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Onyije FM, Dolatkhah R, Olsson A, Bouaoun L, Deltour I, Erdmann F, Bonaventure A, Scheurer ME, Clavel J, Schüz J. Risk factors for childhood brain tumours: A systematic review and meta-analysis of observational studies from 1976 to 2022. Cancer Epidemiol 2024; 88:102510. [PMID: 38056243 PMCID: PMC10835339 DOI: 10.1016/j.canep.2023.102510] [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: 10/09/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Childhood brain tumours (CBTs) are the leading cause of cancer death in children under the age of 20 years globally. Though the aetiology of CBT remains poorly understood, it is thought to be multifactorial. We aimed to synthesize potential risk factors for CBT to inform primary prevention. METHODS We conducted a systematic review and meta-analysis of epidemiological studies indexed in the PubMed, Web of Science, and Embase databases from the start of those resources through 27 July 2023. We included data from case-control or cohort studies that reported effect estimates for each risk factor around the time of conception, during pregnancy and/or during post-natal period. Random effects meta-analysis was used to estimate summary effect sizes (ES) and 95% confidence intervals (CIs). We also quantified heterogeneity (I2) across studies. FINDINGS A total of 4040 studies were identified, of which 181 studies (85 case-control and 96 cohort studies) met our criteria for inclusion. Of all eligible studies, 50% (n = 91) were conducted in Europe, 32% (n = 57) in North America, 9% (n = 16) in Australia, 8% (n = 15) in Asia, 1% (n = 2) in South America, and none in Africa. We found associations for some modifiable risk factors including childhood domestic exposures to insecticides (ES 1.44, 95% CI 1.20-1.73) and herbicides (ES 2.38, 95% CI 1.31-4.33). Maternal domestic exposure to insecticides (ES 1.45, 95% CI 1.09-1.94), maternal consumption of cured meat (ES 1.51, 95% CI 1.05-2.17) and coffee ≥ 2 cups/day (ES 1.45, 95% 95% CI 1.07-1.95) during pregnancy, and maternal exposure to benzene (ES 2.22; 95% CI 1.01-4.88) before conception were associated with CBTs in case-control studies. Also, paternal occupational exposure to pesticides (ES 1.48, 95% CI 1.23-1.77) and benzene (ES 1.74, 95% CI 1.10-2.76) before conception and during pregnancy were associated in case-control studies and in combined analysis. On the other hand, assisted reproductive technology (ART) (ES 1.32, 95% CI 1.05-1.67), caesarean section (CS) (ES 1.12, 95% CI 1.01-1.25), paternal occupational exposure to paint before conception (ES 1.56, 95% CI 1.02-2.40) and maternal smoking > 10 cigarettes per day during pregnancy (ES 1.18, 95% CI 1.00-1.40) were associated with CBT in cohort studies. Maternal intake of vitamins and folic acid during pregnancy was inversely associated in cohort studies. Hormonal/infertility treatment, breastfeeding, child day-care attendance, maternal exposure to electric heated waterbed, tea and alcohol consumption during pregnancy were among those not associated with CBT in both case-control and cohort studies. CONCLUSION Our results should be interpreted with caution, especially as most associations between risk factors and CBT were discordant between cohort and case-control studies. At present, it is premature for any CBT to define specific primary prevention guidelines.
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Affiliation(s)
- Felix M Onyije
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), 25 avenue Tony Garnier, CS 90627, 69366 LYON CEDEX 07, France.
| | - Roya Dolatkhah
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), 25 avenue Tony Garnier, CS 90627, 69366 LYON CEDEX 07, France
| | - Ann Olsson
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), 25 avenue Tony Garnier, CS 90627, 69366 LYON CEDEX 07, France
| | - Liacine Bouaoun
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), 25 avenue Tony Garnier, CS 90627, 69366 LYON CEDEX 07, France
| | - Isabelle Deltour
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), 25 avenue Tony Garnier, CS 90627, 69366 LYON CEDEX 07, France
| | - Friederike Erdmann
- Research Group Aetiology and Inequalities in Childhood Cancer, Division of Childhood Cancer Epidemiology Institute of Medical Biostatistics, Epidemiology, and Informatics (IMBEI), University Medical Center Mainz, Langenbeckstraβe 1, 55131 Mainz, Germany
| | - Audrey Bonaventure
- Epidemiology of Childhood and Adolescent Cancers Team, Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Villejuif, France
| | - Michael E Scheurer
- Department of Pediatrics, Hematology-Oncology, Baylor College of Medicine and Texas Children's Hospital Cancer Center, Houston, TX, United States
| | - Jacqueline Clavel
- Epidemiology of Childhood and Adolescent Cancers Team, Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Villejuif, France; National Registry of Childhood Cancers, Hôpital Paul Brousse, Groupe Hospitalier Universitaire Paris-Sud, Assistance Publique Hôpitaux de Paris (AP-HP), Villejuif, France; Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre-lès-Nancy, France
| | - Joachim Schüz
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer (IARC/WHO), 25 avenue Tony Garnier, CS 90627, 69366 LYON CEDEX 07, France
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Thabet RH, Alessa REM, Al-Smadi ZKK, Alshatnawi BSG, Amayreh BMI, Al-Dwaaghreh RBA, Salah SKA. Folic acid: friend or foe in cancer therapy. J Int Med Res 2024; 52:3000605231223064. [PMID: 38229460 PMCID: PMC10935767 DOI: 10.1177/03000605231223064] [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: 10/14/2023] [Accepted: 12/11/2023] [Indexed: 01/18/2024] Open
Abstract
Folic acid plays a crucial role in diverse biological processes, notably cell maturation and proliferation. Here, we performed a literature review using articles listed in electronic databases, such as PubMed, Scopus, MEDLINE, and Google Scholar. In this review article, we describe contradictory data regarding the role of folic acid in cancer development and progression. While some studies have confirmed its beneficial effects in diminishing the risk of various cancers, others have reported a potential carcinogenic effect. The current narrative review elucidates these conflicting data by highlighting the possible molecular mechanisms explaining each point of view. Further multicenter molecular and genetic studies, in addition to human randomized clinical trials, are necessary to provide a more comprehensive understanding of the relationship between folic acid and cancer.
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Affiliation(s)
- Romany H. Thabet
- Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt
- Department of Basic Medical Sciences, Faculty of Medicine, Aqaba Medical Sciences University, Aqaba, Jordan
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Schraw JM, Petridou ET, Bonaventure A, Dockerty JD, Karalexi M, Ntzani E, Infante-Rivard C, Clavel J, Bracci PM, McKean-Cowdin R, Roman E, Kane E, Erdmann F, Schüz J, Mueller BA, Scheurer ME. Breastfeeding and risk of childhood brain tumors: a report from the Childhood Cancer and Leukemia International Consortium. Cancer Causes Control 2023; 34:1005-1015. [PMID: 37421504 DOI: 10.1007/s10552-023-01746-3] [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: 02/28/2023] [Accepted: 06/26/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE Studies report mixed findings regarding the association of breastfeeding with childhood brain tumors (CBT), the leading causes of cancer-related mortality in young people. Our objective was to determine whether breastfeeding is associated with CBT incidence. METHODS We pooled data on N = 2610 cases with CBT (including 697 cases with astrocytoma, 447 cases with medulloblastoma/primitive neuroectodermal tumor [PNET], 167 cases with ependymoma) and N = 8128 age- and sex-matched controls in the Childhood Cancer and Leukemia International Consortium. We computed unconditional logistic regression models to estimate the odds ratio (OR) and 95% confidence interval (CI) of CBT, astrocytoma, medulloblastoma/PNET, and ependymoma according to breastfeeding status, adjusting for study, sex, mode of delivery, birthweight, age at diagnosis/interview, maternal age at delivery, maternal educational attainment, and maternal race/ethnicity. We evaluated any breastfeeding versus none and breastfeeding ≥ 6 months versus none. We subsequently performed random effects meta-analysis to confirm our findings, identify potential sources of heterogeneity, and evaluate for outliers or influential studies. RESULTS Breastfeeding was reported by 64.8% of control mothers and 64.5% of case mothers and was not associated with CBT (OR 1.04, 95% CI 0.94-1.15), astrocytoma (OR 1.01, 95% CI 0.87-1.17), medulloblastoma/PNET (OR 1.11, 95% CI 0.93-1.32), or ependymoma (OR 1.06, 95% CI 0.81-1.40). Results were similar when we restricted to breastfeeding ≥ 6 months and in meta-analyses. CONCLUSION Our data suggest that breastfeeding does not protect against CBT.
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Affiliation(s)
- Jeremy M Schraw
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, TX, USA.
- Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
| | - Eleni Th Petridou
- Department of Hygiene, Epidemiology, and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Hellenic Society for Social Pediatrics and Health Promotion, Athens, Greece
| | - Audrey Bonaventure
- UMR-1153, CRESS, Université de Paris, INSERM, Epidemiology of Childhood and Adolescent Cancers Team, Villejuif, France
| | - John D Dockerty
- Department of Preventative and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Maria Karalexi
- Hellenic Society for Social Pediatrics and Health Promotion, Athens, Greece
| | - Evangelia Ntzani
- Center for Evidence-Based Medicine, Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, 45110, Ioannina, Greece
| | - Claire Infante-Rivard
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Jacqueline Clavel
- UMR-1153, CRESS, Université de Paris, INSERM, Epidemiology of Childhood and Adolescent Cancers Team, Villejuif, France
- National Registry of Childhood Cancers, APHP, Hôpital Paul-Brousse, Villejuif, and CHU de Nancy, Vandoeuvre-Lès-Nancy, France
| | - Paige M Bracci
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
- Hellen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | | | - Eve Roman
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK
| | - Eleanor Kane
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK
| | - Friederike Erdmann
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer, World Health Organization (IARC/WHO), Lyon, France
- Division of Childhood Cancer Epidemiology, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Mainz, Germany
| | - Joachim Schüz
- Section of Environment and Radiation, International Agency for Research On Cancer (IARC/WHO), Lyon, France
| | - Beth A Mueller
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Michael E Scheurer
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, TX, USA
- Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
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Williams KB, Marley AR, Tibbitts J, Moertel CL, Johnson KJ, Linden MA, Largaespada DA, Marcotte EL. Perinatal folate levels do not influence tumor latency or multiplicity in a model of NF1 associated plexiform-like neurofibromas. BMC Res Notes 2023; 16:275. [PMID: 37848948 PMCID: PMC10580592 DOI: 10.1186/s13104-023-06515-8] [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: 01/13/2023] [Accepted: 09/18/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVE In epidemiological and experimental research, high folic acid intake has been demonstrated to accelerate tumor development among populations with genetic and/or molecular susceptibility to cancer. Neurofibromatosis type 1 (NF1) is a common autosomal dominant disorder predisposing affected individuals to tumorigenesis, including benign plexiform neurofibromas; however, understanding of factors associated with tumor risk in NF1 patients is limited. Therefore, we investigated whether pregestational folic acid intake modified plexiform-like peripheral nerve sheath tumor risk in a transgenic NF1 murine model. RESULTS We observed no significant differences in overall survival according to folate group. Relative to controls (180 days), median survival did not statistically differ in deficient (174 days, P = 0.56) or supplemented (177 days, P = 0.13) folate groups. Dietary folate intake was positively associated with RBC folate levels at weaning, (P = 0.023, 0.0096, and 0.0006 for deficient vs. control, control vs. supplemented, and deficient vs. supplemented groups, respectively). Dorsal root ganglia (DRG), brachial plexi, and sciatic nerves were assessed according to folate group. Mice in the folate deficient group had significantly more enlarged DRG relative to controls (P = 0.044), but no other groups statistically differed. No significant differences for brachial plexi or sciatic nerve enlargement were observed according to folate status.
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Affiliation(s)
- Kyle B Williams
- Department of Pediatrics, Masonic Cancer Center, University of Minnesota - Twin Cities, 515 Delaware St SE, Minneapolis, MN, 55455, USA
| | - Andrew R Marley
- Division of Epidemiology & Clinical Research, Department of Pediatrics, University of Minnesota - Twin Cities, 420 Delaware St SE MMC 715, Minneapolis, MN, 55455, USA
| | - Justin Tibbitts
- Department of Pediatrics, Masonic Cancer Center, University of Minnesota - Twin Cities, 515 Delaware St SE, Minneapolis, MN, 55455, USA
| | - Christopher L Moertel
- Department of Pediatrics, Masonic Cancer Center, University of Minnesota - Twin Cities, 515 Delaware St SE, Minneapolis, MN, 55455, USA
| | - Kimberly J Johnson
- Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Michael A Linden
- Department of Laboratory Medicine and Pathology, Masonic Cancer Center, University of Minnesota - Twin Cities, 420 Delaware St SE, Minneapolis, MN, 55455, USA
| | - David A Largaespada
- Department of Pediatrics, Masonic Cancer Center, University of Minnesota - Twin Cities, 515 Delaware St SE, Minneapolis, MN, 55455, USA
| | - Erin L Marcotte
- Department of Pediatrics, Masonic Cancer Center, University of Minnesota - Twin Cities, 515 Delaware St SE, Minneapolis, MN, 55455, USA.
