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Manson JE, Crandall CJ, Rossouw JE, Chlebowski RT, Anderson GL, Stefanick ML, Aragaki AK, Cauley JA, Wells GL, LaCroix AZ, Thomson CA, Neuhouser ML, Van Horn L, Kooperberg C, Howard BV, Tinker LF, Wactawski-Wende J, Shumaker SA, Prentice RL. The Women's Health Initiative Randomized Trials and Clinical Practice: A Review. JAMA 2024; 331:1748-1760. [PMID: 38691368 DOI: 10.1001/jama.2024.6542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
Importance Approximately 55 million people in the US and approximately 1.1 billion people worldwide are postmenopausal women. To inform clinical practice about the health effects of menopausal hormone therapy, calcium plus vitamin D supplementation, and a low-fat dietary pattern, the Women's Health Initiative (WHI) enrolled 161 808 postmenopausal US women (N = 68 132 in the clinical trials) aged 50 to 79 years at baseline from 1993 to 1998, and followed them up for up to 20 years. Observations The WHI clinical trial results do not support hormone therapy with oral conjugated equine estrogens plus medroxyprogesterone acetate for postmenopausal women or conjugated equine estrogens alone for those with prior hysterectomy to prevent cardiovascular disease, dementia, or other chronic diseases. However, hormone therapy is effective for treating moderate to severe vasomotor and other menopausal symptoms. These benefits of hormone therapy in early menopause, combined with lower rates of adverse effects of hormone therapy in early compared with later menopause, support initiation of hormone therapy before age 60 years for women without contraindications to hormone therapy who have bothersome menopausal symptoms. The WHI results do not support routinely recommending calcium plus vitamin D supplementation for fracture prevention in all postmenopausal women. However, calcium and vitamin D are appropriate for women who do not meet national guidelines for recommended intakes of these nutrients through diet. A low-fat dietary pattern with increased fruit, vegetable, and grain consumption did not prevent the primary outcomes of breast or colorectal cancer but was associated with lower rates of the secondary outcome of breast cancer mortality during long-term follow-up. Conclusions and Relevance For postmenopausal women, the WHI randomized clinical trials do not support menopausal hormone therapy to prevent cardiovascular disease or other chronic diseases. Menopausal hormone therapy is appropriate to treat bothersome vasomotor symptoms among women in early menopause, without contraindications, who are interested in taking hormone therapy. The WHI evidence does not support routine supplementation with calcium plus vitamin D for menopausal women to prevent fractures or a low-fat diet with increased fruits, vegetables, and grains to prevent breast or colorectal cancer. A potential role of a low-fat dietary pattern in reducing breast cancer mortality, a secondary outcome, warrants further study.
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Affiliation(s)
- JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Carolyn J Crandall
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Jacques E Rossouw
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Rowan T Chlebowski
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | - Garnet L Anderson
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Marcia L Stefanick
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, California
| | - Aaron K Aragaki
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Jane A Cauley
- Department of Epidemiology, University of Pittsburgh School of Public Health|Epidemiology, Pittsburgh, Pennsylvania
| | | | - Andrea Z LaCroix
- Division of Epidemiology, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California
| | - Cynthia A Thomson
- Department of Health Promotion Science, University of Arizona, Tucson
| | - Marian L Neuhouser
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Linda Van Horn
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | - Charles Kooperberg
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Barbara V Howard
- MedStar Health Research Institute and Department of Medicine, Georgetown University School of Medicine, Washington, DC
| | - Lesley F Tinker
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, University at Buffalo-SUNY, Buffalo, New York
| | - Sally A Shumaker
- Department of Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Ross L Prentice
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington
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Ahmad A, Mahmood N, Raza MA, Mushtaq Z, Saeed F, Afzaal M, Hussain M, Amjad HW, Al-Awadi HM. Gut microbiota and their derivatives in the progression of colorectal cancer: Mechanisms of action, genome and epigenome contributions. Heliyon 2024; 10:e29495. [PMID: 38655310 PMCID: PMC11035079 DOI: 10.1016/j.heliyon.2024.e29495] [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: 05/08/2023] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 04/26/2024] Open
Abstract
Gut microbiota interacts with host epithelial cells and regulates many physiological functions such as genetics, epigenetics, metabolism of nutrients, and immune functions. Dietary factors may also be involved in the etiology of colorectal cancer (CRC), especially when an unhealthy diet is consumed with excess calorie intake and bad practices like smoking or consuming a great deal of alcohol. Bacteria including Fusobacterium nucleatum, Enterotoxigenic Bacteroides fragilis (ETBF), and Escherichia coli (E. coli) actively participate in the carcinogenesis of CRC. Gastrointestinal tract with chronic inflammation and immunocompromised patients are at high risk for CRC progression. Further, the gut microbiota is also involved in Geno-toxicity by producing toxins like colibactin and cytolethal distending toxin (CDT) which cause damage to double-stranded DNA. Specific microRNAs can act as either tumor suppressors or oncogenes depending on the cellular environment in which they are expressed. The current review mainly highlights the role of gut microbiota in CRC, the mechanisms of several factors in carcinogenesis, and the role of particular microbes in colorectal neoplasia.
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Affiliation(s)
- Awais Ahmad
- Department of Food Science, Government College University Faisalabad, Faisalabad, Pakistan
| | - Nasir Mahmood
- Department of Zoology, University of Central Punjab Bahawalpur, Bahawalpur, Pakistan
| | - Muhammad Ahtisham Raza
- Department of Food Science, Government College University Faisalabad, Faisalabad, Pakistan
| | - Zarina Mushtaq
- Department of Food Science, Government College University Faisalabad, Faisalabad, Pakistan
| | - Farhan Saeed
- Department of Food Science, Government College University Faisalabad, Faisalabad, Pakistan
| | - Muhammad Afzaal
- Department of Food Science, Government College University Faisalabad, Faisalabad, Pakistan
| | - Muzzamal Hussain
- Department of Food Science, Government College University Faisalabad, Faisalabad, Pakistan
| | - Hafiz Wasiqe Amjad
- International Medical School, Jinggangshan University, Ji'an, Jiangxi, China
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3
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Weaver C, Ahles S, Murphy KJ, Shyam S, Cade J, Plat J, Schwingshackl L, Roche HM, Lachat C, Minihane AM, Rigutto-Farebrother J. Perspective: Peer Evaluation of Recommendations for CONSORT Guidelines for Randomized Controlled Trials in Nutrition. Adv Nutr 2024; 15:100154. [PMID: 37996044 PMCID: PMC10716705 DOI: 10.1016/j.advnut.2023.100154] [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: 07/28/2023] [Revised: 10/14/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023] Open
Abstract
Creating effective dietary guidance requires a rigorous evidence base that is predominantly developed from robust clinical trials or large-scale cohort studies, with the quality of the data available depending on the completeness and accuracy of their reporting. An international group of academics from 14 institutions in 12 different countries and on 5 continents, working on behalf of the Federation of European Nutrition Societies within its "Improving Standards in the Science of Nutrition" initiative, reviewed the Consolidated Standards of Reporting Trials (CONSORT) statement checklist as it pertains to nutrition trials. This perspective piece documents the procedure followed to gain input and consensus on the checklist previously published by this group, including its presentation and interrogation at the International Union of Nutritional Sciences International Congress of Nutrition 2022 (IUNS-ICN 22), inputs from a survey of journal editors, and its piloting on 8 nutrition trials of diverse designs. Overall, the initiative has been met with considerable enthusiasm. At IUNS-ICN 22, refinements to our proposal were elicited through a World Café method discussion with participating nutrition scientists. The contributing journal editors provided valuable insights, and the discussion led to the development of a potential tool specific to assess adherence to the proposed nutrition extension checklist. The piloting of the proposed checklist provided evidence from real-life studies that reporting of nutrition trials can be improved. This initiative aims to stimulate further discussion and development of a CONSORT-nutrition-specific extension.
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Affiliation(s)
- Connie Weaver
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, United States.
| | - Sanne Ahles
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands; BioActor BV, Maastricht, The Netherlands
| | - Karen J Murphy
- Clinical and Health Sciences and Alliance for Research in Exercise, Nutrition and Activity University of South Australia, Adelaide, South Australia, Australia
| | - Sangeetha Shyam
- Centre for Translational Research, Institute for Research, Development, and Innovation (IRDI), International Medical University, Kuala Lumpur, Malaysia; Universitat Rovira i Virgili, Department of Biochemistry and Biotechnology, Human Nutrition Unit, Biomedical Research Network Center for Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute (ISCIII), Reus, Spain
| | - Janet Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, United Kingdom
| | - Jogchum Plat
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Lukas Schwingshackl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Helen M Roche
- Nutrigenomics Research Group, UCD Conway Institute, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland; Institute for Global Food Security, The Queen's University of Belfast, Belfast, Northern Ireland, United Kingdom
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
| | - Anne-Marie Minihane
- Nutrition and Preventive Medicine, Norwich Medical School, University of East Anglia, Norwich, United Kingdom; Norwich Institute of Healthy Ageing, University of East Anglia, Norwich, United Kingdom
| | - Jessica Rigutto-Farebrother
- Laboratory of Nutrition and Metabolic Epigenetics, Institute for Food, Nutrition and Health, ETH Zürich, Zürich, Switzerland; Global Center for the Development of the Whole Child, University of Notre Dame, Notre Dame, IN, United States
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4
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Pandey H, Tang DWT, Wong SH, Lal D. Gut Microbiota in Colorectal Cancer: Biological Role and Therapeutic Opportunities. Cancers (Basel) 2023; 15:cancers15030866. [PMID: 36765824 PMCID: PMC9913759 DOI: 10.3390/cancers15030866] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 02/03/2023] Open
Abstract
Colorectal cancer (CRC) is the second-leading cause of cancer-related deaths worldwide. While CRC is thought to be an interplay between genetic and environmental factors, several lines of evidence suggest the involvement of gut microbiota in promoting inflammation and tumor progression. Gut microbiota refer to the ~40 trillion microorganisms that inhabit the human gut. Advances in next-generation sequencing technologies and metagenomics have provided new insights into the gut microbial ecology and have helped in linking gut microbiota to CRC. Many studies carried out in humans and animal models have emphasized the role of certain gut bacteria, such as Fusobacterium nucleatum, enterotoxigenic Bacteroides fragilis, and colibactin-producing Escherichia coli, in the onset and progression of CRC. Metagenomic studies have opened up new avenues for the application of gut microbiota in the diagnosis, prevention, and treatment of CRC. This review article summarizes the role of gut microbiota in CRC development and its use as a biomarker to predict the disease and its potential therapeutic applications.
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Affiliation(s)
- Himani Pandey
- Redcliffe Labs, Electronic City, Noida 201301, India
| | - Daryl W. T. Tang
- School of Biological Sciences, Nanyang Technological University, Singapore 308232, Singapore
| | - Sunny H. Wong
- Centre for Microbiome Medicine, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
- Correspondence: (S.H.W.); (D.L.)
| | - Devi Lal
- Department of Zoology, Ramjas College, University of Delhi, Delhi 110007, India
- Correspondence: (S.H.W.); (D.L.)
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5
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Rogers CJ, Petersen K, Kris-Etherton PM. Preventive Nutrition: Heart Disease and Cancer. Med Clin North Am 2022; 106:767-784. [PMID: 36154699 DOI: 10.1016/j.mcna.2022.06.001] [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] [Indexed: 11/26/2022]
Abstract
Two of the leading chronic diseases are cardiovascular disease (CVD) and cancer. A cornerstone of prevention for CVD and cancer is a healthy dietary pattern throughout the lifespan. Dietary patterns represent the totality of the diet and reflect habitual consumption of combinations and quantities of foods and nutrients that cumulatively affect health and disease. This article summarizes recent evidence on the relationship of diet quality as measured by adherence to healthy dietary patterns and CVD and cancer risk reduction. Optimal adherence to a healthy dietary pattern decreases CVD and cancer risk; even small changes in diet quality are beneficial.
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Affiliation(s)
- Connie J Rogers
- Department of Nutritional Sciences, University of Georgia, 280 Dawson Hall, Athens, GA 30602, USA
| | - Kristina Petersen
- Department of Nutritional Sciences, Texas Tech University, 508 Human Sciences Building, Lubbock, TX 79409 USA
| | - Penny M Kris-Etherton
- Department of Nutritional Sciences, The Pennsylvania State University, 319 Chandlee Lab, University Park, PA 16802 USA.
