Consumption of modern and traditional Moroccan dairy products and colorectal cancer risk: a large case control study
The main objective of this study is to describe the association between the consumption of either traditional or modern dairy products or calcium intakes and the risk of colorectal cancer (CRC) in the adult Moroccan population.
A case–control study was conducted in five Moroccan hospital centers. The study was matched on sex, age (± 5 years) and center. Data were collected using validated food frequency questionnaire (FFQ) taking into account different types of Moroccan dairy products. Conditional logistic regression models were used to assess the association between dairy products consumption, calcium intakes and CRC risk subtypes. In all statistical tests, the significance level was set at 0.05.
Among 1453 cases and 1453 matched controls, 50.7% were women and 49.3% were men. Milk ORb 0.84, 95% CI 0.74–0.96 and yogurt ORb 0.74, 95% CI 0.64–0.86 were inversely associated with CRC risk. Similar inverse associations were observed for traditional dairy products namely Lben ORb 0.77, 95% CI 0.67–0.88, Raib ORb 0.86, 95% CI 0.76–0.96 and Jben ORb 0.77, 95% CI 0.67–0.88. The dairy calcium intake was inversely associated to CRC overall ORb 0.83, 95% CI 0.74–0.93.
Our study supports previous international evidence and suggests that individuals who have a high intake of either modern or traditional dairy products are at lower risk for CRC. These findings should be further confirmed by longitudinal data and studies investigating potential pathways involved.
KeywordsColorectal cancer Dairy products Prevention Morocco
Many thanks to Lalla Salma Foundation, Prevention and Treatment of Cancers (FLSC) and Moroccan Society of Diseases of the Digestive System (SMMAD) for the financing of this study. Many thanks also to all contributors to this work in the Five University Hospitals centers; the directors of UHCs: Fez (Pr. Ait Taleb K), Casablanca (Pr. Afif My H); Rabat (Pr. Chefchaouni Al Mountacer C); Oujda (Pr Daoudi A); and Marrakech (Pr. Nejmi H). The heads of medical services and their teams: Casablanca (Pr. Benider A; Pr Alaoui R; Pr. Hliwa W; Pr. Badre W, Pr. Bendahou K, Pr. Karkouri M.), Rabat (Pr. Ahallat M; Pr. Errabih I; Pr. El Feydi AE; Pr. Chad B; Pr. Belkouchi A; Pr. Errihani H; Pr. Mrabti H; Pr. Znati K), Fez (Pr. Nejjari C; Pr Ibrahimi SA; Pr. El Abkari M; Pr. Mellas N; Pr. Chbani L; Pr. Benjelloun MC), Oujda (Pr. Ismaili N; Pr. Chraïbi M; Pr. Abda N, Pr. Abbaoui S) and Marrakech (Pr. Khouchani M; Pr. Samlani Z; Pr. Belbaraka R; Pr. Amine M).
Funding-source funder-id Lalla Salma Foundation, Prevention and Treatment of Cancers (FLSC), award-id N˚06/AP2013.
Compliance with ethical standards
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
- 4.Global Burden of Disease Cancer Collaboration, Fitzmaurice C, Akinyemiju TF et al (2018) Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990 to 2016: a systematic analysis for the global burden of disease study. JAMA Oncol 4:1553–1568. https://doi.org/10.1001/jamaoncol.2018.2706 CrossRefGoogle Scholar
- 5.Steward BW, Christopher P (2014) World Cancer Report 2014. International Agency for Research on cancer, LyonGoogle Scholar
- 6.Lalla Salma Foundation Prevention (2017) Detection and treatment of cancers. Registry of Greater Casablanca 2008–2012. http://www.contrelecancer.ma/fr/documents/registre-des-cancers-de-la-region-du-grand-casab-2/. Accessed 12 Sept 2018
- 7.Kamangar F, Dores GM, Anderson WF (2006) Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol 24:2137–2150. https://doi.org/10.1200/JCO.2005.05.2308 CrossRefGoogle Scholar
- 9.Haenszel W, Kurihara M (1968) Studies of Japanese migrants. I. Mortality from cancer and other diseases among Japanese in the United States. J Natl Cancer Inst 40:43–68Google Scholar