- Division of Epidemiology & Clinical Research, Department of Pediatrics, University of Minnesota - Twin Cities, 420 Delaware St SE MMC 715, Minneapolis, MN, 55455, USA.
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Podpeskar A, Crazzolara R, Kropshofer G, Hetzer B, Rabensteiner E, Meister B, Obexer P, Salvador C. Recommendations for Nutritional Supplementation in Pediatric Oncology: A Compilation of the Facts. Nutrients 2023; 15:3239. [PMID: 37513658 PMCID: PMC10386187 DOI: 10.3390/nu15143239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND As one of the few modifiable risk factors, the importance of dietary patterns for both disease prevention and treatment outcome in pediatric oncology has gained increasing popularity. Malnutrition is associated with lower survival rates, tolerance to treatment, and quality of life. Yet, especially in children with malignancies, nutritional deterioration is common, and pediatric cancer patients often present with inadequate intake of micro- and macronutrients alike. Despite the reported widespread use of dietary supplements, few empirical data provide a basis for clinical recommendations, and evidence for their efficacy is inconsistent. Current literature lacks a systematic approach as to how and which supplements should be recommended for specific patients, types of cancer, or during specific treatments. The aim of this review is to highlight the role of the most frequently used nutrients in pediatric malignant diseases and to give a practical guide based on current scientific evidence. METHODS A comprehensive literature search was conducted on PubMed through April 2023 to select meta-analyses, systematic reviews, observational studies, and individual randomized controlled trials (RCTs) of macro- and micronutrient supplementation in pediatric oncology. The search strategy included the following medical subject headings (MeSH) and keywords: "childhood cancer", "pediatric oncology", "nutritional status", "dietary supplements", "vitamins", "micronutrients", "calcium", "magnesium", "vitamin D", "zinc" "glutamine", "selen", and "omega-3 fatty acids". The reference lists of all relevant articles were screened to include potentially pertinent studies. RESULTS The present review provides a comprehensive and updated overview of the latest evidence about the role of nutrition and diet in pediatric oncology, also focusing on different nutritional interventions available for the management of the disease. We summarize evidence about the importance of adequate nutrition in childhood cancer and the role of several micronutrients and critically interpret the findings. Possible effects and benefits of supplementation during chemotherapy are discussed, as are strategies for primary and secondary prevention. CONCLUSIONS We here describe the obvious benefits of dietary supplementation for childhood cancer. Further large-scale clinical trials are required to verify the impacts of deficiencies and the possible benefits of supplementation and optimal dosages. (337 words).
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Affiliation(s)
- Alexandra Podpeskar
- Department of Pediatrics I, Division of Hematology and Oncology, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Roman Crazzolara
- Department of Pediatrics I, Division of Hematology and Oncology, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Gabriele Kropshofer
- Department of Pediatrics I, Division of Hematology and Oncology, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Benjamin Hetzer
- Department of Pediatrics I, Division of Hematology and Oncology, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Evelyn Rabensteiner
- Department of Pediatrics I, Division of Hematology and Oncology, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Bernhard Meister
- Department of Pediatrics I, Division of Hematology and Oncology, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Petra Obexer
- Department of Pediatrics II, Institute of Experimental Neonatology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Christina Salvador
- Department of Pediatrics I, Division of Hematology and Oncology, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
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Zhang W, Jiang J, Kang X, Wang C, Chen F, Zhang B, Li S, Huang S, Li W. Dietary B vitamins and glioma: A case-control study based on Chinese population. Front Nutr 2023; 10:1122540. [PMID: 36937346 PMCID: PMC10018137 DOI: 10.3389/fnut.2023.1122540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/16/2023] [Indexed: 03/06/2023] Open
Abstract
Background Dietary antioxidants have long been thought to be likely to prevent the development of gliomas. Previous studies have reported vitamin A, C, and E protective effects against gliomas. B vitamins, one of the main vitamins in the diet, are closely related to human health, but the association with gliomas has rarely been reported. Objective This study aimed to evaluate the relationship between five B vitamins and glioma. Methods In this Chinese population-based case-control study, 506 glioma cases and 506 matched (age and sex) controls were included. The dietary intake of study participants was assessed using a valid 111-item food frequency questionnaire. The intake of five B vitamins was calculated based on participants' dietary information from the food frequency questionnaire. The logistic regression model was used to examine the association between B vitamins and glioma, and the restriction cubic spline evaluated the dose-response relationship between the two. Results After adjusting for confounding factors, thiamine (OR = 0.09, 95%CI: 0.05-0.20), riboflavin (OR = 0.12, 95%CI: 0.06-0.25), nicotinic acid (OR = 0.24, 95%CI: 0.12-0.47), folate (OR = 0.07, 95%CI: 0.03-0.15) and biotin (OR = 0.14, 95%CI: 0.07-0.30) in the highest tertile were associated with a significantly decreased risk of glioma compared with the lowest tertile. The results of thiamine and biotin in glioma with different pathological types and grades were different. The restricted cubic spline function showed significant dose-response relationships between the intake of five B vitamins and the risk of glioma. When B vitamins exceeded a specific intake, the risk of glioma did not change. Conclusion Our study suggests that higher dietary intake of thiamine, riboflavin, nicotinic acid, and folate are associated with a decreased risk of glioma, but the results of biotin are not consistent among different populations. In the future, prospective studies should be conducted better to validate the effects of B vitamins on gliomas.
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Nutraceutical Preventative and Therapeutic Potential in Neuroblastoma: From Pregnancy to Early Childhood. Life (Basel) 2022; 12:life12111762. [DOI: 10.3390/life12111762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 10/26/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
Abstract
Neuroblastoma (NB) is a highly malignant embryonic extracranial solid tumor that arises from sympathoadrenal neuroblasts of neural crest origin. In addition to genetic factors, NB has been linked to maternal exposure to a variety of substances during pregnancy. Recent interest in the potential of nutrients to prevent cancer and reduce malignancy has resulted in the identification of several nutraceuticals including resveratrol, curcumin, and molecular components of garlic, which together with certain vitamins may help to prevent NB development. As NBs arise during fetal development and progress during early childhood, specific NB inhibiting nutraceuticals and vitamins could enhance the preventative influence of maternal nutrition and breast feeding on the development and early progression of NB. In this article, we review NB inhibitory nutraceuticals and vitamins, their mechanisms of action and expound their potential as maternal nutritional supplements to reduce NB development and progression during fetal growth and early childhood, whilst at the same time enhancing maternal, fetal, and infant health.
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Vegrim HM, Dreier JW, Alvestad S, Gilhus NE, Gissler M, Igland J, Leinonen MK, Tomson T, Sun Y, Zoega H, Christensen J, Bjørk MH. Cancer Risk in Children of Mothers With Epilepsy and High-Dose Folic Acid Use During Pregnancy. JAMA Neurol 2022; 79:1130-1138. [PMID: 36156660 PMCID: PMC9513705 DOI: 10.1001/jamaneurol.2022.2977] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/27/2022] [Indexed: 11/14/2022]
Abstract
Importance Women with epilepsy are recommended high doses of folic acid before and during pregnancy owing to risk of congenital anomalies associated with antiseizure medications. Whether prenatal exposure to high-dose folic acid is associated with increases in the risk of childhood cancer is unknown. Objective To assess whether high-dose folic acid supplementation in mothers with epilepsy is associated with childhood cancer. Design, Setting, and Participants Observational cohort study conducted with nationwide registers in Denmark, Norway, and Sweden from 1997 to 2017. Analyses were performed during January 10, 2022, to January 31, 2022. Mother-child pairs were identified in medical birth registers and linked with information from patient, prescription, and cancer registers, as well as with sociodemographic information from statistical agencies, and were categorized by maternal diagnosis of epilepsy. The study population consisted of 3 379 171 children after exclusion of 126 711 children because of stillbirth or missing or erroneous values on important covariates. Exposures Maternal prescription fills for high-dose folic acid tablets (≥1 mg daily) between 90 days before pregnancy start and birth. Main Outcomes and Measures First onset of childhood cancer at younger than 20 years. Cox proportional hazards models were used to calculate adjusted hazard ratios with corresponding 95% CIs, adjusted for potential confounders. Cumulative incidence at aged 20 years was used as a measure of absolute risk. Results The median age at the end of follow-up in the study population of 3 379 171 children was 7.3 years (IQR, 3.5-10.9 years). Among the 27 784 children (51.4% male) born to mothers with epilepsy, 5934 (21.4%) were exposed to high-dose folic acid (mean dose, 4.3 mg), with 18 exposed cancer cases compared with 29 unexposed, producing an adjusted hazard ratio of 2.7 (95% CI, 1.2-6.3), absolute risk if exposed of 1.4% (95% CI, 0.5%-3.6%), and absolute risk if unexposed of 0.6% (95% CI, 0.3%-1.1%). In children of mothers without epilepsy, 46 646 (1.4%) were exposed to high-dose folic acid (mean dose, 2.9 mg), with 69 exposed and 4927 unexposed cancer cases and an adjusted hazard ratio of 1.1 (95% CI, 0.9-1.4; absolute risk, 0.4% [95% CI, 0.3%-0.5%]). There was no association between children born to mothers with epilepsy who were prenatally exposed to antiseizure medications, but not high-dose folic acid, and an increased risk of cancer (absolute risk, 0.6%; 95% CI, 0.2%-1.3%). Conclusions and Relevance Prenatal exposure to high-dose folic acid was associated with increased risk of cancer in children of mothers with epilepsy.
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Affiliation(s)
| | - Julie Werenberg Dreier
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- National Centre for Register-Based Research, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Silje Alvestad
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- National Centre for Epilepsy, Oslo University Hospital, Oslo, Norway
| | - Nils Erik Gilhus
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Mika Gissler
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
- Institute of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Jannicke Igland
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Maarit K. Leinonen
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Torbjörn Tomson
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Yuelian Sun
- National Centre for Register-Based Research, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Helga Zoega
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Jakob Christensen
- National Centre for Register-Based Research, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Marte-Helene Bjørk
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Neurophysiology, Haukeland University Hospital, Bergen, Norway
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Zhang W, Jiang J, He Y, Li X, Yin S, Chen F, Li W. Association between vitamins and risk of brain tumors: A systematic review and dose-response meta-analysis of observational studies. Front Nutr 2022; 9:935706. [PMID: 35967781 PMCID: PMC9372437 DOI: 10.3389/fnut.2022.935706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background Brain tumor is one of the important causes of cancer mortality, and the prognosis is poor. Therefore, early prevention of brain tumors is the key to reducing mortality due to brain tumors. Objective This review aims to quantitatively evaluate the association between vitamins and brain tumors by meta-analysis. Methods We searched articles on PubMed, Cochrane Library, Web of Science, and Embase databases from inception to 19 December 2021. According to heterogeneity, the fixed-effects model or random-effects model was selected to obtain the relative risk of the merger. Based on the methods described by Greenland and Longnecker, we explored the dose-response relationship between vitamins and the risk of brain tumors. Subgroup analysis, sensitivity analysis, and publication bias were also used for the analysis. Results The study reviewed 23 articles, including 1,347,426 controls and 6,449 brain tumor patients. This study included vitamin intake and circulating concentration. For intake, it mainly included vitamin A, vitamin B, vitamin C, vitamin E, β-carotene, and folate. For circulating concentrations, it mainly included vitamin E and vitamin D in the serum (25-hydroxyvitamin D and α-tocopherol). For vitamin intake, compared with the lowest intakes, the highest intakes of vitamin C (RR = 0.81, 95%CI:0.66–0.99, I2 = 54.7%, Pfor heterogeneity = 0.007), β-carotene (RR = 0.78, 95%CI:0.66–0.93, I2 = 0, Pfor heterogeneity = 0.460), and folate (RR = 0.66, 95%CI:0.55–0.80, I2 = 0, Pfor heterogeneity = 0.661) significantly reduced the risk of brain tumors. For serum vitamins, compared with the lowest concentrations, the highest concentrations of serum α-tocopherol (RR = 0.61, 95%CI:0.44–0.86, I2 = 0, Pfor heterogeneity = 0.656) significantly reduced the risk of brain tumors. The results of the dose-response relationship showed that increasing the intake of 100 μg folate per day reduced the risk of brain tumors by 7% (P−nonlinearity = 0.534, RR = 0.93, 95%CI:0.90–0.96). Conclusion Our analysis suggests that the intake of vitamin C, β-carotene, and folate can reduce the risk of brain tumors, while high serum α-tocopherol concentration also has a protective effect on brain tumors. Therefore, vitamins may provide new ideas for the prevention of brain tumors. Systematic Review Registration PROSPERO, identifier CRD42022300683.
