Colon to Rectum
BMJ. 2022;378:e068921
Association of ultraprocessed food consumption with colorectal cancer risk among men and women: Results from 3 prospective US cohort studies
Objective: To examine the association between consumption of ultraprocessed foods and risk of colorectal cancer (CRC) among men and women from 3 large prospective cohorts.
Design: Prospective cohort study with dietary intake assessed every 4 years using food frequency questionnaires.
Setting: Three large US cohorts.
Participants: Men (n = 46,341) from the Health Professionals Follow-up Study (1986–2014) and women (n = 159,907) from the Nurses’ Health Study (1986–2014; n = 67,425) and the Nurses’ Health Study II (1991–2015; n = 92,482) with valid dietary intake measurement and no cancer diagnosis at baseline. Main outcome measure: Association between ultraprocessed food consumption and risk of CRC, estimated using time-varying Cox proportional hazards regression models adjusted for potential confounding factors.
Results: 3216 cases of CRC (1294 men, 1922 women) were documented during the 24–28 years of follow-up. Compared with those in the lowest fifth of ultraprocessed food consumption, men in the highest fifth of consumption had a 29% higher risk of developing CRC (hazard ratio [HR] for highest vs. lowest fifth = 1.29, 95% confidence interval [CI]: 1.08–1.53; ptrend = 0.01), and the positive association was limited to distal colon cancer (72% increased risk; HR = 1.72, 95% CI: 1.24–2.37; ptrend < 0.001). These associations remained significant after further adjustment for body mass index or indicators of nutritional quality of the diet (that is, western dietary pattern or dietary quality score). No association was observed between overall ultraprocessed food consumption and risk of CRC among women. Among subgroups of ultraprocessed foods, higher consumption of meat/poultry/seafood-based ready-to-eat products (HR for highest vs. lowest fifth = 1.44, 95% CI: 1.20–1.73; ptrend < 0.001) and sugar-sweetened beverages (HR = 1.21, 95% CI: 1.01–1.44; ptrend = 0.013) among men and ready-to-eat/heat-mixed dishes among women (HR = 1.17, 95% CI: 1.01–1.36; ptrend = 0.02) was associated with increased risk of CRC; yogurt and dairy-based desserts were negatively associated with the risk of CRC among women (HR = 0.83, 95% CI: 0.71–0.97; ptrend = 0.002).
Conclusions: In the 3 large prospective cohorts, high consumption of total ultraprocessed foods in men and certain subgroups of ultraprocessed foods in men and women was associated with an increased risk of colorectal cancer. Further studies are needed to better understand the potential attributes of ultraprocessed foods that contribute to colorectal carcinogenesis.