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. 2023 Feb 8;115(2):155-164.
doi: 10.1093/jnci/djac221.

Ultra-processed food consumption and risk of colorectal cancer precursors: results from 3 prospective cohorts

Dong Hang  1   2 , Lu Wang  3 , Zhe Fang  4 , Mengxi Du  3 , Kai Wang  4 , Xiaosheng He  5 , Neha Khandpur  2   6   7 , Sinara L Rossato  6   8 , Kana Wu  2 , Zhibin Hu  1 , Hongbing Shen  1 , Shuji Ogino  9   10   11   12 , Andrew T Chan  9   12   13 , Edward L Giovannucci  2   4   12 , Fang Fang Zhang  3 , Mingyang Song  2   4   13
Affiliations

Ultra-processed food consumption and risk of colorectal cancer precursors: results from 3 prospective cohorts

Dong Hang et al. J Natl Cancer Inst. .

Abstract

Background: Growing evidence indicates the adverse effect of ultra-processed food (UPF) consumption. However, it remains unknown whether UPF consumption influences the risk of colorectal cancer (CRC) precursors, namely conventional adenomas and serrated lesions.

Methods: We drew data from the Nurses' Health Study, Nurses' Health Study II, and Health Professionals Follow-up Study, comprising 142 052 participants who had undergone at least 1 lower gastrointestinal endoscopy during follow-up. To handle multiple records per participants, we used multivariable logistic regression for clustered data to calculate odds ratios (OR) and 95% confidence intervals (CIs) of colorectal polyps in relation to cumulative average consumption of UPFs. All statistical tests were 2-sided.

Results: We documented 11 644 patients with conventional adenomas and 10 478 with serrated lesions during 18-20 years of follow-up. Compared with participants in the lowest quintile of UPF consumption, those in the highest quintile had an increased risk of conventional adenomas (OR = 1.18, 95% CI = 1.11 to 1.26) and serrated lesions (OR = 1.20, 95% CI = 1.13 to 1.28). Similar results were found for high-risk polyps (ie, advanced adenomas and ≥10 mm serrated lesions; OR = 1.17, 95% CI = 1.07 to 1.28). These associations were slightly attenuated but remained statistically significant after further adjusting for body mass index, Western dietary pattern score, or individual dietary factors (fiber, folate, calcium, and vitamin D). The results remained essentially unchanged after excluding processed meat from total UPF intake.

Conclusions: Higher consumption of UPFs is associated with an increased risk of CRC precursors. UPFs might be a modifiable target for early prevention of CRC.

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Figures

Figure 1.
Figure 1.
Dose-response relationship between ultra-processed food (UPF) consumption and conventional adenomas (A) and serrated lesions (B). The dot–dash curves represent the 95% confidence intervals of the odds ratio. The vertical solid lines represent 5th and 95th percentile levels of UPF intake, and the vertical dash lines represent the median UPF intakes in each of the quintiles. Multivariable model was adjusted for the same set of covariates as in Model 2. For conventional adenomas in A, P for nonlinear relation less than .0001 and P for overall statistical significance of the curve less than .0001. For serrated lesions in B, P for nonlinear relation less than .0001 and P for overall statistical significance of the curve less than .0001. UPF intake over 99% was not plotted due to wide confidence intervals at the extremes.
Figure 2.
Figure 2.
Stratified analysis for the association between ultra-processed food (UPF) consumption and colorectal polyp risk. Odds ratios (OR) for the highest vs lowest quintiles of UPF consumption were calculated in the multivariable logistic regression model (Model 2). Pinteraction was calculated by comparing the models with and without the product term between UPF consumption (dichotomous) and the stratified variable (categorical). BMI = body mass index; CI = confidence interval; CRC = colorectal cancer; MET = metabolic equivalent tasks; OR = odds ratio; UPF = ultra-processed food.
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