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Mar 2011 Healthy lifestyle leads to reduction of colorectal cancer


Lifestyles correlated with the greatest incidence of colorectal cancer include a diet rich in fat, alcohol consumption, tobacco smoking, low intake of vegetable and fruits as well as no- or low-exercise. Many studies have so far found an association between individual lifestyle factors and risk of colorectal cancer. However, investigations on the combined effect of lifestyle factors on risk of cancer incidence are sparse.

The complex nature and multiple dimensions of health behaviours may be better captured in analyses of lifestyle factors in combination, like lifestyle patterns, than in analyses based on a single lifestyle factor. In relation to this, study of combination of five lifestyle factors has shown that complete adherence to recommended physical activity, waist size, smoking, alcohol intake, and diet may reduce colorectal cancer risk considerably [1].


Main text:
According to the World Health Organization colorectal cancer is the second most common cancer globally, after lung cancer. Although it mainly affects older people, it has been noticed that the rate among younger adults is increasing [2].


Many studies have shown the possibility of combined healthy lifestyle factors to lower mortality and risk of chronic disease [3, 4, 5]. Additionally, there are also studies which have investigated health behaviours in relation to colon cancer. In one of these studies, for example, the authors reported that 71% of the colon cancer cases could have been avoided if participants had been unexposed to risk factors [6].


The results of a Danish study, recently published in the British Medical Journal, indicate a clear link between diet, alcohol consumption, smoking, and waist size to colorectal cancer risk [1]. The researchers of this study assessed the impact of lifestyle on colorectal cancer risk for middle-aged individuals. They also examined whether cancer risk rise when people do not comply with the recommendations.


In this study, the investigators examined data on 55,487 individuals, aged between 50 and 64, who had no history of cancer. These individuals were monitored and were given a questionnaire to complete. The questionnaire included questions on their general health state, reproductive factors, and lifestyle habits. They were also given a food-frequency questionnaire in order to assess their nutritional habits.


With the help of recommendations from World Health Organization, World Cancer Research Fund, and Nordic Nutrition Recommendations, the authors created a lifestyle index which included at least 30 minutes of physical activity per day, consuming no more than 7 alcohol drinks for women and 14 for men per week, not smoking, eating a healthy and balanced diet, and having a waistline of no more than 88cm for women and 102 for men.


After assessing participants' compliance with each of the five lifestyle recommendations, the researchers found out that if the participants had adhered to just one additional recommendation the number of colorectal cancer cases would have been 13% lower. Further, there would have been a 23% rate reduction if everyone had complied with all five recommendations.


Although the results of the Danish study are significant because they evaluate the combined effect of several lifestyle factors on risk of colorectal cancer, there are also certain limitations of the study. A serious constraint of the investigation is the superficial analysis of the diet-factor. It has already been shown that the recurrence rate or death from colon cancer is nearly 3 times higher among patients who ate a typical Western diet [7] and the world wide variation in colon cancer across countries is about a factor 50. This world wide spread is strongly correlated with dietary factors. Countries with diets high in fibrous foods, low in animal fats and low in meats have much lower colon cancer incidence [8].


The Danish study [1] suggests that even modest differences in lifestyle might have a substantial impact on colorectal cancer risk and, therefore, medical experts should continuously convince people to follow the lifestyle recommendations.


By: Svetlana Obradovic and Luuk Simons


[1] Kirkegaard, H., N. F. Johnsen, J. Christensen et. al. (2010). Association of adherence to lifestyle recommendations and risk of colorectal cancer: a prospective Danish cohort study. BMJ 341:c5504



[2] Siegel, R. L., A. Jemal, E. M. Ward (2009): Increase in incidence of colorectal cancer among young man and women in the United States. Cancer Epidemiol Biomarkers Prev 18 pp. 1695–98.



[3] Ford, E.S., M. M. Bergmann, J. Kroger, A. Schienkiewitz A et. al. (2009). Healthy living is the best revenge. Arch Intern Med 169 pp. 1355-62.



[4] Meng, L, G. Maskarinec, J. Lee, L. N. Kolonel (1999). Lifestyle factors and chronic diseases: application of a composite risk index. Prev Med 29 pp. 296-304.


[5] Van Dam, R. M., T. Li, D. Spiegelman et. al. (2008). Combined impact of lifestyle factors on mortality: prospective cohort study in US women. BMJ 337:a1440.



[6] Platz, E. A., W. C. Willett, G. A. Colditz et. al. (2000). Proportion of colon cancer risk that might be preventable in a cohort of middle-aged US men. Cancer Causes Control 11 pp. 579-88.



[7] Meyerhardt, J.A., D. Niedzwiecki, D. Hollis et. al. (2007). Association of dietary patterns with cancer recurrence and survival in patients with stage III colon cancer. JAMA 298 pp. 754-64.



[8] Campbell, T. C., & Campbell-II, T. M. (2006). The China Study: The Most Comprehensive Study of Nutrition Ever Conducted and the Startling Implications for Diet, Weight Loss and Long-Term Health. Dallas: BenBella Books.

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