Imbalanced Nutrient Intake in Cancer Survivors from the Examination from the Nationwide Health Examination Center-Based Cohort

Factors Associated with Dietary Habit Changes in Korean Stomach Cancer Survivors after Cancer Treatment

The current nutritional guidelines for stomach cancer survivors (SCSs) mainly focus on the influence of the surgical resection of the stomach, with limited guidance regarding a wider range of food options. We aimed to investigate the factors associated with healthier dietary changes in Korean adult SCSs. This cross-sectional study assessed dietary pattern changes after cancer treatment for 11 food categories, using a self-administered questionnaire. A 'healthier dietary change' was operationally defined as a reduced consumption of red and processed meat, grains, salt, and burnt food, and an increased consumption of poultry, fish, vegetables, fruits, legumes, and dairy products. Among a total of 624 SCSs, approximately 60% of participants reported dietary changes in a healthier direction in three or more food categories, while 9.1% reported no changes. There was no significant difference in dietary habit changes between surgery types. Multivariable adjusted analysis showed that elderly and long-term survivors were inversely associated with a healthier dietary change. SCSs with a higher level of educational achievement and income were more likely to make healthier changes in their intake of processed meat, vegetables, fruits, burnt food, or salt. SCSs with higher levels of fear of cancer recurrence, anxiety, or depression were more likely to follow healthier dietary changes regarding fish, meat, fruits, grains, or burnt food. Change in dietary pattern varied across different food items, and was associated with various characteristics of SCSs. It is crucial to repeatedly provide SCSs with information about healthier dietary patterns, considering their sociodemographic, clinical, and psychological characteristics.

Association between dietary intake networks identified through a Gaussian graphical model and the risk of cancer: a prospective cohort study

PURPOSE

In this study, we aimed to investigate the association between dietary communities identified by a Gaussian graphical model (GGM) and cancer risk.

METHODS

We performed GGM to identify the dietary communities in a Korean population. GGM-derived communities were then scored and investigated for their association with cancer incidence in the entire population as well as in the 1:1 age- and sex-matched subgroup using a Cox proportional hazards model. In the sensitivity analysis, GGM-derived communities were compared to dietary patterns (DPs) that were identified by principal component analysis (PCA) and reduced rank regression (RRR).

RESULTS

During a median time to follow-up of 6.6 years, 397 cancer cases were newly diagnosed. The GGM identified 17 and 16 dietary communities for the total and matched populations, respectively. For each one-unit increase in the standard deviation of the community-specific score of the community that was composed of dairy products and bread, there was a reduced risk of cancer according to the fully adjusted model (HR: 0.80, 95% CI: 0.66-0.96). In the matched population, the third tertile of the community-specific score of the community composed of poultry, seafood, bread, cakes and sweets, and meat by-products showed a significantly reduced risk of cancer compared to that of the lowest tertile in the fully adjusted model (HR: 0.66, 95% CI: 0.50-0.86, p-trend = 0.002).

CONCLUSION

We found that the GGM-identified community composed of dairy products and bread showed a reduced risk of cancer. Further population-based prospective studies should be conducted to examine possible associations of dietary intake and specific cancer types.

Association between Micronutrient Intake and Breast Cancer Risk According to Body Mass Index in South Korean Adult Women: A Cohort Study

This study investigated the association between micronutrient intake and breast cancer risk in South Korean adult women. This association was stratified according to body mass index (BMI) categories. Data from the Korean Genome and Epidemiology Study (KoGES) and the Health Examinee Study were analyzed. Altogether, 63,337 individuals (aged ≥40 years) completed the baseline and first follow-up surveys; 40,432 women without a history of cancer at baseline were included in this study. The association between micronutrient intake and breast cancer was determined by estimating the hazard ratio (HR) and 95% confidence interval (CI) using the Cox proportional hazard regression model. A stratified analysis by BMI (<25 kg/m2 and ≥25 kg/m2) was performed. The an analysis of 15 micronutrients and breast cancer risk revealed that none of the micronutrients were associated with breast cancer risk after adjusting for covariates. In obese women, the risk of breast cancer was significantly reduced in the group that consumed vitamin C more than the recommended level (HR = 0.54, 95% CI: 0.31−0.93) and vitamin B6 levels above the recommended level (HR = 0.48, 95% CI: 0.25−0.89). In obese women, exceeding the recommended daily intake levels of vitamin C and vitamin B6 was associated with a lower risk of breast cancer. However, other micronutrients were not associated with breast cancer risk in these women.

