Dietary patterns during high school and risk of colorectal adenoma in a cohort of middle- aged women

Adolescent diet may be etiologically relevant for later risk of colorectal adenoma, a precursor of colorectal cancer. We aimed to examine associations between adolescent dietary patterns (derived using factor analysis) and risk of colorectal adenoma in middle adulthood. We analyzed data from 17,221 women participating in the Nurses' Health Study II, who had completed a validated high school (HS) food frequency questionnaire in 1998 when they were 34-51 years old, and had subsequently undergone at least one lower bowel endoscopy. Between 1998 and 2007, 1,299 women were diagnosed with at least one colorectal adenoma. In multivariable models adjusted for adult dietary patterns, a higher prudent pattern during HS, characterized by high consumption of vegetables, fruit and fish was associated with a statistically significantly lower risk of rectal (odds ratio [OR] highest vs. lowest quintile, 0.45, 95% CI 0.27-0.75, p-trend=0.005), but not colon adenomas. A higher Western pattern during HS, characterized by high consumption of desserts and sweets, snack foods and red and processed meat, was significantly associated with rectal (OR 1.78, 95% CI 1.12-2.85, p-trend=0.005) and advanced (OR 1.58, 95% CI 1.07-2.33, p-trend=0.08), but not associated with colon or non-advanced adenomas. This study suggests that overall eating patterns during high school may influence later risk of rectal and advanced adenoma, independent of adult diet. Our results support the hypothesis that diet during early life may influence colorectal carcinogenesis. What's new? Although not widely investigated, adolescent diet may be related to risk of colorectal adenoma, a precursor for colorectal cancer in adulthood. In this paper, analysis of data from the Nurses' Health Study II, which involved completion of a validated high school food frequency questionnaire, suggest that certain eating patterns during high school may influence risk of adenoma later in life. Diets characterized by a high consumption of sweets, snack foods, and red and processed meats posed the greatest risk for rectal and advanced adenoma, independent of adult diet. These findings support the hypothesis that early life exposures may have consequences for later cancer development.