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A longitudinal evaluation of alcohol intake throughout adulthood and colorectal cancer risk

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Abstract

Background

Alcohol intake is an established risk factor for colorectal cancer (CRC); however, there is limited knowledge on whether changing alcohol drinking habits during adulthood modifies CRC risk.

Objective

Leveraging longitudinal exposure assessments on alcohol intake at different ages, we examined the relationship between change in alcohol intake and subsequent CRC risk.

Methods

Within the European Prospective Investigation into Cancer and Nutrition, changes in alcohol intake comparing follow-up with baseline assessments were investigated in relation to CRC risk. The analysis included 191,180, participants and 1530 incident CRC cases, with exclusion of the first three years of follow-up to minimize reverse causation. Trajectory profiles of alcohol intake, assessed at ages 20, 30, 40, 50 years, at baseline and during follow-up, were estimated using latent class mixed models and related to CRC risk, including 407,605 participants and 5,008 incident CRC cases.

Results

Mean age at baseline was 50.2 years and the follow-up assessment occurred on average 7.1 years later. Compared to stable intake, a 12 g/day increase in alcohol intake during follow-up was positively associated with CRC risk (HR = 1.15, 95%CI 1.04, 1.25), while a 12 g/day reduction was inversely associated with CRC risk (HR = 0.86, 95%CI 0.78, 0.95). Trajectory analysis showed that compared to low alcohol intake, men who increased their alcohol intake from early- to mid- and late-adulthood by up to 30 g/day on average had significantly increased CRC risk (HR = 1.24; 95%CI 1.08, 1.42), while no associations were observed in women. Results were consistent by anatomical subsite.

Conclusions

Increasing alcohol intake during mid-to-late adulthood raised CRC risk, while reduction lowered risk.

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Acknowledgements

We are grateful to Mr. Bertrand Hemon, Ms. Corinne Casagrande and Ms. Carine Biessy for their critical work on data harmonization.

Funding

The coordination of EPIC is financially supported by International Agency for Research on Cancer (IARC) and also by the Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London which has additional infrastructure support provided by the NIHR Imperial Biomedical Research Centre (BRC). The national cohorts are supported by: Danish Cancer Society (Denmark); Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle Générale de l’Education Nationale, Institut National de la Santé et de la Recherche Médicale (INSERM) (France); German Cancer Aid, German Cancer Research Center (DKFZ), German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Federal Ministry of Education and Research (BMBF) (Germany); Associazione Italiana per la Ricerca sul Cancro-AIRC-Italy, Compagnia di SanPaolo and National Research Council (Italy); Dutch Ministry of Public Health, Welfare and Sports (VWS), Netherlands Cancer Registry (NKR), LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund (WCRF), Statistics Netherlands (The Netherlands); Health Research Fund (FIS)—Instituto de Salud Carlos III (ISCIII), Regional Governments of Andalucía, Asturias, Basque Country, Murcia and Navarra, and the Catalan Institute of Oncology—ICO (Spain); Swedish Cancer Society, Swedish Research Council and County Councils of Skåne and Västerbotten (Sweden); Cancer Research UK (14136 to EPIC-Norfolk; C8221/A29017 to EPIC-Oxford), Medical Research Council (1000143 to EPIC-Norfolk; MR/M012190/1 to EPIC-Oxford). (United Kingdom).

Author information

Authors and Affiliations

  1. International Agency for Research On Cancer (IARC), World Health Organization, 150, cours Albert Thomas, 69372, Lyon CEDEX 08, France

    Ana-Lucia Mayén, Vivian Viallon, Veronica Batista, Mazda Jenab, Heinz Freisling, Elisabete Weiderpass, Marc J. Gunter & Pietro Ferrari

  2. Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway, Department of Research, Cancer Registry of Norway, Oslo, Norway

    Edoardo Botteri

  3. Univ. Bordeaux, INSERM, Bordeaux Population Health Research Center, U1219, 33000, Bordeaux, France

    Cecile Proust-Lima

  4. Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy

    Vincenzo Bagnardi

  5. Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK

    Amanda J. Cross & Elio Riboli

  6. Université Paris-Saclay, UVSQ, Gustave Roussy, CESP U1018 Inserm, “Exposome and Heredity” Group, Villejuif, France

    Nasser Laouali, Conor J. MacDonald & Gianluca Severi

  7. Department of Statistics, Computer Science, Applications “G. Parenti” (DISIA), University of Florence, Florence, Italy

