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Oyelere AM, Kok DE, Bos D, Gunter MJ, Ferrari P, Keski-Rahkonen P, de Wilt JHW, van Halteren HK, Kouwenhoven EA, van Duijnhoven FJB, Kampman E. Coffee consumption is associated with a reduced risk of colorectal cancer recurrence and all-cause mortality. Int J Cancer 2024; 154:2054-2063. [PMID: 38346920 DOI: 10.1002/ijc.34879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 08/27/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 04/14/2024]
Abstract
Coffee consumption has been associated with a reduced risk of developing colorectal cancer (CRC). However, it is not clear whether coffee consumption is related to CRC progression. Hence, we assessed the association of coffee consumption with CRC recurrence and all-cause mortality using data from a prospective cohort study of 1719 stage I-III CRC patients in the Netherlands. Coffee consumption and other lifestyle characteristics were self-reported using questionnaires at the time of diagnosis. We retrieved recurrence and all-cause mortality data from the Netherlands Cancer Registry and the Personal Records Database, respectively. Cox proportional hazard regression models with and without restricted cubic splines were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) adjusted for age, sex, education, smoking status, cancer stage and tumor location. We observed 257 recurrences during a 6.2-year median follow-up and 309 deaths during a 6.6-year median follow-up. Consuming more than 4 cups/d of coffee compared to an intake of <2 cups/d was associated with a 32% lower risk of CRC recurrence (95% CI: 0.49, 0.94,). The association between coffee consumption and all-cause mortality was U-shaped; coffee intake seemed optimal at 3-5 cups/d with the lowest risk at 4 cups/d (HR: 0.68, 95% CI: 0.53, 0.88). Our results suggest that coffee consumption may be associated with a lower risk of CRC recurrence and all-cause mortality. The association between coffee consumption and all-cause mortality appeared nonlinear. More studies are needed to understand the mechanism by which coffee consumption might improve CRC prognosis.
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Affiliation(s)
- Abisola M Oyelere
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Dieuwertje E Kok
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Daniel Bos
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marc J Gunter
- Nutrition and Metabolism Branch, International Agency for Research on Cancer (IARC-WHO), Lyon, France
- Department of Epidemiology and Biostatistics School of Public Health, Imperial College London, London, UK
| | - Pietro Ferrari
- Nutrition and Metabolism Branch, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Pekka Keski-Rahkonen
- Nutrition and Metabolism Branch, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henk K van Halteren
- Department of Internal Medicine, Admiraal de Ruyter Ziekenhuis, Goes, The Netherlands
| | | | | | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
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Verkaar AJCF, Winkels RM, Kampman E, Luik AI, Voortman T. Associations of dietary patterns with objective and subjective sleep duration and sleep quality in a population-based cohort study. Sleep Med 2024; 119:365-372. [PMID: 38761605 DOI: 10.1016/j.sleep.2024.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/26/2024] [Accepted: 05/07/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVE To examine cross-sectional and longitudinal associations of various types of dietary patterns with self-reported sleep quality and with actigraphy-estimated sleep parameters in the prospective, population-based Rotterdam Study. METHODS For each participant, scores for five different dietary patterns were derived based on food frequency questionnaires; two pre-defined scores developed to estimate adherence to the Dutch dietary guidelines and to the Mediterranean diet; and three data-driven scores indicating a prudent, unhealthy and typical Dutch diet. In 2589 participants (median age 56.9 years; 58 % female), self-rated sleep quality was assessed with the Pittsburgh Sleep Quality Index. In 533 participants, actigraphs were worn for an average of 6.8 days (SD: 0.7) to estimate total sleep time, sleep onset latency, wake after sleep onset, and sleep efficiency. Sleep parameters were measured at baseline and 3-6 years later. Multiple linear regression was used to assess cross-sectional and longitudinal associations. RESULTS No statistically significant associations between dietary patterns and total sleep time, sleep onset latency, wake after sleep onset, sleep efficiency and subjective sleep quality were observed in cross-sectional or longitudinal analyses. To illustrate, the effect estimate for sleep duration was 2.7 min per night (95 % CI -2.1, 7.5) per 5 point increase in Mediterranean diet score in the cross-sectional analyses. Furthermore, in longitudinal analyses, the effect estimate for sleep duration was -1.0 min per night (95 % CI -5.2, 3.1) per SD increase in the prudent diet. CONCLUSIONS Our results suggest that dietary patterns are not associated with sleep in this population-based cohort study. TRIAL REGISTRATION Netherlands National Trial Register and WHO International Clinical Trials Registry Platform (ICTRP; https://apps.who.int/trialsearch/) shared catalogue number NL6645/NTR6831. Registered November 13th, 2017.
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Affiliation(s)
- Auke J C F Verkaar
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Renate M Winkels
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Annemarie I Luik
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Trimbos Institute, The Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Trudy Voortman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands; Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
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van Lanen AS, Kok DE, Wesselink E, Derksen JWG, May AM, Smit KC, Koopman M, de Wilt J, Kampman E, van Duijnhoven FJB. Associations between low- and high-fat dairy intake and recurrence risk in people with stage I-III colorectal cancer differ by sex and primary tumour location. Int J Cancer 2024. [PMID: 38700376 DOI: 10.1002/ijc.34959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/07/2024] [Accepted: 03/05/2024] [Indexed: 05/05/2024]
Abstract
We previously demonstrated that intake of low-fat dairy, but not high-fat dairy, was associated with a decreased colorectal cancer (CRC) recurrence risk. These risks, however, may differ by sex, primary tumour location, and disease stage. Combining data from two similar prospective cohort studies of people with stage I-III CRC enabled these subgroup analyses. Participants completed a food frequency questionnaire at diagnosis (n = 2283). We examined associations between low- and high-fat dairy intake and recurrence risk using multivariable Cox proportional hazard models, stratified by sex, and primary tumour location (colon and rectum), and disease stage (I/II and III). Upper quartiles were compared to lower quartiles of intake, and recurrence was defined as a locoregional recurrence and/or metastasis. During a median follow-up of 5.0 years, 331 recurrences were detected. A higher intake of low-fat dairy was associated with a reduced risk of recurrence (hazard ratio [HR]: 0.60, 95% confidence interval [CI]: 0.43-0.83), which seemed more pronounced in men (HR: 0.51, 95% CI: 0.34-0.77) than in women (HR: 0.84, 95% CI: 0.47-1.49). A higher intake of high-fat dairy was associated with an increased risk of recurrence in participants with colon cancer (HR: 1.60, 95% CI: 1.03-2.50), but not rectal cancer (HR: 0.88, 95% CI: 0.54-1.45). No differences in associations were observed between strata of disease stage. Concluding, our findings imply that dietary advice regarding low-fat dairy intake may be especially important for men with CRC, and that dietary advice regarding high-fat dairy intake may be specifically important in people with colon cancer.
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Affiliation(s)
- Anne-Sophie van Lanen
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Dieuwertje E Kok
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Evertine Wesselink
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Jeroen W G Derksen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Karel C Smit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Johannes de Wilt
- Department of Surgery, Radboud University Medical Center, University of Nijmegen, Nijmegen, The Netherlands
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
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Smit KC, Derksen JWG, Stellato RK, VAN Lanen AS, Wesselink E, Belt EJT, Balen MCVAN, Coene PPLO, Dekker JWT, DE Groot JW, Haringhuizen AW, VAN Halteren HK, VAN Heek TT, Helgason HH, Hendriks MP, DE Hingh IHJT, Hoekstra R, Houtsma D, Janssen JJB, Kok N, Konsten JLM, Los M, Meijerink MR, Mekenkamp LJM, Peeters KCMJ, Polée MB, Rietbroek RC, Schiphorst AHW, Schrauwen RWM, Schreinemakers J, Sie MPS, Simkens L, Sonneveld EJA, Terheggen F, Iersel LVVAN, Vles WJ, Wasowicz-Kemps DK, DE Wilt JHW, Kok DE, Winkels RM, Kampman E, VAN Duijnhoven FJB, Koopman M, May AM. Determinants of Physical Activity among Patients with Colorectal Cancer: From Diagnosis to 5 Years after Diagnosis. Med Sci Sports Exerc 2024; 56:623-634. [PMID: 38079324 DOI: 10.1249/mss.0000000000003351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/16/2024]
Abstract
INTRODUCTION Physical activity (PA) is associated with higher quality of life and probably better prognosis among colorectal cancer (CRC) patients. This study focuses on determinants of PA among CRC patients from diagnosis until 5 yr postdiagnosis. METHODS Sociodemographic and disease-related factors of participants of two large CRC cohort studies were combined. Moderate-to-vigorous PA during sport and leisure time (MVPA-SL) was measured at diagnosis (T0) and 6, 12, 24, and 60 months (T6 to T60) postdiagnosis, using the SQUASH questionnaire. Mixed-effects models were performed to identify sociodemographic and disease-related determinants of MVPA-SL, separately for stage I-III colon (CC), stage I-III rectal cancer (RC), and stage IV CRC (T0 and T6 only). Associations were defined as consistently present when significant at ≥4 timepoints for the stage I-III subsets. MVPA-SL levels were compared with an age- and sex-matched sample of the general Dutch population. RESULTS In total, 2905 CC, 1459 RC and 436 stage IV CRC patients were included. Patients with higher fatigue scores, and women compared with men had consistently lower MVPA-SL levels over time, regardless of tumor type and stage. At T6, having a stoma was significantly associated with lower MVPA-SL among stage I-III RC patients. Systemic therapy and radiotherapy were not significantly associated with MVPA-SL changes at T6. Compared with the general population, MVPA-SL levels of CRC patients were lower at all timepoints, most notably at T6. CONCLUSIONS Female sex and higher fatigue scores were consistent determinants of lower MVPA-SL levels among all CRC patients, and MVPA-SL levels were lowest at 6 months postdiagnosis. Our results can inform the design of intervention studies aimed at improving PA, and guide healthcare professionals in optimizing individualized support.
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Affiliation(s)
- Karel C Smit
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, THE NETHERLANDS
| | - Jeroen W G Derksen
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, THE NETHERLANDS
| | - Rebecca K Stellato
- Department of Data Science and Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, THE NETHERLANDS
| | - Anne-Sophie VAN Lanen
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, THE NETHERLANDS
| | - Evertine Wesselink
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, THE NETHERLANDS
| | - Eric J Th Belt
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, THE NETHERLANDS
| | | | | | | | | | | | - Henk K VAN Halteren
- Department of Medical Oncology, Admiraal de Ruyter Hospital, Goes, THE NETHERLANDS
| | - Tjarda T VAN Heek
- Department of Surgery, Ziekenhuis Gelderse Vallei, Ede, THE NETHERLANDS
| | - Helgi H Helgason
- Department of Medical Oncology, Haaglanden Medical Center, Den Haag, THE NETHERLANDS
| | - Mathijs P Hendriks
- Department of Medical Oncology, Northwest Clinics, Alkmaar, THE NETHERLANDS
| | | | - Ronald Hoekstra
- Department of Medical Oncology, Ziekenhuisgroep Twente, Hengelo, THE NETHERLANDS
| | - Danny Houtsma
- Department of Medical Oncology, Haga Hospital, Den Haag, THE NETHERLANDS
| | - Johan J B Janssen
- Department of Medical Oncology, Canisius Wilhelmina Hospital, Nijmegen, THE NETHERLANDS
| | - Niels Kok
- Department of Gastrointestinal Oncology, Antoni Van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, THE NETHERLANDS
| | | | - Maartje Los
- Department of Medical Oncology, St. Antonius Hospital, Nieuwegein, THE NETHERLANDS
| | - Martijn R Meijerink
- Department of Radiology and Nuclear Medicine, VU Medical Center, Amsterdam, THE NETHERLANDS
| | - Leonie J M Mekenkamp
- Department of Medical Oncology, Medisch Spectrum Twente, Enschede, THE NETHERLANDS
| | - Koen C M J Peeters
- Department of Surgery, Leiden University Medical Center, University of Leiden, Leiden, THE NETHERLANDS
| | - Marco B Polée
- Department of Medical Oncology, Medical Center Leeuwarden, Leeuwarden, THE NETHERLANDS
| | - Ron C Rietbroek
- Department of Medical Oncology, Rode Kruis Hospital, Beverwijk, THE NETHERLANDS
| | | | - Ruud W M Schrauwen
- Department of Gastroenterology and Hepatology, Bernhoven Hospital, Uden, THE NETHERLANDS
| | | | - Mark P S Sie
- Department of Medical Oncology, ZorgSaam Hospital, Terneuzen, THE NETHERLANDS
| | - Lieke Simkens
- Department of Medical Oncology, Maxima Medical Center, Eindhoven, THE NETHERLANDS
| | | | - Frederiek Terheggen
- Department of Medical Oncology, Bravis Hospital, Roosendaal, THE NETHERLANDS
| | - Liselot Valkenburg-VAN Iersel
- Maastricht University Medical Center, Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University, Maastricht, THE NETHERLANDS
| | - Wouter J Vles
- Department of Surgery, Ikazia Hospital, Rotterdam, THE NETHERLANDS
| | | | - Johannes H W DE Wilt
- Department of Surgery, Radboud University Medical Center, University of Nijmegen, Nijmegen, THE NETHERLANDS
| | - Dieuwertje E Kok
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, THE NETHERLANDS
| | - Renate M Winkels
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, THE NETHERLANDS
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, THE NETHERLANDS
| | | | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, THE NETHERLANDS
| | - Anne M May
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, THE NETHERLANDS
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Zhu QR, Dieuwertje EK, Bekele HT, Manusama K, Zhang JX, Xie W, Zong WQ, Zuo H, Zhang J, Kampman E, Dai Y. Association of Serum Folate and Vitamin B 12 Concentrations with Obesity in Chinese Children and Adolescents. Biomed Environ Sci 2024; 37:242-253. [PMID: 38582989 DOI: 10.3967/bes2024.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/08/2023] [Indexed: 04/08/2024]
Abstract
Objective This study aimed to evaluate the associations of serum folate and/or vitamin B 12 concentrations with obesity among Chinese children and adolescents. Methods A cross-sectional study was conducted including 3,079 Chinese children and adolescents, aged 6 to 17 years, from Jiangsu, China. Anthropometric indices, such as, children's body mass index (BMI), BMI z-scores, waist circumference, and waist-to-height ratio were utilized. Multivariable linear regression and generalized additive models were used to investigate the associations of serum folate and vitamin B 12 levels with anthropometric indices and odds of obesity. Results We observed that serum vitamin B 12 concentrations were inversely associated with all anthropometric indices and the odds of general obesity [odds ratio ( OR) = 0.68; 95% confidence interval ( CI) = 0.59, 0.78] and abdominal obesity ( OR = 0.68; 95% CI = 0.60, 0.77). When compared to participants with both serum vitamin levels in the two middle quartiles, those with both serum folate and vitamin B 12 levels in the highest quartile were less prone to general ( OR = 0.31, 95% CI = 0.19, 0.50) or abdominal obesity ( OR = 0.46, 95% CI = 0.31, 0.67). Conversely, participants with vitamin B 12 levels in the lowest quartile alongside folate levels in the highest quartile had higher odds of abdominal obesity ( OR = 2.06, 95% CI = 1.09, 3.91). Conclusion Higher serum vitamin B 12 concentrations, but not serum folate concentrations, were associated with lower odds of childhood obesity. Children and adolescents with high levels of vitamin B 12 and folate were less likely to be obese.
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Affiliation(s)
- Qian Rang Zhu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, Jiangsu, China;Division of Human Nutrition and Health, Wageningen University & Research, Wageningen 176700 AA, The Netherlands
| | - E Kok Dieuwertje
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen 176700 AA, The Netherlands
| | - Hailu Tesfaye Bekele
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen 176700 AA, The Netherlands
| | - Koen Manusama
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen 176700 AA, The Netherlands
| | - Jing Xian Zhang
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, Jiangsu, China
| | - Wei Xie
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, Jiangsu, China
| | - Wen Qi Zong
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, Jiangsu, China
| | - Hui Zuo
- School of Public Health, Medical College of Soochow University, Suzhou 215123, Jiangsu, China
| | - Jian Zhang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen 176700 AA, The Netherlands
| | - Yue Dai
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, Jiangsu, China
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Kiebach J, de Vries-Ten Have J, van Duijnhoven FJB, Kok DE, van Lanen AS, Kouwenhoven EA, de Wilt JHW, Schrauwen RWM, Kampman E, Winkels RM, Wesselink E. Hematocrit Is Associated with Cancer-Related Fatigue in Colorectal Cancer Survivors: A Longitudinal Analysis. Cancer Epidemiol Biomarkers Prev 2024; 33:411-418. [PMID: 38180352 DOI: 10.1158/1055-9965.epi-23-1048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/03/2023] [Accepted: 01/03/2024] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Cancer-related fatigue (CRF) is a frequent symptom in colorectal cancer survivors. It is unknown to what extent anemia may contribute to CRF in colorectal cancer survivors. This study aimed to investigate the association between hematocrit, as marker for anemia, and CRF among colorectal cancer survivors from diagnosis until two years thereafter. METHODS The study population included 1,506 newly diagnosed colorectal cancer survivors at any stage of disease from a prospective cohort study. Hematocrit and CRF (EORTC QLQ-C30) were assessed at diagnosis, six months, and two years after diagnosis. Multivariable logistic regression or multivariable linear mixed models were used to assess the associations of hematocrit with CRF prevalence, or CRF severity over time, respectively. RESULTS A low hematocrit (levels <40% men/<36% women) was present in a third of the survivors at diagnosis and six months thereafter, and among 16% two years after diagnosis. The prevalence of CRF was 15% at diagnosis, peaked at 27% at six months, and was 14% two years after diagnosis. Hematocrit was associated with the prevalence of CRF at diagnosis [OR, 0.92; confidence interval (CI), 0.88-0.95], 6 months (OR, 0.89; 95% CI, 0.86-0.92), and 2 years (OR, 0.91; CI, 0.87-0.96) after diagnosis. Lower hematocrit was associated with higher severity of CRF over time (beta-coefficient = 1.3; CI, 1.5-1.1). CONCLUSIONS Lower hematocrit levels were longitudinally associated with a higher prevalence and severity of CRF in colorectal cancer. IMPACT Our findings emphasize the importance of long-term anemia monitoring and a potential role of anemia in CRF among colorectal cancer survivors.
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Affiliation(s)
- Joann Kiebach
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Judith de Vries-Ten Have
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
- Consumption and Healthy Lifestyles Chair group, Wageningen University & Research, Wageningen, the Netherlands
| | | | - Dieuwertje E Kok
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Anne-Sophie van Lanen
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | | | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ruud W M Schrauwen
- Department of Gastroenterology and Hepatology, Bernhoven, Uden, the Netherlands
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Renate M Winkels
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Evertine Wesselink
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
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Kok DE, van Duijnhoven FJ, Lubberman FJ, McKay JA, Lanen ASV, Winkels RM, Wesselink E, van Halteren HK, de Wilt JH, Ulrich CM, Ulvik A, Ueland PM, Kampman E. Intake and biomarkers of folate and folic acid as determinants of chemotherapy-induced toxicities in patients with colorectal cancer: a cohort study. Am J Clin Nutr 2024; 119:294-301. [PMID: 38070682 DOI: 10.1016/j.ajcnut.2023.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/10/2023] [Accepted: 11/28/2023] [Indexed: 12/25/2023] Open
Abstract
BACKGROUND Capecitabine is an oral chemotherapeutic drug showing antitumor activity through inhibition of thymidylate synthase, an enzyme involved in folate metabolism. There are concerns about the high intake of certain vitamins, and specifically folate, during chemotherapy with capecitabine. Whether folate or folic acid, the synthetic variant of the vitamin, impact treatment toxicity remains unclear. OBJECTIVE We studied associations between intake and biomarkers of folate as well as folic acid and toxicities in patients with colorectal cancer (CRC) receiving capecitabine. METHODS Within the prospective COLON (Colorectal cancer: Longitudinal, Observational study on Nutritional and lifestyle factors that influence recurrence, survival, and quality of life) cohort, 290 patients with stage II to III CRC receiving capecitabine were identified. Dietary and supplemental intake of folate and folic acid were assessed at diagnosis and during chemotherapy using questionnaires (available for 280 patients). Plasma folate and folic acid levels were determined by liquid chromatography tandem mass spectrometry (LC-MS/MS) and were available for 212 patients. Toxicities were defined as toxicity-related modifications of treatment, including dose reductions, regimen switches, and early discontinuation. Associations of intake and biomarkers of folate and folic acid with toxicities were determined using Cox proportional hazards regression adjusted for age and sex. RESULTS In total, 153 (53%) patients experienced toxicities leading to modification of capecitabine treatment. Folate intake and plasma folate levels were not associated with risk of toxicities. However, use of folic acid-containing supplements during treatment (hazard ratio (HR) 1.81 and 95% confidence interval (CI) 1.15-2.85) and presence of folic acid in plasma at diagnosis (HR 2.09, 95% CI: 1.24, 3.52) and during treatment (HR 2.31, 95% CI: 1.29, 4.13) were associated with an increased risk of toxicities. CONCLUSIONS This study suggests a potential association between folic acid and capecitabine-induced toxicities, providing a rationale to study diet-drug interactions and raise further awareness of the use of dietary supplements during oncological treatment. CLINICAL TRIAL DETAILS This trial was registered at clinicaltrials.gov as NCT03191110.
