The healthy eating index 2020 and colorectal cancer risk: a prospective study based on the PLCO cohort.

Authors

Li H, Shen L, Zeng Z, Xiao Y, Feng D, Peng L, Xiang L, Luo Y, Wang Y, Cai H

Affiliations

• Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
• Center of Urology and Nephrology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
• Department of Clinical Nutrition, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
• Thoraxcenter, Department of Cardiology, Cardiovascular Institute, Erasmus University Medical Center, Rotterdam, Netherlands.

Abstract

BACKGROUND: The Healthy Eating Index (HEI-2020), a metric that assesses overall diet quality based on compliance with the 2020-2025 Dietary Guidelines for Americans, has been insufficiently investigated in relation to both colorectal cancer (CRC) incidence and mortality. To address this gap, we conducted a population-based prospective study of 101,709 U.S. adults from the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, examining the associations between HEI-2020 adherence and risks of CRC incidence and death.

METHODS: A total of 101,709 participants were included in this study. Dietary information was collected using the Diet History Questionnaire (DHQ), and adherence to the HEI-2020 was assessed. Higher HEI-2020 scores indicated better adherence to a healthy diet. Cox proportional hazards regression analyses were performed to examine the association between HEI-2020 scores and CRC risk. To further explore the dose-response relationship between HEI-2020 scores and CRC incidence, a restricted cubic spline (RCS) model was applied. Subgroup analyses were conducted to identify potential modifiers that might interact with HEI-2020 in relation to CRC incidence, and sensitivity analyses were performed to assess the robustness of the established association.

RESULT: This study included 101,709 participants, with 1,100 incident CRC cases and 314 deaths. The fully adjusted model showed that participants in the highest HEI-2020 quartile had a lower point estimate for CRC incidence than those in the lowest quartile, although this comparison did not reach statistical significance (HR = 0.86; 95% CI: 0.73-1.02). A significant decreasing trend in CRC incidence risk was observed across HEI-2020 quartiles (P for trend = 0.021). Higher HEI-2020 scores were significantly associated with lower CRC-specific mortality (Q4 vs. Q1: HR = 0.61; 95% CI: 0.45-0.85; P for trend = 0.001), and this association remained consistent in competing-risk analyses. Site-specific analyses suggested lower risks for distal colon cancer and a borderline lower point estimate for rectal cancer, as well as a decreasing trend in proximal colon cancer mortality. Sensitivity and subgroup analyses confirmed the robustness of the findings.

CONCLUSION: This study suggests that higher HEI-2020 scores, reflecting better alignment with the Dietary Guidelines for Americans, are associated with a significant decreasing trend in CRC incidence risk and a lower risk of CRC-specific mortality.