Lifestyle-related Risk Factors Research Articles

Abstract 5249: Crosstalk between visceral adipose and tumor tissue in colorectal cancer patients: Molecular signals driving host-tumor interaction

Abstract Adipose tissue has recently emerged as a driver of tumorigenesis, as adipose-associated factors enhance tumor growth and development. Here we investigated for the first time direct crosstalk between visceral adipose tissue (VAT) and tumor tissues in colorectal cancer (CRC) patients. We analyzed paired transcriptomic profiles of tissues and systemic inflammatory biomarkers among CRC patients to elucidate potential mechanisms and molecular signals driving the host-tumor interaction. Paired presurgery blood and tumor adjacent VAT, colorectal tumor and mucosa tissue samples collected during surgery were obtained from 47 Caucasian patients diagnosed with microsatellite-stable primary CRC enrolled in the ColoCare Study. Clinical/demographic information, and lifestyle-related risk factors, were reported. VAT was quantified by computed tomography. RNA was extracted from VAT, colorectal tumor and mucosa tissues, analyzed using HumanHT-12 Expression BeadChips, processed, and validated. Serum-based assays were conducted in 46 of 47 patients for systemic inflammatory markers with the Mesoscale Discovery Platform. High PTGS2 tumor expression was associated with 131 significantly altered VAT genes, of which 85.5% were upregulated. A significant upstream regulator of dysregulated VAT genes was SAA1. Investigation of circulating inflammatory biomarkers corroborated these transcriptomic findings, as patients with high PTGS2 tumor expression were also significantly more likely to have higher serum-based SAA levels. The differential expression of PPAR-γ in VAT identified 284 significantly altered tumor genes. 71.8% of tumor genes were upregulated in association with higher PPAR-γ VAT expression. Differentially expressed tumor genes were enriched in functional cellular movement. Inflammatory biomarkers in patient sera showed marginally significant differences for soluble ICAM-1 in association with differential PPAR-γ VAT expression. Overlap of the 131 altered VAT genes associated with differential PTGS2 tumor expression with the 284 dysregulated tumor genes associated with differential PPAR-γ VAT expression identified 15 common genes. Gene set enrichment analysis demonstrated that phenotypes associated with these genes in humans included cancer invasiveness signatures from tumor microenvironment interactions. Our multi-omics profiling of paired tissue transcriptomics and systemic inflammatory biomarkers from CRC patients established a bidirectional link between VAT and colorectal tumor tissue. We have demonstrated that this direct crosstalk activates signaling cascades to promote proinflammatory interactions and metabolic reprogramming. Future efforts to develop mechanism-based interventions that disrupt these molecular signals at the nexus of VAT-tumor crosstalk may improve obesity-driven CRC prevention and control. Citation Format: Andreana N. Holowatyj, Mariam Haffa, Tengda Lin, Biljana Gigic, Jennifer Ose, Christy Warby, Caroline Himbert, Clare Abbenhardt, Juergen Boehm, Magnus von Knebel Doeberitz, Nina Habermann, Esther Herpel, Hans-Ulrich Kauczor, Matthias Kloor, Johanna Nattenmüller, Peter Schirmacher, Martin Schneider, Petra Schrotz-King, Thomas Simon, Alexis Ulrich, Laura Bowers, Stephen D. Hursting, Cornelia M. Ulrich. Crosstalk between visceral adipose and tumor tissue in colorectal cancer patients: Molecular signals driving host-tumor interaction [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 5249.

Tumour stage and gender predict recurrence and second primary malignancies in head and neck cancer: a multicentre study within the INHANCE consortium

Recurrence and second primary cancer (SPC) continue to represent major obstacles to long-term survival in head and neck cancer (HNC). Our aim was to evaluate whether established demographics, lifestyle-related risk factors for HNC and clinical data are associated with recurrence and SPC in HNC. We conducted a multicentre study by using data from five studies members of the International Head and Neck Cancer Epidemiology consortium—Milan, Rome, Western Europe, Sao Paulo, and Japan, totalling 4005 HNC cases with a median age of 59 (interquartile range 52–67). Multivariate hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for recurrence and SPC. During follow-up, 1161 (29%) patients had recurrence and 343 (8.6%) developed SPC. Advanced tumour stage was associated with increased risk of recurrence in HNC overall (HR = 1.76, 95% CI 1.41–2.19). Women with laryngeal cancer had a reduced risk of recurrence compared to men (HR = 0.39, 95% CI: 0.24–0.74). Concerning predictors of SPC, advanced age (HR = 1.02; 95% CI: 1.00–1.04) and alcohol consumption (> 1 drink per day, HR = 2.11; 95% CI: 1.13–3.94) increased the risk of SPC among patients with laryngeal cancer. Additionally, women were at higher risk of SPC, in HNC overall group (HR = 1.68; 95% CI: 1.13–2.51) and oropharyngeal cancer group (HR = 1.74; 95% CI: 1.02–2.98). Tumour stage and male gender (larynx only) were positive predictors of cancer recurrence in HNC patients. Predictors of SPC were advanced age and alcohol use among laryngeal cancer cases, and female gender for oropharyngeal and HNC overall.

