Abstract MP35: Physical Activity Before and After Cancer Diagnosis and Total and Cause-Specific Mortality

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Paulette D Chandler ◽  
Deirdre Tobias ◽  
Jule E Buring ◽  
I-Min Lee ◽  
Daniel Chasman ◽  
...  

Background: Given the increased prevalence of cancer survivors in the United States, it is imperative to define risk factors for potential reductions in total and cause-specific mortality. Physical activity (PA) represents a promising target for intervention. Design: We prospectively evaluated PA from questionnaires before and after cancer diagnosis with total and cause-specific mortality among 13,297 subjects diagnosed with invasive cancer combined from the Physicians’ Health Study (PHS) (n=6328), Physicians’ Health Study II (PHS II) (n=912), and Women's Health Study (WHS) (n=6057). WHS and PHS participants were free of baseline cancer; PHS II participants reported no active cancer at baseline. We ascertained PA before and after an incident cancer diagnosis based on reports on repeated follow-up questionnaires. Death was ascertained by medical records and death certificates. Cox regression estimated combined hazard ratios (HRs) of mortality by PA adjusted for age, randomized treatments, BMI, and other lifestyle/demographic factors. We evaluated the interaction between PA before and after cancer diagnosis by comparing PA ≤1 versus ≥2 times/wk. Results: The mean follow-up after cancer diagnosis was 8.0, 7.5, and 5.2 y for WHS, PHS, and PHS II, respectively, during which there were 5623 deaths (WHS, 2164; PHS, 3269; PHS II; 190). Higher PA before cancer diagnosis was associated with significantly lower mortality. Compared with PA ≤ once/wk, the HRs (95% CIs) associated with PA 2-4 and >4 times/wk were 0.87 (0.82-0.93) and 0.88 (0.82-0.94) for total mortality; 0.77 (0.63-0.95) and 0.79 (0.62-0.997) for CVD mortality, and 0.90 (0.83-0.98) and 0.90 (0.83-0.98) for cancer mortality. Higher PA after cancer diagnosis was associated with significantly lower total and cancer mortality and non-significantly lower CVD mortality, with HRs (95% CIs) of 0.65 (0.58-0.72) and 0.66 (0.59-0.73) for total mortality; 0.78 (0.59-1.03) and 0.82 (0.61-1.10) for CVD mortality, and 0.66 (0.57-0.77) and 0.64 (0.55-0.74) for cancer mortality. There was a significant interaction of PA before and after cancer diagnosis for total (p int =0.02) and cancer (p int =0.007) mortality, but not CVD mortality (p int =0.38). Conclusions: Greater PA both before and after cancer diagnosis were significantly associated with lower total and cancer mortality. Higher PA before cancer diagnosis was also associated with lower CVD mortality. PA may be an important target for lower mortality after cancer diagnosis.

Circulation ◽  
2019 ◽  
Vol 140 (12) ◽  
pp. 979-991 ◽  
Author(s):  
Megu Y. Baden ◽  
Gang Liu ◽  
Ambika Satija ◽  
Yanping Li ◽  
Qi Sun ◽  
...  

