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Title: Consumption of sugars, sugary foods, and sugary beverages in relation to adiposity-related cancer risk in the Framingham Offspring Cohort (1991-2013)

Author
item MAKAREM, NOUR - New York University
item BANDERA, ELISA - Rutgers University
item LIN, YONG - Rutgers University
item JACQUES, PAUL - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item HAYES, RICHARD - New York University
item PAREKH, NIYATI - New York University

Submitted to: Cancer Prevention Research
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/12/2018
Publication Date: 4/19/2018
Citation: Makarem, N., Bandera, E.V., Lin, Y., Jacques, P.F., Hayes, R.B., Parekh, N. 2018. Consumption of sugars, sugary foods, and sugary beverages in relation to adiposity-related cancer risk in the Framingham Offspring Cohort (1991-2013). Cancer Prevention Research. 11(6). https://doi.org/10.1158/1940-6207.CAPR-17-0218.
DOI: https://doi.org/10.1158/1940-6207.CAPR-17-0218

Interpretive Summary: It is well known that eating high amounts of sugar is linked to being overweight and obese. However, sugar consumption is also linked to cancer through various mechanisms including insulin resistance (when your body's cells ignore the signal that the hormone insulin sends out to remove a type of sugar called glucose from the blood), oxidative stress (an imbalance between harmful free radicals and the antioxidants that neutralize them in the body), and inflammation. Such issues can create an environment that increases cancer risk. Adiposity-related cancers are cancers that are clearly or possibly linked to being overweight and obese and include common cancers such as gastrointestinal, thyroid, and female-related cancers. However, the impact of sugary foods and beverages in the diet on cancer risk, particularly adiposity-related cancers, is not well characterized in research studies that follow individuals over time to detect the development of cancer. This study aims to examine intakes of sugary foods and beverages, as well as two specific types of sugars, fructose and sucrose, and adiposity-related cancer risk. To do this, we used data on approximately 3,400 individuals enrolled in the Framingham Heart Study from approximately 1991-1995 to 2013. We looked at diet in relation to new cases of breast, prostate, and colorectal cancer. We did not find any association between fructose, sucrose or sugary food consumption and cancer. Overall sugary beverage consumption was not associated with increased risk of developing adiposity-related cancer, but higher intake of fruit juice was associated with a 58% increase in prostate cancer risk. We also found that higher intake of sugary beverages was related to a 59% increased overall risk of adiposity-related cancer in participants with higher central adiposity, which is fat around the torso and abdomen areas. In summary, our work shows that drinking higher amounts of sugary beverages may be associated with increased cancer risk, particularly among participants with higher abdominal fat. Avoiding sugary beverages may be one simple way to improve health and reduce cancer risk.

Technical Abstract: Background: Higher sugar consumption may increase cancer risk by promoting insulin-glucose dysregulation, oxidative stress, hormonal imbalances, and excess adiposity. This prospective study investigates the association between dietary sugars (fructose and sucrose) and sugary foods and beverages in relation to combined and site-specific (breast, prostate, colorectal) adiposity-associated cancers. Methods: The analytic sample consisted of 3,184 adults, aged 26-84 years, from the Framingham Offspring cohort. Diet data were first collected between 1991 and 1995 using a food frequency questionnaire. Intakes of fructose, sucrose, sugary foods, and sugary beverages (fruit juice and sugar-sweetened beverages) were derived. Participants were followed up until 2013 to ascertain cancer incidence; 565 doctor-diagnosed adiposity-related cancers, including 124 breast, 157 prostate, and 68 colorectal cancers occurred. Multivariable-adjusted Cox proportional hazards models were used to evaluate associations. Tests for interaction with BMI and waist circumference were conducted. Results: No associations were observed between fructose, sucrose, sugary food consumption, and combined incidence of adiposity-related cancers or the examined site-specific cancers. While total consumption of sugary beverages was not associated with site-specific cancer risk, higher intakes of fruit juice were associated with 58% increased prostate cancer risk (HR: 1.58; 95% CI, 1.04-2.41) in multivariable-adjusted models. In exploratory stratified analyses, higher sugary beverage intakes increased overall adiposity-related cancer risk by 59% in participants with excessive central adiposity (HR: 1.59; 95% CI, 1.01-2.50; Ptrend = 0.057). Conclusions: In this cohort of American adults, higher sugary beverage consumption was associated with increased cancer risk among participants with central adiposity. Impact: These analyses suggest that avoiding sugary beverages represents a simple dietary modification that may be used as an effective cancer control strategy.