Ultra-processed food consumption and mortality among patients with stages I–III colorectal cancer: a prospective cohort studyResearch in context

Dong Hang; Mengxi Du; Lu Wang; Kai Wang; Zhe Fang; Neha Khandpur; Sinara Laurini Rossato; Eurídice Martínez Steele; Andrew T. Chan; Frank B. Hu; Jeffrey A. Meyerhardt; Dariush Mozaffarian; Shuji Ogino; Qi Sun; John B. Wong; Fang Fang Zhang; Mingyang Song

EClinicalMedicine (May 2024)

Ultra-processed food consumption and mortality among patients with stages I–III colorectal cancer: a prospective cohort studyResearch in context

Dong Hang,
Mengxi Du,
Lu Wang,
Kai Wang,
Zhe Fang,
Neha Khandpur,
Sinara Laurini Rossato,
Eurídice Martínez Steele,
Andrew T. Chan,
Frank B. Hu,
Jeffrey A. Meyerhardt,
Dariush Mozaffarian,
Shuji Ogino,
Qi Sun,
John B. Wong,
Fang Fang Zhang,
Mingyang Song

Affiliations

Dong Hang: Department of Epidemiology, Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
Mengxi Du: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA; Clinical and Translational Epidemiology Unit and Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
Lu Wang: Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
Kai Wang: Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
Zhe Fang: Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
Neha Khandpur: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Division of Human Nutrition and Health, Wageningen University, Netherlands; Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
Sinara Laurini Rossato: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Institute of Geography, Universidade Federal de Uberlândia, Minas Gerais, Brazil
Eurídice Martínez Steele: Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil; Center for Epidemiological Studies in Health and Nutrition (NUPENS), Faculty of Public Health, University of São Paulo, Brazil
Andrew T. Chan: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Clinical and Translational Epidemiology Unit and Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
Frank B. Hu: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
Jeffrey A. Meyerhardt: Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
Dariush Mozaffarian: Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA; Tufts School of Medicine and Division of Cardiology, Tufts Medical Center, Boston, MA, USA
Shuji Ogino: Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women’s Hospital, and Harvard Medical School, Boston, MA, USA; Broad Institute of MIT and Harvard, Cambridge, MA, USA; Division of Nutrition, Harvard Medical School, Boston, MA, USA; Tokyo Medical and Dental University (Institute of Science Tokyo), Tokyo, Japan
Qi Sun: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
John B. Wong: Division of Clinical Decision Making, Tufts Medical Center, Boston, MA, USA
Fang Fang Zhang: Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA; Corresponding author. Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA 02111, USA.
Mingyang Song: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Clinical and Translational Epidemiology Unit and Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Corresponding author. Department of Epidemiology, Harvard T.H. Chan School of Public Health, 667 Huntington Avenue, Kresge 801A, Boston, MA 02115, USA.

Journal volume & issue: Vol. 71
p. 102572

Abstract

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Summary: Background: Ultra-processed foods (UPFs) are emerging as a risk factor for colorectal cancer (CRC), yet how post-diagnostic UPF intake may impact CRC prognosis remains unexplored. Methods: Data collected from food frequency questionnaires were used to estimate intakes of total UPFs and UPF subgroups (serving/d) at least 6 months but less than 4 years post-diagnosis among 2498 patients diagnosed with stages I–III CRC within the Nurses’ Health Study and Health Professionals Follow-up Study during 1980–2016. Hazard ratios (HR) and 95% confidence intervals (CIs) of all-cause, CRC- and cardiovascular disease (CVD)-specific mortality in association with UPF consumption were estimated using an inverse probability weighted multivariable Cox proportional hazards regression model, adjusted for confounders. Findings: The mean (SD) age of patients at diagnosis was 68.5 (9.4) years. A total of 1661 deaths were documented, including 321 from CRC and 335 from CVD. Compared to those in the lowest quintile (median = 3.6 servings/d), patients in the highest quintile (median = 10 servings/d) of post-diagnostic UPF intake had higher CVD mortality (HR = 1.65, 95% CI = 1.13–2.40) but not CRC or all-cause mortality. Among UPF subgroups, higher consumption of fats/condiments/sauces was associated with a higher risk of CVD-specific mortality (highest vs. lowest quintile of intake, HR = 1.96, 95% CI = 1.41–2.73), and higher intake of ice cream/sherbet was associated with an increased risk of CRC-specific mortality (highest vs. lowest quintile, HR = 1.86, 95% CI: 1.33–2.61). No statistically significant association was found between UPF subgroups and overall mortality. Interpretation: Higher post-diagnostic intake of total UPFs and fats/condiments/sauces in CRC survivors is associated with higher CVD mortality, and higher ice cream/sherbet intake is linked to higher CRC mortality. Funding: US National Institutes of Health and the American Cancer Society.

Published in EClinicalMedicine

ISSN: 2589-5370 (Online)
Publisher: Elsevier
Country of publisher: United Kingdom
LCC subjects: Medicine: Medicine (General)
Website: https://www.thelancet.com/journals/eclinm/home

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