Background: Plant-based diets have been associated with lower risk of type 2 diabetes mellitus and cardiovascular disease (CVD) and are recommended for both health and environmental benefits. However, the association between changes in plant-based diet quality and mortality remains unclear. Methods: We investigated the associations between 12-year changes (from 1986 to 1998) in plant-based diet quality assessed by 3 plant-based diet indices (score range, 18–90)—an overall plant-based diet index (PDI), a healthful PDI, and an unhealthful PDI—and subsequent total and cause-specific mortality (1998–2014). Participants were 49 407 women in the Nurses’ Health Study (NHS) and 25 907 men in the Health Professionals Follow-Up Study (HPFS) who were free from CVD and cancer in 1998. Multivariable-adjusted Cox proportional-hazards models were used to estimate hazard ratios (HRs) and 95% CIs. Results: We documented 10 686 deaths including 2046 CVD deaths and 3091 cancer deaths in the NHS over 725 316 person-years of follow-up and 6490 deaths including 1872 CVD deaths and 1772 cancer deaths in the HPFS over 371 322 person-years of follow-up. Compared with participants whose indices remained stable, among those with the greatest increases in diet scores (highest quintile), the pooled multivariable-adjusted HRs for total mortality were 0.95 (95% CI, 0.90–1.00) for PDI, 0.90 (95% CI, 0.85–0.95) for healthful PDI, and 1.12 (95% CI, 1.07–1.18) for unhealthful PDI. Among participants with the greatest decrease (lowest quintile), the multivariable-adjusted HRs were 1.09 (95% CI, 1.04–1.15) for PDI, 1.10 (95% CI, 1.05–1.15) for healthful PDI, and 0.93 (95% CI, 0.88–0.98) for unhealthful PDI. For CVD mortality, the risk associated with a 10-point increase in each PDI was 7% lower (95% CI, 1–12%) for PDI, 9% lower (95% CI, 4–14%) for healthful PDI, and 8% higher (95% CI, 2–14%) for unhealthful PDI. There were no consistent associations between changes in plant-based diet indices and cancer mortality. Conclusions: Improving plant-based diet quality over a 12-year period was associated with a lower risk of total and CVD mortality, whereas increased consumption of an unhealthful plant-based diet was associated with a higher risk of total and CVD mortality.


Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Mercedes Sotos-Prieto ◽  
Howard D Sesso ◽  
Frank B Hu ◽  
Walter C Willett ◽  
Stephanie E Chiuve

Background: The previously validated Healthy Heart Score, based on modifiable health behaviors (diet, physical activity, alcohol intake, smoking, and body weight), effectively predicted the 20-year risk of CVD in mid-adulthood. While these lifestyle behaviors are independently associated with many chronic diseases, it remains unknown whether the Healthy Heart Score may extend to an association with overall mortality risk. Thus, we examined the Healthy Heart Score and total and cause-specific mortality in the Nurses’ Health Study (NHS) and Health Professional Follow-up Study (HPFS). Methods: We conducted a prospective analysis among 58,319 women in the NHS (1984-2010) aged 30-55 y and 30,713 in men in the HPFS (1986-2010) aged 40-75 y free of cancer and CVD at baseline. The Healthy Heart Score was calculated at baseline and included 9 factors that best estimated CVD risk: current smoking, higher BMI, low physical activity, lack of moderate alcohol consumption, low intakes of fruits and vegetables, cereal fiber, and nuts, and high intakes of sugar-sweetened beverages and red and processed meats). Cox proportional hazards models estimated hazard ratios (HR) and 95% confidence intervals (CI) and adjusted for various demographics, medical history, medication use and total energy. Results: During 2,075,504 years of follow-up, there were 19,181 total deaths, including 11,464 in women and 7,717 in men. Compared to participants with the lowest predicted 20-year CVD risk based on the Healthy Heart Score (1 st quintile, median CVD risk: 0.01%), participants with the highest predictive CVD risk (5 th quintile, median CVD risk: 0.03%) had a pooled HR (95%CI) of 2.26 (1.86, 2.13) for total mortality; 2.89 (95 CI%, 1.93, 4.32) for CVD mortality; and 2.55 (95% CI 2.39, 2.72) for cancer mortality. Participants in the 5 th quintile vs . the 1 st quintile of the Healthy Heart Score had also a significantly greater risk of death due to CHD (3.40 [2.20, 5.26]), stroke (1.77 [1.00, 3.14]), lung cancer (6.02 [2.83, 12.79]), breast cancer (1.45 [1.13, 1.85]), colon cancer (1.51 (1.17, 1.94)), respiratory disease (3.94 (1.03, 15.14)), and diabetes (3.63 (2.00, 6.59)). Conclusion: The Healthy Heart Score, comprised of 9 self-reported, modifiable lifestyle predictors of CVD, is strongly associated with a greater risk of all-cause and cause-specific mortality. This risk score is a potentially useful tool for risk assessment and counseling of healthy lifestyles to promote longevity


Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2699
Author(s):  
Xiaoran Liu ◽  
Marta Guasch-Ferré ◽  
Deirdre K. Tobias ◽  
Yanping Li

