.

    Google Scholar 

  38. Greenland S, Longnecker MP. Methods for trend estimation from summarized dose-response data, with applications to meta-analysis. Am J Epidemiol. 1992;135(11):1301–9. https://doi.org/10.1093/oxfordjournals.aje.a116237.

    Article  CAS  PubMed  Google Scholar 

  39. Berlin JA, Longnecker MP, Greenland S. Meta-analysis of epidemiologic dose-response data. Epidemiology. 1993;4(3):218–28. https://doi.org/10.1097/00001648-199305000-00005

  40. Orsini N, Bellocco R, Greenland S. Generalized least squares for trend estimation of summarized dose–response data. Stand Genomic Sci. 2006;6(1):40–57. https://doi.org/10.1177/1536867X0600600103.

    Article  Google Scholar 

  41. Bechthold A, Boeing H, Schwedhelm C, et al. Food groups and risk of coronary heart disease, stroke and heart failure: a systematic review and dose-response meta-analysis of prospective studies. Crit Rev Food Sci Nutr. 2019;59(7):1071–90. https://doi.org/10.1080/10408398.2017.1392288.

    Article  CAS  PubMed  Google Scholar 

  42. Cochran WG. The combination of estimates from different experiments. Biometrics. 1954;10(1):101–29. https://doi.org/10.2307/3001666.

    Article  Google Scholar 

  43. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557. https://doi.org/10.1136/bmj.327.7414.557.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50(4):1088–101. https://doi.org/10.2307/2533446.

    Article  CAS  PubMed  Google Scholar 

  45. Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629. https://doi.org/10.1136/bmj.315.7109.629.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Duval S, Tweedie R. Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000;56(2):455–63. https://doi.org/10.1111/j.0006-341x.2000.00455.x.

    Article  CAS  PubMed  Google Scholar 

  47. Jenab M, Ferrari P, Slimani N, et al. Association of nut and seed intake with colorectal cancer risk in the European Prospective Investigation into Cancer and Nutrition. Cancer Epidemiol Biom Prev. 2004;13(10):1595–603.

    Article  CAS  Google Scholar 

  48. Lin J, Zhang SM, Cook NR, Lee IM, Buring JE. Dietary fat and fatty acids and risk of colorectal cancer in women. Am J Epidemiol. 2004;160(10):1011–22. https://doi.org/10.1093/aje/kwh319.

    Article  PubMed  Google Scholar 

  49. Yang M, Hu FB, Giovannucci EL, et al. Nut consumption and risk of colorectal cancer in women. Eur J Clin Nutr. 2016;70(3):333–7. https://doi.org/10.1038/ejcn.2015.66.

    Article  CAS  PubMed  Google Scholar 

  50. Fang Z, Wu Y, Li Y, et al. Association of nut consumption with risk of total cancer and 5 specific cancers: evidence from 3 large prospective cohort studies. Am J Clin Nutr. 2021;114(6):1925–35. https://doi.org/10.1093/ajcn/nqab295.

    Article  Google Scholar 

  51. Evans RC, Fear S, Ashby D, et al. Diet and colorectal cancer: an investigation of the lectin/galactose hypothesis. Gastroenterology. 2002;122(7):1784–92. https://doi.org/10.1053/gast.2002.33659.

    Article  CAS  PubMed  Google Scholar 

  52. Flood A, Velie EM, Chaterjee N, et al. Fruit and vegetable intakes and the risk of colorectal cancer in the Breast Cancer Detection Demonstration Project follow-up cohort. Am J Clin Nutr. 2002;75(5):936–43. https://doi.org/10.1093/ajcn/75.5.936.

    Article  CAS  PubMed  Google Scholar 

  53. Lin J, Zhang SM, Cook NR, et al. Dietary intakes of fruit, vegetables, and fiber, and risk of colorectal cancer in a prospective cohort of women (United States). Cancer Causes Control CCC. 2005;16(3):225–33. https://doi.org/10.1007/s10552-004-4025-1.

    Article  PubMed  Google Scholar 

  54. Butler LM, Wang R, Koh WP, Yu MC. Prospective study of dietary patterns and colorectal cancer among Singapore Chinese. Br J Cancer. 2008;99(9):1511–6. https://doi.org/10.1038/sj.bjc.6604678.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Bamia C, Lagiou P, Buckland G, et al. Mediterranean diet and colorectal cancer risk: results from a European cohort. Eur J Epidemiol. 2013;28(4):317–28. https://doi.org/10.1007/s10654-013-9795-x.

    Article  CAS  PubMed  Google Scholar 

  56. Vogtmann E, Xiang YB, Li HL, et al. Fruit and vegetable intake and the risk of colorectal cancer: results from the Shanghai Men’s Health Study. Cancer Causes Control CCC. 2013;24(11):1935–45. https://doi.org/10.1007/s10552-013-0268-z.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Jones P, Cade JE, Evans CEL, Hancock N, Greenwood DC. The Mediterranean diet and risk of colorectal cancer in the UK Women’s Cohort Study. Int J Epidemiol. 2017;46(6):1786–96. https://doi.org/10.1093/ije/dyx155.

