A recent study from the Cleveland Clinic has pinpointed diet-derived molecules known as metabolites as key contributors to the likelihood of developing colorectal cancer at a young age. This is particularly true for those linked to the consumption of red and processed meat. The findings, published in NPJ Precision Oncology, suggest that one of the most effective strategies for adults under 60 to reduce their risk of colorectal cancer is to consult with their physicians about their dietary habits.
Enhanced surveillance and testing for colorectal cancer serve as essential measures. Despite the effectiveness of these approaches, the data suggests that healthcare providers might consider a different strategy for younger patients, according to senior author and gastrointestinal oncologist, Dr. Suneel Kamath.
“Ultimately, using the same healthcare models for individuals over 60 on younger adults isn’t practical since we can’t offer annual colonoscopies to everyone,” he clarifies. “A more practical solution is to provide all patients a straightforward test that evaluates a biomarker indicating their colorectal cancer risk. This way, we can prioritize appropriate screenings for those at greatest risk.”
Thejus Jayakrishnan, MD, a former clinical fellow, and Dr. Naseer Sangwan, director of the Microbial Sequencing & Analytics Resource Core, led the research efforts. The Cleveland Clinic’s Center for Young-Onset Colorectal Cancer conducted extensive analyses of patient data from individuals diagnosed with either young- or average-onset colorectal cancer.
Earlier research by this team highlighted differences in the metabolites (molecules derived from diet) found in young-onset versus average-onset colorectal cancer. Another study revealed variations in gut microbiomes between younger and older patients with colorectal cancer. These findings opened up several avenues to explore further regarding young-onset CRC. However, the complexity increases when multiple factors contribute to cancer risk, complicating the understanding of the situation and future research plans, Dr. Sangwan notes. The interactions among these variables—especially when gut bacteria digest metabolites and produce their own—add another layer of complexity.
Dr. Sangwan and his team then created an artificial intelligence (AI) algorithm to integrate and analyze the datasets from previous research, determining which factors are most pertinent for subsequent studies. Interestingly, their analysis discovered that dietary differences (as indicated by metabolites) significantly contributed to the distinctions seen between patients diagnosed at a young age and those diagnosed later.
“Researchers, including ourselves, have increasingly focused on the gut microbiome as a main factor in colon cancer risk. However, our findings clearly indicate that diet is the primary influence,” states Dr. Sangwan. “We are already aware of the key metabolites linked to young-onset risk, allowing us to steer our research in a productive direction.”
The research team found it encouraging that diet has such a significant impact on cancer risk. This is because it is much easier to identify at-risk individuals by measuring metabolites in their blood than by sequencing the bacterial DNA in their stool to analyze various microbes.
“Modifying your microbiome can actually be quite complex and challenging,” Dr. Kamath explains. “While it’s often difficult, it’s generally much simpler to alter your diet to help prevent colorectal cancer.”
Focusing on dietary factors to mitigate colorectal cancer risk
Patients with young-onset colorectal cancer exhibited elevated levels of metabolites linked to the metabolism of an amino acid called arginine and the urea cycle when compared to older patients. These differences might be associated with long-term intake of red and processed meats. The research team is currently examining national datasets to confirm their findings from Cleveland Clinic in patients across the United States.
Once they demonstrate that metabolites related to arginine and the urea cycle (indicating high consumption of red and processed meat) are prevalent among younger adults with colon cancer nationally, they aim to investigate whether certain diets or commercially available medications that influence arginine production and the urea cycle can prevent or even treat young-onset colorectal cancer.
Dr. Kamath asserts that even though further research is essential to fully comprehend how dietary factors contribute to colon cancer, the current evidence has already modified his approach to patient care.
“While I was aware that diet significantly impacts colon cancer risk before this study, I didn’t always emphasize it during initial patient visits. The situation can be overwhelming as it is,” reveals Dr. Kamath. “Now, I make it a point to discuss it with my patients and with any healthy friends or family members they might bring along, ensuring they have the necessary resources to make informed lifestyle choices.”
