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Ghosal R, Matabuena M, Zhang J. Functional proportional hazards mixture cure model with applications in cancer mortality in NHANES and post ICU recovery. Stat Methods Med Res 2023; 32:2254-2269. [PMID: 37855203 DOI: 10.1177/09622802231206472] [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: 10/20/2023]
Abstract
We develop a functional proportional hazards mixture cure model with scalar and functional covariates measured at the baseline. The mixture cure model, useful in studying populations with a cure fraction of a particular event of interest is extended to functional data. We employ the expectation-maximization algorithm and develop a semiparametric penalized spline-based approach to estimate the dynamic functional coefficients of the incidence and the latency part. The proposed method is computationally efficient and simultaneously incorporates smoothness in the estimated functional coefficients via roughness penalty. Simulation studies illustrate a satisfactory performance of the proposed method in accurately estimating the model parameters and the baseline survival function. Finally, the clinical potential of the model is demonstrated in two real data examples that incorporate rich high-dimensional biomedical signals as functional covariates measured at the baseline and constitute novel domains to apply cure survival models in contemporary medical situations. In particular, we analyze (i) minute-by-minute physical activity data from the National Health And Nutrition Examination Survey 2003-2006 to study the association between diurnal patterns of physical activity at baseline and all cancer mortality through 2019 while adjusting for other biological factors; (ii) the impact of daily functional measures of disease severity collected in the intensive care unit on post intensive care unit recovery and mortality event. Our findings provide novel epidemiological insights into the association between daily patterns of physical activity and cancer mortality. Software implementation and illustration of the proposed estimation method are provided in R.
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Affiliation(s)
- Rahul Ghosal
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
| | - Marcos Matabuena
- Department of Biostatistics, Harvard University T. H. Chan School of Public Health, Boston, MA, USA
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
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Khasanova A, Henagan TM. Exercise Is Medicine: How Do We Implement It? Nutrients 2023; 15:3164. [PMID: 37513581 PMCID: PMC10385293 DOI: 10.3390/nu15143164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/08/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Exercise is well known to have beneficial effects on various disease states. In this paper, we broadly describe the fundamental concepts that are shared among various disease states, including obesity, type 2 diabetes (T2D), cardiovascular disease (CVD), heart failure (HF), cancer, and psychological well-being, and the beneficial effects of exercise training within these concepts. We highlight issues involved in implementing exercise recommendations and describe the potential impacts and challenges to medical professionals and patients. Problems are identified and discussed with respect to the future roles of professionals in the current built environment with its limited infrastructure to support current physical activity recommendations.
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Affiliation(s)
- Aliya Khasanova
- Department of Family Medicine, Baton Rouge General Family Health Center, Baton Rouge, LA 70806, USA
- Department of Family Medicine, Baton Rouge General Hospital, Baton Rouge, LA 70808, USA
| | - Tara M Henagan
- Department of Family Medicine, Baton Rouge General Family Health Center, Baton Rouge, LA 70806, USA
- Department of Family Medicine, Baton Rouge General Hospital, Baton Rouge, LA 70808, USA
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Chantaprasopsuk S, Rees-Punia E, Patel AV. Physical activity, obesity, and bladder cancer incidence. Cancer Causes Control 2023:10.1007/s10552-023-01711-0. [PMID: 37202564 DOI: 10.1007/s10552-023-01711-0] [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: 10/28/2022] [Accepted: 05/03/2023] [Indexed: 05/20/2023]
Abstract
PURPOSE Cigarette smoking is an established risk factor for bladder cancer (BC), but evidence for physical inactivity and obesity is limited. METHODS This analysis included 146,027 participants from the Cancer Prevention Study-II (CPS-II) Nutrition Cohort, a large prospective cohort of cancer incidence established in 1992. Multivariable-adjusted Cox proportional hazards models were used to examine associations between body mass index (BMI), moderate-to-vigorous intensity aerobic physical activity (MVPA), leisure-time spent sitting, and BC risk. Effect modification by stage, smoking status, and sex was examined. RESULTS Only participants accumulating 15.0- < 30.0 MET-hrs/wk of MVPA had a lower risk of BC overall (RR 0.88, 95% CI 0.78, 0.99, compared to > 0-7.5 MET-hrs/wk) in the fully adjusted models. When stratifying on BC stage, MVPA (15- < 30 MET-hrs/wk vs. > 0- < 7.5 MET-hrs/wk, RR 0.83, 95% CI 0.70-0.99) and excess sitting time (≥ 6 h/day vs. 0- < 3 h/day RR 1.22, 95% CI 1.02, 1.47) were associated with risk of invasive BC only. There was no consistent evidence for effect modification by smoking status or sex. CONCLUSION This study supports that MVPA and sitting time may play a role in BC incidence, but associations likely differ by stage at diagnosis. While additional studies are needed to confirm associations by stage, this study adds to the evidence of the importance of being physically active for cancer prevention.
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Affiliation(s)
| | - Erika Rees-Punia
- Department of Population Science, American Cancer Society, Kennesaw, GA, USA
| | - Alpa V Patel
- Department of Population Science, American Cancer Society, Kennesaw, GA, USA
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Dibble KE, Baumgartner RN, Boone SD, Baumgartner KB, Connor AE. Treatment-related side effects among Hispanic and non-Hispanic white long-term breast cancer survivors by tamoxifen use and duration. Breast Cancer Res Treat 2023; 199:155-172. [PMID: 36892724 PMCID: PMC10897699 DOI: 10.1007/s10549-023-06900-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 02/16/2023] [Indexed: 03/10/2023]
Abstract
PURPOSE To determine the associations between ethnicity, age at diagnosis, obesity, multimorbidity, and odds of experiencing breast cancer (BC) treatment-related side effects among long-term Hispanic and non-Hispanic white (NHW) survivors from New Mexico and explore differences by tamoxifen use. METHODS Lifestyle and clinical information including self-reported tamoxifen use and presence of treatment- related side effects were collected at follow-up interviews (12-15 years) for 194 BC survivors. Multivariable logistic regression models were used to examine associations between predictors and odds of experiencing side effects overall and by tamoxifen use. RESULTS Women ranged in age at diagnosis (30-74, M = 49.3, SD = 9.37), most were NHW (65.4%) and had in-situ or localized BC (63.4%). Less than half reportedly used tamoxifen (44.3%), of which 59.3% reported using > 5 years. Overall, survivors who were overweight/obese at follow-up were 5.42 times more likely to experience treatment-related pain (95% CI 1.40-21.0) compared to normal weight survivors. Survivors with multimorbidity, compared to survivors without, were more likely to report treatment-related sexual health issues (aOR 6.90, 95% CI 1.43-33.2) and poorer mental health (aOR 4.51, 95% CI 1.06-19.1). The statistical interactions between ethnicity and overweight/obese with tamoxifen use were significant (p-interaction < 0.05) for treatment-related sexual health issues. CONCLUSION Our results demonstrate that survivors with overweightness/obesity or multimorbidity may be more likely to experience BC treatment-related side effects. Tamoxifen use modifies associations between ethnicity, being overweight/obese, and sexual health issues following treatment. The likelihood of experiencing treatment-related side effects were more favorable for those on tamoxifen or those who had used tamoxifen for longer durations. These findings highlight the importance of fostering side effect awareness and applying appropriate interventions to assist with disease management throughout BC survivorship care.
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Affiliation(s)
- Kate E Dibble
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA.
| | - Richard N Baumgartner
- Department of Epidemiology & Population Health, School of Public Health & Information Sciences, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - Stephanie D Boone
- Department of Epidemiology & Population Health, School of Public Health & Information Sciences, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - Kathy B Baumgartner
- Department of Epidemiology & Population Health, School of Public Health & Information Sciences, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - Avonne E Connor
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA
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Noël Racine A, Margaritis I, Duclos M, Carré F, Vuillemin A, Gautier C. Costing the economic burden of prolonged sedentary behaviours in France. Eur J Public Health 2022; 32:i3-i7. [PMID: 36031819 PMCID: PMC9421414 DOI: 10.1093/eurpub/ckac071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND There is strong evidence showing that sedentary behaviour time increase the risk to develop several chronic diseases and to premature death. The economic consequences of this risk have never been evaluated in France. The aim of this study was to estimate the economic burden of prolonged sedentary behaviour in France. METHODS Based on individual sedentary behaviour time, relative risk to develop cardiovascular disease, colon cancer, breast cancer and all-causes of premature mortality were identified. From relative risk and prevalence of sedentary behaviour time, a population attributable fraction approach was used to estimate the yearly number of cases for each disease. Data from the National Health Insurance were used to calculate the annual average costs per case for each disease. Disease-specific and total healthcare costs attributable to prolonged sedentary behaviour time were calculated. Indirect costs from productivity loss due to morbidity and premature mortality were estimated using a friction cost approach. RESULTS In France, 51 193 premature deaths/year appear related to a prolonged daily sedentary behaviour time. Each year prolonged sedentary behaviour cost 494 million € for the national health insurance. Yearly productivity loss due to premature mortality attributable to prolonged sedentary behaviour cost 507 million € and yearly productivity loss due to morbidity cost between 43 and 147 million €. CONCLUSION Significant saving and many deaths could be avoided by reducing prolonged sedentary behaviour prevalence in France. To address this issue, strong responses should be implemented to tackle sedentary behaviour, complementary to physical activity promotion.
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Affiliation(s)
- Antoine Noël Racine
- French Ministry of Sport, Pôle Ressources National Sport Santé Bien-Etre, CREPS AURA/Vichy, Vichy, France
| | - Irène Margaritis
- French Agency for Food, Environmental and Occupational Health & Safety (ANSES), Maisons-Alfort, France
| | - Martine Duclos
- CHU Clermont-Ferrand, Service de Médecine du Sport et des Explorations Fonctionnelles, Université Clermont Auvergne, INRAE, UNH, Clermont-Ferrand, France
| | - François Carré
- LTSI INSERM, U1099, University of Rennes 1, Rennes, France.,Department of Sport Medicine, Pontchaillou Hospital, Rennes, France
| | | | - Christèle Gautier
- French Ministry of Sport, Sport Policy Development Office, National Sport and Health Strategy, Paris, France
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An S, Park S. Association of Physical Activity and Sedentary Behavior With the Risk of Colorectal Cancer. J Korean Med Sci 2022; 37:e158. [PMID: 35578589 PMCID: PMC9110266 DOI: 10.3346/jkms.2022.37.e158] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 04/18/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Although recent evidence supports that prolonged sedentary behavior and reduced physical activity are associated with colorectal cancer risk, there are few studies analyzing the colorectal cancer risk according to different types of physical activity and combined effects of sedentary behavior and physical activity on colorectal cancer. This study aimed to investigate the association of sedentary behavior and physical activity with colorectal cancer. METHODS A cross-sectional study included a total of 33,403 participants from the Korea National Health and Nutrition Examination Survey from 2014 to 2019. Sedentary behavior was dichotomized into < 10 hr/day and ≥ 10 hr/day, and three types of physical activity were investigated, including leisure-time, occupational, and transportation physical activity. Multiple logistic regression analyses were performed to assess the risk of colorectal cancer in relation to sedentary behavior and physical activity. RESULTS Sedentary behavior was associated with an increased risk of colorectal cancer (odds ratio [OR] 1.64; 95% confidence interval [CI], 1.22-2.21), while the different domains of physical activity were not significantly associated with colorectal cancer risk. In a combined analysis, those with sedentary behavior and without physical activity showed an increased risk of colorectal cancer compared to that of the reference category without sedentary behavior and with physical activity (OR, 1.49; 95% CI, 1.02-2.16). CONCLUSION This study found that sedentary behavior was significantly associated with the increased risk of colorectal cancer. Moreover, sedentary behavior without physical activity increased the risk of colorectal cancer. Reducing sedentary behavior and recommending any type of physical activity may reduce the risk of colorectal cancer.
