Association of Lifestyle and Dietary Factors with Colorectal Cancer Risk and Stage at Diagnosis in Northern Punjab: A Case–Control Study
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Background: Colorectal cancer is increasingly recognized as an important public health problem in Pakistan, where lifestyle transition, unhealthy dietary patterns, limited screening, and delayed symptom recognition may contribute to both disease occurrence and advanced-stage presentation. Objective: This study examined the association of lifestyle and dietary factors with colorectal cancer risk and assessed factors associated with advanced stage at diagnosis among colorectal cancer cases. Methods: A hospital-based unmatched case–control study was conducted in selected tertiary care hospitals of Northern Punjab, Pakistan. The study included 300 adults, comprising 150 histopathologically confirmed colorectal cancer cases and 150 controls without colorectal cancer. Data were collected using a structured interview-based questionnaire covering socio-demographic characteristics, dietary exposures, physical activity, sedentary behavior, smoking, body mass index, and family history. Clinical presentation and stage at diagnosis were extracted from hospital records. Odds ratios and multivariable logistic regression were used to estimate associations. Results: Red meat intake ≥3 times/week, processed meat use, low-fiber diet, low physical activity, current smoking, and obesity remained independently associated with colorectal cancer. Daily fruit and vegetable intake showed protective associations. Among cases, 57.3% presented with Stage III–IV disease. Advanced stage was most strongly associated with symptom duration >3 months (AOR 4.12; 95% CI 2.02–8.41), followed by low-fiber diet, low fruit and vegetable intake, and low physical activity. Conclusion: Colorectal cancer in this setting was strongly linked with modifiable dietary and lifestyle factors and delayed symptom presentation. Prevention strategies should combine healthier dietary patterns, physical activity promotion, tobacco control, weight management, symptom awareness, and faster referral pathways
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