scholarly journals Healthy lifestyle, endoscopic screening, and colorectal cancer incidence and mortality in the United States: A nationwide cohort study

PLoS Medicine ◽  
2021 ◽  
Vol 18 (2) ◽  
pp. e1003522
Author(s):  
Kai Wang ◽  
Wenjie Ma ◽  
Kana Wu ◽  
Shuji Ogino ◽  
Andrew T. Chan ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Colon Cancer ◽  
Health Professionals ◽  
Healthy Lifestyle ◽  
The United States ◽  
Proximal Colon ◽  
Health Study ◽  
Endoscopic Screening ◽  
Incidence And Mortality

Background Healthy lifestyle and screening represent 2 major approaches to colorectal cancer (CRC) prevention. It remains unknown whether the CRC-preventive benefit of healthy lifestyle differs by endoscopic screening status, and how the combination of healthy lifestyle with endoscopic screening can improve CRC prevention. Methods and findings We assessed lifestyle and endoscopic screening biennially among 75,873 women (Nurses’ Health Study, 1988 to 2014) and 42,875 men (Health Professionals Follow-up Study, 1988 to 2014). We defined a healthy lifestyle score based on body mass index, smoking, physical activity, alcohol consumption, and diet. We calculated hazard ratios (HRs) and population-attributable risks (PARs) for CRC incidence and mortality in relation to healthy lifestyle score according to endoscopic screening. Participants’ mean age (standard deviation) at baseline was 54 (8) years. During a median of 26 years (2,827,088 person-years) follow-up, we documented 2,836 incident CRC cases and 1,013 CRC deaths. We found a similar association between healthy lifestyle score and lower CRC incidence among individuals with and without endoscopic screening, with the multivariable HR per one-unit increment of 0.85 (95% CI, 0.80 to 0.90) and 0.85 (95% CI, 0.81 to 0.88), respectively (P-interaction = 0.99). The fraction of CRC cases that might be prevented (PAR) by endoscopic screening alone was 32% (95% CI, 31% to 33%) and increased to 61% (95% CI, 42% to 75%) when combined with healthy lifestyle (score = 5). The corresponding PAR (95% CI) increased from 15% (13% to 16%) to 51% (17% to 74%) for proximal colon cancer and from 47% (45% to 50%) to 75% (61% to 84%) for distal CRC. Results were similar for CRC mortality. A limitation of our study is that our study participants are all health professionals and predominantly whites, which may not be representative of the general population. Conclusions Our study suggests that healthy lifestyle is associated with lower CRC incidence and mortality independent of endoscopic screening. An integration of healthy lifestyle with endoscopic screening may substantially enhance prevention for CRC, particularly for proximal colon cancer, compared to endoscopic screening alone.

scholarly journals Yogurt consumption and colorectal cancer incidence and mortality in the Nurses’ Health Study and the Health Professionals Follow-Up Study

2020 ◽  
Vol 112 (6) ◽  
pp. 1566-1575
Author(s):  
Karin B Michels ◽  
Walter C Willett ◽  
Rita Vaidya ◽  
Xuehong Zhang ◽  
Edward Giovannucci
Keyword(s):  
Colorectal Cancer ◽  
Colon Cancer ◽  
Cancer Incidence ◽  
Proximal Colon ◽  
Health Study ◽  
Follow Up Study ◽  
Incidence And Mortality ◽  
Colorectal Cancer Incidence ◽  
Colorectal Cancer Mortality

ABSTRACT Background Yogurt is a commonly consumed fermented food. Regular yogurt consumption may contribute to a favorable gut microbiome and gut health, but few epidemiologic studies have considered the relation between regular yogurt consumption and the incidence of and mortality from colorectal cancer. Objectives We used data from 2 large, prospective cohort studies, the Nurses’ Health Study and the Health Professionals Follow-Up Study, to examine the role of yogurt consumption on colorectal cancer incidence and mortality. Methods During 32 years of follow-up in 83,054 women (mean age at baseline, 45.7 years) and 26 years of follow-up in 43,269 men (mean age at baseline, 52.3 years), we documented a total of 2666 newly diagnosed cases of colorectal cancer in these cohorts. We modeled yogurt consumption at baseline and cumulatively updated it throughout follow-up. Results: Baseline yogurt consumption was associated with a reduced risk of colon cancer in age-adjusted analyses (P for trend < 0.001). Associations remained statistically significant after adjusting for potential confounders, including calcium and fiber intake (P for trend = 0.03), and were restricted to proximal colon cancer. The consumption of 1 + servings per week of yogurt at baseline, compared to no yogurt consumption, was associated with a multivariable HR of 0.84 (95% CI, 0.70–0.99; P trend = 0.04) for the proximal colon cancer incidence. Latency analyses suggested that the most important window of opportunity for regular yogurt consumption to prevent colorectal cancer was 16–20 years in the past. When yogurt consumption was cumulatively updated, associations attenuated and were no longer significant. No statistically significant inverse trend was observed between yogurt consumption and the colorectal cancer mortality. Conclusions In these large cohorts, the frequency of yogurt consumption was associated with a reduced risk of proximal colon cancer with a long latency period. No significant inverse trend was observed for colorectal cancer mortality.

