Longitudinal associations of fast foods, red and processed meat, alcohol and sugar-sweetened drinks with quality of life and symptoms in colorectal cancer survivors up to 24 months post-treatment.

Unhealthy dietary habits can contribute to the development of colorectal cancer (CRC). Such habits may also be associated with post-treatment symptoms experienced by CRC survivors. Therefore, we aimed to assess longitudinal associations of post-treatment unhealthy dietary habits, i.e. intake of ultra-processed foods (UPF), red and processed meat, alcohol and sugar-sweetened drinks, with health-related quality of life (HRQoL), fatigue and chemotherapy-induced peripheral neuropathy (CIPN) in CRC survivors from 6 weeks up to 24 months post-treatment. In a prospective cohort among stage I-III CRC survivors (n 396), five repeated home visits from diagnosis up to 24 months post-treatment were executed. Dietary intake was measured by 7-d dietary records to quantify consumption of UPF, red and processed meat, alcohol and sugar-sweetened drinks. HRQoL, fatigue and CIPN were measured by validated questionnaires. We applied confounder-adjusted linear mixed models to analyse longitudinal associations from 6 weeks until 24 months post-treatment. We applied a post hoc time-lag analysis for alcohol to explore the directionality. Results showed that higher post-treatment intake of UPF and sugar-sweetened drinks was longitudinally associated with worsened HRQoL and more fatigue, while higher intake of UPF and processed meat was associated with increased CIPN symptoms. In contrast, post-treatment increases in alcohol intake were longitudinally associated with better HRQoL and less fatigue; however, time-lag analysis attenuated these associations. In conclusion, unhealthy dietary habits are longitudinally associated with lower HRQoL and more symptoms, except for alcohol. Results from time-lag analysis suggest no biological effect of alcohol; hence, the longitudinal association for alcohol should be interpreted with caution.

Associations of the dietary World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendations with patient-reported outcomes in colorectal cancer survivors 2-10 years post-diagnosis: a cross-sectional analysis.

The World Cancer Research Fund and American Institute for Cancer Research (WCRF/AICR) advise cancer survivors to follow their lifestyle recommendations for cancer prevention. Adhering to these recommendations may have beneficial effects on patient-reported outcomes after a cancer diagnosis, but evidence is scarce. We aimed to assess associations of the individual dietary WCRF/AICR recommendations regarding fruit and vegetables, fibre, fast foods, red and processed meat, sugar-sweetened drinks and alcohol consumption with patient-reported outcomes in colorectal cancer (CRC) survivors. Cross-sectional data of 150 stage I-III CRC survivors, 2-10 years post-diagnosis, were used. Dietary intake was measured by 7-d dietary records. Validated questionnaires were used to measure health-related quality of life (HRQoL), fatigue and neuropathy. Confounder-adjusted linear regression models were used to analyse associations of each WCRF/AICR dietary recommendation with patient-reported outcomes. Higher vegetable intake (per 50 g) was associated with better global QoL (ß 2·6; 95 % CI 0·6, 4·7), better physical functioning (3·3; 1·2, 5·5) and lower levels of fatigue (-4·5; -7·6, -1·4). Higher fruit and vegetables intake (per 100 g) was associated with better physical functioning (3·2; 0·8, 5·5) and higher intake of energy-dense food (per 100 kJ/100 g) with worse physical functioning (-4·2; -7·1, -1·2). No associations of dietary recommendations with neuropathy were found. These findings suggest that adhering to specific dietary WCRF/AICR recommendations is associated with better HRQoL and less fatigue in CRC survivors. Although the recommendations regarding healthy dietary habits may be beneficial for the well-being of CRC survivors, longitudinal research is warranted to gain insight into the direction of associations.

Lifestyle changes and risk of cancer: experience from the Swedish women's lifestyle and health cohort study.