Walnut consumption is associated with health benefits. We aimed to (1) examine the association between walnut consumption and mortality and (2) estimate life expectancy in relation to walnut consumption in U.S. adults. We included 67,014 women of the Nurses’ Health Study (1998–2018) and 26,326 men of the Health Professionals Follow-up Study (1998–2018) who were free of cancer, heart disease, and stroke at baseline. We used Cox regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). During up to 20 years of follow-up, we documented 30,263 deaths. The hazard ratios for total mortality across categories of walnut intake (servings/week), as compared to non-consumers, were 0.95 (95% confidence interval (CI), 0.91, 0.98) for <1 serving/week, 0.94 (95% CI, 0.89, 0.99) for 1 serving/week, 0.87 (95% CI, 0.82, 0.93) for 2–4 servings/week, and 0.86 (95% CI, 0.79, 0.93) for >=5 servings/week (p for trend <0.0001). A greater life expectancy at age 60 (1.30 years in women and 1.26 years in men) was observed among those who consumed walnuts more than 5 servings/week compared to non-consumers. Higher walnut consumption was associated with a lower risk of total and CVD mortality and a greater gained life expectancy among U.S. elder adults.


2018 ◽  
Vol 108 (3) ◽  
pp. 476-484 ◽  
Author(s):  
Marcia C de Oliveira Otto ◽  
Rozenn N Lemaitre ◽  
Xiaoling Song ◽  
Irena B King ◽  
David S Siscovick ◽  
...  

ABSTRACT Background Controversy has emerged about the benefits compared with harms of dairy fat, including concerns over long-term effects. Previous observational studies have assessed self-reported estimates of consumption or a single biomarker measure at baseline, which may lead to suboptimal estimation of true risk. Objective The aim of this study was to investigate prospective associations of serial measures of plasma phospholipid fatty acids pentadecanoic (15:0), heptadecanoic (17:0), and trans-palmitoleic (trans-16:1n–7) acids with total mortality, cause-specific mortality, and cardiovascular disease (CVD) risk among older adults. Design Among 2907 US adults aged ≥65 y and free of CVD at baseline, circulating fatty acid concentrations were measured serially at baseline, 6 y, and 13 y. Deaths and CVD events were assessed and adjudicated centrally. Prospective associations were assessed by multivariate-adjusted Cox models incorporating time-dependent exposures and covariates. Results During 22 y of follow-up, 2428 deaths occurred, including 833 from CVD, 1595 from non-CVD causes, and 1301 incident CVD events. In multivariable models, circulating pentadecanoic, heptadecanoic, and trans-palmitoleic acids were not significantly associated with total mortality, with extreme-quintile HRs of 1.05 for pentadecanoic (95% CI: 0.91, 1.22), 1.07 for heptadecanoic (95% CI: 0.93, 1.23), and 1.05 for trans-palmitoleic (95% CI: 0.91, 1.20) acids. Circulating heptadecanoic acid was associated with lower CVD mortality (extreme-quintile HR: 0.77; 95% CI: 0.61, 0.98), especially stroke mortality, with a 42% lower risk when comparing extreme quintiles of heptadecanoic acid concentrations (HR: 0.58; 95% CI: 0.35, 0.97). In contrast, heptadecanoic acid was associated with a higher risk of non-CVD mortality (HR: 1.27; 95% CI: 1.07, 1.52), which was not clearly related to any single subtype of non-CVD death. No significant associations of pentadecanoic, heptadecanoic, or trans-palmitoleic acids were seen for total incident CVD, coronary heart disease, or stroke. Conclusions Long-term exposure to circulating phospholipid pentadecanoic, heptadecanoic, or trans-palmitoleic acids was not significantly associated with total mortality or incident CVD among older adults. High circulating heptadecanoic acid was inversely associated with CVD and stroke mortality and potentially associated with higher risk of non-CVD death.


BMJ ◽  
2019 ◽  
pp. l6204 ◽  
Author(s):  
Ming Ding ◽  
Jun Li ◽  
Lu Qi ◽  
Christina Ellervik ◽  
Xuehong Zhang ◽  
...  