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Affiliation(s)
- Sanghyun An
- Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sungjin Park
- Department of Occupational and Environmental Medicine, Incheon Nasaret International Hospital, Incheon, Korea.
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Hong R, Huang J, Xu C, Zhang X, Mi F, Xu F, Wang Y, Feng Y, Yin J. Association of Sedentary Behavior and Physical Activity With Hyperuricemia and Sex Differences: Results From the China Multi-Ethnic Cohort Study. J Rheumatol 2022; 49:513-522. [PMID: 35169050 DOI: 10.3899/jrheum.211180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To determine the association of physical activity (PA) and sedentary time (ST; leisure and total ST), commuting mode with hyperuricemia in a multiethnic Chinese population, and to analyze the difference between sexes. METHODS Baseline data were analyzed from 22,094 participants from the China Multi-Ethnic Cohort study in the Yunnan region, China. PA and sedentary behavior were assessed through questionnaires. Hyperuricemia was defined as serum urate > 7.0 mg/dL among men and > 6.0 mg/dL among women. A restricted cubic spline (RCS) was created to model the possible nonlinear relationship of PA and ST with hyperuricemia. Logistic regression was used to estimate the odds ratio (OR) and 95% CI. RESULTS Hyperuricemia prevalence in the observed population was 15.5% (men 25.5%, women 10.7%). Compared to those with light PA, participants with moderate-to-vigorous PA had lower odds of hyperuricemia (adjusted ORs were 0.85 [95% CI 0.77-0.94] and 0.88 [95% CI 0.79-0.97]). However, RCS showed a U-shaped nonlinear relationship between PA and hyperuricemia, and a linear relationship between hyperuricemia prevalence and increasing ST. Total ST ≥ 4 hours/day increased the risk of hyperuricemia in women but not in men. Mode of transportation revealed that sedentary behavior increased the risk of hyperuricemia, but there were inconsistent results based on sex. CONCLUSION Moderate PA may be more beneficial in reducing the risk of hyperuricemia. Reducing ST may have a greater effect on preventing hyperuricemia in females than in males.
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Affiliation(s)
- Rudan Hong
- R. Hong, MMed, J. Huang, MMed, C. Xu, MMed, X. Zhang, BS Med, F. Mi, MD, F. Xu, MMed, Y. Wang, MD, Y. Feng, MD, Department of Nutrition and Food Hygiene, School of Public Health, Kunming Medical University, Kunming City
| | - Juan Huang
- R. Hong, MMed, J. Huang, MMed, C. Xu, MMed, X. Zhang, BS Med, F. Mi, MD, F. Xu, MMed, Y. Wang, MD, Y. Feng, MD, Department of Nutrition and Food Hygiene, School of Public Health, Kunming Medical University, Kunming City
| | - Chuanzhi Xu
- R. Hong, MMed, J. Huang, MMed, C. Xu, MMed, X. Zhang, BS Med, F. Mi, MD, F. Xu, MMed, Y. Wang, MD, Y. Feng, MD, Department of Nutrition and Food Hygiene, School of Public Health, Kunming Medical University, Kunming City
| | - Xuehui Zhang
- R. Hong, MMed, J. Huang, MMed, C. Xu, MMed, X. Zhang, BS Med, F. Mi, MD, F. Xu, MMed, Y. Wang, MD, Y. Feng, MD, Department of Nutrition and Food Hygiene, School of Public Health, Kunming Medical University, Kunming City
| | - Fei Mi
- R. Hong, MMed, J. Huang, MMed, C. Xu, MMed, X. Zhang, BS Med, F. Mi, MD, F. Xu, MMed, Y. Wang, MD, Y. Feng, MD, Department of Nutrition and Food Hygiene, School of Public Health, Kunming Medical University, Kunming City
| | - Fang Xu
- R. Hong, MMed, J. Huang, MMed, C. Xu, MMed, X. Zhang, BS Med, F. Mi, MD, F. Xu, MMed, Y. Wang, MD, Y. Feng, MD, Department of Nutrition and Food Hygiene, School of Public Health, Kunming Medical University, Kunming City
| | - Yanjiao Wang
- R. Hong, MMed, J. Huang, MMed, C. Xu, MMed, X. Zhang, BS Med, F. Mi, MD, F. Xu, MMed, Y. Wang, MD, Y. Feng, MD, Department of Nutrition and Food Hygiene, School of Public Health, Kunming Medical University, Kunming City
| | - Yuemei Feng
- R. Hong, MMed, J. Huang, MMed, C. Xu, MMed, X. Zhang, BS Med, F. Mi, MD, F. Xu, MMed, Y. Wang, MD, Y. Feng, MD, Department of Nutrition and Food Hygiene, School of Public Health, Kunming Medical University, Kunming City
| | - Jianzhong Yin
- J. Yin, MMed, Department of Nutrition and Food Hygiene, School of Public Health, Kunming Medical University, Kunming City, and Baoshan College of Traditional Chinese Medicine, Baoshan, China
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Associations between Pre-Diagnostic Physical Activity with Breast Cancer Characteristics and Survival. Cancers (Basel) 2022; 14:cancers14071756. [PMID: 35406528 PMCID: PMC8997033 DOI: 10.3390/cancers14071756] [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: 02/07/2022] [Revised: 03/18/2022] [Accepted: 03/25/2022] [Indexed: 02/04/2023] Open
Abstract
Physical activity (PA) is known to reduce breast cancer (BC) risk and improve patient prognosis. However, the association between pre-diagnostic PA and the aggressiveness of BC is unclear. We investigated the associations between PA, BC tumour characteristics, and survival. This retrospective observational study included 7688 BC patients from the Singapore Breast Cancer Cohort (2010−2016). PA information from the questionnaire included intensity (light/moderate/vigorous) and duration (<1 h/1−2 h/>2 h per week). A PA score (1−5) incorporating intensity and duration was calculated. Associations between PA score and tumour characteristics such as stage, histological grade, nodal and hormone receptor status were examined using multinomial regression. Moreover, 10-year overall survival was estimated using Cox regression analysis in 6572 patients after excluding patients with invalid survival data and stage IV disease. Breast tumours associated with higher PA score were more likely to be non-invasive (ORinvasive vs. non-invasive(reference) [95% CI]: 0.71 [0.58−0.87], p-trend = 0.001), of lower grade (ORpoorly vs. well differentiated(reference): 0.69 [0.52−0.93], p = 0.014), ER-positive (ORER-negative vs. ER-positive(reference): 0.94 [0.89−1.00], p-trend = 0.049), PR-positive (ORPR-negative vs. PR-positive(reference): 0.82 [0.67−0.99], p = 0.041), HER2-negative (ORHER2-negative vs. HER2-positive(reference): 1.29 [1.02−1.62], p-trend = 0.002), and less likely to be of HER2-overexpressed subtype (ORHER2-overexpressed vs. Luminal A(reference): 0.89 [0.81−0.98], p-trend = 0.018). These associations (odds ratios) were more pronounced among post-menopausal patients. A higher PA score did not improve survival. Higher levels of pre-diagnostic PA were associated with less aggressive tumours in BC patients. This illustrated another benefit of PA in addition to its known role in BC risk reduction.
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Nguyen P, Ananthapavan J, Tan EJ, Crosland P, Bowe SJ, Gao L, Dunstan DW, Moodie M. Modelling the potential health and economic benefits of reducing population sitting time in Australia. Int J Behav Nutr Phys Act 2022; 19:28. [PMID: 35305678 PMCID: PMC8934131 DOI: 10.1186/s12966-022-01276-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/28/2022] [Indexed: 01/22/2023] Open
Abstract
Background Strong evidence indicates that excessive time spent sitting (sedentary behaviour) is detrimentally associated with multiple chronic diseases. Sedentary behaviour is prevalent among adults in Australia and has increased during the COVID-19 pandemic. Estimating the potential health benefits and healthcare cost saving associated with reductions in population sitting time could be useful for the development of public health initiatives. Methods A sedentary behaviour model was developed and incorporated into an existing proportional, multi-state, life table Markov model (ACE-Obesity Policy model). This model simulates the 2019 Australian population (age 18 years and above) and estimates the incidence, prevalence and mortality of five diseases associated with sedentary behaviour (type 2 diabetes, stroke, endometrial, breast and colorectal cancer). Key model inputs included population sitting time estimates from the Australian National Health Survey 2014–2015, healthcare cost data from the Australian Institute of Health and Welfare (2015) and relative risk estimates assessed by conducting literature reviews and meta-analyses. Scenario analyses estimated the potential change in disease incidence as a result of changes in population sitting time. This, in turn, resulted in estimated improvements in long term health outcomes (Health-adjusted life years (HALYs)) and healthcare cost-savings. Results According to the model, if all Australian adults sat no more than 4 h per day, the total HALYs gained would be approximately 17,211 with health care cost savings of approximately A$185 million over one year. Under a more feasible scenario, where sitting time was reduced in adults who sit 4 or more hours per day by approximately 36 min per person per day (based on the results of the Stand Up Victoria randomised controlled trial), potential HALYs gained were estimated to be 3,670 and healthcare cost saving could reach A$39 million over one year. Conclusions Excessive sedentary time results in considerable population health burden in Australia. This paper describes the development of the first Australian sedentary behaviour model that can be used to predict the long term consequences of interventions targeted at reducing sedentary behaviour through reductions in sitting time. These estimates may be used by decision makers when prioritising healthcare resources and investing in preventative public health initiatives. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-022-01276-2.
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Seo HJ, Choi MJ, Ahn SK. Secular trends and related factors in leisure-time sedentary behavior among the South Korean population: using the 2011–2017 community health survey. Epidemiol Health 2022; 44:e2022023. [PMID: 35167740 PMCID: PMC9117099 DOI: 10.4178/epih.e2022023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/14/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Sedentary behavior has gradually increased and has become a public health problem. Therefore, this study investigated trends in weekday leisure-time sedentary behaviors, as well as characteristic socio-demographic and lifestyle correlates in Korean adults. METHODS We analyzed data from 914,946 adults aged ≥19 years who participated in the Korea Community Health Survey (2011, 2013, 2015, and 2017). Leisure-time sedentary behavior was categorized as a binary variable (<4 and ≥4 hr/day). Multivariable regression analysis was used to model the prevalence of sedentary behavior and estimate odds ratios. RESULTS The prevalence of leisure-time sedentary behavior decreased from 15.2% to 14.4% in men and from 16.6% to 16.0% in women between 2011 and 2017, respectively. However, a significant increase was observed in subjects with an education lower than high school in both genders (β coefficient=0.12 for men and 0.08 for women, p for trend <0.001). Women in the lowest household income level (β coefficient=0.08, p for trend=0.001) and with poor subjective health status (β coefficient=0.05, p for trend=0.013) showed an increasing trend. Other factors associated with sedentary behavior were age, education level, body mass index, household income, walking activity, perceived stress level, and subjective health status in both genders. CONCLUSIONS Identifying the secular trends and correlates of sedentary behavior by gender and associated factors will provide empirical evidence for developing public health campaigns and promotion programs to reduce sedentary behavior in Koreans.
