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Wang X, Peng Y, Liu F, Wang P, Si C, Gong J, Zhou H, Zhang M, Song F. Joint association of biological aging and lifestyle with risks of cancer incidence and mortality: A cohort study in the UK Biobank. Prev Med 2024; 182:107928. [PMID: 38471624 DOI: 10.1016/j.ypmed.2024.107928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Aging is a risk factor for cancer incidence and mortality. Biological aging can reflect the aging degree of the body better than chronological age and can be aggravated by unhealthy lifestyle factors. We aimed to assess the joint effect of biological aging and lifestyle with risks of cancer incidence and mortality. METHODS This study included a total of 281,889 participants aged 37 to 73 from the UK Biobank database. Biological age was derived from chronological age and 9 clinical blood indicators, and lifestyle score was constructed by body mass index, smoking status, alcohol consumption, physical activity, and diet. Multivariate Cox hazard proportional regression model was used to analyze the independent and joint association of biological aging and lifestyle with risks of cancer incidence and mortality, respectively. RESULTS Over a median follow-up period of 12.3 years, we found that older biological age was associated with increased risks of overall cancer, digestive system cancers, lung, breast and renal cancers incidence and mortality (HRs: 1.12-2.25). In the joint analysis of biological aging and lifestyle with risks of cancer incidence and mortality, compared with unhealthy lifestyle and younger biological age, individuals with healthy lifestyle and older biological age had decreased risks of incidence (8% ∼ 60%) and mortality (20% ∼ 63%) for overall, esophageal, colorectal, pancreatic and lung cancers. CONCLUSIONS Biological aging may be an important risk factor for cancer morbidity and mortality. A healthier lifestyle is more likely to mitigate the adverse effects of biological aging on overall cancer and some site-specific cancers.
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Affiliation(s)
- Xixuan Wang
- Department of Epidemiology and Biostatistics, Key Laboratory of Molecular Cancer Epidemiology, Key Laboratory of Prevention and Control of Major Diseases in the Population, Ministry of Education, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin 300060, China
| | - Yu Peng
- Department of Epidemiology and Biostatistics, Key Laboratory of Molecular Cancer Epidemiology, Key Laboratory of Prevention and Control of Major Diseases in the Population, Ministry of Education, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin 300060, China
| | - Fubin Liu
- Department of Epidemiology and Biostatistics, Key Laboratory of Molecular Cancer Epidemiology, Key Laboratory of Prevention and Control of Major Diseases in the Population, Ministry of Education, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin 300060, China
| | - Peng Wang
- Department of Epidemiology and Biostatistics, Key Laboratory of Molecular Cancer Epidemiology, Key Laboratory of Prevention and Control of Major Diseases in the Population, Ministry of Education, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin 300060, China
| | - Changyu Si
- Department of Epidemiology and Biostatistics, Key Laboratory of Molecular Cancer Epidemiology, Key Laboratory of Prevention and Control of Major Diseases in the Population, Ministry of Education, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin 300060, China
| | - Jianxiao Gong
- Department of Epidemiology and Biostatistics, Key Laboratory of Molecular Cancer Epidemiology, Key Laboratory of Prevention and Control of Major Diseases in the Population, Ministry of Education, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin 300060, China
| | - Huijun Zhou
- Department of Epidemiology and Biostatistics, Key Laboratory of Molecular Cancer Epidemiology, Key Laboratory of Prevention and Control of Major Diseases in the Population, Ministry of Education, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin 300060, China
| | - Ming Zhang
- Comprehensive Management Department of Occupational Health, Shenzhen Prevention and Treatment Center for Occupational Diseases, Shenzhen 518020, China
| | - Fangfang Song
- Department of Epidemiology and Biostatistics, Key Laboratory of Molecular Cancer Epidemiology, Key Laboratory of Prevention and Control of Major Diseases in the Population, Ministry of Education, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Medical University, Tianjin 300060, China.
