Determinants of adherence to recommendations on physical activity, red and processed meat intake, and body weight among lynch syndrome patients.

This study aimed to identify determinants of adherence to lifestyle and body weight recommendations for cancer prevention among Lynch Syndrome (LS) patients. Cross-sectional baseline data of LS patients participating in the Lifestyle & Lynch (LiLy) study was used to assess determinants of adherence to the World Cancer Research Fund cancer prevention recommendations on body weight, physical activity, and red and processed meat intake. Adherence and potential determinants of adherence were assessed using questionnaires. Multivariable logistic regression analyses were conducted to identify determinants of adherence. Of the 211 participants, 50.2% adhered to the body weight recommendation, 78.7% adhered to the physical activity recommendation, and 33.6% adhered to the red and processed meat recommendation. Being younger and having a higher level of education were associated with adherence to the recommendation on body weight. Having knowledge about the recommendation was associated with adherence to the recommendations on physical activity and red and processed meat. Results confirm that knowledge about recommendations for cancer prevention is an important determinant for adherence and suggest that strategies to increase knowledge should be included in lifestyle promotion targeted at LS patients, along with behavior change techniques influencing other modifiable determinants.

Association of visceral and subcutaneous adiposity with tumor stage and Fuhrman grade in renal cell carcinoma.

Higher BMI has been associated with lower tumor stage and grade and improved survival in renal cell cancer (RCC). BMI cannot distinguish between visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT). We examined associations of BMI, VAT, SAT, total adipose tissue (TAT) and relative VAT (rVAT) with tumor stage and grade in RCC patients. In a Dutch multicenter population-based historical cohort study 1039 RCC patients diagnosed between 2008 and 2012 were assessed for VAT and SAT using Computed Tomography images at L3. Sex-stratified multinomial logistic regression analyses were performed (linearly per 10-unit increase) between BMI, VAT, SAT, TAT and relative VAT (rVAT) with tumor stage and Fuhrman grade. Higher VAT, TAT and rVAT were associated with a lower risk of stage IV versus stage I in males (OR 0.93; 95%CI 0.91-0.96, OR 0.95; 95%CI 0.93-0.98, OR 0.97; 95%CI 0.96-0.99, respectively). Females showed similar associations, but only higher VAT was statistically significantly associated with reduced risk of stage IV (OR 0.95 95%CI 0.89-1.00). No associations with grade, SAT or BMI were found. In conclusion, higher VAT and TAT was associated with lower risk of stage IV RCC. This might be due to weight loss or cancer cachexia in stage IV patients.

Increasing awareness and knowledge of lifestyle recommendations for cancer prevention in Lynch syndrome carriers: Randomized controlled trial.

Lynch syndrome (LS) mutation carriers may reduce their cancer risk by adhering to lifestyle recommendations for cancer prevention. This study tested the effect of providing LS mutation carriers with World Cancer Research Fund-the Netherlands (WCRF-NL) health promotion materials on awareness and knowledge of and adherence to these recommendations. In this randomized controlled trial (n = 226), the intervention group (n = 114) received WCRF-NL health promotion materials. All LS mutation carriers were asked to fill out questionnaires at 2 weeks before (baseline, T0) and at 2 weeks (T1) and 6 months (T2) after the intervention. Linear mixed models were performed on awareness (0-7) and knowledge (0-7) of the recommendations, and on the secondary outcomes, that is adherence, distress, cancer worry, and risk perception. Compared with the control group, the intervention group became significantly more aware (overall mean difference = 1.24; 95%CI = 0.82-1.67) and obtained significantly improved knowledge of the recommendations (overall mean difference = 1.65; 95%CI = 1.27-2.03). Differences were significantly larger for T1 (Pinteraction = .003 and ≤.001, respectively) but remained significant for T2. No effect on secondary outcomes was found. In conclusion, provision of WCRF-NL health promotion materials increases awareness and knowledge of lifestyle recommendations for cancer prevention among LS mutation carriers without causing additional distress, but does not affect adherence.