BACKGROUND: The impact of lifestyle changes on cancer risk is yet to be elucidated. We investigated this issue in the Swedish Women's Lifestyle and Health Cohort Study. MATERIAL AND METHODS: We measured changes by comparing two questionnaires, filled in 1991/92 and 2003. We followed women for cancer from 2003 until 2012. We used Cox regression models to assess the effect of changes in smoking, alcohol consumption, body mass index (BMI), physical activity and a lifestyle score on the risk of lifestyle-related cancer. One point was added to the lifestyle score for each of these: non-smoking, alcohol consumption ≤12 grams/day, BMI <25 kg/m2 and high level of physical activity. RESULTS: We included 29,930 women. From 1991/92 to 2003, median age changed from 40.0 to 51.7 years, alcohol consumption from 2.5 to 4.7 grams/day, BMI from 22.7 to 24.5 kg/m2, proportion of current smokers from 31.0 to 20.6% and women reporting high physical activity from 27.2 to 37.0%. Women who quit smoking had lower risk of smoking-related cancers compared to women who continued (hazard ratio (HR) 0.74, 95% confidence interval (CI) 0.55-1.00). Women who reduced their weight by more than 5%, compared to women with stable weight, had lower risk of breast cancer (HR 0.49, 95% CI 0.31-0.78). Among women with score of 0-2 in 1992/93, those who improved to 3-4 had lower risk of lifestyle-related cancers compared to women who did not (HR 0.81, 95% CI 0.66-0.99). CONCLUSIONS: Healthy lifestyle changes, particularly smoking cessation and weight reduction, were associated with a decreased risk of cancer.

Provision of Lifestyle Recommendations to Cancer Patients: Results of a Nationally Representative Survey of Hematologists/Oncologists.

Adopting a healthy lifestyle during cancer treatment enhances patients' outcomes. The purpose of this study is to evaluate the current practices and attitudes adopted by hematologists/oncologists on providing lifestyle recommendations to cancer patients. The secondary objective includes a correlation between the hematologists/oncologists' sociodemographic with their provision of lifestyle recommendations to their patients. This prospective, cross-sectional study surveyed Lebanese hematologists/oncologists in five major Lebanese governorates. The questionnaire collected information on participants' demographics and personal lifestyle choices as well as practices and perceptions related to lifestyle recommendations provided to cancer patients. A total of 40 hematologists/oncologists practicing in Lebanon completed the questionnaire with a response rate of 33.3%. The top three recommendations that hematologists/oncologists provided to their patients include quit smoking (95%), increase your physical activity (92.5%), and improve your nutrition/diet (85%). The mean number of recommendations provided per hematologist/oncologist was 3.88 (± 1.067). These discussions were consistently provided during clinical encounters with patients. The most frequently reported barriers hindering patient education on lifestyle recommendations included practitioners' lack of time and knowledge and patients' advanced stages of cancer and lack of interest in the topic. Hematologists/oncologists perceived these recommendations to be beneficial to patients' mental health and performance status, while few of them identified other benefits. Only one statistically significant correlation was identified between hematologists/oncologists' sociodemographic and providing the lifestyle recommendations to their patients. To achieve higher quality patient-centered care, communication gaps between hematologists/oncologists and cancer patients should be addressed, and solutions to identified barriers should be implemented.

Healthy lifestyle impact on breast cancer-specific and all-cause mortality.

PURPOSE: While several studies have evaluated the association of combined lifestyle factors on breast cancer-specific mortality, few have included Hispanic women. We constructed a "healthy behavior index" (HBI) and evaluated its associations with mortality in non-Hispanic White (NHW) and Hispanic women diagnosed with breast cancer from the southwestern U.S. METHODS: Diet and lifestyle questionnaires were analyzed for 837 women diagnosed with invasive breast cancer (1999-2004) in New Mexico as part of the 4-Corners Women's Health Study. An HBI score ranging from 0 to 12 was based on dietary pattern, physical activity, smoking, alcohol consumption, and body size and shape, with increasing scores representing less healthy characteristics. Hazard ratios for mortality over 14 years of follow-up were estimated for HBI quartiles using Cox proportional hazards models adjusting for education and stratified by ethnicity and stage at diagnosis. RESULTS: A significant increasing trend was observed across HBI quartiles among all women, NHW women, and those diagnosed with localized or regional/distant stage of disease for all-cause (AC) mortality (p-trend = 0.006, 0.002, 0.03, respectively). AC mortality was increased >2-fold for all women and NHW women in HBI Q4 versus Q1 (HR = 2.18, 2.65, respectively). The association was stronger in women with regional/distant than localized stage of disease (HR = 2.62, 1.94, respectively). Associations for Hispanics or breast cancer-specific mortality were not significant. CONCLUSIONS: These findings indicate the associations between the HBI and AC mortality, which appear to differ by ethnicity and stage at diagnosis. Interventions for breast cancer survivors should address the combination of lifestyle factors on prognosis.

