Dietary Practices, Addictive Behavior and Bowel Habits and Risk of Early Onset Colorectal Cancer: a Case Control Study

Abstract

Background: The abrupt rise of colorectal cancer in developing countries is raising concern in healthcare settings. Studies on assessing relationships with modifiable and non-modifiable risk factors in the Pakistani population have been limited. The present investigation was designed to examine associations of dietary practices, addictive behavior and bowel habits in developing colorectal cancer (CRC) among patients in a low-resource setup. Materials and Methods: An age-gender matched case control study was conducted from October 2011 to July 2015 in Karachi, Pakistan. Cases were from the surgical oncology department of a public sector tertiary care hospital, while their two pair-matched controls were recruited from the general population. A structured questionnaire was used which included questions related to demographic characteristics, family history, dietary patterns, addictive behavior and bowel habits. Results: A family history of cancer was associated with a 2.2 fold higher chance of developing CRC. Weight loss reduced the likelihood 7.6 times. Refraining from a high fat diet and consuming more vegetables showed protective effects for CRC. The risk of CRC was more than twice among smokers and those who consumed Asian specific addictive products as compared to those who avoid using these addictions (ORsmoking: 2.12, 95% CI: 1.08 -4.17, ORpan: 2.92, 95% CI: 1.6 -5.33, ORgutka: 2.13, 95% CI: 1.14 -3.97). Use of NSAID attenuated risk of CRC up to 86% (OR: 0.14, 95% CI: 0.07 -0.31). Conclusions: Most of the findings showed concordance with the literature elucidating protective effects of consuming vegetables and low fat diet while documenting adverse associations with family history, weight loss, constipation and hematochezia. Moreover, this study highlighted Asian specific indigenous addictive products as important factors. Further studies are needed to validate the findings produced by this research.

An Update on the Epidemiology, Molecular Characterization, Diagnosis, and Screening Strategies for Early-Onset Colorectal Cancer

“…Several risk factors have been hypothesized as potential drivers of early-onset CRC based on global temporal trends in these risk factors, with the hypothesis that some of these risk factors exert effects through impacts on colonic inflammation and the gut microbiome. Specifically, lifestyle factors such as a Western diet, 13,14 alcohol, 15 and tobacco 16 are risk factors for early-onset CRC or advanced colorectal neoplasia. Recent work from the Nurses' Health Study found prolonged sedentary television viewing, a surrogate for an inactive lifestyle, was associated with an increased risk of early-onset CRC, particularly for rectal cancer.…”

Cancer in Lahore, Pakistan, 2010–2019: an incidence study

“…In a case–control study conducted in Karachi, a positive association has been suggested between colorectal cancer and a family history of cancer, a high-fat diet, weight loss, constipation, haematochezia, smoking and alcohol consumption. 41 42 Sadly, Pakistan has the second-highest global burden of hepatitis C virus (HCV) infection, with 5% of the population infected (8 million people). 43 Delay in the diagnosis of HCV has resulted in chronic liver disease and hepatocellular carcinoma.…”

Proteomics analysis of colon cancer progression

“…In Asia, choice of unhealthy diet leading to obesity and metabolic syndrome, lack of public awareness on first choice of screening tests, poor public education for prevention, limited resources and support of healthcare authorities is resulting in increased susceptibility to CRC [2]. A positive relationship of family history, high fat diet, smoking and constipation exists among patients with a mean age of 41.47 ± 15.47 [3]. A cohort of 33 studies on over half a million subjects in the Asia-Pacific region concluded that other than body mass index and lack of physical activity (p < 0.05), height was strongly associated with CRC mortality such that an extra 5 cm in height was associated with 10% (95% confidence interval) additional risk, after adjustment for other factors.…”