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Affiliation(s)
- Dieuwertje E Kok
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands.
| | - Fränzel Jb van Duijnhoven
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Floor Je Lubberman
- Department of Clinical Pharmacy, Hospital Gelderse Vallei, Ede, the Netherlands
| | - Jill A McKay
- Department of Applied Sciences, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Anne-Sophie van Lanen
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Renate M Winkels
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Evertine Wesselink
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Henk K van Halteren
- Department of Medical Oncology, Admiraal de Ruyter Hospital, Goes, the Netherlands
| | | | - Cornelia M Ulrich
- Huntsman Cancer Institute and Department of Population Health Sciences, University of Utah, Salt Lake City, United States
| | | | | | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
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Schmutz A, Matta M, Cairat M, Espina C, Schüz J, Kampman E, Ervik M, Vineis P, Kelm O. Mapping the European cancer prevention research landscape: A case for more prevention research funding. Eur J Cancer 2023; 195:113378. [PMID: 37924646 PMCID: PMC10697826 DOI: 10.1016/j.ejca.2023.113378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 04/07/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 11/06/2023]
Abstract
Despite the strong evidence of prevention as a prime defence against the disease, the majority of cancer research investment continues to be made in basic science and clinical translational research. Little quantitative data is available to guide decisions on the choice of research priorities or the allocation of research resources. The primary aim of the mapping of the European cancer prevention research landscape presented in this paper is to provide the evidence-base to inform future investments in cancer research. Using bibliometric data to identify funders that are active in prevention research in Europe and in the world, we have identified that 14% of cancer research papers had a focus on prevention research and those were funded by 16% of all the European cancer research funders. An important finding of our study is the lack of research on primary prevention with primary prevention funders accounting for 25% of European cancer prevention funders, meaning that less than 4% of all European cancer research funders identified show an interest in primary prevention. An additional analysis revealed that 7% of European cancer prevention research papers are categorised as implementation projects, meaning that only 1% of all cancer research publications are implementation research in cancer prevention. This paper highlights that the narrow focus on biology and treatment in Europe needs to be widened to include such areas as primary prevention and secondary prevention and a larger concentration on implementation research. These data can help support a more policy-focused cancer research agenda for individual European governments and charitable and philanthropic organisations and stimulate joining efforts across Europe to create a more systematic and structured approach to cancer prevention.
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Affiliation(s)
- Anna Schmutz
- International Agency for Research on Cancer (IARC/WHO), Resource Mobilization Office, 25 Avenue Tony Garnier CS 90627, 69366 Lyon CEDEX 07, France.
| | - Michele Matta
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 Avenue Tony Garnier CS 90627, 69366 Lyon CEDEX 07, France
| | - Manon Cairat
- Centre de Recherche en Epidémiologie et Santé des Populations (CESP), U1018, INSERM, Hôpital Paul Brousse Bat 15/16, 16 Av PV Couturier, 94807 Villejuif Cedex, France
| | - Carolina Espina
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 Avenue Tony Garnier CS 90627, 69366 Lyon CEDEX 07, France
| | - Joachim Schüz
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, 25 Avenue Tony Garnier CS 90627, 69366 Lyon CEDEX 07, France
| | - Ellen Kampman
- Wageningen University, PO Box 17, 6700 AA Wageningen, Netherlands
| | - Morten Ervik
- International Agency for Research on Cancer (IARC/WHO), Cancer Surveillance Branch, 25 Avenue Tony Garnier CS 90627, 69366 Lyon CEDEX 07, France
| | - Paolo Vineis
- MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Olaf Kelm
- International Human Frontier Science Program Organization (HFSPO), 67000 Strasbourg, France
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de Vries-Ten Have J, Winkels RM, Kampman E, Winkens LHH. Behaviour change techniques used in lifestyle interventions that aim to reduce cancer-related fatigue in cancer survivors: a systematic review. Int J Behav Nutr Phys Act 2023; 20:126. [PMID: 37833784 PMCID: PMC10576285 DOI: 10.1186/s12966-023-01524-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 07/20/2022] [Accepted: 09/29/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Lifestyle interventions that target dietary and/or physical activity behaviours may impact cancer-related fatigue in cancer survivors. Changing lifestyle may be especially difficult for cancer survivors suffering from cancer-related fatigue. To increase effectiveness of lifestyle interventions, behaviour change techniques (BCTs) can be applied. The aim of this review is to systematically describe which BCTs are applied in lifestyle interventions targeting cancer-related fatigue among cancer survivors who finished primary treatment. METHODS PubMed, Scopus, PsycINFO, Cochrane Library and Web of Science were searched to identify randomised controlled trials (RCTs) of dietary and/or physical activity interventions targeting cancer-related fatigue in cancer survivors. The BCT taxonomy was used to code the BCTs that were applied in those interventions. BCTs that were reported in at least 25% of effective interventions were indicated as 'promising BCT', but only retained this classification when these BCTs were present in less than 25% of ineffective interventions. RESULTS Twenty-nine RCTs were identified, of which 17 were effective in reducing cancer-related fatigue. The most frequently applied BCTs were Goal setting (behaviour), Instruction on how to perform the behaviour, Demonstration of the behaviour, Behavioural practice/rehearsal, and Credible Source. The BCT 'Generalisation of the target behaviour' was identified as promising. These results should be interpreted with caution as only three studies screened their participants on level of cancer-related fatigue and most studies focused only on physical activity. Furthermore, many studies did not include a measure for actual behaviour change and had no follow-up period after the intervention ended. CONCLUSIONS There is a need for studies that screen their participants on level of cancer-related fatigue and a need for studies that focus more on dietary behaviours as a possible intervention to reduce fatigue. Also, studies should include follow-up timepoints after the interventions ends to examine long-term behaviour change. Future lifestyle interventions should describe interventions in detail to allow for easier coding of BCTs, and report on actual behaviour change following the intervention. Interventions may apply the BCT 'Generalisation of the target behaviour' to incorporate lifestyle behaviours in daily life. This may increase the chance that interventions will effectively reduce cancer-related fatigue.
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Affiliation(s)
- Judith de Vries-Ten Have
- Division of Human Nutrition and Health, Nutrition and Disease Chair Group, Wageningen University and Research, Stippeneng 4, 6708 WE, Wageningen, The Netherlands.
- Consumption and Healthy Lifestyles Chair Group, Wageningen University and Research, Hollandseweg 1, 6706 KN, Wageningen, The Netherlands.
| | - Renate M Winkels
- Division of Human Nutrition and Health, Nutrition and Disease Chair Group, Wageningen University and Research, Stippeneng 4, 6708 WE, Wageningen, The Netherlands
| | - Ellen Kampman
- Division of Human Nutrition and Health, Nutrition and Disease Chair Group, Wageningen University and Research, Stippeneng 4, 6708 WE, Wageningen, The Netherlands
| | - Laura H H Winkens
- Consumption and Healthy Lifestyles Chair Group, Wageningen University and Research, Hollandseweg 1, 6706 KN, Wageningen, The Netherlands
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van Lanen AS, Kok DE, Wesselink E, Winkels RM, van Halteren HK, de Wilt JHW, Kampman E, van Duijnhoven FJB. Pre- and post-diagnostic dairy intake in relation to recurrence and all-cause mortality in people with stage I-III colorectal cancer. Eur J Nutr 2023; 62:2891-2904. [PMID: 37393586 PMCID: PMC10468734 DOI: 10.1007/s00394-023-03201-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 03/06/2023] [Accepted: 06/23/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE Higher dairy consumption is associated with a lower risk of colorectal cancer (CRC), but no studies thus far have investigated its relation with recurrence in CRC. Few studies have investigated total dairy in relation to mortality in CRC, and yielded inconsistent results. METHODS In this prospective cohort study, people newly diagnosed with stage I-III CRC filled out a food frequency questionnaire at diagnosis (n = 1812) and six months after diagnosis (n = 1672). We examined associations between pre- and post-diagnostic intake of total dairy, low-fat dairy, high-fat dairy, milk, yoghurt, and cheese with recurrence and all-cause mortality using multivariable Cox proportional hazard models and restricted cubic splines (RCS). RESULTS A total of 176 recurrences and 301 deaths occurred during a median follow-up of 3.0 and 5.9 years, respectively. Before diagnosis, a higher low-fat dairy intake was associated with a lower risk of recurrence (HRQ4vsQ1: 0.42, 95% CI 0.26-0.67; PRCS: 0.008) and all-cause mortality (HRQ4vsQ1: 0.58, 95% CI 0.41-0.81; PRCS < 0.001), whereas a higher high-fat dairy consumption tended to be associated with an increased all-cause mortality risk (HRQ4vsQ1: 1.41, 95% CI 0.98-2.01; PRCS: 0.030). After diagnosis, only the associations between low- and high-fat dairy in relation to all-cause mortality remained. CONCLUSIONS This study demonstrated that higher pre- and post-diagnostic intakes of low-fat dairy were associated with a reduced all-cause mortality risk in people with stage I-III CRC, whereas higher intakes of high-fat dairy were associated with an increased all-cause mortality risk. Also, a higher pre-diagnostic low-fat dairy intake was associated with a reduced risk of recurrence. TRIAL REGISTRATION Clinical Trials.gov identifier: NCT03191110.
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Affiliation(s)
- Anne-Sophie van Lanen
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands.
| | - Dieuwertje E Kok
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Evertine Wesselink
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Renate M Winkels
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Henk K van Halteren
- Department of Internal Medicine, Admiraal de Ruyter Hospital, Goes, The Netherlands
| | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
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Zwart NRK, Franken MD, Tissing WJE, Lubberman FJE, McKay JA, Kampman E, Kok DE. Folate, folic acid, and chemotherapy-induced toxicities: a systematic literature review. Crit Rev Oncol Hematol 2023:104061. [PMID: 37353179 DOI: 10.1016/j.critrevonc.2023.104061] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 06/25/2023] Open
Abstract
Folate metabolism is a target for various chemotherapeutic drugs. Folate and its synthetic variant folic acid are B-vitamins. To what extent these vitamins impact treatment tolerance in patients with cancer remains unclear. A systematic literature review was conducted on intake and status of folate and folic acid in relation to chemotherapy-induced toxicities in children and adults with cancer. A total of 6,231 publications were identified, of which 40 publications met the inclusion criteria. In 12 out of 22 studies focusing on antifolates, a deficient folate status and lower folate and folic acid intake were associated with a higher risk of toxicities. In 8 out of 14 studies focusing on fluoropyrimidine treatments, a higher folate status and intake were associated with a higher risk of toxicities. These findings might explain interindividual differences in treatment tolerance and highlight the importance of evaluating nutritional status in oncology care.
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Affiliation(s)
- Nienke R K Zwart
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Mira D Franken
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Wim J E Tissing
- Prinses Máxima Centre for Pediatric Oncology, Utrecht, the Netherlands
| | - Floor J E Lubberman
- Department of Clinical Pharmacy, Hospital Gelderse Vallei, Ede, the Netherlands
| | - Jill A McKay
- Department of Applied Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Dieuwertje E Kok
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands.
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12
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Vidra N, Beeren I, van Zutphen M, Aben KK, Kampman E, Witjes JA, van der Heijden AG, Kiemeney LA, Vrieling A. Longitudinal associations of adherence to lifestyle recommendations and health-related quality of life in patients with non-muscle invasive bladder cancer. Int J Cancer 2023; 152:2032-2042. [PMID: 36594579 DOI: 10.1002/ijc.34418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 12/11/2022] [Accepted: 12/19/2022] [Indexed: 01/04/2023]
Abstract
Although the role of lifestyle in health-related quality of life (HRQoL) outcomes has been increasingly recognized for various types of cancer, evidence in patients with non-muscle invasive bladder cancer (NMIBC) is very limited. We aimed to evaluate the longitudinal association between adherence to the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) lifestyle recommendations and HRQoL in patients with NMIBC. This study included 1029 patients with NMIBC recruited between May 2014 and April 2017 from the Dutch multi-centre prospective cohort study UroLife. Lifestyle and HRQoL data were collected at 6 weeks (baseline), 3 months and 15 months after diagnosis. Information on body mass index (BMI), physical activity, diet and alcohol was used to compute the standardized WCRF/AICR adherence score (0-7). HRQoL outcomes were evaluated by the EORTC QLQ-C30. Linear mixed models were used to assess longitudinal confounder-adjusted associations between the WCRF/AICR adherence score and HRQoL outcomes. Adherence to each additional WCRF/AICR recommendation was associated with better global quality of life, physical, role and social functioning, and less fatigue. We found stronger inter-individual than intra-individual associations, suggesting that associations were mainly driven by between-subject differences. Higher adherence to the BMI, physical activity and dietary recommendations was associated with better scores for most HRQoL outcomes, while adherence to the alcohol recommendation (ie, non-consumption) was associated with worse HRQoL. Following the WCRF/AICR lifestyle recommendations may improve HRQoL in patients with NMIBC. Intervention studies are needed to establish whether the association between lifestyle and HRQoL is causal.
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Affiliation(s)
- Nikoletta Vidra
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ivy Beeren
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Moniek van Zutphen
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Katja K Aben
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - J Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Lambertus A Kiemeney
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alina Vrieling
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
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13
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Gigic B, Ose J, Brezina S, Geijsen AJMR, Ulvik A, van Roekel EH, Holowatyj AN, Kok DE, van Duijnhoven FJB, Damerell V, Li CI, Habermann N, Ulrich AB, Weijenberg MP, Gsur A, Ueland PM, Kampman E, Schneider M, Ulrich CM. Abstract 1010: Circulating biomarkers of vitamin B1, B2, and B3 status and their associations with clinical outcomes among non-metastatic colorectal cancer patients: results from the FOCUS Consortium. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-1010] [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: 04/07/2023]
Abstract
Abstract
Introduction: Circulating levels of biomarkers indicating better B vitamin status appear to have a protective effect on various medical conditions, while they also contribute to the reduction in risk of some cancer entities, e.g. colorectal cancer (CRC). However, little is known about the associations of circulating vitamin B biomarkers with clinical outcomes among CRC patients, such as overall survival (OS), disease-free survival (DFS), and risk of recurrence. Recently, we showed that higher vitamin B6 status is associated with improved OS and DFS. In the present study, we further investigated associations of vitamin B1, B2, and B3 status with clinical outcomes in a prospective cohort of non-metastatic CRC patients.
Materials and Methods: A total of 2,102 patients with stage I-III CRC participated in six cohorts in the international FOCUS Consortium. Circulating concentrations of vitamin B biomarkers (thiamine and thiamine monophosphate (representing vitamin B1), riboflavin (vitamin B2), and vitamin B3 markers N1-methylnicotinamide and nicotinamide were measured by liquid chromatography-tandem mass spectrometry in preoperative blood samples. Using Cox proportional hazards regression, we examined associations of vitamin B1, B2, B3 status, and related biomarkers with OS, DFS, and risk of recurrence. Models were adjusted for patient age, sex, circulating creatinine levels, tumor site, tumor stage, and study site.
Results and Discussion: After a median follow-up of 3.2 years for OS, higher levels of thiamine monophosphate were associated with lower risk of all-cause mortality (HROS: 0.82; 95% CI, 0.71-0.95, p=0.008). Furthermore, higher riboflavin levels were associated with improved OS (HROS: 0.88; 95% CI, 0.78-0.98, p=0.03) and DFS (HRDFS: 0.91; 95% CI, 0.83-0.99, p=0.04). We did not observe any associations of thiamine, N1-methylnicotinamide, and nicotinamide with clinical outcomes among CRC patients.
Conclusion: Findings from this multi-centre study of non-metastatic CRC patients yield important clinical information. We observed significantly improved OS among patients with higher levels of thiamine monophosphate after CRC diagnosis. Further, higher preoperative riboflavin may represent a promising predictor for OS and DFS among non-metastatic CRC patients.
Citation Format: Biljana Gigic, Jennifer Ose, Stefanie Brezina, Anne JMR Geijsen, Arve Ulvik, Eline H. van Roekel, Andreana N. Holowatyj, Dieuwertje E. Kok, Fränzel JB van Duijnhoven, Victoria Damerell, Christopher I. Li, Nina Habermann, Alexis B. Ulrich, Matty P. Weijenberg, Andrea Gsur, Per M. Ueland, Ellen Kampman, Martin Schneider, Cornelia M. Ulrich. Circulating biomarkers of vitamin B1, B2, and B3 status and their associations with clinical outcomes among non-metastatic colorectal cancer patients: results from the FOCUS Consortium [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1010.
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Affiliation(s)
- Biljana Gigic
- 1Heidelberg University Hospital (UKHD), Heidelberg, Germany
| | | | | | | | | | | | | | | | | | | | | | - Nina Habermann
- 9European Molecular Biology Laboratory (EMBL), Heidelberg, Germany
| | | | | | - Andrea Gsur
- 3Medical University of Vienna, Vienna, Austria
| | | | - Ellen Kampman
- 4Wageningen University & Research, Wageningen, Netherlands
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Kok DE, Kers JG, Boshuizen HC, Klaassen N, van Halteren HK, Kruyt FM, Smidt ML, De Wilt JH, Boleij A, Kampman E, Zoetendal EG. Abstract 4380: Pre- and postoperative fecal microbiota and its association with complications after surgery in colon cancer patients. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-4380] [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: 04/07/2023]
Abstract
Abstract
Introduction: Postoperative complications impact morbidity and mortality of colon cancer patients. Emerging evidence suggests that intestinal microbiota might play a critical role in the development of postoperative complications after gastrointestinal surgery. Here, we studied changes in fecal microbiota composition comparing samples collected before and after colon cancer surgery. Moreover, we examined whether the microbiota composition before surgery was associated with postoperative complications, and we explored potential determinants of the preoperative microbiota in colon cancer patients.
Methods: For this study, two fecal samples were provided by 78 patients with colon cancer. The first (preoperative) sample was collected shortly after diagnosis and before (median and interquartile (IQR) range of 4 (2-6) days) colon cancer surgery. The second (postoperative) sample was collected approximately 6 weeks (median and IQR of 42 (37-47) days) after surgery and before start of adjuvant chemotherapy (whenever applicable). Based on 16S ribosomal RNA gene amplicon sequencing, the fecal microbiota diversity and composition were determined. Preoperative microbiota composition of patients who developed postoperative complications in the 30 days following surgery (n=18, 23%) was compared to those who did not (n=60, 77%) using univariate and multivariate analyses. Explorative random forest analyses were conducted to identify predictors of complication status, with relative abundance of the core genera, sex, age, fecal calprotectin levels, dietary fiber intake, body mass index, smoking status, ASA classification, cancer stage and tumor location being considered as potential predictors.
Results: After surgery, microbial alpha diversity was reduced compared to the preoperative situation, whereas compositional changes over time only reached statistical significance for Lachnospiraceae NK4A136 and Coprococcus 1, which both decreased in relative abundance after surgery. Already before the start of surgery, relative abundance of the genera Bacteroides (10% vs 6%) and Lachnoclostridium (0.6% vs 0.2%) appeared to be higher in patients with complications versus those with uncomplicated recovery. In a prediction analysis, current smoking and relative abundance of Lachnoclostridium were identified as most profound predictors of complication status. Fecal calprotectin levels and current smoking status explained most (together 6%) of the overall variation in microbiota composition before surgery.
Conclusion: In this study, higher relative abundances of the genera Bacteroides and Lachnoclostridium before surgery were associated with postoperative complications in patients with colon cancer. Future studies should expand on the potential causal and pathogenic routes underlying these observations.
Citation Format: Dieuwertje E. Kok, Jannigje G. Kers, Hendriek C. Boshuizen, Niels Klaassen, Henk K. van Halteren, Flip M. Kruyt, Marjolein L. Smidt, Johannes H. De Wilt, Annemarie Boleij, Ellen Kampman, Erwin G. Zoetendal. Pre- and postoperative fecal microbiota and its association with complications after surgery in colon cancer patients. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4380.
