Sugar-sweetened beverage and sugar intake during adolescence and risk of colorectal cancer precursors: a large prospective U.S. cohort study
Authors: Joh Hee-Kyung , Lee Dong Hoon , Hur Jinhee , Nimptsch Katharina , Chang Yoosoo , Joung Hyojee , Zhang Xuehong , Rezende Leandro F. M. , Lee Jung Eun , Ng Kimmie , Chen Yuan , Meyerhardt Jeffrey A. , Chan Andrew T , Pischon Tobias , Song Mingyang , Fuchs Charles S. , Willett Walter C. , Cao Yin , Ogino Shuji , Giovannucci Edward , Wu Kana 
Published: November 2020

OBJECTIVE

To examine the associations of adolescent sugar-sweetened beverage (SSB) and sugar intake with risk of colorectal cancer (CRC) precursors.

DESIGN

Prospective cohort study.

SETTING

Nurses’ Health Study II (1998-2015), United States.

PARTICIPANTS

33106 women who completed a validated high school food frequency questionnaire about adolescent diet in 1998 and underwent lower gastrointestinal endoscopy between 1999 and 2015.

MAIN OUTCOME MEASURES

Incident CRC precursors confirmed by medical record review.

RESULTS

During follow-up, 2909 conventional adenoma, 1082 high-risk adenoma (≥1 cm in size, villous, high-grade dysplasia, or number ≥2), and 2355 serrated lesions were identified. Independent of adult intake, adolescent SSB and sugar intake was positively associated with risk of total and high-risk adenoma. Comparing ≥2 servings/dayv<1 serving/week of SSB intake, multivariable odds ratios were 1.21 (95% confidence interval 1.00 to 1.47) for total and 1.21 (0.88 to 1.65) for high-risk adenoma. Per each 5% increment in calorie/day of total fructose intake, odds ratios were 1.17 (1.05 to 1.31) for total and 1.36 (1.14 to 1.62) for high-risk adenoma. By subsite, odds ratios were 1.25 (0.99 to 1.58) for proximal, 1.44 (1.12 to 1.84) for distal, and 1.74 (1.19 to 2.54) for rectal high-risk adenoma. Positive associations were stronger among women with low adolescent fruit, vegetable, or fiber intake. Among women with low fruit intake (<1.3 servings/day), odds ratios of total adenoma were 1.33 (1.11 to 1.59) for SSBs (≥1 serving/dayv<1 serving/week) and 1.51 (1.26 to 1.82) for the highest quintile of total fructose (P≤0.024 for interaction). Neither SSB nor sugar intake during adolescence was associated with risk of serrated lesions.

CONCLUSIONS

Independent of adult intake, adolescent SSB and sugar intake was positively associated with colorectal adenoma, especially high-risk rectal adenoma. Our findings suggest that adolescence may be a critical developmental period of enhanced susceptibility to high sugar intake, possibly promoting precancerous lesions of CRC arising through the adenoma-carcinoma sequence.

What is already known on this topic

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Relatively few studies have examined the association between sugar intake and colorectal neoplasia, and most prospective studies have reported null associations.

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Considering the long process of colorectal carcinogenesis and recent upward trends in early-onset colorectal cancer, early-life diet may be etiologically relevant.

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However, data on the relationship between high sugar intake during early-life and risk of colorectal neoplasia are lacking.

What this study adds

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Higher intake of sugar-sweetened beverages (SSBs) and sugars during adolescence was significantly associated with increased risk of total and high-risk adenoma, especially high-risk rectal adenoma, but not serrated lesions.

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Positive associations were stronger among women with low fruit, vegetable, or fiber intake during adolescence.

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Our results suggest that limiting sugar intake and replacing SSBs with healthy alternatives during early-life may help to reduce risk of colorectal cancer precursors.