Cancer treatment induced metabolic syndrome: Improving outcome with lifestyle.

Increasing numbers of long-term cancer survivors face important treatment related adverse effects. Cancer treatment induced metabolic syndrome (CTIMetS) is an especially prevalent and harmful condition. The aetiology of CTIMetS likely differs from metabolic syndrome in the general population, but effective treatment and prevention methods are probably similar. In this review, we summarize the potential mechanisms leading to the development of CTIMetS after various types of cancer treatment. Furthermore, we propose a safe and accessible method to treat or prevent CTIMetS through lifestyle change. In particular, we suggest that a lifestyle intervention and optimization of energy balance can prevent or mitigate the development of CTIMetS, which may contribute to optimal survivorship care.

Dietary patterns and survival in German postmenopausal breast cancer survivors.

BACKGROUND: Research on the association between dietary patterns and breast cancer survival is very limited. METHODS: A prospective follow-up study was conducted in Germany, including 2522 postmenopausal breast cancer patients diagnosed in 2001-2005 with available food frequency questionnaire data. Vital status, causes of death, and recurrences were verified through the end of 2009. Principle component factor analysis was used to identify pre-diagnostic dietary patterns. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated with Cox proportional hazards models. RESULTS: Two major dietary patterns were identified: 'healthy' (high intakes of vegetables, fruits, vegetable oil, sauces/condiments, and soups/bouillons) and 'unhealthy' (high intakes of red meat, processed meat, and deep-frying fat). Increasing consumption of an 'unhealthy' dietary pattern was associated with an increased risk of non-breast cancer mortality (highest vs lowest quartile: HR, 3.69; 95% CI, 1.66-8.17; P-trend <0.001). No associations with breast cancer-specific mortality and breast cancer recurrence were found. The 'healthy' dietary pattern was inversely associated with overall mortality (HR, 0.74; 95% CI, 0.47-1.15; P-trend=0.02) and breast cancer recurrence (HR, 0.71; 95% CI, 0.48-1.06; P-trend=0.02) in stage I-IIIa patients only. CONCLUSION: Increasing intake of an 'unhealthy' pre-diagnostic dietary pattern may increase the risk of non-breast cancer mortality, whereas increasing intake of a 'healthy' pattern may reduce the risk of overall mortality and breast cancer recurrence.

Alcohol dehydrogenase and aldehyde dehydrogenase gene polymorphisms, alcohol intake and the risk of colorectal cancer in the European Prospective Investigation into Cancer and Nutrition study.

BACKGROUND/OBJECTIVES: Heavy alcohol drinking is a risk factor of colorectal cancer (CRC), but little is known on the effect of polymorphisms in the alcohol-metabolizing enzymes, alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) on the alcohol-related risk of CRC in Caucasian populations. SUBJECTS/METHODS: A nested case-control study (1269 cases matched to 2107 controls by sex, age, study centre and date of blood collection) was conducted within the European Prospective Investigation into Cancer and Nutrition (EPIC) to evaluate the impact of rs1229984 (ADH1B), rs1573496 (ADH7) and rs441 (ALDH2) polymorphisms on CRC risk. Using the wild-type variant of each polymorphism as reference category, CRC risk estimates were calculated using conditional logistic regression, with adjustment for matching factors. RESULTS: Individuals carrying one copy of the rs1229984(A) (ADH1B) allele (fast metabolizers) showed an average daily alcohol intake of 4.3 g per day lower than subjects with two copies of the rs1229984(G) allele (slow metabolizers) (P(diff)<0.01). None of the polymorphisms was associated with risk of CRC or cancers of the colon or rectum. Heavy alcohol intake was more strongly associated with CRC risk among carriers of the rs1573496(C) allele, with odds ratio equal to 2.13 (95% confidence interval: 1.26-3.59) compared with wild-type subjects with low alcohol consumption (P(interaction)=0.07). CONCLUSIONS: The rs1229984(A) (ADH1B) allele was associated with a reduction in alcohol consumption. The rs1229984 (ADH1B), rs1573496 (ADH7) and rs441 (ALDH2) polymorphisms were not associated with CRC risk overall in Western-European populations. However, the relationship between alcohol and CRC risk might be modulated by the rs1573496 (ADH7) polymorphism.