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Affiliation(s)
- Hyun-Ju Seo
- College of Nursing, Chungnam National University, Daejeon, Korea
| | - Min-Jung Choi
- College of Nursing, The Catholic University of Korea, Seoul, Korea
| | - Soon-Ki Ahn
- Department of Preventive Medicine, Chungnam National University Hospital, Daejeon, Korea
- Correspondence: Soon-Ki Ahn Department of Preventive Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon 35015, Korea E-mail:
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Timpel P, Herrmann S, Flößel P, Beck H, Schwarz PE. Effectiveness of digital primary prevention interventions targeting physical activity, motor skills and nutrition in children aged 3-10 years in the setting of day care and primary school: protocol for a systematic review. BMJ Open 2021; 11:e053628. [PMID: 34949625 PMCID: PMC8705251 DOI: 10.1136/bmjopen-2021-053628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Available evidence points to an association of increased screen time and the availability of digital tools during childhood with negative health outcomes in later life. For many years, public discourse focused on restricting access and use of digital technologies below certain ages. However, little is known about the specific benefit of a responsible use of digital primary prevention in the setting of (early) childhood education. The objective of this evidence synthesis is to investigate the effectiveness of digital primary prevention interventions targeting physical activity, motor skills and/or nutrition in children aged 3-10 years in day-care facilities and (pre-) schools. METHODS AND ANALYSIS We present the rationale and methodological steps of a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses procedures. Automated searches will be conducted by applying a pretested search strategy to the databases MEDLINE/PubMed, EMBASE and PsycInfo to identify relevant interventional (randomised controlled trials, controlled trials, crossover trials and pilot and feasibility) and observational (case-control, cohort) studies in English or German, with no date restrictions. The overall search will be complemented by backward, forward and additional hand searches. Two researchers will independently screen titles/abstracts and assess full texts by applying predefined eligibility criteria. Data extraction will be conducted by using a pretested data extraction sheet. The assessment of methodological quality will be performed independently by two review authors using the Critical Appraisals Skills Programme relevant to the study design applied in the given study. Additionally, qualitative content analysis will be conducted to analyse priorities for future research extracted from the discussion sections and conclusions of included studies. PROSPERO REGISTRATION NUMBER CRD42020207682.
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Affiliation(s)
- Patrick Timpel
- Medical Faculty Carl Gustav Carus, Department of Medicine III, Prevention and Care of Diabetes, Technische Universität Dresden, Dresden, Sachsen, Germany
| | - Sandra Herrmann
- Medical Faculty Carl Gustav Carus, Department of Medicine III, Prevention and Care of Diabetes, Technische Universität Dresden, Dresden, Sachsen, Germany
| | - Philipp Flößel
- UniversityCenter for Orthopedics, Trauma & Plastic Surgery, Section Sports Medicine and Rehabilitation, Technische Universität Dresden, Dresden, Sachsen, Germany
| | - Heidrun Beck
- UniversityCenter for Orthopedics, Trauma & Plastic Surgery, Section Sports Medicine and Rehabilitation, Technische Universität Dresden, Dresden, Sachsen, Germany
| | - Peter Eh Schwarz
- Medical Faculty Carl Gustav Carus, Department of Medicine III, Prevention and Care of Diabetes, Technische Universität Dresden, Dresden, Sachsen, Germany
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India-Aldana S, Rundle AG, Zeleniuch-Jacquotte A, Quinn JW, Kim B, Afanasyeva Y, Clendenen TV, Koenig KL, Liu M, Neckerman KM, Thorpe LE, Chen Y. Neighborhood Walkability and Mortality in a Prospective Cohort of Women. Epidemiology 2021; 32:763-772. [PMID: 34347687 PMCID: PMC8969891 DOI: 10.1097/ede.0000000000001406] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is a paucity of prospective cohort studies evaluating neighborhood walkability in relation to the risk of death. METHODS We geocoded baseline residential addresses of 13,832 women in the New York University Women's Health Study (NYUWHS) and estimated the Built Environment and Health Neighborhood Walkability Index (BEH-NWI) for each participant circa 1990. The participants were recruited from 1985 to 1991 in New York City and followed for an average of 27 years. We conducted survival analyses using Cox proportional hazards models to assess the association between neighborhood walkability and risk of death from any cause, obesity-related diseases, cardiometabolic diseases, and obesity-related cancers. RESULTS Residing in a neighborhood with a higher neighborhood walkability score was associated with a lower mortality rate. Comparing women in the top versus the lowest walkability tertile, the hazards ratios (and 95% CIs) were 0.96 (0.93, 0.99) for all-cause, 0.91 (0.86, 0.97) for obesity-related disease, and 0.72 (0.62, 0.85) for obesity-related cancer mortality, respectively, adjusting for potential confounders at both the individual and neighborhood level. We found no association between neighborhood walkability and risk of death from cardiometabolic diseases. Results were similar in analyses censoring participants who moved during follow-up, using multiple imputation for missing covariates, and using propensity scores matching women with high and low neighborhood walkability on potential confounders. Exploratory analyses indicate that outdoor walking and average BMI mediated the association between neighborhood walkability and mortality. CONCLUSION Our findings are consistent with a protective role of neighborhood walkability in obesity-related mortality in women, particularly obesity-related cancer mortality.
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Affiliation(s)
- Sandra India-Aldana
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5 Fl., New York, NY, 10016, USA
| | - Andrew G. Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032 USA
| | - Anne Zeleniuch-Jacquotte
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5 Fl., New York, NY, 10016, USA
| | - James W. Quinn
- Columbia Population Research Center, Columbia University
| | - Byoungjun Kim
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032 USA
| | - Yelena Afanasyeva
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5 Fl., New York, NY, 10016, USA
| | - Tess V. Clendenen
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5 Fl., New York, NY, 10016, USA
| | - Karen L. Koenig
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5 Fl., New York, NY, 10016, USA
| | - Mengling Liu
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5 Fl., New York, NY, 10016, USA
- Department of Environmental Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | | | - Lorna E. Thorpe
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5 Fl., New York, NY, 10016, USA
| | - Yu Chen
- Division of Epidemiology, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 5 Fl., New York, NY, 10016, USA
- Department of Environmental Medicine, NYU Grossman School of Medicine, New York, NY, USA
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Thomas R, Kenfield SA, Yanagisawa Y, Newton RU. Why exercise has a crucial role in cancer prevention, risk reduction and improved outcomes. Br Med Bull 2021; 139:100-119. [PMID: 34426823 PMCID: PMC8431973 DOI: 10.1093/bmb/ldab019] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2021] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Exercise is one of several factors known to lower the risk of developing cancer, as well as improve outcomes in patients already diagnosed. People who exercise after cancer have lower rates of cancer complications, treatment toxicities, relapse and improved survival. This review highlights the supportive data and biochemical processes, which explain these potential benefits. SOURCES OF DATA PubMed, Embase, Medline and Cochrane libraries were searched for papers which addressed the effects of exercise and physical activity on cancer for this review. The search terms used were physical activity, exercise and cancer up to February 2021. We also referred to the background research required for international exercise intervention study involving men with prostate cancer (INTERVAL-GAP4) and scrutinized references within the robust papers published on this subject to ensure we did not miss any clinically studies. One hundred and eighty eight papers were included. AREAS OF AGREEMENT Exercise programmes mitigate many of the complications and risks associated with cancer, particularly thromboembolism, fatigue, weight gain, arthralgia, cognitive impairment and depression. AREAS OF CONTROVERSY Molecular and biomarker changes, resulting from exercise, suggest that exercise elicits beneficial changes in insulin-related pathways, down-regulates inflammation and serum oestrogen levels, and enhances oxidative, immune and cellular repair pathways. Nonetheless, the evidence remains preliminary. GROWING POINTS The timing, intensity and challenges of prehabilitation, adjunct and rehabilitation exercise programmes are being increasingly understood but their implementation remains sporadic. AREAS FOR DEVELOPING RESEARCH More robust clinical trial data are needed to substantiate a causal effect of exercise on overall and cancer-specific survival. These studies are ongoing. Research evaluating the most cost-efficient ways of incorporating prehabilitation, adjunct and rehabilitation programmes into routine practice would be helpful to funding bodies and health care strategists.
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Affiliation(s)
- Robert Thomas
- Department of Oncology, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK
| | - Stacey A Kenfield
- Departments of Urology and Epidemiology and Biostatistics, University of California at San Francisco, Mission Hall, Box 1695-550, 16th Street, 6th Floor, San Francisco, CA 9414, USA
| | - Yuuki Yanagisawa
- Department of Medicine, Bedford Hospital, Kempston road, Bedford MK42 9DJ, UK
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, 270 Joondalup Drive, Perth, WA 6027, Australia
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Lin Y, Liu Q, Liu F, Huang K, Li J, Yang X, Wang X, Chen J, Liu X, Cao J, Shen C, Yu L, Lu F, Wu X, Zhao L, Li Y, Hu D, Lu X, Huang J, Gu D. Adverse associations of sedentary behavior with cancer incidence and all-cause mortality: A prospective cohort study. JOURNAL OF SPORT AND HEALTH SCIENCE 2021; 10:560-569. [PMID: 33878448 PMCID: PMC8500832 DOI: 10.1016/j.jshs.2021.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/04/2021] [Accepted: 03/25/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Inconsistent results have been reported in developed countries for relationships between sedentary behavior and cancer incidence and mortality, and evidence from the Chinese population is scarce. This study aimed to investigate such relationships in large Chinese population-based prospective cohorts and to explore the joint effect and interaction of sedentary behavior and moderate-to-vigorous physical activity (MVPA) on these relationships. METHODS We included 95,319 Chinese adults without cancer from 3 large cohorts and assessed their sedentary behavior and physical activity with a unified questionnaire. Cancer incidence and mortality were confirmed by interviewing participants or their proxies and checking hospital records and death certificates. Hazard ratios (HRs) and 95% confidence intervals (95%CIs) for cancer and mortality were estimated using Cox proportional hazards regression models. RESULTS During 559,002 person-years of follow-up, 2388 cancer events, 1571 cancer deaths, and 4562 all-cause deaths were recorded. Sedentary behavior was associated with increased risk of developing cancer and deaths in a dose-response manner. The multivariable-adjusted HRs (95%CIs) were the following: HR = 1.16, 95%CI: 1.01‒1.33; HR = 1.24, 95%CI: 1.04‒1.48; and HR = 1.15, 95%CI: 1.04‒1.28 for cancer incidence, cancer mortality, and all-cause mortality, respectively, for those having ≥10 h/day of sedentary time compared with those having <6 h/day of sedentary time. Sedentary populations (≥10 h/day) developed cancer or died 4.09 years and 2.79 years earlier, respectively, at the index age of 50 years. Failure to achieve the recommended level of MVPA may further aggravate the adverse associations, with the highest cancer and mortality risks being observed among participants with both ≥10 h/day of sedentary time and <150 min/week of MVPA. Limitations of this study include the fact that physical activity information was obtained via questionnaire instead of objective measurement and that there were insufficient incident cases for the analysis of associations between sedentary behavior and site-specific cancers. CONCLUSION Sedentary behavior was associated with an increased risk of cancer and all-cause mortality among Chinese adults, especially for those with ≥10 h/day of sedentary time. It is necessary to reduce sedentary time, in addition to increasing MVPA levels, for the prevention of cancer and premature death.
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Affiliation(s)
- Yuan Lin
- Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing 100037, China; Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Qiong Liu
- Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing 100037, China; Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Fangchao Liu
- Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing 100037, China; Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Keyong Huang
- Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing 100037, China; Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jianxin Li
- Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing 100037, China; Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xueli Yang
- Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing 100037, China; Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xinyan Wang
- Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing 100037, China; Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jichun Chen
- Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing 100037, China; Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xiaoqing Liu
- Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou 510080, China
| | - Jie Cao
- Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Chong Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Ling Yu
- Department of Cardiology, Fujian Provincial Hospital, Fuzhou 350014, China
| | - Fanghong Lu
- Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan 250062, China
| | - Xianping Wu
- Sichuan Center for Disease Control and Prevention, Chengdu 610041, China
| | - Liancheng Zhao
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Ying Li
- Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing 100037, China; Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Dongsheng Hu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China; Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen 518071, China
| | - Xiangfeng Lu
- Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing 100037, China; Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jianfeng Huang
- Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing 100037, China; Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Dongfeng Gu
- Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing 100037, China; Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China; School of Medicine, Southern University of Science and Technology, Shenzhen 518055, China.
