Case Control Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Feb 15, 2016; 8(2): 207-214
Published online Feb 15, 2016. doi: 10.4251/wjgo.v8.i2.207
Risk factors for the development of colorectal carcinoma: A case control study from South India
Santhana Krishnan Iswarya, Kariyarath Cheriyath Premarajan, Sitanshu Sekhar Kar, Sathasivam Suresh Kumar, Vikram Kate
Santhana Krishnan Iswarya, Kariyarath Cheriyath Premarajan, Sitanshu Sekhar Kar, Departments of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605006, India
Sathasivam Suresh Kumar, Vikram Kate, Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605006, India
Author contributions: Iswarya SK, Premarajan KC and Kate V designed the research; Iswarya SK collected data; Iswarya SK, Kar SS and Kumar SS analyzed the data and prepared the manuscript; Premarajan KC, Kumar SS and Kate V corrected and revised the manuscript; and Kate V is the guarantor.
Institutional review board statement: The study was reviewed and approved by the JIPMER Institute Human Ethics Committee.
Informed consent statement: All patients gave informed written consent to participate in the study before enrollment.
Conflict-of-interest statement: No benefits in any form have been received or will be received from any party related directly or indirectly to the subject of this article.
Data sharing statement: Technical appendix, statistical code and dataset available with the corresponding author at drvikramkate@gmail.com.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Vikram Kate, MS, FRCS (Eng.), FRCS (Ed.), FRCS (Glasg.), PhD, MAMS, FIMSA, MASCRS, FACS, FACG, MFSTEd, Professor of General and Gastrointestinal Surgery, Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Temple Road, Dhanvantri Nagar, Pondicherry 605006, India. drvikramkate@gmail.com
Telephone: +91-413-2296741 Fax: +91-413-2272066
Received: June 6, 2015
Peer-review started: June 8, 2015
First decision: August 26, 2015
Revised: September 15, 2015
Accepted: November 13, 2015
Article in press: November 13, 2015
Published online: February 15, 2016
Processing time: 240 Days and 21 Hours
Abstract

AIM: To study the association of colorectal carcinoma (CRC) with diet, smoking, alcohol, physical activity, body mass index, family history and diabetes.

METHODS: All consecutive patients with CRC confirmed by histopathology diagnosis were included. Age (± 5 years) and gender matched controls were selected among the patients admitted in surgery ward for various conditions without any co-existing malignancy. Food frequency questionnaire (FFQ) was developed and validated after pretesting by investigator trained in data collection techniques. Cases and controls were interviewed ensuring privacy, in similar interview setting, with same duration of time for both cases and controls without any leading question. Biological variables like family history of CRC in first degree relatives, history of diabetes mellitus; behavioral factors like tobacco use both smoking and smokeless form, alcohol consumption and physical activity were recorded. Dietary details were recorded using a FFQ consisting 29 food items with seven categories. Analysis was done using appropriate statistical methods.

RESULTS: Ninety-four histopathologically confirmed cases of CRC and equal number of age and gender matched controls treated over a period of two years were studied. Age distribution, mean age, male to female ratio, education level and socioeconomic status were similar in cases and controls. Intake of food items was categorized into tertile due to skewed distribution of subjects as per recommended cut off for consumption of food item. On univariate analysis red meat [OR = 7.4 (2.935-18.732)], egg [OR = 5.1 (2.26-11.36)], fish, fried food and oil consumption were found to be risk factors for CRC. On multivariate analysis red meat consumption of more than 2-3 times a month (OR = 5.4; 95%CI: 1.55-19.05) and egg consumption of more than 2-3 times a week (OR = 3.67; 95%CI: 1.23-9.35) were found to be independent risk factors for the development of CRC.

CONCLUSION: Egg and red meat consumption found to be independent risk factors for CRC. Smoking, alcohol, physical activity and family history were not associated with increased risk.

Keywords: Dietary factors; Smoking; Rectal cancer; Red meat; Colorectal malignancy

Core tip: In this hospital based case control study, egg consumption of 2-3 times a week and red meat consumption of 2-3 times a month were found to be independent risk factors for the development of colorectal carcinoma. On the other hand smoking, alcohol, physical activity, diabetes and family history were not associated with an increased risk. There was no conclusive evidence to suggest that fruits and vegetable consumption has protective effect on colorectal carcinoma. Since red meat and egg had an increased risk, the community needs to be educated to reduce the consumption of red meat such as mutton and egg.