Comprehensive Assessment of Diet Quality and Risk of Precursors of Early-Onset Colorectal Cancer

doi:10.1093/jnci/djaa164

. 2021 May 4;113(5):543-552.

doi: 10.1093/jnci/djaa164.

Comprehensive Assessment of Diet Quality and Risk of Precursors of Early-Onset Colorectal Cancer

Xiaobin Zheng^{1

2

3}, Jinhee Hur⁴, Long H Nguyen^{5

6}, Jie Liu^{1

7}, Mingyang Song^{4

5

6

8}, Kana Wu⁴, Stephanie A Smith-Warner^{4

8}, Shuji Ogino^{8

9

10}, Walter C Willett^{4

8

11}, Andrew T Chan^{5

6

10

11

12}, Edward Giovannucci^{4

8

11}, Yin Cao^{1

13

14}

Affiliations

¹ Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
² Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, P. R. China.
³ Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China.
⁴ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁵ Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
⁶ Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
⁷ Brown School, Washington University in St. Louis, St. Louis, MO, USA.
⁸ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁹ Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
¹⁰ Eli and Edythe L. Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, MA, USA.
¹¹ Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
¹² Department of Immunology and Infectious Disease, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
¹³ Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.
¹⁴ Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.

PMID: 33136160
PMCID: PMC8096368
DOI: 10.1093/jnci/djaa164

Comprehensive Assessment of Diet Quality and Risk of Precursors of Early-Onset Colorectal Cancer

Xiaobin Zheng et al. J Natl Cancer Inst. 2021.

. 2021 May 4;113(5):543-552.

doi: 10.1093/jnci/djaa164.

Authors

Affiliations

¹ Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
² Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, P. R. China.
³ Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China.
⁴ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁵ Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
⁶ Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
⁷ Brown School, Washington University in St. Louis, St. Louis, MO, USA.
⁸ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁹ Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
¹⁰ Eli and Edythe L. Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, MA, USA.
¹¹ Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
¹² Department of Immunology and Infectious Disease, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
¹³ Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.
¹⁴ Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.

PMID: 33136160
PMCID: PMC8096368
DOI: 10.1093/jnci/djaa164

Abstract

Background: The role of poor diet quality in the rising incidence of colorectal cancer (CRC) diagnosed younger than age 50 years has not been explored. Based on molecular features of early-onset CRC, early-onset adenomas are emerging surrogate endpoints.

Methods: In a prospective cohort study (Nurses' Health Study II), we evaluated 2 empirical dietary patterns (Western and prudent) and 3 recommendation-based indexes (Dietary Approaches to Stop Hypertension [DASH], Alternative Mediterranean Diet [AMED], and Alternative Healthy Eating Index [AHEI]-2010) with risk of early-onset adenoma overall and by malignant potential (high-risk: ≥1 cm, tubulovillous or villous histology, high-grade dysplasia, or ≥3 adenomas), among 29 474 women with 1 or more lower endoscopy before age 50 years (1991-2011). Multivariable logistic regressions were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs).

Results: We documented 1157 early-onset adenomas with 375 at high risk. Western diet was positively associated, whereas prudent diet, DASH, AMED, and AHEI-2010 were inversely associated with risk of early-onset adenoma. The associations were largely confined to high-risk adenomas (the highest vs lowest quintile: Western, OR = 1.67, 95% CI = 1.18 to 2.37; prudent, OR = 0.69, 95% CI = 0.48 to 0.98; DASH, OR = 0.65, 95% CI = 0.45 to 0.93; AMED, OR = 0.55, 95% CI = 0.38 to 0.79; AHEI-2010, OR = 0.71, 95% CI = 0.51 to 1.01; all Ptrend ≤ .03), driven by those identified in the distal colon and rectum (all Ptrend ≤ .04, except AMED: Ptrend = .14).

Conclusion: Poor diet quality was associated with an increased risk of early-onset distal and rectal adenomas of high malignant potential. These findings provide preliminary but strong support to the role of diet in early-onset CRC.

