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Association of the inflammatory balance of diet and lifestyle with colorectal cancer among Korean adults: a case-control study
Shinyoung Jun, Jeonghee Lee, Jae Hwan Oh, Hee Jin Chang, Dae Kyung Sohn, Aesun Shin, Jeongseon Kim
Epidemiol Health. 2022;44:e2022084.   Published online September 30, 2022
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AbstractAbstract AbstractSummary PDFSupplementary Material
Dietary and lifestyle exposures may affect the risk of colorectal cancer (CRC) by promoting chronic inflammation. Therefore, we assessed the separate and joint associations of dietary and lifestyle inflammation scores (DIS and LIS, respectively) with CRC.
Data from 919 pathologically confirmed CRC cases and 1,846 age- and sex-matched controls recruited at the National Cancer Center Korea were analyzed. We calculated the DIS and LIS, which characterize the collective contributions of 19 dietary and 4 lifestyle factors, respectively, to systemic inflammation by applying weights based on high-sensitivity C-reactive protein. A higher score represented a higher balance of pro- to anti-inflammatory exposures. Unconditional logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for CRC risk compared across the DIS and LIS tertile categories, with the lowest tertile as the reference group.
The highest DIS tertile had significantly increased odds of having CRC (OR, 2.65; 95% CI, 2.10 to 3.36), and the odds increased with increasing DIS. The highest LIS tertile group had 1.28-fold higher odds of having CRC (95% CI, 1.03 to 1.58). In the cross-classification analysis, the odds of having CRC increased as the DIS and LIS jointly increased until the DIS reached the highest tertile, where the risk was very high (3-fold or more) regardless of the LIS.
In conclusion, a higher balance of pro-inflammatory relative to anti-inflammatory dietary and lifestyle factors, especially dietary factors, was associated with higher CRC risk among Korean adults.
Korean summary
본 연구는 국립암센터에서 수집한 대장암 환자-대조군 데이터를 활용하여, 새롭게 개발된 식이 염증 지수(Dietary Inflammation Score, DIS) 및 생활습관 염증 지수(Lifestyle Inflammation Score, LIS)와 대장암 발생 위험 간의 연관성을 탐색하였다. 분석 결과, 식이 염증 지수 혹은 생활습관 염증 지수가 높은 집단에서 대장암 위험이 더 높아, 식이와 생활습관이 체내 염증 수준을 높여 대장암 발생 위험을 높일 가능성이 제기되었다
Key Message
Dietary inflammation score (DIS) and lifestyle inflammation score (LIS) quantify the collective effect of dietary and lifestyle factors, respectively, on systemic inflammation. In this case-control study, we assessed the associations of DIS and LIS with colorectal cancer risk among Korean adults. Our results suggest that a higher balance of pro-to anti-inflammatory dietary and lifestyle factors may be associated with higher risk for colorectal cancer. The findings from our study support that reducing inflammation through dietary or lifestyle changes could potentially reduce the risk for colorectal cancer.
Application of a non-parametric non-mixture cure rate model for analyzing the survival of patients with colorectal cancer in Iran
Mehdi Azizmohammad Looha, Mohamad Amin Pourhoseingholi, Maryam Nasserinejad, Hadis Najafimehr, Mohammad Reza Zali
Epidemiol Health. 2018;40:e2018045.   Published online September 17, 2018
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  • 2 Citations
AbstractAbstract PDF
Colorectal cancer (CRC) patients are considered to have been cured when the mortality rate of individuals with the disease returns to the same level as expected in the general population. This study aimed to assess the impact of various risk factors on the cure fraction of CRC patients using a real dataset of Iranian CRC patients with a non-mixture non-parametric cure model.
This study was conducted on the medical records of 512 patients who were definitively diagnosed with CRC at Taleghani Hospital, Tehran, Iran from 2001 to 2007. A non-mixture non-parametric cure rate model was applied to the data after using stepwise selection to identify the risk factors of CRC.
For non-cured cases, the mean survival time was 1,243.83 days (95% confidence interval [CI], 1,174.65 to 1,313.00) and the median survival time was 1,493.00 days (95% CI, 1,398.67 to 1,587.33). The 1- and 3-year survival rates were 92.9% (95% CI, 91.0 to 95.0) and 73.4% (95% CI, 68.0 to 79.0), respectively. Pathologic stage T1 of the primary tumor (estimate=0.58; p=0.013), a poorly differentiated tumor (estimate=1.17; p<0.001), a body mass index (BMI) between 18.6 and 24.9 kg/m2 (estimate=−0.60; p=0.04), and a BMI between 25.0 and 29.9 kg/m2 (estimate=−1.43; p<0.001) had significant impacts on the cure fraction of CRC in the multivariate analysis. The proportion of cured patients was 64.1% (95% CI, 56.7 to 72.4).
This study found that the pathologic stage of the primary tumor, tumor grade, and BMI were potential risk factors that had an impact on the cure fraction. A non-mixture non-parametric cure rate model provides a flexible framework for accurately determining the impact of risk factors on the long-term survival of patients with CRC.