Aging-related trajectories of lung function in the general population-The Doetinchem Cohort Study.

The objective of this study was to explore trajectories of lung function decline with age in the general population, and to study the effect of sociodemographic and life style related risk factors, in particular smoking and BMI. For this purpose, we used data from the Doetinchem Cohort Study (DCS) of men and women, selected randomly from the general population and aged 20–59 years at inclusion in 1987–1991, and followed until the present. Participants in the DCS are assessed every five years. Spirometry has been performed as part of this assessment from 1994 onwards. Participants were included in this study if spirometric measurement of FEV1, which in this study was the main parameter of interest, was acceptable and reproducible on at least one measurement round, leading to the inclusion of 5727 individuals (3008 females). Statistical analysis revealed three typical trajectories. The majority of participants followed a trajectory that closely adhered to the Global Lung Initiative Reference values (94.9% of men and 96.4% of women). Two other trajectories showed a more pronounced decline. Smoking and the presence of respiratory complaints were the best predictors of a trajectory with stronger decline. A greater BMI over the follow-up period was associated with a more unfavorable FEV1 course both in men (β = -0.027 (SD = 0.002); P < 0.001) and in women (β = -0.008 (SD = 0.001); P < 0.001). Smokers at baseline who quit the habit during follow-up, showed smaller decline in FEV1 in comparison to persistent smokers, independent of BMI change (In men β = -0.074 (SD = 0.020); P < 0.001. In women β = -0.277 (SD = 0.068); P < 0.001). In conclusion, three typical trajectories of age-related FEV1 decline could be distinguished. Change in the lifestyle related risk factors, BMI and smoking, significantly impact aging-related decline of lung function. Identifying deviant trajectories may help in early recognition of those at risk of a diagnosis of lung disease later in life.

Assessment of the Mid-Life Demographic and Lifestyle Risk Factors of Dementia Using Data from the Framingham Heart Study Offspring Cohort.

Dementia is the leading cause of dependence and disability in the elderly population worldwide. However, currently there is no effective medication for dementia treatment. Therefore, identifying lifestyle-related risk factors including some that are modifiable may provide important strategies for reducing risk of dementia. This study aims to highlight associations between easily obtainable lifestyle risk factors in mid-life and dementia in later adulthood. Using data from the Framingham Heart Study Offspring cohort, we leveraged well-known classification models (decision tree classifier and random forests) to associate demographic and lifestyle behavioral data with dementia status. We then evaluated model performance by computing area under receiver operating characteristic (ROC) curve. As expected, age was strongly associated with dementia. The analysis also identified 'widowed' marital status, lower BMI, and less sleep at mid-life as risk factors of dementia. The areas under the ROC curves were 0.79 for the decision tree, and 0.89 for the random forest model. Demographic and lifestyle factors that are non-invasive and inexpensive to implement can be assessed in midlife and used to potentially modify the risk of dementia in late adulthood. Classification models can help identify associations between dementia and midlife lifestyle risk factors. These findings inform further research, in order to help public health officials develop targeted programs for dementia prevention.

Cardiovascular Diseases (CVDs) Risk Attitude and Knowledge Level of Major Risk Factors for Cardiovascular Diseases among 15-19 Years Eleventh and Twelfth-Grade Students of Lekhnath Municipality