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Figures

**Figure 1.**
Diet quality and risk of early-onset (aged younger than 50 years) adenoma according to size **(A)** and histology **(B)**, Nurses’ Health Study II, 1991-2011. AHEI = Alternative Healthy Eating Index; AMED = Alternative Mediterranean Diet; CI = confidence interval; DASH = Dietary Approaches to Stop Hypertension; OR = odds ratio; Q1 = lowest quintile; Q5 = highest quintile. Odds ratio was adjusted for the covariates denoted in Table 2. P_trend was calculated using the median of each quintile as a continuous variable.

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References

1. Siegel RL, Fedewa SA, Anderson WF, et al.Colorectal cancer incidence patterns in the United States, 1974-2013. J Natl Cancer Inst. 2017;109(8):djw322. - PMC - PubMed
1. Siegel RL, Miller KD, Goding Sauer A, et al.Colorectal cancer statistics, 2020. CA Cancer J Clin. 2020;70(3):145-164. - PubMed
1. Willauer AN, Liu Y, Pereira AAL, et al.Clinical and molecular characterization of early-onset colorectal cancer. Cancer. 2019;125(12):2002-2010. - PMC - PubMed
1. Keum N, Giovannucci E.. Global burden of colorectal cancer: emerging trends, risk factors and prevention strategies. Nat Rev Gastroenterol Hepatol. 2019;16(12):713-732. - PubMed
1. Randi G, Edefonti V, Ferraroni M, La Vecchia C, Decarli A.. Dietary patterns and the risk of colorectal cancer and adenomas. Nutr Rev. 2010;68(7):389-408. - PubMed

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[1] Siegel RL, Fedewa SA, Anderson WF, et al.Colorectal cancer incidence patterns in the United States, 1974-2013. J Natl Cancer Inst. 2017;109(8):djw322. - PMC - PubMed

[2] Siegel RL, Fedewa SA, Anderson WF, et al.Colorectal cancer incidence patterns in the United States, 1974-2013. J Natl Cancer Inst. 2017;109(8):djw322. - PMC - PubMed

[3] Siegel RL, Miller KD, Goding Sauer A, et al.Colorectal cancer statistics, 2020. CA Cancer J Clin. 2020;70(3):145-164. - PubMed

[4] Siegel RL, Miller KD, Goding Sauer A, et al.Colorectal cancer statistics, 2020. CA Cancer J Clin. 2020;70(3):145-164. - PubMed

[5] Willauer AN, Liu Y, Pereira AAL, et al.Clinical and molecular characterization of early-onset colorectal cancer. Cancer. 2019;125(12):2002-2010. - PMC - PubMed

[6] Willauer AN, Liu Y, Pereira AAL, et al.Clinical and molecular characterization of early-onset colorectal cancer. Cancer. 2019;125(12):2002-2010. - PMC - PubMed

[7] Keum N, Giovannucci E.. Global burden of colorectal cancer: emerging trends, risk factors and prevention strategies. Nat Rev Gastroenterol Hepatol. 2019;16(12):713-732. - PubMed

[8] Keum N, Giovannucci E.. Global burden of colorectal cancer: emerging trends, risk factors and prevention strategies. Nat Rev Gastroenterol Hepatol. 2019;16(12):713-732. - PubMed

[9] Randi G, Edefonti V, Ferraroni M, La Vecchia C, Decarli A.. Dietary patterns and the risk of colorectal cancer and adenomas. Nutr Rev. 2010;68(7):389-408. - PubMed

[10] Randi G, Edefonti V, Ferraroni M, La Vecchia C, Decarli A.. Dietary patterns and the risk of colorectal cancer and adenomas. Nutr Rev. 2010;68(7):389-408. - PubMed

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Comprehensive Assessment of Diet Quality and Risk of Precursors of Early-Onset Colorectal Cancer

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Comprehensive Assessment of Diet Quality and Risk of Precursors of Early-Onset Colorectal Cancer

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