Citations to this article as recorded by  
  • Assessment of prognostic factors in long-term survival of male and female patients with colorectal cancer using non-mixture cure model based on the Weibull distribution
    Mehdi Azizmohammad Looha, Elaheh Zarean, Fatemeh Masaebi, Mohamad Amin Pourhoseingholi, Mohamad Reza Zali
    Surgical Oncology.2021; 38: 101562.     CrossRef
  • Actual survival after resection of primary colorectal cancer: results from a prospective multicenter study
    Inge van den Berg, Robert R. J. Coebergh van den Braak, Jeroen L. A. van Vugt, Jan N. M. Ijzermans, Stefan Buettner
    World Journal of Surgical Oncology.2021;[Epub]     CrossRef
Impaired fasting glucose, single-nucleotide polymorphisms, and risk for colorectal cancer in Koreans
Keum Ji Jung, Miyong To Kim, Sun Ha Jee
Epidemiol Health. 2016;38:e2016002.   Published online January 6, 2016
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  • 7 Citations
AbstractAbstract AbstractSummary PDF
Numerous studies have demonstrated that fasting serum glucose (FSG) levels and certain single-nucleotide polymorphisms (SNPs) are related to an increased risk of colorectal cancer (CRC); however, their combined effects are still unclear.
Of a total of 144,527 men and women free of cancer at baseline, 317 developed CRC during 5.3 years of follow-up. A case-cohort study (n=1,691) was used, consisting of participants with a DNA sample available. Three well-known SNPs (rs3802842, rs6983267, rs10795668) were genotyped. Hazard ratios (HR) and 95% confidence intervals (CI) of CRC, colon and rectal cancer were calculated, with the Cox proportional hazard models.
The crude incidence rates per 100,000 person-years were 41.1 overall, 48.4 for men, and 29.3 for women. Among participants with dysglycemia, SNPs rs3802842 and rs6983267 were both associated with an increased risk of CRC (HR, 3.2; 95% CI, 1.9 to 5.5 and HR, 1.8; 95% CI, 1.1 to 3.1, respectively) and rectal cancer (HR, 3.4; 95% CI, 1.8 to 6.6 and HR, 3.3; 95% CI, 1.6 to 7.1, respectively). The interaction effect of dysglycemia and SNPs was positive, that is, resulted in an elevated risk of CRC, but was not statistically significant.
This study demonstrates that both high FSG and certain SNPs are major risk factors for CRC and rectal cancer but that they did not interact synergistically. The difference in effect size of the SNPs according to CRC subtype (i.e., colon or rectal cancer) and presence of dysglycemia merits further research.
Korean summary
본 연구에서는 공복혈당농도와 대장암과 관련된 단일염기다형성(SNP)과의 관련성을 살펴 보았다. 높은 공복혈당농도와 단일염기다형성(SNP_rs3802842, rs6983267)은 대장암의 주요한 위험요인이었으나, 두 가지 요인의 상호작용으로 인한 시너지 효과는 없는 것으로 나타났다. 대장암의 아형에 따른 다른 효과 크기와 이상혈당증 유무에 따른 향후 연구가 더 필요할 것으로 생각된다.


