TY - JOUR
T1 - Comprehensive assessment of diet quality and risk of precursors of early-onset colorectal cancer
AU - Zheng, Xiaobin
AU - Hur, Jinhee
AU - Nguyen, Long H.
AU - Liu, Jie
AU - Song, Mingyang
AU - Wu, Kana
AU - Smith-Warner, Stephanie A.
AU - Ogino, Shuji
AU - Willett, Walter C.
AU - Chan, Andrew T.
AU - Giovannucci, Edward
AU - Cao, Yin
N1 - Funding Information:
This work was supported by the National Institutes of Health (NIH; NHSII cohort infrastructure grant of U01 CA176726, R00 CA215314 to MS; R03 CA197879 and R21 CA222940 to KW; R21 CA230873 to KWand SO; R01 CA151993 and R35 CA197735 to SO; K24 DK098311 to ATC; R37 CA246175 and K07 CA218377 to YC). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. XZ was supported by International Program for PhD Candidates, Sun Yat-Sen University. LHN is supported by an NIH Loan Repayment Program Scholarship and a Crohn's and Colitis Foundation Research Fellowship Award. MS is supported by a Mentored Research Scholar Grant in Applied and Clinical Research, MRSG-17-220-01-NEC, from the American Cancer Society. KW is supported by an Investigator Initiated Grant from the American Institute for Cancer Research. SO is supported by Nodal Award from the Dana-Farber Harvard Cancer Center and by grants from the Project P Fund for Colorectal Cancer Research, the Friends of the Dana-Farber Cancer Institute, Bennett Family Fund, the Entertainment Industry Foundation through National Colorectal Cancer Research Alliance and American Association for Cancer Research (Stand Up to Cancer Colorectal Cancer Dream Team Translational Research Grant). ATC is a Stuart and Suzanne Steele MGH Research Scholar.
Publisher Copyright:
© 2020 The Author(s). Published by Oxford University Press. All rights reserved.
PY - 2021/5/1
Y1 - 2021/5/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85102100217&partnerID=8YFLogxK
U2 - 10.1093/jnci/djaa164
DO - 10.1093/jnci/djaa164
M3 - Article
C2 - 33136160
AN - SCOPUS:85102100217
VL - 113
SP - 543
EP - 552
JO - Journal of the National Cancer Institute
JF - Journal of the National Cancer Institute
SN - 0027-8874
IS - 5
ER -