A Prospective Pooled Analysis of Meat Mutagens and Colorectal Adenoma and Cancer in the US and EPIC Studies: Findings with an Emphasis on Improving Exposure Measurements

Document Type : Systematic Review and Meta-analysis


1 Department of Internal Medicine, Bach Mai University hospital, Hanoi city, Viet Nam.

2 Food Safety Management Authority of Bac Ninh, Bac Ninh City, Vietnam.

3 Institute of Research and Development, Duy Tan University, Da Nang, Vietnam.

4 Department of Public Health, School of Medicine, International University of Health and Welfare, Japan.


Background: In animal studies, heterocyclic amines (HCAs) are recognized as having strong carcinogenicity, therefore we have hypothesized that HCAs might be associated with the risk of colorectal adenoma (CRA) and cancer (CRC). Methods: We used the Keywords of “Heterocyclic amines and colorectal cancer” to search, there were showing published articles (n=200). After reviews of titles, abstracts, and full articles, seven prospective cohort studies were included in the pooled analysis. Exposures to HCAs 2-amino-3,8-dimethylimidazo(4,5-j)quinoxaline (MeIQx), 2-amino-1-methyl-6-phenylimidazo(4,5-b)pyridine (PhIP), 2-amino-3,4,8-trimethylimidazo(4,5-f)quinoxaline (DiMeIQx), meat-derived mutagenicity (MDM), and the risk of CRA and CRC were examined. The estimated HCA intake as ng/day and ng/1,000 kcal/day by participants and by studies were examined. The ln(HR) and se(ln(HR)) were estimated from the multivariable-adjusted HR, 95%CI derived from seven published prospective studies in the US and EPIC. The random pooled multivariable-adjusted HR, 95%CI was analyzed using ln(HR) and se(ln(HR)) by STATA-10. Results: For CRC and HCA intake, the null association was observed for MDM, the random pooled multivariable-adjusted HR, (95%CI): 1.11, (1.00, 1.23); for PhIP: 1.00, (0.91, 1.09); and for DiMeIQx: 1.03, (0.87, 1.22). A significant positive association was seen for MeIQx, the random pooled multivariable-adjusted HR, (95%CI):1.12, (1.03, 1.22). For CRA and HCA intake, the null association was observed for MDM, randomly pooled multivariable-adjusted HR, (95%CI): 1.15, (0.99, 1.34), and for DiMeIQx: 1.09, (0.97, 1.23). A significant positive association was seen for PhIP, the random pooled multivariable-adjusted HR, (95%CI): 1.19, (1.02, 1.39), and for MeIQx: 1.17, (1.01, 1.35). The major instances of HCAs were contributed by chicken (54%-74%) for PhIP and by red meat (83%-92%) for MeIQx. However, the estimated PhIP intake (ng/1,000 kcal/day) was remarkably different between studies. Conclusions: We observed a positive association between exposures to MeIQx and the risk of both CRC and CRA which supports the hypothesis of the role of HCAs in developing CRA and CRC. Improving the quality of the estimated HCA intake would be highly concerned for further investigation. 


Main Subjects