Skip to main content Accessibility help

Temporal trends in food group availability and cancer incidence in Africa: an ecological analysis

  • Elom K Aglago (a1), Freddie Bray (a2), Francis Zotor (a3), Nadia Slimani (a1), Veronique Chajès (a1), Inge Huybrechts (a1), Pietro Ferrari (a1), Marc J Gunter (a1) and the Members of the African Cancer Registry Network (a1) (a2) (a3)...



We evaluated the relationship between food availability, as the only dietary exposure data available across Africa, and age-standardised cancer incidence rates (ASR) in eighteen countries.


Ecological study.


Availability of food groups and dietary energy was considered for five hypothetical time points: years of collection of ASR (T0) and 5, 10, 15 and 20 preceding years (T–5, T–10, T–15, T–20). Ecological correlations adjusted for human development index, smoking and obesity rates were calculated to evaluate the relationship between food availability and ASR of breast, prostate, colorectal, oesophageal, pancreatic, stomach and thyroid cancer.


Red meat was positively correlated with pancreatic cancer in men (T–20: r–20 = 0·61, P < 0·05), stomach cancer in women (T0: r0 = 0·58, P < 0·05), and colorectal cancer in men (T0: r0 = 0·53, P < 0·05) and women (T–20: r–20 = 0·58, P < 0·05). Animal products including meat, animal fats and higher animal-sourced energy supply tended to be positively correlated with breast, colorectal, pancreatic, stomach and thyroid cancer. Alcoholic beverages were positively correlated to oesophageal cancer in men (r0 = 0·69, P < 0·001) and women (r–20 = 0·72, P < 0·001).


The present analysis provides initial insights into the impact of alcoholic beverages, and increasing use of animal over plant products, on the incidence of specific cancers in Africa. The findings support the need for epidemiological studies to investigate the role of diet in cancer development in Africa.


Corresponding author

*Corresponding author: Email


Hide All

Members of the African Cancer Registry Network are listed in the Appendix.



