1
|
Zhang Y, Song M, Yuan C, Chan AT, Schernhammer ES, Wolpin BM, Stampfer MJ, Meyerhardt JA, Fuchs CS, Roberts SB, Rimm EB, Willett WC, Hu FB, Giovannucci EL, Ng K. Unrestrained eating behavior and risk of mortality: A prospective cohort study. Clin Nutr 2021; 40:5419-5429. [PMID: 34653818 PMCID: PMC8571025 DOI: 10.1016/j.clnu.2021.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/30/2021] [Accepted: 09/10/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND & AIMS Unrestrained eating behavior has been thought to be a proxy for diet frequency, timing, and caloric intake. We investigated the association of unrestrained eating with mortality risk in the Nurses' Health Study prospectively. METHODS During follow-up (1994-2016), 21,953 deaths were documented among 63,999 eligible participants in analyses of eating anything at any time, 22,120 deaths were documented among 65,839 participants in analyses of no concern with figure change. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards models. RESULTS Eating anything at any time was associated with an increased mortality from cancer (overall HR, 95%CI: 1.07, 1.00-1.13; driven by gastrointestinal tract cancer: 1.30, 1.10-1.54) and respiratory disease (1.16, 1.05-1.29), and decreased cardiovascular disease-specific mortality (0.92, 0.86-0.99), compared to those without this behavior; however, no association was observed between this behavior and all-cause mortality (1.02, 0.99-1.05). Women who reported having no concern with figure change experienced higher risk of mortality from all-cause (1.08, 1.05-1.11), cancer (1.08, 1.02-1.14), and respiratory disease (1.18, 1.08-1.30), compared to those not reporting this behavior. Their combined effect was associated with a higher all-cause (1.09, 1.04-1.14), cancer-specific (overall: 1.18, 1.09-1.28; gastrointestinal tract cancer: 1.36, 1.08-1.71; lung cancer: 1.09; 1.04-1.14), and respiratory disease-specific (1.30, 1.13-1.50) mortality, and was inversely associated with cardiovascular disease-specific mortality (0.88, 0.80-0.98), compared to those exhibiting the opposite. CONCLUSIONS Unrestrained eating was associated with increased risk of all-cause, cancer-specific (particularly for gastrointestinal tract cancer and lung cancer), and respiratory disease-specific mortality, and decreased risk of cardiovascular disease-specific mortality.
Collapse
Affiliation(s)
- Yin Zhang
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
| | - Mingyang Song
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Clinical and Translational Epidemiology Unit and Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Chen Yuan
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Andrew T Chan
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Clinical and Translational Epidemiology Unit and Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Eva S Schernhammer
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Brian M Wolpin
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Meir J Stampfer
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Jeffrey A Meyerhardt
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Charles S Fuchs
- Department of Medical Oncology, Smilow Cancer Hospital and Yale Cancer Center, New Haven, CT, USA; Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Susan B Roberts
- USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Eric B Rimm
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Walter C Willett
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Frank B Hu
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Edward L Giovannucci
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Kimmie Ng
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
2
|
Zhang Y, Song M, Chan AT, Schernhammer ES, Wolpin BM, Stampfer MJ, Meyerhardt JA, Fuchs CS, Roberts SB, Willett WC, Hu FB, Giovannucci EL, Ng K. Unrestrained eating behavior and risk of digestive system cancers: a prospective cohort study. Am J Clin Nutr 2021; 114:1612-1624. [PMID: 34293086 PMCID: PMC8588850 DOI: 10.1093/ajcn/nqab235] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/18/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Unrestrained eating behavior, as a potential proxy for diet frequency, timing, and caloric intake, has been questioned as a plausible risk factor for digestive system cancers, but epidemiological evidence remains sparse. OBJECTIVES We investigated prospectively the associations between unrestrained eating behavior and digestive system cancer risk. METHODS Participants in the Nurses' Health Study who were free of cancer and reported dietary information in 1994 were followed for ≤18 y. Cox models were used to estimate HRs and 95% CIs for unrestrained eating (eating anything at any time, no concern with figure change, or both) and risk of digestive system cancers. RESULTS During follow-up, 2064 digestive system cancer cases were documented among 70,450 eligible participants in analyses of eating anything at any time, In total, 2081 digestive system cancer cases were documented among 72,468 eligible participants in analyses of no concern with figure change. In fully adjusted analyses, women with the behavior of eating anything at any time had a higher risk of overall digestive system cancer (HR: 1.22; 95% CI: 1.10, 1.35), overall gastrointestinal tract cancer ((HR: 1.33; 95% CI: 1.18, 1.50), buccal cavity and pharynx cancer (HR: 1.50; 95% CI: 1.02, 2.21), esophageal cancer (HR: 1.62; 95% CI: 1.01, 2.62), small intestine cancer (HR: 1.92; 95% CI: 1.02,3. 59), and colorectal cancer (HR: 1.20; 95% CI: 1.04, 1.38), and a non-statistically significant increased risk of stomach cancer (HR: 1.54; 95% CI: 0.96,2.48), compared with women without this behavior. No statistically significant association was observed for pancreatic cancer and liver and gallbladder cancer. The combined effect of eating anything at any time and having no concern with figure change was associated with a significantly increased risk of overall digestive system cancer (HR: 1.27; 95% CI: 1.10, 1.46), overall gastrointestinal tract cancer (HR: 1.45; 95% CI: 1.23, 1.71), and colorectal cancer (HR: 1.34; 95% CI: 1.11, 1.63), compared with women exhibiting the opposite. CONCLUSIONS Unrestrained eating behavior was independently associated with increased risk of gastrointestinal tract cancers. The potential importance of unrestrained eating behavior modification in preventing gastrointestinal tract cancers should be noted.
