{"entity":{"id":"paper-hur-sugar-sweetened-beverages-early-onset-colorectal-gut-2021","kind":"paper","name":"Sugar-sweetened beverage intake in adulthood and adolescence and risk of early-onset colorectal cancer among women","aka":[],"tldr":"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.\n\nOne 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.","asOf":"2026-09-24","links":[{"label":"Gut 2021","url":"https://doi.org/10.1136/gutjnl-2020-323450"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/33958435/"},{"label":"Europe PMC full text (PMC8571123)","url":"https://europepmc.org/article/MED/33958435"}],"tags":["colorectal-evidence"],"related":["paper-siegel-colorectal-incidence-birth-cohort-jnci-2017","paper-diaz-gay-colibactin-geographic-age-mutational-processes-nature-2025"],"cancers":["colorectal","early-onset-colorectal"],"sections":["prevention","nutrition-lifestyle"],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-prevention-adoption","b-early-detection"],"keyPapers":[],"journals":["gut"],"dependsOn":[],"notes":[],"journal":"Gut","year":2021,"doi":"10.1136/gutjnl-2020-323450","pmid":"33958435","authors":"Hur J, Otegbeye E, Joh HK, et al.","paperType":"observational","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."],"whatItMeans":"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."],"participants":95464},"route":"/key-papers/paper-hur-sugar-sweetened-beverages-early-onset-colorectal-gut-2021/","neighbours":{"paper":[{"id":"paper-siegel-colorectal-incidence-birth-cohort-jnci-2017","kind":"paper","name":"Colorectal cancer incidence patterns in the United States, 1974-2013","route":"/key-papers/paper-siegel-colorectal-incidence-birth-cohort-jnci-2017/"},{"id":"paper-diaz-gay-colibactin-geographic-age-mutational-processes-nature-2025","kind":"paper","name":"Geographic and age variations in mutational processes in colorectal cancer","route":"/key-papers/paper-diaz-gay-colibactin-geographic-age-mutational-processes-nature-2025/"}],"cancer":[{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"early-onset-colorectal","kind":"cancer","name":"Early-onset colorectal cancer (under 50)","route":"/cancers/early-onset-colorectal/"}],"section":[{"id":"nutrition-lifestyle","kind":"section","name":"Diet, Exercise & Lifestyle","route":"/fronts/nutrition-lifestyle/"},{"id":"prevention","kind":"section","name":"Prevention & Risk","route":"/fronts/prevention/"}],"bottleneck":[{"id":"b-prevention-adoption","kind":"bottleneck","name":"Prevention we already have is not deployed","route":"/bottlenecks/b-prevention-adoption/"},{"id":"b-early-detection","kind":"bottleneck","name":"The hardest cancers are found late","route":"/bottlenecks/b-early-detection/"}],"journal":[{"id":"gut","kind":"journal","name":"Gut","route":"/journals/gut/"}],"roadmap":[{"id":"colorectal-roadmap","kind":"roadmap","name":"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","route":"/roadmaps/colorectal-roadmap/"}],"idea":[{"id":"idea-crc-early-onset-cause-hunt","kind":"idea","name":"Find out what is driving early-onset bowel cancer, starting with colibactin, before extending screening any further","route":"/ideas/idea-crc-early-onset-cause-hunt/"}]}}