Diet/Nutrition: Ready to Transition from a Cancer Recurrence/Prevention Strategy to a Chronic Pain Management Modality for Cancer Survivors?

Evidence for the relationship between chronic pain and nutrition is mounting, and chronic pain following cancer is gaining recognition as a significant area for improving health care in the cancer survivorship population. This review explains why nutrition should be considered to be an important component in chronic pain management in cancer survivors by exploring relevant evidence from the literature and how to translate this knowledge into clinical practice. This review was built on relevant evidence from both human and pre-clinical studies identified in PubMed, Web of Science and Embase databases. Given the relationship between chronic pain, inflammation, and metabolism found in the literature, it is advised to look for a strategic dietary intervention in cancer survivors. Dietary interventions may result in weight loss, a healthy body weight, good diet quality, systemic inflammation, and immune system regulations, and a healthy gut microbiota environment, all of which may alter the pain-related pathways and mechanisms. In addition to being a cancer recurrence or prevention strategy, nutrition may become a chronic pain management modality for cancer survivors. Although additional research is needed before implementing nutrition as an evidence-based management modality for chronic pain in cancer survivors, it is already critical to counsel and inform this patient population about the importance of a healthy diet based on the data available so far.

Factors Associated with Health Behaviors in Thyroid Cancer Survivors

In this study, we compared health behaviors, including current smoking, drinking, and physical inactivity, in thyroid cancer survivors and non-cancer controls and investigated the factors associated with unhealthy behaviors among survivors. Baseline data from the Health Examinees study, collected from 2004 to 2013, were used. Thyroid cancer survivors (n = 942), defined as those who had received a clinical diagnosis of thyroid cancer, and 9,420 matched non-cancer controls without past history of any cancer were included in the analysis. The prevalence of smoking, alcohol consumption, and physical inactivity in thyroid cancer survivors were 2.3%, 26.6%, and 52.0%, respectively, with adjusted OR (aOR) and 95% CI between survivors and non-cancer controls of 0.35 (95% CI = 0.08-1.56), 0.46 (95% CI = 0.29-0.74), and 0.65 (95% CI = 0.44-0.96). The prevalence of unhealthy behaviors was higher among male thyroid cancer survivors than female thyroid cancer survivors. In thyroid cancer survivors, those who smoked were more likely to drink (aOR = 4.55 [95% CI = 1.61-12.85]) and those who were physically inactive were less likely to drink (aOR = 0.58 [95% CI = 0.42-0.82]). Current drinking and physical inactivity contributed to a higher likelihood of smoking (aOR = 4.31 [95% CI = 1.35-13.73] and 6.34 [95% CI = 1.65-24.34]). Thyroid cancer survivors had better health behaviors than the non-cancer controls. However, some survivors still had unhealthy lifestyles, especially displaying a clustering of unhealthy behaviors. Thus, health behavior promotion through medical intervention is important for thyroid cancer survivors.

Assessment of Diet Quality and Adherence to Dietary Guidelines in Gastrointestinal Cancer Survivors: A Cross-Sectional Study

Diet quality among short- and long-term gastrointestinal (GI) cancer survivors with different tumor sites was investigated compared to a reference population cohort. Diet quality of GI cancer survivors (n = 307) was compared to an age- and sex-matched reference population with no history of cancer (n = 3070). All were selected from Lifelines, a population-based cohort. GI cancers were defined as having a history of cancer of the bowel, esophagus, or stomach. Diet quality was assessed by a self-administrated food frequency questionnaire in terms of: (i) Lifelines Diet (LLD) scores, where higher scores indicate higher diet quality; (ii) the adherence to dietary guidelines, quantified by the percentage of meeting dietary recommendations, as given by Dutch dietary guidelines; and (iii) the mean daily intake of food components. All analyses were adjusted for lifestyle factors. Diet scores in GI cancer survivors were not different from the reference population (OR = 0.97, 95% CI: 0.73–1.23). Stratification for time since diagnosis and tumor site gave similar results. The intake of vegetables, unsweetened dairies, and nuts and legumes was almost 50% lower than the recommended amount, and the mean intake of unhealthy food components was at least one serving/day among GI cancer survivors, as well as in the reference population. In the long run, GI cancer survivors do not differ from the reference population in their diet quality. In conclusion, both groups can improve their diet quality.

