title: Childhood and adolescent energy restriction and subsequent colorectal cancer risk: results from the Netherlands Cohort Study.
abstract: BACKGROUND
  Energy restriction during childhood and adolescence is suggested to lower colorectal cancer (CRC) risk. We investigated this in the Netherlands Cohort Study.
  
  
  METHODS
  Information on diet and other risk factors was collected by a baseline questionnaire in 1986 when cohort members were 55-69 years of age (n = 120 852). Three indicators of early life exposure to energy restriction were assessed: father's employment status during the Economic Depression (1932-40), place of residence during Second World War years (1940-44) and the 'Hunger Winter' (1944-45), a severe famine. Using the case-cohort approach, incidence rate ratios (RRs) and 95% confidence intervals (CIs) were calculated for total colorectal, proximal colon, distal colon, rectosigmoid and rectal cancers, according to the three time periods of energy restriction. After 16.3 years of follow-up, 2573 cases were available for multivariate analyses.
  
  
  RESULTS
  Men who lived in a western city during the Hunger Winter and therefore exposed to the highest degree of energy restriction, had a lower risk of developing CRC (RR: 0.81, 95% CI: 0.68-0.98), and tumours of the proximal colon (RR: 0.72, 95% CI: 0.54-0.96) and rectum (RR: 0.71, 95% CI: 0.53-0.96). In women, non-statistically significant inverse associations were observed for tumours of the distal colon, rectosigmoid and rectum. Inverse associations were also observed between the other two exposure times and studied endpoints, though not statistically significant.
  
  
  CONCLUSIONS
  This unique observational evidence suggests that severe energy restriction during childhood and adolescence may lower CRC risk, especially in men, thus providing insight regarding the role of energy intake during early life in CRC development.
authors.affiliation: Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands. laura.hughes@epid.unimaas.nl
authors.forename: Laura A E
authors.initials: LA
authors.lastname: Hughes
authors.forename: Piet A
authors.initials: PA
authors.lastname: van den Brandt
authors.forename: R Alexandra
authors.initials: RA
authors.lastname: Goldbohm
authors.forename: Anton F P M
authors.initials: AF
authors.lastname: de Goeij
authors.forename: Adriaan P
authors.initials: AP
authors.lastname: de Bruïne
authors.forename: Manon
authors.initials: M
authors.lastname: van Engeland
authors.forename: Matty P
authors.initials: MP
authors.lastname: Weijenberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001837:Body Weights and Measures; D002648:Child; D015179:Colorectal Neoplasms / Q000453:epidemiology*; D004032:Diet; D002149:Energy Intake; D015444:Exercise; D005260:Female; D006801:Humans; D006815:Hunger; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D055815:Young Adult