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Guerrieri-Gonzaga A, Serrano D, Gnagnarella P, Johansson H, Zovato S, Nardi M, Pensabene M, Buccolo S, DeCensi A, Briata IM, Pistelli L, Sansone C, Mannucci S, Aristarco V, Macis D, Lazzeroni M, Aurilio G, Accornero CA, Gandini S, Bonanni B. Low dose TamOxifen and LifestylE changes for bReast cANcer prevention (TOLERANT study): Study protocol of a randomized phase II biomarker trial in women at increased risk for breast cancer. PLoS One 2024; 19:e0309511. [PMID: 39226292 PMCID: PMC11371200 DOI: 10.1371/journal.pone.0309511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Accepted: 08/13/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND Breast Cancer (BC) prevention strategies range from lifestyle changes such as increasing physical activity and reducing body weight to preventive drugs like tamoxifen, known to reduce BC incidence in high-risk women. Sex Hormone Binding Globulin (SHBG) is related to BC risk due to its ability to bind circulating estradiol at high affinity and to regulate estradiol action. A study protocol is presented based on the assessment of the effect of different interventions such as tamoxifen at 10 mg every other day (LDT), intermittent caloric restriction (ICR) two days per week, lifestyle intervention (LI, step counter use) and their combination on the modulation of SHBG and several other biomarkers associated to BC. METHODS A randomized phase II biomarker study will be conducted in 4 Italian centers. Unaffected women aged between 18 and 70 years, carriers of a germline pathogenetic variant (BRCA1, BRCA2, PALB2, or other moderate penetrance genes), or with a >5% BC risk at 10 years (according to the Tyrer-Cuzick or the Breast Cancer Surveillance Consortium Risk models) or with a previous diagnosis of intraepithelial neoplasia will be eligible. A total of 200 participants will be randomized to one of the four arms: LDT; LDT + ICR; LI; LI + ICR. Interventions will span six months, with baseline and follow-up clinic visits and interim phone calls. DISCUSSION The aim of the study is to verify whether LDT increases circulating SHBG more than LI with or without ICR after 6 months. Secondary objectives include assessing HOMA-index, inflammatory markers, adiponectin/leptin ratio, quality of life (QoL), safety, toxicity, mammographic density, and changes in microbiome composition across groups. The study's innovation lies in its inclusion of diverse BC risk categories and combination of pharmaceutical and behavioral interventions, potentially enhancing intervention efficacy while balancing tamoxifen's side effects on QoL, especially menopausal symptoms. TRIAL REGISTRATION EuCT number:2023-503994-39-00; Clinical trials.gov NCT06033092.
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Affiliation(s)
| | - Davide Serrano
- Division of Cancer Prevention and Genetics, European Institute of Oncology IRCCS, Milan, Italy
| | - Patrizia Gnagnarella
- Division of Epidemiology and Biostatistics, European Institute of Oncology IRCCS, Milan, Italy
| | - Harriet Johansson
- Division of Cancer Prevention and Genetics, European Institute of Oncology IRCCS, Milan, Italy
| | - Stefania Zovato
- Familial Cancer Unit, Veneto Institute of Oncology IOV IRCSS, Padova, Italy
| | - Mariateresa Nardi
- Familial Cancer Unit, Veneto Institute of Oncology IOV IRCSS, Padova, Italy
| | - Matilde Pensabene
- Division of Breast Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Naples, Italy
| | - Simona Buccolo
- Division of Breast Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Naples, Italy
| | - Andrea DeCensi
- Division of Medical Oncology, E.O. Galliera Hospital, Genoa, Italy
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | | | - Luigi Pistelli
- Division of Breast Oncology, Istituto Nazionale Tumori—IRCCS—Fondazione G. Pascale, Naples, Italy
| | - Clementina Sansone
- Stazione Zoologica Anton Dohrn, Istituto Nazionale di Biologia, Ecologia e Biotecnologie Marine, University of Naples "Federico II", Naples, Italy
| | - Sara Mannucci
- Division of Cancer Prevention and Genetics, European Institute of Oncology IRCCS, Milan, Italy
| | - Valentina Aristarco
- Division of Cancer Prevention and Genetics, European Institute of Oncology IRCCS, Milan, Italy
| | - Debora Macis
- Division of Cancer Prevention and Genetics, European Institute of Oncology IRCCS, Milan, Italy
| | - Matteo Lazzeroni
