Study: Do sugared beverages increase the risk of early-onset colorectal cancer?

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Contents

At a glance Clinical trials
Study findings Guidelines
Strengths and limitations Questions for your doctor
What does this mean for me? Resources
In-depth  

 

STUDY AT A GLANCE

What is this study about?

This is study is about whether drinking sugar-sweetened beverages increases the risk for colorectal cancer before age 50.

 

Why is this study important?

Sugar-sweetened beverages or sugary drinks (e.g., soft drinks, fruit drinks, sports drinks, energy drinks and sweetened tea) contain the most added sugar in American diets. Over 10 percent of the population consumes more than three sugary drinks per day.

Frequently drinking sugar-sweetened beverages is linked with many poor health outcomes, such as tooth decay, weight gain/obesity, heart disease and type 2 diabetes. One factor that may potentially be associated with early-onset (before age 50) colorectal cancer is frequently drinking sugary drinks. While these hints have been observed, more research is needed about the direct impact of these products on colorectal cancer risk.

Establishing how much sugar-sweetened beverages may affect colorectal cancer risk may help people make better lifestyle choices and may reduce the risk of disease.

 

Study findings

The researchers followed more than 95,000 female nurses in the United States for 24 years to determine the impact of drinking sugar-sweetened beverages daily on early-onset colorectal cancer risk. All women were under age 50 at the beginning of the study.

Every four years, the participants provided information about their diets (including intake of sugary beverages), overall health and family history.

By the end of the study, 109 participants had been diagnosed with early-onset colorectal cancer. This is a very small fraction (0.1%) of all participants.

The research showed that:

  • Women who drank two or more sugary drinks a day had more than double the risk of early-onset colorectal cancer compared with women who drank less than one sugary drink per week. However the rate of colorectal cancer in women who drank more sugary drinks was not statistically different from those that drank fewer sugary drinks.
  • Each additional serving of a sugary drink per day was associated with a 16 percent increase in relative risk. While the researchers observed a trend of more colorectal cancer with more sugary drink intake, colorectal cancer was not significantly different between those who drank or did not drink sugary beverages.
  • Replacing sugary drinks with artificially sweetened beverages, coffee or milk may offset the increased risk of early-onset colorectal cancer. More research is needed to understand if sugary drinks do or do not increase risk of early-onset colorectal cancer.

 

Strengths and limitations

Strengths

  • The study included over 95,000 participants and represented women from multiple geographical locations throughout the US. Research shows that dietary habits, which are often cultural, can differ across regions. 
  • The study followed participants for a long time, allowing researchers to determine how long-term, regular use of sugary drinks impacts early-onset colorectal cancer risk.
  • The participant surveys provided enough information for researchers to rule out other colorectal cancer risk factors, including hereditary risk.

Limitations

  • None of the trends observed are statistically different between women who drank or did not drink sugary beverages.
  • The study only looked at women in the U.S. who worked as nurses. It is unclear whether these results will apply to other men or women in general.
  • There were a limited number of early-onset colorectal cases that occurred among participants which limits the conclusions.
  • Most of the participants were white, limiting the generalizability to other racial and ethnic populations.
  • The study did not address whether drinking sugary drinks raised colorectal cancer risk among people with an existing increased risk of the disease, such as those with Lynch syndrome.

 

What does this mean for me?

Based on these results, excessive drinking of sugary beverages may increase risk of early-onset colorectal cancer. Although the study did not go into detail about how drinking sugary drinks affects people with a hereditary risk for colorectal cancer, it suggests that replacing sugar-sweetened beverages with other beverages may reduce cancer risk to a small degree. If you have a family history of colorectal cancer, you might discuss with your doctor how your beverage consumption habits may impact your risk for the disease. You may want to also consider limiting the number of sugary beverages that your children regularly drink.

This XRAY was reviewed by FORCE's Scientific Advisory Board.

 

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posted 9/21/21


References

Hur J, Otegbeye E, Joh H-K, et al. Sugar-sweetened beverage intake in adulthood and adolescence and the risk of early-onset colorectal cancer among women. Gut. 2021; Published online May 6, 2021. doi: 10.1136/gutjnl-2020-323450

Joh H-K, Lee D, Hur J, et al. Simple Sugar and Sugar-Sweetened Beverage Intake During Adolescence and Risk of Colorectal Cancer Precursors. Gastroenterology. 2021 Jul;161(1):128-142.e20. Published March 9, 2021.

 

Disclosure

FORCE receives funding from industry sponsors, including companies that manufacture cancer drugs, tests and devices. All XRAYS articles are written independently of any sponsor and are reviewed by members of our Scientific Advisory Board prior to publication to assure scientific integrity.

