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MANUSCRIPT 

Adolescent Added Sugar Consumption and 

Colon Cancer Risk in Hispanic Adults: A 

Public Health Perspective 
 

Marisol Acosta1, Jackylin Vela 1,4, Klarissa Ramos 1,5 , Abigail Salinas1,3  , Sofia Flores1,6, Zasherry 

Salazar 1,6, Mya Velasquez 1,7, Allyson Elizondo 1,2, Olivia Reyes1,4  

 
1DHR Health High School and Community Outreach  
2 South Texas Preparatory Academy  
3La Joya High School 
4 San Isidro High School 
5    Rio Hondo ISD 

6    James Nikki Rowe High School  
7  Lasara High School  

 

Received: July 12, 2024  

Accepted for publication: January 6, 2025  

 

Introduction 

The rising incidence of colorectal cancer (CRC) globally, coupled with concerning trends in 

early-onset CRC, necessitates a comprehensive understanding of its risk factors [1], [2]. Dietary 

habits, particularly during adolescence, are increasingly recognized as playing a significant role 

in CRC development [2]. This literature review examines the current evidence on the association 

between adolescent added sugar consumption and colon cancer risk in Hispanic adults, focusing 

on the public health implications of this relationship. The review will analyze existing studies, 

highlighting methodological strengths and weaknesses, identifying research gaps, and 

synthesizing findings to inform future research and public health interventions. 

Adolescent Sugar Intake and CRC Risk: An Overview 

Numerous studies have investigated the link between sugar intake and CRC risk, but the 

evidence remains complex and often contradictory [3], [4]. Some studies suggest a positive 

association between high sugar and sugar-sweetened beverage (SSB) consumption during 

adolescence and an increased risk of colorectal adenomas, precursors to CRC [2]. Joh et al. [2] 

found a positive association between high adolescent intake of simple sugars (fructose, glucose, 

added sugar, total sugar) and SSBs with the risk of conventional adenomas, particularly rectal 

adenomas. Specifically, for every 5% increase in total fructose intake per day, the multivariable 

odds ratio for total adenoma was 1.17 (95% CI 1.05–1.31), and for high-risk adenoma, it was 



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1.30 (95% CI 1.06–1.60) [2]. Similarly, Hur et al. [5] observed a more than doubled risk of 

early-onset CRC (EO-CRC) among women consuming two servings of SSBs per day compared 

to those consuming less than one serving per week in adulthood. Furthermore, each additional 

serving per day of SSB intake during adolescence (ages 13-18) was associated with a 32% higher 

risk of EO-CRC [5]. 

However, other studies have failed to demonstrate a clear association between overall sugar 

intake and CRC risk [3], [6]. In a large-scale Japanese cohort study, Kanehara et al. [3] found no 

significant association between various types of sugar intake and CRC risk in middle-aged 

adults. While a positive association was observed between total sugar consumption and rectal 

cancer in women, this was not statistically significant in men [3]. Similarly, Cho et al. [6] found 

no association between high sugar intake and the prevalence of colorectal adenomas in the 

Japanese population. These conflicting findings underscore the need for further research to 

clarify the complex relationship between sugar intake and CRC risk, considering factors such as 

ethnicity, age, and other lifestyle factors. 

Methodological Considerations and Research Gaps 

The studies reviewed employed various methodologies, including prospective cohort studies [2], 

[3], [5], [7], case-control studies [8], [9], and cross-sectional studies [6]. Prospective cohort 

studies offer a more substantial design for assessing temporal relationships between exposure 

and outcome, but they are expensive and time-consuming and may suffer from attrition bias [2]. 

Case-control studies are more efficient but susceptible to recall and selection bias [8]. Cross-

sectional studies provide a snapshot of the association at a single point in time, limiting the 

ability to infer causality [6]. 

