Longitudinal associations of sociodemographic, lifestyle, and clinical factors with alcohol consumption in colorectal cancer survivors up to 2 years post-diagnosis

Purpose Alcohol consumption can lead to worse prognosis and mortality among colorectal cancer (CRC) patients. We investigated alcohol consumption of CRC survivors up to 2 years post-diagnosis, and how sociodemographic, lifestyle, and clinical factors were associated longitudinally with these habits. Methods We pooled longitudinal data of 910 CRC survivors from the ongoing PROCORE and EnCoRe studies with data collected at diagnosis (baseline) and 3, 6, 12, and 24 months post-diagnosis. Both studies assessed alcohol consumption, including beer, wine, and liquor. Generalized estimated equation models were used to examine changes over time in alcohol consumption and multivariable longitudinal associations of sociodemographic, lifestyle, and clinical factors with alcohol consumption. Results At baseline, participants were on average 67 years old, 332 (37%) were female, and alcohol was consumed by 79%. Most survivors (68-71%) drank less at all follow-ups. Beer, wine, and liquor were consumed by 51%, 58%, and 25% at baseline, respectively, and these declined over time. Males consumed more alcohol, and higher education, more physical activity, and not having a (permanent) stoma were associated with consuming more alcohol. Conclusion CRC survivors decreased their alcohol consumption in the 2 years post-diagnosis. Future studies should take the significant factors that were associated with alcohol post-diagnosis consumption into account, when they investigate CRC health outcomes or for identifying subgroups for interventions. Males with higher education, more physical activity, and no stoma should be reminded after diagnosis for reducing their alcohol consumption

Longitudinal associations of fiber, vegetable, and fruit intake with quality of life and fatigue in colorectal cancer survivors up to 24 months post-treatment

BACKGROUND: The increasing colorectal cancer (CRC) survivor population highlights the need for dietary recommendations in order to enhance health-related quality of life (HRQoL) and alleviate symptoms of fatigue, chemotherapy-induced peripheral neuropathy (CIPN), and gastrointestinal problems. OBJECTIVES: Because of the therapeutic potential of dietary fiber on the gut, we aim to assess longitudinal associations of postdiagnostic dietary fiber, fruit, and vegetable intake, a major source of dietary fiber, with HRQoL, fatigue, CIPN, and gastrointestinal symptoms in CRC survivors from 6 wk to 24 mo posttreatment. METHODS: In a prospective cohort among stage I–III CRC survivors (n = 459), 5 repeated study measurements between diagnosis and 24 mo posttreatment were executed. Dietary fiber intake and fruit and vegetable intake were measured by 7-d dietary records. HRQoL, fatigue, CIPN, and gastrointestinal symptoms were measured by validated questionnaires. We applied confounder-adjusted linear mixed models to analyze longitudinal associations from 6 wk until 24 mo posttreatment and used hybrid models to disentangle the overall association into intraindividual changes and interindividual differences over time. RESULTS: Higher dietary fiber intake and fruit and vegetable intake were longitudinally associated with statistically significant better physical functioning and less fatigue. Intraindividual analyses showed that an increase of 10 g/d in dietary fiber within individuals over time was associated with better physical functioning (β: 2.3; 95% CI: 0.1, 4.4), role functioning (ability to perform daily activities; 5.9; 1.5, 10.3), and less fatigue (−4.1; −7.7, −0.5). An average increase in fruit and vegetable intake of 100 g/d between individuals over time was predominantly associated with less fatigue (−2.2; −4.2, −0.3). No associations were found with CIPN and gastrointestinal symptoms. CONCLUSIONS: Our results suggest that increasing dietary fiber, fruit, and vegetable intake is related to better physical and role functioning and less fatigue in the first 2 y after the end of treatment for CRC

Circulating B-vitamin biomarkers and B-vitamin supplement use in relation to quality of life in patients with colorectal cancer: results from the FOCUS consortium

Background: B vitamins have been associated with the risk and progression of colorectal cancer (CRC), given their central roles in nucleotide synthesis and methylation, yet their association with quality of life in established CRC is unclear.Objectives: To investigate whether quality of life 6 months postdiagnosis is associated with: 1) circulating concentrations of B vitamins and related biomarkers 6 months postdiagnosis; 2) changes in these concentrations between diagnosis and 6 months postdiagnosis; 3) B-vitamin supplement use 6 months postdiagnosis; and 4) changes in B-vitamin supplement use between diagnosis and 6 months postdiagnosis.Methods: We included 1676 newly diagnosed stage I-III CRC patients from 3 prospective European cohorts. Circulating concentrations of 9 biomarkers related to the B vitamins folate, riboflavin, vitamin B6, and cobalamin were measured at diagnosis and 6 months postdiagnosis. Information on dietary supplement use was collected at both time points. Health-related quality of life (global quality of life, functioning scales, and fatigue) was assessed by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire 6 months postdiagnosis. Confounder-adjusted linear regression analyses were performed, adjusted for multiple testing.Results: Higher pyridoxal 5'-phosphate (PLP) was cross-sectionally associated with better physical, role, and social functioning, as well as reduced fatigue, 6 months postdiagnosis. Associations were observed for a doubling in the hydroxykynurenine ratio [3-hydroxykynurenine: (kynurenic acid + xanthurenic acid + 3-hydroxyanthranilic acid + anthranilic acid); an inverse marker of vitamin B6] and both reduced global quality of life (beta = -3.62; 95% CI: -5.88, -1.36) and worse physical functioning (beta = -5.01; 95% CI: -7.09, -2.94). Dose-response relations were observed for PLP and quality of life. No associations were observed for changes in biomarker concentrations between diagnosis and 6 months. Participants who stopped using B-vitamin supplements after diagnosis reported higher fatigue than nonusers.Conclusions: Higher vitamin B6 status was associated with better quality of life, yet limited associations were observed for the use of B-vitamin supplements. Vitamin B6 needs further study to clarify its role in relation to quality of life

