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Simple Sugar and Sugar-Sweetened Beverage Intake During Adolescence and Risk of Colorectal Cancer Precursors
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Abstract
Background & aims Recent increasing trends in early-onset colorectal cancer (CRC) strongly supports that early-life diet is involved in CRC development. However, data are lacking on the relationship with high sugar intake during early life.Methods We prospectively investigated the association of adolescent simple sugar (fructose, glucose, added sugar, total sugar) and sugar-sweetened beverage (SSB) intake with CRC precursor risk in 33,106 participants of the Nurses' Health Study II who provided adolescent dietary information in 1998 and subsequently underwent lower gastrointestinal endoscopy between 1999 and 2015. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression for clustered data.Results During follow-up, 2909 conventional adenomas (758 high-risk) and 2355 serrated lesions were identified (mean age at diagnoses, 52.2 ± 4.3 years). High sugar and SSB intake during adolescence was positively associated with risk of adenoma, but not serrated lesions. Per each increment of 5% of calories from total fructose intake, multivariable ORs were 1.17 (95% CI, 1.05-1.31) for total and 1.30 (95% CI, 1.06-1.60) for high-risk adenoma. By subsite, ORs were 1.12 (95% CI, 0.96-1.30) for proximal, 1.24 (95% CI, 1.05-1.47) for distal, and 1.43 (95% CI, 1.10-1.86) for rectal adenoma. Per 1 serving/day increment in SSB intake, ORs were 1.11 (95% CI, 1.02-1.20) for total and 1.30 (95% CI, 1.08-1.55) for rectal adenoma. Contrary to adolescent intake, sugar and SSB intake during adulthood was not associated with adenoma risk.Conclusions High intake of simple sugars and SSBs during adolescence was associated with increased risk of conventional adenoma, especially rectal adenoma.
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“another prospective cohort study showed that excessive consumption of sugars and sugar sweetened beverage during adolescence was significantly associated with the risk of colorectal adenoma (odds ratio 1.20, 1.04 to 1.39).146”
From Dietary sugar consumption and health: umbrella review (2023) · cites this paper as [146]
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“Each one serving a day increase in sugar sweetened beverage consumption was associated with 11% (odds ratio 1.11, 1.02 to 1.20) and 30% (1.30, 1.08 to 1.55) higher risks of total colorectal adenoma and rectal adenoma, respectively.146”
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“Similarly, findings from the Nurses’ Health Study II suggest that dietary patterns in adolescence, including meat and fish intake 87 , dairy intake 88 and sugar-sweetened beverage intake 89,90 , increase the risk of early-onset CRC and colorectal adenoma (Supplementary Table 1).”
Metadata
- Authors
- Joh, H.-K., Lee, D. H., Hur, J., Nimptsch, K., Chang, Y., Joung, H., Zhang, X., Rezende, L. F. M., Lee, J. E., Ng, K., Yuan, C., Tabung, F. K., Meyerhardt, J. A., Chan, A. T., Pischon, T., Song, M., Fuchs, C. S., Willett, W. C., Cao, Y., Ogino, S., Giovannucci, E., & Wu, K.
- Affiliations
- Harvard University (US)
- Kangbuk Samsung Hospital (KR)
- Seoul National University (KR)
- Brigham and Women's Hospital (US)
- Universidade Federal de São Paulo (BR)
- Broad Institute (US)
- Max Delbrück Center (DE)
- Yale Cancer Center (US)
- Washington University in St. Louis (US)
- Corresponding author
- Joh, Hee-Kyung
- ORCID
- Joh, Hee-Kyung
- Lee, Dong Hoon
- Hur, Jinhee
- Nimptsch, Katharina
- Chang, Yoosoo
- Joung, Hyojee
- Zhang, Xuehong
- Rezende, Leandro F.M.
- Lee, Jung Eun
- Ng, Kimmie
- Yuan, Chen
- Tabung, Fred K.
- Meyerhardt, Jeffrey A.
- Chan, Andrew T.
- Pischon, Tobias
- Song, Mingyang
- Fuchs, Charles S.
- Willett, Walter C.
- Cao, Yin
- Ogino, Shuji
- Giovannucci, Edward
- Wu, Kana
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 2021-07
- Volume
- 161
- Issue
- 1
- Pages
- 128-142.e20
- ISSN
- 0016-5085 (ISSN-L)
- PMC
- PMC8238879
- OpenAlex
- W3139120779
- Cited by
- 122
- References
- 80
- Citations by year
- 2026: 13 · 2025: 20 · 2024: 20 · 2023: 36 · 2022: 27 · 2021: 6
- FWCI
- 12.94
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Gastroenterology (acceptedVersion)
- medRxiv (acceptedVersion, cc-by-nc)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- MDC Repository (Max-Delbrueck-Center for Molecular Medicine) (acceptedVersion)
- Seoul National University Open Repository (Seoul National University) (submittedVersion)
- Funders
- Amylin Pharmaceuticals
- Taiho Pharmaceutical
- National Cancer Institute Division of Cancer Epidemiology and Genetics (K07 CA188126, K24 DK098311, K99 CA215314, R01 CA151993, R01 CA205406, R03 CA197879, R21 CA222940, R21 CA230873, R35 CA197735, R35 CA253185)
- National Institutes of Health (R01 CA67262, U01 CA176726, U01 HL145386)
- Eli Lilly and Company
- Pfizer
- National Cancer Institute
- American Institute for Cancer Research
- Boehringer Ingelheim
- Unum Therapeutics
- U.S. Department of Defense (CA160344)
- Boston Biomedical
- American Cancer Society (MRSG-17-220-01, RSG-20-124-01-CCE, RSG130476)
- Daiichi-Sankyo
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
- Health Sciences › Medicine › Oncology › Colorectal Cancer Screening and Detection
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Keywords
- sugar-sweetened beverages, fructose, glucose, added sugars, adolescent diet, colorectal cancer precursors, colorectal adenoma, serrated lesions, rectal adenoma, early-onset colorectal cancer, dietary risk factors
- MeSH terms
- Sugar-Sweetened Beverages, Adolescent, Adolescent Behavior, Age Factors, Colonic Polyps, Feeding Behavior, Female, Humans, Middle Aged, Monosaccharides, Precancerous Conditions, Prospective Studies, Risk Factors, Time Factors, United States, Colorectal Neoplasms, Adenomatous Polyps, Risk Assessment
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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