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Gibbs DC, Barry EL, Fedirko V, Baron JA, Bostick RM. Impact of Common Vitamin D-Binding Protein Isoforms on Supplemental Vitamin D3 and/or Calcium Effects on Colorectal Adenoma Recurrence Risk: A Secondary Analysis of a Randomized Clinical Trial. JAMA Oncol 2023; 9:546-551. [PMID: 36701139 PMCID: PMC9880863 DOI: 10.1001/jamaoncol.2022.6924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/17/2022] [Indexed: 01/27/2023]
Abstract
Importance Variants in the vitamin D-binding protein (DBP) gene (GC) encode DBP isoforms that may affect vitamin D metabolism. However, whether these isoforms modify the effects of vitamin D3 and/or calcium supplementation on colorectal adenoma recurrence is unclear. We hypothesized that supplementation effects may be stronger among those with the DBP2 isoform (encoded by the rs4588*A allele), which is associated with vitamin D deficiency and modified the associations of circulating vitamin D with risk for colorectal neoplasms in observational studies. Objective To estimate supplemental vitamin D3 and/or calcium effects on colorectal adenoma recurrence according to 3 common DBP isoforms (DBP1s, DBP1f, DBP2) encoded by 2 missense variants: rs7041 (NG_012837.3:g.57904T>G NP_001191235.1:p.Asp432Glu) and rs4588 (NG_012837.3:g.57915C>A NP_001191235.1:p.Thr436Lys). Design, Setting, and Participants Secondary analysis of a randomized, double-blind, placebo-controlled clinical trial of 2259 participants with a recently diagnosed adenoma and no remaining polyps after complete colonoscopy in the US from July 1, 2004, to August 31, 2013. The current analyses were performed from August 12, 2019, to July 16, 2022. Interventions Daily vitamin D3 (1000 IU), calcium (1200 mg), both, or placebo. Main Outcomes and Measures One or more adenomas diagnosed during 3 to 5 years of follow-up. Treatment effects were estimated according to DBP isoform as risk ratios (RRs) and 95% CIs using Poisson regression analysis. Results Of the 2259 participants randomized (mean [SD] age, 58 [6.8] years; 1033 [64%] men), 1604 non-Hispanic White participants (chosen to avoid population stratification bias) were included in the analysis. Among those with the DBP2 isoform (rs4588*AC or AA), the RRs (95% CI) for adenoma recurrence were 0.84 (0.72-1.00) with vitamin D3 relative to no vitamin D3, 0.83 (95% CI, 0.70-0.99) with calcium relative to no calcium, and 0.76 (95% CI, 0.59-0.98) with both agents relative to neither agent. Conversely, among those without DBP2 (rs4588*CC), the corresponding values were 1.08 (95% CI, 0.93-1.26; P = .03 for interaction) with vitamin D3 relative to no vitamin D3, 0.98 (95% CI, 0.84-1.14; P = .37 for interaction) with calcium relative to no calcium, and 1.09 (0.88-1.36; P = .03 for interaction) with both agents relative to neither agent. Among DBP2 homozygotes (rs4588*AA), the RR for adenoma recurrence was 0.57 (95% CI, 0.31-1.08) with both agents relative to neither agent. Conclusions and Relevance The findings of this secondary analysis of a randomized clinical trial suggest that individuals with the DBP2 isoform-encoding rs4588*A allele may particularly benefit from vitamin D3 and/or calcium supplementation for colorectal adenoma prevention. Trial Registration ClinicalTrials.gov Identifier: NCT00153816.
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Affiliation(s)
- David Corley Gibbs
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Elizabeth L. Barry
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Veronika Fedirko
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Department of Epidemiology, University of Texas M.D. Anderson Cancer Center, Houston
| | - John A. Baron
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill
| | - Roberd M. Bostick
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Troeschel AN, Byrd DA, Judd S, Flanders WD, Bostick RM. Associations of dietary and lifestyle inflammation scores with mortality due to CVD, cancer, and all causes among Black and White American men and women. Br J Nutr 2023; 129:523-534. [PMID: 35535479 PMCID: PMC9646926 DOI: 10.1017/s0007114522001349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
One potential mechanism by which diet and lifestyle may affect chronic disease risk and subsequent mortality is through chronic systemic inflammation. In this study, we investigated whether the inflammatory potentials of diet and lifestyle, separately and combined, were associated with all-cause, all-CVD and all-cancer mortality risk. We analysed data on 18 484 (of whom 4103 died during follow-up) Black and White men and women aged ≥45 years from the prospective REasons for Geographic and Racial Differences in Stroke study. Using baseline (2003-2007) Block 98 FFQ and lifestyle questionnaire data, we constructed the previously validated inflammation biomarker panel-weighted, 19-component dietary inflammation score (DIS) and 4-component lifestyle inflammation score (LIS) to reflect the overall inflammatory potential of diet and lifestyle. From multivariable Cox proportional hazards models, the hazards ratios (HR) and their 95 % CI for the DIS-all-cause mortality and LIS-all-cause mortality risk associations were 1·32 (95 % CI (1·18, 1·47); Pfor trend < 0·01) and 1·25 (95 % CI (1·12, 1·38); Pfor trend < 0·01), respectively, among those in the highest relative to the lowest quintiles. The findings were similar by sex and race and for all-cancer mortality, but weaker for all-CVD mortality. The joint HR for all-cause mortality among those in the highest relative to the lowest quintiles of both the DIS and LIS was 1·91 (95 % CI 1·57, 2·33) (Pfor interaction < 0·01). Diet and lifestyle, via their contributions to systemic inflammation, separately, but perhaps especially jointly, may be associated with higher mortality risk among men and women.
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Affiliation(s)
- Alyssa N. Troeschel
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Doratha A. Byrd
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Suzanne Judd
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, AL, USA
| | - W. Dana Flanders
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Roberd M. Bostick
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
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Mao Z, Gray ALH, Thyagarajan B, Bostick RM. Antioxidant enzyme and DNA base repair genetic risk scores' associations with systemic oxidative stress biomarker in pooled cross-sectional studies. Front Aging 2023; 4:1000166. [PMID: 37152862 PMCID: PMC10161255 DOI: 10.3389/fragi.2023.1000166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 03/28/2023] [Indexed: 05/09/2023]
Abstract
Background: Oxidative stress is hypothesized to contribute to the pathogenesis of several chronic diseases. Numerous dietary and lifestyle factors are associated with oxidative stress; however, little is known about associations of genetic factors, individually or jointly with dietary and lifestyle factors, with oxidative stress in humans. Methods: We genotyped 22 haplotype-tagging single nucleotide polymorphisms (SNPs) in 3 antioxidant enzyme (AE) genes and 79 SNPs in 14 DNA base excision repair (BER) genes to develop oxidative stress-specific AE and BER genetic risk scores (GRS) in two pooled cross-sectional studies (n = 245) of 30-74-year-old, White, cancer- and inflammatory bowel disease-free adults. Of the genotypes, based on their associations with a systemic oxidative stress biomarker, plasma F2-isoprostanes (FiP) concentrations, we selected 4 GSTP1 SNPs for an AE GRS, and 12 SNPs of 5 genes (XRCC1, TDG, PNKP, MUTYH, and FEN1) for a BER GRS. We also calculated a previously-reported, validated, questionnaire-based, oxidative stress biomarker-weighted oxidative balance score (OBS) comprising 17 anti- and pro-oxidant dietary and lifestyle exposures, with higher scores representing a higher predominance of antioxidant exposures. We used general linear regression to assess adjusted mean FiP concentrations across GRS and OBS tertiles, separately and jointly. Results: The adjusted mean FiP concentrations among those in the highest relative to the lowest oxidative stress-specific AE and BER GRS tertiles were, proportionately, 11.8% (p = 0.12) and 21.2% (p = 0.002) higher, respectively. In the joint AE/BER GRS analysis, the highest estimated mean FiP concentration was among those with jointly high AE/BER GRS. Mean FiP concentrations across OBS tertiles were similar across AE and BER GRS strata. Conclusion: Our pilot study findings suggest that DNA BER, and possibly AE, genotypes collectively may be associated with systemic oxidative stress in humans, and support further research in larger, general populations.
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Affiliation(s)
- Ziling Mao
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Abigail L. H. Gray
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Bharat Thyagarajan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, United States
| | - Roberd M. Bostick
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
- Winship Cancer Institute, Emory University, Atlanta, GA, United States
- *Correspondence: Roberd M. Bostick,
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Mao Z, Troeschel AN, Judd S, Shikany JM, Levitan EB, Safford MM, Bostick RM. Association of an evolutionary-concordance lifestyle pattern score with incident CVD among Black and White men and women. Br J Nutr 2022; 129:1-10. [PMID: 35942870 PMCID: PMC9908773 DOI: 10.1017/s0007114522002549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Dietary and lifestyle evolutionary discordance is hypothesised to play a role in the aetiology of CVD, including CHD and stroke. We aimed to investigate associations of a previously reported, total (dietary plus lifestyle) evolutionary-concordance (EC) pattern score with incident CVD, CHD and stroke. We used multivariable Cox proportional hazards regression to investigate associations of the EC score with CVD, CHD and stroke incidence among USA Black and White men and women ≥45 years old in the prospective REasons for Geographic and Racial Differences in Stroke study (2003-2017). The EC score comprised seven equally weighted components: a previously reported dietary EC score (using Block 98 FFQ data) and six lifestyle characteristics (alcohol intake, physical activity, sedentary behaviour, waist circumference, smoking history and social network size). A higher score indicates a more evolutionary-concordant dietary/lifestyle pattern. Of the 15 467 participants in the analytic cohort without a CVD diagnosis at baseline, 1563 were diagnosed with CVD (967 with CHD and 596 with stroke) during follow-up (median 11·0 years). Among participants in the highest relative to the lowest EC score quintile, the multivariable-adjusted hazards ratios and their 95 % CI for CVD, CHD and stroke were, respectively, 0·73 (0·62, 0·86; Ptrend < 0·001), 0·72 (0·59, 0·89; Ptrend < 0·001) and 0·76 (0·59, 0·98; Ptrend = 0·01). The results were similar by sex and race. Our findings support that a more evolutionary-concordant diet and lifestyle pattern may be associated with lower risk of CVD, CHD and stroke.
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Affiliation(s)
- Ziling Mao
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Alyssa N. Troeschel
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Suzanne Judd
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, AL, USA
| | - James M. Shikany
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, AL, USA
| | - Emily B. Levitan
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, AL, USA
| | | | - Roberd M. Bostick
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Mao Z, Gray ALH, Gross MD, Thyagarajan B, Bostick RM. Associations of DNA Base Excision Repair and Antioxidant Enzyme Genetic Risk Scores with Biomarker of Systemic Inflammation. Front Aging 2022; 3:897907. [PMID: 36338835 PMCID: PMC9632613 DOI: 10.3389/fragi.2022.897907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/14/2022] [Indexed: 06/16/2023]
Abstract
Background: Inflammation is implicated in the etiology of various aging-related diseases. Numerous dietary and lifestyle factors contribute to chronic systemic inflammation; genetic variation may too. However, despite biological plausibility, little is known about associations of antioxidant enzyme (AE) and DNA base excision repair (BER) genotypes with human systemic inflammation. Methods: We genotyped 22 single nucleotide polymorphisms (SNPs) in 3 AE genes, and 79 SNPs in 14 BER genes to develop inflammation-specific AE and BER genetic risk scores (GRS) in two pooled cross-sectional studies (n = 333) of 30-74-year-old White adults without inflammatory bowel disease, familial adenomatous polyposis, or a history of cancer or colorectal adenoma. Of the genotypes, based on their associations with a biomarker of systemic inflammation, circulating high sensitivity C-reactive protein (hsCRP) concentrations, we selected 2 SNPs of 2 genes (CAT and MnSoD) for an AE GRS, and 7 SNPs of 5 genes (MUTYH, SMUG1, TDG, UNG, and XRCC1) for a BER GRS. A higher GRS indicates a higher balance of variant alleles directly associated with hsCRP relative to variant alleles inversely associated with hsCRP. We also calculated previously-reported, validated, questionnaire-based dietary (DIS) and lifestyle (LIS) inflammation scores. We used multivariable general linear regression to compare mean hsCRP concentrations across AE and BER GRS categories, individually and jointly with the DIS and LIS. Results: The mean hsCRP concentrations among those in the highest relative to the lowest AE and BER GRS categories were, proportionately, 13.9% (p = 0.30) and 57.4% (p = 0.009) higher. Neither GRS clearly appeared to modify the associations of the DIS or LIS with hsCRP. Conclusion: Our findings suggest that genotypes of DNA BER genes collectively may be associated with systemic inflammation in humans.
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Affiliation(s)
- Ziling Mao
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Abigail L. H. Gray
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Myron D. Gross
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minnesota, MN, United States
| | - Bharat Thyagarajan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minnesota, MN, United States
| | - Roberd M. Bostick
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
- Winship Cancer Institute, Emory University, Atlanta, GA, United States
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Taheri E, Bostick RM, Hatami B, Pourhoseingholi MA, Asadzadeh Aghdaei H, Moslem A, Mousavi Jarrahi A, Zali MR. Dietary and Lifestyle Inflammation Scores Are Inversely Associated with Metabolic-Associated Fatty Liver Disease among Iranian Adults: A Nested Case-Control Study. J Nutr 2022; 152:559-567. [PMID: 34791370 DOI: 10.1093/jn/nxab391] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/13/2021] [Accepted: 11/13/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Diet and lifestyle may affect risk for metabolic-associated fatty liver disease (MAFLD) by chronically elevating systemic inflammation. OBJECTIVES In this study we investigated the separate and joint associations of dietary and lifestyle inflammation scores (DIS and LIS, respectively) with MAFLD risk. METHODS For this nested case-control study we identified and recruited 968 patients with MAFLD (defined as having a fatty liver index ≥60 plus ≥1 of the following conditions: overweight or obese, type II diabetes mellitus, evidence of metabolic dysregulation) and 964 controls from among 35-70-y-old men and women in the baseline phase of the Sabzevar Persian Cohort Study. We collected demographic, lifestyle, anthropometric, biochemical, and dietary intake information (via a validated FFQ) from which we calculated a circulating inflammation biomarker-weighted, predominantly whole foods and beverages-based, 19-component DIS and a 3-component LIS. We estimated DIS- and LIS-MAFLD associations using multivariable unconditional logistic regression. We also calculated equal-weight DIS and LIS to capture all potential mechanisms (inflammation plus other mechanisms) for associations of diet and lifestyle with MAFLD risk. RESULTS Among those in the highest relative to the lowest DIS and LIS tertiles, the multivariable-adjusted ORs and their 95% CIs were OR: 1.84; 95% CI: 1.61, 2.07; Ptrend < 0.001, and OR: 1.96; 95% CI: 1.69, 2.21; Ptrend < 0.001, respectively. For those in the highest relative to the lowest joint DIS and LIS tertile, the values were OR: 2.56; 95% CI: 2.19, 2.93; Pinteraction < 0.001. The findings were similar by sex. The third tertile values for the equal-weight DIS- and LIS-MAFLD associations were OR: 1.87; 95% CI: 1.41, 2.34; and OR: 2.16; 95% CI: 1.85, 2.46, respectively. CONCLUSIONS Our results suggest that higher balances of pro- relative to anti-inflammatory dietary and lifestyle exposures, separately and especially jointly, may be associated with higher MAFLD risk among adults. Also, inflammation may be the primary mechanism through which diet affects MAFLD risk.
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Affiliation(s)
- Ehsaneh Taheri
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Roberd M Bostick
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Behzad Hatami
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Mohammad Amin Pourhoseingholi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Hamid Asadzadeh Aghdaei
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Alireza Moslem
- Cellular and Molecular Research Center, Sabzevar University of Medical Science, Sabzevar, Iran
| | - Alireza Mousavi Jarrahi
- Department of Community Medicine, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Zali
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Science, Tehran, Iran
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Penley MJ, Byrd DA, Bostick RM. Associations of Evolutionary-Concordance Diet and Lifestyle Pattern Scores with Incident, Sporadic Colorectal Adenoma in a Pooled Case-Control Study. Nutr Cancer 2022; 74:2075-2087. [PMID: 35102803 PMCID: PMC10041860 DOI: 10.1080/01635581.2021.2002919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Differences in diet and lifestyle relative to those of our Paleolithic-era ancestors may explain current high incidences of chronic diseases, including colorectal cancer (CRC), in Westernized countries. Previously reported evolutionary-concordance diet and lifestyle pattern scores, reflecting closeness of diet and lifestyle patterns to those of Paleolithic-era humans, were associated with lower CRC incidence. Separate and joint associations of the scores with colorectal adenoma among men and women are unknown. To address this, we pooled data from three case-control studies of incident, sporadic colorectal adenomas (n = 771 cases, 1,990 controls), used participants' responses to food frequency and lifestyle questionnaires to calculate evolutionary-concordance diet and lifestyle pattern scores, and estimated the scores' associations with adenomas using multivariable unconditional logistic regression. The multivariable-adjusted odds ratios comparing those in the highest relative to the lowest diet and lifestyle score quintiles were 0.84 (95% confidence interval [CI] 0.62, 1.12; Ptrend:0.03) and 0.41 (95% CI 0.29, 0.59; Ptrend:<0.0001), respectively. The inverse associations were stronger for high-risk adenomas, and among those with both high relative to those with both low diet and lifestyle scores. These results suggest that more evolutionary-concordant diet and lifestyle patterns, separately and jointly, may be associated with lower risk for incident, sporadic colorectal adenoma.Supplemental data for this article is available online at https://doi.org/10.1080/01635581.2021.2002919 .
