1
|
Bever AM, Hang D, Lee DH, Tabung FK, Ugai T, Ogino S, Meyerhardt JA, Chan AT, Eliassen AH, Liang L, Stampfer MJ, Song M. Metabolomic signatures of inflammation and metabolic dysregulation in relation to colorectal cancer risk. J Natl Cancer Inst 2024; 116:1126-1136. [PMID: 38430005 PMCID: PMC11223797 DOI: 10.1093/jnci/djae047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/18/2024] [Accepted: 02/22/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Inflammation and metabolic dysregulation are associated with increased risk of colorectal cancer (CRC); the underlying mechanisms are not fully understood. We characterized metabolomic signatures of inflammation and metabolic dysregulation and evaluated the association of the signatures and individual metabolites with CRC risk. METHODS Among 684 incident CRC cases and 684 age-matched controls in the Nurses' Health Study (n = 818 women) and Health Professionals Follow-up Study (n = 550 men), we applied reduced rank and elastic net regression to 277 metabolites for markers of inflammation (C-reactive protein, interleukin 6, tumor necrosis factor receptor superfamily member 1B, and growth differentiation factor 15) or metabolic dysregulation (body mass index, waist circumference, C-peptide, and adiponectin) to derive metabolomic signatures. We evaluated the association of the signatures and individual metabolites with CRC using multivariable conditional logistic regression. All statistical tests were 2-sided. RESULTS We derived a signature of 100 metabolites that explained 24% of variation in markers of inflammation and a signature of 73 metabolites that explained 27% of variation in markers of metabolic dysregulation. Among men, both signatures were associated with CRC (odds ratio [OR] = 1.34, 95% confidence interval [CI] = 1.07 to 1.68 per 1-standard deviation increase, inflammation; OR = 1.25, 95% CI = 1.00 to 1.55 metabolic dysregulation); neither signature was associated with CRC in women. A total of 11 metabolites were individually associated with CRC and biomarkers of inflammation or metabolic dysregulation among either men or women. CONCLUSION We derived metabolomic signatures and identified individual metabolites associated with inflammation, metabolic dysregulation, and CRC, highlighting several metabolites as promising candidates involved in the inflammatory and metabolic dysregulation pathways for CRC incidence.
Collapse
Affiliation(s)
- Alaina M Bever
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Harvard-MIT Division of Health Sciences and Technology, Harvard Medical School, Boston, MA, USA
| | - Dong Hang
- Department of Epidemiology and Biostatistics, Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Dong Hoon Lee
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Sport Industry Studies, Yonsei University, Seoul, Republic of Korea
| | - Fred K Tabung
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- The Ohio State University College of Medicine and Comprehensive Cancer Center, Columbus, OH, USA
| | - Tomotaka Ugai
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Program in Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Shuji Ogino
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Program in Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Jeffrey A Meyerhardt
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Andrew T Chan
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - A Heather Eliassen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Liming Liang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Meir J Stampfer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Mingyang Song
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
2
|
Vali M, Maleki Z, Nikbakht HA, Hassanipour S, Kouhi A, Nazemi S, Hajizade-Valokolaee M, Nayeb M, Ghaem H. Survival rate of cervical cancer in Asian countries: a systematic review and meta-analysis. BMC Womens Health 2023; 23:671. [PMID: 38098009 PMCID: PMC10722657 DOI: 10.1186/s12905-023-02829-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVE Cancer is one of the main causes of death, and cervical cancer is the fourth most common cancer and the fourth leading cause of death from malignancy among women. Knowing the survival rate is used to evaluate the success of current treatments and care. This study was conducted to assess the survival rate of cervical cancer in Asia. METHODS This systematic survey was conducted on four international databases, including Medline/PubMed, ProQuest, Scopus, and Web of Knowledge, and includes manuscripts that were published until the end of August 2021. Selected keywords were searched for international databases including cervical neoplasms [mesh], survival analysis or survival or survival rate, Asian countries (name of countries). The Newcastle-Ottawa Qualitative Evaluation Form was used for cohort studies to evaluate the quality of the articles. The analysis process was performed to evaluate the heterogeneity of the studies using the Cochran test and I2 statistics. Additionally, a meta-regression analysis was performed based on the year of the study. RESULTS A total of 1956 articles were selected and reviewed based on their title. The results showed that 110 articles met the inclusion criteria. According to the randomized model, the 1, 3, 5, and 10-year survival rates of cervical cancer were 76.62% (95% Confidence Interval (CI), 72.91_80.34), 68.77% (95% CI, 64.32_73.21), 62.34% (95% CI, 58.10_66.59), and 61.60% (95% CI, 52.31_70.89), respectively. Additionally, based on the results of meta-regression analysis, there was an association between the year of the study and the survival rate, elucidating that the survival rate of cervical cancer has increased over the years. CONCLUSIONS Results can provide the basic information needed for effective policy making, and development of public health programs for prevention, diagnosis, and treatment of cervical cancer.
Collapse
Affiliation(s)
- Mohebat Vali
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Maleki
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein-Ali Nikbakht
- Social Determinants of Health Research Center, Health Research Institute, Department of Biostatistics & Epidemiology, School of Public Health, Babol University of Medical Sciences, Babol, Iran
| | - Soheil Hassanipour
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Aida Kouhi
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sina Nazemi
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Maryam Hajizade-Valokolaee
- Department of Health, Health Systems Research, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - MohammadReza Nayeb
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Haleh Ghaem
- Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran.
| |
Collapse
|
3
|
Li X, Lian Y, Ping W, Wang K, Jiang L, Li S. Abdominal obesity and digestive system cancer: a systematic review and meta-analysis of prospective studies. BMC Public Health 2023; 23:2343. [PMID: 38012596 PMCID: PMC10680266 DOI: 10.1186/s12889-023-17275-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND The diagnostic criteria for abdominal obesity are usually waist circumference or waist-to-hip ratio. The magnitude of the risks for cancers of the digestive system and abdominal obesity is unknown. To assess whether abdominal obesity increases the risk of digestive cancer, we conducted a systematic review and meta-analysis of prospective cohort studies in a database. METHODS PubMed, Embase, and Web of Science databases were searched from their inception to December 2022. The 9-star Newcastle Ottawa Scale was used to assess study quality. Pooled relative risks and 95% confidence intervals were calculated using fixed or random effect models respectively. The stability of the results was explored by one-by-one exclusion. Subgroup analysis was conducted to explore sources of heterogeneity. Publication bias was evaluated by Begg's and Egger's tests. RESULTS A total of 43 cohort studies were included. There were 42 and 31 studies in the meta-analysis of waist circumference and waist-to-hip ratio on digestive system cancer, respectively. The results of the meta-analysis revealed that the greater waist circumference and waist-to-hip ratio were correlated with increased incidence of digestive system cancers: waist circumference: RR 1.48, 95% CI 1.38-1.59, p < 0.001; waist-to-hip ratio: RR 1.33, 95% CI 1.28-1.38, p = 0.001. Subgroup analysis by cancer type showed that higher WC and WHR would increase the prevalence of LC, PC, GC, EC, and CRC. The sensitivity analysis was conducted by a one-by-one elimination method, and the results of the meta-analysis remained stable. It is proved that the results were robust by the trim-and-fill method. CONCLUSIONS There was evidence to suggest that abdominal obesity increased the incidence of digestive cancer, it is necessary to take appropriate measures to reduce abdominal obesity. Waist circumference and waist-to-hip ratio may be better predictors of digestive system cancers. However, the association between waist circumference and digestive system cancer was greater, so more attention should be paid to measuring abdominal obesity with waist circumference.
Collapse
Affiliation(s)
- Xue Li
- School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Yajun Lian
- Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China
| | - Weiwei Ping
- Department of Public Health and Preventive Medicine, Changzhi Medical College, 161 Jiefang East Street, Changzhi, 046000, Shanxi, China.
| | - Kunbo Wang
- Xiangya School of Public Health, Central South University, Changsha City, China
| | - Lingyan Jiang
- Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China
| | - Shaoxia Li
- Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China
| |
Collapse
|
4
|
Su L, Hendryx M, Li M, Shadyab AH, Saquib N, Stefanick ML, Luo J. Body size over the adult life course and the risk of colorectal cancer among postmenopausal women. Public Health Nutr 2023; 26:1539-1548. [PMID: 37199248 PMCID: PMC10410385 DOI: 10.1017/s1368980023000988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 02/10/2023] [Accepted: 05/06/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE To assess the associations among several anthropometric measures, as well as BMI trajectories and colorectal cancer (CRC) risk in older women. DESIGN Prospective cohort study. SETTING Forty clinical centres in the USA. PARTICIPANTS Totally, 79 034 postmenopausal women in the Women's Health Initiative Observational Study. RESULTS During an average of 15·8 years of follow-up, 1514 CRC cases were ascertained. Five BMI trajectories over 18-50 years of age were identified using growth mixture model. Compared with women who had a normal BMI at age 18, women with obesity at age 18 had a higher risk of CRC (HR 1·58, 95 % CI 1·02, 2·44). Compared with women who kept relatively low normal body size during adulthood, women who progressed from normal to obesity (HR 1·29, 95 % CI 1·09, 1·53) and women who progressed from overweight to obesity (HR 1·37, 95 % CI 1·13, 1·68) had higher CRC risks. A weight gain > 15 kg from age 18 to 50 (HR 1·20, 95 % CI 1·04, 1·40) and baseline waist circumference > 88 cm (HR 1·33, 95 % CI 1·19, 1·49) were associated with higher CRC risks, compared with stable weight and waist circumference ≤ 88 cm, respectively. CONCLUSION Women who have a normal weight in early adult life and gain substantial weight later, as well as those who are persistently heavy over adulthood, demonstrated a higher risk of developing CRC. Our study highlights the importance of maintaining a healthy body weight over the life course for reducing the risk of developing CRC in women.
Collapse
Affiliation(s)
- Le Su
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University – Bloomington, Bloomington, IN47408, USA
| | - Michael Hendryx
- Department of Environmental and Occupational Health, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Ming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University – Bloomington, Bloomington, IN47408, USA
| | - Aladdin H Shadyab
- Department of Family Medicine and Public Health, School of Medicine, University of California San Diego, San Diego, California, USA
| | - Nazmus Saquib
- College of Medicine at Sulaiman Al-Rajhi University, Al Bukayriyah, Kingdom of Saudi Arabia
| | - Marcia L Stefanick
- Stanford Prevention Research Center, Stanford University, Stanford, CA, USA
| | - Juhua Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University – Bloomington, Bloomington, IN47408, USA
| |
Collapse
|
5
|
Song JH, Seo JY, Jin EH, Chung GE, Kim YS, Bae JH, Kim S, Han KD, Yang SY. Association of changes in obesity and abdominal obesity status with early-onset colorectal cancer risk: a nationwide population-based cohort study. Front Med (Lausanne) 2023; 10:1208489. [PMID: 37415766 PMCID: PMC10321412 DOI: 10.3389/fmed.2023.1208489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/05/2023] [Indexed: 07/08/2023] Open
Abstract
Background and aims The incidence of early-onset colorectal cancer (EO-CRC, diagnosed before 50 years of age) has increased in recent decades. The aim of this study was to investigate the association between changes in obesity status and EO-CRC risk. Methods From a nationwide population-based cohort, individuals <50 years old who participated in the national health checkup program in both 2009 and 2011 were included. Obesity was defined as a body mass index ≥25 kg/m2. Abdominal obesity was defined as a waist circumference ≥ 90 cm in men and ≥ 85 cm in women. Participants were classified into 4 groups according to the change in obesity (normal/normal, normal/obese, obese/normal, persistent obese) and abdominal obesity (normal/normal, normal/abdominal obesity, abdominal obesity/normal, persistent abdominal obesity) status. Participants were followed up until 2019 and censored when they became 50 years old. Results Among 3,340,635 participants, 7,492 patients were diagnosed with EO-CRC during 7.1 years of follow-up. The risk of EO-CRC was higher in the persistent obesity and persistent abdominal obesity groups than in the normal/normal groups (hazard ratio (HR) [95% confidence interval (CI)] = 1.09 [1.03-1.16] and 1.18 [1.09-1.29], respectively). Participants with both persistent obesity and abdominal obesity had a higher EO-CRC risk than those in the normal/normal groups for both [HR (95% CI) = 1.19 (1.09-1.30)]. Conclusion Persistent obesity and persistent abdominal obesity before the age of 50 are associated with a slightly increased risk of EO-CRC. Addressing obesity and abdominal obesity in young individuals might be beneficial in reducing the risk of EO-CRC.
Collapse
Affiliation(s)
- Ji Hyun Song
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji Yeon Seo
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eun Hyo Jin
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Goh Eun Chung
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Sun Kim
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jung Ho Bae
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sunmie Kim
- Department of Obstetrics and Gynecology, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung-Do Han
- Department of Obstetrics and Gynecology, Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sun Young Yang
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| |
Collapse
|
6
|
Maleki Z, Vali M, Nikbakht HA, Hassanipour S, Kouhi A, Sedighi S, Farokhi R, Ghaem H. Survival rate of ovarian cancer in Asian countries: a systematic review and meta-analysis. BMC Cancer 2023; 23:558. [PMID: 37328812 DOI: 10.1186/s12885-023-11041-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 06/05/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Ovarian cancer is amongst one of the most commonly occurring cancers affecting women, and the leading cause of gynecologic related cancer death. Its poor prognosis and high mortality rates can be attributed to the absence of specific signs and symptoms until advance stages, which frequently leads to late diagnosis. Survival rate of patients diagnosed with ovarian cancer can be used in order to better assess current standard of care; the aim of this study is to evaluate the survival rate of ovarian cancer patients in Asia. METHODS Systematic review was performed on articles that were published by the end of August 2021 in five international databases, including Medline / PubMed, ProQuest, Scopus, Web of Knowledge, and Google Scholar. The Newcastle-Ottawa quality evaluation form was used for cohort studies to evaluate the quality of the articles. The Cochran-Q and I2 tests were used to calculate the heterogeneity of the studies. The Meta-regression analysis was also done according to when the study was published. RESULTS A total of 667 articles were reviewed, from which 108 were included in this study because they passed the criteria. Based on a randomized model, the survival rates of ovarian cancer after 1, 3 and 5 years were respectively 73.65% (95% CI, 68.66-78.64), 61.31% (95% CI, 55.39-67.23) and 59.60% (95% CI, 56.06-63.13). Additionally, based on meta-regression analysis, there was no relationship between the year of study and survival rate. CONCLUSIONS The 1-year survival rate was higher than that of 3- and 5-year for ovarian cancer. This study provides invaluable information that can not only help establish better standard of care for treatment of ovarian cancer, but also assist in development of superior health interventions for prevention and treatment of the disease.
