Colorectal cancer (CRC) rates have increased among young and middle-aged adults in recent years. Changes in diet and lifestyle are likely contributing to these increases. This study examined the association of simple sugar (fructose, glucose, added sugar, total sugar) and sugar-sweetened beverage (SSB) intake during adolescence with CRC precursor risk (specifically adenomas and serrated lesions) among an adult population. Data was used from the Nurses’ Health Study II, an ongoing prospective cohort study of 116,430 female registered nurses. To be included in the analysis, participants must have completed a high school Food Frequency Questionnaire in 1998 and underwent at least one lower GI endoscopy between 1999 and 2015.  Those with cancer, specific GI conditions, or implausible adolescent energy intakes or extensive missing dietary data were excluded.  The final sample included 33,106 women. Odds ratios and 95% confidence intervals were estimated with logistic regression for clustered data. Potential confounding variables during adolescence and adulthood were included. Results showed that high sugar and SSB intake during adolescence was positively associated with risk of adenoma, but not serrated lesions. High SSB intake during adolescence was significantly associated with rectal high-risk adenoma. However, adult sugar and SSB intake was not associated with adenoma risk.

Study strengths: This is the first study to examine the association of sugar and SSB intake during adolescence and CRC precursors. The dietary data was collected prior to endoscopic procedures, which decreases the risk of recall bias. The study had a large sample (n=33,106) including 4,744 polyp cases which allowed for stratified analyses with sufficient power. The dietary data was collected using a Food Frequency Questionnaire which is a valid method to collect data on habitual intake.

Study limitations: The dietary data was collected retrospectively when the participants were adults, which may have resulted in measurement error.  In addition, the study included predominantly white female nurses, and therefore has limited generalizability to other populations.

What this means for your practice: The article provides evidence that SSB intake during adolescence may contribute to risk of CRC in adulthood. This study adds to the myriad of health risks associated with SSB consumption. Remind your patients and their parents/guardians of the importance of limiting added sugars in their diet. The Dietary Guidelines for Americans recommends limiting added sugars to 10 percent of calories for all older than two years old. In addition, they recommend no foods or beverages with added sugars for children younger than two years old. Refer your patients to our website at for fun and healthy drink ideas that have no added sugar.

Original citation: Joh, Hee-Kyung, et al. (2021). Simple Sugar and Sugar-Sweetened Beverage Intake During Adolescence and Risk of Colorectal Cancer Precursors. Gastroenterology, 161:128–142.

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