- Division of Cancer Prevention and Genetics, European Institute of Oncology IRCCS, Milan, Italy
| | - Gaetano Aurilio
- Division of Cancer Prevention and Genetics, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Sara Gandini
- Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Bernardo Bonanni
- Division of Cancer Prevention and Genetics, European Institute of Oncology IRCCS, Milan, Italy
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Visser E, Ten Brinke A, Sizoo D, Pepels JJS, Ten Have L, van der Wiel E, van Zutphen T, Kerstjens HAM, de Jong K. Effect of dietary interventions on markers of type 2 inflammation in asthma: A systematic review. Respir Med 2024; 221:107504. [PMID: 38141862 DOI: 10.1016/j.rmed.2023.107504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/29/2023] [Accepted: 12/17/2023] [Indexed: 12/25/2023]
Abstract
INTRODUCTION Type 2 (T2) inflammation is a key mechanism in the pathophysiology of asthma. Diet may have immunomodulatory effects, and a role for diet in T2 inflammation has been suggested in the literature. Indeed, diet and food allergies play a role in children with atopic asthma, but less is known about diet in relation to adult asthma, which is often non-atopic. OBJECTIVE To review the effect of dietary interventions on markers of T2 inflammation in adults with asthma. METHODS The databases PubMed, Embase, Cochrane Library, and CINAHL were searched for eligible studies until December 2022. We included studies of all types of foods, nutrients, diets or supplements, either as an exposure or as an intervention, in adults and adolescents with asthma. Outcomes of interest included the T2 biomarkers FeNO, eosinophils, IL-4, IL-5, IL-13, eosinophil cationic protein and eosinophil peroxidase. The methodological quality of eligible studies was systematically evaluated, and the results were summarised according to dietary clusters. RESULTS The systematic search identified studies on the dietary clusters antioxidants (n = 14), fatty acids, (n = 14), Mediterranean-style diets (n = 5), phytotherapy (n = 7), prebiotics & probiotics (n = 8), vitamin D (n = 7), and other dietary factors (n = 5). Studies within the phytotherapy and omega-3 poly-unsaturated fatty acids (PUFA) clusters showed possible improvements in T2 inflammation. Furthermore, we found little evidence for an effect of antioxidants, prebiotics & probiotics, and Mediterranean-style diets on T2 inflammation. However, heterogeneity in study protocols, methodological shortcomings and limited power of almost all studies make it difficult to fully determine the impact of different dietary approaches on T2 inflammation in asthma. CONCLUSIONS Overall, the current evidence does not support a specific dietary intervention to improve T2 inflammation in asthma. Interventions involving phytotherapy and omega-3 PUFA currently have the best evidence and warrant further evaluation in well-designed and adequately powered studies, while taking into account T2-high phenotypes of asthma.
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Affiliation(s)
- Edith Visser
- Department of Epidemiology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands; Department of Sustainable Health, Faculty Campus Fryslân, University of Groningen, Leeuwarden, the Netherlands.
| | - Anneke Ten Brinke
- Department of Pulmonary Medicine, Medical Centre Leeuwarden, Leeuwarden, the Netherlands.
| | - Dionne Sizoo
- Department of Sustainable Health, Faculty Campus Fryslân, University of Groningen, Leeuwarden, the Netherlands; Centre Obesity Northern Netherlands (CON), Department of Surgery, Medical Centre Leeuwarden, Leeuwarden, the Netherlands.
| | - Janneke J S Pepels
- Department of Epidemiology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands.
| | - Lianne Ten Have
- Department of Epidemiology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands.
| | - Erica van der Wiel
- Department of Pulmonary Medicine, Martini Hospital, Groningen, the Netherlands.
| | - Tim van Zutphen
- Department of Sustainable Health, Faculty Campus Fryslân, University of Groningen, Leeuwarden, the Netherlands.
| | - Huib A M Kerstjens
- Department of Pulmonary Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands; Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, the Netherlands.
| | - Kim de Jong
- Department of Epidemiology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands.
