S199 Excess Dietary Intake May Increase the Risk of Early Colon Cancer Pathogenesis

Abstract

Introduction: Although non-modifiable factors such as age, sex, and race have been associated with increased risk of developing colon cancer, there are limited studies investigating modifiable factors. Some studies have shown fiber and calcium to be protective, while processed meats and alcohol to be risk factors. The data, however, remains controversial. The aims of this study are to 1) re-evaluate the epidemiology of colon cancer and 2) explore the nutritional status of those with early colon cancer diagnosis. Methods: The National Health and Nutrition Examination Survey (NHANES) is a survey designed to assess the health and nutritional status of adults and children across the United States (US). Nutritional information was collected via a 24-hour diet recall, and those with reliable recall were included in the study. We combined demographic and nutritional datasets from NHANES during 2007-2016 and identified patients who self-reported a diagnosis of colon cancer. The sample size was appropriately weighted and stratified into 2 cohorts: age < 45 years vs age ≥ 45 years. SPSS was used for analysis. Results: There were 5,767,593 self-reported cases of colon cancer in the US from 2007-2016 with reliable nutritional recall. Demographic data stratified by cohort is outlined in Table along with caloric and dietary intake. The average age of colon cancer diagnosis was 56.5 ± 15.3 years of which 19.4% were diagnosed early (age < 45). Univariate analysis showed those with early diagnosis had higher calorie (p< 0.001), fiber (p< 0.001), calcium (p< 0.001), caffeine (p< 0.001), and alcohol consumption (p< 0.001) than those diagnosed over 45. After controlling for BMI, race, sex, education, and income using logistic regression, we found that patients with higher caloric intake (≥ 2000 kcal) were more likely to be diagnosed with early onset colon cancer (OR: 3.81, 95% CI: 3.79-3.82). Conclusion: There were on average 576,759 reported cases of colon cancer per year in the US of which approximately 1/5th were diagnosed before 45. Females, non-Hispanic whites, and higher education/income were associated with early colon cancer diagnosis possibly due to earlier screening. Contrary to other studies, higher fiber and calcium intake did not appear to be protective. However, those with early diagnosis did have higher alcohol intake. Our data suggests those with high caloric intake, a modifiable risk factor, increases the odds of developing early cancer by over threefold, perhaps due to chronic underlying inflammation. Table 1. - Demographic and Dietary Breakdown in Patients Diagnosed with Colon Cancer Colon Cancer Diagnosis ≥ 45 years Colon Cancer Diagnosis < 45 years Average P-value Sex Male (%) 83.8% 16.2% - P< 0.001 Female (%) 78.2% 21.8% - Race Non-Hispanic White (%) 78.3% 21.7% - P< 0.001 Non-Hispanic Black (%) 89.5% 10.5% - Hispanic (%) 95.9% 4.1% - Other (%) 100% 0% - Education Level Less than 9th Grade (%) 80.6% 19.4% - P< 0.001 9-12th Grade (%) 87.0% 13.0% - High School Graduate (%) 89.8% 10.2% - AA Degree or Some College (%) 79.1% 20.9% - College Graduate (%) 72.4% 27.6% - Ratio of Family Income to Poverty Level (FIP) FIP ≥ 1 (%) 78.3% 21.7% - P< 0.001 FIP < 1 (%) 88.2% 11.8% - BMI (kg/m2) 29.9 31.4 30.2 P< 0.001 BMI BMI ≥ 25 79.7% 20.3% - P< 0.001 BMI < 25 83.6% 16.4% Total Caloric Intake (kcal) 1679.1 ± 654.1 2177.6 ± 1092.3 1775.6 ± 784.0 P< 0.001 Total Caloric Intake Kcal ≥ 2000 68.4% 31.6% - P< 0.001 Kcal < 2000 86.3% 13.7% Total Sugar (gm) 94.2 ± 69.7 122.9 ± 150.8 99.8 ± 91.9 P< 0.001 Total Fat (gm) 62.5 ± 28.8 90.7 ± 64.9 68.0 ± 40.1 P< 0.001 Dietary Fiber (gm) 14.3 ± 8.0 16.7 ± 10.5 14.7 ± 8.6 P< 0.001 Calcium (mg) 825.1 ± 537.5 980.1 ± 560.8 855.1 ± 545.6 P< 0.001 Caffeine (mg) 193.0 ± 177.4 284.0 ± 262.3 210.6 ± 200.0 P< 0.001 Alcohol (gm) 4.7 ± 14.3 9.0 ± 35.9 5.5 ± 20.4 P< 0.001