AbstractObjectiveTo examine the association of consumption of dairy foods with risk of total and cause specific mortality in women and men.DesignThree prospective cohort studies with repeated measures of diet and lifestyle factors.SettingNurses’ Health Study, Nurses’ Health Study II, and the Health Professionals Follow-up Study, in the United States.Participants168 153 women and 49 602 men without cardiovascular disease or cancer at baseline.Main outcome measureDeath confirmed by state vital records, the national death index, or reported by families and the postal system. During up to 32 years of follow-up, 51 438 deaths were documented, including 12 143 cardiovascular deaths and 15 120 cancer deaths. Multivariable analysis further adjusted for family history of cardiovascular disease and cancer, physical activity, overall dietary pattern (alternate healthy eating index 2010), total energy intake, smoking status, alcohol consumption, menopausal status (women only), and postmenopausal hormone use (women only).ResultsCompared to the lowest category of total dairy consumption (average 0.8 servings/day), the multivariate pooled hazard ratio for total mortality was 0.98 (95% confidence interval 0.96 to 1.01) for the second category of dairy consumption (average 1.5 servings/day), 1.00 (0.97 to 1.03) for the third (average 2.0 servings/day), 1.02 (0.99 to 1.05) for the fourth (average 2.8 servings/day), and 1.07 (1.04 to 1.10) for highest category (average 4.2 servings/day; P for trend <0.001). For the highest compared to the lowest category of total dairy consumption, the hazard ratio was 1.02 (0.95 to 1.08) for cardiovascular mortality and 1.05 (0.99 to 1.11) for cancer mortality. For subtypes of dairy products, whole milk intake was significantly associated with higher risks of total mortality (hazard ratio per 0.5 additional serving/day 1.11, 1.09 to 1.14), cardiovascular mortality (1.09, 1.03 to 1.15), and cancer mortality (1.11, 1.06 to 1.17). In food substitution analyses, consumption of nuts, legumes, or whole grains instead of dairy foods was associated with a lower mortality, whereas consumption of red and processed meat instead of dairy foods was associated with higher mortality.ConclusionThese data from large cohorts do not support an inverse association between high amount of total dairy consumption and risk of mortality. The health effects of dairy could depend on the comparison foods used to replace dairy. Slightly higher cancer mortality was non-significantly associated with dairy consumption, but warrants further investigation.


2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S387-S388
Author(s):  
Elizabeth Salerno ◽  
Pedro Saint Maurice ◽  
Erik Willis ◽  
Loretta DiPietro ◽  
Charles Matthews

Abstract We examined the association between self-reported walking pace and all-cause mortality among cancer survivors in the NIH-AARP Diet and Health Study. Participants included 30,110 adults (Mage=62.4+/-5.14 years) diagnosed with cancer between study enrollment and follow-up, when they self-reported walking pace. Individuals were followed until death or administrative censoring in 2011. We estimated the hazards ratios (HR) and 95% confidence intervals (CI) for walking pace and all-cause mortality adjusting for age, sex, race, BMI, health status, physical activity and cancer type. Cancer survivors reporting faster walking paces had significantly reduced mortality risk. Relative to those reporting an ‘easy’ walking pace, walking at a ‘normal,’ ‘brisk,’ or ‘very brisk’ pace was associated with significantly lower risk: [HR=0.74 (0.70,0.78)], [HR=0.66 (0.61,0.71)], and [HR=0.73 (0.60,0.89)], respectively. Being ‘unable to walk’ was associated with 30% increased mortality [HR=1.30 (1.15,1.46)]. These findings provide novel support for the association between self-reported walking pace and survival after cancer.


Neurology ◽  
2017 ◽  
Vol 90 (2) ◽  
pp. e135-e141 ◽  
Author(s):  
Yinge Li ◽  
Yanping Li ◽  
John W. Winkelman ◽  
Arthur S. Walters ◽  
Jiali Han ◽  
...  