Introduction: Cardiovascular diseases (CVDs) becoming a major public health problem in developing countries. Both developed and developing countries witnesses the increase in a number of lifestyle-related risk factors such as excessive smoking, tobacco, and alcohol consumption, a poor dietary habit among adult and adolescent. The social and economic burden of CVDS in developing countries is more intensifying compare to developed countries because of higher prevalence of these diseases among economically active or working age population.Objective: The aim of this study is to assess and identify the level of knowledge and cardiovascular disease risk attitude among 15-19 years age students of grade 11th and 12th in Lekhnath Municipality.Methodology: The institution base quantitative cross-sectional study was adopted where Proportionate multistage cluster sampling technique was used to recurit study respondents.Result: Only small percentages (11%) of the respondent have a good level of knowledge regarding CVD risk factors. On the other hand, approximately there a quarter of the respondents (71.9%) have a cardiovascular riskseeking attitude.Conclusion: Majority of adolescents in this study does not have sufficient knowledge about major cardiovascular diseases risk factors. Respondents’ cardiovascular risk adverse attitude was closely connected with knowledge of various cardiovascular risk factors. Thus it is necessary to increase adolescents’ knowledge about various risk factors to interruption the extensive social and economic impacts

Diurnal cortisol and alpha-amylase in the daily lives of older adults with vital exhaustion

ObjectiveVital exhaustion (VE) is characterised by unusual fatigue, increased irritability, and a feeling of demoralisation. It has been found a major risk factor for cardiovascular diseases, and one that is independent of subclinical or clinical manifestations of coronary heart disease or lifestyle-related risk factors. Stress-induced alterations in the hypothalamic-pituitary–adrenal (HPA) axis and sympathetic nervous system may mediate the link between VE and increased cardiovascular risk. However, no studies have yet assessed both systems simultaneously and in high-risk populations, such as older adults. MethodsA total of 72 older adults (34 women, mean age 61.7±7.3) who were free of any major physical or mental illnesses filled out the Maastricht Vital Exhaustion Questionnaire (MVEQ) and the Perceived Stress Scale (PSS). To determine cortisol and alpha-amylase, participants collected saliva samples upon awakening, +30min thereafter, and at 11am, 3pm, and 8pm. ResultsParticipants with higher VE reported lower perceived stress (β=−0.515, p<0.001). Individuals reporting higher VE also exhibited more diminished cortisol concentrations across the day, although only by trend (β=−0.218, p=0.092). There was no significant association between VE and diurnal alpha-amylase activity. Moreover, women had lower diurnal cortisol (β=−0.381, p=0.004) and alpha-amylase (β=−0.329, p=0.011) when compared to men. ConclusionsOur findings provide initial evidence for psychosocial stress to be linked to VE in older adults, while evidence for HPA alterations remains tentative. Future research is warranted to determine whether VE related hypocortisolaemia represents a specific stage of the stress adaptation process that may put individuals at risk for incident cardiovascular diseases.

A Randomized Controlled Trial to Reduce Lifestyle Related Risk Factors for Non-Communicable Diseases through Funeral Societies in Sri Lanka

A cluster randomized controlled trial was conducted to change diet, physical activity, smoking and alcohol consumption among participants through funeral societies in the Western Province. Twenty one administrative subdivisions in the Ragama area were randomized into intervention and control groups. Ten administrative subdivisions in the North Western Province were selected as an additional control group. The primary outcome was change in the proportion of individuals who consumed 5 servings or more of fruits and vegetables per day. The study showed only a modest, not significant increase in the proportion of people consuming 5 servings of fruits and vegetables or more per day. Of the secondary outcomes assessed, their intake of green leaves and mean MET minutes spent on leisure activities increased significantly more in the intervention group than in the control groups, but the differences were small. To effectively reduce non-communicable diseases (NCD) in Sri Lanka, community-based organizations could be utilized to deliver prevention programs.

Alzheimer’s Dementia: An Overview

Alzheimer's disease (AD), the most common cause of dementia, is a chronic illness characterized by cognitive symptoms, behavioural and psychological symptoms and difficulty in performing activities of daily living. Mild cognitive impairment (MCI) is regarded as a transitional state between healthy cognitive ageing and dementia and around 12-15% of individuals with MCI progress to dementia annually. This provides unique opportunity to initiate treatments targeted to delay or prevent the onset of AD. Based on the age at onset, AD is divided into two broad categories: early onset and late onset. Early onset AD follows the classical mendelian pattern of inheritance, whereas the late onset AD has a complex interplay of gene-environment interaction, with several lifestyle-related risk factors strongly implicated in the pathogenesis of this degenerative condition. The onset of AD pathology predates the clinical symptoms by several years. The neurodegenerative processes in AD is related to the accumulation of abnormally folded A beta and tau proteins in amyloid plaques and neuronal tangles. Diagnosis of AD is by presence of cluster of clinical features and aided by biomarkers such as CSF A beta 42 and PET amyloid imaging, CSF tau and tau imaging, 18fluorodeoxyglucose uptake on PET and atrophy on structural magnetic resonance imaging increase the diagnostic certainty. In the absence of curative treatments, the management of AD involves pharmacological treatment to delay the onset or progression of AD and supportive care by family members. Targeting these lifestyle-related factors in young adulthood and middle age may be protective against AD. High educational achievement in early life, involvement in cognitively stimulating activity, physical activity and social engagement including rich social network have been associated with reduced risk of late-life dementia and AD.

