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Dietary flavonoid intake and colorectal cancer risk in the European prospective investigation into cancer and nutrition (EPIC) cohort

  • Raul Zamora-Ros
  • Dinesh Kumar Barupal
  • Joseph A. Rothwell
  • Mazda Jenab
  • Veronika Fedirko
  • Isabelle Romieu
  • Krasimira Aleksandrova
  • Kim Overvad
  • Cecilie Kyrø
  • Anne Tjønneland
  • Aurélie Affret
  • Mathilde His
  • Marie-Christine Boutron-Ruault
  • Verena Katzke
  • Tilman Kühn
  • Heiner Boeing
  • Antonia Trichopoulou
  • Androniki Naska
  • Maria Kritikou
  • Calogero Saieva
  • Claudia Agnoli
  • Maria Santucci de Magistris
  • Rosario Tumino
  • Francesca Fasanelli
  • Elisabete Weiderpass
  • Guri Skeie
  • Susana Merino
  • Paula Jakszyn
  • Maria-José Sánchez
  • Miren Dorronsoro
  • Carmen Navarro
  • Eva Ardanaz
  • Emily Sonestedt
  • Ulrika Ericson
  • Lena Maria Nilsson
  • Stina Bodén
  • Bas H. Bueno-De-Mesquita
  • Petra H. Peeters
  • Aurora Perez-Cornago
  • Nicholas J Wareham
  • Kay-Thee Khaw
  • Heinz Freisling
  • Amanda J Cross
  • Elio Riboli
  • Augustin Scalbert
Publishing year: 2017-04-15
Language: English
Pages: 1836-1844
Publication/Series: International Journal of Cancer
Volume: 140
Issue: 8
Document type: Journal article
Publisher: John Wiley and Sons Inc.

Abstract english

Flavonoids have been shown to inhibit colon cancer cell proliferation in vitro and protect against colorectal carcinogenesis in animal models. However, epidemiological evidence on the potential role of flavonoid intake in colorectal cancer (CRC) development remains sparse and inconsistent. We evaluated the association between dietary intakes of total flavonoids and their subclasses and risk of development of CRC, within the European Prospective Investigation into Cancer and Nutrition (EPIC) study. A cohort of 477,312 adult men and women were recruited in 10 European countries. At baseline, dietary intakes of total flavonoids and individual subclasses were estimated using centre-specific validated dietary questionnaires and composition data from the Phenol-Explorer database. During an average of 11 years of follow-up, 4,517 new cases of primary CRC were identified, of which 2,869 were colon (proximal = 1,298 and distal = 1,266) and 1,648 rectal tumours. No association was found between total flavonoid intake and the risk of overall CRC (HR for comparison of extreme quintiles 1.05, 95% CI 0.93–1.18; p-trend = 0.58) or any CRC subtype. No association was also observed with any intake of individual flavonoid subclasses. Similar results were observed for flavonoid intake expressed as glycosides or aglycone equivalents. Intake of total flavonoids and flavonoid subclasses, as estimated from dietary questionnaires, did not show any association with risk of CRC development.


  • Cancer and Oncology
  • Nutrition and Dietetics
  • colorectal cancer
  • diet
  • EPIC
  • flavonoids
  • prospective cohort


  • Diabetes - Cardiovascular Disease
  • ISSN: 0020-7136
Emily Sonestedt
E-mail: emily [dot] sonestedt [at] med [dot] lu [dot] se

Associate senior lecturer

Nutrition Epidemiology

+46 40 39 13 25

+46 73 700 71 45


Jan Waldenströms gata 35, CRC 60:13, Malmö


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