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Affiliation(s)
- Weichunbai Zhang
- Department of Neuro-Oncology, Cancer Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jing Jiang
- Department of Neuro-Oncology, Cancer Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yongqi He
- Department of Neuro-Oncology, Cancer Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xinyi Li
- College of Nursing, University of South Florida, Tampa, FL, United States
| | - Shuo Yin
- Department of Neuro-Oncology, Cancer Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Feng Chen
- Department of Neuro-Oncology, Cancer Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wenbin Li
- Department of Neuro-Oncology, Cancer Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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10
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Wilson R, O'Connor D. Maternal folic acid and multivitamin supplementation: International clinical evidence with considerations for the prevention of folate-sensitive birth defects. Prev Med Rep 2021; 24:101617. [PMID: 34976673 PMCID: PMC8684027 DOI: 10.1016/j.pmedr.2021.101617] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 10/18/2021] [Accepted: 10/22/2021] [Indexed: 12/17/2022] Open
Abstract
More evidence is available for maternal intake, absorption, distribution, tissue specific concentrations, and pregnancy outcomes with folic acid (fortification/supplementation) during preconception - first trimester. This Quality Improvement prevention review used expert guidelines/opinions, systematic reviews, randomized control trials/controlled clinical trials, and observational case control/case series studies, published in English, from 1990 to August 2021. Optimization for an oral maternal folic acid supplementation is difficult because it relies on folic acid dose, type of folate supplement, bio-availability of the folate from foods, timing of supplementation initiation, maternal metabolism/genetic factors, and many other factors. There is continued use of high dose pre-food fortification 'RCT evidenced-based' folic acid supplementation for NTD recurrence pregnancy prevention. Innovation requires preconception and pregnancy use of 'carbon one nutrient' supplements (folic acid, vitamin B12, B6, choline), using the appropriate evidence, need to be considered. The consideration and adoption of directed personalized approaches for maternal complex risk could use serum folate testing for supplementation dosing choice. Routine daily folic acid dosing for low-risk women should consider a multivitamin with 0.4 mg of folic acid starting 3 months prior to conception until completion of breastfeeding. Routine folic acid dosing or preconception measurement of maternal serum folate (after 4-6 weeks of folate supplementation) could be considered for maternal complex risk group with genetic/medical/surgical co-morbidities. These new approaches for folic acid oral supplementation are required to optimize benefit (decreasing folate sensitive congenital anomalies; childhood morbidity) and minimizing potential maternal and childhood risk.
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Affiliation(s)
- R.D. Wilson
- Cumming School of Medicine, Department of Obstetrics and Gynecology, University of Calgary, FMC NT 435, 1403 29 St NW, Calgary, Alberta, Canada
| | - D.L. O'Connor
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
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11
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Supplemental folic acid and/or multivitamins in pregnancy is associated with a decreased risk of childhood and adolescent nasopharyngeal carcinoma. J Dev Orig Health Dis 2021; 13:550-555. [PMID: 34779376 DOI: 10.1017/s2040174421000635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The aim of this study was to evaluate the association between prenatal and neonatal period exposures and the risk of childhood and adolescent nasopharyngeal carcinoma (NPC). From January 2009 to January 2016, a total of 46 patients with childhood and adolescent NPC (i.e., less than 18 years of age) who were treated at Sun Yat-sen University Cancer Center were screened as cases, and a total of 45 cancer-free patients who were treated at Sun Yat-sen University Zhongshan Ophthalmic Center were selected as controls. The association between maternal exposures during pregnancy and obstetric variables and the risk of childhood and adolescent NPC was evaluated using logistic regression analysis. Univariate analysis revealed that compared to children and adolescents without a family history of cancer, those with a family history of cancer had a significantly higher risk of childhood and adolescent NPC [odds ratios (OR) = 3.15, 95% confidence interval (CI) = 1.02-9.75, P = 0.046], and the maternal use of folic acid and/or multivitamins during pregnancy was associated with a reduced risk of childhood and adolescent NPC in the offspring (OR = 0.07, 95% CI = 0.02-0.25, P < 0.001). After multivariate analysis, only the maternal use of folic acid and/or multivitamins during pregnancy remained statistically significant. These findings suggest that maternal consumption of folic acid and/or multivitamins during pregnancy is associated with a decreased risk of childhood and adolescent NPC in the offspring.
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12
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Zhao L, Dong Q, Luo C, Wu Y, Bu D, Qi X, Luo Y, Zhao Y. DeepOmix: A scalable and interpretable multi-omics deep learning framework and application in cancer survival analysis. Comput Struct Biotechnol J 2021; 19:2719-2725. [PMID: 34093987 PMCID: PMC8131983 DOI: 10.1016/j.csbj.2021.04.067] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 01/23/2023] Open
Abstract
Integrative analysis of multi-omics data can elucidate valuable insights into complex molecular mechanisms for various diseases. However, due to their different modalities and high dimension, utilizing and integrating different types of omics data suffers from great challenges. There is an urgent need to develop a powerful method to improve survival prediction and detect functional gene modules from multi-omics data. To deal with these problems, we present DeepOmix (a scalable and interpretable multi-Omics Deep learning framework and application in cancer survival analysis), a flexible, scalable, and interpretable method for extracting relationships between the clinical survival time and multi-omics data based on a deep learning framework. DeepOmix enables the non-linear combination of variables from different omics datasets and incorporates prior biological information defined by users (such as signaling pathways and tissue networks). Benchmark experiments demonstrate that DeepOmix outperforms the other five cutting-edge prediction methods. Besides, Lower Grade Glioma (LGG) is taken as the case study to perform the prognosis prediction and illustrate the functional module nodes which are associated with the prognostic result in the prediction model.
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Affiliation(s)
- Lianhe Zhao
- Key Laboratory of Intelligent Information Processing, Advanced Computer Research Center, Institute of Computing Technology, Chinese Academy of Sciences, Beijing 100190, China.,University of Chinese Academy of Sciences, Beijing 100049, China
| | - Qiongye Dong
- Key Laboratory of Intelligent Information Processing, Advanced Computer Research Center, Institute of Computing Technology, Chinese Academy of Sciences, Beijing 100190, China
| | - Chunlong Luo
- Key Laboratory of Intelligent Information Processing, Advanced Computer Research Center, Institute of Computing Technology, Chinese Academy of Sciences, Beijing 100190, China.,University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yang Wu
- Key Laboratory of Intelligent Information Processing, Advanced Computer Research Center, Institute of Computing Technology, Chinese Academy of Sciences, Beijing 100190, China
| | - Dechao Bu
- Key Laboratory of Intelligent Information Processing, Advanced Computer Research Center, Institute of Computing Technology, Chinese Academy of Sciences, Beijing 100190, China
| | - Xiaoning Qi
- Key Laboratory of Intelligent Information Processing, Advanced Computer Research Center, Institute of Computing Technology, Chinese Academy of Sciences, Beijing 100190, China.,University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yufan Luo
- Key Laboratory of Intelligent Information Processing, Advanced Computer Research Center, Institute of Computing Technology, Chinese Academy of Sciences, Beijing 100190, China.,University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yi Zhao
- Key Laboratory of Intelligent Information Processing, Advanced Computer Research Center, Institute of Computing Technology, Chinese Academy of Sciences, Beijing 100190, China.,Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo 315000, China
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13
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Heck JE, Lee PC, Wu CK, Li CY, He D, Federman N, Yu F, Olsen J, Ritz B, Arah OA, Hansen J. Spina bifida and pediatric cancers. Pediatr Hematol Oncol 2020; 37:630-636. [PMID: 32364426 PMCID: PMC7577564 DOI: 10.1080/08880018.2020.1760409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Spina bifida has been reported to co-occur with pediatric cancer, but comprehensive evaluations remained elusive. We investigated this co-occurrence in two large, population-based studies in Taiwan (N = 1900 cancer cases, 2,077,137 controls) and Denmark (N = 5508 cases, 137,700 controls). Analyses in Denmark were restricted to the period before prenatal diagnostics became available (2004) and pregnancy terminations of fetuses with birth defects became more common. Using national patient and cancer registries, we linked spina bifida and cancer diagnoses among cases and non-cases. The risk of spina bifida among all cancer cases was increased and similar in Denmark [odds ratio (OR)=8.4, 95% confidence interval (CI) 5.1-13.8] and Taiwan (OR = 8.5, 95% CI 4.0-17.8), particularly for central nervous system (CNS) tumors (Denmark: OR = 16.3, 95% CI 8.1-33.0; Taiwan: OR = 26.6, 95% CI 8.5, 83.1), including benign CNS tumors (Denmark: OR = 41.5, 95% CI 21.2, 81.4). These findings suggest the need for comprehensive investigation of shared risk factors in the link between spina bifida and pediatric cancer.
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Affiliation(s)
- Julia E. Heck
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.,Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, CA, USA
| | - Pei-Chen Lee
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Chia-Kai Wu
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Di He
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Noah Federman
- Department of Pediatrics, Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Fei Yu
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Jorn Olsen
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.,Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Beate Ritz
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Onyebuchi A. Arah
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Johnni Hansen
- Danish Cancer Society Research Center, Copenhagen, Denmark
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14
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Doganis D, Katsimpris A, Panagopoulou P, Bouka P, Bouka E, Moschovi M, Polychronopoulou S, Papakonstantinou E, Tragiannidis A, Katzilakis N, Dana H, Antoniadi K, Stefanaki K, Strantzia K, Dessypris N, Schüz J, Petridou ET. Maternal lifestyle characteristics and Wilms tumor risk in the offspring: A systematic review and meta-analysis. Cancer Epidemiol 2020; 67:101769. [PMID: 32659726 DOI: 10.1016/j.canep.2020.101769] [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: 01/15/2020] [Revised: 06/06/2020] [Accepted: 06/13/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Little is known about the etiology of childhood Wilms tumor (WT) and potentially modifiable maternal risk factors, in particular. METHODS Unpublished data derived from the hospital-based, case-control study of the Greek Nationwide Registry for Childhood Hematological Malignancies and Solid Tumors (NARECHEM-ST) were included in an ad hoc conducted systematic literature review and meta-analyses examining the association between modifiable maternal lifestyle risk factors and WT. Eligible data were meta-analysed in separate strands regarding the associations of WT with (a) maternal folic acid and/or vitamins supplementation, (b) alcohol consumption and (c) smoking during pregnancy. The quality of eligible studies was evaluated using the Newcastle-Ottawa Scale. RESULTS Effect estimates from 72 cases and 72 age- and sex-matched controls contributed by NARECHEM-ST were meta-analysed together with those of another 17, mainly medium size, studies of ecological, case-control and cohort design. Maternal intake of folic acid and/or other vitamins supplements during pregnancy was inversely associated with WT risk (6 studies, OR: 0.78; 95 %CI: 0.69-0.89, I2 = 5.4 %); of similar size was the association for folic acid intake alone (4 studies, OR: 0.79; 95 %CI: 0.69-0.91, I2 = 0.0 %), derived mainly from ecological studies. In the Greek study a positive association (OR: 5.31; 95 %CI: 2.00-14.10) was found for mothers who consumed alcohol only before pregnancy vs. never drinkers whereas in the meta-analysis of the four homogeneous studies examining the effect of alcohol consumption during pregnancy the respective overall result showed an OR: 1.60 (4 studies, 95 %CI: 1.28-2.01, I2 = 0.0 %). Lastly, no association was seen with maternal smoking during pregnancy (14 studies, OR: 0.93; 95 %CI: 0.80-1.09, I2 = 0.0 %). CONCLUSIONS In the largest to-date meta-analysis, there was an inverse association of maternal folic acid or vitamins supplementation with WT risk in the offspring, derived mainly from ecological studies. The association with maternal alcohol consumption found in our study needs to be further explored whereas no association with maternal smoking was detected. Given the proven benefits for other health conditions, recommendations regarding folic acid supplementation as well as smoking and alcohol cessation should apply. The maternal alcohol consumption associations, however, should be further explored given the inherent limitations in the assessment of exposures of the published studies.