Collapse
Affiliation(s)
- Yin Zhang
- Address correspondence to YZ (emails: and )
| | - Mingyang Song
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Clinical and Translational Epidemiology Unit and Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Andrew T Chan
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Clinical and Translational Epidemiology Unit and Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Eva S Schernhammer
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Center of Public Health, Medical University of Vienna, Vienna, Austria
| | - Brian M Wolpin
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Meir J Stampfer
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Jeffrey A Meyerhardt
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Charles S Fuchs
- Department of Medical Oncology, Smilow Cancer Hospital and Yale Cancer Center, New Haven, CT, USA
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Susan B Roberts
- USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Walter C Willett
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Frank B Hu
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Edward L Giovannucci
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Kimmie Ng
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
3
|
Imad FE, Drissi H, Tawfiq N, Bendahhou K, Benider A, Radallah D. [A case-control study on dietary risk factors for colorectal cancer in Morocco]. Pan Afr Med J 2020; 35:59. [PMID: 32537063 PMCID: PMC7250211 DOI: 10.11604/pamj.2020.35.59.18214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 11/28/2019] [Indexed: 12/31/2022] Open
Abstract
Introduction given its frequency and severity, colorectal cancer is a major public health problem. Diet plays a key role in preventing this type of cancer. The purpose of our study was to determine dietary risk factors for colorectal cancer in our Moroccan context. Methods we conducted a case-control study including patients with colorectal cancer compared with controls. The statistical analysis of results was carried out using R software. Results our study included 225 patients treated for cancer at the Mohammed VI Hospital Center and 225 controls. The average age of our study population at the time of diagnosis was 55.49±14.06 years, including 119 men (52.9%) and 106 women (47.1%) with a sex ratio of 1.12. Associations were found between the highest intakes of red meats, cold meats, sausages and the risk of colorectal cancer (p = 0.0001) with F4 (4-7 times / week) vs F1 (never): OR = 4.4 (1.6-11.9); (p = 0.001), OR = 1.7 (0.5-5.7); (p = 0.003), OR = 5.7 (1.2-27.4)). On the other hand, consumption of fish was associated with a reduced risk of colorectal cancer (p = 0.0001; OR = 0.3 (0.11-0.7)), while consumption of poultry and grilled eggs was not associated with colorectal cancer. We also found that consumption of fresh vegetables and cooked vegetables was low in patients compared to controls (p = 0.0001). Furthermore, a high intake of black coffee was associated with a reduced risk of colorectal cancer (p = 0.0001; F4 vs F1: OR = 0.2 (0.1-0.4)). Conclusion our study highlights that dietary changes can prevent or impede the growth of colorectal cancer. It is essential to promote balanced diet, rich in fish, vegetables, fruits and fibers without exceeding recommended levels of red meat and avoiding cold meats and sausages.
