Increasing Burden of Gastrointestinal Cancers in China Due to Lifestyle Factors

Obesity, unhealthy weight. Nutritionist inspecting a woman’s waist using a meter tape to prescribe a weight loss diet
Investigators estimated the time trend of dietary and lifestyle risk factors as they relate to the burden of GI cancers in China.

In China, the impact of lifestyle risk factors on gastrointestinal (GI) cancer burden is expected to increase through 2031, according to a study published in Gastroenterology.

Using data from the China Health and Nutrition Survey 1991 to 2011, researchers investigated the time trends of lifestyle factors relevant to GI cancers. Estimates were made on the population attributable fraction (PAF) of GI cancers ascribed to each risk factor. Additionally, the prevalence of these factors and their association with GI cancer burden was assessed.

The proportion of GI cancers that were attributable to lifestyle factors in 2011, and thus could have potentially been avoided, were 56.5% of colorectal, 59.8% of gastric, 48.5% of esophageal, and 35.2% of liver cancers. The overall estimated PAF of GI cancer cases associated with all lifestyle factors was 50.4%, or 661,028 cases. In 2031, it is estimated that smoking will be responsible for 170,000 GI cancer cases, sodium intake for 35,000 cases, low vegetable intake for 22,000 cases, and low fruit intake for 50,000 cases.  

The top factors contributing to an increasing GI cancer burden in China are high body mass index (BMI), red meat consumption, processed meat consumption, and low physical activity. It is expected that by 2031, these factors will account for 142,000, 185,000, 60,000, and 53,000 cases, respectively. The 2031 estimated PAF of GI cancer for all risk factors is 52.1%.

This study was limited by the lack of consideration for concurrent or synergistic interactions between risk factors. Additionally, researchers standardized the population in all years to that of 2011 in order to make longitudinal PAF comparisons, neglecting the change in population size and structure over time. Finally, because the induction period for each risk factor was not included, the estimated PAF for one year may not still be applicable a few years later.

The researchers concluded, “The impact of the lifestyle risk factors on the risk of GI cancer has been increasing from 1991 to 2011 and is projected to continue growing.” “If everyone could adhere to the optimal lifestyle, half of all GI cancer events would be prevented by year 2031. Even if the recommendations were partially followed, a substantial proportion of incident GI cancers would be preventable by maintaining the mean BMI at the current level, adhering to the Chinese dietary guideline, and reducing tobacco use,” they added.


Wu Y, Li Y, Giovannucci E. Potential impact of time trend of lifestyle risk factors on burden of major gastrointestinal cancers in China. Gastroenterol. Published online August 10, 2021. doi: 10.1053/j.gastro.2021.08.006