Pre-diagnostic meat and fibre intakes in relation to colorectal cancer survival in the European Prospective Investigation into Cancer and Nutrition

AbstractImprovements in colorectal cancer (CRC) detection and treatment have led to greater numbers of CRC survivors, for whom there is limited evidence on which to provide dietary guidelines to improve survival outcomes. Higher intake of red and processed meat and lower intake of fibre are associated with greater risk of developing CRC, but there is limited evidence regarding associations with survival after CRC diagnosis. Among 3789 CRC cases in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, pre-diagnostic consumption of red meat, processed meat, poultry and dietary fibre was examined in relation to CRC-specific mortality (n 1008) and all-cause mortality (n 1262) using multivariable Cox regression models, adjusted for CRC risk factors. Pre-diagnostic red meat, processed meat or fibre intakes (defined as quartiles and continuous grams per day) were not associated with CRC-specific or all-cause mortality among CRC survivors; however, a marginal trend across quartiles of processed meat in relation to CRC mortality was detected (P 0·053). Pre-diagnostic poultry intake was inversely associated with all-cause mortality among women (hazard ratio (HR)/20 g/d 0·92; 95 % CI 0·84, 1·00), but not among men (HR 1·00; 95 % CI 0·91, 1·09) (Pfor heterogeneity=0·10). Pre-diagnostic intake of red meat or fibre is not associated with CRC survival in the EPIC cohort. There is suggestive evidence of an association between poultry intake and all-cause mortality among female CRC survivors and between processed meat intake and CRC-specific mortality; however, further research using post-diagnostic dietary data is required to confirm this relationship.

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DNA Methylation-Based Estimates of Circulating Leukocyte Composition for Predicting Colorectal Cancer Survival: A Prospective Cohort Study

Cancers ◽

10.3390/cancers13122948 ◽

2021 ◽

Vol 13 (12) ◽

pp. 2948

Author(s):

Xīn Gào ◽

Yan Zhang ◽

Xiangwei Li ◽

Lina Jansen ◽

Elizabeth Alwers ◽

...

Keyword(s):

Colorectal Cancer ◽

Dna Methylation ◽

T Cells ◽

Cd4 T Cells ◽

Prospective Cohort ◽

Cancer Survival ◽

Cox Regression ◽

Hazard Ratios ◽

Specific Mortality ◽

Stored Blood

Leukocytes are involved in the progression of colorectal cancer (CRC). The proportion of six major leukocyte subtypes can be estimated using epigenome-wide DNA methylation (DNAm) data from stored blood samples. Whether the composition of circulating leukocytes can be used as a prognostic factor is unclear. DNAm-based leukocyte proportions were obtained from a prospective cohort of 2206 CRC patients. Multivariate Cox regression models and survival curves were applied to assess associations between leukocyte composition and survival outcomes. A higher proportion of lymphocytes, including CD4+ T cells, CD8+ T cells, B cells, and NK cells, was associated with better survival, while a higher proportion of neutrophils was associated with poorer survival. CD4+ T cells outperformed other leukocytes in estimating the patients’ prognosis. Comparing the highest quantile to the lowest quantile of CD4+ T cells, hazard ratios (95% confidence intervals) of all-cause and CRC-specific mortality were 0.59 (0.48, 0.72) and 0.59 (0.45, 0.77), respectively. Furthermore, the association of CD4+ T cells and prognosis was stronger among patients with early or intermediate CRC or patients with colon cancer. In conclusion, the composition of circulating leukocytes estimated from DNAm, particularly the proportions of CD4+ T cells, could be used as promising independent predictors of CRC survival.

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Cholesterol lowering drug use and breast cancer survival: the Multiethnic Cohort Study

Breast Cancer Research and Treatment ◽

10.1007/s10549-021-06360-y ◽

2021 ◽

Author(s):

Nafeesa Moksud ◽

Lenora W. M. Loo ◽

Juan Yang ◽

Chiung-Yu Huang ◽

Christopher A. Haiman ◽

...

