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Cancer is second leading cause of death worldwide, accounting for an estimated 9.6 million deaths in year 2018, from which 70% death occurred in low- and middle-income countries. World Health Organization estimates that there will be 20 million new cases and 12 million deaths from cancer alone by the year 2020 [1]. Furthermore, the WHO reported that in Western countries, the rate of colorectal cancer (CRC) has increased dramatically as compared to other types of cancers, and this increase was attributed to westernization in food choices and dietary pattern as well as adopting a sedentary lifestyle [1, 2]. CRC is the third most common cancer and a major cause of cancer mortality and over 1.8 million cases were reported during 2018. Although the introduction of colonoscopy techniques has made it easier to diagnose CRC at an early stage, in most of the cases it can occur due to sporadic tumorigenesis via the adenoma-carcinoma sequence [3, 4]. Chronic inflammation is implicated in causing cancer and the process can take years to develop CRC [5]. An early screening will therefore allow in making an advance action plan for CRC diagnosis, which will not only help to reduce health cost for secondary treatments but will also support to improve the efficiency of country’s work force. Although the CRC cases in the USA have dropped by 30% during the last decade, the CRC cases in the Arab world have increased [6, 7]. Hyperhomocysteinemia (HHcy) is an independent risk factor of coronary heart disease, stroke, peripheral vascular diseases, and cancers [8]. HHcy induces cancer by cellular oxidative stress, through oxidant-mediated responses, and epigenetic modifications such as alterations of DNA methylation and their regulatory role in gene expression. High levels of plasma homocysteine levels have been observed in cancer patients, indicating its association with venous and arterial thrombosis [9]. Venous thromboembolism is the second most common cause of death in cancer patients [10].

Homocysteine (Hcy) is a sulfur-containing amino acid, which is produced during the metabolism of methionine. Impairment in one carbon metabolism (OCM) is believed to be responsible for elevated plasma homocysteine (Hcy) levels or hyperhomocysteinemia (HHcy), which is considered as an independent risk factor of coronary artery disease (CAD). There are multifactorial causes of HHcy including the genetic factors, polymorphisms of key OCM enzymes, particularly in case of nutritional deficiencies of certain B-vitamins (folate, riboflavin, vitamin B6 and B12), disease state, smoking and drugs. The association between plasma homocysteine levels and cardiovascular disease risk has spawned attention to develop strategies to lower plasma homocysteine levels that may improve the vascular disease-associated morbidity and mortality. The data derived largely from observational and cross-sectional studies as well as from some clinical trials indicate that elevated levels of circulating homocysteine (>12 μM/L) are cytotoxic and can cause vascular damage, increase the risk for developing atherothrombotic CAD, peripheral vascular disease, myocardial infarction, and stroke. Understanding the cellular mechanisms by which homocysteine promotes the oxidative stress-induced vascular dysfunction, has provided sufficient evidence to conduct clinical trials to lower homocysteine levels with B-vitamins as a novel therapeutic approach to patients with cardiovascular diseases. This chapter reviews the scientific evidence about the potential causes of hyperhomocysteinemia and its link as a risk factor in the pathobiology of CAD and the role of B-vitamin supplementation in the prevention of hyperhomocysteinemia-associated CAD.

When it comes to food, there has been a noticeable increase in the consumption of snacks, fast food, sweets, meat, milk products and savory. This increase is met by a decrease in the consumption of fresh fruits and vegetables. This change is moving forward towards transforming the lifestyle, and several surveys showed that the increase in consumption of fats and carbohydrates as well as other mentioned products lead to high calorie intake which increases the risk of type 2 diabetes (T2DM) [1]. It also noted that this risk is transferred to an earlier age as it is now including preadolescents as well as the late adulthood stage, this will increase the incidence of T2DM unless a health program is developed to combat this risk [2].

