The Role of Diet, Alcohol, BMI, and Physical Activity in Cancer Mortality: Summary Findings of the EPIC Study

Evidence on the impact of diet, alcohol, body-mass index (BMI), and physical activity on mortality due to cancer and other cancer-related outcomes is still scarce. Herein, we reviewed the contribution of the European Prospective Investigation into Cancer and Nutrition (EPIC) study to the current state of the art on the role of these factors in cancer mortality. We identified 45 studies using a rapid systematic review methodology. Dietary factors associated with reduced cancer mortality included raw vegetable intake; dietary fiber intake; the Mediterranean diet; other dietary scores; other diet patterns including low meat eaters, vegetarians/vegans, or fish eaters; dietary intake (or biomarkers) of some vitamins (e.g., vitamin D, vitamin K2, or Vitamin C); and intake of lignans. Physical activity and following healthy lifestyle recommendations also reduced cancer mortality risk. In contrast, dietary factors associated with higher cancer mortality risk included poor diet quality, consumption of alcohol and soft drinks including juice, and, to a lesser extent, intake of some fatty acids. Excess weight and obesity also increased the risk of cancer mortality. The EPIC study holds valuable information on diet and lifestyle factors and offers a unique opportunity to identify key diet-related factors for cancer mortality prevention.

Total Protein Usual Intake Is Associated With Reduced Risk of All-Cause and Heart Disease Mortality in US Adults

Objectives Studies have linked animal protein intake with an increased risk in mortality from all-causes and certain chronic diseases, including cancer and heart disease. The objective of the current analysis was to examine associations between usual intake of total and animal protein from various sources and all-cause, cancer, and heart disease-related mortality risk. Methods Data for adults (≥19 y; N = 54,830) from the Third National Health and Nutrition Examination Survey (NHANES) and NHANES 1999–2014 were linked with mortality data through 2015. Individual protein usual intakes were estimated using the National Cancer Institute method. Hazard ratio (HR) models were fit for mortality types (all cause, cancer, heart disease) and measures of total and animal protein usual intake. Multivariable analysis further adjusted for age, gender, ethnicity, waist circumference, smoking status, education level, chronic condition status (i.e., based on cancer, myocardial infarct, and diabetes/diabetes medication reported), weight loss attempts, and % kcal from total fat. Results Total protein usual intake was associated with 10% and 13% lowered risk of mortality from all-causes [HR = 0.90; CI: 0.82–0.99; P = 0.003] and heart disease [HR = 0.87; CI: 0.72–1.05; P = 0.05], respectively. No associations were observed between total protein intake and cancer mortality risk [HR = 0.98; CI: 0.80–1.21; P = 0.84]. No associations were seen between animal protein intake and mortality risk from all-causes [Quartile trend HR = 0.97; confidence intervals (CI): 0.91–1.04; P = 0.32], cancer [HR = 1.08; CI: 0.95–1.23; P = 0.13] and heart disease [HR = 0.98; CI: 0.85–1.13; P = 0.73]. No associations were seen between total dairy protein intake and all-cause and cancer mortality risk, however, there was an 11% reduced risk in heart disease mortality [HR = 0.89; CI: 0.80–1.00; P = 0.008]. No significant associations were seen between total red meat (beef, pork, lamb) protein usual intake and all-cause, cancer, and heart disease-related mortality risk. Conclusions These results contradict previous findings that have linked animal protein intake to increased mortality risk from all-causes, cancer and heart disease. Further, total protein consumption may help lower all-cause and heart disease-related mortality risk in adults. Funding Sources Funded by the Beef Checkoff.

Cancer Mortality and Long-Term Environmental Exposure of Cadmium in Contaminated Community Based on a Third Retrospective Cause of Death Investigation of Residents Living in the Guangdong Province from 2004 to 2005

