Longitudinal associations of adherence to lifestyle recommendations and health-related quality of life in patients with non-muscle invasive bladder cancer.

Although the role of lifestyle in health-related quality of life (HRQoL) outcomes has been increasingly recognized for various types of cancer, evidence in patients with non-muscle invasive bladder cancer (NMIBC) is very limited. We aimed to evaluate the longitudinal association between adherence to the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) lifestyle recommendations and HRQoL in patients with NMIBC. This study included 1029 patients with NMIBC recruited between May 2014 and April 2017 from the Dutch multi-centre prospective cohort study UroLife. Lifestyle and HRQoL data were collected at 6 weeks (baseline), 3 months and 15 months after diagnosis. Information on body mass index (BMI), physical activity, diet and alcohol was used to compute the standardized WCRF/AICR adherence score (0-7). HRQoL outcomes were evaluated by the EORTC QLQ-C30. Linear mixed models were used to assess longitudinal confounder-adjusted associations between the WCRF/AICR adherence score and HRQoL outcomes. Adherence to each additional WCRF/AICR recommendation was associated with better global quality of life, physical, role and social functioning, and less fatigue. We found stronger inter-individual than intra-individual associations, suggesting that associations were mainly driven by between-subject differences. Higher adherence to the BMI, physical activity and dietary recommendations was associated with better scores for most HRQoL outcomes, while adherence to the alcohol recommendation (ie, non-consumption) was associated with worse HRQoL. Following the WCRF/AICR lifestyle recommendations may improve HRQoL in patients with NMIBC. Intervention studies are needed to establish whether the association between lifestyle and HRQoL is causal.

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.

Obesity Prevalence in the Long-Term Future in 18 European Countries and in the USA.

INTRODUCTION: Obesity constitutes a major public health problem in Europe, but how the obesity epidemic in European countries will evolve remains unknown. Most previous obesity projections considered the short-term future only, focused on single non-European countries, and projected ongoing increases foremost. We comparatively project obesity prevalence into the long-term future for 18 European countries and the USA. DATA: We used national age-specific (20-84 years) and sex-specific obesity prevalence estimates (1975-2016) from the NCD Risk Factor Collaboration (NCD-RisC) 2017 study, which are based on available measured height and weight data, supplemented with estimates from a Bayesian hierarchical model. METHODS: We projected age- and sex-specific obesity prevalence up to the year 2100 by integrating the notion of a wave-shaped obesity epidemic into conventional age-period projections. RESULTS: In 1990-2016, the increasing trends in obesity prevalence were decelerating. Obesity is expected to reach maximum levels between 2030 and 2052 among men, and between 2026 and 2054 among women. The maximum levels will likely be reached first in The Netherlands, USA, and UK, and last in Switzerland; and are expected to be highest in the USA and UK, and lowest in The Netherlands for men and Denmark for women. In 2060, obesity prevalence is expected to be lowest among Dutch men and highest among Swiss men. The projected age-specific obesity prevalence levels have an inverse U-shape, peaking at around the age of 60-69 years. DISCUSSION: Applying our novel approach to the NCD-RisC 2017 data, obesity prevalence is expected to reach maximum levels between 2026 and 2054, with the USA and UK reaching the highest maximum levels first, followed by other European countries.

Impact of obesity on life expectancy among different European countries: secondary analysis of population-level data over the 1975-2012 period.

OBJECTIVE: This study assesses the impact of obesity on life expectancy for 26 European national populations and the USA over the 1975-2012 period. DESIGN: Secondary analysis of population-level obesity and mortality data. SETTING: European countries, namely Austria, Belarus, Belgium, the Czech Republic, Denmark, Estonia, Finland, France, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania, Luxembourg, the Netherlands, Norway, Poland, Portugal, the Russian Federation, Slovakia, Spain, Sweden, Switzerland, Ukraine and the UK; and the USA. PARTICIPANTS: National populations aged 18-100 years, by sex. MEASUREMENTS: Using data by age and sex, we calculated obesity-attributable mortality by multiplying all-cause mortality (Human Mortality Database) with obesity-attributable mortality fractions (OAMFs). OAMFs were obtained by applying the weighted sum method to obesity prevalence data (non-communicable diseases (NCD) Risk Factor Collaboration) and European relative risks (Dynamic Modeling for Health Impact Assessment (DYNAMO- HIA)). We estimated potential gains in life expectancy (PGLE) at birth by eliminating obesity-attributable mortality from all-cause mortality using associated single-decrement life tables. RESULTS: In the 26 European countries in 2012, PGLE due to obesity ranged from 0.86 to 1.67 years among men, and from 0.66 to 1.54 years among women. In all countries, PGLE increased over time, with an average annual increase of 2.68% among men and 1.33% among women. Among women in Denmark, Switzerland, and Central and Eastern European countries, the increase in PGLE levelled off after 1995. Without obesity, the average increase in life expectancy between 1975 and 2012 would have been 0.78 years higher among men and 0.30 years higher among women. CONCLUSIONS: Obesity was proven to have an impact on both life expectancy levels and trends in Europe. The differences found in this impact between countries and the sexes can be linked to contextual factors, as well as to differences in people's ability and capacity to adopt healthier lifestyles.