scholarly journals A Prospective Analysis of Meat Mutagens and Colorectal Cancer in the Nurses’ Health Study and Health Professionals Follow-up Study

2016 ◽  
Vol 124 (10) ◽  
pp. 1529-1536 ◽  
Author(s):  
Ngoan Tran Le ◽  
Fernanda Alessandra Silva Michels ◽  
Mingyang Song ◽  
Xuehong Zhang ◽  
Adam M. Bernstein ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health Professionals ◽  
Health Study ◽  
Prospective Analysis ◽  
Follow Up Study

scholarly journals Use of glucosamine and chondroitin supplements in relation to risk of colorectal cancer: Results from the Nurses' Health Study and Health Professionals follow-up study

2016 ◽  
Vol 139 (9) ◽  
pp. 1949-1957 ◽  
Author(s):  
Elizabeth D. Kantor ◽  
Xuehong Zhang ◽  
Kana Wu ◽  
Lisa B. Signorello ◽  
Andrew T. Chan ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health Professionals ◽  
Health Study ◽  
Follow Up Study

scholarly journals Adulthood Weight Change and Risk of Colorectal Cancer in the Nurses' Health Study and Health Professionals Follow-up Study

2015 ◽  
Vol 8 (7) ◽  
pp. 620-627 ◽  
Author(s):  
Mingyang Song ◽  
Frank B. Hu ◽  
Donna Spiegelman ◽  
Andrew T. Chan ◽  
Kana Wu ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Weight Change ◽  
Health Professionals ◽  
Health Study ◽  
Follow Up Study

scholarly journals Vitamin B2 intake and colorectal cancer risk; results from the Nurses' Health Study and the Health Professionals Follow-Up Study cohort

2016 ◽  
Vol 139 (5) ◽  
pp. 996-1008 ◽  
Author(s):  
Yeong Sook Yoon ◽  
Seungyoun Jung ◽  
Xuehong Zhang ◽  
Shuji Ogino ◽  
Edward L. Giovannucci ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cancer Risk ◽  
Health Professionals ◽  
Colorectal Cancer Risk ◽  
Health Study ◽  
Study Cohort ◽  
Vitamin B2 ◽  
Follow Up Study

scholarly journals Recommendation-based dietary indexes and risk of colorectal cancer in the Nurses’ Health Study and Health Professionals Follow-up Study

2018 ◽  
Vol 108 (5) ◽  
pp. 1092-1103 ◽  
Author(s):  
Joshua Petimar ◽  
Stephanie A Smith-Warner ◽  
Teresa T Fung ◽  
Bernard Rosner ◽  
Andrew T Chan ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cancer Risk ◽  
Health Professionals ◽  
Cox Regression ◽  
Meta Analysis ◽  
Healthy Eating Index ◽  
Colorectal Cancer Risk ◽  
Health Study ◽  
Follow Up Study