Mapping evidence on the distribution of human papillomavirus-related cancers in sub-Saharan Africa: scoping review protocol

BackgroundDespite the introduction of HPV vaccines, the incidence of HPV-related cancers (cervical, penile, anal, vulvar, vagina, head, and neck) in sub-Saharan Africa has been rising. The increasing incidence of these HPV-related cancers has been attributed to changes in lifestyle-related risk factors, most notably sexual behavior. The main objective of this study is to map evidence on the distribution of HIV-related cancers in sub-Saharan Africa (SSA).Methods and analysisWe will conduct a scoping review to explore, describe, and map literature on the distribution of HPV-related cancers in sub-Saharan Africa. The primary search will include peer-reviewed and review articles. The list of references from included studies will also be searched. The search will be performed using EBSCOhost platform by searching the following databases within the platform: Academic search complete, health source: nursing/academic edition, CINAHL with full text, PubMed, Science Direct, Google scholar and World Health Organization (WHO) library databases, and gray literature. The researcher will search the articles using keywords, from the included studies; abstract and full articles will be screened by two independent reviewers. The screening will be guided by the inclusion and exclusion criteria. A thematic content analysis will be used to present the narrative account of the reviews, using NVivo version 10.DiscussionWe anticipate finding relevant literature on the distribution of HPV-related cancers in sub-Saharan Africa. The study findings will help reveal research gaps to guide future research.Systematic review registrationPROSPERO CRD42017062403.

Lifestyle Pattern and Hypertension Related Knowledge, Attitude and Practices among Diagnosed Patients of Hypertension Attending a Tertiary Care Hospital

Context: Hypertension can be controlled by modifying lifestyle related risk factors and generating awareness about these risk factors among hypertensive patients. Aim: To assess the life style pattern, knowledge, attitude and practices related to hypertension among diagnosed patients of hypertension attending a tertiary care hospital. Materials and methods: Across sectional hospital based study was conducted in a tertiary care hospital during May and June 2014.102 diagnosed patients of hypertension attending the Medicine out-patient department were included in the study by convenience sampling. Apre-structured questionnaire was used and data related to demographic profile, history of hypertension, knowledge, attitude and practices regarding hypertension etc. were collected. Data were analysed using Statistical Package for the Social Sciences version 20. Results: Out of 102 participants, 55.9% were males and the mean age was 42.98 + 11.85. The mean systolic blood pressure and diastolic blood pressure was 146.01 + 10.59 and 103.7 + 10.76 respectively. 50% of the patients led a sedentary life & only 13.7% were practicing fitness activities daily. 22.5% were current smokers, 12.7% were passive smokers and 8.8% were currently taking alcohol. About 26.5% patients were not concerned about their increased BP, 5.9% didn’t know any of the risk factors of hypertension &7.8% were unaware of the symptoms of hypertension. Logistic regression showed that occurrence of uncontrolled hypertension is reduced by 0.06 times in patients having satisfactory knowledge. Conclusion: Intervention in the form of lifestyle education during hospital visits will be helpful to increase the awareness about modifiable risk factors, controlling blood pressure and preventing complications among these patients.

Suitability of random forest analysis for epidemiological research: Exploring sociodemographic and lifestyle-related risk factors of overweight in a cross-sectional design.

Factors that contribute to the development of overweight are numerous and form a complex structure with many unknown interactions and associations. We aimed to explore this structure (i.e. the mutual importance or hierarchy of sociodemographic and lifestyle-related risk factors of being overweight) using a machine-learning technique called random forest (RF). The results were compared with traditional logistic regression (LR) analysis. The cross-sectional FINRISK 2007 Study included 4757 Finns (aged 25-74 years). Information on participants' lifestyle and sociodemographic characteristics were collected with questionnaires. Diet was assessed, using a validated food-frequency questionnaire. Height and weight were measured. Participants with a body mass index (BMI) ≥25 kg/m2 were classified as overweight. R-statistical software was used to run RF analysis ('randomForest') to derive estimates for variable importance and out-of-bag error, which were compared to a LR model. In total, 704 (32%) men and 1119 (44%) women had normal BMI, whereas 1502 (69%) men and 1432 (57%) women had BMI ≥25. Estimated error rates for the models were similar (RF vs. LR: 42% vs. 40% for men, 38% vs. 35% for women). Both models ranked age, education and physical activity as the most important risk factors for being overweight, but RF ranked macronutrients (carbohydrates and protein) as more important compared to LR. RF did not demonstrate higher power in variable selection compared to LR in our study. The features of RF are more likely to appear beneficial in settings with a larger number of predictors.

