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

Abstract

Background & aims: Recent increasing trends in early-onset 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% 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.

Keywords: Cancer Epidemiology; Colorectal Adenoma; Colorectal Polyp; Conventional Adenoma; Fructose.

Figure 1.. Risk of total adenoma according to (A) total fructose and (B) sugar-sweetened beverage intake during adolescence by lifestyle and dietary factors in the Nurses’ Health Study II, 1998–2015

CRC, colorectal cancer; BMI, body mass index Data were adjusted for age, time period of endoscopy, number of endoscopies, time since most recent endoscopy, reason for endoscopy, family history of CRC, menopausal status/menopausal hormone use, current aspirin use ≥2 times/wk, history of type 2 diabetes, adult height, BMI (age 18 y, current), smoking status (adolescent, current), alcohol consumption (age 18–22 y, current), physical activity (adolescent, current), adolescent and current (adult) dietary intake (total calorie, total calcium, vitamin D, total folate, fiber, fruits, vegetables, and dairy), current total red meat intake, western dietary pattern score during adolescence, and current total fructose or sugar-sweetened beverage intake except for the stratifying variable of each stratum. (A) highest vs lowest (referent) quintile. (B) ≥1 serving/d vs <1 serving/wk (referent). ^aHigh: highest tertile (≥59 MET-hr/wk); low: two lower tertiles (<59 MET-hr/wk). ^bCut-off: median intake (fruits, 1.3 serving/d; fruit juice, 0.4 serving/d; vegetables, 2.8 serving/d; fiber, 20.2 g/d).