Colorectal cancers survivors' adherence to lifestyle recommendations and cross-sectional associations with health-related quality of life.

The lifestyle recommendations of the World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR) are primarily intended for cancer prevention. In the absence of specific recommendations for cancer survivors, we investigated adherence of colorectal cancer (CRC) survivors to the WCRF/AICR lifestyle recommendations and associations with health-related quality of life (HRQoL). The cross-sectional part of the Energy for life after ColoRectal cancer (EnCoRe) study was conducted in 155 CRC survivors (stage I-III), 2-10 years post diagnosis. Dietary intake, physical activity and general body fatness were measured by 7-d food diaries, by questionnaires and accelerometers and BMI, respectively. Adherence to each of the ten WCRF/AICR recommendations was scored as 0 (no/low adherence), 0·5 (moderate adherence) or 1 point (complete adherence), and summed into an overall adherence score (range: 0-10). HRQoL, disability and distress were assessed by validated questionnaires. Associations of the overall WCRF/AICR adherence score with HRQoL outcomes were analysed by confounder-adjusted linear regression. The mean adherence score was 5·1 (sd 1·4, range: 1·5-8·5). In confounder-adjusted models, a higher adherence score was significantly associated with the HRQoL dimension better physical functioning (ß per 1 point difference in score: 2·6; 95 % CI 0·2, 5·1) and with less fatigue (ß: -3·3; 95 % CI -6·4, -0·1). In conclusion, higher adherence of CRC survivors to WCRF/AICR lifestyle recommendations for cancer prevention was associated with better physical functioning and with less fatigue. This study adds to the limited knowledge on adherence to lifestyle behaviours in CRC survivors and relationships with quality of life. Prospective studies are needed to investigate longitudinal associations.

Adherence to the 2006 American Heart Association's Diet and Lifestyle Recommendations for cardiovascular disease risk reduction is associated with bone mineral density in older Chinese.

This cross-sectional study investigated the association between the modified 2006 American Heart Association Diet and Lifestyle Recommendations (AHA-DLR) and bone mineral density in Chinese adults. We found that better adherence to the AHA-DLR associated with higher bone mineral density (BMD) at multiple sites. INTRODUCTION: Accumulating evidence shows that cardiovascular disease (CVD) and osteoporosis are associated with each other, yet little research has focused on whether strategies to reduce CVD risk could also benefit bone health. We aimed to assess the association between adherence to the modified 2006 American Heart Association Diet and Lifestyle Recommendations (AHA-DLR) and BMD in Chinese adults. METHODS: We included 2092 women and 1051 men aged 40-75 years in this community-based cross-sectional study. Dietary information was assessed using a 79-item food frequency survey through face-to-face interviews at baseline (2008-2010) and 3 years later (2011-2013). Adherence to the AHA-DLR was assessed using modified diet and lifestyle scores (American Heart Association Diet and Lifestyle Score (AHA-DLS)) adjusted for bone health. BMD for the whole body, lumbar spine, total hip, femur neck, and trochanter sites was measured using dual-energy X-ray absorptiometry in 2011-2013. RESULTS: After adjusting for potential covariates, greater adherence to the modified AHA-DLS was positively and dose-dependently associated with BMD. The mean BMD was 1.93-3.11% higher in quartile 4 (vs. 1) (all p values <0.01) at multiple sites. Five-unit increases in the modified AHA-DLS score were associated with 4.20-6.07, 4.44-8.51, and 3.36-4.67 mg/cm2 increases in BMD at multiple sites for the total subjects, males, and females, respectively (all p values <0.01). CONCLUSIONS: Better adherence to the AHA-DLR shows protective associations with BMD at multiple sites in the middle-aged and elderly Chinese population.