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6
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Taylor SR, Falcone JN, Cantley LC, Goncalves MD. Developing dietary interventions as therapy for cancer. Nat Rev Cancer 2022; 22:452-466. [PMID: 35614234 DOI: 10.1038/s41568-022-00485-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2022] [Indexed: 12/11/2022]
Abstract
Cancer cells acquire distinct metabolic preferences based on their tissue of origin, genetic alterations and degree of interaction with systemic hormones and metabolites. These adaptations support the increased nutrient demand required for increased growth and proliferation. Diet is the major source of nutrients for tumours, yet dietary interventions lack robust evidence and are rarely prescribed by clinicians for the treatment of cancer. Well-controlled diet studies in patients with cancer are rare, and existing studies have been limited by nonspecific enrolment criteria that inappropriately grouped together subjects with disparate tumour and host metabolic profiles. This imprecision may have masked the efficacy of the intervention for appropriate candidates. Here, we review the metabolic alterations and key vulnerabilities that occur across multiple types of cancer. We describe how these vulnerabilities could potentially be targeted using dietary therapies including energy or macronutrient restriction and intermittent fasting regimens. We also discuss recent trials that highlight how dietary strategies may be combined with pharmacological therapies to treat some cancers, potentially ushering a path towards precision nutrition for cancer.
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Affiliation(s)
- Samuel R Taylor
- Division of Endocrinology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
- Weill Cornell/Rockefeller/Sloan Kettering Tri-I MD-PhD program, New York, NY, USA
| | - John N Falcone
- Division of Endocrinology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Lewis C Cantley
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Marcus D Goncalves
- Division of Endocrinology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA.
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7
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Long-term dietary intervention influence on physical activity in the Women's Health Initiative Dietary Modification randomized trial. Breast Cancer Res Treat 2022; 195:43-54. [PMID: 35821536 DOI: 10.1007/s10549-022-06655-8] [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: 11/08/2021] [Accepted: 06/08/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE In the Women's Health Initiative (WHI) Dietary Modification (DM) randomized trial, dietary intervention significantly reduced breast cancer mortality (P = 0.02). In observational studies, physical activity is associated with lower breast cancer incidence. Currently, dietary intervention influence on other health-related behaviors is unknown. Therefore, we evaluated whether the WHI dietary intervention influenced self-directed physical activity. METHODS Of 48,835 postmenopausal women, 19,541 were randomized to dietary intervention (18 nutritionist-led group sessions first year, then quarterly sessions throughout 8.5 years [median] intervention) and 29,294 to a usual diet comparison (written health-related materials only). Neither randomization group received specific or ongoing instructions to increase physical activity. Episodes per week of moderate or vigorous recreational physical activity (MVPA) were serially reported. Marginal longitudinal logistic regression models were used to assess physically inactive (MVPA = 0) or physically active (MVPA > 0) participants by randomization group. Marginal Poisson regression models estimated mean weekly MVPA. RESULTS At entry, 45.6% of all participants reported physical inactivity (MVPA = 0). In 43,760 women with MVPA information, throughout 15.9 years (median) cumulative follow-up, dietary intervention group participation was associated with 7% lower physical inactivity rate (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.91, 0.95, P < 0.001) and a 4% higher mean MVPA (ratio of means [RM] 1.04 95% CI 1.02, 1.06, P < 0.001), relative to the comparison group. CONCLUSION In a randomized trial setting, a low-fat dietary pattern intervention was associated with a long-term, favorable influence on self-directed recreational physical activity. TRIAL REGISTRATION NCT00000611.
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Bröckelmann N, Balduzzi S, Harms L, Beyerbach J, Petropoulou M, Kubiak C, Wolkewitz M, Meerpohl JJ, Schwingshackl L. Evaluating agreement between bodies of evidence from randomized controlled trials and cohort studies in medical research: a meta-epidemiological study. BMC Med 2022; 20:174. [PMID: 35538478 PMCID: PMC9092682 DOI: 10.1186/s12916-022-02369-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/06/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Randomized controlled trials (RCTs) and cohort studies are the most common study design types used to assess the treatment effects of medical interventions. To evaluate the agreement of effect estimates between bodies of evidence (BoE) from randomized controlled trials (RCTs) and cohort studies and to identify factors associated with disagreement. METHODS Systematic reviews were published in the 13 medical journals with the highest impact factor identified through a MEDLINE search. BoE-pairs from RCTs and cohort studies with the same medical research question were included. We rated the similarity of PI/ECO (Population, Intervention/Exposure, Comparison, Outcome) between BoE from RCTs and cohort studies. The agreement of effect estimates across BoE was analyzed by pooling ratio of ratios (RoR) for binary outcomes and difference of mean differences for continuous outcomes. We performed subgroup analyses to explore factors associated with disagreements. RESULTS One hundred twenty-nine BoE pairs from 64 systematic reviews were included. PI/ECO-similarity degree was moderate: two BoE pairs were rated as "more or less identical"; 90 were rated as "similar but not identical" and 37 as only "broadly similar". For binary outcomes, the pooled RoR was 1.04 (95% CI 0.97-1.11) with considerable statistical heterogeneity. For continuous outcomes, differences were small. In subgroup analyses, degree of PI/ECO-similarity, type of intervention, and type of outcome, the pooled RoR indicated that on average, differences between both BoE were small. Subgroup analysis by degree of PI/ECO-similarity revealed high statistical heterogeneity and wide prediction intervals across PI/ECO-dissimilar BoE pairs. CONCLUSIONS On average, the pooled effect estimates between RCTs and cohort studies did not differ. Statistical heterogeneity and wide prediction intervals were mainly driven by PI/ECO-dissimilarities (i.e., clinical heterogeneity) and cohort studies. The potential influence of risk of bias and certainty of the evidence on differences of effect estimates between RCTs and cohort studies needs to be explored in upcoming meta-epidemiological studies.
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Affiliation(s)
- Nils Bröckelmann
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 86, 79110, Freiburg, Germany
| | - Sara Balduzzi
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Louisa Harms
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 86, 79110, Freiburg, Germany
| | - Jessica Beyerbach
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 86, 79110, Freiburg, Germany
| | - Maria Petropoulou
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Charlotte Kubiak
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 86, 79110, Freiburg, Germany
| | - Martin Wolkewitz
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 86, 79110, Freiburg, Germany
- Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
| | - Lukas Schwingshackl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 86, 79110, Freiburg, Germany.
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Stasiewicz B, Wadolowska L, Biernacki M, Slowinska MA, Stachowska E. Dietary Fat Intake: Associations with Dietary Patterns and Postmenopausal Breast Cancer-A Case-Control Study. Cancers (Basel) 2022; 14:1724. [PMID: 35406496 PMCID: PMC8997044 DOI: 10.3390/cancers14071724] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/20/2022] [Accepted: 03/26/2022] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to assess the associations of dietary fat intake with BC occurrence and dietary patterns. This case-control study involved 420 women aged 40−79 years from northeastern Poland, including 190 newly diagnosed BC cases. Dietary data were collected using a food frequency questionnaire (62-item FFQ-6®). The Quick Food Scan of the National Cancer Institute and the Percentage Energy from Fat Screener scoring procedures were used to estimate the percentage energy from dietary fat (Pfat). The odds of BC occurrence was three times higher in the Pfat > 32%. The Pfat > 32% was positively associated with the ‘Non-Healthy’ DP and inversely associated with the Polish-aMED® score, ‘Prudent’ DP, and ‘Margarine and Sweetened Dairy’ DP. This case-control study suggests that a higher dietary fat intake (>32%) may contribute to an increased occurrence of peri- and postmenopausal breast cancer in women. Given the obtained results, an unhealthy dietary pattern characterized by the consumption of highly processed, high in sugar foods and animal fat foods should be avoided to reduce fat intake. Instead, the frequent consumption of low-processed plant foods, fish, and moderate consumption of low-fat dairy should be recommended since this pro-healthy diet is inversely associated with dietary fat intake.
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Affiliation(s)
- Beata Stasiewicz
- Department of Human Nutrition, The Faculty of Food Science, University of Warmia and Mazury in Olsztyn, Sloneczna 45f, 10-718 Olsztyn, Poland; (L.W.); (M.A.S.)
| | - Lidia Wadolowska
- Department of Human Nutrition, The Faculty of Food Science, University of Warmia and Mazury in Olsztyn, Sloneczna 45f, 10-718 Olsztyn, Poland; (L.W.); (M.A.S.)
| | - Maciej Biernacki
- Department of Surgery, University of Warmia and Mazury in Olsztyn, 11-041 Olsztyn, Poland;
| | - Malgorzata Anna Slowinska
- Department of Human Nutrition, The Faculty of Food Science, University of Warmia and Mazury in Olsztyn, Sloneczna 45f, 10-718 Olsztyn, Poland; (L.W.); (M.A.S.)
| | - Ewa Stachowska
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University, 71-460 Szczecin, Poland
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Van Eenennaam AL, Werth SJ. Animal board invited review: Animal agriculture and alternative meats - learning from past science communication failures. Animal 2021; 15:100360. [PMID: 34563799 DOI: 10.1016/j.animal.2021.100360] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 08/18/2021] [Accepted: 08/23/2021] [Indexed: 01/24/2023] Open
Abstract
Sustainability discussions bring in multiple competing goals, and the outcomes are often conflicting depending upon which goal is being given credence. The role of livestock in supporting human well-being is especially contentious in discourses around sustainable diets. There is considerable variation in which environmental metrics are measured when describing sustainable diets, although some estimate of the greenhouse gas (GHG) emissions of different diets based on varying assumptions is commonplace. A market for animal-free and manufactured food items to substitute for animal source food (ASF) has emerged, driven by the high GHG emissions of ASF. Ingredients sourced from plants, and animal cells grown in culture are two approaches employed to produce alternative meats. These can be complemented with ingredients produced using synthetic biology. Alternative meat companies promise to reduce GHG, the land and water used for food production, and reduce or eliminate animal agriculture. Some CEOs have even claimed alternative meats will 'end world hunger'. Rarely do such self-proclamations emanate from scientists, but rather from companies in their efforts to attract venture capital investment and market share. Such declarations are reminiscent of the early days of the biotechnology industry. At that time, special interest groups employed fear-based tactics to effectively turn public opinion against the use of genetic engineering to introduce sustainability traits, like disease resistance and nutrient fortification, into global genetic improvement programs. These same groups have recently turned their sights on the 'unnaturalness' and use of synthetic biology in the production of meat alternatives, leaving agriculturists in a quandary. Much of the rationale behind alternative meats invokes a simplistic narrative, with a primary focus on GHG emissions, ignoring the nutritional attributes and dietary importance of ASF, and livelihoods that are supported by grazing ruminant production systems. Diets with low GHG emissions are often described as sustainable, even though the nutritional, social and economic pillars of sustainability are not considered. Nutritionists, geneticists, and veterinarians have been extremely successful at developing new technologies to reduce the environmental footprint of ASF. Further technological developments are going to be requisite to continuously improve the efficiency of animal source, plant source, and cultured meat production. Perhaps there is an opportunity to collectively communicate how innovations are enabling both alternative- and conventional-meat producers to more sustainably meet future demand. This could counteract the possibility that special interest groups who promulgate misinformation, fear and uncertainty, will hinder the adoption of technological innovations to the ultimate detriment of global food security.
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Affiliation(s)
- A L Van Eenennaam
- Department of Animal Science, University of California, 1 Shields Ave, Davis, CA 95616, USA.
| | - S J Werth
- Department of Animal Science, University of California, 1 Shields Ave, Davis, CA 95616, USA
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Sasamoto N, Wang T, Townsend MK, Hecht JL, Eliassen AH, Song M, Terry KL, Tworoger SS, Harris HR. Prospective Analyses of Lifestyle Factors Related to Energy Balance and Ovarian Cancer Risk by Infiltration of Tumor-Associated Macrophages. Cancer Epidemiol Biomarkers Prev 2021; 30:920-926. [PMID: 33653814 PMCID: PMC8102357 DOI: 10.1158/1055-9965.epi-20-1686] [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: 11/29/2020] [Revised: 02/01/2021] [Accepted: 02/23/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Lifestyle factors related to energy balance have been associated with ovarian cancer risk and influence the tumor immune microenvironment, including tumor-associated macrophages (TAM). However, no studies have assessed whether these factors differentially impact ovarian cancer risk by TAM densities. METHODS We conducted a prospective analysis in the Nurses' Health Studies to examine the associations of physical activity, sitting time, and a food-based empirical dietary inflammatory pattern (EDIP) score with invasive epithelial ovarian cancer risk by TAM density assessed by immunohistochemistry. We considered density of CD68 (marker of total TAMs) and CD163 (marker of pro-carcinogenic M2-type TAMs), and their ratios. We used multivariable Cox proportional hazards regression to calculate hazard ratios (HR) and 95% confidence intervals (CI) of exposures with risk of ovarian tumors with high versus low TAMs, including analyses stratified by body mass index. RESULTS Analyses included 312 incident ovarian cancer cases with TAM measurements. Physical activity, sitting time, and EDIP score were not differentially associated with ovarian cancer risk by TAM densities (P heterogeneity > 0.05). Among overweight and obese women, higher EDIP score was associated with increased risk of CD163 low-density tumors (HR comparing extreme tertiles, 1.57; 95% CI, 0.88-2.80; P trend = 0.01), but not CD163 high-density tumors (comparable HR, 1.16; 95% CI, 0.73-1.86; P trend = 0.24), though this difference was not statistically significant (P heterogeneity = 0.22). CONCLUSIONS We did not observe differential associations between lifestyle factors and ovarian cancer risk by TAM densities. IMPACT Future investigations examining the interplay between other ovarian cancer risk factors and the tumor immune microenvironment may help provide insight into ovarian cancer etiology.