ObjectiveWe prospectively examined whether women with physician-diagnosed restless legs syndrome (RLS) had a higher risk of total and cardiovascular disease (CVD) mortality relative to those without RLS.MethodsThe current study included 57,417 women (mean age 67 years) from the Nurses' Health Study without cancer, renal failure, and CVD at baseline (2002). Main outcomes were total and CVD mortality. We used the Cox proportional hazards model to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and CVD-specific mortality based on RLS status, adjusting for age, presence of major chronic diseases, and other potential confounders.ResultsWe documented 6,448 deaths during 10 years of follow-up. We did not observe a significant association between presence of physician-diagnosed RLS and high risk of total mortality (adjusted HR 1.15, 95% CI 0.98–1.34). When cause-specific mortality was studied, participants with RLS had a significantly higher risk of CVD mortality (adjusted HR 1.43, 95% CI 1.02–2.00) relative to those without RLS after adjustment for potential confounders. Longer duration of RLS diagnosis was significantly associated with a higher risk of CVD mortality (p for trend = 0.04). Excluding participants with common RLS comorbidities strengthened the association between RLS and total (adjusted HR 1.43, 95% CI 1.03–1.97) and CVD mortality (adjusted HR 2.27, 95% CI 1.21–4.28). However, we did not find a significant association between RLS and mortality due to cancer and other causes.ConclusionsWomen with RLS had a higher CVD mortality rate, which may not be fully explained by common co-occurring disorders of RLS.


2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 1036-1036
Author(s):  
Marta Guasch-Ferre ◽  
Yanping Li ◽  
Walter Willett ◽  
Qi Sun ◽  
Laura Sampson ◽  
...  

Abstract Objectives The association between olive oil intake and the risk of mortality has not been evaluated before in the US population. Our objective was to examine whether olive oil intake is associated with total and cause-specific mortality in two prospective cohorts of US men and women. We hypothesize that higher olive oil consumption is associated with lower risk of total and cause-specific mortality. Methods We followed 61,096 women (Nurses’ Health Study, 1990–2016) and 31,936 men (Health Professionals Follow-up Study, 1990–2016) who were free of diabetes, cardiovascular disease and cancer at baseline. Diet was assessed by a semi quantitative food frequency questionnaire at baseline and then every 4 years. Cox proportional hazards regressions were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results During 26 years of follow-up, 32,868 deaths occurred. Compared with those participants who never consumed olive oil, those with higher olive oil intake (&gt;1/2 tablespoon/d or &gt;8g/d) had 15% lower risk of total mortality [pooled hazard ratio (95% confidence interval): 0.85 (0.81, 0.88)] after adjustment for potential confounders. Higher olive oil intake was associated with 15% lower risk of CVD death [0.85 (0.78, 0.92)], 38% lower risk of neurodegenerative disease death [0.62 (0.54, 0.71)], and 12% lower risk of respiratory death [0.88 (0.77, 1.00)]. Replacing 10 g of margarine, mayonnaise, and dairy fat with the equivalent amount of olive oil was associated with 7–20% lower risk of total mortality, and death from CVD, cancer, neurodegenerative, and respiratory diseases. No significant associations were observed when olive oil was replacing other vegetable oils combined (corn, safflower, soybean and canola oil). Conclusions We observed that higher olive oil intake was associated with a lower risk of total mortality and cause-specific mortality in a large prospective cohort of U.S. men and women. The substitution of margarine, mayonnaise, and dairy fat with olive oil was associated with a reduced risk of mortality. Funding Sources This work was supported by grants from the National Institutes of Health.


2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e24121-e24121
Author(s):  
Yuanyuan Lei ◽  
Winnie Yeo ◽  
Suzanne C. Ho ◽  
Ashley Chi Kin Cheng ◽  
Carol Kwok

