Simple Sugar Intake In Adolescence Tied To Colorectal Adenoma Risk

An analysis of the Nurses' Health Study II revealed a link between high intake of simple sugars and sugar-sweetened beverages (SSBs) in adolescence and increased risk of conventional colorectal adenoma, especially rectal.

"Recently, there has been a shift in paradigm of cancer prevention research focusing on interventions over the life course...rather than just focusing on later-life interventions," Dr. Kana Wu of the Harvard TH Chan School of Public Health told Reuters Health by email. "Exposures during childhood and adolescence are likely critical for cancers because of the long subsequent lifetime at risk and enhanced susceptibility."

"However," she said, "most epidemiological studies on the role of diet and lifestyle in cancers have focused on exposures during mid-to-late adulthood, likely missing important windows for cancer prevention."

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"While hyperinsulinemia is an established risk factor for colorectal cancer (CRC), secular trends in sedentariness and increased consumption of high-insulin foods in children and adolescents during the past 30-40 years have pushed its onset, traditionally at older ages, to alarmingly early."

"In the U.S., compared to other age groups, adolescents have the highest added sugar intake and they also have the worst diet."

As reported in Gastroenterology, Dr. Wu and colleagues investigated the association between adolescent simple sugar (fructose, glucose, added sugar, total sugar) and SSB intake with CRC precursor risk in more than 33,000 Nurses' Health Study II participants who provided adolescent dietary information in 1998 and subsequently underwent lower gastrointestinal endoscopy between 1999 and 2015. The mean age at questionnaire completion in 1998 was about 44.

A total of 2,909 conventional adenomas (758 high-risk) and 2,355 serrated lesions were identified (mean age at diagnoses, 52.2) were found during follow-up.

High sugar and SSB intake during adolescence was positively associated with risk of adenoma, but not serrated lesions, after adjustment for variables including age, time period of endoscopy, number of endoscopies, time since most recent endoscopy, reason for endoscopy, family history of CRC, menopausal status/menopausal hormone use, history of type 2 diabetes, adult height, BMI, smoking status, alcohol consumption, physical activity, and adolescent and current intake of specific foods and nutrients.

Specifically, for each 5% increment in calorie/day of total fructose intake, multivariable odds ratios were: 1.17 for total conventional adenomas and 1.30 for high-risk adenoma. By subsite, ORs were 1.12 for proximal, 1.24 for distal, and 1.43 for rectal adenoma.

For each serving/day increment in SSB intake, ORs were 1.11 for total and 1.30 for rectal adenoma.

In contrast to adolescent intake, sugar and SSB intake during adulthood was not associated with adenoma risk.

Dr. Wu said, "Our study team has developed mechanism-based empirical scores to assess the insulinemic potential of overall diet and lifestyle. Utilizing this approach, we plan to further examine the role of a high-insulin dietary pattern during adolescence in earlier-onset colorectal neoplasia and whether genetic susceptibility to high insulin can modulate these associations."

Dr. Jeffery Nelson, Surgical Director for the Center for Inflammatory Bowel and Colorectal Diseases at Mercy Medical Center in Baltimore, commented by email to Reuters Health, "Intuitively, the study's findings make sense. The incidence of colorectal cancer has been increasing in younger people for a long time."

"I see this in my own practice," he said. "More than half of the rectal cancer patients who presented to Mercy last year were between the ages of 50 and 59. In line with this, the age to begin screening for patients at average risk for CRC has been lowered to 45. Therefore, I think this study is right in line with what our messaging should be to patients right now."

Dr. Bryan Curtin, Director of The Center for Neurogastroenterology and GI Motility at Mercy, also commented by email. "The 'western diet' is proving to be quite unhealthy for us as a population and this presents a unique challenge, especially for our youth and adolescents moving forward."

"I don't think the study is going to change most clinicians' management strategies in a dramatic way, as we usually preach avoidance of these types of beverages during childhood," he said, "but it does give more ammunition for pediatricians to try and convince adolescents and parents of the importance of a healthy diet."

—Marilynn Larkin

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