Lifestyle in patients at increased risk of colorectal cancer.

BACKGROUND: The present study aimed to assess modifiable risk factors in patients at high risk for colorectal cancer (CRC) and their experience of lifestyle advice. METHODS: A questionnaire study was conducted in high-risk CRC patients attending for surveillance colonoscopy. Current lifestyle behaviours [smoking, alcohol, diet (fruit and vegetables, wholegrains, red meat, processed meat), physical activity and bodyweight] related to CRC were ascertained, and experience on receiving, seeking and desire for advice was queried. RESULTS: In total, 385 study invitations were sent and 208 (54%) questionnaires were returned. The majority of participants (72%) were estimated to have a body mass index beyond the healthy range, 89% achieved a fibre score indicative of a low plant-based diet and 91% reported eating processed meat. Overall, 36% were achieving at least four recommendations and 2% were adhering to all recommendations examined. The main area in which participants reported receiving advice on was body weight (33%) and 31% reported that they had personally sought information on this topic, although the data suggest that 72% of people may benefit from such guidance. Fewer participants reported receiving (18-26%) and seeking (15-17%) dietary advice on fruits, vegetables and wholegrains. Many participants said they would find lifestyle information useful, notably in relation to body fatness (43%) and physical activity (38%). CONCLUSIONS: The development of a process for supporting lifestyle change in this patient group, comprising individuals who are already engaging in positive health practices (regular colonoscopy surveillance), could usefully be identified and tested.

Colorectal adenomas and diabetes: implications for disease prevention.

AIM: This study assessed the baseline type II diabetes mellitus (T2DM) risk status among overweight patients with screen-detected colorectal adenomas and explored the implications of the findings for preventative practice. METHOD: Participants aged between 50 and 74 years (73% of whom were men) were recruited from four Scottish health boards and assessed for diabetes risk. Participants were categorized as at 'high' diabetes risk if glycated haemoglobin (HbA1c) was between 6.0 and 6.4% or fasting plasma glucose (FPG) was between 5.5 and 6.9 mmol/l and as potentially undiagnosed T2DM when HbA1c ≥ 6.5% or FPG ≥ 7 mmol/l. Secondary outcome measures included anthropometric measurements, blood pressure and the plasma lipid profile. The tests were repeated at 12 months and diabetes risk categories were reassessed following intervention procedures. RESULTS: Forty-seven (14.3%) of the 329 participants had a preexisting diagnosis of T2DM. Of the remainder with complete biochemistry results (n = 250), 19 (7.6%) were classified as having potentially undiagnosed T2DM and 125 (50.0%) as being at high risk of developing diabetes. More than a quarter of participants in all categories had raised waist circumference, hypertension and plasma lipids, indicative of raised cardiovascular risk. At 12 months' follow-up, the diabetes risk category diminished in 20% of the intervention group vs 11% in the controls [OR 2.26 (95% CI 1.03-4.96)]. CONCLUSION: Our results suggest that a diagnosis of adenoma in overweight patients provides a health service opportunity for diabetes assessment, prevention and management in a high-risk population at a potentially teachable moment.

Obesity and lifestyle advice in colorectal cancer survivors - how well are clinicians prepared?

AIM: This study aimed to assess colorectal clinicians' knowledge and understanding about the risks and benefits of weight management, to document current practice and to identify perceived barriers to providing lifestyle advice to colorectal cancer survivors. METHOD: Questionnaires were sent to 768 clinicians (doctors and nurses) working in colorectal cancer, identified from professional databases. These data were complemented by in-depth interviews exploring opportunities for and barriers to giving lifestyle advice. RESULTS: A total of 323 replies were received (42% response rate) and 20 respondents completed in-depth interviews. Half (52%) reported that they were familiar with guidance for lifestyle advice for cancer survivors. Most (77%) thought reducing weight was important for improving the health of those who were overweight and 75% thought it appropriate to offer lifestyle advice to people with body mass index over 30 kg/m(2) . Half (50%) reported that weight reduction was an important service priority for normal clinical practice. Half (50%) of respondents said that they would value additional training in this area. Interview data revealed that current practice is influenced by the lack of evidence for the impact of weight management and a belief that 'weight gain is good and weight loss bad' in the cancer setting. Patient sensitivity, time available, role constraints and lack of skills in weight management were also factors. CONCLUSION: There is an awareness of the importance of weight management amongst colorectal cancer clinicians and some indication of advice being provided. However, current perceptions, knowledge and skills suggest scope for further training.

Obesity management--an opportunity for cancer prevention.

There is increasing evidence of an association between obesity and the development, morbidity and mortality of cancers of the colorectum, (post menopausal) breast, endometrium, kidney, pancreas and oesophagus. In addition to obesity per se, waist circumference is now emerging as a clear indicator of disease risk. Weight gain during adult life also appears to increase risk for breast and colon cancers. Major causative factors which are influenced by excess energy storage include hormones involved in metabolic control (insulin and leptin), cell growth (IGF-I and IGF-binding proteins) and reproduction (steroids and leptin). In addition, raised oestrogens are likely to contribute to the greater risk of breast and endometrial cancers. In cancer survivors, there are also strong indications that being overweight increases the risk for recurrence and reduces the likelihood of survival. Whilst there are no robust data testing the effect of weight loss on recurrence, current guidance highlights that normal weight, overweight and obese patients should avoid weight gain and that a modest weight loss of 5-10% is likely to have significant health benefits. Two studies have now reported long-term effects of obesity surgery on cancer risk (in addition to reducing metabolic disorders and type 2 diabetes). It is becoming increasingly clear that multi-disciplinary groups (including surgeons) are needed to identify, monitor and evaluate programmes for both obesity prevention and management.

Diet and physical activity in patients with colorectal adenomas: directions for intervention programmes.

BACKGROUND: Screening programmes provide an opportunity to combine early detection programmes with prevention strategies for chronic disease risk reduction. The aim of the current exploratory research was to identify diet and activity habits in adults diagnosed with colorectal adenomas on screening colonoscopy in order to inform the development of an intervention study in this patient group. METHODS: Participants were recruited from colonoscopy clinics and completed a 7-day food diary and physical activity record. RESULTS: Valid food diaries were completed by 32 participants. Mean daily intake of nonstarch polysaccharide was estimated at 14.2 (SD 4.2) g per day and fruit and vegetable intake (FVI) at 3.6 (SD 1.9) portions. The highest quartile of FVI consumers reported greater consumption of fruit (on any occasion) and vegetables (at evening meal) compared with low FVI consumers. Physical activity records (n = 36) indicated that walking was the most common method of activity with few indications of leisure time sport. Overall, 37% of participants failed to meet minimum recommend activity levels. CONCLUSION: The magnitudes of change in activity and diet required to conform with current guidelines were estimated. Food habits that were pertinent to the population were identified and help to provide goal-based guidance for intervention design.