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Table 3 Main results of Included Studies

From: Dairy products and colorectal cancer in middle eastern and north African countries: a systematic review

Author/ Year/Reference County and setting Study design and Population Exposure and Confounders Outcome Comparison Main finding and effect
Tayyem et al., (2016) [50]. -Jordan
-Five large Jordanian hospitals including oncology services.
-Case control study
− 220 Cases were selected from five large Jordanian hospitals with oncology services.
− 281 Controls were selected from hospital personnel, outpatients and visitors.
-Exposure: meats, dairy products and fat.
-Confounders: age, sex, BMI, PA, total EI, income, occupation, education level, marital status, cigarette smoking, other health problems and family history of CRC
CRC in both sexes -Group 1: CRC cases (116 males and 104 females).
-Group 2: healthy disease-free controls (Number of males and females was not determined).
The daily consumption of:
- Labaneh ORa = 1.42 (95% CI: 0.62–3.25), ptrend = 0.03.
-Milk ORa = 1.24 (95% CI: 0.62–2.47), ptrend = 0.59.
-Yoghurt ORa = 0.76 (95% CI: 0.25–2.32), ptrend = 0.65.
-White cheese ORa = 1.06 (95% CI: 0.46–2.45), ptrend = 0.06.
- Ice cream: ORa = 1.68 (95% CI: 0.77–3.65), ptrend = 0.11.
The weekly consumption of:
- Cooked yogurt ORa = 0.59 (95% CI: 0.26–1.39), ptrend = 0.03.
The monthly consumption of:
- Processed cheese ORa = 0.29(95% CI: 0.06–1.45), ptrend = 0.004.
Suhad et al., (2015) [47]. -Jordan
-Five large Jordanian hospitals including oncology services.
-Case control study
− 167 Cases were selected from five major Jordanian hospitals including an oncology center.
− 240 Controls were selected from hospital personnel, outpatients, visitors, and accompanying individuals (not a first degree relative).
-Exposure: five food groups-grains, vegetables, fruits, milk, and meat and legumes.
-Confounders: total EI, age, sex, PA, family history of CRC, household income, marital status, and cigarette smoking.
CRC in both sexes -Group 1: CRC cases (79 males and 88 females).
-Group 2: Healthy controls (108 males and 132 females).
-Milk ORa = 0.75(95% CI: 0.40–1.40),
-Yoghurt ORa = 0.621 (95% CI: 0.36–1.06)
-Labaneh ORa = 1.32 (95% CI: 0.76–2.27)
-White cheese ORa = 1.46 (95% CI: 0.86–2.47).
Mahfouz et al., (2014) [51]. -Egypt
-Minia oncology center
-Case control study
− 150 Cases were selected from Minia oncology center.
− 300 Controls were selected from community
-Exposure: dietary and lifestyles factors.
-Confounders: PA, fruit and vegetables.
CRC in both sexes -Group 1: CRC cases receiving any treatment (72 males and 78 females)
-Group 2: Controls (144 males and 156 females).
Inverse association with calcium rich diet ORa = 0.08 (95% CI: 0.04–0.17).
Arafa et al., (2011) [46]. -Jordan
-Al-Bashir Hospital, the principal governmental center for CRC registry and therapy
-Case control study
− 220 Cases were selected from Al-Bashir Hospital.
− 220 Controls were selected from the outpatient departments.
-Exposure: smoking, alcohol drinking, family history of CRC, vitamins supplement, monthly income and physical activity, dietary intake using a FFQ.
-Confounders: routine exercise practice, smoking history, BMI, fruit, vegetables, meats, tea.
CRC in both sexes Group 1: CRC cases (118 males and 102 females)
Group 2: Controls (118 males and 102 females).
-Milk, yogurt and cheese group OR = 1.60 (95% CI: 0.84–3.04).
-Calcium ORa = 0.99 (95% CI: 0.99–1.00).
Guesmi et al., (2010) [48]. -Tunisia
-Surgery service in Nicole Charles Hospital
And in Institut Salah Azaiez of Cancerology
-Case control study
− 32 Cases were selected from Nicole Charles Hospital
And in Institut Salah Azaiez of Cancerology
− 61 Controls were selected from surgery and orthopaedic departments.
-Exposure: alimentary factors like meats group, fruits, vegetables, Raw oil, olive oil, full cereals, sweets and methods of cooking.
-Confounders: Age, sex, geographic origin, smoking, anemia, sport, walking, frequency of consumption (frequently / rarely), methods of cooking.
CRC in both sexes -Group 1: CRC cases (12 males and 20 females)
-Group 2: Controls (39 males and 22 females).
Milk ORa = 0.14 (95% CI: 0.02–0.71).
Nashar et al., (2008) [49]. -Saudi –Arabia
-King Faisal Specialist Hospital & Research Center, Riyadh
-Case-control study
−50 Cases were selected from the inpatients in KFSH and RC.
− 50 Controls were selected from the outpatients in KFSH and RC.
-Exposure: Eating habits with the frequency of consumption.
- Confounders: frequency of consumption.
Newly colon cancer in both sexes -Group 1: CRC cases (25 males and 25 females).
-Group 2: healthy controls (25 males and 25 females).
-For both sexes
-Milk OR = 9.88 (95% CI: 3.80–24.65).
-Laban OR = 18.66 (95% CI: 3.06–113.86).
-Labnah OR = 24 (95% CI: 1.74–330.82).
-For men
-Cheese OR = 8 (95% CI: 1.40–45.75).
-Laban OR = 15 (95% CI: 1.58–142.17).
-For females
-Laban OR = 27 (95% CI: 1.26–578.38).
Rozen et al., (2001) [52]. -Israël
-Gastro-enterology department at the Tel Aviv Medical Center
-Clinical trial
− 125 adenoma patients:
− 68 Intervened patients receiving 1.5 g calcium ion/day (5 chewable calcium carbonate tablets daily).
− 57 Non-intervened patients receiving no treatment.
-Exposure: dietary factors, lifestyle habits, and calcium supplementation.
-Confounders: dietary components as fat, carbohydrates, fiber, and fluid as well as tobacco uses.
Adenoma patients, without a family history of colorectal neoplasia. - Intervention group: 33 patients completed the 1 year trial (20 males and 13 females).
- Non-intervention group: 19 patients completed rectal biopsy (13 males and 6 females).
-The REP labeling index decreased in 58% of calcium-intervened patients and in only 26% of non-intervened patients
(p = 0.04).
-The interaction between the mean daily total fat and calcium effect on LI was significantly negative (in opposite directions p = 0.02).
-The interaction between the higher mean daily intake of total carbohydrates and the effect of calcium on LI was significantly positive (p = 0.001)
  1. EI: energy intake; CI: confidence interval; FFQ: food frequency questionnaire, ORa: Adjusted Odds Ratio; REP: rectal epithelial proliferation; LI: labeling index; BMI: body mass index; PA: physical activity.