Postdiagnostische Ernährungsmuster, körperliche Aktivität und Lebensqualität und Langzeitüberleben nach einem kolorektalen Karzinom

Due to earlier diagnoses and more effective therapies, the number of individuals surviving colorectal cancer (CRC) is growing. CRC survivors are interested in lifestyle recommendations to improve survival. Also, health-related quality of life (HRQOL) of CRC survivors is a rising public health issue. This thesis evaluated the associations of dietary patterns, physical activity, and HRQOL, obtained on average 6 years after diagnosis, with all-cause mortality in CRC long-term survivors and determined the HRQOL status and correlates of HRQOL in these individuals. Within a prospective cohort study of initially recruited 2733 CRC survivors, the associations of adherence to two a priori-defined dietary patterns, the Mediterranean diet and the healthy Nordic diet, with mortality were examined using Cox regression. Furthermore, total physical activity, different types of physical activity, sleep duration, and television (TV) watching hours were related to survival. The HRQOL status of long-term CRC survivors was determined and sociodemographic and clinical correlates of HRQOL were identified with cross-sectional logistic regression. Cox regression was performed to investigate the association between HRQOL and mortality. Higher adherence to the Mediterranean and to the healthy Nordic dietary patterns was associated with reduced all-cause mortality. Higher total physical activity, and specifically sports, walking, and gardening activities, were related to improved survival. More hours of sleep during day and of watching TV were associated with decreased survival. The HRQOL status of CRC survivors was relatively high. Sex, age, education, tumor location, metastases, other cancer, type of therapy, and current stoma were significant correlates of HRQOL. Higher HRQOL and better functioning was associated with lower all-cause mortality while more symptoms were associated with higher mortality.Aufgrund früherer Diagnosen und effektiverer Therapien steigt die Zahl Kolorektalkrebs (KRK)-Überlebender. KRK-Überlebende zeigen Interesse an Lebensstilempfehlungen zur Verbesserung ihrer Prognose. Auch die Lebensqualität von KRK-Überlebenden wird zu einem zunehmenden Public Health-Thema. Die vorliegende Arbeit untersuchte Assoziationen von Ernährungsmustern, körperlicher Aktivität und der Lebensqualität (durchschn. 6 J. nach der Krebsdiagnose erhoben) mit der Gesamtmortalität von Langzeit-KRK-Überlebenden und bestimmte den Lebensqualitätsstatus und Korrelate der Lebensqualität dieser Personen. In einer prospektiven Kohortenstudie mit initial 2733 KRK-Überlebenden wurden Assoziationen der Mediterranen und der gesunden nordischen Ernährung mit der Mortalität mit Cox Regression untersucht. Zudem wurden körperliche Gesamtaktivität, verschiedene Arten körperlicher Aktivität, Schlafenszeit und Fernsehkonsum im Verhältnis zur Mortalität analysiert. Der Lebensqualitätsstatus der KRK-Überlebenden wurde ermittelt und soziodemographische und klinische Korrelate der Lebensqualität mit logistischer Regression identifiziert. Cox Regression wurde eingesetzt, um Assoziationen zwischen Lebensqualität und Mortalität zu untersuchen. Stärkere Orientierung an Mediterraner oder gesunder nordischer Ernährung war mit geringerer Gesamtmortalität assoziiert. Höhere körperliche Gesamtaktivität und v.a. Sport, Spazieren und Gartenarbeit zeigten Assoziationen mit geringerer Mortalität. Höhere Inaktivität am Tag war mit höherer Mortalität assoziiert. Die Lebensqualität war relativ hoch. Geschlecht, Alter, Bildung, Tumorlokalisation, Metastasen, andere Krebserkrankungen, Therapie und Stoma waren Korrelate der Lebensqualität. Höhere Lebensqualität und bessere Funktion waren mit geringerer und stärkere Symptomatik mit höherer Mortalität assoziiert

Patient Reported Outcomes in Chronic Inflammatory Diseases: Current State, Limitations and Perspectives

Chronic inflammatory diseases (CID) are emerging disorders which do not only affect specific organs with respective clinical symptoms but can also affect various aspects of life, such as emotional distress, anxiety, fatigue and quality of life. These facets of chronic disease are often not recognized in the therapy of CID patients. Furthermore, the symptoms and patient-reported outcomes often do not correlate well with the actual inflammatory burden. The discrepancy between patient-reported symptoms and objectively assessed disease activity can indeed be instructive for the treating physician to draw an integrative picture of an individual's disease course. This poses a challenge for the design of novel, more comprehensive disease assessments. In this mini-review, we report on the currently available patient-reported outcomes, the unmet needs in the field of chronic inflammatory diseases and the challenges of addressing these

Adherence to a plant-based diet in relation to adipose tissue volumes and liver fat content

Background: Better adherence to plant-based diets has been linked to lower risk of metabolic diseases but the effect on abdominal fat distribution and liver fat content is unclear. Objectives: We aimed to examine the association between different plant-based diet indices and measures of abdominal fat distribution and liver fat content. Methods: In a population-based sample of 578 individuals from Northern Germany (57% male, median age 62 y), diet was assessed with a validated FFQ and an overall, a healthy, and an unhealthy plant-based diet index were derived. Participants underwent MRI to assess volumes of visceral and subcutaneous abdominal adipose tissue and liver signal intensity (LSI), a measure of liver fat content. Fatty liver disease (FLD) was defined as log LSI >= 3.0. Cross-sectional associations of the plant-based diet indices with visceral and subcutaneous abdominal fat volumes, LSI, and FLD were assessed in linear and logistic regression analyses. The most comprehensive model adjusted for age, sex, education, smoking, alcohol, physical activity, energy intake, diabetes, hyperlipidemia, and BMI. Results: Higher overall and healthy plant-based diet indices both revealed statistically significant associations with lower visceral and subcutaneous abdominal adipose tissue volumes and with lower odds of FLD in multivariable-adjusted models without BMI. Upon additional adjustment for BMI, only the association of the healthy plant-based diet with visceral adipose tissue remained statistically significant (per 10-point higher healthy plant-based diet index, percentage change in visceral adipose tissue: -4.9%, 95% CI: -8.6%, -2.0%). None of the plant-based diet indices was associated with LSI. The unhealthy plant-based diet index was unrelated to any of the abdominal or liver fat parameters. Conclusions: Adherence to healthy plant-based diets was associated with lower visceral adipose tissue. None of the other examined associations remained statistically significant after adjustment for BMI