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Affiliation(s)
- Dimitrios Doganis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece; Oncology Department, "P & A Kyriakou" Children's Hospital, Athens, Greece
| | - Andreas Katsimpris
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Paraskevi Panagopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece; 4th Department of Pediatrics, Aristotle University of Thessaloniki, Greece
| | - Panagiota Bouka
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Evdoxia Bouka
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Maria Moschovi
- Pediatric Hematology-Oncology Unit, First Department of Pediatrics, National and Kapodistrian University of Athens, "Agia Sofia" Children's Hospital, Athens, Greece
| | - Sofia Polychronopoulou
- Department of Pediatric Hematology-Oncology, "Agia Sofia" Children's Hospital, Athens, Greece
| | | | - Athanasios Tragiannidis
- Hematology-Oncology Unit, 2nd Pediatric Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Nick Katzilakis
- Department of Pediatric Hematology-Oncology, University of Crete, University of Crete General Hospital, Heraklion, Greece
| | - Helen Dana
- Pediatric Hematology-Oncology Department, "Mitera" Children's Hospital, Athens, Greece
| | - Kondilia Antoniadi
- Department of Pediatric Hematology-Oncology, "Agia Sofia" Children's Hospital, Athens, Greece
| | | | - Katerina Strantzia
- Pathology Laboratory, "P & A. Kyriakou" Children's Hospital, Athens, Greece
| | - Nick Dessypris
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Joachim Schüz
- International Agency for Research on Cancer (IARC/WHO), Section of Environment and Radiation, Lyon, France
| | - Eleni Th Petridou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece; Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden.
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15
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Sharma J, Krupenko SA. Folate pathways mediating the effects of ethanol in tumorigenesis. Chem Biol Interact 2020; 324:109091. [PMID: 32283069 DOI: 10.1016/j.cbi.2020.109091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 04/02/2020] [Indexed: 02/08/2023]
Abstract
Folate and alcohol are dietary factors affecting the risk of cancer development in humans. The interaction between folate status and alcohol consumption in carcinogenesis involves multiple mechanisms. Alcoholism is typically associated with folate deficiency due to reduced dietary folate intake. Heavy alcohol consumption also decreases folate absorption, enhances urinary folate excretion and inhibits enzymes pivotal for one-carbon metabolism. While folate metabolism is involved in several key biochemical pathways, aberrant DNA methylation, due to the deficiency of methyl donors, is considered as a common downstream target of the folate-mediated effects of ethanol. The negative effects of low intakes of nutrients that provide dietary methyl groups, with high intakes of alcohol are additive in general. For example, low methionine, low-folate diets coupled with alcohol consumption could increase the risk for colorectal cancer in men. To counteract the negative effects of alcohol consumption, increased intake of nutrients, such as folate, providing dietary methyl groups is generally recommended. Here mechanisms involving dietary folate and folate metabolism in cancer disease, as well as links between these mechanisms and alcohol effects, are discussed. These mechanisms include direct effects on folate pathways and indirect mediation by oxidative stress, hypoxia, and microRNAs.
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Affiliation(s)
- Jaspreet Sharma
- Nutrition Research Institute and Department of Nutrition, University of North Carolina, Chapel Hill, USA
| | - Sergey A Krupenko
- Nutrition Research Institute and Department of Nutrition, University of North Carolina, Chapel Hill, USA; Department of Nutrition, University of North Carolina, Chapel Hill, USA.
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16
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Bauer H, Rios P, Schleiermacher G, Valteau-Couanet D, Bertozzi AI, Thebaud E, Gandemer V, Pellier I, Verschuur A, Spiegel A, Notz-Carrere A, Bergeron C, Orsi L, Lacour B, Clavel J. Maternal and perinatal characteristics, congenital malformations and the risk of wilms tumor: the ESTELLE study. Cancer Causes Control 2020; 31:491-501. [PMID: 32144681 DOI: 10.1007/s10552-020-01288-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 02/24/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Wilms tumor (WT), or nephroblastoma, is an embryonic tumor that constitutes the most common renal tumor in children. Little is known about the etiology of WT. The aim of this study was to investigate whether maternal or perinatal characteristics were associated with the risk of WT. METHODS The ESTELLE study is a national-based case-control study that included 117 cases of WT and 1,100 controls younger than 11 years old. The cases were children diagnosed in France in 2010-2011 and the controls were frequency matched with cases by age and gender. The mothers of case and control children responded to a telephone questionnaire addressing sociodemographic and perinatal characteristics, childhood environment, and lifestyle. Unconditional logistic regression models adjusted on potential cofounders were used to estimate the odds ratios (OR) and their confidence intervals (95% CI). RESULTS High birth weight and the presence of congenital malformation were associated with WT (OR 1.9 [95% CI 1.0-3.7] and OR 2.5 [95% CI 1.1-5.8], respectively). No association with breastfeeding or folic acid supplementation was observed. CONCLUSIONS Although potential recall bias cannot be excluded, our findings reinforce the hypothesis that high birth weight and the presence of congenital malformation may be associated with an increased risk of WT. Further investigations are needed to further elucidate the possible role of maternal characteristics in the etiology of WT.
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Affiliation(s)
- Hélène Bauer
- CRESS, UMR1153, INSERM, Université de Paris, Villejuif, France
| | - Paula Rios
- CRESS, UMR1153, INSERM, Université de Paris, Villejuif, France.
| | | | - Dominique Valteau-Couanet
- Children and Adolescent Cancerology Department, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | | | | | | | | | | | | | | | | | - Laurent Orsi
- CRESS, UMR1153, INSERM, Université de Paris, Villejuif, France
| | - Brigitte Lacour
- CRESS, UMR1153, INSERM, Université de Paris, Villejuif, France.,National Registry of Childhood Cancers, APHP, CHU Paul Brousse, Villejuif, France.,CHU de Nancy, Nancy, France
| | - Jacqueline Clavel
- CRESS, UMR1153, INSERM, Université de Paris, Villejuif, France.,National Registry of Childhood Cancers, APHP, CHU Paul Brousse, Villejuif, France.,CHU de Nancy, Nancy, France
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17
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Wan Ismail WR, Abdul Rahman R, Rahman NAA, Atil A, Nawi AM. The Protective Effect of Maternal Folic Acid Supplementation on Childhood Cancer: A Systematic Review and Meta-analysis of Case-control Studies. J Prev Med Public Health 2019; 52:205-213. [PMID: 31390683 PMCID: PMC6686110 DOI: 10.3961/jpmph.19.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 06/13/2019] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Maternal folic acid supplementation is considered mandatory in almost every country in the world to prevent congenital malformations. However, little is known about the association of maternal folic acid intake with the occurrence of childhood cancer. Hence, this study aimed to determine the effects of maternal folic acid consumption on the risk of childhood cancer. METHODS A total of 158 related articles were obtained from PubMed, Google Scholar, Scopus, and ProQuest using standardized keywords, of which 17 were included in the final review. RESULTS Eleven of the 17 articles showed a significant protective association between maternal folic acid supplementation and childhood cancer. Using a random-effects model, pooled odds ratios (ORs) showed a protective association between maternal folic acid supplementation and childhood acute lymphoblastic leukaemia (OR, 0.75; 95% confidence interval [CI], 0.66 to 0.86). However, there was no significant association between maternal folic acid supplementation and acute myeloid leukaemia (OR, 0.70; 95% CI, 0.46 to 1.06) or childhood brain tumours (OR, 1.02; 95% CI, 0.88 to 1.19). CONCLUSIONS Maternal folic acid supplementation was found to have a protective effect against childhood acute lymphoblastic leukaemia. Thus, healthcare professionals are recommended to provide regular health education and health promotion to the community on the benefits of folic acid supplementation during pregnancy.
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Affiliation(s)
- Wan Rosmawati Wan Ismail
- Department of Community Health, Faculty of Medicine, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Raudah Abdul Rahman
- Department of Community Health, Faculty of Medicine, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Nur Ashiqin Abd Rahman
- Department of Community Health, Faculty of Medicine, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Azman Atil
- Department of Community Health, Faculty of Medicine, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
- Department of Community Health, Faculty of Medicine, University Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Azmawati Mohammed Nawi
- Department of Community Health, Faculty of Medicine, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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18
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Abstract
Folate has been studied in relation to many diseases, especially cancer. Although it has been postulated to exert a dual effect on development of cancer, its role remains to be clearly defined. Its effect on cancer is the result of gene-nutrient interaction between the genes in folate metabolic pathway and dietary folate availability; mutations in genes of folate metabolism have been shown to alter individual susceptibility to certain childhood cancers as well as response to cancer chemotherapy. Although mandatory fortification of food items with folate has been initiated in some countries, many countries are yet to adopt this due to concerns about undesired adverse effects of high folate levels on health, especially cancer. However, initial reports suggest that folate fortification has led to reduction in incidence of certain childhood cancers such as neuroblastoma, wilms tumour and leukaemias. Despite studies showing folate depletion during antifolate chemotherapy and higher toxicity of chemotherapy in folate-depleted individuals, folate supplementation during cancer chemotherapy is not routinely recommended. Studies investigating the precise effect of folate supplementation during chemotherapy on both short- and long-term outcomes of cancer are needed to arrive at a consensus guideline.
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Affiliation(s)
- Nirmalya Roy Moulik
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, King George's Medical University, Lucknow, India
| | - Archana Kumar
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, King George's Medical University, Lucknow, India
| | - Suraksha Agrawal
- Department of Medical Genetics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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19
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Georgakis MK, Ntinopoulou E, Chatzopoulou D, Petridou ET. Season of birth and primary central nervous system tumors: a systematic review of the literature with critical appraisal of underlying mechanisms. Ann Epidemiol 2017; 27:593-602.e3. [DOI: 10.1016/j.annepidem.2017.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Revised: 07/20/2017] [Accepted: 08/15/2017] [Indexed: 01/28/2023]
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Johnson KJ, Lee JM, Ahsan K, Padda H, Feng Q, Partap S, Fowler SA, Druley TE. Pediatric cancer risk in association with birth defects: A systematic review. PLoS One 2017; 12:e0181246. [PMID: 28749971 PMCID: PMC5716403 DOI: 10.1371/journal.pone.0181246] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/28/2017] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Many epidemiological studies have examined associations between birth defects (BDs) and pediatric malignancy over the past several decades. Our objective was to conduct a systematic literature review of studies reporting on this association. METHODS We used librarian-designed searches of the PubMed Medline and Embase databases to identify primary research articles on pediatric neoplasms and BDs. English language articles from PubMed and Embase up to 10/12/2015, and in PubMed up to 5/12/2017 following an updated search, were eligible for inclusion if they reported primary epidemiological research results on associations between BDs and pediatric malignancies. Two reviewers coded each article based on the title and abstract to identify eligible articles that were abstracted using a structured form. Additional articles were identified through reference lists and other sources. Results were synthesized for pediatric cancers overall and for nine major pediatric cancer subtypes. RESULTS A total of 14,778 article citations were identified, of which 80 met inclusion criteria. Pediatric cancer risk was increased in most studies in association with BDs overall with some notable specific findings, including increased risks for CNS tumors in association with CNS abnormalities and positive associations between rib anomalies and several pediatric cancer types. CONCLUSIONS Some children born with BDs may be at increased risk for specific pediatric malignancy types. This work provides a foundation for future investigations that are needed to clarify specific BD types predisposing toward malignancy and possible underlying causes of both BDs and malignancy.