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Affiliation(s)
| | | | | | - Niels Klaassen
- 1Wageningen University & Research, Wageningen, Netherlands
| | | | | | - Marjolein L. Smidt
- 4Maastricht University Medical Center & GROW School for Oncology, Maastricht, Netherlands
| | | | | | - Ellen Kampman
- 1Wageningen University & Research, Wageningen, Netherlands
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Hoedjes M, Vrieling A, de Brauwer L, Visser A, Gómez García E, Hoogerbrugge N, Kampman E. Determinants of adherence to recommendations on physical activity, red and processed meat intake, and body weight among lynch syndrome patients. Fam Cancer 2023; 22:155-166. [PMID: 36151358 PMCID: PMC10020312 DOI: 10.1007/s10689-022-00315-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 02/04/2022] [Accepted: 08/30/2022] [Indexed: 11/26/2022]
Abstract
This study aimed to identify determinants of adherence to lifestyle and body weight recommendations for cancer prevention among Lynch Syndrome (LS) patients. Cross-sectional baseline data of LS patients participating in the Lifestyle & Lynch (LiLy) study was used to assess determinants of adherence to the World Cancer Research Fund cancer prevention recommendations on body weight, physical activity, and red and processed meat intake. Adherence and potential determinants of adherence were assessed using questionnaires. Multivariable logistic regression analyses were conducted to identify determinants of adherence. Of the 211 participants, 50.2% adhered to the body weight recommendation, 78.7% adhered to the physical activity recommendation, and 33.6% adhered to the red and processed meat recommendation. Being younger and having a higher level of education were associated with adherence to the recommendation on body weight. Having knowledge about the recommendation was associated with adherence to the recommendations on physical activity and red and processed meat. Results confirm that knowledge about recommendations for cancer prevention is an important determinant for adherence and suggest that strategies to increase knowledge should be included in lifestyle promotion targeted at LS patients, along with behavior change techniques influencing other modifiable determinants.
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Affiliation(s)
- M Hoedjes
- Center of Research on Psychological and Somatic disorders, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands.
| | - A Vrieling
- Department for Health Evidence, Radboud university medical center, Nijmegen, The Netherlands
| | - L de Brauwer
- Center of Research on Psychological and Somatic disorders, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands
| | - A Visser
- Department for Health Evidence, Radboud university medical center, Nijmegen, The Netherlands
| | - E Gómez García
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - N Hoogerbrugge
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - E Kampman
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands
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16
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Arron MNN, Custers JAE, van Goor H, van Duijnhoven FJB, Kampman E, Kouwenhoven EA, de Wilt JHW, Kok DE. The association between anastomotic leakage and health-related quality of life after colorectal cancer surgery. Colorectal Dis 2023. [PMID: 36999516 DOI: 10.1111/codi.16543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 04/01/2023]
Abstract
AIM Colorectal anastomotic leakage (AL) is a serious complication. Studies on the impact of AL on health-related quality of life (HRQoL) are scarce. We aimed to investigate the association between AL and HRQoL in colorectal cancer patients up to 2 years after diagnosis, and to evaluate whether AL is associated with a clinically relevant decrease in HRQoL over time. METHODS Patients diagnosed with Stage I-III colorectal cancer undergoing elective surgical resection with primary anastomosis between 2010 and 2017 were included. HRQoL was evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30, represented by the summary score, and analysed at diagnosis and at 6 months and 2 years post-diagnosis. Multivariable linear regression was performed to assess the association between AL and HRQoL, while multivariable logistic regression was used to investigate the association between AL and a clinically relevant HRQoL decrease (≥10 points) during follow-up compared to the time of diagnosis. RESULTS In total, 1197 patients were included of whom 63 (5%) developed AL. AL was not associated with HRQoL at 6 months post-diagnosis nor at 2 years post-diagnosis. However, having AL was associated with an increased risk of a clinically relevant decrease in HRQoL at 6 months post-diagnosis (OR 3.65, 95% CI 1.62-8.21) but not at 2 years after diagnosis (OR 1.91, 95% CI 0.62-5.93). CONCLUSION Although AL was not associated with HRQoL at 6 months or 2 years post-diagnosis, AL was a determinant of a clinically relevant decrease in HRQoL at 6 months after diagnosis. Future work should identify feasible and effective strategies to prevent declines in QoL in this patient population.
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Affiliation(s)
- Melissa N N Arron
- Department of Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Jose A E Custers
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | | | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | | | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Dieuwertje E Kok
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
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Maurits JSF, Sedelaar JPM, Aben KKH, Kampman E, Kiemeney LALM, Vrieling A. Cohort profile - the Renal cell cancer: Lifestyle, prognosis and quality of life (ReLife) study in the Netherlands. BMJ Open 2023; 13:e066909. [PMID: 36972960 PMCID: PMC10069500 DOI: 10.1136/bmjopen-2022-066909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
PURPOSE The Renal cell cancer: Lifestyle, prognosis and quality of life (ReLife) study is set up to obtain insight into the association of patient and tumour characteristics, lifestyle habits and circulating biomarkers with body composition features in patients with localised renal cell cancer (RCC). Further, it aims to assess the association of body composition features, lifestyle habits and circulating biomarkers with clinical outcomes, including health-related quality of life. PARTICIPANTS The ReLife study is a multicentre prospective cohort study involving 368 patients with newly diagnosed stages I-III RCC recruited from January 2018 to June 2021 from 18 hospitals in the Netherlands. At 3 months, 1 year and 2 years after treatment, participants fill out a general questionnaire and questionnaires about their lifestyle habits (eg, diet, physical activity, smoking and alcohol consumption), medical history and health-related quality of life. At all three time points, patients wear an accelerometer and have blood samples taken. CT scans for body composition analysis are being collected. Permission is asked for collection of tumour samples. Information about disease characteristics, treatment of the primary tumour and clinical outcomes is being collected from medical records by the Netherlands Cancer Registry. FINDINGS TO DATE A total of 836 invited patients were eligible and 368 patients were willing to participate and were included (response rate 44%). The mean age of patients was 62.5±9.0 years and 70% was male. The majority had stage I (65%) disease and were treated with radical nephrectomy (57%). Data collection at 3 months and 1 years after treatment have been finalised. FUTURE PLANS Data collection at 2 years after treatment is expected to be finalised in June 2023 and longitudinal clinical data will continue to be collected. Results of studies based on this cohort are important to develop personalised evidence-based lifestyle advice for patients with localised RCC to enable them to get more control over their disease course.
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Affiliation(s)
- Jake S F Maurits
- Department for Health Evidence, Radboud Univerity Medical Center, Nijmegen, The Netherlands
| | - J P Michiel Sedelaar
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Katja K H Aben
- Department for Health Evidence, Radboud Univerity Medical Center, Nijmegen, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Ellen Kampman
- Department for Health Evidence, Radboud Univerity Medical Center, Nijmegen, The Netherlands
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | | | - Alina Vrieling
- Department for Health Evidence, Radboud Univerity Medical Center, Nijmegen, The Netherlands
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18
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Cariolou M, Abar L, Aune D, Balducci K, Becerra‐Tomás N, Greenwood DC, Markozannes G, Nanu N, Vieira R, Giovannucci EL, Gunter MJ, Jackson AA, Kampman E, Lund V, Allen K, Brockton NT, Croker H, Katsikioti D, McGinley‐Gieser D, Mitrou P, Wiseman M, Cross AJ, Riboli E, Clinton SK, McTiernan A, Norat T, Tsilidis KK, Chan DSM. Postdiagnosis recreational physical activity and breast cancer prognosis: Global Cancer Update Programme (CUP Global) systematic literature review and meta-analysis. Int J Cancer 2023; 152:600-615. [PMID: 36279903 PMCID: PMC10091720 DOI: 10.1002/ijc.34324] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [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] [Received: 10/04/2021] [Revised: 09/20/2022] [Accepted: 09/23/2022] [Indexed: 02/01/2023]
Abstract
It is important to clarify the associations between modifiable lifestyle factors such as physical activity and breast cancer prognosis to enable the development of evidence-based survivorship recommendations. We performed a systematic review and meta-analyses to summarise the evidence on the relationship between postbreast cancer diagnosis physical activity and mortality, recurrence and second primary cancers. We searched PubMed and Embase through 31st October 2021 and included 20 observational studies and three follow-up observational analyses of patients enrolled in clinical trials. In linear dose-response meta-analysis of the observational studies, each 10-unit increase in metabolic equivalent of task (MET)-h/week higher recreational physical activity was associated with 15% and 14% lower risk of all-cause (95% confidence interval [CI]: 8%-22%, studies = 12, deaths = 3670) and breast cancer-specific mortality (95% CI: 4%-23%, studies = 11, deaths = 1632), respectively. Recreational physical activity was not associated with breast cancer recurrence (HR = 0.97, 95% CI: 0.91-1.05, studies = 6, deaths = 1705). Nonlinear dose-response meta-analyses indicated 48% lower all-cause and 38% lower breast cancer-specific mortality with increasing recreational physical activity up to 20 MET-h/week, but little further reduction in risk at higher levels. Predefined subgroup analyses across strata of body mass index, hormone receptors, adjustment for confounders, number of deaths, menopause and physical activity intensities were consistent in direction and magnitude to the main analyses. Considering the methodological limitations of the included studies, the independent Expert Panel concluded 'limited-suggestive' likelihood of causality for an association between recreational physical activity and lower risk of all-cause and breast cancer-specific mortality.
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Affiliation(s)
- Margarita Cariolou
- Department of Epidemiology and BiostatisticsSchool of Public Health, Faculty of Medicine, Imperial College LondonLondonUK
| | - Leila Abar
- Department of Epidemiology and BiostatisticsSchool of Public Health, Faculty of Medicine, Imperial College LondonLondonUK
| | - Dagfinn Aune
- Department of Epidemiology and BiostatisticsSchool of Public Health, Faculty of Medicine, Imperial College LondonLondonUK
- Department of NutritionBjørknes University CollegeOsloNorway
- Department of EndocrinologyMorbid Obesity and Preventive Medicine, Oslo University HospitalOsloNorway
- Unit of Cardiovascular and Nutritional EpidemiologyInstitute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| | - Katia Balducci
- Department of Epidemiology and BiostatisticsSchool of Public Health, Faculty of Medicine, Imperial College LondonLondonUK
| | - Nerea Becerra‐Tomás
- Department of Epidemiology and BiostatisticsSchool of Public Health, Faculty of Medicine, Imperial College LondonLondonUK
| | - Darren C. Greenwood
- Leeds Institute for Data Analytics, Faculty of Medicine and HealthUniversity of LeedsLeedsUK
| | - Georgios Markozannes
- Department of Epidemiology and BiostatisticsSchool of Public Health, Faculty of Medicine, Imperial College LondonLondonUK
- Department of Hygiene and EpidemiologyUniversity of Ioannina Medical SchoolIoanninaGreece
| | - Neesha Nanu
- Department of Epidemiology and BiostatisticsSchool of Public Health, Faculty of Medicine, Imperial College LondonLondonUK
| | - Rita Vieira
- Department of Epidemiology and BiostatisticsSchool of Public Health, Faculty of Medicine, Imperial College LondonLondonUK
| | - Edward L. Giovannucci
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Department of NutritionHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Marc J. Gunter
- Nutrition and Metabolism SectionInternational Agency for Research on CancerLyonFrance
| | - Alan A. Jackson
- Faculty of Medicine, School of Human Development and HealthUniversity of SouthamptonSouthamptonUK
- National Institute of Health Research Cancer and Nutrition CollaborationSouthamptonUK
| | - Ellen Kampman
- Division of Human Nutrition and HealthWageningen University & ResearchWageningenThe Netherlands
| | - Vivien Lund
- World Cancer Research Fund InternationalLondonUK
| | - Kate Allen
- World Cancer Research Fund InternationalLondonUK
| | | | - Helen Croker
- World Cancer Research Fund InternationalLondonUK
| | | | | | | | | | - Amanda J. Cross
- Department of Epidemiology and BiostatisticsSchool of Public Health, Faculty of Medicine, Imperial College LondonLondonUK
| | - Elio Riboli
- Department of Epidemiology and BiostatisticsSchool of Public Health, Faculty of Medicine, Imperial College LondonLondonUK
| | - Steven K. Clinton
- Division of Medical Oncology, The Department of Internal MedicineCollege of Medicine and Ohio State University Comprehensive Cancer Center, Ohio State UniversityColumbusOhioUSA
| | - Anne McTiernan
- Division of Public Health SciencesFred Hutchinson Cancer Research CenterSeattleWashingtonUSA
| | - Teresa Norat
- Department of Epidemiology and BiostatisticsSchool of Public Health, Faculty of Medicine, Imperial College LondonLondonUK
- World Cancer Research Fund InternationalLondonUK
| | - Konstantinos K. Tsilidis
- Department of Epidemiology and BiostatisticsSchool of Public Health, Faculty of Medicine, Imperial College LondonLondonUK
- Department of Hygiene and EpidemiologyUniversity of Ioannina Medical SchoolIoanninaGreece
| | - Doris S. M. Chan
- Department of Epidemiology and BiostatisticsSchool of Public Health, Faculty of Medicine, Imperial College LondonLondonUK
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Becerra‐Tomás N, Balducci K, Abar L, Aune D, Cariolou M, Greenwood DC, Markozannes G, Nanu N, Vieira R, Giovannucci EL, Gunter MJ, Jackson AA, Kampman E, Lund V, Allen K, Brockton NT, Croker H, Katsikioti D, McGinley‐Gieser D, Mitrou P, Wiseman M, Cross AJ, Riboli E, Clinton SK, McTiernan A, Norat T, Tsilidis KK, Chan DSM. Postdiagnosis dietary factors, supplement use and breast cancer prognosis: Global Cancer Update Programme (CUP Global) systematic literature review and meta-analysis. Int J Cancer 2023; 152:616-634. [PMID: 36279902 PMCID: PMC10092903 DOI: 10.1002/ijc.34321] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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] [Received: 10/04/2021] [Revised: 09/20/2022] [Accepted: 09/23/2022] [Indexed: 02/01/2023]
Abstract
Little is known about how diet might influence breast cancer prognosis. The current systematic reviews and meta-analyses summarise the evidence on postdiagnosis dietary factors and breast cancer outcomes from randomised controlled trials and longitudinal observational studies. PubMed and Embase were searched through 31st October 2021. Random-effects linear dose-response meta-analysis was conducted when at least three studies with sufficient information were available. The quality of the evidence was evaluated by an independent Expert Panel. We identified 108 publications. No meta-analysis was conducted for dietary patterns, vegetables, wholegrains, fish, meat, and supplements due to few studies, often with insufficient data. Meta-analysis was only possible for all-cause mortality with dairy, isoflavone, carbohydrate, dietary fibre, alcohol intake and serum 25-hydroxyvitamin D (25(OH)D), and for breast cancer-specific mortality with fruit, dairy, carbohydrate, protein, dietary fat, fibre, alcohol intake and serum 25(OH)D. The results, with few exceptions, were generally null. There was limited-suggestive evidence that predefined dietary patterns may reduce the risk of all-cause and other causes of death; that isoflavone intake reduces the risk of all-cause mortality (relative risk (RR) per 2 mg/day: 0.96, 95% confidence interval (CI): 0.92-1.02), breast cancer-specific mortality (RR for high vs low: 0.83, 95% CI: 0.64-1.07), and recurrence (RR for high vs low: 0.75, 95% CI: 0.61-0.92); that dietary fibre intake decreases all-cause mortality (RR per 10 g/day: 0.87, 95% CI: 0.80-0.94); and that serum 25(OH)D is inversely associated with all-cause and breast cancer-specific mortality (RR per 10 nmol/L: 0.93, 95% CI: 0.89-0.97 and 0.94, 95% CI: 0.90-0.99, respectively). The remaining associations were graded as limited-no conclusion.
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Affiliation(s)
- Nerea Becerra‐Tomás
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
| | - Katia Balducci
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
| | - Leila Abar
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
- Department of NutritionBjørknes University CollegeOsloNorway
- Department of EndocrinologyMorbid Obesity and Preventive Medicine, Oslo University HospitalOsloNorway
- Unit of Cardiovascular and Nutritional EpidemiologyInstitute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| | - Margarita Cariolou
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
| | - Darren C. Greenwood
- Leeds Institute for Data Analytics, Faculty of Medicine and HealthUniversity of LeedsLeedsUK
| | - Georgios Markozannes
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
- Department of Hygiene and EpidemiologyUniversity of Ioannina Medical SchoolIoanninaGreece
| | - Neesha Nanu
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
| | - Rita Vieira
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
| | - Edward L. Giovannucci
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Department of NutritionHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Marc J. Gunter
- Nutrition and Metabolism SectionInternational Agency for Research on CancerLyonFrance
| | - Alan A. Jackson
- Faculty of Medicine, School of Human Development and HealthUniversity of SouthamptonSouthamptonUK
- National Institute of Health Research Cancer and Nutrition CollaborationSouthamptonUK
| | - Ellen Kampman
- Division of Human Nutrition and HealthWageningen University & ResearchWageningenThe Netherlands
| | - Vivien Lund
- World Cancer Research Fund InternationalLondonUK
| | - Kate Allen
- World Cancer Research Fund InternationalLondonUK
| | | | - Helen Croker
- World Cancer Research Fund InternationalLondonUK
| | | | | | | | | | - Amanda J. Cross
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
| | - Steven K. Clinton
- Division of Medical Oncology, The Department of Internal MedicineCollege of Medicine and Ohio State University Comprehensive Cancer Center, Ohio State UniversityColumbusOhioUSA
| | - Anne McTiernan
- Division of Public Health SciencesFred Hutchinson Cancer Research CenterSeattleWashingtonUSA
| | - Teresa Norat
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
- World Cancer Research Fund InternationalLondonUK
| | - Konstantinos K. Tsilidis
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
- Department of Hygiene and EpidemiologyUniversity of Ioannina Medical SchoolIoanninaGreece
| | - Doris S. M. Chan
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
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20
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Tsilidis KK, Cariolou M, Becerra‐Tomás N, Balducci K, Vieira R, Abar L, Aune D, Markozannes G, Nanu N, Greenwood DC, Giovannucci EL, Gunter MJ, Jackson AA, Kampman E, Lund V, Allen K, Brockton NT, Croker H, Katsikioti D, McGinley‐Gieser D, Mitrou P, Wiseman M, Cross AJ, Riboli E, Clinton SK, McTiernan A, Norat T, Chan DSM. Postdiagnosis body fatness, recreational physical activity, dietary factors and breast cancer prognosis: Global Cancer Update Programme (CUP Global) summary of evidence grading. Int J Cancer 2023; 152:635-644. [PMID: 36279885 PMCID: PMC10092557 DOI: 10.1002/ijc.34320] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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] [Received: 07/29/2022] [Revised: 09/20/2022] [Accepted: 09/23/2022] [Indexed: 02/01/2023]
Abstract
Based on the Global Cancer Update Programme, formally known as the World Cancer Research Fund/American Institute for Cancer Research Continuous Update Project, we performed systematic reviews and meta-analyses to investigate the association of postdiagnosis body fatness, physical activity and dietary factors with breast cancer prognosis. We searched PubMed and Embase for randomised controlled trials and longitudinal observational studies from inception to 31 October 2021. We calculated summary relative risks (RRs) and 95% confidence intervals (CIs) using random-effects meta-analyses. An independent Expert Panel graded the quality of evidence according to predefined criteria. The evidence on postdiagnosis body fatness and higher all-cause mortality (RR per 5 kg/m2 in body mass index: 1.07, 95% CI: 1.05-1.10), breast cancer-specific mortality (RR: 1.10, 95% CI: 1.06-1.14) and second primary breast cancer (RR: 1.14, 95% CI: 1.04-1.26) was graded as strong (likelihood of causality: probable). The evidence for body fatness and breast cancer recurrence and other nonbreast cancer-related mortality was graded as limited (likelihood of causality: limited-suggestive). The evidence on recreational physical activity and lower risk of all-cause (RR per 10 metabolic equivalent of task-hour/week: 0.85, 95% CI: 0.78-0.92) and breast cancer-specific mortality (RR: 0.86, 95% CI: 0.77-0.96) was judged as limited-suggestive. Data on dietary factors was limited, and no conclusions could be reached except for healthy dietary patterns, isoflavone and dietary fibre intake and serum 25(OH)D concentrations that were graded with limited-suggestive evidence for lower risk of the examined outcomes. Our results encourage the development of lifestyle recommendations for breast cancer patients to avoid obesity and be physically active.