Adherence to the World Cancer Research Fund/American Institute for Cancer Research recommendations and breast cancer risk.

The World Cancer Research Fund/American Association for Cancer Research (WCRF/AICR) has published eight nutrition-related recommendations for the prevention of cancer. However, few prospective studies have examined these recommendations by breast cancer hormone receptor subtype and only one case-control study has included the dietary supplements recommendation in their evaluation. We investigated whether adherence to the WCRF/AICR cancer prevention recommendations was associated with breast cancer incidence, overall and by hormone receptor subtype, in the Swedish Mammography Cohort. Among 31,514 primarily postmenopausal women diet and lifestyle factors were assessed with a self-administered food frequency questionnaire. A score was constructed based on adherence to the recommendations for body fatness, physical activity, energy density, plant foods, animal foods, alcoholic drinks and dietary supplements (score range 0-7). Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs). During 15 years of follow-up 1,388 cases of breast cancer were identified. Women who met six to seven recommendations had a 51% decreased risk of breast cancer compared to women meeting only zero to two recommendations (95% CI = 0.35-0.70). The association between each additional recommendation met and breast cancer risk was strongest for the ER-positive/PR-positive subtype (HR = 0.86; 95% CI = 0.79-0.94), while for the ER-negative/PR-negative subtype the individual recommendations regarding plant and animal foods were most strongly associated with reduced risk. Our findings support that adherence to the WCRF/AICR recommendations reduces breast cancer risk in a population of primarily postmenopausal women. Promoting these recommendations to the public could help reduce breast cancer incidence.

A Healthy Lifestyle Score Is Associated with Cardiometabolic and Neuroendocrine Risk Factors among Puerto Rican Adults.

BACKGROUND: Although individual healthy lifestyle behaviors may reduce cardiovascular disease risk, few studies have analyzed the combined effect of multiple lifestyle components as one all-inclusive measure on such outcomes, much less in minority populations. OBJECTIVE: We aimed to develop a Healthy Lifestyle Score (HLS) that included several lifestyle recommendations and to test its association with metabolic syndrome (MetS) and allostatic load (AL) and their cardiometabolic and neuroendocrine factors in Puerto Ricans. METHODS: In a cross-sectional study in 787 Puerto Ricans living in Boston (aged 45-75 y), we developed an HLS that ranged from 0 to 190 (higher score indicative of healthier lifestyle) and included 5 components (diet, physical activity and sedentary behaviors, smoking, social support and network, and sleep). Multivariable-adjusted models were used to test associations between the HLS and biomarkers of dysregulation and odds of MetS and high AL (≥4 out of 10 components). RESULTS: The HLS showed adequate internal consistency (ρ = 0.31-0.69) and was inversely associated with urinary cortisol (ß ± SE = -0.22 ± 0.11; P = 0.042), epinephrine (-0.20 ± 0.09; P = 0.017), and norepinephrine (-0.26 ± 0.11; P = 0.016); waist circumference (-0.014 ± 0.004; P = 0.003); and serum insulin (-0.30 ± 0.13; P = 0.028) and positively associated with plasma HDL cholesterol (0.007 ± 0.003; P = 0.021) after adjustment for potential confounders. For each 20-unit increase in HLS, participants had 19% (95% CI: 2%, 33%) and 25% (11%, 36%) lower odds of MetS or AL, respectively. Healthier scores for social support and network and smoking components were associated with lower odds of high AL (P < 0.005). No significant associations were observed for other individual lifestyle components. CONCLUSIONS: Following an overall healthy lifestyle that comprises a combination of multiple behaviors may provide stronger protection against MetS and AL in Puerto Rican adults than individual components. The HLS may be a useful tool for examining health-related outcomes. This trial was registered at clinicaltrials.gov as NCT01231958.

Temporal trends in adherence to lifestyle recommendations of patients with hypertension in Korea, 2007-2021.