Keyword(s):

Breast Cancer ◽

Hormone Receptor ◽

Cancer Survival ◽

Cox Regression ◽

Cancer Registries ◽

Cholesterol Lowering ◽

Multiethnic Cohort ◽

All Cause Mortality ◽

Specific Mortality ◽

Lower Hazard

Abstract Purpose Prior studies conducted primarily in white populations have suggested that pre-diagnostic cholesterol lowering drugs (CLDs) improved survival among women with breast cancer (BC). However, this association had not been well characterized in diverse racial/ethnic populations. We investigated whether pre-diagnostic CLD use is associated with all-cause and BC-specific mortality among female BC cases of the Multiethnic Cohort (MEC). Methods CLD use was ascertained through questionnaires administered in 2003–2008. A total of 1448 incident BC cases were identified by linkage to SEER cancer registries in Hawaii and California from 2003 to 2014. Multivariable Cox regression was conducted to estimate hazard ratios (HR) and 95% confidence intervals (CI) of the associations of pre-diagnostic CLD use with all-cause and BC-specific mortality, adjusting for tumor characteristics, first course of treatment, health behaviors, co-morbidities, and demographics. Subgroup analyses by stage and hormone receptor status were conducted for all-cause mortality. Results There were 224 all-cause and 87 BC-specific deaths among the 1448 BC cases during a median follow-up of 4.5 years after diagnosis. Women with BC who ever used CLDs had a 27% lower hazard of all-cause mortality (HR 0.73, 95% CI 0.54–0.98) and 17% lower hazard of BC-specific mortality (HR 0.83, 95% CI 0.49–1.39) compared to never users. CLD use reduced mortality among women with advanced-stage tumors and hormone receptor-positive breast tumors (HR 0.54 95% CI 0.33–0.90; HR 0.69, 95% CI 0.48–0.99, respectively). Conclusion These findings demonstrate an improved survival associated with CLD use prior to diagnosis in a multiethnic population of women with BC.

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Whole blood DNA methylation aging markers predict colorectal cancer survival: a prospective cohort study

Clinical Epigenetics ◽

10.1186/s13148-020-00977-4 ◽

2020 ◽

Vol 12 (1) ◽

Author(s):

Xīn Gào ◽

Yan Zhang ◽

Daniel Boakye ◽

Xiangwei Li ◽

Jenny Chang-Claude ◽

...

Keyword(s):

Colorectal Cancer ◽

Dna Methylation ◽

Whole Blood ◽

Cancer Survival ◽

Cox Regression ◽

Treatment Success ◽

Stage Iv ◽

Predictive Performance ◽

Intermediate Stage ◽

Specific Mortality

Abstract Background Blood DNA methylation-based aging algorithms predict mortality in the general population. We investigated the prognostic value of five established DNA methylation aging algorithms for patients with colorectal cancer (CRC). Methods AgeAccelHorvath, AgeAccelHannum, DNAmMRscore, AgeAccelPheno and AgeAccelGrim were constructed using whole blood epi-genomic data from 2206 CRC patients. After a median follow-up of 6.2 years, 1079 deaths were documented, including 596 from CRC. Associations of the aging algorithms with survival outcomes were evaluated using the Cox regression and survival curves. Harrell’s C-statistics were computed to investigate predictive performance. Results Adjusted hazard ratios (95% confidence intervals) of all-cause mortality for patients in the third compared to the first tertile were 1.66 (1.32, 2.09) for the DNAmMRscore, 1.35 (1.14, 1.59) for AgeAccelPheno and 1.65 (1.37, 2.00) for AgeAccelGrim, even after adjustment for age, sex and stage. AgeAccelHorvath and AgeAccelHannum were not associated with all-cause or CRC-specific mortality. In stage-specific analyses, associations were much stronger for patients with early or intermediate stage cancers (stages I, II and III) than for patients with metastatic (stage IV) cancers. Associations were weaker and less often statistically significant for CRC-specific mortality. Adding DNAmMRscore, AgeAccelPheno or AgeAccelGrim to models including age, sex and tumor stage improved predictive performance moderately. Conclusions DNAmMRscore, AgeAccelPheno and AgeAccelGrim could serve as non-invasive CRC prognostic biomarkers independent of other commonly used markers. Further research should aim for tailoring and refining such algorithms for CRC patients and to explore their value for enhanced prediction of treatment success and treatment decisions.