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Affiliation(s)
- McKenna J Penley
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Doratha A Byrd
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Roberd M Bostick
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA.,Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
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Gao Y, Byrd DA, Prizment A, Lazovich D, Bostick RM. Associations of Novel Lifestyle- and Whole Foods-Based Inflammation Scores with Incident Colorectal Cancer Among Women. Nutr Cancer 2022; 74:1356-1369. [PMID: 34296959 PMCID: PMC9281615 DOI: 10.1080/01635581.2021.1952629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Chronic inflammation, associated with lifestyle and dietary factors, may contribute to colorectal carcinogenesis. To address this, we investigated associations of previously validated, inflammation biomarker panel-weighted, novel, 4-component lifestyle (LIS) and 19-component predominately whole foods-based dietary (DIS) inflammation scores with incident colorectal cancer (CRC) in the prospective Iowa Women's Health Study (IWHS; 1986-2012; n = 34,254, of whom 1,632 developed CRC). METHODS We applied the published scores' components' weights, summed the weighted components to constitute the scores (higher scores reflect a higher balance of pro-inflammatory exposures), and investigated LIS- and DIS-CRC associations using multivariable Cox proportional hazards regression. RESULTS The multivariable-adjusted hazards ratios (HR) and their 95% confidence intervals (CI) for CRC among participants in the highest relative to the lowest LIS and DIS quintiles were 1.47 (1.26, 1.72; Ptrend < 0.01) and 1.07 (0.91, 1.25; Ptrend = 0.22), respectively. The corresponding findings for distal colon cancers were HR 1.78 (1.29, 2.47) and HR 1.34 (0.98, 1.84), respectively. Among those in the highest relative to the lowest joint LIS/DIS quintile, the HR for CRC was 1.60 (95% CI 1.30, 1.98). CONCLUSIONS Our results suggest that a more pro-inflammatory lifestyle, alone and jointly with a more pro-inflammatory diet, may be associated with higher CRC risk.
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Affiliation(s)
- Yasheen Gao
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Doratha A. Byrd
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Anna Prizment
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.,Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - DeAnn Lazovich
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota.,Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Roberd M. Bostick
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.,Winship Cancer Institute, Emory University, Atlanta, Georgia
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Kiran N, Prizment AE, Lazovich D, Mao Z, Bostick RM. Sucrose Intakes and Incident Colorectal Cancer Risk among Women. J Am Nutr Assoc 2022; 41:57-63. [PMID: 33315540 PMCID: PMC8428539 DOI: 10.1080/07315724.2020.1848661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND High sucrose intakes are hypothesized to increase colorectal cancer (CRC) risk by several mechanisms, and sucrose intakes have been consistently positively associated with CRC risk in case-control studies. However, all but one prospective study reported a null sucrose-CRC association. The only prospective study to report a positive association was the Iowa Women's Health Study (IWHS) of 35,221 cancer-free Iowa women, aged 55 - 69 years old at baseline in 1986, after four years of follow up. MATERIALS AND METHODS To address the discrepant findings in the literature, after 26 years of follow up in the IWHS, we updated and expanded on our earlier reported analyses. During follow up through 2012, 1,731 women were diagnosed with CRC. Baseline dietary intakes were assessed with a Willett semiquantitative food frequency questionnaire. We used multivariable Cox proportional hazards regression models to estimate adjusted hazards ratios (HRs) and their 95% confidence intervals (CI). RESULTS For those in the highest relative to the lowest intake quintiles, the adjusted HRs (95% CI) for CRC were 1.04 (0.87-1.23; Ptrend = 0.59) for sucrose, 1.00 (0.82-1.21; Ptrend = 0.67) for sucrose-containing foods, and 1.01, (0.83-1.22; Ptrend = 0.56) for nondairy sucrose-containing foods, respectively. These findings did not differ substantially by colorectal site or according to categories of selected participant characteristics. CONCLUSIONS Our findings do not support that intakes of sucrose or sucrose-containing foods are substantially associated with CRC risk among older women.
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Affiliation(s)
- Nfn Kiran
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Anna E. Prizment
- Division of Hematology, Oncology and Transplantation, Medical School, University of Minnesota, Minneapolis, Minnesota.,Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - DeAnn Lazovich
- Division of Hematology, Oncology and Transplantation, Medical School, University of Minnesota, Minneapolis, Minnesota.,Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Ziling Mao
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Roberd M. Bostick
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.,Winship Cancer Institute, Emory University, Atlanta, Georgia
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Kelley CF, Pollack I, Yacoub R, Zhu Z, Van Doren VE, Gumber S, Amara RR, Fedirko V, Kraft CS, de Man TJB, Hu YJ, Grimsley Ackerley C, Sullivan PS, Bostick RM. Condomless receptive anal intercourse is associated with markers of mucosal inflammation in a cohort of men who have sex with men in Atlanta, Georgia. J Int AIDS Soc 2021; 24:e25859. [PMID: 34911162 PMCID: PMC8673926 DOI: 10.1002/jia2.25859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 11/25/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction We previously showed that the rectal mucosal immune environment among men who have sex with men (MSM) engaging in condomless receptive anal intercourse (CRAI) is immunologically distinct from that of men who do not engage in anal intercourse (AI). Here, we further examined these differences with quantitative immunohistochemistry to better understand the geographic distribution of immune markers of interest. Methods We enrolled a cohort of MSM engaging in CRAI (n = 41) and men who do not engage in AI (n = 21) between October 2013 and April 2015. Participants were healthy, HIV‐negative men aged 18–45 from the metro Atlanta area. We performed rectal mucosal sampling via rigid sigmoidoscopy during two study visits separated by a median of nine weeks and timed with sexual activity for MSM engaging in CRAI. We used standardized, automated immunohistochemistry and quantitative image analysis to investigate the rectal mucosal distribution of neutrophils (MPO), IL‐17‐producing cells (IL‐17) and Tregs (FOXP3) in the lamina propria, and cellular proliferation (Ki67) and adherens junction protein (E‐cadherin) in the epithelium. We examined associations between biomarker expression and the rectal mucosal microbiota composition by 16s rRNA sequencing. Results Relative to the colonic crypt base, IL‐17, FOXP3, and MPO expression increased towards the rectal lumen, while Ki67 decreased and E‐cadherin was more uniformly distributed. Throughout the rectal mucosa distribution examined, MSM engaging in CRAI had higher mean lamina propria MPO expression (p = 0.04) and epithelial Ki67 (p = 0.04) compared to controls. There were no significant differences in IL‐17, FOXP3 or E‐cadherin expression. We found no significant associations of the five biomarkers with the global rectal microbiota composition or the individual taxa examined. Conclusions Understanding the mucosal distribution of inflammatory mediators can enhance our knowledge of the earliest events in HIV transmission. Neutrophil enrichment and crypt epithelial cell proliferation likely represent sub‐clinical inflammation in response to CRAI in the rectal mucosa of MSM, which could increase the risk for HIV acquisition. However, the contributory role of the microbiota in mucosal inflammation among MSM remains unclear. HIV prevention may be enhanced by interventions that reduce inflammation or capitalize on the presence of specific inflammatory mechanisms during HIV exposure.
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Affiliation(s)
- Colleen F Kelley
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, The Hope Clinic, Atlanta, Georgia, USA.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Ilana Pollack
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, The Hope Clinic, Atlanta, Georgia, USA
| | - Rami Yacoub
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Zhengyi Zhu
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Vanessa E Van Doren
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, The Hope Clinic, Atlanta, Georgia, USA
| | - Sanjeev Gumber
- Division of Pathology, Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, USA.,Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Rama R Amara
- Division of Microbiology and Immunology, Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, USA.,Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Veronika Fedirko
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.,Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Colleen S Kraft
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, The Hope Clinic, Atlanta, Georgia, USA.,Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Yi-Juan Hu
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Cassie Grimsley Ackerley
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, The Hope Clinic, Atlanta, Georgia, USA
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Roberd M Bostick
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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11
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Li Z, Gao Y, Byrd DA, Gibbs DC, Prizment AE, Lazovich D, Bostick RM. Novel Dietary and Lifestyle Inflammation Scores Directly Associated with All-Cause, All-Cancer, and All-Cardiovascular Disease Mortality Risks Among Women. J Nutr 2021; 151:930-939. [PMID: 33693725 PMCID: PMC8030700 DOI: 10.1093/jn/nxaa388] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/16/2020] [Accepted: 11/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Exogenous exposures collectively may contribute to chronic, low-grade inflammation and increase risks for major chronic diseases and mortality. We previously developed, validated, and reported a novel, FFQ-based and lifestyle questionnaire-based, inflammation biomarker panel-weighted, predominantly whole foods-based 19-component dietary inflammation score (DIS) and 4-component lifestyle inflammation score (LIS; comprising physical activity, alcohol intake, BMI, and current smoking status). Both scores were more strongly associated with circulating biomarkers of inflammation in 3 populations than were previously reported dietary inflammation indices. Associations of the DIS and LIS with mortality risk have not been reported. OBJECTIVES To investigate separate and joint associations of the DIS and LIS with all-cause, all-cancer, and cardiovascular disease (CVD) mortality risks in the prospective Iowa Women's Health Study (1986-2012; n = 33,155 women, ages 55-69 years, of whom 17,431 died during follow-up, including 4379 from cancer and 6574 from CVD). METHODS We summed each study participant's scores' components, weighted by their published weights, to yield the participant's inflammation score; a higher score was considered more pro-inflammatory. We assessed DIS and LIS mortality associations using multivariable Cox proportional hazards regression. RESULTS Among participants in the highest relative to the lowest DIS and LIS quintiles, the adjusted HRs for all-cause mortality were 1.11 (95% CI: 1.05-1.16) and 1.60 (95% CI: 1.53-1.68), respectively; for all-cancer mortality were 1.07 (95% CI: 0.97-1.17) and 1.51 (95% CI: 1.38-1.66), respectively; and for CVD mortality were 1.12 (95% CI: 1.03-1.21) and 1.79 (95% CI: 1.66-1.94), respectively (all Ptrend values < 0.01). Among those in the highest relative to the lowest joint LIS/DIS quintiles, the HRs for all-cause, all-cancer, and all-CVD mortality were 1.88 (95% CI: 1.71-2.08), 1.82 (95% CI: 1.50-2.20), and 1.92 (95% CI: 1.64-2.24), respectively. CONCLUSIONS More pro-inflammatory diets and lifestyles, separately but especially jointly, may be associated with higher all-cause, all-cancer, and all-CVD mortality risks among women.
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Affiliation(s)
- Zhuoyun Li
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Yasheen Gao
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Doratha A Byrd
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - David C Gibbs
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Anna E Prizment
- Division of Hematology, Oncology and Transplantation, Medical School, University of Minnesota, Minneapolis, MN, USA,Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - DeAnn Lazovich
- Division of Hematology, Oncology and Transplantation, Medical School, University of Minnesota, Minneapolis, MN, USA,Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
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12
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Vermandere K, Bostick RM, Tran HQ, Gewirtz AT, Barry EL, Rutherford RE, Seabrook ME, Fedirko V. Effects of Supplemental Calcium and Vitamin D on Circulating Biomarkers of Gut Barrier Function in Patients with Colon Adenoma: A Randomized Clinical Trial. Cancer Prev Res (Phila) 2021; 14:393-402. [PMID: 33229339 PMCID: PMC8137511 DOI: 10.1158/1940-6207.capr-20-0461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/22/2020] [Accepted: 11/11/2020] [Indexed: 11/16/2022]
Abstract
Gut barrier dysfunction promotes chronic inflammation, contributing to several gastrointestinal diseases, including colorectal cancer. Preliminary evidence suggests that vitamin D and calcium could prevent colorectal carcinogenesis, in part, by influencing gut barrier function. However, relevant human data are scarce. We tested the effects of supplemental calcium (1,200 mg/day) and/or vitamin D3 (1,000 IU/day) on circulating concentrations of biomarkers of gut permeability (anti-flagellin and anti-lipopolysaccharide IgA and IgG, measured via ELISA) from baseline to 1 and 3 or 5 years postbaseline among 175 patients with colorectal adenoma in a randomized, double-blinded, placebo-controlled clinical trial. We also assessed factors associated with baseline concentrations of these biomarkers. We found no appreciable effects of supplemental vitamin D3 and/or calcium on individual or aggregate biomarkers of gut permeability. At baseline, a combined permeability score (the summed concentrations of all four biomarkers) was 14% lower among women (P = 0.01) and 10% higher among those who consumed >1 serving per day of red or processed meats relative to those who consumed none (P trend = 0.03). The permeability score was estimated to be 49% higher among participants with a body mass index (BMI) > 35 kg/m2 relative to those with a BMI < 22.5 kg/m2 (P trend = 0.17). Our results suggest that daily supplemental vitamin D3 and/or calcium may not modify circulating concentrations of gut permeability biomarkers within 1 or 3-5 years, but support continued investigation of modifiable factors, such as diet and excess adiposity, that could affect gut permeability. PREVENTION RELEVANCE: Calcium and vitamin D may be involved in regulating and maintaining the integrity of the intestinal mucosal barrier, the dysfunction of which results in exposure of the host to luminal bacteria, endotoxins, and antigens leading to potentially cancer-promoting endotoxemia and chronic colon inflammation. While our results suggest that daily supplementation with these chemopreventive agents does not modify circulating concentrations of gut permeability biomarkers, they support continued investigation of other potential modifiable factors, such as diet and excess adiposity, that could alter gut barrier function, to inform the development of treatable biomarkers of risk for colorectal neoplasms and effective colon cancer preventive strategies.
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Affiliation(s)
- Kelly Vermandere
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Roberd M Bostick
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Hao Q Tran
- Center for Inflammation, Immunity, and Infection, Institute for Biomedical Sciences, Georgia State University, Atlanta, Georgia
| | - Andrew T Gewirtz
- Center for Inflammation, Immunity, and Infection, Institute for Biomedical Sciences, Georgia State University, Atlanta, Georgia
| | - Elizabeth L Barry
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Robin E Rutherford
- Division of Digestive Diseases, Department of Medicine, Emory University, Atlanta, Georgia
| | | | - Veronika Fedirko
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
- Winship Cancer Institute, Emory University, Atlanta, Georgia
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13
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Gibbs DC, Fedirko V, Baron JA, Barry EL, Flanders WD, McCullough ML, Yacoub R, Raavi T, Rutherford RE, Seabrook ME, Bostick RM. Inflammation Modulation by Vitamin D and Calcium in the Morphologically Normal Colorectal Mucosa of Patients with Colorectal Adenoma in a Clinical Trial. Cancer Prev Res (Phila) 2021; 14:65-76. [PMID: 32917645 PMCID: PMC7947029 DOI: 10.1158/1940-6207.capr-20-0140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/29/2020] [Accepted: 08/24/2020] [Indexed: 12/15/2022]
Abstract
Increased COX-2 and decreased 15-hydroxyprostaglandin dehydrogenase (15-HPGD) expression promote prostaglandin-mediated inflammation and colorectal carcinogenesis. Experimental studies suggest that vitamin D and calcium may inhibit these pathways, but their effects on colorectal tissue COX-2 and 15-HPGD expression in humans are unknown. We tested the effects of supplemental vitamin D (1,000 IU/day) and/or calcium (1,200 mg/day) on COX-2 and 15-HPGD expression in the morphologically normal rectal mucosa from 62 paients with colorectal adenoma in a placebo-controlled chemoprevention trial. We measured biomarker expression using automated IHC and quantitative image analysis at baseline and 1-year follow-up, and assessed treatment effects using mixed linear models. The primary outcome was the COX-2/15-HPGD expression ratio, because these enzymes function as physiologic antagonists. After 1 year of treatment, the mean COX-2/15-HPGD expression ratio in full-length crypts proportionately decreased 47% in the vitamin D group (P = 0.001), 46% in the calcium group (P = 0.002), and 34% in the calcium + vitamin D group (P = 0.03), relative to the placebo group. Among individuals with the functional vitamin D-binding protein isoform DBP2 (GC rs4588*A), the COX-2/15-HPDG ratio decreased 70% (P = 0.0006), 75% (P = 0.0002), and 60% (P = 0.006) in the vitamin D, calcium, and combined supplementation groups, respectively, relative to placebo. These results show that vitamin D and calcium favorably modulate the balance of expression of COX-2 and 15-HPGD-biomarkers of inflammation that are strongly linked to colorectal carcinogenesis-in the normal-appearing colorectal mucosa of patients with colorectal adenoma (perhaps especially those with the DBP2 isoform). PREVENTION RELEVANCE: Supplemental calcium and vitamin D reduce indicators of cancer-promoting inflammation in normal colorectal tissue in humans, thus furthering our understanding of how they may help prevent colorectal cancer.
