ABSTRACT

Background:
While dietary and lifestyle factors are well-studied for colorectal cancer (CRC) prevention, less evidence exists on their impact on CRC survival.

Methods:
PubMed and Embase were searched from inception to September 2024. Summary relative risk (SRR) and 95% confidence interval (CI) were estimated using the DerSimonian-Laird random-effects model.

Results:
Lower all-cause mortality was observed with unprocessed red meat (SRR 0.74, 95%CI 0.57-0.94), whole grains (SRR 0.77, 95%CI 0.66-0.90), coffee (SRR 0.65, 95%CI 0.55-0.77), milk (SRR 0.82, 95%CI 0.71-0.93), low-fat dairy (SRR 0.77, 95%CI 0.64-0.94), total calcium (SRR 0.76, 95%CI 0.61-0.94), alcohol intake under 45 g/day (J-shaped association), and physical activity (SRR 0.55, 95%CI 0.44-0.69). Higher all-cause mortality was observed with refined grains (SRR 1.55, 95%CI 1.03-2.33), high-fat dairy (SRR 1.34, 95%CI 1.05-1.71), smoking (current (SRR 1.49, 95%CI 1.24-1.78), former (SRR 1.18, 95%CI 1.04-1.34)), and television watching (SRR 1.28, 95%CI 1.06-1.55). Risk increased linearly with body mass index (BMI) greater than 27 kg/m2, but also increased towards lower BMI. For CRC-specific mortality, most of the results were largely consistent, with calcium supplement showing an inverse association (SRR 0.66, 95%CI 0.47-0.94).

Conclusions:
Factors related to CRC survival share differences as well as similarities with established factors related to CRC prevention. To optimize CRC survival, CRC patients may be recommended to adopt a diet rich in whole grains, coffee, milk, and dietary calcium; but to avoid excessive alcohol, refined grains, high-fat dairy, sugar sweetened beverage, smoking, and sedentary lifestyle; and to engage in regular physical activity while maintaining a healthy weight.

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