Energy restriction early in life and colon carcinoma risk: results of The Netherlands Cohort Study after 7.3 years of follow-up

BACKGROUND: This study evaluated the effects of severe undernutrition during adolescence and subsequent colon carcinoma risk. METHODS: The authors evaluated The Netherlands Cohort Study on Diet and Cancer (NLCS) among 62,573 women and 58,279 men aged 55-69 years at baseline. Information on diet and risk factors was collected by questionnaire in 1986. Additional information was collected concerning residence during the hunger winter (1944-1945), the World War II years (1940-1944), and father's employment status during the economic depression of 1932-1940, which were used as indicators of exposure. After 7.3 years of follow-up, 807 colon carcinoma cases (388 females and 419 males) were available for analysis. RESULTS: Multivariate analysis showed that both men and women who had lived in a western city in 1944-1945 had a decreased colon carcinoma risk (men: relative risk [RR] = 0.85, 95% confidence interval [CI] = 0.62-1.16; women: RR = 0.80, 95% CI = 0.59-1.09). No association between colon carcinoma risk and urban versus rural residence was found during the war years (1940-1944). Having an unemployed father during the economic depression (1932-1940) was also associated with a small decrease in colon carcinoma risk for men (RR = 0.90, 95% CI =0.62-1.31) and women (RR = 0.75, 95% CI 0.49-1.14). In subgroup analyses, a decreased colon carcinoma risk for men and women who were in their adolescent growth spurt and living in a western city during the hunger winter of 1944-1945 was noted (men: RR = 0.72, 95% CI = 0.31-1.65; women: RR = 0.88, 95% CI = 0.40-1.96). No associations were statistically significant because of the limited study size. CONCLUSIONS: In the current study, a weak inverse relation was found between energy restriction early in life and subsequent colon carcinoma risk for men and women. However, these findings need replication in a larger study.