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Affiliation(s)
- Konstantinos K. Tsilidis
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
- Department of Hygiene and EpidemiologyUniversity of Ioannina Medical SchoolIoanninaGreece
| | - Margarita Cariolou
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
| | - Nerea Becerra‐Tomás
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
| | - Katia Balducci
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
| | - Rita Vieira
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
| | - Leila Abar
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
- Department of NutritionBjørknes University CollegeOsloNorway
- Department of Endocrinology, Morbid Obesity and Preventive MedicineOslo University HospitalOsloNorway
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental MedicineKarolinska InstitutetStockholmSweden
| | - Georgios Markozannes
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
- Department of Hygiene and EpidemiologyUniversity of Ioannina Medical SchoolIoanninaGreece
| | - Neesha Nanu
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
| | - Darren C. Greenwood
- Leeds Institute for Data Analytics, Faculty of Medicine and HealthUniversity of LeedsLeedsUK
| | - Edward L. Giovannucci
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Department of NutritionHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Marc J. Gunter
- Nutrition and Metabolism SectionInternational Agency for Research on CancerLyonFrance
| | - Alan A. Jackson
- Faculty of Medicine, School of Human Development and HealthUniversity of SouthamptonSouthamptonUK
- National Institute of Health Research Cancer and Nutrition CollaborationSouthamptonUK
| | - Ellen Kampman
- Division of Human Nutrition and HealthWageningen University & ResearchWageningenThe Netherlands
| | - Vivien Lund
- World Cancer Research Fund InternationalLondonUK
| | - Kate Allen
- World Cancer Research Fund InternationalLondonUK
| | | | - Helen Croker
- World Cancer Research Fund InternationalLondonUK
| | | | | | | | | | - Amanda J. Cross
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
| | - Steven K. Clinton
- Division of Medical Oncology, The Department of Internal Medicine, College of Medicine and Ohio State University Comprehensive Cancer CenterOhio State UniversityColumbusOhioUSA
| | - Anne McTiernan
- Division of Public Health SciencesFred Hutchinson Cancer Research CenterSeattleWashingtonUSA
| | - Teresa Norat
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
- World Cancer Research Fund InternationalLondonUK
| | - Doris S. M. Chan
- Department of Epidemiology and Biostatistics, School of Public HealthImperial College LondonLondonUK
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21
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Chan DS, Vieira R, Abar L, Aune D, Balducci K, Cariolou M, Greenwood DC, Markozannes G, Nanu N, Becerra‐Tomás N, Giovannucci EL, Gunter MJ, Jackson AA, Kampman E, Lund V, Allen K, Brockton NT, Croker H, Katsikioti D, McGinley‐Gieser D, Mitrou P, Wiseman M, Cross AJ, Riboli E, Clinton SK, McTiernan A, Norat T, Tsilidis KK. Postdiagnosis body fatness, weight change and breast cancer prognosis: Global Cancer Update Program (CUP global) systematic literature review and meta-analysis. Int J Cancer 2023; 152:572-599. [PMID: 36279884 PMCID: PMC10092239 DOI: 10.1002/ijc.34322] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 10/04/2021] [Revised: 07/29/2022] [Accepted: 09/05/2022] [Indexed: 02/01/2023]
Abstract
Previous evidence on postdiagnosis body fatness and mortality after breast cancer was graded as limited-suggestive. To evaluate the evidence on body mass index (BMI), waist circumference, waist-hip-ratio and weight change in relation to breast cancer prognosis, an updated systematic review was conducted. PubMed and Embase were searched for relevant studies published up to 31 October, 2021. Random-effects meta-analyses were conducted to estimate summary relative risks (RRs). The evidence was judged by an independent Expert Panel using pre-defined grading criteria. One randomized controlled trial and 225 observational studies were reviewed (220 publications). There was strong evidence (likelihood of causality: probable) that higher postdiagnosis BMI was associated with increased all-cause mortality (64 studies, 32 507 deaths), breast cancer-specific mortality (39 studies, 14 106 deaths) and second primary breast cancer (11 studies, 5248 events). The respective summary RRs and 95% confidence intervals per 5 kg/m2 BMI were 1.07 (1.05-1.10), 1.10 (1.06-1.14) and 1.14 (1.04-1.26), with high between-study heterogeneity (I2 = 56%, 60%, 66%), but generally consistent positive associations. Positive associations were also observed for waist circumference, waist-hip-ratio and all-cause and breast cancer-specific mortality. There was limited-suggestive evidence that postdiagnosis BMI was associated with higher risk of recurrence, nonbreast cancer deaths and cardiovascular deaths. The evidence for postdiagnosis (unexplained) weight or BMI change and all outcomes was graded as limited-no conclusion. The RCT showed potential beneficial effect of intentional weight loss on disease-free-survival, but more intervention trials and well-designed observational studies in diverse populations are needed to elucidate the impact of body composition and their changes on breast cancer outcomes.
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Affiliation(s)
- Doris S.M. Chan
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Rita Vieira
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Leila Abar
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Dagfinn Aune
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- Department of NutritionBjørknes University CollegeOsloNorway
- Department of Endocrinology, Morbid Obesity and Preventive MedicineOslo University HospitalOsloNorway
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| | - Katia Balducci
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Margarita Cariolou
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Darren C. Greenwood
- Leeds Institute for Data Analytics, Faculty of Medicine and HealthUniversity of LeedsLeedsUK
| | - Georgios Markozannes
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- Department of Hygiene and EpidemiologyUniversity of Ioannina Medical SchoolIoanninaGreece
| | - Neesha Nanu
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Nerea Becerra‐Tomás
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Edward L. Giovannucci
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Department of Nutrition, Harvard T. H. Chan School of Public HealthBostonMassachusettsUSA
| | - Marc J. Gunter
- Nutrition and Metabolism Section, International Agency for Research on CancerLyonFrance
| | - Alan A. Jackson
- Faculty of Medicine, School of Human Development and HealthUniversity of SouthamptonSouthamptonUK
- National Institute of Health Research Cancer and Nutrition CollaborationSouthamptonUK
| | - Ellen Kampman
- Division of Human Nutrition and HealthWageningen University & ResearchWageningenThe Netherlands
| | - Vivien Lund
- World Cancer Research Fund InternationalLondonUK
| | - Kate Allen
- World Cancer Research Fund InternationalLondonUK
| | | | - Helen Croker
- World Cancer Research Fund InternationalLondonUK
| | | | | | | | | | - Amanda J. Cross
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Elio Riboli
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Steven K. Clinton
- Division of Medical Oncology, The Department of Internal MedicineCollege of Medicine and Ohio State University Comprehensive Cancer Center, Ohio State UniversityColumbusOhioUSA
| | - Anne McTiernan
- Division of Public Health SciencesFred Hutchinson Cancer Research CenterSeattleWashingtonUSA
| | - Teresa Norat
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- World Cancer Research Fund InternationalLondonUK
| | - Konstantinos K. Tsilidis
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- Department of Hygiene and EpidemiologyUniversity of Ioannina Medical SchoolIoanninaGreece
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22
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van Zutphen M, Hof JP, Aben KK, Kampman E, Witjes JA, Kiemeney LA, Vrieling A. Adherence to lifestyle recommendations after non-muscle invasive bladder cancer diagnosis and risk of recurrence. Am J Clin Nutr 2023; 117:681-690. [PMID: 36781128 DOI: 10.1016/j.ajcnut.2022.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/30/2022] [Accepted: 12/19/2022] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Patients with non-muscle invasive bladder cancer (NMIBC) are at a high risk of tumor recurrence. It has not been previously investigated if adherence to cancer prevention recommendations lowers the risk of recurrence. OBJECTIVES We examined whether the standardized lifestyle score measuring adherence to the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention recommendations was associated with the risk of recurrence and progression among patients with NMIBC. METHODS The study population included patients diagnosed with primary NMIBC between 2014 and 2017 from the prospective cohort UroLife. Lifestyle was assessed at baseline (n = 979; reflecting the prediagnosis period) and 3-mo postdiagnosis (n = 885). The standardized 2018 WCRF/AICR score was constructed based on recommendations for body weight, physical activity, diet, and alcohol intake. We computed multivariable-adjusted HRs and 95% CIs using Cox proportional hazard regression models. RESULTS During a median follow-up time of 3.7 y, 320 patients developed ≥1 recurrence(s) and 49 experienced progression. Patients in the highest compared with the lowest tertile of postdiagnosis WCRF/AICR scores had a lower risk of first bladder cancer recurrence (HR: 0.74; 95% CI: 0.56, 0.98). No associations were observed for multiple recurrences (HR: 0.90; 95% CI: 0.70, 1.15) or for the baseline score with either first (HR: 1.07; 95% CI: 0.82, 1.40) or multiple recurrences (HR: 1.04; 95% CI: 0.82, 1.31). Improving lifestyle after diagnosis (per 1-point increase) was not significantly associated with the risk of first or multiple recurrence(s) (HR: 0.87; 95% CI: 0.74, 1.02; HR: 0.93; 95% CI: 0.80, 1.08, respectively). No associations were observed for bladder cancer progression, but the power was limited. CONCLUSIONS Better adherence to the WCRF/AICR cancer prevention recommendations 3 mo after NMIBC diagnosis, but not before diagnosis, is associated with a decreased risk of first bladder cancer recurrence. More studies evaluating postdiagnosis lifestyles are needed to provide solid support for lifestyle recommendations for cancer survivors.
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Affiliation(s)
- Moniek van Zutphen
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jasper P Hof
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Katja Kh Aben
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands; Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - J Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lambertus Alm Kiemeney
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alina Vrieling
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
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23
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Malcomson FC, Parra-Soto S, Lu L, Ho FK, Perez-Cornago A, Shams-White MM, van Zutphen M, Kampman E, Winkels RM, Mitrou P, Wiseman M, Romaguera D, Celis-Morales C, Sharp L, Mathers JC. Operationalisation of a standardised scoring system to assess adherence to the World Cancer Research Fund/American Institute for Cancer Research cancer prevention recommendations in the UK biobank. Front Nutr 2023; 10:1011786. [PMID: 36845047 PMCID: PMC9950547 DOI: 10.3389/fnut.2023.1011786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 01/26/2023] [Indexed: 02/12/2023] Open
Abstract
Introduction In 2018, The World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR) published ten evidence-based Cancer Prevention Recommendations designed to reduce the risk of cancer via improved lifestyle behaviours. In 2019, Shams-White and colleagues created the "2018 WCRF/AICR Score" which aimed to standardise how adherence to these recommendations is assessed. The standardised scoring system includes seven of the recommendations concerning weight, physical activity and diet, with an optional eighth recommendation on breastfeeding. To promote transparency and reproducibility, the present paper describes the methodology for operationalisation of the standardised scoring system in the UK Biobank. Methods UK Biobank recruited >500,000 individuals aged 37-73 years, between 2006 and 2010. In 2021, we held a workshop with experts which aimed to reach consensus on how to operationalise the scoring system using data available within UK Biobank. We used data on anthropometric measurements, physical activity and diet to calculate adherence scores. 24 h dietary assessment data were used to measure adherence to the following recommendations: "Eat a diet rich in wholegrains, vegetables, fruit, and beans", "Limit consumption of "fast foods" and other processed foods high in fat, starches or sugars" and "Limit consumption of sugar-sweetened drinks"; food frequency questionnaire data were used to assess adherence to "Limit consumption of red and processed meat" and "Limit alcohol consumption". Participants were allocated points for meeting, partially meeting or not meeting each recommendation, using cut-offs defined in the standardised scoring system. Results At our workshop, discussions included the use of national guidelines to assess adherence to the recommendation on alcohol consumption, as well as challenges faced including defining the adapted ultra-processed food variables. A total score was calculated for 158,415 participants (mean 3.9 points, range 0-7 points). We also describe the methodology to derive a partial 5-point adherence score using data from the food frequency questionnaire in 314,616 participants. Conclusion We describe the methodology used to estimate adherence to the 2018 WCRF/AICR Cancer Prevention Recommendations for participants in the UK Biobank, including some of the challenges faced operationalising the standardised scoring system.
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Affiliation(s)
- Fiona C. Malcomson
- Human Nutrition and Exercise Research Centre, Centre for Healthier Lives, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Solange Parra-Soto
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Liya Lu
- Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Frederick K. Ho
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Aurora Perez-Cornago
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Marissa M. Shams-White
- Risk Factor Assessment Branch, Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, United States
| | - Moniek van Zutphen
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
| | - Renate M. Winkels
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
| | - Panagiota Mitrou
- World Cancer Research Fund International, London, United Kingdom
| | - Martin Wiseman
- World Cancer Research Fund International, London, United Kingdom
| | - Dora Romaguera
- Health Research Institute of the Balearic Islands (IdISBa), Palma de Mallorca, Spain
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Madrid, Spain
| | - Carlos Celis-Morales
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
- Human Performance Lab, Education, Physical Activity and Health Research Unit, University Católica del Maule, Talca, Chile
| | - Linda Sharp
- Centre for Cancer, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - John C. Mathers
- Human Nutrition and Exercise Research Centre, Centre for Healthier Lives, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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24
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Wesselink E, Valk AW, Kok DE, Lanen ASV, de Wilt JH, van Kouwenhoven EA, Schrauwen RW, van Halteren HK, Winkels RM, Balvers MG, Kampman E, van Duijnhoven FJ. Postdiagnostic intake of a more proinflammatory diet is associated with a higher risk of recurrence and all-cause mortality in colorectal cancer survivors. Am J Clin Nutr 2023; 117:243-251. [PMID: 36811565 DOI: 10.1016/j.ajcnut.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/17/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The inflammatory potential of the diet has been associated with colorectal cancer (CRC) risk, but its association with CRC prognosis is unclear. OBJECTIVE To investigate the inflammatory potential of the diet in relation to recurrence and all-cause mortality among persons diagnosed with stage I to III CRC. METHODS Data of the COLON study, a prospective cohort among CRC survivors were used. Dietary intake, 6 mo after diagnosis, was assessed by using a food frequency questionnaire and was available for 1631 individuals. The empirical dietary inflammatory pattern (EDIP) score was used as a proxy for the inflammatory potential of the diet. The EDIP score was created by using reduced rank regression and stepwise linear regression to identify food groups that explained most of the variations in plasma inflammatory markers (IL6, IL8, C-reactive protein, and tumor necrosis factor-α) measured in a subgroup of survivors (n = 421). Multivariable Cox proportional hazard models with restricted cubic splines were used to investigate the relation between the EDIP score and CRC recurrence and all-cause mortality. Models were adjusted for age, sex, BMI, PAL, smoking status, stage of disease, and tumor location. RESULTS The median follow-up time was 2.6 y (IQR: 2.1) for recurrence and 5.6 y (IQR: 3.0) for all-cause mortality, during which 154 and 239 events occurred, respectively. A nonlinear positive association between the EDIP score and recurrence and all-cause mortality was observed. For example, a more proinflammatory diet (EDIP score +0.75) compared with the median (EDIP score 0) was associated with a higher risk of CRC recurrence (HR: 1.15; 95% CI: 1.03, 1.29) and all-cause mortality (HR: 1.23; 95% CI: 1.12, 1.35). CONCLUSIONS A more proinflammatory diet was associated with a higher risk of recurrence and all-cause mortality in CRC survivors. Further intervention studies should investigate whether a switch to a more anti-inflammatory diet improves CRC prognosis.
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Affiliation(s)
- Evertine Wesselink
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands.
| | - Anne-Wil Valk
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Dieuwertje E Kok
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Anne-Sophie van Lanen
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Johannes Hw de Wilt
- Department of Surgery, Radboud University and Medical Centre, Nijmegen, the Netherlands
| | | | - Ruud Wm Schrauwen
- Department of Gastroenterology and Hepatology, Bernhoven Hospital, Uden, the Netherlands
| | - Henk K van Halteren
- Department of Internal Medicine, Admiraal de Ruyter Ziekenhuis, Goes, the Netherlands
| | - Renate M Winkels
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Michiel Gj Balvers
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Fränzel Jb van Duijnhoven
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
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25
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Gigic B, van Roekel E, Holowatyj AN, Brezina S, Geijsen AJMR, Ulvik A, Ose J, Koole JL, Damerell V, Kiblawi R, Gumpenberger T, Lin T, Kvalheim G, Koelsch T, Kok DE, van Duijnhoven FJ, Bours MJ, Baierl A, Li CI, Grady W, Vickers K, Habermann N, Schneider M, Kampman E, Ueland PM, Ulrich A, Weijenberg M, Gsur A, Ulrich C. Cohort profile: Biomarkers related to folate-dependent one-carbon metabolism in colorectal cancer recurrence and survival - the FOCUS Consortium. BMJ Open 2022; 12:e062930. [PMID: 36549742 PMCID: PMC9772678 DOI: 10.1136/bmjopen-2022-062930] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The overarching goal of the FOCUS (biomarkers related to folate-dependent one-carbon metabolism in colorectal cancer (CRC) recurrence and survival) Consortium is to unravel the effect of folate and folate-mediated one-carbon metabolism (FOCM) biomarkers on CRC prognosis to provide clinically relevant advice on folate intake to cancer patients and define future tertiary prevention strategies. PARTICIPANTS The FOCUS Consortium is an international, prospective cohort of 2401 women and men above 18 years of age who were diagnosed with a primary invasive non-metastatic (stages I-III) CRC. The consortium comprises patients from Austria, two sites from the Netherlands, Germany and two sites from the USA. Patients are recruited after CRC diagnosis and followed at 6 and 12 months after enrolment. At each time point, sociodemographic data, data on health behaviour and clinical data are collected, blood samples are drawn. FINDINGS TO DATE An increased risk of cancer recurrences was observed among patients with higher compared with lower circulating folic acid concentrations. Furthermore, specific folate species within the FOCM pathway were associated with both inflammation and angiogenesis pathways among patients with CRC. In addition, higher vitamin B6 status was associated with better quality of life at 6 months post-treatment. FUTURE PLANS Better insights into the research on associations between folate and FOCM biomarkers and clinical outcomes in patients with CRC will facilitate the development of guidelines regarding folate intake in order to provide clinically relevant advice to patients with cancer, health professionals involved in patient care, and ultimately further tertiary prevention strategies in the future. The FOCUS Consortium offers an excellent infrastructure for short-term and long-term research projects and for combining additional biomarkers and data resulting from the individual cohorts within the next years, for example, microbiome data, omics and multiomics data or CT-quantified body composition data.
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Affiliation(s)
- Biljana Gigic
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Eline van Roekel
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Andreana N Holowatyj
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA
| | - Stefanie Brezina
- Center for Cancer Research, Medical University of Vienna, Wien, Austria
| | - Anne J M R Geijsen
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | | | - Jennifer Ose
- Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Janna L Koole
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Victoria Damerell
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Rama Kiblawi
- Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | | | - Tengda Lin
- Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | | | - Torsten Koelsch
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Dieuwertje E Kok
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Franzel J van Duijnhoven
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Martijn J Bours
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Andreas Baierl
- Department of Statistics and Operations Research, University of Vienna, Wien, Austria
| | - Christopher I Li
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - William Grady
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Kathy Vickers
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Nina Habermann
- Genome Biology, European Molecular Biology Laboratory (EMBL), Heidelberg, Germany
| | - Martin Schneider
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | | | - Alexis Ulrich
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
- Surgical Department I, Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Neuss, Germany
| | - Matty Weijenberg
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Andrea Gsur
- Center for Cancer Research, Medical University of Vienna, Wien, Austria
| | - Cornelia Ulrich
- Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
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26
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Révész D, van Kuijk SMJ, Mols F, van Duijnhoven FJB, Winkels RM, Kant IJ, van den Brandt PA, Smits LJ, Breukink SO, Kampman E, Beijer S, Weijenberg MP, Bours MJL. External validation and updating of prediction models for estimating the 1-year risk of low health-related quality of life in colorectal cancer survivors. J Clin Epidemiol 2022; 152:127-139. [PMID: 36220623 DOI: 10.1016/j.jclinepi.2022.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/30/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Timely identification of colorectal cancer (CRC) survivors at risk of experiencing low health-related quality of life (HRQoL) in the near future is important for enabling appropriately tailored preventive actions. We previously developed and internally validated risk prediction models to estimate the 1-year risk of low HRQoL in long-term CRC survivors. In this article, we aim to externally validate and update these models in a population of short-term CRC survivors. STUDY DESIGN AND SETTING In a pooled cohort of 1,596 CRC survivors, seven HRQoL domains (global QoL, cognitive/emotional/physical/role/social functioning, and fatigue) were measured prospectively at approximately 5 months postdiagnosis (baseline for prediction) and approximately 1 year later by a validated patient-reported outcome measure (European Organization for Research and Treatment of Cancer Quality of life Questionnaire-Core 30). For each HRQoL domain, 1-year scores were dichotomized into low vs. normal/high HRQoL. Performance of the previously developed multivariable logistic prediction models was evaluated (calibration and discrimination). Models were updated to create a more parsimonious predictor set for all HRQoL domains. RESULTS Updated models showed good calibration and discrimination (AUC ≥0.75), containing a single set of 15 predictors, including nonmodifiable (age, sex, education, time since diagnosis, chemotherapy, radiotherapy, stoma, and comorbidities) and modifiable predictors (body mass index, physical activity, smoking, anxiety/depression, and baseline fatigue and HRQoL domain scores). CONCLUSION Externally validated and updated prediction models performed well for estimating the 1-year risk of low HRQoL in CRC survivors within 6 months postdiagnosis. The impact of implementing the models in oncology practice to improve HRQoL outcomes in CRC survivors needs to be evaluated.
