Plasma Carotenoids and Retinol and Overall and Breast Cancer Risk: A Nested Case-Control Study

Experimental studies suggest that carotenoids and retinol may play a role in carcinogenesis, but epidemiological evidence is lacking. We investigated the prospective associations between plasma concentrations of major carotenoids and retinol, and overall and breast cancer risk. A nested case-control study included all first incident cancer cases diagnosed in the SU.VI.MAX cohort between 1994 and 2002 (n = 159 cases, 1 matched control/case). Baseline plasma concentrations of carotenoids and retinol were measured by high-performance liquid chromatography. Conditional logistic regression was used to assess odds ratios for an increase of 0.1 μmol/L [odds ratio (OR)] and 95% confidence intervals (CI). Plasma β-carotene (OR = 0.95, 95% CI = 0.90–0.99, P_trend = 0.04) and β-cryptoxanthin concentrations (OR = 0.89, 95% CI = 0.81–0.99, P_trend = 0.03) were inversely associated with overall cancer risk. Plasma β-cryptoxanthin concentration was inversely associated with breast cancer risk (OR = 0.83, 95% CI = 0.71–0.96, P_trend = 0.02). The OR between plasma lycopene concentration and overall cancer risk was 1.07 (0.99–1.15), P_trend = 0.06. This association turned significant (P_trend = 0.01) when excluding cancer cases diagnosed during the first year of follow-up. This prospective study suggests an inverse association between plasma concentrations of β-cryptoxanthin and both overall and breast cancer risk, and an inverse association between β-carotene and overall cancer risk. The direct association between lycopene concentration and cancer risk deserves further investigation.     

Dietary fiber intake and risk of breast cancer by menopausal and estrogen receptor status

Purpose

Evaluate the hypothesis that relation of breast cancer associated with dietary fiber intakes varies by type of fiber, menopausal, and the tumor’s hormone receptor status.

Methods

A case–control study of female breast cancer was conducted in Connecticut. A total of 557 incident breast cancer cases and 536 age frequency-matched controls were included in the analysis. Information on dietary intakes was collected through in-person interviews with a semi-quantitative food frequency questionnaire and was converted into nutrient intakes. Odds ratios and 95% confidence intervals were estimated by unconditional logistic regression.

Results

Among pre-menopausal women, higher intake of soluble fiber (highest versus lowest quartile of intake) was associated with a significantly reduced risk of breast cancer (OR = 0.38, 95% CI, 0.15–0.97, P _trend = 0.08). When further restricted to pre-menopausal women with ER^? tumors, the adjusted OR for the highest quartile of intake was 0.15 (95% CI, 0.03–0.69, P _trend = 0.02) for soluble fiber intake. Among post-menopausal women, no reduced risk of breast cancer was observed for either soluble or insoluble fiber intakes or among ER⁺ or ER^? tumor groups.

Conclusions

The results from this study show that dietary soluble fiber intake is associated with a significantly reduced risk of ER^? breast cancer among pre-menopausal women. Additional studies with larger sample size are needed to confirm these results.     

Coffee consumption and the risk of cancer in the Norwegian Women and Cancer (NOWAC) Study