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Affiliation(s)
- David Corley Gibbs
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Veronika Fedirko
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.,Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - John A Baron
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Elizabeth L Barry
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - W Dana Flanders
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - Rami Yacoub
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Tapasya Raavi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Robin E Rutherford
- Division of Digestive Diseases, Department of Medicine, Emory University, Atlanta, Georgia
| | | | - Roberd M Bostick
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia. .,Winship Cancer Institute, Emory University, Atlanta, Georgia
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14
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Gibbs DC, Bostick RM, McCullough ML, Um CY, Flanders WD, Jenab M, Weiderpass E, Gylling B, Gram IT, Heath AK, Colorado-Yohar S, Dahm CC, Bueno-de-Mesquita B, Perez-Cornago A, Trichopoulou A, Tumino R, Kühn T, Fedirko V. Association of prediagnostic vitamin D status with mortality among colorectal cancer patients differs by common, inherited vitamin D-binding protein isoforms. Int J Cancer 2020; 147:2725-2734. [PMID: 32391587 PMCID: PMC7529852 DOI: 10.1002/ijc.33043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/14/2020] [Accepted: 04/20/2020] [Indexed: 12/13/2022]
Abstract
Lower prediagnostic circulating 25-hydroxyvitamin D (25[OH]D)-considered the best marker of total vitamin D exposure-is associated with higher mortality risk among colorectal cancer (CRC) patients. However, it is unknown whether this association differs by the vitamin D-binding protein (GC) isoform Gc2 (encoded by GC rs4588*C>A, Thr436Lys), which may substantially affect vitamin D metabolism and modify associations of 25(OH)D with colorectal neoplasm risk. Prediagnostic 25(OH)D-mortality associations according to Gc2 isoform were estimated using multivariable Cox proportional hazards regression among 1281 CRC cases (635 deaths, 483 from CRC) from two large prospective cohorts conducted in the United States (Cancer Prevention Study-II) and Europe (European Prospective Investigation into Cancer and Nutrition). 25(OH)D measurements were calibrated to a single assay, season standardized, and categorized using Institute of Medicine recommendations (deficient [<30], insufficient [30 - <50], sufficient [≥50 nmol/L]). In the pooled analysis, multivariable-adjusted hazard ratios (HRs) for CRC-specific mortality associated with deficient relative to sufficient 25(OH)D concentrations were 2.24 (95% CI 1.44-3.49) among cases with the Gc2 isoform, and 0.94 (95% CI 0.68-1.22) among cases without Gc2 (Pinteraction = .0002). The corresponding HRs for all-cause mortality were 1.80 (95% CI 1.24-2.60) among those with Gc2, and 1.12 (95% CI 0.84-1.51) among those without Gc2 (Pinteraction = .004). Our findings suggest that the association of prediagnostic vitamin D status with mortality among CRC patients may differ by functional GC isoforms, and patients who inherit the Gc2 isoform (GC rs4588*A) may particularly benefit from higher circulating 25(OH)D for improved CRC prognosis.
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Affiliation(s)
- David Corley Gibbs
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Roberd M. Bostick
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Winship Cancer Institute, Emory University, Atlanta, Georgia
| | | | - Caroline Y. Um
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, Georgia
| | - W. Dana Flanders
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Mazda Jenab
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | | | - Björn Gylling
- Department of Medical Biosciences, Pathology, Umea University, Umea, Sweden
| | - Inger T. Gram
- Faculty of Health Sciences, Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Alicia K. Heath
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Sandra Colorado-Yohar
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Research Group on Demography and Health, National Faculty of Public Health, University of Antioquia, Medellín, Colombia
| | | | - Bas Bueno-de-Mesquita
- Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Aurora Perez-Cornago
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Rosario Tumino
- Cancer Registry and Histopathology Department, Provincial Health Authority (ASP), Ragusa, Italy
| | - Tilman Kühn
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Veronika Fedirko
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Winship Cancer Institute, Emory University, Atlanta, Georgia
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15
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Mao Z, Prizment AE, Lazovich D, Gibbs DC, Bostick RM. Dietary and Lifestyle Oxidative Balance Scores and Incident Colorectal Cancer Risk among Older Women; the Iowa Women's Health Study. Nutr Cancer 2020; 73:2323-2335. [PMID: 32981353 DOI: 10.1080/01635581.2020.1821904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Basic science literature strongly supports a role of oxidative stress in colorectal cancer (CRC) etiology, but in epidemiologic studies, associations of most individual exposures with CRC have been weak or inconsistent. However, recent epidemiologic evidence suggests that the collective effects of these exposures on oxidative balance and CRC risk may be substantial. METHODS Using food frequency and lifestyle questionnaire data from the prospective Iowa Women's Health Study (1986-2012), we investigated associations of 11-component dietary and 4-component lifestyle oxidative balance scores (OBS) with incident CRC using multivariable Cox proportional hazards regression. RESULTS Of the 33,736 cancer-free women aged 55-69 years at baseline, 1,632 developed CRC during follow-up. Among participants in the highest relative to the lowest dietary and lifestyle OBS quintiles (higher anti-oxidant relative to pro-oxidant exposures), the adjusted hazard ratios (HRs) and their 95% confidence intervals (CI) were, respectively, 0.77 (0.63, 0.94) (Ptrend=0.02) and 0.61 (0.52, 0.71) (Ptrend<0.0001). Among those in the highest relative to the lowest joint lifestyle/dietary OBS quintile, the HR was 0.45 (95% CI 0.26, 0.77). CONCLUSIONS Our findings suggest that a predominance of antioxidant over pro-oxidant dietary and lifestyle exposures-separately and especially jointly-may be inversely associated with CRC risk among older women.
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Affiliation(s)
- Ziling Mao
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Anna E Prizment
- Division of Hematology, Oncology and Transplantation, Medical School, University of Minnesota, Minneapolis, Minnesota, USA.,Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - DeAnn Lazovich
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA.,Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - David C Gibbs
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Roberd M Bostick
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.,Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
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16
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Byrd DA, Judd S, Flanders WD, Hartman TJ, Fedirko V, Bostick RM. Associations of Novel Dietary and Lifestyle Inflammation Scores with Incident, Sporadic Colorectal Adenoma. Cancer Epidemiol Biomarkers Prev 2020; 29:2300-2308. [PMID: 32856603 DOI: 10.1158/1055-9965.epi-20-0568] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/02/2020] [Accepted: 08/05/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Colorectal carcinogenesis is mechanistically linked to inflammation and is highly associated with diet and lifestyle factors that may affect chronic inflammation. We previously developed dietary (DIS) and lifestyle (LIS) inflammation scores, comprising inflammation biomarker-weighted components, to characterize the collective contributions of 19 food groups and four lifestyle exposures to systemic inflammation. Both scores were more strongly directly associated with circulating inflammation biomarkers in three validation populations, including a subset of the study population described below, than were the previously reported dietary inflammatory index and empirical dietary inflammatory pattern. METHODS We calculated the DIS and LIS in three pooled case-control studies of incident, sporadic colorectal adenoma (N = 765 cases and 1,986 controls) with extensive dietary and lifestyle data, and investigated their associations with adenoma using multivariable unconditional logistic regression. RESULTS For those in the highest (more proinflammatory) relative to the lowest (more anti-inflammatory) quintiles of the DIS and LIS, the multivariable-adjusted ORs were 1.31 [95% confidence interval (CI), 0.98-1.75; P trend = 0.09] and 1.98 (95% CI, 1.48-2.66; P trend < 0.001), respectively. These associations were strongest for adenomas with high-risk characteristics and among men. Those in the highest relative to the lowest joint DIS/LIS quintile had a 2.65-fold higher odds (95% CI, 1.77-3.95) of colorectal adenoma. CONCLUSIONS These results support that diets and lifestyles with higher balances of pro- to anti-inflammatory exposures may be associated with higher risk for incident, sporadic colorectal adenoma. IMPACT Our findings support further investigation of the DIS and LIS in relation to colorectal neoplasms.
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Affiliation(s)
- Doratha A Byrd
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Suzanne Judd
- Department of Biostatistics, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama
| | - W Dana Flanders
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia.,Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Terryl J Hartman
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia.,Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Veronika Fedirko
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia.,Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Roberd M Bostick
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia. .,Winship Cancer Institute, Emory University, Atlanta, Georgia
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17
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Mao Z, Prizment AE, Lazovich D, Gibbs DC, Bostick RM. Abstract 4645: Lifestyle and dietary oxidative balance scores and risk for incident colorectal cancer among older women: The Iowa Women's Health Study. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-4645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Basic science literature strongly supports a role of oxidative stress in colorectal cancer (CRC) etiology; however, in epidemiologic studies, associations of individual lifestyle and dietary anti- and pro-oxidant exposures with CRC have been largely inconsistent. However, recent epidemiologic evidence suggests that the collective effects of these exposures on oxidative balance and CRC risk may be substantial.
Methods: From lifestyle and food frequency questionnaire data from the prospective Iowa Women's Health Study (1986 - 2012), we calculated equal-weight, 4-component lifestyle and 11-component dietary oxidative balance scores (OBS), and investigated their separate and joint associations with incident CRC using multivariable Cox proportional hazards regression.
Results: Of the 34,135 cancer-free women aged 55 to 69 at baseline, 1,635 developed CRC during follow-up. Among participants in the highest lifestyle and dietary OBS quintiles (higher anti-oxidant relative to pro-oxidant exposures) relative to the lowest, the multivariable-adjusted hazard ratios (HRs) were, respectively, 0.63 (95% confidence interval (CI), 0.54-0.73; Ptrend < 0.0001) and 0.77 (95% CI, 0.64-0.94; Ptrend = 0.01. The lowest risk was among those in the highest relative to the lowest joint lifestyle/dietary OBS quintile (HR = 0.47; 95% CI, 0.29-0.76).
Conclusions: Our findings suggest that a predominance of antioxidant over pro-oxidant lifestyle and dietary exposures–especially lifestyle separately and jointly with dietary exposures–may be inversely associated with CRC risk among older women.
Citation Format: Ziling Mao, Anna E. Prizment, DeAnn Lazovich, David C. Gibbs, Roberd M. Bostick. Lifestyle and dietary oxidative balance scores and risk for incident colorectal cancer among older women: The Iowa Women's Health Study [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 4645.
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Byrd DA, Judd SE, Flanders WD, Hartman TJ, Fedirko V, Agurs-Collins T, Bostick RM. Associations of Novel Dietary and Lifestyle Inflammation Scores With Incident Colorectal Cancer in the NIH-AARP Diet and Health Study. JNCI Cancer Spectr 2020; 4:pkaa009. [PMID: 32455332 PMCID: PMC7236782 DOI: 10.1093/jncics/pkaa009] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/27/2020] [Accepted: 02/28/2020] [Indexed: 12/13/2022] Open
Abstract
Background Chronically higher inflammation, likely contributed to by dietary and lifestyle exposures, may increase risk for colorectal cancer (CRC). To address this, we investigated associations of novel dietary (DIS) and lifestyle (LIS) inflammation scores with incident CRC in the prospective National Institutes of Health–American Association of Retired Persons Diet and Health Study (N = 453 465). Methods The components of our previously developed and externally validated 19-component DIS and 4-component LIS were weighted based on their strengths of associations with a panel of circulating inflammation biomarker concentrations in a diverse subset (N = 639) of participants in the REasons for Geographic and Racial Differences in Stroke Study cohort. We calculated the components and applied their weights in the National Institutes of Health-American Association of Retired Persons cohort at baseline, summed the weighted components (higher scores reflect a higher balance of proinflammatory exposures), and investigated associations of the scores with incident CRC using Cox proportional hazards regression. All statistical tests were two-sided. Results Over a mean 13.5 years of follow-up, 10 336 participants were diagnosed with CRC. Among those in the highest relative to the lowest DIS and LIS quintiles, the multivariable-adjusted hazards ratios (HRs) and their 95% confidence intervals (CIs) were HR = 1.27 (95% CI = 1.19 to 1.35; Ptrend < .001) and 1.38 (95% CI = 1.30 to 1.48; Ptrend < .001), respectively. The associations were stronger among men and for colon cancers. The hazards ratio for those in the highest relative to the lowest joint DIS and LIS quintile was HR = 1.83 (95% CI = 1.68 to 1.99; Pinteraction < .001). Conclusions Aggregates of proinflammatory dietary and lifestyle exposures may be associated with higher risk for CRC.
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Affiliation(s)
- Doratha A Byrd
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Suzanne E Judd
- Department of Biostatistics, University of Alabama, Birmingham School of Public Health, Birmingham, AL, USA
| | - W Dana Flanders
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Terryl J Hartman
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Veronika Fedirko
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | | | - Roberd M Bostick
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA.,Winship Cancer Institute, Emory University, Atlanta, GA, USA
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Gibbs DC, Song M, McCullough ML, Um CY, Bostick RM, Wu K, Flanders WD, Giovannucci E, Jenab M, Brustad M, Tjønneland A, Perez-Cornago A, Trichopoulou A, Tsilidis KK, Hultdin J, Barricarte Gurrea A, Bueno-de-Mesquita B, Mahamat-Saleh Y, Kühn T, Gunter MJ, Weiderpass E, Fedirko V. Association of Circulating Vitamin D With Colorectal Cancer Depends on Vitamin D-Binding Protein Isoforms: A Pooled, Nested, Case-Control Study. JNCI Cancer Spectr 2020; 4:pkz083. [PMID: 32337495 PMCID: PMC7050153 DOI: 10.1093/jncics/pkz083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/17/2019] [Accepted: 10/11/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Higher circulating 25-hydroxyvitamin-D [25(OH)D] concentrations are consistently inversely associated with colorectal cancer (CRC) risk in observational studies. However, it is unknown whether this association depends on the functional GC-rs4588*A (Thr436Lys) variant encoding the vitamin D-binding protein-2 (DBP2) isoform, which may affect vitamin D status and bioavailability. METHODS We analyzed data from 1710 incident CRC cases and 1649 incidence-density-matched controls nested within three prospective cohorts of mostly Caucasians. Study-specific incidence rate ratios (RRs) for associations of prediagnostic, season-standardized 25(OH)D concentrations according to DBP2 isoform with CRC were estimated using multivariable unconditional logistic regression and were pooled using fixed-effects models. All statistical significance tests were two-sided. RESULTS The odds of having 25(OH)D concentrations less than 50 nmol/L (considered insufficient by the Institute of Medicine) were 43% higher for each DBP2-encoding variant (rs4588*A) inherited (per DBP2 odds ratio [OR] = 1.43, 95% confidence interval [CI] = 1.27 to 1.62, P trend = 1.2 × 10-8). The association of 25(OH)D concentrations with CRC risk differed by DBP2: 25(OH)D concentrations considered sufficient (≥ 50 nmol/L), relative to deficient (< 30 nmol/L), were associated with a 53% lower CRC risk among individuals with the DBP2 isoform (RR = 0.47, 95% CI = 0.33 to 0.67), but with a non-statistically significant 12% lower risk among individuals without it (RR = 0.88, 95% CI = 0.61 to 1.27) (P heterogeneity = .01). CONCLUSIONS Our results suggest that the 25(OH)D-CRC association may differ by DBP isoform, and those with a DBP2-encoding genotype linked to vitamin D insufficiency may particularly benefit from adequate 25(OH)D for CRC prevention.
