2
|
Chajès V, Assi N, Biessy C, Ferrari P, Rinaldi S, Slimani N, Lenoir GM, Baglietto L, His M, Boutron-Ruault MC, Trichopoulou A, Lagiou P, Katsoulis M, Kaaks R, Kühn T, Panico S, Pala V, Masala G, Bueno-de-Mesquita HB, Peeters PH, van Gils C, Hjartåker A, Standahl Olsen K, Borgund Barnung R, Barricarte A, Redondo-Sanchez D, Menéndez V, Amiano P, Wennberg M, Key T, Khaw KT, Merritt MA, Riboli E, Gunter MJ, Romieu I. A prospective evaluation of plasma phospholipid fatty acids and breast cancer risk in the EPIC study. Ann Oncol 2017; 28:2836-2842. [PMID: 28950350 DOI: 10.1093/annonc/mdx482] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Intakes of specific fatty acids have been postulated to impact breast cancer risk but epidemiological data based on dietary questionnaires remain conflicting. MATERIALS AND METHODS We assessed the association between plasma phospholipid fatty acids and breast cancer risk in a case-control study nested within the European Prospective Investigation into Cancer and Nutrition study. Sixty fatty acids were measured by gas chromatography in pre-diagnostic plasma phospholipids from 2982 incident breast cancer cases matched to 2982 controls. Conditional logistic regression models were used to estimate relative risk of breast cancer by fatty acid level. The false discovery rate (q values) was computed to control for multiple comparisons. Subgroup analyses were carried out by estrogen receptor (ER) and progesterone receptor expression in the tumours. RESULTS A high level of palmitoleic acid [odds ratio (OR) for the highest quartile compared with the lowest OR (Q4-Q1) 1.37; 95% confidence interval (CI), 1.14-1.64; P for trend = 0.0001, q value = 0.004] as well as a high desaturation index (DI16) (16:1n-7/16:0) [OR (Q4-Q1), 1.28; 95% C, 1.07-1.54; P for trend = 0.002, q value = 0.037], as biomarkers of de novo lipogenesis, were significantly associated with increased risk of breast cancer. Levels of industrial trans-fatty acids were positively associated with ER-negative tumours [OR for the highest tertile compared with the lowest (T3-T1)=2.01; 95% CI, 1.03-3.90; P for trend = 0.047], whereas no association was found for ER-positive tumours (P-heterogeneity =0.01). No significant association was found between n-3 polyunsaturated fatty acids and breast cancer risk, overall or by hormonal receptor. CONCLUSION These findings suggest that increased de novo lipogenesis, acting through increased synthesis of palmitoleic acid, could be a relevant metabolic pathway for breast tumourigenesis. Dietary trans-fatty acids derived from industrial processes may specifically increase ER-negative breast cancer risk.
Collapse
Affiliation(s)
- V Chajès
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon.
| | - N Assi
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon
| | - C Biessy
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon
| | - P Ferrari
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon
| | - S Rinaldi
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon
| | - N Slimani
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon
| | | | - L Baglietto
- Institut Gustave Roussy, Villejuif; Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
| | - M His
- Institut Gustave Roussy, Villejuif; Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
| | - M C Boutron-Ruault
- Institut Gustave Roussy, Villejuif; Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
| | - A Trichopoulou
- Hellenic Health Foundation, Athens; WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - P Lagiou
- Hellenic Health Foundation, Athens; WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece; Department of Epidemiology, Harvard School of Public Health, Boston, USA
| | | | - R Kaaks
- The German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - T Kühn
- The German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - S Panico
- Dipartimento Di Medicina Clinica E Chirurgia, Federico II University, Naples
| | - V Pala
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - G Masala
- Cancer Risk Factors and Life-Style Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy
| | - H B Bueno-de-Mesquita
- Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands; Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, UK; Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - P H Peeters
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - C van Gils
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A Hjartåker
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo
| | - K Standahl Olsen
- Department of Community Medicine, University of Tromsø-UiT-The Artic University of Norway, Tromsø, Norway
| | - R Borgund Barnung
- Department of Community Medicine, University of Tromsø-UiT-The Artic University of Norway, Tromsø, Norway
| | - A Barricarte
- Navarra Public Health Institute, Pamplona; Navarra Institute for Health Research (IdiSNA), Pamplona; CIBER Epidemiology and Public Health CIBERESP, Madrid
