# Trends in colorectal cancer burden attributable to lifestyle in China (1990–2021): based on the global burden of disease study, revealing declining impact of dietary factors and rising influence of tobacco, alcohol, and obesity

## TL;DR

This study shows that while dietary improvements in China have reduced colorectal cancer burden, rising obesity and processed meat consumption are increasing risks, requiring targeted public health actions.

## Contribution

The study identifies shifting lifestyle factors affecting colorectal cancer in China and projects future trends to guide public health strategies.

## Key findings

- Dietary factors like low fiber and low calcium intake showed significant declines in CRC burden from 1990 to 2021.
- Processed meat, alcohol, and high BMI are rising contributors to CRC, with high BMI projected to increase substantially through 2050.
- ARIMA projections suggest continued declines in dietary risk-related CRC burden but rising threats from obesity.

## Abstract

This study aimed to analyze trends in colorectal cancer (CRC) burden attributable to lifestyle factors in China (1990–2021), focusing on shifts of lifestyle, and to project future trajectories to inform public health strategies.

Data from the Global Burden of Disease Study 2021 were utilized to assess deaths, disability-adjusted life years (DALYs), and age-standardized rates (ASRs) for CRC linked to nine lifestyle factors (including: diet low in whole grains, diet low in milk, diet low in fiber, diet low in calcium, diet high in red meat, diet high in processed meat, smoking, high alcohol use, and high BMI). Statistical analyses included estimated annual percentage change (EAPC), Joinpoint regression, age-period-cohort modeling, and Autoregressive Integrated Moving Average (ARIMA) projections (2022–2050).

Between 1990 and 2021, the burden of CRC attributable to most dietary factors declined, with significant reductions in low fiber (DALYs EAPC: -3.77) and low calcium intake (DALYs EAPC: -3.18). In contrast, processed meat intake showed an increase (DALYs EAPC: 1.64). Alcohol-related CRC burden rose slightly (DALYs EAPC: 0.35), while high BMI showed a marked increase (DALYs EAPC: 2.31). ARIMA projections suggest continued declines in dietary risk-related CRC burden. In contrast, the burden attributable to high body-mass index (BMI) is projected to rise substantially through 2050.

While improved dietary habits have reduced CRC burden in China, rising obesity pose growing threats. Public health policies must prioritize interventions targeting processed meat intake, and weight management to curb future CRC incidence and mortality.

The online version contains supplementary material available at 10.1186/s41043-026-01239-4.