Sugar-sweetened beverage and sugar consumption and colorectal cancer incidence and mortality according to anatomic subsite

Chen Yuan^{1

2}, Hee-Kyung Joh^{3

4

5}, Qiao-Li Wang¹, Yin Zhang^{1

2

6}, Stephanie A Smith-Warner^{2

5}, Molin Wang^{2

6

7}, Mingyang Song^{2

8

9}, Yin Cao^{10

11

12}, Xuehong Zhang^{5

6}, Emilie S Zoltick¹³, Jinhee Hur^{5

14}, Andrew T Chan^{6

8

9

15

16}, Jeffrey A Meyerhardt⁴, Shuji Ogino^{2

16

17

18}, Kimmie Ng¹, Edward L Giovannucci^{2

5

6}, Kana Wu⁵

Affiliations

¹ Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA.
² Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA.
³ Department of Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
⁴ Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
⁵ Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA.
⁶ Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
⁷ Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA, USA.
⁸ Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
⁹ Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
¹⁰ Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
¹¹ Alvin J Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.
¹² Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
¹³ Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA.
¹⁴ Department of Food Science and Biotechnology, Sungkyunkwan University, Suwon, Republic of Korea.
¹⁵ Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, MA, USA.
¹⁶ Broad Institute of MIT and Harvard, Cambridge, MA, USA.
¹⁷ Program in Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
¹⁸ Cancer Immunology and Cancer Epidemiology Programs, Dana-Farber Harvard Cancer Center, Boston, MA, USA.

PMID: 35470384
PMCID: PMC9170474
DOI: 10.1093/ajcn/nqac040

Sugar-sweetened beverage and sugar consumption and colorectal cancer incidence and mortality according to anatomic subsite

Chen Yuan et al. Am J Clin Nutr. 2022.

. 2022 Jun 7;115(6):1481-1489.

doi: 10.1093/ajcn/nqac040.

Authors

Affiliations

¹ Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA.
² Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA.
³ Department of Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
⁴ Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
⁵ Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA.
⁶ Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
⁷ Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA, USA.
⁸ Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
⁹ Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
¹⁰ Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
¹¹ Alvin J Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.
¹² Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
¹³ Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA.
¹⁴ Department of Food Science and Biotechnology, Sungkyunkwan University, Suwon, Republic of Korea.
¹⁵ Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, MA, USA.
¹⁶ Broad Institute of MIT and Harvard, Cambridge, MA, USA.
¹⁷ Program in Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
¹⁸ Cancer Immunology and Cancer Epidemiology Programs, Dana-Farber Harvard Cancer Center, Boston, MA, USA.

PMID: 35470384
PMCID: PMC9170474
DOI: 10.1093/ajcn/nqac040

Abstract

Background: Recent preclinical research strongly suggests that dietary sugars can enhance colorectal tumorigenesis by direct action, particularly in the proximal colon that unabsorbed fructose reaches.

Objectives: We aimed to examine long-term consumption of sugar-sweetened beverages (SSBs) and total fructose in relation to incidence and mortality of colorectal cancer (CRC) by anatomic subsite.

Methods: We followed 121,111 participants from 2 prospective US cohort studies, the Nurses' Health Study (1984-2014) and Health Professionals Follow-Up Study (1986-2014), for incident CRC and related death. Cox proportional hazards regression was used to compute HRs and 95% CIs.

Results: During follow-up, we documented 2733 incident cases of CRC with a known anatomic location, of whom 901 died from CRC. Positive associations of SSB and total fructose intakes with cancer incidence and mortality were observed in the proximal colon but not in the distal colon or rectum (Pheterogeneity ≤ 0.03). SSB consumption was associated with a statistically significant increase in the incidence of proximal colon cancer (HR per 1-serving/d increment: 1.18; 95% CI: 1.03, 1.34; Ptrend = 0.02) and a more pronounced elevation in the mortality of proximal colon cancer (HR: 1.39; 95% CI: 1.13, 1.72; Ptrend = 0.002). Similarly, total fructose intake was associated with increased incidence and mortality of proximal colon cancer (HRs per 25-g/d increment: 1.18; 95% CI: 1.03, 1.35; and 1.42; 95% CI: 1.12, 1.79, respectively). Moreover, SSB and total fructose intakes during the most recent 10 y, rather than those from a more distant period, were associated with increased incidence of proximal colon cancer.

Conclusions: SSB and total fructose consumption were associated with increased incidence and mortality of proximal colon cancer, particularly during later stages of tumorigenesis.

Keywords: added sugar; colorectal cancer; fructose; sucrose; sugar-sweetened beverages.

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Figures

**FIGURE 1**
Association of SSB intake with (A) incidence and (B) mortality of colorectal cancer according to refined anatomic location. The sample size was the same as that in Tables 2 and 3. HRs and 95% CIs associated with a 1-serving/d increment in SSB intake were presented, estimated by Cox proportional hazards regression conditioned on and adjusted for the same variables as in the multivariable model in Table 2. SSB, sugar-sweetened beverage.

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Comment in

Let's not sugarcoat it: the association of sugar-sweetened beverage intake with colorectal cancer risk may be subsite-specific.
Rothwell JA, Severi G. Rothwell JA, et al. Am J Clin Nutr. 2022 Jun 7;115(6):1453-1454. doi: 10.1093/ajcn/nqac077. Am J Clin Nutr. 2022. PMID: 35467723 No abstract available.

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Sugar-sweetened beverage and sugar consumption and colorectal cancer incidence and mortality according to anatomic subsite

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Sugar-sweetened beverage and sugar consumption and colorectal cancer incidence and mortality according to anatomic subsite

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