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Affiliation(s)
- Kimberly J. Johnson
- Brown School, Washington University in St. Louis, St. Louis, Missouri,
United States of America
- Department of Pediatrics, Washington University School of Medicine,
Washington University in St. Louis, St. Louis, Missouri, United States of
America
- * E-mail:
| | - Jong Min Lee
- Brown School, Washington University in St. Louis, St. Louis, Missouri,
United States of America
| | - Kazi Ahsan
- Brown School, Washington University in St. Louis, St. Louis, Missouri,
United States of America
| | - Hannah Padda
- Brown School, Washington University in St. Louis, St. Louis, Missouri,
United States of America
| | - Qianxi Feng
- Brown School, Washington University in St. Louis, St. Louis, Missouri,
United States of America
| | - Sonia Partap
- Department of Neurology, Stanford University, Palo Alto, California,
United States of America
| | - Susan A. Fowler
- Brown School, Washington University in St. Louis, St. Louis, Missouri,
United States of America
| | - Todd E. Druley
- Department of Pediatrics, Washington University School of Medicine,
Washington University in St. Louis, St. Louis, Missouri, United States of
America
- Division of Pediatric Hematology and Oncology, Washington University
School of Medicine, Washington University in St. Louis, St. Louis, Missouri,
United States of America
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Silva C, Keating E, Pinto E. The impact of folic acid supplementation on gestational and long term health: Critical temporal windows, benefits and risks. Porto Biomed J 2017; 2:315-332. [PMID: 32258789 DOI: 10.1016/j.pbj.2017.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 05/10/2017] [Accepted: 05/31/2017] [Indexed: 01/23/2023] Open
Abstract
Highlights Associations between FA supplementation in pregnancy and effects on offspring's NTDs, allergy/respiratory problems, cancer and behaviour problems as been studied.There is growing concern about the effects of excessive FA supplementation, whether in terms of doses or times of exposure.FA supplementation in the periconceptional period is protective against NTDs while in later periods it could be deleterious.A daily dose of 0.4 mg FA in the periconceptional period seems to be effective and safe. Abstract Maternal folic acid (FA) supplementation is one of the most popular nutritional interventions during pregnancy for its protective effect against neural tube defects (NTDs).The purposes of this review are: (a) to gather the current evidence regarding supplementation of maternal diet with FA and (b) to problematize the available literature in terms of dosages, critical temporal windows, and its potential benefits and risks.The expression (pregnancy OR fetus OR offspring OR mother) AND ("folic acid" AND supplementation) was searched on PubMed database, filtering for articles published from 2005 to 2014. Publications referring to FA supplementation during the periconceptional period or pregnancy in which there was a conclusion about the effects of isolated FA supplementation on pregnant woman, pregnancy or offspring were included. Of the initial 1182 papers, 109 fulfilled the inclusion criteria.The majority of the publications reported FA supplementation outcomes on offspring's health, with emphasis in NTDs, allergy/respiratory problems, cancer and behaviour problems. Some inconsistency is observed on the impact of FA supplementation on different outcomes, except for NTDs. It is also visible an increased concern about the impact of excessive supplementation, either in terms of doses or exposure's duration.In conclusion, there is a growing interest in FA supplementation issues. The protective effect of FA supplementation over NTDs has been confirmed, being the periconceptional period a critical window, and it is frequently suggested that allergy/respiratory outcomes arise from (excessive) FA supplementation particularly later in pregnancy. Further research on critical doses and time of exposure should be conducted.
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Affiliation(s)
- Carla Silva
- Faculty of Medicine of University of Porto, Porto, Portugal
| | - Elisa Keating
- Department of Biomedicine - Biochemistry Unit, Faculty of Medicine of University of Porto, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - Elisabete Pinto
- CBQF - Centre of Biotechnology and Fine Chemistry - School of Biotechnology, Portuguese Catholic University, Porto, Portugal.,Institute of Public Health of the University of Porto, Porto, Portugal
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22
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McKay JA, Xie L, Adriaens M, Evelo CT, Ford D, Mathers JC. Maternal folate depletion during early development and high fat feeding from weaning elicit similar changes in gene expression, but not in DNA methylation, in adult offspring. Mol Nutr Food Res 2017; 61. [DOI: 10.1002/mnfr.201600713] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/21/2016] [Accepted: 11/21/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Jill A. McKay
- Human Nutrition Research Centre; Institute for Health and Society; Newcastle University; UK
| | - Long Xie
- Human Nutrition Research Centre, Institute of Cellular Medicine; Newcastle University; UK
| | - Michiel Adriaens
- Maastricht Centre for Systems Biology; Maastricht The Netherlands
| | - Chris T. Evelo
- Department of Bioinformatics - BiGCaT; Maastricht University; Maastricht The Netherlands
| | - Dianne Ford
- Human Nutrition Research Centre, Institute for Cell and Molecular Biosciences; Newcastle University; UK
- Faculty of Health and Life Sciences; Northumbria University; UK
| | - John C. Mathers
- Human Nutrition Research Centre, Institute of Cellular Medicine; Newcastle University; UK
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Bailey HD, Rios P, Lacour B, Guerrini‐Rousseau L, Bertozzi A, Leblond P, Faure‐Conter C, Pellier I, Freycon C, Michon J, Puget S, Ducassou S, Orsi L, Clavel J. Factors related to pregnancy and birth and the risk of childhood brain tumours: The ESTELLE and ESCALE studies (SFCE, France). Int J Cancer 2017; 140:1757-1769. [DOI: 10.1002/ijc.30597] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 11/22/2016] [Accepted: 12/09/2016] [Indexed: 12/26/2022]
Affiliation(s)
- Helen D. Bailey
- INSERM, Université Paris‐Descartes, Université Sorbonne‐Paris‐Cité, CRESS‐EPICEA Epidémiologie des cancers de l'enfant et de l'adolescentParis France
| | - Paula Rios
- INSERM, Université Paris‐Descartes, Université Sorbonne‐Paris‐Cité, CRESS‐EPICEA Epidémiologie des cancers de l'enfant et de l'adolescentParis France
| | - Brigitte Lacour
- INSERM, Université Paris‐Descartes, Université Sorbonne‐Paris‐Cité, CRESS‐EPICEA Epidémiologie des cancers de l'enfant et de l'adolescentParis France
- RNCE ‐ National Registry of Childhood Cancers, Inserm, Villejuif and CHU de Nancy France
| | - Léa Guerrini‐Rousseau
- Département de cancérologie de l'enfant et de l'adolescentGustave RoussyVillejuif France
| | | | - Pierre Leblond
- Pediatric Oncology Unit, Oscar Lambret Comprehensive Cancer CenterLille France
| | - Cécile Faure‐Conter
- Institut d'hématologie et d'oncologie pédiatrique, IHOPe, Centre Léon BérardLyon France
| | - Isabelle Pellier
- Hématologie Oncologie et Immunologie pédiatrique, Inserm UMR U1232, CHU d'AngersAngers France
| | - Claire Freycon
- Clinique de pédiatrieHôpital Couple Enfant, CHU Grenoble‐AlpesGrenoble France
| | - Jean Michon
- Département de Pédiatrie ‐Adolescents et Jeunes Adultes, Institut CurieParis France
| | - Stéphanie Puget
- Service de neurochirurgie pédiatrique, Hôpital Necker‐Enfants malades, Université Paris Descartes, Sorbonne Paris CitéParis France
| | - Stéphane Ducassou
- Service d'onco‐hématologie pédiatrique, Hôpital Pellegrin TripodeBordeaux France
| | - Laurent Orsi
- INSERM, Université Paris‐Descartes, Université Sorbonne‐Paris‐Cité, CRESS‐EPICEA Epidémiologie des cancers de l'enfant et de l'adolescentParis France
| | - Jacqueline Clavel
- INSERM, Université Paris‐Descartes, Université Sorbonne‐Paris‐Cité, CRESS‐EPICEA Epidémiologie des cancers de l'enfant et de l'adolescentParis France
- RNCE ‐ National Registry of Childhood Cancers, Inserm, Villejuif and CHU de Nancy France
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Wilson RD. Supplémentation préconceptionnelle en acide folique / multivitamines pour la prévention primaire et secondaire des anomalies du tube neural et d'autres anomalies congénitales sensibles à l'acide folique. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 38:S646-S664. [PMID: 28063572 DOI: 10.1016/j.jogc.2016.09.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIF Offrir des renseignements à jour sur l'utilisation pré et postconceptionnelle d'acide folique par voie orale, avec ou sans supplément de multivitamines / micronutriments, aux fins de la prévention des anomalies du tube neural et d'autres anomalies congénitales. Ces renseignements aideront les médecins, les sages-femmes, les infirmières et les autres professionnels de la santé à contribuer aux efforts de sensibilisation des femmes quant à l'utilisation et aux posologies adéquates de la supplémentation en acide folique / multivitamines, avant et pendant la grossesse. RéSULTATS: La littérature publiée a été récupérée par l'intermédiaire de recherches menées dans PubMed, Medline, CINAHL et la Cochrane Library en janvier 2011 au moyen d'un vocabulaire contrôlé et de mots clés appropriés (p. ex. « folic acid », « prenatal multivitamins », « folate sensitive birth defects », « congenital anomaly risk reduction », « pre-conception counselling »). Les résultats ont été restreints aux analyses systématiques, aux études observationnelles et aux essais comparatifs randomisés / essais cliniques comparatifs publiés en anglais entre 1985 et juin 2014. Les recherches ont été mises à jour de façon régulière et intégrées à la directive clinique jusqu'en juin 2014. La littérature grise (non publiée) a été identifiée par l'intermédiaire de recherches menées dans les sites Web d'organismes s'intéressant à l'évaluation des technologies dans le domaine de la santé et d'organismes connexes, dans des collections de directives cliniques, dans des registres d'essais cliniques, et auprès de sociétés de spécialité médicale nationales et internationales. COûTS, RISQUES ET AVANTAGES: Les coûts financiers sont ceux de la supplémentation quotidienne en vitamines et de la consommation d'un régime alimentaire santé enrichi en folate. Les risques sont ceux qui sont liés à une association signalée entre la supplémentation alimentaire en acide folique et des modifications épigénétiques fœtales / la probabilité accrue d'obtenir une grossesse gémellaire. Ces associations pourraient devoir être prises en considération avant la mise en œuvre d'une supplémentation en acide folique. La supplémentation en acide folique par voie orale (ou l'apport alimentaire en folate combiné à un supplément de multivitamines / micronutriments) a pour avantage de mener à une baisse connexe du taux d'anomalies du tube neural et peut-être même des taux d'autres complications obstétricales et anomalies congénitales particulières. VALEURS La qualité des résultats est évaluée au moyen des critères décrits par le Groupe d'étude canadien sur les soins de santé préventifs (Tableau 1). DéCLARATION SOMMAIRE: RECOMMANDATIONS.
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Gonseth S, Roy R, Houseman EA, de Smith AJ, Zhou M, Lee ST, Nusslé S, Singer AW, Wrensch MR, Metayer C, Wiemels JL. Periconceptional folate consumption is associated with neonatal DNA methylation modifications in neural crest regulatory and cancer development genes. Epigenetics 2016; 10:1166-76. [PMID: 26646725 DOI: 10.1080/15592294.2015.1117889] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Folate deficiency during early embryonic development constitutes a risk factor for neural tube defects and potentially for childhood leukemia via unknown mechanisms. We tested whether folate consumption during the 12 months prior to conception induced DNA methylation modifications at birth in healthy neonates with a genome-wide and agnostic approach. We hypothesized that DNA methylation in genes involved in neural tube development and/or cancer susceptibility would be affected by folate exposure. We retrospectively assessed folate exposure at the time of conception by food-frequency questionnaires administered to the mothers of 343 healthy newborns. We measured genome-wide DNA methylation from neonatal blood spots. We implemented a method based on bootstrap resampling to decrease false-positive findings. Folate was inversely associated with DNA methylation throughout the genome. Among the top folate-associated genes that were replicated in an independent Gambian study were TFAP2A, a gene critical for neural crest development, STX11, a gene implicated in acute myeloid leukemia, and CYS1, a candidate gene for cystic kidney disease. Reduced periconceptional folate intake was associated with increased methylation and, in turn, decreased gene expression at these 3 loci. The top folate-sensitive genes defined by their associated CpG sites were enriched for numerous transcription factors by Gene Set Enrichment Analysis, including those implicated in cancer development (e.g., MYC-associated zinc finger protein). The influence of estimated periconceptional folate intake on neonatal DNA methylation levels provides potential mechanistic insights into the role of this vitamin in the development of neural tube defects and childhood cancers.
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Affiliation(s)
- Semira Gonseth
- a Department of Epidemiology and Biostatistics ; Laboratory for Molecular Epidemiology; University of California ; San Francisco , CA , USA
| | - Ritu Roy
- b Computational Biology Core; HDF Comprehensive Cancer Center; University of California ; San Francisco , CA , USA
| | - E Andres Houseman
- c College of Public Health and Human Sciences; Oregon State University ; Corvallis , OR , USA
| | - Adam J de Smith
- a Department of Epidemiology and Biostatistics ; Laboratory for Molecular Epidemiology; University of California ; San Francisco , CA , USA
| | - Mi Zhou
- a Department of Epidemiology and Biostatistics ; Laboratory for Molecular Epidemiology; University of California ; San Francisco , CA , USA
| | - Seung-Tae Lee
- d Department of Laboratory Medicine ; Yonsei University College of Medicine ; Seoul , Republic of Korea
| | - Sébastien Nusslé
- e Department of Environmental Science ; Policy & Management; University of California ; Berkeley , CA , USA
| | - Amanda W Singer
- f School of Public Health; University of California ; Berkeley , CA , USA
| | - Margaret R Wrensch
- g Department of Neurological Surgery ; University of California ; San Francisco , CA , USA
| | - Catherine Metayer
- f School of Public Health; University of California ; Berkeley , CA , USA
| | - Joseph L Wiemels
- a Department of Epidemiology and Biostatistics ; Laboratory for Molecular Epidemiology; University of California ; San Francisco , CA , USA
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Organ-Specific Gene Expression Changes in the Fetal Liver and Placenta in Response to Maternal Folate Depletion. Nutrients 2016; 8:nu8100661. [PMID: 27782079 PMCID: PMC5084047 DOI: 10.3390/nu8100661] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 10/13/2016] [Accepted: 10/14/2016] [Indexed: 01/25/2023] Open
Abstract
Growing evidence supports the hypothesis that the in utero environment can have profound implications for fetal development and later life offspring health. Current theory suggests conditions experienced in utero prepare, or "programme", the fetus for its anticipated post-natal environment. The mechanisms responsible for these programming events are poorly understood but are likely to involve gene expression changes. Folate is essential for normal fetal development and inadequate maternal folate supply during pregnancy has long term adverse effects for offspring. We tested the hypothesis that folate depletion during pregnancy alters offspring programming through altered gene expression. Female C57BL/6J mice were fed diets containing 2 mg or 0.4 mg folic acid/kg for 4 weeks before mating and throughout pregnancy. At 17.5 day gestation, genome-wide gene expression was measured in male fetal livers and placentas. In the fetal liver, 989 genes were expressed differentially (555 up-regulated, 434 down-regulated) in response to maternal folate depletion, with 460 genes expressed differentially (250 up-regulated, 255 down-regulated) in the placenta. Only 25 differentially expressed genes were common between organs. Maternal folate intake during pregnancy influences fetal gene expression in a highly organ specific manner which may reflect organ-specific functions.
