Nutrients and diet quality in gastrointestinal cancers

Findings on the role of foods in the risk of gastrointestinal cancers are not consistent. This thesis studied the role of some essential dietary components that are required for normal development and function, as well as that of balanced and healthy patterns of diet intake, on the risk of gastrointestinal cancers. We show that neither synthetic folic acid nor the blood level folate is associated with an increased risk of colorectal cancer (Chapter 2). However, the results of a large study show that supplementing folic acid and iron at higher levels than provided in the original food may increase the risk for colorectal cancer (Chapter 3). The risk of colorectal cancer also seems not to be increased for pregnant women taking synthetic folic acid according to data from smaller study (Chapter 4). As anticipated, healthy and balanced diet intake patterns are associated with lower risks of gastrointestinal cancers, yet the findings are of insufficient quality to develop dietary recommendations for gastrointestinal cancers prevention (Chapters 5, 6, & 7). Moreover, healthy food intake is inadequate among cancer survivors (Chapter 8). The effect of folic acid and iron, as well as that of a healthy and balanced pattern of food and beverage intake, remain unclear regarding gastrointestinal cancer. Future studies will need to assess the role of inherited features on the effect of essential nutrients in diet and on the healthiest patterns of diet intake needed to prevent gastrointestinal cancer

Staple Food Fortification with Folic Acid and Iron and Gastrointestinal Cancers:Critical Appraisal of Long-Term National Fortification

The co-occurrence of wheat flour fortification with folic acid and iron and gastrointestinal cancer incidences were critically assessed in the East Azerbaijan province in Northwest of Iran. In an ecological design, overall gastrointestinal cancer rate ratios and their 95% confidence intervals (95% CI) were calculated as primary outcome before (2004-2006) and after (2007-2015) the introduction of fortification. No consistent changes were observed in esophageal and gastric cancer, but the rate ratios of colorectal cancer increased significantly after fortification in the 35-54 years age group (women: 2.07, 95% CI: 1.79-2.49; men: 1.59, 95% CI: 1.33-1.89) and the 55-74 years age group (women 1.50, 95% CI: 1.27-1.76; men: 2.51, 95% CI: 2.13-2.95). The increased incidence of colorectal cancer was contemporary with long-term fortification; further investigation is required to establish the associations

Folic Acid Supplement Intake and Risk of Colorectal Cancer in Women; A Case Control Study

Background: An ongoing controversy exists on the role of folic acid supplementation in colorectal cancer risk among epidemiological studies. Objective: To assess the association between maternal folic acid supplementation and colorectal cancer risk. Methods: A paired matched case control study of 405 subjects was performed, including women residing in 135 villages of East Azerbaijan, Iran. Per area, subjects were followed regularly in local healthcare centers, where health- and social-related information have been collected prospectively in face to face interviews by well-trained health workers. We extracted folic acid supplement intake, baseline characteristics, and confounders from healthcare records. The data for study participants were linked to national cancer registry repositories, from which we retrieved the data of 135 women diagnosed with colorectal cancer between 2005 to 2015. Two hundred seventy controls were individually matched with cases in terms of residing village, age, and gender. We applied multivariate conditional logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Findings: There was no significant association between folic acid supplementation and colorectal cancer risk in those with history of folic acid intake compared to those with no history of intake (OR 0.95; 95% CI 0.59 to 1.53), in those with less than five years of folic acid (0.79; 0.45 to 1.39) or in those with ≥5 years intake (1.09; 0.52 to 2.26). This risk did not change after adjustment for covariates or further stratification. Conclusions: Maternal folic acid supplementation did not affect colorectal cancer risk in a population where supplemental folic acid is prescribed with regular intervals for women of child-bearing age

Assessment of Diet Quality and Adherence to Dietary Guidelines in Gastrointestinal Cancer Survivors:A Cross-Sectional Study

Diet quality among short- and long-term gastrointestinal (GI) cancer survivors with different tumor sites was investigated compared to a reference population cohort. Diet quality of GI cancer survivors (n = 307) was compared to an age- and sex-matched reference population with no history of cancer (n = 3070). All were selected from Lifelines, a population-based cohort. GI cancers were defined as having a history of cancer of the bowel, esophagus, or stomach. Diet quality was assessed by a self-administrated food frequency questionnaire in terms of: (i) Lifelines Diet (LLD) scores, where higher scores indicate higher diet quality; (ii) the adherence to dietary guidelines, quantified by the percentage of meeting dietary recommendations, as given by Dutch dietary guidelines; and (iii) the mean daily intake of food components. All analyses were adjusted for lifestyle factors. Diet scores in GI cancer survivors were not different from the reference population (OR = 0.97, 95% CI: 0.73-1.23). Stratification for time since diagnosis and tumor site gave similar results. The intake of vegetables, unsweetened dairies, and nuts and legumes was almost 50% lower than the recommended amount, and the mean intake of unhealthy food components was at least one serving/day among GI cancer survivors, as well as in the reference population. In the long run, GI cancer survivors do not differ from the reference population in their diet quality. In conclusion, both groups can improve their diet quality

The effect of grape-seed oil on diabetes-related hyperglycemia, dyslipidemia, and inflammation in streptozotocin-induced diabetic rats

