Soukaina El Idrissi¹, Abdallah Mound^1*, Driss Erguibi², Asmaa Houzi³, Kenza Benjelloun², Souha Sahraoui³, Mohamed Benharouga^4,5,6, Nadia Alfaidy^4,5,6, Touria Aboussaouira¹

¹University Hassan II of Casablanca, Faculty of Medicine and Pharmacy, Laboratory of Scientific and Clinical Researches in Cancerous Pathologies, Casablanca, Morocco

²University Hassan II of Casablanca, Faculty of Medicine and Pharmacy, Department of Digestive Cancer Surgery and Liver Transplantation, Ibn Rochd University Hospital Center, Casablanca, Morocco

³University Hassan II of Casablanca, Faculty of Medicine and Pharmacy, Mohammed VI Center for Cancer Treatment, Ibn Rochd University Hospital Center, Casablanca, Morocco

⁴University Grenoble-Alpes, Grenoble, France

⁵Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA), Biosciences and Biotechnology Institute of Grenoble, Grenoble, France

⁶Institut National de la Santé et de la Recherche Médicale, Inserm U1292, Biosanté, Grenoble, France

^*Corresponding Author: Abdallah Mound. University Hassan II of Casablanca, Faculty of Medicine and Pharmacy, Laboratory of Scientific and Clinical Researches in Cancerous Pathologies, Casablanca, Morocco.

Received: 13 May 2025; Accepted: 20 May 2025; Published: 11 June 2025

Article Information

Citation: Soukaina El Idrissi, Abdallah Mound, Driss Erguibi, Asmaa Houzi, Kenza Benjelloun, Souha Sahraoui, Mohamed Benharouga, Nadia Alfaidy, Touria Aboussaouira. Risk Factors and Dietary Patterns in Digestive Cancers: A Case Series from Ibn Rochd University Hospital Center of Casablanca. Journal of Food Science and Nutrition Research. 8 (2025): 41-47.

DOI: 10.26502/jfsnr.2642-110000175

Abstract

Keywords

Digestive cancers, Diet, Risk factors

Article Details

Introduction

By the end of this century, cancer is expected to be the leading cause of death in every country in the world [1,2]. In 2020, an estimated 19.3 million new cases of cancer will be diagnosed worldwide and nearly 10 million people will die from cancer [3]. The global burden of cancer is projected to continue to increase around the world. By 2040, the worldwide incidence of cancers is estimated to increase by 47% compared to 2020 (28.4 million vs. 19.3 million) [1]. This increase would be even more pronounced (64% to 95% increase) in low and medium HDI (Human Development Index) countries such as Morocco [1,4]. The aging and demographic growth of the populations in these areas, along with the rising prevalence of recognized risk factors (such as smoking, physical inactivity, poor diet, and obesity), would all contribute to this projected increase [5]. A growing body of studies has identified certain dietary patterns as one of these risk factors that enhance the risk of cancer development. Therefore, foods such as processed meats, red meats, sugar, food additives, and various cooking methods are suspected to promote carcinogenesis process. However, it is still unclear to what extent dietary habits have an influence on the development of malignancies [6].

Digestive tract cancers rank first among nutrition-related cancers. In Morocco, they are a major public health concern, accounting for 12.41% of all diagnosed cancers and 13.7% of cancer-related mortality, according to the Global Cancer Observatory. Estimates suggest that digestive tract cancers are among those whose incidence is expected to increase significantly in the coming decades, as they are most closely linked to lifestyle changes [1,6].

The aim of the present study is to describe the socio-demographic and dietary profile of patients with digestive tract cancers (esophageal, gastric and colorectal cancer) in the Moroccan population in order to propose dietary strategies that could prevent or at least reduce the incidence of these cancers.

Patients and Methods

Setting and study design

This is a cross-sectional epidemiological study, conducted at the Mohammed VI Center for Cancer Treatment and the Department of Digestive Cancer Surgery and Liver Transplantation at the Ibn Rochd University Hospital Center of Casablanca.

Study population

The study included 110 cases of digestive tract cancers (esophageal, gastric and colorectal cancer) diagnosed and histologically confirmed during an 18-month period from January 2020 to July 2021.

Data collection

Data were collected from medical records and through a self-administered information sheet completed by the patients, which included various clinical, medical, and sociodemographic information, including cancer type, age, sex, marital status, education level, occupation, place of residence, socioeconomic level, family and medical history, and toxicologic behaviors. Concerning dietary habits, data were collected regarding the frequency of consumption of foods prevalent in the Moroccan diet.

