Dietary flavonoids are hypothesized to be protective against colorectal cancer, yet findings have been inconsistent. We examined the association of dietary flavonol, flavone and catechin intake with colorectal cancer endpoints within the Netherlands Cohort Study (NLCS). In addition, we explored whether body mass index (BMI) may be an effect modifier of this association. The NLCS includes 120,852 men and women who were 55-69 years and completed a self-administered questionnaire at baseline in 1986. A case-cohort approach was used for data processing and analysis. After 13.3 years, 1,444 male and 1,041 female colorectal cancer cases were available for estimation of hazard ratios and 95% confidence intervals for quintiles of flavonoid intake. After adjustment for potential confounders, no association of total flavonol and flavone intake and total catechin intake with colorectal cancer endpoints was observed. Analyses stratified for BMI showed significant inverse trends in the association of total catechin intake, (1)-catechin intake and (-)-epicatechin intake with rectal cancer in men with a BMI 25 kg/m 2 and in the association of total catechin intake and intake of kaempferol, myricetin and all individual catechins with colorectal cancer, in particular colon cancer, in women with a BMI < 25 kg/m 2 . In conclusion, our findings generally do not support an association of dietary flavonol, flavone and catechin intake with colorectal cancer endpoints. Dietary catechin intake may be associated with a decreased rectal cancer risk in overweight men. Dietary flavonol and catechin intake may be associated with a decreased colorectal cancer risk in normal weight women. '
UICCKey words: cohort studies; flavonoids; colonic neoplasms; rectal neoplasms Colorectal cancer is one of the most common forms of cancer in the Western world. Most colorectal cancers occur as sporadic (i.e., nonhereditary) forms for which main risk factors lie in diet and lifestyle. 1 The modifiable potential of dietary and lifestyle factors offers opportunities for prevention.Flavonoids are polyphenolic compounds present in foods and beverages from plant origin that are thought to possibly protect against cancer. In cell line and animal studies, flavonoids were shown to have an antioxidant effect, to interfere with or eliminate carcinogens, to inhibit cell proliferation, to induce apoptosis and to inhibit angiogenesis. 2,3 Specific to colorectal carcinogenesis, such findings are still accumulating. [4][5][6][7] Whether dietary intake of flavonoids is protective against colorectal cancer in humans cannot be easily extrapolated from cell line and animal findings. In this perspective, epidemiologic studies on the association of flavonoid intake with colorectal cancer risk are important, yet to date these have been limited. Those studies on flavonoid intake and colorectal cancer risk that were conducted yielded inconsistent results. [8][9][10][11][12][13][14][15][16][17] The most studied flavonoid subgroups are flavonols, flavones and catechins (also known...