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Visser E, de Jong K, van Zutphen T, Kerstjens HAM, Ten Brinke A. Dietary Inflammatory Index and Clinical Outcome Measures in Adults With Moderate-to-Severe Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3680-3689.e7. [PMID: 37652347 DOI: 10.1016/j.jaip.2023.08.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Diet is increasingly recognized as a modifiable factor in lung health, predominantly due to the immunomodulatory effects of nutrients. The Dietary Inflammatory Index (DII) is a score developed to express the inflammatory potential of a diet. OBJECTIVE We aimed to assess the association of the DII and food groups, with clinical, functional, and inflammatory asthma outcomes in adults with asthma. METHODS Patients with moderate-to-severe asthma were included in this cross-sectional study between June 2019 and October 2021, and completed a 3-day food diary, to calculate the DII and intake of food groups (ie, fruits, whole grains, processed meats, and sugar-sweetened beverages). Functional outcomes included pulmonary function tests and the 6-minute walking distance, whereas clinical outcomes were assessed using questionnaires on asthma control, quality of life, and health care utilization. Inflammatory markers were exhaled nitric oxide and blood leukocytes, eosinophils, and IL-6. Multivariable regression analyses were used to examine the association of DII and food groups with asthma outcomes. RESULTS A total of 109 patients participated (35% male, mean ± standard deviation age 51.8 ± 14.2 years, body mass index 27.4 ± 5.3 kg/m2). Overall, 62% had a DII score >0, indicating a proinflammatory diet, which was not related to asthma severity. A more proinflammatory diet was consistently associated with lower forced vital capacity (%pred), but inconsistent results were observed with respect to airway obstruction. Neither the DII nor food groups were associated with clinical outcomes. Except for higher levels of exhaled nitric oxide in relation to an anti-inflammatory diet, we found no associations between inflammatory markers and the DII. CONCLUSION Results from this cross-sectional study among patients with moderate-to-severe asthma do not support the hypothesis that a proinflammatory diet is associated with worse asthma outcomes, although limitations in study design and dietary intake estimation should be considered. Future well-designed experimental studies are needed to assess whether targeting the inflammatory potential of diet could lead to better outcomes in adults with asthma.
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Affiliation(s)
- Edith Visser
- Department of Epidemiology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands; Department of Sustainable Health, Faculty Campus Fryslân, University of Groningen, Leeuwarden, the Netherlands.
| | - Kim de Jong
- Department of Epidemiology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands
| | - Tim van Zutphen
- Department of Sustainable Health, Faculty Campus Fryslân, University of Groningen, Leeuwarden, the Netherlands
| | - Huib A M Kerstjens
- Department of Pulmonary Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands; Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, the Netherlands
| | - Anneke Ten Brinke
- Department of Pulmonary Medicine, Medical Centre Leeuwarden, Leeuwarden, the Netherlands
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Zhao L, Wirth MD, Petermann-Rocha F, Parra-Soto S, Mathers JC, Pell JP, Ho FK, Celis-Morales CA, Hébert JR. Diet-Related Inflammation Is Associated with Worse COVID-19 Outcomes in the UK Biobank Cohort. Nutrients 2023; 15:nu15040884. [PMID: 36839240 PMCID: PMC9959636 DOI: 10.3390/nu15040884] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 01/30/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023] Open
Abstract
Diet, the most important modulator of inflammatory and immune responses, may affect COVID-19 incidence and disease severity. Data from 196,154 members of the UK biobank had at least one 24 h dietary recall. COVID-19 outcomes were based on PCR testing, hospital admissions, and death certificates. Adjusted Poisson regression analyses were performed to estimate the risk ratios (RR) and their 95% confidence intervals (CI) for dietary inflammatory index (DII)/energy-adjusted DII (E-DII) scores. Models were adjusted for sociodemographic factors, comorbidities, smoking status, physical activity, and sleep duration. Between January 2020 and March 2021, there were 11,288 incident COVID-19 cases, 1270 COVID-19-related hospitalizations, and 315 COVID-19-related deaths. The fully adjusted model showed that participants in the highest (vs. lowest) DII/E-DII quintile were at 10-17% increased risk of COVID-19 (DII: RR Q5 vs. Q1 = 1.10, 95% CI 1.04-1.17, Ptrend < 0.001; E-DII: RR Q5 vs. Q1 = 1.17, 95% CI 1.10-1.24, Ptrend < 0.001) and ≈40% higher risk was observed for disease severity (DII: RR Q5 vs. Q1 = 1.40, 95% CI 1.18-1.67, Ptrend < 0.001; E-DII: RR Q5 vs. Q1 = 1.39, 95% CI 1.16-1.66, Ptrend < 0.001). There was a 43% increased risk of COVID-19-related death in the highest DII quintile (RR Q5 vs. Q1 = 1.43, 95% CI 1.01-2.01, Ptrend = 0.04). About one-quarter of the observed positive associations between DII and COVID-19-related outcomes were mediated by body mass index (25.8% for incidence, 21.6% for severity, and 19.8% for death). Diet-associated inflammation increased the risk of COVID-19 infection, severe disease, and death.
