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

Author:

Zheng Xiaobin123ORCID,Hur Jinhee4ORCID,Nguyen Long H56ORCID,Liu Jie17ORCID,Song Mingyang4568ORCID,Wu Kana4,Smith-Warner Stephanie A48ORCID,Ogino Shuji8910ORCID,Willett Walter C4811ORCID,Chan Andrew T56101112,Giovannucci Edward4811ORCID,Cao Yin11314ORCID

Affiliation:

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

Abstract

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.

Funder

National Institutes of Health

NIH Loan Repayment Program Scholarship

Crohn’s and Colitis Foundation Research Fellowship Award

Mentored Research Scholar Grant in Applied and Clinical Research

American Institute for Cancer Research

Dana-Farber Harvard Cancer Center

Project P Fund for Colorectal Cancer Research

Dana-Farber Cancer Institute

Bennett Family Fund

Entertainment Industry Foundation

National Colorectal Cancer Research Alliance and American Association for Cancer Research

Stuart and Suzanne Steele MGH Research Scholar

Publisher

Oxford University Press (OUP)

Subject

Cancer Research,Oncology

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