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Heme Iron from Meat and Risk of Colorectal Cancer: A Meta-analysis and a Review of the Mechanisms Involved
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Abstract
Red meat and processed meat intake is associated with a risk of colorectal cancer, a major cause of death in affluent countries. Epidemiological and experimental evidence supports the hypothesis that heme iron present in meat promotes colorectal cancer. This meta-analysis of prospective cohort studies of colon cancer reporting heme intake included 566,607 individuals and 4,734 cases of colon cancer. The relative risk of colon cancer was 1.18 (95% CI: 1.06-1.32) for subjects in the highest category of heme iron intake compared with those in the lowest category. Epidemiological data thus show a suggestive association between dietary heme and risk of colon cancer. The analysis of experimental studies in rats with chemically-induced colon cancer showed that dietary hemoglobin and red meat consistently promote aberrant crypt foci, a putative precancer lesion. The mechanism is not known, but heme iron has a catalytic effect on (i) the endogenous formation of carcinogenic N-nitroso compounds and (ii) the formation of cytotoxic and genotoxic aldehydes by lipoperoxidation. A review of evidence supporting these hypotheses suggests that both pathways are involved in heme iron toxicity.
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“A high red meat intake (rich in heme iron), increases endogenous formation of N-nitroso compounds in the gastrointestinal tract that are associated with increased epithelial proliferation, oxidative stress, and iron-induced hypoxia signaling (166–168).”
From Food Consumption and its Impact on Cardiovascular Disease: Importance of Solutions Focused on the Globalized Food System (2015) · cites this paper as [167]
In the citing paper
“Potential mechanisms linking unprocessed red meat with CVD include saturated fat, cholesterol, iron, phosphatidylcholine, and carnitine; and cooking methods (e.g., barbecuing), that increase heterocyclic amine content and N-nitroso compounds, also implicated in colorectal cancer (167).”
From Food Consumption and its Impact on Cardiovascular Disease: Importance of Solutions Focused on the Globalized Food System (2015) · cites this paper as [167]
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BackgroundDiscovery and Features of an Alkylating Signature in Colorectal Cancer
Gurjao, C., Zhong, R., Haruki, K., Li, Y. Y., Spurr, L. F., Lee-Six, H., Reardon, B. M., Ugai, T., Zhang, X., Cherniack, A. D., et al. (2021) · Cancer Discovery · doi:10.1158/2159-8290.cd-20-1656 · Cited by 85
“The suggested mechanism is mutagenesis through alkylating damage induced by N-nitroso-compounds (NOC), which are metabolic products of blood heme iron or meat nitrites/ nitrates (11).”
Iron Load Toxicity in Medicine: From Molecular and Cellular Aspects to Clinical Implications
Kontoghiorghes, G. J. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms241612928 · Cited by 91
The role of oral iron in the treatment of adults with iron deficiency
Lo, J. O.-T., Benson, A. E., Martens, K. L., Hedges, M. A., McMurry, H. S., DeLoughery, T. G., Aslan, J. E., & Shatzel, J. J. (2022) · European Journal Of Haematology · doi:10.1111/ejh.13892 · Cited by 77
“associated with heme-iron have been previously raised, as red meat and processed meat consumption has been linked to the incidence of colon cancer in certain epidemiologic studies and in some preclinical studies using mouse models.(34) While there are not definitive studies on this topic, studies that parse out the so…”
ResultQiao, L., & Feng, Y. (2013) · Cancer Causes & Control · doi:10.1007/s10552-013-0197-x · Cited by 75
Ijssennagger, N., Rijnierse, A., de Wit, N. J. W., Jonker-Termont, D. S. M. L., Dekker, J. P., Müller, M. M., & van der Meer, R. (2011) · Gut · doi:10.1136/gutjnl-2011-300239 · Cited by 75
Dietary patterns and colorectal cancer: results from a Canadian population-based study
Chen, Z., Wang, P., Woodrow, J. R., Zhu, Y., Roebothan, B., McLaughlin, J. R., & Parfrey, P. S. (2015) · Nutrition Journal · doi:10.1186/1475-2891-14-8 · Cited by 76
“Another possible mechanism is that heme, sodium nitrate, nitrite and N-nitroso compounds, which were found in lots of red meat and processed meat, have been associated with higher CRC risk [32-35].”
BackgroundRombouts, C., Hemeryck, L., HECKE, T. V., SMET, S. D., Vos, W. H. D., & Vanhaecke, L. (2017) · Scientific Reports · doi:10.1038/srep42514 · Cited by 74
Iron in red meat–friend or foe
Czerwonka, M., & Tokarz, A. (2016) · Meat Science · doi:10.1016/j.meatsci.2016.09.012 · Cited by 82
Martin, O. C. B., Olier, M., Ellero‐Simatos, S., Naud, N., Dupuy, J., Laurence Therese, H. U. C., Taché, S., Graillot, V., Levêque, M., Bézirard, V., et al. (2019) · Microbiome · doi:10.1186/s40168-019-0685-7 · Cited by 73
“Several red meat components have been suspected to explain the link with colorectal cancer risk, including animal fat and proteins, heterocyclic amines, N-nitroso compounds, and haem iron [2, 3].”