Adherence to lifestyle recommendations is crucial in managing hypertension, independent of medical treatment. This study aimed to evaluate the implementation of adherence to lifestyle recommendations and analyze the trends in adherence to lifestyle recommendations among patients with hypertension in Korea from 2007 to 2021 using the Korea National Health and Nutrition Examination Survey (KNHANES). The study included adults aged ≥20 years. Factors such as regular physical activity, smoking and alcohol abstinence, weight and stress management, and adherence to a healthy diet were analyzed. In 2021, A doublefold increase was observed in the proportion of patients with hypertension who adhered to sodium restriction compared to 2007. However, 70% of patients with hypertension consume more sodium than recommended. Moreover, potassium intake has steadily decreased since 2014, with only 23.8% of patients with hypertension meeting the recommended intake. The body mass index (BMI) and waist circumference of patients with hypertension have gradually increased, with fewer patients maintaining an appropriate weight. The neglect of diet and weight control among young patients with hypertension who experience high stress levels poses challenges in modifying their lifestyles. Patients with hypertension in Korea still consume high amounts of sodium, whereas potassium intake is gradually decreasing. Additionally, obesity rates have been increasing, especially among young patients with hypertension. A multidisciplinary approach is necessary for improving the lifestyle habits of hypertensive patients.

Operationalisation of a standardised scoring system to assess adherence to the World Cancer Research Fund/American Institute for Cancer Research cancer prevention recommendations in the UK biobank.

Introduction: In 2018, The World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR) published ten evidence-based Cancer Prevention Recommendations designed to reduce the risk of cancer via improved lifestyle behaviours. In 2019, Shams-White and colleagues created the "2018 WCRF/AICR Score" which aimed to standardise how adherence to these recommendations is assessed. The standardised scoring system includes seven of the recommendations concerning weight, physical activity and diet, with an optional eighth recommendation on breastfeeding. To promote transparency and reproducibility, the present paper describes the methodology for operationalisation of the standardised scoring system in the UK Biobank. Methods: UK Biobank recruited >500,000 individuals aged 37-73 years, between 2006 and 2010. In 2021, we held a workshop with experts which aimed to reach consensus on how to operationalise the scoring system using data available within UK Biobank. We used data on anthropometric measurements, physical activity and diet to calculate adherence scores. 24 h dietary assessment data were used to measure adherence to the following recommendations: "Eat a diet rich in wholegrains, vegetables, fruit, and beans", "Limit consumption of "fast foods" and other processed foods high in fat, starches or sugars" and "Limit consumption of sugar-sweetened drinks"; food frequency questionnaire data were used to assess adherence to "Limit consumption of red and processed meat" and "Limit alcohol consumption". Participants were allocated points for meeting, partially meeting or not meeting each recommendation, using cut-offs defined in the standardised scoring system. Results: At our workshop, discussions included the use of national guidelines to assess adherence to the recommendation on alcohol consumption, as well as challenges faced including defining the adapted ultra-processed food variables. A total score was calculated for 158,415 participants (mean 3.9 points, range 0-7 points). We also describe the methodology to derive a partial 5-point adherence score using data from the food frequency questionnaire in 314,616 participants. Conclusion: We describe the methodology used to estimate adherence to the 2018 WCRF/AICR Cancer Prevention Recommendations for participants in the UK Biobank, including some of the challenges faced operationalising the standardised scoring system.

Reported recommendations to address cardiovascular risk factors differ by socio-economic status in Brazil. Results from the Brazilian National Health Survey 2019.

Background: Management of cardiovascular risk factors (high cholesterol, diabetes, and hypertension) should start by implementing a healthy lifestyle. Whereas lifestyle recommendations are provided irrespective of the patient's socio-economic status has not been recently assessed in the Brazilian population. Aims: To assess the preventive measures against cardiovascular risk factors according to educational level and income in the Brazilian population. Methods: Survey data of the 2019 Brazilian National Health Survey (PNS). The PNS is a nationwide household-based survey carried out by the Brazilian Ministry of Health. The PNS included face-to-face interviews and collected information on lifestyle management of high cholesterol, diabetes, and hypertension by a healthy diet, an adequate weight, exercise, and quitting smoking. The participant's educational level and income (in multiples of the basic salary per capita) was collected. Results: Of the 88,052 participants included, 13,151 (14.9%), 6,986 (7.9%) and 22,516 (25.6%) reported being diagnosed with high cholesterol, diabetes, or hypertension, respectively. Dietary recommendations were the most frequently provided (94.5%, 94.6% and 88.1% for high cholesterol diabetes, and hypertension, respectively), while recommendations to quit smoking to current smokers were the least frequently provided (74.9%, 85.8% and 81.1% for high cholesterol, diabetes, and hypertension, respectively). After multivariable adjustment, participants with a higher educational level or a higher income had a higher likelihood of reporting receipt lifestyle recommendations for high cholesterol or hypertension, while no associations were found for most recommendations for diabetes. Conclusion: Better-educated, wealthier Brazilians report receiving more lifestyle recommendations regarding high cholesterol and hypertension management more frequently than lower-educated or with low-income.