Estimated enterolignans, lignan-rich foods, and fibre in relation to survival after postmenopausal breast cancer.

BACKGROUND: Lignans - oestrogenic substances present in various foods - are associated with postmenopausal breast cancer risk, but not much is known regarding their effects on survival. METHODS: In a follow-up study of 2653 postmenopausal breast cancer patients diagnosed between 2001 and 2005, vital status and causes of death were verified through end of 2009. Hazard ratios (HRs) and 95% confidence intervals (CIs) for estimated enterolignans, lignan-rich foods, and dietary fibre in relation to overall survival (OS) and breast cancer-specific survival (BCSS) were assessed using Cox proportional hazards models stratified by age at diagnosis and adjusted for prognostic/confounding factors. RESULTS: Median follow-up time was 6.4 years, and 321 women died, 235 with breast cancer. High estimated enterolactone and enterodiol levels were associated with significantly lower overall mortality (highest quintile, HR=0.60, 95% CI=0.40-0.89, P(Trend)=0.02 and HR=0.63, 95% CI=0.42-0.95, P(Trend)=0.02, respectively). Fibre intake was also associated with a significantly lower overall mortality. Differentiated by median fibre intake, associations with estimated enterolignans were still evident at low but not high fibre intake. There was no effect modification by oestrogen receptor status and menopausal hormone therapy. CONCLUSION: Postmenopausal breast cancer patients with high estimated enterolignans may have a better survival.

Uphill and downhill walking in unilateral lower limb amputees.

OBJECTIVE: To study adjustment strategies in unilateral amputees in uphill and downhill walking. DESIGN: Observational cohort study. SUBJECTS: Seven transfemoral, 12 transtibial unilateral amputees and 10 able-bodied subjects. METHODS: In a motion analysis laboratory the subjects walked over a level surface and an uphill and downhill slope. Gait velocity and lower limb joint angles were measured. RESULTS: In uphill walking hip and knee flexion at initial contact and hip flexion in swing were increased in the prosthetic limb of transtibial amputees. In downhill walking transtibial amputees showed more knee flexion on the prosthetic side in late stance and swing. Transfemoral amputees were not able to increase prosthetic knee flexion in uphill and downhill walking. An important adjustment strategy in both amputee groups was a smaller hip extension in late stance in uphill and downhill walking, probably related with a shorter step length. In addition, amputees increased knee flexion in early stance in the non-affected limb in uphill walking to compensate for the shorter prosthetic limb length. In downhill walking fewer adjustments were necessary, since the shorter prosthetic limb already resulted in lowering of the body. CONCLUSION: Uphill and downhill walking can be trained in rehabilitation, which may improve safety and confidence of amputees. Prosthetic design should focus on better control of prosthetic knee flexion abilities without reducing stability.

Balance control on a moving platform in unilateral lower limb amputees.

OBJECTIVE: To study balance control on a moving platform in lower limb amputees. DESIGN: Observational cohort study. PARTICIPANTS: Unilateral transfemoral and transtibial amputees and able-bodied control subjects. INTERVENTIONS: Balance control on a platform that moved in the anteroposterior direction was tested with eyes open, blindfolded and while performing a dual task. MAIN OUTCOME MEASURES: Weight bearing symmetry, anteroposterior ground reaction force and centre of pressure shift. RESULTS: Compared to able-bodied subjects, in amputees the anteroposterior ground reaction force was larger in the prosthetic and non-affected limb, and the centre of pressure displacement was increased in the non-affected limb and decreased in the prosthetic limb. In amputees body weight was loaded more on the non-affected limb. Blindfolding or adding a dual task did not influence the outcome measures importantly. CONCLUSION: The results of this study indicate that experienced unilateral amputees with a high activity level compensate for the loss of ankle strategy by increasing movements and loading in the non-affected limb. The ability to cope with balance perturbations is limited in the prosthetic limb. To enable amputees to manage all possible balance disturbances in real life in a safe manner, we recommend to improve muscle strength and control in the non-affected limb and to train complex balance tasks in challenging environments during rehabilitation.

