TABLE 3.
HRs and 95% CIs of colon or rectal cancer according to quintiles of sugar and food intake (n = 155,536)
| No. of cases | Colon cancer |
Proximal colon cancer |
Distal colon cancer |
Rectal cancer |
|---|---|---|---|---|
| 3351 |
2074 |
1173 |
1014 |
|
| HR (95%CI)1 | HR (95%CI)1 | HR (95%CI)1 | HR (95%CI)1 | |
| Total sugars2,3 | ||||
| Q1 | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
| Q2 | 1.04 (0.93, 1.16) | 1.02 (0.88, 1.17) | 1.07 (0.89, 1.28) | 1.07 (0.89, 1.28) |
| Q3 | 1.11 (0.99, 1.25) | 1.10 (0.95, 1.27) | 1.15 (0.95, 1.39) | 0.94 (0.77, 1.15) |
| Q4 | 1.20 (1.06, 1.35) | 1.18 (1.01, 1.37) | 1.23 (1.01, 1.50) | 0.93 (0.75, 1.15) |
| Q5 | 1.16 (1.01, 1.32) | 1.16 (0.98, 1.37) | 1.16 (0.93, 1.44) | 1.11 (0.88, 1.39) |
| P for trend | 0.01 | 0.03 | 0.10 | 0.67 |
| P for heterogeneity (colon vs. rectal, proximal vs. distal) | 0.001 | 0.002 | ||
| Total fructose2,4 | ||||
| Q1 | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
| Q2 | 0.94 (0.84, 1.05) | 0.95 (0.82, 1.10) | 0.93 (0.77, 1.11) | 0.97 (0.81, 1.17) |
| Q3 | 1.09 (0.98, 1.22) | 1.11 (0.96, 1.28) | 1.08 (0.90, 1.30) | 0.89 (0.73, 1.09) |
| Q4 | 1.12 (1.00, 1.26) | 1.10 (0.95, 1.28) | 1.22 (1.01, 1.47) | 0.90 (0.73, 1.10) |
| Q5 | 1.15 (1.01, 1.30) | 1.16 (0.99, 1.36) | 1.14 (0.93, 1.41) | 1.00 (0.80, 1.25) |
| P for trend | 0.002 | 0.02 | 0.04 | 0.92 |
| P for heterogeneity (colon vs. rectal or proximal or distal) | 0.001 | 0.01 | ||
| Added sugars2 | ||||
| Q1 | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
| Q2 | 0.99 (0.89, 1.10) | 0.98 (0.85, 1.12) | 1.04 (0.87, 1.24) | 1.09 (0.90, 1.32) |
| Q3 | 0.97 (0.87, 1.08) | 0.98 (0.86, 1.13) | 0.95 (0.79, 1.14) | 1.05 (0.86, 1.28) |
| Q4 | 0.95 (0.85, 1.06) | 0.95 (0.82, 1.09) | 0.95 (0.78, 1.15) | 0.97 (0.79, 1.19) |
| Q5 | 1.03 (0.92, 1.16) | 1.03 (0.89, 1.20) | 1.04 (0.86, 1.27) | 1.06 (0.86, 1.31) |
| P for trend | 0.65 | 0.68 | 0.87 | 0.89 |
| P for heterogeneity (colon vs. rectal or proximal or distal) | 0.54 | 0.63 | ||
| Glucose2 | ||||
| Q1 | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
| Q2 | 1.05 (0.94, 1.18) | 1.10 (0.95, 1.27) | 0.99 (0.82, 1.19) | 0.92 (0.76, 1.11) |
| Q3 | 1.22 (1.09, 1.36) | 1.17 (1.02, 1.36) | 1.31 (1.09, 1.56) | 0.98 (0.81, 1.19) |
| Q4 | 1.23 (1.10, 1.38) | 1.22 (1.05, 1.42) | 1.27 (1.05, 1.54) | 0.92 (0.75, 1.13) |
| Q5 | 1.26 (1.11, 1.42) | 1.26 (1.07, 1.48) | 1.28 (1.04, 1.57) | 1.02 (0.82, 1.27) |
| P for trend | <0.001 | 0.005 | 0.01 | 0.73 |
| P for heterogeneity (colon vs. rectal or proximal or distal) | 0.005 | 0.09 | ||
| Fructose2 | ||||
| Q1 | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
| Q2 | 1.02 (0.91, 1.13) | 1.01 (0.88, 1.17) | 1.02 (0.85, 1.22) | 0.96 (0.80, 1.17) |
| Q3 | 1.10 (0.98, 1.23) | 1.13 (0.98, 1.31) | 1.08 (0.89, 1.30) | 1.04 (0.86, 1.26) |
| Q4 | 1.20 (1.07, 1.35) | 1.17 (1.01, 1.36) | 1.30 (1.07, 1.57) | 0.94 (0.76, 1.16) |
| Q5 | 1.17 (1.03, 1.33) | 1.16 (0.99, 1.37) | 1.20 (0.97, 1.48) | 1.04 (0.83, 1.30) |