Collapse
Affiliation(s)
- Zahra Maleki
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohebat Vali
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein-Ali Nikbakht
- Social Determinants of Health Research Center, Health Research Institute, Department of Biostatistics & Epidemiology, School of Public Health, Babol University of Medical Sciences, Babol, Iran
| | - Soheil Hassanipour
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Aida Kouhi
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Saman Sedighi
- Department of Neurosurgery, Keck school of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Roya Farokhi
- Department of Health, Health Systems Research, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Haleh Ghaem
- Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran.
| |
Collapse
|
7
|
Mandic M, Safizadeh F, Niedermaier T, Hoffmeister M, Brenner H. Association of Overweight, Obesity, and Recent Weight Loss With Colorectal Cancer Risk. JAMA Netw Open 2023; 6:e239556. [PMID: 37083659 PMCID: PMC10122181 DOI: 10.1001/jamanetworkopen.2023.9556] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
Importance Overweight and obesity, conditions with rising prevalence in many countries, are associated with increased colorectal cancer (CRC) risk. However, many patients with CRC lose weight before diagnosis, which may lead the association to be underestimated. Objective To evaluate the association of body mass index (BMI) and weight change with CRC risk when considering BMI at different time frames, with the intention to account for prediagnostic weight loss. Design, Setting, and Participants This population-based case-control study was conducted in southwestern Germany between 2003 and 2021. Cases with a first diagnosis of CRC and controls (frequency matched by age, sex, and county) with comprehensive risk factor information and self-reported weight at different time points were included. Data were analyzed between October 2022 and March 2023. Exposure BMI and weight change at different time frames before the time of diagnosis (cases) or recruitment (controls). Main Outcomes and Measures Association of BMI and weight change at various points in time before and up to diagnosis with CRC, assessed by multivariable logistic regression with comprehensive confounder adjustment. Results A total of 11 887 participants (6434 CRC cases, 5453 controls; median [IQR] age, 69 [61-77] years; 7173 male [60.3%]) were included. At the time of diagnosis, 3998 cases (62.1%) and 3601 controls (66.0%) were overweight or obese, suggesting an inverse association between excess weight and CRC risk. Conversely, we found significant positive associations of overweight (adjusted odds ratio [aOR], 1.27; 95% CI, 1.03-1.56), obesity (aOR, 2.09; 95% CI, 1.61-2.70), and a 5-unit increase in BMI (aOR, 1.35; 95% CI, 1.21-1.50) with CRC risk when using BMI measured 8 to 10 years before diagnosis. High BMI as a risk factor for CRC was increased as earlier periods before diagnosis were examined, with the association being particularly pronounced using BMI at least 8 years before diagnosis. An opposite trend was found for the association of weight loss (at or exceeding 2 kg) with CRC, with the greatest effect sizes occurring for weight loss within 2 years before diagnosis (aOR, 7.52; 95% CI, 5.61-10.09), and gradually decreased for earlier intervals. Conclusions and Relevance In this population-based case-control study, accounting for substantial prediagnostic weight loss further highlighted the association of overweight and obesity with CRC risk.
Collapse
Affiliation(s)
- Marko Mandic
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilian University of Munich, Munich, Germany
- Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Fatemeh Safizadeh
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Tobias Niedermaier
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Preventive Oncology, DKFZ and National Center for Tumor Diseases, Heidelberg, Germany
- German Cancer Consortium, DKFZ, Heidelberg, Germany
| |
Collapse
|
8
|
Tanriver G, Kocagoncu E. Additive pre-diagnostic and diagnostic value of routine blood-based biomarkers in the detection of colorectal cancer in the UK Biobank cohort. Sci Rep 2023; 13:1367. [PMID: 36693981 PMCID: PMC9873936 DOI: 10.1038/s41598-023-28631-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/20/2023] [Indexed: 01/25/2023] Open
Abstract
Survival rates from colorectal cancer (CRC) are drastically higher if the disease is detected and treated earlier. Current screening guidelines involve stool-based tests and colonoscopies, whose acceptability and uptake remains low. Routinely collected blood-based biomarkers may offer a low-cost alternative or aid for detecting CRC. Here we aimed to evaluate the pre-diagnostic and diagnostic value of a wide-range of multimodal biomarkers in the UK Biobank dataset, including sociodemographic, lifestyle, medical, physical, and blood and urine-based measures in detecting CRC. We performed a Cox proportional hazard and a tree-boosting model alongside feature selection methods to determine optimal combination of biomarkers. In addition to the modifiable lifestyle factors of obesity, alcohol consumption and cardiovascular health, we showed that blood-based biomarkers that capture the immune response, lipid profile, liver and kidney function are associated with CRC risk. Following feature selection, the final Cox and tree-boosting models achieved a C-index of 0.67 and an AUC of 0.76 respectively. We show that blood-based biomarkers collected in routine examinations are sensitive to preclinical and clinical CRC. They may provide an additive value and improve diagnostic accuracy of current screening tools at no additional cost and help reduce burden on the healthcare system.
Collapse
Affiliation(s)
- Gizem Tanriver
- Engineering and Data Science Team, Sanome Limited, 15 Bishopsgate, London, EC2N 3AR, UK
| | - Ece Kocagoncu
- Engineering and Data Science Team, Sanome Limited, 15 Bishopsgate, London, EC2N 3AR, UK.
| |
Collapse
|
9
|
Chaplin A, Rodriguez RM, Segura-Sampedro JJ, Ochogavía-Seguí A, Romaguera D, Barceló-Coblijn G. Insights behind the Relationship between Colorectal Cancer and Obesity: Is Visceral Adipose Tissue the Missing Link? Int J Mol Sci 2022; 23:13128. [PMID: 36361914 PMCID: PMC9655590 DOI: 10.3390/ijms232113128] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/21/2022] [Accepted: 10/25/2022] [Indexed: 09/05/2023] Open
Abstract
Colorectal cancer (CRC) is a major health problem worldwide, with an estimated 1.9 million new cases and 915,880 deaths in 2020 alone. The etiology of CRC is complex and involves both genetic and lifestyle factors. Obesity is a major risk factor for CRC, and the mechanisms underlying this link are still unclear. However, the generalized inflammatory state of adipose tissue in obesity is thought to play a role in the association between CRC risk and development. Visceral adipose tissue (VAT) is a major source of proinflammatory cytokines and other factors that contribute to the characteristic systemic low-grade inflammation associated with obesity. VAT is also closely associated with the tumor microenvironment (TME), and recent evidence suggests that adipocytes within the TME undergo phenotypic changes that contribute to tumor progression. In this review, we aim to summarize the current evidence linking obesity and CRC, with a focus on the role of VAT in tumor etiology and progression.
Collapse
Affiliation(s)
- Alice Chaplin
- Institut d’Investigació Sanitària Illes Balears (IdISBa, Health Research Institute of the Balearic Islands), 07120 Palma, Spain
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Ramon Maria Rodriguez
- Institut d’Investigació Sanitària Illes Balears (IdISBa, Health Research Institute of the Balearic Islands), 07120 Palma, Spain
| | - Juan José Segura-Sampedro
- Institut d’Investigació Sanitària Illes Balears (IdISBa, Health Research Institute of the Balearic Islands), 07120 Palma, Spain
- General & Digestive Surgery Department, University Hospital Son Espases, 07120 Palma, Spain
- School of Medicine, University of the Balearic Islands, 07120 Palma, Spain
| | - Aina Ochogavía-Seguí
- General & Digestive Surgery Department, University Hospital Son Espases, 07120 Palma, Spain
| | - Dora Romaguera
- Institut d’Investigació Sanitària Illes Balears (IdISBa, Health Research Institute of the Balearic Islands), 07120 Palma, Spain
- Consorcio CIBER, M.P. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Gwendolyn Barceló-Coblijn
- Institut d’Investigació Sanitària Illes Balears (IdISBa, Health Research Institute of the Balearic Islands), 07120 Palma, Spain
| |
Collapse
|
10
|
Yu J, Feng Q, Kim JH, Zhu Y. Combined Effect of Healthy Lifestyle Factors and Risks of Colorectal Adenoma, Colorectal Cancer, and Colorectal Cancer Mortality: Systematic Review and Meta-Analysis. Front Oncol 2022; 12:827019. [PMID: 35936678 PMCID: PMC9353059 DOI: 10.3389/fonc.2022.827019] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 06/20/2022] [Indexed: 11/29/2022] Open
Abstract
Background In addition to adiposity, lifestyle factors such as poor diet, low physical activity, alcohol intake and smoking are noted to be associated with the development of colorectal cancer (CRC). This study aims to investigate the association and dose-response relationship between adherence to a healthy lifestyle and CRC risk. Methods A systematic literature search was conducted in MEDLINE and EMBASE for studies examining multiple lifestyle factors with risk of CRC, incident colorectal adenoma (CRA), and CRC-specific mortality through June 2021 without restrictions on language or study design. Meta-analysis was performed to pool hazard ratios using random-effects model. Subgroup analyses were performed based upon study and sample characteristics. Random-effects dose-response analysis was also conducted for CRC risk to assess the effect of each additional healthy lifestyle factor. Results A total of 28 studies (18 cohort studies, eight case-control studies, and two cross-sectional study) were included. When comparing subjects with the healthiest lifestyle to those with the least healthy lifestyle, the pooled HR was statistically significant for CRC (0.52, 95% CI 0.44-0.63), colon cancer (0.54, 95% CI 0.44-0.67), rectal cancer (0.51, 95% CI 0.37-0.70), CRA (0.39, 95% CI 0.29-0.53), and CRC-specific mortality (0.65, 95% CI 0.52-0.81). The pooled HR for CRC was 0.91 (95% CI: 0.88-0.94) for each increase in the number of healthy lifestyles. The inverse association between healthy lifestyle and CRC risk was consistently observed in all subgroups (HR ranging from 0.26 to 0.86). Conclusions Adoption of a higher number of healthy lifestyles is associated with lower risk of CRC, CRA, and CRC-specific mortality. Promoting healthy lifestyle could reduce the burden of CRC. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=231398, identifier CRD42021231398.
Collapse
Affiliation(s)
- Jiazhou Yu
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Qi Feng
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jean H. Kim
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yimin Zhu
- Department of Epidemiology & Biostatistics, and Department of Respiratory Diseases of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Cancer Center, Zhejiang University, Hangzhou, China
- *Correspondence: Yimin Zhu,
| |
Collapse
|
11
|
Role of Perirectal Fat in the Carcinogenesis and Development of Early-Onset Rectal Cancer. JOURNAL OF ONCOLOGY 2022; 2022:4061142. [PMID: 35368890 PMCID: PMC8965599 DOI: 10.1155/2022/4061142] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/24/2022] [Accepted: 03/05/2022] [Indexed: 11/17/2022]
Abstract
Purpose The incidence of early-onset rectal cancer (EORC) has been increasing since the past decade, while its underlying cause remained unknown. This study was aimed at clarifying the relationship between perirectal fat area (PFA) and EORC. Patients and Methods. All patients with rectal cancer who received radical excision between January 2016 and December 2017 at our hospital were included. The fat series images of pelvic magnetic resonance imaging scans were obtained and PFA at the ischial spine level was calculated using the ImageJ software. Results A total of 303 patients were finally included and divided into two groups according to the median PFA: Group 1 (<20.2 cm2, n = 151) and Group 2 (≥20.2 cm2, n = 152). PFA positively correlated with body weight and body mass index. PFA increased with invasion depth, lymph node metastasis, TNM stage, tumor deposits, and vascular invasion. Patients with EORC had higher PFA than those with late-onset rectal cancer (LORC; P = 0.009). Among patients with stage I–III rectal cancers, those in Group 2 had significantly shorter disease-free survival (P = 0.010) and overall survival (P = 0.034) than those in Group 1, and PFA was an independent predictor of disease-free survival (OR: 1.683 [1.126-3.015], P = 0.035) and overall survival (OR: 1.678 [1.022-2.639], P = 0.046). Conclusions Patients with EORC had significantly higher PFA than those with LORC. PFA is positively correlated with T stage, N stage, TNM stage, tumor deposit, and vascular invasion and is an independent predictor of disease-free survival and overall survival. Therefore, perirectal fat may be involved in the carcinogenesis and development of EORC.
Collapse
|
12
|
Fang Z, Song M, Lee DH, Giovannucci EL. The Role of Mendelian Randomization Studies in Deciphering the Effect of Obesity on Cancer. J Natl Cancer Inst 2022; 114:361-371. [PMID: 34021349 PMCID: PMC8902442 DOI: 10.1093/jnci/djab102] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/25/2021] [Accepted: 04/22/2021] [Indexed: 11/12/2022] Open
Abstract
Associations of obesity have been established for at least 11 cancer sites in observational studies, though some questions remain as to causality, strength of associations, and timing of associations throughout the life course. In recent years, Mendelian randomization (MR) has provided complementary information to traditional approaches, but the validity requires that the genetic instrumental variables be causally related to cancers only mediated by the exposure. We summarize and evaluate existing evidence from MR studies in comparison with conventional observational studies to provide insights into the complex relationship between obesity and multiple cancers. MR studies further establish the causality of adult obesity with esophageal adenocarcinoma and cancers of the colorectum, endometrium, ovary, kidney, and pancreas, as well as the inverse association of early life obesity with breast cancer. MR studies, which might account for lifelong adiposity, suggest that the associations in observational studies typically based on single measurement may underestimate the magnitude of the association. For lung cancer, MR studies find a positive association with obesity, supporting that the inverse association observed in some conventional observational studies likely reflects reverse causality (loss of lean body mass before diagnosis) and confounding by smoking. However, MR studies have not had sufficient power for gallbladder cancer, gastric cardia cancer, and multiple myeloma. In addition, more MR studies are needed to explore the effect of obesity at different timepoints on postmenopausal breast cancer and aggressive prostate cancer.