    Article  PubMed  Google Scholar 

  58. Seow A, Quah SR, Nyam D, Straughan PT, Chua T, Aw TC. Food groups and the risk of colorectal carcinoma in an Asian population. Cancer. 2002;95(11):2390–6. https://doi.org/10.1002/cncr.10971.

    Article  PubMed  Google Scholar 

  59. Abu Mweis SS, Tayyem RF, Shehadah I, et al. Food groups and the risk of colorectal cancer: results from a Jordanian case-control study. Eur J Cancer Prev. 2015;24(4):313–20. https://doi.org/10.1097/cej.0000000000000089.

    Article  PubMed  Google Scholar 

  60. Azzeh FS, Alshammari EM, Alazzeh AY, et al. Healthy dietary patterns decrease the risk of colorectal cancer in the Mecca Region, Saudi Arabia: a case-control study. BMC Public Health. 2017;17(1):607. https://doi.org/10.1186/s12889-017-4520-4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. International Nut and Dried Fruit Council Foundation. Nuts & dried fruits statistical yearbook 2020/2021. Reus, Spain; 2021.

  62. Herforth A, Arimond M, Álvarez-Sánchez C, Coates J, Christianson K, Muehlhoff E. A global review of food-based dietary guidelines. Adv Nutr 2019;10(4):590–605. https://doi.org/10.1093/advances/nmy130

  63. Shek LP, Cabrera-Morales EA, Soh SE, et al. A population-based questionnaire survey on the prevalence of peanut, tree nut, and shellfish allergy in 2 Asian populations. J Allergy Clin Immunol. 2010;126(2):324–31, 31.e1–7. https://doi.org/10.1016/j.jaci.2010.06.003

  64. World Cancer Research Fund/American Institute for Cancer Research. Continuous Update Project Export Report 2018. Wholegrains, vegetables and fruit and the risk of cancer.London; Arlington (VA): World Cancer Research Fund International; American Institute for Cancer Research; 2018. https://www.wcrf.org/dietandcancer/wholegrains-vegetables-and-fruit/. Accessed 1 September 2021

  65. Yu J, Bi X, Yu B, Chen D. Isoflavones: anti-inflammatory benefit and possible caveats. Nutrients. 2016;8(6). https://doi.org/10.3390/nu8060361

  66. Khankari NK, Yang JJ, Sawada N, et al. Soy intake and colorectal cancer risk: results from a pooled analysis of prospective cohort studies conducted in China and Japan. J Nutr. 2020;150(9):2442–50. https://doi.org/10.1093/jn/nxaa194.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Zeng H, Lazarova DL, Bordonaro M. Mechanisms linking dietary fiber, gut microbiota and colon cancer prevention. World J Gastrointest Oncol. 2014;6(2):41–51. https://doi.org/10.4251/wjgo.v6.i2.41.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Falasca M, Casari I. Cancer chemoprevention by nuts: evidence and promises. Front Biosci. 2012;4:109–20. https://doi.org/10.2741/254.

    Article  Google Scholar 

  69. Kuiper GG, Lemmen JG, Carlsson B, et al. Interaction of estrogenic chemicals and phytoestrogens with estrogen receptor beta. Endocrinology. 1998;139(10):4252–63. https://doi.org/10.1210/endo.139.10.6216.

    Article  CAS  PubMed  Google Scholar 

  70. Niv Y. Estrogen receptor β expression and colorectal cancer: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol. 2015;27(12):1438–42. https://doi.org/10.1097/meg.0000000000000471.

    Article  CAS  PubMed  Google Scholar 

  71. Sterne JA, Gavaghan D, Egger M. Publication and related bias in meta-analysis: power of statistical tests and prevalence in the literature. J Clin Epidemiol. 2000;53(11):1119–29. https://doi.org/10.1016/s0895-4356(00)00242-0.

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

This work was supported by the National Research Foundation of Korea, funded by Ministry of Science, ICT and Future Planning (Grant number: NRF-2021R1F1A1050847).

Author information

Authors and Affiliations

Authors

Contributions

Study concept and design: SJ and YJ, data collection and statistical analysis: SJ, writing—original draft: SJ, writing—review and editing: YJ, study supervision: YJ, Interpretation of the data, critical revision of the paper for important intellectual content and approval of the final paper for submission: SJ and YJ.

Corresponding author

Correspondence to Youjin Je.

Ethics declarations

Conflict of interest

The authors declare no potential conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jin, S., Je, Y. Nuts and legumes consumption and risk of colorectal cancer: a systematic review and meta-analysis. Eur J Epidemiol 37, 569–585 (2022). https://doi.org/10.1007/s10654-022-00881-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10654-022-00881-6

Keywords

Navigation