Table 1.
Summary of observational studies on the association between ARA and risk of colorectal cancer
| References | Study | Subjects | Exposure Assessment | Colorectal cancer assessment (diagnosis) | Adjustment for potential confounders | Assessment of reporting quality * |
Main findings |
||
|---|---|---|---|---|---|---|---|---|---|
| Intergroup comparison | P or Ptrend | ||||||||
|
Study design: cohort study | |||||||||
|
Exposure assessment: dietary intake | |||||||||
| Murff et al. 2009 [30] |
SWHS, China, 1996-2007, prospective cohort design (7-year biennial follow-up, follow-up rate = 96.7%) |
73,243 women aged 40-70, no prior history of cancer |
SWHS's FFQ, 77 items, previously validated against 24 x 24-HDR |
Self-reported physician diagnosis, combined with annual record linkage with the Shanghai Cancer Registry and Shanghai Vital Statistics database |
Age at baseline, total energy intake, smoking status, alcohol intake, physical activity, energy-adjusted total red meat consumption, menopausal status, use of HRT, multivitamin, aspirin, total n-3 PUFA intake, n-6 to n-3 PUFA ratio |
18 |
Dietary ARA intake, g/day, quintile, median |
RR (95%CI) |
Ptrend |
| Q1: 0.02 |
1.00 |
0.03 |
|||||||
| Q2: 0.03 |
1.20 (0.87-1.64) |
||||||||
| Q3: 0.05 |
1.44 (1.05-1.98) |
||||||||
| Q4: 0.06 |
1.61 (1.17-2.23) |
||||||||
| Q5: 0.09 |
1.39 (0.97-1.99) |
||||||||
| Lin et al. 2004 [28] |
WHS, USA, 1993–2003, prospective cohort design nested randomized, double-blind, placebo-controlled 2 × 2 factorial aspirin and vitamin A trial (average 8.7 years follow-up) |
37,547 female health professionals aged ≥45, free of heart disease and cancer except NMSC |
FFQ, 131 items, validated against 2 x 7-day WR |
Self-reported physician diagnosis, reviewed and confirmed medical diagnoses |
Age, treatment assignment, BMI, family history of CRC, colorectal polyps, physical activity, smoking status, alcohol intake, use of HRT, total energy intake |
15 |
Dietary ARA intake, %energy, quintile, median |
RR (95%CI) |
Ptrend |
| Q1: 0.04 |
1.00 |
0.55 |
|||||||
| Q2: 0.06 |
0.86 (0.57-1.32) |
||||||||
| Q3: 0.07 |
0.84 (0.55-1.28) |
||||||||
| Q4: 0.09 |
0.73 (0.47-1.14) |
||||||||
| Q5: 0.12 |
0.90 (0.59-1.36) |
||||||||
|
Study design: nested case-control study | |||||||||
|
Exposure assessment: blood ARA level | |||||||||
| Hall et al. 2007 [34] |
PHS, USA, 1982-1995, nested case-control design within a randomized, double-blind, placebo-controlled factorial aspirin and beta-carotene trial (average 5 and 7 years follow-up) |
178 CRC patients, 282 controls, male physicians without history of cancer aged 40-84 years at baseline, 1 case matched with 1-2 controls by age, smoking status |
Whole blood fatty acids, GC analysis blinded to case-control status at a time, precision indicated |
Self-report, combined with review of medical records |
None |
23 |
ARA composition%, geometric mean(95%CI) Case: |
ARA composition%, geometric mean(95%CI) Control: |
P |
| 9.77(9.57-9.99) |
9.93(9.77-10.10) |
Not significant |
|||||||
| Kojima et al. 2005 [35] |
JACC Study, Japan, 1988-1997, nested case-control design (7 years follow-up) |
169 primary CRC patients, 481 controls without previous history of cancer, aged 40-79 years at baseline, 1 case matched with 2-3 controls by age, sex, resident area |
Serum fatty acids, GC analysis blinded to case-control status, precision not indicated |
Population-based cancer registries, supplemented by death certificates |
Age at completing final education, family history of CRC, BMI, smoking status, alcohol intake, intake of green leafy vegetables, physical activity |