Development of the Norwegian diet index and the Norwegian lifestyle index and evaluation in a national survey.

Background: Dietary and lifestyle indices are composite tools that are used to estimate risk of health outcomes. Objective: We aimed to develop a diet and a lifestyle index assessing adherence to the national guidelines in Norway, and to investigate adherence in a nationwide survey of healthy subjects (Norkost3). Design: Cut-off values for the indices were based on the Norwegian food based dietary guidelines and national lifestyle guidelines. Adherence was evaluated in the Norkost3 (n = 1,787). Results: Twelve dietary components were included in the diet index 1) fruit and berries, 2) vegetables, 3) whole grains, 4) unsalted nuts, 5) fish, 6) low-fat dairy products, 7) margarine/oils, 8) red meat, 9) processed meat, 10) foods rich in sugar and fat, 11) drinks with added sugar, and 12) dietary supplements. Each of the components was assigned a value of 0, 0.5 or 1 corresponding to low, intermediate and high adherence, except for plant-based foods, which were assigned a value of 0, 1.5 or 3, providing a composite diet index ranging from 0 to 20 points. The five components in the lifestyle index (i.e. diet, body mass index (BMI), physical activity, tobacco and alcohol) was assigned a value of 0, 0.5 or 1, giving a final score ranging from zero to five points. In Norkost3, 49% (95% CI: 47, 52) of the participants had low adherence to the diet component, whereas only 2% (95% CI: 2, 3) achieved high adherence, although most of the subjects had high educational level. High adherence to the recommendations of BMI, tobacco and alcohol intake was observed in 50% (95% CI: 47, 52), 72% (95% CI: 70, 74) and 68% (95% CI: 66, 70) of the participants, respectively. Due to the lack of data on physical activity, adherence to this component in the lifestyle index is not presented in this study. Conclusion: The new diet and lifestyle indices assess adherence to the Norwegian food-based dietary guidelines (FBDGs) and other national lifestyle guidelines. In this study, half of the subjects had low diet and lifestyle index scores. There is a need to implement interventions to improve this by focusing on the specific lifestyle components with low adherence.

Underuse of lifestyle recommendations in hypertension management in France: The Esteban study.

Lifestyle recommendations are first-line elements in the management of arterial hypertension. This cross-sectional study aimed to analyze the level to which lifestyle recommendations are used in hypertension management in France, using data from the Esteban study, which was implemented by Santé Publique France, France's public health agency, from 2014 to 2016 on a representative sample of the French population. The study sample comprised 440 adult Esteban participants who were aware they had hypertension and were aged 18-74 years old. The main outcomes were the proportion of participants who received lifestyle recommendations in their hypertension management plan, and the proportion of recommendations according to the three following dimensions: physical activity, weight loss, and changes in diet. Over half (57.0%) of the 440 participants declared they did not receive lifestyle recommendations as part of their hypertension management plan in the year preceding the study. Of these, 39.0% did not receive pharmacological treatment either. Physical activity was recommended to 31.8% of sedentary participants and weight loss to 26.8% of participants with overweight or obesity. One-fifth of the study sample (20.1%) received dietary recommendations. Of these, 69% and 10.7% were advised to limit their salt and alcohol intake, respectively. Lifestyle interventions are too rarely recommended in hypertension management plans in France. Adherence to lifestyle recommendations needs in-depth discussion not only at the time of diagnosis but also throughout follow-up.