Impact of Different Estimation Methods on Obesity-Attributable Mortality Levels and Trends: The Case of The Netherlands.

The available methodologies to estimate the obesity-attributable mortality fraction (OAMF) affect the levels found and hamper the construction of time series. Our aim was to assess the impact of using different techniques to estimate the levels and the trends in obesity-attributable mortality for The Netherlands between 1981 to 2013. Using Body Mass Index (BMI), all-cause and cause-specific mortality data, and worldwide and European relative risks (RRs), we estimated OAMFs using three all-cause approaches (partially adjusted, weighted sum, and the two combined) and one cause-of-death approach (Comparative Risk Assessment; CRA). We adjusted the CRA approach to purely capture obesity (BMI ≥ 30 kg/m²). The different approaches led to a range of estimates. The weighted sum method using worldwide RRs generated the lowest (0.9%) while the adjusted CRA approach using 2013 RRs generated the highest estimate (1.5%). Using European-specific RRs instead of worldwide RRs resulted in higher estimates. Most of the approaches revealed an increasing OAMF over the period 1981 to 2013 especially from 1993 onwards except for the adjusted CRA approach among women. Estimates of OAMF levels and trends differed depending on the method applied. Given the limited available data, we recommend using the weighted-sum method to compare obesity-attributable mortality across European countries over time.

Past trends in obesity-attributable mortality in eight European countries: an application of age-period-cohort analysis.

OBJECTIVES: To assess age, period, and birth cohort effects and patterns of obesity-attributable mortality in Czech Republic, Finland, France, Germany, Hungary, Italy, Poland, and the UK (UK). METHODS: We obtained obesity prevalence and all-cause mortality data by age (20-79), sex and country for 1990-2012. We applied Clayton and Schifflers' age-period-cohort approach to obesity-attributable mortality rates (OAMRs). RESULTS: Between 1990 and 2012, obesity prevalence increased and age-standardised OAMRs declined, although not uniformly. The nonlinear birth cohort effects contributed significantly (p < 0.01) to obesity-attributable mortality trends in all populations, except in Czech Republic, Finland, and among German women, and Polish men. Their contribution was greater than 25% in UK and among French women, and larger than that of the nonlinear period effects. In the UK, mortality rate ratios (MRRs) increased among the cohorts born after 1950. In other populations with significant birth cohort effects, MRRs increased among the 1935-1960 cohorts and decreased thereafter. CONCLUSIONS: Given its potential effects on obesity-attributable mortality, the cohort dimension should not be ignored and calls for interventions early in life next to actions targeting broader societal changes.

Detailed Dietary Assessment in Patients with Inoperable Tumors: Potential Deficits for Nutrition Care Plans.

Advanced cancer often results in reduced dietary intake; however, data on actual intake at the time of diagnosis are limited. In the present study, a detailed dietary intake assessment was performed in patients with metastatic lung and upper gastrointestinal cancer, before initiation of systemic therapy. Basic demographics and performance status (PS) were recorded. Nutritional status was evaluated through anthropometry, Mini Nutritional Assessment (MNA), and 3 nonconsecutive 24-hour dietary recalls. Of the 84 patients enrolled, 61.4% were protein, energy, or protein-energy undernourished, regardless of body mass index (BMI) or MNA category. No differences in energy, macronutrients, and micronutrients intakes across BMI categories were recorded. Very low consumption of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), irrespective of energy intake, tumor site, BMI category, or PS was found. Suboptimal micronutrients intakes were recorded even in well-nourished and overweight/obese patients. Patients with adequate PS and better MNA score reported significantly higher intake of certain macro- and micronutrients (all P < 0.05). Most patients exhibited reduced dietary intake in terms of energy, macronutrient, and micronutrient. Very low EPA and DHA intake was recorded for the whole sample, whereas micronutrient suboptimal intakes were also prevalent in well-nourished or overweight patients. All the above should be taken into account during patients' nutritional care.

Associations between lifestyle patterns and body mass index in a sample of Greek children and adolescents.