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15
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Biller VS, Leitzmann MF, Sedlmeier AM, Berger FF, Ortmann O, Jochem C. Sedentary behaviour in relation to ovarian cancer risk: a systematic review and meta-analysis. Eur J Epidemiol 2021; 36:769-780. [PMID: 33492550 PMCID: PMC8417015 DOI: 10.1007/s10654-020-00712-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/15/2020] [Indexed: 01/02/2023]
Abstract
Sedentary behaviour is an emerging risk factor for several site-specific cancers. Ovarian cancers are often detected at late disease stages and the role of sedentary behaviour as a modifiable risk factor potentially contributing to ovarian cancer risk has not been extensively examined. We systematically searched relevant databases from inception to February 2020 for eligible publications dealing with sedentary behaviour in relation to ovarian cancer risk. We conducted a systematic review and meta-analysis, calculating summary relative risks (RR) and 95% confidence intervals (CI) using a random-effects model. We calculated the E-Value, a sensitivity analysis for unmeasured confounding. We tested for publication bias and heterogeneity. Seven studies (three prospective cohort studies and four case–control studies) including 2060 ovarian cancer cases were analysed. Comparing highest versus lowest levels of sedentary behaviour, the data indicated a statistically significant increase in the risk of ovarian cancer in relation to prolonged sitting time (RR = 1.29, 95% CI = 1.07–1.57). Sub-analyses of prospective cohort studies (RR = 1.33, 95% CI = 0.92–1.93) and case–control studies (RR = 1.28, 95% CI = 0.98–1.68) showed statistically non-significant results. Sensitivity analysis showed that an unmeasured confounder would need to be related to sedentary behaviour and ovarian cancer with a RR of 1.90 to fully explain away the observed RR of 1.29. Our analyses showed a statistically significant positive association between sedentary behaviour and ovarian cancer risk.
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Affiliation(s)
- Veronika S Biller
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.
| | - Michael F Leitzmann
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Anja M Sedlmeier
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Felix F Berger
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Olaf Ortmann
- Department of Gynaecology and Obstetrics, University of Regensburg, Regensburg, Germany
| | - Carmen Jochem
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
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Mahmood S, MacInnis RJ, Karahalios A, English DR, Lynch BM. Leisure-Time Physical Activity Versus Sedentary Behaviour in Relation to Colorectal Adenoma and Cancer: Are these Two Distinct Risk Factors? CURRENT COLORECTAL CANCER REPORTS 2020. [DOI: 10.1007/s11888-020-00454-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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17
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Patel AV, Friedenreich CM, Moore SC, Hayes SC, Silver JK, Campbell KL, Winters-Stone K, Gerber LH, George SM, Fulton JE, Denlinger C, Morris GS, Hue T, Schmitz KH, Matthews CE. American College of Sports Medicine Roundtable Report on Physical Activity, Sedentary Behavior, and Cancer Prevention and Control. Med Sci Sports Exerc 2020; 51:2391-2402. [PMID: 31626056 DOI: 10.1249/mss.0000000000002117] [Citation(s) in RCA: 393] [Impact Index Per Article: 98.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The American College of Sports Medicine convened an International Multidisciplinary Roundtable on Exercise and Cancer in March 2018 to evaluate and translate the evidence linking physical activity and cancer prevention, treatment, and control. This article discusses findings from the Roundtable in relation to the biologic and epidemiologic evidence for the role of physical activity in cancer prevention and survival. RESULTS The evidence supports that there are a number of biologically plausible mechanisms, whereby physical activity can influence cancer risk, and that physical activity is beneficial for the prevention of several types of cancer including breast, colon, endometrial, kidney, bladder, esophageal, and stomach. Minimizing time spent in sedentary behavior may also lower risk of endometrial, colon and lung cancers. Conversely, physical activity is associated with higher risk of melanoma, a serious form of skin cancer. Further, physical activity before and after a cancer diagnosis is also likely to be relevant for improved survival for those diagnosed with breast and colon cancer; with data suggesting that postdiagnosis physical activity provides greater mortality benefits than prediagnosis physical activity. CONCLUSIONS Collectively, there is consistent, compelling evidence that physical activity plays a role in preventing many types of cancer and for improving longevity among cancer survivors, although the evidence related to higher risk of melanoma demonstrates the importance of sun safe practices while being physically active. Together, these findings underscore the importance of physical activity in cancer prevention and control. Fitness and public health professionals and health care providers worldwide are encouraged to spread the message to the general population and cancer survivors to be physically active as their age, abilities, and cancer status will allow.
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Affiliation(s)
- Alpa V Patel
- Behavioral and Epidemiology Research Program, American Cancer Society, Atlanta, GA
| | - Christine M Friedenreich
- Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Sciences, Calgary, CANADA
| | - Steven C Moore
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - Sandra C Hayes
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, AUSTRALIA
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA
| | - Kristin L Campbell
- Department of Physical Therapy, University of British Columbia, Vancouver, CANADA
| | | | | | - Stephanie M George
- Office of Disease Prevention, National Institutes of Health, Bethesda, MD
| | - Janet E Fulton
- Physical Activity and Health Branch, Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA
| | - Crystal Denlinger
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | | | | | - Kathryn H Schmitz
- Department of Public Health Sciences, Penn State College of Medicine, Penn State University, Hershey, PA
| | - Charles E Matthews
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
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Abstract
PURPOSE OF REVIEW An abundance of data supports the health benefits of physical activity, social connectedness, and spending time outdoors. Yet, a majority of Americans are living lives that are sedentary, lonely, and not connected with nature. We have three primary goals in writing this paper. First, we will review the well-documented health challenges arising from a sedentary, isolated lifestyle. Second, we will discuss the benefits of walking as a primary means of increasing physical activity. Finally, we will shine a light on the exponential success of Walk with a Doc, a national non-profit organization. Walk with a Doc focuses on bringing physician-led enthusiasm into our communities by organizing regular doctor-led walks in the outdoors; as well as Walk with a Future Doc, which encourages medical students to start their own Walk with a Doc programs. RECENT FINDINGS The Physical Activity Guidelines for Americans share that physical activity is an important action that people of all ages can take to improve their health. These guidelines recommend that adults partake in at least 150 min of moderate aerobic physical activity. Currently, only 23% of Americans are achieving this amount of aerobic activity. In addition, recent data suggest that 3 in 4 people are lonely, a significant social determinant of health. Finally, over half of all Americans spend fewer than 5 h outside each week. Walk with a Doc and Walk with a Future Doc are having an enormous impact on combating the negative effects of these health challenges. An evaluability assessment was completed in 2018 showing Walk with a Doc attendees felt the program increased their physical activity and their social connections, with a majority of Walk with a Doc gatherings occurring in nature. Physicians and other Walk with a Doc program leaders also reported high levels of satisfaction with their participation in Walk with a Doc. As teammates in this healthcare fight, we are all painfully aware of the crisis on our hands. Of our patients, 70% are overweight or obese, nearly 80% of us are not getting enough physical activity, with all of this leading to billions of dollars in healthcare costs. Adding fuel to the fire, our doctors are burning out because of it. Today, we want to share what we have learned to be an extremely viable solution. The solution has the capacity to save 5 million lives and $68 billion dollars per year. Additionally, it is bolstering the job satisfaction and happiness of our providers. Personally, it turned my life around in 2005, and since then, it is now greater than 560 communities around the USA (and 34 other countries). We call it, simply, Walk with a Doc.
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Affiliation(s)
- David Sabgir
- Department of Cardiology, OhioHealth, Columbus, OH, USA. .,Walk with a Doc, Columbus, OH, USA.
| | - Joan Dorn
- Department of Community Health and Social Medicine, City University of New York, New York, NY, USA
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Ihira H, Sawada N, Yamaji T, Goto A, Shimazu T, Kikuchi H, Inoue S, Inoue M, Iwasaki M, Tsugane S. Occupational sitting time and subsequent risk of cancer: The Japan Public Health Center-based Prospective Study. Cancer Sci 2020; 111:974-984. [PMID: 31925977 PMCID: PMC7060463 DOI: 10.1111/cas.14304] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 12/20/2019] [Accepted: 12/25/2019] [Indexed: 01/16/2023] Open
Abstract
Although occupational sitting time has been associated with adverse health outcomes and mortality, the association with cancer incidence remains unknown. This study investigated the association between occupational sitting time and risk of total and site‐specific cancer in a Japanese population. We evaluated 33 307 participants aged 50‐79 years who responded to a questionnaire in 2000‐2003 in the Japan Public Health Center‐based Prospective Study and were followed until 2013. Participants were grouped by sitting time at work. Hazard ratio (HR) and 95% confidence interval (CI) of cancer incidence were calculated with adjustment for potential confounders including moderate‐to‐vigorous physical activity. During 10.2 years of follow‐up, 3807 newly diagnosed cases of cancer were identified. Occupational sitting time was marginally associated with total cancer, with multivariable HRs for the ≥7 h/d vs 1 to <3 h/d category of 1.12 (95% CI, 0.99‐1.26; P for trend = .071) in men, but not women. Among findings for cancers at specific sites, long occupational sitting time was associated with increased risk of pancreas cancer, with multivariable HRs for the ≥7 h/d vs 1 to <3 h/d category of 2.25 (95% CI, 1.17‐4.34; P for trend = .021) in men, and lung cancer, with multivariable HRs for the ≥7 h/d vs 1 to <3 h/d category of 2.80 (95% CI, 1.33‐5.90; P for trend = .013) in women. Extended sitting time at work was associated with an increased risk of pancreas cancer in men and lung cancer in women.
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Affiliation(s)
- Hikaru Ihira
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Norie Sawada
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Taiki Yamaji
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Atsushi Goto
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Taichi Shimazu
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Hiroyuki Kikuchi
- Department of Preventive Medicine and Public Health, Tokyo Medical University, Tokyo, Japan
| | - Shigeru Inoue
- Department of Preventive Medicine and Public Health, Tokyo Medical University, Tokyo, Japan
| | - Manami Inoue
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Motoki Iwasaki
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Shoichiro Tsugane
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
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20
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Vainshelboim B, Bopp CM, Wilson OWA, Papalia Z, Bopp M. Behavioral and Physiological Health-Related Risk Factors in College Students. Am J Lifestyle Med 2019; 15:322-329. [PMID: 34025325 DOI: 10.1177/1559827619872436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/05/2019] [Accepted: 08/07/2019] [Indexed: 01/08/2023] Open
Abstract
The purpose of this study was to assess the behavioral and physiological health-related risk factors in college students. A cross-sectional study was conducted in 1620 college students (21.3 ± 1.7 years, 897 males, and 723 females). Physical activity (PA), sitting time, body composition, cardiorespiratory fitness (CRF), muscular endurance (ME), and blood test were assessed. In the total sample, 15.2% were not meeting PA guidelines, 33% were sedentary, 13.3% were obese, 10.7% had low CRF, 36.8% had poor ME, 33.7% had dyslipidemia and 5.9% presented with prediabetes. Obesity and poor CRF were more prevalent in male students, whereas inactivity was more prevalent in female students. Individuals with poor CRF were more likely to be obese (odds ratio = 5.2, 95% CI = 3.5-7.8, P = .007 for male students, and 9.4, 95% CI = 1.5-57.8, P = .021 for female students). Sitting time positively correlated with fat percentage (fat%) and inversely with lean body mass (LBM) in male students, whereas ME inversely correlated with fat% and positively with LBM in female students. Although most students were active, significant prevalence of health-related risk factors were observed. Sedentary behavior and poor fitness were associated with a compromised body composition in both sexes. Improving fitness and reducing sedentary behavior in college students could be a public health strategy for health promotion and chronic diseases prevention.
