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Sugar-sweetened beverage intake in adulthood and adolescence and risk of early-onset colorectal cancer among women
  1. Jinhee Hur1,
  2. Ebunoluwa Otegbeye2,3,
  3. Hee-Kyung Joh1,4,
  4. Katharina Nimptsch1,5,
  5. Kimmie Ng6,
  6. Shuji Ogino7,8,9,
  7. Jeffrey A Meyerhardt6,
  8. Andrew T Chan9,10,11,12,13,
  9. Walter C Willett1,8,12,
  10. Kana Wu1,
  11. Edward Giovannucci1,8,12,
  12. Yin Cao3,14,15
  1. 1Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
  2. 2Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
  3. 3Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
  4. 4Department of Medicine, Seoul National University College of Medicine, Seoul, South Korea
  5. 5Molecular Epidemiology Research Group, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
  6. 6Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
  7. 7Program in Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
  8. 8Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
  9. 9Eli and Edythe L. Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, MA, USA
  10. 10Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
  11. 11Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
  12. 12Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
  13. 13Department of Immunology and Infectious Disease, Harvard T.H. Chan School of Public Health, Boston, MA, USA
  14. 14Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
  15. 15Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
  1. Correspondence to Dr Yin Cao, Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA; yin.cao{at}wustl.edu

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; ptrend=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.

  • colorectal cancer
  • dietary - colon cancer
  • gastrointestinal cancer
  • cancer epidemiology

Data availability statement

No additional data are available.

https://doi.org/10.1136/gutjnl-2020-323450

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    Data availability statement

    No additional data are available.

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    Footnotes

    • Twitter @yincaoScD

    • KW, EG and YC contributed equally.

    • Contributors JH and YC had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. KW, EG and YC contributed equally. Concept and design: JH, EG and YC. Acquisition, analysis or interpretation of data: JH, KNg, SO, JAM, ATC, WCW, KW, EG and YC. Drafting of the manuscript: JH and YC. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: JH. Obtained funding: KNg, SO, ATC, WCW, KW, EG and YC. Administrative, technical or material support: KW, EG and YC. Supervision: EG and YC.

    • Funding This work was supported by grants U01 CA176726 (WCW), R01 CA205406 (KNg), R21 CA230873 (SO, KW), R01 CA151993 (SO), R35 CA197735 (SO), R35 CA253185 (ATC), R03 CA197879 (KW), R21 CA222940 (KW), R37 CA246175 (YC) and K07 CA218377 (YC) from the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. EO is supported by T32 CA009621. KNg is supported in part by Department of Defense CA160344 and the Project P Fund. ATC is the Stuart and Suzanne Steele MGH Research Scholar. KW is supported in part by an Investigator Initiated Grant from the American Institute for Cancer Research.

    • 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.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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