BackgroundPham, N. M., Mizoue, T., Tanaka, K., Tsuji, I., Tamakoshi, A., Matsuo, K., Wakai, K., Nagata, C., Inoue, M., Tsugane, S., et al. (2014) · Japanese Journal of Clinical Oncology · doi:10.1093/jjco/hyu061 · Cited by 74
“Heme iron can also induce DNA damage (55), which is involved in carcinogenesis (56), and catalyze the formation of cytotoxic and genotoxic aldehydes (15).”
BackgroundDietary heme iron and the risk of colorectal cancer with specific mutations in KRAS and APC
Gilsing, A. M. J., Fransen, F., de Kok, T. M. C. M., Goldbohm, A., Schouten, L. J., de Bruïne, A. P., van Engeland, M., van den Brandt, P. A., de Goeij, A. F. P. M., & Weijenberg, M. P. (2013) · Carcinogenesis · doi:10.1093/carcin/bgt290 · Cited by 78
“A recently conducted meta-analysis of five prospective studies showed a consistent, though modest, increased risk of 18% comparing the highest to the lowest category of heme iron intake (11).”
BackgroundXu, X., Yu, E., Gao, X., Song, N., Liu, L., Wei, X., Zhang, W., & Fu, C. (2012) · International Journal of Cancer · doi:10.1002/ijc.27625 · Cited by 72
“Additionally, heme iron from red meat might be another potential risk factor for CRC development.(8) It has been established that most CRCs arise from colorectal adenoma (CRA) by a process referred to as the adenoma–carcinoma sequence.”
BackgroundWindey, K., Preter, V. D., Louat, T., Schuit, F. C., Herman, J., Vansant, G. A. A. M., & Verbeke, K. (2012) · PLoS ONE · doi:10.1371/journal.pone.0052387 · Cited by 72
“As high meat intake is not only associated with higher protein intake but also with a higher intake of fat [14], heterocyclic amines [18] and heme [19], it is extremely difficult to attribute the increased CRC and IBD risk to protein intake or fermentation.”
BackgroundChiavarini, M., Bertarelli, G., Minelli, L., & Fabiani, R. (2017) · Nutrients · doi:10.3390/nu9050514 · Cited by 70
“Meat is rich in heme iron which has been implicated in the colon carcinogenesis by promoting oxidative damage and nitrosilation [7].”
BackgroundMeat-Related Compounds and Colorectal Cancer Risk by Anatomical Subsite
Miller, P. E., Lazarus, P. J., Lesko, S. M., Cross, A. J., Sinha, R. R., Laio, J., Zhu, J., Harper, G. R., Muscat, J. E., & Hartman, T. J. (2013) · Nutrition and Cancer · doi:10.1080/01635581.2013.756534 · Cited by 67
“Several individual compounds have been suggested to explain the underlying mechanisms by which red and processed meat may increase the risk of colorectal cancer, including heme iron (8,9), heterocyclic amines (HCAs) (8,10), polycyclic aromatic hydrocarbons (PAHs) (11), and nitrites and nitrates (8,12).”
BackgroundZhong, Y., Zhu, Y., Li, Q., Wang, F., Ge, X., Zhou, G., & Miao, L. (2020) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/nqaa083 · Cited by 70
Lee, S. Y., Lee, D. Y., Kang, J. H., Kim, J. H., Jeong, J. W., Kim, H. W., Oh, D. H., Yoon, S. H., & Hur, S. J. (2022) · Food Research International · doi:10.1016/j.foodres.2022.111327 · Cited by 69
Joshi, A. D., Kim, A., Lewinger, J. P., Ulrich, C. M., Potter, J. D., Cotterchio, M., Marchand, L. L., & Stern, M. C. (2015) · Cancer Medicine · doi:10.1002/cam4.461 · Cited by 64
“A meta-analysis of prospective cohort studies reported evidence for a positive association between heme intake and CRC risk [8].”
BackgroundIs Timing Important? The Role of Diet and Lifestyle During Early Life on Colorectal Neoplasia
Nimptsch, K., & Wu, K. (2018) · Current Colorectal Cancer Reports · doi:10.1007/s11888-018-0396-7 · Cited by 63
Katidi, A., Xypolitaki, K., Vlassopoulos, A., & Kapsokefalou, M. (2023) · Nutrients · doi:10.3390/nu15020401 · Cited by 66
Parr, C. L., Hjartåker, A., Lund, E., & Veierød, M. B. (2013) · International Journal of Cancer · doi:10.1002/ijc.28101 · Cited by 62
Jeyakumar, A., Dissabandara, L., & Gopalan, V. (2016) · Journal of Gastroenterology · doi:10.1007/s00535-016-1294-x · Cited by 64
Bastide, N. M., Morois, S., Cadeau, C., Kangas, S. T., Serafini, M., Gusto, G., Dossus, L., Pierre, F. H. F., Clavel‐Chapelon, F., & Boutron‐Ruault, M. (2016) · Cancer Epidemiology Biomarkers & Prevention · doi:10.1158/1055-9965.epi-15-0724 · Cited by 60
“In processed red meat, heme iron is nitrosylated because curing salt contains nitrate or nitrite (5), and the International Agency for Research on Cancer recently classified processed red meat as a carcinogen (8).”