Collapse
Affiliation(s)
| | - Houda Drissi
- Laboratoire de Biologie et Santé, Unité de Recherche Associée, Centre National pour la Recherche Scientifique et Technique, Urac-34, Faculté des Sciences Ben M'sik Université Hassan II de Casablanca, Casablanca, Maroc
| | - Nezha Tawfiq
- Centre Mohammed VI pour le Traitement des Cancers, Centre Hospitalier et Universitaire, Ibn Rochd, Faculté de Médecine et de Pharmacie, Université Hassan II, Casablanca, Maroc
| | | | - Abdellatif Benider
- Centre Mohammed VI pour le Traitement des Cancers, Centre Hospitalier et Universitaire, Ibn Rochd, Faculté de Médecine et de Pharmacie, Université Hassan II, Casablanca, Maroc
| | - Driss Radallah
- Laboratoire de Biologie et Santé, Unité de Recherche Associée, Centre National pour la Recherche Scientifique et Technique, Urac-34, Faculté des Sciences Ben M'sik Université Hassan II de Casablanca, Casablanca, Maroc
| |
Collapse
|
4
|
Perrigue MM, Drewnowski A, Wang CY, Song X, Kratz M, Neuhouser ML. Randomized Trial Testing the Effects of Eating Frequency on Two Hormonal Biomarkers of Metabolism and Energy Balance. Nutr Cancer 2016; 69:56-63. [PMID: 27918854 DOI: 10.1080/01635581.2017.1247888] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Eating frequency (EF) may influence obesity-related disease risk by attenuating postprandial fluctuations in hormones involved in metabolism, appetite regulation, and inflammation. MATERIALS/METHODS This randomized crossover intervention trial tested the effects of EF on fasting plasma insulin-like growth factor-I (IGF-1) and leptin. Fifteen subjects (4 males, 11 females) completed two eucaloric intervention phases lasting 21 days each: low EF ("low-EF"; 3 eating occasions/day) and high EF ("high-EF"; 8 eating occasions/day). Subjects were free-living and consumed their own meals using individualized structured meal plans with instruction from study staff. Subjects completed fasting blood draws and anthropometry on the first and last day of each study phase. The generalized estimated equations modification of linear regression tested the intervention effect on fasting serum IGF-1 and leptin. RESULTS Mean (± SD) age was 28.5 ± 8.70 years, and mean (± SD) Body Mass Index was 23.3 (3.4) kg/m2. We found lower mean serum IGF-1 following the high-EF condition compared to the low-EF condition (P < 0.001). There was no association between EF and plasma leptin (P = 0.83). CONCLUSION These results suggest that increased EF may lower serum IGF-1, which is a hormonal biomarker linked to increased risk of breast, prostate, and colorectal cancer.
Collapse
Affiliation(s)
- Martine M Perrigue
- a Cancer Prevention Program , Fred Hutchinson Cancer Research Center , Seattle , Washington , USA
| | - Adam Drewnowski
- b Nutritional Sciences Program , School of Public Health, University of Washington , Seattle , Washington , USA
| | - Ching-Yun Wang
- a Cancer Prevention Program , Fred Hutchinson Cancer Research Center , Seattle , Washington , USA
| | - Xiaoling Song
- a Cancer Prevention Program , Fred Hutchinson Cancer Research Center , Seattle , Washington , USA.,c Translational Research Program , Fred Hutchinson Cancer Research Center , Seattle , Washington , USA
| | - Mario Kratz
- a Cancer Prevention Program , Fred Hutchinson Cancer Research Center , Seattle , Washington , USA.,d Department of Epidemiology , School of Public Health, University of Washington , Seattle , Washington , USA.,e Department of Medicine , University of Washington , Seattle , Washington , USA
| | - Marian L Neuhouser
- a Cancer Prevention Program , Fred Hutchinson Cancer Research Center , Seattle , Washington , USA.,b Nutritional Sciences Program , School of Public Health, University of Washington , Seattle , Washington , USA
| |
Collapse
|
5
|
Liu Y, Tang W, Zhai L, Yang S, Wu J, Xie L, Wang J, Deng Y, Qin X, Li S. Meta-analysis: eating frequency and risk of colorectal cancer. Tumour Biol 2013; 35:3617-25. [PMID: 24307626 DOI: 10.1007/s13277-013-1479-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Accepted: 11/26/2013] [Indexed: 12/14/2022] Open
Abstract
Eating frequency has been implicated in the risk of colorectal cancer (CRC) in several epidemiological studies with contradictory and inconclusive findings. We performed a meta-analysis to evaluate their relationship. The pooled relative risk (RR) with 95% confidence interval (CI) was calculated to estimate the effects. A total of 15 eligible studies with 141,431 subjects and 11,248 cases were retrieved after a comprehensive search of the PubMed, Cochrane Library, and Web of Science databases up to October 2013. The overall meta-analysis revealed no strong significant association between eating frequency and risk of CRC in different eating occasion categories (1 meal/day): RR = 1.01, 95% CI 0.94-1.09, P = 0.709; 3 vs. <3 daily meals: RR = 1.17, 95% CI 0.93-1.46; 4 vs. <3 daily meals: RR = 1.13, 95% CI 0.92-1.38; ≥ 5 vs. <3 daily meals: RR = 0.95, 95% CI 0.61-1.47; 4 vs. ≤ 3 daily meals: RR = 1.18, 95% CI 0.92-1.51; and 1-2 vs. 3 or 4 daily meals: RR = 0.82, 95% CI 0.63-1.06). However, modest evidence of an increased risk of CRC in case-control studies (RR = 1.30; 95% CI, 1.11-1.52) and ≥ 5 vs. ≤ 3 meals group (RR = 1.30; 95% CI, 1.11-1.52) was observed. Our meta-analysis results do not support the hypothesis that eating frequency strongly reduced or increased the risk of CRC. Clinical randomized trials are required to evaluate this relationship further.