e24121 Background: The diagnosis of cancer can motivate patients to change their physical activity habits. No data has reported level of physical activity before and after breast cancer diagnosis in Chinese women. Methods: In an on-going prospective cohort study which involved 1462 Chinese women with early-stage breast cancer, a validated modified Chinese Baecke questionnaire was used to assess physical activity at baseline, 18-, 36- and 60-month after diagnosis. At baseline, patients recalled their habitual physical activity in the preceding 12 months before cancer diagnosis. At 18-, 36- and 60-month follow-up, patients reported their habitual physical activity over the previous 12 months. The level of physical activity at post-diagnosis was defined as the average value assessed at 18-, 36- and 60-month follow-up. Results: Breast cancer patients significantly increased level of physical activity, with median value of 0.6, 5.3, 4.4 and 3.9 MET-hours/week at baseline, 18-, 36- and 60-month follow-up. The average level of physical activity at post-diagnosis was also significantly higher than that at pre-diagnosis ( P < 0.001), with median value of 5.8 MET-hours/week. However, there was no significant difference between any two follow-ups at post-diagnosis. The proportions of participant who met the exercise recommendation (according to WCRF/AICR, 10 MET-hours/week) were low at pre- and post-diagnosis, being 20.7% and 35.1%, respectively. Compared to pre-diagnosis, most of the patients improved or had no change on level of recreational physical activity at post-diagnosis, with the respective proportion being 48.2% and 43.8%. Multivariate analysis showed that higher increase in physical activity after cancer diagnosis was observed among breast cancer patients who were married or cohabitation, unemployed (compared to full time) and had no comorbidity (compared to patients who had one comorbidity). Conclusions: Chinese breast cancer patients reported significant and long-term changes in physical activity after cancer diagnosis, which was in line with current recommendation. However, the proportion of patients who met the exercise recommendation for cancer survivors was still low. Empowering patients on the importance of durable high level of physical activity in breast cancer survivorship is warranted.


Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Martin Bahls ◽  
Sebastian Baumeister ◽  
Henry Völzke ◽  
Sven Gläser ◽  
Michael Leitzmann ◽  
...  

Introduction: Animal studies suggest oppositional effects for voluntary and involuntary physical activity (PA). To assess this in humans, we used distinct domains of PA (sports, leisure time, work) as well as physical fitness and associated these variables with all-cause, cardiovascular (CVD) and cancer mortality in a large population-based cohort. Methods: Data of 2,925 participants from the Study of Health in Pomerania (SHIP-1) were used [median age: 48 (interquartile range (IQR): 35, 62) years (y), 52% [[female symbol]]]. All-cause and cause-specific mortality was determined after a median follow-up of 7.0 y (IQR: 5.6 - 6.2). A Sports index (SI), Leisure Time index (LTI) and Work index (WI) were assessed using a modified Baecke questionnaire. Maximal oxygen consumption (VO2peak), oxygen consumption at the anaerobic threshold (VO2@AT), and maximal work load (Wmax) were measured on a bicycle ergometer during symptom-limited cardiopulmonary exercise testing (CPET). Cox models were adjusted for sex, age, smoking, alcohol consumption, years of schooling, income, and body mass index. Results: A total of 156 subjects died due to all-cause, 53 due to CVD and 50 due to cancer after follow-up. After adjustment, SI [hazard ratio (HR) per SD: 0.27; 95%-confidence interval (CI): 0.13; 0.55] and LTI (HR per SD: 0.34; 95%-CI: 0.15; 0.77) were associated with a reduced risk of all-cause mortality. WI was not associated with all-cause mortality. SI was associated with reduced risk of CVD mortality (HR: 0.26; 95%-CI: 0.07; 0.96). All CPET measures were significantly related to reduced risk of all-cause and cancer mortality (VO2peak - all-cause HR per SD: 0.007; 95%-CI: 0.001; 0.057 and cancer HR per SD: 0.011; 95%-CI: 0.005; 0.210; VO2@AT - all-cause HR per SD: 0.047; 95%-CI: 0.001; 0.028 and cancer HR per SD: 0.052; 95%-CI: 0.004; 0.073; Wmax - all-cause HR per SD: 0.012; 95%-CI: 0.002; 0.074 and cancer HR per SD: 0.01; 95%-CI: 0.0007; 0.166). Conclusion: Voluntary PA was associated with a reduced risk for all-cause and CVD mortality, while occupational PA was not. Exercise capacity was inversely related to all-cause and cancer mortality. Our results indicate that the benefits of PA may be limited to voluntary PA. Thus, questionnaires need to differentiate between voluntary and occupational PA.


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