Colorectal cancer project

Overview | Details of the research | Research published in journals | The research team

Overview

The Colorectal Cancer Project research focuses on increasing our knowledge about colorectal cancer prevention and control in:

• colorectal cancer patients and survivors
• individuals with Lynch syndrome (an inherited disorder that increases the risk of individuals developing colorectal cancer)
• individuals presenting with sporadic colorectal adenomas.

Selected findings from the Colorectal Cancer Project:

• A high BMI is associated with an increased risk of colorectal adenomas in individuals with Lynch syndrome
• Dietary patterns may be associated with colorectal adenoma development in individuals with Lynch syndrome
• The evidence is unclear on the association between dietary supplement use and colorectal adenoma recurrence in individuals previously presenting with sporadic colorectal adenomas

Findings from the literature reviews undertaken by the research team:

• A high intake of red and processed meat is associated with an increased risk of colorectal cancer in a review of prospective cohort studies as part of the Continuous Update Project
• A high intake of dietary fibre, in particular cereal fibre and whole grains, is associated with a reduced risk of colorectal cancer in a review of prospective cohort studies as part of the Continuous Update Project

Although the Colorectal Cancer Project started in October 2008 and ended in July 2014, further funding has been awarded by World Cancer Research Fund International to conduct additional research in the area (using two of the cohorts of Colorectal Cancer Project):

• Body composition and colorectal cancer recurrence and survival
• Body fatness at adolescence, adult attained height and the development of tumours among persons with Lynch syndrome

The Colorectal Cancer Project was funded by Wereld Kanker Onderzoek Fonds (World Cancer Research Fund NL) and conducted by a research team at Wageningen University in the Netherlands. World Cancer Research Fund International supported this collaboration, organising bi-annual meetings with World Cancer Research Fund NL and the Colorectal Cancer Project research group. Scientific advisors working in the field of diet and cancer prevention also assessed and reviewed research developments.

Details of the research

The Colorectal Cancer Project comprised of three major studies:

• The COLON study
• The POLIEP study
• The GEOLynch study

Each study generated BSc, MSc or PhD research project opportunities for students of Division of Human Nutrition at Wageningen University. In addition, the Colorectal Cancer Project group launched a website that outlines some of the research findings from the project.

The COLON study

This prospective study investigated whether diet, dietary supplements and body fatness are associated with survival, recurrence and quality of life in colorectal cancer patients. By November 2014, 1,000 patients had participated in this study.

Findings of this study showed:

• Colorectal cancer patients use dietary supplements around diagnosis, but dietary supplement use is very inconsistent over time
• CT-scans collected show that sarcopenia is common in colorectal cancer patients

Research sub-projects:

• Antioxidant supplements and cancer survival.
• Changes in body weight in colorectal cancer patients during treatment.
• Population characteristics associated with dietary supplement use in colorectal cancer survivors.
• The association between physical activity and physical functioning in colorectal cancer survivors.
• Toxicity of (chemo) therapy.
• Dietary supplement use and fatigue during cancer treatment.

In addition, World Cancer Research Fund awarded the grant Body composition and colorectal cancer recurrence and survival led by Professor Ellen Kampman, that will assess of CT-images of patients from the COLON study.

The POLIEP study

This prospective cohort investigated whether diet, dietary supplements and body fatness reduced colorectal cancer risk in individuals presenting with sporadic colorectal adenomas, (which increases risk of developing this cancer).

The study had a total of 768 participants and the Colorectal Cancer Project Group will continue to use the data generated from this study for future analysis.

The final study findings showed:

• The evidence is unclear on the association between dietary supplement use and colorectal adenoma recurrence in individuals previously presenting with colorectal adenomas.
• Three identified dietary patters – ‘Cosmopolitan’, ‘Low-meat’, and ‘Refined foods’ did not show clear associations with colorectal adenoma recurrence.
• BMI was not associated with colorectal adenoma recurrence or with recurrence of advanced adenomas.

Research sub-projects:

• Dietary supplement use and colorectal adenoma.

The GeoLynch study

This prospective study examined the association between the most frequently used dietary supplements, diet and colorectal adenoma risk in a cohort of individuals with Lynch syndrome, an inherited disorder that increases the risk of individuals developing colorectal cancer.

By the November 2014, 486 individuals with Lynch Syndrome had participated in the study.