Collapse
Affiliation(s)
- Yanqiong Liu
- Department of Clinical Laboratory, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Eating frequency and risk of colorectal cancer. Cancer Causes Control 2013; 24:2107-15. [PMID: 24057417 DOI: 10.1007/s10552-013-0288-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 09/04/2013] [Indexed: 12/20/2022]
Abstract
PURPOSE Eating frequency is a modifiable aspect of dietary behavior that may affect risk of colorectal cancer (CRC). Although most previous case-control studies indicate a positive association, two prospective studies suggest an inverse association between eating frequency and CRC risk, with evidence of effect modification by diet composition. We examined the association between eating frequency and CRC in a large, prospective cohort study, and explored whether this relationship was modified by sex, coffee consumption, or dietary glycemic load. METHODS Between 2000 and 2002, 67,912 western Washington residents aged 50-76 reported average daily meal and snack frequency using a mailed questionnaire as part of the vitamins and lifestyle study. Participants were followed for CRC through linkage with SEER through 2008, over which time 409 CRC cases developed. Hazard Ratios and 95 % Confidence Intervals were obtained using Cox regression. RESULTS In age- and sex-adjusted models higher (5+ times/d) vs. lower (1-2 times/d) eating frequency was associated with a HR of 0.62 (95 % CI 0.43-0.88, Ptrend = 0.001). However, following further adjustment for BMI, race/ethnicity, alcohol, and other known CRC risk factors, the relationship was no longer statistically significant (HR: 0.76; 95 % CI 0.51, 1.14). No effect modification was observed by sex (Pinteraction = 0.45), coffee consumption (Pinteraction = 0.44), or dietary glycemic load (Pinteraction = 0.90). In subgroup analyses by tumor site, higher vs. lower eating frequency was associated with lower risk for colon (HR 0.65 95 % CI 0.39-1.07, Ptrend = 0.04), but not rectal cancers (HR = 1.08 95 % CI 0.54-2.18, Ptrend = 0.94). CONCLUSION The weak inverse association observed between eating frequency and CRC is consistent with findings from other prospective studies. Modification of this relationship by diet quality and participant characteristics should be considered in the future studies.
Collapse
|
7
|
Mekary RA, Hu FB, Willett WC, Chiuve S, Wu K, Fuchs C, Fung TT, Giovannucci E. The joint association of eating frequency and diet quality with colorectal cancer risk in the Health Professionals Follow-up Study. Am J Epidemiol 2012; 175:664-72. [PMID: 22387430 DOI: 10.1093/aje/kwr363] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The results of most case-control studies have suggested a positive association between eating frequency and colorectal cancer risk. Because no prospective cohort studies have done so to date, the authors prospectively examined this association. In 1992, eating frequency was assessed in a cohort of 34,968 US men in the Health Professionals Follow-up Study. Cox proportional hazards regression models were used to estimate relative risks and 95% confidence intervals for various levels of eating frequency. Effect modifications by overall dietary quality (assessed using the Diet Approaches to Stop Hypertension score) and by factors that influence insulin resistance were further assessed. Between 1992 and 2006, a total of 583 cases of colorectal cancer were diagnosed. When comparing the highest eating frequency category (5-8 times/day) with the reference category (3 times/day), the authors found no evidence of an increased risk of colorectal cancer (multivariate relative risk = 0.88, 95% confidence interval: 0.62, 1.26) or colon cancer (multivariate relative risk = 0.78, 95% confidence interval: 0.49, 1.25). There was an implied inverse association with eating frequency among participants who had healthier diets (high Diet Approaches to Stop Hypertension score; P for interaction = 0.01), especially among men in the high-insulin-sensitivity group (body mass index (weight (kg)/height (m)(2)) <25, ≥2 cups of coffee/day, and more physical activity; P for interaction < 0.01, P for trend = 0.01). There was an implied protective association between increased eating frequency of healthy meals and colorectal cancer risk and in men with factors associated with higher insulin sensitivity.