Long-term exposure to particulate matter, NO2 and the oxidative potential of particulates and diabetes prevalence in a large national health survey

BackgroundThe evidence from observational epidemiological studies of a link between long-term air pollution exposure and diabetes prevalence and incidence is currently mixed. Some studies found the strongest associations of diabetes with fine particles, other studies with nitrogen dioxide and some studies found no associations. ObjectivesOur aim was to investigate associations between long-term exposure to multiple air pollutants and diabetes prevalence in a large national survey in the Netherlands. MethodsWe performed a cross-sectional analysis using the 2012 Dutch national health survey to investigate the associations between the 2009 annual average concentrations of multiple air pollutants (PM10, PM2.5, PM10−2.5, PM2.5 absorbance, OPDTT, OPESR and NO2) and diabetes prevalence, among 289,703 adults. Air pollution exposure was assessed by land use regression models. Diabetes was defined based on a combined measure of self-reported physician diagnosis and medication prescription from an external database. Using logistic regression, we adjusted for potential confounders, including neighborhood- and individual socio-economic status and lifestyle-related risk factors such as smoking habits, alcohol consumption, physical activity and BMI. ResultsAfter adjustment for potential confounders, all pollutants (except PM2.5) were associated with diabetes prevalence. In two-pollutant models, NO2 and OPDTT remained associated with increased diabetes prevalence. For NO2 and OPDTT, single-pollutant ORs per interquartile range were 1.07 (95% CI: 1.05, 1.09) and 1.08 (95% CI: 1.05, 1.10), respectively. Stratified analysis showed no consistent effect modification by any of the included known diabetes risk factors. ConclusionsLong-term residential air pollution exposure was associated with diabetes prevalence in a large health survey in the Netherlands, strengthening the evidence of air pollution being an important diabetes risk factor. Most consistent associations were observed for NO2 and oxidative potential of PM2.5 measured by the DTT assay. The finding of an association with the oxidative potential of fine particles but not with PM2.5, suggests that particle composition may be important for a potential effect on diabetes.

Association between socio-demographic characteristics and preventable lifestyle related risk factors of non-communicable diseases among adolescents: a school based study in Berhampur, Odisha

Background: Currently, the health scenario is riddled with the burden of non-communicable diseases. Life style related risk factors established during adolescents may extend into adulthood and may increase risk for non-communicable diseases. So this study was undertaken to ascertain the association of life style related risk factors for Non communicable diseases and socio demographic characteristics among adolescents.Methods: A cross-sectional study was conducted in Berhampur, Odisha. A total of 400 school children were included in the study. Data was collected by pre-tested, structured, close-ended, self-administered questionnaires. Data was entered and analysed using SPSS V.17.Descriptive statistics, chi square test and logistic regression analysis test were applied.Results: Out of 400 students included in the study, 69.5% were males. The mean age of the study subject was 15.77 with S.D 2.81. On multiple regression analysis, it was found that male respondents parents job had strong association with unhealthy dietary practices and educational status of respondents had strongest association with passive smoking and addictions habits.Conclusions: The present study showed a poor practice of healthy lifestyle with a high burden of lifestyle‑related risk factors of NCDs among students. Therefore, the schools should emphasize on including topics related to leading of a healthy life style in the curriculum. Frequent campaigns and educational seminars can be conducted for the adoption of healthy lifestyle.

Community-Based Lifestyle Intervention in Patients With Coronary Artery Disease: The RESPONSE-2 Trial

