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For example, the NIH-AARP DHS found an inverse association between the risk of proximal colon cancer with both caffeinated coffee and decaffeinated coffee, but the subjects who drank decaffeinated coffee happened to consume less alcohol, fewer calories, less red meat, and more fruit and vegetables.

However, they also exercised less and smoked more Does cancer occur because of genes, environmental factors, or merely bad luck ? For colon cancer, Although one could argue that this was only a statistical analysis and that the model might be too ideal, this randomness might explain the heterogeneity and inconsistency among studies or even individuals.

In the current review, we focused mainly on large prospective studies and meta-analyses. In addition, all studies are subject to design bias and measurement errors to a certain degree. Therefore, results from different studies should be carefully interpreted and compared. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript.

The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Surg Oncol Clin N Am. Author manuscript; available in PMC Apr 1. Pan Pan , PH. Author information Copyright and License information Disclaimer. Corresponding author. Copyright notice. Introduction Cancer is the second leading cause of death worldwide, having caused 8. Materials and Methods We conducted a PubMed search for human studies published up to , using the key words: colorectal cancer, diet, nutrition, and epidemiology.

Open in a separate window. Table 2 Characteristics of studies of fish and CRC. Fiber from whole grains and cereals Whole-grains and cereals are major sources of dietary fiber, and accumulating evidence suggests that high fiber intake from whole grains and cereals associates with a lower risk of CRC. Table 3 Characteristics of studies of fiber and CRC. Table 4 Characteristics of studies of fruit and vegetables and CRC. Vitamins and minerals Vitamins and minerals are important micronutrients that support our bodies and benefit our health.

Table 5 Characteristics of studies of vitamins and minerals and CRC. Coffee and tea Although coffee and tea are popular worldwide, only a few studies have investigated their effects on the risk of CRC. Colorectal cancer has a higher incidence in Oceania and Europe, and a lower incidence in Africa and Asia. Colorectal cancer is largely preventable by adapting a healthy lifestyle including healthy diet, adequate physical activity, and avoiding obesity.

Other foods, such as fish, vitamins and minerals, and coffee, might have potential effects on our risk of developing colorectal cancer. Footnotes Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication.

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Obes Rev. Red meat consumption: an overview of the risks and benefits. Meat Sci. Diet and supplements and their impact on colorectal cancer. J Gastrointest Oncol. Baena R, Salinas P. Diet and colorectal cancer. The impact of red and processed meat consumption on cancer and other health outcomes: Epidemiological evidences. Food and chemical toxicology: an international journal published for the British Industrial Biological Research Association.

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J Natl Compr Canc Netw. Red meat and cancer risk in a network of case-control studies focusing on cooking practices. Ann Oncol. A prospective study of red and processed meat intake in relation to cancer risk. PLoS Med. A large prospective study of meat consumption and colorectal cancer risk: an investigation of potential mechanisms underlying this association.

Cancer Res. Meat consumption and the risk of incident distal colon and rectal adenoma. Br J Cancer. PLoS One. Meat, fish, and colorectal cancer risk: the European Prospective Investigation into cancer and nutrition. J Natl Cancer Inst. Red meat intake may increase the risk of colon cancer in Japanese, a population with relatively low red meat consumption. Asia Pacific journal of clinical nutrition. Nutr Cancer. Associations between red meat and risks for colon and rectal cancer depend on the type of red meat consumed.

The Journal of nutrition. Diet and risk of colorectal cancer in a cohort of Finnish men. Red meat, chicken, and fish consumption and risk of colorectal cancer. Cancer Epidemiol Biomarkers Prev. Red meat consumption and risk of cancers of the proximal colon, distal colon and rectum: the Swedish Mammography Cohort.

Salt, processed meat and the risk of cancer. Meat and fish consumption and cancer in Canada. Fish consumption and risk of gastrointestinal cancers: a meta-analysis of cohort studies.

World J Gastroenterol. Fish consumption and colorectal cancer risk in humans: a systematic review and meta-analysis. Am J Med. A year prospective study of fish, n-3 fatty acid intake, and colorectal cancer risk in men. Dietary intake of fish, omega-3 and omega-6 fatty acids and risk of colorectal cancer: A prospective study in U. Prospective investigation of poultry and fish intake in relation to cancer risk. Cancer Prev Res Phila ; 4 11 — Diet and colorectal cancer mortality: results from the Japan Collaborative Cohort Study.