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Affiliation(s)
- Baruch Vainshelboim
- School of Health Sciences, Saint Francis University, Loretto, Pennsylvania (BV).,Department of Kinesiology, College of Health and Human Development, Pennsylvania State University, State College, Pennsylvania (CMB, OWAW, ZP, MB)
| | - Christopher M Bopp
- School of Health Sciences, Saint Francis University, Loretto, Pennsylvania (BV).,Department of Kinesiology, College of Health and Human Development, Pennsylvania State University, State College, Pennsylvania (CMB, OWAW, ZP, MB)
| | - Oliver W A Wilson
- School of Health Sciences, Saint Francis University, Loretto, Pennsylvania (BV).,Department of Kinesiology, College of Health and Human Development, Pennsylvania State University, State College, Pennsylvania (CMB, OWAW, ZP, MB)
| | - Zack Papalia
- School of Health Sciences, Saint Francis University, Loretto, Pennsylvania (BV).,Department of Kinesiology, College of Health and Human Development, Pennsylvania State University, State College, Pennsylvania (CMB, OWAW, ZP, MB)
| | - Melissa Bopp
- School of Health Sciences, Saint Francis University, Loretto, Pennsylvania (BV).,Department of Kinesiology, College of Health and Human Development, Pennsylvania State University, State College, Pennsylvania (CMB, OWAW, ZP, MB)
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21
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Berger FF, Leitzmann MF, Hillreiner A, Sedlmeier AM, Prokopidi-Danisch ME, Burger M, Jochem C. Sedentary Behavior and Prostate Cancer: A Systematic Review and Meta-Analysis of Prospective Cohort Studies. Cancer Prev Res (Phila) 2019; 12:675-688. [PMID: 31362941 DOI: 10.1158/1940-6207.capr-19-0271] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/16/2019] [Accepted: 07/26/2019] [Indexed: 12/24/2022]
Abstract
Prostate cancer is the second most common cancer in men worldwide, and sedentary behavior is widespread, yet reviews and meta-analyses summarizing the role of sedentary behavior as a potential risk factor for prostate cancer are scarce. We searched PubMed, Web of Science, and Cochrane databases for relevant articles up to January 2019. We pooled maximally adjusted risk estimates in a random effects model and performed meta-regression meta-analysis, assessed heterogeneity and publication bias using I², funnel plots, and Egger and Begg tests, and conducted sensitivity analyses and influence diagnostics. Data from 12 prospective cohort studies including a total of 30,810 prostate cancer cases were analyzed. We found no statistically significant association between high versus low sedentary behavior and prostate cancer incidence [RR = 1.07; 95% confidence interval (CI), 0.99-1.16; P = 0.10]. We noted that adjustment for body mass index (BMI) modified the relation of sedentary behavior to prostate cancer, particularly aggressive cancer. Sedentary behavior was related to a statistically significant increased risk of aggressive prostate cancer in analyses not adjusted for BMI (RR = 1.21; 95% CI, 1.03-1.43), whereas no association was apparent in BMI-adjusted analyses (RR = 0.98; 95% CI, 0.90-1.07), and the difference between those summary risk estimates was statistically significant (P difference = 0.02). Sedentary behavior is not independently associated with prostate cancer. However, prolonged sedentary behavior may be related to increased risk of aggressive prostate cancer through a mechanism involving obesity. This finding represents a potentially important step toward considering sedentary behavior as a modifiable behavioral risk factor for aggressive prostate cancer.
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Affiliation(s)
- Felix F Berger
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Germany.
| | - Michael F Leitzmann
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Germany
| | - Andrea Hillreiner
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Germany
| | - Anja M Sedlmeier
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Germany
| | | | - Maximilian Burger
- Department of Urology, Caritas St. Josef Hospital, University of Regensburg, Germany
| | - Carmen Jochem
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Germany
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Rees-Punia E, Patel AV, Fallon EA, Gapstur SM, Teras LR. Physical Activity, Sitting Time, and Risk of Myelodysplastic Syndromes, Acute Myeloid Leukemia, and Other Myeloid Malignancies. Cancer Epidemiol Biomarkers Prev 2019; 28:1489-1494. [PMID: 31196856 DOI: 10.1158/1055-9965.epi-19-0232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/23/2019] [Accepted: 06/07/2019] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION There is limited research on associations of moderate-to-vigorous physical activity (MVPA) and sitting with risk of myeloid neoplasms (MN) or MN subtypes. We examined these associations in the Cancer Prevention Study-II Nutrition Cohort. METHODS Among 109,030 cancer-free participants (mean age 69.2, SD 6.1 years) in 1999, 409 were identified as having been diagnosed with a MN [n = 155 acute myeloid leukemia (AML), n = 154 myelodysplastic syndromes (MDS), n = 100 other ML] through June 2013. Cox proportional hazards regression was used to calculate multivariable adjusted hazard ratios (HR) and 95% confidence intervals (CI) for associations of MVPA (MET-h/wk) and sitting (h/d) with risk of all MN, myeloid leukemia only, MDS, and AML. RESULTS Compared with insufficient MVPA [>0-<7.5 metabolic equivalent hours/week (MET)-h/wk], the HR (95% CI) for meeting physical activity guidelines (7.5-<15 MET-h/wk MVPA) and risk of MN was 0.74 (95% CI, 0.56-0.98) and for doubling guidelines (15-<22.5 MET-h/wk) was 0.75 (0.53-1.07); however, there was no statistically significant association for higher MVPA (22.5+ MET-h/wk, HR, 0.93; 95% CI, 0.73-1.20). Similarly, meeting/doubling guidelines was associated with lower risk of MDS (HR, 0.57; 95% CI, 0.35-0.92/HR, 0.51; 95% CI, 0.27-0.98), but there was no association for 22.5+ MET-h/wk (HR, 0.93; 95% CI, 0.63-1.37). MVPA was not associated with risk of myeloid leukemia or AML. Sitting time was not associated with risk of any outcome. CONCLUSIONS These results suggest that there may be a nonlinear association between MVPA and risk of MDS and possibly other MN. IMPACT Further studies are needed to better understand the dose-response relationships between MVPA and risk of MDS, a highly fatal and understudied cancer.
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Affiliation(s)
- Erika Rees-Punia
- Behavioral and Epidemiology Research Group, American Cancer Society, 250 Williams St., Atlanta, Georgia.
| | - Alpa V Patel
- Behavioral and Epidemiology Research Group, American Cancer Society, 250 Williams St., Atlanta, Georgia
| | - Elizabeth A Fallon
- Behavioral and Epidemiology Research Group, American Cancer Society, 250 Williams St., Atlanta, Georgia
| | - Susan M Gapstur
- Behavioral and Epidemiology Research Group, American Cancer Society, 250 Williams St., Atlanta, Georgia
| | - Lauren R Teras
- Behavioral and Epidemiology Research Group, American Cancer Society, 250 Williams St., Atlanta, Georgia
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23
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Lee J. Physical activity, sitting time, and the risk of ovarian cancer: A brief research report employing a meta-analysis of existing. Health Care Women Int 2018; 40:433-458. [PMID: 30358498 DOI: 10.1080/07399332.2018.1505892] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
We investigated the associations between physical activity, physical inactivity, and ovarian cancer risk and identified the most effective physical activity intensity and amount to reduce ovarian cancer risk. Thirty-four studies were selected for the present meta-analysis. Physical activity helps decrease ovarian cancer risk. Moderate intensity and low amount of physical activity showed the greatest reduction of ovarian cancer risk and prolonged sitting time had the worst ovarian cancer risk. At least 2 h of moderate physical activity per week and <3 h of sitting time per day provided a preventive effect to ovarian cancer.
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Affiliation(s)
- Junga Lee
- a Sports Medicine and Science, Graduate School of Physical Education , Kyung Hee University, Global Campus , Republic of Korea
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24
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Rangul V, Sund ER, Mork PJ, Røe OD, Bauman A. The associations of sitting time and physical activity on total and site-specific cancer incidence: Results from the HUNT study, Norway. PLoS One 2018; 13:e0206015. [PMID: 30352079 PMCID: PMC6198967 DOI: 10.1371/journal.pone.0206015] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 09/24/2018] [Indexed: 12/19/2022] Open
Abstract
Background Sedentary behavior is thought to pose different risks to those attributable to physical inactivity. However, few studies have examined the association between physical activity and sitting time with cancer incidence within the same population. Methods We followed 38,154 healthy Norwegian adults in the Nord-Trøndelag Health Study (HUNT) for cancer incidence from 1995–97 to 2014. Cox proportional hazards regression was used to estimate risk of site-specific and total cancer incidence by baseline sitting time and physical activity. Results During the 16-years follow-up, 4,196 (11%) persons were diagnosed with cancer. We found no evidence that people who had prolonged sitting per day or had low levels of physical activity had an increased risk of total cancer incidence, compared to those who had low sitting time and were physically active. In the multivariate model, sitting ≥8 h/day was associated with 22% (95% CI, 1.05–1.42) higher risk of prostate cancer compared to sitting <8 h/day. Further, men with low physical activity (≤8.3 MET-h/week) had 31% (95% CI, 1.00–1.70) increased risk of colorectal cancer (CRC) and 45% (95% CI, 1.01–2.09) increased risk of lung cancer compared to participants with a high physical activity (>16.6 MET-h/week). The joint effects of physical activity and sitting time the indicated that prolonged sitting time increased the risk of CRC independent of physical activity in men. Conclusions Our findings suggest that prolonged sitting and low physical activity are positively associated with colorectal-, prostate- and lung cancer among men. Sitting time and physical activity were not associated with cancer incidence among women. The findings emphasizing the importance of reducing sitting time and increasing physical activity.
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Affiliation(s)
- Vegar Rangul
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Levanger, Norway
- Nord University, Faculty of Health and Nursing, Levanger, Norway
- * E-mail:
| | - Erik R. Sund
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Levanger, Norway
| | - Paul Jarle Mork
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Levanger, Norway
| | - Oluf Dimitri Røe
- Cancer Clinic, Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Adrian Bauman
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Levanger, Norway
- Prevention Research Collaboration, School of Public Health, University of Sydney, New South Wales, Sydney, Australia
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25
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Patel AV, Maliniak ML, Rees-Punia E, Matthews CE, Gapstur SM. Prolonged Leisure Time Spent Sitting in Relation to Cause-Specific Mortality in a Large US Cohort. Am J Epidemiol 2018; 187:2151-2158. [PMID: 29947736 DOI: 10.1093/aje/kwy125] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 06/08/2018] [Indexed: 12/25/2022] Open
Abstract
The majority of leisure time is spent in sedentary behaviors such as television viewing. Studies have documented that prolonged leisure-time sitting is associated with higher risk of mortality-total, cardiovascular disease, cancer, and "all other causes"-but few have examined the "other" causes of death in detail. To examine associations of leisure-time sitting with risk of specific causes of death, we analyzed data from the Cancer Prevention Study II (CPS-II) Nutrition Cohort, a prospective US cohort including 127,554 men and women who were free of major chronic disease at study entry, and among whom 48,784 died during 21 years of follow-up (1993-2014; median follow-up, 20.3 years, interquartile range, 4.6 years). After multivariable adjustment, prolonged leisure-time sitting (≥6 vs. <3 hours per day) was associated with higher risk of mortality from all causes, cardiovascular disease (including coronary heart disease and stroke-specific mortality), cancer, diabetes, kidney disease, suicide, chronic obstructive pulmonary disease, pneumonitis due to solids and liquids, liver, peptic ulcer and other digestive disease, Parkinson disease, Alzheimer disease, nervous disorders, and musculoskeletal disorders. These findings provide additional evidence for associations between a broad range of mortality outcomes and prolonged sitting time. Given the pervasive nature of sitting in the contemporary lifestyle, this study further supports the recommendation that encouraging individuals to reduce sedentary time may provide health benefits.