BackgroundResultInfluentialQamar, T. R., Syed, F., Nasir, M., Rehman, H., Zahid, M., Liu, R., & Iqbal, S. (2016) · Nutrients · doi:10.3390/nu8080465 · Cited by 60
“Being quite a complex process, many factors contribute to the onset of colon cancer and the major risk factors include family history, age, pre-carcinogens present in the food chain and environment [1,2], inflammatory bowel diseases, low intake of vegetables, fruits and fibers, high consumption of red meat and process…”
BackgroundHeme Iron Intake and Risk of Stroke
Kałuża, J., Wolk, A., & Larsson, S. C. (2013) · Stroke · doi:10.1161/strokeaha.112.679662 · Cited by 59
A prospective study of intakes of zinc and heme iron and colorectal cancer risk in men and women
Zhang, X., Giovannucci, E. L., Smith‐Warner, S. A., Wu, K., Fuchs, C. S., Pollak, M., Willett, W. C., & Ma, J. (2011) · Cancer Causes & Control · doi:10.1007/s10552-011-9839-z · Cited by 55
Lei, L., Zhang, J., Decker, E. A., & Zhang, G. (2021) · Frontiers in Cell and Developmental Biology · doi:10.3389/fcell.2021.665591 · Cited by 57
Iron metabolism in colorectal cancer: a balancing act
Estêvão, D., da Cruz-Ribeiro, M., Cardoso, A. P., Costa, Â. M., Oliveira, M. J., Duarte, T. L., & Cruz, T. (2023) · Cellular Oncology · doi:10.1007/s13402-023-00828-3 · Cited by 56
“Additionally, heme iron is a potential pro-oxidant capable of generating reactive oxygen species (ROS), acting as a nitrosating agent, and consequently, increasing lipid peroxidation and carcinogenic N-nitroso compounds [21, 33, 39].”
BackgroundWhat causes human cancer? Approaches from the chemistry of DNA damage
Kasai, H. (2016) · Genes and Environment · doi:10.1186/s41021-016-0046-8 · Cited by 53
“Based on epidemiological studies, a higher intake of heme iron is positively associated with colorectal cancer risk [46].”
BackgroundDiet and Lifestyle in Survivors of Colorectal Cancer
Lee, J., Jeon, J. Y., & Meyerhardt, J. A. (2014) · Hematology/Oncology Clinics of North America · doi:10.1016/j.hoc.2014.09.005 · Cited by 53
Diallo, A., Srour, B., Sellem, L., Deschasaux, M., Latino‐Martel, P., Herçberg, S., Galan, P., Fassier, P., Guéraud, F., Pierre, F. H. F., et al. (2018) · International Journal of Cancer · doi:10.1002/ijc.31593 · Cited by 53
“heterocyclic amines, polycyclic aromatic hydrocarbons, N-nitroso compounds.(10,11) However, the links between other animal products, notably dairies, and cancer risk are still unclear.”
BackgroundBaradat, M., Jouanin, I., Dalleau, S., Taché, S., Gieules, M., Debrauwer, L., Canlet, C., Laurence Therese, H. U. C., Dupuy, J., Pierre, F. H. F., et al. (2011) · Chemical Research in Toxicology · doi:10.1021/tx2003036 · Cited by 50
Metadata
- Authors
- Bastide, N. M., Pierre, F. H. F., & Corpet, D. E.
- Affiliations
- École Nationale Vétérinaire de Toulouse (FR)
- Corresponding author
- Pierre, Fabrice H.F.
- Venue
- Cancer Prevention Research
- Published
- 2011-02-01
- Volume
- 4
- Issue
- 2
- Pages
- 177-184
- ISSN
- 1940-6207 (ISSN-L)
- 1940-6215
- OpenAlex
- W2106489922
- Cited by
- 397
- References
- 76
- Citations by year
- 2026: 22 · 2025: 24 · 2024: 18 · 2023: 23 · 2022: 18 · 2021: 24 · 2020: 29 · 2019: 28 · 2018: 29 · 2017: 23 · 2016: 45 · 2015: 31 · 2014: 25 · 2013: 31 · 2012: 19
- FWCI
- 3.97
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Cancer Prevention Research (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion, other-oa)
- Funders
- Institut National de la Santé et de la Recherche Médicale
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Health Sciences › Medicine › Oncology › Colorectal Cancer Screening and Detection
- Life Sciences › Agricultural and Biological Sciences › Animal Science and Zoology › Meat and Animal Product Quality
- Keywords
- heme iron, red meat, processed meat, colorectal cancer, colon cancer, aberrant crypt foci, N-nitroso compounds, lipid peroxidation, aldehydes, carcinogenesis mechanisms, hemoglobin
- MeSH terms
- Animals, Heme, Humans, Meat Products, Review Literature as Topic, Colorectal Neoplasms, Iron, Dietary, Rats
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