Comprehensive Assessment of Diet Quality and Risk of Precursors of Early-Onset Colorectal Cancer

Abstract

Background The role of poor diet quality in the rising incidence of colorectal cancer (CRC) diagnosed under age 50 has not been explored. Based on molecular features of early-onset CRC, early-onset adenomas are emerging surrogate endpoints. Methods In a prospective cohort study (Nurses’ Health Study II), we evaluated two empirical dietary patterns (Western and prudent) and three recommendation-based indexes (Dietary Approaches to Stop Hypertension [DASH], Alternative Mediterranean Diet [AMED], and Alternative Healthy Eating Index [AHEI]-2010) with risk of early-onset adenoma overall and by malignant potential (high-risk: ≥1 cm, tubulovillous/villous histology, high-grade dysplasia, or ≥ 3 adenomas), among 29474 women with ≥1 lower endoscopy before age 50 (1991-2011). Multivariable logistic regressions were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results We documented 1157 early-onset adenomas with 375 of high-risk. Western diet was positively, whereas prudent diet, DASH, AMED, and AHEI-2010 were inversely associated with risk of early-onset adenoma. The associations were largely confined to high-risk adenomas (OR [95% CI] for the highest versus lowest quintile: Western = 1.67 [1.18 to 2.37]; prudent = 0.69 [0.48 to 0.98]; DASH = 0.65 [0.45 to 0.93]; AMED = 0.55 [0.38 to 0.79]; AHEI-2010 = 0.71 [0.51 to 1.01]; all P trend≤.03), driven by those identified in the distal colon and rectum (all P trend≤.04 except AMED: Ptrend=.14). Conclusion Poor diet quality was associated with an increased risk of early-onset distal and rectal adenomas of high malignant potential. These findings provide preliminary but strong support to the role of diet in early-onset CRC.

Risk factors for early-onset colorectal cancer: a population-based case–control study in Ontario, Canada

“…More importantly, the association observed for a Western dietary pattern score suggests that poor overall diet quality may be a risk factor for EO-CRC. Western diet, characterized by low-fiber and high-fat/sugar consumption, has been shown to induce inflammation and gut dysbiosis [25,56,57] and was associated with increased risk of early-onset colorectal adenoma in a recent cohort study [58]. Our study further suggests associations between processed foods and beverages-hallmarks of a Western diet-and increased EO-CRC risk.…”

Rising incidence of colorectal cancer in individuals younger than 50 years and increasing mortality from rectosigmoid cancer in England

“…Whilst we found no published evidence to suggest that populations with increasing under‐50s incidence of CRC had increasing height, height is a genetically and early‐life nutritional and health related consequence, and it is therefore a possibility that in utero and early‐life factors, as well as a contribution from genetic and therefore hereditary factors, are drivers of increasing incidence of young‐onset CRC. A ‘Western’ diet theory has also been proposed by authors and researchers such as Zheng and colleagues [22], specifically a diet low in fibre and seeds, low in calcium but high in saturated fats as found in processed meats, and increasing alcohol intake. These dietary components, amongst others, are ‘pro‐inflammatory’, according to the Dietary Inflammatory Index, and are associated with an increased risk of CRC [23,24].…”

An Update on the Epidemiology, Molecular Characterization, Diagnosis, and Screening Strategies for Early-Onset Colorectal Cancer

“…23 Novel work from the Nurses' Health Study II also suggests that a Western diet is associated with an increased risk of early-onset high-risk adenomas (aOR: 1.67; 95% CI: 1.18-2.37, highest vs lowest quintile), particularly in the distal colon and rectum. 24 Other potential risk factors for early-onset CRC that have been proposed, but remain understudied, include antibiotic exposure, perceived stress, red and processed meats, synthetic food coloring, and food additives (e.g., monosodium glutamate, titanium dioxide, high-fructose corn syrup, emulsifiers, etc.). 25,26 Opportunities for advancing the knowledge base regarding risk factors include a need for more studies reporting risk associations stratified by CRC location (i.e., colon versus rectum), as well as studies exploring relationships between exposures that occur during development, from conception to early adulthood, and early-onset CRC.…”