Simple Sugar and Sugar-Sweetened Beverage Intake During Adolescence and Risk of Colorectal Cancer Precursors

Abstract

BACKGROUND & AIMS: Recent increasing trends in earlyonset colorectal cancer (CRC) strongly supports that early-life diet is involved in CRC development. However, data are lacking on the relationship with high sugar intake during early life. METHODS:We prospectively investigated the association of adolescent simple sugar (fructose, glucose, added sugar, total sugar) and sugar-sweetened beverage (SSB) intake with CRC precursor risk in 33,106 participants of the Nurses' Health Study II who provided adolescent dietary information in 1998 and subsequently underwent lower gastrointestinal endoscopy between 1999 and 2015. Odds ratios (ORs) and 95% Gastroenterology 2021;161:128-142 CLINICAL AT confidence intervals (CIs) were estimated using logistic regression for clustered data. RESULTS: During follow-up, 2909 conventional adenomas (758 high-risk) and 2355 serrated lesions were identified (mean age at diagnoses, 52.2 ± 4.3 years). High sugar and SSB intake during adolescence was positively associated with risk of adenoma, but not serrated lesions. Per each increment of 5% of calories from total fructose intake, multivariable ORs were 1.17 (95% CI, 1.05-1.31) for total and 1.30 (95% CI, 1.06-1.60) for high-risk adenoma. By subsite, ORs were 1.12 (95% CI, 0.96-1.30) for proximal, 1.24 (95% CI, 1.05-1.47) for distal, and 1.43 (95% CI, 1.10-1.86) for rectal adenoma. Per 1 serving/day increment in SSB intake, ORs were 1.11 (95% CI, 1.02-1.20) for total and 1.30 (95% CI, 1.08-1.55) for rectal adenoma. Contrary to adolescent intake, sugar and SSB intake during adulthood was not associated with adenoma risk. CONCLUSIONS: High intake of simple sugars and SSBs during adolescence was associated with increased risk of conventional adenoma, especially rectal adenoma.

Diet as a Risk Factor for Early-Onset Colorectal Adenoma and Carcinoma: A Systematic Review

“…Of the ten studies included, five were prospective cohort studies ( 20 – 24 ) and five were a case-control studies ( 25 – 29 ). Four studies examined the relationship between early onset colorectal adenomas ( Table 2 ) and potential risk factors, including diet ( 20 – 23 ) and six examined risk factors, including diet, for developing early onset colorectal cancer ( 24 – 29 ) ( Table 3 ).…”

Sugary Truth of Early-Onset Colorectal Neoplasia—Not So Sweet After All

“…9 The authors found that, regardless of dietary patterns in adulthood, fructose consumption during adolescence was statistically significantly associated with risk of early-onset rectal adenoma and high-risk adenoma (per 5% increase in calories per day). 5 Similarly, there was an elevated but not statistically significant association between SSB consumption during adolescence and risk of early-onset rectal adenoma (per 1 serving/day increase). These findings might partly explain increasing incidence rates of early-onset CRC, although the modest effect sizes (adjusted odds ratios ranging from 1.25 to 2.23) correspond to population attributable fractions of 10%-20%.…”

“…2,3 Higher incidence rates of early-onset CRC observed among those born in and after the 1950s and 1960s suggest risk factors in early life (eg, childhood and adolescence) play an important role. 1,4 In this issue of Gastroenterology, Joh et al 5 examine the association between consumption of fructose and sugarsweetened beverages (SSBs) during adolescence and risk of colorectal neoplasia (ie, total adenoma, proximal adenoma, rectal adenoma, and high-risk adenoma), particularly early-onset (younger than 50 years), in women participating in the Nurses' Health Study II. 5 Consumption of simple sugars, particularly fructose, has paralleled increasing incidence rates of early-onset CRC.…”

“…1,4 In this issue of Gastroenterology, Joh et al 5 examine the association between consumption of fructose and sugarsweetened beverages (SSBs) during adolescence and risk of colorectal neoplasia (ie, total adenoma, proximal adenoma, rectal adenoma, and high-risk adenoma), particularly early-onset (younger than 50 years), in women participating in the Nurses' Health Study II. 5 Consumption of simple sugars, particularly fructose, has paralleled increasing incidence rates of early-onset CRC. 6,7 The steady rise in fructose intake during the past few decades has largely come from SSBs, which consists of carbonated and noncarbonated soft drinks, fruit drinks, and sport drinks.…”

Bringing Primary and Secondary Prevention Into Play in Community Prevention of Gastrointestinal Cancers

“…Recent studies revealed that early-onset CRC is related to prolonged sedentary television viewing time, a surrogate for a sedentary lifestyle, and adolescent simple sugar and sugarsweetened beverage intake was associated with a higher risk of colorectal neoplasms. 19,20…”