Applying multilevel model to the relationship of dietary patterns and colorectal cancer: an ongoing case-control study in Cordoba, Argentina

PURPOSES: Scientific literature has consistently shown the effects of certain diets on health but regional variations of dietary habits, and their relationship colorectal cancer (CRC) has been poorly studied in Argentina. Our aims were to identify dietary patterns and estimate their effect on CRC occurrence and to quantify the association between family history of CRC and CRC occurrence by applying multilevel models to estimate and interpret measures of variation.

METHODS: Principal components factor analysis was performed to identify dietary patterns that were then used in a multilevel logistic regression applied to an ongoing case-control data about dietary exposure and CRC occurrence taking into account familiar clustering.

RESULTS: Three dietary patterns were identified: "Southern Cone pattern" (red meat, wine, and starchy vegetables), "High-sugar drinks pattern", and "Prudent pattern". The study considered 41 cases and 95 controls. There was a significant promoting effects on CRC of "Southern Cone" (OR 1.5, 95%CI 1.0-2.2) and "High-sugar drinks" (OR 3.8, 95%CI 2.0-7.1) patterns, whereas "Prudent pattern" (OR 0.3, 95%CI 0.2-0.4) showed a significant protective effect at third tertile level. BMI, use of NSAIDs, and to have medical insurance showed significant effects. Variance of the random effect of family history of CRC was highly significant.

CONCLUSIONS: This novel approach for Argentina showed that Southern Cone and High-sugar drinks patterns were associated with a higher risk of CRC, whereas the Prudent pattern showed a protective effect. There was a significant clustering effect of family history of CRC.