Trends in incidence, treatment, and relative survival of colorectal cancer in the Netherlands between 2000 and 2021

BACKGROUND

The epidemiology of colorectal cancer (CRC) has changed rapidly over the years. The aim of this study was to assess the trends in incidence, treatment, and relative survival (RS) of patients diagnosed with CRC in the Netherlands between 2000 and 2021.

PATIENTS AND METHODS

2 75667 patients diagnosed with CRC between 2000 and 2021 were included from the Netherlands Cancer Registry. Analyses were stratified for disease extent (localised: T1-3N0M0; regional: T4N0M0/T1-4N1-2M0; distant: T1-4N0-2M1) and localisation (colon; rectum). Trends were assessed with joinpoint regression.

RESULTS

CRC incidence increased until the mid-2010s but decreased strongly thereafter to rates comparable with the early 2000s. Amongst other trend changes, local excision rates increased for patients with localised colon (2021: 13.6 %) and rectal cancer (2021: 34.9 %). Moreover, primary tumour resection became less common in patients with distant colon (2000-2021: 60.9-12.5 %) or rectal cancer (2000-2021: 47.8-6.9 %), while local treatment of metastases rates increased. Five-year RS improved continuously for localised and regional colon (97.7 % and 72.0 % in 2017, respectively) and rectal cancer (95.2 % and 76.3 % in 2017, respectively). The rate of anti-cancer treatments decreased in distant colon (2010-2021: 80.3 % to 67.2 %; p < 0.001) and rectal cancer (2011-2021: 86.0 % to 77.0 %; p < 0.001). The improvement of five-year RS stagnated for distant colon (2010-2017: 11.2 % to 11.9 %; average percentage of change [APC]: 2.1, 95 % confidence interval [CI]: -7.6, 4.7) and rectal cancer (2009-2017: 12.7 % to 15.6 %; APC: 1.4, 95 % CI: -19.1, 5.5).

CONCLUSIONS

Major changes in the incidence and treatment of CRC between 2000 and 2021 were identified and quantified. Five-year RS increased continuously for patients with localised and regional CRC, but stagnated for patients with distant CRC, likely caused by decreased rates of anti-cancer treatment in this group.

Limited impact of the COVID-19 pandemic on colorectal cancer care in the Netherlands in 2020

PURPOSE

The COVID-19 pandemic had a major impact on the health services worldwide. We aimed to investigate the impact of the pandemic on colorectal cancer (CRC) care in the Netherlands in 2020.

METHODS

CRC patients, diagnosed in 2018-2020 in the Netherlands, were selected from the Netherlands Cancer Registry (NCR). The year 2020 was divided in four periods reflecting COVID-19 developments in the Netherlands (pre-COVID, 1st peak, recovery period, 2nd peak) and compared with the same periods in 2018/2019. Patient characteristics and treatment were compared using the Chi-squared test. Median time between diagnosis and treatment, and between (neo)adjuvant therapy and surgery were analyzed by the Mann-Whitney U test.

RESULTS

In total, 38,021 CRC patients were diagnosed in 2018/2019 (n = 26,816) and 2020 (n = 11,205). Median time between diagnosis and initial treatment decreased on average 4 days and median time between neoadjuvant radiotherapy and surgery in clinical stage II or III rectal cancer patients increased on average 34 days during the three COVID-19 periods compared to the same periods of 2018/2019. The proportion of colon cancer patients that underwent elective surgery significantly decreased with 3.0% during the 1st peak. No differences were found in the proportion of patients who received (neo)adjuvant therapy, systemic therapy, or no anti-cancer treatment.

CONCLUSION

Only minor changes in the care for CRC patients occurred during the COVID-19 pandemic, mostly during the 1^st peak. In conclusion, the impact on CRC care in the Netherlands was found to be limited. However, long-term effects cannot be precluded.

Maternal dietary patterns are associated with human milk composition in Chinese lactating women

OBJECTIVES

Dietary patterns are a useful tool to study the impact of overall maternal diet on human milk (HM) composition beyond single foods or nutrients. The present study aimed to identify dietary patterns among Chinese lactating women and assess their associations with HM macronutrient composition.

METHODS

Dietary intake data and HM samples were collected from 122 Chinese mothers at three to five study visits during the first 52 d postpartum. Dietary patterns were derived using principal component analysis. Cross-sectional associations of dietary patterns and HM macronutrients were assessed using multivariable linear regression models adjusted for total energy intake. All analyses were done separately for colostrum (postpartum days 0-7) and mature milk (postpartum days 8-52).