Collapse
Affiliation(s)
- Zhe Fang
- Department of Epidemiology, Harvard T.H. Chan School of Public
Health, Boston, MA, USA
| | - Mingyang Song
- Department of Epidemiology, Harvard T.H. Chan School of Public
Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public
Health, Boston, MA, USA
- Clinical and Translational Epidemiology Unit, Mongan Institute, Massachusetts
General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard
Medical School, Boston, MA, USA
| | - Dong Hoon Lee
- Department of Nutrition, Harvard T.H. Chan School of Public
Health, Boston, MA, USA
| | - Edward L Giovannucci
- Department of Epidemiology, Harvard T.H. Chan School of Public
Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public
Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and
Women’s Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
13
|
Giovannucci E. Molecular Biologic and Epidemiologic Insights for Preventability of Colorectal Cancer. J Natl Cancer Inst 2022; 114:645-650. [PMID: 34978574 PMCID: PMC9086743 DOI: 10.1093/jnci/djab229] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/30/2021] [Accepted: 12/16/2021] [Indexed: 11/12/2022] Open
Abstract
The etiology of colorectal cancer (CRC) has been informed from both a molecular biology perspective, which concerns the study of the nature, timing, and consequences of mutations in driver genes, and epidemiology, which focuses on identifying risk factors for cancer. For the most part, these fields have developed independently, and it is thus important to consider them in a more integrated manner. The molecular mutational perspective has stressed the importance of mutations due to replication of adult stem cells, and the molecular fingerprint of most CRCs does not suggest the importance of direct carcinogens. Epidemiology has identified numerous modifiable risk factors that account for most CRCs, most of which are not direct mutagens. The distribution of CRCs across the large bowel is not uniform, which is possibly caused by regional differences in the microbiota. Some risk factors are likely to act through or interact with the microbiota. The mutational perspective informs when risk factors may begin to operate in life and when they may cease to operate. Evidence from the mutational model and epidemiology supports that CRC risk factors begin early in life and may contribute to the risk of early-onset CRC. Later in carcinogenesis, there may be a "point of no return" when sufficient mutations have accumulated, and some risk factors do not affect cancer risk. This period may be at least 5-15 years for some risk factors. A more precise knowledge of timing of risk factor to cancer is required to inform preventive efforts.
Collapse
Affiliation(s)
- Edward Giovannucci
- Correspondence to: Edward Giovannucci, ScD, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Boston, MA 02115, USA (e-mail: )
| |
Collapse
|
14
|
The Relationship Between Colorectal Cancer and Abdominal Adipose Tissue Distribution. JOURNAL OF CONTEMPORARY MEDICINE 2021. [DOI: 10.16899/jcm.879490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
15
|
Park CH, Jung YS, Kim NH, Park JH, Park DI, Sohn CI. Optimization of the surveillance strategy in patients with colorectal adenomas: A combination of clinical parameters and index colonoscopy findings. J Gastroenterol Hepatol 2021; 36:974-982. [PMID: 32869895 DOI: 10.1111/jgh.15237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/25/2020] [Accepted: 08/25/2020] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM In addition to index colonoscopy findings, demographic parameters including age are associated with the risk of metachronous advanced colorectal neoplasia. Here, we aimed to develop a risk scoring model for predicting advanced colorectal neoplasia (ACRN) during surveillance using a combination of clinical factors and index colonoscopy findings. METHODS Patients who underwent the removal of one or more adenomas and surveillance colonoscopy were included. A risk scoring model for ACRN was developed using the Cox proportional hazard model. Surveillance interval was determined as a time point exceeding 4% of the cumulative ACRN incidence in each risk group. RESULTS Of 9591 participants, 4725 and 4866 were randomly allocated to the derivation and validation cohorts, respectively. Age, abdominal obesity, advanced adenoma, and ≥ 3 adenomas at index colonoscopy were identified as risk factors for metachronous ACRN. Based on the regression coefficients, point scores were assigned as follows: age, 1 point (per 1 year); abdominal obesity, 10 points; advanced adenoma, 10 points; and ≥ 3 adenomas, 15 points. Patients were classified into high-risk (≥ 80 points), moderate-risk (50-79 points), and low-risk (30-49 points) groups. In the validation cohort, the high-risk and moderate-risk groups showed a higher risk of ACRN than the low-risk group (hazard ratio [95% confidence interval]: 7.11 [4.10-12.32] and 1.58 [1.09-2.30], respectively). Two-, 4-, and 5-year surveillance intervals were recommended for the high-risk, moderate-risk, and low-risk groups, respectively. CONCLUSIONS Our proposed model may facilitate effective risk stratification of ACRN during surveillance and the determination of appropriate surveillance intervals.
Collapse
Affiliation(s)
- Chan Hyuk Park
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Yoon Suk Jung
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Nam Hee Kim
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Ho Park
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Il Park
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chong Il Sohn
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
16
|
Xie Y, Shi L, He X, Luo Y. Gastrointestinal cancers in China, the USA, and Europe. Gastroenterol Rep (Oxf) 2021; 9:91-104. [PMID: 34026216 PMCID: PMC8128023 DOI: 10.1093/gastro/goab010] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 02/26/2021] [Indexed: 12/17/2022] Open
Abstract
Gastrointestinal (GI) cancers, including colorectal cancer, gastric cancer, and esophageal cancer, are a major medical and economic burden worldwide and have the largest number of new cancer cases and cancer deaths each year. Esophageal and gastric cancers are most common in developing countries, while colorectal cancer forms the major GI malignancy in Western countries. However, a great shift in the predominant GI-cancer type is happening in countries under economically transitioning and, at the same time, esophageal and gastric cancers are reigniting in Western countries due to the higher exposure to certain risk factors. The development of all GI cancers is highly associated with lifestyle habits and all can be detected by identified precancerous diseases. Thus, they are all suitable for cancer screening. Here, we review the epidemiological status of GI cancers in China, the USA, and Europe; the major risk factors and their distribution in these regions; and the current screening strategies.
Collapse
Affiliation(s)
- Yumo Xie
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Lishuo Shi
- Center for Clinical Research, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiaosheng He
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yanxin Luo
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| |
Collapse
|
17
|
Ahmad R, Singh JK, Wunnava A, Al-Obeed O, Abdulla M, Srivastava SK. Emerging trends in colorectal cancer: Dysregulated signaling pathways (Review). Int J Mol Med 2021; 47:14. [PMID: 33655327 PMCID: PMC7834960 DOI: 10.3892/ijmm.2021.4847] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/14/2020] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) is the third most frequently detected type of cancer, and the second most common cause of cancer‑related mortality globally. The American Cancer Society predicted that approximately 147,950 individuals would be diagnosed with CRC, out of which 53,200 individuals would succumb to the disease in the USA alone in 2020. CRC‑related mortality ranks third among both males and females in the USA. CRC arises from 3 major pathways: i) The adenoma‑carcinoma sequence; ii) serrated pathway; and iii) the inflammatory pathway. The majority of cases of CRC are sporadic and result from risk factors, such as a sedentary lifestyle, obesity, processed diets, alcohol consumption and smoking. CRC is also a common preventable cancer. With widespread CRC screening, the incidence and mortality from CRC have decreased in developed countries. However, over the past few decades, CRC cases and mortality have been on the rise in young adults (age, <50 years). In addition, CRC cases are increasing in developing countries with a low gross domestic product (GDP) due to lifestyle changes. CRC is an etiologically heterogeneous disease classified by tumor location and alterations in global gene expression. Accumulating genetic and epigenetic perturbations and aberrations over time in tumor suppressor genes, oncogenes and DNA mismatch repair genes could be a precursor to the onset of colorectal cancer. CRC can be divided as sporadic, familial, and inherited depending on the origin of the mutation. Germline mutations in APC and MLH1 have been proven to play an etiological role, resulting in the predisposition of individuals to CRC. Genetic alterations cause the dysregulation of signaling pathways leading to drug resistance, the inhibition of apoptosis and the induction of proliferation, invasion and migration, resulting in CRC development and metastasis. Timely detection and effective precision therapies based on the present knowledge of CRC is essential for successful treatment and patient survival. The present review presents the CRC incidence, risk factors, dysregulated signaling pathways and targeted therapies.
Collapse
Affiliation(s)
- Rehan Ahmad
- Colorectal Research Chair, Department of Surgery, King Saud University College of Medicine, Riyadh 11472, Saudi Arabia
| | - Jaikee Kumar Singh
- Department of Biosciences, Manipal University Jaipur, Jaipur, Rajasthan 303007, India
| | - Amoolya Wunnava
- Department of Biosciences, Manipal University Jaipur, Jaipur, Rajasthan 303007, India
| | - Omar Al-Obeed
- Colorectal Research Chair, Department of Surgery, King Saud University College of Medicine, Riyadh 11472, Saudi Arabia
| | - Maha Abdulla
- Colorectal Research Chair, Department of Surgery, King Saud University College of Medicine, Riyadh 11472, Saudi Arabia
| | | |
Collapse
|
18
|
Parra-Soto S, Petermann-Rocha F, Boonpor J, Gray SR, Pell JP, Celis-Morales C, Ho FK. Combined association of general and central obesity with incidence and mortality of cancers in 22 sites. Am J Clin Nutr 2021; 113:401-409. [PMID: 33381801 DOI: 10.1093/ajcn/nqaa335] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 10/22/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Body mass index (BMI) and waist circumference (WC) are measures of general and central obesity, respectively, and both have been shown to be associated with cancer. However, there is insufficient evidence of their combined association with the risk of cancer. OBJECTIVES This study aimed to investigate the associations of combinations of BMI and WC with cancer at 22 sites. METHODS A total of 386,101 (54.5% women) UK Biobank participants aged from 37 to 73 y were included. The outcomes were incidence of and mortality from cancer at 22 sites. Participants were categorized as normal weight (BMI 18.5-24.9) or overweight (including obese, BMI ≥ 25) and as normal WC or centrally obese (WC ≥ 94 cm for men and ≥80 cm for women). Four mutually exclusive groups were derived: 1) normal weight without central obesity, 2) normal weight with central obesity, 3) overweight without central obesity, and 4) overweight with central obesity. We used Cox proportional hazards models to estimate HRs and 95% CIs. RESULTS The mean follow-up period was 8.8 y. Compared with participants with normal weight and WC, men who were overweight and centrally obese had higher cancer incidence risk at 3 sites [stomach (HR: 1.75; 95% CI: 1.33, 2.32; Padj = 0.002), kidney (HR: 1.45; 95% CI: 1.17, 1.81; Padj = 0.016), and colorectal (HR: 1.31; 95% CI: 1.17, 1.47; Padj < 0.001) cancer]. Similar associations were found at 4 sites in women [endometrial (HR: 2.48; 95% CI: 2.06, 2.98; Padj < 0.001), uterine (HR: 2.23; 95% CI: 1.89, 2.64; Padj < 0.001), kidney (HR: 1.84; 95% CI: 1.37, 2.46; Padj = 0.001), and breast (HR: 1.24; 95% CI: 1.16, 1.32; Padj < 0.001) cancer] and for all-cause cancer (HR: 1.07; 95% CI: 1.03, 1.10; Padj = 0.003). Only endometrial cancer mortality (HR: 3.28; 95% CI: 1.77, 6.07; Padj = 0.004) was significantly associated with being overweight and centrally obese. CONCLUSIONS The combination of general and central obesity was associated with a higher risk at several cancer sites and some associations were sex-specific.
Collapse
Affiliation(s)
- Solange Parra-Soto
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Fanny Petermann-Rocha
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Jirapitcha Boonpor
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Stuart R Gray
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Jill P Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Carlos Celis-Morales
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom.,Centre for Exercise Physiology Research (CIFE), University Mayor, Santiago, Chile.,Research Group in Education, Physical Activity and Health (GEEAFyS), University Católica del Maule, Talca, Chile
| | - Frederick K Ho
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| |
Collapse
|
19
|
Marchand NE, Sparks JA, Tedeschi SK, Malspeis S, Costenbader KH, Karlson EW, Lu B. Abdominal Obesity in Comparison with General Obesity and Risk of Developing Rheumatoid Arthritis in Women. J Rheumatol 2021; 48:165-173. [PMID: 32669445 PMCID: PMC8006183 DOI: 10.3899/jrheum.200056] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Being overweight or obese increases rheumatoid arthritis (RA) risk among women, particularly among those diagnosed at a younger age. Abdominal obesity may contribute to systemic inflammation more than general obesity; thus, we investigated whether abdominal obesity, compared to general obesity, predicted RA risk in 2 prospective cohorts: the Nurses' Health Study (NHS) and NHS II. METHODS We followed 50,682 women (1986-2014) in NHS and 47,597 women (1993-2015) in NHS II, without RA at baseline. Waist circumference (WC), BMI, health outcomes, and covariate data were collected through biennial questionnaires. Incident RA cases and serologic status were identified by chart review. We examined the associations of WC and BMI with RA risk using time-varying Cox proportional hazards models. We repeated analyses restricted to age ≤ 55 years. RESULTS During 28 years of follow-up, we identified 844 incident RA cases (527 NHS, 317 NHS II). Women with WC > 88 cm (35 in) had increased RA risk (HR 1.22, 95% CI 1.06-1.41). A similar association was observed for seropositive RA, which was stronger among young and middle-aged women. Further adjustment for BMI attenuated the association to null. In contrast, BMI was associated with RA (HRBMI ≥ 30 vs < 25 1.33, 95% CI 1.05-1.68) and seropositive RA, even after adjusting for WC, and, as in WC analyses, this association was stronger among young and middle-aged women. CONCLUSION Abdominal obesity was associated with increased RA risk, particularly for seropositive RA, among young and middle-aged women; however, it did not independently contribute to RA risk beyond general obesity.
