# Sugar-sweetened beverage intake in adulthood and adolescence and risk of early-onset colorectal cancer among women

Source: https://onco.cc/key-papers/paper-hur-sugar-sweetened-beverages-early-onset-colorectal-gut-2021/  
OnCo record `paper-hur-sugar-sweetened-beverages-early-onset-colorectal-gut-2021` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

In 95,464 nurses followed for 24 years, women who drank two or more sugary drinks a day had double the risk of bowel cancer before 50, and each daily drink in adolescence raised it by a third.

## Summary

Hur, Otegbeye, Joh and colleagues prospectively investigated the association between sugar-sweetened beverage intake and early-onset colorectal cancer in the Nurses' Health Study II from 1991 to 2015, among 95,464 women who reported adulthood beverage intake on validated food frequency questionnaires every four years. A subset of 41,272 participants reported beverage intake at ages 13 to 18 using a validated high-school questionnaire in 1998. Cox proportional hazards models estimated relative risks.

One hundred and nine cases of early-onset colorectal cancer were documented, which is the number that sets the limits of what the study can claim.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Tags: colorectal-evidence
- Journal: Gut
- Year: 2021
- DOI: 10.1136/gutjnl-2020-323450
- Authors: Hur J, Otegbeye E, Joh HK, et al.
- Findings: 109 early-onset colorectal cancer cases over 24 years of follow-up.; Two or more servings a day in adulthood against under one a week: relative risk 2.18 (95 percent CI 1.10 to 4.35, p for trend 0.02).; Each additional serving per day in adulthood: relative risk 1.16 (1.00 to 1.36).; Each additional serving per day at ages 13 to 18: relative risk 1.32 (1.00 to 1.75).; Replacing a daily sugar-sweetened drink with artificially sweetened beverages, coffee or milk was associated with 17 to 36 percent lower risk.
- What it means: One of the few modifiable exposures with a plausible adolescent window to match the birth-cohort pattern; it is the kind of hypothesis a cohort can generate but not settle.
- Caveats: 109 cases: confidence intervals reach 1.00 at the lower bound for two of the three main estimates.; Self-reported diet, including diet recalled from adolescence more than a decade later.; Female nurses in the United States; residual confounding by obesity, physical activity and total energy cannot be excluded.

## Sources

- Gut 2021: https://doi.org/10.1136/gutjnl-2020-323450
- PubMed: https://pubmed.ncbi.nlm.nih.gov/33958435/
- Europe PMC full text (PMC8571123): https://europepmc.org/article/MED/33958435

## Connected records

- key papers: [Colorectal cancer incidence patterns in the United States, 1974-2013](https://onco.cc/key-papers/paper-siegel-colorectal-incidence-birth-cohort-jnci-2017/), [Geographic and age variations in mutational processes in colorectal cancer](https://onco.cc/key-papers/paper-diaz-gay-colibactin-geographic-age-mutational-processes-nature-2025/)
- cancers: [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Early-onset colorectal cancer (under 50)](https://onco.cc/cancers/early-onset-colorectal/)
- fronts: [Diet, Exercise & Lifestyle](https://onco.cc/fronts/nutrition-lifestyle/), [Prevention & Risk](https://onco.cc/fronts/prevention/)
- bottlenecks: [Prevention we already have is not deployed](https://onco.cc/bottlenecks/b-prevention-adoption/), [The hardest cancers are found late](https://onco.cc/bottlenecks/b-early-detection/)
- journals: [Gut](https://onco.cc/journals/gut/)
- roadmaps: [Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation](https://onco.cc/roadmaps/colorectal-roadmap/)
- ideas: [Find out what is driving early-onset bowel cancer, starting with colibactin, before extending screening any further](https://onco.cc/ideas/idea-crc-early-onset-cause-hunt/)

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