Simple Sugar and Sugar-Sweetened Beverage Intake During Adolescence and Risk of Colorectal Cancer Precursors

Hee Kyung Joh, Dong Hoon Lee, Jinhee Hur, Katharina Nimptsch, Yoosoo Chang, Hyojee Joung, Xuehong Zhang, Leandro F.M. Rezende, Jung Eun Lee, Kimmie Ng, Chen Yuan, Fred K. Tabung, Jeffrey A. Meyerhardt, Andrew T. Chan, Tobias Pischon, Mingyang Song, Charles S. Fuchs, Walter C. Willett, Yin Cao, Shuji OginoEdward Giovannucci, Kana Wu

Research output: Contribution to journalArticlepeer-review

56 Citations (Scopus)


Background & aims: Recent increasing trends in early-onset colorectal cancer (CRC) strongly supports that early-life diet is involved in CRC development. However, data are lacking on the relationship with high sugar intake during early life. Methods: We prospectively investigated the association of adolescent simple sugar (fructose, glucose, added sugar, total sugar) and sugar-sweetened beverage (SSB) intake with CRC precursor risk in 33,106 participants of the Nurses’ Health Study II who provided adolescent dietary information in 1998 and subsequently underwent lower gastrointestinal endoscopy between 1999 and 2015. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression for clustered data. Results: During follow-up, 2909 conventional adenomas (758 high-risk) and 2355 serrated lesions were identified (mean age at diagnoses, 52.2 ± 4.3 years). High sugar and SSB intake during adolescence was positively associated with risk of adenoma, but not serrated lesions. Per each increment of 5% of calories from total fructose intake, multivariable ORs were 1.17 (95% CI, 1.05–1.31) for total and 1.30 (95% CI, 1.06–1.60) for high-risk adenoma. By subsite, ORs were 1.12 (95% CI, 0.96–1.30) for proximal, 1.24 (95% CI, 1.05–1.47) for distal, and 1.43 (95% CI, 1.10–1.86) for rectal adenoma. Per 1 serving/day increment in SSB intake, ORs were 1.11 (95% CI, 1.02–1.20) for total and 1.30 (95% CI, 1.08–1.55) for rectal adenoma. Contrary to adolescent intake, sugar and SSB intake during adulthood was not associated with adenoma risk. Conclusions: High intake of simple sugars and SSBs during adolescence was associated with increased risk of conventional adenoma, especially rectal adenoma.

Original languageEnglish
Pages (from-to)128-142.e20
Issue number1
Publication statusPublished - 2021 Jul

Bibliographical note

Publisher Copyright:
© 2021 AGA Institute

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology


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