Healthy Eating Index (HEI-2020) score and colorectal cancer risk

Purpose: The aim of this study is to evaluate if the alignment with the 2020–2025 Dietary Guidelines for Americans (DGA), measured by the Healthy Eating Index 2020 (HEI-2020), is associated with colorectal cancer (CRC) risk in an Italian population. Methods: A multicentric case-control study was carried out in Italy between 1992 and 1996. Cases were 1953 patients (males 58 %, median age = 62 years) admitted to major hospitals with incident, histologically confirmed CRC. Controls were 4154 patients (males 50 %, median age = 58 years) admitted to the same hospitals for acute non-neoplastic conditions. Participants’ usual diet before study enrolment was collected using a validated food frequency questionnaire, and the alignment with DGA was assessed using the HEI-2020 score, ranging between 0 (no alignment) and 100 (complete alignment). Odds ratios (ORs) and the corresponding 95 % confidence intervals (CIs) were estimated using multiple logistic regression models including terms for selected socioeconomic, lifestyle factors, and potential confounders. Results: The HEI-2020 score ranged from 29.4 and 97.0. Subjects in the highest tertile of scores had lower risk of CRC compared to those in the lowest tertile (OR: 0.69, 95 % CI = 0.60–0.80). Similar estimates were found for colon (OR: 0.70, 95 % CI = 0.59 – 0.83) and rectal cancer (OR: 0.69, 95 % CI = 0.56–0.85). The findings were also consistent across strata of different covariates. Conclusions: Alignment with DGA was inversely associated with CRC risk in an Italian population.