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Affiliation(s)
- David Corley Gibbs
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Mingyang Song
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | | | - Caroline Y Um
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, GA
| | - Roberd M Bostick
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
- Winship Cancer Institute, Emory University, Atlanta, GA
| | - Kana Wu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - W Dana Flanders
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Edward Giovannucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Mazda Jenab
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Magritt Brustad
- Department of Community Medicine, The Arctic University of Norway, Tromsø, Norway
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Aurora Perez-Cornago
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Konstantinos K Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Johan Hultdin
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | - Aurelio Barricarte Gurrea
- Navarra Public Health Institute, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
- CIBER Epidemiology and Public Health CIBERESP, Madrid, Spain
| | - Bas Bueno-de-Mesquita
- Former Senior Scientist, Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Former Associate Professor, Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, the Netherlands
- Former Visiting Professor, Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, UK
- Former Visiting Professor, Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yahya Mahamat-Saleh
- CESP, Faculty de médecine, University of Paris-Sud, Fac. de Médecine-UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
- Institut Gustave Roussy, Villejuif, France
| | - Tilman Kühn
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marc J Gunter
- Section of Nutrition and Metabolism, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | | | - Veronika Fedirko
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
- Winship Cancer Institute, Emory University, Atlanta, GA
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Byrd DA, Judd SE, Flanders WD, Hartman TJ, Fedirko V, Bostick RM. Development and Validation of Novel Dietary and Lifestyle Inflammation Scores. J Nutr 2019; 149:2206-2218. [PMID: 31373368 PMCID: PMC6887697 DOI: 10.1093/jn/nxz165] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/03/2019] [Accepted: 06/19/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Chronically higher inflammation, which may partly result from diet and lifestyle, is implicated in risk for multiple chronic diseases. The dietary inflammatory index (DII) and empirical dietary inflammatory pattern (EDIP), developed to characterize dietary contributions to systemic inflammation, have several limitations. There are no scores to characterize contributions of lifestyle to inflammation. OBJECTIVES To reflect dietary/lifestyle contributions to inflammation, we developed novel, inflammation biomarker panel-weighted, dietary (DIS) and lifestyle (LIS) inflammation scores in a subset (n = 639) of the Reasons for Geographic and Racial Differences in Stroke Study (REGARDS) cohort. METHODS We selected a priori 19 food groups and 4 lifestyle characteristics to comprise the DIS and LIS, respectively. We calculated the components' weights based on their strengths of association with an inflammation biomarker score [comprising high-sensitivity C-reactive protein (hsCRP), IL-6, IL-8, and IL-10] using multivariable linear regression. The sums of the weighted components constitute the scores, such that higher scores reflect, on balance, more proinflammatory exposures. We calculated the DIS, LIS, DII, and EDIP with cross-sectional data from the remaining REGARDS cohort ( n = 14,210 with hsCRP measurements) and 2 other study populations with hsCRP and/or an 8-component inflammation biomarker panel, and investigated their associations with circulating inflammation biomarker concentrations using multivariable logistic regression. RESULTS In REGARDS, those in the highest relative to the lowest DIS, LIS, DII, and EDIP quintiles had statistically significant 1.66-, 4.29-, 1.56-, and 1.32-fold higher odds of a high hsCRP concentration (>3 mg/dL), respectively (all P-trend < 0.001). Those in the highest relative to the lowest joint DIS/LIS quintile had a statistically significant 7.26-fold higher odds of a high hsCRP concentration. Similar findings were noted in the other 2 validation populations. CONCLUSION Our results support that dietary and lifestyle exposures collectively contribute substantially to systemic inflammation, and support the use of our novel DIS and LIS.
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Affiliation(s)
- Doratha A Byrd
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Suzanne E Judd
- Department of Biostatistics, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - W Dana Flanders
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Terryl J Hartman
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Veronika Fedirko
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Roberd M Bostick
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
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21
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Gibbs DC, McCullough ML, Song M, Um CY, Wu K, Jenab M, Giovannucci E, Bostick RM, Fedirko V. Abstract 626: Association of circulating vitamin D concentrations with colorectal cancer risk differs depending on inherited genotypes in combination with dietary lifestyle factors. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Higher circulating 25-hydroxyvitamin-D [25(OH)D] concentrations - used clinically to assess vitamin D status - are inversely associated with colorectal cancer (CRC) risk. However, it remains unknown whether this association varies by common, inherited polymorphisms encoding common vitamin D-binding protein (DBP) isoforms linked to differences in vitamin D handling and metabolism. We pooled participant-level data from three prospective cohorts in the United States (Cancer Prevention Study-II [CPS-II], Nurses’ Health Study [NHS]) and Western Europe (European Prospective Investigation into Cancer and Nutrition [EPIC]), comprising 1,710 incident CRC cases diagnosed between 1990 and 2011, and 1,649 matched controls selected using incidence density sampling. There were 1,106, 246 and 358 CRC cases in EPIC, CPS-II and NHS, respectively. Pre-diagnostic 25(OH)D measurements were calibrated to the same assay and seasonally-adjusted. Study-specific relative risks (RRs) for 25(OH)D and CRC risk according to DBP2 isoform (determined by the GC rs4588 variant) were estimated using multivariable unconditional logistic regression and pooled using fixed effects models. We also stratified our models by dietary vitamin D intake to account for differences in fortification/supplementation in the US and Europe. Variation in 25(OH)D concentrations across studies reflected differences in vitamin D intake and supplement use. Among individuals with lower vitamin D intakes (≤ 330 IU/day), for each 25 nmol/L increase in 25(OH)D, CRC risk was 30% lower among those with the DBP2 isoform (RR = 0.70, 95% CI = 0.59-0.83), and 5% lower among those without DBP2 (RR = 0.95, 95% CI = 0.82-1.10) (Pheterogeneity by DBP isoform = 0.009). Among individuals with higher vitamin D intakes (>330 IU/day, CPS-II and NHS only), for each 25 nmol/L increase in 25(OH)D, CRC risk was 18% higher among those with DBP2 (RR = 1.18, 95% CI = 0.82-1.10), and 33% lower among those without the DBP2 isoform (RR = 0.67, 95% CI = 0.53-0.85) (Pheterogeneity by DBP isoform = 0.002). These findings suggest that the association of 25(OH)D with CRC risk differs depending on inheritance of the functional DBP2 isoform in combination with levels of dietary vitamin D intake. <!–EndFragment–>
Citation Format: David C. Gibbs, Marjorie L. McCullough, Mingyang Song, Caroline Y. Um, Kana Wu, Mazda Jenab, Edward Giovannucci, Roberd M. Bostick, Veronika Fedirko. Association of circulating vitamin D concentrations with colorectal cancer risk differs depending on inherited genotypes in combination with dietary lifestyle factors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 626.
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Affiliation(s)
| | | | | | | | - Kana Wu
- 3Harvard University, Cambridge, MA
| | - Mazda Jenab
- 4International Agency for Research on Cancer, Lyon, France
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22
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Byrd D, Bostick RM, Judd SE, Flanders WD, Hartman TJ, Fedirko V, Reedy J, Agurs-Collins T. Abstract 627: Associations of novel dietary and lifestyle inflammation scores with incident colorectal cancer in the National Institutes of Health-American Association of Retired Persons Diet and Health study. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Chronically higher inflammation may play a role in colorectal carcinogenesis. Contributors to inflammation likely include dietary and other lifestyle exposures, such as smoking, physical activity, alcohol intake, and obesity. We developed dietary (DIS) and lifestyle (LIS) inflammation scores to characterize the aggregate contributions of dietary and lifestyle exposures to systemic inflammation, and investigated associations of the scores with incident colorectal cancer (CRC) in the prospective National Institutes of Health-American Association of Retired Persons (NIH-AARP) Diet and Health Study cohort (n = 453,465).
To develop the 19-component DIS, we selected a priori 18 whole food groups, including leafy greens, deep-orange/yellow vegetables, apples/berries, tomatoes/tomato products, other fruits and vegetables, processed meats, red meats, poultry, fish, nuts, legumes, refined grains or starchy vegetables, added sugars, saturated/trans fats, coffee and tea, high- and low-fat dairy, plus a supplemental micronutrient score. Similarly, for the 4-component LIS we selected a priori smoking status, physical activity, alcohol intake, and body mass index. The components were weighted based on the strengths of their associations with a panel of circulating inflammation biomarker concentrations (high sensitivity C-reactive protein and interleukin [IL]-6, IL-8, and IL-10) in a subset of 639 male and female, black and white participants in the Reasons for Geographic and Racial Differences in Stroke cohort study (REGARDS). The sums of the weighted components constitute the scores, such that higher scores reflect a higher balance of more pro-inflammatory exposures. Applying the component weights developed in REGARDS, we calculated a DIS and LIS using baseline data from the NIH-AARP study cohort and investigated their associations with incident CRC using multivariable Cox proportional hazards regression, adjusted for established risk factors for CRC.
Over an average of 13.5 years of follow-up, 10,336 participants were diagnosed with CRC. With increasing levels of the DIS and LIS, there was increasing risk for incident CRC. For men and women in the highest relative to the lowest quintiles of the DIS and LIS, the multivariable-adjusted hazards ratios (HR) and their 95% confidence intervals [CIs]) were: 1.3 (95% CI: 1.2, 1.4; Ptrend: <0.001) and 1.4 (95% CI: 1.3, 1.5; Ptrend: <0.001), respectively. The HR for those in the highest relative to the lowest joint DIS/LIS quintile was 1.8 (95% CI: 1.7, 2.0; Pinteraction: <0.001). The DIS and LIS associations were strongest among men and for cancers of the colon among men and women combined.
These results suggest that pro-inflammatory diet and lifestyle exposures may be associated with higher risk for incident colorectal cancer.
Citation Format: Doratha Byrd, Roberd M. Bostick, Suzanne E. Judd, William D. Flanders, Terryl J. Hartman, Veronika Fedirko, Jill Reedy, Tanya Agurs-Collins. Associations of novel dietary and lifestyle inflammation scores with incident colorectal cancer in the National Institutes of Health-American Association of Retired Persons Diet and Health study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 627.
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Affiliation(s)
| | | | | | | | | | | | - Jill Reedy
- 3National Institute of Health, National Cancer Institute, MD
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23
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Mandle HB, Jahan FA, Bostick RM, Baron JA, Barry EL, Yacoub R, Merrill J, Rutherford RE, Seabrook ME, Fedirko V. Effects of supplemental calcium and vitamin D on tight-junction proteins and mucin-12 expression in the normal rectal mucosa of colorectal adenoma patients. Mol Carcinog 2019; 58:1279-1290. [PMID: 30938860 DOI: 10.1002/mc.23010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 02/22/2019] [Accepted: 03/17/2019] [Indexed: 01/03/2023]
Abstract
The physical gut barrier, comprised of a thick mucus layer and the epithelium, plays an important role in defense against microbes and foreign antigens. Calcium and vitamin D may be involved in maintaining the integrity of the intestinal mucosal barrier, the dysfunction of which may lead to endotoxemia and inflammation, and contribute to colorectal carcinogenesis. We investigated supplemental calcium (1200 mg, daily) and/or vitamin D3 (1000 IU daily) effects on intestinal barrier function-related biomarkers in a subset of 105 participants from a large colorectal adenoma recurrence chemoprevention clinical trial. We assessed expression of the tight junction proteins claudin-1 (CLDN1), occludin (OCLD), and mucin-12 (MUC12) in the normal-appearing colorectal mucosa using standardized, automated immunohistochemistry and quantitative image analysis. Following 1 year of treatment, in the calcium relative to the no calcium group, the CLDN1, OCLD, and MUC12 expression increased by 14% (P = 0.17), 23% (P = 0.11), and 22% (P = 0.07), respectively. In secondary analyses, the estimated calcium treatment effects were greater among participants with baseline serum 25-OH-vitamin D concentrations below the median value of 22.69 ng/mL (CLDN1: 29%, P = 0.04; OCLD: 36%, P = 0.06; MUC12: 35%, P = 0.05). There were no biomarker expression changes in the vitamin D3 alone group; however, modest increases were found in the combined calcium/vitamin D3 group. At baseline, obesity, history of a sessile-serrated adenoma, colorectal MIB-1/Ki-67 expression, and a family history of colorectal cancer were associated with CLDN1, OCLD, and MUC12 expression. Our study supports continued investigation of factors that could affect intestinal mucosal barrier integrity relevant to colorectal carcinogenesis.
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Affiliation(s)
- Hannah B Mandle
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Ferdous A Jahan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Roberd M Bostick
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.,Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - John A Baron
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,Department of Epidemiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Elizabeth L Barry
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Rami Yacoub
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Julia Merrill
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Robin E Rutherford
- Department of Medicine, Division of Digestive Diseases, School of Medicine, Emory University, Atlanta, Georgia
| | | | - Veronika Fedirko
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.,Winship Cancer Institute, Emory University, Atlanta, Georgia
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Calderwood AH, Baron JA, Mott LA, Ahnen DJ, Bostick RM, Figueiredo JC, Passarelli MN, Rees JR, Robertson DJ, Barry EL. No Evidence for Posttreatment Effects of Vitamin D and Calcium Supplementation on Risk of Colorectal Adenomas in a Randomized Trial. Cancer Prev Res (Phila) 2019; 12:295-304. [PMID: 30833381 DOI: 10.1158/1940-6207.capr-19-0023] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/25/2019] [Accepted: 02/25/2019] [Indexed: 12/15/2022]
Abstract
Vitamin D and calcium supplementation are postulated to have chemopreventive effects against colorectal neoplasia, yet in our previously reported randomized trial, there was no overall efficacy of calcium and/or vitamin D3 against colorectal adenoma recurrence. It is possible vitamin D3 and calcium chemopreventive effects are not detectable until beyond the 3- to 5-year follow-up captured in that trial. Accordingly, we explored possible vitamin D and calcium effects on posttreatment (observational) adenoma occurrence. In this secondary analysis of the observational follow-up phase of the Vitamin D/Calcium Polyp Prevention Study, participants who completed the treatment phase were invited to be followed for one additional surveillance colonoscopy cycle. We evaluated adenoma occurrence risk at surveillance colonoscopy, with a mean of 55 ± 15 months after treatment follow-up, according to randomized treatment with vitamin D versus no vitamin D, calcium versus no calcium, and calcium plus vitamin D versus calcium alone. Secondary outcomes included advanced and multiple adenomas. Among the 1,121 participants with observational follow-up, the relative risk (95% confidence interval, CI) of any adenoma was 1.04 (0.93-1.17) for vitamin D versus no vitamin D; 0.95 (0.84-1.08) for calcium versus no calcium; 1.07 (0.91-1.25) for calcium plus vitamin D versus calcium; and 0.96 (0.81-1.15) for calcium plus vitamin D versus neither. Risks of advanced or multiple adenomas also did not differ by treatment. Our results do not support an association between supplemental calcium and/or vitamin D3 for 3 to 5 years and risk of recurrent colorectal adenoma at an average of 4.6 years after treatment.
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Affiliation(s)
- Audrey H Calderwood
- Section of Gastroenterology and Hepatology, Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
| | - John A Baron
- Departments of Epidemiology and Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Leila A Mott
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Dennis J Ahnen
- Division of Gastroenterology and Hepatology, University of Colorado School of Medicine, Denver, Colorado
| | - Roberd M Bostick
- Department of Epidemiology, Emory University; Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Jane C Figueiredo
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Michael N Passarelli
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Judy R Rees
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Douglas J Robertson
- VA Medical Center, White River Junction, Vermont; Section of Gastroenterology and Hepatology, Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Elizabeth L Barry
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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25
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Kwan AK, Um CY, Rutherford RE, Seabrook ME, Barry EL, Fedirko V, Baron JA, Bostick RM. Effects of vitamin D and calcium on expression of MSH2 and transforming growth factors in normal-appearing colorectal mucosa of sporadic colorectal adenoma patients: A randomized clinical trial. Mol Carcinog 2018; 58:511-523. [PMID: 30499618 DOI: 10.1002/mc.22945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 09/24/2018] [Accepted: 11/22/2018] [Indexed: 12/14/2022]
Abstract
Abnormal expression of the DNA mismatch repair protein MSH2 and autocrine/paracrine transforming growth factors TGFα (growth promoter) and TGFβ1 (growth inhibitor) is common during colorectal carcinogenesis. To estimate vitamin D and calcium effects on these biomarkers in the normal-appearing colorectal mucosa of sporadic colorectal adenoma patients, we conducted a pilot, randomized, double-blinded, placebo-controlled, modified 2 × 2 factorial chemoprevention clinical trial (N = 104) of supplemental vitamin D3 (1000 IU daily) and calcium (1200 mg daily), alone and in combination, versus placebo over 1 year. The expression of the three biomarkers and Ki-67/mib-1 in colorectal crypts in biopsies of normal-appearing rectal mucosa were detected using automated immunohistochemistry and quantified using image analysis. In the vitamin D3 and vitamin D3 plus calcium groups, relative to their reference groups, in the upper 40% (differentiation zone) of crypts, it was estimated that, respectively, the MSH2/mib-1 ratio increased by 47% (P = 0.14) and 62% (P = 0.08), TGFβ1 expression increased by 41% (P = 0.25) and 78% (P = 0.14), and the TGFα/TGFβ1 ratio decreased by 25% (P = 0.31) and 44% (P = 0.13). Although not statistically significant, these results support further research into (i) whether supplemental vitamin D3 , alone or in combination with calcium, may increase DNA mismatch repair relative to proliferation, increase TGFβ1 expression, and decrease autocrine/paracrine growth promotion relative to growth inhibition in the colorectal epithelium, all hypothesized to reduce risk for colorectal carcinogenesis; and (ii) the expression of MSH2 relative to mib-1, TGFβ1 alone, and TGFα relative to TGFβ1 in the normal-appearing rectal mucosa as potential modifiable, pre-neoplastic markers of risk for colorectal neoplasms.
