Prospective evaluation of dietary and lifestyle pattern indices with risk of colorectal cancer in a cohort of younger women

Y Yue; J Hur; Y Cao; F K Tabung; M Wang; K Wu; M Song; X Zhang; Y Liu; J A Meyerhardt; K Ng; S A Smith-Warner; W C Willett; E Giovannucci

doi:10.1016/j.annonc.2021.03.200

Prospective evaluation of dietary and lifestyle pattern indices with risk of colorectal cancer in a cohort of younger women

Ann Oncol. 2021 Jun;32(6):778-786. doi: 10.1016/j.annonc.2021.03.200. Epub 2021 Apr 1.

Authors

Y Yue¹, J Hur², Y Cao³, F K Tabung⁴, M Wang⁵, K Wu¹, M Song⁶, X Zhang⁷, Y Liu⁸, J A Meyerhardt⁹, K Ng⁹, S A Smith-Warner¹⁰, W C Willett¹¹, E Giovannucci¹²

Affiliations

¹ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA.
² Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA. Electronic address: [email protected].
³ Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, USA; Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, USA; Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, USA.
⁴ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA; Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, USA; The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, USA.
⁵ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA.
⁶ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA; Harvard Medical School, Boston, USA.
⁷ Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA.
⁸ Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA; Clinical and Translational Epidemiology Unit and Division of Gastroenterology, Massachusetts General Hospital, Boston, USA.
⁹ Evidence-Based Chinese Medicine, School of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, P.R. China.
¹⁰ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA.
¹¹ Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA.
¹² Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA. Electronic address: [email protected].

Abstract

Background: Although colorectal cancer (CRC) incidence in the USA is declining overall, its incidence is increasing among those younger than 50 years of age. The reasons underlying the increasing trend are largely unknown, although behavioral changes, such as unhealthy diet and lifestyle factors, may be partially responsible.

Design: A prospective cohort study included 94 217 women aged 26-45 years at baseline. Validated anthropometric measures and lifestyle information were self-reported biennially. Exposures were four recommendation-based dietary indices-the prime diet quality score and three plant-based dietary indices; and two mechanism-based indices-the empirical dietary and lifestyle index for hyperinsulinemia (EDIH and ELIH). We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) for overall CRC and for early-onset (before age 50) and after age 50 CRC separately.

Results: We documented 332 cases of CRC during 24 years of follow-up (2 113 655 person-years), with an average age of 52 ± 7 years at diagnosis. Hyperinsulinemic dietary and lifestyle patterns were associated with a higher risk of CRC. Multivariable-adjusted HRs (95% CIs) comparing participants in the highest versus lowest quartile were: 1.67 for EDIH (95% CI: 1.15-2.44, P-trend = 0.01) and 1.51 for ELIH (95% CI: 1.10-2.08, P-trend = 0.01). Moreover, per 75% increment in rank, ELIH appeared to be a stronger risk factor for early-onset CRC (HR = 1.86, 95% CI: 1.12-3.07) than after age 50 CRC (HR = 1.20, 95% CI: 0.83-1.73, P-heterogeneity = 0.16). The four recommendation-based indices were not significantly associated with overall, early-onset, or after age 50 CRC risk (per 75% increment in rank, HRs ranged from 0.75 to 1.28).

Conclusion: Dietary and lifestyle patterns contributing to hyperinsulinemia were associated with greater CRC risk in younger women. Moreover, the hyperinsulinemic lifestyle showed a suggestively stronger positive association with early-onset CRC risk, compared with after age 50 CRC. Our findings suggest that dietary and lifestyle interventions to reduce insulinemic potential may be effective for CRC prevention among younger women.

Keywords: colorectal cancer; dietary and lifestyle pattern; young women.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cohort Studies
Colorectal Neoplasms* / epidemiology
Colorectal Neoplasms* / etiology
Diet*
Female
Humans
Life Style
Middle Aged
Prospective Studies
Risk Factors

Abstract

Publication types

MeSH terms

Grants and funding