An association between coffee consumption and cancer has long been investigated. Coffee consumption among Norwegian women is high, thus this is a favorable population in which to study the impact of coffee on cancer incidence. Information on coffee consumption was collected from 91,767 women at baseline in the Norwegian Women and Cancer Study. These information were applied until follow-up information on coffee consumption, collected 6–8 years after baseline, became available. Multiple imputation was performed as a method for dealing with missing data. Multivariable Cox regression models were used to calculate hazard ratios (HR) for breast, colorectal, lung, and ovarian cancer, as well as cancer at any site. We observed a 17 % reduced risk of colorectal cancer (HR = 0.83, 95 % CI 0.70–0.98, p _{trend across categories of consumption} = 0.10) and a 9 % reduced risk of cancer at any site (HR = 0.91, 95 % CI 0.86–0.97, p _trend = 0.03) in women who drank more than 3 and up to 7 cups/day, compared to women who drank ≤1 cup/day. A significantly increased risk of lung cancer was observed with a heavy coffee consumption (>7 vs. ≤1 cup/day HR = 2.01, 95 % CI 1.47–2.75, p _trend < 0.001). This was most likely caused by residual confounding due to smoking, as no statistically significant association was observed in never smokers (>5 vs. ≤1 cup/day HR = 1.42, 95 % CI 0.44–4.57, p _trend = 0.30). No significant association was found between coffee consumption and the risk of breast or ovarian cancer. In this study, coffee consumption was associated with a modest reduced risk of cancer at any site. Residual confounding due to smoking may have contributed to the positive association between high coffee consumption and the risk of lung cancer.     

Breast Cancer Diagnosis from Screening in Trinidad and Tobago: Opportunities for Cancer Prevention

Trinidad and Tobago (TT) experiences the highest breast cancer mortality in the Caribbean; the distribution of traditional breast cancer risk factors in this population has not been analyzed. Data on women who underwent breast cancer screening at the TT Cancer Society between January 2009–December 2011(N = 2,689) were retrospectively collected. The screening detected 131 incident breast cancers; variables significantly associated with breast cancer diagnosis were, a positive family history of breast cancer (adjusted odds ratio [OR_adj]: 1.55; 95 % CI 1.00–2.41), presence of symptoms (OR_adj: 1.91; 95 % CI 1.25–2.92), and previous breast surgery (OR_adj: 1.67; 95 % CI 0.97–2.88). Breast cancer was significantly associated with increased breast density. Among healthy women, breast density was positively associated with nulliparity (OR_adj: 1.46, 1.37, 2.52 respectively for density level 2, 3 and 4 vs. 1) and previous breast surgeries (OR_adj: 2.27, 3.09 and 4.13 respectively for density level 2, 3 and 4 vs. 1). This analysis confirms that breast density is an important predictor of newly diagnosed breast cancer in this Caribbean population. Screening is still a diagnostic tool rather than a preventive measure in TT.     

Predictors of health-related quality of life and association with survival may identify colorectal cancer patients at high risk of poor prognosis

Purpose

To investigate the mediators of health-related quality of life (HR-QoL) in colorectal cancer (CRC) patients and effect on overall survival.

Methods

We analyzed baseline (within 1 year of diagnosis) SF-12v1 questionnaire data from 3734 CRC patients and assessed the differences in mental composite scores (MCS) and physical composite scores (PCS) by socio-demographics and risks of poor HR-QoL by these factors. Hazard ratios were generated using univariate Cox regression for MCS and PCS dichotomized using the normalized scoring-based mean of 50 and survival estimates generated using the Kaplan–Meier method.

Results

Differences in MCS and PCS were identified by sex, age, education level, alcohol use, tobacco use, and stage. Race, marital status, and cancer site differed only by PCS. Being female, never married, former alcohol user, or with stage IV disease significantly increased risk of a poor HR-QoL, with magnitudes of risk from 1.25- to 1.97-fold. Higher education level had a protective effect (MCS: P _trend = 2.32 × 10^?7; PCS: P _trend = 5.62 × 10^?14). Hispanics and African-Americans had a 1.35- and 1.57-fold risk of poor PCS, and increase in age had a protective effect for risk of poor MCS (P _trend = 1.84 × 10^?7). Poor MCS or PCS were associated with poor prognosis and decreased survival at 5 years (HR_MCS 1.57, 95 % CI 1.41–1.76 and HR_PCS 2.38, 95 % CI 2.08–2.72), and both remained significant when adjusting for age, gender, race, education level, tumor stage, and tumor site.

Conclusions

Our findings identify potential mediators for HR-QoL and suggest that baseline HR-QoL assessment may be prognostic for CRC.