Increased intima-media thickness in familial combined hyperlipidemia associated with apolipoprotein B

University Hospital Maastricht, Department of Medicine, Cardiovascular Research Institute Maastricht, the Netherlands. The aim of the present study was to quantify intima-media thickness (IMT) in familial combined hyperlipidemia (FCHL) and to evaluate the relationship of IMT in FCHL-affected subjects with lipids and apolipoproteins, blood pressure values, and surrogate markers of insulin resistance. IMT was measured by ultrasound at the left and right common carotid arteries in 46 FCHL-affected subjects who were free of clinical manifestations of atherosclerosis and in 55 age- and sex-matched healthy control subjects. FCHL-affected subjects had significantly increased IMT compared with healthy control subjects, with a difference of 57 microm (age- and sex-corrected P<0.01). In the FCHL group, significantly positive age- and sex-corrected univariate correlations were observed between IMT and total cholesterol, non-high density lipoprotein cholesterol, and apolipoprotein B. Multivariate regression analyses revealed that age, sex, and apolipoprotein B were significant and independent predictors of IMT, whereas body mass index was of borderline significance. Combined, these factors explained almost 50% of the observed IMT variation (P<0.001). The increased IMT observed in FCHL corresponds with approximately 7 years of physiological IMT increase in excess of the average IMT in age- and sex-matched control subjects. These novel findings show the important relationship between lipoprotein particles, marked by increased apolipoprotein B concentrations, and an increased IMT in FCHL. The increased IMT in FCHL-affected subjects is in agreement with the known high risk of cardiovascular disease in FCHL. Publication Types: Clinical Trial Randomized Controlled Tria

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Associations between alcohol consumption and anxiety, depression, and health-related quality of life in colorectal cancer survivors

Purpose Alcohol consumption is a major risk factor for colorectal cancer (CRC). It is currently poorly understood, however, how alcohol and different alcoholic beverage types are related to psychosocial outcomes in CRC survivors. Methods We used data of N = 910 CRC survivors from the pooled EnCoRe and PROCORE cohorts and harmonized them into five time points: at diagnosis and 3, 6, 12, and 24 months post-diagnosis. Generalized estimated equation models were used to examine longitudinal associations of alcohol consumption, including consumption of beer, wine, and liquor, with anxiety, depression, and health-related quality of life (HRQoL), while correcting for sociodemographic, lifestyle, and clinical factors. Results Survivors were on average 67 years and 37% was female. In the first 2 years post-diagnosis, survivors who consumed more alcoholic drinks/week reported lower anxiety and depressive symptoms and better HRQoL on all domains and symptom scales. This was the case for moderate and heavy amounts of alcohol and mostly for consuming beer and wine, but not for liquor. Associations were more often significant for men and for younger persons (< 67 years at baseline). Conclusions Generally, alcohol consumption was observed to be longitudinally related to less anxiety and depression and better HRQoL in CRC survivors. Implications for Cancer Survivors Although alcohol consumption is generally unfavorable due to increased risk of carcinogenesis and worse prognosis after CRC, it seems to be associated with better psychosocial outcomes in the first 2 years after diagnosis and treatment. More research is needed to gain knowledge about reasons for drinking and causality

Reduced structural and functional skin capillaries in familial combined hyperlipidemia affected men, associated with increased remnant-like lipoprotein cholesterol levels

Laboratory of Molecular Metabolism and Endocrinology, Department of Medicine, Cardiovascular Research Institute Maastricht, University Hospital Maastricht, The Netherlands. We determined whether abnormalities in the number of basal (BC) and post-occlusive (POC) capillaries are present in familial combined hyperlipidemia (FCHL), and investigated the possible relationship of BC and POC with lipids, remnant-like lipoprotein particles (RLP-C), blood pressure, and insulin resistance. Fifty age-matched subjects, 23 (12 men) hyperlipidemic, normotensive FCHL subjects and 27 (14 men) healthy controls participated in this study. Capillary density was measured just above the finger nailfold, before and after 4 min of arterial occlusion. The number of BC and POC were significantly lower in FCHL men compared with healthy men, 113.7+/-15.1 versus 132.0+/-18.0 (P=0.02) and 123+/-19.1 versus 142.3+/-18.3 (P=0.03), respectively. No differences were found between FCHL women and control women. In univariate analyses in FCHL men, BC was inversely correlated with total cholesterol (r=-0.63; P=0.05). POC tended to be inversely correlated with total cholesterol (r=-0.62; P=0.056). No univariate correlations (P>0.3) were observed between BC or POC and blood pressure or insulin resistance. Multivariate analyses revealed that logRLP-C was the only significant independent contributor to BC and POC. This is the first description of a reduction in skin capillaries in FCHL men, which was associated with increased atherogenic lipoprotein levels. Loss of capillary surface may be important in the pathophysiology or can result from adaptation to the hyperlipidemia in FCHL