Hide All
1.Fitzmaurice, C, Allen, C, Barber, RM et al. (2017) Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: a systematic analysis for the Global Burden of Disease Study. JAMA Oncol 3, 524548.
2.Siegel, RL, Miller, KD & Jemal, A (2017) Cancer statistics, 2017. CA Cancer J Clin 67, 730.
3.Arnold, M, Sierra, MS, Laversanne, M et al. (2017) Global patterns and trends in colorectal cancer incidence and mortality. Gut 66, 683691.
4.Sankaranarayanan, R, Swaminathan, R, Brenner, H et al. (2010) Cancer survival in Africa, Asia, and Central America: a population-based study. Lancet Oncol 11, 165173.
5.Bray, F, Ferlay, J, Soerjomataram, I et al. (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68, 394424.
6.Sylla, BS & Wild, CP (2012) A million Africans a year dying from cancer by 2030: what can cancer research and control offer to the continent? Int J Cancer 130, 245250.
7.Bray, F, Jemal, A, Grey, N et al. (2012) Global cancer transitions according to the Human Development Index (2008–2030): a population-based study. Lancet Oncol 13, 790801.
8.Stein, CJ & Colditz, GA (2004) Modifiable risk factors for cancer. Br J Cancer 90, 299303.
9.Norat, T, Scoccianti, C, Boutron-Ruault, MC et al. (2015) European Code against Cancer 4th Edition: Diet and cancer. Cancer Epidemiol 39, Suppl. 1, S56S66.
10.Hawkes, C (2006) Uneven dietary development: linking the policies and processes of globalization with the nutrition transition, obesity and diet-related chronic diseases. Global Health 2, 4.
11.Vorster, HH, Kruger, A & Margetts, BM (2011) The nutrition transition in Africa: can it be steered into a more positive direction? Nutrients 3, 429441.
12.Popkin, BM & Du, S (2003) Dynamics of the nutrition transition toward the animal foods sector in China and its implications: a worried perspective. J Nutr 133, 11 Suppl. 2, 3898S3906S.
13.Popkin, BM (2017) Relationship between shifts in food system dynamics and acceleration of the global nutrition transition. Nutr Rev 75, 7382.
14.Kosulwat, V (2002) The nutrition and health transition in Thailand. Public Health Nutr 5, 183189.
15.Zhang, J, Dhakal, IB, Zhao, Z et al. (2012) Trends in mortality from cancers of the breast, colon, prostate, esophagus, and stomach in East Asia: role of nutrition transition. Eur J Cancer Prev 21, 480489.
16.Armstrong, B & Doll, R (1975) Environmental factors and cancer incidence and mortality in different countries, with special reference to dietary practices. Int J Cancer 15, 617631.
17.World Cancer Research Fund (2018) Recommendations and public health and policy implications. (accessed April 2019).
18.International Agency for Research on Cancer (2018) Global Cancer Observatory (GCO). (accessed October 2018).
19.Parkin, DM, Ferlay, J, Jemal, A et al. (2018) Cancer in Sub-Saharan Africa. IARC Scientific Publication no. 167. Lyon: International Agency for Research on Cancer.
20.Doll, R, Payne, P & Waterhouse, J (1966). Cancer Incidence in Five Continents: A Technical Report. Berlin: Springer-Verlag.
21.Food and Agriculture Organization of the United Nations (2001) Food Balance Sheets: A Handbook. Rome: FAO.
22.Grant, W (2014) A multicountry ecological study of cancer incidence rates in 2008 with respect to various risk-modifying factors. Nutrients 6, 163189.
23.Sasco, AJ, Secretan, MB & Straif, K (2004) Tobacco smoking and cancer: a brief review of recent epidemiological evidence. Lung Cancer 45, Suppl. 2, S3S9.
24.Lauby-Secretan, B, Scoccianti, C, Loomis, D et al. (2016) Body fatness and cancer – viewpoint of the IARC Working Group. N Engl J Med 375, 794798.
25.Buis, ML (2007) PCORRMAT: Stata module to compute partial correlation coefficients controlled for a fixed set of covariates. (accessed October 2018).
26.Benjamini, Y & Hochberg, Y (1995) Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc Series B Methodol 57, 289300.
27.Aune, D, De Stefani, E, Ronco, A et al. (2009) Meat consumption and cancer risk: a case–control study in Uruguay. Asian Pac J Cancer Prev 10, 429436.
28.Genkinger, JM & Koushik, A (2007) Meat consumption and cancer risk. PLoS Med 4, e345.
29.Bouvard, V, Loomis, D, Guyton, KZ et al. (2015) Carcinogenicity of consumption of red and processed meat. Lancet Oncol 16, 15991600.
30.Graham, A, Adeloye, D, Grant, L et al. (2012) Estimating the incidence of colorectal cancer in Sub-Saharan Africa: a systematic analysis. J Glob Health 2, 020404.
