Research data of more than 30,000 people: Colorectal cancer is getting younger, don’t ignore the impact of "high sugar intake in youth" | Research Express

Introduction Recently, the incidence of early-onset colorectal cancer (CRC) has increased.

In the United States, the incidence of CRC among young and middle-aged people is increasing, and 22% of CRC cases in 2013-2017 occurred in people under 55 years of age.

Since the mid-1980s, the incidence of CRC among people aged 20-39, <50 years old since the mid-1990s, and 50-64 years old since 2011 has been on the rise, which strongly illustrates the diet and lifestyle of adolescents.
The change is related to the increase in the incidence of early-onset CRC.

However, there is still a lack of data on the relationship between high sugar intake during adolescence and the occurrence of CRC.

This prospective study aims to assess the relationship between the intake of simple sugars (fructose, glucose, added sugars, total sugars) and sugar-sweetened beverages (SSB) in adolescents and the risk of CRC precancerous lesions.

The results showed that high intake of monosaccharides and SSB in adolescence is associated with an increased risk of traditional adenomas (especially rectal adenomas).

The study introduction included 33106 subjects from the Nurses’ Health Study II, which provided adolescent diet information in 1998, and then underwent lower gastrointestinal endoscopy between 1999 and 2015.

Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for categorical data.

During the follow-up period, 2909 cases of traditional adenomas (including 758 cases of high risk) and 2355 cases of serrated lesions were diagnosed.
The average age at diagnosis was 52.
2±4.
3 years.

The intake of high sugar and SSB in adolescence was positively correlated with the risk of adenoma, but not with the risk of serrated lesions.

In contrast to adolescence, sugar and SSB intake in adulthood is not associated with adenoma risk.

1.
The relationship between sugar and SSB intake and the risk of precancerous lesions of CRC.
The higher intake of total fructose and SSB in youth is significantly related to the increased risk of total adenoma.

In a fully adjusted model, for every 5% increase in total fructose intake per day, the OR of total adenoma is 1.
17 (95% CI 1.
05-1.
31, p=0.
006); for every increase in SSB intake by 1 serving/day , The OR of total adenoma was 1.
11 (95% CI 1.
02-1.
20, p=0.
01).

According to subsite analysis, higher total fructose intake is associated with increased risk of distal adenoma (OR 1.
24, 95% CI 1.
05–1.
47) and rectal adenoma (OR 1.
43, 95% CI 1.
10–1.
86); Higher SSB intake is associated with increased risk of proximal adenoma (OR 1.
13, 95% CI 1.
02–1.
26) and rectal adenoma (OR 1.
30, 95% CI 1.
08-1.
55).

2.
The relationship between sugar and SSB intake and the risk of high-risk adenomas.
The higher total fructose intake in youth is positively correlated with the risk of high-risk adenomas.

For every 5% increase in total fructose intake per day, the multivariate OR of high-risk adenomas was 1.
30 (95% CI 1.
06-1.
60, P=0.
012).

Higher SSB intake in adolescence was significantly associated with the risk of high-risk adenoma of the rectum, with an OR of 1.
34 (95% CI 1.
01-1.
79, P=0.
044).

Conclusion Large intake of monosaccharides and SSB in youth is significantly associated with increased risk of total adenomas and high-risk adenomas (especially rectal adenomas).

Since the intake of sugar and SSB in adolescents has increased significantly in the past few decades, the findings of this study can partly explain why the incidence of early-onset CRC is currently on the rise.

Literature index: Joh HK, Lee DH, Hur J, et al.
Simple sugar and sugar-sweetened beverage intake during adolescence and risk of colorectal cancer precursors: Adolescent sugar intake and colorectal polyp[J].
Gastroenterology.
2021 Mar 19;S0016- 5085(21)00537-0.
E-mail for submission: tougao@medlive.
cn