Several methodological limitations exist across the studies: 

Dietary assessment: Most studies relied on self-reported nutritional data through food frequency 

questionnaires (FFQs) [2], [3], [5], [6], which are subject to measurement error and recall bias. 

Dietary recall accuracy can vary depending on factors like age, education, and cultural 

background [10]. 

Confounding factors: Many studies adjusted for potential confounding factors such as age, sex, 

BMI, smoking, physical activity, and alcohol consumption [2], [3], [5]. However, residual 

confounding may still exist, affecting the observed associations [11]. 

Subgroup analyses: While some studies conducted subgroup analyses by sex, age, or BMI [2], 

[3], [5], further stratification by ethnicity, particularly within Hispanic populations, is crucial to 

understanding potential variations in risk [12]. 



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Specific sugar types: Studies often examine total sugar intake or a limited number of particular 

sugar types [2], [3]. A more detailed assessment of different kinds of added sugars and their 

contributions to CRC risk is needed [13]. 

Longitudinal studies: Long-term follow-up is essential to establish the long-term effects of 

adolescent sugar consumption on CRC risk in adulthood [2]. Many studies lack the extended 

follow-up periods necessary to fully capture the development of CRC [11]. 

Hispanic populations: A significant gap exists in the literature regarding the specific impact of 

adolescent sugar consumption on CRC risk within diverse Hispanic populations [14], [15]. The 

limited number of studies focusing on Hispanic populations hinders the ability to draw definitive 

conclusions about this subgroup [12]. Further research is needed to address the distinct dietary 

patterns and cultural influences within different Hispanic subgroups [14]. 

Biological Mechanisms and Pathways 

The potential biological mechanisms linking high sugar intake, particularly during adolescence, 

to increased CRC risk remain to be fully elucidated [16], [17]. However, several plausible 

pathways have been proposed: 

Inflammation: High sugar intake can promote chronic inflammation, a known risk factor for 

CRC [16]. Stewart et al. [16] found associations between sugar intake and certain inflammation-

related biomarkers in CRC patients, although the findings were influenced by adiposity. 

Oxidative stress: Excess sugar can induce oxidative stress, damaging cellular components and 

potentially contributing to cancer development [17]. Lombello et al. [17] highlight the role of 

oxidative stress as a mechanism linking processed and ultra-processed foods, often high in added 

sugars, to CRC. 

Gut microbiota dysbiosis: High sugar intake can disrupt the gut microbiota, altering its 

composition and function [17], [18]. An imbalance in gut microbiota, known as dysbiosis, has 

been linked to increased CRC risk [17]. Herchenhorn and Tarouquella [18] discuss the potential 

link between nut consumption, which may modify the gut microbiota, and reduced colon cancer 

recurrence. 

Insulin resistance and hyperinsulinemia: High sugar intake can lead to insulin resistance and 

hyperinsulinemia, which have been implicated in CRC development [6], [19]. Increased insulin 

levels may promote cell growth and proliferation, contributing to tumorigenesis [19]. 

Advanced Glycation End Products (AGEs): High-sugar diets and high-temperature cooking 

processes can lead to the formation of AGEs in foods [20]. AGEs are implicated in promoting 

inflammation and oxidative stress, potentially contributing to cancer development [20]. 

Panguluri and Findlay [20] highlight the potential link between dietary AGEs and breast cancer 

risk, suggesting the need for further research into their role in other cancers. 



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Public Health Implications and Interventions 

The potential implications of adolescent sugar consumption on CRC risk in Hispanic adults are 

significant from a public health perspective [21], [22]. Given the rising prevalence of obesity and 

chronic diseases associated with high sugar intake, particularly within Hispanic communities, 

targeted interventions are crucial [23], [24]. These interventions should consider the following: 

Dietary guidelines and education: Public awareness of the potential link between adolescent 

sugar consumption and CRC risk is essential [25]. Educational campaigns targeting adolescents 

and their families, emphasizing the importance of limiting added sugar intake and adopting 

healthier dietary patterns, are vital [26], [27]. The effectiveness of these interventions should be 

assessed across different Hispanic subgroups [12]. 