     

Effectiveness of a community-based intervention for weight loss on cardiometabolic risk factors among overweight and obese women in a low socio-economic urban community: findings of the MyBFF@home

Background

The effectiveness of lifestyle intervention for weight loss on cardiometabolic risk factors among overweight and obese individuals in the community setting remains inconclusive. This study aimed to evaluate the effect of a 6-month weight loss lifestyle intervention on cardiometabolic risk factors among overweight and obese women and the sustainability of the changes in those markers at 12-month follow-up, comparing an intervention group with a control group.

Methods

A total of 243 participants from MyBFF@home were included in this study. Fasting blood samples at baseline, 6- and 12-month were assessed for fasting plasma glucose (FPG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides. The effect of the intervention on cardiometabolic risk markers were investigated within and between study groups using t-test and general linear model (GLM) repeated measure ANOVA.

Results

Results from repeated measures ANOVA showed intervention effect only in TC where significant reduction was found in the intervention group (? 0.26 mmol/L [95% CI: – 0.47 to ? 0.06], p?<?0.01) compared to the control group (? 0.06 mmol/L [95% CI: – 0.28 to 0.17]) at 12 months. At 6 months, TC was reduced significantly in both groups but only intervention group retained the reduction in maintenance phase while, the level increased significantly in the control group (0.22 mmol/L [95% CI: 0.06 to 0.38]). This attributed to significant increase in TC/HDL-C ratio in the control group during maintenance phase (0.32 [95% CI: 0.15 to 0.50], p?<?0.001). The intervention group also showed trend of reduction in FPG at 6 months and further decreased during maintenance phase (??0.19 mmol/L [95% CI: – 0.32 to ? 0.06], p?<?0.01). At 6 months HDL-C was maintained in the intervention group but reduced significantly in the control group (??0.05 mmol/L [95% CI: – 0.10 to ? 0.01], p?<?0.05). No significant difference was detected in both markers when compared between groups.

Conclusions

In the context of low socio-economic communities, this study supports that weight loss related lifestyle modifications over a 6-month period could improve selected cardiometabolic risk factors, particularly fasting glucose, TC and HDL-C in overweight and obese women with favourable sustainability over a 12-month period.

     

Dietary patterns and breast cancer risk among women in northern Tanzania: a case–control study

Background

Breast cancer is the second most common cancer among women in the Kilimanjaro Region of Tanzania. It was tested within a case–control study in this region whether a specific dietary pattern impacts on the breast cancer risk.

Methods

A validated semi-quantitative Food Frequency Questionnaire was used to assess the dietary intake of 115 female breast cancer patients and 230 healthy age-matched women living in the same districts. A logistic regression was performed to estimate breast cancer risk. Dietary patterns were obtained using principal component analysis with Varimax rotation.

Results

The adjusted logistic regression estimated an increased risk for a “Fatty Diet”, characterized by a higher consumption of milk, vegetable oils and fats, butter, lard and red meat (OR = 1.42, 95 % CI 1.08–1.87; P = 0.01), and for a “Fruity Diet”, characterized by a higher consumption of fish, mango, papaya, avocado and watery fruits (OR = 1.61, 95 % CI 1.14–2.28; P = 0.01). Both diets showed an inverse association with the ratio between polyunsaturated and saturated fatty acids (P/S ratio).

Conclusion

A diet characterized by a low P/S ratio seems to be more important for the development of breast cancer than total fat intake.     