The significance of elevated blood homocysteine (Hcy) in clinical practice is a serious subject for researchers and is considered as a marker of certain diseases [1]. Hcy, is a sulfur containing, non-proteinogenic amino acid required for the growth of cells and tissues [2, 3]. It is produced exclusively from methionine (Met), an essential amino acid obtained from diet [4]. Hcy is normally present in human plasma at lower concentrations. The normal range is reported to be 5–15 micromol/L [5]. The level could be affected by health-related behaviours, including diet, excessive coffee intake, alcohol consumption, cigarette smoking, and sedentary lifestyle [6, 7]. Total plasma Hcy could be in the form of free Hcy, protein-bound Hcy, oxidized forms of Hcy, and Hcy-thiolactone [3]. This is used as a predictive risk factor for stroke progression, cardiovascular disorders, test for vitamin B12 deficiency, and screening for inborn errors of Met metabolism. An increase of Hcy is referred to as hyperhomocysteinemia (HHcy) which is a sensitive marker of folate and vitamin B 12 deficiency and is associated with an increased risk of cardiovascular disease (CVD), pregnancy complications, cognitive impairment, stoke, and other diseases [8–10]. Plasma levels between 15 and 30 micromol/L are referred as mild HHcy, whereas levels between 31 and 100 micromol/L are moderate HHcy and levels above 100 micromol/L are described as severe HHcy [11]. There are also other studies which report that HHcy are associated with atherosclerosis, thrombosis, birth defects, osteoporosis, diabetes, and renal disease [2]. It is also reported to be highly prevalent in chronic kidney disease (CKD) patients. There are several risk factors that could lead to HHcy- the main cause being insufficient intake of vitamin B group especially folic acid (B9), pyridoxine (B6), or B12 (cyanocobalamin), and several polymorphisms involved in methionine (Met) metabolism [9]. This could also lead to high excretion of Hcy (oxidized Hcy) in urine (homocystinuria) [12]. The relation between HHcy and morphological changes in the organs are extremely important to improve the diagnostic methods and to develop effective treatment.

Inflammation is a natural clinical repair response of body’s immune system to protect its tissues from various noxious stimuli that continues to remodel throughout the lifecycle because of interactions between genes, lifestyles, and environments. There is a link between inflammation, elevated plasma homocysteine levels and cardiometabolic diseases. Multiple mechanisms have been proposed through which homocysteine can modulate the inflammatory response, though the exact mechanism is not clearly understood. The serum homocysteine concentration is considered as an independent risk factor for many disease conditions including cardiovascular diseases (CVD). Epidemiological evidence indicates that moderate consumption of anthocyanins is associated with reduced risk of atherosclerosis and cardiovascular diseases. However, a clear relationship between anthocyanin and homocysteine has not yet been developed. Anthocyanins are water soluble blue, red, and purple pigments, present in the vacuolar sap of the epidermal tissues of plant parts. As therapeutic agents, they are well-accepted in folk medicine worldwide and are linked to a myriad of health benefits. Anthocyanins impart an amazing role in lessening inflammation in body tissues. The molecular mechanisms involved in anti-inflammatory activities include inhibition of pro-inflammatory enzymes, such as cyclooxygenase-2, lipoxygenase and inducible nitric oxide (NO) synthase, inhibition of NF-kB and activating protein-1 (AP-1) and activation of phase II antioxidant detoxifying enzymes, mitogen-activated protein kinase (MAPK), protein kinase C and nuclear factor-erythroid 2-related factor 2. This chapter discusses the interrelationship between hyperhomocysteinemia, inflammation and anthocyanins, as well as the mechanisms of action and anti-inflammatory role of anthocyanins in the prevention of cardiometabolic diseases.

Chronic diseases have become the largest contributor to worldwide morbidity and mortality. Healthy diet represents an effective primary intervention measure in combating the onset of chronic diseases, and epidemiological studies had documented that Mediterranean foods are associated with low incidence of chronic diseases. Mediterranean diet is a combination of vegetables, fruits, moderate amounts of fish, white meat and some dairy produce. One key aspect of the Mediterranean diet is the inclusion of olive oil, nuts and fish. This chapter aims to clarify the positive effects of Mediterranean foods, mainly olive oil, polyphenols, nuts and fish in relation to human health and therapeutic properties.

Colorectal cancer (CRC) is the world’s third most common cancer. Before the twentieth century, CRC was relatively uncommon; however, the incidence has risen dramatically especially in the last 50 years. Several risk factors have been proposed, including the adoption of westernized diet, obesity, and physical inactivity. The majority of colorectal cancer continues to occur in industrialized countries. According to the recent studies, CRC is associated with several modifiable and non-modifiable risk factors. These risk factors involve CRC history in first-degree relative, inflammatory bowel disease, consumption of red meat, fruit, and vegetables, cigarette smoking, body mass index to overall population, race, gender, personal habit of alcohol consumption and smoking, ethnicity diabetes, and physical activity. Here we review the key evidence for the role of different risk factors and their effect on CRC prevention and progression.