Limited Changes in Lifestyle Behaviours after Non-Muscle Invasive Bladder Cancer Diagnosis.

The aim of our study was to investigate adherence to lifestyle recommendations and lifestyle changes after diagnosis in patients with non-muscle invasive bladder cancer (NMIBC). Second, we aimed to identify distinct trajectories of lifestyle change and their correlates. We analysed data of 935 patients with NMIBC from a prospective cohort study at six weeks (evaluating pre-diagnostic lifestyle), three months, and fifteen months after diagnosis. An overall lifestyle score (range 0-7) was calculated based on the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendations focusing on diet, body mass index, and physical activity. Linear mixed models were used to analyse absolute lifestyle changes over time. Distinct trajectories of change were identified with latent class trajectory models. We found an overall lifestyle score of 3.3 which remained constant over time. The largest lifestyle changes were observed for the consumption of red and processed meat (-96 g/week) and fruit and vegetables (-38 g/day). Two to four trajectory groups were identified for each single lifestyle behaviour. Correlates differed per trajectory group. In conclusion, adherence to the WCRF/AICR recommendations was low. Small to moderate changes in and different trajectories of single lifestyle behaviours were observed. Effective strategies for lifestyle improvement are warranted.

Longitudinal Associations of Adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Lifestyle Recommendations with Quality of Life and Symptoms in Colorectal Cancer Survivors up to 24 Months Post-Treatment.

Post-treatment adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) lifestyle recommendations were associated with health-related quality of life (HRQoL), fatigue, and chemotherapy-induced peripheral neuropathy (CIPN) in colorectal cancer (CRC) survivors. In a prospective cohort among CRC survivors (n = 459), repeated home-visits were performed at 6 weeks, 6, 12, and 24 months post-treatment. Dietary intake, body composition, sedentary behaviour, and physical activity were assessed to construct a lifestyle score based on adherence to seven 2018 WCRF/AICR recommendations. Longitudinal associations of the lifestyle score with HRQoL, fatigue, and CIPN were analysed by confounder-adjusted linear mixed models. A higher lifestyle score was associated with better physical functioning and less activity-related fatigue, but not with CIPN. Adjustment for physical activity substantially attenuated observed associations, indicating its importance in the lifestyle score with regards to HRQoL. In contrast, adjustment for body composition and alcohol inflated observed associations, indicating that both recommendations had a counteractive influence within the lifestyle score. Our findings suggest that CRC survivors benefit from an overall adherence to the WCRF/AICR lifestyle recommendations in terms of HRQoL and fatigue, but not CIPN. Specific recommendations have a varying influence on these associations, complicating the interpretation and requiring further study.

Clinical and Sociodemographic Determinants of Adherence to World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Recommendations in Breast Cancer Survivors-Health-EpiGEICAM Study.

Breast cancer (BC) survivors are advised to follow the WCRF/AICR cancer prevention recommendations, given their high risk of developing a second tumour. We aimed to explore compliance with these recommendations in BC survivors and to identify potentially associated clinical and sociodemographic factors. A total of 420 BC survivors, aged 31-80, was recruited from 16 Spanish hospitals. Epidemiological, dietary and physical activity information was collected through questionnaires. A 7-item score to measure compliance with the recommendations was built according to the 2018 WCRF/AICR scoring criteria. Standardized prevalences and standardized prevalence ratios of moderate and high compliance across participant characteristics were estimated using multinomial and binary logistic regression models. The mean score was 3.9 (SD: 1.0) out of 7 points. Recommendations with the worst adherence were those of limiting consumption of red/processed meats (12% of compliance, 95% CI: 8.2-15.0) and high fibre intake (22% of compliance, 95% CI: 17.6-27.0), while the best compliance was observed for the consumption of fruits and vegetables (73% of compliance, 95% CI: 69.2-77.7). Overall, adherence was worse in women with university education and in those with first-degree relatives with BC. This information may be of interest to design and implement personalized preventive measures adapted to the characteristics of these patients.

The effect of kinesio taping and lifestyle changes on pain, body awareness and quality of life in primary dysmenorrhea.

