Assessing the Role of Ultra-Processed Foods in Colorectal Cancer Incidence - Insights from the EPIC Cohort

Sep 23, 2026

Studies have reported associations between ultra-processed food (UPF) consumption and colorectal cancer (CRC) incidence, yet the magnitude of these associations remains unclear. Using the EPIC cohort of 416,081 middle-aged adults with 5,845 incident CRC cases, the study estimated the cohort-associated fraction (CAF) linking UPFs to CRC incidence and explored potential benefits of substituting UPFs with unprocessed or minimally processed foods through Cox models.

LanguageEnglish

CategoryResearch & Report

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Pages12

Reading Time30 min

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Abstract

Background

Methods

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Berden et al. BMC Public Health (2026) 26:1800 BMC Public Health [https://doi.org/10.1186/s12889-026-27225-3](https://doi.org/10.1186/s12889-026-27225-3) RESEARCH Open Access Assessing the role of ultra-processed foods in colorectal cancer incidence: insights from the EPIC cohort Jeroen Berden 1,2*, Oliver Langselius3, Esther M. González-Gil 1, Jessica Blanco Lopez 1, Geneviève Nicolas 1, Bernard Srour4, Christopher Millett5,6, Eszter P. Vamos5, Harriet Rumgay3, Kiara Chang5, Mathilde Touvier4, Alicia K. Heath7, Cecil ie Kyrø8, Chloé Marques9, Franziska Jannasch 10, Matthias B. Schulze 10,11, Matteo Franco 12, Ana M. Jimenez Zabala 13,14, Anne Tjønneland8,15, Carla H. van Gils 16, Charlotte Le Cornet 17, Claire Cadeau9, Marcela Guevara 18,19,20, Maria-José Sanchez 19,21,22, Mariem Hajji-Louati9, Marta Crous-Bou23,24, Rosario Tumino25, Valeria Pala26, Verena Katzke 17, Guri Skeie27, Paolo Vineis7, Pietro Ferrari 1, Vivian Vial lon 1 and Inge Huybrechts 1 Abstract Background Studies have reported associations between ultra-processed food (UPF) consumption and colorectal cancer (CRC) incidence, yet the magnitude of these associations remains unclear. This study estimated the cohortassociated fraction (CAF), adapted from the population-attributable fraction metric, between UPF consumption and CRC incidence and explored the potential benefits of substituting UPFs with unprocessed or minimally processed foods. Methods Using data from 416,081 middle-aged adults in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, including 5,845 incident CRC cases, Cox proportional hazards models were applied to estimate associations between UPF consumption (grams/day) and CRC, colon and rectal cancer risks. Substitution analyses were also carried out to estimate associations of replacing UPFs with unprocessed or minimally processed foods, to reflect potentially more interpretable estimates. CAFs quantified the magnitude of these associations. Results UPF consumption was positively associated with colon cancer (HR 1-SD Increment: 1.04 [95%CI: 1.01; 1.08]) and CRC (HR 1-SD Increment: 1.04 [95%CI: 1.01; 1.07]) but not with rectal cancer incidence. The CAF for UPF consumption was 5 . 58%(95%CI: 0 . 55; 10. 50) for colon, and 5 . 10%(1 . 10; 9 . 02) for CRC incidence. Substituting 1-SD of UPFs with unprocessed or minimally processed foods was inversely associated with colon cancer (HR: 0 . 93,[95%CI: 0 . 89; 0 . 97]) and CRC incidence (HR: 0 . 94,[95%CI: 0 . 92; 0 . 98]), in energy-and nutrient-adjusted models. In substitution models, the CAF increased to 9 . 67%(4 . 36; 14. 85) for colon cancer and 7. 30%(3 . 05; 11.48) for CRC incidence. Conclusion We estimated the magnitude of associations between UPF consumption and CRC incidence, highlighting the potential public health relevance of reducing UPF intake. Given the rising consumption of UPFs and *Correspondence: Jeroen Berden jeroen.berden@ugent.be Full list of author information is available at the end of the article © The Author(s) 2026. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright

FAQs

What was the study’s main objective regarding UPFs and colorectal cancer?

To estimate the cohort-associated fraction (CAF) between ultra-processed food consumption and colorectal cancer incidence, and to assess potential benefits of substituting UPFs with unprocessed or minimally processed foods.

How was the association between UPF intake and cancer risk analyzed?

Cox proportional hazards models were used with EPIC cohort data to evaluate UPF consumption (grams/day) and risks of CRC, colon cancer, and rectal cancer.

What were the key findings about UPF consumption and CRC incidence?

UPF consumption was positively associated with colon cancer and CRC incidence, and CAF estimates quantified the magnitude. Substituting UPFs with unprocessed or minimally processed foods showed inverse associations with colon cancer and CRC incidence.

Sep 23, 2026

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