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Affiliation(s)
- Dóra Révész
- Department of Epidemiology, GROW - School for Oncology and Reproduction, Maastricht University, P. Debyeplein 1, 6200 MD Maastricht, The Netherlands
| | - Sander M J van Kuijk
- Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, P. Debyelaan 25, PO Box 5800, Maastricht 6202 AZ, The Netherlands
| | - Floortje Mols
- CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Warandelaan 2, 5037 AB Tilburg, The Netherlands; Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT Utrecht, The Netherlands
| | - Fränzel J B van Duijnhoven
- Division of Human Nutrition, Wageningen University & Research, Stippeneng 4, 6708 WE Wageningen, The Netherlands
| | - Renate M Winkels
- Division of Human Nutrition, Wageningen University & Research, Stippeneng 4, 6708 WE Wageningen, The Netherlands
| | - IJmert Kant
- Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, P. Debyeplein 1, 6200 MD Maastricht, The Netherlands
| | - Piet A van den Brandt
- Department of Epidemiology, GROW - School for Oncology and Reproduction, Maastricht University, P. Debyeplein 1, 6200 MD Maastricht, The Netherlands; Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, P. Debyeplein 1, 6200 MD Maastricht, The Netherlands
| | - Luc J Smits
- Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, P. Debyeplein 1, 6200 MD Maastricht, The Netherlands
| | - Stéphanie O Breukink
- Department of Surgery, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Ellen Kampman
- Division of Human Nutrition, Wageningen University & Research, Stippeneng 4, 6708 WE Wageningen, The Netherlands
| | - Sandra Beijer
- Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT Utrecht, The Netherlands
| | - Matty P Weijenberg
- Department of Epidemiology, GROW - School for Oncology and Reproduction, Maastricht University, P. Debyeplein 1, 6200 MD Maastricht, The Netherlands
| | - Martijn J L Bours
- Department of Epidemiology, GROW - School for Oncology and Reproduction, Maastricht University, P. Debyeplein 1, 6200 MD Maastricht, The Netherlands.
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27
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Witteveen A, Beenhakker L, Wijlens K, Kampman E, Winkels R. Patterns and predictors of cancer-related fatigue domains after breast cancer: the influence of lifestyle. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01470-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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28
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Aune D, Markozannes G, Abar L, Balducci K, Cariolou M, Nanu N, Vieira R, Anifowoshe YO, Greenwood DC, Clinton SK, Giovannucci EL, Gunter MJ, Jackson A, Kampman E, Lund V, McTiernan A, Riboli E, Allen K, Brockton NT, Croker H, Katsikioti D, McGinley-Gieser D, Mitrou P, Wiseman M, Velikova G, Demark-Wahnefried W, Norat T, Tsilidis KK, Chan DSM. Physical Activity and Health-Related Quality of Life in Women With Breast Cancer: A Meta-Analysis. JNCI Cancer Spectr 2022; 6:pkac072. [PMID: 36474321 PMCID: PMC9727071 DOI: 10.1093/jncics/pkac072] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/27/2022] [Accepted: 09/16/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Physical activity (PA) is associated with improved health-related quality of life (HRQoL) among women with breast cancer; however, uncertainty remains regarding PA types and dose (frequency, duration, intensity) and various HRQoL measures. A systematic review and meta-analysis of randomized controlled trials was conducted to clarify whether specific types and doses of physical activity was related to global and specific domains of HRQoL, as part of the Global Cancer Update Programme, formerly known as the World Cancer Research Fund-American Institute for Cancer Research Continuous Update Project. METHODS PubMed and CENTRAL databases were searched up to August 31, 2019. Weighted mean differences (WMDs) in HRQoL scores were estimated using random effects models. An independent expert panel graded the evidence. RESULTS A total of 79 randomized controlled trials (14 554 breast cancer patients) were included. PA interventions resulted in higher global HRQoL as measured by the Functional Assessment of Cancer Therapy-Breast (WMD = 5.94, 95% confidence intervals [CI] = 2.64 to 9.24; I2 = 59%, n = 12), Functional Assessment of Cancer Therapy-General (WMD = 4.53, 95% CI = 1.94 to 7.13; I2 = 72%, n = 18), and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (WMD = 6.78, 95% CI = 2.61 to 10.95; I2 = 76.3%, n = 17). The likelihood of causality was considered probable that PA improves HRQoL in breast cancer survivors. Effects were weaker for physical function and mental and emotional health. Evidence regarding dose and type of PA remains insufficient for firm conclusions. CONCLUSION PA results in improved global HRQoL in breast cancer survivors with weaker effects observed for physical function and mental and emotional health. Additional research is needed to define the impact of types and doses of activity on various domains of HRQoL.
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Affiliation(s)
- Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Nutrition, Bjørknes University College, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Georgios Markozannes
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Leila Abar
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Katia Balducci
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Margarita Cariolou
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Neesha Nanu
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Rita Vieira
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Yusuf O Anifowoshe
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Darren C Greenwood
- Leeds Institute for Data Analytics, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Steven K Clinton
- The Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Edward L Giovannucci
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USA
| | - Marc J Gunter
- Section of Nutrition and Metabolism, International Agency for Research on Cancer-World Health Organization, Lyon, France
| | - Alan Jackson
- National Institute for Health Research, Southampton Biomedical Research Centre, Southampton, UK
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
| | - Vivien Lund
- World Cancer Research Fund International, London, UK
| | - Anne McTiernan
- Division of Public Health Sciences, Program in Epidemiology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- School of Public Health, Department of Epidemiology, University of Washington, Seattle, WA, USA
- School of Medicine, Department of Medicine (Geriatrics), University of Washington, Seattle, WA, USA
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Kate Allen
- World Cancer Research Fund International, London, UK
| | | | - Helen Croker
- World Cancer Research Fund International, London, UK
| | | | | | | | | | - Galina Velikova
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | | | - Teresa Norat
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Konstantinos K Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Doris S M Chan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
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29
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El Kinany K, Huybrechts I, Hatime Z, El Asri A, Boudouaya HA, Deoula MMS, Kampman E, El Rhazi K. Food processing groups and colorectal cancer risk in Morocco: evidence from a nationally representative case-control study. Eur J Nutr 2022; 61:2507-2515. [PMID: 35211850 DOI: 10.1007/s00394-022-02820-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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] [Received: 07/28/2021] [Accepted: 01/25/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the association between the consumption of foods and drinks from different food processing categories using the NOVA classification and CRC risk among Moroccan adults. METHODS 1453 cases and 1453 matched controls aged at least 18 years and recruited from the 5 greater Moroccan regions were interviewed by trained investigators about their habitual diet using a standardized food frequency questionnaire (FFQ). Foods were categorized according to their degree of processing by the NOVA classification. Intakes of each food processing group were categorized into tertiles based on the distribution of controls with the lowest tertile considered as the reference category. Multivariable conditional logistic regression models were used to assess the association between each group and CRC risk (Odds Ratio (OR) and 95% Confidence Intervals (CI)), taking relevant confounders into account. RESULTS High consumption of unprocessed or minimally processed foods (NOVA group 1) was significantly inversely (OR = 0.82, 95%CI = 0.72-0.93), while high consumption of ultra-processed foods and drink products (NOVA group 4) was significantly positively (OR = 1.40, 95% CI = 1.22-1.61) associated with CRC risk as compared to the lowest intake group. These results were similar for colon and rectum sub-sites. CONCLUSION This is the first study to evaluate the association between the NOVA classification groups and CRC risk in an African country. Our results suggest that the consumption of ultra-processed foods and drink products may be associated with an increased risk of developing CRC, but longitudinal studies are needed to confirm these results.
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Affiliation(s)
- Khaoula El Kinany
- Department of Epidemiology and Public Health, Faculty of Medicine and Pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez. Km 2, 200 Sidi Harazem Road, 1893, Fez, Morocco
| | - Inge Huybrechts
- Section of Nutrition and Metabolism, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Zineb Hatime
- Department of Epidemiology and Public Health, Faculty of Medicine and Pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez. Km 2, 200 Sidi Harazem Road, 1893, Fez, Morocco
| | - Achraf El Asri
- Department of Epidemiology and Public Health, Faculty of Medicine and Pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez. Km 2, 200 Sidi Harazem Road, 1893, Fez, Morocco
| | - Hanae Abir Boudouaya
- Department of Epidemiology and Public Health, Faculty of Medicine and Pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez. Km 2, 200 Sidi Harazem Road, 1893, Fez, Morocco
| | - Meimouna Mint Sidi Deoula
- Department of Epidemiology and Public Health, Faculty of Medicine and Pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez. Km 2, 200 Sidi Harazem Road, 1893, Fez, Morocco
| | - Ellen Kampman
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - Karima El Rhazi
- Department of Epidemiology and Public Health, Faculty of Medicine and Pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez. Km 2, 200 Sidi Harazem Road, 1893, Fez, Morocco.
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Holowatyj AN, Ose J, Gigic B, Lin T, Ulvik A, Geijsen AJMR, Brezina S, Kiblawi R, van Roekel EH, Baierl A, Böhm J, Bours MJL, Brenner H, Breukink SO, Chang-Claude J, de Wilt JHW, Grady WM, Grünberger T, Gumpenberger T, Herpel E, Hoffmeister M, Keulen ETP, Kok DE, Koole JL, Kosma K, Kouwenhoven EA, Kvalheim G, Li CI, Schirmacher P, Schrotz-King P, Singer MC, van Duijnhoven FJB, van Halteren HK, Vickers K, Vogelaar FJ, Warby CA, Wesselink E, Ueland PM, Ulrich AB, Schneider M, Habermann N, Kampman E, Weijenberg MP, Gsur A, Ulrich CM. Higher vitamin B6 status is associated with improved survival among patients with stage I-III colorectal cancer. Am J Clin Nutr 2022; 116:303-313. [PMID: 35394006 PMCID: PMC9348990 DOI: 10.1093/ajcn/nqac090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 04/04/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Folate-mediated 1-carbon metabolism requires several nutrients, including vitamin B6. Circulating biomarker concentrations indicating high vitamin B6 status are associated with a reduced risk of colorectal cancer (CRC). However, little is known about the effect of B6 status in relation to clinical outcomes in CRC patients. OBJECTIVES We investigated survival outcomes in relation to vitamin B6 status in prospectively followed CRC patients. METHODS A total of 2031 patients with stage I-III CRC participated in 6 prospective patient cohorts in the international FOCUS (folate-dependent 1-carbon metabolism in colorectal cancer recurrence and survival) Consortium. Preoperative blood samples were used to measure vitamin B6 status by the direct marker pyridoxal 5'-phosphate (PLP), as well as the functional marker HK-ratio (HKr)[3'-hydroxykynurenine: (kynurenic acid + xanthurenic acid + 3'-hydroxy anthranilic acid + anthranilic acid)]. Using Cox proportional hazards regression, we examined associations of vitamin B6 status with overall survival (OS), disease-free survival (DFS), and risk of recurrence, adjusted for patient age, sex, circulating creatinine concentrations, tumor site, stage, and cohort. RESULTS After a median follow-up of 3.2 y for OS, higher preoperative vitamin B6 status as assessed by PLP and the functional marker HKr was associated with 16-32% higher all-cause and disease-free survival, although there was no significant association with disease recurrence (doubling in PLP concentration: HROS, 0.68; 95% CI: 0.59, 0.79; HRDFS, 0.84; 95% CI: 0.75, 0.94; HRRecurrence, 0.96; 95% CI: 0.84, 1.09; HKr: HROS, 2.04; 95% CI: 1.67, 2.49; HRDFS, 1.56; 95% CI: 1.31, 1.85; HRRecurrence, 1.21; 95% CI: 0.96,1. 52). The association of PLP with improved OS was consistent across colorectal tumor site (right-sided colon: HROS, 0.75; 95% CI: 0.59, 0.96; left-sided colon: HROS, 0.71; 95% CI: 0.55, 0.92; rectosigmoid junction and rectum: HROS, 0.61; 95% CI: 0.47, 0.78). CONCLUSION Higher preoperative vitamin B6 status is associated with improved OS among stage I-III CRC patients.
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Affiliation(s)
- Andreana N Holowatyj
- Huntsman Cancer Institute, Salt Lake City, Utah, USA,Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA,Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jennifer Ose
- Huntsman Cancer Institute, Salt Lake City, Utah, USA,Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Biljana Gigic
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany
| | - Tengda Lin
- Huntsman Cancer Institute, Salt Lake City, Utah, USA,Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | | | - Anne J M R Geijsen
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Stefanie Brezina
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, Austria
| | - Rama Kiblawi
- Huntsman Cancer Institute, Salt Lake City, Utah, USA,Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA,Medical Faculty, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Eline H van Roekel
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, The Netherlands
| | - Andreas Baierl
- Department of Statistics and Operations Research, University of Vienna, Austria
| | - Jürgen Böhm
- Huntsman Cancer Institute, Salt Lake City, Utah, USA,Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Martijn J L Bours
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, The Netherlands
| | - Hermann Brenner
- Division of Preventive Oncology, National Center for Tumor Diseases and German Cancer Research Center, Heidelberg, Germany,Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stéphanie O Breukink
- Department of Surgery, GROW School for Oncology and Development Biology, Maastricht University, The Netherlands
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg Germany
| | - Johannes H W de Wilt
- Department of Surgery, Division of Surgical Oncology and Gastrointestinal Surgery, Radboud University Medical Center, The Netherlands
| | - William M Grady
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | | | - Tanja Gumpenberger
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, Austria
| | - Esther Herpel
- Institute of Pathology, University of Heidelberg, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Eric T P Keulen
- Department of Internal Medicine and Gastroenterology, Zuyderland Medical Center, Sittard, The Netherlands
| | - Dieuwertje E Kok
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Janna L Koole
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, The Netherlands
| | - Katharina Kosma
- Department of Surgery, Kaiser Franz Josef Hospital, Vienna, Austria
| | | | | | - Christopher I Li
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | | | - Petra Schrotz-King
- Division of Preventive Oncology, National Center for Tumor Diseases and German Cancer Research Center, Heidelberg, Germany
| | - Marie C Singer
- Department of Surgery, Kaiser Franz Josef Hospital, Vienna, Austria
| | | | - Henk K van Halteren
- Department of Internal Medicine, Admiraal de Ruyter Hospital, Goes, The Netherlands
| | - Kathy Vickers
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - F Jeroen Vogelaar
- Department of Surgery, VieCuri Medical Center, Venlo, The Netherlands
| | - Christy A Warby
- Huntsman Cancer Institute, Salt Lake City, Utah, USA,Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Evertine Wesselink
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | | | - Alexis B Ulrich
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany
| | - Martin Schneider
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Germany
| | - Nina Habermann
- Genome Biology, European Molecular Biology Laboratory (EMBL), Heidelberg, Germany
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Matty P Weijenberg
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, The Netherlands
| | - Andrea Gsur
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, Austria
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Beeren I, de Goeij L, Dandis R, Vidra N, van Zutphen M, Witjes JA, Kampman E, Kiemeney LALM, Vrieling A. Limited Changes in Lifestyle Behaviours after Non-Muscle Invasive Bladder Cancer Diagnosis. Cancers (Basel) 2022; 14:cancers14040960. [PMID: 35205711 PMCID: PMC8869990 DOI: 10.3390/cancers14040960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/04/2022] [Accepted: 02/11/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of our study was to investigate adherence to lifestyle recommendations and lifestyle changes after diagnosis in patients with non-muscle invasive bladder cancer (NMIBC). Second, we aimed to identify distinct trajectories of lifestyle change and their correlates. We analysed data of 935 patients with NMIBC from a prospective cohort study at six weeks (evaluating pre-diagnostic lifestyle), three months, and fifteen months after diagnosis. An overall lifestyle score (range 0-7) was calculated based on the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendations focusing on diet, body mass index, and physical activity. Linear mixed models were used to analyse absolute lifestyle changes over time. Distinct trajectories of change were identified with latent class trajectory models. We found an overall lifestyle score of 3.3 which remained constant over time. The largest lifestyle changes were observed for the consumption of red and processed meat (-96 g/week) and fruit and vegetables (-38 g/day). Two to four trajectory groups were identified for each single lifestyle behaviour. Correlates differed per trajectory group. In conclusion, adherence to the WCRF/AICR recommendations was low. Small to moderate changes in and different trajectories of single lifestyle behaviours were observed. Effective strategies for lifestyle improvement are warranted.
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Affiliation(s)
- Ivy Beeren
- Department for Health Evidence, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; (I.B.); (L.d.G.); (R.D.); (N.V.); (M.v.Z.); (L.A.L.M.K.)
| | - Liesbeth de Goeij
- Department for Health Evidence, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; (I.B.); (L.d.G.); (R.D.); (N.V.); (M.v.Z.); (L.A.L.M.K.)
| | - Rana Dandis
- Department for Health Evidence, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; (I.B.); (L.d.G.); (R.D.); (N.V.); (M.v.Z.); (L.A.L.M.K.)
| | - Nikoletta Vidra
- Department for Health Evidence, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; (I.B.); (L.d.G.); (R.D.); (N.V.); (M.v.Z.); (L.A.L.M.K.)
| | - Moniek van Zutphen
- Department for Health Evidence, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; (I.B.); (L.d.G.); (R.D.); (N.V.); (M.v.Z.); (L.A.L.M.K.)
| | - J. Alfred Witjes
- Department of Urology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands;
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University & Research, 6708 WE Wageningen, The Netherlands;
| | - Lambertus A. L. M. Kiemeney
- Department for Health Evidence, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; (I.B.); (L.d.G.); (R.D.); (N.V.); (M.v.Z.); (L.A.L.M.K.)
- Department of Urology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands;
| | - Alina Vrieling
- Department for Health Evidence, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; (I.B.); (L.d.G.); (R.D.); (N.V.); (M.v.Z.); (L.A.L.M.K.)
- Correspondence: ; Tel.: +31-24-3616944
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32
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Arron M, Kok D, Custers J, van Goor H, van Duijnhoven F, Kampman E, de Wilt J. The association between anastomotic leakage and health-related quality of life after colorectal cancer surgery. Eur J Surg Oncol 2022. [DOI: 10.1016/j.ejso.2021.12.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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33
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El Asri A, Ouldim K, Bouguenouch L, Sekal M, Moufid FZ, Kampman E, Huybrechts I, Gunter MJ, Abbaoui S, Znati K, Karkouri M, Kinany KE, Hatime Z, Deoula MMS, Chbani L, Zarrouq B, El Rhazi K. Dietary Fat Intake and KRAS Mutations in Colorectal Cancer in a Moroccan Population. Nutrients 2022; 14:318. [PMID: 35057499 PMCID: PMC8779768 DOI: 10.3390/nu14020318] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/05/2022] [Accepted: 01/09/2022] [Indexed: 01/27/2023] Open
Abstract
Epidemiologic data support an association between diet and mutations in the Kirsten-ras (KRAS) gene involved in colorectal cancer (CRC) development. This study aimed to explore the associations between fat intake and KRAS mutations in codons 12 and 13 in cases of CRC in the Moroccan population. A multicenter case-series study nested in a large-scale Moroccan CRC case-control study was conducted. Among all CRC cases recruited, 151 specimens were available for the DNA mutation analysis. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (Cis) for KRAS mutation status according to the fat intake variables. A KRAS mutation was detected in the CRC tumor of 34.4% of the patients among whom 65.4% had a single mutation at codon 12 and 34.6% had a single mutation at codon 13. Compared to low levels of consumption, a positive association was observed between high polyunsaturated fatty acids (PUFA) consumption (>16.9 g/day) and prevalence of KRAS mutations (OR = 2.15, 95% CI = 1.01-4.59). No statistically significant associations were observed for total fat, monounsaturated fatty acids, saturated fatty acids and KRAS mutations. The results of this study suggest that PUFA may be relevant in the etiology of CRC, possibly through the generation of G > A transitions at the KRAS oncogene. Further studies are needed to verify and explain this finding.