Data analysis

Statistical analysis of the data was performed using IBM SPSS (SPSS version 25) Statistics software.

Results

Sociodemographic information

A total of 110 patients with digestive cancers participated in this study (Table 1). The mean age of patients of all sexes is 59.76 years with a standard deviation of 13.13 and a slight predominance of males (56.4%) over females (43.6%). We note that almost the majority of our patients of both sexes are married, with a percentage of 64.5%. Regarding the level of education, about half of our patients (47.3%) are illiterate, and only 5.5% of our study population had a university education.

In our cohort, 36.4% of patients are unemployed, while 41.8% are employed and 15.5% are retired. Regarding the living environment, more than half of the patients live in an urban area (57.3%), while 34.5% live in a rural area. The majority (69.1%) of patients in our cohort belong to the lower socioeconomic class and (30.9%) to the middle class.

Table 1: Description of the sociodemographic data of the 110 cases of the digestive cancers studied (esophageal, gastric, and colorectal cancers) treated between 2020-2021 at the Center Mohammed VI for Cancer Treatment and the Department of Digestive Cancer Surgery and Liver Transplantation of the Ibn Rochd University Hospital Center of Casablanca.

Toxic habits

Regarding toxic habits, 13.6% of patients - both sexes - were smokers compared to 54.5% of nonsmokers, while 20% of patients were former smokers and 11.8% were exposed to passive smoking. In addition, 10.9% of patients consume alcohol (Table 2).

Table 2: Toxic habits of the 110 cases of digestive cancers studied (esophageal, gastric, and colorectal cancers) treated between 2020-2021 at the Mohammed VI Center for Cancer Treatment and the Department of Digestive Cancer Surgery and Liver Transplantation of the Ibn Rochd University Hospital Center of Casablanca.

Medical history

Based on the data from the exploratory sheet, 28.2% of the patients had a first- or second-degree family history of cancer (Table 3). More than half of the patients in our cohort (53.6%) had no medical history, while 10.9% had diabetes and 6.4% had H. pylori infection.

Table 3: Family history of cancer and medical history of the 110 cases of digestive cancers studied (esophageal, gastric, and colorectal cancers) treated between 2020-2021 at the Mohammed VI Center for Cancer Treatment and the Department of Digestive Cancer Surgery and Liver Transplantation of the Ibn Rochd University Hospital Center of Casablanca.

Types and frequency of consumed food

The number of subjects classified by food group (shown in Table 4). This study included 4 patients with esophageal cancer, 31 with gastric cancer, and 75 with colorectal cancer.

All patients with digestive cancers enrolled in this study - both sexes combined - consume poultry, red meat, and fish with percentages of 99.1%, 95.5% and 92.7%, respectively. Eggs (91.8%) and canned fish (59.1%) were the next most commonly consumed foods. In contrast, patients reported less consumption of charcuterie (32.7%), followed by khlii/guedid - a Moroccan dried and salted meat - (26.4%), and sausages (24.5%). Fruits and vegetables were consumed by all patients. However, 76.4% of the latter also reported eating French fries. The carbohydrates consumed by the patients in our cohort were rice (83.6%), Moroccan pancakes (86.4%), and pasta (52.7%). Regarding fatty products, our results showed a high consumption of olive oil, cooking oil, and butter by 100%, 91.8%, and 78.2% of patients, respectively. In addition, 84.5% of our patients consume fried foods. The results regarding the consumption of dairy products show that a significant proportion of our patients - 70.9%, 50% and 61.8%, respectively - consume milk, raib (fermented milk) and cheese.

Finally, in the category of beverages, we note a very important consumption of tea by 98.2% of the respondents, followed by the consumption of coffee (59.1%).

Table 4: Types and frequency of foods consumed by 110 patients diagnosed with digestive cancers (esophageal, gastric, and colorectal), treated between 2020-2021 at the Mohammed VI Center for Cancer Treatment and the Department of Digestive Cancer Surgery and Liver Transplantation of the Ibn Rochd University Hospital Center of Casablanca.

The frequency of consumption for each food type (in Table 5). Patients were categorized into four groups based on their consumption frequency: never, 1–3 times per month, 1–3 times per week, and 4–7 times per week.

Table 5: Frequency of food type consumption among 110 patients diagnosed with digestive cancers (esophageal, gastric, and colorectal cancers) treated between 2020-2021 at the Mohammed VI Center for Cancer Treatment and the Department of Digestive Cancer Surgery and Liver Transplantation of the Ibn Rochd University Hospital Center of Casablanca.