Collapse
Affiliation(s)
- Rania A Mekary
- Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA.
| | | | | | | | | | | | | | | |
Collapse
|
8
|
WINTHER JF, DREYER L, OVERVAD K, TJØNNELAND A, VERDIER MGERHARDSSON. Diet, obesity and low physical activity. APMIS 2011. [DOI: 10.1111/j.1600-0463.1997.tb05614.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
9
|
Bahadori B, McCarty MF, Barroso-Aranda J, Gustin JC, Contreras F. A “mini-fast with exercise” protocol for fat loss. Med Hypotheses 2009; 73:619-22. [DOI: 10.1016/j.mehy.2008.09.063] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Revised: 09/12/2009] [Accepted: 09/27/2008] [Indexed: 10/20/2022]
|
10
|
Abstract
Increased exposure of the colon to bile acids, as a result of increased eating frequency, might promote the development of colon cancer. Our aim was to evaluate the association between eating frequency and colon cancer. We used data from a population-based case-control study of colon cancer in North Carolina. Eating frequency (a combination of meals and snacks) was categorized as fewer than three, three or four, or more than four eating episodes per day. Multivariate logistic regression was used to calculate odds ratios (ORs) for the association between eating frequency and colon cancer, adjusting for confounders. We also performed stratified analyses to evaluate for differences by sex, coffee intake, or tumor site. Six hundred thirty-six participants with colon cancer and 1,048 control participants were included. The effect of eating frequency on colon cancer differed by sex. Among men, participants in the lowest group of eating frequency had approximately half the risk of colon cancer compared with the middle group (adjusted OR = 0.53; 95% confidence interval, CI = 0.30-0.92). Compared with the middle group, men in the highest group had no greater risk of cancer (adjusted OR = 1.03; 95% CI = 0.74-1.44). No significant associations were detected among women. Decreased eating frequency was associated with a lower risk of colon cancer among men but not women.
Collapse
Affiliation(s)
- Jeffrey T Wei
- Center for Gastrointestinal Biology and Disease, University of North Carolina, Chapel Hill 27599-7080, USA.
| | | | | | | | | |
Collapse
|
11
|
Coates AO, Potter JD, Caan BJ, Edwards SL, Slattery ML. Eating frequency and the risk of colon cancer. Nutr Cancer 2003; 43:121-6. [PMID: 12588690 DOI: 10.1207/s15327914nc432_1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Eating frequency has been found in most previous studies to have a positive association or no association with colon cancer. We report data from a large case-control study to determine the effect of eating frequency on colon cancer risk. Data were analyzed from interviews of 1,966 cases of colon cancer and 2,380 controls from selected areas in Northern California, Utah, and Minnesota. Respondents were asked whether they usually ate or drank something besides water at eight different occasions during the day. We controlled for age, family history of colorectal cancer, body mass index, physical activity, intake of non-steroidal anti-inflammatory medication, and dietary intake of energy, fiber, and calcium. In fully adjusted models, we found no significant associations between number of daily eating occasions and colon cancer in women. In men, risk of overall colon cancer was lower for one to two times per day (odds ratio = 0.54, 95% confidence interval = 0.36-0.83) than for three times per day, but risk was not increased for more than three times per day. Compared with three times per day, we found no evidence for an association between colon cancer risk and eating frequencies more than three times per day. The increased risk of colon cancer limited to men eating less than three times per day may be due to uncontrolled confounding.