- 10.World Cancer Research Fund/American Institute for Cancer Research (2018) Diet, nutrition, physical activity and cancer: a global perspective. Continuous update project expert report. http://dietandcancerreport.org/
- 11.Vieira AR, Abar L, Chan DSM et al (2017) Foods and beverages and colorectal cancer risk: a systematic review and meta-analysis of cohort studies, an update of the evidence of the WCRF-AICR Continuous Update Project. Ann Oncol 28:1788–1802. https://doi.org/10.1093/annonc/mdx171 CrossRefGoogle Scholar
- 13.Ralston RA, Truby H, Palermo CE, Walker KZ (2014) Colorectal cancer and nonfermented milk, solid cheese, and fermented milk consumption: a systematic review and meta-analysis of prospective studies. Crit Rev Food Sci Nutr 54:1167–1179. https://doi.org/10.1080/10408398.2011.629353 CrossRefGoogle Scholar
- 21.FAO (2011) Profil Nutritionnel du Maroc—Division de la nutrition et de la protection des consommateurs. http://www.fao.org/3/a-bc635f.pdf
- 24.Slama K (1998) Tobacco control and prevention: a guide for low-income countries. IUATLD ((International union against tuberculosis and lung disease)), ParisGoogle Scholar
- 25.Global Physical Activity Questionnaire (GPAQ). Surveillance and population-based prevention prevention of non communicable diseases. Department World Health Organization, Geneva, Switzerland. https://www.who.int/ncds/surveillance/steps/GPAQ_EN.pdf
- 26.World Health Organization WHO|Global recommendations on physical activity for health (2019) In: WHO. https://www.who.int/dietphysicalactivity/factsheet_recommendations/en/. Accessed 28 Dec 2018
- 28.Garcia-Larsen V, Luczynska M, Kowalski ML et al (2011) Use of a common food frequency questionnaire (FFQ) to assess dietary patterns and their relation to allergy and asthma in Europe: pilot study of the GA2LEN FFQ. Eur J Clin Nutr 65:750–756. https://doi.org/10.1038/ejcn.2011.15 CrossRefGoogle Scholar
- 29.El Ati J, Béji C, Farhat A et al (2007) Table de composition des aliments tunisiens. INNTA, TunisGoogle Scholar
- 30.Neve J (2008) Aliments et préparations typiques de la population Marocaine. http://www.ciriha.org/index.php/publications/outils-dietetique/product/7-aliments-et-preparations-typiques-de-la-population-marocaine. Accessed 3 Jan 2019
- 32.Mennane Z, Khedid K, Zinedine A et al (2007) Microbial characteristics of Klila and Jben traditional moroccan cheese from raw cow’s milk. World J Dairy Food Sci 2:23–27Google Scholar
- 33.Hamama A, Bayi M (1991) Composition and microbiological profile of two Moroccan traditional dairy products: raib and jben. Int J Dairy Technol 44:118–120. https://doi.org/10.1111/j.1471-0307.1991.tb01921.x CrossRefGoogle Scholar
- 34.Hal F Le Grand Livre de la cuisine marocaine (2019) https://sites.google.com/site/filhalader/le-grand-livre-de-la-cuisine-marocaine-95933791. Accessed 28 Dec 2018
- 38.Newmark HL, Wargovich MJ, Bruce WR (1984) Colon cancer and dietary fat, phosphate, and calcium: a hypothesis. J Natl Cancer Inst 72:1323–1325Google Scholar
- 44.Urbanska AM, Bhathena J, Martoni C, Prakash S (2009) Estimation of the potential antitumor activity of microencapsulated Lactobacillus acidophilus yogurt formulation in the attenuation of tumorigenesis in Apc(Min/+) mice. Dig Dis Sci 54:264–273. https://doi.org/10.1007/s10620-008-0363-2 CrossRefGoogle Scholar
- 46.Rao CV, Sanders ME, Indranie C et al (1999) Prevention of colonic preneoplastic lesions by the probiotic Lactobacillus acidophilus NCFMTM in F344 rats. Int J Oncol 14:939–944Google Scholar
- 50.Ralston RA, Truby H, Palermo CE, Walker KZ (2014) Colorectal cancer and nonfermented milk, solid cheese, and fermented milk consumption: a systematic review and meta-analysis of prospective studies. Crit Rev Food Sci Nutr 54:1167–1179. https://doi.org/10.1080/10408398.2011.629353 CrossRefGoogle Scholar
- 51.Karagianni V, Merikas E, Georgopoulos F et al (2010) Risk factors for colorectal polyps: findings from a Greek case-control study. Rev Med Chir Soc Med Nat Iasi 114:662–670Google Scholar