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Is everything we eat associated with cancer? A systematic cookbook review

Schoenfeld,J.D. and Ioannidis,J.P Am.J.Clin.Nutr. 10.3945/ajcn.112.047142


Objective: To examine the conclusions, statistical significance and reproducibility in the literature on associations between specific foods and cancer risk.

Design: Review. Authors selected 50 common ingredients from random recipes in a cookbook and identified recent cohort or case-control studies, together with the most recent meta-analysis, which had evaluated the relation to cancer risk.

Setting: n/a

Participants: n/a

Main outcome measures: Authors' conclusion regarding risk, the RR estimate (HR for cohort studies, or OR for case-control studies), the exposure contrast, 95%CI and P value. For the latter, the authors considered P values between 0.05 and 0.001 as weak evidence in epidemiologic studies.

Results: At least one study was identified for 40 of the ingredients. Increased risk, decreased risk, borderline effect and no evidence of effect were concluded in 39%, 33%, 5% and 23% of studies. The authors considered that even in studies which concluded increased risk, 75% of these were weak according to their P value. There was wide variability in exposure contrasts (i.e. tertiles, quartiles, etc. or more arbitrary classifications).
Risk estimates were lower from meta-analyses compared to individual studies.

Conclusions: Associations with cancer risk can be claimed for most food ingredients. Many single studies highlight implausibly large effects, even when evidence is weak, but with lower effect sizes in meta-analyses.


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Eating a healthy, balanced diet along with taking regular exercise is key to physical and mental wellbeing.

No foods should be considered as ‘good or bad’ as all foods play an important role in the diet. It is only when foods are eaten in excess that health problems result.

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