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McKay JA, Adriaens M, Evelo CT, Ford D, Mathers JC. Gene promoter DNA methylation patterns have a limited role in orchestrating transcriptional changes in the fetal liver in response to maternal folate depletion during pregnancy. Mol Nutr Food Res 2016; 60:2031-42. [PMID: 27133805 PMCID: PMC5031189 DOI: 10.1002/mnfr.201600079] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/15/2016] [Accepted: 04/04/2016] [Indexed: 12/12/2022]
Abstract
SCOPE Early-life exposures are critical in fetal programming and may influence function and health in later life. Adequate maternal folate consumption during pregnancy is essential for healthy fetal development and long-term offspring health. The mechanisms underlying fetal programming are poorly understood, but are likely to involve gene regulation. Epigenetic marks, including DNA methylation, regulate gene expression and are modifiable by folate supply. We observed transcriptional changes in fetal liver in response to maternal folate depletion and hypothesized that these changes are concomitant with altered gene promoter methylation. METHODS AND RESULTS Female C57BL/6J mice were fed diets containing 2 or 0.4 mg folic acid/kg for 4 wk before mating and throughout pregnancy. At 17.5-day gestation, genome-wide gene expression and promoter methylation were measured by microarray analysis in male fetal livers. While 989 genes were differentially expressed, 333 promoters had altered methylation (247 hypermethylated, 86 hypomethylated) in response to maternal folate depletion. Only 16 genes had both expression and methylation changes. However, most methylation changes occurred in genomic regions neighboring expression changes. CONCLUSION In response to maternal folate depletion, altered expression at the mRNA level was not associated with altered promoter methylation of the same gene in fetal liver.
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Affiliation(s)
- Jill A McKay
- Human Nutrition Research Centre, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
| | - Michiel Adriaens
- Maastricht Centre for Systems Biology-MaCSBio, Maastricht University, Maastricht, the Netherlands
| | - Chris T Evelo
- Department of Bioinformatics-BiGCaT, Maastricht University, Maastricht, the Netherlands
| | - Dianne Ford
- Human Nutrition Research Centre, Institute for Cell and Molecular Biosciences, Newcastle University, Newcastle upon Tyne, UK
| | - John C Mathers
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
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Supplemental folic acid in pregnancy and childhood cancer risk. Br J Cancer 2016; 114:71-5. [PMID: 26757423 PMCID: PMC4716548 DOI: 10.1038/bjc.2015.446] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 11/23/2015] [Accepted: 11/30/2015] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND We investigated the association between supplemental folic acid in pregnancy and childhood cancer in a nation-wide study of 687 406 live births in Norway, 1999-2010, and 799 children diagnosed later with cancer. METHODS Adjusted hazard ratios (HRs) compared cancer risk in children by approximated periconceptional folic acid levels (folic acid tablets and multivitamins (0.6 mg), only folic acid (0.4 mg), only multivitamins (0.2 mg)) and cancer risk in unexposed. RESULTS Any folic acid levels were not associated with leukemia (e.g., high-level folic acid HR 1.25; 95% CI 0.89-1.76, PTrend 0.20), lymphoma (HR 0.96; 95% CI 0.42-2.21, PTrend 0.51), central nervous system tumours (HR 0.68; 95% CI 0.42-1.10, PTrend 0.32), neuroblastoma (HR 1.05; 95% CI 0.53-2.06, PTrend 0.85), Wilms' tumour (HR 1.16; 95% CI 0.52-2.58, PTrend 0.76), or soft-tissue tumours (HR 0.77; 95% CI 0.34-1.75, PTrend 0.90). CONCLUSIONS Folic acid supplementation was not associated with risk of major childhood cancers.
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Maritsi DN, Vartzelis G, Dana H, Kosmidis H, Douna V, Kossiva L. Plasma Folate, Vitamin B12 and Homocysteine Levels in Children with Solid Tumors at Diagnosis; Results from a Pediatric Referral Centre. Indian J Pediatr 2016; 83:483-4. [PMID: 26365156 DOI: 10.1007/s12098-015-1892-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 08/17/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Despoina N Maritsi
- Second Department of Pediatrics, 'P. & A. Kyriakou' Children's Hospital, Medical School, Athens University, Athens, Greece
| | - George Vartzelis
- Second Department of Pediatrics, 'P. & A. Kyriakou' Children's Hospital, Medical School, Athens University, Athens, Greece
| | - Helen Dana
- Department of Oncology, 'P. & A. Kyriakou' Children's Hospital, Athens, Greece
| | - Helen Kosmidis
- Department of Oncology, 'P. & A. Kyriakou' Children's Hospital, Athens, Greece
| | - Varvara Douna
- Laboratory of Hematology, 'P. & A. Kyriakou' Children's Hospital, Athens, Greece
| | - Lydia Kossiva
- Second Department of Pediatrics, 'P. & A. Kyriakou' Children's Hospital, Medical School, Athens University, Athens, Greece.
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Wilson RD, Wilson RD, Audibert F, Brock JA, Carroll J, Cartier L, Gagnon A, Johnson JA, Langlois S, Murphy-Kaulbeck L, Okun N, Pastuck M, Deb-Rinker P, Dodds L, Leon JA, Lowel HL, Luo W, MacFarlane A, McMillan R, Moore A, Mundle W, O'Connor D, Ray J, Van den Hof M. Pre-conception Folic Acid and Multivitamin Supplementation for the Primary and Secondary Prevention of Neural Tube Defects and Other Folic Acid-Sensitive Congenital Anomalies. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015; 37:534-52. [PMID: 26334606 DOI: 10.1016/s1701-2163(15)30230-9] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To provide updated information on the pre- and post-conception use of oral folic acid with or without a multivitamin/micronutrient supplement for the prevention of neural tube defects and other congenital anomalies. This will help physicians, midwives, nurses, and other health care workers to assist in the education of women about the proper use and dosage of folic acid/multivitamin supplementation before and during pregnancy. EVIDENCE Published literature was retrieved through searches of PubMed, Medline, CINAHL, and the Cochrane Library in January 2011 using appropriate controlled vocabulary and key words (e.g., folic acid, prenatal multivitamins, folate sensitive birth defects, congenital anomaly risk reduction, pre-conception counselling). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies published in English from 1985 and June 2014. Searches were updated on a regular basis and incorporated in the guideline to June 2014 Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. Costs, risks, and benefits: The financial costs are those of daily vitamin supplementation and eating a healthy folate-enriched diet. The risks are of a reported association of dietary folic acid supplementation with fetal epigenetic modifications and with an increased likelihood of a twin pregnancy. These associations may require consideration before initiating folic acid supplementation. The benefit of folic acid oral supplementation or dietary folate intake combined with a multivitamin/micronutrient supplement is an associated decrease in neural tube defects and perhaps in other specific birth defects and obstetrical complications. VALUES The quality of evidence in the document was rated using the criteria described in the Report of the Canadian Task Force on Preventative Health Care (Table 1). Summary Statement In Canada multivitamin tablets with folic acid are usually available in 3 formats: regular over-the-counter multivitamins with 0.4 to 0.6 mg folic acid, prenatal over-the-counter multivitamins with 1.0 mg folic acid, and prescription multivitamins with 5.0 mg folic acid. (III) Recommendations 1. Women should be advised to maintain a healthy folate-rich diet; however, folic acid/multivitamin supplementation is needed to achieve the red blood cell folate levels associated with maximal protection against neural tube defect. (III-A) 2. All women in the reproductive age group (12-45 years of age) who have preserved fertility (a pregnancy is possible) should be advised about the benefits of folic acid in a multivitamin supplementation during medical wellness visits (birth control renewal, Pap testing, yearly gynaecological examination) whether or not a pregnancy is contemplated. Because so many pregnancies are unplanned, this applies to all women who may become pregnant. (III-A) 3. Folic acid supplementation is unlikely to mask vitamin B12 deficiency (pernicious anemia). Investigations (examination or laboratory) are not required prior to initiating folic acid supplementation for women with a risk for primary or recurrent neural tube or other folic acid-sensitive congenital anomalies who are considering a pregnancy. It is recommended that folic acid be taken in a multivitamin including 2.6 ug/day of vitamin B12 to mitigate even theoretical concerns. (II-2A) 4. Women at HIGH RISK, for whom a folic acid dose greater than 1 mg is indicated, taking a multivitamin tablet containing folic acid, should be advised to follow the product label and not to take more than 1 daily dose of the multivitamin supplement. Additional tablets containing only folic acid should be taken to achieve the desired dose. (II-2A) 5. Women with a LOW RISK for a neural tube defect or other folic acid-sensitive congenital anomaly and a male partner with low risk require a diet of folate-rich foods and a daily oral multivitamin supplement containing 0.4 mg folic acid for at least 2 to 3 months before conception, throughout the pregnancy, and for 4 to 6 weeks postpartum or as long as breast-feeding continues. (II-2A) 6. Women with a MODERATE RISK for a neural tube defect or other folic acid-sensitive congenital anomaly or a male partner with moderate risk require a diet of folate-rich foods and daily oral supplementation with a multivitamin containing 1.0 mg folic acid, beginning at least 3 months before conception. Women should continue this regime until 12 weeks' gestational age. (1-A) From 12 weeks' gestational age, continuing through the pregnancy, and for 4 to 6 weeks postpartum or as long as breast-feeding continues, continued daily supplementation should consist of a multivitamin with 0.4 to 1.0 mg folic acid. (II-2A) 7. Women with an increased or HIGH RISK for a neural tube defect, a male partner with a personal history of neural tube defect, or history of a previous neural tube defect pregnancy in either partner require a diet of folate-rich foods and a daily oral supplement with 4.0 mg folic acid for at least 3 months before conception and until 12 weeks' gestational age. From 12 weeks' gestational age, continuing throughout the pregnancy, and for 4 to 6 weeks postpartum or as long as breast-feeding continues, continued daily supplementation should consist of a multivitamin with 0.4 to 1.0 mg folic acid. (I-A). The same dietary and supplementation regime should be followed if either partner has had a previous pregnancy with a neural tube defect. (II-2A).