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Al-Fayez S, El-Metwally A. Cigarette smoking and prostate cancer: A systematic review and meta-analysis of prospective cohort studies. Tob Induc Dis 2023; 21:19. [PMID: 36762260 PMCID: PMC9900478 DOI: 10.18332/tid/157231] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 12/07/2022] [Accepted: 12/10/2022] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Cigarette smoking is a well-known cancer-causing behavior and a leading cause of death from cancer. However, according to previously published research and meta-analyses, cigarette smoking has a significant inverse association with prostate cancer incidence. Therefore, this study aims to investigate this association based on updated evidence by conducting a systematic review and meta-analysis. METHODS A search for relevant articles was performed in PubMed and Scopus databases to obtain the pooled relative risk (RR) and the corresponding 95% confidence intervals (CIs) for the risk of prostate cancer incidence among smokers compared to non-smokers. Our search was limited to prospective cohort studies. RESULTS A total of 17 cohort studies were included in the systematic review. Fifteen studies were included in the meta-analysis and showed that cigarette smoking has an inverse association with prostate cancer incidence with a relative risk of 0.84 (95% CI: 0.78-0.91). From all cohorts included in this systematic review, five studies examined the association between current smokers and the risk of death from prostate cancer. Therefore, a meta-analysis of these cohort studies was performed and showed that current smokers had a 42% higher risk of death from prostate cancer when compared to non-smokers with a relative risk of 1.42 (95% CI: 1.20-1.68). CONCLUSIONS Data from observational studies suggest that cigarette smoking has an inverse association with prostate cancer incidence. However, smokers have an increased risk of death from prostate cancer. Important to realize that this lower risk for smokers might be attributed to low prostate cancer screening uptake among smokers, misclassification bias, or selection bias from the included original studies. In summary, our results indicate that the incidence of prostate cancer is lower among smokers. Nevertheless, smokers who develop the disease have a significantly worse prognosis.
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Affiliation(s)
- Sarah Al-Fayez
- College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ashraf El-Metwally
- College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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Öner N, Borlu A, Seyfeli MYA, Tekin T. Turkish validity and reliability of the lifestyle questionnaire related to cancer. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:330-334. [PMID: 36888773 PMCID: PMC9983471 DOI: 10.1590/1806-9282.20221292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/21/2022] [Indexed: 03/08/2023]
Abstract
OBJECTIVE The aim of this study was to adapt the lifestyle questionnaire related to cancer in Turkish and investigate its validity and reliability. METHODS This methodological study was conducted on 1,196 participants. Cronbach's α was used to assess validity and reliability. The internal consistency was evaluated using item-total correlation. RESULTS The normed chi-square in this study was 5.87. The root mean square error of approximation was calculated as 0.051. The comparative fit index and the Tucker-Lewis Index were 0.83 and 0.81, respectively. The split-half method was used to test the reliability of the scale (Part 1 Cronbach's α: 0.826, Part 2 Cronbach's α: 0.812, and Adjusted Cronbach's α: 0.881). CONCLUSION The Turkish version of lifestyle questionnaire related to cancer (8 subscales, 41 items) is a reliable and valid measure to evaluate lifestyle behaviors related to cancer in adults.
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Affiliation(s)
- Neslihan Öner
- Erciyes University, Faculty of Health Sciences, Department of Nutrition and Dietetics - Kayseri, Turkey
| | - Arda Borlu
- Erciyes University, Faculty of Medicine, Department of Public Health -Kayseri, Turkey
| | | | - Tuba Tekin
- Sivas Cumhuriyet University, Faculty of Health Sciences, Department of Nutrition and Dietetics - Sivas, Turkey
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Fruit and vegetable consumption and incident breast cancer: a systematic review and meta-analysis of prospective studies. Br J Cancer 2021; 125:284-298. [PMID: 34006925 PMCID: PMC8292326 DOI: 10.1038/s41416-021-01373-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 02/22/2021] [Accepted: 03/16/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We conducted a systematic review and meta-analysis of prospective studies to clarify the relation of fruit and vegetable consumption with incident breast cancer. METHODS We searched systematically PubMed and EMBASE databases up to November 2020 to include prospective studies that reported the association of fruit and vegetable consumption with incident breast cancer. The pooled relative risks (RRs) and 95% confidence intervals (CIs) were calculated for the highest versus the lowest category of total fruit and vegetable, total fruit and total vegetable consumption, as well as fruit juice and subgroups of vegetables in relation to breast cancer incidence, using a random-effect model. RESULTS Total fruit and vegetable consumption was associated with lower overall (RR = 0.91, 95% CI = 0.87-0.95) and postmenopausal breast cancer risk (RR = 0.88, 95% CI = 0.79-0.99). Total fruit consumption was associated with lower overall (RR = 0.93, 95% CI = 0.88-0.99) and postmenopausal breast cancer risk (RR = 0.93, 95% CI = 0.87-0.99). Total fruit and vegetable intake were associated with 11% and 26% lower risk of oestrogen- and progesterone-receptor-positive (ER+/PR+) and -negative (ER-/PR-) breast cancer, respectively. Total vegetable consumption was associated with 27% lower risk of ER-/PR- breast cancer. Fruit juice consumption was associated with increased overall breast cancer risk (RR = 1.04, 95% CI = 1.01-1.07). We did not find significant associations for subgroups of vegetable intake and breast cancer risk. CONCLUSIONS These findings suggest that high total fruit and vegetable consumption are associated with reduced risk of overall, postmenopausal, ER+/PR+ and ER-/PR- breast cancer.