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Affiliation(s)
- Alpa V Patel
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, Georgia
| | - Maret L Maliniak
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, Georgia
| | - Erika Rees-Punia
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, Georgia
| | - Charles E Matthews
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Susan M Gapstur
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, Georgia
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Physical activity, sedentary time, and risk of colorectal cancer: the Singapore Chinese Health Study. Eur J Cancer Prev 2018; 26:469-475. [PMID: 28542077 DOI: 10.1097/cej.0000000000000369] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Singapore has experienced a marked increase in colorectal cancer incidence over the past 40 years. Evidence from prospective studies in Western Europe and the USA suggests that low physical activity and high amounts of sedentary time are associated with increased colorectal cancer risk. The aim of this study is to evaluate these relationships in an Asian population. The Singapore Chinese Health Study enrolled 63 257 adults between 1993 and 1998. At enrollment, participants reported past year physical activity and time spent sitting. Incident colorectal cancers (n=1994) were identified through 31 December 2014. Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for potential confounders. Any strenuous-vigorous or moderate physical activity was reported by 13.7 and 22.1% of the cohort, respectively. Strenuous-vigorous physical activity was associated with statistically significant reduced colorectal cancer risk (HR=0.85; 95% CI: 0.74-0.99 for ≥0.5 h/week vs. none), but moderate was not. In analysis stratified by time spent watching television, an inverse relationship between moderate physical activity and colorectal cancer risk (HR=0.86; 95% CI: 0.72-1.01 for ≥0.5 h/week vs. none) was observed for those who reported at least 3 h/day sitting watching television (Pinteraction=0.042). Participation in strenuous-vigorous physical activity, such as jogging, swimming, or heavy manual labor, was associated with reduced colorectal cancer risk among Singapore Chinese. Further research on physical activity and sedentary behaviors, independently and in combination, and colorectal cancer risk in Asian populations is needed.
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27
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Physical activity, sedentary time, and risk of colorectal cancer: the Singapore Chinese Health Study. Eur J Cancer Prev 2018. [PMID: 28542077 DOI: 10.1097/cej.0000000000000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Singapore has experienced a marked increase in colorectal cancer incidence over the past 40 years. Evidence from prospective studies in Western Europe and the USA suggests that low physical activity and high amounts of sedentary time are associated with increased colorectal cancer risk. The aim of this study is to evaluate these relationships in an Asian population. The Singapore Chinese Health Study enrolled 63 257 adults between 1993 and 1998. At enrollment, participants reported past year physical activity and time spent sitting. Incident colorectal cancers (n=1994) were identified through 31 December 2014. Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for potential confounders. Any strenuous-vigorous or moderate physical activity was reported by 13.7 and 22.1% of the cohort, respectively. Strenuous-vigorous physical activity was associated with statistically significant reduced colorectal cancer risk (HR=0.85; 95% CI: 0.74-0.99 for ≥0.5 h/week vs. none), but moderate was not. In analysis stratified by time spent watching television, an inverse relationship between moderate physical activity and colorectal cancer risk (HR=0.86; 95% CI: 0.72-1.01 for ≥0.5 h/week vs. none) was observed for those who reported at least 3 h/day sitting watching television (Pinteraction=0.042). Participation in strenuous-vigorous physical activity, such as jogging, swimming, or heavy manual labor, was associated with reduced colorectal cancer risk among Singapore Chinese. Further research on physical activity and sedentary behaviors, independently and in combination, and colorectal cancer risk in Asian populations is needed.
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28
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Hansra DM, McIntyre K, Ramdial J, Sacks S, Patrick CS, Cutler J, McIntyre B, Feister K, Miller M, Taylor AK, Farooq F, de Mayolo JA, Ahn E. Evaluation of How Integrative Oncology Services Are Valued between Hematology/Oncology Patients and Hematologists/Oncologists at a Tertiary Care Center. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2018; 2018:8081018. [PMID: 29849727 PMCID: PMC5925032 DOI: 10.1155/2018/8081018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 12/28/2017] [Accepted: 01/04/2018] [Indexed: 11/20/2022]
Abstract
Evidence regarding opinions on integrative modalities by patients and physicians is lacking. Methods. A survey study was conducted assessing how integrative modalities were valued among hematology/oncology patients and hematologists and oncologists at a major tertiary medical center. Results. 1008 patients and 55 physicians were surveyed. With the exception of support groups, patients valued nutrition services, exercise therapy, spiritual/religious counseling, supplement/herbal advice, support groups, music therapy, and other complimentary medicine services significantly more than physicians (P ≤ 0.05). Conclusion. With the exception of support groups, patients value integrative modalities more than physicians. Perhaps with increasing education, awareness, and acceptance by providers and traditional institutions, integrative modalities could be equally valued between patients and providers. It is possible that increased availability and utilization of integrative oncology modalities at tertiary hospital sites could improve patient satisfaction, quality of life, and other clinical endpoints.
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Affiliation(s)
- D. M. Hansra
- Cancer Treatment Centers of America, Atlanta, GA, USA
- Jackson Memorial Hospital, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - K. McIntyre
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - J. Ramdial
- Jackson Memorial Hospital, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - S. Sacks
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - C. S. Patrick
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - J. Cutler
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - B. McIntyre
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - K. Feister
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - M. Miller
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - A. K. Taylor
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - F. Farooq
- Jackson Memorial Hospital, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | | | - E. Ahn
- Cancer Treatment Centers of America, Atlanta, GA, USA
- Sylvester Comprehensive Cancer Center, Miami, FL, USA
- Miller School of Medicine, University of Miami, Miami, FL, USA
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29
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Mahabir S, Willett WC, Friedenreich CM, Lai GY, Boushey CJ, Matthews CE, Sinha R, Colditz GA, Rothwell JA, Reedy J, Patel AV, Leitzmann MF, Fraser GE, Ross S, Hursting SD, Abnet CC, Kushi LH, Taylor PR, Prentice RL. Research Strategies for Nutritional and Physical Activity Epidemiology and Cancer Prevention. Cancer Epidemiol Biomarkers Prev 2018; 27:233-244. [PMID: 29254934 PMCID: PMC7992195 DOI: 10.1158/1055-9965.epi-17-0509] [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: 06/12/2017] [Revised: 10/02/2017] [Accepted: 12/04/2017] [Indexed: 12/24/2022] Open
Abstract
Very large international and ethnic differences in cancer rates exist, are minimally explained by genetic factors, and show the huge potential for cancer prevention. A substantial portion of the differences in cancer rates can be explained by modifiable factors, and many important relationships have been documented between diet, physical activity, and obesity, and incidence of important cancers. Other related factors, such as the microbiome and the metabolome, are emerging as important intermediary components in cancer prevention. It is possible with the incorporation of newer technologies and studies including long follow-up and evaluation of effects across the life cycle, additional convincing results will be produced. However, several challenges exist for cancer researchers; for example, measurement of diet and physical activity, and lack of standardization of samples for microbiome collection, and validation of metabolomic studies. The United States National Cancer Institute convened the Research Strategies for Nutritional and Physical Activity Epidemiology and Cancer Prevention Workshop on June 28-29, 2016, in Rockville, Maryland, during which the experts addressed the state of the science and areas of emphasis. This current paper reflects the state of the science and priorities for future research. Cancer Epidemiol Biomarkers Prev; 27(3); 233-44. ©2017 AACR.
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Affiliation(s)
- Somdat Mahabir
- Environmental Epidemiology Branch, Epidemiology and Genomics Research Program (EGRP), Division of Cancer Control and Population Sciences (DCCPS), National Cancer Institute (NCI), Bethesda, Maryland.
| | - Walter C Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, Massachusetts
| | - Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Edmonton, Alberta, Canada
| | - Gabriel Y Lai
- Environmental Epidemiology Branch, Epidemiology and Genomics Research Program (EGRP), Division of Cancer Control and Population Sciences (DCCPS), National Cancer Institute (NCI), Bethesda, Maryland
| | - Carol J Boushey
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii
| | - Charles E Matthews
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics (DCEG), NCI, Bethesda, Maryland
| | - Rashmi Sinha
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics (DCEG), NCI, Bethesda, Maryland
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University and Alvin J. Siteman Cancer Center, St. Louis, Missouri
| | - Joseph A Rothwell
- Nutrition and Metabolism Section, Biomarkers Group, International Agency for Cancer Research (IARC), Lyon, France
| | - Jill Reedy
- Risk Factor Assessment Branch, EGRP, DCCPS, NCI, Bethesda, Maryland
| | - Alpa V Patel
- Cancer Prevention Study-3, American Cancer Society, Atlanta, Georgia
| | - Michael F Leitzmann
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Gary E Fraser
- School of Public Health, School of Medicine, Loma Linda University, Loma Linda, California
| | - Sharon Ross
- Nutritional Science Research Group, Division of Cancer Prevention, NCI, Bethesda, Maryland
| | - Stephen D Hursting
- Nutrition Research Institute, Lineberger Comprehensive Cancer Center and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Christian C Abnet
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics (DCEG), NCI, Bethesda, Maryland
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Philip R Taylor
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics (DCEG), NCI, Bethesda, Maryland
| | - Ross L Prentice
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
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30
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Lynch BM, Mahmood S, Boyle T. Sedentary Behaviour and Cancer. SEDENTARY BEHAVIOUR EPIDEMIOLOGY 2018. [DOI: 10.1007/978-3-319-61552-3_10] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Coleman HG, Xie SH, Lagergren J. The Epidemiology of Esophageal Adenocarcinoma. Gastroenterology 2018; 154:390-405. [PMID: 28780073 DOI: 10.1053/j.gastro.2017.07.046] [Citation(s) in RCA: 328] [Impact Index Per Article: 54.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/19/2017] [Accepted: 07/20/2017] [Indexed: 12/18/2022]
Abstract
The incidence of esophageal adenocarcinoma (EAC) has increased in many Western countries and is higher in men than women. Some risk factors for EAC have been identified-mainly gastroesophageal reflux disease, Barrett's esophagus, obesity, and tobacco smoking. It is not clear whether interventions to address these factors can reduce risk of EAC, although some evidence exists for smoking cessation. Although consumption of alcohol is not associated with EAC risk, other exposures, such as physical activity, nutrition, and medication use, require further study. Genetic variants have been associated with risk for EAC, but their overall contribution is low. Studies are needed to investigate associations between risk factors and the molecular subtypes of EAC. The prognosis for patients with EAC has slightly improved, but remains poor-screening and surveillance trials of high-risk individuals are needed.
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Affiliation(s)
- Helen G Coleman
- Cancer Epidemiology Research Group, Centre for Public Health, Queen's University Belfast, UK.
| | - Shao-Hua Xie
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Jesper Lagergren
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Division of Cancer Studies, King's College London, United Kingdom
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Long-term endurance training increases serum cathepsin S levels in healthy female subjects. Ir J Med Sci 2017; 187:845-851. [PMID: 29181829 DOI: 10.1007/s11845-017-1693-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 10/03/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Circulating cathepsin S (CS) has been associated with a lower risk for breast cancer in a large Swedish cohort. Long-term physical activity has been shown to have beneficial effects on the development of various cancer subtypes, in particular breast and colorectal cancers. The aim of this study was to investigate the effect of long-term endurance sport on CS levels in females. MATERIAL AND METHODS Thirty-six of 40 subjects completed the study. Subjects were told to increase their activity pensum for 8 months reaching 150 min/week moderate or 75 min/week intense exercise. Ergometries were performed at the beginning and the end of the study to prove/quantify the performance gain. Blood samples were drawn at baseline and every 2 months. Serum CS levels were measured by ELISA. To analyse the change and the progression of CS, Wilcoxon rank sum and Friedman tests were used. RESULTS The sportive group (performance gain by > 4.9%) showed a significant increase of CS levels from 3.32/2.73/4.09 to 4.00/3.09/5.04 ng/ml (p = 0.008) corresponding to an increase of 20.5%. CONCLUSIONS We could show a significant increase of circulating CS levels in healthy female subjects induced by long-term physical activity. CS, occurring in the tumour microenvironment, is well-known to promote tumour growth, e.g. by ameliorating angiogenesis. However, the role of circulating CS in cancer growth is not clear. As physical activity is known as preventive intervention, in particular concerning breast and colorectal cancers, and long-term physical activity leads to an increase of CS levels in female subjects, circulating CS might even be involved in this protective effect. TRIAL REGISTRATION Clinical trial registration: NCT02097199.