RESULTS

Four dietary patterns were identified: high-in-animal-foods, high-in-eggs, high-in-plant-foods, and high-in-fruits. Compared with the lowest tertile (T1), participants in the highest tertile (T3) of the high-in-animal-foods and high-in-plant-foods patterns had lower protein (respectively, T3 - T1 = -1.09 g/100 mL, P_trend = 0.002; T3 - T1 = -0.54 g/100 mL, P_trend = 0.001) and higher fat (respectively, T3 - T1 = 0.86 g/100 mL, P_trend = 0.040; T3 - T1 = 0.40 g/100 mL, P_trend = 0.004) concentrations in colostrum. In contrast, in mature milk the high-in-animal-foods pattern was positively associated with carbohydrates (T3 - T1 = 0.53 g/100 mL, P_trend = 0.008) and the high-in-plant-foods pattern was negatively associated with fat (T3 - T1 = -0.64 g/100 mL, P_trend = 0.002). The high-in-eggs pattern was weakly positively associated with protein concentration in mature milk (T3 - T1 = 0.10 g/100 mL, P_trend = 0.023).

CONCLUSIONS

Maternal dietary patterns with high proportions of animal and plant-based foods were associated with higher fat and lower protein concentrations in colostrum. Different associations were found in mature milk. Dietary-pattern analysis provides an opportunity to characterize total diet and may be more predictive of HM composition than single foods or nutrients.

Size and shape of the associations of glucose, HbA1c, insulin and HOMA-IR with incident type 2 diabetes: the Hoorn Study

AIMS/HYPOTHESIS

Glycaemic markers and fasting insulin are frequently measured outcomes of intervention studies. To extrapolate accurately the impact of interventions on the risk of diabetes incidence, we investigated the size and shape of the associations of fasting plasma glucose (FPG), 2 h post-load glucose (2hPG), HbA_1c, fasting insulin and HOMA-IR with incident type 2 diabetes mellitus.

METHODS

The study population included 1349 participants aged 50-75 years without diabetes at baseline (1989) from a population-based cohort in Hoorn, the Netherlands. Incident type 2 diabetes was defined by the WHO 2011 criteria or known diabetes at follow-up. Logistic regression models were used to determine the associations of the glycaemic markers, fasting insulin and HOMA-IR with incident type 2 diabetes. Restricted cubic spline logistic regressions were conducted to investigate the shape of the associations.

RESULTS

After a mean follow-up duration of 6.4 (SD 0.5) years, 152 participants developed diabetes (11.3%); the majority were screen detected by high FPG. In multivariate adjusted models, ORs (95% CI) for incident type 2 diabetes for the highest quintile in comparison with the lowest quintile were 9.0 (4.4, 18.5) for FPG, 6.1 (2.9, 12.7) for 2hPG, 3.8 (2.0, 7.2) for HbA_1c, 1.9 (0.9, 3.6) for fasting insulin and 2.8 (1.4, 5.6) for HOMA-IR. The associations of FPG and HbA_1c with incident diabetes were non-linear, rising more steeply at higher values.

CONCLUSIONS/INTERPRETATION

FPG was most strongly associated with incident diabetes, followed by 2hPG, HbA_1c, HOMA-IR and fasting insulin. The strong association with FPG is probably because FPG is the most frequent marker for diabetes diagnosis. Non-linearity of associations between glycaemic markers and incident type 2 diabetes should be taken into account when estimating future risk of type 2 diabetes based on glycaemic markers.

Dietary patterns and mental health after myocardial infarction

BACKGROUND

Diet has been associated with better mental health in general populations, but less is known on this association in patients with a history of coronary heart disease. The objective of this study is to examine the cross-sectional associations between dietary patterns and mental health in elderly patients with a history of myocardial infarction.

METHODS

Data were drawn from the final assessment of the Alpha Omega cohort that monitored patients with a history of myocardial infarction (age range 60-80 years). 2171 patients with complete data for diet and mental health were included in this study. Diet was assessed with the 203-item Food Frequency Questionnaire, and subsequently categorized into two scores: the Dutch Healthy Nutrient and Food Score (DHNaFS) and the Dutch Undesirable Nutrient and Food Score (DUNaFS). Depressive symptoms, assessed with the Geriatric Depression Scale (GDS-15), and dispositional optimism, assessed with the 4-item questionnaire (4Q), were cross-sectionally analyzed in relation to dietary patterns using linear regression analysis.

RESULTS

Patients were on average 72.2 years old and 79.5% were male. The DHNaFS score was associated with less depressive symptoms and higher dispositional optimism (β = -0.108; P<0.001; and β = 0.074; P<0.001), whereas no associations were found with the DUNaFS score. Particularly, consumption of vegetables, fruits, whole grains, fish, and low fat-dairy were associated with less depressive symptoms and higher optimism. Similar associations were found when analyzing the association between average DHNaFS score over the preceding 41 months with depression β = -0.085; P<0.001) and higher dispositional optimism (β = 0.084; P<0.001).