Collapse
Affiliation(s)
- Nathalie E Marchand
- N.E. Marchand, ScD, J.A. Sparks, MD, MMSc, S.K. Tedeschi, MD, MPH, S. Malspeis, K.H. Costenbader, MD, MPH, E.W. Karlson, MD, B. Lu, MD, DrPH, Division of Rheumatology, Inflammation and Immunity, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey A Sparks
- N.E. Marchand, ScD, J.A. Sparks, MD, MMSc, S.K. Tedeschi, MD, MPH, S. Malspeis, K.H. Costenbader, MD, MPH, E.W. Karlson, MD, B. Lu, MD, DrPH, Division of Rheumatology, Inflammation and Immunity, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Sara K Tedeschi
- N.E. Marchand, ScD, J.A. Sparks, MD, MMSc, S.K. Tedeschi, MD, MPH, S. Malspeis, K.H. Costenbader, MD, MPH, E.W. Karlson, MD, B. Lu, MD, DrPH, Division of Rheumatology, Inflammation and Immunity, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Susan Malspeis
- N.E. Marchand, ScD, J.A. Sparks, MD, MMSc, S.K. Tedeschi, MD, MPH, S. Malspeis, K.H. Costenbader, MD, MPH, E.W. Karlson, MD, B. Lu, MD, DrPH, Division of Rheumatology, Inflammation and Immunity, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Karen H Costenbader
- N.E. Marchand, ScD, J.A. Sparks, MD, MMSc, S.K. Tedeschi, MD, MPH, S. Malspeis, K.H. Costenbader, MD, MPH, E.W. Karlson, MD, B. Lu, MD, DrPH, Division of Rheumatology, Inflammation and Immunity, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth W Karlson
- N.E. Marchand, ScD, J.A. Sparks, MD, MMSc, S.K. Tedeschi, MD, MPH, S. Malspeis, K.H. Costenbader, MD, MPH, E.W. Karlson, MD, B. Lu, MD, DrPH, Division of Rheumatology, Inflammation and Immunity, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Bing Lu
- N.E. Marchand, ScD, J.A. Sparks, MD, MMSc, S.K. Tedeschi, MD, MPH, S. Malspeis, K.H. Costenbader, MD, MPH, E.W. Karlson, MD, B. Lu, MD, DrPH, Division of Rheumatology, Inflammation and Immunity, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
| |
Collapse
|
20
|
Jung YS, Kim NH, Park JH, Park DI, Sohn CI. Changes in Abdominal Obesity Affect the Risk of Metachronous Advanced Colorectal Neoplasia Development after Polypectomy. Yonsei Med J 2020; 61:579-586. [PMID: 32608201 PMCID: PMC7329737 DOI: 10.3349/ymj.2020.61.7.579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/24/2020] [Accepted: 06/04/2020] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The impact of changes in body mass index and waist circumference on the development of metachronous colorectal neoplasia (CRN) after polypectomy has rarely been examined. We evaluated the association between changes in overall/abdominal obesity and metachronous CRN risk. MATERIALS AND METHODS We studied patients who underwent ≥1 adenoma removal and surveillance colonoscopy. Patients were classified into the following four groups based on the changes in overall obesity from index to follow-up colonoscopy: non-obesity persisted (group 1), obesity to non-obesity (group 2), non-obesity to obesity (group 3), and obesity persisted (group 4). Patients were also divided into another four groups based on similar changes in abdominal obesity (groups 5-8). RESULTS The number of patients in groups 1, 2, 3, and 4 was 5074, 457, 643, and 3538, respectively, and that in groups 5, 6, 7, and 8 was 4229, 538, 656, and 2189, respectively. Group 4 had a significantly higher risk of metachronous CRN compared to groups 1 and 2. However, metachronous advanced CRN (ACRN) risk was not different among groups 1, 2, 3, and 4. Metachronous CRN risk in group 8 (abdominal obesity persisted) was higher than that in groups 5 (non-abdominal obesity persisted) and 7 (non-abdominal obesity to abdominal obesity), and tended to be higher than that in group 6 (abdominal obesity to non-abdominal obesity). Additionally, group 8 had a significantly higher risk of metachronous ACRN compared to groups 5, 6, and 7. CONCLUSION Changes in obesity affected the metachronous CRN risk. In particular, changes in abdominal obesity affected the metachronous ACRN risk.
Collapse
Affiliation(s)
- Yoon Suk Jung
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Nam Hee Kim
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Ho Park
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Il Park
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chong Il Sohn
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
21
|
Hanyuda A, Lee DH, Ogino S, Wu K, Giovannucci EL. Long-term status of predicted body fat percentage, body mass index and other anthropometric factors with risk of colorectal carcinoma: Two large prospective cohort studies in the US. Int J Cancer 2020; 146:2383-2393. [PMID: 31276608 PMCID: PMC7282530 DOI: 10.1002/ijc.32553] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/19/2019] [Accepted: 06/26/2019] [Indexed: 12/14/2022]
Abstract
Anthropometric measurements, such as body mass index (BMI), waist circumference, and body fat percentage, have been used as indicators of obesity. Despite evidence that excess body fat is a risk factor for colorectal carcinoma (CRC), the magnitude of the association of BMI and other obesity indicators with the long-term risk of CRC remains unclear. Utilizing a Cox proportional hazards regression model, we examined differential associations between predicted body fat percentage and BMI with the risk of CRC (n = 2,017). The associations between CRC incidence and different adiposity measurements were also assessed. Predicted body fat percentage had a similar increased risk of CRC risk as BMI. In multivariable-adjusted analyses, the hazard ratio for CRC in the second to fifth quintiles (compared to the first quintile) of predicted body fat percentage were 1.32, 1.31, 1.53 and 2.09 for men (ptrend < 0.001) and 0.91, 0.90, 0.98 and 1.15 for women (ptrend = 0.03). Among various anthropometric measurements, predicted fat mass and waist circumference were slightly more strongly associated with CRC risk than BMI. In conclusion, the novel anthropometric prediction equations provided further evidence that a greater amount of body fat might contribute to CRC risk in both sexes. An innovative approach enabled us to estimate the susceptibilities of specific body composition with CRC risk, in an inexpensive and minimally invasive manner. Furthermore, the typically used measures of BMI and waist circumference are robust measures of adiposity to predict cancer risk in a relatively healthy population.
Collapse
Affiliation(s)
- Akiko Hanyuda
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Dong Hoon Lee
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Shuji Ogino
- Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital, Boston, MA
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
- Department of Oncologic Pathology, Dana-Farber Cancer Institute, Boston, MA
- Broad Institute of MIT and Harvard, Cambridge, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Kana Wu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Edward L Giovannucci
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| |
Collapse
|
22
|
Sanford NN, Giovannucci EL, Ahn C, Dee EC, Mahal BA. Obesity and younger versus older onset colorectal cancer in the United States, 1998-2017. J Gastrointest Oncol 2020; 11:121-126. [PMID: 32175114 DOI: 10.21037/jgo.2019.12.07] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The etiology behind the increasing incidence of early onset colorectal cancer (EOCRC) are incompletely elucidated, but could be attributed in part to lifestyle factors. We assessed the association between obesity and colorectal cancer (CRC) in younger versus older adults in the National Health Institute Survey. Multivariable logistic regression defined adjusted odds ratios (AORs) and associated 95% confidence intervals (CIs) for CRC including an age (< vs. ≥50 years) *BMI (< vs. ≥30.0 kg/m2) interaction term. Among 583,511 study participants with a total of 3,173 CRC cases, there was a significant age*BMI interaction term (P=0.02) such that for participants aged 18-49 years, BMI ≥30.0 kg/m2 was associated with diagnosis of CRC (34.1% vs. 27.4%, AOR 1.39, 95% CI: 1.00-1.92) but not for participants aged ≥50 (29.6% vs. 31.4%, AOR 0.93, 95% CI: 0.85-1.03). Obese BMI appears to be associated with diagnosis of EOCRC, thus weight control by early adulthood, among other healthy lifestyle behaviors, could serve as potential risk reduction strategies for CRC.
Collapse
Affiliation(s)
- Nina N Sanford
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA
| | - Edward L Giovannucci
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Chul Ahn
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Harold Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA
| | - Edward C Dee
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Brandon A Mahal
- Dana-Farber Cancer Institute McGraw/Patterson Center for Population Sciences, Boston, MA, USA
| |
Collapse
|
23
|
Stoffel EM, Murphy CC. Epidemiology and Mechanisms of the Increasing Incidence of Colon and Rectal Cancers in Young Adults. Gastroenterology 2020; 158:341-353. [PMID: 31394082 PMCID: PMC6957715 DOI: 10.1053/j.gastro.2019.07.055] [Citation(s) in RCA: 302] [Impact Index Per Article: 75.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/02/2019] [Accepted: 07/03/2019] [Indexed: 02/07/2023]
Abstract
In contrast to the decreasing incidence of colorectal cancer (CRC) in older populations, the incidence has nearly doubled in younger adults since the early 1990s. Approximately 1 in 10 new diagnoses of CRC are now made in individuals 50 years or younger. Patients' risk of CRC has been calculated largely by age and family history, yet 3 of 4 patients with early-onset CRC have no family history of the disease. Rapidly increasing incidence rates in younger people could result from generational differences in diet, environmental exposures, and lifestyle factors. We review epidemiologic trends in CRC, data on genetic and nongenetic risk factors, and new approaches for determining CRC risk. These may identify individuals likely to benefit from early screening and specialized surveillance.
Collapse
Affiliation(s)
- Elena M Stoffel
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Caitlin C Murphy
- Division of Epidemiology, Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas; Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
| |
Collapse
|
24
|
Nikbakht HA, Hassanipour S, Shojaie L, Vali M, Ghaffari-fam S, Ghelichi-ghojogh M, Maleki Z, Arab-Zozani M, Abdzadeh E, Delam H, Salehiniya H, Shafiee M, Mohammadi S. Survival Rate of Colorectal Cancer in Eastern Mediterranean Region Countries: A Systematic Review and Meta-Analysis. Cancer Control 2020; 27:1073274820964146. [PMID: 33074714 PMCID: PMC7791530 DOI: 10.1177/1073274820964146] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Colorectal cancer (CRC) is the second most common cause of cancer-related deaths worldwide. Survival rates are among the most important factors in quality control and assessment of treatment protocols. This study was aimed to assess the survival rate of colorectal cancer in Eastern Mediterranean Region Countries. In the present study we comprehensively searched 6 international databases including PubMed/Medline, ProQuest, Scopus, Embase, Web of Knowledge and Google Scholar for published articles until November 2018. The Newcastle-Ottawa Quality Assessment Form for Cohort Studies was applied to evaluate the quality of included studies. The heterogeneity of papers was assessed with the Cochran Test and I-Square statistics. Meta-regression test was performed based on publication year, sample size and Human Development Index (HDI) of each study. Among the total of 1023 titles found in the systematic search, 43 studies were eligible to be included in the present meta-analysis. According to the results, the 1-year, 3-year and 5-year survival rate of patients with Colorectal Cancer was 88.07% (95% CI, 83.22-92.92), 70.67% (95% CI, 66.40-74.93) and, 57.26% (95% CI, 50.43-64.10); respectively. Furthermore, Meta-regressions did not show significant correlations between survival rate and year, sample size or Human Development Index. Survival rates, especially the 5-year survival rate in the EMRO were less than European countries and the USA. Documented and comprehensive evidence-based findings of the present meta-analysis can be used to enhance policies and outcomes of different medical areas including prophylaxis, treatment and health related objectives in colorectal cancer.
