{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T05:01:13Z","timestamp":1781154073222,"version":"3.54.1"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      The Healthy Eating Index (HEI-2020), a metric that assesses overall diet quality based on compliance with the\n                      <jats:italic>2020\u20132025 Dietary Guidelines for Americans<\/jats:italic>\n                      , has been insufficiently investigated in relation to both colorectal cancer (CRC) incidence and mortality. To address this gap, we conducted a population-based prospective study of 101,709 U.S. adults from the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, examining the associations between HEI-2020 adherence and risks of CRC incidence and death.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 101,709 participants were included in this study. Dietary information was collected using the Diet History Questionnaire (DHQ), and adherence to the HEI-2020 was assessed. Higher HEI-2020 scores indicated better adherence to a healthy diet. Cox proportional hazards regression analyses were performed to examine the association between HEI-2020 scores and CRC risk. To further explore the dose\u2013response relationship between HEI-2020 scores and CRC incidence, a restricted cubic spline (RCS) model was applied. Subgroup analyses were conducted to identify potential modifiers that might interact with HEI-2020 in relation to CRC incidence, and sensitivity analyses were performed to assess the robustness of the established association.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Result<\/jats:title>\n                    <jats:p>This study included 101,709 participants, with 1,100 incident CRC cases and 314 deaths. The fully adjusted model showed that participants in the highest HEI-2020 quartile had a lower point estimate for CRC incidence than those in the lowest quartile, although this comparison did not reach statistical significance (HR\u202f=\u202f0.86; 95% CI: 0.73\u20131.02). A significant decreasing trend in CRC incidence risk was observed across HEI-2020 quartiles (P for trend\u202f=\u202f0.021). Higher HEI-2020 scores were significantly associated with lower CRC-specific mortality (Q4 vs. Q1: HR\u202f=\u202f0.61; 95% CI: 0.45\u20130.85; P for trend\u202f=\u202f0.001), and this association remained consistent in competing-risk analyses. Site-specific analyses suggested lower risks for distal colon cancer and a borderline lower point estimate for rectal cancer, as well as a decreasing trend in proximal colon cancer mortality. Sensitivity and subgroup analyses confirmed the robustness of the findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study suggests that higher HEI-2020 scores, reflecting better alignment with the Dietary Guidelines for Americans, are associated with a significant decreasing trend in CRC incidence risk and a lower risk of CRC-specific mortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1793362","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T04:36:26Z","timestamp":1781152586000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The healthy eating index 2020 and colorectal cancer risk: a prospective study based on the PLCO cohort"],"prefix":"10.3389","volume":"13","author":[{"given":"Huang","family":"Li","sequence":"first","affiliation":[{"name":"Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linguo","family":"Shen","sequence":"additional","affiliation":[{"name":"Center of Urology and Nephrology, The Second Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziyao","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dazhan","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linglong","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Xiang","sequence":"additional","affiliation":[{"name":"Department of Clinical Nutrition, The Second Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuxiang","family":"Luo","sequence":"additional","affiliation":[{"name":"Thoraxcenter, Department of Cardiology, Cardiovascular Institute, Erasmus University Medical Center","place":["Rotterdam, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaxu","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongke","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,11]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"10","DOI":"10.3322\/caac.21871","article-title":"Cancer statistics, 2025","volume":"75","author":"Siegel","year":"2025","journal-title":"CA Cancer J Clin"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1732","DOI":"10.3390\/cancers14071732","article-title":"Colorectal Cancer: a review of carcinogenesis, global epidemiology, current challenges, risk factors, preventive and treatment strategies","volume":"14","author":"Hossain","year":"2022","journal-title":"Cancers"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1038\/s41467-024-55219-5","article-title":"Diet-wide analyses for risk of colorectal cancer: prospective study of 12,251 incident cases among 542,778 women in the UK","volume":"16","author":"Papier","year":"2025","journal-title":"Nat 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