CONCLUSIONS

A healthy dietary pattern, in particular a higher consumption of vegetables, fruit, whole grains, fish and low-fat dairy, was associated with less depressive symptoms and higher optimism. However, given the cross-sectional nature of our analyses, our findings may also be explained by more optimistic participants making healthier food choices. Therefore, future prospective or interventions studies are needed to establish the direction of causality of this association.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03192410.

Healthy eating and survival among elderly men with and without cardiovascular-metabolic diseases

BACKGROUND AND AIMS

The strength of the associations of dietary scores with cardiovascular disease (CVD) and all-cause mortality in elderly vary considerably between a priori scores. To assess whether healthy eating lowers the risk of CVD and all-cause mortality among elderly men.

METHODS AND RESULTS

The Zutphen Elderly Study (age 65-84 years) was divided into men with (n = 210) and without (n = 616) cardiovascular-metabolic diseases at baseline in 1985. Diet was assessed with the cross-check dietary history method. We created the "Dutch Healthy Nutrient and Food Score" (DHNaFS) and the "Dutch Undesirable Nutrient and Food Score" (DUNaFS). Associations of the scores with CVD and all-cause mortality were assessed using multivariable Cox regression models. Associations of scores with life years gained used general linear models. During a median follow-up of 10.6 years (IQR 5.8-15.9) 806 participants died, of whom 359 from CVD. In all men, diet scores did not predict death. Among men with cardiovascular-metabolic diseases, DHNaFS was associated with lower CVD (HR: 0.57; 95% CI: 0.35-0.93) and all-cause mortality risk (HR: 0.64; 95% CI: 0.44-0.94) comparing the highest vs. the lowest score tertiles. Men with cardiovascular-metabolic diseases in the highest vs. the lowest tertile of the DHNaFS lived approximately 2.5 years longer. The DHNaFS was not associated with CVD and all-cause mortality in men without cardiovascular-metabolic diseases. The DUNaFS was not associated with any of the outcomes.

CONCLUSION

A high quality diet was associated with a 40% lower mortality risk and 2.5 years longer life expectancy in elderly men with, but not without, cardiovascular-metabolic diseases.

Healthy eating and lower mortality risk in a large cohort of cardiac patients who received state-of-the-art drug treatment

BACKGROUND

Little is known about dietary scores and mortality risk in cardiac patients who are well treated with drugs with attendant relatively low risk of cardiovascular diseases (CVDs).

OBJECTIVE

We assessed whether healthy eating lowers the risk of CVD and all-cause mortality in cardiac patients.

DESIGN

We included 4307 patients from the Alpha Omega Trial aged 60-80 y with a clinically diagnosed myocardial infarction and monitored mortality for 10 y. Diet was assessed at baseline (2002-2006) with a validated 203-item food-frequency questionnaire. We created 2 dietary scores on the basis of nonoverlapping sets of foods: the Dutch Healthy Nutrient and Food Score (DHNaFS) and the Dutch Undesirable Nutrient and Food Score (DUNaFS). The associations of both dietary scores with CVD and all-cause mortality were assessed by using multivariable-adjusted Cox regression models.

RESULTS

The median time after myocardial infarction at baseline was 3.7 y (IQR: 1.7-6.3 y). During a median of 6.5 y of follow-up (IQR: 5.3-7.6 y), 801 patients died; 342 of those died of CVD. One patient was lost to follow-up. A substantially higher average amount of DHNaFS foods (∼1750 g/d) than DUNaFS foods (∼650 g/d) was consumed. Almost all patients received drug treatment: 86% used statins, 90% used antihypertensive medication, and 98% used antithrombotic medication. Patients in the fifth quintile of the DHNaFS had a 30% (HR: 0.70; 95% CI: 0.55, 0.91) lower CVD risk and a 32% (HR: 0.68; 95% CI: 0.47, 0.99) lower all-cause mortality risk than did patients in the first quintile. The DUNaFS was unrelated to both CVD and all-cause mortality.

CONCLUSION

Beyond state-of-the-art drug treatment, healthy eating was associated with a lower risk of CVD and all-cause mortality in cardiac patients. This trial was registered at clinicaltrials.gov as NCT00127452.

Diet quality and markers of endothelial function: the CARDIA study

BACKGROUND AND AIM

Dietary patterns are associated cross-sectionally with cellular adhesion molecules (CAMs). We studied prospective associations of three dietary patterns with CAMs.