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Dietary Intake of Red Meat, Processed Meat, and Poultry and Risk of Colorectal Cancer and All-Cause Mortality in the Context of Dietary Guideline Compliance

Nutrients ◽

10.3390/nu13010032 ◽

2020 ◽

Vol 13 (1) ◽

pp. 32

Author(s):

Heddie Mejborn ◽

Sanne Pagh Møller ◽

Lau Caspar Thygesen ◽

Anja Biltoft-Jensen

Keyword(s):

Colorectal Cancer ◽

Cox Regression ◽

Dietary Quality ◽

Processed Meat ◽

Activity Data ◽

Meat Intake ◽

Dietary Guideline ◽

Increased Risk ◽

All Cause Mortality ◽

Red And Processed Meat

Meat intake has been linked to increased risk of colorectal cancer (CRC) and mortality. However, diet composition may affect the risks. We aimed to estimate associations between red and processed meat and poultry intake and risk of CRC and all-cause mortality and if they are modified by dietary quality using Cox regression analyses. Baseline dietary data were obtained from three survey rounds of the Danish National Survey on Diet and Physical Activity. Data on CRC and all-cause mortality were extracted from national registers. The cohort was followed from date of survey interview—or for CRC, from age 50 years, whichever came last, until 31 December 2017. Meat intake was analysed categorically and continuously, and stratified by dietary quality for 15–75-year-old Danes at baseline, n 6282 for CRC and n 9848 for mortality analyses. We found no significant association between red and processed meat intake and CRC risk. For poultry, increased CRC risk for high versus low intake (HR 1.62; 95%CI 1.13–2.31) was found, but not when examining risk change per 100 g increased intake. We showed no association between meat intake and all-cause mortality. The association between meat intake and CRC or mortality risk was not modified by dietary quality.

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Dietary patterns related to total mortality and cancer mortality in the United States

Cancer Causes & Control ◽

10.1007/s10552-021-01478-2 ◽

2021 ◽

Author(s):

Marcela R. Entwistle ◽

Donald Schweizer ◽

Ricardo Cisneros

Keyword(s):

United States ◽

Dietary Patterns ◽

Cancer Mortality ◽

Cox Regression ◽

Total Mortality ◽

Principal Component ◽

The United States ◽

Red Meat ◽

Increased Risk ◽

All Cause Mortality

Abstract Purpose This study investigated the association between dietary patterns, total mortality, and cancer mortality in the United States. Methods We identified the four major dietary patterns at baseline from 13,466 participants of the NHANES III cohort using principal component analysis (PCA). Dietary patterns were categorized into ‘prudent’ (fruits and vegetables), ‘western’ (red meat, sweets, pastries, oils), ‘traditional’ (red meat, legumes, potatoes, bread), and ‘fish and alcohol’. We estimated hazard ratios for total mortality, and cancer mortality using Cox regression models. Results A total of 4,963 deaths were documented after a mean follow-up of 19.59 years. Higher adherence to the ‘prudent’ pattern was associated with the lowest risk of total mortality (5th vs. 1st quintile HR 0.90, 95% CI 0.82–0.98), with evidence that all-cause mortality decreased as consumption of the pattern increased. No evidence was found that the ‘prudent’ pattern reduced cancer mortality. The ‘western’ and the ‘traditional’ patterns were associated with up to 22% and 16% increased risk for total mortality (5th vs. 1st quintile HR 1.22, 95% CI 1.11–1.34; and 5th vs. 1st quintile HR 1.16, 95% CI 1.06–1.27, respectively), and up to 33% and 15% increased risk for cancer mortality (5th vs. 1st quintile HR 1.33, 95% CI 1.10–1.62; and 5th vs. 1st quintile HR 1.15, 95% CI 1.06–1.24, respectively). The associations between adherence to the ‘fish and alcohol’ pattern and total mortality, and cancer mortality were not statistically significant. Conclusion Higher adherence to the ‘prudent’ diet decreased the risk of all-cause mortality but did not affect cancer mortality. Greater adherence to the ‘western’ and ‘traditional’ diet increased the risk of total mortality and mortality due to cancer.

