title: Pre-adult famine exposure and subsequent colorectal cancer risk in women.
abstract: Nutritional deprivation during growth and development may contribute to colorectal cancer (CRC) risk in later life.
  
  
  
  We studied 7906 women who were aged 0-21 years during the 1944-45 Dutch famine, who enrolled in the Prospect-EPIC study between 1993 and 1997. We used Cox proportional hazard analyses to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for colorectal (proximal, distal and rectal) cancer risk across self-reported famine exposure and exposure-age categories, while adjusting for potential confounders.
  
  
  
  During a median of 17.3 years of follow-up, 245 CRC cases occurred. Moderately and severely famine-exposed women showed a respective 24% and 44% higher CRC risk compared with women who reported no exposure [HR moderate 1.24 (95% CI: 0.93-1.64); HR severe 1.44 (1.03-2.03); P trend 0.027]. This relation attenuated when adjusted for potential confounders [adjusted HR moderate 1.15 (0.87-1.53); HR severe 1.35 (0.96-1.90); P trend 0.091]. Stratified results suggested that severe famine exposure between 10 and 17 years of age was particularly related to CRC risk[adjusted HR moderate 1.39 (0.91-2.11); HR severe 1.76 (1.10-2.83); P trend 0.019; P interaction(famine*10-17yrs) 0.096]. Overall, we found no differences in famine effects across CRC subsites, but age-at-exposure stratified results suggested an increased risk for proximal CRC in those aged 10-17 years during exposure to the famine [adjusted HR moderate 2.14 (1.06-4.32), HR severe 2.96 (1.35-6.46); P trend 0.005]. Overall and within age-at-exposure categories, tests for subsite specific heterogeneity in famine effects were not significant.
  
  
  
  Our findings suggest that severe exposure to a short period of caloric restriction in pre-adult women may relate to CRC risk decades later.
authors: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands and.
authors: Morris P
authors: MP
authors: Brand
authors: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands and.|School of Public Health, Imperial College London, London, UK.
authors: Petra Hm
authors: PH
authors: Peeters
authors: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands and.
authors: Carla H
authors: CH
authors: van Gils
authors: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands and.
authors: Sjoerd G
authors: SG
authors: Elias
mesh_terms: D000293:Adolescent; D017195:Adolescent Nutritional Physiological Phenomena; D000368:Aged; D002648:Child; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D015179:Colorectal Neoplasms / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D044342:Malnutrition / Q000150:complications*; D008875:Middle Aged; D009426:Netherlands; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D057566:Self Report; D013217:Starvation / Q000150:complications*; D055815:Young Adult
keywords: Colorectal cancer; adolescence; caloric restriction; cohort studies; famine; growth and development; metabolism; starvation; vulnerable periods