BACKGROUND: Although eating and physical activity behaviors have been previously individually investigated with regard to overweight in children, multidimensional lifestyle patterns, based on these behaviors, have not been explored. OBJECTIVE: To assess lifestyle patterns in relation to body mass index (BMI), in a nationally representative sample of the Greek pediatric population DESIGN: Cross-sectional study. Data were collected from May through July 2007. SUBJECTS: The sample consisted of 1,305 children and adolescents (ages 3 to 18 years). MAIN OUTCOME MEASURES: Information on participants' dietary intake, eating behaviors, physical activity habits, and BMI were collected. Adherence to the Mediterranean diet guidelines was evaluated using the KIDMED Mediterranean diet quality index; the higher the score in this index the more favorable the dietary pattern. The Goldberg cut-off limits for the ratio of energy intake/basal metabolic rate were used to evaluate dietary low energy reporting and participants were accordingly classified as low-energy reporters. STATISTICAL ANALYSIS: Principal component analysis was performed to identify participants' lifestyle patterns. Associations between BMI and lifestyle patterns were further evaluated using multiple linear regression analyses, after controlling for potential confounders. RESULTS: Principal component analysis identified seven lifestyle patterns explaining 85% of the total variance of lifestyle habits. A lifestyle pattern characterized by higher eating frequency, breakfast consumption and higher KIDMED score was negatively associated with BMI (standardized beta=-.125, P<0.001), after controlling for age, sex, and parental education. The association remained significant even when low-energy reporters were excluded from the analysis. CONCLUSIONS: Results from the study suggest a potential intercorrelation and protective action of selected eating behaviors, namely eating frequency, breakfast consumption, and adherence to the Mediterranean diet, against overweight and obesity in children and adolescents.

Adherence rates to the Mediterranean diet are low in a representative sample of Greek children and adolescents.

Data from studies in pediatric samples exploring adherence to the Mediterranean diet are scarce. The aim of the present work was to explore adherence to a Mediterranean diet pattern in a representative sample of Greek children and adolescents. The study sample (n = 1305, 3-18 y) was representative of the Greek pediatric population in terms of sex and age. Information on participants' sociodemographic, anthropometric, and lifestyle characteristics were collected through telephone interviews. Adherence to the Mediterranean diet guidelines for adults and to the general dietary guidelines for children was evaluated using KIDMED scores: the higher the score, the more favorable the dietary pattern. The Goldberg cut-off limits for the ratio of energy intake:basal metabolic rate were used to evaluate dietary underreporting and children were accordingly classified as low energy reporters (LER) or non-LER. Only 11.3% of children and 8.3% of adolescents had an optimal KIDMED score (>/=8). In adolescents, partial correlation analysis revealed a negative weak association between KIDMED and BMI (r = -0.092; P = 0.031), which remained significant in the non-LER subgroup (r = -0.137, P = 0.011). Multiple regression analysis revealed that higher KIDMED scores were associated, in non-LER children, with less time spent on sedentary activities (P = 0.002) and higher paternal education (P = 0.050), whereas in adolescents, with younger age (P = 0.001), less time spent on sedentary activities (P = 0.015), higher maternal education (P = 0.014), and higher eating frequency (P = 0.041). In conclusion, low adherence rates to the Mediterranean diet were observed in Greek children and adolescents; this evidence needs to be further explored regarding its impact on health and disease.

Dietary factors associated with plasma high molecular weight and total adiponectin levels in apparently healthy women.

OBJECTIVE: Our aim was to investigate associations between dietary factors and high molecular weight (HMW) as well as total adiponectin in a sample of apparently healthy adult Mediterranean women. DESIGN AND METHODS: Two hundred and twenty women were enrolled in this study. Anthropometric and body composition measurements were performed in all subjects. Fasting blood samples were taken; HMW and total adiponectin concentrations were measured. Food intake was evaluated using 3-day food records. The frequency of consumption of several food groups was approximately quantified in terms of number of servings per day. Furthermore, dietary intakes of betaine, choline, and free choline were estimated. RESULTS: Women in the highest HMW adiponectin tertile had higher fruit intake compared with those with lower levels, after adjusting for potential confounders (P=0.04). On the contrary, dietary betaine and choline intakes were not different among HMW adiponectin tertiles. In linear models, fruit consumption, controlling for biological and lifestyle variables, was significantly related to HMW adiponectin (partial r=0.15, P=0.04), but the association with total adiponectin did not reach statistical significance (partial r=0.11, P=0.12). A significant negative correlation between total adiponectin and refined cereals was also observed (partial r=-0.16, P=0.03). DISCUSSION: This is the first study that evaluates associations between dietary factors and HMW adiponectin levels. The associations found are moderate and indicate that, after multivariate adjustment, fruit consumption is related to HMW adiponectin in both linear and nonlinear models.