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Association between glaucoma surgery and all-cause and cause-specific mortality among elderly patients with glaucoma: a nationwide population-based cohort study

Scientific Reports ◽

10.1038/s41598-021-96063-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Sang Yeop Lee ◽

Hun Lee ◽

Ji Sung Lee ◽

Sol Ah Han ◽

Yoon Jeon Kim ◽

...

Keyword(s):

Cohort Study ◽

Elderly Patients ◽

Cox Regression ◽

Open Angle Glaucoma ◽

Glaucoma Surgery ◽

Population Based ◽

Angle Closure ◽

Charlson Comorbidity Index Score ◽

All Cause Mortality ◽

Specific Mortality

AbstractThis population-based, retrospective cohort study aimed to evaluate the association between glaucoma surgery and all-cause and cause-specific mortality among Korean elderly patients with glaucoma. A total of 16210 elderly patients (aged ≥ 60 years) diagnosed with glaucoma between 2003 and 2012 were included, and their insurance data were analyzed. The participants were categorized into a glaucoma surgery cohort (n = 487), which included individuals who had diagnostic codes for open angle glaucoma (OAG) or angle closure glaucoma (ACG) and codes for glaucoma surgery, and a glaucoma diagnosis cohort (n = 15,723), which included patients who had codes for OAG and ACG but not for glaucoma surgery. Sociodemographic factors, Charlson Comorbidity Index score, and ocular comorbidities were included as covariates. Cox regression models were used to assess the association between glaucoma surgery and mortality. The incidence of all-cause mortality was 34.76/1,000 person-years and 27.88/1,000 person-years in the glaucoma surgery and diagnosis groups, respectively. The adjusted hazard ratio (HR) for all-cause mortality associated with glaucoma surgery was 1.31 (95% confidence interval [CI], 1.05–1.62, P = 0.014). The adjusted HR for mortality due to a neurologic cause was significant (HR = 2.66, 95% CI 1.18–6.00, P = 0.018). The adjusted HRs for mortality due to cancer (HR = 2.03, 95% CI 1.07–3.83, P = 0.029) and accident or trauma (HR = 4.00, 95% CI 1.55–10.34, P = 0.004) associated with glaucoma surgery for ACG were significant as well. Glaucoma surgery was associated with an increase of mortality in elderly patients with glaucoma. In particular, the risk of mortality associated with glaucoma surgery due to neurologic causes was significant.

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Associations of Processed Meat, Unprocessed Red Meat, Poultry, or Fish Intake With Incident Cardiovascular Disease and All-Cause Mortality

JAMA Internal Medicine ◽

10.1001/jamainternmed.2019.6969 ◽

2020 ◽

Vol 180 (4) ◽

pp. 503 ◽

Cited By ~ 12

Author(s):

Victor W. Zhong ◽

Linda Van Horn ◽

Philip Greenland ◽

Mercedes R. Carnethon ◽

Hongyan Ning ◽

...

Keyword(s):

Cardiovascular Disease ◽

Red Meat ◽

Fish Intake ◽

Processed Meat ◽

All Cause Mortality ◽

Incident Cardiovascular Disease

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Sex-specific associations of circulating testosterone levels with all-cause and cause-specific mortality

Acta Endocrinologica ◽

10.1530/eje-20-1253 ◽

2021 ◽

Author(s):

Jiayu Wang ◽

Xikang Fan ◽

Mingjia Yang ◽

Mingyang Song ◽

Kai Wang ◽

...

Keyword(s):

