Shifting dietary drivers of colorectal cancer mortality in the United States: A 33-year Global Burden of Disease analysis.

Abstract

3663 Background: Early-onset colorectal cancer (EOCRC; ages 15–49 years) mortality is increasing in the United States. However, temporal changes in diet-attributable risk factors contributing to EOCRC mortality remain poorly characterized. Using three decades of Global Burden of Disease (GBD) data, we examined shifts in dietary risk factors contributing to EOCRC mortality to identify emerging targets for primary prevention. Methods: We conducted a retrospective population-based analysis of U.S. estimates from the GBD 2023 study (1990–2023). Age-standardized death rates (ASDR), years of life lost (YLLs), and disability-adjusted life years (DALYs) attributable to major dietary risk factors (high processed meat, high red meat, low whole grain, low fiber, low calcium, and low milk intake) were assessed among EOCRC. Period-specific percent changes (1990–1999, 2000–2009, 2010–2019, 2020–2023), rank-order transitions, and sex-stratified patterns were examined. All estimates were derived using GBD cause-of-death ensemble modeling and include 95% uncertainty intervals. Results: In 1990, low whole grain intake was the leading diet-attributable risk factor for ASDR (0.44 per 100,000), followed by red meat (0.40) and processed meat (0.34). Although dietary inadequacy–related risks increased early (low whole grain DALYs +338.9% and YLLs +311.1% in 1990–1999), these burdens declined substantially after 2000. In contrast, processed meat consumption demonstrated persistent and increasingly dominant associations with mortality, with DALYs rising by +430.8%, +223.1%, +94.8%, and +15.9% across successive periods. By 2023, processed meat accounted for the highest ASDR (0.55), surpassing low whole grain (0.53) and red meat (0.49). Sex-stratified analyses showed processed meat emerged as the leading diet-attributable risk among males by 2010 and rose from third to second among females, narrowing the gap with low whole grain intake. Conclusions: Over 33 years, diet-attributable EOCRC mortality in the US has undergone a rank-order transition from dietary inadequacy toward processed meat consumption, particularly among males and increasingly among females. The persistence and dominance of processed meat-attributable burden highlight a critical, modifiable lifestyle risk factor and underscore an urgent opportunity for targeted, age- and sex-specific primary prevention strategies aligned with colorectal cancer prevention recommendations. Age-standardized early-onset colorectal cancer death rates (per 100,000 population) attributable to dietary risk factors in the United States, 1990–2023. 1990 2000 2010 2020 2023 Red Meat 0.40 0.48 0.47 0.50 0.49 Processed Meat 0.34 0.46 0.50 0.55 0.55 Low Fiber 0.02 0.03 0.02 0.02 0.02 Low grain 0.44 0.53 0.52 0.54 0.53 Low Ca 0.09 0.09 0.09 0.10 0.09 Low milk 0.26 0.31 0.31 0.29 0.28