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A Case Report on VT from TV: DVT and PE from Prolonged Television Watching. Case Rep Pulmonol 2017; 2017:9347693. [PMID: 29109889 PMCID: PMC5646351 DOI: 10.1155/2017/9347693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/10/2017] [Accepted: 08/24/2017] [Indexed: 11/17/2022] Open
Abstract
Pulmonary embolus (PE) and deep vein thrombosis are diagnoses that are commonly made in the emergency department. Well known risk factors for thromboembolic events include immobility, malignancy, pregnancy, surgery, and acquired or inherited thrombophilias, obesity, cigarette smoking, and hypertension. We present a case of a 59-year-old female who watched TV and developed leg swelling and was found to have PE and DVT.
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34
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Chen P, Song Q, Han J, Xu H, Chen T, Xu J, Cheng Y. Sitting time and occupational and recreational physical activity in relation to the risk of esophageal squamous cell carcinoma. Onco Targets Ther 2017; 10:4787-4794. [PMID: 29033590 PMCID: PMC5628682 DOI: 10.2147/ott.s147711] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Backgrounds Sitting time and physical activity are associated with cancer risk; however, their roles in the development of esophageal squamous cell carcinoma (ESCC) are inconclusive. This study aimed to investigate the effects of total sitting time, occupational activity time (OAT), and recreational activity time (RAT) on ESCC risk. Methods Five hundred fifty-seven ESCC patients and 543 healthy controls matched by sex and age were recruited for this study. Conditional logistic regression was performed to obtain odds ratios (ORs) and 95% confidence intervals (CIs). Results Longer total sitting time (adjusted OR [AOR] 2.54, 95% CI 1.58–4.09) and longer OAT (AOR 2.90, 95% CI 2.11–3.99) were associated with higher ESCC risk, while longer RAT (AOR 0.27, 95% CI 0.19–0.38) could reduce ESCC risk. When the body mass index was incorporated into the multivariable models, the results changed slightly. In risk estimation according to sex, the same trends were observed in both men and women. Furthermore, longer RAT could completely or partially diminish the impacts of longer sitting time and OAT on increasing ESCC risk. Conclusion Long sitting time and long OAT can increase the risk of ESCC, while long RAT is significantly associated with decreased ESCC risk.
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Affiliation(s)
- Pengxiang Chen
- Department of Radiation Oncology, Qilu Hospital of Shandong University
| | - Qingxu Song
- Department of Radiation Oncology, Qilu Hospital of Shandong University
| | - Jie Han
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong University, Jinan
| | - Huapu Xu
- Department of Oncology, Pingyi Hospital of Traditional Chinese Medicine, Pingyi
| | - Tong Chen
- Department of Oncology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan
| | - Jiaqi Xu
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Yufeng Cheng
- Department of Radiation Oncology, Qilu Hospital of Shandong University
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Kerr J, Anderson C, Lippman SM. Physical activity, sedentary behaviour, diet, and cancer: an update and emerging new evidence. Lancet Oncol 2017; 18:e457-e471. [PMID: 28759385 PMCID: PMC10441558 DOI: 10.1016/s1470-2045(17)30411-4] [Citation(s) in RCA: 359] [Impact Index Per Article: 51.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 04/21/2017] [Accepted: 04/27/2017] [Indexed: 12/11/2022]
Abstract
The lifestyle factors of physical activity, sedentary behaviour, and diet are increasingly being studied for their associations with cancer. Physical activity is inversely associated with and sedentary behaviour is positively (and independently) associated with an increased risk of more than ten types of cancer, including colorectal cancer (and advanced adenomas), endometrial cancers, and breast cancer. The most consistent dietary risk factor for premalignant and invasive breast cancer is alcohol, whether consumed during early or late adult life, even at low levels. Epidemiological studies show that the inclusion of wholegrain, fibre, fruits, and vegetables within diets are associated with reduced cancer risk, with diet during early life (age <8 years) having the strongest apparent association with cancer incidence. However, randomised controlled trials of diet-related factors have not yet shown any conclusive associations between diet and cancer incidence. Obesity is a key contributory factor associated with cancer risk and mortality, including in dose-response associations in endometrial and post-menopausal breast cancer, and in degree and duration of fatty liver disease-related hepatocellular carcinoma. Obesity produces an inflammatory state, characterised by macrophages clustered around enlarged hypertrophied, dead, and dying adipocytes, forming crown-like structures. Increased concentrations of aromatase and interleukin 6 in inflamed breast tissue and an increased number of macrophages, compared with healthy tissue, are also observed in women with normal body mass index, suggesting a metabolic obesity state. Emerging randomised controlled trials of physical activity and dietary factors and mechanistic studies of immunity, inflammation, extracellular matrix mechanics, epigenetic or transcriptional regulation, protein translation, circadian disruption, and interactions of the multibiome with lifestyle factors will be crucial to advance this field.
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Affiliation(s)
- Jacqueline Kerr
- Moores Cancer Center, University of California, La Jolla, San Diego, CA, USA; Department of Family Medicine and Public Health, University of California, La Jolla, San Diego, CA, USA
| | - Cheryl Anderson
- Moores Cancer Center, University of California, La Jolla, San Diego, CA, USA; Department of Family Medicine and Public Health, University of California, La Jolla, San Diego, CA, USA
| | - Scott M Lippman
- Moores Cancer Center, University of California, La Jolla, San Diego, CA, USA; Department of Medicine, University of California, La Jolla, San Diego, CA, USA.
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Ma P, Yao Y, Sun W, Dai S, Zhou C. Daily sedentary time and its association with risk for colorectal cancer in adults: A dose-response meta-analysis of prospective cohort studies. Medicine (Baltimore) 2017; 96:e7049. [PMID: 28562564 PMCID: PMC5459729 DOI: 10.1097/md.0000000000007049] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Sedentary behavior is emerging as an independent risk factor for health. However, previous studies have indicated that sedentary behaviors are associated with the colorectal cancer risk, but presented controversial results.Studies in PubMed and EMBASE were searched update to February 2017 to identify and quantify the potential dose-response association between daily sedentary time and colorectal cancer.Twenty-eight eligible studies involving a total of 47,84,339 participants with 46,071 incident cases were included in this meta-analysis. Our results showed statistically significant association between prolong television viewing time and colorectal cancer (odds ratio [OR] 1.17, 95% confidence interval [CI] 1.09-1.24, P < .001). Additionally, we obtained the best fit at an inflection point of 2 hours per day in piecewise regression analysis, the summary relative risk (RR) of colorectal cancer for an increase of 2 hours per day television viewing was 1.07 (95% CI 1.05-1.10, P < .001). Furthermore, prolong occupational sitting time was correlated with a significantly higher risk of colorectal cancer (OR 1.15, 95% CI 1.08-1.22, P < .001), increasing 2 hours per day of occupational sitting time per day was associated with a 4% incremental in the risk of colorectal cancer (RR 1.04, 95% CI 1.01-1.08). Additionally, prolong total sitting time was associated with a significantly higher risk of colorectal cancer (OR 1.06, 95% CI 1.03-1.09, P < .001). Increasing 2 hours of total sitting time per day was associated with a 2% incremental in the risk of colorectal cancer (RR 1.02, 95% CI 1.01-1.06). Subgroup meta-analyses in study design, study quality, number of participants, and number of cases showed consistent with the primary findings.Prolonged television viewing, occupational sitting time, and total sitting time are associated with increased risks of colorectal cancer.
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Reid BM, Permuth JB, Sellers TA. Epidemiology of ovarian cancer: a review. Cancer Biol Med 2017. [PMID: 28443200 DOI: 10.20892/j.issn.2095-3941.2016.0084]+[] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Ovarian cancer (OC) is the seventh most commonly diagnosed cancer among women in the world and the tenth most common in China. Epithelial OC is the most predominant pathologic subtype, with five major histotypes that differ in origination, pathogenesis, molecular alterations, risk factors, and prognosis. Genetic susceptibility is manifested by rare inherited mutations with high to moderate penetrance. Genome-wide association studies have additionally identified 29 common susceptibility alleles for OC, including 14 subtype-specific alleles. Several reproductive and hormonal factors may lower risk, including parity, oral contraceptive use, and lactation, while others such as older age at menopause and hormone replacement therapy confer increased risks. These associations differ by histotype, especially for mucinous OC, likely reflecting differences in etiology. Endometrioid and clear cell OC share a similar, unique pattern of associations with increased risks among women with endometriosis and decreased risks associated with tubal ligation. OC risks associated with other gynecological conditions and procedures, such as hysterectomy, pelvic inflammatory disease, and polycystic ovarian syndrome, are less clear. Other possible risk factors include environmental and lifestyle factors such as asbestos and talc powder exposures, and cigarette smoking. The epidemiology provides clues on etiology, primary prevention, early detection, and possibly even therapeutic strategies.
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Affiliation(s)
- Brett M Reid
- Department of Cancer Epidemiology, Division of Population Sciences, Moffitt Cancer Center, Tampa 33612, FL, USA
| | - Jennifer B Permuth
- Department of Cancer Epidemiology, Division of Population Sciences, Moffitt Cancer Center, Tampa 33612, FL, USA
| | - Thomas A Sellers
- Department of Cancer Epidemiology, Division of Population Sciences, Moffitt Cancer Center, Tampa 33612, FL, USA
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Abstract
Ovarian cancer (OC) is the seventh most commonly diagnosed cancer among women in the world and the tenth most common in China. Epithelial OC is the most predominant pathologic subtype, with five major histotypes that differ in origination, pathogenesis, molecular alterations, risk factors, and prognosis. Genetic susceptibility is manifested by rare inherited mutations with high to moderate penetrance. Genome-wide association studies have additionally identified 29 common susceptibility alleles for OC, including 14 subtype-specific alleles. Several reproductive and hormonal factors may lower risk, including parity, oral contraceptive use, and lactation, while others such as older age at menopause and hormone replacement therapy confer increased risks. These associations differ by histotype, especially for mucinous OC, likely reflecting differences in etiology. Endometrioid and clear cell OC share a similar, unique pattern of associations with increased risks among women with endometriosis and decreased risks associated with tubal ligation. OC risks associated with other gynecological conditions and procedures, such as hysterectomy, pelvic inflammatory disease, and polycystic ovarian syndrome, are less clear. Other possible risk factors include environmental and lifestyle factors such as asbestos and talc powder exposures, and cigarette smoking. The epidemiology provides clues on etiology, primary prevention, early detection, and possibly even therapeutic strategies.