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Affiliation(s)
- Albert K Kwan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Caroline Y Um
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Robin E Rutherford
- Division of Digestive Diseases, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | | | - Elizabeth L Barry
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Veronika Fedirko
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.,Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - John A Baron
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Roberd M Bostick
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.,Winship Cancer Institute, Emory University, Atlanta, Georgia
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Um CY, Prizment A, Hong CP, Lazovich D, Bostick RM. Associations of Calcium, Vitamin D, and Dairy Product Intakes with Colorectal Cancer Risk among Older Women: The Iowa Women's Health Study. Nutr Cancer 2018; 71:739-748. [PMID: 30572720 DOI: 10.1080/01635581.2018.1539188] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Calcium and, to a lesser extent, dairy products are consistently modestly inversely associated with colorectal cancer (CRC). Dairy products may contain components other than calcium and fat, such as insulin-like growth factor-1, that may affect CRC risk. In the prospective Iowa Women's Health Study, calcium, dairy product, and vitamin D intakes were assessed using a semiquantitative food frequency questionnaire. To investigate dairy products independent of their calcium components, we estimated residuals from linear regression models of their associations with dietary calcium. Of the 35,221 55-69-year-old cancer-free women at baseline in 1986, 1,731 developed CRC during follow-up through 2012. For those in the highest relative to the lowest intake quintiles, the adjusted hazards ratios and 95% confidence intervals from multivariable Cox proportional hazards regression models for overall and distal CRC were 0.81 (0.67-0.98; Ptrend = 0.004) and 0.59 (0.44-0.80; Ptrend = 0.003), respectively, for total calcium; and 0.79 (0.66-0.94; Ptrend = 0.01) and 0.69 (0.53-0.90; Ptrend = 0.003) for total dairy products, respectively. The various dairy product residuals were not associated with CRC. These results support that, among women, calcium and dairy products may be inversely associated with CRC-perhaps primarily distal CRC-but suggest that the non-calcium, non-fat component of dairy products may not be associated with CRC.
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Affiliation(s)
- Caroline Y Um
- a Department of Epidemiology, Rollins School of Public Health , Emory University , Atlanta , Georgia , USA
| | - Anna Prizment
- b Division of Epidemiology and Community Health, School of Public Health , University of Minnesota , Minneapolis , Minnesota , USA.,c Masonic Cancer Center, University of Minnesota , Minneapolis , Minnesota , USA
| | - Ching-Ping Hong
- b Division of Epidemiology and Community Health, School of Public Health , University of Minnesota , Minneapolis , Minnesota , USA
| | - DeAnn Lazovich
- b Division of Epidemiology and Community Health, School of Public Health , University of Minnesota , Minneapolis , Minnesota , USA.,c Masonic Cancer Center, University of Minnesota , Minneapolis , Minnesota , USA
| | - Roberd M Bostick
- a Department of Epidemiology, Rollins School of Public Health , Emory University , Atlanta , Georgia , USA.,d Winship Cancer Institute, Emory University , Atlanta , Georgia , USA
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Cheng E, Um CY, Prizment A, Lazovich D, Bostick RM. Associations of evolutionary-concordance diet, Mediterranean diet and evolutionary-concordance lifestyle pattern scores with all-cause and cause-specific mortality. Br J Nutr 2018:1-10. [PMID: 30560736 PMCID: PMC6581641 DOI: 10.1017/s0007114518003483] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Various individual diet and lifestyle factors are associated with mortality. Investigating these factors collectively may help clarify whether dietary and lifestyle patterns contribute to life expectancy. We investigated the association of previously described evolutionary-concordance and Mediterranean diet pattern scores and a novel evolutionary-concordance lifestyle pattern score with all-cause and cause-specific mortality in the prospective Iowa Women's Health Study (1986-2012). We created the diet pattern scores from Willett FFQ responses, and the lifestyle pattern score from self-reported physical activity, BMI and smoking status, and assessed their associations with mortality, using multivariable Cox proportional hazards regression. Of the 35 221 55- to 69-year-old cancer-free women at baseline, 18 687 died during follow-up. The adjusted hazard ratios (HR) and 95 % CI for all-cause, all CVD, and all-cancer mortality among participants in the highest relative to the lowest quintile of the evolutionary-concordance lifestyle score were, respectively, 0·52 (95 % CI 0·50, 0·55), 0·53 (95 % CI 0·49, 0·57) and 0·51 (95 % CI 0·46, 0·57). The corresponding findings for the Mediterranean diet score were HR 0·85 (95 % CI 0·82, 0·90), 0·83 (95 % CI 0·76, 0·90) and 0·93 (95 % CI 0·84, 1·03), and for the evolutionary-concordance diet score they were close to null and not statistically significant. The lowest estimated risk was among those in the highest joint quintile of the lifestyle score and either diet score (both Pinteraction <0·01). Our findings suggest that (1) a more Mediterranean-like diet pattern and (2) a more evolutionary-concordant lifestyle pattern, alone and in interaction with a more evolutionary-concordant or Mediterranean diet pattern, may be inversely associated with mortality.
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Affiliation(s)
- En Cheng
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Caroline Y. Um
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Anna Prizment
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - DeAnn Lazovich
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Roberd M. Bostick
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
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Gao Y, Um CY, Fedirko V, Rutherford RE, Seabrook ME, Barry EL, Baron JA, Bostick RM. Effects of supplemental vitamin D and calcium on markers of proliferation, differentiation, and apoptosis in the normal colorectal mucosa of colorectal adenoma patients. PLoS One 2018; 13:e0208762. [PMID: 30557404 PMCID: PMC6296527 DOI: 10.1371/journal.pone.0208762] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 10/18/2018] [Indexed: 12/14/2022] Open
Abstract
To clarify the roles of vitamin D and calcium as potential chemopreventive agents against colorectal cancer in humans, and to develop “treatable”, pre-neoplastic, phenotypic biomarkers of risk for colorectal neoplasms, we estimated the effects of supplemental vitamin D3 (1,000 IU/day [25 μg/day]) and calcium (1,200 mg/day), alone and in combination, on biomarkers of proliferation (mib-1), differentiation (p21), and apoptosis (bax [apoptosis-promoting] and bcl-2 [apoptosis-inhibiting]), in the normal-appearing rectal mucosa in a subsample of participants (n = 104) in a larger randomized, double-blind, placebo-controlled clinical trial among colorectal adenoma patients. The biomarkers were measured in rectal biopsies at baseline and after one year of follow up, using automated immunohistochemistry and quantitative image analysis. In the vitamin D plus calcium group relative to control, in the crypt differentiation zone (upper 40% of crypts), mib-1 expression decreased 24% (P = 0.28); p21 expression alone and relative to mib-1 expression increased 29% (P = 0.06) and 73% (P = 0.06), respectively; and bax expression relative to mib-1 expression increased 58% (P = 0.21). The estimated vitamin D alone treatment effects were similar but of lesser magnitudes, and those for calcium alone were mixed. All estimated treatment effects on bcl-2 expression were close to the null. These pilot study results support further investigation of whether 1) vitamin D and calcium promote colorectal epithelial cell differentiation, reduce proliferation, and promote apoptosis in the normal-appearing human colorectal mucosa, 2) vitamin D and calcium act as chemopreventive agents against colorectal neoplasms, and 3) mib-1, p21, and bax are potential “treatable”, pre-neoplastic, biomarkers of risk for colorectal neoplasms.
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Affiliation(s)
- Yasheen Gao
- Department of Epidemiology, Emory University, Atlanta, Georgia, United States of America
| | - Caroline Y. Um
- Department of Epidemiology, Emory University, Atlanta, Georgia, United States of America
| | - Veronika Fedirko
- Department of Epidemiology, Emory University, Atlanta, Georgia, United States of America
- Winship Cancer Institute, Emory University, Atlanta, Georgia, United States of America
| | - Robin E. Rutherford
- Division of Digestive Diseases, Department of Medicine, School of Medicine, Emory University, Georgia, United States of America
| | - March E. Seabrook
- Consultants in Gastroenterology, West Columbia, South Carolina, United States of America
| | - Elizabeth L. Barry
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States of America
| | - John A. Baron
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States of America
- Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States of America
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Roberd M. Bostick
- Department of Epidemiology, Emory University, Atlanta, Georgia, United States of America
- Winship Cancer Institute, Emory University, Atlanta, Georgia, United States of America
- * E-mail:
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Swaminath S, Um CY, Prizment AE, Lazovich D, Bostick RM. Combined Mineral Intakes and Risk of Colorectal Cancer in Postmenopausal Women. Cancer Epidemiol Biomarkers Prev 2018; 28:392-399. [PMID: 30464021 DOI: 10.1158/1055-9965.epi-18-0412] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/09/2018] [Accepted: 11/06/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Despite considerable biological plausibility, other than for calcium, there are few reported epidemiologic studies on mineral intake-colorectal cancer associations, none of which investigated multiple minerals in aggregate. METHODS Accordingly, we incorporated 11 minerals into a mineral score and investigated its association with incident colorectal cancer in the Iowa Women's Health Study, a prospective cohort study of 55- to 69-year-old women who completed a food frequency questionnaire in 1986. In the analytic cohort (n = 35, 221), 1,731 incident colorectal cancer cases were identified via the State Health Registry of Iowa. Participants' calcium, magnesium, manganese, zinc, selenium, potassium, and iodine intakes were ranked 1 to 5, with higher ranks indicating higher, potentially anticarcinogenic, intakes, whereas for iron, copper, phosphorus, and sodium intakes, the rankings were reversed to account for their possible procarcinogenic properties. The rankings were summed to create each woman's mineral score. The mineral score-incident colorectal cancer association was estimated using multivariable Cox proportional hazards regression. RESULTS There was decreasing risk with an increasing score (P trend = 0.001). The hazard ratios and 95% confidence intervals (CI) for those in mineral score quintiles 2 to 5 relative to those in the lowest were 0.91 (CI, 0.88-1.08), 0.85 (CI, 0.75-0.95), 0.86 (CI, 0.75-0.97), and 0.75 (CI, 0.71-0.95), respectively. CONCLUSIONS Our findings suggest that a predominance of putative anti- relative to pro-colorectal carcinogenic mineral intakes may be inversely associated with colorectal cancer risk. IMPACT These results support further investigation of colorectal cancer etiology using composite mineral intake scores.
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Affiliation(s)
- Samyukta Swaminath
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Caroline Y Um
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Anna E Prizment
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota.,Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - DeAnn Lazovich
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota.,Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Roberd M Bostick
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia. .,Winship Cancer Institute, Emory University, Atlanta, Georgia
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30
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Barry EL, Lund JL, Westreich D, Mott LA, Ahnen DJ, Beck GJ, Bostick RM, Bresalier RS, Burke CA, Church TR, Rees JR, Robertson DJ, Baron JA. Body mass index, calcium supplementation and risk of colorectal adenomas. Int J Cancer 2018; 144:448-458. [PMID: 30117164 DOI: 10.1002/ijc.31803] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/25/2018] [Accepted: 07/27/2018] [Indexed: 12/20/2022]
Abstract
Calcium supplementation (1,200 mg/day) did not significantly reduce colorectal adenomas in our recent randomized, controlled trial (Vitamin D/Calcium Polyp Prevention Study, VCPPS, 2004-2013) in contrast to our previous trial (Calcium Polyp Prevention Study, CPPS, 1988-1996). To reconcile these findings, we identified participant characteristics that differed between the study populations and modified the effect of calcium supplementation on adenomas or high-risk findings (advanced or multiple adenomas). Compared to the CPPS, more participants in the VCPPS were obese (body mass index (BMI) ≥30 kg/m2 ; 37.5% vs. 24.4%) and fewer had normal BMI (BMI <25 kg/m2 ; 18.5% vs. 31%). BMI appeared to modify the effect of calcium supplementation on adenomas and especially on high risk-findings: in the VCPPS, there was a 44% reduction in high-risk findings among individuals whose BMI was normal (RR = 0.56, 95% CI = 0.26-1.23), but not among overweight (RR = 1.09, 95% CI = 0.62-1.91) or obese (RR = 1.54, 95% CI = 0.92-2.57) individuals (pinteraction = 0.03). Similarly, in the CPPS, there was a 56% reduction in high-risk findings among individuals whose BMI was normal (RR = 0.44, 95% CI = 0.26-0.74), but not among overweight (RR = 0.87, 95% CI = 0.55-1.39) or obese (RR = 1.02, 95% CI = 0.57-1.82) individuals (pinteraction = 0.02). Standardization of each trial's findings to the BMI distribution in the other attenuated calcium's protective effect on adenomas in the CPPS but enhanced it in the VCPPS. In conclusion, 1,200 mg/day calcium supplementation may reduce risk of colorectal adenomas among those with normal BMI but not in overweight or obese individuals; and differences in BMI distribution partially account for the apparent difference in calcium efficacy between the two trials.
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Affiliation(s)
- Elizabeth L Barry
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Jennifer L Lund
- Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Public Health, Chapel Hill, NC
| | - Daniel Westreich
- Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Public Health, Chapel Hill, NC
| | - Leila A Mott
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Dennis J Ahnen
- Division of Gastroenterology and Hepatology, University of Colorado School of Medicine, Denver, CO
| | - Gerald J Beck
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Roberd M Bostick
- Department of Epidemiology, Rollins School of Public Health, Emory University and Winship Cancer Institute, Atlanta, GA
| | - Robert S Bresalier
- Department of Gastroenterology, Hepatology, and Nutrition, University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - Carol A Burke
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH
| | - Timothy R Church
- Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, MN
| | - Judy R Rees
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Douglas J Robertson
- VA Medical Center, White River Junction, VT and Geisel School of Medicine at Dartmouth, Hanover, NH
| | - John A Baron
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH.,Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Public Health, Chapel Hill, NC.,Department of Medicine, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, NC
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Abstract
INTRODUCTION Consumption of nuts, which contain multiple anti-carcinogenic components, has been inversely associated with colorectal cancer (CRC), particularly among women, but has not been investigated in relation to colorectal adenoma, the immediate precursor to most CRCs. METHODS We pooled data from three case-control studies of incident, sporadic colorectal adenoma (n = 785 cases, 2107 controls) in which dietary intakes were assessed using food frequency questionnaires, and analyzed the data using multivariable unconditional logistic regression. RESULTS Among men and women combined, the multivariable-adjusted odds ratios (OR) and 95% confidence intervals (CI) for the association of total nut product (all nuts and peanut butter combined) intakes, for those who consumed 0.5-1.5, 2.0-5.5, and ≥6 servings/week relative to no nut consumption were 0.81 (0.58, 1.12), 0.86 (0.61, 1.23), and 0.93 (0.65, 1.31), respectively. However, among women, the corresponding ORs and 95% CIs were 0.62 (0.40, 0.97), 0.57 (0.35, 0.94), and 0.78 (0.48, 1.25), respectively. CONCLUSIONS These results suggest that moderate nut consumption may be associated with lower risk for colorectal adenoma, primarily among women.
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Affiliation(s)
- Xin Yin
- a Department of Epidemiology , Emory University , Atlanta , Georgia , USA
| | - Roberd M Bostick
- a Department of Epidemiology , Emory University , Atlanta , Georgia , USA.,b Winship Cancer Institute, Emory University , Atlanta , Georgia , USA
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Hodge R, Mandle HB, Ray S, Tandon S, Peterson M, Henry A, Jahan FA, Bostick RM, Baron JA, Barry EL, Yacoub R, Rutherford RE, Seabrook ME, Fedirko V. Effects of Supplemental Calcium and Vitamin D on Expression of Toll-Like Receptors and Phospho-IKKα/β in the Normal Rectal Mucosa of Colorectal Adenoma Patients. Cancer Prev Res (Phila) 2018; 11:707-716. [PMID: 30209117 DOI: 10.1158/1940-6207.capr-18-0123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/19/2018] [Accepted: 08/28/2018] [Indexed: 02/06/2023]
Abstract
Chronic inflammation in the colorectum, a significant contributor to colorectal carcinogenesis, can be triggered by the activation of proinflammatory signaling pathways such as those initiated by Toll-like receptors (TLR) and nuclear factor κB (NF-κB). Although experimental evidence supports calcium and vitamin D potentially modifying these proinflammatory pathways in the colorectum, human data in these regards are scarce. We investigated supplemental calcium (1,200 mg daily) and/or vitamin D3 (1,000 IU daily) effects on inflammatory signaling pathway-related biomarkers in a subset of 105 participants from a colorectal adenoma recurrence chemoprevention clinical trial. We assessed expression of TLR4 and TLR5, which recognize the bacterial components lipopolysaccharides and flagellin, respectively, and phospho-IKKα/β (pIKKα/β), a biomarker of inflammation, in the normal-appearing rectal crypt epithelium and stroma using standardized, automated immunohistochemistry and quantitative image analysis. Following 1 year of treatment, TLR4, TLR5, and pIKKα/β expression in the rectal mucosa did not statistically significantly change with vitamin D or calcium supplementation, taken alone or in combination. Several baseline participant characteristics, including body mass index, history of sessile serrated adenomas, high red/processed meat intake, and high levels of rectal epithelial cell proliferation (as measured by MIB-1/Ki-67), were associated with higher baseline expression of TLRs or pIKKα/β. Our findings suggest that vitamin D and calcium may have no substantial effect on the investigated biomarkers. However, several modifiable lifestyle factors may be associated with TLRs and pIKKα/β expression in the normal rectal mucosa, supporting their future investigation as potentially treatable, preneoplastic risk factors for colorectal neoplasms. Cancer Prev Res; 11(11); 707-16. ©2018 AACR.