Fish consumption and the risk of colorectal cancer: the Ohsaki Cohort Study. Nutrition, lifestyle and colorectal cancer incidence: a prospective investigation of vegetarians and non-vegetarians in the United Kingdom. Br J Nutr. Cancer incidence in a cohort with high fish consumption. A prospective study of dietary polyunsaturated fatty acids and colorectal cancer risk in Chinese women.

Marine polyunsaturated fatty acids and cancer therapy. Burkitt DP. Related disease—related cause? Impact of diet in shaping gut microbiota revealed by a comparative study in children from Europe and rural Africa. The role of pH in determining the species composition of the human colonic microbiota. Environ Microbiol. Cancer Prev Res Phila ; 8 8 — Dietary intake of fiber and decreased risk of cancers of the colon and rectum: evidence from the combined analysis of 13 case-control studies.

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Ann Intern Med. Dietary intake of B vitamins and methionine and colorectal cancer risk. Dietary folate, methionine, riboflavin, and vitamin B-6 and risk of sporadic colorectal cancer.

Zinc deficiency causes stunted growth, poor appetite, dermatitis, alopecia, endocrine dysfunction, and impaired immunity [ ]. Zinc deficiency is not any more commonly seen in vegetarians than in non-vegetarians [ ].

Zinc intake and serum levels for adolescent and adult vegetarians in developed countries are the same or slightly lower than for omnivores, but within the normal range [ , , , , ]. In developing countries, vegans and vegetarians are more likely to show marginal zinc status [ ]. The bioavailability of zinc from plant foods may be reduced.

However, zinc absorption and retention can be regulated by homeostatic mechanisms, adapting to lower intakes by reducing losses and increasing absorption [ ]. During periods of high demand pregnancy, infancy , absorption becomes more efficient [ ]. Phytates in cereals and legumes lower absorption of zinc, but leavening, soaking, fermenting, or sprouting reduces the phytate levels and makes zinc more bioavailable [ ]. Sulfur-containing amino acids and organic acids in a variety of plant foods will also enhance zinc absorption [ , ].

Vegetarian food sources for zinc include nuts, seeds, wholegrains, legumes, tofu, tempeh, and dairy products [ ]. The use of supplements and fortified foods such as fortified breakfast cereals may be necessary for very restricted vegan diets [ , ]. Iodine is essential for thyroid hormones, which regulate metabolic activity.

Iodine is especially important in pregnancy for fetal development and during early childhood. Iodine deficiency in childhood can prevent children from attaining their full physical potential and intellectual capacity [ ].

Major dietary sources of iodine include iodized salt, seafood, and dairy products [ ]. The iodine content of seaweeds and dairy products can vary widely [ , ]. Sea salt, Himalayan salt, and the salt used in processed foods typically do not contain iodine [ ].

Although foods such as soybeans, cruciferous vegetables, and sweet potatoes contain natural substances that interfere with iodine uptake by the thyroid, these foods have not been associated with thyroid dysfunction in healthy people, provided iodine intake is adequate [ , ]. Vitamin B12 is required for red blood cell formation, DNA synthesis, homocysteine metabolism, and the myelination and function of the central nervous system [ ]. Vitamin B12 deficiency is not uncommon among the elderly and unsupplemented vegans.

It can manifest itself with consequential hematological and neurological changes. Typically, the mean dietary intake of vitamin B12 of vegans falls well below the DRI, while that of lacto-ovo-vegetarians may be marginal, depending on the use of dairy products [ , , ].

Vegans must obtain their vitamin B12 either from regular use of vitamin Bfortified foods, such as fortified plant-based beverages, fortified breakfast cereals, fortified vegetarian meat analogs, or from a regular vitamin B12 supplement.

Unfortified plant foods such as fermented soy foods, leafy vegetables, seaweeds, mushrooms, and algae including spirulina do not contain significant amounts of active vitamin B12 to provide daily needs [ ]. Furthermore, a number of medications can impair the absorption or utilization of B Vitamin B12 appears to be a cofactor involved in the production of nitric oxide [ ], which would have important implications for vascular and immune health.

