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Alcohol intake in early adulthood and risk of colorectal cancer: three large prospective cohort studies of men and women in the United States

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Abstract

Heavy alcohol consumption in mid-adulthood is an established risk factor of colorectal cancer (CRC). Alcohol use in early adulthood is common, but its association with subsequent CRC risk remains largely unknown. We prospectively investigated the association of average alcohol intake in early adulthood (age 18–22) with CRC risk later in life among 191,543 participants of the Nurses’ Health Study ([NHS], 1988–2014), NHSII (1989–2015) and Health Professionals Follow-Up Study (1988–2014). Cox proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs), which were pooled using random effects models. We documented 2,624 CRC cases. High alcohol consumption in early adulthood (≥ 15 g/day) was associated with a higher CRC risk (multivariable HR 1.28, 95% CI 0.99–1.66, Ptrend = 0.02; Pheterogeneity = 0.44), after adjusting for potential confounding factors in early adulthood. Among never/light smokers in early adulthood, the risk associated with high alcohol consumption in early adulthood was elevated (HR 1.53, 95% CI 1.04–2.24), compared with those who had < 1 g/day of alcohol intake. The suggestive higher CRC risk associated with high alcohol consumption in early adulthood was similar in those who had < 15 g/day (HR 1.35, 95% CI 0.98–1.86) versus ≥ 15 g/day of midlife alcohol intake (HR 1.35, 95% CI 0.89–2.05), compared with nondrinkers in both life stages. The findings from these large prospective cohort studies suggest that higher alcohol intake in early adulthood may be associated with a higher risk of developing CRC later in life.

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Abbreviations

AHEI:

Alternative healthy eating index

BMI:

Body mass index

CI:

Confidence interval

CRC:

Colorectal cancer

FFQ:

Food frequency questionnaire

HPFS:

Health Professionals Follow-Up Study

HR:

Hazard ratio

MET:

Metabolic equivalent of task

NHS:

Nurses’ Health Study

NHSII:

Nurses’ Health Study II

NSAID:

Nonsteroidal anti-inflammatory drug

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Acknowledgements

We would like to thank the participants and staff of the Nurses’ Health Study (NHS), NHSII and Health Professionals Follow-Up Study for their valuable contributions as well as the following state cancer registries for their help: Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Nebraska, New Hampshire, New Jersey, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Virginia, Washington and Wyoming. The authors assume full responsibility for analyses and interpretation of these data.

Funding

This work was supported by the National Institutes of Health (NIH) grants (UM1 CA186107, P01 CA87969, U01 CA176726, U01 CA167552 as cohort infrastructure grants; R03 CA197879, R21 CA222940 and R21 CA230873 to KW; K07 CA218377 to YC). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. KW is supported by an Investigator Initiated Grant from the American Institute for Cancer Research.

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Author notes

  1. Kana Wu, Yin Cao and Edward Giovannucci contributed equally as senior authors.

Authors and Affiliations

  1. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Jinhee Hur, Stephanie A. Smith-Warner, Eric B. Rimm, Walter C. Willett, Kana Wu & Edward Giovannucci

  2. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Stephanie A. Smith-Warner, Eric B. Rimm, Walter C. Willett & Edward Giovannucci

  3. Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

    Eric B. Rimm, Walter C. Willett & Edward Giovannucci

  4. Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Yin Cao

  5. Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA

    Yin Cao

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  1. Jinhee Hur
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Contributions

JH, YC and EG conceived and designed the study. WCW, KW, YC and EG acquired the data. JH conducted statistical analysis and drafted the manuscript. WCW, KW, YC and EG obtained funding. YC and EG supervised the study. All authors interpreted the results and provided critical revision to the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

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Correspondence to Edward Giovannucci.

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The authors declare that they have no conflict of interest.

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The study protocol was approved by the institutional review boards of the Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health and those of participating state cancer registries as required.

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Return of the completed questionnaire implied informed consent to participate in the study.

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Hur, J., Smith-Warner, S.A., Rimm, E.B. et al. Alcohol intake in early adulthood and risk of colorectal cancer: three large prospective cohort studies of men and women in the United States. Eur J Epidemiol 36, 325–333 (2021). https://doi.org/10.1007/s10654-021-00723-x

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