Discussion

Digestive cancers remain the most frequent cancers worldwide. Colorectal, gastric and esophageal cancers together account for 19.1% of the global incidence and 22.5% of all cancer-related deaths [7]. In Morocco, colorectal and gastric cancers are among the most frequent and the deadly digestive cancers [8]. Indeed, the mortality rates of these cancers in relation to the incidence rates are higher in developing countries than in developed countries [1]. The current study aims to characterize the socio-demographic and nutritional profile of patients with digestive cancers (esophageal, gastric, and colorectal cancers) in the Moroccan population.

In our cohort, the mean age of our patients was 59.76 years with a standard deviation of 13.13 years. Our results are consistent with those of the Cancer Registry of the Greater Casablanca Region for the cancers studied [9] and with those of the Rabat Cancer Registry [10]. The sex distribution of digestive cancers (colorectal, gastric and esophageal) shows a sex ratio of 1.29 with a slight male predominance. This result is comparable to the situation in Morocco and in the world and regarding the male predominance in colorectal cancer patients [11,12]. Similar patterns in incidence were also noted in gastric cancer which is more frequent in men than in women [1,13]. This difference observed between men and women can be explained by the high prevalence of risk factors such as smoking, alcohol and bad eating habits in men [14–16].

In our study, 13.6% of the patients smoked tobacco, 20% were ex-smokers and the rest were non-smokers (54.9%). International studies have shown an association between smoking and the risk of developing colorectal cancer and gastric cancer [17,18]. The other toxic habit, which is alcohol consumption, is associated with a higher risk of colorectal, gastric and esophageal cancers [19,20]. According to data from the 2017 Stepwise survey conducted by the Moroccan Ministry of Health, only 1.7% of Moroccans aged 18 years and older consume alcohol [21]. In our cohort, 10.9% of the patients were regular drinkers. Considering the low rate of alcohol consumption in the Moroccan population, this clearly confirms the association between alcohol and the occurrence of digestive cancers.

Regarding medical history, we notice that 10.9% of our patients are diabetic. Diabetes increases the risk of cancer in several organs/tissues, including the colon/rectum [22]. Although, this association is less evident in gastric cancer [23], but diabetes shares several risk factors with digestive cancers such as obesity [24], hyperinsulinemia [25,26], hyperglycemia [27,28], insulin resistance [26,29], H. pylori infection [30,31] and some of the hypoglycemic therapeutic agents (e.g., sulfonylureas and insulin) [32].

Diet is a major contributor to the increasing incidence of cancer worldwide, including cancers of the digestive tract [33]. In our study, red meat consumption is high. Nearly 95.5% of the surveyed patients of both sexes reported eating red meat every day. Although the results of research on the relationship between red meat consumption and cancer risk have been inconsistent, the findings were robust enough for the International Agency for Research on Cancer (IARC) to categorize red meat as a probable human carcinogen (Group 2A) [34], and for the World Cancer Research Fund (WCRF) to recommend limiting red meat consumption to 350-500 g per week [17]. Consumption of processed meats (charcuterie and sausages) was relatively low among our patient, which was a favorable factor considering that the consumption of processed meats has been associated with the development of several cancers, including colorectal cancer [35–39]. Consequently, for these reasons, processed meats have been classified by the IARC agency as carcinogenic to humans (Group 1) [40]. Poultry, fish, eggs, and dairy products are highly consumed by our patients (more than 50%) and could be valuable sources of protein and micronutrients that can help replace red meat. Several studies have shown either no causal relationship between white meat consumption and the risk of digestive tract cancers or even a reduced risk [41–43].

Among our patients, 26.4% reported the consumption of a Moroccan variety of salt-preserved meat (Khlii/guedid), although it remains a rather infrequent consumption. In fact, previous findings suggest that salt-preserved foods may have a greater impact than salt itself [44–46]. A significant proportion of our patients regularly consume fried foods. Previous studies have suggested a possible link between high-fat fried foods and cancer risk, including colorectal, gastric, and esophageal cancers [47,48].

Other dietary behaviors observed in our patients are, however, thought to be protective against certain types of cancer, such as consumption of fruits and vegetables, dairy products, vegetable oils, and beverages such as tea and coffee.

Conclusion

Our results show that several dietary patterns and toxic habits that increase cancer risk were observed among patients with digestive cancers in this study.

Conflicts of interest

The authors declare no conflict of interest.

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