Gait initiation in lower limb amputees.

OBJECTIVE: To study limitations in function and adjustment strategies in lower limb amputees during gait initiation. DESIGN: Observational cohort study. SETTING: University Medical Center. PARTICIPANTS: Amputees with a unilateral transfemoral or transtibial amputation, and able-bodied subjects. MAIN OUTCOME MEASURES: Leading limb preference, temporal variables, ground reaction forces, and centre of pressure shift. RESULTS: Amputees demonstrated a decrease in peak anterior ground reaction force, a smaller or absent posterior centre of pressure shift, and a lower gait initiation velocity. The main adjustments strategies in amputees were more limb-loading on the non-affected limb, prolonging the period of propulsive force production in the non-affected limb and initiating gait preferably with the prosthetic limb. CONCLUSION: Since an intact ankle joint and musculature is of major importance in gait initiation, functional limitations and adjustment strategies in transfemoral and transtibial amputees were similar. Improving prosthetic ankle properties and initiating gait with the prosthetic limb may facilitate the gait initiation process in amputees.

Gait termination in lower limb amputees.

OBJECTIVE: To study the limitations in function and adjustment strategies of lower limb amputees in gait termination. DESIGN: Observational cohort study. SETTING: University Medical Centre. PARTICIPANTS: Unilateral transfemoral and transtibial amputees, and able-bodied control subjects. MAIN OUTCOME MEASURES: Leading limb preference, temporal variables, lower limb joint angles, ground reaction forces, and centre of pressure shift. RESULTS: Compared to able-bodied subjects, amputees showed a decreased peak braking ground reaction force in the prosthetic limb, no anterior centre of pressure shift during leading with the prosthetic limb and an increased mediolateral centre of pressure shift. Amputees used several adjustment strategies to compensate for the limitations in function; leading limb preference for the non-affected limb, longer production of braking force in the non-affected limb, decreased gait termination velocity and more weight-bearing on the non-affected limb. CONCLUSION: Limitations in function and adjustment strategies were mainly similar in transfemoral and transtibial amputees. Due to the lack of active ankle function, amputees were not able to increase the braking force and to shift the centre of pressure anteriorly. Leading with the non-affected limb is favourable for adequate deceleration and balance control, but in daily life not always applicable. It is important that amputees are trained in gait termination during rehabilitation and prosthetic design should focus on a more active role of the prosthetic foot and knee.

Obstacle crossing in lower limb amputees.

OBJECTIVE: To study limitations in function and adjustment strategies in lower limb amputees during obstacle crossing. DESIGN: Observational cohort study. SUBJECTS: Transfemoral and transtibial amputees and able-bodied control subjects. METHODS: In a motion analysis laboratory unimpeded and obstacle crossing runs were performed. The subjects stepped over an obstacle of 0.1m height and thickness and 1m width. Outcome measures were gait velocity, hip, knee and ankle joint angles and leading limb preference. RESULTS: Whereas able-bodied and transtibial subjects demonstrated an increase in knee flexion during obstacle crossing compared to unimpeded walking, in transfemoral amputees the opposite was seen, namely a decrease in knee flexion. The lack of knee strategy in transfemoral amputees was compensated by circumduction at the hip on the prosthetic side and plantar flexion of the non-affected ankle. Transtibial amputees preferred to cross the obstacle with the prosthetic limb first, while transfemoral amputees preferred the non-affected limb. CONCLUSION: The different leading limb strategy in transfemoral and transtibial amputees could be explained by the restricted flexion and propulsion properties of the prosthetic knee. Training of obstacle crossing tasks during rehabilitation and improvement of prosthetic design may contribute to safe obstacle crossing.