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Affiliation(s)
- Naoko Sasamoto
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Tianyi Wang
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Mary K Townsend
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Jonathan L Hecht
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - A Heather Eliassen
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Mingyang Song
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Clinical and Translational Epidemiology Unit, Mongan Institute, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kathryn L Terry
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Shelley S Tworoger
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Holly R Harris
- Division of Public Health Sciences, Program in Epidemiology, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department in Epidemiology, School of Public Health, University of Washington, Seattle, Washington
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Abstract
PURPOSE OF REVIEW Breast cancer is the most common cancer in women, yet conclusive evidence of the effects of dietary modification in breast cancer survivors is lacking. Here, we summarize the literature and highlight important data regarding the association between dietary interventions and breast cancer outcomes. RECENT FINDINGS Long-term follow-up and secondary analysis of the Women's Health Initiative study demonstrated a significant improvement in overall survival for women who were randomized to the low-fat diet pattern compared with those in the usual-diet group. Dietary quality as measured by Healthy Eating Index score was also associated with both a decrease in cancer-specific mortality and overall mortality. Despite current evidence on the role of diet and nutrition in breast cancer outcomes, conclusive data to translate current findings to clinical practice is lacking and requires multidisciplinary prospective research to advance the field.
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13
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Chlebowski RT, Aragaki AK, Anderson GL, Pan K, Neuhouser ML, Manson JE, Thomson CA, Mossavar-Rahmani Y, Lane DS, Johnson KC, Wactawski-Wende J, Snetselaar L, Rohan TE, Luo J, Barac A, Prentice RL. Dietary Modification and Breast Cancer Mortality: Long-Term Follow-Up of the Women's Health Initiative Randomized Trial. J Clin Oncol 2020; 38:1419-1428. [PMID: 32031879 PMCID: PMC7193750 DOI: 10.1200/jco.19.00435] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2019] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Observational studies of dietary fat intake and breast cancer have reported inconsistent findings. This topic was addressed in additional analyses of the Women's Health Initiative (WHI) Dietary Modification (DM) clinical trial that evaluated a low-fat dietary pattern influence on breast cancer incidence. METHODS In the WHI DM trial, 48,835 postmenopausal women, ages 50-79 years, with no prior breast cancer, and a dietary fat intake of ≥ 32% of energy were randomly assigned at 40 US centers to a usual diet comparison group (60%) or dietary intervention group (40%). The goals were to reduce fat intake to 20% of energy and increase vegetable, fruit, and grain intake. Breast cancers were confirmed after central medical record review and serial National Death Index linkages to enhance mortality findings. RESULTS During 8.5 years of dietary intervention, breast cancer incidence and deaths as a result of breast cancer were nonsignificantly lower in the intervention group, while deaths after breast cancer were statistically significantly lower both during intervention and through a 16.1-year (median) follow-up. Now, after a long-term, cumulative 19.6-year (median) follow-up, the significant reduction in deaths after breast cancer persists (359 [0.12%] v 652 [0.14%] deaths; hazard ratio [HR], 0.85; 95% CI, 0.74 to 0.96; P = .01), and a statistically significant reduction in deaths as a result of breast cancer (breast cancer followed by death attributed to the breast cancer) emerged (132 [0.037%, annualized risk] v 251 [0.047%] deaths, respectively; HR, 0.79; 95% CI, 0.64 to 0.97; P = .02). CONCLUSION Adoption of a low-fat dietary pattern associated with increased vegetable, fruit, and grain intake, demonstrably achievable by many, may reduce the risk of death as a result of breast cancer in postmenopausal women.
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Affiliation(s)
- Rowan T. Chlebowski
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Aaron K. Aragaki
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Garnet L. Anderson
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Kathy Pan
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Marian L. Neuhouser
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - JoAnn E. Manson
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | | | - Yasmin Mossavar-Rahmani
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Dorothy S. Lane
- Department of Family, Population and Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, NY
| | - Karen C. Johnson
- Departments of Preventive Medicine and Medicine, University of Tennessee, Memphis, TN
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY
| | | | - Thomas E. Rohan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Juhua Luo
- Department of Epidemiology and Biostatistics, Indiana University, Bloomington, IN
| | - Ana Barac
- MedStar Heart and Vascular Institute, Georgetown University, Washington, DC
| | - Ross L. Prentice
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - on behalf of the Women’s Health Initiative
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
- Department of Family, Population and Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, NY
- Departments of Preventive Medicine and Medicine, University of Tennessee, Memphis, TN
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY
- Department of Epidemiology and Biostatistics, Indiana University, Bloomington, IN
- College of Public Health, University of Iowa, Iowa City, IA
- MedStar Heart and Vascular Institute, Georgetown University, Washington, DC
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14
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Zeraatkar D, Johnston BC, Bartoszko J, Cheung K, Bala MM, Valli C, Rabassa M, Sit D, Milio K, Sadeghirad B, Agarwal A, Zea AM, Lee Y, Han MA, Vernooij RWM, Alonso-Coello P, Guyatt GH, El Dib R. Effect of Lower Versus Higher Red Meat Intake on Cardiometabolic and Cancer Outcomes: A Systematic Review of Randomized Trials. Ann Intern Med 2019; 171:721-731. [PMID: 31569236 DOI: 10.7326/m19-0622] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
UNLABELLED This article has been corrected. The original version (PDF) is appended to this article as a Supplement. BACKGROUND Few randomized trials have evaluated the effect of reducing red meat intake on clinically important outcomes. PURPOSE To summarize the effect of lower versus higher red meat intake on the incidence of cardiometabolic and cancer outcomes in adults. DATA SOURCES EMBASE, CENTRAL, CINAHL, Web of Science, and ProQuest from inception to July 2018 and MEDLINE from inception to April 2019, without language restrictions. STUDY SELECTION Randomized trials (published in any language) comparing diets lower in red meat with diets higher in red meat that differed by a gradient of at least 1 serving per week for 6 months or more. DATA EXTRACTION Teams of 2 reviewers independently extracted data and assessed the risk of bias and the certainty of the evidence. DATA SYNTHESIS Of 12 eligible trials, a single trial enrolling 48 835 women provided the most credible, though still low-certainty, evidence that diets lower in red meat may have little or no effect on all-cause mortality (hazard ratio [HR], 0.99 [95% CI, 0.95 to 1.03]), cardiovascular mortality (HR, 0.98 [CI, 0.91 to 1.06]), and cardiovascular disease (HR, 0.99 [CI, 0.94 to 1.05]). That trial also provided low- to very-low-certainty evidence that diets lower in red meat may have little or no effect on total cancer mortality (HR, 0.95 [CI, 0.89 to 1.01]) and the incidence of cancer, including colorectal cancer (HR, 1.04 [CI, 0.90 to 1.20]) and breast cancer (HR, 0.97 [0.90 to 1.04]). LIMITATIONS There were few trials, most addressing only surrogate outcomes, with heterogeneous comparators and small gradients in red meat consumption between lower versus higher intake groups. CONCLUSION Low- to very-low-certainty evidence suggests that diets restricted in red meat may have little or no effect on major cardiometabolic outcomes and cancer mortality and incidence. PRIMARY FUNDING SOURCE None (PROSPERO: CRD42017074074).
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Affiliation(s)
- Dena Zeraatkar
- McMaster University, Hamilton, Ontario, Canada (D.Z., B.C.J., J.B., K.C., K.M., B.S., A.M.Z., Y.L., G.H.G.)
| | - Bradley C Johnston
- McMaster University, Hamilton, Ontario, Canada (D.Z., B.C.J., J.B., K.C., K.M., B.S., A.M.Z., Y.L., G.H.G.)
| | - Jessica Bartoszko
- McMaster University, Hamilton, Ontario, Canada (D.Z., B.C.J., J.B., K.C., K.M., B.S., A.M.Z., Y.L., G.H.G.)
| | - Kevin Cheung
- McMaster University, Hamilton, Ontario, Canada (D.Z., B.C.J., J.B., K.C., K.M., B.S., A.M.Z., Y.L., G.H.G.)
| | | | - Claudia Valli
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain (C.V., M.R., P.A.)
| | - Montserrat Rabassa
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain (C.V., M.R., P.A.)
| | - Daegen Sit
- University of British Columbia, Vancouver, British Columbia, Canada (D.S.)
| | - Kirolos Milio
- McMaster University, Hamilton, Ontario, Canada (D.Z., B.C.J., J.B., K.C., K.M., B.S., A.M.Z., Y.L., G.H.G.)
| | - Behnam Sadeghirad
- McMaster University, Hamilton, Ontario, Canada (D.Z., B.C.J., J.B., K.C., K.M., B.S., A.M.Z., Y.L., G.H.G.)
| | - Arnav Agarwal
- University of Toronto, Toronto, Ontario, Canada (A.A.)
| | - Adriana M Zea
- McMaster University, Hamilton, Ontario, Canada (D.Z., B.C.J., J.B., K.C., K.M., B.S., A.M.Z., Y.L., G.H.G.)
| | - Yung Lee
- McMaster University, Hamilton, Ontario, Canada (D.Z., B.C.J., J.B., K.C., K.M., B.S., A.M.Z., Y.L., G.H.G.)
| | - Mi Ah Han
- Chosun University, Gwangju, Republic of Korea (M.A.H.)
| | - Robin W M Vernooij
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands (R.W.V.)
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain (C.V., M.R., P.A.)
| | - Gordon H Guyatt
- McMaster University, Hamilton, Ontario, Canada (D.Z., B.C.J., J.B., K.C., K.M., B.S., A.M.Z., Y.L., G.H.G.)
| | - Regina El Dib
- Institute of Science and Technology, Universidade Estadual Paulista, São José dos Campos, São Paulo, Brazil (R.E.)
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Gut microbiota in colorectal cancer: mechanisms of action and clinical applications. Nat Rev Gastroenterol Hepatol 2019; 16:690-704. [PMID: 31554963 DOI: 10.1038/s41575-019-0209-8] [Citation(s) in RCA: 634] [Impact Index Per Article: 126.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/27/2019] [Indexed: 02/06/2023]
Abstract
Colorectal cancer (CRC) accounts for about 10% of all new cancer cases globally. Located at close proximity to the colorectal epithelium, the gut microbiota comprises a large population of microorganisms that interact with host cells to regulate many physiological processes, such as energy harvest, metabolism and immune response. Sequencing studies have revealed microbial compositional and ecological changes in patients with CRC, whereas functional studies in animal models have pinpointed the roles of several bacteria in colorectal carcinogenesis, including Fusobacterium nucleatum and certain strains of Escherichia coli and Bacteroides fragilis. These findings give new opportunities to take advantage of our knowledge on the gut microbiota for clinical applications, such as gut microbiota analysis as screening, prognostic or predictive biomarkers, or modulating microorganisms to prevent cancer, augment therapies and reduce adverse effects of treatment. This Review aims to provide an overview and discussion of the gut microbiota in colorectal neoplasia, including relevant mechanisms in microbiota-related carcinogenesis, the potential of utilizing the microbiota as CRC biomarkers, and the prospect for modulating the microbiota for CRC prevention or treatment. These scientific findings will pave the way to clinically translate the use of gut microbiota for CRC in the near future.