Policy interventions: Policy interventions, such as sugar-sweetened beverage taxes and 

regulations on marketing to children, have been proposed to reduce SSB consumption [21], [22], 

[28]. The cost-effectiveness of such interventions should be carefully evaluated, considering the 

potential impact on health outcomes and economic burden [21], [22], [29]. Lee et al. [21] 

explored the health and economic impacts of various SSB tax policies in the United States. 

Shangguan et al. [22] modeled the potential effects of voluntary sugar reduction targets in the 

US. Alcaraz et al. [29] estimated the disease burden attributable to SSB consumption in four 

Latin American and Caribbean countries. 

Technology-based interventions: Technology-based interventions, such as smartphone apps and 

online tools, may help monitor sugar intake and provide personalized feedback [30]. These 

interventions can be adapted to different cultural contexts and integrated into existing health 

promotion programs [30]. 

Multi-sectoral approaches: Effective interventions require a multi-sectoral approach involving 

collaboration among government agencies, healthcare professionals, the food industry, 

educators, and community organizations [31]. This collaborative effort is necessary to address 

the complex interplay of factors contributing to high sugar intake and CRC risk [31]. 

Addressing health disparities: Interventions should focus on reducing health disparities within 

Hispanic populations, considering socio-economic factors, cultural beliefs, and access to 

healthcare [23], [24], [22]. Xu et al. [23], [24] highlight the need to consider racial and 

socioeconomic disparities in cancer-related behaviors among adolescents and parents. 

Conclusion 

The existing literature on the association between adolescent added sugar consumption and colon 

cancer risk in Hispanic adults is complex and presents conflicting findings. While some studies 

suggest a positive association, others have not found a clear link. Methodological limitations, 

including reliance on self-reported dietary data, potential confounding factors, and limited 



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research on Hispanic populations, contribute to this uncertainty. Further research is crucial to 

address these limitations and clarify the complex interplay between adolescent sugar intake, 

biological mechanisms, and CRC risk within diverse Hispanic subgroups. Public health 

interventions should consider multi-sectoral approaches, including dietary guidelines, policy 

interventions, technology-based strategies, and culturally tailored programs, to reduce sugar 

consumption and mitigate the risks of CRC within Hispanic communities. A strong focus on 

addressing health disparities and promoting healthy lifestyles throughout adolescence is 

paramount for reducing the burden of CRC. Future research should prioritize longitudinal studies 

with large, diverse samples and detailed dietary assessments, incorporating genetic and other 

biomarkers to understand the underlying mechanisms better and develop effective prevention 

strategies [32]. Including more varied Hispanic populations in future studies is crucial to 

providing culturally relevant and effective interventions [12]. The role of specific types of added 

sugars, the impact of dietary patterns, and the interaction with other risk factors also require 

further investigation [13], [17], [11]. Understanding the interplay between dietary factors, gut 

microbiota, and inflammation in CRC development within Hispanic populations is a significant 

area for future research [16], [17], [18]. Finally, evaluating the long-term impact of adolescent 

dietary habits on adult health outcomes, including CRC risk, is essential for developing effective 

public health strategies [2], [5]. 

Acknowledgements: 

Nori Zapata, MSN, RN, Senior Vice President of Education and Career Development, Vanessa 

Vera, MS, Senior Manager of High School and Community Outreach, Anisa Mirza, Intern 

Program Coordinator.  

Funding: 

Funded  by  DHR  Health High School and Community Outreach;    DHR    Health;    Region    

One    ESC GEARUP  College  Ready,  Career  Set!;  Region  One ESC   GEARUP   College   

Now,   Career   Connected; Region One ESC PATHS; Region One ESC Upward Bound  Math  &  

Science;  Benavides  ISD;  and  Jubilee Academy-Brownsville 

  



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