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Interaction between alcohol drinking and obesity in relation to colorectal cancer risk: a case-control study in Newfoundland and Labrador, Canada

Jinhui Zhao1, Yun Zhu12, Peizhong Peter Wang12*, Roy West1, Sharon Buehler1, Zhuoyu Sun1, Josh Squires1, Barbara Roebothan1, John R McLaughlin3, Peter T Campbell4 and Patrick S Parfrey5

  • * Corresponding author: Peizhong P Wang

  • † Equal contributors

Author Affiliations

1 Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, 300 Prince Philip Drive, St. John's, NL, A1B 3V6, Canada

2 School of Public Health, Tianjin Medical University, 22 Qi Xiangtai Road, Tianjin, 300070, China

3 Samuel Lunenfeld Research Institute, Mount Sinai Hospital, 60 Murray Street #L5-211, Toronto, ON, M5T 3L9, Canada

4 Epidemiology Research Program, American Cancer Society, 250 Williams Street NW, Atlanta, GA, 30303, USA

5 Clinical Epidemiology Unit, Faculty of Medicine, Memorial University of Newfoundland, 300 Prince Philip Drive, St. John's, NL, A1B 3V6, Canada

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BMC Public Health 2012, 12:94  doi:10.1186/1471-2458-12-94

Published: 1 February 2012



While substantive epidemiological literature suggests that alcohol drinking and obesity are potential risk factors of colorectal cancer (CRC), the possible interaction between the two has not been adequately explored. We used a case-control study to examine if alcohol drinking is associated with an increased risk of CRC and if such risk differs in people with and without obesity.


Newly diagnosed CRC cases were identified between 1999 and 2003 in Newfoundland and Labrador (NL). Cases were frequency-matched by age and sex with controls selected using random digit dialing. Cases (702) and controls (717) completed self-administered questionnaires assessing health and lifestyle variables. Estimates of alcohol intake included types of beverage, years of drinking, and average number of alcohol drinks per day. Odds ratios were estimated to investigate the associations of alcohol independently and when stratified by obesity status on the risk of CRC.


Among obese participants (BMI ≥ 30), alcohol was associated with higher risk of CRC (OR: 2.2; 95% CI: 1.2-4.0) relative to the non-alcohol category. Among obese individuals, 3 or more different types of drinks were associated with a 3.4-fold higher risk of CRC relative to non-drinkers. The risk of CRC also increased with drinking years and drinks daily among obese participants. However, no increased risk was observed in people without obesity.


The effect of alcohol of drinking on CRC seems to be modified by obesity.

Case-control study; Alcohol; Obesity; Colorectal cancer; Interaction; Lifestyles; Newfoundland