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Affiliation(s)
- Achraf El Asri
- Laboratory of Epidemiology and Research in Health Sciences, Department of Epidemiology and Public Health, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez 30000, Morocco; (K.E.K.); (Z.H.); (M.M.S.D.); (B.Z.); (K.E.R.)
| | - Karim Ouldim
- Medical Genetics and Oncogenetics Unit, Hassan II University Hospital, Sidi Mohamed Ben Abdellah University, Fez 30000, Morocco; (K.O.); (L.B.); (F.Z.M.)
- Cancer Research Institute, Fez 20192, Morocco
| | - Laila Bouguenouch
- Medical Genetics and Oncogenetics Unit, Hassan II University Hospital, Sidi Mohamed Ben Abdellah University, Fez 30000, Morocco; (K.O.); (L.B.); (F.Z.M.)
| | - Mohammed Sekal
- Department of Anatomy and Cytopathology, Hassan II University Hospital, Sidi Mohammed Ben Abdallah University, Fez 30000, Morocco; (M.S.); (L.C.)
| | - Fatima Zahra Moufid
- Medical Genetics and Oncogenetics Unit, Hassan II University Hospital, Sidi Mohamed Ben Abdellah University, Fez 30000, Morocco; (K.O.); (L.B.); (F.Z.M.)
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University and Research, 69000 Wageningen, The Netherlands;
| | - Inge Huybrechts
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, World Health Organization, 69372 Lyon, France; (I.H.); (M.J.G.)
| | - Marc J. Gunter
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, World Health Organization, 69372 Lyon, France; (I.H.); (M.J.G.)
| | - Sanae Abbaoui
- Faculty of Medicine and Pharmacy, Ibn Zohr University, Agadir 80035, Morocco;
| | - Kaoutar Znati
- Department of Pathology, Ibn Sina University Hospital, Mohammed V University, Rabat 10001, Morocco;
| | - Mehdi Karkouri
- Pathologic Anatomy and Cytology Laboratory, Ibn Rochd University Hospital, Casablanca 20360, Morocco;
| | - Khaoula El Kinany
- Laboratory of Epidemiology and Research in Health Sciences, Department of Epidemiology and Public Health, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez 30000, Morocco; (K.E.K.); (Z.H.); (M.M.S.D.); (B.Z.); (K.E.R.)
| | - Zineb Hatime
- Laboratory of Epidemiology and Research in Health Sciences, Department of Epidemiology and Public Health, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez 30000, Morocco; (K.E.K.); (Z.H.); (M.M.S.D.); (B.Z.); (K.E.R.)
| | - Meimouna Mint Sidi Deoula
- Laboratory of Epidemiology and Research in Health Sciences, Department of Epidemiology and Public Health, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez 30000, Morocco; (K.E.K.); (Z.H.); (M.M.S.D.); (B.Z.); (K.E.R.)
| | - Laila Chbani
- Department of Anatomy and Cytopathology, Hassan II University Hospital, Sidi Mohammed Ben Abdallah University, Fez 30000, Morocco; (M.S.); (L.C.)
| | - Btissame Zarrouq
- Laboratory of Epidemiology and Research in Health Sciences, Department of Epidemiology and Public Health, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez 30000, Morocco; (K.E.K.); (Z.H.); (M.M.S.D.); (B.Z.); (K.E.R.)
- Department of Biology and Geology, Teachers Training College (Ecole Normale Superieure), Sidi Mohamed Ben Abdellah University, Fez 30000, Morocco
| | - Karima El Rhazi
- Laboratory of Epidemiology and Research in Health Sciences, Department of Epidemiology and Public Health, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez 30000, Morocco; (K.E.K.); (Z.H.); (M.M.S.D.); (B.Z.); (K.E.R.)
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Papadimitriou N, Gunter MJ, Murphy N, Gicquiau A, Achaintre D, Brezina S, Gumpenberger T, Baierl A, Ose J, Geijsen AJMR, van Roekel EH, Gsur A, Gigic B, Habermann N, Ulrich CM, Kampman E, Weijenberg MP, Ueland PM, Kaaks R, Katzke V, Krogh V, Bueno-de-Mesquita B, Ardanaz E, Travis RC, Schulze MB, Sánchez MJ, Colorado-Yohar SM, Weiderpass E, Scalbert A, Keski-Rahkonen P. Circulating tryptophan metabolites and risk of colon cancer: Results from case-control and prospective cohort studies. Int J Cancer 2021; 149:1659-1669. [PMID: 34196970 PMCID: PMC8429124 DOI: 10.1002/ijc.33725] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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] [Received: 01/01/2021] [Revised: 06/02/2021] [Accepted: 06/04/2021] [Indexed: 02/06/2023]
Abstract
Dysregulation of tryptophan metabolism has been linked to colorectal tumorigenesis; however, epidemiological studies investigating tryptophan metabolites in relation to colorectal cancer risk are limited. We studied associations of plasma tryptophan, serotonin and kynurenine with colon cancer risk in two studies with cancer patients and controls, and in one prospective cohort: ColoCare Study (110 patients/153 controls), the Colorectal Cancer Study of Austria (CORSA; 46 patients/390 controls) and the European Prospective Investigation into Cancer and Nutrition (EPIC; 456 matched case-control pairs). Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for colon cancer risk. Tryptophan was inversely associated with colon cancer risk in ColoCare (OR per 1-SD = 0.44; 95% CI, 0.31-0.64) and EPIC (OR per 1-SD = 0.86; 95% CI, 0.74-0.99). Comparing detectable vs nondetectable levels, serotonin was positively associated with colon cancer in CORSA (OR = 6.39; 95% CI, 3.61-11.3) and EPIC (OR = 2.03; 95% CI, 1.20-3.40). Kynurenine was inversely associated with colon cancer in ColoCare (OR per 1-SD = 0.74; 95% CI, 0.55-0.98), positively associated in CORSA (OR per 1-SD = 1.79; 95% CI, 1.27-2.52), while no association was observed in EPIC. The kynurenine-to-tryptophan ratio was positively associated with colon cancer in ColoCare (OR per 1-SD = 1.38; 95% CI, 1.03-1.84) and CORSA (OR per 1-SD = 1.44; 95% CI, 1.06-1.96), but not in EPIC. These results suggest that higher plasma tryptophan may be associated with lower colon cancer risk, while increased serotonin may be associated with a higher risk of colon cancer. The kynurenine-to-tryptophan ratio may also reflect altered tryptophan catabolism during colon cancer development.
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Affiliation(s)
| | - Marc J Gunter
- International Agency for Research on Cancer, Lyon, France
| | - Neil Murphy
- International Agency for Research on Cancer, Lyon, France
| | | | | | - Stefanie Brezina
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, Austria
| | - Tanja Gumpenberger
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, Austria
| | - Andreas Baierl
- Department of Statistics and Operations Research, University of Vienna, Austria
| | - Jennifer Ose
- Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Anne JMR Geijsen
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Eline H van Roekel
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Andrea Gsur
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, Austria
| | - Biljana Gigic
- Division of Preventive Oncology, National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nina Habermann
- Division of Preventive Oncology, National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Genome Biology, European Molecular Biology Laboratory (EMBL), Heidelberg, Germany
| | - Cornelia M Ulrich
- Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Matty P Weijenberg
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | | | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Verena Katzke
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Vittorio Krogh
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Bas Bueno-de-Mesquita
- Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), PO Box 1, Bilthoven, The Netherlands
| | - Eva Ardanaz
- Navarra Public Health Institute, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- CIBER Epidemiology and Public Health CIBERESP, Madrid, Spain
| | - Ruth C Travis
- Cancer Epidemiology Unit, Department of Population Health, University of Oxford, Oxford, UK
| | - Matthias B Schulze
- German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- Institute of Nutrition Science, University of Potsdam, Potsdam, Germany
| | - Maria-José Sánchez
- CIBER Epidemiology and Public Health CIBERESP, Madrid, Spain
- Escuela Andaluza de Salud Pública (EASP), Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - Sandra M Colorado-Yohar
- CIBER Epidemiology and Public Health CIBERESP, Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- Research Group on Demography and Health, National Faculty of Public Health, University of Antioquia, Medellín, Colombia
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35
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Geijsen AJMR, Kok DE, van Zutphen M, Keski-Rahkonen P, Achaintre D, Gicquiau A, Gsur A, Kruyt FM, Ulrich CM, Weijenberg MP, de Wilt JHW, Wesselink E, Scalbert A, Kampman E, van Duijnhoven FJB. Diet quality indices and dietary patterns are associated with plasma metabolites in colorectal cancer patients. Eur J Nutr 2021; 60:3171-3184. [PMID: 33544207 PMCID: PMC8354955 DOI: 10.1007/s00394-021-02488-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 01/08/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE Emerging evidence suggests that diet is linked to survival in colorectal cancer patients, although underlying mechanisms are not fully understood. The aim of this study was to evaluate whether dietary exposures are associated with metabolite concentrations in colorectal cancer patients. METHODS Concentrations of 134 metabolites of the Biocrates AbsoluteIDQ p180 kit were quantified in plasma samples collected at diagnosis from 195 stage I-IV colorectal cancer patients. Food frequency questionnaires were used to calculate adherence to the World Cancer Research Fund (WCRF) dietary recommendations and the Dutch Healthy Diet (DHD15) index as well as to construct dietary patterns using Principal Component Analysis. Multivariable linear regression models were used to determine associations between dietary exposures and metabolite concentrations. All models were adjusted for age, sex, body mass index, smoking status, analytical batch, cancer stage, and multiple testing using false discovery rate. RESULTS Participants had a mean (SD) age of 66 (9) years, were mostly men (60%), and mostly diagnosed with stage II and III cancer. For the dietary pattern analyses, Western, Carnivore, and Prudent patterns were identified. Better adherence to the WCRF dietary recommendations was associated with lower concentrations of ten phosphatidylcholines. Higher intake of the Carnivore pattern was associated with higher concentrations of two phosphatidylcholines. The DHD15-index, Western pattern, or Prudent pattern were not associated with metabolite concentrations. CONCLUSION In the current study, the WCRF dietary score and the Carnivore pattern are associated with phosphatidylcholines. Future research should elucidate the potential relevance of phosphatidylcholine metabolism in the colorectal cancer continuum. CLINICAL TRIAL REGISTRY ClinicalTrials.gov Identifier: NCT03191110.
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Affiliation(s)
- Anne J M R Geijsen
- Division of Human Nutrition and Health, Wageningen University and Research, P.O. Box 17, 6700 AA, Wageningen, The Netherlands
| | - Dieuwertje E Kok
- Division of Human Nutrition and Health, Wageningen University and Research, P.O. Box 17, 6700 AA, Wageningen, The Netherlands
| | - Moniek van Zutphen
- Division of Human Nutrition and Health, Wageningen University and Research, P.O. Box 17, 6700 AA, Wageningen, The Netherlands
| | | | - David Achaintre
- Biomarker Group, International Agency for Research on Cancer, Lyon, France
| | - Audrey Gicquiau
- Biomarker Group, International Agency for Research on Cancer, Lyon, France
| | - Andrea Gsur
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Flip M Kruyt
- Department of Surgery, Hospital Gelderse Vallei, Ede, The Netherlands
| | - Cornelia M Ulrich
- Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Matty P Weijenberg
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Johannes H W de Wilt
- Department of Surgery, Division of Surgical Oncology and Gastrointestinal Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Evertine Wesselink
- Division of Human Nutrition and Health, Wageningen University and Research, P.O. Box 17, 6700 AA, Wageningen, The Netherlands
| | - Augustin Scalbert
- Biomarker Group, International Agency for Research on Cancer, Lyon, France
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University and Research, P.O. Box 17, 6700 AA, Wageningen, The Netherlands
| | - Fränzel J B van Duijnhoven
- Division of Human Nutrition and Health, Wageningen University and Research, P.O. Box 17, 6700 AA, Wageningen, The Netherlands.
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de Winter J, Ezendam NPM, Bours MJL, Winkels RM, Weijenberg MP, Kampman E, Vissers PAJ, Mols F, Beijer S. Is sleep associated with BMI, waist circumference, and diet among long-term colorectal cancer survivors? Results from the population-based PROFILES registry. Support Care Cancer 2021; 29:7225-7235. [PMID: 34228174 DOI: 10.1007/s00520-021-06393-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/23/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE In the general population, poor sleep quality and short sleep duration are associated with a higher body mass index (BMI) and waist circumference (WC), and an unhealthy diet. The aim of this study was to assess if the association between sleep quality and duration and BMI, WC, and diet quality also exists among colorectal cancer (CRC) survivors, as many CRC survivors have an unhealthy weight and diet. METHODS Cross-sectional data from a longitudinal CRC cohort were used. In this study, survivors were 4-13 years post diagnosis. The Pittsburgh Sleep Quality Index (PSQI) was used to assess both sleep quality and sleep duration. Diet quality was assessed by scoring adherence (low, moderate, high) to the 2007 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendations of five food groups and nutrients: fruit and vegetables, dietary fiber, red and processed meat, alcoholic beverages, and sugary drinks, using a brief diet screener. BMI and WC were self-measured. Associations were analyzed by multivariable linear and multinomial logistic regression analyses. RESULTS Among 1002 CRC survivors, 23% reported poor sleep quality (PSQI score ≥ 8) and 24% reported short sleep duration (≤ 6 h). No associations between sleep and BMI, WC, and diet quality were found. CONCLUSION Sleep problems are common in long-term CRC survivors; however, sleep quality and duration was not associated with BMI, WC, and diet quality in this population. It is unknown why the results differ from findings in the general population.
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Affiliation(s)
- Janne de Winter
- The Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Nicole P M Ezendam
- The Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.,CoRPS-Center of Research on Psychology in Somatic Diseases, Department of Medical Psychology and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Martijn J L Bours
- Department of Epidemiology, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Renate M Winkels
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Matty P Weijenberg
- CoRPS-Center of Research on Psychology in Somatic Diseases, Department of Medical Psychology and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | | | - Floortje Mols
- CoRPS-Center of Research on Psychology in Somatic Diseases, Department of Medical Psychology and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Sandra Beijer
- The Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
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van Cappellen-van Maldegem SJM, Mols F, Horevoorts N, de Kruif A, Buffart LM, Schoormans D, Trompetter H, Beijer S, Ezendam NPM, de Boer M, Winkels R, Kampman E, Schuit J, van de Poll-Franse L, Seidell JC, Hoedjes M. Towards OPtimal TIming and Method for promoting sUstained adherence to lifestyle and body weight recommendations in postMenopausal breast cancer survivors (the OPTIMUM-study): protocol for a longitudinal mixed-method study. BMC Womens Health 2021; 21:268. [PMID: 34229690 PMCID: PMC8258491 DOI: 10.1186/s12905-021-01406-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 06/30/2021] [Indexed: 11/10/2022]
Abstract
Background The majority of postmenopausal breast cancer (PMBC) survivors do not adhere to lifestyle recommendations and have excess body weight. In this group, this is associated with poorer health-related quality of life and an increased risk of type II diabetes mellitus, cardiovascular disease, second primary cancers, cancer recurrences, and mortality. Gaining and maintaining a healthy lifestyle and body composition is therefore important. It is unknown when and how sustained adherence to these recommendations can be promoted optimally in PMBC survivors. Therefore, the OPTIMUM study aims to identify the optimal timing and method for promoting sustained adherence to lifestyle and body weight recommendations in PMBC survivors.
Methods The OPTIMUM-study has a mixed-methods design. To assess optimal timing, a longitudinal observational study will be conducted among approximately 1000 PMBC survivors. The primary outcomes are adherence to lifestyle and body weight recommendations, readiness for change, and need for support. Questionnaires will be administered at 4–6 months after cancer diagnosis (wave 1: during treatment and retrospectively before diagnosis), 1 year after diagnosis (wave 2: after completion of initial treatment), and 1.5 years after diagnosis (wave 3: during follow-up). Wave 2 and 3 include blood sampling, and either wearing an accelerometer for 7 days or completing a 3-day online food diary (randomly assigned at hospital level). To assess the optimal method, behavioural determinants of the primary outcomes will be matched with Behavior Change Techniques using the Behaviour Change Technique Taxonomy. Qualitative research methods will be used to explore perceptions, needs and preferences of PMBC survivors (semi-structured interviews, focus groups) and health care providers (Delphi study). Topics include perceptions on optimal timing to promote adherence; facilitators and motivators of, and barriers towards (sustained) adherence to recommendations; and acceptability of the selected methods. Discussion The OPTIMUM study aims to gain scientific knowledge on when and how to promote sustained adherence to lifestyle and body weight recommendations among PBMC survivors. This knowledge can be incorporated into guidelines for tailored promotion in clinical practice to improve health outcomes.
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Affiliation(s)
- Sandra J M van Cappellen-van Maldegem
- CoRPS - Center of Research On Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, the Netherlands
| | - Floortje Mols
- CoRPS - Center of Research On Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, the Netherlands.,Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Nicole Horevoorts
- CoRPS - Center of Research On Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, the Netherlands.,Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Anja de Kruif
- Department of Epidemiology and Biostatistics, Amsterdam Public Health (APH), VUmc, Amsterdam, the Netherlands.,Department of Nutrition, Dietetics and Lifestyle, School of Allied Health, HAN University of Applied Sciences, Nijmegen, the Netherlands
| | - Laurien M Buffart
- Radboudumc, Department of Physiology, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Dounya Schoormans
- CoRPS - Center of Research On Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, the Netherlands
| | - Hester Trompetter
- CoRPS - Center of Research On Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, the Netherlands
| | - Sandra Beijer
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Nicole P M Ezendam
- CoRPS - Center of Research On Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, the Netherlands.,Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Michiel de Boer
- Department of Health Sciences and the Amsterdam Public Health Research Institute, VU University Amsterdam, Amsterdam, the Netherlands.,Department of General Practice and Elderly Care Medicine, UMCG, Groningen, the Netherlands
| | - Renate Winkels
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands
| | - Jantine Schuit
- CoRPS - Center of Research On Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, the Netherlands
| | - Lonneke van de Poll-Franse
- CoRPS - Center of Research On Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, the Netherlands.,Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands.,Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Jacob C Seidell
- Department of Health Sciences and the Amsterdam Public Health Research Institute, VU University Amsterdam, Amsterdam, the Netherlands
| | - Meeke Hoedjes
- CoRPS - Center of Research On Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, the Netherlands.
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Ramp D, Mols F, Ezendam N, Beijer S, Bours M, Winkels R, de Vries J, Seidell JC, Kampman E, Hoedjes M. Psychological distress and lower health-related quality of life are associated with need for dietary support among colorectal cancer survivors with overweight or obesity. Support Care Cancer 2021; 29:7659-7668. [PMID: 34142281 PMCID: PMC8550733 DOI: 10.1007/s00520-021-06306-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 05/18/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Two-third of colorectal cancer (CRC) survivors are overweight or obese. Psychological distress and low health-related quality of life (HRQoL) may be barriers to improving diet. We aimed to assess associations between psychological distress and HRQoL and the need for dietary support in CRC survivors with overweight or obesity. METHODS All alive individuals diagnosed with CRC between 2000 and 2009, as registered by the Dutch population-based Eindhoven Cancer Registry, were eligible for participation and received a questionnaire. Multivariable logistic regression analyses were conducted to assess associations between HRQoL (EORTC QLQ-C30), symptoms of anxiety and depression (HADS), and self-reported need for dietary support (single-item). RESULTS A total of 1458 completed the questionnaire (response rate 82%), and 756 (43%) had a BMI of 25.0 or higher and complete data on "need for dietary support" and were included for analyses. BMI ranged between 25.0 and 60.6 (mean, 28.9; SD, 3.6). The majority (71.7%) was overweight (BMI ≥ 25), and 28.3% obese (BMI ≥ 30). Twenty-one percent reported a need for dietary support which was associated with more psychological distress and lower HRQoL. Those who experienced symptoms of anxiety or depression were more likely to report a need for dietary support (27.6% and 28.7%) than those who did not experience symptoms of anxiety (12.3%; OR 2.02; 95% CI 1.22-3.35) or depression (13.5%; OR 1.96; 95% CI 1.19-3.22). CONCLUSIONS Results suggest that psychological distress and lower HRQoL should be taken into account while promoting a healthy diet in overweight or obese CRC survivors since these factors may hinder adherence to a healthy diet.