Collapse
Affiliation(s)
- Hossein-Ali Nikbakht
- Social Determinants of Health Research Center, Health Research
Institute, Babol University of Medical Sciences, Babol, Iran
| | - Soheil Hassanipour
- Gastrointestinal and Liver Diseases Research Center, Guilan
University of Medical Sciences, Rasht, Iran
| | - Layla Shojaie
- Division of GI/Liver, Department of Medicine, Keck school of
Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mohebat Vali
- Student Research Committee, Shiraz University of Medical Sciences,
Shiraz, Iran
| | - Saber Ghaffari-fam
- School of Nursing of Miyandoab, Urmia University of Medical
Sciences, Urmia, Iran
| | | | - Zahra Maleki
- Student Research Committee, Shiraz University of Medical Sciences,
Shiraz, Iran
| | - Morteza Arab-Zozani
- Social Determinants of Health Research Center, Birjand University of
Medical Sciences, Birjand, Iran
| | - Elham Abdzadeh
- GI Cancer Screening and Prevention Research Center, Guilan
University of Medical Sciences, Rasht, Iran
| | - Hamed Delam
- Student Research Committee, Larestan University of Medical Sciences,
Larestan, Iran
| | - Hamid Salehiniya
- Social Determinants of Health Research Center, Birjand University of
Medical Sciences, Birjand, Iran
| | - Maryam Shafiee
- Assistant Professor of Medicine, Shiraz Nephro-Urology Research
Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Salman Mohammadi
- Nutrition Research Center, Shiraz University of Medical Sciences,
Shiraz, Iran
| |
Collapse
|
25
|
Yang K, Li X, Forman MR, Monahan PO, Graham BH, Joshi A, Song M, Hang D, Ogino S, Giovannucci EL, De Vivo I, Chan AT, Nan H. Pre-diagnostic leukocyte mitochondrial DNA copy number and colorectal cancer risk. Carcinogenesis 2019; 40:1462-1468. [PMID: 31556446 PMCID: PMC7346713 DOI: 10.1093/carcin/bgz159] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/20/2019] [Accepted: 09/18/2019] [Indexed: 12/22/2022] Open
Abstract
Mitochondrial DNA (mtDNA) is susceptible to oxidative stress and mutation. Few epidemiological studies have assessed the relationship between mtDNA copy number (mtDNAcn) and risk of colorectal cancer (CRC), with inconsistent findings. In this study, we examined the association between pre-diagnostic leukocyte mtDNAcn and CRC risk in a case-control study of 324 female cases and 658 matched controls nested within the Nurses' Health Study (NHS). Relative mtDNAcn in peripheral blood leukocytes was measured by quantitative polymerase chain reaction-based assay. Conditional logistic regression models were applied to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for the association of interest. Results showed lower log-mtDNAcn was significantly associated with increased risk of CRC, in a dose-dependent relationship (P for trend < 0.0001). Compared to the fourth quartile, multivariable-adjusted OR [95% confidence interval (CI)] was 1.10 (0.69, 1.76) for the third quartile, 1.40 (0.89, 2.19) for the second quartile and 2.19 (1.43, 3.35) for the first quartile. In analysis by anatomic subsite of CRC, we found a significant inverse association for proximal colon cancer [lowest versus highest quartile, multivariable-adjusted OR (95% CI) = 3.31 (1.70, 6.45), P for trend = 0.0003]. Additionally, stratified analysis according to the follow-up time since blood collection showed that the inverse association between mtDNAcn and CRC remained significant among individuals with ≥ 5 years' follow-up, and marginally significant among those with ≥ 10 years' follow-up since mtDNAcn testing, suggesting that mtDNAcn may serve as a long-term predictor for risk of CRC. In conclusion, pre-diagnostic leukocyte mtDNAcn was inversely associated with CRC risk. Further basic experimental studies are needed to explore the underlying biological mechanisms linking mtDNAcn to CRC carcinogenesis.
Collapse
Affiliation(s)
- Keming Yang
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
| | - Xin Li
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
| | - Michele R Forman
- Department of Nutrition Science, College of Health and Human Science, Purdue Center for Cancer Research, Purdue University, West Lafayette, IN, USA
| | - Patrick O Monahan
- Department of Biostatistics, School of Medicine and Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
| | - Bret H Graham
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Amit Joshi
- Clinical and Translational Epidemiology Unit and Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Mingyang Song
- Clinical and Translational Epidemiology Unit and Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Dong Hang
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology and Biostatistics, Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Shuji Ogino
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women’s Hospital, and Harvard Medical School, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Edward L Giovannucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Immaculata De Vivo
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit and Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Hongmei Nan
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
- IU Melvin and Bren Simon Cancer Center, Indiana University, Indianapolis, IN, USA
| |
Collapse
|
26
|
Keum N, Giovannucci E. Global burden of colorectal cancer: emerging trends, risk factors and prevention strategies. Nat Rev Gastroenterol Hepatol 2019; 16:713-732. [PMID: 31455888 DOI: 10.1038/s41575-019-0189-8] [Citation(s) in RCA: 1297] [Impact Index Per Article: 259.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2019] [Indexed: 02/06/2023]
Abstract
Globally, colorectal cancer (CRC) is the third most commonly diagnosed malignancy and the second leading cause of cancer death. Arising through three major pathways, including adenoma-carcinoma sequence, serrated pathway and inflammatory pathway, CRC represents an aetiologically heterogeneous disease according to subtyping by tumour anatomical location or global molecular alterations. Genetic factors such as germline MLH1 and APC mutations have an aetiologic role, predisposing individuals to CRC. Yet, the majority of CRC is sporadic and largely attributable to the constellation of modifiable environmental risk factors characterizing westernization (for example, obesity, physical inactivity, poor diets, alcohol drinking and smoking). As such, the burden of CRC is shifting towards low-income and middle-income countries as they become westernized. Furthermore, the rising incidence of CRC at younger ages (before age 50 years) is an emerging trend. This Review provides a comprehensive summary of CRC epidemiology, with emphasis on modifiable lifestyle and nutritional factors, chemoprevention and screening. Overall, the optimal reduction of CRC incidence and mortality will require concerted efforts to reduce modifiable risk factors, to leverage chemoprevention research and to promote population-wide and targeted screening.
Collapse
Affiliation(s)
- NaNa Keum
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Food Science and Biotechnology, Dongguk University, Goyang, South Korea
| | - Edward Giovannucci
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA. .,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. .,Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. .,Department of Medicine, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
27
|
Guo L, Chen H, Wang G, Lyu Z, Feng X, Wei L, Li X, Wen Y, Lu M, Chen Y, Shi J, Ren J, Lin C, Yu X, Chen S, Wu S, Li N, Dai M, He J. Development of a risk score for colorectal cancer in Chinese males: A prospective cohort study. Cancer Med 2019; 9:816-823. [PMID: 31773920 PMCID: PMC6970029 DOI: 10.1002/cam4.2734] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/31/2019] [Accepted: 11/11/2019] [Indexed: 12/13/2022] Open
Abstract
To build a simple predictive model as a guide to stratify average‐risk population for colonoscopy examinations. We collected data from 92 923 males without a prior history of cancer enrolled in the Kailuan Cohort Study of China. Risk factors included in the evaluation of colorectal cancer (CRC) were collected by questionnaire‐based interviews at the baseline. Logistic regression coefficients for incident CRC predictors were converted into risk scores by the absolute value of the smallest coefficient in the model and rounding up to the nearest integer. Receiver operating characteristic (ROC) analysis with the leave‐one‐out cross‐validation method was applied to evaluate model performance. In the 10‐year follow‐up, 353 CRC patients were in the cohort. Age, alcohol consumption, waist circumference, occupational sitting time, and history of diabetes were selected for the scoring system, and the adjusted area under the ROC was 0.66. Population in the highest risk group (16‐19 points) had a 33.12‐fold (95% CI: 13.44‐81.59) higher risk of CRC than those in the lowest risk group. When we defined 13 points as the cut‐off, the sensitivity and specificity of the scoring system for CRC were 67.99% and 62.42%, respectively. A simple scoring system for CRC has been developed to identify men at an increased relative risk of CRC within 10 years using several well‐established risk factors, which allows selection of asymptomatic candidates for priority of CRC screening and saving the health resource in cancer prevention and control.
Collapse
Affiliation(s)
- Lanwei Guo
- Office for Cancer ScreeningNational Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
- Henan Office for Cancer Control and ResearchThe Affiliated Cancer Hospital of Zhengzhou UniversityHenan Cancer HospitalZhengzhouChina
| | - Hongda Chen
- Office for Cancer ScreeningNational Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Gang Wang
- Department of OncologyKailuan General HospitalTangshanChina
| | - Zhangyan Lyu
- Office for Cancer ScreeningNational Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Xiaoshuang Feng
- Office for Cancer ScreeningNational Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Luopei Wei
- Office for Cancer ScreeningNational Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Xin Li
- Office for Cancer ScreeningNational Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Yan Wen
- Office for Cancer ScreeningNational Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Ming Lu
- Office for Cancer ScreeningNational Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Yuheng Chen
- Office for Cancer ScreeningNational Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Jufang Shi
- Office for Cancer ScreeningNational Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Jiansong Ren
- Office for Cancer ScreeningNational Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Chunqing Lin
- Office for Cancer ScreeningNational Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Xinyang Yu
- Office for Cancer ScreeningNational Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Shuohua Chen
- Health Department of Kailuan (group)Kailuan General HospitalTangshanChina
| | - Shouling Wu
- Health Department of Kailuan (group)Kailuan General HospitalTangshanChina
| | - Ni Li
- Office for Cancer ScreeningNational Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Min Dai
- Office for Cancer ScreeningNational Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Jie He
- Department of Thoracic SurgeryNational Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| |
Collapse
|
28
|
Hillreiner A, Baumeister SE, Sedlmeier AM, Finger JD, Schlitt HJ, Leitzmann MF. Association between cardiorespiratory fitness and colorectal cancer in the UK Biobank. Eur J Epidemiol 2019; 35:961-973. [PMID: 31707551 DOI: 10.1007/s10654-019-00575-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 10/30/2019] [Indexed: 12/12/2022]
Abstract
Increased cardiorespiratory fitness is related to decreased risk of major chronic illnesses, including cardiovascular disease, type 2 diabetes, and cancer, but its association with colorectal cancer specifically has received very little attention. We examined the relation of cardiorespiratory fitness to colorectal cancer in 59,191 UK Biobank participants aged 39-70 years without prevalent cancer at baseline, followed from 2009 to 2014. Submaximal bicycle ergometry was conducted at study entry, and cardiorespiratory fitness was defined as physical work capacity at 75% of the maximum heart rate, standardised to body mass (PWC75%). Multivariable Cox proportional hazards regression was performed to obtain hazard ratios (HR) and corresponding 95% confidence intervals (CI). During a mean follow-up of 4.6 years, 232 participants developed colorectal cancer (151 colon cancers; 79 rectal cancers). When comparing the 75th to the 25th percentiles of PWC75%, the multivariable-adjusted HR of colorectal cancer was 0.78 (95% CI 0.62-0.97). That relation was largely driven by an inverse association with colon cancer (HR 0.74, 95% CI 0.56-0.97) and less so with rectal cancer (HR 0.88, 95% CI 0.62-1.26; p value for difference by colorectal cancer endpoint = 0.056). The inverse relation of cardiorespiratory fitness with colorectal cancer was more evident in men (HR 0.72, 95% CI 0.55-0.94) than women (HR 0.99, 95% CI 0.71-1.38), although the gender difference was not statistically significant (p value for interaction = 0.192). Increased cardiorespiratory fitness is associated with decreased risk of colorectal cancer. Potential heterogeneity by colorectal cancer anatomic subsite and gender requires further study.
Collapse
Affiliation(s)
- Andrea Hillreiner
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
| | - Sebastian E Baumeister
- Chair of Epidemiology, LMU München, UNIKA-T Augsburg, Neusässer Strasse 47, 86156, Augsburg, Germany.,Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstrasse 1, 85764, Munich, Germany
| | - Anja M Sedlmeier
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Jonas D Finger
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape Strasse 62-66, 12101, Berlin, Germany
| | - Hans J Schlitt
- Department of Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Michael F Leitzmann
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| |
Collapse
|
29
|
Petimar J, Smith-Warner SA, Rosner B, Chan AT, Giovannucci EL, Tabung FK. Adherence to the World Cancer Research Fund/American Institute for Cancer Research 2018 Recommendations for Cancer Prevention and Risk of Colorectal Cancer. Cancer Epidemiol Biomarkers Prev 2019; 28:1469-1479. [PMID: 31235471 PMCID: PMC6726499 DOI: 10.1158/1055-9965.epi-19-0165] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 05/02/2019] [Accepted: 06/17/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) 2018 diet, nutrition, and physical activity recommendations aim to reduce cancer risk. We examined adherence to the WCRF/AICR recommendations and colorectal cancer risk in two prospective cohorts. METHODS We followed 68,977 women in the Nurses' Health Study and 45,442 men in the Health Professionals Follow-up Study from 1986 until 2012. We created cumulatively averaged WCRF/AICR scores using updated diet, adiposity, and physical activity data from questionnaires, and used Cox regression to estimate sex-specific HRs and 95% confidence intervals (CI) for incident colorectal cancer. RESULTS We documented 2,449 colorectal cancer cases. Men in the highest quintile of the WCRF/AICR lifestyle score had a lower risk of colorectal cancer compared with those in the lowest quintile (HRQ5vsQ1 = 0.64; 95% CI, 0.52-0.77). The result was weaker in women (HRQ5vsQ1 = 0.86; 95% CI, 0.72-1.02; P heterogeneity by sex = 0.006). When analyzing the diet recommendations alone, we similarly observed stronger inverse associations in men (HRQ5vsQ1 = 0.74; 95% CI, 0.61-0.90) compared with women (HRQ5vsQ1 = 0.93; 95% CI, 0.77-1.12; P heterogeneity by sex = 0.06). In men, the lifestyle score was more strongly inversely associated with risk of distal colon cancer compared with proximal colon or rectal cancer (P common effects = 0.03); we did not observe significant differences between anatomic locations in women. CONCLUSIONS The 2018 WCRF/AICR cancer prevention recommendations are associated with lower colorectal cancer risk in men, with weaker results in women. IMPACT Consideration of adiposity and physical activity in conjunction with diet is important for colorectal cancer prevention.
Collapse
Affiliation(s)
- Joshua Petimar
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Pilgrim Health Care Institute & Harvard Medical School, Boston, Massachusetts
| | - Stephanie A Smith-Warner
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Bernard Rosner
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Andrew T Chan
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
| | - Edward L Giovannucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Fred K Tabung
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio
- The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
| |
Collapse
|
30
|
Kang Y, Huang L, Wang R, Xu L, Yang Y, Cui X. Relationship Between the Estimated Glomerular Filtration Rate and Visceral Fat Thickness Based on Ultrasound in Patients With Obesity Who Have Normal Renal Function Without Hypertension or Diabetes. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2287-2294. [PMID: 30609092 DOI: 10.1002/jum.14921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/14/2018] [Accepted: 11/27/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To investigate the relationship between visceral fat thickness measured by US and the estimated glomerular filtration rate (GFR) in patients with obesity who did not have hypertension or diabetes and who had normal renal function. METHODS Inclusion criteria included an estimated GFR of greater than 90 mL/min/1.73 m2 , blood pressure lower than 120/80 mm Hg, and a fasting blood glucose level of less than 126 mg/dL. Patients were divided into groups with (body mass index ≥28 kg/m2 ) and without (body mass index <28 kg/m2 ) obesity. Subcutaneous and visceral fat thicknesses were measured with ultrasound. RESULTS A total of 95 patients were enrolled with an age range of 25 to 58 years. The patients were divided into groups with (n = 48) and without obesity (n = 47); patients with obesity were further divided into subcutaneous obesity (n = 23) and visceral obesity (n = 25) groups. The estimated GFR in the group with obesity was significantly lower than that in the group without obesity (P = .037), and the estimated GFR in the group with visceral obesity was significantly lower than that in the group with subcutaneous obesity (P = .006). Moreover, the estimated GFR was negatively correlated with visceral fat thickness (V1:r = -0.750;P7 < 0.001;V2:r = -0.824;P < 0.001) but not correlated with subcutaneous fat thickness. CONCLUSIONS Ultrasound is an easy and accurate practical evaluation modality for measuring the thickness of fat. There was an inverse relationship between the estimated GFR and visceral fat thickness in patients with obesity who did not have hypertension or diabetes and who had normal renal function. This result suggests that as visceral fat increases, the estimated GFR may be reduced accordingly.