| | - D Redondo-Sanchez
- CIBER Epidemiology and Public Health CIBERESP, Madrid; Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs.Granada, Hospitales Universitarios de Granada, Granada; Universidad de Granada, Granada
| | | | - P Amiano
- CIBER Epidemiology and Public Health CIBERESP, Madrid; Public Health Division of Gipuzkoa, Health Department, Basque Region, San Sebastian, Spain
| | - M Wennberg
- Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden
| | - T Key
- The Cancer Epidemiology Unit, University of Oxford, Oxford
| | - K T Khaw
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - M A Merritt
- Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, UK
| | - E Riboli
- Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, UK
| | - M J Gunter
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon
| | - I Romieu
- Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon
| |
Collapse
|
3
|
Verkooijen HM, Young Afat D, van den Bongard D, van Vulpen M, May AM, van Gils C. Abstract P5-18-02: The cohort multiple randomized controlled trial is a feasible and patient-acceptable design for pragmatic evaluation of multiple interventions, with potential for improved recruitment and generalisability: The UMBRELLA experience. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p5-18-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: The randomized controlled trial (RCT) is the gold standard for evaluation of effectiveness of new interventions. In oncology, however, RCTs are often complicated by logistic challenges, slow recruitment, limited generalisability, and strong patient's and doctor's preferences for new interventions. At the University Medical Center Utrecht (the Netherlands), we implemented an innovative alternative to the classic RCT: the cohort multiple randomized controlled trial (cmRCT). The cmRCT serves as a multi-trial facility and has the potential to improve recruitment and generalisability.
Methods: We initiated the 'Utrecht cohort for Multiple BREast cancer intervention studies and Long-term evaluation (UMBRELLA)' at the department of radiation oncology. UMBRELLA is a large prospective cohort of breast cancer patients, for whom we capture clinical data (patient and tumor characteristics, treatment, imaging, toxicity, recurrence and survival). Patients provide Patient Reported Outcome Measures (PROMs) on quality of life, pain, fatigue, anxiety and depression, physical activity and cosmetics. For each intervention to be tested, a subcohort of eligible patients is identified within UMBRELLA. From this subcohort, a random sample of patients is selected and offered the intervention (which they can accept or refuse). Patients from the subcohort, who are not randomly selected, receive standard care, serve as controls, and are not informed about the trial. Outcomes of patients offered the intervention are compared to those of patients receiving standard care. This process can be repeated (simultaneously) for multiple experimental interventions.
Results: Since October 2013, some 1000 patients have been enrolled in UMBRELLA. In order to make the design suitable for the clinical oncology practice, we developed a tailored informed consent procedure. First, we ask patients to enroll in the cohort and to provide PROMs. In addition, patients give broad consent to be either randomly selected to receive experimental interventions or to serve as control without further notice. In a second stage, at the initiation of a trial within the cohort, informed consent to receive the experimental intervention is sought in those randomly selected to receive the intervention. After completion of the trial, aggregated results are shared with all patients. Participation in UMBRELLA is 90%, and 90% of enrolled patients give broad consent for randomization. PROMs return rates vary from 70-90%. In September 2015, the first trial will be initiated, which aims to evaluate the impact of exercise programs on quality of life of inactive survivors. Preliminary inclusion and participation rates of this trial will be presented in December.
Conclusion: High participation rates, high PROM return rates and high levels of broad informed consent for randomisation within UMBRELLA indicate that this innovative design is feasible in the oncology practice, acceptable for patients and likely to provide generalisable results. Results of trials within UMBRELLA need to confirm whether cmRCT is indeed an acceptable alternative for classic pragmatic RCTs.
Citation Format: Verkooijen HM, Young Afat D, van den Bongard D, van Vulpen M, May AM, van Gils C. The cohort multiple randomized controlled trial is a feasible and patient-acceptable design for pragmatic evaluation of multiple interventions, with potential for improved recruitment and generalisability: The UMBRELLA experience. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-18-02.