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16
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Prentice RL, Aragaki AK, Howard BV, Chlebowski RT, Thomson CA, Van Horn L, Tinker LF, Manson JE, Anderson GL, Kuller LE, Neuhouser ML, Johnson KC, Snetselaar L, Rossouw JE. Low-Fat Dietary Pattern among Postmenopausal Women Influences Long-Term Cancer, Cardiovascular Disease, and Diabetes Outcomes. J Nutr 2019; 149:1565-1574. [PMID: 31175807 PMCID: PMC6736441 DOI: 10.1093/jn/nxz107] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/14/2019] [Accepted: 04/25/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The preferred macronutrient dietary composition, and the health consequences of dietary fat reduction specifically, have been debated for decades. Here we provide a comprehensive overview of long-term health outcomes in the Women's Health Initiative Dietary Modification (DM) trial. OBJECTIVE The DM trial aimed to examine whether a low-fat dietary pattern would reduce the risk of invasive breast cancer, colorectal cancer, and, secondarily, coronary heart disease (CHD), with various other health outcomes also considered. METHODS The DM trial is a randomized controlled trial conducted at 40 centers in the US, among 48,835 postmenopausal women aged 50-79 y with baseline intake of ≥32% energy from fat. Participants were randomly assigned to a low-fat dietary pattern intervention group or to a usual-diet comparison group, during 1993-1998. Intervention goals were to reduce fat intake from ∼35% to 20% of total energy, in conjunction with increasing vegetables and fruit to 5 servings/d and grains to 6 servings/d. RESULTS Over an 8.5-y (median) intervention period, intervention and comparison group differences included lower fat by 8-10%, and higher carbohydrate by 8-10%, of total energy, in conjunction with higher consumption of vegetables, fruit, and grains. Time-to-outcome analyses did not show significant differences between intervention and comparison groups for invasive breast cancer, colorectal cancer, or CHD, either over the intervention period or over longer-term cumulative follow-up. Additional analyses showed significant intervention group benefits related to breast cancer, CHD, and diabetes, without adverse effects. Over a 19.6-y (median) follow-up period, HRs (95% CIs) were 0.84 (0.74, 0.96) for breast cancer followed by death, and 0.87 (0.77, 0.98) for diabetes requiring insulin. CONCLUSIONS Reduction in dietary fat with corresponding increase in vegetables, fruit, and grains led to benefits related to breast cancer, CHD, and diabetes, without adverse effects, among healthy postmenopausal US women. This trial was registered at clinicaltrials.gov as NCT00000611.
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Affiliation(s)
- Ross L Prentice
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA,Address correspondence to RLP (e-mail: )
| | - Aaron K Aragaki
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Barbara V Howard
- Department of Medicine, Georgetown University Medical Center, and MedStar Health Research Institute, Hyattsville, MD, USA
| | - Rowan T Chlebowski
- Oncology/Hematology, Division of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | - Cynthia A Thomson
- College of Public Health, Department of Nutritional Sciences, University of Arizona, Tucson, AZ, USA
| | - Linda Van Horn
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Lesley F Tinker
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - JoAnn E Manson
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Garnet L Anderson
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Lewis E Kuller
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Marian L Neuhouser
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, TN, USA
| | - Linda Snetselaar
- Preventive Nutrition Education, Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
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17
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Colorectal cancer risk factors in asymptomatic Chilean population: a survey of international collaboration between Japan and Chile. Eur J Cancer Prev 2019; 29:127-133. [PMID: 31436751 DOI: 10.1097/cej.0000000000000531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In Chile, the mortality from colorectal cancer has been on the rise. A national screening program based on a fecal immunochemical test was started in 2012 as an international collaboration with Japan. This case-control study was designed to identify the risk factors for colorectal cancer, with a goal of increasing the participation rate for colorectal cancer screening. In accordance with the Strengthening the Reporting of Observational Studies in Epidemiology guidelines, we conducted a case-control study from 2012 to 2017; 23 845 asymptomatic participants were enrolled in the study. Participants who were fecal immunochemical test-positive or had a family history of colorectal cancer underwent a colonoscopy. We analyzed the odds ratio of the risk factors for colorectal cancer, including sex, age, family history, BMI, hypertension, diabetes, regular use of nonsteroidal anti-inflammatory drugs, alcohol consumption, smoking, physical activity, and daily intake of certain food items. For the screening program, 202 cases of colorectal cancer were detected, and 195 of them were evaluated pathologically after resection. Of these, 173 cases (88.7%) had colorectal cancer stage 0/1, 151 (77.4%) of which were treated with endoscopic resection. In the multivariate analysis, male sex, family history of colorectal cancer, and low intake of cereals or fibers were closely related to a high colorectal cancer incidence. Moreover, participants in their 60s and 70s had a higher incidence of colorectal cancer than those in their 50s. These results suggest that intensive screening of the high-risk population can help in improving the detection of colorectal cancer, whereas higher consumption of cereals or fibers can be effective in preventing its onset.
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18
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Arthur R, Brasky TM, Crane TE, Felix AS, Kaunitz AM, Shadyab AH, Qi L, Wassertheil-Smoller S, Rohan TE. Associations of a Healthy Lifestyle Index With the Risks of Endometrial and Ovarian Cancer Among Women in the Women's Health Initiative Study. Am J Epidemiol 2019; 188:261-273. [PMID: 30407487 PMCID: PMC6357793 DOI: 10.1093/aje/kwy249] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 10/31/2018] [Accepted: 11/01/2018] [Indexed: 12/18/2022] Open
Abstract
Lifestyle-related factors influence risk of endometrial and ovarian cancers, but few studies have examined their joint associations with risk of these cancers. Using multivariable Cox regression models, we assessed the association of a healthy lifestyle index (HLI-a composite score (range, 0-20) involving diet, alcohol consumption, physical activity, body mass index, and smoking; higher scores represent healthier behavior) with risk of endometrial and ovarian cancers among 108,136 postmenopausal women who were recruited in the US Women's Health Initiative study between 1993 and 1998. After a median follow-up of 17.9 years, 1,435 endometrial cancer cases and 904 ovarian cancer cases had been ascertained. Women in the highest quintile of the HLI score had a lower risk of overall, type I, well-differentiated, moderately differentiated, poorly differentiated, and localized endometrial cancer than those in the lowest quintile (for quintile 5 vs. quintile 1, hazard ratio (HR) = 0.61 (95% CI: 0.51, 0.72), HR = 0.60 (95% CI: 0.49, 0.72), HR = 0.66 (95% CI: 0.46, 0.96), HR = 0.69 (95% CI: 0.52, 0.90), HR = 0.49 (95% CI: 0.34, 0.72), and HR = 0.61 (95% CI: 0.50, 0.74), respectively). The HLI score had a weak positive association with risk of serous ovarian cancer. Our findings underscore the potential importance of a healthy lifestyle in lowering endometrial cancer risk among postmenopausal women.
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Affiliation(s)
- Rhonda Arthur
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Theodore M Brasky
- Division of Cancer Prevention and Control, Department of Internal Medicine, Ohio State University College of Medicine, Columbus, Ohio
| | - Tracy E Crane
- College of Nursing, University of Arizona, Tucson, Arizona
| | - Ashley S Felix
- Division of Epidemiology, College of Public Health, Ohio State University, Columbus, Ohio
| | - Andrew M Kaunitz
- Department of Obstetrics and Gynecology, University of Florida, Jacksonville, Florida
| | - Aladdin H Shadyab
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, California
| | - Lihong Qi
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, Davis, California
| | | | - Thomas E Rohan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
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19
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Chlebowski RT, Anderson GL, Manson JE, Prentice RL, Aragaki AK, Snetselaar L, Beresford SAA, Kuller LH, Johnson K, Lane D, Luo J, Rohan TE, Jiao L, Barac A, Womack C, Coday M, Datta M, Thomson CA. Low-Fat Dietary Pattern and Cancer Mortality in the Women's Health Initiative (WHI) Randomized Controlled Trial. JNCI Cancer Spectr 2019; 2:pky065. [PMID: 31360880 PMCID: PMC6649760 DOI: 10.1093/jncics/pky065] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 07/19/2018] [Accepted: 10/03/2018] [Indexed: 01/08/2023] Open
Abstract
Background In the Women’s Health Initiative Dietary Modification trial, a low-fat dietary pattern reduced deaths after breast cancer. Mortality from other cancer sites has not been reported. Methods A low-fat dietary pattern influence on deaths from and after site-specific cancers was examined during 8.5 years (median) of dietary intervention and cumulatively during 17.7 years (median) of follow-up. A total 48 835 postmenopausal women, ages 50–79 years, were randomly assigned from 1993 to 1998 at 40 US clinical centers to dietary intervention (40%, n = 19 541 or a usual diet comparison group (60%, n = 29 294). Dietary intervention influence on mortality from protocol-specified cancers (breast, colon and rectum, endometrium and ovary), individually and as a composite, represented the primary analyses. Results During the dietary intervention period, a reduction in deaths after breast cancer (HR = 0.65 95% CI = 0.45 to 0.94, P = .02) was the only statistically significant cancer mortality finding. During intervention, the HRs for deaths after the protocol-specified cancer composite were 0.90 (95% CI = 0.73 to 1.10) and 0.95 (95% CI = 0.85 to 1.06) for deaths after all cancers. During 17.7 years of follow-up with 3867 deaths after all cancers, reduction in deaths after breast cancer continued in the dietary intervention group (HR = 0.85, 95% CI = 0.74 to 0.99, P = .03). However, no dietary intervention influence on deaths from or after any other cancer or cancer composite was seen. Conclusions A low-fat dietary pattern reduced deaths after breast cancer. No reduction in mortality from or after any other cancer or cancer composite was seen.
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Affiliation(s)
| | - Garnet L Anderson
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - JoAnn E Manson
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA
| | - Ross L Prentice
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Aaron K Aragaki
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | | | - Lewis H Kuller
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | - Karen Johnson
- Department of Preventive Medicine, University of Tennessee, Memphis, TN
| | - Dorothy Lane
- Preventive Medicine, Stony Brook University, Stony Brook, NY
| | - Juhua Luo
- School of Public Health, University of Indiana, Bloomington, IN
| | - Thomas E Rohan
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Li Jiao
- Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Ana Barac
- MedStar Health Research Institute and Georgetown/Howard Universities Center for Clinical and Translational Sciences, Washington, DC
| | | | - Mace Coday
- Department of Preventive Medicine, University of Tennessee, Memphis, TN
| | - Mridul Datta
- School of Public Health, University of Purdue, West Lafayette, IN
| | - Cynthia A Thomson
- Mel and Enid Zuckerman College of Public Health, University of Arizona Cancer Center, Tucson, AZ
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Johnston BC, Alonso-Coello P, Bala MM, Zeraatkar D, Rabassa M, Valli C, Marshall C, El Dib R, Vernooij RWM, Vandvik PO, Guyatt GH. Methods for trustworthy nutritional recommendations NutriRECS (Nutritional Recommendations and accessible Evidence summaries Composed of Systematic reviews): a protocol. BMC Med Res Methodol 2018; 18:162. [PMID: 30518328 PMCID: PMC6280455 DOI: 10.1186/s12874-018-0621-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 11/16/2018] [Indexed: 12/14/2022] Open
Abstract
Background Recent systematic reviews and editorials suggest that many organizations that produce nutritional guideline recommendations do not adhere to internationally recognized standards set forth by the Institute of Medicine (IoM), Guidelines International Network (GIN), Appraisal of Guidelines Research and Evaluation (AGREE), and Grading Recommendations, Assessment, Development and Evaluation (GRADE). Methods The potential solution is an independent group with content expertise and skilled in the methodology of systematic reviews and practice guidelines to produce trustworthy guideline recommendations, recommendations that are supported by publication in a top tier journal. The BMJ Rapid Recommendations project has recently demonstrated the feasibility and utility of this approach. Here, we are proposing trustworthy nutritional guideline recommendations based on internationally accepted guideline development standards, recommendations that will be informed by rigorous and novel systematic reviews of the benefits and harms associated with nutritional exposures, as well as studies on the values and preferences related to dietary behaviors among members of the international community. Discussion Adhering to international guideline standards, conducting high quality systematic reviews, and actively assessing the values and preferences of key stakeholders is expected to improve the quality of nutritional guidelines and their relevance to end-users, particularly patients and community members. We will send our work for peer review, and if found acceptable, we will publish our nutritional recommendations in top-tier general medicine journals.
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Affiliation(s)
- Bradley C Johnston
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Canada. .,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
| | - Pablo Alonso-Coello
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Malgorzata M Bala
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
| | - Dena Zeraatkar
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Montserrat Rabassa
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain
| | - Claudia Valli
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain
| | - Catherine Marshall
- Cochrane Consumer and Honorary Patron of the Guidelines International Network, Wellington, New Zealand
| | - Regina El Dib
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Canada.,Institute of Science and Technology, Unesp - Univ Estadual Paulista, São José dos Campos, Brazil
| | - Robin W M Vernooij
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Canada.,Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Per O Vandvik
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Medicine, Innlandet Hospital Trust-division, Gjøvik, Norway
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
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21
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Ulrich CM, Himbert C, Holowatyj AN, Hursting SD. Energy balance and gastrointestinal cancer: risk, interventions, outcomes and mechanisms. Nat Rev Gastroenterol Hepatol 2018; 15:683-698. [PMID: 30158569 PMCID: PMC6500387 DOI: 10.1038/s41575-018-0053-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Obesity increases the risk of multiple gastrointestinal cancers and worsens disease outcomes. Conversely, strong inverse associations have emerged between physical activity and colon cancer and possibly other gastrointestinal malignancies. The effect of weight loss interventions - such as modifications of diet and/or physical activity or bariatric surgery - remains unclear in patients who are obese and have gastrointestinal cancer, although large clinical trials are underway. Human intervention studies have already shed light on potential mechanisms underlying the energy balance-cancer relationship, with preclinical models supporting emerging pathway effects. Central to interventions that reduce obesity or increase physical activity are pluripotent cancer-preventive effects (including reduced systemic and adipose tissue inflammation and angiogenesis, altered adipokine levels and improved insulin resistance) that directly interface with the hallmarks of cancer. Other mechanisms, such as DNA repair, oxidative stress and telomere length, immune function, effects on cancer stem cells and the microbiome, could also contribute to energy balance effects on gastrointestinal cancers. Although some mechanisms are well understood (for instance, systemic effects on inflammation and insulin signalling), other areas remain unclear. The current state of knowledge supports the need to better integrate mechanistic approaches with preclinical and human studies to develop effective, personalized diet and exercise interventions to reduce the burden of obesity on gastrointestinal cancer.
