Addressing Early Onset Colorectal Cancer Risk Factors Through Weight Management and Stress Reduction

Early-onset colorectal cancer (EOCRC) is defined as a diagnosis of colorectal cancer in patients younger than 50 years old. The American Cancer Society reported that 12% of all colorectal cancer (CRC) diagnoses occur in individuals younger than 50 years old. Worldwide, a steady increase in EOCRC cases is observed among Westernized countries, suggesting that similar risk factors and exposures within these developed countries contribute to EOCRC incidence. Increased adiposity from an early age that persists through adulthood, poor diet quality and chronic psychosocial stress (CPS) are under investigation as drivers of the recent uptick in EOCRC in the United States and other Westernized countries. This dissertation research examined diet quality, chronic stress and body weight as potential modifiable risk factors for EOCRC in young adults. The following is presented in this dissertation: first, a manuscript with a review of diet quality, excess adiposity, and CPS and their implications for EOCRC risk. Second, a manuscript of a study design protocol describing an 8-week pilot randomized controlled trial investigating the feasibility and acceptability of time restricted eating (TRE) for weight management and mindfulness for stress reduction as interventions to risk factors associated with EOCRC is presented. Lastly, a manuscript stating the outcomes of the pilot study is presented. This dissertation research has shed light on the current evidence highlighting association between body weight, dietary quality and CPS and EOCRC risk in developed countries. We also completed a randomized controlled pilot study demonstrating the feasibility and acceptability of a remote TRE and mindfulness intervention among young adults with obesity and moderate to higher self-reported CPS. This study was feasible and well-accepted among its participants. The TRE & Mindfulness arm demonstrated superior improvements in perceived stress, visceral fat mass, fasting insulin, fasting glucose, homeostasis model assessment, hemoglobin A1c, and fecal calprotectin than the other three study arms (TRE alone, Mindfulness alone, and Control). The feasibility and preliminary data generated here will now serve in developing a fully powered efficacy trial of TRE and mindfulness to address risk factors associated with EOCRC among young adults.