Dose-response relation between serum total cholesterol levels and overall cancer risk: evidence from 12 prospective studies involving 1,926,275 participants

This study aimed to clarify the association between serum total cholesterol (TC) levels and overall cancer risk. Study-specific relative risks (RR) and 95% confidence intervals (CI) were pooled using a random-effects model, and dose–response relation was also evaluated. Twelve prospective studies were identified with a total of 1,926,275 participants and 13,1676 cases. High levels of serum TC showed an inverse association with overall cancer risk (RR for the highest versus the lowest category: 0.87, 95% CI: 0.83?～?0.90; I²?=?52.5%). A linear dose-response relation between serum TC levels and overall cancer risk was found (p?=?.004 for Wald test; I²?=?49.6%), and the pooled RR was 0.92 (95% CI: 0.89?～?0.94) for 3?mmol/L, 0.86 (95% CI: 0.81?～?0.90) for 5?mmol/L, 0.80 (95% CI: 0.74?～?0.87) for 7?mmol/L. Our dose-response meta-analysis of 12 prospective studies indicated that higher serum TC levels were significantly associated with reduced cancer risk.     

Body mass index,abdominal fatness,weight gain and the risk of psoriasis: a systematic review and dose–response meta-analysis of prospective studies

Greater body mass index (BMI) has been associated with increased risk of psoriasis in case–control and cross-sectional studies, however, the evidence from prospective studies has been limited. We conducted a systematic review and dose–response meta-analysis of different adiposity measures and the risk of psoriasis to provide a more robust summary of the evidence based on data from prospective studies. PubMed and Embase databases were searched for relevant studies up to August 8th 2017. Summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated using a random effects model. The summary relative risk (RR) for a 5 unit increment in BMI was 1.19 (95% CI 1.10–1.28, I² = 83%, n = 7). The association appeared to be stronger at higher compared to lower levels of BMI, p_nonlinearity < 0.0001, and the lowest risk was observed at a BMI around 20. The summary RR was 1.24 (95% CI 1.17–1.31, I² = 0%, p_{heterogeneity} = 0.72, n = 3) per 10 cm increase in waist circumference, 1.37 (95% CI 1.23–1.53, I² = 0%, p_{heterogeneity} = 0.93, n = 3) per 0.1 unit increase in waist-to-hip ratio, and 1.11 (95% CI 1.07–1.16, I² = 47%, p_{heterogeneity} = 0.15, n = 3) per 5 kg of weight gain. Adiposity as measured by BMI, waist circumference, waist-to-hip ratio, and weight gain is associated with increased risk of psoriasis.     

Serum calcium and the calcium-sensing receptor polymorphism rs17251221 in relation to coronary heart disease, type 2 diabetes, cancer and mortality: the Tromsø Study

Serum calcium measured in 27,158 subjects in 1994 and the calcium-sensing receptor polymorphism rs17251221 genotyped in 9,404 subjects were related to cardiovascular risk factors, incident myocardial infarction (MI), type 2 diabetes (T2DM), cancer and death during follow-up until 2008–2010. In a Cox regression model with adjustment for age, gender, smoking and body mass index, subjects with serum calcium 2.50–2.60 mmol/L had a significantly increased risk of incident MI [n = 1,802, hazards ratio (HR) 1.40, 95 % confidence interval (CI) 1.18, 1.66] and T2DM (n = 705, HR 1.49, 95 % CI 1.15, 1.94) and a significantly reduced risk of cancer (n = 2,222, HR 0.73, 95 % CI 0.62, 0.86) as compared to subjects with serum calcium 2.20–2.29 mmol/L. For rs17251221 there was a mean difference in serum calcium of 0.05 mmol/L between major and minor homozygote genotypes. No consistent, significant relation between rs17251221 and risk factors or the major hard endpoints were found. The minor homozygote genotype (high serum calcium) had a significant twofold increased risk (HR 2.32, 95 % CI 1.24, 4.36) for prostate cancer, as compared to the major homozygote. This may be clinically important if confirmed in other cohorts.     

