In this comprehensive investigation of meat and meat-related compounds in relation to incident distal colorectal adenoma, we observed borderline positive associations for red meat, processed meat, grilled meat, well or very well-done meat, PhIP, haeme iron from meat, as well as nitrate and nitrite from processed meat. However, in analyses by anatomical subsite, there were statistically significant positive associations for rectal adenoma with grilled meat, well or very well-done meat, PhIP, B[a]P, and total mutagenic activity. We also found statistically significant inverse associations between total iron (diet and supplements) and iron from supplements and distal colorectal adenoma