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Affiliation(s)
- Brett M Reid
- Department of Cancer Epidemiology, Division of Population Sciences, Moffitt Cancer Center, Tampa 33612, FL, USA
| | - Jennifer B Permuth
- Department of Cancer Epidemiology, Division of Population Sciences, Moffitt Cancer Center, Tampa 33612, FL, USA
| | - Thomas A Sellers
- Department of Cancer Epidemiology, Division of Population Sciences, Moffitt Cancer Center, Tampa 33612, FL, USA
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Abstract
Growth hormone (GH) replacement in GH deficient (GHD) children secures normal linear growth, while in GHD adults it improves metabolic status, body composition and quality of life. Safety of GH treatment is an important issue in particular concerning the controversy of potential cancer risk. Unlike in congenital IGF-1 deficiency, there is no complete protection against cancer in GHD patients. Important modifiable risk factors in GHD patients are obesity, insulin resistance, sedentary behavior, circadian rhythm disruption, chronic low grade inflammation and concomitant sex hormone replacement. Age, family history, hereditary cancer predisposition syndromes or cranial irradiation may present non-modifiable risk factors. Quantifying the risk of cancer in relation to GH therapy in adult GHD patients is complex. There is evidence that links GH to cancer occurrence or promotion, but the evidence is progressively weaker when moving from in vitro studies to in vivo animal studies to epidemiological studies and finally to studies on GH treated patients. GH-IGF inhibition in experimental animals leads to decreased cancer incidence and progression. Epidemiological studies suggest an association of high normal circulating IGF-1 or GH to cancer incidence in general population. Data regarding cancer incidence in acromegaly are inconsistent but thyroid and colorectal neoplasias are the main source of concern. Replacement therapy with rhGH for GHD is generally safe. Overall the rate of de novo cancers was not increased in studies of GH-treated GHD patients. Additional caution is mandated in patients with history of cancer, strong family history of cancer and with advancing age. Childhood cancer survivors may be at increased risk for secondary neoplasms compared with general population. In this subgroup GH therapy should be used cautiously and with respect to other risk factors (cranial irradiation etc). We believe that the benefits of GH therapy against the morbidity of untreated GH deficiency outweigh the theoretical cancer risk. Proper monitoring of GH treatment with diligent cancer surveillance remains essential.
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Affiliation(s)
- Sandra Pekic
- University of Belgrade, School of Medicine, Dr Subotica 8, 11000 Belgrade, Serbia; Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr Subotica 13, 11000 Belgrade, Serbia
| | - Marko Stojanovic
- University of Belgrade, School of Medicine, Dr Subotica 8, 11000 Belgrade, Serbia; Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, Dr Subotica 13, 11000 Belgrade, Serbia
| | - Vera Popovic
- University of Belgrade, School of Medicine, Dr Subotica 8, 11000 Belgrade, Serbia.
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Abstract
Ovarian cancer (OC) is the seventh most commonly diagnosed cancer among women in the world and the tenth most common in China. Epithelial OC is the most predominant pathologic subtype, with five major histotypes that differ in origination, pathogenesis, molecular alterations, risk factors, and prognosis. Genetic susceptibility is manifested by rare inherited mutations with high to moderate penetrance. Genome-wide association studies have additionally identified 29 common susceptibility alleles for OC, including 14 subtype-specific alleles. Several reproductive and hormonal factors may lower risk, including parity, oral contraceptive use, and lactation, while others such as older age at menopause and hormone replacement therapy confer increased risks. These associations differ by histotype, especially for mucinous OC, likely reflecting differences in etiology. Endometrioid and clear cell OC share a similar, unique pattern of associations with increased risks among women with endometriosis and decreased risks associated with tubal ligation. OC risks associated with other gynecological conditions and procedures, such as hysterectomy, pelvic inflammatory disease, and polycystic ovarian syndrome, are less clear. Other possible risk factors include environmental and lifestyle factors such as asbestos and talc powder exposures, and cigarette smoking. The epidemiology provides clues on etiology, primary prevention, early detection, and possibly even therapeutic strategies.
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Affiliation(s)
- Brett M Reid
- Department of Cancer Epidemiology, Division of Population Sciences, Moffitt Cancer Center, Tampa 33612, FL, USA
| | - Jennifer B Permuth
- Department of Cancer Epidemiology, Division of Population Sciences, Moffitt Cancer Center, Tampa 33612, FL, USA
| | - Thomas A Sellers
- Department of Cancer Epidemiology, Division of Population Sciences, Moffitt Cancer Center, Tampa 33612, FL, USA
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Cannioto R, LaMonte MJ, Risch HA, Hong CC, Sucheston-Campbell LE, Eng KH, Brian Szender J, Chang-Claude J, Schmalfeldt B, Klapdor R, Gower E, Minlikeeva AN, Zirpoli GR, Bandera EV, Berchuck A, Cramer D, Doherty JA, Edwards RP, Fridley BL, Goode EL, Goodman MT, Hogdall E, Hosono S, Jensen A, Jordan S, Kjaer SK, Matsuo K, Ness RB, Olsen CM, Olson SH, Leigh Pearce C, Pike MC, Anne Rossing M, Szamreta EA, Thompson PJ, Tseng CC, Vierkant RA, Webb PM, Wentzensen N, Wicklund KG, Winham SJ, Wu AH, Modugno F, Schildkraut JM, Terry KL, Kelemen LE, Moysich KB. Chronic Recreational Physical Inactivity and Epithelial Ovarian Cancer Risk: Evidence from the Ovarian Cancer Association Consortium. Cancer Epidemiol Biomarkers Prev 2016; 25:1114-24. [PMID: 27197285 PMCID: PMC4930728 DOI: 10.1158/1055-9965.epi-15-1330] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 04/12/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Despite a large body of literature evaluating the association between recreational physical activity and epithelial ovarian cancer (EOC) risk, the extant evidence is inconclusive, and little is known about the independent association between recreational physical inactivity and EOC risk. We conducted a pooled analysis of nine studies from the Ovarian Cancer Association Consortium to investigate the association between chronic recreational physical inactivity and EOC risk. METHODS In accordance with the 2008 Physical Activity Guidelines for Americans, women reporting no regular, weekly recreational physical activity were classified as inactive. Multivariable logistic regression was utilized to estimate the ORs and 95% confidence intervals (CI) for the association between inactivity and EOC risk overall and by subgroups based upon histotype, menopausal status, race, and body mass index. RESULTS The current analysis included data from 8,309 EOC patients and 12,612 controls. We observed a significant positive association between inactivity and EOC risk (OR = 1.34; 95% CI, 1.14-1.57), and similar associations were observed for each histotype. CONCLUSIONS In this large pooled analysis examining the association between recreational physical inactivity and EOC risk, we observed consistent evidence of an association between chronic inactivity and all EOC histotypes. IMPACT These data add to the growing body of evidence suggesting that inactivity is an independent risk factor for cancer. If the apparent association between inactivity and EOC risk is substantiated, additional work via targeted interventions should be pursued to characterize the dose of activity required to mitigate the risk of this highly fatal disease. Cancer Epidemiol Biomarkers Prev; 25(7); 1114-24. ©2016 AACR.
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Affiliation(s)
- Rikki Cannioto
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, New York
| | - Michael J LaMonte
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York
| | - Harvey A Risch
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Chi-Chen Hong
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, New York
| | | | - Kevin H Eng
- Department of Biostatistics & Bioinformatics, Roswell Park Cancer Institute, Buffalo, New York
| | - J Brian Szender
- Department of Gynecologic Oncology, Roswell Park Cancer Institute, Buffalo, New York
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany. University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Barbara Schmalfeldt
- Department of Gynecology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Ruediger Klapdor
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Emily Gower
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, New York. Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York
| | - Albina N Minlikeeva
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, New York. Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York
| | - Gary R Zirpoli
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, New York
| | - Elisa V Bandera
- Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Andrew Berchuck
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| | - Daniel Cramer
- Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jennifer A Doherty
- Department of Epidemiology, The Geisel School of Medicine at Dartmouth Medical, Hanover, New Hampshire
| | - Robert P Edwards
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Ovarian Cancer Center of Excellence, Women's Cancer Research Program, Magee-Women's Research Institute and University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Brooke L Fridley
- Biostatistics and Informatics Shared Resource, University of Kansas Medical Center, Kansas City, Kansas
| | - Ellen L Goode
- Department of Health Science Research, Division of Epidemiology, Mayo Clinic, Rochester, Minnesota
| | - Marc T Goodman
- Cancer Prevention and Control, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Estrid Hogdall
- Department of Virus, Lifestyle, and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark. Molecular Unit, Department of Pathology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Satoyo Hosono
- Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan
| | - Allan Jensen
- Department of Virus, Lifestyle, and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susan Jordan
- Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia. Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Susanne K Kjaer
- Department of Virus, Lifestyle, and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark. Department of Gynaecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Keitaro Matsuo
- Division of Molecular Medicine, Aichi Cancer Center Research Institute, Nagoya, Aichi, Japan
| | - Roberta B Ness
- The University of Texas School of Public Health, Houston, Texas
| | - Catherine M Olsen
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Sara H Olson
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Malcolm C Pike
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mary Anne Rossing
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Elizabeth A Szamreta
- Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Pamela J Thompson
- Cancer Prevention and Control, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Chiu-Chen Tseng
- Department of Preventive Medicine, Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Robert A Vierkant
- Department of Health Science Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Penelope M Webb
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | | | - Kristine G Wicklund
- Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Stacey J Winham
- Department of Health Science Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Anna H Wu
- Department of Preventive Medicine, Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California
| | - Francesmary Modugno
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Ovarian Cancer Center of Excellence, Women's Cancer Research Program, Magee-Women's Research Institute and University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania. Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Joellen M Schildkraut
- Department of Public Health Sciences, The University of Virginia, Charlottesville, Virginia
| | - Kathryn L Terry
- Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Linda E Kelemen
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Kirsten B Moysich
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, New York.
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Henson J, Dunstan DW, Davies MJ, Yates T. Sedentary behaviour as a new behavioural target in the prevention and treatment of type 2 diabetes. Diabetes Metab Res Rev 2016; 32 Suppl 1:213-20. [PMID: 26813615 DOI: 10.1002/dmrr.2759] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 07/28/2015] [Accepted: 07/28/2015] [Indexed: 11/09/2022]
Abstract
Our modern day society encompasses an ecological niche in which sedentary behaviour, labour-saving devices and energy dense foods have become the new reference of living. We now spend more time sedentary, defined as sitting, than in all other activities combined. It has recently been confirmed that the consequences of our modern chair dependency are substantial and a direct contributing factor to the ever increasing epidemic of chronic diseases witnessed within industrialized environments. Epidemiological evidence--from both cross-sectional and prospective observational studies--has indicated that the time spent in sedentary behaviour is a distinct risk factor for several health outcomes, including type 2 diabetes mellitus, insulin resistance, all-cause and cardiovascular disease mortality, depression and some types of cancer. Importantly, these detrimental associations remain even after accounting for time spent in moderate-to-vigorous physical activity, with the strongest and most persistent associations seen between sedentary time and type 2 diabetes mellitus. Importantly, experimental studies have started to confirm the observational associations, with mounting evidence showing that breaking prolonged sitting time with light ambulation is an effective strategy for improving postprandial glucose regulation. Indeed, there is even emerging evidence showing that simply substituting sitting for standing regularly throughout the day may be of sufficient stimulus to improve glucose regulation. We highlight some of the key definitions, issues and evidence underpinning the link between sedentary behaviour and chronic disease in order to better inform clinicians and patients about the importance of incorporating reduced sitting time into type 2 diabetes mellitus management and prevention pathways.
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Affiliation(s)
- Joseph Henson
- NIHR Leicester - Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - David W Dunstan
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Mary MacKillop Institute of Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Melanie J Davies
- NIHR Leicester - Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Thomas Yates
- NIHR Leicester - Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
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Obesity Education Strategies for Cancer Prevention in Women's Health. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2015; 4:249-258. [PMID: 26877893 DOI: 10.1007/s13669-015-0129-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Obesity is the cause of up to one-third of all cancers affecting women today, most notably endometrial, colon and breast cancer. Women's health providers are poised to advise women on obesity's link to cancer development, but often lack resources or training to provide appropriate counseling. Here, we review obesity's role in increasing the risk of several common reproductive system conditions faced by women, including polycystic ovarian syndrome, infertility, gynecologic surgical complications, and pregnancy complications. These events can be used as teachable moments to help frame the discussion of weight management and promote cancer prevention. We also review national guidelines and existing tangible weight-loss strategies that can be employed within the outpatient women's health setting to help women achieve weight loss goals and affect cancer prevention.
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