This article is relevant for:

Healthy people with an average colorectal cancer risk

This article is also relevant for:

Healthy people with average cancer risk

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Expert Guidelines

Lifestyle Factors

 A risk factor is anything that raises your chance of getting a disease. Some risk factors for colorectal cancer, like your age or family history, cannot be changed. Others, like smoking and diet, can be changed (modifiable risk factors). According to the American Cancer Society (ACS) and the National Comprehensive Cancer Network (NCCN), you might be able to lower your risk of colorectal cancer by doing the following:

  • Maintaining a healthy weight     
    • Being overweight or obese are risk factors for colorectal cancer. Regular exercise and healthy eating may help you control your weight.
  • Exercising regularly
    • Physical activity can lower the risk of colorectal cancer as well as other serious diseases such as diabetes and heart disease.
    • Adults should get at least 150 minutes of moderate-intensity activity (equal to a brisk walk) or 75 minutes of vigorous activity (makes your heartbeat and breathing faster and makes you sweat) each week, preferably spread throughout the week.
  • Eating a healthy diet
    • Studies show that eating a variety of different vegetables and fruits, whole grains, and fish or poultry is linked with a lower risk of colorectal cancer. On the other hand, eating more processed foods and red meat is linked to a higher risk of colorectal cancer. The American Cancer Society recommends:
      • eating at least 2½ cups of vegetables and fruits each day.
      • eating less red meat (beef, pork and lamb) and less processed meat (bacon, sausage, luncheon meats and hot dogs).
      • choosing bread, pasta and cereal made from whole grains instead of refined grains, and brown rice instead of white.
      • eating fewer sweets.
  • Avoiding tobacco
  • Long-term smoking is linked to an increased risk of colorectal cancer, as well as other health problems and cancers. Tobacco use is responsible for nearly 1 of every 5 deaths in the U.S.—about 480,000 premature deaths each year.
  • Limiting alcohol consumption
    • Research has shown that alcohol can increase your risk for colorectal cancer, especially among men. The more alcohol you drink, the higher your risk.
    • Men should have no more than 2 drinks a day and women no more than 1. A standard serving of alcohol is defined as 12 ounces of beer, 5 ounces of wine or 1.5 ounces of 80‐proof distilled spirits.

Expert Guidelines

According to the American Cancer Society and the National Comprehensive Cancer Network (NCCN), you may be able to lower your risk of colorectal cancer by doing the following: 

Screening

  • Undergoing recommended colorectal cancer screenings can help prevent colorectal cancer by identifying and removing abnormal growths before they can become cancerous. 

Lifestyle 

  • Getting to and staying at a healthy weight.
    • Being overweight or obese is a risk factor for colorectal cancer. 
  • Exercising regularly.
    • Physical activity has been shown to lower the risk of colorectal cancer as well as other serious diseases.
    • Adults should get at least 150 minutes of moderate-intensity activity (equal to a brisk walk) or 75 minutes of vigorous activity (makes your heartbeat and breathing faster and makes you sweat) each week, preferably spread throughout the week.
  • Eating a healthy diet.
    • Eating a variety of different vegetables and fruits, whole grains and fish or poultry is linked with a lower risk of colorectal cancer. Eating more processed foods and red meat is linked with a higher risk of colorectal cancer. The ACS recommends:
      • Eating at least 2½ cups of vegetables and fruits each day
      • Eating less red meat (beef, pork and lamb) and less processed meat (bacon, sausage, luncheon meats and hot dogs)
      • Choosing bread, pasta and cereal made from whole grains instead of refined grains, and brown rice instead of white
      • Eating fewer sweets
  • Avoiding tobacco.
  • Limiting alcohol consumption.
    • Alcohol can increase the risk for colorectal cancer, especially among men. Men should have no more than 2 drinks a day and women no more than 1. A standard serving of alcohol is: 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of spirits.

Aspirin as a preventative measure

The United States Preventive Services Task Force (USPSTF) and NCCN support the use of daily low-dose aspirin as a preventative measure against colorectal cancer. Daily aspirin protects against colorectal cancer when it is taken at a low dose for at least five to 10 years. The USPSTF and NCCN recommend the following:

  • Low-dose (81 mg) aspirin can be considered as a preventative measure for people ages 45 to 60 years who have elevated risk of cardiovascular disease and who have a life expectancy of at least 10 years.
  • The decision to offer aspirin should take into consideration the risk of bleeding, life expectancy and long-term compliance.

Updated: 11/29/2021

Questions to Ask Your Doctor

  • How can I reduce my risk of colorectal cancer?
  • Should I limit my consumption of sugar-sweetened beverages to reduce my colorectal cancer risk?
  • I have a family history of colorectal cancer. What can I do to reduce my risk?
  • I have a personal history of colorectal cancer. Will this affect my children’s risk of the disease?
  • I have a personal history of colorectal cancer. Will consuming sugar-sweetened beverages affect my chance of cancer returning?
  • I have a diagnosis of colorectal cancer. Is it okay for me to have sugar-sweetened beverages?

Open Clinical Trials

The following are studies focused on nutrition and colorectal cancer prevention. 

Visit our Featured Research Page and Research Search and Enroll Tool to find additional studies enrolling people with, or at high risk for cancer.