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Affiliation(s)
- Dominique Ramp
- Center of Research On Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Floortje Mols
- Center of Research On Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Nicole Ezendam
- Center of Research On Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Sandra Beijer
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Martijn Bours
- Department of Epidemiology, GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Renate Winkels
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | - Jolanda de Vries
- Center of Research On Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Jaap C. Seidell
- Department of Health Sciences and the EMGO+ Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands
| | - Ellen Kampman
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | - Meeke Hoedjes
- Center of Research On Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
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Kok DE, Arron MNN, Huibregtse T, Kruyt FM, Bac DJ, van Halteren HK, Kouwenhoven EA, Wesselink E, Winkels RM, van Zutphen M, van Duijnhoven FJB, de Wilt JHW, Kampman E. Association of Habitual Preoperative Dietary Fiber Intake With Complications After Colorectal Cancer Surgery. JAMA Surg 2021; 156:2781033. [PMID: 34132738 PMCID: PMC8209565 DOI: 10.1001/jamasurg.2021.2311] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 03/31/2021] [Indexed: 02/04/2023]
Abstract
IMPORTANCE Postoperative complications are associated with increased morbidity and mortality among patients with colorectal cancer. As a modifiable factor associated with gut health, dietary fiber intake is of interest with regard to the risk of complications after surgery for colorectal cancer. OBJECTIVE To examine the association between preoperative dietary fiber intake and risk of complications after surgery for colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from the Colorectal Longitudinal, Observational Study on Nutritional and Lifestyle Factors (COLON) study, which recruited adult patients with colorectal cancer at any stage at diagnosis from 11 hospitals in the Netherlands between August 2010 and December 2017. The present study included patients with stage I to IV colorectal cancer who underwent elective abdominal surgery. Data were analyzed between December 2019 and September 2020. EXPOSURES Habitual dietary fiber intake was assessed at diagnosis using a 204-item food frequency questionnaire. MAIN OUTCOMES AND MEASURES Any complications, surgical complications, and anastomotic leakage occurring during the 30 days after surgery for colorectal cancer. The association between fiber intake and risk of postoperative complications was assessed using logistic regression analyses. Additional analyses stratified by sex, tumor location, and fiber source were performed. RESULTS Among the 1399 patients included in the analysis, the median age at inclusion was 66 years (interquartile range, 61-72 years) and 896 (64%) were men. Any complications occurred in 397 patients (28%), and surgical complications occurred in 235 patients (17%). Of 1237 patients with an anastomosis, 67 (5%) experienced anastomotic leakage. Higher dietary fiber intake (per 10 g per day) was associated with a lower risk of any complications (odds ratio [OR], 0.75; 95% CI, 0.62-0.92) and surgical complications (OR, 0.76; 95% CI, 0.60-0.97), whereas no association with anastomotic leakage was found (OR, 0.97; 95% CI, 0.66-1.43). Among women, higher dietary intake was associated with any complications (OR, 0.64; 95% CI, 0.44-0.94), whereas there was no association among men (OR, 0.79; 95% CI, 0.63-1.01). Fiber intake from vegetables (per 1 g per day) was inversely associated with any (OR, 0.90; 95% CI, 0.83-0.99) and surgical (OR, 0.87; 95% CI, 0.78-0.97) complications. CONCLUSIONS AND RELEVANCE In this cohort study, higher habitual dietary fiber intake before surgery was associated with a lower risk of postoperative complications among patients with colorectal cancer. The findings suggest that improving preoperative dietary fiber intake may be considered in future prehabilitation programs for patients undergoing surgery for colorectal cancer.
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Affiliation(s)
- Dieuwertje E. Kok
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Melissa N. N. Arron
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Tess Huibregtse
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Flip M. Kruyt
- Department of Surgery, Hospital Gelderse Vallei, Ede, the Netherlands
| | - Dirk Jan Bac
- Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede, the Netherlands
| | - Henk K. van Halteren
- Department of Internal Medicine, Admiraal de Ruyter Hospital, Goes, the Netherlands
| | | | - Evertine Wesselink
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Renate M. Winkels
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Moniek van Zutphen
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | | | | | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
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40
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Brouwer JGM, Snellen M, Bisseling TM, Koornstra JJ, Vasen HFA, Kampman E, van Duijnhoven FJB. Is a colorectal neoplasm diagnosis a trigger to change dietary and other lifestyle habits for persons with Lynch syndrome? A prospective cohort study. Fam Cancer 2021; 20:125-135. [PMID: 32770331 PMCID: PMC8064993 DOI: 10.1007/s10689-020-00201-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 07/30/2020] [Indexed: 12/20/2022]
Abstract
A cancer diagnosis is suggested to be associated with changes in dietary and lifestyle habits. Whether this applies to persons with familial cancer, such as Lynch syndrome (LS) is unknown. We investigated whether a colorectal neoplasm (CRN) diagnosis in persons with LS is associated with changes in dietary and lifestyle habits over time. We used data of confirmed LS mutation carriers from the GEOLynch study, a prospective cohort study. Information on dietary intake and lifestyle habits was collected with a validated semi-quantitative food frequency questionnaire and a general questionnaire administered at baseline (2006-2008) and follow-up (2012-2017). Participants' medical records were used to identify CRN diagnoses. Changes in dietary and lifestyle habits in the CRN and the no-CRN group were compared using multivariable linear regression models for continuous variables and cross-tables with percentage change at follow-up compared with baseline for categorical variables. Of the 324 included participants, 146 developed a CRN (CRN group) between baseline and follow-up, while 178 did not (no-CRN group). Smoking cessation was more often reported in the CRN than in the no-CRN group (41.4% vs. 35.0%). There were no differences in changes of energy intake, alcohol, red meat, processed meat, dairy, fruit, vegetables and dietary fiber consumption, BMI, physical activity and NSAID use. Apart from a potentially higher likelihood of smoking cessation, we found little evidence that a CRN diagnosis is associated with changes in lifestyle habits in persons with LS.
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Affiliation(s)
- Jesca G M Brouwer
- Division of Human Nutrition and Health, Wageningen University & Research, P.O. Box 17, 6700 AA, Wageningen, The Netherlands
| | - Merel Snellen
- Division of Human Nutrition and Health, Wageningen University & Research, P.O. Box 17, 6700 AA, Wageningen, The Netherlands
| | - Tanya M Bisseling
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan Jacob Koornstra
- Department of Gastroenterology and Hepatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hans F A Vasen
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University & Research, P.O. Box 17, 6700 AA, Wageningen, The Netherlands
| | - Fränzel J B van Duijnhoven
- Division of Human Nutrition and Health, Wageningen University & Research, P.O. Box 17, 6700 AA, Wageningen, The Netherlands.
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41
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Winkels RM, Kampman E, Wu M. Learning from East to West and vice versa: Clinical epidemiology of colorectal cancer in China. Cancer 2021; 127:1736-1738. [PMID: 33788256 DOI: 10.1002/cncr.33444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/21/2020] [Accepted: 12/21/2020] [Indexed: 01/07/2023]
Affiliation(s)
- Renate M Winkels
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands
| | - Ming Wu
- Department of Chronic Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
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Wesselink E, Balvers MGJ, Kok DE, Winkels RM, van Zutphen M, Schrauwen RWM, Keulen ETP, Kouwenhoven EA, Breukink SO, Witkamp RF, de Wilt JHW, Bours MJL, Weijenberg MP, Kampman E, van Duijnhoven FJB. Levels of Inflammation Markers Are Associated with the Risk of Recurrence and All-Cause Mortality in Patients with Colorectal Cancer. Cancer Epidemiol Biomarkers Prev 2021; 30:1089-1099. [PMID: 33771850 DOI: 10.1158/1055-9965.epi-20-1752] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/19/2021] [Accepted: 03/16/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND We investigated whether preoperative and postoperative levels of inflammation markers, which have mechanistically been linked to colorectal cancer progression, were associated with recurrence and all-cause mortality in patients with colorectal cancer. METHODS Data of two prospective cohort studies were used. For the current analysis, patients with stage I to III colorectal cancer were considered. Data on inflammation [IL6, IL8, IL10, TNFα, high-sensitivity C-reactive protein (hsCRP), and a combined inflammatory z-score] were available for 747 patients before surgery and for 614 patients after surgery. The associations between inflammation marker levels and colorectal cancer recurrence and all-cause mortality were examined using multivariable Cox proportional hazard regression models, considering patient characteristics and clinical and lifestyle factors. RESULTS Higher preoperative and postoperative hsCRP levels were associated with a higher risk of recurrence [HRper doubling (95% CI), 1.15 (1.02-1.30) and 1.34 (1.16-1.55)] and all-cause mortality [HRper doubling (95% CI) 1.13 (1.01-1.28) and 1.15 (0.98-1.35)]. A doubling in IL8 levels (preoperative levels HR = 1.23; 95% CI, 1.00-1.53 and postoperative levels HR = 1.61; 95% CI, 1.23-2.12) and a higher combined inflammatory z-score (preoperative HRper doubling = 1.39; 95% CI, 1.03-1.89 and postoperative HRper doubling = 1.56; 95% CI, 1.06-2.28) were associated with a higher risk of all-cause mortality, but not recurrence. No associations between IL6, IL10, and TNFα and recurrence or all-cause mortality were observed. CONCLUSIONS Preoperative and postoperative levels of specific inflammation markers were associated with recurrence and/or all-cause mortality. IMPACT The complex role of inflammation in cancer recurrence merits further elucidation by investigating local inflammation at the tumor site.
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Affiliation(s)
- Evertine Wesselink
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands.
| | - Michiel G J Balvers
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Dieuwertje E Kok
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Renate M Winkels
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Moniek van Zutphen
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | | | - Eric T P Keulen
- Department of Gastroenterology, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands
| | | | - Stephanie O Breukink
- Department of Epidemiology, GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands.,Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Renger F Witkamp
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Martijn J L Bours
- Department of Epidemiology, GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Matty P Weijenberg
- Department of Epidemiology, GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
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Koole JL, Bours MJL, Geijsen AJMR, Gigic B, Ulvik A, Kok DE, Brezina S, Ose J, Baierl A, Böhm J, Brenner H, Breukink SO, Chang-Claude J, van Duijnhoven FJB, van Duijvendijk P, Gumpenberger T, Habermann N, van Halteren HK, Hoffmeister M, Holowatyj AN, Janssen-Heijnen MLG, Keulen ETP, Kiblawi R, Kruyt FM, Li CI, Lin T, Midttun Ø, Peoples AR, van Roekel EH, Schneider MA, Schrotz-King P, Ulrich AB, Vickers K, Wesselink E, de Wilt JHW, Gsur A, Ueland PM, Ulrich CM, Kampman E, Weijenberg MP. Circulating B-vitamin biomarkers and B-vitamin supplement use in relation to quality of life in patients with colorectal cancer: results from the FOCUS consortium. Am J Clin Nutr 2021; 113:1468-1481. [PMID: 33668069 PMCID: PMC8168355 DOI: 10.1093/ajcn/nqaa422] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 12/14/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND B vitamins have been associated with the risk and progression of colorectal cancer (CRC), given their central roles in nucleotide synthesis and methylation, yet their association with quality of life in established CRC is unclear. OBJECTIVES To investigate whether quality of life 6 months postdiagnosis is associated with: 1) circulating concentrations of B vitamins and related biomarkers 6 months postdiagnosis; 2) changes in these concentrations between diagnosis and 6 months postdiagnosis; 3) B-vitamin supplement use 6 months postdiagnosis; and 4) changes in B-vitamin supplement use between diagnosis and 6 months postdiagnosis. METHODS We included 1676 newly diagnosed stage I-III CRC patients from 3 prospective European cohorts. Circulating concentrations of 9 biomarkers related to the B vitamins folate, riboflavin, vitamin B6, and cobalamin were measured at diagnosis and 6 months postdiagnosis. Information on dietary supplement use was collected at both time points. Health-related quality of life (global quality of life, functioning scales, and fatigue) was assessed by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire 6 months postdiagnosis. Confounder-adjusted linear regression analyses were performed, adjusted for multiple testing. RESULTS Higher pyridoxal 5'-phosphate (PLP) was cross-sectionally associated with better physical, role, and social functioning, as well as reduced fatigue, 6 months postdiagnosis. Associations were observed for a doubling in the hydroxykynurenine ratio [3-hydroxykynurenine: (kynurenic acid + xanthurenic acid + 3-hydroxyanthranilic acid + anthranilic acid); an inverse marker of vitamin B6] and both reduced global quality of life (β = -3.62; 95% CI: -5.88, -1.36) and worse physical functioning (β = -5.01; 95% CI: -7.09, -2.94). Dose-response relations were observed for PLP and quality of life. No associations were observed for changes in biomarker concentrations between diagnosis and 6 months. Participants who stopped using B-vitamin supplements after diagnosis reported higher fatigue than nonusers. CONCLUSIONS Higher vitamin B6 status was associated with better quality of life, yet limited associations were observed for the use of B-vitamin supplements. Vitamin B6 needs further study to clarify its role in relation to quality of life.
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Affiliation(s)
- Janna L Koole
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Martijn J L Bours
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Anne J M R Geijsen
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Biljana Gigic
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | | | - Dieuwertje E Kok
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Stefanie Brezina
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Jennifer Ose
- Huntsman Cancer Institute, Salt Lake City, UT, USA,Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Andreas Baierl
- Department of Statistics and Operations Research, University of Vienna, Vienna, Austria
| | - Jürgen Böhm
- Huntsman Cancer Institute, Salt Lake City, UT, USA,Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Hermann Brenner
- Division of Preventive Oncology, National Center for Tumor Diseases and German Cancer Research Center, Heidelberg, Germany,Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stéphanie O Breukink
- Department of Surgery, GROW School for Oncology and Developmental Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | | | - Tanja Gumpenberger
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Nina Habermann
- Genome Biology, European Molecular Biology Laboratory (EMBL), Heidelberg, Germany
| | - Henk K van Halteren
- Department of Internal Medicine, Admiraal de Ruyter Hospital, Goes, The Netherlands
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Andreana N Holowatyj
- Huntsman Cancer Institute, Salt Lake City, UT, USA,Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA,Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA,Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Maryska L G Janssen-Heijnen
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands,Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands
| | - Eric T P Keulen
- Department of Internal Medicine and Gastroenterology, Zuyderland Medical Centre, Sittard, The Netherlands
| | - Rama Kiblawi
- Huntsman Cancer Institute, Salt Lake City, UT, USA,Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA,Medical Faculty, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Flip M Kruyt
- Department of Surgery, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Christopher I Li
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Tengda Lin
- Huntsman Cancer Institute, Salt Lake City, UT, USA,Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | | | - Anita R Peoples
- Huntsman Cancer Institute, Salt Lake City, UT, USA,Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Eline H van Roekel
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Martin A Schneider
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Petra Schrotz-King
- Division of Preventive Oncology, National Center for Tumor Diseases and German Cancer Research Center, Heidelberg, Germany
| | - Alexis B Ulrich
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Kathy Vickers
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Evertine Wesselink
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Johannes H W de Wilt
- Department of Surgery, Division of Surgical Oncology and Gastrointestinal Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andrea Gsur
- Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | | | - Cornelia M Ulrich
- Huntsman Cancer Institute, Salt Lake City, UT, USA,Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
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van Zutphen M, Boshuizen HC, Kenkhuis MF, Wesselink E, Geijsen AJMR, de Wilt JHW, van Halteren HK, Spillenaar Bilgen EJ, Keulen ETP, Janssen-Heijnen MLG, Breukink SO, Bours MJL, Kok DE, Winkels RM, Weijenberg MP, Kampman E, van Duijnhoven FJB. Lifestyle after colorectal cancer diagnosis in relation to recurrence and all-cause mortality. Am J Clin Nutr 2021; 113:1447-1457. [PMID: 33677488 PMCID: PMC8168353 DOI: 10.1093/ajcn/nqaa394] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/24/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND An unhealthy lifestyle is associated with the risk of colorectal cancer (CRC), but it is unclear whether overall lifestyle after a CRC diagnosis is associated with risks of recurrence and mortality. OBJECTIVES To examine associations between postdiagnosis lifestyle and changes in lifestyle after a CRC diagnosis with risks of CRC recurrence and all-cause mortality. METHODS The study population included 1425 newly diagnosed, stage I-III CRC patients from 2 prospective cohort studies enrolled between 2010 and 2016. Lifestyle, including BMI, physical activity, diet, and alcohol intake, was assessed at diagnosis and at 6 months postdiagnosis. We assigned lifestyle scores based on concordance with 2 sets of cancer prevention guidelines-from the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) and the American Cancer Society (ACS)-and national disease prevention guidelines. Higher scores indicate healthier lifestyles. We computed adjusted HRs and 95% CIs using Cox regression. RESULTS We observed 164 recurrences during a 2.8-year median follow-up and 171 deaths during a 4.4-year median follow-up. No associations were observed for CRC recurrence. A lifestyle more consistent with the ACS recommendations was associated with a lower all-cause mortality risk (HR per +1 SD, 0.85; 95% CI: 0.73-0.995). The same tendency was observed for higher WCRF/AICR (HR, 0.92; 95% CI: 0.78-1.08) and national (HR, 0.90; 95% CI: 0.77-1.05) lifestyle scores, although these associations were statistically nonsignificant. Generally, no statistically significant associations were observed for BMI, physical activity, diet, or alcohol. Improving one's lifestyle after diagnosis (+1 SD) was associated with a lower all-cause mortality risk for the ACS (HR, 0.80; 95% CI: 0.67-0.96) and national (HR, 0.84; 95% CI: 0.70-0.999) scores, yet was statistically nonsignificant for the WCRF/AICR score (HR, 0.94; 95% CI: 0.78-1.13). CONCLUSIONS A healthy lifestyle after CRC diagnosis and improvements therein were not associated with the risk of CRC recurrence, but were associated with a decreased all-cause mortality risk.
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Affiliation(s)
| | - Hendriek C Boshuizen
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Marlou-Floor Kenkhuis
- Department of Epidemiology, GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Evertine Wesselink
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Anne J M R Geijsen
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Henk K van Halteren
- Department of Internal Medicine, Admiraal de Ruyter Ziekenhuis, Goes, The Netherlands
| | | | - Eric T P Keulen
- Department of Internal Medicine and Gastroenterology, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Maryska L G Janssen-Heijnen
- Department of Epidemiology, GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands,Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands
| | - Stéphanie O Breukink
- Department of Epidemiology, GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands,Department of Surgery, Maastricht University Medical Centre, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht, The Netherlands
| | - Martijn J L Bours
- Department of Epidemiology, GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Dieuwertje E Kok
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Renate M Winkels
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Matty P Weijenberg
- Department of Epidemiology, GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
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Guo X, Lin W, Wen W, Huyghe J, Bien S, Cai Q, Harrison T, Chen Z, Qu C, Bao J, Long J, Yuan Y, Wang F, Bai M, Abecasis GR, Albanes D, Berndt SI, Bézieau S, Bishop DT, Brenner H, Buch S, Burnett-Hartman A, Campbell PT, Castellví-Bel S, Chan AT, Chang-Claude J, Chanock SJ, Cho SH, Conti DV, Chapelle ADL, Feskens EJM, Gallinger SJ, Giles GG, Goodman PJ, Gsur A, Guinter M, Gunter MJ, Hampe J, Hampel H, Hayes RB, Hoffmeister M, Kampman E, Kang HM, Keku TO, Kim HR, Le Marchand L, Lee SC, Li CI, Li L, Lindblom A, Lindor N, Milne RL, Moreno V, Murphy N, Newcomb PA, Nickerson DA, Offit K, Pearlman R, Pharoah PDP, Platz EA, Potter JD, Rennert G, Sakoda LC, Schafmayer C, Schmit SL, Schoen RE, Schumacher FR, Slattery ML, Su YR, Tangen CM, Ulrich CM, van Duijnhoven FJB, Van Guelpen B, Visvanathan K, Vodicka P, Vodickova L, Vymetalkova V, Wang X, White E, Wolk A, Woods MO, Casey G, Hsu L, Jenkins MA, Gruber SB, Peters U, Zheng W. Identifying Novel Susceptibility Genes for Colorectal Cancer Risk From a Transcriptome-Wide Association Study of 125,478 Subjects. Gastroenterology 2021; 160:1164-1178.e6. [PMID: 33058866 PMCID: PMC7956223 DOI: 10.1053/j.gastro.2020.08.062] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 08/20/2020] [Accepted: 08/28/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIMS Susceptibility genes and the underlying mechanisms for the majority of risk loci identified by genome-wide association studies (GWAS) for colorectal cancer (CRC) risk remain largely unknown. We conducted a transcriptome-wide association study (TWAS) to identify putative susceptibility genes. METHODS Gene-expression prediction models were built using transcriptome and genetic data from the 284 normal transverse colon tissues of European descendants from the Genotype-Tissue Expression (GTEx), and model performance was evaluated using data from The Cancer Genome Atlas (n = 355). We applied the gene-expression prediction models and GWAS data to evaluate associations of genetically predicted gene-expression with CRC risk in 58,131 CRC cases and 67,347 controls of European ancestry. Dual-luciferase reporter assays and knockdown experiments in CRC cells and tumor xenografts were conducted. RESULTS We identified 25 genes associated with CRC risk at a Bonferroni-corrected threshold of P < 9.1 × 10-6, including genes in 4 novel loci, PYGL (14q22.1), RPL28 (19q13.42), CAPN12 (19q13.2), MYH7B (20q11.22), and MAP1L3CA (20q11.22). In 9 known GWAS-identified loci, we uncovered 9 genes that have not been reported previously, whereas 4 genes remained statistically significant after adjusting for the lead risk variant of the locus. Through colocalization analysis in GWAS loci, we additionally identified 12 putative susceptibility genes that were supported by TWAS analysis at P < .01. We showed that risk allele of the lead risk variant rs1741640 affected the promoter activity of CABLES2. Knockdown experiments confirmed that CABLES2 plays a vital role in colorectal carcinogenesis. CONCLUSIONS Our study reveals new putative susceptibility genes and provides new insight into the biological mechanisms underlying CRC development.
