Dietary flavonoid intake and colorectal cancer risk: evidence from human population studies

Flavonoids are biologically active polyphenolic compounds widely distributed in plants. More than 5000 individual flavonoids have been identified, which are classified into at least 10 subgroups according to their chemical structure. Flavonoids of 6 principal subgroups- flavonols, flavones, anthocyanidins, catechins, flavanones, and isoflavones- are relatively common in human diets. Flavonoids are a large and diverse group of phytochemicals and research into their anti-carcinogenic potential with animal and cellular model systems supports a protective role. Whether dietary intake of flavonoids is protective against colorectal cancer in humans cannot be easily extrapolated from cell line and animal findings. Epidemiological assessment of the relationship between dietary flavonoid intake and colorectal cancer is limited, with different case-control and cohort study design investigating different combinations of flavonoids. Epidemiologic studies on flavonoid intake and colorectal cancer risk that were conducted yielded inconsistent results, with positive, inverse, and null associations. Because only a very limited number of epidemiological studies have been conducted to examine the associations of dietary intake of flavonoids with colorectal cancer risk, it is premature to make public health recommendations at this time. However, the data to date are promising and emphasize the need for further investigation of these important bioactive plant compounds. This review summarises the epidemiological evidence from case-control and cohort studies on the associations of dietary flavonoid intake with the risk for colorectal cancer. The difficulties in investigating this topic and possibilities for further research are then discussed.