The 3V score and joint associations of low ultra-processed food, biodiverse and plant-based diets on colorectal cancer risk: results from the European Prospective Investigation into Cancer and Nutrition (EPIC) study

Year: 2025

Type: article

Abstract: Background: Diet may modify colorectal cancer risk. We investigated the associations of three dietary patterns, ultra-processed food (UPF) consumption, healthy plant-based food consumption, and food biodiversity, separately and combined into a "3V" score with risk of colorectal cancer. Methods: This study used data from the prospective European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, which recruited participants between 1992, and 2000, from 23 centres in ten European countries. The 3V score was developed by standardising and summing the healthy plant diet index (hPDI) and dietary species richness per year (DSR) and subtracting UPF (Nova category 4) intake in % g/day. Associations with colorectal cancer risk were assessed among 450,111 middle-aged participants of the EPIC cohort using multivariable-adjusted Cox regression models. Independent associations of each 3V component were assessed using mutually adjusted models. Data-driven thresholds were applied to assess adherence to the 3V components, set at the minimum value of the fourth quintile for hPDI, DSR and low UPF. Findings: During mean (standard deviation (SD)) follow-up of 14.9 (4) years, absolute colorectal cancer rates were 8.59 and 10.37 cases/10,000 person-years for the highest and lowest quintiles of the 3V score, respectively. Inverse associations were found for colorectal (hazard ratio (HR) comparing highest vs lowest quintile: 0.84; 95% confidence interval (CI): 0.76-0.94), colon (HR: 0.82; 95% CI: 0.72-0.93), and distal colon cancer (HR: 0.81; 95% CI: 0.67-0.99), with significant linear trends observed across quintiles. UPF intake was positively associated with colon cancer risk (HR per 1 SD increment: 1.06; 95% CI: 1.02-1.11) when mutually adjusted for the other 3V components. Adherence to low UPF, high hPDI, and high DSR was inversely associated with colorectal (HR: 0.73; 95% CI: 0.61-0.88), colon (HR: 0.72; 95% CI: 0.57-0.91), and rectal cancer (HR: 0.65; 95% CI: 0.46-0.91) compared to adhering to none. Interpretation: Adherence to the 3V diet is associated with lower risk of colorectal cancers. Funding: Cancer Research UK, World Cancer Research Fund.

Source: EClinicalMedicine

DOI: 10.1016/j.eclinm.2025.103662

Institutions: MRC Centre for Environment and Health, Imperial College London, Centre international de recherche sur le cancer, Ghent University, Université Clermont Auvergne, Unité de Nutrition Humaine, Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, Centre de Recherche en Nutrition Humaine d'Auvergne, Centro de Pesquisas Oncológicas, Universidade de São Paulo, Universidad de Salamanca, Instituto de Investigación Biomédica de Salamanca, Conservatoire National des Arts et Métiers, Inserm, Université Paris Cité, Université Sorbonne Paris Nord, Equipe de Recherche en Epidémiologie Nutritionnelle, Centre de Recherche Épidémiologie et Statistique, UiT The Arctic University of Norway, German Institute of Human Nutrition, Aarhus University, Steno Diabetes Center Aarhus, Université de Versailles Saint-Quentin-en-Yvelines, Centre de recherche en Epidémiologie et Santé des Populations, University of Florence, German Cancer Research Center, University of Potsdam, Fondazione IRCCS Istituto Nazionale dei Tumori, Federico II University Hospital, University of Naples Federico II, Associazione Iblea per la Ricerca Epidemiologica E.T.S., Università degli Studi del Piemonte Orientale “Amedeo Avogadro”, Institut d'Investigació Biomédica de Bellvitge, Institut Català d'Oncologia, Instituto de Investigación Biosanitaria de Granada, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Andalusian School of Public Health, Basque Government, Biogipuzkoa Health Research Institute, Instituto Murciano de Investigación Biosanitaria, Instituto de Salud Pública de Navarra, Navarre Institute of Health Research

Language: English

Topic: Nutritional Studies and Diet

Subfield: Public Health, Environmental and Occupational Health

Field: Medicine

Domain: Health Sciences

SDGs: Good health and well-being, Zero hunger

Open Access status: gold

Estimated APC paid: $5,780

Funders: World Health Organization, Compagnia di San Paolo, Universitetet i Tromsø, Kræftens Bekæmpelse, Deutsches Krebsforschungszentrum, Centre International de Recherche sur le Cancer, “la Caixa” Foundation, Skåne County Council's Research and Development Foundation, World Cancer Research Fund International, Cancer Research UK, National Institute for Health and Care Research, Imperial College London, European Commission, Agence Nationale de la Recherche, Institut National de la Santé et de la Recherche Médicale, ZonMw, Bundesministerium für Bildung und Forschung, Cancerfonden, Ministerie van Volksgezondheid, Welzijn en Sport, Ministero della Salute, Ligue Contre le Cancer, Vetenskapsrådet, Ministère de l'Education Nationale, de l'Enseignement Superieur et de la Recherche, Associazione Italiana per la Ricerca sul Cancro, Deutsche Krebshilfe, Institut National Du Cancer, Institut Gustave-Roussy, Mutuelle Générale de l'Education Nationale, Junta de Andalucía, Wereld Kanker Onderzoek Fonds, Ministero dell'Università e della Ricerca, National Institutes of Health, Rollins School of Public Health, Medical Research Council, World Cancer Research Fund, Instituto de Salud Carlos III, Rijksinstituut voor Volksgezondheid en Milieu, NIHR Imperial Biomedical Research Centre, School of Public Health, Imperial College London, Division of Graduate Education

OpenAlex ID: W4416888261