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Affiliation(s)
- Cornelia M. Ulrich
- Huntsman Cancer Institute, Salt Lake City, UT, USA.,Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA.,
| | - Caroline Himbert
- Huntsman Cancer Institute, Salt Lake City, UT, USA.,Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Andreana N. Holowatyj
- Huntsman Cancer Institute, Salt Lake City, UT, USA.,Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Stephen D. Hursting
- Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA.,UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
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22
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Chlebowski RT, Aragaki AK, Anderson GL, Simon MS, Manson JE, Neuhouser ML, Pan K, Stefanic ML, Rohan TE, Lane D, Qi L, Snetselaar L, Prentice RL. Association of Low-Fat Dietary Pattern With Breast Cancer Overall Survival: A Secondary Analysis of the Women's Health Initiative Randomized Clinical Trial. JAMA Oncol 2018; 4:e181212. [PMID: 29800122 PMCID: PMC6233778 DOI: 10.1001/jamaoncol.2018.1212] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 02/26/2018] [Indexed: 01/03/2023]
Abstract
Importance In a randomized clinical trial, a low-fat eating pattern was associated with lower risk of death after breast cancer. However, the extent to which results were driven by dietary influence on survival after breast cancer diagnosis was unknown. Objective To determine the association of a low-fat dietary pattern with breast cancer overall survival (breast cancer followed by death from any cause measured from cancer diagnosis). Design, Setting, and Participants This is a secondary analysis of the Women's Health Initiative randomized clinical trial that was conducted at 40 US clinical centers enrolling participants from 1993 through 1998. Participants were 48 835 postmenopausal women with no previous breast cancer and dietary fat intake of greater than 32% by food frequency questionnaire. Interventions Participants were randomized to a dietary intervention group (40%; n = 19 541) with goals to reduce fat intake to 20% of energy and increase fruit, vegetable, and grain intake or a usual-diet comparison group (60%; n = 29 294). Dietary group participants with incident breast cancers continued to participate in subsequent dietary intervention activities. Main Outcomes and Measures Breast cancer overall survival for incident breast cancers diagnosed during the 8.5-year (median) dietary intervention, examined in post hoc analyses after 11.5 years (median) postdiagnosis follow-up. Results Of 1764 women diagnosed with breast cancer during the dietary intervention period, mean (SD) age at screening was 62.7 (6.7) years and age at diagnosis was 67.6 (6.9) years. With 516 total deaths, breast cancer overall survival was significantly greater for women in the dietary intervention group than in the usual-diet comparison group (10-year survival of 82% and 78%, respectively; hazard ratio [HR], 0.78; 95% CI, 0.65-0.94; P = .01). In the dietary group there were fewer deaths from breast cancer (68 vs 120; HR, 0.86; 95% CI, 0.64-1.17), other cancers (36 vs 65; HR, 0.76; 95% CI, 0.50-1.17), and cardiovascular disease (27 vs 64; HR, 0.62; 95% CI, 0.39-0.99). Conclusions and Relevance In women who received a diagnosis of breast cancer during the dietary intervention period, those in the dietary group had increased overall survival. The increase is due, in part, to better survival from several causes of death. Trial Registration ClinicalTrials.gov Identifier: NCT00000611.
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Affiliation(s)
- Rowan T. Chlebowski
- City of Hope National Medical Center, Department of Medical Oncology and Therapeutics Research, Duarte, California
| | - Aaron K. Aragaki
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, Washington
| | - Garnet L. Anderson
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, Washington
| | - Michael S. Simon
- Wayne State University, Karmanos Cancer Institute, Detroit, Michigan
| | - JoAnn E. Manson
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marian L. Neuhouser
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, Washington
| | - Kathy Pan
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Department of Medicine, Torrance, California
| | - Marcia L. Stefanic
- Stanford Prevention Research Center, School of Medicine, Stanford University, Palo Alto, California
| | - Thomas E. Rohan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Dorothy Lane
- Stony Brook University, Preventive Medicine, Stony Brook, New York
| | - Lihong Qi
- Department of Public Health Sciences, University of California at Davis
| | - Linda Snetselaar
- College of Public Health, University of Iowa, Iowa City/Davenport
| | - Ross L. Prentice
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, Washington
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23
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Howard BV, Aragaki AK, Tinker LF, Allison M, Hingle MD, Johnson KC, Manson JE, Shadyab AH, Shikany JM, Snetselaar LG, Thomson CA, Zaslavsky O, Prentice RL. A Low-Fat Dietary Pattern and Diabetes: A Secondary Analysis From the Women's Health Initiative Dietary Modification Trial. Diabetes Care 2018; 41:680-687. [PMID: 29282203 PMCID: PMC5860839 DOI: 10.2337/dc17-0534] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 11/28/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We performed a secondary analysis to evaluate the effect of the Women's Health Initiative dietary intervention on incident diabetes and diabetes treatment in postmenopausal women. RESEARCH DESIGN AND METHODS A total of 48,835 women were randomized to a comparison group or an intervention group that underwent a behavioral/nutritional modification program to decrease fat and increase vegetable, fruit, and grain intake for an average of 8.1 years. Ninety-three percent of participants completed the intervention, and 71% participated in active follow-up through 30 September 2015 (median 17.3 years). We measured time to development of treated diabetes and progression from oral antihyperglycemic agents to insulin. Serum glucose and insulin were measured in a subsample of women (N = 2,324) at baseline and years 1, 3, and 6. RESULTS During the trial, intervention group women had lower rates of initiation of insulin therapy (hazard ratio [HR] 0.74 [95% CI 0.59, 0.94]; P = 0.01). Moreover, women with baseline waist circumference ≥88 cm (P interaction = 0.01) and worse metabolic syndrome scores (P interaction = 0.02) had the greatest reduction in risk of initiating insulin therapy. The decreased risk from the intervention was present during the cumulative follow-up (HR 0.88 [95% CI 0.78, 0.99]; P = 0.04). In participants with measured biomarkers (5.8% subsample) who had baseline glucose <100 mg/dL, the intervention reduced the risk of developing glucose ≥100 mg/dL by 25% (odds ratio 0.75 [95% CI 0.61, 0.93]; P = 0.008). Adjustment for weight change did not alter the results. CONCLUSIONS In this secondary analysis, a dietary intervention in postmenopausal women aimed at reducing fat and increasing intake of vegetables, fruits, and grains did not increase risk of diabetes and may have slowed progression.
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Affiliation(s)
- Barbara V Howard
- MedStar Health Research Institute, Hyattsville, MD .,Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC
| | - Aaron K Aragaki
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Lesley F Tinker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Matthew Allison
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
| | - Melanie D Hingle
- Department of Nutritional Sciences, College of Agriculture and Life Sciences, University of Arizona, Tucson, AZ
| | | | - JoAnn E Manson
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Aladdin H Shadyab
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
| | | | | | - Cynthia A Thomson
- Department of Nutritional Sciences, College of Agriculture and Life Sciences, University of Arizona, Tucson, AZ
| | | | - Ross L Prentice
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
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24
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Smith LA, O'Flanagan CH, Bowers LW, Allott EH, Hursting SD. Translating Mechanism-Based Strategies to Break the Obesity-Cancer Link: A Narrative Review. J Acad Nutr Diet 2018; 118:652-667. [PMID: 29102513 PMCID: PMC5869082 DOI: 10.1016/j.jand.2017.08.112] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 08/17/2017] [Indexed: 02/08/2023]
Abstract
Prevalence of obesity, an established risk factor for many cancers, has increased dramatically over the past 50 years in the United States and across the globe. Relative to normoweight cancer patients, obese cancer patients often have poorer prognoses, resistance to chemotherapies, and are more likely to develop distant metastases. Recent progress on elucidating the mechanisms underlying the obesity-cancer connection suggests that obesity exerts pleomorphic effects on pathways related to tumor development and progression and, thus, there are multiple opportunities for primary prevention and treatment of obesity-related cancers. Obesity-associated alterations, including systemic metabolism, adipose inflammation, growth factor signaling, and angiogenesis, are emerging as primary drivers of obesity-associated cancer development and progression. These obesity-associated host factors interact with the intrinsic molecular characteristics of cancer cells, facilitating several of the hallmarks of cancer. Each is considered in the context of potential preventive and therapeutic strategies to reduce the burden of obesity-related cancers. In addition, this review focuses on emerging mechanisms behind the obesity-cancer link, as well as relevant dietary interventions, including calorie restriction, intermittent fasting, low-fat diet, and ketogenic diet, that are being implemented in preclinical and clinical trials, with the ultimate goal of reducing incidence and progression of obesity-related cancers.
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25
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Arthur R, Wassertheil-Smoller S, Manson JE, Luo J, Snetselaar L, Hastert T, Caan B, Qi L, Rohan T. The Combined Association of Modifiable Risk Factors with Breast Cancer Risk in the Women's Health Initiative. Cancer Prev Res (Phila) 2018; 11:317-326. [PMID: 29483073 DOI: 10.1158/1940-6207.capr-17-0347] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/09/2018] [Accepted: 02/15/2018] [Indexed: 12/19/2022]
Abstract
Although several modifiable risk factors have been independently associated with risk of breast cancer, few studies have investigated their joint association with breast cancer risk. Using a healthy lifestyle index (HLI) score, we assessed the association of a combination of selected modifiable risk factors (diet, alcohol, physical activity, BMI, and smoking) with risk of invasive breast cancer in the Women's Health Initiative (WHI). This study comprised 131,833 postmenopausal women, of whom 8,168 had breast cancer, who were enrolled in the WHI Observational Study or the WHI clinical trials. Cox proportional hazards regression was used to estimate the HRs and 95% confidence intervals (CI) for the association of the score with the risk of developing breast cancer overall and according to specific breast cancer clinicopathologic characteristics. There was a 4% reduction in the risk of breast cancer per unit increase in the HLI score. Compared with those with an HLI score in the lowest quintile level, those in the highest quintile level had 30%, 37%, and 30% lower risk for overall, ER+/PR+, and HER2+ breast cancer, respectively (HR = 0.70; 95% CI, 0.64-0.76; 0.63, 0.57-0.69; and 0.70; 0.55-0.90, respectively). We also observed inverse associations between the score and risk of breast cancer irrespective of nodal status, tumor grade, and stage of the disease. Most individual lifestyle factors were independently associated with the risk of breast cancer. Our findings support the view that promoting healthy lifestyle practices may be beneficial with respect to lowering risk of breast cancer among postmenopausal women. Cancer Prev Res; 11(6); 317-26. ©2018 AACRSee related editorial by Friedenreich and McTiernan, p. 313.