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Affiliation(s)
- Longgang Zhao
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
- Cancer Prevention and Control Program and Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC 29208, USA
| | - Michael D. Wirth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
- Cancer Prevention and Control Program and Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC 29208, USA
- College of Nursing, University of South Carolina, Columbia, SC 29208, USA
- Department of Nutrition, Connecting Health Innovations LLC, Columbia, SC 29201, USA
| | - Fanny Petermann-Rocha
- School of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8TA, UK
- Centro de Investigación Biomédica, Facultad de Medicina, Universidad Diego Portales, Santiago 8370068, Chile
| | - Solange Parra-Soto
- School of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8TA, UK
- Department of Nutrition and Public Health, Universidad del Bío-Bío, Chillan 3780000, Chile
| | - John C. Mathers
- Human Nutrition & Exercise Research Centre, Centre for Healthier Lives, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Jill P. Pell
- School of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK
| | - Frederick K. Ho
- School of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK
| | - Carlos A. Celis-Morales
- School of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8TA, UK
- Human Performance Lab, Education, Physical Activity and Health Research Unit, University Católica del Maule, Talca 3466706, Chile
| | - James R. Hébert
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
- Cancer Prevention and Control Program and Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC 29208, USA
- Department of Nutrition, Connecting Health Innovations LLC, Columbia, SC 29201, USA
- Correspondence:
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Zhou N, Xie ZP, Liu Q, Xu Y, Dai SC, Lu J, Weng JY, Wu LD. The dietary inflammatory index and its association with the prevalence of hypertension: A cross-sectional study. Front Immunol 2023; 13:1097228. [PMID: 36741368 PMCID: PMC9893776 DOI: 10.3389/fimmu.2022.1097228] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 12/20/2022] [Indexed: 01/21/2023] Open
Abstract
Aims We aim to investigate the association of the Dietary Inflammatory Index (DII) with the prevalence of hypertension in a large multiracial population in the United States. Methods Participants from the National Health and Nutrition Examination Survey (NHANES) (1999-2018) were included in this cross-sectional study. Dietary information was obtained and used to calculate DII. Blood pressures of participants were measured by experienced examiners. The NHANES used the method of "stratified multistage probability sampling," and this study is a weight analysis following the NHANES analytic guidance. Weight logistic regression analysis was adopted to investigate the association of hypertension with DII. Least Absolute Shrinkage and Selection Operator (LASSO) regression was carried out to screen the most important dietary factors associated with the risk of hypertension. Moreover, a nomogram model based on key dietary factors was established; the receiver operating characteristic (ROC) curve was used to evaluate the diagnostic power of the nomogram model for screening hypertension risk. Results A total of 45,023 participants were included in this study, representing 191 million residents in the United States. Participants with hypertension had an elevated DII compared with those without hypertension. Weight logistic regression showed that an increment of DII was strongly associated with hypertension after adjusting for confounding factors. The nomogram model, based on key dietary factors screened by LASSO regression, showed a favorable discriminatory power with an area under the curve (AUC) of 78.5% (95% CI: 78.5%-79.3%). Results of the sensitivity analysis excluding participants who received any drug treatment were consistent with those in the main analysis. Conclusion An increment of DII is associated with the risk of hypertension. For better prevention and treatment of hypertension, more attention should be paid to controlling dietary inflammation.
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Affiliation(s)
- Nan Zhou
- Health Examination Center, Huadong Sanatorium, Wuxi, China
| | - Zhi-Ping Xie
- Health Examination Center, Huadong Sanatorium, Wuxi, China
| | - Qing Liu
- Health Examination Center, Huadong Sanatorium, Wuxi, China
| | - Yun Xu
- Department of Anesthesiology, Huadong Sanatorium, Wuxi, China
| | - Si-Cheng Dai
- Health Examination Center, Huadong Sanatorium, Wuxi, China
| | - Juan Lu
- Department of Anesthesiology, Huadong Sanatorium, Wuxi, China,*Correspondence: Juan Lu, ; Li-Da Wu, ; Jia-Yi Weng,
| | - Jia-Yi Weng
- Department of Cardiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China,*Correspondence: Juan Lu, ; Li-Da Wu, ; Jia-Yi Weng,
| | - Li-Da Wu
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China,*Correspondence: Juan Lu, ; Li-Da Wu, ; Jia-Yi Weng,
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