In Reply We thank Dr Bhopal for his correspondence. He comments on the low incidence of colorectal cancer in Pakistani men in the United Kingdom according to findings of the Scottish Health and Ethnicity Linkage Study.1 He cites other studies describing aspects of the diet (eat red meat but little processed meat, increased fruit and vegetable intake)2 and the high prevalence of diabetes and insulin resistance3 in this population. Dr Bhopal suggests from this that the association of vegetarian dietary patterns with reduced risk of colorectal cancer in Adventist Health Study 2 subjects reported in our study4 may be due to an increased consumption of fruits and vegetables, a reduced consumption of processed meats, and may not be related to insulin levels or adiposity.
Orlich MJ, Fraser GE. Diet and Colorectal Cancer Incidence—Reply. JAMA Intern Med. 2015;175(10):1727. doi:10.1001/jamainternmed.2015.4019