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Affiliation(s)
- Rhonda Arthur
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York.
| | | | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Juhua Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, Indiana
| | - Linda Snetselaar
- Department of Epidemiology, School of Public Health, University of Iowa, Iowa City, Iowa
| | - Theresa Hastert
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan.,Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
| | - Bette Caan
- Division of Research, Kaiser Permanente, Oakland, California
| | - Lihong Qi
- Department of Public Health Science, School of Medicine, UC Davis, Davis, California
| | - Thomas Rohan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
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26
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Jiao L, Chen L, White DL, Tinker L, Chlebowski RT, Van Horn LV, Richardson P, Lane D, Sangi-Haghpeykar H, El-Serag HB. Low-fat Dietary Pattern and Pancreatic Cancer Risk in the Women's Health Initiative Dietary Modification Randomized Controlled Trial. J Natl Cancer Inst 2017; 110:4085218. [PMID: 28922784 DOI: 10.1093/jnci/djx117] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 05/05/2017] [Indexed: 12/13/2022] Open
Abstract
Background Observational studies suggest that diet may influence pancreatic cancer risk. We investigated the effect of a low-fat dietary intervention on pancreatic cancer incidence. Methods The Women's Health Initiative Dietary Modification (WHI-DM) trial is a randomized controlled trial conducted in 48 835 postmenopausal women age 50 to 79 years in the United States between 1993 and 1998. Women were randomly assigned to the intervention group (n = 19 541), with the goal of reducing total fat intake and increasing intake of vegetables, fruits, and grains, or to the usual diet comparison group (n = 29 294). The intervention concluded in March 2005. We evaluated the effect of the intervention on pancreatic cancer incidence with the follow-up through 2014 using the log-rank test and multivariable Cox proportional hazards regression model. All statistical tests were two-sided. Results In intention-to-treat analyses including 46 200 women, 92 vs 165 pancreatic cancer cases were ascertained in the intervention vs the comparison group (P = .23). The multivariable hazard ratio (HR) of pancreatic cancer was 0.86 (95% confidence interval [CI] = 0.67 to 1.11). Risk was statistically significantly reduced among women with baseline body mass indexes (BMIs) of 25 kg/m2 or higher (HR = 0.71, 95% CI = 0.53 to 0.96), but not among women with BMIs of less than 25 kg/m2 (HR = 1.62, 95% CI = 0.97 to 2.71, Pinteraction = .01). Conclusions A low-fat dietary intervention was associated with reduced pancreatic cancer incidence in women who were overweight or obese in the WHI-DM trial. Caution needs to be taken in interpreting the findings based on subgroup analyses.
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Affiliation(s)
- Li Jiao
- Department of Medicine, Department of Obstetrics and Gynecology, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX; Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Family, Population and Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, NY; Texas Medical Center Digestive Disease Center, Houston, TX; Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX; City of Hope National Medical Center, Duarte, CA
| | - Liang Chen
- Department of Medicine, Department of Obstetrics and Gynecology, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX; Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Family, Population and Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, NY; Texas Medical Center Digestive Disease Center, Houston, TX; Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX; City of Hope National Medical Center, Duarte, CA
| | - Donna L White
- Department of Medicine, Department of Obstetrics and Gynecology, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX; Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Family, Population and Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, NY; Texas Medical Center Digestive Disease Center, Houston, TX; Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX; City of Hope National Medical Center, Duarte, CA
| | - Lesley Tinker
- Department of Medicine, Department of Obstetrics and Gynecology, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX; Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Family, Population and Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, NY; Texas Medical Center Digestive Disease Center, Houston, TX; Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX; City of Hope National Medical Center, Duarte, CA
| | - Rowan T Chlebowski
- Department of Medicine, Department of Obstetrics and Gynecology, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX; Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Family, Population and Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, NY; Texas Medical Center Digestive Disease Center, Houston, TX; Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX; City of Hope National Medical Center, Duarte, CA
| | - Linda V Van Horn
- Department of Medicine, Department of Obstetrics and Gynecology, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX; Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Family, Population and Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, NY; Texas Medical Center Digestive Disease Center, Houston, TX; Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX; City of Hope National Medical Center, Duarte, CA
| | - Peter Richardson
- Department of Medicine, Department of Obstetrics and Gynecology, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX; Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Family, Population and Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, NY; Texas Medical Center Digestive Disease Center, Houston, TX; Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX; City of Hope National Medical Center, Duarte, CA
| | - Dorothy Lane
- Department of Medicine, Department of Obstetrics and Gynecology, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX; Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Family, Population and Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, NY; Texas Medical Center Digestive Disease Center, Houston, TX; Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX; City of Hope National Medical Center, Duarte, CA
| | - Haleh Sangi-Haghpeykar
- Department of Medicine, Department of Obstetrics and Gynecology, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX; Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Family, Population and Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, NY; Texas Medical Center Digestive Disease Center, Houston, TX; Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX; City of Hope National Medical Center, Duarte, CA
| | - Hashem B El-Serag
- Department of Medicine, Department of Obstetrics and Gynecology, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX; Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA; Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Family, Population and Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, NY; Texas Medical Center Digestive Disease Center, Houston, TX; Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX; City of Hope National Medical Center, Duarte, CA
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27
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Tabung FK, Steck SE, Ma Y, Liese AD, Zhang J, Lane DS, Ho GYF, Hou L, Snetselaar L, Ockene JK, Hebert JR. Changes in the Inflammatory Potential of Diet Over Time and Risk of Colorectal Cancer in Postmenopausal Women. Am J Epidemiol 2017; 186:514-523. [PMID: 28486621 DOI: 10.1093/aje/kwx115] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 10/25/2016] [Indexed: 12/13/2022] Open
Abstract
We examined the associations between changes in dietary inflammatory potential and risk of colorectal cancer (CRC) in 87,042 postmenopausal women recruited from 1993-1998 by the Women's Health Initiative, conducted in the United States. Food frequency questionnaire data were used to compute patterns of change in dietary inflammatory index (DII) scores and cumulative average DII scores over 3 years. Cox regression models were used to estimate hazard ratios for CRC risk. After a median of 16.2 years of follow-up, 1,038 CRC cases were diagnosed. DII changes were not substantially associated with overall CRC, but proximal colon cancer risk was higher in the proinflammatory-change DII group than in the antiinflammatory-stable DII group (hazard ratio = 1.32, 95% confidence interval: 1.01, 1.74). Among nonusers of nonsteroidal antiinflammatory drugs (NSAIDs) (Pinteraction = 0.055), the proinflammatory-stable DII group was at increased risk of overall CRC and proximal colon cancer. Also among nonusers of NSAIDs, risks of overall CRC, colon cancer, and proximal colon cancer were higher in the highest quintile compared with the lowest cumulative average DII quintile (65%, 61%, and 91% higher risk, respectively). Dietary changes toward, or a history of, proinflammatory diets are associated with an elevated risk of colon cancer, particularly for proximal colon cancer and among nonusers of NSAIDs.
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Kato I, Lane D, Womack CR, Bock CH, Hou L, Lin JH, Wu C, Beebe Dimmer J, Simon MS. Interaction between Nonsteroidal Anti-inflammatory Drugs and Low-fat Dietary Intervention on Colorectal Cancer Incidence; the Women's Health Initiative (WHI) Dietary Modification Trial. J Am Coll Nutr 2017; 36:462-469. [PMID: 28682183 DOI: 10.1080/07315724.2017.1321505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The Women's Health Initiative (WHI) Dietary Modification (DM) trial did not show that reductions in dietary fat accompanied by increases in vegetable and fruit consumption decrease the incidence of colorectal cancer. Secondary analyses suggested that aspirin use may modify the intervention effects of DM on colorectal cancer development, although a recent reanalysis including the postintervention period confirmed no main effect of the intervention on reducing colorectal cancer incidence Methods: We analyzed data from 48,834 postmenopausal women who were randomized into the low-fat DM (N = 19,540) or comparison (N = 29,294) group for an average 8.1 years and followed for an additional 9.4 years through August 31, 2014. Exposure to specific class(es) or strength(s) of nonsteroidal anti-inflammatory drugs (NSAIDs) was modeled at baseline and as time-dependent use through the 9-year clinic visit. A Cox proportional hazard model was employed to assess the association of the DM, medication use, and their interaction with colorectal cancer events. RESULTS A total of 906 incident cases of colorectal cancer were identified during the intervention and postintervention periods. By both exposure models, we found that colorectal cancer incidence was not different in the DM from the comparison group among any type of NSAID users. None of the interactions with any category of NSAID use was statistically significant; however there was most modest evidence for an interaction (p = 0.07) with aspirin use at baseline (hazard ratio [HR] = 0.81, 95% confidence interval [CI], 0.60-1.11 for users; HR = 1.12, 95% CI, 0.97-1.30 for nonusers). Strength and duration of aspirin use at baseline did not alter the associations. CONCLUSION Extended follow-up of women in the WHI DM trial did not confirm combined protective effects of aspirin and low-fat diet on colorectal cancer risk among the postmenopausal women.
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Affiliation(s)
- Ikuko Kato
- a Department of Oncology , Karmanos Cancer Institute at Wayne State University School of Medicine , Detroit , Michigan , USA.,b Department of Pathology , Wayne State University School of Medicine , Detroit , Michigan , USA
| | - Dorothy Lane
- c Department of Family , Population and Preventive Medicine, Stony Brook University , Stony Brook , New York , USA
| | - Catherine R Womack
- d Department of Medicine and Preventive Medicine , the University of Tennessee Health Science Center , Memphis , Tennessee , USA
| | - Cathryn H Bock
- a Department of Oncology , Karmanos Cancer Institute at Wayne State University School of Medicine , Detroit , Michigan , USA
| | - Lifang Hou
- e Department of Preventive Medicine and the Robert H. Lurie Comprehensive Cancer Center Feinberg School of Medicine , Northwestern University , Evanston , Illinois , USA
| | - Jennifer H Lin
- f Janssen Pharmaceutical Inc , Titusville , New Jersey , USA
| | - Chunyuan Wu
- g Fred Hutchinson Cancer Research Center , Division of Public Health Sciences , Seattle , Washington , USA
| | - Jennifer Beebe Dimmer
- a Department of Oncology , Karmanos Cancer Institute at Wayne State University School of Medicine , Detroit , Michigan , USA
| | - Michael S Simon
- a Department of Oncology , Karmanos Cancer Institute at Wayne State University School of Medicine , Detroit , Michigan , USA
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Prentice RL, Aragaki AK, Van Horn L, Thomson CA, Beresford SAA, Robinson J, Snetselaar L, Anderson GL, Manson JE, Allison MA, Rossouw JE, Howard BV. Low-fat dietary pattern and cardiovascular disease: results from the Women's Health Initiative randomized controlled trial. Am J Clin Nutr 2017; 106:35-43. [PMID: 28515068 PMCID: PMC5486201 DOI: 10.3945/ajcn.117.153270] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 04/14/2017] [Indexed: 11/14/2022] Open
Abstract
Background: The influence of a low-fat dietary pattern on the cardiovascular health of postmenopausal women continues to be of public health interest.Objective: This report evaluates low-fat dietary pattern influences on cardiovascular disease (CVD) incidence and mortality during the intervention and postintervention phases of the Women's Health Initiative Dietary Modification Trial.Design: Participants comprised 48,835 postmenopausal women aged 50-79 y; 40% were randomly assigned to a low-fat dietary pattern intervention (target of 20% of energy from fat), and 60% were randomly assigned to a usual diet comparison group. The 8.3-y intervention period ended in March 2005, after which >80% of surviving participants consented to additional active follow-up through September 2010; all participants were followed for mortality through 2013. Breast and colorectal cancer were the primary trial outcomes, and coronary heart disease (CHD) and overall CVD were additional designated outcomes.Results: Incidence rates for CHD and total CVD did not differ between the intervention and comparison groups in either the intervention or postintervention period. However, CHD HRs comparing these groups varied strongly with baseline CVD and hypertension status. Participants without prior CVD had an intervention period CHD HR of 0.70 (95% CI: 0.56, 0.87) or 1.04 (95% CI: 0.90, 1.19) if they were normotensive or hypertensive, respectively (P-interaction = 0.003). The CHD benefit among healthy normotensive women was partially offset by an increase in ischemic stroke risk. Corresponding HRs in the postintervention period were close to null. Participants with CVD at baseline (3.4%) had CHD HRs of 1.47 (95% CI: 1.12, 1.93) and 1.61 (95% CI: 1.02, 2.55) in the intervention and postintervention periods, respectively. However, various lines of evidence suggest that results in women with CVD or hypertension at baseline are confounded by postrandomization use of cholesterol-lowering medications.Conclusions: CVD risk in postmenopausal women appears to be sensitive to a change to a low-fat dietary pattern and, among healthy women, includes both CHD benefit and stroke risk. This trial was registered at clinicaltrials.gov as NCT00000611.