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Affiliation(s)
- Rebecca Hodge
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Hannah B Mandle
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Stephen Ray
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Sonia Tandon
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Meaghan Peterson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Abigail Henry
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Ferdous A Jahan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Roberd M Bostick
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.,Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - John A Baron
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Elizabeth L Barry
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Rami Yacoub
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Robin E Rutherford
- Division of Digestive Diseases, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | | | - Veronika Fedirko
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia. .,Winship Cancer Institute, Emory University, Atlanta, Georgia
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Abdulla KA, Um CY, Gross MD, Bostick RM. Circulating γ-Tocopherol Concentrations Are Inversely Associated with Antioxidant Exposures and Directly Associated with Systemic Oxidative Stress and Inflammation in Adults. J Nutr 2018; 148:1453-1461. [PMID: 30184224 PMCID: PMC6669952 DOI: 10.1093/jn/nxy132] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/31/2018] [Indexed: 12/21/2022] Open
Abstract
Background Although α- and γ-tocopherol are co-consumed antioxidants, circulating γ-tocopherol concentrations were paradoxically found to be inversely associated with total vitamin E intake and circulating α-tocopherol concentrations. There are limited data on this apparent paradox or on determinants of circulating γ-tocopherol concentrations. Objective To help clarify possible determinants of circulating γ-tocopherol concentrations, we investigated associations of circulating γ-tocopherol concentrations with various dietary and lifestyle factors and biomarkers of oxidative stress and inflammation. Methods We pooled cross-sectional data from 2 outpatient, adult, elective colonoscopy populations (pooled n = 419) on whom extensive dietary, lifestyle, and medical information was collected, and the following plasma concentrations were measured: α- and γ-tocopherol (via HPLC), F2-isoprostanes (FiPs; via gas chromatography-mass spectrometry), and high-sensitivity C-reactive protein (hsCRP; via latex-enhanced immunonephelometry). Multivariable general linear models were used to assess mean γ-tocopherol differences across quantiles of plasma antioxidant micronutrients, FiPs, and hsCRP; an oxidative balance score [OBS; a composite of anti- and pro-oxidant dietary and lifestyle exposures (a higher score indicates higher antioxidant relative to pro-oxidant exposures)]; and multiple dietary and lifestyle factors. Results Adjusted for serum total cholesterol, mean γ-tocopherol concentrations among those in the highest relative to the lowest tertiles of circulating α-tocopherol and β-carotene, the OBS, and total calcium and dietary fiber intakes were 31.0% (P < 0.0001), 29.0% (P < 0.0001), 27.6% (P = 0.0001), 29.7% (P < 0.0001), and 18.6% (P = 0.008) lower, respectively. For those in the highest relative to the lowest tertiles of circulating FiPs and hsCRP, mean γ-tocopherol concentrations were 50% (P < 0.0001) and 39.0% (P < 0.0001) higher, respectively. Conclusions These findings support the conclusion that circulating γ-tocopherol concentrations are inversely associated with antioxidant exposures and directly associated with systemic oxidative stress and inflammation in adults. Additional research on possible mechanisms underlying these findings and on whether circulating γ-tocopherol may serve as a biomarker of oxidative stress, inflammation, or both is needed.
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Affiliation(s)
- Kennadiid A Abdulla
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Caroline Y Um
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Myron D Gross
- Department of Laboratory Medicine and Pathology, School of Medicine, University of Minnesota, Minneapolis, MN
| | - Roberd M Bostick
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA,Winship Cancer Institute, Emory University, Atlanta, GA,Address correspondence to RMB (e-mail: )
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Gibbs DC, Fedirko V, Um C, Gross MD, Thyagarajan B, Bostick RM. Associations of Circulating 25-Hydroxyvitamin D3 Concentrations With Incident, Sporadic Colorectal Adenoma Risk According to Common Vitamin D-Binding Protein Isoforms. Am J Epidemiol 2018; 187:1923-1930. [PMID: 29788105 DOI: 10.1093/aje/kwy102] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 04/30/2018] [Indexed: 02/06/2023] Open
Abstract
Concentration of 25-hydroxyvitamin D3 (25(OH)D3), the main circulating form of vitamin D, is inversely associated with incident, sporadic colorectal adenoma risk. We investigated whether this association differs by 2 functional variants in the vitamin D-binding protein (DBP) gene, group-specific component (GC), that encode for common protein isoforms Gc1s, Gc1f, and Gc2 linked to differences in vitamin D metabolism. We pooled data (418 patients with adenoma and 524 polyp-free control subjects) from 3 colonoscopy-based case-control studies (Minnesota, 1991-1994; North Carolina, 1994-1997; South Carolina, 2002). We estimated 25(OH)D3-adenoma associations, stratified by DBP isoforms, using multivariable logistic regression. Higher 25(OH)D3 concentrations were inversely associated with colorectal adenoma risk among those with the Gc2 isoform (per 10-ng/mL increase in 25(OH)D3, odds ratio = 0.71, 95% confidence interval: 0.56, 0.90), but not among those with only Gc1 isoforms (odds ratio = 1.07, 95% confidence interval: 0.87, 1.32; P for interaction = 0.03). Thus, the vitamin D-incident, sporadic colorectal adenoma association may differ by common DBP isoforms, and patients with the Gc2 isoform may particularly benefit from maintaining higher circulating 25(OH)D3 concentrations for adenoma prevention.
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Affiliation(s)
- David C Gibbs
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Veronika Fedirko
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Caroline Um
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Myron D Gross
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Bharat Thyagarajan
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Roberd M Bostick
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Winship Cancer Institute, Emory University, Atlanta, Georgia
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35
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Cheng E, Um CY, Prizment AE, Lazovich D, Bostick RM. Evolutionary-Concordance Lifestyle and Diet and Mediterranean Diet Pattern Scores and Risk of Incident Colorectal Cancer in Iowa Women. Cancer Epidemiol Biomarkers Prev 2018; 27:1195-1202. [PMID: 30108096 DOI: 10.1158/1055-9965.epi-17-1184] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 04/18/2018] [Accepted: 07/31/2018] [Indexed: 01/13/2023] Open
Abstract
Background: Whereas diet and lifestyle are strongly implicated in the etiology of colorectal cancer, single exposures generally are weakly and inconsistently associated with the disease. Exposure patterns may be more helpful for investigating diet and lifestyle-colorectal cancer associations. Evolutionary-concordance diet and Mediterranean diet pattern scores were previously found to be inversely associated with colorectal adenoma.Methods: To investigate associations of these diet scores and an evolutionary-concordance lifestyle score (comprising smoking status, physical activity, and body mass index) with incident colorectal cancer, we analyzed data from the prospective Iowa Women's Health Study. Diet and lifestyle scores were calculated for each participant and categorized into quintiles, and associations estimated using Cox proportional hazards models.Results: Of the 35,221 55- to 69-year-old cancer-free women at baseline, 1,731 developed colorectal cancer during follow-up. The multivariable-adjusted HR comparing persons in the highest relative to the lowest quintile of the lifestyle score was 0.66 (95% confidence interval, 0.56-0.78; P trend < 0.01). Although the estimated associations of the evolutionary-concordance diet and Mediterranean diet scores alone with colorectal cancer were null, relative to those in the lowest tertiles of both the evolutionary-concordance diet and lifestyle scores, those in the highest tertiles of both scores were at the lowest risk (P interaction < 0.01).Conclusions: Our findings suggest that a more evolutionary-concordant lifestyle, alone and in interaction with a more evolutionary-concordant diet pattern, may be inversely associated with colorectal cancer risk.Impact: These results support further investigation of colorectal cancer etiology using evolutionary-concordance dietary and lifestyle pattern scores. Cancer Epidemiol Biomarkers Prev; 27(10); 1195-202. ©2018 AACR.
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Affiliation(s)
- En Cheng
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Caroline Y Um
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Anna E Prizment
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota.,Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - DeAnn Lazovich
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota.,Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Roberd M Bostick
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia. .,Winship Cancer Institute, Emory University, Atlanta, Georgia
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Byrd D, Bostick RM. Abstract LB-163: Associations of whole food and lifestyle-based inflammation scores with incident, sporadic colorectal adenoma. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-lb-163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Colorectal carcinogenesis is mechanistically linked to inflammation, and is highly associated with diet and other lifestyle factors, which in turn can act as sources of chronic inflammation. We developed dietary (DIS), lifestyle (LIS), and overall (OIS) inflammation scores to characterize the aggregate of pro- and anti-inflammatory exposures, and investigated associations of the scores with incident, sporadic colorectal adenoma.
Based on previous literature, we selected a priori 20 components for the DIS, including processed meats, red meats, white meats, fish, nuts, legumes, soy, dairy products, grains, added sugars, saturated/trans fats, leafy greens, citrus, deep-orange/yellow vegetables, cabbage family vegetables, apples/berries, and tomatoes/tomato products. Similarly, for the LIS we selected smoking status, physical activity, alcohol intake, and body mass index. We assessed associations of each score component with a panel of biomarkers of inflammation (CRP, IL-6, IL-8, IL-10) in a subset of 1,101 male and female, black and white participants in the Reasons for Geographic and Racial Differences in Stroke cohort study using multivariable linear regression. The resulting beta coefficients were used to weight each score component.
We used previously collected data from three pooled case-control studies of colorectal adenoma (N = 787 cases and 2,033 controls) in which extensive dietary (via Willett food frequency questionnaires), medical, and lifestyle data were collected. For each study participant, the weighted score components were summed to produce the scores such that a higher score reflected a higher balance of pro- to anti-inflammatory exposures. The scores were categorized according to quintiles of their distributions among the controls, and their associations with adenoma were assessed using unconditional logistic regression.
With increasing levels of each score, there was increasing risk of incident, sporadic adenoma. For those in the highest relative to the lowest quintiles of the DIS, LIS, and OIS, the multivariable-adjusted odds ratios (OR) were 1.4 (95% confidence interval [CI]: 1.0, 1.9; Ptrend = 0.02), 1.9 (95% CI: 1.4, 2.5; Ptrend <0.0001), and 2.6 (95% CI: 1.8, 3.9; Ptrend = <0.0001) respectively. Among those who were overweight/obese or men, the ORs comparing those in the highest relative to the lowest quintile of the DIS were, respectively, 1.8 (95% CI: 1.2, 2.6; Ptrend = 0.003) and 1.8 (95% 1.2, 2.7; Ptrend = 0.007).
These results suggest that diets and lifestyles with a higher balance of pro- to anti-inflammatory exposures may be associated with higher risk for incident, sporadic colorectal adenoma.
Citation Format: Doratha Byrd, Roberd M. Bostick. Associations of whole food and lifestyle-based inflammation scores with incident, sporadic colorectal adenoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr LB-163.
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Thyagarajan B, Guan W, Fedirko V, Barcelo H, Ramasubramaian R, Gross M, Goodman M, Bostick RM. Associations of mitochondrial polymorphisms with sporadic colorectal adenoma. Mol Carcinog 2018; 57:598-605. [PMID: 29323753 DOI: 10.1002/mc.22783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 01/09/2018] [Indexed: 11/12/2022]
Abstract
Somatic mutations in mitochondrial DNA have been reported in colorectal adenomatous polyps (adenomas), the precursors to most colorectal cancers. However, there are no reports of associations of germline variation in mitochondrial DNA with adenoma risk. We investigated associations of germline polymorphisms in the displacement loop (D-loop) and non-D-loop region of the mitochondrial genome with incident, sporadic colorectal adenoma in three pooled colonoscopy-based case-control studies (n = 327 adenoma cases, 420 controls) that used identical methods for case and risk factor ascertainment. We sequenced a 1124 bp fragment to identify all genetic variation in the mitochondrial D-loop region, and used the Sequenom platform to genotype 64 tagSNPs in the non-D-loop region. We used multivariable unconditional logistic regression to estimate associations of the polymorphisms with adenoma. The odds ratios (OR) for associations of four polymorphisms in the HV1 region (mt16294, mt16296, mt16278, mt16069) with adenoma were 2.30, 2.63, 3.34, and 0.56, respectively; all 95% confidence intervals (CI) excluded 1.0, however, after correction for multiple comparisons, none of the findings remained statistically significant. Similar results were found for six polymorphisms in the non-D-loop region. In the HV1 region poly C tract, relative to those with 5 repeats, the ORs for those with fewer or more repeats were, respectively, 2.29 (95%CI 1.07-4.89) and 0.63 (95%CI 0.36-1.08), but repeat numbers in the HV2 region were not associated with adenoma. These findings suggest that mitochondrial D-loop HV1 region polymorphisms may be associated with colorectal adenoma risk and support further investigation.
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Affiliation(s)
- Bharat Thyagarajan
- Department of Laboratory Medicine and Pathology, Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Weihua Guan
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Veronika Fedirko
- Department of Epidemiology, Rollins School of Public Health, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Helene Barcelo
- Department of Laboratory Medicine and Pathology, Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Ramya Ramasubramaian
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Myron Gross
- Department of Laboratory Medicine and Pathology, Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Roberd M Bostick
- Department of Epidemiology, Rollins School of Public Health, Winship Cancer Institute, Emory University, Atlanta, Georgia
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Qayed E, Vora R, Levy S, Bostick RM. Colonoscopy procedural volume increases adenoma and polyp detection rates in gastroenterologytrainees. World J Gastrointest Endosc 2017; 9:540-551. [PMID: 29184610 PMCID: PMC5696606 DOI: 10.4253/wjge.v9.i11.540] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 07/20/2017] [Accepted: 08/15/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate changes in polyp detection throughout fellowship training, and estimate colonoscopy volume required to achieve the adenoma detection rate (ADRs) and polyp detection rate (PDRs) of attending gastroenterologists.
METHODS We reviewed colonoscopies from July 1, 2009 to June 30, 2014. Fellows’ procedural logs were used to retrieve colonoscopy procedural volumes, and these were treated as the time variable. Findings from screening colonoscopies were used to calculate colonoscopy outcomes for each fellow for the prior 50 colonoscopies at each time point. ADR and PDR were plotted against colonoscopy procedural volumes to produce individual longitudinal graphs. Repeated measures linear mixed effects models were used to study the change of ADR and PDR with increasing procedural volume.
RESULTS During the study period, 12 fellows completed full three years of training and were included in the analysis. The average ADR and PDR were, respectively, 31.5% and 41.9% for all fellows, and 28.9% and 38.2% for attendings alone. There was a statistically significant increase in ADR with increasing procedural volume (1.8%/100 colonoscopies, P = 0.002). Similarly, PDR increased 2.8%/100 colonoscopies (P = 0.0001), while there was no significant change in advanced ADR (0.04%/100 colonoscopies, P = 0.92). The ADR increase was limited to the right side of the colon, while the PDR increased in both the right and left colon. The adenoma per colon and polyp per colon also increased throughout training. Fellows reached the attendings’ ADR and PDR after 265 and 292 colonoscopies, respectively.
CONCLUSION We found that the ADR and PDR increase with increasing colonoscopy volume throughout fellowship. Our findings support recent recommendations of ≥ 275 colonoscopies for colonoscopy credentialing.
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Affiliation(s)
- Emad Qayed
- Department of Medicine, Division of Digestive diseases, Emory University School of Medicine, Atlanta, GA 30303, United States
- Grady Memorial Hospital, Atlanta, GA 30303, United States
| | - Ravi Vora
- Department of Medicine, Division of Digestive diseases, Emory University School of Medicine, Atlanta, GA 30303, United States
| | - Sara Levy
- Department of Medicine, Division of Digestive diseases, Emory University School of Medicine, Atlanta, GA 30303, United States
| | - Roberd M Bostick
- Emory University Rollins School of Public Health, Department of Epidemiology, Atlanta, GA 30303, United States
- Emory University, Winship Cancer Institute Atlanta, GA 30303, United States
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Um CY, Judd SE, Flanders WD, Fedirko V, Bostick RM. Associations of Calcium and Dairy Products with All-Cause and Cause-Specific Mortality in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Prospective Cohort Study. Nutr Cancer 2017; 69:1185-1195. [PMID: 29125314 PMCID: PMC6145131 DOI: 10.1080/01635581.2017.1367946] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Associations of calcium and dairy product intakes with cardiovascular disease risk and cancer mortality are controversial. We investigated associations of calcium and dairy product intakes with mortality in the prospective REasons for Geographic and Racial Differences in Stroke study (n = 30,239). Of 2,966 total deaths, 32.3% were from CVD and 28.8% from cancer. For those in the upper relative to the lowest quintile of intakes, from Cox proportional hazards regression models, the multivariable-adjusted hazard ratios (HRs) for all-cause mortality were 1.13 (95% confidence intervals [CI] 0.95-1.35; P-trend 0.004) for whole milk, and 0.75 (CI 0.61-0.93; P-trend 0.001) for nonfat milk; for CVD mortality the corresponding HRs were 0.80 (CI 0.55-1.16; P-trend 0.80) and 0.72 (CI 0.49-1.05; P-trend 0.06); and for cancer mortality they were 1.56 (CI 1.17-2.08; P-trend 0.006) and 0.89 (CI 0.62-1.28; P-trend 0.86). Calcium (total, dietary, supplemental) and total dairy product intakes were not associated with all-cause, cardiovascular, or cancer mortality. These results suggest that whole milk consumption may be directly associated with cancer mortality; non-fat milk consumption may be inversely associated with all-cause and cardiovascular- and cancer-specific mortality; and calcium intake independent of milk product intakes may not be associated with mortality.