23 |
ARA composition, weight % of total serum lipids, quartile |
OR (95%CI) |
P trend |
| Men: |
Men: |
Men: |
|||||||
| Q1: <3.71 |
1.00 |
0.99 |
|||||||
| Q2: 3.71-4.619 |
1.24 (0.55-2.78) |
||||||||
| Q3: 4.62-5.269 |
0.79 (0.32-1.96) |
||||||||
| Q4: ≥5.27 |
1.16 (0.49-2.75) |
||||||||
| Women: |
Women: |
Women: |
|||||||
| Q1: <4.20 |
1.00 |
0.40 |
|||||||
| Q2: 4.20-4.879 |
0.67 (0.31-1.46) |
||||||||
| Q3: 4.88-5.634 |
0.49 (0.22-1.10) |
||||||||
| Q4: ≥5.635 |
0.65 (0.30-1.44) |
||||||||
|
Study design: case-control study (temporal relationship among exposure and outcome is demonstrated) | |||||||||
|
Exposure assessment: dietary intake | |||||||||
| Theodoratou et al. 2007 [36] |
Survey, UK, 1999-2006, case-control design |
1,455 primary CRC patients aged 16-79, 1,455 controls (eligibility criteria not shown), matched by age, sex, resident area |
Scotish FFQ, 150 items, validated against 4-day WR, (response rate = case 82%, control 97%) |
Not shown |
Family history of CRC, total energy intake, total fiber intake, alcohol intake, NSAIDs use, smoking status, BMI, physical activity, total fatty acid intake |
20 |
Dietary ARA intake, mg/day, quartile |
OR (95%CI) |
Ptrend |
| Q1: 0-5.82 |
1.00 |
0.163 |
|||||||
| Q2: 5.83-8.40 |
1.09 (0.87-1.37) |
||||||||
| Q3: 8.41-11.34 |
0.79 (0.63-1.01) |
||||||||
| Q4:≥11.35 |
0.93 (0.72-1.19) |
||||||||
| Nkondjock et al. 2003 [31] |
Survey, Canada, 1989-1993, case-control design |
402 CRC patients aged 35-79, 688 controls, matched by age, language, place of residence |
FFQ, 132 items, validated against 7-day Food Record |
Histological diagnosis |
Age, BMI, family history of CRC, marital status, physical activity |
20 |
Dietary ARA intake, g/day, quartile |
OR (95% CI) |
Ptrend |
| Q1:<0.06 |
1.00 |
0.001 |
|||||||
| Q2:0.06-0.09 |
1.24 (0.84-1.84) |
||||||||
| Q3:0.10-0.14 |
1.64 (1.12-2.40) |
||||||||
| Q4:>0.14 |
2.11 (1.47-3.06) |
||||||||
| Slattery et al. 1997 [37] |
Survey, USA, 1991-1994 |
1993 CRC patients aged 30-79, 2410 controls without history of CRC (population characteristic partially not shown), matched by age, sex, resident state |
CARDIA Diet History Questionnaire, validated against 7 x 24-HDR |
Cancer registries |
Total energy intake, age at selection, BMI, family history of CRC, physical activity, dietary cholesterol, calcium, fiber, NSAIDs use |
19 |
Dietary ARA intake, g/MJ, quintile |
OR (95%CI) |
Ptrend |
| Men: |
Men: |
Men: |
|||||||
| Q1:<0.17 |
1.00 |
Not shown |
|||||||
| Q2:0.17-0.22 |
1.25 (0.95-1.65) |
||||||||
| Q3:0.23-0.26 |
1.08 (0.81-1.44) |
||||||||
| Q4:0.27-0.33 |
1.37 (1.03-1.83) |
||||||||
| Q5:>0.33 |
1.17 (0.85-1.61) |
||||||||
| Women: |
Women: |
Women: |
|||||||
| Q1:<0.039 |
1.00 |
Not shown |
|||||||
| Q2:0.039-0.051 |
0.99 (0.73-1.33) |
||||||||
| Q3:0.052-0.063 |
1.15 (0.86-1.55) |
||||||||
| Q4:0.064-0.077 |
0.98 (0.72-1.35) |
||||||||
| Q5:>0.077 |
0.98 (0.70-1.37) |
||||||||
|
Exposure assessment: blood ARA level | |||||||||
| Kuriki et al. 2006 [38] |
Survey, Japan, 2002-2004, case-control design |
74 CRC patients, 221 controls, aged 20-80 without history of cancer or current diseases, 1 case matched with 3 controls by age, sex, season of blood collection |
Erythrocyte phospholipids, GC analysis blinded to case-control status, precision indicated |
Histological diagnosis |
BMI, habitual exercise, alcohol intake, smoking status, green-yellow vegetable intake, family history of CRC |
22 |
ARA composition, mol%, tertile |
OR (95% CI) |
Ptrend |
| T1: <8.625 |