BackgroundAmong patients with coronary artery disease (CAD), improvement of lifestyle-related risk factors (LRFs) reduces cardiovascular morbidity and mortality. However, modification of LRFs is highly challenging. ObjectivesThis study sought to evaluate the impact of combining community-based lifestyle programs with regular hospital-based secondary prevention. MethodsThe authors performed a randomized controlled trial of nurse-coordinated referral of patients and their partners to 3 widely available community-based lifestyle programs, in 15 hospitals in the Netherlands. Patients admitted for acute coronary syndrome and/or revascularization, with ≥1 LRF (body mass index >27 kg/m2, self-reported physical inactivity, and/or smoking) were included. All patients received guideline-based usual care. The intervention was based on 3 lifestyle programs for weight reduction, increasing physical activity, and smoking cessation. The primary outcome was the proportion of success at 12 months, defined as improvement in ≥1 qualifying LRF using weight (≥5% reduction), 6-min-walking distance (≥10% improvement), and urinary cotinine (200 ng/ml detection limit) without deterioration in the other 2. ResultsThe authors randomized 824 patients. Complete data on the primary outcome were available in 711 patients. The proportion of successful patients in the intervention group was 37% (133 of 360) compared with 26% (91 of 351) in the control group (p = 0.002; risk ratio: 1.43; 95% confidence interval: 1.14 to 1.78). In the intervention group, partner participation was associated with a significantly greater success rate (46% vs. 34%; p = 0.03). ConclusionsAmong patients with coronary artery disease, nurse-coordinated referral to a comprehensive set of community-based, widely available lifestyle interventions, with optional partner participation, leads to significant improvements in LRFs. (RESPONSE-2: Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists 2; NTR3937)

Abstract 2283: Population-level relevance of lifestyle-related risk factors for pancreatic cancer in Australia

Abstract Aim: To estimate the proportion of exocrine pancreatic cancers in Australia that can be attributed to the established risk factors, smoking and excess body weight, and the suggested risk factors, excessive alcohol consumption and excessive red and processed meat consumption. Methods: The proportion of pancreatic cancers attributable to lifestyle-related risk factors was quantified using the Population Attributable Fraction (PAF) which combines estimates of the strength of the exposure-cancer association and the exposure prevalence in the population. The study population included seven Australian cohort studies (N=367,772) with comprehensive data on exposure to lifestyle-related risk factors and long-term follow-up. Pancreatic cancer incidence and all-cause mortality were identified through linkage with the Australian Cancer Database and National Death Index, respectively. A proportional hazards model was used to estimate the strength of exposure-cancer and exposure-death associations adjusting for age, sex and other lifestyle exposures. The age- and sex-specific exposure prevalence was calculated from the Australian National Health Survey (NHS) 2011-2012 except for red and processed meat consumption which was not available and was calculated from the latest 45 and Up study. A newly developed method that takes into account the competing risk of death was used to produce PAF estimates and their 95% confidence intervals (CIs). Results: During the first 10-years follow-up to incidence of pancreatic cancer, death or end of follow-up, there were 21,541 deaths and 613 incident exocrine pancreatic cancers. 10% (CI = 1-17%) of pancreatic cancers in Australia could be attributed to current or past smoking. Current smoking explained 8% (CI = 4-13%) of pancreatic cancers. Using cancer incidence projections estimated by the Australian Institute of Health and Welfare, a PAF of 8% translates to 2,700 potentially preventable pancreatic cancers over the next 10 years. The PAF results for excess body weight (≥ 25 kg/m2), excessive alcohol consumption (&amp;gt; 2 drinks/day) and excessive red and processed meat consumption (≥ 4 times/week) were not statistically significant. Conclusion: According to the first pancreatic cancer PAF results from cohort studies, and accounting for competing risk of death, smoking control could reduce the number of pancreatic cancers by one tenth. Further PAF studies should include confidence intervals for the estimates to allow an evaluation of their significance. Citation Format: Maria E. Arriaga, Maarit A. Laaksonen, Karen Canfell, Robert MacInnis, Emily Banks, Graham Giles, Paul Mitchell, Robert Cumming, Barbra-Ann Adelstein, Julie Byles, Dianna J. Magliano, Jonathan Shaw, Anne Taylor, Kay Price, Vasant Hirani, Claire M. Vajdic. Population-level relevance of lifestyle-related risk factors for pancreatic cancer in Australia [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 2283. doi:10.1158/1538-7445.AM2017-2283

Abstract 2279: Burden of colorectal cancer attributable to lifestyle-related risk factors: a pooled study of seven Australian cohorts