Same-sex marriage,autoimmune thyroid gland dysfunction and other autoimmune diseases in Denmark 1989–2008

Autoimmune diseases have been little studied in gay men and lesbians. We followed 4.4 million Danes, including 9,615 same-sex married (SSM) persons, for 47 autoimmune diseases in the National Patient Registry between 1989 and 2008. Poisson regression analyses provided first hospitalization rate ratios (RRs) comparing rates between SSM individuals and persons in other marital status categories. SSM individuals experienced no unusual overall risk of autoimmune diseases. However, the risk of autoimmune thyroid dysfunction was increased, notably Hashimoto’s thyroiditis (women_SSM, RR = 2.92; 95 % confidence interval (CI) 1.74–4.55) and Graves’ disease (men_SSM, RR = 1.88; 95 % CI 1.08–3.01). There was also an excess of primary biliary cirrhosis (women_SSM, RR = 4.09; 95 % CI 1.01–10.7), and of psoriasis (men_SSM, RR = 2.48; 95 % CI 1.77–3.36), rheumatic fever (men_SSM, RR = 7.55; 95 % CI 1.87–19.8), myasthenia gravis (men_SSM, RR = 5.51; 95 % CI 1.36–14.4), localized scleroderma (men_SSM, RR = 7.16; 95 % CI 1.18–22.6) and pemphigoid (men_SSM, RR = 6.56; 95 % CI 1.08–20.6), while Dupuytren’s contracture was reduced (men_SSM, RR = 0.64; 95 % CI 0.39–0.99). The excess of psoriasis was restricted to same-sex married men with HIV/AIDS (men_SSM, RR = 10.5; 95 % CI 6.44–15.9), whereas Graves’ disease occurred in excess only among same-sex married men without HIV/AIDS (men_SSM, RR = 1.99; 95 % CI 1.12–3.22). Lesbians and immunologically competent gay men in same-sex marriage face no unusual overall risk of autoimmune diseases. However, the observed increased risk of thyroid dysfunction in these lesbians and gay men deserves further study.     

Perinatal risk factors for Wilms tumor in a Swedish national cohort

Perinatal risk factors including high birth weight have been associated with Wilms tumor in case–control studies. However, these findings have seldom been examined in large cohort studies, and the specific contributions of gestational age at birth and fetal growth remain unknown. We conducted the largest population-based cohort study to date consisting of 3,571,574 persons born in Sweden in 1973–2008, followed up for Wilms tumor incidence through 2009 to examine perinatal risk factors. There were 443 Wilms tumor cases identified in 66.3 million person-years of follow-up. After adjusting for gestational age and other perinatal factors, high fetal growth was associated with increased risk of Wilms tumor among girls (hazard ratio per 1 standard deviation (SD), 1.36; 95 % CI 1.20–1.54; P < 0.001), but not boys (1.10; 95 % CI 0.97–1.25; P = 0.14) (P _interaction = 0.02). Among girls, high fetal growth was associated with disease onset before age 5 years (odds ratio per 1 SD, 1.47; 95 % CI 1.28–1.69; P < 0.001), but not beyond (1.00; 95 % CI 0.76–1.31; P = 0.99). No clear associations were found for gestational age at birth or other perinatal factors. In this large cohort study, high fetal growth was associated with Wilms tumor before age 5 years among girls. These findings suggest that early-life growth factor pathways for Wilms tumor may be more common among girls than boys. Further elucidation of these mechanisms may reveal better targets for prevention or treatment of specific subtypes of Wilms tumor.     

Gestational Weight Gain,Body Mass Index,and Risk of Hypertensive Disorders of Pregnancy in a Predominantly Puerto Rican Population