Background: Grape-seed oil has diverse biological functions and is beneficial in treating metabolic complications, such as metabolic syndrome, obesity, diabetes, and dyslipidemia. The purpose of this study was to investigate the anti-hyperglycemic, anti-dyslipidemic, and anti-inflammatory effects of Grape-seed oil in diabetic rats. Materials and methods: 16 streptozotocin-induced diabetic Wistar rats were used in this study. Diabetic rats were randomly allocated to either of two groups (n = 8): diabetic rats treated with grape-seed oil or diabetic control. Grape-seed oil (GSO) (25 mg/kg BW) was administered orally for 40 days, and at the end, blood samples were taken directly from the heart. Results: Diabetic rats treated with oil compared to control diabetic rats demonstrated a significant (p = 0.001) decline in serum glucose concentration. High plasma concentrations of TG, LDL, and VLDL were reduced (p = 0.001, p = 0.001, p = 0.001, respectively). Surprisingly, between inflammatory markers, TNF-α was significantly (p = 0.02) increased. Furthermore, GSO-treated diabetic rats experienced a significant (p = 0.014) weight gain during the study. However, total cholesterol, HDL, and CRP levels did not change significantly. Conclusion: Treatment with grape-seed oil ameliorated dyslipidemia and hyperglycemia in diabetic rats. However, further investigations in peculiar clinical studies are required.</p

Diet quality indices and gastrointestinal cancer risk:results from the Lifelines study

OBJECTIVE: To investigate the long-term association between four dietary quality indices and the risk of gastrointestinal (GI) cancer. METHODS: Baseline details of the dietary intake of participants, assessed by a single food frequency questionnaire from the prospective Lifelines population-based cohort were translated to diet quality scores using several dietary and dietary-lifestyle indices. Incident cases of GI cancer were then assessed by linkage to the Dutch nationwide histo-cytopathology registry. The association between GI cancer risk and diet quality (defined as higher quintiles on dietary indices compared to the first quintile) was assessed by multivariable Cox proportional hazard models. RESULTS: We included 72,695 participants aged 51.20 ± 8.71 years with a median follow-up to cancer diagnosis of 8 years (interquartile range 2 years). During follow-up, 434 colorectal cancers and 139 upper GI cancers were diagnosed. There was a significant reduction in colorectal cancer risk for high categories in the American Cancer Society (ACS) Index (hazard ratio 0.62; 95% CI 0.46–0.84). However, high dietary index scores were not associated with strong beneficial effects on upper GI cancer risk. CONCLUSION: High quintiles on the ACS Index were associated with a significantly reduced risk of colorectal cancer. This index may be of use in a colorectal cancer prevention program. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00394-021-02648-3

Diet Quality and Upper Gastrointestinal Cancers Risk:A Meta-Analysis and Critical Assessment of Evidence Quality

We aimed to assess the effect of a high-quality diet on the risk of upper gastrointestinal cancer and to evaluate the overall quality of our findings by searching PubMed, EMBASE, Web of Science, Cochrane, and the references of related articles to February 2020. Two reviewers independently retrieved the data and performed the quality assessments. We defined the highest-quality diet as that with the lowest Diet Inflammatory Index category and the highest Mediterranean Diet Score category. Overall odds ratios and 95% confidence intervals were estimated for upper gastrointestinal cancer risk comparing the highest- versus lowest-diet quality. A random-effects meta-analysis was then applied with Review Manager, and the quality of the overall findings was evaluated with the Grading of Recommendations Assessment, Development, and Evaluation approach. The highest-quality diets were significantly associated with reduced risk of upper gastrointestinal cancers, achieving odds ratios of 0.59 (95% confidence interval: 0.48-0.72) for the Diet Inflammatory Index, pooling the findings from nine studies, and 0.72 (95% confidence interval: 0.61-0.88) for the Mediterranean Diet Score, pooling the findings from 11 studies. We observed a minimum of 69% heterogeneity in the pooled results. The pooled results were graded as low quality of evidence. Although it may be possible to offer evidence-based general dietary advice for the prevention of upper gastrointestinal cancers, the evidence is currently of insufficient quality to develop dietary recommendations

The effect of grape-seed oil on diabetes-related hyperglycemia, dyslipidemia, and inflammation in streptozotocin-induced diabetic rats

Background: Grape-seed oil has diverse biological functions and is beneficial in treating metabolic complications, such as metabolic syndrome, obesity, diabetes, and dyslipidemia. The purpose of this study was to investigate the anti-hyperglycemic, anti-dyslipidemic, and anti-inflammatory effects of Grape-seed oil in diabetic rats. Materials and methods: 16 streptozotocin-induced diabetic Wistar rats were used in this study. Diabetic rats were randomly allocated to either of two groups (n = 8): diabetic rats treated with grape-seed oil or diabetic control. Grape-seed oil (GSO) (25 mg/kg BW) was administered orally for 40 days, and at the end, blood samples were taken directly from the heart. Results: Diabetic rats treated with oil compared to control diabetic rats demonstrated a significant (p = 0.001) decline in serum glucose concentration. High plasma concentrations of TG, LDL, and VLDL were reduced (p = 0.001, p = 0.001, p = 0.001, respectively). Surprisingly, between inflammatory markers, TNF-α was significantly (p = 0.02) increased. Furthermore, GSO-treated diabetic rats experienced a significant (p = 0.014) weight gain during the study. However, total cholesterol, HDL, and CRP levels did not change significantly. Conclusion: Treatment with grape-seed oil ameliorated dyslipidemia and hyperglycemia in diabetic rats. However, further investigations in peculiar clinical studies are required.</p