Collapse
Affiliation(s)
- Yaning Kang
- From the Traditional Chinese Medicine Hospital of Xi'an, Xi'an, China
| | - Lizhen Huang
- From the Traditional Chinese Medicine Hospital of Xi'an, Xi'an, China
| | - Rongrong Wang
- From the Traditional Chinese Medicine Hospital of Xi'an, Xi'an, China
| | - Lei Xu
- From the Traditional Chinese Medicine Hospital of Xi'an, Xi'an, China
| | - Yuanyuan Yang
- From the Traditional Chinese Medicine Hospital of Xi'an, Xi'an, China
| | - Xiaoyuan Cui
- From the Traditional Chinese Medicine Hospital of Xi'an, Xi'an, China
| |
Collapse
|
31
|
Abdominal Obesity is More Predictive of Advanced Colorectal Neoplasia Risk Than Overall Obesity in Men: A Cross-sectional Study. J Clin Gastroenterol 2019; 53:e284-e290. [PMID: 29939870 DOI: 10.1097/mcg.0000000000001086] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
GOALS We aimed to ascertain whether waist circumference (WC) is associated with risk of colorectal neoplasia (CRN), independent of body mass index (BMI). BACKGROUND Although several studies have reported the association between abdominal obesity, measured by WC, and CRN, it remains unclear whether their association is biased by BMI. STUDY A cross-sectional study was performed on 154,552 asymptomatic examinees who underwent colonoscopy for a health check-up. RESULTS The mean age was 42.6 years, and the proportion of males was 65.2%. The prevalence rate of CRN in subjects in WC quartiles 1, 2, 3, and 4 was 15.6%, 18.1%, 20.4%, and 22.0% among men and 7.8%, 9.4%, 12.2%, and 15.8% among women, respectively. WC and BMI were independent risk factors for overall CRN and nonadvanced CRN in both men and women. In men, the association of BMI with advanced CRN was attenuated to null after adjusting for WC [Q2, Q3, and Q4 vs. Q1; odds ratios (95% confidence intervals), 0.93 (0.79-1.10), 0.85 (0.71-1.03), and 0.99 (0.80-1.22), respectively; Ptrend=0.822], whereas the association of WC with advanced CRN significantly persisted even after adjusting for BMI [Q2, Q3, and Q4 vs. Q1; 1.20 (1.02-1.42), 1.45 (1.20-1.75), and 1.64 (1.32-2.04), respectively; Ptrend<0.001]. In women, neither WC nor BMI was associated with the risk of advanced CRN. CONCLUSIONS Abdominal obesity is associated with an increased risk of advanced CRN, independent of overall obesity (BMI) in men. Our findings suggest that abdominal obesity is more strongly predictive of advanced CRN than overall obesity in men.
Collapse
|
32
|
Alcohol consumption is associated with the risk of developing colorectal neoplasia: Propensity score matching analysis. Sci Rep 2019; 9:8253. [PMID: 31164696 PMCID: PMC6547846 DOI: 10.1038/s41598-019-44719-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 05/23/2019] [Indexed: 01/21/2023] Open
Abstract
Although alcohol intake is known to be associated with the development of colorectal cancer, the effect of alcohol consumption on the development of colorectal neoplasm (CRN) is unclear. We performed a retrospective cohort analysis with 1 to 1 propensity score matching in a single center of Korea. Among 1,448 patients who underwent index and surveillance colonoscopy, 210 matched pairs were analyzed. The 5-year cumulative occurrence of overall CRN after index colonoscopy was higher in the significant alcohol consumption group (defined as alcohol consumption more than 30 g/day in men and 20 g/day in women) (vs. without significant alcohol consumption group) (40% vs. 27.6%, p = 0.004). Significant alcohol consumption increased the development of overall CRN (adjusted hazard ratio [aHR]: 1.86, 95% confidence interval [CI]: 1.28–2.70, p = 0.001) at surveillance colonoscopy. However, this effect was not valid on the development of advanced CRN. In subgroup analysis considering the risk classification of index colonoscopy, significant alcohol consumption increased the overall CRN development at surveillance colonoscopy in the normal group (patients with no detected adenoma in the index colonoscopy) (aHR: 1.90, 95% CI: 1.16–3.13, p = 0.01). Alcohol consumption habits should be considered in optimizing time intervals of surveillance colonoscopy.
Collapse
|
33
|
Staunstrup LM, Nielsen HB, Pedersen BK, Karsdal M, Blair JPM, Christensen JF, Bager CL. Cancer risk in relation to body fat distribution, evaluated by DXA-scans, in postmenopausal women - the Prospective Epidemiological Risk Factor (PERF) study. Sci Rep 2019; 9:5379. [PMID: 30926844 PMCID: PMC6440966 DOI: 10.1038/s41598-019-41550-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 03/11/2019] [Indexed: 12/16/2022] Open
Abstract
Studies with direct measures of body fat distribution are required to explore the association between central and general obesity to cancer risk in postmenopausal women. This study investigates the association between central obesity and general obesity to overall/site-specific cancer risk in postmenopausal women. The analysis included 4,679 Danish postmenopausal women. Body fat distribution was evaluated by whole-body dual-energy X-ray absorptiometry scanners. Cancer diagnoses were extracted from the Danish Cancer Registry and multivariable Cox regression models explored the association between cancer risk and central obesity after adjusting for BMI. Our results showed that high central obese women had a 50% increased risk of overall cancer relative to low central obese women (Q1vs.Q4: [HR:1.50, CI:1.20-1.88]). For site-specific cancers, central obesity was significantly associated with Respiratory (Q1vs.Q4: [HR:2.01, CI:1.17-3.47]), Gastrointestinal (Q1vs.Q4: [HR:1.55, CI:0.99-2.41]) and Female genital organs (Q1vs.Q4: [HR:1.95, CI:1.00-3.78]) cancer diagnoses. Sub-analyses stratified by smoking-habits found a significant association between central obesity and a cancer diagnosis for current (Q1vs.Q4: [HR:1.93, CI:1.25-2.99]) and former smokers (Q1vs.Q4: [HR:1.90, CI:1.23-2.94]). These analyses suggest that central obesity is associated with some cancers in postmenopausal women independent of BMI.
Collapse
Affiliation(s)
| | | | - Bente Klarlund Pedersen
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Jesper Frank Christensen
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | |
Collapse
|
34
|
Cologne J, Takahashi I, French B, Nanri A, Misumi M, Sadakane A, Cullings HM, Araki Y, Mizoue T. Association of Weight Fluctuation With Mortality in Japanese Adults. JAMA Netw Open 2019; 2:e190731. [PMID: 30874785 PMCID: PMC6484619 DOI: 10.1001/jamanetworkopen.2019.0731] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
IMPORTANCE Weight cycling is associated with the risk of mortality from heart disease, but many studies have not distinguished between simple nonlinear (monotone) weight changes and more complex changes that reflect fluctuations. OBJECTIVE To assess whether extreme body weight variation is associated with mortality after controlling for nonlinear weight changes. DESIGN, SETTING, AND PARTICIPANTS In this prospective clinical cohort study, 4796 Japanese atomic bomb survivors were examined in the clinic as part of a biennial health examination and research program. The study consisted of a 20-year longitudinal baseline period (July 1, 1958, to June 30, 1978) and subsequent mortality follow-up of 27 years (July 1, 1978, to June 30, 2005) Participants were initially between the ages of 20 and 49 years during the baseline period and, throughout the baseline period, had no diagnoses of cardiovascular disease (CVD) or cancer and attended at least 7 of 10 scheduled examinations. Data analysis was performed from October 16, 2015, to May 13, 2016. EXPOSURES Residual variability in body mass index (BMI) during the baseline period. MAIN OUTCOMES AND MEASURES Outcomes were mortality from ischemic heart disease, cerebrovascular disease, other CVDs combined, other causes (except cancer), and cancer. Root mean squared error was calculated to capture individual residual variation in BMI after adjustment for baseline BMI trends, and the association of magnitude of residual variation with mortality was calculated as relative risk. RESULTS In total, 4796 persons (mean [SD] age, 35.0 [7.3] years at first baseline examination; 3252 [67.8%] female; mean [SD] BMI, 21.2 [2.8] at first baseline visit [20.6 (2.4) among men and 21.5 (2.9) among women]) participated in the study. During follow-up, 1550 participants died: 82 (5.3% of all deaths) of ischemic heart disease, 181 (11.7%) of cerebrovascular disease, 186 (12.0%) of other CVDs, 615 (39.7%) of cancer, and 486 (31.3%) of other causes. Magnitude of residual variation in weight was associated with all-cause mortality (relative risk, 1.25 for 1 U of additional variation; 95% CI, 1.06-1.47) and ischemic heart disease mortality (relative risk, 2.49; 95% CI, 1.41-4.38). CONCLUSIONS AND RELEVANCE The findings suggest that an association exists between weight variation and heart disease mortality and that weight loss interventions, if deemed to be necessary, should be considered carefully.
Collapse
Affiliation(s)
- John Cologne
- Department of Statistics, Radiation Effects Research Foundation, Hiroshima, Japan
| | - Ikuno Takahashi
- Department of Clinical Studies, Radiation Effects Research Foundation, Hiroshima, Japan
| | - Benjamin French
- Department of Statistics, Radiation Effects Research Foundation, Hiroshima, Japan
| | - Akiko Nanri
- Department of Food and Health Sciences, International College of Arts and Sciences, Fukuoka Women's University, Fukuoka, Japan
- Center for Clinical Sciences, Department of Epidemiology and Prevention, National Center for Global Health and Medicine, Tokyo, Japan
| | - Munechika Misumi
- Department of Statistics, Radiation Effects Research Foundation, Hiroshima, Japan
| | - Atsuko Sadakane
- Department of Epidemiology, Radiation Effects Research Foundation, Hiroshima, Japan
| | - Harry M. Cullings
- Department of Statistics, Radiation Effects Research Foundation, Hiroshima, Japan
| | - Yuko Araki
- Graduate School of Integrated Science and Technology, Department of Informatics, Shizuoka University, Shizuoka, Japan
| | - Tetsuya Mizoue
- Center for Clinical Sciences, Department of Epidemiology and Prevention, National Center for Global Health and Medicine, Tokyo, Japan
| |
Collapse
|
35
|
Pfalzer AC, Leung K, Crott JW, Kim SJ, Tai AK, Parnell LD, Kamanu FK, Liu Z, Rogers G, Shea MK, Garcia PE, Mason JB. Incremental Elevations in TNFα and IL6 in the Human Colon and Procancerous Changes in the Mucosal Transcriptome Accompany Adiposity. Cancer Epidemiol Biomarkers Prev 2018; 27:1416-1423. [PMID: 30291114 DOI: 10.1158/1055-9965.epi-18-0121] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 05/31/2018] [Accepted: 08/16/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Obesity, a risk factor for colorectal cancer, raises systemic levels of proinflammatory mediators. Whether increased levels also reside in the colons of obese individuals and are accompanied by procancerous alterations in the mucosal transcriptome is unknown. METHODS Concentrations of TNFα, IL1β, and IL6 in blood and colonic mucosa of 16 lean and 26 obese individuals were examined. Differences in the mucosal transcriptome between the two groups were defined. RESULTS Plasma IL6 and TNFα were 1.4- to 3-fold elevated in obese subjects [body mass index (BMI) ≥ 34 kg/m2] compared with the lean controls (P < 0.01). Among individuals with BMI ≥ 34 kg/m2 colonic concentrations of IL6 and TNFα were 2- to 3-fold greater than in lean subjects (P < 0.03). In a general linear model, adjusted for NSAID use, colonic IL6 (partial r = 0.41; P < 0.01) and TNFα (partial r = 0.41; P = 0.01) increased incrementally over the entire range of BMIs (18.1-45.7). Regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) was associated with a reduction in colonic IL6 (β = -0.65, P < 0.02). RNA sequencing (NSAID users excluded) identified 182 genes expressed differentially between lean and obese subjects. The two gene networks most strongly linked to changes in expression included several differentially expressed genes known to regulate the procarcinogenic signaling pathways, NFκB and ERK 1/2, in a pattern consistent with upregulation of each in the obese subjects. CONCLUSIONS Incremental increases in two major proinflammatory colonic cytokines are associated with increasing BMI, and in the obese state are accompanied by procancerous changes in the transcriptome. IMPACT These observations delineate means by which an inflammatory milieu may contribute to obesity-promoted colon cancer.