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Affiliation(s)
- Xingyi Guo
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, and Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee.
| | - Weiqiang Lin
- The Kidney Disease Center, the First Affiliated Hospital, Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Wanqing Wen
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, and Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Jeroen Huyghe
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Stephanie Bien
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Qiuyin Cai
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, and Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Tabitha Harrison
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Zhishan Chen
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, and Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Conghui Qu
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Jiandong Bao
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, and Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Jirong Long
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, and Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Yuan Yuan
- The Kidney Disease Center, the First Affiliated Hospital, Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Fangqin Wang
- The Kidney Disease Center, the First Affiliated Hospital, Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Mengqiu Bai
- The Kidney Disease Center, the First Affiliated Hospital, Institute of Translational Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Goncalo R Abecasis
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan, Ann Arbor, Michigan
| | - Demetrius Albanes
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Sonja I Berndt
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Stéphane Bézieau
- Service de Génétique Médicale, Centre Hospitalier Universitaire, Nantes, France
| | - D Timothy Bishop
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, United Kingdom
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Division of Preventive Oncology, German Cancer Research Center and National Center for Tumor Diseases, Heidelberg, Germany
| | - Stephan Buch
- Department of Medicine I, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany
| | | | - Peter T Campbell
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, Georgia
| | - Sergi Castellví-Bel
- Gastroenterology Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, University of Barcelona, Barcelona, Spain
| | - Andrew T Chan
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany; University Medical Centre Hamburg-Eppendorf, University Cancer Centre Hamburg, Hamburg, Germany
| | - Stephen J Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Sang Hee Cho
- Department of Hematology-Oncology, Chonnam National University Hospital, Hwasun, South Korea
| | - David V Conti
- Department of Preventive Medicine and University of Southern California Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Albert de la Chapelle
- Department of Cancer Biology and Genetics and the Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Edith J M Feskens
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
| | - Steven J Gallinger
- Lunenfeld Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Graham G Giles
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Phyllis J Goodman
- SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Andrea Gsur
- Institute of Cancer Research, Department of Medicine I, Medical University Vienna, Vienna, Austria
| | - Mark Guinter
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, Georgia
| | - Marc J Gunter
- Nutrition and Metabolism Section, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Jochen Hampe
- Department of Medicine I, University Hospital Dresden, Technische Universität Dresden, Dresden, Germany
| | - Heather Hampel
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Richard B Hayes
- Division of Epidemiology, Department of Population Health, New York University School of Medicine, New York, New York
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
| | - Hyun Min Kang
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan, Ann Arbor, Michigan
| | - Temitope O Keku
- Center for Gastrointestinal Biology and Disease, University of North Carolina, Chapel Hill, North Carolina
| | - Hyeong Rok Kim
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Korea
| | | | - Soo Chin Lee
- National University Cancer Institute, Singapore; Cancer Science Institute of Singapore, National University of Singapore, Singapore
| | - Christopher I Li
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Li Li
- Department of Family Medicine, University of Virginia, Charlottesville, Virginia
| | - Annika Lindblom
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | | | - Roger L Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Victor Moreno
- Oncology Data Analytics Program, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Neil Murphy
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, Georgia
| | - Polly A Newcomb
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington; School of Public Health, University of Washington, Seattle, Washington
| | - Deborah A Nickerson
- Department of Genome Sciences, University of Washington, Seattle, Washington
| | - Kenneth Offit
- Clinical Genetics Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Rachel Pearlman
- Division of Human Genetics, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Paul D P Pharoah
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Elizabeth A Platz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - John D Potter
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Gad Rennert
- Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Lori C Sakoda
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington; Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Clemens Schafmayer
- Department of General Surgery, University Hospital Rostock, Rostock, Germany
| | - Stephanie L Schmit
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Robert E Schoen
- Department of Medicine and Epidemiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Fredrick R Schumacher
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Martha L Slattery
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Yu-Ru Su
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Catherine M Tangen
- SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Cornelia M Ulrich
- Huntsman Cancer Institute and Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | | | - Bethany Van Guelpen
- Department of Radiation Sciences, Oncology Unit, Umeå University, Umeå, Sweden
| | - Kala Visvanathan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Pavel Vodicka
- Department of Molecular Biology of Cancer, Institute of Experimental Medicine of the Czech Academy of Sciences, Prague, Czech Republic; Institute of Biology and Medical Genetics, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ludmila Vodickova
- Department of Molecular Biology of Cancer, Institute of Experimental Medicine of the Czech Academy of Sciences, Prague, Czech Republic; Institute of Biology and Medical Genetics, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Veronika Vymetalkova
- Department of Molecular Biology of Cancer, Institute of Experimental Medicine of the Czech Academy of Sciences, Prague, Czech Republic; Institute of Biology and Medical Genetics, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Xiaoliang Wang
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Emily White
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington
| | - Alicja Wolk
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Michael O Woods
- Memorial University of Newfoundland, Discipline of Genetics, St John's, Newfoundland and Labrador, Canada
| | - Graham Casey
- Center for Public Health Genomics, University of Virginia, Charlottesville, Virginia
| | - Li Hsu
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Mark A Jenkins
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Stephen B Gruber
- Department of Preventive Medicine and University of Southern California Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Ulrike Peters
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, and Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee
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Wesselink E, Kok DE, de Wilt JHW, Bours MJL, van Zutphen M, Keulen ETP, Kruyt FM, Breukink SO, Kouwenhoven EA, van den Ouweland J, Weijenberg MP, Kampman E, van Duijnhoven FJB. Sufficient 25-Hydroxyvitamin D Levels 2 Years after Colorectal Cancer Diagnosis are Associated with a Lower Risk of All-cause Mortality. Cancer Epidemiol Biomarkers Prev 2021; 30:765-773. [PMID: 33531437 DOI: 10.1158/1055-9965.epi-20-1388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/25/2020] [Accepted: 01/19/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Whether changes in 25 hydroxy vitamin D3 (25(OH)D3) levels after colorectal cancer diagnosis influence clinical outcomes is unclear. We investigated the association of trajectories of 25(OH)D3 levels with recurrence and all-cause mortality. METHODS In total, 679 patients were included in our data analyses. Trajectories of 25(OH)D3 levels were defined on the basis of vitamin D status at diagnosis, at 6 months, and 2 years after diagnosis. Observed trajectories of 25(OH)D3 levels were consistent deficient levels (20%), consistent sufficient levels (39%), increasing levels (20%), and a temporary drop in levels (13%). Associations of trajectories of 25(OH)D3 with recurrence and all-cause mortality were assessed using multivariable Cox proportional hazards regression models. RESULTS During a follow-up time of 2.2 years for recurrence and 3.5 years for all-cause mortality, 31 and 65 events occurred, respectively. No statistically significant associations were observed for vitamin D trajectories and the risk of recurrence. Patients who were consistently sufficient compared with patients who were consistently deficient had a lower risk of all-cause mortality [HR 0.39; 95% confidence interval (CI), 0.21-0.73]. The risk of all-cause mortality seems lower in patients with increasing levels or a temporary drop in levels (HR 0.54; 95% CI, 0.27-1.10 and HR 0.40 95% CI, 0.17-0.93) relative to patients with consistent deficient levels. CONCLUSIONS Patients with colorectal cancer following a trajectory characterized by sufficient levels of 25(OH)D3 2 years after diagnosis all appeared to have a lower risk of all-cause mortality compared with patients having consistent deficient levels. IMPACT Further studies should investigate how trajectories of 25(OH)D3 levels are associated with colorectal cancer recurrence.
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Affiliation(s)
- Evertine Wesselink
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands.
| | - Dieuwertje E Kok
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Martijn J L Bours
- Department of Epidemiology, GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Moniek van Zutphen
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Eric T P Keulen
- Department of Gastroenterology, Zuyderland Medical Centre, Heerlen, the Netherlands
| | - Flip M Kruyt
- Department of Surgery, Hospital Gelderse Vallei, Ede, the Netherlands
| | - Stephanie O Breukink
- Department of Epidemiology, GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands.,Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Jody van den Ouweland
- Department of Clinical Chemistry, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Matty P Weijenberg
- Department of Epidemiology, GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
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Brouwer JGM, Newcomb PA, Bisseling TM, Figueiredo JC, Hopper JL, Jenkins MA, Koornstra JJ, Lindor NM, Vasen HFA, Win AK, Kampman E, van Duijnhoven FJB. Associations of Height With the Risks of Colorectal and Endometrial Cancer in Persons With Lynch Syndrome. Am J Epidemiol 2021; 190:230-238. [PMID: 33524116 PMCID: PMC8210745 DOI: 10.1093/aje/kwaa175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 08/12/2020] [Accepted: 08/12/2020] [Indexed: 11/13/2022] Open
Abstract
People with Lynch syndrome (LS), who carry a pathogenic mutation in a DNA mismatch repair gene, have increased risks of colorectal cancer (CRC) and endometrial cancer (EC). A high reported variability in cancer risk suggests the existence of factors that modify cancer risk for persons with LS. We aimed to investigate the associations between height and CRC and EC risk for persons with LS using data from 2 large studies. Information on 1,115 men and 1,553 women with LS from the Colon Cancer Family Registry (1998–2007) and the GEOLynch Cohort Study (2006–2017) was harmonized. We used weighted Cox proportional hazards regression models with age on the time axis to estimate adjusted hazard ratios and 95% confidence intervals for each 5-cm increment in self-reported height. CRC was diagnosed in 947 persons during 65,369 person-years of observation, and 171 women were diagnosed with EC during 39,227 person-years. Height was not associated with CRC for either men (per 5-cm increment, hazard ratio (HR) = 1.00, 95% confidence interval (CI): 0.91, 1.11) or women (per 5-cm increment, HR = 1.01, 95% CI: 0.92, 1.11), nor was height associated with EC (per 5-cm increment, HR = 1.08, 95% CI: 0.94, 1.24). Hence, we observed no evidence for an association of height with either CRC or EC among persons with LS.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Fränzel J B van Duijnhoven
- Correspondence to Dr. Fränzel J. B. van Duijnhoven, Division of Human Nutrition and Health, Wageningen University & Research, P.O. Box 17, 6700 AA Wageningen, the Netherlands (e-mail: )
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48
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Wesselink E, Staritsky LE, van Zutphen M, Geijsen AJMR, Kok DE, Kruyt F, Veenstra RP, Spillenaar Bilgen EJ, Kouwenhoven EA, de Wilt JHW, Kampman E, van Duijnhoven FJB. The association between the adapted dietary inflammatory index and colorectal cancer recurrence and all-cause mortality. Clin Nutr 2021; 40:4436-4443. [PMID: 33478795 DOI: 10.1016/j.clnu.2021.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/18/2020] [Accepted: 01/01/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS The inflammatory potential of the diet has been linked to colorectal cancer (CRC) development and mortality. However, it is unknown whether it is also associated with CRC recurrence. Therefore, the aim of this study was to investigate the associations between the inflammatory potential of the diet and plasma inflammation markers as well as recurrence and all-cause mortality in CRC patients. METHODS Data of the Colorectal cancer, Observational, LONgitudinal (COLON) study, a prospective cohort study, was used. Dietary intake, assessed using a semi-quantitative food frequency questionnaire, was available for 1478 patients at diagnosis and for 1334 patients six months after diagnosis. Dietary intake data were used to calculate the adapted dietary inflammatory index (ADII). Data about cancer recurrence and all-cause mortality, were assessed through linkage with the Netherlands Cancer Registry and the Municipal Personal Records Database, respectively. The association between the ADII (continuous) and inflammation markers (Interleukin (IL)6, IL8, IL10, Tumor Necrosis Factor (TNF)α, high sensitivity C-reactive protein (hsCRP) and a summary inflammatory z-score), measured with a multiplex assay using electrochemiluminiscence detection, was assessed using quantile regression analyses. Restricted cubic splines (RCS) analyses and multivariable Cox proportional hazard models were used to explore the relationship between the ADII and CRC outcomes. RESULTS During a median follow-up time of 3.2 years (Interquartile range (IQR) 2.0-4.1) for recurrence and 4.8 years (IQR 3.5-5.9) for all-cause mortality, 228 recurrences and 279 deaths occurred. A more pro-inflammatory diet at diagnosis as well as six months after diagnosis was associated with higher levels of TNFα, hsCRP and the summary inflammatory z-score. Results of RCS showed no relationship between the ADII and CRC outcomes at both time points. Also results of the Cox proportional hazard models showed no associations between the ADII at both time points and recurrence (HR (95%CI) 0.98 (0.94-1.04) & 0.96 (0.91-1.02) or all-cause mortality (HR (95%CI) 1.03 (0.98-1.07) & 1.00 (0.95-1.05)). CONCLUSION Our study did not show an association between the ADII and recurrence and all-cause mortality in CRC patients. Further research should also take into account molecular tumor subtypes, as the effect of the inflammatory potential of the diet on cancer recurrence and mortality is more likely to be present in tumors with an inflammatory signature. CLINICAL TRIAL REGISTRY NUMBERS AND WEBSITE The colon study: NCT03191110; clinical trials.gov.
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Affiliation(s)
- Evertine Wesselink
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands.
| | - Laura E Staritsky
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Moniek van Zutphen
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Anne J M R Geijsen
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Dieuwertje E Kok
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Flip Kruyt
- Department of Surgery, Hospital Gelderse Vallei, Ede, the Netherlands
| | - Renzo P Veenstra
- Department of Gastroenterology, Martini Hospital, Groningen, the Netherlands
| | | | | | - Johannes H W de Wilt
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
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49
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de Kruif AJT, Westerman MJ, Winkels RM, Koster MS, van der Staaij IM, van den Berg MMGA, de Vries JHM, de Boer MR, Kampman E, Visser M. Exploring changes in dietary intake, physical activity and body weight during chemotherapy in women with breast cancer: A Mixed-Methods Study. J Hum Nutr Diet 2021; 34:550-561. [PMID: 33411940 PMCID: PMC8248384 DOI: 10.1111/jhn.12843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/03/2020] [Accepted: 10/27/2020] [Indexed: 01/21/2023]
Abstract
Background The present study aimed (i) to assess changes in dietary intake (DI), physical activity (PA) and body weight (BW) in breast cancer patients during chemotherapy; (ii) to describe how women explained, experienced and dealt with these potential changes; and (iii) to eventually develop lifestyle intervention strategies tailored to the women's personal needs during chemotherapy. Methods A longitudinal parallel mixed‐method design was used with quantitative assessment of changes in dietary intake (24‐h recall, Appetite, Hunger, Sensory Perception questionnaire), physical activity (Short Questionnaire to Assess Health‐enhancing physical activity, Multidimensional Fatigue Inventory) and BW (dual‐energy X‐ray absorptiometry), in addition to qualitative interviews with 25 women about these potential changes during chemotherapy. Results Most women who perceived eating less healthily with low energy intake (EI) and being less active before diagnosis continued to do so during chemotherapy, according to quantitative measurements. They struggled to maintain sufficient energy intake. Despite a lower than average reported EI, they unexpectedly gained weight and explained that fatigue made them even more inactive during chemotherapy. Active women usually managed to stay active because exercise was very important to them and made them feel good, although they also suffered from the side‐effects of chemotherapy. They found more ways to deal with taste, smell and appetite problems than women with a lower energy intake. Conclusions The combination of the quantitative and qualitative data provided more insight into the changes in dietary intake, physical activity and BW during chemotherapy. The women's explanations showed why some women remain active and others need support to deal with changes in lifestyle factors such as healthy nutrition and fatigue.
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Affiliation(s)
- Anja JThCM de Kruif
- Department of Health Sciences, Faculty of Science, The Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Epidemiology and Biostatistics, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Marjan J Westerman
- Department of Health Sciences, Faculty of Science, The Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Renate M Winkels
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Marije S Koster
- Department of Health Sciences, Faculty of Science, The Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Irene M van der Staaij
- Department of Quality Assurance and Process Management, Student & Educational Affairs, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Jeanne H M de Vries
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Michiel R de Boer
- Department of Health Sciences, Faculty of Science, The Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, The Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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50
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Postma EM, Kok DE, de Graaf C, Kampman E, Boesveldt S. Chemosensory perception and food preferences in colorectal cancer patients undergoing adjuvant chemotherapy. Clin Nutr ESPEN 2020; 40:242-251. [PMID: 33183544 DOI: 10.1016/j.clnesp.2020.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIM Cancer is one of the major public health problems, with colorectal cancer being one of the most occurring types of cancer. During treatment, patients may experience changes in their dietary intake due to side-effects of treatment, like changes in chemosensory perception, i.e. smell and taste function. This study investigated alterations in chemosensory perception and food preferences in colorectal cancer patients during and after adjuvant chemotherapy. METHODS Objective olfactory and gustatory function were measured by the Sniffin' Sticks and the Taste Strips test. Subjective smell and taste perception were determined with a questionnaire, while food preferences were assessed with a computer-based ranking task. To investigate changes during chemotherapy, patients undergoing adjuvant chemotherapy were measured before the start, halfway through (approximately 3 months after the start of adjuvant chemotherapy), and within one month after finishing chemotherapy (longitudinal measurements, n = 15 patients). As a comparison group, colorectal cancer patients not undergoing chemotherapy (n = 20), underwent the same measurements at similar time points. To measure changes after treatment, chemosensory perception and food preferences of patients who had undergone chemotherapy treatment were measured once, either at 6, 12 or 24 months after diagnosis (cross-sectional measurements; n = 20 for all time points). Changes during treatment were assessed using linear mixed model analyses, and changes after treatment were assessed with a one-way ANOVA or a Kruskal Wallis test. RESULTS Objective olfactory and gustatory function did not differ statistically significantly between any of the groups and at any time point during or after treatment (all p > 0.05). In contrast, subjective smell (F(1,84) = 8.17, p = 0.005) and taste (F(1,99) = 4.08, p = 0.046) perception were rated statistically significantly lower by patients undergoing chemotherapy than the comparison group during treatment. At 6 months after diagnosis, patients who underwent chemotherapy rated their subjective taste perception significantly lower than patients at 12 and 24 months after treatment (F(2,57) = 12.05, p = 0.002). Food preferences did not change during treatment, or thereafter (all p > 0.05). Preference for protein-rich foods was positively correlated with objective gustatory function (r = 0.36, p < 0.001), while the preference for low-energy foods showed a negative correlation with objective gustatory function (r = -0.28, p = 0.004). CONCLUSIONS Similar to other cancer patient populations, mainly subjective smell and taste perception are affected in colorectal cancer patients undergoing adjuvant chemotherapy. Changes in objective olfactory and gustatory function in relation to chemotherapy were not detected by the tests used in our study nor did food preferences change. However, it should be noted that subjective changes in smell and taste perception can affect subsequent flavor perception and food enjoyment, which might negatively impact eating behavior and nutritional intake.
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Affiliation(s)
- E M Postma
- Division of Human Nutrition and Health, Wageningen University & Research, Stippeneng 4, 6708 WE, Wageningen, The Netherlands; Smell and Taste Centre, ENT Department, Hospital Gelderse Vallei, Willy Brandtlaan 10, 6716 RP, Ede, the Netherlands
| | - D E Kok
- Division of Human Nutrition and Health, Wageningen University & Research, Stippeneng 4, 6708 WE, Wageningen, The Netherlands
| | - C de Graaf
- Division of Human Nutrition and Health, Wageningen University & Research, Stippeneng 4, 6708 WE, Wageningen, The Netherlands
| | - E Kampman
- Division of Human Nutrition and Health, Wageningen University & Research, Stippeneng 4, 6708 WE, Wageningen, The Netherlands
| | - S Boesveldt
- Division of Human Nutrition and Health, Wageningen University & Research, Stippeneng 4, 6708 WE, Wageningen, The Netherlands.
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