Objectives To prospectively evaluate the association between gestational weight gain (GWG), prepregnancy body mass index (BMI), and hypertensive disorders of pregnancy using the revised Institute of Medicine (IOM) Guidelines. Methods We examined these associations among 1359 participants in Proyecto Buena Salud, a prospective cohort study conducted from 2006 to 2011 among women from the Caribbean Islands. Information on prepregnancy BMI, GWG, and incident diagnoses of hypertension in pregnancy were based on medical record abstraction. Results Four percent (n = 54) of women were diagnosed with hypertension in pregnancy, including 2.6 % (n = 36) with preeclampsia. As compared to women who gained within IOM GWG guidelines (22.8 %), those who gained above guidelines (52.5 %) had an odds ratio of 3.82 for hypertensive disorders (95 % CI 1.46–10.00; p_trend = 0.003) and an odds ratio of 2.94 for preeclampsia (95 % CI 1.00–8.71, p_trend = 0.03) after adjusting for important risk factors. Each one standard deviation (0.45 lbs/week) increase in rate of GWG was associated with a 1.74 odds of total hypertensive disorders (95 % CI 1.34–2.27) and 1.86 odds of preeclampsia (95 % CI 1.37–2.52). Conclusions for Practice Findings from this prospective study suggest that excessive GWG is associated with hypertension in pregnancy and could be a potentially modifiable risk factor in this high-risk ethnic group.     

Dietary fiber intake and risk of type 2 diabetes: a dose–response analysis of prospective studies

Observational studies suggest an association between dietary fiber intake and risk of type 2 diabetes, but the results are inconclusive. We conducted a meta-analysis of prospective studies evaluating the associations of dietary fiber intake and risk of type 2 diabetes. Relevant studies were identified by searching EMBASE (from 1974 to April 2013) and PubMed (from 1966 to April 2013). The fixed or random-effect model was selected based on the homogeneity test among studies. In addition, a 2-stage random-effects dose–response meta-analysis was performed. We identified 17 prospective cohort studies of dietary fiber intake and risk of type 2 diabetes involving 19,033 cases and 488,293 participants. The combined RR (95 % CI) of type 2 diabetes for intake of total dietary fiber, cereal fiber, fruit fiber and insoluble fiber was 0.81 (0.73–0.90), 0.77 (0.69–0.85), 0.94 (0.88–0.99) and 0.75 (0.63–0.89), respectively. A nonlinear relationship was found of total dietary fiber intake with risk of type 2 diabetes (P _{for nonlinearity} < 0.01), and the RRs (95 % CI) of type 2 diabetes were 0.98 (0.90–1.06), 0.97 (0.87–1.07), 0.89 (0.80–0.99), 0.76 (0.65–0.88), and 0.66 (0.53–0.82) for 15, 20, 25, 30, and 35 g/day. The departure from nonlinear relationship was not significant (P _{for nonlinearity} = 0.72), and the risk of type 2 diabetes decreased by 6 % (RR 0.94, 95 % CI 0.93–0.96) for 2 g/day increment in cereal fiber intake. Findings from this meta-analysis indicate that the intakes of dietary fiber may be inversely associated with risk of type 2 diabetes.     

Is heme iron intake associated with risk of coronary heart disease? A meta-analysis of prospective studies

Purpose

Heme iron may contribute to the development of atherosclerosis by catalyzing production of hydroxyl-free radicals and promoting low-density lipoprotein oxidation. However, epidemiologic findings regarding the association between heme iron intake and risk of coronary heart disease (CHD) are inconsistent. We aimed to investigate the association by carrying out a meta-analysis of prospective studies.

Methods

Relevant studies were identified by using PubMed and EMBASE databases between January 1966 and April 2013 and also by manually reviewing the reference lists of retrieved publications. Summary relative risks (RRs) with corresponding 95 % confidence intervals (CIs) were computed using a random-effects model.

Results

Six prospective studies, which contained a total of 131,553 participants and 2,459 CHD cases, met the inclusion criteria. Combined results indicated that participants with higher heme iron intake had a 31 % increased risk of CHD, compared with those with lower intake (RR = 1.31, 95 % CI 1.04–1.67), with significant heterogeneity (P ^{heterogeneity} = 0.05, I ² = 55.0 %). Excluding the only study from Japan (limiting to Western studies) yielded a RR of 1.46 (95 % CI 1.21–1.76), with no study heterogeneity (P ^{heterogeneity} = 0.44, I ² = 0.0 %). The dose–response RR of CHD for an increase in heme iron intake of 1 mg/day was 1.27 (95 % CI 1.10–1.47), with low heterogeneity (P ^{heterogeneity} = 0.25, I ² = 25.8 %). We observed no significant publication bias.