The aim of this study was to investigate the effects of kinesio taping and lifestyle changes on pain, body awareness, and quality of life in individuals with primary dysmenorrhea (PD). Subjects in the first group underwent kinesio taping and lifestyle changes and subjects in the second group were instructed only lifestyle changes. The pain levels were evaluated using a visual analogue scale, menstrual symptoms using the Menstrual Symptom Questionnaire, health-related life quality using the Short Form-36, and changes in body awareness using the Body Awareness Questionnaire form. Pain intensity decreased, and body awareness and quality of life increased in both groups (p < 0.05). However, in the first group, pain severity decreased more, and body awareness and quality of life increased more (p < 0.05). As a result, it is thought that both kinesio taping and lifestyle changes can be used to improve quality of life and body awareness and to decrease pain level.

Colorectal cancer survivors only marginally change their overall lifestyle in the first 2 years following diagnosis.

PURPOSE: A healthy lifestyle after colorectal cancer (CRC) diagnosis may improve prognosis. Data related to lifestyle change in CRC survivors are inconsistent and potential interrelated changes are unknown. METHODS: We assessed dietary intake, physical activity, body mass index (BMI), waist circumference, and smoking among 1072 patients diagnosed with stages I-III CRC at diagnosis, 6 months and 2 years post-diagnosis. An overall lifestyle score was constructed based on the 2018 World Cancer Research Fund/American Institute of Cancer Research recommendations (range 0-7). We used linear mixed models to analyze changes in lifestyle over time. RESULTS: Participants had a mean (± SD) age of 65 ± 9 years and 43% had stage III disease. In the 2 years following CRC diagnosis, largest changes were noted for sugary drinks (- 45 g/day) and red and processed meat intake (- 62 g/week). BMI (+ 0.4 kg/m2), waist circumference (+ 2 cm), and dietary fiber intake (- 1 g/day) changed slightly. CRC survivors did not statistically significant change their mean intake of fruits and vegetables, alcohol, or ultra-processed foods nor did they change their physical activity or smoking behavior. Half of participants made simultaneous changes that resulted in improved concordance with one component as well as deteriorated concordance with another component of the lifestyle score. Overall lifestyle score changed from a mean 3.4 ± 0.9 at diagnosis to 3.5 ± 0.9 2 years post-diagnosis. CONCLUSIONS: CRC survivors hardly improve their overall lifestyle after diagnosis. IMPLICATIONS FOR CANCER SURVIVORS: Given the importance of a healthy lifestyle, strategies to effectively support behavior changes in CRC survivors need to be identified.

Low awareness, adherence, and practice but positive attitudes regarding lifestyle recommendations among non-muscle-invasive bladder cancer patients.

BACKGROUND: A healthy lifestyle may reduce the risk of non-muscle-invasive bladder cancer (NMIBC) recurrence. The objective of this study was to obtain insight in whether NMIBC patients are aware of possible risk factors for (bladder) cancer, adhere to lifestyle recommendations for cancer prevention, received lifestyle advice from their physician, and what their attitudes are towards physicians giving lifestyle advice. METHODS: Patients with newly diagnosed NMIBC between 2014 and 2017 participating in the UroLife cohort study completed questionnaires at 6 weeks and 3 months after diagnosis about awareness of (bladder) cancer risk factors, adherence to lifestyle recommendations, reception of lifestyle advice, and attitudes towards physicians giving lifestyle advice. RESULTS: A total of 969 NMIBC patients were included (response rate 46%). Most patients (89%) were aware that smoking is a risk factor for cancer, and knowledge of other risk factors for cancer varied between 29% (low fruit and vegetable consumption) and 67% (overweight). Adherence to cancer prevention recommendations varied between 34% (body weight) and 85% (smoking). Of the smokers, 70% reported they were advised to quit, and 36% quit smoking in the three months before or after diagnosis. Only 21% of all patients indicated they received other lifestyle advice. More than 80% of patients had a positive attitude towards receiving lifestyle advice from their physician. CONCLUSIONS: These findings show that awareness of (bladder) cancer risk factors and adherence to cancer prevention lifestyle recommendations among NMIBC patients is low and that physicians' information provision should be improved.