ABSTRACT Background Many dietary indexes exist for chronic disease prevention, but the optimal dietary pattern for colorectal cancer prevention is unknown. Objective We sought to determine associations between adherence to various dietary indexes and incident colorectal cancer in 2 prospective cohort studies. Design We followed 78,012 women in the Nurses’ Health Study and 46,695 men in the Health Professionals Follow-up Study from 1986 and 1988, respectively, until 2012. We created dietary index scores for the Dietary Approaches to Stop Hypertension (DASH) diet, Alternative Mediterranean Diet (AMED), and Alternative Healthy Eating Index-2010 (AHEI-2010) and used Cox regression to estimate HRs and 95% CIs for risk of colorectal cancer (CRC) and by anatomic subsite. We also conducted latency analyses to examine associations between diet and CRC risk during different windows of exposure. We conducted analyses in men and women separately, and subsequently pooled these results in a random-effects meta-analysis. Results We documented 2690 colorectal cancer cases. Pooled multivariable HRs for colorectal cancer risk comparing the highest to lowest quintile of diet scores were 0.89 (95% CI: 0.74, 1.08; P-trend = 0.10) for DASH, 0.89 (95% CI: 0.73, 1.10; P-trend = 0.31) for AMED, and 0.95 (95% CI: 0.83, 1.09; P-trend = 0.56) for AHEI-2010 (P-heterogeneity ≥ 0.07 for all). In sex-specific analyses, we observed stronger associations in men for all dietary indexes (DASH: multivariable HR = 0.81, 95% CI: 0.66, 0.98; P-trend = 0.003; AMED: multivariable HR = 0.80, 95% CI: 0.65, 0.98; P-trend = 0.02; AHEI-2010: multivariable HR = 0.88, 95% CI: 0.72, 1.07; P-trend = 0.04) than in women (multivariable HRs range from 0.98 to 1.01). Conclusions Adherence to the DASH, AMED, and AHEI-2010 diets was inversely associated with colorectal cancer risk in men. These diets were not associated with colorectal cancer risk in women. This observational study was registered at http://www.clinicaltrials.gov as NCT03364582.

scholarly journals Association of dietary insulinemic potential and colorectal cancer risk in men and women

2018 ◽  
Vol 108 (2) ◽  
pp. 363-370 ◽  
Author(s):  
Fred K Tabung ◽  
Weike Wang ◽  
Teresa T Fung ◽  
Stephanie A Smith-Warner ◽  
NaNa Keum ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Colon Cancer ◽  
Cancer Risk ◽  
Insulin Response ◽  
Distal Colon ◽  
Proximal Colon ◽  
Cancer Development ◽  
Men And Women

ABSTRACT Background Insulin response may be important in colorectal cancer development. Diet modulates insulin response and may be a modifiable factor in colorectal cancer prevention. Objective We examined associations between hyperinsulinemic diets and colorectal cancer risk with the use of an empirical dietary index for hyperinsulinemia (EDIH), a food-based index that characterizes dietary insulinemic potential on the basis of circulating C-peptide concentrations. Design Diet was assessed every 4 y with food-frequency questionnaires in 46,210 men (Health Professionals Follow-Up Study, 1986–2012) and 74,191 women (Nurses’ Health Study, 1984–2012) to calculate EDIH scores. Multivariable-adjusted Cox regression was used to calculate HRs and 95% CIs for colorectal, proximal/distal colon, and rectal cancer risk. Results During 26 y of follow-up, we documented 2683 incident colorectal cancer cases. Comparing participants in the highest with those in the lowest quintiles, higher EDIH scores were associated with 33% (men: HR: 1.33; 95% CI: 1.11, 1.61; P-trend = 0.0005), 22% (women: HR: 1.22; 95% CI: 1.03, 1.45; P-trend = 0.01), and 26% (men and women: pooled HR: 1.26; 95% CI: 1.12, 1.42; P-trend <0.0001) higher risk of developing colorectal cancer. The positive associations were limited to the distal colon and rectum in men and to the distal and proximal colon in women; however, combined risk estimates were significant for all anatomic locations except for the rectum. For example, comparing participants in extreme EDIH quintiles, there was no significant association for proximal colon cancer in men (HR: 1.15; 95% CI: 0.84, 1.57; P-trend = 0.32), but the risk was elevated for distal colon (HR: 1.63; 95% CI: 1.14, 2.32; P-trend = 0.002) and rectal (HR: 1.63; 95% CI: 1.09, 2.44; P-trend = 0.01) cancer. Among women, the risk was elevated for proximal (HR: 1.28; 95% CI: 1.00, 1.63; P-trend = 0.03) and distal (HR: 1.46; 95% CI: 1.05, 2.03; P-trend = 0.03) colon cancer but not for rectal cancer (HR: 0.88; 95% CI: 0.60, 1.29; P-trend = 0.61). Conclusion The findings suggest that the insulinemic potential of diet may partly underlie the influence of dietary intake on colorectal cancer development. This observational study was registered at www.clinicaltrials.gov as NCT03364582.

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