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Shih YW, O'Brien AP, Hung CS, Chen KH, Hou WH, Tsai HT. Exposure to radiofrequency radiation increases the risk of breast cancer: A systematic review and meta-analysis. Exp Ther Med 2020; 21:23. [PMID: 33262809 PMCID: PMC7690245 DOI: 10.3892/etm.2020.9455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 07/17/2020] [Indexed: 12/23/2022] Open
Abstract
The present systematic review and meta-analysis investigated the association between exposure to radiofrequency radiation and the risk of breast cancer. The published studies that were available in PubMed, Embase, Cochrane Library, Ovid MEDLINE, CINAHL Plus, Web of Science, Airiti Library, Networked Digital Library of Theses and Dissertations and ProQuest until May 2020 were investigated. A total of eight studies (four case-control and four cohort studies) were eligible for quantitative analysis. A significant association between radiofrequency radiation exposure and breast cancer risk was detected [pooled relative risk (RR)=1.189; 95% confidence interval (CI), 1.056-1.339]. Subgroup analyses indicated that radiofrequency radiation exposure significantly increased the risk of breast cancer susceptibility among subjects aged ≥50 years (RR=2.179; 95% CI, 1.260-3.770). Pooled estimates revealed that the use of electrical appliances, which emit radiofrequency radiation, such as mobile phones and computers, significantly increased breast cancer development (RR=2.057; 95% CI, 1.272-3.327), while occupational radiofrequency exposure and transmitters did not increase breast cancer development (RR=1.274; 95% CI, 0.956-1.697; RR=1.133; 95% CI, 0.987-1.300, respectively). It was concluded that radiofrequency radiation exposure significantly increased the risk of breast cancer, especially in women aged ≥50 years and in individuals who used electric appliances, such as mobile phones and computers. In accordance with Preferred Reporting Items for Systematic Reviews and Meta-analysis, an evaluation protocol was prepared and registered with the PROSPERO database (registration no. CRD42018087283).
