Assessing the role of ultra-processed foods in colorectal cancer incidence: insights from the EPIC cohort

Studies have reported associations between ultra-processed food (UPF) consumption and colorectal cancer (CRC) incidence, yet the magnitude of these associations remains unclear. This study estimated the cohort-associated fraction (CAF), adapted from the population-attributable fraction metric, between UPF consumption and CRC incidence and explored the potential benefits of substituting UPFs with unprocessed or minimally processed foods. Using data from 416,081 middle-aged adults in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, including 5,845 incident CRC cases, Cox proportional hazards models were applied to estimate associations between UPF consumption (grams/day) and CRC, colon and rectal cancer risks. Substitution analyses were also carried out to estimate associations of replacing UPFs with unprocessed or minimally processed foods, to reflect potentially more interpretable estimates. CAFs quantified the magnitude of these associations. UPF consumption was positively associated with colon cancer (HR1-SD Increment: 1.04 [95%CI: 1.01; 1.08]) and CRC (HR1-SD Increment: 1.04 [95%CI: 1.01; 1.07]) but not with rectal cancer incidence. The CAF for UPF consumption was 5.58% (95%CI: 0.55; 10.50) for colon, and 5.10% (1.10; 9.02) for CRC incidence. Substituting 1-SD of UPFs with unprocessed or minimally processed foods was inversely associated with colon cancer (HR: 0.93, [95%CI: 0.89; 0.97]) and CRC incidence (HR: 0.94, [95%CI: 0.92; 0.98]), in energy- and nutrient-adjusted models. In substitution models, the CAF increased to 9.67% (4.36; 14.85) for colon cancer and 7.30% (3.05; 11.48) for CRC incidence. We estimated the magnitude of associations between UPF consumption and CRC incidence, highlighting the potential public health relevance of reducing UPF intake. Given the rising consumption of UPFs and burden of CRC incidence, public health interventions and continued research are needed to address this growing issue.

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Journal
BMC Public Health
Published
2026-04-22
DOI
https://doi.org/10.1186/s12889-026-27225-3
Primary Topic
Consumer Attitudes and Food Labeling
Type
article
Field-Weighted Citation Impact
0.00

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article

Assessing the role of ultra-processed foods in colorectal cancer incidence: insights from the EPIC cohort

M Touvier, Esther M. González‐Gil, Alicia K. Heath, Claire Cadeau et al.
BMC Public Health
Consumer Attitudes and Food Labeling
article

Assessing the role of ultra-processed foods in colorectal cancer incidence: insights from the EPIC cohort

M Touvier, Esther M. González‐Gil, Alicia K. Heath, Claire Cadeau, Guri Skeie, Kiara Chang, Eszter P. Vamos, Mariem Hajji-Louati, Christopher Millett, ­Rosario ­Tumino, Charlotte Le Cornet, Chloé Marques, Cecilie Kyrø, Geneviève Nicolas, Harriet Rumgay, Franziska Jannasch, Matteo Franco, Marcela Guevara, Marta Crous‐Bou, Oliver Langselius, Valeria Pala, Vivian Viallon, Bernard Srour, Maria-Jose Sánchez, Verena Katzke, Pietro Ferrari, Carla H. van Gils, Paolo Vineis, Anne Tjønneland, Matthias B. Schulze, Jeroen Berden, Jessica Blanco Lopez, Inge Huybrechts, Ana M. Jimenez Zabala
article en

Abstract

Studies have reported associations between ultra-processed food (UPF) consumption and colorectal cancer (CRC) incidence, yet the magnitude of these associations remains unclear. This study estimated the cohort-associated fraction (CAF), adapted from the population-attributable fraction metric, between UPF consumption and CRC incidence and explored the potential benefits of substituting UPFs with unprocessed or minimally processed foods. Using data from 416,081 middle-aged adults in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, including 5,845 incident CRC cases, Cox proportional hazards models were applied to estimate associations between UPF consumption (grams/day) and CRC, colon and rectal cancer risks. Substitution analyses were also carried out to estimate associations of replacing UPFs with unprocessed or minimally processed foods, to reflect potentially more interpretable estimates. CAFs quantified the magnitude of these associations. UPF consumption was positively associated with colon cancer (HR1-SD Increment: 1.04 [95%CI: 1.01; 1.08]) and CRC (HR1-SD Increment: 1.04 [95%CI: 1.01; 1.07]) but not with rectal cancer incidence. The CAF for UPF consumption was 5.58% (95%CI: 0.55; 10.50) for colon, and 5.10% (1.10; 9.02) for CRC incidence. Substituting 1-SD of UPFs with unprocessed or minimally processed foods was inversely associated with colon cancer (HR: 0.93, [95%CI: 0.89; 0.97]) and CRC incidence (HR: 0.94, [95%CI: 0.92; 0.98]), in energy- and nutrient-adjusted models. In substitution models, the CAF increased to 9.67% (4.36; 14.85) for colon cancer and 7.30% (3.05; 11.48) for CRC incidence. We estimated the magnitude of associations between UPF consumption and CRC incidence, highlighting the potential public health relevance of reducing UPF intake. Given the rising consumption of UPFs and burden of CRC incidence, public health interventions and continued research are needed to address this growing issue.

BMC Public Health
University of Copenhagen (DK), Conservatoire National des Arts et Métiers (FR), Harvard University (US), Inserm (FR), University of Potsdam (DE), German Cancer Research Center (DE), Université de Versailles Saint-Quentin-en-Yvelines (FR), Université Paris Cité (FR), Heidelberg University (DE), Université Paris-Saclay (FR), Basque Government (ES), Bellvitge University Hospital (ES), University Medical Center Utrecht (NL), Ghent University (BE), Sorbonne Université (FR), Instituto de Salud Pública de Navarra (ES), University College Copenhagen (DK), Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement (FR), Université Sorbonne Paris Nord (FR), Sorbonne Paris Cité (FR), University of Ragusa (IT), Ministry of Health (ES), Centre de recherche en Epidémiologie et Santé des Populations (FR), Institut Català d'Oncologia (ES), Navarre Institute of Health Research (ES), Instituto de Investigación Biosanitaria de Granada (ES), Policlínica Gipuzkoa (ES), Onkologikoa (ES), Danish Cancer Society (DK), Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (ES), Fondazione IRCCS Istituto Nazionale dei Tumori (IT), German Institute of Human Nutrition (DE), Centre international de recherche sur le cancer (FR), Centre de Recherche Épidémiologie et Statistique (FR), Imperial College London (GB), University of Turin (IT), Andalusian School of Public Health (ES), UiT The Arctic University of Norway (NO), IT University of Copenhagen (DK), Universidade Nova de Lisboa (PT)
Universitetet i Tromsø, World Cancer Research Fund International, Government of the United Kingdom, Cancer Research UK, National Institute for Health and Care Research, Bundesministerium für Bildung und Forschung, Cancerfonden, Vetenskapsrådet, Associazione Italiana per la Ricerca sul Cancro, Medical Research Council, World Cancer Research Fund, Instituto de Salud Carlos III
Zero hunger
Openalex Percentile: Top 18%
Consumer Attitudes and Food Labeling
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