Accelerated Biological Aging and Risk of Early-Onset Colorectal Cancer: Findings from a Large Prospective East Asian Cohort.

Authors

Yoosoo Chang, Kyeezu Kim, Sarah H Wild, Christopher D Byrne, Seungho Ryu

Published in

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. Oct 05, 2026. Epub Oct 05, 2026.

Abstract

The global increase in young-onset colorectal cancer (CRC, diagnosed before age 50) necessitates improved risk stratification. Biological age, which better reflects physiological deterioration than chronological age, may serve as a crucial indicator of disease susceptibility. We examined the association between accelerated biological aging and early-onset colorectal adenocarcinoma (EOCRC-AC) risk.
In a prospective cohort of 198,491 Korean adults under 50 years of chronological age, we estimated biological age using Phenotypic Age (PhenoAge), derived from nine routine blood biomarkers, with acceleration calculated as the residual from regressing biological age on chronological age. Cox proportional hazards models, adjusted for demographic, behavioral, and clinical factors, examined the association between biological age acceleration and incident EOCRC-AC, with colorectal neuroendocrine tumors (EOCRC-NET) analyzed as a comparator outcome.
Over a median follow-up of 7.7 years, 127 incident EOCRC-AC and 142 EOCRC-NET were identified through linkage with the National Cancer Registry. Individuals with biological age greater than chronological age (accelerated biological aging) had a 93% higher risk of EOCRC-AC (hazard ratio [HR] 1.93, 95% CI 1.28-2.91), with particularly strong associations for colon adenocarcinoma (HR 2.32, 95% CI 1.38-3.89). Associations remained consistent across subgroups including adults younger than 45 years and lag-time sensitivity analyses. In contrast, no consistent association was observed for EOCRC-NET.
Accelerated biological aging is independently associated with increased EOCRC-AC risk. Biological aging measures could complement chronological age-based criteria, improving risk stratification and identifying younger individuals who may benefit from earlier or tailored screening strategies.

PMID:
42833432
Bibliographic data and abstract were imported from PubMed on 06 Oct 2026.

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