. 2021 Dec;70(12):2330-2336.

doi: 10.1136/gutjnl-2020-323450. Epub 2021 May 6.

Sugar-sweetened beverage intake in adulthood and adolescence and risk of early-onset colorectal cancer among women

Jinhee Hur¹, Ebunoluwa Otegbeye^{2

3}, Hee-Kyung Joh^{1

4}, Katharina Nimptsch^{1

5}, Kimmie Ng⁶, Shuji Ogino^{7

8

9}, Jeffrey A Meyerhardt⁶, Andrew T Chan^{9

10

11

12

13}, Walter C Willett^{1

8

12}, Kana Wu^#¹, Edward Giovannucci^#^{1

8

12}, Yin Cao^#^{14

15

16}

Affiliations

¹ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
² Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
³ Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.
⁴ Department of Medicine, Seoul National University College of Medicine, Seoul, South Korea.
⁵ Molecular Epidemiology Research Group, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany.
⁶ Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA.
⁷ Program in Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
⁸ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁹ Eli and Edythe L. Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, MA, USA.
¹⁰ Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
¹¹ Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
¹² Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
¹³ Department of Immunology and Infectious Disease, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
¹⁴ Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA yin.cao@wustl.edu.
¹⁵ Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
¹⁶ Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.

^# Contributed equally.

PMID: 33958435
PMCID: PMC8571123
DOI: 10.1136/gutjnl-2020-323450

Sugar-sweetened beverage intake in adulthood and adolescence and risk of early-onset colorectal cancer among women

Jinhee Hur et al. Gut. 2021 Dec.

. 2021 Dec;70(12):2330-2336.

doi: 10.1136/gutjnl-2020-323450. Epub 2021 May 6.

Authors

Affiliations

¹ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
² Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
³ Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.
⁴ Department of Medicine, Seoul National University College of Medicine, Seoul, South Korea.
⁵ Molecular Epidemiology Research Group, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany.
⁶ Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA.
⁷ Program in Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
⁸ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁹ Eli and Edythe L. Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, MA, USA.
¹⁰ Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
¹¹ Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
¹² Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
¹³ Department of Immunology and Infectious Disease, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
¹⁴ Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA yin.cao@wustl.edu.
¹⁵ Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
¹⁶ Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.

^# Contributed equally.

PMID: 33958435
PMCID: PMC8571123
DOI: 10.1136/gutjnl-2020-323450

Abstract

Objective: Sugar-sweetened beverage (SSB) consumption had substantially increased across successive US birth cohorts until 2000, and adolescents and young adults under age 50 years have the highest consumption. However, the link between SSBs and early-onset colorectal cancer (EO-CRC) remains unexamined.

Design: In the Nurses' Health Study II (1991-2015), we prospectively investigated the association of SSB intake in adulthood and adolescence with EO-CRC risk among 95 464 women who had reported adulthood beverage intake using validated food frequency questionnaires (FFQs) every 4 years. A subset of 41 272 participants reported beverage intake at age 13-18 years using a validated high school-FFQ in 1998. Cox proportional hazards models were used to estimate relative risks (RRs) with 95% CIs.

Results: We documented 109 EO-CRC cases. Compared with individuals who consumed <1 serving/week of SSBs in adulthood, women who consumed ≥2 servings/day had a more than doubled risk of EO-CRC (RR 2.18; 95% CI 1.10 to 4.35; p_trend=0.02), with a 16% higher risk (RR 1.16; 95% CI 1.00 to 1.36) per serving/day increase. Each serving/day increment of SSB intake at age 13-18 years was associated with a 32% higher risk of EO-CRC (RR 1.32; 95% CI 1.00 to 1.75). Replacing each serving/day of adulthood SSB intake with that of artificially sweetened beverages, coffee, reduced fat milk or total milk was associated with a 17%-36% lower risk of EO-CRC.

Conclusion: Higher SSB intake in adulthood and adolescence was associated with a higher risk of EO-CRC among women. Reduction of SSB consumption among adolescents and young adults may serve as a potential strategy to alleviate the growing burden of EO-CRC.

Keywords: cancer epidemiology; colorectal cancer; dietary - colon cancer; gastrointestinal cancer.

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Conflict of interest statement

Competing interests: KNg has received institutional research funding from Pharmavite, Revolution Medicines and Evergrande Group, has served on an advisory board for Seattle Genetics and Array BioPharma and served as a consultant to X-Biotix Therapeutics. JAM has received institutional research funding from Boston Biomedical, has served as an advisor/consultant to Ignyta and COTA Healthcare and served on a grant review panel for the National Comprehensive Cancer Network funded by Taiho Pharmaceutical. ATC previously served as a consultant for Bayer Pharma, Pfizer and Boehringer Ingelheim for topics unrelated to this work.

Figures

**Figure 1.. Substitution of other beverages for sugar-sweetened beverages with risk of early-onset colorectal cancer**
Abbreviations: ASB, artificially sweetened beverage; CI, confidence interval; RR, relative risk. One beverage serving is 8 oz. The models were adjusted for covariates listed in the footnote of Table 2.

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Comment in

Are sugar-sweetened beverages contributing to the rising occurrence of colorectal cancer in young adults?
Murphy N, Campbell PT, Gunter MJ. Murphy N, et al. Gut. 2021 Dec;70(12):2222-2223. doi: 10.1136/gutjnl-2021-324614. Epub 2021 May 20. Gut. 2021. PMID: 34016645 No abstract available.
Genetically proxied ketohexokinase function and risk of colorectal cancer: a Mendelian randomisation study.
Buziau AM, Law PJ, Blokland G, Schalkwijk C, Scheijen J, Simons P, van der Kallen C, Eussen S, Dagnelie PC, van Greevenbroek M, Houlston RS, Wesselius A, Went M, Stehouwer C, Brouwers MC. Buziau AM, et al. Gut. 2023 Mar;72(3):604-606. doi: 10.1136/gutjnl-2021-326299. Epub 2022 May 10. Gut. 2023. PMID: 35537810 No abstract available.

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Sugar-sweetened beverage intake in adulthood and adolescence and risk of early-onset colorectal cancer among women

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Sugar-sweetened beverage intake in adulthood and adolescence and risk of early-onset colorectal cancer among women

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