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Affiliation(s)
- Caroline Y. Um
- Nutrition and Health Sciences Graduate Program, Emory University, Atlanta, GA
| | - Suzanne E. Judd
- Nutrition and Health Sciences Graduate Program, Emory University, Atlanta, GA
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham AL
| | - W. Dana Flanders
- Department of Epidemiology, Emory University, Atlanta, GA
- Winship Cancer Institute, Emory University, Atlanta, GA
| | - Veronika Fedirko
- Nutrition and Health Sciences Graduate Program, Emory University, Atlanta, GA
- Department of Epidemiology, Emory University, Atlanta, GA
- Winship Cancer Institute, Emory University, Atlanta, GA
| | - Roberd M. Bostick
- Nutrition and Health Sciences Graduate Program, Emory University, Atlanta, GA
- Department of Epidemiology, Emory University, Atlanta, GA
- Winship Cancer Institute, Emory University, Atlanta, GA
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Eldridge RC, Goodman M, Bostick RM, Fedirko V, Gross M, Thyagarajan B, Flanders WD. A Novel Application of Structural Equation Modeling Estimates the Association between Oxidative Stress and Colorectal Adenoma. Cancer Prev Res (Phila) 2017; 11:52-58. [PMID: 29074536 DOI: 10.1158/1940-6207.capr-17-0183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/18/2017] [Accepted: 10/20/2017] [Indexed: 01/12/2023]
Abstract
In vitro evidence implicates oxidative stress in many adverse health conditions, including colorectal neoplasia. In human studies, however, oxidative stress is measured by imperfect biomarkers, which are inconsistently associated with health outcomes. Structural equation modeling (SEM) offers one possible solution by modeling a latent (unobserved) construct from multiple biomarkers. Our goal was to investigate the association of a latent oxidative stress variable with colorectal adenoma. Using SEM, we analyzed pooled data from two cross-sectional studies of colorectal adenoma (n = 526) that measured five plasma biomarkers of oxidative stress and inflammation that comprised the latent oxidative stress variable: F2-isoprostanes (FIP), fluorescent oxidation products (FOP), mitochondrial DNA (MtDNA) copy number, γ-tocopherol (Gtoc), and C-reactive protein (CRP). Higher levels of oxidative stress were associated with colorectal adenoma [OR = 3.23 per SD increase in oxidative stress; 95% confidence interval (CI), 1.28-8.18]. The latent variable estimate was considerably stronger than the associations of adenoma with the individual biomarkers, which were modest and mostly nonsignificant. Risk factors were associated with adenoma via the oxidative stress pathway, particularly overweight and obesity with an OR = 1.50; 95% CI, 1.10-2.81; and OR = 2.95; 95% CI, 1.28-12.45, respectively. Oxidative stress may be positively associated with colorectal adenoma, and important risk factors may act through this mechanism, but the cross-sectional design of the current study precludes observing the directionality of associations. The presence of an adenoma could affect levels of the circulating biomarkers; thus, we should be cautious of strong conclusions until the findings are replicated in a follow-up study. Cancer Prev Res; 11(1); 52-58. ©2017 AACR.
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Affiliation(s)
- Ronald C Eldridge
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
| | - Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Roberd M Bostick
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.,Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Veronika Fedirko
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Myron Gross
- Department of Laboratory Medicine and Pathology, Epidemiology & Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Bharat Thyagarajan
- Department of Laboratory Medicine and Pathology, Epidemiology & Community Health, University of Minnesota, Minneapolis, Minnesota
| | - W Dana Flanders
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.,Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Barry EL, Peacock JL, Rees JR, Bostick RM, Robertson DJ, Bresalier RS, Baron JA. Vitamin D Receptor Genotype, Vitamin D3 Supplementation, and Risk of Colorectal Adenomas: A Randomized Clinical Trial. JAMA Oncol 2017; 3:628-635. [PMID: 27978548 DOI: 10.1001/jamaoncol.2016.5917] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance Despite epidemiological and preclinical evidence suggesting that vitamin D and calcium inhibit colorectal carcinogenesis, daily supplementation with these nutrients for 3 to 5 years was not found to significantly reduce the risk of recurrent colorectal adenomas in a recent randomized clinical trial. Objective To investigate whether common variants in 7 vitamin D and calcium pathway genes (VDR, GC, DHCR7, CYP2R1, CYP27B1, CYP24A1, and CASR) modify the effects of vitamin D3 or calcium supplementation on colorectal adenoma recurrence. Design, Setting, and Participants We examined 41 candidate single-nucleotide polymorphisms (SNPs) in 2259 participants in a randomized, double-blind, placebo-controlled trial conducted at 11 clinical centers in the United States. Eligibility criteria included a recently diagnosed adenoma and no remaining colorectal polyps after complete colonoscopy. The study's treatment phase ended on August 31, 2013, and the analysis for the present study took place from July 28, 2014, to October 19, 2016. Interventions Daily oral supplementation with vitamin D3 (1000 IU) or calcium carbonate (1200 mg elemental calcium) or both or neither. Main Outcomes and Measures The outcomes assessed were the occurrence of 1 or more adenomas or advanced adenomas (estimated diameter, ≥1 cm; or with villous histologic findings, high-grade dysplasia, or cancer) during follow-up. Treatment effects and genotype associations and interactions were estimated as adjusted risk ratios (RRs) and 95% confidence intervals (CIs). The effective number of independent SNPs was calculated to correct for multiple testing. Results Among the 2259 participants randomized, 1702 were non-Hispanic whites who completed the trial and had genotype data for analysis (1101 men; mean [SD] age 58.1 [6.8] years). The effect of vitamin D3 supplementation on advanced adenomas, but not on adenoma risk overall, significantly varied according to genotype at 2 VDR SNPs (rs7968585 and rs731236) in linkage disequilibrium (D' = 0.98; r2 = 0.6). For rs7968585, among individuals with the AA genotype (26%), vitamin D3 supplementation reduced risk by 64% (RR, 0.36; 95% CI, 0.19-0.69; P = .002; absolute risk decreased from 14.4% to 5.1%). Among individuals with 1 or 2 G alleles (74%), vitamin D3 supplementation increased risk by 41% (RR, 1.41; 95% CI, 0.99-2.00; P = .05; absolute risk increased from 7.7% to 11.1%; P < .001 for interaction). There were no significant interactions of genotypes with calcium supplementation. Conclusions and Relevance Our findings suggest that benefits from vitamin D3 supplementation for the prevention of advanced colorectal adenomas may vary according to vitamin D receptor genotype. Trial Registration clinicaltrials.gov Identifier: NCT00153816.
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Affiliation(s)
- Elizabeth L Barry
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Janet L Peacock
- Division of Health and Social Care Research, King's College London, London, England
| | - Judy R Rees
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Roberd M Bostick
- Rollins School of Public Health, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | | | - Robert S Bresalier
- Department of Gastroenterology, The University of Texas MD Anderson Cancer Center, Houston
| | - John A Baron
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire6Department of Medicine, University of North Carolina School of Medicine, Chapel Hill
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Mujtaba S, Bostick RM. Abstract 2302: Differences in risk factor-colorectal adenoma associations according to non-steroidal anti-inflammatory drug use. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-2302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Multiple observational studies and large, randomized controlled trials indicate that non-steroidal anti-inflammatory drugs (NSAIDs) strongly reduce risk for colorectal neoplasms. The strengths of these findings suggest that NSAIDs may so mask various risk factor-colorectal neoplasm associations, that they may be undetectable among NSAID users. Temporal changes and between-population differences in regular NSAID use prevalence may account for some of the inconsistencies in reported findings for risk factor-colorectal neoplasm associations. We investigated whether associations of known colorectal cancer risk factors with colorectal adenoma differed by non-aspirin NSAID use using pooled data from 3 colonoscopy-based case-control studies of incident, sporadic colorectal adenoma conducted in Minnesota, North Carolina, and South Carolina between 1991 and 2002. Participants (n=789 cases, 2,035 polyp-free controls) provided risk factor data prior to colonoscopy. The multivariable-adjusted odds ratios (OR) (95% confidence intervals [CI]) for those in the highest relative to the lowest quartiles of exposure, by regular non-aspirin NSAID non-use/use, respectively, were 1.57 (CI 0.96, 2.55) vs. 1.22 (CI 0.40, 3.70) for total fat, 1.37 (CI 0.86, 2.18) vs. 0.78 (CI 0.26, 2.35) for saturated fat, 0.92 (CI 0.67, 1.26) vs. 1.31 (CI 0.62, 2.76) for total calcium, 0.88 (CI 0.64, 1.22) vs. 1.38 (CI 0.65, 2.93) for total fruits and vegetables, 1.05 (CI 0.73, 1.50) vs. 0.73 (CI 0.33, 1.62) for red and processed meats, and 0.84 (CI 0.65, 1.10) vs. 0.97 (CI 0.54,1.75) for physical activity. For current smokers relative to never smokers, the ORs (CIs) among regular non-NSAID users/non-users were 2.88 (CI 2.20, 3.77) vs. 1.64 (CI 0.85, 3.17), respectively, and for those who were obese relative to those who were normal weight, they were 1.65 (CI 1.27, 2.16) vs. 1.20 (CI 0.70, 2.04). The associations of age, height, and intakes of alcohol, dietary fiber, and total folate with adenoma did not substantially differ according to NSAID use.
These findings suggest that regular non-aspirin NSAID use may mask, beyond simple confounding, associations of various risk factors with colorectal adenoma, suggesting that differential proportions of regular NSAID users between study populations may explain some inconsistencies in reported risk factor-colorectal neoplasm associations, and support routinely assessing such associations stratified by regular non-aspirin NSAID use.
Citation Format: Sobia Mujtaba, Roberd M. Bostick. Differences in risk factor-colorectal adenoma associations according to non-steroidal anti-inflammatory drug use [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 2302. doi:10.1158/1538-7445.AM2017-2302
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Tu H, Sun L, Dong X, Gong Y, Xu Q, Jing J, Bostick RM, Wu X, Yuan Y. Abstract 5304: A serological biopsy using five stomach-specific circulating biomarkers for gastric cancer risk assessment: a multi-phase study. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-5304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Objective: We aimed to assess a serological biopsy using five stomach-specific circulating biomarkers—pepsinogen I (PGI), PGII, PGI/II ratio, anti-Helicobacter pylori (H. pylori) antibody, and gastrin-17 (G-17)—for identifying high-risk individuals and predicting risk of developing gastric cancer (GC).
Methods: Among 12112 participants with prospective follow-up from an ongoing population-based screening program using both serology and gastroscopy in China, we conducted a multi-phase study involving a cross-sectional analysis, a follow-up analysis, and an integrative risk prediction modeling analysis.
Results: In the cross-sectional analysis, the five biomarkers (especially PGII, the PGI/II ratio, and H. pylori sero-positivity) were associated with the presence of precancerous gastric lesions or GC at enrollment. In the follow-up analysis, low PGI levels and PGI/II ratios were associated with higher risk of developing GC, and both low (<0.5 pmol/L) and high (2.0-4.7 or >4.7 pmol/L) G-17 levels were associated with higher risk of developing GC, suggesting a J-shaped association. In the risk prediction modeling analysis, the five biomarkers combined yielded a C statistic of 0.801 (95% CI=0.787-0.815) and improved prediction beyond traditional risk factors (C statistic from 0.580 to 0.811, P<0.001) for identifying precancerous lesions at enrollment, and higher serological biopsy score based on the five biomarkers at enrollment were associated with higher risk of developing GC during follow-up (P for trend <0.001).
Conclusions: A serological biopsy composed of the five stomach-specific circulating biomarkers could be used to identify high-risk individuals for further diagnostic gastroscopy, and to stratify individuals’ risk of developing GC and thus to guide targeted screening/precision prevention.
Citation Format: Huakang Tu, Liping Sun, Xiao Dong, Yuehua Gong, Qian Xu, Jingjing Jing, Roberd M. Bostick, Xifeng Wu, Yuan Yuan. A serological biopsy using five stomach-specific circulating biomarkers for gastric cancer risk assessment: a multi-phase study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5304. doi:10.1158/1538-7445.AM2017-5304
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Affiliation(s)
- Huakang Tu
- 1University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Xiao Dong
- 3The University of Texas School of Biomedical Informatics at Houston, TX
| | | | - Qian Xu
- 2China Medical University, China
| | | | | | - Xifeng Wu
- 1University of Texas MD Anderson Cancer Center, Houston, TX
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Byrd D, Holmes A, Judd S, Flanders WD, Bostick RM. Abstract 3287: Associations of whole food and lifestyle-based inflammation scores with all-cause, cancer- and cardiovascular disease-specific mortality. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-3287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Chronically higher levels of inflammation have been implicated in the etiology of cancer and other major chronic diseases. Contributors to chronic inflammation likely include diet, physical activity, obesity, and smoking. We developed dietary (DIS), lifestyle (LIS), and overall (OIS) inflammation scores to characterize the aggregate of pro- and anti-inflammatory exposures, and investigated associations of the scores with all-cause, cancer- and cardiovascular disease (CVD)-specific mortality in the prospective Reasons for Geographic and Racial Differences in Stroke Study (REGARDS) (n=21,426). The components of the scores were selected based on biological plausibility and previous literature. The dietary components included processed meats, red meat, white meat, fish, nuts, legumes, coffee, tea, dairy products, refined and whole grains, and nine other botanical categories. The lifestyle components included body mass index, smoking status, alcohol intake, and exercise level. Associations of each score component with a panel of biomarkers of inflammation in a subset of 577 male and female, black and white, chronic disease-free participants in REGARDS were assessed using multivariable linear regression, and the resulting beta coefficients were used to weight each score component. For each study participant, the weighted score components were summed to produce the scores such that a higher score was more pro-inflammatory. The scores were categorized according to quintiles of their distributions among all REGARDS participants at baseline, and their associations with mortality were assessed using multivariable Cox proportional hazards regression. Over an average of 7.89 years follow-up, 2,964 individuals died, including 854 from cancer. With increasing levels of each score, there was increasing risk for all-cause, cancer- and CVD-specific mortalities. For those in the highest relative to the lowest quintiles of the OIS, DIS, and LIS, the multivariable-adjusted hazard ratios (95% confidence intervals) for all-cause mortality were: 2.16 (1.87, 2.49; Ptrend<0.0001), 1.25 (1.10, 1.41; Ptrend<0.0001), and 1.94 (1.69, 2.24; Ptrend<0.0001), respectively. The corresponding findings for cancer mortality were 1.79 (1.38, 2.32; Ptrend<0.0001), 1.20 (0.95, 1.50; Ptrend=0.10), and 1.83 (1.42, 2.37; Ptrend<0.0001), respectively, and for CVD mortality 2.38 (1.83, 3.09; Ptrend<0.0001), 1.28 (1.02, 1.61; Ptrend=0.03), and 1.90 (1.49, 2.42; Ptrend<0.0001). These results suggest that pro-inflammatory diets and lifestyles may be associated with higher risk for all-cause, cancer- and CVD-specific mortality.
Citation Format: Doratha Byrd, Ashley Holmes, Suzanne Judd, W Dana Flanders, Roberd M. Bostick. Associations of whole food and lifestyle-based inflammation scores with all-cause, cancer- and cardiovascular disease-specific mortality [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3287. doi:10.1158/1538-7445.AM2017-3287
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Affiliation(s)
| | | | - Suzanne Judd
- 2University of Alabama Birmingham, Birmingham, AL
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Um C, Prizment A, Lazovich D, Bostick RM. Abstract 5313: Associations of calcium and dairy product intakes with colorectal cancer risk among older women: the Iowa Women's Health Study. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-5313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Calcium has been consistently modestly associated with lower risk of colorectal cancer, which remains the second leading cause of cancer deaths among men and women combined in the United States. Dairy products, a major source of dietary calcium, have also been consistently inversely associated with colorectal cancer, although inconsistencies in relation to high-fat dairy products have been noted. Limited evidence suggests that dairy products may contain components other than calcium and fat, such as insulin-like growth factor 1 (IGF-1), that may be independently directly associated with risk of colorectal and other cancers.
Data from the Iowa Women’s Health Study, a prospective cohort study, were used to investigate associations of calcium, dairy products, and the non-calcium component of dairy products with colorectal cancer incidence. Dietary data were collected using a semiquantitative food frequency questionnaire (FFQ) mailed to 55 – 69 year-old women in 1986 who had a valid Iowa driver’s license. Among participants with no history of cancer at baseline and who satisfactorily completed their FFQ (n=35,221), through follow up in 2012, 1,731 incident cases of colorectal cancer were documented via the Iowa SEER registry. To investigate total dairy and total, whole, and non-fat milks independent of their calcium components, we used the residuals from linear regression models of their associations with dietary calcium. Associations of the calcium and dairy product variables with colorectal cancer incidence were estimated using multivariable Cox proportional hazards regression.