The ileal receptors become saturated with 1. Vitamin B12 is well absorbed from either sub-lingual or chewable tablets. While the methylcobalamin supplement is touted as the more effective form of B12, its bioavailability is not superior to that of cyanocobalamin, which is the more stable and most commonly used form of B12 in fortified foods and many supplements [ , ]. A deficiency of vitamin B12 may take years to develop in adults, as most of the B12 secreted into the gut via the bile gets reabsorbed, thus conserving the body stores [ ].

Therefore, a regular consumption of adequate B12 is important to avoid a sub-clinical deficiency that can go undetected for years. An elevated serum methylmalonic acid MMA level is a reliable indicator of B12 deficiency [ ], while the serum B12 level is an insensitive indicator of B12 status.

As a good preventative measure, all vegans should annually check their B12 status. Vitamin D facilitates calcium absorption from the gut, regulates bone mineralization, cell growth, and differentiation. Its other roles include reduction of inflammation and modulation of neuromuscular and immune function [ ]. Because cutaneous production of vitamin D from sunlight exposure is not adequate especially in the elderly, dark-skinned individuals, and heavy sunscreen users to meet nutrition needs in populations living in high latitudes, especially during the winter months, regular food and supplement sources are necessary.

Foods contain limited amounts of vitamin D, so supplements are often needed to meet needs. One study found no significant difference in serum 25 OH D levels between vegetarians and non-vegetarians. Factors such as vitamin D supplementation, degree of skin pigmentation, and amount of sun exposure had a greater influence on serum 25 OH D levels than did diet [ ]. Vitamin D intake by vegans tends to be substantially below that of lacto-ovo-vegetarians and omnivores [ ].

Low serum 25 OH D levels and reduced bone mass have been reported in vegans living in high latitudes who were not using vitamin D-fortified foods or supplements [ , ]. Fortified plant-based beverages, fortified orange juice, ready-to-eat breakfast cereals, and fortified margarines provide vitamin D for vegetarians.

Modest levels of vitamin D are also obtained from mushrooms that have been exposed to ultraviolet light under controlled conditions [ ]. Lacto-ovo-vegetarians also obtain vitamin D from fortified dairy products and eggs. Depending on sunlight exposure and dietary intake, supplements may be needed. For low daily doses, vitamin D2 appears to be as effective as vitamin D3 in maintaining circulating levels of serum 25 OH D [ ]. When given as a single large dose, vitamin D2 appears to be less effective than vitamin D3 for improving the vitamin D status [ ].

With appropriate food and supplement choices, a vegetarian diet can be consistent with having an adequate vitamin D status and supporting a healthy BMD bone mineral density [ ]. Omega-3 fatty acids n-3 are associated with favorable cardiometabolic status [ ]. Normally, only small amounts of ALA are converted to the longer-chain eicosapentaenoic acid EPA , and to a less degree DHA, particularly if linoleic acid intake is high [ , ].

Conversion of ALA is also affected by health status, age, dietary composition, and gender [ ]. Most studies indicate that plasma, serum, erythrocytes, adipose, and platelet levels of EPA and DHA are lower in vegetarians than omnivores [ ], yet there is no evidence of adverse effects on heart health or cognitive function in vegetarians [ , ]. EPA has antithrombotic properties and confers cardiovascular protection [ , ], while DHA has been linked to eye and brain development and is important for ongoing visual, cognitive, cardiovascular health [ , ].

Omega-3 fatty acids may also help regulate gut microbiota and immunity and reduce the risk of inflammatory diseases [ , , ]. The richest sources of ALA include flaxseed, hemp seed, walnuts, chia seeds, and their oils, with smaller amounts present in canola and soy oils, and green leafy vegetables [ ].

To date, an adequate intake of ALA has been specified as 1. Improving the DHA status of an individual is generally regarded as desirable. For the vegetarian, a regular use of an algal DHA supplement would be an effective way to increase serum DHA levels [ , ]. The critical period of pregnancy and lactation requires a higher n-3 status particularly DHA [ , , ].