| P for trend | 0.003 | 0.04 | 0.02 | 0.78 |
| P for heterogeneity (colon vs. rectal or proximal or distal) | 0.01 | 0.0496 | ||
| Galactose2 | ||||
| Q1 | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
| Q2 | 0.90 (0.81, 1.00) | 0.86 (0.75, 0.98) | 0.96 (0.81, 1.15) | 0.82 (0.68, 0.99) |
| Q3 | 0.98 (0.88, 1.09) | 0.88 (0.76, 1.01) | 1.15 (0.96, 1.39) | 0.76 (0.62, 0.94) |
| Q4 | 0.86 (0.77, 0.97) | 0.79 (0.68, 0.92) | 0.99 (0.81, 1.22) | 0.84 (0.68, 1.05) |
| Q5 | 0.90 (0.79, 1.02) | 0.81 (0.69, 0.95) | 1.05 (0.84, 1.31) | 0.93 (0.73, 1.17) |
| P for trend | 0.19 | 0.07 | 0.85 | 0.64 |
| P for heterogeneity (colon vs. rectal or proximal or distal) | 0.048 | 0.09 | ||
| Sucrose2 | ||||
| Q1 | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
| Q2 | 1.04 (0.93, 1.16) | 1.05 (0.92, 1.22) | 1.05 (0.88, 1.25) | 1.03 (0.85, 1.24) |
| Q3 | 1.08 (0.96, 1.20) | 1.12 (0.97, 1.29) | 1.04 (0.86, 1.25) | 0.93 (0.76, 1.13) |
| Q4 | 0.99 (0.88, 1.11) | 1.00 (0.86, 1.16) | 1.01 (0.83, 1.23) | 0.94 (0.76, 1.16) |
| Q5 | 1.06 (0.94, 1.19) | 1.10 (0.94, 1.28) | 1.01 (0.82, 1.24) | 1.03 (0.83, 1.28) |
| P for trend | 0.61 | 0.44 | 0.97 | 0.99 |
| P for heterogeneity (colon vs. rectal or proximal or distal) | 0.04 | 0.002 | ||
| Maltose2 | ||||
| Q1 | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
| Q2 | 1.06 (0.94, 1.18) | 1.13 (0.97, 1.30) | 0.90 (0.75, 1.09) | 1.13 (0.92, 1.38) |
| Q3 | 1.12 (1.00, 1.25) | 1.10 (0.95, 1.28) | 1.11 (0.92, 1.33) | 1.22 (1.00, 1.49) |
| Q4 | 1.21 (1.08, 1.35) | 1.23 (1.07, 1.42) | 1.14 (0.95, 1.37) | 1.22 (1.00, 1.49) |
| Q5 | 1.27 (1.13, 1.42) | 1.30 (1.13, 1.50) | 1.18 (0.98, 1.42) | 1.15 (0.94, 1.42) |
| P for trend | <0.001 | <0.001 | 0.01 | 0.20 |
| P for heterogeneity (colon vs. rectal or proximal or distal) | 0.28 | 0.44 | ||
| Lactose2 | ||||
| Q1 | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
| Q2 | 1.01 (0.90, 1.12) | 0.96 (0.84, 1.10) | 1.08 (0.91, 1.29) | 0.92 (0.76, 1.11) |
| Q3 | 0.90 (0.80, 1.01) | 0.86 (0.74, 0.99) | 0.97 (0.80, 1.18) | 0.85 (0.69, 1.04) |
| Q4 | 1.01 (0.90, 1.14) | 0.98 (0.84, 1.14) | 1.02 (0.83, 1.26) | 0.93 (0.74, 1.16) |
| Q5 | 0.96 (0.83, 1.11) | 0.94 (0.79, 1.12) | 1.01 (0.79, 1.29) | 0.85 (0.65, 1.11) |
| P for trend | 0.72 | 0.82 | 0.81 | 0.41 |
| P for heterogeneity (colon vs. rectal or proximal or distal) | 0.002 | 0.02 | ||
| Whole fruits2 | ||||
| Q1 | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
| Q2 | 0.89 (0.79, 1.00) | 0.88 (0.76, 1.02) | 0.84 (0.69, 1.01) | 1.14 (0.95, 1.38) |
| Q3 | 0.93 (0.82, 1.05) | 0.86 (0.74, 1.00) | 1.03 (0.85, 1.25) | 0.84 (0.67, 1.05) |
| Q4 | 1.05 (0.93, 1.20) | 1.03 (0.88, 1.21) | 1.06 (0.85, 1.31) | 1.00 (0.79, 1.27) |
| Q5 | 1.04 (0.89, 1.21) | 0.97 (0.80, 1.18) | 1.14 (0.88, 1.47) | 1.13 (0.85, 1.49) |
| P for trend | 0.11 | 0.46 | 0.08 | 0.45 |
| P for heterogeneity (colon vs. rectal or proximal or distal) | <0.001 | <0.001 | ||