1.00 |
<0.05 |
|||||||
| T2: 8.625-10.178 |
0.91 (0.48-1.73) |
||||||||
| T3: >10.178 |
0.42 (0.18-0.95) |
||||||||
|
Study design: case-control study (temporal relationship among exposure and outcome is unclear) | |||||||||
|
Exposure assessment: dietary intake | |||||||||
| Busstra et al. 2003 [39] |
Survey, Netherlands, 1995-1998, case-control design |
52 CRC patients, 57 controls, aged under 75 without history of CRC, colon resection, polyposis coli, inflammatory bowel disease, included subjects with familial HNPCC, matching not indicated |
FFQ developed for the Dutch cohorts of the EPIC study, 178 items, validated against 12 x 24-HDR |
Histological diagnosis |
Age, total energy intake, sex, familial background of HNPCC |
13 |
Dietary ARA intake, g/day, tertile |
OR (95% CI) |
Ptrend |
| T1: <0.02 |
1.0 |
0.37 |
|||||||
| T2: 0.02-0.04 |
1.3 (0.4-3.9) |
||||||||
| T3: ≥0.04 |
0.6 (0.2-1.8) |
||||||||
|
Exposure assessment: blood ARA level | |||||||||
| Ghadimi et al. 2008 [40] |
Survey, Japan, 1997-2003, case-control design |
203 CRA patients, 179 controls (negative faecal occult blood test), matching not indicated |
Serum fatty acids (fasting blood), GC analysis, precision indicated |
Histological diagnosis |
Age, BMI, family history of CRA or CRC, history of diabetes, smoking status, alcohol intake, physical activity, season of data collection |
18 |
ARA concentration, mg/dl, quartile |
OR (95%CI) |
Ptrend |
| Men: |
Men: |
Men: |
|||||||
| Q1:<17.40 |
1.00 |
0.104 |
|||||||
| Q2:17.40-19.90 |
0.60 (0.21-1.68) |
Women: |
|||||||
| Q3:19.91-22.50 |
0.58 (0.21-1.60) |
0.001 |
|||||||
| Q4:>22.50 |
0.52 (0.19-1.42) |
||||||||
| Women: |
Women: |
Women: |
|||||||
| Q1:<18.05 |
1.00 |
0.001 |
|||||||
| Q2:18.05-20.50 |
0.49 (0.19-1.24) |
||||||||
| Q3:20.51-22.38 |
0.11 (0.28-0.45) |
||||||||
| Q4:>22.38 |
0.11 (0.03-0.43) |
||||||||
| Baró et al. 1998 [41] |
Survey, Spain |
17 CRC patients aged 35-82, 12 controls aged 33-81 with no malignant diseases, matched by age, resident area |
Plasma and erythrocyte fatty acids (fasting blood), GC analysis, precision not indicated |
Not shown |
None |
12 |
Plasma ARA concentration, mg/dl, mean(SEM) |
Plasma ARA concentration, mg/dl, mean(SEM) |
P |
| Case: |
Control: |
Plasma: |
|||||||
| 18.59(1.31) |
21.31(1.22) |
Not significant |
|||||||
| Erythrocyte ARA composition%, mean(SEM) |
Erythrocyte ARA composition%, mean(SEM) |
Erythrocyte: |
|||||||
| Case: |
Control: |
Not significant |
|||||||
| 14.61(0.24) |
13.50(0.40) |
||||||||
| Neoptolemos et al. 1990 [42] |
Survey, UK |
32 CRC patients, 42 controls admitted for elective operations for benign without DM, metabolic disorders, blood transfusions, matched by age, sex, admittance period |
Erythrocyte phospholipids (fasting blood), GC analysis, precision not indicated |
Not shown |
None |
13 |
ARA composition%, median(range) |
ARA composition%, median(range) |
P |
| Case: |
Control: |
|
|||||||
| 20.7(12.8-48.9) |
18.0(0.0-47.3) |
Not significant |
|||||||
| Neoptolemos et al. 1988 [43] |
Survey, UK |
49 CRC patients aged 49-92, 49 controls with benign diaseases aged 48-90, matched by age, sex |
Erythrocyte phospholipids (fasting blood), GC analysis, precision not indicated |
Not shown |
None |
12 |
ARA composition%, median(range) |
ARA composition%, median(range) |
P |
| Case: |
Control: |
|
|||||||
| 21.8 (15.3-28.4) |
23.5 (13.8-32.8) |
0.043 |
|||||||
|
Exposure assessment: tissue ARA level | |||||||||
| Busstra et al. 2003 [39] |
Survey, Netherlands, 1995-1998, case-control design |