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Momen NC, Olsen J, Gissler M, Kieler H, Haglund B, Li J. Exposure to systemic antibacterial medications during pregnancy and risk of childhood cancer. Pharmacoepidemiol Drug Saf 2015; 24:821-9. [DOI: 10.1002/pds.3806] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 03/23/2015] [Accepted: 04/30/2015] [Indexed: 12/12/2022]
Affiliation(s)
- Natalie C. Momen
- Section for Epidemiology, Department of Public Health; Aarhus University; Denmark
| | - Jørn Olsen
- Section for Epidemiology, Department of Public Health; Aarhus University; Denmark
- Department of Epidemiology; University of California; Los Angeles CA USA
| | - Mika Gissler
- THL National Institute for Health and Welfare; Helsinki Finland
- Nordic School of Public Health NHV; Gothenburg Sweden
| | - Helle Kieler
- Centre for Pharmacoepidemiology; Karolinska Institutet; Stockholm Sweden
| | - Bengt Haglund
- Centre for Pharmacoepidemiology; Karolinska Institutet; Stockholm Sweden
| | - Jiong Li
- Section for Epidemiology, Department of Public Health; Aarhus University; Denmark
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Greenop KR, Scott RJ, Attia J, Bower C, de Klerk NH, Norris MD, Haber M, Jamieson SE, van Bockxmeer FM, Gottardo NG, Ashton LJ, Armstrong BK, Milne E. Folate Pathway Gene Polymorphisms and Risk of Childhood Brain Tumors: Results from an Australian Case–Control Study. Cancer Epidemiol Biomarkers Prev 2015; 24:931-7. [DOI: 10.1158/1055-9965.epi-14-1248] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 03/12/2015] [Indexed: 11/16/2022] Open
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Childhood folate, B6, B12, and food group intake and the risk of childhood brain tumors: results from an Australian case–control study. Cancer Causes Control 2015; 26:871-9. [DOI: 10.1007/s10552-015-0562-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 03/12/2015] [Indexed: 10/23/2022]
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Greenop KR, Bailey HD, Miller M, Scott RJ, Attia J, Ashton LJ, Downie P, Armstrong BK, Milne E. Breastfeeding and nutrition to 2 years of age and risk of childhood acute lymphoblastic leukemia and brain tumors. Nutr Cancer 2015; 67:431-41. [PMID: 25646650 DOI: 10.1080/01635581.2015.998839] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Acute lymphoblastic leukemia (ALL) and childhood brain tumors (CBT) are 2 of the most common forms of childhood cancer, but little is known of their etiology. In 2 nationwide case-control studies we investigated whether breastfeeding, age of food introduction, or early diet are associated with the risk of these cancers. Cases aged 0-14 years were identified from Australian pediatric oncology units between 2003 and 2007 (ALL) and 2005 and 2010 (CBT) and population-based controls through nationwide random-digit dialing. Mothers completed questionnaires giving details of infant feeding up to the age of 2 yr. Data from 322 ALL cases, 679 ALL controls, 299 CBT cases, and 733 CBT controls were analysed using unconditional logistic regression. Breastfeeding was associated with a reduced risk of ALL [odds ratio (OR) = 0.52, 95% confidence interval (CI): 0.32, 0.84), regardless of duration. Introduction of artificial formula within 14 days of birth was positively associated with ALL (OR = 1.57, 95% CI: 1.03, 2.37), as was exclusive formula feeding to 6 mo (OR = 1.81, 95% CI: 1.07, 3.05). No associations were seen between breastfeeding or formula use and risk of CBT. Our results suggest that breastfeeding and delayed introduction of artificial formula may reduce the risk of ALL but not CBT.
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Affiliation(s)
- Kathryn R Greenop
- a Telethon Kids Institute , University of Western Australia , Perth , Western Australia , Australia
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Prescription drug use during pregnancy and risk of childhood cancer – Is there an association? Cancer Epidemiol 2015; 39:73-8. [DOI: 10.1016/j.canep.2014.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 10/16/2014] [Indexed: 11/20/2022]
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36
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Greenop KR, Hinwood AL, Fritschi L, Scott RJ, Attia J, Ashton LJ, Heath JA, Armstrong BK, Milne E. Vehicle refuelling, use of domestic wood heaters and the risk of childhood brain tumours: Results from an Australian case-control study. Pediatr Blood Cancer 2015; 62:229-234. [PMID: 25283072 DOI: 10.1002/pbc.25268] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 08/07/2014] [Indexed: 01/02/2023]
Abstract
BACKGROUND The aetiology of childhood brain tumours (CBT) is largely unknown. Damage to germ cells after parental exposure to airborne carcinogens, such as volatile organic compounds and polycyclic aromatic hydrocarbons is one plausible pathway. This analysis aimed to investigate whether parental refuelling of vehicles or the use of domestic wood heaters in key time periods relating to the child's birth was associated with an increased risk of CBT. PROCEDURE Cases <15 years of age were recruited through 10 paediatric oncology centres around Australia; controls were recruited through nationwide random-digit dialling, frequency matched to cases on age, sex and State of residence. Exposure to refuelling and wood heaters was ascertained through questionnaires from both parents. Odds ratios (ORs) and confidence intervals (CIs) were estimated using unconditional logistic regression, adjusting for relevant covariates. RESULTS Data were available for 306 case and 950 control families. Paternal refuelling ≥4 times/month was associated with an increased risk of CBT (OR 1.59, 95% CI: 1.11, 2.29), and a dose-dependent trend was observed (P = 0.004). No association was seen for maternal refuelling. Use of closed, but not open, wood heaters before (OR 1.51, 95% CI: 1.05, 2.15) and after (OR 1.44, 95% CI: 1.03, 2.01) the child's birth was associated with increased risk of CBT, but dose-response relationships were weak or absent. CONCLUSIONS Paternal refuelling of vehicles ≥4 times/month and the use of closed wood heaters before the child's birth may increase the risk of CBT. Replication in larger studies is needed. Pediatr Blood Cancer 2015;62:229-234. © 2014 Wiley Periodicals, Inc.
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Affiliation(s)
- Kathryn R Greenop
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Andrea L Hinwood
- Centre for Ecosystem Management, Edith Cowan University, Perth, Western Australia, Australia
| | - Lin Fritschi
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Rodney J Scott
- Hunter Medical Research Institute, John Hunter Hospital, Newcastle, New South Wales, Australia.,School of Biomedical Sciences and Pharmacy, Faculty of Health, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Area Pathology Service, HNEHealth, Newcastle, New South Wales, Australia
| | - John Attia
- Hunter Medical Research Institute, John Hunter Hospital, Newcastle, New South Wales, Australia.,School of Medicine and Public Health, Faculty of Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Lesley J Ashton
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Research Portfolio, University of Sydney, Sydney, Australia
| | - John A Heath
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Bruce K Armstrong
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Sax Institute, Haymarket, New South Wales, Australia
| | - Elizabeth Milne
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
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Greenop KR, Miller M, Bailey HD, Scott RJ, Attia J, Bower C, van Bockxmeer FM, Ashton LJ, Armstrong BK, Milne E. Paternal Dietary Folate, B6 and B12 Intake, and the Risk of Childhood Brain Tumors. Nutr Cancer 2015; 67:224-30. [DOI: 10.1080/01635581.2015.990571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Johnson KJ, Cullen J, Barnholtz-Sloan JS, Ostrom QT, Langer CE, Turner MC, McKean-Cowdin R, Fisher JL, Lupo PJ, Partap S, Schwartzbaum JA, Scheurer ME. Childhood brain tumor epidemiology: a brain tumor epidemiology consortium review. Cancer Epidemiol Biomarkers Prev 2014; 23:2716-36. [PMID: 25192704 PMCID: PMC4257885 DOI: 10.1158/1055-9965.epi-14-0207] [Citation(s) in RCA: 222] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Childhood brain tumors are the most common pediatric solid tumor and include several histologic subtypes. Although progress has been made in improving survival rates for some subtypes, understanding of risk factors for childhood brain tumors remains limited to a few genetic syndromes and ionizing radiation to the head and neck. In this report, we review descriptive and analytical epidemiology childhood brain tumor studies from the past decade and highlight priority areas for future epidemiology investigations and methodological work that is needed to advance our understanding of childhood brain tumor causes. Specifically, we summarize the results of a review of studies published since 2004 that have analyzed incidence and survival in different international regions and that have examined potential genetic, immune system, developmental and birth characteristics, and environmental risk factors. Cancer Epidemiol Biomarkers Prev; 23(12); 2716-36. ©2014 AACR.
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Affiliation(s)
- Kimberly J Johnson
- Brown School Masters of Public Health Program, Washington University in St. Louis, St. Louis, Missouri
| | - Jennifer Cullen
- American Childhood Cancer Organization, Kensington, Maryland
| | - Jill S Barnholtz-Sloan
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Quinn T Ostrom
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Chelsea E Langer
- Centre for Research in Environmental Epidemiology, Carrer Doctor Aiguader, Barcelona, Spain. Universitat Pompeu Fabra, Plaça de la Mercè, Barcelona, Spain. CIBER Epidemiología y Salud Pública, Carrer Casanova, Barcelona, Spain
| | - Michelle C Turner
- Centre for Research in Environmental Epidemiology, Carrer Doctor Aiguader, Barcelona, Spain. Universitat Pompeu Fabra, Plaça de la Mercè, Barcelona, Spain. CIBER Epidemiología y Salud Pública, Carrer Casanova, Barcelona, Spain. McLaughlin Centre for Population Health Risk Assessment, Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Roberta McKean-Cowdin
- Department of Preventive Medicine, University of Southern California, USC/Norris Comprehensive Cancer Center, Los Angeles, California
| | - James L Fisher
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Philip J Lupo
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas. Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Sonia Partap
- Division of Neurology, Stanford University, Palo Alto, California
| | - Judith A Schwartzbaum
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Michael E Scheurer
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas. Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas.
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Peters S, Glass DC, Greenop KR, Armstrong BK, Kirby M, Milne E, Fritschi L. Childhood brain tumours: associations with parental occupational exposure to solvents. Br J Cancer 2014; 111:998-1003. [PMID: 24960405 PMCID: PMC4150269 DOI: 10.1038/bjc.2014.358] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 05/16/2014] [Accepted: 06/03/2014] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Parental occupational exposures have been associated with childhood brain tumours (CBT), but results are inconsistent. Few studies have studied CBT risk and parental solvent exposure, suggesting a possible association. We examined the association between CBT and parental occupational exposure to solvents in a case-control study. METHODS Parents of 306 cases and 950 controls completed detailed occupational histories. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for both maternal and paternal exposure to benzene, other aromatics, aliphatics and chlorinated solvents in key time periods relative to the birth of their child. Adjustments were made for matching variables (child's age, sex and state of residence), best parental education and occupational exposure to diesel exhaust. RESULTS An increased risk of CBT was observed with maternal occupational exposures to chlorinated solvents (OR=8.59, 95% CI 0.94-78.9) any time before birth. Paternal exposure to solvents in the year before conception was associated with an increased CBT risk: OR=1.55 (95% CI 0.99-2.43). This increased risk appeared to be mainly attributable to exposure to aromatic solvents: OR=2.72 (95% CI 0.94-7.86) for benzene and OR=1.76 (95% CI 1.10-2.82) for other aromatics. CONCLUSIONS Our results indicate that parental occupational exposures to solvents may be related to an increased risk of CBT.
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Affiliation(s)
- S Peters
- Occupational Respiratory Epidemiology, School of Population Health, University of Western Australia, Perth, Western Australia 6009, Australia
| | - D C Glass
- Monash Centre for Occupational and Environmental Health, Monash University, Melbourne, Victoria 3004, Australia
| | - K R Greenop
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia 6008, Australia
| | - B K Armstrong
- Sax Institute, Haymarket, New South Wales 2000, Australia
- Sydney School of Public Health, University of Sydney, New South Wales 2006, Australia
| | - M Kirby
- Department of Haematology & Oncology, Women's and Children's Hospital, Adelaide, South Australia 5006, Australia
| | - E Milne
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia 6008, Australia
| | - L Fritschi
- School of Public Health, Curtin University, Perth, Western Australia 6845, Australia
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Barua S, Kuizon S, Junaid MA. Folic acid supplementation in pregnancy and implications in health and disease. J Biomed Sci 2014; 21:77. [PMID: 25135350 PMCID: PMC4237823 DOI: 10.1186/s12929-014-0077-z] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 08/11/2014] [Indexed: 12/31/2022] Open
Abstract
Maternal exposure to dietary factors during pregnancy can influence embryonic development and may modulate the phenotype of offspring through epigenetic programming. Folate is critical for nucleotide synthesis, and preconceptional intake of dietary folic acid (FA) is credited with reduced incidences of neural tube defects in infants. While fortification of grains with FA resulted in a positive public-health outcome, concern has been raised for the need for further investigation of unintended consequences and potential health hazards arising from excessive FA intakes, especially following reports that FA may exert epigenetic effects. The objective of this article is to discuss the role of FA in human health and to review the benefits, concerns and epigenetic effects of maternal FA on the basis of recent findings that are important to design future studies.