Updated: 11/13/2021

Find Experts

You can find a registered dietician in your area using the search tool from the Academy of Nutrition and Dietetics.  

Updated: 11/13/2021

IN-DEPTH REVIEW OF RESEARCH

Study background

Sugar-sweetened beverages (sugary drinks) contribute to metabolic conditions (such as type 2 diabetes) and gastrointestinal diseases (such as Crohn’s disease). These diseases increase the risk of colorectal cancer.

The number of new cases of early-onset colorectal cancer (colorectal cancer that is identified in people younger than age 50) has been on the rise for the past two decades. The consumption of sugar-sweetened beverages has more than doubled during the same time.

 

Researchers of this study wanted to know

The researchers wanted to know if consuming sugary drinks increases the risk of early-onset colorectal cancer.

 

Populations looked at in this study

This study looked at a group of 95,464 female nurses in the United States. The participants were between the ages of 24 and 42 when they enrolled.  Women who had a history of colorectal cancer or inflammatory bowel disease prior to the study were excluded.

 

Study design

The women were followed for up to 24 years or until a diagnosis of colorectal cancer, their 50th birthday, death, or they dropped out of the study. Participants were asked to complete questionnaires about lifestyle choices, demographics, medical history and family history of cancer, including colorectal cancer. Additionally, they completed a survey every four years about the frequency of their food and beverage consumption in the previous 12 months.

Some participants were asked to provide information regarding their eating habits as teenagers. This subset of participants completed a food survey that asked them how frequently they consumed different food items when they were between ages 13 and 18.

 

Study findings

By the end of the study, 109 participants had been diagnosed with early-onset colorectal cancer (or 0.1%). This is not a large number of participants which makes detecting small difference among groups of participants difficult. 

Compared to participants who rarely or never consumed sugar-sweetened beverages, participants who drank two or more servings per day had more than double the risk of early-onset colorectal cancer.

Each serving per day of sugary beverages was associated with a 16 percent increase in risk for the disease. However the absolute risk was small and the groups were not different statistically.

Among participants who completed adolescent food surveys, each daily serving of sugary drinks during adolescence was associated with a 32 percent increase in the risk of colorectal cancer. Participants who reported a higher intake of sugar-sweetened beverages during adolescence and adulthood tended to be less physically active and overall more likely to have a poorer diet quality (e.g., consumed higher amounts of red meat and were less likely to take multivitamins). However, the results were not statistically significant.

Researchers found no link between consumption of fruit juice or artificially sweetened beverages and early-onset colorectal cancer.  

 

Strengths and Limitations

Strengths

  • The study looked at a large number of participants which allows the researchers to observe early-onset colorectal cancer cases in the time frame of this study.
  • The study followed the participants for a long time, allowing researchers to look at how consumption impacts risk over time.
  • The surveys provided enough information so that researchers could test statistically for confounding factors, such as hereditary risk.
  • Researchers were able to account for reporting bias and trends in consumption throughout the 24-year study period.

Limitations

  • None of the trends observed were statistically significant.
  • The study only included women in the United States who worked as nurses, many of whom were white. The results of the study may not be generalizable to the broader population, such as men or women from different racial or ethnic backgrounds.
  • Whether sugary beverages are truly a risk factor is not clear. There are many factors that may differ in the people studied and there may be other risk factors for early-onset of colorectal cancer that are still unknown.
  • Researchers were unable to determine whether diabetes was a possible contributor to early-onset of colorectal cancer due to the low numbers of participants with diabetes.
  • The small number of early-onset colorectal cancer cases limited the researchers’ to reach a strong conclusion about the impact of sugary beverages on cancer risk and limits the researcher's ability to identify the time in one’s life when sugary beverage consumption had the greatest impact on cancer risk.

 

Context

Prior studies found no association between consumption of sugar-sweetened beverages and colorectal cancer. However, most previous studies had few total cases of cancer or few individuals who consumed more than one serving per day of sugar-sweetened beverages. This likely limited their ability to identify a connection. Furthermore, previous studies looked at the lifetime risk for colorectal cancer, while this study focused specifically on early-onset colorectal cancer. These researchers propose that the contribution of sugar-sweetened beverage consumption to early-onset colorectal cancer may differ significantly from late-onset colorectal cancer which may account for the difference in findings.

 

Conclusions

Excessive consumption of sugar-sweetened beverages may increase the risk of early-onset colorectal cancer. This relationship may contribute to the rising incidence of early-onset colorectal cancer from 1950 to 2000 when Americans’ consumption of sugary drinks nearly doubled. However, the results of this study may not apply to the general population. More research is needed to validate the link between sugar-sweetened beverages and early-onset colorectal cancer. A balanced diet, and/or dietary intake with moderation promotes a healthy lifestyle, and may in turn have beneficial impact on cancer risk.

 

Share your thoughts on this XRAY review by taking our brief survey.

posted 9/21/21

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