Adherence to dietary recommendations and colorectal cancer risk: results from two prospective cohort studies

BACKGROUND

Understanding the association between diet and colorectal cancer (CRC) risk is essential to curbing the epidemic of this cancer. This study prospectively evaluated adherence to the Chinese Food Pagoda (CHFP), and two American Dietary Guidelines: the Alternative Healthy Eating Index (AHEI-2010) and the Dietary Approaches to Stop Hypertension (DASH) in association with CRC risk among Chinese adults living in urban Shanghai, China.

METHODS

Participants included 60 161 men and 72 445 women aged 40-74, from two ongoing population-based prospective cohort studies. Associations between dietary guideline compliance scores and CRC risk were evaluated by Cox proportional hazard regression analyses, with age as time metric, and potential confounders were adjusted.

RESULTS

We identified 1670 CRC incidence cases (691 males and 979 females) during an average 8.1 years of follow-up for men and 13.4 years for women. CHFP score was inversely associated with risk of CRC, with hazard ratios (HRs) (95% confidence intervals) of 0.88 (0.77, 1.00), 0.86 (0.75, 0.98) and 0.84 (0.73, 0.96) for the 2nd, 3rd and 4th quartiles versus 1st quartile, respectively (Ptrend= 0.01). The inverse association appeared stronger for rectal cancer, individuals at younger age (< 50 years), with a lower BMI (<25 kg/m2) or without any metabolic conditions at baseline, although no multiplicative interactions were noted. No consistent association pattern was observed for the modified DASH score and the modified AHEI-2010.

CONCLUSIONS

Compliance with the Dietary Guidelines for Chinese was associated with reduced risk of CRC among Chinese adults. To maximize health impacts, dietary recommendations need to be tailored for specific populations.

Dietary selenium intake based on the Chinese Food Pagoda: the influence of dietary patterns on selenium intake

Background

Selenium (Se) is essential for humans, with many critical roles in physiological and pathophysiological processes. Fish, eggs and meats are usually the rich food sources of Se. To improve the nutritional status of population, a new version of balanced dietary pattern in the form of the Chinese Food Pagoda (2016) was proclaimed. This study aimed to evaluate the contribution of this balanced dietary pattern to daily Se intake, and to assess Se intake status of Chinese residents under this Food Pagoda scenario.

Methods

Based on the food consumption recommended in the Food Pagoda, this study collected the data of Se contents in various food composites and estimated dietary Se intakes (EI_TDS) in 12 provinces from the 4th China Total Diet Study. The estimated Se intakes based on the Chinese Food Pagoda (EI_CHFP) in 12 provinces were calculated. EI_TDS and EI_CHFP in various food groups among different regions were compared.

Results

The average EI_CHFP in all regions, within the range of 66.23–145.20 μg/day, was greater than the China recommended nutrient intake (RNI) (60 μg/day). None of the highest EI_CHFP went beyond the tolerable upper intake level of Se (400 μg/day). Animal source foods should be the primary source of daily Se intake according to the EI_CHFP. The average EI_TDS in China (88 μg/day) was in line with its range of EI_CHFP (81.01–124.25 μg/day), but that in half of the regions failed to achieve their lowest EI_CHFP. Significant differences between EI_TDS and EI_CHFP were observed in cereal food, aquatic and dairy products (P < 0.05), among which Se intake from aquatic and dairy products presented seriously insufficient in almost all regions.

Conclusions

The ideal dietary pattern recommended in the Food Pagoda can meet the daily requirements of Chinese population for Se intake to maintain optimal health. From the perspective of the balanced diet and Se-rich sources, the consumption of aquatic products should be increased appropriately to improve the general Se intake level of Chinese population.

Dietary Guidelines for Chinese Residents (2016): comments and comparisons

A high quality diet is believed to play a functional role in promoting the healthy growth of mankind and preventing many kinds of chronic degenerative diseases, including cancer, cardiovascular disease, diabetes, and obesity. Adherence to a high quality diet has been strongly associated with a lower risk of mortality. To help promote healthy lifestyles and physical strength, the Chinese government has produced a new revised version of the Dietary Guidelines for Chinese Residents (2016) and the Chinese Food Pagoda, as guidance for dietary intake among its population. Similarly, the Japanese government has produced the Japanese Food Guide Spinning Top Model, and the US government has recently published revised dietary recommendations in its 2015-2020 eighth edition of Dietary Guidelines for Americans. The evidence from all respective cohort studies involved in producing these guidelines shows a reduced risk of many chronic diseases and mortality if the guidelines are followed. All scientific findings support encouraging the general population to consume a broad variety of food on the basis of nutrient and food intakes in order to prevent deficiency diseases and a surplus of energy and nutrients, and recommend daily physical activity for health promotion.

Do older Chinese people's diets meet the Chinese Food Pagoda guidelines? Results from the China Health and Nutrition Survey 2009

OBJECTIVE

To evaluate dietary intake based on the Chinese Food Pagoda (CFP) and to determine what factors may be associated with adherence to CFP guidelines for older Chinese.

DESIGN

This cross-sectional population-based study used 24 h recall over three consecutive days to assess dietary intake and adherence to CFP among older Chinese participating in the China Health and Nutrition Survey 2009.

SETTING

Nine provinces across four diverse regions (Northeast, East Coast, Central and West).

SUBJECTS

A total of 2745 older Chinese, aged 60-69 years (n 1563) and ≥70 years (n 1182), with dietary data.

RESULTS

None of the participants reached all ten food group recommendations. More than half of the participants exceeded the recommended amount for grains (63%), oil (62·8%) and salt (55·7%). Ten per cent of the participants consumed dairy, while merely 0·5% met the recommended amount. Average Chinese Food Pagoda Score (CFPS) was 3·3 in men and 3·5 in women, far below the maximum possible score of 10. Women had 0·26 higher CFPS than men (P<0·001; 95% CI 0·16, 0·36). People living in medium and high urbanicity areas had significantly higher scores than those living in low urbanicity areas (P<0·001). Also, there were significant differences in CFPS according to gender, BMI, work status, education level and region.

CONCLUSIONS

Few older Chinese are meeting the intake of the various food groups based on the recommendations in the CFP guidelines, thus increasing the risk of malnutrition and non-communicable diseases. Action is needed to increase dissemination and uptake of nutrition education, with interventions targeted at socio-economic regions. Moreover, specific dietary guidelines for older Chinese people should be developed.