METHODS AND RESULTS

In the Coronary Artery Risk Development in Young Adults (CARDIA) study, diet was assessed at years 0 (1985-86) and 7 (1992-93) examinations. Four circulating CAMs (E-selectin, P-selectin, soluble intercellular adhesion molecule 1 (sICAM-1), and vascular cellular adhesion molecule (VCAM)) were assayed at years 7 and 15 (2000-01). We created one index score "A Priori Diet Quality Score" and derived dietary patterns using principal components analysis (PCA). Multivariable linear regression models predicted year 15 CAMs from averaged (year 0/7) dietary patterns. The A Priori Diet Quality Score rated 46 food groups beneficial, neutral or adverse based on hypothesized health effects. We derived two PCA dietary patterns: "fruit and vegetables (FV)" (high intakes of fruit, vegetables, and whole grains) and "meat" (high intakes of red meat, refined grain, and butter). All dietary patterns were related to E-selectin and sICAM-1. P-selectin was not related to the FV dietary pattern. VCAM was only related to the A Priori Diet Quality Score. Strongest associations were for the meat dietary pattern with E-selectin (effect size 28% of an SD (+3.9/13.7 ng/mL)) and P-selectin (effect size 37% of an SD (+4.1/11.2 ng/mL)) and the A Priori Diet Quality Score with sICAM-1 (effect size 34% of an SD (-15.1/44.7 ng/mL)) and VCAM (effect size of 26% of an SD (-45.1/170.3 ng/mL)).

CONCLUSION

This prospective analysis suggests that dietary patterns are associated with CAMs.

Dietary patterns are associated with plasma F₂-isoprostanes in an observational cohort study of adults

Associations between individual foods or nutrients and oxidative markers have been reported. Comprehensive measures of food intake may be uniquely informative, given the complexity of oxidative systems and the possibility of antioxidant synergies. We quantified associations over a 20-year history between three food-based dietary patterns (summary measures of whole diet) and a plasma biomarker of lipid peroxidation, F2-isoprostanes, in a cohort of Americans ages 18-30 at year 0 (1985-1986). We assessed diet at years 0, 7, and 20 through a detailed history of past-month food consumption and supplement use and measured plasma F2-isoprostanes at years 15 and 20. We created three dietary patterns: (1) a priori ("a priori diet quality score") based on hypothesized healthfulness of foods, (2) an empirical pattern reflecting high fruit and vegetable intake ("fruit-veg"), and (3) an empirical pattern reflecting high meat intake ("meat"). We used linear regression to estimate associations between each dietary pattern and plasma F2-isoprostanes cross-sectionally (at year 20, n=2736) and prospectively (year 0/7 average diet and year 15/20 average F2-isoprostanes, n=2718), adjusting for age, sex, race, total energy intake, education, smoking, body mass index, waist circumference, physical activity, and supplement use. In multivariable-adjusted cross-sectional analysis, the a priori diet quality score and the fruit-veg diet pattern were negatively, and the meat pattern was positively, associated with F2-isoprostanes (all p values <0.001). These associations remained statistically significant in prospective analysis. Our findings suggest that long-term adherence to a diet rich in fruits and vegetables and low in red meat may decrease lipid peroxidation.

Longitudinal trends in diet and effects of sex, race, and education on dietary quality score change: the Coronary Artery Risk Development in Young Adults study

BACKGROUND

The food supply and dietary preferences have changed in recent decades.

OBJECTIVE

We studied time- and age-related individual and population-wide changes in a dietary quality score and food groups during 1985-2006.

DESIGN

The Coronary Artery Risk Development in Young Adults (CARDIA) study of 5115 black and white men and women [aged 18-30 y at year 0 (1985-1986)] assessed diet at examinations at study years 0, 7 (1992-1993), and 20 (2005-2006). The dietary quality score, which was validated by its inverse association with cardiovascular disease risk, summed 46 food groups rated by investigators as positive or negative on the basis of hypothesized health effects. We used repeated-measures regression to estimate time-specific mean diet scores and servings per day of food groups.

RESULTS

In 2652 participants with all 3 diet assessments, the mean (±SD) dietary quality score increased from 64.1 ± 13.0 at year 0 to 71.1 ± 12.6 at year 20, which was mostly attributable to increased age. However, the secular trend, which was estimated from differences of dietary quality scores across time at a fixed age (age-matched time trend) decreased. The diet score was higher in whites than in blacks and in women than in men and increased with education, but demographic gaps in the score narrowed over 20 y. There tended to be increases in positively rated food groups and decreases in negatively rated food groups, which were generally similar in direction across demographic groups.

CONCLUSIONS

The CARDIA study showed many age-related, desirable changes in food intake over 20 y of observation, despite a secular trend toward a lower diet quality. Nevertheless, demographic disparities in diet persist.