Abstract Aim: To quantify the burden of colorectal cancer in Australia avoidable by modifications to established lifestyle-related risk factors: smoking, excess body weight, excessive red and processed meat consumption, excessive alcohol consumption and physical inactivity. Methods: Data on exposure to lifestyle-related risk factors from seven Australian cohort studies (N = 367,772) were harmonized and pooled. The cohorts were linked to the Australian Cancer Database and National Death Index to identify incident cancers and deaths. The strength of the exposure-cancer and exposure-death associations were estimated using a proportional hazards model, adjusting for age, sex and the other lifestyle exposures. Age- and sex-specific exposure prevalence was estimated from the Australian National Health Survey (NHS) 2011-2012 or from the latest 45 and Up cohort study when not available in the NHS. These estimates were then combined to calculate the Population Attributable Fractions (PAFs), i.e. fractions of cancer attributable to the lifestyle-related risk factors, and their 95% confidence intervals (CIs) using an advanced method accounting for competing risk of death. Results: During the first 10-years follow-up, 3,498 incident colorectal cancers and 20,135 deaths were ascertained as first events. Current or former smoking explained 9% (CI = 5-13%), BMI ≥ 25 kg/m2 9% (CI = 4-14%), red or processed meat consumption 3 or more times/week 6% (CI = 3-8%), and drinking more than 2 alcoholic drinks/day 4% (CI = 2-6%) of the colorectal cancer burden. PAF results for physical inactivity were not significant. The contribution of each factor was more pronounced in men than in women, with most of the burden attributable to excess weight in men (PAF = 15%, CI = 7-22%) and smoking in women (PAF = 7%, CI = 3-12%). Jointly the four significant lifestyle-related risk factors were responsible for 25% (CI = 19-30%) of the colorectal cancer burden, 33% (CI = 25-40%) in men and 15% (CI =7-23%) in women. Given the projected Australian incidence rates, this translates to 49,000 avoidable colorectal cancer cases, 35,000 in men and 14,000 in women, over the next 10 years. Conclusions: These first Australian and international colorectal cancer PAF estimates based on cohort studies and accounting for competing risk of death show that several modifiable risk factors contribute to the burden of colorectal cancer and their ranking differs by sex. Further analyses may identify subpopulations that would benefit from targeted intervention activities. Due to the high incidence of colorectal cancer, these PAF estimates translate into a significant number of avoidable cases. Citation Format: Claire M. Vajdic, Maria Arriaga, Peter Hull, Karen Canfell, Robert MacInnis, Emily Banks, Graham Giles, Paul Mitchell, Robert Cumming, Barbara-Ann Adelstein, Julie Byles, Dianna J. Magliano, Jonathan Shaw, Anne Taylor, Kay Price, Vasant Hirani, Maarit A. Laaksonen. Burden of colorectal cancer attributable to lifestyle-related risk factors: a pooled study of seven Australian cohorts [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 2279. doi:10.1158/1538-7445.AM2017-2279

Abstract 2280: Burden of lung cancer in Australia avoidable by modifications to lifestyle-related risk factors

Abstract Aim: The cancer burden avoidable through risk factor modification can be quantified using the Population Attributable Fraction (PAF) which combines estimates of the prevalence of the risk factor exposure in the population and the strength of the exposure-cancer association. PAF for risk factors causally related to cancer is most accurately estimated from cohort studies, using analytical approaches that account for death as a competing risk. We provide the first such estimates of the lifestyle-related avoidable lung cancer burden. Methods: Seven contemporary Australian cohort studies (N = 367,772), with comprehensive data on exposure to lifestyle-related risk factors, were linked to the Australian Cancer Database and National Death Index to identify lung cancers and deaths from any cause. The risk factors were harmonised across the studies and the data pooled. The strength of the exposure-cancer and exposure-death associations were estimated using a proportional hazards model, adjusting for age, sex and the other lifestyle exposures. Age- and sex-specific exposure prevalence was estimated from the Australian National Health Survey 2011-2012. These estimates were then combined to calculate the PAFs and their 95% confidence intervals (CI) using a newly developed method accounting for competing risk of death. Results: During the first 10-years follow-up, 2,030 incident lung cancers and 20,348 deaths were ascertained as first events. Smoking, physical inactivity and insufficient fruit intake were statistically significantly associated with both lung cancer incidence and death. Most of the lung cancer burden (PAF = 73%, CI = 69-76%) was attributable to current or past smoking, with 31% (CI = 27-35%) of the burden attributable to current smokers. Physical activity below Australian recommendations (&amp;lt; 150 minutes of moderate or 75 minutes of vigorous exercise per week) explained 14% (CI = 6-22%) and fruit intake below Australian recommendations (&amp;lt; 2 daily serves) explained 6% (CI = 0-12%) of the lung cancer burden. Each risk factor contributed more to the lung cancer burden in men than in women. Overall, 78% (CI = 74-81%) of the lung cancer burden was attributable to current or past smoking, physical inactivity and insufficient fruit intake. The combined contribution of modifiable risk factors (i.e. excluding past smoking) was 44% (CI = 37-50%). Based on projected Australian cancer incidence rates, this would translate to 59,000 avoidable lung cancers in the next 10 years. Conclusions: According to these joint PAF estimates, the current lung cancer burden in Australia could be reduced by up to half in 10 years by quitting smoking and increasing physical activity and fruit intake to the recommended levels. As the combined effect of risk factors is rarely additive, knowing both individual and joint effects of risk factors on cancer burden is essential in planning cancer interventions and public health policies and predicting their potential impact. Citation Format: Maarit A. Laaksonen, Maria Arriaga, Peter Hull, Karen Canfell, Robert MacInnis, Emily Banks, Graham Giles, Paul Mitchell, Robert Cumming, Barbara-Ann Adelstein, Julie Byles, Dianna J. Magliano, Jonathan Shaw, Anne Taylor, Kay Price, Vasant Hirani, Claire M. Vajdic. Burden of lung cancer in Australia avoidable by modifications to lifestyle-related risk factors [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 2280. doi:10.1158/1538-7445.AM2017-2280