Collapse
Affiliation(s)
| | | | | | | | - AM May
- UMC Utrecht, Utrecht, Netherlands
| | | |
Collapse
|
5
|
Hanft JR, Pollak RA, Barbul A, van Gils C, Kwon PS, Gray SM, Lynch CJ, Semba CP, Breen TJ. Phase I trial on the safety of topical rhVEGF on chronic neuropathic diabetic foot ulcers. J Wound Care 2008; 17:30-2, 34-7. [PMID: 18210954 DOI: 10.12968/jowc.2008.17.1.27917] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To assess the safety/tolerability and perform a preliminary efficacy evaluation of a multiple-dosing regimen of recombinant human vascular endothelial growth factor (VEGF165 or rhVEGF; telbermin) applied topically to chronic diabetic neuropathic foot ulcers. METHOD Subjects with type 1 or 2 diabetes mellitus were randomised to receive either topical applied telbermin (72 microg/cm2) (n=29) or placebo (n=26) treatment to the foot ulcer surface in conjunction with standard ulcer care. Subjects received treatment every 48 hours (maximum three doses per week) for up to six weeks. Weekly 35mm photography, quantitative planimetry and physical examinations documented the ulcer appearance, surface area and stage. Safety endpoints included incidence of clinically significant hypotension, adverse events and ulcer infection. Exploratory efficacy endpoints included percentage reduction in total ulcer surface area, incidence of complete ulcer healing and time to complete ulcer healing. RESULTS Incidence of adverse events was comparable in the two treatment groups. None of the adverse events were attributed to study drug, and no hypotension was observed as a result of telbermin treatment. Occurrence of infected study ulcers appeared to be balanced between the treatment groups. Positive trends suggestive of potential signals of biological activity were observed for incidence of complete ulcer healing (41.4% telbermin versus 26.9% placebo at day 43 [P=0.39]) and time to complete ulcer healing (25th percentile of 32.5 days telbermin versus 43.0 days placebo [log-rank P=0.13]). CONCLUSION The topical application of telbermin 72 microg/cm2 three times a week for up to six weeks appeared to be well tolerated. Further studies are required to characterise the safety/efficacy of telbermin more completely.
Collapse
Affiliation(s)
- J R Hanft
- Doctor's Research Network, South Miami, Florida, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Dierckx N, Horvath G, van Gils C, Vertommen J, van de Vliet J, De Leeuw I, Manuel-y-Keenoy B. Oxidative stress status in patients with diabetes mellitus: relationship to diet. Eur J Clin Nutr 2003; 57:999-1008. [PMID: 12879095 DOI: 10.1038/sj.ejcn.1601635] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the relationship between dietary intakes and in vivo oxidative stress (OS) status in diabetic patients. DESIGN Case-control study. SETTING Outpatient-Clinic and Laboratory Endocrinology, University Antwerp. SUBJECTS AND METHODS A total of 30 patients (24 type 1 diabetes mellitus (T1DM)/6 type 2 diabetes mellitus (T2DM) were asked to complete a 2 weekdays+1 weekend day food consumption questionnaire during the week preceding their yearly diabetes control consultation, when samples were collected for the assay of oxidative stress (OS) (blood levels of antioxidants, peroxides, malondialdehyde (MDA) and minerals). Blood samples were also collected from 25 age- and sex-matched healthy controls. RESULTS Diabetic patients had lower glutathione (5.80+/-1.15 vs 6.75+/-1.03 micromol/g Hb in the controls, P=0.002) and higher MDA (0.687+/-0.212 vs 0.545+/-0.101 micromol/l, P=0.002). Although the group average intakes were within the Belgian RDA, intakes of fat >35% energy, fibre <15 g/1000 kcal, fruit <2 portions and vitamin E <10 mg/day were seen in more than 20 patients. Blood antioxidants did not correlate with intakes of energy, fat, protein or fibres or of their respective antioxidant. Vitamins A and E correlated with serum lipids (r=0.58, P <0.0005 between serum alpha-tocopherol and cholesterol). Blood peroxide levels were only related to intakes of saturated fat and cholesterol (P<0.05). In diabetic subjects but not in controls (P<0.05) MDA was related to glutathione and uric acid. CONCLUSIONS In diabetic patients, blood levels of antioxidants are not related to their dietary intakes but to serum lipids. Levels of oxidative damage products are only related to intakes of saturated fats and cholesterol and to levels of endogenous antioxidants.
Collapse
Affiliation(s)
- N Dierckx
- Laboratory of Endocrinology, University of Antwerp, Belgium
| | | | | | | | | | | | | |
Collapse
|