Pregnant and breastfeeding women, and those at greater risk for poor ALA conversion, such as people with diabetes, older people, and premature infants, are most likely to benefit from DHA supplements derived from micro-algae [ , ]. Individuals following vegetarian diets generally consume more than adequate protein, particularly in western countries, although intakes are typically lower than those of omnivores [ ]. Furthermore, as long as a variety of protein-rich foods are consumed, vegetarian diets are able to provide all of the indispensable amino acids [ , ].

While there is no need for different protein foods to be combined in one meal, a variety of plant foods should be included each day [ ]. Most plant foods contain some protein, with the best sources being legumes, soy foods including fortified soy milk, tofu, and tempeh , nuts, and seeds.

Grains and vegetables also contain protein but in smaller amounts. While the lower protein intake and quality of protein in a vegetarian diet is often cited as a concern, there is increasing evidence for the health benefits of consuming protein from plant sources rather than animal sources, and this may be one of the reasons why vegetarians have a lower risk of obesity and chronic diseases [ ].

Those consuming omnivorous diets in western countries tend to get 1. Significant health benefits are associated with vegetarian, including vegan, diets. Plant-based diets, even if not completely vegetarian, also offer significant health benefits. Health professionals should discuss the benefits of vegetarian and near-vegetarian diets with their clients and provide supportive, reliable, evidence-based information and resources.

If the practitioner is unfamiliar with vegetarian nutrition, clients should be referred to other health professionals with expertise in this area, such as registered dietitians.

Health professionals are ethically obligated to respect vegetarian dietary patterns and to provide information so that clients are aware of their nutritional needs, sources of nutrients, and any dietary modifications needed to meet their individual situation. Health professionals who work with vegetarians and those interested in vegetarian diets should be familiar with current research on vegetarian nutrition as well as with vegetarian foods and food preparation.

There are a number of excellent books and other resources available for health professionals to acquaint themselves with evidence-based data [ , , , ]. Individualized counseling materials should be developed that feature vegetarian foods. Some traditional cultures have plant-based traditions.

When working with clients from these cultures, professionals should focus on the retention of healthy traditional practices, with modification of other practices to promote more healthful diets instead of promoting the eating patterns of the dominant culture [ ].

It is incumbent on any health professional providing counsel regarding dietary choices to remember it is not what a diet is called, but what foods an individual consumes on a regular basis that determines the adequacy of a diet.

Plant-based diets continue to grow in popularity. Currently, there is a vibrant interest in the sustainability of diets and a growing awareness of the need to focus on both human health and the health of the planet in formulating dietary guidelines. Plant-based diets are more sustainable than diets based on animal products, since they use fewer natural resources and produce fewer GHG emissions.

Vegetarian and vegan diets provide protection against a number of common chronic diseases, such as CVD, obesity, T2D, and certain types of cancer. The consumption of a plant-based diet rich in fiber and phytochemicals not only provides disease-preventing benefits but also has a substantial impact on the composition and function of the gut microbiome, which in turn influences overall health.

Both a vegetarian and vegan diet are appropriate for all stages of the life cycle, including pregnancy and lactation, all stages of childhood, the elderly, and for athletes. When appropriately planned, a plant-based diet consisting substantially of minimally processed foods can be nutritionally adequate. Special attention should be paid to calcium, iron, vitamin D, and vitamin B A deficiency may be exacerbated when supplements are not utilized and when food choices are limited or self-restricting.

Health professionals who work with vegetarians and those interested in vegetarian diets should be familiar with current research on vegetarian nutrition and be able to provide information so that clients are aware of their nutritional needs, sources of nutrients, and any dietary modifications needed to meet their individual situation.

Conceptualization, W. All authors have read and agreed to the published version of the manuscript. Published online Nov Winston J. Miles , 1, 5 Angela V. Saunders , 6 Ella H. Haddad , 1 Celine E. Find articles by Winston J. Fayth L. Angela V. Ella H. Find articles by Ella H. Celine E. Find articles by Celine E. Find articles by Patricia Johnston. Stephen Ives, Academic Editor.

Author information Article notes Copyright and License information Disclaimer. Received Oct 27; Accepted Nov Abstract Plant-based diets, defined here as including both vegan and lacto-ovo-vegetarian diets, are growing in popularity throughout the Western world for various reasons, including concerns for human health and the health of the planet. Keywords: plant-based diets, vegetarian, vegan, sustainability, microbiome, vitamin B12, CV disease, diabetes, bone health, life cycle.

