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Journal of Translational Medicine (2023) 21:482

Adherence to the Paleolithic diet
and Paleolithic-like lifestyle reduce the risk
of colorectal cancer in the United States:
a prospective cohort study

Yi Xiao1†, Yaxu Wang1†, Haitao Gu1, Zhiquan Xu1, Yunhao Tang1, Hongmei He1, Linglong Peng1* and Ling Xiang2*

Abstract

Background

The plant-based paleolithic diet (PD) and the paleolithic-like lifestyle (PLL) may reduce the risk
of chronic diseases, including colorectal adenomas. These dietary and lifestyle approaches are proposed to exert their effects through mechanisms such as reducing inflammation, oxidative stress, and insulin levels. However, whether PD and PLL is associated with the risk of colorectal cancer (CRC) has not been determined.

Methods

A cohort of 74,721 individuals who participated in the PLCO study were included in this analysis. Adher- ence to the PD and PLL was assessed using PD and PLL scores, where higher scores indicated greater adherence. Multivariable Cox models were utilized to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk of CRC and its subsites (proximal colon cancer and distal CRC). Subgroup analyses were conducted to identify poten- tial effect modifiers.

Results

During a mean follow-up of 9.2 years, a total of 694 CRC cases were identified. Participants in the high-
est compared with the lowest quartiles of PD score had a lower risk of CRC (Q4 vs Q1: HR 0.76, 95% CI 0.61–0.95,
Ptrend = 0.009) and proximal colon cancer (Q4 vs Q1: HR 0.73, 95% CI 0.55–0.97, Ptrend = 0.02). A stronger inverse associa- tion was observed for PLL score with the risk of CRC (Q4 vs Q1: HR 0.64, 95% CI 0.51–0.81, Ptrend < 0.001), proximal colon (Q4 vs Q1: HR 0.62, 95% CI 0.46–0.83, Ptrend = 0.001) and distal CRC (Q4 vs Q1: HR 0.69, 95% CI 0.48–0.98, Ptrend = 0.03). Subgroup analyses revealed the inverse association of PD score with the risk of CRC was more pronounced in par- ticipants with BMI < 30 (Q4 vs Q1: HR 0.68, 95% CI 0.53–0.87) than in those with BMI ≥ 30 (Q4 vs Q1: HR 1.07, 95% CI 0.68–1.67) (Pinteraction = 0.02).

Conclusions

Our findings suggest that adhering to the PD and PLL could be a new option to reduce CRC risk.