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Affiliation(s)
- Ross L Prentice
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA;
| | - Aaron K Aragaki
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Linda Van Horn
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Cynthia A Thomson
- Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | - Shirley AA Beresford
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
| | | | | | - Garnet L Anderson
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Matthew A Allison
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
| | | | - Barbara V Howard
- MedStar Health Research Institute and Georgetown/Howard Universities Center for Clinical and Translational Research, Washington, DC
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Chlebowski RT, Aragaki AK, Anderson GL, Thomson CA, Manson JE, Simon MS, Howard BV, Rohan TE, Snetselar L, Lane D, Barrington W, Vitolins MZ, Womack C, Qi L, Hou L, Thomas F, Prentice RL. Low-Fat Dietary Pattern and Breast Cancer Mortality in the Women's Health Initiative Randomized Controlled Trial. J Clin Oncol 2017; 35:2919-2926. [PMID: 28654363 DOI: 10.1200/jco.2016.72.0326] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Purpose Earlier Women's Health Initiative Dietary Modification trial findings suggested that a low-fat eating pattern may reduce breast cancers with greater mortality. Therefore, as a primary outcome-related analysis from a randomized prevention trial, we examined the long-term influence of this intervention on deaths as a result of and after breast cancer during 8.5 years (median) of dietary intervention and cumulatively for all breast cancers diagnosed during 16.1 years (median) of follow-up. Patients and Methods The trial randomly assigned 48,835 postmenopausal women with normal mammograms and without prior breast cancer from 1993 to 1998 at 40 US clinical centers to a dietary intervention with goals of a reduction of fat intake to 20% of energy and an increased intake of fruits, vegetables, and grains (40%; n = 19,541) or to a usual diet comparison (60%; n = 29,294). Results In the dietary group, fat intake and body weight decreased (all P < .001). During the 8.5-year dietary intervention, with 1,764 incident breast cancers, fewer deaths occurred as a result of breast cancer in the dietary group, which was not statistically significant (27 deaths [0.016% per year] v 61 deaths [0.024% per year]; hazard ratio [HR], 0.67; 95% CI, 0.43 to 1.06; P = .08). During the same period, deaths after breast cancer (n = 134) were significantly reduced (40 deaths [0.025% per year] v 94 deaths [0.038% per year]; HR, 0.65; 95% CI, 0.45 to 0.94; P = .02) by the dietary intervention. During the 16.1-year follow-up, with 3,030 incident breast cancers, deaths after breast cancer also were significantly reduced (234 deaths [0.085% per year] v 443 deaths [0.11% per year]; HR, 0.82; 95% CI, 0.70 to 0.96; P = .01) in the dietary group. Conclusion Compared with a usual diet comparison group, a low-fat dietary pattern led to a lower incidence of deaths after breast cancer.
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Affiliation(s)
- Rowan T Chlebowski
- Rowan T. Chlebowski, Los Angeles Biomedical Research Institute, Torrance; Lihong Qi, University of California, Davis, Davis, CA; Aaron K. Aragaki, Garnet L. Anderson, Wendy Barrington, and Ross L. Prentice, Fred Hutchinson Cancer Research Center, Seattle, WA; Cynthia A. Thomson, University of Arizona Cancer Center, Tucson, AZ; JoAnn E. Manson, Brigham and Women's Hospital, Boston, MA; Michael S. Simon, Wayne State University, Detroit, MI; Barbara V. Howard, MedStar Health Research Institute; Barbara V. Howard, Georgetown-Howard Universities Center for Clinical and Translational Sciences, Washington, DC; Thomas E. Rohan, Albert Einstein College of Medicine, New York City; Dorothy Lane, Stony Brook University, Stony Brook, NY; Linda Snetselar, University of Iowa, Iowa City, IA; Catherine Womack, Methodist Healthcare; Fridtjof Thomas, University of Tennessee Health Science Center, Memphis, TN; Mara Z. Vitolins, Wake Forest School of Medicine, Winston-Salem, NC; and Lifang Hou, Northwestern University, Chicago, IL
| | - Aaron K Aragaki
- Rowan T. Chlebowski, Los Angeles Biomedical Research Institute, Torrance; Lihong Qi, University of California, Davis, Davis, CA; Aaron K. Aragaki, Garnet L. Anderson, Wendy Barrington, and Ross L. Prentice, Fred Hutchinson Cancer Research Center, Seattle, WA; Cynthia A. Thomson, University of Arizona Cancer Center, Tucson, AZ; JoAnn E. Manson, Brigham and Women's Hospital, Boston, MA; Michael S. Simon, Wayne State University, Detroit, MI; Barbara V. Howard, MedStar Health Research Institute; Barbara V. Howard, Georgetown-Howard Universities Center for Clinical and Translational Sciences, Washington, DC; Thomas E. Rohan, Albert Einstein College of Medicine, New York City; Dorothy Lane, Stony Brook University, Stony Brook, NY; Linda Snetselar, University of Iowa, Iowa City, IA; Catherine Womack, Methodist Healthcare; Fridtjof Thomas, University of Tennessee Health Science Center, Memphis, TN; Mara Z. Vitolins, Wake Forest School of Medicine, Winston-Salem, NC; and Lifang Hou, Northwestern University, Chicago, IL
| | - Garnet L Anderson
- Rowan T. Chlebowski, Los Angeles Biomedical Research Institute, Torrance; Lihong Qi, University of California, Davis, Davis, CA; Aaron K. Aragaki, Garnet L. Anderson, Wendy Barrington, and Ross L. Prentice, Fred Hutchinson Cancer Research Center, Seattle, WA; Cynthia A. Thomson, University of Arizona Cancer Center, Tucson, AZ; JoAnn E. Manson, Brigham and Women's Hospital, Boston, MA; Michael S. Simon, Wayne State University, Detroit, MI; Barbara V. Howard, MedStar Health Research Institute; Barbara V. Howard, Georgetown-Howard Universities Center for Clinical and Translational Sciences, Washington, DC; Thomas E. Rohan, Albert Einstein College of Medicine, New York City; Dorothy Lane, Stony Brook University, Stony Brook, NY; Linda Snetselar, University of Iowa, Iowa City, IA; Catherine Womack, Methodist Healthcare; Fridtjof Thomas, University of Tennessee Health Science Center, Memphis, TN; Mara Z. Vitolins, Wake Forest School of Medicine, Winston-Salem, NC; and Lifang Hou, Northwestern University, Chicago, IL
| | - Cynthia A Thomson
- Rowan T. Chlebowski, Los Angeles Biomedical Research Institute, Torrance; Lihong Qi, University of California, Davis, Davis, CA; Aaron K. Aragaki, Garnet L. Anderson, Wendy Barrington, and Ross L. Prentice, Fred Hutchinson Cancer Research Center, Seattle, WA; Cynthia A. Thomson, University of Arizona Cancer Center, Tucson, AZ; JoAnn E. Manson, Brigham and Women's Hospital, Boston, MA; Michael S. Simon, Wayne State University, Detroit, MI; Barbara V. Howard, MedStar Health Research Institute; Barbara V. Howard, Georgetown-Howard Universities Center for Clinical and Translational Sciences, Washington, DC; Thomas E. Rohan, Albert Einstein College of Medicine, New York City; Dorothy Lane, Stony Brook University, Stony Brook, NY; Linda Snetselar, University of Iowa, Iowa City, IA; Catherine Womack, Methodist Healthcare; Fridtjof Thomas, University of Tennessee Health Science Center, Memphis, TN; Mara Z. Vitolins, Wake Forest School of Medicine, Winston-Salem, NC; and Lifang Hou, Northwestern University, Chicago, IL
| | - JoAnn E Manson
- Rowan T. Chlebowski, Los Angeles Biomedical Research Institute, Torrance; Lihong Qi, University of California, Davis, Davis, CA; Aaron K. Aragaki, Garnet L. Anderson, Wendy Barrington, and Ross L. Prentice, Fred Hutchinson Cancer Research Center, Seattle, WA; Cynthia A. Thomson, University of Arizona Cancer Center, Tucson, AZ; JoAnn E. Manson, Brigham and Women's Hospital, Boston, MA; Michael S. Simon, Wayne State University, Detroit, MI; Barbara V. Howard, MedStar Health Research Institute; Barbara V. Howard, Georgetown-Howard Universities Center for Clinical and Translational Sciences, Washington, DC; Thomas E. Rohan, Albert Einstein College of Medicine, New York City; Dorothy Lane, Stony Brook University, Stony Brook, NY; Linda Snetselar, University of Iowa, Iowa City, IA; Catherine Womack, Methodist Healthcare; Fridtjof Thomas, University of Tennessee Health Science Center, Memphis, TN; Mara Z. Vitolins, Wake Forest School of Medicine, Winston-Salem, NC; and Lifang Hou, Northwestern University, Chicago, IL
| | - Michael S Simon
- Rowan T. Chlebowski, Los Angeles Biomedical Research Institute, Torrance; Lihong Qi, University of California, Davis, Davis, CA; Aaron K. Aragaki, Garnet L. Anderson, Wendy Barrington, and Ross L. Prentice, Fred Hutchinson Cancer Research Center, Seattle, WA; Cynthia A. Thomson, University of Arizona Cancer Center, Tucson, AZ; JoAnn E. Manson, Brigham and Women's Hospital, Boston, MA; Michael S. Simon, Wayne State University, Detroit, MI; Barbara V. Howard, MedStar Health Research Institute; Barbara V. Howard, Georgetown-Howard Universities Center for Clinical and Translational Sciences, Washington, DC; Thomas E. Rohan, Albert Einstein College of Medicine, New York City; Dorothy Lane, Stony Brook University, Stony Brook, NY; Linda Snetselar, University of Iowa, Iowa City, IA; Catherine Womack, Methodist Healthcare; Fridtjof Thomas, University of Tennessee Health Science Center, Memphis, TN; Mara Z. Vitolins, Wake Forest School of Medicine, Winston-Salem, NC; and Lifang Hou, Northwestern University, Chicago, IL
| | - Barbara V Howard
- Rowan T. Chlebowski, Los Angeles Biomedical Research Institute, Torrance; Lihong Qi, University of California, Davis, Davis, CA; Aaron K. Aragaki, Garnet L. Anderson, Wendy Barrington, and Ross L. Prentice, Fred Hutchinson Cancer Research Center, Seattle, WA; Cynthia A. Thomson, University of Arizona Cancer Center, Tucson, AZ; JoAnn E. Manson, Brigham and Women's Hospital, Boston, MA; Michael S. Simon, Wayne State University, Detroit, MI; Barbara V. Howard, MedStar Health Research Institute; Barbara V. Howard, Georgetown-Howard Universities Center for Clinical and Translational Sciences, Washington, DC; Thomas E. Rohan, Albert Einstein College of Medicine, New York City; Dorothy Lane, Stony Brook University, Stony Brook, NY; Linda Snetselar, University of Iowa, Iowa City, IA; Catherine Womack, Methodist Healthcare; Fridtjof Thomas, University of Tennessee Health Science Center, Memphis, TN; Mara Z. Vitolins, Wake Forest School of Medicine, Winston-Salem, NC; and Lifang Hou, Northwestern University, Chicago, IL
| | - Thomas E Rohan
- Rowan T. Chlebowski, Los Angeles Biomedical Research Institute, Torrance; Lihong Qi, University of California, Davis, Davis, CA; Aaron K. Aragaki, Garnet L. Anderson, Wendy Barrington, and Ross L. Prentice, Fred Hutchinson Cancer Research Center, Seattle, WA; Cynthia A. Thomson, University of Arizona Cancer Center, Tucson, AZ; JoAnn E. Manson, Brigham and Women's Hospital, Boston, MA; Michael S. Simon, Wayne State University, Detroit, MI; Barbara V. Howard, MedStar Health Research Institute; Barbara V. Howard, Georgetown-Howard Universities Center for Clinical and Translational Sciences, Washington, DC; Thomas E. Rohan, Albert Einstein College of Medicine, New York City; Dorothy Lane, Stony Brook University, Stony Brook, NY; Linda Snetselar, University of Iowa, Iowa City, IA; Catherine Womack, Methodist Healthcare; Fridtjof Thomas, University of Tennessee Health Science Center, Memphis, TN; Mara Z. Vitolins, Wake Forest School of Medicine, Winston-Salem, NC; and Lifang Hou, Northwestern University, Chicago, IL
| | - Linda Snetselar
- Rowan T. Chlebowski, Los Angeles Biomedical Research Institute, Torrance; Lihong Qi, University of California, Davis, Davis, CA; Aaron K. Aragaki, Garnet L. Anderson, Wendy Barrington, and Ross L. Prentice, Fred Hutchinson Cancer Research Center, Seattle, WA; Cynthia A. Thomson, University of Arizona Cancer Center, Tucson, AZ; JoAnn E. Manson, Brigham and Women's Hospital, Boston, MA; Michael S. Simon, Wayne State University, Detroit, MI; Barbara V. Howard, MedStar Health Research Institute; Barbara V. Howard, Georgetown-Howard Universities Center for Clinical and Translational Sciences, Washington, DC; Thomas E. Rohan, Albert Einstein College of Medicine, New York City; Dorothy Lane, Stony Brook University, Stony Brook, NY; Linda Snetselar, University of Iowa, Iowa City, IA; Catherine Womack, Methodist Healthcare; Fridtjof Thomas, University of Tennessee Health Science Center, Memphis, TN; Mara Z. Vitolins, Wake Forest School of Medicine, Winston-Salem, NC; and Lifang Hou, Northwestern University, Chicago, IL
| | - Dorothy Lane
