Ultraprocessed Foods, Ice Cream Associated With Mortality in CRC Survivors

There is an association between higher mortality in colorectal cancer (CRC) and cardiovascular disease (CVD) in patients with a diagnosis of CRC and a higher intake of ice cream or sherbet and ultraprocessed foods (UPFs), respectively, according to a study published in eClinicalMedicine.

In 2023, an estimated 53,000 deaths in the US were due to CRC, making it 1 of the leading causes of cancer deaths in the country. Early detection and treatment has led to many more survivors of CRC than before and "emerging evidence suggests that diet is a modifiable factor that can prevent recurrence, comorbidities, and premature deaths in CRC," the authors noted.

A total of 60% of the daily calories of Americans are from UPFs, which have been found to be associated with a higher risk of developing CRC. However, there is a lack of data on how UPFs affect survival in CRC. This study aimed to analyze how UPFs and other subgroups of UPFs are associated with increased mortality in CRC and CVDs after a diagnosis of CRC.

Processed foods | Image credit: colorcocktail - stock.adobe.com

Data from 2 US prospective cohorts, the Nurses’ Health Study (NHS) and the Health Professionals Follow-up Study (HPFS), were used for this study. Questionnaires were completed by all participants at baseline, with follow-up questionnaires received every 2 years. The food frequency questionnaire (FFQ) was used to evaluate diet in these patients every 4 years. The baseline years were 1980 and 1986 for NHS and HPFS respectively.

Participants reported if they had a diagnosis of CRC in the prior 2 years through December 2016. Patients who were diagnosed at the time of death, had diet assessed within 6 months or more than 4 years after diagnosis, or had missing dietary data from before or after diagnosis were excluded as well as those with stage IV CRC. There were 2498 cases of CRC that were included in this study overall.

Foods and drinks that participants had consumed in the previous year were reported using the FFQ. Frequency of food consumption and standard portion sizes were reported by the participant. UPF consumption was estimated using the Nova classification system, which categorizes all food into 4 categories: unprocessed or minimally processed foods, processed culinary ingredients, processed foods, and UPFs. UPFs were also categorized into ultra-processed bread/breakfast foods, fats/condiments/sauces, packaged sweet snacks/desserts, artificially sweetened beverages, protein-based ready-to-eat foods, yogurts, savory snacks, and ready-to-eat mixed dishes.

The mean (SD) age of the 2498 patients with CRC was 68.5 (9.4) years and the median (IQR) intake of UPFs after a diagnosis of CRC was 6.0 (4.6-7.8) servings per day. Ultra-processed breads/breakfast foods (27%), fats/condiments/sauces (24%), and sweet snacks/desserts (17%) were the top 3 subgroups of UPFs.

There were 1661 total deaths, with 19.3% due to CRC and 20.2% due to CVD. Total UPF intake after diagnosis was associated with higher mortality due to CVD (HR, 1.80; 95% CI, 1.31-2.47) which remained significant after multivariable adjustment (HR, 1.65; 95% CI, 1.13-2.40). Patients who had reduced their uptake of UPFs after diagnosis had lower mortality related to CVD (HR, 0.65; 95% CI, 0.45-0.92).

Higher consumption of fats/condiments/sauces was associated with increased mortality related to CVD (HR, 1.96; 95% CI, 1.41-2.73). Higher intake of flavored yogurt and dairy-based desserts, specifically ice cream and sherbet, was associated with increased mortality related to CRC (HR, 1.86; 95% CI, 1.33-2.61). Overall mortality and other UPF subgroups did not have a significant association.

There were some limitations to this study. Detailed data about treatment were often unavailable. Data on recurrences were also unavailable. FFQ data were used to determine UPF classification; however, FFQ does not cover all UPFs. Survival bias could have played a role in the study. Residual compounding is possible due to the observational nature of the study.

The researchers concluded that UPFs can lead to higher risks of mortality due to both CRC and CVD in patients who receive a diagnosis of CRC. This finding could help in giving patients a better prognosis when eating a diet of less UPFs.

Reference

Hang D, Du M, Wang L, et al. Ultra-processed food consumption and mortality among patients with stages I-III colorectal cancer: a prospective cohort study. eClinicalMedicine. 2024;71:102572. doi:10.1016/j.eclinm.2024.102572