Collapse
Affiliation(s)
- Anna C Pfalzer
- Vitamins & Carcinogenesis Laboratory, The Jean Mayer U.S.D.A. Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts
| | - Keith Leung
- Vitamins & Carcinogenesis Laboratory, The Jean Mayer U.S.D.A. Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts
| | - Jimmy W Crott
- Vitamins & Carcinogenesis Laboratory, The Jean Mayer U.S.D.A. Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts
| | - Susan J Kim
- Vitamins & Carcinogenesis Laboratory, The Jean Mayer U.S.D.A. Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts
| | - Albert K Tai
- Genomics Core, Tufts University School of Medicine, Boston, Massachusetts
| | - Laurence D Parnell
- Agricultural Research Service, The Jean Mayer U.S.D.A. Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts
| | - Frederick K Kamanu
- Nutrition and Genomics Laboratory, The Jean Mayer U.S.D.A. Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts
| | - Zhenhua Liu
- School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts
| | - Gail Rogers
- Nutritional Epidemiology Laboratory, The Jean Mayer U.S.D.A. Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts
| | - M Kyla Shea
- Vitamin K Laboratory, The Jean Mayer U.S.D.A. Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts
| | - Paloma E Garcia
- Vitamins & Carcinogenesis Laboratory, The Jean Mayer U.S.D.A. Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts
| | - Joel B Mason
- Vitamins & Carcinogenesis Laboratory, The Jean Mayer U.S.D.A. Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts. .,Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts.,Division of Gastroenterology, Tufts Medical Center, Boston, Massachusetts.,Division of Clinical Nutrition, Tufts Medical Center, Boston, Massachusetts
| |
Collapse
|
36
|
Abar L, Vieira AR, Aune D, Sobiecki JG, Vingeliene S, Polemiti E, Stevens C, Greenwood DC, Chan DSM, Schlesinger S, Norat T. Height and body fatness and colorectal cancer risk: an update of the WCRF-AICR systematic review of published prospective studies. Eur J Nutr 2018; 57:1701-1720. [PMID: 29080978 PMCID: PMC6060816 DOI: 10.1007/s00394-017-1557-1] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 06/25/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE There is no published dose-response meta-analysis on the association between height and colorectal cancer risk (CRC) by sex and anatomical sub-site. We conducted a meta-analysis of prospective studies on the association between height and CRC risk with subgroup analysis and updated evidence on the association between body fatness and CRC risk. METHODS PubMed and several other databases were searched up to November 2016. A random effects model was used to calculate dose-response summary relative risks (RR's). RESULTS 47 studies were included in the meta-analyses including 50,936 cases among 7,393,510 participants. The findings support the existing evidence regarding a positive association of height, general and abdominal body fatness and CRC risk. The summary RR were 1.04 [95% (CI)1.02-1.05, I² = 91%] per 5 cm increase in height, 1.02 [95% (CI)1.01-1.02, I² = 0%] per 5 kg increase in weight, 1.06 [95% (CI)1.04-1.07, I² = 83%] per 5 kg/m2 increase in BMI, 1.02 [95% (CI)1.02-1.03, I² = 4%] per 10 cm increase in waist circumference, 1.03 [95% (CI)1.01-1.05, I² = 16%] per 0.1 unit increase in waist to hip ratio. The significant association for height and CRC risk was similar in men and women. The significant association for BMI and CRC risk was stronger in men than in women. CONCLUSION The positive association between height and risk of CRC suggests that life factors during childhood and early adulthood might play a role in CRC aetiology. Higher general and abdominal body fatness during adulthood are risk factors of CRC and these associations are stronger in men than in women.
Collapse
Affiliation(s)
- Leila Abar
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, Paddington, London, W2 1PG, UK.
| | - Ana Rita Vieira
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, Paddington, London, W2 1PG, UK
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, Paddington, London, W2 1PG, UK
| | - Jakub G Sobiecki
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, Paddington, London, W2 1PG, UK
| | - Snieguole Vingeliene
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, Paddington, London, W2 1PG, UK
| | - Elli Polemiti
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, Paddington, London, W2 1PG, UK
| | - Christophe Stevens
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, Paddington, London, W2 1PG, UK
| | - Darren C Greenwood
- Biostatistics Unit, Centre for Epidemiology and Biostatistics, University of Leeds, Leeds, UK
| | - Doris S M Chan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, Paddington, London, W2 1PG, UK
| | - Sabrina Schlesinger
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, Paddington, London, W2 1PG, UK
| | - Teresa Norat
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St. Mary's Campus, Norfolk Place, Paddington, London, W2 1PG, UK
| |
Collapse
|
37
|
Cologne J, Loo L, Shvetsov YB, Misumi M, Lin P, Haiman CA, Wilkens LR, Le Marchand L. Stepwise approach to SNP-set analysis illustrated with the Metabochip and colorectal cancer in Japanese Americans of the Multiethnic Cohort. BMC Genomics 2018; 19:524. [PMID: 29986644 PMCID: PMC6038257 DOI: 10.1186/s12864-018-4910-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 06/29/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Common variants have explained less than the amount of heritability expected for complex diseases, which has led to interest in less-common variants and more powerful approaches to the analysis of whole-genome scans. Because of low frequency (low statistical power), less-common variants are best analyzed using SNP-set methods such as gene-set or pathway-based analyses. However, there is as yet no clear consensus regarding how to focus in on potential risk variants following set-based analyses. We used a stepwise, telescoping approach to analyze common- and rare-variant data from the Illumina Metabochip array to assess genomic association with colorectal cancer (CRC) in the Japanese sub-population of the Multiethnic Cohort (676 cases, 7180 controls). We started with pathway analysis of SNPs that are in genes and pathways having known mechanistic roles in colorectal cancer, then focused on genes within the pathways that evidenced association with CRC, and finally assessed individual SNPs within the genes that evidenced association. Pathway SNPs downloaded from the dbSNP database were cross-matched with Metabochip SNPs and analyzed using the logistic kernel machine regression approach (logistic SNP-set kernel-machine association test, or sequence kernel association test; SKAT) and related methods. RESULTS The TGF-β and WNT pathways were associated with all CRC, and the WNT pathway was associated with colon cancer. Individual genes demonstrating the strongest associations were TGFBR2 in the TGF-β pathway and SMAD7 (which is involved in both the TGF-β and WNT pathways). As partial validation of our approach, a known CRC risk variant in SMAD7 (in both the TGF-β and WNT pathways: rs11874392) was associated with CRC risk in our data. We also detected two novel candidate CRC risk variants (rs13075948 and rs17025857) in TGFBR2, a gene known to be associated with CRC risk. CONCLUSIONS A stepwise, telescoping approach identified some potentially novel risk variants associated with colorectal cancer, so it may be a useful method for following up on results of set-based SNP analyses. Further work is required to assess the statistical characteristics of the approach, and additional applications should aid in better clarifying its utility.
Collapse
Affiliation(s)
- John Cologne
- Department of Statistics, Radiation Effects Research Foundation, Hiroshima, 732-0815, Japan.
| | - Lenora Loo
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, 96813, USA
| | - Yurii B Shvetsov
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, 96813, USA
| | - Munechika Misumi
- Department of Statistics, Radiation Effects Research Foundation, Hiroshima, 732-0815, Japan
| | - Philip Lin
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, 96813, USA
| | - Christopher A Haiman
- Department of Preventive Medicine and Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA
| | - Lynne R Wilkens
- Biostatistics and Informatics Shared Resource, University of Hawaii Cancer Center, Honolulu, HI, 96813, USA
| | - Loïc Le Marchand
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, 96813, USA
| |
Collapse
|
38
|
Vajdic CM, MacInnis RJ, Canfell K, Hull P, Arriaga ME, Hirani V, Cumming RG, Mitchell P, Byles JE, Giles GG, Banks E, Taylor AW, Shaw JE, Magliano DJ, Marker J, Adelstein BA, Gill TK, Laaksonen MA. The Future Colorectal Cancer Burden Attributable to Modifiable Behaviors: A Pooled Cohort Study. JNCI Cancer Spectr 2018; 2:pky033. [PMID: 31360860 PMCID: PMC6649699 DOI: 10.1093/jncics/pky033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/04/2018] [Accepted: 06/08/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Previous estimates of the colorectal cancer (CRC) burden attributed to behaviors have not considered joint effects, competing risk, or population subgroup differences. METHODS We pooled data from seven prospective Australian cohort studies (n = 367 058) and linked them to national registries to identify CRCs and deaths. We estimated the strength of the associations between behaviors and CRC risk using a parametric piecewise constant hazards model, adjusting for age, sex, study, and other behaviors. Exposure prevalence was estimated from contemporary National Health Surveys. We calculated population attributable fractions for CRC preventable by changes to current behaviors, accounting for competing risk of death and risk factor interdependence. Statistical tests were two-sided. RESULTS During the first 10 years of follow-up, there were 3471 incident CRCs. Overweight or obesity explained 11.1%, ever smoking explained 10.7% (current smoking 3.9%), and drinking more than two compared with two or fewer alcoholic drinks per day explained 5.8% of the CRC burden. Jointly, these factors were responsible for 24.9% (95% confidence interval [CI] = 19.7% to 29.9%) of the burden, higher for men (36.7%) than women (13.2%, P difference < .001). The burden attributed to these factors was also higher for those born in Australia (28.7%) than elsewhere (16.8%, P difference = .047). We observed modification of the smoking-attributable burden by alcohol consumption and educational attainment, and modification of the obesity-attributable burden by age group and birthplace. CONCLUSIONS We produced up-to-date estimates of the future CRC burden attributed to modifiable behaviors. We revealed novel differences between men and women, and other high-CRC burden subgroups that could potentially benefit most from programs that support behavioral change and early detection.
Collapse
Affiliation(s)
- Claire M Vajdic
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Robert J MacInnis
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Karen Canfell
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
- Cancer Research Division, Cancer Council New South Wales, Sydney, Australia
- School of Public Health, University of Sydney, Sydney, Australia
| | - Peter Hull
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Maria E Arriaga
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Vasant Hirani
- School of Public Health, University of Sydney, Sydney, Australia
- School of Life and Environmental Sciences, Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Robert G Cumming
- School of Public Health, University of Sydney, Sydney, Australia
- ANZAC Research Institute, University of Sydney and Concord Hospital, Sydney, Australia
| | - Paul Mitchell
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Sydney, Australia
| | - Julie E Byles
- Research Centre for Gender, Health and Ageing, University of Newcastle, Newcastle, Australia
| | - Graham G Giles
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Emily Banks
- ANU College of Medicine, Biology and Environment, Australian National University, Canberra, Australia
| | - Anne W Taylor
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Jonathan E Shaw
- Clinical Diabetes Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Dianna J Magliano
- Diabetes and Population Health Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Julie Marker
- Cancer Voices South Australia, Adelaide, Australia
| | | | - Tiffany K Gill
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Maarit A Laaksonen
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| |
Collapse
|
39
|
Brakenhoff TB, Mitroiu M, Keogh RH, Moons KGM, Groenwold RHH, van Smeden M. Measurement error is often neglected in medical literature: a systematic review. J Clin Epidemiol 2018; 98:89-97. [PMID: 29522827 DOI: 10.1016/j.jclinepi.2018.02.023] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 02/01/2018] [Accepted: 02/28/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVES In medical research, covariates (e.g., exposure and confounder variables) are often measured with error. While it is well accepted that this introduces bias and imprecision in exposure-outcome relations, it is unclear to what extent such issues are currently considered in research practice. The objective was to study common practices regarding covariate measurement error via a systematic review of general medicine and epidemiology literature. STUDY DESIGN AND SETTING Original research published in 2016 in 12 high impact journals was full-text searched for phrases relating to measurement error. Reporting of measurement error and methods to investigate or correct for it were quantified and characterized. RESULTS Two hundred and forty-seven (44%) of the 565 original research publications reported on the presence of measurement error. 83% of these 247 did so with respect to the exposure and/or confounder variables. Only 18 publications (7% of 247) used methods to investigate or correct for measurement error. CONCLUSIONS Consequently, it is difficult for readers to judge the robustness of presented results to the existence of measurement error in the majority of publications in high impact journals. Our systematic review highlights the need for increased awareness about the possible impact of covariate measurement error. Additionally, guidance on the use of measurement error correction methods is necessary.
Collapse
Affiliation(s)
- Timo B Brakenhoff
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, 3508 Utrecht, The Netherlands.
| | - Marian Mitroiu
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, 3508 Utrecht, The Netherlands
| | - Ruth H Keogh
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Karel G M Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, 3508 Utrecht, The Netherlands
| | - Rolf H H Groenwold
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, 3508 Utrecht, The Netherlands
| | - Maarten van Smeden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, 3508 Utrecht, The Netherlands
| |
Collapse
|
40
|
Abstract
The ageing trajectory is plastic and can be slowed down by lifestyle factors, including good nutrition, adequate physical activity and avoidance of smoking. In humans, plant-based diets such as the Mediterranean dietary pattern are associated with healthier ageing and lower risk of age-related disease, whereas obesity accelerates ageing and increases the likelihood of most common complex diseases including CVD, T2D, dementia, musculoskeletal diseases and several cancers. As yet, there is only weak evidence in humans about the molecular mechanisms through which dietary factors modulate ageing but evidence from cell systems and animal models suggest that it is probable that better dietary choices influence all 9 hallmarks of ageing. It seems likely that better eating patterns retard ageing in at least two ways including (i) by reducing pervasive damaging processes such as inflammation, oxidative stress/redox changes and metabolic stress and (ii) by enhancing cellular capacities for damage management and repair. From a societal perspective, there is an urgent imperative to discover, and to implement, cost-effective lifestyle (especially dietary) interventions which enable each of us to age well, i.e. to remain physically and socially active and independent and to minimise the period towards the end of life when individuals suffer from frailty and multi-morbidity.