| Fruit juice 2 | ||||
| Q1 | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
| Q2 | 1.04 (0.93, 1.15) | 1.01 (0.88, 1.16) | 1.10 (0.91, 1.31) | 0.96 (0.80, 1.16) |
| Q3 | 1.03 (0.93, 1.15) | 0.97 (0.84, 1.12) | 1.17 (0.97, 1.40) | 0.95 (0.78, 1.15) |
| Q4 | 0.95 (0.85, 1.06) | 0.95 (0.83, 1.10) | 0.94 (0.78, 1.15) | 0.90 (0.74, 1.09) |
| Q5 | 1.08 (0.96, 1.20) | 1.03 (0.89, 1.18) | 1.24 (1.03, 1.49) | 0.79 (0.64, 0.97) |
| P for trend | 0.36 | 0.70 | 0.12 | 0.02 |
| P for heterogeneity (colon vs. rectal or proximal or distal) | <0.001 | 0.58 | ||
| Sugar-sweetened beverages2,5 | ||||
| Q1 | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
| Q2 | 0.97 (0.87, 1.08) | 0.94 (0.82, 1.07) | 1.02 (0.85, 1.23) | 1.05 (0.86, 1.28) |
| Q3 | 0.99 (0.89, 1.11) | 0.96 (0.84, 1.10) | 1.03 (0.86, 1.25) | 0.91 (0.74, 1.12) |
| Q4 | 0.98 (0.87, 1.09) | 0.90 (0.78, 1.04) | 1.11 (0.91, 1.34) | 0.99 (0.80, 1.21) |
| Q5 | 1.05 (0.93, 1.18) | 0.98 (0.84, 1.14) | 1.15 (0.94, 1.41) | 0.99 (0.80, 1.23) |
| P for trend | 0.23 | 0.93 | 0.12 | 0.93 |
| P for heterogeneity (colon vs. rectal or proximal or distal) | 0.17 | 0.004 | ||
| Confectionary2 | ||||
| Q1 | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) | 1.00 (reference) |
| Q2 | 1.10 (0.98, 1.23) | 1.10 (0.95, 1.27) | 1.13 (0.94, 1.36) | 1.10 (0.90, 1.34) |
| Q3 | 1.07 (0.95, 1.19) | 1.07 (0.92, 1.23) | 1.12 (0.93, 1.35) | 0.96 (0.78, 1.18) |
| Q4 | 1.05 (0.93, 1.18) | 1.08 (0.93, 1.25) | 1.01 (0.83, 1.23) | 1.12 (0.91, 1.38) |
| Q5 | 1.07 (0.95, 1.21) | 1.07 (0.92, 1.25) | 1.13 (0.92, 1.39) | 1.09 (0.87, 1.36) |
| P for trend | 0.60 | 0.62 | 0.55 | 0.44 |
| P for heterogeneity (colon vs. rectal or proximal or distal) | 0.73 | 0.97 | ||
Abbreviations: CI, confidence interval; CRC, colorectal cancer; HR, hazard ratio; NSAID, nonsteroidal anti-inflammatory drug.
Analyses were performed excluding participants with missing data on any of the covariates. CRC cases with subsites other than the one of interest were censored at the time of the CRC diagnosis.
1
Adjusted for race/ethnicity, sex, age at cohort entry, body mass index, alcohol consumption, smoking status, number of pack-years, physical activity, education, family history of CRC, history of polyps of intestines, history of diabetes, use of exogenous female hormones (women only), NSAID use, total energy intake, and intake of saturated fatty acids, n–3 polyunsaturated fatty acids, vitamin D, calcium, dietary fiber, and folate.
2
Participants were categorized into quintiles of sugar or food intake by sex for the analyses of the corresponding sugar type and food.
3
“Total sugars” represent the sum of the consumption of the following saccharides: glucose, fructose, galactose, sucrose, maltose, and lactose.
4
“Total fructose” represents the sum of the consumption of fructose and half of sucrose.
5
Sugar-sweetened beverages include regular sodas, fruit drinks, and coffee and tea with added sugar.