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  • The effect of pain-education nursing based on a mind map on postoperative pain score and quality of life in patients with colorectal cancer
    Shan Li, Xiaohong Zhu, Lihua Zhang, Cui Huang, Dan Li
    Medicine.2023; 102(19): e33562.     CrossRef
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    Zhiyuan Wu, Yufeng Liang, Yunlong Zuo, Yufen Xu, Hanran Mai, Lei Pi, Di Che, Xiaoqiong Gu
    Infection and Drug Resistance.2021; Volume 14: 2969.     CrossRef
  • Distinct patterns of interleukin-12/23 and tumor necrosis factor α synthesis by activated macrophages are modulated by glucose and colon cancer metabolites
    Ching-Ying Huang, LindaChia-Hui Yu
    Chinese Journal of Physiology.2020; 63(1): 7.     CrossRef
  • Glucose Metabolites Exert Opposing Roles in Tumor Chemoresistance
    Chung-Yen Huang, Ching-Ying Huang, Yu-Chen Pai, Been-Ren Lin, Tsung-Chun Lee, Pi-Hui Liang, Linda Chia-Hui Yu
    Frontiers in Oncology.2019;[Epub]     CrossRef
  • Association among genetic variants in the vitamin D pathway and circulating 25-hydroxyvitamin D levels in Korean adults: results from the Korea National Health and Nutrition Examination Survey 2011–2012
    So-Young Kwak, Clara Yongjoo Park, Garam Jo, Oh Yoen Kim, Min-Jeong Shin
    Endocrine Journal.2018; 65(9): 881.     CrossRef
  • Body mass index and incidence of thyroid cancer in Korea: the Korean Cancer Prevention Study-II
    Hyun-Young Shin, Yong Ho Jee, Eo Rin Cho
    Journal of Cancer Research and Clinical Oncology.2017; 143(1): 143.     CrossRef
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    Yong Hyun Byun, Sang Yeun Kim, Yejin Mok, Youngwon Kim, Sun Ha Jee
    Asia Pacific Journal of Public Health.2017; : 101053951774563.     CrossRef
Predictors of Colorectal Cancer Survival in Golestan, Iran: A Population-based Study
Mohammad Aryaie, Gholamreza Roshandel, Shahryar Semnani, Mohsen Asadi-Lari, Mohsen Aarabi, Mohammad Ali Vakili, Vahideh Kazemnejhad, Seyed Mehdi Sedaghat, Masoud Solaymani-Dodaran
Epidemiol Health. 2013;35:e2013004.   Published online June 20, 2013
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  • 15 Citations
AbstractAbstract PDF

We aimed to investigate factors associated with colorectal cancer survival in Golestan, Iran.


We used a population based cancer registry to recruit study subjects. All patients registered since 2004 were contacted and data were collected using structured questionnaires and trained interviewers. All the existing evidences to determine the stage of the cancer were also collected. The time from first diagnosis to death was compared in patients according to their stage of cancer using the Kaplan-Meir method. A Cox proportional hazard model was built to examine their survival experience by taking into account other covariates.


Out of a total of 345 subjects, 227 were traced. Median age of the subjects was 54 and more than 42% were under 50 years old. We found 132 deaths among these patients, 5 of which were non-colorectal related deaths. The median survival time for the entire cohort was 3.56 years. A borderline significant difference in survival experience was detected for ethnicity (log rank test, p=0.053). Using Cox proportional hazard modeling, only cancer stage remained significantly associated with time of death in the final model.


Colorectal cancer occurs at a younger age among people living in Golestan province. A very young age at presentation and what appears to be a high proportion of patients presenting with late stage in this area suggest this population might benefit substantially from early diagnoses by introducing age adapted screening programs.



