Sugar-sweetened beverage intake in adulthood and adolescence and risk of early-onset colorectal cancer among women.
Level 3 - non-randomized controlled study
Prospective cohort study
PubMed 33958435 · doi:10.1136/gutjnl-2020-323450
What was done
Researchers prospectively tracked 95,464 female nurses in the Nurses' Health Study II from 1991 to 2015 to evaluate the association between sugar-sweetened beverage (SSB) intake and early-onset colorectal cancer (EO-CRC). Adulthood beverage intake was assessed every 4 years using validated food frequency questionnaires (FFQs). A subset of 41,272 participants reported their beverage intake at ages 13–18 using a high school FFQ administered in 1998. Cox proportional hazards models were used to estimate relative risks (RRs) and 95% confidence intervals.
What was found
Across follow-up, 109 cases of EO-CRC were documented. Women consuming ≥2 servings/day of SSBs in adulthood had more than double the risk of EO-CRC compared with those consuming <1 serving/week (RR 2.18; 95% CI 1.10 to 4.35; p-trend = 0.02), representing a 16% increase in risk per serving/day (RR 1.16; 95% CI 1.00 to 1.36). Each additional serving/day of SSB intake during adolescence (ages 13–18) was associated with a 32% higher risk of EO-CRC (RR 1.32; 95% CI 1.00 to 1.75). Substituting one serving/day of adulthood SSBs with artificially sweetened beverages, coffee, reduced fat milk, or total milk was associated with a 17%–36% lower risk.
Why it matters
This study provides longitudinal evidence linking high intake of sugar-sweetened beverages in both adolescence and adulthood to an increased risk of colorectal cancer diagnosed before age 50.
Limits
The total number of EO-CRC cases was small (109 cases), yielding relatively wide confidence intervals. Adolescent dietary intake was recalled retrospectively via a 1998 questionnaire, introducing potential recall bias. The cohort was restricted to female nurses, limiting generalizability to men and other demographics. Residual confounding cannot be ruled out.
Cited by
- contradicts Women who consume two or more sugary or sweetened drinks daily have more than double the risk of early-onset colorectal cancer compared to those consuming less than one per week.