Comprehensive Assessment of Diet Quality and Risk of Precursors of Early-Onset Colorectal Cancer. (2nd November 2020)

• Record Type: Journal Article
• Authors: Zheng, Xiaobin; Hur, Jinhee; Nguyen, Long H; Liu, Jie; Song, Mingyang; Wu, Kana; Smith-Warner, Stephanie A; Ogino, Shuji; Willett, Walter C; Chan, Andrew T; Giovannucci, Edward; Cao, Yin
• Is Part Of: Journal of the National Cancer Institute. Volume 113:Number 5(2021)
• Page Start: 543
• Page End: 552
• Publication Date: 2020-11-02
• Subjects: Cancer -- Periodicals; Cancer -- Research -- Periodicals; 616.994
• DOI: 10.1093/jnci/djaa164
• Languages: English
• ISSNs: 0027-8874

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 P trend ≤ .03), driven by those identified in the distal colon and rectum (all P trend ≤ .04, except AMED: P trend = .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.