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Affiliation(s)
- Ya-Wen Shih
- School of Nursing, College of Nursing, Taipei Medical University, Taipei 11031, Taiwan R.O.C
| | - Anthony Paul O'Brien
- Faculty of Health and Medicine, School of Nursing and Midwifery, The University of Newcastle, Callaghan, New South Wales 2308, Australia
| | - Chin-Sheng Hung
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, New Taipei City, Taipei 11031, Taiwan R.O.C.,Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taipei 11031, Taiwan R.O.C
| | - Kee-Hsin Chen
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei 11031, Taiwan R.O.C.,Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei 11031, Taiwan R.O.C.,Evidence-based Knowledge Translation Center, Wan Fang Hospital, Taipei Medical University, Taipei 11031, Taiwan R.O.C.,Cochrane Taiwan, Taipei 11031, Taiwan R.O.C
| | - Wen-Hsuan Hou
- Cochrane Taiwan, Taipei 11031, Taiwan R.O.C.,Department of Physical Medicine and Rehabilitation/Center of Evidence-Based Medicine in Department of Education, Taipei Medical University Hospital, Taipei 11031, Taiwan R.O.C.,Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei 11031, Taiwan R.O.C.,Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan R.O.C
| | - Hsiu-Ting Tsai
- School of Nursing, College of Nursing, Taipei Medical University, Taipei 11031, Taiwan R.O.C.,Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei 11031, Taiwan R.O.C
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Murray JM, Coleman HG, Hunter RF. Physical activity and cancer risk: Findings from the UK Biobank, a large prospective cohort study. Cancer Epidemiol 2020; 68:101780. [DOI: 10.1016/j.canep.2020.101780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 06/29/2020] [Accepted: 07/02/2020] [Indexed: 12/18/2022]
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Al Ajmi K, Lophatananon A, Mekli K, Ollier W, Muir KR. Association of Nongenetic Factors With Breast Cancer Risk in Genetically Predisposed Groups of Women in the UK Biobank Cohort. JAMA Netw Open 2020; 3:e203760. [PMID: 32329772 PMCID: PMC7182796 DOI: 10.1001/jamanetworkopen.2020.3760] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE The association between noninherited factors, including lifestyle factors, and the risk of breast cancer (BC) in women and the association between BC and genetic makeup are only partly characterized. A study using data on current genetic stratification may help in the characterization. OBJECTIVE To examine the association between healthier lifestyle habits and BC risk in genetically predisposed groups. DESIGN, SETTING, AND PARTICIPANTS Data from UK Biobank, a prospective cohort comprising 2728 patients with BC and 88 489 women without BC, were analyzed. The data set used for the analysis was closed on March 31, 2019. The analysis was restricted to postmenopausal white women. Classification of healthy lifestyle was based on Cancer Research UK guidance (healthy weight, regular exercise, no use of hormone replacement therapy for more than 5 years, no oral contraceptive use, and alcohol intake <3 times/wk). Three groups were established: favorable (≥4 healthy factors), intermediate (2-3 healthy factors), and unfavorable (≤1 healthy factor). The genetic contribution was estimated using the polygenic risk scores of 305 preselected single-nucleotide variations. Polygenic risk scores were categorized into 3 tertiles (low, intermediate, and high). MAIN OUTCOMES AND MEASURES Cox proportional hazards regression was used to assess the hazard ratios (HRs) of the lifestyles and polygenic risk scores associated with a malignant neoplasm of the breast. RESULTS Mean (SD) age of the 2728 women with BC was 60.1 (5.5) years, and mean age of the 88 489 women serving as controls was 59.4 (4.9) years. The median follow-up time for the cohort was 10 years (maximum 13 years) (interquartile range, 9.44-10.82 years). Women with BC had a higher body mass index (relative risk [RR], 1.14; 95% CI, 1.05-1.23), performed less exercise (RR, 1.12; 95% CI, 1.01-1.25), used hormonal replacement therapy for longer than 5 years (RR, 1.23; 95% CI, 1.13-1.34), used more oral contraceptives (RR, 1.02; 95% CI, 0.93-1.12), and had greater alcohol intake (RR, 1.11; 95% CI, 1.03-1.19) compared with the controls. Overall, 20 657 women (23.3%) followed a favorable lifestyle, 60 195 women (68.0%) followed an intermediate lifestyle, and 7637 women (8.6%) followed an unfavorable lifestyle. The RR of the highest genetic risk group was 2.55 (95% CI, 2.28-2.84), and the RR of the most unfavorable lifestyle category was 1.44 (95% CI, 1.25-1.65). The association of lifestyle and BC within genetic subgroups showed lower HRs among women following a favorable lifestyle compared with intermediate and unfavorable lifestyles among all of the genetic groups: women with an unfavorable lifestyle had a higher risk of BC in the low genetic group (HR, 1.63; 95% CI, 1.13-2.34), intermediate genetic group (HR, 1.94; 95% CI, 1.46-2.58), and high genetic group (HR, 1.39; 95% CI, 1.11-1.74) compared with the reference group of favorable lifestyle. Intermediate lifestyle was also associated with a higher risk of BC among the low genetic group (HR, 1.40; 95% CI, 1.09-1.80) and the intermediate genetic group (HR, 1.37; 95% CI, 1.12-1.68). CONCLUSIONS AND RELEVANCE In this cohort study of data on women in the UK Biobank, a healthier lifestyle with more exercise, healthy weight, low alcohol intake, no oral contraceptive use, and no or limited hormonal replacement therapy use appeared to be associated with a reduced level of risk for BC, even if the women were at higher genetic risk for BC.
