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Ultraprocessed Food Consumption and Risk of Early-Onset Colorectal Cancer Precursors Among Women

Wang, Chen ; Du, Mengxi ; Kim, Hanseul ; Nguyen, Long H. ; Wang, Qiao Li LU orcid ; Drew, David A. ; Leeming, Emily R. ; Khandpur, Neha ; Sun, Qi and Zong, Xiaoyu , et al. (2026) In JAMA Oncology 12(1). p.49-57
Abstract

Importance Early-onset colorectal cancer (EOCRC) (diagnosed age <50 years) incidence is increasing globally, in parallel with increased consumption of ultraprocessed foods (UPFs). The role of UPFs in early-onset colorectal neoplasia remains underexplored. Objective To evaluate the association between UPF consumption and risk of EOCRC precursors. Design, Setting, and Participants This prospective cohort study included participants of the Nurses’ Health Study II, an ongoing US prospective cohort of female registered nurses established in 1989. Participants were followed up from June 1, 1991, through June 1, 2015. Data were analyzed from October 2024 to July 2025. UPF intake, derived from food-frequency questionnaires administered every... (More)

Importance Early-onset colorectal cancer (EOCRC) (diagnosed age <50 years) incidence is increasing globally, in parallel with increased consumption of ultraprocessed foods (UPFs). The role of UPFs in early-onset colorectal neoplasia remains underexplored. Objective To evaluate the association between UPF consumption and risk of EOCRC precursors. Design, Setting, and Participants This prospective cohort study included participants of the Nurses’ Health Study II, an ongoing US prospective cohort of female registered nurses established in 1989. Participants were followed up from June 1, 1991, through June 1, 2015. Data were analyzed from October 2024 to July 2025. UPF intake, derived from food-frequency questionnaires administered every 4 years and classified using the Nova system, was modeled as quintiles of energy-adjusted servings per day. Of the nurses enrolled, those who had completed the baseline 1991 food-frequency questionnaire, undergone at least 1 lower endoscopy before age 50 years after baseline, had no history of cancer (except for nonmelanoma skin cancer) before endoscopy, and no colorectal polyp or inflammatory bowel disease were included. Main Outcomes and Measures Incidence of EOCRC precursors, including conventional adenomas and serrated lesions, confirmed via medical records and pathology reports. Multivariable logistic regression models with generalized estimating equations for clustered data were used to estimate adjusted odds ratios (AORs) and 95% CIs, accounting for known and putative risk factors. Results Among 29 105 female participants (mean [SD] age, 45.2 [4.5] years) over 24 years of follow-up, 1189 cases were documented of early-onset conventional adenomas and 1598 serrated lesions. UPFs provided 34.8% of total daily calories (median, 5.7 [IQR, 4.5-7.4] servings per day). Participants with higher UPF intake had an increased risk of early-onset conventional adenomas (highest vs lowest intake: AOR, 1.45; 95% CI, 1.19-1.77; overall P <.001) but not serrated lesions (AOR, 1.04; 95% CI, 0.89-1.22; P =.48 for trend). Findings were consistent after further adjustment for body mass index, type 2 diabetes, dietary factors (fiber, folate, calcium, and vitamin D), and Alternative Healthy Eating Index–2010 score. Conclusions and Relevance In this study, higher UPF intake was associated with increased risk of early-onset colorectal conventional adenomas. These data highlight the important role of UPFs in early-onset colorectal tumorigenesis and support improving dietary quality as a strategy to mitigate the increasing burden of EOCRC.

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type
Contribution to journal
publication status
published
in
JAMA Oncology
volume
12
issue
1
pages
49 - 57
publisher
American Medical Association
external identifiers
  • pmid:41231486
  • scopus:105022411512
ISSN
2374-2437
DOI
10.1001/jamaoncol.2025.4777
language
English
LU publication?
no
additional info
Publisher Copyright: © 2026 American Medical Association. All rights reserved, including those for text and data mining, AI training, and similar technologies.
id
704820d5-41bb-47cd-8fd4-62454cb44225
date added to LUP
2026-08-30 19:46:51
date last changed
2026-09-13 21:09:29
@article{704820d5-41bb-47cd-8fd4-62454cb44225,
  abstract     = {{<p>Importance Early-onset colorectal cancer (EOCRC) (diagnosed age &lt;50 years) incidence is increasing globally, in parallel with increased consumption of ultraprocessed foods (UPFs). The role of UPFs in early-onset colorectal neoplasia remains underexplored. Objective To evaluate the association between UPF consumption and risk of EOCRC precursors. Design, Setting, and Participants This prospective cohort study included participants of the Nurses’ Health Study II, an ongoing US prospective cohort of female registered nurses established in 1989. Participants were followed up from June 1, 1991, through June 1, 2015. Data were analyzed from October 2024 to July 2025. UPF intake, derived from food-frequency questionnaires administered every 4 years and classified using the Nova system, was modeled as quintiles of energy-adjusted servings per day. Of the nurses enrolled, those who had completed the baseline 1991 food-frequency questionnaire, undergone at least 1 lower endoscopy before age 50 years after baseline, had no history of cancer (except for nonmelanoma skin cancer) before endoscopy, and no colorectal polyp or inflammatory bowel disease were included. Main Outcomes and Measures Incidence of EOCRC precursors, including conventional adenomas and serrated lesions, confirmed via medical records and pathology reports. Multivariable logistic regression models with generalized estimating equations for clustered data were used to estimate adjusted odds ratios (AORs) and 95% CIs, accounting for known and putative risk factors. Results Among 29 105 female participants (mean [SD] age, 45.2 [4.5] years) over 24 years of follow-up, 1189 cases were documented of early-onset conventional adenomas and 1598 serrated lesions. UPFs provided 34.8% of total daily calories (median, 5.7 [IQR, 4.5-7.4] servings per day). Participants with higher UPF intake had an increased risk of early-onset conventional adenomas (highest vs lowest intake: AOR, 1.45; 95% CI, 1.19-1.77; overall P &lt;.001) but not serrated lesions (AOR, 1.04; 95% CI, 0.89-1.22; P =.48 for trend). Findings were consistent after further adjustment for body mass index, type 2 diabetes, dietary factors (fiber, folate, calcium, and vitamin D), and Alternative Healthy Eating Index–2010 score. Conclusions and Relevance In this study, higher UPF intake was associated with increased risk of early-onset colorectal conventional adenomas. These data highlight the important role of UPFs in early-onset colorectal tumorigenesis and support improving dietary quality as a strategy to mitigate the increasing burden of EOCRC.</p>}},
  author       = {{Wang, Chen and Du, Mengxi and Kim, Hanseul and Nguyen, Long H. and Wang, Qiao Li and Drew, David A. and Leeming, Emily R. and Khandpur, Neha and Sun, Qi and Zong, Xiaoyu and Gweon, Tae Geun and Ogino, Shuji and Ng, Kimmie and Berry, Sarah and Giovannucci, Edward L. and Song, Mingyang and Cao, Yin and Chan, Andrew T.}},
  issn         = {{2374-2437}},
  language     = {{eng}},
  month        = {{01}},
  number       = {{1}},
  pages        = {{49--57}},
  publisher    = {{American Medical Association}},
  series       = {{JAMA Oncology}},
  title        = {{Ultraprocessed Food Consumption and Risk of Early-Onset Colorectal Cancer Precursors Among Women}},
  url          = {{http://dx.doi.org/10.1001/jamaoncol.2025.4777}},
  doi          = {{10.1001/jamaoncol.2025.4777}},
  volume       = {{12}},
  year         = {{2026}},
}