Collapse
Affiliation(s)
- Ashley O Coates
- Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA 94612-2304, USA.
| | | | | | | | | |
Collapse
|
12
|
Tseng M, Ingram DD, Darden R, Ziegler RG, Longnecker MP. Eating frequency and risk of colorectal cancer. Nutr Cancer 2001; 36:170-6. [PMID: 10890027 DOI: 10.1207/s15327914nc3602_5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Case-control studies have found elevated risk of colorectal cancer with higher eating frequency. The present analyses, the first to examine this association using prospectively collected information, utilized nationally representative data from the Epidemiologic Follow-Up Study of the First National Health and Nutrition Examination Survey (NHEFS). The study population included 9,978 subjects followed from 1982-84 to 1992. Colorectal cancer cases (n = 141) were identified by self-report, hospital records, and death certificates. Interviews conducted in 1982-84 provided information on meal and snack frequencies and covariates of interest. Relative risk (RR) of colorectal cancer and 95% confidence intervals (CI) were estimated using Cox proportional hazards models adjusted for age, gender, and race and energy, alcohol, total fat, and fiber intake. Compared with those eating < 3 times/day, those eating 3-4 times/day had an RR of 0.66 (95% CI = 0.42-1.03) and those eating > 4 times/day had an RR of 0.74 (95% CI = 0.41-1.32). The association was due to decreased risk with more meals rather than more snacks per day. Given limitations of previous studies as well as the possibility of a protective effect of higher eating frequency through improved glycemic control, the present findings suggest that the influence of eating frequency on colorectal cancer risk is more complex than has been previously supposed and merits additional study.
Collapse
Affiliation(s)
- M Tseng
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC 27709, USA
| | | | | | | | | |
Collapse
|
13
|
La Vecchia C, Braga C, Franceschi S, Dal Maso L, Negri E. Population-attributable risk for colon cancer in Italy. Nutr Cancer 1999; 33:196-200. [PMID: 10368816 DOI: 10.1207/s15327914nc330212] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Risk factors for colon cancer have essentially been considered in terms of relative risks. From a public health viewpoint, however, their impact depends not only on the strength of the association, but also on the distribution of exposures in the population. Thus we used data from a case-control study conducted in Italy between 1992 and 1996 to estimate the population-attributable risks (PARs) for colon cancer in relation to educational level, physical activity, energy and vegetable intake, eating frequency, and family history of colorectal cancer. Cases were 1,225 incident, histologically confirmed colon cancer patients admitted to the major teaching and general hospitals in six Italian areas; controls were 4,154 subjects with no history of cancer, admitted to hospitals in the same catchment areas for acute, nonneoplastic diseases. By use of the distribution of the risk factors in the cases and the multivariate relative risk estimates, PARs were computed, i.e., the proportion of colon cancer that would have been avoided if all subjects were moved to the lowest exposure level. The PARs were 12% for high education, 14% for low physical activity, 14% for high energy intake, 22% for low vegetable intake, 7% for high eating frequency, and 8% for a family history of colorectal cancer. These factors together accounted for 56% of colon cancer cases. PARs were similar across age strata. Men had higher PARs for education, physical activity, and their combination, but lower PARs for energy, eating frequency, vegetable intake, and their combination than women. The percentage of colon cancers attributable to all factors considered together was 50% in men and 67% in women. Even if the PAR estimates were based on several arbitrary assumptions on the exposure distribution for various risk factors, available knowledge could, in principle, explain > 50% of cases in this Italian population, thus indicating and quantifying the theoretical scope for prevention.
Collapse
Affiliation(s)
- C La Vecchia
- Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | | | | | | | | |
Collapse
|
14
|
Favero A, Franceschi S, La Vecchia C, Negri E, Conti E, Montella M. Meal frequency and coffee intake in colon cancer. Nutr Cancer 1998; 30:182-5. [PMID: 9631488 DOI: 10.1080/01635589809514661] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Several studies suggested that frequent eating may increase colon cancer risk. To further clarify this issue, a case-control study was carried out in six areas of Italy on 1,225 incident cases < 75 years of age with histologically confirmed colon cancer and 4,154 control subjects. The controls were hospitalized for acute, nonneoplastic conditions unrelated to long-term dietary modifications. After allowance for education, physical activity, intake of vegetables, and major energy sources, there was a trend of increasing risk with increasing eating frequency (odds ratio for > or = 4 vs. < or = 2 daily meals = 1.24). Coffee intake, which was inversely associated with cancer risk, exerted a modification effect, with an odds ratio of 1.89 for frequent eaters who drank fewer than two cups of coffee per day. Frequent eating increases, whereas high coffee intake decreases, the excretion of bile acids, which are suspected to be carcinogenic to the colon. Thus, it is conceivable that frequent coffee intake may counterbalance the effect of frequent eating.
Collapse
Affiliation(s)
- A Favero
- Servizio di Epidemiologia, Centro di Riferimento Oncologico, Aviano, Italy
| | | | | | | | | | | |
Collapse
|