ArticleAnnals of oncology : official journal of the European Society for Medical Oncology2021
Prospective evaluation of dietary and lifestyle pattern indices with risk of colorectal cancer in a cohort of younger women.
Article in Annals of oncology : official journal of the European Society for Medical Oncology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 40 papers, 3 of them syntheses that pooled it.
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Who cites it
40 citing papers in PubMed, 3 syntheses or guidelines pooled it, 76 citations in OpenAlex.
- Dietary patterns and colorectal cancer risk: Global Cancer Update Programme (CUP Global) systematic literature review.The American journal of clinical nutrition · 2025Pooled it
- Lifestyle scores and their potential to estimate the risk of multiple non-communicable disease-related endpoints: a systematic review.BMC public health · 2025Pooled it
- Diet as a Risk Factor for Early-Onset Colorectal Adenoma and Carcinoma: A Systematic Review.Frontiers in nutrition · 2022Pooled it
- Shaping the future of early-onset colorectal cancer prevention.Nature reviews. Cancer · 2026Review
- Cytoplasmic relocation of nuclear Ku70 by Bruceine A augments cGAS-STING pathway-mediated anti-tumor immunity.Acta pharmaceutica Sinica. B · 2026Article
- Emerging trends in the global burden of colorectal cancer.Nature reviews. Clinical oncology · 2026Review
- Risk Factors in Sporadic Early-Onset Colorectal Cancer, Current Evidence and Emerging Insights: A Systematic Review.Cancers · 2026Review
- Early-Onset Digestive System Cancers: Risk Factors and Clinicopathological and Molecular Features Across Organ Sites.Cancer science · 2026Review
- Article
- A review of dietary patterns and the colorectal polyp-to-carcinoma sequence: polyp occurrence, polyp recurrence, and colorectal cancer.Frontiers in nutrition · 2026Review
- Healthy lifestyle reduces frailty-associated overall and site-specific cancer risks: a prospective large cohort study in Chinese adults.Journal of translational medicine · 2025Article
- Early-onset colorectal cancer as an emerging disease of metabolic dysregulation.Nature reviews. Endocrinology · 2025Review
- Global, regional, and national burden of gastrointestinal cancers in early onset and young women, 1990-2021: analysis of data from the Global Burden of Disease study 2021.Journal of gastrointestinal oncology · 2025Article
- Trends in Cancer Incidence and Mortality Rates in Early-Onset and Older-Onset Age Groups in the United States, 2010-2019.Cancer discovery · 2025Article
- Article
- Risk Factors and Prevention of Cancer and CVDs: A Chicken and Egg Situation.Journal of clinical medicine · 2025Review
- Allura Red AC is a xenobiotic. Is it also a carcinogen?Carcinogenesis · 2024Review
- Metabolic Dysregulation and Cancer Risk Program (MeDOC): a transdisciplinary approach to obesity-associated cancers.Journal of the National Cancer Institute · 2024Article
- A Perspective Review on Diet Quality, Excess Adiposity, and Chronic Psychosocial Stress and Implications for Early-Onset Colorectal Cancer.The Journal of nutrition · 2024Review
- Unraveling the complexities of early-onset colorectal cancer: a perspective on dietary and microbial influences.Frontiers in public health · 2024Article
Corrections and comments
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Authors and funding
14 authors at 4 institutions in 2 countries.
Funding
Abstract
backgroundAlthough 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.
designA 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.
resultsWe 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).
conclusionDietary 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.
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