Risk factors and protective factors associated with incident or increase of frailty among community-dwelling older adults: A systematic review of longitudinal studies.

IntroductionFrailty is one of the greatest challenges facing our aging population, as it can lead to adverse outcomes such as institutionalization, hospitalization, and mortality. However, the factors that are associated with frailty are poorly understood. We performed a systematic review of longitudinal studies in order to identify the sociodemographic, physical, biological, lifestyle-related, and psychological risk or protective factors that are associated with frailty among community-dwelling older adults.MethodsA systematic literature search was conducted in the following databases in order to identify studies that assessed the factors associated with of frailty among community-dwelling older adults: Embase, Medline Ovid, Web of Science, Cochrane, PsychINFO Ovid, CINAHL EBSCOhost, and Google Scholar. Studies were selected if they included a longitudinal design, focused on community-dwelling older adults aged 60 years and older, and used a tool to assess frailty. The methodological quality of each study was assessed using the Quality of Reporting of Observational Longitudinal Research checklist.ResultsTwenty-three studies were included. Significant associations were reported between the following types of factors and frailty: sociodemographic factors (7/7 studies), physical factors (5/6 studies), biological factors (5/7 studies), lifestyle factors (11/13 studies), and psychological factors (7/8 studies). Significant sociodemographic factors included older age, ethnic background, neighborhood, and access to private insurance or Medicare; significant physical factors included obesity and activities of daily living (ADL) functional status; significant biological factors included serum uric acid; significant lifestyle factors included a higher Diet Quality Index International (DQI) score, higher fruit/vegetable consumption and higher tertile of all measures of habitual dietary resveratrol exposure; significant psychological factors included depressive symptoms.ConclusionsA broad range of sociodemographic, physical, biological, lifestyle, and psychological factors show a longitudinal association with frailty. These factors should be considered when developing interventions aimed at preventing and/or reducing the burden associated with frailty among community-dwelling older adults.

The burden of cancer attributable to modifiable risk factors: the Australian cancer-PAF cohort consortium

PurposeTo estimate the Australian cancer burden attributable to lifestyle-related risk factors and their combinations using a novel population attributable fraction (PAF) method that accounts for competing risk of death, risk...

Risk factors of bloating and its association with common gastrointestinal disorders in a sample of Iranian adults.

Bloating is an unpleasant but common gastrointestinal symptom that is experienced by many people at some stage in their lives. The current survey was conducted to investigate the epidemiology and risk factors of bloating and functional bloating (FB). In addition, we aimed to assess the association between bloating and functional gastrointestinal disorders (FGIDs). In this cross-sectional study, the self-administered modified Rome III questionnaire was used to assess gastrointestinal symptoms and FGIDs. Severity of bloating, demographic and anthropometric measurements, physical activity level, psychological distress, and depression and anxiety were also assessed. Among the 4763 participants, 52.9% reported having experienced bloating at least occasionally in the past three months (among which 14.1% had severe or very severe symptoms); 19.7% of subjects were found to have FB. After adjusting for multiple variables, female gender, university degree, obesity, and anxiety were associated with both bloating and FB, while depression and psychological distress were only associated with bloating. The positive predictive value and negative predictive value of bloating for the diagnosis of functional bowel disorder were 92.9% and 80.1%, respectively. Bloating and FB are highly prevalent in the study population. We also identified several demographic, psychological, and lifestyle-related risk factors of bloating in this population.