Clinical studies have claimed in general to show a correlation between high consumption of phenolic antioxidants and reduced risks of certain types of cancer. The main antioxidant activity that has been associated with polyphenols is the ability to scavenge free radicals. Prevention of cancer may be accomplished through primary prevention, secondary prevention, or a combination of these approaches. The objective of primary prevention is to prohibit effective contact of a carcinogenic agent with a susceptible target in the human body, so that the sequence of events that culminates in the occurrence of clinical cancer does not begin or is aborted at the start. Primary prevention of cancer might be implemented by fortifying the human diet with an effective dietary chemoprevention, among this approach is the date pit extract.

The preventive measures of diseases are based on the risk and their severity. However, in reality, multiple risks are involved and cumulative risk factor is defined as the combination of threats from exposure to multiple agents or stressors. Cancer is a multifactorial disease caused by combined effects of both genetic and environmental factors. The environmental risk factors include non-genetic factors, such as diet, alcohol consumption, smoking, lifestyle, and infectious agents. The environmental factors include wide exposure of chemicals from environment, atmosphere, and foods. The genetic factors and their interrelationships with the environmental factors also play an important role. Consequently, it is important to understand both genetic and environmental risk factors properly to take actions towards the reduction of the overall risk. It is also important to be aware of the risk factors and initiate communications between different parties to combat cancer.

Today, millions of people are living with cancer or have had cancer. The risk of developing most types of cancer can be reduced by changes in a person’s lifestyle or by adopting primary intervention strategies. Often, the sooner a cancer is found and treatment begins, the better are the chances for living for many years. Cancer is a disorder of cell proliferation and it is the leading global cause of death. Cancer research has traditionally focused on allocating bioactive components for the cancer prevention by eliminating cancerous cells and cellular carcinogenesis metabolites. Carcinogenesis is a multistage process that is distinguished with two steps; the first step is called initiation that occurs when cells are exposed to cancer-producing agents, which damage the cell’s deoxynucleic acid. The second step is called promotion which occurs when the cancerous cells divided subsequently, and this post ignition step is characterized by neoplasia and DNA adducts formation. Cancer morbidity and mortality afflicts both genders, and at a global level, there are about 945,000 new cancer cases and 620,000.

Environmental toxins and oxidizing agents are the common causes of oxidative stress in different biological systems. Oxidative stress is a common etiological factor of cancer in different human organs, and the oxidative stress-mediated carcinogenesis includes activation of oncogenic transcription factors, inhibition of antioxidant enzymes (catalase, glutathione-S-transferase, glutathione peroxidase, and superoxide dismutase), and depletion of glutathione, the major cellular antioxidant. Clinical studies continue to support the notion that different beehive products (honey, pollen, propolis, royal jelly, and venom) supplementation combats cancer development based on their antioxidant and health properties.

The search for new sources of natural antioxidants from plant material may have beneficial therapeutic potential for those diseases associated with oxidative stress, including cancer. Natural products are rich in flavonoids, phenolic, alkaloids carotenoids, and organosulfur compounds, these bioactive components are known to combat oxidative stress-mediated diseases pathogenesis, including cancer. A novel approach for preventing cancer is chemoprevention using natural products for suppression, prevention, or reversion premalignancy before the induction of aggressive cancer. Natural products are fruits, vegetables, grains, spices, nuts, herbs, and medicinal plants. During the last few decades, it was found that cancer risk is decreased by having a diet rich in fruits, vegetables, green tea, and legumes and has led research to discover many plant constituents specially phytochemicals that might help in the protection against oxidative stress and blocking specific carcinogenic pathways.

The common etiological factors for cancer are obesity, nutritional deficiencies, smoking, radiation, environmental toxins, sedentary lifestyle, and aging. These factors cause cancer by damaging genes in combination with existing genetic mutation within cells. Epidemiological studies have shown that diet containing fruits and vegetables reduce the risk of several types of cancer. High intake of fruits and vegetables has an active role in the prevention of chronic disease associated with oxidative stress-mediated carcinogenesis. World Health Organization projects 10,000,000 cases of cancer per year worldwide and 6,000,000 mortality from cancer per year worldwide. It also projected 15 million cases/year in 2020. Cancers vary on the basis of age, gender, race, and genetic predisposition.