For those in the highest relative to those in the lowest quintiles of intakes, the adjusted hazards ratios and 95% confidence intervals (CI) were 0.81 (CI 0.67-0.98; P-trend 0.004) for total calcium, 0.85 (CI 0.68-1.03; P-trend 0.07) for dietary calcium, and 0.85 (CI 0.68-1.06; P-trend 0.16) for supplemental calcium. For total dairy and total milk, the corresponding findings were 0.79 (CI 0.66-0.94; P-trend 0.01) and 0.82 (CI 0.69-0.96; P-trend 0.09), respectively. Low-fat dairy products, non-fat milk, and residuals of total dairy products and total and non-fat milk were not associated with colorectal cancer.
These results are consistent with previous findings of lower colorectal cancer risk with higher intakes of calcium and dairy products, but provide little support for the hypothesis that the non-calcium, non-fat component of dairy products may be associated with colorectal cancer.
Citation Format: Caroline Um, Anna Prizment, DeAnn Lazovich, Roberd M. Bostick. Associations of calcium and dairy product intakes with colorectal cancer risk among older women: the Iowa Women's Health Study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5313. doi:10.1158/1538-7445.AM2017-5313
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Anderson JC, Baron JA, Ahnen DJ, Barry EL, Bostick RM, Burke CA, Bresalier RS, Church TR, Cole BF, Cruz-Correa M, Kim AS, Mott LA, Sandler RS, Robertson DJ. Factors Associated With Shorter Colonoscopy Surveillance Intervals for Patients With Low-Risk Colorectal Adenomas and Effects on Outcome. Gastroenterology 2017; 152:1933-1943.e5. [PMID: 28219690 PMCID: PMC6251057 DOI: 10.1053/j.gastro.2017.02.010] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 02/08/2017] [Accepted: 02/09/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND & AIMS Endoscopists do not routinely follow guidelines to survey individuals with low-risk adenomas (LRAs; 1-2 small tubular adenomas, < 1 cm) every 5-10 years for colorectal cancer; many recommend shorter surveillance intervals for these individuals. We aimed to identify the reasons that endoscopists recommend shorter surveillance intervals for some individuals with LRAs and determine whether timing affects outcomes at follow-up examinations. METHODS We collected data from 1560 individuals (45-75 years old) who participated in a prospective chemoprevention trial (of vitamin D and calcium) from 2004 through 2008. Participants in the trial had at least 1 adenoma, detected at their index colonoscopy, and were recommended to receive follow-up colonoscopy examinations at 3 or 5 years after adenoma identification, as recommended by the endoscopist. For this analysis we collected data from only participants with LRAs. These data included characteristics of participants and endoscopists and findings from index and follow-up colonoscopies. Primary endpoints were frequency of recommending shorter (3-year) vs longer (5-year) surveillance intervals, factors associated with these recommendations, and effect on outcome, determined at the follow-up colonoscopy. RESULTS A 3-year surveillance interval was recommended for 594 of the subjects (38.1%). Factors most significantly associated with recommendation of 3-year vs a 5-year surveillance interval included African American race (relative risk [RR] to white, 1.41; 95% confidence interval [CI], 1.14-1.75), Asian/Pacific Islander ethnicity (RR to white, 1.7; 95% CI, 1.22-2.43), detection of 2 adenomas at the index examination (RR vs 1 adenoma, 1.47; 95% CI, 1.27-1.71), more than 3 serrated polyps at the index examination (RR=2.16, 95% CI, 1.59-2.93), or index examination with fair or poor quality bowel preparation (RR vs excellent quality, 2.16; 95% CI, 1.66-2.83). Other factors that had a significant association with recommendation for a 3-year surveillance interval included family history of colorectal cancer and detection of 1-2 serrated polyps at the index examination. In comparisons of outcomes, we found no significant differences between the 3-year vs 5-year recommendation groups in proportions of subjects found to have 1 or more adenomas (38.8% vs 41.7% respectively; P = .27), advanced adenomas (7.7% vs 8.2%; P = .73) or clinically significant serrated polyps (10.0% vs 10.3%; P = .82) at the follow-up colonoscopy. CONCLUSIONS Possibly influenced by patients' family history, race, quality of bowel preparation, or number or size of polyps, endoscopists frequently recommend 3-year surveillance intervals instead of guideline-recommended intervals of 5 years or longer for individuals with LRAs. However, at the follow-up colonoscopy, similar proportions of participants have 1 or more adenomas, advanced adenomas, or serrated polyps. These findings support the current guideline recommendations of performing follow-up examinations of individuals with LRAs at least 5 years after the index colonoscopy.
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Affiliation(s)
- Joseph C. Anderson
- Department of Medicine, Department of Veterans Affairs Medical Center, White River Junction, Vermont;,Department of Epidemiology for ELB, JAB, and LM and Department of Medicine in the Division of Gastroenterology and Hepatology for JCA and DJR, The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - John A Baron
- Department of Epidemiology for ELB, JAB, and LM and Department of Medicine in the Division of Gastroenterology and Hepatology for JCA and DJR, The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire;,Department of Medicine in the Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Dennis J. Ahnen
- Department of Medicine in the Division of Gastroenterology and Hepatology, University of Colorado School of Medicine and Gastroenterology of the Rockies, Denver and Boulder, Colorado
| | - Elizabeth L. Barry
- Department of Epidemiology for ELB, JAB, and LM and Department of Medicine in the Division of Gastroenterology and Hepatology for JCA and DJR, The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Roberd M. Bostick
- Department of Epidemiology, Rollins School of Public Health, and Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Carol A. Burke
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio
| | - Robert S. Bresalier
- Department of Medicine in the Division of Gastroenterology and Hepatology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Timothy R. Church
- Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Bernard F. Cole
- Interim Dean and Professor of Statistics in the College of Engineering and Mathematical Sciences, University of Vermont, Burlington, Vermont
| | - Marcia Cruz-Correa
- Department of Medicine in the Division of Gastroenterology and Hepatology, University of Puerto Rico, San Juan, Puerto Rico
| | - Adam S. Kim
- Minnesota Gastroenterology, P.A., Minneapolis, Minnesota
| | - Leila A. Mott
- Department of Epidemiology for ELB, JAB, and LM and Department of Medicine in the Division of Gastroenterology and Hepatology for JCA and DJR, The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Robert S. Sandler
- Department of Medicine in the Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Douglas J. Robertson
- Department of Medicine, Department of Veterans Affairs Medical Center, White River Junction, Vermont;,Department of Epidemiology for ELB, JAB, and LM and Department of Medicine in the Division of Gastroenterology and Hepatology for JCA and DJR, The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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Um CY, Fedirko V, Flanders WD, Höflich C, Wirthgen E, Bostick RM. Circulating insulin-like growth factor-related biomarkers: Correlates and responses to calcium supplementation in colorectal adenoma patients. Mol Carcinog 2017; 56:2127-2134. [PMID: 28467661 DOI: 10.1002/mc.22669] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 04/24/2017] [Accepted: 05/01/2017] [Indexed: 01/09/2023]
Abstract
Circulating insulin-like growth factor 1 (IGF-1) may be directly associated with colorectal cancer risk, and IGF binding protein 3 (IGFBP-3) is one of the most abundantly expressed binding proteins in various cancers. Calcium intakes, primarily from food, have been directly associated with circulating IGF-1, but whether supplemental calcium affects IGF-1 and IGFBP-3 is unknown. We tested the effects of 1.0 and 2.0 g of supplemental elemental calcium daily on circulating IGF-1 and IGFBP-3 concentrations in colorectal adenoma patients in a randomized, double-blinded, placebo-controlled clinical trial (n = 193). IGF-1 and IGFBP-3 were quantified using enzyme-linked immunoassay and quantitative Western ligand blot, respectively. We also assessed cross-sectional associations of these biomarkers with participants' baseline characteristics. We found no appreciable effect of calcium relative to placebo on circulating IGF-1, IGFBP-3, or the IGF-1:IGFBP-3 molar ratio. Mean IGF-1 concentrations were 11.1% higher in those with greater milk intakes (P = 0.05). Mean IGF-1 and IGFBP-3 concentrations were, respectively, 18.0% (P = 0.003) and 16.5% (P = 0.01) higher in men and were monotonically lower with increasing age (both P = 0.01). IGFBP-3 was 17.7% higher among those with higher relative to no alcohol consumption (P = 0.04). While these results support previous findings that IGF-1 concentrations are higher with greater milk intakes, and IGF-1 and IGFBP-3 concentrations differ according to sex and age, they provide no evidence to suggest that supplemental calcium appreciably affects circulating IGF-1, IGFBP-3, or the IGF-1:IGFBP-3 molar ratio in sporadic colorectal adenoma patients.
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Affiliation(s)
- Caroline Y Um
- Nutrition and Health Sciences Program, Emory University, Atlanta, Georgia
| | - Veronika Fedirko
- Nutrition and Health Sciences Program, Emory University, Atlanta, Georgia.,Department of Epidemiology,, Emory University, Atlanta, Georgia.,Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - W Dana Flanders
- Department of Epidemiology,, Emory University, Atlanta, Georgia.,Winship Cancer Institute, Emory University, Atlanta, Georgia
| | | | - Elisa Wirthgen
- Ligandis GbR, Gülzow, Germany.,Institute of Genome Biology, Leibniz Institute for Farm Animal Biology (FBN), Dummerstorf, Germany
| | - Roberd M Bostick
- Nutrition and Health Sciences Program, Emory University, Atlanta, Georgia.,Department of Epidemiology,, Emory University, Atlanta, Georgia.,Winship Cancer Institute, Emory University, Atlanta, Georgia
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Qayed E, Shea L, Goebel S, Bostick RM. Association of trainee participation with adenoma and polyp detection rates. World J Gastrointest Endosc 2017; 9:204-210. [PMID: 28572874 PMCID: PMC5437386 DOI: 10.4253/wjge.v9.i5.204] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 01/12/2017] [Accepted: 03/02/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate whether adenoma and polyp detection rates (ADR and PDR, respectively) in screening colonoscopies performed in the presence of fellows differ from those performed by attending physicians alone.
METHODS We performed a retrospective review of all patients who underwent a screening colonoscopy at Grady Memorial Hospital between July 1, 2009 and June 30, 2015. Patients with a history of colon polyps or cancer and those with poor colon preparation or failed cecal intubation were excluded from the analysis. Associations of fellowship training level with the ADR and PDR relative to attendings alone were assessed using unconditional multivariable logistic regression. Models were adjusted for sex, age, race, and colon preparation quality.
RESULTS A total of 7503 colonoscopies met the inclusion criteria and were included in the analysis. The mean age of the study patients was 58.2 years; 63.1% were women and 88.2% were African American. The ADR was higher in the fellow participation group overall compared to that in the attending group: 34.5% vs 30.7% (P = 0.001), and for third year fellows it was 35.4% vs 30.7% (aOR = 1.23, 95%CI: 1.09-1.39). The higher ADR in the fellow participation group was evident for both the right and left side of the colon. For the PDR the corresponding figures were 44.5% vs 40.1% (P = 0.0003) and 45.7% vs 40.1% (aOR = 1.25, 95%CI: 1.12-1.41). The ADR and PDR increased with increasing fellow training level (P for trend < 0.05).
CONCLUSION There is a stepwise increase in ADR and PDR across the years of gastroenterology training. Fellow participation is associated with higher adenoma and polyp detection.
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Whalen KA, Judd S, McCullough ML, Flanders WD, Hartman TJ, Bostick RM. Paleolithic and Mediterranean Diet Pattern Scores Are Inversely Associated with All-Cause and Cause-Specific Mortality in Adults. J Nutr 2017; 147:612-620. [PMID: 28179490 PMCID: PMC5368578 DOI: 10.3945/jn.116.241919] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 11/03/2016] [Accepted: 01/17/2017] [Indexed: 12/23/2022] Open
Abstract
Background: Poor diet quality is associated with a higher risk of many chronic diseases that are among the leading causes of death in the United States. It has been hypothesized that evolutionary discordance may account for some of the higher incidence and mortality from these diseases.Objective: We investigated associations of 2 diet pattern scores, the Paleolithic and the Mediterranean, with all-cause and cause-specific mortality in the REGARDS (REasons for Geographic and Racial Differences in Stroke) study, a longitudinal cohort of black and white men and women ≥45 y of age.Methods: Participants completed questionnaires, including a Block food-frequency questionnaire (FFQ), at baseline and were contacted every 6 mo to determine their health status. Of the analytic cohort (n = 21,423), a total of 2513 participants died during a median follow-up of 6.25 y. We created diet scores from FFQ responses and assessed their associations with mortality using multivariable Cox proportional hazards regression models adjusting for major risk factors.Results: For those in the highest relative to the lowest quintiles of the Paleolithic and Mediterranean diet scores, the multivariable adjusted HRs for all-cause mortality were, respectively, 0.77 (95% CI: 0.67, 0.89; P-trend < 0.01) and 0.63 (95% CI: 0.54, 0.73; P-trend < 0.01). The corresponding HRs for all-cancer mortality were 0.72 (95% CI: 0.55, 0.95; P-trend = 0.03) and 0.64 (95% CI: 0.48, 0.84; P-trend = 0.01), and for all-cardiovascular disease mortality they were 0.78 (95% CI: 0.61, 1.00; P-trend = 0.06) and HR: 0.68 (95% CI: 0.53, 0.88; P-trend = 0.01).Conclusions: Findings from this biracial prospective study suggest that diets closer to Paleolithic or Mediterranean diet patterns may be inversely associated with all-cause and cause-specific mortality.
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Affiliation(s)
| | - Suzanne Judd
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL
| | | | - W Dana Flanders
- Departments of Epidemiology and
- Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, GA
- Winship Cancer Institute, Emory University, Atlanta, GA
| | - Terryl J Hartman
- Departments of Epidemiology and
- Winship Cancer Institute, Emory University, Atlanta, GA
| | - Roberd M Bostick
- Departments of Epidemiology and
- Winship Cancer Institute, Emory University, Atlanta, GA
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Eldridge RC, Flanders WD, Bostick RM, Fedirko V, Gross M, Thyagarajan B, Goodman M. Using multiple biomarkers and determinants to obtain a better measurement of oxidative stress: a latent variable structural equation model approach. Biomarkers 2017; 22:517-524. [PMID: 28298141 DOI: 10.1080/1354750x.2017.1306752] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE Since oxidative stress involves a variety of cellular changes, no single biomarker can serve as a complete measure of this complex biological process. The analytic technique of structural equation modeling (SEM) provides a possible solution to this problem by modelling a latent (unobserved) variable constructed from the covariance of multiple biomarkers. METHODS Using three pooled datasets, we modelled a latent oxidative stress variable from five biomarkers related to oxidative stress: F2-isoprostanes (FIP), fluorescent oxidation products, mitochondrial DNA copy number, γ-tocopherol (Gtoc) and C-reactive protein (CRP, an inflammation marker closely linked to oxidative stress). We validated the latent variable by assessing its relation to pro- and anti-oxidant exposures. RESULTS FIP, Gtoc and CRP characterized the latent oxidative stress variable. Obesity, smoking, aspirin use and β-carotene were statistically significantly associated with oxidative stress in the theorized directions; the same exposures were weakly and inconsistently associated with the individual biomarkers. CONCLUSIONS Our results suggest that using SEM with latent variables decreases the biomarker-specific variability, and may produce a better measure of oxidative stress than do single variables. This methodology can be applied to similar areas of research in which a single biomarker is not sufficient to fully describe a complex biological phenomenon.
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Affiliation(s)
- Ronald C Eldridge
- a Department of Epidemiology, Rollins School of Public Health , Emory University , Atlanta , GA , USA
| | - W Dana Flanders
- a Department of Epidemiology, Rollins School of Public Health , Emory University , Atlanta , GA , USA.,b Department of Biostatistics and Bioinformatics, Rollins School of Public Health , Emory University , Atlanta , GA , USA
| | - Roberd M Bostick
- a Department of Epidemiology, Rollins School of Public Health , Emory University , Atlanta , GA , USA.,c Winship Cancer Institute, Emory University , Atlanta , GA , USA
| | - Veronika Fedirko
- a Department of Epidemiology, Rollins School of Public Health , Emory University , Atlanta , GA , USA.,c Winship Cancer Institute, Emory University , Atlanta , GA , USA
| | - Myron Gross
- d Department of Laboratory Medicine and Pathology, Epidemiology & Community Health , University of Minnesota , Minneapolis , MN , USA
| | - Bharat Thyagarajan
- d Department of Laboratory Medicine and Pathology, Epidemiology & Community Health , University of Minnesota , Minneapolis , MN , USA
| | - Michael Goodman
- a Department of Epidemiology, Rollins School of Public Health , Emory University , Atlanta , GA , USA
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