This study compared the temporal and geographic trends of cancer in China with a specific focus on the long-term exposure to soil cadmium (Cd) pollution. The geographic information system (GIS; kriging interpolation method) was used to detect the Cd contained in the soil from the Dabaoshan area, Guangdong Province. The standard rate ratio (SRR) was calculated to describe the relationship between Cd exposure and cancer mortality risk using the low-exposure group as a reference. Eight hundred six cancer deaths (533 male and 273 female) in the total population of 972,970 were identified, and the age-standardized rate (world) was 145.64 per 100,000. Significant dose-response relationships were found using the low-exposure group as the reference group. The Cd soil levels were positively associated with the cancer mortality risk in the community population, particularly for all cancers (SRR = 3.27; 95% CI = 2.42–4.55), esophageal cancer (SRR = 5.42; 95% CI = 1.07–30.56), stomach cancer (SRR = 5.99; 95% CI = 2.00–18.66), liver cancer (SRR = 4.45; 95% CI = 2.16–10.34), and lung cancer (SRR = 2.86; 95% CI = 1.62–5.31) for the total population. Additionally, similar results were obtained when using the 2000 China standard population. Cd exposure significantly affected the standardized mortality rates (China) by age group for all cancers, esophageal cancer, stomach cancer, liver cancer, and lung cancer in the total population, particularly in the age groups of 35–54, 55–74, and ≥ 75 years, respectively. Cd soil level is likely positively associated with increased cancer mortality of all cancer types and esophageal, stomach, liver, and lung cancers but not for other specific categories of cancer.

The Association Between Psychological Distress and Cancer Mortality in the United States: Results from the 1997–2014 NHIS-NDI Record Linkage Study

Background/Purpose Psychological distress can influence cancer mortality through socioeconomic disadvantage, health-risk behaviors, or reduced access to care. These disadvantages can result in higher risks of cancer occurrence, a delayed cancer diagnosis, hamper adherence to treatment, and provoke inflammatory responses leading to cancer. Previous studies have linked psychological distress to cancer mortality. However, studies are lacking for the U.S. population. Methods This study examines the Kessler six-item psychological distress scale as a risk factor for U.S. cancer mortality using the pooled 1997–2014 data from the National Health Interview Survey (NHIS) linked to National Death Index (NDI) (N = 513,012). Cox proportional hazards regression was used to model survival time as a function of psychological distress and sociodemographic and behavioral covariates. Results In Cox models with 18 years of mortality follow-up, the cancer mortality risk was 80% higher (hazard ratio [HR] = 1.80; 95% CI = 1.64, 1.97) controlling for age; 61% higher (HR = 1.61; 95% CI = 1.46, 1.76) in the SES-adjusted model, and 33% higher (HR = 1.33; 95% CI = 1.21, 1.46) in the fully-adjusted model among adults with serious psychological distress (SPD), compared with adults without psychological distress. Males, non-Hispanic Whites, and adults with incomes at or above 400% of the federal poverty level had greater cancer mortality risk associated with SPD. Using an 8 years of mortality follow-up, those with SPD had 108% increased adjusted risks of mortality from breast cancer. Conclusion Our study findings underscore the significance of addressing psychological well-being in the population as a strategy for reducing cancer mortality.

Association of Happiness and Life Satisfaction with Cancer Mortality in the United States: A Longitudinal Analysis

Background: Theimpact of happiness and life satisfaction on cancer mortality is not well studied. Using a longitudinal dataset, we examined the association between levels of happiness/life satisfaction and cancer mortality in the United States. Methods: We analyzed the 2001 National Health Interview Survey (NHIS) prospectively linked to 2001-2014 mortality records in the National Death Index (NDI) (N=30,933). Cox proportional hazards regression was used to model survival time as a function of happiness, life satisfaction, and sociodemographic and behavioral characteristics. Results: In Cox models with 14 years of mortality follow-up, cancer mortality risk was 78% higher (hazard ratio [HR]=1.78; 95% CI=1.42,2.23) in adults with little or no happiness, controlling for age, and 53% higher (HR=1.53; 95% CI=1.19,1.97) in adults with little/no happiness, controlling for sociodemographic, behavioral and health characteristics, when compared with adults reporting happiness most or all of the time. Age-adjusted cancer mortality risk increased by 41% (HR=1.41; 95% CI=1.21,1.77) in adults who were very dissatisfied with their life. Cancer mortality did not vary by life satisfaction after adjusting for all covariates. Conclusions and Implications for Translation: Adults with lower happiness levels had significantly higher cancer mortality risks than those with higher happiness levels. Excess mortality was substantially accounted for by sociodemographic, behavioral, and health risk factors. Key words: • Happiness • Life satisfaction • Cancer • Mortality • Longitudinal • Social determinants Copyright © 2020 Lee and Singh. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.