Collapse
Affiliation(s)
- Fiona C Malcomson
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - John C Mathers
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
| |
Collapse
|
41
|
Changes in Adult BMI and Waist Circumference Are Associated with Increased Risk of Advanced Colorectal Neoplasia. Dig Dis Sci 2017; 62:3177-3185. [PMID: 28983748 PMCID: PMC5653429 DOI: 10.1007/s10620-017-4778-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 09/21/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Waist circumference (WC) is a stronger predictor of colon cancer (CRC) risk than body mass index (BMI). However, how well change in either WC or BMI predicts risk of advanced colorectal neoplasia (AN) is unclear. AIMS To determine the relationship between change in BMI and WC from early adulthood to later age and the risk of AN and which change measure is a stronger predictor. METHODS In 4500 adults, ages 50-80, with no previous neoplasia and undergoing screening colonoscopy, BMI and WC at age 21 and at time of screening were reported. Changes in BMI and WC were defined using universal risk cutoffs. Known CRC risk factors were controlled in the logistic models. RESULTS Overall, model statistics showed WC change (omnibus test χ 2 = 10.15, 2 DF, p value = 0.006) was a statistically stronger predictor of AN than BMI change (omnibus test χ 2 = 5.66, 5 DF, p value = 0.34). Independent of BMI change, participants who increased WC (OR 1.44; 95% CI 1.05-1.96) or maintained a high-risk WC (OR 2.50; 95% CI 1.38-4.53) at age 21 and at screening had an increased risk of AN compared to those with a low-risk WC. Study participants who were obese at age 21 and at screening had an increased risk of AN (OR 1.87; 95% CI 1.08-3.23) compared to those who maintained a healthy BMI. Maintaining an overweight BMI or increasing BMI was not associated with AN. CONCLUSIONS Maintaining an unhealthy BMI and WC throughout adult life may increase risk of AN. WC change may be a better predictor of AN than BMI change.
Collapse
|
42
|
Vissers PAJ, Martucci RB, Mols F, Bours MJL, Winkels RM, Kampman E, Weijenberg MP, van de Poll-Franse LV, Beijer S. The Impact of Body Mass Index and Waist Circumference on Health-related Quality of Life Among Colorectal Cancer Survivors: Results from the PROFILES Registry. Nutr Cancer 2017; 69:1177-1184. [PMID: 29035593 DOI: 10.1080/01635581.2017.1367938] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND We aimed to assess the association of waist circumference (WC) and body mass index (BMI) with health-related quality of life (HRQL) among colorectal cancer (CRC) survivors. METHODS CRC survivors diagnosed between 2000 and 2009 completed questionnaires in August 2013 (with self-reported weight, height, and self-assessed WC) and January 2014 (with HRQL using the EORTC-QLQ-C30). Clinical characteristics were retrieved from the Netherlands Cancer Registry. In multivariable linear regression analyses associations of BMI only, WC only and both BMI and WC with HRQL outcomes were assessed. RESULTS 1,111 CRC survivors were included of whom 34% had a normal weight (18.5 ≤ BMI < 25 kg/m2), 49% had overweight (25 ≤ BMI < 30 kg/m2), 17% had obesity (BMI ≥ 30 kg/m2), and 44% had an increased WC (i.e., >102 and >88 cm for men and women, respectively). Both BMI and WC were separately associated with worse global health status, functioning, and more symptoms of fatigue. Increased WC was associated with lower physical, role and emotional functioning, regardless of BMI, with average differences ranging between 3 and 5 points. CONCLUSION Future research on HRQL among CRC survivors should consider both BMI and WC. Furthermore, weight reduction trials should not only focus on general weight loss but also on the loss of abdominal fat.
Collapse
Affiliation(s)
- Pauline A J Vissers
- a Netherlands Comprehensive Cancer Organisation (IKNL) , 3501 DB Utrecht , The Netherlands
| | - Renata B Martucci
- b Nutrition and Dietetic Service , Cancer Hospital I, National Cancer Institute , Rio de Janeiro , Brazil.,c Nutrition Institute , State University of Rio de Janeiro , Rio de Janeiro , Brazil
| | - Floortje Mols
- d CoRPS-Center of Research on Psychology in Somatic Diseases, Department of Medical Psychology and Clinical Psychology , Tilburg University , 5000 LE Tilburg , The Netherlands
| | - Martijn J L Bours
- e Department of Epidemiology, GROW - School for Oncology and Developmental Biology , Maastricht University , 6200 MD Maastricht , The Netherlands
| | - Renate M Winkels
- f Division of Human Nutrition Wageningen University , 6700 AA Wageningen , The Netherlands
| | - Ellen Kampman
- f Division of Human Nutrition Wageningen University , 6700 AA Wageningen , The Netherlands
| | - Matty P Weijenberg
- e Department of Epidemiology, GROW - School for Oncology and Developmental Biology , Maastricht University , 6200 MD Maastricht , The Netherlands
| | - Lonneke V van de Poll-Franse
- a Netherlands Comprehensive Cancer Organisation (IKNL) , 3501 DB Utrecht , The Netherlands.,d CoRPS-Center of Research on Psychology in Somatic Diseases, Department of Medical Psychology and Clinical Psychology , Tilburg University , 5000 LE Tilburg , The Netherlands.,g Division of Psychosocial Research and Epidemiology , Netherlands Cancer Institute , 1006 BE Amsterdam , The Netherlands
| | - Sandra Beijer
- a Netherlands Comprehensive Cancer Organisation (IKNL) , 3501 DB Utrecht , The Netherlands
| |
Collapse
|
43
|
Alsharari ZD, Risérus U, Leander K, Sjögren P, Carlsson AC, Vikström M, Laguzzi F, Gigante B, Cederholm T, De Faire U, Hellénius ML, Marklund M. Serum Fatty Acids, Desaturase Activities and Abdominal Obesity - A Population-Based Study of 60-Year Old Men and Women. PLoS One 2017; 12:e0170684. [PMID: 28125662 PMCID: PMC5270324 DOI: 10.1371/journal.pone.0170684] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 01/09/2017] [Indexed: 01/20/2023] Open
Abstract
Abdominal obesity is a key contributor of metabolic disease. Recent trials suggest that dietary fat quality affects abdominal fat content, where palmitic acid and linoleic acid influence abdominal obesity differently, while effects of n-3 polyunsaturated fatty acids are less studied. Also, fatty acid desaturation may be altered in abdominal obesity. We aimed to investigate cross-sectional associations of serum fatty acids and desaturases with abdominal obesity prevalence in a population-based cohort study. Serum cholesteryl ester fatty acids composition was measured by gas chromatography in 60-year old men (n = 1883) and women (n = 2015). Cross-sectional associations of fatty acids with abdominal obesity prevalence and anthropometric measures (e.g., sagittal abdominal diameter) were evaluated in multivariable-adjusted logistic and linear regression models, respectively. Similar models were employed to investigate relations between desaturase activities (estimated by fatty acid ratios) and abdominal obesity. In logistic regression analyses, palmitic acid, stearoyl-CoA-desaturase and Δ6-desaturase indices were associated with abdominal obesity; multivariable-adjusted odds ratios (95% confidence intervals) for highest versus lowest quartiles were 1.45 (1.19–1.76), 4.06 (3.27–5.05), and 3.07 (2.51–3.75), respectively. Linoleic acid, α-linolenic acid, docohexaenoic acid, and Δ5-desaturase were inversely associated with abdominal obesity; multivariable-adjusted odds ratios (95% confidence intervals): 0.39 (0.32–0.48), 0.74 (0.61–0.89), 0.76 (0.62–0.93), and 0.40 (0.33–0.49), respectively. Eicosapentaenoic acid was not associated with abdominal obesity. Similar results were obtained from linear regression models evaluating associations with different anthropometric measures. Sex-specific and linear associations were mainly observed for n3-polyunsaturated fatty acids, while associations of the other exposures were generally non-linear and similar across sexes. In accordance with findings from short-term trials, abdominal obesity was more common among individuals with relatively high proportions of palmitic acid, whilst the contrary was true for linoleic acid. Further trials should examine the potential role of linoleic acid and its main dietary source, vegetable oils, in abdominal obesity prevention.
Collapse
Affiliation(s)
- Zayed D. Alsharari
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Ulf Risérus
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Karin Leander
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Per Sjögren
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Axel C. Carlsson
- Division of Family medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Max Vikström
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Federica Laguzzi
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Bruna Gigante
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Ulf De Faire
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Cardiology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Mai-Lis Hellénius
- Cardiology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Matti Marklund
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
- * E-mail:
| |
Collapse
|
44
|
Sex differences in the association of obesity and colorectal cancer risk. Cancer Causes Control 2016; 28:1-4. [DOI: 10.1007/s10552-016-0831-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
|
45
|
Karahalios A, Simpson JA, Baglietto L, MacInnis RJ, Hodge AM, Giles GG, English DR. Change in weight and waist circumference and risk of colorectal cancer: results from the Melbourne Collaborative Cohort Study. BMC Cancer 2016; 16:157. [PMID: 26917541 PMCID: PMC4768408 DOI: 10.1186/s12885-016-2144-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 02/08/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Studies reporting the association between change in weight or body mass index during midlife and risk of colorectal cancer have found inconsistent results, and only one study to date has reported the association between change in waist circumference (a measure of central adiposity) and risk of colorectal cancer. METHODS We investigated the association between risk of colorectal cancer and changes in directly measured waist circumference and weight from baseline (1990-1994) to wave 2 (2003-2007). Cox regression, with age as the time metric and follow-up starting at wave 2, adjusted for covariates selected from a causal model, was used to estimate the Hazard Ratios (HRs) and 95 % Confidence Intervals (CIs) for the change in waist circumference and weight in relation to risk of colorectal cancer. RESULTS A total of 373 cases of colorectal cancer were diagnosed during an average 9 years of follow-up of 20,605 participants. Increases in waist circumference and weight were not associated with the risk of colorectal cancer (HR per 5 cm increase in waist circumference = 1.02; 95 % CI: 0.95, 1.10; HR per 5 kg increase in weight = 0.93; 0.85, 1.02). For individuals with a waist circumference at baseline that was less than the sex-specific mean value there was a slight increased risk of colorectal cancer associated with a 5 cm increase in waist circumference at wave 2 (HR = 1.08; 0.97, 1.21). CONCLUSION Increases in waist circumference and weight during midlife do not appear to be associated with the risk of colorectal cancer.
Collapse
Affiliation(s)
- Amalia Karahalios
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Bouverie Street, Melbourne, 3010, Australia.
| | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Bouverie Street, Melbourne, 3010, Australia. .,Cancer Epidemiology Centre, Cancer Council Victoria, 615 St Kilda Road, Melbourne, 3004, Australia.
| | - Laura Baglietto
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Bouverie Street, Melbourne, 3010, Australia. .,Cancer Epidemiology Centre, Cancer Council Victoria, 615 St Kilda Road, Melbourne, 3004, Australia. .,Team 9, Lifestyle, Genes and health: integrative trans-generational epidemiology, Inserm U1018, Centre for Research in Epidemiology and Population Health, Gustave Roussy Institute, 114 rue Edouard Vaillant, Villejuif Cedex, 94805, France. .,Paris-South University, Villejuif, France.
| | - Robert J MacInnis
- Cancer Epidemiology Centre, Cancer Council Victoria, 615 St Kilda Road, Melbourne, 3004, Australia.
| | - Allison M Hodge
- Cancer Epidemiology Centre, Cancer Council Victoria, 615 St Kilda Road, Melbourne, 3004, Australia.
| | - Graham G Giles
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Bouverie Street, Melbourne, 3010, Australia. .,Cancer Epidemiology Centre, Cancer Council Victoria, 615 St Kilda Road, Melbourne, 3004, Australia.
| | - Dallas R English
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Bouverie Street, Melbourne, 3010, Australia. .,Cancer Epidemiology Centre, Cancer Council Victoria, 615 St Kilda Road, Melbourne, 3004, Australia.
| |
Collapse
|
46
|
Martinez-Useros J, Garcia-Foncillas J. Obesity and colorectal cancer: molecular features of adipose tissue. J Transl Med 2016; 14:21. [PMID: 26801617 PMCID: PMC4722674 DOI: 10.1186/s12967-016-0772-5] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 01/05/2016] [Indexed: 02/06/2023] Open
Abstract
The huge part of population in developed countries is overweight or obese. Obesity is often determined by body mass index (BMI) but new accurate methods and ratios have recently appeared to measure body fat or fat located in the intestines. Early diagnosis of obesity is crucial since it is considered an increasing colorectal cancer risk factor. On the one hand, colorectal cancer has been strongly associated with lifestyle factors. A diet rich in red and processed meats may increase colorectal cancer risk; however, high-fiber diets (grains, cereals and fruits) have been associated with a decreased risk of colorectal cancer. Other life-style factors associated with obesity that also increase colorectal cancer risk are physical inactivity, smoking and high alcohol intake. Cutting-edge studies reported that high-risk transformation ability of adipose tissue is due to production of different pro-inflammatory cytokines like IL-8, IL-6 or IL-2 and other enzymes like lactate dehydrogenase (LDH) and tumour necrosis factor alpha (TNFα). Furthermore, oxidative stress produces fatty-acid peroxidation whose metabolites possess very high toxicities and mutagenic properties. 4-hydroxy-2-nonenal (4-HNE) is an active compounds that upregulates prostaglandin E2 which is directly associated with high proliferative colorectal cancer. Moreover, 4-HNE deregulates cell proliferation, cell survival, differentiation, autophagy, senescence, apoptosis and necrosis via mitogen-activated protein kinase (MAPK), phosphoinositide 3-kinase (PIK3CA)—AKT and protein kinase C pathways. Other product of lipid peroxidation is malondialdehyde (MDA) being able to regulate insulin through WNT-pathway as well as having demonstrated its mutagenic capability. Accumulation of point mutation enables genomic evolution of colorectal cancer described in the model of Fearon and Vogelstein. In this review, we will summarize different determination methods and techniques to assess a truthfully diagnosis and we will explain some of the capabilities that performs adipocytes as the largest endocrine organ.
Collapse
Affiliation(s)
- Javier Martinez-Useros
- Translational Oncology Division, Oncohealth Institute, FIIS-Fundacion Jimenez Diaz, Av. Reyes Catolicos 2, 28040, Madrid, Spain.
| | - Jesus Garcia-Foncillas
- Translational Oncology Division, Oncohealth Institute, FIIS-Fundacion Jimenez Diaz, Av. Reyes Catolicos 2, 28040, Madrid, Spain.
| |
Collapse
|