Intake of sugar-sweetened beverages linked to early-onset colorectal cancer
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Among women, a higher intake of sugar-sweetened beverages in adulthood and adolescence correlated with a higher risk for early-onset colorectal cancer, according to research published in Gut.
“Early-onset colorectal cancer (EO-CRC, age <50 years at diagnosis) is rapidly rising in the U.S., with an unclear understanding of its etiology and contributors to the rise. Sugar-sweetened beverages (SSBs) exert adverse metabolic repercussions throughout the life course, including insulin resistance and inflammation. Higher SSB intake was also associated with obesity, which has been previously linked to risk of EO-CRC,” Yin Cao, MPH, ScD, division of public health sciences, department of surgery, Washington University School of Medicine, told Healio. “Thus, we expect SSB may be an emerging risk factor for EO-CRC and likely contribute to the rising incidence of EO-CRC.”
In a prospective cohort study, researchers analyzed 95,464 women from the Nurses’ Health Study to investigate the association between SSB intake and EO-CRC risk. Participants reported adulthood beverage intake via validated food frequency questionnaire every 4-years from 1991 to 2015; researchers estimated relative risks using Cox proportional hazards models.
According to study results, there were 109 incident EO-CRC cases over up to 24-years of follow-up. Compared with women who consumed less than one serving per week of SSBs in adulthood, women who consumed more than two servings per day of SSBs had a 2.2-fold higher risk for EO-CRC (RR = 2.18; 95% CI, 1.1-4.35) with a 16% higher risk for each additional serving per day (RR = 1.16; 95% CI, 1-1.36).
In a subset of 41,272 women who reported beverage intake at age 13 years to age 18 years, each serving per day increment of SSB intake correlated with a 32% higher risk for EO-CRC (RR = 1.32; 95% CI, 1-1.75). Researchers noted replacement of one SSB serving per day with an equivalent amount of artificially sweetened beverage, coffee, reduced fat milk or total milk correlated with a 17% to 36% decreased risk for EO-CRC (RR = 0.83; 95% CI, 0.69-0.99; RR = 0.82; 95% CI, 0.68-0.99; RR = 0.65; 95% CI, 0.47-0.90 and RR = 0.64; 95% CI, 0.46-0.89, respectively).
“On top of the well-known adverse metabolic and health consequences of SSBs, our findings have added another reason to avoid SSBs since earlier life stages provided preliminary support that SSB intake may contribute to the rising incidence CRC under age 50. In addition, our findings also suggest that reducing SSB intake and/or replacing SSBs with other healthier beverages, in particular milk, would be a better choice for long-term health,” Cao said. “We hope our work helps raise the awareness of the rising incidence of EO-CRC among healthcare providers and the general public and advance the current and future understanding of the etiology of EO-CRC.”
Perspective
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Stacy Cavagnaro, RD
CRC was once thought of as a disease typically only found in older adults. With early onset colorectal cancer on the rise, and the lack of routine screening in those under 45 years, there is a pressing need to determine contributing factors to this rise and identify those most at risk.
Established risk factors for early onset colorectal cancer include obesity and those chronic diseases that often accompany obesity including hyperlipidemia, metabolic syndrome and hypertension. While family history remains one of the largest risk factors, it is important to note what we can control to help decrease risk factors, such as our nutrition choices, exercise routine and lifestyle.
SSBs are associated with an increase in heart disease, stroke, type 2 diabetes, hypertension and metabolic syndrome. Study results have shown the highest consumers of SSBs tend to be younger, engaged in the least amount of physical activity, were more likely to smoke and consumed the most red and processed meats and the least vegetables and whole grains. Obesity, high consumption of red and processed meats, low fiber consumption, and smoking are all risk factors for colon cancer.
The study did not control for variables such as obesity and metabolic syndrome, which are known to increase the risk for early onset colorectal cancer. This makes it difficult to determine if it’s the SSBs themselves that increase risk, or the intake that leads to obesity and metabolic syndrome, which are known to increase early colorectal cancer risk. Regardless, on a population-wide level, improving the diets of individuals will be crucial in reducing risks for many chronic diseases from heart disease to cancer.
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