Introduction Interest in plant-based diets has soared in the past decade for a myriad of reasons [ 1 ]. Environmental Sustainability of Vegetarian Diets The production of different foods can have very diverse environmental impacts.

Plant-Based Diets and Chronic Diseases 4. Type 2 Diabetes Observational studies in a variety of populations have consistently shown that compared to non-vegetarians, those following a vegetarian or vegan diet have a significantly lower risk of T2D [ 41 , 49 , 50 , 51 , 52 , 53 ].

Cancer Each of the plant food-groups has shown that they possess chemo-protective properties. Bone Health Healthy bones require a variety of essential nutrients and healthy lifestyle practices to maximize peak bone mass during growth and minimize bone loss later in life [ ]. Eating Disorders Previous use of a vegetarian or vegan diet apparently does not increase the risk of developing any eating disorder, such as anorexia nervosa, bulimia nervosa, and binge eating disorder [ , ].

Plant-Based Diets and the Gut Microbiome The human gut microbiota is a highly complex community of some 10 14 microorganisms. Plant-Based Diets and the Life Cycle Vegetarian, including vegan, diets can satisfy the nutritional requirements of all stages of the life cycle.

Pregnancy and Lactation Vegetarian diets can effectively meet energy and nutrient needs in pregnancy and lactation [ , ]. Infants, Children, and Adolescents Vegetarian, including vegan, diets that are nutritionally adequate are appropriate for use in infancy, childhood, and adolescence and support normal growth [ , , ]. Older Adults Older adults generally have decreased energy requirements, although nutrient requirements are often similar to, or higher than, those of younger adults.

Athletic Performance Vegetarian diets can meet the needs of athletes at all levels, from recreational to elite athletes [ , ], and have been followed by athletes throughout history [ ]. Nutrients of Concern in a Plant-Based Diet 9. Calcium In addition to its role in bone mineralization, calcium is required for blood clotting, muscle function, nerve transmission, hormone release, intracellular signaling, and regulating key enzymes [ ].

Iron In addition to its ability to transfer oxygen by means of hemoglobin and myoglobin, iron functions as a co-factor for many important enzymes such as myeloperoxidase, important for immune function and has a role in thyroid hormone synthesis and amino acid metabolism [ ]. Zinc Zinc acts as a coenzyme for multiple enzymes involved with growth, immunity, cognitive function, bone function, and regulation of gene expression [ , ].

Iodine Iodine is essential for thyroid hormones, which regulate metabolic activity. Vitamin B12 Vitamin B12 is required for red blood cell formation, DNA synthesis, homocysteine metabolism, and the myelination and function of the central nervous system [ ]. Vitamin D Vitamin D facilitates calcium absorption from the gut, regulates bone mineralization, cell growth, and differentiation. Omega-3 Fatty Acids Omega-3 fatty acids n-3 are associated with favorable cardiometabolic status [ ].

Protein Individuals following vegetarian diets generally consume more than adequate protein, particularly in western countries, although intakes are typically lower than those of omnivores [ ].

Guidelines for Health Professionals Significant health benefits are associated with vegetarian, including vegan, diets. Conclusions Plant-based diets continue to grow in popularity. Acknowledgments U. Author Contributions Conceptualization, W. Funding This research received no external funding. Institutional Review Board Statement Not applicable. Informed Consent Statement Not applicable. Data Availability Statement Not applicable. Conflicts of Interest The authors declare no conflict of interest.

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ISME J. Ferrocino I. Matijasic B. Association of dietary type with fecal microbiota in vegetarians and omnivores in Slovenia. Fat, fibre and cancer risk in African Americans and rural Africans. Dietary fiber intervention on gut microbiota composition in healthy adults: A systematic review and meta-analysis. Cuevas-Tena M. Lipid Sci. Dingeo G. Phytochemicals as modifiers of gut microbial communities.

Food Funct. Wiese M. Azad M. Muralidharan J. David L. Diet rapidly and reproducibly alters the human gut microbiome. Klimenko N. Lin A. Distinct distal gut microbiome diversity and composition in healthy children from Bangladesh and the United States.

