A longitudinal evaluation of alcohol intake throughout adulthood and colorectal cancer risk

Ana Lucia Mayén, Vivian Viallon, Edoardo Botteri, Cecile Proust-Lima, Vincenzo Bagnardi, Veronica Batista, Amanda J. Cross, Nasser Laouali, Conor J. MacDonald, Gianluca Severi, Verena Katzke, Manuela M. Bergmann, Mattias B. Schulze, Anne Tjønneland, Anne Kirstine Eriksen, Christina C. Dahm, Christian S. Antoniussen, Paula Jakszyn, Maria Jose Sánchez, Pilar AmianoSandra M. Colorado-Yohar, Eva Ardanaz, Ruth Travis, Domenico Palli, Sieri Sabina, Rosario Tumino, Fulvio Ricceri, Salvatore Panico, Bas Bueno-de-Mesquita, Jeroen W.G. Derksen, Emily Sonestedt, Anna Winkvist, Sophia Harlid, Tonje Braaten, Inger Torhild Gram, Marko Lukic, Mazda Jenab, Elio Riboli, Heinz Freisling, Elisabete Weiderpass, Marc J. Gunter, Pietro Ferrari

Research output: Indexed journal article Articlepeer-review

9 Citations (Scopus)


Background: Alcohol intake is an established risk factor for colorectal cancer (CRC); however, there is limited knowledge on whether changing alcohol drinking habits during adulthood modifies CRC risk. Objective: Leveraging longitudinal exposure assessments on alcohol intake at different ages, we examined the relationship between change in alcohol intake and subsequent CRC risk. Methods: Within the European Prospective Investigation into Cancer and Nutrition, changes in alcohol intake comparing follow-up with baseline assessments were investigated in relation to CRC risk. The analysis included 191,180, participants and 1530 incident CRC cases, with exclusion of the first three years of follow-up to minimize reverse causation. Trajectory profiles of alcohol intake, assessed at ages 20, 30, 40, 50 years, at baseline and during follow-up, were estimated using latent class mixed models and related to CRC risk, including 407,605 participants and 5,008 incident CRC cases. Results: Mean age at baseline was 50.2 years and the follow-up assessment occurred on average 7.1 years later. Compared to stable intake, a 12 g/day increase in alcohol intake during follow-up was positively associated with CRC risk (HR = 1.15, 95%CI 1.04, 1.25), while a 12 g/day reduction was inversely associated with CRC risk (HR = 0.86, 95%CI 0.78, 0.95). Trajectory analysis showed that compared to low alcohol intake, men who increased their alcohol intake from early- to mid- and late-adulthood by up to 30 g/day on average had significantly increased CRC risk (HR = 1.24; 95%CI 1.08, 1.42), while no associations were observed in women. Results were consistent by anatomical subsite. Conclusions: Increasing alcohol intake during mid-to-late adulthood raised CRC risk, while reduction lowered risk.

Original languageEnglish
Pages (from-to)915-929
Number of pages15
JournalEuropean Journal of Epidemiology
Issue number9
Publication statusPublished - Sept 2022


  • Alcohol change
  • Alcohol intake
  • Colorectal cancer
  • Latent class mixed models
  • Longitudinal exposure
  • Trajectory profile analysis


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