52 CRC patients, 57 controls, aged under 75 without history of CRC, colon resection, polyposis coli, inflammatory bowel disease, included subjects with familial HNPCC, matching not indicated |
Buttock adipose tissue fatty acids, GC analysis, precision not indicated |
Histological diagnosis |
Age, total energy intake, sex, familial background of HNPCC |
13 |
ARA composition mass%, tertile |
OR(95%CI) |
Ptrend |
| T1: <0.35 |
1.0 |
0.42 |
|||||||
| T2: 0.35-0.45 |
2.6 (0.7-8.5) |
||||||||
| T3: ≥0.45 |
1.7 (0.5-5.8) |
||||||||
|
Study design: cross-sectional study | |||||||||
|
Exposure assessment: blood ARA level | |||||||||
| Almendingen et al. 2006 [44] |
Survey, Norway |
38 FAP patients aged 24-70 (all colectomized), 160 healthy controls aged 21-66 |
Serum phospholipids (fasting blood), GC analysis, precision indicated |
Diagnosis by endoscopy and histology |
None |
17 |
ARA composition weight%, mean(SD) |
ARA composition weight%, mean(SD) |
P |
| Case: |
Control: |
|
|||||||
| 10.96(1.85) |
7.26(1.51) |
≤0.0001 |
|||||||
| Fernández-Bañares et al. 1996 [45] |
Survey, Spain |
22 colonic cancer patients, 27 colonic adenoma patients, 12 controls with benign diseases, no significant differences in sex and age |
Plasma phospholipids (fasting blood), GC analysis, precision not indicated |
Total fibreoptic colonoscopy |
None |
13 |
ARA composition%, mean(SEM) Carcinoma: |
ARA composition%, mean(SEM) Controls: |
P |
| 9.38(0.37) |
10.2(0.32) |
Not significant |
|||||||
| Adenoma: |
|||||||||
| 9.95(0.49) | |||||||||
| Hietanen et al. 1994 [46] |
Survey, UK, cross-sectional design |
20 colon cancer patients aged 38-84, controls, matched by age, sex, smoking status |
Erythrocyte phospholipids (fasting blood), GC analysis, precision not indicated |
Not shown |
None |
8 |
ARA concentration, mg/dl, mean(SD) |
ARA concentration, mg/dl, mean(SD) |
P |
| Case: |
Control: |
|
|||||||
| 18.5(0.6) |
20.2(0.5) |
<0.05 |
|||||||
|
Exposure assessment: tissue ARA level | |||||||||
| Fernández-Bañares et al. 1996 [45] |
Survey, Spain |
15 colonic cancer patients, 21 colonic adenoma patients, 8 controls with benign diseases |
Normal colon mucosa fatty acids, GC analysis, precision not indicated |
Total fibreoptic colonoscopy |
None |
13 |
ARA composition%, mean(SEM) Carcinoma: |
ARA composition%, mean (SEM) Controls: |
P |
| 10.9(0.57) |
11.4 (0.88) |
Not significant |
|||||||
| Adenoma: |
|
||||||||
| 12.3(0.55) |
|
||||||||
| Berry et al. 1986 [47] | Survey, Israel, 1982-1985 | 155 consecutive colonoscopies (53 carcinoma, 34 benign neoplastic polyps, 68 controls) | Buttock adipose tissue fatty acids, GC analysis, precision indicated | Histological diagnosis | None | 13 | ARA composition%, mean (SD) Carcinoma: |
ARA composition%, mean (SD) Controls: |
P |
| 0.54 (0.2) |
0.55 (0.2) |
Not significant | |||||||
| Benign neoplastic polyps: |
|||||||||
| 0.52 (0.2) | |||||||||
24-HDR 24-h dietary recall, ARA Arachidonic acid, BMI Body mass index, CRA Colorectal adenoma, CRC Colorectal cancer, DM Diabetes mellitus, FAP Familial adenomatous polyposis, FFQ Food frequency questionnaire, GC Gas chromatography, HNPCC Hereditary non-polyposis colorectal cancer, HRT Hormone replacement therapy, JACC Japan Collaborative Cohort, NMSC Nonmelanoma skin cancer, NSAIDs Nonsteroidal antiinflammatory drugs, OR Odds ratio, PHS Physician's health study, RR Relative risk, SWHS Shanghai Women's Health Study, UK United Kingdom, USA United States of America, WHS Women's Health Study, WR Weighed dietary record.
*Result of the critical evaluation carried out using the STROBE tool.