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Affiliation(s)
- Kawthar Al Ajmi
- Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, Centre for Epidemiology, University of Manchester, Manchester, United Kingdom
| | - Artitaya Lophatananon
- Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, Centre for Epidemiology, University of Manchester, Manchester, United Kingdom
| | - Krisztina Mekli
- Cathie Marsh Institute for Social Research, School of Social Sciences, Faculty of Humanities, University of Manchester, Manchester, United Kingdom
| | - William Ollier
- Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, Centre for Epidemiology, University of Manchester, Manchester, United Kingdom
- School of Healthcare Science, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, United Kingdom
| | - Kenneth R Muir
- Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, Centre for Epidemiology, University of Manchester, Manchester, United Kingdom
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Impact of a Tailored Nutrition and Lifestyle Intervention for Overweight Cancer Survivors on Dietary Patterns, Physical Activity, Quality of Life, and Cardiometabolic Profiles. JOURNAL OF ONCOLOGY 2019; 2019:1503195. [PMID: 31871455 PMCID: PMC6906801 DOI: 10.1155/2019/1503195] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/09/2019] [Accepted: 10/05/2019] [Indexed: 02/06/2023]
Abstract
Survivors of cancer often experience treatment-related toxicity in addition to being at risk of cancer recurrence, second primary cancers, and greater all-cause mortality. The objective of this study was to test the safety and efficacy of an intensive evidence-based garden intervention to improve outcomes for cancer survivors after curative therapy. To do so, a clinical trial of adult overweight and obese cancer survivors within 2 years of completing curative therapy was completed. The 6-month intervention, delivered within the context of harvesting at an urban garden, combined group education with cooking demonstrations, remote motivational interviewing, and online digital resources. Data on dietary patterns, program satisfaction, and quality of life were collected via questionnaires; anthropometrics, physical activity, and clinical biomarkers were measured objectively. Of the 29 participants, 86% were white, 83% were female, and the mean age was 58 years. Compared to baseline, participants had significant improvements in Healthy Eating Index (HEI) scores (+5.2 points, p = 0.006), physical activity (+1,208 steps, p = 0.033), and quality of life (+16.07 points, p = 0.004). Significant improvements were also documented in weight (−3.9 kg), waist circumference (−5.5 cm), BMI (−1.5 kg/m2), systolic BP (−9.5 mmHg), plasma carotenoids (+35%), total cholesterol (−6%), triglycerides (−14%), hs-CRP (−28%), and IGFBP-3 (−5%) (all p < 0.010). These findings demonstrate a tailored multifaceted garden-based biobehavioral intervention for overweight and obese cancer survivors after curative therapy is safe and highly effective, warranting larger randomized controlled trials to identify program benefits, optimal maintenance strategies, program value relative to cost, and approaches for integration into a survivor's oncology management program. This trial is registered on ClinicalTrials.gov NCT02268188.
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Abstract
PURPOSE OF REVIEW Colorectal cancer (CRC) is one of the most common cancers and the fourth leading cause of cancer-related deaths worldwide. Diet has a significant impact on the risk of developing CRC, but though processed meat is a known positive contributor, the effects of other dietary components are largely mixed. This review focuses on dietary patterns to describe the complexity of dietary diversity and overall food consumption and to examine the relationship between dietary patterns and risk of CRC. RECENT FINDINGS After searching human studies published in 2017-2018, we selected and evaluated 30 articles, including meta-analyses, cohort studies, and prospective studies. These studies suggest that the prudent or Mediterranean dietary pattern significantly decreases the risk of CRC compared to the Western dietary pattern; a lower dietary inflammatory index or a higher dietary quality index associates with a lower risk of CRC; closely following all aspects of the World Cancer Research Fund/American Institute for Cancer Research cancer prevention guidelines and recommendations correlates with a reduced risk of CRC. SUMMARY The risk of developing CRC can be reduced by adopting a healthier lifestyle. More studies of the impact of diet on clinical outcomes of CRC are needed.
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