Postmenopausal Women ◽

Cancer Mortality ◽

Multiple Testing ◽

Cox Regression ◽

Positive Association ◽

Total Testosterone ◽

Critical Determinant ◽

All Cause Mortality ◽

Specific Mortality ◽

Risk Of Cancer

Objective: Testosterone is a critical determinant of health in both genders. However, the relationship between circulating levels of testosterone and mortality remains undetermined. Methods: We examined the associations of serum total testosterone (TT) and free testosterone (FT) with all-cause and cause-specific mortality in 154,965 men and 93,314 postmenopausal women from UK Biobank. Cox regression models were used to calculate the hazard ratios (HR) and 95% confidence intervals (CI). Given multiple testing, P < 0.005 was considered statistically significant. Results: Over a median follow-up of 8.9 (inter-quartile range, 8.3-9.5) years, we documented 5,754 deaths in men, including 1,243 (21.6%) from CVD and 2,987 (51.9%) from cancer. In postmenopausal women, 2,435 deaths occurred, including 346 (14.2%) from CVD and 1,583 (65.0%) from cancer. TT and FT concentrations were inversely associated with all-cause mortality in men, with the multivariable HR of 0.82 (95% CI: 0.75-0.91) and 0.80 (95% CI: 0.73-0.87) for the highest (Q5) versus the lowest quintile (Q1), respectively. In postmenopausal women, TT concentrations showed a positive association with all-cause mortality (HR for Q5 versus Q1 = 1.20, 95% CI: 1.06-1.37). Furthermore, higher TT and FT concentrations were associated with a lower risk of cancer mortality in men (both P for trend = 0.001), whereas TT concentrations were suggestively associated with a higher risk of cancer mortality in postmenopausal women (P for trend = 0.03). Conclusions: Our findings suggest that high levels of circulating testosterone may be beneficial for all-cause and cancer mortality in men but detrimental in postmenopausal women.

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Pure Fruit Juice and Fruit Consumption Are Not Associated with Incidence of Type 2 Diabetes after Adjustment for Overall Dietary Quality in the European Prospective Investigation into Cancer and Nutrition–Netherlands (EPIC-NL) Study

Journal of Nutrition ◽

10.1093/jn/nxz340 ◽

2020 ◽

Vol 150 (6) ◽

pp. 1470-1477 ◽

Cited By ~ 1

Author(s):

Floor R Scheffers ◽

Alet H Wijga ◽

W M Monique Verschuren ◽

Yvonne T van der Schouw ◽

Ivonne Sluijs ◽

...

Keyword(s):

Type 2 Diabetes ◽

Fruit Juice ◽

Cox Regression ◽

Diabetes Risk ◽

Dietary Guidelines ◽

Dietary Quality ◽

Fruit Consumption ◽

Incident Cases ◽

Prospective Investigation

ABSTRACT Background Dietary guidelines on pure fruit juice consumption vary from country to country regarding the inclusion of pure fruit juice in the recommendations as an acceptable alternative for fruit. Current epidemiological evidence on the association between pure fruit juice consumption and diabetes risk is scarce. Objective We studied the association of both pure fruit juice and fruit consumption with diabetes risk and investigated the differences between low and high fruit consumers in the association of pure fruit juice consumption with diabetes risk. Methods This prospective cohort study included 36,147 participants in the European Prospective Investigation into Cancer and Nutrition–Netherlands (EPIC-NL) Study aged 20–69 y at baseline. Fruit juice and fruit consumption were assessed using a validated food-frequency questionnaire; amounts of consumption were divided into 5 categories and quintiles, respectively. Incident type 2 diabetes cases were mainly self-reported and verified against medical records. Cox regression was used to estimate adjusted HRs and 95% CIs. Results After an average follow-up of 14.6 y, 1477 verified incident cases of type 2 diabetes were documented. Compared with no consumption, pure fruit juice consumption was not significantly associated with type 2 diabetes, with adjusted HRs ranging from 0.92 (95% CI: 0.79, 1.09) to 1.03 (95% CI: 0.83, 1.26). The associations did not differ between participants with low and high fruit consumption. None of the categories of fruit consumption were associated with type 2 diabetes (lowest quintile as reference). Adjusted HRs ranged between 0.93 (95% CI: 0.78, 1.10) and 1.00 (95% CI: 0.84, 1.19). Adjustment for the Dutch Healthy Diet Index, as an overall measure of dietary quality, strongly attenuated the observed associations of type 2 diabetes with both fruit juice and fruit consumption. Conclusions We found no evidence for associations between pure fruit juice and fruit consumption and diabetes risk after adjustment for overall dietary quality for participants in the EPIC-NL study. This trial was registered at https://www.trialregister.nl/trial/6939 as NL6939.

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