Ultra-processed food consumption and mortality among patients with stages I-III colorectal cancer: a prospective cohort study

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

doi:10.1016/j.eclinm.2024.102572

Ultra-processed food consumption and mortality among patients with stages I-III colorectal cancer: a prospective cohort study

EClinicalMedicine. 2024 Mar 28:71:102572. doi: 10.1016/j.eclinm.2024.102572. eCollection 2024 May.

Authors

Dong Hang^{1

2

3}, Mengxi Du^{2

3

4

5}, Lu Wang⁴, Kai Wang³, Zhe Fang³, Neha Khandpur^{2

6

7}, Sinara Laurini Rossato^{2

8}, Eurídice Martínez Steele^{7

9}, Andrew T Chan^{2

5}, Frank B Hu^{2

3

10}, Jeffrey A Meyerhardt¹¹, Dariush Mozaffarian^{4

12}, Shuji Ogino^{3

13

14

15

16}, Qi Sun^{2

3

10}, John B Wong¹⁷, Fang Fang Zhang⁴, Mingyang Song^{2

3

5}

Affiliations

¹ 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.
² Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
³ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁴ Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.
⁵ Clinical and Translational Epidemiology Unit and Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
⁶ Division of Human Nutrition and Health, Wageningen University, Netherlands.
⁷ Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil.
⁸ Institute of Geography, Universidade Federal de Uberlândia, Minas Gerais, Brazil.
⁹ Center for Epidemiological Studies in Health and Nutrition (NUPENS), Faculty of Public Health, University of São Paulo, Brazil.
¹⁰ Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
¹¹ Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA.
¹² Tufts School of Medicine and Division of Cardiology, Tufts Medical Center, Boston, MA, USA.
¹³ Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA.
¹⁴ Broad Institute of MIT and Harvard, Cambridge, MA, USA.
¹⁵ Division of Nutrition, Harvard Medical School, Boston, MA, USA.
¹⁶ Tokyo Medical and Dental University (Institute of Science Tokyo), Tokyo, Japan.
¹⁷ Division of Clinical Decision Making, Tufts Medical Center, Boston, MA, USA.

Abstract

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.

Keywords: Colorectal cancer survivorship; Longitudinal analysis; Patient care; Post-diagnostic dietary intake.

Grants and funding

K99 CA283146/CA/NCI NIH HHS/United States