Association of Circulating Vitamin E (α- and γ-Tocopherol) Levels with Gallstone Disease

In addition to well-established risk factors like older age, female gender, and adiposity, oxidative stress may play a role in the pathophysiology of gallstone disease. Since vitamin E exerts important anti-oxidative functions, we hypothesized that circulating vitamin E levels might be inversely associated with prevalence of gallstone disease. In a cross-sectional study, we measured plasma levels of α- and γ-tocopherol using high performance liquid chromatography in a community-based sample (582 individuals; median age 62 years; 38.5% women). Gallstone disease status was assessed by ultrasound. Multivariable-adjusted logistic regression models were used to estimate the association of circulating α- and γ-tocopherol/cholesterol ratio levels with prevalent gallstone disease. Lower probabilities of having gallstone disease were observed in the top (compared to the bottom) tertile of the plasma α-tocopherol/cholesterol ratio in multivariable-adjusted models (OR (Odds Ratio): 0.31; 95% CI (Confidence Interval): 0.13–0.76). A lower probability of having gallstone disease was also observed for the γ-tocopherol/cholesterol ratio, though the association did not reach statistical significance (OR: 0.77; 95% CI: 0.35–1.69 for 3rd vs 1st tertile). In conclusion, our observations are consistent with the concept that higher vitamin E levels might protect from gallstone disease, a premise that needs to be further addressed in longitudinal studies

Vitamin E (α- and γ-Tocopherol) Levels in the Community: Distribution, Clinical and Biochemical Correlates, and Association with Dietary Patterns

Little is known about the distribution and determinants of circulating vitamin E levels in a German population. In this cross-sectional study we assessed the distribution of both α- and γ-tocopherol levels, identified their clinical and biochemical correlates, and assessed their relationships with a priori and a posteriori derived dietary patterns. Plasma α- and γ-tocopherol concentrations were measured using high performance liquid chromatography (HPLC) with fluorescence detection in 641 individuals (mean-age: 61 years; 40.6% women). Correlates of both markers were determined using linear regression with backward selection. Using a validated food-frequency questionnaire (FFQ), an a priori defined vitamin E-rich dietary pattern was constructed, and three a posteriori derived dietary patterns were identified by principal component analysis. Each pattern was related to α- and γ-tocopherol levels using linear regression. Median concentrations of α- and γ-tocopherol were 31.54 μmol/L and 1.35 µmol/L, respectively. 57.6% of participants had α-tocopherol levels >30 µmol/L. Triglycerides, high density lipoprotein (HDL)- and low density lipoprotein (LDL)-cholesterol, and vitamin E supplementation were identified as correlates of vitamin E levels. After excluding supplement users, a dietary pattern rich in meat, bread, fats, potatoes, and sugar/confectionery was inversely related to α-tocopherol levels (β, −0.032, SE = 0.016; p = 0.047). Prospective studies are warranted to evaluate the actual impact of the reported findings in terms of nutrition and health outcomes

Postdiagnostic physical activity, sleep duration, and TV watching and all-cause mortality among long-term colorectal cancer survivors: a prospective cohort study

Background: Lifestyle recommendations for cancer survivors are warranted to improve survival. In this study, we aimed to examine the association of total physical activity, different types of physical activity, hours of sleeping at day and night, and hours spent watching television (TV) with all-cause mortality in long-term colorectal cancer (CRC) survivors. Methods: We assessed physical activity in 1376 CRC survivors (44% women; median age, 69 years) at median 6 years after CRC diagnosis using a validated questionnaire. Multivariable-adjusted Cox regression models were used to estimate hazard ratios (HRs) for all-cause mortality according to categories of physical activities, sleep duration, and TV watching. Results: During a median follow-up time of 7 years, 200 participants had died. Higher total physical activity was significantly associated with lower all-cause mortality (HR: 0.53; 95% CI: 0.36–0.80, 4th vs. 1st quartile). Specifically, sports, walking, and gardening showed a significant inverse association with all-cause mortality (HR: 0.34; 95% CI: 0.20–0.59, HR: 0.65; 95% CI: 0.43–1.00, and HR: 0.62; 95% CI: 0.42–0.91, respectively for highest versus lowest category). Individuals with ≥2 h of sleep during the day had a significantly increased risk of all-cause mortality compared to individuals with no sleep at day (HR: 2.22; 95% CI: 1.43–3.44). TV viewing of ≥4 h per day displayed a significant 45% (95% CI: 1.02–2.06) higher risk of dying compared to ≤2 h per day of watching TV. Conclusions: Physical activity was inversely related to all-cause mortality; specific activity types might be primarily responsible for this association. More hours of sleep during the day and a higher amount of TV viewing were each associated with higher all-cause mortality. Based on available evidence, it is reasonable to recommend CRC survivors to engage in regular physical activity. Electronic supplementary material The online version of this article (10.1186/s12885-017-3697-3) contains supplementary material, which is available to authorized users