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Exploring high\u2010risk factors and screening high\u2010risk populations may help lower early\u2010onset CRC (EO\u2010CRC) incidence. We developed noninvasive predictive models for EO\u2010CRC and investigated its risk factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective multicenter study collected information on 1756 patients (811 patients with EO\u2010CRC and 945 healthy controls) from two medical centers in China. Sociodemographic features, clinical symptoms, medical and family history, lifestyle, and dietary factors were measured. Patients from one cohort were randomly assigned (8:2) to two groups for model establishment and internal validation, and another independent cohort was used for external validation. Multivariable logistic regression, random forest, and eXtreme Gradient Boosting (XGBoost) were performed to establish noninvasive predictive models for EO\u2010CRC. Some variables in the model influenced EO\u2010CRC occurrence and were further analyzed. Multivariable logistic regression analysis yielded adjusted odd ratios (ORs) and 95% confidence intervals (CIs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All three models showed good performance, with areas under the receiver operator characteristic curves (AUCs) of 0.82, 0.84, and 0.82 in the internal and 0.78, 0.79, and 0.78 in the external validation cohorts, respectively. Consumption of sweet (OR 2.70, 95% CI 1.89\u20133.86, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001) and fried (OR 2.16, 95% CI 1.29\u20133.62, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001) foods \u22653 times per week was significantly associated with EO\u2010CRC occurrence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We established noninvasive predictive models for EO\u2010CRC and identified multiple nongenetic risk factors, especially sweet and fried foods. The model has good performance and can help predict the occurrence of EO\u2010CRC in the Chinese population.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jgh.16243","type":"journal-article","created":{"date-parts":[[2023,6,1]],"date-time":"2023-06-01T04:50:02Z","timestamp":1685595002000},"page":"1768-1777","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Noninvasive predictive models based on lifestyle analysis and risk factors for early\u2010onset colorectal cancer"],"prefix":"10.1111","volume":"38","author":[{"given":"Jia\u2010Wen","family":"Deng","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology; Shanghai Institute of Digestive Disease; NHC Key Laboratory of Digestive Diseases; State Key Laboratory for Oncogenes and Related Genes; Renji Hospital, School of Medicine Shanghai Jiao Tong University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi\u2010Lu","family":"Zhou","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology; Shanghai Institute of Digestive Disease; NHC Key Laboratory of Digestive Diseases; State Key Laboratory for Oncogenes and Related Genes; Renji Hospital, School of Medicine Shanghai Jiao Tong University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei\u2010Xing","family":"Dai","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, Fudan University Shanghai Cancer Center Fudan University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui\u2010Min","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology; Shanghai Institute of Digestive Disease; NHC Key Laboratory of Digestive Diseases; State Key Laboratory for Oncogenes and Related Genes; Renji Hospital, School of Medicine Shanghai Jiao Tong University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng\u2010Bei","family":"Zhou","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology; Shanghai Institute of Digestive Disease; NHC Key Laboratory of Digestive Diseases; State Key Laboratory for Oncogenes and Related Genes; Renji Hospital, School of Medicine Shanghai Jiao Tong University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun\u2010Qi","family":"Zhu","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology; Shanghai Institute of Digestive Disease; NHC Key Laboratory of Digestive Diseases; State Key Laboratory for Oncogenes and Related Genes; Renji Hospital, School of Medicine Shanghai Jiao Tong University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin\u2010Yue","family":"Ma","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology; Shanghai Institute of Digestive Disease; NHC Key Laboratory of Digestive Diseases; State Key Laboratory for Oncogenes and Related Genes; Renji Hospital, School of Medicine Shanghai Jiao Tong University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5630-1684","authenticated-orcid":false,"given":"Si\u2010Yuan","family":"Pan","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology; Shanghai Institute of Digestive Disease; NHC Key Laboratory of Digestive Diseases; State Key Laboratory for Oncogenes and Related Genes; Renji Hospital, School of Medicine Shanghai Jiao Tong University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun","family":"Cui","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology; Shanghai Institute of Digestive Disease; NHC Key Laboratory of Digestive Diseases; State Key Laboratory for Oncogenes and Related Genes; Renji Hospital, School of Medicine Shanghai Jiao Tong University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"En\u2010Hao","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin\u2010Xian","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zheng","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Pathology, Renji Hospital, School of Medicine Shanghai Jiao Tong University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji\u2010Lin","family":"Wang","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology; 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