Findings from the study showed:

• A high BMI is associated with an increased risk of colorectal adenomas in individuals with Lynch syndrome
• Dietary patterns may be associated with colorectal adenoma development in individuals with Lynch syndrome
• Use of dietary supplements was not statistically significantly associated with colorectal adenoma risk

Research sub-projects:

• Dietary supplement use in the Netherlands and related health claims.
• Adherence to WCRF-guidelines and colorectal adenomas.
• Associations between food groups and colorectal adenomas.
• Physical activity and colorectal adenoma development.
• Dairy & calcium intake and colorectal adenomas.
• Interaction between body mass index, SNPs and colorectal adenomas.
• Dietary supplement use and colorectal tumour risk
• Associations between food groups and colorectal adenomas.
• Physical activity and colorectal adenoma development.
• Comparison of methods to assess associations in the GeoLynch cohort.
• Vitamin D/calcium intake and colorectal adenomas.

World Cancer Research Fund awarded grant Body fatness at adolescence, adult attained height and the development of tumours among persons with Lynch syndrome led by Dr Fränzel van Duijnhoven that will use data collected from participants of the GEOLynch study.

Research published in journals

The following research papers generated from the Colorectal Cancer Project have been published in peer-reviewed journals.

2014 publications

• Jung et al. “Dietary B vitamin and methionine intake and MTHFR C677T genotype on risk of colorectal tumors in Lynch syndrome: the GEOLynch cohort study.”
• Winkels et al. “The COLON study: Colorectal cancer: Longitudinal, Observational study on Nutritional and lifestyle factors that may influence colorectal tumour recurrence, survival and quality of life.”

2013 publications

• van Duijnhoven et al. “Do lifestyle factors influence colorectal cancer risk in Lynch syndrome?“
• Heine-Broring et al. “Dietary supplement use is not associated with recurrence of colorectal adenomas: a prospective cohort study.”
• Heine-Broring et al. “Dietary supplement use and colorectal tumour risk in individuals with Lynch syndrome: The GEOLynch cohort study.”
• Winkels et al. “Diet and colorectal cancer risk and survival.”
• Botma et al. “Dietary patterns and colorectal adenomas in Lynch Syndrome: The GEOLynch cohort study.”
• Jung et al. “Plasma B vitamins and LINE-1 DNA methylation in leukocytes of patients with a history of colorectal adenomas.”
• Aune et al. “Red and processed meat intake and risk of colorectal adenomas: a systematic review and meta-analysis of epidemiological studies.”

2012 publications

• Aune et al. “Dairy products and colorectal cancer risk: a systematic review and meta-analysis of cohort studies.”
• Kampman et al. “Impact of Diet, Body Mass Index, and Physical Activity on Cancer Survival.”
• Winkels et al. “Smoking increases the risk for colorectal adenomas in patients with Lynch syndrome.”
• Kuiper et al. “Recreational physical activity, body mass index, and survival in women with colorectal cancer.”
• Wark et al. “Magnesium intake and colorectal tumor risk: a case-control study and meta-analysis.”
• Aune et al. “Carbohydrates, glycemic index, glycemic load, and colorectal cancer risk: a systematic review and meta-analysis of cohort studies.”

2011 publications

• Aune et al. “Dietary fibre, whole grains, and risk of colorectal cancer: systematic review and dose-response meta-analysis of prospective studies.”
• Aune et al. “Nonlinear reduction in risk for colorectal cancer by fruit and vegetable intake based on meta-analysis of prospective studies.”
• Chan et al. “Red and processed meat and colorectal cancer incidence: meta-analysis of prospective studies.”
• Touvier et al. “Meta-Analyses of Vitamin D Intake, 25-Hydroxyvitamin D Status, Vitamin D Receptor Polymorphisms, and Colorectal Cancer Risk.”

2010 publications

• Vrieling & Kampman “The role of body mass index, physical activity, and diet in colorectal cancer recurrence and survival: a review of the literature.”

The research team

All research undertaken by the Colorectal Cancer Project Group has been conducted at Wageningen University’s Division of Human Nutrition.

Professor Ellen Kampman, PhD

Professor Ellen Kampman is the Principle Investigator of the Colorectal Cancer Project. She is Chair of the Division of Human Nutrition and Lecturer in Diet and Cancer at Wageningen University, as well as a Visiting Professor of Cancer and Nutrition at Free University, Amsterdam, Netherlands.

