High Consumption of Sugar During Adolescence Associated With Risk of Adenoma

Researchers analyzed the relationship between adolescent simple sugar and sugar-sweetened beverages intake and the development of colorectal cancer.

High consumption of simple sugars and sugar-sweetened beverages (SSB) during adolescence were found to be significantly associated with increased risk of conventional adenoma, particularly rectal adenoma. On the contrary, high consumption of sugar and SSB during adulthood does not appear to be associated with an increased risk of adenoma. These findings are based on a study published in Gastroenterology.

This prospective cohort study included 33,106 women and 4744 polyp cases. In 1998, the study participants completed the 124-item self-administered high school Food Frequency Questionnaire (HS-FFQ) to assess adolescent diet. Thereafter, the enrollees underwent lower gastrointestinal endoscopy between 1999 and 2015. Logistic regression for clustered data was utilized to estimate odds ratios (ORs) and 95% confidence intervals (CIs).

During the follow-up period, the investigators identified 2909 conventional adenomas (758 high-risk) and 2355 serrated lesions (196 large serrated lesions). The mean age at diagnoses was determined to be 52.2±4.3 years. The researchers noted that high consumption of sugar and SSB during adolescence was positively associated with risk of adenoma, but not serrated lesions.

Per each 5% increase in calorie/day of total fructose consumption, multivariable ORs were the following: 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 the following: 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 increase in SSB consumption, ORs were the following: 1.11 (95% CI, 1.02-1.20) for total and 1.30 (95% CI, 1.08-1.55) for rectal adenoma.

After adjustment for adolescent consumption, adult sugar and SSB consumption was not associated with adenoma risk with multivariable ORs of 0.97 (95% CI, 0.80-1.17) for total fructose (per 5% calorie/day) and 0.99 (95% CI, 0.84-1.16) for SSBs (per 1 serving/day).

This study had several potential limitations, such as the possibility of measurement error as well as residual and unmeasured confounding. Additionally, there was insufficient information to distinguish hyperplastic polpys from sessile serrated adenoma/polyps and traditional serrated adenoma. Lastly, the study consisted of mostly white female nurses, which may preclude these findings from being generalizable to other populations.

Nevertheless, this prospective investigation is considered the first study to evaluate the association of sugar consumption during adolescence with risk of colorectal cancer (CRC) precursors.

The study authors concluded that “high intake of simple sugars and SSBs during adolescence was significantly associated with increased risk of total and high-risk adenoma, especially rectal adenoma.”

They added, “Given the profound increase in added sugar and SSB intake during the past several decades, our findings may partly explain the current upward trends in early-onset CRC rates.”

Disclosures: Multiple authors declared affiliations with the industry and this study was funded by multiple sources. Please refer to the original article for a full list of disclosures.


Joh H-K, Lee DH, Hur J, et al. Simple sugar and sugar-sweetened beverage intake during adolescence and risk of colorectal cancer precursors. Gastroenterol. Published online March 19, 2021. doi: 10.1053/j.gastro.2021.03.028