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Affiliation(s)
- Subit Barua
- Department of Developmental Biochemistry, New York State Institute for Basic Research in Developmental Disabilities, 1050 Forest Hill Road, Staten Island 10314, NY, USA
| | - Salomon Kuizon
- Department of Developmental Biochemistry, New York State Institute for Basic Research in Developmental Disabilities, 1050 Forest Hill Road, Staten Island 10314, NY, USA
| | - Mohammed A Junaid
- Department of Developmental Biochemistry, New York State Institute for Basic Research in Developmental Disabilities, 1050 Forest Hill Road, Staten Island 10314, NY, USA
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41
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Maternal consumption of coffee and tea during pregnancy and risk of childhood brain tumors: results from an Australian case–control study. Cancer Causes Control 2014; 25:1321-7. [DOI: 10.1007/s10552-014-0437-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 07/09/2014] [Indexed: 10/25/2022]
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Greenop KR, Miller M, de Klerk NH, Scott RJ, Attia J, Ashton LJ, Dalla-Pozza L, Bower C, Armstrong BK, Milne E. Maternal Dietary Intake of Folate and Vitamins B6 and B12 During Pregnancy and Risk of Childhood Brain Tumors. Nutr Cancer 2014; 66:800-9. [DOI: 10.1080/01635581.2014.916326] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Bortolus R, Blom F, Filippini F, van Poppel MNM, Leoncini E, de Smit DJ, Benetollo PP, Cornel MC, de Walle HEK, Mastroiacovo P. Prevention of congenital malformations and other adverse pregnancy outcomes with 4.0 mg of folic acid: community-based randomized clinical trial in Italy and the Netherlands. BMC Pregnancy Childbirth 2014; 14:166. [PMID: 24884885 PMCID: PMC4045958 DOI: 10.1186/1471-2393-14-166] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 04/25/2014] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND In 2010 a Cochrane review confirmed that folic acid (FA) supplementation prevents the first- and second-time occurrence of neural tube defects (NTDs). At present some evidence from observational studies supports the hypothesis that FA supplementation can reduce the risk of all congenital malformations (CMs) or the risk of a specific and selected group of them, namely cardiac defects and oral clefts. Furthermore, the effects on the prevention of prematurity, foetal growth retardation and pre-eclampsia are unclear.Although the most common recommendation is to take 0.4 mg/day, the problem of the most appropriate dose of FA is still open.The aim of this project is to assess the effect a higher dose of peri-conceptional FA supplementation on reducing the occurrence of all CMs. Other aims include the promotion of pre-conceptional counselling, comparing rates of selected CMs, miscarriage, pre-eclampsia, preterm birth, small for gestational age, abruptio placentae. METHODS/DESIGN This project is a joint effort by research groups in Italy and the Netherlands. Women of childbearing age, who intend to become pregnant within 12 months are eligible for the studies. Women are randomly assigned to receive 4 mg of FA (treatment in study) or 0.4 mg of FA (referent treatment) daily. Information on pregnancy outcomes are derived from women-and-physician information.We foresee to analyze the data considering all the adverse outcomes of pregnancy taken together in a global end point (e.g.: CMs, miscarriage, pre-eclampsia, preterm birth, small for gestational age). A total of about 1,000 pregnancies need to be evaluated to detect an absolute reduction of the frequency of 8%. Since the sample size needed for studying outcomes separately is large, this project also promotes an international prospective meta-analysis. DISCUSSION The rationale of these randomized clinical trials (RCTs) is the hypothesis that a higher intake of FA is related to a higher risk reduction of NTDs, other CMs and other adverse pregnancy outcomes. Our hope is that these trials will act as catalysers, and lead to other large RCTs studying the effects of this supplementation on CMs and other infant and maternal outcomes. TRIAL REGISTRATION Italian trial: ClinicalTrials.gov Identifier: NCT01244347.Dutch trial: Dutch Trial Register ID: NTR3161.
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Affiliation(s)
- Renata Bortolus
- Office for Research Promotion, Department of the Hospital Management and Pharmacy, Verona University Hospital, P.le A. Stefani, 1-37126 Verona, Italy
| | - Fenneke Blom
- Community Genetics, Department of Clinical Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Francesca Filippini
- Office for Research Promotion, Department of the Hospital Management and Pharmacy, Verona University Hospital, P.le A. Stefani, 1-37126 Verona, Italy
| | - Mireille NM van Poppel
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Emanuele Leoncini
- Alessandra Lisi International Centre on Birth Defects and Prematurity-ICBD, WHO Collaborating Centre, Rome, Italy
| | | | | | - Martina C Cornel
- Community Genetics, Department of Clinical Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Hermien EK de Walle
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Pierpaolo Mastroiacovo
- Alessandra Lisi International Centre on Birth Defects and Prematurity-ICBD, WHO Collaborating Centre, Rome, Italy
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Been RA, Ross JA, Nagel CW, Hooten AJ, Langer EK, DeCoursin KJ, Marek CA, Janik CL, Linden MA, Reed RC, Schutten MM, Largaespada DA, Johnson KJ. Perigestational dietary folic acid deficiency protects against medulloblastoma formation in a mouse model of nevoid basal cell carcinoma syndrome. Nutr Cancer 2014; 65:857-65. [PMID: 23909730 DOI: 10.1080/01635581.2013.804940] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Hereditary nevoid basal cell carcinoma syndrome (NBCCS) is caused by PTCH1 gene mutations that result in diverse neoplasms including medulloblastoma (MB). Epidemiological studies report reduced pediatric brain tumor risks associated with maternal intake of prenatal vitamins containing folic acid (FA) and FA supplements specifically. We hypothesized that low maternal FA intake during the perigestational period would increase MB incidence in a transgenic NBCCS mouse model, which carries an autosomal dominant mutation in the Ptch1 gene. Female wild-type C57BL/6 mice (n = 126) were randomized to 1 of 3 diets with differing FA amounts: 0.3 mg/kg (low), 2.0 mg/kg (control), and 8.0 mg/kg (high) 1 mo prior to mating with Ptch1 (+/-) C57BL/6 males. Females were maintained on the diet until pup weaning; the pups were then aged for tumor development. Compared to the control group, offspring MB incidence was significantly lower in the low FA group (Hazard Ratio = 0.47; 95% confidence interval 0.27-0.80) at 1 yr. No significant difference in incidence was observed between the control and high FA groups. Low maternal perigestational FA levels may decrease MB incidence in mice genetically predisposed to tumor development. Our results could have implications for prenatal FA intake recommendations in the presence of cancer syndromes.
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Affiliation(s)
- Raha A Been
- Masonic Cancer Center and Brain Tumor Program, University of Minnesota, Minneapolis, Minnesota 55455, USA
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Greenop KR, Blair EM, Bower C, Armstrong BK, Milne E. Factors relating to pregnancy and birth and the risk of childhood brain tumors: results from an Australian case-control study. Pediatr Blood Cancer 2014; 61:493-8. [PMID: 24039139 DOI: 10.1002/pbc.24751] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 08/02/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Childhood brain tumors (CBT) are the leading cause of cancer death in children, yet their causes are largely known. This study investigated the association between maternal and birth characteristics and risk of CBT. PROCEDURES Cases families were recruited from all 10 Australian pediatric oncology centers between 2005 and 2010. Control families were recruited via random-digit dialing, frequency matched to cases on the basis of child's age, sex, and State of residence. Maternal and birth characteristics of children were ascertained by questionnaires. Odds ratios (ORs) and 95% confidence intervals (CI) were estimated using unconditional logistic regression, adjusting for relevant confounders. RESULTS For this analysis, data on 319 case children and 1,079 control children were available. No association was found between risk of CBT and birth weight, fetal growth, birth order, gestational age, or maternal body mass index. The ORs for inadequate and excessive maternal gestational weight gain (GWG) (Institute of Medicine 2009 guidelines) were 1.8 (95% CI 1.2-2.6) and 1.4 (95% CI 1.0-2.1), respectively; similar findings for GWG were seen across categories of child's age, fetal growth, maternal body mass index and height, maternal smoking, and parental education. Risk of low grade glioma appeared increased with preterm birth (OR 1.6 (95% CI 0.8-3.1) and admission to neonatal intensive care (NICU) for >2 days (OR 1.7, 95% CI 0.9-3.6). CONCLUSION We found little evidence of associations between risk of CBT and most birth characteristics. The associations we observed with GWG, prematurity and NICU admission require corroboration in other studies.
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Affiliation(s)
- Kathryn R Greenop
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
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46
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Childhood and parental diagnostic radiological procedures and risk of childhood brain tumors. Cancer Causes Control 2014; 25:375-83. [DOI: 10.1007/s10552-014-0338-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 01/08/2014] [Indexed: 11/27/2022]
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Orbach D, Sarnacki S, Brisse HJ, Gauthier-Villars M, Jarreau PH, Tsatsaris V, Baruchel A, Zerah M, Seigneur E, Peuchmaur M, Doz F. Neonatal cancer. Lancet Oncol 2014; 14:e609-20. [PMID: 24275134 DOI: 10.1016/s1470-2045(13)70236-5] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Neonatal cancer is rare and comprises a heterogeneous group of neoplasms with substantial histological diversity. Almost all types of paediatric cancer can occur in fetuses and neonates; however, the presentation and behaviour of neonatal tumours often differs from that in older children, leading to differences in diagnosis and management. The causes of neonatal cancer are unclear, but genetic factors probably have a key role. Other congenital abnormalities are frequently present. Teratoma and neuroblastoma are the most common histological types of neonatal cancer, with soft-tissue sarcoma, leukaemia, renal tumours, and brain tumours also among the more frequent types. Prenatal detection, most often on routine ultrasound or in the context of a known predisposition syndrome, is becoming more common. Treatment options pose challenges because of the particular vulnerability of the population. Neonatal cancer raises diagnostic, therapeutic, and ethical issues, and management requires a multidisciplinary approach.
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Affiliation(s)
- Daniel Orbach
- Department of Paediatric Oncology, Institut Curie, Paris, France
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48
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Greenop KR, Peters S, Fritschi L, Glass DC, Ashton LJ, Bailey HD, Scott RJ, Daubenton J, de Klerk NH, Armstrong BK, Milne E. Exposure to household painting and floor treatments, and parental occupational paint exposure and risk of childhood brain tumors: results from an Australian case-control study. Cancer Causes Control 2013; 25:283-91. [PMID: 24337771 DOI: 10.1007/s10552-013-0330-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 12/04/2013] [Indexed: 12/30/2022]
Abstract
PURPOSE Childhood brain tumors (CBT) are the leading cause of cancer death in children, yet their etiology remains largely unknown. This study investigated whether household exposure to paints and floor treatments and parental occupational painting were associated with CBT risk in a population-based case-control study conducted between 2005 and 2010. METHODS Cases were identified through all ten Australian pediatric oncology centers, and controls via nationwide random-digit dialing, frequency matched to cases on age, sex, and state of residence. Data were obtained from parents in mailed questionnaires and telephone interviews. Information on domestic painting and floor treatments, and parental occupational exposure to paint, in key periods relating to the index pregnancy and childhood was obtained for 306 cases and 950 controls. Data were analyzed using unconditional logistic regression, adjusting for frequency matching variables and potential confounders. RESULTS Overall, we found little evidence that parental, fetal, or childhood exposure to home painting or floor treatments was associated with risk of CBT. There was, though, some evidence of a positive association between childhood exposure to indoor painting and risk of high-grade glioma [odds ratio (OR) 3.31, 95 % confidence interval (CI) 1.29, 8.52] based on very small numbers. The OR for the association between CBT and paternal occupational exposure to paint any time before the pregnancy was 1.32 (95 % CI 0.90, 1.92), which is consistent with the results of other studies. CONCLUSIONS Overall, we found little evidence of associations between household exposure to paint and the risk of CBT in any of the time periods investigated.
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Affiliation(s)
- Kathryn R Greenop
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, PO Box 855, Perth, WA, 6872, Australia
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Abstract
Neonatal or perinatal tumours frequently relate to prenatal or developmental events and have a short exposure window which provides an opportunity to study tumours in a selective sensitive period of development. As a result, they display a number of host-specific features which include occasional spontaneous maturational changes with cells still responding to developmental influences. Neonatal tumours (NNT) are studied for a number of important reasons. Firstly, many of the benign tumours arising from soft tissue appear to result from disturbances in growth and development and some are associated with other congenital anomalies. Study of these aspects may open the door for investigation of genetic and epigenetic changes in genes controlling foetal development as well as environmental and drug effects during pregnancy. Secondly, the clinical behaviour of NNT differs from that of similar tumours occurring later in childhood. In addition, certain apparently malignant NNT can 'change course' in infancy leading to the maturation of apparently highly malignant tumours. Thirdly, NNT underline the genetic associations of most tumours but appear to differ in the effects of proto-oncogenes and other oncogenic factors. In this context, there are also connections between the foetal and neonatal period and some "adult" cancers. Fourthly, they appear to arise in a period in which minimal environmental interference has occurred, thus providing a unique potential window of opportunity to study the pathogenesis of tumour behaviour. This study will seek to review what is currently known in each of these areas of study as they apply to NNT. Further study of the provocative differences in tumour behaviour in neonates provides insights into the natural history of cancer in humans and promotes novel cancer therapies.
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Affiliation(s)
- S W Moore
- Department of Paediatric Surgery, Faculty of Medicine and Health Sciences, University of Stellenbosch, P.O. Box 19063, Tygerberg, 7505, South Africa,
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50
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Peters S, Glass DC, Milne E, Fritschi L. Rule-based exposure assessment versus case-by-case expert assessment using the same information in a community-based study. Occup Environ Med 2013; 71:215-9. [DOI: 10.1136/oemed-2013-101699] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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