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  • Prognostic Factors of Rectal Cancer in Southern Iran
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    Journal of Gastrointestinal Cancer.2022; 53(1): 113.     CrossRef
  • Colorectal cancer incidence and mortality trends by sex and population group in South Africa: 2002–2014
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    BMC Cancer.2021;[Epub]     CrossRef
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    Middle East Journal of Digestive Diseases.2021; 13(4): 314.     CrossRef
  • Associated Factors of Survival Rate and Screening for Colorectal Cancer in Iran: a Systematic Review
    Hossein Mozafar Saadati, Farzad Khodamoradi, Hamid Salehiniya
    Journal of Gastrointestinal Cancer.2020; 51(2): 401.     CrossRef
  • Survival Status and Predictors of Mortality Among Colorectal Cancer Patients in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: A Retrospective Follow-up Study
    Bantalem Tilaye Atinafu, Fekadu Aga Bulti, Tefera Mulugeta Demelew
    Journal of Cancer Prevention.2020; 25(1): 38.     CrossRef
  • Survival Rate of Colorectal Cancer in Eastern Mediterranean Region Countries: A Systematic Review and Meta-Analysis
    Hossein-Ali Nikbakht, Soheil Hassanipour, Layla Shojaie, Mohebat Vali, Saber Ghaffari-fam, Mousa Ghelichi-ghojogh, Zahra Maleki, Morteza Arab-Zozani, Elham Abdzadeh, Hamed Delam, Hamid Salehiniya, Maryam Shafiee, Salman Mohammadi
    Cancer Control.2020; 27(1): 107327482096414.     CrossRef
  • Temporal and geographical variations in colorectal cancer incidence in Northern Iran 2004–2013
    Susan Hasanpour-Heidari, Abdolreza Fazel, Shahryar Semnani, Seyyed-Reza Khandoozi, Taghi Amiriani, SeyedMehdi Sedaghat, Reza Hosseinpoor, Ramin Azarhoush, Mohammad Poorabbasi, Mohammad Naeimi-Tabiei, Gholamreza Roshandel, Freddie Bray, Elisabete Weiderpas
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    Health Scope.2018;[Epub]     CrossRef
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    Medicine.2017; 96(6): e5941.     CrossRef
  • Colorectal Cancer in Iran: Molecular Epidemiology and Screening Strategies
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    Journal of Cancer Epidemiology.2015; 2015: 1.     CrossRef
  • Recurrence and Five Year Survival in Colorectal Cancer Patients After Surgery
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    Iranian Journal of Cancer Prevention.2015;[Epub]     CrossRef
  • An Overview of Clinical and Pathological Characteristics and Survival Rate of Colorectal Cancer in Iran
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    Annals of Colorectal Research.2014;[Epub]     CrossRef
  • Overview of Cancer Registration Research in the Asian Pacific from 2008-2013
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Analysis of Studies on Colorectal Cancers Published in Korean Medical Journals Between 1967 and 2004.
Eunkyoung Paik, Soonduck Kim, Jesuk Lee
Korean J Epidemiol. 2007;29(2):146-154.
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AbstractAbstract PDF
The study analyzed and categorized the colorectal cancers related medical journals published in Korea by the name of the journal, research materials, study method, statistical method and by content of study for the quality improvement of colorectal cancers related studies.
The authors reviewed a total of 567 colorectal cancer-related studies published in the Korean medical journals during the period 1967 and 2004 and kept in the National Assembly Library. The distribution of research materials, study method, statistical method and content of these studies were analyzed by the 5 year publication interval.
By study period, the number of published studies steeply increase during the period between 2000 and 2004. As the research materials, hospital patients(64.6%) and In-vitro(16.6%) were the most prevalently used research materials, but health adults were the lowest research materials by only taking up 0.4%. In study methods, patient follow up studies(28.7%) and human in vitro experimental(27.9%) were prevalent, and human in vitro experimental were relatively the most popular performed studies during the years of 1990-1994. As the statistical method, life table and survival analysis(27.0%) were the mostly performed methods, and the use of statistical method was applied in nearly all studies. The contents of the studies mainly focused on the patient prognostic estimations(27.6%) of therapeutic safety & efficacy(25.6%), but only the 4.1% of risk factors studies. Among the 109 studies which analyzed the survival term 78.9% of the studies mainly used the 5 year term in the analysis of survival rates.
The results of the study could be utilized as the basic data for the quality improvement of further colorectal cancers related studies.
Mortality Trends in Colorectal Cancer and Breast Cancer in Korea: Birth Cohort Effects?.
Jae Kwan Jun, Yeon Ju Kim, Jin Gwack, Yunhee Choi, Yun Chul Hong, Keun Young Yoo
Korean J Epidemiol. 2005;27(1):154-162.
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  • 34 Download
AbstractAbstract PDF
Cancer has been the leading cause of deaths since 1980s in Korea. Among them, colorectal cancer and breast cancer shows steadily increasing pattern, being the fourth and the fifth common site of cancer death in Korea, respectively. This analysis aimed to evaluate potential contribution of birth cohort effects to the recent increases in mortality of colorectal cancer and breast cancer since 1983 in Korea.
Mortality statistics on deaths of both cancers for the past 20 years of 1983~2002 were obtained from the National Statistical Office. The age-standardized mortality rates were calculated based on the census population of 1992 as a standard.
Age-standardized mortality rate for colorectal cancer increased 4.7-fold in men and 3.6-fold in women, whereas 2.1-fold increase in breast cancer mortality during 1983~2002. Age-specific mortality rates for colorectal cancer were steadily increasing by age before 1991 in both genders. However, the mortality rates showed an exponentially increasing pattern for the age group of 70 and over during 1993~2001, which was more prominent in female. The birth cohort curves showed that there were 2- to 3-fold increases in the mortality rates of people who were born in 1931 for colorectal cancer compared to those of people who were born in 1921. Differences in mortality for breast cancer by birth cohort were 1.7-fold among age group of 45~49 and 50~54 between 1936 and 1946.
This analysis suggests that recent increases in mortality of colorectal cancer and breast cancer could potentially be due to birth cohort effects, i.e. rapid changes in life-style in younger generation. The quantitative approach using age-period-cohort model should be pursued.

Epidemiol Health : Epidemiology and Health