Anti-inflammatory effect from extracts of Red Chinese cabbage and Aronia in LPS-stimulated RAW 264.7 cells

A chronic inflammatory environment facilitates tumor growth and proliferation. Fruits and vegetables are important sources of anthocyanins, polyphenols, and other biologically active substances that can favorably affect the pathogenesis of cancer. The objective of the study was to investigate the anti-inflammatory effects of Red Chinese cabbage (RC) and mixture of commercial Red Chinese cabbage leaves and Aronia fruits (ARC) in LPS-stimulated RAW 264.7 cells. The RAW 264.7 cells were cultured and measured the cytotoxicity by using an MTT assay. The inflammatory markers, such as nitrite, IL-6, and TNF-alpha expression, were evaluated using ELISA, and protein expression of inflammatory markers like iNOS and COX-2 was analyzed using Western blot. MTT assays showed that pretreatment of RAW 264.7 cells with RC and ARC did not change cell growth or cytotoxicity. We also found that ARC extracts reduced inflammation-related biomarker (TNF-a, IL-6, and NO) production and gene expression (iNOS, COX-2). Our results suggested that ARC has good anti-inflammatory properties compared with RC that maybe used as potential nutrients for treating inflammatory diseases.

Visceral Adiposity Index in Breast Cancer Survivors: A Case-Control Study

BACKGROUND

Breast cancer (BC) is the first cause of cancer morbidity and mortality in women. This disease has been linked to obesity; however, it is not clear how fat accumulation affects women who survive breast cancer. Although the visceral adiposity index (VAI) is a marker of cardiometabolic risk and adipose tissue dysfunction, it is not clear how it changes in breast cancer survivors. The aim of this investigation was to compare VAI in women with and without breast cancer.

METHODS

A case-control cross-sectional study was conducted on women who were BC survivors and women without the history of BC (control group). Body composition was assessed using electrical bioimpedance while VAI by means of waist circumference (WC), body mass index (BMI), triacylglycerols (TG), and high-density lipoprotein cholesterol (HDL-C).

RESULTS

49 women in the BC survivor group and 50 in the control group. WC was wider in the survivor group as regards control (93.65 ± 10.48 vs. 88.52 ± 9.61 cm) (p=0.025); at once, TG and VAI were significantly higher for the survivor group (243.55 ± 199.84 vs. 159.84 ± 75.77) (p=0.007) and (11.03 ± 11.15 vs. 6.41 ± 3.66) (p < 0.005), respectively. Body composition parameters were similar in both groups.

CONCLUSIONS

VAI is higher in women who are BC survivors in comparison with controls matched by age and bodyweight.

Food Intake Behavior in Cancer Survivors in Comparison With Healthy General Population; From the Health Examination Center-based Cohort

Background

This study aimed to investigate the food intake behavior of cancer survivors based on main sources of energy intake from different food groups in comparison with healthy individuals.

Methods

Baseline survey data from the Health Examinee cohort, which recruited participants from 2014 to 2013 were applied. A total of 5,269 cancer survivors and 5,219 healthy subjects without comorbidities who were matched by age, sex, and enrollment center were included in the analysis. The proportion of energy intake for 17 food groups was devided into lower median and median or upper. OR and 95% CIs were determined to measure the difference of energy intake proportion in cancer survivors, five major types of cancer survivors versus healthy individuals.

Results

Generally, the proportion of calories intake from sugars and sweets, meat and poultry, oils and fats, and beverage was lower in cancer survivors than in healthy individuals (OR = 0.83 [95% CI = 0.79–0.88], 0.75 [95% CI = 0.71–0.80], 0.84 [95% CI = 0.80–0.89], and 0.93 [95% CI = 0.88–0.99], respectively) with more prominently shown in breast, colon, and thyroid cancer individuals. In contrast, cancer survivors tended to intake calories from potatoes and starches, legume, seeds and nuts, vegetables, mushrooms, fruits, and seasonings more than healthy individuals (OR = 1.09 [95% CI = 1.03–1.16], 1.13 [95% CI = 1.06–1.19], 1.15 [95% CI = 1.09–1.22], 1.07 [95% CI = 1.01–1.13], 1.07 [95% CI = 1.02–1.14], 1.15 [95% CI = 1.08–1.21], and 1.17 [95% CI = 1.10–1.23], respectively) which were more prominent in gastric and breast cancer survivors.

Conclusions

The dietary behavior measured by main sources of energy intake in cancer survivors was different from healthy individuals in terms of several food groups. Although there are nutrition guidelines for cancer survivors, because of the differences between Western population and Asian people in terms of food culture, the guidelines for balanced nutritious behavior should be established among Asian cancer survivors.