Conclusions

This meta-analysis suggests that heme iron intake was associated with an increased risk of CHD.     

Dietary intake of total polyphenol and polyphenol classes and the risk of colorectal cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort

Polyphenols may play a chemopreventive role in colorectal cancer (CRC); however, epidemiological evidence supporting a role for intake of individual polyphenol classes, other than flavonoids is insufficient. We evaluated the association between dietary intakes of total and individual classes and subclasses of polyphenols and CRC risk and its main subsites, colon and rectum, within the European Prospective Investigation into Cancer and Nutrition (EPIC) study. The cohort included 476,160 men and women from 10 European countries. During a mean follow-up of 14 years, there were 5991 incident CRC cases, of which 3897 were in the colon and 2094 were in the rectum. Polyphenol intake was estimated using validated centre/country specific dietary questionnaires and the Phenol-Explorer database. In multivariable-adjusted Cox regression models, a doubling in total dietary polyphenol intake was not associated with CRC risk in women (HR_log2?=?1.06, 95% CI 0.99–1.14) or in men (HR_log2?=?0.97, 95% CI 0.90–1.05), respectively. Phenolic acid intake, highly correlated with coffee consumption, was inversely associated with colon cancer in men (HR_log2?=?0.91, 95% CI 0.85–0.97) and positively associated with rectal cancer in women (HR_log2?=?1.10, 95% CI 1.02–1.19); although associations did not exceed the Bonferroni threshold for significance. Intake of other polyphenol classes was not related to colorectal, colon or rectal cancer risks. Our study suggests a possible inverse association between phenolic acid intake and colon cancer risk in men and positive with rectal cancer risk in women.     

Intake of vegetables and fruit and risk of esophageal adenocarcinoma: a meta-analysis of observational studies

Objectives

To study the association between the intake of fruit and vegetables and risk of esophageal adenocarcinoma (EAC), we summarized the evidence from observational studies in categorical and linear dose–response meta-analyses.

Methods

Eligible studies published up to June 2013 were retrieved via computerized searches of MEDLINE and EMBASE. Random-effects models were used to calculate summary relative risks (SRRs) and the corresponding 95 % confidence intervals (CIs). Between-study heterogeneity was assessed using the Cochran’s Q and I ² statistics.

Results

A total of 12 studies involving 1,572 cases of EAC were included in this meta-analysis. Based on the highest versus lowest analysis, inverse associations were observed between intakes of vegetable (SRRs = 0.76, 95 % CIs 0.59–0.96; P _{heterogeneity} = 0.098, I ² 40.4 %; n = 9 studies), intakes of fruit (SRRs = 0.73, 95 % CIs, 0.55–0.98; P _{heterogeneity} = 0.03, I ² = 52.9 %; n = 9 studies), and intakes of total vegetables and fruit combined (SRRs = 0.68, 95 % CI 0.49–0.93; P _{heterogeneity} = 0.162, I ² = 38.9 %; n = 5 studies). Similar results were also observed in a linear dose–response analysis.

Conclusion

These data support the hypothesis that intakes of vegetables and fruit may significantly reduce the risk of EAC. Further investigation with prospective designs, validated questionnaires, and good control of important confounders is warranted.     

Physical activity in relation to quality of life in newly diagnosed colon cancer patients: a 24-month follow-up

Purpose

Self-reported health status in cancer patients is an independent predictor of medical outcomes. This study investigated the association between changes in recreational physical activity in colon cancer survivors and quality of life (QoL) across a 24-month follow-up beginning at diagnosis.

Methods

Patients (n = 453) diagnosed with stage II colon cancer were recruited from the North Carolina Central Cancer Registry from 2009 to 2011. Patients were interviewed annually about health behaviors (e.g., dietary intake, physical activity, alcohol and tobacco use), socioeconomic variables, and treatment. To index QoL, the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) and Short Form-12 (SF-12) were utilized.