31.Irabor, D (2017) Emergence of colorectal cancer in West Africa: accepting the inevitable. Niger Med J 58, 8791.
32.Wie, GA, Cho, YA, Kang, HH et al. (2014) Red meat consumption is associated with an increased overall cancer risk: a prospective cohort study in Korea. Br J Nutr 112, 238247.
33.McCullough, ML, Jacobs, EJ, Shah, R et al. (2018) Meat consumption and pancreatic cancer risk among men and women in the Cancer Prevention Study-II Nutrition Cohort. Cancer Causes Control 29, 125133.
34.Zheng, J, Guinter, MA, Merchant, AT et al. (2017) Dietary patterns and risk of pancreatic cancer: a systematic review. Nutr Rev 75, 883908.
35.Zhang, J, Zhao, Z & Berkel, HJ (2005) Animal fat consumption and pancreatic cancer incidence: evidence of interaction with cigarette smoking. Ann Epidemiol 15, 500508.
36.Ghadirian, P, Thouez, JP & PetitClerc, C (1991) International comparisons of nutrition and mortality from pancreatic cancer. Cancer Detect Prev 15, 357362.
37.Thiebaut, AC, Jiao, L, Silverman, DT et al. (2009) Dietary fatty acids and pancreatic cancer in the NIH–AARP diet and health study. J Natl Cancer Inst 101, 10011011.
38.Shen, QW & Yao, QY (2015) Total fat consumption and pancreatic cancer risk: a meta-analysis of epidemiologic studies. Eur J Cancer Prev 24, 278285.
39.Schaafsma, T, Wakefield, J, Hanisch, R et al. (2015) Africa’s oesophageal cancer corridor: geographic variations in incidence correlate with certain micronutrient deficiencies. PLoS One 10, e0140107.
40.Patel, K, Wakhisi, J, Mining, S et al. (2013) Esophageal cancer, the topmost cancer at MTRH in the Rift Valley, Kenya, and its potential risk factors. ISRN Oncol 2013, 503249.
41.Menya, D, Kigen, N, Oduor, M et al. (2019) Traditional and commercial alcohols and esophageal cancer risk in Kenya. Int J Cancer 44, 459469.
42.Kane-Diallo, A, Srour, B, Sellem, L et al. (2018) Association between a pro plant-based dietary score and cancer risk in the prospective NutriNet-Santé cohort. Int J Cancer 143, 21682176.
43.Burkitt, DP (1971) Epidemiology of cancer of the colon and rectum. Cancer 28, 313.
44.Aune, D, Chan, DS, Greenwood, DC et al. (2012) Dietary fiber and breast cancer risk: a systematic review and meta-analysis of prospective studies. Ann Oncol 23, 13941402.
45.Simpson, HL & Campbell, BJ (2015) Review article: dietary fibre–microbiota interactions. Aliment Pharmacol Ther 42, 158179.
46.O’Keefe, SJ, Li, JV, Lahti, L et al. (2015) Fat, fibre and cancer risk in African Americans and rural Africans. Nat Commun 6, 6342.
47.Ntandou, G, Delisle, H, Agueh, V et al. (2009) Abdominal obesity explains the positive rural–urban gradient in the prevalence of the metabolic syndrome in Benin, West Africa. Nutr Res 29, 180189.
48.Sodjinou, R, Agueh, V, Fayomi, B et al. (2009) Dietary patterns of urban adults in Benin: relationship with overall diet quality and socio-demographic characteristics. Eur J Clin Nutr 63, 222228.
49.White, MC, Shoemaker, ML, Park, S et al. (2017) Prevalence of modifiable cancer risk factors among US adults aged 18–44 years. Am J Prev Med 53, 3S1, S14S20.
50.Jensen, BE, Oette, M, Haes, J et al. (2017) HIV-associated gastrointestinal cancer. Oncol Res Treat 40, 115118.
51.Angkurawaranon, C, Nitsch, D, Larke, N et al. (2016) Ecological study of HIV infection and hypertension in Sub-Saharan Africa: is there a double burden of disease? PLoS One 11, e0166375.
52.Jacobs, I, Taljaard-Krugell, C, Ricci, C et al. (2019) Dietary intake and breast cancer risk in black South African women: the South African Breast Cancer study. Br J Nutr 121, 591600.


Related content

Powered by UNSILO
Type Description Title
Supplementary materials

Aglago et al. supplementary material
Aglago et al. supplementary material 1

 Word (21 KB)
21 KB
Supplementary materials

Aglago et al. supplementary material
Aglago et al. supplementary material 2

 Unknown (1.6 MB)
1.6 MB

Temporal trends in food group availability and cancer incidence in Africa: an ecological analysis

  • Elom K Aglago (a1), Freddie Bray (a2), Francis Zotor (a3), Nadia Slimani (a1), Veronique Chajès (a1), Inge Huybrechts (a1), Pietro Ferrari (a1), Marc J Gunter (a1) and the Members of the African Cancer Registry Network (a1) (a2) (a3)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.