“Five years ago we started the Colorectal Cancer Project Group: a 5-year close collaboration between Wageningen University and World Cancer Research Fund International; it has been a programme which enabled us to set up the COLON-study and continue two ongoing prospective cohorts: the POLIEP-study and GEOLynch-study, all focused on diet, dietary supplements, body fatness and colorectal cancer risk and survival. We are now combining data from the COLON-study with other centres to continue this prospective study and make sure we will have enough participants to answer specific research questions. The GEOLynch-study is a prospective study on diet and other lifestyle habits in those with Lynch Syndrome, an inherited form of colorectal cancer. This study will also be continued through collaboration with other international centres. With funding from WCRF, we are now also starting an adjacent study involving persons with Lynch Syndrome at Radboudumc. Here, we will evaluate in an intervention study, whether persons with Lynch Syndrome are aware of the WCRF guidelines and whether awareness will increase through providing them with WCRF information materials.”

Dr Renate Winkels, PhD

Dr Renate Winkels is a postdoctoral researcher working alongside Dr Kampman. Her work focuses on nutrition and health, body composition and colorectal cancer. She also coordinates a module entitled ‘Study design and interpretation in epidemiology and public health’ at Wageningen University.

“I have been involved on the COLON-study from the beginning; it started off as a small team with Ellen Kampman, Renate Heine-Bröring and myself. We have expanded hospital recruitment from 2-3 hospital sites, to a total of 11 hospital sites now involved in participant recruitment. We also expanded the study by recruiting more personnel, and now have collaborations with Maastricht University, the Netherlands, and Heidelberg University, Germany. Moreover almost a dozen students have performed MSc-projects within the project. The COLON-study will continue to grow, and I am glad to be involved.”

Renate Heine-Bröring, MSc

Renate Heine-Bröring is a PhD student working on the project. Renate’s work focuses on dietary supplements in colorectal tumour recurrence and survival. She is a dietician by training and has a Master’s degree in Nutrition and Epidemiology (Wageningen University). Additionally, Renate was awarded a WCRF International Academy Fellowship to attend the International Course in Nutritional Epidemiology at Imperial College London, 2012.

“In my PhD project I am investigating the association of dietary supplement use and colorectal tumours in high risk populations for colorectal cancer. The COLON-study is a part of my PhD project, and is a study among patients who are diagnosed with colorectal cancer. My PhD project has been very diverse involving a mixture of practical and theoretical work on the COLON-study, GEOLynch-study, and POLIEP study. It has been very nice to work with an enthusiastic team on the project. I hope that, with my PhD thesis, I support WCRF to provide recommendations for patients at risk for cancer, and for patients diagnosed with cancer. At the moment, I am finishing my PhD-thesis, and I cannot give the final results yet; there are no firm conclusions on dietary supplements use and colorectal cancer survival as the COLON-study is still ongoing.”

Moniek van Zutphen, MSc

Moniek is a research assistant working on the project. She has expertise in epidemiology and food sciences.

“In 2010 recruitment for the COLON study started in two hospitals, and now we are recruiting colorectal cancer patients in 11 hospitals. We work hard to ensure we have enough hospital sites and keep them motivated to recruit participants. I am the project coordinator, responsible for recruitment of participants on the study, processing of the questionnaires and data management. I enjoy the diversity and dynamics of the project. We hope to reach 1000 participants on this study by end of 2014. Participants are asked to complete 4 questionnaires at each time point, which takes them at least one hour. I am also editor of ColoNews; a newsletter published three times a year and distributed to participants of the COLON-study as well as hospital staff. The newsletter informs them on the progress of the study. Participants are especially interested in the results of the study – this can be tricky as we have to wait some more years until we have results on colorectal cancer survival, however they are updated on some results from small projects conducted by students working on the COLON-study.”

In addition, the following Scientific Advisors have provided input and guidance on the project:

Professor John Mathers, PhD

Professor John Mathers is Director of the Human Nutrition Research Centre at Newcastle University. His work focuses on prevention of common non-communicable diseases including colon cancer.

Professor Tim Key, PhD

Professor Tim Key is Deputy Director of the Cancer Epidemiology Unit at the University of Oxford. His research focuses on the role of diet and sex hormones in the aetiology of breast, prostate and colon cancer.