- Rowan T. Chlebowski, Los Angeles Biomedical Research Institute, Torrance; Lihong Qi, University of California, Davis, Davis, CA; Aaron K. Aragaki, Garnet L. Anderson, Wendy Barrington, and Ross L. Prentice, Fred Hutchinson Cancer Research Center, Seattle, WA; Cynthia A. Thomson, University of Arizona Cancer Center, Tucson, AZ; JoAnn E. Manson, Brigham and Women's Hospital, Boston, MA; Michael S. Simon, Wayne State University, Detroit, MI; Barbara V. Howard, MedStar Health Research Institute; Barbara V. Howard, Georgetown-Howard Universities Center for Clinical and Translational Sciences, Washington, DC; Thomas E. Rohan, Albert Einstein College of Medicine, New York City; Dorothy Lane, Stony Brook University, Stony Brook, NY; Linda Snetselar, University of Iowa, Iowa City, IA; Catherine Womack, Methodist Healthcare; Fridtjof Thomas, University of Tennessee Health Science Center, Memphis, TN; Mara Z. Vitolins, Wake Forest School of Medicine, Winston-Salem, NC; and Lifang Hou, Northwestern University, Chicago, IL
| | - Wendy Barrington
- Rowan T. Chlebowski, Los Angeles Biomedical Research Institute, Torrance; Lihong Qi, University of California, Davis, Davis, CA; Aaron K. Aragaki, Garnet L. Anderson, Wendy Barrington, and Ross L. Prentice, Fred Hutchinson Cancer Research Center, Seattle, WA; Cynthia A. Thomson, University of Arizona Cancer Center, Tucson, AZ; JoAnn E. Manson, Brigham and Women's Hospital, Boston, MA; Michael S. Simon, Wayne State University, Detroit, MI; Barbara V. Howard, MedStar Health Research Institute; Barbara V. Howard, Georgetown-Howard Universities Center for Clinical and Translational Sciences, Washington, DC; Thomas E. Rohan, Albert Einstein College of Medicine, New York City; Dorothy Lane, Stony Brook University, Stony Brook, NY; Linda Snetselar, University of Iowa, Iowa City, IA; Catherine Womack, Methodist Healthcare; Fridtjof Thomas, University of Tennessee Health Science Center, Memphis, TN; Mara Z. Vitolins, Wake Forest School of Medicine, Winston-Salem, NC; and Lifang Hou, Northwestern University, Chicago, IL
| | - Mara Z Vitolins
- Rowan T. Chlebowski, Los Angeles Biomedical Research Institute, Torrance; Lihong Qi, University of California, Davis, Davis, CA; Aaron K. Aragaki, Garnet L. Anderson, Wendy Barrington, and Ross L. Prentice, Fred Hutchinson Cancer Research Center, Seattle, WA; Cynthia A. Thomson, University of Arizona Cancer Center, Tucson, AZ; JoAnn E. Manson, Brigham and Women's Hospital, Boston, MA; Michael S. Simon, Wayne State University, Detroit, MI; Barbara V. Howard, MedStar Health Research Institute; Barbara V. Howard, Georgetown-Howard Universities Center for Clinical and Translational Sciences, Washington, DC; Thomas E. Rohan, Albert Einstein College of Medicine, New York City; Dorothy Lane, Stony Brook University, Stony Brook, NY; Linda Snetselar, University of Iowa, Iowa City, IA; Catherine Womack, Methodist Healthcare; Fridtjof Thomas, University of Tennessee Health Science Center, Memphis, TN; Mara Z. Vitolins, Wake Forest School of Medicine, Winston-Salem, NC; and Lifang Hou, Northwestern University, Chicago, IL
| | - Catherine Womack
- Rowan T. Chlebowski, Los Angeles Biomedical Research Institute, Torrance; Lihong Qi, University of California, Davis, Davis, CA; Aaron K. Aragaki, Garnet L. Anderson, Wendy Barrington, and Ross L. Prentice, Fred Hutchinson Cancer Research Center, Seattle, WA; Cynthia A. Thomson, University of Arizona Cancer Center, Tucson, AZ; JoAnn E. Manson, Brigham and Women's Hospital, Boston, MA; Michael S. Simon, Wayne State University, Detroit, MI; Barbara V. Howard, MedStar Health Research Institute; Barbara V. Howard, Georgetown-Howard Universities Center for Clinical and Translational Sciences, Washington, DC; Thomas E. Rohan, Albert Einstein College of Medicine, New York City; Dorothy Lane, Stony Brook University, Stony Brook, NY; Linda Snetselar, University of Iowa, Iowa City, IA; Catherine Womack, Methodist Healthcare; Fridtjof Thomas, University of Tennessee Health Science Center, Memphis, TN; Mara Z. Vitolins, Wake Forest School of Medicine, Winston-Salem, NC; and Lifang Hou, Northwestern University, Chicago, IL
| | - Lihong Qi
- Rowan T. Chlebowski, Los Angeles Biomedical Research Institute, Torrance; Lihong Qi, University of California, Davis, Davis, CA; Aaron K. Aragaki, Garnet L. Anderson, Wendy Barrington, and Ross L. Prentice, Fred Hutchinson Cancer Research Center, Seattle, WA; Cynthia A. Thomson, University of Arizona Cancer Center, Tucson, AZ; JoAnn E. Manson, Brigham and Women's Hospital, Boston, MA; Michael S. Simon, Wayne State University, Detroit, MI; Barbara V. Howard, MedStar Health Research Institute; Barbara V. Howard, Georgetown-Howard Universities Center for Clinical and Translational Sciences, Washington, DC; Thomas E. Rohan, Albert Einstein College of Medicine, New York City; Dorothy Lane, Stony Brook University, Stony Brook, NY; Linda Snetselar, University of Iowa, Iowa City, IA; Catherine Womack, Methodist Healthcare; Fridtjof Thomas, University of Tennessee Health Science Center, Memphis, TN; Mara Z. Vitolins, Wake Forest School of Medicine, Winston-Salem, NC; and Lifang Hou, Northwestern University, Chicago, IL
| | - Lifang Hou
- Rowan T. Chlebowski, Los Angeles Biomedical Research Institute, Torrance; Lihong Qi, University of California, Davis, Davis, CA; Aaron K. Aragaki, Garnet L. Anderson, Wendy Barrington, and Ross L. Prentice, Fred Hutchinson Cancer Research Center, Seattle, WA; Cynthia A. Thomson, University of Arizona Cancer Center, Tucson, AZ; JoAnn E. Manson, Brigham and Women's Hospital, Boston, MA; Michael S. Simon, Wayne State University, Detroit, MI; Barbara V. Howard, MedStar Health Research Institute; Barbara V. Howard, Georgetown-Howard Universities Center for Clinical and Translational Sciences, Washington, DC; Thomas E. Rohan, Albert Einstein College of Medicine, New York City; Dorothy Lane, Stony Brook University, Stony Brook, NY; Linda Snetselar, University of Iowa, Iowa City, IA; Catherine Womack, Methodist Healthcare; Fridtjof Thomas, University of Tennessee Health Science Center, Memphis, TN; Mara Z. Vitolins, Wake Forest School of Medicine, Winston-Salem, NC; and Lifang Hou, Northwestern University, Chicago, IL
| | - Fridtjof Thomas
- Rowan T. Chlebowski, Los Angeles Biomedical Research Institute, Torrance; Lihong Qi, University of California, Davis, Davis, CA; Aaron K. Aragaki, Garnet L. Anderson, Wendy Barrington, and Ross L. Prentice, Fred Hutchinson Cancer Research Center, Seattle, WA; Cynthia A. Thomson, University of Arizona Cancer Center, Tucson, AZ; JoAnn E. Manson, Brigham and Women's Hospital, Boston, MA; Michael S. Simon, Wayne State University, Detroit, MI; Barbara V. Howard, MedStar Health Research Institute; Barbara V. Howard, Georgetown-Howard Universities Center for Clinical and Translational Sciences, Washington, DC; Thomas E. Rohan, Albert Einstein College of Medicine, New York City; Dorothy Lane, Stony Brook University, Stony Brook, NY; Linda Snetselar, University of Iowa, Iowa City, IA; Catherine Womack, Methodist Healthcare; Fridtjof Thomas, University of Tennessee Health Science Center, Memphis, TN; Mara Z. Vitolins, Wake Forest School of Medicine, Winston-Salem, NC; and Lifang Hou, Northwestern University, Chicago, IL
| | - Ross L Prentice
- Rowan T. Chlebowski, Los Angeles Biomedical Research Institute, Torrance; Lihong Qi, University of California, Davis, Davis, CA; Aaron K. Aragaki, Garnet L. Anderson, Wendy Barrington, and Ross L. Prentice, Fred Hutchinson Cancer Research Center, Seattle, WA; Cynthia A. Thomson, University of Arizona Cancer Center, Tucson, AZ; JoAnn E. Manson, Brigham and Women's Hospital, Boston, MA; Michael S. Simon, Wayne State University, Detroit, MI; Barbara V. Howard, MedStar Health Research Institute; Barbara V. Howard, Georgetown-Howard Universities Center for Clinical and Translational Sciences, Washington, DC; Thomas E. Rohan, Albert Einstein College of Medicine, New York City; Dorothy Lane, Stony Brook University, Stony Brook, NY; Linda Snetselar, University of Iowa, Iowa City, IA; Catherine Womack, Methodist Healthcare; Fridtjof Thomas, University of Tennessee Health Science Center, Memphis, TN; Mara Z. Vitolins, Wake Forest School of Medicine, Winston-Salem, NC; and Lifang Hou, Northwestern University, Chicago, IL
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Lifestyle and Breast Cancer. Breast Cancer 2017. [DOI: 10.1007/978-3-319-48848-6_72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Affiliation(s)
- Pamela J Goodwin
- Pamela J. Goodwin, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Rowan T. Chlebowski, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Rowan T Chlebowski
- Pamela J. Goodwin, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; Rowan T. Chlebowski, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
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Chlebowski RT, Reeves MM. Weight Loss Randomized Intervention Trials in Female Cancer Survivors. J Clin Oncol 2016; 34:4238-4248. [PMID: 27903147 DOI: 10.1200/jco.2016.69.4026] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose Observational study evidence has associated overweight/obesity with decreased survival in women with breast cancer and with several other cancers. Although full-scale, definitive weight loss adjuvant intervention trials with cancer end points remain to be conducted, a number of randomized controlled trials have evaluated weight loss interventions in survivors of cancer in women. Findings from these trials in breast, endometrial, and ovarian cancer are reviewed. Methods A systematic review of randomized controlled clinical trials evaluating weight loss interventions was updated (for studies published 2013 to 2016), and clinical trials registers were searched for ongoing trials. Results Six new randomized trials in breast cancer survivors and two randomized trials in endometrial cancer survivors were identified. Evidence from these trials and the 10 earlier randomized trials in female cancer survivors provide support for the feasibility of recruiting women closer to the cancer diagnosis and efficacy for achieving weight loss, in particular with telephone-based interventions, and have identified the challenge of achieving significant weight loss in African American cancer survivors and of maintaining weight loss in any cancer survivor group. Seven ongoing randomized trials are evaluating the influence of weight loss interventions on cancer end points (five in breast cancer, one in ovarian cancer, and one in endometrial cancer). Conclusion After a decade of preliminary studies, ongoing randomized, controlled clinical trials will potentially provide definitive assessment of whether weight loss can improve breast cancer clinical outcome. Longer-term interventions (> 2 years' duration) may be needed to optimize weight loss maintenance and any potential benefits on cancer end points.
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Affiliation(s)
- Rowan T Chlebowski
- Rowan T. Chlebowski, Harbor-University of California, Los Angeles Medical Center, Torrance, CA; and Marina M. Reeves, The University of Queensland, Brisbane, Queensland, Australia
| | - Marina M Reeves
- Rowan T. Chlebowski, Harbor-University of California, Los Angeles Medical Center, Torrance, CA; and Marina M. Reeves, The University of Queensland, Brisbane, Queensland, Australia
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Abstract
The global incidence of cancer is expected to increase substantially over the next decades. This trend is very much driven by a rise in lifestyle-related cancers due to economic and demographic transitions worldwide. Lifestyle factors, such as smoking, alcohol consumption, obesity, diet, and physical inactivity, and also reproductive and hormonal factors are considered as causes of cancer and main targets for primary prevention. While smoking, which may be responsible for around 20% to 30% of all incident cancers, is clearly the strongest lifestyle-related risk factor overall, followed by alcohol consumption and obesity, the importance of specific factors for individual cancer types and subtypes varies greatly. Remarkably, it has been argued that half of all cancers in industrially developed and affluent societies could be avoided by nonsmoking, reducing alcohol consumption, weight control and physical activity, a plant-based diet, and breast-feeding.
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35
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Blot WJ, Tarone RE. Doll and Peto's Quantitative Estimates of Cancer Risks: Holding Generally True for 35 Years. J Natl Cancer Inst 2015; 107:djv044. [DOI: 10.1093/jnci/djv044] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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