    Gianluca Severi

  8. Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany

    Verena Katzke

  9. German Institute of Human Nutrition, Potsdam-Rehbruecke, Nuthetal, Germany

    Manuela M. Bergmann

  10. Department of Molecular Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbruecke, Nuthetal, Germany

    Mattias B. Schulze

  11. Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany

    Mattias B. Schulze

  12. Danish Cancer Society Research Center, Diet, Genes and Environment, Copenhagen, Denmark

    Anne Tjønneland & Anne Kirstine Eriksen

  13. Department of Public Health, Aarhus University, Aarhus, Denmark

    Christina C. Dahm & Christian S. Antoniussen

  14. Unit of Nutrition and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain

    Paula Jakszyn

  15. Blanquerna School of Health Sciences, Ramon Llull University, Barcelona, Spain

    Paula Jakszyn

  16. Escuela Andaluza de Salud Pública (EASP), 18011, Granada, Spain

    Maria-Jose Sánchez

  17. Instituto de Investigación Biosanitaria Ibs.GRANADA, 18012, Granada, Spain

    Maria-Jose Sánchez

  18. Centro de Investigación Biomédica en Red de Epidemiología Y Salud Pública (CIBERESP), 28029, Madrid, Spain

    Maria-Jose Sánchez, Pilar Amiano, Sandra M. Colorado-Yohar & Eva Ardanaz

  19. Department of Preventive Medicine and Public Health, University of Granada, 18071, Granada, Spain

    Maria-Jose Sánchez

  20. Ministry of Health of the Basque Government, Sub Directorate for Public Health and Addictions of Gipuzkoa, San Sebastian, Spain

    Pilar Amiano

  21. Biodonostia Health Research Institute, Epidemiology of Chronic and Communicable Diseases Group, San Sebastián, Spain

    Pilar Amiano

  22. Instituto de Salud Carlos III, Madrid, Spain

    Pilar Amiano

  23. Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain

    Sandra M. Colorado-Yohar

  24. Research Group On Demography and Health, National Faculty of Public Health, University of Antioquia, Medellín, Colombia

    Sandra M. Colorado-Yohar

  25. Navarra Public Health Institute, Pamplona, Spain

    Eva Ardanaz

  26. IdiSNA, Navarra Institute for Health Research, Pamplona, Spain

    Eva Ardanaz

  27. Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Oxford, OX3 7LF, UK

    Ruth Travis

  28. Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy

    Domenico Palli

  29. Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy

    Sieri Sabina

  30. Hyblean Association for Epidemiological Research AIRE-ONLUS Ragusa, Milan, Italy

    Rosario Tumino

  31. Department of Clinical and Biological Sciences, University of Turin, Regione Gonzole 10, Orbassano, TO, Italy

    Fulvio Ricceri

  32. Dipartimento Di Medicina Clinica E Chirurgia, Federico II University, Naples, Italy

    Salvatore Panico

  33. Former Senior Scientist, Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA, Bilthoven, The Netherlands

    Bas Bueno-de-Mesquita

  34. Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

    Jeroen W. G. Derksen

  35. Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, 21428, Malmö, Sweden

    Emily Sonestedt

  36. Department of Public Health and Clinical Medicine, Sustainable Health, Umeå University, 901 85, Umeå, Sweden

    Anna Winkvist

  37. Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden

    Sophia Harlid

  38. Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway

    Tonje Braaten, Inger Torhild Gram & Marko Lukic

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  1. Ana-Lucia Mayén
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  2. Vivian Viallon
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  4. Cecile Proust-Lima
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  5. Vincenzo Bagnardi
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  7. Amanda J. Cross
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  10. Gianluca Severi
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  11. Verena Katzke
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  12. Manuela M. Bergmann
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  13. Mattias B. Schulze
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  14. Anne Tjønneland
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  15. Anne Kirstine Eriksen
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  17. Christian S. Antoniussen
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  18. Paula Jakszyn
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  19. Maria-Jose Sánchez
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  20. Pilar Amiano
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  21. Sandra M. Colorado-Yohar
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  22. Eva Ardanaz
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  23. Ruth Travis
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  24. Domenico Palli
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  25. Sieri Sabina
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  27. Fulvio Ricceri
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  28. Salvatore Panico
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  29. Bas Bueno-de-Mesquita
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  30. Jeroen W. G. Derksen
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  31. Emily Sonestedt
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  32. Anna Winkvist
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  33. Sophia Harlid
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  34. Tonje Braaten
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  35. Inger Torhild Gram
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  36. Marko Lukic
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  37. Mazda Jenab
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  38. Elio Riboli
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  39. Heinz Freisling
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  40. Elisabete Weiderpass
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  41. Marc J. Gunter
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  42. Pietro Ferrari
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Study concept and design: PF, ALM. Analysis and interpretation of data: PF, ALM, VV, CPL, EB, VB. Drafting of manuscript: PF, ALM. Revision of the manuscript: all authors contributed to revisions and gave final approval for this manuscript.

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Correspondence to Pietro Ferrari.

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Mayén, AL., Viallon, V., Botteri, E. et al. A longitudinal evaluation of alcohol intake throughout adulthood and colorectal cancer risk. Eur J Epidemiol 37, 915–929 (2022). https://doi.org/10.1007/s10654-022-00900-6

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