Results

Baseline vigorous exercise showed a positive correlation with the Functional Assessment of Cancer Therapy-General (FACT-G) Colorectal Cancer Scale (CCS) (β = 0.15, 95 % CI 0.07–0.23), FACT-C (β = 0.39, 95 % CI 0.06–0.72), and Trial Outcome Index (TOI) (β = 0.28, 95 % CI 0.01–0.55). Race modified the association between vigorous activity and the FACT-G (P _interaction = 0.010), FACT-C (P _interaction = 0.020), TOI (P _interaction < 0.010), and the PCS (P _interaction < 0.010). As compared to no change, increasing physical activity over a 24-month period following diagnosis significantly improved scores from the FACT-G (β = 3.13, 95 % CI 0.48–5.77, P _trend = 0.054), FACT-C (β = 3.51, 95 % CI 0.35–6.68, P _trend = 0.08) TOI (β = 2.46, 95 % CI 0.16–4.75, P _trend = 0.04), and PCS of the SF-12 (β = 3.28, 95 % CI 0.93–5.63, P _trend < 0.01).

Conclusion

Vigorous exercise is a significant predictor of higher QoL in stage II colon cancer patients. Patients with increased recreational physical activity have significantly improved QoL over 24 months following diagnosis.     

PAHs and PM2.5 emissions and female breast cancer incidence in metro Atlanta and rural Georgia

Environmental chemical exposure could be an important etiologic factor for geographic differences in breast cancer incidence. In this study, we examined emissions of polycyclic aromatic hydrocarbons (PAHs) and PM_2.5 in relation to breast cancer incidence in metro Atlanta and rural Georgia by analyzing data from the Surveillance, Epidemiology, and End Results Program and the Environmental Protection Agency. The results showed that metro Atlanta had a significantly higher age-adjusted annual incidence rate of female breast cancer than rural Georgia (132.6 vs. 113.7 per 100,000) for 1992–2011. Emissions of both PAHs [adjusted β = 0.568 (95 % CI: 0.209, 0.927); p = 0.004] and PM_2.5 [adjusted β = 2.964 (95 % CI: 0.468, 5.459); p = 0.023] were significantly associated with breast cancer incidence in metro Atlanta area. This study suggests that ambient air pollution, especially PAHs and PM_2.5, could have a significant impact on the increased incidence of female breast cancer in urban areas.     

Mortality risk and perceived quality of life as a function of waking time in discretionary movement-based behaviors: isotemporal substitution effects

Objective

Previous research has examined associations of sedentary behavior (SB), light-intensity physical activity (LIPA) and moderate-to-vigorous physical activity (MVPA) with health-related quality of life (HRQOL) and mortality. However, most of these studies have been limited to examining their potential “independent” effects, as opposed to whether mortality risk and HRQOL vary as a function of waking time in these discretionary movement-related behaviors, which was this study’s purpose.

Methods

Data from the 2003–2006 NHANES were employed, with follow-up mortality assessed through 2011 (5377 adults 20–85 years). HRQOL was assessed via survey, with physical activity assessed using an accelerometer over a 7-day monitoring period. Isotemporal substitution analyses were employed.

Results

Participants engaged in little MVPA during their monitored waking time and higher mortality risk appeared to cluster more so among those spending a greater proportion of their day in SB with less LIPA engagement. Substituting 30 min/day of SB with MVPA would be expected to reduce mortality risk by 81 % (HR_adjusted = 0.19; 95 % CI: 0.06–0.60; P = 0.006) and reduce worse HRQOL by 72 % (OR = 0.28; 95 % CI: 0.13–0.58; P = 0.001).

Conclusions

Allocation of waking time in movement-based behaviors is associated with all-cause mortality and HRQOL. Thus, clinicians should encourage their patients to substitute SB with reasonable amounts of LIPA and MVPA.