Ruengsomwong S. Zimmer J. A vegan or vegetarian diet substantially alters the human colonic faecal microbiota. Linking long-term dietary patterns with gut microbial enterotypes. Franco-de-Moraes A. Worse inflammatory profile in omnivores than in vegetarians associates with the gut microbiota composition. De Filippo C. Diet, Environments, and Gut Microbiota. Obregon-Tito A. Subsistence strategies in traditional societies distinguish gut microbiomes.

Schnorr S. Gut microbiome of the Hadza hunter-gatherers. Fava F. Losasso C. Abulizi N. De Wit N. Saturated fat stimulates obesity and hepatic steatosis and affects gut microbiota composition by an enhanced overflow of dietary fat to the distal intestine.

Liver Physiol. Lecomte V. Changes in gut microbiota in rats fed a high fat diet correlate with obesity-associated metabolic parameters. Wolters M. Dietary fat, the gut microbiota, and metabolic health—A systematic review conducted within the MyNewGut project.

In: Mariotti F. Academic Press; London, UK: Koliada A. BMC Microbiol. Magne F. Comparative metabolomics in vegans and omnivores reveal constraints on diet-dependent gut microbiota metabolite production.

Miles F. Schmidt J. Metabolic profiles of male meat eaters, fish eaters, vegetarians, and vegans from the EPIC-Oxford cohort. Wang N. New-onset vegetarian diet shows differences in fatty acid metabolites in European American and African American women. Tang W. Intestinal microbial metabolism of phosphatidylcholine and cardiovascular risk. Associations of plasma trimethylamine N-oxide, choline, carnitine, and betaine with inflammatory and cardiometabolic risk biomarkers and the fecal microbiome in the Multiethnic Cohort Adiposity Phenotype Study.

Koeth R. Intestinal microbiota metabolism of L-carnitine, a nutrient in red meat, promotes atherosclerosis. Desai M. Toor D. Sebastiani G. Agnoli C. Position paper on vegetarian diets from the working group of the Italian Society of Human Nutrition. Piccoli G. Vegan-vegetarian diets in pregnancy: Danger or panacea? A systematic narrative review. Zulyniak M. Does the impact of a plant-based diet during pregnancy on birth weight differ by ethnicity? A dietary pattern analysis from a prospective Canadian birth cohort alliance.

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Consultant at accenture salary	The weight loss experienced on a hypocaloric lacto-ovo-vegetarian diet was similar to that observed with a hypocaloric Mediterranean diet [ ]. Diet and colorectal cancer mortality: results from adgentist Japan Collaborative Cohort Study. Due to lower saturated fat and cholesterol levels and more optimal plant sterol and fiber content, greater favorable effects of vegan diets on heart disease risk factors are expected. The absence or limited adventist health study cancer luck of animal protein and red meat also likely plays a role. Ferritin levels and risk of type 2 diabetes mellitus: An updated systematic review and meta-analysis of prospective evidence. This paper will discuss the environmental issues and the benefits for the planet of significantly reducing or eliminating meat and dairy foods from our diet. Meet the 'charismatic and genuine' financial advisor from Essex who is Love Island's first partially-sighted contestant He's still The Dude 25 years on!
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Early death and cancer incidence rates were lower among black AHS-2 participants by 36 and 22 percent, respectively, compared with blacks in the census data. The authors attribute lower cancer risk, increased quality of life in later years, and benefits to other health outcomes in the AHS-2 group to lifestyle habits, including nonsmoking, exercise, and reduced consumption of meat and suggest these results may transfer to the general U.

Get Started. Lower rates of cancer and all-cause mortality in an Adventist cohort compared with a US census population. Published online November 25, More on Cancer. Health behaviors promoted by the Seventh-day Adventist Church include not smoking, eating a plant-based diet, regular exercise and maintaining normal body weight.

Previous research suggests that Seventh-day Adventists have lower risks of many cancers, heart disease, and diabetes, and in California, live longer than individuals in the general population. Results vary by cancer type, however, with little published data for Black individuals. To provide additional insights, lead researcher, Gary Fraser, MBChB , PhD , and his colleagues compared death rates and cancer incidence between a national Seventh-day Adventist population and a representative sample of the U.

Specifically, the researchers analyzed data from the nationally inclusive Adventist Health Study-2 and a U.